Summary Background 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. Methods 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 . Findings 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. Interpretation 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. Funding National Institute for Health Research Global Health Research Unit.

Background: Chronic kidney disease (CKD) is one of the main public health issues. It increases the morbidity and mortality of patients. Treatment includes multiple aspects such as dialysis and lifestyle modifications. The primary goal of this study was to determine factors associated with self-efficacy and health-related quality of life (HRQoL) among haemodialysis (HD) patients. Methods: A cross-sectional descriptive correlation study was conducted on CKD patients undergoing HD at 12 different dialysis centres in Palestine. Self-efficacy was assessed by the Self-Efficacy for Managing Chronic Disease Six-Item Scale (SEMCD-6), and HRQoL was assessed using the Five-level EuroQol Five-Dimensions (EQ-5D-5L) tool. Multiple linear regression analysis was carried out to assess the association of factors with each of the SEMCD-6 and HRQoL scale scores. Results: A total of 283 HD patients were included in the study. A correlation test revealed moderately positive association between the EQ-5D and SEMCD-6 scores (r = 0.497, p value < 0.001). In multiple linear regression analysis, age, living status, and number of co-morbid diseases were negatively associated with SEMCD-6 scores (β = − 2.66, p = 0.016; β = − 5.71, p = 0.033; β = − 1.84, p = 0.006, respectively). Furthermore, there is a positive association between educational level and SEMCD-6 score with QoL score (β = 0.05, p = 0.017; β = 0.01, p < 0.001, respectively), while there is a negative association between the number of co-morbid diseases and QoL score (β = − 0.07, p = 0.001).Conclusions: This study assessed factors associated with impaired self-efficacy and HRQoL in HD patients. The results show that impaired self-efficacy was associated with the elderly, patients living with family, and patients with a high number of co-morbid diseases. Furthermore, this study found that the worst HRQoL was associated with patients with a low education level, lower levels of self-efficacy, and a high number of co-morbid diseases.

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Background Self-efficacy is a widely applied psychosocial concept that is commonly used in association with management of chronic diseases, including hypertension. The aim of this study was to assess self-efficacy of hypertension management and patient-physician communication, as well as the factors associated with self-efficacy and patient-physician communication among patients with hypertension in Palestine. Methods We conducted face-to-face, questionnaire-based interviews using validated instruments to assess self-efficacy in managing hypertension (Self-Efficacy for Managing Chronic Disease 6-Item Scale (SES6C)) and patient-physician communication (Perceived Efficacy in Patient-Physician Interaction Questionnaire (PEPPI)) in patients with hypertension at the three main primary healthcare centers in Nablus district in northern West Bank, Palestine. We also performed a multiple linear regression analysis to determine the variables independently associated with PEPPI and SES6C scores. Results We enrolled 377 participants with hypertension in this study. The average age (measured in years) was 56.8 with a standard deviation of 11.6. The mean PEPPI and SES6C scores were 20.0 (SD 4.4) and 41.1 (SD 10.6), respectively. In a multiple linear regression model, subjects who were city dwellers (B=3.597, p=0.004), and subjects with high education levels (B=4.010, p=0.001) achieved higher PEPPI scores, whereas subjects in the normal weight category (B=5.566, p<0.001) and those with higher PEPPI scores (B=0.706, p<0.001) achieved higher SES6C scores. Conclusions We found that impairment in self-efficacy was linked to overweight and obesity, as well as lower patient-physician communication. Moreover, our results showed that lower patient-physician communication was independently associated with low education level as well as non-city residency types. We recommend making the appropriate changes by both the policy-makers and the health care providers to improve the health facilities and its services, especially outside the cities. We also suggest holding specific counseling and training session on the management and control of hypertension.

Background: To compare anatomical hepatic resection (AHR) to wedge resection (WR) for gallbladder cancer. Methods: Hepatic resections for GBCA at 13 medical centers (2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017) were included. WR was defined as non-anatomical resection of 2-3 cm of the gallbladder fossa. AHR was defined as identifying and dividing the vasculobiliary pedicle for hepatic segments 4b and 5. Overall postoperative morbidity (OM), 90-day major (Clavien !3) morbidity (MM), mortality, and hospital length of stay (LOS) were compared using bivariate and multivariate analysis. Results: In 753 patients with GBCA, 341 (45%) underwent cholecystectomy only and 112 (15%) underwent hepatic resection. Four resection cases were excluded, because they involved extended right hepatectomy. Of the remaining 108 cases, 25 (23%) underwent AHR. OM, MM and mortality were 44%, 25% and 1.8% respectively. Patients undergoing AHR were more likely to have hepaticojejunostomy (28% vs. 6%, p < 0.001) and open surgery (76% vs. 53%, p = 0.041). There was an association of AHR with OM (60% vs. 40%, p = 0.082), but this difference was not statistically significant. There was no difference in mortality (4% vs. 1.2%, p = 0.363), MM (32% vs. 24%, p = 0.429), organ/ space infection (24% vs. 19%, p = 0.587), bile leak (12% vs. 10%, p = 0.869), and LOS (7.8 AE 4.7 vs. 6.7 AE 4.7 days, p = 0.307) between groups. Patients undergoing AHR and WR had comparable 5-year overall survival (43% vs. 46%, p = 0.113), disease-free survival (44% vs. 54%, p = 0.510) and disease-specific survival (59% vs. 51%, p = 0.657). Conclusion: AHR for GBCA is associated with more complex hepatic resection than WR without improved long-term oncologic outcomes. Further studies with larger sample size are needed to confirm these findings.