Fast-track Program Research Articles

Navigator Nurse within a Fast Track Program of Liver Resections: How to Improve the Healthcare Service and Perioperative Results

Introduction: The introduction into the clinical practice of the navigator nurse (NaNu) to address the task of counselling and short term follow up has this specific goal. The aim of the present study was to investigate the impact of the standardization of the NaNu's role in patients undergoing liver surgery.

Fast-Track Failure After Cardiac Surgery: Risk Factors and Outcome With Long-Term Follow-Up

An important cornerstone of the Enhanced Recovery After Cardiac Surgery initiative is a fast-track cardiac anesthesia management protocol. Fast-track failure has been described to have a detrimental impact on immediate postoperative outcomes. The authors here evaluated risk factors for short- and long-term effects of fast-track failure. A retrospective cohort study. A single academic center. Adult cardiac surgery was performed on 7,064 patients between January 2013 and October 2019. The inclusion criteria for the fast-track program at the postanesthesia care unit were met by 1,097 patients. Univariate and multivariate logistic regression analyses were used to identify independent risk factors. Fast-track failure occurred in 69 (6.3%) patients. These were associated with significant increases in the incidences of coronary revascularization, cardiac tamponade or bleeding requiring surgical intervention, new-onset atrial fibrillation, pneumonia, delirium, and sepsis. Likewise, the postoperative length of stay, and up to 5-year mortality, were significantly higher in the fast-track failure than the nonfailure group. The European System for Cardiac Operative Risk Evaluation II and transfusion of any blood product could be identified as independent risk factors for fast-track failure, with only limited discriminative ability (area under the curve=0.676; 95% confidence interval, 0.611-0.741). Fast-track failure is associated with increases in morbidity and long-term mortality, but remains difficult to predict.

Non-GM Genome Editing Approaches in Crops.

CRISPR/Cas-based genome editing technologies have the potential to fast-track large-scale crop breeding programs. However, the rigid cell wall limits the delivery of CRISPR/Cas components into plant cells, decreasing genome editing efficiency. Established methods, such as Agrobacterium tumefaciens-mediated or biolistic transformation have been used to integrate genetic cassettes containing CRISPR components into the plant genome. Although efficient, these methods pose several problems, including 1) The transformation process requires laborious and time-consuming tissue culture and regeneration steps; 2) many crop species and elite varieties are recalcitrant to transformation; 3) The segregation of transgenes in vegetatively propagated or highly heterozygous crops, such as pineapple, is either difficult or impossible; and 4) The production of a genetically modified first generation can lead to public controversy and onerous government regulations. The development of transgene-free genome editing technologies can address many problems associated with transgenic-based approaches. Transgene-free genome editing have been achieved through the delivery of preassembled CRISPR/Cas ribonucleoproteins, although its application is limited. The use of viral vectors for delivery of CRISPR/Cas components has recently emerged as a powerful alternative but it requires further exploration. In this review, we discuss the different strategies, principles, applications, and future directions of transgene-free genome editing methods.

O-P02 A fast-track surgery programme leads to timelier treatment and higher resection rates in pancreatic cancer

Abstract Background Pancreatic cancer is currently the fourth most common cause of cancer-related mortality in the economically developed world and is set to become the second most common cause of cancer-related mortality within the next few years. NICE guidance makes a strong recommendation to offer up-front surgery to people with resectable pancreatic cancer, without preoperative biliary drainage, if sufficiently fit for surgery. The aim of this study was to perform a propensity-matched comparison of patients with pancreatic cancer undergoing surgery, with and without biliary stenting, to examine perioperative outcomes and to perform an intention to treat analysis to evaluate long-term survival between the two groups. Methods This was an observational study of a cohort of consecutive patients presenting with obstructive jaundice and undergoing pancreatoduodenectomy for pancreatic and periampullary malignancies between November 2015 and May 2019. Data related to patient and tumour characteristics, biliary drainage, surgery and histopathology were gathered and analysed from a prospectively maintained electronic database. Post-operative complications were defined and graded according to the definitions of the International Study Group on Pancreatic Surgery (ISGPS) and the Clavien-Dindo system. Data related to adjuvant treatment, disease recurrence and overall survival were also analysed. Results In this retrospective study of 216 consecutive operable patients, 70 followed the fast-track (FT) pathway and 146 had pre-operative biliary drainage (PBD). All 70 patients in the fast-track group and 122 out of 146 in the PBD group proceeded to surgery (100% and 83.6% respectively, p = 0.001). Interval time from diagnostic CT scan to surgery and from MDT decision to treat to surgery was much shorter in the FT group (median range) 8 vs 43 days p < 0.001 and 3 vs 36 days p < 0.001 respectively) as was the overall time from diagnostic CT to adjuvant treatment (88 vs 121 days p < 0.001). Postoperative outcomes including in-hospital stay, number and grading of complications, readmission rate and mortality rates were comparable in the two groups. There was no difference in survival between the two groups. Conclusions These data strengthen the existing evidence that, for a person with pancreatic cancer who is proceeding to surgery, the best approach is to avoid pre-operative biliary drainage. The optimal comparison to the neoadjuvant approach is upfront fast-track surgery without biliary drainage followed by adjuvant therapy.

Knee Scores of Patients with Non-Lateral Compartmental Knee Osteoarthritis Undergoing Mobile, Fixed-Bearing Unicompartmental Knee and Total Knee Arthroplasties: A Randomized Controlled Trial.

ObjectiveTo evaluate knee scores and clinical efficacies of patients with non‐lateral unicompartmental knee osteoarthritis (OA) who randomly underwent mobile‐bearing (MB) unicompartmental knee arthroplasty (UKA), fixed‐bearing (FB) UKA, and total knee arthroplasty (TKA).MethodsFrom September 2015 to February 2017, a prospective, randomized, parallel, single‐center trial of 180 patients (78 males and 102 females; 63.3 ± 6.9 years) with non‐lateral compartmental knee OA was performed in the first author‐affiliated hospital. The patients were randomly divided into three groups (each group included 60 patients) and received medial cemented Oxford phase 3 MB UKA, medial cemented Link FB UKA, or cemented DePuy Sigma PFC TKA, respectively. A similar perioperative management and fast‐track surgery program was carried out for all patients. The knee scores at 3‐year follow‐up after operation and clinical efficacies of these three groups of patients were recorded, investigated, and compared.ResultsPrimarily, compared to the TKA group, the UKA groups (MB UKA and FB UKA) had shorter operative time (median 63.2 < 67.1 min), less bleeding (8.6 < 30.0 mL), earlier resumption of walking without crutches (3.0 < 8.0 days) and walking up and down the stairs (5.0 < 10.0 days) (P < 0.001), higher FJS scores (78.0 > 74.5) (P = 0.007), better results in all knee scores (except VAS and KSS function scores) (P < 0.05), and a larger maximum flexion angle of the knee at the 3‐year follow‐up (123.0° > 96.0°) (P = 0.001). Secondarily, compared to the TKA group, the MB UKA group showed better results in the Western Ontario and McMaster Universities index (WOMAC) stiffness (83.6 > 79.6), WOMAC total (86.3 > 83.2), Oxford knee score (OKS) (20.0 < 23.0), Forgotten Joint Score (FJS) (78.5 > 74.5), and a larger maximum flexion angle of the knee (123.0 > 96.0) (P < 0.05). Moreover, the FB UKA group showed higher Hospital for Special Surgery Knee Score (HSS) (91.0 > 88.5), WOMAC stiffness (84.3 > 79.6), WOMAC function (85.2 > 81.7), WOMAC total scores (87.6 > 83.2), and a larger maximum flexion angle of the knee (119.0° > 96.0°) than the TKA group (P < 0.05). Overall, there was no significant difference in all knee scores and maximum flexion angles of the knee for the MB UKA and FB UKA groups (P > 0.05). There was one case with original bearing dislocation in MB UKA group. One patient with displacement of the femoral component caused by a fall injury, and another patient, who lost his life in a car accident, were involved in the FB UKA group. There was an infection case and an intermuscular vein thrombosis case in TKA group.ConclusionUKA showed more advantages than TKA; however, there was no significant difference between the MB UKA and FB UKA groups for treatment of non‐lateral compartmental knee OA.

Risk analysis of restrictive factors for fast-track hip arthroplasty - a retrospective study of 1138 patients.

Fast track programs have been introduced to reduce perioperative complication rates and to quickly reintegrate the patient into everyday life. The aim of this retrospective case-control study was to identify patient characteristics and patient-independent factors that influence fast track programs in hip arthroplasty. A total of 1138 patients were examined. A hospital stay of more than seven days was used to define the case group. In addition to the causes for the longer hospitalisation, age, sex, BMI, chronic nicotine and alcohol abuse, ASA score, surgical duration, anaemia and blood transfusion as well as concomitant diseases were assessed. The statistical analysis included two-sample t-test, chi-square test and logistic regression analyses. An 95% confidence interval was calculated (p<0.05). 16.9% of patients could not leave the hospital on the seventh day. The main causes were delayed wound healing (69.4%), increased CRP (43.0%>100 mg/l), and internal complications (19.7%). At a mean of 69.2 ± 10.7 years, the age of the case group was significantly higher than that of the control group, which had a mean of 63.3 ± 10.3 years (p<0.001). Cardiac comorbidities (p<0.001), BMI (p=0.023), and alcohol consumption (p<0.001) increased the risk for longer hospitalisation. Significant patient-independent factors were duration of the surgery (p<0.001) and transfusion (p<0.001). Successful application of fast-track hip arthroplasty is possible for every patient. However, longer hospi- talisation and delayed discharge must be taken into account for patients with advanced age, cardiac comorbidities, alcohol consumption, and high BMI.

Sistem Monitoring Instrument Air Compressor (IAC) berbasis SCADA dengan Komunikasi Modbus RTU RS-485

PLTU Pacitan adalah salah satu pembangkit listrik di Jawa Timur yang memiliki kapasitas 2 x 315 MW yang dibangun pemerintah pada Fast Track Program 1. Instrument Air Compressor (IAC) adalah salah satu peralatan bantu di PLTU Pacitan yang berfungsi sebagai suplai udara ke sistem pneumatik seluruh plant. Namun, peralatan ini tidak bisa dimonitor oleh operator Central Control Room (CCR) dengan maksimal. Parameter yang dapat dikontrol sangat terbatas. Hal ini dikarenakan terbatasnya jumlah terminal Field Bus Module (FBM) yang tersedia. Rumusan masalah adalah bagaimana cara membuat modul komunikasi untuk menampilkan parameter Instrument Air Compressor System ke display HMI operator CCR secara real time. Tujuan dari perancangan alat ini adalah membuat modul komunikasi yang aman dan handal untuk menampilkan semua parameter Instrument Air Compressor yang ada dilokal tampil di display komputer CCR. Metode yang digunakan adalah pengontrolan dan pemantauan parameter ditransmisikan dari lapangan ke CCR menggunakan komunikasi serial protokol modbus RS485. Untuk meningkatkan pengelolaaan peralatan tidak hanya dikontrol dan dimonitor tetapi juga menampilkan fault alarm untuk mengingatkan operator bahwa peralatan mengalami ketidaknormalan. Perancangan prototype mengunakan komputer sebagai HMI dan arduino nano sebagai mikrokontroller. Manfaat dari perancangan modul komunikasi ini adalah mengganti peran FBM yang jumlah terminal input dan output yang terbatas dan memiliki harga yang mahal serta meningkatkan kehandalan Instrument Air Compressor System.

The "Big Five" of Invasiveness - the Usefulness of Drains, Probes and Catheters in Colorectal Surgery

The perioperative management of colorectal resections is often dominated by traditional procedures and a strong focus on safety. Evidence-based measures such as those established in Fast Track or ERAS programs, are rarely applied in a standardised manner. As part of elective colorectal surgery, many patients therefore continue to routinely receive central venous access, peridural catheters, urinary catheters, drains and/or gastric tubes ("Big Five" of invasiveness). This article presents the currently available evidence on these measures in colorectal surgery. In addition, results relating to the "Big Five" from the author's own centre are presented. This review shows that the "Big Five" of invasiveness are clinically unnecessary or supported by evidence. In addition, they often impair the patient's function.

Rehabilitation following total knee replacement

Total knee replacement requires follow-up treatment. This can take place on an outpatient basis as part of health insurance coverage, but also as outpatient or inpatient rehabilitation. Outpatient rehabilitation provides comparable results to inpatient rehabilitation, but only for those patients who are suitable for outpatient rehabilitation. Inpatient rehabilitation should be indicated depending on general health status, general physical fitness, housing situation, accessibility of rehabilitation facilities and possibilities of social support in the home environment, as well as age and comorbidities. Physiotherapeutic procedures should focus on exercise therapy. Passive reactive measures complement the therapy. For patients of working age, the activity profile should be considered as part of the rehabilitation process. Patient education, with information on prosthesis-appropriate behavior, represents an important component in follow-up treatment. Demographic change requires increasing consideration of orthogeriatric aspects. Fast-track programs will not make follow-up treatment superfluous, but with accelerated processes they represent anew challenge for sectoral cooperation.

Evaluation of the implementation of multidisciplinary fast-track program for acute geriatric hip fractures at a University Hospital in resource-limited settings

BackgroundHip fractures are common among frail, older people and associated with multiple adverse outcomes, including death. Timely and appropriate care by a multidisciplinary team may improve outcomes. Implementing a team to jointly deliver the service in resource-limited settings is challenging, particularly on the effectiveness of patient outcomes.MethodsA retrospective cohort study to compare outcomes of hip fracture patients aged 65 or older admitted at Siriraj hospital before and after implementation of the Fast-track program for Acute Geriatric Hip Fractures. The primary outcome was the incidence of medical complications. The secondary outcomes were time to surgery, factors related to the occurrence of various complications, in-hospital mortality, and mortality at month 3, month 6 and month 12 after the operation.ResultsThree hundred two patients were enrolled from the Siriraj hospital’s database from October 2016 to October 2018; 151 patients in each group with a mean age of 80 years were analyzed. Clinical parameters were similar between groups except the Fast-track group comprising more patients with dementia (37.1% VS 23.8%, p < 0.012). In the Fast-track group, there was a significantly higher proportion of patients underwent surgery within 72-h (80.3% VS 44.7%, p < 0.001) and the length of stay was significantly shorter (11 days (8–17) VS 13 days (9–18), p = 0.017). There was no significant difference in medical complications. Stratified analysis by dementia status showed a trend in delirium reduction in both patients with dementia and without dementia groups, and a pressure injury reduction among patients with dementia after the program was implemented but without statistical significance. There was no significant difference in mortality.ConclusionsThe implementation of a multidisciplinary team for hip fracture patients is feasible in resource-limited setting. In the Fast-track program, time to surgery was reduced and the length of stay was shortened. Other outcome benefits were not shown, which may be due to incomplete uptake of all involved disciplines.

The impact of firms’ and CEOs’ social media usage on corporate performance

The impact of social media usage on corporate performance has not been examined in the Saudi context. This paper aims to investigate the influence of social media, namely companies’ and CEOs’ involvement in Twitter and LinkedIn, on the profitability of Saudi Arabia listed firms. A dynamic panel estimation method is used to empirically assess this relationship. The study employs 120 firms listed on the Saudi Stock Exchange Tadawul from 2014 to 2017. Data are obtained from the companies’ annual reports. Statements of financial status as well as income statements are used to collect data on the dependent variable and control variables. The results show that having a LinkedIn official account by both the CEO and the company does not improve the enterprise performance. In contrast, companies that are active on Twitter will contribute to an increase in their short-term performance. CEOs who engage in Twitter via a high number of followers help to boost the performance of their companies in the long and short term. Hence, this paper recommends that Saudi firms should be aware that their performance could be increased by monitoring their presence on social networks and by having a strong intention to use these tools. AcknowledgmentsThis study was funded by the Deanship of Scientific Research at Princess Nourah bint Abdulrahman University through the Fast-track Research Funding Program.

A first-generation haplotype map (HapMap-1) of tea (Camellia sinensis L. O. Kuntz).

Tea is a cross-pollinated woody perennial plant, which is why, application of conventional breeding is limited for its genetic improvement. However, lack of the genome-wide high-density SNP markers and genome-wide haplotype information has greatly hampered the utilization of tea genetic resources toward fast-track tea breeding programs. To address this challenge, we have generated a first-generation haplotype map of tea (Tea HapMap-1). Out-crossing and highly heterozygous nature of tea plants, make them more complicated for DNA-level variant discovery. In this study, whole genome re-sequencing data of 369 tea genotypes were used to generate 2,334,564 biallelic SNPs and 1,447,985 InDels. Around 2928.04 million paired-end reads were used with an average mapping depth of ∼0.31× per accession. Identified polymorphic sites in this study will be useful in mapping the genomic regions responsible for important traits of tea. These resources lay the foundation for future research to understand the genetic diversity within tea germplasm and utilize genes that determine tea quality. This will further facilitate the understanding of tea genome evolution and tea metabolite pathways thus, offers an effective germplasm utilization for breeding the tea varieties. Supplementary data are available at Bioinformatics online.

Fab Advances in Fabaceae for Abiotic Stress Resilience: From 'Omics' to Artificial Intelligence.

Legumes are a better source of proteins and are richer in diverse micronutrients over the nutritional profile of widely consumed cereals. However, when exposed to a diverse range of abiotic stresses, their overall productivity and quality are hugely impacted. Our limited understanding of genetic determinants and novel variants associated with the abiotic stress response in food legume crops restricts its amelioration. Therefore, it is imperative to understand different molecular approaches in food legume crops that can be utilized in crop improvement programs to minimize the economic loss. ‘Omics’-based molecular breeding provides better opportunities over conventional breeding for diversifying the natural germplasm together with improving yield and quality parameters. Due to molecular advancements, the technique is now equipped with novel ‘omics’ approaches such as ionomics, epigenomics, fluxomics, RNomics, glycomics, glycoproteomics, phosphoproteomics, lipidomics, regulomics, and secretomics. Pan-omics—which utilizes the molecular bases of the stress response to identify genes (genomics), mRNAs (transcriptomics), proteins (proteomics), and biomolecules (metabolomics) associated with stress regulation—has been widely used for abiotic stress amelioration in food legume crops. Integration of pan-omics with novel omics approaches will fast-track legume breeding programs. Moreover, artificial intelligence (AI)-based algorithms can be utilized for simulating crop yield under changing environments, which can help in predicting the genetic gain beforehand. Application of machine learning (ML) in quantitative trait loci (QTL) mining will further help in determining the genetic determinants of abiotic stress tolerance in pulses.

1624P Impact of the COVID-19 pandemic in the cancer fast-track programme

The COVID-19 pandemic has disrupted many aspects of clinical practice in oncology, particularly in making timely cancer diagnosis. Our public health system has been concerned about potential delays leading to a higher proportion of patients with advanced stages. Our cancer diagnosis fast-track program (CFP) in the Clinic-Malvarrosa Health department in Valencia (Spain) is connecting primary care (PC) with different specialists to speed cancer diagnosis and treatment upon well founded suspicion. A 10-year evaluation of our CFP has recently been published. The aim of this analysis was to investigate the impact of the COVID-19 pandemic on the CFP. We analysed the programme flow during the state of emergency starting on March 16, 2020 for one year. During that year, 975 suspected cancer cases were submitted to the CFP. The submissions only decreased during the times of highest COVID-19 incidence and stricter lockdown (March, April and October 2020). However, referrals were slightly higher than in the two previous years (average 877). Of those 975 patients, 817 were seen by the corresponding specialist. A cancer diagnosis was confirmed in 197 (24.1%) with 33% urological, 23% breast, 16% gastrointestinal and 9% lung cancer. Median time from referral to the specialist visit was 13 (interquartile range, 8 to 22 days) days and a diagnosis was reached in a median of 18 days (interquartile range, 10 to 30 days). In cancer patients, treatment was started in around 30 days (interquartile range, 13.5 to 51 days) from the time of diagnosis. Sixty-one percent of cancers were found in an early stage, 20% in a locally advanced stage, and 19% in an advanced stage. These intervals and proportions were similar to the previous years. Our programme has proven to be a reliable tool to help PC physicians referring patients with cancer suspicion cancer, maintaining its normal flow and efficacy despite the current pandemic.

The Improvement of Maize (Zea mays L.) for Drought Stress Tolerance

Maize is one of the important cereals in the world after rice and wheat. It is grown for grain as well as fodder in tropical, sub-tropical and temperate regions of the World. The reduction of maize productivity under drought stress conditions depends on different factors such as plant development stage, drought intensity and duration of water deficit, and varietal sensitivity to drought stress. Drought stress is one of the major constraints to agriculture where limited water availability for crop irrigation causes a reduction in carbon fixation by the photosynthetic apparatus that result in net yield losses. Plant breeders desire novel and more accurate tools to fast-track breeding programs required for the increasing demands of food and fodder because farmers are facing a changing climate in which drought stress has major impacts on crop damages globally. Crop loss, because of drought stress, has a huge impact on agriculture industry and the economy. Therefore, to prevent economic loss and to make the crop plants more tolerant to drought stress, a variety of approaches such as conventional breeding and molecular/ genetic engineering are being practiced. Keywords: Genetic engineering, Conventional breeding, Molecular assisted selection, Drought and Stress DOI: 10.7176/JBAH/11-17-04 Publication date: September 30 th 2021

Enhanced recovery program in liver surgery

Since the development of fast-track programs in colorectal surgery with promising results, many centers started with these programs, and improved them. These programs were applied to different organs with the same results observed in colorectal surgery. Liver resections were not excluded from enhanced recovery programs, with a significant reduction in length of hospital stay and costs. Adequate patient information and commitment, multimodal analgesia, fluid therapy and early oral intake are the most important items of these programs.

Demographic Landscape of Cardiothoracic Surgeons and Residents at United States Training Programs

BackgroundRecruiting and promoting women and racial/ethnic minorities could help enhance diversity and inclusion in the academic cardiothoracic (CT) surgery workforce. However, the demographics of trainees and faculty at US training programs have not yet been studied. MethodsTraditional, integrated (I-6), and fast-track (4+3) programs listed in the Accreditation Council for Graduate Medical Education (ACGME) public database were analyzed. Demographics of trainees and surgeons, including gender, race/ethnicity, subspecialty, and academic appointment (if applicable), were obtained from ACGME Data Resource Books, institutional websites, and public profiles. Chi-square and Cochran-Armitage trend tests were performed. ResultsIn July 2020, 78 institutions had at least 1 CT surgery training program; 40 (51%) had only a traditional program, 20 (26%) traditional and I-6, 6 (8%) all 3 types of program, and 4 (5%) only I-6. The proportion of female trainees increased significantly from 2011 to 2019 (19% vs 24%, P < .001), with female I-6 trainees outnumbering female traditional trainees since 2018. Significant increases by race/ethnicity were observed overall and by program type, notably for Asian and Hispanic individuals in I-6 programs and Black individuals in traditional programs. Finally, of the 1175 CT surgeons identified, 633 (54%) were adult cardiac surgeons, 360 (37%) assistant professors, 116 (10%) women, and 33 (3%) Black. ConclusionsThe demographic landscape of CT surgery trainees and faculty across multiple training pathways reflects increasing representation by gender and race/ethnicity. However, we must continue to work toward equitable representation in the workforce to benefit the diverse patients we treat.

Land (In)Justice and Ambiguous Conservationisms in Cathy Buckle’s Letters of the Zimbabwean Crisis

It is more than two decades now since the earliest state-endorsed appropriations of mostly white-owned commercial farms in Zimbabwe. The Third Chimurenga – or Fast-Track Land Reform Programme, as the land takeovers were later on officially tagged – triggered an unprecedented economic cataclysm from which the country is struggling to emerge. Over the years, there has been a rush to document, in multiple archives, experiences of the Third Chimurenga. Naturally, white Zimbabwean farm life-writings thrived during this period as victims of land loss sought to inscribe themselves into its narration. In available studies, their writings are usually read against the backdrop of the state’s Third Chimurenga narrative as complex alternative archives of the event. Such studies have mainly explored existential complications of landed whiteness, focusing primarily on how it informs particular notions of land (in)justice. In open letters written by Cathy Buckle during and following her farm’s invasion, land justice is discursively entangled with concerns about ecological/environmental justice. This article examines the semantic and aesthetic implications of this ‘entanglement’. Focus is placed on the ways in which environmental damage is discursively deployed as a moral site for contesting the state’s narrative of land. Beyond this, however, the article argues that, in her preoccupation with establishing moral deficits in violent farm appropriations, Buckle’s construction of white victimhood in terms of environmental harm manifests stereotypic sub/un/conscious innuendos that ambiguate and problematise the moral claim of her concept of land (in)justice. This, I further contend, complicates the status and function of the Zimbabwean ‘farm narrative’ as an unproblematic archive pluralising the Third Chimurenga narrative of land upheavals.

Morbidity and mortality after liver surgery for colorectal liver metastases: a cohort study in a high-volume fast-track programme

BackgroundFor colorectal liver metastases, surgery is a high-risk procedure due to perioperative morbidity. The objective was to assess severity of complications after fast-track liver surgery for colorectal liver metastases and their impact on morbidity and mortality.MethodsAll patients were treated according to the same fast-track programme. Complications were graded according to the Clavien–Dindo classification for patients undergoing surgery from 2013 to 2015. Correlation between complications and length of stay was analysed by multivariate linear regression.Results564 patient cases were included of which three patients died within 3 months (0.53%, 95% CI: 0.17–1.64%). Complications were common with Grade ≤ 2 in 167 patients (30%) and ≥ Grade 3a in 93 (16%). Patients without complications had a mean length of stay of 4.1 days, which increased with complications: 1.4 days (95% CI: 1.3–1.5) for Grade 2, 1.7 days (1.5–2.0) for Grade 3a, 2.3 days (1.7–3.0) for Grade 3b, 2.6 days (1.6–4.2) for Grade 4a, and 2.9 days (2.8–3.1) for Grade 4b. Following were associated with increased length of stay: complication severity grade, liver insufficiency, ascites, biliary, cardiopulmonary, and infectious complications.ConclusionsComplications after liver surgery for colorectal liver metastases, in a fast track setting, were associated with low mortality, and even severe complications only prolonged length of stay to a minor degree.

The impacts of land reforms on water infrastructure use and investment: A case study of the Biri dam, Zimbabwe

This paper sought to answer the question, how did Zimbabwe land reforms impact on water use, property rights and investment in water infrastructure? This was done for Biri dam in Middle Manyame subcatchment. Landuse and landcover changes from 1984 through the land reform period to 2019 were analysed through GIS and remote sensing techniques. Water allocation and dam levels records were analysed to understand water use patterns within the subcatchment in the aftermath of the land reforms. Interviews were used to investigate perceptions on property rights and investment in water infrastructure. The study found that construction of the Biri dam coincided with the commencement of the Fast-Track Land Reform Programme. As a part of the reform process, the custodianship of the Biri dam was moved to the national water authority. Consequently, farmers who had invested in the dam lost their investment. Changes in land ownership affected water use, so much that between 2007 and 2020 the dam mostly maintained water storage levels above 70%. The study attributed the 85% decrease in land put under irrigation from 1984 to 2019 to the land reforms. Municipal water use, rather than agriculture for which the dam was primarily constructed, has now become the largest water user in the subcatchment. The study concluded that land reforms impacted negatively on water utilization and loss of investment in water infrastructure. The study recommends that land and water changes be implemented concurrently, taking into account how changes in one resource affects the other.