bluuebunny/crossref_metadata_2025_split huggingface dataset:
Frailty in Emergency Laparotomy and Laparoscopic Scottish Audit (ELLSA) Patients
Authors: McCulloch Alison , Watson Hannah , Richmond Victoria , Sturrock Claire , McCleary Andrew , Payne Christopher 
Published: December 2023

Abstract

Aims
Early identification of frailty is essential in the older emergency surgical patient. The latest NELA report highlights the importance of care of the elderly reviews in reducing mortality in this patient population. In our organisation, the geriatrician led Surgical Acute Frailty Team (SAFT) reviews patients aged ≥ 65 years included in the Emergency Laparotomy and Laparoscopic Scottish Audit (ELLSA). Our aim was to establish frailty identification in ELLSA patients and to review outcomes on discharge.

Methods
A subset of data collected as part of our organisation’s ELLSA was reviewed. Data included documentation of Clinical Frailty Scale Score (CFS), review pre-operatively and during admission by SAFT and discharge destinations.

Results
146 patients aged ≥ 65 years underwent emergency surgery as defined by ELLSA criteria from July 2022 to August 2023. 98.6% of patients had a documented CFS score (mean 3.6). 87.7% of patients were reviewed by SAFT; 63.3% of patients had a pre-operative frailty review. 70% of patients were discharged home independently with 7% requiring a care package on discharge.

Conclusions
In our organisation, frailty assessment in emergency laparotomy patients is significantly above the 31.8% documented in the 8th NELA report. The majority of patients are discharged home without additional support. Shared decision making is vital in this patient cohort. We have established frailty screening on admission, introduced a weekly MDT for ELLSA patients and installed a designated ELLSA patient MDT board with the aim of ensuring 100% of ELLSA patients aged ≥ 65 years have a geriatrician review.
Improving access to patient information leaflets utilising QR codes in patients undergoing emergency appendicectomy.
Authors: Louden Harriet , Lawday Samuel , Hewes James 
Published: December 2023

Abstract

Background
Informed consent is a cornerstone of ethical surgical practise. Patients undergoing emergency surgery have reduced time to consider their options when compared to the elective setting. Therefore, improving informed consent in this setting is critical. We aim to increase the provision of a pre-operative patient information leaflet (PIL) for patients undergoing an emergency appendicectomy by 50% over two audit cycles.

Methods
The same methodology were used for both cycles of this audit. Patients were identified through histopathology lists over a two week period. Medical notes were reviewed for documentation of provision of trust approved patient information leaflets. A QR code for an electronic version of the information leaflet was added to emergency clinic rooms, doctors handover rooms and the SHO on call bleep between audit periods.

Results
Empirical results from two audit cycles revealed that introduction of a QR code increased uptake from 0% of patients receiving the recommended appendicectomy leaflet, to 58%, achieving our aim.

Conclusion
The QR code provided a useful transportable resource, which was utilised by doctors. This provides scope for progression in provision of leaflet for other surgical issues, both in inpatient and outpatient settings, through utilisation of a QR code.
Reducing Unnecessary Group and Screen Sampling for Laparoscopic Appendicectomy: A retrospective single centre analysis.
Authors: Siddique Nayyab , O’Brien Catherine 
Published: December 2023

Abstract

Aims
Blood transfusion is rarely required for patients undergoing laparoscopic appendicectomies (LA) however some NHS trusts still require group and screen (G&S) sampling. This study aimed to assess G&S sampling for LA, rate of transfusion and the cost of G&S sampling at our hospital. It re-assessed these parameters after introduction of a guideline specifying that G&S are not needed routinely and should only be considered in case of high-risk patients (including those with deranged clotting, anticoagulation or profound anaemia).

Methods
A retrospective observational study was conducted in our centre from 01/02/2022-01/06/2022 (cycle one) and 20/04/23- 20/08/2023 (cycle two post, guideline introduction). All patients undergoing emergency LA were included. Laboratory costs of G&S sampling was estimated at £18.37 excluding consumables, CO2 emissions estimated at 116g/ test.

Results
The first cycle included 48 patients for which 85 G&S samples were sent costing £1561.45. 21 samples were rejected / not required and estimated CO2 emissions were 9.86kg. In second cycle, 32 G&S samples were sent for 52 patients, only 2 samples were rejected. No patients required blood transfusion. £973.61 and an estimated 6.1kg CO2 emissions were saved.

Conclusions
We established a guideline which negates the need for routine G&S sampling in patients undergoing LA in our hospital. Projected savings are approximately £30,000 per annum excluding theatre delay costs, personnel and other consumables. We recommend other NHS trusts should look to implement similar guidelines in order to reduce cost and CO2 impact of unnecessary testing in EGS.
Unplanned Returns to Theatres in Emergency General Surgery; What can be improved?
Authors: Salam Ammara , Alabri Badar , Patel Bhavnisha , Osunlusi Oluwafemi , Waraich Naseem 
Published: December 2023

Abstract

Introduction
Unplanned return to theatre impacts physical, psychological, social and financial aspects of patients and healthcare. It is a significant adverse event, which can be avoided, nonetheless reduced. This study aims to review the incidence of unplanned return to theatre in Emergency General Surgery at a District General Hospital.

Methods
A retrospective review of patients undergoing Emergency General Surgery between January 2019 to January 2021 was done. Data was obtained from the hospital management information systems. The operations were classified based on primary operation, followed by indication for the return.

Results
A total number of 1578 patients underwent emergency general surgery operations over a period of 25 months (Jan 2019-Jan 2021). The unplanned return to theatres (URTT) were 85 (5.3%), with a 90-day mortality of 16. There were 12 (14.11%) appendicectomies, 7 (8.2%) necrotizing fasciitis, 25 (29.4%) abscess, 5 (5.8%) hernias, 16 (18.8%) large bowel, 19 (22.3%) small bowel operations and 1 (1.17%) laparoscopic cholecystectomy. The total number of appendicectomies were 302 with 3.9% (12) URTT. Similarly, 4.2% (n=583) abscesses, 22.8% (n=70) large bowel operations, 6% (n=316) small bowel operations were returned. 66% of the abscesses were returned for redo/debridement.

Conclusion
Unplanned returns to theatres pose a major burden to the healthcare system. There is no established data for an acceptable rate of URTT in emergency general surgery. Most of the returns in our study, are due to haemorrhage or inadequate drainage of the abscess, both of these complications could easily be prevented with meticulous surgical technique.
Assessment of the documentation of frailty at admission in emergency general surgery admission at a tertiary care hospital
Authors: Singh Anurag , Siby Jayas , Kaur Mandeep , Sajid Muhammad 
Published: December 2023

Abstract

Background
NHS frailty guidelines advise that frailty score should be documented at the first time of contact for patients aged 65+ years. The Aim of this quality improvement project (QIP) was to assess the adequate documentation of frailty at the time of first encounter by the general surgery department for patients aged 65+ years.

Method
Data was collected for October 2022 for the first cycle and January and February 2023 for the second cycle. Data collection was done from an electronic database in the trust and patient notes maintained throughout the admission.

Results
136 patients were included in the QIP for the first cycle. 3/136 (2.2%) patients had documented frailty at the first encounter. These findings were discussed in the clinical governance meeting, followed by a teaching session for the junior doctors. A specific section was added in the documentation as a reminder for the team to document the frailty upon the first encounter.
212 patients were included in the second cycle and documentation of frailty improved to 39/212 (18.4%).

Conclusion
There was a lack of documentation, which improved after the intervention advised by QIP. A teaching session for new junior doctors is planned at the induction session, to strengthen the importance of frailty documentation.
Outcomes of Emergency Surgical patients with acute pathology managed without emergency laparotomy - a single site review
Authors: Bakrania Shiv , Manor Kristin , Capozzi Patrizia 
Published: December 2023

Abstract

Aim
To establish the outcomes of Emergency General Surgery patients admitted with acute pathology that did not progress to Emergency Laparotomy

Method
Retrospective single site review of all Emergency General Surgery patients admitted over three calendar months. Review of patient demographics, diagnostics, diagnosis and management. 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 12 were female patients.
Median age of 86 years (range 42 – 91 years).
At 30 days post admission 6 patients who did not proceed to laparotomy were alive.
7 patients survived to discharge, 5 were discharged home and 2 were discharged to a Nursing Home for full nursing care requirements.

Conclusion
Surgeons are starting to explore the issues around futility in emergency general surgery. This snapshot retrospective review shows alignment with the very limited published literature. We recognise our numbers are extremely limited. Further data collection and analysis is needed to explore futility in emergency general surgery.
Clinical audit to assess diagnosis and severity stratification of acute pancreatitis
Authors: Woods Hannah , Roberts Rhianna , Bradley Rebecca 
Published: December 2023

Abstract

Background
Acute Pancreatitis (AP) has varying presentations, and guidelines recommend severity stratification of these patients to guide management. Surgical departments commonly use varying methods and/or use these methods incorrectly. The prominent Alanta criteria utilises examination findings, CT scan findings and elevated pancreatic enzymes to diagnose AP. Using the criteria incorrectly can lead to misdiagnosis and unnecessary radiation exposure. Additionally, diagnosing pancreatitis aetiology is crucial to providing targeted treatments, such as a laparoscopic cholecystectomy.

Aim
The aim of this study was to identify aspects of AP diagnosis and severity scoring requiring improvement in a large general surgery department.

Methods
We identified adult patients admitted with AP between 01.01.2023 and 31.03.2023, and retrospectively collected data points recommended by a combination of national guidelines and the Atlanta criteria. The results were presented to a panel of expert Upper Gastrointestinal Surgeons and, with the panel’s guidance, an AP protocol was created to improve severity scoring and rapid diagnosis of AP.

Results
The severity scoring was only completed in 33% of cases and incorrectly used in the majority of cases. Based on request information and cases already fulfilling the diagnostic criteria, almost half of all CT scans performed were deemed unnecessary. Results on interventions for alcohol and gallstone cases highlighted significant shortfallings.

Conclusion
Significant improvements are required in severity scoring, adherence to diagnostic criteria and targeted treatment. A pancreatic protocol has since been established in this department and further analysis will be completed to create a closed-loop audit.
The glucocorticoid dexamethasone inhibits HIF-1α stabilization and metabolic reprogramming in lipopolysaccharide-stimulated primary macrophages
Authors: Clayton Sally A , Lockwood Chloe , O’Neil John D , Daley Kalbinder K , Hain Sofia , Abdelmottaleb Dina , Bolimowska Oliwia O , Tennant Daniel A , Clark Andrew R 
Published: December 2023

Abstract
Synthetic glucocorticoids are used to treat many chronic and acute inflammatory conditions. Frequent adverse effects of prolonged exposure to glucocorticoids include disturbances of glucose homeostasis caused by changes in glucose traffic and metabolism in muscle, liver, and adipose tissues. Macrophages are important targets for the anti-inflammatory actions of glucocorticoids. These cells rely on aerobic glycolysis to support various pro-inflammatory and antimicrobial functions. Employing a potent pro-inflammatory stimulus in two commonly used model systems (mouse bone marrow-derived and human monocyte-derived macrophages), we showed that the synthetic glucocorticoid dexamethasone inhibited lipopolysaccharide-mediated activation of the hypoxia-inducible transcription factor HIF-1α, a critical driver of glycolysis. In both cell types, dexamethasone-mediated inhibition of HIF-1α reduced the expression of the glucose transporter GLUT1, which imports glucose to fuel aerobic glycolysis. Aside from this conserved response, other metabolic effects of lipopolysaccharide and dexamethasone differed between human and mouse macrophages. These findings suggest that glucocorticoids exert anti-inflammatory effects by impairing HIF-1α-dependent glucose uptake in activated macrophages. Furthermore, harmful and beneficial (anti-inflammatory) effects of glucocorticoids may have a shared mechanistic basis, depending on the alteration of glucose utilization.
The degree of permanent pacemaker dependence and clinical outcomes following transcatheter aortic valve implantation: implications for procedural technique
Authors: Dykun Iryna , Mahabadi Amir Abbas , Jehn Stefanie , Kalra Ankur , Isogai Toshiaki , Wazni Oussama M , Kanj Mohamad , Krishnaswamy Amar , Reed Grant W , Yun James J , Totzeck Matthias , Jánosi R Alexander , Lind Alexander Y , Kapadia Samir R , Rassaf Tienush , Puri Rishi 
Published: December 2023

Abstract

Aims
Conduction abnormalities necessitating permanent pacemaker (PPM) implantation remain the most frequent complication post-transcatheter aortic valve implantation (TAVI), yet reliance on PPM function varies. We evaluated the association of right-ventricular (RV)-stimulation rate post-TAVI with 1-year major adverse cardiovascular events (MACE) (all-cause mortality and heart failure hospitalization).

Methods and results
This retrospective cohort study of patients undergoing TAVI in two high-volume centers included patients with existing PPM pre-TAVI or new PPM post-TAVI. There was a bimodal distribution of RV-stimulation rates stratifying patients into two groups of either low [≤10%: 1.0 (0.0, 3.6)] or high [&gt;10%: 96.0 (54.0, 99.9)] RV-stimulation rate post-TAVI. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated comparing MACE in patients with high vs. low RV-stimulation rates post-TAVI. Of 4659 patients, 408 patients (8.6%) had an existing PPM pre-TAVI and 361 patients (7.7%) underwent PPM implantation post-TAVI. Mean age was 82.3 ± 8.1 years, 39% were women. A high RV-stimulation rate (&gt;10%) development post-TAVI is associated with a two-fold increased risk for MACE [1.97 (1.20, 3.25), P = 0.008]. Valve implantation depth was an independent predictor of high RV-stimulation rate [odds ratio (95% CI): 1.58 (1.21, 2.06), P=&lt;0.001] and itself associated with MACE [1.27 (1.00, 1.59), P = 0.047].

Conclusion
Greater RV-stimulation rates post-TAVI correlate with increased 1-year MACE in patients with new PPM post-TAVI or in those with existing PPM but low RV-stimulation rates pre-TAVI. A shallower valve implantation depth reduces the risk of greater RV-stimulation rates post-TAVI, correlating with improved patient outcomes. These data highlight the importance of a meticulous implant technique even in TAVI recipients with pre-existing PPMs.
Novel methods to determine the slowness and ray-velocity vectors in viscoelastic anisotropic media
Authors: Zhou Bing , Liu Xu , Wang Pengde , Kumar Manjeet 
Published: December 2023

SUMMARY
Determination of the slowness vector and the homogeneous ray-velocity vector is critical for seismic ray tracing in a viscoelastic anisotropic medium. Three formulae, the traditional g-Hamiltonian, newly developed conjugate real ray tracing (C-RRT) and innovative g*-Hamiltonian, are employed to calculate the ray-velocity vectors with the determined slowness vectors in a viscoelastic anisotropic medium. We demonstrate the forward and reverse searching procedures to determine the ray-velocity vectors' slowness vectors.
The former implements either a linear search or an optimization method to find the slowness vectors that lead to homogeneous complex ray-velocity vectors (its real and imaginary parts are parallel). The latter is based on a new generalized cost function and applies an optimization method to find the slowness vector for a known ray direction. Using sandstone as an example material, we compare the accuracies and efficiencies of the three formulae and the two searching procedures. Our examples show that the forward searching procedure with the traditional g-Hamiltonian formula and the linearly searching method may generate unphysical solutions for qSV wave due to its cusps or triplication, but using the optimization method may not only mitigate the influence of the cusps and triplication but also significantly improve the accuracies and efficiencies almost two orders higher. For the reverse searching procedure, we propose a general form of the cost function valid for all the formulae of the ray-velocity vector and easily solved by an optimization method. The examples demonstrate that the solutions yielded by the forward and reverse searching procedures coincide well for all three body waves (qP, qSV and qSH), except for the triplication of the qSV wave. In particular, the optimization method combined with the novel g*-Hamiltonian formula may completely overcome the issues of spurious solutions and the qSV-wave cusp and triplication.
Massachusetts’ opioid limit law associated with a reduction in postoperative opioid duration among orthopedic patients
Authors: Shuey Bryant , Zhang Fang , Rosen Edward , Goh Brian , Trad Nicolas K , Wharam James Franklin , Wen Hefei 
Published: December 2023

Abstract
Postoperative orthopedic patients are a high-risk group for receiving long-duration, large-dosage opioid prescriptions. Rigorous evaluation of state opioid duration limit laws, enacted throughout the country in response to the opioid overdose epidemic, is lacking among this high-risk group. We took advantage of Massachusetts’ early implementation of a 2016 7-day-limit law that occurred before other statewide or plan-wide policies took effect and used commercial insurance claims from 2014–2017 to study its association with postoperative opioid prescriptions greater than 7 days’ duration among Massachusetts orthopedic patients relative to a New Hampshire control group. Our sample included 14 097 commercially insured, opioid-naive adults aged 18 years and older undergoing elective orthopedic procedures. We found that the Massachusetts 7-day limit was associated with an immediate 4.23 percentage point absolute reduction (95% CI, 8.12 to 0.33 percentage points) and a 33.27% relative reduction (95% CI, 55.36% to 11.19%) in the percentage of initial fills greater than 7 days in the Massachusetts relative to the control group. Seven-day-limit laws may be an important state-level tool to mitigate longer duration prescribing to high-risk postoperative populations.
Whole of government approaches to accelerate adolescent success: efficiency and financing considerations
Authors: Desmond Chris , Watt Kathryn , Rudgard William E , Sherr Lorraine , Cluver Lucie 
Published: December 2023

Abstract
The multiple domains of development covered by the Sustainable Development Goals (SDGs) present a practical challenge for governments. This is particularly acute in highly resource-constrained settings which use a sector-by-sector approach to structure financing and prioritization. One potentially under-prioritized solution is to implement interventions with the potential to simultaneously improve multiple outcomes across sectors, what United Nations Development Programme refer to as development ‘accelerators’. An increasing number of accelerators are being identified in the literature. There are, however, challenges associated with the evaluation and implementation of accelerators. First, as accelerators have multiple benefits, possibly in different sectors, they will be undervalued if the priority setting is conducted sector-by-sector. Second, even if their value is recognized, accelerators may not be adopted if doing so clashes with any of the multiple competing interests policymakers consider, of which efficiency/social desirability is but one. To illustrate the first challenge, and outline a possible solution, we conduct a cost-effectiveness analysis comparing the implementation of three sector-specific interventions to an accelerator, first using a sector-by-sector planning perspective, then a whole of government approach. The case study demonstrates how evaluating the cost-effectiveness of interventions sector-by-sector can lead to suboptimal efficiency rankings and overlook interventions that are efficient from a whole of government perspective. We then examine why recommendations based on a whole of government approach to evaluation are unlikely to be heeded. To overcome this second challenge, we outline a menu of existing and novel financing mechanisms that aim to address the mismatch between political incentives and logistical constraints in the priority setting and the economic evaluation evidence for cost-effective accelerators. These approaches to financing accelerators have the potential to improve efficiency, and in doing so, progress towards the SDGs, by aligning political incentives more closely with recommendations based on efficiency rankings.