Abstracts from the 4th Annual Student Medical Summit

s – BMC ProceedingsA01: An audit of frequent attenders in Cork university hospital emergency departmentEmer Dight1, Conor Deasy2 1School of Medicine, University College Cork, Co. Cork, Ireland; 2Emergency department, Cork University Hospital, Co. Cork, Ireland Correspondence: Emer Dight Background In recent decades overcrowding of hospitals has become a major issue in Ireland. The emergency department, by nature of its walk-in attendees, has been put under increasing pressure. Frequent attenders (FA) have been shown to have increased mortality rates compared to non-frequent attenders (NFA) [1].The primary aim of this audit was to profile Cork University Hospital's (CUH) emergency department (ED) FAs and to describe their prevalence. FA were also then compared to NFA where possible. An FA is defined as any patient that attends five or more times per annum. Materials and Methods A retrospective audit of CUH's 358 FAs from 1st January to 31st December 2019 was completed. NFA were also analysed for comparative purposes. All data was recorded on Microsoft Excel. The data collected included: arrival date, age, time spent in department, discharge destination and preliminary diagnosis. Results Approximately 01.1% of patients accounted for 5.7% of attendances in 2019. 358 patients presented a total of 2,565 times to the emergency department. The number of visits per patients ranged from 5 to 68. The average number of visits per patient was seven. The mean age was 56 years. 47% of FA were female and 53% were male. 40% of FA visits were by ambulance compared with 30% by NFAs. FAs were discharged to a ward to receive further care in 43% of cases where NFA went to a ward 29%. FA's top presenting complaint was 'unwell adult' and 4.7% of FA attendances were due to mental illness compared to 0.75% of NFA. Conclusion This audit was the first of its kind to be done analysing CUH's FA. Further studies are required to examine measures to reduce FA attendance if appropriate and to reduce the risk of adverse outcomes for this vulnerable group. Acknowledgments This audit could not have been completed without the aid of my supervisor, Prof Conor Deasy and the Bryan Lynch CUH ED Administration department for assisting in gathering the data. Reference 1. Davison A, Boyle A, Hayhurst C. 44 Quantifying the 5 year mortality of frequent attenders to the emergency department. Emerg Med J [Internet]. 2017 Dec 1 [cited 2020 December 12];34(12):A889–90A02: A survey of compliance with the HSE paediatric anaesthesia model of care in Irish hospitals and a local audit of paediatric anaesthesia outcomesCiara Walsh1, John Chandler2 1School of Medicine, University College Cork, Cork, Ireland; 2Department of Anaesthesia, University Hospital Cork, Cork, Ireland Correspondence: Ciara Walsh Background In 2015, the HSE released the Paediatric Anaesthesia Model of Care (PAMoC). It provides a framework for the governance of paediatric anaesthesia in Ireland. The document outlines recommendations pertaining to facilities, training, and structure of the paediatric anaesthesia service. It aims to improve patient outcomes such as postoperative nausea and vomiting, unplanned admissions and fasting times [1]. Thus far, there has been no research investigating the implementation of the PAMoC. This study sought to document the uptake of the PAMoC in non-specialist Irish public hospitals and to assess anaesthesiologists' attitudes towards this model of care. Materials and methods All public hospitals in the Republic of Ireland providing a paediatric anaesthesia service, excluding specialist centres operated by Children's Health Ireland, were invited to participate in this study. An anonymous survey requesting information regarding facilities, training and structure of their paediatric anaesthesia service was sent via email, to assess their compliance with the model of care.Anonymized data of a random sample of 10% of all children aged 1-5 who had general anaesthesia in 2018 in Cork University Hospital was provided by the Hospital Inpatient Enquiry. Top performance indicators as set out by the PAMoC were collected and compared to international standards. These included fasting times, post-operative nausea/vomiting or unplanned admission after day-case surgery. Results 16 departments responded to the survey (response rate 57%), representing both model 3 and model 4 hospitals. Overall, 93.75% felt the model of care had not meaningfully changed or influenced practice in their department. Only 50% of hospitals have a lead paediatric anaesthesiologist and of these, only 31% lead paediatric anaesthesiologists undertake a paediatric list weekly. In terms of quality improvement, 12 (75%) departments are not routinely recording performance indicators for paediatric anaesthesia.65 patients were included in the audit. Mean fasting time for this sample was 12 hours. Post-operative nausea and vomiting was identified in 9.7% of the sample. The unplanned admission rate was 18%. In comparison to other specialities, children undergoing orthopaedic surgery were significantly more likely to have an unplanned admission (p<0.003). 73% of unplanned admissions were orthopaedic cases. Conclusions This study indicates the PAMoC has not been effectively implemented in non-specialist Irish public hospitals, with comparatively high fasting times [2] and unplanned admissions [3] highlighting an area for future study and quality improvement to deliver the best quality anaesthesia care for children in Ireland References 1. HSE Model of Care for Paediatric Anaesthesia. 20152. Thomas M, Morrison C, Newton R, Schindler E. Consensus statement on clear fluids fasting for elective pediatric general anesthesia. Pediatric Anesthesia. 2018;28(5):411-414.3. Royal College of Anaesthetists. Raising the Standard: a compendium of audit recipes. Section 5: Day Surgery Services, Section 9: Paediatrics. 3rd edition, 2012A03: A functionalized self-assembling hydrogel for the treatment of osteoarthritis and partial thickness defect of cartilageAlizé Gourrege1, Baichuan Wang1,2, Hana Alruzaiqi1, Zhidao Xia1 1Centre for Nanohealth, ILS2, Swansea university Medical school, Swansea, SA2 8PP, UK; 2Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China Correspondence: Alizé Gourrege; Zhidao Xia Background Cartilage is a tough and flexible connective tissue made up of chondrocytes, which synthesize and turn over the components of the extracellular matrix [1]. It has a role of weight bearing, and act as a cushion and a shock absorber between the bones [2]. Today, 25 million people worldwide suffer from cartilage defect [3]. Once damaged, the cartilage is very unlikely to self-heal due to its avascular nature and the passive diffusion of cells through the matrix [2]. The actual treatments for cartilage damage, including medication, physiotherapy and surgery, do not allow for a complete cure of the tissue and are often seen as both clinically and cost expensive for the patient. There is therefore a need for new treatments which could promote the regeneration of cartilage to a healthy state instead of solely focusing on relieving the symptoms. Tissue engineering appears like a promising option and uses functional scaffolds to recruit endogenous chondrocytes in vivo, at the site of injury [4]. Materials and methods In this study, a new functionalized peptide hydrogel named RA-GF was designed by enriching the bio scaffold PuraMatrix (RADA16) with platelet derived growth factor (PDGF). We hypothesized that RA-GF would better promote the proliferation and cell viability of chondrocytes compared to RADA16 alone. The chondrocytes were isolated and cultured from femoral condyle of bovine knee joints [5,6]. Proliferation tests were performed using RADA16 as control and measurements were taken at day 1,3 and 7. The results were analysed with an ANOVA test to determine any difference between RA-GF and RADA16. Finally, a cytotoxicity test was completed using three different dyes, namely Calcein Acetoxymethyl (Calcein AM), Propidium Iodide (IP) and NucBlue [7]. The number of cells was counted manually based on images obtained from fluorescence microscopy for calculation of percent viability. Results PDGF significantly increased the proliferation of chondrocytes in vitro (Figure 1). The increase in proliferation and the cell viability seen with RA-GF was not statistically significant compared to RADA16 alone (Figure 2 and 3). Conclusions RA-GF shows potential as a bio scaffold, however in-depth research over longer periods of time is required to properly evaluate the benefits of this hydrogel in articular cartilage regeneration.Future work should include the effect of RA-GF on chondrocytes migration, differentiation and expression of chondrogenic related genes in vitro, as well as the in vivo regenerative capacity of RA-GF in induced cartilage defect. Acknowledgements I would like to express my sincere gratitude to my supervisor Dr Zhidao Xia, who substantially guided me through this research project. Without his valuable advices and help, the writing of this paper would not have been achieved. I would also like to thank the leader of this project, Dr Baichuan Wang. Its invaluable knowledge and experience in regenerative medicine kept me on the right track during this journey. The technical and intellectual contributions of Xiao Li and Hana Alruzaiqi on the ground during laboratory manipulations added up to the quality of this project. References 1. Akkiraju H, Nohe A. Role of Chondrocytes in Cartilage Formation, Progression of Osteoarthritis and Cartilage Regeneration. Journal of Developmental Biology. 2015;3(4):177-192.2. Sophia Fox A, Bedi A, Rodeo S. The Basic Science of Articular Cartilage: Structure, Composition, and Function. Sports Health: A Multidisciplinary Approach. 2009;1(6):461-468.3. Damage? W. What is a Cartilage Damage? | Patient Education [Int

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