Prospective study comparing the safety and efficacy of totally tubeless percutaneous nephrolithotomy vs standard percutaneous nephrolithotomy

Background: To evaluate the feasibility and safety of totally tubeless percutaneous nephrolithotomy (PCNL) Vs standard PCNL.Methods: From August 2014 to January 2016, 66 patients underwent PCNL in our institute. Of this group, 35 patients underwent traditional nephrostomy drainage following PCNL. A tubeless procedure was performed in the remaining 31 patients. These  groups were compared with respect to age, stone burden, intraoperative events, postoperative pain, analgesic requirements, soakage, postoperative change in hemoglobin, hospitalization time and complication rates.Results: Two groups were comparable with respect to age, stone burden (2.03 cm Vs. 2.12 cm) and intraoperative events. The mean pain score (day2 - 4.95 vs. 2.95) (day3 - 4.33 vs. 1.44) and analgesic requirement (mg diclofenac) (day2 - 140.22 vs. 65.31) (day3 - 124.44 vs. 43.89) was significantly less for group 2 on day 2 and 3. There was significant problem of soakage from nephrostomy tract in group 1. Patients in group 2 returned faster to normal activities but there was no difference found in drop in hemoglobin, complication rates even in subset of patients with large stone burden. No patient required readmission in the follow-up for pain, obstruction or infection in group 2. One patient developed urinoma which resolved conservativelyConclusions: In selected cases totally tubeless PCNL is feasible and safe

HyperLoRA for PDEs

Physics-informed neural networks (PINNs) have been widely used to develop neural surrogates for solutions of Partial Differential Equations. A drawback of PINNs is that they have to be retrained with every change in initial-boundary conditions and PDE coefficients. The Hypernetwork, a model-based meta learning technique, takes in a parameterized task embedding as input and predicts the weights of PINN as output. Predicting weights of a neural network however, is a high-dimensional regression problem, and hypernetworks perform sub-optimally while predicting parameters for large base networks. To circumvent this issue, we use a low ranked adaptation (LoRA) formulation to decompose every layer of the base network into low-ranked tensors and use hypernetworks to predict the low-ranked tensors. Despite the reduced dimensionality of the resulting weight-regression problem, LoRA-based Hypernetworks violate the underlying physics of the given task. We demonstrate that the generalization capabilities of LoRA-based hypernetworks drastically improve when trained with an additional physics-informed loss component (HyperPINN) to satisfy the governing differential equations. We observe that LoRA-based HyperPINN training allows us to learn fast solutions for parameterized PDEs like Burger's equation and Navier Stokes: Kovasznay flow, while having an 8x reduction in prediction parameters on average without compromising on accuracy when compared to all other baselines.Comment: 8 pages, 4 figures, 3 Table

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

Background: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. Methods: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. Findings: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96–1·28). Interpretation: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. Funding: National Institute for Health Research Health Services and Delivery Research Programme

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

BACKGROUND: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. METHODS: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. FINDINGS: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96-1·28). INTERPRETATION: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. FUNDING: National Institute for Health Research Health Services and Delivery Research Programme

Prospective study comparing the safety and efficacy of totally tubeless percutaneous nephrolithotomy vs standard percutaneous nephrolithotomy

Background: To evaluate the feasibility and safety of totally tubeless percutaneous nephrolithotomy (PCNL) Vs standard PCNL.Methods: From August 2014 to January 2016, 66 patients underwent PCNL in our institute. Of this group, 35 patients underwent traditional nephrostomy drainage following PCNL. A tubeless procedure was performed in the remaining 31 patients. These  groups were compared with respect to age, stone burden, intraoperative events, postoperative pain, analgesic requirements, soakage, postoperative change in hemoglobin, hospitalization time and complication rates.Results: Two groups were comparable with respect to age, stone burden (2.03 cm Vs. 2.12 cm) and intraoperative events. The mean pain score (day2 - 4.95 vs. 2.95) (day3 - 4.33 vs. 1.44) and analgesic requirement (mg diclofenac) (day2 - 140.22 vs. 65.31) (day3 - 124.44 vs. 43.89) was significantly less for group 2 on day 2 and 3. There was significant problem of soakage from nephrostomy tract in group 1. Patients in group 2 returned faster to normal activities but there was no difference found in drop in hemoglobin, complication rates even in subset of patients with large stone burden. No patient required readmission in the follow-up for pain, obstruction or infection in group 2. One patient developed urinoma which resolved conservativelyConclusions: In selected cases totally tubeless PCNL is feasible and safe

Prevalence and predictors of gestational diabetes mellitus in rural Assam: a cross-sectional study using mobile medical units

Objective To determine the prevalence and predictors of gestational diabetes mellitus (GDM) in rural Assam, India using a network of Mobile Medical Units.Study design A field-based cross-sectional study.Settings Rural areas of Assam state, India.Participants A total of 1410 pregnant women in gestational age of 24–28 weeksIntervention Identification of pregnant women in 24–28 weeks of pregnancy from villages and administering them Government of India recommended oral glucose tolerance test for GDM confirmation.Primary and secondary outcome measures Presence of gestational diabetes among pregnant women, risk factors and predictors of GDM.Results A total of 1212 pregnant women underwent the oral glucose tolerance test. One hundred and ninety-eight women were ineligible due to existing chronic diseases or very high blood glucose level before the test. The overall GDM prevalence in Assam was 16.67% (95% CI 14.61% to 18.89%). Women aged 26–30 years (adjusted odds ratio, aOR 1.70; CI 1.14 to 2.52), who passed 10th class (aOR 1.58; CI 1.05 to 2.37), belonging to Muslim religion (aOR 1.52; 95% CI 1.05 to 2.21) and above poverty line (aOR 1.38; 95% CI 1.00 to 1.91) had significantly increased likelihood of developing GDM compared with respective baseline groups (p<0.05). Body mass index, gravida and being non-anaemic were non-significant risk factors for GDM. Family history of diabetes (aOR 1.82; 95% CI 1.08 to 3.06) and smoking (aOR 1.61; 95% CI 1.10 to 2.35) were significant and independent predictors of GDM.Conclusion The prevalence of GDM in rural Assam is high. The mobile medical units may play a significant role in the implementation of GDM screening, diagnosis, treatment to ensure better maternal and foetal health outcomes in rural Assam