bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of topography on extraordinary magnetoresistive devices
Authors: Sasi Kumar Sreejith , Pollok Stefan , Pomar Thierry Désiré , Christensen Dennis Valbjørn , Bjørk Rasmus 
Published: January 2025

Abstract
The extraordinary magnetoresistance (EMR) effect is a form of geometric magnetoresistance that occurs when the current redistribution inside a hybrid metal-semiconductor device changes when subjected to an external out-of-plane magnetic field. While the influence of material and geometrical properties on sensor performance has been extensively studied, the topography of EMR devices has not yet received much attention. Typically, flat, 2D topographies are assumed when optimizing EMR devices, which does not reflect the significant topography present in actual devices. This study fills this gap by numerically investigating concentric circular EMR devices with different topographies using a 3D finite element model. We show that EMR devices with metal top contacts, which are more straightforward to fabricate, behave similarly to conventional EMR devices where the metal shunt of the same thickness is embedded into the devices. For InSb/Au devices, both types of devices produce a magnetoresistance of 4.9×105 % at 1 T. Our results also reveal that the magnetoresistance increases with the thickness for a large range of metal thicknesses. In addition, we also explore sidewall dimensions and show that it is desirable to have a thicker shunt with thinner sidewalls, compared to the opposite case.
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

Abstract

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&gt;0.05) and IOH (HACON: ≥0.45 mL and HAJVOL: ≥0.57 mL; p&gt;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.
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

Abstract

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

Abstract

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 (&lt;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

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract
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 &gt;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

Abstract

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

Abstract

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.