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

Background 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

Efficacy of the essential oil of Origanum glandulosum Desf against skin infections With PVL-producing Staphylococcus aureus strains in mice.

International audienceSkin and soft tissue infections (SSTI) caused by staphylococcal toxins including Panton-Valentine leukocidin (PVL) have increased these last years. Treatment of these complicated infections is often difficult. The search for new methods and new antimicrobial substances is necessary. Natural products such as essential oils appear among the possible solutions. The objective of our work was to prove the effectiveness of treatment of these infections with essential oils in vivo on Wistar rats; we have chosen the oil of Origanum glandulosum from Algeria to perform this treatment because of its antiseptic properties. The treatment was done on infections induced in Wistar rats using PVL producing Staphylococcus aureus strain isolated from Tlemcen University Hospital. The results of our experiment have shown a significant decrease in the number of colonies collected from rats treated by the concentrations of 1 and 5% of O. glandulosum essential oil. The treatment of skin infections especially wounds caused by PVL positive S. aureus is possible with the essential oil of O. glandulosum which seems to be effective in eradicating the germ from infected wounds