England Guidelines Research Articles

A New Corpus of Roman Coins from England and Wales. An Overview of the Evidence and Analysis of the Data

Abstract This paper considers a new corpus of 490,154 Roman coins (site finds) which have been recorded from England and Wales. The corpus provides British and regional means to aid in the preparation of coin reports in line with Historic England guidelines, along with spatial data providing new opportunities for research. The methods of data collection will be detailed and some of the possibilities this dataset can provide presented through a number of case studies. Through the consideration of applied numismatic analyses, the social distribution of the material and, crucially, the spatial distribution of Roman coinage, we can identify new trends and patterns. Case studies evaluating the fourth century will emphasise the changing importance of settlements in Roman Britain and identify those linked with the late Roman state. Furthermore, the retraction of coinage distributions in the second half of the fourth century will be explored. Building on the national and site type means explored within the paper, the full dataset has been made available in a range of forms on the Archaeology Data Service and in an interactive map developed by Maploom.

Assessing the Quality of Urological Operation Notes in Accordance With the Royal College of Surgeons of England Guidelines: A Retrospective Cross-Sectional Study

Assessing the Quality of Urological Operation Notes in Accordance With the Royal College of Surgeons of England Guidelines: A Retrospective Cross-Sectional Study

EP427 - Are we following the RCS England Guidelines for documentation of the operation note for a laparoscopic appendicectomy: A complete audit loop

Abstract Introduction The audit outlines the importance of adhering to RCS England Guidelines for documenting laparoscopic appendicectomies. Following these guidelines ensures standardized documentation, facilitating effective communication and promoting patient safety. Moreover, it underscores the significance of recording key procedural steps and techniques employed during the operation. It highlights the guidelines' emphasis on legible, timely, and complete documentation, emphasizing the role of the operation note as a legal document. Method This audit involved collecting data from September 2022 - August 2023 for the first loop to analyse operative notes of 92 laparoscopic appendicectomy cases. For the second loop, after introducing an electronic procedure-specific checklist as a guide, we reviewed 30 notes prospectively over a 2-month period (November-December 2023). The notes were compared against RCS England ‘Good Surgical Practice’ 2014 Guidelines using 18 parameters. We assessed for compliance with the guidelines and the legibility of notes. Results After introduction of a checklist, average compliance with guidelines increased significantly in 9 of the 18 parameters assessed, 6 remained unchanged at almost 100% compliance. Two key areas for emphasis were identified: instructions for post-op antibiotics (83%), DVT prophylaxis (53%). The most noticeable lack of documentation was in the gynaecological findings of females, recorded in only 13% of cases. There has been a noticeable effort in improving the legibility of the notes. Conclusion Introduction of a checklist increased compliance with guidelines. The comprehensive documentation will ultimately promote optimal patient outcomes and advance the overall quality of surgical care.

Comparison of Patients Classified as High-Risk between International Cardiovascular Disease Primary Prevention Guidelines.

Background: Cardiovascular disease (CVD) primary prevention guidelines classify people at high risk and recommended for pharmacological treatment based on clinical criteria and absolute CVD risk estimation. Despite relying on similar evidence, recommendations vary between international guidelines, which may impact who is recommended to receive treatment for CVD prevention. Objective: To determine the agreement in treatment recommendations according to guidelines from Australia, England and the United States. Methods: Cross-sectional analysis of the National Health and Nutrition Examination Survey (n = 2647). Adults ≥ 40 years were classified as high-risk and recommended for treatment according to Australia, England and United States CVD prevention guidelines. Agreement in high-risk classification and recommendation for treatment was assessed by Kappa statistic. Results: Participants were middle aged, 49% were male and 38% were white. The proportion recommended for treatment was highest using the United States guidelines (n = 1318, 49.8%) followed by the English guidelines (n = 1276, 48.2%). In comparison, only 26.6% (n = 705) of participants were classified as recommended for treatment according to the Australian guidelines. There was moderate agreement in the recommendation for treatment between the English and United States guidelines (κ = 0.69 [0.64-0.74]). In comparison, agreement in recommendation for treatment was minimal between the Australian and United States guidelines (κ = 0.47 [0.43-0.52]) and weak between the Australian and English guidelines (κ = 0.50 [0.45-0.55]). Conclusions: Despite similar evidence underpinning guidelines, there is little agreement between guidelines regarding the people recommended to receive treatment for CVD prevention. These findings suggest greater consistency in high-risk classification between CVD prevention guidelines may be required.

592 Standardising General Surgery Operation Notes According to Royal College of Surgeons England Guidelines

592 Standardising General Surgery Operation Notes According to Royal College of Surgeons England Guidelines

E016 An audit on patient initiated follow up in rheumatology in Manchester Royal Infirmary

Abstract Background/Aims PIFU is not a new concept in rheumatology. Instead of arranging regular routine appointments for patients with stable diseases, PIFU empowers patients to seek help when needed, enabling them to take control of their care and reduce pressure on rheumatology services. NHS England recommends PIFU for rheumatology patients with stable inflammatory arthritis. They should also have a good understanding of their disease management and be able to contact the service promptly. If patients on PIFU contact the service and require face-to face appointments, they should be seen within 2-4 weeks. Despite existing recommendations, there appears to be wide variation between clinicians and managers on the understanding of PIFU. The aim of this audit is to compare diagnoses of rheumatology patients for PIFU in a single rheumatology department, and the waiting time for review once patients placed on PIFU have made contact, to NHS England standards. Methods A list of rheumatology patients placed on PIFU between October 2022 and July 2023 at Manchester Royal Infirmary was obtained. Data were collected from electronic patient records. Results A total of 130 (1.5%) patients were listed on PIFU by 18 clinicians. The table outlines the demographics and detailed breakdown of diagnoses1. 1 (1%) was put on PIFU after patient declined biologic treatment for active inflammatory arthritis. 3 patients contacted the department whilst on PIFU, 2 of them required face-face review. Median time from start of PIFU to patient-initiated contact was 60 days (IQR 47.5-107.5). One with palindromic rheumatism was seen at 6 weeks and one with osteoarthritis had no appointment date yet 8 weeks after initial contact. Conclusion The audit confirmed that only 22 (17%) patients followed NHS England guidelines and 0% was seen as recommended once the patient contacted the department. Currently, 1.5% of patients in the rheumatology department are placed on PIFU, which is below 5% as per NHS England guidelines. This audit highlights the urgency to educate clinicians and managers on the cohort of patients listed on PIFU and to ensure all these patients are seen within the recommended time. Work is being done in the department to address these issues. Disclosure A. Cheung: None. G. Nowell: None. S. Ling: None. Y. Chiu: None. P. Ho: None.

Assessing the standard of emergency general surgical (EGS) operation notes in accordance with the Royal College of Surgeons guidelines.

Operation notes are important for care in surgical patients. The objectives of this study were to analyze the emergency general surgery (EGS) operation note documentation in accordance with the Royal College of Surgeons of England (RCSEng) guidelines and to assess the impact of creating awareness of the guidelines and effect of a new proforma. A retrospective review of 50 EGS operation notes was conducted between December 2019 and March 2020 and compared to RCSEng guidelines. Education was delivered on the importance of documentation in accordance with RCSEng guidelines. A new electronic proforma was introduced. A further 50 EGS operation notes were analysed between August 2020 and December 2020. One hundred operation notes were reviewed, and each given a score out of 19. Our interventions showed significant improvement to the average score (15.64 vs 17.96; p <0.001). Within the second cycle, there was a statistically significance difference when comparing electronic to handwritten notes (18.55 vs 17.50; p= 0.001). Implementation of the new proforma showed improvement in operation note documentation when compared to the RCSEng standard. Therefore, this study emphasizes the need for surgeons to familiarize themselves with the current guidelines.

Pilot study to develop a pre-operative "Cardiothoracic Clinical Handover Tool" and its effect on handover quality.

Clinical handover is an essential step in the surgical patient's hospital journey, but one that is not without risk. Within cardiothoracic surgery, endeavours to protocolise post-operative handover from cardiac theatre to cardiac intensive care units have resulted in enhanced patient safety, but little to no effort has focused on the pre-operative setting and the dissemination of information throughout the surgical team. We designed a pre-post study examining the quality of pre-operative cardiothoracic patient handovers before and after the introduction of an intra-departmentally designed "Cardiothoracic Clinical Handover Tool" based on the Royal College of Surgeons of England's guidelines for "Safe Handover". Forty clinical handovers were assessed in each arm of the study. Handover quality improved from a score of 63.75% to 88.57% (p = < 0.001). This prolonged handover duration from a mean of 72.1 to 102.4seconds per case (p = 0.003). Interruptions occurred in 27.5% of pre- and 25% of post-intervention handovers. Interruptions resulted in increased handover duration in both pre- and post-intervention groups (114.6 vs 77.7seconds, p = 0.012) and poorer quality handovers in the pre-intervention group (51.28% vs 68.42%, p = 0.03) but failed to impact handover quality in the post-intervention group (88.57% vs 88.57%, p = 1). Clinical handover tools have the potential to enhance the quality of pre-operative handover and protect against poor handover practices such as interruptions, safe-guarding patient welfare. We provide the first cardiothoracic specific pre-operative handover tool based on the RCSE guidelines.

Undergraduate teaching of surgical skills in the UK: systematic review.

Students must be proficient in surgical skills according to General Medical Council and Royal College of Surgeons of England guidelines. If these skills are not appropriately taught, there is a risk of an incoming junior workforce with inadequate surgical skills. This paper aimed to review the literature relating to undergraduate teaching of surgical skills in the UK and summarize future suggested training methods. The databases MEDLINE, Embase and SCOPUS were searched, and the existing literature relating to methodology of undergraduate teaching of surgical skills in the UK over the past 10 years was summarized. The Medical Education Research Quality Instrument was used to assess research quality. A total of 19 papers were included. Cross-sectional evaluations and survey-based studies highlight a clear deficit in surgical skills teaching in the UK. Medical students are currently unable to fulfil their own learning needs and meet requirements set out by the General Medical Council. This lack of surgical teaching appears to negatively affect student desire to pursue a surgical career. The three main themes for improvement are extracurricular surgical skills days, near-peer teaching and simulation. Each method appeared to improve learning, although no studies utilized medium- to long-term follow-up to demonstrate efficacy and there lacks a clear consensus as to the 'standard' of undergraduate surgical skill education. There was also potential for selection bias and response shift bias in many of the studies assessing pre- and postintervention confidence and opinions. There is a concerning lack of surgical skills teaching that has resulted in medical students and junior doctors not having the necessary surgical skills as per General Medical Council guidance and students feel that their own learning needs are not met. This failure to address the learning deficit may be responsible for the fall in surgical competition ratios. While surgical skills teaching must be improved urgently, more robust evidence is required to evaluate the optimal ways of approaching this issue.

1251 A Project Aimed at Improving the Completeness and Quality of Admission Clerking in the ENT Department

Abstract Aim Admissions notes are essential in communicating information regarding patients. The project aimed to improve the proportion of completed admission clerking and the quality of the recorded data for the ENT patients admitted to the ward. Method We have included emergency presentations and elective admissions for moderate and major head and neck surgery. Patients were identified from handover lists. Baseline data were collected across a period of six weeks, and 103 admission notes were included. Following the intervention, the data collection lasted another six weeks, and 93 documents were identified. Documents were compared against The Royal College of Surgeons of England Guidelines for Clinicians on Medical Records and Notes. Interventions to improve the standard of admission clerking included: a short departmental presentation, educational posters, and an introduction of the electronic clerking proforma. Results Following the intervention, the proportion of completed admission clerking has increased and the quality of recorded data has improved.The proportion of completed admission clerking increased from 95.4% to 100% for emergency presentations, and from 2.6% to 68.2%for elective admissions. Data completeness has improved across all documentation domains. For emergency presentations, the most notable improvement was recorded for the medication history (76.9% vs 93.0%) and allergy status (73.9% vs 87.3%). For elective admissions, the greatest improvement was noted for past medical history (2.6% vs 65.6%) and social history (0% vs. 56.5%). Conclusions In conclusion, the use of clerking proforma alongside educational presentation and posters increased the completeness and quality of admission clerking, for both emergency and elective presentations in the ENT department.

Evidence-based appraisal of two guidelines for the diagnosis of suspected, uncomplicated urinary tract infections in primary care: a diagnostic accuracy validation study.

Given the lack of accurate rapid diagnostics for urinary tract infection (UTI) in women, many countries have developed guidelines aiming to support appropriate antibiotic prescribing, but some guidelines have not been validated. We performed a diagnostic accuracy validation study of two guidelines: Public Health England (GW-1263) and Scottish Intercollegiate Guidelines Network (SIGN160). We used data from women with symptoms suggestive of uncomplicated UTI from a randomized controlled trial comparing urine collection devices. Symptom information was recorded via baseline questionnaire and primary care assessment. Women provided urine samples for dipstick testing and culture. We calculated the number within each risk category of diagnostic flowcharts who had positive/mixed growth/no significant growth urine culture. Results were presented as positive/negative predictive values, with 95% CIs. Of women aged under 65 years, 311/509 (61.1%, 95% CI 56.7%-65.3%) classified to the highest risk category (recommended to consider immediate antibiotic prescribing) and 80/199 (40.2%, 95% CI 33.4%-47.4%) classified to the lowest risk category (recommended to reassure that UTI is less likely) by the GW-1263 guideline (n = 810) had positive culture. For the SIGN160 guideline (n = 814), the proportion with positive culture ranged from 60/82 (73.2%, 95% CI 62.1%-82.1%) in those for whom immediate treatment was indicated to 33/76 (43.4%, 95% CI 32.3%-55.3%) in those recommended a self-care/waiting strategy. Clinicians should be aware of the potential for diagnostic error when using diagnostic guidelines for managing uncomplicated UTI and making antimicrobial prescribing decisions. Infection cannot be excluded on the basis of symptoms and dipstick testing alone.

Levelling up: should all continuous glucose monitoring systems be available on prescription in the NHS?

Dear Editor, the launch of the FreeStyle Libre intermittently scanned continuous glucose monitoring system (also known as Flash or isGCM) on prescription in November 2017 and subsequently Libre 2 has brought about a paradigm shift in the widespread availability of CGM for people living with type 1 diabetes (T1D) in the UK.1 Libre has been available for self-funding since 2014 and real-time (rt) CGM has been around commercially for a decade or so before this.2 Strong clinical leadership from Professor Partha Kar and colleagues from the Diabetes Technology Network along with campaigning from patient organisations have undoubtedly accelerated and catalysed this change with over 69% of the English population of people living with T1D being prescribed a Libre, and – with the exception of two (out of 42) integrated care systems – all other systems have at least half of their population of people living with T1D on Libre from almost zero five years earlier.3 This growth occurred prior to the publication of 2022 NICE guidance (NG17)4 recommending all forms of CGM be offered to all people living with T1D. Previous NHS England guidelines suggested about 20% of the T1D population would be eligible for FreeStyle Libre and funding for sensors up to this number of patients was available centrally for a limited time. National Diabetes Audit data for rtCGM from 2020–215 (until recently rtCGM was not available on prescription at all) show that the majority of specialist adult diabetes care providers in England had none or a miniscule percentage of their patients using rtCGM; many of these same units had large numbers of people using FreeStyle Libre. (See Figure 1.) These data would suggest that there were (and still may be) large parts of the country where, for adults with T1D, rtCGM was (or still may be) either not available or difficult to access. The data would further suggest that there is an even greater variation in the use of rtCGM than there is with FreeStyle Libre. The recent update to NG174 on the use of all forms of CGM has undoubtedly encouraged companies to include some of their rtCGM products on prescription, but not all. At present there appears to be inconsistent, non-transparent and often complicated local schemes for providing access to many rtCGM systems. This makes delivery on the promise of NG17 unnecessarily difficult -- especially in terms of giving people with T1D a genuine choice in the device they use to monitor their glucose levels. If we are to fully meet the glucose monitoring needs of our adult population of people with T1D, surely the time has come for all CGM systems to be available on prescription. This would create a level playing field for people living with diabetes and those who provide their care, thereby affording access based on NICE 2022 criteria in keeping with the founding principles of the NHS. There are no conflicts of interest declared.

938 ‘TO DIP OR NOT TO DIP’: IMPROVING THE MANAGEMENT OF LOWER URINARY TRACT INFECTIONS IN OLDER PEOPLE

Abstract Introduction I completed two PDSA cycles of a Quality Improvement project, from 2019 to 2021, aimed at improving the management of lower urinary tract infections (UTIs) in older people. My interest in this subject was instilled after it was brought to my attention that Public Health England (PHE) guidelines were revised in 2018 to state that urine dipsticks tests (UDTs) should not be used as a diagnostic aid in any patient over the age of 65 years. I became concerned that geriatric patients may be misdiagnosed and mistreated with unnecessary antibiotics, given the high prevalence of asymptomatic bacteriuria in this population. Method I sampled patients diagnosed with a urinary tract infection in the Emergency Department of the Queen Elizabeth Hospital, Gateshead over a 7-day period. I extracted medical notes of patients prescribed one of 7 antibiotics, then excluded patients under 65-years-old and those treated for an infection outside the lower urinary tract. Next, I established whether a UDT was used as a diagnostic aid using the medical notes. Results Before and after intervention: my initial findings revealed that a UDT was performed in 100% patients diagnosed with a UTI (i.e. no cases were in line with best practice). My first educational intervention involved sharing the revised PHE guidelines with staff via an interactive teaching-session, following this I found that a UDT was performed in 62% patients. My next intervention was a flow-chart entitled ‘to dip or not to dip’ pasted in the ED. Following this final intervention, I found that 27% cases were in line with best practice (a UDT was used in 73% cases). Conclusion With this modest improvement, I concluded that my recommendations reduced the number of over 65-year-old patients undergoing unnecessary UDTs as part of their diagnostic work-up.

Are UK medical schools using recommended national curricula for the teaching of clinical neuroscience?

BackgroundMedical schools are responsible for training medical students to recognise and commence management for a broad spectrum of diseases, including clinical neuroscience conditions. To guide medical schools on topics that should be taught, speciality bodies have produced speciality-based core curricula. It is unknown to what extent these guidelines are used in designing each medical school’s curriculum. This survey aimed at assessing the use of these guidelines in designing clinical neuroscience curricula. MethodsThis is a national survey. A 21-item questionnaire was sent to faculty members involved in the development of the clinical neuroscience curriculum in each medical school in the UK. Data collection occurred from1st September 2020–31 st August 2021. The Association of British Neurologists (ABN) and the Royal College of Surgeons England (RCSEng) guidelines were used as a benchmark. Descriptive statistics are reported. ResultsData was collected from 91.9% of eligible UK medical schools. 61.8% respondents were aware of ABN guidelines and 35.3% were aware of RCSEng guidelines. 17/28 (60.7%) topics recommended by the guidelines were taught in the neuroscience curricula of over 90% of the medical schools. Neurologists were involved in the design of the clinical neuroscience curriculum in 94.1% (n = 32/34) of medical schools, and neurosurgeons in 61.8%. Tutorials/seminars were used by all medical schools to teach clinical neuroscience content. Neurologists were involved in teaching at all schools and neurosurgeons in 70.6%. Objective Structured Clinical Examination (OSCE)/oral examinations and single best answer (SBA)/multiple-choice question (MCQ) tests were used in all medical schools as methods of assessment. ConclusionsThere is variation between medical schools on what clinical neuroscience topics are taught and by whom. Multi-modality educational delivery was evident. Some medical schools did not currently use, advertise, or recommend external clinical neuroscience educational resources; but there was support for future use of external resources including guidelines.

A retrospective audit of the introduction of a facial trauma admission Proforma

<b>Introduction</b>: Comprehensive documentation has particular pertinence when recording information for facial trauma patients. Patient records have a medico legal value, as a common aetiology of facial trauma is as a result of a criminal event. In addition notes ensure continuity of care whilst being reviewed by multiple members of the team and aid effective surgical decision. Commonly, documentation at presentation is incomplete and varied in format. This retrospective two-cycle audit analysed information captured at initial presentation of surgically managed mandibular fractures at the Queen's Medical Centre, Nottingham, to identify if an improvement in record keeping occurred using a dedicated trauma proforma. <b>Materials and Methods</b>: Ten clerking records before and after proforma introduction were accessed through Medway or DHR computer systems, and analysed against the minimum dataset for documentation stipulated by Royal College of Surgeons of England guidelines. These included dates of injury/assessment; referral source; mechanism of injury; medical history; occlusion; tenderness; dental trauma; imaging; diagnosis and management plan recording. The standard was that 100% of records were complete. <b>Results/Statistics</b>: Prior to the proforma, some data points were consistently not recorded; presence of pain (50%); dental trauma (30%); diagnosis (50%) and analgesia (30%). Overall, the proforma improved record keeping by 26% in data captured, particularly in domains that were poorly recorded. However it should be noted that one third of patients records examined in the second cycle, included completed proformas. <b>Conclusions/Clinical Relevance</b>: This audit demonstrated an increase in data quantity and quality, with the use of a dedicated proforma. With multiple handovers during shifts and frequent staff turnover, a structured proforma prevents information from being omitted and provides a way of obtaining the information needed, in a standardised, reproducible way. A structured proforma aids future audits and assessment of service performance. Furthermore, proformas provided a high education value to junior members of the team, who commonly admit trauma patients, and act as an aid-memoir to guide clinical examination. Consequently, digitalisation of this proforma on Medway, is planned to increase access to the proforma, which is particularly apt for this cohort of patients examined in this study, as access to a paper proforma has its limitations.

Consenting patients for elective procedures during the pandemic: Are we consenting for risk of nosocomial COVID-19 infection.

Introduction: Nosocomial COVID-19 increases morbidity and mortality in patients undergoing surgical procedures. This study assesses the consenting process in patients admitted for surgical procedures with regard to risks of contracting nosocomial COVID-19 infection during the three lockdown periods in the United Kingdom.Methods: Retrospective review of consecutive surgical patients admitted to our tertiary referral centre for surgical procedures during the lockdown periods in the United Kingdom. Data from our hospital’s electronic theatre database cross-referenced with the online surgical operative, admission and discharge records were reviewed by three independent reviewers.Discussion: A total of 180 patients (104 males and 76 females) were studied. No patients tested positive perioperatively for COVID-19. The first lockdown had a significantly larger proportion of consultants consenting (P < 0.001). Surgeons consented patients for risk of COVID-19 infection in 34.4% of cases, COVID-19-related illness in 33.9%, inpatient Intensive Care Unit (ITU) admission secondary to COVID-19 infection and risk of death due to COVID-19 in 0.0% and risk of death secondary to inpatient COVID infection in 1.1%.Conclusion: As surgical activity continues and COVID-19 persists, surgeons should be vigilant and ensure proper documentation for consent regarding COVID-19-related complications in line with the Royal College of Surgeons of England guidelines.

EP.WE.568Compliance with the Royal College of Surgeons of England Guidelines on the Surgical Consenting Process in the Era of the COVID-19 Pandemic

AimsDue to the current COVID-19 pandemic, The Royal College of Surgeons of England released guidelines advising on additional considerations which should be discussed with patients as part of the informed consent process prior to surgery.We conducted a prospective audit on whether COVID-19 infection was mentioned as a possible complication during the consenting process for patients undergoing emergency and elective general surgical procedures at a District General Hospital.MethodologyWe prospectively collected data on the patients admitted for surgical procedures over a 2-week period. Consent forms were reviewed noting whether COVID-19 infection was listed as a possible complication.Results35 patients were audited with a median age of 54 (12-94) years including 17 males and 18 females. Patients presented with varying surgical diagnoses, with 16 and 19 undergoing emergency and elective operations, respectively. 77.1% (27) of patients had COVID-19 infection mentioned as a possible complication on their consent forms. Five out of six consent forms completed by Clinical Fellows or CT trainees, 10 out of 13 by Registrars, 12 out of 16 by Consultants mentioned COVID-19 infection. We found no significant correlation between the grade of the consent taker and COVID-19 infection being mentioned as a possible complication.ConclusionMost of the consent takers were aware of the guidelines and mentioned COVID-19 infection as a possible complication during consenting. However, this awareness could be expanded. The results will be presented to the department before a plan to re-audit and close the loop in a few weeks.

EP.TH.861Compliance with guidelines for inguinal hernia repair in a large teaching hospital

Abstract Background The Royal College of Surgeons of England guidelines recommends laparoscopic repair for bilateral inguinal hernias, recurrent hernia after an initial open approach and Groin hernias in women. Aim This study assessed the surgical management of inguinal hernia over 6 years to see how well we adhered to national guidelines and investigated reasons for non-adherence. Methods A retrospective study from January 2013 to December 2018 of all patients undergoing inguinal hernia repair. Data collected were patient identifiers, gender, date of birth, date of admission and discharge, type of inguinal hernia, type of repair and the operating consultant. If the type of repair performed was outside of national guidance, patients’ case-notes were reviewed. Results 2593 patients were included, 93.4% male and median age of 63 (interquartile range 49-74 years). 403 patients underwent laparoscopic repair (15.5%). For unilateral primary inguinal herniae, 221 out of 2222 patients underwent laparoscopic repair (9.9%). 29 of 170 (17%) of female patients underwent laparoscopic repair. 118 out of 160 patients with bilateral hernia underwent laparoscopic repair (73.8%) - no explanation was identified for selecting open repair in 25 out of 42. Regarding recurrent hernia, 64 out of 211 patients underwent laparoscopic repair (30.3%). No explanation for selection of open approach was identified for 61 of the 147. Conclusion National guidelines recommending laparoscopic inguinal hernia repair for females, bilateral and recurrent herniae are not well followed. A likely contributing factor is the overall low rate of laparoscopic repair. Changes to practice are underway and repeat audit is planned.

1565 In Covid-19 Pandemic, Following the Updated Royal College of Surgeons of England Guidelines in Management of Acute Appendicitis; A General District Hospital Audit

AimThe Aim of the study is assessment of the compliance with the updated Royal College of Surgeons of England (RCS) guidelines in management of acute appendicitis in a general district hospital during COVID-19 pandemic. Conservative treatment of acute appendicitis is encouraged unless unresponsiveness to treatment or complications ensues.MethodCollection of retrospective data using hospital coding system was done from 63 patients medical records who were diagnosed with acute appendicitis from April 2020 to June 2020.ResultsThe collected data analysis showed adherence to conservative treatment in 16 out of 63 (16/63) patients (25.4%). It succeeded in 10/16 patients (63 %). 6/16 patients were switched to operative intervention (37 %). There were no complications in patients who needed operative intervention after failure of conservative management. Operative management was primarily chosen in 47/63 patients (74.6 %). Re-admissions were 3/16 patients (18.75 %) in conservative group in comparison to 1/47 patient (2.12 %) in primarily operative group.ConclusionsThe work showed a promising rate of success of conservative treatment. However, there is a low level of compliance with RCS guidelines in management of acute appendicitis during COVID-19 pandemic. The study showed increased re-admission rate for conservative management versus primarily operative management pathways. No complications were detected in cases who needed operative intervention after failure of conservative management. Re-auditing is to follow. The study recommends national comparison of data as it might be worthwhile considering primary management of acute appendicitis.

Advancing leadership in medical radiation sciences: Incorporating systematic leadership education in pre-registration curricula

Advancing leadership in medical radiation sciences: Incorporating systematic leadership education in pre-registration curricula