Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Chemical Additives for Corrosion Control in Desalination Plants

The addition of chemical additives has been considered as a standard operation in water treatment systems. This chapter discusses the chemical additives used for the control of corrosion in desalination systems. Specifically, corrosion inhibitors for various metallurgies, biocides, and oxygen scavengers are covered. The pros and cons of the additive chemicals have been highlighted. The need to utilize green corrosion inhibitors based on plants and ionic liquids materials have been emphasized. This class of materials are environmentally friendly, cheap, and readily available

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Tarikhu 'ashri al-khulafa' ar-rasyidin (u) asma al-muthalib fi siroh amir al-mu'minin 'ali bin abi tohb syakhsiyatihi wa 'ashrihi

24,3 cm ; 5-784 hl

Tarikhu 'ashri al-khulafa' ar-rasyidin (u) asma al-muthalib fi siroh amir al-mu'minin 'ali bin abi tohb syakhsiyatihi wa 'ashrihi

24,3 cm ; 5-784 hl

Experiences and Perceptions of Post-Stroke Fatigue Among Stroke Survivors in Saudi Arabia: A Qualitative Interview Study

Wafa Saeed Alahmari,1,2 Kholood Matouq Shalabi,1 Reem M Basuodan,1 Ahmed Saad Alhowimel,3 Mazyad Alotaibi3 1Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia; 2Centre for Rehabilitation and Ageing Research, School of Medicine, University of Nottingham, Nottingham, UK; 3Physical Therapy and Rehabilitation Department, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi ArabiaCorrespondence: Kholood Matouq Shalabi, Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, PO Box 84428, Riyadh, Saudi Arabia, Email [email protected]: Post-stroke fatigue (PSF) is a debilitating condition that negatively impacts the quality of life of stroke survivors. The rehabilitation of stroke survivors is important for their quality of life, and rehabilitation programs that cater to the needs of these patients are required. However, there is very little published information on their needs, especially in the Middle East. Therefore, this study aimed to explore stroke survivors’ perceptions and experiences of PSF and its causes, its impact on their daily life, their coping strategies, and support from physicians and caregivers in the context of Saudi Arabia.Patients and Methods: This qualitative interview study was conducted with eight post-stroke survivors from two tertiary stroke centers in Saudi Arabia.Results: The responses in the interviews showed high heterogeneity. From the responses, five main themes and several subthemes were generated: (1) description of PSF as both a physical and psychological experience; (2) perceived causes of PSF (physical causes, psychological causes, and stroke-related causes); (3) impact of PSF on daily life (activities of daily living and social interactions); (4) coping strategies for PSF (pacing, self-motivation, and social participation); and (5) perspectives about support from caregivers and healthcare practitioners (lack of support, provision of information about PSF and its management, physiotherapy interventions, encouragement, and overprotectiveness).Conclusion: Stroke survivors have variable physical and psychological experiences of PSF and variable perceptions of its causes and impact. High heterogeneity was also noted in the perception of support provided by healthcare providers and families or caregivers—ranging from lack of support to overprotection. Similarly, patients’ perceptions of the role of physiotherapy and their attitude towards physiotherapy were also variable. Despite this, the findings do highlight the need for more individualized understanding of PSF and the development of treatment strategies that consider biological, psychological, and social factors.Keywords: cerebrovascular stroke, fatigue, inductive thematic analysis, patient perspective, Saudi Arabia, semi-structured intervie

Biomechanics of the press-fit phenomenon in dental implantology: an image-based finite element analysis

<p>Abstract</p> <p>Background</p> <p>A fundamental pre-requisite for the clinical success in dental implant surgery is the fast and stable implant osseointegration. The press-fit phenomenon occurring at implant insertion induces biomechanical effects in the bone tissues, which ensure implant primary stability. In the field of dental surgery, the understanding of the key factors governing the osseointegration process still remains of utmost importance. A thorough analysis of the biomechanics of dental implantology requires a detailed knowledge of bone mechanical properties as well as an accurate definition of the jaw bone geometry.</p> <p>Methods</p> <p>In this work, a CT image-based approach, combined with the Finite Element Method (FEM), has been used to investigate the effect of the drill size on the biomechanics of the dental implant technique. A very accurate model of the human mandible bone segment has been created by processing high resolution micro-CT image data. The press-fit phenomenon has been simulated by FE analyses for different common drill diameters (D_A = 2.8 mm, D_B = 3.3 mm, and D_C = 3.8 mm) with depth L = 12 mm. A virtual implant model has been assumed with a cylindrical geometry having height L = 11 mm and diameter D = 4 mm.</p> <p>Results</p> <p>The maximum stresses calculated for drill diameters D_A, D_B and D_C have been 12.31 GPa, 7.74 GPa and 4.52 GPa, respectively. High strain values have been measured in the cortical area for the models of diameters D_A and D_B, while a uniform distribution has been observed for the model of diameter D_C . The maximum logarithmic strains, calculated in nonlinear analyses, have been ϵ = 2.46, 0.51 and 0.49 for the three models, respectively.</p> <p>Conclusions</p> <p>This study introduces a very powerful, accurate and non-destructive methodology for investigating the effect of the drill size on the biomechanics of the dental implant technique.</p> <p>Further studies could aim at understanding how different drill shapes can determine the optimal press-fit condition with an equally distributed preload on both the cortical and trabecular structure around the implant.</p