Are the outcomes of emergency Lichtenstein hernioplasty similar to the outcomes of elective Lichtenstein hernioplasty?

AbstractBackgroundThe safe use of polypropylene prosthesis for the repair of complicated inguinal hernias has been established even when small bowel resection was required. Few reports have completely addressed this subject; none have compared the outcomes of emergency and elective Lichtenstein hernioplasty.MethodsFrom January 2001 to December 2003, 343 patients were electively operated for inguinal hernia and 62 for complicated inguinal hernia. A follow-up period of 17–57 months using the Quantitative and Qualitative Measurement Instrument for evaluation of Lichtenstein hernioplasty outcomes (QQMI) was completed for 48 emergency patients and 326 elective patients.ResultsThe mean QQMI score showed that most patients felt that the outcomes of their surgery were very good or excellent. Mean QQMI score for elective surgery was 10.1 and 9.5 for emergency surgery.ConclusionsThe outcomes of emergency Lichtenstein hernioplasty were inferior to the outcomes of elective Lichtenstein hernioplasty

Contribuições da perspectiva crítica de base histórico-cultural para a produção científica em psicologia educacional

Com ênfase na importância do monitoramento da produção científica, podendo o mesmo indicar qualidade da e rumos tomados pela produção do saber, o presente estudo visa a mapear as produções no âmbito da psicologia escolar educacional e, mais especificamente, nos artigos científicos que apresentem uma perspectiva crítica nessa área. Para tanto, foi realizada uma busca bibliográfica das versões on-line, publicadas entre 2007 e 2011, disponíveis na página da revista Psicologia Escolar e Educacional, publicação semestral da Associação Brasileira de Psicologia Escolar e Educacional (ABRAPEE). Ao todo, foram analisados 134 artigos. Os resultados apontaram que 17 artigos (12,69%) foram classificados na perspectiva crítica. Cada estudo trata de importantes aspectos da psicologia escolar educacional, tendo como foco o papel do psicólogo na escola, a formação docente e a postura crítica dos agentes escolares. Todos os artigos selecionados fundamentam-se na teoria histórico-cultural, uma das abordagens críticas da psicologia resgatadas para a compreensão dos fenômenos educacionais, aqui considerados essencialmente psicossociais. Entende-se que esse levantamento representa um instrumento de fundamentação e de questionamento na formação acadêmica (graduação e pós-graduação) de alunos de psicologia, da área de educação e de áreas afins, e propicia um maior aprofundamento acerca de como vem se configurando a psicologia escolar educacional contemporânea e dos impactos nas práticas profissionais orientadas por uma perspectiva crítica

Paediatric acute respiratory distress syndrome incidence and epidemiology (PARDIE): an international, observational study

BackgroundPaediatric acute respiratory distress syndrome (PARDS) is associated with high mortality in children, but until recently no paediatric-specific diagnostic criteria existed. The Pediatric Acute Lung Injury Consensus Conference (PALICC) definition was developed to overcome limitations of the Berlin definition, which was designed and validated for adults. We aimed to determine the incidence and outcomes of children who meet the PALICC definition of PARDS.MethodsIn this international, prospective, cross-sectional, observational study, 145 paediatric intensive care units (PICUs) from 27 countries were recruited, and over a continuous 5 day period across 10 weeks all patients were screened for enrolment. Patients were included if they had a new diagnosis of PARDS that met PALICC criteria during the study week. Exclusion criteria included meeting PARDS criteria more than 24 h before screening, cyanotic heart disease, active perinatal lung disease, and preparation or recovery from a cardiac intervention. Data were collected on the PICU characteristics, patient demographics, and elements of PARDS (ie, PARDS risk factors, hypoxaemia severity metrics, type of ventilation), comorbidities, chest imaging, arterial blood gas measurements, and pulse oximetry. The primary outcome was PICU mortality. Secondary outcomes included 90 day mortality, duration of invasive mechanical and non-invasive ventilation, and cause of death.FindingsBetween May 9, 2016, and June 16, 2017, during the 10 study weeks, 23 280 patients were admitted to participating PICUs, of whom 744 (3·2%) were identified as having PARDS. 95% (708 of 744) of patients had complete data for analysis, with 17% (121 of 708; 95% CI 14-20) mortality, whereas only 32% (230 of 708) of patients met Berlin criteria with 27% (61 of 230) mortality. Based on hypoxaemia severity at PARDS diagnosis, mortality was similar among those who were non-invasively ventilated and with mild or moderate PARDS (10-15%), but higher for those with severe PARDS (33% [54 of 165; 95% CI 26-41]). 50% (80 of 160) of non-invasively ventilated patients with PARDS were subsequently intubated, with 25% (20 of 80; 95% CI 16-36) mortality. By use of PALICC PARDS definition, severity of PARDS at 6 h after initial diagnosis (area under the curve [AUC] 0·69, 95% CI 0·62-0·76) discriminates PICU mortality better than severity at PARDS diagnosis (AUC 0·64, 0·58-0·71), and outperforms Berlin severity groups at 6 h (0·64, 0·58-0·70; p=0·01).InterpretationThe PALICC definition identified more children as having PARDS than the Berlin definition, and PALICC PARDS severity groupings improved the stratification of mortality risk, particularly when applied 6 h after PARDS diagnosis. The PALICC PARDS framework should be considered for use in future epidemiological and therapeutic research among children with PARDS.FundingUniversity of Southern California Clinical Translational Science Institute, Sainte Justine Children's Hospital, University of Montreal, Canada, Réseau en Santé Respiratoire du Fonds de Recherche Quebec-Santé, and Children's Hospital Los Angeles, Department of Anesthesiology and Critical Care Medicine