bluuebunny/crossref_metadata_2025_split huggingface dataset:
1230 Infrainguinal Bypass Informed Consent: An Audit Driven Standardisation Of Perioperative Risk Profiling
Authors: Muhammad K , Al-Khaffaf H 
Published: October 2021

Abstract

Introduction
It is a fundamental good clinical practice in our medicolegal rights era to obtain standard, adequate, and transparent informed consent before any planned intervention. Currently, there are neither national approved vascular intervention-specific consents nor explicit guidelines for it. We aim to achieve a standardisation of perioperative risk profiling of infrainguinal bypass surgical consents and produce a model one.

Method
A retrospective analysis of 45 infrainguinal bypass consents (audit/reaudit) between (2013-2019) retrieved to evaluate quality and completeness against GMC 2008 guidance: "Consent: patients and doctors making decisions together". Data included basic consent requirements according to guidelines and speciﬁc risks of infrainguinal bypass. It was registered with the Trust Clinical Audit Department.

Results
(100%) of audit and reaudit consents documented the intended benefits of surgery. Inclusion into the National Vascular Registry (NVR) was achieved (0%) in audit vs (80%) in reaudit forms. Of the 19 documented postoperative complications, reaudit significant improvement observed in % of documenting 16 items with 9 complications recorded above 50%. The maximum number of audit documented risks was 15 (79%), the median 8 (42%), and the least was 3 (16%) compared to maximum 16 (84%), the median 10 (53%) and the least was 4 (21%) when reaudited, respectively.

Conclusions
Deficiencies in performing and adequately completing surgical consents still occur. Introducing a national pre-printed vascular intervention-specific consent is vital for accomplishing and maintaining a good clinical practice. It should include all complications with relative % risk to minimise errors, provide good quality consent, and promote clinical practice at a national level.
1248 “Passing the Surgical Torch”- A Review of Appropriate Surgical Handover Protocol on The Acute Surgical Take
Authors: Shaladi A , Marshall K , Fernandes R 
Published: October 2021

Abstract

Aim
Effective handover between shifts is vital to protect patient safety. The Royal College of Surgeons has detailed the necessary information needed for each patient at handover. We aimed to assess compliance with this handover protocol.

Method
Weekday surgical handover was reviewed over an 8-week period of time. Data was collected on documentation of diagnosis, up to investigations/bloods, clinical state of patient, management plan and resuscitation status/ceiling of care and COVID status.

Results
210 patients were reviewed. Of these, a clear diagnosis was documented for 152 patients. Up to date imaging results if applicable was documented in 111 of 153 patients. Up to date bloods were included in 140 of 210 patients. COVID status was only noted in 31 of 210 patients and DNAR status in only 24. After re-audit of 197 a clear diagnosis was seen in 183 patients, COVID status was documented in 170 patients and DNAR status in 169.

Conclusions
Surgical handover is hugely crucial for provision of patient care. Following clear guidance from the royal college of surgeons, better compliance with handover was noted, including a critical improvement in COVID and DNAR status.
1316 An Evaluation of The Consent Process in One of The Largest Spinal Surgery Units in Europe
Authors: Daitey E , Afolayan J , Shah N , Stringfellow T , Shafafy R , Gibson A 
Published: October 2021

Abstract
Complex spinal surgery has high morbidity and mortality making the process of consent central to patient care [1]. Our aim was to qualitatively assess our consent process with three set metrics; how far in advance patients were consented prior to the date of surgery, the inclusion of all relevant risks on the consent form and the provision of supplementary patient information leaflets or equivalent.
We retrospectively reviewed 100 consecutive patients undergoing elective spinal surgery at our tertiary centre which is the one of the largest spinal units in Europe between December 2019 and March 2020.
All patients had valid consent forms. 16% of patients were consented on the day of surgery, 22% were consented the day before. Of the remaining 62%, 22 patients (35%) were consented within 2 weeks of surgery, and 40 (65%) over 2 weeks prior to surgery.
94% were consented for all relevant risks as determined by the senior authors. 81% had no documentation of receiving supplementary information and 11% had documentation of consent discussion in clinic.
In conclusion, this audit revealed a significant variation in the consent process within our unit. This may highlight a deficit in the consenting process which we aim to explore further.
1348 Quality Improvement Project to Promote Betablocker Therapy Post CABG In Patients with Low Left Ventricular Ejection Fraction (LVEF): A Single Centre Study
Authors: Roy Dorina , Aljanadi Firas , Jones Mark 
Published: October 2021

Abstract

Aim
Statistically significant and strong evidence suggests that beta-blockers reduce the number of deaths in patients with reduced LVEF (&lt;35%). The 2017 European Association for Cardio-Thoracic Surgery (EACTS) guidelines for perioperative medications in cardiac surgery recommended betablockers should be commenced or continued on discharge for patients with low LVEF after Coronary Artery Bypass Graft (CABG). The EACTS recommends the use of Bisoprolol, Metoprolol, Carvedilol and Nebivolol. We aimed to assess the discharge prescription of patients undergoing CABG at a regional tertiary care centre.

Method
A retrospective observational analysis of patients admitted between 2013 and 2020 with low LVEF was done. A. total of 101 patients were finally included. Electronic care records of patients were reviewed to collect patient data, including clinic and discharge letters. Audit registration was conducted as per local hospital policies.

Results
Demographics revealed average age to be 66 years. There were 23% females and 77% males. Out of 101 patients, 90 (89%) patients were discharged with betablockers. 11 (11%) patients were not discharged with Betablockers. 83 (81%) patients were discharged with recommended betablockers.

Conclusions
This comprises the first cycle of the audit. Data is currently being analysed for a second cycle. Findings from this audit suggest good compliance with established guidelines, however there is scope for improvement. We employed simple measures like departmental presentation and raising awareness. Additional methods such as inclusion in discharge checklists is also a recommendation. Outcome from the second cycle will guide further interventions and data from both cycles will be presented at the meeting.
1365 Analysis of Outcomes Pre- and Post-Physiotherapy Protocol for Centenarian Patients Presenting with Neck of Femur Fractures
Authors: Shaladi A , Abdelkarim I , Kitson J 
Published: October 2021

Abstract

Aim
The number of centenarians has quadrupled over the last 2 decades with an increase in the number presenting with proximal femur fractures. Very little is known about mortality and morbidity in this age group. There is a subjective assumption that they are too frail and may not do well with surgery. This audit aims to outline improved outcomes of surgery in centenarian patients with NOF fractures following dedicated modified physiotherapy intervention.

Method
Data reviewing centenarian NOF outcomes over a two-year period (2015-2016) was compared with outcomes following a dedicated post-operative physiotherapy trust protocol for centenarian NOF patients. 16 patients (15 female, 1 male) from Jan 2017- August 2019 were identified. Data was analysed for patient demographics, surgical details including anaesthesia, post-operative complications, physiotherapy outcomes and mortality.

Results
10 patients had dynamic hip screws and 6 patients had hemiarthroplasties. Inpatient mortality was 0% compared to previous audit of 8.3%. The average length of stay had reduced from 23.3 days in previous audit to 18.5 days in current. 82% of patients could transfer with frame in the post-operative period.

Conclusions
Positive surgical outcomes are demonstrated even in centenarians particularly when given tailored post-operative physiotherapy with reduced length of stay, mortality, and high levels of physiotherapy compliance. Comparisons with younger elderly patients will help guide future management.
1371 “The Nosebleed Effect”: Advice Given to Epistaxis Patients Discharged from The Emergency Department
Authors: Shaladi A , Loizou P , Michael M 
Published: October 2021

Abstract

Introduction
Many patients with epistaxis are seen in the A&E department. A significant number are discharged without need for inpatient admission due to minor bleeds. Many are given limited information on management of further bleeds and even fewer are advised on the prevention of bleeds.

Aim
To evaluate the advice given to patients with epistaxis who are seen and discharged from A+E, to instigate an improvement in advice and to examine the subsequent effect on re-attendance rates

Method
Epistaxis patients discharged from A+E were audited over a 6-week period looking at advice given on discharge. A questionnaire was distributed to all A&E and ENT doctors probing current practice. A presentation on the management and prevention of epistaxis and the appropriate verbal/written advice to give was delivered and epistaxis advice sheets were made available. The practice regarding advice and the re-attendance rates were re-audited.

Results
53 patients presented to the A&E department with epistaxis. 31 patients presenting with epistaxis were seen and discharged by A&E doctors. The remaining seen by ENT. Only 9 patients received verbal advice and 1 received written advice. There were 13 re-attenders. After re-audit showed a significant increase in the proportion of patients receiving advice by A&E doctors. Verbal and written advice increased from 18% to 61% and 1% to 60% respectively. The number of re-attenders was reduced to 13 to 6.
1382 Retrospective Audit to Assess Compliance to National Guidance for The Follow-Up of Acute Uncomplicated Diverticulitis and Adenoma Detection Rate at University Hospital Bristol
Authors: Newton L , Huppler L , McCabe T , Gourbault L , Embury-Young Y , Handa I , Muir D , Sivalingam N , Archdeacon J , Chan J , Macleod-Hall C , Shabbir J 
Published: October 2021

Abstract

Aim
Diverticulitis is a common cause for acute surgical admissions. UK guidance recommends uncomplicated diverticulitis is managed with antibiotics, and follow-up outpatient lower gastrointestinal (LGI) endoscopy (flexible sigmoidoscopy or colonoscopy) arranged 6-8 weeks after discharge. This audit aimed to assess compliance to national guidance and assess adenoma detection rate.

Method
Retrospective analysis of discharge summaries coded ‘diverticulitis’ from January 2017 – April 2020 at University Hospital Bristol(UHB).

Results
426 patients presented with uncomplicated diverticulitis, mean age 60.5 years (22-92 years). 42% (179/426) of patients underwent LGI endoscopy as an inpatient or on discharge. Median time to outpatient endoscopy was 70 days (6-287 days). 23% (99/426) had LGI endoscopy within the 8-week target. Histology showed: 21% (37/179) polyp; 5% (9/179) tubular adenoma; and one patient had high grade dysplasia. The histology for the remaining 28 patients with polyps showed: hyperplasia; granulation tissue; inflammation; or samples were not sent for histology. No cases of malignancy were detected.

Conclusions
58% of patients admitted with acute uncomplicated diverticulitis did not have a follow-up LGI endoscopy and only 23% had LGI endoscopy within the 8-week target. 21% had a polyp with a 5% rate of tubular adenoma and no cases of malignancy. UHB needs to improve compliance with national guidance for the arrangement of follow-up LGI endoscopy, however the absence of detection of malignancy raises the question of whether we need to re-consider its necessity for patients with uncomplicated diverticulitis.
Cardiac SARS-CoV-2 infection is associated with pro-inflammatory transcriptomic alterations within the heart
Authors: Bräuninger Hanna , Stoffers Bastian , Fitzek Antonia D E , Meißner Kira , Aleshcheva Ganna , Schweizer Michaela , Weimann Jessica , Rotter Björn , Warnke Svenja , Edler Carolin , Braun Fabian , Roedl Kevin , Scherschel Katharina , Escher Felicitas , Kluge Stefan , Huber Tobias B , Ondruschka Benjamin , Schultheiss Heinz-Peter , Kirchhof Paulus , Blankenberg Stefan , Püschel Klaus , Westermann Dirk , Lindner Diana 
Published: October 2021

Abstract

Aims
Cardiac involvement in COVID-19 is associated with adverse outcome. However, it is unclear whether cell-specific consequences are associated with cardiac SARS-CoV-2 infection. Therefore, we investigated heart tissue utilizing in situ hybridization, immunohistochemistry, and RNA-sequencing in consecutive autopsy cases to quantify virus load and characterize cardiac involvement in COVID-19.

Methods and results
In this study, 95 SARS-CoV-2-positive autopsy cases were included. A relevant SARS-CoV-2 virus load in the cardiac tissue was detected in 41/95 deceased (43%). Massive analysis of cDNA ends (MACE)-RNA-sequencing was performed to identify molecular pathomechanisms caused by the infection of the heart. A signature matrix was generated based on the single-cell dataset ‘Heart Cell Atlas’ and used for digital cytometry on the MACE-RNA-sequencing data. Thus, immune cell fractions were estimated and revealed no difference in immune cell numbers in cases with and without cardiac infection. This result was confirmed by quantitative immunohistological diagnosis. MACE-RNA-sequencing revealed 19 differentially expressed genes (DEGs) with a q-value &lt;0.05 (e.g. up: IFI44L, IFT3, TRIM25; down: NPPB, MB, MYPN). The upregulated DEGs were linked to interferon pathways and originate predominantly from endothelial cells. In contrast, the downregulated DEGs originate predominately from cardiomyocytes. Immunofluorescent staining showed viral protein in cells positive for the endothelial marker ICAM1 but rarely in cardiomyocytes. The Gene Ontology (GO) term analysis revealed that downregulated GO terms were linked to cardiomyocyte structure, whereas upregulated GO terms were linked to anti-virus immune response.

Conclusion
This study reveals that cardiac infection induced transcriptomic alterations mainly linked to immune response and destruction of cardiomyocytes. While endothelial cells are primarily targeted by the virus, we suggest cardiomyocyte destruction by paracrine effects. Increased pro-inflammatory gene expression was detected in SARS-CoV-2-infected cardiac tissue but no increased SARS-CoV-2 associated immune cell infiltration was observed.
Toward the economic evaluation of participatory approaches in health promotion: lessons from four German physical activity promotion projects
Authors: Gelius Peter C , Sommer Raluca M , Abu-Omar Karim , Schätzlein Valentin , Suhrcke Marc 
Published: October 2021

Abstract
Health promotion increasingly employs participatory approaches, but the question arises whether the likely higher costs of participation also translate into greater benefits. This article takes a first step toward a full health economic evaluation by comprehensively reporting the costs of a specific participatory approach, Cooperative Planning, in a German research consortium to promote physical activity. We conducted a costing analysis of Cooperative Planning at 22 sites across six settings. Project teams used a custom template to record resource use. We calculated average costs per meeting, site and setting using the opportunity costs approach, and obtained feedback from participating researchers. A total of 144 planning meetings with an average of nine participants were conducted. Costs per meeting varied significantly across settings. Differences were mostly attributable to varying meeting duration, preparation time and numbers of participants. Across settings, human resources accounted for roughly 95% of the costs. Implementing researchers reported challenges regarding the logic and methods of the health economic analysis. A participatory approach to physical activity promotion may cause substantially varying costs in different settings despite similar cost structures. However, their value for money could turn out comparably favorable if (and only if) the expected benefits is indeed forthcoming. Despite some challenges implementing the costing exercise into the logistics of ongoing participatory projects, this analysis may pave the way toward a full health economic evaluation, and the template may be useful to future participatory health promotion projects.
Becoming an ocean scientist: learning from surprise
Authors: Schneider David C 
Published: October 2021

AbstractAn invitation to write a thought piece is an opportunity to reflect on one's early career, when events and choices shaped what we became. Because I teach at a university, I wrote a narrative for those thinking of becoming an ocean scientist, and are now encountering the research literature. It is a chronicle of episodes, each a discovery or surprising event and what I learned. It moves from early memories of the natural world to first attempts at science. A near-fatal surprise led to a course in environmental policy, to a commitment to public good science, and to learning benthic ecology in Woods Hole. Failure at publishing an original finding from a thesis spurred me to self-directed practice in writing scientific prose. Skill at running statistical analyses resulted in a post-doc on a topic where I had no other expertise. Publication success led to a second post-doc and a faculty position in Canada, where I funded three decades of student-oriented research, taught statistics, and wrote a book on ecological scaling from the point of view of an oceanographer. Teaching statistics came with surprises, which I list as further food for thought.
What Do You Mean by “Democrat” and “Republican”? Evidence from a Conjoint Experiment
Authors: Ogura Ikuma , Miwa Hirofumi , Iida Takeshi 
Published: October 2021

Abstract
To better understand the nature of American mass party identification, it is crucial to examine how voters understand terms used in measuring partisanship in public opinion surveys, such as “Democrat” and “Republican.” For this purpose, we conducted a conjoint experiment where respondents evaluated hypothetical profiles’ partisanship. We show that, in contrast to previous studies which rely on one theoretical perspective to understand mass partisanship, multiple theories are reflected in how voters understand labels representing their partisanship. Further, the results suggest that many Americans seem to equate party identification with vote choice, contrary to standard assumptions in American political behavior research that these are separate concepts.
Trust in AI: why we should be designing for APPROPRIATE reliance
Authors: Benda Natalie C , Novak Laurie L , Reale Carrie , Ancker Jessica S 
Published: October 2021

Abstract
Use of artificial intelligence in healthcare, such as machine learning-based predictive algorithms, holds promise for advancing outcomes, but few systems are used in routine clinical practice. Trust has been cited as an important challenge to meaningful use of artificial intelligence in clinical practice. Artificial intelligence systems often involve automating cognitively challenging tasks. Therefore, previous literature on trust in automation may hold important lessons for artificial intelligence applications in healthcare. In this perspective, we argue that informatics should take lessons from literature on trust in automation such that the goal should be to foster appropriate trust in artificial intelligence based on the purpose of the tool, its process for making recommendations, and its performance in the given context. We adapt a conceptual model to support this argument and present recommendations for future work.
PSV-14 Using Bayesian Hamiltonian Monte Carlo and a nonlinear model for the estimation of genetic parameters for lactation curves in goats
Authors: Araujo Andre C , Gloria Leonardo , Abreu Paulo , Silva Fabyano , Rodrigues Marcelo , Brito Luiz F 
Published: October 2021

Abstract
Hamiltonian Monte Carlo (HMC) is an algorithm of the Markov Chain Monte Carlo (MCMC) method that uses dynamics to propose samples that follow a target distribution. This algorithm enables more effective and consistent exploration of the probability interval and is more sensitive to correlated parameters. Therefore, Bayesian-HMC is a promising alternative to estimate individual parameters of complex functions such as nonlinear models, especially when using small datasets. Our objective was to estimate genetic parameters for milk traits defined based on nonlinear model parameters predicted using the Bayesian-HMC algorithm. A total of 64,680 milk yield test-day records from 2,624 first, second, and third lactations of Saanen and Alpine goats were used. First, the Wood model was fitted to the data. Second, lactation persistency (LP), peak time (PT), peak yield (PY), and total milk yield [estimated from zero to 50 (TMY50), 100(TMY100), 150(TMY150), 200(TMY200), 250(TMY250), and 300(TMY300) days-in-milk] were predicted for each animal and parity based on the output of the first step (the individual phenotypic parameters of the Wood model). Thereafter, these predicted phenotypes were used for estimating genetic parameters for each trait. In general, the heritability estimates across lactations ranged from 0.10 to 0.20 for LP, 0.04 to 0.07 for PT, 0.26 to 0.27 for PY, and 0.21 to 0.28 for TMY (considering the different intervals). Lower heritabilities were obtained for the nonlinear function parameters (A, b and l) compared to its predicted traits (except PT), especially for the first and second lactations (range: 0.09 to 0.18). Higher heritability estimates were obtained for the third lactation traits. To our best knowledge, this study is the first attempt to use the HMC algorithm to fit a nonlinear model in animal breeding. The two-step method proposed here allowed us to estimate genetic parameters for all traits evaluated.