Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine.

BackgroundSleep quality is an essential component of athlete’s recovery. However, a better understanding of the parameters to adequately quantify sleep quality in team sport athletes is clearly warranted.ObjectiveTo identify which parameters to use for sleep quality monitoring in team sport athletes.MethodsSystematic searches for articles reporting the qualitative markers related to sleep in team sport athletes were conducted in PubMed, Scopus, SPORTDiscus and Web of Science online databases. The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. For the meta-analysis, effect sizes with 95% CI were calculated and heterogeneity was assessed using a random-effects model. The coefficient of variation (CV) with 95% CI was also calculated to assess the level of instability of each parameter.ResultsIn general, 30 measuring instruments were used for monitoring sleep quality. A meta-analysis was undertaken on 15 of these parameters. Four objective parameters inferred by actigraphy had significant results (sleep efficiency with small CV and sleep latency, wake episodes and total wake episode duration with large CV). Six subjective parameters obtained from questionnaires and scales also had meaningful results (Pittsburgh Sleep Quality Index (sleep efficiency), Likert scale (Hooper), Likert scale (no reference), Liverpool Jet-Lag Questionnaire, Liverpool Jet-Lag Questionnaire (sleep rating) and RESTQ (sleep quality)).ConclusionsThese data suggest that sleep efficiency using actigraphy, Pittsburgh Sleep Quality Index, Likert scale, Liverpool Jet-Lag Questionnaire and RESTQ are indicated to monitor sleep quality in team sport athletes.PROSPERO registration numberCRD42018083941.

IntroductionThe surgeon's formation process has changed in recent decades. The increase in medical schools, new specialties and modern technologies induce an overhaul of medical education. Medical residency in surgery has established itself as a key step in the formation of the surgeon, and represents the ideal and natural way for teaching laparoscopy. However, the introduction of laparoscopic surgery in the medical residency programs in surgical specialties is insufficient, creating the need for additional training after its termination.ObjectiveTo review the surgical teaching ways used in services that published their results.MethodsSurvey of relevant publications in books, internet and databases in PubMed, Lilacs and Scielo through july 2014 using the headings: laparoscopy; simulation; education, medical; learning; internship and residency.ResultsThe training method for medical residency in surgery focused on surgical procedures in patients under supervision, has proven successful in the era of open surgery. However, conceptually turns as a process of experimentation in humans. Psychomotor learning must not be developed directly to the patient. Training in laparoscopic surgery requires the acquisition of psychomotor skills through training conducted initially with surgical simulation. Platforms based teaching problem solving as the Fundamentals of Laparoscopic Surgery, developed by the American Society of Gastrointestinal Endoscopic Surgery and the Laparoscopic Surgical Skills proposed by the European Society of Endoscopic Surgery has been widely used both for education and for the accreditation of surgeons worldwide. ConclusionThe establishment of a more appropriate pedagogical process for teaching laparoscopic surgery in the medical residency programs is mandatory in order to give a solid surgical education and to determine a structured and safe professional activity.

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high‐ (HICs) and low‐ and middle‐income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7‐day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally.

Recebido em 07/12/200107/12/ Aceito para publicação em 18/11/2002 Trabalho realizado na Clínica Especializada em Doenças do Aparelho Digestivo (DIGEST) INTRODUÇÃOHá cerca de 10 anos considerava-se como contra-indicação absoluta da colecistectomia laparoscópica situações como gravidez, cirurgia abdominal prévia, intolerância ao aumento da pressão intra-abdominal, obstrução intestinal, coagulopatia, obesidade, cirrose, intolerância à anestesia geral, coledocolitíase e colecistite aguda 1 . Com o passar dos anos, a maior experiência do cirurgião com o método e o melhor conhecimento e controle das RESUMO: Objetivo: Relatar a experiência com a colecistectomia laparoscópica na colecistite aguda, em pacientes de alto risco (ASA 4). Método: De 1982 a 2001 foram realizadas, na Clínica Especializada em Doenças do Aparelho Digestivo (DIGEST), 1507 colecistectomias laparoscópicas, sendo 150 (10%) em colecistite aguda, dentre as quais 10 (0,7%) em pacientes ASA 4. Resultados: Entre estes 10 pacientes observou-se uma faixa etária elevada com média de 70,9 anos (variando entre 50 e 89 anos), maior freqüência do sexo masculino (60%), período de internação pré-operatório bastante variável (de três a 22 dias), prevalência elevada de colecistite aguda alitiásica (30%) e grande freqüência de insuficiência renal (40%) dentre as doenças associadas. Como complicações de pós-operatório houve uma coleção sub-hepática tratada por drenagem guiada por ultrassonografia; duas infecções de sítio operatório, tratadas pela abertura da pele do portal infectado, e um óbito decorrente da perpetuação do quadro séptico em paciente previamente submetido a colecistostomia percutânea. Não houve necessidade de conversão em nenhum dos pacientes operados. Conclusão: Os autores concluem pela viabilidade do método laparoscópico no tratamento da colecistite aguda em pacientes de alto risco, observando-se algumas estratégias específicas. Descritores: Colecistectomia laparoscópica; Colecistite agudaABSTRACT Background: Evolution and experience with laparoscopic cholecystectomy in acute cholecystitis, a better knowledge of alterations provoked by the laparoscopic approach specially related to pneumoperitonium, allowed accomplishment of this procedure in high risk patients (ASA 4), objective of this research. Methods: From 1992 to 2001, 1507 patients underwent laparoscopic cholecystectomy at Clínica Especializada em Doenças do Aparelho Digestivo (DIGEST), 150 (10%) of them with acute cholecistitis and 10 (0,7%) ASA 4 patients. Results: Mean age was 70,9 years, varying between 50 and 89 years, and 60% were males. Preoperative hospitalization varied from 3 to 22 days. There was a 30% incidence of acute acalculous cholecystitis and 40% of renal disfunction. Other associated diseases were also observed. Postoperative complications included a sub-liver collection with associated pneumonia, solved by drainage guided by ultrasound, two surgical site infections, and a death due to perpetuation of sepsis on a patient previously submitted to a percutaneus cholecystosto...