3 research outputs found

    The Effect of Batched Production on Demand Amplification

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    Demand amplification is the tendency of small fluctuations in demand at the retailer end of the supply chain to be amplified as they are communicated down the chain. A brief review of the literature on this phenomenon is presented, concentrating particularly on the causes propounded. A continuous-time differential equation model of a production-inventory system is then proposed. The application of a novel optimal control algorithm is applied in order to simulate the rational behaviour of inventory managers. This algorithm allows us to mimic the discontinuous cost structures implied by the advantages of batched production. By simulating the response of the system to small changes in demand, the relationship between batch size and the magnitude of demand amplification is investigated

    Safety and efficacy of non-steroidal anti-inflammatory drugs to reduce ileus after colorectal surgery

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    Background: Ileus is common after elective colorectal surgery, and is associated with increased adverse events and prolonged hospital stay. The aim was to assess the role of non-steroidal anti-inflammatory drugs (NSAIDs) for reducing ileus after surgery. Methods: A prospective multicentre cohort study was delivered by an international, student- and trainee-led collaborative group. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The primary outcome was time to gastrointestinal recovery, measured using a composite measure of bowel function and tolerance to oral intake. The impact of NSAIDs was explored using Cox regression analyses, including the results of a centre-specific survey of compliance to enhanced recovery principles. Secondary safety outcomes included anastomotic leak rate and acute kidney injury. Results: A total of 4164 patients were included, with a median age of 68 (i.q.r. 57-75) years (54路9 per cent men). Some 1153 (27路7 per cent) received NSAIDs on postoperative days 1-3, of whom 1061 (92路0 per cent) received non-selective cyclo-oxygenase inhibitors. After adjustment for baseline differences, the mean time to gastrointestinal recovery did not differ significantly between patients who received NSAIDs and those who did not (4路6 versus 4路8 days; hazard ratio 1路04, 95 per cent c.i. 0路96 to 1路12; P = 0路360). There were no significant differences in anastomotic leak rate (5路4 versus 4路6 per cent; P = 0路349) or acute kidney injury (14路3 versus 13路8 per cent; P = 0路666) between the groups. Significantly fewer patients receiving NSAIDs required strong opioid analgesia (35路3 versus 56路7 per cent; P < 0路001). Conclusion: NSAIDs did not reduce the time for gastrointestinal recovery after colorectal surgery, but they were safe and associated with reduced postoperative opioid requirement

    Safety and efficacy of non-steroidal anti-inflammatory drugs to reduce ileus after colorectal surgery

    No full text
    Background: Ileus is common after elective colorectal surgery, and is associated with increased adverse events and prolonged hospital stay. The aim was to assess the role of non-steroidal anti-inflammatory drugs (NSAIDs) for reducing ileus after surgery. Methods: A prospective multicentre cohort study was delivered by an international, student- and trainee-led collaborative group. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The primary outcome was time to gastrointestinal recovery, measured using a composite measure of bowel function and tolerance to oral intake. The impact of NSAIDs was explored using Cox regression analyses, including the results of a centre-specific survey of compliance to enhanced recovery principles. Secondary safety outcomes included anastomotic leak rate and acute kidney injury. Results: A total of 4164 patients were included, with a median age of 68 (i.q.r. 57\u201375) years (54\ub79 per cent men). Some 1153 (27\ub77 per cent) received NSAIDs on postoperative days 1\u20133, of whom 1061 (92\ub70 per cent) received non-selective cyclo-oxygenase inhibitors. After adjustment for baseline differences, the mean time to gastrointestinal recovery did not differ significantly between patients who received NSAIDs and those who did not (4\ub76 versus 4\ub78 days; hazard ratio 1\ub704, 95 per cent c.i. 0\ub796 to 1\ub712; P = 0\ub7360). There were no significant differences in anastomotic leak rate (5\ub74 versus 4\ub76 per cent; P = 0\ub7349) or acute kidney injury (14\ub73 versus 13\ub78 per cent; P = 0\ub7666) between the groups. Significantly fewer patients receiving NSAIDs required strong opioid analgesia (35\ub73 versus 56\ub77 per cent; P &lt; 0\ub7001). Conclusion: NSAIDs did not reduce the time for gastrointestinal recovery after colorectal surgery, but they were safe and associated with reduced postoperative opioid requirement
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