Critical View Research Articles

Alternative Clinical Practice Experiences of Korean Nursing Students during the COVID-19 Pandemic.

Background: Routine clinical practice (RCP) experiences provide nursing students with the opportunity to gain confidence in their professional roles. The purpose of this study was to explore the alternative clinical practice (ACP) experiences of nursing students during the COVID-19 pandemic using the Q methodology. Methods: Fifty-two nursing students located in four cities across South Korea participated. The participants sorted the order of and ranked 41 Q statements about their experiences with ACP into a Q sort table; the data were analyzed using the PQ method. Results: The following three distinct viewpoints were extracted: (1) ACP helps with balancing learning and life (favorable view of ACP); (2) ACP does not help with balancing theory and clinical field practice (critical view of ACP); and (3) RCP cannot be replaced by ACP (negative view of ACP). Conclusions: The findings of this study indicate that developing a curriculum for clinical practice that can enhance the strengths of ACP while compensating for its weaknesses will help promote learning among nursing students.

Levels of Schematicity in Metaphorical Animal Nicknames: The Case Study of Koczkodan Nickname in Polish

The aim of this paper is to recognise the contemporary meaning of the nickname koczkodan in Polish [English: hag, frump; literally: a vervet monkey], based on extracts of real discurse taken from the Polish Corpus. This meaning has been obtained by examining the metaphors underlying the nickname, which are motivated by various contextual factors, e.g. the speaker’s gender and discourse registers in which the phrase is pronounced. Accordingly, the working CMT-CMA hybrid model is applied for the purpose of the study, which derives both from the extended view of Conceptual Metaphor Theory (CMT) and from the discursive and critical view of metaphor within Critical Metaphor Analysis (CMA). The results obtained in the study reveal that the meaning of the koczkodan nickname is based on six metaphorical dynamic structures organised hierarchically, from the most schematic image schema that emerges at the very moment when the speaker needs to use the nickname, through more detailed metaphors at the levels of domains and frames, until the level of mental spaces is reached. This level is of great importance for the new meaning of the koczkodan nickname, as the integration of two incompatible input spaces (animal and human characteristics) are blended to form one single space. This results in the generation of a novel meaning of koczkodan in Polish, which makes reference not only to one’s physical ugliness but also to one’s evil character traits.

1186 Cholecystectomy Operation Notes - a Review and Core Trainee Survey

Abstract Aim The “Good Surgical Practice” document by Royal College of Surgeons (RCS) England, in line with GMC’s “Good Medical Practice” emphasises the importance of “clear operative notes for every procedure”. The importance of clear documentation is well-established, facilitates effective handover and represents a legal document. A study was conducted to assess current documentation standards, including a survey amongst core surgical trainees on the use of a proforma for documenting cholecystectomies. Method A retrospective review of cholecystectomy operation notes collected from hospital database was performed between February 2022 and July 2022. Operative documentation was compared to the guideline published by RCS England. Specific information relevant to cholecystectomy operation were reviewed; critical view of safety/Calot’s triangle, number and type of clips, gallbladder dissection difficulty and spillage of bile/stones. Compliance to RCS standards was considered satisfactory at ≥80%. Results 109 typed operation notes were reviewed. Majority of information including date and time (100%), procedure name (99%), name of surgeon and assistant (100%), operative findings (100%) and post-operative care instructions including VTE prophylaxis (92%) were clearly documented. Shortfalls in documentation included priority of operation (63%), intraoperative complications (66%), gallbladder dissection difficulty (53%), anaesthetist name (52%), removal of ports under vision (33%) and local anaesthetic details (70%). Survey of eight core surgical trainees found a consensus that a proforma would improve understanding and documentation of the procedure. Conclusions The use of an operation note proforma in cholecystectomies could improve patient care and compliance with RCS guideline, and act as a learning modality for surgical trainees.

Rethinking of EMI in higher education: a critical view on its scope, definition and quality

ABSTRACT Although it has grown at an exponential rate globally, English medium instruction’s (EMI) conceptually problematic nature steered more confusion than clarity and consensus in the contexts of higher education (HE). In the field literature, the dominant paradigm pertains to descriptive statements rather than definitions and research seemed to reach a saturation point where a new vision is required that of problem solving. By employing a critical stance towards globalisation hence internationalisation and opting for a multilingual perspective, this conceptual paper presents arguments firstly on the concepts that are involved in the definition of EMI and then on EMI teacher training and EMI policy while keeping a focus on learning in EMI HE settings. In so doing, definitions for the concepts of EMI and EMI quality are provided as prospective reference points for HE stakeholders to adhere to during their EMI development practices. Concluding remarks on internationalization as being one of the motivations to implement EMI in HE settings and calls for research on critical EMI and EMI content teacher competencies are also provided.

Achieving Critical View of Safety via a New Technique: The Triple One (111) Technique.

Misidentification of anatomical structures is one of the most common causes of bile duct injury following laparoscopic cholecystectomy. Achieving Critical View of Safety (CVS) is a standard step in conducting safe cholecystectomy all over the world. In our institute, we achieve CVS via a unique technique called Triple One or 111 and find it very helpful and easy to achieve CVS. Moreover, the rate of conversion has also decreased while achieving CVS via this technique. The unique aspect of the Triple One technique is that by following this method, even new laparoscopic surgeons can achieve CVS very easily in difficult cases and, hence, it decreases the chances of vasculobiliary injury (VBI). This study aimed to determine how effective the Triple One technique is in achieving CVS as well as in lessening the chances of VBI. A total of 545 patients were admitted through the outpatient department, ranging in age from 30 to 70 years, with a mean of 50 years. The study comprised patients with American Society of Anaesthesiologists (ASA) I & II, acute and chronic cholecystitis, and symptomatic cholelithiasis. The study excluded patients with co-morbidities, prior abdominal procedures, and suspected complications. On the second postoperative day, all patients received their discharge papers and on the seventh postoperative day, follow-up was completed. Successful gallbladder extraction using the Triple One technique was achieved in 540 (99%) cases. The other five (1%) cases converted to open cholecystectomy because of the difficult gallbladder anatomy and extensive scarring. No VBI or bile duct injury was noted. No mortality was recorded during the study period. By incorporating CVS using the Triple One technique into our policies and curriculum, we may encourage safe cholecystectomy practices and prevent bile duct injuries.

Why go public? Public configurations and the supportive and divergent views towards public district heating in the Netherlands

IntroductionCities are taking up services of social importance under the (re)municipalisation movement. The Dutch government embarked on an ambitious heat transition and proposed in 2022 to make all district heating projects public or semi-public, with a majority public share. This proposal has sparked intense debates among groups in favour of and against a shift to public ownership.MethodsThis study assessed 16 public projects through qualitative research and uncovered the arguments for and against public ownership among key public and private stakeholders.ResultsWhile public ownership is deemed necessary to meet social objectives and address the shortcomings of private models, critical views question the economic performance and inappropriate political choices in some public projects. These critical views propose alternative ways to safeguard public values, such as ensuring affordability and meeting climate goals. Despite disagreements, public and private actors recognise the shared responsibility and the importance of the other's role. They agree that the central government's proposed mandate for public ownership may limit flexibility at the local level and prevent other effective configurations like public-private partnerships with equal public-private shares.DiscussionReflecting on the study findings, it is debatable whether mandating public ownership nationwide, as proposed by the Dutch government, should become the approach to tackle current challenges instead of allowing more flexibility. The upcoming Heat Act may reduce key issues justifying public ownership, such as affordability, cherry-picking and the lack of transparency of private projects. Further research is needed to determine whether public ownership would enhance citizens' support and speed up realisation. Public ownership may still be necessary if social and cost benefits outweigh those from other configurations or long-term concession contracts are too risky. Implementing regulations protecting public values and enabling the coexistence of public, private or public-private configurations tailored to each unique local context could be an alternative, as successful district heating sectors abroad demonstrate.

Experience of patients with restraints in acute care hospitals and the view of their relatives: A qualitative study.

To describe the experiences of patients and relatives with any form of restraints in somatic acute care hospitals. Qualitative explorative design. Qualitative research methods were used. Participants were recruited through clinical nursing specialists in participating departments of a university hospital between June and August 2020. Individual interviews were conducted and analysed using content analysis. Four interviews with patients and five interviews with relatives were conducted with a mean duration of 25 min. The following three topics emerged in the analysis as important: What was perceived as restraints, Assessing the experiences of restraint use on a continuum, and Lack of information about restrictive measures. Patients and relatives defined restraint very broadly and assessed the experiences of restraint on a continuum from positive to negative, with a more critical view from patients. Relatives clearly seemed to approve of the use of restraints in acute care hospitals because it provided them with a sense of security. In general, there seemed to be a lack of information about the use of restraint and its effects on patients and relatives alike. The involvement of patients and relatives in the decision-making process about restraint use seems to be low. Healthcare professionals need to be better educated to be able to pass on adequate information and to involve patients and their relatives adequately in all processes of restraint use. However, when relatives are involved in decision-making as proxies for patients, it is important to consider that patients' and relatives' opinions on restraints may differ. Patients and relatives agreed to participate in the study and shared their experiences with us.

Literary Genders in the Narrative Text: Between Fashion and Chaos a Critical View of Some Creative Models

Literary Genders in the Narrative Text: Between Fashion and Chaos a Critical View of Some Creative Models

SP11.11 Getting It Right First Time (GIRFT): An Audit of General Surgical Documentation in a District General Hospital

Abstract Aim Getting It Right the First Time (GIRFT) has released national guidance regarding operation documentation for common general surgical procedures, namely laparoscopic appendicectomy, laparotomy & laparoscopic bowel resection surgery, laparoscopic cholecystectomy and inguinal hernia repair. This audit sought to assess compliance in a single District General Hospital Surgical Department. Method Retrospective analysis of operation notes was undertaken for consecutive cases. The audit included 25 laparoscopic appendicectomy, 25 laparoscopic cholecystectomy, 10 laparoscopic inguinal hernia, 20 open inguinal hernia and 10 laparotomy/laparoscopy with bowel resection procedures. Cases were included from a range of Consultants (range: 4 for laparoscopic inguinal hernia to 9 for laparoscopic appendicectomy). Operation notes were compared to the GIRFT guidelines. Results Overall compliance was 36% for open inguinal hernia, 44% for laparoscopic cholecystectomy, 45% for laparoscopic inguinal hernia, 54% for laparoscopy/laparotomy with bowel resection and 56% for laparoscopic appendicectomy. Notable areas of poor compliance included documentation of achievement of the critical view of safety in laparoscopic cholecystectomy (28%), if the appendiceal base was healthy in appendicectomy (60%), if the ilioinguinal nerve was protected or divided (35%) or if the vas deferens/testicular vessels were protected (50%) in open inguinal hernia repair and post operative oral intake status after bowel resection (80%). Conclusions Overall there was poor compliance between the operation notes and the GIRFT guidelines. These can potentially jeopardise the position of the surgeon and Trust during medicolegal claims. Use of standardised pre-populated electronic operation notes will be introduced Department-wide and compliance re-audited.

131 Cholecystectomy operation notes - a review and core trainee survey

Abstract Aim The “Good Surgical Practice” document by Royal College of Surgeons (RCS) England, in line with GMC’s “Good Medical Practice” emphasises the importance of “clear operative notes for every procedure”. The importance of clear documentation is well-established, facilitates effective handover and represents a legal document. A study was conducted to assess current documentation standards, including a survey amongst core surgical trainees on the use of a proforma for documenting cholecystectomies. Methods A retrospective review of cholecystectomy operation notes collected from hospital database was performed between February 2022 and July 2022. Operative documentation was compared to the guideline published by RCS England. Specific information relevant to cholecystectomy operation were reviewed; critical view of safety/Calot’s triangle, number and type of clips, gallbladder dissection difficulty and spillage of bile/stones. Compliance to RCS standards was considered satisfactory at ≥80%. Results 109 typed operation notes were reviewed. Majority of information including date and time (100%), procedure name (99%), name of surgeon and assistant (100%), operative findings (100%) and post-operative care instructions including VTE prophylaxis (92%) were clearly documented. Shortfalls in documentation included priority of operation (63%), intraoperative complications (66%), gallbladder dissection difficulty (53%), anaesthetist name (52%), removal of ports under vision (33%) and local anaesthetic details (70%). Survey of eight core surgical trainees found a consensus that a proforma would improve understanding and documentation of the procedure. Conclusion The use of an operation note proforma in cholecystectomies could improve patient care and compliance with RCS guideline, and act as a learning modality for surgical trainees.

325 Modified Abdominal Assess for Laparoscopic Cholecystectomy in Obese Population: Our Recommendation

Abstract Background and Aim Conventional Umbilical access can be time consuming, surgically challenging due to inadequate ‘Critical View of Safety’ and pneumoperitoneum maintenance for high BMI patients undergoing laparoscopic cholecystectomy (LC). Assess the feasibility, safety and outcome of our modified access for patients of BMI ≥30. Method and Technique Prospective study of consecutive patients undergoing LC in a large DGH (2007-2022) that included age, sex, BMI, ASA, grade of operation with stay and complications were analysed. Group A: Veress needle pneumoperitoneum through Palmer’s point. After 2 litre (minimum) insufflations, optical port introduced at intersection of two imaginary lines: a 15cm oblique line starting from where the right mid-clavicular line cuts the right lower costal margin and directed medially meeting the other vertical line running 3cm to the right of midline. Remaining ports standard. Group B (BMI <30): Conventional umbilicus entry. Results Group A: 543 with Female: Male 4:1 (436:107), Age 49* (16-82) years, BMI 36*(30-65), ASA 2 * (1-3), Grade 1 * (1-4), Operating time 50* (15-200) mins, PO stay 0* (0-15) day. One conversion, 2 bile leaks, 5 collections and 4 wound infections. Group B: 1168 with Female: Male 3:1 (861:307), Age 53* (16-89) years, BMI 26 * (17-29), ASA 2* (1-3), Grade 1* (1-4), Operating time 45 *(15-240) mins, PO stay 0* (0-12) day. Ten conversions, 3 bile leaks, 5 collections, 8 wound infections, and 6 wash outs. Conclusion Modified LC abdominal access for obese patients allows safe quick entry with excellent ‘Critical view of Safety’ for a good outcome. * Median

Nudge Concept and its Controversy - The Behavioural Economics Applications

Over the decades, the nudge idea of behavioural economics (BE), disseminated by Thaler & Sunstein (2008) in their well-known book, has generated controversial views among many academics and scientists around the world. As an application area of behavioural economics (BE), nudge theory and the nudge concept has found many supporters, but at the same time has generated controversial views among many academics and scholars around the world, especially with regard to its broad definition, decision-making architectures, and libertarian paternalism concepts. Interestingly, this concept has attracted a lot of attention from key government officials, especially in the UK and the US, to change the behaviour of the population to a significant extent. The aim of this study is to discuss the nudge concept and its application to current situations and also to shed light on the critical views of this concept. It was found that this concept, although it has many critics, is considered a useful tool to change the behaviour of people or customers without using coercive measures to achieve the desired result.

When Critical View of Safety Fails: A Practical Perspective on Difficult Laparoscopic Cholecystectomy.

The incidence of common bile duct injuries following laparoscopic cholecystectomy (LC) remains three times higher than that following open surgery despite numerous attempts to decrease intraoperative incidents by employing better training, superior surgical instruments, imaging techniques, or strategic concepts. This paper is a narrative review which discusses from a contextual point of view the need to standardise the surgical approach in difficult laparoscopic cholecystectomies, the main strategic operative concepts and techniques, complementary visualisation aids for the delineation of anatomical landmarks, and the importance of cognitive maps and algorithms in performing safer LC. Extensive research was carried out in the PubMed, Web of Science, and Elsevier databases using the terms "difficult cholecystectomy", "bile duct injuries", "safe cholecystectomy", and "laparoscopy in acute cholecystitis". The key content and findings of this research suggest there is high intersocietal variation in approaching and performing LC, in the use of visualisation aids, and in the application of safety concepts. Limited papers offer guidelines based on robust data and a timid recognition of the human factors and ergonomic concepts in improving the outcomes associated with difficult cholecystectomies. This paper highlights the most relevant recommendations for dealing with difficult laparoscopic cholecystectomies.

A critical view of the use of predictive energy equations for the identification of hypermetabolism in motor neuron disease: A pilot study

People living with motor neuron disease (MND) frequently struggle to consume an optimal caloric intake. Often compounded by hypermetabolism, this can lead to dysregulated energy homeostasis, prompting the onset of malnutrition and associated weight loss. This is associated with a poorer prognosis and reduced survival. It is therefore important to establish appropriate nutritional goals to ensure adequate energy intake. This is best done by measuring resting energy expenditure (mREE) using indirect calorimetry. However, indirect calorimetry is not widely available in clinical practice, thus dietitians caring for people living with MND frequently use energy equations to predict resting energy expenditure (pREE) and estimate caloric requirements. Energy prediction equations have previously been shown to underestimate resting energy expenditure in over two-thirds of people living with MND. Hypermetabolism has previously been identified using the metabolic index. The metabolic index is a ratio of mREE to pREE, whereby an increase of mREE by≥110% indicates hypermetabolism. We aim to critically reflect on the use of the Harris-Benedict (1919) and Henry (2005) energy prediction equations to inform a metabolic index to indicate hypermetabolism in people living with MND. mREE was derived using VO₂ and VCO₂ measurements from a GEMNutrition indirect calorimeter. pREE was estimated by Harris-Benedict (HB) (1919), Henry (2005) and kcal/kg/day predictive energy equations. The REE variation, described as the percentage difference between mREE and pREE, determined the accuracy of pREE ([pREE-mREE]/mREE) x 100), with accuracy defined as≤± 10%. A metabolic index threshold of ≥110% was used to classify hypermetabolism. All resting energy expenditure data are presented as kcal/24hr. Sixteen people living with MND were included in the analysis. The mean mREE was 1642 kcal/24hr ranging between 1110 and 2015 kcal/24hr. When REE variation was analysed for the entire cohort, the HB, Henry and kcal/kg/day equations all overestimated REE, but remained within the accuracy threshold (mean values were 2.81% for HB, 4.51% for Henry and 8.00% for kcal/kg/day). Conversely, inter-individual REE variation within the cohort revealed HB and Henry equations both inaccurately reflected mREE for 68.7% of participants, with kcal/kg/day inaccurately reflecting 41.7% of participants. Whilst the overall cohort was not classified as hypermetabolic (mean values were 101.04% for HB, 98.62% for Henry and 95.64% for kcal/kg/day), the metabolic index ranges within the cohort were 70.75%-141.58% for HB, 72.82%-127.69% for Henry and 66.09%-131.58% for kcal/kg/day, indicating both over- and under-estimation of REE by these equations. We have shown that pREE correlates with body weight (kg), whereby the lighter the individual, the greater the underprediction of REE. When applied to the metabolic index, this underprediction biases towards the classification of hypermetabolism in lighter individuals. Whilst predicting resting energy expenditure using the HB, Henry or kcal/kg/day equations accurately reflects derived mREE at group level, these equations are not suitable for informing resting energy expenditure and classification of hypermetabolism when applied to individuals in clinical practice.

Cyclic Sulfinamides.

The literature on cyclic sulfinamides (put simply, sultims) published from 1989 to 2022 has been summarized and reviewed. The information is divided into two sections: the analysis of synthetic methods on the preparation of cyclic sulfinamides and the discussion of the chemical properties of cyclic sulfinamides focusing on their reactions and applications. The survey of the reaction conditions, provided in the most detailed way, and a critical view of the reaction mechanisms add an extra dimension to the text. The data presented will be useful to specialists in different areas, especially those who work in the field of synthetic organic and pharmaceutical chemistry.

Differences in the learning curve of robotic transabdominal preperitoneal inguinal hernia repair according to surgeon’s robotic experience

PurposeIn this study, we aim to analyze the learning curve of each step of robotic transabdominal pre-peritoneal inguinal hernia repair (rTAPP) in two surgeons with varying degrees of expertise with the robotic platform but no experience with laparoscopic hernia repair.MethodsData on 124 rTAPP cases performed by two surgeons were retrospectively reviewed. Cumulative sum (CUSUM) analysis was applied to visualize the learning curve of rTAPP on operation time of each step of the procedure [the peritoneal flap creation (T1), the completion of the critical view of the myopectineal orifice (T2), the mesh application (T3) and the peritoneal flap closure (T4)]. Each intraoperative and postoperative outcome was compared according to surgeon’s experience with the robotic platform and learning phase. The robotic surgeon mentored the surgeon-in-training and was present during all surgeries in his learning period.ResultsThe surgeon in training with the robotic platform showed a learning phase till the 20th procedure followed by a gradual improvement in performances. The expert surgeon showed a learning phase till the 35th procedure after which a constant decrease of operative time was recorded till the last procedure included. The operative times of each step of the procedures of both surgeons were significantly improved after the learning phase. In the late phase, the surgeon in training could achieve operative times in T2 and T3, which are similar to those of an experienced robotic surgeon with no experience with TAPP before the completion of the learning phase.ConclusionsIn conclusion, the learning phase of rTAPP surgery may vary between 20 and 35 cases, depending on the surgeon’s experience in robotic surgery.

Targeted NO Oxidation and Synchronous NO2 Inhibition via Oriented 1O2 Formation Based on Lewis Acid Site Adjustment.

An appealing strategy for ensuring environmental benefits of the photocatalytic NO oxidation reaction is to convert NO into NO3- instead of NO2, yet the selectivity of products remains challenging. Here, such a scenario could be realized by tailoring the exposure of Lewis acid sites on the surface of ZrO2, aiming to precisely regulate the ROS evolution process for the selective oxidation of NO into NO3-. As evidenced by highly combined experimental characterizations and density functional theory (DFT) simulations, Lewis acid sites serving as electron acceptors could induce itinerant electron redistribution, charge-carrier transfer, and further oxidation of •O2-, which promotes the oriented formation of 1O2. As a result, monoclinic ZrO2 with more Lewis acid sites exhibited an outstanding NO conversion efficiency (56.33%) and extremely low NO2 selectivity (5.04%). The ROS-based reaction process and promotion mechanism of photocatalytic performance have been revealed on the basis of ESR analysis, ROS-quenching experiments, and in situ ROS-quenching DRIFTS. This work could provide a critical view toward oriented ROS formation and advance a unique mechanism of selective NO oxidation into NO3-.

Precedents to Think About Social Work in Chile in the Current Uncertain Political Scenario: Reflections From Critical Feminisms

In this In Brief, the authors present an argument about the challenges for feminist social work in Chile, given the political transformation process occurring since 2019 in the country. Through an approach that addresses the history of social work in dialogue with important political events for Chile and their consequences for the feminist and social movements, the authors argue that—despite the progress achieved—the main challenge for feminist social work today continues to be a male privilege. This is exemplified by a critical view of two main social work development fields: social services and academia. Finally, referring to critical and feminist perspectives, the authors reflect on possibilities for change in social work practice and education, given the political uncertainty that Chile is facing, particularly after the failure of the first constitutional election.

Development of an artificial intelligence system for real-time intraoperative assessment of the Critical View of Safety in laparoscopic cholecystectomy.

The Critical View of Safety (CVS) was proposed in 1995 to prevent bile duct injury during laparoscopic cholecystectomy (LC). The achievement of CVS was evaluated subjectively. This study aimed to develop an artificial intelligence (AI) system to evaluate CVS scores in LC. AI software was developed to evaluate the achievement of CVS using an algorithm for image classification based on a deep convolutional neural network. Short clips of hepatocystic triangle dissection were converted from 72 LC videos, and 23,793 images were labeled for training data. The learning models were examined using metrics commonly used in machine learning. The mean values of precision, recall, F-measure, specificity, and overall accuracy for all the criteria of the best model were 0.971, 0.737, 0.832, 0.966, and 0.834, respectively. It took approximately 6fps to obtain scores for a single image. Using the AI system, we successfully evaluated the achievement of the CVS criteria using still images and videos of hepatocystic triangle dissection in LC. This encourages surgeons to be aware of CVS and is expected to improve surgical safety.

Assessing cancer communication and identifying prospective health interventions among the ethnic Mizo population

BackgroundCancer prevalence reports reveal Aizawl district in Mizoram to be inflicted with the highest age-adjusted cancer incidence rate in India. The present study aims to provide a critical view of health communication in Mizoram and evaluate cancer communication. MethodA field survey (n = 400) with structured interview schedules in Aizawl district was conducted. ResultsThe data reveals high awareness of cancer and the mass media as the top sources for cancer information. The result also highlights the preference of entertainment news as compared to health news. ConclusionIt identifies the need for developing efficient, tailored cancer communication strategies that are customized for a specific population and for dissemination of cancer science beyond health institutions. Improving health news coverage on cancer risk factors, church-based health interventions, and novel strategies to strengthen societal knowledge, at both individual and in groups, could be an effective shift in cancer communication and interventions in Mizoram.