Patient reporting of complications after surgery: What impact does documenting postoperative problems from the perspective of the patient using telephone interview and postal questionnaires have on the identification of complications after surgery?

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. Objectives To identify the frequency of postoperative complications, including problems identified by patients and complications occurring after discharge from hospital. To identify how these impact on quality of life (QoL) and the patient's perception of the success of their treatment. Design Data from three prospective sources: Surgical audit, a telephone interview (2 weeks after discharge) and a patient-focused questionnaire (2 months after surgery) were retrospectively analysed. Setting Dunedin Hospital, Dunedin, New Zealand. Participants Of the 500 patients, 100 undergoing each of the following types of surgeries: Anorectal, biliary, colorectal, hernia and skin. Primary and secondary outcome measures The primary outcomes were complications and the 36-item Short Form Health Survey (SF-36). Secondary outcomes included the patient's ratings of their treatment and a questionnaire-derived patient satisfaction score. Results 226 patients reported a complication; there were 344 separate complications and 411 reports of complications (16% of complications were reported on more than one occasion). The audit, telephone interview and questionnaire captured 12.6%, 36.3% and 51% of the 411 reports, respectively. Patients with complications had a lower SF-36 Physical Composite Summary (PCS) score (48.5 vs 43.9, p=0.021) and a lower Patient Satisfaction Score (85.6 vs 74.6, p<0.001). Rating of information received, care received, symptoms experienced, QoL and satisfaction with surgery were all significantly worse for patients with complications. On linear regression analysis, surgical complications, American Society of Anaesthesiologists score and age all made a similar contribution to the SF-36 PCS score, with standardised beta coefficients between 0.19 and 0.21. Conclusions Following surgery, over 40% of patients experienced complications. The QoL and satisfaction score were significantly less than for those without complications. The majority of complications were diagnosed after discharge from hospital. Taking more notice of the patient perspective helps us to identify problems, to understand what is important to them and may suggest ways to improve perioperative care

Update kosten en baten van harmonisatie van de rechtspositie van overheidspersoneel

Dit rapport beschrijft de kosten en baten voor de overheid als ambtenaren dezelfde rechtspositie krijgen als andere werknemers (‘harmonisatie’). Zij krijgen dan een arbeidscontract in plaats van een aanstelling; gaan voor rechtszaken naar de kantonrechter in plaats van de bestuursrechter; en krijgen een eigen CAO. Omdat er bij verschillende kosten en baten onzekerheid bestaat, wordt gewerkt met drie scenario’s. De kosten van harmonisatie zijn eenmalig en liggen tussen € 53 en 186 miljoen. Dit betreft met name opleidingen en administratieve organisatie. De baten zijn € 6,6 tot 21,9 miljoen per jaar. Deze baten bestaan uit besparingen bij de rechtspraak en besparingen door deregulering. In het middenscenario is de terugverdientijd ruim zeven jaar. In het meest ongunstige geval loopt de terugverdientijd op tot 28 jaar. Bij een goede planning en sturing van het proces - waarbij de kosten in de hand worden gehouden - en baten die gunstig uitvallen, is de investering in drie jaar terugverdiend. Dit rapport bouwt voort op een rapport van SEO en Regioplan uit 2006. De kosten zijn gedaald omdat de huidige inzichten wijzen op minder behoefte aan opleidingen. De baten zijn hoger door een betere inschatting van de opbrengsten van de overgang van bestuursrechter naar kantonrechter

Deformed two center shell model

A highly specialized two-center shell model has been developed accounting for the splitting of a deformed parent nucleus into two ellipsoidaly deformed fragments. The potential is based on deformed oscillator wells in direct correspondance with the shape change of the nuclear system. For the first time a potential responsible for the necking part between the fragments is introduced on potential theory basis. As a direct consequence, spin-orbit {\bf ls} and {\bf l$^2$} operators are calculated as shape dependent. Level scheme evolution along the fission path for pairs of ellipsoidaly deformed fragments is calculated. The Strutinsky method yields the shell corrections for different mass asymmetries from the superheavy nucleus $^{306}$122 and $^{252}$Cf all along the splitting process.Comment: 32 pages, 8 figure

Recombinants between Deformed wing virus and Varroa destructor virus-1 may prevail in Varroa destructor-infested honeybee colonies

We have used high-throughput Illumina sequencing to identify novel recombinants between deformed wing virus (DWV) and Varroa destructor virus-1 (VDV-1), which accumulate to higher levels than DWV in both honeybees and Varroa destructor mites. The recombinants, VDV-1VVD and VDV-1DVD, exhibit crossovers between the 5’-untranslated region (5’-UTR), and/or the regions encoding the structural (capsid) and non-structural viral proteins. This implies the genomes are modular and that each region may evolve independently, as demonstrated in human enteroviruses. Individual honeybee pupae were infected with a mixture of observed recombinants and DWV. The strong correlation between VDV-1DVD levels in honeybee pupae and the associated mites was observed, suggesting that this recombinant, with a DWV-derived 5’-UTR and non-structural protein region flanking VDV- 1-derived capsid encoding region, is better adapted to transmission between V. destructor and honeybees than the parental DWV or a recombinant bearing the VDV-1-derived 5’-UTR (VDV-1VVD)

Extinction of ants' feeding and social foraging on myrmecochorous seeds

BACKGROUND/AIMS: Fibrocaps is a dry powder fibrin sealant containing human plasma-derived fibrinogen and thrombin. The safety, efficacy, and application methods for Fibrocaps were evaluated in an exploratory, first-in-human, noncomparative, clinical study. METHODS: Patients with minor bleeding/oozing after elective partial hepatic resection had Fibrocaps applied to the bleeding site either directly from the vial or from a spray device, with manual pressure applied using a cellulose, collagen, or gelatin sponge, if needed. Safety was evaluated at screening and postoperative days 1, 2, and 5, and weeks 4 and 12. The formation of anti-thrombin antibodies was assessed at baseline, and after 4 and 12 weeks. Time to hemostasis (TTH) within 10 min was determined. RESULTS: Twenty-nine patients were treated with Fibrocaps; 6 experienced serious adverse events that were not related to the course of treatment. Adverse events occurring in >10% of patients were nausea, constipation, hypotension, obstipation, hypokalemia, and postoperative pain. Most adverse events were mild or moderate in severity. No patient developed anti-thrombin antibodies. The percentage of patients who achieved hemostasis was 93%; the median TTH was 3.8 min (range 0.3-10.3). Manual pressure was applied with Fibrocaps in 19 patients and considered beneficial in most. CONCLUSION: Fibrocaps was well tolerated in patients undergoing elective hepatic resection and resulted in rapid hemostasis. These safety and efficacy results support further clinical testing of this ready-to-use fibrin sealant as an adjunct to surgical hemostasis. (c) 2015 S. Karger AG, Basel

Induction and suppression of NF-κB signalling by a DNA virus of <i>Drosophila</i>

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