Risk Factors for Postoperative Unplanned Intubation: Analysis of a National Database.

Postoperative unplanned intubation (PUI) is a significant complication and is associated with severe adverse events and mortality. By participating in the National Surgical Quality Improvement Program (NSQIP), we learned that PUI occurred more frequently than expected at our institution. The aim of this study was to identify risk factors that are predictors of PUI at our institution. We reviewed the NSQIP data from our institution and the NSQIP national database for surgery patients from 2010 through 2013. The rate of PUI at our institution was 1.54 per cent compared with the national rate of 1.03 per cent. Perioperative risk factors were analyzed by multivariate logistic regression. Analysis of the national NSQIP database identified 14 independent risk factors for PUI. Analysis of the NSQIP data at our institution demonstrated that emergent cases, preoperative ventilator status, smoking, chronic obstructive pulmonary disease, and older age were independent risk factors. In conclusion, patients at our institution with these five risk factors were at higher risk of requiring PUI. These risk factors could be used to help identify patients at high risk and possibly help prevent postoperative respiratory failure and unplanned intubation.

Comprehensive enhanced recovery pathway significantly reduces postoperative length of stay and opioid usage in elective laparoscopic colectomy.

BACKGROUND: A comprehensive enhanced recovery pathway (ERP) was implemented in patients undergoing laparoscopic colectomy in an attempt to reduce postoperative opioid consumption. We hypothesized that improved local analgesia and increased use of non-opioid pain medication, combined with earlier feeding and ambulation, would allow for earlier return of bowel function and shorter postoperative length of stay (LOS). METHODS: We retrospectively reviewed 89 patients who underwent elective partial laparoscopic colectomy with our ERP fully integrated compared to a historical control group of 162 patients. Differences between the ERP and control groups average return of bowel function, postoperative LOS, opioid medication usage, and complications were compared statistically using the student's t-test and Fisher exact test. Pain was controlled with the laparoscope-guided transversus abdominis plane (TAP), scheduled doses of non-narcotic medications, and reserved use of opioids. Patient, nursing and resident education regarding all aspects of the ERP was emphasized. RESULTS: Patients in the ERP group had a significant decrease of opioid usage, earlier return of bowel function, and shorter postoperative hospital LOS. Opioid use was reduced from 75 to 19 mg I.V. morphine (p = 0.0001). Patients had an average return of bowel function of 0.66 days earlier from postoperative day (POD) 2.99 to POD 2.33 (p = 0.0001) and were discharged from the hospital 1 day sooner on POD 2.7 compared with POD 3.7 (p = 0.0013). There was no statistically significant difference in postoperative complications between the control and ERP groups. CONCLUSION: The new ERP, including TAP block and postoperative pain medication protocol limiting I.V. narcotics, is effective in controlling pain in elective partial laparoscopic colectomy. Pain control management together with regimented early feeding and ambulation allow for significantly earlier return of bowel function and shorter postoperative LOS.

Mobilome and genetic modification of bifidobacteria.

Until recently, proper development of molecular studies in Bifidobacterium species has been hampered by growth difficulties, because of their exigent nutritive requirements, oxygen sensitivity and lack of efficient genetic tools. These studies, however, are critical to uncover the cross-talk between bifidobacteria and their hosts' cells and to prove unequivocally the supposed beneficial effects provided through the endogenous bifidobacterial populations or after ingestion as probiotics. The genome sequencing projects of different bifidobacterial strains have provided a wealth of genetic data that will be of much help in deciphering the molecular basis of the physiological properties of bifidobacteria. To this end, the purposeful development of stable cloning and expression vectors based on robust replicons - either from temperate phages or resident plasmids - is still needed. This review addresses the current knowledge on the mobile genetic elements of bifidobacteria (prophages, plasmids and transposons) and summarises the different types of vectors already available, together with the transformation procedures for introducing DNA into the cells. It also covers recent molecular studies performed with such vectors and incipient results on the genetic modification of these organisms, establishing the basis that would allow the use of bifidobacteria for future biotechnological applications.

Physical and mechanical properties of various field lacrosse balls.

Although the sport of lacrosse has evolved dramatically over the last few decades and is presently the fastest growing team sport in the United States, the current specifications for balls date back to 1943. The purpose of this study was to see if various commercially available field lacrosse balls meet these specifications and to determine additional mechanical properties of the ball that may more completely characterize ball performance. Eight models from several manufacturers were tested. Seven models were designated for game play, while one model was promoted as a practice ball. In accordance with the specifications, the mass, circumference, and rebound height were recorded for one dozen balls from each model. The load required to compress the balls 0.0125 m and the coefficient of restitution (COR) with an incident speed of 26.80 m/s were also determined. We found that some balls met several of the specifications, but none of the models had every ball meet all the specifications. For the two measures of ball liveliness, rebound height had a weak correlation with COR. Ball compression loads averaged about 750 N over most models, but were almost 85% less for the practice model. It appears that current governing body specifications are outdated, as no ball model we tested met these specifications. The determination of ball liveliness at more realistic speeds should also be taken into account. Since balls with low compression loads can pass through face protectors worn by lacrosse players, the sport's governing bodies may wish to consider a specification on ball compression.

The spectrophtal: an instrument for ocular spectrophotometry and fluorophotometry.

We describe the technical characteristic of a new instrument, which is controlled by a microcomputer and is aimed at ocular spectrophotometric and fluorophotometric studies. We also discuss some practical applications.