Public Knowledge About Emergency Care—Results of a Population Survey From Germany

Background: Knowledge and beliefs about health and health care are part of the general concept of health literacy. Studies demonstrated that large parts of the population report inadequate health literacy. There are only few studies specifically addressing public knowledge and beliefs about emergency care. We examine magnitude and social variations of public knowledge about emergency care in Germany.Methods: Analyses make use of a telephone survey conducted in Hamburg, Germany. Random sample consisted of 1,207 adult respondents. We asked whether the respondents know various emergency care services. Moreover, capabilities of dealing with an emergency case were assessed. Sex, age, education, and migration background were introduced as predictors into regression models.Results: 98% of the respondents stated to know the rescue service, while 74% knew the medical on call service and 49% were aware of an emergency practice nearby. About 71% of the interviewees said it was easy for them to find out whom to turn to in a case of a medical emergency. Fewer respondents found it easy to evaluate when to use emergency medical services and to evaluate whether a health problem is a medical emergency. Knowledge and capabilities were positively associated with education and negatively related to migration background.Conclusions: This study indicates a lack of public knowledge about emergency care and social inequalities in public knowledge according to education and migration status. Findings suggest that interventions are needed to improve public knowledge and that considering social inequalities should be a basic principle for such interventions.

Intimate partner violence in Pakistan: Ethical implications in an emergency case

In developing countries, the patriarchal social construct, unsatisfactory legal protection, and underlying cultural bias against women have resulted in increasing intimate partner violence, which largely goes unaddressed, undocumented, and unreported in healthcare settings. This case study presents a common scenario of intimate partner violence and carefully analyzes its ethical implications in an emergency case at a tertiary care hospital in Karachi, Pakistan. In this study, basic ethical principles are used to discuss important ethical challenges faced daily by healthcare workers in the medical, social, and legal context. It further highlights the dire need of patient education, safety, and a solid framework for addressing, documenting, and reporting intimate partner violence for healthcare workers.

EP.WE.205Impact of the Covid-19 Pandemic on Loop Ileostomy Formation

Aim Uncertainty during the early phases of the Covid-19 pandemic regarding availability of critical care beds and peri-operative impact of SARS-CoV-2 led to changing intercollegiate guidance in favour of increased stoma formation. This study assessed the impact the Covid-19 pandemic had on loop ileostomy formation. Methods Data were reviewed from a prospectively collected database on the number of loop ileostomies formed over a 10-month period from 1st March to 31st December 2020. Comparison was made with the same period in 2019. Details were confirmed using clinical letters. Results 114 loop ileostomies were formed in the 20-month period. There was a 10.0% reduction in loop ileostomy formation in 2020 compared with 2019. The median number of loop ileostomies formed per month over the two 10-month periods was 6. This peaked at 11 in April 2020 coinciding with the first wave of Covid-19, falling in subsequent months. All 11 of these loop ileostomies were formed in colorectal cancer patients undergoing anterior resection, after appropriate counselling. Conclusions There was a reduction in the number of ileostomies formed in 2020 compared with 2019 reflecting the impact of the Covid-19 pandemic on both elective and emergency case load and presentations. These results show reactive change in surgical practice corresponding to guidance at a time of maximum uncertainty. Primary anastomosis still occurred but with an increased likelihood of a defunctioning stoma to minimise the consequences of an anastomotic leak. A subsequent reduction in stoma formation in the following months indicates that practice rapidly returned to normal.

EP.FRI.530 ‘Emergency’ Laparoscopic Common Bile Duct (CBD) Exploration: Is this the right time to change?

Aims Common Bile Duct (CBD) stones are becoming more common on surgical emergency take and accounts for up to 20 % of patients presenting with acute biliary pathologies. The hospital stay is prolonged whilst waiting for Endoscopic Retrograde Cholangio Pancreatography (ERCP). We aim to evaluate the feasibility, safety and cost-effectiveness of emergency laparoscopic CBD exploration (LCBDE) in these patients. Methods A cohort of patients with CBD stones underwent emergency LCBDE between January 2016 and December 2020 at a regional hospital in the United Kingdom was retrospectively reviewed. Results In total, 11 LCBDE were performed on emergency list. All patients were admitted with acute symptoms of either obstructive jaundice cholangitis or pancreatitis. All procedures were performed with choledochotomy. The mean patient age was 58 years and male-to-female ratio was 2:9. 3 patients (27%) had T- tube otherwise all ducts were primarily closed. Average hospital stay was 8.5 days. 1 patient returned to theatre for retained stone of 11mm. There was no 30 days mortality. There were no readmissions. Initial analysis with small number of patients showed, performing these procedures on emergency basis not only improved patient’s overall experience but also benefitted NHS Trust by approximately £18,500 as per the National Tariff System 2020/21. Conclusions Emergency LCBDE is safe, feasible and cost effective. We can safely aim to increase the proportion of LCBDE performed as an emergency case, where clinically appropriate, to reduce the financial burden and improve patient’s outcome with overwhelming NHS Trust funds.

Post-operative surgical site infection among general surgery patients: Rate and risk factors.

Objectives: High rate of post-surgical infections are reported with scanty effort for controlling them. The objectives were to evaluate frequency of surgical site infections in patients undergoing general surgery. Study Design: Cross Sectional Observational Study. Setting: Naz Memorial Hospital. Period: March 2019 to March 2020. Material & Methods: This study was conducted in general surgery ward for 1 year. All patients over 18 years admitted in surgery ward either as elective or emergency case were included while patients having any wound infection, operated in other hospital or diabetic foot and all those operated for incision and drainage of abscess were excluded. All patients that were operated during the study period were followed for any wound infection development till one qAqmonth. SPSS was used for data entry and analysis keeping p-value of <0.05 as significant. Results: 75 from 200 patients developed surgical site infection, 46 (61.3%) were operated in emergency. Among 24 contaminated surgeries type, 70.8% were reported having SSI (p-0.05) while from 28 dirty types of surgeries 78.6% of patients had a SSI (p-0.03). 25% were anemic, 21% diabetic while (20%) were reported to be hypertensive, 13 (17%) gave positive history of smoking while 12 (16%) were obese. Conclusion: Higher proportion of surgical site infection was observed in patients undergoing contaminated and dirty type of surgeries. Most patients with SSI were operated in emergency setting and anemia and diabetes were the most common risk factor reported in the infected patients.

A Dire Emergency Case of Stab Injury with Impending Ischemia of Eviscerated Bowel with Colonic Perforation - A Case Report

Penetrating abdominal trauma is mostly caused by gunshots or stab wounds.1 Management of penetrating abdominal trauma is often challenging and time between the injury and surgical intervention play a pivotal role in such cases depending upon the clinical presentation of the patient.The success rate depends so much on early surgical intervention that one cannot wait for pre-operative work up before taking the patient to operation theatre2. We present a case of stab injury presented with eviscerated ischemic bowel and perforation in transverse colon with mesenteric arterial spurter.

A Novel Filtering Recommendation Algorithm for User Emergency Information Adoption

Emergency case data resources are widely distributed and heterogeneous. At the same time, the command of emergency field needs the cooperation of multiple departments. Therefore, it is urgent to establish an emergency analysis and mining platform, realize the sharing and collaboration of emergency data resources among multiple departments, and assist emergency command and scheduling. According to the actual situation of the current emergency, a similarity measure method (TCRD) is proposed to solve this problem by adding temporal information to reflect information adoption, which integrates user context information and temporal information. Firstly, the temporal information of historical adoption behavior is expressed as a binary coded characteristic matrix, and then the characteristic matrix is mapped into a feature vector by using restricted Boltzmann machine, and finally added to the similarity measurement formula. The improved TCRD method can measure the similarity more accurately, and further improve the quality of emergency information adoption recommendation results.