Alexander Osborne

This review aims to highlight the key areas in which changes to the epigenome have played an important role in the evolution and development of our species. Firstly, there will be a brief introduction into the topic of epigenetics to outline the current understanding of the subject and inform the reader of the basic mechanisms and functions of the epigenome. This will lead on to more focussed detail on the role played by epigenetic changes in the rapid evolution of our species and emergence from our ancestor species, as well as the Human Accelerated Regions that played a role in this. The discussion highlights how epigenetics has helped and hindered our species’ development via changes to the epigenome in more modern times, discussing case examples of documented instances where it is shown that epigenetics has played a role in the evolution of humanity.

Abstract The Annual Scientific Meeting of the Association of Surgeons of Great Britain and Ireland takes place this year at the Scottish Exhibition and Conference Centre, Glasgow, UK (13th–15th May 2009), under the presidency of Professor Michael Horrocks.

<h3>Introduction</h3> We report a project to generate profiles of NHS activity for IBD patients receiving care in English hospitals, with national and local level activity reports (Trust and Primary Care Organisation) as the basis for clinically validated metrics to support services. <h3>Methods</h3> COHORT: 352,614 patients with a specific IBD diagnosis between 2003/4 and 2013/14. DATASETS: All-cause events for the cohort for each year from HES datasets: Admitted Patient Care (<b>APC</b>, daycase and inpatient care), Outpatient (<b>OP</b>) and Accident &amp; Emergency (<b>A&amp;E</b>). Source: Health &amp; Social Care Information Centre. ANALYSIS: In IBM-SPSS, Excel and SAS. Clinical review of ICD-10 (diagnosis) and OPCS-4 (procedure) codes for all APC events, categorising all-cause activity into logical baskets of IBD-related primary diagnoses (e.g. perianal abscess) or procedures (e.g. colonoscopies). <b>APC</b>categorised as <b>elective daycases</b> (<b>El-D</b>), <b>admissions</b> (<b>El-Ad</b>) or <b>emergencies</b> (<b>Em-Ad</b>). The OP dataset lacks diagnosis, so categorised by GI-relevant specialities. A&amp;E contacts were all-cause (non-admitted). Data reported are 2013/14. <h3>Results</h3> <b>APC: </b>149,115 IBD patients (42% of cohort) had hospital admission in 13/14 (389,574 admissions; <b>El-D</b>, 246,064; <b>El-Ad</b>, 26,911; <b>Em-Ad</b>, 105,482; <b>Other</b>, 11,117). Of <b>Em-Ad</b>, the primary diagnosis code was <i>IBD-specific</i> in 17,274 (CD: 10,077; UC: 7,197), <i>non-specific IBD</i> in 455, <i>IBD-related conditions</i> in 9,709, relevant <i>GI symptoms</i> in 6,934, <i>benign anorectal conditions</i> in 2,445, <i>anaemias</i> in 1,158, <i>enteric infections</i> in 1,148, <i>colonic or small bowel cancers</i> in 472. Categorising <b>Em-Ad </b>by procedures identified 5,515 with <i>GI surgery</i> (Perianal: 1,233; Colonic or SB resection: 1,547). Of <b>El-Ad</b>, 7,030 included <i>GI surgery</i>. <b>El-D</b> included 70,354 <i>lower endoscopies</i> and 73,968 <i>infusions/injections</i>. <b>Outpatient Activity</b>: 244,248 IBD patients (69% of cohort) attended clinic (1,351,807 all-cause visits), of which 387,503 were <i>gastroenterology </i>or<i> general surgery</i>. <b>A&amp;E Activity: </b>98,838 all-cause attendances for 53,083 IBD patients (non-admitted). At organisation level (PCT), mean emergency bed days (primary IBD diagnosis) was 247 per 100,000. <h3>Conclusion</h3> Analysis of IBD-related hospital activity in routine data is possible but requires complex algorithms. Our candidate metrics at Trust and Primary Care Organisation level will be shared with front line teams, including links between A&amp;E, OPD and APC events and refined iteratively. Linkage to IBD Registry dataset has been tested and will allow future enhancements. <h3>Disclosure of Interest</h3> M. Shawihdi Grant/research support from: Crohn’s &amp; Coliitis UK, A. Osborne: None Declared, E. Devonport: None Declared, R. Driscoll Consultant for: AbbVie, F. Cummings: None Declared, S. Bloom: None Declared, P. Williamson: None Declared, M. Pearson: None Declared, K. Bodger Grant/research support from: Crohn’s &amp; Colitis UK, Speaker bureau with: AbbVie