Hannah Thomas

All Publications

• Association Between Surgeon Sex and Days Alive at Home Following Surgery: A Population-Based Cohort Study. Annals of surgery open : perspectives of surgical history, education, and clinical approaches Heybati, K., Satkunasivam, R., Aminoltejari, K., Thomas, H. S., Salles, A., Coburn, N., Wright, F. C., Gotlib Conn, L., Luckenbaugh, A. N., Ranganathan, S., Riveros, C., McCartney, C., Armstrong, K., Bass, B., Detsky, A. S., Jerath, A., Wallis, C. J. 2024; 5 (3): e477

  Abstract

  The objective of this study was to measure potential associations between surgeon sex and number of days alive and at home (DAH).Patients treated by female surgeons appear to have lower rates of mortality, complications, readmissions, and healthcare costs when compared with male surgeons. DAH is a validated measure, shown to better capture the patient experience of postoperative recovery.We conducted a retrospective study of adults (≥18 years of age) undergoing common surgeries between January 01, 2007 and December 31, 2019 in Ontario, Canada. The outcome measures were the number of DAH within 30-, 90-, and 365-days. The data was summarized using descriptive statistics and adjusted using multivariable generalized estimating equations.During the study period, 1,165,711 individuals were included, of which 61.9% (N = 721,575) were female. Those managed by a female surgeon experienced a higher mean number of DAH when compared with male surgeons at 365 days (351.7 vs. 342.1 days; P < 0.001) and at each earlier time point. This remained consistent following adjustment for covariates, with patients of female surgeons experiencing a higher number of DAH at all time points, including at 365 days (343.2 [339.5-347.1] vs. 339.4 [335.9-343.0] days). Multivariable regression modeling revealed that patients of male surgeons had a significantly lower number of DAH versus female surgeons.Patients of female surgeons experienced a higher number of DAH when compared with those treated by male surgeons at all time points. More time spent at home after surgery may in turn lower costs of care, resource utilization, and potentially improve quality of life. Further studies are needed to examine these findings across other care contexts.

  View details for DOI 10.1097/AS9.0000000000000477

  View details for PubMedID 39310349

  View details for PubMedCentralID PMC11415092

• Understanding the Burden of Pediatric Traumatic Injury in Uganda: A Multicenter, Prospective Study. The Journal of surgical research Thomas, H. S., Emmanuel, A., Kayima, P., Ajiko, M. M., Grabski, D. F., Situma, M., Kakembo, N., Ozgediz, D. E., Sabatini, C. S. 2024; 300: 467-476

  Abstract

  Traumatic injury is responsible for eight million childhood deaths annually. In Uganda, there is a paucity of comprehensive data describing the burden of pediatric trauma, which is essential for resource allocation and surgical workforce planning. This study aimed to ascertain the burden of non-adolescent pediatric trauma across four Ugandan hospitals.We performed a descriptive review of four independent and prospective pediatric surgical databases in Uganda: Mulago National Referral Hospital (2012-2019), Mbarara Regional Referral Hospital (2015-2019), Soroti Regional Referral Hospital (SRRH) (2016-2019), and St Mary's Hospital Lacor (SMHL) (2016-2019). We sub-selected all clinical encounters that involved trauma. The primary outcome was the distribution of injury mechanisms. Secondary outcomes included operative intervention and clinical outcomes.There was a total of 693 pediatric trauma patients, across four hospital sites: Mulago National Referral Hospital (n = 245), Mbarara Regional Referral Hospital (n = 29), SRRH (n = 292), and SMHL (n = 127). The majority of patients were male (63%), with a median age of 5 [interquartile range = 2, 8]. Chiefly, patients suffered blunt injury mechanisms, including falls (16.2%) and road traffic crashes (14.7%) resulting in abdominal trauma (29.4%) and contusions (11.8%). At SRRH and SMHL, from which orthopedic data were available, 27% of patients suffered long-bone fractures. Overall, 55% of patients underwent surgery and 95% recovered to discharge.In Uganda, non-adolescent pediatric trauma patients most commonly suffer injuries due to falls and road traffic crashes, resulting in high rates of abdominal trauma. Amid surgical workforce deficits and resource-variability, these data support interventions aimed at training adult general surgeons to provide emergency pediatric surgical care and procedures.

  View details for DOI 10.1016/j.jss.2024.04.043

  View details for PubMedID 38870654

• Impact of postoperative cardiovascular complications on 30-day mortality after major abdominal surgery: an international prospective cohort study. Anaesthesia 2024; 79 (7): 715-724

  Abstract

  Cardiovascular complications after major surgery are associated with increases in morbidity and mortality. There is confusion over definitions of cardiac injury or complications, and variability in the assessment and management of patients. This international prospective cohort study aimed to define the incidence and timing of these complications and to investigate their impact on 30-day all-cause mortality. We performed a prospective, international cohort study between January 2022 and May 2022. Data were collected on consecutive patients undergoing major abdominal surgery in 446 hospitals from 28 countries across Europe. The primary outcome measure was cardiovascular complications as defined by the Standardised Endpoints for Perioperative Medicine-Core Outcome Measures for Perioperative and Anaesthetic Care initiative up to 30 days after surgery. The secondary outcome was 30-day postoperative mortality. This study included 24,203 patients, of whom 611 (2.5%) developed cardiovascular complications. In total, 458 (1.9%) patients died within 30 days of surgery, of which 123 (26.9%) deaths were judged to be cardiac-related. Mortality rates were higher in patients who developed postoperative cardiovascular complications than in those who did not (19.8% vs. 1.4%), which persisted after risk adjustment (hazard ratio (95%CI) 4.15 (3.14-5.48)). We estimated an absolute risk reduction (95%CI) of 0.4 (0.3-0.5) in mortality in the absence of all cardiovascular complications. This would confer a relative risk reduction in mortality of 21.1% if all cardiovascular complications were prevented. Postoperative cardiovascular complications are relatively common and occur early after major abdominal surgery. However, over 1 in 5 postoperative deaths were attributable to these complications, highlighting an important area for future randomised trials.

  View details for DOI 10.1111/anae.16220

  View details for PubMedID 38303634

• Association between multimorbidity and postoperative mortality in patients undergoing major surgery: a prospective study in 29 countries across Europe Anesthesia Collaborative, S., Collaborative, E., Thomas, H. S. 2024

  View details for DOI 10.1111/anae.16324

• Impact of malnutrition on early outcomes after cancer surgery: an international, multicentre, prospective cohort study. The Lancet. Global health 2023; 11 (3): e341-e349

  Abstract

  Malnutrition represents a key priority for global health policy, yet the impact of nutritional state on cancer surgery worldwide remains poorly described. We aimed to analyse the effect of malnutrition on early postoperative outcomes following elective surgery for colorectal or gastric cancer.We did an international, multicentre, prospective cohort study of patients undergoing elective surgery for colorectal or gastric cancer between April 1, 2018, and Jan 31, 2019. Patients were excluded if the primary pathology was benign, they presented with cancer recurrence, or if they underwent emergency surgery (within 72 h of hospital admission). Malnutrition was defined with the Global Leadership Initiative on Malnutrition criteria. The primary outcome was death or a major complication within 30 days of surgery. Multilevel logistic regression and a three-way mediation analysis were done to establish the relationship between country income group, nutritional status, and 30-day postoperative outcomes.This study included 5709 patients (4593 with colorectal cancer and 1116 with gastric cancer) from 381 hospitals in 75 countries. The mean age was 64·8 years (SD 13·5) and 2432 (42·6%) patients were female . Severe malnutrition was present in 1899 (33·3%) of 5709 patients, with a disproportionate burden in upper-middle-income countries (504 [44·4%] of 1135) and low-income and lower-middle-income countries (601 [62·5%] of 962). After adjustment for patient and hospital risk factors, severe malnutrition was associated with an increased risk of 30-day mortality across all country income groups (high income: adjusted odds ratio [aOR] 1·96 [95% CI 1·14-3·37], p=0·015; upper-middle income: 3·05 [1·45-6·42], p=0·003; low income and lower-middle income: 11·57 [5·87-22·80], p<0·0001). Severe malnutrition mediated an estimated 32% of early deaths in low-income and lower-middle-income countries (aOR 1·41 [95% CI 1·22-1·64]) and an estimated 40% of early deaths in upper-middle-income countries (1·18 [1·08-1·30]).Severe malnutrition is common in patients undergoing surgery for gastrointestinal cancers and is a risk factor for 30-day mortality following elective surgery for colorectal or gastric cancer. There is an urgent need to examine whether perioperative nutritional interventions can improve early outcomes following gastrointestinal cancer surgery worldwide.National Institute for Health Research Global Health Research Unit.

  View details for DOI 10.1016/S2214-109X(22)00550-2

  View details for PubMedID 36796981

• Comparison of Male and Female Surgeons' Experiences With Gender Across 5 Qualitative/Quantitative Domains. JAMA surgery Zogg, C. K., Kandi, L. A., Thomas, H. S., Siki, M. A., Choi, A. Y., Guetter, C. R., Smith, C. B., Maduakolam, E., Kondle, S., Stein, S. L., Shaughnessy, E. A., Ahuja, N. 2022: e226431

  Abstract

  A growing body of literature has been developed with the goal of attempting to understand the experiences of female surgeons. While it has helped to address inequities and promote important programmatic improvements, work remains to be done.To explore how practicing male and female surgeons' experiences with gender compare across 5 qualitative/quantitative domains: career aspirations, gender-based discrimination, mentor-mentee relationships, perceived barriers, and recommendations for change.This national concurrent mixed-methods survey of Fellows of the American College of Surgeons (FACS) compared differences between male and female FACS. Differences between female FACS and female members of the Association of Women Surgeons (AWS) were also explored. A randomly selected 3:1 sample of US-based male and female FACS was surveyed between January and June 2020. Female AWS members were surveyed in May 2020.Self-reported gender.Self-reported experiences with career aspirations (quantitative), gender-based discrimination (quantitative), mentor-mentee relationships (quantitative), perceived barriers (qualitative), and recommendations for change (qualitative).A total of 2860 male FACS (response rate: 38.1% [2860 of 7500]) and 1070 female FACS (response rate: 42.8% [1070 of 2500]) were included, in addition to 536 female AWS members. Demographic characteristics were similar between randomly selected male and female FACS, with the notable exception that female FACS were less likely to be married (720 [67.3%] vs 2561 [89.5%]; nonresponse-weighted P < .001) and have children (660 [61.7%] vs 2600 [90.9%]; P < .001). Compared with female FACS, female AWS members were more likely to be younger and hold additional graduate degrees (320 [59.7%] were married; 238 [44.4%] had children). FACS of both genders acknowledged positive and negative aspects of dealing with gender in a professional setting, including shared experiences of gender-based harassment, discrimination, and blame. Female FACS were less likely to have had gender-concordant mentors. They were more likely to emphasize the importance of gender when determining career aspirations and prioritizing future mentor-mentee relationships. Moving forward, female FACS emphasized the importance of avoiding competition among female surgeons. They encouraged male surgeons to acknowledge gender bias and admit their potential role. Male FACS encouraged male and female surgeons to treat everyone the same.Experiences with gender are not limited to supportive female surgeons. The results of this study emphasize the importance of recognizing the voices of all stakeholders involved when striving to promote workforce diversity and the related need to develop quality improvement/surgical education initiatives that enhance inclusion through open, honest discourse.

  View details for DOI 10.1001/jamasurg.2022.6431

  View details for PubMedID 36477515

• Spotlighting Research During COVID-19: Introduction of an International Online Multi-Round Research Competition for Trainees. The American surgeon Thomas, H. S., Siki, M. A., Lansing, S. S., Zogg, C. K., Patrick, B., Towe, C. W., Stein, S. L. 2022; 88 (11): 2644-2648

  Abstract

  The coronavirus pandemic led to the cancellation of many academic events. While some transitioned to virtual formats, others disappeared, offering fewer opportunities for trainees to share research. Facing this challenge, the Association of Women Surgeons developed a novel approach. Designed to promote greater global inclusion, increase audience engagement and opportunities for networking and feedback from practicing surgeons, they restructured their annual trainee research symposium as a virtual, multi-round competition.Submission to the research competition was open to trainees at any level. The competition comprised four rounds: (1) visual abstracts (all welcomed), (2) three-minute "Quickshot" presentation (32 advance), (3) eight-minute oral presentations (16 advance), and (4) final question-and-answer style defense (final 4 compete). Progression through the first three rounds was determined by public voting. Winners were determined by live voting during the final session.A total of 73 visual abstracts were accepted for presentation. Fifty-six percent (n = 41) of first authors were medical students, 36% residents (n = 26), and 7% fellows (n = 6). Five were from international first authors (7%). Abstracts represented research topics including basic science (n = 6, 8%)), clinical outcomes (n = 38, 52%), and education (n = 29, 40%). Social media impressions exceeded a total of 30,000 views.This virtual, multi-round research competition served as a blueprint for a novel approach to research dissemination. The format enabled expanded US national and international engagement with trainees in all stages of their career. Future research symposia should consider the impact of popularity bias, timing, and voting strategies during the event planning period to optimize success.

  View details for DOI 10.1177/00031348221101474

  View details for PubMedID 35574734

  View details for PubMedCentralID PMC9118000

• Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study LANCET GLOBAL HEALTH Knight, S. R., Chu, K., Lapitan, M., Dare, A. J., Pius, R., Shaw, C. A., Drake, T. M., Norman, L., Ademuyiwa, A. O., Adisa, A. O., Aguilera, M., Al-Saqqa, S. W., Al-Slaibi, I., Bhangu, A., Biccard, B. M., Brocklehurst, P., Costas-Chavarri, A., Elhadi, M., Fairfield, C. J., Fitzgerald, J., Ghosh, D., Glasbey, J., Henegouwen, M., Ingabire, J., Kingham, T., Lawani, I., Lieske, B., Lilford, R., Martin, J., Mclean, K. A., Moore, R., Morton, D., Nepogodiev, D., Ntirenganya, F., Pata, F., Pinkney, T., Qureshi, A., Ramos-De la Medina, A., Riad, A., Salem, H., Simoes, J., Spence, R., Smart, N., Tabiri, S., Thomas, H., West, M., Whitaker, J., Weiser, T. G., Harrison, E. M., GlobalSurg Collaborative, NIHR Global Hlth Res Unit Global S 2022; 10 (7): E1003-E1011

  Abstract

  Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58-5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23-0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised.National Institute for Health and Care Research.

  View details for DOI 10.1016/S2214-109X(22)00168-1

  View details for Web of Science ID 000835720300001

  View details for PubMedID 35623378

  View details for PubMedCentralID PMC9210173

• Awareness, Clinical Experience and Knowledge of Female Genital Mutilation/Cutting Among Female Pelvic Medicine and Reconstructive Surgeons in the United States. Urology Thomas, H. S., Mmonu, N. A., Amend, G., Dubinskaya, A., Johnson-Agbakwu, C., Rowen, T. S., Anger, J. T., Breyer, B. N. 2022; 159: 59-65

  Abstract

  To promote the recognition and care of patients with female genital mutilation/cutting (FGM/C), we aimed to evaluate the awareness, clinical experience and knowledge of FGM/C among female pelvic medicine and reconstructive surgery (FPMRS) specialists. FGM/C is a cultural practice whereby there is removal of external female genitalia for non-therapeutic reasons. Despite the high prevalence of urogynecologic complications, there is a paucity of literature discussing FGM/C from the lens of urologists and urogynecologists.By cross-sectional design, we distributed a 27-item survey via email to members of the Society of Urodynamics, Female Pelvic Medicine and Reconstructive Surgery. We collected variables pertaining to previous FGM/C education, clinical confidence, cultural and medical knowledge, and desire for future education.A total of 54 US-based, mostly urologists and FPMRS specialists, completed the survey. All providers had heard of FGM/C; however only 13% received formal education during medical training. Over 50% had encountered a patient with FGM/C in clinical practice. Only 19% and 13% felt completely confident recognizing and discussing FGM/C, respectively. Seventy percent believed religious doctrine informed FGM/C practice and 24% correctly identified FGM/C type on clinical representation. Finally, only 17% of respondents were aware of FGM/C guidelines, and providers expressed a desire for increased availability of multimodal resources.Education regarding FGM/C remains sparse and variable for US FPMRS specialists. Cultural and clinical knowledge is also lacking, which is a detriment to patient care. In order to strengthen awareness and knowledge, we must develop high-quality FGM/C educational resources for urologists and gynecologists.

  View details for DOI 10.1016/j.urology.2021.10.023

  View details for PubMedID 34758373

• Comment on "The Compounding Access Problem for Surgical Care: Innovations in the Post-COVID Era". Annals of surgery Ma, X., Thomas, H. S., Nazir, A., Vervoort, D. 2021; 274 (6): e813-e814

  View details for DOI 10.1097/SLA.0000000000004226

  View details for PubMedID 33055592

• National, collaborative evaluation of medical student and faculty perspectives on global surgery - Survey of undergraduate respondents on global surgery education (SURGE): A cross-sectional study. International journal of surgery (London, England) 2021; 93: 106049

  Abstract

  It is estimated that 28-32% of the global burden of disease can be treated with surgery. Most of this burden is concentrated in low and middle-income countries, underpinning the importance of the topic of global surgery (GS). The multidisciplinary principles of GS are increasingly recognised as being key to modern practice and as such, must be fostered at early stages of medical training. However, it is unclear whether medical students are being exposed to GS. This study aimed to assess the importance of GS and its presence in medical curricula.A novel, 22-item online questionnaire was developed and disseminated to medical students and faculty members using social media platforms. Data collection was conducted by a collaboration of medical students, who acted as regional leads at their institutions.795 medical students and 141 faculty members representing 38/42 (90.4%) of UK medical schools completed the questionnaire. Only 84 students (10.6%) were previously exposed to GS. Most students (66.3%) and faculty (60.6%) agreed that GS should be an integral part of the curriculum. Only 20 students (2.5%) were familiar with what a career in GS means.Approximately two-third of students and faculty agree that global surgery should be an integral part of the mandatory curriculum. Findings of this study should underpin further incorporation of GS into curricula, as high-income countries can decisively contribute to achieving the global surgery 2030 targets, by training a new generation of clinicians who are ready for the challenges of the 21st century.

  View details for DOI 10.1016/j.ijsu.2021.106049

  View details for PubMedID 34418568

• Characterizing online crowdfunding campaigns for patients with kidney cancer. Cancer medicine Thomas, H. S., Lee, A. W., Nabavizadeh, B., Namiri, N. K., Hakam, N., Martin-Tuite, P., Rios, N., Enriquez, A., Mmonu, N. A., Cohen, A. J., Breyer, B. N. 2021; 10 (13): 4564-4574

  Abstract

  Cancer patients incur high care costs; however, there is a paucity of literature characterizing unmet financial obligations for patients with urologic cancers. Kidney cancer patients are particularly burdened by costs associated with novel systemic treatments. This study aimed to ascertain the characteristics of GoFundMe® crowdfunding campaigns for patients with kidney cancer, in order to better understand the financial needs of this population.We performed a cross-sectional, quantitative, and qualitative analysis of all kidney cancer GoFundMe® campaigns since 2010. Fundraising metrics such as goal funds and amount raised, were extracted. Eight independent investigators collected patient, disease and campaign-level variables from campaign stories (κ = 0.72). In addition, we performed a content analysis of campaign narratives spotlighting the primary appeal of the patient's life story.A total of 486 GoFundMe® kidney cancer campaigns were reviewed. The median goal funds were 10,000USD [IQR = 5000, 20,000] and the median amount raised was 1450USD [IQR = 578, 4050]. Most campaigns were for adult males (53%) and 62% of adults had children. A minority were for pediatric patients (17%). Thirty-seven percent of adult patients were primary wage earners and 43% reported losing their job or substantially reducing hours due to illness. Twenty-nine percent reported no insurance or insufficient coverage. Campaigns most frequently sought funds for medical bills (60%), nonmedical bills (27%), and medical travel (23%). Qualitative campaign narratives mostly emphasized patients' hardship (46.3%) or high moral character (35.2%). Only 8% of campaigns achieved their target funds.Despite fundraising efforts, patients with kidney cancer face persistent financial barriers, incurring both medical and nonmedical cost burdens. This may be compounded by limited or no insurance. Cancer care providers should be aware of financial constraints placed on kidney cancer patients, and consider how these may impact treatment regimens.

  View details for DOI 10.1002/cam4.3974

  View details for PubMedID 34102000

  View details for PubMedCentralID PMC8267118

• Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries LANCET Knight, S. R., Shaw, C. A., Pius, R., Drake, T. M., Norman, L., Ademuyiwa, A. O., Adisa, A. O., Aguilera-Arevalo, M., Al-Saqqa, S. W., Al-Slaibi, I. S., Bhangu, A., Biccard, B. M., Brocklehurst, P., Costas-Chavarri, A., Chu, K. M., Dare, A. J., Elhadi, M., Fairfield, C. J., Fitzgerald, J., Ghosh, D. N., Glasbey, J., Henegouwen, M., Ingabire, J., Kingham, T., Lapitan, M. M., Lawani, I., Lieske, B., Lilford, R. J., Martin, J., Mclean, K. A., Moore, R. L., Morton, D., Nepogodiev, D., Ntirenganya, F., Pata, F., Pinkney, T. D., Qureshi, A. U., Ramos-De la Medina, A., Riad, A. M., Salem, H., Simoes, J., Spence, R. T., Smart, N. J., Tabiri, S., Thomas, H. S., Weiser, T. G., West, M. A., Whitaker, J., Harrison, E. M., GlobalSurg Collaborative, Global Surg Writing Grp 2021; 397 (10272): 387–97

  Abstract

  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.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.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.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.National Institute for Health Research Global Health Research Unit.

  View details for DOI 10.1016/S0140-6736(21)00001-5

  View details for Web of Science ID 000614227700026

  View details for PubMedID 33485461

  View details for PubMedCentralID PMC7846817

• Use of Urology-Based Clinical Practice Guidelines in International Settings Societe Internationale d'Urologie Journal Patino, G., Ndoye, M., Thomas, H. S., Cohen, A. J., Mmonu, N., Chu, C., Breyer, B. 2021
• Evaluating the primary use, strengths and weaknesses of pelvic floor muscle training devices available online. Neurourology and urodynamics Thomas, H. S., Lee, A. W., Nabavizadeh, B., Martin-Tuite, P., Namiri, N. K., Hakam, N., Rios, N., Enriquez, A., Mmonu, N. A., Breyer, B. N. 2021; 40 (1): 310-318

  Abstract

  Treatment for urinary incontinence (UI) includes pelvic floor muscle training (PFMT). There is limited data appraising the characteristics of PFMT devices. We aimed to ascertain the primary use, strengths and weaknesses of PFMT devices available online, through evaluation of consumer reviews.We performed an analysis of PFMT devices on Amazon.com. Four key device categories were recognized. Reviews from the five most frequently-reviewed products per category were analyzed (n = 20). W characterized device use, strengths and weaknesses using thematic analysis.We evaluated 2574 PFMT device reviews including 1168 vibrating Kegel balls, 750 non-vibrating Kegel balls, 411 pelvic floor or thigh exercisers, and 245 electric probes. Non-vibrating Kegel balls were rated highest (4.6/5 stars), followed by vibrating Kegel balls, electric probes and pelvic floor or thigh exercisers (4.4/5, 4.1/5, and 3.8/5 stars, respectively). Most reviews were positive (77%) or negative (16%) with few neutral (7%). While all were marketed to treat UI, most reviews did not mention the intended use. Vibrating and non-vibrating Kegel balls and electric probes were most likely to be used for UI, and pelvic floor or thigh exercisers for toning. Some used non-vibrating and vibrating Kegel balls for sexual function. Electric probes were the most beneficial device for incontinence control (27%, 67/245). Twenty-five percent of all product reviews praised device ease of use and good quality or design. A minority of reviewers found products difficult to use, of poor quality or design and uncomfortable.Consumers utilized online PFMT devices for multiple purposes, including UI, toning and sexual function. Reviewers generally praised PFMT products, particularly electric probes for UI.

  View details for DOI 10.1002/nau.24560

  View details for PubMedID 33137215

• Qualitative analysis of Amazon customer reviews of penile clamps for male urinary incontinence. Neurourology and urodynamics Lee, A., Mmonu, N. A., Thomas, H., Rios, N., Enriquez, A., Breyer, B. N. 2021; 40 (1): 384-390

  Abstract

  Penile clamps offer an alternative to manage male urinary incontinence in patients who are unfit for surgery. Patient experience with penile clamps is poorly understood. Our study elucidates patient opinions on commercially available penile clamps and the factors that associate with favorable and unfavorable opinions.We collected Amazon reviews of all penile clamps marketed for male urinary incontinence from November 2011 to January 2020 and qualitatively assessed the overall sentiment towards penile clamps, key praises and key complaints. Covariates such as designated Amazon star rating were further explored for association with coding patterns.Amazon reviews of penile clamps were found to be more positive (n = 425) in overall sentiment than negative (n = 294). The most frequent praise was effective incontinence control (n = 334) and the most frequent complaint was bad design or material (n = 166). The majority of reviews were for lower priced penile clamps, had higher Amazon star ratings, were written for Wiesner-produced clamps, and were written more recently (i.e., 2015-2020). Penile clamps with higher Amazon star ratings were more often coded positive and with a praise compared to lower rated penile clamps.Penile clamps are seen favorably by users as an effective treatment modality for male urinary incontinence. User reviews suggest opportunities for improvement in penile clamp design. The most frequently reviewed clamp seen positively is the Wiesner Incontinence Clamp Penile Clamp whereas the most frequently reviewed clamp seen negatively is the Pacey Cuff Male Incontinence Device.

  View details for DOI 10.1002/nau.24572

  View details for PubMedID 33165983

• Global health education in medical schools (GHEMS): a national, collaborative study of medical curricula. BMC medical education 2020; 20 (1): 389

  Abstract

  Global health is the study, research, and practice of medicine focused on improving health and achieving health equity for all persons worldwide. International and national bodies stipulate that global health be integrated into medical school curricula. However, there is a global paucity of data evaluating the state of global health teaching in medical schools. This study aimed to evaluate the extent of global health teaching activities at United Kingdom (UK) medical schools.A national, cross-sectional study assessing all timetabled teachings sessions within UK medical courses for global health content during the academic year 2018/19. Global health content was evaluated against a comprehensive list of global health learning outcomes for medical students.Data from 39 medical courses representing 86% (30/36) of eligible medical schools was collected. Typically, medical courses reported timetabled teaching covering over three-quarters of all global health learning outcomes. However, a wide degree of variation existed among granular global health learning objectives covered within the different medical courses. On average, each learning outcome had a 79% [95% CI: 73, 83%] probability of being included in course curricula. There were a number of learning outcomes that had a lower probability, such as 'access to surgeons with the necessary skills and equipment in different countries' (36%) [95% CI: 21, 53%], 'future impact of climate change on health and healthcare systems' (67%) [95% CI: 50, 81%], and 'role of the WHO' (54%) [95% CI: 28, 60%].This study served as the first national assessment of global health education and curricula within UK medical schools. Through a formalised assessment of teaching events produced by medical schools around the country, we were able to capture a national picture of global health education, including the strengths of global health prioritisation in the UK, as well as areas for improvement. Overall, it appears broad-level global health themes are widely discussed; however, the granularities of key, emerging areas of concern are omitted by curricula. In particular, gaps persist relating to international healthcare systems, multilateral global health agencies such as the WHO, global surgery, climate change and more.

  View details for DOI 10.1186/s12909-020-02315-x

  View details for PubMedID 33115465

  View details for PubMedCentralID PMC7594419

• Beyond technology: review of systemic innovation stories in global surgery Journal of Public Health and Epidemiology Ma, X., Thomas, H. S., Kanmounye, U. S. 2020

  View details for DOI 10.21037/jphe-2020-gs-06

• Incidental Findings Identified on Head MRI for Investigation of Cognitive Impairment: A Retrospective Review. Dementia and geriatric cognitive disorders Glasmacher, S. A., Thomas, H. S., Stirland, L., Wilkinson, T., Lumsden, J., Langlands, G., Waddell, B., Holloway, G., Thompson, G., Pal, S. 2019; 48 (3-4): 123-130

  Abstract

  Incidental findings are common in presumed healthy volunteers but are infrequently studied in patients in a clinical context.To determine the prevalence, nature, and management implications of incidental findings on head MRI in patients presenting with cognitive symptoms, and to quantify and describe unexpected MRI abnormalities that are of uncertain relevance to the patient's cognitive symptoms.A single-centre retrospective review of patients attending a regional early-onset cognitive disorders clinic between March 2012 and October 2018. Medical records of consecutive patients who underwent head MRI were reviewed. Unexpected MRI findings were classified according to their severity and likelihood of being incidental. Markers of small vessel disease and cerebral atrophy were excluded.Records of 694 patients were reviewed (median age 60 years, 49.9% female), of whom 514 (74.1%) underwent head MRI. 54% of the patients received a diagnosis of a neurodegenerative disorder. Overall 111 incidental findings were identified in 100 patients of whom 18 patients (3.5%, 95% CI 2.2-5.6%) had 18 incidental findings classified as requiring additional medical evaluation. 82 patients (16%, 95% CI 13.0-19.5%) had 93 incidental findings without clearly defined diagnostic consequences. 17 patients (3.3%) underwent further investigations, 14 patients (2.7%) were referred to another specialist clinic and 3 patients (0.6%) were treated surgically. Two patients had MRI findings of uncertain relevance to their cognitive symptoms, necessitating prolonged clinic follow-up.Incidental findings are common in patients with cognitive impairment from this large clinic-based series; however, few required additional medical evaluation. These data could help inform discussions between clinicians and people with cognitive symptoms regarding the likelihood and potential implications of incidental imaging findings.

  View details for DOI 10.1159/000503956

  View details for PubMedID 31805574

• Medical equipment donation in low-resource settings: a review of the literature and guidelines for surgery and anaesthesia in low-income and middle-income countries. BMJ global health Marks, I. H., Thomas, H., Bakhet, M., Fitzgerald, E. 2019; 4 (5): e001785

  Abstract

  Medical equipment donation to low-resource settings is a frequently used strategy to address existing disparities, but there is a paucity of reported experience and evaluation. Challenges such as infrastructure gaps, lack of technological and maintenance capabilities, and non-prioritisation of essential supplies have previously been highlighted. This pragmatic review summarises existing guidelines and literature relevant to surgical and anaesthesia equipment, with recommendations for future initiatives and research.Retrospective literature review including both academic and grey literature from 1980 to 2018. We conducted a narrative synthesis to identify key factors that were condensed thematically.Thirty-three biomedical equipment donation guidelines were identified from governments, WHO, World Bank, academic colleges and non-governmental organisations, and 36 relevant studies in peer-reviewed literature. These highlighted the need to consider all stages of the donation process, including planning, sourcing, transporting, training, maintaining and evaluating equipment donation. Donors were advised to consult national guidelines to ensure equipment was appropriate, desirable and non-costly to both parties. User training and access to biomechanical engineers were suggested as necessary for long-term sustainability. Finally, equitable partnerships between donors and recipients were integral to reducing inappropriate donations and to improve follow-up and evaluation.There is a paucity of evidence on the causes of success or failure in medical equipment donation, despite its domination of equipment sourcing across many low-resource settings. Equitable partnerships, consultation of policies and guidelines, and careful planning may improve equipment usability and life span. A concerted effort is required to increase awareness of guidelines among health professionals worldwide.

  View details for DOI 10.1136/bmjgh-2019-001785

  View details for PubMedID 31637029

  View details for PubMedCentralID PMC6768372

• Global Health Education in UK Medical Schools (GHEMS) study protocol Journal of Global Health Reports Bandyopadhyay, S., Shortland, T., Wadanamby, S. W., Thomas, H. S., Gurung, B., Akhbari, M., Trout, I., Patel, R., Sharma, K., Fitzgerald, J., Smith, A. D. 2019

  View details for DOI 10.29392/joghr.3.e2019052

• Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy BRITISH JOURNAL OF SURGERY Thomas, H. S., Weiser, T. G., Drake, T. M., Knight, S. R., Fairfield, C., Ademuyiwa, A. O., Aguilera, M., Alexander, P., Al-Saqqa, S. W., Borda-Luque, G., Costas-Chavarri, A., Ntirenganya, F., Fitzgerald, J., Fergusson, S. J., Glasbey, J., Ingabire, J., Ismail, L., Salem, H., Kojo, A., Lapitan, M., Lilford, R., Mihaljevic, A. L., Morton, D., Mutabazi, A., Nepogodiev, D., Adisa, A. O., Ots, R., Pata, F., Pinkney, T., Poskus, T., Qureshi, A., Ramos-De la Medina, A., Rayne, S., Shaw, C. A., Shu, S., Spence, R., Smart, N., Tabiri, S., Bhangu, A., Harrison, E. M., Verjee, A., Runigamugabo, E., Ademuyiwa, A. O., Adisa, A. O., Aguilera, M., Altamini, A., Alexander, P., Al-Saqqa, S. W., Borda-Luque, G., Cornick, J., Costas-Chavarri, A., Drake, T. M., Fergusson, S. J., Fitzgerald, J., Glasbey, J., Ingabire, J., Ismail, L., Jaffry, Z., Salem, H., Khatri, C., Kirby, A., Kojo, A., Lapitan, M., Lilford, R., Mihaljevic, A. L., Mohan, M., Morton, D., Mutabazi, A., Nepogodiev, D., Ntirenganya, F., Ots, R., Pata, F., Pinkney, T., Poskus, T., Qureshi, A., Ramos-De la Medina, A., Rayne, S., Recinos, G., Soreide, K., Shaw, C. A., Shu, S., Spence, R., Smart, N., Tabiri, S., Harrison, E. M., Bhang, A., Khatri, C., Gobin, N., Freitas, A., Hall, N., Kim, S., Negida, A., Khairy, H., Jaffry, Z., Chapman, S. J., Arnaud, A. P., Tabiri, S., Recinos, G., Manipal, C., Mohan, M., Amandito, R., Shawki, M., Hanrahan, M., Pata, F., Zilinskas, J., Roslani, A., Goh, C., Ademuyiwa, A. O., Irwin, G., Shu, S., Luque, L., Shiwani, H., Altamimi, A., Alsaggaf, M., Fergusson, S. J., Spence, R., Rayne, S., Jeyakumar, J., Cengiz, Y., Raptis, D. A., Glasbey, J. C., Modolo, M., Iyer, D., King, S., Arthur, T., Nahar, S., Waterman, A., Ismail, L., Walsh, M., Agarwal, A., Zani, A., Firdouse, M., Rouse, T., Liu, Q., Camilo Correa, J., Salem, H., Talving, P., Worku, M., Arnaud, A., Tabiri, S., Kalles, V., Aguilera, M., Recinos, G., Kumar, B., Kumar, S., Amandito, R., Quek, R., Pata, F., Ansaloni, L., Altibi, A., Venskutonis, D., Zilinskas, J., Poskus, T., Whitaker, J., Msosa, V., Tew, Y., Farrugia, A., Borg, E., Ramos-De la Medina, A., Bentounsi, Z., Ademuyiwa, A. O., Soreide, K., Gala, T., Al-Slaibi, I., Tahboub, H., Alser, O. H., Romani, D., Shu, S., Major, P., Mironescu, A., Bratu, M., Kourdouli, A., Ndajiwo, A., Altwijri, A., Alsaggaf, M., Gudal, A., Jubran, A., Seisay, S., Lieske, B., Rayne, S., Spence, R., Ortega, I., Jeyakumar, J., Senanayake, K. J., Abdulbagi, O., Cengiz, Y., Raptis, D., Altinel, Y., Kong, C., Teasdale, E., Irwin, G., Stoddart, M., Kabariti, R., Suresh, S., Gash, K., Narayanan, R., Maimbo, M., Fermani, C., Balmaceda, R., Modolo, M., Macdermid, E., Gobin, N., Chenn, R., Yong, C., Edye, M., Jarmin, M., D'amours, S. K., Iyer, D., Youssef, D., Phillips, N., Brown, J., George, R., Koh, C., Warren, O., Hanley, I., Dickfos, M., Nawara, C., Ofner, D., Primavesi, F., Mitul, A., Mahmud, K., Hussain, M., Hakim, H., Kumar, T., Oosterkamp, A., Assouto, P. A., Lawani, I., Souaibou, Y., Tun, A., Chong, C., Devadasar, G. H., Chong, C., Qadir, M., Aung, K., Yeo, L., Chong, C., Palomino Castillo, V., Munhoz, M., Moreira, G., Barros De Castro Segundo, L., Khouri Ferreira, S., Careta, M., Kim, S., De Sousa, A., Lazzarini Cury, A., Soares Miguel, G., Carreiro De Freitas, A., Silvestre, B., Vianna, J., Felipe, C., Valente Laufer, L., Altoe, F., Da Silva, L., Pimenta, M., Giuriato, T., Bezerra Morais, P., Luiz, J., Araujo, R., Menegussi, J., Leal, M., Barroso de Lima, C., Tatagiba, L., Leal, A., dos Santos, D., Fraga, G., Simoes, R., Stock, S., Nigo, S., Kabba, J., Ngwa, T., Brown, J., King, S., Zani, A., Azzie, G., Firdouse, M., Kushwaha, S., Agarwal, A., Bailey, K., Cameron, B., Livingston, M., Horobjowsky, A., Deckelbaum, D. L., Razek, T., Marinkovic, B., Grasset, E., D'aguzan, N., Grasset, E., Jimenez, J., Macchiavello, R., Zhang, Z., Guo, W., Oh, J., Zheng, F., Montes, I., Sierra, S., Mendez, M., Isabel Villegas, M., Mendoza Arango, M., Mendoza, I., Naranjo Aristizaibal, F., Montoya Botero, J., Quintero Riaza, V., Restrepo, J., Morales, C., Mendoza Arango, M., Cruz, H., Munera, A., Mendoza Arango, M., Karlo, R., Domini, E., Mihanovic, J., Radic, M., Zamarin, K., Pezelj, N., Hache-Marliere, M., Lemaire, S., Rivas, R., Khyrallh, A., Hassan, A., Shimy, G., Fahmy, M., Nabawi, A., Elfil, M., Ghoneem, M., Gohar, M., Asal, M., Abdelkader, M., Gomah, M., Rashwan, H., Karkeet, M., Gomaa, A., Hasan, A., Elgebaly, A., Saleh, O., Fattah, A., Gouda, A., Elshafay, A., Gharib, A., Menshawy, A., Hanafy, M., Al-Mallah, A., Abdulgawad, M., Baheeg, M., Alhendy, M., AbdelFattah, I., Kenibar, A., Osman, O., Gemeah, M., Mohammed, A., Adel, A., Gharib, A., Mohammed, A., Sayed, A., Abozaid, M., Kotb, A., Ata, A., Nasr, M., Alkammash, A., Saeed, M., Abd El Hamid, N., Attia, A., Abd El Galeel, A., Elbanby, E., El-Dien, K., Hantour, U., Alahmady, O., Mansour, B., Elkorashy, A., Taha, E., Lasheen, K., Elkolaly, S., Abdel-Wahab, N., Abozyed, M., Adel, A., Saeed, A., El Sayed, G., Youssif, J., Ahmed, S., El-Shahat, N., Khedr, A., Elsebaaye, A., Elzayat, M., Abdelraheim, M., Elzayat, I., Warda, M., El Deen, K., Elnemr, A., Salah, O., Abbas, M., Rashad, M., Elzayyat, I., Hemeda, D., Tawfik, G., Salama, M., Khaled, H., Seisa, M., Elshaer, K., Hussein, A., Elkhadrawi, M., Afifi, A., Ebrahim, O., Metwally, M., Elmelegy, R., Elsawahly, D., Safa, H., Nofal, E., Elbermawy, M., Ghazy, A., Samih, H., Abdelgelil, A., Abdelghany, S., El Kholy, A., Aboraya, M., Elkady, F., Salma, M., Samy, S., Fakher, R., Aboarab, A., Samir, A., Sakr, A., Haroun, A., Al-Aarag, A., Elkholy, A., Elshanwany, S., Ghanem, E., Tammam, A., Hammad, A., El Shoura, Y., El Ashal, G., Khairy, H., Antar, S., Mehrez, S., Abdelshafy, M., Hamad, M., Hosh, M., Abdallah, E., Magdy, B., Alzayat, T., Gamaly, E., Elfeki, H., Abouzahra, A., Elsheikh, S., Elgendy, F. I., Abd El-Salam, F., Seifelnasr, O., Ammar, M., Eysa, A., Sadek, A., Toeema, A., Nasr, A., Abuseif, M., Zidan, H., Barakat, S., Elsayed, N., Abd Elrasoul, Y., Elkelany, A., Ammar, M., Mustafa, M., Hegazy, Y., Etman, M., Saad, S., Alrahawy, M., Raslan, A., Morsi, M., Rslan, A., Sabry, A., Elwakil, H., Shaker, H., Zidan, H., Abd-Elrasoul, Y., Elkelany, A., El-Kashef, H., Shaalan, M., Tarek, A., Elwan, A., Nayel, A., Seif, M., Elwan, A., Emadeldin, D., Ghonaim, M., Almallah, A., Fouad, A., Sayma, E., Elbatahgy, A., El-Ma'doul, A., Mosad, A., Tolba, H., Elsorogy, D., Mostafa, H., Omar, A., Abd El Hameed, O., Lasheen, A., Abd El Salam, Y., Morsi, A., Ismail, M., El-badawy, H., Amer, M. A., Elkelany, A., Elkelany, A., El-Hamouly, A., Attallah, N. A., Mosalum, O., Afandy, A., Mokhtar, A., Abouelnasr, A., Ayad, S., Shaker, R., Sakr, R., Shaker, R., Amreia, M., Elsobky, S., Mustafa, M., El Magd, A., Marey, A., Hafez, A., Zalabia, M. 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M., Mohammed, M., Mohamed, O., Habeeb, M., Worku, M., Starr, N., Desta, S., Wondimu, S., Abebe, N., Thomas, E., Asele, F., Dabessa, D., Abebe, N., Zerihun, A., Mentula, P., Leppaniemi, A., Sallinen, V., Scalabre, A., Frade, F., Irtan, S., Graffeille, V., Gaignard, E., Alimi, Q., Graffieille, V., Gaignard, E., Abbo, O., Mouttalib, S., Bouali, O., Hervieux, E., Aigrain, Y., Botto, N., Faure, A., Fievet, L., Panait, N., Eyssartier, E., Schmitt, F., Podevin, G., Parent, V., Martin, A., Arnaud, A., Muller, C., Bonnard, A., Peycelon, M., Abantanga, F., Boakye-Yiadom, K., Bukari, M., Owusu, F., Awuku-Asabre, J., Tabiri, S., Bray, L., Lytras, D., Psarianos, K., Bamicha, A., Kefalidi, E., Gemenetzis, G., Dervenis, C., Gouvas, N., Agalianos, C., Kontos, M., Kouraklis, G., Karousos, D., Germanos, S., Marinos, C., Anthoulakis, C., Nikoloudis, N., Mitroudis, N., Recinos, G., Estupinian, S., Forno, W., Arevalo Azmitia, J., Ramarez Cabrera, C., Guevara, R., Aguilera, M., Mendez, N., Azmitia Mendizabal, C., Ramazzini, P., Contreras Urquizu, M., Tale, F., Soley, R., Barrios, E., Marroquin Rodriguez, D., Perez Velasquez, C., Contreras Merida, S., Regalado, F., Lopez, M., Siguantay, M., Lam, F., Szeto, K., Szeto, C., Li, W., Li, K., Leung, M., Mak, T., Ng, S., Prasad, S. S., Kirishnan, A., Gyanchandani, N., Kumar, B., Rangarajan, M., Bhat, S., Sreedharan, A., Kinnera, S. 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A., Suleiman, S., Adeniyi, A., Adesanya, O., Adebanjo, A., Osuoji, R., Atobatele, K., Ogunyemi, A., Williams, O., Oludara, M., Oshodi, O., Ademuyiwa, A., Lawal, A., Alakaloko, F., Elebute, O., Osinowo, A., Bode, C., Adesuyi, A., Tade, A., Adekoya, A., Nwokoro, C., Ayandipo, O. O., Lawal, T., Ajao, A. E., Ali, S., Odeyemi, B., Olori, S., Popoola, A., Adeyeye, A., Adeniran, J., Lossius, W. 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  Abstract

  The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy.In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation.Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89·6 per cent) compared with that in countries with a middle (753 of 1242, 60·6 per cent; odds ratio (OR) 0·17, 95 per cent c.i. 0·14 to 0·21, P < 0·001) or low (363 of 860, 42·2 per cent; OR 0·08, 0·07 to 0·10, P < 0·001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -9·4 (95 per cent c.i. -11·9 to -6·9) per cent; P < 0·001), but the relationship was reversed in low-HDI countries (+12·1 (+7·0 to +17·3) per cent; P < 0·001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0·60, 0·50 to 0·73; P < 0·001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries.Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.

  View details for DOI 10.1002/bjs.11051

  View details for Web of Science ID 000455102200014

  View details for PubMedID 30620059

  View details for PubMedCentralID PMC6492154

• Evidence of insufficient quality of reporting in patent landscapes in the life sciences. Nature biotechnology Smith, J. A., Arshad, Z., Thomas, H., Carr, A. J., Brindley, D. A. 2017; 35 (3): 210-214

  View details for DOI 10.1038/nbt.3809

  View details for PubMedID 28267720