Predictors of patient satisfaction with anaesthesia and surgery care: a cohort study using the Postoperative Quality of Recovery Scale

Context Previous research has shown that most patients are satisfied with their anaesthetic care. For those who are not the causes may be multifactorial including dissatisfaction with surgical outcomes. Objectives We aimed to identify whether quality of recovery after anaesthesia and surgery measured in multiple domains affects patient satisfaction. Design Sub-group analysis of previously published observational cohort study of quality of recovery after surgery (using the Postoperative Quality of Recovery Scale) was used to identify predictors of incomplete satisfaction 3 days after surgery. Setting Multicentre perioperative surgery. Patients Patients !6 years old, undergoing a variety of operation types and all receiving general anaesthesia. Observations Of 701 patients, 573 completed the satisfaction question on day 3. Satisfaction was rated by a single fivepoint rating question. Patients were divided into two groups: 477 (83%) were completely satisfied and 96 (17%) were not completely satisfied. Multivariable logistic regression analysis was performed on preoperative and patient characteristics and recovery in five domains as follows: physiological, nociceptive (pain and nausea), emotive (anxiety and depression), activities of daily living and cognition. Recovery was defined as return to baseline values or better for all questions within each domain. Results Incomplete satisfaction was predicted by persistent pain or nausea at day 3 [OR 8.2 (95% CI 2.5 to 27), P < 0.01] and incomplete satisfaction at day 1 [OR 28 (95% CI 10 to 77), P < 0.01]. Paradoxically, incomplete satisfaction was less likely to occur if pain or nausea was present 15 min after surgery [OR 0.34 (95% CI 0.11 to 0.99), P < 0.05] or at day 1 [OR 0.30 (95% CI 0.10 to 0.91), P ¼ 0.03]. Incomplete recovery in the other domains did not influence satisfaction. Conclusion Of the recovery domains measured using the Postoperative Quality of Recovery Scale, only nociception (pain or nausea) contributed to incomplete satisfaction. Eur J Anaesthesiol 2012; 29:000-00

Learning Analytics to Assess Beliefs about Science: Evolution of Expertise as Seen through Biological Inquiry

Epistemological beliefs about science (EBAS) or beliefs about the nature of science knowledge, and how that knowledge is generated during inquiry, are an essential yet difficult to assess component of science literacy. Leveraging learning analytics to capture and analyze student practices in simulated or game-based authentic science activities is a potential avenue for assessing EBAS. Our previous work characterized inquiry practices of experts and novices engaged in simulated authentic science inquiry and suggested that practices may reflect EBAS. Here, we extend our prior qualitative work to quantitatively examine differences in practices and EBAS between non&ndash;science majors, biology majors, and biology graduates. We observed that inquiry practices of non&ndash;science majors and biology graduates were similar to the novice and expert practices, respectively, in our prior work. However, biology majors sometimes appeared to act like their undergraduate peers (e.g., performing fewer planning actions) but other times were more similar to biology graduates (e.g., performing complex investigations). We noted that cognitive constructs like metacognition were also important for understanding which practices were most likely to be reflective of EBAS. This work advances how to assess EBAS using learning analytics and raises questions regarding the development of cognitive processes like EBAS among aspiring biologists. </div

The association between protease inhibitors and anal cancer outcomes in veterans living with HIV treated with definitive chemoradiation: a retrospective study

Background: The incidence of anal squamous cell carcinoma has been increasing, particularly in people living with HIV (PLWH). There is concern that radiosensitizing drugs, such as protease inhibitors, commonly used in the management of HIV, may increase toxicities in patients undergoing chemoradiation. This study examines treatment outcomes and toxicities in PLWH managed with and without protease inhibitors who are receiving chemoradiation for anal cancer. Methods: Patient demographic, HIV management, and cancer treatment information were extracted from multiple Veterans Affairs databases. Patients were also manually chart reviewed. Among PLWH undergoing chemoradiation for anal carcinoma, therapy outcomes and toxicities were compared between those treated with and without protease inhibitors at time of cancer treatment. Statistical analysis was performed using chi-square, Cox regression analysis, and logistic regression. Results: A total of 219 PLWH taking anti-retroviral therapy undergoing chemoradiation for anal cancer were identified and included in the final analysis. The use of protease inhibitors was not associated with any survival outcome including colostomy-free survival, progression-free survival, or overall survival (all adjusted hazard ratio p-values\u3e 0.05). Regarding toxicity, protease inhibitor use was not associated with an increased odds of hospitalizations or non-hematologic toxicities; however, protease inhibitor use was associated with increased hospitalizations for hematologic toxicities, including febrile neutropenia (p \u3c 0.01). Conclusion: The use of protease inhibitors during chemoradiation for anal carcinoma was not associated with any clinical outcome or increase in non-hematologic toxicity. Their use was associated with increased hospitalizations for hematologic toxicities. Further prospective research is needed to evaluate the safety and efficacy of protease inhibitors for patients undergoing chemoradiation

Surgery for rheumatic heart disease in the Northern Territory, Australia, 1997-2016: what have we gained?

Background: Between 1964 and 1996, the 10-year survival of patients having valve replacement surgery for rheumatic heart disease (RHD) in the Northern Territory, Australia, was 68%. As medical care has evolved since then, this study aimed to determine whether there has been a corresponding improvement in survival. Methods: A retrospective study of Aboriginal patients with RHD in the Northern Territory, Australia, having their first valve surgery between 1997 and 2016. Survival was examined using Kaplan-Meier and Cox regression analysis. Findings: The cohort included 281 adults and 61 children. The median (IQR) age at first surgery was 31 (18-42) years; 173/342 (51%) had a valve replacement, 113/342 (33%) had a valve repair and 56/342 (16%) had a commissurotomy. There were 93/342 (27%) deaths during a median (IQR) follow-up of 8 (4-12) years. The overall 10-year survival was 70% (95% CI: 64% to 76%). It was 62% (95% CI: 53% to 70%) in those having valve replacement. There were 204/281 (73%) adults with at least 1 preoperative comorbidity. Preoperative comorbidity was associated with earlier death, the risk of death increasing with each comorbidity (HR: 1.3 (95% CI: 1.2 to 1.5), p50 mm Hg before surgery (HR 1.9 (95% CI: 1.2 to 3.1) p=0.007) were independently associated with death. Interpretation: Survival after valve replacement for RHD in this region of Australia has not improved. Although the patients were young, many had multiple comorbidities, which influenced long-term outcomes. The increasing prevalence of complex comorbidity in the region is a barrier to achieving optimal health outcomes

Restrictive or Liberal Red-Cell Transfusion for Cardiac Surgery.

BACKGROUND The effect of a restrictive versus liberal red-cell transfusion strategy on clinical outcomes in patients undergoing cardiac surgery remains unclear. METHODS In this multicenter, open-label, noninferiority trial, we randomly assigned 5243 adults undergoing cardiac surgery who had a European System for Cardiac Operative Risk Evaluation (EuroSCORE) I of 6 or more (on a scale from 0 to 47, with higher scores indicating a higher risk of death after cardiac surgery) to a restrictive red-cell transfusion threshold (transfuse if hemoglobin level was <7.5 g per deciliter, starting from induction of anesthesia) or a liberal red-cell transfusion threshold (transfuse if hemoglobin level was <9.5 g per deciliter in the operating room or intensive care unit [ICU] or was <8.5 g per deciliter in the non-ICU ward). The primary composite outcome was death from any cause, myocardial infarction, stroke, or new-onset renal failure with dialysis by hospital discharge or by day 28, whichever came first. Secondary outcomes included red-cell transfusion and other clinical outcomes. RESULTS The primary outcome occurred in 11.4% of the patients in the restrictive-threshold group, as compared with 12.5% of those in the liberal-threshold group (absolute risk difference, -1.11 percentage points; 95% confidence interval [CI], -2.93 to 0.72; odds ratio, 0.90; 95% CI, 0.76 to 1.07; P<0.001 for noninferiority). Mortality was 3.0% in the restrictive-threshold group and 3.6% in the liberal-threshold group (odds ratio, 0.85; 95% CI, 0.62 to 1.16). Red-cell transfusion occurred in 52.3% of the patients in the restrictive-threshold group, as compared with 72.6% of those in the liberal-threshold group (odds ratio, 0.41; 95% CI, 0.37 to 0.47). There were no significant between-group differences with regard to the other secondary outcomes. CONCLUSIONS In patients undergoing cardiac surgery who were at moderate-to-high risk for death, a restrictive strategy regarding red-cell transfusion was noninferior to a liberal strategy with respect to the composite outcome of death from any cause, myocardial infarction, stroke, or new-onset renal failure with dialysis, with less blood transfused. (Funded by the Canadian Institutes of Health Research and others; TRICS III ClinicalTrials.gov number, NCT02042898 .)

Geoscience for urban development

The population of London is around seven million. The infrastructure to support this requires London’s ground conditions to be thoroughly investigated and understood. Countless boreholes have been drilled for ground investigation and water supplies. Yet subterranean construction work in London continues to reveal the presence of ‘anomalous’ ground conditions. These occurrences have been discovered in isolation, with no further work to explain them, yet such conditions can prove costly if not predicted by initial site surveys. Thus there is a need to establish a refined geological framework for London, within which these ‘anomalies’ can be explained

High density ammonia storage materials

This Thesis considers the use of solid-state metal ammines as ammonia storage materials and endeavours to understand these materials on a fundamental chemical level. The ammines of LiBH₄, MgCl₂, MgBr₂, MgI₂ and Mg(BH₄)₂, are investigated. The structures of lithium borohydride ammines, Li(NH₃)nBH₄ with n = 1, 2, 3 and 4 are solved using X-ray and neutron diffraction, vibrational spectroscopy, nuclear magnetic resonance, and first-principles calculations. The reversibility, bonding and ammonia storage properties of this system are discussed, and investigated using gravimetric analysis and vibrational spectroscopy. The ammines of magnesium halides are investigated using X-ray and neutron powder diffraction, gravimetric techniques, nuclear magnetic resonance, first-principles calculations and vibrational spectroscopy. Their disordered structures, bonding, and decomposition are discussed, and the trends in their properties are used to interpret the properties of other ammines. The ammines of magnesium borohydride are investigated using X-ray and neutron powder diffraction, gravimetric techniques, first-principles calculations and vibrational spectroscopy. The structure, decomposition and reversibility of Mg(NH₃)₆(BH₄)₂ as an ammonia store are presented. Throughout the Thesis and at the end of each Chapter the possibility of using these ammines as solid-state ammonia stores is discussed

The mitochondrial permeability transition pore and its role in anaesthesia-triggered cellular protection during ischaemia-reperfusion injury

C1 - Journal Articles Referee