bluuebunny/crossref_metadata_2025_split huggingface dataset:
EP584 - The standard of evening handover in the acute surgical department of a single regional centre: a closed-loop audit
Authors: Tiwari Abhinav , Hayat Muhammad , Everett Katherine , Howse Frances 
Published: September 2024

Abstract

Aims
Handover is an important period that represents a potential risk to patient safety. The Royal College of Surgeons of England (RCSEng) have published guidelines on safe handover practice. The aim of this closed-loop two-cycle audit was to ensure general surgery patients at a single regional centre were handed over according to RCSEng guidelines.

Method
Evening handovers were prospectively audited between May 2023 to July 2023 using a proforma adapted from the RCSEng guidelines. A questionnaire relating to junior doctors’ views on the night handover was electronically disseminated prior to the first cycle. The intervention was an educational guide for foundation doctors on how to effectively hand over surgical patients, based on the RCSEng guidelines. P-values were calculated using a Mann-Whitney U test.

Results
15 handovers were audited in the first cycle; of 84 patients handed over, 31% (26/84) met the RCSEng handover ‘minimum’ standard. 13 handovers were audited in the second cycle; 84 patients were handed over, the ‘minimum’ standard rate increased to 67% (56/84) (p=0.003). There were 25 responses to the questionnaire, 92% (23/25) were by foundation doctors, 48% (12/25) volunteered wanting more teaching on handovers.

Conclusions
Introduction of an educational handover guide is a useful method to improve the quality of surgical handovers, particularly in regional centres that may have a more complex case mix. This guide was later introduced as part of the ‘induction pack’ for foundation doctors rotating into surgery.
EP621 - Surgical waiting times at a busy general surgical unit at a district hospital oin NHS
Authors: Arifuzaman Mohammed 
Published: September 2024

Abstract

Aims
To understand the general surgical waiting times at NMGH. To estimate the degree of mismatch among the original booking consultant and performing surgeon. To accurately assess the median waiting times for each type of surgery.

Methods
Retrospective observational study. Data collected include date of surgery, date of listing for surgery, consultant listing for surgery and name of surgeon performing procedure, MRN, age, sex and type of surgery. Times calculated from the original listing for surgery in the clinic or during inpatient and actual date of surgery.

Results
Total patients included in the study were 330. Overall median delay for all the surgical cases was 345.5 days (49.35 weeks). 173 female patients and 157 male patients were included. Patients’ records were checked for any cancellations or refusal for surgery, but most did not present any reason for delay and hence the date of booking and surgery done were recorded.

Conclusion
Overall colorectal waiting time at NMGH is median 393.5 days (56.2 weeks), mean time of 298.6 days (42.6 weeks) which is higher than MFT mean time of 26 weeks. Overall, for colorectal cases, about 62 % of times, the booking Consultant is the operating surgeon. Overall General Surgery waiting time at NMGH is median 356.6 days (50.9 weeks), mean 318 days (45.4 weeks) which is higher than MFT mean waiting time of 33 weeks. Median waiting time for lap chole is 369.5 days (52.7 weeks), mean 317.6 days (45.3 weeks) which is within the NHS standards of 18 to 52 weeks (1). West Suffolk NHS foundation Trust has published the mean waiting time of 53 weeks.
Cardiogenic shock in phaeochromocytoma multisystem crisis: a case report
Authors: Go Yun Yun , Ng Audrey Jing Ting , Balakrishnan Iswaree Devi , Tiwari Raj Vikesh , Tong Aaron Kian Ti , Lee Lianne Ai Ling , Keh Yann Shan , Tay Donovan 
Published: September 2024

Abstract

Background
Phaeochromocytoma multisystem crisis (PMC) is characterized by labile blood pressures (extremes of hypo- and/or hypertension) and multiorgan failure as a result of catecholamine excess. Initial stabilization requires pharmacological and/or mechanical circulatory support, followed by the institution of antihypertensives to correct the underlying pathophysiology.

Case summary
A previously well 40-year-old male developed a sudden onset of breathlessness. On presentation, he was in shock with multiorgan failure. He required intubation, mechanical ventilation, dual inotropic support, and renal replacement therapy. Bedside echocardiogram showed a severely impaired left ventricular ejection fraction (LVEF) of 25%. Coronary angiography revealed normal coronary arteries. In view of raised inflammatory markers and transaminitis, a computed tomography abdomen/pelvis was performed. An incidental left adrenal mass was found. Further work-ups revealed raised plasma metanephrine and normetanephrine, 24-h urine epinephrine, and norepinephrine. A cardiac magnetic resonance (CMR) showed myocardial inflammation and reverse Takotsubo pattern of regional wall motion abnormality (RWMA). The diagnosis of cardiogenic shock and stress cardiomyopathy secondary to PMC was made. He was subsequently initiated on α- and β-blockers and goal-directed medical therapy for heart failure. A 68Ga-DOTATATE scan showed avid tracer uptake of the left phaeochromocytoma. An interval CMR 3 weeks from presentation showed near normalization of the LVEF and RWMA. He underwent a successful laparoscopic left adrenalectomy and was antihypertensive-free since.

Discussion
The clinical suspicion for PMC as the cause of cardiogenic shock requires astute clinical judgement, while the management requires an understanding of the underlying pathophysiology that calls for multidisciplinary inputs.
Y and mitochondrial chromosomes in the heterogeneous stock rat population
Authors: Okamoto Faith , Chitre Apurva S , Missfeldt Sanches Thiago , Chen Denghui , Munro Daniel , Aron Allegra T , Beeson Angela , Bimschleger Hannah V , Eid Maya , Garcia Martinez Angel G , Han Wenyan , Holl Katie , Jackson Tyler , Johnson Benjamin B , King Christopher P , Kuhn Brittany N , Lamparelli Alexander C , Netzley Alesa H , Nguyen Khai-Minh H , Peng Beverly F , Tripi Jordan A , Wang Tengfei , Ziegler Kendra S , Adams Douglas J , Baud Amelie , Carrette Lieselot L G , Chen Hao , de Guglielmo Giordano , Dorrestein Pieter , George Olivier , Ishiwari Keita , Jablonski Monica M , Jhou Thomas C , Kallupi Marsida , Knight Rob , Meyer Paul J , Solberg Woods Leah C , Polesskaya Oksana , Palmer Abraham A 
Published: September 2024

Abstract
Genome-wide association studies typically evaluate the autosomes and sometimes the X Chromosome, but seldom consider the Y or mitochondrial (MT) Chromosomes. We genotyped the Y and MT Chromosomes in heterogeneous stock (HS) rats (Rattus norvegicus), an outbred population created from 8 inbred strains. We identified 8 distinct Y and 4 distinct MT Chromosomes among the 8 founders. However, only 2 types of each nonrecombinant chromosome were observed in our modern HS rat population (generations 81–97). Despite the relatively large sample size, there were virtually no significant associations for behavioral, physiological, metabolome, or microbiome traits after correcting for multiple comparisons. However, both Y and MT Chromosomes were strongly associated with the expression of a few genes located on those chromosomes, which provided a positive control. Our results suggest that within modern HS rats there are no Y and MT Chromosomes differences that strongly influence behavioral or physiological traits. These results do not address other ancestral Y and MT Chromosomes that do not appear in modern HS rats, nor do they address effects that may exist in other rat populations, or in other species.
Stop antibiotics when you feel better? Opportunities, challenges and research directions
Authors: Borek A J , Ledda A , Pouwels K B , Butler C C , Hayward G , Walker A S , Robotham J V , Tonkin-Crine S 
Published: September 2024

Abstract
Shortening standard antibiotic courses and stopping antibiotics when patients feel better are two ways to reduce exposure to antibiotics in the community, and decrease the risks of antimicrobial resistance and antibiotic side effects. While evidence shows that shorter antibiotic treatments are non-inferior to longer ones for infections that benefit from antibiotics, shorter courses still represent average treatment durations that might be suboptimal for some. In contrast, stopping antibiotics based on improvement or resolution of symptoms might help personalize antibiotic treatment to individual patients and help reduce unnecessary exposure. Yet, many challenges need addressing before we can consider this approach evidence-based and implement it in practice. In this viewpoint article, we set out the main evidence gaps and avenues for future research.
Within-population variation in preference functions reveals substantial among-female disagreement in mate assessment
Authors: Stratman Kane , Höbel Gerlinde 
Published: September 2024

Abstract
The mate choice behaviours of females can greatly affect patterns of reproductive success in males and influence the evolution of sexually selected male traits. Population-level estimates of display preferences may provide an accurate estimate of the strength and direction of selection by female choice if all females in the population show homogeneous preferences. However, population-level estimates may yield misleading estimates if there is within-population variation in mate preferences. While it is increasingly clear that the latter situation is common in nature, empirical data on the magnitude of variation in female preferences are required to improve our current understanding of its potential evolutionary consequences. We explored variations in female preference functions for 3 male call properties in a treefrog. We document substantial within-population variation not only in peak preferences but also in preference function shape (open, closed, flat), with at best 62% of females sharing a preference function shape with the respective population curve. Our findings suggest that population curves may accurately capture the direction of sexual selection, but depending on the properties of the constituting individual functions they may over- or underestimate the strength of selection. Particularly population estimates suggesting weak selection may in fact hide the presence of individual females with strong but opposing preferences. Moreover, due to the high within-population variation in both peak preferences and preference function shapes, the population functions drastically underestimate the predicted variation in male mating success in the population.
A randomized controlled trial to test the efficacy of a brief Triple P discussion group to increase healthy feeding practices and reduce risk factors for infant obesity
Authors: Gelmini Agnes , Tellegen Cassandra L , Morawska Alina 
Published: September 2024

Abstract

Objective
Test the efficacy of a brief 2-hr parenting intervention in increasing protective factors against and reducing risk factors for infant obesity.

Method
A 2 (Baby Healthy Living Triple P vs. care-as-usual) × 3 (baseline, postintervention, 6-month follow-up) design was used. Eighty-two parents of 4- to 18-month-old infants meeting at least two risk factors for early childhood obesity (e.g., parent/child overweight, low education level) were randomized to intervention (n = 42) or control group (n = 40). Parents questionnaires and child weight status was measured.

Results
Results showed an intervention effect on a primary outcome, early feeding practices (restrictive: d = 0.44, 95% CI [−0.01,0.88], pressuring: d = 0.11, 95% CI [−0.32,0.54], nonresponsive behaviors: (d = 0.32, 95% CI [−0.11,0.75]), and on a secondary outcome, feeding beliefs (d = 0.29, 95% CI [−0.14,0.73]). No beneficial impact was found on other primary outcomes (responsiveness in feeding: quantity d = 0.50, 95% CI [−0.03,1.03]) and nutritive d = 0.52, 95% CI [−0.03,1.07], mealtime environment: d = 0.35, 95% CI [−0.78,0.08], self-efficacy in responsive feeding: d = 0.21, 95% CI [−0.22,0.64]), or secondary outcomes (parental self-efficacy: d = 0.08, 95% CI [−0.50,0.35]), parent emotional eating (d = 0.01, 95% CI [−0.43,0.43]), food restraint (d = 0.42, 95% CI [−0.85,0.02]), and body satisfaction (d = 0.01, 95% CI [−0.43,0.43]) and child weight status (d = 0.11, 95% CI [−0.54,0.32]).

Conclusions
Promising though limited support was demonstrated for a brief, low-intensity program to help parents in the prevention of obesity for infants at risk.
Treatment-related survival patterns in diffuse intrinsic pontine glioma using a historical cohort: A report from the European Society for Pediatric Oncology DIPG/DMG Registry
Authors: Baugh Joshua N , Veldhuijzen van Zanten Sophie , Fiocco Marta , Colditz Niclas , Hoffmann Marion , Janssens Geert O , Valentini Chiara , Hargrave Darren , Wiese Maria , von Bueren André O , Karremann Michael , Perwein Thomas , Nussbaumer Gunther , Benesch Martin , Sturm Dominik , Gielen Gerrit H , Krause Mechthild , Eyrich Matthias , Hoving Eelco W , Bison Brigitte , van Vuurden Dannis G , Kramm Christof M 
Published: September 2024

Abstract

Background
Our aim is to investigate the association of treatment with survival in patients with diffuse intrinsic pontine glioma (DIPG) by examining 6 historical treatment paths.

Methods
We retrospectively analyzed data from 409 patients with radiologically centrally reviewed DIPG, sourced from the German Society of Pediatric Oncology and Hematology HIT-HGG trial database and the SIOPE-DIPG/DMG Registry. Survival outcomes were estimated using the Kaplan–Meier method, and univariable and multivariable Cox proportional hazard models were estimated to study treatment effects.

Results
The median overall survival (OS) from diagnosis was 11.2 months (95% confidence interval [CI], 10.5–11.9). Patients who by choice received no frontline treatment had an OS of 3.0 months (95% CI, 2.0–4.0), while those treated with radiation therapy (RT) alone had a median OS of 10.4 months (95% CI, 9.1–11.8). Those receiving RT combined with chemotherapy had the longest median OS of 11.7 months (95% CI, 10.8–12.6). The median post-progression survival (PPS) was 4.1 months (95% CI, 3.5–4.7). Patients who relapsed and did not receive treatment had a PPS of 2.2 months (95% CI, 1.8–2.6), while those treated with chemotherapy alone had a PPS of 4.4 months (95% CI, 3.7–5.0), and those who underwent reirradiation, with or without chemotherapy, had the longest survival after relapse of 6.6 months (95% CI, 5.3–8.0). Treatment differences remained significant in multivariable analysis adjusted for age and symptom duration in both diagnosis and relapse setting.

Conclusions
This study shows increased survival outcomes associated with radiation and chemotherapy treatment or a combination thereof, at diagnosis and relapse, in a historical DIPG cohort.
Incompatibility of Y-site-administered drugs: the case of acyclovir and ciprofloxacin
Authors: Labrosse Dorine , Flacher Lugan , Bachelart Thomas , Boumendjel Ahcène 
Published: September 2024

Abstract

Objectives
Multiple drug administration is a common practice in hospitals and clinics. This is the case when multiple pathologies are treated. In this context, frequently, antivirals and antibiotics are co-administrated either simultaneously or sequentially ignoring potential incompatibilities. In this study, we focused on an antiviral (acyclovir) and an antibiotic (ciprofloxacin) compatibility/incompatibility when they are co-administrated.

Methods
In this study, we focused on the effect of drug ratio, pH, and delay by implementing robust high-performance liquid chromatography methods to determine the main factors leading to potential modification of concentration of one of the two drugs in the mixture.

Key findings
The results showed that acyclovir is quantitatively recovered in all conditions related to pH, concentration, and time (up to 24 hours). However, ciprofloxacin is strongly altered depending on the acidic and basic conditions, the quantity of ciprofloxacin used, and the time after mixing the two drugs. The most valuable piece of information is that the ratio of acyclovir/ciprofloxacin is crucial.

Conclusions
The volume ratio of acyclovir/ciprofloxacin (prepared at 2 mg/ml each) should be calculated and managed to provide at least two-fold quantity of acyclovir versus ciprofloxacin or at least nine-fold quantity of ciprofloxacin versus acyclovir to maintain the administrated doses and prevent physicochemical interactions.
Developing a shared language: a proposed guide to frame early implementation science collaboration discussions
Authors: Best Stephanie , Peters Sanne , Guccione Lisa , Francis Jillian , Klaic Marlena 
Published: September 2024

Abstract
Miscommunication between health care practitioners and implementation researchers can lead to a mismatch of expectations and understandings, resulting in wasted research and frustration. Conversely, combining the expertise and knowledge of those working in health care practice and implementation research can deliver context informed research questions and appropriate study designs. Achieving this ambition requires a shared language. We sought to develop a guide to identify a common language to constructively explore nascent implementation research concepts. We set up a working group, comprising of implementation researchers, health care practitioners and operational managers, to work through ideas generation, debate and a consensus process to generate and refine a discussion guide. The resultant guide steps health care practitioners and implementation researchers through a three-phase enquiry - Question 1: What is the implementation question? Question 2: What is the proposed implementation solution? And Question 3: How can the investigation of this idea be resourced? At each step, the health care practitioner and implementation researcher collaborate to include theory and practice and rigorously work through the question to build implementation on evidence and to promote diverse stakeholder engagement. The next steps for this study will be operationalising the discussion guide, as an interactive tool. Future evaluation, to test effectiveness, acceptability and feasibility will be designed with health care practitioners and implementation researchers.
Lactobacillus delbrueckii alleviates lipopolysaccharide‐induced muscle inflammation and atrophy in weaned piglets associated with inhibition of endoplasmic reticulum stress and protein degradation
Authors: Zhong Songshi , Sun Zhiyuan , Tian Qiyu , Wen Wei , Chen Fengming , Huang Xingguo , Li Yinghui 
Published: September 2024

AbstractPro‐inflammatory cytokines in muscle play a pivotal role in physiological responses and in the pathophysiology of inflammatory disease and muscle atrophy. Lactobacillus delbrueckii (LD), as a kind of probiotics, has inhibitory effects on pro‐inflammatory cytokines associated with various inflammatory diseases. This study was conducted to explore the effect of dietary LD on the lipopolysaccharide (LPS)—induced muscle inflammation and atrophy in piglets and to elucidate the underlying mechanism. A total of 36 weaned piglets (Duroc × Landrace × Large Yorkshire) were allotted into three groups with six replicates (pens) of two piglets: (1) Nonchallenged control; (2) LPS‐challenged (LPS); (3) 0.2% LD diet and LPS‐challenged (LD+LPS). On d 29, the piglets were injected intraperitoneally with LPS or sterilized saline, respectively. All piglets were slaughtered at 4 h after LPS or saline injection, the blood and muscle samples were collected for further analysis. Our results showed that dietary supplementation of LD significantly attenuated LPS‐induced production of pro‐inflammatory cytokines IL‐6 and TNF‐α in both serum and muscle of the piglets. Concomitantly, pretreating the piglets with LD also clearly inhibited LPS‐induced nuclear translocation of NF‐κB p65 subunits in the muscle, which correlated with the anti‐inflammatory effects of LD on the muscle of piglets. Meanwhile, LPS‐induced muscle atrophy, indicated by a higher expression of muscle atrophy F‐box, muscle RING finger protein (MuRF1), forkhead box O 1, and autophagy‐related protein 5 (ATG5) at the transcriptional level, whereas pretreatment with LD led to inhibition of these upregulations, particularly genes for MuRF1 and ATG5. Moreover, LPS‐induced mRNA expression of endoplasmic reticulum stress markers, such as eukaryotic translational initiation factor 2α (eIF‐2α) was suppressed by pretreatment with LD, which was accompanied by a decrease in the protein expression levels of IRE1α and GRP78. Additionally, LD significantly prevented muscle cell apoptotic death induced by LPS. Taken together, our data indicate that the anti‐inflammatory effect of LD supply on muscle atrophy of piglets could be likely regulated by inhibiting the secretion of pro‐inflammatory cytokines through the inactivation of the ER stress/NF‐κB singling pathway, along with the reduction in protein degradation.
The Effect of Spaced Repetition on Learning and Knowledge Transfer in a Large Cohort of Practicing Physicians
Authors: Price David W. , Wang Ting , O’Neill Thomas R. , Morgan Zachary J. , Chodavarapu Prasad , Bazemore Andrew , Peterson Lars E. , Newton Warren P. 
Published: September 2024

Abstract

Purpose
Spaced repetition is superior to repeated study for learning and knowledge retention, but literature on the effect of different spaced repetition strategies is lacking. The authors evaluated the effects of different spaced repetition strategies on long-term knowledge retention and transfer.

Method
This prospective cohort study, conducted from October 1, 2020, to July 20, 2023, used the American Board of Family Medicine Continuous Knowledge Self-Assessment (CKSA) to assess learning and knowledge transfer of diplomates and residents. Participants were randomized to a control group or 1 of 5 spaced repetition conditions during 5 calendar quarters (January 1, 2021, to March 31, 2022). Participants in the spaced repetition groups received 6 repeated questions once or twice. Incorrectly but confidently answered questions were prioritized for repetition, with decreasing priority for questions answered incorrectly with lesser confidence. All participants received 6 rewritten questions corresponding to their initial questions chosen for repetition in quarter 10 (second quarter of calendar year 2023).

Results
A total of 26,258 family physicians or residents who completed the CKSA in the baseline period were randomized. Spaced repetition was superior to no spaced repetition for learning at quarter 6 (58.03% vs 43.20%, P < .001, Cohen d = 0.62) and knowledge transfer at quarter 10 (58.33% vs 52.39%, P < .001, Cohen d = 0.26). Double-spaced repetitions were superior to single-spaced repetitions for learning (62.24% vs 51.83%, P < .001, Cohen d = 0.43) and transfer (60.08% vs 55.72%, P < .001, Cohen d = 0.20). There were no meaningful differences in learning or transfer between repetition strategy chosen in the single- or double-repetition groups.

Conclusions
This study affirms the value of spaced repetition in improving learning and retention in medical education and ongoing professional development.