Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Background: Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. // Methods: We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. // Findings: We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. // Interpretation: Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Classificações de enfermagem: mapeamento entre termos do foco da prática Clasificaciones de enfermería: mapeamento entre los términos del foco de la práctica Nursing classification: cross-mapping between focus axis terms

Devido às mudanças estruturais das classificações: CIPE®beta 2, versão 1.0 e CIPESC®, este estudo descritivo tem como objetivo construir um mapeamento entre os termos do foco da prática, identificando semelhanças e diferenças. A CIPE® 1.0 em relação à beta 2 apresenta: 41% dos termos novos; 33% idênticos; 4% com conceito ampliado; 12% modificados; 8% diferentes; e 2% conceituados apenas na beta 2. A CIPE® 1.0 em relação à CIPESC® apresenta: 79% são novos; 8% idênticos; 1% ampliado; 5% modificados; 4% diferentes; e 3% sem conceito. Houve dificuldades oriundas do processo de tradução e editoração da CIPE® 1.0 e da inexistência de conceitos em alguns termos da CIPESC®. Este trabalho desencadeará um processo de validação dos termos não equivalentes.<br>Debido a los cambios estructurales de las clasificaciones: CIPE® beta-2, versión 1.0 y CIPESC®, este estudio descriptivo tiene como objetivo construir un mapeamiento entre los términos del foco de la práctica, identificando semblenzas y diferencias. La CIPE® 1.0 en relación a beta-2 presenta: 41% de los términos nuevos; 33% idénticos; 4% con el concepto ampliado; 12% modificados; 8% diferentes y 2% conceptuados solamente en la versión beta-2. La CIPE® 1.0 en relación a CIPESC® presenta: 79% son nuevos; 8% idéntico, 1% ampliado; 5% modificados; 4% diferentes y 3% sin concepto. Hubieron dificultades provenientes del proceso brasileiro de traducción y editoración de la CIPE® 1.0 y de la ausencia de algunos conceptos en términos de CIPESC®. Este trabajo va a iniciar un proceso de validación de los términos no equivalentes.<br>Due to structural changes of classifications: ICNP® beta-2, version 1.0 and CIPESC®, this descriptive study aims to identify similarities and differences by building a map between the terms of the focus of practice. The ICNP® 1.0 on the beta-2 shows: 41% are new terms, 33% identical, 4% with expanded concepts, 12% modified; 8% different and 2% there are concepts only in beta-2. The ICNP® 1.0 in relation to CIPESC® presents: 79% are new; 8% identical; 1% extended; 5% modified; 4% different and 3% without concept. There were difficulties from the process of Brazilian translating and publishing of ICNP® 1.0 and the absence of some concepts in terms of CIPESC®. This work will trigger the validation process for non equivalent terms

Validação da nomenclatura diagnóstica de enfermagem direcionada ao pré-natal: base CIPESC® em Curitiba - PR Validación de la nomenclatura diagnóstica de enfermería direccionada al periodo de embarazo: base CIPESC® en Curitiba - PR Validating the nomenclature diagnosis of pre-natal nursing: base CIPESC® in Curitiba

É de fundamental importância uma linguagem específica da profissão e a CIPESC® -Classificação Internacional para as Práticas de Enfermagem em Saúde Coletiva tem como um dos objetivos desvelar a atuação dos enfermeiros na saúde coletiva. No Brasil, a ABEn, responsável pela classificação, encontrou na Secretaria Municipal da Saúde de Curitiba - PR aliada para efetiva implantação. O objetivo deste artigo foi validar a nomenclatura dos 52 diagnósticos de enfermagem do pré-natal - base CIPESC® - Curitiba. É um estudo exploratório-descritivo, desenvolvido com enfermeiras assistenciais e com experts na área de gineco-obstetrícia e terminologia. Os resultados foram apresentados pelo Índice de Concordância por meio de freqüência absoluta, todas as definições foram validadas, porém necessitam de adequações à linguagem cotidiana. As enfermeiras apresentam dificuldades para inter-pretar intervenção de enfermagem na promoção do bem-estar, sendo premente a discussão do conceito de promoção à saúde e o processo saúde-doença na saúde coletiva.<br>Es de fundamental importancia un lenguaje específico de la profesión y la CIPESC® -Clasificación Internacional para las Prácticas de Enfermería en Salud Colectiva que tiene como uno de los objetivos desvedar la actuación de los enfermeros en la salud colectiva. En Brasil, la ABEn, responsable por la clasificación, encontró como aliada para realizar la efectiva implantación la Secretaria Municipal de la Salud de Curitiba - PR. El objetivo de este artículo fue validar la nomenclatura de los 52 diagnósticos de enfermería del periodo de embarazo - base CIPESC® - Curitiba. Es un estudio exploratorio-descriptivo, desarrollado con enfermeras asistenciales y con experts en el sector de ginecología-obstetricia y terminología. Los resultados fueron presentados por el Índice de Concordancia por medio de la frecuencia absoluta, todas las definiciones fueron validadas, sin embargo, necesitan de adecuaciones para el lenguaje cotidiano. Las enfermeras presentan dificultades para interpretar la intervención de enfermería en la promoción del bienestar, siendo apremiante la discusión del concepto de promoción a la salud y el proceso salud-enfermedad en la salud colectiva.<br>The existence of a specific language for the profession is essential, and the International Nursing Practice Classification in Collective Health (CIPESC, in the Portuguese-language acronym) has as one of its goals the classification of the work of nurses in collective health. In Brazil, the Brazilian Nursing Association (ABEn, in the Portuguese-language acronym), responsible for the classification, found in the Municipal Secretary of Health of Curitiba, in the State of Paraná, an ally for its effective implantation. The purpose of this article was to validate the nomenclature of the 52 diagnoses of pre-natal Nursing - CIPESC base - in Curitiba. It is an exploratory-descriptive study developed with assisting nurses and experts in the area of gynecology obstetrics and terminology. The results were presented through the Consonance Index through absolute frequency. All the definitions were validated, but they need to be adjusted to the daily language. The nurses show difficulty in interpret nursing intervention in the promotion of well-being, and it is urgent to discuss the concept of health promotion and the health-illness process in collective health