10 research outputs found
Photography-based taxonomy is inadequate, unnecessary, and potentially harmful for biological sciences
The question whether taxonomic descriptions naming new animal species without type specimen(s) deposited in collections should be accepted for publication by scientific journals and allowed by the Code has already been discussed in Zootaxa (Dubois & NemĂ©sio 2007; Donegan 2008, 2009; NemĂ©sio 2009aâb; Dubois 2009; Gentile & Snell 2009; Minelli 2009; Cianferoni & Bartolozzi 2016; Amorim et al. 2016). This question was again raised in a letter supported
by 35 signatories published in the journal Nature (Pape et al. 2016) on 15 September 2016. On 25 September 2016, the following rebuttal (strictly limited to 300 words as per the editorial rules of Nature) was submitted to Nature, which on
18 October 2016 refused to publish it. As we think this problem is a very important one for zoological taxonomy, this text is published here exactly as submitted to Nature, followed by the list of the 493 taxonomists and collection-based
researchers who signed it in the short time span from 20 September to 6 October 2016
Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study
Summary
Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally.
Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies
have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of
the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income
countries globally, and identified factors associated with mortality.
Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to
hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis,
exomphalos, anorectal malformation, and Hirschsprungâs disease. Recruitment was of consecutive patients for a
minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical
status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary
intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause,
in-hospital mortality for all conditions combined and each condition individually, stratified by country income status.
We did a complete case analysis.
Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital
diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal
malformation, and 517 with Hirschsprungâs disease) from 264 hospitals (89 in high-income countries, 166 in middleincome
countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male.
Median gestational age at birth was 38 weeks (IQR 36â39) and median bodyweight at presentation was 2·8 kg (2·3â3·3).
Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income
countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups).
Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome
countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries;
pâ€0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients
combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88â4·11],
p<0·0001; middle-income vs high-income countries, 2·11 [1·59â2·79], p<0·0001), sepsis at presentation (1·20
[1·04â1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention
(ASA 4â5 vs ASA 1â2, 1·82 [1·40â2·35], p<0·0001; ASA 3 vs ASA 1â2, 1·58, [1·30â1·92], p<0·0001]), surgical safety
checklist not used (1·39 [1·02â1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed
(ventilation 1·96, [1·41â2·71], p=0·0001; parenteral nutrition 1·35, [1·05â1·74], p=0·018). Administration of
parenteral nutrition (0·61, [0·47â0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65
[0·50â0·86], p=0·0024) or percutaneous central line (0·69 [0·48â1·00], p=0·049) were associated with lower mortality.
Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome,
middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will
be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger
than 5 years by 2030
CInĂNCIA: CiĂȘncia e Cultura Andarilha na Formação Integral
O CInĂNCIA utiliza a linguagem cinematogrĂĄfica juntamente com a SemiĂłtica, num projeto andarilho, articulado Ă polĂtica de extensĂŁo do governo, que atende escolas pĂșblicas no interior dos estados de RJ, MG (em parceria com a UFJF), e a partir do ano de 2015 no MS (em parceria com a UFMS), integrado aos projetos de educação integral nessas localidades (atividades em contra-turno). O objetivo do projeto Ă© usar o conceito de alfabetização visual. As atividades tĂȘm duração de trĂȘs horas e compreendem (i) uma apresentação do tema ao grupo; (ii) apresentação do filme; e (iii) um conjunto de atividades sobre as leituras produzidas no filme. Um dos objetivos Ă© debater e verificar a manifestação expressiva (Ăcone) e simbĂłlica e suas relaçÔes com o tema central da atividade. O CInĂNCIA iniciou suas atividades em 2013 e atĂ© o momento realizou 45 oficinas atuando em 15 escolas nos municĂpios do Rio de Janeiro, Arraial do Cabo, Itaperuna, TrĂȘs Rios, Paracambi, Pinheiral, Nova Iguaçu e Belford Roxo e em 9 escolas nos municĂpios de Juiz de Fora, Barroso e Prados em Minas Gerais, totalizando 24 escolas com a participação de 3.820 alunos, sendo 2.110 do ensino mĂ©dio (55%) e 1.710 do ensino fundamental (45%). A metodologia utiliza binĂŽmios dialĂ©ticos para exercitar a contradição e conduzir Ă apreensĂŁo das formas simbĂłlicas contidas nos filmes. Os repertĂłrios imagĂ©ticos sĂŁo debatidos na atividade pĂłs-filme com a retomada de trechos selecionados, que sĂŁo colocados discursivamente em contraponto com cada elemento do binĂŽmio. Desse modo, para o binĂŽmio Sustentabilidade & SobrevivĂȘncia, sĂŁo usados os filmes Saneamento BĂĄsico (2007, Jorge Furtado) e Blade Runner (1982, Ridley Scott), associando nesse caso o processo de sustentabilidade ao valor da sobrevivĂȘncia. Para o binĂŽmio Inovação & Imprevisibilidade, os filmes sĂŁo Homem de Ferro (2008, Jon Favreau) e Oz, MĂĄgico Poderoso (2013, Sam Raimi), para Estigma & Pertencimento, usa-se os filmes Gattaca (1997, Andrew Niccol) e Detona Ralph (2012, Rich Moore). O CInĂNCIA recebe apoio do MEC-PROEXT e segue ampliando seu espectro de ação, com o permanente desafio de nuclear a formação de grupos de discussĂŁo sobre a importĂąncia da matriz audiovisual como recurso em processos de ensino. (1) Oliveira, M. M. C. Alfabetização visual. Estudos SemiĂłticos, v. 5, n. 1, p. 17-27, 2009; (2) Silva, R. B et al, CinĂNCIA: a cultura andarilha na perspectiva da inclusĂŁo social. CaleidoscĂłpio. 2014
UMA EXPERIĂNCIA DE ETNODESENVOLVIMENTO E ECONOMIA SOLIDĂRIA NUMA COMUNIDADE TRADICIONAL QUILOMBOLA DE PARATY: TERRITĂRIO, GERAĂĂO DE TRABALHO E RENDA E EDUCAĂĂO
O trabalho apresentado trata-se de uma pequena experiĂȘncia de Etnodesenvolvimento e Economia SolidĂĄria em uma comunidade tradicional Quilombola na RegiĂŁo da Costa Verde, no municĂpio de Paraty â RJ, chamada Campinho da IndependĂȘncia, com uma população de 59 famĂlias e 3 nĂșcleos familiares, numa ĂĄrea titulada em 23 de março de 1999, com 287,9461 hectares.O objetivo principal do projeto de extensĂŁo - Proext/MEC/SESu 2015 é contribuir para o Etnodesenvolvimento, atravĂ©s do fomento Ă Economia SolidĂĄria e o fortalecimento das organizaçÔes locais, culturais e empreendimentos quilombolas, por meio de processos de formação dialĂłgicos, da pesquisa-ação, formação de redes e de cadeias produtivas; Identificar e criar espaços de geração de trabalho e renda na comunidade. Com base no conceito de desenvolvimento local, atuamos em trĂȘs frentes de pesquisas: a) Estudo sobre gestĂŁo dos empreendimentos solidĂĄrios (turismo de base comunitĂĄria, restaurante tradicional e casa de artesanatos); b) Geração de renda com aplicação de tecnologias de energias alternativas; c) Educação de jovens usando a metodologia do CinĂNCIA (Cine com CiĂȘncia na Mochila - Alfabetização Visual, SemiĂłtica e Cultura).Foram diagnosticadas na Ășltima visita a campo algumas demandas passĂveis de realização: Aplicação de tecnologias de energias renovĂĄveis suprindo o restaurante atravĂ©s de fontes alternativas, dado o alto preço da conta de luz e instalação de postes solares em ĂĄreas pĂșblicas especĂficas. Houve tambĂ©m uma proposta de haver oficinas para que a prĂłpria comunidade solucione questĂ”es simples de manutenção do sistema.A multidisciplinaridade permite parceria com Rede de Informação e Pesquisa em ResĂduos RIPeR-   contribuindo para implementação da economia solidĂĄria participando do FĂłrum, analisando demanda sobre coleta seletiva nos territĂłrios tradicionais e a utilização dos mesmos para geração de renda, com intuito de fazer  com que as polĂticas publicas sejam efetivadas. Podendo contar com  diversos parceiros no territĂłrio: APA Cairuçu, Secretaria de Turismo de Paraty, Secretaria de Cultura de Paraty e Secretaria de Educação de Paraty, Escola TecNaval da UFRJ, NĂșcleo Interdisciplinar de Desenvolvimento Social â NIDES, NĂșcleo Solidariedade TĂ©cnica âSOLTEC, LaboratĂłrio CinĂNCIA/UFRJ, CĂĄritas Brasileiras, Instituto Federal do Rio de Janeiro - IFRJ e Secretaria Nacional de Economia SolidĂĄria - SENAES/MTE.Em suma o projeto visa elaborar uma diretriz de planejamento que contribua para o desenvolvimento local, apoiando-se no fortalecimento e sustentabilidade dos empreendimentos de economia popular solidĂĄria, com a promoção da igualdade racial em iniciativas de geração de trabalho e renda e do patrimĂŽnio turĂstico da comunidade Quilombola
The Transcriptomic Portrait of Locally Advanced Breast Cancer and Its Prognostic Value in a Multi-Country Cohort of Latin American Patients
Purposes: Most molecular-based published studies on breast cancer do not adequately represent the unique and diverse genetic admixture of the Latin American population. Searching for similarities and differences in molecular pathways associated with these tumors and evaluating its impact on prognosis may help to select better therapeutic approaches. Patients and Methods: We collected clinical, pathological, and transcriptomic data of a multi-country Latin American cohort of 1,071 stage II-III breast cancer patients of the Molecular Profile of Breast Cancer Study (MPBCS) cohort. The 5-year prognostic ability of intrinsic (transcriptomic-based) PAM50 and immunohistochemical classifications, both at the cancer-specific (OSC) and disease-free survival (DFS) stages, was compared. Pathway analyses (GSEA, GSVA and MetaCore) were performed to explore differences among intrinsic subtypes. Results: PAM50 classification of the MPBCS cohort defined 42·6% of tumors as LumA, 21·3% as LumB, 13·3% as HER2E and 16·6% as Basal. Both OSC and DFS for LumA tumors were significantly better than for other subtypes, while Basal tumors had the worst prognosis. While the prognostic power of traditional subtypes calculated with hormone receptors (HR), HER2 and Ki67 determinations showed an acceptable performance, PAM50-derived risk of recurrence best discriminated low, intermediate and high-risk groups. Transcriptomic pathway analysis showed high proliferation (i.e. cell cycle control and DNA damage repair) associated with LumB, HER2E and Basal tumors, and a strong dependency on the estrogen pathway for LumA. Terms related to both innate and adaptive immune responses were seen predominantly upregulated in Basal tumors, and, to a lesser extent, in HER2E, with respect to LumA and B tumors. Conclusions: This is the first study that assesses molecular features at the transcriptomic level in a multicountry Latin American breast cancer patient cohort. Hormone-related and proliferation pathways that predominate in PAM50 and other breast cancer molecular classifications are also the main tumor-driving mechanisms in this cohort and have prognostic power. The immune-related features seen in the most aggressive subtypes may pave the way for therapeutic approaches not yet disseminated in Latin America. Clinical Trial Registration: ClinicalTrials.gov (Identifier: NCT02326857). Copyright © 2022 Llera, Abdelhay, Artagaveytia, Daneri-Navarro, MĂŒller, Velazquez, Alcoba, Alonso, Alves da Quinta, Binato, Bravo, Camejo, Carraro, Castro, Castro-Cervantes, Cataldi, Cayota, Cerda, Colombo, Crocamo, Del Toro-Arreola, Delgadillo-Cisterna, Delgado, Dreyer-Breitenbach, Fejerman, FernĂĄndez, FernĂĄndez, FernĂĄndez, Franco-Topete, Gabay, Gaete, Garibay-Escobar, GĂłmez, Greif, Gross, Guerrero, Henderson, Lopez-Muñoz, Lopez-Vazquez, Maldonado, MorĂĄn-Mendoza, Nagai, Oceguera-Villanueva, Ortiz-MartĂnez, Quintero, Quintero-Ramos, Reis, Retamales, Rivera-Claisse, Rocha, RodrĂguez, Rosales, Salas-GonzĂĄlez, Sanchotena, Segovia, Sendoya, Silva-GarcĂa, Trinchero, Valenzuela, Vedham, Zagame, United States-Latin American Cancer Research Network (US-LACRN) and Podhajcer.Fil: Llera, Andrea Sabina. FundaciĂłn Instituto Leloir-CONICET. Molecular and Cellular Therapy Laboratory; ArgentinaFil: Abdelhay, Eliana Saul Furquim Werneck. Instituto Nacional de CĂąncer. Bone Marrow Transplantation Unit; BrasilFil: Artagaveytia, Nora. Universidad de la RepĂșblica. Hospital de ClĂnicas Manuel Quintela; UruguayFil: Daneri-Navarro, AdriĂĄn. Universidad de Guadalajara; MĂ©xicoFil: MĂŒller, Bettina. Instituto Nacional del CĂĄncer; ChileFil: Velazquez, Carlos. Universidad de Sonora; MĂ©xicoFil: Alcoba, Elsa B. Hospital Municipal de OncologĂa MarĂa Curie; ArgentinaFil: Alonso, Isabel. Centro Hospitalario Pereira Rossell; UruguayFil: Alves da Quinta, Daniela B. FundaciĂłn Instituto Leloir-CONICET. Molecular and Cellular Therapy Laboratory; ArgentinaFil: Alves da Quinta, Daniela B. Universidad Argentina de la Empresa (UADE). Instituto de TecnologĂa (INTEC); ArgentinaFil: Binato, Renata. Instituto Nacional de CĂąncer. Bone Marrow Transplantation Unit; BrasilFil: Bravo, Alicia InĂ©s. Hospital Regional de Agudos Eva PerĂłn; ArgentinaFil: Camejo, Natalia. Universidad de la RepĂșblica. Hospital de ClĂnicas Manuel Quintela; UruguayFil: Carraro, Dirce Maria. AC Camargo Cancer Center. Centro Internacional de Pesquisa (CIPE). Laboratory of Genomics and Molecular Biology; BrasilFil: Castro, MĂłnica. Instituto de OncologĂa Angel Roffo; ArgentinaFil: Castro-Cervantes, Juan M. Hospital de Especialidades CMNO-IMSS; MĂ©xicoFil: Cataldi, Sandra. Instituto Nacional del CĂĄncer; UruguayFil: Cayota, Alfonso. Institut Pasteur de Montevideo; UruguayFil: Cerda, Mauricio. Universidad de Chile. Instituto de Neurociencias BiomĂ©dicas. Facultad de Medicina. Centro de InformĂĄtica MĂ©dica y Telemedicina. Instituto de Ciencias BiomĂ©dicas (ICBM). Integrative Biology Program; ChileFil: Colombo, Alicia. Universidad de Chile. Facultad de Medicina y Hospital ClĂnico. Department of Pathology; ChileFil: Crocamo, Susanne. Instituto Nacional de CĂąncer. Oncology Department; BrasilFil: Del Toro-Arreola, Alicia. Universidad de Guadalajara; MĂ©xicoFil: Delgadillo-Cisterna, RaĂșl. Hospital de Especialidades CMNO-IMSS; MĂ©xicoFil: Delgado, LucĂa. Universidad de la RepĂșblica. Hospital de ClĂnicas Manuel Quintela; UruguayFil: Dreyer-Breitenbach, Marisa. Universidade do Estado do Rio de Janeiro. Instituto de Biologia Roberto Alcantara Gomes; BrasilFil: Fejerman, Laura. University of California Davis. Department of Public Health Sciences and Comprehensive Cancer Center; Estados UnidosFil: FernĂĄndez, Elmer A. Universidad CatĂłlica de CĂłrdoba. CONICET. Centro de InvestigaciĂłn y Desarrollo en InmunologĂa y Enfermedades Infecciosas [Centro de InvestigaciĂłn y Desarrollo en InmunologĂa y Enfermedades Infecciosas (CIDIE); ArgentinaFil: FernĂĄndez, Elmer A. Universidad Nacional de CĂłrdoba. Facultad de Ciencias Exactas, FĂsicas y Naturales; ArgentinaFil: FernĂĄndez, Wanda. Hospital San Borja ArriarĂĄn; ChileFil: Franco-Topete, RamĂłn A. Universidad de Guadalajara. Hospital Civil de Guadalajara. Organismo PĂșblico Descentralizado (OPD); MĂ©xicoFil: Gabay, Carolina. Instituto de OncologĂa Angel Roffo; ArgentinaFil: Gaete, Fancy. Hospital Luis Tisne; ChileFil: Garibay-Escobar, Adriana. Universidad de Sonora; MĂ©xicoFil: GĂłmez, Jorge. Texas A&M University; Estados UnidosFil: Greif, Gonzalo. Institut Pasteur de Montevideo; UruguayFil: Gross, Thomas G. Center for Global Health, National Cancer Institute; Estados UnidosFil: Guerrero, Marisol. Hospital San JosĂ©; ChileFil: Henderson, Marianne K. Center for Global Health, National Cancer Institute; Estados UnidosFil: Lopez-Muñoz, Miguel E. Universidad de Sonora; MĂ©xicoFil: Lopez-Vazquez, Alejandra. Universidad de Sonora; MĂ©xicoFil: Maldonado, Silvina. Hospital Regional de Agudos Eva PerĂłn; ArgentinaFil: MorĂĄn-Mendoza, AndrĂ©s J. Hospital de Gineco-Obstetricia CMNO-IMSS; MĂ©xicoFil: Nagai, Maria Aparecida. Sao Paulo University Medical School. Cancer Institute of SĂŁo Paulo (ICESP). Center for Translational Research in Oncology; BrasilFil: Oceguera-Villanueva, Antonio. Instituto Jalisciense de Cancerologia; MĂ©xicoFil: Ortiz-MartĂnez, Miguel A. Hospital General Regional No. 1. IMSS; MĂ©xicoFil: Quintero, Jael. Universidad de Sonora; MĂ©xicoFil: Quintero-Ramos, Antonio. Universidad de Guadalajara; MĂ©xicoFil: Reis, Rui M. Hospital de CĂąncer de Barretos. Molecular Oncology Research Center; BrasilFil: Retamales, Javier. Grupo OncolĂłgico Cooperativo Chileno de InvestigaciĂłn; ChileFil: Rivera-Claisse, Ernesto. Centro Estatal de Oncologia; MĂ©xicoFil: Rocha, DarĂo. Universidad Nacional de CĂłrdoba. Facultad de Ciencias Exactas, FĂsicas y Naturales; ArgentinaFil: RodrĂguez, Robinson. Hospital Central de las Fuerzas Armadas; UruguayFil: Rosales, Cristina. Hospital Municipal de OncologĂa MarĂa Curie; ArgentinaFil: Salas-GonzĂĄlez, Efrain. Hospital de Gineco-Obstetricia CMNO-IMSS; MĂ©xicoFil: Sanchotena, VerĂłnica. Hospital Municipal de OncologĂa MarĂa Curie; ArgentinaFil: Segovia, Laura. Hospital Barros Luco Trudeau; ChileFil: Sendoya, Juan MartĂn. FundaciĂłn Instituto Leloir-CONICET. Molecular and Cellular Therapy Laboratory; ArgentinaFil: Silva-GarcĂa, Aida A. Universidad de Guadalajara. Hospital Civil de Guadalajara. Organismo PĂșblico Descentralizado (OPD); MĂ©xicoFil: Trinchero, Alejandra. Hospital Regional de Agudos Eva PerĂłn; ArgentinaFil: Valenzuela, Olivia. Universidad de Sonora; MĂ©xicoFil: Vedham, Vidya. National Cancer Institute. Center for Global Health; Estados Unido
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The Transcriptomic Portrait of Locally Advanced Breast Cancer and Its Prognostic Value in a Multi-Country Cohort of Latin American Patients.
PurposesMost molecular-based published studies on breast cancer do not adequately represent the unique and diverse genetic admixture of the Latin American population. Searching for similarities and differences in molecular pathways associated with these tumors and evaluating its impact on prognosis may help to select better therapeutic approaches.Patients and methodsWe collected clinical, pathological, and transcriptomic data of a multi-country Latin American cohort of 1,071 stage II-III breast cancer patients of the Molecular Profile of Breast Cancer Study (MPBCS) cohort. The 5-year prognostic ability of intrinsic (transcriptomic-based) PAM50 and immunohistochemical classifications, both at the cancer-specific (OSC) and disease-free survival (DFS) stages, was compared. Pathway analyses (GSEA, GSVA and MetaCore) were performed to explore differences among intrinsic subtypes.ResultsPAM50 classification of the MPBCS cohort defined 42·6% of tumors as LumA, 21·3% as LumB, 13·3% as HER2E and 16·6% as Basal. Both OSC and DFS for LumA tumors were significantly better than for other subtypes, while Basal tumors had the worst prognosis. While the prognostic power of traditional subtypes calculated with hormone receptors (HR), HER2 and Ki67 determinations showed an acceptable performance, PAM50-derived risk of recurrence best discriminated low, intermediate and high-risk groups. Transcriptomic pathway analysis showed high proliferation (i.e. cell cycle control and DNA damage repair) associated with LumB, HER2E and Basal tumors, and a strong dependency on the estrogen pathway for LumA. Terms related to both innate and adaptive immune responses were seen predominantly upregulated in Basal tumors, and, to a lesser extent, in HER2E, with respect to LumA and B tumors.ConclusionsThis is the first study that assesses molecular features at the transcriptomic level in a multicountry Latin American breast cancer patient cohort. Hormone-related and proliferation pathways that predominate in PAM50 and other breast cancer molecular classifications are also the main tumor-driving mechanisms in this cohort and have prognostic power. The immune-related features seen in the most aggressive subtypes may pave the way for therapeutic approaches not yet disseminated in Latin America.Clinical trial registrationClinicalTrials.gov (Identifier: NCT02326857)
Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries
Background
Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks.
Methods
The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned.
Results
A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31).
Conclusion
Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)