bluuebunny/crossref_metadata_2025_split huggingface dataset:
378 Comparison of Outcomes Between Early and Delayed Weight Bearing Following Lower Limb Free Flaps
Authors: Roman M , Al-Khalil M , Emam A , Marsden N 
Published: November 2022

Abstract

Aim
Post-operative protocols following lower limb free flap surgery are not well defined with a lack of consensus in the literature around limb dependency and weight bearing. The aim was to compare the complication rate for lower limb free flaps before and after the introduction of an enhanced lower limb free flap protocol with earlier dangling (day 3 vs day 4) and weight bearing (day 5 vs day 14) post lower limb free flap surgery.

Method
All lower limb free flaps between June 2020-October 2021 were identified from a departmental flap database. Patient data was collected retrospectively from the comprehensive lower limb free flap database, medical notes and electronic records. Exclusion criteria was any patient prescribed non-weight bearing due to the method of bone fixation.

Results
A total of 30 patients, 14 pre- and 16 post-enhanced protocol were identified for comparison. Mean age was 43 (17–72) with a M:F of 2:1 and RTC as the most common mechanism of injury. There was no difference in the type of flap reconstruction between groups, with the anterolateral thigh flap the most common in both groups. No differences were identified in the number of complications related to dependency/weight bearing before and after the introduction of the enhanced protocol, with mean length of stay reduced from 12 to 11 days.

Conclusions
The new enhanced protocol remains the standard of care in our unit, as we demonstrated a reduction in length of stay with no difference in complication rates following lower limb free flap surgery.
486 The Use of Ketamine Sedation for the Treatment of Nail Bed Repairs in the Paediatric Emergency Department
Authors: Bradley A , Faulkner J , Jatan A , Stewart C 
Published: November 2022

Abstract

Aim
To determine if ketamine sedation is a safe and cost-effective way of treating paediatric patients presenting with nail bed injuries to the emergency department.

Method
A retrospective cohort study was carried out over a nine-month period in children between ages 18 months and 16 years old, presenting to the paediatric emergency department (PED) at Chelsea and Westminster Hospital, London, with nail bed injuries requiring repair by the plastic surgery team. The primary outcome measures are complications at the time of sedation and at outpatient follow up including surgical site infection at seven days. A secondary outcome measure of parental satisfaction was collected at four months. A cost analysis comparison against procedures completed under general anaesthetic was also undertaken.

Results
During the 9-month period, 10 nail bed repairs were performed under ketamine sedation in the PED. There were no serious adverse events recorded. No cases required further procedures and there were no cases of surgical site infections at 7 days. Parents reported favourable outcomes, with an average overall satisfaction score of 9.4 (where 10 is complete satisfaction). At follow up, there was one recorded complication which was successfully treated, with all patients being discharged from follow up within 3 months.

Conclusion
This small study has shown ketamine procedural sedation in the paediatric population to be a safe and cost-effective method for the treatment of nail bed injuries in children presenting to PED. We believe that this management strategy, brought to the fore during the COVID-19 pandemic, should be considered as standard across all PEDs.
546 A Longitudinal Case History of Skin Cancer Presentations from One of the UK's Longest Surviving Renal Transplant Patients
Authors: Rela M , Sarginson J , Rickard R 
Published: November 2022

Abstract

Introduction
The immunosuppression required by solid-organ transplant patients not only increases their risk of severe infections but also pre-disposes them to post-transplant malignancy, with skin cancers being the most frequent type. We present a longitudinal history of skin cancers in a patient who received their kidney transplant as a child and has been on immunosuppression for 50 years.

Case Report
The patient developed renal failure at 12 years of age and received a living donor renal transplant in 1970. He developed his first skin cancer in 2004, 34 years later. To date he has had a total of 173 lesions excised of which 123 were a non-melanoma skin cancer (NMSC) (108 basal cell carcinomas (BCCs) and 15 squamous cell carcinomas (SCCs)). None of these lesions had any high-severity features such as poor differentiation or lymphovascular invasion. Numbers of BCCs have not varied, but numbers of SCCs, Bowen's disease and Actinic Keratoses have risen gradually over time.

Discussion
The patient developed his first skin cancer later than has typically been reported in transplant patients and has had a ratio of BCCs to SCCs more similar to the non-transplant population.

Conclusion
Whilst the patient has had a large number of NMSCs over time, a recognised association for those taking immunosuppressive medications, the types and nature of his lesions mirrored that of the non-transplant population, which could relate to the fact he received his transplant as a child.
706 Cleft Palate in Pierre Robin Sequence
Authors: El Hasnaoui C 
Published: November 2022

Abstract

Introduction
Pierre Robin's sequence PRS is a congenital malformative sequence with a retrognathism, a glossoptosis, and an upper respiratory obstruction with an associated cleft palate. This malformative association can be disabling for both the child and his parents, because of its aesthetic, functional, psychological, and social impacts.

Aim
To assess how the cleft palate repair in PRS patients can help in the management of the condition.

Method
We have investigated 14 patients with PRS presenting cleft palates, collected over a period of 5 years, from March 2014 to November 2019 in the pediatric surgical emergencies department (PSE) in Rabat Children's Hospital (HER).

Results
Nine of the 14 patients had a complete cleft palate. The average age of intervention was 23 months ranging from 13 months to 4 years. The study showed a slight female predominance (n = 8, 57%). Regarding the treatment, 3 patients were treated with the Bardach's technique, 3 had the Von Langenbeck's technique, 3 had the Push-back technique and one patient who suffered from a post-operative persisting velar division was treated by veloplasty 3rd generation. The hospital stay was around 24 hours, and the post-operative follow-up was uncomplicated for all our patients.

Conclusion
Although we had relatively high success with our approach, the complexity and lack of consensus regarding the management of Pierre Robin's sequence still requires the involvement of a multidisciplinary team. The main aim is to give the best cosmetic and functional results in order to reduce the suffering of the PRS children and families.
725 Paediatric Resuscitation Burns Maintenance Fluid Selection - a Retrospective Review of Cases and Adherence to NICE, LSEBN and EMSB Guidelines
Authors: Noton T , Al Omran Y , Williams A 
Published: November 2022

Abstract

Aim
Appropriate fluid management in major burn injuries is directly related to burn survival rates. Despite this fact, there are still controversies regarding the choice of replacement fluid given during the resuscitation and maintenance stages in the acute management of burns. The aims of this study are to compare current paediatric maintenance fluid prescriptions against current guidelines, and to assess whether there is of any adverse effects (i.e., electrolyte disturbance).

Method
Details of all paediatric burn's patients (aged 18 years or under) who were admitted to the paediatric burns ward during an 18-month-period were screened. Only those coded as having sustained 10% TBSA burns or greater were included in data analysis. Data was then sourced using Cerner electronic patient record software.

Results
A total of 17 patients were identified, all sustaining scald injuries with between 10% and 22% TBSA burns. Every patient was given 0.45% NaCl with 5% dextrose as maintenance fluid. All IV maintenance supplementation was ceased after 24hrs. Only 53% of patients had pre- and post-fluid bloods taken. Average drop in sodium amongst these patients was 2mmol, with largest drop (5mmol) in the patient with the largest burns % TBSA.

Conclusions
We found zero compliance with current NICE guidelines, which suggests an isotonic crystalloid (such as 0.9% NaCl with 5% dextrose) for maintenance, therefore guidance in line with this should be considered. Larger burns TBSA or prolonged IV fluids may amplify electrolyte imbalances. The importance of consistent electrolyte monitoring amongst this patient cohort is key and should be encouraged.
963 Paediatric Full-Thickness Burns Caused by Cyanoacrylate Nail Adhesive - a Case Series
Authors: Noton T , Leon-Villapalos J , Atkins J 
Published: November 2022

Abstract
Cyanoacrylate glue, often found in acrylic nail kits, reacts in an aggressive exothermic reaction with cotton fabric. These potentially dangerous adhesives are freely available and there remains little understanding about the consequences on contact with cotton.
We present two paediatric cases of thermal burns related to the use of cyanoacrylate glue, both seen after the application of acrylic false nails.
The first patient is a 14-year-old girl, who presented with a 0.25% TBSA full thickness burn to the left heel, after she spilt some of nail glue onto her sock. The burn wound was initially dressed in Flamazine, but later required a formal debridement and split thickness skin graft (SSG).
The second patient is a 11-year-old girl, who presented with a 0.1% TBSA full thickness burn to the dorsal right foot, after applying false nails and again spilling the glue onto her sock. Immediate first aid with cold water was used. This patient was first managed in a local hospital before being referred to the burn's unit due to worsening pain. The wound was dressed in Acticoat, due to a sloughy appearance, and then underwent formal debridement and SSG.
Cyanoacrylate burns are caused by a thermal reaction rather than chemical as most may believe. In both cases described, cotton is likely to have acted as a catalyst, which is consistent with published literature. Warnings on packaging to increase awareness of potential reactions should be mandatory, as well as childproof packaging to help deter the unsupervised use of such adhesives.
965 Removal of Polydactyly in Paediatric Patients with Ligaclips, 10 Year Retrospective Analysis Establishing a Complication Rate and Acceptance to Patients
Authors: Herron Jonathan , Mishra Vaibhav , Al-Badry Waleed , Milroy Catherine 
Published: November 2022

Abstract
Polydactyly is the most common congenital hand deformity. There remains no consensus opinion on the management of a type B post axial polydactyly leading to variations in approach. This study aimed to assess the complication rate and acceptance to patients.
A retrospective analysis of Polydactyly type B patients in a tertiary London hospital was performed over a 10-year period. All of these patients had undergone a clinic ligation of the accessory digit with ligaclips. Those with bony elements (type A patients) were operated on in theatre and were excluded. Parents were asked to rate the outcome on a linkert scale as very poor, poor, fair, good, outstanding and complications from the procedure were recorded.
339 procedures were performed with a 100% success rate in removal of the accessory digits. Reported complications were as follows: one clip fell off but made no difference to the outcome, and seven ‘nubbins’ remained on the limb (2.06%) of which none were painful. There were no other complications reported. All parents rated the success of the procedure as good (1%, n=3) or outstanding (99%, n=336).
Using a ligaclip as the preferred method of removal for Polydactyly type B patients gave a complication rate of 2.06% which was exclusively in the form of ‘nubbins’ and the results were acceptable to patients.
984 The Efficacy of Different Nerve Transfers to Restore Elbow Flexion in Adults Following Brachial Plexus Injury: A Systematic Review and Meta-Analysis
Authors: Lee CYV , Cochrane E , Chew M , Bains RD , Bourke G , Wade RG 
Published: November 2022

Abstract

Aim
There are numerous donors available for neurotisation of the musculocutaneous nerve, following traumatic brachial plexus injury (BPI). However, there is uncertainty over which method is most effective for restoring elbow flexion. We set out to summarise and compared different nerve transfers for restoring elbow flexion after traumatic BPI in adults.

Method
Medline, Embase, medRxiv and bioRxiv were systematically searched from inception to 12 th April 2021. Studies reporting outcomes of nerve transfers to restore elbow flexion in adults were included. BPIs were categorised as partial or pan plexus. The primary outcome was ≥M4 elbow flexion on the British Medical Research Council (BMRC) scale.

Results
We included 64 articles, describing 13 different nerve transfers. There were 1335 adults with 813 (61%) partial and 522 (39%) pan plexus injuries. 75% of patients with partial BPIs achieved ≥M4 (95% CI 69%-80%); double Oberlin or two intercostal nerves appeared to give recovery. For patients with pan plexus injuries, 45% achieved ≥M4 (95% CI 31%-60%) and each month delay from injury to reconstruction reduced the probability of achieving ≥M4 by 7% (95% CI 1%-12%) where intercostal, phrenic or spinal accessory nerves were used as donors.

Conclusions
The choice of donor nerve affects the chance of attaining BMRC ≥4 in upper trunk reconstruction. For patients with pan plexus injuries, delay to neurotisation appears to be detrimental to motor outcome. This information may help clinicians and patients reach shared decisions about the choice of donor nerve(s) and the timing of surgery.
44 Empowering Surgical Foundation Year 1s (F1s) in the Management of High-Risk Post-Op Patients
Authors: Hawkins T 
Published: November 2022

Abstract

Aim
To improve the confidence of a cohort of surgical F1s in the management of high-risk post-op patients. Patients due to have an emergency laparotomy can be risk stratified using the National Emergency Laparotomy Audit (NELA) score. This score gives a percentage risk of mortality within 30 days of the emergency-laparotomy. Patients with a NELA score &gt;5% are classified as high-risk. A proportion of patients will go to the Surgical high dependency unit (SHDU) post-op. The primary doctor presence in the SHDU is a single surgical F1. This leads to the surgical F1s having exposure to the management of high-risk post-op patients1.

Method
Data was collected on every patient to have an emergency laparotomy in the emergency theatre of a tertiary hospital. Over the course of 15 weeks in 2020–21, 36% of post-emergency –laparotomy patients in a tertiary hospital with a NELA score of &gt;10% went to the SHDU post-op.

Results
A combined teaching and simulation workshop on common post-op complications was delivered for a cohort of surgical F1s. The feedback from this showed that all attendees felt that they were now more confident in managing common post-op complications.

Conclusion
Surgical F1s are exposed to the management of high-risk post-op patients. Feedback has shown that a combined teaching and simulation workshop on common post-op complications can increase the F1s’ confidence in managing these conditions.
1. NELA - National Emergency Laparotomy Audit [Internet]. Nela.org.uk. 2021 [cited 26 October 2021]. Available from: https://www.nela.org.uk/
53 Optimising the Holter Monitoring Process: A Quality Improvement Project
Authors: Musai J , Xhabija N , Sula F , Taho E 
Published: November 2022

Abstract

Aim
This quality improvement project began when we observed a lot of unsuccessful 24h Holter readings in our Cardiology clinic. Our project aim was to decrease the number of failed tests by improving health literacy, designing information leaflets, and organizing teaching sessions for the staff.

Method
First, brainstorm sessions were held, and we audited the service for a month to assess the inefficiency problem. A total of 3 PDSA cycles were completed between June 2021 and October 2021. We implemented a laminated information sheet for adult outpatients needing a Holter monitor that was handed out to patients in the waiting area. In addition, scripted messages were also created to guide the health care assistants when scheduling cases and conducting follow-up phone calls. We then introduced a patient information leaflet for patients to take home. Teaching sessions were organised, and we designed a Holter box to contain all equipment.

Results
Initial audit revealed a failure rate of 13.5% and an average turnaround time of 56 minutes. The failure rate after the first PDSA cycle was 13.04% and turnaround time 47 minutes. Data showed a 65.2% patient compliance despite 100% staff compliance. The second PDSA showed a decrease in failed tests to 5.7%, but turnaround time was 1:07. Final results revealed that the failure rate dropped to 2.85% and turnaround time was satisfactory (41 minutes).

Conclusions
The use of effective information tools to promote health literacy can improve workflow efficiency and patients’ understanding of ambulatory tests positively impacting service and patients’ experience.
102 Postoperative Haemoglobin Monitoring in Neck of Femur Fracture Patients. Can a Simple Teaching Session Improve Patient Safety on the Orthopaedic Ward?
Authors: Luckwell R , Van Binsbergen B , Harrison J 
Published: November 2022

Abstract

Aim
Patients who suffer neck of femur fractures (NOF#) are typically frail and at risk of postoperative anaemia which can contribute to a high mortality in this demographic.
This QiP reviewed how well postoperative haemoglobin (Hb) was being monitored on a Orthopaedic unit and assessed the effectiveness of a teaching session to improve this.
A secondary measure was to compare day 1 and day 3 Hb to establish an evidence base for the timing of postoperative Hb monitoring.

Method
Two cycles (1st loop: 8/3/21–21/3/21, n = 21. 2nd loop:3/7/21–16/7/21, n=15) were performed either side of a teaching session.
Day 1 and day 3 post-op Hb were recorded.
Inclusion criteria were patients who fitted NOF# best practice tariffs.

Results
Pre-intervention saw 90% of patients have day 1 Hb and 52% have day 3 Hb taken, this increased to 93% and 67% post intervention.
81% of patients showed a Hb drop between day 1 and day 3 (mean = 11 g/dL), with 90% of day 1 bloods already below reference range.

Conclusions
We demonstrated that a teaching session highlighting the importance of Hb monitoring in this patient demographic can improve the monitoring of postoperative haemoglobin and thus improve patient safety.
Secondly, a Hb drop is possible from day 1 to day 3 and therefore a day 1 Hb should not be relied on.
Future work will aim to investigate the longer-term trend of postoperative Hb to establish when an outpatient Hb should be performed.
275 ENT and Plastic Surgery Senior House Officers/house Officers Access to Patient Clinic Letters - Closed Loop Audit
Authors: Lam CM , Yii NW 
Published: November 2022

Abstract

Aim
To evaluate whether senior house officers (SHOs) and house officers (HOs) on plastic surgery and ENT: 1. have received training to access healthcare records and 2. feel confident with accessing healthcare records when needed.

Method
Retrospective audit. Questionnaires were sent to ENT and plastic surgery SHOs and HOs. After the first cycle of audit, the induction that ENT and plastic surgery SHOs and HOs receive at the start of rotation was changed to incorporate training for accessing healthcare records and a second audit cycle was completed. The audit gold standard were local trust guidelines, and the target benchmark was 100%.

Results
First audit cycle showed 0% of SHOs and HOs on plastic surgery and ENT were trained to access healthcare records at induction and 25% felt confident with accessing healthcare records when needed after their induction. After the changes to induction were implemented, the second audit cycle showed that 80% of SHOs and HOs were trained to access healthcare at induction and 100% of SHOs and HOs felt confident with accessing healthcare records when needed after their induction.

Conclusions
Induction at the start of a rotation is essential for junior doctors to be equipped with the knowledge required to deliver their clinical duties effectively. It is important to listen to feedback and improve this induction process. Further cycles of audit are required to assess if this change has been sustainable.
292 Patient Experience of Urodynamics Within a Urology Unit at a District General Hospital
Authors: Hayes J , Bahn-Christensen L , Perkins J , Pullar B , Foley C 
Published: November 2022

Abstract

Aim
Urodynamic assessment is an invasive outpatient diagnostic modality that is performed in most urological centres. What is the patient experience of our service, in regard to levels of anxiety, embarrassment and overall satisfaction?

Method
Patients undergoing urodynamic investigation, between August and November 2021, were asked to complete a questionnaire, with a visual analogue scale (VAS), where 1 was ‘not at all’, 2 ‘a little’, 3 ‘moderate’, 4 ‘a lot’ and 5 ‘extremely’. Levels of anxiety (pre- and peri-procedure), embarrassment, pain and overall satisfaction were assessed. Basic patient demographic data were obtained, in addition to the type of lower urinary tract symptoms (LUTS) under investigation.

Results
Questionnaires from 26 patients were obtained. The majority were male (80.8%) with a myriad of symptoms: 30.8% storage, 23% voiding and 46.2% mixed LUTS. The mean overall satisfaction, via the VAS, was 4.35. Anxiety was 3.38 pre-procedure, and 2.23 peri-procedure. Both pain and embarrassment scores were 1.81 and 2.08 respectively. All patients received a urodynamics information leaflet prior to their appointment. Furthermore, all patients would have been willing to undergo the procedure again in the future, if necessary, and recommended the unit to a friend or colleague.

Conclusions
On review of our local urodynamics service overall patient satisfaction is excellent, with low levels of peri-procedural anxiety, pain and embarrassment. Prior to their appointment, patients are understandably anxious and additional adjuncts to mitigate this, such as an informative telephone call in advance or urodynamics information video, are currently being explored.