An audit on general surgical readmissions

Introduction: The objective of this study was to investigate general surgical readmissions at Salford Royal Foundation Trust (SRFT) and to assess the patterns of readmission in pathology and patient group characteristics. Methods: We performed a retrospective audit of patients re-admitted as an emergency within 30 days of being discharged by the general surgery team at SRFT over seven months from April 2018 to October 2018. Patient NHS numbers were provided by Hospital Episode Statistics via the Information Business Team at SRFT. Data was input into Microsoft Excel and statistical analysis was performed using StatsDirect 2018. Results: During this period, 171 patients were coded as general surgery emergency readmissions. Subsequent exclusion left 91 patients in our readmissions group. We compared this with 3261 patients who had been admitted to the general surgical team over the same time period. Gallstone pathology made up 26.4% of the readmission patients, but only 9.26% of all general surgical patients. 58.5% of the surgery on the readmission group was non-elective, compared to 29.7% of all patients. In the readmission group, patients who had a previous operation cancelled had higher rates of early post-operative complications per operation (0.6 complications per operation) from their subsequent operation, than patients who had no previous cancellations (0.229). Four patients (4.4%) had no discharge summary; another seven (7.7%) did not get any patient advice. For 16.5% of patients, the written discharge advice to them, or lack of such advice, was involved in their readmission. Conclusions: Gallstone pathology was over-represented in the readmissions group. Of the patients who had surgery on index admission, the readmission group had a higher proportion of non-elective surgery than all surgery patients. Written discharge advice was varied and inconsistent, and was not present for 12.1% of patients. Clearer discharge advice with more available written advice could reduce avoidable readmissions

Analysing student-generated digital media in science

Background Student-generated digital media is being increasingly incorporated into assessed components of tertiary science courses in an effort to enhance communication skills, encourage engagement and develop conceptual understanding (Hoban, Nielsen, & Shepherd, 2015). Such media products, for example, are developed as explanations of content material or scientific processes for a non-expert audience. Instructors, although slowly embracing new media forms and in agreement of their importance for developing key graduate attributes such as communication, still feel overwhelmingly more comfortable developing ‘traditional’ abilities in students, such as problem solving and written communication (de la Harpe et al., 2009). In the research-sphere, analysis of student-generated digital media products is still in its infancy and as such, we do not yet have access to the range of methods that could help us to understand or communicate the nature of the content, purpose, function and markers of success of student-generated digital media products. Aims This paper presents the development of a novel analytical method for examining multimodal student-generated products both for the purposes of research and for the informing of tertiary science practice. We ask the research question: How can we describe the scientific knowledge presented in student-generated digital media and what are the implications for instruction? Design and methods Two student-generated digital media products were collected as data as part of a wider program of research undertaken for an ARC project focused on student-generated digital media product (Nielsen & Jones, 2016). The two digital media products were selected on the basis of stated quality (by instructor) and superficial dissimilarity to act as illustrative examples for the application of the novel analysis. The products are four-minute long multimodal ‘YouTube videos’ and were created as part of a formal assessment task in a third year pharmacology course at an Australian university. These products were analysed using the construct of ‘semantic density’ from a conceptual framework being increasingly used in science education, Legitimation Code Theory (Maton, 2014). Semantic density refers to the ‘condensation of meaning’ and provides an indicator of how complexity is built across the text. Relative strengths of semantic density (condensation of meaning) were traced throughout the video and across the modes and represented ‘semantic density profiles’ (Maton & Doran, in pressa,b) using qualitative analyses software. Results The two digital media products showed distinct semantic density profiles. The first example exhibited a ‘waving’ profile; representing the building and unpacking meaning through the use of narration and images, animations and videos. The second example exhibited a ‘flatline’ profile, representing the use of specialized and complex scientific knowledge only. Conclusions These findings offer a way to conceptualise the way scientific knowledge is presented in a multimodal presentation. Future research is needed to develop the framework and assess its use as an instructional or evaluative technique for instructors. Proceedings of the Australian Conference on Science and Mathematics Education, The University of Queensland, Sept 28th to 30th, 2016, page X, ISBN Number 978-0-9871834-4-6. References de la Harpe, B., David, C., Dalton, H., Thomas, J., Grirardi, A., Radloff, A., & Lawson, A. (2009). The B factor Project: Understanding academic staff beliefs about graduate attributes, final report. Retrieved from Sydney: Australian Learning and Teaching Council: Hoban, G., Nielsen, W., & Shepherd, A. (2015). Student-generated Digital Media in Science Education: Learning, Explaining and Communicating Content: Routledge. Maton, K. (2014). Knowledge and Knowers: Towards a realist sociology of education. London: Routledge. Maton, K. & Doran, Y.J. (in press, 2016a) Semantic density: A translation device for revealing complexity of knowledge practices in discourse, part 1 - wording, Onomázein, August. Maton, K. & Doran, Y.J. (in press, 2016b) Condensation: A translation device for revealing complexity of knowledge practices in discourse, part 2 - clausing and sequencing, Onomázein, August. Nielsen, W., & Jones, P. (2016). The Quality of Learning as Students Create Digital Explanations of Science: Australian Government

Abdominal massage plus advice, compared with advice only, for neurogenic bowel dysfunction in MS:a RCT

This project was funded by the National Institute for Health Research Health TechnologyPeer reviewedPublisher PD

The Orphan Adhesion-GPCR GPR126 Is Required for Embryonic Development in the Mouse

Adhesion-GPCRs provide essential cell-cell and cell-matrix interactions in development, and have been implicated in inherited human diseases like Usher Syndrome and bilateral frontoparietal polymicrogyria. They are the second largest subfamily of seven-transmembrane spanning proteins in vertebrates, but the function of most of these receptors is still not understood. The orphan Adhesion-GPCR GPR126 has recently been shown to play an essential role in the myelination of peripheral nerves in zebrafish. In parallel, whole-genome association studies have implicated variation at the GPR126 locus as a determinant of body height in the human population. The physiological function of GPR126 in mammals is still unknown. We describe a targeted mutation of GPR126 in the mouse, and show that GPR126 is required for embryonic viability and cardiovascular development

General practitioners and emergency departments (GPED) - Efficient models of care: A mixed-methods study protocol

© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY. Published by BMJ. Introduction Pressure continues to grow on emergency departments in the UK and throughout the world, with declining performance and adverse effects on patient outcome, safety and experience. One proposed solution is to locate general practitioners to work in or alongside the emergency department (GPED). Several GPED models have been introduced, however, evidence of effectiveness is weak. This study aims to evaluate the impact of GPED on patient care, the primary care and acute hospital team and the wider urgent care system. Methods and analysis The study will be divided into three work packages (WPs). WP-A; Mapping and Taxonomy: Mapping, description and classification of current models of GPED in all emergency departments in England and interviews with key informants to examine the hypotheses that underpin GPED. WP-B; Quantitative Analysis of National Data: Measurement of the effectiveness, costs and consequences of the GPED models identified in WP-A, compared with a no-GPED model, using retrospective analysis of Hospital Episode Statistics Data. WP-C; Case Studies: Detailed case studies of different GPED models using a mixture of qualitative and quantitative methods including: non-participant observation of clinical care, semistructured interviews with staff, patients and carers; workforce surveys with emergency department staff and analysis of available local routinely collected hospital data. Prospective case study sites will be identified by completing telephone interviews with sites awarded capital funding by the UK government to implement GPED initiatives. The study has a strong patient and public involvement group that has contributed to study design and materials, and which will be closely involved in data interpretation and dissemination. Ethics and dissemination The study has been approved by the National Health Service East Midlands - Leicester South Research Ethics Committee: 17/EM/0312. The results of the study will be disseminated through peer-reviewed journals, conferences and a planned programme of knowledge mobilisation

Risk factors for postoperative complications after adrenalectomy for phaeochromocytoma: multicentre cohort study

Background: To determine the incidence and risk factors for postoperative complications and prolonged hospital stay after adrenalectomy for phaeochromocytoma. Methods: Demographics, perioperative outcomes and complications were evaluated for consecutive patients who underwent adrenalectomy for phaeochromocytoma from 2012 to 2020 in nine high-volume UK centres. Odds ratios were calculated using multivariable models. The primary outcome was postoperative complications according to the Clavien–­­Dindo classification and secondary outcome was duration of hospital stay. Results: Data were available for 406 patients (female n = 221, 54.4 per cent). Two patients (0.5 per cent) had perioperative death, whilst 148 complications were recorded in 109 (26.8 per cent) patients. On adjusted analysis, the age-adjusted Charlson Co-morbidity Index ≥3 (OR 8.09, 95 per cent c.i. 2.31 to 29.63, P = 0.001), laparoscopic converted to open (OR 10.34, 95 per cent c.i. 3.24 to 36.23,

Do general practitioners working in or alongside the emergency department improve clinical outcomes or experience? A mixed-methods study

OBJECTIVES: To examine the effect of general practitioners (GPs) working in or alongside the emergency department (GPED) on patient outcomes and experience, and the associated impacts of implementation on the workforce. DESIGN: Mixed-methods study: interviews with service leaders and NHS managers; in-depth case studies (n=10) and retrospective observational analysis of routinely collected national data. We used normalisation process theory to map our findings to the theory's four main constructs of coherence, cognitive participation, collective action and reflexive monitoring. SETTING AND PARTICIPANTS: Data were collected from 64 EDs in England. Case site data included: non-participant observation of 142 clinical encounters; 467 semistructured interviews with policy-makers, service leaders, clinical staff, patients and carers. Retrospective observational analysis used routinely collected Hospital Episode Statistics alongside information on GPED service hours from 40 hospitals for which complete data were available. RESULTS: There was disagreement at individual, stakeholder and organisational levels regarding the purpose and potential impact of GPED (coherence). Participants criticised policy development and implementation, and staff engagement was hindered by tensions between ED and GP staff (cognitive participation). Patient 'streaming' processes, staffing and resource constraints influenced whether GPED became embedded in routine practice. Concerns that GPED may increase ED attendance influenced staff views. Our quantitative analysis showed no detectable impact on attendance (collective action). Stakeholders disagreed whether GPED was successful, due to variations in GPED model, site-specific patient mix and governance arrangements. Following statistical adjustment for multiple testing, we found no impact on: ED reattendances within 7 days, patients discharged within 4 hours of arrival, patients leaving the ED without being seen; inpatient admissions; non-urgent ED attendances and 30-day mortality (reflexive monitoring). CONCLUSIONS: We found a high degree of variability between hospital sites, but no overall evidence that GPED increases the efficient operation of EDs or improves clinical outcomes, patient or staff experience. TRIAL REGISTRATION NUMBER: ISCRTN5178022

A horizon scan of global conservation issues for 2014

This paper presents the output of our fifth annual horizon-scanning exercise, which aims to identify topics that increasingly may affect conservation of biological diversity, but have yet to be widely considered. A team of professional horizon scanners, researchers, practitioners, and a journalist identified 15 topics which were identified via an iterative, Delphi-like process. The 15 topics include a carbon market induced financial crash, rapid geographic expansion of macroalgal cultivation, genetic control of invasive species, probiotic therapy for amphibians, and an emerging snake fungal disease. © 2013 Elsevier Ltd

A 2018 Horizon Scan of Emerging Issues for Global Conservation and Biological Diversity.

This is our ninth annual horizon scan to identify emerging issues that we believe could affect global biological diversity, natural capital and ecosystem services, and conservation efforts. Our diverse and international team, with expertise in horizon scanning, science communication, as well as conservation science, practice, and policy, reviewed 117 potential issues. We identified the 15 that may have the greatest positive or negative effects but are not yet well recognised by the global conservation community. Themes among these topics include new mechanisms driving the emergence and geographic expansion of diseases, innovative biotechnologies, reassessments of global change, and the development of strategic infrastructure to facilitate global economic priorities