bluuebunny/crossref_metadata_2025 huggingface dataset:
eP17 Evaluating the Impact of the Children's Appendicitis Score on the Management of Suspected Paediatric Appendicitis at a District General Hospital
Authors: Kafagi Abdul-Hadi , Peaple Luke , Frerichs Carley
Published: January 2025

Introduction

Appendicitis is a common cause of abdominal pain in children and presents diagnostic challenges due to varied clinical presentations. This audit evaluates the management of suspected paediatric appendicitis at a District General Hospital, comparing it with the GIRFT Paediatric Acute Abdominal Pain Pathway. Our goal was to assess the impact of the Children's Appendicitis Score (CAS) on clinical decision-making and refine practices among emergency clinicians, paediatricians, general surgeons and radiologists.

Methods

A retrospective review of patient data from November 2023 to May 2024 for children under 16 was conducted. CAS scores were assigned based on clinical notes and key patient journey times were analysed. Data on baseline characteristics, initial assessments, imaging and surgical outcomes were recorded.

Results

Of 103 patients, 30 underwent appendectomy, with a negative appendectomy rate of 13.3% (4/30). The remaining 73 were discharged with non-surgical abdominal pain or other diagnoses. CAS demonstrated 100% sensitivity and negative predictive value in low-risk patients (n=36), effectively ruling out appendicitis. Among intermediate-risk patients (n=44), 32% were diagnosed with appendicitis, while 78% of high-risk patients (n=18) had the condition. CAS identified 2 negative appendectomies and highlighted an intermediate-risk patient who was discharged and later returned with a perforated appendix. Of 82 abdominal ultrasounds performed, 26 (31.7%) were deemed inappropriate for low-risk patients, with 86.36% sensitivity and 92.73% specificity.

Conclusion

Integrating CAS into the management of suspected paediatric appendicitis improves risk stratification, reduces unnecessary interventions and enhances diagnostic precision. CAS allows confident discharge of low-risk patients, optimising resource use and patient outcomes.
eP43 Analysis of the Adherence to Guidelines for Consent Forms for Laparoscopic Cholecystectomy at a Hot-Lap-Chole-Center
Authors: Almoshantaf Mohammad Badr , Lopes Sousa Erica Ramos , Hunt Hannah , Jokar Jasmine , Wong WenKyle , Abdalla Sala , Hussein Abdelaal Ibrahim Ahmed
Published: January 2025

Aim

The primary aim of this study is to assess how well LC consent-forms at Ealing Hospital adhere to NHS guidelines. A secondary aim is to evaluate whether the introduction of procedure-specific consent forms would improve compliance and patient care.

Methods

The study reviewed 150 patient records from those who underwent laparoscopic cholecystectomy (LC) over three years at Ealing Hospital, including both elective and emergency cases. Consent forms were analyzed to check if they listed key complications as per NHS guidelines: infection, bleeding, bile duct injury, injury to surrounding structures, deep vein thrombosis (DVT), and post-cholecystectomy syndrome (PCS). Post-operative complications were also recorded, and statistical analysis was conducted to compare differences between elective and emergency procedures.

Results

Only 16 consent forms (10.6%) included all NHS-recommended complications. Infection and bleeding were the most frequently mentioned risks, with infection cited in 98.43% of forms and bleeding in 96.83%. Bile duct injury was mentioned in 93.7% of cases, while over 25% of the forms failed to mention bile leakage, and half of them omitted the risk of PCS entirely. Postoperative complications were observed in 25 patients (16.7%), all of which were listed on their respective consent forms. No statistically significant difference was found between elective and emergency procedures in terms of complication listing in the consent form.

Conclusion

Introducing a standardized, procedure-specific consent-form would ensure comprehensive risk disclosure, improve patient care, and provide better legal protection. Increased education and awareness among healthcare professionals about the importance of thorough consent documentation are also necessary.
eP50 Water-Soluble Contrast Agent Use in Adhesional Small Bowel Obstruction: A Survey of Surgical Practices and Clinical Trial Considerations
Authors: Aimar Kelsey , Walshaw Josephine , Peckham-Cooper Adam , Smart Neil , Magill Laura , Lee Matthew J
Published: January 2025

Background

The role of water-soluble contrast agent (WSCA) as a therapeutic tool in the non-operative management of adhesional small bowel obstruction (ASBO) remains indeterminate. This survey aimed to understand current surgical practices in WSCA utilisation in the conservative approach to ASBO, and to evaluate key design and feasibility factors to inform a future controlled trial of WSCA in ASBO.

Methods

This study is reported in line with CROSS guidance. The survey consisted of 16 questions organised into three sections: respondent characteristics, current decision-making and WSCA use, and opinions on future trial. Pilot testing was conducted prior to online distribution to surgeons in the UK delivering Emergency General Surgery. Descriptive analysis was performed.

Results

Of 73 total respondents, 52 (71.2%) were consultants. When treating ASBO conservatively, 80.8% (59/73) reported using WSCA in more than half of cases, but there was wide variation in timings, utilisation, and repeat challenges. Between 71.2% and 89.0% of respondents affirmed their willingness to adhere to specific trial protocols. Regarding feasibility, 76.7% (56/73) of respondents agreed or strongly agreed that they would be willing to recruit to a trial and 75.3% (55/73) agreed or strongly agreed that their unit would be able to deliver a trial.

Conclusions

The survey revealed widespread acceptance of WSCA as a therapeutic tool in ASBO among emergency general surgeons. While practices around its administration varied, there was a clear readiness to adopt standardised protocols. The majority of respondents expressed support for a controlled trial comparing WSCA against a placebo.
eP56 Gall Stone Pancreatitis: Timing of Surgery is Critical
Authors: Unadike Chinedu , Namme Etomby
Published: January 2025

Aim

Gallstone pancreatitis is a significant contributor to acute pancreatitis, leading to substantial morbidity and healthcare burden. It has been emphasized that early laparoscopic cholecystectomy following an initial episode of gallstone pancreatitis remains more beneficial in outcome compared to delayed cholecystectomy. This retrospective cohort study examines the outcomes associated with index admission versus delayed laparoscopic cholecystectomy, including the impact of delayed surgery performed within and beyond six weeks on readmission rates, length of hospital stays, and complications.

Methods

Data from 99 patients diagnosed with gallstone pancreatitis at a tertiary hospital in the UK between April 2022 and March 2023 were analysed. Patients were categorized based on the timing of their cholecystectomy: index admission, within six weeks, after six weeks, or awaiting surgery. Outcomes assessed included readmission rates, length of stay, intensive care unit (ICU) admissions.

Results

72 patients had surgery: 15% of them had index cholecystectomy, while 85% had delayed surgery (< 6 weeks: 33, >6 weeks: 28). Readmission rates were higher in the delayed group. Between the delayed groups, there was no statistical significance with reference to readmissions (< 6 weeks 7, > 6 weeks: 8). Those who had index cholecystectomy had longer hospital stay (p = 0.0006). ICU admissions were seen in patients who had surgery delayed beyond six weeks.

Conclusions

Early laparoscopic cholecystectomy during index admission, while associated with a longer hospital stay, appears to reduce readmission rates and complications, confirming it is a more effective approach in managing gallstone pancreatitis. Surgeries beyond 6 weeks are associated with severe complications.
eP65 Is routine collection of pus swabs necessary during emergency incision and drainage of abscesses?
Authors: Sonoo Prithvirao , Gull Sadaf
Published: January 2025

Aim

Pus swabs for microbiological analysis are routinely sent during abscess incision and drainage (I&D) procedures. However, this remains a debated issue, particularly regarding its cost-effectiveness, which is often overlooked. This study evaluated whether avoiding routine swabs during I&D could maintain patient outcome while improving cost-effectiveness in ever under pressure NHS trusts.

Methods

Between August and October 2023, all abscess I&D procedures performed at the Surgical Triage Unit in a tertiary centre were retrospectively reviewed. Data collected included patient demographics, pyrexia on admission, co-morbidities, microbiological swab results, documentation of reviewed swab results, perioperative antibiotic use, and 30-day re-attendance.

Results

A total of 72 patients underwent I&D (44 males, 28 females; age range 17–83; median 45). Two patients presented with fever (T ≥ 37.5°C). Antibiotics had already been prescribed in primary care for 42% of patients. The most frequent abscess locations were pilonidal (22%) and back (21%). Microbiological swabs were sent for 32 patients (78%), with 57% showing no bacterial growth. The remaining swabs revealed MRSA (N=1), mixed growth, staphylococcus, and gram-positive cocci. Only one case had a documented review of swab results. Two patients re-attended within 30 days: one for inadequate drainage and another for recurrence despite appropriate antibiotic therapy.

Conclusion

Pus swabs may be avoided in most I&D cases unless specific circumstances such as immunocompromised status or extensive tissue necrosis exist. Most patients are discharged prior to results being available and no link between microbiology results and abscess recurrence or re-attendance was found.
eP66 Do emergency general surgery patients know their consultant? An audit based on the Francis Report
Authors: Thorne Thomas , McCabe Joanne , Littler Sophie , Nandra Saroop , Akbari Khalid
Published: January 2025

Introduction

The Francis Report recommended introducing a responsible consultant, with a headboard showing this by the patient. It is frequently reported that patients are unaware of their responsible consultant. We set out to audit awareness of a responsible consultant at a tertiary referral centre.

Methods

Inpatients from March–August ’24 across 3 general surgical subspecialties (UGI, HPB and colorectal surgery) were included, with eligibility generated from ward round lists. Being unable to answer questions was an exclusion criterion. This audit was registered locally. After cycle 1, data presentation occurred, a change was initiated, then cycle 2 was conducted. Standard: 100% patients are aware of their responsible consultant.

Results

Overall, 107 patients were included. 68.6% (n=72) of patients with data were emergency admissions. There were insignificant demographic differences between cycles. Between cycles 1 and 2, patient awareness of responsible consultant significantly improved for UGI patients (p<0.001), and for all patients improved from 56.5% to 71.1%, though this difference was insignificant (p=0.089). Headboards showing named consultant improved from 43.5% to 53.3%, though this difference was insignificant (p=0.234).

Conclusion

During cycle 1, poor adherence existed. Results were presented to FY1 doctors and surgical departments, with juniors given whiteboard pens, aiding writing headboards. Cycle 2 results improved from cycle 1. It should be noted, electronic noting was introduced between cycles. Further cycles should aim to further improve headboards and improve awareness.
eP75 The effect of time of intra-abdominal drain insertion on surgical outcomes in patients undergoing emergency laparotomy
Authors: Maheshwari Parth , Basu Somprakas
Published: January 2025

Background & Aim

Management of perforation peritonitis involves source control, decontamination of peritoneal cavity, and antibiotics for systemic sepsis. Preoperative abdominal drain placement helps in early decontamination and reduces intra-abdominal pressure. However, it is not fully known how the treatment outcomes are influenced. This study explores any relationship between timing of preoperative drain placement and surgical outcome in emergency exploratory laparotomy.

Method

Consecutive patients (>18 years) with perforation peritonitis planned for emergency exploratory laparotomy were recruited after obtaining informed consent. All underwent preoperative intra-abdominal drain insertion as per protocol. Time to drain insertion from patient’s presentation was recorded, and its effect on APACHE II scores and intra-abdominal pressure (IAP) before and after drain placement, 30-day postoperative mortality and morbidity, and duration of hospital and ICU stays were assessed. Spearman correlation test was used to compare time to pre-operative drain placement with APACHE II scores, IAP, ICU and hospital stay. Effects on Clavien-Dindo scores and 30-day mortality were evaluated using one-way ANOVA test.

Result

In total of 92 cases, a significant correlation (p < 0.01) was observed between time to drain placement (mean 9.15 hours) and change in APACHE II scores (mean 3.85), and with length of ICU stay (p = 0.017), and not with mean hospital stay, Clavien-Dindo score, and 30-day postoperative mortality. Changes in IAP before and after drain placement were not significantly correlated with changes in APACHE II scores (p = 0.08).

Conclusion

Delayed drain placement may impact patient outcomes, particularly APACHE II scores and ICU stay duration significantly.
eP78 Emergency laparoscopic repair of groin hernia in a district hospital: a case series
Authors: Mohamed Mohamed S , Assiri Adel , Myers Alistair , Koronfel Ashraf , Mallappa Sreelakshmi , Aly Mohamed
Published: January 2025

Background

Groin hernia (GH) represents a common surgical presentation, predominantly affecting one third of men worldwide, and adversely impacting their quality of life and work capacity. On emergency sitting they represent a life-threatening condition with mortality rate of 4.9%. Outcomes are significantly worse for emergency hernia repair than the elective one, with increased risk of adverse events up to 18.5 %. Minimally invasive techniques showed a safe and effective therapeutic option for GH requiring emergency surgery. We present a case series of emergency GH repaired laparoscopically at a district general hospital over the past year.

Methods

A retrospective review of prospectively well-maintained data of patients presented with emergency GH, including patient characteristics, Complications, Length of stay (LOS) and recurrence were collected and analyzed to identify the primary outcomes of laparoscopically repaired GH between December 2023 and August 2024.

Results

Eight patients underwent Emergency Transabdominal pre peritoneal repair (TAPP) repair with mesh was used in all included GH cases. One patient had a right femoral hernia, one had both left inguinal and femoral hernia and the remaining 6 patients had inguinal hernias. Average LOS is 1.5 days. One patient developed seroma, one developed an ileus, and one had unexplained hematuria. No recurrence reported.

Conclusions

Several operative techniques were described to repair GH. We opted for the laparoscopic TAPP as a safe option, aids in confirming diagnosis, bowel assessment, and has all laparoscopic surgery benefits. Randomized trials needed to establish the proper guidance and patient selection for such approach.
eP90 Interventions to improve prescribing accuracy in the management of intra-abdominal sepsis in emergency general surgical patients; experiences from an acute teaching hospital
Authors: Reyhani Hadis , Kaur Mandeep
Published: January 2025

Background

Antibiotic stewardship reduces microbial resistance and spread of multidrug-resistant organisms, reducing patient morbidity, mortality, and length of stay.

Sepsis is a significant contributor to poor patient outcomes.

Fishbone conceptualisation suggests possible causes of poor prescribing compliance for intra-abdominal sepsis (IAS) may include lack of experience, awareness, accessibility, and training of prescribing guidelines.

‘Enabling’ interventions, such as audit and feedback, have been proven as most effective in improving pan-specialty antibiotic prescribing practices.

Question

Can enabling, behaviour change techniques successfully improve antibiotic prescribing accuracy for intra-abdominal sepsis in a large, tertiary general surgical unit?

Methods

Data on antibiotic choice was collected for all consecutive patients with a new diagnosis of IAS, over two 2-week periods, one pre- and one post-enabling interventions.

Interventions were: Presentation of audit and group feedback data at consecutive governance meetings attended by key multidisciplinary team members; regular group educational emails; streamlined access to prescribing guidelines with concurrent graphic reminder of sepsis parameters, placed in strategic prescribing locations.

Results

N= 33 across both cycles. Predominant causes of IAS were cholecystitis (N=10) and appendicitis (N=9).

Correct antibiotic choice, initially 18%, significantly increased to 74% after 1 month of sustained interventions.

Discussion/Conclusions

Established interventions to improve antibiotic prescribing practices can be successfully applied in the context of emergency general surgery.

Educational outreach of recommended change, shared directly with target prescribing groups may substantially improve surgical departments’ prescribing practices and antibiotic stewardship, thus improving patient outcomes.

Sustainability of these interventions over time and with rotational staff requires further investigation.
eP94 Addressing antibiotic prescription in acute appendicitis
Authors: Taneja Surina , Gopalan Vignesh , Wijeyaratne Manuk , Sheerin Fatima , Pullyblank Anne
Published: January 2025

Aims/Background

Poor antibiotic stewardship in emergency general surgical patients can increase morbidity and contribute to antibiotic resistance. National guidelines state that all patients with suspected appendicitis should be given pre-operative antibiotics, and only patients with complicated appendicitis (perforation, abscess, phlegmon) should have a post-operative antibiotics. Local microbiology guidelines recommend a course length of 4 days from source control in complicated appendicitis.

Our study aimed to ascertain local compliance with these guidelines.

Methods

In this retrospective audit, data collection included patient demographics, intra-/post-operative findings and pre-/post-operative antibiotic prescription for all patients who underwent an appendicectomy for acute appendicitis between 30th July and 30th August 2024 at a single NHS tertiary surgical unit

Results

Across the study period, 35 patients (20 female) underwent appendicectomy. Median age was 29 years (range 18 – 79). 34 patients (97.1%) received pre-operative prophylaxis.

Documented operative appearance of the appendix was: uncomplicated appendicitis (n=19, 54.3%), complicated appendicitis (n=12, 34.4%), suspected malignancy (n=1, 2.9%) and normal (n=3, 8.6%). 11/12 (91.7%) patients with complicated appendicitis received post-operative antibiotics. 11/23 (47.8%) patients without complicated appendicitis were prescribed post-operative antibiotics. Antibiotic duration was a median of 7 days (range 2 – 12).

Conclusions

This audit showed poor compliance with acute appendicitis antibiotic guidelines. Interventions include delivering educational sessions to the surgical team, liaising with the microbiology team to update trust guidelines, and automated electronic reminders on patients’ records. Results of a second audit cycle to evaluate these will be available for presentation.
eP100 Investigating the incidence of appendiceal neoplasms and peri-operative factors indicating their presence
Authors: Moore Eleanor , Durrell Chloe , Battersby Christopher
Published: January 2025

Aims

Appendiceal neoplasms are rare and are often diagnosed incidentally on histology after appendicectomy. Informed consent for non-operative management of appendicitis must include the risk of missed neoplasia. Surgical technique must minimise the risk of a suboptimal specimen. This study aimed to clarify the incidence of appendiceal neoplasms and investigate peri-operative factors indicating a diagnosis of neoplasia.

Methods

This single-centre retrospective study included all appendix specimens from January 2015 to July 2023. Appendiceal neoplasms were identified from pathology coding. All other data was gathered from review of patient records.

Results

44 appendiceal neoplasms were identified from 1661 appendix specimens (2.65%). The median age of patients with a neoplasm was 60 (IQR 46-71); 52.3% were male.

Histology: mucinous neoplasms (59.1%); neuroendocrine tumours (25.0%); adenocarcinomas (13.6%); adenomas with high grade dysplasia (2.30%). 25 neoplasms (56.8%) were resected as an emergency. 60.0% of emergency patients underwent pre-operative CT scanning; only 20.0% of CTs raised suspicion of an appendiceal neoplasm; 53.3% were reported as uncomplicated appendicitis. Of the neoplasms resected during emergency surgery, there was no intra-operative suspicion of neoplasia in 56.0% of cases. Operation notes did not reliably record mesoappendix management or delivery of the specimen.

Conclusions

Missed primary appendiceal neoplasms are an important consideration when counselling patients for management of acute appendicitis. This study shows that peri-operative suspicion of neoplasia is unreliable. It is, therefore, important to adopt a standardised approach for all appendicectomies to include the mesoappendix in all specimens with clear documentation of operative technique to optimise patient care.
eP106 Jejunal Diverticulosis: A Rare Cause of An Acute Abdomen
Authors: Selorfia Shammael , Pettit Harry
Published: January 2025

Background and Aim

Jejunal diverticulosis is a rare condition with a reported incidence rate of approximately 1% in the literature. Patients with this condition often present with non-specific abdominal pain and occasionally suffer complications including perforation, gastrointestinal bleed and sepsis requiring emergency surgical intervention. Diverticulum refers to the outpouching of any part of a hollow organ in the body. It can often be seen in the large bowel of the gastrointestinal tract and less frequently in the small bowel. Jejunal diverticulae presentations are often seen in the sixth and seventh decades. There have been reports of a slight male to female predominance with ratio of 1.52:1. Here, we present a case of a 36-year-old female with previously undiagnosed jejunal diverticulae, that presented with severe abdominal pain and signs of acute abdomen.

Results

Perioperative Computer Tomography examination suggestive of perforation and examination eliciting signs of generalised peritonitis led to an emergency laparotomy revealing multiple jejunal diverticulae.

Conclusion

It is important to highlight this condition because although rare, it should be considered as a differential diagnosis in patients presenting with an acute abdomen.
eP107 Adherence to guidelines re: providing patient, the copy of consent form prior to procedure
Authors: Najdawi Amal , Selorfia Shammael , Malkawi Hashem , Sajid Muhammad
Published: January 2025

Aims

To identify General Surgery patients on elective and CEPOD theatre case lists and measure how often patients are offered a copy of their consent forms. In accordance with the Royal College of Surgeons guideline on consent- “Consent: Supported Decision-Making ”The patient should be offered a copy of their consent form after signing so they can review and retain. We aim to establish the number and percentage of patients receiving a copy of their consent forms in the General Surgery Departments at a Major Trauma Centre and a DGH.

Methods

Retrospective study. Patients were identified on Elective Surgical lists using Bluespier theatres Patients were identified on the CEPOD list during morning handover, confirmed surgical list from theatre coordinator on the day off and using Bluespier theatres

Results

70 adult consent forms were reviewed during the patients admission over a period of 4 weeks. Data collected included number of patients provided a copy of the consent forms (0%).

Interventions in an attempt to improve adherence to guidelines were introduced.

A repeat audit of a further set of set of 35 patients was completed to assess the effectiveness of our interventions and there was an increased rate of 28% in the patients consent forms copies being offered as part of the consent process.

Conclusion

The results of this study suggests important areas of improvement. Our intervention has improved the quality of consenting within our hospitals. With these enhancements set to continue to further develop.
eP108 Analysis of outcomes of anterior resections in an emergency setting for large bowel pathologies.Is defunctioning mandatory?
Authors: Subramanian Atreya Mukund , Swaminathan Christie , Brooks Benjamin
Published: January 2025

Aim

Analysis of outcomes of emergency anterior resections.

Methods

This was a retrospective single centre study conducted over 5 years, including all emergency anterior resections. Elective/semi-elective cases with adequate bowel preparation were excluded .Soft and healthy bowel proximal to the staple line with no contamination were additional criteria considered to not defunction the anastamosis. Cases with perforation/peritonitis/ high physiological risk (ASA >=4) were defunctioned. Patients refusing a stoma were also excluded. The primary outcome of this study was to determine the complication/leak rates following an emergency anterior resection in both groups(defunctioned vs not defunctioned) . Complications were classified as major or minor (clavien-dindo score >=3 Vs <=2) respectively.

Results

47 patients were studied of which 13 were not defunctioned. Major complications in the non-defunctioned vs defunctioned group were 1 and 2 respectively (7.7%, 5.9%); all being secondary to anastamotic leaks. Minor complications were 3 and 20 respectively (23%, 58.8%); majority being wound infections. Both groups had a comparable duration of hospital stay at 21.6 and 21.3 days respectively. Similarly ITU admission rates were 4 and 14 respectively (30.7%, 41.1%) Readmission rates were 0 vs 4 respectively.Both groups were physiologically comparable with ASA grades of 2.18 and 1.91 respectively.

Conclusion

The leak rates for both groups were similar, despite a higher septic complication rate in the defunctioned group. With careful case selection defunctioning of an anterior resection anastamosis maybe avoided even in the emergency setting, though further studies will be needed to validate our results.
eP120 Adoption of a "mass casualty" model of triage on the surgical SDEC. A model to allow prioritisation of the Senior Decision Maker resource
Authors: McArdle Alistair , Evans Luke
Published: January 2025

Traditional models of acute care have been changing to meet targets of ambulance offload and ED decompression. This has led to a step change in the number of patients sent to the surgical SDEC without an increase in pathology. The most precious resource on the SDEC is the availability of the Senior Decision Maker and is not sufficient to meet the aspiration that every patient has early SDM input. Patients without pathology are often harder to manage for less experienced staff and can endure over investigation and unnecessary admission without the input of SDM's. As a corollary, patients with more urgent surgical pathology often have a simpler process of decision making in the initial stages. We sought to determine if a model can be found to predict which patients were likely to be discharged (and therefore benefit from SDM input) and which need admission and protocolised (intial)care.

3000 consecutive GI surgical referrals were analysed to determine which patients were more or less likely to be admitted based on pre-admission referral information.

There was a significant increased risk of admission for male sex, age and NEWS2. RR of admission was four times higher for male, over the age >70yr with NEWS2 ≥2 RR 2.01 (1.4-2.9) vs female, <50yr with NEWS2 ≤1 RR 0.46 (0.36 - 0.57).

When faced with a mass-casualty situation where flow is paramount, SDM resources should be directed to younger, female patients with normal physiology as these are most likely to be discharged.
eP129 Malnutrition risk assessment of patients with acute small bowel obstruction; a ‘MUST’ for all members of the surgical team
Authors: Obure Ralph , Lin Naychi , Krishna A , Patel Panna
Published: January 2025

Aim

The Malnutrition Universal Screening Tool (MUST) is widely utilised however is frequently completed by the least experienced healthcare providers who may not fully appreciate the impact and management course for Small Bowel Obstruction (SBO). Patients with SBO have acute intestinal failure with unpredictable periods of nil nutritional intake hence score a minimum of 2 (high risk) on MUST.

Methods

Records of patients managed for small bowel obstruction over a 6-month period (January to June 2024) meeting the inclusion criteria of the 2017 National Audit on Small Bowel Obstruction (NASBO) were reviewed.

Results

Sixty-two patients were managed for SBO over the period reviewed. Post-operative adhesions was the commonest aetiology (53%). Overall, 36 patients (58%) had surgical management. All patients had a MUST assessment at admission however only 26% of patients had a score of ≥ 2. Majority of patients presented within 2 days of onset of symptoms. Restoration of enteral nutrition was achieved within 72 hours for 90% of patients managed conservatively and 67% for those managed operatively. A dietician review and/or any form of nutritional intervention was undertaken in 42% of patients.

Conclusion

Malnutrition risk was underestimated in patients with small bowel obstruction despite all patients having a MUST assessment. This may have led to missed opportunities for nutritional interventions. It is imperative to not only educate staff delegated to complete the MUST score but also to have more experienced members of the team involved in malnutrition risk assessment.
eP136 Enhancing Morbidity Prediction in Emergency Laparotomy: A Comparative Study of NELA and ACS Risk Calculators
Authors: Ahmed Nauman , Khawaja Zeeshan
Published: January 2025

Introduction

Emergency laparotomy (EL) is a high-risk procedure often linked to significant morbidity and mortality. While efforts have reduced mortality in EL patients, limited research focuses on predicting and improving morbidity outcomes. Current tools like the National Emergency Laparotomy Audit (NELA) and the American College of Surgeons (ACS) calculators mostly estimate mortality risks, with less focus on morbidity. This study aims to compare the predictive accuracy of these calculators to address the gap in morbidity predictions for EL patients.

Methods

A descriptive cross-sectional study analyzed data from 330 patients who underwent emergency laparotomy from January 2021 to January 2023, using the Hospital NELA database. Patient characteristics, surgery type, estimated risk, and adverse events were assessed with SPSS version 26. Stepwise Multiple Linear Regression, Spearman and Pearson correlation coefficients, and Paired Sample T-tests were used to evaluate morbidity predictors and compare outcomes.

Results

The study found significant discrepancies between the NELA and ACS morbidity predictions. NELA overestimated both preoperative (Mean = 70.17, SD = 23.14) and postoperative morbidity (Mean = 70.58, SD = 24.23), compared to ACS (Mean = 33.20, SD = 15.55), which was much higher than the actual observed morbidity (Mean = 1.37, SD = 0.49). No significant correlation was found between morbidity predictions, although a moderate correlation was noted for hospital stay predictions (r = 0.560, p < 0.001).

Conclusion

This study underscores the need for improved morbidity prediction tools in EL. NELA significantly overestimates morbidity, highlighting the importance of refining these models to better guide clinical decisions.
eP138 A Surgical Remote Monitoring Virtual Ward (RMVW); A one year experience
Authors: Pospyelova Darya , Sheehan Ciara , Uttley Abigail , D’angelo Alissia , Peckham-Cooper Adam
Published: January 2025

Background

Virtual wards are becoming an integral part of NHS service delivery, offering hospital-level care at patients’ usual place of residence. They aim to reduce hospital bed occupancy and pressure on hospital resources. In September 2023 a tertiary teaching hospital introduced a RMVW accessible to acute surgical patients, and offering novel digitally supported healthcare solutions.

Aims & Methods

This study aimed to evaluate the effectiveness of the RMVW in managing acute surgical patients. Prospective data was collected of all patients admitted to the RMVW on any of four bespoke pathways from October 2023. Data was collected using the local electronic patient record and organised in Excel before analysis by two clinical professionals.

Results

Since inception in October 2023, 267 patients were admitted to the RMVW across four pathways: 83:ERCP, 102:general surgical monitoring (GSM), 52:hot gallbladder (HGB) and 30:ambulatory pancreatitis. Average length of stay (LOS) was 5.7, 6.4, 5.6 and 4.5 days respectively. Readmission rates were highest for both ERCP and GSM (13%). Cumulatively the RMVW saved x acute inpatient beds in a year.

Conclusion

The RMVW is both effective and safe for managing a variety of acute surgical patients at home. This study demonstrates a clear reduction in hospital bed occupancy and good safety profile with low readmission rates reported. With increasing pressures on the established hospital bed base these pathways present a huge opportunity to deliver novel and innovative strategies to manage the unselected emergency surgical patients better.
Toward comparative analysis of right-authoritarian politics: Argentina, India, and the US
Authors: Bauer A J , Roy Srirupa , Gago Verónica
Published: January 2025

Right-wing parties and ideologies have grown more salient in several country contexts over the course of the past decade, coinciding with widespread international adoption of social media. This interview, which features specialists in the contexts of Argentina, India, and the US, challenges conventional media determinist approaches. Emphasizing historical contingency and country-level political specificity, it models a comparative approach to studying right authoritarianism across distinct country contexts—against determinism and toward international resistance.
Stabilized mascon solutions through combinations of GRACE and SLR normal equations
Authors: Croteau M J , Loomis B D , Sabaka T J
Published: January 2025

A new global mascon solution using the Gravity Recovery and Climate Experiment (GRACE) and GRACE Follow-On data is co-estimated with satellite laser ranging (SLR) measurements to seven major geodetic satellites. This combined solution is compared with an otherwise similar GRACE-only solution to determine improvements in the estimate. We find similar performance between both solutions in the recovered mass change, but significant improvements in the associated errors in the combination solution. Errors in recovered basin mass change are 10–20 per cent better for the combination solution across all basin sizes, with the greatest improvements in high-latitude ice sheets. These results lead to our recommendation that all GRACE Level 3 mascon and spherical harmonic user-oriented gridded solutions should include SLR information during the solution inversion. As an ancillary contribution, we also provide validation of the choice of truncated spherical harmonics used in determining GRACE Technical Note 14, the current recommended mechanism for including SLR information with GRACE solutions in post-processing.
Nutrition literacy in Vietnamese pregnant women: a cross-sectional study
Authors: Nguyen Hoan Thi , Tran Hang Thi Thuy , Dao-Tran Tiet-Hanh , Huang Li-Chi
Published: January 2025

Inadequate nutrition intake during pregnancy elevates the risk of adverse health outcomes during pregnancy, with potential long-term repercussions for both mother and child, extending to subsequent generations. Current initiatives to improve individual dietary habits emphasize promoting nutrition literacy (NL), which encompasses the ability to access, comprehend, and use basic nutrition information and services necessary for making appropriate nutrition decisions. However, there were limited data on the NL of pregnant women in Vietnam. Therefore, this study aims to explore the NL levels of Vietnamese pregnant women and examine the factors related to their NL. A total of 360 Vietnamese pregnant women participated in the study from May to September 2023. A validated questionnaire (Nutrition Literacy Assessment Instrument for Pregnant Women, NLAI-P), assessing the knowledge, behavior and skill, was applied. A general linear model with univariate linear regression analysis was conducted to identify predictor factors of NL. The findings revealed that 70.3% of participants had inadequate NL. Among the three dimensions, nutrition knowledge was particularly low, with no respondents achieving an adequate level and 94.7% scoring at an inadequate level. High household monthly income, age, normal prepregnancy weight and indoor work were statistically associated with higher NL scores. This study highlights the limited NL among Vietnamese pregnant women. Increasing NL is crucial for supporting their optimal healthy diet, enhancing the health of pregnant women and their offspring and future generations.
Measurement tools used to assess individual health assets among refugee populations: a scoping review
Authors: Ewunie Temesgen Muche , Hayen Andrew , Dawson Angela
Published: January 2025

Forced migration is increasing globally, which has detrimental effects on the physical and mental health of refugees, who may face significant challenges accessing healthcare services. However, refugees also possess considerable strengths or assets that can protect against various health challenges. Identifying and strengthening the individual health assets of refugees is critical to promoting their health and mitigating these health challenges. Yet, there is a paucity of data on refugees’ individual health assets, including tools to measure them. Therefore, this scoping review aimed to identify and summarise the available measurement tools to assess the individual health assets of refugees. We conducted a comprehensive literature search using six electronic databases and a Google search without restrictions on publication dates. We used Arksey and O’Malley’s methodological framework approach to streamline the review processes. Forty-one eligible studies were included, from which 28 individual health asset tools were identified. Of these, 11 tools were tested for validity in refugee populations. Among the validated tools, the reliability scores for the measures of individual health asset outcomes, including resilience (Child and Youth Resilience Measure, Wagnild and Young's Resilience Scale, and Psychological Resilience Scale), acculturation (Vancouver Index of Acculturation and Bicultural Involvement Questionnaire), self-esteem (Rosenberg Self-Esteem Scale), and self-efficacy (Generalized Self-Efficacy Scale), ranged from good to excellent. The findings provide guidance for health service planners, humanitarian organisations, and researchers regarding the appropriateness and quality of tools that can be applied to assess individual health assets, which are crucial for designing culturally sensitive asset-based health promotion interventions for refugees.
Genome-wide association study of urinary cadmium levels in current smokers from the multiethnic cohort study
Authors: Sullivan Shannon M , Murphy Sharon E , Stram Daniel O , Wilkens Lynne R , Haiman Christopher A , Le Marchand Loïc , Stepanov Irina , Park S Lani
Published: January 2025

Background

Cadmium (Cd), classified as an International Agency for Research on Cancer (IARC) Group 1 human carcinogen, is present in cigarette smoke. Recent studies have illustrated the potential role of genetics in influencing Cd biomarker levels.

Methods

We conducted a genome-wide association study (GWAS) of urinary Cd levels in 1977 current smokers from the Multiethnic Cohort Study, comprising participants from five different racial and ethnic groups. Linear regression models were adjusted for age at urine collection, sex, self-reported race/ethnicity, and the top ten leading principal components.

Results

Among the 11 710 497 single nucleotide polymorphisms (SNP) analyzed, no associations with urinary Cd reached genome-wide significance (P < 5.0 × 10−8). Notably, five variants demonstrated suggestive associations with urinary Cd levels (P < 1.0 × 10−6). Lead variants included: rs10097646 in the SCARA gene at 8q13.2 (P = 2.62 × 10−7); rs7444817 in the NIPBL gene at 5p13.2 (P = 3.10 × 10−7), rs830422 in the SPINK4 gene at 9q13.2 (P = 4.89 × 10−7); chrX:145489901 in the SLC9A7 gene at Xq121.1 (P = 5.38 × 10−7); and rs73074456 at 5p13.3 (P = 5.86 × 10−7).

Conclusions

Our GWAS of urinary Cd levels in a diverse population of people who smoke, revealed suggestive associations with variants in SCARA5, NIPBL, SPINK4, SLC9A7, and 5p13.3. These findings underscore the potential role of genetic factors in understanding and mitigating the health risks associated with internal dose of carcinogens, particularly in the context of tobacco-related carcinogens.
Flexibility and Rigidity of Conformal Embeddings in Lorentzian Manifolds
Authors: Boukholkhal Alaa
Published: January 2025

We prove that for any Riemannian metric $g$ on a closed orientable surface $\Sigma $ and any spacelike embedding $f:\Sigma \rightarrow M$ in a pseudo-Riemannian manifold $(M,h)$, the embedding $f$ can be $C^{0}$-approximated by a smooth conformal embedding for $g$. If in addition, $M$ is a quotient of the $(2+1)$-dimensional solid timelike cone by a cocompact lattice of $SO^{\circ }(2,1)$, we show that the set of negatively curved metrics on $\Sigma $ that admit isometric embeddings in $M$ projects into a relatively compact set in the Teichmüller space.
Sofosbuvir as post-exposure prophylaxis for yellow fever–associated viscerotropic disease (YEL-AVD)
Authors: Barrett Jessica , Muntengesa Ernest , Warrell Clare , Rampling Tommy , Owen Jodie , Patel Dipti , Bhagani Sanjay , Moores Rachel , Scobie Antonia
Published: January 2025

Objectives

Yellow fever–associated viscerotropic disease (YEL-AVD) is a rare but serious complication arising from administration of live-attenuated yellow fever vaccine to individuals with risk factors such as thymectomy. At present there is no evidence-based treatment, and case fatality rates are high. Sofosbuvir, an NS5B nucleotide inhibitor, has activity against yellow fever virus in vitro and in vivo.

Patient and methods

Here we describe clinical and virological response to use of off-licence sofosbuvir as post-exposure prophylaxis for a patient inadvertently given yellow fever vaccine despite previous thymectomy.

Results

A 14-day course of oral sofosbuvir was administered in an outpatient setting with regular clinical and biochemical monitoring. The patient remained well without developing clinical features of YEL-AVD and did not experience adverse effects from the treatment.

Conclusions

This supports the use of sofosbuvir as post-exposure prophylaxis in patients at high risk of developing YEL-AVD. Ongoing trials of efficacy of sofosbuvir in yellow fever infection may result in stronger support for this approach in the future.
Chain Restaurant Calorie Posting Laws, Obesity, and Consumer Welfare
Authors: Courtemanche Charles , Frisvold David , Jimenez-Gomez David , Ouayogodé Mariétou H , Price Michael K
Published: January 2025

This paper investigates whether and why laws requiring chain restaurants to post calories on menus and menu boards work. We develop a model of calories consumed that highlights multiple potential channels through which these laws influence choice and that outlines an empirical strategy to disentangle these alternatives. We test the predictions of our model using data from the Behavioral Risk Factor Surveillance System on body mass index and consumer well-being, as well as our own surveys on how the law influences where people eat and how randomized exposure to calorie information affects feelings toward menu items. Viewed in its totality, our results are consistent with an economic model in which calorie labels influence consumers both by providing salient information and by imposing a welfare-reducing moral cost (or feelings of guilt) on unhealthy eating.
Sustainability and the WTO trading system
Authors: Bacchus James
Published: January 2025

Trade has been closely intertwined with sustainable development since the early 1990s. From its inception, the World Trade Organization has served as an active agent for advancing trade while also promoting sustainable development. Several contemporary developments within the WTO system reflect the centrality of sustainable development in trade discussions. The conclusion of the multilateral fisheries subsidies agreement in 2021 is one example of a major accomplishment with sustainability at its core. The structured discussions on trade and environmental sustainability are focused on four key issues: trade in environmental goods and services, trade-related climate measures, circular economy, and subsidies. These discussions shine a welcome light on these linkages. In parallel, the WTO is host to the dialogues on ‘Plastics Pollution and Environmentally Sustainable Plastics Trade’ and ‘Fossil Fuel Subsidies Reform’. This article catalogues these developments, their priorities and their outcomes.
How to organize in turbulence: arrangements and pathways for robust governance
Authors: Micacchi Marta , Cucciniello Maria , Trivellato Benedetta , Cristofoli Daniela , Turrini Alex , Valotti Giovanni , Nasi Greta
Published: January 2025

Robustness has recently taken center stage as an emerging paradigm to cope with turbulence and “build back better” toward new normalcy. Existing literature has shown how robust governance, with its mix of flexible adaptation and proactive innovation, is well-suited to addressing turbulence. However, there remains a gap in understanding the empirical variations within robust governance arrangements. In this article, we address three questions: how (1) structures, (2) coordination mechanisms, and (3) leadership are designed and unfold in robust governance. Through a qualitative approach grounded in case studies, interviews, and archival data, we provide evidence from six Italian regions, examining how they addressed the challenges of the COVID-19 vaccination campaign. Results enable the formulation of propositions about organizational arrangements in robust governance, in addition to suggesting competing pathways for flexible adaptation and proactive innovation.
Prediction sets for high-dimensional mixture of experts models
Authors: Javanmard Adel , Shao Simeng , Bien Jacob
Published: January 2025

Large datasets make it possible to build predictive models that can capture heterogenous relationships between the response variable and features. The mixture of high-dimensional linear experts model posits that observations come from a mixture of high-dimensional linear regression models, where the mixture weights are themselves feature-dependent. In this article, we show how to construct valid prediction sets for an ℓ1-penalized mixture of experts model in the high-dimensional setting. We make use of a debiasing procedure to account for the bias induced by the penalization and propose a novel strategy for combining intervals to form a prediction set with coverage guarantees in the mixture setting. Synthetic examples and an application to the prediction of critical temperatures of superconducting materials show our method to have reliable practical performance.