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Objective To study paediatric surgery rates in south-western Uganda, compare them to rates in England, and determine if existing surgical facilities and workforce meet World Health Organization (WHO) standards. Methods To obtain information on surgical facilities and worcorce, we conducted a cross-sectional survey of all hospitals performing major surgery in 14 districts of south-western Uganda in 2007-2008. Using theatre logbook data, we determined the surgical rates, types of surgery performed and in-theatre surgical outcomes. Findings Of 72 hospitals surveyed, 29 were performing major surgery. None met WHO standards for essential surgery. There were 0.7 accredited Surgeons per 100 000 population and no paediatric surgeons. Most anaesthetists were not physicians (accredited anaesthetist per 100 000 population: 1.1). The annual surgical rate for children aged [less than or equal to] 14 years was 180 operations per 100 000 population; most were emergency procedures. The annual surgical rate for patients of all ages was 652 operations per 100 000 population, with a median of 422 per operating theatre (range: 60-3497) and of 226 per surgeon (range: 60-1748). Mission or nongovernmental organization (NGO) hospitals, which had 44% of the hospital beds in the region, performed 3039 (55%) of the paediatric operations. Externally funded surgeons performed 80% of the 140 cleft lip and palate operations. Four in-theatre deaths occurred in children [less than or equal to] 14 years old (in-theatre mortality: 7.7 deaths per 10 000 operations). Conclusion Access to all surgery, including paediatric surgery, is poor in south-western Uganda and investment in basic health-care facilities and surgical workforce and training is urgently needed. Mission and NGO hospitals make a valuable contribution to elective surgery, and externally funded surgeons make an important contribution to specialist surgery. In-theatre mortality was lower than reported for similar settings. Objectif Etudier les taux de chirurgie pediatrique dans le ud-ouest de l'Ouganda, puis les comparer aux taux en Angleterre et determiner si les installations et les effectifs chirurgicaux existants repondent aux normes de l'Organisation mondiale de la Sante (OMS). Methodes Pour obtenir des informations sur les installations et les effectifs en matiere de chirurgie, nous avons mene une etude transversale sur l'ensemble des hopitaux effectuant des actes chirurgicaux majeurs dans 14 districts du Sud-ouest de l'Ouganda en 2007-2008. Par le biais des donnees des registres des blocs operatoires, nous avons determine les taux et les types de chirurgie pratiquee, ainsi que les resultats chirurgicaux en salle d'operation. Resultats Sur 72 hopitaux etudies, 29 pratiquaient des actes chirurgicaux majeurs. Aucun d'entre eux ne respectait les normes de l'OMS en matiere de chirurgie fondamentale. On comptait 0,7 chirurgien accredite pour 100 000 habitants et aucun chirurgien pediatrique. La majorite des anesthesistes n'etaient pas medecins (nombre d'anesthesistes accredites pour 100 000 habitants: 1,1). Le taux de chirurgie annuel pour les enfants ages de moins de 14 ans etait de 180 operations pour 100 000 habitants, la plupart etant des interventions d'urgence. Le taux de chirurgie annuel pour les patients tous ages confondus etait de 652 operations pour 100 000 habitants, avec une moyenne de 422 operations par salle operatoire (fourchette: 60-3 497) et de 226 operations par chirurgien (fourchette: 60-1 748). Les hopitaux des missions ou des organisations non gouvernementales (ONG), soit 44% des lits de la region, ont effectue 3 039 operations pediatriques (55%). Les chirurgiens subventionnes par retranger ont effectue 80% des 140 interventions de palais fendu et de bec-de-lievre. Quatre deces en salle d'operation ont ete recenses chez des enfants ages de moins de 14 ans (mortalite en cours d'intervention chirurgicale: 7,7 deces pour 10 000 operations). Conclusion L'acces a tous les actes chirurgicaux, y compris a la chirurgie pediatrique, est mediocre dans le sud-ouest ougandais. De plus, il est urgent d'investir dans des installations sanitaires de base, de recruter du personnel chirurgical et de le former. Les hopitaux des missions et des ONG contribuent largement a la chirurgie elective, et les chirurgiens subventionnes par l'etranger interviennent quant a eux de facon importante dans la chirurgie specialisee. La mortalite en cours d'intervention chirurgicale etait inferieure aux chiffres annonces dans d'autres configurations similaires. Objetivo Estudiar las tasas de intervenciones quirurgicas pediatricas en el Sudoeste de Uganda, compararlas con las tasas de Inglaterra (Reino Unido) y determinar si las instalaciones y el personal quirurgico existentes cumplen las pautas de la Organizacion Mundial de La Salud (OMS). Metodos Para obtener informacion sobre las instalaciones y el personal quirurgicos, se realizo un estudio transversal de todos los hospitales que realizaban intervenciones de cirugia mayor en 14 distritos del Sudoeste de Uganda entre 2007 y 2008. Gracias a los datos del cuaderno de registro de quirofano pudimos determinar los indices de cirugias, los tipos de intervenciones quirurgicas Ilevadas a cabo y los resultados internos del quirofano. Resultados De los 72 hospitales estudiados, 29 realizaron intervenciones de cirugia mayor. Ninguno cumplia las pautas de la OMS para las intervenciones quirurgicas esenciales. EI numero de cirujanos acreditados por cada 1 O0 000 habitantes fue de 0,7 y no habia cirujanos pediatricos. La mayoria de los anestesistas no eran medicos (anestesistas acreditados por cada 100 000 habitantes: 1,1). El indice anual de intervenciones quirurgicas realizadas en ninos de hasta 14 anos fue de 180 operaciones por cada 100 000 habitantes, siendo en su mayoria procedimientos de urgencia. EI indice anual de intervenciones quirurgicas realizadas en pacientes de todas las edades fue de 652 operaciones por cada 100 000 habitantes, con una media de 422 intervenciones por quirofano (intervalo: 60-3497) y de 226 operaciones por cirujano (intervalo: 60-1748). Los hospitales de las misiones o de organizaciones no gubernamentales (ONG), que contaban con el 44% de las camas hospitalarias de la region, realizaron 3039 (55%) de las operaciones pediatricas. Los cirujanos financiados externamente realizaron el 80% de las 140 intervenciones de labio leporino y de lisura palatina. En el quirofano fallecieron cuatro ninos [less than or equal to] 14 anos (mortalidad en quirofano: 7,7 fallecimientos por cada 10 000 intervenciones quirurgicas). Conclusion El acceso en el Sudoeste de Uganda a todas las intervenciones quirurgicas, incluyendo la cirugia pediatrica, es deficiente, por lo que se requiere una inversion urgente en instalaciones sanitarias basicas, asi como personal y formacion quirurgica. Los hospitales de las misiones y de las ONG estan realizando una valiosa contribucion a la cirugia programada y los cirujanos pagados con fondos externos estan contribuyendo de manera importante a la cirugia especializada. La mortalidad en quirofano fue inferior a la notificada en ambitos similares., Introduction Despite increasing awareness of the unmet burden of surgical conditions, little information is available on surgery and anaesthesia in children. (1) It has been estimated that 85% of children [...]

OBJECTIVES There is a significant global burden of preventable morbidity and mortality after surgery caused by avoidable adverse events. Venous thromboembolism (VTE) prophylaxis, despite evidence for its efficacy, is not reliably and consistently prescribed, and is currently a serious concern for patient safety. The aim of this study was to prospectively audit errors captured by an extended surgical time out checklist and relate them to the introduction of a safety culture. METHODS The use of an extended surgical time out checklist was prospectively audited, in consecutive patients in one operating theatre over a period of two years. Errors captured were analysed and related to other improvements to safety culture; human factors training, debriefing and regular departmental meetings. RESULTS Time out was performed in 959 patients of 990 (96.8%) undergoing thoracic surgery. Performance was consistent over time. Errors were categorized as VTE prophylaxis (n = 53, 6%), blood products (n = 11), clerical (n = 5), imaging (n = 2) and miscellaneous (n = 2). After a lag period of 15 months, during which the team underwent human factors training, introduced debriefing and escalated VTE prophylaxis to regular departmental meetings, VTE prophylaxis errors were substantially reduced. The temporal relationship between error capture and error elimination is explored. CONCLUSIONS Use of checklists alongside appropriate human factors training, debriefing and regular multidisciplinary communication can substantially improve VTE prophylaxis in patients undergoing surgery. [ABSTRACT FROM AUTHOR]

Two letters to the editor and replies are presented in response to articles in previous issue concerning perioperative monitoring with pulse oximetry.

Background: Current knowledge of the situation of anaesthesia in developing countries is limited. A survey of the status of education and research based on hospital records, records of the anaesthesia section, nursing records, personal observations as well as personal communication with staff, patients and hospital managers was carried out in a 1863-bed university teaching hospital located in the capital of a least developed Sub-Saharan African Country. Methods: Classification and evaluation of the data was based on the three aspects of the role of university teaching hospitals in Western countries: (I) patient care, (II) university teaching and post-graduation training, as well as (III) research activities. The section "patient care" was subdivided into anaesthesia, intensive care medicine, emergency medicine, and pain therapy. The Department of Anaesthesia at the University Teaching Hospital of Lusaka, Zambia, is organized as a subdivision of the surgical department and is not involved in emergency medicine or pain therapy. Thirteen out of seventeen operating theatres, one recovery room, and a ten bed intensive care unit are serviced by the Department of Anaesthesia. Results: Anaesthetic equipment, medical supplies, drugs, and consumables are all in limited supply. There are limited statistics on perioperative complications and mortality. Anaesthesia at the university teaching hospital of a least developed Sub-Saharan African Country is severely short of both a workforce and resources. Conclusion: We have described strategies which may help to reverse this trend, the most important of which is to promote anaesthesia as an essential specialty within hospitals in developing countries. [ABSTRACT FROM AUTHOR]

The ongoing conflict in the Eastern Republic of the Congo (DRC) has claimed up to 5.4 million lives by 2008. Whereas few deaths were directly due to violence, most victims died from medical conditions such as infectious diseases. This survey investigates the availability of resources required to provide adequate sepsis care in Eastern DRC. The study was conducted as a self-reported, questionnaire-based survey in four Eastern provinces of the DRC. Questionnaires were sent to a cluster of 80 urban-based hospitals in the North Kivu, South Kivu, Maniema and Orientale provinces. The questionnaire contained 74 questions on the availability of resources required to adequately treat sepsis patients as suggested by the latest Surviving Sepsis Campaign (SSC) guidelines. Sixty-six questionnaires were returned (82.5%) and analyzed. Crystalloid solutions and intravenous fluid giving sets were the only resources constantly available in all hospitals. None of the respondents reported to have constant access to piperacillin, carbapenems, fresh frozen plasma, platelets, dobutamine, activated protein C, echocardiography or equipment to measure lactate levels, invasive blood pressure, central venous pressure, cardiac output, pulmonary artery pressure or endtidal carbon dioxide. No respondent stated that a mechanical ventilator, syringe pump, fluid infuser, peritoneal dialysis or haemodialysis/hemofiltration machine was constantly available at his/her hospital. Resources required for consistent implementation of the SSC guidelines were not available in any hospital. care and implement the SSC guidelines in a cluster of hospitals in the Eastern DRC.