bluuebunny/crossref_metadata_2025_split huggingface dataset:
348 The New Normal? – a Survey of Patients’ and Clinicians’ Satisfaction of Remote Consultations During the COVID-19 Pandemic
Authors: Byrne H. , Roslan F. , Kasbia H. , Alzuri H. , Kazi S. , Sheikh F. , Ahmed J. 
Published: February 2022

Abstract

Aim
Remote consultations (RC) were implemented during the COVID-19 pandemic with the aim of preventing transmission of the virus. We conducted a survey to assess patients’ and clinicians’ satisfaction of RC.

Method
Two online surveys were created for patient and clinician feedback, and each recorded a cohorts' opinions on various aspects of RC. The surveys were distributed to Urology, General and Vascular surgery departments at three NHS trusts. Patient feedback was collected over the phone, whilst clinicians completed the survey online.

Results
Overall, responses from 99 patients and 22 clinicians were collected. 89.9% of patients were either ‘satisfied or very satisfied’ with RC, compared to 77.2% of clinicians who practiced RC. 93.9 % of patients felt they were able to discuss all their concerns during their RC. However, outside of the COVID-19 setting 50% of patients and 59.1% of clinicians would prefer face to face consultations. Both cohorts reported adherence to social distancing and convenience as key advantages of RC; furthermore 68.2% of clinicians thought RC were economically beneficial. 100% of clinicians felt the inability to examine patients was a disadvantage of RC and 33.8% of patients agreed with this.

Conclusions
The majority of feedback from patients and clinicians was positive for RC. However, in future approximately 55% of both cohorts would prefer face to face consultations. Looking forward, we believe RC can form a part of routine practice in selected groups of patients, where it could potentially save time and money without compromising patient or clinician satisfaction.
351 Oral Opioids vs Patient Controlled Analgesia: Efficacy of Analgesia Post Lung Resection and Association with Postoperative Bronchoscopy and Bronchial Aspiration – a Single Center Observational Retrospective Study
Authors: Dey A. , Khan N. , DiChiara F. 
Published: February 2022

Abstract

Aim
Respiratory complications arising from disrupted evacuation of bronchopulmonary secretions are frequently encountered following anatomical lung resections. In cases refractory to mucolytics and chest physiotherapy, definitive management usually entails bronchoscopic aspiration. Pain is an important precipitating factor for sputum retention impeding mucociliary clearance and productive cough. Opioids remain the mainstay of postoperative analgesia but can also promote retention of secretions due to their anti-tussive properties and ventilatory depression. In this study, we aimed to review the efficacy of oral opioids against patient-controlled analgesia (PCA) in immediate post-operative period. We further explored if use of PCA predisposed to post-operative bronchoscopy.

Method
A retrospective case note analysis was conducted for all 329 patients undergoing lung resections (lobectomy, wedge resection, segmentectomy, pneumonectomy, metastasectomy both via thoracotomy and VATS approach) between May 2016 and December 2019 in a Thoracic Surgery Unit under a single consultant surgeon.

Results
Of the 329 patients undergoing lung resections, 46.8% patients received oral opioids and remaining 53.1% received PCA for immediate postoperative pain management. Pain scores at rest were documented for 48.02% patients – scores calculated at 10.39+/-8.7 hours after completion of surgery were 1.023+/-0.754 for the PCA cohort and 0.904+/-0.756 for patients receiving oral opioids (p = 0.131). 13 patients were noted to undergo bronchoscopy to aid in secretion clearance. Univariate analysis failed to establish a correlation between use of PCA and incidence of post-operative bronchoscopy (p = 0.603).

Conclusions
PCA is not associated with significant sputum retention necessitating bronchoscopic aspiration. It, however, does not offer superior analgesia for static pain compared to oral opioids.
368 Challenges Moving to a Fully Electronic System: An Audit
Authors: John H. , Donnachie D. , Shapev M. 
Published: February 2022

Abstract

Aim
In October 2020, our hospital moved to an all-online clinical record keeping system, resulting in clinicians becoming responsible for electronically requesting follow up appointments at the time of each clinical encounter. We aimed to ensure that with the introduction of the new computing system, appropriate follow up was booked and all members of staff were proficient in utilising this new system.

Method
Operative notes were reviewed to obtain the requirements for follow up, specifically for wound assessment clinic (WAC), hand therapy (HT) and outpatient clinic (OPC). Patient charts were then reviewed to ascertain if planned follow up happened, was booked, or was requested. We re-audited this 4 months later, following departmental education.

Results
In the first week of using the new electronic system, 100% of required WAC (24/24) and HT (13/13) follow up appointments were completed, however 14% (4/27) of required OPC appointments had not been requested.
Following departmental education, the re-audit found similar results, however the 12% (4/31) of cases where OPC follow up was not requested, it was not specified in the operation note whether or not this was required.

Conclusions
When introducing new clinical systems there is potential for unfamiliarity with use to impact on patient care, even after trust-wide training. It is important to bear this in mind and continue to audit and educate staff, implementing appropriate safety netting systems. Detailing the follow up plan in operation notes, including when follow up is not required, improves communication between staff and ensures required follow up is not lost.
372 Efficacy of Enhanced Figure of 8 Percutaneous Repair of Failed Closed Soft Tissue Mallet Finger
Authors: Alsadoun L. , Eltentawy T. 
Published: February 2022

Abstract

Introduction
Chronic tendinous mallet finger injuries are commonly treated with an open operative fixation.

Aim
To evaluate a new technique of closed reduction and fixation using a percutaneous figure of 8 suture for treating closed tendinous mallet finger injury.

Method
We conducted a retrospective analysis of prospectively collected data of 8 consecutive patients, undergoing percutaneous fixation of chronic mallet finger injuries. All patients had failed conservative splinting of duration 10.5 weeks (9–12 weeks) with a residual extensor lag of the distal interphalangeal joint greater than 30 degrees. Surgery was performed using a minimally invasive technique using a 3–0 proline suture in a percutaneous figure of 8 pattern, by going through the periosteum on both sides and providing rigid hyperextension. Patients were kept in a splint for 7 days followed by full mobilisation under supervision of hand therapists.

Results
The average age of our cohort was 51 (40–62 years old). At an average of 6.2 months All patients achieved correction of deformity to less than10 degrees. The overall functional outcome was good to excellent in all patients with no incidence of recurrence at last follow up. There was no instance of skin necrosis or wound complications in any of the patients.

Conclusions
The new figure of 8 percutaneous technique is an effective, safe, and minimally invasive approach for closed tendinous mallet finger injures. This needs further validation by analysing outcomes in a larger cohort.
376 Prognosis in Patients Presenting with Non-Reactive Pupils with a Chronic Subdural Haematoma
Authors: Edwards B. , Zolnourian A. , Sadek A.R. 
Published: February 2022

Abstract

Introduction
Chronic subdural haematoma (CSDH) is a common neurosurgical pathology which is increasing in prevalence due to the ageing population. Predicting neurological outcome from defined metrics following surgery for CSDH is key to defining a neuroprognostic tool. Non-reactive pupils, due to coma, is recognised as an indicator of raised intracranial pressure (ICP) and poorer neurological outcome. There remains limited evidence defining its exact effect on outcome in patients with CSDH.

Method
Data from 1278 patients surgically managed for CSDH between 2009 and 2019 were retrospectively reviewed. Those with a GCS of 8 or less pre-operatively were identified (n = 77). These patient’s pupillary response at presentation, inpatient mortality, and Glasgow Outcome Score (GOS) on discharge were recorded from electronic and paper notes.

Results
8 patients (10.3%) had a non-reactive pupil at presentation. 4 patients with an unreactive pupil died as inpatients (50% mortality) versus 2 with bilaterally reactive pupils (2.8%) (p&lt;0.01). Overall, only 1 survivor with non-reactive pupils had a good neurological outcome (GOS 4 or 5) meaning 7 or 87.5% had a poor neurological outcome (GOS 1-3) (p = 0.03). This compares to 35 patients or 50.7% having a poor neurological outcome in the bilaterally reactive pupil group. There is a statistically significant difference in mortality and morbidity in patients with a non-reactive pupil.

Conclusions
An unreactive pupil is a poor prognostic indicator of morbidity and mortality in patients presenting with CSDH.
383 Introduction of a Burns Admission Proforma to Improve Patient Admission Clerking and Management
Authors: Rose A. , Carter J. 
Published: February 2022

Abstract

Introduction
Patients who suffer burns present with a variation in the cause, depth, and size of their burns. A number of factors are important in determining the successful management of these patients such as age, cause, time since burn, first aid, co-morbidities, medication, burn size, depth and area, associated injuries, and social circumstances. Appropriate documentation, assessment, and examination in order to guide treatment is therefore imperative to good management and positive outcomes. We performed an audit of admission documentation to our burns unit and introduced a proforma to determine whether there was an improvement in important assessment criteria in order to enhance patient care.

Method
We retrospectively assessed burns admission documentation in 25 patients recently admitted against important assessment criteria. We then introduced a burns admission proforma to the unit and collected the results of 25 further patients in which the proforma was used.

Results
Introduction of the proforma showed an improvement in documentation, examination, and recorded management in almost all areas assessed, excluding allergies where there was a reduction.

Conclusions
Use of a proforma is beneficial in enhancing patient admission documentation and assessment, therefore directing appropriate management by focusing on all areas of patient care. However, the content of the proforma results in adherence to the assigned assessment parameters with limited deviation. Therefore, it is important when using a proforma to include all areas which are important to assessment otherwise they may be overlooked. Their use could be expanded to local emergency departments to ensure appropriate initial assessment, resuscitative management, and referral.
396 Rotator Cuff Assessment Following Traumatic Anterior Shoulder Dislocation
Authors: Nair G. , Ramasubbu R. , Wilson S. , Liao Q. , Chambers M. , Chan K. 
Published: February 2022

Abstract

Aim
Glenohumeral joint dislocation is the most common traumatic joint dislocation with a high recurrence rate correlating with age at first dislocation. There is an associated increased incidence in concurrent rotator cuff tears with increasing age affecting 40% aged 40–60. Patient care was assessed against BESS/BOA standard: These patients should have rotator cuff assessment and those aged 40–60 should undergo routine MRI/Ultrasound imaging.

Method
All patients admitted to the emergency departments of the 3 Lanarkshire hospitals undergoing first time traumatic anterior dislocation of the shoulder in February 2021 were included. This was the third cycle of this audit. Previous interventions were presentation at a CPD meeting after cycle one and an NHS Lanarkshire regional meeting after cycle two.

Results
Cycle one (2018)-14 patients. 3/14 underwent rotator cuff assessment. 5/14 aged 40–60. 1/5 underwent rotator cuff imaging.
Cycle two (2020)-11 patients. 0/9 underwent rotator cuff assessment (Two excluded as managed operatively). 4/11 aged 40–60. 0/4 underwent rotator cuff imaging.
Cycle three (2021)-13 patients. 3/11 underwent rotator cuff assessment (Two excluded as managed operatively). 3/13 aged 40–60. 0/3 underwent rotator cuff imaging.

Conclusions
Although a slight improvement has been made over the 3 cycles with rotator cuff assessment the BOA standard is not being met. There has been no improvement in the additional imaging required in traumatic anterior shoulder dislocations in those aged 40–60 over the 3 cycles. These patients may develop pain, reduced function, and rotator cuff arthropathy. There is now an aim to introduce a pathway for these patients across the health board.
398 Abdominal X-Rays: Are They Still Relevant? a Review of Outcomes Following Emergency Abdominal Plain Films
Authors: Van P.T.M. , Masoodi S. , Cribbs E. , Pawa N. 
Published: February 2022

Abstract

Background
Abdominal plain films (AXR) have historically been a routine investigation in Surgical and Emergency Departments (ED), however when considering CT imaging yields significantly more diagnostic information, AXRs are ineffectual in comparison as an aid to decision making. With CT scanning and reporting readily available 24/7, are AXRs still practical?

Aim
To assess the utilisation and outcomes of emergency abdominal films.

Method
All emergency AXRs performed across the trust in a 15-day period were identified retrospectively from our electronic database and were compared with outcomes obtained from our electronic record system.

Results
248 emergency AXRs were performed, 153 Emergency Department and 95 inpatient (IP) requests. 163 (66%) were reported normal, 85 (34%) as abnormal. Of those reported as normal, 26% had further imaging (30% from ED, 17% from IP). Of those reported abnormal, 49% had no further imaging performed (62% from ED, 37% from IP). The odds ratio of admission between ED patients with a significant AXR and an insignificant AXR was 1.34 (95%CI: 0.68–2.83, p&lt;0.05).

Conclusions
One quarter of AXRs reported as normal underwent further imaging, but almost half of the AXRs with reported pathologies did not. This suggests that the usefulness of AXRs acutely is limited, as the presence or absence of abnormalities on the AXR was not a reliable predictor of further investigation nor patient outcome. We therefore suggest re-examination of their utilisation.
408 Blood Parameters as an Early Indicator of Complications Following Oesophagogastric Resection
Authors: Nair G. , Haque S. , Wilson M. 
Published: February 2022

Abstract

Aim
Oesophageal and gastric cancers are the eighth and fifth most prevalent cancers with a high degree of morbidity and mortality. Oesophagogastric resections are associated with a high degree of complications postoperatively. Complications following resection are associated with poorer hospital recovery, recurrence of cancer, readmission to hospital and increased mortality. A study was carried out to examine if there was an association between post-operative bloods and the development of complications.

Method
Data was collected from theatre logbooks, Integrated Clinical Environment (ICE) and clinical portal. Patients undergoing oesophagogastric resection for gastric and oesophageal cancer between October 2010 and November 2014 were included. Complications were organised using the Clavien Dindo classification. Data was analysed using the Student’ T test and Chi-Squared test. A P-value of 0.05 was classed as being statiscally significant.

Results
94 patients met the inclusion criteria for this study. 55 patients (58.5%) underwent Oesophagectomy, 18 (19.1%) total gastrectomy and 21 (22.3%) partial gastrectomy. A significant association was seen between development of complications and higher Day 5 White Cell count (WCC) (p = 0.048), lower Day 2–5 Albumin (Day 2 Albumin p = 0.038) and higher Day 2–5 C Reactive Protein (CRP) (Day 2 CRP p&lt;0.001).

Conclusions
This study suggests Albumin, CRP and WCC may be used to predict postoperative complications in patients undergoing oesophagogastric resections for malignancy. Changes in the blood parameters present as early as day 2 postoperatively and can highlight patients who require closer monitoring, allowing earlier re-intervention if required.
411 Mesenchymal Stem Cells for Shoulder Tendon Injury and Osteoarthritis
Authors: Yasen Z. , Funk L. 
Published: February 2022

Abstract

Introduction
In recent years there has been a boom in the advancements and research in mesenchymal stem cells (MSCs) injections for tissue regeneration. This has led to commercial products and early adoption of the technology. High profile cases, media and internet prominence of stem cell therapies have led to a patient demand for the treatment for numerous traumatic and degenerative musculoskeletal conditions.

Aim
In this article we aim to review the evidence for mesenchymal stem cell therapy so far, focusing on its use in osteoarthritis and specifically tendon repair within the shoulder.

Method
Through the database PubMed, the search included all animal models and clinical trials assessing the use of mesenchymal stem cells for treatment of osteoarthritis or rotator cuff pathology, up to the year 2018.

Results
We identified 20 animal studies (95% positive findings) and 17 human studies (94% positive findings) for Osteoarthritis (OA) (399 patients assessed), however all therapy was targeted at the knee. Rotator cuff tear studies yielded 8 animal studies findings and 3 human studies (100% positive findings in both) (106 patients assessed).

Conclusions
There is a reasonable body of evidence to support its use for the early stages of OA and as such phase III trials should be implicated. Evidence to support use of MSCs for rotator cuff tendon pathology is still in early stages with variable significance, but promising. More trials need to be done to assess its efficacy for injection both at the point of surgical repair and in non-surgical patients.
419 Medium- Long Term Clinical Outcome of Distal Metaphyseal Metatarsal Osteotomy (DMMO) for Lesser Toe Metatarsalgia
Authors: Ekpo E. , Inegbedion E. , Ball T. 
Published: February 2022

Abstract

Aim
The surgical management of metatarsalgia is usually with an intra-articular Weil’s type of metatarsal osteotomy. Minimally invasive surgery has become increasing successful for a variety of forefoot conditions. Performing a distal metaphyseal metatarsal osteotomy to decompress the affected ray may result in substantial improvement to quality of life. The aim of this study was to evaluate the outcome of patients following minimally invasive distal metaphyseal metatarsal osteotomy surgery (DMMO).

Method
This is a single-centre consecutive series of 12 patients who underwent DMMO. The aim was to decompress the affected rays and restore metatarsal parabola. DMMO was performed under image intensifier, using burrs inserted via stab incisions. Clinical data was recorded and pre-operatively and immediately post operatively Manchester-Oxford Foot Questionnaire (MOXFQ) scores were collected. Another MOXFQ score was then collected with a minimum follow-up period of 12 months to ascertain is scores had improved in the interim.

Results
Average age of patients was 57years. The sex ratio was M:F 8:4. The average pre-operative MOXFQ score was 36. The average immediate post-operative MOXFQ score was 25. The average follow-up MOXFQ was 16. The reduction in MOXFQ score with a minimum of 12 months follow up was statistically significant (p&lt;0.0040)

Conclusions
DMMO is a safe and effective method for the treatment of metatarsalgia with low complication rates. Our study highlights that clinical improvement of patient’s symptoms may take up to 12 months and beyond following surgery. This should be reiterated to patients prior to surgical intervention.
420 ResPect Forms for ENT Inpatients: An Audit (Complete Cycle)
Authors: Hussain S. , Collines R. , Thakar S. 
Published: February 2022

Abstract

Aim
To ascertain the percentage of ReSPECT forms completed by the time of consultant review for ENT patients (section 4, resuscitation decision).

Method
Complete cycle, retrospective audit of ENT inpatient. Data was collected for three weeks. During first cycle there was total 42 patients included. In second phase there was 37 patients. Data was collected from patients' notes. We excluded patients whose ResPect form was not counter signed by the consultant within 24 hours of admission. Also, we excluded patients whose ResPect was signed after 72 hours of admission.

Results
We identified 42 patients between three weeks period from 18th of November-08th of December 2020. Out of which 40.47 % (n = 17) in patients had section 4, resuscitation decision completed. In second phase, we identified 37 patients between three weeks period from 12th of December 2020–1st of January 2021. Out of which 64.86 % (n = 17) in patients had section 4, resuscitation decision completed (Figure 1).
After the first phase, we added some recommendations, everyone needs to complete their RESPECT training (via ESR), check Respect form on ward round and SHO’s to complete Respect form when clerking new patient.
We added flow chart as well in our second phase to make sure, we adhere with the policy.

Conclusions
Add ReSPECT introduction in induction, especially when new SHO's are rotating. In additon, ReSPECT should be part of plan.
16 To What Extent, if Any, Do Software Developers Owe Patients a Duty of Care in the Event of Injury to Them When Clinicians Negligently Use AI Innovations and Technologies?
Authors: Kazzazi F. 
Published: February 2022

Abstract

Introduction
Artificial Intelligence software (AIS) brings the ability to assimilate and analyse tremendous amounts of information at super-human levels. This dawns an exhilarating era for diagnosis, investigation, resource-utility, and management. However, one must ensure that medicine's future evolves so to not jeopardize patients' health and rights in favour of operational gains. This work examines the duty of care that software developers (SD) may hold for patients.

Method/Results
In three sections, legal case analysis and medico-legal reasoning is used to explore how patient journeys, patient-doctor relationships, and hospital environments are changing. The first section discusses the medicolegal sphere in which AIS has developed. In section II, the hypothetical case of “Rogers & SD v. Whitaker” stimulates discussion on the first two components of the “three-stage” test for duty of care outlined in Caparo v. Dickmann. It scrutinizes the foreseeability of medical AIS outcomes and the proximity between SDs & patients.
The final section establishes the circumstances under which it may be “fair, just, and reasonable” for SDs to owe patients a duty of care. It deliberates the special relationships and “third agents” that emerge in traditional patient-doctor interactions. It examines how SDs design and deliver their AIS, and why this may impact rulings on a duty.
A modified threshold test is proposed that incorporates the idiosyncrasies of medical AIS when establishing the duty of care that SDs have towards patients. This test is re-applied to “Rogers & SD v. Whitaker” for insight into its real-world applicability.

Conclusions
Under specific conditions, SDs owe patients a duty of care.