Summary Statement Research Articles

Early rearing of European seabass (Dicentrarchus labrax) with mild current enrichment modifies fish swimming behavior without altering their growth performance.

The implementation of conditions that favor optimum swimming activity (e.g., suitable flow regimes), has been associated with enhanced growth and improved welfare in some farmed fish species. Despite the importance of European seabass in aquaculture, the potential beneficial effects of rearing flow conditions have not been sufficiently explored in this species. This study investigates how the application of fast (F, 0.01-0.20 m s-1) or slow (S, <0.01 m s-1) steady flows in rearing tanks for 75-77 days affected physiological and behavioral traits in seabass fingerlings. Growth performance, external and internal morphology, and several physiological variables, including hematocrit, plasma cortisol concentration, and osmotic and ionic balance were not affected by flow conditions during rearing. Also, behavioral tests implemented in groups or isolated individuals suggest that coping styles were not affected by the two tank-rearing conditions. On the contrary, the swimming behavior assessed in tests was modified by the flow condition experienced during rearing. Mean swimming speed, peak acceleration, swimming distance, angular velocity, and meander showed some variability across different tests and time, although consistently displaying higher values in seabass reared in the F condition, suggesting increased activity and more consistent swimming patterns in that group. However, the cumulative time in proximity between individuals measured in behavioral group tests suggested that group cohesion was variable, without displaying differences between F and S groups. These findings have particularly important implications for fish welfare and may suggest plasticity in the behavioral response to rearing conditions for this species, although not affecting the assignment of the individuals to the different coping styles. SUMMARY STATEMENT: We investigated how mild current enrichment applied during early rearing in seabass modifies physiological and behavioral responses involving swimming activity, exploring the potential associations to fish welfare.

Analysis of tweets from 25 Unofficial ASCO Representatives from ASCO 2024

Aim of the studyThe American Society of Clinical Oncology (ASCO) hosts an annual conference and is one of the largest medical conferences globally. For ASCO 2024, they selected 25 featured voices, advertising them as individuals to follow on Twitter/X throughout the conference. The aim of this study was to characterize tweets from each of the 25 featured individuals. Brief summary of the methodsFrom May 16, 2024 through June 19, 2024 we filtered tweets by using the twitter advanced search tool and applying the following criteria in the tweet text: #ASCO OR #ASCO24 OR #ASCO2024. Tweets were classified as being about research (yes or no) and if media was included (yes or no). Additional information about research related tweets was gathered such as whether the research was observational or interventional. If it was interventional we characterized whether the tweet was supportive, critical, or neutral of the research. ResultsWe find that 229 (28.3%) of 810 tweets commented on research. Of the 229 research related tweets, 136 (59.4%) were related to interventional trials of which they were supportive 65.3% of the time. Media was included in 280 (34.6%) of 810 tweets. ConclusionIt is concerning that more tweets include media than are research related. And when research is referenced, individuals are rarely critical. Trials presented at ASCO have the ability to impact guidelines so it is important that they are appraised critically which can be difficult to complex methodology. This analysis provides data and brings awareness so that improvements can be made in future ASCO conferences. Policy summary statement at the endThe American Society of Clinical Oncology should disclose financial relationships in the future when selecting featured voices to represent the organization and provide insight.

8749 Skeletal effects among pre and postmenopausal women with hypoparathyroidism (HypoPT); data from the Canadian National Hypoparathyroidism Registry (CNHR)

Abstract Disclosure: H. AbuAlrob: None. S. Hussein: None. H. Afifi: None. D.S. Ali: None. A. Almoulia: None. D. Bole: None. M. Braga: None. P. Chandra: None. A. Cheng: None. R. Cheung: None. J.E. Young: None. J. Hetal: None. S. Khan: None. T.S. Khan: None. J. Malhem: None. H. Malik: None. S. Mehmood: None. A. Millar: None. E. Morgante: None. F. Naveed: None. H. Niazi: None. T.L. Paul: None. A. Prebtani: None. Z. Punthakee: None. J.A. Shaban: None. R. Shah: None. M. Shrayyef: None. M. Shaikh: None. C. Tagra: None. S.R. Teschke: None. I.T. Tauqir: None. S. Van Uum: None. W. Robert: None. M. Ovize: Employee; Self; Amolyt. A.A. Khan: Research Investigator; Self; Amolyt, Ascend Therapeutics (A Besins Healthcare company), Takeda. Introduction: the CNHR registry was established in 2014 with the objectives of identifying the etiology, presentation, natural history and current treatment of hypoPT[1]. Methods: 101 patients with hypoPT were included in this prospective study. Patients completed baseline assessments including 3 site bone mineral density (BMD), trabecular bone score (TBS), fracture risk assessments, and bone biomarkers. Baseline data is presented. Results: A total of 101 participants were enrolled, 83 (82%) were female, and 18 (18%) were male. There were 35 (42%) premenopausal females and 48 (58%) postmenopausal females (PMF). Only PMF were on antiresorptive therapy. Seven (7/8) were on bisphosphonate therapy (i.e., alendronate), and 3 females were on denosumab. Among premenopausal females the average corrected calcium (Ca) was 2.03 mmol/L (SD=0.26), calcium phosphate product (Ca PO4) was 2.75 (SD=0.62), and the eGFR 94.63 mL/min (SD=18.08). The average bone turnover markers among premenopausal women for the Telopeptide-C (CTX) was 242.4 ng/L (SD=209.4) (CTX within the reference range (WRR) 136-689 ng/L) while the Propeptide 1 Collagen (P1NP) was 37.6 ug/L (SD=39.2) (P1NP WRR 19-83 ug/L). Among PMF, the average corrected Ca was 2.22 mmol/L (SD=0.18), Ca PO4 was 2.14 (SD=0.17), and the eGFR 73.9 mL/min (SD=23.0). The average bone turnover markers among PMF for CTX was 346.1 ng/L (SD=488.4) (WRR 177-1015 ng/L) while P1NP was 47.1 ug/L (SD=33.1) (WRR 16-98 ug/L). Among premenopausal women (n=35), the mean total hip Z-score was 0.87 (SD=1.29), L1-L4 Z-score 0.98 (SD=1.19), FN Z-score 0.59(SD=1.17), and 1/3R Z-score -0.04 (SD=0.77). Among PMF (n=48) the mean total hip T-score was -0.20 (SD=1.65), L1-L4 T-score -0.24 (SD=1.88), FN T-score -0.43(SD=1.59), and 1/3R T-score -0.94(SD=1.23).TBS scores in premenopausal women were normal (TBS=1.41 (SD=0.10)) however the TBS was partially degraded among PMF (TBS= 1.28(SD=0.15)). Fracture data has previously been reported3. Conclusion: The effects of hypoPT on bone strength needs further study2. Our data suggests that bone quality maybe impaired in PMF with hypoPT as noted by the presence of degraded TBS scores and the presence of fragility fracture in this population. Reference 1.Khan AA et al Canadian national hypoparathyroidism registry: an overview of hypoparathyroidism in Canada. Endocrine 2021. 2.Khan AA et al JBMR 2022 Evaluation and Management of Hypoparathyroidism Summary Statement and Guidelines from the Second International Workshop3.Hussein S et al. Skeletal effects of hypoparathyroidism (HypoPT); data from the Canadian National Hypoparathyroidism Registry (CNHR). Available here: https://amolytpharma.com/wp-content/uploads/2023/10/ASBMR-CNHR_FINAL.pdf Presentation: 6/2/2024

Moves and language expressions of conclusion section of thesis at postgraduate English education study program of Bengkulu University

The conclusion section is a compulsory chapter of a thesis and a dissertation. A good thesis or dissertation conclusion should tell the reader what work has been done and why the issue is being taken. The conclusion section of theses in the field of English language education is a form of a summary statement of the cases investigated. The summary is expressed with certain language expressions, indicating each of the 5-move of the section. The purpose of this research was to describe moves and language expressions of conclusion sections of theses written by the postgraduate English Language Study Program students of Bengkulu University. The study employed the descriptive quantitative method. The subjects of the research were 40 theses of postgraduate students of Bengkulu University which were selected purposively. The data of the conclusion moves were examined based on the five-move model proposed by Bunton (2005), and the language features were analysed based on Morley (2014). The results show that move 3 (Practical application/implications/recommendations embedded elsewhere) and move 4 (recommendations for future research embedded elsewhere) were used by 33 authors (88%) and 35 authors (77.5%) respectively. However, the move formats of the conclusion section were widely varied, nonconforming to Bunton’s model. The language expressions used in the majority of the conclusion sections have adhered to guidelines proposed by Morley (2014), but many authors tended to choose weaker language expressions to emphasize the points. This study concludes that five Move Models of the conclusion section proposed by Bunton (2014) have not been reflected markedly in most of the thesis conclusion sections written by the Postgraduate English Language Study Program students of Bengkulu University, although some moves have been written in suitable language expressions.

Enhancing Radiological Reporting in Head and Neck Cancer: Converting Free-Text CT Scan Reports to Structured Reports Using Large Language Models

Objective The aim of this study was to assess efficacy of large language models (LLMs) for converting free-text computed tomography (CT) scan reports of head and neck cancer (HNCa) patients into a structured format using a predefined template. Materials and Methods A retrospective study was conducted using 150 CT reports of HNCa patients. A comprehensive structured reporting template for HNCa CT scans was developed, and the Generative Pre-trained Transformer 4 (GPT-4) was initially used to convert 50 CT reports into a structured format using this template. The generated structured reports were then evaluated by a radiologist for instances of missing or misinterpreted information and any erroneous additional details added by GPT-4. Following this assessment, the template was refined for improved accuracy. This revised template was then used for conversion of 100 other HNCa CT reports into structured format using GPT-4. These reports were then reevaluated in the same manner. Results Initially, GPT-4 successfully converted all 50 free-text reports into structured reports. However, there were 10 places with missing information: tracheostomy tube (n = 3), noninclusion of involvement of sternocleidomastoid muscle (n = 2), extranodal tumor extension (n = 3), and contiguous involvement of the neck structures by nodal mass rather than the primary (n = 2). Few instances of nonsuspicious lung nodules were misinterpreted as metastases (n = 2). GPT-4 did not indicate any erroneous additional findings. Using the revised reporting template, GPT-4 converted all the 100 CT reports into a structured format with no repeated or additional mistakes. Conclusion LLMs can be used for structuring free-text radiology reports using plain language prompts and a simple yet comprehensive reporting template. Summary Statement Large language models can successfully and accurately convert conventional radiology reports for oncology scans into a structured format using a comprehensive predefined template and thus can enhance the utility and integration of these reports in routine clinical practice. Key Points

Return to the Mental Interpretation of the Nature of Life

Bringing consciousness into the realm of the mind and returning the mind to the essence of life, the core is how to place the self of life. It is necessary to provide answers within the realm of the central intelligence of life and explore its natural realization in order to overcome the difficulty of consciousness. Firstly, in our view, consciousness is merely a common interpretation of the state of the mind, which is essentially integrated into life and contained in life traits. Therefore, the interpretation of the mind should be projected onto the characteristics of life itself and project onto phenomena. Understanding the mind also requires solving some basic problems and establishing interpretation norms: firstly, the basis of argument is to establish three classification concepts for objects in the sense of structure function: non self energy system, self energy system, and quasi self energy system, in order to determine a sphere of existence for life and the central intelligence of life, and to explain the available effects and spiritual phenomena of the mind; Secondly, in order to overcome the problem of the use of names for the detriment of the meaning of the word, issues such as mind and intelligence, mind and brain in mental understanding were distinguished, and the real-life experiences of consciousness were questioned. The problems in the understanding of mind such as mind and intelligence, mind and brain, and traces the reality of what happens to consciousness. Then, a summary statement was made on the occurrence and evolution of life, as well as the spiritual phenomena that arise with the supply and use effect of the mind. From the perspective of availability, based on the biological value of life control, the sense of dependence on motion, the functionality of memory, image and image flow editing, and self reflection and self illumination, the possible abilities of the mind were stated.

How to present and summarize a scientific journal article

The success of a journal club hinges on the presentation of articles that are both relevant and scientifically robust. It’s insufficient for presenters to merely read through an article and highlight a few points without a clear focus. A strong presentation should thoroughly describe the relevance and validity of the study, offer a critique, suggest how further research might address the issue, and discuss the implications for patient care. Selecting the right article is crucial. It is recommended to begin the presentation with a case scenario to emphasize the article’s clinical relevance and to revisit the case at the conclusion of the presentation. The components of the article presentation should include background information, methodology and results, and the authors’ discussion. Additionally, the presenter should critique the article’s validity, noting any potential biases, evaluating the risks and costs of the proposed intervention, and assessing how well the article supports its hypothesis. The presentation should conclude with a summary statement that includes conclusions, implications, and future directions. Having a structured process for journal club presentations guides presenters and ensures that attendees derive maximum benefit from the educational activity. This organized approach fosters a deeper understanding and encourages critical thinking among participants.

Hypoparathyroidism update.

Since the release of the 2022 Second International Workshop Evaluation and Management of Hypoparathyroidism Summary Statement and Guidelines, updates and advances are now available in the cause, complications, and treatment of adult chronic hypoparathyroidism (hypoPTH). This review aims to highlight these new findings and implications to patient care. Postsurgical hypoparathyroidism remains the most common cause, immune-related hypoparathyroidism from checkpoint inhibitors is an emerging autoimmune cause. In a large retrospective cohort study of thyroidectomies, incident fracture was lower, particularly in the vertebra, in the hypoPTH cohort, compared with postthyroidectomy control group. Hypercalciuria increases risk for renal calculi in hypoPTH independent of disease duration and treatment dose. Quality of life is impaired in hypoPTH patients on conventional therapy, improvement was noted post-PTH replacement. TranCon PTH phase 3 RCT reported eucalcemia with reduced renal calcium excretion, normalization of bone turn-over markers, stable BMD and improved quality of life. HypoPTH is a chronic disease associated with significant morbidity and poor Quality of Life. Awareness of treatment targets and follow-up investigations can alleviate patient anxiety regarding over-treatment and under-treatment. Progress in long-acting PTH replacement strategies might provide accessible, feasible alternatives to conventional therapy in brittle hypoPTH patients.

Applying user-centered design to improve drinking water consumer confidence reports: A Baltimore case study

The US Environmental Protection Agency is revising its policy on drinking water quality reports for consumers. These reports are intended to enhance the public’s “right to know” and to spur action to protect and promote safe water. However, these reports are known to be highly technical and difficult to access compromising their communication value. This study engaged a 10-person focus group to gather evidence on how these reports can be improved. We applied user-centered design principles to understand public drinking water consumer information needs and preferences and to develop new communication tools and methods. Through a set of in-depth interviews, we learned that most participants were unaware of the report until introduced to it during the study. The focus group participants voiced preferences for: better ways to convey technical information; more health information; a clearer understanding of costs and billing; and neighborhood or household level water quality information. Following the interviews, we convened two rounds of small group meetings to create new report designs and to review and refine the designs. The focus group developed a one-page summary statement, water contaminant trend charts, an interactive map, and other recommendations on ways to improve dissemination of the report. The project results, focus group recommendations and designs were submitted to the US Environmental Protection Agency for consideration as the policy for these reports is finalized. We believe these findings provide valuable insights into water quality communication challenges and that this approach is widely applicable and can be informative for water utilities as they prepare future reports.

Self-reported anterograde memory loss in older persons that is not validated on neuropsychological assessment: Considerations for a dissociative diagnosis

The past decade has witnessed amplified public awareness of age-related dementias. This has resulted in a dramatic rise in the number of older persons referred to memory clinics with a primary complaint of self-reported memory loss without an antecedent neurological event (e.g., stroke) who produce neuropsychological test profiles that lack evidence of such impairment. Since the latter part of the 19th century, a confusing array of changing terminology, criteria, and perceived causation have been ascribed to patients with unverified medical symptoms to implicate psychological causation. Such terms are often misperceived by laypersons as reflecting character flaws or malingering. Of import for clinical neuropsychologists, the 11th edition of the International Classification of Diseases added cognitive to symptoms eligible for a diagnosis of the modern formulation, dissociative neurological symptom disorder. One dissociative option for referrals with self-reported neurocognitive symptoms not validated on neuropsychological testing is functional memory disorder, conceived as a psychological disorder where emotional distress is plausibly related to the perceived memory loss but is of less severity than would warrant a major depressive or anxiety diagnosis. If evidence of psychological distress or behavioral impairment is not present the referral likely reflects the increased public awareness of age-related dementias interacting with the high base rate of self-perceived memory loss in the general population. In such cases, a dissociative diagnosis should be avoided as there is evidence of neither a medical nor a psychological disorder. A summary statement of not dementia or similar is likely sufficient to help the patient.

Comparison of Ga-68 PSMA PET/CT and Multiparametric MRI for Initial Detection and Staging of Prostate Cancer

Abstract Background Multiparametric magnetic resonance imaging (mpMRI) is widely used for the evaluation of prostate cancer and is known to have better accuracy. Gallium-68 prostate-specific membrane antigen (Ga-68 PSMA) is a radiotracer that shows high localization in prostate cancer cells. Purpose The purpose of this study was to assess the sensitivity and utility of Ga-68 PSMA positron emission tomography/computed tomography (PET/CT) in comparison with mpMRI as a noninvasive imaging technique for the initial diagnosis and locoregional staging of prostate cancer using transrectal ultrasound (TRUS)-guided biopsy as gold standard. Materials and Methods This prospective observational study conducted from August 2017 to April 2020 evaluated 60 men (n = 60) with biopsy-proven prostate carcinoma. They underwent mpMRI and Ga-68 PSMA PET/CT scans within 14 days with TRUS biopsy being gold standard. T staging of disease, N staging of lymph nodes within the pelvis, and M staging of lesions in pelvic bones (within the imaging field of mpMRI) were compared using PSPP version 1.0.1 statistical software. Results All 60 men with a mean age of 69.9 ± 9.35 years showed Ga-68 PSMA avid disease, whereas 55 were detected by mpMRI. The sensitivity in detection of prostate lesions (with 95% confidence interval) was 99.08% for Ga-68 PSMA PET/CT and 84.40% for mpMRI. Ga-68 PSMA PET/CT detected greater number of patients with regional lymph nodal involvement (19/60) as compared with mpMRI (12/60). Ga-68 PSMA PET/CT showed PSMA avid pelvic skeletal lesions in nine patients, whereas mpMRI detected pelvic lesions in six patients. In addition, four other patients showed extrapelvic skeletal lesions on Ga-68 PSMA PET/CT. Conclusion Ga-68 PSMA PET/CT has superior sensitivity in detection of primary prostate tumor, as compared with mpMRI. Both modalities correlate well in detection of seminal vesicle involvement. Ga-68 PSMA PET/CT outperformed mpMRI in detection of lymph nodal and skeletal metastases. Hence, Ga-68 PSMA PET/CT should be considered as first-line diagnostic modality for carcinoma prostate. Summary Statement: Ga-68 PSMA PET/CT shows superior diagnostic performance than mpMRI in the evaluation of prostate cancer.

Academic conference posters: Describing visual impression in pharmacy education

BackgroundAcademic conference posters are a key communication before journal articles. Attention to visual attributes can enhance academic poster communication. ObjectiveThis investigation's purpose was to create a visual impression measurement instrument, and then to describe and compare visual impression among scientific posters from an academic conference. MethodsA mixed-approach rubric was created to quickly measure visual impression of academic posters. Then, posters from a pharmacy education conference were retrospectively reviewed and scored. Visual impression was compared for traditional versus contemporary poster-formats. Various poster characteristics (poster-format, summary statement presence, abstract presence, wordiness, QR-code presence, logical sequencing, visuals) that might have impacted visual communication were coded. These characteristics were regressed onto visual impression scores. ResultsThree-hundred seventy-eight posters were scored with sound inter-rater reliability. Contemporary poster-format scored significantly higher than traditional. Poster-format, abstract absence, lack of wordiness, QR-code presence, logical sequencing, and number of visuals were significant when regressed. ConclusionPosters at one academic conference had varied visual impression. While a contemporary poster-format appeared more helpful, it was not a panacea; variation from poor through exemplary was seen with both poster-formats. Posters are not text-filled articles; displaying a combination of visuals/text clearly and concisely can help effective communication with academic posters.

ОСОБЛИВОСТІ ВИКОРИСТАННЯ ТАРГЕТОВАНОЇ РЕКЛАМИ В ДІЯЛЬНОСТІ ВІТЧИЗНЯНОГО БІЗНЕСУ

The article outlines the general features of using targeted advertising for Ukrainian business. The popularity and relevance of advertising in social networks is substantiated through the prism of the large number of Facebook users, and argumentative factors from prominent practitioners-scientists are provided. The definition of targeted advertising from different people, namely: practitioners, scientists, businessmen was analyzed and a summary statement was presented. According to the Ukrainian Advertising Coalition, it has been determined that the digital advertising market in Ukraine is gradually recovering after the first year of the war and is taking on new forms. A comparative analysis of the advantages of using advertising in social networks has been carried out and the disadvantages that may be present in the work process have been contrasted. The key characteristics of running each level of targeted advertising in Facebook Ads Manager are defined. The work describes the main elements when setting up targeted advertising, namely: audience types, advertising goals, stages of the client's journey through the sales funnel. It has been determined that Ukrainians are quite picky when viewing advertisements, it is difficult to impress them, so the success of targeted advertising requires creative photos, videos and texts that will be unique and will be able to engage customers, regardless of the stage of the sales funnel. A fairly popular way of advertising – promoting posts on Instagram and the advantages of more professional implementation through Meta Business Suite is also analyzed. The importance of a personal and business Facebook page for launching targeted advertising is noted, because Meta algorithms often block suspicious users, so this is an important element in preparation. You also need to be aware of the requirements for what you can advertise and follow to avoid being permanently banned. That is, targeted advertising is a good way to promote business both in the B2C and B2B sphere, as it is close to the user who spends a lot of time on social networks every day, and considering that paid promotion in Tik Tok is prohibited in Ukraine, the target is still the only one way of advertising in social networks.

Perioperative Management for Complex Spine Fusion Surgery.

Complex spine surgeries performed worldwide continue to increase in number, as do the age and comorbidity of patients undergoing these operations. Perioperative care protocols related to blood management, postoperative pain control, and intraoperative measures to mitigate morbidity may improve clinical workflows and patient outcomes.

DanioCTC: Analysis of Circulating Tumor Cells from Metastatic Breast Cancer Patients in Zebrafish Xenografts.

Circulating tumor cells (CTCs) serve as crucial metastatic precursor cells, but their study in animal models has been hindered by their low numbers. To address this challenge, we present DanioCTC, an innovative xenograft workflow that overcomes the scarcity of patient-derived CTCs in animal models. By combining diagnostic leukapheresis (DLA), the Parsortix microfluidic system, flow cytometry, and the CellCelector setup, DanioCTC effectively enriches and isolates CTCs from metastatic breast cancer (MBC) patients for injection into zebrafish embryos. Validation experiments confirmed that MDA-MB-231 cells, transplanted following the standard protocol, localized frequently in the head and blood-forming regions of the zebrafish host. Notably, when MDA-MB-231 cells spiked (i.e., supplemented) into DLA aliquots were processed using DanioCTC, the cell dissemination patterns remained consistent. Successful xenografting of CTCs from a MBC patient revealed their primary localization in the head and trunk regions of zebrafish embryos. DanioCTC represents a major step forward in the endeavors to study the dissemination of individual and rare patient-derived CTCs, thereby enhancing our understanding of metastatic breast cancer biology and facilitating the development of targeted interventions in MBC. Summary statement: DanioCTC is a novel workflow to inject patient-derived CTCs into zebrafish, enabling studies of the capacity of these rare tumor cells to induce metastases.

Leaving no culture undrawn: Time to revisit the CLABSI and CAUTI metrics

Central line-associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs) are quality metrics for many ICUs, and financial ramifications can be applied to hospitals and providers who perform poorly on these measures. Despite some perceived benefits to tracking these metrics, there are a range of issues associated with this practice: lack of a solid evidence base that documenting them has led to decreased infection rates, moral distress associated with identifying these infections, problems with their definitions, and others. We discuss each of these concerns while also including international perspectives then recommend practical steps to attempt to remediate use of the CLABSI and CAUTI metrics. Specifically, we suggest forming a task force consisting of key stakeholders (e.g., providers, Centers for Medicare & Medicaid Services (CMS), patients/families) to review CLABSI and CAUTI-related issues and then to create a summary statement containing recommendations to improve the use of these metrics.

Teaching Clinical Reasoning inthe Preclinical Period.

Developing the clinical reasoning skills necessary to becoming an astute diagnostician is essential for medical students. While some medical schools offer longitudinal opportunities for students to practice clinical reasoning during the preclinical curriculum, there remains a paucity of literature fully describing what that curriculum looks like. As a result, medical educators struggle to know what an effective clinical reasoning curriculum should look like, how it should be delivered, how it should be assessed, or what faculty development is necessary to be successful. We present our Introduction to Clinical Reasoning course that is offered throughout the preclinical curriculum of the Uniformed Services University of the Health Sciences. The course introduces clinical reasoning through interactive lectures and 28 case-based small group activities over 15 months.The curriculum is grounded in script theory with a focus on diagnostic reasoning. Specific emphasis is placed on building the student's semantic competence, constructing problem lists, comparing and contrasting similar diagnoses, constructing a summary statement, and formulating a prioritized differential diagnosis the student can defend. Several complementary methods of assessment are utilized across the curriculum. These include assessments of participation, knowledge, and application. The course leverages clinical faculty, graduate medical education trainees, and senior medical students as small group facilitators. Feedback from students and faculty consistently identifies the course as a highly effective and engaging way to teach clinical reasoning. Our Introduction to Clinical Reasoning course offers students repeated exposure to well-selected cases to promote their development of clinical reasoning. The course is an example of how clinical reasoning can be taught across the preclinical curriculum without extensive faculty training in medical education or clinical reasoning theory. The course can be adapted into different instructional formats to cover a variety of topics to provide the early learner with sequential exposure and practice in diagnostic reasoning.

SP4.7 Improving the documentation of breast surgery operation notes: Closing the loop on a quality improvement project

Abstract Aims The operative note is an important document for ensuring patient safety and effective communication between the MDT. This quality improvement project (QIP) audited the completeness of the breast surgery operative note against the recommendations outlined in the Association of Breast Surgery (ABS) Summary Statement (2015). We developed an operative note proforma to address the deficiencies identified and evaluated the effectiveness of this tool. Methods 31 operative notes were retrospectively reviewed in our baseline audit (cycle 1) against the recommendations. We audited 17 parameters per note. Questionnaires were also circulated amongst 8 of our nursing colleagues to gather their feedback on the current operative note. An electronic proforma was devised from published recommendations and MDT feedback. We performed a prospective re-audit (cycle 2) of 33 notes following our intervention. Results Our baseline audit (cycle 1) identified that 7/17 of the parameters failed to meet the audit standard. 61% (19/31) of the operative notes were electronic. 63% (5/8) of our nursing colleagues agreed the handwritten operative notes were often illegible and all preferred an electronically written document. 1/17 of the parameters failed to meet the audit standard in the re-audit (cycle 2) post-intervention. 97% (32/33) of the notes were electronic and 52% (17/33) was documented using the proforma. Conclusions This QIP has demonstrated that improvements in the operative note documentation can be achieved through simple interventions. The proforma has been uploaded onto the local intranet for universal access. The outcome of this QIP is likely to be sustained by our departmental surgeons as documentation now meets recommended standards.

The significance of omega-3 fatty acids in the treatment of non-alcoholic fatty liver disease

Today, non-alcoholic fatty liver disease is the most common chronic liver disease, yet there is no clearly accepted effective therapy. What is certain is that the number of people suffering from the disease is increasing, making prevention, treatment and recognition of co-morbidities of paramount importance. Current evidence suggests that the development of non-alcoholic fatty liver disease may be due to pathological factors of different origins. The main risk factors include genetic factors, acquired environmental influences and lifestyle. Lifestyle modification, i.e., the elimination or reduction of these harmful factors, can reverse liver damage, depending on the stage of the disease. In this summary statement, we review the pathophysiology of non-alcoholic fatty liver disease, risk factors and therapeutic options, within that in particular lifestyle modification (dietary changes, increasing physical activity, weight loss). Furthermore, we also show the importance of omega-3 fatty acids such as eicosapentaenoic acid and docosahexaenoic acid in detail. With our knowledge, the personalized treatment of non-alcoholic fatty liver disease can be elaborated. Orv Hetil. 2023; 164(33): 1294-1299.

The surgical management of diffuse gliomas: Current state of neurosurgical management and future directions.

After recent updates to the World Health Organization pathological criteria for diagnosing and grading diffuse gliomas, all major North American and European neuro-oncology societies recommend a maximal safe resection as the initial management of a diffuse glioma. For neurosurgeons to achieve this goal, the surgical plan for both low- and high-grade gliomas should be to perform a supramaximal resection when feasible based on preoperative imaging and the patient's performance status, utilizing every intraoperative adjunct to minimize postoperative neurological deficits. While the surgical approach and technique can vary, every effort must be taken to identify and preserve functional cortical and subcortical regions. In this summary statement on the current state of the field, we describe the tools and technologies that facilitate the safe removal of diffuse gliomas and highlight intraoperative and postoperative management strategies to minimize complications for these patients. Moreover, we discuss how surgical resections can go beyond cytoreduction by facilitating biological discoveries and improving the local delivery of adjuvant chemo- and radiotherapies.