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

The neurobiology of prefrontal transcranial direct current stimulation (tDCS) in promoting brain plasticity : a systematic review and meta-analyses of human and rodent studies

202206 bcchNot applicableOthersThe Hong Kong Polytechnic UniversityPublished12 month

Assessing The Health And Safety Performance Of Residential Buildings In Hong Kong

Hong Kong is well known for its high population density and its highly compact living environment. With the outbreak of SARS in densely populated areas and the prolonged neglect of fire risk and structural safety in condominium buildings, it is necessary to understand the concept of sustainable cities in the light of building health and safety. This paper applied an assessment model to evaluate the health and safety performance of residential buildings in Hong Kong. The model consists of a set of performance-based objectives and can be translated into a hierarchy of parameters concerning the quality of building design, building management, and the surrounding environment. The assessment results of 140 residential buildings in Hong Kong were presented and discussed. To encourage more sustainable buildings at the community level, a method was also devised to integrate the assessment results into two simple and user-friendly performance indicators for public consumption, namely the Building Health and Hygiene Index (BHHI) and the Building Safety and Conditions Index (BSCI). These indices help inform the public of the health and safety risks of different buildings so that building owners, developers, and government bodies can make more informed and socially responsible decisions in the future.link_to_OA_fulltex

A Sustainable Framework Of Building Quality Assessment For Achieving A Sustainable Urban Environment

Information asymmetry in building quality has resulted in under-investment in building maintenance, which has a consequential negative impact on sustainable urban development. Devising and publicizing a building classification system can reveal “hidden” information to the public and lessen the problem of information asymmetry. However, if such a system is purely voluntary, property owners will normally adopt a wait-and-see attitude in view of the high cost of assessment and uncertainty of realizing any benefits. This will hamper the effectiveness of a building classification system. This paper explores the possibility of “jump-starting” a voluntary system by synthesizing the resources of various stakeholders. First, universities can make use of their research capacity to develop an assessment scheme. Second, the government can make use of the building information it possesses to provide data for assessments. Third, private or community donations can be used as initial funding to operate the classification system. Once the system is jump-started, with its benefits proven, it will become self sustainable by a user pays mechanism. It is believed that the disclosure of more information on the quality of buildings on the market will lead to a solution that ensures a net welfare gain, and thus a more sustainable environment for society.link_to_OA_fulltex

對維護香港樓宇質量之建議

20th anniversary journal (20週年特刊)link_to_OA_fulltex

對維護香港樓宇質量之建議

20th anniversary journal (20週年特刊)link_to_OA_fulltex

Association of Laribacter hongkongensis in community-acquired gastroenteritis with travel and eating fish: A multicentre case-control study

Background Laribacter hongkongensis has been recovered from several patients with gastroenteritis. However, the causative role of this organism in human gastroenteritis is still unproven, and sources of the bacterium are unknown. We undertook a multicentre case-control study to investigate the association of L hongkongensis with gastroenteritis. Methods Faecal samples from patients with community-acquired gastroenteritis and controls were cultured for L hongkongensis. Targeted food surveillance was done to identify potential sources of this bacterium. All isolates of this organism from patients and food items were characterised by pulsed-field gel electrophoresis and ribotyping. Findings During a 4-month period, L hongkongensis was recovered from 17 of 3788 patients with community-acquired gastroenteritis, but was absent in 1894 controls (p=0·001). Those who were culture-positive for this bacterium had a recent history of travel (ten [59%] patients vs two [6%] of 34 matched controls, p<0·0001), of fish consumption (16 [94%] vs 19 [56%], p=0·009), and of eating minced freshwater fish meat (five [29%] vs one [3%], p=0·012). We recovered 25 L hongkongensis isolates from intestinal samples of freshwater fish and two from minced freshwater fish meat. Bacteria with the same pulsed-field gel electrophoretic pattern and ribotype were recovered from one patient and a sample of minced freshwater fish meat, which was from the same retail market recently visited by the patient. We did not see this particular combination of electrophoretic pattern and ribotype in any other isolates. Interpretation L hongkongensis is associated with community-acquired gastroenteritis and traveller's diarrhoea. However, its causative role has not been shown. Freshwater fish is one source of this bacterium.link_to_subscribed_fulltex

A natural carotenoid crocin exerts antidepressant action by promoting adult hippocampal neurogenesis through Wnt/β-catenin signaling

202212 bckwVersion of RecordEarly releas