ANÁLISE ASSISTENCIAL da UNIDADE DE CUIDADOS PALIAT IVOS ONCOLÓGICOS EM UM HOSPITAL PART ICULAR NA CIDADE DE MONTEVIDÉU

“The Palliative Care Unit is defined as an organization of health professionals providing multidisciplinary care through a broad spectrum of forms of assistance which necessarily includes hospitalization in specific beds. The UCP must meet functional, structural and organizational requirements that ensure adequate conditions of quality, safety and efficiency to perform this activity “(1). The overall objective is to analyze the welfare aspect of the Oncology Palliative Care Unit of a Hospital located in Montevideo in its first year of operation. The methodology performed is a descriptive, retrospective cross-sectional study.The results show that 379 users were treated and 2487 consultations were performed in sanatorium, clinic and user´s home. Most users served are males with an average age of 76, being derived mostly by oncologists. The elastomeric infusor was used in 85 of them. 301 died, the majority of deaths occurring in the Hospi Saunders II. In regards to psychological care, its risk and need was assessed for 117 users and their families. A letter of condolence was sent to 57 families, and 13 mourning families were assisted. The Ministry of Public Health considers that 921 users could receive palliative care in our institution. 379 users were helped in a year by this unit. This is an important quantity; comparing data concerning other palliative care units in Uruguay.“La UCP (Unidad de Cuidados Paliativos) se define como una organización de profesionales sanitarios, que ofrece atención multidisciplinaria mediante un amplio espectro de modalidades de asistencia que incluye necesariamente la hospitalización en camas específicas. Para realizar esta actividad la UCP debe cumplir unos requisitos funcionales, estructurales y organizativos, que garantizan las condiciones adecuadas de calidad,seguridad y eficiencia”(1). El objetivo general es analizar el aspecto asistencial de una Unidad de Cuidados Paliativos Oncológicos de la ciudad de Montevideo en su primer año defuncionamiento. Para esto se realizó un estudio descriptivo, retrospectivo de corte transversal. Los resultados arrojaron que se atendieron 379 usuarios, realizándose 2487 consultas distribuidas en sanatorio, policlínica y domicilio. La mayoría de los usuarios atendidos son de sexo masculino con una edad media de 76 años, siendo derivados casi todos por médicos oncólogos. Fallecieron 301 de los usuarios, muchos de ellos en elHospi Saunders II. Se utilizó el recurso del infusor elastomérico en 85 de ellos. En relación a la asistencia psicológica se evaluó el riesgo y la necesidad en 117 usuarios y sus familias,enviándose a 57 familias cartas de condolencias. Se asistió en duelo a 13 familias. El Ministerio de Salud Pública considera que 921 usuarios serían pasibles de cuidados paliativos en esta mutualista. En un año fueron captados por esta unidad 379 usuarios. Este es un número importante comparando los datos con unidades de cuidados paliativos referentes en Uruguay.“A UCP (Unidade de Cuidados Paliativos) é definida como uma organização de profissionais de saúde que prestam atendimento multidisciplinar através de um amplo espectro de formas de assistência que necessariamente inclui camas de hospitalização específicas. A UCP deve atender aos requisitos funcionais, estruturais e organizacionais que assegurem condições adequadas de qualidade, segurança e eficiência para realizar esta atividade “(1). O objetivo geral é analisar o aspecto do bem-estar de Oncologia Palliative Care Unit da Associação Espanhola de Montevidéu, em seu primeiro ano de operação. Metodologia: um estudo descritivo transversal, retrospectivo foi realizado. 379 usuários atendidos, realizando consultas distribuídas em 2.487 sanatório, clínica e em casa. A maioria dos usuários atendidos são do sexo masculino, com idade média de 76, sendo derivada principalmente por médicos oncologistas. O uso de infusor elastomérica em 85 usuários usada, 301 morreram ea maioria das mortes no Hospice Saunders II. No que diz respeito ao risco de atendimento psicológico e da necessidade de 117 usuários e suas famílias, o envio de uma carta de condolências 57 famílias, com a assistência de 13 famílias enlutadas que foram avaliados. O Ministério da Saúde considera 921 usuários seria susceptível de nossa mútua paliativos, cuidados em um ano foram apanhados por esta unidade 379 usuários. Este é um número importante comparar dados relativos às unidades de cuidados paliativos no Uruguai

Performance of Comprehensive Complication Index and Clavien-Dindo Complication Scoring System in Liver Surgery for Hepatocellular Carcinoma

Simple SummaryThe comprehensive complication index (CCI) and the Clavien-Dindo Complication (CDC) scoring system are two metrics designed to quantify the burden of postoperative morbidity. We performed a retrospective study retrieving data from a multi-institutional Italian register. The aim was to compare the performance of the two metrics in predicting excessive length of hospital stay (e-LOS) of patients who underwent liver resections for hepatocellular carcinoma. A total of 2669 patients were analyzed. A derivation (n = 1345) and validation sets (n = 1324) were created to test the strength of results. In both cohorts, the analysis showed that CCI was slightly superior in predicting e-LOS in complicated patients. The accuracy of CCI was even better when considering a subgroup of patients who experienced at least two complications. The results of this population-specific analysis suggest that CCI is preferable in weighting postoperative morbidity burden.Background: We aimed to assess the ability of comprehensive complication index (CCI) and Clavien-Dindo complication (CDC) scale to predict excessive length of hospital stay (e-LOS) in patients undergoing liver resection for hepatocellular carcinoma. Methods: Patients were identified from an Italian multi-institutional database and randomly selected to be included in either a derivation or validation set. Multivariate logistic regression models and ROC curve analysis including either CCI or CDC as predictors of e-LOS were fitted to compare predictive performance. E-LOS was defined as a LOS longer than the 75th percentile among patients with at least one complication. Results: A total of 2669 patients were analyzed (1345 for derivation and 1324 for validation). The odds ratio (OR) was 5.590 (95%CI 4.201; 7.438) for CCI and 5.507 (4.152; 7.304) for CDC. The AUC was 0.964 for CCI and 0.893 for CDC in the derivation set and 0.962 vs. 0.890 in the validation set, respectively. In patients with at least two complications, the OR was 2.793 (1.896; 4.115) for CCI and 2.439 (1.666; 3.570) for CDC with an AUC of 0.850 and 0.673, respectively in the derivation cohort. The AUC was 0.806 for CCI and 0.658 for CDC in the validation set. Conclusions: When reporting postoperative morbidity in liver surgery, CCI is a preferable scale

Augmented reality (AR) in minimally invasive surgery (MIS) training: where are we now in Italy? The Italian Society of Endoscopic Surgery (SICE) ARMIS survey

Minimally invasive surgery (MIS) is a widespread approach in general surgery. Computer guiding software, such as the augmented reality (AR), the virtual reality (VR) and mixed reality (MR), has been proposed to help surgeons during MIS. This study aims to report these technologies' current knowledge and diffusion during surgical training in Italy. A web-based survey was developed under the aegis of the Italian Society of Endoscopic Surgery (SICE). Two hundred and seventeen medical doctors' answers were analyzed. Participants were surgeons (138, 63.6%) and residents in surgery (79, 36.4%). The mean knowledge of the role of the VR, AR and MR in surgery was 4.9 ± 2.4 (range 1-10). Most of the participants (122, 56.2%) did not have experience with any proposed technologies. However, although the lack of experience in this field, the answers about the functioning of the technologies were correct in most cases. Most of the participants answered that VR, AR and MR should be used more frequently for the teaching and training and during the clinical activity (170, 80.3%) and that such technologies would make a significant contribution, especially in training (183, 84.3%) and didactic (156, 71.9%). Finally, the main limitations to the diffusion of these technologies were the insufficient knowledge (182, 83.9%) and costs (175, 80.6%). Based on the present study, in Italy, the knowledge and dissemination of these technologies are still limited. Further studies are required to establish the usefulness of AR, VR and MR in surgical training