Bassetlaw Hospital

This study aims to identify UK general surgical trainees' perceptions, attitudes, and perceived barriers to EBM training and assessment so that interventions by general surgery educators to improve integration of EBM are informed by stakeholder data. A mixed-method survey was developed by adapting the validated McColl and BARRIERS questionnaires, informed by a scoping review and focus group discussions. Ethical approval was obtained (University of Sheffield - 056808). The survey was distributed through social media, surgical society newsletters, and deanery mailing lists, adhering to the CHERRIES checklist. The survey yielded 101 responses, 53 of which were complete (65% male, 35% female). A quarter of the 53 respondents did not hold higher academic degrees. Most participants (61%) worked in district general hospitals, with the highest response rates from Yorkshire and West Midlands. Attitudes towards EBM were predominantly positive from trainees (50.3%), with most of the respondents indicating their ability to understand and explain EBM terminology. However, they perceived their senior colleagues to be less enthusiastic about EBM (41.5%). Barriers to developing EBM competencies included lack of time, excessive evidence volume, limited access to resources, inadequate critical appraisal skills and limited opportunities for application during clinical practice. Existing postgraduate assessment strategies were deemed adequate for EBM by most of the trainees. The surveyed UK General surgical trainees exhibit positive attitudes towards EBM but face barriers in its application within their training. One way of addressing this issue is through research informed targeted curricular interventions.

Melakukan perhitungan anggaran biaya merupakan salah satu hal yang penting untuk dilakukan dalam perencanaan pembangunan. Nilai awal proyek konstruksi dapat diprediksi dengan menggunakan metode artificial intelligence (AI). Menghasilkan model prediksi yang akurat merupakan salah satu tujuan yang ingin dicapai. Pada penelitian ini dilakukan evaluasi mengenai pemodelan prediksi biaya proyek konstruksi dengan menggunakan metode artificial neural network (ANN). Sebagai evaluasi digunakan empat indikator error yaitu coefficient of correlation (R), mean absolute percentage error (MAPE), root mean square error (RMSE), mean absolute error (MAE), dan satu indikator normalisasi untuk mengevaluasi pemodelan yang dihasilkan yaitu reference index (RI). Pada penelitian ini data yang didapat dipecah kedalam dua dataset. Hasilnya, pada dataset 1 nilai MAPE yang didapat sebesar 26,12% dan R 0,916. Pada dataset 2 MAPE yang didapat 33,79% dengan R 0,841. Pada hasil normalisasi data pada kedua dataset, dengan adanya normalisasi tidak memberi perubahan yang signifikan terhadap metode ANN.

Cancer care guidelines have been developed in many subspecialities, usually in advanced health systems. However, there are notable global disparities in healthcare access, which can impact sarcoma care. Unfortunately, there is a lack of global data on this subject. Our aim was to describe access to sarcoma care based on a comprehensive global survey among orthopaedic oncologists, and assess for global as well as regional differences. A 25-question survey was emailed to the attendees of the 2024 Birmingham Orthopaedic Oncology Meeting and included questions about the respondents' training and practice, access to sarcoma centres, and specific items for sarcoma diagnosis and treatment. For data analysis and comparison, countries were grouped geographically and per the World Bank's income classification. A total of 192 specialists from 47 countries completed the survey (67%). Overall, 40% declared that most patients in their country were treated in a specialized sarcoma centre. Declared access to specific diagnostic technology ranged from 69% (translocation studies) to 86% (various immunohistochemistry). Only 31% stated having access to proton therapy and 82% to all possible reconstruction methods. Compromise of ideal surgical management because of prior treatments and financial constraints was declared to have happened regularly in 40% and 17% of practices, respectively. Regions with better-developed healthcare systems had improved access to all aspects surveyed. Similar results were observed when comparing high-income countries against low- to middle-income countries. Our study highlights substantial global and regional disparities in access to sarcoma services, which could potentially impact clinical outcomes. Further studies are needed to clarify this reality.

Intragastric Balloons are a temporary, reversible and safer option compared to bariatric surgery to promote significant weight loss, leading to improved metabolic outcomes. However, due to subsequent weight regain, alternative procedures are now preferred in adults. In adolescents, more amenable to lifestyle change, balloons may be an alternative to less reversible procedures. Our aim was to assess the tolerability and efficacy of the intragastric balloon in severely obese adolescents and the impact of associated weight loss on biomedical outcomes (glucose metabolism, blood pressure, lipid profiles) and bone density. A 2-year cohort study of 12 adolescents (BMI >3.5 s.d., Tanner stage >4) following 6 months intragastric balloon placement was carried out. Subjects underwent anthropometry, oral glucose tolerance test, and DEXA scans at 0, 6 and 24 months. The results showed clinically relevant improvements in blood pressure, insulin: glucose metabolism, liver function and sleep apnoea at 6 months. Changes were not sustained at 2 years though some parameters (Diastolic BP, HBA1c, insulin AUC) demonstrated longer-term improvement despite weight regain. Despite weight loss, bone mass accrual showed age appropriate increases. In conclusion, the intragastric balloon was safe, well tolerated and effective in supporting short-term weight loss and clinically relevant improvement in obesity-related complications, which resolved in some individuals. Benefits were not sustained in the majority at 2 years.

Background:Linaclotide, a guanylate cyclase C agonist, has been shown in clinical trials to improve symptoms of irritable bowel syndrome with constipation (IBS-C). Here we report data from a real-world study of linaclotide in the UK.Methods:This 1-year, multicentre, prospective, observational study in the UK enrolled patients aged 18 years and over initiating linaclotide for IBS-C. The primary assessment was change from baseline in IBS Symptom Severity Scale (IBS-SSS) score at 12 weeks, assessed in patients with paired baseline and 12-week data. Change from baseline in IBS-SSS score at 52 weeks was a secondary assessment. Adverse events were recorded.Results:In total, 202 patients were enrolled: 185 (91.6%) were female, median age was 44.9 years (range 18.1–77.2) and 84 (41.6%) reported baseline laxative use. Mean (standard deviation) baseline IBS-SSS score was 339 (92), with most patients (n = 129; 66.8%) classified as having severe disease (score ⩾300). In patients with paired data, there was a significant mean (95% confidence interval) decrease in IBS-SSS score from baseline to 12 weeks [−77.0 (−96.3, −57.7); p < 0.001; n = 124] and baseline to 52 weeks [−70.7 (−95.0, −46.5); p < 0.001; n = 76]. Overall, 174 adverse events were reported in 77 (38.1%) patients, most commonly diarrhoea (n = 54; 26.7%), abdominal pain (n = 21; 10.4%) and abdominal distension (n = 13; 6.4%).Conclusion:Linaclotide significantly improved IBS-SSS score at 12 and 52 weeks. These results provide insights into outcomes with linaclotide treatment over 1 year in patients with IBS-C in real-world clinical practice.

BackgroundGlobally, the rate of emergency hospital admissions is increasing. However, little evidence exists to inform the development of interventions to reduce unplanned Emergency Department (ED) attendances and hospital admissions. The objective of this evidence synthesis was to review the evidence for interventions, conducted during the patient’s journey through the ED or acute care setting, to manage people with an exacerbation of a medical condition to reduce unplanned emergency hospital attendance and admissions.MethodsA rapid evidence synthesis, using a systematic literature search, was undertaken in the electronic data bases of MEDLINE, EMBASE, CINAHL, the Cochrane Library and Web of Science, for the years 2000–2014. Evidence included in this review was restricted to Randomised Controlled Trials (RCTs) and observational studies (with a control arm) reported in peer-reviewed journals. Studies evaluating interventions for patients with an acute exacerbation of a medical condition in the ED or acute care setting which reported at least one outcome related to ED attendance or unplanned admission were included.ResultsThirty papers met our inclusion criteria: 19 intervention studies (14 RCTs) and 11 controlled observational studies. Sixteen studies were set in the ED and 14 were conducted in an acute setting. Two studies (one RCT), set in the ED were effective in reducing ED attendance and hospital admission. Both of these interventions were initiated in the ED and included a post-discharge community component. Paradoxically 3 ED initiated interventions showed an increase in ED re-attendance. Six studies (1 RCT) set in acute care settings were effective in reducing: hospital admission, ED re-attendance or re-admission (two in an observation ward, one in an ED assessment unit and three in which the intervention was conducted within 72 h of admission).ConclusionsThere is no clear evidence that specific interventions along the patient journey from ED arrival to 72 h after admission benefit ED re-attendance or readmission. Interventions targeted at high-risk patients, particularly the elderly, may reduce ED utilization and warrant future research. Some interventions showing effectiveness in reducing unplanned ED attendances and admissions are delivered by appropriately trained personnel in an environment that allows sufficient time to assess and manage patients.

The recent history of the public interest is one of misappropriation. Practitioners have been found to value the concept but have struggled to articulate how it guides day-to-day planning practice. It has been used to portray a homogeneous public, furthering the interests of the powerful at the expense of recognising social diversity, and leading to calls for the concept’s abandonment. Yet this article starts from the argument that the public interest remains the justification that fundamentally underpins planning activities, in light of a continuing need to address collective concerns. To this end, the article adopts the typology put forward by Campbell and Marshall, outlining different ways in which the public interest may practically be addressed. Alongside this, Dewey’s work is used to understand how the extent of the public may vary, leading to the use of scale as a way of recognising when different conceptualisations of the public interest might be practically drawn upon. Following this approach, the typology is brought together with scale, as a lens for understanding the extent of a public with a common interest, to form a framework for analysing practice. This framework is used to analyse how the interests of different publics are addressed in a case study of the Peak District, a national park in England. From the case, conclusions are drawn around the need to pay greater attention to the extent of different publics with a common interest and, in turn, how the interests of different publics can be reconciled.