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 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

Encapsulation of α-cyano-4-hydroxycinnamic acid into a NaY zeolite

The authors are thankful to Dr. K. Biernacki for DFT calculations and Dr. A.S. Azevedo for collecting the powder diffraction data.The faujasite zeolite structure was studied to investigate its suitability for development of new drug delivery systems (DDS). The sodium form (NaY) of the zeolite was used for encapsulation of a-cyano-4-hydroxy-cinnamic acid (CHC), an experimental anticancer drug used in colorectal cancer therapy. The DDS was prepared by diffusion in liquid phase of CHC as a guest in the void space of the host zeolite structure at pH 7.0. The molecular integrity of CHC in the encapsulation process was evaluated by proton nuclear magnetic resonance spectroscopy(1H NMR) and Ultraviolet–Visible spectroscopy (UV–Vis). The new drug delivery system, CHC@NaY, was characterized by Fourier transform infrared spectroscopy and UV–Vis, chemical analysis, powder X-ray diffraction, and Scanning electron microscopy. Analysis of the data of the drug alone and encapsulated in NaY show that CHC and the zeolite framework preserved their original structure. The effect of the zeolite and DDS on HCT-15 human colon carcinoma cell line viability was evaluated. The encapsulation of CHC significantly increased its potency.OM and RA are recipients of fellowships (SFRH/BD/ 36463/2007, SFRH/BI/51118/2010) from Fundacão para a Ciência e Tecnologia (FCT, Portugal).This study was supported by the Centre of Chemistry and Life and Health Sciences Research Institute (ICVS), University of Minho, Portugal, FCT (Portugal) through POCTI and FEDER projects (ref. POCTI-SFA-3-686) and by the FCT grant ref. PTDC/SAU-FCF/104347/2008, under the scope of ‘‘Programa Operacional Temático "Factores de Competitividade’’ (COMPETE) of ‘‘Quadro Comunitário de Apoio III’’ and co-financed by Fundo Comunitário Europeu FEDER

Some computational aspects for solving deep penetration problems in geomechanics

Penetration problems in geomechanics involve the insertion or intrusion of solid bodies into the ground. Such problems are extremely difficult to model numerically, because they usually involve severe mesh distortion caused by large deformation and frictional contact. In this paper, an Arbitrary Lagrangian–Eulerian method is used to overcome the mesh distortion problem. Some specific issues associated with the ALE method, such as node relocation and remapping of contact history variables, are discussed. The ALE method, incorporated with an automatic load stepping scheme and a smooth contact discretisation technique, is then used to analyse the penetration of axial displacement piles into the ground