Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

International longitudinal registry of patients with atrial fibrillation and treated with rivaroxaban: RIVaroxaban Evaluation in Real life setting (RIVER)

Background Real-world data on non-vitamin K oral anticoagulants (NOACs) are essential in determining whether evidence from randomised controlled clinical trials translate into meaningful clinical benefits for patients in everyday practice. RIVER (RIVaroxaban Evaluation in Real life setting) is an ongoing international, prospective registry of patients with newly diagnosed non-valvular atrial fibrillation (NVAF) and at least one investigator-determined risk factor for stroke who received rivaroxaban as an initial treatment for the prevention of thromboembolic stroke. The aim of this paper is to describe the design of the RIVER registry and baseline characteristics of patients with newly diagnosed NVAF who received rivaroxaban as an initial treatment. Methods and results Between January 2014 and June 2017, RIVER investigators recruited 5072 patients at 309 centres in 17 countries. The aim was to enroll consecutive patients at sites where rivaroxaban was already routinely prescribed for stroke prevention. Each patient is being followed up prospectively for a minimum of 2-years. The registry will capture data on the rate and nature of all thromboembolic events (stroke / systemic embolism), bleeding complications, all-cause mortality and other major cardiovascular events as they occur. Data quality is assured through a combination of remote electronic monitoring and onsite monitoring (including source data verification in 10% of cases). Patients were mostly enrolled by cardiologists (n = 3776, 74.6%), by internal medicine specialists 14.2% (n = 718) and by primary care/general practice physicians 8.2% (n = 417). The mean (SD) age of the population was 69.5 (11.0) years, 44.3% were women. Mean (SD) CHADS2 score was 1.9 (1.2) and CHA2DS2-VASc scores was 3.2 (1.6). Almost all patients (98.5%) were prescribed with once daily dose of rivaroxaban, most commonly 20 mg (76.5%) and 15 mg (20.0%) as their initial treatment; 17.9% of patients received concomitant antiplatelet therapy. Most patients enrolled in RIVER met the recommended threshold for AC therapy (86.6% for 2012 ESC Guidelines, and 79.8% of patients according to 2016 ESC Guidelines). Conclusions The RIVER prospective registry will expand our knowledge of how rivaroxaban is prescribed in everyday practice and whether evidence from clinical trials can be translated to the broader cross-section of patients in the real world

Phytoplankton-zooplankton relations in three inland seas along the Qatari coast (Arabian Gulf)

Phyloplankton and zooplankton community structures and abundance were studied in three inland seas around Qatar, two along the eastern coast and one along the northwestern coast. Despite some irregularities, the direct relationship between phytoplankton and zooplankton in both seasons indicates that despite of the oligotrophic nature of the inland seas and consequently the low diversity of species, the zooplankton community density is dependent, with different magnitudes, on the density of the phytoplankton community. Multiple regression analysis indicated that at the time where permissible pollution limits were not exceeded, salinity is the main factor controlling zooplankton distribution in the inland seas, followed by phytoplankton. © 2005 Taylor & Francis

التركيب البيوكيميائي للكوبيبودا يوتربينا اكيوتفرانز في المياه الساحلية للأسكندرية

Protein, carbohydrate and lipid contents were determined in the most numerous and wide spread copepod Euterpina acutifrons collected from the coastal waters of Alexandria. Protein is the major biochemical component of the copepod constituting on the average 35.2 ± 6.7% of the organisms' dry weight followed by carbohydrate (7.9 ± 1.6%) and lipid (3.7 ± 1.9%) contents. Organisms collected from the Eastern Harbor (eutrophic basin) affected by sewage discharge were characterized by high biochemical contents while opposite to landbased sources affected by industrial discharge, the organisms' biochemical components were at a minimum. Compared to other representatives of the zooplankton community, Euterpina retains high protein content indicating its suitability as food for marine fishes. The step wise multiple regression equations revealed that the different biochemical components of Euterpina are mostly affected with the occurrence of available food represented by chlorophyll a concentrations. The average Protein/Carbohydrate ratio for E. acutifrons i.e. 4.46 ± 2.3 indicate that the organism is inhabiting a nutrient sufficient environment. Lipid/protein ratios more than 0.2 observed at industrial discharge affected areas indicate pollution impact on protein production.تم تعيين المحتوى البيوكيميائي لكائن يوتريبنا اكيوتفرانز ، اكثر الكوبيبودات عددا وانتشارا في المياه الساحلية لمدينة الاسكندرية. كان البروتين هو المكون البيوكيميائي الرئيسي حيث كون 25,2% من الوزن الجاف للكائن تلاه الكربوهيدرات (9 , 7%) ثم الدهون (3,7%) . أظهرت الكائنات المجموعة من الميناء الشرقي للإسكندرية المعرض للتلوث بمخلفات الصرف الصحي أعلى قيم للمركبات البيو كيميائية في حين سجلت أقل قيم في المناطق المعرضة للصرف الصناعي . مقارنة بمثيلاتها من العوالق الحيوانية . أظهرت يوتربينا أعلى مستويات للبروتين مؤكدة فائدتها كغذاء للأسماك البحرية . أوضحت الدراسات الإحصائية تأثر المحتوى البيوكيميائي للكائن تأثرا كبيراً بتوفر الغذاء الممثل في الكلوروفيل أ. كما أثبتت النسبة المرتفعة للبروتين / كربوهيدرات أن الكائن يعيش في بيئة غنية بالأملاح المغنية ، في حين أن نسبة الدهون / البروتين التي تتجاو 2، و التي تم تسجيلها في المناطق المتأثرة بالصرف الصناعي تدل على تا اثير التلوث على زيادة إنتاجية البروتينات