RAPP, a systematic e-assessment of postoperative recovery in patients undergoing day surgery: study protocol for a mixed-methods study design including a multicentre, two-group, parallel, single-blind randomised controlled trial and qualitative interview studies.

INTRODUCTION: Day surgery is a well-established practice in many European countries, but only limited information is available regarding postoperative recovery at home though there is a current lack of a standard procedure regarding postoperative follow-up. Furthermore, there is also a need for improvement of modern technology in assessing patient-related outcomes such as mobile applications. This article describes the Recovery Assessment by Phone Points (RAPP) study protocol, a mixed-methods study to evaluate if a systematic e-assessment follow-up in patients undergoing day surgery is cost-effective and improves postoperative recovery, health and quality of life. METHODS AND ANALYSIS: This study has a mixed-methods study design that includes a multicentre, two-group, parallel, single-blind randomised controlled trial and qualitative interview studies. 1000 patients >17 years of age who are undergoing day surgery will be randomly assigned to either e-assessed postoperative recovery follow-up daily in 14 days measured via smartphone app including the Swedish web-version of Quality of Recovery (SwQoR) or to standard care (ie, no follow-up). The primary aim is cost-effectiveness. Secondary aims are (A) to explore whether a systematic e-assessment follow-up after day surgery has a positive effect on postoperative recovery, health-related quality of life (QoL) and overall health; (B) to determine whether differences in postoperative recovery have an association with patient characteristic, type of surgery and anaesthesia; (C) to determine whether differences in health literacy have a substantial and distinct effect on postoperative recovery, health and QoL; and (D) to describe day surgery patient and staff experiences with a systematic e-assessment follow-up after day surgery.The primary aim will be measured at 2 weeks postoperatively and secondary outcomes (A-C) at 1 and 2 weeks and (D) at 1 and 4 months. TRIAL REGISTRATION NUMBER: NCT02492191; Pre-results.

Searchability of networks.

We investigate the searchability of complex systems in terms of their interconnectedness. Associating searchability with the number and size of branch points along the paths between the nodes, we find that scale-free networks are relatively difficult to search, and thus that the abundance of scale-free networks in nature and society may reflect an attempt to protect local areas in a highly interconnected network from nonrelated communication. In fact, starting from a random node, real-world networks with higher order organization like modular or hierarchical structure are even more difficult to navigate than random scale-free networks. The searchability at the node level opens the possibility for a generalized hierarchy measure that captures both the hierarchy in the usual terms of trees as in military structures, and the intrinsic hierarchical nature of topological hierarchies for scale-free networks as in the Internet.

Eosinophilic cystitis--diagnosis and treatment in Denmark.

OBJECTIVE: The purpose of this study was to evaluate the incidence, diagnostic criteria and treatment of eosinophilic cystitis (EC) in Denmark during the period 1989-94. MATERIAL AND METHODS: A questionnaire was sent to all Danish departments of surgery, urology and pathology. RESULTS: Fifty-six cases of EC were diagnosed in the departments of surgery and urology, and 135 patients were diagnosed in the departments of pathology. The therapy was most often steroid instillation in the bladder or peroral antihistamines. Success rates of treatment were reported to be acceptable. CONCLUSION: The questionnaire confirmed that EC is a rare disease, which is often confused with other bladder diseases. We recommend strict histological criteria combined with clinical information when making the diagnosis of EC. Therapy is generally symptomatic. A diagnostic code number from the Danish Health Board is needed.

[Eosinophilic cystitis. A survey]. / Eosinofil cystit. En enquete.

The purpose of this study was to evaluate the incidence, diagnostic criteria and treatment of eosinophilic cystitis in the period 1989-94 in Denmark. A questionnaire was sent to all Danish surgical, urological and pathological-anatomical departments. Fifty-six patients were diagnosed as having eosinophilic cystitis at the surgical departments and 135 patients were diagnosed at the pathological-anatomical departments. The treatment was most often instillation of steroids in the bladder or oral antihistamine. Success of treatment was generally acceptable. The questionnaire confirmed that eosinophilic cystitis is a rare disease. We recommend the pathological-anatomical departments to use certain diagnostic criteria for eosinophilic cystitis. The treatment is symptomatic. A diagnostic number from the Danish Health Board is needed.

Bladder diverticulectomy: operative technique.

We present a simple technique of bladder diverticulectomy. Etiology, pathogenesis, diagnosis, and treatment of bladder diverticula are discussed. We recommend this technique for common use, since it is safe and time-saving.

Pyelitis cystica.

We present four cases of pyelitis cystica. Aetiology, pathogenesis, diagnoses, treatment and differential diagnosis are discussed. We recommend follow-up until malignant disease has been excluded.

[Breech presentation, vaginal delivery or cesarean section?]. / Underkropspraesentation, vaginal forløsning eller sectio?

Since the late sixties, the question of wether a breech presentation should be delivered vaginally or by caesarean section has been discussed by obstetricians, with special reference to the aim of improving foetal outcome. This review of the literature surveys the ante- and intrapartum considerations and activities which should be carried out in cases of breech presentation. The factors influencing foetal and maternal morbidity and mortality are discussed, and external cephalic version is considered. Based on these considerations and a careful examination of the pregnant woman and her obstetric history, we suggest vaginal delivery in strictly selected breech presentations. Selection criteria are given.

Fluid resuscitation of hypotensive emergency patients with and without an algorithm.

Seventy-seven consecutive hypotensive (mean arterial pressure (MAP) less than 80 mmHg) surgical emergency patients were resuscitated according to either physicians' individual orders (38 patients) or an algorithm (39 patients). The shock was mainly caused by accidental injuries or acute gastrointestinal bleeding. The patients of the algorithm group were given more plasma expanders than the patients of the control group, while the total amount of fluids administered was similar in both groups. The primary goal of the resuscitation (MAP greater than 80 mmHg) was reached within 30 min in three cases in the control group and in seven cases in the algorithm group. The treatment times at the emergency department and the intensive care unit were similar for the groups. The number of severe and moderate pulmonary disturbances was the same, but mild disturbances were significantly more common in the control group. Renal failure was somewhat more common in the control group and the renal function disturbances were significantly more severe among the control patients. The results suggest that the physicians in some extent altered their practices in fluid resuscitation when the algorithm was put to use, and that this change, perhaps, produced the somewhat better outcome of the patients. The authors recommend the algorithm to be used as a basis of shock treatment and particularly in those emergency departments where the resuscitation of hypotensive patients is performed by junior or inexperienced physicians.

Transport of aromatic amino acids by Pseudomonas aeruginosa.

Kinetic studies of the transport of aromatic amino acids by Pseudomonas aeruginosa revealed the existence of two high-affinity transport systems which recognized the three aromatic amino acids. From competition data and studies on the exchange of preformed aromatic amino acid pools, the first transport system was found to be functional with phenylalanine, tyrosine, and tryptophan (in order of decreasing activity), whereas the second system was active with tryptophan, phenylalanine, and tyrosine. The two systems also transported a number of aromatic amino acid analogues but not other amino acids. Mutants defective in each of the two and in both transport systems were isolated and described. When the amino acids were added at low external concentrations to cells growing logarithmically in glucose minimal medium, the tryptophan pool very quickly became saturated. Under identical conditions, phenylalanine and tyrosine each accumulated in the intracellular pool of P. aeruginosa at a concentration which was 10 times greater than that of tryptophan.

Metabolism of 14C-urea by T-strain mycoplasma.

When (14)C-labeled urea was metabolized by T-strain mycoplasma, 94 to 95% of the radioactivity was recovered as (14)CO(2), and significant radioactivity was not incorporated into cellular material.

Carbohydrate transport in Clostridium perfringens type A.

Resting-cell suspensions of Clostridium perfringens actively transported glucose and mannose but not six other carbohydrates which would support at least limited growth of the microorganism. Competition studies suggested that glucose and mannose were transported by a common mechanism which was highly specific. Analyses of intracellular pools demonstrated that the accumulated carbohydrates were present as phosphorylated derivatives, not as free carbohydrates, and specificity data indicated that phosphorylation occurred at the transport level rather than via the soluble hexokinase.

Influence of carbon or nitrogen starvation on amino acid transport in Pseudomonas aeruginosa.

Pseudomonas aeruginosa was shown to utilize the majority of commonly occurring amino acids for growth as either the sole carbon or the sole nitrogen source. During carbon or nitrogen deprivation, the rates of transport of most of the amino acids remained unchanged; however, the transport rates for glutamate, alanine, and glycine increased under these conditions and the transport rates for leucine and valine decreased. Normal transport rates for these amino acids were resumed immediately upon the addition of the required nutrient. In the absence of an external source of carbon or of nitrogen, pool amino acids underwent rapid degradation. (14)C-Amino acid pulse experiments indicated that the constitutive amino acid catabolic enzymes, normally present in the organism during growth with glucose as the carbon source, were responsible for rapid pool losses. Nutrient starvation in the presence of chloramphenicol did not prevent amino acid catabolism. This enzymic activity is interpreted as providing P. aeruginosa with a selective advantage for survival during conditions of carbon or nitrogen starvation.

Isolation of amino acid transport-negative mutants of Pseudomonas aeruginosa and cells with repressed transport activity.

Methods are described for the isolation of amino acid transport-negative mutants of Pseudomonas aeruginosa and for the preparation of cells with repressed, specific amino acid permeases. P. aeruginosa was resistant to high concentrations of the majority of the 53 amino acid analogues examined and was unaffected by low concentrations of any of them. Cells which had been grown in the presence of sublethal concentrations of the few analogues which were inhibitory were subsequently more resistant to the analogues. These cells were also defective in the transport of the corresponding amino acid, as the analogue caused repression of the synthesis of the specific amino acid permease. The cells with repressed transport activity rapidly regained their normal level of constitutive permease when grown in the absence of the analogue. Higher levels of the permeases were induced when these cells were grown in the presence of the appropriate amino acid. The possible mechanisms for the mode of regulation of amino acid permeases are discussed.

Amino acid transport in Pseudomonas aeruginosa.

Properties of the transport systems for amino acids in Pseudomonas aeruginosa were investigated. Exogenous (14)C-labeled amino acids were shown to equilibrate with the internal native amino acid pool prior to incorporation into protein. When added at low external concentrations, the majority of the amino acids examined entered the protein of the cell unaltered. The rates of amino acid transport, established at low concentrations with 18 commonly occurring amino acids, varied as much as 40-fold. The transport process became saturated at high external amino acid concentrations, was temperature-sensitive, and was inhibited by sodium azide and iodoacetamide. Intracellular to extracellular amino acid ratios of 100- to 300-fold were maintained during exponential growth of the population in a glucose minimal medium. When the medium became depleted of glucose, neither extracellular nor intracellular amino acids could be detected.

Amino acid pool formation in Pseudomonas aeruginosa.

The accumulation and behavior of various amino acids in the pool of Pseudomonas aeruginosa (ATCC 9027) were investigated. Patterns of pool formation and maintenance varied with different amino acids tested and were dependent, to a considerable extent, upon the ability of the organism to catabolize the particular amino acid. The establishment of steady-state amino acid pool levels depended upon the activity of the amino acid permease involved and upon the rate of protein synthesis. The presence of a relatively large specific amino acid pool did not affect the formation of a pool of a structurally different amino acid, and a preformed steady-state pool was not displaced by structurally unrelated amino acids. Steady-state amino acid pools decreased rapidly in the presence of inhibitors of energy metabolism and at 0 C. Steady-state internal amino acid pools were found to be in equilibrium with the corresponding external amino acid, present at low levels. A multiplicity of proline pools was demonstrated.