bluuebunny/crossref_metadata_2025_split huggingface dataset:
85 A Closed Loop Audit of Consent for Trauma and Orthopaedic Surgery in the COVID-19 Pandemic
Authors: Goh J.Y. , Neary C. , Razii N. , Little K. , Leach W. 
Published: February 2022

Abstract

Aim
Surgical patients with perioperative SARS-CoV-2 infection have increased risks of morbidity and mortality. The primary aim was to audit the inclusion of COVID-19 as a specified risk on trauma and orthopaedic consent forms. The secondary aim was to calculate the indicative risk of acquiring COVID-19 in the perioperative period.

Method
Case notes were reviewed for 193 patients, including 160 consent forms, over one-week data collection periods in February 2021 and April 2021, at a Major Trauma Centre. Following the initial audit, data were presented at a departmental governance meeting and an infographic was disseminated to all clinicians. 33 patients, comprising 24 Adults with Incapacity (AWI) and 9 others who had been consented prior to departmental guidance, were excluded from the primary analysis but included in the secondary analysis, where all SARS-CoV-2 RT-PCR test results up to 2 weeks postoperatively were reviewed.

Results
In the initial audit period, 91 patients underwent surgery (79 consent forms), whilst 100 patients underwent surgery in the re-audit period (81 consent forms). Following our intervention, 70% of patients had COVID-19 specified as a risk on the consent form, representing a statistically significant improvement from 49% in the previous cycle (p = 0.007). During the initial audit, 2 patients tested positive for COVID-19 postoperatively, whilst there were no positive tests during the re-audit.

Conclusions
The consent process for the risk of perioperative COVID-19 significantly improved following our intervention. The indicative risk of acquiring perioperative COVID-19 reduced from 2.15% to less than 1%, which likely reflects the impact of the vaccination programme.
86 Adherence to Best Practice Tariffs (BPT) for Neck of Femur (NOF) Fracture Admissions During the COVID-19 Pandemic
Authors: Basha A. , Singh A. , Barmpagianni C. 
Published: February 2022

Abstract

Introduction
For patients with fragility hip fractures, care needs to be promptly organised to undertake a holistic assessment and preparation for surgery. The aim of the Best Practice Tariffs (BPT) is to promote hip fracture programmes that provide best practice in the care and secondary prevention of fragility fractures.

Method

Results

Conclusions
88 Blood Cultures on a Cardiothoracic Surgery Ward- a Quality Improvement Project
Authors: Brown J. , Zamvar V. 
Published: February 2022

Abstract

Aim
Blood cultures are an important practice when patients spike temperatures, allowing treatment to be targeted and rationalised. However, often it is missed or forgotten about when a patient is unwell. The aims of this project were: to look at the rate of blood cultures being taken after patient’s spiked temperatures and to try and improve on these rates with education.

Method
All patients on the ward had their observation charts examined. Any patient with a temperature of 38 degrees or more was noted down and seen whether blood cultures had been taken. Nurse led education then occurred between each cycle of data collection. Three cycles of data of 10 patients were collected.

Results
In the first cycle only 20% of patients had blood cultures taken. After nurse led education, this improved to 30% of patients. A crib sheet on when/why blood cultures should be taken was then distributed to nursing staff on the ward. The final cycle of results showed an improvement to 60% of patients having blood cultures taken.

Conclusions
Educating ward staff on when blood cultures should/shouldn’t be taken and why has led to a significant improvement on the proportion of pyrexic patients having blood cultures taken on the ward. However, there is still room for improvement and future work should be done to continue to improve compliance rates on the ward.
89 Covid-19 and the Impact on Oncological General Surgery at a District General Hospital
Authors: Brown J. , Dick L. , Berlansky M. 
Published: February 2022

Abstract

Introduction
Covid-19 has had a significant impact on all aspects of healthcare. We aimed to characterise our experience of oncological general surgery during the first 4-months of the pandemic and compare with the same period in 2019.

Method
A prospective cohort study was performed from 23/03/20 to 08/07/20. All elective oncological operations were included. Data on patient demographics, waiting times, inpatient characteristics and oncological outcomes were recorded. Statistical analysis was used to compare with retrospective data from 2019.

Results
78 patients were included in total, 38 in 2019 and 40 in 2020. There were no differences in length of stay (2.5 vs 3.5 days, p = 0.355) or waiting list time (27.2 vs 24.2 days, p = 0.574).
Oncological outcomes were comparable with no statistical difference in clear resection margin status (94.4 vs 84.6%, p = 0.168) or positive nodal status (24.1 vs 37.1%, p = 0.298).
The percentage of staging CT scans requested externally was higher in 2020 (4 vs 32%, p = &lt;0.05).
There was no difference in time from urgent referral to first assessment (30.5 vs 26.4 days, p = 0.384) or time to operation (96.6 vs 85.7 days, p = 0.618).

Conclusions
Oncological surgery during Covid-19 can be performed safely with favourable oncological outcomes. The longer-term effects from delayed diagnoses remain to be evaluated.
96 Adult Nasal Chondromesenchymal Hamartoma: A Rare and Benign Tumour with Aggressive Malignant Transformation
Authors: Collins R. , Lafford G. , Meghji S. , Burrows S. 
Published: February 2022

Abstract
Nasal chondromesenchymal hamartoma (NCMH) is an extremely rare benign tumour of the nasal cavity predominantly described in infants. To date, a total of 59 cases have been described. We report a case involving a 48-year-old female who had been diagnosed with NCMH a year earlier and now represented with a short history of progressive nasal blockage, recurrent epistaxis, and orbital apex syndrome.
Histopathology was suggestive of malignant transformation into sinonasal sarcoma. However, following multi-disciplinary team (MDT) discussions including a second and third opinion from external departments, the histological diagnosis was revised to ‘NCMH with bizarre stromal cells. Despite this, clinically the lesion demonstrated malignant features with rapid, invasive growth and was treated with palliative radiotherapy. The patient later developed radiological signs of lung and liver metastases and subsequent pulmonary emboli. Shortly after this she passed away. This case is unique in its diagnostic challenge, with ambiguous histopathological findings, and highlights the importance of an MDT approach when managing complex sinonasal tumours.
97 Paralysis From an Ear Infection: A Severe Case of Otitis Externa Leading to Acute Complete Cervical Cord Syndrome
Authors: Collins R. , Lafford G. 
Published: February 2022

Abstract
We report a case of a generally fit and well 54-year-old gentleman who presented with a two-day history of worsening left sided ottorhea, headache, neck stiffness, vomiting and pyrexia on the background of a seven-week history of OE. His condition progressed dramatically as he developed symptoms consistent with acute complete cervical cord syndrome with radiological evidence of skull base osteomyelitis, parapharyngeal, retropharyngeal and paravertebral abscesses and sigmoid sinus thrombus. Ultimately, he made a significant, although not complete, recovery.
This case is unique in demonstrating how OE can develop into a potentially life-threatening condition. It emphasises the importance of early diagnosis and treatment of OE, the recognition of ‘red flag’ symptoms and highlights the importance of a multi-disciplinary team (MDT) approach when managing complex complications of OE.
98 Developing Minor Operation Services in Plastic Surgery to Reduce Theatre Burden and Improve Time to Surgery
Authors: Peberdy D. 
Published: February 2022

Abstract

Aim
The primary aim was to assess safety of a single centre minor operations service run by plastic surgery over the course of one year with data collected for over 100 procedures.

Method
Data was prospectively gathered using our electronic trauma database to record date of referral, date of procedure, and type of procedure. Complications were checked for 6 weeks post procedure by review of patient notes. Comparison of time to surgery and complication rate were made using similar cases performed in dedicated theatres in the same time period.

Results
We found that 6 weeks post procedure complication rates were less than 5%. In addition to this we found that the minor operations service significantly reduced the burden on plastics trauma lists as well as reducing the time to surgery when compared to the same types of procedures listed in our main theatres.

Conclusions
Our data shows that the minor operation service is a safe way to increase the trauma capacity of plastic surgery units. We feel a minor operation service is an integral part of an efficient plastic surgery department with better patient service and reduced costs.
103 Antibiotics Prescription Pattern and Resistance Profile of Common Isolates at Soba University Hospital, Sudan 2018
Authors: Mohammed O.A.A. , Ahmed F.A. , Koko A.I. , Mohamed M.E.A. , Abdelaziz H.A.M. , Elhag R.Y. 
Published: February 2022

Abstract

Aim
Antimicrobial resistance is an increasingly global public health threat. Antimicrobial stewardship programs have been introduced to tackle this problem. In this study we aim to determine the pattern of antibiotics prescription and resistance profile of common bacterial isolates at Soba university hospital, Sudan.

Method
A retrospective cross-sectional study that was conducted at the medicine and surgery wards in a tertiary care hospital. Records of all patients who were admitted during the study period were included. A pretested data collection form was used to collect information.

Results
Records of 269 patients were reviewed, the most frequently reported diagnosis on admission was cerebrovascular accidents (10.6%). The mean duration of hospital stay was 6.6 ± 6 days. Almost 81.8% of admitted patients received antibiotics with No documented indication in about 40.5% of them. Most antibiotics were administered intravenously (82.1%). More than one-third of the prescribed antibiotics (38%) were 3rd generation cephalosporin (38%). The main reason for stopping antibiotics was the patients’ discharge (63.6%). Of patients receiving antibiotics, only 5 (1.9%) had undergone culture. A total of 100 cultures were performed during the study time. Most of them were urine cultures (64%). Escherichia coli was isolated from 14 (29.2%) cultures. Resistance percentage was highest for erythromycin, and oxacillin (100% for both).

Conclusions
The study shows a trend of antibiotic misuse. Most patients received antibiotics without documented indication. Antibiotics sensitivity results showed high levels of resistance among isolated organisms. We recommend a wider study and formulation and implementation of clear guidelines to regulate antibiotic use.
104 The Assessment of the Clinical Frailty Scale in Emergency Department (Quality Improvement Project)
Authors: Aung M. , Khalil A. , Abdelaal M. 
Published: February 2022

Abstract

Aim
To enforce clinicians to use clinical frailty scale (CFS) in the elderly population which can guide the management pathway i.e., suitable for ITU admission or surgical intervention

Method
As part of the QIP, an audit was carried out which looked at two criteria:
The above criteria are based on NICE guidelines NG191 and the specialized Clinical Frailty Network website.
The inclusion criteria are patients older than 80 years of age. The first cycle looks at 50 randomized patients presented to A&E in July 2021, followed by the implementation of change. The target for all criteria is 75%. The second cycle looks at 50 randomized patients presented to A&E in August 2021.

Results
Initial audit data suggests the following:
Crit 1: 40%
Crit 2: 2%
This suggests we are performing less than the national standard. Therefore, an implementation that involves a change in a software system, poster and teaching session was done. This approach improves our performance immensely.
Crit 1: 100% (now mandatory due to software system i.e., sustainable change)
Crit 2: 40%
The third cycle was currently underway with a plan to undertake CFS awareness month.

Conclusions
This QIP helps not only the emergency team but also admission teams particularly ITU and surgical speciality to reach the management decision for the elderly population.
106 Laparoscopic Cholecystectomy Following an Episode of Cholecystitis: Are We Meeting the NICE Guidance?
Authors: Singh P. , Pufal K. , Robinson S.J. 
Published: February 2022

Abstract

Aim
On average, acute cholecystitis is responsible for 3% of admissions to emergency general surgery wards. NICE Guideline [QS104] states that adult patients admitted with acute cholecystitis should be offered a laparoscopic cholecystectomy within one week of diagnosis. This study aims to assess adherence to this guideline in a medium size district general hospital.

Method
Data was gathered retrospectively from contemporaneous electronic-based patient record system. Patients with a first case of cholecystitis within a 486-days’ time period were included; incorrect coding or repeat admissions within our time period were excluded. Data was gathered on admission length, aetiology, investigations undergone and procedure type (open vs laparoscopic). Additionally, for those that underwent a cholecystectomy, the length of time between diagnosis and operation was calculated.

Results
72 adults were admitted with acute cholecystitis in the 486-day study period. The median length of stay was 3 days. The commonest aetiology was either gallstones or unknown (47.2% of cases each), followed by bacterial infection (5.6%). 9 patients (12.5%) underwent laparoscopic cholecystectomy, and 10 (13.9%) were placed on a waiting list. The remaining 53 (73.6%) had no mention of being listed for surgery in their notes. Of those undergoing laparoscopic cholecystectomy (n = 9), none were within the recommended one-week period from time of diagnosis.

Conclusions
Over 486 days, no patients diagnosed with acute cholecystitis in our unit were being treated according to NICE guidance. We therefore recommend reinstating the hot gallbladder list at this hospital, which will enable surgeons to deliver the biliary emergency service advocated by the national guidelines.
108 Improving the Quality of General Surgery Operation Notes
Authors: Hammenga C. , Ekowo O. , Altaf K. , Nada H. , Bhardwaj R. 
Published: February 2022

Abstract

Introduction
As outlined in Good Surgical Practice by the Royal College of Surgeons (RCS), accurate, comprehensive, legible, contemporaneous, and preferably electronic operation notes are fundamental in maintaining effective communication, patient safety and overall quality of patient care.

Aim
To improve the quality of general surgery operation notes by increasing the documentation of the 18 key criteria recommended by the RCS, and increasing the quantity of operation notes completed electronically.

Method
Operation notes were reviewed for the documentation of the 18 key criteria. Initial audit aimed to gather baseline after which five actions aimed to increase the use of electronic notes were undertaken (including implementation of electronic operation notes proforma, presentation in the surgical morbidity and mortality meeting). Thereafter, a re-audit reviewed operation notes for the documentation of the same 18 criteria. As handwritten notes continued to be used in the re-audit, we took the initiative to also compare documentation between handwritten and electronic notes. For this purpose, 158 operation notes were randomly selected (80 handwritten, 78 electronic) and documentation of key criteria were compared.

Results
Use of electronic notes increased by 59%. There was an overall increase in documentation between the initial audit and the re-audit. On comparison of handwritten vs electronic notes, the total relative risk of not completing key criteria 0.461 (95%CI 0.417-0.509), p&lt;0.0001.

Conclusions
The audit was successful in increasing the documentation of key criteria. When comparing handwritten vs electronic notes, the data show that electronic notes significantly reduce the risk of not completing key criteria.
112 Improving Neonatal Vascular Access in Surgical Patients
Authors: Rupra R. , Loveday R. , O’Sullivan B. , Soccorso G. , Arul S. 
Published: February 2022

Abstract

Aim
Many neonatal surgical patients require intravenous (IV) access for &gt;1 week. Technical, organisational, and cultural factors reduced placement of peripherally inserted central catheters (PICCs). Most babies requiring parenteral nutrition/central medications undergo central venous line placement under general anaesthetic (GA). Repeated bedside cannulation causes distress to patients and parents, with workload burden resulting in extravasation injuries. We aim to reduce these factors by increasing PICC usage in a ward setting.

Method
We followed a Plan, Do, Study, Act cycle over 4 months.

Results
Final results pending. The intervention has occurred, in 1 month we will re-measure:
We will measure risks of increasing PICC placement (through an iterative process), including:

Conclusions
The initial message yielded perceptions that ‘the department is doing things wrong’. The message of PICCs adding an ‘extra string to our bow’ was clearer, non-judgemental and with strong rationale for change.
Training non-rotating staff promotes sustainability but required senior clinician agreement to procure equipment, delaying our timeline – target completion is in 1 month.
119 Evaluating the Quality and Readability of Online Information on Unspecified Kidney Donation
Authors: Stavropoulou-Tatla S. , Awal D. , Fardanesh A. , McCaig F. , Hossain M.A. 
Published: February 2022

Abstract

Introduction
Living kidney transplantation from donors bearing no genetic or emotional relationship with the recipient, is known as unspecified kidney donation (UKD). UKD can create multiple living donor transplantation opportunities and shorten the national waiting list for cadaveric organs. Consequently, the UK Living Donor Kidney Transplantation 2020 Strategy, has prioritised maximising UKDs.
The Internet has an established role in raising awareness, offering support, and potentially influencing the decision for or against UKD. This is the first study assessing the quality and readability of online material related to UKD.

Method
Google was used to search for the following terms: ‘kidney donation’ and one of ‘unspecified’, ‘altruistic’, ‘non-directed’, ‘anonymous’ or ‘good Samaritan’ as well as ‘giving or donating a kidney to a stranger’. Two independent assessors reviewed the top 100 websites and assessed their quality using the Journal of the American Medical Association (JAMA) criteria, the DISCERN instrument and HONcode (Health on the Net Code) certification. Readability was assessed using the Flesch Reading Ease (FRE), Flesch-Kincaid Grade (FKG) and Simple Measure of Gobbledygook (SMOG) scores.

Results
Only 6% of websites displayed a HONcode stamp. The mean (± SD) JAMA and DISCERN scores of 1.96 (±1.00) and 32.34 (±11.19) respectively, indicate poor quality. The mean (± SD) FRE, FKG and SMOG scores of 52.92 (±13.62), 10.60 (±2.72) and 9.64 (±2.22), respectively, reveal poor readability.

Conclusions
Transplant centres and medical organisations should prioritise improving the standards of online material on UKD. This enables informed and ethical decision-making when attempting to expand the living donor pool.
122 Tetanus Prophylaxis for Injuries Referred to a Plastic Surgery Service
Authors: Stark D. , Nagrath N. 
Published: February 2022

Abstract

Aim
To ascertain whether there is appropriate documentation of tetanus immunisation status. To determine whether appropriate tetanus prophylaxis is offered to those with an incomplete or unknown immunisation history for tetanus prone and high-risk tetanus prone wounds. To improve adherence to the green book of immunisation tetanus guidance.

Method
We performed an audit of wounds referred to plastic surgery in a 3-week period to ascertain whether the green book guidance was satisfied. A poster intervention for junior colleagues that illustrated the guidance was implemented. Re-audit was performed.

Results
Tetanus immunisation status was documented in 17 (34%) patients. Of 22 with tetanus prone wounds, 11 (50%) had an incomplete tetanus immunisation, but only 3 (27%) received a booster vaccine. Of the 11 high risk tetanus prone wounds, 10 (91%) had an incomplete tetanus immunisation status, but only 5 (50%) received a booster vaccine and none were offered tetanus immunoglobulins.
Following intervention, tetanus immunisation status was documented in 23 (46%) patients. In the re-audit, 12 (24%) sustained a tetanus prone injury and 4 (33%) of these had complete immunisation. Of the remaining 8, 7 (88%) received a booster vaccine and 1 patient refused. Of the 4 high risk tetanus prone wounds, 3 (75%) had an incomplete tetanus immunisation status, all of whom received a booster vaccine and 1 (25%) was offered tetanus immunoglobulins.

Conclusions
We observed greater engagement with the tetanus immunisation guidance and improvement in the assessment and management of tetanus prone injuries.
123 Effectiveness of the “Emergency Neurosurgery Referral Card”
Authors: Baig A.A. , Lo W.B. 
Published: February 2022

Abstract

Aim
The recording of patient and clinical information is important during the neurosurgery referral process, as time-critical communication with the referring teams and appropriate clinical decisions are dependent on the accuracy and completeness of the information recorded. A ‘Neurosurgery Emergency Referral Card’ was introduced to assist the process for the on-call registrars/consultants.

Method
Following the first audit cycle was carried out over 52 weeks (1st January 2020 – 31st December 2020), which assessed the percentage of incomplete data entry in the referral database, a ‘Neurosurgery Emergency Referral Card’ was introduced. Data entry was then re-audited (12 weeks; 21st May 2021 – 21st August 2021).

Results
Referral type (emergency, urgent, semi-urgent, non-urgent) is the most inadequately recorded data field, with a completion rate of 68%. Following the implantation of the card, it improved to 89%. The pre- and post-implementation completion rate for patient age was 82% and 98% respectively, and 85% and 96% respectively for time of referral. The completion rates for the remaining data fields in the 1st cycle (e.g., referring doctor, diagnosis, gender) were generally above 94% but still improved with the usage of the card. The average improvement in referral taking after implementation is 6%.

Conclusions
Even in the digital age, a ‘low-technology’ yet simple physical card can be an effective adjunct to improve referral accuracy and efficiency.