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Abstract Background Adhesive small bowel obstruction (ASBO) is a leading cause of hospitalization in emergency surgery. The occurrence of bowel ischemia significantly increases the morbidity and mortality rates associated with this condition. Current clinical, biochemical and radiological parameters have poor predictive value for bowel ischemia. This study is designed to ascertain predictive elements for the progression to bowel ischemia in patients diagnosed with non-strangulated ASBO who are initially managed through conservative therapeutic approaches. Methods The study was based on the previously collected medical records of 128 patients admitted to the Department of Acute Care Surgery of Padua General Hospital, from August 2020 to April 2023, with a diagnosis of non-strangulated adhesive small bowel obstruction, who were then operated for failure of conservative treatment. The presence or absence of bowel ischemia was used to distinguish the two populations. Clinical, biochemical and radiological data were used to verify whether there is a correlation with the detection of bowel ischemia. Results We found that a Neutrophil-Lymphocyte ratio (NLR) > 6.8 (OR 2.9; 95% CI 1.41–6.21), the presence of mesenteric haziness (OR 2.56; 95% CI 1.11–5.88), decreased wall enhancement (OR 4.3; 95% CI 3.34–10.9) and free abdominal fluid (OR 2.64; 95% CI 1.08–6.16) were significantly associated with bowel ischemia at univariate analysis. At the multivariate logistic regression analysis, only NLR > 6.8 (OR 5.9; 95% CI 2.2–18.6) remained independent predictive factor for small bowel ischemia in non-strangulated adhesive small bowel obstruction, with 78% sensitivity and 65% specificity. Conclusions NLR is a straightforward and reproducible parameter to predict bowel ischemia in cases of non-strangulated adhesive small bowel obstruction. Employing NLR during reevaluation of patients with this condition, who were initially treated conservatively, can help the acute care surgeons in the early prediction of bowel ischemia onset.

Background: Adhesive small bowel obstruction (ASBO) is a leading cause of hospitalization in emergency surgery. The occurrence of bowel ischemia significantly increases the morbidity and mortality rates associated with this condition. Current clinical, biochemical and radiological parameters have poor predictive value for bowel ischemia. This study is designed to ascertain predictive elements for the progression to bowel ischemia in patients diagnosed with non-strangulated ASBO who are initially managed through conservative therapeutic approaches. Methods: The study was based on the previously collected medical records of 128 patients admitted to the Department of Acute Care Surgery of Padua General Hospital, from August 2020 to April 2023, with a diagnosis of non-strangulated adhesive small bowel obstruction, who were then operated for failure of conservative treatment. The presence or absence of bowel ischemia was used to distinguish the two populations. Clinical, biochemical and radiological data were used to verify whether there is a correlation with the detection of bowel ischemia. Results: We found that a Neutrophil-Lymphocyte ratio (NLR) > 6.8 (OR 2.9; 95% CI 1.41–6.21), the presence of mesenteric haziness (OR 2.56; 95% CI 1.11–5.88), decreased wall enhancement (OR 4.3; 95% CI 3.34–10.9) and free abdominal fluid (OR 2.64; 95% CI 1.08–6.16) were significantly associated with bowel ischemia at univariate analysis. At the multivariate logistic regression analysis, only NLR > 6.8 (OR 5.9; 95% CI 2.2–18.6) remained independent predictive factor for small bowel ischemia in non-strangulated adhesive small bowel obstruction, with 78% sensitivity and 65% specificity. Conclusions: NLR is a straightforward and reproducible parameter to predict bowel ischemia in cases of non-strangulated adhesive small bowel obstruction. Employing NLR during reevaluation of patients with this condition, who were initially treated conservatively, can help the acute care surgeons in the early prediction of bowel ischemia onset. [ABSTRACT FROM AUTHOR]

Background: ASBO is a frequent abdominal surgical emergency and a leading cause of morbidity and mortality in emergency surgery. The aim of this study is to provide insight into the current management of adhesive small bowel obstruction (ASBO) and associated outcomes. Methods and materials: A nationwide prospective cross-sectional cohort study was conducted. All patients with clinical signs of ASBO admitted to participating Dutch hospitals were included during a 6 months inclusion period between April 2019 and December 2020. Ninety-day clinical outcomes were described and compared for nonoperative management (NOM) and laparoscopic and open surgery. Results: In 34 participating hospitals, 510 patients were included, of whom 382 (74.9%) had a definitive diagnosis of ASBO. Initial management consisted of emergency surgery in 71 (18.6%) patients and NOM in 311 (81.4%) patients, 119 (31.1%) of whom required delayed surgery after failure of NOM. Surgical interventions started laparoscopically in 51.1%, of which 36.1% were converted to laparotomy. Intentional laparoscopy resulted in shorter hospital stays compared with open surgery (median 8.0 vs. 11.0 days; P <0.001) and comparable hospital mortality (5.2 vs. 4.3%; P =1.000). Oral water-soluble contrast use was associated with a decreased length of stay (P =0.0001). Hospital stay for surgical patients was shorter in patients who were operated on within 72 h of admission (P< 0.001). Conclusion: This nationwide cross-sectional study demonstrates shorter hospital stay in ASBO patients who received watersoluble contrast, were operated within 72 h of admission or were operated with minimally invasive techniques. Results may support the standardization of ASBO treatment. [ABSTRACT FROM AUTHOR]

Introduction Adhesive small bowel obstruction (ASBO) is a common cause of admissions to general surgery services. Water-soluble contrast (WSC), such as Gastrografin® (GGF), can be utilised in the conservative management of patients with ASBO, with predictive and possible therapeutic value. We audited the non-operative management of ASBO in the general surgery department of East and North Hertfordshire NHS Trust, a district general hospital. Following the introduction of a hospital-wide protocol standardising the use of GGF in patients with ASBO, a re-audit was conducted to assess its impact. Methods A retrospective audit of ASBO patients who received GGF was conducted in two cycles: before and after the implementation of the protocol. Data were collected between February and June 2022 for group 1 (pre-protocol) and between August and November 2023 for group 2 (post-protocol). Results Forty-eight patients were included in the analysis across both groups: 31 in group 1 (pre-protocol) and 17 in group 2 (post-protocol). The success rate of this non-operative trial with GGF increased from 77% (24/31) in group 1 to 88% (15/17) in group 2. The median duration of conservative management was two days in both groups. The median time from CT scan to GGF administration decreased from 24 hours in group 1 to 19 hours 22 minutes in group 2, and the interval between GGF administration and first abdominal radiograph decreased from 9 hours in group 1 to 6 hours 25 minutes in group 2. Conclusion Our closed-loop audit suggests that by streamlining the non-operative management pathway of adhesive small bowel obstruction, our standardised protocol is safe and possibly improves efficiency within a district general hospital setting., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Rehman et al.)

This paper explores the process of punitive reform through a cultural theory lens. The existing literature focuses on high-end punishments of historical pedigree e.g. imprisonment or the death penalty. This paper instead takes as its focus low-end, contemporary punishments. In doing so, it provides original insights into the utility a cultural methodology can bring to understanding punitive reform in the digital age. It tests the applicability of Philip Smith's theory of the cultural life of punishment to case studies of the Anti-Social Behaviour Order (ASBO) and its replacements in England and Wales, the Criminal Behaviour Order and the Injunction. The ASBO was a punitive zeitgeist of its time becoming rooted in popular culture. However, it was ultimately abolished after attracting a predominantly negative cultural narrative. Thus far, after attracting some controversy at the legislative stage, the Criminal Behaviour Order and Injunction have received minimal scrutiny, despite being more problematic than their predecessor. This paper argues that the lower cultural impacts of the new punishments are responsible for the lack of scrutiny. [ABSTRACT FROM AUTHOR]

The Anti-Social Behaviour Order (ASBO) was designed as a civil/criminal hybrid, preventive in structure and with a largely undefined object. After 2002, legal challenges to the ASBO led to the use of justificatory arguments from cumulative effect, and to the introduction of new measures which offered to regulate anti-social behaviour in more legally acceptable forms. In 2014 the Coalition government replaced the ASBO with two new instruments: a post-conviction Criminal Behaviour Order (CBO) and a wholly-civil anti-social behaviour injunction (ASB Injunction). While the CBO and the ASB Injunction build on this history, it is argued that they do not represent a new approach to anti-social behaviour so much as a continuation of the ASBO by other means. [ABSTRACT FROM AUTHOR]

An ongoing commitment to tackling anti-social behaviour was a central part of the New Labour policy agenda throughout their 13 years in government. Their policy and practice became increasingly enforcement-led with the anti-social behaviour order (ASBO) at the cornerstone of their agenda. Police and local authorities came under pressure to see the ASBO, along with a whole range of other enforcement powers, as almost a panacea for tackling anti-social behaviour and, in particular, youth disorder. This article draws upon the literature, the authors’ own evaluation experience and recently released statistics from the Ministry of Justice and the British Crime Survey to examine the legacy of New Labour in terms of tackling anti-social behaviour. These are discussed within the context of the Coalition Government’s emerging ideas about how best to tackle anti-social behaviour, including their plans to abandon the ASBO along with other enforcement measures introduced under New Labour. We suggest that rather than abandoning the ASBO altogether, there may be advantages to ‘rehabilitating’ the ASBO within the context of a range of more far-sighted and proactive community-based measures. We discuss the lessons to be learnt from New Labour’s legacy and discuss ways forward within the context of coalition government policy. [ABSTRACT FROM PUBLISHER]

Tackling anti-social behaviour (ASB) was given central place in the 2004–2008 Home Office Strategic Plan, Tony Blair describing his government's policy agenda as a cultural ‘crusade’. Scholarly attention has often focused upon the implementation of the ASB management agenda but rather less attention has been given to the fast-moving politics behind the developing ASB debate. Following an introductory discussion connecting the ‘narrow politics’ of ASB strategy to a wider analysis of social divisions and the state of cultural politics in contemporary Britain, the article proceeds to consider ‘four phases’ embracing key changes, developments and turning points in the politics of ASB.British Politics (2008) 3, 300–323. doi:10.1057/bp.2008.16 [ABSTRACT FROM AUTHOR]

Government responses to 'anti-social behaviour' have included, amongst others, two trends that employ shame in pursuit of crime prevention: "naming and shaming" of those subject to anti-social behaviour orders (ASBOs) on one hand and restorative justice on the other. This article considers how the Government has made use of each, the dynamics of each shaming process, and the compatibility of these approaches. It argues that they are mutually exclusive, and that restorative justice should be preferred as a potentially more constructive shaming process. [ABSTRACT FROM AUTHOR]

This article focuses on media reportage of offensive juveniles, past and present, to elicit lessons that the twenty-first century can learn from the Victorian past in terms of diversionary responses. How to prevent vulnerable juveniles sliding into dangerous criminality is a continuing preoccupation: the issue explored in this article relates to the creation of the identity of the criminal juvenile. In utilising the concept of semi-criminality to label certain types of juvenile anti-social behaviour the Victorians avoided actual criminalisation of socially offensive but, in legal terms, minor behaviours. The reasons for and negative consequences of the abandonment of this concept by the modern age are explored, including the reconceptualisation of where responsibility for juvenile offending lies in the modern era. [ABSTRACT FROM AUTHOR]

Abstract: The Anti-Social Behaviour Order is now a fixture, not just of the legal system in the United Kingdom, but also of the culture and in the public consciousness. The definition of ‘anti-social behaviour’ was left deliberately vague, but this has led to ASBOs being used in a number of situations for which they were not intended. In addition, the zealotry of some local policy-makers has produced huge regional differences in their use. ASBOs are still used against the most vulnerable in society, including children and the mentally ill, and large numbers of people have been imprisoned for breaching them, often for crimes that were not themselves imprisonable or for acts that were not even criminal. There has been widespread criticism of ASBOs from legal and diplomatic quarters, and from officials appointed by the Government itself; and it seems likely that they bring the United Kingdom into breach of many of its most important obligations under international law. The baleful effect of the ASBO is now coming to be seen in other, adjacent areas of social policy, and in some cases, it has actually reversed progressive developments in social policy. [Copyright &y& Elsevier]

Background and Aims: Approximately 75% of patients admitted with small bowel obstruction have intra-abdominal adhesions as their cause (adhesive small bowel obstruction). Up to 70% of adhesive small bowel obstruction cases, in the absence of strangulation and bowel ischemia, can be successfully treated with conservative management. However, emerging evidence shows that surgery performed early during the first episode of adhesive small bowel obstruction is highly effective. The objective of this narrative review is to summarize the current evidence on adhesive small bowel obstruction management strategies., Materials and Methods: A review of the literature published over the last 20 years was performed to assess Who, hoW, Why, When, What, and Where diagnose and operate on patients with adhesive small bowel obstruction., Results: Adequate patient selection through physical examination and computed tomography is the key factor of the entire management strategy, as failure to detect patients with strangulated adhesive small bowel obstruction and bowel ischemia is associated with significant morbidity and mortality. The indication for surgical exploration is usually defined as a failure to pass contrast into the ascending colon within 8-24 h. However, operative management with early adhesiolysis, defined as operative intervention on either the calendar day of admission or the calendar day after admission, has recently shown to be associated with an overall long-term survival benefit compared to conservative management. Regarding the surgical technique, laparoscopy should be used only in selected patients with an anticipated single obstructing band, and there should be a low threshold for conversion to an open procedure in cases of high risk of bowel injuries., Conclusion: Although most adhesive small bowel obstruction patients without suspicion of bowel strangulation or gangrene are currently managed nonoperatively, the long-term outcomes following this approach need to be analyzed in a more exhaustive way, as surgery performed early during the first episode of adhesive small bowel obstruction has shown to be highly effective, with a lower rate of recurrence.