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 GUSS test as a good indicator to evaluate dysphagia in healthy older people: a multicenter reliability and validity study

Purpose: Dysphagia is known to be a disorder of the swallowing function, and is a growing health problem in aging populations. Swallowing screening tests have mostly been studied in comorbidities such as stroke associated with old age. There is no simple, quick and easy screening test to best determine the risk of oropharyngeal dysphagia in geriatric guidelines. We aimed to evaluate whether the Gugging Swallowing Screen (GUSS) test is an effective method for evaluating swallowing difficulty in healthy older people. Methods: This cross-sectional and multicenter study was conducted at 13 hospitals between September 2017 and February 2019. The study included 1163 participants aged ?65 years and who had no secondary dysphagia. Reliability was evaluated for data quality, scaling assumptions, acceptability, reliability, and validity as well as cutoff points, specificity and sensitivity. Results: The age distribution of 773 (66.5%) patients was between 65 and 74 years and 347 (29.8%) of them were male and 767 (66%) patients were female. The average total GUSS score was 18.57 ± 1.41. The Cronbach’s alpha was 0.968. There was a moderate statistically significant negative correlation between the total GUSS and 10-item Eating Assessment Tool scores as well as between the total GUSS score and quality of life. The cutoff point of the total GUSS score was 18.50, sensitivity was 95.5% and specificity was 94.4%. Conclusions: The GUSS test is a valid and reliable test to identify possible oropharyngeal dysphagia risk in healthy older people who had no secondary dysphagia. It is suitable as a screen test for clinical practice. © 2019, © 2019, European Geriatric Medicine Society

Assessment of the relationship between Vitamin D level and non-specific musculoskeletal system pain: A Multicenter Retrospective Study (Stroke Study Group) [Vitamin D Düzeyi ile Non-spesifik Kas İskelet Sistemi Ağrıları Arasındaki İlişkinin Değerlendirilmesi: Çok Merkezli Retrospektif Bir Çalışma (İnme Çalışma Grubu)]

Objective: In this study, it was aimed to evaluate the relationship between vitamin D level and pain severity, localization and duration in atients with non-specific musculoskeletal pain.Materials and Methods: Patients who applied to physical medicine and rehabilitation outpatient clinics due to non-specific muscle pain in 19centers in Turkey were retrospectively screened. Three thousand four hundred fourpatients were included in the study, whose pain level wasdetermined by visual analog scale (VAS) and the painful region, duration of pain and vitamin D level were reached. D group was found to beD deficient (group 1) when 25 (OH)D level was 20 ng/mL or less and group D 2 (vitamin D deficiency) was higher than 30 ng/mL (group 3).The groups were compared in terms of pain duration, localization and severity. In addition, the correlations of pain localization, severity andduration with vitamin D levels were examined.Results: D vitamin deficiency was detected in 2202 (70.9%) of 3 thousand four hundred and four registered patients, and it was foundthat vitamin D deficiency in 516 (16.6%) and normal vitamin D in 386 (12.4%). The groups were similar in terms of age, body mass index,income level, duration of complaint, education level, family type and working status between groups in terms of VAS, pain localization and duration scores (p>0.05). Conclusion: Our study shows that vitamin D deficiency in patients with nonspecific musculoskeletal pain is not associated with the severity and duration of pain. © Copyright 2017 by the Turkish Osteoporosis Society

The effect of the palmaris longus muscle on wrist flexion and extension strength

BACKGROUND: The palmaris longus (PLM) is a fusiform-shaped muscle that appears in the superficial flexor compartment of the forearm. It has been suggested that PLM is a phylogenetically degenerate metacarpophalangeal joint flexor. OBJECTIVE: The aim of this study was to compare the strength of wrist flexion and extension in healthy volunteers with and without the PLM. METHODS: Sixty-four healthy subjects, 30 men and 34 women, 18-22 years old were enrolled in this study. The database consisted of 128 wrist tests. The inclusion criteria were as follows: Sedentary lifestyle, unknown musculoskeletal disorders and right-handedness. Musculoskeletal ultrasound imaging was used for assessing the presence of PLM. A hand-held digital dynamometer was used to assess the peak force of wrist extension and flexion. Data were analyzed separately for women and men RESULTS: The existence of right-sided PLM was 73.3% in male subjects and 55.9% in female subjects. For men, the strength of wrist flexion was 36.03 ± 13.92 N and 34.24 ± 12.23 N for the right and left side, respectively. For women, the respective strengths were 16.20 ± 7.29 N and 15.26 ± 6.79 N. For both sexes, there was no statistically significant difference between those with and without a PLM (p> 0.05). There was also no significant difference in the agonist/antagonist (flexion/extension) ratio of the wrist between those with and without a PLM in both sexes and sides. CONCLUSIONS: The existence or absence of PLM plays no role in the strength of either the flexors or extensors of the wrist. © 2017 - IOS Press and the authors

Impact of the ST101 clone on fatality among patients with colistin-resistant Klebsiella pneumoniae infection

Objectives: We describe the molecular characteristics of colistin resistance and its impact on patient mortality