bluuebunny/crossref_metadata_2025 huggingface dataset:
Split-Face Comparison of Two Hyaluronic Acid Fillers: Intersection of Rheology and Tissue Behavior in Midface Rejuvenation
Authors: Weiner Steven , Hicks Jessica , Nguyen Thu , Meckfessel Matthew
Published: January 2025

Background

Hyaluronic acid (HA) fillers are one of the most popular aesthetic treatments for midface volumization, achieving optimal aesthetic improvements. Given the variety of HA filler products available, it is important for injectors to understand how their rheological properties can influence behavior in tissues.

Objectives

To evaluate and compare 1) product integration and dynamic support, and 2) lifting capacity of two rheologically different HA fillers (HA Contour [HACON] and HA Voluma [HAJVOL]) via ultrasound and clinical photography.

Methods

Randomized, split-face study (N=11) comparing two midface HA fillers over a 12-month period with initial injection along the zygomatic arch at Day 0 and optional touch-up at Month 1. Eligible subjects were aged 22 to 65 years with midface volume loss and contour deficiency. Assessments included ultrasound (neutral and smiling), clinical photography with 3D volume change (lifting capacity) analyses, and adverse event reporting. Volume change was assessed at two regions: midface and infraorbital hollow (IOH).

Results

With similar average total injection volumes, both fillers had comparable lifting capacity in the midface (HACON: ≥2.07 mL and HAJVOL: ≥2.08 mL; p>0.05) and IOH (HACON: ≥0.45 mL and HAJVOL: ≥0.57 mL; p>0.05) areas for up to 12 months. Ultrasound showed that HACON integrated into the tissue, stretching and elongating during a smiling expression while HAJVOL did not integrate as much, with aggregates consistent in size and shape during both neutral and smiling expressions through 12 months. No adverse events were reported during the study.

Conclusions

HACON demonstrated a similar duration of lifting capacity (volumization) as HAJVOL but had more distributed product integration and flexibility to support dynamic expressions through 12 months.
Fibroblast Growth Factor Receptor 2 Variants in Schimmelpenning–Feuerstein–Mims Syndrome
Authors: Wang Yixin , Zhao Lingyun , Chen Yuling , Pan Lingyu , Zhou Runke , Li Li
Published: January 2025

We report a patient diagnosed for SFM with a variant in the FEFR2 gene. The clinical presentation of skin fold changes was different from that of other gene variants causing the disease, showing specific skin fold changes. In SFM patients with skin folds, evaluation for FGFR2 gene variants should be considered.
O2 Are elderly patients undergoing emergency laparotomy receiving appropriate geriatrician input: a closed loop audit as looking at NELA standards
Authors: Govind Garima , Jayasankar Balaji , Street Anna , Bashford Sally , Di Franco Filippo
Published: January 2025

Aims

Patients over the age of 65 years undergoing emergency laparotomy (EmLap) have a higher 30-day mortality rate. NELA recommends that all surgical patients undergoing EmLap over the age of 65 have their clinical frailty score (CFS) documented on admission. Those aged 80 or above, as well as those aged 65 and above with a CFS of 5 or more, should have a prompt geriatrician review as an inpatient.

Methods

We completed an initial audit cycle over 6 months looking at the proportion of patients who had their CFS documents, and the proportion of patients who were referred for an inpatient geriatric review. We then implemented change by sharing clear ways of referring such patients via email, displayed posters in our offices and invited a senior Geriatric Medicine registrar to give a talk at our governance meeting. We then repeated the audit over another 6 months.

Results

In the first cycle, there were a total of 70 EmLaps, of which 42 were aged 65 years or more. Only 40% of these patients had a CFS documents and there were zero referrals to Geriatric Medicine. In the second cycle, there were 59 EmLaps, of which 40 were aged 65 years or more. 58% of patients had a CFS documented. 15 patients had an inpatient Geriatrician review.

Conclusions

We improved on our documentation of CFS and also increased our rate of Geriatrician referral for elderly patients undergoing EmLaps.
O3 Estimating the effect of frailty on longer-term survival following emergency laparotomy an observational study using National Emergency Laparotomy Audit data
Authors: Price Angeline , Griffiths Jane , Pearce Lyndsay , Smith Jonathan , Tomkow Louise , Martin Peter
Published: January 2025

Background

Around 30,000 emergency laparotomies are performed annually in the UK. Over half are in people aged ≥ 65 years and a third are frail. Frailty and its association with 90-day mortality is well documented. Longer-term mortality risk has been less extensively studied, despite clear implications for person-centred care. We aimed to estimate the influence of frailty on short (<90 days) and longer-term (≥ 90 days) mortality following emergency laparotomy.

Methods

A retrospective analysis of National Emergency Laparotomy Audit (NELA) data was undertaken. Baseline patient characteristics including Clinical Frailty Scale (CFS) are routinely collected by NELA. Data are linked with Office for National Statistics mortality data. A multivariate analysis was undertaken using a Cox proportional hazards model with hospital-level random effects. Potential confounders were included as covariates.

Results

28,289 patients were included in the analysis. As expected, frailty was strongly associated with the hazard of death in the first 90-days post-surgery. Importantly this association persisted beyond 90 days. Compared with CFS 1-3, adjusted HR were 1.86 (95% CI 1.68 – 2.05) for CFS 4, 2.23 (95% CI 2.03 – 2.45) for CFS 5, 3.26 (95% CI 2.99 – 3.57) for CFS 6, 4.53 (95% CI 3.97 (95% CI 5.17) for CFS 7, 5.80 (95% CI 4.44 – 7.57) for CFS 8 and 5.36 (95% CI 4.06 – 7.08) for CFS 9.

Conclusion

Older people living with frailty remain increased risk of death beyond the immediate post-operative period. Further work is needed to understand the fuller, longer-term implications of surgery, identifying strategies that support optimal recovery.
O5 SBO ACTION: conservative Small Bowel Obstruction management in the Absence of standard ConTrast agents ON outcomes
Authors: SBO ACTION Collaborative
Published: January 2025

Aims

Small bowel obstruction (SBO) is a common emergency surgical condition. A national shortage of Gastrografin, a contrast agent used for diagnostic and therapeutic purposes in adhesional SBO (aSBO), raises questions about the impact on non-operatively managed (NOM) patients. This study aimed to assess the management and outcomes of patients with aSBO during the Gastrografin shortage.

Methods

This national prospective cohort study was conducted in 19 UK hospitals between 1st April and 1st July 2024. Consecutive adult patients with CT-confirmed aSBO intended for conservative management were included. The primary outcome measure was the success rate of NOM. Secondary outcomes included rate of progression to surgery, incidence of bowel ischaemia, and in-hospital mortality. A descriptive analysis was performed.

Results

Of the 391 patients identified, 361 (92.3%) underwent a trial of NOM (median age 70 (58-81)). 60.9% (220/361) received a contrast challenge. Following the first challenge, 14% (30/213) progressed to surgery. Fourteen patients received a second challenge with a 100% failure rate, and 8/14 (57%) thereafter underwent surgery. Two patients underwent a third challenge, both progressed to surgery. Reported rates of intraoperative bowel ischaemia were 25/69 (36.2%); 33.3% vs 38.2% for contrast and no contrast respectively. In-hospital mortality was 5.5% for NOM patients and 2% for operatively managed patients.

Conclusions

Despite national shortages, Gastrografin remained widely used. Repeated contrast challenges appear ineffective, supporting a “one and done” approach. The high rate of bowel ischaemia is concerning and highlights the need for optimised management protocols for aSBO.
eP8 Post-operative Antibiotic Trends in Appendicectomy
Authors: Smith Christopher , Siddique Nayyab , Ghosh Debolina , Khan Asad , Chatzikonstantinou Michail
Published: January 2025

Aims

This study evaluates post-operative antibiotic use in laparoscopic appendicectomy, examining its correlation with uncomplicated vs. complicated appendicitis and surgeon grade, in the absence of national guidelines.

Methods

We reviewed all laparoscopic appendicectomies at an urban DGH from February 1 to April 30, 2024. Non-laparoscopic and repeat procedures were excluded. We focused on intra-operative findings of appendicitis complications and post-operative antibiotic prescriptions, correlating these with surgeon grades.

Results

We reviewed 47 cases, identifying 33 uncomplicated and 14 complicated. Complications included abscess (n=9), perforation (n=9), and gangrene (n=7). Twenty-eight patients received post-operative antibiotics. The mean duration was 2.3 days. Patients with complicated appendicitis were significantly more likely to receive post-operative antibiotics (100% vs. 42%, p=0.0002). Consultants were most likely to prescribe antibiotics for uncomplicated cases, followed by registrars and SHOs, though not statistically significant (p=0.431).

Conclusions

This study highlights variability in post-operative antibiotic use in laparoscopic appendicectomy, influenced by appendicitis complexity and surgeon grade. The lack of national guidelines underscores the need for research to standardise protocols, improving patient care and outcomes.
eP23 Do Early Registrar Reviews Shorten Advanced Imaging Completion Times for Emergency General Surgery Patients?
Authors: Mamareli Christina
Published: January 2025

Aim

Efficient patient flow optimises outcomes and experiences in healthcare. In emergency general surgery admissions, timely access to advanced imaging is essential for prompt diagnosis and management. Imaging delays can disrupt flow, extend hospital stays, and increase costs. This study examines whether the timing of senior registrar reviews influences advanced imaging completion times.

Method

A retrospective analysis was conducted on all Surgical Assessment Unit (SAU) admissions at a district hospital over a two-month period (January-February 2023). Data collected included admission times, registrar review times, and advanced imaging completion times. Patients were categorized based on registrar review timing: within 2 hours, between 2 and 4 hours, and after 4 hours. The primary outcome measured was the time from admission to advanced imaging completion.

Results

Among the 24 patients requiring advanced imaging, 50% were reviewed by a registrar within 2 hours, with most undergoing imaging within 24 hours. A modest delay in imaging was observed with later reviews: 16.6% of patients reviewed within 2 hours were scanned within 24-72 hours, compared to 20% reviewed between 2 and 4 hours. For those reviewed after 4 hours, all underwent imaging within 24-72 hours. Delays in registrar review were associated with a slight increase in imaging completion times.

Conclusion

Timely senior review positively influences access to advanced imaging and patient flow in SAU. While delays in registrar reviews slightly extend imaging completion times, the majority of patients still receive timely scans. These findings highlight the importance of prompt senior assessments to reduce imaging waiting times.
eP24 Streamlining Diverticulitis Care: An Audit of Hospital Admission Practices
Authors: de Andres Crespo Marta , Wubetu Jonathan , Dilaver Nafi , Boulton Richard
Published: January 2025

Aim

Colonic diverticulosis affects about 25% of the population in developed countries, with 25% of these individuals developing symptoms, creating a significant burden on healthcare resources. This audit aimed to enhance clinicians' confidence in discharging patients with uncomplicated Hinchey 1 diverticulitis, reduce antibiotic use, ensure dietary advice is provided to all patients, and improve adherence to national guidelines for outpatient colonoscopy requests.

Methods

A prospective analysis was conducted, collating data on patients reviewed by surgical teams in A&E across two centres. Data collected included the date of admission, initial investigations (observations, bloods, imaging) and management (antibiotics, fluids, complications and follow-up colonoscopies). After the first cycle, we reported findings at our M&M session, teaching session and created posters throughout the department to reiterate the learning points.

Results

Prospective observations captured 20 patients in the first cycle and 15 patients in the second cycle, admitted between March-April 2024 and July-August 2024. Post-intervention, there was a positive correlation between admissions and the presence of significant co-morbidities, consistent with NICE guidelines. Although no reduction in IV antibiotic use was observed for uncomplicated diverticulitis, dietary advice significantly improved, with a 57.8% increase in specific guidance. Additionally, outpatient colonoscopy requests after diverticulitis flares rose by 30.7%, with notable improvements in the timing of these requests.

Conclusions

The interventions led to better adherence to guidelines, reducing unnecessary hospital admissions, and improving dietary advice and colonoscopy follow-ups. Targeted teaching and department-wide posters effectively enhanced guideline adherence, thereby improving patient outcomes.
eP42 Managing the NELA 'No-Lap' Cohort: Can We Do Better?
Authors: Mostafa Omar , Khan Amnah , Quddus Ratul , Zaman Shafquat , RajaChooam Viswa
Published: January 2025

Aim

Emergency laparotomies are associated with significant morbidity and mortality. We assessed our Institutes’ provision of care for patients presenting with an acute abdomen but managed conservatively (non-operatively).

Methods

A retrospective cohort study was conducted in accordance with SQUIRE guidelines and measured against the NELA ‘No-Lap’ criteria. Patients admitted over a 1-year period (April 2023-April 2024) with acute intra-abdominal pathology necessitating surgical intervention but were managed conservatively (no surgical, radiological, or endoscopic intervention) were included. Patient demographics, radiology findings, and outcomes were extracted into Microsoft Excel for statistical analysis.

Results

25 patients with a mean age of 82±9.7 years were included and 44% (n=11) were male. The LOS was 5±5.8 days. Bowel perforation was reported in 56% (n=14) and ischaemia in 44% (n=11). There was a 96% mortality (n=24).

Standards of care were compared against seven criteria. Risk assessment was performed and documented in 36% (n=9), and frailty assessment in 48% (n=12). 52% (n=13) had a CT scan reported within 1 hour of being performed and findings communicated to a surgical registrar or above. 88% (n=22) had a documented discussion regarding an advance care plan. 40% (n=10) had an end-of-life care plan in place or palliative input during admission.

Conclusion

A ‘No-Lap’ pathway supplementing the existing ‘Em-Lap’ protocol is being designed to standardise care for patients managed non-operatively. This cohort of patients should be managed in a coordinated way, using a multidisciplinary approach, to ensure their care is not compromised at any point during their inpatient stay.
eP46 Developing the rib fracture management pathway: a quality improvement project in a large district general hospital in the North East of England
Authors: Ghosh Sreemoyee , Thrikandiyur Anuradha , Agarwal Anil
Published: January 2025

Background

Rib fractures, a prevalent injury in trauma, are increasingly observed in individuals over 65 years old, particularly following falls from standing height. These injuries are associated with significant morbidity, including higher risks of pulmonary complications, ICU admission, and mortality, especially in the elderly. Effective pain management, often via regional anaesthesia like Erector Spinae (ES) plane blocks, is crucial for reducing pulmonary complications. At this institution, ES blocks are commonly used for rib fracture pain control. This quality improvement project aimed to evaluate the ES block service at a large district general hospital.

Methods

A retrospective analysis was conducted on rib fracture patients from June 2022 to June 2023. Patient data, identified using OPC codes, were extracted from hospital systems (Trakcare, ICE, and PACS) and analyzed using Microsoft Excel.

Results

Data from 55 patients were analyzed after excluding two for incorrect coding. Among these, 26 patients (49.1%) received an ES block. Of those, 57.7% received the block within 24 hours of the request, while 23.1% experienced delays over 48 hours.

Intervention

This project identified the absence of a dedicated rib fracture management protocol at this hospital. It also emphasized the need for early referral and improved access to the ES block service. As a result, a new ES block pathway has been established and is now well-integrated within the department. Additionally, a rib fracture management protocol based on patients' Battle scores has been implemented to enhance care and reduce complications.
eP49 A Systematic Review of Emergency General Surgery Ambulatory Pathways: Developing an Ambulatory Pathway Protocol
Authors: Fox Benjamin , Walters Mary , Pathak Samir , Peckham-Cooper Adam , Blencowe Natalie
Published: January 2025

Ambulatory care is defined as the provision of medical treatment by healthcare professionals outside an inpatient hospital setting. Whilst well-established in acute medicine, uptake of ambulatory pathways in surgery has been variable and optimal design and delivery is unclear. This systematic review sought to i) appraise current surgical ambulatory pathway literature and ii) ascertain the constituent components across the identified pathways, guiding the development of comprehensive templates for future ambulatory pathways.

Systematic searches including the terms ‘ambulatory care’, ‘general surgery’ and specific surgical conditions were undertaken from 2018-2023. Reporting of components of ambulatory pathways was assessed. For diseases/conditions where >5 pathways were identified across included papers, reporting was compared between studies.

Of 43 included studies, there were 8 RCTs, 31 cohort studies and 4 studies using other methods. Reporting of all aspects of surgical ambulatory pathways was heterogeneous. 24 (56%) papers reported the specialty and grade of clinician acting as senior decision maker. 17 different scoring/classification systems were used. 32 (74%) papers described using investigations to select ambulatory patients, including blood tests (n=12) and imaging (n=16). 8 studies (19%) specified both admission and discharge criteria. Information about follow-up was described in 29 papers, with location (n=29), time-points (n=26), personnel (n=16), and form of the follow-up (n=23) all reported variably.

This study has identified inconsistencies in the reporting of surgical ambulatory pathways. Future work to identify and agree on guidelines for the ‘core’ components of ambulatory surgical pathways is needed, to facilitate cross-study comparisons, and crucially, optimise patient care.
eP58 QIP: Overview of the current management strategies of Rib fracture at a UK District General Hospital in comparison to Trust Guidelines
Authors: Mustafai Muneeba Rehman , Ansar Mehwish , Tarannum Tasnuva , Mehrab Tora , Aniebo Ikechimka
Published: January 2025

Aims

Our study is aimed at analysing the management strategies and outcomes of patients presenting with Rib fractures at a UK District General Hospital to measure compliance with the Trust Guidelines and look for the areas of improvement.

Methods

A comprehensive retrospective review was conducted from January 2023 to December 2023. We studied the patient demographics, types of injury, associated complications, multidisciplinary involvement, timing and type of interventional modalities for pain management and treatment outcomes.

Results

We had a total of 67 patients with the age group of 35 - 97 years. 91% had associated health problems and 18% had previous respiratory compromise. All the patients were investigated using CT scan as per trauma protocol. Physiotherapy team review was 100% and 16.5 % patients required an intercostal drain due to haemo/pneumothorax. 16.5% received nerve blocks including erector spinae and serratus anterior block while 83% received just simple analgesia. Level 3 care was needed for 1 patient due to respiratory complications and mortality was 3% reason being HAP and frailty. None of them required a surgical intervention. The overall compliance with the trust guidelines was good.

Conclusions

In treating rib fractures, optimum pain control is crucial in preventing respiratory complications and mortality. It was evident in our study that effective pain management can help shortening the length of stay. The study highlighted the need that Intercostal nerve blocks along with other peripheral nerve blocks can be used as an effective and economic method of pain control for level 1 care patients.
eP59 Boosting Discharge Letter Compliance in the Surgical Assessment Unit – A Success Story from A District General Hospital
Authors: Davis Samuel , Oyeniyi Opeyemi , Phiri Caleb , Jose Elenza , Midya Sumit
Published: January 2025

Aim

This clinical audit aimed to assess the completion rate of discharge letters for patients seen in the Surgical Assessment Unit (SAU) at a district general hospital. Discharge letters are essential for informing General Practitioners of their patients’ hospital visits and ensuring continuity of care.

Method

Data was collected from SAU records over two audit cycles. Medical Record Numbers (MRNs) of patients seen by the Emergency Surgical Team (EST) were extracted, and Electronic Patient Record (EPIC) was used to verify if discharge letters were sent. Exclusions included patients seen by other specialties (e.g., Vascular and ENT) and those admitted directly or returning for review. A series of interventions were implemented after the first cycle, including the creation of a standardized PDF template, visual reminders, one-on-one clinician training, and instruction for nurses to ensure completion of discharge letters before patient discharge.

Results

In the first audit cycle (May 2024), only 7% of patients had discharge letters sent, while 93% had no discharge letter documented or sent. Following interventions, the second cycle (August 2024) showed marked improvement, with 69% of patients receiving discharge letters, 13% having discharge letters documented but not sent, and 18% were completely absent.

Conclusion

The audit identified a significant gap in discharge letter completion. Interventions raised awareness and improved compliance, leading to a substantial increase in discharge letter completion. Further audits and ongoing training are planned to maintain improvement and expand the initiative across the trust.
eP61 Demographics and Outcomes of Rib Fractures in a NHS England Trust
Authors: Karina Irene Melisa , Kiran Amrita , Jaskani Sadia
Published: January 2025

Rib fractures make up 15% of emergency department (ED) admissions and are the most common fracture following major trauma. They are also associated with underlying pulmonary contusions such as pneumothorax and haemothorax, with the most common complication being pneumonia. Yet, there is no standardised guideline for its management in a NHS England Trust. An audit was therefore done to analyse the demographics of, and also to assess the outcomes of patients treated for rib fractures.

Three months’ worth of data was collected retrospectively from hospital medical records. Collection criteria included all patients who presented to ED with blunt chest trauma. STUMBL score was calculated individually using MDCalc.

Of the data collected (n = 147), 76 were included in the analysis. 71 were excluded (age <18, no rib fracture, polytrauma). The largest proportion (30.2%) of patients had a STUMBL score of 16-20. Mean age at presentation was 73.5. 76.3% had multiple rib fractures and 92% of these were unilateral. Over a third (35%) were on anticoagulants. 38.2% of patients were discharged home directly by ED. 12% of admissions developed pneumonia as a complication with 100% of them having a STUMBL score >11. 7.1% were readmitted within 30 days of discharge.

Patients who presented with rib fractures had suboptimal outcomes. This has necessitated the development of a trust-wide, easily accessible guideline for its management. This guideline is currently mid-development with the input of a multidisciplinary team including ED, anaesthetics, frailty and general surgery. Another audit will be done after its implementation.
eP73 Readmissions with biliary pathology in patients awaiting laparoscopic cholecystectomy: a single centre's experience
Authors: Chhugani Simran , Gavrila Ana
Published: January 2025

Background

Acute biliary pathology counts for approximately 1/3 of emergency surgical admissions in the UK. It is recommended that early laparoscopic cholecystectomy (LC) is performed within 1 week of diagnosis in patients with acute cholecystitis, and within 6 weeks after an index attack of biliary colic. Patients with gallstone pancreatitis should undergo LC during their index admission. We sought to identify the number of biliary readmissions in patients awaiting LC, and the economic implications for the Trust.

Methods

We retrospectively reviewed the electronic records for all patients who underwent LC at our hospital between January 2023 and January 2024 (n=257).

Results

Within the timeframe studied, 18.3% of LCs carried out were classed as emergency operations. Of those not undergoing LC during their index admission, 67 patients were readmitted to hospital with biliary symptoms.Index diagnosisNumber of patients admitted between January 2023 + January 2024Number of readmissions while awaiting LCMean length of time from referral to LC (days)Biliary colic12640429Acute cholecystitis6422312Gallstone pancreatitis220163Obstructive jaundice244195Other e.g. gallbladder polyp191565

The total bed days of readmissions was 84 days, with a median length of stay of 5 days. The non-elective cost to the NHS was calculated at £75,684 per year.

Discussion

Currently, we are not meeting targets for offering timely LC to patients across the spectrum of biliary diseases, resulting in a high proportion of readmissions, at a significant cost to the Trust.
eP76 Management of suspected testicular torsion – audit of current practice
Authors: Stuart-Delavaine Caitlin , Willis Kelly-Anne
Published: January 2025

Aims

Recent publications from NCEPOD and GIRFT have prompted a review of the care provided to patients with suspected testicular torsion. A local audit was performed comparing our practice to these new guidelines.

Methods

All patients who underwent emergency surgery for suspected testicular torsion between 1st January and 31st December 2023 were included in the audit. Primary outcomes were time from arrival to review by a surgical decision maker, and time from decision to operate to surgery. Secondary outcomes included post-operative diagnosis, procedures performed, and post-operative complications.

Results

32 patients were included in the audit. 53.1% of patients (n=17) were reviewed by the surgical team within 1 hour of presentation and 37.5% (n=12) of patients underwent surgical exploration within 1 hour of surgical review. 21.8% (n=7) of patients were diagnosed with testicular torsion, 3 of which (42.8%) required an orchidectomy. A further 3 patients (9.3%) were suspected to have had testicular torsion which had de-torted by the time of surgery. Other post-operative diagnoses included hydrocoele (15.6%), epididymo-orchitis (21.9%) and torted hydatid of Morgagni (12.5%).

7 patients (21.8%) re-presented post-operatively: 3 were discharged with reassurance, 3 required antibiotics, and 1 required contralateral scrotal exploration following trauma.

Conclusion

Improvement is required to meet the standards recommended by GIRFT and NCEPOD. The data has been presented at a local governance meeting and a new clinical pathway has been created to facilitate prompt assessment and treatment of these patients. Data will be re-audited following this to monitor progress.
eP85 Documentation of Consent in Appendicectomy: A Closed Loop Quality Improvement Project
Authors: Fabre Ismay , Bateman Kellie , Ghosh Anil
Published: January 2025

Aim

The aim of this quality improvement project was to enhance documentation of informed consent for patients undergoing diagnostic laparoscopy and/or appendicectomy, ensuring compliance with legal standards and the Montgomery ruling.

Methods

Retrospective data were collected in an initial audit followed by two Plan-Do-Study-Act (PDSA) cycles from handwritten consent forms of adult patients listed for emergency diagnostic laparoscopy and/or appendicectomy. Data included: grade of consenting clinician, pre-operative imaging, and documentation of recognised risks, for example, conversion to open and drain insertion. Interventions implemented between cycles included providing EIDO leaflets on the surgical unit and teaching consent practices during induction.

Results

Data from 54 patients were analysed (Initial=18, Cycle1=15, Cycle2=21). Consent was performed by SHO’s in 38%-47%. Significant improvements were observed in documenting risks such as blood transfusion (0% to 71.4%), drain insertion (16.7% to 85.7%) and adhesions (38.9% to 76.2%). Documentation of risks such as damage to structures, bleeding and infection remained above 90% throughout. EIDO leaflet use increased from 11.1% to 80.0% within the first cycle but decreased (66.7%) in the second. Overall documentation of COVID risk decreased from 66.7% to 28.6%.

Conclusion

The initial cycle revealed poor documentation of risks, correlating with lack of informed consent. Subsequent PDSA cycles demonstrated significant improvement, particularly in recording recognised risks such as blood transfusion, drain insertion and adhesions. These improvements align with the Montgomery ruling, which requires detailed disclosure of risks to patients. Continued focus and further implementation of information leaflets/ digital resources is required to ensure consistent practice.
eP93 The Effect of an eReferral Pathway on the Emergency General Surgical Take – A Closed Loop Audit
Authors: Baker William , Boyce Tamsin
Published: January 2025

Aims

To assess whether introducing electronic referrals for emergency general surgery in a single-centre District General Hospital would improve time efficiency in terms of quantity of bleeps and influence the number of general surgical admissions.

Methods

Data was collected retrospectively for patients admitted under general surgery between 9th to 13th and 16th to 20th September 2024. The primary outcome was the number of bleeps received by the surgical senior house officer (SHO) and registrar from 08:00 to 20:00. The secondary outcomes were number of patients clerked and admitted over a 24-hour period. The primary intervention was introduced on 16th September by emergency department (ED) stakeholders and consisted of all general surgical referrals being placed onto an online platform, with bleeps only reserved for patients of clinical concern. All ED and surgical staff members were given 1-weeks’ notice of this intervention with online access to guidance and training.

Results

During the first cycle, 188 bleeps were received, with an average of 37 bleeps per day (SHO: 11 and registrar: 26). A mean average of 34 patients per-day were clerked by the general surgical team with 17 admissions. Following the eReferral intervention, the total number of bleeps increased to 189 and averaged 38 per-day (SHO: 13 and registrar: 25). The average number of patients clerked increased to 39 per-day, with 22 admissions per-day.

Conclusions

An eReferral pathway has not been shown to mitigate the significant quantity of bleeps received by the general surgical on-call team and possibly increases the number of referrals.
eP101 Stepping out mild acute Pancreatitis: Optimising Ambulatory pathway in a Tertiary care centre
Authors: Farooq Rahy , Broadhurst Damian , Shabbir Shazia , Blencowe Natalie , Pathak Samir , Peckham-Cooper Adam
Published: January 2025

Introduction

Acute pancreatitis (AP) results in approximately 25,000 UK hospital admissions annually. 70% of these cases are mild i.e. tolerating orally and not experiencing any complications. The Harmless Acute Pancreatitis (HAP) score predicts a mild disease course in 97% of patients, presenting an opportunity for ambulatory management. In 2023, a modified HAP score was introduced in our department (criteria: peritonism, creatinine >177 µmol/L, hematocrit >43% in males and >39% in females, NEWS >2, neutrophils >15x10⁹/L, and CRP >100 mg/L) to assess the suitability for virtual care, aiming to reduce hospital resource use while maintaining patient safety. This study evaluates the burden of AP in our Emergency General Surgery department, exploring the potential for optimizing ambulatory pancreatitis pathway.

Methods

All patients presenting with AP for a period of June till August 2024 were retrospectively identified using electronic records. REDCap database was used for data management. Modified HAP score was used in identifying the suitability of ambulation, where those with absence of complications and modified HAP<2 were considered mild AP.

Results

Of 88 AP cases (48 males, 40 females), 77 (87.5%) were classified as mild. However, only 10 patients were ambulated, while 67 were admitted, accumulating a total length of stay (LOS) of 418 days. The primary reasons for admission included symptom monitoring (39%), further investigations (23%), and social/medical issues (32%).

Conclusion

Missed opportunities in utilizing the ambulatory pathway suggest a need for greater clinician awareness. Optimizing this pathway could significantly reduce unnecessary admissions and hospital resource utilization.
eP104 Use of Hospital NELA Data informs Quality Improvement Project leading to Reduced 30 day Peri-operative Mortality
Authors: Clark Edwin
Published: January 2025

Aims

Regional surgical service provision reorganisation proposed moving Emergency General Surgery to “hub” centres to reduce operative mortality, nationally 11% on 1st NELA report 2015. We aimed to use unit NELA Data to inform emergency surgery pathway design & identify all high-risk (>5% risk of death) laparotomy patients requiring transfer. Previous Ambulance service audit had confirmed inability to identify at pre-hospital stage the need for laparotomy. Previous hospital audit had shown failure to identify need for laparotomy (1in 5 on National NELA) was associated with a 300% increase of risk of death.

Methods

All unit NELA cases in 1 year were reviewed & CT reports on unit database were reviewed to confirm indication for laparotomy identified (161 cases). The National NELA reports were reviewed to identify “high risk” characteristics; these were incorporated into an “Abdominal Pain Pathway” leading to abdominal CT in ED (ASA >2, previous surgery, sepsis, raised lactate, >45yrs). 2 cycles of the pathway over 2 fortnights of all patients presenting to ED were audited before pathway implementation.

Results

All patients requiring laparotomy identified on CT (164 cases NELA Yr6). Implementation of “Abdominal Pain Pathway” resulted in mortality reduction from 11.1% (Yr3) to 2.4% (Yr6) after implementation. Time to CT dropped from 2d19hrs to <4Hr.

Conclusions

Use of individual hospital NELA Data can inform emergency surgery pathways leading to reduced mortality - 11.1% to 2.4% (approximately 14 patients extra surviving on ∼160 pts/year). We recommend all units utilise NELA data to inform local policy via quality improvement process.
eP110 Assessment of outcomes following acute surgical intervention for patients admitted with Complicated Inguinal Hernia: A 10-year review
Authors: Eadala Haripriya , Nassar Ahmed , Shivaraj Rahul , Ramsay George
Published: January 2025

Objectives

This study aims to evaluate the surgical outcomes of emergency intervention in patients admitted with complicated inguinal hernia at NHS Grampian hospitals.

Methods

A retrospective analysis was conducted on patients admitted to Aberdeen Royal Infirmary or Dr. Gray's Hospital between January 2014 and May 2024 with complications related to inguinal hernia. Patient demographics, intraoperative details, and postoperative outcomes were collected and analysed. Outcomes included hospital stay, complications (haematoma, seroma, infection), acute and chronic pain, and hernia recurrence.

Results

A total of 238 episodes in 235 patients were recorded, with three patients presenting with bilateral hernias requiring separate admissions. The majority were male, with a mean age of 68 ± 17 years. Presenting conditions included bowel obstruction (4.6%), incarceration (52.9%), pain (28.5%), and strangulation (7.5%). The median hospital stay was 7.7 days (IQR 8.7-11.7), with a mean operative time of 84.7 ± 37 minutes. Most patients (89.9%) underwent mesh repair, while 1.4% had Bassini repair, and 8.6% had non-specified suture repair. Postoperative complications were low: haematoma occurred in 2% of patients, with only one requiring reoperation; seroma in 0.8%, managed conservatively; and wound infection in 1.6%, all involving mesh repairs. Chronic pain was reported in 1.6%. Recurrence was observed in 2% of patients. One mortality was recorded due to severe chest infection.

Conclusion

The complication rates associated with emergency surgical repair for complicated inguinal hernia were acceptable. Mesh repair appears to be safe for most patients, except in cases requiring bowel resection. Preoperative antibiotics did not significantly reduce infection rates.
eP123 Emergency TPN- Are we using correctly?
Authors: Ravichandran Srinath , Kumar Anil
Published: January 2025

Introduction

Total Parenteral Nutrition (TPN) is used to provide nutrition in a non-functioning GI tract. It is administered intravenously. TPN should ‘only’ be used if there is a non-functional, inaccessible (by NG tube) or perforated GI tract.

Aims and Objectives

Emergency TPN is used following local and National guidelines

Rate of TPN and duration

Review by dietician.

Materials and Methods

Data is collected retrospectively from August 2019 to October 2019. Patients who had TPN prescribed except in the intensive care unit are included. List is obtained from aseptics department.

Initial audit - December 2013 to February 2014, reaudited twice in 2014 and 2016.

Results

A total 16 patients were prescribed TPN of which indication was documented in all patients, but BMI before and after the TPN was not documented in nearly 90%. In about 81% of patients, other routes of feeding were analysed and suitability was documented. In about 68% of patients, TPN is started only by dieticians and rest by the doctors, which is a significant improvement. 37% of patients had TPN upto 5 days and in about 25% of patients, it was more than 20 days which is significantly higher compared to previous studies. All patients had correct regime and 87% were reviewed by a dietician.

Conclusion

MDT involvement is essential in making a TPN plan. Documentation of BMI, a dietician review of the regime and patients is very essential for continued care. Since the risks are higher TPN should be carefully prescribed as per NICE and NCEPOD guidelines.
eP127 Assessing quality and completeness of emergency general surgical operative notes: audit from a single institution
Authors: Brown Jade , Wijaya Anthony , Beach Timothy
Published: January 2025

Aims

To improve the quality and completeness of emergency (CEPOD) operative notes written by surgical trainees in a single institution

Methods

CEPOD operation notes from August 1st 2024 - August 31st 2024 were retrospectively reviewed and assessed against Royal College of Surgeons Good Surgical Practice recommendations of what to include in an operative note.

Results

Operation notes for 78 patients were assessed. 20% (N=16) were written by Core Trainees, 60% by Specialist Trainees (N=47) and 20% by Consultants (N=15). The areas that were most complete included: type of incision (N=71; 91%), operative diagnosis (N=74; 95%), operative findings (N=77; 99%) and the post-operative care plan (N=75; 96%). The areas that were least complete included: blood loss (N=5; 6%), DVT prophylaxis (N=20; 25%), details of implanted material where appropriate (N=2; 50%) and antibiotic prophylaxis (N=41; 52%).

Conclusions

Areas of improvement have been identified and have been addressed in the form of introducing a standard Emergency Surgery operation note template, introduced and accessible to all surgical trainees. A prospective re-audit is being undertaken in October 2024.
A case of non-scarring alopecia with follicular accentuation at the limbs of a paediatric patient
Authors: Kearney Nicola , Stefanovic Nicholas , Murray Gregg , Stacey Catherine , Kilgallen Clive , Molloy Kevin , Watchorn Richard
Published: January 2025

A 15-year-old male presented with a two-year history of patches of hair loss on his body and skin changes. Initial examination revealed scattered erythematous patches with associated follicular accentuation and concurrent non-scarring alopecia, predominantly affecting his limbs. Histopathological revealed spongiosis in the superficial- to mid-part of the hair follicle. Additionally noted was exocytosis of lymphocytes which displayed subtle cytological atypia marked by nuclear irregularity and slight enlargement. Immunohistochemistry indicated a predominance of CD4+ T cells, raising the possibility of mycosis fungoides. An external expert histopathological opinion was sought and the diagnosis of folliculotropic mycosis fungoides was confirmed.
A Comparison of Large Language Model Powered Search Tools Reveal Differences in Output Quality, Information Transparency, and Accessibility for Mohs Micrographic Surgery Inquiries
Authors: Jairath Neil K , Chennareddy Sumanth , Manduca Sophia , Lopez Adriana , Alam Murad , Golda Nicholas , Ng Elise , Patel Vishal A , Ruiz Emily S , Trufant Joshua W , Lewin Jesse M
Published: January 2025

Our study evaluates large language model (LLM)-powered search engines in addressing patient questions about Mohs surgery and found that they generally produce responses more aligned with surgeons’ communication preferences than traditional web searches, with Google Gemini excelling in content quality and Microsoft Copilot providing the most credible citations. However, all models lacked in "soft skills" like empathy and trustworthiness, and the credibility of references was poor across most models except Copilot. The authors suggest that developers should improve LLMs by grounding outputs in reliable sources and enhancing empathetic communication to better support patients pre- and post-visit, recognizing the potential of LLMs to augment—but not replace—human physician consultations.
Bundling Threats: Why Dominant Perceptions of China Changed in Europe
Authors: Breslin Shaun , Mattlin Mikael
Published: January 2025

Popular perceptions of China in Europe have clearly shifted over the past few years. This article builds on the literature that assesses how narratives of China emerge and change, and how they influence policy on how best to respond to China’s rise. We construct an analytical framework in which we identify two different types of reasons for change in dominant perceptions, underlying and precipitating, and a transmitting process (narrative diffusion). We argue that four underlying and three precipitating reasons together with active diffusion of a particular academic and policy narrative explain why dominant perceptions of China changed in Europe to predominantly negative within a relatively short time period. We explore what foundational assumptions this dominant narrative depends on, and what is considered as evidence (and evidence of what). We suggest that a projected threatening future image of China explains how current actions of Chinese actors are interpreted and that this interpretation in turn reinforces the projected future image in a circular logic, with clear policy implications. The associated assumptions, conflations, evaluation, and beliefs regarding ability and agency bundle together many different concerns that analytically should be kept separate. This leads to difficulties in discerning between diverse kinds of risks and threats on different timescales, with policymakers often opting for playing safe.
Longitudinal leucocyte DNA methylation changes in Mesoamerican nephropathy
Authors: Oomatia Amin , Chervova Olga , Al-Rashed Ali M , Smpokou Evangelia-Theano , Ecker Simone , Pearce Neil , Heggeseth Brianna , Nitsch Dorothea , Cardenas Andres , Beck Stephan , Gonzalez-Quiroz Marvin , Caplin Ben
Published: January 2025

Mesoamerican nephropathy (MeN) is a leading cause of morbidity and mortality in Central America, yet its aetiology remains unclear. Environmental exposures including heat stress, pesticides, and heavy metals have all been suggested as possible causes or exacerbating factors of the disease, but intermittent and cumulative exposures are difficult to capture using conventional biomonitoring. Locus-specific differential DNA-methylation (DNAm) which is known to occur in association with these environmental exposures can be readily measured in peripheral blood leucocytes, and therefore have the potential to be used as biomarkers of these exposures. In this study, we aimed first to perform a hypothesis-free epigenome-wide association study of MeN to identify disease-specific methylation signatures, and second to explore the association of DNAm changes associated with potentially relevant environmental exposures and MeN onset. Whole-blood epigenome-wide DNAm was analysed from a total of 312 blood samples: 53 incident cases (pre- and post-evidence of disease onset), 61 matched controls and 16 established cases, collected over a 5-year period. Mixed-effect models identified three unique differentially methylated regions that associated with incident kidney injury, two of which lie within the intron of genes (Amphiphysin on chromosome 7, and SLC29A3 chromosome 10), none of which have been previously reported with any other kidney disease. Next, we conducted a hypothesis-driven analysis examining the coefficients of CpG sites reported to be associated with ambient temperature, pesticides, arsenic, cadmium, and chromium. However, none showed an association with MeN disease onset. Therefore, we did not observe previously reported patterns of DNA methylation that might support a role of pesticides, temperature, or the examined metals in causing MeN.