bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessment for the risk of malnutrition and nutritional support in older emergency laparotomy patients: a clinical audit
Authors: Windle Angela , Nair Sherena , Ispoglou Theocharis , Burke Dermot 
Published: December 2023

Abstract

Aims
Patients undergoing urgent abdominal surgery should undergo an assessment of the risk of malnutrition upon admission using the Malnutrition Universal Screening Tool (MUST). This assessment should trigger a response when patients are categorised as high-risk. This clinical audit aimed to determine whether older patients included in the National Emergency Laparotomy Audit (NELA) were identified as being at risk of malnutrition and whether they received appropriate nutritional support to address deficiencies if they were classed as high-risk as per the recommendations of the NICE (2017) guidelines.

Methods
Patients entered into the NELA database at a single NHS trust who were over 65 or older between January 1, 2021, and December 31, 2022, were included. The patient records were reviewed for the MUST score upon admission, and the presence of nutritional supplementation prescriptions, or dietetic referrals following the identification of a high-risk MUST score of 2 or above.

Results
Out of the 300 older NELA patients included in this clinical audit, 98% had a recorded MUST score. Between them, 114 patients had a high-risk MUST score, but 35% of these high-risk patients did not undergo a dietetic review. Additionally, 24% of high-risk patients received neither oral nor parenteral supplementation.

Conclusions
High-risk MUST scores in older NELA patients are readily available to surgical teams within the electronic patient record but do not consistently lead to interventions addressing nutritional deficiencies and nutritional screening is not currently included in NELA.
Prescription Practice Protocol of Antibiotics in A&E for Acute Diverticulitis in DGH: A Closed Loop Audit
Authors: Thapa Nabin , Kalaskar Shrinivas , Atif Qurrat Al Ain 
Published: December 2023

Abstract

Aim of the study
To examine the level of adherence, of local antibiotics prescription practice, for Diverticulitis to NICE guidelines 2019.

Introduction
Acute diverticulitis is an inflammation of a diverticulum, a sac-like protrusion from the colon wall, due to micro-perforation. Based on clinical and radiological findings they are classified as complicated and uncomplicated diverticulitis. As per nice guidelines, diverticulitis can be managed on the basis of classification,

Method
Retrospect data collection for 3 months, for each cycle, was done from the surgical on-call take list and reviewed the management of diverticulitis. Patients with a confirmed diagnosis of acute diverticulitis by Ct scan were only included in the study.

Results
In our 1st cycle of study, we found that our practice was not competent with NICE guidelines and 98% of patients were treated with antibiotics despite their requirement.
We made a local guideline in association with NICE guidelines for the management of acute diverticulitis and organized teaching sessions and did templates presentation in various wards.
In 2nd cycle of the study 71% of the patient was treated with antibiotic and 71% were in need of antibiotics as per NICE guideline.

Conclusion
We are now 100% compliant with NICE guidelines in antimicrobial prescription in acute diverticulitis.
How Patients who needed CT scans on an ambulatory basis are scanned and reviewed in a major teaching hospital
Authors: Pha Sai Yan 
Published: December 2023

Abstract

Aim
This study focuses on the status of service provision for Emergency General Surgical patients requiring Ambulatory CT scans at a major teaching hospital.

Method
CT scans that took place between May 2023 – July 2023 where patients who received scans were reviewed and categorized between Urology and EGS.

Results
During the 13-week study, we were able to scan 233 patients (17.92 scans per week) in total between both specialties where 82 scans were for EGS patients (35%).
All of these patients were reviewed by a member of the EGS team before they were booked for ambulatory scans at an allotted time and date where patients were scanned at an average of 2.15 days after initial review.
After the scan, the patients are reviewed in the Ambulatory Clinic with their results where decisions were made. 93% of the patients were seen on the same day after the scan. Most wait was 11 days due to delay of scanning.
Of all the scans 75% of the scans are for common indication for scans in an Ambulatory setting. Indication for scanNumberDiverticular20Post-operative collections14Appendicitis11Non-specific abdominal pain10Hernias8

Conclusion
After symptomatic management, scanning and reviewing patients on an ambulatory pathway is effective in both receiving scans in a timely manner as well as making timely appropriate decisions regarding their cause of presentation. It also helps reducing the number of patients going into the acute team.
Percutaneous Cholecystostomy for acute calculous cholecystitis. Analysis of complications.
Authors: Castillo Ana Maria Gonzalez , De Miguel Palacio Maite , Rodríguez Andrea Rabasa , Ramos Maria Martin , Manzano Amalia Pelegrina , Fernandez Estela Membrilla 
Published: December 2023

Abstract

Aims
Acute cholecystitis (AC) is the second most frequent pathology in Surgical Emergencies.Laparoscopic cholecystectomy (LC) is the gold standard treatment, but not all patients are fit for surgery.
Percutaneous Choleystostomy (PC) is an alternative to LC but has high comorbidity and the efficacy of bridge therapy is still in debate. This study aims to analyse the complications of non-surgical treatment in AC.

Methods
Single-centre retrospective study of 1652 adults with AC during 2011 to 2022, including baseline demographic characteristics, comorbidity severity defined as Charlson Comorbidity Index (CCI), ASA Score, Tokyo Guidelines’ severity classification. The primary outcome is to study the complications of non-surgical treatment.

Results
The 94,6% of the series had LC. Only 88 patients received NST, and were 12 yearls old older, had a higher CCI and the 44% were severe cholecystitis the 83% were pure-cholecystitis, and 44% were successfully treated with antibiotics alone. A 55% needed a PC, in 7 patients was for resuscitation before surgery. The Hospital stay was 6 days longer and the 45% had a complication. The mortality was 11%. Risk factors for complications were severe cholecystitis, diabetes, and age over 70. Only 3 patients were studied with a cholangiography before remove the drainage. The recurrence was 28%.

Conclusions
NST has a high complication rate, it should be only for a diminutive subgroup of patients with an AC. A severe cholecystitis, diabetes, and age over 70 are risk factors for complications. Resucitative cholecystostomy could be an option in selective patients.
Do patients with acute diverticulitis need to be in the hospital? - Implementation of an @Home treatment pathway to reduce admissions
Authors: Batra Suketu , Winterborn Rebecca , Saunders Lucinda , Pullyblank Anne 
Published: December 2023

Abstract

Aims
Acute complicated diverticulitis is often treated as an in-patient, despite few needing intervention. Virtual wards are designed to treat patients at home. The aim was to develop an NHS@Home service for acute diverticulitis to reduce hospital admissions.

Methods
A retrospective review of patients with diverticulitis examined daily WCC & CRP, analgesia and IV antibiotic requirements, NEWS2 & pain scores. This was used to develop an @Home treatment protocol. In this, patients with CT-confirmed diverticulitis +/- localized perforation &lt;3cm, NEWS2 &lt;2, Pain score &lt;5, and CRP &lt;200 were given one dose of IV antibiotics, then oral antibiotics at home with thrice-a-day observations and daily bloods. Discharge was nurse-led on day 2 or 3 with criteria for re-admission.

Results
Of 42 admissions, mean WCC was 12.7, mean CRP was 171 if perforated, and 85 if not. All NEWS2 scores were &lt;2 and mean pain score was 3.
65% of patients (28/42) had no perforation on CT. Most patients (60.5%) did not require opioid analgesia, mean IV antibiotic treatment duration was 2.5 days and mean LOS was 3.75 days.
Only 6/42 patients (14.28%) had a collection.
In all patients, WCC was static or reduced during admission but CRP increased in a third.
35 patients were treated on the Diverticulitis@Home Pathway in the first 4 months with one readmission.
The pathway was used to standardize colonic imaging according to guidelines. As a result, 60% (36/61) of endoluminal imaging previously ordered by clinicians was canceled.

Conclusion
An @home diverticulitis pathway is safe, effective and saves bed days.
Long term outcomes after negative appendicectomy: does morbidity justify mandatory pre-operative confirmation of appendicitis prior to surgery?
Authors: Hammett Felix , Nasir Uzair , Singh Gautam , Ghoneima Ahmed , Saha Arin 
Published: December 2023

Abstract

Aims
Negative appendicectomy is sometimes described as a quality indicator of an acute surgical service. Previous studies have suggested that negative appendicectomy carries an unacceptably high risk of morbidity and advocate pre-operative imaging to confirm a diagnosis in all cases, despite the resource implications this policy carries. This study quantified long term morbidity after negative appendicectomy.

Methods
This retrospective cohort study identified all patients who underwent appendicectomy for suspected appendicitis from June 2010 to August 2015 at a single centre. Patients with a histologically normal appendix were identified and their notes were interrogated to record outcomes; median follow-up was 10.6 (range, 8 – 13) years. Complications after surgery were classified using the Clavien-Dindo system.

Results
1914 patients had an appendicectomy. 181 patients (9.5%) had a negative appendicectomy. There were 40 re-admissions after surgery; half (20 patients) were within 30 days. The most common causes of re-admission were ongoing symptoms with no identifiable cause (15 patients, 37.5%) or post-operative pain (9 patients (22.5%). Overall post-operative complication rate was 11 patients (6.1%). Of these, 6 patients had Grade 1 or 2 complications, 5 patients (3%) had Grade 3 complications (return to theatre for infection, bleeding or hernia) and none had Grade 4 or 5 complications. There was no mortality.

Conclusions
There is low short and long-term morbidity after negative appendicectomy which suggests that routine pre-operative imaging to confirm a diagnosis of appendicitis before surgery is unwarranted. The concerns around complications after negative appendicectomy appear unjustified and should not be a quality indicator.
Impact of percutaneous cholecystostomy on National Health Service (NHS) service provision and subsequent clinical as well as surgical outcomes.
Authors: Chong Li Cheng , Jatania Jignesh , Wynne Kamil 
Published: December 2023

Abstract

Aims
To evaluate the impact of percutaneous cholecystostomy on the NHS and clinical/surgical outcomes.

Methods
Retrospective analysis of patients who underwent percutaneous cholecystostomy between 01/01/2020 to 31/12/2022. Data collected included patient demographics, procedure (indications, mean time for insertion/removal), microbiology (bile aspirate, blood culture), imaging (endoscopic retrograde cholangio-pancreatography (ERCP) / tubogram) performed, clinical outcome, number of planned/unplanned follow-ups and difficulty of cholecystectomy.

Results
The cohort included 33 patients (20 male, 13 female) with mean age of 74 years. Top indications were (1) gallbladder empyema identified on computed tomographic imaging (76%) and (2) being unfit for surgery i.e., significant comorbidities (55%) / septic (30%). Mean time of insertion and removal was 5 and 59 days, respectively. Escherichia coli (67%) was the most common microorganism from bile aspirate. Most (52%) blood cultures showed no growth. Within the initial admission, majority (82%) did not have ERCP and one-third (36%) had a tubogram. In terms of outcome, 14 (42%) subsequently had cholecystectomy, 12 (36%) were discharged, 6 (18%) died and 1 (3%) is awaiting cholecystectomy. There was a mean of 2 follow-ups before patients were discharged from service. Of those who underwent cholecystectomy, 12/14 were done electively, 12/14 were total cholecystectomy and 13/14 were laparoscopic. Mean surgical time was 116 minutes.

Conclusions
Percutaneous cholecystostomy is an effective treatment/bridging therapy for patients unsuitable for emergency cholecystectomy. It does not reduce time/difficulty of subsequent cholecystectomy. However, it does put a strain on the NHS with regards to length of stay and planned/unplanned follow-ups.
Making the decision not to proceed to Emergency Laparotomy in the acute general surgical patient - a multi-disciplinary approach?
Authors: Bakrania Shiv , Manor Kristin , Capozzi Patrizia 
Published: December 2023

Abstract

Aim
To establish who was involved in making the decision not to proceed to emergency laparotomy for emergency general surgery patients with acute pathology.

Methods
Retrospective single site review of all Emergency General Surgery patients admitted over three calendar months. Identification of and further collection of data from electronic patient records for patients that did not proceed to Emergency Laparotomy despite indicative pathology.

Results
A total of 619 emergency general surgical patients were admitted from 1st January to 31st March 2023.
39 (6.3%) patients had an Emergency Laparotomy.
17 (2.7%) patients did not proceed to laparotomy despite pathology that could indicate the need for emergency laparotomy. 100% of these patients has CT imaging to diagnose the pathology.
Of the 17 patients without laparotomy median age of 86 years (range 42 – 91 years) and 12 were female patients.
A consultant surgeon was involved in the decision making not to proceed to laparotomy 100% of all cases.
A consultant in care of the elderly was involved in the decision making for those aged &gt;65 years in 73% of cases (11/15).
Anaesthetic specialists were involved in the decision making in only 18% (3/17) cases.
Intensivists were involved in only one patient’s case.
The patient (when appropriate) and the patients relatives were consulted in the decision making for 88% (15/17).

Conclusion
NELA has clear standards for emergency laparotomy. We believe the decision not to operate is complex and as such advocate multi-disciplinary input and inclusion of patients and relatives wishes.
Atypical Influx: Navigating Invasive Group A Streptococcus Cases in Emergency General Surgery
Authors: Saunders Jada , Gerges Farid , Shaikh Amarah Ghani , Mumuni Quadri , Mithany Reda , Sriskandarajah Kumuthan 
Published: December 2023

Abstract

Aim
To highlight the rising national incidence of iGAS infections, particularly during the post emergency phase of the COVID-19 pandemic, and emphasise its significance as a differential diagnosis in acutely unwell emergency surgical patients.

Methods
Data was gathered retrospectively from December 2022 - August 2023. Inclusion criteria were emergency surgical patients testing positive for GAS isolated from sterile sites, or non-sterile sites in case of septic shock.

Results
Six cases (four females, two males), with a mean age of 55 (36-67) were identified. Four had necrotizing fasciitis, one bacterial peritonitis in the presence of a ventriculo-peritoneal shunt, and one streptococcal bacteremia. All presented in septic shock, with metabolic acidosis and multiorgan impairment. The initial diagnosis was clinical in 66% of cases. iGAS was confirmed via wound, peritoneal fluid, tissue or blood culture in five patients and via genital swab in one. 50% of cases were sensitive to clindamycin and amoxicillin. Two received IV immunoglobulins. All cases were managed according to Sepsis 6 protocols, involving multidisciplinary teams. Five patients underwent immediate surgery for debridement and washout. The mortality rate was 16.6%. Three patients were transferred to tertiary centres once stabilised (1 for neurosurgical input, and 2 for plastics grafting).

Conclusion
It is crucial for frontline doctors to consider iGAS as a differential when encountering critically ill surgical patients. Simultaneous systemic resuscitation, early surgical intervention, multidisciplinary care, tailored antibiotic therapy and immunoglobulins are essential to minimise morbidity and mortality.
The importance of accuracy in consenting in Laparoscopic Appendicectomies and Cholecystectomies in Emergency General Surgery
Authors: Johnston Magnus , Fourie Amy , Damaskos D 
Published: December 2023

Abstract

Background
Emergency General Surgery frequently necessitates expediting the consent due to clinic pressure often reducing the time for extensive and accurate consents. New recommendations from GIRFT, RCS and ASGBI advise the best practice for laparoscopic appendicectomy and cholecystectomies documentation to ensure that clinicians are adhering to safe practice with focus on consenting and informing patients accurately.

Aim
The aim of this study is to look at the accuracy of the documentation of consent in emergency general surgery laparoscopic appendicectomies and cholecystectomies to ensure and promote best practice.

Method
A retrospective analysis of 75 patients from the emergency general surgical take requiring laparoscopic appendicectomy or cholecystectomy from 08/09/23-14/9/23 in the Royal infirmary of Edinburgh, a tertiary trauma centre. The consent forms were analysed for scribed operation, legibility, abbreviations, and risks/ complications. The patients’ notes were then analysed to find out the operation carried out and any operative or immediate post operative complications. The consents forms were then compared to the post operative notes looking at the immediate operative complications to assess their accuracy.

Conclusion
The retrospective study demonstrated that there is scope for improvement within the consenting process to ensure the accuracy of the predicted operation and subsequent risks thus to improve true informed consent. The areas which could easily be improved on as such is the legibility, use of abbreviations and complete documentation of risks/complications the use of Procedure specific consent forms (PSCF) may be beneficial in creating standardisation.
From active affordance to active inference: vertical integration of cognition in the cerebral cortex through dual subcortical control systems
Authors: Luu Phan , Tucker Don M , Friston Karl 
Published: December 2023

Abstract
In previous papers, we proposed that the dorsal attention system’s top-down control is regulated by the dorsal division of the limbic system, providing a feedforward or impulsive form of control generating expectancies during active inference. In contrast, we proposed that the ventral attention system is regulated by the ventral limbic division, regulating feedback constraints and error-correction for active inference within the neocortical hierarchy. Here, we propose that these forms of cognitive control reflect vertical integration of subcortical arousal control systems that evolved for specific forms of behavior control. The feedforward impetus to action is regulated by phasic arousal, mediated by lemnothalamic projections from the reticular activating system of the lower brainstem, and then elaborated by the hippocampus and dorsal limbic division. In contrast, feedback constraint—based on environmental requirements—is regulated by the tonic activation furnished by collothalamic projections from the midbrain arousal control centers, and then sustained and elaborated by the amygdala, basal ganglia, and ventral limbic division. In an evolutionary-developmental analysis, understanding these differing forms of active affordance—for arousal and motor control within the subcortical vertebrate neuraxis—may help explain the evolution of active inference regulating the cognition of expectancy and error-correction within the mammalian 6-layered neocortex.
The co-activation pattern between the DMN and other brain networks affects the cognition of older adults: evidence from naturalistic stimulation fMRI data
Authors: Sun Fengzhu , Cui Dong , Jiao Qing , Niu Jinpeng , Zhang Xiaotong , Shi Yajun , Liu Haiqin , Ouyang Zhen , Yu Guanghui , Dou Ruhai , Guo Yongxin , Dong Li , Cao Weifang 
Published: December 2023

Abstract
Brain function changes affect cognitive functions in older adults, yet the relationship between cognition and the dynamic changes of brain networks during naturalistic stimulation is not clear. Here, we recruited the young, middle-aged and older groups from the Cambridge Center for Aging and Neuroscience to investigate the relationship between dynamic metrics of brain networks and cognition using functional magnetic resonance imaging data during movie-watching. We found six reliable co-activation pattern (CAP) states of brain networks grouped into three pairs with opposite activation patterns in three age groups. Compared with young and middle-aged adults, older adults dwelled shorter time in CAP state 4 with deactivated default mode network (DMN) and activated salience, frontoparietal and dorsal-attention networks (DAN), and longer time in state 6 with deactivated DMN and activated DAN and visual network, suggesting altered dynamic interaction between DMN and other brain networks might contribute to cognitive decline in older adults. Meanwhile, older adults showed easier transfer from state 6 to state 3 (activated DMN and deactivated sensorimotor network), suggesting that the fragile antagonism between DMN and other cognitive networks might contribute to cognitive decline in older adults. Our findings provided novel insights into aberrant brain network dynamics associated with cognitive decline.
Dietary history of click beetles and wireworms in the genus Limonius (Coleoptera: Elateridae) revealed by molecular gut content analysis
Authors: Serrano Jacqueline M , Cook Rachel , Headrick Heather , Cooper W Rodney 
Published: December 2023

Abstract
Wireworms, the larval stage of pest click beetle species (Coleoptera: Elateridae), are pests of many crops in North America including root vegetables and cereals. There is cause for concern amongst growers who are facing pressure from wireworms because there are a decreasing number of effective pesticides that can be used for wireworm management. Most research on pest elaterids has focused on the wireworm stage, which is the damage causing life stage. Recently, the focus in elaterid research has shifted to the adult click beetle stage, including identification of semiochemicals and development of effective traps. However, there is still a lot to be discovered about the basic biology of click beetles, including their feeding ecology. In an effort to understand the feeding ecology of click beetles, we investigated the presence of plant DNA in the digestive tracts of Limonius californicus (Mann.), L. canus (LeConte), and L. infuscatus (Mots.) beetles collected in 3 different locations within central Washington. To examine dietary histories of beetles and wireworms, specimens were collected from natural habitats and high-throughput sequencing of the plant genes trnF and ITS was used to identify their dietary history. Results revealed that click beetles do feed on a large variety of plants, which included a large quantity of brassicaceous plants commonly found in areas surrounding wireworm infested plots. The identification of the dietary history of the click beetles allowed us to infer their landscape-scale movements thus providing a means to better understand their behavior.