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1.
Ann Palliat Med ; 10(3): 3452-3458, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33849129

RESUMO

The novel coronavirus disease 2019 (COVID-19) epidemic broke out in 2019, it is highly contagious, and the infection rate among medical staff is high. The management of infection prevention and control during emergency surgery of COVID-19 patients has been outlined and the perioperative infection management checklist for emergency surgery of COVID-19 patients has been summarized and validated. There have been 13 emergency surgeries performed on COVID-19 patients at our hospital during this time. Two cases were cured and discharged, and the others were discharged after improvement and transferred to further rehabilitation, 30-day mortality of the emergency surgical is 0%. Once the emergency surgery protocol in the hospital is successfully established, emergency surgery can be performed as soon as the surgical planning decision is made, and the operating room can be prepared for use at any time. The incidence of surgical site infection (SSI) was largely higher than that of ordinary patients in the same time; however, the successful implementation of emergency surgery for COVID-19 had positive significance in reducing the incidence of death, risk of bleeding, and hypoxia. The current cumulative cure rate of COVID-19 in our hospital is 98%, patient mortality rate is 0%, and the incidence of COVID-19 infection in medical staff is 0%. The emergency surgical infection management checklist is feasible and effective in guiding the preoperative and intraoperative surgical procedures.


Assuntos
Lista de Checagem , Serviço Hospitalar de Emergência , Controle de Infecções/normas , Procedimentos Cirúrgicos Operatórios/normas , China , Humanos
2.
World J Emerg Surg ; 16(1): 14, 2021 03 22.
Artigo em Inglês | MEDLINE | ID: mdl-33752721

RESUMO

BACKGROUND: Since the COVID-19 pandemic has occurred, nations showed their unpreparedness to deal with a mass casualty incident of this proportion and severity, which resulted in a tremendous number of deaths even among healthcare workers. The World Society of Emergency Surgery conceived this position paper with the purpose of providing evidence-based recommendations for the management of emergency surgical patients under COVID-19 pandemic for the safety of the patient and healthcare workers. METHOD: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) through the MEDLINE (PubMed), Embase and SCOPUS databases. Synthesis of evidence, statements and recommendations were developed in accordance with the GRADE methodology. RESULTS: Given the limitation of the evidence, the current document represents an effort to join selected high-quality articles and experts' opinion. CONCLUSIONS: The aim of this position paper is to provide an exhaustive guidelines to perform emergency surgery in a safe and protected environment for surgical patients and for healthcare workers under COVID-19 and to offer the best management of COVID-19 patients needing for an emergency surgical treatment. We recommend screening for COVID-19 infection at the emergency department all acute surgical patients who are waiting for hospital admission and urgent surgery. The screening work-up provides a RT-PCR nasopharyngeal swab test and a baseline (non-contrast) chest CT or a chest X-ray or a lungs US, depending on skills and availability. If the COVID-19 screening is not completed we recommend keeping the patient in isolation until RT-PCR swab test result is not available, and to manage him/she such as an overt COVID patient. The management of COVID-19 surgical patients is multidisciplinary. If an immediate surgical procedure is mandatory, whether laparoscopic or via open approach, we recommend doing every effort to protect the operating room staff for the safety of the patient.


Assuntos
/prevenção & controle , Controle de Infecções/normas , Assistência Perioperatória/normas , Procedimentos Cirúrgicos Operatórios/normas , /diagnóstico , /transmissão , /normas , Emergências , Saúde Global , Humanos , Controle de Infecções/instrumentação , Controle de Infecções/métodos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Laparoscopia/métodos , Laparoscopia/normas , Pandemias , Assistência Perioperatória/métodos , Equipamento de Proteção Individual , Procedimentos Cirúrgicos Operatórios/métodos
3.
Artigo em Inglês | IBECS | ID: ibc-199912

RESUMO

Antibiotic prophylaxis in surgery is one of the most effective measures for preventing surgical site infection, although its use is frequently inadequate and may even increase the risk of infection, toxicities and bacterial resistance. As a result of advances in surgical techniques and the emergence of multidrug-resistant organisms, the current guidelines for prophylaxis need to be revised. La Sociedad Española de Enfermedades Infecciosas (Spanish Society of Infectious Diseases and Clinical Microbiology) (SEIMC) together with the Asociación Española de Cirujanos (Spanish Association of Surgeons) (AEC) have revised and updated the recommendations for antibiotic prophylaxis to adapt them to any type of surgical intervention and to current epidemiology. This document gathers together the recommendations on antimicrobial prophylaxis in the various procedures, with doses, duration, prophylaxis in special patient groups, and in epidemiological settings of multidrug resistance to facilitate standardized management and the safe, effective and rational use of antibiotics in elective surgery


La profilaxis antibiótica en cirugía es una de las medidas más eficaces para la prevención de la infección de localización quirúrgica, aunque su uso es con frecuencia inadecuado, pudiendo incrementar el riesgo de infección, toxicidades y resistencias bacterianas. Debido al avance en las técnicas quirúrgicas y la emergencia de microorganismos multirresistentes, las actuales pautas de profilaxis precisan ser revisadas. La Sociedad Española de Enfermedades Infecciosas (SEIMC), conjuntamente con la Asociación Española de Cirujanos (AEC), ha revisado y actualizado las recomendaciones de profilaxis antimicrobiana para adaptarlas a cada tipo de intervención quirúrgica y a la epidemiología actual. En este documento se recogen las recomendaciones de los antimicrobianos utilizados en profilaxis en los diferentes procedimientos, las dosis, la duración, la profilaxis en huéspedes especiales, y en situación epidemiológica de multirresistencia, de tal forma que permitan un manejo estandarizado, un uso racional, seguro y efectivo de los mismos en la cirugía electiva


Assuntos
Humanos , Conferências de Consenso como Assunto , Sociedades Médicas/organização & administração , Antibioticoprofilaxia/normas , Procedimentos Cirúrgicos Operatórios/normas , Sociedades Médicas/normas , Antibioticoprofilaxia/métodos , Controle de Infecções/organização & administração
4.
Cir. Esp. (Ed. impr.) ; 99(1): 11-26, ene. 2021. tab
Artigo em Espanhol | IBECS | ID: ibc-200217

RESUMO

La profilaxis antibiótica en cirugía es una de las medidas más eficaces para la prevención de la infección de localización quirúrgica, aunque su uso es con frecuencia inadecuado, pudiendo incrementar el riesgo de infección, toxicidades y resistencias bacterianas. Debido al avance en las técnicas quirúrgicas y la emergencia de microorganismos multirresistentes las actuales pautas de profilaxis precisan ser revisadas. La Sociedad Española de Enfermedades Infecciosas (SEIMC), conjuntamente con la Asociación Española de Cirujanos (AEC) ha revisado y actualizado las recomendaciones de profilaxis antimicrobiana para adaptarlas a cada tipo de intervención quirúrgica y a la epidemiología actual. En este documento se recogen las recomendaciones de los antimicrobianos utilizados en profilaxis en los diferentes procedimientos, las dosis, la duración, la profilaxis en huéspedes especiales, y en situación epidemiológica de multirresistencia, de tal forma que permitan un manejo estandarizado, un uso racional, seguro y efectivo de los mismos en la cirugía electiva


Antibiotic prophylaxis in surgery is one of the most effective measures for preventing surgical site infection, although its use is frequently inadequate and may even increase the risk of infection, toxicities and antimicrobial resistance. As a result of advances in surgical techniques and the emergence of multidrug-resistant organisms, the current guidelines for prophylaxis need to be revised. The Sociedad Española de Enfermedades Infecciosas (Spanish Society of Infectious Diseases and Clinical Microbiology) (SEIMC) together with the Asociación Española de Cirujanos (Spanish Association of Surgeons) (AEC) have revised and updated the recommendations for antibiotic prophylaxis in surgery to adapt them to any type of surgical intervention and to current epidemiology. This document gathers together the recommendations on antimicrobial prophylaxis in the various procedures, with doses, duration, prophylaxis in special patient groups, and in epidemiological settings of multidrug resistance to facilitate standardized management and the safe, effective and rational use of antibiotics in elective surgery


Assuntos
Humanos , Conferências de Consenso como Assunto , Consenso , Sociedades Médicas/normas , Antibioticoprofilaxia/normas , Procedimentos Cirúrgicos Operatórios/normas , Infecção da Ferida Cirúrgica/prevenção & controle , Projetos
5.
Arq Bras Cir Dig ; 33(3): e1544, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33470374

RESUMO

BACKGROUND: In Brazil, the goal-based approach was named Project ACERTO and has obtained good results when applied in elective surgeries with shorter hospitalization time, earlier return to activities without increased morbidity and mortality. AIM: To analyze the impact of ACERTO on emergency surgery care. METHODS: An intervention study was performed at a trauma hospital. Were compared 452 patients undergoing emergency surgery and followed up by the general surgery service from October to December 2018 (pre-ACERTO, n=243) and from March to June 2019 (post-ACERTO, n=209). Dietary reintroduction, volume of infused postoperative venous hydration, duration of use of catheters, probes and drains, postoperative analgesia, prevention of postoperative vomiting, early mobilization and physiotherapy were evaluated. RESULTS: After the ACERTO implantation there was earlier reintroduction of the diet, the earlier optimal caloric intake, earlier venous hydration withdrawal, higher postoperative analgesia prescription, postoperative vomiting prophylaxis and higher physiotherapy and mobilization prescription were achieved early in all (p<0.01); in the multivariate analysis there was no change in the complication rates observed before and after ACERTO (10.7% vs. 7.7% (p=0.268) and there was a decrease in the length of hospitalization after ACERTO (8,5 vs. 6,1 dias (p=0.008). CONCLUSION: The implementation of the ACERTO project decreased the length of hospital stay, improved medical care provided without increasing the rates of complications evaluated.


Assuntos
Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/prevenção & controle , Procedimentos Cirúrgicos Operatórios/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , Protocolos Clínicos , Feminino , Hospitais Públicos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Recuperação de Função Fisiológica , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
6.
Int J Qual Health Care ; 33(Supplement_1): 51-55, 2021 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-33432983

RESUMO

BACKGROUND: In response to the coronavirus disease of 2019 (COVID-19) pandemic, healthcare systems worldwide have stepped up their infection prevention and control efforts in order to reduce the spread of the infection. Behaviours, such as hand hygiene, screening and cohorting of patients, and the appropriate use of antibiotics have long been recommended in surgery, but their implementation has often been patchy. METHODS: The current crisis presents an opportunity to learn about how to improve infection prevention and control and surveillance (IPCS) behaviours. The improvements made were mainly informal, quick and stemming from the frontline rather than originating from formal organizational structures. The adaptations made and the expertise acquired have the potential for triggering deeper learning and to create enduring improvements in the routine identification and management of infections relating to surgery. RESULTS: This paper aims to illustrate how adopting a human factors and ergonomics perspective can provide insights into how clinical work systems have been adapted and reconfigured in order to keep patients and staff safe. CONCLUSION: For achieving sustainable change in IPCS practices in surgery during COVID-19 and beyond we need to enhance organizational learning potentials.


Assuntos
Controle de Infecções/métodos , Procedimentos Cirúrgicos Operatórios/normas , Antibacterianos/uso terapêutico , Infecção Hospitalar/prevenção & controle , Monitoramento Epidemiológico , Ergonomia/métodos , Higiene das Mãos , Humanos , Controle de Infecções/normas
7.
Khirurgiia (Mosk) ; (1): 93-97, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33395519

RESUMO

It is very difficult to find certain surgical field in which surgeon's decision is absolutely evidence-based. The objective of evidence-based medicine (and surgery) is offering the best treatment for each patient that should encourage conducting the randomized trials (RT) as the highest level of evidence. The results of RTs often contradict the existing clinical experience, and experience per se does not always confirm the significance of the results obtained. One cannot make any conclusions based on RT data. Treatment strategy for a particular patient remains unclear. The authors have analyzed the results of large-scale RTs devoted to laparoscopic cholecystectomy, rectal surgery, lung cancer surgery, postoperative care, treatment of pulmonary emphysema. It was shown that RT data as the highest level of evidence are not always true for surgery. In most clinical situations, the decision is not based on RT results. The desire of surgeons to master a new technique is often more significant than patient care, while clinical experience and the laws of the market are more important than science. There is no doubt that knowledge of RT results are essential in training period, but this means quite a bit for a particular patient. The best decision can be made during discussion and conversation with colleagues, where an experience of each specialist will have the same value as the best evidence.


Assuntos
Medicina Baseada em Evidências/normas , Medicina de Precisão/normas , Prática Profissional/normas , Qualidade da Assistência à Saúde/normas , Ensaios Clínicos Controlados Aleatórios como Assunto , Procedimentos Cirúrgicos Operatórios , Colecistectomia Laparoscópica , Competência Clínica/normas , Tomada de Decisões , Procedimentos Cirúrgicos do Sistema Digestório , Medicina Baseada em Evidências/métodos , Humanos , Relações Interprofissionais , Cuidados Pós-Operatórios/normas , Enfisema Pulmonar/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto/normas , Procedimentos Cirúrgicos Operatórios/métodos , Procedimentos Cirúrgicos Operatórios/normas
8.
Zhonghua Wai Ke Za Zhi ; 59(1): 2-5, 2021 Jan 01.
Artigo em Chinês | MEDLINE | ID: mdl-33412627

RESUMO

Since the concept of enhanced recovery after surgery(ERAS) has been proposed,it is valued,enriched and developed along with controversy and discussion. Although the content of ERAS involves multidisciplinary fields and is not an independent branch of surgery,surgeons,as an indispensable part,play an important role. At present,surgeons should pay more attention to post-operation complication rate,unplanned readmission rate and reoperation rate,and avoid these problems to the most extent by combining excellent surgical techniques with solid non-technical skills. As consequence,we would implement ERAS much better and be of great benefit to patients.


Assuntos
Recuperação Pós-Cirúrgica Melhorada/normas , Procedimentos Cirúrgicos Operatórios/normas , Competência Clínica/normas , Humanos , Readmissão do Paciente , Complicações Pós-Operatórias , Período Pós-Operatório , Reoperação , Procedimentos Cirúrgicos Operatórios/efeitos adversos
9.
Anaesthesia ; 76 Suppl 1: 89-99, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33426666

RESUMO

Improvement in healthcare delivery depends on the ability to measure outcomes that can direct changes in the system. An overview of quality indicators within the field of regional anaesthesia is lacking. This systematic review aims to synthesise available quality indicators, as per the Donabedian framework, and provide a concise overview of evidence-based quality indicators within regional anaesthesia. A systematic literature search was conducted using the databases MEDLINE, Embase, CINAHL and Cochrane from 2003 to present, and a prespecified search of regional anaesthesia society websites and healthcare quality agencies. The quality indicators relevant to regional anaesthesia were subdivided into peri-operative structure, process and outcome indicators as per the Donabedian framework. The methodological quality of the indicators was determined as per the Oxford Centre for Evidence-Based Medicine's framework. Twenty manuscripts met our inclusion criteria and, in total, 68 unique quality indicators were identified. There were 4 (6%) structure, 12 (18%) process and 52 (76%) outcome indicators. Most of the indicators were related to the safety (57%) and effectiveness (19%) of regional anaesthesia and were general in nature (60%). In addition, most indicators (84%) were based on low levels of evidence. Our study is an important first step towards describing quality indicators for the provision of regional anaesthesia. Future research should focus on the development of structure and process quality indicators and improving the methodological quality and usability of these indicators.


Assuntos
Anestesia por Condução/normas , Indicadores de Qualidade em Assistência à Saúde , Procedimentos Cirúrgicos Operatórios/normas , Humanos , Melhoria de Qualidade , Procedimentos Cirúrgicos Operatórios/efeitos adversos
12.
Spine (Phila Pa 1976) ; 46(1): E48-E55, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-32991516

RESUMO

STUDY DESIGN: Case series. OBJECTIVE: To evaluate the impact of a multidisciplinary spine surgery indications conference (MSSIC) on surgical planning for elective spine surgeries. SUMMARY OF BACKGROUND DATA: Identifying methods for pairing the proper patient with the optimal intervention is of the utmost importance for improving spine care and patient outcomes. Prior studies have evaluated the utility of multidisciplinary spine conferences for patient management, but none have evaluated the impact of a MSSIC on surgical planning and decision making. METHODS: We implemented a mandatory weekly MSSIC with all spine surgeons at our institution. Each elective spine surgery in the upcoming week is presented. Subsequently, a group consensus decision is achieved regarding the best treatment option based on the expertise and opinions of the participating surgeons. We reviewed cases presented at the MSSIC from September 2019 to December 2019. We compared the surgeon's initial proposed surgery for a patient with the conference attendees' consensus decision on the best treatment and measured compliance rates with the group's recommended treatment. RESULTS: The conference reviewed 100 patients scheduled for elective spine surgery at our indications conference during the study period. Surgical plans were recommended for alteration in 19 cases (19%) with the proportion statistically significant from zero indicated by a binomial test (P < 0.001). The median absolute change in the invasiveness index of the altered procedures was 3 (interquartile range [IQR] 1-4). Participating surgeons complied with the group's recommendation in 96.5% of cases. CONCLUSION: In conjunction with other multidisciplinary methods, MSSICs can lead to surgical planning alterations in a significant number of cases. This could potentially result in better selection of surgical candidates and procedures for particular patients. Although long-term patient outcomes remain to be evaluated, this care model will likely play an integral role in optimizing the care spine surgeons provide patients. LEVEL OF EVIDENCE: 4.


Assuntos
Congressos como Assunto , Estudos Interdisciplinares , Coluna Vertebral/cirurgia , Procedimentos Cirúrgicos Operatórios/normas , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa , Cirurgiões
14.
Surg Clin North Am ; 101(1): 15-27, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33212076

RESUMO

Effective teamwork, both in and out of the operating room, is an essential component of safe and efficient surgical performance. There are multiple available assessment tools for evaluating teamwork and important contributors to teamwork such as safety culture and nontechnical skills. Multiple types of interventions exist to improve and train providers on teamwork, and many have been demonstrated to improve not only teamwork but also patient outcomes. Teamwork strategies can be adapted to different contexts, based on provider needs and resources.


Assuntos
Equipe de Assistência ao Paciente/normas , Segurança do Paciente/normas , Procedimentos Cirúrgicos Operatórios/educação , Procedimentos Cirúrgicos Operatórios/normas , Humanos , Salas Cirúrgicas
15.
Surg Clin North Am ; 101(1): 1-13, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33212071

RESUMO

This article explores the role of human factors engineering in patient safety in surgery. The authors discuss the history and evolution of human factors and the role of human factors in patient safety and provide a description of human factors methods used to study and improve patient safety.


Assuntos
Ergonomia , Segurança do Paciente/normas , Procedimentos Cirúrgicos Operatórios/normas , Humanos
16.
Surg Clin North Am ; 101(1): 121-134, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33212073

RESUMO

Acquisition of data on clinical performance is essential to improve outcomes in surgery. Large, national datasets allow hospitals to monitor events involving patient safety, complications, and benchmark against peer hospitals and facilitate quality improvement (QI) development. Although clinical datasets are often preferable, administrative data also have potential for actionable QI. Hospitals should use whatever data resources may be available and be creative in combining data sources for the most clinically meaningful metrics. Although collection of data is essential in understanding the problems an individual hospital is facing, rigorous QI infrastructure is necessary to translate data to action and achieve sustained change.


Assuntos
Bases de Dados Factuais , Registros Hospitalares , Segurança do Paciente/normas , Melhoria de Qualidade , Sistema de Registros , Procedimentos Cirúrgicos Operatórios/normas , Humanos
17.
Surg Clin North Am ; 101(1): 135-148, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33212074

RESUMO

Adverse surgical events are a major cause of morbidity, mortality, and disability worldwide. Serious reportable events, such as wrong site surgery, retained foreign bodies, and surgical fires, are preventable adverse events that have significant consequences. These "never events" are costly to the patient, health care systems, and society and have led to many efforts to reduce their occurrence. However, these costly events still occur, and more research is needed to obtain a better understanding of their causes and how to prevent them.


Assuntos
Erros Médicos/economia , Erros Médicos/prevenção & controle , Segurança do Paciente/economia , Procedimentos Cirúrgicos Operatórios/economia , Procedimentos Cirúrgicos Operatórios/normas , Humanos
18.
Surg Clin North Am ; 101(1): 149-160, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33212075

RESUMO

"The focus on patient safety offers a new framework not only for delivering health care but also for training physicians. Medical school and surgical graduate medical education must transition to a more holistic approach by teaching technical and nontechnical skills. Formalized safety curricula can be developed by adopting recommended guidelines and content from national and international organizations, existing validated practices of training programs, frequent simulation exercises, and objective evaluation tools."


Assuntos
Internato e Residência , Segurança do Paciente/normas , Procedimentos Cirúrgicos Operatórios/educação , Procedimentos Cirúrgicos Operatórios/normas , Humanos
19.
Surg Clin North Am ; 101(1): 29-36, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33212077

RESUMO

This article discusses the processes, interventions, and methods by which health care systems can change the culture of their workplace to promote safety. The importance of this culture shift is discussed, as well as an organizational approach, highlighting the importance of investment of time and resources to the cause. Efforts must include an educational focus on patient safety where a culture of patient safety is emphasized. This attitude along with several specific key interventions, including, measurement, teamwork, briefings, checklists, and developmental infrastructure, are discussed.


Assuntos
Segurança do Paciente/normas , Gestão da Segurança/métodos , Procedimentos Cirúrgicos Operatórios/normas , Humanos
20.
Surg Clin North Am ; 101(1): 37-48, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33212078

RESUMO

The success of patient safety and quality improvement interventions depends, in part, on the effectiveness of implementation. Surgical safety checklists have been introduced into thousands of operating rooms across 6 continents since the debut of the original World Health Organization 19-item checklist in 2008. However, the effect of checklists on patient outcomes has varied. Here, we review 5 examples of large-scale efforts (eg, population level or across health systems) where surgical checklists were introduced into the operating room and the associated effects on patient outcomes. Each experience provides an opportunity to reflect on best practices that inform strategies for effective implementation.


Assuntos
Lista de Checagem/normas , Segurança do Paciente/normas , Procedimentos Cirúrgicos Operatórios/normas , Humanos , Resultado do Tratamento
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