RESUMO RACIONAL: O câncer colorretal é o terceiro tipo de câncer mais comum no Brasil apesar dos métodos de rastreamento que reduzem seu risco. A colonoscopia é o único método com possibilidade terapêutica. O adequado rastreio por colonoscopia está relacionado à qualidade dos exames, avaliados de acordo com critérios de qualidade recomendados por diversas instituições. Dentre os fatores, o mais utilizado é a Taxa de Detecção de Adenoma, que deve ser de pelo menos 25% na população geral. OBJETIVOS: Avaliar a qualidade das colonoscopias de rastreamento do câncer colorretal realizadas em um centro brasileiro. MÉTODOS: Estudo retrospectivo avaliando os indicadores de qualidade em colonoscopias de rastreio nos pacientes assintomáticos com mais de 45 anos. O desfecho primário foi a Taxa de Detecção de Adenoma, e os secundários incluíram a taxa de detecção de pólipos e a segurança do procedimento. Subanálises incluíram a correlação dos achados endoscópicos com sexo e idade e a evolução das taxas de detecção de adenoma ao longo dos anos. RESULTADOS: Foram incluídos 2.144 pacientes, com media de idade de 60.54 anos. Pólipos foram diagnosticados em 68,6% dos procedimentos. A taxa de detecção de adenoma foi de 46,8%, aumentando ao longo dos anos, principalmente em homens. A taxa de efeitos adversos foi de 0.23%, sem necessidade de intervenção cirúrgica ou registro de óbitos. CONCLUSÕES: Este estudo demonstra que é possível realizar colonoscopias com qualidade para o rastreio do câncer colorretal quando efetuadas por médicos experientes e enfermeiras treinadas em hospitais com infraestrutura adequada. RACIONAL risco terapêutica exames instituições fatores Adenoma 25 geral OBJETIVOS brasileiro MÉTODOS 4 anos procedimento RESULTADOS 2144 2 144 2.14 6054 60 54 60.5 686 68 6 68,6 procedimentos 468 46 8 46,8% homens 023 0 23 0.23% óbitos CONCLUSÕES adequada 214 14 2.1 605 5 60. 68, 46,8 02 0.23 21 1 2. 46, 0.2 0.

ABSTRACT BACKGROUND: Colorectal cancer is the third most common type of cancer in Brazil, despite the availability of screening methods that reduce its risk. Colonoscopy is the only screening method that also allows therapeutic procedures. The proper screening through colonoscopy is linked to the quality of the exam, which can be evaluated according to quality criteria recommended by various institutions. Among the factors, the most used is the Adenoma Detection Rate, which should be at least 25% for general population. AIMS: To evaluate the quality of the screening colonoscopies performed in a quarternary private Brazilian hospital. METHODS: This is a retrospective study evaluating the quality indicators of colonoscopies performed at a private center since its inauguration. Only asymptomatic patients aged over 45 years who underwent screening colonoscopy were included. The primary outcome was the Adenoma Detection Rate, and secondary outcomes included polyps detection rate and safety profile. Subanalyses evaluated the correlation of endoscopic findings with gender and age and the evolution of detection rates over the years. RESULTS: A total of 2,144 patients were include with a mean age of 60.54 years-old. Polyps were diagnosed in 68.6% of the procedures. Adenoma detection rate was 46.8%, with an increasing rate over the years, mainly in males. A low rate of adverse events was reported in 0.23% of the cases, with no need for surgical intervention and no deaths. CONCLUSIONS: This study shows that high quality screening colonoscopy is possible when performed by experienced endoscopists and trained nurses, under an adequate infrastructure. BACKGROUND Brazil risk procedures exam institutions factors Rate 25 population AIMS hospital METHODS inauguration 4 profile RESULTS 2144 2 144 2,14 6054 60 54 60.5 yearsold. yearsold old. old years-old 686 68 6 68.6 468 46 8 46.8% males 023 0 23 0.23 cases deaths CONCLUSIONS nurses infrastructure 214 14 2,1 605 5 60. 68. 46.8 02 0.2 21 1 2, 46. 0.

Abstract Background: Alarms alert healthcare professionals of deviations from normal/physiologic status. However, alarm fatigue may occur when their high pitch and diversity overwhelm clinicians, possibly leading to alarms being disabled, paused, and/or ignored. We aimed to determine whether a staff educational program on customizing alarm settings of bedside monitors may decrease inconsistent alarms in the Post-Anesthesia Care Unit (PACU). Methods: This is a prospective, analytic, quantitative, pragmatic, open-label, single-arm study. The outcome was evaluated on PACU admission before (P1) and after (P2) the implementation of the educational program. The heart rate, blood pressure, and oxygen saturation alarms were selected for clinical consistency. Results: A total of 260 patients were included and 344 clinical alarms collected, with 270 (78.4%) before (P1), and 74 (21.6%) after (P2) the intervention. Among the 270 alarms in P1, 45.2% were inconsistent (i.e., false alarms), compared to 9.4% of the 74 in P2. Patients with consistent alarms occurred in 30% in the P1 and 27% in the P2 (p = 0.08). Patients with inconsistent alarms occurred in 25.4% in the P1 and in 3.8% in the P2. Ignored consistent alarms were reduced from 21.5% to 2.6% (p = 0.004) in the P2 group. The educational program was a protective factor for the inconsistent clinical alarm (OR = 0.11 [95% CI 0.04-0.3]; p < 0.001) after adjustments for age, gender, and ASA physical status. Conclusion: Customizing alarm settings on PACU admission proved to be a protective factor against inconsistent alarm notifications of multiparametric monitors. Background normalphysiologic normal physiologic status However clinicians disabled paused andor or ignored PostAnesthesia Post Anesthesia PACU. . (PACU) Methods prospective analytic quantitative pragmatic openlabel, openlabel open label, label open-label singlearm single arm study P (P1 (P2 rate pressure consistency Results 26 34 collected 27 78.4% 784 78 4 (78.4% , 7 21.6% 216 21 6 (21.6% intervention 452 45 2 45.2 i.e., ie i e (i.e. alarms, alarms) 94 9 9.4 30 0.08. 008 0.08 0 08 0.08) 254 25 25.4 38 3 8 3.8 215 5 21.5 2.6 0.004 0004 004 group OR 011 11 0.1 95% 95 [95 0.040.3 00403 0.04 0.3 04 0.04-0.3] 0.001 0001 001 age gender Conclusion (PACU (P 78.4 (78.4 21.6 (21.6 45. i.e. (i.e 9. 00 0.0 25. 3. 21. 2. 0.00 000 01 1 0. [9 040 0.040. 0040 03 0.04-0.3 78. (78. (21. i.e [ 0.040 0.04-0. (78 (21 0.04-0 (7 (2 0.04- (

Abstract Introduction and objectives Multimodal Analgesia (MMA) has shown promising results in postoperative outcomes across a broad spectrum of surgeries, including bariatric surgery. We compared the analgesic effect immediately after Laparoscopic Bariatric Surgery (LBS) of the combined effect of MMA and methadone against two techniques that were based mainly on the use of high-potency medium-acting opioids. Methods Two hundred seventy-one patients were retrospectively reviewed. The primary outcome was postoperative pain score > 3/10 measured by the Verbal Numeric Scale (VNS) during the Postanesthetic Care Unit (PACU) stay. The three protocols of intraoperative analgesia were: (P1) sufentanil at anesthetic induction followed by remifentanil infusion; (P2) sufentanil at induction followed by dexmedetomidine infusion; and (P3) remifentanil at induction followed by MMA including dexmedetomidine, magnesium, lidocaine, and methadone. Only P1 and P2 patients received morphine toward the end of surgery. Poisson regression was used to adjust confounding factors and calculate Prevalence Ratio (PR). Results Postoperative VNS > 3 was recorded in 135 (49.81%) patients, of which 93 (68.89%) were subjected to P1, 25 (18.56%) to P2, and 17 (12.59%) to P3. In the final adjusted model, both anesthetic techniques (P3) (PR = 0.10; 95% CI [0.03-0.28]), and (P2) (PR = 0.42%; 95% CI [0.20-0.90]) were associated with lower occurrence of VNS > 3, whereas age range 20-29 was associated to higher occurrence of VNS > 3 (PR = 3.21; 95% CI [1.22-8.44]) in PACU. Postoperative Nausea and Vomiting (PONV) was distributed as follows: (P1) 20.3%, (P2) 31.25% and (P3) 6.77%; (P3 < P1, P2; p< 0.05). Intraoperative hypotension occurred more often in P3 (39%) compared to P2 (20.31%) and P1 (17.46%) (p< 0.05). Conclusion MMA + methadone was associated with higher incidence of intraoperative hypotension and lower incidence of moderate/severe pain in PACU after LBS.

RESUMO JUSTIFICATIVA E OBJETIVOS: O manejo da dor pela equipe multidisciplinar continua como um desafio na saúde. O objetivo deste estudo foi analisar o impacto de estratégias educacionais para efetivação da dor como 5º sinal vital e seu gerenciamento em um hospital de alta complexidade. MÉTODOS: Estudo não controlado de intervenção por meio de análise de três diferentes estratégias educativas sequenciais: Semana de treinamentos sobre Dor (SD), visitas educacionais pelo enfermeiro da dor para orientar os profissionais em relação à dor e treinamento eletrônico virtual de revisão. A análise do impacto das estratégias educativas foi realizada por meio de indicadores em relação à dor como 5º sinal vital e tratamento adequado da dor. RESULTADOS: Na avaliação da dor como 5° sinal vital, a auditoria prévia à SD mostrou mediana de conformidade de 46,4% na unidade de internação, de 53,1% na maternidade e de 16,7% no Pronto Socorro. Nas avaliações após a SD, a mediana de conformidade na unidade de internação foi de 78,4%, na maternidade de 79,62% e no pronto atendimento de 32,9% (p<0,05). Houve melhora no tratamento da dor em todos os setores após avaliações subsequentes aos treinamentos (p<0,05). CONCLUSÃO: A implantação de um programa de educação continuada se mostrou efetivo em promover melhora na assistência no cuidado ao paciente com dor e dos resultados dos indicadores assistenciais em relação ao protocolo de dor institucional.

ABSTRACT BACKGROUND AND OBJECTIVES: Pain management by the multidisciplinary team remains a challenge in the health field. The aim of this study was to analyze the impact of educational strategies for the implementation of pain as the fifth vital sign and its management in a highly complex hospital. METHODS: An interventional non-controlled study analyzed three different sequential educational processes: Pain training week (PW), educational visits by the pain nurse to guide professionals in relation to pain management and e-learning. The impact of the educational strategy was assessed through pain as the 5th vital sign and adequate pain management. RESULTS: For pain as the 5th vital sign, the audit previous to PW showed a median of compliance of 46.4% at the inpatient unit, 53.1% at the maternity ward and 16.7% at the emergency room. In the evaluations after PW, the median of compliance at the inpatient unit was 78.4%, at the maternity ward 79.62% and at the emergency room 32.9% (p<0.05). There was an improvement in pain management in all hospital sectors after subsequent training (p<0.05). CONCLUSION: The implementation of a continuing education program has improved pain care assistance and increased compliance to the institutional pain protocol.

RESUMO JUSTIFICATIVA E OBJETIVOS: O objetivo deste estudo foi comparar técnicas anestésicas com sufentanil em diferentes doses na indução anestésica e infusão contínua de remifentanil ou dex medetomidina no intraoperatório para manutenção da anestesia, relacionando tais fatores à incidência de dor, náuseas e vômitos no pós-operatório e demais complicações na sala de recuperação pós-anestésica. MÉTODOS: Estudo observacional analítico retrospectivo reali zado em pacientes obesos (n=120). Os pacientes incluídos foram selecionados aleatoriamente e constituíram 4 grupos de 30 pa cientes cada: G1 - indução com sufentanil 0,5 µg.kg-1 associado à infusão continua de remifentanil; G2 - indução com sufentanil 0,7 µg.kg-1 associado à infusão contínua de remifentanil; G3 - indução com sufentanil 0,5 µg.kg-1 associado à infusão contínua de dexmedetomidina; G4 - indução com sufentanil 0,7 µg.kg-1 associado à infusão contínua de dexmedetomidina. Considerou -se como critério de significância valor de p<0,05. RESULTADOS: A incidência de dor na sala de recuperação pós -anestésica foi de 52,5% (n=63) e, entre esses, em 36,11% dos casos foi considerada intensa. A incidência de dor foi menor nos pacientes que receberam infusão de dexmedetomidina compara do àqueles que receberam infusão de remifentanil. A dose de su fentanil na indução anestésica não influenciou na incidência de dor (G1=G2>G3=G4) (p<0,05). A ocorrência de complicações respiratórias não apresentou diferença estatisticamente significa tiva entre os grupos. CONCLUSÃO: O uso de dexmedetomidina apresentou vanta gem em relação à analgesia na sala de recuperação pós-anestésica, sem aumento no risco de complicações respiratórias, quando comparado à infusão contínua de remifentanil, independente mente da dose de sulfentanil utilizada na indução.

ABSTRACT BACKGROUND AND OBJECTIVES: Compare anesthesia techniques with sufentanil and intraoperative infusion of remifentanil or dexmedetomidine, and to then analyze their associations with the incidence of pain and other complications in the post-anesthesia care unit. METHODS: A retrospective analytical observational study conducted in a reference center for bariatric surgery in São Paulo, São Paulo State, Brazil. Patients (n=120) included in the study were randomly selected using this site’s anesthesia records for bariatric surgery. Four 30-patient groups were established: G1 - induction with 0.5 µg.kg-1 sufentanil associated with the continuous infusion of remifentanil; G2 - induction with 0.7 µg.kg-1 sufentanil associated with the continuous infusion of remifentanil; G3 - induction with 0.5 µg.kg-1 sufentanil associated with the continuous infusion of dexmedetomidine; and G4 - induction with 0.7 µg.kg-1 sufentanil associated with the continuous infusion of dexmedetomidine. Significance was set at p<0.05. RESULTS: The incidence of pain in the post-anesthesia care unit was 52.5% (n=63). It was considered intense in 36.11% of these cases. The incidence of pain in the post-anesthesia care unit was lower in patients receiving a continuous infusion of dexmedetomidine relative to those who received remifentanil infusion. Sufentanil dosage in anesthesia induction did not influence the incidence of pain (G1=G2>G3=G4; p<0.05). The occurrence of respiratory complications did not differ significantly between the groups. CONCLUSION: The use of dexmedetomidine proved to be better for analgesia in the post-anesthesia care unit, and it did not increase the risk of respiratory complications when compared to the continuous infusion of remifentanil, regardless of the sufentanil dose used for induction.