Anaemia in patients undergoing major bowel surgery – Prevalence and current practice: A public and private institution experience

Aim: The study aimed to compare the frequency and alignment of preoperative anaemia screening and treatment with Australian guidelines in elective bowel surgery and determine the impact on clinical outcomes. Methods: We performed a retrospective observational study, with an audit of 559 adult patients who underwent major elective bowel surgery in an Australian metropolitan hospital, January 2016–December 2018. Outcome measures included rate of anaemia, guideline compliance, hospital length of stay, and transfusion rate. Results: Preoperative anaemia assessment occurred in 82.6% of patients. However, only 5.2% received recommended biochemical tests at least one week before surgery. Only 25.2% of anaemic patients received preoperative treatment; they experienced a longer hospital length of stay (9.93 days versus 7.88 days, p < 0.001) and an increased rate of transfusion (OR: 3.186, p < 0.05). Conclusion: The gaps between current preoperative anaemia screening, management and national guidelines may place patients at higher risk of poor surgical outcome

Bildung für eine Nachhaltige Entwicklung und Lehrerinnen- und Lehrerbildung – eine Beziehung mit Potenzial

Bildung für eine Nachhaltige Entwicklung (BNE) hat für die Lehrerinnen- und Lehrerbildung auf wissenschaftlicher und bildungspolitischer Ebene an Bedeutung gewonnen. Im Rahmen der «Beiträge zur Lehrerinnen- und Lehrerbildung» (BzL) ist das Thema indes kaum abgebildet – es erschienen nur wenige Beiträge in den vergangenen 25 Jahren. Es lässt sich daher feststellen, dass BNE im schweizerischen Professionalisierungsdiskurs noch kaum wahrgenommen wird, obwohl das Thema in der Lehrerinnen- und Lehrerbildung angekommen ist und in der professionsspezifischen Auseinandersetzung durchaus ein Potenzial vorliegt, auf Herausforderungen zu reagieren, mit denen die Lehrerinnen- und Lehrerbildung konfrontiert ist: die zunehmende fachliche Fragmentierung sowie das Verhältnis von Unterrichtspraxis und wissenschaftlicher Praxis. (DIPF/Orig.)Education for sustainable development (ESD) has become an important issue within teacher education at the scientific level and at the level of education policy. The topic is only marginally represented in the context of the journal «BzL», however merely a few contributions have been published in the past 25 years. It can therefore be stated that ESD is still hardly perceived in the Swiss discourse on professionalization although the topic has arrived in teacher education and there is certainly potential in the profession-specific debate to react to challenges with which teacher education is confronted: the increased fragmentation of subjects and the relationship between teaching practice and academic practice

Treatment as usual (TAU) as a control condition in trials of cognitive behavioural-based psychotherapy for self-harm:impact of content and quality on outcomes in a systematic review

Background: Randomized controlled trials (RCTs) are the mainstay of evaluations of the efficacy of psychosocial interventions. In a recent Cochrane systematic review we analysed the efficacy of cognitive behavioural-based psychotherapies compared to treatment as usual (TAU) in adults who self-harm. In this study we examine the content and reporting quality of TAU in these trials and their relationship to outcomes. Methods: Five electronic databases (CCDANCTR-Studies and References, CENTRAL, MEDLINE, EMBASE, and PsycINFO) were searched for RCTs, indexed between 1 January 1998 and 30 April 2015, of cognitive-behavioural interventions compared to TAU for adults following a recent (within six months) episode of self-harm. Comparisons were made between outcomes for trials which included different categories of TAU, which were grouped as: multidisciplinary treatment, psychotherapy only, pharmacotherapy only, treatment by primary care physician, minimal contact, or unclear. Results: 18 trials involving 2433 participants were included. The content and reporting quality of TAU varied considerably between trials. The apparent effectiveness of cognitive behavioural psychotherapy varied according to TAU reporting quality and content. Specifically, effects in favour of cognitive-behavioural psychotherapy were strongest in trials in which TAU content was not clearly described (Odds Ratio: 0.29, 95% Confidence Interval 0.15–0.62; three trials) compared to those in which TAU comprised multidisciplinary treatment (Odds Ratio: 0.79, 95% CI 0.63 to 0.97; 12 trials). Limitations: The included trials had high risk of bias with respect to participant and clinical personnel blinding, and unclear risk of bias for selective outcome reporting. Conclusions: TAU content and quality represents an important source of heterogeneity between trials of psychotherapeutic interventions for prevention of self-harm. Before clinical trials begin, researchers should plan to carefully describe both aspects of TAU to improve the overall quality of investigations.</p

Cross-Species Transmission of a Novel Adenovirus Associated with a Fulminant Pneumonia Outbreak in a New World Monkey Colony

Adenoviruses are DNA viruses that naturally infect many vertebrates, including humans and monkeys, and cause a wide range of clinical illnesses in humans. Infection from individual strains has conventionally been thought to be species-specific. Here we applied the Virochip, a pan-viral microarray, to identify a novel adenovirus (TMAdV, titi monkey adenovirus) as the cause of a deadly outbreak in a closed colony of New World monkeys (titi monkeys; Callicebus cupreus) at the California National Primate Research Center (CNPRC). Among 65 titi monkeys housed in a building, 23 (34%) developed upper respiratory symptoms that progressed to fulminant pneumonia and hepatitis, and 19 of 23 monkeys, or 83% of those infected, died or were humanely euthanized. Whole-genome sequencing of TMAdV revealed that this adenovirus is a new species and highly divergent, sharing <57% pairwise nucleotide identity with other adenoviruses. Cultivation of TMAdV was successful in a human A549 lung adenocarcinoma cell line, but not in primary or established monkey kidney cells. At the onset of the outbreak, the researcher in closest contact with the monkeys developed an acute respiratory illness, with symptoms persisting for 4 weeks, and had a convalescent serum sample seropositive for TMAdV. A clinically ill family member, despite having no contact with the CNPRC, also tested positive, and screening of a set of 81 random adult blood donors from the Western United States detected TMAdV-specific neutralizing antibodies in 2 individuals (2/81, or 2.5%). These findings raise the possibility of zoonotic infection by TMAdV and human-to-human transmission of the virus in the population. Given the unusually high case fatality rate from the outbreak (83%), it is unlikely that titi monkeys are the native host species for TMAdV, and the natural reservoir of the virus is still unknown. The discovery of TMAdV, a novel adenovirus with the capacity to infect both monkeys and humans, suggests that adenoviruses should be monitored closely as potential causes of cross-species outbreaks

Outcomes in Transcatheter Aortic Valve Replacement for Bicuspid Versus Tricuspid Aortic Valve Stenosis

Cardiolog

Means versus ends in opaque institutional fields: Trading off compliance and achievement in sustainability standard adoption

__Abstract__ The long-standing discussion on decoupling has recently moved from adopters not implementing the agreed-upon policies to compliant adopters not achieving the goals intended by institutional entrepreneurs. This “means-ends decoupling” prevails especially in highly opaque fields, where practices, causality, and performance are hard to understand and chart. I conceptualize the conditions under which the adoption of institutions in relatively opaque fields leads to the achievement of the envisaged goals. Voluntary sustainability standards governing socioenvironmental issues illustrate these arguments. I argue that the lack of field transparency drives institutional entrepreneurs to create and maintain concrete and uniform rules, apply strong incentives, and disseminate “best practices” to ensure substantive adopter compliance. However, such rigid institutions are ill-equipped to deal with the causal complexity and practice multiplicity underlying opacity while they smother adopter agency. The ensuing tension between substantive compliance and goal achievement leads to an inherent trade-off: institutional entrepreneurs who remedy the policy-practice decoupling may enhance the disparity between means and ends, and vice versa. While sustainability standards and other institutions in highly opaque fields can, therefore, not fully achieve the envisaged goals, the trade-off can be reduced through systemically designed institutions that promote goal internalization and contain niche institutions

Sequential Structural and Fluid Dynamics Analysis of Balloon-Expandable Coronary Stents: A Multivariable Statistical Analysis

Several clinical studies have identified a strong correlation between neointimal hyperplasia following coronary stent deployment and both stent-induced arterial injury and altered vessel hemodynamics. As such, the sequential structural and fluid dynamics analysis of balloon-expandable stent deployment should provide a comprehensive indication of stent performance. Despite this observation, very few numerical studies of balloon-expandable coronary stents have considered both the mechanical and hemodynamic impact of stent deployment. Furthermore, in the few studies that have considered both phenomena, only a small number of stents have been considered. In this study, a sequential structural and fluid dynamics analysis methodology was employed to compare both the mechanical and hemodynamic impact of six balloon-expandable coronary stents. To investigate the relationship between stent design and performance, several common stent design properties were then identified and the dependence between these properties and both the mechanical and hemodynamic variables of interest was evaluated using statistical measures of correlation. Following the completion of the numerical analyses, stent strut thickness was identified as the only common design property that demonstrated a strong dependence with either the mean equivalent stress predicted in the artery wall or the mean relative residence time predicted on the luminal surface of the artery. These results corroborate the findings of the large-scale ISAR-STEREO clinical studies and highlight the crucial role of strut thickness in coronary stent design. The sequential structural and fluid dynamics analysis methodology and the multivariable statistical treatment of the results described in this study should prove useful in the design of future balloon-expandable coronary stents

Temporary cervical sling and uterine twist before B-Lynch for massive uterine bleeding after delivery

Massive uterine bleeding occurring after delivery is in most cases unpredictable and can have fatal consequences. This article presents the technique of combining the twisting of uterus on a 90° rotation on its axis and positioning a sling around the cervix, allowing to decrease incoming blood flow from uterine and ovarian arteries. The aim of this easy-to-use procedure is to enable surgeons and anaesthesiologists to respectively ensure the presence of an experienced surgeon and to stabilise the haemodynamic of the patient. It is a modus operandi of particular interest in resources’ challenged environments