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

Whipple's disease revisited

Whipple's disease has traditionally been considered to be a rare multisystem disorder dominated by malabsorption. The recent identification of the Whipple's disease bacillus has, using polymerase chain reaction based assays, fuelled advances in the investigation, diagnosis, and management of this disease. This leader reviews the aetiology, clinical manifestations, investigation, and treatment of Whipple's disease in the light of this new information. Key Words: Tropheryma whippelii • immune system • polymerase chain reactio

Antecedents of employee involvement with the comparative model

Emotional labor, Intimacy relationship, Employee involvement,

An extension to the internal/external frame of reference model to two verbal and numerical domains

Moeller J, Streblow L, Pohlmann B, Koeller O. An extension to the internal/external frame of reference model to two verbal and numerical domains. EUROPEAN JOURNAL OF PSYCHOLOGY OF EDUCATION. 2006;21(4):467-487.Beside interindividual social comparisons, intraindividual dimensional comparisons in which students compare their achievements in one subject with their achievements in other subjects have an impact on their academic self-concepts. The internal/external frame of reference (I/E) model by Marsh (1986) assumes that dimensional comparisons lead to negative paths from achievement in one subject (e.g., math) to self-concept in another subject (e.g., English). In the present study, the I/E model was extended to two verbal domains (German as the native language and English as a foreign language) and two numerical domains (mathematics and physics). Grades and domain-specific academic self-concepts of N= 1440 students from 63 classes were assessed In support of the extended I/E model, (a) math, physics, German, and English achievement were positively correlated, as were; (b) se flconcepts within the verbal and numerical domains, while; (c) self-concepts between the verbal and the numerical domains were almost uncorrelated; (d) positive paths were received from math, physics, German, and English achievement on the corresponding self-concepts; (e) negative paths were found from achievement in one domain to self-concept in the other; (f) positive paths were found from math (physics) achievement to physics (math) self-concept. Finally, (g), almost no effects were found within the verbal domain, i.e., from English (German) achievement to German (English) self-concept. Therefore, there is some support for the I/E model between domains; whereas effects from achievements on self-concepts within the domains were not negative