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

Evaluation of the Antioxidant Potential of Mixed Fruit-Based Beverages: a New Insight on the Folin-Ciocalteu Method

Definition of a standard method for measuring antioxidant capacity is still a necessity for both researchers and food industry. This study is aimed to evaluate if Folin-Ciocalteu (F-C) method could be reconsidered as suitable for antioxidant potency comparison purposes in food matrices. F-C and four other common tests for measuring antioxidant capacity (ORAC, TEAC, FRAP, CUPRAC) were applied to mixed fruit-based beverages. An overall antioxidant potency composite index (API composite) was calculated by assigning each test equal weight, in order to establish the ranking of antioxidant capacity in the analyzed samples. In addition, the study provides an evaluation of the compounds related to the antioxidant potential of these beverages (total phenolics, anthocyanins, and ascorbic acid) through principal component analysis (PCA). Total phenolics were the principal component influencing the antioxidant capacity of these samples. This is highlighted with the high correlation found between FBBB and all the antioxidants assays performed (P orange fruit formulated juices > mixed fruit nectars. As a result, the use of F-C for antioxidant potency comparison of fruit-based beverages is encouraged.This work has been possible thanks to the funding from ALIMNOVA research group (UCM-GR3/14).Peer reviewe