bluuebunny/crossref_metadata_2025 huggingface dataset:
255 Attitudes and Perceptions Among Iraqi Young Adults Towards Organs Donation and Transplantation: A Call for Action
Authors: Al-Abbasi G , Al-Jasim A
Published: August 2023

Aim

Organ’s transplantation is the only treatment for end-stage organ failure. However, the disparity between organs availability and the number of patients in the waiting lists is widening globally, especially in Iraq for many reasons. This study aims to assess the level of attitudes and perceptions among Iraqi young adults towards organs donation and transplantation as the first study to be conducted in Iraq for such purpose.

Method

This observational study was conducted among 912 Iraqi young adults through a structured questionnaire which was disseminated among social media platforms. Participants consented before filling the questionnaire and their responses were analyzed to test the hypothesis of the study.

Results

Most of the participants were females, Muslims and in their undergraduate level. Overall, 84.2% of the participants were willing to donate their organs after death and (97.9%) of them actually agreed to sign for organs donation. Most of those who were not willing to donate have no idea whether their religion approves it or not. There was no statistically significant difference in willingness to donate between different socioeconomic classes or residency areas.

Conclusions

Most of the participants are convinced with donating their organs after death and are willing to sign for organ donation programs, advocating for initiating an official governmental transplant agency with multiple local committees distributed among health directorates all over the country managing it. The hesitancy to donate organs was attributed mostly to religious and associated with lack of knowledge issues, thus education might be the key to positive attitudes.
1195 Association of Vessel-Specific Coronary Artery Stenosis with Major Adverse Cardiovascular Events in a Renal Transplant Cohort
Authors: Chow B J , Khurram M A , Yaqoob M , Mohamed I H
Published: August 2023

Aim

Coronary artery stenosis is a key risk factor for major adverse cardiovascular events (MACE). Left anterior descending (LAD) artery stenosis is regarded to be the most severe vessel-specific coronary artery stenosis as depicted by its appellation widow-maker. We hypothesised that right coronary artery (RCA) stenoses may present poorer or similar outcomes to LAD. This study sought to investigate the association of vessel-specific coronary artery stenosis using computed tomography coronary angiogram (CTCA) with MACE in a renal transplant cohort.

Method

This was a single-centre retrospective study of all end-stage renal disease (ESRD) patients eligible for kidney transplantation who underwent CTCA between 2012 to 2014. MACE occurrences (heart failure, AMI, unstable angina, CVA, PVD, and TIA) were recorded within a 10-year follow-up period. CTCA datasets were assessed by 2 independent specialists, visually grading stenosis severity into 2 classifications (<50% or >50% coronary diameter reduction).

Results

Of 106 patients in our study, a total of 419 coronary arteries (106 RCA, 104 LAD, 104 circumflex (CX), 104 left mainstem (LM)) were graded by CTCA. 43 patients (40.6%) experienced at least one MACE within the timeframe. Statistical significance in MACE was observed when stratified by RCA stenosis severity (p = 0.022) while no statistical significance in MACE observed when stratified by LAD (p = 0.904), CX (p = 0.472) & LM (p = 0.222).

Conclusions

This challenges the conventional wisdom on individual vessel-specific coronary artery stenosis and suggests that RCA stenoses are associated with MACE in the transplant cohort. This also offers the possibility of RCA stenosis as a prognostic tool in predicting MACE in ESRD patients.
1221 Recipient Outcomes After Simultaneous Pancreas and Kidney Transplant Delineated by Donor eGFR
Authors: Owen R , Fitzpatrick N , Counter C , Malik A , Mahendran B , Tingle S , Wilson C , Manas D , Sheerin N , White S
Published: August 2023

Aim

This study aimed to assess if the use of kidneys with a decreased eGFR had an adverse effect on patient and graft survival.

Method

Data on all UK SPKT’s from 2001-2021 were obtained from the NHSBT UK Transplant Registry (n = 2,631). Cases with missing information were removed, leaving a final cohort of 1,819 (69.1%). eGFR was calculated using the CKD-EPI equation. Pancreas Graft (PGS), Kidney Graft (KGS) and patient survival analyses were conducted using Kaplan-Meier plots and Cox-regression models.

Results

71% (n = 1,292) of grafts were from donors with an eGFR>90 and 29%(n = 530) were from donors with an eGFR<90. Donors with an eGFR<90 were statistically significantly more likely to be older (p<0.0001), a DBD donor (p = 0.0086**) and have a higher BMI(p<0.0001). Recipients who received a graft from a donor with an eGFR<90 were well matched with those who received a graft from a donor with an eGFR>90. Univariate analysis showed a statistically significant decreased KGS(p = 0.007**) when the donor had an eGFR<90. This trend was not seen when comparing patient or pancreas survival.

Conclusions

We accept a lower GFR could be indicative of either an AKI or a sign of early chronic kidney disease. In this current data analysis, we have been unable to successfully distinguish between the two however we have shown poorer KGS in those with a lower eGFR (<90). This had no impact on pancreas or patient survival. Further analysis is needed to explain the precise reasons for the lower eGFR’s at the time of organ donation.
131 Clinical Value of Elective Post Operative Radiographs in Total Knee Arthroplasty
Authors: Ponsworno K V , Keehan R , Ahmad R
Published: August 2023

Background

Post operative radiographs following total knee arthroplasty are requested as part of routine follow up in some institutions. The purpose of this study was to assess the clinical value of performing elective post operative radiographs.

Method

All patients who underwent total knee arthroplasty at a district general hospital from 2019 to 2020 were included. Data was collected retrospectively from medical records. Alterations to clinical management based on radiographic findings were reviewed.

Results

This study looked at 116 patients who underwent total knee arthroplasty and 28 (24%) were excluded due to having no clinic follow up. Of the 88 (76%) patients included, 31 (35%) had post operative elective radiograph, while 43 (49%) had none. There were no abnormalities detected from the elective radiographs and none of the patients returned to the theatre. The remaining 14 (16%) presented with new symptoms and had non-elective radiographs. 8 out of 14 patients did not have any intervention, while the remaining 6 returned to theatre.

Discussion

In our institution, a 2-view knee radiograph costs £28.75 and takes roughly 48 minutes. In the larger context, the cost associated with elective radiographs is significant. The value of not performing these radiographs saves time, cost, and prevents radiation exposure. However, performing post operative radiographs remains beneficial for patients who have clinical indication.

Conclusions

Elective post operative radiographs did not detect any abnormalities. Information from these radiographs have no clinical significance and did not change management. Therefore, this study recommends that there is no rationale requesting elective post operative knee radiographs.
280 Does Delayed Physiotherapy Assessment Postoperatively Affect Mortality or Length of Stay in Patients Following Surgery for a Neck of Femur Fracture?
Authors: H'ng E T H , Hoggett L , Van-Meirlo R , McLauchlan G
Published: August 2023

Aim

National guidance states that patients with a neck of femur fracture (NOFF) should be assessed by a physiotherapist on the first postoperative day. This can pose problems given the finite availability of physiotherapists. This study aims to determine if delayed assessment impacts patients' postoperative mortality or length of stay in the hospital.

Method

A prospective case series of all NOFFs surgically treated at a major trauma centre between 2013-2022 was performed. Patients ≥65 years of age were included from a unit-based prospective database.

Results

A total of 3411 patients were included. 3062 were assessed by a physiotherapist on the first postoperative day (POD1), and 349 on day two and beyond (POD2+). Delayed physiotherapy was principally due to the day of operation, where the POD2+ group more likely had surgery on a Friday or Saturday, p<0.001. The two groups were comparable in age, gender, fracture morphology, preoperative ASA and Rockwood frailty scores, and surgical procedure. The average length of stay for POD1 was 16.9 days (SD = 21.1), and 16.0 days (SD = 12.4) for POD2+, p = 0.450. Mortality was lower in the POD2+ group at 30 days after surgery, p = 0.040. There was no difference in mortality at 1 year, p = 0.295, 2 years, p = 0.724, and overall, p = 0.826.

Conclusions

Delayed physiotherapy assessment does not worsen length of stay in NOFF patients. Lower early mortality in this group indicates a possible benefit in delaying physiotherapy assessment although there was no significant difference in mortality beyond 30 days. However, a seven-day physiotherapy service would still be required for continuity of postoperative care.
565 The SPAIRE Technique for Hip Hemiarthroplasty - an Alternative Approach to the Hip
Authors: Leong D , Apostolides M , Thomas W , Robu B , Patel N
Published: August 2023

Aim

Over 20,000 hip hemiarthroplasties for hip fractures are performed annually in the UK. NICE currently recommends performing these via the anterolateral approach, to reduce the risk of dislocation, with the potential expense of reducing function and mobility post-operatively. To address these issues, muscle-sparing approaches have been utilised and "SPAIRE" (Sparing Piriformis and Internus Repairing Externus) is one of them.

Method

Retrospective analysis of prospectively collected data over a 10-month period was performed at a single centre. All hip fracture patients who had hip hemiarthroplasty as their primary treatment were included. We collected demographic data, pre- and post- operative mobility status, and time to reach that, surgical approach, duration of surgery and complications. Our primary outcome was the dislocation rate and secondary outcomes were post-operative time to mobilisation and duration of surgery.

Results

Between October 2021 and August 2022, we identified 194 cases, divided into three groups based on the surgical approach used: SPAIRE = 43, Anterolateral = 97, Posterior = 54. All groups had similar demographics and a minimum two-month follow-up. There were no dislocations in the SPAIRE group, compared to 2 (2%) in the Anterolateral and 2 (3.7%) in the Posterior groups. The mean return to mobility was 1.4 days for "SPAIRE" patients, compared to 2 and 2.6 days for patients in other groups. All three groups had similar mean surgical times (74min, 79min, and 71min respectively).

Conclusions

The "SPAIRE" approach seems to be lowering the risk of dislocation, and reducing the time to mobilisation, potentially improving function for patients undergoing hip hemiarthroplasty.
788 Virtual Scaphoid Fracture Management; How Effective Is It?
Authors: Murhekar S
Published: August 2023

Background

The virtual clinic has been used to manage patients out of the hospital setting, decreasing footfall in the hospital, avoiding the need for unnecessary travel and helping decrease carbon footprint. A similar clinic has been running to manage patients presenting to the orthopaedic department with the presentation of suspected scaphoid fracture. As missed scaphoid fractures potentially lead to non-union and complications arising due to it, this study was thought of to see how effective the virtual clinics are in managing suspected scaphoid fractures.

Aim

To assess a number of suspected scaphoid presentations, and their management. Delay in diagnosis and potential presentation with non-union or SLAC wrist.

Method

Retrospective data collection for a year of patients presenting to the orthopaedic unit at a busy secondary hospital. The outcome of their presentation associated complications.

Results

Over a duration of one year from January 2021 to December 2021, 160 patients presented to the virtual clinic. Average age 44yrs. 32% of patients were offered second scaphoid series imaging. 9% of patients underwent MRI with a suspected diagnosis of occult scaphoid fracture. Average gap in second imaging was 21 days. Almost 33% of patients were discharged from virtual clinic with no further need for imaging. 16% of of the suspected cases were confirmed as scaphoid fracture.

Conclusions

This study highlights the effective use of a virtual clinics in managing scaphoid fractures presenting to a secondary unit.
925 Consent for Carpal Tunnel Decompression and Trigger Finger Release – Are We Following Standards? a Closed Loop Audit
Authors: Roberts-Walsh S , Minty I , Tse S , White A , Davy A
Published: August 2023

Aim

Every surgeon has a legal and ethical duty to ensure the consent process is comprehensive and documented. The RCS and GMC have provided guidance on this. Our aim was to assess current practice of consent in two common hand surgical procedures - carpal tunnel decompression (CTD) and trigger finger release (TFR). We evaluated the effect of departmental education following a previous audit of standards.

Method

A retrospective review was conducted on patients who underwent CTD or TFR during the three-month period of September–November 2021. Auditing against GMC and RCS standards, medical records were assessed for documentation of risks of procedure, presentation of alternative options to surgery, and whether risks on the consent form were consistent with pre-operative clinic discussions. Following re-education of surgeons on the consent process, the audit loop was closed with re-evaluation between September–November 2022.

Results

57 patients were included in the first audit cycle and 50 patients in the second. Prior to re-education, 88% of patients had risks explained and 61% had alternatives discussed and documented in clinic. Post-intervention, both improved to 100%. 79% (vs 66% before) had “new” risks on the consent form not documented on the clinic letter. However only 3.5% of cases in the first cycle and 2% in the second cycle had identical risks documented in the consent form and clinic notes.

Conclusions

Education on the gold-standard consenting process had a positive impact on compliance. We also recommend departmental standardisation on risks and benefits for common procedures which can be supplemented by patient-focused literature.
1081 The Challenge of Fixing Multi-Fragmentary Neck of Femur Fractures: A Retrospective Case Control Study for Unstable A2 Type Neck of Femur Fractures Fixed with Dynamic Hip Screws, and Short Intramedullary Nails
Authors: George H , Salih S , Patko J , Bhosale A
Published: August 2023

Aim

Not all Neck of Femur (NOF) fractures are equivalent. AO-A2 subtype are multi-fragmentary and include a lesser trochanter fracture; they can be inherently unstable. Some believe Intramedullary Nails (IMN) offer greater stability however there is concern regarding increased operative time and blood loss. This project compared operative time and perioperative blood loss between Dynamic Hip Screw (DHS) and IMN used to treat matched groups of A2 NOF fractures.

Method

A patient list was compiled from the national hip fracture database from 01/01/2020 to 31/05/2022. Fractures were classified according to AO standards; radiographs pre- and post-surgery, blood results, and operative records were reviewed.

Results

A total of 41 IMNs were performed for A2 NOF fractures, a comparison group of 41 patients treated with DHS was created. Patients were matched for ASA grade. The IMN group had an average ASA of 3.0 (DHS 3.1), perioperative haemoglobin drops of 30.8 (DHS 29.8), operation time of 64 minutes (DHS 57), and Tip Apex Distance (TAD) of 19.6mm (DHS 24.8). The difference in perioperative haemoglobin drop and operating time were not statistically significant. The TAD was significantly lower in the IMN group.

Conclusions

There was no difference in surgical time or perioperative blood loss. An improved TAD in the IMN group, despite less surgical experience with this implant, may correlate with lower long-term rates of failure. Our project suggests IMN is a safe implant, at least in the short term for A2 fractures, but further research of long-term benefits including mobility and pain is required.
1100 Fragility Fractures Post-Operative Mobilisation - A Major Trauma Centre Audit
Authors: Narayana Murthy S , Cheruvu S M , Narayanswamy N E , Nasr H
Published: August 2023

Introduction

Fragility fractures occur as a result of "low energy trauma" often from fall from standing height or less that would not normally result in fracture. Early post-operative mobilisation is the key for successful rehabilitation. BOAST guidelines suggest, all surgery in frail patients should be performed, to allow full weight-bearing (FWB) for activities required for daily living and within 36 hours of admission. The purpose of this audit is to determine the weightbearing practice of operatively managed fragility fractures in the setting of Major Trauma Centre.

Method

Retrospective data collection, from July 1st to September 30. Inclusion criteria: Aged 60 years and older, isolated lower limb fragility fractures managed operatively. Exclusion criteria: Fractures from high energy mechanisms, multiple injuries, associated, with infection/metastasis. Fragility fractures which were managed non-operatively.

Results

A total of 157 patients [mean age 82 years (SD 9.5), 135 having a hip fracture, 22 non-hip fractures] were included. Overall, 146 patients (93%) were allowed FWB, of which 133 (98.5%) were hip fractures and 12 (54.5%) were non-hip fractures. Mean days of restricted weight bearing was 42 (range 28 to 56).

Conclusions

Surgeons are confident to allow hip fracture patients to bear full weight post-operatively; however only 54.5% of non-hip fracture patients are allowed the same. We pose a question that even though the national guidelines mandate FWB post-operatively, is it still valid to limit weightbearing for fragility fracture patients when the benefits of early mobilisation are significant?

The routine use of frailty assessments would aid the surgeons to assess this population.
1325 Impact of the VFC in Fracture Clinic Referral Times
Authors: Akhteruzzaman T , Khan O , Zarifian A , Abdus Samee M
Published: August 2023

Aim

According to BOAST guidelines, patients should be seen in fracture clinic within 72 hours of presentation, following acute traumatic orthopaedic injury. Our audit aimed to assess the efficacy of a Virtual Fracture Clinic (VFC) in meeting the standard of care outlined by the guidelines.

Method

A retrospective review of notes was carried out for patients seen in fracture clinic on a random week before the VFC was introduced and a random week after VFC was introduced. Incomplete records and follow up referrals were excluded.

Results

A total of 51 new patients were seen on a random week in clinic prior to VFC introduction. The range of time before clinic review was 1 - 17 days, with a mean of 6 days. 83% of patients were seen later than 72 hours. After introduction of VFC, 44 patients were seen on a random week. Range was 1 - 11 days, with a mean 3.6 days. Only 5% were seen later than 72 hours.

Conclusions

Introduction of the VFC ensured BOAST guidelines for time to be seen in clinic were met for 95% of patients. Delays in seeing patients are generally cut to at least half. Suggestions for further improvement in time to be seen include increasing the capacity of virtual clinics and making a separate triage for trauma patients in A&E.
147 Pre-Operative Urine Culture for Endourology Surgeries
Authors: Maniarasu S , McNicholas D P , Iordan N
Published: August 2023

Aim

Our aim was to reduce post-operative endourology infection rates by screening all patient pre-operatively with urine culture. Our local guidelines recommend single dose Gentamicin for prophylaxis prior to endourology procedures. Pre-operative urine culture can identify patients with positive cultures to be treated prior to surgery and to identify multi-resistant microorganisms to aid alternative antibiotic prophylaxis choice.

Method

We identified patients that underwent elective endourological surgeries in a 3-month period (July-September2021). We identified if pre-operative urine cultures were performed, if the cultures were positive and were they treated appropriately. We identified if any patients had re-admissions postoperatively within 30 days of their procedure with UTI. We identified if the microorganism grown in the culture was resistant to Gentamicin and if an alternative prophylaxis was given pre-operatively.

Results

104 patients were identified. 65 had pre-operative cultures done. Of the 39 patients that did not have cultures done, 2 were re-admitted within 30 days with UTI. 14 pre-operative cultures were positive (21.5%) and was treated with a course of antibiotics per sensitivities and Gentamicin pre-operatively. 4 were resistant to Gentamicin (6.2%). An alternative prophylactic antibiotic was used per microbiologist’s advice for those resistant. No one was re-admitted with a UTI within 30 days in the group that had pre-operative cultures done.

Conclusions

Around 1 in 5 urine cultures done was positive for growth. Almost a third of this was resistant to Gentamicin and this aided our choice of alternative prophylactic treatment. By performing pre-operative cultures, we reduced our postoperative infection complication and re-admission rates.
624 Medication Cessation Post-TURP: Are We Getting It Right?
Authors: Guven T , Gillams K , Pignatari R , Aldesouki A , Beck R
Published: August 2023

Aim

Most patients who have a TURP should be advised to discontinue medication for bladder outflow obstruction secondary to benign prostate hyperplasia (BPH) after their surgery. This closed loop QIP audited whether this was the case, presented the findings to the department and re-audited to see whether there had been a decrease in continuing unnecessary post-TURP medication.

Method

The QIP began in October 2020 with a retrospective review of 50 patients that underwent a TURP at a large district general hospital. Patient records were reviewed to ascertain if patients were taking alpha-blockers (ABs) or 5 alpha-reductase inhibitors (5ARIs) pre-operatively, and if these were discontinued post-procedure. Any instruction to continue medication post-operatively was noted in the data collection.

This data was presented at a departmental research and audit meeting. The second QIP cycle used the same data collection methodology for the subsequent 50 patients who underwent a TURP (June 2021).

Results

The presentation resulted in a statistically significant decrease in unclear documentation 30% to 10% (p = .0124). Although there was an increase medication discontinuation post-TURP (27.3% to 48%) this wasn’t statistically significant (p = .246). The percentage of patients who were continued on an AB or 5ARI post-op without documentation decreased from 63.3% to 48%, but this change was also not statistically significant (p = .384).

Conclusions

Simple departmental audits help improve patient safety through clearer documentation and presentation of new literature. It would be beneficial to produce clear guidelines to patients and their primary care physicians to advise to discontinue BPH medication TURP unless otherwise advised by the urologist.
679 Regional Closed Loop Audits on Quality Predictive Indicators of Renal Cell Carcinoma Management in Northern Ireland
Authors: Simon N , Curry D , Devine A
Published: August 2023

Aim

To conduct a full cycle Regional Audit in Northern Ireland to assess the ten Quality Predictive Indicators (QPI) in the management of Renal Cell Carcinoma (RCC) as per National Cancer Quality Steering Group (NCQSG) of NHS Scotland. Each cycle lasted for 6 months.

Method

QPIs were assessed in four major domains such as radiological, histological, surgical and pre-treatment performance indicators in the management of RCC. Using the Northern Ireland Electronic Care record, data were collected, recorded in MS Excel and analysed and arrived at conclusions. The results were compared with NHS Scotland RCC audit reports published in August 2019 and October 2022.

Results

In audit cycle 1, NCGSQ targets of quality prediction was achieved in 3 QPIs (Nephron Sparing Surgery, Trifecta rate and 30/90 mortality rate) among the 10 QPIs. In Audit Cycle 2, additional 4 NCGSQ targets were achieved namely- pre-treatment CT/MRI, Histodiagnosis in cryotherapy, histodiagnosis in chemotherapy and MDT discussion.

Conclusions

There has been significant improvement in all QPIs in the management of Renal Cell Carcinoma in Northern Ireland during the audited period. We have achieved NCGSQ quality performance indicator targets in 7 among the 10 QPIs that were audited. Further interventions may be required to achieve targets in QPIs such as Leibovich scoring, pre-treatment TNM staging and prognostic scoring in metastatic RCC.
864 Does the PROMIS Trial Deliver What It Promised? Validation in a North West Population
Authors: Brenac S , Nambirajan T
Published: August 2023

Aim

The PROMIS trial changed the landscape on how men with raised PSA are evaluated. We changed the pathway at a North West hospital, utilising multiparametric MRI (MP-MRI) scans and incorporated additional safety parameters (family history and PSA density) to maintain the advantage of avoiding unnecessary biopsy whilst not missing significant cancers. We present the performance of this pathway.

Method

We retrospectively reviewed 596 referrals of men with high PSA level between January - December 2021. Variables audited included demographics, PSA level, PSA density, Prostate Imaging-Reporting and Data System (PI-RADS) score on MP-MRI, biopsy results, Gleason score and prognostic grade grouping.

Results

Of 596 patients, 65.9% of men were aged between 50-75 years. The most common quintile of presenting PSA was 4.00-9.99 (53.2%). Of the 381 patients with non-metastatic prostate cancer who underwent MP-MRI, 38.3% were classed as PI-RAD 1-2, 16% PI-RAD 3 and 45.7% PI-RAD 4-5. Overall, 48.3% of patients did not undergo biopsy. Biopsy rates in PI-RAD 1-5 were 2.3%, 3.9%, 52.5%, 92.5% and 91.5% respectively, the decision made to monitor PSA instead in some cases due to co-morbidities or patient preference. Of 197 biopsies, 79.2% were positive, 87.8% initially classed as PI-RADS 4 or 5. Of the cancers picked up, 82.1% were clinically significant (Gleason score ≥3+4).

Conclusions

This study shows the pathway incorporating MP-MRI, family history and PSA density enables 48.3% of patients to avoid unnecessary biopsy and therefore overdiagnosis of clinically insignificant cancers. The PROMIS trial delivers what it promised.
1270 Elevated PSA in Elderly Men
Authors: Debo-Aina A , Farag F , Rafiq M
Published: August 2023

Introduction

Elevated PSA is a common urological cancer pathway referral. Investigating older men can result in overdiagnosis and overtreatment. Routine screening for prostate cancer is not recommended. Current NICE guidelines advice referring PSAs > 3 in 50-69-years, but no guidelines exist for elderly patients (>80-years).

Aim

1)To identity the number of elderly men investigated under the 2WW pathway for elevated PSA. 2) Review of outcomes of newly diagnosed prostate-cancer in the elderly with PSA <20ng/ml.

Method

Retrospective data between Jan 2020-July 2021 identified 108 patients ≥ 80-years referred with elevated PSA: 38% with PSA ≤10ng/ml (n = 60), 32% with PSA 10ng-19/ml (n = 51). Patients were classified according to age-group; 1) 80-85-years, 2) 86-90-years, 3) >90-years. A further sub-group within each age-group according to PSA: 1) PSA 0-10ng/ml and 2) PSA 10-19ng/ml.

Results

45% (n = 18) of <85-years (n = 40) with PSA <10ng/ml progressed to investigations with MRI (n = 16), TP-biopsy(n = 12) and bone-scan (n = 9). Within this group 17.5%(n = 7) were treated with hormone and/or radiotherapy. In a similar cohort (n = 32) with PSA 10-19ng/ml 56% (n = 18) were investigated (MRI n = 11, TP-biopsy n = 6, and bone-scan n = 13), of which 15.6% (n = 5) had hormone and/or radiotherapy. Men aged 86-90-years 5.6% (n = 1) and 53.8% (n = 7) had bone-scans only for respective PSA <10ng/ml (n = 18), and 10-19ng/ml(n = 13) group. Men >90-years had no investigations. Men >85-years had no treatment.

Conclusions

11% of 80-85 years-old with PSA <20ng/ml received hormone or radiotherapy. Managing elevated PSA in the elderly is a contentious issue, requiring further large-study investigations, and new guidelines to avoid over-diagnosis and investigation.
The EvMed Assessment
Authors: Misheva Taya , Nesse Randolph M , Grunspan Daniel Z , Brownell Sara E
Published: August 2023

Background and objectives

Universities throughout the USA increasingly offer undergraduate courses in evolutionary medicine (EvMed), which creates a need for pedagogical resources. Several resources offer course content (e.g. textbooks) and a previous study identified EvMed core principles to help instructors set learning goals. However, assessment tools are not yet available. In this study, we address this need by developing an assessment that measures students’ ability to apply EvMed core principles to various health-related scenarios.

Methodology

The EvMed Assessment (EMA) consists of questions containing a short description of a health-related scenario followed by several likely/unlikely items. We evaluated the assessment’s validity and reliability using a variety of qualitative (expert reviews and student interviews) and quantitative (Cronbach’s α and classical test theory) methods. We iteratively revised the assessment through several rounds of validation. We then administered the assessment to undergraduates in EvMed and Evolution courses at multiple institutions.

Results

We used results from the pilot to create the EMA final draft. After conducting quantitative validation, we deleted items that failed to meet performance criteria and revised items that exhibited borderline performance. The final version of the EMA consists of six core questions containing 25 items, and five supplemental questions containing 20 items.

Conclusions and implications

The EMA is a pedagogical tool supported by a wide range of validation evidence. Instructors can use it as a pre/post measure of student learning in an EvMed course to inform curriculum revision, or as a test bank to draw upon when developing in-class assessments, quizzes or exams.
DNA cytosine methylation dynamics and functional roles in horticultural crops
Authors: Liu Peipei , Liu Ruie , Xu Yaping , Zhang Caixi , Niu Qingfeng , Lang Zhaobo
Published: August 2023

Methylation of cytosine is a conserved epigenetic modification that maintains the dynamic balance of methylation in plants under the regulation of methyltransferases and demethylases. In recent years, the study of DNA methylation in regulating the growth and development of plants and animals has become a key area of research. This review describes the regulatory mechanisms of DNA cytosine methylation in plants. It summarizes studies on epigenetic modifications of DNA methylation in fruit ripening, development, senescence, plant height, organ size, and under biotic and abiotic stresses in horticultural crops. The review provides a theoretical basis for understanding the mechanisms of DNA methylation and their relevance to breeding, genetic improvement, research, innovation, and exploitation of new cultivars of horticultural crops.
Role of methylation in vernalization and photoperiod pathway: a potential flowering regulator?
Authors: Shi Meimei , Wang Chunlei , Wang Peng , Yun Fahong , Liu Zhiya , Ye Fujin , Wei Lijuan , Liao Weibiao
Published: August 2023

Recognized as a pivotal developmental transition, flowering marks the continuation of a plant’s life cycle. Vernalization and photoperiod are two major flowering pathways orchestrating numerous florigenic signals. Methylation, including histone, DNA and RNA methylation, is one of the recent foci in plant development. Considerable studies reveal that methylation seems to show an increasing potential regulatory role in plant flowering via altering relevant gene expression without altering the genetic basis. However, little has been reviewed about whether and how methylation acts on vernalization- and photoperiod-induced flowering before and after FLOWERING LOCUS C (FLC) reactivation, what role RNA methylation plays in vernalization- and photoperiod-induced flowering, how methylation participates simultaneously in both vernalization- and photoperiod-induced flowering, the heritability of methylation memory under the vernalization/photoperiod pathway, and whether and how methylation replaces vernalization/photoinduction to regulate flowering. Our review provides insight about the crosstalk among the genetic control of the flowering gene network, methylation (methyltransferases/demethylases) and external signals (cold, light, sRNA and phytohormones) in vernalization and photoperiod pathways. The existing evidence that RNA methylation may play a potential regulatory role in vernalization- and photoperiod-induced flowering has been gathered and represented for the first time. This review speculates about and discusses the possibility of substituting methylation for vernalization and photoinduction to promote flowering. Current evidence is utilized to discuss the possibility of future methylation reagents becoming flowering regulators at the molecular level.
Why Pandemics and Climate Change Are Hard to Understand and Make Decision-Making Difficult
Authors: Dix Alan , Bond Raymond , Caraban Ana
Published: August 2023

This paper draws on diverse psychological, behavioural and numerical literature to understand some of the challenges we all face in making sense of large-scale phenomena and use this to create a road map for HCI responses. This body of knowledge offers tools and principles that can help HCI researchers deliver value now, but also highlights challenges for future HCI research. The paper is framed by looking at patterns and information that highlight some of the common misunderstandings that arise—not just for politicians and the general public but also for many in the academic community. This paper does not have all the answers to this, but we hope it provides some and, perhaps more importantly, raises questions that we need to address as scientific and technical communities.
Integrating REDCap patient-reported outcomes with the HealtheIntent population health platform: proof of concept
Authors: Espinoza Juan , Tut Maurice , Shah Payal , Kingsbury Paul , Nagaraj Gayathri , Meeker Daniella , Bahroos Neil
Published: August 2023

Objective

Patient-reported outcome measures (PROMs) are critical to drive patient-centered care and to understanding patients’ perspectives on their health status, quality of life, and the overall effectiveness of the care they receive. PROMs are increasingly being used in clinical and research settings, but the mechanisms to aggregate data from different systems can be cumbersome.

Materials and methods

As part of an FDA Real-World Evidence demonstration project, we enriched routine care clinical data from our Cerner electronic health record (EHR) with PROMs collected using REDCap. We used SSIS, sFTP, and the REDCap Application Programming Interface to aggregate both data sources into the Cerner HealtheIntent Population Health Platform.

Results

We successfully built dashboards, reports, and datasets containing both REDCap and EHR data collected prospectively.

Discussion

This technically straightforward approach using commonly available clinical and research tools can be readily adopted and adapted by others to better integrate PROMs with clinical data sources.
Development and validation of a sensitive LC–MS-MS method to quantify psilocin in authentic oral fluid samples
Authors: Cardoso Marilia Santoro , da Cunha Kelly Francisco , Silva Izabelly Geraldes , Fiorentin Taís Regina , de Campos Eduardo G , Costa Jose Luiz
Published: August 2023

Psilocin is an active substance and a dephosphorylated product of psilocybin formed after the ingestion of mushrooms. The low stability caused by the quick oxidation of this analyte requires sensitive methods for its determination in biological matrices. In this work, we described the development, optimization and validation of a method for the quantification of psilocin in authentic oral fluid samples by liquid chromatography–tandem mass spectrometry. Liquid–liquid extraction was performed using 100 µL of oral fluid samples collected with a Quantisal™ device and t-butyl methyl ether as the extraction solvent. The method showed acceptable performance, with limits of detection and quantification of 0.05 ng/mL, and the calibration model was achieved between 0.05 and 10 ng/mL. Bias and imprecision results were below −14.2% and 10.7%, respectively. Ionization suppression/enhancement was lower than −30.5%, and recovery was >54.5%. Dilution integrity bias was <14.4%. No endogenous and exogenous interferences were observed upon analyzing oral fluid from 10 different sources and 56 pharmaceuticals and drugs of abuse, respectively. No carryover was observed at 10 ng/mL. Psilocin was stable in oral fluid at −20°C, 4°C and 24°C up to 24, 72 and 24 h, respectively, with variations <17.7%. The analyte was not stable after three freeze/thaw cycles, with variations between −73% and −60%. This suggests the instability of psilocin in oral fluid samples, which requires timely analysis, as soon as possible after the collection. The analyte remained stable in processed samples in an autosampler (at 10°C) for up to 18 h. The method was successfully applied for the quantification of five authentic samples collected from volunteers attending parties and electronic music festivals. Psilocin concentrations ranged from 0.08 to 36.4 ng/mL. This is the first work to report psilocin concentrations in authentic oral fluid samples.
Plasma exchange as a tool for removal of bevacizumab: Highlighting application for urgent surgery
Authors: Neth Bryan J , Winters Jeffrey L , Sairaj Revathi Thirumushi , Gharibi Loron Ali , Rahman Masum , Hirte Renee , Riviere-Cazaux Cecile , Ruff Michael W , Burns Terry C
Published: August 2023

Background

Bevacizumab is commonly used to manage cerebral edema associated with brain tumors. However, its long half-life poses challenges for patients requiring urgent surgery due to wound complications. We present a case of utilizing therapeutic plasma exchange (TPE) to remove bevacizumab in a patient with recurrent glioblastoma requiring urgent surgery.

Methods

A 58-year-old male with recurrent glioblastoma, IDH-wildtype, presented with clinical and radiographic concern for ventriculitis requiring urgent wound washout only 4 days after his last bevacizumab infusion. TPE was performed for 3 sessions after surgery using a centrifugation-based cell separator. Replacement fluids included normal serum albumin, normal saline, and fresh frozen plasma. Bevacizumab levels were quantified using an enzyme-linked immunoabsorbent assay before and after each TPE session.

Results

TPE effectively removed bevacizumab, enabling safe surgery without new complications. Plasma bevacizumab levels decreased from 1087.63 to 145.35 ng/mL (13.4% of original) by the end of the last TPE session. This decline is consistent with nearly 3 half-lives, which compares favorably to the expected timeline of natural decline given the 21-day half-life.

Conclusions

We report a complex clinical scenario of a patient requiring urgent wound washout 4 days after last bevacizumab infusion for CNS infection. Surgery was successfully performed without new complications with use of TPE to remove bevacizumab immediately following surgery. This case highlights the feasibility of this approach, which may be utilized effectively in patients requiring surgery after having recently received bevacizumab.
Fear of a Black Neighborhood: Anti-Black Racism and the Health of White Americans
Authors: Louie Patricia , DeAngelis Reed T
Published: August 2023

Does anti-Black racism harm White Americans? We advance hypotheses that address this question within the neighborhood context. Hypotheses are tested with neighborhood and survey data from a probability sample of White residents of Nashville, Tennessee. We find that regardless of neighborhood crime rates or socioeconomic compositions, Whites report heightened perceptions of crime and danger in their neighborhoods as the proportion of Black residents increases. Perceived neighborhood danger, in turn, predicts increased symptoms of psychophysiological distress. When stratified by socioeconomic status (SES), however, low-SES Whites also report perceptions of higher status when living near more Black neighbors, which entirely offsets their distress. We conclude that although anti-Black racism can ironically harm the health of White Americans, compensatory racist ideologies can also offset these harms, particularly for lower-status Whites. We situate our findings within broader discussions of anti-Black racism, residential segregation, and psychiatric disorders commonly observed among White Americans.
Effectiveness of Sublingual Buprenorphine for Pain Control in the ICU*
Authors: Patanwala Asad E. , Moran Benjamin , Johnstone Charlotte , Koelzow Heike , Penm Jonathan
Published: August 2023

OBJECTIVES:

The objective of this study was to compare pain control and opioid consumption in critically ill patients who were treated with buprenorphine sublingual or oxycodone oral/enteral during ICU admission.

DESIGN:

This was a retrospective, parallel, cohort study.

SETTING:

General medical or surgical ICUs of a quaternary, urban hospital in Sydney, NSW, Australia.

PATIENTS:

Data were obtained for all patients admitted to two general medical or surgical ICU from January 2019 to January 2023. Patients were grouped as those who received buprenorphine sublingual versus oxycodone oral/enteral.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Pain control was compared between a propensity score matched cohort of patients who received buprenorphine versus oxycodone. The primary outcome was the probability of significant pain. A significant pain score was defined as greater than or equal to 4 on the 0–10 Numeric Rating Scale or greater than or equal to 6 on the Behavioral Pain Scale. The study cohort included 1,070 patients (288 buprenorphine and 782 oxycodone). After propensity score matching, there were 288 patients in each group. The mean age of the matched cohort was 64 ± 16 years, 295 (51%) were male, and 359 (62%) had a surgical admission. The median probability of significant pain was 0.16 with buprenorphine and 0.17 with oxycodone (median difference, 0.01; 95% CI, –0.02 to 0.04; p = 0.50). Median opioid consumption in oral morphine milligram equivalents (MMEs) was 65 with buprenorphine and 70 with oxycodone (median difference, –1 mg; 95% CI, –10 to 10 mg; p = 0.73). Median MME per ICU day was 22 with buprenorphine and 22 with oxycodone (median difference, 1 mg; 95% CI, –2 to 5 mg; p = 0.38).

CONCLUSIONS:

Buprenorphine sublingual is as effective as oxycodone oral/enteral with regard to pain control and opioid consumption in the ICU. Buprenorphine sublingual is an appropriate option for patients in the ICU who are unable to take oral/enteral medications.
The effects of music therapy on the psychological status of women with perimenopause syndrome
Authors: Kim Soyeon , Kim Sun Mi , Hwang Hyunchan , Kim Min Kyoon , Kim Hee Jun , Park Seojin , Han Doug Hyun
Published: August 2023

Objective

Women experience many physical and psychological changes with the reduction of progesterone and estrogen as ovarian function gradually weakens. This study applied a music psychotherapy program as a nonpharmacological treatment method in addition to treatment using drugs such as hormone therapy for perimenopausal women.

Method

This study's pre-post, control-experimental research compared 20 women in the music psychotherapy experimental group and 20 in the cognitive behavioral therapy (CBT) control group. The perimenopausal women aged between 40 and 60 years experienced no menstrual period for 1 year. We provided eight sessions of music psychotherapy, including CBT, each lasting 60 minutes. The study period was 4 months from the time of recruitment.

Results

The music therapy group showed a more significant decrease in the Menopause Rating Scale total (change over time, 9.2 points and 3.5 points, respectively; P = 0.008) and psychology subcategory (change over time, 6.5 points and 0.9 points, respectively; P = 0.004) of Menopause Rating Scale scores, compared with the CBT group. In addition, the music therapy group increased their quality of life psychological score, but the CBT group did not.

Conclusions

These results suggest that music therapy can help the psychological and emotional symptoms of perimenopausal women and is effective for treatment. The study result provides a therapeutic basis for developing treatments for nonpharmacological mediation.
Povidone-iodine-induced transient triiodothyronine thyrotoxicosis in a Japanese patient with prolonged habitual gargling: A case report and literature review
Authors: Suzuki Ryuji , Suzuki Seiji
Published: August 2023

Rationale:

Iodine-induced hyperthyroidism and triiodothyronine (T3) thyrotoxicosis in patients who routinely gargle with povidone-iodine (PVP-I) gargling solution are rare in Japan.

Patient concerns:

A 50-year-old man presented to our hospital for a close examination of an enlarged thyroid, which was noted during a complete health checkup. The thyroid was slightly enlarged with no palpable nodules. He had an increased appetite but no weight gain. He had been routinely gargling with PVP-I gargling solution 4 times daily for >10 years. He had no history of thyroid disease.

Diagnoses:

Test results revealed suppressed thyroid-stimulating hormone, normal free thyroxine, and increased free triiodothyronine levels, leading to the diagnosis of T3 thyrotoxicosis.

Interventions:

The patient agreed to stop gargling with PVP-I gargle solution.

Outcomes:

The free triiodothyronine and thyroid-stimulating hormone levels returned to normal at 18 and 21 weeks, respectively, after discontinuation of PVP-I gargling. After an improvement in thyroid function, he gained 5 kg in 1 year.

Lessons:

To our knowledge, this is the first case report that describes PVP-I gargle-induced T3 thyrotoxicosis in a healthy individual without thyroid disease. In Japan, which is an iodine-sufficient country, considering the possibility of high-dose iodine intake-induced thyrotoxicosis due to long-term PVP-I gargling or other causes is necessary, even in individuals with no history of thyroid disease.