Conhecimento de enfermeiras sobre plano de parto

Aim: To identify the knowledge of nurses from a municipality on the western border of Rio Grande do Sul about the birth plan (PP). Method: Qualitative, descriptive and exploratory research, developed with 15 nurses who attended prenatal care in Family Health Strategies (FHS). Data collection took place in April and May 2016. Using a semistructured instrument, the analysis was of content in the thematic modality. Results: Three categories emerged: Birth Plan, what is it?, which addresses the nurses' lack of knowledge about PP; The need for training for professional practice, which presents the interest of nurses in training; Possibilities and limitations for PP implementation, in which the nurses report easinesses and weaknesses in view of delivery attention in the municipality. Final considerations: The study allowed a deepening of the thematic, providing reflections to professionals who were included in Primary Health Care.Identificar el conocimiento de enfermeros, de un municipio de la frontera oeste del RS, sobre Plan de Parto (PP). Método: Investigación cualitativa, descriptiva y exploratoria, desarrollada com 15 enfermeros responsables por la atenciónprenatal, en Estrategias de Salud de la Familia (ESF). La recolección de datos ocurrió entre abril y mayo de 2016, por medio de instrumento semiestructurado,y el análisis del contenido temático. Resultados:Se evidenció tres categorías: “Plan de Parto, ¿qué es eso?” – trata del desconocimiento de los enfermeros sobre el PP; “Necesidad de capacitación para la práctica profesional”– presenta el interés de los enfermeros en realizar capacitaciones; “Posibilidades y limitaciones para la implementación del PP”– los enfermeros relatan facilidades y fragilidades,considerando la atención al parto en el municipio. Consideraciones finales: El estudio posibilitó tratarla temáticade forma más amplia, propiciando reflexiones con profesionales insertadosen la Atención Primaria a la Salud.Objetivo: Identificar o conhecimento de enfermeiras de um município da fronteira oeste do RS, sobre plano de parto. Método: Pesquisa qualitativa, descritiva e exploratória, desenvolvida com 15 enfermeiros que atendiam pré-natal em Estratégias de Saúde da Família (ESF). A coleta de dados ocorreu em abril e maio de 2016, com a utilização de um instrumento semiestruturado, e a análise foi de conteúdo na modalidade temática. Resultados: Emergiram três categorias: Plano de Parto, o que é isso? – que aborda o desconhecimento dos enfermeiros sobre o assunto; Necessidade de capacitação para a prática profissional – que demonstra o interesse dos enfermeiros em realizar capacitações; Possibilidades e limitações para implantação do Plano de Parto – que destaca facilidades e fragilidades relatadas pelos enfermeiros tendo em vista o tipo de atenção ao parto no município. Considerações finais: O estudo possibilitou aprofundamento na temática, propiciando algumas reflexões junto a profissionais que estavam inseridos na Atenção Primária à Saúde.

Apoio social na perspectiva de jovens mães de crianças prematuras

Objetivo: conhecer o apoio social de jovens puérperas, mães de bebês prematuros. Método: Trata-se de uma pesquisa qualitativa desenvolvida no primeiro semestre de 2019 por meio de entrevistas semiestruturadas com 10 jovens mães. Os dados foram submetidos à análise de conteúdo operativa. Resultados: Os resultados apontaram que três esferas de apoio estiveram presentes na vida das participantes, ou seja, o instrumental, o informativo e o emocional. O apoio instrumental surgiu como o mais frequente e esteve relacionado ao auxílio aos cuidados com o bebê, às atividades domésticas e ao apoio financeiro. Considerações Finais: Concluiu-se que a rede de atenção básica à saúde precisa constituir fonte de apoio neste período

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

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research