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

La diffusion et l'enseignement du français en Grèce au XIXe siècle à travers les programmes institutionnels et l'analyse du discours des manuels

La présente recherche sur la diffusion et l'enseignement du français en Grèce au XIXe siècle s'articule autour de trois axes : exposé historique, analyse quantitative et qualitative. L'exposé historique présente les acteurs, érudits ou intellectuels de l'époque, et les auteurs et traducteurs de manuels d'apprentissage, le contexte et la place de l'enseignement du français oral et écrit dans le système éducatif, à partir des textes législatifs, d'une sélection de manuels ainsi que de tableaux comparatifs des programmes institutionnels. L'analyse quantitative porte sur le "péritexte" des manuels : préfaces, avertissements ou avant-propos, ainsi que sur le contenu de différents manuels (grammaires, dialogues ou exercices, recueils de textes, abécédaires, guides de conversation) : la phonétique, l'orthographe, les différentes parties du discours, la syntaxe et les activités langagières. L'analyse qualitative s'applique également au péritexte des manuels, où les auteurs exposent le but de leur démarche, leurs sources, le public visé, leur point de vue pédagogique ...The present research on the development and teaching of the French language in Greece during the 19th century is structured on three main lines : historical and analytical on a two-fold way, i.e. quantitative and qualitative. The historical report includes the actors, namely the authors and the translators of the textbooks, also the general background as well as the place assigned to the teaching of spoken and written French within the educational system based on the study of the Greek legislation. A selection of text books and comparative tables of the schools curriculum is included. The quantitative analysis concentrates on the "peritext", the prefaces and preambles, as well as the contents of the different learning books (grammars, dialogues or exercises, anthologies, spelling books, conversation guides), i.e. the phonetics, the spelling, the various parts of the discourse, the syntax and language-oriented activities. The qualitative analysis has also been applied to the "peritext" of the learning books, where the aims of the education, the sources, the target group, the educational approach ...LYON-ENS LSH (693872305) / SudocPARIS3-BU (751052102) / SudocLYON-BIU-LSH (693872101) / SudocSudocFranceF

Virtual reality simulators and training in laparoscopic surgery

Virtual reality simulators provide basic skills training without supervision in a controlled environment, free of pressure of operating on patients. Skills obtained through virtual reality simulation training can be transferred on the operating room. However, relative evidence is limited with data available only for basic surgical skills and for laparoscopic cholecystectomy. No data exist on the effect of virtual reality simulation on performance on advanced surgical procedures. Evidence suggests that performance on virtual reality simulators reliably distinguishes experienced from novice surgeons Limited available data suggest that independent approach on virtual reality simulation training is not different from proctored approach. The effect of virtual reality simulators training on acquisition of basic surgical skills does not seem to be different from the effect the physical simulators. Limited data exist on the effect of virtual reality simulation training on the acquisition of visual spatial perception and stress coping skills. Undoubtedly, virtual reality simulation training provides an alternative means of improving performance in laparoscopic surgery. However, future research efforts should focus on the effect of virtual reality simulation on performance in the context of advanced surgical procedure, on standardization of training, on the possibility of synergistic effect of virtual reality simulation training combined with mental training, on personalized training. © 2014 Surgical Associates Ltd

Minimally invasive surgery and oxidative stress response: What have we learned from animal studies?

Oxidative stress (OS) is an integral part of the surgical stress response. Minimally invasive surgery causes less trauma, and thus attenuated stress response is anticipated. However, the pneumoperitoneum or pneumoretroperitoneum is implicated in free radical production. This study reviewed available data on the impact of minimally invasive surgery on OS response of animal models in a systematic way. Databases were searched up to and including January 2010. Most of the studies investigated the effect of pneumoperitoneum on OS, 3 studies investigated the effect of pneumoretroperitoneum on OS. There was a great heterogeneity on experimental conditions including animal models, measured OS markers, methods, and time periods of measurement. Published animal data do not allow a reliable conclusion on the effect of minimally invasive surgery on OS because of the great heterogeneity of experimental conditions. Besides, most studies focus on the effect of pneumoperitoneum, without taking into consideration the effect of less surgical trauma. Copyright © 2013 by Lippincott Williams & Wilkins

Effect of laparoscopic surgery on oxidative stress response: Systematic review

This systematic review aimed to investigate: (a) the impact of laparoscopic surgery on oxidative stress (OS) and (b) the effect of laparoscopic surgery on OS in comparison with open surgery. Eligible trials were clinical trials or retrospective studies with at least 1 arm for laparoscopic surgery with measurements of at least 1 marker of OS or of antioxidant defenses. Twenty-nine trials fulfilled inclusion criteria. There was a great heterogeneity on measured OS markers, methods, and time periods of measurement and on the type of investigated operations. Methodological issues were raised including heterogeneity on study design, lack of reliability, low sensitivity, low specificity of the applied assays, and the limitations of the statistical methods. However, results were highly discordant with some studies suggesting less pronounced OS after laparoscopic surgery, other studies suggesting potentiation of OS after laparoscopic surgery and some studies demonstrating no difference in OS between open and laparoscopic surgery. © 2013 by Lippincott Williams and Wilkins

Pharmacological modulation of oxidative stress response in minimally invasive surgery: Systematic review

This systematic review aims to synthesize the data on the effectiveness of pharmacological modulation of stress response in minimally invasive surgery. Eligible trials were clinical trials randomized or not or experimental trials that investigated the effect of pharmacological agents on modulation of surgical stress response to minimally invasive surgery. No clinical trials were identified. Eight experimental trials met the inclusion criteria and were obtained in full text. Experimental models were rats or rabbits subjected to pneumoperitoneum, or pneumoretroperitoneum, not to a whole operation. Pharmacological modulation of surgical stress response was attempted with erythromycin, melatonin, mesna, verapamil, pentoxifylline, N-acetylcysteine, and zinc. All the pharmacological agents, except pentoxifylline, seemed to reduce oxidative stress markers. However, only mesna pretreatment prevented oxidative stress, because oxidative stress markers remained in the sham levels. Contrasting data were obtained for pentoxyphilline. In conclusion, available data suggest that pharmacological modulation of surgical stress response to minimally invasive surgery might be feasible. Copyright © 2012 by Lippincott Williams & Wilkins

Laparoscopic Adrenalectomy: Where Do We Stand Now?

Laparoscopic adrenalectomy (LA) has become the procedure of choice for the surgical removal of the vast majority of small sized adrenal tumors (<= 6 cm), because of its significant and multiple advantages: reduced hospital stay and wound morbidity, decreased transfusion requirements, postoperative pain and complications. The role of LA in patients with large adrenal lesions or potential malignancy remains controversial. The aim of this article is to review the current and up-to-date surgical approaches for LA, which include: 1) transabdominal anterior or flank approach and 2) retroperitoneal technique with the patient in either lateral or prone position. Specific advantages and disadvantages are referred to for each of them. The choice of each of these techniques is determined particularly by the preference and the experience of the surgeon, but other objective criteria must be taken into consideration, such as the size of the adrenal and history of previous abdominal surgeries