bluuebunny/crossref_metadata_2025_split huggingface dataset:
124 Administration of Fascia Iliaca Block to Patients Who Have Suffered a Neck of Femur Fracture
Authors: West C. , Wright C. 
Published: February 2022

Abstract

Aim
Hip fractures are the most common serious injury affecting elderly people and are associated with a total cost to the health and social services over £1 billion per year. This injury takes approximately 1% of the NHS budget. Furthermore current 30-day mortality rate is 6.5% so has serious implications for patients. NICE recommend that nerve blocks should be used to help perioperative pain and limit the use of opioids. We audited our use of analgesia, especially fascia iliaca blocks (FIB), to see whether training could improve the management of these patients.

Method
We conducted a retrospective cohort study in which a total of 188 patients, who had sustained a hip fracture, were audited during 4 discrete periods between March 2021-July 2021. The primary outcome assessed was whether they had received a FIB preoperatively. Improvements were implemented between audit cycles to see if they achieved desired outcomes.

Results
Implementation of good quality teaching to orthopaedic juniors and emergency department registrars and juniors successfully improved rate of FIB from 2.5% to 47%. The rate of FIB was not sustained over time and declined to 22%. Factors thought to influence this decline included regular rotation of junior doctors and increasing time pressures in the emergency department.

Conclusions
Our data suggested that low rates of FIB resulted in high opioid use in the emergency department. Allocated teaching sessions on administration of FIB were a successful way to improve use of blocks and reduce opioid use.
127 Optimum Treatment for Sigmoid Volvulus Remains Elusive but Surgery May Provide Considerable Benefit: Results of a 5-Year Audit
Authors: Issa M. , Nair D. , David B. , Banks J. , Lewis E. , Monk C. , Griffin A. , Guy R. 
Published: February 2022

Abstract

Background
Sigmoid volvulus is a surgical emergency and patients are often elderly with significant comorbidities. Whilst endoscopic decompression is easy and effective in the short-term, recurrence and repeated admissions are common with surgery generally being reserved for non-resolution or complications. Consensus an optimum management is lacking.

Method
A retrospective audit of all patients admitted with sigmoid volvulus to a DGH General Surgery service between 01/01/2015-20/10/2020 was undertaken. Patient demographics, comorbidities, clinical findings, investigations, and treatment were recorded.

Results
Sixty-three patients were identified (median age 71.5 years; 58.7% male]. Some 50.8% had more than one previous presentation (range 1–6), 19% presented after 3 days of symptoms and 3.2% presented with perforation. Plain radiography and CT scanning was undertaken in 90.5% and 54%, respectively.
Endoscopic detorsion was performed in 77.77% and repeated in the same admission for 33.3% of cases. Flatus tubes and rigid sigmoidoscopy was used in 47.6% with a 59.6% success rate. Seventeen patients (27%) underwent sigmoid resection, 14 having open surgery and 3 laparoscopic. Primary anastomosis was undertaken in 64.7% (11 patients), with only one anastomotic leak; the remaining 6 patients had a colostomy. The re-admission rate was 30.1% (19% non-operated patients, 11.1% operated patients).

Conclusions
Most patients with sigmoid volvulus are managed non-operatively with endoscopic detorsion which may be associated with a considerable healthcare burden and high readmission rates. Selective resection can be associated with low morbidity and good outcomes. Clinicians could reasonably adopt a lower threshold for surgical intervention, particularly for recurrent volvulus.
128 Thickness and Porosity of the Human Calvarium Layers: A Systematic Review
Authors: Cheong J. , Bhumitrakul J. 
Published: February 2022

Abstract

Introduction
With the advent of 3D printing in surgical training, producing realistic cranial bone models can benefit cranio-surgical training greatly. This includes the measurements of the individual layers of the skull. Hence, we have done this systematic review to identify the calvarial thickness measurement in the literature, if the different modalities affect the thickness and if calvarial thickness in human and cadaveric samples differ.

Method
Our literature search explored the terms, “Calvarium thickness” and “Cranial thickness” on PubMed and Google Scholar databases. A total of 6871 papers were identified and following the implementation of the PRISMA criteria, 7 papers were included in this review. Our inclusion criterias are studies that report on thickness, density and porosity, samples obtained from people greater than 20 years old and studies that included parietal bones and frontal bones.

Results
Our review identified inconsistent results with the thickness of the inner and outer table in the frontal bone. The results for the parietal bone were more consistent, which shows that the diploe is the thickest, followed by the outer table then the inner table. The porosity for the different layers in both parietal and frontal bones were consistent with the highest in the diploe and lowest in the outer table. CT scans showed similar measurements across different studies and are more accurate than ultrasound. However, the lack of standardised protocol could have resulted in the heterogeneous results obtained.

Conclusions
Our findings from this systematic review will provide insight into some of the improvements needed for future studies and applications.
130 Paediatric Hand Fractures Requiring Surgery – the Results of a Bespoke Hand Surgery Service
Authors: Donnachie D. , Yim G. , Watts A. 
Published: February 2022

Abstract

Aim
To evaluate the management of The Royal Devon and Exeter Hospital (RD&E) bespoke hand surgery service on paediatric closed hand fractures. In particular, an assessment against The British Society for Surgery of the Hand (BSSH) closed fracture standards on treatment timelines and national guidance compliance.

Method
A retrospective review of all paediatric patients requiring plastic surgery seen at the RD&E plastics trauma clinic from 1st Nov 2020 to 28th Feb 2021 was performed. This was compared to two previous audit cycles completed during winter 2019 and summer 2020. Health informatics was collated via our IT department and thoroughly reviewed using departmental notes. Exclusion criteria included: all non-fracture injuries, patients &gt; 18 years old and open fractures.

Results
In winter 2020–21 all patients were referred the same day of injury and 92% were seen by a Plastic Surgeon within 24 hours of injury. This was an improvement from the mean time from referral to clinic of 5 days in winter 2019 and 1.33 days in summer 2020 respectively. 85% of cases are now operated within 48 hours of review and 92% of cases were operated within 72 hours of the decision to operate where conservative management had failed.

Conclusions
The introduction of a ‘rapid-access’ musculoskeletal unit with early senior review and a dedicated theatre has created ‘gold-standard’ compliance with national standards for the operative management of closed paediatric fractures. We should continue to focus on improving and increasing capacity of this service as it has likely improved both the patient journey and outcomes.
138 Using Peer-to-Peer Induction to Improve the Confidence of Incoming Surgical FY1s During Changeover
Authors: Smitheman M. , Zafar A.Q. 
Published: February 2022

Abstract

Aim
The benefits of peer-led teaching are well evidenced, as are the benefits of interactive over passive learning in a clinical setting.
This project aimed to create an FY1-led induction model that could be reproduced across departments, cost-effectively boosting junior trainee confidence, and improving continuity of care during quarterly changeover periods with minimal pressure on senior clinicians.

Method
Areas for focus were identified by consultants and departing FY1s to produce an FY1-led, presentation-based induction for December and April changeovers.
Incoming FY1 confidence was assessed using pre-induction and post-induction surveys to identify areas for improvement in future.
An interactive e-learning induction replaced the presentation for the new FY1s in August, again using surveys assessing trainee’s confidence versus previous cycles.

Results
The first two inductions both showed a complete reduction in trainees rating themselves overall ‘not so confident' or below.
Four of the six targeted areas showed increased improvement in confidence in April versus December.
The August e-learning induction showed a 71% increase in newly qualified FY1s rating themselves as overall ‘confident’ or ‘very confident’, an improvement on previous inductions. ‘Confident’ and ‘very confident’ ratings for focused areas increased by 62% on average, versus 37% and 27% previously.

Conclusions
This induction greatly increased FY1s’ confidence, with feedback citing peer-gained insights as the main positive addition to the consultant-led induction.
Combining the evidence-based methods of peer-led teaching and interactive e-learning resulted in a replicable, cost-effective, and time-efficient template for improving confidence and continuity of care in the changeover period. This could be implemented in any department nationwide.
145 Best Medical Therapy for Patients with Peripheral Arterial Disease: A Quality Improvement Project in Vascular Surgery, Aberdeen Royal Infirmary
Authors: Hapca S. , Shepherd J. , Messeder S.J. 
Published: February 2022

Abstract

Introduction
Peripheral arterial disease (PAD) is the leading cause of limb amputation and cardiovascular morbidity. The National Institute for Health and Care Excellence (NICE) advocates best medical therapy (BMT) with high-dose statin (atorvastatin 80mg) and antiplatelets (clopidogrel or aspirin) for secondary prevention in patients with PAD. We assessed compliance to BMT prescribing in our vascular department.

Method
Retrospective data were collected for all patients admitted with symptomatic PAD in our vascular department over a 2-week period. Criteria for BMT were as per NICE guidelines with a standard set to 100%. Following cycle 1, a new admission document prompting antiplatelet and statin review was designed and departmental teaching on BMT delivered. Standard compliance was re-audited after 3 months.

Results
Twenty-five patients were admitted with PAD during cycle 1 with 28% of patients (n = 7) on BMT on admission. This increased to 40% (n = 10) on discharge with 100% (n = 25) on an antiplatelet and 28% (n = 7) on high-dose statin. Overall, there were twenty patients in cycle 2 with 25% of patients (n = 5) on BMT on admission. This increased to 80% (n = 16) on discharge with 100% (n = 20) on an antiplatelet and 80% (n = 16) on high-dose statin.

Conclusions
Our data demonstrated poor implementation of BMT for patients with PAD managed in primary care suggesting a need for primary care education. Adaption of our admission proforma to prompt BMT prescribing as well as departmental teaching was associated with drastic improvement of BMT prescription on discharge and standard adherence.
148 Posterior Malleolus Fractures: Classification and Patient Outcomes
Authors: Banks P. , Lineham B. 
Published: February 2022

Abstract

Aim
Posterior malleolus (PM) fractures are a common and significant injury. Historically, only fractures constituting &gt;30% of the joint surface were managed operatively, however more recent research suggests that the type of fracture and injury mechanism carry more importance. This study compared the patient outcome scores with the most common classification systems, percentage tibial plafond involved (PTP) and fixation method.

Method
Patients diagnosed with PM fractures between December-2020 and January-2015 were identified and invited to answer a Foot and Ankle Outcome Survey (FAOS). Responding patients had CT scans reviewed by a consultant radiologist. The fractures were classified using Mason Malloy, Haraguchi, Bartonicek and PTP. Groups were further divided into those managed as recommended by each classification. The classifications were correlated against FAOS using Pearson correlation coefficient or one-way ANOVA test as appropriate.

Results
59 patients responded with a completed FAOS. When classifications were measured against FAOS no statistically significant difference was identified (Bartonicek F = 1.78 p = 0.15, Haraguchi = F = 0.41 p = 0.66, Mason Malloy F = 1.24 p = 0.30, PTP = 0.11 p = 0.41). When only those managed as recommended by the classification system were included there remained no significant difference (Bartonicek F = 1.8 p = 0.18, Haraguchi F = 2.4 p = 0.10, Mason Malloy F = 0.25 p = 0.86, PTP = 0.25 p = 0.06).

Conclusions
Categorisation of PM fractures by any of the three main classification methods or PTP did not correlate with FAOS in this group including in patients managed as suggested by the classification. Whilst recognising the limitations of this retrospective study this may suggest patient outcome from PM fractures is more significantly influenced by other factors than fracture classification.
152 Improving Imaging in Acute Pancreatitis
Authors: Al-Khazaali B. 
Published: February 2022

Abstract

Aim
In the UK it is not a current practice to perform early (&lt; 3 days) CT for detection and staging of severe cases of acute pancreatitis. Findings of pancreatic necrosis, fat stranding and intraperitoneal fluid should be included in the CT scan report as they are important prognostic factors. Furthermore, radiological facilities should be available to permit US examination of the gallbladder &lt;24 hours of the diagnosis. The aim was to meet 95% for all standards.

Method
Retrospective baseline data were obtained for 83 patients presented with acute pancreatitis between January 2020 and February 2021. Several interventions were implemented including educational posters, emails and lectures to general surgeons and radiologists. Re-auditing was conducted between May and August 2021 to measure the effectiveness of these interventions.

Results
Baseline showed low compliance to standards, and 62% of presented patients underwent early CT (&lt; 3 days). Only 78% received US scan within 24 hours of admission. Second cycle showed increased adherence to NICE guidelines with 56% of patients had CT scan in optimal timing. Reports of CT scans showed minimal improvement in terms of including the prognostic factors. US examination of gall bladder improved with 83% of patients diagnosed with acute pancreatitis.

Conclusions
Early CT may underestimate final severity of acute pancreatitis. Low adherence to guidelines was noticed in the first audit cycle which was increased after the interventions. Further interventions and auditing will be needed.
155 Fracture of Pubic Rami During Hip Fracture Fixation - a Rare Case of Traction Table Related Injury
Authors: Gomindes A.R. , Remtulla M. , Mohammed A. , Cooper J. , Nikolaidis A. 
Published: February 2022

Abstract

Background
Traction tables form the mainstay of closed reduction techniques for lower limb fracture and in particular hip fractures. They offer a versatile solution to continuous traction required in a variety of operations such as closed intramedullary femoral fixation and hip fixation. Counter traction on the table is provided by the perineal post, this has been associated with significant complications such as neuropraxia, erectile dysfunction, cutaneous necrosis, and urethral injuries.

Case presentation
We present a case of an elderly and co-morbid patient who was scheduled to undergo a hip fracture fixation using an intramedullary nail. Unfortunately, this was delayed by 3 weeks as the patient was unfit to undergo this procedure. She was placed onto the traction table and intra-operatively sustained a superior and inferior pubic rami fracture while attempting reduction on the traction table.

Conclusions
Closed reduction techniques using traction tables and perineal posts are not without morbidity. Risk factors such as osteoporosis and delayed fixation should be accounted for when managing this complex and often frail group of patients.
156 A QIP on Improving Approach Towards Suspected Cauda Equina Syndrome Referrals
Authors: Salik M. , Bhagawati D. 
Published: February 2022

Abstract

Aim
To improve the assessment, documentation, and management of suspected Cauda Equina Syndrome (?CES) referrals by supporting and educating new doctors joining T&O

Method
A survey was done to assess the level of training received by Junior Doctors in Assessment, Documentation, and Management of a ?CES Referral. A need for such training was established from the Survey Report. Teaching was organized and an Infographic poster was published to aid new doctors in safe assessment, documentation, and management of? CES cases. A post Survey was done to assess the impact.

Results
There was a significant need for teaching and training regarding the approach towards dealing with a suspected Cauda Equina Syndrome patient. The teaching was very well received. 90% of the participants believed that the QIP and the infographic poster were useful in training, will be a helpful guide for new doctors in assessment, documentation, and management of suspected Cauda Equina Syndrome patients, and will lead to improvement in patient care and documentation.

Conclusions
Suspected Cauda Equina Syndrome bears a huge significance in Emergency Care and Trauma and Orthopaedics. Mismanagement of such a case and unnecessary delays can have a drastic impact on a patient’s life and as such can also lead to significant medico-legal implications from the managing team. Teaching and training regarding approach towards a suspected Cauda Equina Syndrome can lead to significant improvement in the competence and confidence of the Junior Doctors and New Trainees and thus lead to better patient care, better documentation standards, and potentially prevent unnecessary delays.
164 Testicular Torsion: A Race to Beat the Golden Hours
Authors: Rai A. , Singh R. , Mehana O. , Alam A. 
Published: February 2022

Abstract

Introduction
Testicular torsion is a condition requiring immediate attention and the golden time period for its management is 6 hours at which rate of salvageability of the testes is 90 percent (NICE). This decreases considerably with passing time. Imaging has minimal value.

Method
The electronic data of 36 patients from June 2020 to May 2021 were reviewed and analysed. Majority of patients were between the age of 11–20 i.e., 21. We analysed the mode of admission of these patients, the time between the A&E triage and surgical clerking and A&E triage and induction of anaesthesia.

Results
Majority (70 percent) patients were admitted through Emergency A&E. The time between the A&E triage and surgical clerking was less than 30 minutes for 10 patients while 11 patients had no proper documentation of time. The time between the A&E triage and the induction of anaesthesia was less than 6 hours in 23 patients, and more than 6 hours for 7 of them. 14 underwent Scrotal Exploration and Bilateral orchidopexy and 13 orchidectomies. Out of 13 orchidectomies, 6 had crossed the golden time period at the time of induction. Out of 10 patients booked for USS testis, 8 underwent Orchidectomy and 6 had crossed the golden hour (6 Hours).

Conclusions
Early presentation, diagnosis and exploration of testicular torsion improves the salvable rate of testes. 6 patients who underwent USS testis passed the golden timeframe which shows that there is a scope for faster and appropriate management of testicular torsion.
165 Cataract Surgery: What Intraoperative Factors Impact Surgical Outcomes in Low- and Middle- Income Countries (LMICs)
Authors: Sondh R. , Azizi S. 
Published: February 2022

Abstract

Aim
To describe what intraoperative factors affect the outcomes of cataract surgery in LMICs.

Method
The following databases were screened to find relevant articles: EMBASE (1974–2019), MEDLINE (1946–2019), Global health (1973–2019), PubMed, Cochrane library and Cumulative Index to Nursing and Allied Health Literature. Following this, duplicates were removed, and articles underwent screening.

Results
Perioperative checks – It has been recommended for LMICs to implement similar surgical checklists to what is used in the UK, to reduce the chance of surgical complications. Having the right team - The cataract surgery team may vary in different countries. For example, in Ethiopia the staffing model includes ophthalmologists, non-physician cataract surgeons (NPCS), ophthalmic officers, ophthalmic nurses, operating room nurses and integrated eye care workers. It is common in LMICs for NPCS to outnumber ophthalmologists. Adequately skilled professionals – It’s important to consider having vitreoretinal surgical input available should surgical complications arise. This will help to optimise outcomes. Surgical technique – Techniques performed in LMICs include ICCE (intracapsular cataract extraction), ECCE (extracapsular cataract extraction and MSICS (manual small incision surgery) and phacoemulsification. ECCE and MSICS is the most commonly used in LMICS due to comparable outcomes with phacoemulsification and cost effectiveness. Surgical training and skills transfer – Various international training programmes such as the HelpMeSee programme is designed to help train ophthalmologists and NPCS in MSICS via simulation.

Conclusions
The above factors are important considerations which influence surgical availability and success. LMICs have an increasingly aging population and cataract services will be required to adapt to the increase demand.
168 Innovation Surgical Leadership: Future Directions
Authors: Haque S. 
Published: February 2022

Abstract

Aim
Which theories, concepts and frameworks have been evidenced for surgical innovation in leadership in the United Kingdom, European Union, and the United States of America?

Method
Systematic scoping synthesis of literature will be employed where appropriate theories, concepts and frameworks will be identified. Drawing upon broader literature on leadership innovation in surgery further examples will be utilised within surgery. s and full- text articles will be used and reviewed for relevance to the research question against an inclusion and exclusion criteria.

Results
The theories of innovative leadership in surgery are broad and non-specific. It demands a professionalism, competence, teamwork, and motivation. Upon comparison of the three country/region profiles there are strong similarities but present differences. It is paramount to understand and underpin these theories in order to foster the future of innovation in surgery. Surgery is fast evolving and developments in leadership must evolve with it. Within innovation, leadership skills must be harnessed including experience and observation. It is through an interprofessional team that surgeons must collaborate in order to provide optimum results and to permit the profession to evolve.

Conclusions
Innovation and surgery are symbiotic, and the next generation of surgical leaders must foster an environment where this is possible to cultivate. Programmes across these country profiles must ensure innovative leadership is present through good mentorship, coaching, team empowerment and feedback. Future directions must be put in place in post -graduate surgical training programmes to ensure that patient care is optimised as the primary objective.