Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

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

Violência doméstica e enfermagem: da percepção do fenômeno à realidade cotidiana Violencia doméstica y enfermería: de la percepción del fenómeno a la realidad cotidiana Domestic Violence and Nursing: from the Perception of the Phenomenon to Daily Reality

Aviolência decorre dos conflitos de autoridade, das lutas de poder, da vontade de domínio, do desejo de aniquilação dos outros e de seus bens. É importante considerar os impactos que os casos de violência têm na sociedade. O estudo teve como objetivo a identificação da percepção dos enfermeiros de Atenção Básica sobre o fenômeno da violência doméstica e sua relação com as famílias. Foi um estudo prospectivo, descritivo e exploratório, de abordagem qualitativa, e sustentada pela Teoria de Intervenção "Práxica" da Enfermagem de Saúde Coletiva. Foram propostas três categorias de análise: conceito de família, processo de trabalho do enfermeiro na Atenção Básica e gênero. Sete entrevistas em profundidade foram feitas a enfermeiras das Unidades Básicas de Saúde na região metropolitana de São Paulo. A técnica de Análise do Discurso de Fiorin foi utilizada, surgindo dela quatro categorias empíricas: Refletindo sobre a família e o processo Saúde-Doença; a família e seus conceitos atuais; o trabalho de enfermeira com as famílias das vítimas de violência, eles exprimiram sua impotência para ultrapassá-las e percebem uma carência de cursos de preparação e de capacitação que dificultam a ação profissional perante este tema. É sugerida a capacitação dos profissionais através da educação permanente para reorganizar o processo de trabalho, focalizado nas necessidades das famílias vítimas de violência.La violencia transcurre de los conflictos de autoridad, de las luchas por el poder, de la voluntad de dominio, deseo de aniquilamiento de otro o de sus bienes. Se debe considerar los impactos que los casos de violencia causan en los servicios de salud. Tuvo como objetivo identificar la percepción de los enfermeros de la Atención Básica acerca del fenómeno de la violencia doméstica y su relación con las familias. Es un estudio prospectivo, descriptivo y exploratorio, abordaje cualitativo, sustentado por la Teoría de Intervención "Práxica" de la Enfermería en Salud Colectiva; fueron propuestas tres categorías analíticas: concepto de familia, proceso de trabajo del enfermero en la Atención Básica y género. Fueron realizadas siete entrevistas en profundidad con enfermeras de Unidades Básicas de Salud en la región Metropolitana de São Paulo. Fue utilizada la técnica de Análisis de Discurso de Fiorin, emergiendo cuatro categorías empíricas: Reflexionando sobre la familia y el proceso Salud Enfermedad; la familia y sus conceptos actuales; el trabajo de la enfermera con las familias víctimas de violencia; y las conductas realizadas frente a los casos de violencia. Se concluye que las enfermeras reconocen las dificultades y facilidades en la atención de familias víctimas de violencia, expresaron impotencia para superarlas y perciben escasez de cursos preparatorios y capacitaciones que dificultan la actuación profesional frente a la temática. Se sugiere la capacitación de los profesionales a través de la educación permanente para reorganizar el proceso de trabajo, enfocando a las necesidades de las familias víctimas de violencia.Violence is derived from conflicts of authority, power struggles, the will to dominate, the desire to destroy others and their assets. It is important to consider the impact that cases of violence have on health services. The goal was to identify the Basic Care nurses' perception of the phenomenon of domestic violence and their relation with the families. Thanks to a prospective, descriptive and exploratory study, made with a qualitative approach and based upon the "Práxica" theory of intervention of Collective Health nursing. Three analytical categories were proposed: the concept of family, the work process of the Basic Attention nurses and gender. Seven in-depth interviews were made to the nurses of the Basic Care Units in the metropolitan region of Sao Paulo. The Fiorin Discourse analysis technique was used, which resulted in four empirical categories: Reflection about families and the health-disease process; the family and its current concepts; the nurse's work with the families that are victims of violence and the position taken when faced to cases of violence. It was concluded that the nurses recognize the difficulties and simplicities in the attention of families that were victims of violence. They expressed their impotence to overcome the difficulties and they sense a lack of preparation and training courses related to this matter, which in turn makes professional performance rather difficult. It was also suggested that professional training through permanent education is the way to reorganize the work processes, focusing on the needs of the families that were victims of violence