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

The formation of risk groups for development of occupational diseases during the pre-employment and periodic medical examinations to conduct recreational activities

Research objective. The purpose ofthe study was to develop methodology for the formation of groups at risk of developing chronic diseases and complex of measures for their prevention when carrying out a compulsory medical examination of workers. Materials and methods. The results of periodic medical examinations for 2012 were analyzed according to 19 the final acts and reports 61 subjects ofthe Russian Federation. The results ofthe examination ofthe connection between disease and occupation were analyzed according to 50 examination protocols ofthe Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency during 200-2010. Results. Based on the results ofthe conducted analysis methodology was developed to assess the risk of occupational disease fully meets the current legislative and regulatory framework of the Russian Federation and enable the individual and group level: to assess the risk of occupational diseases (high, medium, low, no); to identify possible nosological forms of diseases that should be expected, in accordance with the current list of occupational diseases; — to predict the presence or absence of responsibility employer for any case of occupational disease; to generate the necessary recommendations to the employer for the prevention of occupational diseases among workers. Conclusion. The method of formation of risk groups for development of occupational diseases recommended for medical organizations, conducting preliminary and periodic medical examinations

Results of endovascular treatment of aortic valve disease in patients with intermediate surgical risk

Aim. To assess the results of a one­year follow­up after transcatheter aortic valve implantation (TAVI) in patients with intermediate surgical risk with severe aortic stenosis.Material and methods. The study included 42 patients with hemodynamically significant aortic stenosis and intermediate surgical risk. We assess the incidence of prosthesis­associated complications, one­year survival, clinical and hemodynamic characteristics, as well as the dynamics of the quality of life and social adaptation in the early postoperative period and one year after the intervention.Results. In patients with intermediate surgical risk prosthesis­associated complications were not registered in the early postoperative period and one year after TAVI, the survival rate was 97,6% and 88%, respectively. The hemodynamic effect of the operation according to the results of echocardiography persisted a year after the intervention with the positive dynamics of the myocardial contractile function. The quality of life a year after the TAVI increased on the scale of the physical health of the SF­36 questionnaire from 25 (22;29) to 42 (28;46) points (p=0,031), on the mental health from 42 (33;50) up to 53 (48;57) points (p=0,025). The level of social adaptation has increased significantly; score of the Holmes and Rahe scale decreased from 250 (198;300) to 200 (180;220) (p=0,027). Conclusion. The hemodynamic efficacy of TAVI in patients with intermediate surgical risk with severe aortic stenosis is associated with a significant improvement of life quality and the level of social adaptation one year after the endovascular correction of valve defect

Telehealth in cardiac rehabilitation: a review of current applications and future prospects for practical use

The article provides an overview of actual studies on cardiac rehabilitation using telehealth technologies, presents the types of telerehabilitation in clinical practice. The physiological mechanisms of exercise effects in rehabilitation programs in cardiovascular patients are considered in most detail. Telerehabilitation areas with potential for further study are presented

Spin alignment of K∗(892)±K^{*}(892)^{\pm} mesons produced in neutron-carbon interactions

A new precise measurements of spin density matrix element $\rho_{00}$ of$K^*(892)^{\pm}$ mesons produced inclusively in neutron-carbon interactions at\~60 GeV have been carried out in the EXCHARM experiment at the Serpukhovaccelerator. The values of $\rho_{00}$ obtained in the transversity frame are$0.424\pm0.011(stat)\pm0.018(sys)$ for $K^*(892)^+$ and$0.393\pm0.025(stat)\pm0.018(sys)$ for $K^*(892)^-$. Significant $P_T$dependence of $\rho_{00}$ has been observed in $K^*(892)^+$ production