Background:People diagnosed with cancer following emergency presentation have poorer short-term survival. To what extent this signifies a missed opportunity for earlier diagnosis in primary care remains unclear as little detailed data exist on the patient/general practitioner interaction beforehand.Methods:Analysis of primary care and regional data for 1802 cancer patients from Northeast Scotland. Adjusted odds ratios (OR) and 95% confidence intervals (CIs) for patient and GP practice predictors of emergency presentation. Qualitative context coding of primary care interaction before emergency presentation.Results:Emergency presentations equalled 20% (n=365). Twenty-eight per cent had no relevant prior GP contact. Of those with prior GP contact 30% were admitted while waiting to be seen in secondary care, and 19% were missed opportunities for earlier diagnosis. Associated predictors: no prior GP contact (OR=3.89; CI 95% 2.14–7.09); having lung (OR=23.24; 95% CI 7.92–68.21), colorectal (OR=18.49; CI 95% 6.60–51.82) and upper GI cancer (OR=18.97; CI 95% 6.08–59.23); ethnicity (OR=2.78; CI 95% 1.27–6.06).Conclusions:Our novel approach has revealed that emergency cancer presentation is more complex than previously thought. Patient delay, prolonged referral pathways and missed opportunities by GPs all contribute, but emergency presentation can also represent effective care. Resources should be used proportionately to raise public and GP awareness and improve post-referral pathways.

ELBS continues to carry a high risk despite several major changes in the provision of emergency surgery. Further developments are needed to improve postoperative outcomes in these patients.

Introduction Horse riding carries risk of injury which can result in fatality. The majority of published literature describes major trauma centre experience. We aimed to characterise injury patterns following equine trauma at a Scottish district general hospital. Methods A retrospective review of admissions following equine trauma was undertaken from 2014 to 2019. Mechanism and nature of injuries were noted. Patient management and outcomes were recorded and analysed to determine correlation. Results Of the 162 patients identified, 121 (74.7 per cent) were female. The commonest mechanism and injury sustained were falling from a horse (86.4 per cent) and head injury (17.9 per cent) respectively. Forty-four (27.2 per cent) had multiple injuries identified. Being crushed or kicked resulted in more abdominal visceral injuries (22.7 vs 0.7 per cent, p = <0.05) and ITU admissions (18.2 vs 6.4 per cent, p = 0.06) when compared with falling from alone. Eight (4.9 per cent) required transfer to a major trauma centre and 30-day mortality was 0.6 per cent. Conclusion Although variable, injuries following equine trauma can be life threatening. Increased awareness and development of safety legislation is needed. In addition, research could be directed at assessing functional outcomes given the large number of orthopaedic injuries.

Introduction Although a popular recreational and competitive sport, horse riding carries risk of injury. We aimed to characterise demographics, injury patterns and outcomes of patients with an equine-related injury over a 20-year period. Methods Patients were identified through local coding. Data relevant to the study aims were extracted. Statistical analysis was used to determine any association between patient demographic with injury pattern or outcome. Results Of the 701 patients included, 71.3% were female and the mean age was 34.9 years. Simple head injury (25.4%) and upper limb fracture (21.3%) were the commonest injuries. Abdominal visceral injury occurred in 1.6% with 2 patients requiring laparotomy and splenectomy. Overall, operations were performed in 32.8%. Open reduction and internal fixation was the commonest procedure (42.4%). 30-day mortality was 0.3% and 3.1% required transfer to a tertiary centre. Older patients were more likely to have a rib (46.3 vs 33.5 years, p = &lt;0.05) or lower limb fracture (37.9 vs 34.5 years, p = 0.04) whilst upper limb fractures were seen in younger patients (30.3 vs 36.1 years, p = &lt;0.05). There was no statistical difference with other injury patterns or gender.  Conclusion Although mortality is rare, a significant proportion of patients sustain injury requiring surgical intervention. Given the predisposition towards orthopaedic injury, adequate rehabilitation facilities need to be available. Continued development and promotion of safety equipment are also required to reduced incidence.

Aim: The effect of chitosan coating of Vicryl and PDS on the intraabdominal adhesion, the inflammatory response and in vivo, in vitro comparison of the tensile strength of sutures were investigated. Method: Vicryl and PDS sutures were coated with 2% chitosan. Under general anesthesia, laparotomy was performed in 96 Wistar albino female rats. In the first group, only laparotomy was performed. In the second group, chitosan was applied to the peritoneal cavity. In the third group, Vicryl were used to perform colon anastomosis; in the fourth group, PDS were used to perform anastomosis. In the fifth and sixth groups, chitosancoated versions of sutures were applied. On the 7th and 14th days, eight randomly selected rats from each group were killed. The Diamond scale for adhesions, Ehrlich-Hunt scale for histology of anastomosis was used. The tensile strength of the sutures was measured. Results: The adhesion score was comparable among suture groups. The tensile strength of sutures didn't differ comparing in vivo and in vitro. Fibroblast cells and vascularisation of anastomosis with chitosan-coated Vicryl was lower than Vicryl and chitosan-coated PDS on 14th day (P < 0.05). Conclusion: The chitosan coating didn't affect the adhesion potential, the tensile strength of sutures in vivo and in vitro. P002Effects of sacral nerve electrostimulation in GI motility and function in patients with chronic refractory constipation Aim: Sacral nerve stimulation (SNS) has recently been proposed to treat unresponsive constipation, but its effects on GI motility have never been confirmed. Method: Fourteen patients (12 females) affected by refractory constipation (lasting >12 months, n°evacuation/week = 1.1 AE 0.6, Bristol 1.5) entered the study. Gastric and gallbladder motility, orocecal transit time (OCTT), bowel habits, colonic transit time (CTT), autonomic neuropathy (AN), PAC-QoL, and upper/lower gastrointestinal symptoms were assessed before and during temporary SNS. Results: Seven patients completed the evaluation and 3 underwent permanent SNS. AN was detected in all. Gastrointestinal symptoms significantly improved (P = 0.03) during SNS, but gallbladder/stomach motility did not change (28.5 AE 4.2 vs 35.2 AE 4.5, P = 0.07; 48.8 AE 7.1 vs 43.5 AE 7.4 min, P = 0.23, respectively). OCTT was delayed at baseline compared to normal controls and did not change during SNS (141.7 AE 102.6 vs 144 AE 115.2, P = 0.97). CTT did not improved significantly although in two patients it improved from 90.6 AE 75.5 to 52.8 AE 59.4. Overall, the number of bowel movements/week was unchanged, however in three patients it improved from 1 to 2/week. PAC-QoL did not improve during SNS. Conclusion: Temporary SNS does not affect upper/lower GI motility and QoL, however it can help a selected group of constipated patients and might represent an alternative treatment in patients who are candidates for colectomy.Aim: This is a report of an initial investigation to obtain long-term experience with the TOPAS â System, a new, minimally invasive, self-fixating pol...

ObjectivesA significant proportion (13.9-21.8%) of cancers are diagnosed during emergency admissions to hospital. Patients who are diagnosed in this way have poorer outcomes. Cancer type, increasing age, and deprivation have shown to be associated with cancer diagnosis as an emergency. The role of primary care consulting behaviour prior to emergency presentation with a new cancer diagnosis is unclear and therefore the principle aim of the present study was to investigate this. ApproachAll GP practices in the North East of Scotland were invited to participate. 2015 patients with a diagnosis of either colorectal, upper GI, prostate, lung, breast and melanoma were randomly selected from participating practices. A dataset was created that contained routinely collected data from primary care records from these patients. This information was consolidated with information from the NHS Grampian Cancer Care pathway database. Those diagnosed by screening were removed, leaving 1803 patients. The main characteristic examined was whether or not the patient had seen a GP with relevant symptoms in the 2 years before the consultation that resulted in their diagnosis or referral. Chi squared analysis and univariate linear regression analysis was performed on each characteristic to examine the association of independent variables with each outcome. Multivariate linear regression was then carried out across the characteristics.Results 362 (20.1%) of new cancer diagnosis were by emergency. Only 16.2% (n=260) of patients who saw their GP prior to their admission were diagnosed by emergency. 54.5% (n=97) of patients who had not seen their GP prior to diagnosis were emergency diagnoses. 20.7% (n=75) of patients diagnosed by emergency admission had been referred by their GP at the time of diagnosis and were awaiting their appointment with secondary care. Patients who had been seen in primary care before their cancer diagnosis were significantly less likely to have their cancer diagnosed by emergency admission (p<0.0001). ConclusionPatients who present to their GP with symptoms of cancer are much less likely to be diagnosed as a result of an emergency admission. It is therefore postulated that GPs are adequately referring patients with cancer for further investigation and diagnosis. However around a fifth of patients overall are still being diagnosed through emergency admission to hospital, and in the majority of cases this is because they are not presenting themselves to primary care. In order to rectify this we suggest that greater awareness about cancer symptoms amongst the public is necessary. * Corresponding Author: Email Address: m.s.yule.10@aberdeen.ac.uk (M. Yule) http://dx