A critical evaluation of the electronic surgical logbook

BACKGROUND: The Association of Surgeons of Great Britain and Ireland (ASGBI) devised the electronic surgical logbook (version 2.4) for higher trainees in General Surgery enabling trainees to compile a uniform data set of their operative and training experience. This is in use by higher surgical trainees (HST) in the United Kingdom. This logbook permits trainees to submit data centrally into a Regional Analysis Database (RAD). With the implementation of the European Working Time Directive (EWTD) there is need for reliable data to assess the effects of the directive on training. In order to draw meaningful conclusions from the database the quality of data needs to be validated. We critically analysed the RAD in the Yorkshire region for a one-year period. METHODS: The RAD from the ASGBI for the Yorkshire region was analysed. Data for the period 01/10/2002–30/09/2003 was identified and interrogated using Microsoft Excel (2000 version). The RAD was compared with information obtained from the Regional Surgical Advisor for Yorkshire with respect to hospitals, surgical consultants and HST's in the region during the study period. RESULTS: There were 13,755 operations entered for the study period. 579 corrections to the data had to be made (4.2%) and a further 1140 entries were deleted (8.2%). Following corrections and deletions 12,615 operative entries were available for analysis. Overall 12.5% of the data required either correction or exclusion from the database prior to analysis. CONCLUSION: The RAD has a large dataset useful to monitor and assess training. However, the quality of the data needs to be verified prior to use. Recommendations have been made to develop the ASGBI logbook, which would eventually translate to improved data reliability of the RAD

Refeeding Syndrome: A Literature Review

Refeeding syndrome (RFS) describes the biochemical changes, clinical manifestations, and complications that can occur as a consequence of feeding a malnourished catabolic individual. RFS has been recognised in the literature for over fifty years and can result in serious harm and death. Crude estimates of incidence, morbidity, and mortality are available for specific populations. RFS can occur in any individual but more commonly occurs in at-risk populations. Increased awareness amongst healthcare professionals is likely to reduce morbidity and mortality. This review examines the physiology of RFS and describes the clinical manifestations. A management strategy is described. The importance of a multidisciplinary approach is emphasized

Localization and Chemical Speciation of Cadmium in the Roots of Barley and Lettuce

Plants have the potential to accumulate toxic amounts of cadmium (Cd), and understanding how and where Cd is stored in plants is important for ensuring food safety. Previous experiments have determined that a greater amount of Cd is translocated into the leaves of lettuce (Lactuca sativa) as compared to barley leaves (Hordeum vulgare). Preferential retention of Cd in root of barley would explain this difference. Hence, the purpose of this study was to determine the localization and coordination environment of Cd (i.e., the ligands to which Cd was bound) in the different root tissues of lettuce and barley using histochemical staining, electron microscopy and micro X-ray spectroscopy. Retention of Cd in barley roots could be explained by accumulation of Cd at the endodermis, comparatively higher amounts of Cd sequestered in the symplast of cortical cells and binding to xylem cell walls. Increased translocation of Cd to lettuce shoots seemed to be due to a less effective barrier at the endodermis and less sequestration of Cd in the cortex. Regardless of the tissue type, most of the Cd2+ was bound to S ligands in the roots of barley, possibly reflecting accumulation of Cd–phytochelatin and Cd–S molecules in the vacuoles. In lettuce roots, Cd was more evenly distributed among ligands containing S, O and NO3 groups, which is indicative of proportionately more Cd binding to the cell walls, relative to barley. These results will be useful in uncovering the mechanisms of differential Cd-tolerance and sequestration in lettuce and barley

Adam Smith and Colonialism

In the context of debates about liberalism and colonialism, the arguments of Adam Smith have been taken as illustrative of an important line of anti-colonial liberal thought. The reading of Smith presented here challenges this interpretation. It argues that Smith’s opposition to colonial rule derived largely from its impact on the metropole, rather than on its impact on the conquered and colonised; that Smith recognised colonialism had brought ‘improvement’ in conquered territories and that Smith struggled to balance recognition of moral diversity with a universal moral framework and a commitment to a particular interpretation of progress through history. These arguments have a wider significance as they point towards some of the issues at stake in liberal anti-colonial arguments more generally

A prospective, multicentre, observational cohort study of analgesia and outcome after pneumonectomy

Background Meta-analysis and systematic reviews of epidural compared with paravertebral blockade analgesia techniques for thoracotomy conclude that although the analgesia is comparable, paravertebral blockade has a better short-term side-effect profile. However, reduction in major complications including mortality has not been proven. Methods The UK pneumonectomy study was a prospective observational cohort study in which all UK thoracic surgical centres were invited to participate. Data presented here relate to the mode of analgesia and outcome. Data were analysed for 312 patients having pneumonectomy at 24 UK thoracic surgical centres in 2005. The primary endpoint was a major complication. Results The most common type of analgesia used was epidural (61.1%) followed by paravertebral infusion (31%). Epidural catheter use was associated with major complications (odds ratio 2.2, 95% confidence interval 1.1–3.8; P=0.02) by stepwise logistic regression analysis. Conclusions An increased incidence of clinically important major post-pneumonectomy complications was associated with thoracic epidural compared with paravertebral blockade analgesia. However, this study is unable to provide robust evidence to change clinical practice for a better clinical outcome. A large multicentre randomized controlled trial is now needed to compare the efficacy, complications, and cost-effectiveness of epidural and paravertebral blockade analgesia after major lung resection with the primary outcome of clinically important major morbidity

Novel opsin gene variation in large-bodied, diurnal lemurs

Some primate populations include both trichromatic and dichromatic (red-green colour blind) individuals due to allelic variation at the X-linked opsin locus. This polymorphic trichromacy is well described in day-active New World monkeys. Less is known about colour vision in Malagasy lemurs, but, unlike New World monkeys, only some day-active lemurs are polymorphic, while others are dichromatic. The evolutionary pressures underlying these differences in lemurs are unknown, but aspects of species ecology, including variation in activity pattern, are hypothesized to play a role. Limited data on X-linked opsin variation in lemurs make such hypotheses difficult to evaluate. We provide the first detailed examination of X-linked opsin variation across a lemur clade (Indriidae). We sequenced the X-linked opsin in the most strictly diurnal and largest extant lemur, Indri indri, and nine species of smaller, generally diurnal indriids (Propithecus). Although nocturnal Avahi (sister taxon to Propithecus) lacks a polymorphism, at least eight species of diurnal indriids have two or more X-linked opsin alleles. Four rainforest-living taxa-I. indri and the three largest Propithecus species-have alleles not previously documented in lemurs. Moreover, we identified at least three opsin alleles in Indri with peak spectral sensitivities similar to some New World monkeys

Lignes directrices pour de meilleures pratiques en matière de suivi de la santé et de contrôle des maladies des populations de grands singes

Ces lignes directrices ont pour objectif de fournir aux gouvernements, aux décideurs politiques, aux acteurs de la conservation, aux chercheurs, aux professionnels du tourisme de vision des grands singes et aux bailleurs de fonds des recommandations en terme de meilleures pratiques pour le suivi sanitaire des grands singes et la prévention des maladies. Ces recommandations reprennent et mettent à jour, le cas échéant, les normes antérieures de protection sanitaire recommandées par Homsy (1999). Tout en reconnaissant que le risque zéro de maladie n’existe pas et que les mesures de prévention ou de contrôle de la propagation des maladies n’élimineront jamais le risque, ces recommandations visent principalement à minimiser, plutôt qu’à tenter d’éliminer la menace de transmission de maladies des hommes aux grands singes. L’application des meilleures pratiques présentées ici devrait réduire substantiellement les risques que les activités humaines peuvent poser à la santé des grands singes, et ce faisant, envoyer un signal clair d’engagement vis-à-vis de la conservation des grands singes

Best Practice Guidelines for Health Monitoring and Disease Control in Great Ape Populations

First paragraph: Due to their phylogenetic relatedness, great apes and humans share susceptibility to many infectious diseases, and the potential for new diseases to be transmitted to wild great apes is of particular concern (Calvignac-Spencer et al. 2012). As great ape tourism becomes more popular, great ape research more imperative, and landscape conversion more rampant, the risk that human pathogens will be introduced to immunologically naïve wild populations becomes greater, and this could result in catastrophic losses of great apes. Therefore, it is critical that tourism and research projects involving close proximity1 between great apes and people assess the risks entailed, and establish and implement disease prevention and control measures. Disease prevention should be regarded as a top priority, recognising that it is easier and more economical to prevent the introduction of an infectious agent into a great ape population, than to attempt to treat, control or eradicate a health problem once introduced. Disease prevention programmes should be centred on monitoring health parameters, and modifying human activities accordingly, in order to reduce the risk of disease transmission to great apes. By design, such programmes will also minimise the risk of disease transfer from great apes to humans, and even from humans to other humans. Continual monitoring of the health of great apes forms the basis for establishing what is normal and abnormal and thus improves our understanding of great ape population health, allows us to determine the effectiveness of disease prevention and health management strategies, and provides a basis for conducting responsible and reasonable health interventions when needed.  To access this book go to: https://portals.iucn.org/library/node/4579

Best Practice Guidelines for Health Monitoring and Disease Control in Great Ape Populations

First paragraph: Due to their phylogenetic relatedness, great apes and humans share susceptibility to many infectious diseases, and the potential for new diseases to be transmitted to wild great apes is of particular concern (Calvignac-Spencer et al. 2012). As great ape tourism becomes more popular, great ape research more imperative, and landscape conversion more rampant, the risk that human pathogens will be introduced to immunologically naïve wild populations becomes greater, and this could result in catastrophic losses of great apes. Therefore, it is critical that tourism and research projects involving close proximity1 between great apes and people assess the risks entailed, and establish and implement disease prevention and control measures. Disease prevention should be regarded as a top priority, recognising that it is easier and more economical to prevent the introduction of an infectious agent into a great ape population, than to attempt to treat, control or eradicate a health problem once introduced. Disease prevention programmes should be centred on monitoring health parameters, and modifying human activities accordingly, in order to reduce the risk of disease transmission to great apes. By design, such programmes will also minimise the risk of disease transfer from great apes to humans, and even from humans to other humans. Continual monitoring of the health of great apes forms the basis for establishing what is normal and abnormal and thus improves our understanding of great ape population health, allows us to determine the effectiveness of disease prevention and health management strategies, and provides a basis for conducting responsible and reasonable health interventions when needed.  To access this book go to: https://portals.iucn.org/library/node/4579