bluuebunny/crossref_metadata_2025 huggingface dataset:
979 Enhancing Surgical Training Through Augmented Reality: A Pilot Study on the Use of the Microsoft HoloLens for Live-Streaming from Theatre
Authors: Patel R D , Patrick S , Hanibal G , Murphy Lonergan R , Naparus A , Bartholomew B
Published: August 2024

Aim

Reduced theatre exposure for trainees and students is increasingly detrimental to the surgical workforce. One potential solution is live-streaming from the operating theatre - the Microsoft HoloLens, a mixed-reality headset, facilitates immersive two-way audio and video stream from the perspective of the surgeon. This pilot explores the use of the HoloLens to facilitate trainees’ operative exposure.

Method

Patient operation (BCC removal with rotational flap) was live streamed to an audience of trainees using the HoloLens device and platform Remote Assist. This activity was incorporated into an existing course on plastic surgery aimed at postgraduates.

Written consent was gained and later verified from the patient, to live-stream the procedure for educational purposes. Recording was prohibited. Evaluation of the experience was obtained from the surgeon and observers (n=8) via a post-procedure focus group and anonymous written feedback. Qualitative analysis of feedback was performed by OpenAI GPT.

Results

Observers cited that learning was facilitated by excellent image and audio quality, close communication with the surgeon and improved visibility of the procedure from the operator’s perspective. They also referenced interactive audience discussion and increased comfort as benefits over scrubbed theatre time. Learning was disrupted by technical delays and hardware unreliability. The device also blighted the surgeon’s visual field, comfort, and initial confidence in theatre.

Conclusions

Overall, we demonstrate the value of the HoloLens in increasing surgical exposure, with myriad of observer perceived benefits, likely at the surgeon’s expense.
1216 A QIP to Improve FY1s’ Prescribing in Acute Pain for Patients Admitted Under General Surgery at a District General Hospital
Authors: Carter L , O’Callaghan G , Pagarkar A , Shah K , Engleback M
Published: August 2024

Aim

To improve self-reported confidence in prescribing analgesia in acute pain amongst FY1s on General Surgery at a DGH by improving knowledge of relevant guidelines and improving pain management teaching for FY1s.

Method

We surveyed General Surgery FY1s to assess self-reported confidence scores for prescribing in acute pain and to collect qualitative data about barriers to good pain prescribing. Our first intervention was to create a dedicated folder on the shared drive for the FY1s to easily access the pain management guidelines, as surveys showed that the FY1s found the intranet difficult to navigate and the guidelines difficult to find. Our second intervention was to implement the Essential Pain Management course (initially developed by the Australian and New Zealand College of Anaesthetists and supported by the Royal College of Anaesthetists and the Faculty of Pain Medicine in the UK) as part of the FY1 teaching programme. We reassessed self-reported confidence scores in pain prescribing after each of these interventions.

Results

The first cohort of FY1s had initial self-reported confidence scores of 3.76/5. Following our first intervention this improved to 4.25/5 - a 13% improvement. Our second intervention improved the self-reported confidence scores from 3.2/5 to 4.2/5 – a 31% improvement.

Conclusions

Implementation of the Essential Pain Management course for FY1s can have a positive impact on self-reported confidence in pain prescribing for patients admitted under General Surgery at a DGH, more so than simply improving awareness and knowledge of the guidelines.
1023 Implementation of NHS Net Zero: An Analysis of Clinician Engagement and Quality Improvement
Authors: Sinha V , Taylor L , Swarnkar P , Vijayan R
Published: August 2024

Aim

Since the NHS Net zero report in 2020, UK hospital trusts have been working to achieve net zero carbon emissions by 2040. Henceforth, sustainability leads and working groups have been appointed to formulate and implement “Green Plans”. Clinician involvement and quality improvement (QI) are crucial to achieving net zero emissions. 133 Hospital Trusts in England were surveyed, to establish the extent to which sustainability has been embedded into clinical governance and quality improvement.

Method

130 NHS Trusts in England were contacted during two time periods between 2021 and 2023 using Freedom of Information (FOI) requests. Each trust received a standardised sustainability questionnaire involving induction programmes, clinical governance, audits, QI and research projects. Trusts were required to respond within 20 working days upon receiving an FOI request. Follow-up emails were sent to trusts which did not respond within the timeframe. Requests for further clarification were answered. Data collection and extraction were undertaken using an Excel spreadsheet.

Results

In 2023 sustainability was identified as the theme of 38.8% of audits, QI, or research projects. Most trusts had a sustainability working group (70.7%), the majority of trusts had 0-5 clinicians in their sustainability working group (44.4%). 73.2% of respondents had a sustainability lead, 22.4% included sustainability in clinical governance meetings, and 18.1% included sustainability in junior doctor inductions.

Conclusions

Clinicians remain poorly engaged in matters relating to healthcare sustainability and carbon impact. This may represent a glaring omission in Trusts’ Net Zero plans and a missed opportunity to maximise progress.
440 Intra-Articular Haematoma Block vs Procedural Sedation for Manipulation of Closed Ankle Fracture Dislocations: An Efficacious, Resource Sparing Solution?
Authors: Elmesalmi M , Morcos Z , Mcfall J , Hindi F , KoÇ T
Published: August 2024

Background

Emergency Departments faced amplified pressures during COVID, with Procedural sedation (PS) demands on clinical spaces and PPE use. Queen Alexandra Hospital, Portsmouth, tested intra-articular haematoma blocks (IAHB) as an alternative to PS for manipulating closed ankle fracture dislocations.

Method

Between October 2020 and April 2021, patients with displaced ankle fractures received IAHB using 10ml of 1% lignocaine. Data collected comprised pain scores, time from first x-ray to reduction, and acceptability of the reduction. A retrospective analysis compared this with patients who underwent PS for ankle fractures between March and August 2020.

Results

25 patients received IAHB and 28 received PS . Time from the first x-ray to manipulation was faster with IAHB (65.9 min) compared to PS (82.9 min). In the IAHB group, six had unsatisfactory first attempts, of which five had a second manipulation, with three being successful. One required manipulation under anaesthesia, and another had an unsuccessful PS followed by fixation. In the PS group, five had unsatisfactory reductions. One underwent multiple PS attempts before fixation, and four others required external or open reduction. The number of unsuccessful reductions was similar in both groups. Importantly, IAHB demonstrated significant reductions in pain scores with no post-operative infections. The cost analysis revealed a notable difference, with the approximate cost per case being £0.60 for IAHB, compared to £4.50 for procedural sedation.

Conclusions

IAHB for ankle fractures is effective, safe, and cost-efficient. It negates risks of PS and the need for specific clinical space and skilled personnel for sedation.
527 Identifying the Validity of ChatGPT in the Diagnosis of Orthopaedic Emergencies
Authors: Pankhurst A , Kumar N
Published: August 2024

Aim

Chat Generated Pre-Trained Transformer (ChatGPT) is a large language model that is pre-trained to predict the next token in a document. Our aim is to evaluate the clinical accuracy of ChatGPT in the diagnosis and management of orthopaedic emergencies. ChatGPT has been tested to pass high level medical licencing and board exams. However, there remains concerns regarding the use of artificial intelligence (AI) models, specifically surrounding data governance and accuracy.

Method

Ten clinical scenarios were drafted and then vetted by fellowship level orthopaedic surgeons. The scenarios cover the breadth of orthopaedic emergencies such as septic arthritis, open fractures, and cauda equina syndrome. The scenarios were run through ChatGPT which generated differentials and management options. The answers were then scored by orthopaedic registrars.

Results

The results demonstrated that ChatGPT is largely accurate and safe in the diagnosis of orthopaedic emergencies. In particular, it demonstrated excellent scoring regarding conversation structure with clearly written diagnosis and management plans.

Conclusions

This novel validity study demonstrates that ChatGPT has potential in the diagnosis of orthopaedic emergencies. Given the nature of the AI model, the answers are continually changing as more information is fed into the transformer, thus reproducibility remains a major challenge in testing the model. Furthermore, scoring the quality of the answers provided by the model is subjective. Nevertheless, this study suggests that ChatGPT could provide clinical assistance and more research in the area is necessary to test its limits and safety.
1116 Staples vs. Sutures for Skin Closure in Patients Who Had Hip Arthroplasty for Treatment of a Neck of Femur Fracture
Authors: Okata D , Khin C , Kyaw O , Bannister P , Stott P
Published: August 2024

Aim

Following an arthroplasty procedure (hemi and total) for fractured neck of femur, the incision can be closed with sutures or clips, depending on surgeon’s preference. This study aims to evaluate the incidence of complications when comparing skin closure with staples vs. sutures in patients who have had a hip arthroplasty for treatment of neck of femur fractures.

Method

We analysed the numbers of patients who had further procedures following a hip arthroplasty. We compared the 2 groups for numbers and types of further procedures. A retrospective study which looked at neck of femur fracture patients who were treated with a hip arthroplasty within a 1-year period. We looked at the type of skin closure used during the operation and if any of these patients needed to have a further procedure such as a washout, DAIR or revision surgery.

Results

A total of 372 patients were studied. 247 had a hemiarthroplasty and 125 had a total hip replacement. There was no statistical difference in the patient’s demographics (age and sex). Of the 128 patients that had skin closure with staples, 7 of them required further procedures (5.5%), while of the 244 patients had skin closure with sutures, 4 of them required further procedures (1.6%).

Conclusions

Skin closure using sutures is associated with a much lower risk of surgical site infection and further procedures when compared to skin closure with staples in neck of femur fracture patients who have been treated with a hip arthroplasty.
1204 Efficacy of Novel Regional Anaesthetic Techniques in Day-Case Hip and Knee Arthroplasty
Authors: White C , Yakubi M , Manlapaz K , Knight U , Abdalla W , Tiwatane S , Subramanian P
Published: August 2024

Introduction

Pericapsular nerve group block (PENG) and infiltration of local anaesthetic between the popliteal artery and capsule of the knee (iPACK) are novel regional anaesthetic techniques that have not been well studied. PENG targets the anterior hip capsule through blocking articular branches of the femoral, obturator and accessory obturator nerves whilst sparing motor function. iPACK targets the sensory articular branches of the sciatic nerve whilst sparing motor branches of the tibial and common peroneal nerves. This study aims to evaluate the efficacy of PENG and iPACK in day-case arthroplasty.

Method

A case-series of 30 consecutive day-case arthroplasty patients undergoing total hip replacement (THR) (12/30), total knee replacement (TKR) (13/30) and unicompartmental knee replacement (UKR) (5/30). Multimodal analgesia included paracetamol, NSAID and high dose dexamethasone.

Results

For THR patients, the mean post-operative visual analogue scores (VAS) for pain were 4/10 (immediate post-operative), 5/10 (6 hours post-operative) and 5/10 (24 hours post-operative). The mean time to mobilisation was 188 minutes (90 – 360 minutes). The mean post-operative opioid consumption was 25mg (0 – 55mg).

For TKR and UKR patients, the mean post-operative VAS for pain were 4/10 (immediate post-operative), 5/10 (6 hours post-operative) and 5/10 (24 hours post-operative). The mean time to mobilisation was 176 minutes (60 – 480 minutes). The mean post-operative opioid consumption was 65mg (0 – 240mg). The mean pre-discharge knee range of motion was 90 degrees (80 – 95 degrees). There were no nerve block related complications.

Conclusions

PENG and iPACK are novel regional anaesthetic techniques that show promise in day-case arthroplasty.
647 An Audit of Spontaneous Stone Passage in Patients on the Waiting List for Ureteroscopy
Authors: McGurk S , Gabriel M , Wilson G
Published: August 2024

Aim

To determine the waiting list time from emergency stenting to elective management of ureteric stones. To identify the number of emergency patients who spontaneously pass their stone, whilst awaiting elective Ureteroscopy. To assess the benefit of pre-operative CT in reducing negative elective ureteroscopy rates.

Method

Retrospective study of all patients who underwent emergency stenting for renal colic and were placed on the waiting list for ureteroscopy. Patients were identified from the waiting list register using the relevant procedure codes and data was taken from the electronic patient record system.

Results

We identified 51 patients who were added to the waiting list in 2022 following emergency stenting for renal colic. Median waiting list time from emergency stent to URS was 21 weeks, with 41% affected by cancellations. 21 patients had pre-operative CT scans, of which 7 had passed their stones. 2 patients were found to have no stones at the time of ureteroscopy. 14 patients had encrusted stents at the time of elective surgery.

Conclusions

Our negative ureteroscopy rate was surprisingly low, however it may still be beneficial to repeat imaging in patients waiting longer than 6 months for surgery or where symptoms have changed. Of those patients who had undergone pre-operative imaging, a third had passed their stones. Thus, avoiding the risks of a further surgery and anaesthetic.
1130 Clinical Outcomes of Sacral Nerve Stimulation for Neuromodulation of the Lower Urinary Tract in a Tertiary Hospital
Authors: Akpala A , King T
Published: August 2024

Aim

To assess clinical outcomes in terms of first to second stage conversion rates, revision rates , complications, battery life span and device survival for all patients undergoing sacral neuromodulation for the past 5 years at the Queen Elizabeth hospital Birmingham.

Method

Retrospective observational study. Only patients who had first stage of sacral neuromodulation between January 2017 and January 2023 were included in the study. The data collected included age, type of first stage i.e PNE vs tined lead, response after first stage, if a second trial was carried out, response after second trial, indication for SNS, complications, revisions, etc.

Results

94% of the total (198 ) patients had PNE at first trial while 6% had tined lead. 130 patients had a positive response after first trial, 48 had a negative response and 20 had equivocal response. 15 patients from the equivocal group had a second trial with tined lead with 53.3% receiving a positive response making our conversion rate 69% . Of the 100 patients who had permanent implant fitted, only 18 had complications and 14 of these required revision. The indications for the revision were lead migration (36%), connection failure (14%), battery charging problem (7%), pain around battery site (36%) and device infection (7%).

Conclusions

The conversion and complication rates are comparable to national standards while the infection rates were lower than what has been reported in the literature. Higher conversion rates may be attained when tined lead is used at first trial.
Clinical Impact of Pleural Fluid Streptococcus pneumoniae Polymerase Chain Reaction Testing in Children With Complicated Pneumonia
Authors: Ho Erin C , Olson Kaitlin E , Butler Molly , Birkholz Meghan , Miller Kristen , MacBrayne Christine E , Jung Sarah , Messacar Kevin , Asturias Edwin J , Dominguez Samuel R
Published: August 2024

Background

While Streptococcus pneumoniae (Spn) is the leading cause of pediatric complicated community-acquired pneumonia (cCAP), it is infrequently recovered by culture-based methods. We studied the real-world clinical impact of an Spn polymerase chain reaction (PCR) assay for pleural fluid.

Methods

This pre–post quasi-experimental cohort study compared pathogen detection, antibiotic usage, and outcomes in children hospitalized with cCAP requiring pleural effusion or empyema drainage at Children's Hospital Colorado between 2016 and 2023. Patients were compared across 2 diagnostic periods: pre-Spn PCR and post-Spn PCR. Cox proportional hazard models compared time from admission to pathogen detection, optimal therapy (narrowest pathogen-directed or guideline-recommended empiric therapy), and methicillin-resistant Staphylococcus aureus (MRSA) therapy discontinuation between periods.

Results

Compared to the pre-Spn PCR cohort (n = 149), the post-Spn PCR cohort (n = 79) was more likely to have a pathogen detected (73.4% post-PCR vs 38.9% pre-PCR, P < .001), driven by more Spn detections (45.6% vs 14.1%, P < .001). Time to pathogen detection during hospitalization was shorter in the post-Spn PCR period (P < .001). The post-PCR cohort was more likely to receive optimal therapy (84.8% vs 53.0%, P < .001), with shorter median times to optimal antibiotics (4.9 vs 10.0 days, P < .001) and MRSA therapy discontinuation (1.5 vs 2.5 days, P = .03). There were no differences in hospital length of stay or readmissions.

Conclusions

Spn molecular testing of pleural fluid in children with cCAP resulted in significantly more microbiologic diagnoses and was associated with the optimization of antibiotics and decreased exposure to MRSA therapy, suggesting its clinical impact for pediatric complicated pneumonia.
Risk of Non–AIDS–Defining Events Is Lower in Antiretroviral Therapy (ART)–Naive Human Immunodeficiency Virus Controllers Than in Normal Progressors on Suppressive ART
Authors: Groenendijk Albert L , Miranda Afonso Pedro , Wit Ferdinand W N M , Blaauw Martinus J T , van Eekeren Louise E , Otten Twan , Vos Wilhelm A J W , Vadaq Nadira , dos Santos Jéssica C , van Lunzen Jan , van der Ven Andre , Rokx Casper , Verbon Annelies
Published: August 2024

Background

We aimed to compare the non-AIDS event (nADE) risk between normal progressors using antiretroviral therapy (NP-ART) and people with human immunodeficiency virus (HIV, PWH) who naturally control HIV infection (HIV controllers), as well as the risk of nADE following ART in HIV controllers.

Methods

The primary end point was the composite of cardiovascular disease, non-AIDS malignancy, or all-cause mortality, whichever came first. The role of ART in HIV controllers was assessed as a time-varying covariate.

Results

We included 1007 ART-naive HIV controllers (60 of them were elite controllers), 1510 early-ART (<6 months after negative HIV test), and 15437 NP-ART (reference group), contributing 3813, 11 060, and 160 050 years of follow-up, respectively. HIV controllers had lower risk of the primary end point (hazard ratio [HR], 0.55; 95% confidence interval [CI]: .38–.81; P = .0023), all-cause mortality (adjusted HR [aHR], 0.45; 95% CI: .25–.79; P = .0054), and cardiovascular disease (aHR, 0.47; 95% CI: .22–.99; P = .046), but not non-AIDS malignancy (aHR, 0.74; 95% CI: .41–1.35; P = .33), compared with NP-ART. Among HIV controllers, each log10 lower baseline viral load further decreased the risk of a nADE (aHR, 0.54; 95% CI: .29–.99; P = .045). ART in HIV controllers did not reduce the risk of any nADE (aHR, 1.22; 95% CI: .66–2.29; P = .53).

Conclusions

HIV controllers had a lower n ADE risk than NP-ART, especially in those with low plasma viral loads. ART did not alter the nADE risk in HIV controllers. Our findings help clinicians to decide on prescribing ART in HIV controllers.
The Groupe d’Etude sur les Affections Inflammatoires Digestives (GETAID): 40 Years of a Family Story in Inflammatory Bowel Disease
Authors: Laharie David , Vuitton Lucine , Bourreille Arnaud , Bouhnik Yoram , Colombel Jean-Frédéric , Louis Edouard , Fumery Mathurin , Mailhat Charlotte , Mary Jean-Yves , Peyrin-Biroulet Laurent
Published: August 2024

The Groupe d’Etude sur les Affections Inflammatoires Digestives (GETAID) was founded in Paris in 1983 by Professor Robert Modigliani and colleagues. From the beginning, the aim of this international (France, Belgium, and Switzerland), multicenter, French-speaking group was to address clinical questions raised by patients or physicians in their daily practice or the inflammatory bowel disease community, by focusing on clinical research on treatments through randomized controlled trials, prospective cohorts, and cross-sectional studies, quantifying the severity of various facets of the disease when necessary for these studies. This very innovative approach has contributed to the advancement of knowledge in inflammatory bowel diseases by publishing more than 120 original articles in peer-reviewed journals throughout the GETAID’s 40-year history, most of them in top publications in gastroenterology and hepatology journals. In this paper, we will see what GETAID’s contribution has been over the last 4 decades and review the reasons for its success and forthcoming challenges.
Distinct patterns of genetic variation at low-recombining genomic regions represent haplotype structure
Authors: Ishigohoka Jun , Bascón-Cardozo Karen , Bours Andrea , Fuß Janina , Rhie Arang , Mountcastle Jacquelyn , Haase Bettina , Chow William , Collins Joanna , Howe Kerstin , Uliano-Silva Marcela , Fedrigo Olivier , Jarvis Erich D , Pérez-Tris Javier , Illera Juan Carlos , Liedvogel Miriam
Published: August 2024

Genomic regions sometimes show patterns of genetic variation distinct from the genome-wide population structure. Such deviations have often been interpreted to represent effects of selection. However, systematic investigation of whether and how non-selective factors, such as recombination rates, can affect distinct patterns has been limited. Here, we associate distinct patterns of genetic variation with reduced recombination rates in a songbird, the Eurasian blackcap (Sylvia atricapilla), using a new reference genome assembly, whole-genome resequencing data and recombination maps. We find that distinct patterns of genetic variation reflect haplotype structure at genomic regions with different prevalence of reduced recombination rate across populations. At low-recombining regions shared in most populations, distinct patterns reflect conspicuous haplotypes segregating in multiple populations. At low-recombining regions found only in a few populations, distinct patterns represent variance among cryptic haplotypes within the low-recombining populations. With simulations, we confirm that these distinct patterns evolve neutrally by reduced recombination rate, on which the effects of selection can be overlaid. Our results highlight that distinct patterns of genetic variation can emerge through evolutionary reduction of local recombination rate. The recombination landscape as an evolvable trait therefore plays an important role determining the heterogeneous distribution of genetic variation along the genome.
How Does an Integrated Pharmacist Add Value in the Management of Inflammatory Bowel Disease in the Era of Values-Based Healthcare?
Authors: Hilley Patrick , Wong Darren , De Cruz Peter
Published: August 2024

The World Health Organization has recommended that the management of chronic diseases such as inflammatory bowel disease (IBD) should be undertaken using an integrated approach delivered by a multidisciplinary team. Although the composition of an IBD multidisciplinary team has been well described, the inclusion of an IBD pharmacist as a core member has been more recent, with variable uptake within IBD services internationally. While pharmacists continue to play the traditional role of safe prescribing and monitoring of immunosuppressive therapies, their role within the IBD team is rapidly expanding; however, the value, in terms of both clinical outcomes as well as financial savings (where available), which they add to IBD services has been less well described. In this narrative review, we perform a comprehensive evaluation of the literature detailing the expanding roles that IBD pharmacists play and describe opportunities that exist for integrated pharmacists to add value to IBD service delivery. Medication and adherence counseling, immunosuppressive monitoring, uptake of biosimilars, therapeutic drug monitoring, health promotion and prevention appear to be key areas where integrated pharmacists can add the most value to IBD patients and services. In particular, integrated IBD pharmacists can improve patient outcomes via rigorous monitoring pre and post initiation of drug therapies; focused medication counseling; advice on improving adherence; implementation of novel approaches to medication usage, and; strategies to help sustain IBD service delivery. These data can be used to further build a case for those seeking to add pharmacists to their team/services. Future studies should focus on evaluating the impact of an integrated IBD pharmacist on quality-of-care delivery together with the clinical and financial value added to IBD services compared to services that lack an integrated IBD pharmacist role.
Sustained Spread of HIV-1 CRF55_01B in its Place of Origin: Dynamics and Hotspots
Authors: An Minghui , Zheng Chenli , Chen Lin , Li Hao , Zhang Yan , Gan Yongxia , Zhao Bin , Zhang Hui , Han Xiaoxu , Zhao Jin , Shang Hong
Published: August 2024

Background

Shenzhen, a city with a substantial mobile population, was identified as the first discovered region of human immunodeficiency virus-1 (HIV-1) CRF55_01B and epicenter of its severe epidemic. During the implementation of venue-based behavioral interventions and the “treat-all” policy, identifying the patterns of spread and transmission hotspots of CRF55_01B is imperative.

Methods

In this study, 1450 partial pol sequences, with demographic information, were collected from all newly diagnosed CRF55_01B infections in Shenzhen from 2008 to 2020. Molecular networks were constructed using the maximum likelihood and time-resolve phylogenies. Transmission rates, effective reproduction numbers (Re) of clusters, and viral dispersal were evaluated using Bayesian inference.

Results

In total, 526 sequences formed 114 clusters, including 7 large clusters. The status and size of clusters were strongly correlated with age, ethnicity, occupation, and CD4+ T-cell counts. The transmission rates of clusters were significantly higher than the national epidemic estimate. Four large clusters had Re exceeding 1 at the end of the sampling period. Immigrants from Guangdong and Hunan, along with local residents, were identified as the transmission hubs, with heterosexual men being the main source and MSM being the main destination. The virus exhibited a high movement frequency from individuals aged 30–49 years toward diverse age groups.

Conclusions

This study demonstrated that the hidden CRF55_01B transmissions continued despite current combined interventions in Shenzhen, and at-risk individuals susceptible to infection or transmission were identified, potentially serving as targets for more effective prevention and control of the local epidemic, thereby mitigating cross-regional spread nationwide due to population migration.
Development and validation of supervised machine learning multivariable prediction models for the diagnosis of Pneumocystis jirovecii pneumonia using nasopharyngeal swab PCR in adults in a low-HIV prevalence setting
Authors: Chew Rusheng , Woods Marion L , Paterson David L
Published: August 2024

Background

The global burden of the opportunistic fungal disease Pneumocystis jirovecii pneumonia (PJP) remains substantial. Polymerase chain reaction (PCR) on nasopharyngeal swabs (NPS) has high specificity and may be a viable alternative to the gold standard diagnostic of PCR on invasively collected lower respiratory tract specimens, but has low sensitivity. Sensitivity may be improved by incorporating NPS PCR results into machine learning models.

Methods

Three supervised multivariable diagnostic models (random forest, logistic regression and extreme gradient boosting) were constructed and validated using a 111-person Australian dataset. The predictors were age, gender, immunosuppression type and NPS PCR result. Model performance metrics such as accuracy, sensitivity, specificity and predictive values were compared to select the best-performing model.

Results

The logistic regression model performed best, with 80% accuracy, improving sensitivity to 86% and maintaining acceptable specificity of 70%. Using this model, positive and negative NPS PCR results indicated post-test probabilities of 84% (likely PJP) and 26% (unlikely PJP), respectively.

Conclusions

The logistic regression model should be externally validated in a wider range of settings. As the predictors are simple, routinely collected patient variables, this model may represent a diagnostic advance suitable for settings where collection of lower respiratory tract specimens is difficult but PCR is available.
Evolutionary history and origins of Dsr-mediated sulfur oxidation
Authors: Klier Katherine M , Martin Cody , Langwig Marguerite V , Anantharaman Karthik
Published: August 2024

Microorganisms play vital roles in sulfur cycling through the oxidation of elemental sulfur and reduction of sulfite. These metabolisms are catalyzed by dissimilatory sulfite reductases (Dsr) functioning in either the reductive or reverse, oxidative direction. Dsr-mediated sulfite reduction is an ancient metabolism proposed to have fueled energy metabolism in some of Earth’s earliest microorganisms, whereas sulfur oxidation is believed to have evolved later in association with the widespread availability of oxygen on Earth. Organisms are generally believed to carry out either the reductive or oxidative pathway, yet organisms from diverse phyla have been discovered with gene combinations that implicate them in both pathways. A comprehensive investigation into the metabolisms of these phyla regarding Dsr is currently lacking. Here, we selected one of these phyla, the metabolically versatile candidate phylum SAR324, to study the ecology and evolution of Dsr-mediated metabolism. We confirmed that diverse SAR324 encode genes associated with reductive Dsr, oxidative Dsr, or both. Comparative analyses with other Dsr-encoding bacterial and archaeal phyla revealed that organisms encoding both reductive and oxidative Dsr proteins are constrained to a few phyla. Further, DsrAB sequences from genomes belonging to these phyla are phylogenetically positioned at the interface between well-defined oxidative and reductive bacterial clades. The phylogenetic context and dsr gene content in these organisms points to an evolutionary transition event that ultimately gave way to oxidative Dsr-mediated metabolism. Together, this research suggests that SAR324 and other phyla with mixed dsr gene content are associated with the evolution and origins of Dsr-mediated sulfur oxidation.
Glioblastoma multiforme in a patient with neurofibromatosis type 1: a case report and review of literature
Authors: Ayasa Laith A , Rahhal Sara , Najjar Alaa Khaled , Suboh Bashar N , Aliwaiai Mohammed , Daqour Ahmad M , Bakri Izzeddin
Published: August 2024

Glioblastoma multiforme (GBM) is a highly aggressive brain tumor. Individuals with neurofibromatosis type 1 (NF1) have an increased risk of developing GBM. We present a case report of a 44-year-old male with NF1 who developed GBM. NF1-associated GBM presents distinct molecular features and younger age at diagnosis compared to sporadic cases. Treatment typically follows standard protocols for GBM. Despite advancements in neuro-oncology, gaps in knowledge persist regarding NF1-associated GBM, including its prevalence, molecular mechanisms, and optimal treatment strategies. Larger studies and collaborative efforts are needed to address these gaps and enhance patient care.
Three-dimensional endoscopy in lumbar spine surgery as a novel approach for degenerative pathologies: a case report
Authors: Ma Alison , Xie Nathan , Reidy Joseph , Mobbs Ralph Jasper
Published: August 2024

Endoscopic spine surgery has evolved exponentially. However, the two-dimensional (2D) view results in lack of stereoscopic vision and depth perception, contributing to the steep learning curve. This case report recounts a world first trial of a three-dimensional (3D) endoscopic system that converts 2D to 3D images and explores its potential role in the surgical management of degenerative lumbar spine diseases. The 3D endoscopic system was used for two patient cases and both 2D and 3D images were displayed side by side and compared. Advantages of the 3D endoscopic system include increased perception of depth, rapid identification of bleeding points, and greater visualization of anatomical details. Field of view and exposure were identical in 2D and 3D views. Limitations include costs and need for additional equipment. Overall, 3D endoscopy improved depth perception, instrument manoeuvrability, and recognition of anatomical details. This case report can guide further research and training in endoscopic spine surgery.
Iatrogenic tracheal rupture in the elderly: a case report and review of tracheobronchial repair techniques
Authors: Chang Shantel , Cistulli David , Harden Michael
Published: August 2024

Tracheobronchial rupture is an extremely rare and potentially fatal complication. We present the case of a delayed presentation of an iatrogenic tracheobronchial rupture following orotracheal intubation, requiring veno-venous extracorporeal membrane oxygenator on standby. We review the clinical presentation, investigations, and management of tracheobronchial rupture, including conservative treatment and invasive surgical repair techniques.
Cardiac tamponade caused by a ruptured coronary aneurysm treated with open-chest hemostasis after esophageal cancer surgery: a case report
Authors: Hasegawa Makoto , Kikuchi Tomohiro , Yago Hiroki , Mitsui Dai , Matsuishi Akira , Tsumuraya Hideaki , Kaneta Akinao , Matsuida Hajime , Nirei Azuma , Hanayama Hiroyuki , Saze Zenichiro , Takase Shinya , Kono Koji
Published: August 2024

Cardiac tamponade is a rare postoperative complication of esophagectomy, with no previous reports of association with coronary artery aneurysm rupture. We present a case of cardiac tamponade caused by coronary aneurysm rupture following esophageal cancer surgery. A 68-year-old man with no history of heart disease underwent robotic subtotal esophagectomy for esophageal squamous cell carcinoma. He experienced intermittent chest pain on postoperative day (POD) 17. Echocardiography revealed increasing pericardial fluid, and pericardiocentesis on POD 34 revealed bloody pericardial fluid. Contrast-enhanced computed tomography and coronary angiography revealed a ruptured coronary aneurysm causing cardiac tamponade. Emergency surgery with a median sternotomy achieved hemostasis, and the patient recovered successfully. Cardiac tamponade after esophageal surgery, particularly from coronary aneurysm rupture, is rare. Prompt diagnosis and treatment are crucial for patient survival. Despite its risks, median sternotomy was effective in achieving rapid hemostasis and patient recovery in this case.
Transverse colonic volvulus presenting in a 19-year-old female with subsequent sigmoid volvulus
Authors: Stiene Jennifer , Barber Meghan , Silva Francisco Rodriguez , Halloran Sean J , Sferra Joseph J
Published: August 2024

Transverse colonic volvulus is exceptionally rare and is the rarest compared to sigmoid or cecal volvulus. This case report summarizes the care of a young 19-year-old woman who presented with transverse colonic volvulus. This woman came to the emergency room with abdominal pain, nausea, and vomiting, and she had no risk factors for a volvulus. This case report has the goal of raising awareness among those taking care of anyone coming in for abdominal pain. Volvulus is a serious issue and can be life threatening if not treated appropriately.
UNESCO and the Right to Science
Authors: Romano Cesare PR , Boggio Andrea
Published: August 2024

This chapter maps the right to science within the UN Educational, Scientific and Cultural Organization (UNESCO). The first part describes the origins of UNESCO and explains how science came to be part of its mission. Then, it discusses the high hopes the establishment of UNESCO created, particularly in the scientific field, the grand ambitions its leadership and the organization had, and the harsh political realities that tempered many of them. It describes the governance structure of UNESCO, paying particular attention to its standard-making process. UNESCO’s role in articulating international human rights standards is seldom recognized, but it is significant and, in the case of the right to science, paramount. The chapter reviews four recommendations: Recommendation on Science and Scientific Researchers (2017); Declaration of Ethical Principles in Relation to Climate Change (2017); Recommendation on Open Science (2021); and Recommendation on the Ethics of Artificial Intelligence (2021); three declarations regarding genetics and bioethics: Universal Declaration on Human Genome and Human Rights (1997); International Declaration on Human Genetic Data (2003); and Universal Declaration on Bioethics and Human Rights (2005); and two statements of expert meetings sponsored by UNESCO: Declaration on Science and the Use of Scientific Knowledge of the World Conference of Science (1999) and Venice Statement on the Right to Enjoy the Benefits of Scientific Progress and its Applications (2009). All these instruments give greater depth to the right to science.
An Ethics Lens for Nursing Leadership
Authors: Brown-Saltzman Katherine
Published: August 2024

With the innumerable skills required for the nursing leadership role, the demands of the work, and conflicting obligations, it is no wonder that an ethical lens can be so easily lost. Yet ethics is so central to every decision that is made, it should be the filter that is incorporated consistently. When ethics becomes the vista—whether considering the myriad of ethical conflicts, hiring practices, budgeting, limited resources, ethics supports, policy, motivational practices, or supporting the nurses’ voice—one has an opportunity to create an ethical environment. A leadership practice that utilizes a habituated ethics perspective may be more complex and may require a greater upfront effort. However, it will also be extraordinarily rich and will provide for outcomes that establish a foundation of thoughtful and ethically based governance. One’s own voice must walk the fine line of role modeling ethical mindfulness, owning moral authority, and acting with responsible courage. In firmly representing nursing’s core values, one has the opportunity and the responsibility to create the milieu that empowers moral agency. In this way, one honors nursing’s commitment to the profession that cherishes the moral obligations of caring for the sick and promoting health and well-being.
Emerging Ethical Issues in Dementia Care
Authors: Lingler Jennifer H. , Arias Jalayne J.
Published: August 2024

Alzheimer’s disease (AD) is a neurodegenerative condition affecting over 6 million Americans. As a disorder with no known cure or means of prevention, AD has been ranked the most feared disease among older adults. Despite recent advances in AD pharmacotherapeutics, most current FDA-approved treatments are regarded as symptomatic and do not prevent those affected from progressing to the final stages of dementia. Indeed, the overwhelming majority of dementia care provision remains nonpharmacological in nature and includes assisting individuals with the performance of instrumental and, as the disease progresses, basic activities of daily living (ADL), including medication taking, meal preparation, and self-care. ADL assistance as well as nonpharmacologic behavioral management of persons with AD can be distinctly characterized as nursing care. Nurses on the frontline of dementia care occupy a corresponding frontline role in the identification of and initial response to ethical dilemmas that manifest during dementia care. The purpose of this chapter is to review the shifting and expanding landscape of ethical issues in dementia care, and to argue that as the field transitions to an era of preventive care for AD, nurses will continue to have a key role in identifying and responding to emerging ethical dilemmas, including those arising during pre-test counseling for biomarker tests of AD risk. In doing so, the authors argue that a unique form of bias, called hypercognitivism, has not only tainted the extant bioethics literature on dementia, but represents a threat to the analysis of emerging issues in dementia ethics.
Collaborative Quality Improvement to Promote Evidence-based Surfactant for Preterm Infants
Authors: Kharrat Ashraf , Shah Prakesh S.
Published: August 2024

Although earlier surfactant administration was believed to reduce the risk of death and pneumothorax among preterm infants, administration was frequently delayed. This cluster randomized trial explored whether a multifaceted quality improvement intervention would improve timeliness of surfactant administration among infants 23 to 29 weeks’ gestation. One hundred fourteen neonatal intensive care units from the Vermont Oxford Network participated, enrolling 6039 infants. Infants in intervention hospitals were more likely to receive surfactant in the delivery room (adjusted odds ratio 5.38, 95% CI 2.84 to 10.20) and received surfactant sooner after birth (median 21 versus 78 minutes; adjusted hazard ratio 1.57, 95% CI 1.42 to 2.07, p <0.001). There was no impact on mortality or pneumothorax.
Kangaroo Mother Versus Traditional Care for Newborn Infants <2000 Grams
Authors: Murki Srinivas
Published: August 2024

Kangaroo mother care (KMC) is promoted as a caring alternative for low birth weight infants. This trial randomized 746 infants to either KMC (with early discharge to home, regardless of weight or gestational age, to spend 24 hours per day in an upright position, in skin-to-skin contact and “firmly” attached to the mother’s chest) or standard care. Mother–infant dyads in the KMC group were transferred from the birth hospital upon randomization, to receive training in KMC at a separate hospital prior to discharge to home. The risk of mortality by 41 weeks’ postmenstrual age did not differ between the groups (relative risk 0.59, 95% confidence interval 0.22 to 1.6), and growth indices were similar. Infants receiving standard care experienced longer hospital stays with more nosocomial infections.
Hemorrhagic Disease of the Newborn
Authors: Curley Anna E.
Published: August 2024

Full-term newborn infants at the Cincinnati General Hospital were randomly assigned to prophylactically receive 1 of 2 doses of IM vitamin K (100 μg or 5 mg of menadione sodium bisulfite) or saline placebo. Bleeding was recorded daily. When bleeding occurred, coagulation screens were performed. The incidence of any bleeding in infants was 5.3% (100 μg vitamin K) and 5.7% (5 mg vitamin K), compared with 7.5% (placebo) (p <0.025). Serious bleeding occurred only in the placebo group (0.7%; p <0.0005). There was 15 to 20 times more moderate and severe bleeding among breastfed infants who received no vitamin K compared with formula-fed infants.
Hypothermia for Moderate or Severe Neonatal Encephalopathy in Low-Income and Middle-Income Countries
Authors: Murki Srinivas
Published: August 2024

This trial was among the first to evaluate the safety and efficacy of therapeutic hypothermia in low- and middle-income countries (LMIC), with concerning results. It enrolled 408 infants ≥36 weeks’ gestation with moderate or severe neonatal encephalopathy, with randomization within 6 hours of life to either receive whole-body hypothermia or standard care. There was no difference in the primary outcome of proportion of infants who either died or survived with moderate or severe disability. Mortality was higher with therapeutic hypothermia (42% versus 31%; risk ratio 1.35, 95% confidence interval 1.04 to 1.76, p = 0.022). These results call into question the use of therapeutic hypothermia as currently practiced in this setting.
Motivation and Workplace Incentives
Authors: Wyatt-Johnson Claudia , Johnson Richard , Kohler Jim
Published: August 2024

A pay-for-performance structure can drive and reward behaviors needed to ensure better patient outcomes. Focusing on greater productivity creates tremendous pressure on providers, leading to burnout, dissatisfaction, and turnover. It is important to pay attention to lifestyle needs and build appreciation of the value of nonfinancial rewards. Total rewards programs (TRP) are both economic and psychosocial in nature. They deliver all cash and non-cash compensation, benefits, and learning offerings in an integrated way. An effective TRP is comprehensive, effective, creative, flexible, and simple. The goals of a total rewards framework include embracing health and well-being, integrating work–life balance, championing career development and professional growth, and rewarding performance. Engagement of institutional leadership and supervisors for support and using a multichannel approach are keys to success.
Informed Consent, Autonomy, and Shared Decision-Making
Authors: Micah Hester D. , Leding Emily
Published: August 2024

Informed consent is a fundamental ethical requirement in medical decision-making. It is predicated on a patient’s autonomy (self-determination) and decisional capacity (the ability to make intelligent decisions). Clinicians have a legal and moral obligation to garner valid informed consent (or refusal) from a patient before proceeding with (or avoiding) medical care. This obligation includes more than disclosure of information to the patient, however. Instead, clinicians are required to get to know patients well enough to support them in partnering in decision-making, helping them to make medical decisions that fit well with the patient’s own values and interests.
The Patient’s Bill of Rights and Discrimination Against Healthcare Providers
Authors: Allen Ebony Renee , Shaw Margie Hodges
Published: August 2024

The enactment of Medicare in 1965 was the catalyst that led to the adoption of the first Patient’s Bill of Rights. Though these rights promote patient autonomy and dignity, patients have sometimes used the concept of autonomy as a way to discriminate against healthcare providers. Discrimination by patients can lead to detrimental effects on healthcare providers and the healthcare system as a whole. While patient experience is important, the narratives and experiences of those caring for patients is essential as well. Healthcare organizations are obligated to provide their employees with a work environment free from hostility. By establishing internal policies, healthcare organizations can support and improve the well-being of its providers, which leads to better patient outcomes.