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BackgroundIn this study, we aimed to compare the performance of the National Emergency Laparotomy Audit (NELA) and Portsmouth Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity (P-POSSUM) mortality risk scores in predicting 30-day and 90-day mortality in patients undergoing emergency laparotomy. MethodologyA retrospective cohort study was conducted to compare the predictive performance of preoperative NELA, postoperative NELA, and P-POSSUM predicted mortality scores in patients undergoing emergency laparotomy between 2014 and 2021. The outcomes of interest included the observed 30-day and 90-day mortality. The discrimination of the mortality tools was assessed and compared by determining the area under the curve (AUC) for each tool using the receiver operating characteristic curve analysis. ResultsA total of 681 patients were included. The observed risk of 30-day and 90-day mortality was 10.4% (71/681) and 14.2% (97/681), respectively. Regarding 30-day mortality, the AUC was 0.791 (0.727-0.855) for the preoperative NELA score, 0.784 (0.721-0.848) for the preoperative P-POSSUM score, and 0.761 (0.699-0.824) for the postoperative NELA score. Regarding 90-day mortality, the AUC was 0.765 (0.708-0.821) for the preoperative NELA score, 0.749 (0.692-0.807) for the preoperative P-POSSUM score, and 0.745 (0.691-0.800) for the postoperative NELA score. The observed/expected ratio for 30-day and 90-day mortality was 3.25 and 4.43 for preoperative NELA, 2.81 and 3.84 for preoperative P-POSSUM, and 2.17 and 2.96 for postoperative NELA, respectively. Pairwise comparisons showed no statistically significant difference in discrimination among the three models. ConclusionsPreoperative NELA, postoperative NELA, and P-POSSUM scores underestimated the risk of 30-day and 90day mortality in patients undergoing emergency laparotomy. No significant difference in predictive performance was found among the three models.

This study aims to determine the effect of thinking style, integrity, and meaning of work on counterproductive work behavior in creative industries. The concept in explaining phenomenon start from elaboration from each of the keywords mentioned: thinking style, integrity, work meaning, and counterproductive behavior. The research method used in this research is explanatory research. The data used are primary. The population in this study is the entire creative industry sector in Indonesia. This research model is multivariate using SPSS as an analytical tool in this research. The results showed partially and simultaneously that the style of thinking, integrity, and meaning of work did not affect counterproductive behavior. So we can conclude that this study shows that if there is counterproductive behavior in employees in the creative industry who have a more open-minded pattern but no influence from thinking style, integrity, and work meaning.

Background: Many different minimally invasive techniques for cholecystectomy were described in the literature to achieve better cosmetic results. Trans umbilical cholecystectomy (TUC) gained popularity but with associated challenging ergonomic and higher cost due to the need of specialized access platform and instruments (SAPI). This has led to limiting their widespread especially in low economic countries. We aimed here to study the feasibility and safety of using the conventional laparoscopic set-up in performing trans umbilical cholecystectomy (TUC) in our tertiary care university hospital. Patients and methods:We conducted a prospective cohort study, from January 2016 to June 2018, eligible patients with symptomatic gall stones (100 cases) were divided into two groups: group A, TUC with conventional instruments (TUC-CI) versus group B, TUC with specialized instruments (TUC-SI). Exclusion criteria were acute cholecystitis, biliary pancreatitis, choledocholithiasis, BMI ≥ 35, previous upper abdominal surgeries, pregnancy, and ASA score higher than 2. Demographic data, perioperative complications, conversion rate, hospital stay, and procedure cost were recorded and statistically compared between the groups.Results: There was sample homogeneity between both groups regarding age, sex, and BMI. No significant difference (P -Value ≥0.05) between both groups regarding the mean operative time (48± 23.50, 45.5 ± 19.11), hospital stay (0.4 ± 1.06 vs 0.32 ± 0.84) respectively, postoperative complications, and conversion rate to CLC. No major intraoperative complications or conversion to open surgery were needed in both groups. The cost of TUC-SI was significantly higher due to the cost of SAPI. Conclusions:Trans umbilical single incision laparoscopic cholecystectomy is feasible with the same set-up used in conventional laparoscopic cholecystectomy in selected patients without any additional cost of specialized access platform & instruments. CLC is still our primary procedure.

Aim Ultrasound scan is a crucial clinical tool in the management of acute appendicitis in children. That is because it can aid in the diagnosis without exposing the patient to potentially harmful ionising radiation from computed tomography scans. In this project, we were assessing whether children presented with right iliac fossa pain receive their scans on time. In addition, we were exploring whether definitive management and hospital length of stay were affected by the scan delay. Method This was a retrospective project in which we assessed case notes of paediatric patients who had an ultrasound scan between September 2019 and September 2020 in one of the district general hospitals in the UK. The project included notes of patients who were below 16, admitted with right iliac fossa pain, and had an inpatient ultrasound scan. Results A total of 33 patients met the inclusion criteria. The waiting time ranged from 1 hour to 89 hours with a mean of around 19.5 hours and a median of 14.5 hours. The hospital length of stay ranged from 1 day to 21 days with a mean of around 2.5 days and a median of 1 day. Conclusions An ultrasound scan should be conducted within the same day of admission for all paediatric patients presented with right iliac fossa pain.