Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

Contains fulltext : 172380.pdf (publisher's version ) (Open Access

Repeated observation of immune gene sets enrichment in women with non-small cell lung cancer

There are different biological and clinical patterns of lung cancer between genders indicating intrinsic differences leading to increased sensitivity to cigarette smoke-induced DNA damage, mutational patterns of KRAS and better clinical outcomes in women while differences between genders at gene-expression levels was not previously reported. Here we show an enrichment of immune genes in NSCLC in women compared to men. We found in a GSEA analysis (by biological processes annotated from Gene Ontology) of six public datasets a repeated observation of immune gene sets enrichment in women. “Immune system process”, “immune response”, “defense response”, “cellular defense response” and “regulation of immune system process” were the gene sets most over-represented while APOBEC3G, APOBEC3F, LAT, CD1D and CCL5 represented the top-five core genes. Characterization of immune cell composition with the platform CIBERSORT showed no differences between genders; however, there were differences when tumor tissues were compared to normal tissues. Our results suggest different immune responses in NSCLC between genders that could be related with the different clinical outcome

Moche: propuestas y perspectivas

Entre el 12 y 16 de abril de 1993 se realizó en la ciudad de Trujillo el Primer Coloquio sobre la Cultura Moche, organizado por la Facultad de Ciencias Sociales y el Provecto Arqueológico Huaca de la Luna de la Universidad Nacional de Trujillo, y gracias al apoyo de el Instituto Francés de Estudios Andinos (IFFA), la Fundación Ford, la Sociedad Cervecera de Trujillo y la Asociación Peruana de Fomento a las Ciencias Sociales (FOMCIENCIAS). Se reunieron veintiocho especialistas sobre la cultura Moche, con la finalidad de presentar y debatir las investigaciones realizadas durante las últimas dos décadas, así como hacer una evaluación de las investigaciones primigenias y proponer líneas de trabajo para el futuro. Este libro contiene los resultados de estas deliberaciones. Está organizado en cuatro partes con un total de 16 ponencias, además de un estudio introductorio y Otro de conclusiones y recomendaciones. La primera parte, titulada Nuevas Investigaciones, contiene ocho informes de campo que presentan datos nuevos producto de excavaciones realizadas durante los últimos seis años. Fa segunda parte, titulada Nuevas interpretaciones, incluye cuatro contribuciones (que tienen por común denominador el ofrecer principalmente revisiones críticas y de síntesis sobre la cultura Moche. La tercera parte. Ideología y poder, contiene tres artículos que tratan sobre la parte ideológica del mundo Moche. La cuarta incluye una ponencia sobre la importante tarea de conservación del patrimonio cultural, con especial énfasis en los murales polícromos de barro. Culmina el libro con una recopilación completa de la Bibliografía existente sobre la cultura Moche en sus diversos aspectos. Los trabajos que este libro contiene significan -sin duda alguna- un estado de la cuestión de nuestros conocimientos sobre la cultura Moche, y proporciona nuevos lineamentos que orientarán las investigaciones futuras. Por tanto, será un libro de interés tanto para los científicos como para el público en general. El libro consta de 550 páginas, con 228 ilustraciones en blanco y negro, 4 encartes, lo láminas con 40 lotos a color y 18 cuadros

Safety of hospital discharge before return of bowel function after elective colorectal surgery

Background: Ileus is common after colorectal surgery and is associated with an increased risk of postoperative complications. Identifying features of normal bowel recovery and the appropriateness for hospital discharge is challenging. This study explored the safety of hospital discharge before the return of bowel function. Methods: A prospective, multicentre cohort study was undertaken across an international collaborative network. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The main outcome of interest was readmission to hospital within 30 days of surgery. The impact of discharge timing according to the return of bowel function was explored using multivariable regression analysis. Other outcomes were postoperative complications within 30 days of surgery, measured using the Clavien–Dindo classification system. Results: A total of 3288 patients were included in the analysis, of whom 301 (9·2 per cent) were discharged before the return of bowel function. The median duration of hospital stay for patients discharged before and after return of bowel function was 5 (i.q.r. 4–7) and 7 (6–8) days respectively (P &lt; 0·001). There were no significant differences in rates of readmission between these groups (6·6 versus 8·0 per cent; P = 0·499), and this remained the case after multivariable adjustment for baseline differences (odds ratio 0·90, 95 per cent c.i. 0·55 to 1·46; P = 0·659). Rates of postoperative complications were also similar in those discharged before versus after return of bowel function (minor: 34·7 versus 39·5 per cent; major 3·3 versus 3·4 per cent; P = 0·110). Conclusion: Discharge before return of bowel function after elective colorectal surgery appears to be safe in appropriately selected patients