bluuebunny/crossref_metadata_2025_split huggingface dataset:
518 Efficacy and Safety of Embolo-Sclerotherapy of Low-Flow Vascular Malformations Based on the Experience from a Single Specialist Centre
Authors: Pang C , Arasakumar D , Evans N , Papadopoulou A , Khalifa M , Hamilton G , Brookes J , Lim CS 
Published: November 2022

Abstract

Aim
To evaluate the efficacy and safety of embolo-sclerotherapy (EST) of low-flow vascular malformations (LFVM) in a specialist vascular anomalies centre.

Method
All patients with LFVM who underwent EST from 01 January 2015–31 December 2019 were retrospectively reviewed. All ESTs were performed with foam STS 3%, ethanol, coils and/or other substances e.g., triamcinolone. LFVMs were grouped according to Puig's classification. The outcome measures were treatment effects and complications. Continuous variables were compared using analysis of variance (ANOVA) F test. Other discrete variables were compared using Chi-squared tests. P&lt;0.05 were considered significant.

Results
A total of 207 patients, with a mean age of 32 years (range 1–71 years) were included. The use of EST with foam STS was significantly lower for type I LFVM (61.8%) compared to others (p&lt;0.001). However, significantly higher type I LFVM (26.5%) were treated with surgery than EST (p&lt;0.001). Overall, outcome categories were significantly different across all types of LFVM (p&lt;0.001), with more discharges for Type I (52.9%) LFVMs but more failure to follow-up in patients with Type II (24.5%) LFVM. EST complications was significantly higher with type I (14.7%) LFVMs (p=0.030). The doses of STS in the first procedure were significantly different across all types of LFVM (p&lt;0.001) with most type I LFVM patients receiving ≤2ml.

Conclusions
EST particularly with foam sclerotherapy is clinically effective and safe for patients with LFVM especially in those with Puig's type I and II lesions. This classification may provide an important guide to volume of sclerosant required and the potential success rate.
522 Early Follow-Up Quality of Life and Mental Health of Patients with Congenital Vascular Malformations Cared for in a Multi-Disciplinary Specialist Center
Authors: Pang C , Nisbet R , Gibson M , Evans N , Khalifa M , Papadopoulou A , Tsui J , Hamilton G , Brookes J , Lim CS 
Published: November 2022

Abstract

Aim
To evaluate the early follow-up quality of life (QoL), pain and mental health of patients with congenital vascular malformation (CVM) receiving care by a single multi-disciplinary specialist center

Method
This was a prospective observational study. All patients with CVM who received care (supportive treatment only, open surgery, targeted pharmacological therapy, embolosclerotherapy), and had follow-up, between February 1st 2018 and January 31st 2020 were included. The health-related QoL, pain, and mental health were assessed with validated questionnaires: SF-36, VAS-P and HADS. The CVM were categorized into types – low-flow (LFVM) and high-flow (HFVM), and anatomical locations. Paired t-test was used for all analyses. P&lt;0.05 were considered significant.

Results
110 patients (85 LFVM and 25 HFVM) with a mean age of 36.9 years were included. Significant improvement was found in the bodily pain domain of SF-36 and VAS-P (both P = 0.01) in all patients. However, only patients with HFVM reported significant improvement in the bodily pain domain of SF-36 (P=0.002) and VAS-P (P = 0.02). Patients who received supportive treatment only reported significant improvement in mental health (P=0.004) and social functioning (P=0.03) domains of SF-36. Meanwhile, patients treated with embolo-sclerotherapy reported significant improvement only in VAS-P (P=0.02). Patients who received targeted pharmacological therapy reported no significant early changes.

Conclusions
The effects of care on early follow-up QoL, pain and mental health of patients with CVM were heterogenous. Future research is required to understand the various factors that affect the QoL and mental health of these patients, as well as the holistic approaches to manage them.
793 Examining the True Incidence and Staging of Amelanotic Melanoma in an Irish Population
Authors: Mc Cormack D 
Published: November 2022

Abstract

Introduction
Many patients diagnosed with amelanotic melanoma (AM) have often gone undetected for a long time due to the difficulty in diagnosis of these skin lesion, likely causing underestimation of the prevalence of AM in Ireland. This study aims to determine associated risk factors, incidence, and prevalence of AM in an Irish population.

Aim
Determine the true incidence, staging and prevalence of amelanotic melanoma.

Method
This is a retrospective cohort study of AM patients with melanoma diagnoses made in 2019 in two large Irish hospitals. Data was extracted from hospital patient records and histopathology reports, based on confirmed melanomas. AM was clinically defined as melanomas devoid of pigment on visual inspection before biopsy.

Results
A total of 265 patients with a diagnosis of melanoma were included. The overall prevalence of AM was 17%. Comparison of age between AM and non-AM patients (pigmented melanoma) showed a significantly higher age for AM patients (73 +/- 14 versus 66 +/- 15 years). Breslow Thickness was higher in AM versus non-AM patients (3.4 +/-3.7 versus 1.6 +/-1.8), which is an indicator decreased survival 5-year survival. The estimated incidence of AM was 5.41 per 100,000 of our target population

Conclusions
The incidence of AM has been grossly underestimated in an Irish context and these non-pigmented lesions are far more prevalent than previously thought. It is known that amelanotic melanoma is associated with worse outcomes. These patients are not benefitting from rapid access to pigmented lesion clinics and therefore likely have a worse outcome due to going.
810 The Spiderman Sign - a Novel Method to Identify the Distal End of the Carpal Tunnel
Authors: Mc Cormack D , Sugrue R 
Published: November 2022

Abstract

Aim
Identify the distal end of the carpal tunnel safely and effectively, by passive flexion of their ring and middle finger.

Method
We assessed 20 patients, prior to carpal tunnel decompression surgery and recorded the findings. A number of measurements were taken. The line at which the flexed ring and middle finger lay on the palm was marked, then following surgical exploration measurements were made with the distal end of the carpal tunnel and assessed how accurately this lined up with our pre-operative markings.

Results
Of 20 patients assessed the distal end of the carpal tunnel aligned with the preoperative markings made using the patients’ flexed fingers. 100% of cases the preoperative markings aligned with the distal end of the carpal tunnel found on surgical exploration.

Conclusion
There are various methods described to identify the distal end of the carpal tunnel. We feel our technique is a simple and effective method using the patient's own anatomy to identify this important landmark, which we call the Spiderman sign.
183 Improving Documentation of Antibiotic Prophylaxis and Anticoagulation in Vascular Surgery Operation Notes at a Tertiary Centre: A Quality Improvement Project
Authors: Curlewis K , Weerakkody R , Harris M , Constantinou J 
Published: November 2022

Abstract

Aim
Operation notes have important medico-legal implications and should follow the Good Surgical Practice framework to enable continuity of care.
The aim of this quality improvement project was to determine adherence of vascular surgery operation notes to the Good Surgical Practice framework at a tertiary vascular centre, identify areas of improvement and introduce sustainable change to improve patient care.

Method
Two Plan-Do-Study-Act cycles were enacted. A prospective audit was conducted over September 2021 to identify areas of improvement in documentation. The first intervention that was introduced was electronic patient records (EPR). The second intervention introduced was departmental education via posters, regular educational sessions, and presentations.

Results
The prospective audit of 31 operations over September 2021 identified antibiotic prophylaxis was only recorded in 4/31 (13%) and post-operative anticoagulation in 21/31 (68%). A retrospective audit of 28 operations over October 2021 after the introduction of EPR demonstrated improved documentation of antibiotic prophylaxis (16/28, 57%) but no improvement in post-operative anticoagulation documentation (17/28, 61%). Departmental education improved the documentation of antibiotic prophylaxis (18/30, 60%) and post-operative anticoagulation (22/30, 73%).

Conclusions
We have demonstrated that EPR and departmental education can improve operation note documentation and patient care. Next steps include designing vascular surgery proformas to further improve documentation.
216 Improving Patient Education About Pre-Diabetes in the Community
Authors: Carey C , Natarajan S 
Published: November 2022

Abstract

Aim
Pre-diabetes is a common condition and although its development is linked to lifestyle factors, many patients are unaware of interventions that can improve their condition. One-to-one consultations between patients and GPs focused on reducing carbohydrate consumption are known to be effective at improving pre-diabetes. This QIP aimed to improve patients' understanding of pre-diabetes and reduce carbohydrate intake.

Method
Patients were included if they had 2 HbA1c measurements between 42 – 48mmol/mol and the ability to make dietary changes independently. A questionnaire based on the UK Diabetes and Diet Questionnaire was constructed and used to ask patients about their concern about pre-diabetes, knowledge of foods that contribute to the condition and the frequency at which they consumed various carbohydrates. Advice about reducing carbohydrate intake was given verbally and patients were provided with a diet sheet produced by Unwin et al. Patients were called again after 7 – 14 days to assess dietary changes and the impact of the advice.

Results and Conclusions
31 patients responded to the initial telephone call of which 58.1% were concerned about pre-diabetes and 38.7% mentioned foods high in carbohydrate as a cause of pre-diabetes. 90.3% of patients consumed food high in carbohydrate on 4 or more days per week. 22 patients responded to the follow up telephone call of which 63.6% reported a reduction in carbohydrate intake, 95.5% knew more about pre-diabetes and 90.9% found the dietary advice helpful. These results suggest that pre-diabetic patients should be given verbal and written information about lowering carbohydrate intake at GP consultations.
283 Delayed Discharge-a Pitfall for NHS; Can We Improve?
Authors: Nessa A , Pawloy K , Purewal R , Ganeshamoorthy K , Tayo O , Ghazanfar M 
Published: November 2022

Abstract

Aim
Identify reasons for discharge delays in a tertiary care hospital and find areas of improvement.

Method
Data were collected for seven days, and all inpatients (Elective and Emergency) admissions were included. Patient's demographic data, length of hospital stay, and discharge data were entered on Microsoft Excel and analysed using SPSS.

Results
Out of 102 total patients, 48 (47.1%) were male and 54 (52.9%) females. Mean age was 60.5 years (min 20 max 91). Clinical frailty score (CFS) was not calculated in more than half of the patients (n=55, 57.4%). 47(46.5%) patients had polypharmacy. 61(59.80%) patients did not have a documented Expected date of Discharge (EDD). Median hospital stay was 10 days (1–161 days).
27(26.47%) patients had delayed discharge (mean 4.93 days, median 1 day). Reasons for delay included unavailability of rehab bed (n=5, 4.9%), stoma nurse review (n=6, 5.88%), and awaiting bloods, diabetic control or discharge hub planning (n=3, 2.94%). Delayed discharges do not seem to be affected by polypharmacy (p=0.067), DNACPR (p=0.926), frailty score (p=0.761) or gender (p=0.518). However, Patients aged 65 or above were more likely to have delayed discharge (p=0.037).

Conclusions
Delayed discharge is more likely in over 65years. We recommend early identification of at-risk patients. Possible interventions to avoid discharge delays are EDD, pre-emptive preparation of discharge letters, early morning bloods and training of ward nurses for stoma care.
393 Communication in Catheter Care: A Closed Loop Audit of Catheter Documentation in Emergency Presentations to a Tertiary Urology Centre
Authors: James J , Warwick A 
Published: November 2022

Abstract

Aim
Estimates suggest that 20% of patients admitted to hospital undergo catheterisation, some of whom will end up discharged with catheters. Clear documentation assists in communication between hospital and community teams. The EAUN has identified key areas for documentation including use of care plans. We audited compliance with documentation pre- and post-intervention in a tertiary urology department

Method
Emergency patients presenting to urology were identified over a 3-week period pre-intervention and 3-weeks post-intervention. Clinical notes were audited for documentation of catheterisation. Domains assessed included indication, type/size of catheter, catheter balloon volume, residual volume, urinalysis, and plan. Use of care plans was also audited. Intervention involved development and deployment of a poster as well as discussion with staff.

Results
In total 274 patients were identified. 47 catheters were inserted pre-intervention, with variable compliance in documentation throughout the domains with similar pattern of compliance noted in the post-intervention group (n=42). Compliance was highest in size of catheter and indication for insertion, with urinalysis the most frequently missed domain (14.9% pre-intervention, 9.5% post-intervention). The only area with significant improvement was documentation of balloon volume (p=0.0019). Use of the care plan showed some minor improvement but was generally poor.

Conclusion
Use of visual cues did not result in approvement in documentation. Discussion with the teams suggested awareness of the domains and care plan however, they didn't necessarily think of them at time of documentation. As such a text prompt for the electronic notes is now in development and further audit to assess impact pending.
498 Junior Doctor Checklist for the Management of Neck of Femur Fracture: A Quality Improvement Project
Authors: Leow TW , Chalkley M , Karmarkar A , Pawar R , Sharma V 
Published: November 2022

Abstract

Aim
Patients admitted with Neck of Femur (NOF) fracture are often complex and frail. Junior doctors in our institution are first on call and have minimal orthopaedic experience. Anecdotal experience has shown that patients are often inadequately optimised. For example, fluids not prescribed, and anticoagulants not reversed which could lead to further complications and delay to surgery, affecting patient outcomes. Therefore, we developed a junior doctor checklist to improve the quality of care for patients with NOF fracture.

Method
A plan-do-study-act (PDSA) methodology was utilized in designing this project. Data was collected prospectively from 50 patients presented with NOF fracture pre and post intervention. Clerking proforma, drug chart and electronic systems were reviewed. Outcome measures were prescription of analgesia, fluids, anti-emetics and laxatives, completion of venous thromboembolism (VTE) prophylaxis, abbreviated mental test (AMT), group and save and reversal of anticoagulation, if available. Intervention included production of a checklist outlining the management plan which was distributed to junior doctors.

Results
Areas for improvement identified from pre intervention cycle were prescription of fluids, anti-emetics, laxatives, and anticoagulant reversal, with a compliance of 56%, 44%, 42% and 50%. Other parameters had a compliance of &gt;90% pre and post intervention. Post intervention compliance was 90% for fluids, 66% for anti-emetics, 74% for laxatives and 80% for anticoagulant reversal.

Conclusion
Introduction of a checklist is effective in improving the quality of care for patients with neck of femur fracture. More interventions incorporating the PDSA methodology will be carried out to strive for further quality improvement.
558 An Evaluation of Surgical Input and Management of Head Injury in a New Acute Hospital in South Wales: Does It Need to Be a Headache?
Authors: Owen A , David E , Edwards P 
Published: November 2022

Abstract

Aim
The Grange University Hospital is a new major acute hospital in South Wales. Similarly, to other hospitals without neurosurgery, patients presenting to A&E with head injury (HI) that do not require transfer to a neurosurgery centre are admitted under general surgery. This audit aimed to:

Method
Patients admitted via A&E with the diagnosis code “Head Injury” (N=119) identified between November 28th-April 28th, 2021 (6 months). Paediatric (Aged 0–18) patients (N=25) were excluded as identified admitting team as per protocol is paediatrics. Relevant data extracted using Clinical Workstation.

Results
N =94 patients. Of these, 12 were discussed with neurosurgery and 1 patient transferred to a tertiary centre. 44% were referred to a surgical speciality other than general surgery for assessment. Despite this, of those 41, 61% (25) were admitted under general surgery (Average length of stay 2.5 days). Only 8 admitted patients necessitated plans beyond neuro observations. 28% of patients admitted under general surgery required medical assessment (4 falls assessments, 3 COTE referrals and subsequent takeovers). 0 patients had any general surgical pathology.

Conclusions
629 Improving Gentamicin Prescribing for Intra-Abdominal Sepsis on a General Surgical Firm
Authors: Fardanesh A , Koo HF , Van den Berghe C , Gathercole G , Dilke S , Sengupta N 
Published: November 2022

Abstract

Aim
Gentamicin is recommended by local guidelines for the empirical treatment of intra-abdominal sepsis. However, severe side effects that can occur through prolonged raised through levels requires its use through a specific dosing protocol. Challenges of this means it often “falls off” the drug chart, leading to suboptimal drug-levels. The aim of this quality improvement project was to improve the process of gentamicin prescription.

Method
A two-week retrospective analysis of all patients admitted was performed to obtain baseline data. Information was collected on gentamicin use, if levels were taken at 6–14 hours post-dose, and if subsequently correctly re-prescribed. PDSA 1 involved placing posters in the surgical office, reminding the clerking doctor of the gentamicin protocol. PDSA 2 involved a departmental teaching session to reiterate the above intervention.

Results
At baseline, only 7% (1/15) of patients prescribed gentamicin had a correct post-dose level taken and subsequently received a correct second dose. After PDSA 1, this rose to 67% (2/3). After PDSA 2, this level was similar at 60% (3/5). Furthermore, at baseline 47% (15/32) of patients deemed to have intra-abdominal sepsis received gentamicin. After PDSA 1, this proportion fell to 11% (3/28) and after PDSA 2 this was 38% (5/13).

Conclusions
Education sessions and posters were effective at increasing the proportion of patients that received a safely prescribed second dose of gentamicin, as a result of correctly taken trough levels. However, a reduction in the percentage of patients receiving gentamicin for intra-abdominal sepsis possibly suggests further education on the role of gentamicin is required.
656 Making an Effective Ward Round Model in the Department of Trauma and Orthopaedic Surgery for University Hospitals of Birmingham Trust
Authors: Khaleeq T , Lo N , King J , Turner A , Howland E , Graham T 
Published: November 2022

Abstract

Background
Ward rounds in hospitals are crucial for decision-making in the context of patient treatment processes.

Objectives
Improve the standard of ward rounds with a review of care and planning.

Method
6 key elements were established using the Modern ward rounds report by the Royal College of Physicians and Nursing. This includes daily ward rounds which will be multidisciplinary, documented clearly and handed over to relevant staff; consisting of a board, bedside ward round and debrief; using Prompts in the form of REMIND mnemonic : R = Respect form, E = Electronic Prescribing, M = Mental Capacity, mobility status, I = Investigations, N = Nutrition and Hydration, NBM status, D=DVT assessment and Thromboprophylaxis; with practices being audited.

Results
After running a successful pilot in Respiratory in August 2021 the quality improvement project (QIP) was introduced in Trauma and Orthopaedic surgery.
88 patients were included in the initial audit prior to implementation and 91 in the re-audit. There was a 85% improvement seen in completion of respect and dementia forms with a 90% improvement in electronic prescribing. There was an 75% improvement in documentation of mobility status, investigations performed and NBM status. Fluid prescription, DVT assessment and LMWH prescription also improved by 85%.

Conclusions
A successful Pilot in Respiratory and Trauma and Orthopaedic Surgery shows the feasibility of the QIP in other departments. However, Education should also include Consultant and nurses. We are overcoming this but establishing a virtual module that can be made mandatory for induction of junior doctors, consultants, and nurses.
745 Does a Smartphone Application Improve Medical Students and New ENT Junior Doctors Confidence When Dealing with ENT Clinical Scenarios?
Authors: Akbar S 
Published: November 2022

Abstract

Introduction
Through the use of online applications, doctors can efficiently access an abundance of medical information to ease transition into subspecialities. This is valuable for otolaryngology in which junior doctors may possess little prior experience. The development of a electronic application within otolaryngology may improve doctors’ ability to carry out the junior doctor role.

Method
A cohort of 10 junior doctors and 10 medical students based at Blackpool Victoria Hospital with no prior clinical otolaryngology experience were asked to rate their confidence in approaching 5 common otolaryngology scenarios before and after being granted access to a clinical e-application. The otolaryngology application was locally constructed and included important otolaryngology information and resources for the junior doctor role.

Results
During the course of the project, every single participant showed an increase in their confidence score when dealing with each scenario following access to the application. This was true for both medical students and junior doctors. Junior doctor confidence scores increased for every scenario following access to the otolaryngology application with an overall average increase of 148%. Medical student confidence scores also increased for every scenario following access to the application with an overall average increase in confidence of of 124%.

Discussion
ENT smartphone applications have been shown to be successful in providing relevant information to medical students and junior doctors to develop their confidence in approaching common clinical scenarios. The provision of such a resource for surgical subspecialties promotes a further step towards a paperless NHS as well as a standardised way of approaching patient care.