Contribution of hospitals and clinical services to global warming: protocol for a scoping review.

INTRODUCTION: Climate change is one of the greatest threats to public health today, placing considerable pressure on the healthcare sector. During patient care processes, hospital facilities contribute to greenhouse gas emissions through the use of greater resources and higher energy consumption. Consequently, there is growing interest among researchers, universities, organisations and governments to study the impact of the healthcare sector on the environment and to develop strategies to mitigate its effects. The aim of this scoping review is to determine the extent and nature of current literature on global warming from hospitals and clinical services, and ways in which they contribute to its effect. Planning and execution of future research are possible once those areas with existing gaps are identified. METHODS AND ANALYSIS: A broad literature search will be carried out to illustrate the ways in which hospitals and clinical services, processes and activities contribute to climate change. Our protocol was drafted using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. The final protocol was registered prospectively with the Open Science Framework. All identified studies indexed in Medline, Scopus and Embase will be examined. ETHICS AND DISSEMINATION: This project is literature-based research; therefore, it does not require ethical approval. The results will be presented to researchers as well as policymakers in this particular area, via conferences, webinars, podcasts and online events. A peer-reviewed publication will be submitted to specific journals of interest.

Medición del dolor durante el trabajo de parto: evaluación de la usabilidad de un nuevo dispositivo / Pain measurement during labor: usability evaluation of a new device

Objetivo: Evaluar la usabilidad de un dispositivo para medir el dolor durante el trabajo de parto a través de siete ítems: tamaño, textura, facilidad de uso, peso, resistencia, comodidad y seguridad. Método: Estudio descriptivo. Se solicitó a 60 pacientes usar el sensor manual durante el transcurso de seis contracciones uterinas (aproximadamente 10-20 minutos) y al día siguiente se aplicó una encuesta en la que las pacientes evaluaron la usabilidad del dispositivo en cuanto a textura, peso, resistencia, comodidad, facilidad de uso, tamaño del sensor, seguridad de uso, peso del sensor, resistencia y comodidad, mediante una escala de Likert de 1 a 7. La seguridad fue evaluada con una escala de 1 a 5. Resultados: Se realizaron gráficos de caja. Con respecto a la seguridad, un 86% de las usuarias marcaron 5 puntos en la escala, percibiendo el dispositivo como seguro. Conclusiones: El dispositivo fue percibido como seguro, liviano, fácil de usar y cómodo.

Objective: To evaluate the usability of a device to measure pain during labor through seven items: size, texture, ease of use, weight, resistance, comfort, and safety. Method: Longitudinal observational study. 60 patients were asked to use the manual sensor during the course of six uterine contractions (approximately 10-20 minutes) and the following day a survey was applied where the patients evaluated the usability of the device in terms of texture, weight, resistance, comfort, easiness of use, sensor size, safety of use, sensor weight, resistance and comfort through a Likert scale from 1 to 7. Safety was evaluated with a scale from 1 to 5. Results: They were schematized with a box plot. Regarding safety, 86% of the users scored 5 points on the scale, perceiving the device as safe. Conclusions: It can be seen that the device was perceived as safe, light, easy to use and comfortable.

Dolor crónico posoperatorio: Una revisión necesaria de un problema ignorado / Chronic post-surgical pain: A necessary review for a disregarded problem

INTRODUCTION: Postoperative chronic pain (PCP) is defined as a discomfort that lasts more than expected or beyond 3 months after surgery. The recognition and study of this clinical entity has been gaining interest in the past few years. One of the main reasons is the great impact it can have on the quality of life of patients who suffer from it. OBJECTIVE: To describe the prevalence, risk factor and impact of PCP on patients subjected to different surgical procedures. MATERIALS AND METHODS: Search on MED- LINE/Pubmed, using the following terms: "chronic postsurgical pain", "chronic post operative pain", "chronic post operative pain", "chronic post surgical pain". Publications were then sieved using their title and abstract. RESULTS: Fifty-seven articles were analyzed. Ten to fifty percent of patients were reported as suffering PCP, with up to 10% incidence of severe pain. The main risk factors identified were the use of analgesics, pre-operative pain and type of surgery. Orthopedic surgery was highly associated with moderate to severe PCP within the first year. Twenty-one percent of patients referred PCP affected their quality of life and sleep; ability to carry out physical activity and return to work. CONCLUSION: The first approach to PCP is getting to know its impact and epidemiology. Surgical treatments can cause PCP, which will affect patient recovery and increase costs. Recognizing those patients at risk and establishing preventive management protocols could improve the quality of life of postsurgical patients.

INTRODUCCIÓN: El dolor crónico posoperatorio (DCPO) es aquel que aparece tras un procedimiento quirúrgico y se mantiene por más tiempo de lo esperado o más de tres meses luego de la cirugía. Es una entidad de reciente estudio y que tiene un gran impacto en la calidad de vida de los pacientes postoperados. OBJETIVO: Describir la prevalencia, factores de riesgo y el impacto del DCPO en pacientes sometidos a diferentes procedimientos quirúrgicos. MATERIAL Y MÉTODO: Se realizó una revisión de la literatura utilizando la base de datos MEDLINE/Pubmed. Los términos libres fueron "chronic postsurgical pain", "chronic postoperative pain", "chronic post operative pain", "chronic post surgical pain". Se realizó un cribado según título y resumen. RESULTADOS: Fueron analizados 57 artículos. De 10%-50% de los pacientes presentan DCPO y hasta 10% puede ser severo. El uso de analgésicos, presencia de dolor preoperatorio y especialidad quirúrgica han sido señalados como los principales factores de riesgo. La cirugía traumatológica aparece como la más asociada a DCPO moderado y severo a un año. Hasta 21% de los pacientes refieren que afecta su calidad de vida, el sueño, actividad física y reincorporación laboral. CONCLUSIÓN: El conocimiento de la epidemiología e impacto del DCPO es un primer acercamiento a este problema. Patologías de resolución quirúrgica pueden evolucionar con DCPO, afectando su recuperación y aumentando los costos que se desea contener. El reconocimiento de la población de riesgo y la instauración de protocolos preventivos pudiera mejorar la calidad de vida de los pacientes postoperados.

Cauda equina syndrome following an uneventful spinal anesthesia in a patient undergoing drainage of the Bartholin abscess: A case report.

RATIONALE: Neuraxial anesthesia is a commonly used type of regional anesthesia. Cauda equina syndrome is an unusual and severe complication of neuraxial anesthesia, and is caused by damage to the sacral roots of the neural canal. We present a case of cauda equina syndrome following spinal anesthesia in a patient who underwent Bartholin abscess drainage. PATIENT CONCERNS: A 23-year old female scheduled to undergo surgical drainage of Bartholin abscess. Spinal anesthesia was performed with bupivacaine and fentanyl. There were no perioperative adverse events reported. On postoperative day 1, the patient went to the emergency department describing bilateral weakness and pain of the lower extremities (LE). DIAGNOSES: Lumbar magnetic resonance imaging showed increased gadolinium accumulation in the neural sheath at the level of the cauda equina tracts, consistent with the diagnosis of arachnoiditis and the diagnosis of cauda equina was established. INTERVENTIONS: The patient received the following emergent treatment: 75 mg pregabalin (oral) every 12 hours, 20 mg (8 drops) tramadol (oral) every 8 hours, and 4 mg dexamethasone (intravenous) every 6 hours. On postoperative day 4, the patient still experienced bilateral flaccid paraparesis (accentuated in the left side), neuropathic pain in low extremities, and left brachial monoparesis. Hence, dexamethasone was instantly replaced with 1 g methylprednisolone (intravenous) for 5 days. OUTCOMES: After completing 5 days of methylprednisolone, on postoperative day 9, the patient experienced less pain in left extremities, osteotendinous reflexes were slightly diminished, and she was able to walk with difficulty for 3 to 5 minutes. Greater mobility was evidenced, with right proximal and distal low extremities Medical Research Council Scale grades of 2 and 3 and left proximal and distal low extremities Medical Research Council Scale grades 1 and 2, respectively. Oral prednisone was restarted. Consequently, she was discharged home in stable conditions on postoperative day 25 with a prescription for sertraline, clonazepam, pregabalin, paracetamol, and prednisone. LESSON: The early detection and treatment of complications after neuraxial anesthesia is essential to minimize the risk of permanent damage.