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

This study was conducted at a time the International institutions are seeking to move forward towards involving the private sector in the development process

جاءت هذه الدراسة في الوقت الذي تسعى فيه القوى والمؤسسات الدولية الى الدفع باتجاه ضرورة اشراك القطاع الخاص في عمليات التنمية، وتقديم الدعم للحكومات لتشجيعها على تبني سياسة اقتصاد السوق واعادة الهيكلة وتقليص دور الدولة في الانشطة الاقتصادية(الخصخصة) وصولا الى قيام القطاع الخاص بقيادة عملية التنمية، بالشراكة مع الدولة، ولكي يكون القطاع الخاص قادرا على التاثير فمن الافضل له وللدولة ان يكون هناك جسم تمثيلي يتحدث باسم هذا القطاع ويعبر عنه لضمان تنسيق فعال واتصال جيد بين الشريكين . تناولت هذه الدراسة مسالة تمثيل القطاع الخاص الفلسطيني، من حيث الجهة التي تقوم بتمثيل هذا القطاع امام الجهات الاخرى ذات العلاقة بانشطته، هذا القطاع الذي من ابرز سماته انة تعرض على مدى تاريخة الى مجموعة من الظروف اثرت على تطوره بشكل طبيعي، كما انه قطاع ضعيف سريع التأثر بالظروف الاستثنائية المحيطة، وان عملية تمثيل هذا القطاع كانت تاريخيا من خلال الغرف التجارية الصناعية الزراعية، الا انه وبعد قدوم السلطة الوطنية الفلسطينية عام 1994 وما ترتب على ذلك من تغيرات عامة اثرت بالضرورة على وضع القطاع الخاص الفلسطيني ولو نظريا في بعض الجوانب، حيث اثبتت الاحداث ان القطاع الخاص الفلسطيني بقي عرضة للضرر من اجراءات الاحتلال رغم وجود السلطة، الا ان تغيرات حقيقية طرأت على عملية التمثيل . ان قيام السلطة الوطنية رافقة وجود واقع جديد من حيث القوانين التي عملت السلطة على اقرارها في مختلف مناحي الحياة ومن ضمنها ما يتعلق بالاقتصاد والقطاع الخاص، الا ن هذه القوانين جاءت غير ملائمة وبقي قسم منها غير مكتمل ولم يطبق الجزء المكتمل منها لاسباب لها علاقة بعدم الاستقرار والاضرابات التي كانت السمة السائدة منذ قيام السلطة وحتى اليوم، هذا بالاضافة الى حداثة اجهزة هذه السلطة، وضعف الجهاز القضائي الذي يقع على عاتقه ضمان تطبيق القانون مع الاجهزة الامنية . كما ان عملية تمثيل القطاع الخاص ايضا حدث عليها تغيرات بعد قيام السلطة الوطنية، اذ اصبح هناك مجموعة من الجهات تمثل او تدعي انها تمثل القطاع الخاص الفسطيني، وهي جهات غير حكومية، جاءت على شكل اتحادات ومجالس وجمعيات، تمثل قطاع معين مثل اتحاد الصناعات او نشاط معين مثل مجلس الشاحنين او جمعية المستوردين، وهناك من يدعي انه يمثل كل القطاع الخاص مثل المجلس التنسيقي للقطاع الخاص او جمعية رجال الاعمال، وكان من نتائج ذلك ان كل جهة تعتبر نفسها هي الممثل الاقوى او الانسب لتمثيل القطاع الخاص، فالغرف التجارية تدعي ذلك وتنكره على المجلس التنسيقي والعكس صحيح . ونظرا لصغر مجتمع الدراسة الذي هو عبارة عن المؤسسات التمثيلية، فقد ارتأى الباحث اعتماد منهج المقابلة المباشرة مع القائمين على هذه المؤسسات، من خلال استمارة مقابلة تضمنت مجموعة من المحاور تم مناقشتها مع المبحوثين . وقد بينت الدراسة ان هناك اشكالية في عملية التمثيل تم الحديث عنها في المجلس التشريعي، وتحدث عنها المبحوثون بكل وضوح، وكان من ابرز ملامح هذه الاشكالية ان هناك اكثر من جهة تدعي تمثيل القطاع الخاص، وهي في حالة من التنافس اللاصحي على الدعم المالي الخارجي بالدرجة الاولى، وعلى القيمة المعنوية لعملية التمثيل وما يترتب عليها من فتح المجال لاقامة علاقات دولية واقليمية، يجيرها بعض المتنفذين لخدمة اعمالهم الخاصة، وسبب ذلك كله هو القوانين السائدة بالدرجة الاولى، وضعف الغرف التجارية في القيام بدورها كممثل يتصف بالشمول من حيث القطاعات . وقد بينت الدراسة ان غالبية المعنيين يؤيدون ويرغبون في وجود جسم تمثيلي واحد للقطاع الخاص بشرط ان ياخذ شكلا مؤسسيا ذو مرجعية قانونية، ويراعى فيه انه ممثل لكل القطاعات وممثل قادر على تقديم الخدمات المطلوبة وقادر على الضغط على الحكومة لاحداث التغييرات المطلوبة واولها القانونية، وترى هذه المؤسسات انها تشارك في سن القوانين، الا انها في الوقت ذاته غير راضيه عنها مما يشير الى ان مشاركتها غير فعالة . وقد اوصت الدراسة بان على القطاع الخاص نفسه، والجهات الحكومية ذات العلاقة ان تشترك وتنسق فيما بينها لاجراء التعديل المطلوب في القوانين بما لا يسمح بوجود حالة الارباك القائمة بالنسبة لعملية التمثيل على اعتبار انها حالة لا تخدم القطاع الخاص وتصعب من عملية التنسيق من قبل الحكومة مع القطاع الخاص، وهي عملية ضرورية ومطلوبة لوضع السياسات الاقتصادية والعمل على تنفيذها، كما انه من الضروري ان تكون الشراكة بين القطاع الخاص والعام شراكة حقيقية على صعيد التشريع ورسم السياسات والخطط التنموية.This study was conducted at a time the International institutions are seeking to move forward towards involving the private sector in the development process, and providing support to governments to encourage them to adopt the policy of market economy, restructuring and decreasing the state’s role in economic activities (privatization)in order to reach a stage where the private sector will be able to influence in partnership with the state, it is better for it and the state to have a representing body that speaks on its behalf and to ensure effective coordination and good communication between the two partners. This study addresses the question of the representation of the Palestinian private sector, in terms of who represents the sector to other parties which are related to its activities. One of the most prominent features for this sector is that it went through different circumstances over history that affected its development. In addition, the Palestinian it is a weak sector that is easily impacted by the surrounding exceptional circumstances. The representation of this sector was historically made through the Chambers of Commerce, Industry and Agriculture. However, after the arrival of the Palestinian National Authority in 1994 and the consequent changes that affected the private sector even if theoretically in some aspects, events have proven that the Palestinian private sector continued to be endangered from the occupation despite the existence of the Palestinian Authority. In spite of this, real changes were made on the process of representation. The establishment of the national authority was accompanied by a new reality in terms of laws that the authority has adopted in various life perspectives. Some of which are related to economy and the private sector. These laws came inappropriate and part of it remained incomplete. In addition to newly established authority systems, and the weakness of judicial system which is responsible for ensuring the implementation of rules with the security systems. The representation of the private sector also was subject to changes after the establishment of the national authority. A group of non-governmental parties established to represent or claim to represent the Palestinian private sector. These parties came in the form of unions, councils and associations representing a particular sector, such as the Federation of Industries, Shipper’s Council or the Importers Association. While others claim that they represent all the private sector such as the Private Sector Coordinating Council or Businessmen Association. This resulted in each of them considers itself the strongest or the most appropriate representation to represent the private sector, the Chambers of Commerce denied the role the Coordinating Council and vice versa. Due to the fact that the case study is on a small community, the representative institutions, the researcher saw that adopting the approach of directly interviewing directors of these institutions, through a questionnaire that included different aspects with the people involved. The study revealed that a problem exists in the representation process that was discussed in the Legislative Council. This was made clear in the interviews conducted. One of the most prominent features of this dilemma is that more than one party claims to represent the private sector. The study showed that the majority of those interviewed, supports the presence of one representative body of the private sector given that it takes the institutionalized form with a legal reference. Taking into account that it represents all sectors capable of providing the required services and it is capable to pressure the government to bring about legal changes. These institutions sees that it participates in setting laws, but at the same time it is not pleased which implies the non effectiveness of its participation. This study recommended that the private sector itself, and related government agencies to participate and coordinate with each other to conduct the required amendment in laws in order to avoid causing a state of confusion concerning the representation. It is an essential and required process to put forth economical policies and work on executing it, also essential that the partnership between the private and public sector is a real partnership at the legislative level, policy formulation and development plans

JUST-CRS master programme: an interdisciplinary curriculum for occupation and physical therapy

JUST-CRS is a capacity building Project in higher education funded by the EU Erasmus+ aims to establish an interdisciplinary master program in rehabilitation sciences at JUST for both occupational and physical therapy. Consortium partners, led by the grant holder (JUST) and universities from Portugal, England, Turkey and Jordan have worked collaboratively to build an international curriculum with structure that provides innovative solutions to Jordanian rehabilitation gaps and ts Jordanian Higher Education standards and the European standards set in the European Qualification Framework. This presentation intends to shed light on the process, steps, outcomes and insights of developing this master’s degree program in rehabilitation sciences. The process highlights the steps starting from needs assessment, setting up program graduate competencies, setting up core and elective courses’ skeletal structure and descriptions, establishing courses learning outcomes, courses’ contents and topics as well as establishing the courses’ evaluation methods. Each step was collaboratively crafted to t multiple international culturally-different partners, multi-disciplines, multiple views and perspective of educational and professional systems. Ultimately, the program has been a success. The recipe for this success as well as better suggestions for future international collaborations in the eld of higher education for rehabilitation sciences will be disseminated.N/

Dynamic imaging of oil shale pyrolysis using synchrotron X-ray microtomography

© 2016. The Authors.The structure and connectivity of the pore space during the pyrolysis of oil shales determines hydrocarbon flow behavior and ultimate recovery. We image the time evolution of the pore and microfracture networks during oil shale pyrolysis using synchrotron X-ray microtomography. Immature Green River (Mahogany Zone) shale samples were thermally matured under vacuum conditions at temperatures up to 500°C while being periodically imaged with a 2μmvoxel size. The structural transformation of both organic-rich and organic-lean layers within the shale was quantified. The images reveal a dramatic change in porosity accompanying pyrolysis between 390 and 400°C with the formation of micron-scale heterogeneous pores. With a further increase in temperature, the pores steadily expand resulting in connected microfracture networks that predominantly develop along the kerogen-rich laminations

Management outcome(s) in eyes with retinoblastoma previously inadequately treated with systemic chemotherapy alone without focal therapy

OBJECTIVE: The objective of this study was to evaluate the outcome of management in eyes with intraocular retinoblastoma (RB) that had received inadequate initial therapy (chemotherapy without focal therapy) before eventually receiving necessary consolidation therapy at a tertiary referral center. METHODS: A retrospective observational case series of 30 eyes from 26 RB patients who had initially received systemic chemotherapy as a sole therapy. The main outcome measures were demographics, laterality, International Classification of RB (ICRB), treatments, tumor control, and survival. RESULTS: The median age at diagnosis was 24 months and the median delay between time at diagnosis and time at referral to a tertiary center that has adequate focal therapy for RB was 9.5 months (range 5–20 months). Sixteen (62%) patients were monocular from enucleation of the contralateral eye. Features of ICRB Group A tumors were seen in 3 (10%) eyes, Group B in 7 (23%) eyes, Group C in 2 (7%) eyes, Group D in 16 (53%) eyes, and Group E in 2 (7%) eyes. Eighteen (69%) patients required more systemic chemotherapy (median, 4.4 cycles; range, 2–8 cycles), and 8 (26%) eyes received local chemotherapy (subtenon, intravitreal, or intra-arterial). All treated eyes received consolidation therapy as transpupillary thermotherapy and/or cryotherapy. Radioactive plaque therapy was used in 1 (3%) eye and external beam radiation therapy in 3 (10%) eyes. At a mean follow-up of 13 months (median, 11.5 months; range, 9–27 months), enucleation was avoided in 25 (83%) eyes. Two (7%) eyes were enucleated initially, and 3 (10%) were enucleated after failure of additional therapy. Twenty-three (77%) eyes did not show any viable tumor after a median of 11.5 months of follow-up after the last treatment, and 2 (7%) eyes still have residual tumor recurrences that need more consolidation focal therapy. CONCLUSION: Chemotherapy alone cannot eradicate RB cells in effected eyes without combination with consolidation therapy by a multidisciplinary team to salvage the affected eye as well as its vision. Nonetheless, chemotherapy can be initiated (to keep the tumor at a less invasive stage) for patients from centers or countries where combination therapy is not available until they gain access to adequate management of RB

DataSheet1_The Mental Health Impact of the COVID-19 Pandemic on Healthcare Workers in the Eastern Mediterranean Region: A Scoping Review.pdf

Objectives: This scoping review is to investigate the existing literature on the mental health of Healthcare workers, including stress or distress, anxiety, depression, burnout, insomnia, and fear or phobia within the different countries in the Eastern Mediterranean region (EMR) during the COVID-19 pandemic.Methods: We systematically searched to consolidate studies across EMR countries regarding the mental health morbidity studied, the scales, and the methodology used. The review focused on peer-reviewed academic literature published from March 2020 to November 2021.Results: One hundred sixty-seven articles were included in the review. Most publications came from lower-middle-income countries such as Iran, Pakistan, and Egypt. Most of the literature was specific to Stress/Distress (n = 94), followed by anxiety (n = 93), depression (n = 66), burnout (n = 27), insomnia (n = 20), and fear/phobia (n = 12).Conclusion: Fear, phobia, and insomnia have all been examined extensively worldwide, yet they were among the Eastern Mediterranean region’s least explored outcomes. In addition, most underdeveloped countries have a low rate of publication.</p