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BackgroundEnd colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection.MethodsThis study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model.ResultsIn total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P

The current COVID-19 pandemic has focused attention on the vulnerability of the human race in the face of communicable disease. But the pandemic also serves as a wake-up call to the cataclysmic impact that would befall the world if nuclear weapons were ever to be used again. Overwhelming pressure on health-services, considerable disruption to normal life, difficult choices regarding suspension of civil liberties, how to protect key workers and ensure society continues to function – these would all be magnified many times over in the event of a nuclear explosion. Thus, in addition to refocusing attention on the prevention and mitigation of global pandemics, the lessons of the current crisis are much more wide-ranging, and should lead to a renewal of public education, interest, and activism in reducing nuclear dangers. [ABSTRACT FROM AUTHOR]

Objective To evaluate the cost-effectiveness of pulse oximetry--compared with no peri-operative monitoring--during surgery in low-income countries. Methods We considered the use of tabletop and portable, hand-held pulse oximeters among patients of any age undergoing major surgery in low-income countries. From earlier studies we obtained baseline mortality and the effectiveness of pulse oximeters to reduce mortality. We considered the direct costs of purchasing and maintaining pulse oximeters as well as the cost of supplementary oxygen used to treat hypoxic episodes identified by oximetry. Health benefits were measured in disability-adjusted life-years (DALYs) averted and benefits and costs were both discounted at 3% per year. We used recommended cost-effectiveness thresholds--both absolute and relative to gross domestic product (GDP) per capita--to assess If pulse oximetry is a cost-effective health intervention. To test the robustness of our results we performed sensitivity analyses. Findings In 2013 prices, tabletop and hand-held oximeters were found to have annual costs of 310 and 95 United States dollars (US$), respectively. Assuming the two types of oximeter have identical effectiveness, a single oximeter used for 22 procedures per week averted 0.83 DALYs per annum. The tabletop and hand-held oximeters cost US$ 374 and US$ 115 per DALY averted, respectively. For any country with a GDP per capita above US$ 677 the hand-held oximeter was found to be cost-effective if it prevented just 1.7% of anaesthetic-related deaths or 0.3% of peri-operative mortality. Conclusion Pulse oximetry is a cost-effective intervention for low-income settings. Objectif Evaluer la rentabilite de l'oxymetrie de pouls par rapport a l'absence de surveillance perioperatoire lors d'une chirurgie dans les pays a revenu faible. Methodes Nous avons considere l'utillsation d'oxymetres de pouls a poser et d'oxymetres de pouls portatifs chez des patients detous ages ayant subi une operation chirurgicale Importante dans des pays a revenu faible. A partir d'etudes anterieures, nous avons obtenu la mortalite de reference et l'efficadte des oxymetres de pouls pour reduire la mortalite. Nous avons considere les couts directs de l'achat et de l'entretlen des oxymetres de pouls, ainsl que le cout de l'oxygene supplementaire utillse pourtraiter les episodes hypoxlques identifies par oxymetrie. Les avantages pour la sante ont ete mesures en esperance de vie corrigee de l'incapacite (EVCI) evitee, et les avantages et les couts ont ete actualises a 3% paran. Nous avons utillse les seulls de rentabilite recommandes--a la fois de maniere absolue et relative par rapport au produit interieur brut (PIB) par habitant--afin d'evaluer si l'oxymetrie de pouls etait une intervention de sante rentable. Pour tester la solidite de nos resultats, nous avons effectue des analyses de sensiblllte. Resultats Avec les prix de 2013, les oxymetres a poser et les oxymetres portatifs presentaient des couts annuels de 310 et 95 dollars, respectivement. En supposant que les deux types d'oxymetre ont une efficadte identique, un seul oxymetre utllise pour 22 interventions par semaine permettait d'eviter 0,83 EVCI par an. Les oxymetres a poser et les oxymetres portatifs coutaient 374$ et 115$ par EVCI evitee, respectivement. Pour tous les pays avec un PIB par habitant superieur a 677 $, l'oxymetre portatif s'est avere rentable s'il evltait seulement 1,7% des deces lies a l'anesthesie ou 0,3% de mortalite perioperatoire. Conclusion L'oxymetrie de pouls est une Intervention rentable pour les pays a faible revenu. Objetivo Evaluarla rentabilidad de la oximetria de pulso en comparacion con la ausencia de vigilancia perioperatoria durante la cirugia en paises de Ingresos bajos. Metodos Se tuvieron en cuenta oximetros de pulso manuales, tanto de mesa como portatiles, entre los pacientes de todas las edades sometidos a una Intervencion quirurgica importante en paises de ingresos bajos. A partir de los estudios anteriores se obtuvo la mortalidad inicial y la eficacia de los oximetros de pulso para reducir la mortalidad. Se consideraron los costes directos de la adquisicion y del mantenimiento de los oximetros de pulso, asi como el coste del oxigeno complementario que se utiliza para tratar los episodios de hipoxia identificados mediante la oximetria. Se midieron los beneficios para la salud en anos de vida con discapacidad (AVAD) evitados, mientras que los beneficios y los costes se descontaron al 3% por ano. Utilizamos los umbrales de rentabilidad recomendados, tanto absolutos como relativos, respecto al producto interno bruto (PIB) per caplta para evaluar si la oximetria de pulso es una intervencion de salud rentable. Por ultimo, se realizo un analisis de sensibilidad para ponera prueba la solidez de los resultados. Resultados En 2013, se hallo que los precios de los oximetros de mesa y portatiles suponian unos costes anuales de 310 y 95 dolares estadounidenses (US$), respectivamente. En el supuesto de que ambos tipos de oximetro tengan la misma eficacia, el uso de un unico oximetro para 22 procedimientos por semana evito 0,83 AVAD por ano. Los oximetros de mesa y manuales cuestan 374 US$ y 115 US$ por AVAD evitado, respectivamente. Para cualquier pais con un PIB per caplta superior a 677 US$ el oximetro manual resulto ser rentable con tan solo impedir un 1,7% de las muertes relacionadas con la anestesia o el 0,3% de la mortalidad perioperatoria. Conclusion La oximetria de pulso es una intervencion rentable para entornos de ingresos bajos., Introduction The pulse oximeter is a non-invasive medical device that monitors oxygen saturation and pulsation. When used continuously during surgery, it can provide early warning of hypoxia, hypovolaemia and impending [...]