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

Connaissances, attitudes et pratiques de l’hygiene des mains par les infirmiers du service de pediatrie du CHU Sylvanus Olympio : Knowledge, attitudes and practices of hand hygiene by nurses in the paediatric ward of the CHU Sylvanus Olympio

Titre : Connaissances, attitudes et pratiques de l’hygiène des mains par les infirmiers du service de pédiatrie du CHU Sylvanus OlympioObjectif : décrire les connaissances, attitudes et pratiques des infirmiers soignant les enfants sur l’hygiène des mains et les évaluer.Population et méthode : étude transversale a visée descriptive menée du 10 juin au 3 juillet 2018 par l’interview des infirmiers du service de pédiatre du CHU SO.Résultats : l’âge moyen des infirmiers était de 32 ± 8 ans avec des extrêmes de 19 et 53 ans. Le lavage des mains était plus connu (100%) que la friction hydro-alcoolique (75%) et plus pratiqué. La majorité des infirmiers pratiquaient l’hygiène des mains pour se protéger contre les infections (86,1%). L’eau et le savon liquide étaient insuffisamment connus (63,9%) comme matériel d’hygiène des mains, la solution hydro-alcoolique était moins connue (50%). Les étapes de l’hygiène des mains n’étaient pas connues par 55,6% des infirmiers. La durée de l’hygiène des mains et le volume d’antiseptique n’étaient pas connus. La connaissance du type d’hygiène des mains adapté à des situations de soins était mauvaise. La majorité des infirmiers (88,9%) avait entendu parler de l’hygiène des mains dans une sensibilisation.Conclusion : les connaissances, attitudes et pratiques des infirmiers souffrent d’insuffisance qui rendent leur pratique inadéquate alors qu’en milieu hospitalier ce geste simple est irremplaçable. Un programme rigoureux s’avère indispensable pour un changement de comportement. Title: Knowledge, attitudes and practices of hand hygiene by nurses in the paediatric ward of the CHU Sylvanus OlympioObjective: to describe the knowledge, attitudes and practices of nurses caring for children on hand hygiene and to evaluate them.Population and method: descriptive cross-sectional study conducted from 10 June to 3 July 2018 by interviewing nurses in the paediatric department of the CHU SO.Results: The average age of the nurses was 32 ± 8 years with extremes of 19 and 53 years. Hand washing was more widely known (100%) than hydro-alcoholic friction (75%) and more widely practiced. The majority of nurses practised hand hygiene to protect themselves against infection (86.1%). Water and liquid soap were insufficiently known (63.9%) as hand hygiene materials, hydro-alcoholic solution was less known (50%). The steps of hand hygiene were not known by 55.6% of the nurses. The duration of hand hygiene and the volume of antiseptic were not known. Knowledge of the type of hand hygiene adapted to care situations was poor. The majority of nurses (88.9%) had heard about hand hygiene in an awareness-raising event.Conclusion: Nurses' knowledge, attitudes and practices suffer from inadequacies that make their practice inappropriate, whereas in a hospital environment this simple gesture is irreplaceable. A rigorous programme is essential for a change in behaviour

Cout direct hospitalier de l’osteomyelite aiguë chez l’enfant drepanocytaire au CHU Sylvanus Olympio de Lome : Direct hospital costs of acute osteomyelitis in children with sickle cell disease

Objectif : Évaluer le coût global moyen de la prise en charge de l’Ostéomyélite Aigüe (OA) chez un enfant drépanocytaire.Méthode : Étude rétrospective sur la période du 1er janvier 2008 au 30 novembre 2019, portant sur 23 dossiers de patients drépanocytaires pris en charge pour OA dans le service de pédiatrie du CHU Sylvanus Olympio.Résultats : L’âge moyen des patients était de 7 ans ± 4 ans avec des extrêmes de 15 mois et 17 ans. Le membre inférieur droit était le plus touché par l’OA (n=10). Dix-huit patients ont été hospitalisés et 5 patients traités en ambulatoire. Le coût global moyen de la prise en charge de l’OA était de 144 796,522 ± 48 785,034 francs CFA (84 310 - 250 855 francs CFA). Le coût global moyen était dominé par le coût du traitement antibiotique (26,8%), le coût du traitement de relai (23,8%), le coût des frais d’hospitalisation (17,90%) et le coût des examens paracliniques (14,80%).Conclusion : Le coût global moyen de la prise en charge de l’OA chez l’enfant drépanocytaire au CHU Sylvanus Olympio est très onéreux comparé au niveau de vie du togolais. Il a représenté 5 fois le SMIG au Togo. Objective: To assess the average overall cost of managing acute osteomyelitis in children with sickle cell disease.Method: Retrospective study of 23 sickle cell patients treated for acute osteomyelitis in the paediatric ward of the CHU Sylvanus Olympio from 1 January 2008 to 30 November 2019.Results: The mean age of the patients was 7 years ± 4 years with extremes of 15 months and 17 years. The right lower limb (n=10) was the most affected by acute osteomyelitis. Eighteen patients were hospitalized and 5 patients were treated as outpatients. The average overall cost of management of acute osteomyelitis was 144 796.522 ± 48 785.034 CFA francs (84 310 – 250 855 CFA francs). The average overall cost was dominated by the cost of antibiotic treatment (26.8%), the cost of follow-up treatment (23.8%), the cost of hospitalization (17.90%) and the cost of paraclinical examinations (14.80%).Conclusion: The average overall cost of treating acute osteomyelitis in children with sickle cell disease at the Sylvanus Olympio University Hospital is very expensive compared to the standard of living of Togolese people. It represented 5 times the minimum wage in Togo