Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background: Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods: The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results: A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion: Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)

Untersuchungen mit Stroemungen mit begrenzten Abloesegebieten

SIGLEAvailable from TIB Hannover: DW 3793 / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekDEGerman

Evaluation of 17 medicinal plants from Northern C&#244te d'Ivoire for their in vitro activity against Streptococcus pneumoniae

A total of 20 Côte d'Ivoire plant extracts, belonging to 17 different species out of 11 families, were investigated for their antibacterial activity against Streptococcus pneumoniae (Pneumococcus). The plants were selected on the base of their ethnomedicinal use, in Northern Côte d'Ivoire, against various infections such as upper track diseases. From all the crude extracts tested, only 7 from 6 plant species showed a promising in vitro bactericidal activity against peumococcus, some of which were resistant to penicillin. The most active extracts were from Erythrina senegalensis (Fabaceae), Piliostigma thonningii (Caesalpiniaceae), Waltheria indica (Sterculiaceae), Andira inermis (Fabaceae), Uapaca togoensis (Euphorbiaceae), Keetia hispida (Rubiaceae) and Combretum molle (Combretaceae). This is the first report of the antipneumococcal activity of the tested plant species. The results of this preliminary investigation support the traditional use of the active plants in the treatment of pneumococcal infections. The most active could be candidates for isolation of compounds which could develop into new lead structures for drugs against Streptococcus pneumoniae. Keywords: antibacterial activity; Côte d'Ivoire; medicinal plants; Pneumococcus; Streptococcus pneumoniae The African Journal of Traditional, Complementary and Alternative Medicines Vol. 4 (1) 2007: pp. 17-2

New Polymer Concrete with Superior Ductility and Fracture Toughness Using Alumina Nanoparticles

Emiroglu, Mehmet/0000-0002-0214-4986WOS: 000400522100010This study investigates the effect of alumina nanoparticles (ANPs) on tension and fracture characteristics of polymer concrete (PC). ANPs with a maximum particle size of 50nm were used at 0.5, 1.0, 2.0, and 3.0wt.% of epoxy resin. Tensile strength, tensile failure strain, and fracture toughness (KIC, GIC, and JIC) were determined experimentally. A PC with superior ductility showing a tensile failure strain of 4.89% (compared with 2.56% for neat PC) was observed at ANP content of 3.0wt.%. Using ANPs in producing epoxy PC can significantly improve ductility (+60.6%) and fracture toughness (+131.8%) compared with neat PC. Scanning electron microscope (SEM), dynamic mechanical analyzer (DMA), and Fourier transform infrared (FTIR) observations were conducted to understand the role ANPs play to manifest the observed improvements in tension and fracture characteristics of PC.Southern Plains Transportation Center (SPTC); Scientific and Technological Research Council of Turkey (TUBITAK)Turkiye Bilimsel ve Teknolojik Arastirma Kurumu (TUBITAK) [BIDEB-2219]; Egyptian Science and Technology FundScience and Technology Development Fund (STDF) [STDF-CSE 5213]Southern Plains Transportation Center (SPTC) has funded this research work. The authors greatly acknowledge this support. The first author acknowledges financial support from the Scientific and Technological Research Council of Turkey (TUBITAK) BIDEB-2219 Postdoctoral Research program. Finally, support to the fourth author by the Egyptian Science and Technology Fund (STDF-CSE 5213) is also appreciated