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These results demonstrate the efficacy of the abbreviated MEDS score, the MEW score and NPT venous lactate levels in predicting 28-day mortality in ED patients with sepsis. The abbreviated MEDS score was found to be the best performing risk assessment model which, with prospective validation, may aid early clinical decision-making in ED patients with sepsis and might affect the outcome from sepsis.

Faecal immunochemical testing (FIT) has a high sensitivity for the detection of colorectal cancer (CRC). In a symptomatic population FIT may identify those patients who require colorectal investigation with the highest priority. FIT offers considerable advantages over the use of symptoms alone, as an objective measure of risk with a vastly superior positive predictive value for CRC, while conversely identifying a truly low risk cohort of patients. The aim of this guideline was to provide a clear strategy for the use of FIT in the diagnostic pathway of people with signs or symptoms of a suspected diagnosis of CRC. The guideline was jointly developed by the Association of Coloproctology of Great Britain and Ireland/British Society of Gastroenterology, specifically by a 21-member multidisciplinary guideline development group (GDG). A systematic review of 13 535 publications was undertaken to develop 23 evidence and expert opinion-based recommendations for the triage of people with symptoms of a suspected CRC diagnosis in primary care. In order to achieve consensus among a broad group of key stakeholders, we completed an extended Delphi of the GDG, and also 61 other individuals across the UK and Ireland, including by members of the public, charities and primary and secondary care. Seventeen research recommendations were also prioritised to inform clinical management.

Aim There is a requirement for an expansive and up to date review of the management of emergency colorectal conditions seen in adults. The primary objective is to provide detailed evidence‐based guidelines for the target audience of general and colorectal surgeons who are responsible for an adult population and who practise in Great Britain and Ireland. Methods Surgeons who are elected members of the Association of Coloproctology of Great Britain and Ireland Emergency Surgery Subcommittee were invited to contribute various sections to the guidelines. They were directed to produce a pathology‐based document using literature searches that were systematic, comprehensible, transparent and reproducible. Levels of evidence were graded. Each author was asked to provide a set of recommendations which were evidence‐based and unambiguous. These recommendations were submitted to the whole guideline group and scored. They were then refined and submitted to a second vote. Only those that achieved >80% consensus at level 5 (strongly agree) or level 4 (agree) after two votes were included in the guidelines. Results All aspects of care (excluding abdominal trauma) for emergency colorectal conditions have been included along with 122 recommendations for management. Conclusion These guidelines provide an up to date and evidence‐based summary of the current surgical knowledge in the management of emergency colorectal conditions and should serve as practical text for clinicians managing colorectal conditions in the emergency setting.

There has been recognition across the Department of Defense (DoD) that psychologists are increasingly called on by military commanders to support military operations in unique and diverse ways. This call has resulted in the expansion of the role of military psychology. Military psychologists are treading where they have not previously, and this has raised a number of concerns in terms of training preparation and ethics. In this article we explore an emerging subdiscipline in behavioral science, operational psychology. A series of vignettes illustrates this subdiscipline in practice, and a discussion of training implications and ethical considerations follows accordingly.In recent years a new subdiscipline has emerged in psychology: operational psychology. This subdiscipline has revealed itself predominantly within military psychology, although other government agencies employ psychologists and behavioral science experts who perform duties similar to those performed by operational psychologists. Although psychology has been applied to nontraditional (nonmedical) areas for many decades, the nature of these applications and the frequency with which they are occurring has increased significantly since 9/11 and the Global War on Terrorism (GWOT). One result of this change has been recognition by many that a new area of specialization is emerging. As a relatively new area of practice, operational psychology has remained somewhat obscure and is often misunderstood by psychologists, including those within the military.

This study presents the experience with laparoscopic deroofing of nonparasitic liver cysts at a single center over a 9-year period. A total of 25 patients, undergoing 32 operations, were identified. Median cyst diameter was 10 cm for de novo cysts and 9.5 cm for recurrent cysts. Six patients had multiple cysts consistent with polycystic liver disease. In total, there were 26 laparoscopic procedures and 2 open conversions. Four procedures were commenced as open, three of which were for recurrent cysts. Minor complications were bleeding from a port site (n=1), pneumothorax (n=2), and intra-abdominal collection (n=1). One major complication of bile leak and relaparotomy occurred following an open deroofing. No major complications were recorded for laparoscopic procedures. Symptomatic recurrence of cysts occurred in four patients with simple cysts (5%) and one patient with polycystic liver disease. We conclude that laparoscopic liver cyst deroofing is an effective method of dealing with symptomatic nonparasitic liver cysts.

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Pancreatic surgery is still associated with a relatively high morbidity and mortality compared with other specialties. This is a result of the complex nature of the organ, the difficult access as a result of the retroperitoneal position and the number of technically challenging anastomoses required. Nevertheless, the past two decades have witnessed a steady improvement in morbidity and a decrease in mortality achieved through alterations of technique (particularly relating to the pancreatic anastomoses) together with hormonal manipulation to decrease pancreatic secretions. Recently minimally invasive pancreatic surgery has been attempted by several centres around the world which has stimulated considerable interest in this approach. The majority of the cases attempted have been distal pancreatectomies, because of the more straightforward nature of the resection and the lack of a pancreatic ductal anastomosis, but more recently reports of laparoscopic pancreaticoduodenectomy have started to appear. The reports of the series to date have been difficult to interpret and although the results are claimed to be equivalent or better than those associated with a traditional approach a careful examination of the literature and comparison with the best results previously reported does not presently support this. In the present review we examined all the reports of pancreatic procedures performed laparoscopically and compared the results with those previously achieved at open surgery.