Contribuições da odontologia hospitalar para a recuperação do paciente: uma análise integrativa

Objetivo: Avaliar a relevância da Odontologia Hospitalar (OH) e do cirurgião-dentista (CD) em ambientes hospitalares, destacando sua contribuição na prevenção de complicações e promoção de melhorias na saúde dos pacientes em terapia intensiva (UTIs), em tratamento oncológico, na gestação de alto risco/neonatologia e em pacientes com necessidades especiais. Materiais e Métodos: Foi realizada uma revisão integrativa da literatura, nas bases PubMed, Google Acadêmico e SciELO, com os termos “Equipe de Odontologia Hospitalar”, “Atendimento Odontológico em UTIs”, “Odontologia para Gestantes de Alto Risco e Neonatos”, “Oncologia Integrativa e Saúde Bucal” e “Odontologia Hospitalar para Pessoas com Deficiência”. A seleção dos artigos foi conduzida por dois revisores independentes, utilizando as ferramentas de avaliação crítica do Joanna Briggs Institute (JBI). Resultados: A presença de CDs em hospitais reduz significativamente a pneumonia nosocomial em UTIs através da gestão da higiene bucal. Além disso, a OH é essencial no manejo de complicações bucais que afetam a recuperação de pacientes oncológicos e a saúde de gestantes de alto risco e neonatos. A oficialização da OH como especialidade odontológica no Brasil e propostas legislativas para sua implementação em UTIs destacam a necessidade de sua integração aos protocolos de saúde hospitalar. Conclusão: A atuação da equipe de OH pode prevenir infecções hospitalares e melhorar a saúde geral dos pacientes internados. A formação contínua de CDs e a inclusão da OH nos currículos de graduação são essenciais para integrar esses profissionais nas equipes multidisciplinares, promovendo a recuperação dos pacientes por meio de uma abordagem integrada de cuidados em saúde

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

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 RP. The study was sponsored by Queen Mary University of London

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine

Erratum to: Guidelines for the use and interpretation of assays for monitoring autophagy (3rd edition) (Autophagy, 12, 1, 1-222, 10.1080/15548627.2015.1100356

non present