Impact of the WHO Surgical Safety Checklist Relative to Its Design and Intended Use: A Systematic Review and Meta-Meta-Analysis

BackgroundThe aim of this study was to identify what parts of the World Health Organization Surgical Safety Checklist (WHO SSC) are working, what can be done to make it more effective, and to determine if it achieved its intended effect relative to its design and intended use. Study DesignWe conducted a qualitative thematic analysis and meta-meta-analyses of findings in WHO SSC systematic reviews following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Results Twenty systematic reviews were included for qualitative thematic analysis. Narrative information was coded in 4 primary areas with a focus on impact of the WHO SSC. Four themes—Clinical Outcomes, Process Measures, Team Dynamics and Communication, and Safety Culture—pertained directly to the aims or purposes behind the development of the SSC. The other 2 themes—Efficiency and Workload involved in using the checklist and Checklist Impact on Institutional Practices—are associated with SSC use, but were not focal areas considered during its development. Included in the 20 systematic reviews were 24 unique observational cohort studies that reported pre-post data on a total of 18 clinical outcomes. Mortality, morbidity, surgical site infection, pneumonia, unplanned return to the operating room, urinary tract infection, blood loss requiring transfusion, unplanned intubation, and sepsis favored the use of the WHO SSC. Deep vein thrombosis was the only postoperative outcome assessed that did not favor use of the WHO SSC. ConclusionsThe WHO SSC positively impacts the things it was explicitly designed to address and does not positively impact things it was not explicitly designed for

Spectrum-based feature localization: A case study using ArgoUML

Feature localization (FL) is a basic activity in re-engineering legacy systems into software product lines. In this work, we explore the use of the Spectrum-based localization technique for this task. This technique is traditionally used for fault localization but with practical applications in other tasks like the dynamic FL approach that we propose. The ArgoUML SPL benchmark is used as a case study and we compare it with a previous hybrid (static and dynamic) approach from which we reuse the manual and testing execution traces of the features. We conclude that it is feasible and sound to use the Spectrum-based approach providing promising results in the benchmark metrics

Self-organization of (001) cubic crystal surfaces

Self-organization on crystal surface is studied as a two dimensional spinodal decomposition in presence of a surface stress. The elastic Green function is calculated for a $(001)$ cubic crystal surface taking into account the crystal anisotropy. Numerical calculations show that the phase separation is driven by the interplay between domain boundary energy and long range elastic interactions. At late stage of the phase separation process, a steady state appears with different nanometric patterns according to the surface coverage and the crystal elastic constants

Reframing Academic Productivity, Promotion and Tenure As a Result of the COVID-19 Pandemic

Faculty members have been impacted in a multitude of ways by the COVID-19 pandemic. In particular, faculty seeking promotion and tenure have been impacted by the disruption and inconsistent levels of productivity. In this article, we consider academic productivity in the context of clinical, research, education and service missions within higher education and the academic medicine professoriate. We offer a series of recommendations to faculty members, to institutions, and to professional societies in hopes we can challenge pre-existing deficits in promotion and tenure processes, and academic worth

TOLL-LIKE RECEPTORS (TLR) 2 AND 4 EXPRESSION OF KERATINOCYTES FROM PATIENTS WITH LOCALIZED AND DISSEMINATED DERMATOPHYTOSIS

There are few studies on the role of innate immune response in dermatophytosis. An investigation was conducted to define the involvement of Toll-Like Receptors (TLRs) 2 and 4 in localized (LD) and disseminated (DD) dermatophytosis due to T. rubrum. Fifteen newly diagnosed patients, eight patients with LD and seven with DD, defined by involvement of at least three body segments were used in this study. Controls comprised twenty skin samples from healthy individuals undergoing plastic surgery. TLR2 and TLR4 were quantified in skin lesions by immunohistochemistry. A reduced expression of TLR4 in the lower and upper epidermis of both LD and DD patients was found compared to controls; TLR2 expression was preserved in the upper and lower epidermis of all three groups. As TLR4 signaling induces the production of inflammatory cytokines and neutrophils recruitment, its reduced expression likely contributed to the lack of resolution of the infection and the consequent chronic nature of the dermatophytosis. As TLR2 expression acts to limit the inflammatory process and preserves the epidermal structure, its preserved expression may also contribute to the persistent infection and limited inflammation that are characteristic of dermatophytic infections

Dosage effect on uropathogenic Escherichia coli anti-adhesion activity in urine following consumption of cranberry powder standardized for proanthocyanidin content: a multicentric randomized double blind study

International audienc

Propolis can potentialise the anti-adhesion activity of proanthocyanidins on uropathogenic Escherichia coli in the prevention of recurrent urinary tract infections

<p>Abstract</p> <p>Background</p> <p><it>Escherichia coli</it>, the main bacteria found in recurrent urinary tract infections (UTI), is now frequently resistant to several currently used antibiotic treatments making new solutions essential. In this study, we evaluated the association propolis and proanthocyanidins type A to reduce bacterial anti-adhesion activity of <it>E. coli </it>on urothelial cells.</p> <p>Results</p> <p>This first double-blind, randomized, cross-over human trial included 5 volunteers that followed 6 different regimens with or without variable doses of cranberry and propolis with a washout period of at least 1 week between each regimen. Urine samples were collected at 0 h, 4-6 h, 12 h and 24 h after cranberry plus propolis or placebo capsule consumption. In vivo urinary bacterial anti-adhesion activity was assessed with a bioassay (a human T24 epithelial cell-line assay) and an in vivo <it>Caenorhabditis elegans </it>model. HPLC-PDA-MS was used to detect propolis and cranberry compounds in urine. Bioassays indicated significant bacterial anti-adhesion activity in urine collected from volunteers who had consumed cranberry plus propolis powder compared to placebo (<it>p </it>< 0.001). This inhibition was clearly dose-dependent, increasing with the amount of PACs and propolis equivalents consumed in each regimen. Results suggested that propolis had an additional effect with PACs and prevent a bacterial anti-adhesion effect over 1 day. An in vivo model showed that the <it>E. coli </it>strain presented a reduced ability to kill <it>C. elegans </it>after their growth in urine samples of patients who took cranberry plus propolis capsules. HPLC confirmed that propolis is excreted in urine.</p> <p>Conclusions</p> <p>This study presents an alternative to prevent recurrent UTI. Administration of PACs plus propolis once daily offers some protection against bacterial adhesion, bacterial multiplication and virulence in the urinary tract, representing an interesting new strategy to prevent recurrent UTI.</p