22 research outputs found
Pedestrian traffic in Sofia
No full textIch bin Boris Yotsov. Ich komme aus Bulgarien. Der Titel meiner Diplomarbeit ist: "Fußgängerverkehr in Sofia". Ich habe die aktuelle Situation des Fußgängerverkehrs in Sofia bestimmt, das Problem des Fußgängerverkehrs definiert, einen Verbesserungsmassnahmenplan geschaffen, einen Vergleich zwischen Fußgängerverkehr in Sofia und in Wien gezogen. Die Arbeit setzt sich aus zwei großen Blöcken zusammen, einem theoretischen Teil und einer Untersuchung. Der theoretische Teil stellt allgemeine Parameter des Fußgängerverkehrs, auch einen Vergleich zwischen österreichischen und bulgarischen Richtlinien und Vorschriften dar. Die Untersuchung beschäftigt sich mit der Bestimmung der aktuellen Situation der Geh-Infrastruktur in Sofia und Definition des Problems. Ich bestimme auch hier die Geh-Geschwindigkeiten der Menschen in verschiedenen Abschnitten in Wien und Sofia. Im zweiten Teil der Untersuchung wird die Beobachtung durch eine Befragung ergänzt. Hier wird neben den theoretischen Kennziffern der Fußgänger ein hypothetisches Verhalten in unterschiedlichen Situationen abgefragt. Ich probierte auch den Verwalter und die Gemeindeverwaltung über bestehende Projekte zu befragen. Am Ende vorschlage ich eine neue Verkehrsstrategie für Fußgängerverkehr auch eine mögliche Vorgehensweise für eine weitere Attraktivierung des Fußgängerverkehrs im politische Niveau. Ich möchte alle Stadt-, Verkehrsplaner und Politiker inspirieren die Welt mit anderen Augen zu sehen. Sofia hat zentrale Funktion in Bulgarien. Die Population in Sofia vergrößert sich jedes Jahr mit beschleunigtem Tempo. Sofia bewirbt um "Europäische Stadt der Kultur" für Jahr 2019. Das braucht viele Verbesserungsmaßnahmen nicht nur in Kultur, sondern auch in Fußgängerinfrastruktur. Die gut geplante und gestaltete Infrastruktur ist ein Merkmal für Lebensqualität der Stadt. Die Hauptergebnisse sind von vielen Dokumenten, Linien und Vorschriften für Gestaltung und Projektierung, meiner Untersuchung, Befragungen der Fußgänger in Sofia zusammengefasst. Ich habe auch den Verkehrsmasterplan in Sofia - Fußgängerverkehr bekommnen. Die Untersuchung hat gezeigt, dass die mittlere Fußgängergeschwindigkeit in Wien um 0,12 m/s höher als jene in Sofia ist. Die Gruppe der Behinderten und die Gruppe der kleinen Kinder, alter Menschen in Wien haben eine höhere Geschwindigkeit als die in Sofia.Die Ursachen dafür sind: der bessere Zustand der Fußgängerinfrastruktur besonders die Gehsteigbelage, die frühere Uhrzeit der Messung der Geschwindigkeiten und auch die behindertenfreundliche Gestaltung des Fußgängernetzes in Wien. Die Wiener Frauen und Männer gehen mit 0,1 m/s schneller als jene in Sofia. Die Ursache ist vielleicht, dass der Freizeitverkehr in Sofia überwiegt. In der Befragung habe ich erfahrt, dass der Fußgänger nicht mit Ist - Zustand der Fußgängerinfrastruktur zufrieden ist, insbesondere mit mehreren Nachteilen, die auch in anderen Europäischen Städten vorhanden sind. Der Fußgänger fühlt sich unsicher und gefährdet durch das Auto. Ich habe fünf Abschnitte von Fußgängerinfrastruktur in Sofia untersucht. Ich habe die Probleme definiert. Für jeden Defekt habe ich genauere Vorschläge für seine Beseitigung geboten. Die Bewertung von Resultaten von der Untersuchung hat viele Probleme gezeigt, die mit schlechtem Zustand der Gehsteigbeläge, schmale Gehsteige, fehlende Querungshilfen und etc. verbunden sind.I am Boris Yotsov and I 'm from Bulgaria. The title of my master thesis is: "Pedestrian Traffic in Sofia." I determine the current situation of pedestrian traffic in Sofia, define the problem of pedestrian traffic, provide an improvement action plan, and make a comparison between pedestrian traffic in Sofia and Vienna. The master thesis consists of two major parts, a theoretical part and an investigation. The theoretical part represents general parameters of the pedestrian traffic, including a comparison between Austrian and Bulgarian policies and regulations. The investigation deals with the determination of the current situation of pedestrian infrastructure in Sofia and definition of the problem. Here I determine also the walking speed of people in various locations in Vienna and Sofia. In the second part of the study, the observation is performed by an inquiry. In addition to a hypothetical behavior, inquired in different situations, theoretical behavior of pedestrians will be considered. In addition, I try to have a meeting with people from the local and regional government to obtain information about existing projects for improvement of the pedestrian traffic in Sofia. Finally I suggest a new transport strategy for pedestrian traffic and possible procedures for making it more attractive in political level. My goal is all city traffic planners and politicians to be inspired and see the world with other eyes. Sofia has central role in Bulgaria. The population in Sofia is increased each year with an accelerated pace. Sofia is a candidate for "European City of Culture" for 2019. There is need of many improvements not only connected with culture, but also with pedestrian infrastructure. The well-planned and designed Infrastructure is a sign of quality of life. The main results are summarized from many documents, lines and prescriptions of design, my own analysis and surveys of foot passengers in Sofia. I have obtained the transport master plan of Sofia for pedestrian traffic. The investigation has shown that the average pedestrian speed in Vienna is higher with 0,12 m/s than in Sofia. The group of disabled people and the group of small children, old people in Vienna have shown a very higher speed than those in Sofia. The reasons are: the better condition of the pedestrian infrastructure, particularly the sidewalk coverings, the earlier time of the calculation of the velocities and also the disabled friendly design of the pedestrian network in Vienna. The Viennese women and men go with 0,1 m/s faster than those in Sofia. The reason is that a free time traffic predominates in Sofia. In the survey, I learned that the pedestrians are not satisfied with the current state of pedestrian infrastructure, especially with its multiple defects, which are also present in other European cities. The pedestrians feel insecure and threatened by cars. I have examined five sections of the pedestrian infrastructure in Sofia. I have defined the problems. For each defect I have considered detailed proposals for its removal. The evaluation of the results of the investigation has shown many problems, associated with poor condition of the sidewalk coverings, narrow sidewalks, lack of crossing facilities and etc
Complications in Transanal Total Mesorectal Excision (TATME) – Early Experience
No full textTransanal total mesorectal excision (TaTME) is a trending and promising surgical procedure to treat rectal cancer with oncologically oriented precision. Complication rates are promising after the learning curve is passed. A prospective study on the first 12 consecutive TaTME patients was done. The primary aim was the intraoperative and the early and late postoperative complications rate. Оne persisting failure as an intraoperative complication was reported: two anastomotic leaks and a ventral hernia as postoperative complications. TaTME is safe in terms of intra- and postoperative complications
Review on Anastomotic Leak Rate after ICG Angiography during Minimally Invasive Colorectal Surgery
No full textColorectal cancer is the 3rd most common type of cancer worldwide. The most devastating complication after colorectal surgery remains the anastomotic leak (AL). Many techniques have been developed to reduce its rate. One such new method is perfusion angiography using indocyanine green (ICG). A literary search in PUBMED on 1.03.2021 for full-text English articles published between 2014 and 2021 was performed. ICG, colorectal cancer, and angiography were the keywords we used. The review was performed following the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The literature search yielded 27 results when searching the database of PUBMED with the above keywords. Twenty-one out of 27 identified articles were included. Six were excluded from the analysis – four case reports, one review on the evolution of treating gastrointestinal cancers, and one containing no information on AL rate with ICG. One included article was RCT, sixteen were cohort studies, and four were meta-analyses or reviews. All articles reported a reduction in the anastomotic leak rate. However, the reduction was significant only in nine of them. Anastomotic leak is a severe complication and a subject of extensive research. Perfusion angiography with ICG is a step towards predicting and preventing AL, although it does not guarantee success in all cases
Towards safer colorectal surgery worldwide: Outcomes and benchmarks from the ESCP CORREA 2022 audit
No full textIntroduction: Benchmarking colorectal surgery outcomes informs quality improvement. The ESCP CORREA 2022 snapshot audit aimed to assess contemporary colorectal resection practices and short-term outcomes across European countries and beyond. Methods: An international prospective multicentre audit was conducted in which adults undergoing elective or emergency colorectal resection during a 6-week period (January-April 2022) at participating hospitals were included. Data on patient demographics, indications, surgical approach (open, laparoscopic or robotic) and 30-day postoperative outcomes (complications, reoperation and mortality) were collected for analysis. The outcomes were analysed and compared with those of previous audits to identify trends in colorectal surgery. Results: The study enrolled 3521 patients (56.8% men) from 216 hospitals across 53 countries. In 72.2% of the cases, the indication for resection was malignancy, followed by diverticular disease in 9.0%, Crohn's disease in 3.7% and ulcerative colitis in 2.3% of the cases. Of the surgeries, 74.4% were elective. Minimally invasive surgery was performed in 55.2% of the cases (48.7% laparoscopic and 6.5% robotic). Primary anastomosis was performed in 90.3% of the patients. The 30-day anastomotic leak rate was 7.96%; in malignant and benign diseases, the leak rates were 7.3% and 10.2%, respectively. The leak rates for right, left, anterior rectal resection, pouch and subtotal colectomy were 6.9%, 7.7%, 9.7%, 16.0% and 11.8%, respectively. In the multivariable analysis, the risk factors for leakage included male sex (9.3% vs. 6.3%, OR = 0.69, 95% CI 0.51-0.95, p = 0.023) and emergency surgery (11.4% vs. 7.1%, OR = 1.58, 95% CI 1.10-2.27, p = 0.013). Thirty-day mortality was 2.38%. Conclusions: This large international audit provides the status of the management of colorectal surgery. This shows that minimally invasive techniques are widely adopted, and 30-day mortality is low; however, anastomotic leak rates remain persistently high. These findings highlight the ongoing need for targeted research and quality-improvement initiatives to reduce anastomotic failure and improve outcomes of colorectal surgery
Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study
No full text© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: 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. Methods: 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. Findings: 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. Interpretation: 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. Funding: National Institute for Health and Care Research
Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries
No full text© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 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
Safety and efficacy of intraperitoneal drain placement after emergency colorectal surgery: An international, prospective cohort study
No full textSafety and efficacy of intraperitoneal drain placement after emergency colorectal surgery. An international, prospective cohort study
No full textIntraperitoneal drains are often placed during emergency colorectal surgery. However, there is a lack of evidence supporting their use. This study aimed to describe the efficacy and safety of intraperitoneal drain placement after emergency colorectal surgery. Method: COMPlicAted intra-abdominal collectionS after colorectal Surgery (COMPASS) is a prospective, international, cohort study into which consecutive adult patients undergoing emergency colorectal surgery were enrolled (from 3 February 2020 to 8 March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included rate and time-to-diagnosis of postoperative intraperitoneal collections, rate of surgical site infections (SSIs), time to discharge and 30-day major postoperative complications (Clavien-Dindo III-V). Multivariable logistic and Cox proportional hazards regressions were used to estimate the independent association of the outcomes with drain placement. Results: Some 725 patients (median age 68.0 years; 349 [48.1%] women) from 22 countries were included. The drain insertion rate was 53.7% (389 patients). Following multivariable adjustment, drains were not significantly associated with reduced rates (odds ratio [OR] = 1.56, 95% CI: 0.48-5.02, p = 0.457) or earlier detection (hazard ratio [HR] = 1.07, 95% CI: 0.61-1.90, p = 0.805) of collections. Drains were not significantly associated with worse major postoperative complications (OR = 1.26, 95% CI: 0.67-2.36, p = 0.478), delayed hospital discharge (HR = 1.11, 95% CI: 0.91-1.36, p = 0.303) or increased risk of SSIs (OR = 1.61, 95% CI: 0.87-2.99, p = 0.128). Conclusion: This is the first study investigating placement of intraperitoneal drains following emergency colorectal surgery. The safety and clinical benefit of drains remain uncertain. Equipoise exists for randomized trials to define the safety and efficacy of drains in emergency colorectal surgery
Intraperitoneal drain placement and outcomes after elective colorectal surgery: International matched, prospective, cohort study
No full textSafety and efficacy of intraperitoneal drain placement after emergency colorectal surgery: An international, prospective cohort study
No full textAim: Intraperitoneal drains are often placed during emergency colorectal surgery. However, there is a lack of evidence supporting their use. This study aimed to describe the efficacy and safety of intraperitoneal drain placement after emergency colorectal surgery. Method: COMPlicAted intra-abdominal collectionS after colorectal Surgery (COMPASS) is a prospective, international, cohort study into which consecutive adult patients undergoing emergency colorectal surgery were enrolled (from 3 February 2020 to 8 March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included rate and time-to-diagnosis of postoperative intraperitoneal collections, rate of surgical site infections (SSIs), time to discharge and 30-day major postoperative complications (Clavien–Dindo III–V). Multivariable logistic and Cox proportional hazards regressions were used to estimate the independent association of the outcomes with drain placement. Results: Some 725 patients (median age 68.0 years; 349 [48.1%] women) from 22 countries were included. The drain insertion rate was 53.7% (389 patients). Following multivariable adjustment, drains were not significantly associated with reduced rates (odds ratio [OR] = 1.56, 95% CI: 0.48–5.02, p = 0.457) or earlier detection (hazard ratio [HR] = 1.07, 95% CI: 0.61–1.90, p = 0.805) of collections. Drains were not significantly associated with worse major postoperative complications (OR = 1.26, 95% CI: 0.67–2.36, p = 0.478), delayed hospital discharge (HR = 1.11, 95% CI: 0.91–1.36, p = 0.303) or increased risk of SSIs (OR = 1.61, 95% CI: 0.87–2.99, p = 0.128). Conclusion: This is the first study investigating placement of intraperitoneal drains following emergency colorectal surgery. The safety and clinical benefit of drains remain uncertain. Equipoise exists for randomized trials to define the safety and efficacy of drains in emergency colorectal surgery
