The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

Identity Formation Among Kurds in Sweden: A study on second-generation immigrants

This thesis concerns theories of identity formation and feeling of belonging amongst people in Sweden with Kurdish background. The purpose of this thesis is to study the processes of identity and feelings of belonging among second-generation immigrants of Kurds in the Swedish society. The study presents some theories about identity formation and diaspora making, as well as secondary theories to give the reader a broader understanding on the subject as a whole. The research focus on the individual understanding of identity construction of five Kurds whom have been interview for this purpose. This study will show that identity and belonging are core issues that second-generation Kurds have to deal with. Additionally, the thesis will also show that induvial identities are not static but change depending on circumstances and context. The results show that young Kurds have the ability to navigate and feel a strong sense of belonging to their Kurdish identity while still feeling part of the Swedish community. By balancing the two identities and socializing with both cultural contexts, a third space is formed in which their hybrid identity emerges