BackgroundThere is currently conflicting evidence surrounding the effects of obesity on postoperative outcomes. Previous studies have found obesity to be associated with adverse events, but others have found no association. The aim of this study was to determine whether increasing body mass index (BMI) is an independent risk factor for development of major postoperative complications.MethodsThis was a multicentre prospective cohort study across the UK and Republic of Ireland. Consecutive patients undergoing elective or emergency gastrointestinal surgery over a 4‐month interval (October–December 2014) were eligible for inclusion. The primary outcome was the 30‐day major complication rate (Clavien–Dindo grade III–V). BMI was grouped according to the World Health Organization classification. Multilevel logistic regression models were used to adjust for patient, operative and hospital‐level effects, creating odds ratios (ORs) and 95 per cent confidence intervals (c.i.).ResultsOf 7965 patients, 2545 (32·0 per cent) were of normal weight, 2673 (33·6 per cent) were overweight and 2747 (34·5 per cent) were obese. Overall, 4925 (61·8 per cent) underwent elective and 3038 (38·1 per cent) emergency operations. The 30‐day major complication rate was 11·4 per cent (908 of 7965). In adjusted models, a significant interaction was found between BMI and diagnosis, with an association seen between BMI and major complications for patients with malignancy (overweight: OR 1·59, 95 per cent c.i. 1·12 to 2·29, P = 0·008; obese: OR 1·91, 1·31 to 2·83, P = 0·002; compared with normal weight) but not benign disease (overweight: OR 0·89, 0·71 to 1·12, P = 0·329; obese: OR 0·84, 0·66 to 1·06, P = 0·147).ConclusionOverweight and obese patients undergoing surgery for gastrointestinal malignancy are at increased risk of major postoperative complications compared with those of normal weight.
During the COVID-19 pandemic, early graduation of senior medical students simultaneously offers useful clinical experience in preparation for junior doctor posts, whilst helping address staffing shortages due to illness or selfisolation. Having recently graduated early from medical school, we offer our reflections on the obstacles and opportunities associated with working in an uncharted clinical environment. We are not the only ones on a steep learning curve at this time: this pandemic will challenge and provide learning for staff of all levels.
A rapid, facile, and modular surface modification scheme for the covalent attachment of pre-formed polymer moieties to self-assembled monolayers via ‘click’ chemistry within glass microfluidic channels (3 cm long, 110 μm wide and 15 μm deep) is described. The effect that different moieties have on the electroosmotic flow (EOF) within the microchannels is evaluated. The application of linear polymers such as poly(ethylene glycol) (PEG) generates hydrophilic surfaces that reduce the analyte-wall interactions, thereby increasing separation efficiency and improving resolution, especially in bio-separations. Dendritic polymers such as poly(amido amine) (PAMAM) on channel walls can provide high-surface area structures with tunable surface charge depending on the generation of the dendrimer coating. Modified surfaces are characterized by X-ray photoelectron spectroscopy (XPS), Fourier Transform Infrared-Attenuated Total Reflection spectroscopy (FTIR-ATR), and contact angle measurements. EOF measurements in modified and unmodified channels provide information about wall-analyte interactions. A PAMAM dendrimer coated channel presents an amine terminated surface with a positive charge in contrast to a negatively charged bare-glass surface. Use of surface coatings can lead to an increase of the EOF by 15% as is the case for an azide terminated surface or reverse the direction of EOF as is the case for the PAMAM coatings by changing the surface charge polarity.
Purpose Understanding the factors that influence prosocial behaviour during the COVID-19 pandemic is essential due to the disruption to healthcare provision. Methods We conducted an in-depth, mixed-methods cross-sectional survey, from 2 May 2020 to 15 June 2020, of medical students at medical schools in the United Kingdom. Data analysis was informed by Latané and Darley’s theory of prosocial behaviour during an emergency. Results A total of 1145 medical students from 36 medical schools responded. Although 947 (82.7%) of students were willing to volunteer, only 391 (34.3%) had volunteered. Of the students, 92.7% understood they may be asked to volunteer; however, we found deciding one’s responsibility to volunteer was mitigated by a complex interaction between the interests of others and self-interest. Further, concerns revolving around professional role boundaries influenced students’ decisions over whether they had the required skills and knowledge. Conclusion We propose two additional domains to Latané and Darley’s theory that medical students consider before making their final decision to volunteer: ‘logistics’ and ‘safety’. We highlight modifiable barriers to prosocial behaviour and provide suggestions regarding how the conceptual framework can be operationalized within educational strategies to address these barriers. Optimizing the process of volunteering can aid healthcare provision and may facilitate a safer volunteering process. Key messages What is already known on this topic: There is a discrepancy between the number of students willing to volunteer during pandemics and disasters, and those who actually volunteer. Understanding the factors that influence prosocial behaviour during the current COVID-19 pandemic and future pandemics and disasters is essential. What this study adds: We expanded on Latané and Darley’s theory of prosocial behaviour in an emergency and used this to conceptualize students’ motivations to volunteer, highlighting a number of modifiable barriers to prosocial behaviour during the COVID-19 pandemic. How this study might affect research, practice, or policy: We provide suggestions regarding how the conceptual framework can be operationalized to support prosocial behaviours during emergencies for the ongoing COVID-19 pandemic and future crises.
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