Influence of Internal Structure of the Sorbents on Diazepam Sorption from Simulated Intestinal Fluid

The capacity of natural Na-montmorillonite and activated charcoal for sorption of diazepam from simulated intestinal fluid (SIF) was studied. The main characteristics of the sorbents were determined. In order to characterize the sorption process of diazepam the influence of the pH, contact time and ethanol presence in SIF was analyzed. Adsorption isotherms for the diazepam-activated charcoal and diazepam-natural Na-montmorillonite systems were determined. The Langmuir isotherm model provided a very good description of diazepam sorption. Furthermore, the pH-drift method was used to determine the specific pH at zero point of charge (pHzpc) of the sorbents. The obtained results show that the internal structure of the sorbents and pH of the SIF solutions are very important for diazepam sorption. Both the surface of the activated charcoal and natural Na-montmorillonite are positively charged below the pHzpc so the sorption of diazepam is higher below this point and occur by van der Waals forces. The presence of ethanol in simulated intestinal fluid lowers the adsorption of diazepam on both sorbents

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)