bluuebunny/crossref_metadata_2025_split huggingface dataset:
235 Understanding Stage of Innovation of Invasive Procedures and Devices
Authors: Scroggie D. , Elliott D. , Cousins S. , Avery K. , Blazeby J. , Blencowe N. 
Published: February 2022

Abstract

Aim
New and modified surgical procedures and devices are often introduced into clinical practice without adequate evidence of their safety and efficacy. To promote systematic evaluation of surgical innovations, the IDEAL and IDEAL-D frameworks outline recommendations for study design and governance for procedures and devices according to their stage of innovation. However, determining stage of innovation can be difficult, hindering use of such frameworks. There is a need for a detailed understanding of what stage of innovation means, and how it can be determined. The aim of this study is to understand the concept of stage of innovation as reported in the literature.

Method
A systematic review is being conducted. Searches of Ovid Medline and Embase databases have been performed. Articles were screened by title and, then by full text. s and foreign language articles were excluded. Data will be extracted verbatim regarding approaches to evaluating surgical innovations and determining stage of innovation. A thematic analysis will be conducted, and findings summarised in a narrative report.

Results
The search returned 2,946 articles, of which 46 were included. Preliminary findings have identified two approaches for evaluating procedures, and one for devices. Following thematic analysis, the narrative report will explore approaches to evaluating surgical innovations and determining stage of innovation, including barriers to implementation and proposed solutions.

Conclusions
A report of progress will be presented at the Surgical Innovation Summit. An improved understanding of stage of innovation will facilitate better evaluation of surgical innovations.
236 E-Prescribing and Smart Antimicrobial Stewardship in Upper Limb Infections
Authors: Rela M. , Peberdy D. , Heard K. , Fok R. 
Published: February 2022

Abstract

Aim
Upper limb infections secondary to traumatic wounds, animal bites and other causes are a common reason for admission to the plastic surgery service for intravenous antibiotics. This audit investigated the compliance of treatment of upper limb infections with trust guidance. The guidance stipulated an antibiotic treatment duration of five to seven days total and microbiology advice suggested that in cases requiring multiple washouts, this should start from the date of the last surgical washout where pus was present.

Method
There was retrospective sampling for four months using inpatient lists to include patients admitted for intravenous antibiotics for upper limb infections. Notes were requested by the secretaries and data was collected using patient notes, discharge summaries and electronic drug charts.

Results
The analysis included twenty-seven suitable patients. All patients had the correct antibiotics prescribed according to guidance, however only 22% of patients had five to seven days total of antibiotics either from the start of therapy or from the date of last infected washout in those who underwent surgical treatment. 14/27 patients had more than seven days total antibiotics. 13/27 patients were discharged with an additional seven days of oral antibiotics regardless of the total duration.

Conclusions
These infections are significantly over-treated with antibiotics, which has serious potential consequences for antimicrobial resistance. The findings of the audit prompted new trust guidelines to be produced and prescribing guidance was sent to the junior doctors to calculate the total antibiotic duration when preparing discharge summaries. There is a plan for re-audit in a few months’ time.
238 The Use of MRCP in the Assessment of Choledocholithiasis in Patients Presenting with Symptomatic Gallstone Disease
Authors: Hobbs J. , Marks B. , Young J. 
Published: February 2022

Abstract

Aim
Magnetic Resonance Cholangiopancreatography (MRCP) is the investigation of choice for choledocholithiasis; however, use is varied and guidelines vague. The National Institute for Health and Care (NICE) recommend MRCP when common bile duct (CBD) dilatation ≥ 8mm or liver function tests (LFTs) are abnormal but do not quantify this further. The Sunflower Study classifies patients as “high-risk” for choledocholithiasis if alanine aminotransferase (ALT) ≥ 80 IU/L, alkaline phosphatase (ALP) ≥ 200 IU/L or CBD ≥ 8mm. We aimed to assess compliance with NICE criteria and determine what biochemical abnormalities are most associated with choledocholithiasis.

Method
A retrospective analysis of inpatient MRCPs performed at QEH between March and May 2021 was performed (n = 72). Pre-MRCP bloods and imaging were used to assess concordance with NICE guidelines. We compared LFTs between patients with and without choledocholithiasis, looking for significant differences.

Results
84.7% of MRCPs were performed in accordance with NICE guidance, of which 31.1% demonstrated choledocholithiasis. No cases of choledocholithiasis were identified if NICE criteria were not fulfilled. A significant difference between the mean values of gamma glutamyltransferase (GGT) and ALP was noted between patients with and without choledocholithiasis.

Conclusions
We identified that the majority of MRCPs were performed in accordance with guidance. Significantly, no cases of choledocholithiasis were identified if these criteria were not met. Although our sample size was small, we found the most specific biochemical markers were ALP and GGT and propose that further research with larger cohorts may help develop a risk stratification tool to aid decision making.
242 The Importance of Frailty Assessment as a Mortality Indicator and Surgical Decision-Making Tool
Authors: Cheng Y.S. , Brown K. , Harley S. , Allen C. , Nasr H. , Rudzki D. , Claridge M. , Adam D. , Juszczak M.T. 
Published: February 2022

Abstract

Background
Frailty is a multidimensional syndrome, which can lead to poorer health outcome. Frailty score is a proven reliable indicator of post-operative morbidity and mortality; however, its application in clinical practice is limited.

Aim
The study aimed to assess the association between frailty marker and one- year mortality rate and explore its impact in clinical decision making in patients with abdominal aortic aneurysms.

Method
Consecutive patients with abdominal, thoracic, and thoracoabdominal aortic aneurysms presented at dedicated aortic clinic between July 2019 and April 2020 were included. Markers for frailty and sarcopenia using Rockwood Clinical Frailty Scale, SARC-F questionnaire, morphometric analysis for sarcopenia, one-year mortality and fitness were recorded. Multi-disciplinary team (MDT) was blinded to frailty and sarcopenia data; surgical decisions made by MDT were recorded separately.

Results
We assessed 83 patients (median age 75 [72,82], 85% male; median aneurysm diameter 6cm [5.8,7.0]. Sixteen patients were deemed frail, five patients had sarcopenia and thirty-one patients had myopenia. Seventeen patients were deemed not fit for surgery; 41% of these were frail compared with 14% out of those who were deemed fit. The odds ratio of being frail and unfit for surgery was 4.33 (95% CI 1.27–14.82, p = 0.010). Frailty was significantly associated with one-year mortality irrespective of fitness for surgery, sarcopenia and myopenia (OR 10.28, 95%CI 1.82–57.93, p = 0.009). SARC-F and myopenia was not associated with one-year mortality at (OR 1.66, 95%CI 0.03–19.25, p = 0.523) and (OR 0.59, 95%CI 0.09–2.85, p = 0.514), respectively.

Conclusions
Frailty score was associated with both one-year mortality and fitness for surgery decision made by MDT.
243 How to Reduce Breaches of Trauma & Orthopaedics Patients in the Emergency Department: A District General Hospital Experience
Authors: Burnett-Jones L. , Eltagy H. , Elerian S. , Elashry S. 
Published: February 2022

Abstract

Aim
The handbook to the NHS constitution for England pledges a maximum four-hour wait in the Emergency Department (ED) from arrival to admission, transfer, or discharge. We present a closed-loop audit of ED waiting times for patients admitted under Trauma and Orthopaedics (T&O), before and after implementation of a change in practice, with the aim of reducing the number of patients that breached the four-hour target.

Method
An initial single-centre audit of patients that were admitted under T&O through ED was undertaken (25/11/2019 – 02/12/2019). All stakeholders were educated on audit findings through departmental meetings. Protocols were updated and new guidelines were synthesised and implemented in collaboration between the ED and T&O departments. Waiting times were re-audited (21/06/2021 – 28/06/2021). Data was collected retrospectively from clinical e-documentation.

Results
57 patients were included in the initial audit and 51 patients in the loop closure. The total number of breaches improved from 86% to 65% (p &lt; 0.05). The first audit highlighted that the biggest cause of breaches was ‘waiting for an ED review’ (56%) followed by ‘waiting for over thirty minutes for a bed’ (28%). Following our intervention, breaches due to ‘waiting for an ED review’ reduced (28%) and the biggest cause of breaches changed to ‘waiting for over thirty minutes for a bed’ (45%).

Conclusions
Our closed-loop audit identified that improved formalised protocols for ED referrals to specialities and clinical guidelines agreed upon by both parties (ED and T&O) reduces the number of breaches in ED.
245 Changing Demographics of Head Injury During the COVID-19 Pandemic
Authors: Chia C.W.L. , Merola J. , Taylor P. , Hayhurst C. 
Published: February 2022

Abstract

Introduction
Studies have shown that men are more likely to sustain head injuries (HI) due to a higher likelihood of participation in high-risk behaviours. However, the COVID-19 lockdown caused substantial alterations to the daily routines of the Welsh population. We aimed to describe the demographical changes of HI patients caused by this large-scale restriction of public social activity.

Method
A retrospective review of our neurosurgical referral database was performed between 1/1/19 to 31/12/20 to extract patient demographics and referral outcomes (admission/advice only) of adult head injury patients. Referrals during lockdown in Wales (26/3/20 – 1/6/20 and 31/10/20 and 2/12/20) were compared with non-lockdown periods in 2019 and 2020.

Results
There was no significant difference in HI referral volume in 2019 (n = 1228) vs 2020 (n = 1179) (OR: 0.71; 95% CI: 0.53 – 0.96, p = 0.02). Women were less likely to be admitted in 2019 (OR: 0.60, 95%CI: 0.39 – 0.91, p = 0.02) and 2020 (OR: 0.52, 95%CI: 0.31–0.88, p = 0.01). We observed evidence of interaction by age and sex in lockdown vs non-lockdown (p = 0.02). Most strikingly, there was higher odds of admission in women aged 40–70 years during lockdown (OR: 10.4, 95%CI: 1.13 – 95.8, p = 0.04).

Conclusions
We observed significant demographical shifts in HI during lockdown periods, with striking increases in admission rates of men under 40 years and women aged 40–70. The cause of these substantial changes need clarification and have important public health implications. Given likely reduced road traffic accidents during lockdown, other factors such as alcohol or assault need considering.
246 A Case Report on Bilateral Spontaneous Carotico-Cavernous Fistula with Literature Review
Authors: Porag R. , Kulkarni G. 
Published: February 2022

Abstract

Background
CCF is an abnormal vascular communication that allows blood to either directly or indirectly flow from the carotid arteries to the cavernous sinus. We present a rare case of spontaneous bilateral direct CCF. Coil embolization is a very effective treatment for CCF.

Case report
86-year-old lady presented in ED with two weeks history of progressive painful, swollen right eye & drooping of eyelid with double vison in left eye. Patient also had a history of intermittent headache and had pulsatile tinnitus in right ear. There was no history of head or eye trauma. On examination, the lady had proptosis, chemosis and restricted movement in right eye, 3rd nerve palsy in left eye. Corrected vision +0.3 in right eye, +0.1 in left eye. Pupils were bilaterally sluggish, there was no relative afferent pupillary defect.
CTA showed bilateral direct CCF along with dilated superior ophthalmic veins on both sides (L&gt;R). No other associated or underlying pathologies were seen.
She was started on oral Acetazolamide, Travoprost and Brimonidine topically. Patient was urgently referred to neurosurgery department and Coil embolization of her CCF was done successfully the following day.
Eye casualty review was done day after her coil embolization. IOP pressure was decreased to normal limits -12 RE and 8 LE. Although her VA was slightly down compared to her preoperative visit, her other symptoms were improving.
Six months later her vision has returned to normal.

Conclusions
Bilateral spontaneous CCF is a rare entity.
Early diagnosis and treatment lead to successful outcomes.
Neuro-radiological intervention is an effective treatment in acute setting.
247 Axillary Hidradenitis Suppurativa: A One-Stage Reconstruction Approach Using Acellular Dermal Substitute
Authors: Dhannoon A. , Hurley C.M. , Carr S. , Hussey A. 
Published: February 2022

Abstract
Hidradenitis suppurativa (HS) is a chronic recurrent debilitating condition. It is characterized by abscesses, and can be complicated by rupture, scarring sinuses. The management of HS is multidisciplinary, involving general lifestyle modification, medical treatment, and surgery. A wide range of surgical interventions have been described for HS disease control and management. However, surgical management strategies are highly variable. We present a case of a 33-year-old female with extensive HS in both axillae resulting in extreme pain, restriction of shoulders movement with severe impact on quality of life. After failure of non-operative management, she underwent a wide excision of all pathological axillary disease. One week later, she had a single-stage reconstruction with Matriderm®. and a meshed split thickness skin graft. Acellular dermal skin substitutes may be an alternative to conventional means of hidradenitis suppurativa reconstruction, producing subtle, pliable, and durable skin.
248 Urethral Self-Insertion of a USB Cable as Sexual Experimentation: A Case Report
Authors: Loufopoulos I. , Kapriniotis K. , Kennedy C. , Huq S. , Reid T. , Sridhar A. 
Published: February 2022

Abstract

Introduction
The insertion of a foreign body in the urethra is an uncommon urological emergency. A wide variety of inserted objects have been described, presenting either asymptomatically or with lower abdominal discomfort and lower urinary tract symptoms. Sexual experimentation and gratification as well as mental disorders are considered the main underlying causes. The aim of this report is to present the case of a USB wire self-insertion and its challenging urological management.

Case Presentation
A 15-year-old male patient presented to his local Accident and Emergency department with gross haematuria following self-insertion of the knotted cable of a USB wire into his urethra in the context of sexual experimentation. Endoscopic approach via rigid cystoscopy and optical urethrotomy was not effective. A suprapubic catheter was inserted, and the patient was urgently transferred to our hospital for tertiary management.
Following radiological assessment to confirm the position of the wire, a longitudinal peno-scrotal incision over the palpable foreign body was made. Urethrotomy revealed the knotted cable in the proximal aspect of the penile urethra, which was cut and removed. Urethra was subsequently closed over a urethral catheter. Postoperative recovery was uneventful, and patient was discharged home with oral antibiotics. Urethral catheter was removed following normal fluoroscopic assessment of the urethra two weeks later.

Conclusions
The management of a foreign urethral body can be challenging and usually requires tertiary expertise to achieve optimal outcomes. Poor initial management could potentially lead to devastating long-term complications such as urethral strictures and fistulas.
256 Implementing and Reinforcing Positive Change to Regional Hand Trauma Service with Introduction of the Golden Patient Initiative
Authors: Jayasuriya N. , Milto K. , Liew M.Y. , Douglas H. , Hughes D. , Rust P. 
Published: February 2022

Abstract

Introduction
Significant theatre delays were identified in hand trauma lists at our regional adult hand surgery unity. We aimed to improve theatre delays by implementing a golden patient initiative.

Method
Literature review identified the golden patient initiative, which ensures first patient on the list is identified, communicated to multidisciplinary team, and is optimized for theatre.
Multi-stage intervention according to change management models (ADKAR and McKinsey 7s) was used. This included (1) a new protocol, (2) educational intervention, 3) poster and (4) a variety of information dissemination methods. To ensure multidisciplinary staff engagement and reinforce positive change, we used multiple verbal, visual and written prompts: trauma co-ordinator-led daily reminders, senior involvement, new column in handover list, verbal reminders at departmental meetings, posters in key areas and widely-accessible reference booklet.
Prospective analysis of theatre utilisation pre- and post-intervention to measure impact of intervention.

Results
Analysis of emergency general list (EG) and local anaesthetic list (LA) start times identified an average 40 and 20-minute-long delays respectively. Following introduction of golden patient there was a reduction in delays by 9 minutes in LA and 5 minutes in EG. The latest start time improvement by 8 minutes in LA and 50 minutes in EG. There was also a reduction in operation delays by 2.8% in LA and 14.3% in EG. The estimated annual cost saved in EG is approximately £45,200.

Conclusions
We believe that implementing sustainable change is a complex and challenging process. Implementing the golden patient initiative resulted in a positive impact on hand trauma services.
258 The Impact of Types of Clerking Document on the Compliance of Initial HAT Risk Assessment on Admission in Trauma and Orthopaedic Patients
Authors: Toe K.K.Z. , Tarar Y.M. , Moussa W. , Shah N. 
Published: February 2022

Abstract

Aim
Assessment of risk of venous thromboembolism (VTE) is crucial as VTE is a significant problem in surgical patients. Trauma and orthopaedic (T&O) patients have additional risks given lower limbs and/or pelvic surgery with restricted mobility periods/ weightbearing status. Risks should be assessed as soon as possible after admission. At this point, clerking is a first point of patients’ information gathering. This study aims to examine the compliance of VTE risk assessment on admission against guideline and its relation to the types of clerking proforma.

Method
A QI project was undertaken using PDSA cycle analysing documents of clerking and VTE risk assessment in 44 T&O patients. Education sessions and routine reminder emails were conducted aimed at oncall doctors receiving admissions. A further 44 patients’ records were audited after 3 months. Primary outcome: VTE risk assessment completion on admission, secondary outcome: impact of types of admission pro-forma upon risk completion rate.

Results
Initial VTE risk assessment compliance was improved after interventions: from 77.27% to 88.63% generally and from 69% to 100% full compliance particularly in neck of femur cases. Use of structured pro-forma can increase the compliance rate of 91.3% (pre-intervention) to 100% (post-intervention) compared to other 2 freehand documents: 91% Vs 85.71% and 30% Vs 63.64%.

Conclusions
VTE risk assessment is improved through education sessions, and it is evident the use of structured clerking document can help to optimize the compliance rate although further sustained input is needed to achieve the targeted compliance rate.
259 Effect of Telegram Videos on Anatomy Education Among 2nd Year Medical Students, University of Khartoum, 2021
Authors: Ibrahim A. , Elhassan A.B.E. , Salman M. , Mohammed O. , Bashir S. , Mohamed N. , Ali M. , Awad K. , Abdelkarem A. 
Published: February 2022

Abstract

Aim
COVID-19 had major effect on the health and medical education. In order to oblige with the social distancing and quarantine, universities shifted to online learning. This study aimed to assess the effect of online education on anatomy DR (dissection room) teaching by the use of telegram software.

Method
This was a cross-sectional, prospective interventional study, which was carried out among 2nd year medical students in University of Khartoum. Students undertook initial tests on the heart and anterior abdominal wall modules. Telegram videos, prepared by the author, on the anatomy of the heart and the anterior abdominal wall were distributed to students. Students took a second test after watching the videos. A total number of 41 students attended heart sessions and 40 students attended the anterior abdominal wall sessions were included.

Results
The pre-test mean score for the heart and abdomen modules were 4.56 ± 2.335 and 6.15 ± 2.94, respectively. The post-tests means were 9.98 ± 2.877 and 8.95 ± 3.14, respectively. 90% and 75% of the students were satisfied with these videos, respectively.

Conclusions
This study revealed that Telegram videos as a method of online teaching had a positive effect on the students' performance, which was evidenced by the significant improvement in student's scores after watching the videos. Additionally, most of the students were satisfied with the videos and give positive feedback.
260 Comparison of Patient Satisfaction and Outcomes of Day Case Mastectomy Versus Inpatient Model, Using a Validated Questionnaire
Authors: Ramasamy S. , Fazel M. , Patel G. 
Published: February 2022

Abstract

Introduction
Many women undergoing simple mastectomy have an overnight hospital stay. Offering a day case procedure for simple mastectomy has the potential to improve outcomes in terms of patient safety, feasibility, and reduction in associated costs. We aimed to study the proportion of day case mastectomies over a 2-year period and assessed relative readmission and complication rates alongside patient reported outcome measures (PROMs). Following this, we wanted to analyse whether a day case procedure should be routinely offered.

Method
A retrospective audit was conducted on all patients undergoing a simple mastectomy. Data were collected from patient and pathology records. PROMs were obtained via telephone conversation using the validated BREAST-Q survey. Patient demographics, reason for mastectomy and readmission for complications were all assessed.

Results
Out of the 202 patients analysed, over 75% had an overnight stay. The most common complications for both groups of patients were readmission due to infection and haematoma evacuation, with similar rates across the two (p = 0.26, p = 0.69). Data from PROMs also suggested that patients had similar outcome and satisfaction levels (p = 0.27).

Conclusions
The result from this study shows that it is safe as well as acceptable to patients to offer simple mastectomies as a day case procedure. This has become more important since COVID-19 reduced inpatient theatre capacity, and it is anticipated that these outcomes will allow a routine day case mastectomy pathway to be established even when normal operations recommence as encouraged by the association of day case surgery.