RESUMO
INTRODUCTION: the attraction of women by Surgery has always existed. Although Surgery has been considered a specialty for men, several women chose it, despite gender bias issues that have persisted over many years. Several obstacles have impacted the practice of women surgeons, leading them to abandon the profession, while others, perhaps bearers of a stronger spirit, managed to overcome them, and won. OBJECTIVE: to assess the rates of perception of harassment against female surgeons as a cause of difficulty and negative feelings related to the specialty. METHODS: we conducted a quantitative and qualitative (personal accounts) research through a questionnaire via Google Forms® sent to all women surgeons registered in the Brazilian College of Surgeons and in a WhatsApp women surgeons' groups. The qualitative analysis was made with the Wordle® app. RESULTS: from 821 questionnaires sent, we obtained 232 responses (28.2%). Harassment perception during training was 49.1% (n=114). From the women surgeons who perceived harassment, 56.1% reported having undergone different training than expected, with statistical significance (p<0.001). The question of having been treated differently due to being a woman also had an impact on harassment perception (77.2% harassed vs 47.5%; p<0.001). Physical (42.1% vs 6.8%) and emotional (92.1% vs 39.8%) threats were also different between groups. CONCLUSION: women surgeons still report great harassment perception, both moral and sexual, which impacts their feelings about the specialty.
Assuntos
Assédio Sexual , Cirurgiões , Feminino , Humanos , Masculino , Percepção , Sexismo , Inquéritos e QuestionáriosRESUMO
BACKGROUND & AIMS: Across the globe, the prevalence of hospital malnutrition varies greatly depending on the population served and on local socioeconomic conditions. While malnutrition is widely recognized to worsen patient outcomes and add financial burdens to healthcare systems, recent data on hospital malnutrition in Latin America are limited. Our study objectives were: (1) to quantify the prevalence of malnutrition risk in Latin American hospital wards, and (2) to explore associations between nutritional risk status, in-hospital food intake, and health outcomes. METHODS: On nutritionDay (nDay), a specific day every year, hospital wards worldwide can participate in a one-day, cross-sectional audit. We analyzed nDay data collected in ten Latin American countries from 2009 to 2015, including demographic and nutrition-related findings for adult patients (≥18 years) from 582 hospital wards/units. Based on patient-reported responses to questions related to the Malnutrition Screening Tool, we determined the prevalence of malnutrition risk (MST score ≥2). We also summarized patient-reported food intake on nDay, and we analyzed staff-collected outcome data at 30 days post-nDay. RESULTS: The prevalence of malnutrition risk in the Latin American nDay study population (N = 14,515) was 39.6%. More than 50% of studied patients ate one-half or less of their hospital meal, ate less than normal in the week before nDay, or experienced weight loss in the prior three months. The hospital-mortality hazard ratio was 3.63 (95% CI [2.71, 4.88]; P < 0.001) for patients eating one-quarter of their meal (compared with those who ate the full meal), increasing to 6.6 (95% CI [5.02, 8.7]; P < 0.0001) for patients who ate none of the food offered. CONCLUSIONS: Based on compilation of nDay surveys throughout Latin America, 2 of every 5 hospitalized patients were at risk for malnutrition. The associated risk for hospital mortality was up to 6-fold higher among patients who ate little or none of their meal on nDay. This high prevalence showed scant improvement over rates two decades ago-a compelling rationale for new focus on nutrition education and training of professionals in acute care settings.
Assuntos
Dieta/mortalidade , Mortalidade Hospitalar/tendências , Hospitais/estatística & dados numéricos , Pacientes Internados/estatística & dados numéricos , Desnutrição/mortalidade , Adulto , Idoso , Estudos Transversais , Ingestão de Alimentos , Feminino , Humanos , América Latina/epidemiologia , Masculino , Desnutrição/diagnóstico , Refeições , Pessoa de Meia-Idade , Inquéritos Nutricionais , Estado Nutricional , Avaliação de Resultados em Cuidados de Saúde , Prevalência , Modelos de Riscos Proporcionais , Medição de Risco , Redução de Peso , Adulto JovemRESUMO
ABSTRACT Introduction: the attraction of women by Surgery has always existed. Although Surgery has been considered a specialty for men, several women chose it, despite gender bias issues that have persisted over many years. Several obstacles have impacted the practice of women surgeons, leading them to abandon the profession, while others, perhaps bearers of a stronger spirit, managed to overcome them, and won. Objective: to assess the rates of perception of harassment against female surgeons as a cause of difficulty and negative feelings related to the specialty. Methods: we conducted a quantitative and qualitative (personal accounts) research through a questionnaire via Google Forms® sent to all women surgeons registered in the Brazilian College of Surgeons and in a WhatsApp women surgeons' groups. The qualitative analysis was made with the Wordle® app. Results: from 821 questionnaires sent, we obtained 232 responses (28.2%). Harassment perception during training was 49.1% (n=114). From the women surgeons who perceived harassment, 56.1% reported having undergone different training than expected, with statistical significance (p<0.001). The question of having been treated differently due to being a woman also had an impact on harassment perception (77.2% harassed vs 47.5%; p<0.001). Physical (42.1% vs 6.8%) and emotional (92.1% vs 39.8%) threats were also different between groups. Conclusion: women surgeons still report great harassment perception, both moral and sexual, which impacts their feelings about the specialty.
RESUMO Introdução: a atração das mulheres pela Cirurgia sempre existiu. Embora a Cirurgia seja considerada especialidade para homens, várias mulheres a escolheram, apesar de questões de preconceito de gênero que têm se mantido ao longo de vários anos. Vários obstáculos têm impactado na prática das cirurgiãs, levando-as a abandonar a profissão, mas outras, talvez, as de espírito mais forte, conseguiram superá-los e venceram. Objetivo: avaliar a taxas de percepção de assédio contra cirurgiãs como causa de dificuldade e sentimentos negativos relacionados com a especialidade. Método: pesquisa, quantitativa e qualitativa (relatos pessoais), realizada por meio de questionário via Google Forms® enviado para todas as cirurgiãs registradas no Colégio Brasileiro de Cirurgiões e em grupo WhatsApp de cirurgiãs. A análise qualitativa foi feita com o aplicativo Wordle®. Resultados: Foram enviados 821 questionários e obtidas 232 respostas (28,2%). A percepção de assédio durante o treinamento foi de 49.1% (n=114). As cirurgiãs com percepção de assédio foram estatisticamente aquelas que reportaram ter tido treinamento diferente do que ansiavam (56,1%) (p<0,001). O quesito tratamento distinto por ser mulher também impactou na percepção do assédio (77,2% assediadas vs 47,5%; p<0,001). Ameaça física (42,1% vs 6,8%) e emocional (92,1% vs 39,8%) também foram distintas entre os grupos. Conclusão: cirurgiãs ainda reportam grande percepção de assédio moral e sexual, o que impacta na forma de encarar a profissão.
Assuntos
Humanos , Masculino , Feminino , Assédio Sexual , Cirurgiões , Percepção , Inquéritos e Questionários , SexismoRESUMO
The current world Covid-19 pandemic has been the most discussed topic in the media and scientific journals. Fear, uncertainty, and lack of knowledge about the disease may be the significant factors that justify such reality. It has been known that the disease presents with a rapidly spreading, it is significantly more severe among the elderly, and it has a substantial global socioeconomic impact. Besides the challenges associated with the unknown, there are other factors, such as the deluge of information. In this regard, the high number of scientific publications, encompassing in vitro, case studies, observational and randomized clinical studies, and even systematic reviews add up to the uncertainty. Such a situation is even worse when considering that most healthcare professionals lack adequate knowledge to critically appraise the scientific method, something that has been previously addressed by some authors. Therefore, it is of utmost importance that expert societies supported by data provided by the World Health Organization and the National Health Department take the lead in spreading trustworthy and reliable information. The Brazilian College of Surgeons suggests in this document various initiatives that may help surgeons, healthcare providers, and patients who will have to face a surgical event under the pandemic.
A atual pandemia do novo coronavírus, Covid-19, tem sido o assunto mais discutido no momento, tanto na mídia como em periódicos científicos. O medo, a incerteza e o desconhecimento sobre o comportamento da doença são os fatores preponderantes que podem justificar essa realidade. Sabe-se de antemão que a enfermidade tem grande disseminação, é mais grave entre idosos e está associada a grande impacto socioeconômico mundial. Além dos desafios em lidar com o desconhecido, há outros relacionados com a sobrecarga de informação e nesse quesito, a grande quantidade de estudos científicos, que englobam pesquisas in vitro, relatos de casos, estudos observacionais e randomizados, além de revisões sistemáticas complementam o panorama de dúvidas. Essa situação é piorada porque o conhecimento sobre o método científico não é dominado pela maioria dos profissionais de saúde, algo que há muito já vem sendo divulgado por vários autores. De sorte que em função desta realidade, torna-se fundamental que sociedades de especialidades apoiadas por dados da Organização Mundial da Saúde e do Ministério da Saúde assumam a liderança da divulgação da informação correta e confiável. O Colégio Brasileiro de Cirurgiões sugere neste documento medidas que podem auxiliar cirurgiões e outros profissionais de saúde, assim como pacientes, em caso de necessidade cirúrgica, a lidar com a atual pandemia.
Assuntos
Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Guias de Prática Clínica como Assunto , Cirurgiões , Procedimentos Cirúrgicos Operatórios/normas , Brasil/epidemiologia , COVID-19 , Infecções por Coronavirus/epidemiologia , Pessoal de Saúde/normas , Humanos , Pneumonia Viral/epidemiologia , Fatores de RiscoRESUMO
BACKGROUND & AIMS: Between 30 and 50% of Colombian patients are malnourished or at-risk of malnutrition on hospital admission. Malnutrition is associated with poor outcomes and increased costs. We used cost modeling to estimate savings that could be derived from implementation of a nutrition therapy program for patients at malnutrition risk. METHODS: The budget impact analysis was performed using previously-published outcomes data. Outcomes included length of stay, 30-day readmissions, and infectious/non-infectious complications. We developed a Markov model that compared patients who were assigned to receive early nutrition therapy (started within 24-48 h of hospital admission) with those assigned to receive standard nutrition therapy (not started early). Our model used a 60-day time-horizon and estimated event probabilities based on published data. RESULTS: Average total costs over 60 days were $3770 US dollars for patients with delayed nutrition therapy vs $2419 for patients with early nutrition therapy-a savings of $1351 (35.8% decrease) per nutrition-treated patient. Cost differences between the groups were: $2703 vs $1600 for hospital-associated costs; $883 vs $665 for readmissions; and $176 vs $94 for complications. Taken broadly, the potential costs savings from a nutrition care program for an estimated 638,318 hospitalized Colombian patients at malnutrition risk is $862.6 million per year. CONCLUSIONS: Our budget impact analysis demonstrated the potential for hospital-based nutrition care programs to improve health outcomes and reduce healthcare costs for hospitalized patients in Colombia. These findings provide a rationale for implementing comprehensive nutrition care in Colombian hospitals.
Assuntos
Hospitalização/estatística & dados numéricos , Desnutrição/prevenção & controle , Desnutrição/terapia , Terapia Nutricional/métodos , Colômbia , Redução de Custos , Análise Custo-Benefício , Custos de Cuidados de Saúde , Custos Hospitalares/estatística & dados numéricos , Hospitalização/economia , Humanos , Tempo de Internação , Desnutrição/economia , Terapia Nutricional/economia , Estado Nutricional , Readmissão do Paciente/economia , Readmissão do Paciente/estatística & dados numéricos , QuinolinasRESUMO
RESUMO A atual pandemia do novo coronavírus, Covid-19, tem sido o assunto mais discutido no momento, tanto na mídia como em periódicos científicos. O medo, a incerteza e o desconhecimento sobre o comportamento da doença são os fatores preponderantes que podem justificar essa realidade. Sabe-se de antemão que a enfermidade tem grande disseminação, é mais grave entre idosos e está associada a grande impacto socioeconômico mundial. Além dos desafios em lidar com o desconhecido, há outros relacionados com a sobrecarga de informação e nesse quesito, a grande quantidade de estudos científicos, que englobam pesquisas in vitro, relatos de casos, estudos observacionais e randomizados, além de revisões sistemáticas complementam o panorama de dúvidas. Essa situação é piorada porque o conhecimento sobre o método científico não é dominado pela maioria dos profissionais de saúde, algo que há muito já vem sendo divulgado por vários autores. De sorte que em função desta realidade, torna-se fundamental que sociedades de especialidades apoiadas por dados da Organização Mundial da Saúde e do Ministério da Saúde assumam a liderança da divulgação da informação correta e confiável. O Colégio Brasileiro de Cirurgiões sugere neste documento medidas que podem auxiliar cirurgiões e outros profissionais de saúde, assim como pacientes, em caso de necessidade cirúrgica, a lidar com a atual pandemia.
ABSTRACT The current world Covid-19 pandemic has been the most discussed topic in the media and scientific journals. Fear, uncertainty, and lack of knowledge about the disease may be the significant factors that justify such reality. It has been known that the disease presents with a rapidly spreading, it is significantly more severe among the elderly, and it has a substantial global socioeconomic impact. Besides the challenges associated with the unknown, there are other factors, such as the deluge of information. In this regard, the high number of scientific publications, encompassing in vitro, case studies, observational and randomized clinical studies, and even systematic reviews add up to the uncertainty. Such a situation is even worse when considering that most healthcare professionals lack adequate knowledge to critically appraise the scientific method, something that has been previously addressed by some authors. Therefore, it is of utmost importance that expert societies supported by data provided by the World Health Organization and the National Health Department take the lead in spreading trustworthy and reliable information. The Brazilian College of Surgeons suggests in this document various initiatives that may help surgeons, healthcare providers, and patients who will have to face a surgical event under the pandemic.
Assuntos
Humanos , Pneumonia Viral/prevenção & controle , Procedimentos Cirúrgicos Operatórios/normas , Guias de Prática Clínica como Assunto , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Cirurgiões , Pneumonia Viral/epidemiologia , Brasil/epidemiologia , Fatores de Risco , Pessoal de Saúde/normas , Infecções por Coronavirus/epidemiologiaRESUMO
The prevalence of malnutrition ranges up to 50% among patients in hospitals worldwide, and disease-related malnutrition is all too common in long-term and other health care settings as well. Regrettably, the numbers have not improved over the past decade. The consequences of malnutrition are serious, including increased complications (pressure ulcers, infections, falls), longer hospital stays, more frequent readmissions, increased costs of care, and higher risk of mortality. Yet disease-related malnutrition still goes unrecognized and undertreated. To help improve nutrition care around the world, the feedM.E. (Medical Education) Global Study Group, including members from Asia, Europe, the Middle East, and North and South America, defines a Nutrition Care Pathway that is simple and can be tailored for use in varied health care settings. The Pathway recommends screen, intervene, and supervene: screen patients' nutrition status on admission or initiation of care, intervene promptly when needed, and supervene or follow-up routinely with adjustment and reinforcement of nutrition care plans. This article is a call-to-action for health caregivers worldwide to increase attention to nutrition care.
Assuntos
Procedimentos Clínicos , Prática Clínica Baseada em Evidências , Pacientes Internados , Distúrbios Nutricionais/prevenção & controle , Melhoria de Qualidade , Saúde Global , Humanos , Terapia Nutricional , Estado Nutricional , Cultura OrganizacionalRESUMO
PURPOSE OF REVIEW: Postoperative complications in gastrointestinal elective surgery have been described as low. In certain circumstances, however, such as those including high-risk patients, the incidence is higher. In such situations, bacteremia and infectious complications may be caused by translocation of either gastrointestinal bacteria or its toxins as the result of bacterial overgrowth, loss of intestinal epithelial integrity, or immunologic compromising of the host. Attempts should be made to reduce the impact of these factors. Probiotics, which confer to the host health benefits similar to those offered by a balanced indigenous microbiota, are thought to act through a variety of mechanisms including the competition with potential pathogens for nutrients or enterocyte adhesion sites, degradation of toxins, production of antimicrobial factors, and local and systemic immunomodulation. RECENT FINDINGS: Recent studies have shown that probiotics play a role in decreasing postoperative complications in patients undergoing major gastrointestinal operations. SUMMARY: Considering the mechanisms of action of probiotics in the gastrointestinal tract, mainly in the intestine, evidence strongly suggests that the use of these microorganisms might positively affect the complication rate in patients undergoing surgery on the gastrointestinal tract.
Assuntos
Trato Gastrointestinal/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Probióticos , Translocação Bacteriana , Humanos , Enteropatias/prevenção & controleRESUMO
Malnutrition has been identified as affecting patient outcome. The purpose of this study was to correlate the nutritional status of hospitalized patients with their morbidity, mortality, length of hospital stay and costs. The patients were nutritionally assessed within the first 72 h of hospital admission. The patients' charts were surveyed on the incidence of complications and mortality. Hospital costs were calculated based on economic tables used by insurance companies. Multivariate logistic regression analysis and the Cox regression model were used to identify possible confounding factors. A P<0.05 was considered statistically significant. The mean age was 50.6+/-17.3 years with 50.2% being male. The incidence of complications in the malnourished was 27.0% [Relative risk (RR)=1.60]. Mortality in the malnourished patients was 12.4% vs 4.7% in the well nourished (RR = 2.63). Malnourished patients stayed in the hospital for 16.7+/-24.5 days vs 10.1+/-11.7 days in the nourished. Hospital costs in malnourished patients were increased up to 308.9%. It was concluded that malnutrition, as analyzed by a multivariate logistic regression model, is an independent risk factor impacting on higher complications and increased mortality, length of hospital stay and costs.
Assuntos
Mortalidade Hospitalar , Tempo de Internação/economia , Desnutrição/mortalidade , Análise de Variância , Brasil/epidemiologia , Estudos de Coortes , Feminino , Humanos , Masculino , Desnutrição/economia , Desnutrição/epidemiologia , Pessoa de Meia-Idade , Morbidade , Análise Multivariada , Estado Nutricional , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de RiscoRESUMO
O grande interesse pelo papel das vitaminas no metablismo humano se faz frente à comprovada açäo destes nutrientes no combate aos radicais livres. Contudo, há que se salientar que a produçäo de radicais livres é um processo fisiológico para o qual o organismo possui defesas: os antioxidantes. Na grande maioria das vezes, uma dieta adequada é suficiente para fornecer as vitaminas necessárias para a açäo antioxidante. Contudo, em situaçöes de estresse metabólico, na desnutriçäo, no alcoolismo e em outras condiçöes, há uma diminuiçäo destes substratos, o que justifica a sua provável necessidade de suplementaçäo. Existe dúvidas sobre as reais vantagens de dosagens elevadas de vitaminas antioxidantes e sobre seu papel preventivo na ocorrências de doenças degenerativas, no câncer e no envelhecimento, de sorte que a realizaçäo de estudos clínicos randomizados é fundamental para responder a todas as perguntas sobre o uso de vitaminas antioxidantes, näo só na prevençäo como na terapêutica de um grande número de enfermidades.(au)
Assuntos
Antioxidantes , VitaminasRESUMO
Este trabalho apresenta a metodologia usada no estudo do Inquérito Brasileiro de Avaliaçäo Nutricional Hospitalar (IBRANUTRI). A Sociedade Brasileira de Nutriçäo Parenteral e Enteral considerando de alta importância avaliar a desnutriçäo hospitalar no Brasil, desenvolveu um estudo multicêntrico em todo o território nacional, envolvendo 25 hospitais com atendimento a pacientes adultos do Sistema ünico de Saúde. Os principais objetivos do IBRANUTRI foram: diagnosticar o estado nutricional, através da técnica de avaliaçäo nutricional subjetiva(ANS), e verificar a preocupaçäo das equipes de saúde com o estado nutricional dos doentes, além de se aquilatar o uso da Terapia Nutricional. Foi um estudo seccional, com sorteio aleatório de 4.000 pacientes, de 1 de maio a 30 de outubro de 1996. Equipes de profissionais de saúde especialmente treinadas para este estudo avaliaram individualmente cada um dos doentes sorteados. É descrito o estudo piloto usado para validar o emprego da técnica de ANS populaçäo a ser analisada.(au)