Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Neuartiges Gefahrstofflagersystem - speziell fuer den Einsatz in kleinen und mittleren Unternehmen Abschlussbericht

Industrial use of special chemicals has been drastically increasing within the last few years. Many of these chemicals are hazardous to environment. Due to high investment costs for correct storage these materials are often stored not according to regulations thus negligibling the perils for environment. This is especially true for smaller and medium companies. Objective of the project was the developing of a modular storage system for hazardous materials, especially designed for smaller and medium companies. The project was successful in all details. With the developed system costs for planning and construction of a storage for hazardous materials can be cut down drastically. The HERING-BAU group constructed its own storage due to the developed concept. From the beginning, this storage has been planned as 'demonstration object' just to inform interested people about the new system. (orig.)SIGLEAvailable from TIB Hannover: F96B263 / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekBundesministerium fuer Umwelt, Naturschutz und Reaktorsicherheit, Bonn (Germany); Umweltbundesamt, Berlin (Germany)DEGerman

Selection of reference films based on reliability assessment of a classification of high-resolution computed tomography for pneumoconioses.

Worldwide demand has increased for the development of a computed tomography (CT) classification system that supplements the ILO classification of radiographs for pneumoconioses. The authors aimed to show preliminary reliability test results for selected referent films for the CT classification system developed through an international effort by researchers from seven countries.Journal ArticleResearch Support, Non-U.S. Gov'tValidation Studiesinfo:eu-repo/semantics/publishe