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

Myopia during emergency improvisation: lessons from a catastrophic wildfire

Purpose: The purpose of this paper is to explore how a number of processes joined to create the microlevel strategies and procedures that resulted in the most lethal and tragic forest fire in Portugal's history, recalled as the EN236-1 road tragedy in the fire of Pedrógão Grande. Design/methodology/approach: Using an inductive theory development approach, the authors consider how the urgency and scale of perceived danger coupled with failures of system-wide communication led fire teams to improvise repeatedly. Findings: The paper shows how structure collapse led teams to use only local information prompting acts of improvisational myopia, in the particular shape of corrosive myopia, and how a form of incidental improvisation led to catastrophic results. Practical implications: The research offers insights into the dangers of improvisation arising from corrosive myopia, identifying ways to minimize them with the development of improvisation practices that allow for the creation of new patterns of action. The implications for managing surprise through improvisation extend to risk contexts beyond wildfires. Originality/value: The paper stands out for showing the impact of improvisational myopia, especially in its corrosive form, which stands in stark contrast to the central role of attention to the local context highlighted in previous research on improvisation. At the same time, by exploring the effects of incidental improvisation, it also departs from the agentic conception of improvisation widely discussed in the improvisation literature

Comparative analysis of MR sequences to detect structural brain lesions in tuberous sclerosis

Background: Tuberous sclerosis (TS) is a neurocutaneous genetically inherited disease with variable penetrance characterized by dysplasias and hamartomas affecting multiple organs. MR is the imaging method of choice to demonstrate structural brain lesions in TS. Objective: To compare MR sequences and determine which is most useful for the demonstration of each type of brain lesion in TS patients. Materials and methods: We reviewed MR scans of 18 TS patients for the presence of cortical tubers, white matter lesions (radial bands), subependymal nodules, and subependymal giant cell astrocytoma (SGCA) on the following sequences: (1) T1-weighted spin-echo (T1 SE) images before and after gadolinium (Gd) injection; (2) nonenhanced T1 SE sequence with an additional magnetization transfer contrast medium pulse on resonance (T1 SE/MTC); and (3) fluid-attenuated inversion recovery (FLAIR) sequence. Results: Cortical tubers were found in significantly (P < 0.05) larger numbers and more conspicuously in FLAIR and T1 SE/MTC sequences. the T1 SE/MTC sequence was far superior to other methods in detecting white matter lesions (P < 0.01). There was no significant difference between the T1 SE/MTC and T1 SE (before and after Gd injection) sequences in the detection of subependymal nodules; FLAIR sequence showed less sensitivity than the others in identifying the nodules. T1 SE sequences after Gd injection demonstrated better the limits of the SGCA. Conclusion: We demonstrated the importance of appropriate MRI sequences for diagnosis of the most frequent brain lesions in TS. Our study reinforces the fact that each sequence has a particular application according to the type of TS lesion. Gd injection might be useful in detecting SGCA; however, the parameters of size and location are also important for a presumptive diagnosis of these tumors.Santa Casa Misericordia São Paulo, Sect Radiol, Ctr Med Diagnost Fleury, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Diagnost Imaging, Escola Paulista Med, São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Sect Radiol, Ctr Med Diagnost Fleury,Dept Neurol, São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Dept Diagnost Imaging, Div Diagnost Imaging Pediat, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Diagnost Imaging, Escola Paulista Med, São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Sect Radiol, Ctr Med Diagnost Fleury,Dept Neurol, São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Dept Diagnost Imaging, Div Diagnost Imaging Pediat, São Paulo, BrazilWeb of Scienc

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