Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background: Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods: The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results: A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion: Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)

Sensitisation study of normalized 316L stainless steel

"Austenitic stainless steels with excellent corrosion resistance and good weldability have wide applications in industry. These iron-based alloys contain a high level of chromium which form protective oxide film on the surface hence resisting corrosion. The oxide film regenerates when damaged, making the steel 'stainless'. However, carbide precipitation due to a welding process or heat treatment can cause the occurrence of chromium-depleted zones at the boundaries, leading to a phenomenon known as sensitisation, in which the depleted zones become the focus of the intense corrosion. The present work was concerned with the study of the sensitization and desensitisation of 316L steel at the normalizing temperatures of 750- 9500 C and soaking times of 0.5, 1, 2 and 8 hrs. 316L stainless steel was observed to be sensitized when heated to 750- 8500 C and held for short soaking times of 0.5 – 2hrs before normalizing. Increasing soaking times at these temperatures to 8 hrs triggered the desensitization process which was fully accomplished at 7500 C but ongoing at 800 and 8500 C. At 9000 C, sensitization did not occur at 30 mins soaking time but observed at soaking times of 1 and 2hrs. At a longer soaking time of 8 hrs, there was full desensitization. At 9500 C, sensitization was already observed at 30 mins. Soaking time and desensitization was observed to be in progress at 1 and 2 hrs soaking time. By 8 hrs there was full desensitization. Thus it was observed that at 9500 C, diffusion of Cr was thermally aided making desensitization fast. The hardness of normalized 316L stainless steel was also observed to decrease with soaking time and normalization temperature

Comparative quality of life of Nigerian caregivers of children with cerebral palsy

Background: Information on how caring for children with cerebral palsy (CP) affects Nigerian caregivers' quality of life (QoL) is scarce. The QoL of Nigerian caregivers for children with cerebral palsy (CGCP) was compared with that of their age-matched counterparts with similar socioeconomic backgrounds who were caring for normally developing children, who made up the control group (CG). Motor function of the children with CP was also correlated with the QoL of their caregivers. Methods: Participants in this longitudinal study were 312 people comprising 107 CCP, 107 CGCP and 98 CG. The QoL was assessed at baseline and at the second, fifth and eighth month using the 26–item World Health Organization Quality of Life-Bref (WHOQoL-Bref) questionnaire. Motor function performance of the children with CP was assessed at the same intervals using the Gross Motor Function Measure (GMFM). Findings: Most of the CGCP and CG (82.3% and 93.8% respectively) were mothers of the children. At every point of assessment, the CGCP recorded significantly lower WHOQoL-Bref scores. Significant improvement in the GMFM score of the children with CP was observed during the study. The WHOQoL-Bref scores in CGCP correlated significantly with the GMFM scores of children with CP (P&lt;0.05) at the fifth and eighth month. Conclusion: People caring for children with CP have a lower quality of life than their counterparts caring for normally developing children. </jats:sec

KNOWLEDGE AND PERCEPTION OF A NIGERIAN UNIVERSITY UNDERGRADUATES ABOUT THE RISKS ASSOCIATED WITH USING COMMERCIAL MOTORCYCLE FOR TRANSPORTATION

Background and Purpose of Study: Commercial motorcycle is a popular mode of mass transportation in Nigeria, which despite being acknowledged benefits has been associated with health and social problems. This mode of transportation is embraced largely by young Nigerians, including university undergraduates who have not been well studied with respect to this mode of transportation. We determined the proportion of undergraduates of a Nigerian university regularly using commercial motorcycle. Level of knowledge and perception of risks associated with usage and some factors that may influence choice of commercial motorcycle were also investigated.&#x0D; Methods: This cross-sectional survey was conducted among Nigeria premier University of Ibadan undergraduates, recruited from their halls of residence using consecutive sampling technique.     A self-administered questionnaire was hand-distributed to obtain information on the respondents’ socio-demographic variables, knowledge and perception of risks associated with using commercial motorcycle for transportation. Descriptive statistics were calculated and Chi- square test was used as inferential statistics at α = 0.05.&#x0D; Results: Among the 1000 respondents, 75% regularly used commercial motorcycle for transportation. A statistically significant association was found between gender and the knowledge of risks     (p˂ 0.001) and also between age and the perception of risks associated with using this mode of transportation. However, there was no significant difference in the knowledge (p=0.03 and perception of risks (p=0.97) associated with using commercial motorcycle for transport between users and non- users.&#x0D; Conclusions: Respondents had limited knowledge and low perception of the risks associated with using commercial motorcycle for transport. Strategies should be put in place to educate these youths on the risks associated with using commercial motorcycle for transport.</jats:p

The management of complicated colorectal cancer in older patients in a global perspective after COVID-19: the CO-OLDER WSES project

BACKGROUND: Colorectal (CRC) cancer is becoming a disease of the elderly. Ageing is the most significant risk factor for presenting CRC. Early diagnosis of CRC and management is the best way in achieving good outcomes and longer survival but patients aged ≥75 years are usually not screened for CRC. This group of patients is often required to be managed when they are symptomatic in the emergency setting with high morbidity and mortality rates. Our main aim is to provide clinical data about the management of elderly patients presenting complicated colorectal cancer who required emergency surgical management to improve their care. METHODS: The management of complicated COlorectal cancer in OLDER patients (CO-OLDER; ClinicalTrials.gov ID: NCT05788224; evaluated by the local ethical committee CPP EST III-France with the national number 2023-A01094-41) in the emergency setting project provides carrying out an observational multicenter international cohort study aimed to collect data about patients aged ≥75 years to assess modifiable risk factors for negative outcomes and mortality correlated to the emergency surgical management of this group of patients at risk admitted with a complicated (obstructed and perforated) CRC. The CO-OLDER protocol was approved by Institutional Review Board and released. Each CO-OLDER collaborator is asked to enroll ≥25 patients over a study period from 1st January 2018 to 30th October 2023. Data will be analyzed comparing two periods of study: before and after the COVID-19 pandemic. A sample size of 240 prospectively enrolled patients with obstructed colorectal cancer in a 5-month period was calculated. The secured database for entering anonymized data will be available for the period necessary to achieve the highest possible participation. RESULTS: One hundred eighty hospitals asked to be a CO-OLDER collaborator, with 36 potentially involved countries over the world. CONCLUSIONS: The CO-OLDER project aims to improve the management of elderly people presenting with a complicated colorectal cancer in the emergency setting. Our observational global study can provide valuable data on the effectiveness of different management strategies in improving primary assessment, management and outcomes for elderly patients with obstructed or perforated colorectal cancer in the emergency setting, guiding clinical decision-making. This information can help healthcare providers make informed decisions about the best course of action for these patients

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background: Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods: The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results: A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion: Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)

The management of complicated colorectal cancer in older patients in a global perspective after COVID-19: the CO-OLDER WSES project

BACKGROUND: Colorectal (CRC) cancer is becoming a disease of the elderly. Ageing is the most significant risk factor for presenting CRC. Early diagnosis of CRC and management is the best way in achieving good outcomes and longer survival but patients aged ≥75 years are usually not screened for CRC. This group of patients is often required to be managed when they are symptomatic in the emergency setting with high morbidity and mortality rates. Our main aim is to provide clinical data about the management of elderly patients presenting complicated colorectal cancer who required emergency surgical management to improve their care. METHODS: The management of complicated COlorectal cancer in OLDER patients (CO-OLDER; ClinicalTrials.gov ID: NCT05788224; evaluated by the local ethical committee CPP EST III-France with the national number 2023-A01094-41) in the emergency setting project provides carrying out an observational multicenter international cohort study aimed to collect data about patients aged ≥75 years to assess modifiable risk factors for negative outcomes and mortality correlated to the emergency surgical management of this group of patients at risk admitted with a complicated (obstructed and perforated) CRC. The CO-OLDER protocol was approved by Institutional Review Board and released. Each CO-OLDER collaborator is asked to enroll ≥25 patients over a study period from 1st January 2018 to 30th October 2023. Data will be analyzed comparing two periods of study: before and after the COVID-19 pandemic. A sample size of 240 prospectively enrolled patients with obstructed colorectal cancer in a 5-month period was calculated. The secured database for entering anonymized data will be available for the period necessary to achieve the highest possible participation. RESULTS: One hundred eighty hospitals asked to be a CO-OLDER collaborator, with 36 potentially involved countries over the world. CONCLUSIONS: The CO-OLDER project aims to improve the management of elderly people presenting with a complicated colorectal cancer in the emergency setting. Our observational global study can provide valuable data on the effectiveness of different management strategies in improving primary assessment, management and outcomes for elderly patients with obstructed or perforated colorectal cancer in the emergency setting, guiding clinical decision-making. This information can help healthcare providers make informed decisions about the best course of action for these patients