Antioxidant Therapy Does Not Reduce Pain in Patients with Chronic Pancreatitis: The ANTICIPATE Study

Background & Aims: We investigated whether antioxidant therapy reduces pain and improves quality of life in patients with chronic pancreatitis. Methods: We performed a double-blind, randomized, controlled trial that compared the effects of antioxidant therapy with placebo in 70 patients with chronic pancreatitis. Patients provided 1 month of baseline data and were followed up for 6 months while receiving either Antox version 1.2 (Pharma Nord, Morpeth, UK) or matched placebo (2 tablets, 3 times/d). The primary analysis was baseline-adjusted change in pain score at 6 months, assessed by an 11-point numeric rating scale. Secondary analyses included alternative analyses of clinic and diary pain scores, scores on quality-of-life tests (the EORTC-QLQ-C30, QLQ-PAN28, EuroQOL EQ-5D, and EQ visual analog score), levels of antioxidants, use of opiates, and adverse events. Analyses, reported by intention to treat, were prospectively protocol-defined. Results: After 6 months, pain scores reported to the clinic were reduced by 1.97 from baseline in the placebo group and by 2.33 in the antioxidant group but were similar between groups (−0.36; 95% confidence interval, −1.44 to 0.72; P = .509). Average daily pain scores from diaries were also similar (3.05 for the placebo group, 2.93 for the antioxidant group, a difference of 0.11; 95% confidence interval, 1.05–0.82; P = .808). Measures of quality of life were similar between groups, as was opiate use and number of hospital admissions and outpatient visits. Blood levels of vitamin C and E, β-carotene, and selenium were increased significantly in the antioxidant group. Conclusi1ons: In patients with painful chronic pancreatitis of predominantly alcoholic origin, antioxidant therapy did not reduce pain or improve quality of life, despite causing a sustained increase in blood levels of antioxidants. Trial registration: ISRCTN-21047731

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Unionisation, Industrial Relations and Labour Productivity Growth in Australia: A Pooled Time-Series/Cross-Section Analysis of TFP Growth

This study examines the impact of unionisation and other industrial relations variables on total factor productivity (TFP) levels and growth in a conventional Cobb-Douglas production function. The estimation employs quarterly time-series data from 1976 to 1990 on output, employment and the capital stock for fifteen separate industries pooled with cross-sectional data on unionisation and other industrial relations characteristics derived from AWIRS. Preliminary results suggest that union density has a negative effect on the level of TFP while the number of awards had a negative effect over the sample period. However, union density has had a positive effect on TFP growth. Variables reflecting the proportion of workplaces having 'enlightened' industrial relations policies, such as profit sharing, worker share ownership and superannuation schemes appear to have been positively related to TFP levels and growth over the sample period. This evidence seems to suggest the existence of a collective 'voice' effect

Unionisation, Industrial Relations and Labour Productivity Growth in Australia: A Pooled Time-Series/Cross-Section Analysis of TFP Growth

This study examines the impact of unionisation and other industrial relations variables on total factor productivity (TFP) levels and growth in a conventional Cobb-Douglas production function. The estimation employs quarterly time-series data from 1976 to 1990 on output, employment and the capital stock for fifteen separate industries pooled with cross-sectional data on unionisation and other industrial relations characteristics derived from AWIRS. Preliminary results suggest that union density has a negative effect on the level of TFP while the number of awards had a negative effect over the sample period. However, union density has had a positive effect on TFP growth. Variables reflecting the proportion of workplaces having 'enlightened' industrial relations policies, such as profit sharing, worker share ownership and superannuation schemes appear to have been positively related to TFP levels and growth over the sample period. This evidence seems to suggest the existence of a collective 'voice' effect.

A European survey on the aetiology, investigation and management of the "Sportsman's Groin"

INTRODUCTION: A sportsman's groin has no accepted definition or consensus on treatment. The aim of this study was to assess current opinion among a large body of European surgeons using an online survey.METHODS: An online questionnaire comprising 16 multiple-choice questions was sent by email to general surgeons in Europe. The survey was live from the 6th to 30th September 2011.RESULTS: In total 143 responses were received. One hundred and six respondents (74\ua0%) expressed experience in managing this condition. The majority (91\ua0%) managed <26 cases per year. Posterior wall weakness (53\ua0%), pubic tendinitis (43\ua0%), nerve entrapment (37\ua0%) and conjoint tendon injury (36\ua0%) were the commonest aetiological factors described. Preferred diagnostic investigations were ultrasound of the groin (44\ua0%) and MRI of the pelvis (29\ua0%). The most common initial treatment (91\ua0% of respondents) was conservative measures (rest and analgesia) for a maximum of 6-month period. When surgery was undertaken, Lichtenstein repair (29\ua0%), TEP (27\ua0%), TAPP (20\ua0%), and posterior wall repair (21\ua0%) were the commonest procedures. The majority (95\ua0%) of respondents would not offer bilateral surgery for those presenting with unilateral groin pain.CONCLUSIONS: Most European surgeons see <26 cases of "sportsman's groin" per year, which is in keeping with the low incidence of this condition. There remains wide variation in its investigation and management, which reflects the differences in opinion on its aetiology. The majority of surgeons agree that surgery is not the only treatment option available, but there is little consensus on the optimal management