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

Action research in English and Anatomy

Abstrac

Action research in English and Anatomy

Abstrac

Techniques for rapid quantitative assessment of activity levels in small-group tutorials

Two techniques for the rapid quantitative analysis of student participation in small-group teaching were investigated. In the first approach an observer, who also acted as a 'critical friend', recorded the length of individual contributions using a computer keyboard as a simple timing device. In the second approach, small-group sessions were recorded with a portable stereophonic audiotape recorder. The teacher was recorded on one channel, all students on the other. A computer program produced automated analysis of these small group interactions by computing relative amount of speech on each channel. Simple analysis produced automatically by the programs revealed the overall style of the tutorial - variably 'mini-lectures' by teachers with very little participation by the student body, rapid 'question and answer' sessions with about equal teacher/student body involvement or 'mini-presentations' by students with the teacher offering sparse comments in the manner of a facilitator. By presenting results in a graphic format, teachers can be given rapid objective feedback on their teaching style. Coupled with short verbal/non-verbal quizzes at the end of tutorials and information from other assessments, the value of using levels of participation as a measure of the efficiency of such small-group sessions can itself be assessed.link_to_subscribed_fulltex

Language as a barrier to the acquisition of anatomical knowledge

The language of instruction for medical students at the University of Hong Kong is English, which is their second language. This presents a potential barrier to their academic learning. We have studied the extent of this problem by looking at the amount of terminology students have to assimilate during their anatomy course and the way in which the terminology is structured and explained (this provides, more generally, an indication of the factual loading to which medical students are exposed). We have also investigated the effect of the quality of students' language skills on their examination results in anatomy class tests and MBBS exams. It was found that students' entrance levels in English correlated well with their final examination results and that the quality and quantity of their English also correlated highly with scores in class tests. On this basis, we conclude that language is one of the most important barriers to students' academic success in the department and that current teaching materials may not be appropriate.link_to_subscribed_fulltex