bluuebunny/crossref_metadata_2025_split huggingface dataset:
301 Blood Grouping and Save in Day Case Laparoscopic Surgery – Potential for Resource Savings?
Authors: Ramasamy S. , Kumar S. , Al-Habsi R. , GS D. , Keeler B. , Khanna A. 
Published: February 2022

Abstract

Introduction
Currently, patients listed for Laparoscopic cholecystectomy and Laparoscopic Appendicectomy undergo routine Blood Grouping and Saving (G&S) pre-operatively. Blood transfusion administration in this context is a rare occurrence. Processing of G&S samples takes approximately 45 minutes and costs £31 per sample. This excludes the phlebotomy and junior doctor resources for sample collection, which incurs additional costs.
We retrospectively assessed the blood transfusion requirements in those patients who underwent either a laparoscopic appendicectomy or cholecystectomy in the last 18 months at a busy District General Hospital (Milton Keynes Hospital) to determine if there were any potential costs and resource savings that could have been made.

Method
Retrospective case notes analysis of patients who had laparoscopic cholecystectomy and laparoscopic appendicectomy from January 2019 to June 2020 focusing on timing of G&S, preoperative and postoperative haemoglobin, the timing of blood transfusion and the number of units transfused.

Results
Of a total of 613 patients, 323 patients had laparoscopic cholecystectomy. 256 (78.8%) of these had 1 G&S sample and 96 (29.7%) had 2 samples.
290 patients had laparoscopic appendicectomy. 190 (65.5%) of these laparoscopic appendicectomy patients had 1 G&S sample and 89 (30.6%) had two G&S samples.
None of the 613 patients was transfused. The total cost of G&S was £22,196.

Conclusions
Our study illustrates that in this group there was no requirement for blood transfusion. Routine group and save samples result in a significant waste of resources and finances. Targeted groups and save samples should be reserved for high-risk groups only.
304 To Raise Awareness About the NHS Cervical Screening Programme and to Reduce the Number of Did-Not-Attend (DNAs) Cervical Screening Appointments Among Women Aged 25–35 Years Through a Collaborative Reward System with Local Businesses
Authors: Singh S. 
Published: February 2022

Abstract

Introduction
Cervical screening is offered free under NHS Cervical Screening Programme since 1988. However, compliance is dwindling in the last decade, especially among women aged 25–35 years who had the least awareness. NHS Digital suggests overall coverage be 72 percent with 1.2 million Did-Not-Attend appointments.

Method
This project proposes financial and non-financial incentives can propel people to adopt healthier lifestyles. Project advocates CSR with local businesses, especially MSEs such as local gyms, local pharmacies, boutiques, salons, restaurants, and takeaways usually frequented by women aged 25–35 years. The project proposes, firstly, participating businesses will display ‘we support cervical screening program’ on their on-site and online portals. Secondly, they will provide exclusive offers (cash rewards, hampers, vouchers, priority services, free home deliveries, and personalised picture cards signed by staff) to women attending their cervical screening appointments. Thirdly, in their adverts, they would promote the cervical screening programme in a respectable manner to prevent the embarrassment of cervical swab and body-shaming. Fourthly, the businesses will ensure flexible staff working hours to attend the cervical screening to eradicate work-related practical barriers.

Conclusions
Cervical screening program is the best prevention against cervical cancer and can potentially reduce mortality by cervical cancer by up to 70 percent. If NHSCSP coverage reaches 84%, £10million can be saved per annum. Apart from early detection of cervical cancer and reducing Did-Not-Attend appointments by offering exclusive rewards for attending Cervical Screening to the participants.
320 Augmented Reality in Vascular and Endovascular Surgery: A Scoping Review
Authors: Eves J. , Sudarsanam A. , Shalhoub Joseph. , Amiras D. 
Published: February 2022

Abstract

Introduction
Technological advances have transformed vascular intervention over recent decades. Augmented reality (AR) is a subject of growing interest within surgery, with potential to improve the clinicians’ understanding of 3D anatomy and their processing of real-time information. The aim of this review was to summarise the fundamental concepts of these technologies and to systematically assess the literature currently applying AR to vascular surgery.

Method
A systematic literature review of ‘Medline,’ ‘Scopus’ and ‘Embase’ was performed according to PRISMA guidelines. Studies were selected by a blinded process between two investigators and assessed with data quality tools.

Results
AR technologies have had a number of applications across vascular and endovascular surgery. The majority of studies use 3D imaging (e.g.) CT angiogram derived images of vascular anatomy to augment the clinicians anatomical understanding during procedures. A wide range of AR technologies have been employed with ‘heads up’ fusion imaging and AR head-mounted displays the most commonly clinically applied. AR applications have included guiding open, robotic, and endovascular surgery while minimising dissection, improving procedural times, and reducing radiation and contrast exposure. Additionally, AR has been successfully applied to surgical training, with scope to improve technical and team communication skills.

Conclusions
AR has shown promising developments in the field of vascular and endovascular surgery, with potential benefits to surgeons and patients alike. While more technological advances are required to overcome current limitations, it is likely that AR will be a regular feature of vascular surgery clinical practice and training in the future.
332 Paediatric Ultrasound Scan: Are We Providing a Quality Service?
Authors: Barghash M. , Nassif S. , Anwar S. , Obayi E. , Alnsour A. , Mansour M. 
Published: February 2022

Abstract

Aim
Ultrasound scan is the preferred imaging modality in children as it carries no risk of radiation exposure. In this audit, the number of inpatient paediatric ultrasound referrals was assessed over a period of one year. The waiting time was also reviewed in addition to the impact of the results on the management plan.

Method
This was a retrospective audit which included patients who were below 16 and had inpatient ultrasound scan. Case notes were included from January 2020 to December 2020 in a busy district hospital in the UK. The time taken to perform the ultrasound scans and the impact on the management plan were only analysed for the scans requested for abdominal pain.

Results
A total of 914 paediatric ultrasounds scans were requested in 2020. A total number of 28 scans were requested for abdominal pain. The waiting time ranged from 3 to 135 hours with a mean of 23 hours. No scans were positive for appendicitis. Only 2 scans were positive for gynaecological pathologies, i.e., ovarian cysts. All the 28 patients were discharged without undergoing any procedure. Out of the 28 patients, 15 patients had a length of hospital stay of more than 24 hours before discharge.

Conclusions
A mean delay of 23 hours could potentially delay the management of paediatric patients with acute abdominal pathology. None of the patients in this audit underwent any procedure following performed scans. This may indicate that such scans did not alter the management of the studied patients in this audit.
335 Early Initiation of Biochemical Venous Thromboembolism Prophylaxis Following Traumatic Spleen Injury Is Safe and Effectively Reduce VTE Events.
Authors: Rizkallah G. , Lee S.L. , Mahmoud A. , Handa I. , Long J. , Massella V. , Modi S. , Fun Ngan F.S. , Rahman A. , Elberm H. 
Published: February 2022

Abstract

Aim
This study examines the safety and timing initiating VTE prophylaxis post traumatic splenic injuries (TSI).

Method
Patients with TSI were identified from prospectively maintained Trauma Audit and Research Network (TARN) database from 2015–2020 in a single tertiary trauma centre. Clinical and radio-logical information were collected retrospectively. TSI were graded using American Association for the Surgery of Trauma (AAST) splenic injury scale. Chemical venous thromboprophylaxis initiation were categorised as not given, &lt;48h and &gt;48h following the injury.

Results
In total 102 patient were included out of 136 patients identified with TSI. 34 patients were excluded for lack of electronic data, palliative decision, or fatal condition on arrival. 12 patients out of 102 required operative management (OM) and 90 patients NOM. VTE prophylaxis was not given for 31 (30.4%). Medical reasons for this include severe brain injury and early discharge before 48 hours. VTE prophylaxis was initiated for 37 (36.3%) patients within 48 hours, and for 34 patients (33.3%) after 48 hours of admission. Seven patients developed thromboembolic events, majority of which (6/7) received VTE prophylaxis after 48 hours. Importantly, none of the patients who received VTE prophylaxis had rebleeding.

Conclusions
This study showed that early initiation of chemical VTE prophylaxis (&lt;48h) is safe, resulted in lower incidence of DVTs/PEs without increasing the risk of bleeding. Results from this study supports recommendation from other studies 1 to initiate chemical VTE prophylaxis after TSI as early as 24h post injury with no other contra-indications.
342 Percutaneous Cholecystostomy: Single Hospital Review of Indications and Outcome
Authors: Saleh D. , Rawashdeh A. , Parmar J. 
Published: February 2022

Abstract

Aim
Percutaneous cholecystostomy is used for the treatment of various gallbladder conditions and biliary emergencies, such as cholecystitis or cholangitis. Patients undergoing this procedure are usually elderly and surgically high risk. The objective of this audit is to investigate risks versus the benefits of percutaneous cholecystostomy at University Hospital Birmingham and hence propose a work plan for cholecystostomy drain placements and reduce drain-related complications.

Method
We retrospectively identified patients who underwent percutaneous Cholecystostomy between January 2018 and December 2019. Clinical and demographic data were collected, including age, co-morbidities, ASA grade, indications, pre-procedure blood tests, complications, and re-admissions.

Results
25 patients were identified and included median age was 76.3 years, 16 out of 25 patients had deranged Liver function tests. All patients were deemed unfit for surgery at the time of decision. Median Hospital stays after the procedure was 7 days. The number of patients required readmission with a blocked drain is 16. Total number of readmissions for blocked drain is 33. Number of patients required readmission after drain removal with cholecystitis/cholangitis is 14. Total number of readmissions for cholecystitis/cholangitis after drain removal is 21.

Conclusions
The main reason for readmissions was for blocked cholecystostomy drains. A protocol where patients are educated about flushing their cholecystostomy drains prior to discharge is vital to reduce complications with a blocked drain. Also, careful selection of patients for cholecystostomy is important due to the high morbidity associated with this procedure.
345 Development of Breast Disease Teaching in the Low and Lower-Middle Income Countries
Authors: Nojoum M. , Macaskill E.J. , Al Khairalla M. , Al-Barrak S.M. 
Published: February 2022

Abstract

Aim
Breast cancer is the most common cancer worldwide, with incidence and mortality rates significantly worse in the developing world. There is a need to improve general health professional’s knowledge of breast disease. The recent COVID-19 pandemic has led to an increase in use of online resources, and remote teaching has had a significant role in medical education particularly post-pandemic. This project aims to assess available breast disease related online resources for use in the context of medical undergraduate education in low and lower-middle income countries.

Method
A search for online resources was conducted using generic search engine and specialist databases. In the planning phase, predefined search terms were selected, and exclusion and inclusion criteria were identified. In the search execution phase resources were searched for, and the main target and resources type were recorded. In the screening and information management phase resources identified were assessed for comprehensiveness using the Royal College of Surgeons Breast learning outcomes.

Results
A total of 33 e-resources were identified that met predefined criteria. This included text-based websites (n = 19), tutorials (n = 8), and video resources (n = 6). The majority of resources were aimed at patients (n = 12). None of the resources identified met all 11 outcomes outlined by the Royal College of Surgeons, however most resources met 10 of the learning objectives (n = 7).

Conclusions
There was a good selection of available educational resources in the area of breast disease, however further exploration of the suitability and usefulness of e-resources in the setting of low and lower-middle income countries is required.
350 New Service of Intravenous Antibiotics Administration at Home- a Single Centre Experience
Authors: Bista A. , Singh H. , Unnithan A. , Das G. , Kesawarini D. , Bristoll S. , Lewis N. , Alnoori N. 
Published: February 2022

Abstract

Introduction
Outpatient Parenteral Antibiotics Therapy (OPAT) provides a safe and effective alternative to prevent a long-term hospital stay. If used efficiently, it is beneficial and cost-effective.

Method
199 patients from January 2017 since the services started to March 2021 were included in this retrospective observational study. Demographics, clinical management and OPAT outcome data were studied and compared with local guidelines. Patients receiving services for oral medications or ambulant to reach AECU were excluded.

Results
205 patients received the service with a total of 248 patient episodes. 6 patients were excluded because of inadequate data availability. 199 cases were analysed with a mean age of 72±13.9 years (age ≥60 years: 79.8%; M:F 3:2). 24.6% cases were osteomyelitis followed by 12% prosthetic infections. The average duration of antibiotics received was 38.4 days (3–187 days). We assumed 3 days as a benchmark for duration deviated from the planned duration and found 45% of patients got more antibiotics than they were planned: with an average of 20 days excess. 65.8% of patients had microbiological investigations done before antibiotics. Flucloxacillin was the first-choice antibiotic. When compared to the trust guidelines, 29% of patients were managed in line with the recommended duration, proper investigations, and choice of antibiotics. 14.5% of patients developed side effects.

Conclusions
With this being a new service, there are a lot of opportunities to improve monitoring, patient experience and safe clinical practice. We have already started the improvement by changing our record-keeping for clinical governance and are working on the clinical pathway.
352 Improving Consent for Elective Inguinal Hernia Repair
Authors: Lorimer J. 
Published: February 2022

Abstract

Introduction
Litigation costs the NHS billions each year. To avoid litigation against known risks of elective surgery it is important that proper consent it obtained. The initial aim was to establish the percentage of patients consented fully for inguinal hernia repair at Warrington and Halton teaching hospitals, a moderately sized district general hospital. The Trust uses the information produced by EDIO as their standard of informed consent. One of the main outcomes was the rate of consent for risk of chronic pain as this is the 3rd most commonly litigated complication and an identified risk of inguinal hernia repair.

Method
A retrospective audit looking at consent forms for adult men who underwent elective open inguinal hernia repair, over a 6-month period in 2019, was undertaken. After the first audit the results were discussed at the local audit meeting and teaching was given for what should be included on a consent form for inguinal hernia repair. A second cycle of the audit was run in 2021, after the COVID pandemic, to assess if consenting had improved.

Results
66 vs 22 cases met the inclusion criteria for the first and second 6-month periods respectively. An improvement in consent for chronic pain was observed with 91% of patients in the second cycle being consented for chronic pain vs 79% in the first cycle. In the second cycle 32% of patients were also consented for the risk of “COVID”.

Conclusions
Teaching proper consent works effectively to improve consenting.
359 Standardised Management Guidelines of Sudden Sensorineural Hearing Loss for Departmental Use
Authors: Kujeke H. , Reddy-Kolanu G. 
Published: February 2022

Abstract

Introduction
Sudden sensorineural hearing loss (SSNHL) remains a condition of unknown aetiology with low incidence of 20 cases per 100,000 per year. This has led to a lack of consensus on overall management as there are no NICE guidelines. Trends in management are aimed at attempting to find an identifiable cause and to treat accordingly.

Method
A double loop audit performed at East Surrey Hospital looked at the management of Sudden sensorineural hearing loss. The first loop looked at retrospective data over 7 years identifying how patients with this diagnosis were managed by assessing the following 6 parameters: Pure tone audiometry test performed, Oral steroids, tympanic injection, autoimmune blood screen, MRI booked, and outpatient follow up appointment given. The inconsistent management of those patients led to the design of an algorithm for standardised management ensuring all 6 parameters were covered. This was implemented over a three-year period and a retrospective audit was performed.

Results
Between 2010–2017, 7 patients were diagnosed on audiometry as having SSNHL. Only 1 patient was managed comprehensively with all 6 parameters covered. The department algorithm was implemented in 2018 suggesting all patients are to be managed according to the algorithm within the first 72hrs of diagnosis. From 2018–2020,14 patients had the diagnosis and managed as per algorithm. There was 92% compliance.

Conclusions
Although there are no current NICE guidelines, there is great benefit to the patients diagnosed with sudden sensorineural hearing loss in having standardised departmental guidelines. This ensures that pertinent investigations and medications are administered in a timely manner.
374 Are Operative Notes Adhering to the Standards of Good Practice?
Authors: Lipski C. , Bleibeh S. , Hanif U. , Sinha M. , Waites M. 
Published: February 2022

Abstract

Aim
Thorough documentation is imperative for postoperative care, quality improvement, research, and medico-legal enquiries. For these reasons this closed loop audit aimed to assess whether the local Trauma and Orthopaedic departments’ operative notes were adhering to the guidance outlined by The Royal College of Surgeons, in order to to follow good practice.

Method
This was a random data collection, single centre study performed which analysed 50 operative notes from a variety of Trauma and Orthopaedic surgical procedures (not including neck of femur fractures and elective surgeries). The next cycle of the audit was completed after departmental re-education and a new operative note pro forma was created and put in place.

Results
The first audit cycle demonstrated that 8 categories in the operative note were below 96 % compliance with the guidance, of these being: time, name of operating surgeon/anaesthetist, operative procedure, incision, operative diagnosis, DVT prophylaxis, signature. Furthermore, an interesting finding showed no complications were identified in any operative note, similarly no extra procedures were documented. The second audit cycle showed that there was 100% compliance gained across all categories. Additionally, the new pro forma had an option to specify if there was/or not any complications, which had 100 % compliance in the second cycle and identified one complication.

Conclusions
Overall this audit was able to standardise the operative notes and improve quality and structure in order to follow good practice, by implementing a new pro forma and re-educating the department. This ensures that the best standard of care is being delivered.
382 Compliance With Current Excision Margin Guidelines for Non-Melanoma Skin Cancer: Do We Make the Cut?
Authors: Kungwengwe G. , Li Z. , Nijran A. , Ibrahim Y. , Tang L. 
Published: February 2022

Abstract

Aim
Non-melanoma skin cancers (NMSC) are the most common malignancies worldwide, with basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs) constituting an ever-growing clinical burden within Plastic & Reconstructive Surgery. In this 3-cycle Quality Improvement (QI) initiative we sought to evaluate and improve our unit’s compliance with British Association of Dermatology (BAD) guidance on excision margins for NMSCs.

Method
Following results from two Plan-Do-Study-Act (PDSA) cycles, a third retrospective review of clinic letters, operative notes and histopathology reports was undertaken to identify NMSCs that were excised during May 2021 and assess compliance with recommended excision margins according to risk stratification.

Results
The dissemination of cycle 1 findings at departmental meetings, as well as the implementation of guideline posters and operative note templates conferred a significant improvement in both clinical documentation (12% to 100%) and local compliance with excision margin guidelines for BCCs (53% to 71%) and SCCs (50% to 79%). Following the adoption of new BAD guidelines on SSC margins in early 2021, a third cycle comprising 42 lesions demonstrated a sustained improvement in clinical documentation (100%) after a 7-month period and similar guideline compliance rates for both BCC (67%) and SCC (78%).

Conclusions
Adequate excision margins in cutaneous malignant pathology are vital to ensure complete removal, thus minimising the risk of recurrence. Although improvement across the PDSA cycles has been sustained despite the introduction of new SCC margin guidelines, we aim to introduce further interventions such as a knowledge and practice survey to continue improving excision margin compliance.
386 Consent Practices in General Surgery – the Importance of the “Process”?
Authors: Martyn C.J. , McGowan K.E. , Clements J.M. , Kirk S. 
Published: February 2022

Abstract

Aim
Achieving valid informed consent is an essential component of the shared decision-making process. National guidance exists on the content of consent discussions. However, controversy exists as to when consent should be obtained. We aimed to assess consent practices in our institution.

Method
A Prospective snapshot audit was conducted on consecutive general surgical patients undergoing elective surgery over a 4-week period. Information on consent discussions were obtained from electronic patient care records and from the written consent form prior to surgery. Local audit approval was granted.

Results
56 patients underwent an elective general surgical procedure in August 2021. Median age was 55. 73% (n = 41) were female. 63% of cases were for malignant disease (n = 35). All patients had capacity. 95% (n = 53) completed their consent form on the day of surgery. 54 patients had documented pre-operative consultant consultations with all patients receiving a diagnosis and discussion regarding treatment. 69% of patients underwent discussion about alternative options. Discussion about surgical risk took place in 30% of cases.

Conclusions
Variation exists in pre-operative consent discussions. However, these discussions reflect consent as a “continuum” which may carry greater importance than the act of signing a consent form at an isolated time point.