57 research outputs found

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

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    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

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    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

    Economic Interests, Party, and Ideology in Early Cold War Era U.S. Foreign Policy

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    Trade and asymmetric alliances

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    Alliances are usually understood as a way for states to aggregate military capabilities in the face of a common threat. From this perspective, the willingness of relatively powerful states to form alliances with much weaker partners is puzzling. The weaker ally often adds little to the stronger state’s security and may increase its chance of military entanglement. This article presents evidence that international trade helps explain these alliances. States that have the power to do so have incentives to protect their trading relationships against interference from either third states or internal conflict. Alliances are one means of providing this protection. This argument differs from most other research on trade and alliances, which reverses the causal arrow and suggests instead that alliances increase trade. Empirical analysis indicates that trade increases the probability of alliance formation in major power—minor power dyads and decreases the chance that alliances will dissolve. These results are robust to a variety of changes in the specification of the model and the data used for estimation. They also do not stem from any influence of alliance relationships on trade. An analysis of the effect of alliance formation on change in the level of bilateral trade turns up no evidence that the formation of an alliance increases commerce.alliances; security commitments; trade

    Revisionism Reconsidered: Exports and American Intervention in World War I

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    Why did the United States intervene in World War I, breaking with its long tradition of noninvolvement in European political and military conflicts? During the 1920s and 1930s, many revisionist historians argued that American efforts to protect its trade with the Allies ultimately led to intervention. The logic of the revisionist position closely parallels the contemporary liberal case that interdependence promotes peace but arrives at different conclusions about the relationship between trade and conflict. Historians have largely abandoned this economic interpretation of American intervention, but data on the impact of the wartime export boom on the United States suggest that it should be reconsidered. The export boom was so large that it would have been difficult to ignore, and its progress corresponds to the timing of important decisions leading to American belligerency. An analysis of congressional voting on war-related measures also suggests that export income helped shape politicians views of the war.
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