Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Participative leadership in the management process of nightshift nursing

This is a qualitative, exploratory, descriptive study, aiming to identify the perceptions of nurses regarding the leadership process and to analyze how this process takes place on the nightshift. Data collection was performed through the Focus Groups Technique, with 13 nightshift nurses of a public teaching hospital. Two categories that resulted from the thematic analysis are the focus of this article: the context of nightshift nursing work and leadership from the perception of the nightshift nurses. Teamwork is an important condition to vitalize the participatory perspective of the leadership process, given the necessary relationship of support and integration, above all in the nightshift nursing work. This exercise challenges the nurse in the solidification of a culture that promotes spaces for reflection regarding the work, integrating leadership with a learning process that is constituted through constructive bonds between the workers.Se trata de investigación cualitativa, exploratoria y descriptiva, con los objetivos de identificar las percepciones de los enfermeros sobre el proceso de liderazgo y analizar como transcurre ese proceso en el turno nocturno. La recolección de datos fue realizada por medio de la Técnica de Grupos Focales, con 13 enfermeras que trabajaban en ese turno en un hospital público de enseñanza. Dos categorías que resultaron del análisis temático son enfoque de este artículo: contexto del trabajo nocturno en enfermería y el liderazgo en la percepción de las enfermeras del turno nocturno. El trabajo en equipo es una importante condición para vitalizar la perspectiva participativa del proceso de liderazgo, considerando la necesaria relación de apoyo e integración, sobre todo en el trabajo nocturno de enfermería. Ese ejercicio lanza un desafío al enfermero, en la concretización de una cultura que promueva espacios de reflexión acerca del trabajo, integrando el liderazgo a un proceso de aprendizaje que se constituye mediante vínculos constructivos entre los trabajadores.Trata-se de pesquisa qualitativa, exploratória, descritiva, objetivando identificar as percepções dos enfermeiros sobre o processo de liderança, e analisar como transcorre esse processo no turno noturno. A coleta de dados foi realizada por meio da Técnica de Grupos Focais, com 13 enfermeiras que trabalham nesse turno, em um hospital público de ensino. Duas categorias que resultaram da análise temática são foco deste artigo: o contexto do trabalho noturno em enfermagem, e a liderança na percepção das enfermeiras do noturno. O trabalho em equipe é importante condição para vitalizar a perspectiva participativa do processo de liderança, haja vista a necessária relação de apoio e integração, sobretudo no trabalho noturno de enfermagem. Esse exercício lança um desafio ao enfermeiro, caracterizado como uma busca de concretização de uma cultura que promova espaços de reflexão acerca do trabalho, integrando a liderança a um processo de aprendizagem que se constitui mediante vínculos construtivos entre os trabalhadores