Objective- This study aims to identify the microorganisms and antibiotic resistance patterns in necrotising fasciitis. Methods- This is a retrospective audit over two consecutive years (June 2015 - July 2017) of all patients who had surgery for necrotising fasciitis at an ACS unit. Results- Necrotising fasciitis accounted for 15% of all skin and soft tissue sepsis that required surgery. There were 10 male (52.6%) and nine female (47.4%) patients. The most common co-morbidity was diabetes mellitus in 10 (52.6%) patients, the compliance and control were monitored by glycosylated haemoglobin (HbA1C) in 50% of the diabetic group, with a mean of 8.98 (Range 5-12.9). Fifteen percent of cases (n=3) had a confirmed diagnosis of HIV, with a negative result in eight (42%). ICU was required in three patients two of whom were on inotropes and one patient required renal replacement therapy. Surgery was performed within 24 hours for 11 (57%) patients. The most common anatomical site for debridement was perineum in nine patients (47%). Monomicrobial infection was the most common subtype of necrotising fasciitis withmethicillin sensitive staphylococcus aureus in five (26%) as the predominant microbe. Gram-negative organism Escherichia-coli was the second most common monomicrobial infection. All Gram-positive organisms were sensitive to cloxacillin and co- amoxiclavulanic acid. Two gram negatives(15%) of the 13 organisms cultured were resistant to coamoxiclavulanic acid. The 30 day mortality was 15%. Conclusion- Necrotising fasciitis is a rare but lethal infection.In our limited series, monomicrobial infection is the most common subtype. 15% of the community acquired organisms were resistant to the empiric antibiotic of choice co-amoxiclavulanic acid. (word count= 261).

Introduction: Acute Care Surgery (ACS) is a new model of emergency general surgery care developed to provide prompt, comprehensive, and evidence-based care to acutely ill non-trauma surgical patients. Our objective was to determine the impact of implementing ACS on efficiency of care (EOC) and patient outcomes. Methods: A retrospective review was performed for patients with acute appendicitis (AA) and biliary tract disease (BTD). EOC measures and patient outcomes were compared over two time periods: pre-ACS (2007) and ACS (2011). Results: n=1,229 patients were included in this study; n=507 (pre-ACS), and n=722 (ACS). Surgical response times and acquisition of imaging were significantly faster with ACS. Time to OR and total LOS were similar between cohorts. Similar rates of daytime operating were present. With ACS and AA, there were more perforations, more ORs were performed at night and patients were readmitted more frequently. Conclusions: Increased volumes of patients were seen with ACS, but surgical assessments and imaging were significantly faster. Inpatient EOC measures were unchanged with ACS; outcomes for AA were worse. / October 2015

Yes / Medical technologies have the potential to improve quality and efficiency of healthcare. The design of clinical trials should consider participants' perspectives to optimise enrolment, engagement and satisfaction. This study aims to assess patients' perceptions of their involvement in medical device trials, to inform the designs of future medical technology implementation and evaluation. Four focus groups were undertaken with a total of 16 participants who had participated in a study testing hospital inpatient remote monitoring devices. Interviews were audio-recorded, transcribed verbatim and underwent thematic analysis. Four main themes emerged: patients' motivations for participating in medical device research; patients' perceptions of technology in medicine; patients' understanding of trial methodology; and patients' perceptions of the benefits of involvement in medical device trials. The appeal of new technology is a contributing factor to the decision to consent, although concerns remain regarding risks associated with technology in healthcare settings. Perceived benefits of participating in device trials include extra care, social benefits and comradery with other participants seen using the devices, although there is a perceived lack of confidence in using technology amongst older patients. Future device trials should prioritise information sharing with participants both before and after the trial. Verbal and written information alongside practical demonstrations can help to combat a lack of confidence with technology. Randomised trials and those with placebo- or sham-controlled arms should not be considered as barriers to participation. Study results should be disseminated to participants in lay format as soon as possible, subject to participant permission. / The patients in this study were participating in a randomised controlled trial funded by a Health Foundation Innovating for Improvement Award (Grant number: GIFTS 7643 CRM 2674). Candice Downey is in possession of a Doctoral Research Fellowship (DRF-2016-09- 037) supported by the National Institute for Health Research. DGJ received funding support through an NIHR Research Professorship. The research is supported by the NIHR infrastructure at Leeds.

Introduction : The acute care surgery (ACS) units are dedicated to the prompt management of surgical emergencies. It is a systemic way of organizing on-call services to diminish conflict between urgent care and elective obligations. The aim of this study was to define the characteristics of an ACS unit and to find common criteria in units with reported good functioning. Methods : As of July 1st 2014, 22 Canadian hospitals reported having an ACS unit. A survey with questions about the organization of the ACS units, the population it serves, the number of emergencies and trauma cases treated per year, and the satisfaction about the implementation of this ACS unit was sent to those hospitals. Results : The survey’s response rate was 73%. The majority of hospitals were tertiary or quaternary centers, served a population of more than 200 000 and had their ACS unit for more than three years. The median number of surgeons participating in an ACS unit was 8.5 and the majority were doing seven day rotations. The median number of operating room days was 2.5 per week. Most ACS units (85%) had an estimated annual volume of more than 2500 emergency consultations (including both trauma and non-trauma) and 80% operated over 1000 cases per year. Nearly all the respondents (94%) were satisfied with the implementation of the ACS unit in their hospital. Conclusion : Most surgeons felt that the implementation of an ACS unit resulted in positive outcomes. However, there should be a sizeable catchment population and number of surgical emergencies to justify the resulting financial and human resources. / Introduction : Les unités de soins aigus chirurgicaux (USAC) sont des unités dédiées à la prise en charge rapide des patients se présentant avec des urgences chirurgicales. Elles ont pour rôle de diviser le service de chirurgie générale afin d’organiser le système de garde en diminuant le conflit entre la prise en charge des urgences chirurgicales et les obligations électives. Nous avions pour objectif de définir les caractéristiques des USAC et de trouver des critères communs aux unités ayant rapporté un fonctionnement efficace et une bonne organisation. Méthodes : En date du 1er juillet 2014, vingt-deux hôpitaux canadiens rapportaient posséder une USAC. Un questionnaire comportant des questions sur l’organisation de leur USAC, la population desservie, le nombre d’urgences chirurgicales annuelles et la satisfaction en lien avec l’implantation de leur USAC leur a été envoyé. Résultats : Nous avons obtenu un taux de réponse de 73%. La majorité des hôpitaux étaient des centres tertiaires ou quaternaires, servaient une population de plus de 200 000 personnes et possédaient une USAC depuis plus de trois ans. Un nombre médian de 8,5 chirurgiens participaient à l’USAC et travaillaient en alternance sur une période de 7 jours. Le nombre médian de priorités opératoires était de 2,5 jours par semaine. La plupart des unités (85%) avait un nombre annuel estimé de plus de 2 500 consultations urgentes et 80% des unités opéraient plus de 1 000 cas par année. La grande majorité des répondants (94%) se disait satisfaite de la création d’une USAC dans leur hôpital. Conclusion : La majorité des chirurgiens affirme avoir vu un impact positif depuis la mise en place de l’USAC. Par contre, pour justifier la création d’une USAC, il semble nécessaire que soient présents un certain bassin de population, un nombre minimal annuel d’urgences chirurgicales ainsi qu’un certain nombre de chirurgiens y participant.