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.

Quantitative laboratory spectroscopy of atmospheric trace gases

info:eu-repo/semantics/published

Volcanic Gases

info:eu-repo/semantics/published

Predicting toxic gas concentrations resulting from enclosure fires using local equivalence ratio concept linked to fire field models

A practical CFD method is presented in this study to predict the generation of toxic gases in enclosure fires. The model makes use of local combustion conditions to determine the yield of carbon monoxide, carbon dioxide, hydrocarbon, soot and oxygen. The local conditions used in the determination of these species are the local equivalence ratio (LER) and the local temperature. The heat released from combustion is calculated using the volumetric heat source model or the eddy dissipation model (EDM). The model is then used to simulate a range of reduced-scale and full-scale fire experiments. The model predictions for most of the predicted species are then shown to be in good agreement with the test results

Invivo Changes In The Activity Of Gill ATPases And Hemolymph Ions Of Carcinus Maenas Exposed To p p'-DDT And Reduced Salinities

1. Haemolymph osmoregulation by the shore crab, Carcinus maenas was confirmed over a range of salinities. 2. Na+K+-ATPase and Mg2+-ATPase activities in gill tissue increased with a decrease in salinity. 3. Na+K+-ATPase and Mg2+-ATPase activities were inhibited after exposure to p,p′-DDT. 4. K+ ion levels of the haemolymph remained unchanged, but Na+ ion levels were affected after 7 hr when transferred from 100 to 5% SW after exposure to DDT.

The Effects Of Reduced Salinity On Colonial Growth And Membership In A Hydroid

The effect of different salinity levels on colonial growth and gonozooid frequency of the hydroid Campanularia flexuosa Hincks has been studied. It is shown that the usual cumulative presentation of growth data tends to obscure evidence of acclimation and other features of importance to an interpretation of adaptations of the growth process to salinity changes. A method of analysis is described that not only demonstrates acclimation, but apparently shows how growth is controlled after disturbance by changes in salinity. One other response to reduced salinity and other unfavourable changes in water chemistry is an increase in gonozooid frequency due to the diversion of resources from the formation of new hydranths.