Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

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

Priorities for Health Education in Hong Kong in Relation to Non-Communicable Diseases

Chronic non-communicable diseases (NCDs) are increasing rapidly worldwide and therefore have considerable implications for health education. Like other advanced countries, Hong Kong, which is a special administrative region of Mainland China, has experienced an epidemiological transition wherein chronic NCDs have overtaken communicable diseases as the major cause of mortality and morbidity. Registered deaths due to infectious and parasitic diseases decreased from 10.1% in 1964 to 2.8% in 2004, while the mortality rate due to neoplasms and diseases of the circulatory system increased twofold, from 30.9% to 59.5% in the same period of time (Department of Health, 2008a)

The Perceptions of Obese School Children in Hong Kong Toward Their Weight-Loss Experience

Most studies related to addressing weight management of obese children have focused on understanding the perceptions of parents and health professionals. This study identifies the factors that obese children who have tried to lose weight perceive as affecting their efforts. This descriptive qualitative study has sought to identify factors affecting obese children's weight-loss decision making and process and to explore the development of an effective weight-loss program. This study screened 603 primary school children equivalent to U.S. Grades 5 and 6 of age 10-12. Seventy-nine out of 93 obese children who had been trying on their own to lose weight for at least 1 month formed 6 focus groups. Four themes were identified: Making the decision, self-efficacy, social influences, and environmental constraints. The results suggest that the design of a weight-loss program for obese children should include the contribution of family members, school, and health professionals. © The Author(s) 2012.link_to_subscribed_fulltex

Did Vitamin D Loading before Parathyroidectomy Improve surgical Outcome in Patients with Hyperparathyroidism due to Renal Disease?

Extra Free Paper Session I

Symptom recognition and illness labelling: comparison between Chinese patients with psychosis and their caregivers

Oral Presentation 3.3 – Severe Mental Illness (III)no. OP3.3.2Congress Theme: Yin and Yang of Mental Health in Asia - Balancing PolaritiesOBJECTIVES: Recognition of symptoms and attribution of the condition form some essential parts of illness representation and appraisal for patients with schizophrenia and their caregivers. However, there has been no study exploring their symptoms recognition with illness labelling and thus, fail to provide an overall view of illness appraisal. This study aimed to explore the perception of symptoms and illness labelling by Chinese schizophrenic patients and their respective caregivers. METHODS: A total of 80 patient-caregiver dyads were recruited from the Early Assessment Service for Young people with psychosis (EASY) service in Hong Kong. The symptoms experienced by patients during illness and how participants labelled the condition of patients were explored using open-ended questions. The association between the illness labelling with the symptoms reported by participants was also assessed. RESULTS: The most frequently reported symptom class by patients was positive symptoms (Reported times [RT] = 76, 42.8%), followed by behavioural problems (RT = 33, 18.6%) whereas caregivers reported behavioural problems (RT = 70, 36.8%) more than positive symptoms (RT = 40, 21.1%). Negative and cognitive symptoms were reported less by both groups. A significant relationship was found between the psychosis label and the positive symptoms of the illness for caregivers (X2 = 5.367, df = 1, p = 0.021). CONCLUSIONS: By exploring symptoms recognition, illness labelling by patients and their caregivers and its relationship, these give us a more comprehensive understanding of their illness appraisal. Our results suggested that communication with patients and their caregivers should go beyond illness label and focus also on the actual understanding of other aspects of the illness such as symptoms. Our findings also guide us in the refinement of psychoeducation programme for caregivers and patients, that is, to put more emphasis on the recognition of negative symptoms as part of the condition, and alignment of their understanding.link_to_OA_fulltex

Selenium nanoparticles (SeNPs) immunomodulation is more than redox improvement : serum proteomics and transcriptomic analyses

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Risk factors for community-associated methicillin-resistant Staphylococcus aureus infection in Hong Kong

OBJECTIVES: The risk factors for community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infection were not well understood. The objective of this study was to identify risk factors associated with CA-MRSA infection in Hong Kong. METHODS: We carried out a matched case control study. Cases and controls were recruited from 14 acute public hospitals in Hong Kong. One control was individually matched to one case based on sex, age, admission date and ward location. We interviewed each case and control by telephone using a standard questionnaire. We used a conditional logistic regression model for multivariate analysis. RESULTS: We successfully recruited 127 pairs of matched case and control. We found that sharing of personal items with other persons had a higher risk of CA-MRSA infection (Adjusted matched odds ratio [aOR]: 4.71, 95% confidence interval [CI] 1.43-15.59). On the other hand, patients who had frequent hand washing practice (aOR: 0.21, 95%CI 0.06-0.72) and those who reported history of acne (aOR: 0.12, 95%CI 0.02-0.74) had a lower risk of CA-MRSA infection. CONCLUSIONS: We concluded that sharing of personal items with other persons is a risk factor for CA-MRSA infection while frequent hand washing is a protective factor against the infection.link_to_subscribed_fulltex