Introduction Metronidazole is commonly prescribed for intra-abdominal infections. Oral metronidazole has high bioavailability (>95%) and intravenous metronidazole should be reserved for patients not suitable for oral preparations. Methods and materials This full cycle audit evaluated the type of metronidazole preparation prescribed in adult emergency surgical patients requiring first-line empirical antimicrobial therapy for intra-abdominal infections. The criterion for audit was the proportion of patients who were prescribed intravenous metronidazole when the oral route was available. The first cycle included all consecutive eligible patients between 20 April and 14 May 2020. After an intervention phase educating prescribers about the similar pharmacokinetic properties of oral and intravenous metronidazole, clinical practice was reaudited between 22 June and 16 July 2020. Data were collected by case note and drug chart review. Results A total of 54 patients were included in the first audit cycle. Of these, 11 (20.4%) were prescribed oral metronidazole and 43 (79.6%) were prescribed intravenous metronidazole. In the majority of cases (35/43, 81.4%), intravenous metronidazole was prescribed in the absence of clear contraindications to the oral preparation. Of the 61 patients included in the reaudit cycle, 23 (37.7%) were prescribed oral metronidazole and 38 (62.3%) were prescribed intravenous metronidazole. The proportion of patients prescribed intravenous metronidazole despite being suitable for oral preparation decreased from 81.4% in the first cycle to 34.2% (13/38) in the reaudit cycle (risk ratio 0.42, 95% CI: 0.26 to 0.67, p<0.0001). Prescribing oral metronidazole when suitable saved up to £10.53/day per patient. Conclusion This full cycle audit led to a significant improvement in the use of oral metronidazole in suitable patients, as well as a considerable reduction in healthcare costs.

: Purpose of Review: We explore how to develop Maastricht category I and II donation in the UK. We discuss lessons learned from previous UK pilots and define future steps in the journey to establishing a sustainable uDCD programme in the UK. Recent Findings: The emergence of normothermic regional perfusion (NRP) as a successful strategy in cDCD donation with excellent clinical results creates the optimal platform for the development of a uDCD programme. Coordinated logistics with ambulance services and ED departments, embedded donor coordination in ED, public acceptance and wider discussion on acceptable peri-mortem interventions are key for future developments. Summary: A uDCD programme in the UK is feasible. Despite an increase in public awareness and recent changes in legislation, there remain several challenges. Recent advances in perfusion and preservation and an established national retrieval infrastructure, create the premises for future sustainable developments.

Background/Objectives: Obesity is extremely common among patients with end stage renal disease (ESRD) due to shared metabolic risk factors. Renal transplantation is the gold standard treatment for ESRD, however obesity is a major barrier due to increased anaesthetic risks, surgical complications and poorer graft outcomes. The aim of this study was to assess ESRD patients referred for metabolic bariatric surgery (MBS) in Scotland. Methods: Data from all adult patients with ESRD who were referred for MBS in Scotland from January 2014 to August 2025 were obtained retrospectively. Categorical data are presented as number and percentage; non-parametric continuous data are presented as median and inter-quartile range. A focused review of comparable published cohorts was performed for context. Results: A total of 9 patients with ESRD were referred for MBS over the study period; of these, 5 patients went on to have MBS. Of the patients who underwent MBS, the median age at referral was 47 years, 3 of 5 were female and the median starting weight and body mass index (BMI) were 131 kg and 49 kg/m² respectively. Four patients underwent laparoscopic sleeve gastrectomy, and 1 patient underwent one-anastomosis gastric bypass. The median length of hospital stay was 2 days. The median total percentage weight loss was 33.5% (range 27.7% to 48.1%). Four of the five patients were able to be activated on the transplant waiting list after successfully achieving their target weight after a median of 8.4 months. Of the 4 listed patients, 3 were transplanted with no post-operative complications, and 1 remains active on the waiting list. Across seven comparable cohorts (19 to 198 operated patients), all single- or two-centre, ours had the only national coverage. Listing and transplantation outcomes (4 of 5 listed, 3 of 5 transplanted) were broadly consistent with the range reported in these cohorts, although the small sample precludes formal comparison. Conclusions: In this small case series and review, MBS appeared safe and feasible in a highly selected group of patients with obesity and ESRD. MBS facilitates access to renal transplant but is under-utilised in Scotland. We plan to formalise a national treatment pathway to streamline access to bariatric services for patients with ESRD and enable more patients to undergo renal transplantation.