Resultado de la implantación de consultas telemáticas en cirugía ortopédica y traumatología durante la pandemia COVID-19 / Result of the implementation of telematic consultations in orthopaedic surgery and traumatology during COVID-19 laparoscopic surgery

La pandemia COVID ha hecho de las consultas telemáticas una herramienta básica en la práctica diaria. El objetivo principal del estudio es valorar los resultados de la aplicación de consultas telemáticas para limitar la movilidad de los pacientes. Son objetivos operativos: proponer un plan de consultas, conocer cómo limita la asistencia a las consultas, definir qué patologías se benefician más con este plan. MATERIAL Y MÉTODOS: Se propone un esquema con la creación de consultas previas a las agendadas para valorar idoneidad y posibilidad de realizarla en acto único no presencial. RESULTADOS: Se han realizado 5.619 consultas con una falta de respuesta telefónica del 19%. El 74% de los pacientes fueron resueltos de forma virtual. Existe diferencia entre unidades, siendo más probable la respuesta telefónica para las consultas de unidad, OR = 0,60 o de traumatología general, OR = 0,67 y menos para los derivados desde urgencias. El 20% de las consultas no se acompañaban de pruebas complementarias. Las consultas de traumatología general, OR = 0,34, control postoperatorio, OR = 0,49, y unidades, OR = 0,40, cumplieron mejor este requisito. De los pacientes restantes, las consultas de traumatología general, OR = 0,50, y las derivadas a unidades, OR = 0,54 fueron las que más se resolvieron sin acudir presencialmente. CONCLUSIONES: Se han resuelto de forma no presencial el 74% de los pacientes que atendieron a la llamada telefónica. El 20% de los pacientes acuden a la visita sin pruebas complementarias. Las consultas de seguimiento de osteosíntesis y postoperatorio de cirugía artroscópica son las que más precisan de ser realizadas de forma presencial

The COVID pandemic has made telematic consultations a basic tool in daily practice. AIMS: The main objective of the study is to assess the results of the application of telematic consultations to limit the mobility of patients. The operational objectives are; to propose a consultation plan, to know how attendance limits consultations and to define which pathologies benefit the most from this plan. METHODS: A scheme is proposed with the creation of pre-scheduled clinic to assess suitability and the possibility of carrying them out in a single non face-to-face act. RESULTS: Phone call to 5,619 patients were made with a lack of response of 19%. The cases of 74% of the patients that answered were resolved virtually. There is a difference between units, obtaining a higher answering rate from patients appointed to specific clinic units, OR = 0.60, or to general trauma ones, OR = 0.67. The lowest answering rate was obtained from those derived from the emergency department. Twenty per cent of the consultations were not accompanied by complementary tests that would have favored the resolution in a single act. The general trauma consultations, OR = 0.34, postoperative control, OR = 0.49, and specific unit ones, OR = 0.40, were the ones that better met this requirement. Out of the remaining patients, the general trauma consultations, OR = 0.50, and those referred to units, OR = 0.54, were the ones that had a higher resolution rate without in- person consultation. CONCLUSIONS: The cases of 74% of the patients who answered the phone call were resolved virtually. Cases of 20% of the patients cannot be solved in a single act because they are derived without complementary tests. Osteosynthesis and postoperative arthroscopic follow-up consultations are the ones that need to be carried out in person the most

Result of the implementation of telematic consultations in orthopaedic surgery and traumatology during COVID-19 laparoscopic surgery. / Resultado de la implantación de consultas telemáticas en cirugía ortopédica y traumatología durante la pandemia COVID-19.

The COVID pandemic has made telematic consultations a basic tool in daily practice. AIMS: The main objective of the study is to assess the results of the application of telematic consultations to limit the mobility of patients. The operational objectives are; to propose a consultation plan, to know how attendance limits consultations and to define which pathologies benefit the most from this plan. METHODS: A scheme is proposed with the creation of pre-scheduled clinic to assess suitability and the possibility of carrying them out in a single non face-to-face act. RESULTS: Phone call to 5,619 patients were made with a lack of response of 19%. The cases of 74% of the patients that answered were resolved virtually. There is a difference between units, obtaining a higher answering rate from patients appointed to specific clinic units, OR = 0.60, or to general trauma ones, OR = 0.67. The lowest answering rate was obtained from those derived from the emergency department. Twenty per cent of the consultations were not accompanied by complementary tests that would have favored the resolution in a single act. The general trauma consultations, OR = 0.34, postoperative control, OR = 0.49, and specific unit ones, OR = 0.40, were the ones that better met this requirement. Out of the remaining patients, the general trauma consultations, OR = 0.50, and those referred to units, OR = 0.54, were the ones that had a higher resolution rate without in- person consultation. CONCLUSIONS: The cases of 74% of the patients who answered the phone call were resolved virtually. Cases of 20% of the patients cannot be solved in a single act because they are derived without complementary tests. Osteosynthesis and postoperative arthroscopic follow-up consultations are the ones that need to be carried out in person the most.

Preoperative oral antibiotic prophylaxis reduces Pseudomonas aeruginosa surgical site infections after elective colorectal surgery: a multicenter prospective cohort study.

BACKGROUND: Healthcare-associated infections caused by Pseudomonas aeruginosa are associated with poor outcomes. However, the role of P. aeruginosa in surgical site infections after colorectal surgery has not been evaluated. The aim of this study was to determine the predictive factors and outcomes of surgical site infections caused by P. aeruginosa after colorectal surgery, with special emphasis on the role of preoperative oral antibiotic prophylaxis. METHODS: We conducted an observational, multicenter, prospective cohort study of all patients undergoing elective colorectal surgery at 10 Spanish hospitals (2011-2014). A logistic regression model was used to identify predictive factors for P. aeruginosa surgical site infections. RESULTS: Out of 3701 patients, 669 (18.1%) developed surgical site infections, and 62 (9.3%) of these were due to P. aeruginosa. The following factors were found to differentiate between P. aeruginosa surgical site infections and those caused by other microorganisms: American Society of Anesthesiologists' score III-IV (67.7% vs 45.5%, p = 0.001, odds ratio (OR) 2.5, 95% confidence interval (95% CI) 1.44-4.39), National Nosocomial Infections Surveillance risk index 1-2 (74.2% vs 44.2%, p < 0.001, OR 3.6, 95% CI 2.01-6.56), duration of surgery ≥75thpercentile (61.3% vs 41.4%, p = 0.003, OR 2.2, 95% CI 1.31-3.83) and oral antibiotic prophylaxis (17.7% vs 33.6%, p = 0.01, OR 0.4, 95% CI 0.21-0.83). Patients with P. aeruginosa surgical site infections were administered antibiotic treatment for a longer duration (median 17 days [interquartile range (IQR) 10-24] vs 13d [IQR 8-20], p = 0.015, OR 1.1, 95% CI 1.00-1.12), had a higher treatment failure rate (30.6% vs 20.8%, p = 0.07, OR 1.7, 95% CI 0.96-2.99), and longer hospitalization (median 22 days [IQR 15-42] vs 19d [IQR 12-28], p = 0.02, OR 1.1, 95% CI 1.00-1.17) than those with surgical site infections due to other microorganisms. Independent predictive factors associated with P. aeruginosa surgical site infections were the National Nosocomial Infections Surveillance risk index 1-2 (OR 2.3, 95% CI 1.03-5.40) and the use of oral antibiotic prophylaxis (OR 0.4, 95% CI 0.23-0.90). CONCLUSIONS: We observed that surgical site infections due to P. aeruginosa are associated with a higher National Nosocomial Infections Surveillance risk index, poor outcomes, and lack of preoperative oral antibiotic prophylaxis. These findings can aid in establishing specific preventive measures and appropriate empirical antibiotic treatment.

Multistate modelling to estimate excess length of stay and risk of death associated with organ/space infection after elective colorectal surgery.

BACKGROUND: Accounting for time-dependency and competing events are strongly recommended to estimate excess length of stay (LOS) and risk of death associated with healthcare-associated infections. AIM: To assess the effect of organ/space (OS) surgical site infection (SSI) on excess LOS and in-hospital mortality in patients undergoing elective colorectal surgery (ECS). METHODS: A multicentre prospective adult cohort undergoing ECS, January 2012 to December 2014, at 10 Spanish hospitals was used. SSI was considered the time-varying exposure and defined as incisional (superficial and deep) or OS. Discharge alive and death were the study endpoints. The mean excess LOS was estimated using a multistate model which provided a weighted average based on the states patients passed through. Multivariate Cox regression models were used to assess the effect of OS-SSI on risk of discharge alive or in-hospital mortality. FINDINGS: Of 2778 patients, 343 (12.3%) developed SSI: 194 (7%) OS-SSI and 149 (5.3%) incisional SSI. Compared to incisional SSI or no infection, OS-SSI prolonged LOS by 4.2 days (95% confidence interval (CI): 4.1-4.3) and 9 days (8.9-9.1), respectively, reduced the risk of discharge alive (adjusted hazard ratio (aHR): 0.36 (95% CI: 0.28-0.47) and aHR: 0.17 (0.14-0.21), respectively), and increased the risk of in-hospital mortality (aHR: 8.02 (1.03-62.9) and aHR: 10.7 (3.7-30.9), respectively). CONCLUSION: OS-SSI substantially extended LOS and increased risk of death in patients undergoing ECS. These results reinforce OS-SSI as the SSI with the highest health burden in ECS.

O Processo de trabalho dos enfermeiros da atenção primária e a Política Nacional de Plantas Medicinais/Fitoterápicos / The nurses’ work process of Primary Health Care and the National Politics of MedicinalPlants/Phytoterapies

RESUMO O estudo objetivou conhecer o processo de trabalho dos enfermeiros da atenção primária em relação à Política Nacional de Plantas Medicinais e Fitoterápicos. O referencial foi baseado em Guareschi e Kleinman. A abordagem foi qualitativa, descritiva. Fizeram parte dos estudos enfermeiros de 21 municípios da região Sul do estado do Rio Grande do Sul. Os dados foram coletados por questionário autoadministrado, no período de junho a agosto de 2013. A análise seguiu a proposta operativa de Minayo, emergindo dois temas: processo de trabalho dos enfermeiros e a Política Nacional de Plantas Medicinais e Fitoterápicos; viabilização desta na atenção primária. Observou-se o desconhecimento da política, apesar de ter sido constatado a indicação de plantas medicinais no processo de trabalho. A política é viável quando o enfermeiro organiza grupos, coloca em prática o diálogo interdisciplinar, e contempla a questão dos aspectos culturais do usuário.

ABSTRACT This study aimed to understand nurses’ work processes in primary health care in relation to the National Politics of Medicinal Plants and Phytotherapies. The referential was based on Guareschi and Kleinman. The approach was qualitative and descriptive. Nurses from 21 towns of Southern Rio Grande do Sul participated. Data collection was a self-administrated questionnaire, in the period of June to August of 2013. The analysis followed Minayo’s operative proposal, two themes emerged: nurses’ work processes and the National Politics of Medicinal Plants and Phytotherapies and the viability of this in primary health care. The ignorance of the policy, but they indicate medicinal plants in the work process. The policy is practicable, when the nurses make groups, put the interdisciplinary dialogue in practice and contemplate the users’ cultural aspects.

Post-discharge surgical site infections after uncomplicated elective colorectal surgery: impact and risk factors. The experience of the VINCat Program.

BACKGROUND: Surgical site infection (SSI) after colorectal procedures represents a measurable quality indicator of a healthcare system. There is an increasing interest in comparing SSI rates between different hospitals and countries: however, the variability of the data regarding the incidence of SSI makes this comparison difficult. For the purposes of evaluation, data collection must be standardized and must include reliable post-discharge surveillance (PDS). AIM: To determine impact and risk factors for PDS SSI after elective colorectal surgery. METHODS: VINCat is a nosocomial infection surveillance programme in Catalonia, Spain. Between 2007 and 2011, 52 hospitals joined the programme. Hospitals performed active, prospective, standardized surveillance of elective colorectal resection. PDS was implemented by a multimodal approach and was mandatory within the first 30 days after surgery. FINDINGS: During the study period, 13,661 elective colorectal procedures were included. SSI was diagnosed in 2826 (20.7%) patients, of whom 22.5% during PDS; of these, 52% required readmission. Patients with PDS SSI were younger (odds ratio: 1.57; 95% confidence interval: 1.29-1.91), predominantly female (1.40; 1.16-1.69), had more frequently undergone endoscopic procedures (1.56; 1.30-1.88) and had more incisional SSI (1.88; 1.54-2.28) than patients with in-hospital SSI. CONCLUSION: SSI rates in elective colorectal procedures at VINCat hospitals were inside the higher range of those reported by other national programmes. PDS SSI increased the overall rate of SSI, had a significant clinical impact, and accounted for almost a quarter of SSI. Younger age and laparoscopic procedures were the most relevant risk factors. Standardized multimodal PDS should be implemented for hospitals performing surveillance of colorectal surgery.

Plantas medicinais no processo de cicatrização de feridas: uma revisão de literatura / Medicinal plants in the wound healing process: a literature review

Uma busca foi realizada na literatura, visando sumarizar as pesquisas realizadas e obter informações acerca da utilização de plantas medicinais no processo de cicatrização de feridas. Utilizaram-se os descritores: Plantas Medicinais e Cicatrização de Feridas e seus equivalentes em inglês e espanhol, com o operador booleano "AND" em três bases eletrônicas de dados (PubMed, LILACS e COCHRANE). Foram selecionados 57 artigos para compor a revisão. Os resultados apontam que um total de 52 plantas medicinais e um composto de ervas foram estudados experimentalmente ou clinicamente, quanto aos seus efeitos no auxílio do processo de cicatrização, sendo que a maioria (88,5%) apresentou eficácia. Com isso, verifica-se que a utilização de plantas medicinais trata de importante alternativa no tratamento de feridas, que começa a fazer parte da atenção à saúde brasileira, o que sugere novos estudos de comprovação clínica, custos, e benefícios e a constante atualização acerca das publicações realizadas.

It was done a literature search aiming to sumarize earlier conducted researches and in order to obtain information on the use of medicinal plants in wound healing process. The descriptors used were as follows: Medicinal Plants and Wound Healing and their equivalents in English and Spanish with the Boolean operator "AND" in three electronic databases (PubMed, LILACS and COCHRANE). Fifty seven articles were chosen to compose the review. The findings from a total of fifty two medicinal plants and one herbal compound that were experimentally or clinically studied in respect to their effects in wound healing process indicate that the majority of them (eighty eight point five per cent) showed efficacy. Thus, it can be seen that the use of medicinal plants is an important alternative in wounds treatment that becomes part of Brazilian health care, suggesting further studies of clinical evidence, costs and benefits and constantly updating on produced publications.

Lesiones vasculares de la extremidad inferior causados por osteocondromas / Vascular lesions in the lower limbs caused by osteochondromas

Introducción. El tumor óseo más frecuente de la población es el osteocondroma (OC). Se puede encontrar deforma esporádica o múltiple, y característicamente afecta a los huesos largos de la extremidad inferior durante la etapade crecimiento. Suele ser asintomático, pero en su crecimiento puede lesionar estructuras vasculares, originando roturay formación de pseudoaneurismas. En la bibliografía médica hasta hoy, la serie más numerosa refiere seis pacientes conlesión vascular por este tumor. Objetivo. Presentar y analizar nuestra experiencia sobre cuatro casos de este tipo de complicacionesvasculares originadas por OC. Pacientes y métodos. En todos se vio afectada la arteria poplítea. Caso 1: varón,16 años, OC múltiple y rotura arterial de cinco días de evolución; caso 2: varón, 9 años, OC esporádico y pseudoaneurismade un mes de evolución; caso 3: varón, 17 años, OC esporádico y pseudoaneurisma gigante de mes y mediode evolución; caso 4: mujer, 19 años, OC múltiple y pseudoaneurisma de once meses de evolución. La reconstrucción arterialfue con parche venoso en tres casos y sutura directa en uno. Resultados. No hubo recidivas de los OC en los casos1 y 2, de prolongado seguimiento. El análisis anatomopatológico confirmó la benignidad en todos. Curso postoperatoriofavorable y alta hospitalaria precoz. Conclusión. Es necesario descartar este cuadro ante dolor en extremidades inferioresen adolescentes debido a la frecuencia de estos tumores, especialmente si se conoce la existencia previa de OC. Es importanteel estudio de imagen con reconstrucción arterial antes de la cirugía. Es necesario resecar de modo preventivolos OC de crecimiento hacia trayectos vasculares, aun siendo asintomáticos

Introduction. The most common bone tumour is osteochondroma (OC). It may be found in both sporadicsolitary or multiple forms, and characteristically affects the long bones of the lower limbs while the individual is stillgrowing. It is usually asymptomatic but as it grows it may injure vascular structures, giving rise to ruptures and theformation of pseudoaneurysms. In the medical literature to date, the most numerous series consisted of six patients withvascular lesions due to this kind of tumour. Aim. To report and analyse our experience on four cases of this sort ofvascular complications produced by OC. Patients and methods. In all cases the popliteal artery was involved. Case 1:male, 16 years old, multiple OC and a five-day history of arterial rupture; case 2: male, 9 years old, sporadic OC and aone-month history of pseudoaneurysm; case 3: male, 17 years old, sporadic OC and a one-month history of giantpseudoaneurysm; case 4: female, 19 years old, sporadic OC and an 11-months’ history of pseudoaneurysm. Arterialreconstruction was performed with a vein patch in three cases and direct suturing in one case. Results. There were norecurrences of OC in cases 1 and 2, which were subject to long follow-ups. Pathological analysis confirmed the tumourswere benign in all cases. Post-operative progress was favourable and patients were soon discharged from hospital.Conclusions. This condition needs to be ruled out when dealing with pain in the lower limbs in teenagers, due to thefrequency of these tumours, especially if OC is known to have existed previously. An imaging study is important witharterial reconstruction before surgery. OCs growing towards vascular pathways must be excised as a preventivemeasure, even though they are asymptomatic

Carcinoma simultáneo gástrico y de recto. Informe de un caso / Gastric and rectus carcinoma. Report of a case

Se informa de un paciente con cáncer gástrico y del recto simultáneo, cuyos orígenes distintos se comprueban histológicamente. Se revisa la literatura nacional e internacional, así como los criterios de estas lesiones y se hacen recomendaciones(AU)

Esofagectomía sin toracotomía. Informe de 4 casos / Esofagectomy without thoracotomy. Report of four cases

Se presentan 3 casos de neoplasias de tercio inferior del esófago y uno de neoplasia del tercio superior, en los cuales se ha realizado esofagectomía sub-total por la técnica sin toracotomía, con incisión media abdominal y cervicotomía-izquierda. La reconstrucción se realiza en un solo tiempo y se coloca el estómago, en tres pacientes, en el antiguo lecho del esófago en el mediastino posterior, y en un paciente en el espacio retro-esternal(AU)

Litiasis vesicular y grupos sanguíneos / Vesicular lithiasis and blood groups

Se realiza un estudio de los primeros 100 pacientes operados de litiasis vesicular en el año 1982, relacionándolos con los grupos sanguíneos A, B, C. Se demostró estadísticamente que los pacientes del grupo sanguíneo A tienen una mayor predisposición a padecer de litiasis vesicular que el resto de la población, con cifras que arrojan una alta significación. V = 3 X² = 33519, 19 P< 0, 005(AU)