Pooled analysis of who surgical safety checklist use and mortality after emergency laparotomy

Background: 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. Methods: 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. Results: 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 percent; 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. Conclusion: 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

Kajian Eksperimental Mekanisme Retak pada Balok Beton Bertulang

xvi,72 ha

2-Dimensional Failure-Free Warranty Policies - 2-Dimensional Point Process Models

A two-dimensional warranty policy is characterized by a region in a two-dimensional plane with the horizontal axis representing time and the vertical axis the usage. In this paper, we study two-dimensional failure-free warranty policies for nonrepairable items that require the manufacturer to replace all items which fail under warranty by new ones at no cost to the buyer. We derive expressions for the expected warranty cost per item sold and for the expected life cycle cost for four different warranty regions. We illustrate these by numerical examples and discuss some resulting implications for the consumer and the manufacturer

A repair-replace strategy based on usage rate for items sold with a two-dimensional warranty

When a repairable item fails under warranty. the manufacturer has the option of either repairing the failed item or replacing it with a new one. In this paper, a repair-replace strategy is discussed for the manufacturer of a product sold with a two-dimensional warranty. The strategy is based on a specified region of the warranty defined in terms of age and usage with the first failure in the region rectified by replacement and all other failures being minimally repaired. An accelerated failure time (AFT) model is Used to allow for the effect of usage rate on item degradatio

A Simulation Approach to Analysis of Free Replacement Policies

The cost analysis of one and two-dimensional free replacement policies involve renewal functions. This paper deals with the simulation approach to obtaining such renewal functions

Evaluasi Teknis penggunaan shotcrete studi kasus PT. Freeport IndonesiaTembagapura Papua

ABSTRAKEvaluasi Teknis penggunaan shotcrete studi kasus PT. Freeport IndonesiaTembagapura PapuaMalik000.09.07.2014Dr. Ir. Hanafi Ashad, MT, Dr. Ir. Iskandar BP.,M.Si.Pascasarjana Magister Sipil EngineeringUniversitas Muslim IndonesiaMakassarSistem penambangan bawah tanah mempunyai resiko yang sangat besar, salah satunya adalah masalah evaluasi teknis penggunaan shotcrete rekayasa secara permanen.Metode beton tembak (shotcrete) adalah suatu metode pengendalian mutu yang salah satu acuan untuk menggunakan campuran antara semen, air, pasir dan agregat dengan cara disemprotkan dengan menggunakan alat bantu. Pengendalian mutu yang dihasilkan oleh beton tembak (shotcrete) diharapkan mampu memberi mutu dan kualitas sesuai standar PT. Freeport Indonesia. Untuk itu perlu adanya kajian teknis untuk penggunaan shocrete pengendalian mutu mengetahui keberhasilan pengunaan beton tembak (shotcrete) di di PT Freeport Indonesia.PT. Freeport Indonesia mempunyai standar yaitu pengendalian mutu sesuai dengan JSA dan SOP waktu yang direncanakan. Demikianpun kekuatan akhir sebesar 30 MPa dalam waktu maksimal 28 hari harus melalui slum test uji bahan beton shotcrete yang diperoleh Semen: Air : Pasir : Kerikil 1: 0,615 : 1,178 : 2,372. Kondisi selama ini menunjukan bahwa ada beberapa penyimpangan yang terjadi sehingga nilai pengendalian mutu shotcrete tidak tercapai dengan optimum. Banyak ditemui juga kondisi shotcrete yang rusak setelah disemprot. Umumnya kondisi ini terjadi karena pengerjaan yang tidak sesuai prosedur yang telah ditetapkan baik itu untuk proses mixing-nya maupun cara penyemprotannnya. Sehingga pengawasan perlu dilakukan terhadap ke-dua hal di atas.Kata kunci pekerjaan shotcrete rekayasa beton permane

Ketahanan Beton Terahadap Asam Sulfat Dengan Bahan Tambah Silica Fume

xiv, 67 ha

Analisis Perbaikan Struktur dengan Metode Eksternal Prestress

viii, 60 ha