bluuebunny/crossref_metadata_2025_split huggingface dataset:
eP61 Demographics and Outcomes of Rib Fractures in a NHS England Trust
Authors: Karina Irene Melisa , Kiran Amrita , Jaskani Sadia 
Published: January 2025

Abstract
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 &lt;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 &gt;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

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract

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 &gt;177 µmol/L, hematocrit &gt;43% in males and &gt;39% in females, NEWS &gt;2, neutrophils &gt;15x10⁹/L, and CRP &gt;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&lt;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

Abstract

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 (&gt;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 &gt;2, previous surgery, sepsis, raised lactate, &gt;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 &lt;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

Abstract

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

Abstract

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

Abstract

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.
Bundling Threats: Why Dominant Perceptions of China Changed in Europe
Authors: Breslin Shaun , Mattlin Mikael 
Published: January 2025

Abstract
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

Abstract
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.