bluuebunny/crossref_metadata_2025_split huggingface dataset:
450 Patient Care and Flow in Patients Admitted with Rib Fractures Under General Surgery: One Centre's Experience
Authors: Niina A , McKenna M , Williams G 
Published: November 2022

Abstract

Aim
Following the introduction of the ‘South Wales Trauma Network’ in September 2020, patients admitted with traumatic rib fractures who meet the criteria for conservative management are admitted under the care of General Surgery at the Grange University Hospital (GUH). Conservative management includes chest drain placement, pain management, respiratory physiotherapy, and rehabilitation. Our aims were to look at the outcomes of these patients and the efficacy of patient flow.

Method
Quality improvement methodology was followed. Retrospective data collection on patients (115) diagnosed with rib fractures between January to September 2021 at GUH, Aneurin Bevan University Health Board. Demographics, method of injury, management, admission duration, discharge destination, readmission rate and mortality were collected.

Results
The mean age of the 115 patients admitted was 68 years (range 20 to 97). Mean age increased to 80 in those who were stepped down for rehabilitation. Over half (60%) of patients sustained rib fractures from mechanical falls. A third of patients needed simple analgesia and 10% had chest drains. Half of patients had no antibiotics and 20% received prophylactic antibiotics. Mean admission duration was 13 days (range 0–103 days). Eleven percent of patients were readmitted within one week. The one-year mortality rate was 2.6%.

Conclusions
Those who require admission following traumatic rib fractures commonly have complex medical and rehabilitation needs. There is currently a paucity of National Guidelines for these patients, despite advances in ‘Silver Trauma’. We believe a multi-specialty approach towards the establishment of such guidelines is needed and are in the process of coordinating a multi-centre re-audit.
479 Closed Loop Quality Improvement Project Improving Time to Peripherally Inserted Central Catheters (PICCs) and Intravenous (IV) Antibiotic Administration in Patients with Complex Orthopaedic Infections
Authors: Balfour J , Holland G , Powell-Bowns M 
Published: November 2022

Abstract

Aim
Bone, joint and soft tissue infections often require long term antibiotic therapy. Reliable IV access is essential for IV antibiotic administration and monitoring. PICCs provide consistent, long-term IV access. Aim: improve time to PICC request, insertion, and reduce issues with poor IV access in patients requiring long term IV antibiotics.

Method
Standard audit protocol. Data tool was developed and tested. Data was collected retrospectively from departmental database and online records for all patients admitted with suspected bone, joint or soft tissues infection from 01/11/19–29/2/20. Department policy and induction programme were updated. Cycle 2 included all patients from 1/8/20–30/11/21.

Results
Cycle 1 included 91 patients. 30 PICCs were requested with 26 inserted. Mean time to PICC request from diagnosis was 8.7 days(1–33). Mean time to PICC from request was 6.7 days(1–15). Mean time to PICC from diagnosis was 15.9 days(4–39). 10 of 30(33.3%) patients missed antibiotics due to lack of IV access. Cycle 2 included 156 patients. 36 PICCs were requested with 18 inserted. Mean time from diagnosis to request was 4.4 days(1–15). Mean time from request to insertion was 4.2(1–8) days. Mean time from diagnosis to insertion was 8.6 days(1–21). Missed IV antibiotics were reduced from 33.3% to 15.4%.

Conclusions
Time to PICC insertion was improved through education and introduction of new policy at departmental induction. This low-cost change can significantly improve both treatment and patient experience when admitted for complex orthopaedic infection through reliable antibiotic administration and reducing the number of IV access attempts.
683 Improving CEPOD Efficiency: The ‘Golden Patient’
Authors: Curley D , Shahmiri A , Arulampalam T 
Published: November 2022

Abstract

Aim
Delayed start times in the CEPOD theatre were observed locally and a ‘Golden Patient’ initiative was proposed, whereby a patient is identified the day before as the first case for the following day. We aimed to increase the percentage of CEPOD theatre list patients sent for before 08:15.

Method
We conducted a retrospective analysis of the first case on the CEPOD theatre list each day between 18th May 2021 and 8th August 2021 and theatre timings were recorded. We introduced the ‘Golden Patient’ concept on 9th August 2021. The proposal included the prospect of using recovery as a holding bay prior to 08:00. A second retrospective analysis was conducted between 9th August 2021 and 28th October 2021.

Results
Prior to the ‘Golden Patient’ intervention 0 patients were sent for before 08:00 and 12 (14.6%) patients were sent for before 08:15. Following the introduction of the ‘Golden Patient’ 17 patients (21%) were sent for before 08:00 and 31 (38%) of patients were sent for before 08:15. Sending times were earlier on the whole post intervention and sending prior to 08:15 appears to occur in consecutive days, suggesting a proactive team on duty.

Conclusion
The ‘Golden Patient’ initiative has been a success and appears to be most productive with a proactive team on duty. We can see clear and obvious change but there is still room for further improvement. We hope to engrain the ‘Golden Patient’ concept into our local culture, show further improvement and sustain this over time.
887 Design and Implementation of a Standardised Protocol to Assess the Pre-Operative Prophylactic Antimicrobial Guidelines in Vascular Surgery – a Trust-Wide Experience
Authors: Ford A , Charlwood N , Morton H 
Published: November 2022

Abstract

Aim
The project's aim was to design and implement a replicable protocol in order to assess the pre-operative prophylactic antimicrobial prescribing that could be universally applied to all patients undergoing major vascular surgery.

Method
A retrospective audit was undertaken to establish existing guidelines in circulation and current practice trends at Worcestershire Acute Hospitals NHS Trust. Multiple theoretical models to stratify procedure and infection risks were designed including clean verses dirty site surgery, procedure specific surgery, procedures with or without utilisation of prosthesis, universal one size fits all guidelines. A panel consisting of consultant vascular surgeons, the antimicrobial stewardship lead consultant microbiologist, and a core surgical trainee co-ordinating the project appraised the results. Criteria included ease of implementation minimising prescribing errors, anaphylaxis, and the need for a tailored guideline for different major vascular procedures to determine suitability of the guideline.

Results
The initial audit signified a need to standardised guidelines in order to provide patients with a standardised care pathway that utilises best practice. In this instance an anatomical approach to the pre-operative prophylactic antimicrobial guideline for major vascular surgery was adopted and implemented at Trust level.

Conclusions
A replicable protocol has been established in order to appraise, design, and implement antimicrobial guidelines that can be transferable between departments and trusts alike.
138 Lung Cancer Surgery in the Early Phase After Acute COVID-19 Pneumonitis
Authors: Robinson D , Smith A , Okiror L 
Published: November 2022

Abstract
As the number of post-COVID-19 patients requiring surgery increases, it becomes pressing to develop guidelines outlining time requirements between active COVID-19 infection and surgery. We present a case of successful pulmonary segmentectomy 6 weeks following an acute COVID-19 infection in a 65-year-old female.
The case patient was scheduled for a robotic assisted left upper lobectomy for radiologically diagnosed early-stage lung cancer. Unfortunately, prior to surgery she contracted Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-COV-2), resulting in the operation being rescheduled for 6 weeks’ time. She was managed in the community for COVID pneumonitis and developed significant shortness of breath. At admission, with resolution of breathlessness, a repeat chest computed tomography scan showed the nodule had increased in size from 2 to 2.5cm, and widespread interstitial pneumonitis. The patient was saturating at 91% on air with no respiratory compromise. On balance of risk, surgery went ahead as planned due to concerns over tumour progression. A smaller lung resection was undertaken, with robot-assisted left upper division segmentectomy preferred to lobectomy. Post-operatively the patient received aggressive physiotherapy and high flow nasal oxygen to aid sputum expectoration. Chest tube was removed on day 2 post-operatively and the patient discharged 5 days following surgery without complication. Final histology confirmed a fully resected stage T1cN0M0 adenocarcinoma of the lung.
This case highlights the importance of timing surgery correctly in post-COVID-19 patients to achieve the most favourable outcomes. We must balance clinical priority and the risk of disease progression against the severity of COVID-19 infection and the patient's comorbid status.
593 Squamous Cell Carcinoma in Renal Pelvis of a Fused Pelvic Kidney; Case Report and Literature Review
Authors: Ilangovan S , Neves J , Bex A , Tran M 
Published: November 2022

Abstract
This case report details a rare case of squamous cell carcinoma present in the renal pelvis of a fused pelvic kidney, a congenital complete renal fusion anomaly. A 52-year-old man with no previous urological history presented with intermittent haematuria and weight loss. He was found to have a large complex mass (14.3 cm×4.5 cm×15.5 cm) in the right moiety of a pelvic fused kidney on CT and subsequently underwent an open hemi-nephrectomy. He recovered well following surgery, however, unfortunately developed rapid recurrence, and died from disease progression after 6 months.
This report demonstrates the use of 3D anatomical reconstruction to help pre-operative planning of complex surgical cases. We also include histological analysis of the tumour in detail. This case report emphasises that squamous cell carcinoma can occur due to precipitating factors such as renal calculi or infection, which are more prevalent in fusion anomalies of the kidney. Although a rare malignancy, this tumour type is associated with an aggressive behaviour and poor prognosis.
1006 Supersized-Simulation vs Traditional Cardiothoracic Surgery Education: A Prospective, Randomised Controlled Trial
Authors: Hirniak J , Adil S , Hayes J , Vaghela M , Mani K , Abbas A , Aboulelea Y , Syed N 
Published: November 2022

Abstract

Aim
Exposure to cardiothoracic surgery is limited during medical school in the United Kingdom. This study evaluated the effectiveness of a supersized simulation model (SSM) compared to traditional methods (TM) in developing coronary anastomosis surgical skills.

Method
This was a prospective, randomised controlled trial with a 1:1 allocation ratio. Undergraduate medical students with no prior cardiothoracic surgical skills training were eligible for inclusion. Both groups received a guided didactic lecture followed by modified Objective Structured Assessment of Technical Skills (OSATS) assessment for baseline. The control group then received traditional teaching and the intervention group received additional teaching with SSM before being reassessed. Modified OSATS score were the primary outcome, adjudicated by two senior cardiothoracic registrars. Performance time (PT), self-assessment (SA), confidence (CON) and global rating scale (GRS) were secondary outcomes.

Results
48 novice medical students were randomised. OSATS scores were significantly higher in SSM group compared to TM group (13.2 vs 9.8, p&lt;0.01). The secondary outcomes PT (17.7 minutes vs 22.2 minutes, p&lt;0.01) and CON (3.04 vs 1.73, p&lt;0.01) were also significantly different between groups, favouring SSM. SSM participants were more likely to want to pursue a career in cardiothoracic surgery (12 participants vs 2 participants). All participants agreed that SSM improved visualisation and comprehension of surgical procedure. SSM cost £0.75 per model.

Conclusions
Supersized simulation is effective for coronary anastomosis surgical training with technical skills successfully transferred to a clinical task. Supersized models can accelerate the novice trainee's surgical skill progression and represents a valuable resource in one's educational armamentarium.
740 Improving the Management of Epistaxis in Clinical Practice
Authors: Kabaso M , Vanker R , Townsley R 
Published: November 2022

Abstract

Aim
Improving the standard of epistaxis management in Ayrshire & Arran.

Method
A survey was distributed to doctors assessing their familiarity with epistaxis assessment and management. Working with the ENT department, a teaching programme was then developed aimed at improving skill in nasal packing, cautery and first aid, based on local guidelines. After the first session, all participants filled in a post-education questionnaire and results collated.

Results
The survey collected information throughout Ayrshire & Arran, from 21 doctors across 10 different specialities, ranging from Foundation, Clinical Fellows, and Core Trainee's. Using a rating of one to five, least confident to most confident respectively. 95% of participants chose between one and three when asked about independently managing epistaxis, which significantly reduced to 0%. 52% of participants chose ‘least confident’ with familiarity of nasal packing and nasal cauterisation, reducing to 0%. In addition, 40% of doctors were unfamiliar with options for packing, which increased to 100%.

Conclusions
Epistaxis is one of the most common acute ENT presentations. 86% of cases will be initially managed by junior doctors using first aid management, packing, or cauterisation. This is not taught as standard in undergraduate or postgraduate education. Currently, there are no nationally accepted guidelines for its management, regardless of its high presentation, readmission, and mortality rate. There is an observable gap in epistaxis education, crucial when considering majority of its’ management will be handled by junior doctors. We have seen an increase in participants confidence and familiarity of the condition which merits running this teaching programme.
789 The Impact of a Virtual Orthopaedic On-Call Survival Course on Junior Doctors’ Confidence in Managing an Orthopaedic On-Call
Authors: Pennock H , Cheema K , Swafe L 
Published: November 2022

Abstract

Aim
Junior doctors often feel underprepared for their orthopaedic on-call shifts during their foundation placements. Studies have shown that medical schools are failing to prepare students to manage trauma and orthopaedic patients. The aim of this study was to assess the effects of an orthopaedic on-call survival course on the confidence levels of junior doctors in managing an orthopaedic on-call.

Method
We developed a one day orthopaedic on-call survival course, designed to provide junior doctors with the relevant knowledge to be able to confidently navigate an orthopaedic on-call shift. We designed a pre-course and post-course questionnaire which were distributed to the participants. Self-assessed confidence levels were recorded in managing an orthopaedic on-call and a number of orthopaedic knowledge domains using visual analogue scale 1–5. The course was delivered over 4 hours using Microsoft Teams.

Results
We received 47 matched pre- and post-course questionnaires. Overall, 87% of participants reported an increase in confidence in managing an orthopaedic on-call shift. 83% of participants reported an increase in confidence in orthopaedic radiology teaching. 80% of participants reported an increase in confidence in both upper limb emergencies and lower limb emergencies. 91% of participants reported an increase in confidence in spinal trauma.

Conclusions
An orthopaedic on-call survival course can provide junior doctors with the knowledge to be able to confidently manage trauma and orthopaedic patients during on-call shifts.
We recommend that an orthopaedic on-call survival course can be used as an effective teaching method towards preparing junior doctors for their on-calls during foundation training.
879 Attitudes to Research and Academic Careers Among Surgical Trainees and Medical Students: A Survey of Attendees at the 2021 Oxford Surgical Innovation Conference
Authors: Hennessy C , Brameier D , Williams M , McVeigh J , Handa A 
Published: November 2022

Abstract

Introduction
Participation in research throughout medical training is essential in developing and implementing evidence-based practice. Increasing competitiveness across many surgical specialties has led to increased desire to participate in research by medical students and surgical trainees of all grades, with the aim of increasing their employability.

Method
The Oxford surgical innovation conference (OxSI) took place on the 23rd of April. The 121 attendees were surveyed regarding their attitudes to medical research, levels of research experience, and their confidence in seeking out and engaging with research opportunities. Survey respondents included clinical medical students, foundation trainees, core surgical trainees and higher specialist trainees.

Results
From 121 surveyed attendees at OxSI 2021, we received 88 responses (72%). 90% of respondents were interested in/pursuing a surgical career, with 70% interested in a career in academic surgery specifically. Furthermore, 97.8% agreed that engaging in research and innovation are an important part of surgical training. However only 48.9% were actively engaged in research. Furthermore only 26.2% of respondents were confident in engaging in independent research, with 56.8% stating they would not know how to engage in research or pursue new surgical innovations without outside assistance.

Conclusions
There is significant interest among medical trainees in research and academic surgical careers. However, many struggle to engage with research due to time constraints, or inadequate exposure to research opportunities. This survey suggests a larger study examining barriers to research exposure and participation could assist in addressing the discrepancy between desire to engage with research and opportunities to do so.
436 Barriers for Cadaveric Kidney Organ Utilisation: Results of a National Transplant Access to Theatre (NTACT) Pilot Study
Authors: Borbas B , Mujeeb M , Tanase A , Aroori S 
Published: November 2022

Abstract

Background
There are various barriers to cadaveric organ utilisation across the UK. However, there is a paucity of data on the barriers after the arrival of organ/s at the implanting centre. We set up the national “NTACT” study to identify barriers after arrival of organs at implanting centre.

Method
Prospective pilot study collecting data on adult kidney/pancreas cadaveric organs across five UK transplant centres in July 2021. Data collected includes time intervals between significant checkpoints prior to transplantation and perceived reasons for delays after arrival at implanting centre. Data was recorded on RedCap and analysed for delays using descriptive statistics.

Results
Between five transplant centres, data was entered on 27 transplants. Five patients were excluded from the study (live transplant-2, incomplete data-3). There were six donations after circulatory death (DCD) and 16 donations after brainstem death (DBD) organs. Fifty percent (n=3/6) of DCD and 12.5% (n=2/16) of DBD allografts surpassed the national recommendations for CIT. The majority of crossmatches were virtual (15 virtual and seven full). Delays included crossmatch results (median=03:37:30), time between the arrival of the kidney and patient into theatre (median=03:13:00), time between anaesthetic induction and knife to skin (median=00:52:00). The median warm ischaemia time was 00:41:30 (IQR-00:33:00–00:49:30). Qualitative answers highlight themes: “surgical team occupied in another case”, “emergency theatre occupied”, “porter availability for transporting patients”.

Discussion
Our pilot study identified various barriers to implantation, and a significant proportion of kidneys are implanted beyond nationally accepted CIT. Further work is required to get a national picture over an extended period.
864 The Efficacy and Safety of Bariatric Surgery in Patients with Previous Kidney Transplantation: A Systematic Review and Meta-Analysis
Authors: Varma J , Fernando S , Dengu F , Menon V , O'Callaghan J 
Published: November 2022

Abstract

Introduction
Obesity is associated with adverse outcomes in end-stage renal disease (ESRD) and those with prior kidney transplantation (KT). Bariatric surgery (BS) is an effective solution to obesity. The authors aim to summarise the evidence for the efficacy and safety of BS in those with KT.

Method
We performed a systematic review and meta-analysis to determine the efficacy and safety of BS in patients with ESRD awaiting KT. A literature search of MEDLINE, EMBASE and Web of Science was conducted from inception to April 2021. The methodological quality of selected studies was assessed using the Newcastle-Ottowa tool. Our primary outcome was change in BMI, with secondary outcomes including adverse events, graft outcomes and KT listing rate.

Results
Ten observational studies met the inclusion criteria with a total of 198 patients (45.1% male). Mean change in BMI following BS was -11.0 (-14.9 to -7.1, p &lt; 0.001) within a median follow up time of 30 months (IQR 25 to 139 months). Gastric bypass (49.5%, n=98) was the most common procedure. Mean age at BS was 46.5 years (SD = 5.5) with a mean time from KT to BS of 4.9 (SD = 1.9). The 5-year graft failure rate (Post BS) was 18.6% (n = 7).

Conclusions
This review highlights that BS is both safe and efficacious on patients with a previous history of KT.
2 A Retrospective Analysis of the Definitive Management of Open Talus Fractures at a Major Trauma Centre and an Audit of BOAST 4 Guidelines
Authors: Zhou A , Jou E , Bhatti F , Patel R , Zhang J , Lu V , Krkovic M 
Published: November 2022

Abstract
Currently, the management of open talus fractures is based upon BOAST 4 guidelines although there is no suggested definitive management, thus definitive management is based upon surgeon preference. This retrospective analysis aims to clarify the debate between ORIF and tibiocalcaneal fusion (FUSION).
A review of open talus fractures from 2014–2021 returned foureen patients with fifteen open talus fractures. Seven cases were initially managed with ORIF, five cases were definitively managed with FUSION. We collected patient's age, gender, surgical complications, surgical risk factors and post-treatment functional ability and pain and compliance with BOAST guidelines.
Comparison between FUSION and ORIF groups showed no statistically significant difference in EQ-5D-5L score (P = 0.13), FAAM-ADL (P = 0.20), FAAM-Sport (P = 0.34), infection rate (P = 0.55), surgical times (P = 0.91) and time to weight bearing (P = 0.39), despite a higher proportion of polytrauma and Hawkins III and IV fractures in the FUSION group.
FUSION is typically used as second line to ORIF or failed ORIF. However, there are a lack of studies that directly compared outcome in open talus fracture patients definitively managed with FUSION or ORIF. Our results demonstrate for the first time, that FUSION may not be inferior to ORIF in terms of patient functional outcome, infection rate, and quality-of-life, in the management of patients with open talus fracture patients. Of note, as open talus fractures have increased risks of complications such as osteonecrosis and non-union, FUSION should be considered as a viable option to mitigate these potential complications in these patients.