The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

Dimethyl fumarate in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Dimethyl fumarate (DMF) inhibits inflammasome-mediated inflammation and has been proposed as a treatment for patients hospitalised with COVID-19. This randomised, controlled, open-label platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing multiple treatments in patients hospitalised for COVID-19 (NCT04381936, ISRCTN50189673). In this assessment of DMF performed at 27 UK hospitals, adults were randomly allocated (1:1) to either usual standard of care alone or usual standard of care plus DMF. The primary outcome was clinical status on day 5 measured on a seven-point ordinal scale. Secondary outcomes were time to sustained improvement in clinical status, time to discharge, day 5 peripheral blood oxygenation, day 5 C-reactive protein, and improvement in day 10 clinical status. Between 2 March 2021 and 18 November 2021, 713 patients were enroled in the DMF evaluation, of whom 356 were randomly allocated to receive usual care plus DMF, and 357 to usual care alone. 95% of patients received corticosteroids as part of routine care. There was no evidence of a beneficial effect of DMF on clinical status at day 5 (common odds ratio of unfavourable outcome 1.12; 95% CI 0.86-1.47; p = 0.40). There was no significant effect of DMF on any secondary outcome

Dimethyl fumarate in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Dimethyl fumarate (DMF) inhibits inflammasome-mediated inflammation and has been proposed as a treatment for patients hospitalised with COVID-19. This randomised, controlled, open-label platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing multiple treatments in patients hospitalised for COVID-19 (NCT04381936, ISRCTN50189673). In this assessment of DMF performed at 27 UK hospitals, adults were randomly allocated (1:1) to either usual standard of care alone or usual standard of care plus DMF. The primary outcome was clinical status on day 5 measured on a seven-point ordinal scale. Secondary outcomes were time to sustained improvement in clinical status, time to discharge, day 5 peripheral blood oxygenation, day 5 C-reactive protein, and improvement in day 10 clinical status. Between 2 March 2021 and 18 November 2021, 713 patients were enroled in the DMF evaluation, of whom 356 were randomly allocated to receive usual care plus DMF, and 357 to usual care alone. 95% of patients received corticosteroids as part of routine care. There was no evidence of a beneficial effect of DMF on clinical status at day 5 (common odds ratio of unfavourable outcome 1.12; 95% CI 0.86-1.47; p = 0.40). There was no significant effect of DMF on any secondary outcome

Fishery-specific differences in the size selectivity and catch of diamond- and square-mesh codends in two Australian penaeid seines

The selectivities and catch compositions of conventional 30-mm diamond-mesh codends and a new square-mesh design made from 20-mm mesh hung on the bar for river and lagoon penaeid seines in south-eastern Australia were compared. The square-mesh design significantly improved the selectivities of the river seine for school prawns, 'Metapenaeus macleayi' (Haswell), and the lagoon seine for greasyback prawns, 'Metapenaeus bennettae' (Racek & Dall), by increasing their carapace length at 50% probability of retention (L50) and by decreasing between-haul variability in selectivity. The presence of weed reduced the L50 for greasyback prawns caught in the conventional diamond-mesh codend during the lagoon-seine experiment. The differences among codend performances are discussed in terms of the differing methods of operation and composition of catches between the seines. These differences highlight the need to develop and manage modifications to improve the selectivity of fishing gears on a fishery-specific basis

Isolating selection mechanisms in beach seines

The selection mechanisms of beach seines were investigated during two separate experiments in New South Wales (NSW), Australia to determine the effects on catches associated with changing mesh size in the (i) posterior wings and (ii) bunt. Irrespective of the seine configuration, in all deployments fewer than 8% of fish were meshed in the anterior wings (combined length of 375 m and a mesh size of 80 mm), while between 11 and 40% were meshed in the posterior wings (combined length of 60 m) and between 64 and 87% were retained in the bunt (total length of 12.5 m). In experiment 1, increasing the mesh size from 57 (conventional) to 80 mm in the posterior wings had significant (

Improving Selectivity in an Australian Penaeid Stow-net Fishery

Two experiments were conducted in an Australian penaeid stow-net fishery to: (i) validate the use of a fine-meshed cover for determining the selectivity of codends, and (ii) use this cover to quantify and compare the selectivity of a conventional 30-mm diamond-mesh codend and two new square-mesh designs made from 20- and 30-mm mesh, hung on the bar. In the first experiment the codend cover had minimal impact on the fishing performance of the stow net. The 30-mm square-mesh codend tested during the second experiment significantly improved the selectivity of the stow net, measured as an increase in school prawn ('Metapenaeus macleayi' Haswell, 1879) carapace length at 50% probability of retention (L50), and a reduction in the unwanted bycatches of juvenile eastern king prawns ('Penaeus plebejus' Hess, 1865) and small, non-commercial fish. However, a concomitant increase in selection range (SR) indicated that unacceptable quantities of target-sized school prawns escaped. In contrast, the 20-mm square- and 30-mm diamond-mesh codends were virtually non-selective for the sizes of school prawns encountering the gear. Compared to the 30-mm diamond-mesh codend, the 20-mm square-mesh codend did, however, reduce the quantities of eastern king prawns and non-penaeid bycatch retained. The results are attributed to the geometries of the codends tested and provide directions for future research into modifications to improve the selectivity of stow nets

Intra-fleet variability in the size selectivity of a square-mesh trawl codend for school prawns ('Metapenaeus macleayi')

A covered-codend experiment was done to assess the size selectivity of a codend made from 27-mm mesh hung on the bar (i.e. square mesh) for school prawns ('Metapenaeus macleayi') across 10 vessels within the New South Wales (NSW) estuarine penaeid-trawl fishery. Prior to starting the experiment, a codend cover (18-mm diamond-shaped mesh) was tested and demonstrated to have no effect on the catching efficiency of a typical estuarine trawl, thereby validating its use for assessing size selectivity. There was substantial variability in the estimated carapace lengths at 50% probability of retention (L50 ± S.E.: between 7.90 ± 0.97 and 13.76 ± 0.23 mm) and selection ranges (SR: between 2.70 ± 0.18 and 6.71 ± 1.72 mm) of the 27-mm square-mesh codend among trawlers and estuaries. Multi-level, generalised linear mixed-effects modelling demonstrated that this variation was explained by: (i) the catch weight of school prawns; (ii) the particular estuary being fished; and (iii) random between-tow and -trawler variability. The results are discussed in terms of the various operational, biological and environmental factors unique to each fishing operation. Despite the variability in the performance of the 27-mm square-mesh codend, an overall improvement in size selectivity compared to conventional diamond-mesh designs, combined with a high survival rate of escapees, justifies its adoption and legislation throughout the NSW estuarine penaeid-trawl fishery as a means for mitigating unwanted fishing mortalities. We also conclude that similar codends may have application in other penaeid-trawl fisheries around the world

Thigh-length compression stockings and DVT after stroke

Controversy exists as to whether neoadjuvant chemotherapy improves survival in patients with invasive bladder cancer, despite randomised controlled trials of more than 3000 patients. We undertook a systematic review and meta-analysis to assess the effect of such treatment on survival in patients with this disease

Azithromycin in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Background Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatory actions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19. Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospital with COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients were randomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once per day by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatment groups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment and were twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants and local study staff were not masked to the allocated treatment, but all others involved in the trial were masked to the outcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treat population. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936. Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) were eligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was 65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomly allocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall, 561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days (rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median 10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days (rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, no significant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilation or death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24). Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or other prespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restricted to patients in whom there is a clear antimicrobial indication. Funding UK Research and Innovation (Medical Research Council) and National Institute of Health Research