Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

BACKGROUND

Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications.

METHODS

We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC).

FINDINGS

In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]).

INTERPRETATION

In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required.

FUNDING

British Journal of Surgery Society.

The psychological burden of long-term care facilities personnel during the SARS-COV-2 pandemic – a national survey in poland

Introduction

The high COVID-19 morbidity and mortality are observed among residents in long-term care facilities (LTCF) worldwide. Employees of LTCF, who are facing a critical epidemiological situation endangering the vulnerable residents, are exposed to pandemic’s psychological consequences daily.

Objectives

The main aim of this study was to assess psychological consequences (somatic symptoms, anxiety and insomnia, social dysfunction, and depression) among LTCF employees exposed to the SARS-CoV-2 pandemic crisis. Moreover, we investigated if factors such as: personal protective equipment (PPE) availability, safety guidelines or access to psychiatric and psychological support at the workplace, correlated with the level of psychological distress experienced by personnel.

Methods

A cross-sectional study was conducted among personnel of LTCF in Poland. The survey consisted of the sociodemographic section, the authors’ questionnaire with questions related to COVID-19 exposure, working conditions, access to PPE and mental health services, GHQ Questionnaire-28.

Results

show that access to PPE (P= .018), to workplace safety guidelines (P= .031), psychological support at workplace (P<0.01), fixed shift schedule (P= .05) and feeling that the right number of staff are employed in the workplace (P= .009), were related to the lower severity of psychopathological symptoms evaluated with the GHQ-28.

Conclusions

The study indicates an evidence that LTCF personnel are susceptible to the development of anxiety, depression, insomnia and social dysfunction during the pandemic crisis. However, these can be modified by: access to PPE, safety guidelines and psychological support. Findings from this study lay a basis for effective interventions aiming to support psychological health within this group.

1,000,000 cases of COVID-19 outside of China: The date predicted by a simple heuristic

We forecast 1,000,000 COVID-19 cases outside of China by March 31st, 2020 based on a heuristic and WHO situation reports. We do not model the COVID-19 pandemic; we model only the number of cases. The proposed heuristic is based on a simple observation that the plot of the given data is well approximated by an exponential curve. The exponential curve is used for forecasting the growth of new cases. It has been tested for the last situation report of the last day. Its accuracy has been 1.29% for the last day added and predicted by the 57 previous WHO situation reports (the date 18 March 2020). Prediction, forecast, pandemic, COVID-19, coronavirus, exponential growth curve parameter, heuristic, epidemiology, extrapolation, abductive reasoning, WHO situation report.

Alginate based hydrogel for tissue regeneration: optimization, antibacterial activity and mechanical properties

Purpose: In this work our aim was to reveal the relationship between sodium alginate concentration and crosslinking level, also the ratio of release of the antibacterial additives: silver nanoparticles and metronidazole. Moreover, we examine obtained hydrogel as a potential dressing material for regenerative medicine. Design/methodology/approach: In the research specimens of hydrogels were tested to define their mechanical and physicochemical properties like antibacterial activity against gramnegative Escherichia coli and gram-positive Staphylococcus aureus, viscosity and conductivity. Findings: The concentration of alginate and presence of antibacterial additives influence on the crosslinking level. Mechanical properties of hydrogels are similar to human skin. Only hydrogels with addition of metronidazole and AgNP inhibits bacteria growth after 18 h. In case of gram-negative Escherichia coli both of the aseptic additives inhibits bacteria growth, but sodium alginate hydrogel with silver nanoparticles gives better results in tests with grampositive Staphylococcus aureus. Research limitations/implications: The presence of metronidazole in hydrogel, especially its incorporation and binding with mannuronic and guluronic acid residues must be clarified in more advanced research. Practical implications: Obtained results shows that sodium alginate hydrogels with 0.1mg/ml of alginate, due to its properties are proper as a dressing material. Based on the results, and more advanced tests with metronidazole, we can consider dressing design. Originality/value: Unique value of this work is that we completed the gap in knowledge about the relation of crosslinking level and mechanical properties with are crucial to proper tissue healing and addition of popular aseptic agents.

Evaluation of hepatitis C surveillance in Poland in 1998

The aim was to evaluate hepatitis C surveillance in Poland during 1998. Hepatitis C reports were obtained from epidemiology offices. Public health staff were interviewed to collect information on surveillance operations. To estimate the proportion of acute cases among the total reported, a study was conducted in the Warsaw district to validate case reports. A total of 1661 (97.2%) hepatitis C cases were studied. Hepatitis C surveillance was timely and acceptable to the user, but did not provide a number of information elements required to differentiate acute from chronic cases of infection. Of the 268 case reports available in the Warsaw district, only 15 (5.6%) met the acute hepatitis C case definition. It is concluded that hepatitis C surveillance in Poland cannot provide useful incidence estimates and information regarding risk factors for acute infection. A strict case definition and a modified case form with specific questions for HCV transmission routes should be applied.

[The impact of the case of definition in public health surveillance. Assessment of the number of hepatitis C cases]

BACKGROUND/AIMS

Hepatitis C cases in Poland are notified based on symptoms of hepatic disease and anti-HCV and/or PCR for HCV RNA test results. The purpose of this study was to make an effort to define hepatitis C for public health surveillance and assessment of the number of acute hepatitis C cases reported from Warsaw Voivodeship during 1998.

METHODS

The 1998 hepatitis C infection case reports were analyzed. Additional data were collected through medical charts and laboratory reports review. The definition for an acute case of hepatitis C included: positive anti-HCV or PCR for HCV RNA, symptoms of acute hepatic disease, negative IgM anti-HAV, and negative IgM anti-HBc or HBsAg.

RESULTS

Of the 268 (99.3% of 270) available case reports, 15 (5.6%) were identified as acute cases of hepatitis C.

CONCLUSION

Currently used hepatitis C case criteria do not allowed for a proper assessment of the burden of disease. It is necessary to create explicit definition of acute and chronic hepatitis C cases for public health surveillance.

The cost of developing site-specific environmental regulations: evidence from EPA's project XL

The flagship of the Environmental Protection Agency's regulatory reinvention initiative, Project XL has been touted as a regulatory blueprint for a site-specific, performance-based pollution-control system, but widespread complaints about the costs of the program beg the question of whether the costs of tailoring regulations to individual facilities are manageable. To address this question, this paper presents original survey data on a sample of 11 XL projects. We find that the fixed costs of putting in place XL agreements are substantial, averaging over $450,000 per firm. While stakeholder negotiations are widely cited as the principal source for these costs, we find that they actually arise mainly from interaction between participating facilities and the EPA. Moreover, EPA management problems are perceived by our survey respondents as having inflated project development costs. Finally, we find that the key factors that explains differences in costs across XL projects are the scope and complexity of the project proposal. These findings suggest that Project XL favors large firms that can afford to pay significant project development costs, that EPA management problems must be resolved to reduce costs, and that there may be a significant economic bias against complex and innovative proposals--precisely the type of proposals that Project XL was designed to foster in order to improve the efficiency of the regulatory system.

[The effect of 6 week treatment with theophylline on spirometric parameters, nonspecific bronchial reactivity and the concentration of soluble interleukin 2 receptor in serum of asthmatic patients]

This study allowed to investigate the effect of theophylline (Theo-Dur Astra) given 1 tablet á 200 mg per day in the evening for six weeks on histamine-induced airways responsiveness++ (PC20H), spirometric parameters and the concentration of soluble interleukin 2 receptor (sIL-2R) in serum. 21 patients with mild asthma (6 women, 15 men), average age 34.8 +/- 11.4 years were qualified for this study. PC20H was estimated according to Cockroft's method using pneumatic inhalator (Voyage-Secura Nova). Concentration of sIL-2R in serum was measured by Predicta Interleukin 2 Receptor Kit (Genzyme). Lung function test was measured by means of ABC PNEUMO (abc MED). Six week treatment with theophylline significantly increased PC20H in comparison with basal results (0.74 +/- 0.68 mg/ml before and 0.89 +/- 0.71 mg/ml after p < 0.04). The concentration of sIL-2R in serum did not change significantly during theophylline therapy. Treatment with theophylline significantly increased FEV1 (3.64 l/sec before and 3.84 l/sec after p < 0.001). The anti-inflammatory effect of theophilline is more clearly shown in the decrease of histamine-inducted airways responsiveness than in the decreased concentration of sIL-2R in serum.

[Hospital acquired infections caused by hepatitis C virus]

The purpose of the paper was to present opinions endosed in the literature regarding risk factors, modes of transmission and sources of hepatitis C virus (HCV) infections in the hospital settings. Infections occurring among health care workers and patients, residual risks to the blood supply and blood transfusion, routes of hepatitis C transmission in haemodialysis centers were analyzed. In the paper significance of disinfection, sterilization, work practices designed to minimize or eliminate exposure, and use of personal protective equipment (universal precautions) wa showed. The importance of the invasive diagnostic and therapeutic procedures in HCV transmission was stressed. Based on the presented findings, procedures to prevent nosocomial infections of HCV should be defined and implemented in all hospitals.

[Treatment with salmeterol and quality of life in patients with asthma]

The aim of this study was to assess an influence of 4-week treatment with salmeterol on quality of life in asthmatic patients. It was a double blind, placebo controlled study. On the first visit spirometer parameters and PC20H were measured. Within one week of observation all patients recorded scores of asthma symptoms and after that time 22 patients were randomised to the treatment with salmeterol or placebo. On the fourth visit 4-week salmeterol or placebo therapy was finished and all parameters were carried out as on the first visit. Symptoms severity recorded in diary cards was reduced after 4-week of salmeterol therapy. Four week treatment with salmeterol did not change PC20H. Treatment with salmeterol reduced severity of asthma symptoms and use of short-acting beta 2-agonists. The reduction of asthma severity and the use of bronchodilators was more pronounced in the group of patients treated with salmeterol than in the placebo group, but the differences were not significant.

[Cost analysis of treating depression. Comparison of tricyclic antidepressants and selective serotonine re-uptake inhibitors]

The question of costs in treating the most widely spread diseases has appeared in medical literature for several years. A task of modern health economics is to estimate and, if possible, to reduce direct and indirect costs of illnesses having social dimension. Since depression takes important place among them, it also stays in a circle of economists' interests. Latest changes in pharmacotherapy of depression, connected with appearence, by tricyclics, selective serotonine reuptake inhibitors, seem to be very promising: they have similar antidepressive effectiveness, but differ in toxicity after overdose, quantity and quality of side-effects, treatment dropout. However the organisation of Polish health service still passes over this economic aspect, it is probable that this situation will change in the nearest future, so it can be interesting to approach the methods of economic thinking in western psychiatric services.

The Salmonella mutagenicity test: evaluation of 29 drug candidates

The Salmonella mutagenicity test (Ames assay) is part of the routine screening battery applied to all new drugs at The Upjohn Company. The purpose of this paper is to report results for 29 compounds. These compounds are very diverse in chemical structure and represent classes of compounds selected because of known biological activity and other reasons. None of the compounds reported here produced an increase in revertant colonies in the Salmonella strains employed (TA98, TA100, TA1535, TA1537 and TA1538) and therefore the Salmonella mutagenicity results with these materials do not suggest potential for mutagenesis or carcinogenesis.

Bacterial mutagenicity and mammalian cell DNA damage by several substituted anilines

Several substituted alkyl- and haloanilines were tested for their ability to mutate Salmonella typhimurium and to damage the DNA of mammalian (V79) cells. These results were correlated with their reported carcinogenicity. Of 9 suspected carcinogens, 4 were bacterial mutagens and 4 (out of 7 tested) damaged DNA of V79 cells. The following compounds were weakly mutagenic (less than 150 revertants/mumole): 4-fluoroaniline, 2,3-, 2,4-, 2,5- and 3,4-dimethylaniline, and 2-methyl-4-fluoroaniline. The following compounds were strong mutagens: 2,4,5-trimethylaniline, 2-methyl-4-chloro-, and 2-methyl-4-bromo-, 4-methyl-2-chloro-, 4-methyl-2-bromo- and 2-ethyl-4-chloroaniline. The compounds which damaged DNA in V79 cells were: 2 methyl-4-chloroaniline, 2-methyl-4-bromoaniline, 2,4,5- and 2,4,6-trimethylaniline.

Acute barbiturate poisoning in the 39th week of pregnancy. Case report

A rare case of suicidal barbiturate poisoning in the 39th week of pregnancy is reported. Diagnostic difficulties and prolonged coma were the reason that the foetus was delivered by Caesarean section. The authors discuss the effect of barbiturates on the foetus and the possibilities of other ways of management.