Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

Despite current guidelines, intraperitoneal drain placement after elective colorectal surgery remains widespread. Drains were not associated with earlier detection of intraperitoneal collections, but were associated with prolonged hospital stay and increased risk of surgical-site infections.Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien-Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P < 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P < 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk

Experimentelle Untersuchung zur Beugung von Neutronen unter streifendem Einfalls- und Ausfallswinkel

It was shown by scatter experiments on the systems silicon, calcium fluoride, indium phosphide and manganese-fluoride that the surface-sensitive Bragg bending of neutrons is also possible for extremely small angles of incidence with a high angular accuracy. The scatter of neutrons from a surface layer of a few nanometres was shown. (orig./DG)Mit Streuexperimenten an den Systemen Silizium, Kalziumfluorid, Indiumphosphid und Manganfluorid konnte gezeigt werden, dass die oberflaechenempfindliche Braggbeugung mit Neutronen auch bei extrem kleinen Einfallswinkeln mit hoher Winkelgenauigkeit moeglich ist. Die Streuung von Neutronen aus einer Oberflaechenschicht von einigen Nanometern wurde nachgewiesen. (orig./DG)SIGLEAvailable from TIB Hannover: H94B723 / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekBundesministerium fuer Forschung und Technologie (BMFT), Bonn (Germany)DEGerman

Tenue sous irradiation de multicouches NixC1-x/Ti

Nous présentons ici les résultats de l'étude du vieillissement sous irradiation aux neutrons thermiques de multicouches NiC/Ti utilisées dans la fabrication des supermiroirs pour guides de neutrons. Nous montrons que le titane subit, sous irradiation, un changement de phase avec ou sans formation d'hydrure. De plus, les contraintes dans le nickel varient en fonction des taux d'irradiation

Supermirrors study by neutron multireflection

We present here time of flight neutron multireflection measurements. This technique has been developed at the Laboratoire Léon Brillouin (Saclay-France). Used in the investigation of supermirrors NiC/Ti, it allows us to increase the precision of the measurement of the most important part of the curve for technological applications : the extension of the total reflection plateau. The results on three systems (58Ni single layer, multilayer NiC/Ti, supermirror NiC/Ti) are presented in this paper. Beyond the good quality of the mirrors, they demonstrate the very good reliability of such a measurement. Moreover, they show that compared to a classical single reflection measurement, multireflection experiment enables us to increase the accuracy of the reflectivity value measured on the extended plateau

Titanium Evolution and Nickel Restoration Under Neutron Irradiation in Ni/Ti Multilayers

Ni/Ti multilayers are used as supermirrors for neutron guides. These multilayers are submitted to neutron irradiation. In order to determine the effect of irradiation on supermirrors performances we studied Ni/Ti multilayers irradiated with thermal neutrons. We present here the results obtained by neutron reflectivity, X-ray diffraction and EXAFS on one sample. It has been found that the supermirrors performances are not reduced. Nevertheless, Ti shows an evolution from the hcp structure to another crystalline state while Ni layers show a restoration of the fcc structure

Reported child sexual abuse in Bahrain: 2000-2009

<b>Background and Objective</b>: Child sexual abuse (CSA) is a common problem with severe short and long-term consequences to the abused child, the family and to society. The aim of this study was to evaluate the extent of CSA, and demographic and other characteristics of the abused and their families. <b>Design and Setting</b>: Retrospective and descriptive study based on a review of medical records of CSA cases from 2000-2009 at Sulmaniya Medical Complex, the main secondary and tertiary medical care facility in Bahrain. <b>Patients and Methods</b>: The review included demographic data, child and family characteristics, manifestations and interventions. <b>Results</b>: The 440 children diagnosed with CSA had a mean age of 8 years (range, 9 months to 17 years); 222 were males (50.5&#x0025;) and 218 were females (49.5&#x0025;). There was a steady increase in cases from 31 per year in 2000 to 77 cases in 2009. Children disclosed abuse in 26&#x0025; of cases, while health sector professionals recognized 53&#x0025; of the cases. Genital touching and fondling (62.5&#x0025;) were the most common form of CSA, followed by sodomy in 39&#x0025;. Gonorrhea was documented in 2&#x0025; of the cases and pregnancy in 4&#x0025; of the females. The illiteracy rate among the fathers and mothers was 9&#x0025; and 12&#x0025;, respectively, which is higher than the rate among the adult general population. Children came from all socio-economic classes. There was referral to police in 56&#x0025;, public prosecution in 31&#x0025; of the cases, but only 8&#x0025; reached the court. <b>Conclusion</b>: During ten years there has been a 2.5&#x0025; increase in reported cases of CSA. Improving the skill of professionals in identifying CSA indicators and a mandatory reporting law might be needed to improve the rate of recognition and referral of CSA cases. Further general population-based surveys are needed to determine more accurately the scope of CSA and the risk and protective factors in the family and community