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

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

Antología del pensamiento crítico guatemalteco contemporáneo

La tarea de elaborar una antología del pensamiento social crítico en Guatemala ha supuesto un esfuerzo en varios sentidos. En primer lugar, delimitar qué se entiende por pensamiento crítico, y luego, decidir qué período abarcar, cuáles autoras y autores incluir, y cuáles los textos pertinentes []. Para acotar la búsqueda se comprendió como pensamiento social crítico al conjunto de ideas elaboradas desde perspectivas divergentes, a contracorriente de los discursos y las historias oficiales, que han sido el resultado de la investigación, análisis, sistematización y reflexión sobre la realidad de la sociedad guatemalteca, con el propósito de desentrañar las estructuras de poder que sostienen un orden desigual, de raíces coloniales, que niega derechos y limita el desarrollo humano de la mayoría de la población, particularmente de las mujeres, y los pueblos indígenas. En la antología que ahora se presenta, se incluye a treinta y cinco autoras y autores, mujeres y hombres, de diversas identidades, y generaciones. Algunos con una producción muy vasta y otros que inician sus reflexiones. Se trató de mostrar una polifonía de voces y perspectivas, y para efectos de una mejor comprensión se establecieron cuatro ejes que dan cuenta de las principales preocupaciones sociales, intelectuales y políticas que han predominado en las décadas de finales del siglo veinte e inicios del veintiuno: Estado, política, sociedad y economía (Eje 1); Violencia política, movimientos sociales, memoria e historia (Eje 2); Etnicidad, relaciones interétnicas, racismo (Eje 3); y, por último, Cuerpos, género, feminismos, sexualidades, violencia (Eje 4). [] Considero este texto como un aporte más en el conocimiento de la producción intelectual en Guatemala, una invitación a profundizar en el pensamiento social crítico, a identificar autorías, temas y problemáticas que ahora no fueron incorporadas. Una motivación para continuar indagando y construyendo la historia de los aportes intelectuales en el país, ampliando miradas y ejes de análisis, temporalidades y temáticas. Del Prólogo de Ana Silvia Monzó

Mortality from HIV and TB coinfections is higher in Eastern Europe than in Western Europe and Argentina

Membro del HIV/TB Study Writing Group per la ricerca collaborativa pubblicata sulla rivista: AID