Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Citizen Participation in Smart Government: A Conceptual Model and Two IoT Case Studies

In its simplest form, smart government can be understood as the combination of new technologies and organizational innovation strategies to further modernize the public sector. Within this development, the Internet of Things (IoT) often forms a key technological foundation, offering government authorities new possibilities for inter-action with citizens and local communities. On one hand, citizens can indirectly partic-ipate in governmental services’ value creation by using public infrastructure or (un)knowingly sharing their data with the community. On the other hand, smart gov-ernment initiatives may rely more intensively on citizens’ active participation to im-prove public service delivery, increase trust in government actions, and strengthen community sentiment. In this chapter, we discuss active and passive participation sce-narios of smart government initiatives and explain how sensor-based systems may en-hance citizens’ opportunities to participate in local governance. We present two prac-tical cases from Switzerland demonstrating these two citizen involvement modes. We argue that active and passive participation of citizens and other stakeholders play key role in generating necessary data for algorithmic decision-making to enable personal-ized interaction and real-time control of infrastructure in the future. We close with a discussion of the possibilities and boundaries of the IoT in the public sector and their possible influences on citizens’ private lives and policy-making

Kuluttajabarometri maakunnittain 2000, 2. neljännes

Suomen virallinen tilasto (SVT

Use of failure-to-rescue to identify international variation in postoperative care in low-, middle- and high-income countries: a 7-day cohort study of elective surgery

This was an investigator-initiated study funded by Nestle Health Sciences through an unrestricted research grant and by a National Institute for Health Research (UK) Professorship held by R.P. The study was sponsored by Queen Mary University of London