The Importance of the Nutritional Factor and the Stage of the Disease in Postoperative Fistula in Patients with Gastric Cancer.

Introduction: In gastric cancer there are multiple local and general risk factors for the occurrence of postoperative fistulas. In the present study, we proposed to analyse the role of the preoperative nutritional state and nutritional therapy along with the disease stage, the age and the sex of patients in the occurrence of fistulas. Material and method: This retrospective study included 158 patients operated for gastric cancer in Surgery Department of Bucharest Oncology institute between January 2010 and December 2016 in which we analysed the incidence of anastomotic fistula according to the nutritional status, disease status, age and sex of the patients. Results: The global incidence of fistulas was of 11%, out of which 8 % were fistulas of the duodenal stump and 3.19% fistulas of the eso-jejunal anastomosis. Out of the 30 patients with weight loss and parenteral nutrition in the preop period, we had 4 fistulas (13%), and out of the 36 patients with weight loss and nutritional measures in the postop we had 5 fistulas (14%), also, out of the 24 patients with weight loss and without nutritional intervention, we had 5 fistulas (21%), finally, out of the 68 patients without weight loss we had fistulas in 4 patients (6%).. The incidence of fistulas was 5% in patients with stage I, II and III and 24% in stage IV patients. The distribution of fistulas according to the age of the patients showed a much higher incidence of fistulae in patients over 70 years old. Conclusions: The number of postoperative fistulas was higher in the advanced stages of the disease (p=0.027) and in patients over 70 years old (p=0.047) and the differences were statistically significant. The difference between the number of fistulae occurred in patients who had weight loss but did not receive nutritional support from those who received this support was not statistically significant (p 0.001).

Reinternação de pacientes com doenças crônicas: antecedentes pessoais, uso de medicamentos e independência nas atividades de vida diária / Rehospitalization of patients with chronicles diseases: personal antecedents, use of drugs and independence in activities of daily living

Objetivo: caracterizar a amostra, identificar a relação entre os antecedentes pessoais, o uso regular de medicação e o nível de independência nas atividades de vida diária de pacientes com doenças crônicas reinternados. Método: Trata-se de um estudo quantitativo e descritivo, no qual os dados foram coletados através de uma análise dos prontuários informatizados de pacientes com doenças crônicas, de todas as enfermarias de adultos/idosos que se reinternaram em um hospital do interior de São Paulo. Resultados: A especialidade médica mais frequente dos 88 pacientes reinternados foi 20 (21,3%) da cardiologia e afecção de base foi a cardiopatia - 16 (17%) pacientes. A maioria dos pacientes faz uso regular de medicamentos; destes, 48% apresentam algum nível de dependência. O antecedente pessoal mais encontrado foi hipertensão arterial 44 (50%). No ex tabagismo/tabagismo pode-se identificar predisposição com as afecções de base em 14 (45%) dos casos e em relação ao ex etilismo/etilismo observou-se predisposição de 6 (32%). Conclusão: Considerando a prevalência das doenças no processo da reinternação, reforça-se a necessidade da equipe multiprofissional na promoção, prevenção, tratamento e reabilitação em saúde, sendo o Terapeuta Ocupacional um dos profissionais desta equipe.

Objective: To characterize the sample, identify the relation between personal antecedents, regular use of drugs and level of independence in activities of daily living of rehospitalized patients with chronicles diseases. Methods: It's a quantitative and descriptive study, in which data were collected through a review of computerized records from patients with chronicles diseases, in all adults/elders wards, that were readmitted in a hospital of an inner city of São Paulo. Results: The most frequent medical speciality from the 88 patients readmitted was cardiology - 20 (21,3%) patients, and cardiopathy was the underlying disease - 16 (17%) patients. Most patients make regular use of drugs; from these, 48% had some dependence level. The personal antecedents more founded were arterial hypertension 44 (50%). In smoking/ ex smoking, can be identified predisposition with underlying disease in 14 (45%) cases, and in relation to alcoholism/ex alcoholism it was observed predisposition of 6 (32%). Conclusion: Considering the prevalence of the diseases from the rehospitalization process, it reinforces the necessity of a multiprofessional team in promotion, prevention, treatment and rehabilitation in health, in which the Occupational Therapist is one of the professionals from thos team.

Doenças crônicas não transmissíveis e antecedentes pessoais em reinternados e contribuição da terapia ocupacional / Chronic non-communicable diseases and personal history in readmitted patients and occupational therapy contribution

ResumoObjetivosIdentificar as doenças crônicas não transmissíveis (DCNT), os antecedentes pessoais e a frequência destes em pacientes reinternados em um hospital geral e verificar a contribuição da terapia ocupacional nesse contexto.MétodoParticiparam 544 participantes reinternados em um hospital geral. Os dados foram coletados por meio de uma entrevista semiestruturada e da análise do prontuário.ResultadosPrevalência de idosos, gênero masculino, casados, escolaridade até a 4ª série e aposentados. A maioria apresentou duas reinternações e os principais motivos da internação atual foram afecções respiratórias, dor, afecções urinárias e da ferida operatória. A maioria apresentou a frequência de dois antecedentes pessoais, sendo que os mais encontrados foram hipertensão e diabetes.DiscussãoHouve prevalência de idosos, os quais, devido ao processo de envelhecimento, utilizam mais os serviços de saúde, com consequente aumento nas internações, nas reinternações e nos custos destas. Observou-se alta porcentagem de DCNT e de antecedentes pessoais. Identificou-se a necessidade de estratégias e de ações eficazes nos setores primários e secundários para que se diminuam os números e os altos custos de reinternações. Torna-se relevante, como parte da equipe multiprofissional, a atuação do terapeuta ocupacional jcom essa população por meio de ações preventivas com melhor custo-efetividade.

AbstractObjectivesTo identify non-communicable chronic diseases and personal history and the frequency of the latter in patients readmitted in a general hospital, as well as determine the contribution of occupational therapy in this context.MethodThe presented study included 544 participants readmitted in a General Hospital. Data were collected through semi-structured interviews and analysis of medical records.ResultsThe participants were predominantly elderly, male, married, retired, with schooling up to the 4th grade. Most of them presented two readmissions and the main reasons for the current hospitalization were respiratory diseases, pain, and urinary and surgical wound disorders. The most frequent personal history included hypertension and diabetes, with frequency of two individuals.DiscussionThis study showed a prevalence of elderly who, due to the aging process, use health services more often, with the consequent increase in admissions and readmissions and their high costs. There was a high percentage of chronic diseases and personal history. We identified the need for effective strategies and actions in the primary and secondary sectors to decrease the number of readmissions and their high costs. As part of the multidisciplinary team, the work of occupational therapists with this population becomes relevant through preventive actions with better cost-effectiveness.