Hospital Theatre Research Articles

Comparative Study between Ultrasound Guided Pectoral Nerve Block Type-II (PECS II) and Serratus Anterior Plane Block (SAPB) in Postoperative Analgesic Efficacy in Modified Radical Mastectomy

Abstract Background Breast cancer has continued to be the most common cancer afflicting women, accounting for 31% of all new cancer cases in the female population. Every year, thousands of patients undergo surgery in the region of the breast and axilla. Surgery is one of the mainstays of treatment, and a procedure called modified radical mastectomy (MRM) is now a standard surgical treatment for early-stage breast cancers. Aim of the Work to evaluate the effectiveness of ultrasound guided pectoral nerve block (PECS II) versus serratus anterior plane block (SAPB) for postoperative Analgesia in modified radical mastectomy. Patients and Methods After obtaining approval from the medical ethical committee in Ain Shams University and written informed consent. This Double Blind Prospective Randomized Controlled study was conducted in the operating theatres of Ain Shams University Hospitals. It included Sixty Female patients undergoing Modified Radical Mastectomy. Results The two groups were adequately monitored and assessed post-operatively and they were compared regarding analgesic outcome by using the visual analogue scaling system, besides, recording time for first for analgesic need and total consumption of opioid and analgesic in the 1st 24 postoperative hours. Demographic data and post-operative hemodynamics were also assessed. Conclusion SAPB was effective in reducing postoperative pain scores for 6 -12 hours and lower total 24-h postoperative opioid and analgesic consumption after Modified Radical Mastectomy under general anesthesia, compared to PECS II block.

1276 Creating Safer Theatres. Tackling Religious Headwear Discrimination Nationally

Abstract Aim To identify and challenge discriminatory EDI practices. To improve adoption of national policies on surgical headwear in theatre. Method Freedom of information requests were sent to 124 hospitals with emergency general surgery theatres. Data requested included total staff number, BAME staff percentage, theatre staff percentage, Muslim theatre staff (including ODPs, porters, medical, nursing staff, surgeons, junior doctors), female Muslim staff number, and copies of uniform policies, especially on religious headwear. Two senior trainees reviewed policies. Results 100 of 124 trusts responded to the FOI request. Percentage of BAME staff ranged from 5% to 47%. 12 trusts had no BAME members of staff working in theatres or could not release this data for risk of their few personal being identified. 97 policies were reviewed. 80% of the policies reviewed adhered or replicated the national guidance. Potentially discriminatory practices included necessitating disposable head wear be always worn, lack of specific guidance on the wearing of hijabs, and one policy which appeared to request they would not be worn. Conclusions This project highlights significant disparities in EDI policies within hospital theatre teams, especially regarding religious headwear. The lack of specific accommodations for religious garments creates an exclusionary environment. This can lead to increased stress and lower sense of belonging amongst minority staff. The findings emphasise the need for hospitals to re-evaluate and reform their policies, those with poor practices have been contacted. We aim to foster a more inclusive, equitable workplace.

Pilonidal sinus: an overview of historical and current management modalities.

Pilonidal disease is a common condition that commonly affects the younger adult population and is often seen in both the general practice and the hospital setting. Multiple treatment methods have gained and lost popularity over the last several decades, but more recent intervention principles show promising results. This article details the different methods of managing acute and chronic pilonidal disease ranging from treatments in the primary care setting to those in hospital theatres, with special attention to newer modalities of minimally invasive interventions. As a chronic illness that often affects those of working age, pilonidal disease can confer significant morbidity especially, but not limited to, a substantial amount of time off work. Treatment of chronic disease in particular, has evolved from midline techniques to off-midline techniques, with more recent developments offering promising solutions to reduce acute flare ups and hasten recovery time.

Sustainability in the Breast Operating Theatre: Promoting a Multidisciplinary Sustainability strategy across multiple centres

Operating theatres in hospitals are critical areas that generate a significant amount of waste, including single-use items such as disposable hats which has a significant effect on our NHS carbon footprint. The use of appropriate surgical attire, including hats, plays a vital role in maintaining hygiene and promoting a sterile environment within operating theatres. The introduction of the RCS surgical green checklist has highlighted several ways to improve sustainability in a theatre setting.

Appendectomy in Management of Malrotation of Gut is it Necessary?

Malrotation is a congenital anatomical anomaly that affects the normal positioning of the intestines. Traditional management of malrotation, as described by Ladd, consists of detorsion of the volvulus if present, division of Ladd's bands, widening of the mesenteric root, proper positioning of the small and large bowels, and a prophylactic appendectomy. This study was done to determine whether appendectomy should be an integral part of the Ladds procedure or if it can be avoided. This retrospective observational study was conducted in one pediatric surgical unit in the tertiary care center of North India. All the cases of malrotation of the gut managed from January 2008 to December 2018 were reviewed. The details of the patients were recovered from the electronic data recording system of the hospital and manual operation theater records. The cases that have a follow-up of <5 years were not included in the study. The details were charted in an Excel Sheet for the analysis. No statistical test was performed because there was no event in patients in whom prophylactic appendectomy was not done. The data analysis revealed that a total of 66 malrotation patients were managed during this period, those who fulfilled the inclusion criteria. Among 66 cases included in the study, in 41 cases, prophylactic appendectomy was done, whereas in the rest 25, prophylactic appendectomy was not done. During the follow-up, none of the patients in whom the appendix was preserved presented with signs or symptoms related to appendicitis or any other complications. Ladds procedure without appendectomy can be performed in view of the potential use of the appendix in the future, and with the fact that in the current era of advanced medicine, appendicitis can be diagnosed early due to the advancement of imaging and better record keeping.

Ultrasound Guided Pectoral Nerve Block (PEC I) versus Serratus Anterior Plane block (SAPB) for Postoperative Analgesia in Modified Radical Mastectomy

Abstract Background Breast cancer is the most common cancer in women both in the developed and less developed world. In 2012, it represented about 12 percent of all new cancer cases and 25 percent of all cancers in women. A procedure called Modified radical mastectomy is now a standard surgical treatment for early stage breast cancers. These procedures cause significant acute pain and may progress to chronic pain states in 25–60% of cases. Though various risk factors have been suggested, inappropriate acute postoperative pain management has been associated with the development of chronic postmastectomy pain, a complex post-surgical pain syndrome that may occur following any type of breast surgery. Objective To evaluate the effectiveness of ultrasound guided pectoral nerve block (PEC1) versus Serratus Anterior plane block (SAPB) for postoperative Analgesia in modified radical mastectomy Methods This is Randomized controlled double blind clinical trial was conducted in the operating theatres of Ain Shams University Hospitals for 6 months after approval of ethical committee of faculty of medicine, Ain Shams Univeristy on 64 female patients undergoing Modified Radical Mastectomy divided randomly into two groups, each group consisted of 32 patients group I in which patients received PEC 1 and group II in which patients received Serratus Anterior Plane Block (SAPB). Results There was a statistically significant decrease mean of group II compared to group I according to postoperative systolic blood pressure (mmHg) from 1 hr. to 6 hrs. While there was no statistically significant difference between groups according to postoperative diastolic blood pressure (mmHg). However, a statistically significant decrease mean of group II compared to group I according to postoperative heart rate (beat/min) from 1 hr. to 6 hrs was found. A statistically significant decrease mean of group II compared to group I according to numeric rating score for pain from 1 hr to after 6 hrs also was found. The current study shows highly statistically significant difference between groups according to time of first analgesia (hour), number of patients who received postoperative Diclofenac 75 mg and total consumption of Diclofenac 75 mg. Conclusion SAPB was effective in reducing postoperative pain scores for 6 -12 hours and lower total 24-h postoperative opioid and analgesic consumption after modified radical mastectomy under general anesthesia, compared to PEC 1 block.

Feasibility Study of the Grid-Connected Hybrid Energy System for Supplying Electricity to Support the Health and Education Sector in the Metropolitan Area

One of the biggest issues impeding a country’s progress is the lack of power. To overcome this issue, hybrid renewable energy systems (HRES) play an important role. Due to rising consumption and diminishing resources globally, sustainability has recently attracted more attention. Bangladesh has access to renewable energy sources, including solar, micro-hydro, biomass, wind, and others. The objective of this research is to minimize the net present cost (NPC), cost of energy (COE), and CO2 emissions of the suggested electricity network using the Hybrid Optimization Model for Multiple Energy Resources (HOMER) Pro Software. This investigation explores the possible use of a hybridized energy system (i.e., solar, wind, and diesel) with battery storage in Bangladesh’s northern area. Utilizing HOMER Pro software, an optimal grid-connected system is chosen after evaluating the techno-economic viability of several configuration options. For the Rangpur metropolitan region, seven distinct grid-connected solutions with stationary renewable sources are simulated. The HRES is designed to meet demands for hospital, diagnostic, school, and operation theatre loads of 3250.00 kWh, 250.00 kW maximum requirement, and 570.00 kWh, 71.25 kW maximum electricity demand, respectively. Multivariate linear regression (MLR) is used to assess the suggested optimal combination in terms of system size, cost, technical performance, and environmental stability. The findings show that the metric real-time rate (annual) has emerged as the most advantageous option since economic criteria like total NPC and COE are preferred above others.

Orthopaedic surgical antibiotic prophylaxis administration compliance with prescribing guidelines in a private hospital in North West province, South Africa

BACKGROUND: The correct use of surgical antibiotic prophylaxis (SAP), as stipulated in evidence-based guidelines, is essential to prevent surgical site infections (SSIs) following orthopaedic procedures and consequently the impact thereof on the patient and healthcare system. Orthopaedic SSIs are associated with devastating complications with a great burden of disease on patients. METHODS: A cross-sectional study was performed in a 186-bed private hospital, located in North West province, South Africa. Retrospective data of adult patients who underwent orthopaedic surgery from 1 January 2020 to 31 December 2020 were included. Data were obtained from the study hospital's theatre registers, anaesthetic notes, patient medical records and patient antimicrobial prescription charts. Descriptive statistical analysis was used to determine the compliance (indication, choice, route of administration, dose, administration time, re-dosing and duration) of orthopaedic SAP administration with prescribing guidelines. RESULTS: Of the 942 orthopaedic procedures, SAP was correctly administered or omitted in 742 cases (78.8%). The total choice of SAP was correct in 738 cases (78.3%). SAP was administered intravenously 100% of the time and was prescribed at the correct dose in 632 cases (77.5%). However, SAP re-dosing occurred only in one of the three prolonged procedures, and the preoperative SAP administration time was only indicated in 34.4% of the cases. The correct duration of SAP was 75.9%. The overall compliance rate to SAP guidelines regarding indication, choice, dose and duration was 57.5%. SSIs developed in 0.9% of the patients, resulting in the death of one. CONCLUSION: Orthopaedic SAP practices moderately deviated from current SAP guidelines. Apparent overuse, incorrect dosing and prolonged duration were identified as burdens to overcome. Special attention should be paid to dosing adjustments for patients weighing more than 120 kg. However, certain components such as route of administration, administration time, SAP indication and SAP correct choice showed greater compliance percentages. The low prevalence of SSIs supports a positive reporting of the findings Level of evidence: Level 4.

Scotland becomes first country to stop use of environmentally harmful desflurane

NHS Scotland is the first health service in the world to stop purchasing desflurane, a high-carbon- footprint anaesthetic gas, for use in hospital theatres. According to a statement published by NHS Scotland on 3 March 2023, the gas, which is used for general anaesthesia, has a global warming potential that is “2,500 times greater than […]

Novel Technique in Performing Standard Transperineal Template Prostate Biopsies Under Local Anaesthetic.

Transperineal template prostate biopsies (TPTPB) are now increasingly commonly performed for the diagnosis of prostate cancer. TPTPB are traditionally performed under general anaesthetic. However, this poses a significant strain on hospital theatre capacity. As such, local anaesthetic (LA) TPTPB are becoming more popular. We describe a novel technique in performing the standard TPTPB under LA in the outpatient setting. Between February 2019- February 2021, 254 consecutive men (median age 69; range: 44-80 years) with a median PSA of 8.7 ng/ml (range: 2.2-76) underwent L/A TPTPB using our novel technique. This is whereby 50mls of 1% prilocaine was injected partially around the perineal skin and partially deep bilateral periprostatic areas. Multiple simultaneous prostate biopsies were then taken with the standard template grid and stepper. A total of 250/254 (98.4%) men underwent successful L/A TPTPB with a median visual analogue pain score of 4 (range: 2-8). The median prostate volume was 49cc (range: 14-240cc). The median number of cores taken were 18 (range: 14-24). A total of 163/250 men (65.2%) had a positive histology for prostate cancer with a median of 5 cores being involved with prostate cancer (range: 1-18). In addition, 101/163 men (62.0%) diagnosed with prostate cancer had either Gleason score 3+4=7 or greater. None experienced urosepsis and only 2/250 men (0.8%) had temporary urinary retention. Our novel LA technique in performing the standard TPTPB is safe, feasible and well tolerated and associated with a high rate of prostate cancer detection.

Nonobstetric lower genital tract injury patients of a tertiary care center in Eastern Uttar Pradesh, India: A cross-sectional study.

Injuries of lower genital tract are commonly seen in obstetrics patients during labor and delivery. Nonobstetric genital injuries are seen less commonly. Research on injuries to the lower genital tract from nonobstetric trauma is therefore scant. The purpose of this study was to document causes, treatment, and outcomes among patients of lower genital tract injuries visiting to B. R. D. Medical College and Nehru hospital, Gorakhpur, U.P. Admission and operation theater registers of the department of obstetrics and gynecology during 1 year were scrutinized for cases admitted with the diagnosis of genital trauma. Bed-head tickets of patients were scrutinized with the help of a data abstraction form, and information regarding age, cause of injury, site, size and pattern of injuries, treatment, and short-term outcome were recorded. Of a total of 43 cases of traumatic genital tract injuries, 39 women received treatment. Maximum cases were seen in girls aged 6-10 years. Three women were pregnant at the time of injury. Noncoital injuries predominated over coital injuries, i.e., 59% versus 38.4%. Among the noncoital injuries, fall was the most common cause accounting for 75% of the cases. Coital injuries following consensual sex occurred more commonly in women who were sexually active, lactating, or postmenopause. The chief presenting complaint was vaginal bleeding. Vaginal wall laceration/tear was the most common injury reported. Multiple injuries were seen in 40% (17/39) of the cases. Twenty-one cases of laceration/tear (53.8%) were repaired surgically of which seven required examination and repair under anesthesia. Vulvar hematomas were managed by incision and drainage. There was no major morbidity or mortality. The results of this study from eastern Uttar Pradesh, India, support those from other developing nations. Noncoital injuries were found to be the most predominant cause of non-obstetric genital trauma, though, contrary to others, children were seen to be at the greatest risk. It is important to teach children about playing safely and following safety measures while on the road. We must also make them aware so that they do not become victims of rape.

The Impact of a Pandemic on the Provision of Diabetic Foot Care. Then, Now and the Future

Category: Diabetes Introduction/Purpose: 2020-2022 saw the COVID-19 coronavirus pandemic. Stratification of access to theatres based on urgency resulted in many diabetic patients 'falling through the crack'. Diabetic patients with foot disease, who presented acutely and/or with sepsis were often managed by the vascular team, who often deemed that there was no salvage option available. However, patients who had recurrent ulceration but were systemically well were unable to access the theatre and clinical skills required to address the mechanical deformity that was responsible for the recurrence of the ulcer. Methods: Scotland National Database for all diabetic foot disease collates information for all new diabetic foot ulcers. The system is designed to collate data pertaining to the control of the patients' diabetes, peripheral vascular disease and smoking. It is less robust had assessing orthopaedic and biomechanical abnormalities which would benefit from surgical intervention. A collaborative approach with the diabetologists, diabetic podiatrists and orthotics, orthopaedic and vascular surgeons across Scotland has anecdotally recorded a significant reduction in services for this group of patients. Community podiatry services were redeployed during the pandemic. Access to hospital clinics and theatre utilisation was stopped for periods of time. The very first weeks had patients staying at home with loved ones and as a result, active ulcers decreased due to off-loading and patients taking care of themselves. Recovery however is painfully slow, with disjointed services. It is however an opportunity to reshape a national diabetic foot service. Results: Initial review with all the major stakeholders anecdotally has reported significant increases in diabetic foot disease during the two years of the pandemic. The lack of access to elective orthopaedic procedures has meant that patients are now presenting very late. Often the only surgical option available to save life or limb is amputation. However new ways of working have brought some benefits to patients. Virtual and remote communication has facilitated a reduction in the number of hospital visits. However, lack of coordination means that many of these patients are suboptimally managed pre and peri-operatively. Clinical competencies are very varied across the country, and there has been no face-to-face training. This is however a perfect opportunity to re-think the delivery of service and allocation of training and vital resources across the country. Conclusion: A complete review of the national picture of delivery of services for patients with diabetic foot disease allows identification of patients' needs. The allocation of resources and training needs for both surgeons and Allied Health Professionals will be identified and addressed. The main focus of the review remains the reduction in amputation rates, with an associated reduction in mortality for this group of patients.Once pathways have been reassessed, escalation should become more robust. The review will also identify major training needs.

Improvement and standardization of disinfection in hospital theatre with ultraviolet-C technology

The level of disinfection between operating sessions is important to prevent cross-contamination risk in operating theatres. To assess the difference in microbial contamination between different disinfection levels, before (T0) and after (T1) application of a UVC device (UVC-D). A cross-sectional study was conducted between December 2019 and August 2020 in a clinic. Three disinfection levels - no disinfection after surgery, after in-between cleaning, and after terminal cleaning - were compared to assess the reduction of microbial presence at T0 and T1 according to the use of UVC-D for 3-5min per bedside. A total of 260 Petri dishes, divided into a preliminary phase followed by a probabilistic model-driven experiment, were used in three operating theatres, and colony-forming units (cfu) were counted. The Mann-Whitney test was performed in the preliminary phase to establish UVC exposure time. Using the probabilistic model, descriptive statistics and percentage and log10 reduction were calculated. The multivariate analysis of variance (MANOVA) for repeated measures was performed to verify the 95% statistical difference between T0 and T1, combined with the disinfection levels and different operating theatres. The Mann-Whitney test showed no cfu difference between 3 and 5min of UVC exposure time; the MANOVA test showed no significant difference between disinfection levels in T0 - T1 cfu reduction with a mean cfu reduction of 72% (95% confidence interval: 61.7-84.9) regardless of the disinfection level applied previously. UVC-D has improved environmental disinfection in all initial conditions. Together with the classic sanitizing procedures already present, it improves and standardizes the level of environmental hygiene.

P-018 Serum Follicle-Stimulating Hormone (FSH) levels as a predictor of outcomes after Surgical Sperm Retrieval (SSR) for male infertility

Abstract Study question Is there an association between pre-operative FSH levels and successful outcomes following Surgical Sperm Retrieval (SSR), and subsequent fertility treatment? Summary answer Higher levels of pre-operative FSH are associated with unsuccessful SSR, and, in the cases of successful retrieval, sperm less likely to produce healthy live births. What is known already Surgical Sperm Retrieval (SSR) techniques combined with Intracytoplasmic Sperm Injection (ICSI) offer men with azoospermia a chance to father biological children. However, the variable success rates of these physically, psychologically, and financially costly procedures highlights the potential value of pre-operative predictors of success. A literature review indicated serum FSH a promising pre-operative prognostic factor. However, only very few papers investigated pregnancy outcomes as an endpoint. Study design, size, duration An extensive literature review was undertaken examining literature between 2015-2020. This led to determination of the serum cut-off level to apply to the different groups’ outcomes. The study was a retrospective clinical analysis of SSR offered by a university Hospital between 2014-2021. Sample size was 118 (mainly Testicular Sperm Aspiration (TESA) and Percutaneous Epididymal Sperm Aspiration (PESA) patients. Patients with Klinefelter’s (KF) (N = 3) were excluded from analysis due to the genetic nature of their azoospermia. Participants/materials, setting, methods Databases from the University Hospital's Theatres and Andrology Department provided data on patients who underwent SSR 2014-present. A retrospective evaluation of physical and electronic notes identified preoperative hormone profiles and other potential influencers. Pregnancy outcomes were ascertained from the ICSI and Frozen Embryo transfer (FET) databases. Using a serum FSH cut-off of 15IU/mL (chosen based on previous literature review) data was analysed for differences between the groups’ outcomes. ROC analysis generated potential alternate cut-offs. Main results and the role of chance Using the initial 15IU/mL cut-off analysis demonstrated significantly more patients had unsuccessful SSR and sperm that did not produce healthy live birth where FSH was ≥15IU/mL at a 95% confidence level. The ROC curves for both SSR and pregnancy outcomes also proved significant – suggesting various potential cut-offs from our data. One potentially valuable cut-off for identifying men unlikely to produce sperm capable of producing a healthy live birth following all treatment is 14.0IU/mL (FSH above this predicting failure in pregnancy outcomes) (sensitivity 40.8%, specificity 90.5%), i.e., above this level the model predicts 90.5% of men will not have success. The lower bound 95% CI for this curve was above 0.5, indicating the curve to be statistically significant at a 95% confidence level. Limitations, reasons for caution SSR is rare and a lack of documentation available for some patients resulted in a relatively small sample size. Our data comprises primarily TESE and PESA patients. Different surgeon technique or service standards may influence outcomes. Our findings did not consider KF patients, who may have favourable SSR outcomes. Wider implications of the findings SSR is a costly procedure financially and physically with variable success rates. Hopefully these findings can help counsel men as to their likelihood of success in having a healthy live birth following SSR and subsequent treatment, helping to reduce both a financial burden on services and emotional burden on patients. Trial registration number Not applicable

Building a critical incident peer response team: A full theatre team welfare intervention.

The psychological impact (second victim effect) of in-theatre critical incidents is increasingly recognised. Different styles of psychological support programme have recently been published, including some utilising 'near in time' peer support. Most of these programmes either target their support to individuals, or focus on one vocational group rather than the multidisciplinary team. However, the in-theatre team consists of different craft groups who nonetheless function as a single team and are therefore 'peers'. This paper sets out the design and implementation of a critical incident peer response programme at Waikato Hospital, New Zealand, which provides peer-led group psychological first aid to full theatre teams. The programme is administered by trained representatives from multiple in-theatre craft groups including nurses, midwives, anaesthetic technicians, recovery room nurses, surgeons and anaesthetists. It emphasises team education and peer support, and has a wholly welfare focus. The programme has voluntary participation but mandatory activation triggers so that individuals do not need to seek support actively at a time when they may not recognise the need to do so. The programme is becoming embedded in the Waikato Hospital theatre culture so that participating in psychological support is normalised following a critical event. This framework is shared in the hope that it will assist other hospitals to develop welfare interventions to support full theatre teams.

The George Hospital theatre documentation and information system

The George Hospital theatre documentation and information system

The impact and restoration of colorectal services during the coronavirus disease 2019 pandemic: A view from Oxford.

AimThe coronavirus pandemic has significantly disrupted the way we deliver healthcare worldwide. We have been flexible and creative in order to continue providing elective colorectal cancer operations and to restart services for benign cases during the recovery period of the pandemic. In this paper, we describe the impact of coronavirus on our elective services and how we have implemented new patient pathways to allow us to continue providing patient care.Patients and MethodsData on major colorectal elective resections were prospectively collected in an Enhanced Recovery After Surgery (ERAS) database. Data on the number of proctology cases and telemed appointments were collected from the hospital theatre information management system and electronic patient record system, respectively.ResultsDuring the pandemic, there was a complete shift towards cancer cases, with benign services and proctology cases being placed on hold. Hospital length of stay was reduced. We implemented earlier hospital discharge and more intense telephone follow‐up after elective major surgery. This has not resulted in an increase in postoperative complications, nor any increase in readmission to hospital. During the recovery phase, we have introduced a higher proportion of telemed consultations, including one‐stop telemed proctology clinics, resulting in straight to tests or investigations.ConclusionWe have created a streamlined multidisciplinary pathway to reinstate our elective colorectal services as soon as possible and to minimise potential harm caused to patients whose treatment have been delayed. We anticipate many of these changes will be permanently incorporated into our clinical practice once the pandemic is over.

Business and property types experiencing excess violent crime: a micro-spatial analysis.

:Background:Beyond alcohol retail establishments, most business and property types receive limited attention in studies of violent crime. We sought to provide a comprehensive examination of which properties experience the most violent crime in a city and how that violence is distributed throughout a city.Methods:For a large urban city, we merged violent incident data from police reports with municipal tax assessor data from 2012-2017 and tabulated patterns of violent crime for 15 commercial and public property types. To describe outlier establishments, we calculated the proportion of individual parcels within each property-type that experienced more than 5 times the average number of crimes for that property-type and also mapped the 25 parcels with the highest number of violent incidents to explore what proportion of violent crime in these block groups were contributed by the outlier establishments. Results:While the hotel/lodging property-type experienced the highest number of violent crimes per parcel (2.72), each property-type had outlier establishments experiencing more than 5 times the average number of violent crimes per business. Twelve of 15 property-types (80%) had establishments with more than 10 times the mean number of violent incidents. The 25 parcels with the most violent crime comprised a wide variety of establishments, ranging from a shopping center, grocery store, gas station, motel, public park, vacant lot, public street, office building, transit station, hospital, pharmacy, school, community center, and movie theatre, and were distributed across the city. Eight of the 25 parcels with the highest amount of violent crime, accounted for 50% or more of the violent crime within a 400-meter buffer.Conclusions:All property-types had outlier establishments experiencing elevated counts of violent crimes. Furthermore, the 25 most violent properties in the city demonstrated remarkable diversity in property-type. Further studies assessing the risk of violent crime among additional property-types may aid in violence prevention.

Predictors of cesarean delivery in public referral hospitals in Botswana: a case control study

INTRODUCTION: Globally there is concern of rising cesarean delivery trend over the decades from a world average of 6.7% in 1990 to a high of 19.1% in 2014. Similarly, predictors of the cesarean delivery have been documented in other parts of the world, but there is paucity of evidence of those in Botswana. This study therefore aims to determine socio-demographic, obstetrics predictors as well as common indications for cesarean delivery in public referral hospitals in Botswana. METHODS: a case control study was conducted that involved retrospective review of 672 (112 cases:223 for each facility) patient´s medical records, hospital delivery registers and theater records from 01/01/2018 to 31/12/2018. Multivariate logistic regression modelling was applied using SPSS 24 to determine association between independent predictors and cesarean section. RESULTS: logistic regression analysis found out the following; women who were referred from other facilities (AOR=2.551; C.I=1.686 - 3.861), history of previous cesarean delivery (aOR=15.840; C.I 8.826 - 28.430), delivered with fetal birth weight of over 4000 grams (AOR=4.420; C.I 1.303 - 14.997), attended antenatal clinics less than four times during the index pregnancy (AOR=2.584; C.I 1.708 - 3.908), unemployed (AOR=1.619; C.I1.066 - 2.458) as well as those whose moment of delivery was at night (AOR=1.511; C.I 1.004 - 2.275). There was no statistically significant association between HIV serostatus and cesarean delivery. The most common indication for cesarean delivery was the previous cesarean delivery at 29.5%. CONCLUSION: predictors of cesarean delivery were identified as birth weight over 4000 grams, history of previous Cesarean delivery, unemployed status as well referral cases from other facilities.

EP.WE.406Adherence to operative standards for ulnar polydactyly excision in times of COVID-19 pandemic

AimsSimple ulnar polydactyly excision is a very common surgical procedure ideally performed within the first 6 months of infants life and under local anaesthetic. In conditions preceding COVID-19 pandemic this procedure was performed in controlled environment of operating theatres on a weekly basis. Increase in pressure on the NHS and operating theatre reorganisation meant elective procedures had to be cancelled with no alternatives in sight. We have suggested therefore, it be performed in a clinic environment instead under strict supervision and guidelines. No recommendations however, have been implemented when considering completion of WHO checklist and standard operation documentation. We investigated therefore adherence to typical Evelina Hospital theatre guidelines when considering documentation.MethodsCompleted documentation for each patient undergoing ulnar polydactyly excision in clinic room was reviewed between May 2020 and December 2020. Categories of WHO checklist completion, operation note present and legible, appropriate local anaesthetic information and instrument count correct were reviewed.Results92% of procedures did not have WHO checklist completed. Furthermore, as many as two thirds of the documents were completed illegibly and did not contain required information.ConclusionsFollowing the transfer of ulnar polydactyly excision procedure to clinic rooms we found the quality of documentation to be substandard. This provides opportunity for error and cause for concern. We introduced therefore standardised operative documentation pack to be completed at each polydactyly excision procedure in clinic room. Re-audited results showed improved compliance with standard operative rules and regulations and therefore improved quality of care.