bluuebunny/crossref_metadata_2025_split huggingface dataset:
262 Full Cycle Audit on Definitive Management of Biliary Pancreatitis
Authors: Islam R. , Hashmi Z.Z. , Aljarad F. , Madanur M.A. , Imtiaz N. , Warren R. 
Published: February 2022

Abstract

Aim
To reaudit the practice of definitive management of gall stones pancreatitis in our trust for the period of 1st May-31st October and compare the result with previous one (1st June 2019–31st Dec 2019).

Method
It was a retrospective collection of data of patients admitted to our trust with biliary pancreatitis. Electronic notes, PACS for US report, Electronic discharge summary and Operative notes analysed.

Results
We identified 4 patients admitted with biliary pancreatitis during the re-audit period. US report was checked for confirmation of diagnosis of gall stones. The EDN was checked for date for Laparoscopic cholecystectomy. Unfortunately, none of them had their procedure time in 2 weeks’ time of their diagnosis. The reason behind this was because of COVID-19 pandemic, we were backlogging with our elective list. All the patients eventually underwent their procedure, but not in 2 weeks’ time as per the guidelines. All suitable patients had their cholecystectomy in a timely manner during first audit. None had it in timely manner during second audit.

Conclusions
Early Laparoscopic cholecystectomy for simple gallstone pancreatitis prevents life threatening Pancreatitis and readmissions.
The UK guidelines on management of pancreatitis issued by British society guidelines (BSG) states that all mild gall stones pancreatitis should have definitive management of lithiasis on the same admission or within 2 weeks (Recommendation B). In our practice, all our suitable patients during first audit had timely Laparoscopic cholecystectomy, however, no one had it in timely manner on the next audit for COVID-19 pandemic.
263 Tuberculosis of the Bile Duct: A Rare Cause of Obstructive Jaundice
Authors: Islam R. , Sarder M.M. , Rabbi H. , Arefin M.S. 
Published: February 2022

Abstract
Tuberculosis (TB) is a very rare cause of biliary stricture that is difficult to diagnose and usually requires surgical intervention in order to rule out underlying malignant etiology. A 28-years old woman with obstructive jaundice, who was originally thought to have cholangio-carcinoma. Diagnosis of tuberculosis was made on PCR testing of bile. Patient was started on antitubercular treatment, and she responded well. This case presented a rare case of common bile duct stricture due to biliary tuberculosis. This is an important condition to diagnose because early recognition with prompt treatment results in complete resolution. Even though biliary tuberculosis is a rare cause of obstructive jaundice, in endemic areas, it should be considered as a differential diagnosis and investigated, as it can be potentially curable.
265 Assessing Management of Rib Fractures in the ICU Patient
Authors: Kenny L. 
Published: February 2022

Abstract

Aim
Assess if the General Intensive Care Unit (ICU) are appropriately following trust guidelines on rib fracture management.

Method
Data gathered from patients admitted to the General Intensive Care Unit between March and May 2021 with any diagnosis code involving rib fracture (n = 19). Exclusions: patients not admitted to general ICU, or who died before being extubated.
Of the remaining patients (n  = 14) data gathered on:

Results
All patients were prescribed regular simple analgesia. Most patients were prescribed strong analgesia (n = 10) and lidocaine patches (n = 13). All patients had regular pain assessments. 9 patients were referred for a block/epidural, out of 12 who met criteria for referral. 10 patients were referred for rib fixation, and 4 patients had rib fixation, out of 11 who met criteria for referral. 6 patients developed a LRTI post rib fracture.

Conclusions
The basic management of rib fractures in General ICU is appropriate; 100% of patients had analgesia prescribed and had regular assessments of pain. However, some patients who met criteria for consideration of a block (n = 3) or fixation (n = 1) did not have documentation that they were referred. Rib fractures often do not occur in isolation, and it may be that other injuries served as distractors.
267 Improving the Surgical Teaching Opportunities: A QI Project to Deliver a Course at a Local Hospital Level During COVID-19 Pandemic
Authors: Rezk K. , Alamassi A. 
Published: February 2022

Abstract

Aim
During the COVID-19 pandemic, the training opportunities were markedly disrupted particularly, the surgical teaching which usually requires face to face teaching to help the acquisition of procedural skills. We implemented a QI project in a district hospital to improve the training opportunities for medical students & foundation doctors. The project was a face-to-face free course for teaching generic procedural and clinical skills in surgery.

Method
The course was a mixture of two well-known surgical courses in the UK, Basic Surgical Skills and the CCrISP courses. It included clinical and procedural skills sessions on models which simulated the basic wound closure techniques and types of knots, as well as skin lesion excision training. The course was delivered to medical students, foundation year one & two doctors and core surgical trainees. The improvement achieved by the course was measured by a questionnaire assessing the level of confidence between the candidates before and after each session. The questionnaire’s answers were categorised into (not confident, neutral, confident & very confident).
The course was delivered on two occasions.

Results
The qualitative analysis of the results on two different occasions showed a considerable improvement in the level of confidence between the candidates. They were able to demonstrate engagement throughout the course especially with the procedural skills sessions.

Conclusions
Formulating a course at a local hospital level was an efficient alternative for maximising the training opportunities reduced during the pandemic. It was an impressive opportunity for newly graduated doctors and medical students having any surgical placement.
268 Improve Clerking of Vascular Patients at Royal Devon and Exeter (RDE) Hospital Presenting with Acute Limb Ischaemia (ALI) Using Standardized Electronic Proforma
Authors: Chillarge G. , Abouelella Y. , Burton H. 
Published: February 2022

Abstract

Aim
Improve clerking of vascular patients at Royal Devon and Exeter (RDE) hospital presenting with acute limb ischaemia (ALI) using standardized electronic proforma.

Method

Results
A total of 65 patients presented to vascular surgery during the 3-month period. Of these 20 patients presented with ‘acute limb ischaemia’. Documentation of rest pain (75%), pulses (Dorsalis paedis in 90%) and exam finding of cold feet (95%) was adequate. However, poor documentation of vascular risk factors such as previous stroke (20%) and atrial fibrillation (15%) was identified. ECG was performed on admission in only 35% patients. Examination like ABPI (10%) and Buerger's test (15%) were also inadequately documented.

Conclusions
This audit shows inadequate clerking of vascular patients presenting with ALI. The second cycle will include further data collection post-implementation of the electronic proforma to analyse improvements in documentation of the above-mentioned factors at initial clerking.
270 Mid-Oesophageal Traction Diverticulum in a Patient with Systemic Lupus Erythematosus
Authors: Chillarge G. , O'Neill R. , Safranek P. 
Published: February 2022

Abstract
Oesophageal diverticulae are rare out-pouchings of oesophageal wall with a prevalence of 2/100,000 population/year. Known associations of traction diverticula are causes of mediastinal inflammation including tuberculosis, histoplasmosis, anthracosis, sarcoidosis and rarely systemic lupus erythematosus. Two-thirds of oesophageal diverticula are asymptomatic, and they are a rare cause of dysphagia. Most asymptomatic oesophageal diverticula are managed conservatively with surveillance imaging or endoscopy. Symptomatic patients with diverticula &gt;4cm are usually treated surgically due to the increased risk of aspiration pneumonia and malignancy.
In this report, a case of a large mid-oesophageal traction diverticulum in a 66-year-old female with systemic lupus erythematosus has been presented. She was initially managed conservatively with active surveillance for 6 years. When her symptoms progressed, she had repeat endoscopy and computed tomography scan which showed an increase in size of the diverticulum to 6cm in diameter.
Her dysphagia had progressively deteriorated, and she was only managing a liquid diet. She therefore proceeded to resection of the diverticulum by right thoracotomy and stapled diverticulectomy. She made an excellent post-operative recovery and at last review, 5 months after the operation, she was back at work, had put on weight, and was tolerating a normal diet.
Several surgical/endoscopic treatment options exist for management of oesophageal diverticula, and these must be tailored to every individual case. In this case report, we have compared minimally invasive (laparoscopic/thoracoscopic/robotic assisted) and open (transabdominal/transthoracic) techniques. Patients often have a good symptomatic outcome following surgery. Multi-Disciplinary Team (MDT) involvement with dietetic support is important for optimal recovery of these patients.
272 Factors Influencing Medical Student Future Career Choice – Why Not Surgery?
Authors: Madden S. , Clements J.M. , Martin N. , Kirk S.J. 
Published: February 2022

Abstract

Introduction
Decisions made by medical students on future career choice have demonstrated consistency with resulting postgraduate career path. The aim of this qualitative study was to identify factors influencing career choice amongst medical students in Northern Ireland.

Method
An anonymous voluntary non-monetised survey consisting of binominal, Likert and free text responses was distributed to all medical students registered at Queen’s University Belfast (QUB). Data was collected over 6 weeks in April-May 2021. Primary outcomes were factors influencing future career choice and the secondary outcomes were the impact of finance and mentorship on ultimate career choice. Local ethical approval was obtained.

Results
202 responses were received (Response rate 15%). 67% (n = 135) were female. One third of respondents remained undecided about their future career choice. Respondents were least likely to choose a career in Surgery (33%). Factors positively influencing career choice were academic interest and flexibility in working hours. Negative predictors of career choice were lack of interest in the area, perceived workload, and duration of training schemes. 71% (n = 144) of respondents reported that a subspecialty mentor would positively influence their career choice and two-thirds of respondents reported that financial factors would not influence their career decision.

Conclusions
Surgery was the least the popular specialty. Mentorship, integrating flexibility in training and enhancing academic interest may create greater traction for prospective trainees to surgery.
274 Peri-Operative Communication with Next of Kin (NOK) for Patients Receiving Laparotomies: A Complete Audit Loop with an Educational intervention
Authors: Nwokedi E. , Butterworth J.W. , Lotca N. , Shakir A. , Islam R. , Oke T. 
Published: February 2022

Abstract

Aim
NICE Clinical Guidelines (CG138) specify the importance of involvement of family members and carers at key patient care junctures. Furthermore, published literature and our own experience reaffirm that ‘low-quality communication causes profound distress to families that can affect the quality of dying and bereavement'. There is little evidence on NOK’s experience for surgical patients, so we sought to assess whether NOK details were available and whether they had been contacted peri-operatively for patients receiving laparotomies.

Method
We performed a closed loop audit using NELA database to identify patients admitted for laparotomies between February 1st to July 31st, 2021. The initial data was collated, analysed, and presented during educational meetings with informal reminders for a week to implement changes. Thereafter, data was collected to complete the audit cycle on communication with NOK.

Results
A total of 70 patients were included. Prior to the implementation, 86% of patients undergoing laparotomies had NOK information documented in clinical records, with only 75% of telephone numbers reachable and 33% had documented evidence of contact within 48 hours post-operation. Post-implementation, 97% of patients had their NOK information in their clinical records, with 97% telephone numbers reachable and 41% had documented evidence of contact with 48hours.

Conclusions
The importance of clerical staff and clerking doctors establishing NOK’s details, documenting these within iCare/notes and establishing whether patient are happy with NOK being contacted for updates on patient management, could reduce distress and potentially improve the experiences of hospital admission, recovery and in some cases, bereavement.
277 Implementation of the ROSA Robot in a DGH
Authors: Easwaran A. , Jones R. , Easwaran P. , Kincaid R. 
Published: February 2022

Abstract

Introduction
The ROSA (Robotic Surgical Assistant) is designed to assist orthopaedic surgeons performing total knee arthroplasty (TKA). It is postulated that the real-time data provided by the ROSA robot aids the surgeon by providing objective values to bone resections and soft tissue balance, enabling better implant selection and positioning. This is thought to improve patient outcomes through reduced post-operative pain, reduced hospital stays and reduced revision rate. To date, the ROSA robot has solely been implemented in tertiary centres in the UK. This study investigates the implementation of the ROSA robot in a district general hospital (DGH) in a geographically isolated region of the UK.

Method
The ROSA robot was installed in St. Michael’s Hospital, Cornwall in July 2021. Prior to its clinical deployment, six surgeons undertook saw bone training. Following this, six ROSA-assisted TKAs were performed in six weeks between July and August 2021. Logistical challenges to implementation included difficulty in ROSA component delivery given geographical isolation, consultant training time dedicated to ROSA operation in the context of a busy DGH trauma rota and increased operative time during the learning curve.

Conclusions
Despite the challenges faced, we have demonstrated that ROSA can be implemented in a rural, geographically distanced DGH. Given the use of robotic assistance in other surgical specialties, this is an exciting prospect for elective knee surgery in the future.
278 The Paediatric Major Trauma Tertiary Survey: Are We Missing the Mark on Missed Injuries?
Authors: Bhojwani D. , Kapuge L. , Dewar G. , Bradshaw C. 
Published: February 2022

Abstract
The tertiary survey is an integral part of assessment in major trauma. This has been shown to reduce missed injuries resulting in better patient care and favourable medico-legal outcomes. A formal tertiary survey should be carried out for all paediatric major trauma patients.
The primary aim of this audit was to assess completion rates of the tertiary survey proforma for major trauma admissions under the paediatric surgery team at the Bristol Royal Hospital for Children. The secondary aim was to evaluate the adequacy of the current proforma and detect areas for improvement.
Paediatric surgery major trauma admissions were audited over a 7-month period and data was collected retrospectively from patient notes on Evolve (n = 20).
A formal tertiary survey was completed for 6 patients which equated to a completion rate of 30%. A total of 1 missed injury was identified (lip laceration) which required no further treatment. Head-to-toe examination was documented in all of the completed surveys but lacked detail. Documentation of gait was absent in 85% and a body map was not filled in for any of the patients.
The audit was presented at a departmental meeting to increase awareness about the tertiary survey and requirements for completion. An MDT of doctors, nurses and trauma co-ordinators was consulted to design a more thorough proforma which included specific sections for review of bloods and imaging.
Re-audit of the new proforma is ongoing and it is hoped that, in combination with educational initiatives, this will lead to increased identification of missed injuries.
279 Reconstruction as Part of Breast Care Service: Are We Doing It Right?
Authors: Ng H.Y. , Ng A.W.Ya. , Shaaban Mohamed 
Published: February 2022

Abstract

Aim
Breast cancer is the most common cancer in the United Kingdom. About one-third of our breast cancer patients underwent mastectomy. The Association of Breast Surgery (ABS) and the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) guidelines state that all patients who undergo mastectomy should be offered immediate breast reconstruction (IBR) and delayed breast reconstruction (DBR) unless contraindicated. This audit aimed to evaluate our service compliance to the guidelines and identify factors affecting the number of patients offered breast reconstruction (BR).

Method
Our audit evaluated all mastectomy cases (n = 137) done between March 2018 and February 2021. Patients with previous breast cancers were excluded. Data were collected from clinical notes and letters.

Results
20.4% and 32.1% of patients were offered IBR and DBR respectively. Only 14.7% of patients not offered IBR had contraindications recorded whereas the remaining had no discussions recorded. Of those not offered IBR, 57.8% were expected to have adjuvant radiotherapy. All male patients (n = 3) and those with American Society of Anesthesiologists (ASA) grade 4 (n = 5) were not offered any BR. The average age of patients not offered IBR was 63.9 whereas that of DBR was 66.7. The average estimated size of tumour of patients not offered IBR and DBR were 42.3mm and 45.7mm respectively. Only &lt;10% of patients not offered BR were smokers.

Conclusions
There is room for improvement in terms of our service compliance. Breast care services should aim to provide all-inclusive care to patients. A consultation checklist can be used to ensure BR is discussed alongside mastectomy.
282 Audit for the Management of Acute Gallstone Disease
Authors: Garner J. 
Published: February 2022

Abstract

Aim
The aim of this audit was to investigate how patients referred by the Emergency Department (ED) with biliary disease were managed. Also, to identify a cohort of patients which could be safely discharged from ED with an outpatient US and follow up with the Surgical Assessment Unit.

Method
Data was collected from 23/11/20 to 11/12/20. The inclusion criteria were patients referred by ED with abdominal pain and a diagnosis of biliary disease. Data collected included blood results, US results and if they underwent a laparoscopic cholecystectomy (LC).

Results
There were 22 patients identified; 5 had biliary colic, 4 had cholangitis and 13 had cholecystitis.
The 5 patients with biliary colic had almost completely normal bloods on admission. While 16/17 patients with cholecystitis/cholangitis had elevated FBC, CRP or LFTs.
US was performed on 3 patients with biliary colic within 3 days of ED attendance. US was performed on 16/17 patients with cholecystitis/cholangitis, mainly within 2 days.
None of the patients with biliary colic received antibiotics and 2 had an inpatient LC. All patients with cholecystitis and cholangitis were admitted and treated with antibiotics. 1 patient with cholecystitis had a LC and 7 were on the waiting list.

Conclusions
This has shown that patients are being imaged with US efficiently and are treated appropriately with antibiotics. It has demonstrated that a blood test in ED is effective at differentiating between biliary colic and other diseases that require admission. However, improvements need to be made to increase access for patients to undergo timely LCs.
283 Creating an ERAS for Living Donors for Renal Transplant
Authors: Parfitt C. , Sutaria R. 
Published: February 2022

Abstract

Aim
To design and facilitate an enhanced recovery after surgery (ERAS) protocol for the Wessex Kidney Centre (WKC) for live donors for renal transplants. This audit focussed on the post-operative analgesia guidelines and average length of hospital stay post the ERAS protocol implementation.

Method
An enhanced recovery after surgery (ERAS) protocol was created for renal living donors. The protocol incorporated pre, peri and post-operative guidelines to optimise patient care. The protocol was based on a survey sent to all transplant units in the UK regarding their own pathways for live donors(13/23 units responded). The ERAS protocol was then trialled on all live donors throughout 2020 and into 2021 at WKC. For this audit, data was collected on length of stay, analgesia used post-operatively and the VAS scores recorded by patients to grade their pain levels.

Results
There were a total of 11 renal live donors from September 2020 to January 2021 during which data was collected on all donors. National average length of stay for live donors is 3.9 days. Post ERAS, the average length of stay at WKC is 2.1 days, reduced from an average of 6 days pre-protocol. There was a minimal change in VAS score at 6 hours post-operatively: 3.9 (pre-ERAS average 4.2). However, at 24 hours post-operatively, average VAS score was 2.6 (pre-ERAS average 3.7).

Conclusions
The introduction of a specific ERAS protocol for live donors for renal transplant notably improved the average post-operative pain scores and reduced the average length of stay to below the national average.
285 ‘Smart Phrase’ Ward Rounds: Do They Improve Documentation and Efficiency?
Authors: Kapriniotis K. , Loufopoulos I. , Kennedy Hutchinson C. , Geropoulos G. , Gresty H. , Pakzad M. , Greenwell T. , Ockrim J. 
Published: February 2022

Abstract

Aim
Accurate ward round documentation plays a crucial role in patient management. In the last two years, UCLH has introduced EPIC software. This gives opportunity to create templates for repetitive processes (‘smart phrases’). The aim of this project was to assess if the introduction of ‘smart phrase’ templates can improve the quality of ward round documentation.

Method
Following consultation, 5 fundamental domains were agreed to be included in the template, namely: Procedure and postoperative day, current clinical issues, physical examination, objective assessment (including vital signs, fluid balance/drains, blood tests, DVT prophylaxis, antibiotic status), and 24h treatment plan. A baseline audit was performed, then the new template was introduced. Two PDSA cycles were performed, for 3 weeks after introduction, and repeated two months later. Chi-square tests was used to assess statistical significance of change (p&lt;0.05).

Results
A statistically significant improvement in documentation for all domains - apart from ‘current clinical issues’ and ‘24h planning', which were well documented to start - was observed after the introduction of smart phrases; with an average improvement of 34.8% (range 0–65.6%). The improvement was maintained at 2 months (improvement from baseline 35.1%, range 0–59%). A small decrement in documentation occurred between introduction and the 2-month PDSA assessments in some domains (mean change 0.7%, range -12.3 to 23%), although this was not statistically significant.

Conclusions
The introduction of smart phrases significantly improved ward round documentation of important parameters. Evolution of additional smart phrase is expected to further improve the accuracy leading to more efficient decisions and safer clinical practice.