Epidemiology, practice of ventilation and outcome for patients at increased risk of postoperative pulmonary complications

BACKGROUND Limited information exists about the epidemiology and outcome of surgical patients at increased risk of postoperative pulmonary complications (PPCs), and how intraoperative ventilation was managed in these patients. OBJECTIVES To determine the incidence of surgical patients at increased risk of PPCs, and to compare the intraoperative ventilation management and postoperative outcomes with patients at low risk of PPCs. DESIGN This was a prospective international 1-week observational study using the ‘Assess Respiratory Risk in Surgical Patients in Catalonia risk score’ (ARISCAT score) for PPC for risk stratification. PATIENTS AND SETTING Adult patients requiring intraoperative ventilation during general anaesthesia for surgery in 146 hospitals across 29 countries. MAIN OUTCOME MEASURES The primary outcome was the incidence of patients at increased risk of PPCs based on the ARISCAT score. Secondary outcomes included intraoperative ventilatory management and clinical outcomes. RESULTS A total of 9864 patients fulfilled the inclusion criteria. The incidence of patients at increased risk was 28.4%. The most frequently chosen tidal volume (VT) size was 500 ml, or 7 to 9 ml kg1 predicted body weight, slightly lower in patients at increased risk of PPCs. Levels of positive end-expiratory pressure (PEEP) were slightly higher in patients at increased risk of PPCs, with 14.3% receiving more than 5 cmH2O PEEP compared with 7.6% in patients at low risk of PPCs (P < 0.001). Patients with a predicted preoperative increased risk of PPCs developed PPCs more frequently: 19 versus 7%, relative risk (RR) 3.16 (95% confidence interval 2.76 to 3.61), P < 0.001) and had longer hospital stays. The only ventilatory factor associated with the occurrence of PPCs was the peak pressure. CONCLUSION The incidence of patients with a predicted increased risk of PPCs is high. A large proportion of patients receive high VT and low PEEP levels. PPCs occur frequently in patients at increased risk, with worse clinical outcome

Epidemiology, practice of ventilation and outcome for patients at increased risk of postoperative pulmonary complications: LAS VEGAS - An observational study in 29 countries

BACKGROUND Limited information exists about the epidemiology and outcome of surgical patients at increased risk of postoperative pulmonary complications (PPCs), and how intraoperative ventilation was managed in these patients. OBJECTIVES To determine the incidence of surgical patients at increased risk of PPCs, and to compare the intraoperative ventilation management and postoperative outcomes with patients at low risk of PPCs. DESIGN This was a prospective international 1-week observational study using the ‘Assess Respiratory Risk in Surgical Patients in Catalonia risk score’ (ARISCAT score) for PPC for risk stratification. PATIENTS AND SETTING Adult patients requiring intraoperative ventilation during general anaesthesia for surgery in 146 hospitals across 29 countries. MAIN OUTCOME MEASURES The primary outcome was the incidence of patients at increased risk of PPCs based on the ARISCAT score. Secondary outcomes included intraoperative ventilatory management and clinical outcomes. RESULTS A total of 9864 patients fulfilled the inclusion criteria. The incidence of patients at increased risk was 28.4%. The most frequently chosen tidal volume (V T) size was 500 ml, or 7 to 9 ml kg−1 predicted body weight, slightly lower in patients at increased risk of PPCs. Levels of positive end-expiratory pressure (PEEP) were slightly higher in patients at increased risk of PPCs, with 14.3% receiving more than 5 cmH2O PEEP compared with 7.6% in patients at low risk of PPCs (P ˂ 0.001). Patients with a predicted preoperative increased risk of PPCs developed PPCs more frequently: 19 versus 7%, relative risk (RR) 3.16 (95% confidence interval 2.76 to 3.61), P ˂ 0.001) and had longer hospital stays. The only ventilatory factor associated with the occurrence of PPCs was the peak pressure. CONCLUSION The incidence of patients with a predicted increased risk of PPCs is high. A large proportion of patients receive high V T and low PEEP levels. PPCs occur frequently in patients at increased risk, with worse clinical outcome.</p

International Human Resource Management- Academic parochialism in editorial boards of the top 21 IHRM journals

Despite over twenty years of academic hype, IHRM text was only partly successful in its claim to offer a universal panacea for complexities of managing people that can transcend national, cultural and economic divides. This paper provides evidence from earlier studies on limited nature of geographic coverage of the main IHRM journals and surveys the editorial membership of a select number of journals with a view to contribute to the understanding of North American and Western European domination in their publications. Exploring the major constraints in representativeness of the IHRM journals and their editorial membership, the paper offers strategies for change

Comparative analysis of sex equality in employment in Turkey and Britain- Where next

Providing a review of the legal framework, national machinery, and organisational approaches to sex equality in Turkey and Britain, this paper identifies patterns and trends of change and explores how real change towards sex equality could be achieved in both countries. It is explained that despite the socio-economic and cultural differences between Turkey and Britain, women in both countries share a common position as a disadvantaged group in employment. However, it is demonstrated that the nature of proposed agendas of change in legislation, state policy and organisational approaches to equality shows divergence between Turkey and Britain

Would the current pension reform improve the wellbeing of women retirees in Turkey

This paper explores the implications of pension reform on the wellbeing of women retirees in Turkey. The pension reform in Turkey has been widely researched and documented by national institutions, academics and also by international organisations such as the World Bank and the International Labour Organisation. However, the position of women retirees has not been specifically examined, partly due to an assumption that their welfare needs would be met by an aggregate pension reform. This inattention to women retirees was also evident in the feminist literature, which solely focused on issues of sex equality for economically active women in Turkey. This paper highlights that women retirees constitute a highly vulnerable and under-researched group and that sex discrimination in pension entitlement, which is embedded in the Turkish pension system, appears to be the main reason for the current socio-economic vulnerability of this group. Hence, this paper argues that a mainstream pension reform will only serve to further widen the inequality gap between pension benefits of female and male pensioners in Turkey and that gender equality considerations should be embedded in any future reform in order to prevent the discriminatory impact of an aggregate reform

Gendered aspects of career development experiences of university professors in Turkey

This paper examines the gendered nature of the career development of university professors in Turkey, where 23 per cent of professors are women. This proportion is much higher than in Western Europe generally and therefore Turkey provides an important example of womens experiences at professorial levels in academic institutions. The paper shows how historical, political, social and educational policies and institutional dynamics inter-relate to shape senior men and womens experiences

What's ethics got to do with it Providing an ethical framework for the cinema exhibition sector in the shadow of 'the dirty dozen' in the UK

This paper explores how film marketing in the UK fares in terms of its ethical theory, practice and policy. Based on an examination of film marketing theory, practice and policy, the paper identifies three ethical dilemmas- These are the discrepancy between national policy and commercial practice in terms of social access, sustainability and diversity of choice. The paper offers an integrated supply chain model as a method for redressing commercial as well as ethical challenges facing the industry

Work-life, diversity and intersectionality: a critical review and research agenda

Work-life issues have important implications at both organizational and individual levels. This paper provides a critical review of the work-life literature from 1990 onwards through the lens of diversity, with a particular focus on disparities of power induced by methodological and conceptual framings of work and life. The review seeks to answer the following questions: What are the gaps and omissions in the work-life research? How may they be overcome? To answer these questions, the review scrutinizes blind spots in the treatment of life, diversity and power in work-life research in both positivist and critical scholarship. In order to transcend the blind spots in positivist and critical work-life research, the review argues the case for an intersectional approach which captures the changing realities of family and workforce through the lens of diversity and intersectionality. The theoretical contribution is threefold: first, the review demonstrates that contemporary framing of life in the work-life literature should be expanded to cover aspects of life beyond domestic life. Second, the review explains why and how other strands of diversity than gender also manifest as salient causes of difference in experiences of the work-life interface. Third, the review reveals that social and historical context has more explanatory power in work-life dynamics than the micro-individual level of explanations. Work-life literature should capture the dynamism in these contexts. The paper also provides a set of useful recommendations to capture and operationalize methodological and theoretical changes required in the work-life literature