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

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

Quantitative measure of sexual selection with respect to the operational sex ratio: a comparison of selection indices

Despite numerous indices proposed to predict the evolution of mating systems, a unified measure of sexual selection has remained elusive. Three previous studies have compared indices of sexual selection under laboratory conditions. Here, we use a genetic study to compare the most widely used measures of sexual selection in natural populations. We explored the mating and reproductive successes of male and female bank voles, Clethrionomys glareolus, across manipulated operational sex ratios (OSRs) by genotyping all adult and pup bank voles on 13 islands using six microsatellite loci. We used Bateman's principles (I(s) and I and Bateman gradients) and selection coefficients (s′ and β′) to evaluate, for the first time, the genetic mating system of bank voles and compared these measures with alternative indices of sexual selection (index of monopolization and Morisita's index) across the OSRs. We found that all the sexual selection indices show significant positive intercorrelations for both males and females, suggesting that Bateman's principles are an accurate and a valid measure of the mating system. The Bateman gradient, in particular, provides information over and above that of other sexual selection indices. Male bank voles show a greater potential for sexual selection than females, and Bateman gradients indicate a polygynandrous mating system. Selection coefficients reveal strong selection gradients on male bank vole plasma testosterone level rather than body size

Comparative chemical and antimicrobial study of nine essential oils obtained from medicinal plants growing in Egypt

Essential oils are one of interesting natural products group that are used in different aspects of life due to their various biological activities. This study investigate the antimicrobial activities of 9 herbal essential oils on survival and growth of selected pathogenic and spoilage microorganisms. Essential oils were obtained by hydrodistillation method and were analyzed using GC/MS technique. The oils were tested for their antimicrobial activity against 2 Gram +ve, Staphylococcus aureus (S. aureus) and Listeria innocua (L. innocua), 2 Gram −ve, Pseudomonas aeruginosa (P. aeruginosa) and Salmonella Typhi (S. Typhi) as well as 2 Fungi, Aspergillus niger (A. niger) and Candida albicans (C. albicans), using agar dilution method. Minimum inhibitory concentration (MIC) was determined. The antibiotic susceptibility test was performed against the test organisms by disc diffusion method. Results showed that Cinnamon oil was found effective against all the tested strains (MIC ≤ 1 μl/ml). Peppermint, lemon grass, caraway, anise, fennel and clove showed activity at (MIC ≤ 1 μl/ml) with all the tested organisms except for P. aeruginosa. Lavender oil exhibited antimicrobial activities against 4 strains (S. aureus, L. innocua, A. niger and C. albicans) with MIC (≤1 μl/ml) while geranium oil was inhibitory at (MIC ≤ 1 μl/ml) against S. aureus, S. Typhi, A. niger and C. albicans and with MIC ∼ 2 μl/ml against L. innocua. Although Gram −ve organisms had shown high resistance toward different essential oils, they were found to be susceptible to cinnamon oil even at lower concentration. Cinnamon oil is effective against drug resistant organisms. It can be suggested to use essential oils/constituents as potential natural preservatives and would be helpful in the treatment of various infections