Audit Data Research Articles

Protocol for a scoping review to explore governance for national hip fracture clinical audits

Background Hip Fractures are serious injuries leading to increased morbidity and mortality. The global incidence of hip fracture is rising. National hip fracture audits facilitate improvements in patient outcomes and care quality. There is a wealth of literature regarding hip fracture care, evidence-based standards, use of registry/clinical audit data for improvement, benchmarking and outcomes. There is however a gap in the literature for describing how to establish the governance for a national hip fracture audit. Objective This scoping review aims to identify the core governance components for national clinical audits (NCAs) of hip fractures. Methods The Joanna Briggs Institute guidance will be used in conducting the review and Preferred Reporting Items for Systematic Reviews extensions for Scoping Reviews (PRISMA-ScR) guidance for scoping reviews will be followed. has been used. Articles published in English, between 1988–2024 and indexed in MEDLINE (Ovid), Embase (Elsevier) and CINAHL (EBSCOHost) will be included in this review. Two reviewers will independently screen the articles, with any disagreements resolved by a third reviewer. Data extraction will be conducted by two reviewers and shared with external stakeholders to ascertain whether there is documentation or reports that were missed and preliminary analysis will be shared to validate the data we have extracted. The results will be disseminated widely through publication in an international peer reviewed journal and through the Global Fragility Fracture Network (FFN) Hip Fracture Audit Special Interest Group. Conclusions By identifying the core components for the governance of NCAs for hip fracture it is hoped that application of these components will support the existing NCAs for hip fracture to enhance their current governance and aid in the establishment of NCAs in the future.

Effect of the COVID-19 pandemic on diabetic retinopathy and referral levels in the English National Health Service Diabetic Eye Screening Programme.

The aim was to determine the effect of the COVID-19 pandemic on diabetic retinopathy and referral rates in the English National Health Service (NHS) Diabetic Eye Screening Programme (DESP). Non-patient identifiable data are submitted centrally from the 57 regional centres in the NHS DESP on a quarterly basis and analysed using STATA, comparing 01/04/2019-31/03/2020 and 01/04/2021-31/03/2022. Patient characteristics were analysed from National Diabetes Audit (NDA) data. There were 2,274,635 grades from the 57 centres in 2019-2020 and 2,199,623 grades in 2021-2022. The proportion of eyes with referable DR increased from 3.1% in 2019-2020 to 3.2% in the 2021-2022 NHS year (p < 0.01) with a small increase in the level of non-referable DR from 24.6% to 24.8% (p < 0.01). The median proportion of ungradable eyes in 2019-2020 was 2.6% (IQR: 2.3% to 3.3%) increasing to 3.1% (IQR: 2.5% to 3.7%) in 2021-2022. NDA data demonstrated that the proportions with type 1 diabetes receiving eye screening were higher in the latter year (8.3% vs. 7.3%). The COVID-19 pandemic was associated with small increases in referable retinopathy rates from 3.1% to 3.2%, non-referable DR from 24·6% to 24.8% and an increase in the ungradable image rate from 2.6% to 3.1%, the latter increase possibly being caused by untreated cataract during the pandemic. Risk stratification of invitations in the recovery period was believed to have contributed to keeping the referable rates low and supports a similar approach in extension of the screening interval for low-risk groups.

Perceptions and experiences of healthcare professionals of implementing the Organ Donation (Deemed Consent) Act in England during the Covid-19 pandemic

ContextIn May 2020 during the COVID-19 pandemic, England implemented a ‘soft’ opt-out system of consent to deceased organ donation. As part of a wider evaluation, this analysis focused on the perceptions of health care professionals, specifically their experiences of implementation.MethodsMixed-methods study informed by Normalisation Process Theory, based on two national surveys of health care professionals and interviews, observations and document analysis, across two case study sites. Routine NHS Blood and Transplant’s audit data provided context.Findings70 interviews with 59 staff and 244 first and 738 second surveys. COVID-19 affected every aspect of implementation. Although supportive in principle, many staff were unconvinced that legislative changes alone would increase consent rates. Many staff were redeployed or left their jobs. As a result, staff were not able to work collectively as intended for implementation. Staff received routine donor audit data suggesting the law was yet to make a difference to consent rates, reducing their enthusiasm and commitment.ConclusionsImplementation could have been more impactful if delayed. The National Health Service needs to reprioritise organ donation and relaunch the implementation plan in the post-pandemic period, though it is unlikely the changes will bring about a significant increase in consent rates.

2663 Estimating the effect of frailty on long term survival following emergency laparotomy

Abstract Introduction Around 30,000 emergency laparotomies are performed each year across the United Kingdom. Over half are in people aged 65 years or above, with a third of this group living with frailty. The association between frailty and 90-day mortality following surgery is well documented, but longer-term mortality risk has been less extensively studied, despite clear implications for person-centred care. This study aimed to estimate the influence of frailty on longer-term mortality (&amp;gt; 90 days) following emergency laparotomy. Methods A retrospective analysis of National Emergency Laparotomy Audit (NELA) data was undertaken, including records entered between 01/12/18 and 30/11/20. Baseline patient characteristics including Clinical Frailty Scale (CFS) are routinely collected within NELA. Data are linked via NHS Digital 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 identified via a directed acyclic graph and included in the model as covariates. Results 23,290 patients remained alive at 90 days post-surgery and were therefore included in the analysis. After adjusting for other covariates, increasing frailty was associated with an increased risk of longer-term mortality. 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 at increased risk of death beyond 90 days following emergency laparotomy. This information should be incorporated into shared decision-making, enabling patients to make informed choices about their care. Future work must explore how outcomes for this group might be improved through targeted post-operative support.

P-1674. Comparative study of advance practice providers and physician prescribing practices for complicated intra-abdominal infections in patients hospitalized at a safety-net community hospital

Abstract Background The expansion of advanced practice providers (APPs) in the inpatient setting warrants understanding of their antimicrobial prescribing practices in these settings to help adapt antimicrobial stewardship (ASP) strategies. Variability in APP training programs further complicates the landscape. This study aims to investigate disparities in antibiotic prescription practices for complicated intra-abdominal infections (cIAI) between APPs and physicians. Figure 1 clAl severity and empiric antimicrobial selection by physicians and APPs Methods A retrospective review of antibiotic orders was conducted at a 151-bed community hospital. ASP prospective audit and feedback (PAF) data from July 2022 to June 2023 was reviewed, including initial antibiotic selection, duration, and guideline concordance for APPs and physicians. Guideline adherence, antimicrobial effectiveness, and days of therapy (DOT) per 1000 patient days was compared between APPs and physicians. FIgure 2 Empiric antimicrobial selection by physicians and APPs Results A total of 175 initial empiric PAF entries for cIAI were reviewed, of which 145 were from physicians and 30 from APPs. Guideline non-adherence was 10% (14) for physicians and 20% (6) for APPs. Additionally, 3% (5) of physician and 7% (2) of APP prescriptions were ineffective. Critical illness was higher for physician cases (Figure 1). Physicians prescribed more antipseudomonal beta-lactam (APBLs) than APPs (52% vs 30%). APPs prescribed more quinolones (FQ) than physicians (33% vs 26%). Of the patients treated with FQs by APPs, 37% had allergies to beta-lactams, compared to 22% of patients treated by physicians. Total DOT/1000 during the study period was 145. DOT/1000 was 44 for physicians, of which 11% were anti-pseudomonal beta lactams (APBLs) and 34% non-APBLs. DOT/1000 was 21 for APPs, of which 19% were anti-pseudomonal beta lactams (APBLs) and 27% non-APBLs (Figure 2). Conclusion Empiric antimicrobial selection for cIAI differed between APPs and physicians, with APP showing higher quinolone use, a non-preferred agent, and almost double the level of non-adherence to guidelines. These findings underscore the need for tailored ASP education and interventions that address the unique practices and educational backgrounds of APPs, aiming to standardizing and optimizing antimicrobial use. APPs may require specific education for cIAI and ASP guidance. Disclosures All Authors: No reported disclosures

P-1695. Antimicrobial prescribing differences for urinary tract infections between advanced practice practitioners and physicians at a safety-net community hospital

Abstract Background Advanced practice practitioners (APPs) are increasingly working in inptient settings as hospitalists. Despite these trends, there's a paucity of data on APP antimicrobial prescribing practices. Antimicrobial stewardship programs (ASPs) can reduce antimicrobial overuse and misuse. One of the most common infections in the inpatient setting is urinary tract infections (UTIs). We examine antibiotic prescribing practices of APPs and physicians for treatment ofUTIs. Understanding prescribing practices can highlihgt stewardship gaps and help guide ASP efforts. Figure 1 UTI severity and empiric antimicrobial selection by physicians and APPs Methods A retrospective analysis of antimicrobial prescriptions was conducted at a 151-bed community hospital. ASP prospective audit and feedback (PAF) data for UTIs from July 2022 to June 2023 was reviewed, including initial antimicrobial selection, duration, and guideline concordance for APPs and physicians. Guideline adherence, antimicrobial effectiveness based on local antibiogram, and days of therapy (DOT) per 1000 patient days was compared between APPs and physicians. Figure 2 Empiric antimicrobial selection by physicians and APPs Results A total of 209 initial PAF events for UTIs were reviewed, of which, 161 were physicians and 48were APPs. Physicians’ initial empiric choice was 9% (15) guideline discordant and ineffective. APP initial choice was 17% (8) guideline discordant and ineffective. TMP-SMX was more commonly used by APPs (Figure 1). Total DOT/1000 was 145. DOT/1000 was 44 for physicians, of which 11% were anti-pseudomonal beta lactams (APBLs) and 34% non-APBLs. DOT/1000 was 21 for APPs, of which 19% were APBLs and 27% non-APBLs (Figure 2). DOT/1000 was 44 for physicians, of which 11% were anti-pseudomonal beta lactams (APBLs) and 34% non-APBLs. DOT/1000 was 21 for APPs, of which 19% were anti-pseudomonal beta lactams (APBLs) and 27% non-APBLs (Figure 2). Conclusion APPs more commonly chose guideline discordant or ineffective initial empiric choices for UTIs compared to physicians. Empiric selection of ineffective agents according to local antibiogramswas higher for APPs. This underscores the importance of targeted ASP education on UTI guidelines and local antibiogram interpretation to improve antibiotic prescribing practices among APPs. Disclosures All Authors: No reported disclosures

Intelligent Upgrading of the Localized GNSS Monitoring System: Profound Integration of Blockchain and AI

With the extensive application of the Global Navigation Satellite System (GNSS), the intelligent upgrading of the GNSS monitoring system is of particular significance. Traditional GNSS monitoring systems typically rely on a centralized architecture, which possesses certain drawbacks when it comes to data tampering, fault tolerance, and data sharing. This paper presents an intelligently upgraded localized GNSS monitoring system that integrates blockchain and artificial intelligence (AI) technology to achieve the deep integration of security, transparency, and intelligent processing of monitoring data. Firstly, this paper employs blockchain technology to guarantee the integrity and tamper-resistance of GNSS monitoring data and utilizes a distributed ledger structure to realize the decentralization of data storage and transmission, thereby enhancing the anti-attack capability and reliability of the system. Secondly, the LSTM model is utilized to analyze and predict the vast amount of monitoring data in real-time, enabling the intelligent detection of GNSS signal anomalies and deviations and providing real-time early warnings to optimize the monitoring effect. Based on this architecture, we also combine the trained model with smart contracts to realize real-time monitoring and early warnings of GNSS satellites. By integrating the security guarantee of blockchain and the intelligent analysis ability of AI, the localized GNSS monitoring system can offer more efficient and accurate data monitoring and management services. In the study, we constructed a prototype system and tested it in both simulated and real environments. The results indicate that the system can effectively identify and respond to GNSS signal anomalies, and enhance the monitoring accuracy and response speed. Additionally, the application of blockchain enhances the immutability and traceability of data, providing a solid foundation for the long-term storage and auditing of GNSS data. The introduction of AI algorithms, especially the application of the Long Short-Term Memory (LSTM) network in anomaly detection, has significantly enhanced the system’s ability to recognize complex patterns.

A novel efficient data storage and data auditing in cloud environment using enhanced child drawing development optimization strategy

ABSTRACT The optimization on the cloud-based data structures is carried out using Adaptive Level and Skill Rate-based Child Drawing Development Optimization algorithm (ALSR-CDDO). Also, the overall cost required in computing and communicating is reduced by optimally selecting these data structures by the ALSR-CDDO algorithm. The storage of the data in the cloud platform is performed using the Divide and Conquer Table (D&CT). The location table and the information table are generated using the D&CT method. The details, such as the file information, file ID, version number, and user ID, are all present in the information table. Every time data is deleted or updated, and its version number is modified. Whenever an update takes place using D&CT, the location table also gets upgraded. The information regarding the location of a file in the Cloud Service Provider (CSP) is given in the location table. Once the data is stored in the CSP, the auditing of the data is then performed on the stored data. Both dynamic and batch auditing are carried out on the stored data, even if it gets updated dynamically in the CSP. The security offered by the executed scheme is verified by contrasting it with other existing auditing schemes.

Formulation of Quality Improvement Methodology for Risk Mitigation in Congenital Cardiac Catheterization.

The C3PO collaborative, with a history of successful quality improvement (QI) initiatives, leveraged registry participants to develop a multi-center QI initiative to reduce adverse events (AEs) in congenital cardiac catheterization. A 32-person, interdisciplinary working group analyzed audited data for all congenital cardiac catheterization cases from 2014-2017. The primary outcome was the occurrence of any high-severity (level 3/4/5) AE. Cases were organized from shortest to longest duration, and level 3/4/5 and 4/5 AE rates were summarized for each procedure duration decile. Observations from the root cause analysis were used to inform the creation of a key driver diagram and determine change strategies and implementation tools. To facilitate pre-procedure communication and risk assessment, an online risk calculator was developed using 2014-2019 data. Between 2014-2017, 14,717 cases were entered from 10 sites. Level 3/4/5 AEs occurred in 732 (5.0%) cases, while 4/5 AEs occurred in 224 (1.5%) cases. The key driver diagram defined three drivers: (1) Pre-Procedure Risk Assessment, (2) Possibly Preventable Events, and (3) Procedure Length Optimization. Actionable change strategies organized around five communication timepoints were developed in interdisciplinary discussions. Pre-case risk calculator outputs were available as a case summary print out and incorporated into a calendar for weekly schedule planning. Pre-intervention (2019) and preliminary intervention period data (2020-2021) are presented here. Through improved resource planning, the protocol equips catheterization teams to respond efficiently to AEs and possibly prevent escalation into dangerous events. This protocol provides reproducible interventions that can be adapted to local practice.

A Comparison Between Industrial Energy Efficiency Measures in Guatemala and the United States

Energy auditing has been cited as a key tool in closing the gap between the actual energy consumption in industrial facilities and what should be at an environmentally sustainable level. Several factors affect the likelihood that energy audits will be effective in closing that gap, and more analysis is needed to understand these factors, especially for developing nations. This study compares three energy efficiency measures (EEMs) frequently recommended in both the United States and Guatemala, namely, installing solar panels to generate electricity, installing higher-efficiency lighting, and upgrading to premium efficiency motors. The implementation of each of these EEMs contributes to more sustainable energy consumption, and each of these EEM’s payback periods is affected by capital costs, energy costs, and other local factors analyzed in this study. Projected payback periods for each EEM based on Guatemalan and U.S. capital cost and energy cost ranges are assessed via EEM-specific payback period calculations and compared to the energy audit data from each country. While lower capital costs incentivize EEM implementation and reduce payback periods, there is an interplay between energy cost and capital cost that impacts the trends in the U.S. and Guatemala. As in the case of the solar panel installation EEM, though Guatemalan companies pay ~110% more for electricity than U.S. companies, when Guatemalan capital costs are lower, payback periods are lower than in the U.S. Conversely, in cases where Guatemalan capital costs are higher—as for higher-efficiency lighting and motor installation—Guatemalan payback periods are roughly the same as those in the U.S. because of the higher Guatemalan energy costs.

Mobility and living status at discharge and after three-months for extramedullary versus intramedullary fixation of AO type 31-A1 trochanteric fractures; an analysis of Dutch hip fracture audit data

PurposeThe use of intramedullary fixation of AO type 31-A1 fractures is rising, despite evidence of non-superiority when compared with extramedullary fixation. The aim of this study was to evaluate mobility and living status for extramedullary fixation (EMF) versus intramedullary fixation (IMF) in Dutch hospitals during the initial hospital stay and until three-months after trauma.MethodsData on patient characteristics, mobility, living status, complications, reoperation, and mortality were extracted from the Dutch Hip Fracture Audit Indicator Taskforce. Data were collected for patients (> 65 years) at baseline, at discharge, and at three-months follow-up. Univariate analysis was used for comparing the EMF versus IMF group.ResultsA total of 836 patients were included; 138 (16%) were treated with EMF and 698 (84%) with IMF. No significant differences were found between groups for the overall complication rate during the initial hospital stay (EMF: n = 55 (40%) versus IMF: n = 270 (39%)). Patients treated with EMF showed better mobility at discharge (mobility with frame/2 supports or better, EMF 77% versus IMF 50%), but otherwise no significant difference was found after a three-month follow-up (EMF 80% versus IMF 82%), suggesting faster improved mobility for IMF. However, matched subgroup analysis showed no meaningful differences in rates of deteriorated mobility or living status after three months.ConclusionThis study showed no meaningful differences between EMF and IMF of type 31-A1 trochanteric fractures during hospital stay and until three-month follow-up. Despite little differences in outcome and EMF being the treatment option of first choice by the Dutch Hip fracture guideline, IMF is used in the vast majority of patients.

Technology usage and glycaemic outcomes in a single tertiary centre with an ethnically diverse and socioeconomically deprived cohort of children with type 1 diabetes mellitus.

The UK National Paediatric Diabetes Audit (NPDA) data reports disparities in Haemoglobin A1c (HbA1c) levels among children and young people (CYP) with Type 1 Diabetes (T1D), with higher levels in those of Black ethnic background and lower socioeconomic status who have less access to technology. We investigate HbA1c differences in a T1D cohort with higher than national average technology uptake where > 60% come from an ethnic minority and/or socioeconomically deprived population. Retrospective cross-sectional study investigating the influence of demographic factors, technology use, and socioeconomic status (SES) on glycaemic outcomes. The study population was 222 CYP with T1D who attended the diabetes clinic in 2022 at a single tertiary paediatric diabetes centre. Among 222 CYP, 60% were of ethnic minority (Asian, Black, Mixed and Other were 32%, 12%, 6% and 10% respectively) and 40% of white heritage. 94% used Continuous Glucose Monitoring (CGM) and 60% used Continuous Subcutaneous Insulin Infusion (CSII) via open or closed loop. 6% used Self-Monitoring of Blood Glucose (SMBG) and Multiple Daily Injections (MDI), 34% used CGM and MDI, 38% used CGM and CSII and 22% used Hybrid Closed-Loop (HCL) systems. Significant differences in HbA1c across therapy groups (p < 0.001) was noted with lowest HbA1c in HCL group (55 mmol/mol; p <0.001). Despite adjusting for therapy type, the Black group had higher HbA1c than their white and Asian counterparts (p<0.001). CYP from the most deprived tertile had significantly higher HbA1c levels (p < 0.001) but the difference was not sustained after adjusting for therapy type. Advanced diabetes technologies improve glycaemic control. Whilst equalising technology access mitigates socioeconomic disparities in HbA1c, CYP from Black ethnic background continue to display a higher HbA1c. The study underscores the necessity of fair technology distribution and further research into elevated HbA1c levels among Black CYP using advanced diabetes technology.

Analysis of the Influence of Information Technology on the Effectiveness and Efficiency of the Audit Process

The development of information technology (IT) has brought significant changes to various aspects of life, including in the audit process. This study aims to examine the influence of IT use on the efficiency, effectiveness, and quality of audits. The use of audit software, data analytics, and information management systems allows auditors to access and analyze large amounts of data more quickly and accurately. Information technology not only speeds up the audit process, but also improves the quality and reliability of audit results through a more in-depth and comprehensive approach. The results of the study show that the use of IT provides various advantages in the implementation of audits and the overall audit process. However, the study also identifies challenges that auditors face, such as risks associated with IT usage. In conclusion, the rapid development of IT has a significant influence on the continuity of the company. IT implementation can improve the efficiency, effectiveness, and internal control of the company, thereby assisting the company in obtaining relevant and accurate information and supporting the achievement of the company's goals.

Block Chain-Based Distributed NoSQL Databases with secure and Scalable Framework

This paper explores the convergence of block chain technology with distributed NoSQL databases to address the growing demand for secure and scalable decentralized systems. Block chain ensures tamper- resistant and auditable data records, while NoSQL databases offer high- speed data operation for large- scale operations. By integrating these technologies, the proposed system leverages block chain’s agreement- driven synchronization and NoSQL’s effective storage capabilities to produce a flexible frame. The architecture addresses common challenges analogous as data redundancy, quiescence, and performance backups through innovative optimizations. Practical use cases in disciplines analogous as healthcare, finance, and IoT emphasize the eventuality of this approach. also, the paper outlines a crossbred model featuring cryptographic safeguards and off- chain data operation strategies, paving the way for future advancements in decentralized data systems.

Enterprise internal audit data encryption based on blockchain technology.

Internal auditing demands innovative and secure solutions in today's business environment, with increasing competitive pressure and frequent occurrences of risky and illegal behaviours. Blockchain along with secure databases like encryption improves internal audit security through immutability and transparency. Hence integrating blockchain with homomorphic encryption and multi-factor authentication improves privacy and mitigates computational overhead. Recently, blockchain applications for internal audits in the enterprise sector are still emerging. Thus, blockchain technology in auditing provides the benefits of enhanced transparency and immutability in data processing, which can establish new solutions for internal auditing but still lacks encryption techniques. The research proposed a framework called "BlockCryptoAudit" to enhance internal audit processes through cryptographic encryption methods and blockchain technology, ensuring secure and transparent audit operations. The proposed approach integrates an additive homomorphic Paillier encryption scheme with blockchain to create a safe and tamper-resident audit trail. Utilizing homomorphic Paillier encryption, BlockCryptoAudit ensures that computations may be performed on encrypted audit data while safeguarding data privacy. The applied blockchain hyperledger component guarantees the immutability and transparency of encrypted audit records, resulting in a decentralized and tamper-resistant record. By limiting data accessibility to authorized individuals based on specified responsibilities, role-based access restrictions handled using smart contracts further strengthen security. The study protects audit data's security and confidentiality by encrypting it and putting it on a blockchain. The study compares the proposed BlockCryptoAudit with models like B-OAP, BSE-DF, and EG-FLB regarding risk mitigation, audit quality, security overhead, and audit trail effectiveness. With little security overhead, BlockCryptoAudit beats out B-OAP, BSE-DF, and EG-FLB in terms of risk mitigation (98%) and audit quality (99%). It is an effective way to improve internal audit processes and guarantee data integrity due to its high performance.

Towards Efficient Consistency Auditing of Dynamic Data in Cross-Chain Interaction

Towards Efficient Consistency Auditing of Dynamic Data in Cross-Chain Interaction

Impact of pre-treatment waiting intervals on short-term postoperative outcomes in neoadjuvant chemotherapy followed by gastrectomy: A population-based study using the Dutch Upper Gastrointestinal Cancer Audit (DUCA) data.

The pre-treatment waiting interval of gastric cancer patients receiving neoadjuvant chemotherapy (nCT) followed by gastrectomy includes pre-nCT (diagnosis to nCT) and preoperative (diagnosis to surgery) waiting intervals. This study aimed to investigate the impact of these two distinct intervals on short-term postoperative outcomes. Patients (cT1-4aN0-3M0) who underwent nCT plus gastrectomy were included using the Dutch national DUCA-database. Multivariate logistic regression was used to determine the impact of the two waiting intervals upon short-term postoperative outcomes: pre-nCT waiting intervals (≤5, 5-8 and 8-12 weeks) and preoperative waiting intervals (≤17, 17-22, and >22 weeks). Between 2010 and 2021, 1242 patients were included. Compared to the pre-nCT waiting interval ≤5 weeks, the longer intervals (5-8 and 8-12 weeks) were not associated with worse 30-day mortality (p-value=0.707; p-value=0.900), overall complications (p-value=0.733; p-value=0.453), pulmonary complications (p-value=0.250; p-value=0.238), gastrointestinal complications (p-value=0.396; p-value=0.992), re-interventions (p-value=0.407; p-value=0.072) and 30-day readmission (p-value=0.992; p-value=0.664). Compared to the preoperative waiting interval ≤17 weeks, the longer intervals (17-22 and>22 weeks) were also not associated with worse 30-day mortality (p-value=0.926; p-value=0.732), overall complications (p-value=0.286; p-value=0.510), pulmonary complications (p-value=0.912; p-value=0.351), gastrointestinal complications (p-value=0.765; p-value=0.882), re-interventions (p-value=0.617; p-value=0.800) and 30-day readmission (p-value=0.592; p-value=0.782). A longer pre-nCT or preoperative waiting interval is not associated with worse short-term postoperative outcomes in Western gastric cancer patients undergoing nCT plus gastrectomy.

O3 Estimating the effect of frailty on longer-term survival following emergency laparotomy an observational study using National Emergency Laparotomy Audit data

O3 Estimating the effect of frailty on longer-term survival following emergency laparotomy an observational study using National Emergency Laparotomy Audit data

Integration of a specialist pharmacist-led multidisciplinary team in primary care: preventing strokes in people with atrial fibrillation across North East London

Public Health England outlines a national ambition of anticoagulating 90% of eligible patients with atrial fibrillation (AF) by 2029. In 2019/2020, two out of three boroughs reviewed in this study...

Equity-Focused Evaluation of a Medicaid-Funded Statewide Diabetes Quality Improvement Project Collaborative.

To evaluate the Ohio Diabetes Quality Improvement Project (QIP) equity aim to reduce the percentage of Non-Hispanic Black (NHB) and Hispanic patients with A1C >9% by ≥20% over 2 years. The Ohio Department of Medicaid, Ohio Colleges of Medicine Government Resource Center, Ohio Medicaid managed care plans, and seven medical schools in Ohio formed the Diabetes QIP collaborative using the collective impact model to improve diabetes outcomes and equity in 20 practices across 11 health systems. The quality improvement (QI) strategies included data audit and feedback, peer-to-peer learning, QI coaching/practice facilitation, and subject matter expert consultation through coaching calls, monthly webinars, and annual virtual learning sessions. Electronic health record data were collected for preintervention (2019-2020) and intervention (2020-2022) periods. Assessments of improvements in A1C were based on prevalence of A1C >9% from preintervention, year 1, and year 2 with stratification by race and ethnicity. The Diabetes QIP included 7,689 (54% female) sociodemographically diverse patients, self-identifying as non-Hispanic White (NHW) (42%), NHB (43%), Hispanic (8%), non-Hispanic Asian (4%), or other (3%). In year 2 compared with baseline, there were decreases in the proportion of patients with A1C >9% among NHW, NHB, and Hispanic patients (NHW from 19% to 12% [37% reduction], NHB 23% to 18% [22% reduction], and Hispanic 29% to 23% [20% reduction]). The Ohio Diabetes QIP, focused on multisector collaborative approaches, reduced the percentage of patients with A1C >9% by ≥20% among NHW, NHB, and Hispanic populations. Given the persistence of disparities, further equity-focused refinements are warranted to address disparities in diabetes control.