TECNOLOGÍAS DEL CUIDADO UTILIZADAS POR LA ENFERMERÍA EN LA ASISTENCIA AL PACIENTE POLITRAUMATIZADO: REVISIÓN INTEGRATIVA

The aim of this study was to identify healthcare technologies used by nurses in the care for polytraumatized patients. This is an integrative review, with articles found in three databases in the period from May to July 2014. Nineteen articles from the period between 2009 and 2014 were selected and distributed among the three categories of healthcare technology: soft, soft-hard and hard. It was found that nursing workers adopted the three types of healthcare technology when caring for polytraumatized patients, emphasizing the soft-hard category. Soft technologies included health support and education of patient and family members/caregivers and training of the nursing team; soft-hard technologies: care management, admission of patients under risk, assessment and treatment of pain, nursing process and development of protocols; and hard technologies: information systems. Care improvements caused by healthcare technologies were found, since they reach all aspects of care.El objetivo del estudio fue identificar las tecnologías del cuidado utilizadas por el enfermero en la asistencia al paciente politraumatizado. Revisión integrativa, cuya búsqueda de artículos ocurrió en tres bases de datos, en el periodo de mayo a julio de 2014. Fueron seleccionados 19 artículos, comprendidos en el periodo de 2009 a 2014, distribuidos en las tres categorías tecnológicas de cuidado: leves, leve-duras y duras. Se verificó que los profesionales de enfermería utilizan los tres tipos de tecnologías del cuidado en la asistencia al paciente politraumatizado, con énfasis a las leve-duras. Entre las tecnologías leves: apoyo y educación en salud del paciente y familiares/cuidadores y la capacitación del equipo de enfermería; tecnologías leve-duras: gerencia del cuidado, acojimiento del paciente con clasificación de riesgo, evaluación y tratamiento del dolor, proceso de enfermería y elaboración de protocolos; y tecnologías duras: sistemas de información. Se percibió la mejoría asistencial proporcionada por las tecnologías del cuidado, a causa de que estas abarcan todos los aspectos del cuidar.Objetivou-se identificar as tecnologias do cuidado utilizadas pelo enfermeiro na assistência ao paciente politraumatizado. Revisão integrativa, com busca de artigos em três bases de dados, no período de maio a julho de 2014. Foram selecionados 19 artigos, compreendidos no período de 2009 a 2014, distribuídos nas três categorias tecnológicas do cuidado: leves, leve-duras e duras. Verificou-se que os profissionais de enfermagem utilizam os três tipos de tecnologias do cuidado na assistência ao paciente politraumatizado, com ênfase às leve-duras. Entre as tecnologias leves: apoio e educação em saúde do paciente e familiares/cuidadores e a capacitação da equipe de enfermagem; tecnologias leve-duras: gerência do cuidado, acolhimento do paciente com classificação de risco, avaliação e tratamento da dor, processo de enfermagem e elaboração de protocolos; e tecnologias duras: sistemas de informação. Percebeu-se a melhoria assistencial proporcionada pelas tecnologias do cuidado, por estas abrangerem todos os aspectos do cuidar

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

ENTEROCOCCUS FAECIUM E E. FAECALIS SENSÍVEIS E RESISTENTES À VANCOMICINA (VRE) ISOLADAS DE INFECÇÃO E COLONIZAÇÃO, RESPECTIVAMENTE, EM UM HOSPITAL UNIVERSITÁRIO DO RIO DE JANEIRO: UMA COMPARAÇÃO DA RESISTÊNCIA ANTIMICROBIANA

Introdução/Objetivo: Enterococcus estão normalmente associados a infecções relacionadas à assistência à saúde, geralmente apresentando perfil de multidroga resistência. Esse estudo objetivou comparar a resistência antimicrobiana de amostras VRE (Enterococcus resistentes à vancomicina) oriundas de swab retal com o perfil de amostras de Enterococcus sensíveis à vancomicina, isoladas de materiais clínicos diversos, coletados de dezembro de 2021 a junho de 2022, de pacientes atendidos em um Hospital Universitário. Métodos: Amostras identificadas como Enterococcus pelo método automatizado foram selecionadas, e confirmadas quanto à espécie por MALDI-TOF MS. O perfil de susceptibilidade aos antimicrobianos foi determinado pelo método de disco-difusão. A concentração mínima inibitória (CMI) para vancomicina foi determinada pelo método de microdiluição em caldo para amostras VRE e a presença do gene vanA foi observada pela técnica da reação em cadeia da polimerase (PCR) para todas as amostras. Resultados: Um total de 59 amostras foram identificadas, sendo 31 de colonização anal (VRE) e 28 de materiais clínicos diversos. Dentre as VRE, 55% foram caracterizadas como E. faecalis (VREfa) e 45% como E. faecium (VREfm). Já entre as amostras de origem infecciosa, 89% eram da espécie E. faecalis e 11% E. faecium. Entre E. faecalis (n = 41), amostras VREfa apresentaram maiores taxas de resistência à cloranfenicol, eritromicina, quinolonas e vancomicina (p-valor 90%) das amostras VRE, independente da espécie bacteriana, apresentou CMI > 64 µg/mL para vancomicina, sendo todas vanA positivas. Conclusão: Apesar de observado uma alta taxa de resistência à quinolonas entre amostras VREfa, ao compararmos as duas espécies, independente da resistência à vancomicina, cepas E. faecium apresentaram maiores taxa de resistência aos antimicrobianos, de maneira geral. Nossos resultados contribuem para elucidar os aspectos da emergência e disseminação de microrganismos multirresistentes, ressaltando a importância da vigilância epidemiológica de Enterococcus, especialmente aqueles caracterizados como VRE