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 economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

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

Shawki Farag Oral History

Shawki Farag was an accounting professor the American University in Cairo from the late 1970s through 2012, in addition to being a renowned Egyptian public intellectual, author, and columnist. He describes his upbringing and education in Cairo in the 1940s and 1950s, and life as a graduate student in the United States at Illinois in the 1960s. His return to Egypt at the time of the 1967 War and early career with the World Bank (including international posts and interaction with major figures like Robert McNamara and Sudan’s President Nimeiri) are recalled. Farag recalls joining AUC as the Management Department was developing in the early 1980s, and discusses the emergence of an accounting program and in 2009 AUC’s Accounting Department. The School of Business, Economics, and Communication and its Deans are discussed, along with management continuing education programs. Students at AUC and in the accounting program, their career paths, and the history and context of the accounting profession in Egypt are also addressed. Farag describes the downtown Tahrir Square campus and its facilities to the New Cairo campus, and comments on faculty issues such as the discrepancies in compensation and retirement age between Egyptian and foreign faculty. His research and professional activities like involvement in the creation of the Egyptian Banking Institute are covered, and he also discusses the career and role of his wife, opera singer Valerie de Casas Farag, in the creation of AUC’s music program

Shawki Farag Oral History

Shawki Farag was an accounting professor the American University in Cairo from the late 1970s through 2012, in addition to being a renowned Egyptian public intellectual, author, and columnist. He describes his upbringing and education in Cairo in the 1940s and 1950s, and life as a graduate student in the United States at Illinois in the 1960s. His return to Egypt at the time of the 1967 War and early career with the World Bank (including international posts and interaction with major figures like Robert McNamara and Sudan’s President Nimeiri) are recalled. Farag recalls joining AUC as the Management Department was developing in the early 1980s, and discusses the emergence of an accounting program and in 2009 AUC’s Accounting Department. The School of Business, Economics, and Communication and its Deans are discussed, along with management continuing education programs. Students at AUC and in the accounting program, their career paths, and the history and context of the accounting profession in Egypt are also addressed. Farag describes the downtown Tahrir Square campus and its facilities to the New Cairo campus, and comments on faculty issues such as the discrepancies in compensation and retirement age between Egyptian and foreign faculty. His research and professional activities like involvement in the creation of the Egyptian Banking Institute are covered, and he also discusses the career and role of his wife, opera singer Valerie de Casas Farag, in the creation of AUC’s music program

The accounting profession in Egypt: Its origin and development

The purpose of this paper is to present a historical review of the evolution of accounting and the accounting profession in Egypt. Such a review aims at providing the perspectives necessary to understand and evaluate the contemporary scene. The origin of accounting practices in Egypt can be traced to ancient Egyptian civilization, and the temples exhibit paintings of early accounting records and activities. Modern accounting practices can be dated from November 1883, when Egypt adopted the Commerce ACT. In the ensuing 125 years (1883-2008), Egyptian accounting practice can be divided into three stages: record keeping (1883-1939); financial reporting under changing economic regimes (1939-1975); and the move to adopt international accounting standards in an attempt to liberalize and integrate the Egyptian economy into the global economy (1975-). Each one of these stages reflects the impact of the socioeconomic conditions prevailing at the time. The evolution of accounting in Egypt demonstrates its ability to adapt in response to changing conditions. While there are several lessons to be drawn, and their relevance is noted, it is especially important for the accounting profession to anticipate changes in order to be responsive, in a timely manner, to the changing needs of the society.Evolution Accounting practices Stages of development Changing conditions Responsiveness Timely manner

An Investigation of Input - Output Analysis and Its Applications to Business Accounting

204 p.Thesis (Ph.D.)--University of Illinois at Urbana-Champaign, 1967.U of I OnlyRestricted to the U of I community idenfinitely during batch ingest of legacy ETD