Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy

Background A reliable system for grading operative difficulty of laparoscopic cholecystectomy would standardise description of findings and reporting of outcomes. The aim of this study was to validate a difficulty grading system (Nassar scale), testing its applicability and consistency in two large prospective datasets. Methods Patient and disease-related variables and 30-day outcomes were identified in two prospective cholecystectomy databases: the multi-centre prospective cohort of 8820 patients from the recent CholeS Study and the single-surgeon series containing 4089 patients. Operative data and patient outcomes were correlated with Nassar operative difficultly scale, using Kendall’s tau for dichotomous variables, or Jonckheere–Terpstra tests for continuous variables. A ROC curve analysis was performed, to quantify the predictive accuracy of the scale for each outcome, with continuous outcomes dichotomised, prior to analysis. Results A higher operative difficulty grade was consistently associated with worse outcomes for the patients in both the reference and CholeS cohorts. The median length of stay increased from 0 to 4 days, and the 30-day complication rate from 7.6 to 24.4% as the difficulty grade increased from 1 to 4/5 (both p < 0.001). In the CholeS cohort, a higher difficulty grade was found to be most strongly associated with conversion to open and 30-day mortality (AUROC = 0.903, 0.822, respectively). On multivariable analysis, the Nassar operative difficultly scale was found to be a significant independent predictor of operative duration, conversion to open surgery, 30-day complications and 30-day reintervention (all p < 0.001). Conclusion We have shown that an operative difficulty scale can standardise the description of operative findings by multiple grades of surgeons to facilitate audit, training assessment and research. It provides a tool for reporting operative findings, disease severity and technical difficulty and can be utilised in future research to reliably compare outcomes according to case mix and intra-operative difficulty

Population‐based cohort study of outcomes following cholecystectomy for benign gallbladder diseases

Background The aim was to describe the management of benign gallbladder disease and identify characteristics associated with all‐cause 30‐day readmissions and complications in a prospective population‐based cohort. Methods Data were collected on consecutive patients undergoing cholecystectomy in acute UK and Irish hospitals between 1 March and 1 May 2014. Potential explanatory variables influencing all‐cause 30‐day readmissions and complications were analysed by means of multilevel, multivariable logistic regression modelling using a two‐level hierarchical structure with patients (level 1) nested within hospitals (level 2). Results Data were collected on 8909 patients undergoing cholecystectomy from 167 hospitals. Some 1451 cholecystectomies (16·3 per cent) were performed as an emergency, 4165 (46·8 per cent) as elective operations, and 3293 patients (37·0 per cent) had had at least one previous emergency admission, but had surgery on a delayed basis. The readmission and complication rates at 30 days were 7·1 per cent (633 of 8909) and 10·8 per cent (962 of 8909) respectively. Both readmissions and complications were independently associated with increasing ASA fitness grade, duration of surgery, and increasing numbers of emergency admissions with gallbladder disease before cholecystectomy. No identifiable hospital characteristics were linked to readmissions and complications. Conclusion Readmissions and complications following cholecystectomy are common and associated with patient and disease characteristics

Projeto Flora na comunidade Xucuru Kariri Warkanã de Aruanã, MG e as possibilidades do currículo narrativ

Projeto Flora na comunidade Xucuru Kariri Warkanã de Aruanã, MG e as possibilidades do currículo narrativoResumo   O artigo apresenta uma experiência vivida na comunidade escolar Xucuru Kariri, Caldas, MG, que teve como referência uma ação pedagógica denominada Projeto Flora, baseado na obra literária de Bartolomeu Campos de Queirós e na história de vida da matriarca da comunidade. As semelhanças entre a personagem Flora e a matriarca Flora suscitaram uma estreita relação entre a ficção e a realidade, promovendo a produção de um currículo narrativo, fazendo emergir o registro e memória com o potencial  mobilizar identidades na perspectiva da cultura local. Do ponto de vista teórico, a experiência é ressignificada a partir da proposição de Ivor Goodson que considera a possibilidade de tratar o currículo como narrativa.  As narrativas foram ouvidas e ressignificadas como mônadas, a partir de uma perspectiva benjaminiana. Palavras Chaves: currículo narrativo, mônadas, memória

The power of music to prevent and control emerging infectious diseases

Music is a powerful approach to engage communities and disseminate information. Specifically, health campaigns employing music have been used to promote behaviors that can prevent emerging infectious diseases (EIDs). For example, hip hop artists supported campaigns to prevent acquired immunodeficiency syndrome in the 70s in the United States, while Brazilian funk promoted vaccination to mitigate the ongoing COVID-19 pandemic. Similarly, we broadcast musical messages in local languages to increase community awareness and support prevention measures in Guinea and Liberia in response to the recent Ebola outbreak in 2021. Given the potential of music to promote both individual and population-level behavioral changes to prevent transmission, there is a need to consolidate information on music-based health interventions, and on how we can measure their effectiveness. In this perspective, we provide examples of relevant initiatives, discussing challenges and solutions associated with implementing interventions based on our experience with the 2021 Ebola outbreak. We recommend four steps for a successful music-based health intervention including (1) establishing a task force, (2) compose a “catchy” song including critical preventive measures, (3) deliver the song to the target audience, and (4) evaluate the campaign effectiveness. We argue that close interactions between scientists and musicians can produce rapid musical content for disease prevention. We also identify and discuss several methodological frameworks for testing the effectiveness of such interventions. We conclude that support from public health authorities, government media departments, and international agencies, is necessary to deliver wide outreach and long-term sustainability of musical messaging toward effective EID prevention

Digestibilidade da ração de frangos de corte suplementados com probióticos e antibiótico Digestibility of broiler chickens diet supplemented with probiotics and antibiotics

O objetivo deste experimento foi avaliar a digestibilidade da ração de frangos de corte a qual continha ou não antibiótico e probióticos na fase inicial (um a 20 dias) e na fase final (21-40 dias). As aves foram distribuídas em um delineamento inteiramente casualizado com quatro tratamentos: Tratamento 1- Dieta Testemunha; Tratamento 2 - Dieta Testemunha + 0,02 % de probiótico 1 (Calsporin 10®), Tratamento 3 - Dieta Testemunha + 2,0% na fase inicial e 0,63% na fase final de probiótico 2 (Estibion aves®); Tratamento 4 - Dieta Testemunha + 0,013% de antibiótico (Bacitracina de Zinco®) e 5 repetições de 10 e 8 aves por unidade experimental por fase, respectivamente. Os pintos foram criados em gaiolas de metabolismo. Os resultados demonstram que a digestibilidade de matéria seca, nitrogênio e energia metabolizável aparente não foi afetada pela suplementação de antibiótico e probióticos na dieta de frangos de corte.<br>The objective of this experiment was to evaluate the diets digestibility in broiler chickens with and without antibiotic and probiotics, in the initial phase (one to 20 days) and finish phase (21 to 40 days). Chickens distributed in a completely randomized design were used in four treatments: Treatment 1- Control diet; Treatment 2 - Control diet + 0.02% probiotic 1 (Calsporin 10®), Treatment 3 - Control diet + 2.0% initial phase and 0.63% finish phase probiotic 2 (Estibion aves®); Treatment 4 - Control diet + 0.013% of antibiotic (Bacitracina de Zinco®), and five repetitions, with ten and eight birds, respectively, were used in each experimental unit, which were kept in metabolism cages. The results demonstrate that the digestibility of dry matter, nitrogen and apparent metabolized energy were not affected by the supplementation of antibiotic and probiotics in the broiler chickens diet