Mesenteric vascular disease: A population-based cohort study.

OBJECTIVES: Mesenteric vascular disease carries a high risk of mortality and morbidity; however, due to obscure clinical presentation, it can be under-recognized. Currently, epidemiology of mesenteric vascular disease remains poorly defined. The aim of this study is to analyze changes in Scottish mortality rates from mesenteric vascular disease overtime. METHODS: This is a retrospective, longitudinal population-based cohort study using data extracted from death certificates and Scottish Index of Multiple Deprivation. All deaths related to a vascular disorder of the intestines recorded as an underlying cause of death between 1979 and 2014 were identified using International Classification of Disease-9 or International Classification of Disease-10 code groups. Data included demographics and location of death. The residence postcodes were used to classify socio-economic status using the Scottish Index of Multiple Deprivation. RESULTS: From 2,142,921 deaths over 36 years, 14,530 (0.7%) were due to mesenteric vascular disease with a median (interquartile range) age of 77 and a 2:1 female to male gender ratio. The mean ± standard deviation age significantly increased from 72.6 ± 12.1 in 1979 to 76.8 ± 11.1 in 2014 (p < 0.001, R2 = 0.772). Males were consistently younger than females at the time of death. The two lowest Scottish Index of Multiple Deprivation categories accounted for half of the cohort, throughout the study period (p = 0.068). The adjusted death rate per 100,000 population increased from 7.6 in 1979 to 12.1 in 2014. CONCLUSIONS: The reported death rates of mesenteric vascular disease in Scotland between 1979 and 2014 have nearly doubled. Mesenteric vascular disease affects twice as many women as men and is associated with social deprivation. The increased reporting of mesenteric vascular disease is likely due to increased recognition and incidence. These implications should be considered when planning healthcare provision in Scotland.

Heuristics and bias in rectal surgery.

PURPOSE: Deciding to defunction after anterior resection can be difficult, requiring cognitive tools or heuristics. From our previous work, increasing age and risk-taking propensity were identified as heuristic biases for surgeons in Australia and New Zealand (CSSANZ), and inversely proportional to the likelihood of creating defunctioning stomas. We aimed to assess these factors for colorectal surgeons in the British Isles, and identify other potential biases. METHODS: The Association of Coloproctology of Great Britain and Ireland (ACPGBI) was invited to complete an online survey. Questions included demographics, risk-taking propensity, sensitivity to professional criticism, self-perception of anastomotic leak rate and propensity for creating defunctioning stomas. Chi-squared testing was used to assess differences between ACPGBI and CSSANZ respondents. Multiple regression analysis identified independent surgeon predictors of stoma formation. RESULTS: One hundred fifty (19.2%) eligible members of the ACPGBI replied. Demographics between ACPGBI and CSSANZ groups were well-matched. Significantly more ACPGBI surgeons admitted to anastomotic leak in the last year (p < 0.001). ACPGBI surgeon age over 50 (p = 0.02), higher risk-taking propensity across several domains (p = 0.044), self-belief in a lower-than-average anastomotic leak rate (p = 0.02) and belief that the average risk of leak after anterior resection is 8% or lower (p = 0.007) were all independent predictors of less frequent stoma formation. Sensitivity to criticism from colleagues was not a predictor of stoma formation. CONCLUSIONS: Unrecognised surgeon factors including age, everyday risk-taking, self-belief in surgical ability and lower probability bias of anastomotic leak appear to exert an effect on decision-making in rectal surgery.

Spiritual/cultural competency: methods in diversity education.

Diversity education in clinical training such as CPE is best developed in an interactive group context, guided by methods and approaches promoting mutual disclosure that includes the leader. Each member is invited to portray a web of meaning with cultural, spiritual and religious threads that comprise a personally knitted reality, a narrative foundational to identity and interaction. Differences between people in the training context challenge previously held notions, distribute authority in the group and foster open ended learning that enriches the activities of clinical supervision. This article describes group educational methods with case examples that foster spiritual/cultural competency, each member a person in context with the opportunity to be distinct and connected, a threshold for all other dimensions of diversity learning in pastoral practice.

Non-Invasive Radial Artery Blood Pressure Monitoring Using Error Compensated Tactile Sensors and Patient Specific Oscillometry.

This paper presents a new method of measuring non-invasive blood pressure at the radial artery based on oscillometry and tonometry. A localized capacitive tactile sensor array is used with a novel algorithm based on waveform features for optimizing oscillometry ratios. A novel tonometer is presented with typically 1% base measurement error, with sensor errors compensated using a custom error model, and applied to blood pressure measurement at the radial artery. The tonometer gives a direct arterial waveform, and uses a manual pressure sweep to determine blood pressure. Key points on the oscillogram are correlated with optimal ratios for minimizing mean errors and standard deviation for an individual. This paper details an initial assessment into the dominant sources of error, for the purpose of determining feasibility and directing future research. Over a limited clinical trial of Np = 20, No = 180, the reported BP accuracy is MAE = 0.61/0.38mmHg and 1SD = 7.14/5.91mmHg for systolic and diastolic measurements respectively. The average load on the patient is in the order of 5N, compared with around 1000N for a brachial cuff, which represents a clear improvement in patient comfort. This is a positive result, indicating larger scale performance within AAMI and BHS standards, and stands as a useful benchmark for further development of the system into a clinical product for rapid and comfortable BP measurement. Clinical Relevance This paper demonstrated that direct tonometry can measure blood pressure if sensor error is compensated by the designer. This method uses 200x less load than conventional cuffs suitable for long term and supine use.

Outcomes following abdominal trauma in Scotland.

PURPOSE: Traumatic abdominal injury is associated with significant mortality, especially in hemodynamically unstable patients. Trauma management now supports more conservative surgical management with judicious non-operative management. The aim of this study is to use STAG data to characterize abdominal trauma outcomes, focusing on factors that may influence mortality. METHODS: A retrospective analysis of prospectively collected STAG data was queried using AIS codes for Scottish abdominal trauma patients between 2011 and 2015. Patients were divided into non-survivor and survivor groups, reflecting mortality. Following this, outcomes and injury patterns of patients undergoing operative or non-operative management were compared between groups. RESULTS: A total of 1226 were analyzed. The mean age of the cohort was 42.47 ± 19.42 years, with most patients suffering blunt injuries. Non-survivors had more severe injuries to the liver, diaphragm, pancreas, vasculature, and pelvis (p < 0.001, p = 0.005, p = 0.025, p < 0.001, and p < 0.001, respectively). Survivors more often received CT scanning (0.09 [0.03-0.27]) and underwent surgical intervention (57.4% vs 39.7%; p = 0.001). Non-survivors more often had a shorter time till operative intervention (2.6 h vs 6.3 h, p < 0.001). CONCLUSIONS: About 7% of patients in the STAG registry display abdominal injury. Mortality was found to have strong associations with older age, hemodynamic instability, poor neurological status, and head and neck injury. Outcomes may improve with the anticipated creation of the Scottish Trauma System.

Chemistry beyond the academy: diversity in Scotland in the early nineteenth century.

Outside formal university chemistry classes in Scotland, which existed mainly to fulfil the requirements of medical courses, chemistry teaching was available from extramural lecturers. This form of teaching was often aimed at medical students, who could fulfil their graduation requirements if the lecturer had approved status. However, most of those attending would not have been seeking any formal qualification: there was a wave of enthusiasm among people from many walks of life about gaining chemical knowledge. Audiences included fashionable gentlefolk, manufacturers and industrialists, apprentice surgeons, mechanics, and artisans. Much of the teaching was at a highly proficient level, chemists of the stature of Thomas Thomson, Andrew Ure, Andrew Fyfe, Edward Turner, William Gregory, Thomas Graham, David Boswell Reid and George Wilson all offering classes. For several such teachers, it was the first step in a career that would later lead to significant academic or governmental appointments. In an Appendix, the article lists forty-eight chemists who have been identified as having taught extramurally between the later eighteenth and mid-nineteenth centuries.

Teaching the Chemistry of Platinum.

Following colonisation of South America by the Spanish, many new naturally occurring substances were sent to Europe. One of these was the silvery, unreactive metal, platinum, discovered in New Grenada in the mid-eighteenth century. It was often found in granular form, associated with gold, and the challenge to chemists was to refine it, produce it as wire or sheet, and determine its chemical properties. This interested the professor of chemistry at the University of Edinburgh, Joseph Black, who was able to obtain samples from London-based Spanish contacts, particularly Ignacio Luzuriaga. This paper examines how Black transmitted his knowledge of the metal to large numbers of students attending his annual course.

The search for spiritual/cultural competency in chaplaincy practice: five steps that mark the path.

Chaplains who are clinically trained and certified spiritual care professionals can make a unique contribution in today's increasingly pluralistic and global health care context with diverse religious, spiritual and cultural values, beliefs and practices. The author characterizes this contribution as spiritual/cultural competency. A self-defined web of meaning is unique to each person, comprised of a composite of values and beliefs, a fabric woven by way of one's life narrative. The proven approach of clinical learning, with heightened introspective and interpersonal awareness, serves as the chaplain's primary pathway to multi-spiritual/cultural competency, integrated with the exploration of context in a way not prioritized before. Utilizing sources from pastoral theology, anthropology and multicultural counseling, a five-step process of competency assessment is introduced and discussed with the aid of two cases. Knowing one's own spiritual/cultural grounding is the first step in this open-ended search.