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

Synergistic Effect of Poultry Manure and Sawdust on Changes in Soil Structural Indices of a Sandy-Clay Loam Ultisol

The effect of organic matter and exchangeable cations from admixture of poultry manure and sawdust incorporated into a field soil on soil structural indices of a tropical sandy clay loam soil was carried out. The aim was to investigate the level of amelioration of the poor structural attribute of the soil by balancing the cation and/or organic matter deficiency associated with the use of either saw dust (SD) or poultry manure (PM) alone in intensively cultivated soils in the tropics. The amendments SD, PM and PM + SD were applied at the rates 0t/ha, 2t/ha, 4t/ha and 8t/ha, making twelve treatment combinations with three replicates. Soil samples were collected for laboratory analysis at 4, 8 and 12 weeks. The structural indices analysed were aggregate stability (AS), dispersion ratio (DR), clay dispersion index (CDI), clay flocculation index (CFI) and aggregated silt and clay (ASC). Data were analysed using a 3 x 3 factorial in Randomized Complete Block Design (RBCD), significant means were detected using Fischer’s Least Significant difference (F – LSD) at 5% probability level. Data were also subjected to correlation analysis using Spearman’s Rank Correlation Coefficient. Result show that the treatments were statistically significant (P = 0.05) in affecting aggregate stability relative to the control. Decreases in bulk density occurred as a result of increase in amendment applied, the trend was 8t>4t>2t for all the amendments. However, only the application of 8t/ha of poultry manure decrease bulk density significantly (p = 0.05). The soil properties studied showed increased strength in the level of correlations with time, these correlations were highest at two months of sampling and was associated with the highest level of coefficient of determination, indicating that these properties influenced each other under the amendment condition and became intrinsic factors in determining the status of each other with increase in age of the soil.  Specifically, effective cation exchange capacity (ECEC), and total exchangeable base (TEB) correlated negatively with ASC and CFI, but positively with CDI and DR for all sampling times.Keywords: Aggregate stability, dispersion ratio, clay flocculation index, cation exchang

Saturate hydraulic conductivity, water stable aggregates and soil organic matter in a sandy-loam soil in Ikwuano lga of Abia state

A study was carried out along a toposequence in Ikwuano LGA. of Abia state to evaluate changes in saturated hydraulic conductivity (Ksat) and percent water stable aggregates (WSA%). Five points: crest (A), upper slope (B), middle slope(C),lower slope (D) and Valley bottom (E), along the toposequence with an average distance of about 150m apart were delineated and samples for soil analysis collected from two depths (0-15cm and 15-30cm) using core samplers and auger. Samples were collected from each topo-unit at the respective depths in triplicate. Samples were analyzed for soil properties like; Ksat, WSA (%) and percent organic carbon (OC %), Data from the analysis were subjected to ANOVA using a split plot in RCBD. Results indicated that for both slope positions, WSA, Ksat and OC were significantly different with depth (P≤ 0.01). These properties also varied significantly (

Early warning signs of a mental health tsunami: a coordinated response to gather initial data insights from multiple digital services providers

Introduction: The immediate impact of COVID-19 on morbidity and mortality has raised the need for accurate and real time data monitoring and communication. The aim of this study is to document initial observations from multiple digital services providers during the COVID-19 crisis, especially those related to mental health and wellbeing. Methods: We used email and social media to announce an urgent call for support. Digital mental health services providers (N=46), financial services providers (N=4) and other relevant digital data source providers (N=3) responded with quantitative and/or qualitative data insights. People with lived experience of distress, as service users/consumers, and carers are included as co-authors. Results: This study provides proof-of-concept of the viability for researchers and private companies to work collaboratively towards a common good. Digital services providers reported a diverse range of mental health concerns. A recurring observation is that demand for digital mental health support has risen, and that the nature of this demand has also changed since COVID-19, with an apparent increased presentation of anxiety and loneliness. Conclusion: Following this study, we will continue to work with providers in more in-depth ways to capture follow-up insights at regular time points. We will also onboard new providers to address data representativeness. Looking ahead, we anticipate the need for a rigorous process to interpret insights from an even wider variety of sources in order to monitor and respond to mental health needs

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

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