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

Managing Online Communities and E-WOM: Prosumers\u2019 Characteristics and Behaviors in the Food Service Sector

Nowadays having a good online corporate reputation is a valuable resource for organizations, especially in the food and beverage service sector. Poten-tial diners frequently rely on people\u2019s opinions shared online in choosing a new restaurant. In so doing, online communities are gaining increasing im-portance in influencing the customer journey. This research aims to better understand the prosumers\u2019 use of social media (i.e. people that are both con-sumers and social media users and that contribute to create digital contents) in choosing a restaurant and reviewing it online. In particular, we want to in-vestigate if prosumers\u2019 characteristics or habits, can influence their use and perception of social media, such as looking for information, writing feed-backs, and trust online reviews. In this paper we will focus on two main prosumers\u2019 characteristics or habits: the frequency of going to a restaurant and the willingness to try new restaurants. Our main findings suggest that prosumers that frequently go to a restaurant have a different approach to so-cial media being more inclined to used them both for gathering information and for reviewing their experience. Similarly, we find that prosumers that have an \u201cexplorative\u201d behavior (i.e. enjoy to frequently try new restaurants), use social media differently from prosumers that have a \u201cloyal\u201d behavior, i.e. that choose the same and familiar restaurant. In this explorative study we adopted a quantitative methodology by using a survey on 315 Millennials prosumers. Theoretical and managerial implications are also developed

Dopamine D1 and μ-opioid receptor antagonism blocks anticipatory 50 kHz ultrasonic vocalizations induced by palatable food cues in Wistar rats

RATIONALE: Fifty kilohertz ultrasonic vocalizations (USVs) have been sometimes shown to reflect positive affective-like states in rats. Rewarding events, such as access to palatable food or drugs of abuse, increase the number of anticipatory 50 kHz USVs. However, little is known about the predictability of USVs, subtypes of USVs involved, and underlying neurobiological mechanisms. OBJECTIVES: We examined whether cue-induced anticipatory 50 kHz USVs predict palatable food intake and tested the effects of dopamine D(1) and μ-opioid receptor antagonism on anticipatory USVs. MATERIALS: Food-restricted rats received repeated sessions of a 2 min cue light immediately followed by 5 min access to palatable food. Ultrasonic vocalizations were recorded during cue presentation. After 24 pairing sessions, the rats were pretreated with the D(1) receptor antagonist SCH 23390 (5, 10, and 20 μg/kg) and μ-opioid receptor antagonist naltrexone (0.03, 0.06, 0.13, 0.25, 0.5, and 1 mg/kg) in a Latin-square design, and USVs were recorded during cue presentation. RESULTS: Rats emitted 50 kHz USVs during cue presentation, and the number of USVs increased across sessions with robust and stable interindividual differences. Escalation in USVs was subtype-dependent, with non-trill calls significantly increasing over time. Palatable food intake was positively correlated with anticipatory 50 kHz USVs. Moreover, anticipatory USVs were dose-dependently prevented by antagonism of D(1) and μ-opioid receptors. CONCLUSIONS: These findings demonstrate that anticipatory 50 kHz USVs represent a stable phenotype of increased motivation for food, and dopamine and opioid systems appear to mediate anticipatory 50 kHz USVs