Simplified risk-prediction for benchmarking and quality improvement in emergency general surgery. Prospective, multicenter, observational cohort study.

BACKGROUND AND AIMS: Emergency General Surgery (EGS) conditions account for millions of deaths worldwide, yet it is practiced without benchmarking-based quality improvement programs. The aim of this observational, prospective, multicenter, nationwide study was to determine the best benchmark cutoff points in EGS, as a reference to guide improvement measures. METHODS: Over a 6-month period, 38 centers (5% of all public hospitals) attending EGS patients on a 24-h, 7-days a week basis, enrolled consecutive patients requiring an emergent/urgent surgical procedure. Patients were stratified into cohorts of low (i.e., expected morbidity risk <33%), middle and high risk using the novel m-LUCENTUM calculator. RESULTS: A total of 7258 patients were included; age (mean ± SD) was 51.1 ± 21.5 years, 43.2% were female. Benchmark cutoffs in the low-risk cohort (5639 patients, 77.7% of total) were: use of laparoscopy ≥40.9%, length of hospital stays ≤3 days, any complication within 30 days ≤ 17.7%, and 30-day mortality ≤1.1%. The variables with the greatest impact were septicemia on length of hospital stay (21 days; adjusted beta coefficient 16.8; 95% CI: 15.3 to 18.3; P < .001), and respiratory failure on mortality (risk-adjusted population attributable fraction 44.6%, 95% CI 29.6 to 59.6, P < .001). Use of laparoscopy (odds ratio 0.764, 95% CI 0.678 to 0.861; P < .001), and intraoperative blood loss (101-500 mL: odds ratio 2.699, 95% CI 2.152 to 3.380; P < .001; and 500-1000 mL: odds ratio 2.875, 95% CI 1.403 to 5.858; P = .013) were associated with increased morbidity. CONCLUSIONS: This study offers, for the first time, clinically-based benchmark values in EGS and identifies measures for improvement.

MACVIA-LR (Fighting Chronic Diseases for Active and Healthy Ageing in Languedoc-Roussillon): A Success Story of the European Innovation Partnership on Active and Healthy Ageing.

The Région Languedoc Roussillon is the umbrella organisation for an interconnected and integrated project on active and healthy ageing (AHA). It covers the 3 pillars of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA): (A) Prevention and health promotion, (B) Care and cure, (C) and (D) Active and independent living of elderly people. All sub-activities (poly-pharmacy, falls prevention initiative, prevention of frailty, chronic respiratory diseases, chronic diseases with multimorbidities, chronic infectious diseases, active and independent living and disability) have been included in MACVIA-LR which has a strong political commitment and involves all stakeholders (public, private, patients, policy makers) including CARSAT-LR and the Eurobiomed cluster. It is a Reference Site of the EIP on AHA. The framework of MACVIA-LR has the vision that the prevention and management of chronic diseases is essential for the promotion of AHA and for the reduction of handicap. The main objectives of MACVIA-LR are: (i) to develop innovative solutions for a network of Living labs in order to reduce avoidable hospitalisations and loss of autonomy while improving quality of life, (ii) to disseminate the innovation. The three years of MACVIA-LR activities are reported in this paper.

Evaluación de galletas dulces enriquecidas con germen de maíz y fibra de soya / Evaluation of cookies enriched with corn germ and soy fiber

El objetivo del estudio fue evaluar cuatro galletas dulces en cuyas formulaciones la harina de trigo fue parcialmente sustituida por la fracción fina de germen de maíz y/o fibra de soya. Calidad del horneado, proteína grasa, cenizas, fibra dietética, dureza, color, relación de eficiencia proteica PER y digestibilidad aparente in vivo DA fueron las variable evaluadas. Un panel entrenado evaluó el color, la dureza y la fracturabilidad de las galletas. La aceptación de las cuatro galletas fue determinada en un grupo de consumidores habituales de galletas dulces. La fibra dietética de las galletas varió entre 8,2 y 24,9 por ciento, la proteína entre 11,3 y 12,7 por ciento. La fuente y la cantidad de fibra afectaron las propiedades físicas, sensoriales y nutritivas de las galletas. Al incrementar la fibra, las galletas fueron más oscuras, menos amarillas y menos duras. Las galletas con el mayor valor de PER, DA, mejor textura y mayor aceptabilidad fueron aquellas formuladas con 20 por ciento de la harina fraccionada del germen de maíz. Este estudio demostró la factibilidad de usar el germen desgrasado de maíz y la fibra de soya como ingredientes funcionales

Degradation of poly[bis(glycine ethyl ester)phosphazene] in aqueous media.

The degradation of poly[bis(glycine ethyl ester)phosphazene] in aqueous media was studied by following the appearance of some of its expected by-products in solution. Disc-shaped polymer slabs of 12 mm diameter and 1.2 mm thickness were prepared by compression moulding, followed by incubation in aqueous media under carefully controlled conditions of pH and temperature. Low molecular weight by-products (phosphate and glycine) were assayed for up to 60 d using ultraviolet and visible spectroscopy. Slabs placed in pH 12.0 media at 20 degrees C took 16 d to disappear completely (no longer visible), while at 37 and 47 degrees C this occurred in 12 d. Also, slabs placed in pH 7.0 and 4.0 media took 60 and 24 d, respectively, to disappear at 47 degrees C. However, at 20 and 37 degrees C only some of the material disappeared at pH 7.0 after 60 d. In all cases, the cumulative fractional loss of by-products from the slabs was < 1, indicating the presence in solution of other species which were unaccounted for. This study showed that poly[bis(glycine ethyl ester)phosphazene] slabs have a lifetime in physiological media which makes them an acceptable support for short-term controlled drug release, and complements others, in which polyphosphazenes were used for a similar application.