Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

An evaluation of barriers in implementing disaster planning and the housing programme in Malaysia

Implementation of full regulatory compliance in Malaysian disaster management mechanism will probably come in the form of a directive from Prime Minister's Department of Malaysia. The success or failure of regulatory compliance in Malaysia will depend to a large extent on the readiness of actors to accept responsibility to implement at every level. This article highlights discussion concerning barriers to implementation of disaster management policy in Malaysia. Concerning the main negative attitudes as a result of a research on actors' perceptions about compliance with disaster planning policy in Malaysia, it is essential to recognise them as the barriers which would have to be systematically addressed by the Prime Minister's Department to minimise their negative effects on regulatory compliance implementation. Undoubtedly, some actors have reservations about accepting regulatory compliance. This reservation might be the key to the main issue towards implementation. They have broadly negative general attitudes towards regulatory compliance, arguing that currently too many barriers are present in department levels to make regulatory compliance implementation straightforward. Actors in Malaysia appear to see the process of regulatory compliance from the point of view of the existing public service system. They underestimate barriers in disaster planning by not taking appropriate and effective measures (preparedness) to reduce or minimise(mitigate) effects in response to disaster

Governance of disaster management

No abstract available