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1.
World J Surg Oncol ; 19(1): 196, 2021 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-34215273

RESUMO

BACKGROUND: Programs of Enhanced Recovery After Surgery reduces morbidity and shorten recovery in patients undergoing colorectal resections for cancer. Patients presenting with more advanced disease such as T4 cancers are frequently excluded from undergoing ERAS programs due to the difficulty in applying established protocols. The primary aim of this investigation was to evaluate the possibility of applying a validated ERAS protocol in patients undergoing colorectal resection for T4 colon and rectal cancer and to evaluate the short-term outcome. METHODS: Single-center, retrospective cohort study. All patients with a clinical diagnosis of stage T4 colorectal cancer undergoing surgery between November 2016 and January 2020 were treated following the institutional fast track protocol without exclusion. Short-term postoperative outcomes were compared to those of a control group treated with conventional care and that underwent surgical resection for T4 colorectal cancer at the same institution from January 2010 to October 2016. Data from both groups were collected retrospectively from a prospectively maintained database. RESULTS: Eighty-two patients were diagnosed with T4 cancer, 49 patients were included in the ERAS cohort and 33 in the historical conventional care cohort. Both, the mean time of tolerance to solid food diet and postoperative length of stay were significantly shorter in the ERAS group than in the control group (3.14 ± 1.76 vs 4.8 ± 1.52; p < 0.0001 and 6.93 ± 3.76 vs 9.50 ± 4.83; p = 0.0084 respectively). No differences in perioperative complications were observed. CONCLUSIONS: Results from this cohort study from a single-center registry support the thesis that the adoption of the ERAS protocol is effective and applicable in patients with colorectal cancer clinically staged T4, reducing significantly their length of stay and time of tolerance to solid food diet, without affecting surgical postoperative outcomes.


Assuntos
Laparoscopia , Neoplasias Retais , Estudos de Coortes , Estudos de Viabilidade , Humanos , Tempo de Internação , Assistência Perioperatória , Complicações Pós-Operatórias , Prognóstico , Neoplasias Retais/cirurgia , Estudos Retrospectivos
2.
Medicine (Baltimore) ; 100(27): e25743, 2021 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-34232163

RESUMO

INTRODUCTION: The effect of perioperative omega-3 fatty acids for liver surgery remained controversial. We conducted a systematic review and meta-analysis to explore the influence of omega-3 fatty acids versus placebo in patients undergoing liver surgery. METHODS: We have searched PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through May 2020, and included randomized controlled trials (RCTs) assessing the effect of omega-3 fatty acids versus placebo for liver surgery. This meta-analysis was performed using the random-effect model. RESULTS: Five RCTs were included in the meta-analysis. Overall, compared with control group for liver surgery, omega-3 fatty acids were associated with substantially reduced incidence of infection (odd ratio [OR]=0.56; 95% confidence interval [CI] =0.34-0.91; P = .02), but revealed no remarkable influence on complications (OR = 0.60; 95% CI = 0.29-1.24; P = .17), mortality (OR = 0.76; 95% CI = 0.06-9.37; P = .83), liver failure (OR = 0.72; 95% CI = 0.10 to 5.00; P = 0.74), biliary leakage (OR=1.24; 95% CI = 0.41 to 3.76; P = .70), bleeding (OR = 1.76; 95% CI = 0.63-4.95; P = .28), or ileus (OR = 0.39; 95% CI = 0.07-2.05; P = .27). CONCLUSION: Perioperative omega-3 fatty acids may be beneficial to reduce the incidence of infection after liver surgery.


Assuntos
Ácidos Graxos Ômega-3/uso terapêutico , Hepatectomia , Hepatopatias/cirurgia , Assistência Perioperatória/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Suplementos Nutricionais , Humanos
3.
Surg Clin North Am ; 101(4): 577-586, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34242601

RESUMO

Surgical training programs have long used quantitative measures of knowledge, as well as subjective evaluation of technical skills, to define the competence of trainees. However, a growing body of literature has shown the importance of nontechnical surgical skills as vital components of quality surgical care. Institutions must train nontechnical surgical skills, including leadership, communication, teamwork, situational awareness, and decision making, and incorporate these attributes into their evaluative processes to maximally enhance surgical performance at every career stage.


Assuntos
Conscientização , Competência Clínica , Comunicação , Tomada de Decisões , Cirurgia Geral/educação , Liderança , Equipe de Assistência ao Paciente , Humanos , Relações Interprofissionais , Modelos Educacionais , Assistência Perioperatória/educação , Assistência Perioperatória/métodos , Estados Unidos
4.
J Surg Oncol ; 124(2): 216-220, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34245574

RESUMO

Team training and crisis management derive their roots from fundamental learning theory and the culture of safety that burgeoned forth from the industrial revolution through the rise of nuclear energy and aviation. The integral nature of telemedicine to many simulation-based activities, whether to bridge distances out of convenience or necessity, continues to be a common theme moving into the next era of surgical safety as newer, more robust technologies become available.


Assuntos
Educação à Distância/métodos , Educação de Pós-Graduação em Medicina/métodos , Equipe de Assistência ao Paciente , Assistência Perioperatória/educação , Treinamento por Simulação/métodos , Especialidades Cirúrgicas/educação , Procedimentos Cirúrgicos Operatórios/educação , Competência Clínica , Educação à Distância/organização & administração , Educação de Pós-Graduação em Medicina/organização & administração , Emergências , Humanos , Tutoria/métodos , Tutoria/organização & administração , Salas Cirúrgicas/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Segurança do Paciente/normas , Assistência Perioperatória/métodos , Assistência Perioperatória/normas , Treinamento por Simulação/organização & administração , Especialidades Cirúrgicas/normas , Procedimentos Cirúrgicos Operatórios/métodos , Procedimentos Cirúrgicos Operatórios/normas , Telemedicina/métodos , Telemedicina/organização & administração , Estados Unidos
6.
Medicine (Baltimore) ; 100(24): e26079, 2021 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-34128845

RESUMO

ABSTRACT: Enhanced recovery after surgery (ERAS) and perioperative surgical home (PSH) initiatives are widely utilized to improve quality of patient care. Despite their established benefits, implementation still has significant barriers. We developed a survey for perioperative clinicians to gather information on perception and knowledge of ERAS/PSH programs to guide future expansion of these programs at our institution. The survey included questions about familiarity with ERAS/PSH and perceived value, perceived barriers to protocol implementation, preferred learning methods and prioritization of various ERAS/PSH protocol elements into care delivery and provider education. Faculty surgeons and anesthesiologists, in addition to advanced practice nurses and postgraduate physician trainees in the Departments of Surgery and Anesthesiology were asked to complete the survey. Overall survey participation was 25% (223/888). About half of survey respondents had provided care to a patient on an ERAS/PSH protocol, and a majority felt at least somewhat knowledgeable about ERAS/PSH protocols. Perception of the value of ERAS/PSH was positive. Participants were enthusiastic about on-going learning, with multimodal pain management being the topic of most interest and learning by direct participation in care of protocol patients being the favored educational approach. A significant majority of participants felt that upcoming health providers should receive formal ERAS/PSH education as part of their training. Based on our survey results, we plan to explore teaching methods that successfully engage learners of all levels of clinical expertise and also overcome the major barriers to gaining knowledge about ERAS/PSH identified by study participants, most notably lack of time for busy clinicians.


Assuntos
Anestesiologistas/psicologia , Atitude do Pessoal de Saúde , Recuperação Pós-Cirúrgica Melhorada , Assistência Perioperatória/psicologia , Cirurgiões/psicologia , Adulto , Anestesiologistas/educação , Protocolos Clínicos , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Cirurgiões/educação , Inquéritos e Questionários , Centros de Atenção Terciária
7.
Lancet Haematol ; 8(7): e492-e502, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34171280

RESUMO

BACKGROUND: Dosing of replacement therapy with factor VIII concentrate in patients with haemophilia A in the perioperative setting is challenging. Underdosing and overdosing of factor VIII concentrate should be avoided to minimise risk of perioperative bleeding and treatment costs. We hypothesised that dosing of factor VIII concentrate on the basis of a patient's pharmacokinetic profile instead of bodyweight, which is standard treatment, would reduce factor VIII consumption and improve the accuracy of attained factor VIII levels. METHODS: In this open-label, multicentre, randomised, controlled trial (OPTI-CLOT), patients were recruited from nine centres in Rotterdam, Groningen, Utrecht, Nijmegen, The Hague, Leiden, Amsterdam, Eindhoven, and Maastricht in The Netherlands. Eligible patients were aged 12 years or older with severe or moderate haemophilia A (severe haemophilia was defined as factor VIII concentrations of <0·01 IU/mL, and moderate haemophilia as 0·01-0·05 IU/mL), without factor VIII inhibitors, and planned for elective low or medium risk surgery as defined by surgical risk score. Patients were randomly assigned (1:1) using a web-based randomisation system and treatment minimisation, stratified by method of administration of factor VIII concentrate (continuous infusion vs bolus administration) and risk level of surgery (low and medium risk surgery), to the pharmacokinetic-guided or standard treatment group. The primary endpoint was total amount of infused factor VIII concentrate (IU per kg bodyweight) during perioperative period (from day of surgery up to 14 days after surgery). Analysis was by intention to treat and the safety analysis population comprised all participants who underwent surgery with factor VIII concentrate. This study is registered with the Netherlands Trial Registry, NL3955, and is now closed to accrual. FINDINGS: Between May 1, 2014, and March 1, 2020, 98 patients were assessed for eligibility and 66 were enrolled in the trial and randomly assigned to the pharmacokinetic-guided treatment group (34 [52%]) or the standard treatment group (32 [48%]). Median age was 49·1 years (IQR 35·0 to 62·1) and all participants were male. No difference was seen in consumption of factor VIII concentrate during the perioperative period between groups (mean consumption of 365 IU/kg [SD 202] in pharmacokinetic-guided treatment group vs 379 IU/kg [202] in standard treatment group; adjusted difference -6 IU/kg [95% CI -88 to 100]). Postoperative bleeding occurred in six (18%) of 34 patients in the pharmacokinetic-guided treatment group and three (9%) of 32 in the standard treatment group. One grade 4 postoperative bleeding event occurred, which was in one (3%) patient in the standard treatment group. No treatment-related deaths occurred. INTERPRETATION: Although perioperative pharmacokinetic-guided dosing is safe, it leads to similar perioperative factor VIII consumption when compared with standard treatment. However, pharmacokinetic-guided dosing showed an improvement in obtaining factor VIII concentrations within the desired perioperative factor VIII range. These findings provide support to further investigation of pharmacokinetic-guided dosing in perioperative haemophilia care. FUNDING: Dutch Research Council (NWO)-ZonMw and Takeda.


Assuntos
Coagulantes/uso terapêutico , Fator VIII/uso terapêutico , Hemofilia A/tratamento farmacológico , Adulto , Coagulantes/farmacocinética , Esquema de Medicação , Procedimentos Cirúrgicos Eletivos , Fator VIII/farmacocinética , Hemofilia A/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Assistência Perioperatória , Índice de Gravidade de Doença , Resultado do Tratamento
8.
J Cardiothorac Surg ; 16(1): 161, 2021 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-34090464

RESUMO

BACKGROUND: This study aimed to compare the effects of N-acetyl cysteine on renal function after coronary artery bypass graft surgery. METHODS: In this randomized clinical trial conducted in Golestan Hospital, Ahvaz, Iran, 60 candidates for coronary artery bypass graft surgery were selected and divided into two N-acetyl cysteine and control groups (30 people each). Patients received 3 (2 intraoperative and 1 postoperative) doses of IV N-acetyl cysteine (100 mg/kg) (n = 30) or placebo (n = 30) over 24 h. Prescription times were as follows: after induction of anesthesia, in the Next 4 h, and in the 16 h after on. Primary outcomes were serum levels of BUN and Cr, at baseline,4 and 48 h after surgery. And also need renal replacement therapy (RRT). Secondary outcomes included the hemodynamic variables, Blood products transfusion. RESULTS: There were significant differences in BUN between groups at 4 h (P = 0.02) and 48 h after surgery (P = 0.001) There were significant differences in Cr level between groups at 4 h (P < 0.001) and 48 h after surgery (P = 0.001). MAP at different times (at 4 h p = 0.002 and 48 h after surgery P < 0.001) were significantly different between the two groups. There was a significant difference between the two groups in terms of the unit of Packed cell transfusion (P = 0.002) and FFP transfusion (P < 0.001). CONCLUSION: In the present study, we found that administration of N-acetyl cysteine can reduce the incidence of acute kidney injury in patients undergoing coronary artery bypass graft surgery and improved kidney functions. TRIAL REGISTRY: IRCT20190506043492N3 Registered at 2020.06.07.


Assuntos
Acetilcisteína/uso terapêutico , Injúria Renal Aguda/prevenção & controle , Antioxidantes/uso terapêutico , Ponte de Artéria Coronária , Complicações Pós-Operatórias/prevenção & controle , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/epidemiologia , Injúria Renal Aguda/etiologia , Adulto , Idoso , Método Duplo-Cego , Esquema de Medicação , Feminino , Humanos , Injeções Intravenosas , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Assistência Perioperatória/métodos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Resultado do Tratamento
10.
J Clin Neurosci ; 89: 144-150, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34119258

RESUMO

Gliomas are a heterogeneous group of primary brain cancers with poor survival despite multimodality therapy that includes surgery, radiation and chemotherapy. Numerous clinical trials have investigated systemic therapies in glioma, but have largely been negative. Multiple factors have contributed to the lack of progress including tumour heterogeneity, the tumour micro-environment and presence of the blood-brain barrier, as well as extrinsic factors relating to trial design, such as the lack of a contemporaneous biopsy at the time of treatment. A number of strategies have been proposed to progress new agents into the clinic. Here, we review the progress of perioperative, including phase 0 and 'window of opportunity', studies and provide recommendations for trial design in the development of new agents for glioma. The incorporation of pre- and post-treatment biopsies in glioma early phase trials will provide valuable pharmacokinetic and pharmacodynamic data and also determine the target or biomarker effect, which will guide further development of new agents. Perioperative 'window of opportunity' studies must use drugs with a recommended-phase-2-dose, known safety profile and adequate blood-brain barrier penetration. Drugs shown to have on-target effects in perioperative trials can then be evaluated further in a larger cohort of patients in an adaptive trial to increase the efficiency of drug development.


Assuntos
Neoplasias Encefálicas/patologia , Ensaios Clínicos como Assunto/métodos , Glioma/patologia , Assistência Perioperatória/métodos , Antineoplásicos/farmacologia , Antineoplásicos/uso terapêutico , Biópsia , Barreira Hematoencefálica/patologia , Barreira Hematoencefálica/cirurgia , Neoplasias Encefálicas/tratamento farmacológico , Neoplasias Encefálicas/cirurgia , Terapia Combinada/métodos , Resistencia a Medicamentos Antineoplásicos/efeitos dos fármacos , Resistencia a Medicamentos Antineoplásicos/fisiologia , Glioma/tratamento farmacológico , Glioma/cirurgia , Humanos , Assistência Perioperatória/tendências , Microambiente Tumoral/fisiologia
11.
Curr Opin Obstet Gynecol ; 33(4): 262-269, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-34183549

RESUMO

PURPOSE OF REVIEW: This article will review current guidelines regarding surgical protocols for elective and nonelective surgeries during the severe acute respiratory syndrome coronavirus 2 pandemic. RECENT FINDINGS: Perioperative management for surgical patients should be modified to promote the safety and wellbeing of patients and caregivers amidst the COVID-19 pandemic. COVID-19 testing should be performed preoperatively with subsequent preprocedure quarantine. Nonemergent or nonlife-threatening surgery should be postponed for COVID-19 positive patients. The consensus of surgical societies is to use a laparoscopic surgical approach for COVID-19 positive patients when appropriate and to avoid port venting at the end of procedures. For COVID-19 positive patients requiring an emergent procedure, the use of personal protective equipment is strongly recommended. SUMMARY: After over a year of the COVID-19 pandemic, effective protocols and precautions have been established to decrease the morbidity and mortality of patients undergoing surgery and to promote the safety of healthcare personnel. Continued investigations are necessary as cases of new, possibly more virulent, strains of the virus arise.


Assuntos
COVID-19/prevenção & controle , Transmissão de Doença Infecciosa/prevenção & controle , Procedimentos Cirúrgicos em Ginecologia/normas , Procedimentos Cirúrgicos Minimamente Invasivos/normas , Assistência Perioperatória/normas , Guias de Prática Clínica como Assunto , Feminino , Humanos , Laparoscopia , Equipamento de Proteção Individual , SARS-CoV-2
12.
J Cardiothorac Surg ; 16(1): 166, 2021 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-34099003

RESUMO

BACKGROUND: Re-exploration of bleeding after cardiac surgery is associated with significant morbidity and mortality. Perioperative blood loss and rate of re-exploration are variable among centers and surgeons. OBJECTIVE: To present our experience of low rate of re-exploration based on adopting checklist for hemostasis and algorithm for management. METHODS: Retrospective analysis of medical records was conducted for 565 adult patients who underwent surgical treatment of congenital and acquired heart disease and were complicated by postoperative bleeding from Feb 2006 to May 2019. Demographics of patients, operative characteristics, perioperative risk factors, blood loss, requirements of blood transfusion, morbidity and mortality were recorded. Logistic regression was used to identify predictors of re-exploration and determinants of adverse outcome. RESULTS: Thirteen patients (1.14%) were reexplored for bleeding. An identifiable source of bleeding was found in 11 (84.6%) patients. Risk factors for re-exploration were high body mass index, high Euro SCORE, operative priority (urgent/emergent), elevated serum creatinine and low platelets count. Re-exploration was significantly associated with increased requirements of blood transfusion, adverse effects on cardiorespiratory state (low ejection fraction, increased s. lactate, and prolonged period of mechanical ventilation), longer intensive care unit stay, hospital stay, increased incidence of SWI, and higher mortality (15.4% versus 2.53% for non-reexplored patients). We managed 285 patients with severe or massive bleeding conservatively by hemostatic agents according to our protocol with no added risk of morbidity or mortality. CONCLUSION: Low rate of re-exploration for bleeding can be achieved by strict preoperative preparation, intraoperative checklist for hemostasis implemented by senior surgeons and adopting an algorithm for management.


Assuntos
Algoritmos , Procedimentos Cirúrgicos Cardíacos , Lista de Checagem , Hemostasia Cirúrgica/normas , Assistência Perioperatória/normas , Hemorragia Pós-Operatória/diagnóstico , Hemorragia Pós-Operatória/cirurgia , Adulto , Idoso , Feminino , Seguimentos , Hemostasia Cirúrgica/métodos , Humanos , Incidência , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Assistência Perioperatória/métodos , Hemorragia Pós-Operatória/epidemiologia , Hemorragia Pós-Operatória/prevenção & controle , Reoperação , Estudos Retrospectivos , Fatores de Risco
15.
Zentralbl Chir ; 146(3): 241-248, 2021 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-34154005

RESUMO

Malignancies are among the most common diseases, especially in old age, and are responsible for 25% of all deaths in Germany. Especially carcinomas of the gastrointestinal tract can be cured in most cases only through extensive surgery with significant morbidity. About 25 years ago, the multimodal, perioperative Fast Track (FT) concept for reducing postoperative complications was introduced and additional elements were added in the following years. Meanwhile, there is growing evidence that adherence to the key elements of more than 70% leads to reduction in postoperative adverse events as well as a shorter hospital stay and could be associated with an improved oncological outcome. Despite the high level of awareness and the proven advantages of the FT concept, the implementation and maintenance of the measures is difficult and results in an adherence of only 20 - 40%. There are many reasons for this: In addition to a lack of interdisciplinary and interprofessional cooperation and the time consuming and extended logistical efforts, limited human resources are often listed as one of the main causes. We took these aspects as an opportunity and started to develop a S3 guideline for perioperative treatment to accelerate the recovery of patients with gastrointestinal malignancies. By creating a consensus- and evidence-based, multidisciplinary guideline, many of the problems listed above could probably be solved by optimising and standardising interdisciplinary care, which is particularly important in a setting with many different disciplines and their competing interests. Furthermore, the standardisation of the perioperative procedures will reduce the time and logistical effort. The presentation of the evidence allows increased transparency and justifies the additional personnel expenditure on hospital medicine and health insurance companies. In addition, the evidence-based quality indicators generated during the development of the guideline make it possible to include perioperative standards in certification systems and thus to measure and check the quality of perioperative care.


Assuntos
Neoplasias Gastrointestinais , Assistência Perioperatória , Neoplasias Gastrointestinais/cirurgia , Alemanha , Humanos , Tempo de Internação , Complicações Pós-Operatórias/prevenção & controle
18.
Enferm. foco (Brasília) ; 12(1): 191-195, jun. 2021. ilus
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1280850

RESUMO

Objetivo: descrever a experiência relacionada a reabilitação respiratória para pacientes submetidos à cirurgia torácica e abdominal superior durante a execução de um programa de extensão universitária. Método: relato de experiência, com abordagem descritiva, sobre a criação de um programa interdisciplinar de reabilitação respiratória para pacientes submetidos à cirurgia torácica e abdominal superior com parceria entre universidade pública e hospital municipal de Imperatriz, Maranhão. Resultados: as atividades do programa universitário de reabilitação respiratória para pacientes em pós-operatório são desempenhadas em três eixos in locus: Educação em Exercícios Respiratórios, Capacitação sobre assistência de enfermagem no pós-operatório de cirurgias torácicas e abdominais e, Educação em saúde e intervenções de enfermagem na atenção ao paciente no período pós-operatório. Conclusão: a atuação em projeto respiratório interdisciplinar, focado em ações educativas, mostrou-se uma ferramenta inovadora de apoio ao cuidado clínico de pacientes submetidos à cirurgia torácica e abdominal superior. (AU)


Objective: To describe the experience related to respiratory rehabilitation for patients undergoing thoracic and upper abdominal surgery during the execution of a university extension program. Methods: Experience report, with a descriptive approach, on the creation of an interdisciplinary program of respiratory rehabilitation for patients undergoing thoracic and upper abdominal surgery in partnership with a public university and a municipal hospital in Imperatriz, Maranhão. Results: The activities of the university respiratory rehabilitation program for patients in the postoperative period are performed in three axes in locus: Education in Respiratory Exercises, Training in nursing care in the postoperative period of thoracic and abdominal surgeries, and Health education and interventions nursing in patient care in the postoperative period. Conclusion: Acting in an interdisciplinary respiratory project, focused on educational actions, proved to be an innovative tool to support the clinical care of patients undergoing thoracic and upper abdominal surgery. (AU)


Objetivo: Describir la experiencia relacionada con la rehabilitación respiratoria para pacientes sometidos a cirugía torácica y abdominal superior durante la ejecución de un programa de extensión universitaria. Métodos: Informe de experiencia, con un enfoque descriptivo, sobre la creación de un programa interdisciplinario de rehabilitación respiratoria para pacientes sometidos a cirugía torácica y abdominal superior en colaboración con una universidad pública y un hospital municipal en Imperatriz, Maranhão. Resultados: Las actividades del programa universitario de rehabilitación respiratoria para pacientes en el postoperatorio se realizan en tres ejes en el locus: educación en ejercicios respiratorios, capacitación en cuidados de enfermería en el postoperatorio de cirugías torácicas y abdominales, y educación e intervenciones de salud enfermería en atención al paciente en el postoperatorio. Conclusión: Actuar en un proyecto respiratorio interdisciplinario, centrado en acciones educativas, demostró ser una herramienta innovadora para apoyar la atención clínica de pacientes sometidos a cirugía torácica y abdominal superior. (AU)


Assuntos
Ensino , Complicações Pós-Operatórias , Exercícios Respiratórios , Assistência Perioperatória , Práticas Interdisciplinares
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