Does the implementation of a Quality Improvement Care Bundle reduce the incidence of acute kidney injury in patients undergoing emergency laparotomy?

Previous work has demonstrated a survival improvement following the introduction of an enhanced recovery protocol in patients undergoing emergency laparotomy (the emergency laparotomy pathway quality improvement care (ELPQuiC) bundle). Implementation of this bundle increased the use of intra-operative goal directed fluid therapy and ICU admission, both evidence-based strategies recommended to improve kidney outcomes. The aim of this study was to determine if the observed mortality benefit could be explained by a difference in the incidence of AKI pre- and post-implementation of the protocol.This article is freely available via Open Access. Click on the Publisher URL to access the full-text via the publisher's site

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

Effectiveness of a repellent containing DEET and EBAAP for preventing tick bites

OBJECTIVE Topical repellents can provide effective personal protection from tick-borne diseases by preventing the attachment of ticks. The goal of this study was to assess the effectiveness of a commercially available repellent spray containing both N,N-diethyl-3-methylbenzamide, previously known as N,N-diethyl-m-toluamide (DEET), and ethyl-butylacetylaminopropionate (EBAAP) against tick bites in a population at risk in Switzerland under real-life conditions. METHODS The effectiveness of an insect repellent spray containing both DEET and EBAAP was evaluated in a randomized, double-blind, placebo-controlled field study. The study, requiring simple application of the repellent to exposed skin, was carried out on 276 forestry workers and orienteers under everyday conditions in Switzerland from May to September 1999. We measured total effectiveness of the repellent by the following formula: percentage effectiveness = 100 x (T(P) - T(R))/T(P), where T(P) and T(R) were the average number of ticks per hour spent in wooded areas for the repellent and placebo groups, respectively. RESULTS The average number of tick bites per hour of exposure to wooded areas differed significantly between the placebo (n = 138) and repellent (n = 138) groups, 0.17 vs 0.10 (P < .05). Total repellent effectiveness against tick attachment was 41.1% (95% CI, 2.5-79.6). On the arms, an effectiveness of 66% (95% CI, 17.3-114.7) was observed. No significant difference in the average number of unattached ticks could be found. CONCLUSIONS This study found that an easily applied repellent is moderately effective in reducing the risk of tick bites

Nuclear excitation in muonic gold

Energies and intensities of muonic X-rays in gold were measured at the CERN muon channel with an experimental set-up as described by Backe et al. (1972). The 2p-1s and 3d-2p transitions could only be analysed taking into account beside the static quadrupole interaction a dynamical hyperfine interaction of the 2p states, which leads to an excitation of the first four nuclear levels. The dynamical hyperfine interaction was calculated using the core excitation model (de Shalit, (1961)). (0 refs)

Dexamethasone but not tadalafil improves exercise capacity in adults prone to high-altitude pulmonary edema

SCOPUS: ar.jinfo:eu-repo/semantics/publishe