Reporting of health-related quality of life in emergency laparotomy trials: a systematic review and narrative synthesis

Purpose Emergency laparotomy is associated with high morbidity for the surgical patient. Understanding patients’ health-related quality of life after their surgery is important to enhance the informed consent process, and to enable the evaluation and improvement of surgical care. This review aims to summarise the use of health-related quality of life tools in clinical trials involving patients undergoing emergency laparotomy. Methods A systematic review was undertaken of the scientific literature published in the MEDLINE® and PubMed databases between January 2011 and July 2021. A narrative synthesis approach was chosen to synthesise the diverse range of studies in a structured manner. All included papers were evaluated using the Cochrane Collaboration’s tool for assessing risk of bias. Results Eleven studies were selected for inclusion. Most of the studies had a low risk of bias. Two of the studies used health-related quality of life as the primary outcome measure. A variety of health-related quality of life measurement tools were used; the EQ-5D tool was the most popular questionnaire. Protocol adherence was dependent on the length of time which had elapsed after emergency surgery. Conclusion There are many perceived challenges to collecting health-related quality of life data in the emergency surgery setting. Many of these can be offset with progressive trial designs. There is a need for further research in the systematic development of patient-reported outcomes for use in emergency surgery

Canola seed as affected by swathing time

Non-Peer ReviewedYield, weight, protein content (oil-free meal) and oil content of canola seed increased as seeds developed. Maximum values were obtained between 45-49 days after flowering, when seed moisture was 29-38%. Fatty acid composition of canola seed oil changed during seed development. The proportion of oleic (C18:1) and linolenic (C18:3) acids increased, while that of most other fatty acids decreased, as seeds developed, while Eicosenoic (C20:1) and erucic (C22:1) acids did not show a clear trend. Fatty-acids tended to stabilize by the 49th day after flowering. Early seeding resulted in higher seed yield, larger seeds, lower seed protein content and higher seed oil content, when compared to late seeding

Impact of in-hospital postoperative complications on quality of life up to 12 months after major abdominal surgery

Background Postoperative complications are common, but there are limited data regarding their implications on patients’ quality of life. This study aimed to address this gap in the literature by analysing the impact of postoperative complications on patients’ health-related quality of life. Methods Data from the Perioperative Quality Improvement Programme were analysed, and included patient-level data for 19 685 adults who underwent elective major abdominal procedures in England since 2016. Postoperative complications were graded using the Clavien–Dindo classification. Quality of life was assessed by responses to the EuroQol five-dimension five-levels-of-response (EQ-5D-5L™) questionnaire before surgery, and at 6 and 12 months after operation. Ordinal logistic regression was used to estimate the association between Clavien–Dindo grades and quality of life. Tobit and ordinary least squares regression analyses were used to estimate the quality-adjusted life-year (QALY) loss resulting from postoperative complications between admission and 12 months after surgery. Results At 6 and 12 months after surgery, increasingly severe postoperative complications were significantly associated with poorer health-related quality of life. The effect of postoperative complications on quality of life was sustained until at least 12 months after operation. Between admission and 12 months after surgery, 0.012, 0.026, 0.033, and 0.086 QALYs were lost for those experiencing a grade I, II, III, or IV postoperative complication respectively. Conclusion Postoperative complications have a significant and sustained effect on patients’ quality of life after surgery; this effect worsens as the severity of the complications increases

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

Activation of Bovine Oocytes Following Intracytoplasmic Sperm Injection (ICSI)

Intracytoplasmic sperm injection (ICSI), one of the methods of assisted fertilization, is the mechanical placement of a spermatozoon directly into the cytoplasm of an oocyte. With the use of this technique, the normal barriers to sperm penetration including the cumulus cell-hyaluronic acid matrix, the zona pellucida and the ooplasmic membrane are bypassed.[...

Parameterized tractability of edge-disjoint paths on directed acyclic graphs

Given a graph and terminal pairs (si, ti), i ∈ [k], the edge-disjoint paths problem is to determine whether there exist siti paths, i ∈ [k], that do not share any edges. We consider this problem on acyclic digraphs. It is known to be NP-complete and solvable in time n O(k) where n is the number of nodes. It has been a long-standing open question whether it is fixed-parameter tractable in k, i.e. whether it admits an algorithm with running time of the form f(k) n O(1). We resolve this question in the negative: we show that the problem is W [1]-hard, hence unlikely to be fixed-parameter tractable. In fact it remains W [1]-hard even if the demand graph consists of two sets of parallel edges. On a positive side, we give an O(m+k O(1) k! n) algorithm for the special case when G is acyclic and G + H is Eulerian, where H is the demand graph. We generalize this result (1) to the case when G + H is “nearly ” Eulerian, (2) to an analogous special case of the unsplittable flow problem, a generalized version of disjoint paths that has capacities and demands. Keywords. Disjoint paths, fixed-parameter tractability, W[1]-hardness, Eulerian graphs, unsplittable flow

Differential colonization with segmented filamentous bacteria and <em>Lactobacillus murinus</em> do not drive divergent development of diet-induced obesity in C57BL/6 mice.

Alterations in the gut microbiota have been proposed to modify the development and maintenance of obesity and its sequelae. Definition of underlying mechanisms has lagged, although the ability of commensal gut microbes to drive pathways involved in inflammation and metabolism has generated compelling, testable hypotheses. We studied C57BL/6 mice from two vendors that differ in their obesogenic response and in their colonization by specific members of the gut microbiota having well-described roles in regulating gut immune responses. We confirmed the presence of robust differences in weight gain in mice from these different vendors during high fat diet stress. However, neither specific, highly divergent members of the gut microbiota (Lactobacillus murinus, segmented filamentous bacteria) nor the horizontally transmissible gut microbiota were found to be responsible. Constitutive differences in locomotor activity were observed, however. These data underscore the importance of selecting appropriate controls in this widely used model of human obesity