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

Relationship of Transport Infrastructure, China-Pakistan Economic Corridor (CPEC) and Elimination of Poverty: A Case of Hazara Division

Poverty is a critical problem for humanity, and still, no adequate measures are taken to get rid of it in the world, especially in the third world specifically. Road and transportation infrastructure can also play a pivotal role in eliminating Poverty at a certain level and enhances economic growth and development in the region. The current research aims to identify the impact of Poverty and the use of roads &amp; infrastructure on CPEC (China–Pakistan economic corridor, CPEC). For this research, 4 Districts of Hazara Division were selected, and data were collected from 800 Citizens (Mansehra, Abbottabad, Haripur, and Battagram) with the help of the snowball sampling technique. For compiling the data, a structured questionnaire was used. Results indicate that transport and infrastructure facilitieshave a positive impact on CPEC benefits and elimination of Poverty. Similarly, CPEC “Benefits” partially mediate the relationship of transport infrastructure Facilities with poverty elimination

REPRESENTATION AND RESPONSIBILITIES OF WOMEN LIBRARIANS IN UNIVERSITY LIBRARIES OF PAKISTAN

Academic libraries evolve to meet the demands of the contemporary era and it is imperative to critically examine the composition of library professionals, specifically focusing on the representation and responsibilities of women librarians. The role of women in the library profession has undergone significant transformations over time, and understanding the challenges and opportunities they encounter within this dynamic environment is essential for fostering inclusivity and equality. The current study shed light on the perspectives, difficulties, and suggestions of female librarians at the university libraries in Punjab in respect of leadership practices. The current study used quantitative research approach. An extensive literature review was conducted to develop questionnaire for the current study. This questionnaire survey was shared with chief librarians, deputy chief librarians, senior librarians and librarians. Descriptive and inferential statistics was used to analyze data. The results show that female librarians share working in different organizations 31.67% but the female’s share as a heads in different organizations is 8.2%. The most females are working in different sections like, Circulation patterns, Cataloging / Metadata Services, Acquisitions, and very low numbers of females are working in digital services / electronic resources sections. Women librarians intend to work in digital resources and library automation systems departments. Their less preferred areas are user literacy and collaboration with different stakeholders. The study also explores that female librarian indicated a need for regular evaluations and extensive training courses in this regard. The results highlight how important it is to implement gender-inclusive policies, and leadership professional development to improve the efficacy of women librarians

FACTORS AFFECTING SATISFACTION AND USE OF INSIGNIA MOBILE APPLICATION: A SURVEY OF UNIVERSITY STUDENTS

As technology continues to shape educational landscapes, the integration of mobile library services into academic environments has become increasingly significant. The role of academic libraries is important for integration of these services. The current study investigates the level of satisfaction and use. It also examined the relationship of different factors with satisfaction and actual use of mobile app Insignia among students of two universities in Pakistan. The current study used quantitative research approach. Questionnaire was used to collect data. Both the descriptive and inferential statistics were used to analyze data. Data was collected from 269 students through the structured questionnaire. The findings showed that less than one third of the students were using this app always or frequently. Furthermore, students were not satisfied with Insignia app. The results showed low or insignificant effects of gender, age, and education on satisfaction and use of mobile app. Perceived ease of use and perceived usefulness has positive but weak correlation with satisfaction and actual use of mobile app. This research contributes to the growing body of literature on mobile technology in education and offers practical implications for librarians, students, and technology developers striving to optimize mobile library services for student needs

Current and potential role of public libraries in Pakistan for serving homeless and poor (e.g., nomads, beggars, street children)

Purpose One of the toughest issues in public libraries have ever faced is serving homeless. The homeless people need a way out of poverty and assistance to lessen the suffering along the way because their numbers are growing yearly. By giving information on every conceivable topic in a wide range of formats, public libraries open up new worlds to the underprivileged. The public libraries have the capacity to get access, empower and enable the poor to change their lives. It is possible to overcome the dilemma between serving the majority groups and extending services to special groups like the nomads, beggars or street children. Methodology This study adopted a quantitative approach and used a questionnaire to explore the outreach services of public libraries for underserved users and to measure the current and future services for such users. E-mails including a link to an online survey were sent to librarians of public libraries in Punjab to collect data. Seventy-one participants responded to the survey. Findings Overall, the participants indicated that outreach services for nomads, beggars and street children are not currently being provided by public libraries in Punjab but respondents wanted to provide such services in future. The findings of the study revealed that public libraries in Punjab ignored nomads, beggars and street children for providing outreach services. All the respondents were of the view that public libraries should provide such services. The study indicated the need for more inclusive and welcoming library services for vulnerable and neglected segments of the society by public libraries. Conclusion They belong to one of the underserved user groups who deserve to be treated with respect. Libraries should be a safe haven and provide a stable learning environment for all users, regardless of their social and living status. Libraries have the social responsibility to promote sensitivity among the public toward the homeless and to be proactive in providing community support to the homeless

Preoperative risk factors for conversion from laparoscopic to open cholecystectomy: a validated risk score derived from a prospective U.K. database of 8820 patients

Background Laparoscopic cholecystectomy is commonly performed, and several factors increase the risk of open conversion, prolonging operating time and hospital stay. Preoperative stratification would improve consent, scheduling and identify appropriate training cases. The aim of this study was to develop a validated risk score for conversion for use in clinical practice. Patients and methods Preoperative patient and disease-related variables were identified from a prospective cholecystectomy database (CholeS) of 8820 patients, divided into main and validation sets. Preoperative predictors of conversion were identified by multivariable binary logistic regression. A risk score was developed and validated using a forward stepwise approach. Results Some 297 procedures (3.4%) were converted. The risk score was derived from six significant predictors: age (p&nbsp;=&nbsp;0.005), sex (p&nbsp;&lt;&nbsp;0.001), indication for surgery (p&nbsp;&lt;&nbsp;0.001), ASA (p&nbsp;&lt;&nbsp;0.001), thick-walled gallbladder (p&nbsp;=&nbsp;0.040) and CBD diameter (p&nbsp;=&nbsp;0.004). Testing the score on the validation set yielded an AUROC&nbsp;=&nbsp;0.766 (p&nbsp;&lt;&nbsp;0.001), and a score &gt;6 identified patients at high risk of conversion (7.1% vs. 1.2%). Conclusion This validated risk score allows preoperative identification of patients at six-fold increased risk of conversion to open cholecystectomy