Post Emergency Research Articles

SP9.2 - Changes in frailty and discharge destination post emergency laparotomy

Abstract Aims Frailty affects morbidity and mortality post emergency laparotomy (EmLap). Studies have shown that some frail patients do not return to baseline post EmLap. We aim to explore the change in frailty status at 90-day post EmLap and the association between pre-EmLap frailty and changes in home environment on discharge. Methods EmLap patients age ≥65years from a district hospital were recruited from May 2022 to April 2023. Discharge data were collected prospectively, and frailty was assessed using Rockwood Clinical Frailty Scale at pre-EmLap and day-90 post-EmLap with score >4 as frail. EmLap patients with no complete 90-day follow-up were excluded. P-value of <0.05 was considered significant. Results 63 EmLap patients were included, 57.1% were female and median age was 75years. 17.5% were frail pre-EmLap and on day-90 post-EmLap, 33.3% were found frail (15.9% developed frailty). Pre-EmLap, all patients came from home with 13.6% had package of care service (POC) already in place. On discharge post-EmLap, 27% had change of home environment; 1 to care home, 1 still an inpatient at 90-day post EmLap, 2 had new POC and 13 had increased POC. Of this cohort, 52.9% were frail pre-EmLap. There was a significant association between pre-EmLap frailty and change in home circumstances on discharge (p<0.00001). Conclusion About 16% developed frailty post-EmLap with almost a third had a change in home environment on discharge. Frailty should be assessed in all EmLap patients to improve shared decision making and development of post-EmLap discharge strategies.

Drawing blood from a peripheral intravenous cannula and its effect on cannula dwell time, phlebitis, and bloodstream infection: A randomised controlled study

BackgroundRoutine blood sampling can be conducted using venepuncture, inserting a new peripheral intravenous cannula (PIVC), or utilising an existing one. The practice of blood sampling from a cannula requires handling and movement of the cannula bung. It is discouraged due to safety concerns linked to increased risk of phlebitis, infection, or reduced dwell time. AimTo assess cannula dwell time, the prevalence of phlebitis, and bloodstream infection when using a PIVC compared with venepuncture for blood sampling. DesignA randomised controlled study. Reporting followed CONSORT recommendations. MethodsAdult patients admitted to the emergency department whose health condition required a blood sample to be drawn and insertion of a PIVC were screened for eligibility between May and July 2022. Participants were randomised to either have blood sampled by venepuncture as the control or drawn through the PIVC as the intervention. Follow-up occurred on day three post emergency department presentation. ResultsOne hundred and five participants were randomised of whom 50 had blood sampled by venepuncture and 55 through the PIVC. No difference was observed in cannula dwell time, prevalence of phlebitis, or signs of bloodstream infection. ConclusionThis study showed PIVC outcomes were no different when the PIVC was used to sample blood compared with participants whose blood was sampled by venepuncture.

Is Travel Resurgence in the Post-Global Health Emergency a Form of Revenge Travel? A Multi-phase Qualitative Study

This paper aims to conceptualize whether revenge tourism is an apt description of travel in the post global health emergency period from the perspective of travelers. Furthermore, it examines the outcomes of post global health emergency travel. The multiphase work included screening and three phases of qualitative study. Participants perceived the term “ revenge” with skepticism, although the nature of travel and activities and consumption in the post global health emergency have changed for them. In this period, the need for introspection was greater, and travel was a way of rediscovering oneself. Furthermore, participants were negotiating new, different boundaries again after a tumultuous period, which indicated tourism travel was inextricably intertwined with several important aspects of their lives. The most important implication of the study is that it enables us to understand the connectedness between the process by which the post global health emergency phenomenon influences travel and its outcomes.

COVID-19: Remote diagnostic assessment of children with suspected Autism Spectrum Disorder, a selected literature review

Diagnostic evaluations of neurodevelopmental disorders dramatically reduced and slowed down following the disruptions caused by Sars-CoV-2 pandemic. For this, it was necessary to identify solutions allowing diagnostic assessment, screening, and early patient care by implementing remote diagnostic protocols respecting the restrictions imposed by the lockdown. Centres and services specialized in Autism Spectrum Disorder (ASD) had to quickly implement innovative diagnostic protocols able to satisfy patients' needs, minimizing the chances of spreading the virus at the same time. This work collects the studies conducted so far on remote assessment of ASD both prior to and relating to the period of the SARS-CoV-2 pandemic. It also explores standard diagnostic tools that have been adapted for remote administration, in order to evaluate strengths and limitations of these methodologies. Remote assessment methodologies were initially employed to overcome the difficulties of long-distance diagnoses and to respond to families' need for continuity of public and private services. These studies underlined the validity of some remote diagnostic protocols and how telediagnosis may enable the diagnostic evaluation, making it more accessible and thus favouring timely intervention. We discussed the opportunity to integrate in person and remote approaches for diagnosing neurodevelopmental conditions, even in the post covid emergency period.

Bridging the gap: a simulation-based education programme to improve the management of postoperative neck haematomas

Postoperative neck haematomas have a reported incidence of 3.4%. They result in a longer length of hospital stay, higher costs and a higher mortality rate. Consensus guidelines provide an algorithm for the management of a suspected neck haematoma and recommend that staff are trained to recognise the symptoms and signs of a neck haematoma. They also suggest the introduction of a post thyroid surgery emergency box. Our aims were to provide education in the form of simulation scenarios and to introduce a neck haematoma evacuation box. This quality improvement project was carried out in a large tertiary referral hospital, with over 1000 beds. It is the major head and neck surgical centre in Ireland. Ethical approval was granted by the hospital. Four simulation training sessions were carried out with Ear, Nose and Throat (ENT) nurses and interns. Voluntary surveys were conducted before and after the sessions. A sample neck haematoma evacuation box was used for the simulation scenarios. 50 staff participated in simulation training. 7% of staff had seen a neck being evacuated on the ward. 37% had received prior teaching on the management of neck haematomas. Significantly more participants reported to know the symptoms and signs of a neck haematoma and the required management of a neck haematoma after completion of the simulation sessions. All participants agreed neck haematoma evacuation boxes were necessary and would improve patient outcomes. The pre-simulation survey demonstrated that an unacceptably low amount of staff had previous training on this topic. Simulation training resulted in more participants being able to identify the signs and symptoms of a neck haematoma and more participants feeling confident regarding the necessary actions. The results show the positive impact of simulation training and provide a basis for advocating for this training to continue on a regular basis. Simulation works to increase participants confidence and familiarity with a given situation. Simulation training also improves technical skills and teamwork. There was unanimous support for the introduction of the post neck surgery haematoma evacuation boxes, which suggests that these would be a valuable introduction in our hospital.

Atypical Influx: Navigating Invasive Group A Streptococcus Cases in Emergency General Surgery

Abstract Aim To highlight the rising national incidence of iGAS infections, particularly during the post emergency phase of the COVID-19 pandemic, and emphasise its significance as a differential diagnosis in acutely unwell emergency surgical patients. Methods Data was gathered retrospectively from December 2022 - August 2023. Inclusion criteria were emergency surgical patients testing positive for GAS isolated from sterile sites, or non-sterile sites in case of septic shock. Results Six cases (four females, two males), with a mean age of 55 (36-67) were identified. Four had necrotizing fasciitis, one bacterial peritonitis in the presence of a ventriculo-peritoneal shunt, and one streptococcal bacteremia. All presented in septic shock, with metabolic acidosis and multiorgan impairment. The initial diagnosis was clinical in 66% of cases. iGAS was confirmed via wound, peritoneal fluid, tissue or blood culture in five patients and via genital swab in one. 50% of cases were sensitive to clindamycin and amoxicillin. Two received IV immunoglobulins. All cases were managed according to Sepsis 6 protocols, involving multidisciplinary teams. Five patients underwent immediate surgery for debridement and washout. The mortality rate was 16.6%. Three patients were transferred to tertiary centres once stabilised (1 for neurosurgical input, and 2 for plastics grafting). Conclusion It is crucial for frontline doctors to consider iGAS as a differential when encountering critically ill surgical patients. Simultaneous systemic resuscitation, early surgical intervention, multidisciplinary care, tailored antibiotic therapy and immunoglobulins are essential to minimise morbidity and mortality.

Эффективность применения динамического метода оценивания состояния параметров режима электроэнергетической системы

The results of the estimation of power system mode parameters are used to solve important technological tasks by real-time hardware-software packages (HSPs), for instance, the calculation of maximum allowed power flows (MAPFs) via sections by a Control System of Stability Margin (HSP CSSM). Now, in the HSP CSSM the state estimation is realized by the static method. Remote measurements (RMs) obtained from an operative informational complex are used as initial data. With the introduction of Wide-Area Measurement Systems and the possibility to obtain synchronized phasor measurements (SPMs) with a high update rate, it becomes possible to apply and improve state estimation dynamic methods. Even though, many researchers pay attention to the state estimation dynamic method, but practical application of this method and obtained results are presented in papers insufficiently. The goal of the study is to improve the state estimation dynamic method based on the extended Kalman filter and analyze the effectiveness in determining the mode parameters of electric power system. The studies are performed by the developed algorithm of the state estimation dynamic method based on extended Kalman filter. С# is the language for software code. Practical evaluation of the state estimation algorithm has been carried out on the basis of a power system model containing 55 nodes and 76 branches. An improved dynamic method to estimate the state of mode parameters is proposed. The test results show that in steady-state modes, when RMs are not updated on time, the developed dynamic method demonstrates high accuracy for the estimation of mode parameters and MAPFs. The estimation error of a voltage and an active power is low, therefore MAPFs are more specifically than MAPFs obtained by CSSM. Also, this method operates with high accuracy in the post emergency states, but only for that part of the power system, where the topology and mode have not been changed. For the part, where the topology and mode affected, the best result shows the static state estimation method by RMs and SPMs. In post emergency states the static state estimation method offers to form the transfer matrix for the dynamic method, therefore, static and dynamic state estimation methods must be used simultaneously in real-time HSPs. It is an undoubted fact that the use of synchronized phasor measurements as input data increases the accuracy of estimation. These results are expected to implement in the software of HSPs, involving the state estimation component.

The impact of unplanned 30-day readmission as a quality indicator in pediatric surgery.

Hospital readmission is one of the indicators used to assess quality of service provided in healthcare. Based on accumulated knowledge, risk management teams assess data related to readmissions to find curative solutions for underlying factors. The current article's aim is investigating readmission routes within the workplace in paediatric surgery service during the first 30 days post discharge from Mater Dei Hospital (MDH). A retrospective study of children's hospital readmissions between October 2017 and November 2019 was performed, strictly before COVID-19 pandemic. Demographics and clinical records including age, gender, pre-existing comorbidities, diagnosis during primary admission and readmission, procedure carried out, ASA grade, length of stay, and outcomes were collected. All children re-admitted under a single paediatric surgical department within 30 days from initial admission to tertiary referral hospital were included. Patients undergoing emergency visitation without subsequent admissions were excluded. Readmissions were classified into cohorts: elective and emergency, depending on the nature of primary admission. Contributing factors and outcomes were compared. 935 surgical admissions (221 elective and 714 emergencies) were registered at MDH over the given period, with an average hospital stay of 3.62 days. Total readmission rate was 1.7% (n = 16). 25% (n = 4) of readmissions were post elective, 75% (n = 12) post emergency admission, with an average stay of 4.37 days and no mortalities. 43.7% (n = 7) were re-admissions post-surgical intervention. Further surgical interventions were necessary in 25% (n = 4) of readmitted patients, the remainder (n = 12) treated conservatively. Published reports concerning paediatric surgical readmission rates are limited, challenging healthcare systems. Most readmissions area voidable; therefore, healthcare workers must provide adequate strategies tailored to their resources, efficient multidisciplinary approaches with improved communication to decrease morbidity and prevent readmissions.

Role of General Practice Led Observation Ward to Support Emergency Ward to Improve Health Outcomes at a Major Kathmandu Hospital in Nepal

Introduction:Tribhuvan University Teaching Hospital (TUTH) is a tertiary care hospital in Kathmandu. The emergency department sees between 130 to 140 cases per day. These patients get initial evaluation and basic investigation for acute emergency management and treatment. Those requiring further treatment are then admitted to the department of General Practice for post emergency care which acts as an observation ward. This step allows for the patients to be observed on a short-term basis and permits patient monitoring and/or treatment for an initial 24-48 hour period and up to a maximum of five days. These steps allow for focused follow up, improved efficiency and minimizes inappropriate admissions to other hospital inpatient wards. This paper evaluates functionality, admission criteria, patient categorization and subspeciality referral to specialty patient care, discharge criteria and cost effectiveness.Method:A descriptive observational study was carried out of the patients admitted to the observational ward between 2020-2021.Results:Most articles suggest these wards improve patient satisfaction and clinical care, decrease length of stay, reduce unnecessary inpatient hospital admissions and are useful in fever under evaluations, COPD, poisoning, pneumonia, mild head injuries, high sugar, hypertension, gastroenteritis etc. Around 14% of patients were sent to the observation ward after acute emergency care. 84% were discharged from observation ward with a mean stay of three days and were followed up in community care or GP OPD. Nine percent were admitted to hospital wards, and 7% transferred to yellow/red area emergencies for derange vitals.Conclusion:Observation wards seem to have advantages, excluding those who will inevitably need longer treatment, reduces cost savings and unnecessary burden of hospital admission.

Nightmares and bad dreams preceding suicidal behaviors

IntroductionSleep and circadian markers are of increasingly growing interest to help better predicting suicide. Indeed, specific sleep disorders and circadian rhythm disorders have been associated to suicidal behaviors, and the most replicated findings are insomnia and nightmares. Nevertheless, these interesting preliminary studies did not examine the chronology and trajectories of these dream contents’ alterations before a suicidal crisis.ObjectivesIn this context, we decided to perform a naturalistic study to better understand the characteristic of this population during suicidal crisis, and to evaluate their past dream contents. We aimed to distinguish in this phenomenology three different experiences: bad dreams, nightmares (i.e. awakening bad dreams), and suicidal scenarii during dreams. We hypothesized that these dream experiences may have different chronologies of emergence, and that individuals with dream alterations, compared to individuals without dream alterations, present with different clinical characteristics.MethodsThis naturalistic study included individuals hospitalized between January 2021 and May 2021 in a psychiatric post emergency unit for suicidal crisis (thoughts and attempts).ResultsThe study observed that 80% (n=32/40) of patients had altered dreams (AD) before the suicidal crisis, including 27 (67.5%) with bad dreams, 21 (52.5%) with nightmares -awakening bad dreams- and 9 (22.5%) with suicidal scenarii during dreams. No differences were observed between the AD group versus no altered dream (ND) regarding sociodemographic characteristics. We observed a progression of dream content alterations: bad dreams appear 111 days (4 months) before the suicidal crisis, then nightmares appear 87.3 days before (3 months), and suicidal scenarii were reported 45.2 days before (1.5 month). For the AD and ND population in suicidal crisis, 80% met at least one subtype of dream alterations, 40% had bad dreams and nightmares, and 17.5% had the 3 subtypes. The AD group, compared to ND, had significantly more family history of insomnia (p=0.046). Almost all patients (97.5%) had depressive symptoms (MADRS≥7; 82.5% had moderate to severe symptoms, MADRS≥20), 60% had insomnia (ISI>14), 92.5% had altered sleep quality (PSQI>5), and 57.5% reported sleepiness (ESS>10).ConclusionsDream alterations and their progression could be readily assessed and may help to better identify prodromal signs of suicidal behaviors.Disclosure of InterestNone Declared

Use of Whole Blood in Civilian Trauma Resuscitation: Is It Better Than Component Therapy?

Use of Whole Blood in Civilian Trauma Resuscitation: Is It Better Than Component Therapy?

A Survey on the Perceived Impact of the COVID 19 Pandemic on Dental Undergraduate Students in the North Gujarat Region, India

Aim: This study aimed to assess and compare the perceived impact of covid 19 pandemic on dental undergraduate students in the north Gujarat region. Objective: To assess & compare the percentage difference in impact of covid 19 on dental undergraduate students based on their academic year. Material and method: This questionnaire study utilized a validated 28 questions survey. The questionnaire distributed to 200 dental undergraduate students. The questions were divided into categories : demographic and academic information, study career, knowledge about covid 19 infection, risk perception and psychological reactions. The survey was administered through online google form and all the responses kept confidential. The impact of covid 19 on students were recorded. Result: The questionnaire was completed by 160 students (80%). Responses were from all the academic years in which majority of respondents were interns. Most of the students experienced difficulties in clinical training during and post COVID-19 emergency due to lack of patients’ OPD and reduced training hours. For over half of them online teaching could replace traditional face-to-face lessons. The negative impact on the study career was particularly high by interns. The level of concern of contracting COVID-19 during clinical activities were higher among students. Most of the students showed symptoms related to high to moderate levels of fear and anxiety. Conclusion: The data showed that the students perceived the COVID-19 pandemic as a negative impact on their study career and their future practice with higher impact on interns compared to other years. Most of the students showed high to moderate levels of fear and anxiety related to effect of pandemic on their study career. This data could help universities to implement communication modalities to reduce students’ fear and anxiety.

A novel method of aviation safety prediction based on Lstm-Rbf model

The aviation industry has great economic value. The traditional aviation safety management strategy is mainly “post emergency”, which has been difficult to meet the current needs of intelligent and refined safety management. Therefore, this paper proposes a new aviation safety prediction method based on LSTMRBF (Long and Short Term Memory-Radial Basis Function) neural network model. Firstly, based on SHEL (software, hardware, environment, liveware) accident causativeity theory, an aviation causativeity identification model was established to optimize the key causative events. Secondly, based on LSTM network, the temporal analysis model of causative events was established to predict the change trend of each causative event. Finally, the predicted value of the causative event was substituted into the trained RBF fitting model to obtain the results. For this purpose, we employ survey data collected from a transport aircraft. Result shows that the RMSE (Root Mean Square Error) and MAPE(Mean Absolute Percentage Error) are 6.191 and 4.4321(15% lower than the existing prediction model of temporal series prediction method), which proves the effectiveness of the proposed method.

Exploring heterogeneity in hospital length of stay post emergency abdominal surgery in Ireland: A quantile regression approach

Background Emergency Abdominal Surgery (EAS) refers to a range of complex intra-abdominal surgical procedures associated with high mortality risk and long length of hospital stay (LOS). LOS is often used as a proxy measure for hospital resource utilisation in hospital capacity management and planning. Our objective was to explore the heterogeneity in LOS among EAS patients admitted at publicly funded hospitals in Ireland. Methods We analysed national hospital inpatient data (2014 – 2022) for adults discharged following EAS. We used Quantile Regression (QR) methods to explore the heterogeneous effects along the LOS distribution between 10 th - 90 th percentiles. We compared QR with Ordinary Least Squares (OLS) estimates, and identified from which point in the LOS distribution heterogeneous effects were different from OLS estimates. Results From the National Healthcare Quality Reporting System (NHQRS) records for 15,408 EAS adult inpatient episodes were obtained for analysis. We observed significant (p < 0.001) heterogeneous effects across most quantiles of the LOS distribution. LOS was longer for patients with Charlson comorbidity indices of 4 or higher, American Society of Anaesthesiologists physical status scores of 2 and higher, admissions to critical care units, hospital readmissions within 30-days, discharges to nursing home and other hospital, and for patients treated in Model 4 hospitals. LOS was shorter for patients with a cancer diagnosis and patients who died during admission. Across these factors, statistically significant heterogeneous effects above OLS estimates were observed at the 70 th to the 90 th quantile. Conclusions The QR methods identified the presence of significant heterogeneity across the entire LOS distribution. Relative to OLS mean estimates, QR is a better method for identifying heterogeneous effects by exploring the entire LOS distribution. Our results highlight the importance of using appropriate methods for estimating skewed outcomes. This is important to provide valid and relevant empirical analysis to inform policy.

Bad Dreams and Nightmares Preceding Suicidal Behaviors.

Objective: Nightmares seem to predict suicidal behaviors, and the aim of this study is to explore the chronology and trajectories of alterations in dream contents before a suicidal crisis, distinguishing 3 different experiences: bad dreams, nightmares, and suicidal scenarios during dreams. Methods: This naturalistic study included individuals hospitalized between January 2021 and May 2021 in a psychiatric post–emergency room unit for suicidal crisis (thoughts and attempts). Results: The study observed that 80% (n = 32/40) of patients had altered dreams (AD) before the suicidal crisis, including 27 (67.5%) with bad dreams, 21 (52.5%) with nightmares (bad dreams that awaken the sleeper), and 9 (22.5%) with suicidal scenarios during dreams. No differences were observed between the AD group versus patients with no altered dreams (ND) regarding sociodemographic characteristics. We observed a progression of dream content alterations: bad dreams appear 111 days (4 months) before the suicidal crisis, then nightmares appear 87.3 days before (3 months), and suicidal scenarios during dreams were reported 45.2 days before (1.5 months). For the AD and ND populations in suicidal crisis, 80% had at least 1 subtype of dream alterations, 40% had bad dreams and nightmares, and 17.5% had all 3 subtypes. The AD group, compared to the ND group, had significantly more family history of insomnia (P = .046). Almost all patients (97.5%) had depressive symptoms (Montgomery-Asberg Depression Rating Scale score ≥ 7; 82.5% had moderate to severe symptoms, MADRS ≥ 20), 60% had insomnia (Insomnia Severity Index > 14), 92.5% had altered sleep quality (Pittsburgh Sleep Quality Index > 5), and 57.5% reported sleepiness (Epworth Sleepiness Scale > 10). Conclusions: Dream alterations and their progression can be readily assessed and may help to better identify prodromal signs of suicidal behaviors.

DEVELOPMENT AND IMPLEMENTATION OF ACUTE CARE PSYCHIATRIC SERVICES WITHIN OUTPATIENT MENTAL HEALTH SETTINGS

Rapid response pathways and programs were developed within existing outpatient care systems during the pandemic to offer brief service out of the fear of missing the acute care needs of children and youth. Our objectives are to present 3 rapid response intervention models, review the evidence-based treatment components of post–emergency department (ED) follow-up care interventions, and discuss how these programs map on to the evidence and how they might be improved.

61.1 Post–Emergency Department Care and Brief Support Interventions for Adolescents with Suicidal Behaviors

As many clinical programs worldwide seek to develop post–emergency department (ED) discharge psychiatric services for youth, this paper reviews the existing literature on brief services for suicidal youth. It has 2 aims: 1) to describe the brief services models that have demonstrated efficacy in reducing suicidal behaviors; and 2) to compare and contrast the treatment components, their timing, and their delivery method.

THE IMPACT OF DROUGHT ON LIVESTOCK IN AFGOI, LOWER SHABELLE - SOMALIA

Drought is generally an extended period of months or years in which precipitation is less than the annual average and results in severe water scarcity. For the Horn of Africa region, drought occurrence has become increasingly severe during the last decade, with rainfall totals of at least 50–75 % below normal encountered in most areas, amounts that are not sufficient to support crop and pasture growth for livelihood security (Nicholson 2014). The main objective of this study was to evaluate and measure the impacts of the drought on stock market, milk, fodder, and meat productivity, along with the major effects on the pastoralist’s daily life. Methodology adopted in this research was quantitative approach include questionnaire and data analysis procedure, this study was employ through explanatory research design. The purpose affecting the variables involves in this study and helped to achieve all the objectives of research. The study was conducted from the livestock sales and pastoralists, afgoye district livestock market. The researcher had selected 80 respondent(s) randomly from the population. The data analyzed was performed using statistical package for social sciences (SPSS) version 16. Result, The study clarified the reason related to poverty caused by drought in various households 46.3%. As well as The study indicated that responders 56.3% was agreed to provided feed supplements for livestock during drought while 3.8% of responders not agreed. Also The study proven that the (55%) of responders said the Shortage of rainfall experienced towards the end of 2016 and early 2017 resulted in degradation of grazing veld, while (1.3%) of responders said not resulted in degradation of grazing veld. Conclusion, The survey results and field observations indicated that the afgoye livestock market was seriously affected by drought particularly in dry seasons. According to responder`s understand towards the period of drought time, the study indicated the majority of people lose their jobs, particularly in the livestock sector. Recommendation, the study recommended to all shepherds to establish an alternative project to store water and fodder to benefit from it during the long drought. , also the study recommended the government, NGO`s in dealing with disaster management in Somalia are currently focused on either emergency health preparedness or post emergency relief. There is need for them to shift their mindsets from reaction and charity to anticipation and preemption.

TH5.13 Stoma reversal post emergency laparotomy

Abstract Aims Approximately a fifth of stomas have to be sited in emergency setting and the National Bowel Cancer Audit found almost one third of patients undergoing anterior resection do not have reversal of their stoma within 18 months following surgery. We aim to explore the reversal rate of stoma post emergency laparotomy (EmLap). Methods Retrospective analysis was performed on all patients undergoing EmLap over 12 months (2018) from one site using the local ELLSA (Emergency Laparoscopic and Laparotomy Scottish Audit) database. Demographic, indication for surgery, stoma formation/ type, 30-days morbidity and mortality were collected. Follow-up and stoma reversal data were evaluated at 12 months postoperative. Results 205 patients underwent EmLap (52.5% female, median age 66 years). 42% (n=85) had emergency stoma formation: 58% ileostomy, 42% colostomy. Of those who had stoma formed (51% female, median age 67 years), 45% presented with bowel obstruction and 24% had new colorectal cancer diagnosis. Of those alive at follow-up (89%), 19% had stoma reversed (1:1 ileostomy:colostomy; mean reversal time 11 months). Of the 81% not reversed: 28% declined, 12% were unfit, 4% technically not feasible, 4% on waiting list, 11% had 30-day mortality. The remaining 22% had no documented stoma reversal discussion (5%) or no follow-up (17%). Conclusions Compared to the elective setting, the stoma reversal rate post-EmLap is significantly lower (reversal of ileostomy 9.5% in this study vs 85% in Close-IT study). Although this may reflect a higher risk surgical population, post-EmLap pathways should consider routine follow up to ensure shared decision making.

A spatiotemporal decay model of human mobility when facing large-scale crises

A common feature of large-scale extreme events, such as pandemics, wildfires, and major storms is that, despite their differences in etiology and duration, they significantly change routine human movement patterns. Such changes, which can be major or minor in size and duration and which differ across contexts, affect both the consequences of the events and the ability of governments to mount effective responses. Based on naturally tracked, anonymized mobility behavior from over 90 million people in the United States, we document these mobility differences in space and over time in six large-scale crises, including wildfires, major tropical storms, winter freeze and pandemics. We introduce a model that effectively captures the high-dimensional heterogeneity in human mobility changes following large-scale extreme events. Across five different metrics and regardless of spatial resolution, the changes in human mobility behavior exhibit a consistent hyperbolic decline, a pattern we characterize as "spatiotemporal decay." When applied to the case of COVID-19, our model also uncovers significant disparities in mobility changes-individuals from wealthy areas not only reduce their mobility at higher rates at the start of the pandemic but also maintain the change longer. Residents from lower-income regions show a faster and greater hyperbolic decay, which we suggest may help account for different COVID-19 rates. Our model represents a powerful tool to understand and forecast mobility patterns post emergency, and thus to help produce more effective responses.