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

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

Contains fulltext : 172380.pdf (publisher's version ) (Open Access

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

Preparation and Characterization of a Novel Poly(vinylidene fluoride-co-hexafluoropropylene)/Poly(ethersulfone) Blend Membrane Fabricated Using an Innovative Method of Mixing Electrospinning and Phase Inversion

In this work, a novel polymeric membrane was innovated in terms of composition and preparation techniques. A blend of poly(vinylidene fluoride-co-hexafluoropropylene) (PcH) and poly(ethersulfone) (PES) (18 wt.% total polymer concentration) was prepared using a N-methylpyrrolidone (NMP) and N, N-Dimethylformamide (DMF) solvents mixture, while Lithium chloride (0.05–0.5 wt.%) was used as an additive. The electrospinning and phase inversion techniques were used together to obtain a novel membrane structure. The prepared membranes were characterized using scanning electron microscope imaging, energy dispersive X-Ray, differential scanning calorimeter, thermogravimetric analysis, and Fourier transfer infrared spectroscopy-attenuated total reflectance analyses. Moreover, the static water contact angle, membrane thickness, porosity, surface roughness as well as water vapor permeability were determined. ImageJ software was used to estimate the average fiber diameter. Additionally, the effect of the change of PcH concentration and coagulation bath temperature on the properties of the fabricated membrane was studied. The novel developed membrane has shown a good efficiency in terms of properties and features, as a membrane suitable for membrane distillation (MD); a high porosity (84.4% ± 0.6), hydrophobic surface (136.39° ± 3.1 static water contact angle), and a water vapor permeability of around 4.37 × 10−5 g·m/m2·day·Pa were obtained. The prepared membrane can be compared to the MD membranes commercially available in terms of properties and economic value

Simulation of dendritic L-type ca channels\u27 warm-up phenomenon in spinal motoneurons

In this study a computer-based model was developed to simulate the warm-up property of the low-voltage activated (LVA) L-type calcium channels. The LVA L-type calcium channel is one of two channels that mediate persistent inward currents in spinal alpha (a) motoneurons and plays an important role in integrating & modulating motor firing behaviors. This study was prompted by experimental observations that showed nonlinear and hysteretic behaviors of the LVA L-type calcium channel in a membrane patch, indicating that these nonlinear properties are part of the channel behavior. In this work, we introduce a new model for the LVA L-type calcium channel that incorporated the warm-up property. The new model has successfully reproduced experimental recordings from the membrane patch and from the whole cell. Our work provides a more accurate model of the LVA L-type calcium channel that could be used to reexamine the dendritic distribution of these channels on a-motoneurons

Simulation of dendritic L-type ca channels\u27 warm-up phenomenon in spinal motoneurons

In this study a computer-based model was developed to simulate the warm-up property of the low-voltage activated (LVA) L-type calcium channels. The LVA L-type calcium channel is one of two channels that mediate persistent inward currents in spinal alpha (a) motoneurons and plays an important role in integrating & modulating motor firing behaviors. This study was prompted by experimental observations that showed nonlinear and hysteretic behaviors of the LVA L-type calcium channel in a membrane patch, indicating that these nonlinear properties are part of the channel behavior. In this work, we introduce a new model for the LVA L-type calcium channel that incorporated the warm-up property. The new model has successfully reproduced experimental recordings from the membrane patch and from the whole cell. Our work provides a more accurate model of the LVA L-type calcium channel that could be used to reexamine the dendritic distribution of these channels on a-motoneurons

Enhancing the performance of photovoltaic panels by water cooling

The objective of the research is to minimize the amount of water and electrical energy needed for cooling of the solar panels, especially in hot arid regions, e.g., desert areas in Egypt. A cooling system has been developed based on water spraying of PV panels. A mathematical model has been used to determine when to start cooling of the PV panels as the temperature of the panels reaches the maximum allowable temperature (MAT). A cooling model has been developed to determine how long it takes to cool down the PV panels to its normal operating temperature, i.e., 35 °C, based on the proposed cooling system. Both models, the heating rate model and the cooling rate model, are validated experimentally. Based on the heating and cooling rate models, it is found that the PV panels yield the highest output energy if cooling of the panels starts when the temperature of the PV panels reaches a maximum allowable temperature (MAT) of 45 °C. The MAT is a compromise temperature between the output energy from the PV panels and the energy needed for cooling

Iron-Nickel Alloy with Starfish-like Shape and Its Unique Magnetic Properties: Effect of Reaction Volume and Metal Concentration on the Synthesized Alloy

Iron-nickel alloy is an example of bimetallic nanostructures magnetic alloy, which receives intensive and significant attention in recent years due to its desirable superior ferromagnetic and mechanical characteristics. In this work, a unique starfish-like shape of an iron-nickel alloy with unique magnetic properties was presented using a simple, effective, high purity, and low-cost chemical reduction. There is no report on the synthesis of such novel shape without complex precursors and/or surfactants that increase production costs and introduce impurities, so far. The synthesis of five magnetic iron-nickel alloys with varying iron to nickel molar ratios (10–50% Fe) was undertaken by simultaneously reducing Fe(II) and Ni(II) solution using hydrazine hydrate as a reducing agent in strong alkaline media for 15 min at 95–98 °C. The effect of reaction volume and total metal concentration on the properties of the synthesized alloys was studied. Alloy morphology, chemical composition, crystal structure, thermal stability, and magnetic properties of synthesized iron-nickel alloys were characterized by means of SEM, TEM, EDX, XRD, DSC and VSM. ImageJ software was used to calculate the size of the synthesized alloys. A deviation from Vegard’s law was recorded for iron molar ration higher than 30%., in which superstructure phase of FeNi3 was formed and the presence of defects in it, as well as the dimensional effects of nanocrystals. The saturation magnetization (Ms), coercivity (Hc), retentivity (Mr), and squareness are strongly affected by the molar ratio of iron and nickel and reaction volume as well as the total metal concentration

Novel Magnetic Mixed Cellulose Acetate Matrix Membranes with Oxygen-Enrichment Potential

This work presents novel magnetic mixed cellulose-based matrix membranes that combine the advantages of a low-cost common polymer matrix, such as cellulose acetate (CA), and a low-cost magnetic filler. Moreover, the presented magnetic mixed CA matrix membranes were fabricated and used without applying an external magnetic field during either the membrane casting or the separating process. Poly(methylmethacrylate) and lithium chloride were used in order to improve the mechanical properties and porosity of the fabricated membranes. The iron–nickel magnetic alloys used were prepared through a simple chemical reduction method with unique morphologies (Fe10Ni90—starfish-like and Fe20Ni80—necklace-like). The novel magnetic mixed CA matrix membranes fabricated were characterized using different analysis techniques, including SEM, EDX, XRD, TGA, and FTIR-ATR analyses. Furthermore, the static water contact angle, membrane thickness, surface roughness, tensile strength, and membrane porosity (using ethanol and water) were determined. In addition, vibrating sample magnetometer (VSM) analysis was conducted and the oxygen transition rate (OTR) was studied. The magnetic mixed CA matrix membrane containing starfish-like Fe10Ni90 alloy was characterized by high coercivity (109 Oe) and an efficient 1.271 × 10−5 cm3/(m2·s) OTR compared to the blank CA membrane with 19.8 Oe coercivity and no OTR. The effects of the polymeric matrix composition, viscosity, and compatibility with the alloys/fillers used on the structure and performance of the fabricated mixed CA matrix membranes compared to the previously used poly(ethersufone) polymeric matrix are discussed and highlighted. The novel magnetic mixed CA matrix membranes presented have good potential for use in the oxygen-enrichment process