Bedford Hospital Research Articles

ODP628 Quality Improvement Project (QIP) On Management Of Diabetic Ketoacidosis (DKA) In Adults In A District General Hospital.

Abstract Aim A Quality Improvement Project was conducted to assess if Bedford Hospital NHS Foundation Trust was meeting current Trust guidelines for the diagnosis and management of diabetic ketoacidosis (DKA) in adult patients. Method Retrospective data was collected from adult patients admitted with a diagnosis of DKA from January 2020 to December 2020. Data was collected for five key standards based on Trust guidelines: (1) Correct diagnosis of DKA, (2) Correct prescription of Intravenous (IV) fluids and potassium chloride (KCL) replacement, (3) Switching from Fixed Rate Intravenous Insulin Infusion (FRIII) to Variable Rate Intravenous Insulin Infusion (VRIII) following resolution of DKA, (4) The prescription of long-acting insulin during FRIII/VRIII and (5) Appropriate biochemical monitoring via regular venous blood gases (VBGs). Following data analysis, an intervention phase (with distribution of 'DKA diagnosis and management' posters, DKA teaching sessions and email updates on DKA management for medical doctors) was implemented. The cycle was repeated a further two times, with the most recent cycle based on patients admitted between August to November 2021. Results The first cycle consisted of 25 patients. Results showed a 72% adherence to Standard 1, a 64% adherence to Standard 3 and a 76% adherence to Standard 5. There was a notably low adherence to Trust guidelines for Standards 2 and 5, which were 32% and 12% respectively. After the intervention phases described earlier, results from the final cycle of 20 patients admitted between August to November 2021 showed significant improvement in standards 1,3 and 4 with 90%, 100% and 100% adherence to Trust guidelines respectively. Although there was a slight improvement in biochemical monitoring of patients with regular VBGs (20% adherence in the final cycle versus 12% in the first cycle), the correct prescription of IV fluids and KCL replacement remained low (17% adherence in the final cycle versus 32%). Conclusion Awareness and diagnosis of DKA remains high at Bedford Hospital, however there are issues regarding the ongoing management of DKA patients. In particular, the correct prescription of IV fluids with KCL replacement, and regular biochemical monitoring. There is still a lack of awareness as to the appropriate rate of IV fluid resuscitation, and the correct monitoring and replacement of potassium, as well as pH. Recommended changes to improve DKA management are to expand teaching sessions to include Emergency Department (ED) doctors, as well as ED and medical nursing staff, to improve awareness of the correct management and diagnosis of DKA. Further emphasis will be placed on keeping a paper copy of the Trust Adult DKA management protocol in the patients’ notes. Presentation: No date and time listed

649 Compliance of Carotid Endarterectomy Pathway at a Vascular Unit - a Regional Audit

Abstract Aim To identify reasons for delays in a pathway for patients presenting with Transient Ischemic Attack (TIA) and requiring Carotid Endarterectomy (CEA). Method Bedford hospital is a vascular unit covering 3 hospitals (Bedford, Milton Keynes and Luton Hospital) requiring a complex referral system. Patients who develop TIA secondary to carotid disease are referred to the vascular team. This audit includes patients who underwent carotid endarterectomy from Dec 2020 to Jun 2021. Data was initially collected and analysed as a single vascular unit. The analysis included all steps of referrals and investigations, a subset of data was analysed to identify delays related to each hospital. Results A total of 73 patients were included in the analysis, overall delays (>14 Days) from the onset of symptoms to surgery was 57.5%, the delays were 19 (55%) at LDH, 14 (50%) BHT, 9 (90%) at MKUH. 41 (56%) were delayed referrals to the vascular team. 36 (49%) delays were related to factors after the referral was made. 8 (10%) patients had secondary events awaiting CEA. Conclusions The audit demonstrated that there were significant delays in the carotid endarterectomy referral pathway, there were patients who had delays at multiple levels, delays can be due to the complex referral system between 3 different hospitals. 10% of the patients had developed secondary events while awaiting treatment.

651 Timeliness of Ultrasound Investigation in Patients Presenting with Acute Abdominal Pain – Single-Centre Audit

Abstract Aim To identify patients delays in ultrasound investigation in patients who present with acute abdominal pain; patients who require ultrasound investigation to decide if they require admission or can be safely discharged home. Method Patients who presented to Bedford Hospital Accident and Emergency department with acute abdominal pain and an ultrasound was requested were included in the analysis. The indication was divided into 3 main categories (Upper abdominal pain, post-cholecystectomy, and other pathology). Data were analysed in relation to admission and discharge. Patients who had outpatient ultrasounds were excluded from the study. Mean and standard deviations were used for the delays. Results A total of 322 patients were included in the study, 160 (49.7%) patients were due to cholelithiasis or upper abdominal pain, 158 (49.1%) were due to other pathologies, 4 (1%) were post-cholecystectomy ultrasounds. The mean admission to ultrasound request was 1.77 (±5.48) with 290 (90.1%) being requested within 2 days of admission. Mean days from request to ultrasound being performed was 1.37 (±4.04) with 299 (93.1%) performed within 2 days. Conclusions The study concluded that the average time from ultrasound being requested to being performed in patients with acute abdominal pain was 0–2 days, this shows that the ultrasound is performed appropriately and there are minimal delays.

652 Quality of Ultrasound Report in Patients with Biliary Symptoms in the Context of Surgical Diseases

Abstract Aim The diagnosis of surgical pathology in patients presenting with biliary symptoms is highly reliant on a good quality ultrasound report, our aim was to identify if there are any deficiencies in reports of ultrasound which are important diagnostic parameters of upper GI abnormalities. Method Patients presenting to Bedford hospital with biliary symptoms who require an ultrasound of biliary diseases were included, 8 parameters from the guidelines of Society and College of Radiographers were taken and analysed, means of missing data was calculated, CBD diameter was considered as a significant parameter. Quality of report for CBD was further scrutinized with patients who required 2nd investigations like MRCP and CTAP using crosstabs. Results A total of 278 patients were included in the study, 97.9% were due to gallstone diseases and 2.1% were for post-cholecystectomy. 89.7% had mentioned the normality of CBD while only 21.1% mentioned the actual value of CBD. 93% reports mentioned flow of portal vein, 7% did not mention portal vein flow. Interestingly 2.1% of ultrasounds were for post cholecystectomy but during scans, 4.6% of patients had absent gallbladder. 98 (34.5%) patients had one or more secondary investigations. 22.9% of normally reported CBD on ultrasound had positive CBD findings on MRCP. Conclusions This audit demonstrates the importance of a good quality ultrasound report. A good quality ultrasound can aid in clinical diagnosis and guidance of further investigations. Important factors to consider are the value of CBD Diameter, portal vein flow and quality of biliary stone/sludge.

EP-254 Do not forget about bowel ischemia: a thematic review at Bedford Hospital

Abstract Introduction Bowel ischaemia (BI) is a life-threatening emergency with a mortality rate of 60–80%, which requires early diagnosis and surgical intervention. Clinical presentation is nonspecific, being characterised by initial discrepancy between severe abdominal pain and minimal clinical findings, abdominal CT has poor sensitivity and specificity. BI remains a diagnostic challenge for clinicians and often is an autopsy finding (1–1.5% of all adults’ autopsy). We conducted a thematic review to identify major issues which led to fail to recognise BI. Methods Data was collected retrospectively from NELA database on 626 patients who underwent emergency laparotomy, between 2013–2021 at Bedford Hospital, including preoperative clinical-radiological data, operation details, postoperative complications according to Clavien-Dindo (CD) classification and mortality. Results A total of 68 (10.8%) patients had BI as intra-operative finding, average age 71.3 (37–99), 35 (51.4%) female and 33 (48.5%) male. 25 (36.7%) had BI as indication for emergency laparotomy. 65 (95.5%) presented as emergency versus 3 (0.5%) as elective admission. The average waiting time for surgery was 8.9 hours. 53 (77.9%) patients received CT AP (46 triple phase, 4 angiogram, 3 without contrast), presence of BI was highlighted in 11 (21.1%) cases. In 14 (20.5%) patients a stoma was fashioned during laparotomy. 28 (41.2%) complications were recorded, of which 8 (28.5%) CD grade I, 5 (17.8%) CD grade 3b and 13 (46.4%). Conclusions Our results showed a mortality rate of 19.1% at 30 days postoperatively. We recommend strong clinical suspicion and aggressive approach should be adopted to improve the clinical outcome of BI.

Haematological and biochemical pathology markers for a predictive model for ITU admission and death from COVID-19: A retrospective study.

Coronavirus disease (COVID‐19) caused by SARS‐CoV‐2 has affected over 227 countries. Changes in haematological and biochemical characteristics in patients with COVID‐19 are emerging as important features of the disease. This study aims to identify the pathological findings of COVID‐19 patients at Bedford Hospital by analysing laboratory parameters that were identified as significant potential markers of COVID‐19. Patients who were admitted to Bedford Hospital from March–July 2020 and had a positive swab for COVID were selected for this study. Clinical and laboratory data were collected using ICE system. Multiple haematological and biochemistry biomarkers were analysed using univariate and multivariate logistic regression to predict intensive therapy unit (ITU) admission and/or survival based on admission tests. Neutrophil‐to‐lymphocyte ratio (NLR) and C‐reactive protein were elevated in most patients, irrespective of ITU status, representing a common outcome of COVID‐19. This was driven by lymphopenia in 80% and neutrophilia in 42% of all patients. Multivariate logistic regression identified an increase in mortality associated with greater age, elevated NLR, alkaline phosphatase activity and hyperkalaemia. With the area under the receiver operating characteristic (ROC) curve of 0.706 +/− 0.04117, negative predictive value (NPV) 66.7% and positive predictive value (PPV) 64.9%. Analysis also revealed an association between increases in serum albumin and potassium concentrations and decreases in serum calcium, sodium and in prothrombin time, with admission to ITU. The area under the ROC curve of 0.8162 +/− 0.0403, NPV 63.3% and PPV 80.5%. These data suggest that using admission (within 4 days) measurements for haematological and biochemical markers, that we are able to predict outcome, whether that is survival or ITU admission.

Ethical Issue Related to ‘Save the Life of the Patient’ at Mthatha General Hospital in South Africa

Background: Resuscitation of a patient with life threatening conditions, before referral to another department or hospital, is a legal obligation on the part of the health professionals. Several deaths occur every year in hospitals and health care centres without an emergency management. Objective: To highlight the ethical issue related to ‘Save the Life of the Patient’ at Mthatha hospital in South Africa. Case History: This is the case (AM) report of a 16-year-old Grade 10 learner who was assaulted physically as well as sexually. She was bleeding from a stab wound to her when she was brought to the Mthatha General Hospital’s (MGH) casualty. She was then referred to the Bedford hospital for repair of the tendon of her right wrist as recommended by the doctor on duty. The patient was referred to Sinawe Centre for forensic management, where she collapsed during an interview. The patient was taken on a stretcher to the MGH casualty for an emergency treatment of her blood pressure. The history of the patient and the care duty of the health professionals are discussed. Ethical issues are also highlighted in relation to the ‘preserve the life first’ principle in this case report.
 Conclusion: There was a serious breach in duty of care by medical officers in the Mthatha hospital, South Africa. It is an ethical priority to save the life of the patient.

Audit on Steroid Replacement in Confirmed or Suspected COVID-19 Patients With Adrenal Insufficiency or Adrenal Suppression in a District General Hospital

Aim: In response to new updated guidance from Society For Endocrinology April 2020, this Audit was conduct to assess the adequacy of steroid replacement in confirmed or suspected COVID-19 patients with adrenal insufficiency or adrenal suppression admitted to Bedford District General Hospital. In steroid dependent patients (Addison’s disease, adrenal insufficiency, pituitary steroid insufficiency, use of long term steroids for other conditions - 5mg or more of prednisolone (or equivalent doses) daily for longer than 4 weeks) admitted to hospital very unwell with confirmed or suspected COVID recommendations is to start on Hydrocortisone 100 mg per IV injection followed by continuous IV infusion of 200 mg hydrocortisone/24h (alternatively 50 mg every 6 h per intravenous or IM bolus injection). Method: Retrospect data collection on Patients admitted in May 2020 to Bedford Hospital with suspected or confirmed COVID 19 disease with adrenal insufficiency or on long term steroid use. Those patients should be started on Hydrocortisone 100 mg per IV injection followed by continuous IV infusion of 200 mg hydrocortisone/24h (alternatively 50 mg every 6 h per intravenous or IM bolus injection). Results: In May 2020, 295 patients admitted under the medical team in Bedford Hospital with confirmed or suspected COVID-19. Only 12 patients met the inclusion criteria, one patient with a diagnosis of Addison disease and the remaining 11 patients on long term steroids. None of these patients were managed as per updated guidelines. 6 patients had less than the adequate dose, they were started on prednisolone 30-40mg. 4 patients dose of oral steroids was only doubled, 1 patient received the same dose of oral steroid and the only confirmed Addison had higher dose of hydrocortisone. Moreover, In June 2020, The RECOVERY Outcome trial results showed that Dexamethasone 6mg for 10 days reduces the death by one third in hospitalised patient with severe respiratory complications of COVID-19. Dexamethasone 6mg is 12 times the physiological required steroid dose, this is equivalent to 240mg hydrocortisone, which is adequate for steroid replacement in patients with adrenal insufficiency or suppression. Conclusion: In view of these results and the outcome of the RECOVERY Trial, Local trust guidelines updated, indicated that any patient with Adrenal insufficiency or suppression including those on long term steroids very unwell admitted to the hospital should receive Dexamethasone if requiring oxygen or Hydrocortisone if not requiring oxygen. Recommendation of changes included teaching sessions delivered to doctors, posters on updated guidelines distributed in major areas in hospital and trust guidelines updated on the intranet.

Management and outcomes of the small pupil in cataract surgery: iris hooks, Malyugin ring or phenylephrine?

To investigate outcomes for small versus large pupils in cataract surgery using different pupil expansion techniques. Retrospective case-series reviewing 20,175 patients' cataract surgery electronic medical records at Moorfields Eye Clinic in Bedford Hospital NHS Trust from January 2010 to April 2020. Outcomes such as visual acuity (VA), intraocular pressure, intraoperative, post-operative complications were recorded and small pupil expansion device outcome. One thousand, four hundred twenty-six patients were identified as having small pupil (SP). Of these, 1110 patients (77.8%) had interventions to expand the pupil including 447 (31.3%) with intracameral phenylephrine (IC PE) alone, 194 (13.6%) with iris hooks and 469 (32.9%) with a Malyugin ring. The large pupil (LP) group had a statistically significant greater gain in VA than the SP group (p < 0.05). SPs had a significantly higher rate of intraocular complications including posterior capsular rupture (PCR) with vitreous loss (OR 2.75, p < 0.001). There was also a significantly higher rate of post-operative complications such as corneal oedema (OR 2.64, p < 0.001) and anterior uveitis (OR 2.11, p < 0.001) in the SP group. However, VA improvement and complications between the different pupil expansion groups showed no significant differences (p > 0.05) except for a greater rate of iris tears in the Malyugin group (p < 0.05). To date, this is the largest reported case-series comparing Malyugin rings and iris hooks with other pupil expansion techniques. The various techniques to expand pupil size appear to be safe and equally effective in improving VA with a similar rate of complications except for a greater rate of iris tears with Malyugin ring.

Virtual on-call increases medical student preparedness for practice.

Medical EducationVolume 54, Issue 5 p. 482-482 REALLY GOOD STUFF: Lessons learned through innovation in medical education Virtual on-call increases medical student preparedness for practice Rynda Nitiahpapand, Rynda NitiahpapandAuthors contributed equally as first authorSearch for more papers by this authorThomas Western, Thomas WesternAuthors contributed equally as first authorSearch for more papers by this authorMatthew Byrne, Corresponding Author Matthew Byrne mhvbyrne@doctors.org.uk orcid.org/0000-0002-2414-352X Authors contributed equally as first author Correspondence Matthew Byrne, Bedford Hospital Trust, Bedford, Bedfordshire, UK. Email: mhvbyrne@doctors.org.ukSearch for more papers by this authorLucia Curran, Lucia CurranSearch for more papers by this author Rynda Nitiahpapand, Rynda NitiahpapandAuthors contributed equally as first authorSearch for more papers by this authorThomas Western, Thomas WesternAuthors contributed equally as first authorSearch for more papers by this authorMatthew Byrne, Corresponding Author Matthew Byrne mhvbyrne@doctors.org.uk orcid.org/0000-0002-2414-352X Authors contributed equally as first author Correspondence Matthew Byrne, Bedford Hospital Trust, Bedford, Bedfordshire, UK. Email: mhvbyrne@doctors.org.ukSearch for more papers by this authorLucia Curran, Lucia CurranSearch for more papers by this author First published: 13 March 2020 https://doi.org/10.1111/medu.14099Citations: 1 Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume54, Issue5May 2020Pages 482-482 RelatedInformation

How to Set Up a Multidisciplinary Foot Team (MDFT) for Patients with Diabetic Foot Ulcers?

Introduction - We would like to share our experience of setting up an MDFT for patients with diabetic foot ulcers according to NICE guidelines and present early results. Methods - NICE guidelines indicate that every centre that treats patients with Diabetic foot ulcers should have an MDFT that is based in the hospital. The MDFT should be led by a hospital-based specialist diabetic podiatrist and should comprise of a diabetic physician, vascular surgeon, orthopaedic surgeon with special interest in foot and ankle surgery, diabetic nurse, vascular nurse, tissue viability nurse and Orthotic specialist. There should be close contact with the community podiatry for a seamless pathway for patients with diabetic foot ulcers in primary and secondary care. The main aims of the Diabetic MDFT are to reduce major amputations, reduce hospital stay and reduce readmissions. Screening patients for diabetic foot problems and education of patients and healthcare professionals are secondary aims of the MDFT. A diabetic foot ulcer MDFT has been operational at Bedford Hospital since August 2017. This comprises of a weekly diabetic foot round where inpatients and outpatients are discussed. We were successful in securing the National Diabetes Treatment and Care – Transformation Funding bid to help set up the MDFT. We encountered several hurdles in setting up the MDFT, which included dialogue and collaboration between finance officers and clinicians from primary and secondary care and between various hospital departments as well. The hub and spoke model of vascular services adds to the complexity of this venture. We have struggled with Orthopaedic input in the MDFT and organization of podiatry services in hospital. We present some strategies in overcoming these obstacles and recount our experience of setting up the MDFT. Results - A diabetic foot resister was started in August 2017 and so far >100 patients have been entered in this register. 79 patient episodes have been discussed in the MDFT involving 66 patients. We have had 48 new emergency referrals from the community and of these 30 have been triaged as needing an urgent podiatry appointment. This has been achieved on an average in 1.8 days. We have established an emergency hotline number to the diabetic podiatry clinic in hospital. Revamping of the ‘Hospital at Home’ team has been a tremendous support to the MDFT. We have reinforced links with community podiatry and MDFTs in other spoke hospitals in the Bedfordshire – Milton Keynes (BMK) Vascular Unit. Early results indicate a marked reduction in hospital admissions and hospital stay due diabetic foot problems. There have been only 3 major amputations since September 2017. Conclusion - It has been a huge struggle to set up the Diabetic MDFT at the BMK vascular unit, but early results indicate considerable benefits in terms of patient outcomes and costs. References - https://www.nice.org.uk/guidance/ng19

How do paper and electronic records compare for completeness? A three centre study.

Medical records are legal documentation of patients' care hence must be accurate and complete for both medical and legal purposes. Electronic patient record (EPR) systems aim to improve the accuracy of documentation, provide better organisation and access of data. This study compares the completeness of traditional note records and EPR in glaucoma patients. Using criteria from the April 2009 National Institute for Health and Care Excellence (NICE) guidelines completeness of data entry was compared between EPR and paper notes in three units. Moorfields Eye Hospital (City Road) uses the Openeyes EPR. Bedford Hospital (Moorfields Eye Centre) and Western Eye Hospital use the Medisoft EPR. The standard was set at 100% compliance for predetermined parameters. One hundred seventy paper notes and 270 electronic records were analysed. With the exception of central corneal thickness (p = 0.31), all other key parameters were more consistently recorded in the paper records than in the EPR. Intraocular pressure (p = 0.004), anterior chamber configuration and depth assessments using gonioscopy (p < 0.001), fundus examination (p = 0.015), past medical history (p < 0.001), medication including glaucoma medication (p < 0.001) and drug allergies (p < 0.001). Our results show that paper records are significantly more complete than EPR. This is the case for two different EPRs and three separate sites. We propose additional training to aid data-collection; improving the design of EPRs by investigating factors such as layout and use of forced choice fields.

Outpatient cervical ripening in a district general hospital: a five-year retrospective cohort study

The number of women undergoing induction of labour has risen steadily in recent years. Outpatient induction is becoming more common in the UK in response to the required increase in resources, although evidence supporting its safety is lacking. We reviewed the notes of low-risk women presenting for outpatient cervical ripening using prostaglandins over a five-year period, and compared our neonatal and maternal outcomes to local and national data. Of the 502 eligible women, 400 underwent outpatient treatment. Most women returned early, in labour. There were no foetal, neonatal or maternal deaths, and our neonatal morbidity compared favourably with local rates. Mode of delivery and major maternal complication rates were comparable to national maternity indicators. We conclude that outpatient cervical ripening following careful case selection does not appear to increase neonatal or maternal mortality or morbidity. It offers patients an alternative to traditional inpatient induction and may improve allocation of hospital resources.Impact statementWe present a retrospective cohort study of neonatal and maternal outcomes in 502 women selected for outpatient cervical ripening for postmaturity at Bedford Hospital over the five-year period from 2010 to 2015.This study was conceived following a previous publication in this journal from Bedford Hospital in 2002 by Neale et al., which described the outcomes of 100 women who underwent outpatient cervical ripening. Our conclusions compare the results from the two studies.Out of our combined sample of 602 women, 491 were discharged home following administration of prostaglandins. This represents the largest sample size in the published literature on outpatient induction of labour, which was first undertaken in our unit in 1998 and is now widely practiced within the UK.Several publications, including the 2013 Cochrane review by Kelly et al. and a recent large survey of practice (Sharp et al. 2016) have highlighted the paucity of available data regarding the safety of this procedure as an outpatient. We therefore hope that the results of our study will be of interest to many maternity units who currently undertake or are considering to provide the facility for outpatient cervical ripening as a prelude to induction of labour.

'She has given me the confidence and strength to get through this'.

Since I was diagnosed with a neuroendocrine tumour in June 2011, my upper gastrointestinal specialist nurse Eleanor Church has been a pillar of support. She is so cheerful, warm, kind and compassionate that I actually look forward to my oncology appointments at Bedford Hospital.

How well surgeons are aware of risks associated with routine diagnostic imaging?

s / International Journal of Surgery 23 (2015) S15eS134 S104 concise review of current assessment, diagnosis and management of each disease. Conclusion: The Gordon Museum and similar collections present unique opportunities to learn about fundamental surgical disease. We hope that the study presented here offers a novel insight into the wealth of educational material available. 0747: HOW WELL SURGEONS ARE AWARE OF RISKS ASSOCIATED WITH ROUTINE DIAGNOSTIC IMAGING? R. Hafeez , A. Ahad , N. Obeid , F. Smedley . King’s college Hospital, UK; Darent valley Hospital, UK; 3 Lewisham and Greenwich NHS Trust, UK Aim: To assess the level of awareness among surgeons of the nature and risks associated with routine diagnostic imaging. Methods: 114 clinicians from different surgical specialties were asked to fill a questionnaire which include total 32 questions about nature of radiations used in routine imaging, effective radiation dose, natural background radiation exposure, dose of single chest X-ray, estimated dose of other radiological investigation in comparisons to CXR, common side effects and organs aff5cted by the exposure. Participants were also asked to select the level of cancer risk association among different age groups and whether they consider alternative investigations. Results: 54(47.37%) participants have misunderstanding that routine radiological imaging involve non ionizing radiations. 47 (41.2%) knew correct effective radiation dose unit (mSv) while just 30% were aware of natural background radiation exposure. 73% overestimated the dose of CXR but 42% underestimated the cancer risk associated with CT abdomen. Although only 27% identified common side effects and organs aff5cted by exposure however majority (80%) do consider patient’s age and alternative investigations before requesting one. Conclusion: Surgeons need to be educated about the linear relation between radiation exposure and cancer development in order to minimize unnecessary exposure of patients. 0752: DEVELOPING THE LEADERSHIP SKILLS OF JUNIOR SURGICAL TRAINEES THROUGH A HANDS ON APPROACH A.A. Abdullah, J.M. Norris, N. Noor, L. Thorley. Bedford Hospital, UK Aim: The expanding role of doctors continues to evolve within the healthcare setting, in particular the need for leadership and managerial (L&M) skills. This case series provides a platform for junior doctors to develop their L&M skills through running structured courses Methods: A surgical course is designed based on a tested infrastructure to meet the needs of junior doctors, following an audit. The course is carried out with the support of previous course directors (CD). Effectiveness of the course and it's delivery are ascertained through a reaudit process. Participants are then encouraged to repeat the course using the same infrastructure with the help of their CD, ensuring the cycle continues. The CD are evaluated using a questionnaire and subsequent projects they run. Results: 3 CD in 3 different trusts ran 3 courses with 50 participants. A reaudit showed 100% of participants had benefitted from the course with 60% implementing their new skills in a clinical context. 67% of the CD have since lead other projects. 100% of the CD had learnt new skills, gained confidence from the process and would recommend it to others. Conclusion: This process offers junior doctors hands-on experience in developing L&M skills under supervision and support 0754: SIMULATION OF TENDON REPAIR USING MICROFOAM TAPE A. Elfaki, N. Abreo, M. Wilmot, S. Murphy, P. Gillespie. Addenbrookes

Training to resume at Bedford Hospital’s paediatrics department

The training of junior doctors is to resume at Bedford Hospital’s paediatrics department after the lifting of a suspension imposed last year over safety concerns. Health Education East of England said it was confident that training standards would be met at Bedford Hospital after an inspection had taken place and staffing numbers, “processes,” and “assurance” had all improved. Hospital chief executive Stephen Conroy said trainees would start to return from August 2014 with “better support” than in the past and a further assessment would take place after six months …

94 Lung nodule surveillance programme (LNSP) in a cancer unit: Lung cancer team experience from Bedford Hospital, UK

94 Lung nodule surveillance programme (LNSP) in a cancer unit: Lung cancer team experience from Bedford Hospital, UK

Prostatic biopsies in selected men aged 75 years and older guide key clinical management decisions

Increasing life expectancy and PSA testing has increased the number of men over the age of seventy-five presenting for investigation of potential prostate malignancies. Prostatic biopsies provide diagnostic information; however, they are invasive and may not alter management decisions. Therefore, this study aimed to investigate whether prostate biopsies in this age group were justified. All men aged 75 years and older who underwent prostatic biopsies between January 2010 and November 2011 at Bedford Hospital were identified and the indication for the biopsies, histopathological results and subsequent management plan investigated. One hundred and thirty-eight (138) prostatic biopsies were undertaken and malignancies identified in 60/138 (43 %) cases. Prebiopsy PSA and examination findings had a poor positive predictive value of 54 %. Fifty-five out of sixty (92 %) cancers were classified as high or medium risk disease with 30/60 (50 %) patients commencing radiotherapy treatment with curative intent. In selected patients aged 75 years or over, prostatic biopsies provide important diagnostic information which directly impacts on clinical decisions, supporting their use in this age group.

Paediatric trainees withdrawn from training over supervision concerns

An NHS trust has said it will halt training of junior doctors in paediatrics after concerns over lack of supervision. The trust has announced an urgent review of its children’s services. Bedford Hospital NHS Trust said that an external independent review would take place after a decision by the local medical training body to withdraw the department’s most junior medical trainees. Health Education East of England acted after trainee doctors raised concerns about inadequate levels of senior clinical supervision for trainee doctors in paediatrics. The situation was “recognised as an unacceptable potential risk to …

Surgical outcomes of nephron sparing surgery for renal tumours

Surgical outcomes of nephron sparing surgery for renal tumours