Good Medical Practice Research Articles

Literacy in the Scope of Radiation Protection for Healthcare Professionals Exposed to Ionizing Radiation: A Systematic Review.

Background: The use of radiation is important in different medical procedures, and to ensure a high level of good medical practice, radiation protection (RP) should be seen as a very important subject. This review shows information about the knowledge in the scope of radiation protection among healthcare professionals exposed to ionizing radiation. There are not many studies that evaluate the radiation exposure of healthcare professionals. Methods: A systematic search was performed, using PRISMA guidelines, in Pubmed and Scopus databases and manually to identify relevant articles to answer the PICOS question, "Is there an adequate level of literacy in the scope of radiation protection among healthcare professionals exposed to ionizing radiation?". This systematic review included cross-sectional studies with the following inclusion criteria: (i) in Portuguese, Spanish, or English; (ii) about literacy in the scope of radiation protection; (iii) published between 2017 and 2024; and (iv) participants must be dentists, radiographers, doctors, and nurses. The JBI critical assessment tool was used to assess the risk of bias. Results: The search identified 566 potentially relevant references, which, after applying inclusion/exclusion criteria, resulted in 12 articles. Studies found that the overall knowledge of these healthcare workers was unsatisfactory, and a lack of knowledge in radiation protection negatively affects health services' quality. Training is essential and must emphasize how radiation exposure can be minimized, safeguarding health professionals' trust and sense of security. Results showed that more years of experience make workers more attentive to protection measures, suggesting that training strategies focused on basic radiological risks and radiation safety are needed. Conclusions: Key findings recommend implementing a standardized national training program on the basic principles and safety of ionizing radiation for all healthcare professionals.

Viral hepatitis in persons living with HIV in the post-COVID era.

Coinfection with hepatitis viruses A to E is frequent in persons living with HIV (PLWH) and causes significant morbidity and mortality. Oro-fecal transmissible hepatitis A and E mostly produce acute self-limited episodes in poor income regions and in non-vaccinated travelers. In high-income countries, outbreaks of hepatitis A occur in men having sex with men (MSM) and chronic hepatitis E is occasionally reported among PLWH with severe immunodeficiency. Chronic hepatitis B, C, and D are frequent in PLWH in highly endemic regions and globally in persons who inject drugs (PWID) and MSM. Progression to liver cirrhosis and development of hepatocellular carcinoma (HCC) is major clinical complications in coinfected patients. Current estimates for PLWH are of 38 million worldwide. Roughly 12% have chronic viral hepatitis (5 million). Coinfection figures are of 5-10% for HBV (2-4 million), 4% for HCV (1.5 million), and 15% of HBsAg+ for HDV (0.5 million). Oral direct-acting antivirals (DAA) cure almost all treated patients with hepatitis C. However, given that there is no protective HCV immunity, PLWH with high-risk behaviors may experience HCV reinfection episodes. Tenofovir is the drug of choice in PLWH with chronic hepatitis B, given its dual effect on HIV and HBV. Lifelong oral tenofovir suppresses HBV replication and ameliorate liver damage. However, the risk of HCC persists even in the absence of cirrhosis. Finally, HDV causes the worst of viral hepatitis with faster progression to cirrhosis and HCC. An entry inhibitor, bulevirtide, has recently been approved and another drug, lonafarnib, is completing Phase 3 trials. Combination antiviral therapy for hepatitis D could improve dramatically the poor prognosis of HIV-HDV coinfected patients. The resumption of good medical practices in PLWH after the big disruption caused by COVID-19 will reduce the burden of viral hepatitis coinfections. Renewed efforts on HAV and HBV vaccination of susceptible individuals and earlier and wider prescription of antiviral therapy for HBV, HCV, and/or HDV coinfection should be prioritized in PLWH. The benefits of innovative strategies for viral hepatitis, including pre-exposure prophylaxis or use of long-acting antivirals, warrant further consideration in PLWH.

Can the Pioneering Impact of Artificial Intelligence in Anaesthetic Practice Uphold Good Medical Practice?

The potential applications of Artificial Intelligence (AI) in anaesthesia are expansive.~However, like any technological advancement, the integration of AI in anaesthetic practice comes with both benefits and potential risks. This article seeks to set out some of the advantages and disadvantages of the use of AI technologies within the field of anaesthesia. Benefits of the application of AI in anaesthesia include an improvement in perioperative risk stratification, personalisation of anaesthetic plans, improvement in efficiency and ultimately reduce healthcare costs. However, reliance on technology may reduce clinical acumen but furthermore there are issues surrounding data quality, privacy as well as legal and ethical concerns, which require further evaluation. Whilst AI within anaesthetic practice holds immense promise, there are substantial challenges which require careful consideration and ongoing evaluation. A collaborative approach will be required from healthcare staff, developers and regulators to promote the safe, responsible, and effective application of AI in anaesthesia practice.

Screening for depression in patients with epilepsy: What are the benefits for physicians and patients in the real-life setting.

Screening for depression in people with epilepsy (PWE) is highly recommended in order to avoid underdiagnosis, misdiagnosis, or delayed diagnosis of this highly impacting comorbidity. Here we evaluated the impact of reporting and suggesting depression via the Beck Depression Inventory (BDI) on medical decision-making, and thereby the value of a depression screening for good medical practice. Of 445 BDI data sets, PWE with scores indicating moderate (BDI 19-29) to severe depressive disorder (BDI >29) were extracted and clinical reports were retrospectively reviewed regarding decisions on antidepressants, anti-seizure medications (ASMs), and non-pharmaceutical interventions. Sixty-four PWE (14%; 56% female; mean age 39.7 years) showed elevated BDI scores, with 40 (63%) categorized as moderate depression and 24 (37%) as severe depression. Thirty-nine percent of PWE already had a pre-existing diagnosis of depression and 53% left the clinic with the diagnosis of depression, half of them with antidepressants. High depression scores were associated with any intervention in 53%, interventions with potentially mood affecting ASM in 19%, treatment with antidepressants in 11%, and non-pharmaceutical interventions in 41%. Non-pharmaceutical interventions were related to BDI scores. Changes of potentially mood-affecting ASMs were more frequent in PWE with moderate scores, and introduction of antidepressants appeared as a trend related to higher depression scores. The finding of an only weak relation between high depression scores, diagnoses of depression, and treatment consequences questions the diagnosis and treatment pathway and the clinical value of the BDI screening in PWE. Prospective standard procedures need to be established for depression diagnosis and treatment including follow-up evaluations of the validity of the diagnosis and effectiveness of the decisions taken.

Prehospital transfusion of labile blood product using intraosseous perfusion with multi-lumen extender: Why not?

French prehospital military medical teams are provided with labile blood products to effectively address hemorrhagic shock. In combat environment, standard good medical practice may limit efficacy of therapeutic goals regarding damage control resuscitation. We present here a case report describing the management of a soldier heavily wounded during a helicopter forward medical evacuation in Sahel region. We report the challenge encountered by medical team using only a humeral intraosseous route available due to severity of lesions and challenging environment. In this configuration, multi-lumen extender enabled transfusion of two units of packed red blood cells and two units of plasma, and analgesia while limiting manipulation and dislodgment of the fragile intraosseous route. This situation, outside of usual good medical practice, raises issues of hemolysis, physicochemical compability of drugs and blood products, and consequences on flow rate reduction. With this case, we emphasize the benefit of multi-lumen extender associated with intraosseous route for early management of heavy casualties in harsh prehospital environment. Literature suggests that hemolysis and physicochemical compability should remain limited. The main issue of this setting consists of flow reduction and can be addressed by prioritizing humeral route, and using counter pressure cuffs, until a second peripheral or central line is available and management can resume without the need for multi-lumen extender.

Doctors',Patients' and Physician Associates' Perceptions of the Physician Associate Role in the Emergency Department.

The Emergency Department (ED) has seen increased patient attendance and difficultymeeting demands. New healthcare professions such as Physician Associates (PAs) are being utilised to complement the existing medical workforce. Despite the growth of their professions in the United Kingdom, little evidence is available about the perceptions of their roles. This study aims to provide evidence of doctors', PAs' and patients'perceptions of the PA role in the UK ED. A mixed methods approach consisted of the following: 1. An online exploratory survey of ED doctors at one English EDover 1 month (February-March 2022). 2. Post consultation semi-structured patient questionnaires over 2 weeks (April 2022). 3. Semi-structured virtual interviews with ED consultants across thefour regions of theUnited Kingdom (3 months in 2022). 4. Semi-structured virtual interviews with ED PAs across thefour regions of theUnited Kingdom(3 months in 2022). The analysis methods that were used includedfrequency counts and percentages from closed questions, andhybrid thematic analysis of free text and interview transcripts. Four ED consultants and four ED PAs across the United Kingdom were interviewed. Twenty-eight ED doctors participated in the online survey. Fifty-seven patients completed the post consultation questionnaire. Four main themes (PAs being fit for purpose; patient recognition of PAs, PAs providing continuity of care, and future PAs and regulation) were deduced as per the General Medical Council, Good Medical Practice domains (knowledge, skillsand development; patients, partnership and communication; colleagues, culture and safety; and trust and professionalism). Other subthemes were induced via hybrid thematic analysis. In this study, doctors and patients had mixed comments about the role of PAs. Most of them were positive as doctor participants perceived PAs to be knowledgeable, highly skilled, with mostly good communication skills, team players, providing continuity of care and overall being fit for purpose. However, some doctor participants commented negatively about PAsfor providing little quality healthcare and being inexperienced. There was a desire for career progression amongthe PA participants and a need to work to their full potential. Although the clinicians of this study displayed a clear understanding of the PA role in the ED,a high frequency of surveyed patients mistook PAs for doctors. It was suggested that future PAs could complete a postqualification programme in emergency medicine, combine roles, be paid on an alternative scaleand be formally regulated. In this study, mixed views were expressed by ED consultants, ED junior doctorsand patients regarding the role of the PA in the ED. Stakeholders can use the information presented to develop a better understanding of the perceptions of the PA role within the UK ED. The Patient and Public Involvement and Engagement (PPIE) group, led by Healthwatch, made significant contributions to the study's design by providing valuable feedback on the information sheets and consent forms utilised. The patients' responses helped guide the study's direction and shape its future work. As part of the dissemination activities, the study findings was shared with both the PPIE team and Healthwatch media production team.

1088 The Quality of Information Recorded in Neurosurgical Operation Notes: A Closed Loop Audit

Abstract Introduction Operation notes are critically important documents which serve as record for significant events in the lives of patients. They serve multiple functions, but chiefly to help guide peri-operative management. Surgeons must keep records that are accurate, thorough, and readable. This is fundamental part of the GMC’s Good Medical Practice as well as the Royal College of Surgeons of England Good Surgical Practice guidelines which lays out 18 various parameters for what should be included in an operation note. Aim This retrospective audit aimed to evaluate the compliance of neurosurgical operation notes with the Royal College of Surgeons guidelines, identifying areas for improvement. Method All neurosurgical procedures between October 1 and October 31, 2023, at a Major Trauma Centre in the West Midlands were retrospectively audited. Two independent reviewers used a standardized proforma in Microsoft Excel for data extraction, comparing compliance. Results 91 operation records were examined and found high compliance (100%) in key fields: date, surgeon's name, assistant's name, operative procedure, operative diagnosis, and signature. Negligible compliance was found in identification of prosthesis (0%), estimated blood loss (1%), extra procedures (1%), elective/emergency classification (1%), time (4%), and problems/complications (19.8%). Notably, detailed post-op instructions were lacking in over 1 in 3 operation notes, with 19.7% omitting DVT prophylaxis, and 20% neglecting clip/suture removal instructions. Conclusions While certain aspects showed exemplary compliance, critical deficiencies were identified, particularly in post-operative instructions. A template proforma for post op instructions is required in addition to more targeted guidelines for operation notes within neurosurgery.

Reassessing ‘good’ medical practice and the climate crisis

In August 2023, the General Medical Council released the latest update of Good Medical Practice, which sets out the standards of patient care and professional behaviour to be expected of...

Neurodevelopmental lags and type of delivery in a Colombian infant population

IntroductionThe Choice giving birth by cesarean section when it is not biologically necessary implies a greater risk to the health of the mother and child Toral et al. Eletrônica Estácio Saúde 2018; 95(1) 27-30,refers the psychological relevance to identify perinatal effects of a good medical practice at birth. In this respect Poojari et al. Early Hum Dev 2019;115 93-98, state that a cesarean section as a surgical risk, causes decrease fetal oxygenation and an impairment release of stress-related hormones in the maternal-fetal binomial that does not favor neural connections at birthObjectivesIdentify the neurodevelopmental lags in infant on children under 24 months of age born by cesarean section and vaginal delivery,MethodsA cross-sectional descriptive correlational; Sample consisted of 100 children of a term gestation, 70 with spontaneous vaginal birth and 30 whose birth was by cesarean section, aged between one and twenty-four months; using the Abbreviated Development Scale, an instrument created and validated for the Colombian population (Cronbach’s alpha, 0.94). All parents signed the informed consent.ResultsAll test scales were applied (gross and fine motor, language and social personal), the results showed that children born by cesarean section had better development in areas of fine motor and language, while children born by vaginal delivery had better development of gross motor. See (graphic 1).Graphic 1: Areas of development according to the type of delivery.ReferencesConclusionsThe influence of contextual variables such as age and educational level of the mother on language and social areas was also foundDisclosure of InterestNone Declared

Digital health technologies: Compounding the existing ethical challenges of the 'right' not to know.

Doctors hold a prima facie duty to respect the autonomy of their patients. This manifests as the patient's 'right' not to know when patients wish to remain unaware of medical information regarding their health, and poses ethical challenges for good medical practice. This paper explores how the emergence of digital health technologies might impact upon the patient's 'right' not to know. The capabilities of digital health technologies are surveyed and ethical implications of their effects on the 'right' not to know are explored. Digital health technologies are increasingly collecting, processing and presenting medical data as clinically useful information, which simultaneously presents large opportunities for improved health outcomes while compounding the existing ethical challenges generated by the patient's 'right' not to know. These digital tools should be designed to include functionality that mitigates these ethical challenges, and allows the preservation of their user's autonomy with regard to the medical information they wish to learn and not learn about.

Perceptions of Clinical Experience and Scientific Evidence in Medical Decision Making: A Survey of a Stratified Random Sample of Swedish Health Care Professionals.

Evidence-based medicine recognizes that clinical expertise gained through experience is essential to good medical practice. However, it is not known what beliefs clinicians hold about how personal clinical experience and scientific knowledge contribute to their clinical decision making and how those beliefs vary between professions, which themselves vary along relevant characteristics, such as their evidence base. We investigate how years in the profession influence health care professionals' beliefs about science and their clinical experience through surveys administered to random samples of Swedish physicians, nurses, occupational therapists, dentists, and dental hygienists. The sampling frame was each profession's most recent occupational registry. Participants (N = 1,627, 46% response rate) viewed science as more important for decision making, more certain, and more systematic than experience. Differences among the professions were greatest for systematicity, where physicians saw the largest gap between the 2 types of knowledge across all levels of professional experience. The effect of years in the profession varied; it had little effect on assessments of importance across all professions but otherwise tended to decrease the difference between assessments of science and experience. Physicians placed the greatest emphasis on science over clinical experience among the 5 professions surveyed. Health care professions appear to share some attitudes toward professional knowledge, despite the variation in the age of the professions and the scientific knowledge base available to practitioners. Training and policy making about clinical decision making might improve by accounting for the ways in which knowledge is understood across the professions. Study participants, representing 5 health care professions-medicine, nursing, occupational therapy, dentistry, and dental hygiene-viewed science as more important for decision making, more certain, and more systematic than their personal clinical experience.Of all the professions represented in the study, physicians saw the greatest differences between the 2 types of knowledge.The effect of years of professional experience varied but tended to be small, attenuating the differences seen between science and clinical experience.

Primary results of the brazilian registry of atherothrombotic disease (NEAT)

There is limited contemporary prospective real-world evidence of patients with chronic arterial disease in Latin America. The Network to control atherothrombosis (NEAT) registry is a national prospective observational study of patients with known coronary (CAD) and/or peripheral arterial disease (PAD) in Brazil. A total of 2,005 patients were enrolled among 25 sites from September 2020 to March 2022. Patient characteristics, medications and laboratorial data were collected. Primary objective was to assess the proportion of patients who, at the initial visit, were in accordance with good medical practices (domains) for reducing cardiovascular risk in atherothrombotic disease. From the total of patients enrolled, 2 were excluded since they did not meet eligibility criteria. Among the 2,003 subjects included in the analysis, 55.6% had isolated CAD, 28.7% exclusive PAD and 15.7% had both diagnoses. Overall mean age was 66.3 (± 10.5) years and 65.7% were male patients. Regarding evidence-based therapies (EBTs), 4% were not using any antithrombotic drug and only 1.5% were using vascular dose of rivaroxaban (2.5 mg bid). Only 0.3% of the patients satisfied all the domains of secondary prevention, including prescription of EBTs and targets of body-mass index, blood pressure, LDL-cholesterol, and adherence of lifestyle recommendations. The main barrier for prescription of EBTs was medical judgement. Our findings highlight that the contemporary practice does not reflect a comprehensive approach for secondary prevention and had very low incorporation of new therapies in Brazil. Large-scale populational interventions addressing these gaps are warranted to improve the use of evidence-based therapies and reduce the burden of atherothrombotic disease.ClinicalTrials.gov NCT04677725

(025) Compliance with GMC Guidelines for the Use of a Chaperone in Urology Outpatient Clinic

Abstract Introduction Intimate physical examination is an integral part of our urological practice. There is a paucity of literature regarding the use of chaperones among urologists. As per GMC guidelines: The offer, and use, of a chaperone, including their full name and designation, should be clearly documented in patients’ notes. Objective Given the importance of this ethical topic for both patient safety as well as in providing support for the urologist, we decided to assess our performance as per the GMC guidelines for good medical practice. Methods We completed an audit loop to evaluate the performance of 12 members in our urology team as regards compliance with GMC guidance for the documentation of chaperone use in urology clinic. Based on our scoring system, we objectively assessed both overall team performance as well as individual scores for documenting chaperone use. • For each urologist, We checked records for 10 patients who attended urology clinic AND had a physical examination as evidenced in the notes and/or clinic letter •N= 120 patient records checked • Each urologist was given a score; NO mention of a chaperone= 0 point A chaperone JUST mentioned= 1 point The chaperone specified (name/signature)= 2 points Results Initial audit revealed overall chaperone documentation in clinical notes was 75.25% which may be acceptable while in the clinic letters, it was only 14.6%. At individual level, results were quiet variable reflecting the actual difference in practice between individuals in real life. Following the discussion of the 1st audit results in the urology clinical governance meeting, posters were made to raise awareness of the audit outcome as well as direct discussions with the urology team members to encourage them to improve their score. Six months later, re-audit showed significant improvement was achieved for individual as well as overall documentation to 85% of clinical notes and more than 50% of clinic letters. Conclusions Documenting chaperone presence during patient examination in urology clinics, is mandatory given the intimate nature of urological examination. We present the first report using a scoring system for objective assessment of a pertinent topic such as the use of chaperone and its documentation. This managed to achieve a significant improvement in our practice in accordance with GMC guidance for Good Medical Practice. Disclosure No.

Shared decision making in older people after severe stroke.

Stroke is a major cause of death and lifelong disability. Although stroke treatments have improved, many patients are left with life-changing deficits. Shared decision making and consent are fundamental to good medical practice. This is challenging because stroke often causes mental incapacity, prior views might not be known and prognosis early after stroke is often uncertain. There are no large trials of shared decision making after severe stroke, so we need to rely on observational data to inform practice. Core ethical principles of autonomy, beneficence, non-maleficence and justice must underpin our decision making. 'Surrogate' decision makers will need to be involved if a patient lacks capacity, and prior expressed views and values and beliefs need to be taken into account in decision making. Patients and surrogates often feel shocked at the sudden nature of stroke, and experience grief including anticipatory grief. Health care professionals need to acknowledge these feelings and provide support, be clear about what decisions need to be made and provide sufficient information about the stroke, and the risks and benefits of treatments being considered. Shared decision making can be emotionally difficult for health care professionals and so working in a supportive environment with compassionate leadership is important. Further research is needed to better understand the nature of grief and what sort of psychological support would be most helpful. Large randomised trials of shared decision making are also needed.

Massive Transfusion/Hemorrhage Protocols Versus Goal-Directed Bleeding Management: Science Gone Eerie?

Key questions in bleeding management are “Why does my patient bleed?” and “How to fix it?” To answer the first question, the high negative predictive value of viscoelastic testing can be used to identify coagulopathic bleeding. Accordingly, goal-directed bleeding management (GDBM) guided by viscoelastic testing has been shown to be an effective and essential part of the second pillar of patient blood management (PBM) with the aim to improve patients’ outcomes and safety. Patient’s medical and drug history – with a focus on medication with oral anticoagulants and antiplatelet drugs – are important in emergency, urgent, and elective surgery. Furthermore, risk scores have been developed and validated for traumatic and obstetric hemorrhage and can be helpful tools to predict severe hemorrhage and the need for massive transfusion. Acidosis, hypocalcemia, anemia, and hypothermia (“diamond of death in trauma”) are important basic conditions for hemostasis and good predictors of coagulopathy and should be closely monitored by blood gas analysis and corrected in bleeding patients. Earlier time to hemostasis was associated with decreased mortality in trauma studies. Therefore, GDBM aims to stop the bleeding as soon as possible and avoid the main killers in blood transfusion: Transfusion-associated circulatory overload, transfusion-related acute lung injury, transfusion-related immune modulation, and thrombosis. Thromboelastometry-guided bleeding management follows the concepts of Good Medical Practice and Precision Medicine. Here, rotational thromboelastometry (ROTEM)-guided bleeding management algorithms are using a stepwise approach based on the sequence “Treat first what kills first:” (1) Fibrinolysis management, (2) clot firmness management, (3) thrombin generation management, and (4) avoidance of hypercoagulability and thrombosis. Here, thromboelastometry can not only identify patients with hypercoagulability and increased risk of thrombosis but also ROTEM-guided bleeding management can avoid thromboembolic complications, too. This may support the idea of personalized antithrombotic therapy guided by viscoelastic testing in the postoperative period. Finally, PBM is not about blood transfusion: It is about patients’ outcomes. Accordingly, several meta-analyses based on more than 20 randomized controlled trials on the effect of viscoelastic testing-guided perioperative bleeding management did not only demonstrate a significant reduction in transfusion requirements but also a significant reduction in mortality and postoperative acute kidney injury. The reduction in postoperative acute kidney injury again has a significant impact on long-term survival. Accordingly, recent PBM guidelines recommend the implementation of viscoelastic testing-guided bleeding management algorithms with a 1B or 1A recommendation. This is also addressed in the World Health Organization policy brief about the urgent need to implement PBM in all member states in a timely manner. However, even if the number of national activities is increasing, there is still a long way to go.

Inclusion of systems-based practice in medical education: Is it a necessity?

Abstract: Systems-based practice (SBP) is a core competency that concentrates on the foundation of health care in good medical practice. It is to be aware of the systems in which we work and to make sure to achieve the maximum outcome response in our work by remaining in the system. Compared to medical schools, fellowship programs are active in developing and evaluating SBP curricula. The Graduate Medical Education Regulation-2019 describes competency-based learning which includes designing and implementing a medical education curriculum that focuses on the desired and observable ability in real-life situations. For achieving good patient care, good medical practice is a requirement. For attaining optimal medical practice, it is important to understand how one functions within the system as a whole and how one’s actions affect all other aspects of the system. The graduating residents immediately start participating in the health-care system as a whole. Therefore, residents must be aware of the health-care systems in which they have to operate and also have the ability to provide high-quality, cost-effective medical care to the patients with the available resources. These residents should have enough exposure to SBP to efficiently work in a team. Competency-based medical education should include SBP as a competency where doctors would understand what is happening to the health-care system in which they practice, why the system is changing so rapidly, and what they can do about it.

A comparative analysis of the doctoral regulations at the medical faculties in Germany.

Objective: In order to be allowed to use the title "Dr. med." in Germany, an independent scientific achievement under the supervision of an established scientist is necessary. The research question, analysis and results are essentially carried out and developed independently by the doctoral student. The doctorate serves as proof that the doctoral candidate is capable of independent academic work. The acquisition of scientific skills and knowledge is of particular importance in medicine, as Germany´s international competitiveness is based on the education of today´s young academics. Fair conditions and uniform quality standards for doctoral studies are therefore indispensable to attract future young scientists at an early stage. Methods: The currently valid doctoral regulations of the medical faculties in Germany were analysed with regards to the following target criteria; update date, dissertation language, possibility of publication-based dissertation and its details (number of first and total authorships, publication organ), knowledge of methods and consideration of "Good Medical Practice" (GMP), plagiarism check, review process and disputation. Results: All faculties with the right to award doctorates, and, thus 40 valid regulations were included in the analysis. This revealed a great divergence in the requirements for doctoral candidates. Although a publication-based doctorate is now possible at 93% (n=37) of the faculties, in addition to the monographic dissertation, the required first and total authorships vary from one required first authorship (n=26, 70%) to two or three first authorships (n=5, 14%), as well as some faculties having no information regarding the number of publications (n=6, 16%). The quality of the publication organ was not described in detail in seven faculties (19%). To ensure quality, requirements have increasingly been anchored in the regulations, so that 22 regulations (56%) now stipulate participation in courses on GMP or qualification programmes. The regulations leave a lot of room for manoeuvre in terms of content and do not allow for comparability of the conditions for preparing doctoral researchers. The specifications range from mere mention, to instruction, to compulsory course participation. Another means of quality assurance is the prevention of plagiarism through the applications of software systems. However, this simple and effective means is not yet mentioned in 65% of the regulations (n=26). While the other regulations make use of this possibility, it is not an obligatory application. A total of 34 regulations provide for the regular drawing up of a supervision agreement to define the rights and obligations of the actors involved. Conclusion: The analysis showed a divergent picture. Although imprecise regulations or gaps in information allow scope for design, they also prevent transparency. Despite revisions of many regulations in the past, these revisions have not led to any significant harmonisation. The implementation of standardised and structured doctoral programmes is desirable and could be tackled within the framework of the planned amendment of medical studies. This opens up the possibility of dealing efficiently with the scarce resource of time in the face of competing curriculum content and of making a doctoral project more attractive to potential young scientists at an early stage.

HPB P36 Good Medical Practice: Patient's right to the information - An audit of the patient's understanding and satisfaction with the information provided to the patients with acute pancreatitis

Abstract Background Acute pancreatitis is one of the important and common causes of abdominal pain presenting to the emergency surgical take. The incidence of pancreatitis in the UK is approximately 56 cases per 100,000 people per year. Due to variation in the causes, disease course, investigations and treatment, it may be confusing for the patient to fully understand all the information. NICE guidelines and good medical practice recommends ‘to give people with pancreatitis, and their family members or carers (as appropriate), written and verbal information in a way they can understand’. Methods The aim of this audit was to find out if adequate information as per the NICE guidelines was being provided to the patients and their family members, and to assess patients’ satisfaction in terms of the provided information. 30 patients who were admitted in the department of general surgery with acute pancreatitis were provided with a questionnaire containing 10 questions asking about the information provided to them about their condition by the healthcare professionals. At the end of the first cycle an intervention in the form of following leaflet was introduced and a re-audit was done: Results Overall, 60% of the patients were not satisfied with the information provided. None of the patients was provided written information and more than 90% were not explained condition with the help of a diagram. The other areas where the patients were not provided information were: investigations done (40%), treatment (60%), provision of verbal information (26%) and alcohol as the potential causes of the condition (27%). A re-audit was done the results of which are compared with the first cycle below: Conclusions This audit emphasized the need of a proper explanation of acute pancreatitis to the patients and their family members. It was also found that no leaflets were available for the patients. Results were shared in the surgical team group and a leaflet has been designed and distributed to every patient with acute pancreatitis. Second Cycle: After the introduction of the leaflet, improvement has been seen in almost all the areas of the information provided to the patients. Overall, satisfaction has improved from 60% to 92% in the patients admitted with acute pancreatitis.

EGS P39 The first cycle of an audit assessing the quality of documentation of emergency laparoscopic appendicectomies at Birmingham Heartlands Hospital, a District General Hospital

Abstract Background Laparoscopic appendicectomy is a common general surgical procedure. Poor documentation can a) result in misunderstandings between healthcare workers looking after patients and b) limit fair investigation of incidents. The Get It Right First Time (GIRFT) guidance was produced to advise on the information that should be available in patient records to reduce risk of both of the above. Aims and objectives To assess how well laparoscopic appendicectomies are documented in accordance with the GIRFT criteria. To then develop interventions to improve documentation and ultimately improve communication with other healthcare workers and allow defence of good medical practice. Methods Three people collected data on 100 laparoscopic appendicectomies that took place in 2022-2023 at Heartlands Hospital. Data was collected based on the 34 GIRFT recommendations and the sources were: electronic patient notes (adults); scanned patient notes (children); electronic operation notes (all); and theatre logbooks. It was then analysed and grouped into factors that were documented well (>75% of the cases), moderately well (>50% but £75%), poorly (>25% but £50%) or very poorly (£25%). Results Factors that that were documented well (23%) included use of a sterile bag for appendix removal (83%), details of closure (96%), and instructions for post-operative antibiotics (88%) and recovery (97%). Those documented moderately well (19%) included port location and size (70%) and achievement of haemostasis (62%). Those documented poorly (23%) included whether ports were inserted under direct vision (38%) and whether any residual appendix was left behind (39%). Those documented very poorly (36%) included sending a sample to histology and grade of doctors. Several of these were documented primarily in paper records that are not scanned - hence not readily accessible). Conclusions While there are several aspects of documentation which we are currently doing well, there is still much scope to improve documentation as a whole. The current format of the operation note itself limits the information which can be communicated. This in combination with the documentation of some important information on paper – which is largely inaccessible outside of theatre or once a patient has been discharged – produces unnecessary ambiguity. Discussion is ongoing with electronic records teams to alter the operation note format to improve documentation quality. These findings will be discussed at a departmental audit meeting to specify changes before re-auditing.

‘I Did No Harm’

Objective: To assess the performance of our urology team against GMC guidelines for using chaperone during intimate clinical examination. Background data: intimate physical examination is an integral part of our urological practice. There is a paucity of literature regarding the use of chaperones among urologists. Given the importance of this topic for both patient safety and providing support for the urologist, we decided to assess our performance as per the GMC guidelines for good medical practice. Methods: We completed an audit loop to evaluate the performance of 12 members in our urology team as regards compliance with GMC guidance for the documentation of chaperone use in urology clinic. Based on our scoring system, we objectively assessed both overall team performance as well as individual scores for documenting chaperone use. Results: There was a significant improvement in the overall documentation rate in both clinical notes (+9.85%) and clinic letters (+36.65%). Raising awareness among team members managed to increase the individual performance scores as well. Conclusion: This is the first report using a scoring system for objective assessment of a pertinent topic such as the use of chaperone and its documentation. This managed to achieve a significant improvement in our practice.