SP10.2.10Efficacy of Outpatient Appointment Reminders in Colorectal Surgery: A Prospective Analysis

Introduction There is increasing mandate to improve attendance in outpatient clinics to support delivery of High-Quality Care. Non-attendance in Colorectal Cancer (CRC) has clinical and financial implications. Patient appointment reminders (letters, text-messages and telephone) have been implemented to reduce non-attendance. We examine the efficacy of patient appointment reminders in CRC patients. Methods A prospective study was conducted for 3-months in our CRC department surveying patients on their appointment reminders. Non-attending patients were surveyed via telephone to ascertain cause of non-attendance and preference of patient reminders. Data collected was analysed on SPSS. Results 547 patients were prospectively surveyed. 19% did not receive appointments letters, from which 73% were made aware via Text message and 25% via Phone calls. 50% received letters > 2 weeks’ notice. 183 patients did not attend (DNA) their appointment from which 100 were successfully surveyed through telephone. 60% of patients did not received an appointment reminder (letter), or received it following the date of their appointment. 79% patients preferred to be contacted via text messaging or an appointment app vs 13% via letters. Cost analysis releveled significant losses due to missed appointments. Conclusion Patient appointment reminders are fundamental in reducing non-attendance in clinics. Our study demonstrates that appointment letters are an unreliable method of patient communication. In an ever-increasing digital age, methods such as timely text-messages or an appointment app for CRC patients’ needs urgent implementation as per patient preferences. Further research is required to assess non-attendance and causality in other specialities for comparison.

X-ray of the pituitary gland in the treatment of fibroids

Hirsch (Zntrlb. F. G., 1924, No. 8) considers x-ray of the pituitary gland in the treatment of myomas to be an unreliable method and resorts to it only in cases where it is impossible to accurately determine the position of the ovaries, for example, with obesity, large fibroids, etc.

Evaluation of Vitek®2 performance for colistin susceptibility testing for Gram-negative isolates

Background The emerging resistance to the last-resort antimicrobial colistin is being reported globally. Underestimation of the burden of colistin resistance and misinterpretation of colistin susceptibility test results, using suboptimal testing methods, may be causing unexplained treatment failures and even mortality among critically ill patients. Thus, this study was conducted at an apex trauma centre to assess the performance of Vitek®2 for colistin susceptibility testing. Methods A total of 910 clinical isolates of Gram-negative bacteria (GNB), including Enterobacterales, Acinetobacter baumannii and Pseudomonas aeruginosa, were tested and analysed for colistin resistance using Vitek®2. Broth microdilution (BMD) was taken as the reference method. The essential (EA) and categorical (CA) agreements and very major error (VME) and major error (ME) rates were calculated. An MIC correlation was taken to be positive with EA ≥ 90%, CA ≥ 90%, VME ≤ 1.5% and ME ≤ 3.0% rates. Spearman’s coefficient was calculated and P < 0.05 was considered statistically significant. Results A total of 64% of isolates were MDR. Overall, 196 (21.5%) and 110 (12%) of isolates were resistant to colistin by BMD and Vitek®2, respectively. The automated Vitek®2 method failed to detect the resistance in up to 48.5% of GNB tested. When comparing Vitek®2 colistin interpretive results with reference BMD for all 910 isolates, the CA was 88% (798/910) with 10% (95/910) VMEs and 1% (9/910) MEs. Conclusions The Vitek®2 method for colistin susceptibility testing, still in use in some settings; is a suboptimal and unreliable method.

Optimization of cryopreservation and in vitro fertilization techniques for the African turquoise killifish Nothobranchius furzeri

Over the last decade, the African turquoise killifish, Nothobranchius furzeri, has emerged as an important model system for the study of vertebrate biology and ageing. However, rearing this fish in captivity can pose challenges, due to the short window of fertility, inbreeding problems, and the continuous maintenance of different strains and transgenic lines. To date, the main means of long term strain maintenance is to arrest embryos in diapause, a poorly understood and unreliable method. To solve these problems, we developed a robust protocol to cryopreserve sperm and to revive them for in vitro fertilization (IVF), as a better option for long term storage of N. furzeri lines. We tested a variety of extender and activator buffers for sperm in vitro fertilization, as well as cryoprotectants to achieve maximal long term storage and fertilization conditions tailored to this species. Our optimized protocol was able to preserve sperm in a cryogenic condition for months and to revive an average of 40% upon thawing. Thawed sperm were able to fertilize nearly the same number of eggs as natural fertilization, with an average of ~25% and peaks of ~55% fertilization. This technical advance will greatly facilitate the use of N. furzeri as a model organism.

Automatic Tuning of High Piano Tones

Piano tuning is known to be difficult because the stiffness of piano strings causes the tones produced to be inharmonic. Aural tuning is time consuming and requires the help of a professional. This motivates the question of whether this process can be automated. Attempts at automatic tuning are usually assessed by comparing the Railsback curve of the results with the curve of a professional tuner. In this paper we determine a simple and reliable rule for tuning the high tones of a piano with the help of a listening test. This rule consists of matching the two tones in an octave interval so that the first partial frequency of the upper tone becomes exactly the same as the second partial frequency of the lower tone. This rule was rated best among four tuning rules that were compared in the test. The results found are explained using a beat-based analysis, and are consistent with some previous studies. They are also tested against the existing method of using Railsback curves, and it is shown that comparison using Railsback curves is an unreliable method of assessing different tunings. The findings from this paper can be used to create a complete automatic tuner that could make the process of piano tuning quick and inexpensive.

Changes in polyhydroxyalkanoate granule accumulation make optical density measurement an unreliable method for estimating bacterial growth in Burkholderia thailandensis

Optical density (OD) measurement is the standard method used in microbiology for estimating bacterial concentrations in cultures. However, most studies do not compare these measurements with viable cell counts and assume that they reflect the real cell concentration. Burkholderia thailandensis was recently identified as a polyhydroxyalkanoate (PHA) producer. PHA biosynthesis seems to be coded by an orthologue of the Cupriavidus necator phaC gene. When growing cultures of wild-type strain E264 and an isogenic phaC mutant, we noted a difference in their OD600 values, although viable cell counts indicated similar growth. Investigating the cellular morphologies of both strains, we found that under our conditions the wild-type strain was full of PHA granules, deforming the cells, while the mutant contained no granules. These factors apparently affected the light scattering, making the OD600 values no longer representative of cell density. We show a direct correlation between OD600 values and the accumulation of PHA. We conclude that OD measurement is unreliable for growth evaluation of B. thailandensis because of PHA production. This study also suggests that B. thailandensis could represent an excellent candidate for PHA bioproduction. Correlation between OD measurements and viable cell counts should be verified in any study performed with B. thailandensis.

Polyhydroxyalkanoate granule accumulation makes optical density measurement an unreliable method for bacterial growth assessment inBurkholderia thailandensis

Optical density (OD) measurement is the standard method used in microbiology for estimating bacterial concentrations in cultures. However, most studies do not compare these measurements with viable cell counts and assume that they reflect the real cell concentration.Burkholderia thailandensiswas recently identified as a polyhydroxyalkanoate (PHA) producer. PHA biosynthesis seems to be coded by an ortholog of theCupriavidus necator phaCgene. When growing cultures of wildtype strain E264 and an isogenicphaC- mutant, we noted a difference in their OD600values, although viable cell counts indicated similar growth. Investigating the cellular morphologies of both strains, we found that under our conditions the wildtype strain was full of PHA granules, deforming the cells, while the mutant contained no granules. These factors apparently affected the light scattering, making the OD600values no longer representative of cell density. We show a direct correlation between OD600values and the accumulation of PHA. We conclude that OD measurement is unreliable for growth evaluation ofB. thailandensisbecause of PHA production. This study also suggests thatB. thailandensiscould represent an excellent candidate for PHA bioproduction. Correlation between OD measurements and viable cell counts should be verified on any study realized inB. thailandensis.

Computed tomography scan can be misleading in the lateralisation of aldosterone excess

Summary Primary aldosteronism (PA) is characterised by aldosterone hypersecretion and represents a common cause of secondary hypertension. During diagnostic evaluation, it is essential to determine the aetiology of PA since the treatment of unilateral and bilateral disease differs significantly. Adrenal vein sampling (AVS) has been implemented as a gold standard test for the diagnosis of PA subtype. However, due to the AVS complexity, costs and limited availability, many patients with PA are being treated based on the computed tomography (CT) findings. In this article, we present two patients with discrepant CT and AVS results, demonstrating that AVS is the only reliable method for localising the source of aldosterone excess. Learning points: CT is an unreliable method for distinguishing aldosterone-producing adenoma (APA) from bilateral adrenal hyperplasia (BAH). CT can be misleading in defining lateralisation of the aldosterone excess in case of unilateral disease (APA). AVS is the gold standard test for defining the PA subtype.

Gallbladder Polyps: Real or Imagined?

The finding of gallbladder polyps on imaging studies prompts further workup. Imaging results are often discordant with final pathology. The goal of this study is to compare polypoid lesions of the gallbladder found on preoperative ultrasound (US) with final pathologic diagnosis after cholecystectomy to help guide clinical decision-making. A retrospective study was conducted identifying adult patients who were diagnosed with polyps via US and who underwent cholecystectomy from 2008 through 2015. Imaging data, final pathology, and demographics were manually reviewed. A total of 2290 cholecystectomy patients had US-based polyps. Of these, 1661 patients (73%) did not have polyps on final pathology; primarily, stones or sludge were identified. Adenomyosis was diagnosed in 61 patients (2.7%). A total of 556 patients (24.2%) had pathologic polypoid lesions with the following breakdown: 463 (20.2%) cholesterol polyps, 43 other benign polyps (1.8%), 40 adenomas (1.7%), and 10 adenocarcinomas (0.4%). All patients with adenocarcinoma were older than 40 years and 91 per cent had US findings of polyps >10 mm. Ultrasound alone is an unreliable method of detecting real gallbladder polyps. This large database study found a very low risk of cancer. Size on US and patient age should be considered in the selection of appropriate surgical candidates with sonographic “polyps.”