The SCARE Statement: Consensus-based surgical case report guidelines

AbstractIntroductionCase reports have been a long held tradition within the surgical literature. Reporting guidelines can improve transparency and reporting quality. However, recent consensus-based guidelines for case reports (CARE) are not surgically focused. Our objective was to develop surgical case report guidelines.MethodsThe CARE statement was used as the basis for a Delphi consensus. The Delphi questionnaire was administered via Google Forms and conducted using standard Delphi methodology. A multidisciplinary group of surgeons and others with expertise in the reporting of case reports were invited to participate. In round one, participants stated how each item of the CARE statement should be changed and what additional items were needed. Revised and additional items from round one were put forward into a further round, where participants voted on the extent of their agreement with each item, using a nine-point Likert scale, as proposed by the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) working group.ResultsIn round one, there was a 64% (38/59) response rate. Following adjustment of the guideline with the incorporation of recommended changes, round two commenced and there was an 83% (49/59) response rate. All but one of the items were approved by the participants, with Likert scores 7–9 awarded by >70% of respondents. The final guideline consists of a 14-item checklist.ConclusionWe present the SCARE Guideline, consisting of a 14-item checklist that will improve the reporting quality of surgical case reports

The SCARE Statement: Consensus-based surgical case report guidelines

Introduction: Case reports have been a long held tradition within the surgical literature. Reporting guidelines can improve transparency and reporting quality. However, recent consensus-based guidelines for case reports (CARE) are not surgically focused. Our objective was to develop surgical case report guidelines.Methods: The CARE statement was used as the basis for a Delphi consensus. The Delphi questionnaire was administered via Google Forms and conducted using standard Delphi methodology. A multidisciplinary group of surgeons and others with expertise in the reporting of case reports were invited to participate. In round one, participants stated how each item of the CARE statement should be changed and what additional items were needed. Revised and additional items from round one were put forward into a further round, where participants voted on the extent of their agreement with each item, using a nine-point Likert scale, as proposed by the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) working group.Results: In round one, there was a 64% (38/59) response rate. Following adjustment of the guideline with the incorporation of recommended changes, round two commenced and there was an 83% (49/59) response rate. All but one of the items were approved by the participants, with Likert scores 7–9 awarded by >70% of respondents. The final guideline consists of a 14-item checklist.Conclusion: We present the SCARE Guideline, consisting of a 14-item checklist that will improve the reporting quality of surgical case reports.</p

Hydrologic Variability Affects Invertebrate Grazing on Phototrophic Biofilms in Stream Microcosms

The temporal variability of streamflow is known to be a key feature structuring and controlling fluvial ecological communities and ecosystem processes. Although alterations of streamflow regime due to habitat fragmentation or other anthropogenic factors are ubiquitous, a quantitative understanding of their implications on ecosystem structure and function is far from complete. Here, by experimenting with two contrasting flow regimes in stream microcosms, we provide a novel mechanistic explanation for how fluctuating flow regimes may affect grazing of phototrophic biofilms (i.e., periphyton) by an invertebrate species (Ecdyonurus sp.). In both flow regimes light availability was manipulated as a control on autotroph biofilm productivity and grazer activity, thereby allowing the test of flow regime effects across various ratios of biofilm biomass to grazing activity. Average grazing rates were significantly enhanced under variable flow conditions and this effect was highest at intermediate light availability. Our results suggest that stochastic flow regimes, characterised by suitable fluctuations and temporal persistence, may offer increased windows of opportunity for grazing under favourable shear stress conditions. This bears important implications for the development of comprehensive schemes for water resources management and for the understanding of trophic carbon transfer in stream food webs

Evaluating Alliance Non-cost Performance Measurement

Effective performance measurement is critical to organisation and project management success and has been extensively studied in both disciplines. However, there is a wide range of research that criticises the current use and understanding of performance measurement and management in the construction industry. Alliancing is a performance based collaborative project delivery method where the Owner and non-Owner participants share in the outcomes of a project through the formation of a temporary organisation. Sharing in outcomes is facilitated by a risk/reward commercial model where the amount the non-owner participants gain or lose is determined by the value of any cost underruns or overruns against a pre-agreed Target Outturn Cost and performance in non-cost key result areas. Despite the obvious importance of non-cost performance to both the Owner and NOP, there is limited research that specifically looks at non-cost performance measurement in alliances. This research uses a case study approach to investigate non-cost performance management of the Stronger Christchurch Infrastructure Rebuild Team (SCIRT) programme alliance. Three focal points were established to study the non-cost performance of SCIRT. Firstly, analyse how non-cost performance is measured and managed in the uncertain and complex environment that exists for an alliance programme. Secondly, examine the effect of using the three limb compensation model in conjunction with a project allocation model. Finally, a theoretical performance measurement framework for alliance organisations is developed based on programme document analysis, a literature review and evaluation by members of an alliance management team. Document analysis, literature review, and semi-structured interviews were the primary research instruments used to analyse and gather multiple sources of data including programme management plans and data, and responses to semi-structured interviews. This thesis found that a flexible approach to performance measurement using a refined set of Key Performance Indicators in conjunction with rigorous management processes is required to measure and manage non-cost performance in an uncertain environment. Secondly, SCIRT used a commercial model intended to balance collaboration and competition between the NOPs. The typical limb three calculation used for alliances was used to drive collaboration. A project allocation model was used to motivate competition and provided a more immediate incentive for outstanding performance. The immediate financial impact of the project allocation model made it a more powerful driver of non-cost performance compared with the less tangible financial effect of the Limb 3 calculation. Finally, a theoretical framework was developed that converted alliance critical success factors into a set of interactions that illustrates the organisational factors necessary for an alliance to be successful

A case report of a rare and challenging gangrenous splenic flexure volvulus in a pregnant patient

Introduction: Splenic flexure volvulus is a rare cause of intestinal obstruction and is uncommonly encountered in young patients from developed countries. Presentation of case: This report details a challenging case of a gangrenous large bowel volvulus in a 25 year old woman 20 weeks pregnant, highlighting the diagnostic and operative challenges that this rare clinical situation presents. After urgent MRI confirming a splenic flexure volvulus, an emergency open left hemicolectomy and end colostomy was performed. Following uneventful recovery and successful delivery of her baby at full term, she was reversed 6 months later. Discussion: Splenic flexure volvulus is a rare cause of large bowel obstruction, and as such can result in a delay in diagnosis, particularly in the setting of pregnancy. In this case, the patient was not diagnosed until day 3 of her admission when she decompensated with a rising white cell count. Conclusion: Splenic flexure volvulus is a rare occurrence. This case report of a young pregnant woman presenting with a large bowel obstruction due to splenic flexure volvulus highlights the importance of considering and investigating for this diagnosis

A case report of incidental ectopic pancreatic tissue during laparoscopic appendicectomy

Ectopic or heterotopic pancreas is a congenital disorder defined as abnormally located pancreatic tissue found outside the pancreatic frame. It is a rare entity that occasionally causes symptoms depending on its location.We present the case of an incidental finding of proximal jejunal ectopic pancreas in a middle-aged woman presenting with appendicitis.Although rare it is necessary to be aware that jejunal ectopic pancreas can lead to jejunojejunal intussusception. Although diagnostic tools are emerging, pre operative diagnosis is difficult and resection is the management of choice of the incidentally found lesion

Concurrent Spigelian hernia and falciform ligament hernia in a 67-year-old female

Introduction: Internal abdominal hernias account for 1% of all hernias but 5.8% of all bowel obstructions and hence are of significant clinical importance. Similarly Spigelian hernias account for only 0.12–2% of all abdominal wall hernias. Case presentation: We present and discuss the management of a case that presented with concurrent falciform ligament internal abdominal hernia and Spigelian hernia. We believe this is the first reported case of such an occurrence in the literature. Conclusion: Due to the advancements in computer topography (CT) imaging many internal and Spigelian hernias are diagnosed pre-operatively though these scan are not always available or indicated in cases of suspected small bowel obstruction. Due to the high mortality rate of undiagnosed internal hernias a high clinical suspicion must be maintained. The authors recommend laparoscopic trans-abdominal repair of Spigelian hernias in order to examine the abdominal contents and exclude rare, though potentially serious internal hernias

The impact of individualizing sodium bicarbonate supplementation strategies on world-class rowing performance

Contemporary meta-analyses have generally demonstrated a positive effect of sodium bicarbonate (NaHCO3) supplementation on exercise performance. However, despite these claims, there is limited data on contrasting individualized and standardized timing of NaHCO3 ingestion prior to exercise to further enhance performance outcomes. Purpose: To determine whether NaHCO3 ingestion timing impacts 2,000-m rowing time-trial (TT) performance in elite-level rowers (Senior National team including Olympic/World Championships level) adhering to their own individualized pre-race strategies (e.g. nutrition, warm-up, etc.). Methods: Twenty three (n = 23) rowers across two research centers (using the exact same methods/protocols) completed three trials: NaHCO3 loading profile at rest to determine the individual's time-to-peak bicarbonate concentration [(Formula presented.)], followed by two randomized 0.3 g·kgBM−1 NaHCO3 supplementation experimental trials conducted at different time points [consensus timing (CON): TT performed 60 min post-NaHCO3 ingestion; and individualized peak (IP): TT performed at the rower's individual peak [(Formula presented.)] determined from the profiling trial post-NaHCO3 ingestion]. Results: There was a significant mean difference of +2.9 [± 0.4 mmol·L−1 (Formula presented.) for IP vs. CON (95% CI 2.0 to 3.8 mmol·L−1); p = 0.02; d = 1.08] at pre warm-up, but not immediately prior to the TT (post warm-up). Performance times were significantly different between IP (367.0 ± 10.5 s) vs. CON (369.0 ± 10.3 s); p = 0.007; d = 0.15). Conclusions: The present study demonstrated a small but significant performance effect of an individualized NaHCO3 ingestion strategy. Similarities after warm-up between pre-TT (Formula presented.) values (CON ~ + 5.5 mmol·L−1; IP ~ + 6 mmol·L−1), however, would suggest this effect was not a result of any meaningful differences in blood alkalinity

Residential provision for people with learning disabilities Factors considered to be important in determining a high quality of life

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Adding value? School's responsibility for pupils' personal development

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