Effect of a comprehensive surgical safety system on patient outcomes

Adverse events in patients who have undergone surgery constitute a large proportion of iatrogenic illnesses. Most surgical safety interventions have focused on the operating room. Since more than half of all surgical errors occur outside the operating room, it is likely that a more substantial improvement in outcomes can be achieved by targeting the entire surgical pathway. We examined the effects on patient outcomes of a comprehensive, multidisciplinary surgical safety checklist, including items such as medication, marking of the operative side, and use of postoperative instructions. The checklist was implemented in six hospitals with high standards of care. All complications occurring during admission were documented prospectively. We compared the rate of complications during a baseline period of 3 months with the rate during a 3-month period after implementation of the checklist, while accounting for potential confounders. Similar data were collected from a control group of five hospitals. In a comparison of 3760 patients observed before implementation of the checklist with 3820 patients observed after implementation, the total number of complications per 100 patients decreased from 27.3 (95% confidence interval [CI], 25.9 to 28.7) to 16.7 (95% CI, 15.6 to 17.9), for an absolute risk reduction of 10.6 (95% CI, 8.7 to 12.4). The proportion of patients with one or more complications decreased from 15.4% to 10.6% (P <0.001). In-hospital mortality decreased from 1.5% (95% CI, 1.2 to 2.0) to 0.8% (95% CI, 0.6 to 1.1), for an absolute risk reduction of 0.7 percentage points (95% CI, 0.2 to 1.2). Outcomes did not change in the control hospitals. Implementation of this comprehensive checklist was associated with a reduction in surgical complications and mortality in hospitals with a high standard of care. (Netherlands Trial Register number, NTR1943.

Stratospheric ozone and surface ultraviolet

As a result of the Montreal Protocol, ozone is expected to recover from the effect of ozone-depleting substances (ODSs) as their abundances decline in the coming decades. The 2006 Assessment showed that globally averaged column ozone ceased to decline around 1996, meeting the criterion for the first stage of recovery. Ozone is expected to increase as a result of continued decrease in ODSs (second stage of recovery). This chapter discusses recent observations of ozone and ultraviolet radiation in the context of their historical records. Natural variability, observational uncertainty, and stratospheric cooling necessitate a long record in order to attribute an ozone increase to decreases in ODSs. Table S2-1 summarizes ozone changes since 1980. The primary tools used in this Assessment for prediction of ozone are chemistry-climate models (CCMs). These CCMs are designed to represent the processes determining the amount of stratospheric ozone and its response to changes in ODSs and greenhouse gases. Eighteen CCMs have been recently evaluated using a variety of process-based comparisons to measurements. The CCMs are further evaluated here by comparison of trends calculated from measurements with trends calculated from simulations designed to reproduce ozone behavior during an observing period.Fil: Douglass, Anne R.. No especifíca;Fil: Fioletov, Vitali E.. No especifíca;Fil: Godin Beekmann, Sophie. No especifíca;Fil: Müller, Rolf. No especifíca;Fil: Stolarski, Richard S.. No especifíca;Fil: Webb, Ann R.. No especifíca;Fil: Arola, Antti. No especifíca;Fil: Burkholder, James B.. No especifíca;Fil: Burrows, John P.. No especifíca;Fil: Chipperfield, Martyn P.. No especifíca;Fil: Cordero, Raul. No especifíca;Fil: David, Christine. No especifíca;Fil: den Outer, Peter N.. No especifíca;Fil: Diaz, Susana Beatriz. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Investigaciones en Ingeniería Genética y Biología Molecular "Dr. Héctor N. Torres"; ArgentinaFil: Flynn, Lawrence E.. No especifíca;Fil: Hegglin,Michaela I.. No especifíca;Fil: Herman, Jay R. No especifíca;Fil: Huck, Petra. No especifíca;Fil: Janjai, Serm. No especifíca;Fil: Jánosi, Imre M. No especifíca;Fil: Krzyścin, Janusz W. No especifíca;Fil: Liu, Yi. No especifíca;Fil: Logan, Jennifer. No especifíca;Fil: Matthes, Katja. No especifíca;Fil: McKenzie, Richard L.. No especifíca;Fil: Muthama, Nzioka John. No especifíca;Fil: Petropavlovskikh, Irina. No especifíca;Fil: Pitts, Michael. No especifíca;Fil: Ramachandran, S.. No especifíca;Fil: Rex, Markus. No especifíca;Fil: Salawitch, Ross J.. No especifíca;Fil: Sinnhuber, Björn Martin. No especifíca;Fil: Staehelin, Johannes. No especifíca;Fil: Strahan, Susan. No especifíca;Fil: Tourpali, Kleareti. No especifíca;Fil: Valverde Canossa, Jéssica. No especifíca;Fil: Vigouroux, Corinne. No especifíca