Epidemiology and outcomes of advanced necrotising enterocolitis

Background: A life-threatening gastrointestinal emergency, necrotising enterocolitis (NEC) presents commonly in neonates. It may be medically or surgically managed. The demographics of NEC patients in the University Hospital of Wales (UHW) and their long-term outcomes are largely unknown. Aims: To investigate factors associated with NEC, including methods of management, and correlate these with outcomes (mortality/discharge). Methods: A retrospective service evaluation comparing inborn and outborn infants diagnosed with NEC during a 5-year period, who were admitted to the Neonatal Intensive Care Unit (NICU), UHW. The Vermont-Oxford Network (VON) criteria determined the confirmed cases and the data was collected from the ‘BadgerNet’ database and IMPAX image viewer. Results: All infants with poor outcomes (mortality) were preterm. Most were born by emergency caesarean, had low APGAR scores and birth weights <1kg. There was a significant difference in the volume of feeds at diagnosis between the inborn and outborn cohort (p<0.01) and between those who died and those with better outcomes (p<0.05). Discussion: Most infants in UHW with NEC require surgical input, but surgery alone does not correlate directly with higher mortality. Low gestation/birthweight and larger volume of feeds at diagnosis are high contributors. Further research will expand the database and permit follow-up of the cohort post-discharge

Investigation into background levels of small organic samples at the NERC Radiocarbon Laboratory

Recent progress in preparation/combustion of submilligram organic samples at our laboratories is presented. Routine methods had to be modified/refined to achieve acceptable and consistent procedural blanks for organic samples smaller than 1000 g C. A description of the process leading to a modified combustion method for smaller organic samples is given in detail. In addition to analyzing different background materials, the influence of different chemical reagents on the overall radiocarbon background level was investigated, such as carbon contamination arising from copper oxide of different purities and from different suppliers. Using the modified combustion method, small amounts of background materials and known-age standard IAEA-C5 were individually combusted to CO2. Below 1000 g C, organic background levels follow an inverse mass dependency when combusted with the modified method, increasing from 0.13 0.05 pMC up to 1.20 0.04 pMC for 80 g C. Results for a given carbon mass were lower for combustion of etched Iceland spar calcite mineral, indicating that part of the observed background of bituminous coal was probably introduced by handling the material in atmosphere prior to combustion. Using the modified combustion method, the background-corrected activity of IAEA-C5 agreed to within 2 s of the consensus value of 23.05 pMC down to a sample mass of 55 g C

Progress in AMS target production in sub-milligram samples at the NERC Radiocarbon Laboratory

. Recent progress in graphite target production for sub-milligram environmental samples in our facility is presented. We describe an optimized hydrolysis procedure now routinely used for the preparation of CO2 from inorganic samples, a new high-vacuum line dedicated to small sample processing (combining sample distillation and graphitization units), as well as a modified graphitization procedure. Although measurements of graphite targets as small as 35 µg C have been achieved, system background and measurement uncertainties increase significantly below 150 µg C. As target lifetime can become critically short for targets &lt;150 µg C, the facility currently only processes inorganic samples down to 150 µg C. All radiocarbon measurements are made at the Scottish Universities Environmental Research Centre (SUERC) accelerator mass spectrometry (AMS) facility. Sample processing and analysis are labor-intensive, taking approximately 3 times longer than samples ≥500 µg C. The technical details of the new system, graphitization yield, fractionation introduced during the process, and the system blank are discussed in detail

Red-flag sepsis and SOFA identifies different patient population at risk of sepsis-related deaths on the general ward

Controversy exists regarding the best diagnostic and screening tool for sepsis outside the intensive care unit (ICU). Sequential organ failure assessment (SOFA) score has been shown to be superior to systemic inflammatory response syndrome (SIRS) criteria, however, the performance of “Red Flag sepsis criteria” has not been tested formally. The aim of the study was to investigate the ability of Red Flag sepsis criteria to identify the patients at high risk of sepsis-related death in comparison to SOFA based sepsis criteria. We also investigated the comparison of Red Flag sepsis to quick SOFA (qSOFA), SIRS, and national early warning score (NEWS) scores and factors influencing patient mortality. Patients were recruited into a 24-hour point-prevalence study on the general wards and emergency departments across all Welsh acute hospitals. Inclusion criteria were: clinical suspicion of infection and NEWS 3 or above in-line with established escalation criteria in Wales. Data on Red Flag sepsis and SOFA criteria was collected together with qSOFA and SIRS scores and 90-day mortality. 459 patients were recruited over a 24-hour period. 246 were positive for Red Flag sepsis, mortality 33.7% (83/246); 241 for SOFA based sepsis criteria, mortality 39.4% (95/241); 54 for qSOFA, mortality 57.4% (31/54), and 268 for SIRS, mortality 33.6% (90/268). 55 patients were not picked up by any criteria. We found that older age was associated with death with OR (95% CI) of 1.03 (1.02–1.04); higher frailty score 1.24 (1.11–1.40); DNA-CPR order 1.74 (1.14–2.65); ceiling of care 1.55 (1.02–2.33); and SOFA score of 2 and above 1.69 (1.16–2.47). The different clinical tools captured different subsets of the at-risk population, with similar sensitivity. SOFA score 2 or above was independently associated with increased risk of death at 90 days. The sequalae of infection-related organ dysfunction cannot be reliably captured based on routine clinical and physiological parameters alone

Sepsis-related deaths in the at-risk population on the wards: attributable fraction of mortality in a large point-prevalence study

Objective Sepsis mortality is reported to be high worldwide, however recently the attributable fraction of mortality due to sepsis (AFsepsis) has been questioned. If improvements in treatment options are to be evaluated, it is important to know what proportion of deaths are potentially preventable or modifiable after a sepsis episode. The aim of the study was to establish the fraction of deaths directly related to the sepsis episode on the general wards and emergency departments. Results 839 patients were recruited over the two 24-h periods in 2016 and 2017. 521 patients fulfilled SEPSIS-3 criteria. 166 patients (32.4%) with sepsis and 56 patients (17.6%) without sepsis died within 90 days. Out of the 166 sepsis deaths 12 (7.2%) could have been directly related to sepsis, 28 (16.9%) possibly related and 96 (57.8%) were not related to sepsis. Overall AFsepsis was 24.1%. Upon analysis of the 40 deaths likely to be attributable to sepsis, we found that 31 patients (77.5%) had the Clinical Frailty Score ≥ 6, 28 (70%) had existing DNA-CPR order and 17 had limitations of care orders (42.5%)

Anti-cholinergic drug burden in patients with dementia increases after hospital admission: a multicentre cross-sectional study

Background: Anticholinergic medications are drugs that block cholinergic transmission, either as their primary therapeutic action or as a secondary effect. Patients with dementia may be particularly sensitive to the central effects of anticholinergic drugs. Anticholinergics also antagonise the effects of the main dementia treatment, cholinesterase inhibitors. Our study aimed to investigate anticholinergic prescribing for dementia patients in UK acute hospitals before and after admission. Methods: We included 352 patients with dementia from 17 UK hospital sites in 2019. They were all inpatients on surgical, medical or Care of the Elderly wards. Information about each patient’s medications were collected using a standardised form, and the anticholinergic drug burden of each patient was calculated with an evidence-based online calculator. Wilcoxon’s rank test was used to look at the correlation between two subgroups upon admission and discharge. Results: On admission to hospital, 37.8% of patients had an anticholinergic burden score ≥ 1 and 5.68% ≥3. On discharge, 43.2% of patients with an anticholinergic burden score ≥ 1 and 9.1% ≥3. The increase in scores was statistically significant (p = 0.001). Psychotropics were the most common group of anticholinergic medications prescribed at discharge. Of those patients taking cholinesterase inhibitors, 44.9% were also prescribed anticholinergic medications. Conclusions: Our cross-sectional, multicentre study found that people with dementia are commonly prescribed anticholinergic medications, even if concurrently taking cholinesterase inhibitors, and are significantly more likely to be discharged from hospital with a higher anticholinergic burden than on admission

Widening Participation in Medicine: The Impact of Medical Student-Led Conferences for Year 12 Pupils

PURPOSE: Individuals from lower socio-economic backgrounds are under-represented in the medical profession: confidence is a barrier to them successfully applying to medical school. This study examined the impact of two student-led conferences for Year 12 pupils, at which they had the opportunity to present their work. It looked at the ability of the conferences to improve participant confidence, and the feasibility of its replication by other student-led groups. METHODS: The first, Conference A, had more time and finances invested into it than the second, Conference B. The latter relied solely on university society funding, but utilised WP criteria for selection of participants. Participants identified their confidence in six areas on a ten-point scale, immediately before and after the intervention. RESULTS: A paired t-test showed a significant improvement (p < 0.01) in all areas of confidence for both conferences. Cohen’s d showed Conference A had larger effect sizes in five out of six areas than Conference B. CONCLUSION: This intervention has demonstrated a significant positive impact on participant confidence: a key factor to improve their chance of successful admission to medical school. Supporting participants with their presentations prior to the conference was found to further enhance their confidence. The authors feel that this work could be replicated successfully by other student groups