Assuntos
Cicatriz/prevenção & controle , Gastos em Saúde/estatística & dados numéricos , Preferência do Paciente/psicologia , Neoplasias Cutâneas/cirurgia , Técnicas de Fechamento de Ferimentos/psicologia , Dorso , Bochecha , Comportamento de Escolha , Cicatriz/etiologia , Humanos , Renda/estatística & dados numéricos , Preferência do Paciente/economia , Inquéritos e Questionários/estatística & dados numéricos , Técnicas de Fechamento de Ferimentos/economia , Técnicas de Fechamento de Ferimentos/estatística & dados numéricosRESUMO
Background/Aim: To compare early stoma closure with conventional stoma closure following defunctioning diversion stoma surgery with respect to the frequency of complications, health-related quality of life (QoL), and length of hospitalization (LoH). Patients and Methods: This study was designed as a prospective parallel-arm randomized controlled trial. Patients who underwent temporary stoma following bowel surgery between February 2014 and November 2015 were included. The rate of complications (medical and surgical) following early and conventional stoma closure was assessed. Health-related QoL and LoH were also measured. Results: One hundred patients were included, with 50 cases in each group. Postoperative complications including laparostoma (6% vs. 2%;P = 0.307), wound infection (32% vs. 18%; P = 0.106), intra-abdominal collection (14% vs. 18%; P = 0.585), anastomotic leak (4%vs. 8%;P = 0.400), and medical complications were comparable (22% vs. 32%;P = 0.257). The length of hospital stay, overall mortality and morbidity (64% vs. 44%; P = 0.05) were similar across the two groups. There was a significant reduction in the cost towards stoma care (96% vs. 2%; P = 0.001) in the early stoma closure group. Patients in the early stoma closure group also had a significantly better QoL. Conclusion: Early stoma closure does not carry an increased risk of postoperative complications, reduces cost towards stoma care, and leads to better a QoL.
Assuntos
Intestinos/cirurgia , Qualidade de Vida/psicologia , Técnicas de Fechamento de Ferimentos/efeitos adversos , Feminino , Humanos , Tempo de Internação , Masculino , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Estomas Cirúrgicos/economia , Fatores de Tempo , Técnicas de Fechamento de Ferimentos/economia , Técnicas de Fechamento de Ferimentos/psicologiaRESUMO
The purpose of the message was the comparison of change in the width and quality of keratinized tissue created in the lower vestibuloplasty area. Preliminary results of the case-control study involving 71 patients showed that autotransplantation managed to create the necessary buffer zone with the desired thickness of the mucosa and is particularly justified in cases of «washing board effect¼. However, the method is technically complicated and more expensive and painfull for patients. The use of alternative materials of artificial origin, such as «Mucograft¼ and bloodstatic and desinfecting sponge simplifies the procedure technique thereby reducing operational risk but often does not lead to the formation of a fully keratinized gingiva.
Assuntos
Analgésicos/uso terapêutico , Emoções , Hipnóticos e Sedativos/uso terapêutico , Mandíbula/cirurgia , Dor Pós-Operatória/tratamento farmacológico , Ferida Cirúrgica/terapia , Vestibuloplastia/efeitos adversos , Técnicas de Fechamento de Ferimentos/psicologia , Adulto , Bandagens , Estudos de Casos e Controles , Feminino , Retalhos de Tecido Biológico , Gengiva/fisiologia , Gengiva/cirurgia , Hemostasia Cirúrgica/métodos , Humanos , Queratinas/metabolismo , Masculino , Pessoa de Meia-Idade , Mucosa Bucal/transplante , Período Pós-Operatório , Cuidados Pré-Operatórios , Transplante Autólogo/métodos , Vestibuloplastia/psicologia , Adulto JovemRESUMO
OBJECTIVES: Procedures are common in pediatric emergency departments and frequently cause distress from pain and/or anxiety. The objective of this study was to describe the incidence, types, and magnitude of long-term behavior changes after procedures in the emergency setting. METHODS: This is a descriptive pilot study to determine if children display negative behavioral changes after a minor emergency department procedure (abscess drainage or laceration repair). Behavior change was measured at 1 week by telephone follow-up using the 27-item Post Hospitalization Behavior Questionnaire, a well-validated instrument that measures behavior changes across 6 categories: general anxiety, separation anxiety, anxiety about sleep, eating disturbances, aggression toward authority, and apathy/withdrawal. Significant behavior change was defined as 5 or more negative behavior changes on the 27-item questionnaire. RESULTS: Twenty percent of children who underwent abscess drainage (n = 30) and 20% who underwent laceration repair (n = 30) displayed significant negative behavior change at 1 week. Children who displayed significant negative behavior change tended to be younger (3.6 vs 5.9 years) and trended toward being more likely to have received anxiolysis or sedation (16.7% vs 8.3%). Separation anxiety, sleep difficulties, and aggression toward authority were the most common behavior changes. CONCLUSIONS: In this pilot study, a significant percentage of children undergoing common emergency procedures exhibited an appreciable burden of negative behavior change at 1 week; these results demonstrate the need for further rigorous investigation of predictors of these changes and interventions, which can ameliorate these changes.