The effect of early oral postoperative feeding on the recovery of intestinal motility after gastrointestinal surgery: a systematic review and meta-analysis of randomized clinical trials.

Background and aims: Postoperative ileus is a frequent condition, leading to complications and a longer hospital stay. Few studies have demonstrated the benefit of early oral feeding in preventing ileus after gastrointestinal surgery. This study aims to evaluate the efficacy of early versus delayed oral feeding on the recovery of intestinal motility, length of hospital stay, and complications. Methods: We conducted a systematic review and meta-analysis of randomized control trials, searching PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, and the ClincalTrials.gov until 31 December 2022. We evaluated the first passage of the stool, the first flatus, complications, length of postoperative stay, and vomiting. We assessed the risk of bias using the Cochrane risk of bias tool (version 2) for randomized trials and the quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation methodology. Results: We included 34 studies with a median sample size of 102 participants. With a moderate certainty of the evidence, the early oral feeding may reduce the time taken for the first passage of the stool (MD -0.99 days; CI 95% -1.25, -0.72), the first flatus (MD -0.70 days; CI 95% -0.87, -0.53), and the risk of complications (RR 0.69; CI 95% 0.59-0.80), while with a low certainty of evidence, it may reduce the length of stay (MD -1.31 days; CI 95% -1.59, -1.03). However, early feeding likely does not affect the risk of vomiting (RR 0.90; CI 95% 0.68, 1.18). Conclusion: This review suggests that early oral feeding after gastrointestinal surgery may lead to a faster intestinal recovery, shorter postoperative stays, and fewer complications. However, careful interpretation is needed due to high heterogeneity and the moderate-to-low quality of evidence. Future studies should focus on the type and starting time of early oral feeding.

[Measuring nurses' attitudes to family care: a longitudinal mixed method study]. / Misurare l'atteggiamento degli infermieri nel prendersi cura della famiglia: uno studio mixed method longitudinale.

. Measuring nurses' attitudes to family care: a longitudinal mixed method study. INTRODUCTION: In a scenario of demographic changes with an ageing population and an increase in people with chronic illnesses, the family assumes a central role in the care of their family member. Providing nurses with knowledge and strategies of family-centred care may change current standards of practice to a more family-focused approach. OBJECTIVES: To explore nurses' perceptions on the importance of involving families in the project of care and their attitudes before, during and after an implementation of family-centred care. METHODS: A longitudinal mixed method study was conducted during the implementation of family-centred care in a health district. A training package for the district nurses and individual coaching by an experienced nurse were offered. The Families' Importance in Nursing Care-Nurses Attitudes (FINC-NA) questionnaire was administered pre- and post training and one year later and two focus groups were conducted. RESULTS: All the 19 health district nurses participated in the study; average age 49.3 years, working experience 26.8 years. Statistically significant changes were observed in all four dimensions of the FINC-NA: family as a personal and professional resource, as a partner and a burden. The same results were confirmed by the focus groups. CONCLUSIONS: An educational intervention for home care nurses proved to be useful during the implementation of family-centred care. A key aspect was the support offered to nurses in transferring their knowledge and skills to their practice.

The effect of early oral postoperative feeding on the recovery of intestinal motility after gastrointestinal surgery: Protocol for a systematic review and meta-analysis.

BACKGROUND: Given the ever-shorter length of hospital stay after surgical procedures, nowadays it is more important than ever to study interventions that may have an impact on surgical patients' wellbeing. According to the ERAS (Enhanced Recovery After Surgery protocols) program, early feeding must be considered one of the key components to facilitate early recovery while improving outcomes and patients' overall experiences. To date, the international literature has reported that early postoperative feeding compared with traditional (or late) timing is safe; nevertheless, small clinical outcomes effects has been reported, also for recovery of gastrointestinal function. Therefore, the effectiveness of early postoperative feeding to reduce postoperative ileus duration remains still debated. OBJECTIVE: To analyse the effects of early versus delayed oral feeding (liquids and food) on the recovery of intestinal motility after gastrointestinal surgery. SEARCH METHODS: Pubmed, Embase, Cinahl, Cochrane Central Register of Controlled Trials (CENTRAL), and the ClincalTrials.gov register will be searched to identify the RCTs of interest. STUDY INCLUSION: Randomized clinical trials (RCTs) comparing the effect of early postoperative versus late oral feeding on major postoperative outcomes after gastrointestinal surgery will be included. DATA COLLECTION AND ANALYSIS: Two review authors will independently screen titles and abstracts to determine the initially selected studies' inclusion. Any disagreements will be resolved through discussion and consulting a third review author. The research team members will then proceed with the methodological evaluation of the studies and their eligibility for inclusion in the systematic review.