Pressurized intraperitoneal aerosol chemotherapy: a review of the introduction of a new surgical technology using the IDEAL framework

Background The IDEAL (Idea, Development, Evaluation, Assessment, Long‐term study) framework is a scheme of investigation for innovative surgical therapeutic interventions. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a procedure based on laparoscopy to deliver intraperitoneal chemotherapy for peritoneal metastases, introduced in 2011. The aim of this article was to review literature on PIPAC and assess whether development of the technique has followed the IDEAL framework. Methods A search of MEDLINE and Embase was carried out to identify scientific reports on PIPAC published between January 2000 and February 2019. The studies were categorized according to the IDEAL stages. Results Eighty‐six original research papers on PIPAC were identified. There were 23 stage 0, 18 stage 1, 25 stage 2a and six stage 2b studies. Protocol papers for stage 1, 2b and 3 studies, and trial registrations for stage 2a studies, were also identified. The number of centres publishing reports and the number of publications has increased each year. Overall, there has been progression through the IDEAL stages; however, about 60 per cent of clinical reports published in 2018 were stage 1 Idea‐type studies. Conclusion Since its introduction, studies investigating PIPAC have progressed in line with the IDEAL framework. However, the majority of studies reported recently were stage 0 and 1 studies

Discourse(s) of growth and sustainability in national tourism policy documents

Using a corpus of seven European national tourism policy documents, this research examined the language used to resolve the apparently conflicting goals of economic growth and social and environmental sustainability. The detailed discourse analysis, using a combination of quantitative and qualitative methods, found wide scale appropriation of the term ‘sustainable’, but no definitions or operationalisation. In fact, there was no acknowledgement that growth and sustainability were conflicting priorities, but ‘sustainable’ was used to give a hint of ecological sustainability, while actually meaning ‘sustained’ in phrases such as ‘sustainable growth’ and ‘sustainable development’. Thus ‘sustainable’ is appropriated to suggest continued growth, rather than reflecting the finite limits of ecological and societal sustainability. Economic goals were portrayed as instrumental to communities’ wellbeing, without evaluation, while environmental sustainability was depicted as instrumental to maintaining tourist demand. A variety of linguistic devices were used to normalise and promote economic growth including up/down metaphors and associating growth with good health and thriving and a lack of growth with poor health and looking for recovery. Countries’ competitive aspirations militate against cooperative action to reduce the environmental damage caused by international tourism. The findings illustrate how language supports neoliberal hegemony, while paying lip-service to sustainability

A case-control study of risk factors for wound infection in a colorectal unit

INTRODUCTION Postoperative wound infections have been responsible for increasing morbidity and are associated with an increased use of hospital resources. Previous studies have identified several risk factors. However, most studies are outdated, and few relate to the era of enhanced recovery and laparoscopic surgery. This study investigated the association between patient and operative factors and the development of postoperative wound infections in colorectal surgery. METHODS Patients with documented wound infections or dehiscences were identified from a database of elective and emergency colorectal surgery. Patients with wound infections were matched by operation type to a control group of colorectal patients. Differences in patient and operative factors between case and control group were analysed using conditional logistic regression. RESULTS A total of 56 patients with wound infection were identified from 647 operations (8.6%). Fifty-seven per cent were emergency operations and eighty-eight per cent were performed as open surgery or as laparoscopic surgery converted to open. Forty per cent of patients had high ASA (American Society of Anesthesiologists) grades (3 or 4). Multivariate logistical regression showed that obese patients and those having open surgery had the highest risk of infections. The median postoperative hospital stay for patients with wound infections was twice as long as for those patients without wound infections. CONCLUSIONS Open surgery and obesity are independent risk factor for wound infections. An increase in laparoscopically performed operations and new strategies for managing wounds in obese patients may help to reduce the rate of wound infection

Acceptability and benefit of rectal irrigation in patients with low anterior resection syndrome: a qualitative study

Aim Low Anterior Resection Syndrome (LARS) following rectal cancer surgery impairs the patient's quality of life (QoL). Rectal Irrigation has been demonstrated to be effective for anterior resection syndrome but many surgeons do not suggest it as a treatment. This feasibility study aimed to explore treatment acceptability and the benefit of rectal irrigation in patients who developed LARS following an anterior resection for rectal cancer. Methods This was a qualitative study, involving semi-structured interviews. Twenty-one patients diagnosed with LARS following anterior resection for rectal cancer in a single tertiary centre were offered rectal irrigation as a treatment option. Qualitative interviews (n=17) were conducted at baseline to explore patient reported impact of LARS on QoL, treatment acceptability and factors influencing the decision to accept/decline treatment. Follow up interviews were carried out at six months for the treatment group only (n=12), to assess its practicality and impact on QoL. Results Qualitative interview findings suggest rectal irrigation is an acceptable method of treatment for LARS. Participants who perceived their symptoms to be more severe or poorly controlled were most likely to consider rectal irrigation as a treatment option. The patients who completed treatment reported improvements in their QoL, the ability to control the time of defaecation being the key benefit Conclusion Clinicians should consider offering rectal irrigation as a treatment option to patients presenting with bowel dysfunction following anterior resection as it can improve symptoms. Patients who perceive that their symptoms are severe are more likely to consider treatment. This article is protected by copyright. All rights reserved

Retention of basic laparoscopic skills after a structured training program

The purpose of this study was to test the retention of basic laparoscopic skills on a box trainer 1 year after a short training program. For a prior study, eight medical students without prior experience (novices) underwent baseline testing, followed by five weekly training sessions and a final test. During each of seven sessions, they performed five tasks on an inanimate box trainer. Scores were calculated by adding up the time to completion of the task with penalty points, consequently rewarding speed and precision. The sum score was the sum of the five scores. One year later, seven of them underwent retention testing for the current study. The final test results were compared with retention test results as a measure of durability of acquired skills. Novices’ scores did not worsen significantly for four out of five tasks (i.e., placing a pipe cleaner p = 0.46, placing beads p = 0.24, cutting a circle p = 0.31, and knot tying p = 0.13). However, deterioration was observed in the performance on stretching a rubber band (p < 0.05), as well as in the sum score (p < 0.05). Nevertheless, all retention scores remained better than the baseline results. In conclusion, basic laparoscopic skills acquired during a short training program merely sustain over time. However, ongoing practice is advisable, especially to preserve tissue-handling skills, since these may be the first to deteriorate

The Psycho-social Outcomes following emergency Laparotomy (POLO) study: A study protocol for a multi-centre mixed method, prospective cohort study, assessing the psycho-social outcomes following emergency laparotomy in adults

Introduction Morbidity from an emergency laparotomy (EmLap) is difficult to define and poorly understood. Morbidity is a holistic concept, reliant upon an interplay of bio-psychosocial outcomes that evolve long after discharge. To date, no previous study has explored the psychosocial outcomes following EmLap as a collective, nor their change over time. This study aims to describe the holistic morbidity following EmLap within the first year following surgery.Methods and analysis This is a multicentre, mixed-methods prospective 12-month cohort study with two participant populations: patient participants and family caregivers (FCGs). A target of 160 adult patients who undergo EmLap and can give informed consent will be included in the patient participant group. Patient participants will be asked to complete three patient surveys, incorporating validated patient-reported outcome measures (PROMs) to assess bio-psychosocial outcomes (EuroQol five-dimension five-level (EQ5D-5L), Gastrointestinal Quality Life Index-36, Patient Health Questionnaire-9, Generalised Anxiety Disorder 7, International Trauma Questionnaire, Caregiver Interaction Scale and Fatigue Severity Scale) in the 12 months following surgery. A subgroup of 15 patient participants will be asked to take part in two semistructured interviews at 6 and 12 months. A target of 15 associated family caregivers will be included in the FCG group. FCGs will be asked to take part in a semi-structured interview at 6 months to assess the EmLap impact on the wider support network. The primary outcome will be a change in quality of life (EQ5D-5L) at 12 months. Secondary outcomes will be changes in bio-psychosocial status at 3 and 12 months. Qualitative analysis will allow contextualisation of PROMS and further explore themes of EmLap morbidity. It is anticipated that the results of this study will help inform and develop standards of aftercare for future EmLap patients.Ethics and dissemination This study has received ethical approval (Wales REC7;12/WA/0297) and will be undertaken in accordance with the principles of Good Clinical Practice. We intend to disseminate study results in peer-reviewed journals and medical conferences, as well as a lay report to study participants.Trial registration number Clinical Trials.gov NCT05281627

Airbnb and crime in Barcelona (Spain): testing the relationship using a geographically weighted regression

The existence of works proving the possible relationship empirically that Airbnb lodgings could have with crime in Spain is not known. This research analyzes the relationship between Airbnb lodgings and crimes against the properties and people in Barcelona’s neighbourhoods. To achieve this, we use an ordinary least squares regression model and a geographically weighted regression model. The results show a significant and positive relationship between the higher density of Airbnb lodgings and the higher crime rates in the neighbourhoods, especially of patrimonial nature. Divided by type of leased space, the Airbnb homes, in which the guest shares a room with other guests, show a higher relationship with crimes against property and people. The results of the local model show a spatial heterogeneity in all variables used, indicating the need to address non-stationary spatial processes that reveal hidden patterns. However, the only variable that shows statistically significant local variability is the total Airbnb lodgings variable. Finally, we discussed some unexpected results, proposing some future lines of research. © 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group, on behalf of Nanjing Normal University

Psychological sequelae of colonic resections

Aim The prevalence of anxiety, depression and post‐traumatic stress disorder (PTSD) in the general population has been estimated to be 5.9, 3.3 and 4.4% respectively. The aim of this study was to determine whether psychological problems are more prevalent following colorectal surgery. Method Patients who had undergone colorectal resection in a 2‐year period across 4 centres were asked to complete validated screening questionnaires for anxiety, depression and PTSD (GAD‐7, PHQ‐9, PCL‐5) 12‐48 months after surgery. Risk factors were identified using multiple linear regression analysis. Results After excluding those who had died or received palliative diagnoses, questionnaires were sent to 1150 patients. 371 responded (32.3% response rate); median age 67 (20‐99) years, 51% were male. 58% of patients underwent surgery for cancer, 23% had emergency surgery. 28% of patients screened positive for at least one psychological condition, with 20% screening positive for anxiety, 22% for depression and 14% for PTSD. Patients who were younger, female, had surgery as an emergency, for benign conditions, had stomas and critical care stay were more likely to have poorer psychological outcomes. Multiple linear regression found that only younger age (p=0.000) and female gender (p=0.048) were significant risk factors. Conclusion The prevalence of anxiety, depression and PTSD appears to be high in patients who have undergone colorectal surgery. Younger patients and women are particularly at risk. Further work is needed to determine how best to prevent, detect and treat people with adverse psychological outcomes following colorectal surgery