This is a repository copy of Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH) : a stepped-wedge cluster-randomised trial. Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH) : a stepped-wedge cluster-randomised trial. The Lancet. ISSN 0140-6736 https://doi.org/10.1016/S0140-6736(18)32521-2 eprints@whiterose.ac.uk https://eprints.whiterose.ac.uk/ ReuseThis article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs (CC BY-NC-ND) licence. This licence only allows you to download this work and share it with others as long as you credit the authors, but you can't change the article in any way or use it commercially. More information and the full terms of the licence here: https://creativecommons.org/licenses/ Implications of all the available evidenceDespite the success of some smaller projects, there was no survival benefit from a national quality improvement programme to implement a care pathway for patients undergoing emergency abdominal surgery. To succeed, large national quality improvement programmes need to allow for differences between hospitals and ensure teams have both the time and resources needed to improve patient care.

No abstract

Gas chromatography-mass spectrometry was used to measure the oxidative DNA damage in diabetic subjects and controls. Levels of multiple DNA base oxidation products, but not DNA base de-amination or chlorination products, were found to be elevated in white blood cell DNA from patients with type II diabetes as compared with age-matched controls. The chemical pattern of base damage is characteristic of that caused by an attack on DNA by hydroxyl radical. An increased formation of the highly reactive hydroxyl radical could account for many of the reports of oxidative stress in diabetic subjects. There was no evidence of an increased DNA damage by reactive nitrogen or chlorine species.z 1999 Federation of European Biochemical Societies.

No abstract

1 The nitric oxide synthase inhibitor N G -nitro-L-arginine methyl ester (L-NAME) is widely used to study the role of NO . in physiological and pathological processes, including its role in the generation of the cytotoxic species peroxynitrite (ONOO 7) and of reactive oxygen radicals such as hydroxyl (OH . ). Often L-NAME is applied to tissues at mM concentrations. At such high concentrations, it might act as a free radical scavenger. A similar possibility might apply to the use of high levels of arginine to study the role of NO . in atherogenesis. 2 We therefore examined the rate of scavenging of OH. by L-NAME and found that L-NAME reacts more quickly with OH. than the established`OH . scavenger' mannitol and the widely used`OH . trap' salicylate. However, D-NAME can scavenge OH. at rates equal to L-NAME. Both L-and D-arginine were also good OH . scavengers, comparable in eectiveness to mannitol. 3 Neither L-NAME, D-NAME, L-arginine nor D-arginine was able to inhibit ONOO 7 -dependent nitration of tyrosine, suggesting that they are unlikely to be scavengers of ONOO 7 -derived nitrating species. 4 Neither L-NAME, D-NAME, L-arginine nor D-arginine was able to inhibit the inactivation of a 1 -antiproteinase by ONOO 7 , suggesting that they cannot prevent direct oxidations by peroxynitrite. 5 We conclude that L-NAME has sucient activity as an OH. scavenger to confound certain pharmacological experiments. However, this explanation of its biological eects can be ruled out if control experiments show that D-NAME has no eect and that L-arginine (also a free radical scavenger) antagonizes the action of L-NAME.