Introduction The COVID-19 pandemic is having a deep impact on emergency surgical services, with a significant reduction of patients admitted into emergency surgical units world widely. Reliable figures of this reduction have not been produced yet. Our international audit aimed at giving a precise snapshot of the absolute and relative changes of emergency surgical admissions at the outbreak of the pandemic. Materials and methods Datasets of patients admitted as general surgical emergencies into 45 internationally distributed emergency surgical units during the months of March and April 2020 (Covid-19 pandemic outbreak) were collected and compared with those of patients admitted into the same units during the months of March and April 2019 (pre-Covid-19). Primary endpoint was to evaluate the relative variation of the presentation symptoms and discharge diagnoses between the two study periods. Secondary endpoint was to identify the possible change of therapeutic strategy during the same two periods. Results Forty-five centres participated sent their anonymised data to the study hub, for a total of 6263 patients. Of these, 3810 were admitted in the pre-Covid period and 2453 in the Covid period, for a 35.6% absolute reduction. The most common presentation was abdominal pain, whose incidence did not change between the two periods, but in the Covid period patients presented less frequently with anal pain, hernias, anaemia and weight loss. ASA 1 and low frailty patients were admitted less frequently, while ASA>1 and frail patients showed a relative increase. The type of surgical access did not change significantly, but lap-to-open conversion rate halved between the two study periods. Discharge diagnoses of appendicitis and diverticulitis reduced significantly, while bowel ischaemia and perianal ailments had a significant relative increase. Conclusions Our audit demonstrates a significant overall reduction of emergency surgery admissions at the outbreak of the Covid-19 pandemic with a minimal change of the proportions of single presentations, diagnoses and treatments. These findings may open the door to new ways of managing surgical emergencies without engulfing the already busy hospitals.
Introduction The concept of “weekend effect”, that is, substandard healthcare during weekends, has never been fully demonstrated, and the different outcomes of emergency surgical patients admitted during weekends may be due to different conditions at admission and/or different therapeutic approaches. Aim of this international audit was to identify any change of pattern of emergency surgical admissions and treatments during weekends. Furthermore, we aimed at investigating the impact of the COVID-19 pandemic on the alleged “weekend effect”. Methods The database of the CovidICE-International Study was interrogated, and 6263 patients were selected for analysis. Non-trauma, 18+ yo patients admitted to 45 emergency surgery units in Europe in the months of March–April 2019 and March–April 2020 were included. Demographic and clinical data were anonymised by the referring centre and centrally collected and analysed with a statistical package. This study was endorsed by the Association of Italian Hospital Surgeons (ACOI) and the World Society of Emergency Surgery (WSES). Results Three-quarters of patients have been admitted during workdays and only 25.7% during weekends. There was no difference in the distribution of gender, age, ASA class and diagnosis during weekends with respect to workdays. The first wave of the COVID pandemic caused a one-third reduction of emergency surgical admission both during workdays and weekends but did not change the relation between workdays and weekends. The treatment was more often surgical for patients admitted during weekends, with no difference between 2019 and 2020, and procedures were more often performed by open surgery. However, patients admitted during weekends had a threefold increased risk of laparoscopy-to-laparotomy conversion (1% vs. 3.4%). Hospital stay was longer in patients admitted during weekends, but those patients had a lower risk of readmission. There was no difference of the rate of rescue surgery between weekends and workdays. Subgroup analysis revealed that interventional procedures for hot gallbladder were less frequently performed on patients admitted during weekends. Conclusions Our analysis revealed that demographic and clinical profiles of patients admitted during weekends do not differ significantly from workdays, but the therapeutic strategy may be different probably due to lack of availability of services and skillsets during weekends. The first wave of the COVID-19 pandemic did not impact on this difference.
Objectives: to understanding the perception of Primary Health Care users about the professional identity of nurse. Methods: this is an exploratory, descriptive, cross-sectional and quantitative study, using the STROBE instrument. The sample included 94 users grouped according to the Family Health Strategy coverage. Results: the idealized identity of nurses dates back to the past of the profession. The subjects, in 81.9%, associate the female gender to the profession. 63.8% of them believed that the nurse is a subordinate, and from these, 90% believed they were subordinate to physicians. The analysis of the perception of the activities under responsibility of the nurse showed the predominance of assistance activities that are not exclusive to them. Conclusions: the findings indicate partial awareness about the identity and the role of nurses in Primary Health Care. The main deficits are related to the competences of this professional. The understanding of the role of the nurse was higher in the population under the coverage of the Family Health Strategy.
Parada Cardiorrespiratória (PCR) é a interrupção súbita dos batimentos cardíacos, da respiração e perda da consciência. Identificar a percepção da equipe de enfermagem quanto ao manejo da parada cardiorrespiratória em neonatos na Unidade de Terapia Intensiva Neonatal (UTIN); Identificar os fatores do ambiente de trabalho que interferem na atuação da equipe de enfermagem na parada e; Discutir as implicações desse manejo para prática clínica. Estudo descritivo, qualitativo, realizado em uma UTIN no Rio de Janeiro. Os dados foram coletados em setembro 2020, através de questionário e entrevista. Participaram 23 profissionais de enfermagem e foram construídas três categorias: Percepção dos profissionais de enfermagem sobre atuação e o manejo da PCR neonatal; Fatores no ambiente de trabalho facilitadores e dificultadores da assistência; e Sugestões para melhoria do atendimento. O manejo da PCR ainda é um desafio para os profissionais de saúde. Descritores: Reanimação Cardiopulmonar, Neonatologia, Enfermagem. Nursing perception on the management of cardiorespiratory arrest in neonatology Abstract: Cardiorespiratory Arrest (CRP) is the sudden interruption of heartbeat, breathing and immediate loss of consciousness. To identify the perception of the nursing team regarding the management of cardiorespiratory arrest in neonates in the NICU; To identify the factors in the work environment that interfere with the performance of the nursing team during the arrest and; Discuss the implications of this management for the clinical practice. This is a descriptive, qualitative study carried out in a NICU in Rio de Janeiro. Data were collected using a semi-structured questionnaire/interview instrument. Twenty-three nursing professionals participated and three categories were constructed: a) Perception of nursing professionals about performance and the management of neonatal CRP; b) Factors in the work environment that facilitate and hinder assistance; and c) Suggestions for improving service. The management of CRP is still a challenge for health professionals. Descriptors: Cardiopulmonary Resuscitation, Neonatology, Nursing. Percepción de enfermería sobre el manejo del paro cardiorrespiratorio en neonatología Resumen: La parada Cardiorrespiratoria (PCR) es la interrupción súbita de los latidos cardíacos, de la respiración y pérdida inmediata de la consciencia. Identificar la percepción del equipo de enfermería en relación al manejo de la PCR en neonatos en la Unidad de Terapia Intensiva Neonatal (UTIN); Analizar las informaciones encontradas sobre esa percepción y; Discutir las implicaciones de este manejo para la práctica clínica de la atención neonatal en eventos de la PCR frente a su percepción. Estudio descriptivo, cualitativo, realizado en la UTIN en Rio de Janeiro. Los datos fueron colectados utilizando un instrumento de cuestionarios/entrevista semiestructurada. Fueron entrevistados 11 enfermeros e 12 técnicos de enfermería. Emergieron tres categorías: Percepción de los profesionales de enfermería acerca de la actuación y del manejo de la PCR neonatal; Factores en el ambiente laboral que facilitan y dificultan la asistencia; y Sugerencias para la mejoraría de la atención. El manejo de la PCR aún es un desafío para los profesionales de salud. Descriptores: Reanimación Cardiopulmonar, Neonatología, Enfermería.
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