Loop ileostomy closure is a common procedure in colorectal surgery. Often seen as a simple operation associated with a low complication rate, it still leads to lengthy hospitalizations. Reducing ...postoperative complications and ileus rates could lead to a shorter length of stay and even ambulatory surgery.
This study aimed to assess the safety and feasibility of ileostomy closure performed in a 23-hour hospitalization setting using a standardized enhanced recovery pathway.
Randomized controlled trial.
Two high-volume colorectal surgery centers.
Healthy adults undergoing elective ileostomy closure from July 2019 to January 2022.
All patients were enrolled in a standardized enhanced recovery pathway specific to ileostomy closure, including daily irrigation of efferent limb with a nutritional formula for 7 days before surgery. Patients were randomly allocated to either conventional hospitalization (n = 23) or a 23-hour stay (n = 24).
Primary outcome was total length of stay and secondary outcomes were 30-day rates of readmission, postoperative ileus, surgical site infections, and postoperative morbidity and mortality.
A total of 47 patients were ultimately randomly allocated. Patients in the 23-hour hospitalization arm had a shorter median length of stay (1 vs 2 days, p = 0.02) and similar rates of readmission (4% vs 13%, p = 0.35), postoperative ileus (none in both arms), surgical site infection (0% vs 4%, p = 0.49), postoperative morbidity (21% vs 22%, p = 1.00), and mortality (none in both arms).
Due to coronavirus disease 2019, access to surgical beds was greatly limited, leading to a shift toward ambulatory surgery for ileostomy closure. The study was terminated early, which affected its statistical power.
Loop ileostomy closures as 23-hour stay procedures are feasible and safe. Ileus rate might be reduced by preoperative intestinal stimulation with nutritional formula through the stoma's efferent limb, although specific randomized controlled trials are needed to confirm this association. See Video Abstract .
ANTECEDENTES:El cierre de la ileostomía en asa es un procedimiento común en la cirugía colorrectal. A menudo vista como una operación simple asociada con bajas tasas de complicaciones, aún conduce a largas hospitalizaciones. La reducción de las complicaciones postoperatorias y las tasas de íleo podría conducir a una estadía hospitalaria más corta o incluso a una cirugía ambulatoria.OBJETIVOS:El presente estudio pretende evaluar la seguridad y la viabilidad del cierre de ileostomía realizadas en un entorno de hospitalización de 23 horas utilizando una vía de recuperación mejorada y estandarizada.DISEÑO:Estudio aleatorio controladoAJUSTES:Dos centros de cirugía colorrectal de gran volúmenPACIENTES:Adultos sanos sometidos a cierre electivo de ileostomía, desde Julio de 2019 hasta Enero de 2022.INTERVENCIÓN:Todos los pacientes fueron inscritos en una vía de recuperación mejorada y estandarizada específica para el cierre de la ileostomía, incluyendo la irrigación diaria de la extremidad eferente del intestino asociada a una fórmula nutricional durante 7 días previos a la cirugía. Los pacientes fueron asignados aleatoriamente en hospitalización convencional (n = 23) o a una estadía de 23 horas (n = 24).PRINCIPALES MEDIDAS DE RESULTADO:El resultado primario fue la duración total de la estadía hospitalaria y los resultados secundarios fueron las tasas de reingreso a los 30 días, el íleo postoperatorio, las infecciones de la herida quirúrgica, la morbilidad y mortalidad postoperatorias.RESULTADOS:Finalmente fueron randomizados un total de 47 pacientes. Aquellos que se encontraban en el grupo de hospitalización de 23 horas tuvieron una estadía media más corta (1 día versus 2 días, p = 0,02) y tasas similares de reingreso (4% vs 13%, p = 0,35), de íleo postoperatorio (ninguno en ambos brazos), de infección del sitio quirúrgico (0 vs 4%, p = 0,49), de morbilidad postoperatoria (21% vs 22%, p > 0,99) y de mortalidad (ninguna en ambos brazos).LIMITACIONES:Debido a la pandemia SARS CoV-2, el acceso a las camas quirúrgicas fue muy limitado, lo que llevó a un cambio hacia la cirugía ambulatoria para el cierre de ileostomías. El estudio finalizó anticipadamente, lo que afectó su poder estadístico.CONCLUSIÓN:Los cierres de ileostomía en asa como procedimientos de estadía de 23 horas son factibles y seguros. La tasa de íleo podría reducirse mediante la estimulación intestinal preoperatoria a través de la rama eferente del estoma asociada a fórmulas nutricionales, por lo que se necesitan estudios randomizados específicos para confirmar esta asociación. (Traducción-Dr. Xavier Delgadillo ).
Background: Loop ileostomy closure is associated with low complication rates, consisting mostly of postoperative ileus, but is still leading to significant length of hospitalization. Hence, decreased ...length of stay could be achieved by decreasing ileus rates. The purpose of this study was to assess the safety and feasibility of ileostomy closure performed in a 23-hour hospitalization setting using a standardized enhanced recovery pathway. Methods: This randomized controlled trial included healthy adults undergoing elective ileostomy closure. All patients were enrolled in a standardized enhanced recovery pathway specific to ileostomy closure, including daily irrigation of the efferent limb with an enteral nutritional formula for 7 days preoperatively. Once surgery was completed, patients were randomized to either conventional hospitalization (CH) or to 23-hour stay (23HS). Primary outcome was total length of stay in days, and secondary outcomes were 30-day rates of readmission, postoperative ileus, surgical site infection, postoperative morbidity and mortality. Owing to COVID-19 limiting access to surgical beds, the study was terminated early. Results: A total of 47 patients were randomized; 23 in the CH arm and 24 in the 23HS arm. Patients in the 23HS arm had a shorter median length of stay (1 d v. 2 d, p = 0.015) and similar readmission rates (4% v. 13%, p = 0.348), postoperative ileus (0% in both arms), surgical site infection (0% v. 4%, p = 0.489), postoperative morbidity rates (17% v. 22%, p = 0.724) and mortality rate (0% in both arms). Conclusion: This study suggests that loop ileostomy closure as a 23-hour stay procedure in a standardized enhanced recovery pathway is feasible and safe.
This paper examines the notion of document importance in personal information management. Based on a literature review and the results of a previous study, we propose a typology of the factors that ...can affect office workers’ perception of the importance of electronic documents. A methodology for testing and refining this model is then described.Cet article examine la notion d’importance relative des documents dans la gestion personnelle de l’information. En se basant sur une revue de la littérature ainsi que sur les résultats d’une précédente étude, nous proposons une typologie des facteurs pouvant conduire un employé de bureau à considérer un document numérique comme important. Une méthodologie visant à tester et raffiner ce modèle est ensuite proposée.
Since the late 1960s, several studies have investigated personal information management (PIM) in the workplace. However, very few studies have focused on the behaviour of office support staff in a ...work environment. The purpose of this exploratory study was to examine the document management behaviour of office support staff in a large Canadian university.The methodological approach used for this study was grounded theory. Fifteen in-depth interviews were conducted in participants' offices, and visual observations of their document structures were made. A pre-interview survey was also administered in order to gather additional information. Participants were chosen according to the principles of theoretical sampling, and simultaneous data collection and analysis continued until theoretical saturation was reached. Transcribed interviews were coded, after which abstract concepts were derived and grouped into categories, using the constant comparison method. A substantive theory was then developed.The findings suggest the existence of several distinct document spaces within workers' document landscape: a main folder, secondary folders, the operating system desktop, e-mail, paper documents and shared environments. Behaviour pertaining to the handling of orphan files and multiple versions, the naming of files and folders as well as searching and browsing were described. Overall, despite several elements in common, significant variation was noted among participants.In order to explain the variation observed, a model of the factors that are likely to influence PIM behaviour was developed. It comprises seven main categories of factors: job content, job status, existing documents, relationship with the superior, worker characteristics, organizational context and document attributes. Several of the factors identified had never been mentioned in the PIM literature, while in other cases, the evidence presented helped confirm previous findings. The proposed model also highlights the inherent complexity of PIM, and the importance of adopting an all-encompassing view when analyzing PIM behaviour.
Since the late 1960s, several studies have investigated personal information management (PIM) in the workplace. However, very few studies have focused on the behaviour of office support staff in a ...work environment. The purpose of this exploratory study was to examine the document management behaviour of office support staff in a large Canadian university. The methodological approach used for this study was grounded theory. Fifteen in-depth interviews were conducted in participants' offices, and visual observations of their document structures were made. A pre-interview survey was also administered in order to gather additional information. Participants were chosen according to the principles of theoretical sampling, and simultaneous data collection and analysis continued until theoretical saturation was reached. Transcribed interviews were coded, after which abstract concepts were derived and grouped into categories, using the constant comparison method. A substantive theory was then developed. The findings suggest the existence of several distinct document spaces within workers' document landscape: a main folder, secondary folders, the operating system desktop, e-mail, paper documents and shared environments. Behaviour pertaining to the handling of orphan files and multiple versions, the naming of files and folders as well as searching and browsing were described. Overall, despite several elements in common, significant variation was noted among participants. In order to explain the variation observed, a model of the factors that are likely to influence PIM behaviour was developed. It comprises seven main categories of factors: job content, job status, existing documents, relationship with the superior, worker characteristics, organizational context and document attributes. Several of the factors identified had never been mentioned in the PIM literature, while in other cases, the evidence presented helped confirm previous findings. The proposed model also highlights the inherent complexity of PIM, and the importance of adopting an all-encompassing view when analyzing PIM behaviour.
Depuis la fin des années 1960, plusieurs études ont porté sur la gestion personnelle de l'information (GPI) en milieu de travail. Néanmoins, très peu d'études se sont penchées sur les comportements des employés de soutien tels que les commis de bureau ou les assistantes administratives. L'objectif de cette étude exploratoire était d'examiner les comportements de gestion documentaire d'employés de soutien dans une grande université canadienne. L'approche méthodologique utilisée est celle de la théorisation ancrée. Quinze entrevues en profondeur ont été menées dans le bureau des participantes, et des observations visuelles de leurs structures de documents ont été effectuées. Un questionnaire pré-entrevue a également permis de recueillir des informations additionnelles. Les participants ont été sélectionnés selon un principe d'échantillonnage théorique, et la collecte et l'analyse des données, menées en parallèle, se sont poursuivies jusqu'au point de saturation théorique. Les entrevues transcrites ont été codées, à la suite de quoi des concepts ont été dérivés et groupés en catégories, selon la méthode de la comparaison constante. Une théorie substantive a ensuite été développée.Les résultats suggèrent que le paysage documentaire de ces employés est composé de plusieurs espaces documentaires distincts: un répertoire principal, des répertoires secondaires, le bureau du système d'exploitation, le courriel, les documents papiers ainsi que les environnements partagés. Les habitudes des participants face à la gestion des fichiers orphelins, des versions multiples, au nommage des fichiers et répertoires ainsi qu'à la recherche et la navigation ont été décrites. En somme, malgré certains éléments en commun, des variations significatives ont pu être observées parmi les participants.Afin d'expliquer la variation observée, un modèle des facteurs pouvant influencer la GPI a été développé. Il comprend sept catégories de facteurs: nature de l'emploi, statut de l'emploi, documents existants, relation avec le ou la supérieur(e), caractéristiques de l'employé, contexte organisationnel et caractéristiques des documents. Plusieurs des facteurs identifiés dans cette étude n'avaient jamais été mentionnés dans la littérature sur la GPI, alors que dans d'autres cas les éléments présentés ici viennent confirmer les résultats d'études précédentes. Le modèle proposé met également en lumière la complexité inhérente à la GPI, et l'importance d'adopter une approche holistique dans l'analyse des comportements de GPI.
Since the late 1960s, several studies have investigated personal information management (PIM) in the workplace. However, very few studies have focused on the behaviour of office support staff in a ...work environment. The purpose of this exploratory study was to examine the document management behaviour of office support staff in a large Canadian university. The methodological approach used for this study was grounded theory. Fifteen in-depth interviews were conducted in participants' offices, and visual observations of their document structures were made. A pre-interview survey was also administered in order to gather additional information. Participants were chosen according to the principles of theoretical sampling, and simultaneous data collection and analysis continued until theoretical saturation was reached. Transcribed interviews were coded, after which abstract concepts were derived and grouped into categories, using the constant comparison method. A substantive theory was then developed. The findings suggest the existence of several distinct document spaces within workers' document landscape: a main folder, secondary folders, the operating system desktop, e-mail, paper documents and shared environments. Behaviour pertaining to the handling of orphan files and multiple versions, the naming of files and folders as well as searching and browsing were described. Overall, despite several elements in common, significant variation was noted among participants. In order to explain the variation observed, a model of the factors that are likely to influence PIM behaviour was developed. It comprises seven main categories of factors: job content, job status, existing documents, relationship with the superior, worker characteristics, organizational context and document attributes. Several of the factors identified had never been mentioned in the PIM literature, while in other cases, the evidence presented helped confirm previous findings. The proposed model also highlights the inherent complexity of PIM, and the importance of adopting an all-encompassing view when analyzing PIM behaviour.
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