During the period from September 1990 to March 1992, 155 nerve blocks were performed for 125 patients as part of the clinical management of pain due to malignant disease. The efficacy, in terms of pain score reduction, and spontaneously reported side effects secondary to these procedures were prospectively audited. Neural blockade was undertaken in accordance with strict clinical criteria, and medication was optimized with the aim of achieving maximum analgesia with minimum side effects at all times. Pain was assessed before the block, 24 hours after the block and at follow-up (two to six weeks) using visual analogue scores or verbal rating scales. All patients were audited. The total (all patients, all blocks) median (lower-upper quartile) pain score dropped from 8 (6-10) cm before the block to 2 (0-4) cm at 24 hours after the block (p < 0.05) and to 1 (0-4) cm at follow-up (p < 0.005). A concomitant reduction in analgesic requirements was observed. The incidence of serious side effects was low (two patients in this series). The results indicate the usefulness of these techniques for patients in the palliative care setting.

course. The underlying decisive early-life factor is not yet known. An increasing number of studies have shown an association between eczema and skin microbiome fluctuations. Evidence has revealed an association between gut microbiome and persistence of eczema, but currently limited data are available in terms of skin microbiome. Objectives This prospective study aimed to investigate whether skin microbiome profiles differ between patients with transient eczema and those with persistent eczema. Methods We followed up 120 Chinese infants living in Hong Kong from childbirth to 2 years old. At 6, 12 and 24 months, participants attended clinic visits in our hospital and eczema was diagnosed based on Hanifin and Rajka criteria by paediatricians. Based on physician diagnoses, participants were further classified into transient eczema group, persistent eczema group and never eczema group. Skin microbes at left antecubital fossa (LAF) were serially sampled by flocked swabs at 1, 6 and 12 months. Skin microbiome data was later generated by 16S rRNA sequencing. A recently developed statistical method for microbiome called Analysis of Compositions of Microbiomes with Bias Correction (ANCOM-BC) was used to assess differentially abundant taxa among groups. Results In our birth cohort, 60/119 (50%) participants are male, and 28/119 (24%) were born by caesarean section. Forty-three out of 120 (36%) participants' mothers have history of allergies. Forty-six out of 101 (46%) participants developed eczema within 6 months, and 33/97 (34%) presented with active eczema at 12 months. At 24 months, 18/ 100 (18%) participants still had active eczema. During the study period in total 297 skin swab samples from LAF were collected. Alpha diversity represented by Shannon and Simpson indices significantly increased from 1 month to 6 months (p=0.001 and p=0.004 respectively). Relative abundance of Staphylococcus and Corynebacterium progressively decreased from 1 month to 6 months (b =-1.95, p<0.001; and b = -1.72, p<0.001, respectively) and further to 12 months (b =-1.14, p=0.04; and b = À1.59, p<0.001, respectively). Alpha diversity did not significantly differ among groups of children with persistent eczema, transient eczema and without eczema. Besides, this study failed to detect significantly differentially abundant bacterial taxa associated with eczema persistence. Conclusions Establishment of skin microbiome is highly dynamic in early life. Our results do not support that earlylife microbiota at left antecubital fossa is associated with eczema persistence during infancy.

Aim A patient's discharge summary (TTO) should be accurate. Most of them are conducted by junior doctors at the beginning of their medical training. The information mentioned in a TTO ensures patient safety, continuity of care as well as correct clinical coding for the NHS. Therefore, a re-audit was designed to check the quality of the discharge summaries of endocrine surgical patients In Nottingham City Hospital i.e., the type of operation, diagnosis, or postoperative instructions. Method The first cycle included all the TTOs for the endocrine surgical patients operated from April 2018 to November 2018. Then we re-audited those who had endocrine surgeries from April 2019 to November 2019. NOTIS e-TTO, Bluespier theatre lists and Medway were used to retrieve the data. All general surgery patients were excluded. Results 142 and 104 patients TTOs were included in each audit cycle, respectively. Type of operation was improved from 84% to 95% in the second cycle. Correct diagnosis was reported from 68% to 72% in the second cycle audit. Conclusions The introduction of electronic operation notes in our practice improved the correct clinical coding for the type of operation mentioned in the TTO. The accuracy of correct diagnosis remains suboptimal. Therefore, education of junior doctors and an idea of double-checking from a more senior colleague should be assessed.