The Cholecystectomy As A Day Case (CAAD) Score: A Validated Score of Preoperative Predictors of Successful Day-Case Cholecystectomy Using the CholeS Data Set

Background Day-case surgery is associated with significant patient and cost benefits. However, only 43% of cholecystectomy patients are discharged home the same day. One hypothesis is day-case cholecystectomy rates, defined as patients discharged the same day as their operation, may be improved by better assessment of patients using standard preoperative variables. Methods Data were extracted from a prospectively collected data set of cholecystectomy patients from 166 UK and Irish hospitals (CholeS). Cholecystectomies performed as elective procedures were divided into main (75%) and validation (25%) data sets. Preoperative predictors were identified, and a risk score of failed day case was devised using multivariate logistic regression. Receiver operating curve analysis was used to validate the score in the validation data set. Results Of the 7426 elective cholecystectomies performed, 49% of these were discharged home the same day. Same-day discharge following cholecystectomy was less likely with older patients (OR 0.18, 95% CI 0.15–0.23), higher ASA scores (OR 0.19, 95% CI 0.15–0.23), complicated cholelithiasis (OR 0.38, 95% CI 0.31 to 0.48), male gender (OR 0.66, 95% CI 0.58–0.74), previous acute gallstone-related admissions (OR 0.54, 95% CI 0.48–0.60) and preoperative endoscopic intervention (OR 0.40, 95% CI 0.34–0.47). The CAAD score was developed using these variables. When applied to the validation subgroup, a CAAD score of ≤5 was associated with 80.8% successful day-case cholecystectomy compared with 19.2% associated with a CAAD score >5 (p < 0.001). Conclusions The CAAD score which utilises data readily available from clinic letters and electronic sources can predict same-day discharges following cholecystectomy

Determination of Michaelis-Menten parameters obtained from isothermal flow calorimetric data

Recent papers have reported [Thermochim. Acta 399 (2003) 63; Thermochim. Acta, in press] the results of a preliminary inter/intra laboratory study into the suitability of the base-catalysed hydrolysis of methyl paraben as a test and reference reaction for isothermal flow-through calorimeters. It was shown that this reaction can be used to investigate the flow characteristics of the instrument being used. It has also allowed, for the first time, the calculation of accurate values for the rate constant and for the enthalpy change, DeltaH (hereafter H (enthalpy) for simplicity) of reaction directly from the calorimetric data, free from assumption. These findings have been extended to permit the direct determination of Michaelis-Menten based kinetic parameters from calorimetric data again free from assumption (except that the system conforms to Michaelis-Menten kinetic theory). This paper describes the method used for such an analysis and reports the results of a preliminary study on the urea/urease enzymatic system

Informacje o autorach

The effects of acidosis on cardiac electrophysiology and excitation-contraction coupling have been studied extensively. Acidosis decreases the strength of contraction and leads to altered calcium transients as a net result of complex interactions between protons and a variety of intracellular processes. The relative contributions of each of the changes under acidosis are difficult to establish experimentally, however, and significant uncertainties remain about the key mechanisms of impaired cardiac function. In this paper, we review the experimental findings concerning the effects of acidosis on the action potential and calcium handling in the cardiac ventricular myocyte, and we present a modelling study that establishes the contribution of the different effects to altered Ca2+ transients during acidosis. These interactions are incorporated into a dynamical model of pH regulation in the myocyte to simulate respiratory acidosis in the heart

Survey of the effect of fill volume on the values for the enthalpy and rate constant derived from isothermal microcalorimetry: applications of a newly developed test reaction

A recent paper has reported the results of an inter/intralaboratory study into a test and reference reaction for isothermal microcalorimeters, the imidazole catalysed hydrolysis of triacetin. The values derived were 2.8 x 10(-6)+/-9.7 x 10(-8) dm(3) mol(-1) s(-1) and -91.7+/-3 kJ mol(-1) for the rate constant and enthalpy, respectively. This paper reports the findings of an investigation, using this test reaction, into the effect of ampoule fill volume on the recovery of the derived rate constant and enthalpy. Fill volume is likely to be of significance for all commercially available, heat conduction, isothermal microcalorimeters. Experiments, reported here, were performed in a thermal activity monitor (TAM, thermometric AB, Jarfalla, Sweden) operating in the batch mode, for 3, 4 and 20 ml glass ampoules and 4 ml stainless steel ampoules. It is shown that the rate constant can be accurately recovered at fill volumes greater than 50% but below 50% fill volume this accuracy diminishes