Influence of Clinical pathways on treatment and outcome quality for patients undergoing pancreatoduodenectomy? A retrospective cohort study.

BACKGROUND: Pancreatic surgery demands complex multidisciplinary management. Clinical pathways (CPs) are a tool to facilitate this task, but evidence for their utility in pancreatic surgery is scarce. This study evaluated the effect of CPs on quality of care for pancreatoduodenectomy. METHODS: Data of all consecutive patients who underwent pancreatoduodenectomy before (n = 147) or after (n = 148) CP introduction were evaluated regarding catheter and drain management, postoperative mobilization, pancreatic enzyme substitution, resumption of diet and length of stay. Outcome quality was assessed using glycaemia management, morbidity, mortality, reoperation and readmission rates. RESULTS: Catheters and abdominal drainages were removed significantly earlier in patients treated with CP (p < 0.0001). First intake of liquids, nutritional supplement and solids was significantly earlier in the CP group (p < 0.0001). Exocrine insufficiency was significantly less common after CP implementation (47.3% vs. 69.7%, p < 0.0001). The number of patients receiving intraoperative transfusion dropped significantly after CP implementation (p = 0.0005) and transfusion rate was more frequent in the pre-CP group (p = 0.05). The median number of days with maximum pain level >3 was significantly higher in the CP group (p < 0.0001). There was no significant difference in mortality, morbidity, reoperation and readmission rates. CONCLUSIONS: Following implementation of a CP for pancreatoduodenectomy, several indicators of process and outcome quality improved, while others such as mortality and reoperation rates remained unchanged. CPs are a promising tool to improve quality of care in pancreatic surgery.

Habitat differences in dung beetle assemblages in an African savanna-forest ecotone: implications for secondary seed dispersal.

The probability and pattern of secondary seed dispersal by dung beetles (Scarabaeinae) depend on their community structure and composition at the site of primary deposition, which, in turn, seem to be strongly determined by vegetation. Consequently, we expected pronounced differences in secondary seed dispersal between forest and savanna in the northern Ivory Coast, West Africa. We found 99 dung beetle species at experimentally exposed dung piles of the olive baboon (Papio anubis (Lesson, 1827)), an important primary seed disperser in West Africa. Seventy-six species belonged to the roller and tunneler guilds, which are relevant for secondary seed dispersal. Most species showed a clear habitat preference. Contrary to the Neotropics, species number and abundance were much higher in the savanna than in the forest. Rollers and tunnelers each accounted for approximately 50% of the individuals in the savanna, but in the forest rollers made up only 4%. Seeds deposited into the savanna by an omnivorous primary disperser generally have a higher overall probability of being more rapidly dispersed secondarily by dung beetles than seeds in the forest. Also, rollers disperse seeds over larger distances. In contrast to other studies, small rollers were active in dispersal of large seeds, which were seemingly mistaken for dung balls. Our results suggest that rollers can remove seeds from any plant dispersed in primate dung in this ecosystem.

Seed size selection by olive baboons.

Seed size is an important plant fitness trait that can influence several steps between fruiting and the establishment of a plant's offspring. Seed size varies considerably within many plant species, yet the relevance of the trait for intra-specific fruit choice by primates has received little attention. Primates may select certain seed sizes within a species for a number of reasons, e.g. to decrease indigestible seed load or increase pulp intake per fruit. Olive baboons (Papio anubis, Cercopithecidae) are known to select seed size in unripe and mature pods of Parkia biglobosa (Mimosaceae) differentially, so that pods with small seeds, and an intermediate seed number, contribute most to dispersal by baboons. We tested whether olive baboons likewise select for smaller ripe seeds within each of nine additional fruit species whose fruit pulp baboons commonly consume, and for larger seeds in one species in which baboons feed on the seeds. Species differed in fruit type and seed number per fruit. For five of these species, baboons dispersed seeds that were significantly smaller than seeds extracted manually from randomly collected fresh fruits. In contrast, for three species, baboons swallowed seeds that were significantly longer and/or wider than seeds from fresh fruits. In two species, sizes of ingested seeds and seeds from fresh fruits did not differ significantly. Baboons frequently spat out seeds of Drypetes floribunda (Euphorbiaceae) but not those of other plant species having seeds of equal size. Oral processing of D. floribunda seeds depended on seed size: seeds that were spat out were significantly larger and swallowed seeds smaller, than seeds from randomly collected fresh fruits. We argue that seed size selection in baboons is influenced, among other traits, by the amount of pulp rewarded per fruit relative to seed load, which is likely to vary with fruit and seed shape.

The disregarded West: diet and behavioural ecology of olive baboons in the Ivory Coast.

Despite living under environmental conditions considerably distinct from those of savannah baboons (Papio spp.) in East and southern Africa, very little is known about western Papio populations. We monitored the abundance and group sizes of olive baboons (P. anubis) in the savannah-forest mosaic of the Comoé National Park, northern Ivory Coast, and observed 2 habituated groups of different sizes. Against expectations for the kind of habitat, the individual density was low, yielding only 1.2 baboons/km(2). The groups were small, comprising on average 15 individuals, and the proportion of 1-male groups (50-63%) was remarkably high. One-male groups were more female biased than multi-male groups. The baboons were highly frugivorous, spending about 50% of their feeding time on fruits and seeds of at least 79 woody plant species. The 2 habituated groups had comparatively large home ranges and used forests more often than expected by random. We argue that regular subgrouping of the larger focal group and different habitat quality countervailed inter-group variations. Differences from other study sites, however, are not completely explained by current models of baboon (socio)ecology. It appears that the social organization of olive baboons is more flexible than assumed from data on East African populations.

Evaluation of the Duopath Legionella lateral flow assay for identification of Legionella pneumophila and Legionella species culture isolates.

Duopath Legionella (Merck KGaA, Darmstadt, Germany) is a new immunochromatographic assay for the simultaneous identification of cultured L. pneumophila and Legionella species other than L. pneumophila. In tests of 89 L. pneumophila strains and 87 Legionella strains other than L. pneumophila representing 41 different species, Duopath and a widely used latex agglutination assay detected L. pneumophila with 100% and 98% accuracy, respectively, whereas the percentages differed significantly for other Legionella spp. (93% versus 37% [P < 0.001]). Since many countries' regulations require the identification of Legionella spp. in water and environmental samples, the use of Duopath Legionella to comply with those regulations could contribute to significantly fewer false-negative results.