Assessing the use of cell phones to monitor health and nutrition interventions: Evidence from rural Guatemala.

In-person (face-to-face) data collection methods offer many advantages but can also be time-consuming and expensive, particularly in areas of difficult access. We take advantage of the increasing mobile phone penetration rate in rural areas to evaluate the feasibility of using cell phones to monitor the provision of key health and nutrition interventions linked to the first 1,000 days of life, a critical period of growth and development. We examine response rates to calendarized text messages (SMS) and phone calls sent to 1,542 households over a period of four months. These households have children under two years old and pregnant women and are located across randomly selected communities in Quiche, Guatemala. We find that the overall (valid) response rate to phone calls is over 5 times higher than to text messages (75.8% versus 14.4%). We also test whether simple SMS reminders improve the timely reception of health services but do not find any effects in this regard. Language, education, and age appear to be major barriers to respond to text messages as opposed to phone calls, and the rate of response is not correlated with a household's geographic location (accessibility). Moreover, response veracity is high, with an 84-91% match between household responses and administrative records. The costs per monitored intervention are around 1.12 US dollars using text messages and 85 cents making phone calls, with the costs per effective answer showing a starker contrast, at 7.76 and 1.12 US dollars, respectively. Our findings indicate that mobile phone calls can be an effective, low-cost tool to collect reliable information remotely and in real time. In the current context, where in-person contact with households is not possible due to the COVID-19 crisis, phone calls can be a valuable instrument for collecting information, monitoring development interventions, or implementing brief surveys.

Long-term functional results from a randomized clinical study of transverse coloplasty compared with colon J-pouch after low anterior resection for rectal cancer.

BACKGROUND: The colonic pouch is considered as an alternative to the standard straight low anastomosis after resection for rectal cancer. The aim of this prospective randomized trial was to compare short- and long-term functional results of colonic J-pouch (CJP) and transverse coloplasty (TCP) after low anterior resection for rectal cancer. METHODS: Between 2000 and 2005, patients with mid or low rectal cancer scheduled for an elective sphincter-preserving resection were eligible. The primary end point was to compare bowel functional results 6 months and 3 years after ileostomy closure. Fecal incontinence score and a questionnaire that included items for clinical evaluation of bowel function were used. RESULTS: One-hundred six patients were randomized; 54 patients were allocated to the CJP group and 52 in the TCP group. There were no differences between the 2 groups in terms of demographic and clinical data. Overall, postoperative complication rate was 19.8% without differences between the groups. Two patients (1.9%; one in each group) presented with anastomotic dehiscence. Long-term incomplete evacuation rates were 29.2% in the CPT group and 33.3% in the CJP group, without substantial differences. Overall, short- and long-term functional outcomes of both procedures were comparable. No differences were observed in terms of fecal incontinence or in all the items included in the questionnaire. CONCLUSION: TCP reconstruction after rectal cancer resection and coloanal anastomosis is functionally similar to CJP both in short- and long-term outcomes. The TCP technique does not seem to improve significantly the incomplete defecation symptom respect to CJP. REGISTRATION NUMBER: NCT01396928; http://register.clinicaltrial.gov.

Estado actual de la intervención de Hartmann en nuestro medio / The Hartmann procedure: current situation in Spain

Introducción. Las alternativas terapéuticas en la cirugía urgente del colon son motivo constante de discusión y, entre ellas, la intervención de Hartmann es una de las más controvertidas. El objetivo de nuestro trabajo es analizar cuándo, quién y por qué se realiza y cuáles son los resultados obtenidos. Pacientes y método. Análisis descriptivo de 105 intervenciones de Hartmann en cirugía de urgencias. Se analizan variables clínicas (edad, sexo, antecedentes, sintomatología, factores de riesgo, diagnóstico preoperatorio) que se correlacionan con variables quirúrgicas (hallazgos quirúrgicos, cirujano), indicándose la realización de una intervención de Hartmann según los factores generales y locales. Resultados. La edad media fue de 69,3 años, con un 56% de varones. El 73% presentaba antecedentes personales. La clínica se inicia, en el 48% de los casos, como oclusión, en el 30% como abdomen agudo y en el 12% como shock séptico. El 78% se encuentra en estadio ASA III-IV. Los hallazgos quirúrgicos más frecuentes fueron oclusión intestinal ( 39%), peritonitis purulenta (22%) y peritonitis fecal (18%). En el 14% había perforación de colon. La morbilidad fue del 51% y la mortalidad del 11%. El 63% de las intervenciones fue realizado por cirujanos generales y el 37% por cirujanos con dedicación colorrectal. En 20 casos se reconstruyó el tránsito digestivo con una media de espera de 9 meses. Al evaluar retrospectivamente por qué se realizó una intervención de Hartmann se observa que en el 50,5% de los casos se hubiera podido realizar una anastomosis y se valoran las causas por las cuales no se realizó. Conclusión. Según nuestra experiencia, la intervención de Hartmann se realiza, en primer lugar, debido al propio estado del paciente (factores de riesgo, condiciones generales del paciente y condiciones locales del abdomen) y, en segundo lugar, debido a las condiciones del propio cirujano de guardia (AU)

Introduction. The therapeutic alternatives in emergency surgery of the colon are a constant subject of debate and the Hartmann procedure is one of the most controversial techniques. The aim of the present study was to analyze when, why and in whom this procedure is performed, as well as its results. Patients and method. The mean age was 69.3 years and 56% of the patients were men. Seventy-three percent percent had personal antecedents. Presenting symptoms were occlusion in48%, acute abdomen in 30% and septic shock in 12%. Seventy-eight percent were ASA III-IV. The most frequent surgical findings were intestinal occlusion (39%), purulent peritonitis (22%) and fecal peritonitis (18%). Perforation of the colon was found in 14%. Morbidity was 51% and mortality was 11%. Sixty-three percent of the procedures were performed by general surgeons and 37% by specialists in colorectal surgery. In 20 patients intestinal continuity was restored after a mean wait of 9 months. Retrospective evaluation of the indications for the Hartmann procedure revealed that 50.5% of the patients could have undergone anastomosis and the reasons for not performing this procedure were analysed. Conclusion. Inour experience the Hartmann procedure is performed primarily for factors related to the patient (risk factors, general status and local status of the abdomen) and secondly due to factors related to the duty surgeon (AU)

[The Hartmann procedure: current situation in Spain]. / Estado actual de la intervención de Hartmann en nuestro medio.

INTRODUCTION: The therapeutic alternatives in emergency surgery of the colon are a constant subject of debate and the Hartmann procedure is one of the most controversial techniques. The aim of the present study was to analyze when, why and in whom this procedure is performed, as well as its results. PATIENTS AND METHOD: We performed a descriptive analysis of 105 emergency Hartmann procedures. Clinical variables (age, sex, antecedents, symptoms, risk factors, preoperative diagnosis) were analyzed and correlated with surgical variables (surgical findings, surgeon) indicating the Hartmann procedure depending on general and local factors. RESULTS: The mean age was 69.3 years and 56% of the patients were men. Seventy-three percent had personal antecedents. Presenting symptoms were occlusion in 48%, acute abdomen in 30% and septic shock in 12%. Seventy-eight percent were ASA III-IV. The most frequent surgical findings were intestinal occlusion (39%), purulent peritonitis (22%) and fecal peritonitis (18%). Perforation of the colon was found in 14%. Morbidity was 51% and mortality was 11%. Sixty-three percent of the procedures were performed by general surgeons and 37% by specialists in colorectal surgery. In 20 patients intestinal continuity was restored after a mean wait of 9 months. Retrospective evaluation of the indications for the Hartmann procedure revealed that 50.5% of the patients could have undergone anastomosis and the reasons for not performing this procedure were analyzed. CONCLUSION: In our experience the Hartmann procedure is performed primarily for factors related to the patient (risk factors, general status and local status of the abdomen) and secondly due to factors related to the duty surgeon.

Resultados clinicofuncionales de dos reservorios ileoanales (S-J) en la colitis ulcerosa / Clinical and functional results of two ileoanal pouches (S-J) in ulcerative colitis

Introducción. La proctocolectomia con reservorio ileoanal es la técnica de elección en la colitis ulcerosa. El objetivo del trabajo es presentar nuestra experiencia y su relación con los resultados funcionales en dos tipos de reservorio. Pacientes y método. Se analizó a 40 pacientes afectados de colitis ulcerosa, portadores en 23 casos de reservorio en S y 17 en J. Se realizó sutura manual en las bolsas en S y mecánica en las bolsas en J. Se practicó cirugía en tres tiempos en 33 y en 7 pacientes, en dos con un tiempo medio de cierre de ileostomía de 3 meses. Resultados. En el 95 por ciento de los casos el reservorio fue funcionante y en 2 casos (5 por ciento) fue extirpado por pouchitis y mal vaciamiento. La morbilidad postoperatoria fue del 32,5 por ciento y en el seguimiento del 30 por ciento, destacando la pouchitis (10 por ciento), la oclusión por bridas (7,5 por ciento) y la estenosis anal (5 por ciento). La mortalidad es nula y no existieron alteraciones sexuales. Dos pacientes (5 por ciento) fueron diagnosticados de enfermedad de Crohn. La media de deposiciones fue de cuatro, con buena continencia, y en 5 casos se produjeron fugas esporádicas. La dieta fue libre en todos los pacientes y el 20 por ciento ingirió fármacos astringentes. No se apreciaron diferencias dependiendo del tipo de reservorio. Conclusión. A pesar de ser una cirugía compleja, nuestra experiencia nos sugiere que esta técnica permite unos resultados funcionales satisfactorios con una buena calidad de vida (AU)