Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background: Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods: The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results: A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion: Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)

Posicionamento de gestores e lideranças de enfermagem diante dos erros divulgados na mídia

Resumo OBJETIVO Analisar o posicionamento de gestores e lideranças de enfermagem acerca dos erros de enfermagem divulgados na mídia. METODOLOGIA Estudo qualitativo, retrospectivo, documental, coleta de dados realizada em jornais do Brasil e Portugal, entre 2012 e 2016. Análise realizada no Atlas.ti, utilizando a hermenêutica de Ricoeur fundamentada na Teoria do Agir Comunicativo de Habermas. RESULTADOS Gestores e lideranças destacam as condições de trabalho da enfermagem, e prestaram esclarecimentos quanto à ausência de supervisão e déficits na força de trabalho, seguiram com a abertura de sindicância interna, afastamento do cargo e demissão. As lideranças se posicionaram abrindo Processo Ético Disciplinar, realizando fiscalização, solicitando documentos e questionando acerca dos fatos, assim como repudiando algumas notas divulgadas. CONCLUSÃO As lideranças em enfermagem desempenham papel crucial no momento da divulgação de notícias que envolvem erros assistenciais, a fim de expor uma problemática complexa. Entretanto, isso não tem sido feito de forma eficiente

Seasonal Reproductive Biology of the Bignose Fanskate Sympterygia acuta (Chondrichthyes, Rajidae)

Most skates are adapted to shelf and slope environments experiencing less seasonal variation than coastal ecosystems. Here, we analyze the reproductive ecology of Sympterygia acuta. We hypothesize that, like its congener Sympterygia bonapartii, S. acuta has a seasonal reproductive cycle. To test this hypothesis, we examined multiple lines of evidence: (1) time of appearance of females carrying egg cases and wild neonates; (2) seasonal variation in gonadosomatic index and follicle diameter, as indicators of reproductive activity; and (3) egg-laying season, incubation time, and fecundity in captive individuals. A total of 351 specimens were examined. Size at 50 % maturity was 475 and 478 mm total length for males and females, respectively. A marked seasonal reproductive cycle was observed. Both gonadosomatic index and follicle diameter of wild adult females increased from winter to spring and reached their lowest value during summer. Fecundity was, on average, 52 eggs per female per laying season. Egg laying of captive females peaked between August and December; eggs hatched after 119–131 days. This schedule predicts the appearance of neonates in the wild by January through April. Accordingly, wild neonates and young-of-the-year were observed between January and May. Unlike most other skates, southwest Atlantic Sympterygia species are adapted to life in shallow, coastal waters, matching the seasonality of the coastal environment with egg-laying activity in spring and hatching in summer. These shallow coastal waters, which are important in the life cycle of Sympterygia spp., are threatened by human impacts.Fil: Mabragaña, Ezequiel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mar del Plata. Instituto de Investigaciones Marinas y Costeras. Universidad Nacional de Mar del Plata. Facultad de Ciencia Exactas y Naturales. Instituto de Investigaciones Marinas y Costeras; ArgentinaFil: Lucifora, Luis Omar. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste. Instituto de Biología Subtropical. Instituto de Biología Subtropical - Nodo Puerto Iguazú | Universidad Nacional de Misiones. Instituto de Biología Subtropical. Instituto de Biología Subtropical - Nodo Puerto Iguazú; ArgentinaFil: Corbo, Maria de Lourdes. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mar del Plata. Instituto de Investigaciones Marinas y Costeras. Universidad Nacional de Mar del Plata. Facultad de Ciencia Exactas y Naturales. Instituto de Investigaciones Marinas y Costeras; Argentina. Provincia de Buenos Aires. Gobernación. Comisión de Investigaciones Científicas; ArgentinaFil: Díaz de Astarloa, Juan Martín. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mar del Plata. Instituto de Investigaciones Marinas y Costeras. Universidad Nacional de Mar del Plata. Facultad de Ciencia Exactas y Naturales. Instituto de Investigaciones Marinas y Costeras; Argentin