bluuebunny/crossref_metadata_2025_split huggingface dataset:
113 Where Did the Ureteric Stent Disappear? – Mystery Solved
Authors: Narayan P. , Mukhtar S. 
Published: February 2022

Abstract
38-year-old male presented to A&E with bilateral flank and suprapubic pain associated with mild VH. A CTKUB was suggestive of 10 cm ureteric stent noted in the left distal ureter and a few left sided lower calyceal non-obstructive stones.
Patient denied any previous urological procedures or significant history. He even called up his mother in Hungary to ensure that. He was discharged with an outpatient follow up after his symptoms settled. In the clinic it was decided to carry out a CT Urogram and a flexible cystoscopy. The urine was also sent for cytology and acid-fast bacilli. His Calcium and urate profile was normal.
On a CT Urogram, mysteriously the 10cm distal stent like calcification and the lower calyceal stones were not found, and on flexible cystoscopy the bladder looked pristine. The patient’s symptoms had resolved, and he had not spotted passage of any stone as he was asked to stay vigilant.

Discussion
Flexible cystoscopy along with CT Urogram was likely the best approach in this case- as it provided a holistic approach and excluded any upper tract pathology as well as a FB or abnormality in the urinary bladder.
118 Improving the Knowledge and Confidence of Diverse NHS Workforce: An Innovated Teaching Program on Research Methodology
Authors: Win M. , Htet W. , Bharathan B. 
Published: February 2022

Abstract

Aim
International medical graduates (IMG) are a significant contributor to the NHS workforce. According to GMC, there has been an increase in the number of IMG joining the NHS, and their proportion was higher than the combination of UK and EEA graduates in 2020. Clinical research is one of the pillars of clinical governance in the UK; however, their exposure to research methodology in their native countries may be limited, impacting their engagement in clinical research. Our objectives were to measure their knowledge and confidence in research methodology and help them improve imperative skills.

Method
A total of seven teaching sessions were delivered virtually over two months to IMG working across the UK. The average number of attendees per session was thirty. The lectures covered research ethics, integrity, study designs, literature review, statistics, scientific writing, and critical appraisal. The change in the level of knowledge and confidence in research methodology was evaluated by analysing the responses to the survey completed before and after the novel teaching program.

Results
50% reported increase in knowledge of the research methodology

Conclusions
Substantial improvement in self-reported confidence and knowledge of research methodology was achieved among IMG featuring the high-quality support to the diverse workforce. The innovation of dedicated teaching sessions on research methodology for IMG is crucial in the development of a happy workforce as well as the maintenance of clinical governance of the UK.
121 A Novel Technique for Infected Metalwork Salvage: Negative Pressure Wound Therapy with Copious Saline Irrigation and Direct Wound Closure Over Dressing
Authors: Summers S. , Daniels N. , Thahir A. , Krkovic M. 
Published: February 2022

Abstract

Aim
Metalwork infection is a challenging complication, often requiring surgical removal. The senior author devised a novel technique consisting of negative pressure wound therapy (NPWT) with high-flow rate saline irrigation and direct skin closure over the standard NPWT dressing. This study aims to evaluate the utility of this modified technique in resolving metalwork infection to allow fracture union without metalwork removal.

Method
This is a retrospective chart review of 24 patients (3 upper and 21 lower limb cases) with infected orthopaedic metalwork from a single centre over a seven-year period, who were all managed with this modified technique as an adjunct to standard antibiotic therapy and surgical debridement. Demographic data, surgical data and infectious disease data were collected. Patients were followed up for signs of infection recurrence.

Results
23 of 24 (96%) patient had successful metalwork retention with infection resolution to achieve fracture union. No metalwork was removed due to infection. Original metalwork was maintained in 16 of 24 (67%) patients. The average duration of NPWT was 19 days and the average number of visits to the theatre for NPWT change or removal was 2.5 (mode: 2).

Conclusions
This series demonstrates that the modified NPWT technique is an effective adjunct therapy for infected metalwork salvage. This novel technique is safe and reliable with timely resolution of infection to allow fracture union.
125 Surgical Outcomes and Graft Use in Quadriceps & Patella Tendon Rupture Repairs
Authors: West C. , Kwaees T. 
Published: February 2022

Abstract

Aim
Quadriceps and patella tendon ruptures are relatively uncommon injuries affecting approximately 1% and 0.5% of the population respectively. The literature surrounding preferable surgical technique, graft implant used, and surgical outcomes are relatively obscure. We audited all quadricep and patella tendon repairs within the trust to identify whether they have the same surgical outcomes, if any factors affect surgical outcomes and if there is a graft/implant which has superior outcomes.

Method
We conducted a retrospective cohort study which included 34 patients who had undergone a patella or quadriceps tendon rupture repair, over a 5-year period. The outcomes assessed were surgical failure, long term complications and graft/implant used.

Results
Our data demonstrated that patella tendon rupture repairs carried higher failure rates (14%) and poorer surgical outcomes (42%) than quadriceps tendon rupture repairs. Within the patella cohort, revision surgery was required due to decreased range of movement secondary to loosening of the graft. A wide variety of graft/implant were used in surgical fixation, however there was no significance in surgical outcomes or complications. It was apparent that weight was a significant factor in tendon rupture injury, however co-morbidities, medications or lifestyle appeared to have no impact on surgical outcomes.

Conclusions
The findings of our single centre study are inconclusive due to small sample size; however, it is apparent that patella tendon repair ruptures are associated with higher failure rates and poorer outcomes. A regional study would provide a larger cohort of patients to help determine the objectives outlined in this study.
132 Improving the Long Term Follow Up of Bisphosphonates in the Community
Authors: Moran E. 
Published: February 2022

Abstract

Aim
Bisphosphonates are generally first line treatment for osteoporosis in primary care. However, long term bisphosphonate use has been associated with atypical femoral fractures. Therefore, it is recommended that bisphosphonates are reviewed every 3–5 years. This study set out to assess and improve the long term follow up of bisphosphonates in a GP practice in Leeds.

Method
System One was searched to identify patients prescribed alendronic acid or risedronate in January and February of 2021 from Aire Valley Surgery, a GP practice in Leeds. These patient’s notes were then used to see if they had planned bisphosphate follow up and if this was via a script note, scheduled task, or recall. In March of 2021 a teaching session on osteoporosis and bisphosphonates was delivered to GPs working at the practice. GPs were also asked to make sure that they planned follow up when prescribing bisphosphonates via a script note. System One was searched again to identify patients prescribed alendronic acid or risedronate in April and May of 2021.

Results
Prior to the teaching session 47.9% of patients had planned follow up with 56.4% via script note, 16.4% via scheduled task and 27.3% via recall. Following the teaching session 48.4% of patients had planned follow up with 73.1% via script note, 13.5% via scheduled task and 13.5% via recall.

Conclusions
This study has identified a group of patients who are taking oral bisphosphonates in the community without planned follow up and are therefore more likely to sustain an atypical femoral fracture.
139 Absence of Coding in an Outpatient Paediatric Orthopaedic Department – Where Does the Money Go?
Authors: Dhingra M. , Chong H. , Shyamsundar S. 
Published: February 2022

Abstract

Aim
Paediatric orthopaedics conditions are often managed in the outpatient department (OPD) setting. Due to the lack of official coding for these minor procedures in our OPD, the hospital receives neither financial benefit nor evidence for a formal auditing process. With the Paediatric Get It Right First Time (GIRFT) report underway, we have looked at building a coding pathway for paediatric interventions in our OPD.

Method
The number of paediatric orthopaedic interventions were collated and grouped in a 6-month period, and a clinical outcome form was created accordingly. After consulting with the coding department, a cost analysis of prospective earnings was conducted, as well as comparisons to current standard tariff rates for OPD attendance.

Results
From January 2021 to June 2021, 100 interventions were performed in our OPD with the breakdown of: 21 clubfoot serial casting, 70 serial casting for pathology such as tip toe walkers, 6 Botox injections in spastic contracture limbs and 3 Pavlik harnesses for developmental dysplasia of the hip. With the assistance of coding department, a new paediatric procedural coding form was created with 14 relevant interventions listed. A loss of £6110 was calculated due to tariff rates being solely attendance based compared to interventional based.

Conclusions
Paediatric orthopaedic OPD should have clinical coding outcomes in place for each intervention that is performed to ensure that the hospital trust receives appropriate financial commission as well as ensure a formal audit trial can be produced.
142 Amyand’s Hernia: An Extensive Review of History, Aetiopathogenesis, Symptomatology, and Management – Should We Scan, Scope & Snip?
Authors: Ballanamada Appaiah N.N. , Probert S. , Menon N.J. , Alam S. 
Published: February 2022

Abstract

Background
Amyand’s hernia, first described by Claudius Amyand in 1735, continues to remain a diagnostic & therapeutic challenge. By definition includes inguinal herniae that contain the vermiform appendix.

Aim
This up-to-date review aims to define and classify Amyand’s hernia and suggest appropriate management options in the current era. Aim to shed light on the value of pre-operative cross-sectional imaging and the use of laparoscopic surgery to provide a one stop solution.

Method
Published English literature was reviewed (1735–2021), using PubMed and Embase, combining the MeSH terms “hernia”, “inguinal”, “appendix”, “Amyand”, “low dose CT” and “laparoscopic herniotomy”. Most cited open access reviews, case series and case reports were chosen to provide a framework. A recent case is described with selected images (radiological, histology and intra operative).

Results
Since the original publication, by Claudius Amyand in 1735, there exists a gulf on this condition in the available British medical literature. Nearly 100,000 hernia repairs are performed in the UK annually. If Amyand’s hernia account for 1% of these (according to the most stated estimate), there should be a thousand Amyand’s herniae repaired annually in the UK alone. Unfortunately, the management options remain nonstandard.

Conclusions
Computerized tomography (CT) allows for pre-operative diagnosis and should be considered more often, even in children. Laparoscopic appendicectomy combined with a laparoscopic herniotomy is a safe one stop solution, in experienced hands, for paediatric patients.
158 Telemedicine and Cleft Care in the UK: Adequacy and Appropriateness
Authors: Takenoshita M. , Miyagi K. 
Published: February 2022

Abstract

Aim
The efficacy of teleconsultations for cleft lip/palate (CLP) patients is not established. Accurate speech assessment and intraoral examinations pose unique challenges. This study evaluates the adequacy, benefits, and limitations of video-consultation for CLP patients.

Method
Retrospective analysis of all cleft multidisciplinary team (MDT) clinics on the electronic hospital system, Epic, from 05/2020–03/2021 covering East Anglia, UK. Adequacy of video consultations was based on: difficulties faced during the consultation, conversion to telephone, and whether additional face-to-face appointments were generated. MDT members were surveyed to identify benefits of teleconsultation, and types of appointments deemed most suitable for teleconsultation.

Results
Of 353 cleft MDT clinic appointments, 90% were by video and 10% by telephone; 75% of video consultations were rated as ‘adequate’. 72 additional face-to-face appointments were generated, 38 (53%) of which were due to technical factors such as connectivity. Child (e.g., shyness) and carer (e.g., digital literacy) factors accounted for 8 and 4 cases respectively. Three- and five-year reviews, and those requiring formal speech assessment, generated most additional appointments, followed by surgical reviews requiring intraoral examination. Staff survey revealed reduced travel, flexibility, and regular contact as most frequently reported benefits, concerns were raised over the loss of the ‘human touch’. Overall, respondents agreed that teleconsultation is suitable for select patients, and as a screening tool.

Conclusions
Selective use of teleconsultations that considers patient preference, age, and clinical factors is necessary. Anticipated surgical examination, speech assessment, and younger patients should be scheduled for face-to-face appointments. Technical issues must be addressed as a priority.
159 The Role of Proformas in Improving the Documentation of Surgical Ward Rounds
Authors: Coyle M. , McManaman C. , Smith B. 
Published: February 2022

Abstract

Introduction
Several NHS trusts rely on handwritten notes, including ward round (WR) reviews. These are essential in-patient care and must be completed/documented thoroughly. The General Medical Council and Royal College of Surgeons have both published guidance on WR documentation.

Method
This was a prospective study aiming to review WR documentation within general surgery at Frimley Park Hospital. 17 WR entries were reviewed using an 18-point checklist. A proforma was created based on published guidance and gaps in reviewed documentation. This was introduced for two months before a repeat review was conducted. A third review was conducted after an additional month to monitor for sustained improvement.

Results
Strengths in the baseline included documentation of WR leads (100%) and plans (100%), legible handwriting (95%), and NEWS score (88%). Common weaknesses were documentation of full observations, anticoagulation (both 6%), and relevant bloods and imaging (both 12%). The two months post-proforma review found improvement in all 18 areas of documentation, with five elements scoring 100%. Documentation of anticoagulation improved from 6% to 94%, relevant bloods from 12% to 82%, and full observations from 6% to 76%. Higher scoring WRs were linked to pre-prepared proformas, with lower scores linked to post-take WRs. The review was repeated after an additional month, showing consistently improved results in all areas.

Conclusions
This project has shown significant and sustainable improvement in WR documentation with the proforma. This project would therefore recommend the continued use of the proforma, and an additional review after the junior doctor change over to show continued sustainability.
160 Emphysematous Epididymo-Orchitis: Is Imaging Critical in Active Management? Case Report and Literature Review
Authors: Ilangovan S. , Ghazanfar N. , Chitale S. 
Published: February 2022

Abstract
We hereby present a case report regarding a rare cause of acute scrotum secondary to emphysematous epididymo-orchitis (EEO), often not diagnosed until it reaches an advanced stage, when it becomes a clinical diagnosis with crepitus palpable in scrotal wall with cellulitis.
This case report details a 55-year-old man with poorly controlled diabetes who presented with an acute scrotum that failed to resolve with oral antibiotics in primary care. Following rapid detection of EEO on an early scrotal ultrasound scan, the patient had surgical debridement and a near-total orchidectomy with only a small stump of testis and tunica albuginea left behind.
This highlights the importance of timely imaging in diabetic men with an acute scrotum following a high clinical suspicion of testicular abscess and an incidental, rare but significant finding of the complication of EEO, as both but particularly the latter would warrant early surgical intervention to prevent a catastrophic sequela: Fournier’s gangrene.
This case report also emphasises that as clinicians, we should have a high index of suspicion for local complications and low threshold for intervention in patients with epididymo-orchitis refractory to adequate period of treatment with oral antibiotics (1–2 weeks), particularly in immuno-compromised and poorly controlled diabetics.
166 ReAudit - Review of Elective Procedures for Pilonidal Disease in a Single Centre, Jan 2020 – Aug 2021
Authors: William B. , Khan A.E. , Mellor S. , Naseer M. , Abraham S. 
Published: February 2022

Abstract
Review of elective procedures for pilonidal disease in a single centre, Jan 2020 – Aug 2021

Introduction
Pilonidal disease continues to be managed with a variety of surgical techniques. We review results with Bascom 2 operation comparing to other practices at our institution.

Method
All elective procedures for pilonidal disease reviewed from Jan 2020 to August 2021. Age, gender, previous emergency and elective procedures for pilonidal disease, follow-up, recurrence and dehiscence rates, all-cause morbidity was examined retrospectively.

Results
In the study period there were 44 procedures. Average age was 26.4 years (range 16–44). Male to female ratio was 2:1. Procedure techniques performed included modified Bascoms flap (20), excision and primary closure (20), excision and packing (3) and Rhomboid flap (1). The number of previous emergency and elective procedures in the cohort were 18 and 3 respectively. In 24 (55%) procedures there was documented follow up, at a mean time of 49 days (median 56 days, range 3–84). Overall modified Bascom dehiscence (partial / full) dehiscence and recurrence rates were 10% and 5% respectively. Overall median number of bed related days length of stay was 0 days (range 0–3 days).

Conclusions
The modified Bascoms procedure is both technically simple and reproducible and offers comparatively good dehiscence and recurrence rates relative to other pilonidal sinus procedures.
170 Are Templates the Future? a Comparison of Compliance with GIRFT Guidelines on Post-Operative Documentation for Hip Arthroplasty
Authors: Hunt A. , Kapoor S. , Adegeye S. , Patel P. 
Published: February 2022

Abstract

Aim
Departmental audit cycle on post-operative documentation following hip arthroplasty in comparison with national ‘Get It Right First Time’ recommendations 2019. This project set out to review compliance with the new national GIRFT medical records standards and promote patient safety through improved documentation following the introduction of a post-operative template.

Method
50 hip arthroplasty post-operative notes from 2019 performed at ESHT were evaluated against all of the 24 criteria from Get It Right First-Time guidelines 2019. A post-operative template was introduced and a further 50 post-operative notes from 2020 were evaluated.

Results
Following the introduction of the template, compliance against the 24 criteria improved by an average of 38%. The greatest improvement observed related to commenting on bone quality with a 71% increase in compliance following the introduction of the template. Certain criteria such as the named surgeon, implant stickers, wound closure, haemoglobin check, and weight-bearing status remained at 100% across both groups. Only one criterion, assistant grade, saw a decrease across the two groups with an 18% reduction in compliance.

Conclusions
When utilised, the introduction of a post-operative template significantly increased compliance with respect to the GIRFT guidelines 2019. This is important given the ever-increasing litigation the NHS is subjected to and indeed is mentioned in the original GIRFT report. A significant limitation of this audit cycle was when surgeons opted to write the post-operative note free hand. A further period of education is suggested in order to increase the uptake of this and other post-operative templates.
174 An Audit on First Time Shoulder Dislocations: Are We Following BESS Guidelines?
Authors: Tariq F. , Remtulla M.A. , Jordan R. 
Published: February 2022

Abstract

Aim
Traumatic shoulder dislocations are the most common joint dislocation in the UK. They are often associated with concurrent injury to the joint and its stabilisers which can occasionally get missed. This can severely affect functional recovery and lead to chronic instability. Our aim was to assess adherence to the BESS guidelines for first time shoulder dislocations in a large acute general hospital.

Method
We conducted a retrospective review of all patients who attended the emergency department at Birmingham Heartlands Hospital between January and December 2019. A total of 20 patients were selected after verifying data received from the health informatics team. Patient notes, investigations and clinic letters were reviewed.

Results
The average age of our cohort was 50 with a male to female ratio of 13:7. The cohort was divided into three groups depending on their age i.e.,16–25, 25–40 and &gt;40. Although 85% were seen in a fracture clinic only 25% were seen by a consultant. It was noted that among all three groups only 40% of appropriate imaging was requested. In addition, only 50% were correctly referred to a shoulder surgeon or shoulder clinic to assess shoulder function, however most patients were seen by a physiotherapist.

Conclusions
We found a large number of concomitant injuries in those investigated for a first-time dislocation. We have therefore designed a pathway to ensure that all patients with a first-time shoulder dislocation are followed up in fracture clinic and appropriate investigations ordered in a timely manner.