Observations from a study tour of Bangladesh and Indonesia on their family welfare programme

Bangladesh has a successful family planning (FP) program and has succeeded in bringing about a demographic transition at a much faster rate than many of its neighboring countries. The contraceptive prevalence rate in Bangladesh increased from 3 percent in 1971 to 45 percent in 1993, and the fertility rate decreased from 7.0 to 3.4 births per woman during the same period. This reflects the effort that the Government of Bangladesh, with the help of international agencies, has made to educate couples about FP and increase access and choice of contraceptive methods, even in remote areas. Another predominantly Muslim country that has achieved remarkable success in FP is Indonesia which has had unprecedented economic growth in recent years. A visit to these countries to study their FP programs provided opportunities to closely observe activities that have contributed to this success. The Population Council, under the Asia and Near East Operations Research and Technical Assistance (ANE OR/TA) project funded by USAID, organized a study tour of Bangladesh and Indonesia for Indian officials, and results are provided in this report

The Cholecystectomy As A Day Case (CAAD) Score: A Validated Score of Preoperative Predictors of Successful Day-Case Cholecystectomy Using the CholeS Data Set

Background Day-case surgery is associated with significant patient and cost benefits. However, only 43% of cholecystectomy patients are discharged home the same day. One hypothesis is day-case cholecystectomy rates, defined as patients discharged the same day as their operation, may be improved by better assessment of patients using standard preoperative variables. Methods Data were extracted from a prospectively collected data set of cholecystectomy patients from 166 UK and Irish hospitals (CholeS). Cholecystectomies performed as elective procedures were divided into main (75%) and validation (25%) data sets. Preoperative predictors were identified, and a risk score of failed day case was devised using multivariate logistic regression. Receiver operating curve analysis was used to validate the score in the validation data set. Results Of the 7426 elective cholecystectomies performed, 49% of these were discharged home the same day. Same-day discharge following cholecystectomy was less likely with older patients (OR 0.18, 95% CI 0.15–0.23), higher ASA scores (OR 0.19, 95% CI 0.15–0.23), complicated cholelithiasis (OR 0.38, 95% CI 0.31 to 0.48), male gender (OR 0.66, 95% CI 0.58–0.74), previous acute gallstone-related admissions (OR 0.54, 95% CI 0.48–0.60) and preoperative endoscopic intervention (OR 0.40, 95% CI 0.34–0.47). The CAAD score was developed using these variables. When applied to the validation subgroup, a CAAD score of ≤5 was associated with 80.8% successful day-case cholecystectomy compared with 19.2% associated with a CAAD score >5 (p < 0.001). Conclusions The CAAD score which utilises data readily available from clinic letters and electronic sources can predict same-day discharges following cholecystectomy

ANALISIS KUALITAS DESAIN JARING PEMANTAU HORISONTAL CANDI BOROBUDUR UNTUK STUDI DEFORMASI (KALA PENGAMATAN 2011 DAN 2012)

Borobudur temple has a historical value and this is one of the world cultural heritage. This temple stands on on the soil and can be deformed in the horizontal direction . Horizontal deformation monitoring is done by performing the calculation and analysis of the data size of angle and distance measurements obtained from the monitoring of network in the form of a closed traverse. It is consist of several monitoring points will be analyzed deformation, so it also analysis the quality of the design of a closed traverse that used in the study of horizontal deformation. In practice, this study used geodetic measurements data such as distance and horizontal angle at two time observations . First measurement was made on July 5, 2011, while the second observation was made on July 13, 2012. Objects monitoring and studied were several monitoring points totaled 8 points in horizontal displacement monitoring. These points are evenly spread out in the yard and around the temple area. Data processing used the parameter least squares method. Analysis quality of web design used absolute error ellipse methode at each monitoring points, while horizontal displacement monitoring analysis used statistically and numerically through the test object point displacement. Based on the data processing and analysis, then the results obtained from visual analysis absolute error ellipse on the monitoring points showed that measurement accuracy, the number of reference points used, and geometric shapes of network effect on the measurement of the design network quality. In addition, the horizontal deformation analysis using a statistics confidence level of 95%, obtained a result there was a horizontal displacement at point 2P3 of 8,5 mm with soutwest direction

Peran Dana Desa Terhadap Pembangunan Ekowisata Boon Pring Andeman Di Desa Sanankerto, Kecamatan Turen, Kabupaten Malang, Jawa Timur

Peran Dana Desa Terhadap Pembangunan Ekowisata Boon Pring Andeman di Desa Sanankerto Kecamatan Turen Kabupaten Malang Jawa Timur mencoba untuk mengkaji tentang peran dana desa dan pengelolaan ekowisata. Sehingga dapat diketahui peran dana desa untuk pengelolaan ekowisata dan dapat menganalisis pengelolaan ekowisata serta kontribusinya ke PADes di Desa Sanankerto.Penelitian ini menggunakan teori pembangunan desa, agensi dan eksternalitas, juga UU No.6 Tahun 2014 tentang desa sebagai bentuk relevansi atas penerapan dana desa serta penelitian terdahulu sebagai pendukung dalam melihat permasalahan yang terjadi di Desa Sanankerto tentang peran dana desa terhadap pembangunan ekowisata. Jenis penelitian yang digunakan deskriptif analisis dengan metode pengumpulan data melalui wawancara dan dokumentasi terhadap unit analisis yaitu Direktur BUMDes Kertoraharjo dan Kepala Desa Sanankerto. Tehnik analisis menggunakan metode analisis statistic deskriptif dan pengujian keabsahan data dengan metode triangulasi. Hasil penelitian didapatkan bahwa peran dana desa di Desa Sanankerto berdampak secara luas terhadap masyarakat desa dengan meningkatnya ekonomi masyarakat serta terbukanya lapangan kerja baru sehingga dapat mengurangi angka pengangguran melalui pengelolaan Ekowisata Boon Pring Andeman. Pengelolaan Ekowisata Boon Pring Andeman melibatkan stakeholder yang ada di Desa Sanankerto sebagai proses dalam penyusunan dan pelaksanaan destinasi wisata tersebut

Predicting the difficult laparoscopic cholecystectomy: development and validation of a pre-operative risk score using an objective operative difficulty grading system

Background: The prediction of a difficult cholecystectomy has traditionally been based on certain pre-operative clinical and imaging factors. Most of the previous literature reported small patient cohorts and have not used an objective measure of operative difficulty. The aim of this study was to develop a pre-operative score to predict difficult cholecystectomy, as defined by a validated intra-operative difficulty grading scale. Method: Two cohorts from prospectively maintained databases of patients who underwent laparoscopic cholecystectomy were analysed: the CholeS Study (8755 patients) and a single surgeon series (4089 patients). Factors potentially predictive of difficulty were correlated to the Nassar intra-operative difficulty scale. A multivariable binary logistic regression analysis was then used to identify factors that were independently associated with difficult laparoscopic cholecystectomy, defined as operative difficulty grades 3 to 5. The resulting model was then converted to a risk score, and validated on both internal and external datasets. Result: Increasing age and ASA classification, male gender, diagnosis of CBD stone or cholecystitis, thick-walled gallbladders, CBD dilation, use of pre-operative ERCP and non-elective operations were found to be significant independent predictors of difficult cases. A risk score based on these factors returned an area under the ROC curve of 0.789 (95% CI 0.773–0.806, p &lt; 0.001) on external validation, with 11.0% versus 80.0% of patients classified as low versus high risk having difficult surgeries. Conclusion: We have developed and validated a pre-operative scoring system that uses easily available pre-operative variables to predict difficult laparoscopic cholecystectomies. This scoring system should assist in patient selection for day case surgery, optimising pre-operative surgical planning (e.g. allocation of the procedure to a suitably trained surgeon) and counselling patients during the consent process. The score could also be used to risk adjust outcomes in future research

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (&gt; 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations &gt; 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p &lt; 0.001), with the proportions of operations lasting &gt; 90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

Surgical site infection after gastrointestinal surgery in children: An international, multicentre, prospective cohort study

Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45·1%) children were from high HDI, 397 (34·2%) from middle HDI and 239 (20·6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12·8% (51/397) in middle HDI and 24·7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda

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