Reducing inpatient opioid consumption after caesarean delivery: effects of an opioid stewardship programme and racial impact in a community hospital.

Caesarean section is the most common inpatient surgery in the USA, with more than 1.1 million procedures in 2020. Similar to other surgical procedures, healthcare providers rely on opioids for postoperative pain management. However, current evidence shows that postpartum patients usually experience less pain due to pregnancy-related physiological changes. Owing to the current opioid crisis, public health agencies urge providers to provide rational opioid prescriptions. In addition, a personalised postoperative opioid prescription may benefit racial minorities since research shows that this population receives fewer opioids despite greater pain levels. Our project aimed to reduce inpatient opioid consumption after caesarean delivery within 6 months of the implementation of an opioid stewardship programme.A retrospective analysis of inpatient opioid consumption after caesarean delivery was conducted to determine the baseline, design the opioid stewardship programme and set goals. The plan-do-study-act method was used to implement the programme, and the results were analysed using a controlled interrupted time-series method.After implementing the opioid stewardship programme, we observed an average of 80% reduction (ratio of geometric means 0.2; 95% CI 0.2 to 0.3; p<0.001) in inpatient opioid consumption. The institution designated as control did not experience relevant changes in inpatient opioid prescriptions during the study period. In addition, the hospital where the programme was implemented was unable to reduce the difference in inpatient opioid demand between African Americans and Caucasians.Our project showed that an opioid stewardship programme for patients undergoing caesarean delivery can effectively reduce inpatient opioid use. PDSA, as a quality improvement method, is essential to address the problem, measure the results and adjust the programme to achieve goals.

Failure of 3 different methods and biopsy sites to diagnose a patient with invasive colorectal cancer: A case report.

RATIONALE: Colorectal cancer is one of the most commonly diagnosed cancers worldwide, and the majority arise from neoplastic adenomatous polyps. Bladder involvement in colorectal cancer is uncommon and found in approximately 3% of the cases, most commonly in sigmoid and rectal tumors and the diagnosis is classically based on biopsies of affected tissues. PATIENT CONCERNS: A 68-year-old male with no significant past medical history underwent diagnostic colonoscopy for abdominal distension and constipation with positive fecal occult blood test ordered by the primary care physician. DIAGNOSIS: Colonoscopy showed a sigmoid mass with biopsy finding of tubulovillous adenoma. Laparoscopy was performed for sigmoid colonic resection, but as the mass was large, a diverting loop colostomy and multiple biopsies were performed revealing tubulovillous adenoma again. Postoperative workup revealed right hydronephrosis, and cystoscopy was performed confirming bladder wall invasion with biopsies showing benign bladder wall tissue with no evidence of dysplasia or malignancy. Furthermore, computed tomography (CT)-guided core-needle biopsies of the colonic mass were performed but revealed adenomatous colonic mucosa without evidence of carcinoma. INTERVENTION: Definitive surgical en bloc excision of the tumor and anterior bladder wall was performed with urology team until grossly free margins were attained. Final pathology revealed well-differentiated mucinous adenocarcinoma arising from a preexisting tubulovillous adenoma with direct invasion of the bladder wall. OUTCOMES: The patient's postoperative recovery was uneventful, and he was discharged 2 weeks postoperatively with planned adjuvant chemotherapy. LESSONS: This case represents a classical presentation of invasive colorectal cancer. Perioperative workup, however, was confounded by failure of open, cystoscopic, and CT-guided biopsies to establish a tissue diagnosis for directed therapy. Upon literature review, evidence exists to support our approach to this unique dilemma.

Evaluation of anesthesiologists' knowledge about occupational health: Pilot study.

BACKGROUND: An anesthesiologists' work presents with numerous occupational risks owing to the large amount of time spent inside the operating room where constant noise, anesthetic vapors, ionizing radiation, infectious agents, and psychological stress are present. Herein, we evaluated anesthesiologists' knowledge about occupational health. METHODS: A cross-sectional study was conducted to assess 158 anesthesiologists from a tertiary hospital on their knowledge about occupational health using a structured questionnaire. RESULTS: The survey revealed a lack of knowledge on the forms of prevention of occupational accidents (74.6% did not know how to act in case of a fire during surgery, 56% failed to identify the post-anesthesia care unit as the place with the highest contamination by inhalation anesthetics, and 42.7% failed to identify all personal protective equipment) and a surprisingly high rate of lack of observance of preventive measures (30.3% washed their hands before touching every patient, 52.5% did not use gloves during intravenous access, and 88.6% used protective equipment against ionizing radiation). CONCLUSIONS: Despite improvements in safety standards in healthcare facilities, our research showed lack of knowledge about major topics on occupational health by physicians. Improving safety awareness is an important goal of training programs and continued medical education.

[Gastric lipoma case report]. / Lipoma gástrico: relato de caso.

We report a case of gastric lipoma, a rare benign stomach tumor. There are approximately 200 cases previously described in literature. A male, 62-year-old patient with no clinical complaint presented a tumor lesion in the stomach antrum found in a routine upper endoscopy. A surgical resection (subtotal gastrectomy) was done and the histological examination showed submucosal lipoma without signs of malignancy. This report points to the growth of routine examination in the current clinical practice and the dilemma brought by overdiagnosis.

Lipoma gástrico: relato de caso / Gastric lipoma case report

We report a case of gastric lipoma, a rare benign stomach tumor. There are approximately 200 cases previously described in literature. A male, 62-year-old patient with no clinical complaint presented a tumor lesion in the stomach antrum found in a routine upper endoscopy. A surgical resection (subtotal gastrectomy) was done and the histological examination showed submucosal lipoma without signs of malignancy. This report points to the growth of routine examination in the current clinical practice and the dilemma brought by overdiagnosis.

[Knowledge is prevention: a novel approach to breast cancer prevention]. / Saber é prevenir: uma nova abordagem no combate ao câncer de mama.

Data from the Brazilian Ministry of Health shows that the breast cancer is one of the leading causes of women's death, despite the enhancements in treatment and diagnosis of this disease. Successive explanatory advertising campaigns emphasized the methods available for prevention: auto examination, clinical examination by a health care professional and mammography. Regardless of their relevance, only these strategies did not reduced incidence of breast cancer, since they do not impact on the oncogenesis factors. The objective of this article is to develop a health promotion activity through the reinforcement of the previous knowledge and aggregation of new information about breast cancer of a basic health unit. The methodology used was a transversal study of pedagogical intervention in the waiting rooms of a basic health unit. The pedagogical intervention was composed by an interactive questionnaire, lecture and discussion about the topic associated with a qualitative and quantitative evaluation of the activity. The proposed activity had positive results since the participants had qualitative and quantitative improvement in their knowledge and also a good interactivity with the researchers.

Saber é prevenir: uma nova abordagem no combate ao câncer de mama / Knowledge is prevention: a novel approach to breast cancer prevention

No Brasil, dados do Ministério da Saúde apontam o câncer de mama como principal causa de morte em mulheres, apesar dos avanços no diagnóstico e tratamento desta enfermidade. Sucessivas campanhas de esclarecimento à população enfatizaram os meios disponíveis para prevenção: autoexame, exame clínico por profissional da saúde e a mamografia. Apesar da sua importância, estas estratégias isoladamente não reduziram a incidência deste agravo à saúde, já que não atuam nos fatores predisponentes para sua iniciação. O objetivo desse estudo foi desenvolver uma atividade de promoção à saúde através do reforço de conhecimentos existentes e agregação de novas informações sobre o câncer de mama no contexto de Unidade Básica de Saúde. Trata-se de um estudo transversal de intervenção pedagógica em salas de espera de Unidade Básica de Saúde. A intervenção pedagógica foi realizada através de questionário interativo, palestra informativa e discussão livre sobre o tópico, associados à avaliação quantitativa e qualitativa desta intervenção. A abordagem proposta foi positiva, uma vez que houve melhora quantitativa e qualitativa da compreensão do público sobre os temas abordados, boa interatividade entre os palestrantes e o público, e criação de agentes multiplicadores de conhecimento.

Data from the Brazilian Ministry of Health shows that the breast cancer is one of the leading causes of women's death, despite the enhancements in treatment and diagnosis of this disease. Successive explanatory advertising campaigns emphasized the methods available for prevention: auto examination, clinical examination by a health care professional and mammography. Regardless of their relevance, only these strategies did not reduced incidence of breast cancer, since they do not impact on the oncogenesis factors. The objective of this article is to develop a health promotion activity through the reinforcement of the previous knowledge and aggregation of new information about breast cancer of a basic health unit. The methodology used was a transversal study of pedagogical intervention in the waiting rooms of a basic health unit. The pedagogical intervention was composed by an interactive questionnaire, lecture and discussion about the topic associated with a qualitative and quantitative evaluation of the activity. The proposed activity had positive results since the participants had qualitative and quantitative improvement in their knowledge and also a good interactivity with the researchers.