Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

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

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

The Impact of Massive Open Online Courses (MOOCs) on Knowledge Management Using Integrated Innovation Diffusion Theory and the Technology Acceptance Model

MOOCs have grown in popularity in universities, but the agents that influence users’ acceptance of MOOCs are little understood. The large and open nature of MOOCs puts the student in charge of their own learning. As a result, it is critical to comprehend learner behavior. The research is conceptually founded on the innovation diffusion theory (IDT), as well as knowledge management (KM) and the technological adoption paradigm (TAM). In theory, eight separate factors were discovered as contributing to perceived usefulness, as well as perceived ease of use toward attitude toward utilizing MOOC systems and MOOC use intention. A survey questionnaire based on the innovation diffusion theory (IDT), knowledge management (KM) components, and the technological acceptance model (TAM) was used to collect data from 284 university students who were randomly selected. SPSS and SEM-Amos were used for data analysis. The findings show that perceived technology fit, perceived enjoyment, perceived compatibility (PC), trialability (TR), observability (OB), perceived usefulness (PU), perceived ease of use (PEOU), and attitude towards using the system (MOOCs) are the most important predictors of university students’ continued intention to use MOOCs (MOOCs). Through attitudes toward utilizing systems, perceived utility and perceived ease of use have an indirect impact on sustained intention (MOOCs). Both effort-perceived utility and perceived ease of use impact knowledge application, knowledge access, perceived technology fit, perceived pleasure, perceived compatibility (PC), trialability (TR), and observability (OB). Perceived compatibility (PC) has no bearing on perceived ease of use, while perceived technological fit (PTF) has no bearing on perceived utility. The findings will aid researchers and practitioners in better understanding university students’ intentions to use MOOCs in the future. This study’s ramifications and shortcomings are also discussed

Massive Open Online Course (MOOCs) Acceptance: The Role of Task-Technology Fit (TTF) for Higher Education Sustainability

The aim of the present study was to narrow the gap in the literature on the adoption of massive open online courses (MOOCs) and the role of task-technology fit (TTF), which influences student satisfaction, academic performance, and the long-term viability (sustainability) of MOOCs in higher education. While researchers have examined MOOC acceptance in a variety of contexts, the role of TTF as a mediating variable in evaluating education sustainability has not been explored using the technology acceptance model (TAM). As a result, the aim of this study was to create a new paradigm by combining two theories: TTF and TAM. Therefore, this study surveyed 277 university students from public universities using the structural equation modeling (SEM) approach to learn about their perceptions toward MOOCs as a method of achieving higher education sustainability. According to the findings, perceived ease of use had a positive impact on perceived enjoyment, perceived usefulness, and social influence, which in turn had a positive impact on task-technology fit and MOOCs use as a method of sustainability in higher education. Task-technology fit also had a positive impact on MOOC use as a method of sustainability. Finally, the role of task-technology fit and MOOCs in educational sustainability had a positive effect on students satisfaction and academic performance. As a result, the use of MOOCs in learning processes should be encouraged in higher education institutions to ensure their long-term viability (sustainability)

An Empirical Investigation on Students’ Acceptance of (SM) Use for Teaching and Learning

Abstract—The current work aims at developing a model of teaching and learning measurement through using social media, incorporating the literature of social media adoption on resource sharing, collaborating and communicating for educational purpose. The current study hypothesizes that perceived usefulness, perceived ease of use, attitude toward use, and social media use have certain influence on adoption of resource sharing, collaboration and communication for educational use. Therefore, resource sharing, collaboration and communication influence educational use, while educational use influences perceived ease of use, perceived usefulness, social media use and attitude toward the use of social media for teaching and learning. A Technology Acceptance Model (TAM) version was utilized in this research to be the main framework. Both the processes of collecting and analysing the data followed the quantitative approach. The main tool of data collection was a survey that has been distributed among 236 students using stratified random sampling technique. The view of the students and their implication of social media use for teaching and learning were solicited through the survey. Structure Equation Modelling (SEM) was used as the main tool in the process of data analysis. The results of this study were related to two main constructs: teaching and learning as well as educational use. According to the results, it appears that perceived usefulness, perceived ease of use, attitude toward use, and social media are considered powerful determinants of the former while resource sharing, collaboration and communication were significant indicators of the latter. Educational use, perceived usefulness, perceived ease of use, attitude toward use succeeded in explaining 65.5% of social media use for teaching and learning

E-Learning Acceptance: The Role of Task–Technology Fit as Sustainability in Higher Education

The aim of this study was to fill the gap in the literature on e-learning acceptance and its role in the sustainability of learning and the role of task-technology fit (TTF), which influences student satisfaction and academic performance. While researchers have examined e-learning acceptance in a variety of contexts, the role of TTF as a mediating variable in measuring education sustainability has not been explored using the technology acceptance model (TAM). As a result, the goal of this study was to develop a new paradigm by combining two theories: TFF and the TAM. In total, 432 students and researchers from public universities participated in this study. We surveyed students using the structural equation modelling (SEM) approach to learn about their expectations with regard to e-learning adoption. According to the findings, perceived ease of use has a positive impact on perceived enjoyment and usefulness, which in turn has a positive impact on task–technology fit and e-learning use in higher education, resulting in a positive impact on student satisfaction and academic performance as well as sustainability. Finally, the role of task-technology fit and e-learning usage in education sustainability had a positive effect on student satisfaction and learning performance. As a result, the use of e-learning in learning processes should be encouraged as a long-term strategy in higher education institutions

Factors Influencing Students&rsquo; Acceptance of M-Learning in Higher Education: An Application and Extension of the UTAUT Model

The goal of this study was to develop a new model and conduct confirmatory factor analysis to learn more about how students use M-learning in higher education. The study is theoretically based on the unified theory of acceptance and use of technology (UTAUT) theory and the technology acceptance model (TAM). Theoretically, the factors related to the adoption of M-learning in higher education, identified as contributory to perceived ease of use, perceived usefulness, and attitudes towards M-learning and actual use of M-learning, were analyzed. A questionnaire survey was distributed to 362 university students who were randomly selected. Structural Equation Modeling (SEM)-AMOS was used for data analysis. Based on the findings, M-learning appears to be one of the most promising educational technologies for development in educational environments. Perceived facilitating conditions, performance expectancy, effort expectancy, social influence, and perceived enjoyment have a significant positive effect on the perceived ease of use and perceived usefulness, while performance expectancy has a negative effect on the perceived ease of use. Perceived ease of use and perceived usefulness have a positive and significant effect on attitudes towards using M-learning and actual use of M-learning. Therefore, we recommend lecturers encourage students to utilize M-learning for educational purposes in higher education

Essential Factors to Improve Student Performance Using an E-Learning Model: Review Study

The e-learning system is one of the most common methods for improving student performance and the ongoing goal of using e-learning in higher education. The most popular kind of e-learning system is a big one that is used at the college level, including Moodle, MOOCs, and e-learning systems. A rigorous review of various e-learning tools that can be used to raise students' performance is presented in this paper. Based on a survey of the literature, a comparison was established between the key elements employed in e-learning. The method used was to extract the common elements used in more than one popular model, then to connect these factors to e-learning. In order to create a better model with full element constraints, this paper also includes extracting causal links between these aspects. The analysis's finding is that the most recent models accepted for use in raising student performance are TAM2, TAM3, and ECT. This study reveals the framework used to highlights the easy and popular factors according to the updated related studies.