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- Ademuyiwa, Adesoji O., et al.
(författare)
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Determinants of morbidity and mortality following emergency abdominal surgery in children in low-income and middle-income countries
- 2016
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Ingår i: BMJ Global Health. - : BMJ Publishing Group Ltd. - 2059-7908. ; 1:4
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Tidskriftsartikel (refereegranskat)abstract
- Background: Child health is a key priority on the global health agenda, yet the provision of essential and emergency surgery in children is patchy in resource-poor regions. This study was aimed to determine the mortality risk for emergency abdominal paediatric surgery in low-income countries globally.Methods: Multicentre, international, prospective, cohort study. Self-selected surgical units performing emergency abdominal surgery submitted prespecified data for consecutive children aged <16 years during a 2-week period between July and December 2014. The United Nation's Human Development Index (HDI) was used to stratify countries. The main outcome measure was 30-day postoperative mortality, analysed by multilevel logistic regression.Results: This study included 1409 patients from 253 centres in 43 countries; 282 children were under 2 years of age. Among them, 265 (18.8%) were from low-HDI, 450 (31.9%) from middle-HDI and 694 (49.3%) from high-HDI countries. The most common operations performed were appendectomy, small bowel resection, pyloromyotomy and correction of intussusception. After adjustment for patient and hospital risk factors, child mortality at 30 days was significantly higher in low-HDI (adjusted OR 7.14 (95% CI 2.52 to 20.23), p<0.001) and middle-HDI (4.42 (1.44 to 13.56), p=0.009) countries compared with high-HDI countries, translating to 40 excess deaths per 1000 procedures performed.Conclusions: Adjusted mortality in children following emergency abdominal surgery may be as high as 7 times greater in low-HDI and middle-HDI countries compared with high-HDI countries. Effective provision of emergency essential surgery should be a key priority for global child health agendas.
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| 2. |
- Hammad, Yasser A., et al.
(författare)
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Quality improvement can decrease blood delivery turnaround time : Evidence from a single tertiary-care academic medical center
- 2018
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Ingår i: Middle East Journal of Anesthesiology. - : American University of Beirut. - 0544-0440. ; 25:3, s. 273-281
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Tidskriftsartikel (refereegranskat)abstract
- Context: Blood transfusion services are critical to any hospitals’ functioning, and timely blood/ component therapy resuscitation is lifesaving. Yet, few blood delivery turnaround time (TAT) studies have been undertaken. Aims: We assessed blood delivery TAT at our institution before and after implementing an intervention. Settings and Design: This before-after study assessed blood delivery TAT at our institution at baseline (first audit, December 2015 - February 2016); analyzed the causes of any delays and implemented a multipronged organizational, educational and operational remedial actions for risk mitigation for 3 months, aiming to shorten the blood delivery TAT; and then 9 months later assessed the blood delivery TAT again (second audit, November 2017 - December 2017). Methods and Material: For each of the two audits, we assessed three indices that comprise TAT: Response time (time from doctor’s request until blood is ready for collection, T1); processing time (time from the arrival of technician to blood bank and start of paperwork processing at the blood bank’s front desk until actual collection of the blood, T2); and, Transport time (time from blood bank to arrival to operating theatre, T3). Statistical analysis used: The observed proportions for categorical variables were reported as percentage and compared using Chi square test. Results: After implementing the remedial actions, the second audit confirmed considerable improvements across all three components that comprise the blood TAT. The transport time significantly decreased from an initial majority of > 15 mins duration, to a majority of < 15 mins transport time after the second audit; there was a 50% improvement in 30 mins response time; and the percentage of requests processed in < 10 mins were significantly higher after the second audit. Conclusions: Our program and its findings in terms of much improved blood delivery TAT after implementing this quality improvement approach represent an appropriate and effective solution to the challenge of making blood available fast enough to meet true hemorrhagic emergencies.
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