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

Zolpidem Maintains Memories for Negative Emotions Across a Night of Sleep.

UNLABELLED: Zolpidem, a common medication for sleep complaints, also shows secondary, unexpected memory benefits. We previously found that zolpidem prior to a nap enhanced negative, highly arousing picture memory. As zolpidem is typically administered at night, how it affects overnight emotional memory processing is relevant. We used a double-blind, placebo-controlled, within-subject, cross-over design to investigate if zolpidem boosted negative compared to neutral picture memory. Subjects learned both pictures sets in the morning. That evening, subjects were administered zolpidem or placebo and slept in the lab. Recognition was tested that evening and the following morning. We found that zolpidem maintained negative picture memory compared to forgetting in the placebo condition. Furthermore, zolpidem increased slow-wave sleep time, decreased rapid eye movement sleep time, and increased the fast spindle range in NREM. Our results suggest that zolpidem may enhance negative memory longevity and salience. These findings raise concerns for zolpidem administration to certain clinical populations. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s42761-021-00079-1

How to deliver an oral presentation.

Delivering an oral presentation in conferences and meetings can seem daunting. However, if delivered effectively, it can be an invaluable opportunity to showcase your work in front of peers as well as receive feedback on your project. In this "How to" article, we demonstrate how one can plan and successfully deliver an engaging oral presentation.This article is freely available online. Click on the Additional Link above to access the full-text via the publisher's site

How to design and deliver a local teaching program.

Teaching is an invaluable aspect of any medical or surgical career. Many trainees will find themselves delivering teaching at several stages in their career and in this "How to" article we explain how to design, set up, and deliver a successful teaching program, as well as how to evidence this in your portfolio.This article is freely available online. Click on the Additional Link above to access the full-text via the publisher's site

How to get shortlisted for medical jobs.

Progressing up the medical career ladder is a tough business. Most medical and surgical applications center the requirement for a holistic, balanced individual. As a result, there are usually specific marking criteria in predefined sections. This article provides a guide into what employers are looking for and how best to build your portfolio in these areas.This article is freely available online. Click on the Additional Link above to access the full-text via the publisher's site

How to publish a book

Writing a book can seem like a daunting prospect. However, with the right idea, motivation, and effort, it is entirely possible. In this "How to" article we demonstrate and explain how one can take their book idea and successfully deliver it to publication.This article is freely available online. Click on the Additional Link above to access the full-text via the publisher's site

Reflective practice in health care and how to reflect effectively.

Reflective practice is a paper requirement of your career progression in health care. However, if done properly, it can greatly improve your skills as a health care provider. This article provides some structure to reflective practice to allow a health care provider to engage more with reflective practice and get more out of the experience.This article is freely available online. Click on the Additional Link above to access the full-text via the publisher's site

Compliance of systematic reviews in ophthalmology with the PRISMA statement

Abstract Background Systematic reviews and meta-analyses are becoming increasingly important methods to summarize published research. Studies of ophthalmology may present additional challenges because of their potentially complex study designs. The aim of this study was to evaluate the reporting quality of systematic reviews and meta-analyses on topics in ophthalmology to determine compliance with the PRISMA guidelines. We assessed articles published between 2010 and 2015 in the five major relevant journals with the highest impact factors. Methods The MEDLINE and EMBASE databases were searched to identify systematic reviews published between January 2010 and December 2015 in the following 5 major ophthalmology journals: Progress in Retinal and Eye Research, Ophthalmology, Archives of Ophthalmology, American Journal of Ophthalmology, and Survey of Ophthalmology. The screening, identification, and scoring of articles were independently performed by two teams, and the results were submitted to statistical analysis to determine medians, ranges, and 95% CIs. Results A total of 115 articles were included. The median compliance was 15 out of 27 items (56%), the range was 5–26 (26–96%), and the inter-quartile range was 10 (37%). Compliance was highest in items related to the ‘description of rationale’ (item 3, 100%) and sequentially lower in ‘the general interpretation of results’ (item 26, 96%) and ‘the inclusion of a structured summary in the abstract’ (item 2, 90%). Compliance was poorest in the items ‘indication of review protocol and registration’ (item 5, 9%), ‘specification of risk of biases that may affect the cumulative evidence’ (item 15, 24%), and ‘description of clear objectives in the introduction’ (item 4, 26%). Conclusion The reporting quality of systematic reviews and meta-analyses in ophthalmology should be significantly improved. While we recommend the use of the PRISMA criteria as a guideline before journal submission, additional research aimed at identifying potential barriers to compliance may be required to improve compliance with PRISMA guidelines