Background Ileus is common after elective colorectal surgery, and is associated with increased adverse events and prolonged hospital stay. The aim was to assess the role of non‐steroidal anti‐inflammatory drugs (NSAIDs) for reducing ileus after surgery. Methods A prospective multicentre cohort study was delivered by an international, student‐ and trainee‐led collaborative group. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The primary outcome was time to gastrointestinal recovery, measured using a composite measure of bowel function and tolerance to oral intake. The impact of NSAIDs was explored using Cox regression analyses, including the results of a centre‐specific survey of compliance to enhanced recovery principles. Secondary safety outcomes included anastomotic leak rate and acute kidney injury. Results A total of 4164 patients were included, with a median age of 68 (i.q.r. 57–75) years (54·9 per cent men). Some 1153 (27·7 per cent) received NSAIDs on postoperative days 1–3, of whom 1061 (92·0 per cent) received non‐selective cyclo‐oxygenase inhibitors. After adjustment for baseline differences, the mean time to gastrointestinal recovery did not differ significantly between patients who received NSAIDs and those who did not (4·6 versus 4·8 days; hazard ratio 1·04, 95 per cent c.i. 0·96 to 1·12; P = 0·360). There were no significant differences in anastomotic leak rate (5·4 versus 4·6 per cent; P = 0·349) or acute kidney injury (14·3 versus 13·8 per cent; P = 0·666) between the groups. Significantly fewer patients receiving NSAIDs required strong opioid analgesia (35·3 versus 56·7 per cent; P < 0·001). Conclusion NSAIDs did not reduce the time for gastrointestinal recovery after colorectal surgery, but they were safe and associated with reduced postoperative opioid requirement.
RESUMOObjetivo: avaliar o conhecimento e a compreensão dos profissionais da saúde em relação à prática de higiene das mãos. Método: trata-se de estudo quantitativo, descritivo, transversal, com 56 profissionais de um hospital filantrópico. Utilizaram-se, para a coleta de dados, dois questionários. Inseriram-se os dados em um banco de dados no Programa Microsoft® Office Excel, analisando-os por meio de estatística descritiva. Apresentaram-se os resultados em forma de tabelas. Resultados: verificou-se que 100% dos profissionais consideram importante a higienização das mãos e reconhecem as mãos como agente indutor de infecção e que a prática da higiene leva à sua prevenção; 64% afirmaram que praticam uma perfeita higienização antes e após o contato com o paciente. Observou-se, entretanto, após a avaliação da taxa de adesão a oportunidades de higiene de mãos, baixa taxa de adesão de 8,5%. Conclusão: revela-se que, apesar de a equipe de profissionais ter uma percepção adequada da importância da higienização das mãos e de ter conhecimento sobre o tema, isso não se reflete no cotidiano. Descritores: Higiene das Mãos; Segurança do Paciente; Infecção Hospitalar; Hospital; Assistência à Saúde; Prevenção de Doenças; Recursos Humanos em Saúde. ABSTRACT Objective: to evaluate the knowledge and understanding of health professionals in relation to the practice of hand hygiene. Method: this is a quantitative, descriptive, cross-sectional study, with 56 professionals from a philanthropic hospital. Data collection occurred by means of two questionnaires. The data were entered into a database in Microsoft® Office Excel, analyzing them by means of descriptive statistics. The results are presented as tables. Results: 100% of the professionals consider hand hygiene important and recognize the hands as inducing agent of infection and that the practice of hygiene leads to its prevention; 64% reported carrying out a perfect hygiene before and after patient contact. However, the evaluation of the rate of adherence to opportunities of hand hygiene was low, with the 8.5%. Conclusion: although the team of professionals has an adequate perception of the importance of hand washing and has knowledge about the topic, this is not reflected in the routine. Descriptors: Hand Hygiene; Patient Safety; Cross Infection; Hospital; Health Care; Disease Prevention; Health Human Resources. RESUMEN Objetivo: evaluar el conocimiento y la comprensión de los profesionales de la salud en relación con la práctica de la higiene de las manos. Método: se trata de un estudio cuantitativo, descriptivo, transversal, con 56 profesionales de un hospital filantrópico. Se utilizaron para la recolección de datos dos cuestionarios. Los datos fueron introducidos en una base de datos de Microsoft® Office Excel, y analizados por medio de estadísticas descriptivas. Los resultados se presentan en forma de tablas. Resultados: se encontró que 100% de los profesionales consideran importante la higiene de las manos y reconocen las manos como agentes inductores de la infección y que la práctica de la higiene conduce a su prevención; 64% dijieron que hacen una práctica perfecta de higiene antes y después del contacto con el paciente. También se observó, sin embargo, después de la evaluación de la tasa de adhesión a las oportunidades de higiene de manos, la baja adhesión, con 8,5%. Conclusión: se revela que, a pesar de que el equipo de profesionales tiene una adecuada percepción de la importancia de lavarse las manos y tiene conocimientos sobre el tema, pero no lo hacen en su cotidiano. Descriptores: Higiene de las Manos; Seguridad del Paciente; Infección Hospitalaria; Hospitales; Atención de Salud; Prevención de Enfermedades; Recursos Humanos en Salud.
Objective: To identify common mental disorders and resilience in homeless persons. Method: Cross-sectional study with 49 homeless persons, assisted in the Casa da Acolhida Adulta and the Specialized Reference Center in a municipality in the Northeast of Brazil. Data collection performed between February and March 2018, using SRQ20 scales for common mental disorders and another for Resilience. Kruskal Wallis test, Student's T-test and Chi-Square test were used. Results: In the study, 61.2% (30) participants have poor sleep; 69.4% (34) feel nervous, tense or worried; 71.4% (35) feel unhappy; 63.3% are unable to play a useful role in their lives; 71.4% (35) have common mental disorders, and 44.9% (22) presented low resilience. Resilience influences common mental disorders, which, in turn, are influenced by gender and age. Conclusion: Professionals who assist homeless persons need to have a look directed at common mental disorders and resilience. RESUMO Objetivo: Rastrear transtornos mentais comuns e a resiliência de pessoas em situação de rua. Método: Estudo transversal com 49 pessoas em situação de rua, assistidas na Casa de Acolhida e Centro de Referência Especializado em município do Nordeste do Brasil. Coleta realizada entre fevereiro e março de 2018, utilizando escalas SRQ20 para transtornos mentais comuns e outra de Resiliência. Utilizaram-se os testes de Kruskal Wallis, t e Qui Quadrado. Resultados: 61,2% (30) dormem mal, 69,4% (34) sentem-se nervosos, tensos ou preocupados, 71,4% (35) tristes, 63,3% são incapazes de desempenhar um papel útil na sua vida, em 71,4% (35) rastreou-se transtornos mentais comuns e em 44,9% (22) baixa resiliência. A resiliência influencia os transtornos mentais comuns, os quais são influenciados pelo gênero e a idade. Conclusão: Os profissionais que assistem pessoas em situação de rua necessitam ter um olhar direcionado aos transtornos mentais comuns e resiliência. Descritores: Transtornos Mentais; Resiliência Psicológica; Pessoas em Situação de Rua; Saúde Mental; Enfermagem. RESUMENObjetivo: Identificar los trastornos mentales comunes y la resiliencia en personas en situación de calle. Método: Estudio transversal realizado con 49 personas en situación de calle, que recibían asistencia en la Casa de Acogida y Centro de Referencia Especializado, en un municipio del Nordeste de Brasil. La recolección de datos ocurrió entre febrero y marzo de 2018, siendo utilizado el SRQ-20 para los trastornos mentales comunes, y otro cuestionario para la resiliencia. Se utilizaron las pruebas de Kruskal-Wallis, t y de Qui-cuadrado. Resultados: El 61,2% (30) de los participantes duermen mal, el 69,4% (34) se sienten nerviosos, tensos o preocupados, el 71,4% (35) tristes, el 63,3% son incapaces de desempeñar un papel útil en la vida, el 71,4% (35) presentan trastornos mentales comunes y el 44,9% (22) tienen baja resiliencia. La resiliencia influye en los trastornos mentales comunes, que son influenciados por el género y la edad. Conclusión: Los profesionales que asisten a personas en situación de call...
Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien–Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P < 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P < 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk.
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