The Hummingbird Project year 2: decreasing distress and fostering flourishing in a pragmatic pre-post study.

Multi-component Positive Psychology Interventions (mPPIs) in secondary schools have been shown to improve mental health outcomes for young people. The Hummingbird Project mPPI is a six-week program of workshops designed to introduce a variety of positive psychology (PP) concepts to secondary school-aged children in schools to improve well-being, resilience, and hope. The effects on mental distress, however, were not explored.

The Hummingbird Project: A Positive Psychology Intervention for Secondary School Students.

Mental health in schools has attracted a lot of attention in recent years. Positive Psychology Interventions (PPIs) in secondary schools have been shown to improve mental health outcomes for students. Previous PPIs have tended to be delivered by trained Psychology specialists or have tended to focus on a single aspect of Positive Psychology such as Mindfulness.

Targeted killing of colorectal cancer cell lines by a humanised IgG1 monoclonal antibody that binds to membrane-bound carcinoembryonic antigen.

The distribution of carcinoembryonic antigen (CEA) in colorectal cancer (CRC) differs from that in normal colorectal tissue, being found on all borders of the cell membrane and hence enabling access to intravenous antibody, making CEA a good target for antibody-based therapy. The distinctive anti-CEA antibody, PR1A3, binds only membrane-bound CEA. Humanised PR1A3 (hPR1A3) was assessed both in vitro cytotoxicity and binding assays with colorectal cancer cell lines expressing varying levels of CEA.

Colonoscopy for screening and follow up of patients with a family history of colorectal cancer.

Objective: To determine the minimum family history of colorectal cancer (CRC), which justifies colonoscopy and to establish whether further colonic assessment is necessary after a negative screening colonoscopy.

Method: A retrospective review of every colonoscopy undertaken for family screening at the Royal Berkshire and Battle Hospitals, Reading between October 1996 and July 2004.

Results: Four hundred and thirty-two patients (261 women) with an average age of 48 years (range 14-84) were screened.

Management of early rectal cancer.

Background: Early rectal cancer (ERC) is adenocarcinoma that has invaded into, but not extended beyond, the submucosa of the rectum (that is a T1 tumour). Local excision is curative for low-risk ERCs but for high-risk cancers such management is controversial.

Methods: This review is based on published literature obtained by searching the PubMed and Cochrane databases, and the bibliographies of extracted articles.

Is a minor clinical anastomotic leak clinically significant after resection of colorectal cancer?

Background: There are few reports comparing the variety and frequency of postoperative complications between patients with a major clinical leak requiring emergency abdominal reoperation and those with a minor leak diagnosed from clinical signs and managed expectantly without reoperation. This study examined the association between severity of leakage and 18 other postoperative complications, postoperative mortality, and length of postoperative hospital stay.

Study Design: Data were drawn from a comprehensive, prospective hospital registry of 1,507 colorectal cancer resections involving an anastomosis from January 1995 to December 2006.

Combined surgery and chemoradiation as a treatment for the Buschke-Löwenstein tumour.

Background: The Buschke-Löwenstein tumour (BLT) or giant condyloma acuminata is a rare disease which affects the anogenital region. Although histologically benign, it behaves in a malignant fashion, infiltrating the surrounding tissues. The morbidity and mortality from this tumour is high, as is the risk of recurrence following treatment.

Subspecialisation and its effect on the management of rectal cancer.

Introduction: To assess the impact of subspecialisation on surgical and oncological outcomes after rectal cancer surgery in a single surgical unit within a district general hospital.

Patients And Methods: A total of 207 patients with rectal cancer treated surgically by two colorectal surgeons and four experienced general surgeons at the Royal Berkshire Hospital, Reading, England between January 1995 and December 1999 were studied. A retrospective case-note review of each patient's personal details, operative and histological findings, their subsequent clinical progress and oncological outcomes, including 5-year survival were recorded.

A prospective audit of 300 consecutive young women with an acute presentation of right iliac fossa pain.

Introduction: A prospective study of 300 women of child-bearing age presenting with right iliac fossa pain was carried out to determine what proportion had appendicitis and whether active observation resulted in a delay in diagnosis to the detriment of the patient.

Patients And Methods: Data were prospectively collected for 300 consecutive women of childbearing age referred with right iliac fossa pain to general surgeons at a district general hospital.

Results: After clinical assessment, 71 were discharged home immediately.

Intra-operative peritoneal lavage--who does it and why?

Introduction: Intra-operative peritoneal lavage (IOPL) is widely practised but its benefits are unclear. The frequency and pattern of its use amongst general surgeons is investigated.

Methods: A postal questionnaire was sent to 153 general surgical consultants and registrars enquiring about their use of IOPL.

Diagnostic conscious pain mapping using laparoscopy under local anaesthetic and sedation in general surgical patients.

Background: Patients in whom extensive investigations have failed to identify the cause of abdominal pain present a challenge to surgeons. We present our initial experience of using laparoscopy under local anaesthetic and sedation in the diagnosis of chronic abdominal pain.

Methods And Patients: Nine patients with chronic abdominal pain and multiple normal investigations underwent laparoscopy under local anaesthetic and sedation.

Mineralocorticoid and glucocorticoid receptors and their differential effects on memory performance in people with Addison's disease.

The effects of corticosteroids on memory performance have been the subject of some controversy. Whilst many studies have shown that high levels of corticosteroids can impair memory performance, others have shown they can facilitate it. One explanation for these discrepant effects arises from the differential activation of the two types of corticosteroid receptor--the mineralocorticoid receptor (MRs) and the glucocorticoid receptor (GRs), and the function each subserves during memory formation.

Options for sphincter preservation in surgery for low rectal cancer.

Background: Abdominoperineal excision of the rectum with a permanent end-sigmoid colostomy was the classical operation for cancer of the distal third of the rectum. A number of factors have recently led to a more conservative approach, allowing sphincter preservation when excising tumours that are not invading the anal sphincter.

Methods: The review is based on the published literature of the treatment of low rectal cancers accessed by searching Medline and other online databases.

Surgical specialist registrars can safely perform resections for carcinoma of the rectum.

Aim: To assess morbidity, mortality and cancer-related outcomes after supervised rectal resection for cancer by surgical specialist registrars (SpRs).

Patients: A total of 205 consecutive patients (115 male; median age 64 years [range, 24-90 years]) under the care of six consultant surgeons, who underwent elective rectal resection of their rectal cancer between 1995-1999 were studied. The modified Dukes' stages were A in 28 patients (13%), B in 47 (21%), C in 103 (51%), and D in 30 (15%).

The assessment of surgical skills and a simple knot-tying exercise.

Basic surgical skills courses are mandatory for all surgical trainees taking the MRCS examination. An important aspect of these courses is the level of practical skill achieved by junior surgeons attending them. We present a simple knot-tying exercise, which may be used to assess the baseline skill level of trainees at the outset of the course and against which their progress can be judged after tuition and practice.

Acute stress, memory, attention and cortisol.

An investigation was conducted to explore the relationship between acute changes in cortisol and memory and attention in the context of an acute naturalistic stressor, namely, examination stress. Sixty students (36 male, 24 female) participated in an assessment of self-reported levels of stress, salivary cortisol, short term memory, selective and divided attention and auditory verbal working memory. Assessments were conducted during a non-exam and exam period.

Estimation of mortality and morbidity risk in vascular surgery using POSSUM and the Portsmouth predictor equation.

Background: The Physiological and Operative Severity Score for enUmeration of Mortality and morbidity (POSSUM) is a simple scoring system previously validated in general surgical patients which enables estimation of the risk of complications and death after operation. The Portsmouth predictor equation (P-POSSUM) is a modification that may result in more accurate prediction of death than POSSUM. The aim of this study was to test the validity of POSSUM and P-POSSUM in patients undergoing major arterial surgery in a specialist unit.

Patients' and partners' perceptions of uvulopalatopharyngoplasty for snoring.

Objective: Uvulopalatopharyngoplasty (UPPP) has become a routine operation for snoring. Many centres have published their results. Few, if any, have questioned their patient's subjective feelings regarding the operation and more importantly, the patient's partner.

Closed rupture of the posterior tibial artery secondary to a soccer injury.

Arterial damage following blunt trauma is uncommon and is usually the result of high-energy injury. We report a case of posterior tibial artery rupture after a closed distal tibial fracture, sustained during a low-energy soccer tackle.

Spontaneous pneumomediastinum.

Spontaneous pneumomediastinum, or Hamman's syndrome, is a rare condition which may present with the symptoms of chest pain, dyspnoea, dysphagia, or neck pain. The signs of subcutaneous emphysema and Hamman's crunch (the presence of a crepitance sound that varies with the heartbeat on auscultation of the precordium) are usually present. A case of this syndrome occurring in an elderly patient with none of the recognised risk factors is presented.