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

Geselekteerde tegniese skeppinge van die Tsongavrou, met spesifieke verwysing na die Tsongakraal-Opelugmuseum (Afrikaans)

AFRIKAANS: Enkele tegniese skeppinge wat die Tsongavrou in die tradisionele lewenswyse vervaardig en wat prominent by die Tsongakraal-Opelugmuseum in die Hans Merensky-Natuurreservaat gedemonstreer word, is as studiemateriaal geselekteer. Weens die museologiese vereiste en noodsaaklikheid van goedgedokumenteerde voorwerpe is pottebakkery, soutontginning en kralewerk deeglik volgens vorm, funksie en vervaardigingswyse binne die museum sowel as in Gazankulu, tuiste van die Tsongavrou, nagevors. Dit is ook volkekundig binne funksionele kultuurverband behandel. Historiese gebeurtenisse is nagegaan wat die Tsonga van die huidige Gazankulu met die Tsonga van Mosambiek, hul oorspronklike tuiste vir baie eeue, verbind. Ook die kulturele lewe van die mense van wie in hierdie studie sprake is, is kortliks geskets. Beperkinge wat die museumopset op 'n lewensgetroue weergawe van 'n volk meebring, en die mate van kunsmatigheid wat wel voorkom, is kortliks bespreek. Pottebakkery by die Tsonga, alhoewel deur die omliggende stamme beïnvloed, toon 'n eie karakter, veral as daar meer gekonsentreer word op die oorspronklike Tsonga-keramiekware wat tot in Mosambiek nagevors kon word. Vervaardiging kom nie meer so algemeen voor nie, maar benutting is meer verspreid. 'n Hele stel potte wat kookpotte, bier- en waterpotte, eetbakke, waskomme en maalbakke insluit, word volgens vorm, funksie, voorkoms en vervaardigingswyse bespreek. Soutvervaardiging tref ons by die Tsonga aan, omdat daar 'n paar southoudende minerale warmwaterbronne in Gazankulu voorkom. Argeologiese en etnologiese gegewens dui daarop dat hierdie ontginningsproses alreeds vir die afgelope 1800 jaar bedryf word. Handel is met sout gedryf en hierdie sout is gesog, omdat magies-religieuse eienskappe daaraan toegeskryf word. Die Tsonga was die soutvervaardigers ten minste gedurende die afgelope 100 jaar. Die Tsonga beskik oor hul eiesoortige kralewerk wat as bykomstige versiering gedra word. Veral tydens feestelikhede word hierdie kleurvolle kralesierade vertoon. 'n Kralewerk-klassifikasie kon volgens voorkoms, funksie en vervaardigingswyse saamgestel word. Hierdie bedryf kan, as 'n aspek van die tegniese skeppinge van die Tsongavrou, met welslae in die opelugmuseum uitgebeeld en uitgebrei word. Daar is tot die gevolgtrekking gekom dat die Tsongakraal-Opelugmuseum definitief bestaansreg het, omdat die Tsonga 'n eiesoortige kultuurlewe openbaar. Met 'n weldeurdagte en goedbestuurde uitstallings-, vervaardigings-, en verkoopsaksie het hierdie opelugmuseum besliste uitbreidingsmoontlikhede en kan die bestaande funksies van versameling, bewaring en opvoeding deur middel van programme en uitstallings nog beter tot hul reg kom. Band II bestaan uit 'n fotodokumentasie wat die teks oor die vervaardigingswyse van tegniese skeppinge aanvul. Bylaes wat handel oor die vervaardigingswyse van tegniese skeppinge, Tsongabotanie, 'n Tsongawoordelys oor tegniese skeppings wat in hierdie studie genoem word, asook aanvullende historiese inligting en liggingskaarte word aangeheg. ENGLISH: A description is given of some aspects of the material culture of the Tsonga women of Gazankulu as demonstrated at the Tsongakraal Open-air Museum in the Hans Merensky Nature Reserve. Pottery, headwork and the salt extraction process have been described museologically according to form, function and the process of manufacture. Anthropologically the functional approach to culture has been followed. A short historic and cultural survey has been given of the Tsonga people who first lived in Mozambique, their role as traders over the centuries on the old trade routes through Gazankulu and their reason for settlement in present Gazankulu. The restrictions and superficiality in portraying a way of life within the museum has been discussed in short. Pottery has been influenced by the surrounding tribes, but a specific Tsonga pottery tradition has been identified, leading back to Mozambique. Although there seems to be a decline in the manufacture of pots, a whole range of ceramic ware which includes cooking pots, beer and water pots and bowls could be described according to form, function, manufacturing process and decorative patterns. Archaeological and ethnological references to the 1800 year old salt extraction industry from salt pans near mineral springs in Gazankulu, assisted in the reconstruction of the whole process with its uses and magico-religious properties. The Tsonga were the salt producers for at least the last one hundred years. Headwork as adornment features prominently amongst Tsonga women, especially during festivals. A classification system of all the headwork has been compiled and described according to appearance, function and manufacture. The manufacturing of headwork can be introduced as a further aspect of material culture in the open-air museum. The study concludes that the distinguishing material culture of the Tsonga gives purpose to the existence of the Tsongakraal Open-air Museum. With creativity and a well-planned management programme, the museological functions of collection, preservation and education (recreational programmes and displays) of this museum can be extended. Annexures include a detailed photographic record of the manufacturing of items of material culture, the ethno-botany of the Tsonga, a list of Tsonga cultural terms as well as maps and historical information.Dissertation (MA)--University of Pretoria, 2013.Anthropology and Archaeologyunrestricte

Towards bridging worldviews in biodiversity conservation: Exploring the Tsonga concept of ntumbuloko in South Africa

http://www.intechopen.com/books/research-in-biodiversity-models-and-applications/towards-bridging-worldviews-in-biodiversity-conservation-exploring-the-tsonga-concept-of-ntumbuloko

Kuluttajabarometri maakunnittain 2000, 2. neljännes

Suomen virallinen tilasto (SVT

Use of failure-to-rescue to identify international variation in postoperative care in low-, middle- and high-income countries: a 7-day cohort study of elective surgery

This was an investigator-initiated study funded by Nestle Health Sciences through an unrestricted research grant and by a National Institute for Health Research (UK) Professorship held by R.P. The study was sponsored by Queen Mary University of London

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

This was an investigator initiated study funded by Nestle Health Sciences through an unrestricted research grant, and by a National Institute for Health Research (UK) Professorship held by RP. The study was sponsored by Queen Mary University of London