Utilization of Single-Incision Laparoscopy in the Management of Ingested Magnets.

Background: A ban on neodymium magnets was lifted by the U.S. Consumer Product Safety Commission in 2016. Pediatric gastroenterologists and surgeons were increasingly tasked with removing these problematic objects. The purpose of this study was to assess the utility of single-incision laparoscopic surgery (SILS) in the management of ingested magnets. Patients and Methods: This is a single-center, retrospective assessment of surgical interventions for ingested magnets. International Classification of Disease, 10th revision codes were used to identify 349 patients ≤21 years of age evaluated for foreign body ingestion over a 4.5-year period. A medical record review helped isolate 29 (8.3%) magnet ingestions, 9 requiring surgical intervention. RedCap was used for analysis. Results: Of 9 surgical patients, 7 underwent SILS intervention by 1 surgeon. Another surgeon performed an open operation, whereas a third performed a multiport operation. Of the 7 SILS cases, 3 were completed without conversion to open. In one of these cases, bowel resection with primary anastomosis was performed. For SILS cases, average operating room time was 109 minutes (38-170 minutes), time to enteral feeds was 23 hours (0.28-79.2 hours), and hospital length of stay (LOS) was 3.8 days (1.96-6.68 days). Thirty-day readmission for SILS was 14.3%. No other complications were observed. Conclusions: SILS has been safely utilized for magnet retrieval. It offers an ability to identify the affected intestinal segment and an opportunity to intervene extracorporeally through an uncapped port. In addition, knowing where matted bowel is located can direct a limited incision during conversion to laparotomy. This may confer benefits of decreased pain, shortened time to enteral feeds, and decreased hospital LOS.

Impact of Perioperative Ketamine on Postoperative Bariatric Surgery Opioid Use and Length of Stay.

SETTINGS: Postoperative pain management is an ever-growing challenge with the rise of the opioid crisis. Ketamine is an NMDA channel blocker, considered an alternative to perioperative opioid use; small concentrations are safe. Objective: The primary objective of this study was to evaluate the impact of perioperative ketamine administration on postoperative opioid use and the length of hospital stay in bariatric patients. METHODS: Four hundred (366) charts were retrospectively reviewed; of those, 187 received ketamine and were placed in the Ketamine group, 179 received standard-of-care pain management and were part of the No-Ketamine group. Data was collected using medical databases from July 2020 to January 2021. RESULTS: A greater length of stay was recorded in the No-Ketamine group (45.67±20.6 hours) when compared with the Ketamine group (40.6±14.3 hours); P <0.05. The Ketamine group had a mean MME of 17.5±16.5 whereas the No-Ketamine had a mean MME of 22.3±17.7, P <0.05. CONCLUSIONS: Ketamine may be a feasible alternative to reduce opioid use and hospital length of stay. We believe that ketamine can be an important contribution to ERABS pathways, being responsible for improved outcomes after bariatric/metabolic surgical procedures.

[Users' perspective inclusion in mental health services evaluation]. / La inclusión de la perspectiva de los usuarios en los servicios de Salud Mental.

It has been progressively recognized the importance of including users and their perspective in the evaluation of health and mental health services. This paper develops some ideas related to the involvement of users in the service improvement process -from their participation as consumers up to their citizens' place in full exercise of rights-; and the way in which they perceive received services and attention, as well as some discussions about the possibilities and difficulties for taking into account that perspective.

¿La pobreza del desastre o el desastre de la pobreza? / Disaster and poverty

Con base en un estudio descriptivo realizado por el GAPPD (Grupo de Atención Psiquiátrica y Psicosocial en Desastres) con habitantes de ®campamentos temporales¼ después de dos años de ocurrido el terremoto de Armenia, Colombia, se realiza una discusión en torno a los efectos de la estancia prolongada en este tipo de albergues y de los aspectos psicosociales relacionados con la pobreza y la vulnerabilidad, desde una concepción cíclica de los desastres, que pone en evidencia la correlación causal y circular que se expresa entre estas tres situaciones y su lugar fundamental en la perpetuación del subdesarrollo