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1.
Am Surg ; 86(6): 635-642, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32683978

RESUMO

OBJECTIVES: The purpose of this study was to identify trauma patients who would benefit from surgical placement of an enteral feeding tube during their index abdominal trauma operation. METHODS: We performed a retrospective analysis of all patients admitted to 2 level I trauma centers between January 2013 and February 2018 requiring urgent exploratory abdominal surgery. RESULTS: Six-hundred and one patients required exploratory abdominal surgery within 24 hours of admission after trauma activation. Nineteen (3% of total) patients underwent placement of a feeding tube after their initial exploratory surgery. On multivariate analysis, an intracranial Abbreviated Injury Scale ≥4 (odds ratio [OR] = 9.24, 95% CI 1.09-78.26, P = .04) and a Glasgow Coma Scale ≤8 (OR = 4.39, 95% CI 1.38-13.95, P = .01) were associated with increased odds of requiring a feeding tube. All patients who required a feeding tube had an Injury Severity Score ≥15. While not statistically significant, patients with an open surgical feeding tube compared with interventional radiology/percutaneous endoscopic gastrostomy placement had lower median intensive care unit length of stay, fewer ventilator days, and shorter median total hospital length of stay. CONCLUSIONS: Trauma patients with severe intracranial injury already requiring urgent exploratory abdominal surgery may benefit from early, concomitant placement of a feeding tube during the index abdominal operation, or at fascial closure.


Assuntos
Traumatismos Abdominais , Lesões Encefálicas Traumáticas/terapia , Nutrição Enteral/estatística & dados numéricos , Intubação Gastrointestinal/estatística & dados numéricos , Traumatismos Abdominais/diagnóstico , Traumatismos Abdominais/cirurgia , Adulto , Nutrição Enteral/métodos , Feminino , Humanos , Escala de Gravidade do Ferimento , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Retrospectivos
2.
Rev. Hosp. Ital. B. Aires (2004) ; 40(1): 4-10, mar. 2020. ilus, tab
Artigo em Espanhol | LILACS | ID: biblio-1100756

RESUMO

Se realizó un estudio prospectivo y descriptivo, incluyendo 103 pacientes que fueron tratados por cáncer de laringe en etapa inicial (T1-T2) con cirugía transoral. De ellos, 55 se diagnosticaron en estadio T1, 16 en estadio T1-b y 32 en estadio T2. El control local inicial (CLI) en pacientes con tumores malignos de laringe estadificados T1 fue 91%, el control local con rescate (CLR) 96%, la preservación de la función de la laringe (PFL) 93% y la sobrevida específica 96%. En T1-b, el CLI fue 81%, el CLR 94%, la PFL 94% y la sobrevida específica 94%. En T2, el CLI fue 63%, el CLR 94%, la PFL 72% y la sobrevida específica 78%. La cirugía transoral en cáncer de laringe con T inicial tiene resultados oncológicos similares a otros tratamientos (cirugía externa o radioterapia), pero consideramos que es la mejor opción por su baja morbilidad, menor duración del tratamiento, y porque deja abiertas todas las posibilidades para tratar posibles recurrencias. (AU)


A prospective and descriptive study was conducted, including 103 patients who were treated for early stage laryngeal cancer (T1-T2) with transoral surgery. Of these, 55 were diagnosed in stage T1, 16 in stage T1-b and 32 in stage T2. The initial local control (CLI) in patients with malignant T1 laryngeal tumors was: 91%, local control with rescue (CLR) 96%, preservation of larynx function (PFL) 93% and specific survival 96%. In T1-b the CLI was 81%, the CLR 94%, the PFL 94% and the specific survival 94%. In T2 the CLI was 63%, the CLR 94%, the PFL 72% and the specific survival 78%. Transoral surgery in laryngeal cancer with initial T has oncological results similar to other treatments (external surgery or radiotherapy), but we consider that it is the best option because of its low morbidity, shorter duration of treatment, and because it leaves open all the possibilities to treat possible recurrences. (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Neoplasias Laríngeas/cirurgia , Recidiva Local de Neoplasia/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Procedimentos Cirúrgicos Operatórios/métodos , Prega Vocal/patologia , Qualidade da Voz , Traqueostomia/estatística & dados numéricos , Neoplasias Laríngeas/classificação , Neoplasias Laríngeas/diagnóstico , Neoplasias Laríngeas/fisiopatologia , Neoplasias Laríngeas/mortalidade , Neoplasias Laríngeas/radioterapia , Estudos Prospectivos , Epiglote/patologia , Duração da Terapia , Intubação Gastrointestinal/estatística & dados numéricos
3.
Pediatrics ; 145(2)2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31996405

RESUMO

OBJECTIVES: Oropharyngeal dysphagia and aspiration may occur in infants and children. Currently, there is wide practice variation regarding when to feed children orally or place more permanent gastrostomy tube placement. Through implementation of an evidence-based guideline (EBG), we aimed to standardize the approach to these patients and reduce the rates of gastrostomy tube placement. METHODS: Between January 2014 and December 2018, we designed and implemented a quality improvement intervention creating an EBG to be used by gastroenterologists evaluating patients ≤2 years of age with respiratory symptoms who were found to aspirate on videofluoroscopic swallow study (VFSS). Our primary aim was to encourage oral feeding and decrease the use of gastrostomy tube placement by 10% within 1 year of EBG initiation; balancing measures included total hospital readmissions or emergency department (ED) visits within 6 months of the abnormal VFSS. RESULTS: A total of 1668 patients (27.2%) were found to have aspiration or penetration noted on an initial VFSS during our initiative. Mean gastrostomy tube placement in these patients was 10.9% at the start of our EBG implementation and fell to 5.2% approximately 1 year after EBG initiation; this improvement was sustained throughout the next 3 years. Our balancing measures of ED visits and hospital readmissions also did not change during this time period. CONCLUSIONS: Through implementation of this EBG, we reduced gastrostomy tube placement by 50% in patients presenting with oropharyngeal dysphagia and aspiration, without increasing subsequent hospital admissions or ED visits.


Assuntos
Medicina Baseada em Evidências , Gastrostomia/instrumentação , Melhoria de Qualidade , Aspiração Respiratória de Conteúdos Gástricos/terapia , Transtornos de Deglutição/complicações , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Gastrostomia/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Intubação Gastrointestinal/instrumentação , Intubação Gastrointestinal/estatística & dados numéricos , Masculino , Aspiração Respiratória de Conteúdos Gástricos/diagnóstico por imagem , Fatores de Tempo
4.
Rev Lat Am Enfermagem ; 27: e3198, 2019 Oct 14.
Artigo em Português, Inglês, Espanhol | MEDLINE | ID: mdl-31618391

RESUMO

OBJECTIVE: to evaluate the clinical and nutritional evolution of elderly patients receiving home enteral nutritional therapy. METHOD: retrospective cohort observational study. Data collection was performed through the analysis of clinical and nutritional records. The demographic, nutritional and clinical variables were analyzed. The sample consisted of elderly patients using home enteral nutritional therapy via the probe or the stomach. For the statistical analysis, the Statistical Package for the Social Sciences program was used, adopting the level of significance of 5%. RESULTS: the sample was 218 participants, with a mean age of 76 ± 10.12 years, of which 54.1% were female. The main morbidity was the stroke sequelae. Malnutrition was the nutritional diagnosis and the overall subjective assessment, the main instrument of nutritional evaluation. The route of administration of the most prevalent diet was the nasoenteric/nasogastric tube, however, after one year of follow-up, gastrostomy became the main route. It was observed the predominance of general condition maintenance and the most prevalent clinical outcome was death. CONCLUSION: the majority of patients in home enteral nutrition therapy presented maintenance and / or improvement of clinical and nutritional status. Therefore, this therapy may contribute to a better clinical and nutritional evolution.


Assuntos
Nutrição Enteral/estatística & dados numéricos , Serviços de Assistência Domiciliar/estatística & dados numéricos , Estado Nutricional , Acidente Vascular Cerebral/terapia , Idoso , Idoso de 80 Anos ou mais , Feminino , Gastrostomia/estatística & dados numéricos , Avaliação Geriátrica/estatística & dados numéricos , Humanos , Intubação Gastrointestinal/estatística & dados numéricos , Masculino , Desnutrição/terapia , Estudos Retrospectivos , Resultado do Tratamento
5.
Rev. esp. enferm. dig ; 111(7): 507-513, jul. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-190096

RESUMO

Introducción: estudio prospectivo y aleatorizado para valorar la influencia de la sedación consciente, con midazolam y fentanilo, sobre la calidad global de la colonoscopia, cuantificando simultáneamente su efecto sobre la calidad científica, la calidad percibida y la seguridad del paciente. Método: se incluyeron prospectivamente pacientes remitidos para colonoscopia y se aleatorizaron para recibir o no sedación. Se recogieron datos demográficos, indicación de la colonoscopia, intubación cecal, grado de limpieza colónica, tiempo de introducción y retirada, adenomas resecados y complicaciones durante la exploración y recuperación del paciente. Treinta días después se realizó un cuestionario de satisfacción (GHAA 9-me) y se preguntó por las complicaciones tras la exploración. Resultados: se incluyeron 5.328 pacientes (edad 62 +/- 15,22; 47% varones; 3.734 sedados y 1.594 sin sedación). Los pacientes sedados mostraron menor tiempo de introducción del endoscopio (7'20 +/- 2'15 vs. 6'15 +/- 3'12 minutos; p < 0,019), mayor tasa de intubaciones del ciego (96% vs. 88%; p < 0,05), tiempo de retirada más prolongado (7'20 +/- 2'15 vs. 6'15 +/- 3'12 minutos; p < 0,01) y mayor tasa de adenomas (22% vs. 17; p < 0,05), adenomas avanzados (8% vs. 4,3%; p < 0,05) y pólipos serrados (1,9% vs. 0,6%; p = 0,05). El uso de sedación disminuyó las molestias durante y después de la exploración, sin aumentar las complicaciones. La puntuación del cuestionario de satisfacción fue mayor (23,6 +/- 1,5 vs. 16,6 +/- 4,8; p < 0,001) en los pacientes sedados. Conclusiones: la sedación superficial con midazolam y fentanilo no solo disminuye las molestias de los pacientes, sino que mejora la calidad global de la colonoscopia. Por esto, debemos considerar el uso de sedación como una parte imprescindible de la colonoscopia


Introduction: a prospective, randomized study was performed to assess the influence of conscious sedation on the overall quality of colonoscopy, simultaneously quantifying its effect on the scientific quality, perceived quality and patient safety. Methods: patients referred for a colonoscopy were included in the study and were randomized to receive or not receive sedation. Demographic data, indication for colonoscopy, cecal intubation, introduction and withdrawal time, resected adenomas and complications during the exploration were collected. Thirty days later, a satisfaction questionnaire was performed (GHAA 9-me) and patients were asked about complications after the examination. Results: a total of 5,328 patients were included, the average age was 62 +/- 15.22 years, 47% were male, 3,734 were sedated and 1,594 were not sedated. The sedated patients had a shorter endoscope insertion time (7'20 +/- 2'15 min vs 6'15 +/- 3'12 min, p < 0.019), a higher rate of cecal intubations (96% vs 88%, p < 0.05), longer withdrawal time (7'20 +/- 2'15 min vs 6'15 +/- 3'12 min, p < 0.01) and higher adenoma detection rates (22% vs 17%, p < 0.05). The use of sedation reduced discomfort during and after the exploration, without increasing the complications. The satisfaction questionnaire score was higher (23.6 +/- 1.5 vs 16.6 +/- 4.8, p < 0.001) in the sedated patients. Conclusions: superficial sedation not only reduces patient discomfort but also improves the overall quality of the colonoscopy. Therefore, we must consider the use of sedation as an essential part of colonoscopy


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Sedação Consciente/métodos , Colonoscopia/métodos , Midazolam/administração & dosagem , Fentanila/administração & dosagem , Adenoma/diagnóstico por imagem , Pólipos do Colo/diagnóstico por imagem , Estudos Prospectivos , Hipnóticos e Sedativos/administração & dosagem , Qualidade da Assistência à Saúde/estatística & dados numéricos , Segurança do Paciente/estatística & dados numéricos , Intubação Gastrointestinal/estatística & dados numéricos , Estudos de Casos e Controles , Complicações Pós-Operatórias/epidemiologia
6.
J Pediatr Surg ; 54(5): 1041-1044, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30819544

RESUMO

BACKGROUND: Gastrojejunostomy tubes (GJTs) have been associated with intestinal perforation in children <6 months or <6 kg. This study evaluated the impact of an institutional practice change recommending a new soft tip GJT for children <10 kg. METHODS: We performed a single-center review of GJT placements among children <10 kg before (1/1/2010-12/31/2013) and after (7/1/2014-12/31/2016) the practice change. Intestinal perforation, nasojejunal tube (NJT) for >30 days, and GJT replacement were assessed. RESULTS: Sixty GJTs were placed in 35 children (54% male; 17.2±9.0 months old) after compared to 147 GJTs in 77 children (44% male, p=0.32; 14.1±11.8 months, p=0.08) before the practice change. Use of soft tip GJT was adhered to in 19 placements (32%). There were no intestinal perforations after the practice change (before: 6 (4.1%); p=0.11). NJT remained >30 days in 15 patients (65%) after the practice change (before: 13 (35%); p=0.02). Replacement was required for 53% with soft tip GJT and 18% with standard GJT (p=0.006). DISCUSSION: A reduction in intestinal perforation with an institutional practice change may be explained by fewer GJT placements in high-risk children and longer length of NJT placement. Future protocols may consider age and size restrictions rather than alternative tube types. TYPE OF STUDY: Treatment study. LEVEL OF EVIDENCE: Level III.


Assuntos
Derivação Gástrica , Perfuração Intestinal/etiologia , Intubação Gastrointestinal , Pré-Escolar , Desenho de Equipamento , Feminino , Derivação Gástrica/efeitos adversos , Derivação Gástrica/instrumentação , Derivação Gástrica/estatística & dados numéricos , Humanos , Lactente , Intubação Gastrointestinal/efeitos adversos , Intubação Gastrointestinal/instrumentação , Intubação Gastrointestinal/estatística & dados numéricos , Masculino , Estudos Retrospectivos
7.
Obes Surg ; 29(4): 1236-1241, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30613935

RESUMO

INTRODUCTION: The Ellipse intragastric balloon (EIGB) is a new swallowable balloon that does not require endoscopy at insertion or removal. The aim of this study is to investigate the safety of EIGB and its efficiency in weight reduction even after 1 year of expulsion. METHOD: Prospective study on our initial experience with a consecutive group of patients who underwent the insertion of EIGB in the period between September 2016 and February 2017. The patients were followed up to assess pain, nausea, and vomiting after procedure. As well as, the time of balloon extraction, route of extraction, and weight loss. RESULTS: Total of 112 patients underwent EIGB placement. A 1-year follow-up was obtained on 85% of patients. Mean weight and BMI before the procedure 92.2 kg and 34.3 kg/m2, respectively. One patient had small bowel obstruction. Six patients did not tolerate EIGB and three patients had early deflation. Total weight loss % (TWL%) 10.7, 10.9, and 7.9% at 3, 6, and at date of last follow-up. When data were stratified according to BMI into two groups: group 1 (BMI 27.5-34.9) and group 2 (BMI 35-49), the TWL% for group 1 at 3 months, 6 months, and last day of follow-up are as follows: 10.2%, 10.6%, and 8.8%, while it was 11.5%, 11.2%, and 6.6% for group 2. CONCLUSION: EIGB are effective, safe, and feasible non-invasive method for weight loss.


Assuntos
Remoção de Dispositivo , Balão Gástrico , Intubação Gastrointestinal , Obesidade Mórbida/terapia , Perda de Peso/fisiologia , Dor Abdominal/epidemiologia , Dor Abdominal/etiologia , Adulto , Remoção de Dispositivo/efeitos adversos , Remoção de Dispositivo/estatística & dados numéricos , Endoscopia Gastrointestinal/efeitos adversos , Endoscopia Gastrointestinal/instrumentação , Endoscopia Gastrointestinal/estatística & dados numéricos , Desenho de Equipamento , Feminino , Seguimentos , Balão Gástrico/efeitos adversos , Balão Gástrico/estatística & dados numéricos , Humanos , Intubação Gastrointestinal/efeitos adversos , Intubação Gastrointestinal/instrumentação , Intubação Gastrointestinal/métodos , Intubação Gastrointestinal/estatística & dados numéricos , Masculino , Náusea/epidemiologia , Náusea/etiologia , Obesidade Mórbida/epidemiologia , Fatores de Tempo , Resultado do Tratamento , Vômito/epidemiologia , Vômito/etiologia , Adulto Jovem
8.
J Formos Med Assoc ; 118(1 Pt 3): 401-405, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30006232

RESUMO

BACKGROUND/PURPOSE: This study aims to investigate the safety and feasibility of laparoscopic adrenalectomy for benign adrenal tumor without peri-operative NGT decompression. METHODS: From July 2010 to March 2014, 82 consecutive patients with benign unilateral adrenal tumor underwent elective laparoscopic adrenalectomy by a single surgeon were recruited for this study. We compared the clinico-demographic profile, estimated blood loss, operative time, time to full diet, time to ambulate, the length of hospital staying, analgesics use and complications between two groups stratified by the use of NGT. RESULTS: There were no significant differences in the clinico-demographic profile of the two groups, including age, laterality, body mass index, gender, ASA classification, tumor diameter and histologic types between two groups. Peri-operative parameters were similar between NGT and Non-NGT groups (estimated blood loss, 55.85 vs. 54.4 ml; operative time, 110.3 vs. 112.3 min; p > 0.05) The post-operative outcome of interests, including days to full oral intake (3.32 vs. 3.34 days), days to ambulate (2.07 vs. 2.10 days), hospital stay (4.32 vs. 4.34 days), and analgesics use (6.00 vs. 5.83 mg; all p > 0.05) showed no significant difference between NGT and non-NGT group. CONCLUSION: Laparoscopic adrenalectomy in patients with benign unilateral adrenal tumor without the use of peri-operative nasogastric tube decompression is safe and feasible.


Assuntos
Neoplasias das Glândulas Suprarrenais/cirurgia , Adrenalectomia/métodos , Descompressão Cirúrgica/estatística & dados numéricos , Laparoscopia Assistida com a Mão/estatística & dados numéricos , Intubação Gastrointestinal/estatística & dados numéricos , Adrenalectomia/efeitos adversos , Adulto , Perda Sanguínea Cirúrgica , Descompressão Cirúrgica/instrumentação , Feminino , Laparoscopia Assistida com a Mão/métodos , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias , Taiwan , Resultado do Tratamento
9.
J Am Geriatr Soc ; 66(7): 1388-1391, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29799111

RESUMO

OBJECTIVES: To identify trends in percutaneous endoscopic gastrostomy (PEG) tube placement and intravenous hyperalimentation (IVH) in nonhospital settings (as a potential alternative to tube feeding for nutrition) and to summarize published reports concerning the decision-making process for PEG placement. DESIGN: National survey and systematic review. SETTING: Japan. PARTICIPANTS: All Japanese people. MEASUREMENTS: Data on numbers of individuals with a PEG tube and IVH were obtained from the website of the Japanese Ministry of Health, Labour, and Welfare and published reports concerning the decision-making process for PEG placement in Japan were summarized. RESULTS: The number of PEG tube placements peaked in 2007 and has been decreasing since Japan experienced the Great East Japan Earthquake in 2011. A further decline was seen in 2015 after the Japanese Ministry of Health, Labour and Welfare revised the fee schedule in 2014. More than half of individuals who had tubes were aged 80 and older during the years observed. In contrast, the number of individuals receiving IVH was lowest in the same year as PEG tube placement peaked and has been increasing ever since. Four studies reported that the decision-making process included consideration of not only the underlying disease, but also the individual's age and social barriers and the physician's personal philosophy. CONCLUSION: The number of PEG tube placements has been decreasing since its peak in 2007, and the number of individuals receiving IVH has been increasing. Many factors influence the decision-making process for PEG tube placement. Physicians in Japan may be realizing that there is little evidence to support the use of tube feeding in frail elderly adults.


Assuntos
Tomada de Decisões , Endoscopia Gastrointestinal/estatística & dados numéricos , Nutrição Enteral/estatística & dados numéricos , Intubação Gastrointestinal/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Assistência de Longa Duração , Masculino , Padrões de Prática Médica/estatística & dados numéricos
10.
Dysphagia ; 33(5): 636-644, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29468269

RESUMO

We sought to determine individual and system contributions to race disparities in percutaneous endoscopic gastrostomy (PEG) tube placement after stroke. Ischemic stroke admissions were identified from the Nationwide Inpatient Sample between 2007 and 2011. Hospitals were categorized based on the percentage of ethnic/racial minority stroke patients (< 25% ethnic/racial minorities ["majority-white hospitals"], 25-50% ethnic/racial minorities ["racially integrated hospitals"], or > 50% ethnic/racial minorities ["minority-serving hospitals"]). Logistic regression was used to evaluate the association between ethnicity/race and PEG utilization within and between the different hospital strata. Among 246,825 stroke admissions, patients receiving care in minority-serving hospitals had higher odds of PEG compared to patients in majority-white hospitals, regardless of individual patient race (adjusted odds ratio [OR] 1.24, 95% CI 1.12-1.38). Ethnic/racial minorities had higher odds of PEG than whites in any hospital strata; however, this discrepancy was largest in majority-white hospitals (OR 1.62, 95% CI 1.48-1.76), and smallest in minority-serving hospitals (OR 1.22, 95% CI 1.11-1.33; p for interaction < 0.001). Ethnic/racial minority patients had similar odds of PEG in any hospital strata, while white patients had increasing odds of PEG in racially integrated and minority-serving compared to majority-white hospitals (OR 1.28, 95% CI 1.15-1.43 in racially integrated, and OR 1.39, 95% CI 1.23-1.57 in minority-serving, compared to majority-white hospitals, p for trend < 0.001). The likelihood of PEG after ischemic stroke was increased in minority-serving compared to majority-white hospitals. White patients had higher odds of PEG in minority-serving compared to majority-white hospitals, indicating a systemic difference in PEG placement across hospitals.


Assuntos
Grupos Étnicos/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Gastrostomia , Intubação Gastrointestinal , Acidente Vascular Cerebral/etnologia , Afro-Americanos/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Americanos Asiáticos/estatística & dados numéricos , Grupos de Populações Continentais/estatística & dados numéricos , Feminino , Hispano-Americanos/estatística & dados numéricos , Hospitais , Humanos , Intubação Gastrointestinal/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estados Unidos
11.
Am J Crit Care ; 27(1): 24-31, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29292272

RESUMO

BACKGROUND: Endotracheal and nasogastric tubes are recognized risk factors for nosocomial sinusitis. The extent to which these tubes affect the overall incidence of nosocomial sinusitis in acute care hospitals is unknown. OBJECTIVE: To use data for 2008 through 2013 from the Nationwide Inpatient Sample database to compare the incidence of sinusitis in patients with nasogastric tubes with that in patients with an endotracheal tube alone or with both an endotracheal tube and a nasogastric tube. METHODS: Patients' data with any of the following International Classification of Disease, Ninth Revision, Clinical Modification codes were abstracted from the database: (1) 96.6, enteral infusion of concentrated nutritional substances; (2) 96.07, insertion of other (naso-)gastric tube; or (3) 96.04, insertion of an endotracheal tube. Sinusitis was defined by the appropriate codes. Weighted and unweighted frequencies and weighted percentages were calculated, categorical comparisons were made by χ2 test, and logistic regression was used to examine odds of sinusitis development by tube type. RESULTS: Of 1 141 632 included cases, most (68.57%) had an endotracheal tube only, 23.02% had a nasogastric tube only, and 8.41% had both types of tubes. Sinusitis was present in 0.15% of the sample. Compared with patients with only a nasogastric tube, the risk for sinusitis was 41% greater in patients with an endotracheal tube and 200% greater in patients with both tubes. CONCLUSION: Despite the low incidence of sinusitis, a significant association exists between sinusitis and the presence of an endotracheal tube, especially when a nasogastric tube is also present.


Assuntos
Intubação Gastrointestinal/estatística & dados numéricos , Intubação Intratraqueal/estatística & dados numéricos , Sinusite/epidemiologia , Adolescente , Adulto , Idoso , Grupos de Populações Continentais , Feminino , Humanos , Incidência , Intubação Gastrointestinal/efeitos adversos , Intubação Intratraqueal/efeitos adversos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Sinusite/etiologia , Estados Unidos/epidemiologia , Adulto Jovem
12.
Am Surg ; 84(10): 1555-1559, 2018 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-30747668

RESUMO

Apprehension in taking independent care of children with medical devices may lead to unnecessary visits to the ED and/or acute clinic (AC). To address these concerns, our institution implemented a gastrostomy tube (GT) class in 2011 for caretakers. We hypothesized that inappropriate GT-related ED/AC visits would be lower in preoperatively educated caregivers. We performed a retrospective cohort study of all patients aged 0 to 18 who received GT (surgical or percutaneous) at our institution between 2006 and 2015 (n = 1340). Class attendance (trained vs untrained) and unscheduled GT-related ED/AC visits one year after GT placement were reviewed. Gastrostomy-related ED/AC visits were classified as appropriate (hospital-based intervention) or inappropriate (site care and education/reassurance). Occurrence of ED/AC visits was compared between trained and untrained cohorts. We found that 59 per cent of patients had an unscheduled GT-related ED/AC visit within one year of placement. The trained cohort had 27 per cent less unplanned ED/AC visits within one year (mean 1.21 (SD 1.82) vs untrained 1.65 (2.24), P < 0.001). On multivariate analysis, GT education independently decreased one-year GT-related health care utilization (Odds Ratio 0.75, 95% Confidence Interval 0.59-0.95). Formal education seems to decrease GT-related health care utilization within one year of placement and should be integrated into a comprehensive care plan to improve caregiver self-efficacy.


Assuntos
Gastrostomia/instrumentação , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adolescente , Assistência Ambulatorial/estatística & dados numéricos , Cuidadores/educação , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Gastrostomia/métodos , Humanos , Lactente , Recém-Nascido , Intubação Gastrointestinal/economia , Intubação Gastrointestinal/estatística & dados numéricos , Tempo de Internação/economia , Masculino , Educação de Pacientes como Assunto , Complicações Pós-Operatórias/economia , Complicações Pós-Operatórias/etiologia , Cuidados Pré-Operatórios/métodos , Estudos Retrospectivos , Procedimentos Desnecessários/economia
13.
Colorectal Dis ; 20(6): 536-544, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29091330

RESUMO

AIM: Postoperative ileus (POI) is characterised by delayed gastrointestinal recovery and is common after colorectal surgery. Numerous strategies to optimise POI have been proposed but its management remains an unmet clinical need. This study aimed to characterise the duration and management of gastrointestinal recovery in patients undergoing elective colorectal surgery. METHOD: A snapshot, prospective, observational study was undertaken between November 2016 and January 2017 at 10 regional hospitals in the United Kingdom. Adult patients undergoing elective colorectal surgery with resection of bowel or reversal of stoma were included. Outcomes included time until return of gastrointestinal function, timing of nasogastric tube (NGT) insertion, uptake of targeted interventions and clinical outcomes. Data were validated for accuracy by independent investigators. RESULTS: 204 patients met the eligibility criteria. The median time for gastrointestinal recovery was 3 days (IQR 2-4); right-sided resections were associated with longer gastrointestinal recovery than left sided (4 days (2.75-5.25) vs 3 days (2-4); P = 0.002). The rate of NGT insertion was 22.5% at a median time of 4 (4-4.75) days. NGT insertion after vomiting was associated with a higher incidence of bronchopneumonia compared to early placement (13.3% vs 29.0%). Targeted interventions, such as chewing gum (4.4%), selective mu-receptor antagonists (1.0%) and pro-kinetic agents (13.7%) were infrequently used. CONCLUSION: The average time to gastrointestinal recovery after elective colorectal surgery was three days. Late NGT insertion was associated with an increased incidence of bronchopneumonia. The clinical uptake of targeted interventions to improve gastrointestinal recovery was poor.


Assuntos
Colectomia , Íleus/fisiopatologia , Complicações Pós-Operatórias/fisiopatologia , Protectomia , Recuperação de Função Fisiológica , Adolescente , Adulto , Broncopneumonia/epidemiologia , Goma de Mascar , Neoplasias Colorretais/cirurgia , Colostomia , Procedimentos Cirúrgicos Eletivos , Feminino , Humanos , Íleus/epidemiologia , Doenças Inflamatórias Intestinais/cirurgia , Intubação Gastrointestinal/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Proctocolectomia Restauradora , Receptores Opioides mu/antagonistas & inibidores , Reoperação , Fatores de Tempo , Reino Unido , Vômito/epidemiologia , Adulto Jovem
14.
Pediatr Emerg Care ; 33(10): e71-e74, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28968311

RESUMO

OBJECTIVES: This study aims to evaluate frequency, type, and cost of gastrostomy tube (GT) versus gastrojejunostomy tube (GJT) complications in children presenting to the emergency department (ED). METHODS: Patients were selected by electronic health record search for International Classification of Diseases, Ninth Revision, and procedure codes for GTs and GJTs/jejunostomy tubes. All children aged less than 18 years with GTs or GJTs placed during a 5-year period (2007-2012) at the University of Minnesota Masonic Children's Hospital were identified for retrospective review. Comparisons were made on demographic data, number and type of complications, and interventions performed for ED visits, which were abstracted from the electronic health record. Cost data were abstracted from the financial data system. RESULTS: A total of 161 GT and GJT patients were identified; 31 children had 43 ED visits for complications. Ages ranged from 1 month to 17 years; median, 12 months; mean, 5.4 years; 25 (58%) were male, and 18 female (42%). Complications occurred in 15 GT (48.4%) and 16 GJT (51.6%) patients. The most common ED presenting complication was dislodgement, which occurred in 14 GTs (67%) and 18 GJTs (82%), followed by clogging 6 GTs (29%) and 1 GJTs (4.5%). Those presenting to the ED with GJT complications had higher mean overall charge (US $1987.00 vs US $913.10, P = 0.05). CONCLUSIONS: Although GTs and GJTs had similar rates of complications and ED visits, GJT complications were more likely to result in hospital admission and intervention by radiology, require specialist involvement, and have a higher cost charged to the patient.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Derivação Gástrica/efeitos adversos , Gastrostomia/efeitos adversos , Hospitalização/estatística & dados numéricos , Intubação Gastrointestinal/efeitos adversos , Adolescente , Criança , Pré-Escolar , Feminino , Derivação Gástrica/economia , Derivação Gástrica/estatística & dados numéricos , Gastrostomia/economia , Gastrostomia/estatística & dados numéricos , Humanos , Lactente , Intubação Gastrointestinal/economia , Intubação Gastrointestinal/estatística & dados numéricos , Masculino , Complicações Pós-Operatórias/economia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos
15.
Am J Gastroenterol ; 112(10): 1553-1555, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28978953

RESUMO

Cecal intubation rate (CIR) is an important metric for colonoscopy quality. Guidelines propose a minimum CIR of 90% for all indications, and 95% in screening procedures. In this issue, a study of three UK teaching hospitals demonstrated one-third of endoscopists inappropriately converted colonoscopies to flexible sigmoidoscopies, and several endoscopists only reached the 90% CIR benchmark because of these inappropriate conversions. Our professional societies and healthcare organizations must continue to work to improve the accurate assessment of colonoscopy quality in order to identify underperforming clinicians who should be provided with additional training for the benefit of their patients.


Assuntos
Doenças do Colo/diagnóstico , Colonoscopia , Intubação Gastrointestinal , Sigmoidoscopia , Competência Clínica , Colonoscopia/métodos , Colonoscopia/estatística & dados numéricos , Humanos , Intubação Gastrointestinal/métodos , Intubação Gastrointestinal/normas , Intubação Gastrointestinal/estatística & dados numéricos , Melhoria de Qualidade , Indicadores de Qualidade em Assistência à Saúde , Sigmoidoscopia/métodos , Sigmoidoscopia/estatística & dados numéricos , Reino Unido
16.
Am J Gastroenterol ; 112(10): 1545-1552, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28555631

RESUMO

OBJECTIVES: A cecal intubation rate (CIR) of >90% is a well-accepted quality indicator of colonoscopy and is consequently monitored within endoscopy units. Endoscopists' desire to meet this target may mean that incomplete colonoscopies are recorded as flexible sigmoidoscopies. The aim of this study was to examine whether the conversion of requested colonoscopies is a clinically significant phenomenon and whether this impacts upon the measurement of quality indicators. METHODS: A retrospective review of all flexible sigmoidoscopies performed between 1 January 2015 and 31 December 2015 at Nottingham University Hospitals, Sheffield Teaching Hospitals, and Cambridge University Hospitals was performed. Where a colonoscopy was requested but a flexible sigmoidoscopy performed, the patient's records and endoscopy reports were reviewed to determine whether this conversion was decided before the start of the procedure and documented. RESULTS: During the 12-month period, 6,839 flexible sigmoidoscopies were performed by 125 endoscopists. The original requests of 149 sigmoidoscopies could not be retrieved and were therefore excluded from this analysis. Of the 6,690 sigmoidoscopy requests reviewed, 2.8% (n=190) procedures were originally requested as a colonoscopy. On review of patient records, 85 conversions were appropriate according to pre-defined criteria. However, 105 conversions were deemed inappropriate, occurring in patients who had a valid documented indication for colonoscopy and had undergone full bowel preparation. The most common reasons cited included poor bowel preparation (n=37), technically challenging procedure (n=24), at the endoscopist's discretion based on clinical factors (n=21), and obstructing patology (n=8). A clear reason for conversion was not apparent in 11 cases. During the study period, 21,271 colonoscopies were performed and so conversions represent 0.45% of the total requests. When inappropriate conversions were included in individuals' performance data, 15 endoscopists fell to ≤90% target cecal intubation target. CONCLUSIONS: A small, but significant number of colonoscopies are converted to flexible sigmoidoscopies at the time of the procedure. This study demonstrates the conversion of colonoscopy to sigmoidoscopy as being a potential limitation of relying on CIR alone. Endoscopy units should consider monitoring the rate of inappropriate conversions to ensure quality.


Assuntos
Doenças do Colo/diagnóstico , Colonoscopia , Intubação Gastrointestinal , Sigmoidoscopia , Idoso , Competência Clínica/normas , Colonoscopia/métodos , Colonoscopia/normas , Colonoscopia/estatística & dados numéricos , Feminino , Humanos , Intubação Gastrointestinal/métodos , Intubação Gastrointestinal/normas , Intubação Gastrointestinal/estatística & dados numéricos , Masculino , Registros Médicos Orientados a Problemas/estatística & dados numéricos , Pessoa de Meia-Idade , Indicadores de Qualidade em Assistência à Saúde , Estudos Retrospectivos , Sigmoidoscopia/métodos , Sigmoidoscopia/estatística & dados numéricos , Gestão da Qualidade Total/métodos , Reino Unido
17.
Obes Surg ; 27(9): 2272-2278, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28285471

RESUMO

BACKGROUND: The Orbera intragastric balloon (IGB) has been approved by the US Food and Drug Administration for use in patients with a body mass index (BMI) between 30 and 40 kg/m2 and is in wide use worldwide as a primary and bridge obesity management tool. The balloon filling volume (BFV) ranges between 400 and 700 mL of saline. Our objective was to determine whether there is an association between BFV and clinically relevant endpoints, namely weight loss outcomes, balloon tolerability, and adverse events. METHODS: A systematic review of studies investigating the use of the Orbera IGB system for obesity treatment was performed. Data was examined using random effects modelling and meta-regression analyses. RESULTS: Forty-four studies (n = 5549 patients) reported BFV and % total body weight loss (TBWL) at 6 months. Pooled %TBWL at 6 months was 13.2% [95% CI 12.3-14.0]. A funnel plot demonstrated a low risk of publication bias. Meta-regression showed no statistically significant association between filling volume and %TBWL at 6 months (p = 0.268). Higher BFV was associated with lower rates of esophagitis (slope = -0.008, p < 0.001) and prosthesis migration (slope = -0.015, p < 0.001). There was no association between BFV and early removal (p = 0.1), gastroesophageal reflux symptom (p = 0.64), or ulcer rates (p = 0.09). CONCLUSIONS: No association was observed between Orbera IGB filling volume and weight loss outcomes. Higher volumes appear to be associated with lower migration and esophagitis rates; thus, a balloon filling volume of 600-650 mL is recommended.


Assuntos
Cirurgia Bariátrica , Balão Gástrico , Obesidade Mórbida/cirurgia , Complicações Pós-Operatórias , Perda de Peso , Cirurgia Bariátrica/efeitos adversos , Cirurgia Bariátrica/estatística & dados numéricos , Índice de Massa Corporal , Feminino , Balão Gástrico/efeitos adversos , Balão Gástrico/estatística & dados numéricos , Humanos , Intubação Gastrointestinal/efeitos adversos , Intubação Gastrointestinal/estatística & dados numéricos , Masculino , Obesidade Mórbida/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Falha de Prótese/efeitos adversos , Falha de Prótese/etiologia
18.
Nutr Hosp ; 34(1): 15-18, 2017 02 01.
Artigo em Espanhol | MEDLINE | ID: mdl-28244767

RESUMO

Objective: To present the results of the Spanish home enteral nutrition (HEN) registry of the NADYA-SENPE group for the years 2014 and 2015. Methods: From January 1st 2014 to December 31st 2015 the HEN registry was recorded and afterwards a further descriptive and analytical analysis was done. Results: In 2014, 3749 patients were recorded, and 4202 in 2015; prevalence was 80.58 patients/one million inhabitants in Spain in 2014 and 90.51 in 2015. There were 49.9% females in 2014 and 50.3% in 2015. Median age was 73 years (IQI 59-83) in 2014 as well as in 2015. 684 episodes finished in 2014 and 631 in 2015, with death as the main cause, in 54.9% and 50.4%, respectively. The ones who were fed through nasogastric tube had a mean age higher than the ones fed by any other route (p-value < 0.001). Sisty-seven paediatric patients were recorded in 2014 (56.7% females) and 77 in 2015 (55.8% females). Median age at the beginning of HEN among children was 5 months in 2014 and 5 months in 2015. The main route of administration was gastrostomy, in 52.5% in 2014 and nasogastric tube in 50.8% in 2015. 7 episodes finished in 2014 and 13 in 2015, having death as the main cause (57.1% in 2014 and 38.5% in 2015). It was found that were younger children the ones who were mainly fed by nasogastric tubes (p-value 0.004 vs. 0.002). Among paediatric patients as well as adults, the main diagnosis leading to HEN was neurological disease which gives aphagia or severe dysphagia. Conclusions: There has been an increase in the number of patients in the registry as well as the participating centers and the number of patients per center, without any significant change in the characteristics of the patients other than longer duration of the episodes.


Assuntos
Nutrição Parenteral no Domicílio/estatística & dados numéricos , Sistema de Registros , Adolescente , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Intubação Gastrointestinal/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Espanha , Adulto Jovem
19.
Rev Esp Anestesiol Reanim ; 64(6): 313-322, 2017.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-28214097

RESUMO

OBJECTIVE: To evaluate the results of the implementation of an enhanced recovery program (ERAS) for open approach radical cystectomy compared to the historical cohort of the same hospital. MATERIAL AND METHODS: A retrospective analysis of 138 consecutive patients who underwent radical cystectomy with Bricker or Studer ileal derivation (97 historical vs. 41 ERAS). Overall complication rate, Clavien-Dindo stage>2 complications, mortality, hospital and critical care length of stay and readmission rates, as well as need for reoperation, nasogastric intubation, transfusion or parenteral nutrition were compared. RESULTS: No statistically significant differences in overall complication rate were found (73.171 vs. 77.32%; OR 1.25, 95% CI 0.54-2.981; P=.601) nor in Clavien-Dindo>2 complications (41.463 vs. 42.268%; OR 1.033, 95% CI 0.492-2.167; P=.93), mortality, lengths of stays readmission and reoperation rates. The need for nasogastric tube insertion was lower in the ERAS group (43.902 vs. 78.351%; OR 4.624, 95% CI 2.112-10.123; P<.0001), as well as the need for total parenteral nutrition (26.829 vs. 34.021%; OR 12.234, 95% CI 5.165-28.92; P<.0001), and time under endotracheal intubation since anaesthesia induction (median [IRQ]=325 (285-355) vs. 540 (360-600) min; P<.0001). CONCLUSION: Enhanced recovery programs in radical cystectomy decrease interventionism on the patient without increasing morbidity and mortality.


Assuntos
Protocolos Clínicos , Cistectomia/reabilitação , Cuidados Pós-Operatórios/métodos , Complicações Pós-Operatórias/prevenção & controle , Derivação Urinária/reabilitação , Idoso , Feminino , Estudo Historicamente Controlado , Mortalidade Hospitalar , Humanos , Intubação Gastrointestinal/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/reabilitação , Cuidados Pré-Operatórios/métodos , Avaliação de Programas e Projetos de Saúde , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Neoplasias da Bexiga Urinária/cirurgia
20.
Nutr. hosp ; 34(1): 15-18, ene.-feb. 2017.
Artigo em Espanhol | IBECS | ID: ibc-161136

RESUMO

Objetivo: exponer los resultados del registro de nutrición enteral domiciliaria (NED) del año 2014 y 2015 del Grupo NADYA-SENPE. Métodos: se recopilaron los pacientes introducidos en el registro desde el 1 de enero al 31 de diciembre de 2014 y la mismas fechas de 2015, y se procedió al análisis descriptivo y analítico de los datos. Resultados: en el año 2014, se registraron 3.749 pacientes y en 2015, 4.202; la prevalencia fue de 80,58 pacientes/millón de habitantes en el año 2014 y de 90,51 en 2015. Por sexos, hubo un 49,9% de mujeres en 2014 y un 50,3% en 2015. La edad media fue de 73 años (IIQ 59-83) en ambos años. Finalizaron 684 episodios de NED en 2014 y 631 en 2015, la causa principal fue el fallecimiento en el 54,9% y 50,4% de los casos, respectivamente. Los portadores de sonda nasogástrica presentan una edad media superior a los pacientes con cualquier otra vía (p < 0,001). Se registraron 67 pacientes pediátricos en 2014 (56,7% niñas) y 77 en 2015 (55,8% niñas). La vía principal de administración fue la gastrostomía en el 52,0% de los casos de 2014 y sonda nasogástrica en el 50,8% de los casos de 2015. La causa principal de finalización de la nutrición fue el fallecimiento (57,1% en 2014 y 38,5% en 2015). Se observó que los niños más pequeños eran los que se alimentaban preferentemente por SNG (p 0,004 vs. 0,002).Tanto en pacientes pediátricos como en adultos el diagnóstico principal que motivó la necesidad de NED fue la enfermedad neurológica que cursa con afagia o disfagia severa. Conclusiones: se ha incrementado el número de pacientes del registro, así como el número de centros participantes y el número medio de pacientes comunicados por cada centro respecto a años anteriores, sin que se hayan modificado sustancialmente las características de los pacientes, salvo mayor duración de los episodios (AU)


Objective: To present the results of the Spanish home enteral nutrition (HEN) registry of the NADYA-SENPE group for the years 2014 and 2015. Methods: From January 1st 2014 to December 31st 2015 the HEN registry was recorded and afterwards a further descriptive and analytical analysis was done. Results: In 2014, 3749 patients were recorded, and 4202 in 2015; prevalence was 80.58 patients/one million inhabitants in Spain in 2014 and 90.51 in 2015. There were 49.9% females in 2014 and 50.3% in 2015. Median age was 73 years (IQI 59-83) in 2014 as well as in 2015. 684 episodes finished in 2014 and 631 in 2015, with death as the main cause, in 54.9% and 50.4%, respectively. The ones who were fed through nasogastric tube had a mean age higher than the ones fed by any other route (p-value < 0.001). Sixty-seven paediatric patients were recorded in 2014 (56.7% females) and 77 in 2015 (55.8% females). Median age at the beginning of HEN among children was 5 months in 2014 and 5 months in 2015. The main route of administration was gastrostomy, in 52.5% in 2014 and nasogastric tube in 50.8% in 2015. 7 episodes finished in 2014 and 13 in 2015, having death as the main cause (57.1% in 2014 and 38.5% in 2015). It was found that were younger children the ones who were mainly fed by nasogastric tubes (p-value 0.004 vs. 0.002). Among paediatric patients as well as adults, the main diagnosis leading to HEN was neurological disease which gives aphagia or severe dysphagia. Conclusions: There has been an increase in the number of patients in the registry as well as the participating centers and the number of patients per center, without any significant change in the characteristics of the patients other than longer duration of the episodes (AU)


Assuntos
Humanos , Nutrição Enteral/estatística & dados numéricos , Intubação Gastrointestinal/estatística & dados numéricos , Gastrostomia/estatística & dados numéricos , Transtornos de Deglutição/terapia , Registros de Doenças/estatística & dados numéricos , Serviços Hospitalares de Assistência Domiciliar/estatística & dados numéricos , Distribuição por Idade e Sexo
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