Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Púrpura em paciente com estrongiloidíase disseminada Purpura in patient with disseminated strongiloidiasis

A infecção pelo Strongyloides stercoralis em associação com imunosupressão pode manifestar-se com lesões em múltiplos órgãos e sistemas, caracterizando a forma disseminada da doença. Lesões cutâneas não são freqüentemente relatadas e, se presentes, manifestam-se como rash e petéquias. Púrpuras bem definidas são pouco descritas. No presente trabalho é descrito um caso de estrongiloidíase disseminada, com acometimento cutâneo em forma de púrpura, que se desenvolveu em um paciente timectomizado e usuário crônico de corticosteróide devido à miastenia gravis.<br>The association of systemic corticosteroid therapy and dissemination of Strongyloides stercoralis has been increasingly documented in the literature. Skin involvement in disseminated strongyloidiasis has been reported and the most commonly described cutaneous manifestations are rash and petechial eruptions. We present a case of an immunosuppressed man that developed disseminated strongyloidiasis with extensive purpura

De Florence Nightingale às perspectivas atuais sobre o cuidado de enfermagem: a evolução de um saber/fazer Desde Florence Nightingale a las perspectivas actuales sobre el cuidado en enfermería: la evolución del saber/hacer From Florence Nightingale to the current perspectives about nursing care: the evolution of a know-how

O trabalho apresenta uma reflexão teórica sobre a evolução do cuidado de enfermagem a partir dos princípios nightingaleanos confrontados com as perspectivas atuais de alguns autores que vem abordando essa temática. Concluímos que as bases sólidas fincadas por Florence Nightingale estão permitindo à Enfermagem avançar em estudos que legitimam e fundamentam o cuidado enquanto essência do saber e fazer de enfermeiras e enfermeiros nos seus vários campos de atuação. Atualmente esses estudos apontam o cuidado como objeto de teorização em dimensões que aliam aspectos internos e externos à profissão, inserindo e explorando temas que antes eram velados, embora presentes no cotidiano da nossa prática, como o significado do corpo e suas formas de expressão na interação entre quem cuida e é cuidado.<br>El trabajo presenta una reflexión teórica sobre la evolución del cuidado en el oficio de enfermeros a partir de los principios Nightingaleanos confrontados con las perspectivas actuales de algunos autores que vienen abordando esa temática. Concluimos que las bases sólidas lanzadas por Florence Nightingale están permitiendo al oficio de enfermeros avanzar en estudios que legitiman y fundamentan el cuidado en cuanto esencia del saber y hacer de las enfermeras y enfermeros en sus variados campos de actuación. Actualmente eses estudios indican el cuidado como objeto de teoría en dimensiones que alían aspectos internos y externos a la profesión, proponiendo y explorando temas que antes eran velados aunque presentes en el cotidiano de nuestra práctica como el significado del cuerpo y sus formas de expresión en la interacción entre quien cuida y quien es cuidado.<br>The work presents a theoretical observation on the evolution of the nursing care from the Nightingalean principles faced to the current perspectives of some authors that approach this subject. We concluded that the solid base proposed by Florence Nightingale allow to Nursing an evolution in studies that legitimate and support the care as an essence of the nurses know-how in their several fields of work. Nowadays, these studies indicate the care as object of theorization in dimensions that unite internal and external aspects to the career, proposing and discussing themes that were previously masked although present in the day-by-day of our practice as the meaning of the body and its ways of expression in the interaction between who cares and those who receive care

Lesões dermatológicas em pacientes infectados pelo vírus linfotrópico humano de células T do tipo 1 (HTLV-1) Dermatologic lesions in patients infected with the human T-cell lymphotropic vírus type 1 (HTLV-1)

O vírus linfotrópico humano de células T do tipo 1 (HTLV-1) é o primeiro retrovírus isolado do ser humano. Descreveu-se, em pouco tempo, o seu papel etiológico em algumas doenças, com destaque para a leucemia/linfoma de células T do adulto (ATLL), a mielopatia associada ao HTLV-1/paraparesia espástica tropical (HAM/TSP) e a uveíte associada ao HTLV-1 (HAU). Na década de 90, o HTLV-1 foi associado a eczema grave da infância, conhecido como dermatite infecciosa (DI). Desde então, diversos outros tipos de lesões cutâneas têm sido observados em pacientes infectados pelo HTLV-1, em especial, nos doentes de HAM/TSP ou de ATLL. Porém, mesmo portadores assintomáticos do vírus apresentam doenças dermatológicas. Excetuando-se a dermatite infecciosa, não há lesão da pele específica da infecção pelo HTLV-1. Aqui, os autores apresentam as principais lesões dermatológicas descritas em pacientes infectados pelo HTLV-1, destacando o valor epidemiológico e clínico desses achados.<br>Human T-cell Lymphotropic vírus type I (HTLV-1) was the first human retrovírus described. Some time after its discovery a group of diseases were related to this vírus, such as, adult T-cell leukemia lymphoma (ATLL), HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP) and HTLV-1 associated uveitis (HAU). In the nineties, HTLV-1 was associated to a severe eczema of children, called infective dermatitis (ID). Since then, several other skin manifestations have been observed in HTLV-1-infected individuals, particularly in patients with ATLL or HAM/TSP. However, according to some reports, dermatologic lesions are also common in asymptomatic HTLV-1 carriers. Besides ID, all other skin lesions reported are nonspecific. The aim of this review is to outline the dermatologic manifestations reported in HTLV-1 infected patients, emphasizing the clinical and epidemiological value of these findings

Use of failure-to-rescue to identify international variation in postoperative care in low-, middle- and high-income countries: a 7-day cohort study of elective surgery

This was an investigator-initiated study funded by Nestle Health Sciences through an unrestricted research grant and by a National Institute for Health Research (UK) Professorship held by R.P. The study was sponsored by Queen Mary University of London

Kuluttajabarometri maakunnittain 2000, 2. neljännes

Suomen virallinen tilasto (SVT