Goodbye Hartmann trial: a prospective, international, multicenter, observational study on the current use of a surgical procedure developed a century ago

Background: Literature suggests colonic resection and primary anastomosis (RPA) instead of Hartmann's procedure (HP) for the treatment of left-sided colonic emergencies. We aim to evaluate the surgical options globally used to treat patients with acute left-sided colonic emergencies and the factors that leading to the choice of treatment, comparing HP and RPA. Methods: This is a prospective, international, multicenter, observational study registered on ClinicalTrials.gov. A total 1215 patients with left-sided colonic emergencies who required surgery were included from 204 centers during the period of March 1, 2020, to May 31, 2020. with a 1-year follow-up. Results: 564 patients (43.1%) were females. The mean age was 65.9 ± 15.6 years. HP was performed in 697 (57.3%) patients and RPA in 384 (31.6%) cases. Complicated acute diverticulitis was the most common cause of left-sided colonic emergencies (40.2%), followed by colorectal malignancy (36.6%). Severe complications (Clavien-Dindo ≥ 3b) were higher in the HP group (P < 0.001). 30-day mortality was higher in HP patients (13.7%), especially in case of bowel perforation and diffused peritonitis. 1-year follow-up showed no differences on ostomy reversal rate between HP and RPA. (P = 0.127). A backward likelihood logistic regression model showed that RPA was preferred in younger patients, having low ASA score (≤ 3), in case of large bowel obstruction, absence of colonic ischemia, longer time from admission to surgery, operating early at the day working hours, by a surgeon who performed more than 50 colorectal resections. Conclusions: After 100 years since the first Hartmann's procedure, HP remains the most common treatment for left-sided colorectal emergencies. Treatment's choice depends on patient characteristics, the time of surgery and the experience of the surgeon. RPA should be considered as the gold standard for surgery, with HP being an exception

Guidelines for the use and interpretation of assays for monitoring autophagy (4th edition)1.

In 2008, we published the first set of guidelines for standardizing research in autophagy. Since then, this topic has received increasing attention, and many scientists have entered the field. Our knowledge base and relevant new technologies have also been expanding. Thus, it is important to formulate on a regular basis updated guidelines for monitoring autophagy in different organisms. Despite numerous reviews, there continues to be confusion regarding acceptable methods to evaluate autophagy, especially in multicellular eukaryotes. Here, we present a set of guidelines for investigators to select and interpret methods to examine autophagy and related processes, and for reviewers to provide realistic and reasonable critiques of reports that are focused on these processes. These guidelines are not meant to be a dogmatic set of rules, because the appropriateness of any assay largely depends on the question being asked and the system being used. Moreover, no individual assay is perfect for every situation, calling for the use of multiple techniques to properly monitor autophagy in each experimental setting. Finally, several core components of the autophagy machinery have been implicated in distinct autophagic processes (canonical and noncanonical autophagy), implying that genetic approaches to block autophagy should rely on targeting two or more autophagy-related genes that ideally participate in distinct steps of the pathway. Along similar lines, because multiple proteins involved in autophagy also regulate other cellular pathways including apoptosis, not all of them can be used as a specific marker for bona fide autophagic responses. Here, we critically discuss current methods of assessing autophagy and the information they can, or cannot, provide. Our ultimate goal is to encourage intellectual and technical innovation in the field

Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTIC‐HF: baseline characteristics and comparison with contemporary clinical trials

Aims: The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC‐HF) trial. Here we describe the baseline characteristics of participants in GALACTIC‐HF and how these compare with other contemporary trials. Methods and Results: Adults with established HFrEF, New York Heart Association functional class (NYHA) ≥ II, EF ≤35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic‐guided dosing: 25, 37.5 or 50 mg bid). 8256 patients [male (79%), non‐white (22%), mean age 65 years] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NT‐proBNP 1971 pg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTIC‐HF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure < 100 mmHg (n = 1127), estimated glomerular filtration rate < 30 mL/min/1.73 m2 (n = 528), and treated with sacubitril‐valsartan at baseline (n = 1594). Conclusions: GALACTIC‐HF enrolled a well‐treated, high‐risk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation

Análisis de indicadores gerenciales y de atención posteriores a adecuación de personal de enfermería

Objetivo: analisar indicadores assistenciais e gerenciais após adequação do quadro de pessoal de enfermagem. Método: estudo descritivo, retrospectivo com dados obtidos dos sistemas de registros informatizados de um hospital universitário do Sul do Brasil. Foram analisados estatisticamente indicadores assistenciais e gerenciais, referentes aos primeiros semestres de 2013 e 2014. Resultados: o incremento de 40,0% no número de enfermeiros e 16,0% no número de técnicos de enfermagem resultou na redução de 12,0% no percentual de afastamentos por doença, 21,8% no total do banco de horas excedentes, 92,0% nas horas extras pagas. Houve redução de 75,0% nas taxas de úlcera por pressão, de 10,5% no número de quedas e 50,0% nas infecções por sonda vesical de demora. Conclusão: a adequação do quantitativo de pessoal repercutiu positivamente nos indicadores gerenciais e assistenciais, e contribuiu para qualifi car o cuidado e melhorar as condições de trabalho da equipe de enfermagem.Objective: analyze healthcare and managerial indicators after nursing personnel upsizing. Method: a retrospective, descriptive study was conducted using data from computer systems of a university hospital in southern Brazil. Healthcare and managerial indicators related to the fi rst half of 2013 and 2014 were statistically analyzed. Results: increases of 40.0% in the number of nurses and 16.0% in the number of nursing technicians led to reductions of 12.0% in the number of sickness absences, 21.8% in positive balance for compensatory time off, 92.0% in paid overtime. Reductions of 75.0% in pressure ulcer rates, 10.5% in the number of falls and 50.0% in infections due to indwelling catheter use were also observed. Conclusion: nursing staff upsizing caused a positive impact on managerial and healthcare indicators and helped qualify care and improve work conditions for the nursing team.Objetivo: analizar indicadores gerenciales y de atención luego de adecuación del plantel de personal de enfermería. Método: estudio descriptivo, retrospectivo, con datos obtenidos del sistema de registros informáticos de hospital universitario del sur de Brasil. Fueron analizados estadísticamente indicadores gerenciales y de atención correspondientes a los primeros semestres de 2013 y 2014. Resultados: el incremento del 40,0% en cantidad de enfermeros y 16,0% de técnicos de enfermería resultó en una reducción del 12,0% del porcentaje de licencias de salud, 21,8% del total del banco de horas excedentes, 92,0% de horas extra pagas. Hubo reducción del 75,0% en tasas de úlcera por presión, de 10,5% en número de caídas y de 50,0% en infecciones por sonda vesical de demora. Conclusión: la adecuación cuantitativa del personal repercutió positivamente en los indicadores gerenciales y de atención, y contribuyó a calificar el cuidado y mejorar las condiciones laborales del equipo de enfermería

Análisis de indicadores gerenciales y de atención posteriores a adecuación de personal de enfermería

Objetivo: analisar indicadores assistenciais e gerenciais após adequação do quadro de pessoal de enfermagem. Método: estudo descritivo, retrospectivo com dados obtidos dos sistemas de registros informatizados de um hospital universitário do Sul do Brasil. Foram analisados estatisticamente indicadores assistenciais e gerenciais, referentes aos primeiros semestres de 2013 e 2014. Resultados: o incremento de 40,0% no número de enfermeiros e 16,0% no número de técnicos de enfermagem resultou na redução de 12,0% no percentual de afastamentos por doença, 21,8% no total do banco de horas excedentes, 92,0% nas horas extras pagas. Houve redução de 75,0% nas taxas de úlcera por pressão, de 10,5% no número de quedas e 50,0% nas infecções por sonda vesical de demora. Conclusão: a adequação do quantitativo de pessoal repercutiu positivamente nos indicadores gerenciais e assistenciais, e contribuiu para qualifi car o cuidado e melhorar as condições de trabalho da equipe de enfermagem.Objective: analyze healthcare and managerial indicators after nursing personnel upsizing. Method: a retrospective, descriptive study was conducted using data from computer systems of a university hospital in southern Brazil. Healthcare and managerial indicators related to the fi rst half of 2013 and 2014 were statistically analyzed. Results: increases of 40.0% in the number of nurses and 16.0% in the number of nursing technicians led to reductions of 12.0% in the number of sickness absences, 21.8% in positive balance for compensatory time off, 92.0% in paid overtime. Reductions of 75.0% in pressure ulcer rates, 10.5% in the number of falls and 50.0% in infections due to indwelling catheter use were also observed. Conclusion: nursing staff upsizing caused a positive impact on managerial and healthcare indicators and helped qualify care and improve work conditions for the nursing team.Objetivo: analizar indicadores gerenciales y de atención luego de adecuación del plantel de personal de enfermería. Método: estudio descriptivo, retrospectivo, con datos obtenidos del sistema de registros informáticos de hospital universitario del sur de Brasil. Fueron analizados estadísticamente indicadores gerenciales y de atención correspondientes a los primeros semestres de 2013 y 2014. Resultados: el incremento del 40,0% en cantidad de enfermeros y 16,0% de técnicos de enfermería resultó en una reducción del 12,0% del porcentaje de licencias de salud, 21,8% del total del banco de horas excedentes, 92,0% de horas extra pagas. Hubo reducción del 75,0% en tasas de úlcera por presión, de 10,5% en número de caídas y de 50,0% en infecciones por sonda vesical de demora. Conclusión: la adecuación cuantitativa del personal repercutió positivamente en los indicadores gerenciales y de atención, y contribuyó a calificar el cuidado y mejorar las condiciones laborales del equipo de enfermería