Objective
To assess whether instillation of lidocaine gel both before and after flexible cystoscopy is more effective at reducing post procedural symptoms than instillation of lidocaine gel pre ...flexible cystoscopy alone. We hypothesise that inadequate urethral dwell time and dilution of lidocaine gel by the irrigation fluid during flexible cystoscopy limits its anaesthetic efficacy. Only one other study has attempted to reduce bothersome urinary symptoms through an intervention after flexible cystoscopy.
Methods
This was a randomised controlled trial in which patients were randomised 1:1 to receive lidocaine gel pre and post flexible cystoscopy (treatment) or lidocaine gel pre flexible cystoscopy only (control). Patient-reported outcome measures were used to assess symptoms and quality of life prior to cystoscopy, on day 2 and day 7 post cystoscopy.
Result
Fifty patients were divided equally between the treatment and control groups. There were no significant differences in baseline characteristics between the groups (
p
= 1.000). An overall symptoms variable was measured, though no significant difference was found in the distribution of responses between the groups at baseline, 2 or 7 days after the flexible cystoscopy (
p
= 0.423, 0.651,0.735). In the treatment group, 1 patient (4.0%) presented to a doctor for review following flexible cystoscopy, and 4 patients (16.0%) presented in the control group (
p
= 0.349).
Conclusion
Initial study results suggest that post-operative lidocaine does not significantly limit the exacerbation of urinary symptoms following flexible cystoscopy; however, our results are not powered to detect a small difference. We do not recommend a change in practice based on our results.
Background
Recent evidence has suggested an association between postoperative non‐steroidal anti‐inflammatory drugs (NSAIDs) and increased operation‐specific complications. This study aimed to ...determine the safety profile following gastrointestinal surgery across a multicentre setting in the UK.
Methods
This multicentre study was carried out during a 2‐week interval in September–October 2013. Consecutive adults undergoing elective or emergency gastrointestinal resection were included. The study was powered to detect a 10 per cent increase in major complications (grade III–V according to the Dindo–Clavien classification). The effect of administration of NSAIDs on the day of surgery or the following 2 days was risk‐adjusted using propensity score matching and multivariable logistic regression to produce adjusted odds ratios (ORs). The type of NSAID and the dose were registered.
Results
Across 109 centres, early postoperative NSAIDs were administered to 242 (16·1 per cent) of 1503 patients. Complications occurred in 981 patients (65·3 per cent), which were major in 257 (17·1 per cent) and minor (Dindo–Clavien grade I–II) in 724 (48·2 per cent). Propensity score matching created well balanced groups. Treatment with NSAIDs was associated with a reduction in overall complications (OR 0·72, 95 per cent confidence interval 0·52 to 0·99; P = 0·041). This effect predominately comprised a reduction in minor complications with high‐dose NSAIDs (OR 0·57, 0·39 to 0·89; P = 0·009).
Conclusion
Early use of NSAIDs is associated with a reduction in postoperative adverse events following major gastrointestinal surgery.
Some non‐steroidal anti‐inflammatory drugs may be beneficial
Harvest data are widely used to understand hunting in tropical forests. However, survey methods are susceptible to biases which could affect results. We compare catch data from two approaches applied ...concurrently in the same villages (n = 7) in Gola Forest, Liberia: hunter recall interviews (n = 208 hunters, 253 trips) and continuous monitoring by village‐based assistants (n = 53 hunters, 404 trips). We use Bayesian multi‐level models to: (a) compare estimates of animals killed per trip for each data source; (b) test whether differences between villages are consistent across data sources and (c) identify potential sources of bias. Hunter recall produced higher, and more variable, catch estimates than village‐based monitoring, with mean of 7.3 animals 6.0–8.8 95%CI compared to 3.0 2.4–3.6, for a trip lasting 3.2 days (the average duration from village‐based monitoring). Mean catch‐per‐village from village‐based monitoring failed to predict hunter recall catch and villages with highest catch differed between methods. Differences in trip duration were a potential source of bias: hunter recall recorded longer, more variable, trips (mean 4.0 ± SD 3.0 days, range = 1–32) than village‐based monitoring (mean 3.2 ± SD 1.7, range = 1–10). Longer trips were associated with higher catch‐per‐day, use of guns, forest camps and accompaniment by another person; so nonrandom sampling of these traits may have introduced bias. Between‐hunter variability was lower with village‐based monitoring, suggesting sampling captured a less diverse subgroup of hunters, or that recall data were noisier due to reporting errors. Our results demonstrate that methodological biases can have large effects on catch estimates and should be carefully considered when designing or interpreting hunting studies.
Appl. Phys. Lett. 88, 062514 (2006) We report measurements of the electron transport through atomic-scale
constrictions and tunnel junctions between ferromagnetic electrodes. Structures
are ...fabricated using a combination of e-beam lithography and controlled
electromigration. Sample geometries are chosen to allow independent control of
electrode bulk magnetizations. As junction size is decreased to the single
channel limit, conventional anisotropic magnetoresistance (AMR) increases in
magnitude, approaching the size expected for tunneling magnetoresistance (TMR)
upon tunnel junction formation. Significant mesoscopic variations are seen in
the magnitude and sign of the magnetoresistance, and no evidence is found of
large ballistic magnetoresistance effects.
Trainee research collaboratives (TRCs) have pioneered high quality, prospective 'snap-shot' surgical cohort studies in the UK. Outcomes After Kidney injury in Surgery (OAKS) was the first TRC cohort ...study to attempt to collect one-year follow-up data. The aims of this study were to evaluate one-year follow-up and data completion rates, and to identify factors associated with improved follow-up rates.
In this multicentre study, patients undergoing major gastrointestinal surgery were prospectively identified and followed up at one-year following surgery for six clinical outcomes. The primary outcome for this report was the follow-up rate for mortality at 1 year. The secondary outcome was the data completeness rate in those patients who were followed-up. An electronic survey was disseminated to investigators to identify strategies associated with improved follow-up.
Of the 173 centres that collected baseline data, 126 centres registered to participate in one-year follow-up. Overall 62.3% (3482/5585) of patients were followed-up at 1 year; in centres registered to collect one-year outcomes, the follow-up rate was 82.6% (3482/4213). There were no differences in sex, comorbidity, operative urgency, or 7-day postoperative AKI rate between patients who were lost to follow-up and those who were successfully followed-up. In centres registered to collect one-year follow-up outcomes, overall data completeness was 83.1%, with 57.9% (73/126) of centres having ≥95% data completeness. Factors associated with increased likelihood of achieving ≥95% data completeness were total number of patients to be followed-up (77.4% in centres with < 15 patients, 59.0% with 15-29 patients, 51.4% with 30-59 patients, and 36.8% with > 60 patients, p = 0.030), and central versus local storage of patient identifiers (72.5% vs 48.0%, respectively, p = 0.006).
TRC methodology can be used to follow-up patients identified in prospective cohort studies at one-year. Follow-up rates are maximized by central storage of patient identifiers.
Nano Lett. 6, 1518-1521 (2006) We report electronic transport measurements of single-molecule transistor
devices incorporating bipyridyl-dinitro oligophenylene-ethynylene dithiol
(BPDN-DT), a ...molecule known to exhibit conductance switching in other
measurement configurations. We observe hysteretic conductance switching in 8%
of devices with measurable currents, and find that dependence of the switching
properties on gate voltage is rare when compared to other single-molecule
transistor devices. This suggests that polaron formation is unlikely to be
responsible for switching in these devices. We discuss this and alternative
switching mechanisms.
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