ACIDENTES COM MOTOCICLETAS: CARACTERÍSTICAS DA OCORRÊNCIA E SUSPEITA DO USO DE ÁLCOOL

Se objetivó analizar la relación entre las características de accidentes motociclísticos y la sospecha de consumo alcohólico. Estudio descriptivo, transversal, realizado con 110 pacientes víctimas de accidentes en motocicleta atendidos en hospital de referencia en emergencias de una capital del noreste de Brasil. Datos recolectados en noviembre y diciembre de 2016, analizados mediante estadística descriptiva, aplicándose tests inferenciales. Se verificaron asociaciones significativas entre consumo de alcohol y la condición de la víctima en el vehículo, habilitación, turno del accidente y uso de casco. Las víctimas sin casco y que consumieron alcohol presentaron mayor prevalencia entre los accidentados. Los datos alertan sobre la relevancia de una fiscalización directa, efectiva y continúan por parte de los organismos de tránsito, tomándose en consideración la insuficiencia de medidas preventivas para accidentes.Objetivou-se analisar a relação entre as características dos acidentes motociclísticos e a suspeita do uso de álcool. Estudo descritivo e transversal, realizado com 110 pacientes vítimas de acidentes de motocicleta atendidos em hospital de referência em urgência em uma capital do nordeste do Brasil, cujos dados foram coletados em novembro e dezembro de 2016, e analisados por meio da estatística descritiva, aplicando-se testes inferenciais. Verificou-se associações significativas entre o uso de álcool e a condição da vítima no veículo, habilitação, turno do acidente e uso de capacete. Vítimas sem capacete e que consumiram bebidas alcoólicas apresentaram prevalência maior dentre os acidentados. Os dados alertam sobre a relevância de uma fiscalização direta, efetiva e contínua por parte dos órgãos de trânsito, levando-se em consideração a insuficiência de medidas preventivas para acidentes.The present study aimed to analyze the relationship between the characteristics of motorcycle accidents and suspected alcohol use. Descriptive and cross-sectional study with 110 patients involved in motorcycle accidents assisted at an emergency hospital in a large city (state capital) in Northeastern Brazil. Data was collected in November-December 2016 and analyzed through descriptive statistics and inferential tests. Significant associations were found between alcohol consumption and injury severity, licensed or unlicensed drivers, time of the accident (night or day) and helmet use. Most victims of motorcycle accidents were not using a helmet and had consumed alcoholic beverages. The findings call attention to the need for a direct, effective and sustainable traffic crash surveillance system by the responsible bodies, given the lack of effective preventive measures

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

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 RP. The study was sponsored by Queen Mary University of London

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine