Large General Hospital Research Articles

Alleviating the medical strain: a triage method via cross-domain text classification

It is a universal phenomenon for patients who do not know which clinical department to register in large general hospitals. Although triage nurses can help patients, due to the larger number of patients, they have to stand in a queue for minutes to consult. Recently, there have already been some efforts to devote deep-learning techniques or pre-trained language models (PLMs) to triage recommendations. However, these methods may suffer two main limitations: (1) These methods typically require a certain amount of labeled or unlabeled data for model training, which are not always accessible and costly to acquire. (2) These methods have not taken into account the distortion of semantic feature structure and the loss of category discriminability in the model training. To overcome these limitations, in this study, we propose a cross-domain text classification method based on prompt-tuning, which can classify patients' questions or texts about their symptoms into several given categories to give suggestions on which kind of consulting room patients could choose. Specifically, first, different prompt templates are manually crafted based on various data contents, embedding source domain information into the prompt templates to generate another text with similar semantic feature structures for performing classification tasks. Then, five different strategies are employed to expand the label word space for modifying prompts, and the integration of these strategies is used as the final verbalizer. The extensive experiments on Chinese Triage datasets demonstrate that our method achieved state-of-the-art performance.

BN O02 - Introducing the Cholecystectomy Urgency Index (CUI) – A novel way to visualise and optimise the waiting list for laparoscopic cholecystectomy at a large district general hospital

Abstract Background Gallstone disease effects approximately 10-15% of the adult population, and laparoscopic cholecystectomy is one of the most common surgical procedures in the UK, with over 60,000 performed each year. Delays to surgery from diagnosis has been found to increase patient morbidity and readmission rate. Waiting lists in the UK have been struck with a significant backlog from the COVID-19 pandemic, and navigating this ever-expanding patient population to determine priority for booking cases is complex. We propose a new system to prioritise and visualise this cohort of patients in real time – the Cholecystectomy Urgency Index. Method At one large district general hospital, we had a waiting list of 148 patients for laparoscopic cholecystectomy. We identified the individual underlying pathology and established the waiting time since diagnosis to allocation of operative date. We used excel to formulate a pairwise scatter plot of the waiting list patients based upon the time waiting. We were able then to colour code them based on pathology (biliary colic/cholecystitis/cholangitis/pancreatitis/obstructive jaundice). We were then able to link this directly to our scheduling to create a live, visual representation of our waiting list, by both days waited and causative pathology. Results We found our median wait times for patients varied based on pathology: Biliary Colic = 185 days, Cholecystitis = 57 days, Pancreatitis, Cholangitis and Obstructive Jaundice (OJ) = 65 days. We found that the pairwise scatter plot provided a rapidly accessible, easily identifiable visual representation of our patient cohort by both days waited and diagnosis. This allows relevant staff, surgeons and schedulers to plan elective cases according to both urgency and time waited. Long waiters are easily identified as outliers on the graph and can therefore be flagged for last minute cancellation slots. Conclusion By using this system, we can optimise our waiting lists, improve productivity and patient outcomes. We propose a system to enable this further when booking patients: to give them a colour coded CUI number of 1-3. 1 being biliary colic, 2 – cholecystitis, 3 – pancreatitis/cholangitis/OJ. This will be directly linked to our scatter graph and in doing so, provides us with a readily available, live snapshot in time of the current wait list. This system allows for both clinical urgency prioritisation and easy visualisation of patient cohorts, thus catalysing the elimination of long waiters by means of clear identification.

The influence of policy advocacy and education on medical staff's adaptation to diagnosis related groups payment reform in China: an analysis of the mediating effect of policy cognition.

In recent years, China has been carrying out the Diagnosis Related Groups (DRGs) payment reform, which has an impact not only on payment methods and medical expenses, but also on the behaviors of medical staff. Some of these behaviors are unexpected by policymakers, such as turning away critically ill patients, disaggregating hospitalization costs, setting up disease groups with higher points, and so on. This phenomenon attracted the attention of some scholars, who put forward a few positive intervention measures, mainly including policy advocacy and system improvement. The scholars believed that the former was more feasible. However, there is a lack of research on the effects and influencing processes of these interventions. Therefore, this study aims to explore the influence of policy advocacy and education on medical staff's adaptation to DRGs payment reform in China and the role of policy cognition in this process, in order to provide experiences for the smooth implementation and sustainable development of DRGs payment system. A questionnaire survey was conducted among 650 medical staff in five large general hospitals in Zhejiang Province, China, to understand their participation and feedback on policy advocacy and education, their adaptation to the current DRGs payment reform, and their cognition of relevant policies. After descriptive statistical analysis, partial correlation analysis, multiple linear regression models and bias correction Bootstrap sampling method were used to analyze the mediating effect of policy cognition factors. All respondents had participated in organized collective policy advocacy and education activities in the past year, but the degree of satisfaction and recognition was not very high. 59.5 percent said their adaptation to the DRGs payment reform was average. Nearly half did not regularly pay attention to and participate in the management of the medical costs of patients with DRGs through compliance. And they had a low understanding of the specific rules of DRGs payment and did not form a high policy identity. The mediating effect values of policy cognition were 0.148, 0.152, 0.108, and 0.057, respectively, when the frequency and quality of policy advocacy and education influenced medical staff's adaptive perception and adaptive behaviors. The organized collective policy advocacy and education can promote medical staff's adaptation to DRGs payment reform by improving their policy cognition, and the action paths are diverse. Policymakers and hospital managers need pay attention to this phenomenon, and formulate demand-centered, value-oriented whole-process advocacy and education strategies while constantly improving the DRGs payment system. All of these provided a basis for further research and practice of positive intervention in DRGs payment reform.

EGS SO08 - How best to time the operative management of acute cholecystitis: Is there a difference in outcomes between hot and smouldering cholecystectomy?

Abstract Background Laparoscopic Cholecystectomy (LC) is the main treatment for symptomatic gallstone disease. Acute cholecystitis (AC) is a common emergency presentation in the UK and the 2015 AUGIS guidelines recommend emergency cholecystectomy within 72 hours of admission if the patient is fit. On a practical level this can sometimes be difficult to implement and often patients are discharged to return for an elective procedure (the smouldering gallbladder). We aimed to analyse our practice at a large district general hospital for the management of patients with AC and their post-operative outcomes. Method All patients undergoing LC between 1st July 2020 and 30th June 2022 were identified. Patients with an ICD-10 code of K81 (AC) associated with an inpatient stay within a year of their operation were included. Those admitted and operated on during that admission were classified as hot cholecystectomies (HC), whereas those admitted and discharged for an elective procedure were termed smouldering cholecystectomies (SC). Patient and operative details were retrieved from their electronic record and a Charlson co-morbidity index was calculated. Statistical analysis was performed using SPSS with Chi-squared tests performed for categorical data and ANOVA for continuous data. Results 276 patients underwent cholecystectomy for AC with 52.2% elective and 47.8% emergency (91% within 72 hours of admission). HC patients were younger (52.3 vs. 57.5, p<0.01) and less-comorbid (1.67 vs 2.12, p<0.05). The subtotal cholecystectomy rate was comparable between the groups (9.8% vs 16.0%, p=0.131). HC patients had more post-operative drains (38.6% vs 27.1%, p<0.05) and thick-walled gallbladders (92.4% vs 64.6%, p<0.001). Median post-operative length of stay was 1 day for HC and 0 days for SC. No difference was observed for 30-day readmission (4.5% vs 7.6%, p=0.286), morbidity (12.9% vs 11.8%, p=0.786) or mortality (0.8% vs 0.7%, p=0.951). Conclusion This study adds to the evidence that emergency cholecystectomy is as safe an option as discharging patients to return for an elective procedure in the future. Although a proportion of those discharged to return for an elective operation will have thin-walled gallbladders, the rate of subtotal cholecystectomy remains similar, if not slightly higher in the elective group (although not reaching statistical significance). Most emergency cholecystectomy patients were discharged the following day, therefore demonstrating that they do not significantly contribute to bed blocking and reduce the burden on already strained elective waiting lists.

Efficiency of Inventory in Thai Hospitals: Comparing Traditional and Vendor-Managed Inventory Systems

Background: Traditional procurement and price negotiation methods in public hospitals in Thailand involve group purchasing agreements and bulk orders, posing challenges to improving inventory management efficiency. The vendor-managed inventory (VMI) model is a promising alternative for enhancing hospital performance, especially during crises. This study aimed to assess the potential cost savings in implementing VMI in a large general hospital in Thailand. Methods: A simulation modeling approach was used to compare the current inventory system with three VMI models: VMI1, focused on improving inventory turnover rate (ITR); VMI2, emphasized frequent replenishment with a 1-month supply; and VMI3, eliminated safety stock. Results: The results demonstrated significant cost savings, with potential reductions in total inventory management expenses. Specifically, VMI1 improved ITR from 6.31 to 7.76, reducing average inventory by 36% and cutting management costs by 40%. VMI2, with an ITR of 12.80, reduced inventory by 44% and saved 47% in management costs, while VMI3 achieved a 70% reduction in inventory and a 69% saving in management costs. Conclusions: This study highlights the VMI’s transformative potential in hospital inventory management, demonstrating significant cost savings. However, in the public sector, the feasibility of procurement regulations requires further exploration.

EP502 - Outcome of 5 years of endoscopic oesophageal stenting: a retrospective analysis

Abstract Background Oesophageal endoscopic stenting has a wide range of indications however dysphagia and use in cancer of the oesophagus is by far the most common, being the 14th most common cancer in the UK, despite advances in diagnosis and therapy with patients often presenting at advanced stages of the disease. Greater than 50% of presentations are at an advanced stage of disease where resection is often not possible and palliation is required. Palliation often is a potential combination of palliative chemotherapy, radiotherapy and endoscopic stenting to control the disease burden and improve symptoms. One of the most limiting palliative symptoms is dysphagia for which oesophageal stenting has become the standard of treatment showing immediate results. However, intra/post procedural complication rates can be high leading to: oesophageal perforation, mediastinitis, aspiration pneumonia, failed stent insertion or slippage. Method A retrospective analysis of 97 patients who underwent oesophageal stenting, in a 5 year time period between 2018-2023 in the Dumfries Royal Infirmary, a large district general hospital. Patients electronic notes were retrospectively analysed for patient characteristics, indication for stenting, early complications, successful hospital discharge and mortality. Conclusion The retrospective study demonstrated oesophageal stenting is a relatively safe procedure with a low mortality and the majority of patients being discharged from hospital. However, complications are not uncommon and patients should be properly counselled; on the risks, benefits and also food habits to prevent bolus.

WP7.4 - A closed loop audit assessing adherence to NELA frailty guidelines in over 75’s undergoing Emergency Laparotomy

Abstract Background and Aims The National Emergency Laparotomy Audit (NELA) 2023 recommend patients over 65 should have clinical frailty score (CFS) recorded, and, if frail or aged 80 or over, should have Care of the Elderly (COE) input. Due to the multi-morbid nature of frailty this population carry additional surgical and post-operative risk. This audit reviewed use of these recommendations at a large District General Hospital (DGH). Methods We performed a closed loop audit on all patients aged 75 and older who had an emergency laparotomy between September 2020 to December 2023. We collected data from their admissions, including CFS and if COE reviews had occurred. The data was analysed. Interventions included presentation at clinical governance, discussion with the COE consultant and a poster was developed for the surgical assessment unit. The data was again retrospectively collected to complete the audit cycle. Results A total of 94 patients were included. The initial audit found 0 patients had CFS recorded and 16% had COE review. The reaudit found significant improvement, with 92% of patients having CFS recorded and 46% having had COE review. Conclusion The second cycle audit has shown significant improvement at the DGH in recording CFS and organising COE reviews for patients over 75 having an emergency laparotomy. However, there remains scope for improvement. Suggested improvements include: a referral pathway to prompt COE reviews and the creation of the “general surgery geriatrician” similar to the ortho-geriatrician role. Organising COE reviews could improve patient outcomes and provide more holistic care.

EP503 - A retrospective assessment of quantitative futility in emergency laparotomy using pre-operative frailty as the predictor

Abstract Background Recent literature has proposed that emergency laparotomy in the frail population may be qualitatively futile leading to negative desired morbidity and missed opportunities for palliation. The aim of this study was to appraises the futility of emergency laparotomies within a 3 month period based on the predictor of pre-operative frailty with in a large district general hospital. Method Retrospective analysis of all patients undergoing emergency laparotomy in a 3 month time period in the Dumfries Royal Infirmary. Futility was defined as all-cause mortality within 3 days of emergency laparotomy and frailty based on the characteristics set out by the Rockwood frailty score. A assessment of surgical futility in emergency laparotomy was carried out based on the pre-operative frailty. Conclusions Increased frailty demonstrates an increase in futile emergency laparotomies. It is therefore recommended that a multidisciplinary team approach with careful assessment and consent should be made prior to any surgical intervention on this patient cohort.

Self-poisoning with paracetamol in England: short report of characteristics of individuals and their overdoses according to source of tablets.

Self-poisoning with paracetamol is the most frequently used overdose method in the UK. Psychosocial assessments were conducted by mental health clinicians with 127 consecutive individuals who presented with pure paracetamol overdoses to a large general hospital over 8 months, including asking about the source of the tablets and scoring the patients' acts on the Beck Suicide Intent scale (BSI). Patients were predominantly female (86%) and young (79% aged 12-24 years). Most had used paracetamol which was available in the home (77%). Those who purchased paracetamol for the act took double the number of tablets compared with those who used paracetamol available in the home (37 v. 18), had higher suicidal intent (mean BSI: 11 v. 7) and more often required treatment with N-acetyl cysteine (71% v. 43%). These results highlight the need for safer home storage of paracetamol and consideration of reducing pack size limits on paracetamol that can be purchased.

Patient reported outcome measures at a large district general hospital post-mastectomy and implant based reconstruction.

11 Background: Breast reconstruction surgery for cancer can be a debilitating and life changing experience for patients, with complex affects on physical and mental health throughout the rehabilitation journey. We conduct a study on a cohort of patients undergoing this procedure, with focus on patient reported outcome measures. Methods: We reviewed all patients who underwent breast reconstruction surgery at our hospital from 2017 to 20223. Demographic, diagnosis, pre- and post-operative adjuvant treatment, and implant characteristics were collected. Psychosocial well being, physical wellbeing, satisfaction with breasts scales of the BREAST-Q were used. Independent t-test was conducted to find differences between PROMs for each group, and linear regression of age and implant size on each score. Results: 69 patients were contacted and 39 PROMS collected. The average age of patients was 57.6 years old. 40% were previous or current smokers and 40.8% had BMI>30. 29 had pre-pectoral placement and 40 sub-pectoral. 17 had smooth implants and 52 textured. The average size of implant was 330mm. Immediate reconstruction was associated with a lower psychosocial score (66.0vs86.9, p=0.02) compared to multi-stage implants. Sub pectoral placement was associated with a higher (75.7vs61.9 p=0.046) psychosocial score than pre pectoral placement. Textured surface was associated with lower physical score than smooth surface (34.7vs50.2 P=0.046). On linear regression, age was positively associated (p=0.007) with psychosocial score. Conclusions: These findings underscore the importance of personalized approaches in surgery, considering implant type, placement technique, and patient age. Surgeons should prioritize patient preferences and needs to optimize post-surgical satisfaction and well-being.

Factors affecting health-related quality of life after coronary artery bypass grafting

Abstract Background Cardiovascular diseases are one of the major causes of mortality in the world. According to the World Health Organization (WHO), approximately 17.9 million people die annually due to cardiovascular diseases worldwide. The most common cardiovascular disease is coronary artery disease (CAD), which involves the narrowing or blockage of the heart arteries as a result of atherosclerosis. Coronary Artery Bypass Grafting (CABG) is a common surgical approach for patients with coronary heart disease (CHD), which improves symptoms and survival, and expected to enhance Health-Related quality of life (HR-QoL). Patients, even after recovery from GABG, may have physical and psychological limitations that reduce HR-QoL. Aim The investigation of factors that affecting the HR-QoL of people after coronary artery bypass grafting (CABG). The secondary aim of the study was the investigation of demographic or clinical factors, physical activity, stress or depression may affect the HR-QoL of people after CABG. Methods This is a descriptive correlational study with a cross-sectional design. Data were collected from the cardiac surgery department of two large general hospitals in Cyprus after consent from both, the management and their ethics committee. The study sample (N=56) included all patients who had undergone CABG surgery from January to June 2022. At, the patients completed a questionnaire at three to six months postoperatively. The data collection tool included: Demographic and Clinical Characteristics Record Form, the SF12 Health Survey Tool for assessing the Health-Related Quality of Life (HR-QoL) of patients, the HADS Tool for evaluating the anxiety and depression levels of patients, and the IPAQ tool for assessing Physical Activity. Descriptive statistic was used for the analysis and presentation of the data and ANOVA analysis to investigate the factors that affect the health-related quality of life. Results Gender (64.2±19.3 vs. 49.8±11.9, p<0.05) and education level (78.5±6.7) (P<0.05) were both found to influence HR-QoL. Other factors that affect the HR-QoL of subjects after CABG are intense physical activity, increased anxiety levels, severe depression and patient's symptoms such as dyspnea (53.3±18.6 vs. 64.6±18.4, p<0.05) and orthopnea (45.4±17.4 vs. 65.6±17.3, p<0.05). Conclusion The identification of the factors that were found to affect the HR-QoL of patients after coronary artery bypass grafting enlighten health professionals where they should pay attention when they develop rehabilitation programs.

Utilization of psychiatry services in the emergency department following a terror event in Israel

In October 2023, Israel sustained a massive terror attack, with 1,300 people murdered, over 240 kidnapped, and millions exposed to the horrors. This study's aim is to examine the profile of patients arriving to the emergency department (ED) for psychiatric services during the month following the attack, compared to a similar period the year prior. In this cohort study, we compared patients arriving to the ED of a large general hospital in the center of Tel Aviv for psychiatric services during the month post-attack with the previous year using t-tests and chi-square exams. In 2023, 256 patients arrived in the ED for psychiatric evaluation and/or treatment, 46 % more than in 2022. Of these, 64 % were examined due to symptoms related to the terror attack. In 2023, significantly fewer patients had a prior psychiatric diagnosis (68% vs. 89 %). Significantly more patients were diagnosed with acute stress reaction or acute stress disorder in the ED, compared to almost no such diagnoses in 2022 (14 % and 43% vs. 0 % and 1 %). Major terror incidents profoundly influence psychiatric ED visits. Planning efforts for major emergencies should be adapted accordingly.

Nursing care for maintenance and prevention of enteral probe loss

Objective: To understand the perception and practice of nursing professionals about care related to the maintenance and prevention of enteral probe loss in hospitalization units. Methods: Quanti-qualitative and descriptive study carried out in a large general hospital in Belo Horizonte, Minas Gerais, Brazil. It was attended by 40 professionals, 19 nurses and 21 nursing technicians, interviewed in September and October 2018. Secondary data were collected from the medical records of 114 patients who were using an enteral probe from 01/01/2017 to 01 /01/2018. Results: It was observed that the majority (68.4%) of patients undergoing enteral nutritional therapy were over 60 years of age. Nutritional causes were the main indication for the use of probes, occurring in 51.7% of patients. Most (90.0%) of professionals recognize that washing the probe is the main care in terms of preventing loss of this device and recognize that the biggest complication of its use is bronchoaspiration. Conclusion: It was found that nursing professionals have knowledge about care related to maintenance and prevention of probe loss, but the perception of these professionals is different from the information introduced in the medical records, which may highlight a disarticulation between knowledge and care practice.

Effects of nursing intervention based on gratitude extension-construction theory on gratitude level, recurrence fear and post-traumatic growth of patients with breast cancer after surgery.

e23162 Background: To explore the effects of nursing intervention based on gratitude extension-construction theory on gratitude level, recurrence fear and post-traumatic growth of patients after breast cancer surgery. Methods: 104 patients with breast cancer treated in a large general hospital from August 2023 to January 2024 were selected as the study objects, and randomly divided into control group and intervention group with 52 cases in each group. The control group received routine nursing intervention, and the intervention group was treated with nursing intervention based on gratitude extension and construction theory on the basis of routine nursing intervention. The intervention plan included organizing patients to give motivational lectures before discharge, watching gratitude videos, and teaching patients to carry out positive memory, gratitude meditation and gratitude expression every day through bedside talk. After discharge, patients were instructed to conduct interest cultivation, gratitude expression, gratitude visit, gratitude diary and gratitude sharing through phone or wechat follow-up. After 12 weeks, the results were evaluated by general information questionnaire, gratitude level questionnaire, Cancer Recurrence Fear Scale, and post-traumatic Growth Rating Scale. Results: After intervention, the gratitude level of the intervention group was significantly higher than that of the control group (P < 0.001), the total score and all dimension scores of fear of cancer recurrence were significantly lower than those of control group (P < 0.05), post-traumatic growth score and all dimensions were higher than those of control group (P < 0.001). Conclusions: This study established a set of scientific, practical and effective intervention program suitable for patients with breast cancer after surgery to improve the level of gratitude, alleviate the fear of cancer recurrence, and promote post-traumatic growth, and verified that the intervention program can effectively improve the level of gratitude of patients, especially in the aspect of gratitude around people and matters. It can also alleviate the fear of cancer recurrence, overall worry, health worry, female worry, role worry, death worry, etc. Post-traumatic growth has been significantly improved, especially in terms of personal strength and interpersonal relationship improvement. Under the general trend that breast cancer has become the largest cancer in the world, it is one of the effective ways to improve the psychological state of breast cancer patients, and it is worth promoting in breast cancer patients.

Epidemiological analysis of in patients with sepsis in a large tertiary general hospital in Southwest China

To analyze the epidemiological characteristics of hospitalized patients diagnosed with sepsis in a large class III general hospital in Southwest China in a period of 2 years, and to explore the risk factors related to death in patients with sepsis. A retrospective study was conducted to select patients with sepsis admitted to Sichuan Provincial People's Hospital from September 1, 2021 to August 31, 2023, and general characteristics such as gender, age, discharge diagnosis, discharge department, hospitalization cost, length of stay, and prognosis during hospitalization were collected. The baseline of two groups of patients was compared, and the risk factors of in-hospital cause of death in patients with sepsis were analyzed by multivariate Logistic regression. A total of 3 568 patients with sepsis were included with median age of 58 (35, 74) years old. Of all patients, there were 2 147 males (60.17%). The median length of hospitalization was 13 (8, 24) days, and the median hospitalization cost was 3.98 (1.87, 8.83) ten thousand yuan. The departments with more than 100 cases of sepsis in 2 years were central intensive care unit (ICU), pediatrics department, nephrology department, emergency medicine department, emergency intensive care unit (EICU), infectious department, respiratory medicine department, hematology department, neonatal care unit and emergency surgical department. A total of 1 210 patients (33.91%) admitted to ICU (including central ICU and EICU). The hospitalization cost of ICU patients were higher [6.7 (3.1, 15.5) ten thousand yuan], the hospitalization duration was longer [9 (3, 17) days], and the mortality was higher [35.29% (427/1 210)]. Among 3 568 patients with sepsis, 448 died and 3 120 survived during hospitalization. The age, male proportion and hospitalization cost of patients with sepsis in the death group were significantly higher than those in the survival group [age (years old): 75 (60, 86) vs. 57 (30, 71), male proportion: 67.86% (304/448) vs. 59.07% (1 843/3 120), hospitalization cost (ten thousand yuan): 6.7 (3.0, 16.9) vs. 3.7 (1.8, 8.1)], the ratio of diabetes mellitus was significantly lower than that of survival group [4.91% (22/448) vs. 10.45% (326/3 120)], the length of hospitalization was shorter than that of survival group [days: 10.0 (3.0, 19.0) vs. 13.0 (8.0, 24.0)], the differences were statistically significant (all P < 0.01). Multivariate Logistic regression analysis showed that male [odds ratio (OR) = 0.75, 95% confidence interval (95%CI) was 0.59-0.96], elder (OR = 1.04, 95%CI was 1.03-1.05) and diabetes (OR = 0.32, 95%CI was 0.19-0.54) were independent risk factors for in-hospital death in patients with sepsis (all P < 0.05). Sepsis is a heavy burden in Southwest China, especially for ICU, with high mortality, high hospitalization costs, and heavy economic burden on patients and society. Male, elder and diabetes were independent risk factors for in-hospital death of sepsis patients.

#2657 Evaluation of the impact of a nephrologist led acute kidney Injury clinic in a large district general hospital

Abstract Background and Aims Acute kidney injury (AKI) has a significant impact on inpatient hospital admissions costing the NHS in the UK an estimated £1bn. Hospitalisation complicated by AKI results in increased length of stay and mortality and up to a fifth of discharged patients are readmitted to hospital within 30 days. Traditionally district general hospitals in the UK have limited nephrology cover. In our large district general hospital, a new nephrologist led AKI clinic was established to review patients whose inpatient admissions were complicated by a stage 2 or 3 AKI. Over a 7-month period the aim was to evaluate this new clinic and its impact for local patients and the hospital trust. Method Inpatients with stage 2 and 3 AKI were identified by a specialist AKI nurse and nephrologist as suitable for the clinic. A discharge summary was generated with the stage and cause of AKI. Patients were seen within 6 weeks of discharge by either a nephrologist or a specialist AKI nurse. Data was retrospectively collected, and this included diagnosis, causes of AKI, highest stage of AKI, progression of chronic kidney disease (CKD) and referral to tertiary chronic kidney disease services. Using the hospital's own AKI dashboard, we looked at 30-day readmission rates of all AKIs and overall hospital length of stay over this period. Results Retrospective data was collected for 245 patients who attended the clinic over 7 months. 43.9% had a stage 3 AKI, 41.4% had a stage 2 AKI, the remainder of patients were CKD patients with progression or had an underlying glomerular pathology. The most common cause for AKI was hypovolaemia (41.8%) followed by infection/sepsis (37.7%). Most AKIs fully resolved (58.1%), 7% of patients had not resolved and 27% partially resolved. 12.3% of patients were referred onto nephrology tertiary services. Over the course of the 7 months, the trend of 30-day readmission rates dropped from 18.2% to 10.1% (Fig. 1). There was no significant change in hospital length of stay. Conclusion The nephrology led AKI clinic has had a meaningful impact in our post discharge patient care. We have been able to review patients in a timely manner providing them with a holistic approach. A significant number of patients were identified and referred early for specialist tertiary CKD management. Over the 7-month period there was a reduction in 30-day readmission rates however it has not yet affected overall length of stay. This study supports a nephrologist led AKI clinic in a district general hospital.

Analysis of Risk Factors for Death in the Coronavirus Disease 2019 (COVID-19) Population: Data Analysis from a Large General Hospital in Anhui, China.

During the coronavirus disease 2019 (COVID-19) pandemic, clinical prevention, early diagnosis, and hematological monitoring were challenging areas.This study aims to comparerisk factors and hematological and biochemical data in non-survivor group patientswith COVID-19 versus survivor group patients.A total of 204 patients with COVID-19 were selected as research subjects from December 2022 to January 2023. We analyzed the age, sex, time from onset to admission, and laboratory test indicators upon admission. The differences between surviving and deceased patients and mortality-related risk factors were examined. Among the 204 patients, 168 survived, whereas 36 died during hospitalization. Significant differences were observed between the two groups with COVID-19 across various factors, including age (p < 0.0001), WBC count (p < 0.0001), RBC count (p < 0.05), neutrophils (p < 0.0001), lymphocytes (p < 0.05), mean corpuscular hemoglobin concentration (MCHC) (p < 0.0001), RBC distribution width-standard deviation (RDW-SD) (p < 0.0001), RBC distribution width coefficient of variation (RDW-CV) (p < 0.0001), aspartate aminotransferase (AST) (p < 0.05), albumin (ALB) (p < 0.0001), creatinine (CR) (p < 0.0001), uric acid (UA) (p < 0.0001), blood urea nitrogen (BUN) (p < 0.0001), plasma thrombin time (TT) (p < 0.05), prothrombin time (PT) (p < 0.0001), and D-dimer (p < 0.0001). Multivariate logistic analysis revealed that older age, CR, UA, and ALB were independent factors associated with death (p < 0.05).Elderly patients with underlying diseases, abnormal routine blood test indices, and abnormal renal function and coagulation indices are at an increased worse prognosisand should be identified early. Age, UA, CR, and ALB can be used as predictors to assess the worse prognosisin the hospital.

Comparison of the Diagnosis and Treatment of Nasal Bone Fracture by Physicians in China With Different Levels of Experience.

This study aimed to investigate the conflicts in the diagnosis and treatment of nasal bone fracture by Chinese otolaryngologists to improve the diagnosis and treatment accuracy of junior otolaryngologists and emergency physicians. A questionnaire was designed and filled out by otolaryngologists in large general hospitals. The questions included how to choose an auxiliary examination to diagnose nasal bone fracture, whether tamponade is required after closed reduction, the selection of packing materials, the timing of an operation, and the evaluation of postoperative effect. The questionnaire results were divided into 3 groups according to the experience levels of experienced of physicians. A total of 151 otolaryngologists with different levels of experience from 26 provinces in China completed the questionnaire. 90.73% of physicians thought that nasal bone computed tomography was the most important auxiliary examination to diagnose a nasal bone fracture. 52.32% of them compared photos before and after the operation to evaluate postoperative effects. About 53% of physicians thought that 7 to 10 days after reducing local swelling is the optimal time for closed reduction. There is no obvious difference in the diagnosis and treatment of nasal bone fracture among otolaryngologists with different levels of experience in Chinese otolaryngologists with different levels. Most physicians choose nasal bone computed tomography for diagnosis, perform surgery at 7 to 10 days after injury, and compare photos from before and after the operation to evaluate the postoperative effect.

P110 Characteristics of Difficult to treat Rheumatoid Arthritis patients in a large District Hospital in the UK

Abstract Background/Aims Difficult-to-treat rheumatoid arthritis (D2T RA) has a notably higher impact on a patient’s quality of life and is a significant cost and service pressure to the health care provision in comparison to non-D2T RA. The primary aim of this study is to delineate the major contributing factors and characteristics of patients leading to a diagnosis of D2T RA, using the criteria established by the European League Against Rheumatism (EULAR). Methods A retrospective study was conducted within the Rheumatology department in a large district general hospital, with a catchment population of over 700,000 people. A cohort of 722 patients, all of which were on biologic Disease Modifying Anti-Rheumatic Medications (DMARDs) was selected. In this study, we present our findings for the first 95 consecutive patients. Results Of the selected 95 patients, 13% met the EULAR criteria for D2T RA. The key characteristics within this subset include 75% being sero-positive (both Rheumatoid factor and anti-cyclic citrullinated peptide), 66% being categorized as obese, and 42% having concurrent fibromyalgia and osteoarthritis. Among these 13% D2T RA patients, 25% demonstrated a high disease activity index and 75% showed moderate severity. All these patients had been started on at least two conventional DMARDs including methotrexate before escalating to more advanced treatments in line with NICE guidelines. From the subgroup of high disease activity D2T RA patients, 67% had tried at least three types of biologic or targeted synthetic DMARDs (b/ts DMARDs), and 33% had been trialled on four different types of b/ts DMARDs. Similarly, out of the medium severity D2T RA subgroup, 45% had tried three and four DMARDs respectively and 10% had been given five biologic or synthetic DMARDs. Conclusion The major contributing factors leading to D2T RA within this study population appear to be seropositivity for both RF and anti-CCP, obesity, and the presence of comorbidities like fibromyalgia and osteoarthritis. The intertwined relationship between these factors emphasizes the need for a comprehensive and individualized approach to managing patients with D2T RA. Although this cohort is larger than the previous studies, the sample size is relatively small. We aim to look at the remaining 627 patients to identify trends and modifiable risk factors that could help prevent the future development of D2T RA. Disclosure K. Oo: None. M. Memon: None. P. Sharma: None. S. Dahiya: None.

Detection of iodixanol-induced allergic reaction signals in Chinese inpatients: a multi-center retrospective database study using prescription sequence symmetry analysis.

This study aimed to explore the signal detection method for allergic reactions induced by inpatient iodixanol injection. A database of 3,719,217 hospitalized patients from 20 large Chinese general hospitals was processed and analyzed using the prescription sequence symmetry analysis (PSSA) method. 126,680 inpatients who used iodixanol and were concurrently treated with anti-allergic drugs were analyzed. In the medical records of these patients, only 32 had documented iodixanol allergies. Statistical analysis identified 22 drugs in 4 categories-calcium preparations, adrenergic/dopaminergic agents, glucocorticoids, and antihistamines-as marker drugs. With time intervals of 3, 7, and 28days, the adjusted sequence ratios (aSRs) for all anti-allergics and the 4 categories were greater than 1. The 7-day aSRs were 2.12 (95% CI: 2.08-2.15), 1.70 (95% CI: 1.68-1.73), 3.85 (95% confidence interval [CI]: 3.75-2.30), 2.30 (95% CI: 2.26-2.35), and 1.95 (95% CI: 1.89-2.02), respectively. The proportions of adverse drug events indicated by each signal were as follows: all anti-allergics (2.92%-3%), calcium gluconate (0.19%-0.52%), adrenergic/dopaminergic agents (2.20%-3.37%), glucocorticoids (3.13%-3.76%), and antihistamines (1.05%-1.32%). This first multi-center Chinese inpatient database study detected iodixanol-induced allergy signals, revealing that reactions may be much higher than those in collected spontaneous reports. Iodixanol risk exposure was closer to actual pharmaceutical care findings. PSSA application with ≤7-day intervals appears better suited for monitoring late allergic reaction signals with these drugs.