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

A relevância das soft skills em auditoria

Mestrado em AuditoriaAs Soft Skills são capacidades interpessoais, de comunicação, traços de personalidade, atitudes e inteligência emocional que se encontram relacionadas com os hábitos comportamentais dos indivíduos, derivando também da personalidade de cada um. Comstock (2016) considera que, as soft skills são aptidões que não se encontram directamente relacionadas com uma área profissional em específico, sendo assim transversais. O autor defende que estas competências não técnicas mostram-se vantajosas quando aliadas às competências técnicas ou profissionais, uma vez que se complementam. As competências técnicas ou profissionais, também designadas por hard skills, distinguem-se das soft skills pois não são aptidões mas sim competências que estão relacionadas com a aprendizagem do indivíduo. Estas competências podem ser conseguidas através da formação profissional, académica ou da experiência adquirida. Este trabalho visa responder à seguinte questão-chave “Existem Soft Skills preponderantes para a actividade de Auditoria?” Para responder a esta questão realizaram-se pesquisas bibliográficas, procedeu-se à definição dos principais conceitos apresentados e elaborou-se um questionário de forma a aferir qual a visão dos indivíduos sobre este tema. Após recolha e análise dos dados, apresentam-se as conclusões resultantes de 132 questionários válidos, recebidos em 2018. Tendo por base os elementos recolhidos na elaboração deste trabalho, pode-se concluir que as soft skills contribuem para a melhoria do processo de Auditoria, que estas englobam competências fundamentais para AI e também englobam competências centrais para o desempenho da função de auditor externo.Soft Skills can be described as interpersonal and communication skills, personality traits, attitudes and emotional relationships that relate to the habits and other behavioral of individuals, deriving on each ones ability. Comstock (2016) believes that soft skills are abilities not directly related with a specific professional area, therefore cross-sectional. The author explains that this non-technical skill is more valued when combined with technical or professional skills, once they complement each other. The technical or professional skills are also referred as hard skills, distinguish themselves from soft skills because they are not abilities but competences that are related with the individual learning process. These competences can be achieved through vocational and professional training or through experienced gained. This dissertation seeks to respond to the question “There are relevant Soft Skills for Audit activity?” Therefore, it was developed a bibliographic research and a characterization of the key used concepts, along with the elaboration of a survey to better understand the vision of the individuals about this theme. After the data consolidation and analysis, there are discussed the conclusions of the 132 valid surveys received in 2018. Based on all the elements gathered in this dissertation, we can conclude that soft skills add value to the audit process and encompass fundamental skills to Internal and External Audit.info:eu-repo/semantics/publishedVersio

ATLAS

% ATLAS \\ \\ ATLAS is a general-purpose experiment for recording proton-proton collisions at LHC. The ATLAS collaboration consists of 144 participating institutions (June 1998) with more than 1750~physicists and engineers (700 from non-Member States). The detector design has been optimized to cover the largest possible range of LHC physics: searches for Higgs bosons and alternative schemes for the spontaneous symmetry-breaking mechanism; searches for supersymmetric particles, new gauge bosons, leptoquarks, and quark and lepton compositeness indicating extensions to the Standard Model and new physics beyond it; studies of the origin of CP violation via high-precision measurements of CP-violating B-decays; high-precision measurements of the third quark family such as the top-quark mass and decay properties, rare decays of B-hadrons, spectroscopy of rare B-hadrons, and $B ^0 _{s}$-mixing. \\ \\The ATLAS dectector, shown in the Figure includes an inner tracking detector inside a 2~T~solenoid providing an axial field, electromagnetic and hadronic calorimeters outside the solenoid and in the forward regions, and barrel and end-cap air-core-toroid muon spectrometers. The precision measurements for photons, electrons, muons and hadrons, and identification of photons, electrons, muons, $\tau$-leptons and b-quark jets are performed over $| \eta |$ < 2.5. The complete hadronic energy measurement extends over $| \eta |$ < 4.7. \\ \\The inner tracking detector consists of straw drift tubes interleaved with transition radiators for robust pattern recognition and electron identification, and several layers of semiconductor strip and pixel detectors providing high-precision space points. \\ \\The e.m. calorimeter is a lead-Liquid Argon sampling calorimeter with an integrated preshower detector and a presampler layer immediately behind the cryostat wall for energy recovery. The end-cap hadronic calorimeters also use Liquid Argon technology, with copper absorber plates. The end-cap cryostats house the e.m., hadronic and forward calorimeters (tungsten-Liquid Argon sampling). The barrel hadronic calorimeter is an iron-scintillating tile sampling calorimeter with longitudinal tile geometry. \\ \\Air-core toroids are used for the muon spectrometer. Eight superconducting coils with warm voussoirs are used in the barrel region complemented with superconducting end-cap toroids in the forward regions. The toroids will be instrumented with Monitored Drift Tubes (Cathode Strip Chambers at large rapidity where there are high radiation levels). The muon trigger and second coordinate measurement for muon tracks are provide

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

Biomarkers, genetic association, and genomic studies

Rheumatoid arthritis (RA) is a common autoimmune disorder which shows clinical heterogeneity. IT has multiple treatment options and there is individual variation in response to treatment. These features make RA an ideal condition to develop biomarkers for its pre-clinical detection, diagnosis, subtyping, prognostic stratification and selection of most optimal treatment. While a number of markers have been assessed for their biomarker quality, currently no marker has the statistical properties of a biomarker to be considered as a good classifier. In this chapter, a general review of biomarkers is followed by a detailed discussion of biomarker candidates for various aspects of RA. It is unlikely that a single marker will ever be sufficiently powerful as a biomarker, but combinations of clinical, biochemical, genetic, epigenetic, proteomic and metabolomic markers have the strongest potential to fulfill the requirements of biomarkers. Given the high heritability of RA and the progress in methodology of genome-wide association studies, genetic markers are the most promising group to be developed as biomarkers, in particular when epigenetic markers become more widely used. It is possible that in the near future, biomarkers with documented clinical utility will be available for use in clinical decision making and will most probably use multiple omics platforms

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