E-Handover in Surgery Improves Clinical Efficiency and Adherence to COVID-19 Infection Control Measures.

Introduction The ongoing coronavirus disease 2019 (COVID-19) pandemic has impacted all aspects of clinical practice. A district general hospital's surgical department identified that ward rounds based on a paper-based handover system did not adhere to good COVID-19 pandemic infection control measures, including social distancing, reduction of footfall, and reducing contact events during documentation. Surgical E-Handover was introduced as a quality improvement project focussing on increasing efficiency and improving patient safety and compliance with COVID-19 social distancing measures. Other objectives were to reduce the risk of information governance breaches. During the COVID pandemic, there was a significant investment in digital technology, which supported rapid advancement in the use of electronic healthcare solutions to deliver new ways of working. We used the opportunity of the emergency situation to disrupt existing work patterns and introduce surgical E-Handover. Methods A quality improvement team of stakeholders was assembled, and a project to introduce E-Handover was carried out using the trust quality improvement methodology aligned to the Institute of Healthcare Improvement (IHI). Questionnaires were sent out pre- and post-implementation to evaluate the impact of using E-Handover during ward rounds. Results The efficiency of ward rounds was improved and improving compliance with COVID 19 social distancing measures was highly successful. These outcomes were achieved by reducing footfall during ward rounds, as key clinical information was available at the bedside (p<0.001). Doctors spent less time in crowded clinical multi-disciplinary team (MDT) rooms, and the integrated paper healthcare records were not accessed by multiple staff members simultaneously. The implementation of the E-Handover improved the safety and efficiency of the surgical department, particularly with reference to potential information governance breaches (p<0.001). Conclusion Surgical E-Handover, as compared to a printed patient list, significantly improved clinical efficiency and adherence to COVID-19 social distancing measures. E-Handover should be routinely used in surgical ward rounds.

The average enzyme principle.

The Michaelis-Menten equation for an irreversible enzymatic reaction depends linearly on the enzyme concentration. Even if the enzyme concentration changes in time, this linearity implies that the amount of substrate depleted during a given time interval depends only on the average enzyme concentration. Here, we use a time re-scaling approach to generalize this result to a broad category of multi-reaction systems, whose constituent enzymes have the same dependence on time, e.g. they belong to the same regulon. This "average enzyme principle" provides a natural methodology for jointly studying metabolism and its regulation.

The stubborn roots of metabolic cycles.

Efforts to catalogue the structure of metabolic networks have generated highly detailed, genome-scale atlases of biochemical reactions in the cell. Unfortunately, these atlases fall short of capturing the kinetic details of metabolic reactions, instead offering only topological information from which to make predictions. As a result, studies frequently consider the extent to which the topological structure of a metabolic network determines its dynamic behaviour, irrespective of kinetic details. Here, we study a class of metabolic networks known as non-autocatalytic metabolic cycles, and analytically prove an open conjecture regarding the stability of their steady states. Importantly, our results are invariant to the choice of kinetic parameters, rate laws, equilibrium fluxes and metabolite concentrations. Unexpectedly, our proof exposes an elementary but apparently open problem of locating the roots of a sum of two polynomials S = P + Q, when the roots of the summand polynomials P and Q are known. We derive two new results named the Stubborn Roots Theorems, which provide sufficient conditions under which the roots of S remain qualitatively identical to the roots of P. Our study illustrates how complementary feedback, from classical fields such as dynamical systems to biology and vice versa, can expose fundamental and potentially overlooked questions.

An incidental finding of an intraosseous metallic object within the os calcis.

The authors present a case of an incidental finding of a metallic foreign body located within the calcaneus of a 17-year-old girl. Although the presence of foreign material is a common occurrence in the foot, intraosseous metallic bodies are rare, especially so when they present as an incidental finding. A literature review of PubMed using keywords metallic, foreign body, and calcaneus revealed only a single case report, which did not present as an incidental finding. The presentation described here is rare and provides a platform for discussion about possible management options.