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OBJECTIVEComplications occur in diabetes despite rigorous efforts to control risk factors. Since 2000, the National Development Programme for the Prevention and Care of Diabetes has worked to halve the incidence of amputations in 10 years. Here we evaluate the impact of the efforts undertaken by analyzing the major amputations done in 1997–2007.RESEARCH DESIGN AND METHODSAll individuals with diabetes (n = 396,317) were identified from comprehensive national databases. Data on the first major amputations (n = 9,481) performed for diabetic and nondiabetic individuals were obtained from the National Hospital Discharge Register.RESULTSThe relative risk for the first major amputation was 7.4 (95% CI 7.2–7.7) among the diabetic versus the nondiabetic population. The standardized incidence of the first major amputation decreased among the diabetic and nondiabetic populations (48.8 and 25.2% relative risk reduction, respectively) over 11 years, and the time from the registration of diabetes to the first major amputation was significantly longer, on average 1.2 years more. The cumulative five-year postamputation mortality among diabetic individuals was 78.7%.CONCLUSIONSIn our nationwide diabetes database, the duration from the registration of diabetes to the first major amputation increased, and the incidence of major amputations decreased almost 50% in 11 years. Approximately half of this change was due to the increasing size of the diabetic population. The risk for major amputation is more than sevenfold that among the nondiabetic population. These results pose a continuous challenge to improve diabetes care.

The checklist increased OR teams' awareness of patient-related issues, the procedure and expected risks. It also enhanced team communication and prevented communication failures. Our findings support use of the WHO checklist in various surgical fields.

Objectives: The World Health Organisation has developed a Surgical Safety Checklist to improve patient safety during surgery. This checklist has reduced postoperative morbidity and mortality. Prior to checklist implementation, we wanted to evaluate how it would fit into the process of otorhinolaryngology-head and neck surgery and whether it would have an impact on the awareness of safety-related issues. Design: A structured questionnaire was addressed to the operating room team after consecutive operations during a 1-month period before and after checklist implementation. Setting and participants: This study was conducted at the Department of Otorhinolaryngology at the Helsinki University Central Hospital as a part of a multicentre study. Responses were received regarding 288 operations before and 412 after checklist implementation. Main outcome measures: The questions concerned patient-related safety checks, teamwork and communication.Results: The checklist improved verification of the patient's identity (P < 0.001). Awareness of the patient's medical history, medication and allergies increased (P < 0.001). Knowledge of the names and roles among the team members improved. The otolaryngologists and anaesthesiologists discussed possible critical events more often (P < 0.001), and postoperative instructions were better recorded after use of the checklist. In addition, the checklist enhanced communication between operation team members. Conclusions: Our study confirms that the Surgical Safety Checklist fits well into the surgical working process in otorhinolaryngology-head and neck surgery improving the sharing of patient-related medical information between team members. Development of a specific checklist for otolaryngology calls for further study.Adverse events in surgery often result from simple human error. All types of surgeries including otolaryngology are prone to complications related to the wrong side ⁄ wrong site, wrong procedure and wrong patient (WSPE). These complications are often preventable by reducing risk for serious mistakes. 1-5The World Health Organisation (WHO) has developed a Surgical Safety Checklist to improve patient safety in the operating room. In an international multicentre study, this checklist was associated with significant reductions in complications and deaths regardless of the healthcare system or the economical setting. 6 Few studies concern implementation of this checklist in various surgical surroundings, which has diminished complications in urgent surgery by more than a third. 7 In paediatric surgery, it has improved teamwork and communication. 8 Similarly, in a study on trauma and orthopaedic patients, team communication improved, but no significant reduction in early complication emerged.The idea of the checklist is to be an add-on security tool for the defined safety standards. This checklist should be customised, some suggest, to meet the needs of quite different surgical specialities and institutions. 8,9 Thus far, authors have failed to find published data on checklist...

Background and Aims: the World health organization's surgical safety checklist is designed to improve adherence to operating room safety standards, and its use has been shown to reduce complications among surgical patients. the objective of our study was to assess the impact of the implementation of the checklist on safety-related issues in the operating room and on postoperative adverse events in neurosurgery.Material and Methods: from structured questionnaires delivered to operating room personnel, answers were analyzed to evaluate communication and safety-related issues during 89 and 73 neurosurgical operations before and after the checklist implementation, respectively. from the analyzed operations, 83 and 67 patients, respectively, were included in a retrospective analysis of electronic patient records to compare the length of hospital stay, reported adverse events, and readmissions. in addition, the consistency of operating room documentation and patient records was assessed.Results and Conclusions: communication between the surgeon and the anesthesiologist was enhanced, and safety-related issues were better covered when the checklist was used. unplanned readmissions fell from 25% to 10% after the checklist implementation (p = 0.02). Wound complications decreased from 19% to 8% (p = 0.04). the consistency of documentation of the diagnosis and the procedure improved. the use of the checklist improved safety-related performance and, contemporarily, reduced numbers of wound complications, and readmissions were observed.

Our results in the first non-human primate model of GVD showed that treatment with sirolimus not only halted the progression of preexisting GVD but also was associated with partial regression. Sirolimus trough blood levels were correlated with efficacy. Therefore, sirolimus has the potential to control clinical chronic allograft rejection.

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ObjectiveLow socioeconomic position is a known health risk. Our study aims to evaluate the association between socioeconomic position (SEP) and lower limb amputations among persons with diabetes mellitus.DesignPopulation-based register study.SettingFinland, nationwide individual-level data.ParticipantsAll persons in Finland with any record of diabetes in the national health and population registers from 1991 to 2007 (FinDM II database).MethodsThree outcome indicators were measured: the incidence of first major amputation, the ratio of first minor/major amputations and the 2-year survival with preserved leg after the first minor amputation. SEP was measured using income fifths. The data were analysed using Poisson and Cox regression as well as age-standardised ratios.ResultsThe risk ratio of the first major amputation in the lowest SEP group was 2.16 (95% CI 1.95 to 2.38) times higher than the risk in the highest SEP group (p<0.001). The incidence of first major amputation decreased by more than 50% in all SEP groups from 1993 to 2007, but there was a stronger relative decrease in the highest compared with the lowest SEP group (p=0.0053). Likewise, a clear gradient was detected in the ratio of first minor/major amputations: the higher the SEP group, the higher the ratio. After the first minor amputation, the 2-year and 10-year amputation-free survival rates were 55.8% and 9.3% in the lowest and 78.9% and 32.3% in the highest SEP group, respectively.ConclusionsAccording to all indicators used, lower SEP was associated with worse outcomes in the population with diabetes. Greater attention should be paid to prevention of diabetes complications, adherence to treatment guidelines and access to the established pathways for early expert assessment when diabetic complications arise, with a special attention to patients from lower SEP groups.