Outcomes of intervention treatment for concurrent cardio-cerebral infarction: a case series and meta-analysis

Background: The concurrent occurrence of acute ischemic stroke and acute myocardial infarction is an extremely rare emergency condition that can be lethal. The causes, prognosis and optimal treatment in these cases are still unclear.Methods: We conducted the literature review and 2 additional cases at Al-Shifa Hospital, we analyzed clinical presentations, risk factors, type of myocardial infarction, site of stroke, modified ranking scale and treatment options. We compare the mortality rate among patients with combination intervention treatment (both percutaneous coronary intervention for coronary arteries and mechanical thrombectomy for cerebral vessels) and medical treatment at the hospital and 90 days after stroke. Results: In addition to our cases, we identified 94 cases of concurrent cardio-cerebral infarction from case reports and series with a mean age of 62.5 ± 12.6 years. Female 36 patients (38.3%), male 58 patients (61.7%). Only 21 (22.3%) were treated with combination intervention treatment.The mortality rate at hospital discharge was (33.3%) and the mortality rate at 90 days was (49.2%). In patients with the combination intervention treatment group: the hospital mortality rate was 13.3% and the 90-day mortality rate was: 23.5% compared with the mortality rate in medical treatment (23.5% at the hospital and 59.5% at 90 days (p value 0.038 and 0.012 respectively) Conclusion: Concurrent cardio-cerebral infarction prognosis is very poor, about a third of patients died before discharge and half of the patients died 90 days after stroke. Despite only one-quarter of patients being treated by combination intervention treatment, this treatment modality significantly reduces the mortality rate compared to medical treatment

علاج المرضى في بيئة آمنة: دراسة مقطعية لمواقف الأطباء في قطاع غزة عن سلامة المرضى بين ، فلسطين

Background: Patient safety is important, as in increasingly complex medical systems, the potential for unintended harm to patients also increases. This study assessed the attitudes of doctors in the Gaza Strip towards patient safety and medical error. It also explored variables that impacted their attitudes. Methods: Doctors, working for at least 6 months in one of the four major government hospitals of the Gaza Strip, were invited to complete a 28-item, self-administered Arabic version of the Attitudes to Patient Safety Questionnaire III (APSQ-III); which assessed patient safety attitudes over nine domains, independent of the workplace. Results: A total of 150 doctors from four government hospitals participated in this study, representing 43.5% of all 345 doctors working in the four study hospitals at the time of the study. The mean age was 36.6 (±9.7) years. The majority (72.7%) were males, 28.7% worked in surgical, 26.7% in pediatric, 23.3% in medical, 16.7% in obstetrics and gynecology, and 4.7% in other departments. Most participants (62.0%) had never received patient safety training. The overall APSQ score was 3.58 ± 0.3 (of a maximum of 5). The highest score was received by the domain “Working hours as a cause of errors” (4.16) and the lowest score by “Importance of Patient Safety in the Curriculum” (3.25). Older doctors with more professional experience had significantly higher scores than younger doctors (p = 0.003), demonstrating more positive attitudes toward patient safety. Furthermore, patient safety attitudes became more positive with increasing years of experience in some domains. However, no significant impact on overall APSQ scores was found by workplace, specialty or whether the participants had received previous training about patient safety. Conclusion: Doctors in Gaza demonstrated relatively positive patient safety attitudes in areas of “team functioning” and “working hours as a cause for error”, but neutral attitudes in understanding medical error or patient safety training within the curriculum. Patient safety concepts appear to be acquired by doctors via informal learning over time in the job. Inclusion of such concepts into formal postgraduate curricula might improve patient safety attitudes among younger and less experienced doctors, support behaviour change and improve patient outcomes.خلفية البحث: تعتبر سلامة المرضى ذات أهمية قصوي، كما هو الحال في الأنظمة الطبية المتزايدة التعقيد ، تزداد أيضًا احتمالية حدوث ضرر غير مقصود للمرضى. قيمت هذه الدراسة اتجاهات الأطباء في قطاع غزة تجاه سلامة المرضى والخطأ الطبي. كما استكشفت المتغيرات التي أثرت على مواقفهم. طرق البحث: تمت دعوة الأطباء ، الذين يعملون لمدة 6 أشهر على الأقل في أحد المستشفيات الحكومية الرئيسية الأربعة في قطاع غزة ، لتعبثة النسخة العربية من استبيان المواقف تجاه سلامة المرضى (III (APSQ-III) ؛ والتي تقيم مواقف سلامة المرضى في تسعة مجالات ، بغض النظر عن مكان العمل. النتائج: شارك في هذه الدراسة ما مجموعه 150 طبيبًا من أربعة مستشفيات حكومية ، يمثلون 43.5٪ من إجمالي 345 طبيبًا يعملون في المستشفيات الأربعة التي خضعت للدراسة في وقت الدراسة. كان متوسط ​​العمر 36.6 (± 9.7) سنة. الغالبية (72.7٪) من الذكور ،يعمل 28.7٪ في الجراحة ، 26.7٪ في طب الأطفال ، 23.3٪ في الباطنة ، 16.7٪ في التوليد وأمراض النساء ، و 4.7٪ في الأقسام الأخرى. معظم المشاركين (62.0٪) لم يتلقوا أي تدريب على سلامة المرضى. كانت النتيجة الإجمالية APSQ 3.58 ± 0.3 (بحد أقصى 5). تم الحصول على أعلى درجة في البند "ساعات العمل كسبب للأخطاء" (4.16) وأدنى درجة في البند "أهمية سلامة المريض في المنهج الدراسي" (3.25). كان لدى الأطباء الأكبر سنًا الذين يتمتعون بخبرة مهنية درجات أعلى بكثير من الأطباء الأصغر سنًا (p = 0.003) ، مما يدل على مواقف أكثر إيجابية تجاه سلامة المرضى. علاوة على ذلك ، أصبحت مواقف سلامة المرضى أكثر إيجابية مع زيادة سنوات الخبرة في بعض المجالات. ومع ذلك ، لم يتم العثور على تأثير كبير على درجات APSQ الإجمالية حسب مكان العمل أو التخصص أو ما إذا كان المشاركون قد تلقوا تدريبًا سابقًا حول سلامة المرضى. النتائج: شارك في هذه الدراسة ما مجموعه 150 طبيبًا من أربعة مستشفيات حكومية ، يمثلون 43.5٪ من إجمالي 345 طبيبًا يعملون في المستشفيات الأربعة التي خضعت للدراسة في وقت الدراسة. كان متوسط ​​العمر 36.6 (± 9.7) سنة. الغالبية (72.7٪) من الذكور ،يعمل 28.7٪ في الجراحة ، 26.7٪ في طب الأطفال ، 23.3٪ في الباطنة ، 16.7٪ في التوليد وأمراض النساء ، و 4.7٪ في الأقسام الأخرى. معظم المشاركين (62.0٪) لم يتلقوا أي تدريب على سلامة المرضى. كانت النتيجة الإجمالية APSQ 3.58 ± 0.3 (بحد أقصى 5). تم الحصول على أعلى درجة في البند "ساعات العمل كسبب للأخطاء" (4.16) وأدنى درجة في البند "أهمية سلامة المريض في المنهج الدراسي" (3.25). كان لدى الأطباء الأكبر سنًا الذين يتمتعون بخبرة مهنية درجات أعلى بكثير من الأطباء الأصغر سنًا (p = 0.003) ، مما يدل على مواقف أكثر إيجابية تجاه سلامة المرضى. علاوة على ذلك ، أصبحت مواقف سلامة المرضى أكثر إيجابية مع زيادة سنوات الخبرة في بعض المجالات. ومع ذلك ، لم يتم العثور على تأثير كبير على درجات APSQ الإجمالية حسب مكان العمل أو التخصص أو ما إذا كان المشاركون قد تلقوا تدريبًا سابقًا حول سلامة المرضى

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

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

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: 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. Funding: National Institute for Health and Care Research