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

Reflections on the Projection of a New Liberal Arts from Japan

publisher藤沢This essay offers a few indices on the relation between the processes of contemporary globalization and the historical projection of liberal arts education. It calls for the development of a ‘liberal’ education under an idea of the planetary. In such a pedagogical practice, the cultivation of the capacity to inhabit multiplicity at all levels would be its guide.

Of Horizon: An Introduction to “The Afro-American” by W. E. B. Du Bois—circa 1894

<p>This article offers an introduction to the hitherto unpublished early essay by W. E. B. Du Bois, “The Afro-American.” More precisely it outlines the problematic of the essay and places the essay amidst Du Bois’s writings of the 1890s and the production of the text that became <em>The Souls of Black Folk: Essays and Sketches</em> of 1903. In so doing it proposes a path for the initial reading of this essay by rendering thematic the worldwide horizon that framed Du Bois’s projection from this early moment and by bringing into relief the interwoven motifs of the global “problem of the color-line” and the sense of “double-consciousness” for the “Afro-American” in the United States.</p&gt

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