Burton Hospitals NHS Foundation Trust

BackgroundAcute upper gastrointestinal bleeding (AUGIB) is a medical emergency associated with significant morbidity and mortality. Prognosis and management are typically determined by the patient’s clinical features and findings on endoscopy.ObjectiveThis study aimed to evaluate the demographic characteristics, risk stratification, endoscopic findings, and therapeutic interventions in patients presenting with AUGIB at Queens Hospital, Burton, United Kingdom, in 2024.MethodsA retrospective analysis was performed of all inpatients who underwent upper gastrointestinal endoscopy for hematemesis and/or melena from January to December 2024. Data on demographics, Glasgow-Blatchford Score (GBS), hemodynamic status, endoscopic diagnoses, interventions, and outcomes were obtained from electronic medical records and analyzed using SPSS Version 23 (IBM Corp., Armonk, NY, USA).ResultsSixty-four patients (mean age 72.1±15.8; 71% male) were included. Nonvariceal bleeding accounted for 92% of cases, with duodenal ulcers (17%) and gastric ulcers (11%) as leading etiologies. All patients were risk-assessed using the GBS on admission. Twenty-five percent of patients with nonvariceal bleeding required therapeutic endoscopy, primarily using dual or triple modalities. Variceal bleeds (8%) were managed with terlipressin, antibiotics, and band ligation based on endoscopic grade. Re-bleeding occurred in 3.1% of patients, necessitating further interventions.ConclusionAUGIB predominantly affected elderly males, with nonvariceal etiologies, particularly peptic ulcers, being most common. Universal risk stratification and timely endoscopic intervention in line with best practices helped improve outcomes. The study recorded a low re-bleeding rate.

Bechterew’s disease, or ankylosing spondylitis (AS), is a chronic inflammatory spondyloarthropathy that causes spinal rigidity and increases the risk of unstable fractures, often after low-energy trauma. This systematic review included seven studies encompassing 672 patients with ankylosed spines who sustained spinal fractures. Clinical presentation commonly involves sudden back or neck pain, kyphotic deformity, limited spinal mobility, and neurological deficits, which may be subtle and easily overlooked. Fractures predominantly affect the cervical spine (C5-C7) and thoracolumbar junction (T11-L2), often extending through all three spinal columns, resulting in high instability and risk of spinal cord injury. Accurate imaging is critical; computed tomography delineates bony injuries, while magnetic resonance imaging identifies spinal cord damage, ligamentous disruption, and epidural hematomas. Nonoperative management carries a high risk of secondary displacement and neurological deterioration, whereas early surgical stabilization, typically via posterior or combined anterior-posterior fixation, improves outcomes. Multidisciplinary care involving orthopedic, neurosurgical, and critical care teams is essential for optimizing recovery. Limitations of the current literature include small sample sizes and heterogeneous study designs. Future research should focus on prospective multicenter studies, standardized imaging and management protocols, and long-term functional outcomes to reduce fracture risk and improve care in this high-risk population.

Necrotizing fasciitis (NF) is a rapidly progressive infection with high mortality. When NF complicates orthopedic fractures, early recognition is particularly challenging because swelling, erythema, and pain may be misattributed to trauma or postoperative changes. A systematic review was conducted using PubMed, Embase, Scopus, and Cochrane databases up to June 2025 according to Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 guidelines. Eligible studies included human patients with orthopedic fractures complicated by NF in whom radiologic evaluation and clinical outcomes were reported. Risk of bias was assessed using the Joanna Briggs Institute checklist for case reports. Six studies were included, comprising six individual patients with fracture-associated NF. Radiologic evaluation revealed that plain radiographs occasionally demonstrated subcutaneous gas, while CT consistently identified fascial gas, edema, and fluid tracking. MRI was most sensitive for detecting fascial necrosis, particularly in cases under immobilization casts. Clinical outcomes were poor: four patients died, one underwent limb amputation with subsequent death, and one achieved limb salvage with fracture union. Diabetes, ischemia, and virulent pathogens (e.g., Aeromonas hydrophila) were major contributors to adverse prognosis. Reporting of systemic complications, including renal dysfunction, was limited despite their recognized prognostic value. Fracture-associated NF is exceedingly rare but carries devastating outcomes, with mortality in the majority of reported cases. CT and MRI play a critical adjunctive role in diagnosis, but cannot replace urgent surgical exploration. Standardized reporting of systemic complications, especially acute kidney injury, is needed. Multicenter registries are essential to establish more robust diagnostic and prognostic frameworks.

Abstract Introduction Colorectal cancer (CRC) is one of the most preventable cancers and represents the third most common cancer globally. Emerging trends of association with diverticulitis highlight the need for updated follow-up protocols. This study aimed to examine the risk factors associated with CRC within 12 months of the index admission of acute diverticulitis to optimise the follow-up strategies. Methods Retrospective multicenter study included adult patients with CT-confirmed acute diverticulitis from four UK hospitals in 2022. Data on demographics, comorbidities, clinical presentation, vital signs, blood results, admission details, and colonic follow-up investigations were analysed. The primary outcome was CRC incidence within 12 months of index presentation; secondary outcomes examined associated factors with the CRC and follow-up patterns. Statistical analysis was performed using R version 4.4, with p-values <0.05 considered significant. Results Among 542 patients, the median age was 62 (51–73) years, with 204 (37.6%) males. CRC was diagnosed in 10 (1.8%) patients within a year. Hinchey grade Ib diverticulitis was significantly associated with CRC (OR 4.51, p=0.028). Male gender, age (18–40), and elevated CRP were associated with CRC but not statistically significant. Despite these findings, the follow-up strategies were inconsistent; only 53.7% had a colonic evaluation. Conclusion The incidence of CRC in this study was 1.8%, consistent with current literature. Hinchey 1b grade was a key predictor. These findings emphasise the importance of specialised radiological reviews to detect malignancy obscured by inflammation. The inconsistency of post-diverticulitis surveillance protocols underscores the need for a standardised strategy for early cancer detection.

To systematically evaluate the clinical utility of machine learning in predicting postoperative outcomes following colorectal surgery. A systematic literature search was conducted using PubMed, MEDLINE, Embase, and Google Scholar. Clinical studies investigating the role of machine learning models in predicting postoperative complications following colorectal surgery were included. Outcome measure was area under the curve for the model under investigation. The area under the curve and standard error were pooled using a random effects model to estimate the overall effect size. Statistical analyses were performed using the MedCalc (version 23) software, and the results presented as forest plots. Eighteen eligible articles were included. These reported outcomes on postoperative complications, namely anastomotic leak, mortality, prolonged length of hospitalization, re-admission rates, risk of bleeding, paralytic ileus occurrence, and surgical site infection. Pooled area under the curve for anastomotic leak was 0.813 [standard error: 0.031, 95% confidence interval (0.753-0.873)]; mortality 0.867 [standard error: 0.015, 95% confidence interval (0.838-0.896)]; prolonged length of stay 0.810 [standard error: 0.042, 95% confidence interval (0.728-0.892)]; and surgical site infection 0.802 [standard error: 0.031, 95% confidence interval (0.742-0.862)], respectively. Machine learning methods and techniques are displaying promising clinical utility and applicability in accurately predicting the risk of developing complications following colorectal surgery. Future well-designed, adequately powered, multi-center studies are needed to investigate the usefulness and generalizability of these novel approaches in optimizing peri-operative surgical care.

IntroductionColorectal cancer (CRC) is the third most common cancer worldwide, accounting for approximately 10% of all malignancies. Emerging trends of association with risk factors such as diverticulitis highlight the need for updated screening and follow-up protocols. We aimed to examine risk factors associated with the development of CRC within 12 months following an episode of acute diverticulitis, and identify areas to streamline follow-up.MethodsWe performed a retrospective multicentre study of adult patients admitted in 2022 with computed tomography (CT) confirmed acute diverticulitis across four large NHS Trusts in the UK. Patient demographics, comorbidities, clinical presentation, vital signs, laboratory results, details of in-patient stay, and follow-up investigations were collected and analysed. Our primary outcome was the incidence of CRC within 12 months of index presentation with acute diverticulitis. Analysed secondary outcomes were potential patient risk factors associated with a diagnosis of CRC and follow-up protocols. All statistical analysis was performed using R (version 4.4) and P-values of < 0.05 were considered statistically significant.ResultsA total of 542 patients with acute diverticulitis over the study period were included. The median age of our cohort was 62 (51–73) years, and 204 (37.6%) were male. Ten (1.8%) patients were diagnosed with CRC within the 12-month period. Hinchey grade Ib was significantly associated with CRC (OR 4.51, P = 0.028). Colonoscopic follow-up requests were associated with age between 40 and 60 years, mild white cell count (WCC) elevation, and a hospital stay of 3–7 days. Male gender, age between 18 and 40 years, and elevated C-reactive protein (CRP) were all strongly associated with CRC but not statistically significant. Follow-up was inconsistent with 53.7% of the cohort having luminal investigations.ConclusionThe incidence of CRC was in-keeping with published literature. Hinchey grade 1b was significantly associated with a subsequent CRC diagnosis. These findings emphasise the need for specialised radiological review of CT scans to detect underlying malignancy. Moreover, standardised follow-up protocols following an episode of acute diverticulitis are needed to avoid missing malignant lesions.

Most commercial beers are made using water, malted barley, and hops as the principal ingredients and Saccharomyces yeast as the transforming microorganism. The yeast is used in a semi-conservative process in which crops are collected from one fermentation, stored, and a proportion recycled into a subsequent fermentation. This process differs from wine, cider, and spirit manufacturing where the yeast culture is only used once. The serial fermentation process is continued approximately 8-12 times after which a new culture of verified purity and identity is introduced. This increases the likelihood that the yeast remains true to type. Many commercial brewers use proprietary strains the origins of which are usually unknown. Advances in genetic analyses provide a means for probing the origins of brewing yeast strains, and in this study, six historical Irish brewing yeasts from five breweries located within Ireland were assessed. Using Illumina sequencing technology, whole-genome sequencing data were generated. Single nucleotide polymorphism analysis of these data established that the historical Irish brewing yeast group falls within the previously described "Britain" subpopulation Beer 1 clade. Further analysis established that the six historical Irish brewing yeasts separate into two subgroupings, which associated with specific regional locations. Furthermore, the assessment of the six historical Irish brewing yeast phenotypic attributes relevant to brewing correlated within the same regional location groupings. Our data provide further evidence of how brewing requirements associated with specific beer styles have influenced yeast strain selection.

Colorectal cancer (CRC) is the fourth most common malignancy in the UK and represents a high-volume diagnostic and clinical burden on the National Health Service (NHS). To maximise the use of limited diagnostic resources and increase efficiency, the colorectal services at University Hospitals North Midlands Trust (UHNM) developed the triage-to-test (TTT) service with risk stratification for diagnostic testing in patients with suspected colorectal cancer using faecal immunochemical testing (FIT) result. Our retrospective cohort study looked at the pick-up rate of colorectal cancer (CRC) and non-colorectal cancer (non-CRC) in FIT-negative patients. The study was a retrospective review of all symptomatic patients over 18 years of age who had undergone FIT testing in the community between 1November 2021 and 11February 2022 and whowere referred directly to the UHNM colorectal pathway from primary care (n=2,374). FIT negativity was set at <9.9 μg/g of faeces, as per the National Institute for Health and Care Excellence (NICE) DG30 guidelines. Patients were investigated and risk stratified in accordance with their FIT result and presenting symptoms. About 61.5% of patients referred were FIT negative (n=1,459) and 38.5% were FIT positive (n=915). Of those FIT-negative patients, 82 were excluded as their clinical outcomes were pending at the time of analysis. FIT positivity conferred a greater likelihood of colorectal cancer when compared with FIT-negative patients (p<0.0001). FIT-negative patients were most likely to have no significant pathology (32.5%, n=474). Incidence of colorectal cancer in the FIT-negative group was 0.5% (n=7) compared with 9.8% (n=89) in the FIT-positive group (odds ratio: 5.252, 95% CI: 4.012-6.875). Within the FIT-negative cohort, five patients were diagnosed with rectal cancer, one proximal descending colon cancer and one caecal cancer. The use of a FIT-negative TTT pathway ensures that any symptomatic patients presenting with red flag symptoms can be investigated appropriately. It also provides reassurance to clinicians who have an ethical duty to investigate patients in whom they suspect sinister pathology. Moreover, a triage-to-Test pathway reduces outpatient capacity burden onhealthcare trusts as they may send patients directly for investigation.

Microsoft Teams meetings can accommodate many different scenarios looking both at the way participants are able to join and at the number of participants. A Teams meeting can host a maximum of 20,000 attendees, with the initial 1,000 participants having fully interactive features such as chat and reactions. Once this threshold is reached, additional attendees will enter in view-only mode. Teams meetings enable both internal and external members of your organization to join.

In this chapter, we will talk about features that are essential for completing the services offered by Microsoft Teams Phone. Configuring auto attendants, call queues, and resource accounts ensures efficient call routing and management and improves customer service and operational efficiency. Customizing features like Music on Hold and caller ID adds branding to the service. Proper user and policy management for the additional phone features like dial-out conferencing, on top of what we have already seen, ensures that the Microsoft Teams services are tailored on the specific usages.