Avoidance of preferred beta-lactam therapy in patients who report allergy is associated with an increased risk of adverse events. Development of inpatient programs aimed at accurately identifying beta-lactam allergies to safely promote beta-lactam administration among these patients is warranted.

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.

ObjectivesLittle attention has been paid to the study of evidence-based practice (EBP) among nurses in Oman. Our aim was to explore knowledge, practice, and attitudes towards EBP among nurses working in Oman.MethodsThis multi-institutional cross-sectional study utilized the self-reported EBP Questionnaire with a random sample of 262 nurses working in three different health care settings in Al Dakhliyah governorate, Oman (local hospitals, primary health centers and polyclinics, and schools).ResultsA total of 202 nurses (response rate: 77.1%) completed the questionnaire. The mean age was 32.4±4.7 years. Most respondents were females (92.5%), Omani (79.1%), and holders of a diploma in nursing (73.5%) with a mean clinical experience of 10.9±4.2 years. Attitudes towards EBP showed the highest mean score of 5.5±1.2 followed by knowledge (4.9±0.8) and practice (4.7±1.2). Significant positive correlations were identified between the total years of nursing experience and knowledge (rs = 0.145, n = 198, p = 0.041), practice (rs = 0.172, n = 198, p = 0.015), and attitudes (rs = 0.158, n = 197, p = 0.026) mean scores. No significant difference in EBP scores was found among the three clinical settings.ConclusionAlthough attitudes towards EBP were positive, knowledge and implementation of EBP were low. This study serves as a baseline assessment for future evaluations and provides a basis for the implementation of strategies to promote EBP utilization among nurses in three different health care settings in Oman.

Introduction There has been a growing interest in addressing the surgical disease burden in low-and middle-income countries (LMICs). Assessing the current state of global surgery research activity is an important step in identifying gaps in knowledge and directing research efforts towards important unaddressed issues. The aim of this bibliometric analysis was to identify trends in the publication of global surgical research over the last 30 years. Methods Scopus Ò was searched for global surgical publications . Results were hand-screened, and data were collected for included articles. Bibliometric data were extracted from Scopus Ò and Journal Citation Reports. Country-level economic and population data were obtained from the World Bank. Descriptive statistics were used to summarise data and identify significant trends. Results A total of 1623 articles were identified. The volume of scientific production on global surgery increased from 14 publications in 1987 to 149 in 2017. Similarly, the number of articles published open access increased from four in 1987 to 68 in 2017. Observational studies accounted for 88.7% of the included studies. The three most common specialties were obstetrics and gynaecology 260 (16.0%), general surgery 256 (15.8%), and paediatric surgery 196 (12.1%). Over two times as many authors were affiliated to an LMIC institution than to a high-income country (HIC) institution (6628, 71.5% vs 2481, 28.5%, P \ 0.001). A total of 965 studies (59.5%) were conducted entirely by LMIC authors, and 534 (32.9%) by collaborations between HICs and LMICs. ConclusionThe quantity of research in global surgery has substantially increased over the past 30 years. Authors from LMICs seemed the most proactive in addressing the global surgical disease burden. Increasing the funding for interventional studies, and therefore the quality of evidence in surgery, has the potential for greater impact for patients in LMICs.