Hospital Trust Research Articles

Misinformation, Trust, and Use of Ivermectin and Hydroxychloroquine for COVID-19

The COVID-19 pandemic has been notable for the widespread dissemination of misinformation regarding the virus and appropriate treatment. To quantify the prevalence of non-evidence-based treatment for COVID-19 in the US and the association between such treatment and endorsement of misinformation as well as lack of trust in physicians and scientists. This single-wave, population-based, nonprobability internet survey study was conducted between December 22, 2022, and January 16, 2023, in US residents 18 years or older who reported prior COVID-19 infection. Self-reported use of ivermectin or hydroxychloroquine, endorsing false statements related to COVID-19 vaccination, self-reported trust in various institutions, conspiratorial thinking measured by the American Conspiracy Thinking Scale, and news sources. A total of 13 438 individuals (mean [SD] age, 42.7 [16.1] years; 9150 [68.1%] female and 4288 [31.9%] male) who reported prior COVID-19 infection were included in this study. In this cohort, 799 (5.9%) reported prior use of hydroxychloroquine (527 [3.9%]) or ivermectin (440 [3.3%]). In regression models including sociodemographic features as well as political affiliation, those who endorsed at least 1 item of COVID-19 vaccine misinformation were more likely to receive non-evidence-based medication (adjusted odds ratio [OR], 2.86; 95% CI, 2.28-3.58). Those reporting trust in physicians and hospitals (adjusted OR, 0.74; 95% CI, 0.56-0.98) and in scientists (adjusted OR, 0.63; 95% CI, 0.51-0.79) were less likely to receive non-evidence-based medication. Respondents reporting trust in social media (adjusted OR, 2.39; 95% CI, 2.00-2.87) and in Donald Trump (adjusted OR, 2.97; 95% CI, 2.34-3.78) were more likely to have taken non-evidence-based medication. Individuals with greater scores on the American Conspiracy Thinking Scale were more likely to have received non-evidence-based medications (unadjusted OR, 1.09; 95% CI, 1.06-1.11; adjusted OR, 1.10; 95% CI, 1.07-1.13). In this survey study of US adults, endorsement of misinformation about the COVID-19 pandemic, lack of trust in physicians or scientists, conspiracy-mindedness, and the nature of news sources were associated with receiving non-evidence-based treatment for COVID-19. These results suggest that the potential harms of misinformation may extend to the use of ineffective and potentially toxic treatments in addition to avoidance of health-promoting behaviors.

EMBIO trial study protocol: left gastric artery embolisation for weight loss in patients living with obesity with a BMI 35–50 kg/m2

IntroductionLeft gastric artery embolisation (LGAE) is a well-established treatment for major upper gastrointestinal (GI) bleeding when control is not established via upper GI endoscopy and recently has shown promising results...

A-294 Duplicate Testing of Samples Suspected of SARS-CoV-2 Infection Could Prevent Misdiagnosis of Covid-19

Abstract Background There is no doubt that the whole world has been shaken by the SARS-CoV-2 pandemic, which has affected both global health and the global economy. At the same time the importance of molecular methods for the accurate diagnosis of respiratory infections has been reinforced together with the need of testing methodologies that minimize the risk of misleading results. During the last three years of the pandemic, SARS-CoV-2 exhibited a tremendous adaptation capability through numerous mutations, leading to the appearance of the well-known Variants of Concern (VOCs) responsible of increased transmission rates. Therefore, the development of molecular methods capable of detecting all variants has become a challenge. To overcome this, potential genetic targets with low mutation rates have been identified, including ORF1ab, N gene, S gene and E gene. While Real-time PCR based detection assays of viral genomes are very accurate, testing naso/oropharyngeal samples using singlet analysis does not guarantee the error free detection of true positive results for SARS-CoV-2 infections. Furthermore, it has been documented that the probability of a false-negative testing results is influenced by a number of variables . Therefore, testing protocol adaptations, such as replicate testing, has been shown to efficiently reduce the probability of missing SARS-CoV-2 positive cases. The pilot study presented here investigates the outcome of testing 10 014 nasopharyngeal samples collected from patients with a suspected SARS-CoV-2 infection using two separate detection kits. In this study the error rate of single vs duplicate testing is discussed. Methods 10 014 nasopharyngeal swabs, collected from three different U.K. hospital trusts and Kent based care homes, were tested at the North Kent Pathology Service (NKPS). Each swab collected was placed in sterile transport media and stored at 4°C prior to viral genome isolation using the HigherPurity™ Viral RNA extraction kit. All collected specimens were processed within 24 h from collection. Total RNA isolated was immediately analyzed using two commercial CE-IVD kits: Vitassay qPCR SARS-CoV-2 and Primerdesign™ LTD, Coronavirus (COVID-19) Genesig Real-Time PCR assay. All samples were tested in duplicate. Results Following the testing and subsequent analysis, 491 samples (4.9%) were detected positive for SARS-CoV-2 using both assay kits. Of these, 302 samples (61.5%) were reported as duplicate positive (on both replicate 1 and 2) whereas 189 samples (38.5%) were detected positive on either replicate 1 or 2. In particular, 85 (17.3%) were detected positive on replicate 1 and 104 (21.2%) were detected positive on replicate 2. Conclusions Approximately 19% of tested individuals were detected as SARS-CoV-2 positive based on a positive Real-time PCR result in one of the two reactions. This percentage represents the potential SARS-CoV-2 infections that can be missed when a single reaction Real-time PCR testing is employed for infection detection in the wider population, and equates to 940 individuals out of 100 000 potentially being falsely confirmed as SARS-CoV-2 negative The authors believe that in the presence of fast transmitting variants this is a significant number of false negative tests and should be taken into consideration when testing protocols are developed and disease modelling is employed.

Effect of Customer Value and Trust on Patient Revisit Intention: Satisfaction as Mediator

Customer value is an important marketing strategy aspect that refers to the evaluation of products that meet value and satisfaction. Hospital has intangible characteristics of services so trust is needed. Hospitals need to instill credibility to the extent that customers believe that they can provide service products that satisfy customer needs. This study aims to determine the effect of customer value and hospital trust on repeat visits at Bekasi Public Hospital. The type of research is a quantitative observational cross-sectional using random sampling. PLS-SEM was used to evaluate the data of 125 respondents who were patients outpatient. The results of this study indicate that customer value has an effect on satisfaction, trust has an effect on satisfaction, customer value and satisfaction have an effect on the revisit intention, and trust has no effect on the revisit intention. Customer value can affecttsatisfaction and revisit intention and trust affect patient satisfaction, but trust does not directly affect intention to revisit. Satisfaction can affect the patient's revisit intention.

Evaluation of Acute Outcomes and Factors Influencing the Care of Chest Trauma in a District General Hospital in the United Kingdom.

Background The rate of chest trauma admissions under the Queen Hospital Burton Orthopedic team has been steadily increasing, surpassing other hospital trusts. Patients are managed locally by the Orthopedic department, unlike in major trauma centres. Understanding the management outcomes and patient factors in this setting is crucial for enhancing patient safety. Methodology A retrospective analysis of 139 patients with chest trauma referred to the QHB Orthopedic team from October 2017 to May 2021 was conducted using the Meditech-V6 electronic medical records system (Meditech, Westwood, US). This study aims to evaluate the outcomes of patients admitted with chest trauma and improve current practices. The objectives include assessing patient factors influencing outcomes, initiating discussions with a major trauma centre, and enhancing the quality of care for chest trauma patients. Results The mechanism of injury in all cases of chest injuries was blunt trauma, accounting for 100% of the cases. The specific mechanisms of injury observed in the study included falls from standing, falls from height, road traffic collisions, and assault. The study comprised 139 individuals, 128 of whom were diagnosed with rib fractures, and 11 who did not have any rib fractures. In addition, two patients were hospitalized with bilateral rib fractures, both of which were life-threatening. Tragically, one of these cases resulted in the death of the patient. With regardto outcomes,67% of the patients received a consultation at Royal Stoke Hospital (RSH). Eight individuals were transferred to RSH for further management, while the remaining 131 patients were not transferred.Eighty-seven individuals were discharged from the hospital, indicating successful recovery and readiness for discharge. However, it is noteworthy that nine patients experienced complications during their hospital stay, highlighting the potential challenges and risks associated with chest trauma management. Tragically, seven patients succumbed to their injuries and passed away. Conclusions The majority of patients in this study were aged 65 and over and presented with multiple comorbidities, indicating the complex medical profile of this population. However, despite the presence of life-threatening injuries and the associated risks, only a minority of patients in the study were transferred to a designated trauma centre. This raises concerns about the adequacy of the current transfer protocols and the potential impact on patient outcomes.

Treatment Decision-Making in Myocardial Infarction for People With Advanced Kidney Disease: Protocol for a Qualitative Study

Background: People with chronic kidney disease (CKD) have significantly higher morbidity and mortality following myocardial infarction (MI) than the general population. Despite this, they are less likely to receive invasive management and guideline-directed medications than those without kidney disease. It is unclear why this treatment variation exists and whether or not it reflects equal and appropriate access to care for the high-risk CKD population. Aims: The aims are to (1) understand how management decisions following an MI are made for, and with, people with CKD, and (2) describe the experiences of people with CKD who have recently received MI care in England. Method: We will recruit 15–20 patients with CKD and previous MI, and 15–20 clinical staff who are involved in treatment decision-making, from 3–5 NHS hospital trusts in the UK. Purposive sampling will be used to ensure diversity in participants with respect to age, gender, ethnicity and, where relevant, profession or degree of kidney impairment. We will undertake semi-structured interviews following flexible topic guides developed for patients and clinical staff. Interviews will be audio-recorded and transcribed. Transcripts will be analysed using the six steps outlined in Braun and Clarke’s thematic analysis, within an interpretivist, constructionist approach. Analysis will be primarily inductive. We will label sections of text with codes to reflect semantic or latent meaning and cluster similar codes together to derive themes which we will define and name. We will produce a report comprising themes central to MI treatment decision-making in people with CKD, illustrated with examples of data and analytic commentary, and demonstrate where our research stands within the context of the literature and wider context.

Unintended consequences of the 18-week referral to treatment standard in NHS England: a threshold analysis

ObjectiveIn 2012, an ‘18-week referral to treatment standard’ was introduced in England. Among people on the list of those waiting for hospital treatment at a point in time, the standard...

Choix d'un protocole d'administration d'héparine sodique au pousse-seringue électrique par des infirmières et des prescripteurs

ObjectivesSeveral protocols for administering heparin by electric syringe pump can coexist within the same hospital. This puts patients at risk of medication errors. In our hospital trust, two preparation protocols coexist (20000UI/48mL and 25000UI/50mL). The objective is to relate the work carried out with prescribers and nurses to retain only one protocol. MethodsWe questioned prescribers and nurses about the differences between the two protocols in terms of the simplicity of implementation and the risk of error to which nurses are exposed when preparing the syringe. Contextual information (heparin shortage, waste) was given in order to support the answers. ResultsAccording to the 96 nurses and 82 prescribers who responded, the protocol to use is 25000IU/50mL for 98% and 83% of them respectively. The 20000IU/48mL protocol was considered the riskiest due to the possibility of mistakenly collecting 5mL instead of the required 4mL. Given the heparin shortage, the waste inherent to the 20000IU/48mL protocol reinforced this choice. ConclusionsThe consultation of nurses and prescribers allowed the choice of a protocol with very strong agreement. This work also brought to light what appears to be a medical misconception, namely that the non-concerted choice by physicians of a mode of administration of a drug can put nurses in a situation to make preparation errors more frequently. This emphasizes that nurses must be stakeholders in the decision-making processes that affect their practice.

Trust as Key to Health Sector Reforms

Globally, the coronavirus disease (COVID-19) pandemic has sparked unexpected and violent outbursts against doctors, nurses, and other health personnel. In the Indian context, studies on violence against doctors and other medical staff largely focus on supply-demand imbalances in health care, overcrowding, drug shortages, negligence of critical care patients, lack of diagnostic and other essential devices (e.g., X-ray and ultrasound equipment and oxygen cylinders), deaths of patients, and bribery and corruption (collusion between doctors and pharmaceutical companies). While these factors explain such violence against medical personnel partly, we argue that it is largely rooted in a lack of trust in doctors and hospitals, which eroded rapidly during the COVID-19 pandemic. We analyze the covariates of trust in public and private health-care providers based on an all-India panel survey and delineate policies to rebuild trust, especially in public health care.

Translation and Validation of Childhood Healthcare Assessment Questionnaire in Urdu Language for Juvenile Idiopathic Arthritis

Aim: To translate and validate Childhood Healthcare Assessment Questionnaire (CHAQ) in Urdu language and assess its psychometric properties for cross cultural adaptation. Methods: The Childhood Healthcare Assessment Questionnaire (CHAQ) was translated into the target language of Urdu by two independent translators, one of whom was familiar with the questionnaire's concept while the other was not, and the two translations were then compared as part of a cross-cultural linguistic validation study. These two initial translations of the questionnaire were blindly reversed, and the results were compared1. The pre-final version of the translated version underwent thorough psychometric testing in a sample of 38 members of the target population (parents of children with juvenile idiopathic arthritis at Ghurki Trust and Teaching Hospital, Lahore) who satisfied the inclusion requirements. The final version was reviewed by an expert panel. Parents' prior approval was obtained before testing. Results: The Cronbach’s alpha for the Urdu version of CHAQ was calculated as 0.993 after testing on the population showing excellent internal consistency. For test-retest reliability, Pearson correlation ranged from (0.378–0.956).The inter-item correlation of the Urdu version of CHAQ after applying to the targeted population has a mean value of 1.177, a minimum value of 0.056, a maximum value of 4.00, a variance value of 0.723, and a range of 3.944. The scale statistics have a mean value of 103.55, a variance of 1462.37, a standard deviation of 38.241, and a total number of items of 88.The intraclass correlation coefficient ranges from 0.606-0.993. Conclusion: The Childhood Healthcare Assessment Questionnaire in Urdu is a screening tool for parents of children with juvenile idiopathic arthritis since it has adequate inter-item correlation values and great internal consistency. Keywords: Childhood Healthcare Assessment Questionnaire (CHAQ), Juvenile Idiopathic Arthritis (JIA), Reliability, Validity, Cross-cultural adaptation

Translation and Validation of FLACC scale in Urdu Language

Aim: To translate and validate FLACC scale in Urdu language Methods: At the Ghurki Trust and Teaching Hospital (GTTH), cross-cultural linguistic validation research using non-probability convenient sampling was carried out for 7 months, from July 2021 to January 2022. Two native Urdu speakers with sound English language understanding, one from medical background and second from educational background translated the English FLACC scale. Two English-certified linguists who did not have access to the English version subsequently reverse-translated these two versions into English. These Urdu translations and back translations were critically analyzed and reviewed by a committee of paediatric physical therapists and paediatric clinical practitioners, and a final Urdu version was prepared. After approval of the final translation, this Urdu FLACC scale was applied in the post-operative paediatric population to assess its validity and reliability. After 2 hours, bilingual subjects were administered the English version, while others were again assessed with the Urdu FLACC scale to check linguistic interchangeability and test-retest reliability. Informed consent was taken and documented as well; this study was approved by the Ethical Review Board of Lahore Medical and Dental College, Lahore, Punjab, Pakistan. SPSS version 26 was used for data entry and as well as analysis. Inter-rater reliability was evaluated by using Intraclass correlation coefficients, which determines the strength of association and measure of chance-corrected agreement. The construct validity of the FLACC tool was evaluated by using ABC of content validation and content Validity Index Calculation. Results: The mean age and standard deviation of patients was 5.333+1.5599. The ABC of Content Validation Index, which yielded an average proportion of 0.97. The Cronbach’s alpha of translated FLACC scale is 0.701 when applied on population. Intraclass correlation coefficient ranged from 0.319-0.701 with acceptable reliability. Conclusion: The FLACC scale's translated Urdu version shows good validity and reliability. Key terms: Consolability, Pain, Preverbal population, Validity, Reliability, neonatal ICU

554 One Stop Flexible Cystoscopy; Impact of COVID-19

Abstract Introduction Due to the COVID-19, there has been a decrease in patient access to flexible cystoscopy within urology and an increase in telemedicine to assist with patient contact and care. It is pertinent to consider the impact of the pandemic on the patient experience, satisfaction, and awareness of services alongside clinical delays. Aim The aim was to assess degree of patient satisfaction across East Kent University Hospital Trust and illicit the prevalence of patient education across the cohort. The secondary aim was to report distribution of referral time as well as timings of CT/USS scans across the cohort. Method A retrospective analysis of hospital appointments from March-October 2020 and telephone surveying of the patient population was conducted. A 14-question survey was created to consider patient-reported outcomes and experiences. Results 539 flexible cystoscopy appointments took place from March-October 2020. From these, 44.4% of CT/USS scans were done after the flexible cystoscopy, rather than before (16.40%). 76% of referral times took under 14 days. Patient satisfaction remained high, 60% and 27% reported feeling very satisfied and satisfied, respectively, with the service. However, 47.1% of the cohort did not completely understand the plan after discharge. Conclusions While patient experience appears to have remained positive despite the COVID-19 pandemic, there has been a significant impact on secondary investigation timings and patient education. There is a need to consider the clinical implications of delayed imaging and consider methods to improve patient care and information after discharge. QIPs are underway to address issues raised.

Exploring the Impact of a Housing Support Service on Hospital Discharge: A Mixed-Methods Process Evaluation in Two UK Hospital Trusts

Delayed discharge from hospital is a global healthcare problem with negative impacts on patient outcomes and the wider health system. Delays to discharge can arise when a patient remains in hospital even when they are medically fit due to nonmedical reasons such as a lack of appropriate housing or social care. However, whilst several nonmedical interventions have been developed to facilitate timely hospital discharge, there remains a lack of evidence on their impact. This study reports on findings from a mixed-methods process evaluation of a newly integrated housing and health service in two United Kingdom- (UK-) based hospitals (one mental health hospital and one general hospital). The service involved housing support coordinators (HSCs) being based within hospitals and supporting inpatients with their housing-related needs. We employed qualitative interviews with service users and hospital/housing staff (N = 16) and routine data analysis (n = 488) to understand the impact of the service and any challenges to service delivery. Service users faced different housing barriers, for example: 28.3% experienced homelessness (n = 136) whilst 80 (16.4%) faced challenges with their accommodation no longer meeting their physical needs. Service users received support for a variety of issues such as assistance with medical priority applications, support to apply for social housing, and referral to other support services. Healthcare professionals at all levels credit the service for improving hospital discharge processes and reducing stress on clinical staff, enabling them to concentrate more effectively on clinical tasks. Key to success is experienced housing staff providing patient-centred support, being integrated within a multidisciplinary team with management and oversight from the health service, and the availability of appropriate housing stock and wider services to support people after discharge. Our findings indicate that other hospitals may benefit from implementing similar housing and health integrated services.

1121 Evaluating the Practice and Post-Procedural Outcomes of Endoscopic Retrograde Cholangiopancreatography in United Lincolnshire Hospitals Trust in 2019

Abstract Aim To evaluate the performance of ERCPs within our trust through exploring the rates of post-procedural complications and outcomes. Method Data was collected from multiple databases including EndoWeb, which had all the reports of ERCPs performed, including indications, diagnosis and whether there were any complications during the procedure. We used WebV to look at post-procedural blood results and any tests from readmission that could be consistent with a complication. We also used CarePortal to look at clinic and discharge letters post-ERCP to identify whether readmission was necessary. The data collected was entered in an Excel Spreadsheet and analysis was performed in Microsoft Excel. Results We collected data for 248 ERCP procedures and there were 37 patients with repeat ERCPs in the same year. The most common indications were gallstones (34%) and jaundice with dilated ducts (36%). 81% ERCPs were successful, diagnostically and therapeutically and the complication rate was 6% with acute pancreatitis and bleeding being the most common complications. Finally, we noted a 30-day mortality rate of 2.8% but none of the deaths were related to ERCPs and were mostly due to co-morbidities. Conclusions The British Society of Gastroenterologists published a standards framework in 2014 concluding that the UK requires a national system to check ERCP practice similar to that of the US, the ERCP Quality Framework. Our post-ERCP pancreatitis rate is within the standards set by the BSG. This audit is a step in developing a national standardising system, however, there is a requirement of 100% engagement from all centres within the UK.

444 Post Colonoscopy Colorectal Cancer, Are We Compliant? A Year in Review

Abstract Post Colonoscopy Colorectal Cancer (PCCRC) is defined as a Colorectal Cancer (CRC) that is diagnosed after a colonoscopy in which no cancer was found. Aim To identify the incidence of PCCRC at a district hospital trust and to check our compliance with national guidance (audit against Joint Advisory Group on GI Endoscopy standards). We review the performance in our second cycle and take lessons forward. Method Phase 1 collected data from January 2016 to June 2019 following approval. Patients with colorectal cancer were identified from the MDT pathway. Those newly diagnosed with CRC who had colonoscopy within 6-36 months prior to their diagnosis were included. Patients with appendiceal tumours, anal SCC, small bowel GIST, carcinoid tumours or those who had surveillance endoscopies were excluded. Hospital records were used to collect data retrospectively on patient demographics and comorbid diseases. Phase 2 collected data from 01/09/2021 to 01/09/2022 with similar criteria. Results The first phase of the study identified 1334 patients. Those not meeting the inclusion criteria as set out from the World Endoscopy Organisation (WEO), or those with non-primary CRC were excluded. Histologically confirmed CRC from phase one yielded 1323 cases. The rate of PCCRC according to the WEO classification was 3%. Phase 2 identified 330 patients with histologically proven CRC, the rate of PCCRC in phase 2 was a marginal decrease to 2%. Conclusions Our rate of PCCRC is compliant with national guidance, however key learning points and recommendations are drawn to help NHS services to reach national targets and improve care.

Comparison of Lapidus procedure fixation methods for hallux valgus: a 10-year retrospective analysis

Background: The purpose of this study was to identify the type of Lapidus fixation method used in Leeds Teaching Trust Hospital that produces the best post-operative radiographical measurements. Methods: Thirty-five patients who underwent the Lapidus procedure were reviewed. Pre-operative and post-operative X-rays were measured to obtain angles; hallux valgus angle (HVA), first intermetatarsal angle (IMA), distal metatarsal articulate angle (DMA), meary angle (MA), and metatarsal declination angle (MDA). The fixation groups compared were dorso-medial plate vs dorsal plate vs medial plate and plate-single screw versus plate-crossed screw. The change in angle (Δ-angles) between pre-operative and post-operative were measured and the groups were compared. The fixation method that resulted in the largest Δ-angles and is statistically significant will be regarded as a superior fixation type within that group. Results: Groups with plate-single screw fixation showed a statistically significant (p<0.05) larger change in distal metatarsal articulate angle compared to plate-crossed screw fixation. Dorso-medial plate showed largest Δ-angles in the plate group although none were statistically significant. Conclusions: Fixation systems with single-screw result in better radiographical measurements compared to crossed-screws, significantly with the distal metatarsal articular angle. Dorso-medial plates result in better radiographical measurements followed by dorsal plate and then medial plate. However, these findings need validation with a randomized controlled trial before being generalized.

Survey of Nutritional Screening Status as Well as Dietitian to Patient Ratio in Various Healthcare Setups in India

It’s very well documented that malnutrition is an independent risk factor that has an impact on treatment outcomes and further influences the quality of life and survivorship. Nutritional attention with timely intervention is an integral component of patient care which corresponds to improved disease outcomes. Adequate nutrition not only provides economic and physiological benefits but also ensures psychological comfort throughout the patient’s journey and during and after treatment. Evaluation of the patient’s nutritional status is critical in determining the nutritional prescription for the patient. Several studies indicate early identification of malnourished patients or at risk of malnutrition is the key to begin timely and adequate nutrition attention. This multi-centre study attempted a nationwide online survey on malnutrition screening from 19th November to 18th December 2022. Out of 644 responses received, 443 were considered for analysis, and 201 were excluded. Responses from hospitals with less than 50 beds and multiple entries from the same hospital were not considered for analysis. Out of 443 hospitals, 287 (64.7%) were accredited and 156 (35.2%) were non-accredited. It was observed in the survey that nutritional screening (NS) was performed in 361 (81.5%) hospitals out of 443. A majority (90.9%) of the accredited hospitals (n=261) undertook regular NS as opposed to government and charitable trust hospitals (n=100). For NS, 47.4% of accredited and 22.4 % of non-accredited hospitals used a single screening tool of choice. There were 26 non-accredited hospitals with no dietician service. The average number of dieticians in accredited hospitals and non-accredited hospitals were 4.4±3.94 SD and 2.3±3.93 respectively. The dietician-patient ratio in accredited and non-accredited hospitals was 1:73, and 1:212 respectively. Conclusion: Adequate and standard NS practices are lacking in both accredited and non-accredited hospitals with a poor dietitian-to-patient ratio. We propose a better dietician-patient ratio and a simple and rapid first-line tool to detect malnutrition in patients in Indian healthcare setups where there is a massive influx of patients to be matched with multifaceted socio-economic issues and fewer staff. Keywords: Nutrition screening, Malnutrition, Dietitian­Patient ratio, Nutrition care pathway

219 Chronic Fungal Sinusitis: Pre and Post COVID-19, A single UK Tertiary Centre study

Abstract Aims Anecdotal evidence suggests an increase in the incidence of cases of Chronic Fungal Sinusitis pre- and post-Covid 19 Pandemic. We aimed to audit our patient incidence of fungal sinusitis pre- and post-COVID-19 pandemic, alongside auditing our management of these cases against national guidelines. Objectives: 1. To assess the incidence of Chronic Fungal Sinusitis pre- and post-COVID-19 pandemic at a single UK Tertiary centre 2. To audit the management of Chronic Fungal patients against national guidelines pre- and post- COVID-19 pandemic. Methods All Chronic Fungal Sinusitis patients at a UK Tertiary centre NHS Trust from the years 2018 to 2022 were collected. 2. Incidence of Chronic Fungal Sinusitis pre- and post-COVID-19 pandemic was assessed. 3. Patient notes were assessed for demographic, species of fungi, management, and patient outcomes. 4. Patient management was audited against national guidelines. Results Post-COVID-19 pandemic there was a higher incidence of patients presenting with Chronic Fungal Sinusitis 2. National guidelines were adhered to at the Hospital Trust pre/post-COVID-19. Conclusion Based on limited data from a single tertiary UK centre there appears to be a relationship between COVID-19 and the increase in the incidence of Chronic Fungal Sinusitis. However, larger multi-centre studies with a greater sample size need to be assessed to accurately assess this trend

FTP2.4 Colorectal Resections at an Elective Hub; A service evaluation

Abstract Aim Rising acute hospital bed pressures that have persisted post-pandemic have led to increased surgical cancellations and growing waiting lists. Ashford and St Peters Hospital Trust set up a unique elective surgical hub at Ashford Hospital to ensure the continued provision of surgical services, unaffected by the capacity pressures of an acute hospital site. The introduction of a level 1.5 Enhanced Care Unit (ECU) has enabled many colorectal resections to be performed at the elective hub. We aim to evaluate elective colorectal resections at this hub since the introduction of ECU. Methods Evaluated all elective colorectal resections in the 12 month period since the introduction of ECU (1st April 2021 - 31st March 2022). Procedure, surgical approach, histology, length of stay, post-operative complications and inter-hospital transfers were recorded for each case. Statistical analysis was performed on the data collected. Results In 12 months,169 and 36 colorectal resections took place at the acute site versus the elective respectively. At the elective hub, 50% of patients were male, the median age was 62.5 yrs, 89% were ASA 2. Right hemicolectomy was the most common procedure (50%) followed by high anterior resection (36%). The open conversion rate was 8%. Three patients (8%) required transfer to St Peter’s, 2 of which had an anastomotic leak. Conclusions An elective hub provides a safe location for colorectal resections. Appropriate case selection involving consultant surgeons and anaesthetists ensures low transfer rates. Expanding this service will relieve bed pressures at St Peters and reduce waiting lists.

Is There a Consensus on Air Travel Following Hip and Knee Arthroplasty?

Introduction "When can I fly after my hip or knee replacement?" is a question frequently encountered by surgeons. Both air travel and arthroplasty increase the risk of venous thromboembolism (VTE); however, few studies examine the risk of air travel following arthroplasty. This study aimed to review the advice given to patients by surgeons, airlines, and insurance providers about flying after arthroplasty. We also review the current literature and available guidelines. Materials and methods A survey was sent to consultants with a specialinterest in hip or knee arthroplasty at 14 hospital trusts in the United Kingdom (UK) asking how long they would advise patients to avoid flying after surgery. We contacted all UK commercial airlines asking if they imposed any limitations on flying after arthroplasty. We contacted 15 UK insurance providers to determine whether they would provide insurance coverage following arthroplasty. Results A total of 110 knee surgeons and 105 hip surgeons were contacted. The response rate was 42% for hip surgeons and 44% for knee surgeons. Advised time to avoid flying varied widely from 14 to 180 days. A total of 22 airlines were contacted, and the response rate was 63% (n=14). Five airlineswould not allow passengers to fly following arthroplasty and seven airlines required certification from a doctor. Fifteen insurance providers were contacted and the response rate was 73% (n=11). Seven insurance providers had restrictions on providing cover to passengers after arthroplasty. Conclusion Advice given to patients by surgeons, airlines, and insurance providers about flying following arthroplasty varies greatly. There is an absence of evidence-based guidelines to inform such advice. Further study is required to provide the evidence on which to base such advice.Therefore, we recommend that surgeons exercise caution when providing advice to patients.