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

Preparing a catalogue and bibliography of and researching into independant Labour Party archive

SIGLEAvailable from British Library Document Supply Centre- DSC:8318.172(SSRC-HR--1573)(microfiche) / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Towards an Approach for Stakeholder-Oriented Elicitation and Identification of Concerns in EA

Part 5: Enterprise ArchitectureInternational audienceThe concept of concern is used in Enterprise Architecture (EA) to express a stakeholder’s area of interest in a system whose architecture is to be described. Many EA-related problems are rooted in weak stakeholder orientation. We propose an approach to explicitly model stakeholders’ concerns as part of an architecture description. Our contribution is a modeling notation for concern elicitation and a method for concern identification. Our approach is based on goal-oriented requirements engineering and is compatible to the conceptual framework of the ISO 42010 international standard. We claim that our approach allows for a more thorough understanding of stakeholders’ concerns and facilitates a stronger stakeholder orientation in EA