Implementation of an enhanced recovery program after bariatric surgery: Clinical and cost-effectiveness analysis

Enhanced recovery after surgery (ERAS) programs are perioperative evidence-based interventions that have the purpose of making the perioperative pathway more efficient in safeguarding patient safety and quality of care. Recently, several ERAS components have been introduced in the setting of bariatric surgery (Enhanced Recovery After Bariatric Surgery, ERABS). The aim of the present study was to evaluate clinical efficiency and cost-effectiveness of the implementation of an ERABS program. It was a retrospective case-control study comparing a group of adult obese (body mass index >40) patients treated according to the ERABS protocol (2014-2015) with a historical control group that received standard care (2013-2014) in the General and Emergency Surgery Department, Arcispedale S. Maria Nuova Hospital, Reggio Emilia, Italy. Data on the occurrence of complications, mortality, re-admissions and re-operations were extracted retrospectively from medical case notes and emergency patient admission lists. Length of hospital stay was significantly different between the two cohort patients. In the control group, the mean length of stay was 12.6±10.9 days, whereas in the ERABS cohort it was 7.1±2.9 days (p=0.02). During hospital stay, seven patients in the control group developed surgical complications, including one patient with major complications, whereas in the ERABS group three patients developed minor complications. Economic analysis revealed a different cost distribution between the two groups. On the whole, there were significant savings for almost all the variables taken into consideration, mainly driven by exclusion of using intensive care unit, which is by far more expensive than the average cost of post-anesthesia care unit. Our study confirmed the implementation of an ERABS protocol to have shortened hospital stay and was cost-saving while safeguarding patient safety

Assessing the Effectiveness of Chemical Marker Extraction from Amazonian Plant Cupuassu (Theobroma grandiflorum) by PSI-HRMS/MS and LC-HRMS/MS.

Acknowledgments The authors acknowledge the institutional and financial support from the Brazilian Federal Agency for Support and Evaluation of Graduate Education (CAPES) and the Brazilian Research Council (CNPq). Funding This research received no external funding.Peer reviewedPublisher PD

Effects of Bariatric Surgery on COVID-19: a Multicentric Study from a High Incidence Area

Introduction: The favorable effects of bariatric surgery (BS) on overall pulmonary function and obesity-related comorbidities could influence SARS-CoV-2 clinical expression. This has been investigated comparing COVID-19 incidence and clinical course between a cohort of patients submitted to BS and a cohort of candidates for BS during the spring outbreak in Italy. Materials and Methods: From April to August 2020, 594 patients from 6 major bariatric centers in Emilia-Romagna were administered an 87-item telephonic questionnaire. Demographics, COVID-19 incidence, suggestive symptoms, and clinical outcome parameters of operated patients and candidates to BS were compared. The incidence of symptomatic COVID-19 was assessed including the clinical definition of probable case, according to World Health Organization criteria. Results: Three hundred fifty-three operated patients (Op) and 169 candidates for BS (C) were finally included in the statistical analysis. While COVID-19 incidence confirmed by laboratory tests was similar in the two groups (5.7% vs 5.9%), lower incidence of most of COVID-19-related symptoms, such as anosmia (p: 0.046), dysgeusia (p: 0.049), fever with rapid onset (p: 0.046) were recorded among Op patients, resulting in a lower rate of probable cases (14.4% vs 23.7%; p: 0.009). Hospitalization was more frequent in C patients (2.4% vs 0.3%, p: 0.02). One death in each group was reported (0.3% vs 0.6%). Previous pneumonia and malignancies resulted to be associated with symptomatic COVID-19 at univariate and multivariate analysis. Conclusion: Patients submitted to BS seem to develop less severe SARS-CoV-2 infection than subjects suffering from obesity

Multivariate classification techniques and mass spectrometry as a tool in the screening of patients with fibromyalgia

Abstract: Fibromyalgia is a rheumatological disorder that causes chronic pain and other symptomatic conditions such as depression and anxiety. Despite its relevance, the disease still presents a complex diagnosis where the doctor needs to have a correct clinical interpretation of the symptoms. In this context, it is valid to study tools that assist in the screening of this disease, using chemical work techniques such as mass spectroscopy. In this study, an analytical method is proposed to detect individuals with fibromyalgia (n = 20, 10 control samples and 10 samples with fibromyalgia) from blood plasma samples analyzed by mass spectrometry with paper spray ionization and subsequent multivariate classification of the spectral data (unsupervised and supervised), in addition to the treatment of selected variables with possible associations with metabolomics. Exploratory analysis with principal component analysis (PCA) and supervised analysis with successive projections algorithm with linear discriminant analysis (SPA-LDA) showed satisfactory results with 100% accuracy for sample prediction in both groups. This demonstrates that this combination of techniques can be used as a simple, reliable and fast tool in the development of clinical diagnosis of Fibromyalgia

Physiological parameters for Prognosis in Abdominal Sepsis (PIPAS) Study : a WSES observational study

BackgroundTiming and adequacy of peritoneal source control are the most important pillars in the management of patients with acute peritonitis. Therefore, early prognostic evaluation of acute peritonitis is paramount to assess the severity and establish a prompt and appropriate treatment. The objectives of this study were to identify clinical and laboratory predictors for in-hospital mortality in patients with acute peritonitis and to develop a warning score system, based on easily recognizable and assessable variables, globally accepted.MethodsThis worldwide multicentre observational study included 153 surgical departments across 56 countries over a 4-month study period between February 1, 2018, and May 31, 2018.ResultsA total of 3137 patients were included, with 1815 (57.9%) men and 1322 (42.1%) women, with a median age of 47years (interquartile range [IQR] 28-66). The overall in-hospital mortality rate was 8.9%, with a median length of stay of 6days (IQR 4-10). Using multivariable logistic regression, independent variables associated with in-hospital mortality were identified: age > 80years, malignancy, severe cardiovascular disease, severe chronic kidney disease, respiratory rate >= 22 breaths/min, systolic blood pressure 4mmol/l. These variables were used to create the PIPAS Severity Score, a bedside early warning score for patients with acute peritonitis. The overall mortality was 2.9% for patients who had scores of 0-1, 22.7% for those who had scores of 2-3, 46.8% for those who had scores of 4-5, and 86.7% for those who have scores of 7-8.ConclusionsThe simple PIPAS Severity Score can be used on a global level and can help clinicians to identify patients at high risk for treatment failure and mortality.Peer reviewe

Transverse Emittance Measurement at REX ISOLDE

The transverse emittance of REX-ISOLDE beams has been measured at 0.3 MeV/u (RFQ energy) and 2.85 MeV/u (maximum energy). This document compares RMS emittances measured with a slit-grid emittance meter (NTG emittance-meter) and RMS emittances measured with the quadrupole-scan method or three-gradient method. The results are compared with other measurements made with the slitgrid emittance meter in 2006 and 2008. The data treatment process is also described

Three-gradient Emittance Measurements at REX-ISOLDE

The transverse emittance was measured using the three-gradient method (also known as the quadrupole scan method) and compared to the slit-grid method that is normally used at REX-ISOLDE. For a 2.85 MeV/u beam with A=q = 4 the rms normalised emittance was measured as 0:32 0:06 mm mrad with the three-gradient method, a factor of 5 larger than was measured by the NTG emittance meter. An investigation into the discrepancy and a hypothesis for its cause are detailed in this note

Preliminary Beam Tests at REX for an Automatic Cavity Phasing Routine at HIE-ISOLDE

The HIE upgrade at ISOLDE will use 32 independently phased superconducting quarterwave cavities, which will impose new demands on the operation and set-up of the linac. The large range of different radioactive species and the broad experimental programme means that the same beam species and energy are rarely studied twice, and the accelerator must be re-tuned for each experimental run. In order to expedite machine set-up it is foreseen to calculate and set automatically the cavity phases when the operator inputs the desired beam energy and A/q of the beam species. In this note we explore our understanding of the REX rf system and test our beam dynamics calculations with two independently phased 7-gap split-ring cavities

Transverse beam profile measurements with slit scanner and Faraday cup at REX-ISOLDE

The transverse profiles for the HIE-ISOLDE beams will be measured using a system composed of a scanning slit and a Faraday cup. A validation test of the proposed device was performed using the REX-ISOLDE stable beam and a prototype diagnostic box designed for HIE-ISOLDE. The slit used for this test was very thin (0.2 mm width), but still fairly good profiles could be obtained for beams with total current of around 20 pA (typical beam intensity during normal set-up procedures for REX-ISOLDE)

Transverse beam profile measurements with slit scanner and Faraday cup at REX-ISOLDE

The transverse profiles for the HIE-ISOLDE beams will be measured using a system composed of a scanning slit and a Faraday cup. A validation test of the proposed device was performed using the REX-ISOLDE stable beam and a prototype diagnostic box designed for HIE-ISOLDE. The slit used for this test was very thin (0.2 mm width), but still fairly good profiles could be obtained for beams with total current of around 20 pA (typical beam intensity during normal set-up procedures for REX-ISOLDE)