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With a stretched healthcare system and elective surgery backlog, measures to improve efficiency and decrease costs associated with surgical procedures need to be prioritized. This study compares the benefits of multi-disciplinary involvement in an enhanced recovery after surgery (ERAS) protocol-led overnight model following total hip replacement (THR) and total knee replacement (TKR).Patients in each of two private hospitals undergoing THR or TKR were prospectively enrolled. One hospital (Overnight) was fully committed to the ERAS protocol implementation on all levels and formed the treatment group while in the other hospital (control), patients only had the anaesthetic and operative procedure as part of the ERAS protocol but did not follow the perioperative measures of the protocol. Outcomes on hospital length of stay (LOS), inpatient rehabilitation, functional outcomes, satisfaction, adverse events and readmission rates were investigated.Median LOS in the Overnight group was significantly smaller than in the control group (1 vs. 3 days, P 0.0001). The Overnight group had lower rates of inpatient rehabilitation utilization (4% vs. 41.2%, P 0.0001), similar improvements in functional hip and knee scores and no increased rate of adverse events or readmission. All patients in both groups were satisfied with their treatment.Overnight THR and TKR can safely be performed in the majority of patients, with a multi-disciplinary approach protocol and involvement of all perioperative stakeholders.

Ingestion of food grain grown in metal-contaminated soils may cause serious effects on human health. This study assessed the concentrations of Pb, As, Cd and Zn in agricultural soils and in rice grains near a former secondary lead smelter in Khulna, Bangladesh. It analyzed 29 samples of surface soil and rice grain collected around 500 m of the smelter. Contamination factor (Cf), pollution load index and total hazard quotient (THQ) were calculated to determine ecological and human health risks. Cd was not detected in any of the samples. For the soil samples, medians of the concentrations of Pb, As and Zn were 109, 6.2 and 514 mg/kg, respectively. For the rice grain samples, medians of the concentrations of Pb, As and Zn were 4, 1.4 and 25 mg/kg fw, respectively. Medians of the concentrations of Pb and As in rice grain were higher compared to their maximum allowable limit (0.2 mg/kg), which indicate potential health risks to inhabitants near the Pb smelter. The mean values of Cf for Pb, As, and Zn were, respectively, 11.6, 2.1 and 7.4. For Pb, around 41% of the samples had Cf > 6 indicating very strong contamination. THQ values for Pb and As were greater than 1.0, which evinces the health hazards of these trace elements. Measures should be taken to prevent trace elements exposure from Pb smelter in the study area.

Aim: This study examined the effects on disinfection by-product (DBP) concentrations of common household methods for processing drinking water. Methods: We investigated the effects of refrigerator storage, jug filtering, boiling in an electric kettle, and supply from an instant boiling water unit, with or without filtering, on four species of trihalomethanes (THMs) and nine species of haloacetic acids (HAAs) in water ready for consumption in Sydney, Australia. Water samples were processed in such a way as to simulate real life conditions for drinking filtered water or hot water drinks prepared from tap water drawn from public water supply systems. Results: There was a large reduction in total THMs in kettle-boiled water, instant boiled water, jug-filtered water and instant boiled-filtered water (reductions of 85.8, 93.5, 92.6 and 87.8% of their concentration in tap water respectively). Refrigerator storage did not appear to have a consequential effect on THMs or HAAs. Jug-filtering and instant boiling and filtering resulted in large decreases (77–94%) in all species of HAAs in tap water. Conclusion: This study suggests that different methods of processing tap water can change DBP concentration to an extent that would have a meaningful impact on exposure assessment in epidemiological studies.

There is inconclusive evidence from observational studies that disinfection by-products (DBPs) in drinking water are associated with colorectal cancer.A literature search, without language or time limits, was performed to identify relevant case-control and cohort studies. Separate risk estimates for colon and rectal cancer were extracted from studies meeting the inclusion criteria. Relative risks (RRs) or odds ratios (ORs) comparing the highest exposure category with the lowest were pooled using random effects methods.A total of 13 studies (3 cohort and 10 case-control) were analysed. For colon cancer, the pooled RR estimates were 1.11 [95% confidence interval (CI): 0.73-1.70] for cohort studies, 1.33 (95% CI: 1.12-1.57) for case-control studies and 1.27 (95% CI: 1.08-1.50) combining both study types. For rectal cancer, the corresponding RR estimates were 0.88 (0.57-1.35), 1.40 (1.15-1.70) and 1.30 (1.06-1.59). Sensitivity analysis showed these results were not importantly influenced by any single study. Publication bias was not evident for the colon cancer analysis but may have been a minor issue for the rectal cancer analysis. The results for rectal cancer may have been influenced by the quality of the studies.The study findings provide limited evidence of a positive association between colorectal cancer and exposure to DBPs in drinking water. The small number of studies and limitations in study quality prevent causal inference.

To critically analyse the learning curve for a single experienced open surgeon converting to robotic surgery. From February 2006 to July 2009, 300 patients underwent a robot-assisted laparoscopic prostatectomy (RALP) by a single urologist. This study is a prospective analysis of the baseline patient and tumour characteristics, intraoperative and postoperative data, and histopathologic features. To analyse the RALP learning curve, the joinpoint regression method was used. Mean age of the patient was 61.3 years (range 46–76). Mean pre-operative PSA level was 7 ng/ml (range 0.7–41), and follow-up was 14 months (0.7–41). The mean operating time was 185 min (range 119–525). One hundred and ten cases were required to achieve 3-h proficiency. There were no conversions. The mean hospital stay was 2.8 days (range 2–7). Major complications rate was 1.3%. The blood transfusion rate was 0.6%. The overall positive surgical margin (PSM) rate was 21.3%. pT2 and pT3 PSM rate was 10 and 44%, respectively. The joinpoint regression method showed that the learning curve started to plateau for the overall PSM rate after 205 cases (95% CI 200–249). For pT2 and pT3, PSM rate, the learning curve tended to flatten after 130 and 170 cases, respectively. The analysis of an experienced open surgeon learning curve in transferring his skills to the robotic platform has shown that 3-h proficiency requires 110 cases. The overall, pT2, and pT3 PSM rate take approximately 200, 130, and 170 cases, respectively, to flatten.