Effect of remote ischaemic conditioning on clinical outcomes in patients with acute myocardial infarction (CONDI-2/ERIC-PPCI): a single-blind randomised controlled trial.

BACKGROUND: Remote ischaemic conditioning with transient ischaemia and reperfusion applied to the arm has been shown to reduce myocardial infarct size in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). We investigated whether remote ischaemic conditioning could reduce the incidence of cardiac death and hospitalisation for heart failure at 12 months. METHODS: We did an international investigator-initiated, prospective, single-blind, randomised controlled trial (CONDI-2/ERIC-PPCI) at 33 centres across the UK, Denmark, Spain, and Serbia. Patients (age >18 years) with suspected STEMI and who were eligible for PPCI were randomly allocated (1:1, stratified by centre with a permuted block method) to receive standard treatment (including a sham simulated remote ischaemic conditioning intervention at UK sites only) or remote ischaemic conditioning treatment (intermittent ischaemia and reperfusion applied to the arm through four cycles of 5-min inflation and 5-min deflation of an automated cuff device) before PPCI. Investigators responsible for data collection and outcome assessment were masked to treatment allocation. The primary combined endpoint was cardiac death or hospitalisation for heart failure at 12 months in the intention-to-treat population. This trial is registered with ClinicalTrials.gov (NCT02342522) and is completed. FINDINGS: Between Nov 6, 2013, and March 31, 2018, 5401 patients were randomly allocated to either the control group (n=2701) or the remote ischaemic conditioning group (n=2700). After exclusion of patients upon hospital arrival or loss to follow-up, 2569 patients in the control group and 2546 in the intervention group were included in the intention-to-treat analysis. At 12 months post-PPCI, the Kaplan-Meier-estimated frequencies of cardiac death or hospitalisation for heart failure (the primary endpoint) were 220 (8·6%) patients in the control group and 239 (9·4%) in the remote ischaemic conditioning group (hazard ratio 1·10 [95% CI 0·91-1·32], p=0·32 for intervention versus control). No important unexpected adverse events or side effects of remote ischaemic conditioning were observed. INTERPRETATION: Remote ischaemic conditioning does not improve clinical outcomes (cardiac death or hospitalisation for heart failure) at 12 months in patients with STEMI undergoing PPCI. FUNDING: British Heart Foundation, University College London Hospitals/University College London Biomedical Research Centre, Danish Innovation Foundation, Novo Nordisk Foundation, TrygFonden

Planeación e integración de los sistemas de gestión de la seguridad y salud en el trabajo y sistema de gestión ambiental de acuerdo a los requisitos del Decreto 1072 de 2015 (libro 2, parte 2, título 4, capítulo 6) y la NTC-ISO 14001:2015

El presente trabajo de investigación permite identificar cuáles son los puntos claves al momento de realizar una implementación unificada e integrada de los Sistemas de Gestión Ambiental y de la Seguridad y Salud en el Trabajo, de acuerdo a los requerimientos establecidos por la NTC-ISO 14001:2015 y el Decreto Único Reglamentario del Sector Trabajo 1072 del 2015(Capitulo 6).This research work allows us to identify the key points at the time of carrying out a unified and integrated implementation of the Environmental Management Systems and Safety and Health at Work, according to the requirements established by NTC-ISO 14001: 2015 and the Single Regulatory Decree of the Labor Sector 1072 of 2015 (Chapter 6).Universidad Libre Seccional Pereira - Facultad de Ciencias de Salud - Especialización en Seguridad y Salud en el Trabaj

Propuesta educativa de apoyo a la adherencia farmacológica en síndrome coronario agudo, dirigida a profesionales de enfermería

Objetivo: Diseñar una propuesta educativa de apoyo a la adherencia farmacológica en Síndrome Coronario Agudo, dirigida a profesionales de enfermería Metodología: se sustenta en tres pasos del marco lógico: revisión integrativa de la literatura, diseño de la propuesta educativa y la elaboración final de la misma. Resultados: la revisión integrativa concluye en las proposiciones empíricas para cada grupo de fármacos antiisquémico del síndrome coronario agudo. Con base en la teoría de sistemas de enfermería de Orem, el diseño final de la propuesta se hace a través del método de ayuda de algoritmos. Conclusiones: El algoritmo es un método fácil y confiable para un aprendizaje rápido y efectivo para la enfermera, se sugiere que la enfermera acuda a este de una forma prudente para la toma de decisiones, con el fin de apoyar la adherencia farmacológica.Abstract. Objective: To design an educational support drug adherence in acute coronary syndrome, targeting nurses Methodology: is based on three steps log frame: integrative literature review, design of the educational and development end of it. Results: integrative review concludes the empirical propositions for each group of anti-ischemic drugs of acute coronary syndrome. Based on the theory of Orem nursing systems, the final design of the proposal is done through the help of algorithms method. Conclusions: The algorithm is an easy and reliable method for rapid and effective learning for the nurse, the nurse suggested that go to this in a prudent decision making in order to support drug adherence.Otr

Conceptos claves en un programa educativo Conceitos chave em um programa educativo Key Concepts in an Educational Program

Se presentan los resultados de la revisión de literatura sobre los conceptos comunicación asertiva, afecto y las visiones de enfermería de reciprocidad y simultaneidad como sustento base de un programa educativo de intervención con adolescentes para promover la responsabilidad procreativa. La revisión bibliográfica sistemática tomó como bases de datos Ebsco-Host y Scielo. Conclusiones: la comunicación asertiva es una habilidad social aprendida, que es necesario fortalecer en los programas de salud sexual y reproductiva; el afecto es un elemento motivador para la transmisión y apropiación de conocimientos en educación sexual y reproductiva; la visión de reciprocidad orienta la interacción entre el (la) adolescente y la (el) enfermera (o) componente necesario para una construcción mutua del autocuidado en este ámbito, y la visión de simultaneidad integra el contexto como elemento fundamental en el abordaje de la temática dentro de un programa educativo.<br>O trabalho apresenta os resultados da revisão de literatura sobre os conceitos de comunicação assertiva, carinho e as visões de reciprocidade e simultaneidade na enfermagem como alicerces de um programa educativo de intervenção com adolescentes para promover a responsabilidade procriativa. A revisão bibliográfica sistemática utilizou como bancos de dados Ebsco-Host e Scielo. Conclusões: a comunicação assertiva é uma habilidade social apreendida, que é preciso fortalecer nos programas de saúde sexual e reprodutiva; o carinho é um elemento motivador para a transmissão e apropriação de conhecimentos em educação sexual e reprodutiva; a visão de reciprocidade permite uma interação entre o (a) adolescente e a (o) enfermeira e é um componente necessário para construir mutuamente o auto-cuidado nesta área, e a visão de simultaneidade integra o contexto como elemento fundamental na aproximação da temática dentro de um programa educativo.<br>The results of the review are hereby presented on literature regarding assertive communication concepts, feelings and visions of nursing as a reciprocal and a simultaneous support for an educational program based on intervention with adolescents to promote responsible procreation. The present literature review took Ebsco-Host and Scielo as databases. Conclusion: Assertive communication is a learned social skill, which needs to be strengthened in as much as programs of sexual and reproductive health are concerned. Affection is a motivator for transmission and acquisition of knowledge in sexual and in reproductive education matters; the vision of reciprocity allows for interaction between the adolescent and the nurse and is a necessary component for mutual construction of self - care in this area, and the vision of simultaneity integrates the context as a key element in addressing the issue within a educational program

Key Concepts in an Educational Program Conceptos claves en un programa educativo Conceitos chave em um programa educativo

&lt;span style="font-family: verdana; font-size: x-small;"&gt;&lt;p&gt;The results of the review are hereby presented on literature regarding assertive communication concepts, feelings and visions of nursing as a reciprocal and a simultaneous support for an educational program based on intervention with adolescents to promote responsible procreation. The present literature review took Ebsco-Host and Scielo as databases.&lt;/p&gt; &lt;p&gt;Conclusion: Assertive communication is a learned social skill, which needs to be strengthened in as much as programs of sexual and reproductive health are concerned. Affection is a motivator for transmission and acquisition of knowledge in sexual and in reproductive education matters; the vision of reciprocity allows for interaction between the adolescent and the nurse and is a necessary component for mutual construction of self - care in this area, and the vision of simultaneity integrates the context as a key element in addressing the issue within a educational program.&lt;/p&gt;&lt;/span&gt;&lt;span style="font-family: verdana; font-size: x-small;"&gt;&lt;p&gt;Se presentan los resultados de la revisión de literatura sobre los conceptos comunicación asertiva, afecto y las visiones de enfermería de reciprocidad y simultaneidad como sustento base de un programa educativo de intervención con adolescentes para promover la responsabilidad procreativa. La revisión bibliográfica sistemática tomó como bases de datos Ebsco-Host y Scielo.&lt;/p&gt; &lt;p&gt;Conclusiones: la comunicación asertiva es una habilidad social aprendida, que es necesario fortalecer en los programas de salud sexual y reproductiva; el afecto es un elemento motivador para la transmisión y apropiación de conocimientos en educación sexual y reproductiva; la visión de reciprocidad orienta la interacción entre el (la) adolescente y la (el) enfermera (o) componente necesario para una construcción mutua del autocuidado en este ámbito, y la visión de simultaneidad integra el contexto como elemento fundamental en el abordaje de la temática dentro de un programa educativo.&lt;/p&gt;&lt;/span&gt;&lt;span style="font-family: verdana; font-size: x-small;"&gt;&lt;p&gt;O trabalho apresenta os resultados da revisão de literatura sobre os conceitos de comunicação assertiva, carinho e as visões de reciprocidade e simultaneidade na enfermagem como alicerces de um programa educativo de intervenção com adolescentes para promover a responsabilidade procriativa. A revisão bibliográfica sistemática utilizou como bancos de dados Ebsco-Host e Scielo.&lt;/p&gt; &lt;p&gt;Conclusões: a comunicação assertiva é uma habilidade social apreendida, que é preciso fortalecer nos programas de saúde sexual e reprodutiva; o carinho é um elemento motivador para a transmissão e apropriação de conhecimentos em educação sexual e reprodutiva; a visão de reciprocidade permite uma interação entre o (a) adolescente e a (o) enfermeira e é um componente necessário para construir mutuamente o auto-cuidado nesta área, e a visão de simultaneidade integra o contexto como elemento fundamental na aproximação da temática dentro de um programa educativo.&lt;/p&gt;&lt;/span&gt

Conceptos claves en un programa educativo

Se presentan los resultados de la revisión de literatura sobre los conceptos comunicación asertiva, afecto y las visiones de enfermería de reciprocidad y simultaneidad como sustento base de un programa educativo de intervención con adolescentes para promover la responsabilidad procreativa. La revisión bibliográfica sistemática tomó como bases de datos Ebsco-Host y Scielo. Conclusiones: la comunicación asertiva es una habilidad social aprendida, que es necesario fortalecer en los programas de salud sexual y reproductiva; el afecto es un elemento motivador para la transmisión y apropiación de conocimientos en educación sexual y reproductiva; la visión de reciprocidad orienta la interacción entre el (la) adolescente y la (el) enfermera (o) componente necesario para una construcción mutua del autocuidado en este ámbito, y la visión de simultaneidad integra el contexto como elemento fundamental en el abordaje de la temática dentro de un programa educativo

Conceitos chave em um programa educativo

O trabalho apresenta os resultados da revisão de literatura sobre os conceitos de comunicação assertiva, carinho e as visões de reciprocidade e simultaneidade na enfermagem como alicerces de um programa educativo de intervenção com adolescentes para promover a responsabilidade procriativa. A revisão bibliográfica sistemática utilizou como bancos de dados Ebsco-Host e Scielo. Conclusões: a comunicação assertiva é uma habilidade social apreendida, que é preciso fortalecer nos programas de saúde sexual e reprodutiva; o carinho é um elemento motivador para a transmissão e apropriação de conhecimentos em educação sexual e reprodutiva; a visão de reciprocidade permite uma interação entre o (a) adolescente e a (o) enfermeira e é um componente necessário para construir mutuamente o auto-cuidado nesta área, e a visão de simultaneidade integra o contexto como elemento fundamental na aproximação da temática dentro de um programa educativo.Se presentan los resultados de la revisión de literatura sobre los conceptos comunicación asertiva, afecto y las visiones de enfermería de reciprocidad y simultaneidad como sustento base de un programa educativo de intervención con adolescentes para promover la responsabilidad procreativa. La revisión bibliográfica sistemática tomó como bases de datos Ebsco-Host y Scielo. Conclusiones: la comunicación asertiva es una habilidad social aprendida, que es necesario fortalecer en los programas de salud sexual y reproductiva; el afecto es un elemento motivador para la transmisión y apropiación de conocimientos en educación sexual y reproductiva; la visión de reciprocidad orienta la interacción entre el (la) adolescente y la (el) enfermera (o) componente necesario para una construcción mutua del autocuidado en este ámbito, y la visión de simultaneidad integra el contexto como elemento fundamental en el abordaje de la temática dentro de un programa educativo.The results of the review are hereby presented on literature regarding assertive communication concepts, feelings and visions of nursing as a reciprocal and a simultaneous support for an educational program based on intervention with adolescents to promote responsible procreation. The present literature review took Ebsco-Host and Scielo as databases. Conclusion: Assertive communication is a learned social skill, which needs to be strengthened in as much as programs of sexual and reproductive health are concerned. Affection is a motivator for transmission and acquisition of knowledge in sexual and in reproductive education matters; the vision of reciprocity allows for interaction between the adolescent and the nurse and is a necessary component for mutual construction of self - care in this area, and the vision of simultaneity integrates the context as a key element in addressing the issue within a educational program

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care. We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit