[Assessment of adherence to the WHO surgical safety checklist in urological and gynecological surgeries at two teaching hospitals in Natal, Rio Grande do Norte State, Brazil]. / Avaliação da adesão ao checklist de cirurgia segura da OMS em cirurgias urológicas e ginecológicas, em dois hospitais de ensino de Natal, Rio Grande do Norte, Brasil.

The WHO surgical safety checklist is a useful tool for decreasing the number of adverse events in hospitals, but its implementation is still a challenge. This study aimed to assess adherence to the checklist in urological and gynecological surgeries at two teaching hospitals in Natal, Rio Grande do Norte, Brazil. A cross-sectional observational design was used, elective surgeries were selected, and data were collected from medical charts. Adherence was based on the quality and proper completion of the checklist, and the association of structural and socio-professional factors was analyzed using multiple regression. Of the 375 surgeries reviewed, 61% included a checklist and 4% were correctly filled out. The existence of a checklist was associated with gynecological surgeries (OR = 130.18) and longer operating time (OR = 2.13), while quality of the checklist was related to urological surgeries (ß = 26.36). Adherence to the checklist needs to be improved, and the observed differences suggest the influence of distinct implementation strategies at the two institutions.

Avaliação da adesão ao checklist de cirurgia segura da OMS em cirurgias urológicas e ginecológicas, em dois hospitais de ensino de Natal, Rio Grande do Norte, Brasil / Assessment of adherence to the WHO surgical safety checklist in urological and gynecological surgeries at two teaching hospitals in Natal, Rio Grande do Norte State, Brazil / Evaluación de la adherencia al checklist de cirugía segura de la OMS en cirugías urológicas y ginecológicas en dos hospitales universitarios en Natal, Rio Grande do Norte, Brasil

O checklist de cirurgia segura da Organização Mundial da Saúde é uma ferramenta útil para diminuir eventos adversos em hospitais, porém sua implantação efetiva ainda é um desafio. Este estudo objetiva avaliar a adesão ao checklist em cirurgias urológicas e ginecológicas de dois hospitais de ensino em Natal, Rio Grande do Norte, Brasil. O desenho foi observacional transversal; selecionaram-se cirurgias eletivas, e a coleta se deu por meio de revisão de prontuários. Descreveu-se a adesão mediante a existência e qualidade do preenchimento do checklist, e analisou-se a associação de fatores estruturais e socioprofissionais valendo-se de análise de regressão múltipla. Das 375 cirurgias revisadas, 61% tinham checklist, e 4% estavam totalmente preenchidos. A existência do checklist se associou às cirurgias ginecológicas (maternidade) (OR = 130,18) e à maior duração da cirurgia (OR = 2,13), enquanto a qualidade do preenchimento se relacionou com as cirurgias urológicas (hospital geral) (β = 26,36). A adesão ao checklist precisa ser aprimorada, e as diferenças sugerem a influência das distintas estratégias de implantação utilizadas em cada instituição.

The WHO surgical safety checklist is a useful tool for decreasing the number of adverse events in hospitals, but its implementation is still a challenge. This study aimed to assess adherence to the checklist in urological and gynecological surgeries at two teaching hospitals in Natal, Rio Grande do Norte, Brazil. A cross-sectional observational design was used, elective surgeries were selected, and data were collected from medical charts. Adherence was based on the quality and proper completion of the checklist, and the association of structural and socio-professional factors was analyzed using multiple regression. Of the 375 surgeries reviewed, 61% included a checklist and 4% were correctly filled out. The existence of a checklist was associated with gynecological surgeries (OR = 130.18) and longer operating time (OR = 2.13), while quality of the checklist was related to urological surgeries (β = 26.36). Adherence to the checklist needs to be improved, and the observed differences suggest the influence of distinct implementation strategies at the two institutions.

El checklist de cirugía segura es una herramienta útil para disminuir los eventos adversos en hospitales, pero su implantación efectiva aún es un reto. Este estudo tiene por objetivo evaluar la adherencia al checklist en cirugías urológicas y ginecológicas de dos hospitales universitarios en Natal, Rio Grande do Norte, Brasil. El diseño fue observacional transversal, se seleccionaron cirugías electivas y la recogida de datos fue mediante revisión de historias clínicas. Se describe la adherencia a partir de la existencia y calidad de la cumplimentación del checklist y se analiza la asociación de factores estructurales y socioprofesionales mediante análisis de regresión múltipla. De las 375 cirugías revisadas, el 61% tenía checklist y el 4% estaba totalmente cumplimentado. La existencia del checklist se asoció a las cirugías ginecológicas (maternidad) (OR = 130,18) y a la mayor duración de la cirugía (OR = 2,13), mientras la calidad de la cumplimentación se relacionó con las cirugías urológicas (hospital general) (β = 26,36). La adherencia al checklist es una oportunidad de mejora y las diferencias sugieren la influencia de diferentes estrategias de ejecución utilizados en cada institución.

[Influence of thyroid function in CPK serum levels]. / Influência da função tireoidiana nos níveis séricos de CPK.

OBJECTIVE: To determine serum CPK variation based on TSH e free T4 (FT4), and to assess serum CPK in pathological states of the thyroid (hyperthyroidism and hypothyroidism), in relation to the euthyroidism. MATERIAL AND METHODS: We evaluated retrospectively 6,230 laboratory results of TSH and CPK from 2007 to 2011. From these, 3,369 had free T4 results. We evaluated the correlation between CPK and TSH and the pathological states of the thyroid. RESULTS: The correlation between TSH and CPK was positive (r = 0.065), while that between CPK and FT4 was negative (r = -0.091, p < 0.05). From the total of results analyzed, 586 (9.4%) were measures of hyperthyroidism, with a median (range) of CPK of 98 U/L (27 to 1,113), and 556 (8.9%) were of hypothyroidism, with CPK of 114 U/L (25-4,182). CONCLUSION: A positive correlation was found between serum CPK and TSH, and a negative correlation between CPK and FT4. CPK was lower in the group with hyperthyroidism, and greater in that with hypothyroidism.

Influência da função tireoidiana nos níveis séricos de CPK / Influence of thyroid function in CPK serum levels

OBJETIVO: Determinar a variação da CPK sérica em função do TSH e T4 livre (FT4) e avaliar a CPK sérica nos estados patológicos da tireoide (hipertireoidismo e hipotireoidismo), em relação ao eutireoidismo. MATERIAIS E MÉTODOS: Analisaram-se, retrospectivamente, 6.230 exames laboratoriais de 2007 a 2011, com as dosagens de TSH e CPK. Destas, 3.369 com dosagens de FT4. Avaliou-se a correlação entre CPK com TSH e com os estados patológicos da tireoide. RESULTADOS: A correlação entre TSH e CPK foi positiva (r = 0,065), enquanto entre CPK e FT4 foi inversamente proporcional (r = -0,091, p < 0,05). Do total, 586 (9,4%) medidas foram de hipertireoidismo com mediana (intervalo) do CPK de 98 U/L (27 a 1.113) e 556 (8,9%), hipotireóideos com CPK de 114 U/L (25-4.182). CONCLUSÃO: Houve correlação positiva entre CPK sérica e TSH e negativa com FT4, sendo a CPK menor no grupo com hipertireoidismo e maior no grupo de hipotireoidismo.

OBJECTIVE: To determine serum CPK variation based on TSH e free T4 (FT4), and to assess serum CPK in pathological states of the thyroid (hyperthyroidism and hypothyroidism), in relation to the euthyroidism. MATERIAL AND METHODS: We evaluated retrospectively 6,230 laboratory results of TSH and CPK from 2007 to 2011. From these, 3,369 had free T4 results. We evaluated the correlation between CPK and TSH and the pathological states of the thyroid. RESULTS: The correlation between TSH and CPK was positive (r = 0.065), while that between CPK and FT4 was negative (r = -0.091, p < 0.05). From the total of results analyzed, 586 (9.4%) were measures of hyperthyroidism, with a median (range) of CPK of 98 U/L (27 to 1,113), and 556 (8.9%) were of hypothyroidism, with CPK of 114 U/L (25-4,182). CONCLUSION: A positive correlation was found between serum CPK and TSH, and a negative correlation between CPK and FT4. CPK was lower in the group with hyperthyroidism, and greater in that with hypothyroidism.