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Vianna FSL, Neves LL, Testa R, Nassar AP, Peres JHF, da Silva RÁJ, de Paula Sales F, Raglione D, Del Bianco Madureira B, Dalfior L, Malbouisson LMS, Ribeiro U, da Silva JM. Impact of the COVID-19 Pandemic on the Outcomes of Patients Undergoing Oncological Surgeries: CORONAL Study. Ann Surg Oncol 2024:10.1245/s10434-024-15152-9. [PMID: 38530529 DOI: 10.1245/s10434-024-15152-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 02/20/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND The impact of coronavirus disease 2019 (COVID-19) on postoperative recovery from oncology surgeries should be understood for the clinical decision-making. Therefore, this study was designed to evaluate the postoperative cumulative 28-day mortality and the morbidity of surgical oncology patients during the COVID-19 pandemic. METHODS This retrospective cohort study included patients consecutively admitted to intensive care units (ICU) of three centres for postoperative care of oncologic surgeries between March to June 2019 (first phase) and March to June 2020 (second phase). The primary outcome was cumulative 28-day postoperative mortality. Secondary outcomes were postoperative organic dysfunction and the incidence of clinical complications. Because of the possibility of imbalance between groups, adjusted analyses were performed: Cox proportional hazards model (primary outcome) and multiple logistic regression model (secondary outcomes). RESULTS After screening 328 patients, 291 were included. The proportional hazard of cumulative 28-day mortality was higher in the second phase than that in the first phase in the Cox model, with the adjusted hazard ratio of 4.35 (95% confidence interval [CI] 2.15-8.82). The adjusted incidences of respiratory complications (odds ratio [OR] 5.35; 95% CI 1.42-20.11) and pulmonary infections (OR 1.53; 95% CI 1.08-2.17) were higher in the second phase. However, the adjusted incidence of other infections was lower in the second phase (OR 0.78; 95% CI 0.67-0.91). CONCLUSIONS Surgical oncology patients who underwent postoperative care in the intensive care unit during the COVID-19 pandemic had higher hazard of 28-day mortality. Furthermore, these patients had higher odds of respiratory complications and pulmonary infections. Trials registration The study is registered in the Brazilian Registry of Clinical Trials under the code RBR-8ygjpqm, UTN code U1111-1293-5414.
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Affiliation(s)
- Felipe Souza Lima Vianna
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
- Departamento de Pacientes Graves, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | | | - Renato Testa
- Fundação Antonio Prudente- A C Camargo Cancer Center, São Paulo, SP, Brazil
| | | | | | | | | | - Dante Raglione
- Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brazil
| | | | - Luiz Dalfior
- Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brazil
| | - Luiz Marcelo Sá Malbouisson
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
- Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brazil
| | - Ulysses Ribeiro
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
- Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brazil
| | - João Manoel da Silva
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
- Hospital do Câncer de Barretos- Fundação Pio XII, Barretos, SP, Brazil
- Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brazil
- Departamento de Pacientes Graves, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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Vinicius Santinelli Pestana D, Raglione D, Junior LD, Liberatti CDSP, Braga EC, Ezequiel VADL, Alves ADS, Mauro JG, Dias JODA, Moreira PTF, Madureira BDB, Paiva LP, de Lucena BMN, Junior JMS, Malbouisson LMS. Stress and substance abuse among workers during the COVID-19 pandemic in an intensive care unit: A cross-sectional study. PLoS One 2022; 17:e0263892. [PMID: 35143590 PMCID: PMC8830709 DOI: 10.1371/journal.pone.0263892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 01/28/2022] [Indexed: 11/18/2022] Open
Abstract
Objective Professionals working in intensive care units (ICUs) during the COVID-19 pandemic have been exposed to stressful situations and increased workload. The association between symptoms of traumatic stress disorders, substance abuse and personal/occupational characteristics of Brazilian COVID-19-ICU workers is still to be addressed. Our aim was to evaluate the prevalence of those conditions and to find if those associations exist. Methods In this observational, single-center, cross-sectional study, all professionals working in a COVID-19 ICU were invited to fill an anonymous form containing screening tools for traumatic stress disorders and substance abuse, and a section with questions regarding personal and occupational information. Results Three hundred seventy-six ICU professionals participated. Direct exposure to patients infected by COVID-19, history of relatives infected by COVID-19, and sex (female) were significantly associated with signs and symptoms of traumatic stress disorders. 76.5% of the participants had scores compatible with a diagnosis of traumatic stress disorders. Moreover, the prevalence of scores suggestive of Tobacco and Alcohol abuse were 11.7% and 24.7%, respectively. Conclusion ICU workers had significantly elevated scores on both screening forms. Providing psycho-social support to ICU professionals may prevent future problems with traumatic stress disorders or substance abuse.
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Affiliation(s)
- Diego Vinicius Santinelli Pestana
- Department of Anesthesiology, Intensive Care Unit, Instituto do Câncer do Estado de São Paulo/Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- * E-mail:
| | - Dante Raglione
- Department of Anesthesiology, Intensive Care Unit, Instituto do Câncer do Estado de São Paulo/Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Luiz Dalfior Junior
- Department of Anesthesiology, Intensive Care Unit, Instituto do Câncer do Estado de São Paulo/Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Caroline de Souza Pereira Liberatti
- Department of Anesthesiology, Intensive Care Unit, Instituto do Câncer do Estado de São Paulo/Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Elisangela Camargo Braga
- Department of Anesthesiology, Intensive Care Unit, Instituto do Câncer do Estado de São Paulo/Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Vitor Augusto de Lima Ezequiel
- Department of Anesthesiology, Intensive Care Unit, Instituto do Câncer do Estado de São Paulo/Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Adriana da Silva Alves
- Department of Anesthesiology, Intensive Care Unit, Instituto do Câncer do Estado de São Paulo/Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Juliana Gil Mauro
- Department of Anesthesiology, Intensive Care Unit, Instituto do Câncer do Estado de São Paulo/Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - José Omar de Araújo Dias
- Department of Anesthesiology, Intensive Care Unit, Instituto do Câncer do Estado de São Paulo/Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Paulo Thadeu Fantinato Moreira
- Department of Anesthesiology, Intensive Care Unit, Instituto do Câncer do Estado de São Paulo/Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Bruno Del Bianco Madureira
- Department of Anesthesiology, Intensive Care Unit, Instituto do Câncer do Estado de São Paulo/Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Lilian Petroni Paiva
- Department of Anesthesiology, Intensive Care Unit, Instituto do Câncer do Estado de São Paulo/Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Bruno Melo Nóbrega de Lucena
- Department of Anesthesiology, Intensive Care Unit, Instituto do Câncer do Estado de São Paulo/Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - João Manoel Silva Junior
- Department of Anesthesiology, Intensive Care Unit, Instituto do Câncer do Estado de São Paulo/Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Luiz Marcelo Sá Malbouisson
- Department of Anesthesiology, Intensive Care Unit, Instituto do Câncer do Estado de São Paulo/Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Santos YDAPD, Younes-Ibrahim MS, Crozatti LL, Raglione D, Cardozo Junior LCM, Besen BAMP, Taniguchi LU, Park M, Mendes PV. Adherence to a stress ulcer prophylaxis protocol by critically ill patients: a prospective cohort study. Rev Bras Ter Intensiva 2020; 32:37-42. [PMID: 32401969 PMCID: PMC7206951 DOI: 10.5935/0103-507x.20200007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 09/03/2019] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To evaluate adherence to the stress ulcer prophylaxis protocol in critically ill patients at a tertiary university hospital. METHODS In this prospective cohort study, we included all adult patients admitted to the medical and surgical intensive care units of an academic tertiary hospital. Our sole exclusion criterion was upper gastrointestinal bleeding at intensive care unit admission. We collected baseline variables and stress ulcer prophylaxis indications according to the institutional protocol and use of prophylaxis. Our primary outcome was adherence to the stress ulcer prophylaxis protocol. Secondary outcomes were appropriate use of stress ulcer prophylaxis, upper gastrointestinal bleeding incidence and factors associated with appropriate use of stress ulcer prophylaxis. RESULTS Two hundred thirty-four patients were enrolled from July 2nd through July 31st, 2018. Patients were 52 ± 20 years old, 125 (53%) were surgical patients, and the mean SAPS 3 was 52 ± 20. In the longitudinal follow-up, 1499 patient-days were studied; 1069 patient-days had stress ulcer prophylaxis indications, and 777 patient-days contained prophylaxis use (73% stress ulcer prophylaxis protocol adherence). Of the 430 patient-days without stress ulcer prophylaxis indications, 242 involved prophylaxis (56% inappropriate stress ulcer prophylaxis use). The overall appropriate use of stress ulcer prophylaxis was 64%. Factors associated with proper stress ulcer prophylaxis prescription were mechanical ventilation OR 2.13 (95%CI 1.64 - 2.75) and coagulopathy OR 2.77 (95%CI 1.66 - 4.60). The upper gastrointestinal bleeding incidence was 12.8%. CONCLUSION Adherence to the stress ulcer prophylaxis protocol was low and inappropriate use of stress ulcer prophylaxis was frequent in this cohort of critically ill patients.
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Affiliation(s)
| | | | | | - Dante Raglione
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | | | | | - Leandro Utino Taniguchi
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Marcelo Park
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Pedro Vitale Mendes
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
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Raglione D, Bezerra GAM, Lopes MH, Nerger MLBR, Guimarães TC, Sartori AMC. [Evaluation of the cold chain for vaccine conservation in primary healthcare centers in the South and Midwest regions of São Paulo city, Brazil, in 2011-2012]. Epidemiol Serv Saude 2016; 25:65-74. [PMID: 27861679 DOI: 10.5123/s1679-49742016000100007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 01/07/2016] [Indexed: 11/02/2022] Open
Abstract
OBJECTIVE to assess the cold chain capacity, health workers' immunobiological product conservation knowledge and practices in Primary Healthcare Centers (PHC) in São Paulo city, Brazil. METHODS this descriptive study included 24 randomly selected PHC in the South and Midwest regions of the city; between December 2011 and July 2012, we interviewed the health workers on their vaccine conservation knowledge/practice and observed the local infrastructure, using a form developed for this project; we assigned points to items of the form and classified each PHC as sufficient, regular or insufficient. RESULTS most of the 24 PHC evaluated were administered by Social Organizations; all of them had vaccine storage chambers; 5 PHC reported using their maximum storage capacity; 9 PHC were classified as having sufficient knowledge/practice and 15 as having regular knowledge/practice. CONCLUSION in these PHC, cold chain utilization was close to its maximum capacity; many health workers did not have basic knowledge about vaccine conservation.
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Affiliation(s)
- Dante Raglione
- Universidade de São Paulo, Faculdade de Medicina, São Paulo-SP, Brasil
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