Usefulness of standard plasma coagulation tests in the management of perioperative coagulopathic bleeding: is there any evidence?

Standard laboratory coagulation tests (SLTs) such as prothrombin time/international normalized ratio or partial thromboplastin time are frequently used to assess coagulopathy and to guide haemostatic interventions. However, this has been challenged by numerous reports, including the current European guidelines for perioperative bleeding management, which question the utility and reliability of SLTs in this setting. Furthermore, the arbitrary definition of coagulopathy (i.e. SLTs are prolonged by more than 1.5-fold) has been questioned. The present study aims to review the evidence for the usefulness of SLTs to assess coagulopathy and to guide bleeding management in the perioperative and massive bleeding setting. Medline was searched for investigations using results of SLTs as a means to determine coagulopathy or to guide bleeding management, and the outcomes (i.e. blood loss, transfusion requirements, mortality) were reported. A total of 11 guidelines for management of massive bleeding or perioperative bleeding and 64 studies investigating the usefulness of SLTs in this setting were identified and were included for final data synthesis. Referenced evidence for the usefulness of SLTs was found in only three prospective trials, investigating a total of 108 patients (whereby microvascular bleeding was a rare finding). Furthermore, no data from randomized controlled trials support the use of SLTs. In contrast, numerous investigations have challenged the reliability of SLTs to assess coagulopathy or guide bleeding management. There is actually no sound evidence from well-designed studies that confirm the usefulness of SLTs for diagnosis of coagulopathy or to guide haemostatic therap

The development of a new measure of quality of life for children with congenital cardiac disease

The purpose of the study was to develop a questionnaire measuring health-related R1 quality of life for children and adolescents with congenital heart disease, the ConQol, that would have both clinical and research applications. We describe here the process of construction of a questionnaire, the piloting and the development of a weighted scoring system, and data on the psychometric performance of the measure in a sample of 640 children and young people recruited via 6 regional centres for paediatric cardiology from across the United Kingdom. The ConQol has two versions, one designed for children aged from 8 to 11 years, and the other for young people aged from 12 to 16 years. Initial findings suggest that it is a valid and reliable instrument, is acceptable to respondents, and is simple to administer in both a research and clinical context

Suppression of Implanted MDA-MB 231 Human Breast Cancer Growth in Nude Mice by Dietary Walnut

Walnuts contain components that may slow cancer growth including omega 3 fatty acids, phytosterols, polyphenols, carotenoids, and melatonin. A pilot study was performed to determine whether consumption of walnuts could affect growth of MDA-MB 231 human breast cancers implanted into nude mice. Tumor cells were injected into nude mice that were consuming an AIN-76A diet slightly modified to contain 10% corn oil. After the tumors reached 3 to 5 mm diameter, the diet of one group of mice was changed to include ground walnuts, equivalent to 56 g (2 oz) per day in humans. The tumor growth rate from Day 10, when tumor sizes began to diverge, until the end of the study of the group that consumed walnuts (2.9 ± 1.1 mm3/day; mean ± standard error of the mean) was significantly less (P \u3e 0.05, t-test of the growth rates) than that of the group that did not consume walnuts (14.6 ± 1.3 mm 3 /day). The eicosapentaenoic and docosahexaenoic acid fractions of the livers of the group that consumed walnuts were significantly higher than that of the group that did not consume walnuts. Tumor cell proliferation was decreased, but apoptosis was not altered due to walnut consumption. Further work is merited to investigate applications to cancer in humans

Optically guided linear Mach Zehnder atom interferometer

We demonstrate a horizontal, linearly guided Mach Zehnder atom interferometer in an optical waveguide. Intended as a proof-of-principle experiment, the interferometer utilises a Bose-Einstein condensate in the magnetically insensitive |F=1,mF=0> state of Rubidium-87 as an acceleration sensitive test mass. We achieve a modest sensitivity to acceleration of da = 7x10^-4 m/s^2. Our fringe visibility is as high as 38% in this optically guided atom interferometer. We observe a time-of-flight in the waveguide of over half a second, demonstrating the utility of our optical guide for future sensors.Comment: 6 pages, 3 figures. Submitted to Phys. Rev.

Embracing virtual outpatient clinics in the era of COVID-19

The response to the COVID-19 pandemic has raised the profile and level of interest in the use, acceptability, safety and effectiveness of virtual outpatient consultations and telemedicine. These models of care are not new but a number of challenges have so far hindered widespread take up and endorsement of these ways of working. With the response to the COVID-19 pandemic, remote and virtual working and consultation have become the default. This paper explores our experience of and learning from virtual and remote consultation and questions how this experience can be retained and developed for the future

Acute carpal tunnel syndrome: early nerve decompression and surgical stabilization for bony wrist trauma

Background We undertook this study to investigate the outcomes of surgical treatment for acute carpal tunnel syndrome following our protocol for concurrent nerve decompression and skeletal stabilization for bony wrist trauma to be undertaken within 48-hours. Methods We identified all patients treated at our trauma centre following this protocol between 1 January 2014 and 31 December 2019. All patients were clinically reviewed at least 12 months following surgery and assessed using the Brief Michigan Hand Outcomes Questionnaire (bMHQ), the Boston Carpal Tunnel Questionnaire (BCTQ) and sensory assessment with Semmes-Weinstein monofilament testing. Results The study group was made up of 35 patients. Thirty-three patients were treated within 36-hours. Patients treated with our unit protocol for early surgery comprising nerve decompression and bony stabilization within 36-hours, report excellent outcomes at medium term follow up. Conclusions We propose that nerve decompression and bony surgical stabilization should be undertaken as soon as practically possible once the diagnosis is made. This is emergent treatment to protect and preserve nerve function. In our experience, the vast majority of patients were treated within 24-hours however where a short period of observation was required excellent results were generally achieved where treatment was completed within 36-hours

In vitro comparison of conventional film and direct digital imaging in the detection of approximal caries

This is the published version. Copyright 2014 British Institute of Radiology.Objectives: To compare the diagnostic accuracy of conventional film, unenhanced direct digital and inversion grayscale direct digital imaging in the detection of approximal caries. Methods: 150 approximal surfaces of extracted permanent molars and premolars were selected for the study on the basis of varying lesion depth. The teeth were radiographed using Ektaspeed Plus film; digital images were made with a Schick CMOS-APS sensor. 7 examiners evaluated 58 randomized images of each modality. Histological sectioning of the teeth was used to verify the presence and extent of decay. Results: No significant difference was found between the diagnostic accuracies of the three imaging modalities (P=0.226). Analysis of the diagnostic accuracy of the three modalities on lesion depth showed no statistically significant interaction; however, the main effect of the lesion depth was significant (P<0.001, η2=0.936). Conclusions: The overall diagnostic accuracy of the three modalities in the detection of approximal carious lesions was comparable. All three modalities performed poorly in the detection of enamel lesions

The Impact of Same Gender Speed-Mentoring on Women's Perceptions of a Career in Surgery – A Prospective Cohort Study

BACKGROUND: Mentoring is critically important for the personal and professional development of a surgeon. Early career stage mentoring by same-gender role models may help ameliorate the gender imbalance in surgery based on our understanding of barriers for women pursuing surgical careers. A novel method of establishing these relationships is speed mentoring. This study aims to examine the impact of a one-day speed-mentoring session with same gender mentors on a cohort's perceptions of a career in surgery. DESIGN: This prospective pre-post study compared attitudes and perceptions of a career in surgery before and after a speed-mentoring session with female surgeons. Mentees were assigned into groups of 1 or 2 and were paired with a female surgeon for 8 minutes. Each mentee group then rotated to another mentor for the same amount of time and this process continued for a total of twelve sessions. Mentees completed a 19-point questionnaire before and after the speed mentoring intervention. Setting: This multicenter study included participants from across the United Kingdom. PARTICIPANTS: Inclusion criteria were female gender and medical student or foundation year doctor (internship year 1 or 2) status. Three hundred and forty participants participated in the intervention, 191 were included in the analysis. RESULTS: Following intervention, the percentage of participants who agreed that having a family would negatively impact a woman's surgical career progression significantly decreased from 46.6% to 23.0%. The percentage of participants who agreed that an “old boys’ club” attitude exists in surgery also significantly decreased (73.8%-58.1%). The percentage of participants who agreed it was more difficult for a woman to succeed in her surgical career than a man significantly decreased (73.8%-64.9%). One hundred and eighty-three (96%) participants agreed that mentorship is important for career progression and 153 (71.2%) participants stated that they did not have someone who they considered a mentor. CONCLUSIONS: Conducting a speed mentoring program with same-gender role models significantly changed female medical students’ and junior doctors’ perceptions of women in surgery. The results suggest that such programs may be effective tools for facilitating mentor-mentee relationships and could be employed by surgical organizations to encourage a diverse uptake into surgery

Observation of a Modulational Instability in Bose-Einstein condensates

We observe the breakup dynamics of an elongated cloud of condensed $^{85}$Rb atoms placed in an optical waveguide. The number of localized spatial components observed in the breakup is compared with the number of solitons predicted by a plane-wave stability analysis of the nonpolynomial nonlinear Schr\"odinger equation, an effective one-dimensional approximation of the Gross-Pitaevskii equation for cigar-shaped condensates. It is shown that the numbers predicted from the fastest growing sidebands are consistent with the experimental data, suggesting that modulational instability is the key underlying physical mechanism driving the breakup.Comment: 6 pages, 5 figure