bluuebunny/crossref_metadata_2025_split huggingface dataset:
932 A QI PROJECT TO IMPROVE USE OF BOWEL CHARTS IN CLINICAL PRACTICE
Authors: Bharmal A , McGowan T 
Published: June 2022

Abstract

Introduction
Bowel movements are vital to decision making, but are frequently overlooked in practice due to the fast-paced nature of medical ward rounds, impacting on patient care. This was felt to be exacerbated locally by the difficulties of finding the information in the nursing notes.
Aim To improve the documentation of bowel movements.

Method
We performed a closed loop audit examining how well patients’ bowel movements are documented in nursing and medical notes across 3 wards at a district general hospital. We collected snapshot data on whether a bowel chart was present, whether bowel movements were recorded regularly and whether doctors documented bowel movements during ward rounds. We then changed the colour of bowel chart paper from white to yellow, with identical contents. This data was prospectively collected again 5 weeks later for comparison.

Results
The sample size included 62 inpatients. Prior to the change in bowel chart, 79% of patients’ nursing folders had a bowel chart. Documentation of bowel movements in nursing and medical notes was 25% and 30% respectively. Following the introduction of yellow coloured bowel charts, 90% of patients’ nursing notes had a bowel chart present, with an increase in documentation in nursing and medical notes to 74% and 69% respectively.

Conclusion
(s) The importance of good bowel movements is essential to management decisions and discharge planning. Locally, this has been inhibited by the difficulties of locating white bowel charts in a folder of white paper, leading to incomplete documentation and poor recognition of problems in bowel movements. Changing the colour of the bowel charts made it easier to recognise the bowel chart, allowing nurses and doctors to use the bowel chart more efficiently, hopefully improving patient care. This change has been recognised as effective and has been rolled out trust wide.
971 PERIOPERATIVE MEDICINE PRESCRIBING IN OLDER ADULTS - IMPROVING PRESCRIBING ACCURACY USING QUALITY IMPROVEMENT METHODOLOGY
Authors: Kiang J , Shamsiddinova A , Jegard J 
Published: June 2022

Abstract

Introduction
Accurate medication prescribing perioperatively is an essential component of peri-operative optimisation. Older adults are uniquely vulnerable due to polypharmacy and age-related changes in pharmacokinetics and pharmacodynamics. Barriers to this include the urgency of surgery, unclear drug history and poor knowledge of how to manage the patient’s medications. This quality improvement project aimed to improve the accuracy of regular medications prescribed in older adults undergoing emergency laparotomy.

Method
Multiple Plan, Do, Study, Act (PDSA) cycles were conducted at Southend University Hospital. Patients over 65 undergoing emergency laparotomy were included. Regular medications were retrospectively analysed to assess whether they were continued or suspended appropriately in the perioperative period, according to UKCPA guidelines. The initial cycle analysed prescribing practices for nine medications which were pre-defined as ‘high risk’ of causing adverse effects when prescribed inappropriately. Subsequent cycles scoped all regular medications. Our interventions aimed to increase conscious prescribing by improving prescriber education. Interventions included introducing joint Geriatrician & Surgeon-led teaching sessions, and dissemination of a poster guide with links to resources to aid decision making.

Results
First cycle (September—November 2020): 32 patients included. Only 30% of all regular medications were within the ‘high risk’ group; 50% of which were prescribed appropriately. Second cycle (May—July 2021): 26 patients included. 72% appropriately prescribed regular medications. Third cycle (September—October 2021): 13 patients included. Sustained improvement in prescribing accuracy to 75%. Problems identified include 1) delay in prescribing 2) regular medications not prescribed 3) prescribed but not administered.

Conclusion
Improvement in prescribing accuracy amongst doctors is achievable following education-focused intervention. The goal is active decision making with every drug prescribed. Integrating this inter-departmental teaching session into Induction teaching is a sustainable method to improve prescribing practice. This can be translated to every surgical department.
987 TACKLING OVERPRESCRIBING; WHAT ABOUT THE HABITUAL OFFENDER, PPI?
Authors: Eastwood A , Deng J , Dwivedi R 
Published: June 2022

Abstract

Introduction
Overprescribing is a serious problem in health systems internationally and can lead to preventable hospital assessments and admissions, even premature deaths1. Proton pump inhibitors (PPIs) are commonly prescribed in older people. They are associated with risk of C difficile infection, hypomagnesemia, osteoporosis, hypergastrinaemia, and are considered falls risk increasing drugs (FRID). Unfortunately, there isn’t a guideline which unifies the various indications of PPIs.

Method
303 discharges were screened from 2 acute geriatric wards between 01/10/2020 and 31/12/2020. After exclusions (34 deaths, 5 readmissions), 264 notes were reviewed. Those with a PPI mentioned on their discharge summaries were audited against both NICE dyspepsia guidelines and our hospital trust guidelines (PPI usage in those on co-medications), assessing whether long term use was advocated. Additional information was obtained from our hospital systems including digital health records.

Results
153/264(58%) patients had PPIs listed on their discharge summaries. Of those using PPIs, 146 (95%) had polypharmacy and 140(92%) had a CFS ≥5. More PPIs were commenced (18) than discontinued (16). Against NICE dyspepsia guidelines, 46/153(30%) patients did not require long term PPI treatment. 81/153 (53%) patients had a PPI prescribed due to anticoagulation, however, 37/81 (46%) did not fulfil our trust criteria for co-prescription.

Conclusion
PPI usage is prevalent in older people and often continued without a valid indication which could result in preventable harm in an already vulnerable cohort. There is a need to actively deprescribe PPIs within all healthcare settings. Our findings have been widely shared with our departmental colleagues and other relevant specialties and a guideline on long term use of PPIs in older people (&gt;65) has been developed. Going forward, we plan to re-audit against this new guideline in 6 months to assess improvement.
References 1. Good for you, good for us, good for everybody. Published 22/9/21.
1029 EVEN LIMITED GERIATRICIAN INVOLVEMENT REDUCES LENGTH OF STAY FOR ALL-AGE ACUTE GENERAL SURGERY PATIENTS
Authors: Luo R , Hudson M , Cepeda V , Reese G , Sritharan G , Peck G , Morgan C , Koizia L , Fertleman M 
Published: June 2022

Abstract

Background
More than half of patients undergoing emergency general surgery are older than 651. The Emergency Laparotomy and Frailty (ELF) study identified that frail patients (CFS ≥5) were vulnerable to adverse outcomes and longer hospital stays and should be reviewed by a geriatrician2. The 2021 National Emergency Laparotomy Audit (NELA) found that only 27% were reviewed by a geriatrician1. Local problem A local hospital had no routine geriatrician input to perioperative care of older people admitted under the care of general surgeons.

Method/Intervention
In one month prior to intervention, we noted CFS recorded once and a geriatrician involved in only 3 patients over the age of 65 (n = 35). We introduced a service comprising twice-weekly geriatrician-led multi-disciplinary team (MDT) meetings of all-age patients followed by selected patient ward rounds. This equated to 2.5 Programmed Activity’s (PA) per week. After another month we measured the number of patients having CFS recorded, those who had geriatrician involvement and length of stay. We also surveyed members of the MDT.

Results
All 31 patients aged over 65 received geriatrician input with 93.5% having a CFS recorded. Length of stay of all-age patients (n = 75) was reduced from 12.8 to 8.8 days, with the most significant reduction of 6.5 days in over 65’s (16.7 to 10.2); &gt;200 bed days saved for older people. The MDT comments included: ‘improved MDT communication’, ‘early identification of discharge barriers’ and ‘pro-active approach’.

Conclusion
NELA highlights that consistent geriatrician input remains generally poor. Even a limited geriatrician-led service can be highly effective at guaranteeing review of appropriate patients in line with recommendations from NELA. Alongside targeted patient review geriatricians can support and lead decision making of all-age patients. This cost-effective strategy can reduce length of stay for young and old alike and gained excellent feedback from the MDT.
1058 ESTABLISHING A VIRTUAL MULTIDISCIPLINARY TEAM MEETING FOR CARE HOME RESIDENTS IN NEWCASTLE-UPON-TYNE
Authors: Collins N , Madhra M , Noble J 
Published: June 2022

Abstract

Introduction
Care home (CH) residents are frail with complex physical and mental health needs. Healthcare provided is often by different organisations and fragmented. Optimising quality of life and reducing avoidable hospital attendance is crucial. The Newcastle Specialist Care Home Support Team (SCHST) provides care for 2,482 residents across 55 Newcastle CHs. Between April 2019–2020, there were 2,428 unplanned hospital attendances in this cohort. SCHST looked to establish multidisciplinary team (MDT) meetings to streamline care by collaboration and integrating pre-existing services. We aimed to establish weekly virtual MDT meetings to facilitate coordinated care for CH residents, reduce unplanned hospital attendances and improve communications between services, reducing need for additional referrals.

Method
Members identified to comprise the MDT included SCHST staff, Geriatricians, Old Age Psychiatrists, Pharmacists and GPs. Weekly meetings via Microsoft Teams were established, with the SCHST undertaking initial assessments of those referred. Management plans were formulated and actioned with feedback to GPs, CH staff and relatives. Residents were either discharged, planned for MDT re-review, or planned for in-person CH review. Interventions include medications optimisation, CH staff education, psychiatric and comprehensive geriatric assessments.

Results
From April-Nov 2021, 77 residents were referred to MDT. The number of reviews ranged from 1–6 (median = 2). All residents received an initial assessment by SCHST, with only 18 requiring in-person geriatrician input. Analysis of 22 residents showed fewer unplanned admissions in the 6 months following MDT review, compared to 6 months before. (Pre-MDT median 2 (range 0–6); post-MDT 0 (0–9); p &lt; 0.05).

Conclusion
Preliminary data suggest that the virtual Care Home MDT may reduce the number of unplanned hospital admissions of care home residents, with less than one quarter requiring face-to-face geriatrician reviews. The CH MDT has shown to provide effective delivery of care, whilst reducing workload and improving efficiency, through collaborative interdisciplinary working.
Influence of Obesity on Blood Pressure Responses to Antihypertensive Drug Therapy in an Urban Hypertension Specialty Clinic
Authors: Bhandari Priyanka , Prakash Vivek , Flack John M 
Published: June 2022

Abstract

Background
Previous studies have reported that lean hypertensives have worse clinical outcomes than obese hypertensives as obesity confers pharmacological resistance to antihypertensive therapy. We explored whether the higher prescribed doses of antihypertensives in obese hypertensives were adequate for the attainment of similar on-treatment blood pressure (BP) versus leaner hypertensives.

Methods
A retrospective chart review of predominantly African American females from a deidentified urban referral clinic was conducted (N = 851; median follow-up = 11.3 months). Body mass index (BMI, kg/m2) was categorized as either below or above or equal to 30. Antihypertensive therapeutic intensity score (TIS) was calculated as the total daily antihypertensive dose/maximum United States Food and Drug Administration (USFDA) approved daily dose, summed across all hypertensive drugs. General linear models were used to estimate the significance of continuous variables across BMI categories.

Results
At baseline, systolic blood pressure (SBP) was similar between groups (P = 0.14), though 2.7 mm Hg higher in the highest BMI group. Antihypertensive TIS was greater in the highest BMI category at both baseline and end of follow-up (both P &lt; 0.001). After covariate adjustment end of follow-up SBP and diastolic blood pressure was higher in the obese group by 3.4 (0.6–6.1) and 1.8 (0.1–3.53) mm Hg, respectively (P = 0.02, P = 0.04).

Conclusions
Attained on-treatment BP is higher in obese than non-obese hypertensives despite greater prescription of antihypertensive medications. Whether even more prescription of medications or other interventions will equalize BP responses relative to non obese hypertensives merits further study.
Objective Cognitive Outcomes and Subjective Emotional Sequelae in Litigating Adults with a Traumatic Brain Injury: The Impact of Performance and Symptom Validity Measures
Authors: Uiterwijk Daniel , Stargatt Robyn , Crowe Simon F 
Published: June 2022

AbstractObjectiveThis study examined the relative contribution of performance and symptom validity in litigating adults with traumatic brain injury (TBI), as a function of TBI severity, and examined the relationship between self-reported emotional symptoms and cognitive tests scores while controlling for validity test performance.MethodParticipants underwent neuropsychological assessment between January 2012 and June 2021 in the context of compensation-seeking claims related to a TBI. All participants completed a cognitive test battery, the Personality Assessment Inventory (including symptom validity tests; SVTs), and multiple performance validity tests (PVTs). Data analyses included independent t-tests, one-way ANOVAs, correlation analyses, and hierarchical multiple regression.ResultsA total of 370 participants were included. Atypical PVT and SVT performance were associated with poorer cognitive test performance and higher emotional symptom report, irrespective of TBI severity. PVTs and SVTs had an additive effect on cognitive test performance for uncomplicated mTBI, but less so for more severe TBI. The relationship between emotional symptoms and cognitive test performance diminished substantially when validity test performance was controlled, and validity test performance had a substantially larger impact than emotional symptoms on cognitive test performance.ConclusionValidity test performance has a significant impact on the neuropsychological profiles of people with TBI, irrespective of TBI severity, and plays a significant role in the relationship between emotional symptoms and cognitive test performance. Adequate validity testing should be incorporated into every neuropsychological assessment, and associations between emotional symptoms and cognitive outcomes that do not consider validity testing should be interpreted with extreme caution.
Stimulating native seizures with neural resonance: a new approach to localize the seizure onset zone
Authors: Smith Rachel J , Hays Mark A , Kamali Golnoosh , Coogan Christopher , Crone Nathan E , Kang Joon Y , Sarma Sridevi V 
Published: June 2022

AbstractSuccessful outcomes in epilepsy surgery rely on the accurate localization of the seizure onset zone. Localizing the seizure onset zone is often a costly and time-consuming process wherein a patient undergoes intracranial EEG monitoring, and a team of clinicians wait for seizures to occur. Clinicians then analyse the intracranial EEG before each seizure onset to identify the seizure onset zone and localization accuracy increases when more seizures are captured. In this study, we develop a new approach to guide clinicians to actively elicit seizures with electrical stimulation. We propose that a brain region belongs to the seizure onset zone if a periodic stimulation at a particular frequency produces large amplitude oscillations in the intracranial EEG network that propagate seizure activity. Such responses occur when there is ‘resonance’ in the intracranial EEG network, and the resonant frequency can be detected by observing a sharp peak in the magnitude versus frequency response curve, called a Bode plot. To test our hypothesis, we analysed single-pulse electrical stimulation response data in 32 epilepsy patients undergoing intracranial EEG monitoring. For each patient and each stimulated brain region, we constructed a Bode plot by estimating a transfer function model from the intracranial EEG ‘impulse’ or single-pulse electrical stimulation response. The Bode plots were then analysed for evidence of resonance. First, we showed that when Bode plot features were used as a marker of the seizure onset zone, it distinguished successful from failed surgical outcomes with an area under the curve of 0.83, an accuracy that surpassed current methods of analysis with cortico-cortical evoked potential amplitude and cortico-cortical spectral responses. Then, we retrospectively showed that three out of five native seizures accidentally triggered in four patients during routine periodic stimulation at a given frequency corresponded to a resonant peak in the Bode plot. Last, we prospectively stimulated peak resonant frequencies gleaned from the Bode plots to elicit seizures in six patients, and this resulted in an induction of three seizures and three auras in these patients. These findings suggest neural resonance as a new biomarker of the seizure onset zone that can guide clinicians in eliciting native seizures to more quickly and accurately localize the seizure onset zone.
Right coronary artery originating from the left ventricular outflow tract diagnosed after a Ross procedure: a case report
Authors: Venkatesh Prashanth , Tan Weiyi , Bravo-Jaimes Katia , Aboulhosn Jamil 
Published: June 2022

Abstract

Background
Anomalous coronary origin from the left ventricular outflow tract (LVOT) is an exceedingly rare condition thought to be associated with the bicuspid aortic valve (BAV). While the malignant presentation of this entity has been described, its pathophysiology and diagnostic evaluation are poorly understood.

Case summary
A 33-year-old woman status post Ross procedure in childhood for congenital aortic stenosis due to BAV with presumed common origin of right and left coronary arteries based on single coronary ostium seen on aortic valve inspection, presented with symptomatic pulmonary regurgitation and stenosis. Invasive left coronary angiography revealed retrograde filling of the right coronary artery (RCA) with systolic washout of contrast indicating a patent RCA ostium. No RCA ostium was found on aortic root injection, but an injection into the LVOT revealed an RCA ostium below the aortic valve. Selective RCA angiography revealed pulsatile antegrade flow down the RCA occurring during systole. There was no anatomic RCA stenosis. We proceeded with valve-in-valve TcPVR. The patient had significant improvement of symptoms and RCA reimplantation was hence deferred.

Discussion
This case is the first of an anomalous coronary artery arising from the LVOT diagnosed in a patient after the Ross procedure. Our angiograms shed light on the unusual physiology of coronary filling during systole and ischaemia arising from inadequate perfusion gradient between the left ventricle and the coronary during systole, leading to collateralization despite the lack of anatomic stenosis. We urge consideration of this potentially malignant entity in any symptomatic patient, especially with concomitant BAV.
Impact of lactic acid bacteria on the control of Listeria monocytogenes in ready-to-eat foods
Authors: Webb Laura , Ma Luyao , Lu Xiaonan 
Published: June 2022

Abstract
Due to the increased demand for ready-to-eat (RTE) minimally processed foods, alternatives to chemical and thermal preservation methods to maintain food safety are highly demanded. A significant safety hazard in RTE food products is the growth of the foodborne pathogen Listeria monocytogenes (L. monocytogenes). After processing, recontamination or cross-contamination of L. monocytogenes in RTE food products may occur and the lack of cooking can lead to an increased risk of listeriosis. Further, some RTE food products (e.g. cheese and cured meat) can have a long processing period and shelf life, thus allowing for the growth and proliferation of L. monocytogenes in the food matrix. Lactic acid bacteria (LAB) are generally recognized as safe probiotics and have been proposed as a biological control approach to eliminate foodborne pathogens including L. monocytogenes. LAB have been reported to extend the shelf life of food products and inhibit pathogen proliferation via growth competition and metabolite production. LAB are native microflora of many RTE foods, but only certain LAB may inhibit pathogen growth. Therefore, the specificity of LAB species should be employed in their use in RTE foods. This review will discuss the antimicrobial mechanisms of LAB against L. monocytogenes, selective use of LAB in food matrices, and their uses in food processing and packaging.
QTLViewer: an interactive webtool for genetic analysis in the Collaborative Cross and Diversity Outbred mouse populations
Authors: Vincent Matthew , Gerdes Gyuricza Isabela , Keele Gregory R , Gatti Daniel M , Keller Mark P , Broman Karl W , Churchill Gary A 
Published: June 2022

Abstract
The Collaborative Cross and the Diversity Outbred mouse populations are related multiparental populations, derived from the same 8 isogenic founder strains. They carry &gt;50 M known genetic variants, which makes them ideal tools for mapping genetic loci that regulate phenotypes, including physiological and molecular traits. Mapping quantitative trait loci requires statistical and computational training, which can present a barrier to access for some researchers. The QTLViewer software allows users to graphically explore Collaborative Cross and Diversity Outbred quantitative trait locus mapping and related analyses performed through the R/qtl2 package. Additionally, the QTLViewer website serves as a repository for published Collaborative Cross and Diversity Outbred studies, increasing the accessibility of these genetic resources to the broader scientific community.
A decade of GigaScience: the importance of community organizations for open and FAIR efforts in neuroinformatics
Authors: Martone Maryann E 
Published: June 2022

Abstract
Neuroscience has undergone a significant transformation over the past decade, becoming an increasingly open and FAIR discipline. I provide personal perspectives on the importance of two community organizations, FORCE11: The Future of Research Communications and e-Scholarship and INCF: The International Neuroinformatics Coordinating Facility in providing the intellectual and community environment where ideas and open sharing of data and code were incubated and tried.