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

Sugarcane

Key Messages:\ud \ud It is likely that the greatest direct climate change impact (and adaptation challenge) on Australian sugarcane production will be the projected change in the amount, frequency and intensity of future rainfall. In many of the sugarcane growing regions the amount of effective rainfall available to the crop will be reduced, while demand is likely to increase due to increased rates of evapotranspiration linked to atmospheric warming.\ud \ud A range of adaptation strategies (both tactical and strategic) is needed across the entire sugar cane industry value chain if it is to remain sustainable under a changing climate. Strategies must be tailored to individual mill regions to take account of location-specific biophysical and logistical impacts.\ud \ud Adaptation options available to the sugarcane industry include improvements to the management of limited water supplies; technological fixes based on reductionist analysis; engineering design principles, or computer-aided modelling; altered cropping system design and agronomic management; enhanced utilisation of decision-making tools, and effective institutional change (Park et al. 2007a).\ud \ud Building capacity through targeted extension, improving skills and providing a more industry-wide knowledge base are all essential for future adaptation.\ud \ud Many adaptation strategies involve an enhancement or extension of existing activities aimed at building resilience to climatic variability. Additional longer-term adaptation options will also need to be iteratively developed and evaluated in an adaptive management context if the industry is to remain sustainable into the future.\u

Nitrogen management guidelines for sugarcane production in Australia: can these be modified for wet tropical conditions using seasonal climate forecasting?

Sugarcane is a highly valuable crop grown in tropical and subtropical climates worldwide primarily for the production of sucrose-based products. The Australian sugarcane industry is located in close proximity to sensitive environments and the apparent declining health of the Great Barrier Reef has been linked to damaging levels of land-based pollutants entering reef waters as a result of sugarcane cultivation undertaken in adjacent catchments. Unprecedented environmental scrutiny of N fertiliser application rates is necessitating improved N fertiliser management strategies in sugarcane.Over time the focus of N fertiliser management has shifted from maximising production to optimising profitability and most recently to improved environmental sustainability. However, current N calculations are limited in their ability to match N fertiliser inputs to forthcoming crop requirements. Seasonal climate forecasts are being used to improve decision-making capabilities across different sectors of the sugarcane value chain. Climate is a key driver of crop growth, N demand and N loss processes, but climate forecasts are not being used to guide N management strategies. Seasonal climate forecasts could be used to develop N management strategies for 'wet' and 'dry' years by guiding application rate, timing and/or frequency of N inputs and the benefit of using alternative forms of N fertiliser. The use of seasonal climate forecasts may allow more environmentally sensitive yet profitable N management strategies to be developed for the Australian sugarcane industry

Kuluttajabarometri maakunnittain 2000, 2. neljännes

Suomen virallinen tilasto (SVT

Use of failure-to-rescue to identify international variation in postoperative care in low-, middle- and high-income countries: a 7-day cohort study of elective surgery

This was an investigator-initiated study funded by Nestle Health Sciences through an unrestricted research grant and by a National Institute for Health Research (UK) Professorship held by R.P. The study was sponsored by Queen Mary University of London