Review of Lyric Opera Production of Show Boat

The premiere effort of the Renée Fleming Initiative brought Jerome Kern and Oscar Hammerstein’s masterpiece Show Boat to the Lyric Opera stage, demonstrating an annual commitment to producing works of the American musical theatre. As Lyric’s general director Anthony Freud asserted in an open letter to patrons, “great works of musical theatre profit enormously from the resources of a major opera company.” While Francesca Zambello’s lavish production may have affirmed that statement within the context of the opera house, little attention was paid to the elements that make American musical theatre generically different from opera, most notably book scenes with storytelling and narrative expressed through realistic spoken dialogue. Such scenes often require a style of acting that conveys relationship and emotional content through nuance and subtlety, rather than through size and scale. Some elements of Zambello’s production served the scope and scale of the musical very well, while others robbed it of a sense of realism or fluidity. Indeed, the Lyric production conjured ghosts from what one might imagine to be the original Ziegfeld production of 1927, evident in static stage pictures of massive ensembles framed by elaborate scenography. The Lyric production may have revived the work and injected it with fresh color and sound, but it neither reinvented it nor provided any new illumination to the eighty-five-year-old piece. If this is to be an ongoing tradition, the Lyric will need to find a way to adequately address those generic differences between opera and musical theatre, especially if it intends to produce more contemporary works

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)