The aim of this study was to compare open surgery (OS) with laparoscopic surgery (LS) for perforated peptic ulcer (PPU) disease using a National dataset.
PPU disease is typically treated surgically ...with an omental patch. This can be performed through OS or a LS. Current evidence in OS versus LS suggests equivalence in mortality and postoperative complications, but a decrease in pain and wound infections with LS.
A one-to-one propensity score-matched analysis of patients who underwent PPU repair from December 2013 to December 2017 using data from the National Emergency Laparotomy Audit was performed. Patients with an initially laparoscopic approach were classed as LS even if converted to OS. The primary end-point was 90-day mortality; secondary endpoints were length of stay (LOS), re-operation, and re-admission to critical care. Multivariable logistic and linear models were created to compare the effect of operative approach on binary and continuous outcomes with log-rank tests for time-to-event data.
A total of 5253 patients underwent surgery in the study period. After propensity-matching, 2 groups of 1158 patients were created. Overall 90-day mortality was 7.5%. There was no difference between the LA and OA for 90-day mortality (7.2% vs 8.5%, OR 0.80, 95% CI 0.56- 1.15, P = 0.23), median LOS (equivalent at 7 days, P = 0.09), reoperation (3.6% vs 4.0%, P = 0.74), or re-admission to critical care (2.8% vs 2.9%, P = 0.92). Across the 4-year study period LS use increased from 20% to 26% and the conversion rate decreased from 40% to 31%.
Short outcomes from laparoscopic PPU repair appear equivalent to open repair. There is increasing adoption of LS with decreasing conversion rates. LS for PPU appears to be an acceptable approach in this setting.
Inconsistent reporting of patient characteristics in clinical research hampers reproducibility and limits analysis opportunities. This paper proposes condition-specific ‘Core Descriptor Sets’ ...comprising key factors like demographics, disease severity, comorbidities, and prognosis to standardize Table 1 reporting.
Development entails stakeholder involvement, systematic identification of descriptors, value rating, and consensus-building using multiple Delphi rounds. Final agreement comes at an expert meeting.
Benefits include easier cross-study comparison, for example, through individual patient meta-analysis, facilitated by comparison of consistently reported individual data rather than group-level analysis. This may also support routine data analyses, subgroup and risk identification, and reduced research waste. Core Descriptor Sets describe cohorts thoroughly while minimizing research burden. They are intended to enable improved clinical characterization, personalization, reproducibility, data sharing, and knowledge building.
•We propose a community consensus approach to agree on a ‘Core descriptor set’ for conditions.•This identifies community priorities and theories of disease•CDS will ensure consistent capture of baseline data relevant to a condition•This method could be adopted into research practice.•This might aid future reporting, and facilitate comparisons between studies.
Excess body adiposity is associated with increased risk of pancreatic cancer, and in animal models excess intra-pancreatic fat is a driver of pancreatic carcinogenesis. Within a programme to evaluate ...pancreatic fat and PC risk in humans, we assessed whether MR-quantified pancreatic fat fraction (PFF) was ‘fit for purpose’ as an imaging biomarker.
We determined PFF using MR spectroscopy (MRS) and MR chemical shift imaging (CS-MR), in two groups. In Group I, we determined accuracy of MR-derived PFF with histological digital fat quantification in 12 patients undergoing pancreatic resection. In a second study, we assessed reproducibility in 15 volunteers (Group IIa), and extended to 43 volunteers (Group IIa & IIb) to relate PFF with MR-derived hepatic fat fraction (HFF), body mass index (BMI), and waist circumference (WC) using linear regression models. We assessed intra- and inter-observer, and between imaging modality levels of agreement using Bland-Altman plots.
In Group I patients, we found strong levels of agreement between MRS and CS-MR derived PFF and digitally quantified fat on histology (rho: 0.781 and 0.672 respectively). In Group IIa, there was poor reproducibility in initial assessments. We refined our protocols to account for 3D dimensionality of the pancreas, and found substantially improved intra-observer agreements. In Group II, HFF and WC were significantly correlated with PFF (p values < 0.05).
Both CS-MR and MRS (after accounting for pancreatic 3D dimensionality) were ‘fit for purpose’ to determine PFF and might add information on cancer prediction independent from measures of general body adiposity.
Diese Festschrift ist Professor Alfred Bergmann zum 65. Geburtstag gewidmet. Das renommierte Herausgeberteam aus bekannten Gesellschaftsrechtlern würdigt den Jubilar, der als Vorsitzender des II. ...Senats des Bundesgerichtshofs über lange Jahre an zentraler Stelle des deutschen Gesellschaftsrechts wirkte.
Der vorliegende Band bietet eine breitgefächerte vergleichende Analyse zu grundlegenden gesellschaftsrechtlichen Themen in Deutschland, China, Japan und Südkorea. Er untersucht verschiedene ...Unternehmensbereiche sowie die Bewertung der Aktien und deren Verfahren und analysiert die zivilrechtliche Haftung des Unternehmens und seiner Direktoren bzgl. falscher Jahresabschlüsse wie auch die gesellschaftsrechtlichen Regeln zum Ausschluss von Minderheitsaktionären.
Aim
Adhesive small bowel obstruction (ASBO) is a common surgical emergency condition. Research in the field is plentiful; however, inconsistency in outcome reporting makes comparisons challenging. ...The aim of this study was to define a core outcome set (COS) for studies of ASBO.
Methods
The long list of outcomes was identified through systematic review, and focus groups across different geographical regions. A modified Delphi consensus exercise of three rounds was undertaken with stakeholder groups (patients and clinicians). Items were rated on a 9‐point Likert scale. Items exceeding 70% rating at 7–9 were passed to the consensus meeting. New item proposals were invited in round 1. Individualised feedback on prior voting compared to other participants was provided. An international consensus meeting was convened to ratify the final COS.
Results
In round 1, 56 items were rated by 118 respondents. A total of 18 items reached consensus, and respondents proposed an additional 10 items. Round 2 was completed by 90 respondents, and nine items achieved consensus. In round 3, 80 surveys were completed; one item achieved consensus, and five borderline items were identified. The final COS included 26 outcomes, mapped to the following domains: Interventions, need for stoma, septic complications, return of gut function, patient reported outcomes, and recurrence of obstruction, as well as mortality, failure to rescue, and time to resolution.
Conclusion
This COS should be used in future studies in the treatment of adhesive SBO. Further studies to define a core measurement set are needed to identify the optimum tools to measure each outcome.
Der Bankrechtstag 2015 in Frankfurt am Main widmete sich Themen wie"Verbraucherschutz und Institutsaufsicht" und "Aktuelle Rechtsfragen der (bürgerlich-rechtlichen) Prospekthaftung". Referenten aus ...Wissenschaft und Praxis diskutierten unter der Leitung von Andreas Früh undKatja Langenbucher.
We present an analysis of 15 Type Ia supernovae (SNe Ia) at redshift (9 at ) recently discovered in the CANDELS and CLASH Multi-Cycle Treasury programs using WFC3 on the Hubble Space Telescope. We ...combine these SNe Ia with a new compilation of ∼1050 SNe Ia, jointly calibrated and corrected for simulated survey biases to produce accurate distance measurements. We present unbiased constraints on the expansion rate at six redshifts in the range based only on this combined SN Ia sample. The added leverage of our new sample at leads to a factor of ∼3 improvement in the determination of the expansion rate at z = 1.5, reducing its uncertainty to ∼20%, a measurement of . We then demonstrate that these six derived expansion rate measurements alone provide a nearly identical characterization of dark energy as the full SN sample, making them an efficient compression of the SN Ia data. The new sample of SNe Ia at usefully distinguishes between alternative cosmological models and unmodeled evolution of the SN Ia distance indicators, placing empirical limits on the latter. Finally, employing a realistic simulation of a potential Wide-Field Infrared Survey Telescope SN survey observing strategy, we forecast optimistic future constraints on the expansion rate from SNe Ia.
PDF