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1.
Arq. ciências saúde UNIPAR ; 27(2): 611-624, Maio-Ago. 2023.
Article in Portuguese | LILACS | ID: biblio-1419225

ABSTRACT

INTRODUÇÃO: A imobilização prolongada acarreta prejuízos sistêmicos que repercute diretamente em maiores agravos aos pacientes, dentre eles se encontra a redução da VFC, indicativo de maior morbimortalidade clínica. OBJETIVO: Analisar se o tempo de internação hospitalar influencia a modulação autonômica da frequência cardíaca em pacientes pediátricos. METODOLOGIA: Estudo longitudinal, quantitativo e prospectivo, realizado em uma enfermaria pediátrica. A amostra foi de pacientes entre 4 a 11 anos, ambos gêneros, internados dentro das primeiras 48 horas. A coleta iniciou após a assinatura do TCLE pelo responsável, seguida do colhimento dos dados pessoais e clínicos dos pacientes seguida da coleta da VFC, repetida no último dia de internação. A captação da VFC foi realizada pelo monitor Polar RS800CX. Os dados foram transferidos e passados por uma análise matemática no programa Kubios HRV2.2. Por fim, os dados foram tabulados e analisados pelo Microsoft Excel 2013 e software BioEstat® 5.3 respectivamente. RESULTADOS: Os valores lineares no domínio do tempo obtiveram média pré (IRR=644,7 com P=0,42; RMSSD= 46,1 com P=0,017 e SDNN=43,5 com P=0,017) e pós (IRR=656,3; RMSSD=34,8; SDNN=35,38) e no domínio da frequência média pré (LF=41,9 com P=0,013; HF=58,0 com P=0,013; LF/HF=1,03 com P=0,04) e pós (LF=52,2; HF=47,7; LF/HF=3,56). A correlação de Pearson na análise tanto de RMSSD pós x tempo de internação, quanto SDNN pós x tempo de internação demonstraram R=0,55 e R=0,59 respectivamente. CONCLUSÃO: Foi observado que o tempo de internação exerce influência negativa sobre a modulação autonômica da frequência cardíaca em pacientes pediátricos.


INTRODUCTION: Prolonged immobilization causes systemic damage that has a direct impact on greater harm to patients, among which is the reduction in HRV, indicative of greater clinical morbidity and mortality. OBJECTIVE: To analyze whether the length of hospital stay influences the autonomic modulation of heart rate in pediatric patients. METHODOLOGY: Longitudinal, quantitative and prospective study, carried out in a pediatric ward. The sample consisted of patients between 4 and 11 years old, both genders, hospitalized within the first 48 hours. The collection began after the signature of the TCLE by the guardian, followed by the collection of the patients' personal and clinical data, followed by the HRV collection, repeated on the last day of hospitalization. HRV capture was performed by the Polar RS800CX monitor. The data were transferred and passed through a mathematical analysis in the Kubios HRV2.2 program. Finally, data were tabulated and analyzed using Microsoft Excel 2013 and BioEstat® 5.3 software, respectively. RESULTS: Linear values in the time domain obtained mean pre (IRR=644.7 with P=0.42; RMSSD=46.1 with P=0.017 and SDNN=43.5 with P=0.017) and post (IRR=656.3; RMSSD=34.8; SDNN=35.38) and in the pre mean frequency domain (LF=41.9 with P=0.013; HF=58.0 with P=0.013; LF/HF=1,03 with P=0.04) and powders (LF=52.2; HF=47.7; LF/HF=3.56). Pearson's correlation in the analysis of both the RMSSD post x length of stay and the SDNN post x length of stay showed R=0.55 and R=0.59 respectively. CONCLUSION: It was observed that the length of stay has a negative influence on the autonomic modulation of heart rate in pediatric patients.


INTRODUCCIÓN: La inmovilización prolongada provoca daños sistémicos que repercuten directamente en un mayor perjuicio para los pacientes, entre los que se encuentra la disminución de la VFC, indicativa de una mayor morbimortalidad clínica. OBJETIVO: Analizar si la duración de la estancia hospitalaria influye en la modulación autonómica de la frecuencia cardiaca en pacientes pediátricos. METODOLOGÍA: Estudio longitudinal, cuantitativo y prospectivo, realizado en una planta de pediatría. La muestra consistió en pacientes entre 4 y 11 años, de ambos sexos, hospitalizados dentro de las primeras 48 horas. La recogida se inició tras la firma del TCLE por el tutor, seguida de la recogida de los datos personales y clínicos de los pacientes, seguida de la recogida de la VFC, repetida el último día de hospitalización. La captura de la VFC se realizó con el monitor Polar RS800CX. Los datos se transfirieron y pasaron por un análisis matemático en el programa Kubios HRV2.2. Finalmente, los datos fueron tabulados y analizados utilizando Microsoft Excel 2013 y el software BioEstat® 5.3, respectivamente. RESULTADOS: Se obtuvieron valores lineales en el dominio temporal medios pre (TIR=644,7 con P=0,42; RMSSD=46,1 con P=0,017 y SDNN=43,5 con P=0,017) y post (TIR=656,3; RMSSD=34. 8; SDNN=35,38) y en el dominio de la frecuencia media pre (LF=41,9 con P=0,013; HF=58,0 con P=0,013; LF/HF=1,03 con P=0,04) y polvos (LF=52,2; HF=47,7; LF/HF=3,56). La correlación de Pearson en el análisis tanto de la RMSSD post x duración de la estancia como de la SDNN post x duración de la estancia mostró R=0,55 y R=0,59 respectivamente. CONCLUSIÓN: Se observó que la duración de la estancia influye negativamente en la modulación autonómica de la frecuencia cardíaca en pacientes pediátricos.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Pediatrics , Hospitalization , Autonomic Nervous System , Child , Prospective Studies , Hospitals , Length of Stay
2.
RFO UPF ; 28(1): 104-114, 20230808. graf, tab
Article in Portuguese | LILACS, BBO | ID: biblio-1509417

ABSTRACT

Objetivo: avaliar se a condição bucal favoreceu a presença de desfechos adversos da gestação (DAG) em mulheres internadas e acompanhadas em um hospital escola. Métodos: um estudo de coorte retrospectiva com mulheres grávidas que foram internadas entre setembro de 2019 e início de março de 2020 e que continuaram o acompanhamento obstétrico. Resultados: Das 65 gestantes que seguiram acompanhamento, 27 (41,5%) dos bebês nasceram pré-termo e 20 (30,8%) com baixo peso, sendo que as duas condições estavam presentes em 15 crianças (23,1%), sendo significantemente relacionadas com a menor semana gestacional na internação. Ao relacionar diferentes fatores com o desfecho pré-termo, houve diferença significante em gestantes com a ocupação "do lar" e com o tempo de internação igual ou maior que 10 dias e com a presença de baixo peso ao nascer. Não foi observada relação dos dados avaliados da condição bucal das gestantes na internação com o parto pré-termo. Conclusões: Gestantes que necessitam de internação hospitalar durante a gravidez, independente da condição bucal, aumentam a possibilidade de apresentarem DAG, sendo fundamental a realização do correto acompanhamento pré-natal.(AU)


Objective: to assess whether the oral condition favored the presence of adverse effects during pregnancy in pregnant women hospitalized and followed up at a teaching hospital. Methods: a retrospective cohort study with mothers who were hospitalized during pregnancy between September 2019 and early March 2020 and who continued obstetric follow-up. Results: 83 pregnant women were interviewed and 65 were followed up Of the 65 pregnant women who followed up, 27 (41.5%) of the babies were born preterm and 20 (30.8%) with low birth weight, and both conditions were present in 15 children (23.1%), being significantly related to the shortest gestational week at admission. When relating different factors with the preterm outcome, there was a significant difference in pregnant women with the occupation "housewife" and with the length of hospital stay equal to or greater than 10 days and with the presence of low birth weight. There was no relationship between the evaluated data on the oral condition of pregnant women during hospitalization and preterm delivery. Conclusions: Pregnant women who require hospitalization during pregnancy, regardless of oral condition, increase the possibility of having negative pregnancy outcomes, and correct prenatal care is essential. (AU)


Subject(s)
Humans , Male , Female , Pregnancy , Infant, Newborn , Adult , Pregnancy Complications/epidemiology , Pregnancy Outcome , Oral Health/statistics & numerical data , Brazil/epidemiology , Infant, Low Birth Weight , Retrospective Studies , Risk Factors , Follow-Up Studies , Gestational Age , Length of Stay
3.
RFO UPF ; 27(1): 118-133, 08 ago. 2023. tab
Article in Portuguese | LILACS, BBO | ID: biblio-1509389

ABSTRACT

Objetivo: Avaliar se a hospitalização na gestação pode influenciar na condição bucal do filho no terceiro ano de vida. Métodos: Estudo longitudinal com bebês de gestantes internadas e acompanhadas no setor da Obstetrícia de um Hospital Escola em Pelotas, RS, Brasil. Os dados referentes a hospitalização e ao parto foram coletados do prontuário hospitalar e no terceiro de vida do filho (a) de um questionário aplicado a mãe e do exame bucal da criança. Cada agravo bucal foi avaliado com critérios específicos, por uma examinadora calibrada e analisado no programa IBM SPSS Statistics com 5% de nível de significância. Resultados: Participaram 20 díades mãe-filho (a). Alterações da oclusão acometeram 95% das crianças, sendo a mordida aberta anterior (MAA) a principal. Ainda, 25% das crianças apresentaram opacidades demarcas e/ou hipoplasia do esmalte, sendo significativamente maior em filhos de mães mais jovens e 20% tinham cárie da primeira infância (CPI), estando relacionada à ausência de creme dental fluoretado e à qualidade da higiene bucal. Conclusão: O reflexo mais evidente da hospitalização na gestação na saúde bucal no terceiro ano de vida do filho (a) foi a oclusão alterada, especialmente a MAA.(AU)


Objective: To assess whether hospitalization during pregnancy can influence the child's oral condition in the third year of life. Methods: Longitudinal study with babies of pregnant women hospitalized and followed up in the Obstetrics sector of a Teaching Hospital in Pelotas, RS, Brazil. Data referring to hospitalization and childbirth were collected from the hospital records and in the child's third of life through a questionnaire applied to the mother and the child's oral examination. Each oral condition was evaluated with specific criteria, by a calibrated examiner and analyzed in the IBM SPSS Statistics program with a 5% minimum significance level. Results: 20 mother-child participated. Occlusion alterations affected 95% of the children, with anterior open bite (AOB) being the main. Still, 25% of the children had opacities and/or enamel hypoplasia, which was significantly higher in children of younger mothers, and 20% had early childhood caries, which is related to the absence of fluoride toothpaste and the quality of oral hygiene. Conclusion: The clearest reflection of hospitalization during pregnancy on oral health in the third year of the child's life was altered occlusion, especially the AOB.(AU)


Subject(s)
Humans , Male , Female , Pregnancy , Child, Preschool , Adult , Stomatognathic Diseases/epidemiology , Oral Health/statistics & numerical data , Length of Stay/statistics & numerical data , Oral Hygiene , Brazil/epidemiology , Infant, Low Birth Weight , Stomatognathic Diseases/etiology , Surveys and Questionnaires , Retrospective Studies , Longitudinal Studies , Gestational Age , Diagnosis, Oral
4.
J. coloproctol. (Rio J., Impr.) ; 43(3): 235-242, July-sept. 2023. tab, ilus
Article in English | LILACS | ID: biblio-1521151

ABSTRACT

Introduction: The introduction of Enhanced Recovery After Surgery led to increasing twenty-four hours discharge pathways, for example in laparoscopic cholecystectomy and bariatric surgery. However, implementation in colorectal surgery still must set off. This systematic review assesses safety and feasibility of twenty-four hours discharge in colorectal surgery in terms of readmission and complications in current literature. Secondary outcome was identification of factors associated with success of twenty-four hours discharge. Methods: Pubmed and EMBASE databases were searched to identify studies investigating twenty-four hours discharge in colorectal surgery, without restriction of study type. Search strategy included keywords relating to ambulatory management and colorectal surgery. Studies were scored according to MINORS score. Results: Thirteen studies were included in this systematic review, consisting of six prospective and seven retrospective studies. Number of participants of the included prospective studies ranged from 5 to 157. Median success of discharge was 96% in the twenty-four hours discharge group. All prospective studies showed similar readmission and complication rates between twenty-four hours discharge and conventional postoperative management. Factors associated with success of twenty-four hours discharge were low ASA classification, younger age, minimally invasive approach, and relatively shorter operation time. Conclusions: Twenty-four hours discharge in colorectal surgery seems feasible and safe, based on retro- and prospective studies. Careful selection of patients and establishment of a clear and adequate protocol are key items to assure safety and feasibility. Results should be interpreted with caution, due to heterogeneity. To confirm results, an adequately powered prospective randomized study is needed. (AU)


Subject(s)
Patient Discharge , Colorectal Neoplasms/surgery , Length of Stay , Postoperative Complications , Postoperative Period
5.
J. coloproctol. (Rio J., Impr.) ; 43(2): 99-103, Apr.-June 2023. tab, ilus, graf
Article in English | LILACS | ID: biblio-1514436

ABSTRACT

Objective: In the present study, we aimed to examine the treatments and their outcomes in cases with colon injuries after blunt and penetrating abdominal traumas. Materials and Methods: Twenty-six patients who underwent a laparotomy and were found to have a colon injury due to blunt abdominal trauma, penetrating stab injury, gunshot injury, and traffic accident were included. All patients were admitted into the emergency outpatient clinic of Gazi Yasargil Training and Research Hospital General Surgery Clinic between 2016 and 2020. The records of the cases were analyzed retrospectively. Results: Colon injuries were detected in 26 cases. All 26 (100%) cases were males with an average age of 29.80 ± 11.4 (range: 17-60) years old. Colon injuries observed during emergency operations included 18 (69.23%) patients with a GSI (gunshot injuries), 3 (11.53%) with penetrating stab injuries, 4 (15.38%) who were a part of traffic accidents and 1 (3.85%) patient with a blunt abdominal trauma. A primary colon repair was performed in 10 patients. Five patients underwent a colon resection and there were end colostomies. Four patients underwent a loop ileostomy after a colon resection and anastomosis. Colon resections with anastomoses were performed in seven patients. The mean hospitalization period was 26 ± 29.28 days. Conclusion: Patients should be classified intraoperatively with findings, such as peritoneal contamination, degree of colon injury, duration of the injury, and any accompanying injuries. (AU)


Subject(s)
Humans , Male , Adolescent , Adult , Middle Aged , Treatment Outcome , Abdominal Injuries/surgery , Postoperative Complications , Operative Time , Length of Stay
6.
Rev. bras. ortop ; 58(3): 435-442, May-June 2023. tab
Article in English | LILACS | ID: biblio-1449825

ABSTRACT

Abstract Objective To assess the risk factors involving longer hospital stays and early postoperative complications (first 30 days after surgery) in patients undergoing total knee arthroplasty (TKA). Materials and Methods Across-sectional study was conducted with collection of data of patients who underwent TKA in a private hospital between 2015 and 2019. The following data were collected: age, gender, body mass index, and clinical comorbid-ities. We also collected intraoperative data such as the grade on the classification of the American Society of Anesthesiologists (ASA), the duration of the surgery, the length of stay, the postoperative complications, and readmission within 30 days. Statistical models were used to investigate the possible risk factors associated with longer hospital stays and postoperative complications. Results There was evidence of an increase in the length of hospital stay in older patients, with higher grades on the ASA classification or who suffered postoperative complications. For each increase in 1 year of age, we expect the length of stay to be multiplied by 1.008 (95% confidence interval [95%CI]: 1.004 to 1.012; p < 0,001). In patients who were ASA grade III, the time is expected to be multiplied by 1.297 (95%CI: 1.083 to 1.554; p = 0,005) when compared with grade-I patients. In patients who suffered postoperative complications, the time is expected to be multiplied by 1.505 (95%CI: 1.332 to 1.700; p < 0.001) compared with patients without complications. Conclusion The present study demonstrated that, in patients who underwent primary TKA, preoperative characteristics such as older age and ASA grade > III, as well as the development of postoperative complications, independently predict the increase in the length of hospital stay.


Resumo Objetivo Avaliar os fatores de risco relacionados a um tempo de internação mais longo e às complicações pós-operatórias precoces (primeiros 30 dias após a cirurgia) em pacientes submetidos a artroplastia total do joelho (ATJ). Materiais e Métodos Este é um estudo transversal com coleta de dados de pacientes submetidos a ATJ em um hospital privado entre 2015 e 2019. Os seguintes dados foram coletados: idade, gênero, índice de massa corporal, e comorbidades clínicas. Também coletamos dados intraoperatórios, como o grau na classificação da American Society of Anesthesiologists (ASA) e a duração da cirurgia, além do tempo de internação, as complicações pós-operatórias, e a readmissão em 30 dias. Os possíveis fatores de risco associados a um tempo de internação mais longo e às taxas de complicações pós-operatórias foram investigados por meio de modelos estatísticos. Resultados Os pacientes mais velhos, com graus mais elevados na classificação da ASA ou que sofreram complicações pós-operatórias, ficaram internados por mais tempo. Para cada aumento em um ano de idade, esperamos que o tempo de internação seja multiplicado por 1,008 (intervalo de confiança de 95% [IC95%]: 1,004 a 1,012; p < 0,001). Em pacientes de grau III na classificação da ASA, espera-se que o tempo seja multiplicado por 1,297 (IC95%: 1,083 a 1,554; p = 0,005) em comparação com pacientes de grau I. Em pacientes com complicações pós-operatórias, espera-se que o tempo seja multiplicado por 1,505 (IC95%: 1,332 a 1,700; p < 0,001) em comparação com pacientes sem complicações. Conclusão Este estudo demonstrou que, em pacientes submetidos a ATJ primária, características pré-operatórias, como idade avançada e grau ≥ III na classificação da ASA, e o desenvolvimento de complicações pós-operatórias predizem o aumento do tempo de internação hospitalar de forma independente.


Subject(s)
Humans , Postoperative Complications , Outcome Assessment, Health Care , Arthroplasty, Replacement, Knee , Length of Stay
7.
Braz. J. Anesth. (Impr.) ; 73(3): 316-339, May-June 2023. tab, graf
Article in English | LILACS | ID: biblio-1439605

ABSTRACT

Abstract Background and objectives: In this systematic review, we carried out an assessment of perioperative costs of local or regional anesthesia versus general anesthesia in the ambulatory setting. Methods: A systematic literature search was conducted to find relevant data on costs and cost-effectiveness analyses of anesthesia regimens in outpatients, regardless of the medical procedure they underwent. The hypothesis was that local or regional anesthesia has a lower economic impact on hospital costs in the outpatient setting. The primary outcome was the average total cost of anesthesia calculated on perioperative costs (drugs, staff, resources used). Results: One-thousand-six-hundred-ninety-eight records were retrieved, and 28 articles including 27,581 patients were selected after reviewing the articles. Data on the average total costs of anesthesia and other secondary outcomes (anesthesia time, recovery time, time to home readiness, hospital stay time, complications) were retrieved. Taken together, these findings indicated that local or regional anesthesia is associated with lower average total hospital costs than general anesthesia when performed in the ambulatory setting. Reductions in operating room time and postanesthesia recovery time and a lower hospital stay time may account for this result. Conclusions: Despite the limitations of this systematic review, mainly the heterogeneity of the studies and the lack of cost-effectiveness analysis, the economic impact of the anesthesia regimes on healthcare costs appears to be relevant and should be further evaluated.


Subject(s)
Humans , Outpatients , Anesthesia, Conduction , Cost-Benefit Analysis , Anesthesia, General , Length of Stay
8.
Braz. J. Anesth. (Impr.) ; 73(2): 171-176, March-Apr. 2023. tab, graf
Article in English | LILACS | ID: biblio-1439593

ABSTRACT

Abstract Background Emergence Delirium (ED) is a combination of disturbance of perception and psychomotor agitation that is common in pediatric patients after general anesthesia, especially at preschool age. Since the effect of ED on the length of stay has been studied in adults but infrequently in children, the aim of this study was to investigate the relationship between ED and length of stay in this population. Methods A single center, retrospective, observational study was carried out in children who underwent tonsillectomy or adenotonsillectomy. The Pediatric Anesthesia Emergence Delirium (PAED) scale was used to assess ED. In addition to the time to hospital discharge (time frame 24 hours), drugs used, comorbidities, early postoperative complications, and pain were investigated if potentially associated with the complication. Results Four hundred sixteen children aged from 1.5 to 10 years (183 female, 233 male) were included. ED occurred in 25.5% of patients (n = 106). Patients were divided into the ED group and the No-ED group. The discharge time was similar in both groups. No significant differences were observed in the frequency of postoperative complications. The use of fentanyl or dexmedetomidine did not affect ED occurrence. The frequency of pain was greater in the ED group, both in the recovery room and in the ward (p= 0.01). Conclusions The occurrence of ED in children after tonsillectomy/adenotonsillectomy did not extend the length of stay.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Tonsillectomy , Dexmedetomidine , Emergence Delirium/epidemiology , Pain , Postoperative Complications/epidemiology , Anesthesia Recovery Period , Length of Stay
9.
Rev. colomb. cir ; 38(2): 300-312, 20230303. tab
Article in Spanish | LILACS | ID: biblio-1425203

ABSTRACT

Introducción. La condición de pandemia por COVID-19 impactó a la sociedad y los sistemas de salud a nivel mundial. Las adaptaciones institucionales procuraron mantener la calidad de la atención a pesar de un contexto organizacional desfavorable. La apendicitis aguda requirió ser manejada en un nuevo escenario institucional. El objetivo de este estudio fue evaluar la efectividad del tratamiento quirúrgico de la apendicitis durante la pandemia. Métodos. Estudio observacional analítico, retrospectivo, en el que se incluyeron pacientes sometidos a apendicectomía, antes y durante la pandemia por COVID-19. Se evaluaron las complicaciones, infección del sitio operatorio, reingresos y estancia hospitalaria. Adicionalmente, se analizaron los desenlaces en los 3 picos epidemiológicos de la pandemia. Se efectuaron estadísticas descriptivas y analíticas entre los grupos a comparar. Resultados. Se incluyeron 1521 pacientes con apendicitis, 48,3 % operados antes y 51,7 % durante la pandemia. No hubo diferencias entre los grupos en complicaciones (p=0,352), infección del sitio operatorio (p=0,191), reingreso en los primeros 30 días (p=0,605) y estancia hospitalaria (p=0,514). El manejo de la apendicitis durante el tercer pico fue similar a las prácticas habituales. El tiempo de evolución fue mayor durante la pandemia (p=0,04) y los pacientes fueron llevados a cirugía más pronto que previo a la pandemia (p<0,001). Conclusiones. No se evidenció un incremento de complicaciones quirúrgicas, reingresos, estancia hospitalaria ni infección del sitio operatorio en los pacientes operados durante la pandemia. Hubo un efecto favorable para los pacientes como consecuencia de la adaptación institucional en la pandemia por COVID-19


Introduction. COVID-19 pandemic impacted society and health systems worldwide. The institutional adaptations sought to maintain the quality of care in an unfavorable organizational context. Acute appendicitis was required to be managed in a new institutional setting. The effectiveness of surgical treatment of appendicitis during the pandemic was evaluated. Methods. Retrospective analytical observational study, in patients with appendectomy, before and during COVID-19 pandemic. Complications, surgical site infections, readmissions, and hospital stay were evaluated. Additionally, the outcomes in the 3 epidemiological peaks of the pandemic were analyzed. Descriptive and analytical statistics were performed between the groups to be compared. Results. A total of 1521 patients with appendicitis were included, 48.3% before and 51.7% during the pandemic. There were no differences in complications (p=0.352), operative site infection (p=0.191), readmission at 30 days (p=0.605), and hospital stay (p=0.514) between the groups. Management of appendicitis during the 3rd peak was like usual practices. There was a long evolution time during the pandemic (p=0.04) and the patients were taken to surgery sooner than before the pandemic (p<0.001). Conclusions. There was no evidence of an increase in surgical complications, readmissions, hospital stay, and surgical site infections during patients who underwent surgery. There was a favorable effect for patients because of institutional adaptation in the COVID-19 pandemic


Subject(s)
Humans , Appendicitis , Outcome Assessment, Health Care , Coronavirus Infections , Postoperative Complications , Pandemics , Length of Stay
10.
Braz. J. Anesth. (Impr.) ; 73(1): 25-35, Jan.-Feb. 2023. tab, graf
Article in English | LILACS | ID: biblio-1420645

ABSTRACT

Abstract Background Enhanced Recovery After Surgery (ERAS) protocol is composed by evidence-based interventions that aim to improve recovery through a reduction in surgical stress response. Although ERAS protocols have been introduced across the globe, exhaustive implementation is not as common. We aimed to study the ERAS protocol compliance in colorectal surgery, assessing the relationship between compliance and postoperative complications. Methods A single-center cohort study was conducted. All consecutive patients admitted to elective colorectal surgery were included. We assessed study endpoints according to ERAS protocol perioperative compliance score above 75%. Our primary endpoint was a composite of postoperative events, which includes in-hospital postoperative complications and need for reoperation after 30 days and need for readmission after discharge. Secondary endpoints were surgery-to-discharge time, postoperative use of only non-opioid adjuvants and the individual components of the primary endpoint. Results A total of 224 colorectal patients were included. The primary endpoint occurred in 59.2% (n = 58) of non-compliant patients comparing to 34.1% (n = 43) in compliant patients. In univariate analysis, compliance to ERAS protocol had an inferior risk for the primary endpoint (p< 0.001). In a logistic regression model, compliance was independently associated with a reduced risk for the primary endpoint with a odds-ratio of 0.42 (95% CI 0.23-0.75, p= 0.004). Conclusion Compliance with the ERAS protocol is associated with less complications, a reduced surgery-to-discharge time and use of only non-opioid adjuvants in the postoperative period. More studies are needed to target the most appropriate compliance goal.


Subject(s)
Humans , Enhanced Recovery After Surgery , Postoperative Complications/prevention & control , Postoperative Complications/epidemiology , Cohort Studies , Guideline Adherence , Length of Stay
11.
Braz. J. Anesth. (Impr.) ; 73(1): 16-24, Jan.-Feb. 2023. tab, graf
Article in English | LILACS | ID: biblio-1420646

ABSTRACT

Abstract Objective To analyze the effects of an ERAS program on complication rates, readmission, and length of stay in patients undergoing pulmonary resection in a tertiary university hospital. Methods Ambispective cohort study with a prospective arm of 50 patients undergoing thoracic surgery within an ERAS program (ERAS group) versus a retrospective arm of 50 patients undergoing surgery before the protocol was implemented (Standard group). The primary outcome was the number of patients with 30-day surgical complications. Secondary outcomes included ERAS adherence, non-surgical complications, mortality, readmission, reintervention rate, pain, and hospital length of stay. We performed a multivariate logistic analysis to study the correlation between outcomes and ERAS adherence. Results In the univariate analysis, we found no difference between the two groups in terms of surgical complications (Standard 18 [36%] vs. ERAS 12 [24%], p = 0.19). In the ERAS group, only the readmission rate was significantly lower (Standard 15 [30%] vs. ERAS 6 [12%], p = 0.03). In the multivariate analysis, ERAS adherence was the only factor associated with a reduction in surgical complications (OR [95% CI] = 0.02 [0.00, 0.59], p = 0.03) and length of stay (HR [95% CI] = 18.5 [4.39, 78.4], p < 0.001). Conclusions The ERAS program significantly reduced the readmission rate at our hospital. Adherence to the ERAS protocol reduced surgical complications and length of stay.


Subject(s)
Humans , Postoperative Complications/etiology , Postoperative Complications/prevention & control , Postoperative Complications/epidemiology , Thoracic Surgery , Prospective Studies , Retrospective Studies , Cohort Studies , Hospitals , Length of Stay
12.
Braz. J. Anesth. (Impr.) ; 73(1): 54-71, Jan.-Feb. 2023. tab, graf
Article in English | LILACS | ID: biblio-1420654

ABSTRACT

Abstract Background Early mobilization after surgery is a cornerstone of the Enhanced Recovery After Surgery (ERAS) programs in total hip arthroplasty (THA) or total knee arthroplasty (TKA). Our goal was to determine the time to mobilization after this surgery and the factors associated with early mobilization. Methods This was a predefined substudy of the POWER.2 study, a prospective cohort study conducted in patients undergoing THA and TKA at 131 Spanish hospitals. The primary outcome was the time until mobilization after surgery as well as determining those perioperative factors associated with early mobilization after surgery. Results A total of 6093 patients were included. The median time to achieve mobilization after the end of the surgery was 24 hours [16-30]. 4,222 (69.3%) patients moved in ≤ 24 hours after surgery. Local anesthesia [OR = 0.80 (95% confidence interval [CI]: 0.72-0.90); p= 0.001], surgery performed in a self-declared ERAS center [OR = 0.57 (95% CI: 0.55-0.60); p< 0.001], mean adherence to ERAS items [OR = 0.93 (95% CI: 0.92-0.93); p< 0.001], and preoperative hemoglobin [OR = 0.97 (95% CI: 0.96-0.98); p< 0.001] were associated with shorter time to mobilization. Conclusions Most THA and TKA patients mobilize in the first postoperative day, early time to mobilization was associated with the compliance with ERAS protocols, preoperative hemoglobin, and local anesthesia, and with the absence of a urinary catheter, surgical drains, epidural analgesia, and postoperative complications. The perioperative elements that are associated with early mobilization are mostly modifiable, so there is room for improvement.


Subject(s)
Humans , Arthroplasty, Replacement, Hip , Arthroplasty, Replacement, Knee , Early Ambulation , Postoperative Complications/etiology , Hemoglobins , Prospective Studies , Length of Stay
13.
Chinese Journal of Pediatrics ; (12): 440-445, 2023.
Article in Chinese | WPRIM | ID: wpr-985888

ABSTRACT

Objective: To explore the risk factors of malnutrition in infants with congenital heart disease within one year after surgery. Methods: This retrospective cohort study selected 502 infants with congenital heart disease who underwent surgical treatment in Guangzhou Women and Children's Medical Center from February 2018 to January 2019. Their basic information and clinical data were analyzed, and their nutrition status after the surgery was followed up by questionnaire survey. Weight-for-age Z score (WAZ)≤-2 one year after operation was defined as malnutrition group, and WAZ>-2 was non-malnutrition group. The perioperative indicators and complementary food advancement were compared between the two groups by chi-square test, t-test, and Kruskal-Wallis test. The risk factors of malnutrition were analyzed by Logistic regression. Results: A total of 502 infants were selected, including 301 males and 201 females, with the age of 4.1 (2.0, 6.8) months. There were 90 cases in malnutrition group and 412 cases in non-malnutrition group. The body length and weight at birth in the malnutrition group were lower than those in the non-malnutrition group ((47.8±3.8) vs. (49.3±2.5) cm, (2.7±0.6) vs.(3.0±0.5) kg, both P<0.001). The proportion of paternal high school education or above and the proportion of family per capita income of 5 000 yuan or above in the malnutrition group were lower than those in the non-malnutrition group ((18.9% (17/90) vs. 30.8% (127/412), 18.9% (17/90) vs. 33.7% (139/412), both P<0.05). Compared to the non-malnutrition group, the proportion of complex congenital heart disease in the malnutrition group was higher (62.2% (56/90) vs. 47.3% (195/412), P<0.05). The postoperative mechanical ventilation time, postoperative intensive care unit (ICU) stay time, postoperative hospital stay, total length of ICU stay and total hospital stay in the malnutrition group were significantly longer than those in non-malnutrition group (all P<0.05). The proportion of egg and fish supplementation over 2 times/week within one year after the surgery was also lower in the malnutrition group (both P<0.05). Logistic regression analysis showed that mother's weight at delivery (OR=0.95,95%CI 0.91-0.99), the pre-operative WAZ≤-2 (OR=6.04, 95%CI 3.13-11.65), the complexity of the cardiac disease (OR=2.23, 95%CI 1.22-4.06), the hospital stay after the surgery over 14 days (OR=2.61, 95%CI 1.30-5.26), the types of complementary food<4 (OR=2.57, 95%CI 1.39-4.76), and the frequency of meat and fish<2 times/week (OR=2.11, 95%CI 1.13-3.93) were the risk factors associated with malnutrition within one year after the surgery. Conclusion: Mother's weight at delivery pre-operative nutritional status, complexity of cardiac disease, postoperative hospital stay, types of daily supplements and frequency of fish are risk factors associated with malnutrition within one year after surgery in children with congenital heart disease.


Subject(s)
Male , Humans , Female , Cardiac Surgical Procedures , Retrospective Studies , Malnutrition/complications , Heart Defects, Congenital/surgery , Risk Factors , Length of Stay , Infant Nutrition Disorders/complications
14.
Southern Philippines Medical Center Journal of Health Care Services ; (2): 1-2023.
Article in English | WPRIM | ID: wpr-980702

ABSTRACT

BACKGROUND@#In 2016, the Philippine Health Insurance Corporation (PhilHealth) introduced the Z-package to provide financial coverage for, among others, intramedullary nailing procedures and implant costs for eligible patients with femoral shaft fractures.@*OBJECTIVE@#To compare health care durations and expenses between patients with closed femoral shaft fractures requiring intramedullary fixation who utilized the PhilHealth Z-package and those who did not. @*DESIGN@#Retrospective cohort study.@*PARTICIPANTS@#66 male and female patients, aged 19 to 39 years, who underwent intramedullary nailing for closed femoral shaft fractures. @*SETTING@#Orthopedic Ward, Southern Philippines Medical Center, Davao City, January to December 2018. @*MAIN OUTCOME PROCEDURE@#Time to surgery, length of hospital stay, total hospital bill, total PhilHealth coverage, other funds for medical assistance (OFMA) coverage, and out-of-pocket (OOP) expenses.@*MAIN RESULTS@#Among the 66 patients, 33 had the Z-package, while the remaining 33 did not. The median time to surgery (19 days vs 24 days; p=0.156), median length of hospital stay (24 days vs 29 days; p=0.546), and median total hospital bill (Php 62,392.00 vs Php 62,404.80; p=0.314) were comparable between those without the Z-package and those who had, respectively. However, patients without the Z-package had significantly lower total PhilHealth coverage (Php 30,740.00 vs Php 48,740.00; p<0.001) and higher OFMA coverage (Php 49,909.90 vs Php 34,409.20; p=0.024), and OOP expenses (Php 0.00; IQR: Php 0.00 to Php 20,000.00 vs Php 0.00; IQR: Php 0.00 to Php 0.00; p=0.004) compared to those with the Z-package. @*CONCLUSION@#Patients with the Z-package had a slightly longer time to surgery, although this difference was not statistically significant. However, they benefited from significantly lower remaining bills after PhilHealth coverage and reduced OOP expenses compared to patients without Z-package coverage.


Subject(s)
Health Expenditures , Medical Assistance , Length of Stay
15.
Chinese Journal of Gastrointestinal Surgery ; (12): 175-180, 2023.
Article in Chinese | WPRIM | ID: wpr-971248

ABSTRACT

Objective: To assess the effect of jejunal feeding tube placement on early complications of laparoscopic radical gastrectomy in patients with incomplete pyloric obstruction by gastric cancer. Methods: This was a retrospective cohort study. Perioperative clinical data of 151 patients with gastric antrum cancer complicated by incomplete pyloric obstruction who had undergone laparoscopic distal radical gastrectomy from May 2020 to May 2022 in the First Affiliated Hospital of Nanchang University were collected. Intraoperative jejunal feeding tubes had been inserted in 69 patients (nutrition tube group) and not in the remaining 82 patients (conventional group). There were no statistically significant differences in baseline characteristics between the two groups (all P>0.05). The operating time, intraoperative bleeding, time to first intake of solid food, time to passing first flatus, time to drainage tube removal, and postoperative hospital stay, and early postoperative complications (occurded within 30 days after surgery) were compared between the two groups. Results: Patients in both groups completed the surgery successfully and there were no deaths in the perioperative period. The operative time was longer in the nutritional tube group than in the conventional group [(209.2±4.7) minutes vs. (188.5±5.7) minutes, t=2.737, P=0.007], whereas the time to first postoperative intake of food [(2.7±0.1) days vs. (4.1±0.4) days, t=3.535, P<0.001], time to passing first flatus [(2.3±0.1) days vs. (2.8±0.1) days, t=3.999, P<0.001], time to drainage tube removal [(6.3±0.2) days vs. (6.9±0.2) days, t=2.123, P=0.035], and postoperative hospital stay [(7.8±0.2) days vs. (9.7±0.5) days, t=3.282, P=0.001] were shorter in the nutritional tube group than in the conventional group. There was no significant difference between the two groups in intraoperative bleeding [(101.1±9.0) mL vs. (111.4±8.7) mL, t=0.826, P=0.410]. The overall incidence of short-term postoperative complications was 16.6% (25/151). Postoperative complications did not differ significantly between the two groups (all P>0.05). Conclusion: It is safe and feasible to insert a jejunal feeding tube in patients with incomplete outlet obstruction by gastric antrum cancer during laparoscopic radical gastrectomy. Such tubes confer some advantages in postoperative recovery.


Subject(s)
Humans , Stomach Neoplasms/etiology , Pyloric Antrum , Retrospective Studies , Flatulence/surgery , Treatment Outcome , Postoperative Complications/etiology , Laparoscopy , Gastrectomy/adverse effects , Length of Stay , Pyloric Stenosis/surgery
16.
Chinese Critical Care Medicine ; (12): 415-420, 2023.
Article in Chinese | WPRIM | ID: wpr-982604

ABSTRACT

OBJECTIVE@#To develop a mortality prediction model for critically ill patients based on multidimensional and dynamic clinical data collected by the hospital information system (HIS) using random forest algorithm, and to compare the prediction efficiency of the model with acute physiology and chronic health evaluation II (APACHE II) model.@*METHODS@#The clinical data of 10 925 critically ill patients aged over 14 years old admitted to the Third Xiangya Hospital of Central South University from January 2014 to June 2020 were extracted from the HIS system, and APACHE II scores of the critically ill patients were extracted. Expected mortality of patients was calculated according to the death risk calculation formula of APACHE II scoring system. A total of 689 samples with APACHE II score records were used as the test set, and the other 10 236 samples were used to establish the random forest model, of which 10% (n = 1 024) were randomly selected as the validation set and 90% (n = 9 212) were selected as the training set. According to the time series of 3 days before the end of critical illness, the clinical characteristics of patients such as general information, vital signs data, biochemical test results and intravenous drug doses were selected to develope a random forest model for predicting the mortality of critically ill patients. Using the APACHE II model as a reference, receiver operator characteristic curve (ROC curve) was drawn, and the discrimination performance of the model was evaluated through the area under the ROC curve (AUROC). According to the precision and recall, Precision-Recall curve (PR curve) was drawn, and the calibration performance of the model was evaluated through the area under the PR curve (AUPRC). Calibration curve was drawn, and the consistency between the predicted event occurrence probability of the model and the actual occurrence probability was evaluated through the calibration index Brier score.@*RESULTS@#Among the 10 925 patients, there were 7 797 males (71.4%) and 3 128 females (28.6%). The average age was (58.9±16.3) years old. The median length of hospital stay was 12 (7, 20) days. Most patients (n = 8 538, 78.2%) were admitted to intensive care unit (ICU), and the median length of ICU stay was 66 (13, 151) hours. The hospitalized mortality was 19.0% (2 077/10 925). Compared with the survival group (n = 8 848), the patients in the death group (n = 2 077) were older (years old: 60.1±16.5 vs. 58.5±16.4, P < 0.01), the ratio of ICU admission was higher [82.8% (1 719/2 077) vs. 77.1% (6 819/8 848), P < 0.01], and the proportion of patients with hypertension, diabetes and stroke history was also higher [44.7% (928/2 077) vs. 36.3% (3 212/8 848), 20.0% (415/2 077) vs. 16.9% (1 495/8 848), 15.5% (322/2 077) vs. 10.0% (885/8 848), all P < 0.01]. In the test set data, the prediction value of random forest model for the risk of death during hospitalization of critically ill patients was greater than that of APACHE II model, which showed by that the AUROC and AUPRC of random forest model were higher than those of APACHE II model [AUROC: 0.856 (95% confidence interval was 0.812-0.896) vs. 0.783 (95% confidence interval was 0.737-0.826), AUPRC: 0.650 (95% confidence interval was 0.604-0.762) vs. 0.524 (95% confidence interval was 0.439-0.609)], and Brier score was lower than that of APACHE II model [0.104 (95% confidence interval was 0.085-0.113) vs. 0.124 (95% confidence interval was 0.107-0.141)].@*CONCLUSIONS@#The random forest model based on multidimensional dynamic characteristics has great application value in predicting hospital mortality risk for critically ill patients, and it is superior to the traditional APACHE II scoring system.


Subject(s)
Female , Male , Humans , Aged , Adult , Middle Aged , Adolescent , Critical Illness , Hospitalization , Length of Stay , APACHE , Hospital Information Systems
17.
São Paulo; s.n; 2023. 107 p. ilus, tab.
Thesis in Portuguese | LILACS, Inca | ID: biblio-1433964

ABSTRACT

INTRODUÇÃO: Pacientes com câncer em estágio avançado continuam a receber cuidados médicos cada vez mais agressivos perto da morte, apesar da crescente preocupação de que isso reflita uma má qualidade de cuidados. No entanto, existem poucos dados na literatura sobre os ônus das admissões na UTI de pacientes com câncer consideradas inapropriadas ou potencialmente inapropriadas. Assim, o objetivo desse estudo foi avaliar as características, uso de recursos e desfechos dos pacientes com câncer com admissão potencialmente inapropriada na UTI. MÉTODOS: Estudo de coorte retrospectiva de pacientes com câncer internados nas UTIs do Hospital A.C.Camargo Cancer Center entre janeiro de 2017 e dezembro de 2018. Os pacientes foram classificados como apropriados, potencialmente inapropriados ou inapropriados para admissão na UTI de acordo com as diretrizes da Society of Critical Care Medicine (SCCM). O desfecho principal foi o tempo de internação na UTI, tendo a morte como evento competitivo. Os desfechos secundários foram a mortalidade em um ano, na UTI e no hospital, o tempo de internação hospitalar e o uso de recursos durante a internação na UTI. Utilizamos modelos de regressão de Fine e Gray (risco competitivo) para o desfecho primário, e de regressão logística para análise da mortalidade em 1 ano. RESULTADOS: Dos 6.700 pacientes admitidos, 5803 (86,6%) foram classificados como apropriados, 683 (10,2%) como potencialmente inapropriados e 214 (3,2%) como inapropriados para admissão na UTI. Após a análise ajustada para fatores de confusão, os pacientes com admissões na UTI potencialmente inapropriadas e inapropriadas tiveram uma menor probabilidade de alta da UTI do que os pacientes com admissão apropriada (sHR 0,55; 95% CI 0,49 ­ 0,61 e sHR 0,65; 95% CI 0,53 ­ 0,81, respectivamente). Dentre os pacientes com internação apropriada, potencialmente inapropriada e inapropriada, a mortalidade na UTI foi 4,8%, 32,6% e 35,0%, e a mortalidade intra-hospitalar foi 12,2%, 71,6% e 81,3%, respectivamente (p < 0,01). As admissões potencialmente inapropriadas e inapropriadas também foram associadas a uma maior mortalidade em 1 ano (OR 6,39; 95% CI 5,60­7,29 e OR 11,12; 95% CI 8,33-14,83, respectivamente). O uso de suporte orgânico na UTI foi mais comum e mais prolongado nos pacientes com admissão potencialmente inapropriada. CONCLUSÕES: A inadequação da admissão na UTI de pacientes com câncer foi associada ao maior uso de recursos e à maior mortalidade a curto e longo prazo. Esses achados destacam a necessidade de se melhorar a utilização da UTI entre os pacientes com câncer em estágio avançado.


INTRODUCTION: Patients with advanced-stage cancer continue to receive increasingly aggressive medical care near death, including admission to intensive care unit (ICU) within the last month of life, despite growing concerns that this reflects poor quality care at end of life. However, there is a lack of data regarding the burden of inappropriate and potentially inappropriate ICU care among patients with cancer. The aim of the study was to evaluate the characteristics, resource use and outcomes of critically ill patients with cancer according to appropriateness of ICU admission. METHODS: Retrospective cohort study of patients with cancer admitted to ICU in a dedicated cancer center in Brazil from January 2017 to December 2018. Patients were classified as appropriate, potentially inappropriate, or inappropriate for ICU admission according to the Society of Critical Care Medicine (SCCM) guidelines. The primary outcome was ICU length of stay (LOS). Secondary outcomes were one-year, ICU and hospital mortality, hospital LOS, utilization of ICU organ support, and decisions to forgo lifesustaining therapies during the ICU stay. We used logistic regression competing risk models accounting for relevant confounders for the primary outcome analyses, and a logistic regression model for one-year mortality analysis. RESULTS: From 6,700 admitted patients, 5,803 (86.6%) were classified as appropriate for ICU admission, 683 (10.2%) as potentially inappropriate and 214 (3.2%) as inappropriate for ICU admission. After adjusted analysis, potentially inappropriate and inappropriate ICU admissions had lower likelihood of being discharged from the ICU than patients with appropriate ICU admission (sHR 0.55, 95% CI 0.49 - 0.61 and sHR 0.65, 95% CI 0.53 - 0.81, respectively). Among patients considered to have had appropriate, potentially inappropriate, and inappropriate ICU admissions, ICU mortality was 4.8%, 32.6% and 35.0%, and in-hospital mortality was 12.2%, 71.6% and 81.3%, respectively (p < 0.01). Potentially inappropriate and inappropriate ICU admissions were also associated with higher 1-year mortality (OR 6.39, 95% CI 5.60-7.29 and OR 11.12, 95% CI 8.33-14.83, respectively). Use of organ support was more common and longer among patients with potentially inappropriate ICU admission. CONCLUSIONS: Inappropriateness for ICU admission among patients with cancer was associated with higher resource use in ICU and higher one year mortality among ICU survivors. These findings highlight the need to improve utilization of ICU services among patients with advanced-stage cancer


Subject(s)
Humans , Male , Female , Intensive Care Units , Patient Admission , Length of Stay , Neoplasms
18.
Psicol. ciênc. prof ; 43: e253403, 2023.
Article in Portuguese | LILACS, INDEXPSI | ID: biblio-1448955

ABSTRACT

O hospital constitui-se como um contexto em que a urgência subjetiva pode vir a se apresentar de forma frequente, instaurando, para cada sujeito, uma vivência de angústia. O objetivo desta pesquisa foi investigar as possibilidades para uma clínica das urgências subjetivas no contexto de um hospital universitário em Salvador, considerando as vivências em uma residência multiprofissional. Trata-se de uma pesquisa qualitativa de caráter exploratório, em que se realizou revisão teórica sobre o tema e se construiu um caso clínico, sob orientação psicanalítica. A escolha do caso baseou-se na escuta clínica ao longo dos atendimentos e da atuação em equipe multiprofissional, considerando os impasses ao longo do tratamento. Foram utilizados registros documentais produzidos pela psicóloga residente ao longo dos atendimentos, que ocorreram durante três meses. Os resultados apontam para as contribuições da escuta psicanalítica no tratamento das urgências e na atuação em equipe multiprofissional no contexto hospitalar. A subjetivação da urgência permitiu, no caso em questão, um tratamento pela palavra do que havia incidido diretamente no corpo como fenômeno. Conclui-se pela relevância em discutir o tema da urgência e suscitar novas pesquisas, reintroduzindo no contexto hospitalar a questão sobre a subjetividade.(AU)


Hospitals are contexts in which subjective urgency can frequently materialize, triggering an experience of anguish for each subject. Hence, this research investigates the possibilities of establishing a subjective urgency clinic at a university hospital in Salvador, considering the experiences in a multidisciplinary residence. A qualitative, exploratory research was conducted by means of a theoretical review on the topic and construction of a clinical case, under psychoanalytical advisement. The case was chosen based on clinical listening during the sessions and performance in a multidisciplinary team, considering the obstacles for long-term treatment. Data were collected from documentary records produced by the resident psychologist during three months. Results point to the contributions of psychoanalytic listening to treating subjective urgencies and to the performance of a multidisciplinary team in the hospital context. In the case in question, subjectivation of urgency allowed a treatment through the word of affecting phenomenon. In conclusion, discussing urgency and conducting further research, are fundamental to reintroduce subjectivity in the hospital context.(AU)


El hospital es un contexto en el que frecuentemente se puede percibir una urgencia subjetiva, estableciendo una experiencia de angustia para cada sujeto. El objetivo de esta investigación fue investigar las posibilidades de una clínica de urgencia subjetiva en el contexto de un hospital universitario en Salvador (Brasil), considerando las experiencias en una Residencia Multiprofesional. Se trata de una investigación cualitativa, de carácter exploratorio, en la que se realizó una revisión teórica sobre el tema y construcción de un caso clínico, con orientación psicoanalítica. La elección del caso se basó en la escucha clínica a lo largo de las sesiones y actuación en un equipo multidisciplinar, considerando los impasses para el tratamiento a largo plazo. Se utilizaron registros documentales elaborados por el psicólogo residente, durante las atenciones, que se realizaron durante tres meses. Los resultados apuntan a las contribuciones de la escucha psicoanalítica en el tratamiento de urgencias y en la actuación de un equipo multidisciplinario en el contexto hospitalario. La subjetivación de la urgencia permitió, en el caso en cuestión, un tratamiento a través de la palabra de lo que había afectado directamente al cuerpo como fenómeno. Se concluye que es relevante discutir el tema de la urgencia y plantear nuevas investigaciones, reintroduciendo el tema de la subjetividad en el contexto hospitalario.(AU)


Subject(s)
Humans , Female , Personal Satisfaction , Psychoanalysis , Emergencies , Hospitals, University , Anxiety , Outcome and Process Assessment, Health Care , Pain , Parapsychology , Patient Discharge , Primary Health Care , Psychiatry , Psychology , Quality of Life , Rehabilitation , Religion , Safety , Pathological Conditions, Signs and Symptoms , Teaching , Therapeutics , Universities , Wounds and Injuries , Behavior and Behavior Mechanisms , Unified Health System , Patients' Rooms , Health Infrastructure , Case Reports , Bereavement , Family , Patient Acceptance of Health Care , Laboratory and Fieldwork Analytical Methods , Mental Health , Disease , Liability, Legal , Treatment Refusal , Occupational Therapy , Treatment Outcome , Patient Satisfaction , Long-Term Care , Comprehensive Health Care , Life , Benchmarking , Critical Care , Personal Autonomy , Patient Rights , Death , Delivery of Health Care , Information Dissemination , Qualitative Research , After-Hours Care , Diagnosis , Education, Medical, Continuing , Emotions , Empathy , Academic Medical Centers , Publications for Science Diffusion , Disease Prevention , Humanization of Assistance , Health Care Facilities, Manpower, and Services , Electronic Health Records , Health Communication , Early Medical Intervention , Financial Management , Neurological Rehabilitation , Psychological Trauma , Mentoring , Universalization of Health , Psychological Distress , Patient Care , Diversity, Equity, Inclusion , Health Planning , Health Planning Guidelines , Health Policy , Hospital Administration , Hospitalization , Hospitals, Teaching , Human Rights , Accounting , Learning , Length of Stay , Life Change Events , Medical Assistance , Memory , Nursing Care
19.
Rev. chil. obstet. ginecol. (En línea) ; 87(6): 375-380, dic. 2022. tab, graf
Article in Spanish | LILACS | ID: biblio-1423747

ABSTRACT

Introducción: El prolapso de órganos pélvico (POP) es una patología frecuente que afecta hasta el 60% de las mujeres. La fijación alta al ligamento uterosacro (FAUS) transvaginal es una alternativa para el tratamiento del prolapso apical con buenos resultados, tiempos operatorios y de recuperación acotados, además de bajas tasas de complicaciones. Objetivo: Evaluar la tasa de éxito anatómico y subjetivo en pacientes portadoras de un prolapso apical sometidas a FAUS en el Hospital de Quilpué a 24 meses de seguimiento. Materiales y método: Se realizó un estudio retrospectivo observacional descriptivo, seleccionando a todas las pacientes sintomáticas con un prolapso apical ≥ 2 de la clasificación de POP-Q, sometidas a una FAUS entre septiembre de 2014 y octubre de 2019. Los datos fueron obtenidos desde la base de datos de la unidad de uroginecología del Hospital de Quilpué, previa aprobación del comité de ética. El éxito objetivo se definió como un punto C a 1 centímetro sobre el himen y el éxito subjetivo con una escala de impresión de mejora global del paciente (PGI-I) mejor o mucho mejor y/o una escala visual analógica (EVA) mayor al 80%, a 24 meses de seguimiento. Resultados: Se incluyeron 46 pacientes. La tasa de éxito objetivo fue del 84% y de éxito subjetivo del 70%. Conclusiones: La FAUS transvaginal con suturas permanentes es una excelente alternativa para el tratamiento del prolapso apical con una tasa de éxito similar al gold standard a 24 meses de seguimiento.


Introduction: Pelvic organ prolapse (POP) is a frequent pathology that affects up to 60% of women. Transvaginal uterosacral ligament high fixation (USLs: utero-sacral ligaments) is an alternative for the treatment of apical prolapse with good results, limited operative and recovery times, as well as low rates of complications. Objective: To evaluate the anatomical and subjective success rate in patients with an apical prolapse undergoing STALUS at the Quilpué Hospital at 24 months of follow-up. Materials and method: A descriptive observational retrospective study was carried out, selecting all symptomatic patients with an apical prolapse ≥ 2 of the POP Q classification, submitted to a FAUS between September 2014 and October 2019. The data were obtained from the database of the Urogynecology Unit of the Quilpué Hospital, prior approval of the ethics committee. Objective success was defined as a C-point 1 centimeter above the hymen and subjective success with better or much better Patient Global Impression-Improvement (PGI-I) scale and/or a greater than 80% Visual Analogue Scale (VAS), at 24 months of follow-up. Results: 46 patients were included. The objective success rate was 84% and the subjective success rate was 70%. Conclusions: The transvaginal FAUS with permanent sutures is an excellent alternative for the treatment of apical prolapse with a success rate similar to the gold standard at 24 months of follow-up.


Subject(s)
Humans , Female , Middle Aged , Aged , Gynecologic Surgical Procedures/methods , Suture Techniques , Pelvic Organ Prolapse/surgery , Ligaments/surgery , Postoperative Complications , Retrospective Studies , Follow-Up Studies , Uterine Prolapse/surgery , Treatment Outcome , Operative Time , Length of Stay
20.
Rev. Odontol. Araçatuba (Impr.) ; 43(3): 33-39, set.-dez. 2022. tab
Article in Portuguese | LILACS, BBO | ID: biblio-1381093

ABSTRACT

O presente estudo aborda os protocolos odontológicos instituídos na Unidade de Terapia Intensiva COVID de um Hospital do Extremo Sul Catarinense. A cavidade oral, considerada uma abertura para a entrada de microrganismos, possui características favoráveis ao seu crescimento, com temperatura e umidade ideais para sua sobrevivência em longo prazo. A odontologia, por manipular diretamente mucosa oral, fica exposta e vulnerável ao contágio do COVID-19, assim como a equipe multiprofissional que manipula o paciente nas diversas áreas de atenção à saúde, no ambiente hospitalar. A COVID-19 é uma infecção respiratória aguda causada pelo coronavírus SARS-CoV-2, potencialmente grave, de elevada transmissibilidade e de distribuição global. A maioria das pessoas (cerca de 80%) se recupera da doença sem precisar de tratamento hospitalar. Uma em cada seis pessoas infectadas por COVID-19 fica gravemente doente e desenvolve dificuldade de respirar. As pessoas idosas e as que têm outras condições de saúde, como pressão alta, problemas cardíacos e do pulmão, diabetes ou câncer, têm maior risco de ficarem gravemente doentes. No entanto, qualquer pessoa pode pegar a COVID-19 e ficar gravemente doente. Constatou-se que a aplicação de protocolos odontológicos na Unidade de Terapia Intensiva apresenta uma série de vantagens em relação à prevenção da contaminação dos profissionais de saúde, à manutenção da saúde bucal do paciente, aos benefícios gerais para a saúde, à prevenção e ao tratamento de infecções oportunistas, que podem reduzir o tempo de internação do paciente, pois infecção generalizada e pneumonia são doenças nosocomiais também causadas por distúrbios na microbiota oral. Os resultados mostraram que não há cirurgiões dentistas atuando na Unidade de Terapia Intensiva, os protocolos não são específicos para área de odontologia e os equipamentos de proteção individuais são utilizados, porém, não em todos atendimentos(AU)


The present study addresses the dental protocols established in the COVID Intensive Care Unit of a Hospital in Extremo Sul Santa Catarina. The oral cavity, considered an opening for the entry of microorganisms, has characteristics favorable to its growth, with ideal temperature and humidity for its long-term survival. Dentistry, by directly manipulating the oral mucosa, is exposed and vulnerable to COVID-19 contagion, as well as the multidisciplinary team that handles the patient in the different areas of health care, in the hospital environment. COVID-19 is a potentially serious acute respiratory infection caused by the SARS-CoV-2 coronavirus, with high transmissibility and global distribution. Most people (about 80%) recover from the disease without needing hospital treatment. One in six people infected with COVID-19 becomes seriously ill and develops difficulty breathing. Elderly people and those with other health conditions, such as high blood pressure, heart and lung problems, diabetes or cancer, are at increased risk of becoming seriously ill. However, anyone can take COVID-19 and become seriously ill. It was found that the application of dental protocols in the Intensive Care Unit has a number of advantages in relation to the prevention of contamination of health professionals, the maintenance of the patient's oral health, the general benefits for health, prevention and treatment of opportunistic infections, which can reduce the patient's hospital stay, as generalized infection and pneumonia are nosocomial diseases also caused by disorders in the oral microbiota. The results showed that there are no dentists working in the Intensive Care Unit, the protocols are not specific to the field of dentistry and individual protective equipment is used, however, not in all cases(AU)


Subject(s)
Dentists , COVID-19 , Intensive Care Units , Patient Care Team , Oral Health , Disease Transmission, Infectious , Length of Stay , Mouth Mucosa
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