bluuebunny/crossref_metadata_2025_split huggingface dataset:
38 Virtual Trauma Meeting-the Game Changer During COVID 19 Era. A Quantitative Comparative Analysis
Authors: Elerian S. , El Tagy H. , Munuswamy S. , Singh T. , De C. 
Published: February 2022

Abstract

Introduction
In an orthopaedic department, majority of plans and decision-making cases occur at the daily trauma meeting. With the advent of COVID-19 pandemic, it was challenging to deliver the standard care maintaining social distancing guidelines. Therefore, virtual trauma handover replaced the traditional face-to-face handover as a standalone solution. This study has tried to report on effectivity of the new virtual trauma handover process.

Method
This single centre observational study compared retrospectively collected data during pre-COVID-19 period (2019) and prospectively followed data from virtual trauma meetings during COVID 19 pandemic. The study analysed comparison of meeting start and finish time, attendance of key members, punctuality of attendees and interruptions during the handover process.

Results
Changing from face-to-face to virtual trauma meetings, average participation doubled from 9 to 18 with increased consultant attendance (Mean: 7.5 vs 2) -statistically significant (p &lt; 0.05). Enhanced senior clinician participation helped in multidisciplinary decision making promptly. Punctuality of attendance noted as declining late arrivals in 28/34 face-to-face to 4/34 virtual meetings. Although meetings start-time remained similar overall, there was less interruptions during virtual handover and mean meeting span reduced by 13 minutes.

Conclusions
As part of adaptive changes during COVID-19 pandemic, virtual trauma handover meetings have introduced changes in delivery of existing acute trauma services. Within very few limitations, it could be an aid to improve clinician participation, easiness of having multidisciplinary opinion and decision making. Moreover, it helped to practice social distancing guidelines. Educational activities are also effectively managed through virtual meetings.
42 The Accuracy of the Multi-Slice Detector CT scan (MDCT) in Staging Borderline Respectable Periampullary Carcinoma
Authors: Issa M. , Noureldin K. , Jones L. 
Published: February 2022

Abstract

Aim
Assess MDCT accuracy in staging cancers periampullary cancers.

Method
Periampullary malignancies are highly aggressive with poor outcomes. Surgery is the only curative option. It is crucial to define the patients who can advantage from a Whipple’s resection and who can avoid. RCT investigated randomly 28 patients over 15 months. The patients were sub-divided into 2 groups. Group A, we relied mainly on the MDCT for preoperative staging, while in Group B staging laparoscopy was added before the abdominal exploration. Sensitivity of the MDCT and its accuracy were 100% in defining the signs of irresectability. For borderline staging, the accuracy of the scan was 62.5% and 71%, in groups A and B. The Overall accuracy of MDCT was 75%. It decreased to 68.1% for borderline lesions. The addition of staging laparoscopy to the diagnostic work up, increased the accuracy to 92.5%. The camera test was able to see occult findings which were missed in the images. Liver Mets and malignant peritoneal fluid were localized in 18% and 9% respectively. 3 cases in group A and one in group B underwent unnecessary laparotomy. Thus, the false negative incidences were 21% and 7% in group A and B, with overall incidence 14.2%.

Conclusion
MDCT is highly sensitive and specific with high stage periampullary cancers. These parameters drop in border tumours with reduced accuracy in detecting the degree of vascular abutment and distant-occult findings. Addition of other adjuncts to decrease the rate of un-indicated laparotomy.
47 Patient and Physician Positioning During Anterior Skull Base Surgery Impacts Physician Ergonomics
Authors: Maniam P. , Lucocq J. , Gohil R. , Lewis-Morgan G. , Rokade A. 
Published: February 2022

Abstract

Aim
The effects of anterior skull base surgery on surgeon’s ergonomics remain unclear and this study explore the impact of patient, surgeon, and screen positioning on surgeon’s ergonomics during the surgery.

Method
A total of 20 different surgical positions involving the operating surgeon, assisting surgeon, patient head position, camera position and screen position/number were simulated. For each position, the ergonomic effects on the upper limb, neck, trunk, and lower limb of surgeons were analysed using the Rapid Upper Limb Assessment (RULA) tool.

Results
The majority of scores ranged from 2 to 3 suggesting the majority of positions have acceptable postures. The average RULA score of the right side of operating surgeon was 2.8 versus 2.95 on the left-side (p = 0.297). For the assisting surgeon, the average RULA score of the right side was 3.65 versus 3.25 for the left side (p = 0.053). The average combined (left and right) RULA score for the operating surgeon was 5.76 versus 6.9 for the assisting surgeon (p&lt;0.001). Position 17 (operating surgeon to the right of patient, assisting surgeon to the left of patient, central patient head position and two screens) is the most ergonomically favourable position. Position 2 (operating and assisting surgeon to the right of patient, patient head position to the right and one screen position to the left of patient) is the least favourable position.

Conclusions
This simulation raises awareness of risk of musculoskeletal injury in anterior skull base surgery and highlights those certain positional behaviours are better for reducing injury risk than others.
48 Consenting Surgical Patients for the Risk Associated with Contracting COVID-19 During Their Stay at the Hospital
Authors: Al Aaraj M. , Abdeen B. , Alkilani Y. , Kaul S. , Yang Y.H. , Wain M. 
Published: February 2022

Abstract

Aim
Literature is suggesting significant perioperative mortality and morbidity associated with COVID-19. Therefore, the Royal College of Surgeons (RCS) has produced guidance detailing additional considerations in consenting for surgery whilst COVID-19 is prevalent within society. Section 3A of this document emphasizes the need to discuss the risk of contracting COVID-19 while patients are in hospital. We conducted a multi-cycle closed-loop audit to examine the adherence to this guidance.

Method
We completed four audit cycles, each comprising data collection and educational intervention to disseminate the guidance. Data was obtained from consent forms for patients who had consented to both emergency and elective surgery over a two-month period at a large NHS Trust in London. The intervention consisted of teaching sessions, regular emails to the general surgical department, and posters displayed in common areas.

Results
Consent forms from 139 patients were reviewed over the four cycles (n = 38, 41, 28, and 32). The proportion of patients consented for the risk of contracting COVID-19 during the perioperative period rose serially between the cycles (37%, 61%, 71%, and 85% respectively), and was significantly increased between the first and last cycle (p &lt; 0.01, two-sided Z-test). The interventions proved most effective for senior house officers who improved from consenting 8% initially to 100% on completion of the audit.

Conclusions
We demonstrate the marked effectiveness of simple interventions combined with serial auditing to disseminate this message. The same practice may help improve consenting practice at other centres whilst COVID-19 is prevalent in society.
50 Ward Round Documentation in Vascular Surgery – a Closed Loop Audit Cycle
Authors: White A. , Hyde-Baker C. , Elahwal M. , Caruana M. 
Published: February 2022

Abstract

Introduction
Ward Rounds are a fundamental part of multidisciplinary team assessment, planning patient care and co-ordinating management decisions. Accurate documentation of patient assessment, relevant history and investigations, discussions with the patient and decisions made is crucial for continuity of patient care, medico-legally and overall patient safety. Despite the variety of record-keeping methods used throughout the NHS, it remains imperative that documentation remains accurate, contemporaneous, and can be used as a reliable source of reference throughout the patient’s journey.

Method
We used Royal College of Physician’s Ward Round Audit Standard 2015, with Cycle 1 of data collection from 17/5/21-23/5/21, followed by introducing interventions from 24/5/21-30/6/21. Interventions consisted of a Ward Round Proforma, displayed in each set of patient notes and communal ward areas. We completed Cycle 2 (31/5/21-6/6/21) using the same standard following which our results were analysed both individually and in respect to each other.

Results
Overall documentation improved by 14% across all domains from 67% to 81% following our interventions, in the 230 entries analysed (109 Cycle 2, 121 Cycle 2). Key areas included: Patient identification improving 25%, from 68% to 93%; Operation name and date improving 28% and 24% respectively and documentation of abnormal observations improving by 48%. Antibiotics and Thromboprophylaxis improved by 25% and 30% respectively, however remained under 50% in Cycle 2.

Conclusions
We conclude that simple, cost-effective interventions such as proformas & memory aids can significantly improve the documentation of ward rounds, thereby leading to improved patient care and safety and cohesive patient management throughout the multidisciplinary team.
51 Restructuring of the UK Vascular Services: Does the Hub and Spoke Model Affect Patient Mortality in Ruptured AAAs?
Authors: Nyamedom-Bonsi T. , O’Malley O. , Abbud N. , Safar M. 
Published: February 2022

Abstract

Aim
Ruptured Abdominal Aortic aneurysms (rAAA) are a fatal vascular condition. In 2018, The Get It Right First Time Programme (GRIFT) recommended the restructuring of vascular services in England to a Hub and Spoke model where AAA repairs should be performed in higher volume centres, the hub sites. This study aims to assess the mortality rates in patients presenting at hub versus spoke sites in the Merseyside region.

Method
We conducted a retrospective review, 1st January 2017 to 31st December 2020, recognising 110 patients with a rAAA presenting to hub and spoke sites in the Merseyside Region. We determined if there was any association in mortality and the presenting site. We also assessed the mean time to theatre for both Hub and Spoke patients.

Results
41 patients presented to Hub site and 69 patients to the spoke sites. 81% underwent operative intervention and 19% died in A+E or were palliated. 57% of those who underwent an intervention survived. Overall mortality rate in hospital was 53% (58 patients). There was no association between mortality and transfer from a spoke site (p = 0.58). The median time to theatre for Hub patients was 160 minutes from presentation and 315 minutes from Spoke sites. Time to theatre had no overall effect on mortality (p = 0.1)

Conclusions
This study indicates that the GRIFT programme does not have a negative effect on mortality irrespective of time taken to theatre. Therefore, transferring patients to a specialist hub site will positively influence patient outcomes.
55 Laparoscopic Cholecystectomy Consent Form Analysis Audit
Authors: Manson D. , McKnight G. , Alessandri G. , O’Reilly D. 
Published: February 2022

Abstract

Aim
To assess consent forms in the new urgent laparoscopic cholecystectomy theatre (ESAC) list in the University Hospital of Wales. With procedure-specific consent forms becoming more regularly utilised, we assess the need for them in our Trust.

Method
We prospectively assessed the consent forms of the first 20 patients who were enrolled in ESAC. We measured the complications list against national standards to assess completeness, including any use of abbreviations and the overall legibility. To complete our assessment and for posterity, we called each patient and gave them an official questionnaire to ensure their understanding before, during and after surgery.

Results
We found that of the complications included in the ESAC consent forms, there was a high degree of variability. For example, 75% contained ‘bile leak’ and 55% ‘post-cholecystectomy syndrome’; both named examples in national guidelines. Additionally, while the vast majority were legible, 50% of the consent forms utilised abbreviations in their written sections. Lastly, patient understanding surrounding the details of the operation was sound, with the majority correctly identifying their surgery, what it entailed and what they were expected to do post-operatively. However, just over half were able to provide a moderately detailed list of the associated complications that may have occurred.

Conclusions
That the trust would benefit from a procedure-specific consent form (PSCF) to provide exhaustive information on procedure details, complications, and their rates, as well as mortality rates. Additionally, this would eliminate issues of legibility and usage of abbreviations. We anticipate that it will also improve patient understanding.
60 Neoadjuvant Imatinib Mesylate – an Ace of Spaces for Surgical Management of an Oesophago-Gastric Junction Gastro-Intestinal Stromal Tumour
Authors: Arora A. , Arkle T. , Sreedharan L. , Kumar B. 
Published: February 2022

Abstract

Introduction
Oesophageal gastro-intestinal stromal tumours (GISTs) are rare, accounting for less than five percent of all GIST, with the majority of these occurring at the oesophago-gastric junction (OGJ). Due to the anatomical location and size of these tumours at presentation, surgical resection is often a major undertaking.
Neoadjuvant treatment with tyrosine kinase inhibitors, such as Imatinib mesylate, have the potential to downstage such tumours, thereby limiting the extent of subsequent surgical resection. This may therefore reduce any potentially associated morbidity and mortality.

Case Description
We report the case of a 75-year-old gentleman who presented with a large OGJ GIST, which presented with dysphagia. The tumour was deemed too large for local excision due to the risk of compromising the lumen at the OGJ in attempting to obtain a clear resection margin. Given the patient’s co-morbidity, oesophagectomy or total gastrectomy was deemed too major an undertaking. Therefore, endoscopic biopsies were obtained with a view to possible neoadjuvant therapy. These confirmed DOG-1 and Exon-11 mutations, suggesting sensitivity to Imatinib mesylate. A standard dose regime of 400mg daily for a planned 36-month course was commenced. Subsequent imaging showed a substantial decrease in tumour bulk and the decision was made to perform a local excision. A local enucleation procedure was performed, and the patient made a sound recovery.
Post-operative histology of resected tumour showed almost complete tumour regression.

Discussion
This significant response to neoadjuvant Imatinib mesylate therapy demonstrates clear potential for its use in similar cases, where radical resection would cause significant morbidity and risk mortality.
72 Transperineal Prostate Biopsies: Has the Change in Technique Been Effective?
Authors: Horn C. , Fordyce W. , Daggamseh A. 
Published: February 2022

Abstract

Aim
In March 2020 Derriford Hospital Urology Department changed its technique for biopsying prostates, going from a transrectal (TR) approach to a transperineal (TP) one. This method is now used for initial biopsies as well as when taking template biopsies. Our aim was to demonstrate whether either technique was more effective at diagnosing cancer, with a secondary aim of ensuring we were selecting the right patients to undergo template prostate biopsies after initially inconclusive results.

Method
We obtained a list of all patients who had undergone procedures coded under General Anaesthetic Prostate Biopsies between March 2019 and March 2021. We discounted patients who appeared on this list as they could not tolerate biopsies under local anaesthetic. We looked at initial biopsy technique and initial histology results, as well as number of template biopsies taken, histology results and subsequent management.

Results
Our sample size was small with 26 patients in total, with an even split between the 2 techniques, with 13 patients in each group. Following template biopsies, 15 patients were diagnosed with prostate cancer. 11 of these 15 patients had undergone TR biopsies initially. As a result, the management for all these patients changed. Incidentally we did also note that there was a wide variation in the amount of template biopsies taken.

Conclusions
It appears that TP biopsies are more effective than TR biopsies at not missing cancer. It also appears that the Derriford MDT has been selecting the correct patients to undergo further template biopsies.
73 Computed Tomography Imaging to Determine Reduction in Intracrainal Pressure Before & After Posterior Vault Expansion in Apert Syndrome
Authors: Khera B. , van de Lande L. , Sidpra J. , Knoops P. , Borghi A. , Ong J. , James G. , Hayward R. , Schievano S. , Mankad K. , Dunaway D. , Jeelani N.u.O. , Breakey W. 
Published: February 2022

Abstract

Introduction
Apert syndrome is an autosomal dominant malformation syndrome, accounting for 4.5% of all craniosynostoses. Raised intracranial pressure (ICP) in Apert syndrome has a multifactorial aetiology, with an incidence of up to 45% if left untreated [1, 2]. Raised ICP can be determined clinically, with non-invasive and invasive methods. In this study, we want to assess whether the use of CT scans is reliable in identifying changes in ICP.

Method
Pre and postoperative CT scans for 13 Apert syndrome patients who had posterior vault expansion were assessed and graded for severity of intracranial pressure (ICP). The grading system used was departmental specific and the assessment was carried out by a single clinician on different brain structures. This process was repeated on the same patients, using the same CT scans, 4 months later to determine consistency and repeatability. The relationship between the pre and postoperative scans was explored using the chi squared test. Intra-observer variability was assessed using Kappa statistics [SS1].

Results
There was no statistically significant difference between the pre and postoperative CT scan grading. Across instances, only one assessed structure had a p-value &lt;0.05. The Kappa interobserver reliability test did not identify a strong agreement in the comparison of the two instances of data analysis.

Conclusions
Assessment of CT scans is not a reliable method to determine changes in intracranial pressure in Apert syndrome patients who have had a posterior vault expansion.
78 Hand Injury and K – Wire Related Infection Rates in the Plastic Surgery Department – Closed Cycle Audit
Authors: Kandil M. , Abdul Z. , De La Cruz Monroy M. , Abdelaty M. , Shariff Z. 
Published: February 2022

Abstract

Aim
To identify the rate of K-wire infection in hand injuries and ascertain compliance with NICE guidelines on antibiotic prophylaxis and surgical skin preparation.

Method
Retrospective audit/service evaluation – EPR Operations first cycle (August – December 2019), and the second cycle (August – November 2020). Included all cases (adult and paediatric) of hand injuries managed with K – wire fixation – Plastic Surgery Trauma theatre lists.

Results
After the first cycle recommendations, the infection rates fell from 15 % to 11 %.

Conclusions
Infection rates were lower in the group of patients who had antibiotics on induction and on discharge.
79 Yellow Nail Syndrome Management with Nail Ablation and Reconstruction with a Full-Thickness Skin Graft
Authors: Kandil M. , Rahman S. , Abdul Z. , Abelaty M. 
Published: February 2022

Abstract

Aim
Yellow nail syndrome is a very rare and complex syndrome associated with aberrant nail growth multiple digits, in this case, the report we offer this as a solution to a challenging and rare condition.

Method
A 56-year-old lady underwent nail ablation and reconstruction with a full-thickness skin graft (FTSG).

Results
The patient had good cosmetic results.

Conclusions
Yellow nail syndrome is a rare but complex condition that is not yet fully understood. Nail plate deformity and discoloration are on the way the disease can manifest itself. Although not often encountered by plastic surgeons; The role of surgical excision for patients affected by dystrophic nails in yellow nail syndrome was given more emphasis within the literature. It is an effective technique that can be adapted as a standardized treatment modality
80 “To Freeze or Not to Freeze, That Is the Question”: A Case of Septic Arthritis in a Finger Resulting from Cryotherapy for Warts
Authors: Kandil M. , Sarwar U. , Abdul Z. , Shariff Z. , Abdulaty M. 
Published: February 2022

Abstract

Aim
Cryotherapy is a common treatment for a variety of skin conditions; however, it has to be performed with care due to the risks of inadvertent tissue damage including burns, damage to healthy tissue, and scarring. We report on the first case of septic arthritis developing post cryotherapy to a digit.

Method
A 57yr-old female retired podiatrist who five days prior received cryotherapy, by a Dermatologist, for a long standing presumed viral wart on the dorsum of her hand.

Results
septic arthritis to the distal interphalangeal joint.

Conclusions
-The delicate skin and tissues over the dorsum of the fingers and hand can result in significant trauma. Care must be exercised in these areas to prevent full-thickness wounds that involve the joint and result in septic arthritis and functional disability.
82 Timely Prescribing of Regular Medications in General Surgery
Authors: Barter R. , Harrison B. 
Published: February 2022

Abstract

Aim
It’s crucial that regular medications are prescribed in a timely manner for hospital inpatients. Missed or delayed doses of critical medications (insulin, anti-parkinsonian medication, antiepileptics and steroids) can compromise patient safety. This audit, with two closed-loop cycles, aimed to improve prescribing on surgical wards.

Method
Data was gathered from &gt;48 adult non-elective general surgery patients pre- and post-intervention with four outcomes measured, listed in results. Data was re-collected after one month and the cycle repeated one year later.
Interventions:

Results
Average time for prescribing regular medications improved from 13hrs to 11.2hrs in the first cycle and 22.5hrs to 13.1hrs in the second cycle.
Percentage of patients with critical medications prescribed on admission improved by 50% in the first cycle and remained at 100% pre- and post-intervention in the second cycle.
Percentage of patients who missed medication due to delayed prescribing reduced by 11% in the first cycle and 16% in the second cycle.
Percentage of patients who had regular medications prescribed before pharmacy medicines reconciliation improved by 9% in the first cycle and 28% in the second cycle.

Conclusions
In both cycles, all measurements experienced improvements. Largest improvements were in the 2nd cycle with the addition of educational posters. SCR access improves ability to prescribe regular medications. Educational posters act as effective visual aids. Both can be recommended.