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

Temperature dependence of Raman-active mode frequencies and linewidths in TlGaSe2 layered crystals

Raman spectra of TlGaSe2 crystal at different temperatures are discussed. The temperature dependence of frequency shifts and linewidths of the Raman peaks in the frequency region of 10-320 cm(-1) have been measured in the range from 50 to 320 K. The analysis of the experimental data showed that the temperature dependencies of phonon frequencies and linewidths are well described by considering the contributions from thermal expansion and lattice anharmonicity. The anharmonic contribution (phonon-phonon coupling) is found to be due to three-phonon processes. (c) 2005 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim

Low-temperature Raman scattering in TlGaxIn1-xS2 layered mixed crystals: Compositional dependence of the mode frequencies and line shapes

The Raman spectra of TlGaxIn1-xS2 layered mixed crystals were studied for a, wide range of composition (0 <= x <= 1) at T = 50 K. The effect of crystal disorder on the line width broadening of the Raman-active modes are discussed. The asymmetry in the Raman line shape is analyzed for two interlayer and intralayer modes exhibiting one-mode behavior

Thermally stimulated current analysis of shallow levels in TlGaS2 layered single crystals

We have carried out thermally stimulated current measurements on as-grown T1GaS(2) layered single crystals in the temperature range of 10-60 K with various heating rates. We found experimental evidence for the presence of three trapping centres in TlGaS2, located at 6, 12 and 26 meV. We have determined the trap parameters using various methods of analysis, and these agree well with each other. The retrapping process is negligible for these levels, as confirmed by the good agreement between the experimental results and the theoretical predictions of the model that assumes slow retrapping

Thermally stimulated currents in n-InS single crystals

Thermally stimulated current measurements are carried out on as-grown n-InS single crystals in the temperature range of 10-125 K. Experimental evidence is found for four trapping centers present in InS. They are located at 20, 35, 60 and 130 meV. The trap parameters have been determined by various methods of analysis, and they agree well with each other

Trapping center parameters of TlGaSe2 layered crystals

Thermally stimulated current measurements are carried out on as-grown TlGaSe2 layered single crystals in the temperature range of 90-220 K with various heating rates. Experimental evidence is found for the presence of two trapping centers with activation energy 98 and 130 meV. The retrapping process is negligible for these levels, as confirmed by good agreement between the experimental results and theoretical predictions of the model that assumes slow retrapping. The calculation yielded 2.3 x 10(-24) and 1.8 x 10(-24) cm(2) for the capture cross section and 1.4 x 10(14) and 3.8 x 10(14) cm(-3) for the concentration of the traps studied

Trapping centers in undoped GaS layered single crystals

Nominally undoped p-GaS layered single crystals were grown using the Bridgman technique. Thermally stimulated current measurements in the temperature range 10-300 K were performed at a heating rate of 0.10 K/s. The analysis of the data revealed six trap levels at 0.05, 0.06, 0.12, 0.63, 0.71, and 0.75 eV. The calculations for these traps yielded 1.2x10(-21), 2.9x10(-23), 2.4x10(-21), 8.0x10(-9), 1.9x10(-9) and 4.3x10(-10) cm(2) for the capture cross sections and 1.6x10(13), 5.0x10(12), 7.3x10(12), 1.2x10(14), 8.9x10(13) and 2.6x10(13) cm(-3) for the concentrations, respectively

Trapping Center Parameters in TlInS 2

Thermally stimulated current measurements are carried out on TlInS2 layered single crystal with the current flowing perpendicular to the c-axis in the temperature range of 10 to 90 K. The results are analyzed according to various methods, such as curve fitting, heating rate, and initial rise methods, which seem to be in good agreement with each other. Experimental evidence is found for one trapping center in TlInS2 crystal in the low-temperature region

Trapping center parameters in TlInS2 layered crystals by thermally stimulated current measurements

Thermally stimulated current measurements are carried out on TlInS2 layered single crystal with the current flowing perpendicular to the c-axis in the temperature range of 10 to 90 K. The results are analyzed according to various methods, such as curve fitting, heating rate, and initial rise methods, which seem to be in good agreement with each other. Experimental evidence is found for one trapping center in TlInS2 crystal in the low-temperature region