This project aims to assess the impact of the introduction of a hepatobiliary and pancreatic (HPB) Quality Improvement Program (QIP) on postoperative complications following liver, biliary and pancreatic surgery.A prospective analysis of postoperative complications over a six month period was performed. Complications were analysed and graded according to internationally agreed definitions. Justification was sought and errors identified. Weekly meetings were performed to review each complication enabling an action plan to be created to prevent future recurrence. Rates were compared with previously audited and published results, using the chi-square test. A total of 326 procedures were performed over the six months including 30 pancreatectomies, 45 liver resections and 251 other procedures. 37 patients developed complications (11.3%) with 47 complications in total including two deaths. Using the ISGPS grading, eight complications were identified; two grade A, four grade B and two grade C. There were three grade A ISGLS complications and one grade B. 30 complications were justified as unavoidable, 16 as avoidable and one as indeterminate. Action plans included continued monitoring (n=41), formulation of new policy (n=3), individual counselling (n=4), educational offering (n=4). When compared with 2010 complication rates, 114 complications occurred in 233 liver operations during the baseline period, compared with 17 complications in 45 liver operations during the QIP period, OR=0.63 (95% CI: 0.33 to 1.22), p=0.17 and 86 complications occurred in 99 pancreatic resections during the baseline period, compared with 20 complications in 30 pancreatic resections during the QIP period OR=0.30 (95% CI: 0.12 to 0.79), p=0.01The HPB QIP is a rigorous approach to grade every complication and death. A statistically significant reduction in pancreas related complications has already been obtained. Further work is required to determine the persistence and magnitude of this quality improvement.

Clinical Audit Dovepress submit your manuscript | www.dovepress.com Dovepress 1 S h o rt r e p o rt open access to scientific and medical research open Access Full text Article Background: The purpose of this study was to assess the effectiveness of a single focused teaching session in improving junior doctors' knowledge of intravenous fluid therapy. Methods: A questionnaire was developed from the current national guidelines on perioperative intravenous fluid therapy, ie, the 2008 British Consensus Guidelines on Intravenous Fluid Therapy for Adult Surgical Patients. The questionnaire was administered to foundation year 1 doctors atbaseline. Subsequently a teaching session on intravenous fluid therapy was organized. The participants completed the questionnaire immediately after and again 2-5 weeks after the teaching session. The main outcome measure was the change in mean score after the intervention. Results:The mean pre-education score was 4.3 (36%). The mean post-education scores immediately and an average of 22 days after the teaching session were 10.3 (85%) and 9.5 (79%), respectively. Conclusion: A single focused teaching session is a simple and effective way of improving junior doctors' knowledge of intravenous fluid therapy. We recommend that a teaching session on intravenous fluids be integrated into the teaching program for all junior doctors.

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Results All procedures were completed laparoscopically. Follow-up at 6 months, 1, 2 and 3 years was 96%, 92%, 87% and 47% respectively. Mean (SD) % excess weight loss at these time periods was 81.4 (25.6), 102.1 (27.3), 108.7 (38.2) and 97.5 (29.1) respectively. Mean (SD) weight loss at 2 years was 34.2(19.3) kg. 83% of patients demonstrated partial or complete resolution of their preoperative comorbidities including hypertension, diabetes, sleep apnoea and hyperlipidaemia. 17% developed new-onset reflux. 53% of patients required vitamin supplementation. Complications: Wound infection (1.8%), food bolus obstruction requiring endoscopy (3.8%) and silastic ring removal for food intolerance (7.5%). There were no deaths. Conclusion While the banded (silastic ring) SG is a safe procedure with good medium term excess weight loss and comorbidity resolution, around 11% of patients required endoscopic or surgical reintervention within 3 years. Introduction Obesity is common after spinal cord injuries (SCI) 1 and it is associated with chronic nutrition related complications. We previously reported that a simple dietetic-intervention can help SCI patients to lose weight without compromising lean body mass. 2Methods The present study aimed to assess the effectiveness of a dietitian led weight management clinic. Thirty-one individuals (52.4611.5 years; body mass index (BMI): 32.9 kg/m 2 ; 41% female) with SCI were referred for consultation to include nutritional advice and cognitive behaviour therapy in three consultations over 4 months. Outcomes measures included body composition from anthropometric measurements of BMI, mid upper-arm circumference (MUAC), triceps skinfold thickness (TSF) and mid-arm muscle circumference (MAMC), sitting blood pressure and dietary assessment of nutrient intake by 7-d food diary. Results Of the thirty-one individuals, 15 (48.4%) reported one or more co-morbidities. Mean weight loss was 4.5 kg (SD 6.2) at week 16. Analysis of the pre-to post-intervention difference (using paired t-test) showed a significant reduction in weight (104.2 vs 100.4 kg, p¼0.001), BMI (34 vs 33.1 kg/m 2 , p¼0.004), total energy intake (6.84 vs 5.62 MJ/d, p¼0.029), total fat (p¼0.005), saturated fat (p¼0.001) and alcohol (p¼0.003). No significant changes were found in MUAC, TSF, MAMC and sitting blood pressure post intervention. We noted a significant reduction in MAMC at 1-year follow-up (30.2 vs 27.1 cm, p<0.001). The 7-d food diary showed an average energy intake of 7.65 MJ/d, which is 15% below the estimated requirement. Conclusion The findings of this study suggest that current guidance overestimates nutritional requirements in the SCI population, and that simple dietetic-intervention could help overweight SCI patients to achieve weight loss, but that it may not be sufficient to stimulate/maintain muscle mass long term. Further research is warranted to test whether combining lifestyle and intensive physical therapy could reduce long-term muscle wasting.