Reduced length of hospital stay in colorectal surgery after implementation of an enhanced recovery protocol.

BACKGROUND: Enhanced recovery after surgery (ERAS) is a multimodal approach to perioperative care that combines a range of interventions to enable early mobilization and feeding after surgery. We investigated the feasibility, clinical effectiveness, and cost savings of an ERAS program at a major U. S. teaching hospital. METHODS: Data were collected from consecutive patients undergoing open or laparoscopic colorectal surgery during 2 time periods, before and after implementation of an ERAS protocol. Data collected included patient demographics, operative, and perioperative surgical and anesthesia data, need for analgesics, complications, inpatient medical costs, and 30-day readmission rates. RESULTS: There were 99 patients in the traditional care group, and 142 in the ERAS group. The median length of stay (LOS) was 5 days in the ERAS group compared with 7 days in the traditional group (P < 0.001). The reduction in LOS was significant for both open procedures (median 6 vs 7 days, P = 0.01), and laparoscopic procedures (4 vs 6 days, P < 0.0001). ERAS patients had fewer urinary tract infections (13% vs 24%, P = 0.03). Readmission rates were lower in ERAS patients (9.8% vs 20.2%, P = 0.02). DISCUSSION: Implementation of an enhanced recovery protocol for colorectal surgery at a tertiary medical center was associated with a significantly reduced LOS and incidence of urinary tract infection. This is consistent with that of other studies in the literature and suggests that enhanced recovery programs could be implemented successfully and should be considered in U.S. hospitals.

Integrated analysis of CANVAS 1 and 2: phase 3, multicenter, randomized, double-blind studies to evaluate the safety and efficacy of ceftaroline versus vancomycin plus aztreonam in complicated skin and skin-structure infection.

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is a common cause of complicated skin and skin-structure infection (cSSSI). Increasing antimicrobial resistance in cSSSI has led to a need for new safe and effective therapies. Ceftaroline was evaluated as treatment for cSSSI in 2 identical phase 3 clinical trials, the pooled analysis of which is presented here. The primary objective of each trial was to determine the noninferiority of the clinical cure rate achieved with ceftaroline monotherapy, compared with that achieved with vancomycin plus aztreonam combination therapy, in the clinically evaluable (CE) and modified intent-to-treat (MITT) patient populations. METHODS: Adult patients with cSSSI requiring intravenous therapy received ceftaroline (600 mg every 12 h) or vancomycin plus aztreonam (1 g each every 12 h) for 5-14 days. RESULTS: Of 1378 patients enrolled in both trials, 693 received ceftaroline and 685 received vancomycin plus aztreonam. Baseline characteristics of the treatment groups were comparable. Clinical cure rates were similar for ceftaroline and vancomycin plus aztreonam in the CE (91.6% vs 92.7%) and MITT (85.9% vs 85.5%) populations, respectively, as well as in patients infected with MRSA (93.4% vs 94.3%). The rates of adverse events, discontinuations because of an adverse event, serious adverse events, and death also were similar between treatment groups. CONCLUSIONS: Ceftaroline achieved high clinical cure rates, was efficacious against cSSSI caused by MRSA and other common cSSSI pathogens, and was well tolerated, with a safety profile consistent with the cephalosporin class. Ceftaroline has the potential to provide a monotherapy alternative for the treatment of cSSSI. TRIAL REGISTRATION: ClinicalTrials.gov identifiers: NCT00424190 for CANVAS 1 and NCT00423657 for CANVAS 2.

Studies in Aetiology and Historical Methodology in Herodotus

This dissertation interrogates existing scholarly paradigms regarding aetiology in the Histories of Herodotus in order to open up new avenues to approach a complex and varied topic. Since aetiology has mostly been treated as the study of cause and effect in the Histories, this work expands the purview of aetiology to include Herodotus’ explanations of origins more generally. The overarching goal in examining the methodological principles of Herodotean aetiology is to show the extent to which they resonate across the Histories according to their initial development in the proem, especially in those places that seem to deviate from the work’s driving force (i.e. the Persian Wars). Though the focus is on correlating the principles espoused in the proem with their deployment in Herodotus’ ethnographies and other seemingly divergent portions of his work, the dissertation also demonstrates the influence of these principles on some of the more “historical” aspects of the Histories where the struggle between Greeks and barbarians is concerned. The upshot is to make a novel case not only for the programmatic significance of the proem, but also for the cohesion of Herodotean methodology from cover to cover, a perennial concern for scholars of Greek history and historiography.

Chapter One illustrates how the proem to the Histories (1.1.0-1.5.3) prefigures Herodotus’ engagement with aetiological discussions throughout the Histories. Chapter Two indicates how the reading of the proem laid out in Chapter One allows for Herodotus’ deployment of aetiology in the Egyptian logos (especially where the pharaoh Psammetichus’ investigation of the origins of Egyptian language, nature, and custom are concerned) to be viewed within the methodological continuum of the Histories at large. Chapter Three connects Herodotus’ programmatic interest in the origins of erga (i.e. “works” or “achievements” manifested as monuments and deeds of abstract and concrete sorts) with the patterns addressed in Chapters One and Two. Chapter Four examines aetiological narratives in the Scythian logos and argues through them that this logos is as integral to the Histories as the analogous Egyptian logos studied in Chapter Two. Chapter Five demonstrates how the aetiologies associated with the Greeks’ collaboration with the Persians (i.e. medism) in the lead-up to the battle of Thermopylae recapitulate programmatic patterns isolated in previous chapters and thereby extend the methodological continuum of the Histories beyond the “ethnographic” logoi to some of the most representative “historical” logoi of Herodotus’ work. Chapter Six concludes the dissertation and makes one final case for methodological cohesion by showing the inextricability of the end of the Histories from its beginning.