1999 Ruby Yearbook

A digitized copy of the 1999 Ruby, the Ursinus College yearbook.https://digitalcommons.ursinus.edu/ruby/1102/thumbnail.jp

2000 Ruby Yearbook

A digitized copy of the 2000 Ruby, the Ursinus College yearbook.https://digitalcommons.ursinus.edu/ruby/1103/thumbnail.jp

The Compulsive Culture

Adelaide Festival of Ideas session, Brookman Hall, 12:00pm, Sunday 15 July, 2001. Chaired by Phillip Adams.http://adelaidefestivalofideas.com.au

In reply: congress of neurological surgeons systematic review and evidence-based guidelines on the treatment of pediatric hydrocephalus: update of the 2014 guidelines

We appreciate the thoughtful critique1 of our recent publication “Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Treatment of Pediatric Hydrocephalus: Update of the 2014 Guidelines.”2 We must emphasize that our process used a rigorous methodology to update answers to questions asked in the original 2014 guidelines. 3 One question in our original publication regarded the use of antibiotic-impregnated shunts (AISs) in children with hydrocephalus. For this question, we evaluated whether AIS reduced the risk of infection compared to standard shunts. In our update, we found level I evidence that supported our finding, based on the British antibiotic and silver-impregnated catheters for ventriculoperitoneal shunts (BASICS) of AISs.4 In our posed PICO (population, intervention, control, and outcomes) question, we did not evaluate long-term function or mechanical failure related to AIS. The hypothesis that mechanical failure may be caused by masked AIS infections has yet to be proven with published medical evidence. In addition, while the Fragility Index (FI) of the BASICS study may be low, the study was still statistically significant and adequately powered to answer this question

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit