The Cholecystectomy As A Day Case (CAAD) Score: A Validated Score of Preoperative Predictors of Successful Day-Case Cholecystectomy Using the CholeS Data Set

Background Day-case surgery is associated with significant patient and cost benefits. However, only 43% of cholecystectomy patients are discharged home the same day. One hypothesis is day-case cholecystectomy rates, defined as patients discharged the same day as their operation, may be improved by better assessment of patients using standard preoperative variables. Methods Data were extracted from a prospectively collected data set of cholecystectomy patients from 166 UK and Irish hospitals (CholeS). Cholecystectomies performed as elective procedures were divided into main (75%) and validation (25%) data sets. Preoperative predictors were identified, and a risk score of failed day case was devised using multivariate logistic regression. Receiver operating curve analysis was used to validate the score in the validation data set. Results Of the 7426 elective cholecystectomies performed, 49% of these were discharged home the same day. Same-day discharge following cholecystectomy was less likely with older patients (OR 0.18, 95% CI 0.15–0.23), higher ASA scores (OR 0.19, 95% CI 0.15–0.23), complicated cholelithiasis (OR 0.38, 95% CI 0.31 to 0.48), male gender (OR 0.66, 95% CI 0.58–0.74), previous acute gallstone-related admissions (OR 0.54, 95% CI 0.48–0.60) and preoperative endoscopic intervention (OR 0.40, 95% CI 0.34–0.47). The CAAD score was developed using these variables. When applied to the validation subgroup, a CAAD score of ≤5 was associated with 80.8% successful day-case cholecystectomy compared with 19.2% associated with a CAAD score >5 (p < 0.001). Conclusions The CAAD score which utilises data readily available from clinic letters and electronic sources can predict same-day discharges following cholecystectomy

Superação da dormência de sementes de capim colonião Dormancy overcoming in Panicum maximum seeds

O objetivo da pesquisa foi o de identificar tratamentos capazes de superar a dormência e elevar a taxa de germinação das sementes de Panicum maximum Jacq., passíveis de utilização visando semeadura a campo. Para tanto, sementes foram submetidas a tratamentos de imersão em H2SO4 (98%, 36N) por 5 minutos, de umedecimento do substrato de germinação com KNO3 (0,2%) e a tratamentos térmicos de 40, 55, 70 e 85OC por períodos de exposição de 5, 10 e 15h, em estufa com circulação forçada de ar. As sementes tratadas foram avaliadas por meio do teste de germinação, finalizado pelo teste de tetrazólio nas sementes não germinadas, bimestralmente, ao longo de 6 meses de armazenamento. Foi constatado que os tratamentos químicos (KNO3 e H2SO4) e térmicos (40, 55, 70 e 85 oC por 5, 10 e 15 h) são eficientes na superação da dormência que, não necessariamente, é revertida em elevação da taxa de germinação. A utilização da temperatura de 40oC reduz a taxa de dormência promovendo elevação na taxa de germinação das sementes.<br>The objective of this research was to develop procedures to overcome the dormancy of Panicum maximum seeds. The following treatments were used: soaking in H2SO4 (98% and 36N) for 5 minutes; germination in paper moistened with KNO3 (0.2%); exposition to the temperatures of 40, 55 70 or 85ºC for 5, 10 or 15 hours. The seeds from all treatments were stored for 0, 2, 4 and 6 months. Germination was estimated using standard methods. The viability of non germinated seeds was evaluated using tetrazolium test. The dormancy was overcome by all the chemical and thermal treatments, but only the exposure to 40ºC increased the germination rate