Surgery school-who, what, when, and how: results of a national survey of multidisciplinary teams delivering group preoperative education

Background

Group education is increasing in popularity as a means of preparing patients for surgery. In recent years, these ‘surgery schools’ have evolved from primarily informing patients of what to expect before and after surgery, to providing support and encouragement for patients to ‘prehabilitate’ prior to surgery, through improving physical fitness, nutrition and emotional wellbeing.

Method

A survey aimed at clinicians delivering surgery schools was employed to capture a national overview of activity to establish research and practice priorities in this area. The survey was circulated online via the Enhanced Recovery after Surgery UK Society and the Centre for Perioperative Care mailing lists as well as social media.

Results

There were 80 responses describing 28 active and 4 planned surgery schools across the UK and Ireland. Schools were designed and delivered by multidisciplinary teams, contained broadly similar content and were well attended. Most were funded by the National Health Service. The majority included aspects of prehabilitation most commonly the importance of physical fitness. Seventy five percent of teams collected patient outcome data, but less than half collected data to establish the clinical effectiveness of the school. Few describe explicit inclusion of evidence-based behavior change techniques, but collaboration and partnerships with community teams, gyms and local charities were considered important in supporting patients to make changes in health behaviors prior to surgery.

Conclusion

It is recommended that teams work with patients when designing surgery schools and use evidence-based behavior change frameworks and techniques to inform their content. There is a need for high-quality research studies to determine the clinical effectiveness of this type of education intervention.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13741-021-00188-2.

Antibacterial activity of disulfiram and its metabolites

AIMS

Disulfiram (Antabuse™) and its metabolites formed in vivo were evaluated as antibacterial agents against thirty species of Gram-positive and Gram-negative bacteria. The synergistic potential of disulfiram (DSF) and metabolite diethyldithiocarbamate (DDTC) with approved antibiotics were also compared by isobologram (checkerboard) analysis.

METHODS AND RESULTS

Standard microdilution susceptibility testing showed that most DSF metabolites did not possess appreciable antibacterial activity except for DDTC in Bacillus anthracis. Checkerboard studies revealed similarities between the combination drug effects of DSF and DDTC with standard antibiotics.

CONCLUSIONS

It was concluded from the susceptibility data that the metabolites would not extend the antibacterial spectrum of DSF in vivo. The data also suggest that the DDTC by-product of DSF metabolism potentiates the antibacterial activity of DSF as both a standalone and combination agent.

SIGNIFICANCE AND IMPACT OF THE STUDY

The study provides a greater understanding of the antibacterial effects of Antabuse and its metabolites. This research also demonstrates the potential application of DSF as an antibiotic adjuvant for the treatment of resistant staph infections.

Automated electrotransformation of Escherichia coli on a digital microfluidic platform using bioactivated magnetic beads

This paper reports on the use of a digital microfluidic platform to perform multiplex automated genetic engineering (MAGE) cycles on droplets containing Escherichia coli cells. Bioactivated magnetic beads were employed for cell binding, washing, and media exchange in the preparation of electrocompetent cells in the electrowetting-on-dieletric (EWoD) platform. On-cartridge electroporation was used to deliver oligonucleotides into the cells. In addition to the optimization of a magnetic bead-based benchtop protocol for generating and transforming electrocompetent E. coli cells, we report on the implementation of this protocol in a fully automated digital microfluidic platform. Bead-based media exchange and electroporation pulse conditions were optimized on benchtop for transformation frequency to provide initial parameters for microfluidic device trials. Benchtop experiments comparing electrotransformation of free and bead-bound cells are presented. Our results suggest that dielectric shielding intrinsic to bead-bound cells significantly reduces electroporation field exposure efficiency. However, high transformation frequency can be maintained in the presence of magnetic beads through the application of more intense electroporation pulses. As a proof of concept, MAGE cycles were successfully performed on a commercial EWoD cartridge using variations of the optimal magnetic bead-based preparation procedure and pulse conditions determined by the benchtop results. Transformation frequencies up to 22% were achieved on benchtop; this frequency was matched within 1% (21%) by MAGE cycles on the microfluidic device. However, typical frequencies on the device remain lower, averaging 9% with a standard deviation of 9%. The presented results demonstrate the potential of digital microfluidics to perform complex and automated genetic engineering protocols.

Homo- and Co-Polycarbonates and Blends Derived from Diphenolic Acid

The properties of materials derived from diphenolic acid (4-(bis(hydroxyphenyl))pentanoic acid, DPA), such as polycarbonate homo- and co-polymers (with bisphenol A, BPA), have been determined. The influence of copolymer composition on the thermal properties of these materials has been determined. Blends of polycarbonates from BPA and from DPA appear to be compatible.

SU-F-BRCD-06: Multiple Anatomy Optimization of Accumulated Dose

PURPOSE

Multiple anatomy optimization (MAO) utilizing deformable dose accumulation on entire 4DCT data sets is implemented to overcome ambiguity between optimal dose defined on a single anatomy and optimal accumulated dose resulting from dose delivery to moving and deforming anatomy.

METHODS

Six lung cancer patients are planned using two methods of radiotherapy optimization: the internal target volume (ITV) envelope method and MAO, which simultaneously optimizes a single fluence for delivery to all 10 breathing phases such that the accumulated dose satisfies the plan objectives. Target dose is constrained to 70 Gy. The ITV-plan is optimized on a single breathing phase with the planning target volume defined as the ITV; the MAO target is the moving CTV. MAO is compared to single image ITV optimization based on the accumulated dose assuming equal monitor-units to each phase. Dose-volume differences between single image estimations and 10-image accumulation are examined.

RESULTS

Single image optimal dose distributions overestimate target V70 by 4.2%±3.1% (average, one standard deviation) and in five of six cases ipsilateral lung V20 is underestimated (1.4%±0.9%). For these five cases, MAO increases V70 by 2.8%±2.5% (maximum of 6% increase in V70) and reduces ipsilateral lung V20 by up to 3% (average decrease of 1.2%±1.3%). Contralateral lung V20, esophagus V25, and heart V30 are also reduced by up to 5%, 3%, and 3%. For the sixth case, lung tumor motion is on the order of the dose voxel size (3mm), and MAO did not improve upon the ITV plan.

CONCLUSIONS

Dose-volume optimization on a stationary image does not ensure accumulated dose coverage to the moving CTV. Multiple anatomy optimization can remove dose ambiguity and improve plan quality. P01CA11602 and Philips Medical Systems.

Patient safety incidents associated with obesity: a review of reports to the National Patient Safety Agency and recommendations for hospital practice

BACKGROUND

The incidence and prevalence of obesity are increasing world wide. In the UK, obesity governmental strategy has primarily focused on prevention measures, with less focus on the demands of treating obese patients in hospital. Increasing service demand by obese patients coupled with a lack of adequate provision for care of these patients may lead to an increase in patient safety incidents. By classifying patient safety incidents associated with obesity reported to the National Patient Safety Agency, this report aims to identify areas for improvement in the quality and safety of care of the obese patient.

METHODS

A search of the National Reporting and Learning System database was conducted for all incidents caused by or relating to obesity for the period 1 January 2005 to 31 August 2008. The keywords 'obesity', 'overweight', 'BMI' (body mass index), and 'bariatric' were used. The relevant free text fields of the resulting set of incidents were then searched for the terms designed to isolate incidents occurring in anaesthesia, critical care, and surgery. Reported incidents were analysed and subsequently categorised to identify incident themes. Levels of harm were also established.

RESULTS

555 patient safety incidents were identified; 388 met inclusion criteria for analysis. 148 incidents were related to assessment, diagnosis or treatment, 213 related to infrastructure and 27 related to staffing. The majority of incidents were classified as no or low harm. Three deaths were reported, all within the domain of anaesthesia.

CONCLUSIONS

This report identifies that the majority of safety incidents associated with obesity were related to infrastructure, suggesting that there is inadequate provision in place for the care of obese patients. While levels of harm were mostly low, the occurrence of incidents resulting in severe harm or death highlights the specific dangers associated with the care of the obese patient. A global approach to improving the safety of care delivery for obese patients is recommended, including obesity specific training, management structures, care pathways, and equipment provisioning.Further planning and development of operation policies is needed to ensure the safe delivery of healthcare to obese patients in the future.

Vapor Deposition of Parylene Films from Precursors

Parylene films, depending on the type, are thermally stable up to 530°C and have low dielectric constants ranging from 2.35 to 3.15. One of the most interesting properties of this material is its vapor depositability. Conventional vapor deposition involves cracking the parylene dimers at temperatures from 600 to 730 °C and polymerizingthe monomers at - 35 °C to RT. We have developed a simpler and less expensive technique that directly uses the precursors from which the dimers are made. This method requires the use of metal catalysts to produce parylene films. We have used the precursors α,α'-dibromo-p-xylene and dibromotetrafluoro-p-xylene to produce N-type and F-type parylene films. FTIR, XPS, thermal stability, and electrical studies show that the F-type parylene films grown from the precursors are comparable to, or sometimes better than, the films grown from dimer, and have potential microelectronics applications.

Vapor Deposition Of Very Low K Polymer Films, Poly(Naphthalene), Poly(Fluorinated Naphthalene)

Several novel processes have been developed in our lab to synthesize and deposit polymers that have extremely low dielectric constants (below 2.5) as thin films. These reactive intermediates are condensed onto wafers in a vacuum chamber and no chemical waste is produced. Furthermore, cold traps can be used to recover uncondensed monomers through the pumping system. Because of the extremely low dielectric constant, very low moisture uptake and high temperature stability of these vapor depositable materials, these environmentally friendly polymers are very attractive for future electronic applications as interlayer dielectrics. Examples are Parylene-F(fluorinated), poly(naphthalene) (PNT-N), poly(fluorinated naphthalene) (PNT-F), and Teflon AF 1600 (amorphous). These films were deposited at substrate temperatures between −20 and 350 °C and at deposition pressure was 10−4−2.5 Torr. The film thicknesses were between 0.1–10 μ. and dielectric constants were between 1.9–2.5. The thermal stabilities of these films were between 360–590 °C. Among them, poly(fluorinated naphthalene) dissociates at about 590 °C. Poly(naphthalene) and poly(fluorinated naphthalene) are obtained as films by vaporizing monomers in vacuo and transporting the vapor to a hot surface.

Excellence in teaching for promotion and tenure in animal and dairy sciences at doctoral/research universities: a faculty perspective

In this study, animal or dairy sciences faculty from doctoral/research universities were surveyed to clarify teaching performance expectations for the purpose of promotion and tenure of assistant professors. A survey tool including 15 evaluation criteria was available online and at the registration desk of the 2005 Joint Annual Meeting of the American Dairy Science Association and the American Society of Animal Science. The analyzed data set included 47 faculty (41 tenured and 6 tenure-track) with a substantial teaching responsibility from 27 different departments in 25 states. Four criteria were perceived as currently overemphasized: student evaluation of the instructor, student evaluation of the course, authoring peer-reviewed publications, and authoring an undergraduate textbook or book chapter. Nevertheless, more than 50% of respondents reported that these criteria should be used. One criterion emerged as being currently underemphasized: documentation of personal assessment of one's own teaching by preparing a portfolio. The lack of consensus for the remaining 10 items may have reflected substantial differences in institutional practices. The significance of overemphasis or underemphasis of certain criteria varied substantially depending on the respondent's perceived institutional mission. When asked about recognition within their department, 68% of respondents indicated that efforts in teaching improvement were properly rewarded. Respondents doubted the meaningfulness and appropriateness of student ratings tools as currently used. Results also suggested that animal and dairy science faculty placed a higher value on criteria recognizing excellence in teaching based on intradepartmental recognition (e.g., interactions with close-up peers and students) rather than recognition within a broader community of scholars as evidenced by authorship or success in generating funding for teaching. Proposed improvements in the evaluation of teaching for promotion and tenure include 1) providing tenure-track faculty with written guidelines at the time of hiring; 2) ensuring that student ratings tools are reliable and valid; 3) carefully mentoring new faculty within the departmental and institutional culture; and 4) encouraging self-reflection and documentation of attempts to address pedagogical issues in one's own teaching. Educational leaders in doctoral/research universities should promote changes to enhance teaching performance of future faculty graduating from their institutions.

Chitin Degradation Proteins Produced by the Marine Bacterium Vibrio harveyi Growing on Different Forms of Chitin

Relatively little is known about the number, diversity, and function of chitinases produced by bacteria, even though chitin is one of the most abundant polymers in nature. Because of the importance of chitin, especially in marine environments, we examined chitin-degrading proteins in the marine bacterium Vibrio harveyi. This bacterium had a higher growth rate and more chitinase activity when grown on (beta)-chitin (isolated from squid pen) than on (alpha)-chitin (isolated from snow crab), probably because of the more open structure of (beta)-chitin. When exposed to different types of chitin, V. harveyi excreted several chitin-degrading proteins into the culture media. Some chitinases were present with all of the tested chitins, while others were unique to a particular chitin. We cloned and identified six separate chitinase genes from V. harveyi. These chitinases appear to be unique based on DNA restriction patterns, immunological data, and enzyme activity. This marine bacterium and probably others appear to synthesize separate chitinases for efficient utilization of different forms of chitin and chitin by-products.

H-gene-mediated resistance to Hessian fly exhibits features of penetration resistance to fungi

Features shared by host-specific phytophagous insects and biotrophic plant pathogens include gene-for-gene interactions and the ability to induce susceptibility in plants. The Hessian fly shows both. To protect against Hessian fly, grasses have H genes. Avirulent larvae die on H-gene-containing resistant plants but the cause of death is not known. Imaging techniques were used to examine epidermal cells at larval attack sites, comparing four resistant wheat genotypes (H6, H9, H13, and H26) to a susceptible genotype. Present in both resistant and susceptible plants attacked by larvae were small holes in the tangential cell wall, with the size of the holes (0.1 microm in diameter) matching that of the larval mandible. Absent from attacked resistant plants were signs of induced susceptibility, including nutritive tissue and ruptured cell walls. Present in attacked resistant plants were signs of induced resistance, including cell death and fortification of the cell wall. Both presumably limit larval access to food, because the larva feeds on the leaf surface by sucking up liquids released from ruptured cells. Resistance was associated with several subcellular responses, including elaboration of the endoplasmic reticulum-Golgi complex and associated vesicles. Similar responses are observed in plant resistance to fungi, suggesting that "vesicle-associated penetration resistance" also functions against insects.

Synthesis and characterization of fluorescent displacers for online monitoring of displacement chromatography

One of the major impediments to the implementation of displacement chromatography for the purification of biomolecules is the need to collect fractions from the column effluent for time-consuming offline analysis. The ability to employ direct online monitoring of displacement chromatography would have significant implications for applications ranging from analytical to preparative bioseparations. To this end, a set of novel fluorescent displacers were rationally designed using known chemically selective displacers as a template. Fluorescent cores were functionalized with different charge moieties, creating a homologous library of displacers. These compounds were then tested on two protein pairs, alpha-chymotrypsinogen A/ribonuclease A and cytochrome c/lysozyme, using batch and column displacement experiments. Of the synthesized displacers, two were found to be highly selective while one was determined to be a high-affinity displacer. Column displacements using one of the selective displacers yielded complete separation of both protein pairs while facilitating direct online detection using UV and fluorescence detection. Saturation transfer difference NMR was also carried out to investigate the binding of the fluorescent displacers to proteins. The results indicated a selective binding between the selective displacers and alpha-chymotrypsinogen A, while no binding was observed for ribonuclease A, confirming that protein-displacer binding is responsible for the selectivity in these systems. This work demonstrates the utility of fluorescent displacers to enable online monitoring of displacer breakthroughs while also acting as efficient displacers for protein purification.

A simple radon chamber for educational use

Radon chambers are typically able to maintain a constant, known concentration of radon by pumping a constant activity concentration of radon gas into the chamber. A radon chamber has been designed by placing a radon source inside the chamber volume and allowing radon to build up inside the chamber. Because the radon concentration is not constant, calculations have been made to determine the integrated equivalent constant radon concentration in MBqhm for up to 4 d. The chamber, made by placing a radium dial inside an incubator, has interior dimensions of 87.6 cm x 55.9 cm x 51.4 cm for a total volume of 0.25 m. The chamber can produce an integrated equivalent constant radon activity concentration level of 0.013 MBq h m over the initial 24 h, 0.043 MBq h m over the initial 48 h, 0.078 MBq h m over the initial 72 h, and 0.118 MBq h m over the initial 96 h. The chamber can also demonstrate, for educational purposes, the kinetics of the build-up of a radioactive gas in an enclosed environment as well as the kinetics of washout and leakage.

Soybean hulls as an alternative feed for horses

Soybean hulls have been successfully fed to ruminant animals as an economical substitute for hay. This feedstuff is a source of highly digestible fiber that does not contain starch. The purpose of this trial was to evaluate soybean hulls as a replacement fiber in horse diets. Four cecally cannulated Quarter Horse geldings, aged 6 to 10 yr and averaging 502 kg, were used in a 4 x 4 Latin square design with 21-d periods. Diets consisted of alfalfa/bromegrass hay (14.4% CP, 58.1% NDF, 39.1% ADF; DM basis) with the replacement of either 0, 25, 50, or 75% (as-fed basis) unpelleted soybean hulls (13.1% CP, 60.6% NDF, 43.7% ADF; DM basis). Diets were offered at 1.8% of BW (DM) daily and body weights were measured weekly. Cecal samples (90 min after feeding) and total fecal collections (3 d) were taken at the end of each treatment period. Fecal collection bags were emptied every 6 h and 10% of the total amount was frozen for later analysis. Total cecal VFA production increased linearly (P = 0.02) from 70 mM to 109 mM as proportions of soybean hulls in diets increased. Proportions of propionate increased linearly (P < 0.01) with means of 15.7, 18.0, 16.6, and 21.9 mol/100 mol total VFA for the 0, 25, 50, and 75% soybean hulls diets respectively. Proportions of butyrate decreased linearly (P < 0.01) from 5.3 to 3.9 mol/100 mol total VFA. The acetate:propionate ratio decreased linearly (P = 0.02) and cubically (P = 0.03) with means of 4.9, 4.2, 4.9, and 3.3. Apparent digestibility of DM (P = 0.95), OM (P = 0.70), NDF (P = 0.34), ADF (P = 0.31), cellulose (P = 0.93), and hemicellulose (P = 0.25) did not differ among treatments. Apparent digestibility of N decreased linearly (P < 0.01) as concentrations of soybean hulls increased in the diet, and this response was associated with increased cecal fermentation and microbial biomass production. Cecal pH decreased linearly (P = 0.01) from 7.00 to 6.45 as the level of soybean hulls increased, but there was no change (P = 0.68 for the linear effect) for cecal ammonia (mean concentration of 3.85 mM). Soybean hulls stimulate cecal fermentation and are a suitable replacement for hay in equine diets.

Botulinum toxin injection inhibits myogenic tone and sympathetic nerve function in the porcine internal anal sphincter

OBJECTIVE

Botulinum toxin is an effective treatment for anal fissure, though there is a lack of agreement over the optimal site for its injection. This reflects our current ignorance of its mechanism, and whether it has any action on the nerves of the internal anal sphincter (IAS). This study set out to resolve this issue through use of a pig model.

MATERIALS AND METHODS

Eight pigs were studied in pairs: one of each pair received a botulinum toxin injection into the anal sphincter, whilst the other acted as its control. Manometry was performed every two weeks under anaesthesia. Pigs were slaughtered at between four and six weeks after injection and the properties of the IAS compared in vitro.

RESULTS

Whilst maximum anal resting pressure (MARP) increased slowly in control pigs during the experimental period, reflecting weight gain, a fall was observed in treated pigs. In vitro, IAS strips from control pigs generated 400 mg of spontaneous tone per gram of tissue (+/- 45; standard error), compared to 250 (+/- 25) mg/g tissue from treated pigs (P < 0.01). Electric Field Stimulation at 50 Hz produced 150 (+/- 22) mg contraction/gram tissue in IAS strips from control pigs compared to 53 (+/- 13) mg/g tissue in treated pigs (P < 0.0005). This contractile response was blocked by guanethidine.

CONCLUSION

Botulinum toxin has a significant action on the IAS. It reduces myogenic tone and contractile responses of this tissue to sympathetic nerve stimulation. Further studies are required to clarify its mechanism of action more precisely.

By-product feeds for meat goats: effects on digestibility, ruminal environment, and carcass characteristics

Crossbred wether goats (n = 24; 50% Boer, 6 per diet) initially averaging 27.4+/-0.4 kg were fed either wheat middlings (wheat midds), soybean hulls (soyhulls), or corn gluten feed at 1% BW (as-fed) along with orchardgrass hay (10.7% CP) offered to ad-libitum consumption for 72 d followed by 5 d total fecal collection. The Control (hay) diet was supplemented with 5.7% soybean meal to bring total dietary protein to 12.5%, by-products were brought to a higher Ca:P ratio with limestone or dicalcium phosphate to make total dietary Ca:P 1.5:1, and soybean meal was added to soyhulls to bring them up to 17% CP (wheat midds = 17% and corn gluten feed = 21% CP). Total DMI (916 g/d+/-57 or 3.2%+/-0.2 BW) did not differ (P > 0.92) among treatments. Initial BW (P = 0.25), final BW (P = 0.48), and ADG (P = 0.56) did not differ for the four treatments. Carcass weight was greater (P = 0.05) for goats fed soyhulls (16.0 kg) or wheat midds (15.6 kg) as compared with goats fed the hay diet (14.5 kg), with carcass weight from goats fed corn gluten feed being intermediate (15.3 kg, SEM = 0.3 kg). Carcass grade did not differ (P = 0.80) and averaged 5.42+/-0.4. Dressing percentage tended (P = 0.12) to be lower for goats fed the hay diet (46.4%) compared with soyhull (48.3%), corn gluten feed (48.3%), or wheat midd (48.8%) diets (SEM = 0.7). Ruminal pH was highest (P < 0.01) for goats fed the hay diet (6.52) and lowest for goats fed wheat midds (6.23) with soyhull (6.41) and corn gluten feed diets (6.35) being intermediate (SEM = 0.05). Digestibility of DM (70.1+/-2.5%), OM (70.3+/-2.6%,), CP (75.5+/-2.0%), GE (68.5+/-2.7%), NDF (68.1+/-3.0%), ADF (65.4+/-3.4%), cellulose (70.1+/-2.9%), and lignin (31.1+/-8.2%) did not differ (P > 0.15). Total ruminal VFA did not differ (86.0+/-6.1 mM, P = 0.59), but acetate:propionate ratio was higher (P < 0.01) for hay (3.1) and soyhull diets (3.3) than for corn gluten feed (2.4) and wheat midd diets (2.4, SEM = 0.11). Ruminal ammonia (mg/100 mL) was lower (P < 0.01) for goats fed hay (15.4) and soyhull diets (11.6) than those fed corn gluten feed (25.2) and wheat midd diets (23.0, SEM = 1.35). Ruminal pH was lower for goats fed the byproducts, but remained above 6. Serum urea nitrogen (mg/100 mL) averaged 21.0+/-1.0 (P = 0.11) with soyhulls tending to be lowest (19.3) and corn gluten feed tending to be highest (22.8). Soyhulls, corn gluten feed, and wheat midds appear to be viable feed ingredients for meat goat diets.