Implementation of Guidelines Limiting Postoperative Opioid Prescribing at a Children's Hospital.

OBJECTIVES: Variability in opioid-prescribing practices after common pediatric surgical procedures at our institution prompted the development of opioid-prescribing guidelines that provided suggested dose limitations for narcotics. The aims of this study were to improve opioid prescription practices through implementation of the developed guidelines and to assess compliance and identify barriers preventing guideline utilization. METHODS: We conducted a single-center cohort study of all children who underwent the most common outpatient general surgery procedures at our institution from August 1, 2018, to February 1, 2020. We created guidelines designed to limit opioid prescription doses based on data obtained from standardized postoperative telephone interviews. Three 6-month periods were evaluated: before guideline implementation, after guideline initiation, and after addressing barriers to guideline compliance. Targeted interventions to increase compliance included modification of electronic medical record defaults and provider educations. Differences in opioid weight-based doses prescribed, filled, and taken, as well as protocol adherence between the 3 timeframes were evaluated. RESULTS: A total of 1033 children underwent an outpatient procedure during the 1.5-year time frame. Phone call response rate was 72.22%. There was a significant sustained decrease in opioid doses prescribed ( P < 0.0001), prescriptions filled ( P = 0.009), and opioid doses taken ( P = 0.001) after implementation, without subsequent increase in reported pain on postoperative phone call ( P = 0.96). Protocol compliance significantly improved (62.39% versus 83.98%, P < 0.0001) after obstacles were addressed. CONCLUSIONS: Implementation of a protocol limiting opioid prescribing after frequently performed pediatric general surgery procedures reduced opioids prescribed and taken postoperatively. Interventions that addressed barriers to application led to increased protocol compliance and sustained decreases in opioids prescribed and taken without a deleterious effect on pain control.

Clinical and microbiological characterization of Salmonella spp. isolates from patients treated in a university hospital in South America between 2012-2021: a cohort study.

BACKGROUND: Salmonellosis is a major cause of morbidity and mortality and one of the most frequent etiologies of diarrhea in the world. Mortality due to Salmonellosis in Latin America still poorly understood, and there is a lack of studies that evaluate resistance and clinical manifestations. The aims of this study were to characterize patients infected with Salmonella spp. seen in a university hospital in Colombia between 2012 and 2021, to evaluate trends in antibiotic resistance and to determine the proportion of overall mortality and related factors. METHODS: Retrospective observational study. All patients with microbiological diagnosis of Salmonella spp. were included. The sociodemographic, clinical and microbiological characteristics were described, and the proportion of antibiotic resistant isolates per year was estimated. The prevalence of mortality according to age groups was calculated. Log binomial regression models were used to establish factors associated with mortality. RESULTS: Five hundred twenty-two patients were analyzed. Salmonellosis accounted for 0.01% of all medical consultations. The median age was 16 years old. The most common clinical presentation was gastroenteric syndrome (77.1%) and symptoms included diarrhea (79.1%), fever (66.7%), abdominal pain (39.6%) and vomiting (35.2%). Of the Salmonella spp. isolates, 78.2% were not classified, 19.1% corresponded to non-typhoidal Salmonella and 2.7% to Salmonella typhi. Mortality occurs in 4.02% of the patients and was higher in patients with hematologic malignancy (11.6%). When analyzing by age group, the proportion of deaths was 2.8% in patients aged 15 years or younger, while in those older than 15 years it was 5.4%. Factors associated to mortality where bacteremia (aPR = 3.41 CI95%: 1.08-10.76) and to require treatment in the ICU (aPR = 8.13 CI95%: 1.82-37.76). In the last 10 years there has been a steady increase in resistance rates to ciprofloxacin, ampicillin, ampicillin/sulbactam and ceftriaxone, reaching rates above 60% in recent years. CONCLUSIONS: Despite improved availability of antibiotics for the treatment of salmonellosis in the past decades, mortality due to salmonellosis continues occurring in children and adults, mainly in patients with hematological malignancies and bacteremia. Antibiotic resistance rates have increased significantly over the last 10 years. Public health strategies for the control of this disease should be strengthened, especially in vulnerable populations.

An Evaluation of Pediatric Gastrocutaneous Fistula Closure Through the Punch Excision of Epithelized Tract Procedure.

BACKGROUND: Persistent gastrocutaneous fistulae frequently complicate gastrostomy tube placement. A minimally invasive technique for tract closure employing balloon catheter retraction and punch excision of the epithelized tract (PEET) was recently reported. We hypothesized the PEET technique of closure would lead to decreased complications without an increased incidence of recurrence. METHODS: We conducted a single-center retrospective cohort study evaluating children who underwent gastrocutaneous fistula (GCF) closure 1/1/2018-12/31/2021, comparing patients who underwent the PEET procedure to those repaired with layered closure. Procedure duration and outcomes were additionally compared to the 2018-2019 National Surgical Quality Improvement Program (NSQIP) Participant Use File (PUF) database. RESULTS: Sixty-two children underwent operative GCF closure, including 25 with PEET and 37 traditional layered closure. Procedural time was significantly decreased employing PEET (14 vs 26 minutes, P < .0001), less than half the national median by the NSQIP PUF database of 292 GCF closures (14 vs 34.5 minutes, P < .0001). Those repaired with the PEET method experienced no episodes of recurrence, surgical site infection, readmission, reoperation, or mortality within 30 days of the procedure. Conversely, in traditional closure, there was a 24.3% complication rate, including 7 surgical site infections, 1 readmission, and 2 unplanned reoperations. National procedural complication rate by NSQIP PUF was 5.5%, with a 4.8% rate of surgical site infection, .3% reoperation incidence, and .3% mortality. DISCUSSION: Our study suggests GCF closure employing the PEET procedure is a safe, more efficient method of tract closure than the traditional layered closure technique.

In-vitro Chemopreventive Potential of a Chromone from Bomarea setacea (ALSTROEMERIACEAE) against Colorectal Cancer.

Chemoprevention with natural products may provide important alternatives in the search for new drugs to treat cancer. Thus, the ethanol extract of Bomarea setacea and its secondary metabolite (chromone) were evaluated in-vitro in SW480 and SW620 human adenocarcinoma colon cells to identify a possible effect on cell growth, antiproliferative and/or proapoptotic activity. The ethanol extract did not show growth inhibition of these cell lines 48 h after treatment; besides, it required higher concentration and time to have an antiproliferative effect. On the other hand, although the chromone was not as active as the reference drug (5-FU), it displayed a greater selectivity, being 156-fold more selective against SW480 cells (SI => 100) and 255-fold against SW620 cells (SI => 86,9). Additionally, the chromone caused an important arrest in G2/M (44.18%) with an important accumulation in subG0/G1 phase in SW620 cells, inducing loss in mitochondrial membrane potential and damage in the cell membrane of both cell lines, with activation of caspase 3, suggesting an apoptotic process independent of ROS production and p53 activation.

A multi-institutional review of endovenous thermal ablation of the saphenous vein finds male sex and use of anticoagulation are predictors of long-term failure.

BACKGROUND: To review long-term outcomes and saphenous vein (SV) occlusion rate after endovenous ablation (EVA) for symptomatic varicose veins. METHODS: A review of our EVA database (1998-2018) with at least 3-years of clinical and sonographic follow-up. The primary end point was SV closure rate. RESULTS: 542 limbs were evaluated. 358 limbs had radiofrequency and 323 limbs had laser ablations; 542 great saphenous veins (GSV), 106 small saphenous veins (SSV) and 33 anterior accessory saphenous veins (AASV) were treated. Follow-up was 5.6 ± 2.3 years; 508 (74.6%) veins were occluded, 53 (7.8%) partially occluded and 120 (17.6%) were patent. On multivariable Cox regression analysis, male sex (HR 1.6, 95% CI [0.46-018], p = 0.012) and use anticoagulation (HR 2.0, 95% CI [0.69-0.34], p = 0.044) were predictors of long-term failure. On Kaplan-Meier curve, we had an 86.3% occlusion rate. CONCLUSION: Our experience revealed a 5-year closure rate of 86.3%. Ablations have satisfactory occlusion rate.

Effects of overfeeding and high-fat diet on cardiosomatic parameters and cardiac structures in young and adult zebrafish.

Obesity is a complex global health problem because it is a risk factor for multiple chronic pathologies such as cardiovascular, endocrine, metabolic, and neoplastic diseases. It is considered a multicausal disease, and one of the determining factors is nutritional imbalances, which include high-fat diets. In this paper, we use the zebrafish model to assess the impact of overfeeding and a high-fat diet in somatic and cardiac parameters in young and adult zebrafish. The results show that fish receiving a high-fat diet showed greater weight gain compared to fish receiving a standard fat diet. Additionally, changes in the heart, including increases in size, a change in the triangular shape of the ventricle to a globular shape, and an increase in the thickness of the trabeculae of the spongy myocardium were observed. These changes could be indicators of cardiovascular overload. The results show that there is a direct relationship between the intake of a high-fat diet and obesity, which in turn can induce cardiac changes, supporting the hypothesis of the relationship between high-fat diets and cardiovascular risk factors. Given the genetic similarity between zebrafish and humans, these results could be extrapolated to human beings, and the findings similarly highlight the importance of incorporating a balanced diet from the early life stages to reduce the risk of cardiovascular disease.

Conocimientos médicos sobre enfermedades raras por parte de los profesionales de la salud / Medical knowledge on rare diseases of health professionals

Las enfermedades raras (ER) se caracterizan por ser de baja prevalencia, crónicas, causar invalidez y alta morbimortalidad y afectan a tres millones de personas en España. Un diagnóstico precoz y un tratamiento adecuado disminuyen los efectos de la enfermedad y mejoran la calidad de vida de los afectados y sus familias. Objetivo: Valorar el grado de conocimientos de los profesionales de atención primaria(AP) de la salud acerca de las ER. Diseño: Estudio descriptivo transversal. Aplicación de un cuestionario diseñado a propósito del estudio para evaluar conocimientos médicos. Emplazamiento: AP del sistema sanitario público. Participantes: 128 profesionales de la salud (32.7% hombres, 67.3% mujeres). Mediciones principales: A través de la aplicación del cuestionario se midieron los conocimientos teóricos y la autopercepción relacionados con formación e información recibida sobre ER, unidades de referencia, registros y dispositivos de actuación. Resultados: Alto desconocimiento en los aspectos analizados. Los niveles menos puntuados (escala Likert: 1 a 5) están relacionados con los dispositivos de actuación(media = 1.95), seguidos por formación e información recibida (media = 2.12), unidades y registros de ER (media = 2.20). Conclusiones: Es necesario implementar medidas que mejoren el conocimiento de los profesionales de AP sobre las ER, ello repercutirá en mejorar la calidad de la atención al paciente y su familia. Nuestro cuestionario aporta una herramienta útil y adecuada para valorar qué aspectos se han mejorado, cómo hay que priorizar las actuaciones y evaluar el impacto de acciones formativas y de capacitación en el ámbito de las ER...

El ser humano como una totalidad / The human being as a totality

A través de este artículo se quiere invitar a los trabajadores de la salud a desarrollar o buscar mediosDe atención que mejoren el cuidado en salud de los seres humanos. Si bien el personal de salud conocelas maneras para desarrollar estos medios, parece olvidarlos. Debido a lo anterior cada día aumentanlas quejas de los usuarios acerca de los servicios recibidos. Todos los esfuerzos que se hagan paraimplementar medidas que conlleven a la humanización tendrán sentido; por ello el énfasis enprofundizar en los mismos, dada las necesidades del individuo considerado como una totalidad.

Through this paper we invite all health workers to improve care and treat given to patients becausethere is a lot of variables unminded of on delivering health service. Although health personnel isacquainted with these variables, their behavior leaves them behind, and thus patients’ claims increaseday after day. All efforts must be deployed to customize the health service bringing in humanity senseand insight into people’s needs.

Proyecto CARMEN Colombia: resumen ejecutivo / Colombiaïs CARMEN project: executive abstract

Las Enfermedades Crónicas no Transmisibles constituyen una prioridad para la salud pública en el país, debido a su elevado impacto incluso en las etapas más productivas de la vida y a la enorme carga social y económica que representan para el país por la demanda de atención médica, ausentismo laboral, discapacidad y muerte que ocasionan. Al hacer un análisis cuidadoso de la situación de salud en Colombia, se observa claramente la necesidad de abordar desde una perspectiva más integral la problemática de las Enfermedades Crónicas no Transmisibles, e intervenir con un enfoque intersectorial, los diferentes factores de riesgo que están provocando enfermedades, discapacidad y pérdidas prematuras de vidas humanas, deben tenerse en cuenta que estas intervenciones solo son posibles si se logra la incorporación de todas las instancias responsables de crear desde sus diferentes ámbitos entornos socio-económicos, físicos y culturales que promuevan la salud. La intersectorialidad se convierte entonces en la base fundamental para desarrollar metodologías integrales, interdisciplinarias y comunitarias que facilitan el control y apoyan la disminución de estas enfermedades. El presente documento contiene el resumen del Protocolo Nacional de CARMEN Colombia. El cual se ha construído y revisado con la colaboración de diferentes instituciones, que han contribuído con sus aportes en la priorización de problemas y la identificación de estrategias y alternativas de intervención