Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

milling of satellite 6 using an artificial neural network

In this study, artificial neural networks (ANNs) was used for modeling the effects of machinability on chip removal cutting parameters for face milling of stellite 6 in asymmetric milling processes. Cutting forces with three axes (F(x), F(y) and F(z)) were predicted by changing cutting speed (V(c)), feed rate (f) and depth of cut (a(p)) under dry conditions. Experimental studies were carried out to obtain training and test data and scaled conjugate gradient (SCG) feed-forward back-propagation algorithm was used in the networks. Main parameters for the experiments are the cutting speed (V(c) n/min), feed rate (f, mm/min), depth of cut (ap, mm) and cutting forces (F(x), F(y) and F(z), N). V(c), f and a(p) were used as the input dataset while F(x), F(y) and F(z) were used as the output dataset. Average percentage error (APEs) values for F(x), F(y) and F(z) using the proposed model were obtained around 2 and 10% for training and testing, respectively. These results show that the ANNs can be used for predicting the effects of machinability on chip removal cutting parameters for face milling of stellite 6 in asymmetric milling processes. (c) 2007 Published by Elsevier B.V

Genetic research on sleep, sleep disturbances and associated difficulties

Sleep is a fundamental state. We spend approximately one third of our lives asleep and our dedication to this activity is likely to reflect its profound significance in many areas of our functioning and well-being. Whereas sleep is often taken for granted and berated by those who are keen to achieve more in their waking hours; its disruption can be profound. Indeed, any new parent can testify to the draining effects of sleep loss; and those suffering from insomnia can often spend many desperate hours lying awake. Those who have been touched by horrific accidents caused by someone “falling asleep on the job” know of the sometimes catastrophic effects of its disruption