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

El Jarama medieval

Convocatoria de Premios Nacionales de Innovación Educativa 2004, Tercer premio. Esta innovación no está publicad. El material complementario contiene: 1 libro antiguo, 1 saquito aromático, pelotas de malabares, 1 marioneta, 1 collar, 1colgante estrella, 1 cometa, cestería (cesta o posavasos), pintura de códices, las tres en raya de arcilla, fular, vidriera de cristal, vidriera de acetato, 1 códice de música, menú de la comida medieval, libro de seres mágicos, Programa 'El Jarama medieval', Programa 'El asedio a un castillo', Programa de Carnaval, Taller cultural de Escuela Infantil 'La Edad Media', Taller cultural, hiervas medicinales y trucos de botica, cuadros de arpilleraProyecto para el acercamiento del alumnado al estudio de la época medieval a través de distintos aspectos: historia, costumbres forma de vida, ocio, diferentes culturas, leyendas, debates, críticas, manifestaciones artísticas, etc. La elección del tema estuvo determinada por considerar la Edad Media una época histórica altamente didáctica y motivadora tanto para el alumnado como para el profesorado. Una época desde la que arrancan una gran variedad de oficios, tradiciones, una época donde distintas religiones y culturas convivían y que facilita su tratamiento desde todos los ámbitos y áreas curriculares que facilita la participación de toda la comunidad escolar. Se dio un enfoque a la metodología que sirviese a los alumnos para aprender gracias a la experiencia propia y avanzar en la adquisición de conocimientos a través de la utilización de los medios de comunicación e información que proporcionan las nuevas tecnologías. El propósito era que los alumnos madurasen de una forma integral, proporcionándoles aprendizajes significativos. El desarrollo de la innovación se inició con el conocimiento general de la época y con los disfraces en Carnaval, se visitó el Castillo de Coca y un parque temático de edificios representativos de la época y tuvo su mayor esplendor en el desarrollo de la Semana Cultural.Ministerio Educación CIDEBiblioteca de Educación del Ministerio de Educación, Cultura y Deporte; Calle San Agustín, 5 - 3 Planta; 28014 Madrid; Tel. +34917748000; Fax +34917748026; [email protected]

Effects of climate and atmospheric nitrogen deposition on early to mid-term stage litter decomposition across biomes

International audienceLitter decomposition is a key process for carbon and nutrient cycling in terrestrial ecosystems and is mainly controlled by environmental conditions, substrate quantity and quality as well as microbial community abundance and composition. In particular, the effects of climate and atmospheric nitrogen (N) deposition on litter decomposition and its temporal dynamics are of significant importance, since their effects might change over the course of the decomposition process. Within the TeaComposition initiative, we incubated Green and Rooibos teas at 524 sites across nine biomes. We assessed how macroclimate and atmospheric inorganic N deposition under current and predicted scenarios (RCP 2.6, RCP 8.5) might affect litter mass loss measured after 3 and 12 months. Our study shows that the early to mid-term mass loss at the global scale was affected predominantly by litter quality (explaining 73% and 62% of the total variance after 3 and 12 months, respectively) followed by climate and N deposition. The effects of climate were not litter-specific and became increasingly significant as decomposition progressed, with MAP explaining 2% and MAT 4% of the variation after 12 months of incubation. The effect of N deposition was litter-specific, and significant only for 12-month decomposition of Rooibos tea at the global scale. However, in the temperate biome where atmospheric N deposition rates are relatively high, the 12-month mass loss of Green and Rooibos teas decreased significantly with increasing N deposition, explaining 9.5% and 1.1% of the variance, respectively. The expected changes in macroclimate and N deposition at the global scale by the end of this century are estimated to increase the 12-month mass loss of easily decomposable litter by 1.1– 3.5% and of the more stable substrates by 3.8–10.6%, relative to current mass loss. In contrast, expected changes in atmospheric N deposition will decrease the mid-term mass loss of high-quality litter by 1.4–2.2% and that of low-quality litter by 0.9–1.5% in the temperate biome. Our results suggest that projected increases in N deposition may have the capacity to dampen the climate-driven increases in litter decomposition depending on the biome and decomposition stage of substrate

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