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1.
Medicina (Kaunas) ; 58(9)2022 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-36143876

RESUMO

Background and Objectives: There is a growing interest in the measurement of attitudes towards older people in healthcare professionals, as there is a need to implement interventions to improve ageist attitudes. A one group pretest-posttest study was carried out to explore the change in nursing student attitudes towards the elderly during their university careers. Materials and Method: A total of 97 nursing students were enrolled. Attitudes were analyzed using Kogan's Attitudes Toward Old People Scale. Results: The attitude was positive from the beginning of the study, with a score of 110.06 (12.92). No differences were observed after completing the subject "Care of the elderly" (106.21 (10.77)), though a significant increase was recorded after the completion of clinical placement (142.88 (12.64)), with a large effect size (η2p = 0.754). The score of the positive items was significantly increased, but not that of the negative items, as ageist attitude was not reduced. Conclusion: The current curricular design, that includes taking the theoretical course before clinical placement in the geriatric area, increases positive attitudes in nursing students but does not reduce ageist attitudes.


Assuntos
Etarismo , Estudantes de Enfermagem , Idoso , Atitude do Pessoal de Saúde , Humanos , Otimismo , Inquéritos e Questionários , Universidades
2.
J Adv Nurs ; 75(7): 1484-1492, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30666702

RESUMO

BACKGROUND: Lupus erythematosus (LE) is an autoimmune disease that can have negative repercussions on the quality of life (QL) of those who suffer from it. The QL can be influenced by socio-demographic factors are related to the disease itself. AIMS: To analyse the associative power of socio-demographic (age and sex) and medical variables (type of lupus, diagnostic time and symptomatically associated with lupus) on the QL in patients with lupus by comparing linear relations models and models based on comparative qualitative fuzzy analysis. DESIGN: This is a retrospective cross-sectional design. PARTICIPANTS: The sample consisted of 161 patients (88.4% female) diagnosed with LE between the ages of 18-66 years. METHODS: Data were collected between 2015 - 2017 using the Lupus Erythematosus Quality of Life Questionnaire. Two different statistical methodologies were used: traditional regression models and qualitative comparative analysis models of fuzzy sets. RESULTS: The results of the regression model suggest that none of the variables considered could explain the QL of these patients. On the other hand, the results of the fuzzy models suggest that being female, young and a shorter time to diagnosis explain higher levels of QL in these types of patients. CONCLUSIONS: Since nurses are the people who interact most with patients, detecting risk groups of patients with lupus respect to their QL. This can help develop intervention programs from a nursing perspective.


Assuntos
Lúpus Eritematoso Sistêmico/fisiopatologia , Qualidade de Vida , Adolescente , Adulto , Idoso , Estudos Transversais , Feminino , Lógica Fuzzy , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Análise de Regressão , Estudos Retrospectivos , Adulto Jovem
3.
Am J Otolaryngol ; 37(2): 103-7, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26954861

RESUMO

OBJECTIVE: To study the long-term radiological findings after endonasal endoscopic approach to the skull base. MATERIAL AND METHODS: Prospective study that included 55 patients who underwent advance endoscopic skull base surgery. All patients were evaluated with MRI before, 3 months and 12 months after surgery. We used the Lund-Mackay staging system for chronic rhinosinusitis to evaluate the paranasal cavities and the sinonasal scoring system to assess sinonasal symptoms. RESULTS: Seventeen patients (30.9%) underwent extended endonasal approach that required a nasoseptal flap (NSF) for reconstruction of skull base. At baseline the mean total Lund-Mackay score was 0.63 ± 1.2 (range 0-4), and at 3 and 12 months postoperatively the mean scores were 3.5 ± 3.8 (range 0-14) and 2.0 ± 2.5 (range 0-8) respectively. Patients who needed an NSF for reconstruction had a greater Lund-Mackay score (p<0.05). Moreover, NSF is correlated with sinonasal mucosal thickening and fluid retention at 3 months (r=0.45, p<0.01) and 12 months (r=0.4, p<0.01). Total 5-symptom score (T5SS) was similar between both groups at baseline. Patients with extended endoscopic approach reported more smell loss (40.1 ± 26.2; p<0.05) and posterior nasal discharge (49.3 ± 30.1; p<0.05) than TTEA patients (21.6 ± 30.9 and 22.5 ± 27.5 respectively). CONCLUSIONS: We observed that sinus opacity is still present after one year of advance endoscopic skull base surgery but symptoms seems to return to basal after 12 months of follow-up.


Assuntos
Endoscopia/métodos , Imageamento por Ressonância Magnética/métodos , Seios Paranasais/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Sinusite/cirurgia , Base do Crânio/diagnóstico por imagem , Retalhos Cirúrgicos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Nariz , Seios Paranasais/diagnóstico por imagem , Período Pós-Operatório , Estudos Prospectivos , Sinusite/diagnóstico , Base do Crânio/cirurgia , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
4.
Eur Arch Otorhinolaryngol ; 273(7): 1809-17, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26688432

RESUMO

UNLABELLED: Little is known about the long-term effects of either transnasal transsphenoidal endoscopic approach (TTEA) or expanded endonasal approach (EEA). This study assessed the long-term impact of endoscopic skull base surgery on olfaction, sinonasal symptoms, mucociliary clearance time (MCT), and quality of life (QoL). Patients with pituitary adenomas underwent TTEA (n = 38), while patients with other benign parasellar tumours who underwent an EEA with vascularised septal flap reconstruction (n = 17) were enrolled in this prospective study between 2009 and 2012. Sinonasal symptoms (Visual Analogue Scale), subjective olfactometry (Barcelona Smell Test-24, BAST-24), MCT (saccharin test), and QoL (short form SF-36, rhinosinusitis outcome measure/RSOM) were evaluated before, and 12 months after, surgery. At baseline, sinonasal symptoms, MCT, BAST-24, and QoL were similar between groups. Twelve months after surgery, both TTEA and EEA groups experienced smell impairment compared to baseline. Moreover, EEA (but not TTEA) patients reported increased posterior nasal discharge and longer MCTs compared to baseline. No significant changes in olfactometry or QoL were detected in either group 12 months after surgery. Over the long-term, expanded skull base surgery, using EEA, produced more sinonasal symptoms (including loss of smell) and longer MCTs than pituitary surgery (TTEA). EEA showed no long-term impact on smell test or QoL. LEVEL OF EVIDENCE: IIb.


Assuntos
Cirurgia Endoscópica por Orifício Natural/métodos , Procedimentos Neurocirúrgicos/métodos , Neoplasias Hipofisárias/cirurgia , Base do Crânio/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Nariz , Neoplasias Hipofisárias/diagnóstico , Estudos Prospectivos , Qualidade de Vida , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
5.
Artigo em Inglês | MEDLINE | ID: mdl-36981814

RESUMO

Soft skills (SKs) are skills related to the interaction among people and their way of dealing with tasks. Increasingly valued in the workplace, they are especially relevant in health professionals due to the importance of the relationship among them and their patients and families. Given their importance, the university training of healthcare professionals must promote the development of SKs. The COVID-19 pandemic has been a turning point in many areas, changing the learning process and, even more, the use of these soft skills as a fundamental ingredient in human relationships. The aim of this study was to analyse the available evidence regarding SKs in health science students, specifically nursing students, and to describe whether there is a worsening in the development of such skills after the COVID-19 pandemic. According to the PRISMA-ScR methodology for systematic reviews, this study included articles on social skills and possible changes in these skills as a consequence of the pandemic in health sciences students The results highlight the importance of these emotional competences for future nurses, being particularly relevant for communication and emotional self-awareness and showing their influence on academic aspects, such as academic performance or mental health and coping skills. A major limitation of the present study was not considering aspects such as compassion or empathy. However, the novelty provided by this work is the analysis of the changes in SKs produced as a consequence of the pandemic. It is definitely clear that there is a need to enhance emotional intelligence, and thus soft skills, in future health professionals.


Assuntos
COVID-19 , Estudantes de Enfermagem , Humanos , COVID-19/epidemiologia , Inteligência Emocional , Empatia , Pandemias , Estudantes de Enfermagem/psicologia
6.
Nurse Educ Today ; 110: 105269, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35063781

RESUMO

OBJECTIVE: To determine which interventions are the most effective in improving attitudes toward older persons in undergraduate health and social sciences students. DESIGN: Systematic review and meta-analysis. DATA SOURCES: A literature search was made in PubMed, EBSCO and SCOPUS and additional records were identified by manual searching. The selection criteria were studies that evaluated an intervention designed to improve positive attitudes; studies in undergraduate health and social sciences students; and studies using direct instruments to measure attitudes. REVIEW METHODS: Two independent reviewers extracted study-level data from records using a common data collection spreadsheet. Two reviewers also assessed study quality by using the Cochrane Risk of Bias Tool. The primary outcome was the effect of an intervention upon attitudes toward older people, while the secondary outcome was the effect upon knowledge about aging and older people in those studies that had previously assessed subject attitude. The meta-analysis was carried out based on mixed statistical models. RESULTS: The search identified 53 eligible studies published during 1982-2020, comprising 35 pre-post studies and 18 randomized clinical trials, of which 14 were included in the meta-analysis. A strongly significant effect upon attitudes was observed for empathy-based interventions (differences of standardized mean differences (dSMD) = 1.26; 95%CI: 0.04-2.48; p = 0.04), knowledge + empathy-based interventions (dSMD = 0.22; 95%CI: 0.05-0.39; p = 0.01), and knowledge + clinical skills-based interventions (dSMD = 0.22; 95%CI: 0.01-0.43; p = 0.04). The overall effect was dSMD = 0.50; 95%CI: 0.01-0.43; p = 0.004. In addition, a positive effect in terms of increased knowledge about the older was observed after knowledge + empathy-based and knowledge + clinical skills-based interventions (dSMD = 0.24; 95%CI: 0.07-0.40; p = 0.005). CONCLUSIONS: Interventions to improve attitudes in health and social sciences students are effective, with those based on empathy having the greatest impact. Improving attitudes among future professionals could improve the management and quality of care of older people. More rigorous and better designed studies are recommended to determine the effect of the interventions. Registered on PROSPERO ID: CRD42021220677. TWITTABLE ABSTRACT: Ageism is present in healthcare settings. Empathy-based interventions are the most effective strategies in health and social sciences students.


Assuntos
Etarismo , Atitude , Idoso , Idoso de 80 Anos ou mais , Envelhecimento , Humanos , Ciências Sociais , Estudantes
7.
Artigo em Inglês | MEDLINE | ID: mdl-35409503

RESUMO

(1) Background: Evidence-based practice (EBP) informs daily clinical interventions with the purpose of seeking changes to traditional practice through scientific evidence that justifies the reasons for our actions. The objectives were to describe the barriers, beliefs, and attitudes in the application of EBP among university health professionals (not doctors) and to evaluate the influence of the COVID-19 pandemic among them. (2) Methods: This prospective study is both descriptive and observational. The individuals under study were university health professionals (not doctors) from various autonomous regions within Spain, in both public and private spheres. Sociodemographic and labor-related variables linked to the research and its completion were studied. Likewise, the survey instrument Health Sciences Evidence-Based Practice questionnaire (HS-EBP) was administered to evaluate the barriers to, beliefs in, and attitudes towards evidence-based practice. (3) Results: A total of 716 responses were gathered, of which 387 were collected during the period of confinement, and 343 in the COVID-19 post-confinement period. Possible associations that might help respond to the objectives were explored through a correlational study between the sociodemographic variables and each sub-scale of the HS-EBP 30 questionnaire (n = 716). (4) Conclusions: Barriers to, beliefs in, and attitudes towards evidence-based practice are described. There is a leadership gap where line management provides insufficient motivation to follow work routines. The COVID-19 pandemic has caused immense stress among health professionals. The post-confinement group showed a significant change in the variables "beliefs and attitudes", and likewise in the "evaluation" block, justified by the need to update knowledge and to apply evidence.


Assuntos
COVID-19 , Atitude do Pessoal de Saúde , COVID-19/epidemiologia , Prática Clínica Baseada em Evidências , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Pandemias , Estudos Prospectivos , Inquéritos e Questionários
8.
Healthcare (Basel) ; 9(9)2021 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-34575004

RESUMO

BACKGROUND: The population of older people is increasing worldwide. The social and healthcare systems need many nurses to care for the elderly. Positive attitudes increase the preference to work with older people and improve the quality of care. This study describes attitudes towards the elderly in a sample of nursing students, and analyzes the potential factors influencing these attitudes. METHODS: A cross-sectional study was carried out in nursing students during the academic course 2017-2018. Kogan's Attitude Toward Old People Scale was used to assess student attitudes towards older people. RESULTS: The study included 377 undergraduate nursing students, of which 75.9% were women. The mean age was 22.23 (5.69) years. Attitude proved positive, with a mean Kogan's score of 131.04 (12.66). Women had higher scores than men, with a mean difference of 7.76 (95% CI: 4.87-10.66; p < 0.001). The male sex, age ≥ 25 years, and previous experience with institutionalized older adults worsened attitudes, while studying the subject of geriatrics, each higher course within the degree, work placements in hospitals and nursing homes, and previous experience with community older adults or with older relatives favored a more positive attitude. Participants with no interest in working with older adults yielded lower scores. CONCLUSIONS: Attitudes towards the elderly among nursing students are positive. Women have a more positive attitude. Analyzing the factors that improve attitudes in nursing students is suggested, as it may contribute to improve nursing care.

9.
Rev Lat Am Enfermagem ; 28: e3333, 2020.
Artigo em Português, Espanhol, Inglês | MEDLINE | ID: mdl-32813778

RESUMO

OBJECTIVE: to evaluate the relation and the moderating effect of the organizational factors on the attitudes towards communication, empathy, and emotional intelligence in the nurses. METHOD: a cross-sectional study was conducted with a convenience sample of 268 nurses from Valencia, Spain. The attitudes towards communication were evaluated by means of the specifically designed instrument, those towards empathy with the Jefferson's Scale of Empathy for Nursing Students, and those towards emotional intelligence by means of the Trait Meta-Mood Scale, consisting of 24 items. The effect of the studied variables was assessed by means of ANOVA, multiple linear regression models were applied, and the moderating effect was analyzed using PROCESS. RESULTS: there are statistically significant differences based on the type on contract (permanent); and statistically significant differences were found in the cognitive dimension of the attitudes towards communication. Regarding the regression models, the perspective taking dimension of empathy was the main predictive variable tn the dimensions of the attitudes towards communication. Finally, a moderating effect of the type of contract was evidenced in the effect of emotional reparation over the cognitive dimension of the attitudes towards communication. CONCLUSION: the organizational factors exert an influence on the attitudes towards communication, empathy, and emotional intelligence.


Assuntos
Empatia , Estudantes de Enfermagem , Comunicação , Estudos Transversais , Inteligência Emocional , Humanos , Espanha , Inquéritos e Questionários
10.
Front Psychol ; 11: 585826, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33391105

RESUMO

Clinical practices are considered one of the cornerstones in nurses' education. This study provides a framework to determine how factors in the academic environment, influence nursing student's satisfaction with their practices. A cross-sectional analytical study was conducted in a convenience sample of 574 nursing students at a private university in Valencia, during the 2016/2017 academic year, 79% (456) were women. Two statistical methodologies were used for data analysis: hierarchical regression models (HRM) and fuzzy sets qualitative comparative analysis (fsQCA). The HRM indicate that the students' mean score influences all dimensions of satisfaction. Furthermore, in the fsQCA, the type of service and center, as well as the type of management, the preference in the choice of the practice center and the number of students per period per clinical educator influence satisfaction with clinical practices. These results could be used to understand how academic factors influence nursing students' satisfaction with their clinical practices and to create intervention programmes that improve it. This will help prepare students to be the future nursing workforce.

11.
Artigo em Inglês | MEDLINE | ID: mdl-33233805

RESUMO

Lupus erythematosus (LE) affects patients' quality of life. Nevertheless, no instrument has been developed to assess the quality of life in systemic lupus erythematosus (SLE) and cutaneous lupus erythematosus (CLE) patients. This study aims to develop and psychometrically test the "Quality of Life of Patients with Lupus Erythematosus Instrument" (LEQoL) and study the quality of life of these patients. Finally, percentiles for interpreting scores of LEQoL in patients with LE are provided. This study is cross-sectional, with a sample of 158 patients recruited from a lupus association for the psychometric evaluation of the final version of LEQoL. The scale's reliability was assessed by Cronbach's alpha, composite reliability (CR), and average variance extracted (AVE). Validity was examined through exploratory factorial analyses (EFA) and confirmatory factorial analyses (CFA). The definitive model, composed of 21 items grouped into five factors, presented good psychometric properties. Mean levels of quality of life were observed in patients with systemic LE, with higher values in patients with cutaneous LE. The LEQoL instrument is a useful tool for assessing the quality of life of patients with LE, allowing the evaluation of current clinical practices, the identification of educational needs, and the assessment of the effectiveness of interventions intended to improve the quality of life of patients with LE, SLE, and CLE.


Assuntos
Lúpus Eritematoso Sistêmico , Qualidade de Vida , Estudos Transversais , Feminino , Humanos , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/psicologia , Masculino , Psicometria , Reprodutibilidade dos Testes , Inquéritos e Questionários
12.
Acta Otorrinolaringol Esp ; 66(1): 1-7, 2015.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-25052487

RESUMO

INTRODUCTION AND OBJECTIVES: Cerebrospinal fluid leaks associated to meningoencephaloceles of the sphenoid lateral recess are rare entities. A congenital bony defect at this level results in the persistence of Sternberg's canal, or a lateral craniopharyngeal canal, which is supposed to be the origin of these lesions. Our objective was to show that the endoscopic transpterygoid approach is an effective technique for their treatment. METHODS: We present a series of 5 cases of meningoencephaloceles of the sphenoid lateral recess treated with endoscopic sinus surgery (4 women and one man; mean age=59, range 37-72 years). Cerebrospinal fluid rhinorrhoea was present in all of them and they all underwent a transpterygoid approach with reconstruction of the skull base. We describe the surgical technique and review the literature. RESULTS: No complications were observed during surgery or the postoperative period. After a mean follow-up of 81 months, only one recurrence was seen. CONCLUSIONS: The transpterygoid approach has proven to be effective for the treatment of meningoencephaloceles of the sphenoid lateral recess. Providing wide access to identify the defect, followed by meningoencephalocele ablation, is the key for successful surgery.


Assuntos
Encefalocele/cirurgia , Endoscopia/métodos , Procedimentos de Cirurgia Plástica/métodos , Base do Crânio/cirurgia , Osso Esfenoide/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Rinorreia de Líquido Cefalorraquidiano/etiologia , Rinorreia de Líquido Cefalorraquidiano/cirurgia , Traumatismos Craniocerebrais/complicações , Encefalocele/diagnóstico por imagem , Feminino , Humanos , Masculino , Seio Maxilar/diagnóstico por imagem , Seio Maxilar/cirurgia , Meningites Bacterianas/etiologia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Recidiva , Base do Crânio/diagnóstico por imagem , Osso Esfenoide/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Conchas Nasais/cirurgia
13.
Rev. latinoam. enferm. (Online) ; 28: e3333, 2020. tab
Artigo em Inglês | BDENF - Enfermagem, LILACS | ID: biblio-1126956

RESUMO

Objective: to evaluate the relation and the moderating effect of the organizational factors on the attitudes towards communication, empathy, and emotional intelligence in the nurses. Method: a cross-sectional study was conducted with a convenience sample of 268 nurses from Valencia, Spain. The attitudes towards communication were evaluated by means of the specifically designed instrument, those towards empathy with the Jefferson's Scale of Empathy for Nursing Students, and those towards emotional intelligence by means of the Trait Meta-Mood Scale, consisting of 24 items. The effect of the studied variables was assessed by means of ANOVA, multiple linear regression models were applied, and the moderating effect was analyzed using PROCESS. Results: there are statistically significant differences based on the type on contract (permanent); and statistically significant differences were found in the cognitive dimension of the attitudes towards communication. Regarding the regression models, the perspective taking dimension of empathy was the main predictive variable tn the dimensions of the attitudes towards communication. Finally, a moderating effect of the type of contract was evidenced in the effect of emotional reparation over the cognitive dimension of the attitudes towards communication. Conclusion: the organizational factors exert an influence on the attitudes towards communication, empathy, and emotional intelligence.


Objetivo: avaliar a relação e o efeito moderador dos fatores organizacionais nas atitudes dos enfermeiros em relação à comunicação, empatia e inteligência emocional. Método: estudo transversal em amostra de conveniência de 268 enfermeiros de Valência, Espanha. As atitudes em relação à comunicação foram avaliadas usando o instrumento desenvolvido para esse fim, a empatia com a Jefferson Scale of Empathy for Nursing Student e a inteligência emocional usando a Trait Meta-Mood Scale de 24 itens. O efeito das variáveis estudadas foi avaliado por meio de ANOVA, modelos de regressão linear múltipla foram realizados e o efeito moderador foi analisado por PROCESS. Resultados: existem diferenças estatisticamente significativas dependendo do tipo de contrato (permanente); e diferenças estatisticamente significantes foram encontradas na dimensão cognitiva das atitudes em relação à comunicação. Em relação aos modelos de regressão, a dimensão tomada de perspectiva da empatia foi a principal variável preditora nas dimensões das atitudes em relação à comunicação. Finalmente, um efeito moderador do tipo de contrato foi demonstrado no efeito do reparo emocional sobre a dimensão cognitiva das atitudes em relação à comunicação. Conclusão: fatores organizacionais influenciam atitudes em relação à comunicação, empatia e inteligência emocional.


Objetivo: evaluar la relación y el efecto moderador de los factores organizacionales sobre las actitudes hacia la comunicación, empatía e inteligencia emocional de los enfermeros. Método: se realizó un estudio transversal en una muestra por conveniencia de 268 enfermeros de Valencia, España. Las actitudes hacia la comunicación se evaluaron mediante el instrumento diseñado para tal fin: la empatía con la Jefferson Scale of Empathy for Nursing Student y la inteligencia emocional mediante la Trait Meta-Mood Scale de 24 ítems. El efecto de las variables estudiadas se evaluó mediante ANOVA, se realizaron modelos de regresión lineal múltiple y el efecto moderador se analizó mediante PROCESS. Resultados: existen diferencias estadísticamente significativas en función del tipo de contrato (permanente); se encontraron diferencias estadísticamente significativas en la dimensión cognitiva de las actitudes hacia la comunicación. Con respecto a los modelos de regresión, la dimensión toma de perspectiva de la empatía fue la principal variable predictora en las dimensiones de las actitudes hacia la comunicación. Finalmente, se evidenció un efecto moderador del tipo de contrato en el efecto de la reparación emocional sobre la dimensión cognitiva de las actitudes hacia la comunicación. Conclusión: los factores organizacionales influyen en las actitudes hacia la comunicación, empatía e inteligencia emocional.


Assuntos
Humanos , Masculino , Feminino , Estudantes de Enfermagem , Estudos Transversais , Comunicação , Indicadores de Qualidade em Assistência à Saúde , Afeto , Contratos , Empatia , Inteligência Emocional , Serviço Hospitalar de Enfermagem
14.
Acta Otorrinolaringol Esp ; 65(3): 162-9, 2014.
Artigo em Espanhol | MEDLINE | ID: mdl-24698399

RESUMO

OBJECTIVE: We present our experience in the reconstruction of cerebrospinal fluid (CSF) leaks according to their size and location. MATERIAL AND METHODS: Fifty-four patients who underwent advanced skull base surgery (large defects) and 62 patients with CSF leaks of different origin (small and medium-sized defects) were included. Large defects were reconstructed with a nasoseptal pedicled flap positioned on fat and fascia lata and lumbar drainage was used. In small and medium-sized leaks of other origin, intrathecal fluorescein 5% was applied previously to identify the defect. Fascia lata in an underlay position was used for reconstruction, which was then covered with mucoperiosteum from the turbinate. Perioperative antibiotics were administered for 5-7 days. Nasal packing was removed after 24-48 hours. RESULTS: The most frequent aetiology for small and medium-sized defects was spontaneous (48.4%), followed by trauma (24.2%), iatrogenic (5%) and others. The success rate was of 91% after the first surgery and 98% in large skull base defects and small/medium-sized respectively. After rescue surgery, the rate of closure achieved was 100%. The follow-up was 15.6 ± 12.4 months for large defects and 75.3 ± 51.3 months for small/medium-sized defects without recurrence. CONCLUSIONS: Endoscopic surgery for closure of any type of skull base defect is the gold standard approach. Defect size does not play a significant role in the success rate. Fascia lata and mucoperiosteum allow a reconstruction of small/medium-sized defects. For larger skull base defects, a combination of fat, fascia lata and nasoseptal pedicled flaps provide a successful reconstruction.


Assuntos
Rinorreia de Líquido Cefalorraquidiano/diagnóstico , Rinorreia de Líquido Cefalorraquidiano/cirurgia , Algoritmos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos
15.
Biomed Res Int ; 2014: 346873, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24895567

RESUMO

INTRODUCTION: We present our experience in the reconstruction of these leaks depending on their size and location. MATERIAL AND METHODS: Fifty-four patients who underwent advanced skull base surgery (large defects, >20 mm) and 62 patients with CSF leaks of different origin (small, 2-10 mm, and midsize, 11-20 mm, defects) were included in the retrospective study. Large defects were reconstructed with a nasoseptal pedicled flap positioned on fat and fascia lata. In small and midsized leaks. Fascia lata in an underlay position was used for its reconstruction covered with mucoperiosteum of either the middle or the inferior turbinate. RESULTS: The most frequent etiology for small and midsized defects was spontaneous (48.4%), followed by trauma (24.2%), iatrogenic (5%). The success rate after the first surgical reconstruction was 91% and 98% in large skull base defects and small/midsized, respectively. Rescue surgery achieved 100%. CONCLUSIONS: Endoscopic surgery for any type of skull base defect is the gold standard. The size of the defects does not seem to play a significant role in the success rate. Fascia lata and mucoperiosteum of the turbinate allow a two-layer reconstruction of small and midsized defects. For larger skull base defects, a combination of fat, fascia lata, and nasoseptal pedicled flaps provides a successful reconstruction.


Assuntos
Vazamento de Líquido Cefalorraquidiano/diagnóstico , Vazamento de Líquido Cefalorraquidiano/cirurgia , Endoscopia/métodos , Osteotomia/métodos , Procedimentos de Cirurgia Plástica/métodos , Base do Crânio/anormalidades , Base do Crânio/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Base do Crânio/patologia , Retalhos Cirúrgicos , Resultado do Tratamento , Adulto Jovem
16.
Am J Rhinol Allergy ; 27(5): 426-31, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24119608

RESUMO

BACKGROUND: Endoscopic transsphenoidal surgery is currently the optimal treatment for skull base tumors. This study was designed to assess patient's sinonasal symptoms and quality of life (QoL) after resection of pituitary adenoma or skull base tumors using vascularized septal flap (VSF) reconstruction. METHODS: Patients with pituitary adenoma underwent the transnasal transsphenoidal endoscopic approach (TTEA; n = 38), and patients with other benign parasellar tumors underwent the expanded endonasal approach (EEA; n = 17) with VSF. Assessment of sinonasal symptoms and QoL by the 36-item Short-Form (SF-36) and the 31-item Rhinosinusitis Outcome Measure (RSOM-31) were performed before and 3 months after surgery. RESULTS: At baseline, the total seven-sinonasal symptom score (T7SSS) was similar between both groups. After surgery, T7SSS significantly increased in EEA but not in TTEA patients. EEA patients reported more smell loss (40.1 ± 26.2; p < 0.05) and posterior nasal discharge (49.3 ± 30.1; p < 0.05) than TTEA patients (21.6 ± 30.9 and 22.5 ± 27.5, respectively). At baseline, both groups had poorer SF-36 compared with the general population. TTEA patients had poorer QoL (on general health, vitality, and mental health) than EEA patients. After surgery, TTEA patients showed impaired physical role and bodily pain compared with baseline, and EEA patients showed impaired physical role and mental health. At baseline, RSOM scores were similar in TTEA and EEA groups. After surgery, EEA but not TTEA patients reported poorer nasal and general symptoms. CONCLUSION: The EEA with VSF produces more sinonasal symptoms than pituitary surgery, surgery for skull base and pituitary tumors has negative impact on QoL, and functioning tumors have no further negative effect on sinonasal symptoms and QoL.


Assuntos
Adenoma/cirurgia , Mucosa Nasal/patologia , Septo Nasal/cirurgia , Seios Paranasais/cirurgia , Neoplasias Hipofisárias/cirurgia , Procedimentos de Cirurgia Plástica , Retalhos Cirúrgicos/estatística & dados numéricos , Adenoma/fisiopatologia , Adulto , Endoscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mucosa Nasal/cirurgia , Neoplasias Hipofisárias/fisiopatologia , Qualidade de Vida , Resultado do Tratamento
17.
Acta Otorrinolaringol Esp ; 62(5): 398-400, 2011.
Artigo em Espanhol | MEDLINE | ID: mdl-21106185

RESUMO

We report the case of a 28-year-old woman initially diagnosed with a left peritonsillar abscess, which was drained, resulting in clinical relief. Twelve days later, a bulge was observed in the posterior pharyngeal wall. CT and MRI showed a tumour with destruction of atlas lateral mass, with a soft tissue component in prevertebral, retropharyngeal, left carotid and paraspinal spaces. Biopsy and microbiological study confirmed the presence of Mycobacterium tuberculosis. Therapy was initiated with isoniazid, pyrazinamide, rifampicin and ethambutol, an occipitocervical-C1-C2 arthrodesis was performed, and the patient improved successfully.


Assuntos
Vértebras Cervicais , Abscesso Peritonsilar/diagnóstico , Tuberculose da Coluna Vertebral/diagnóstico , Adulto , Diagnóstico Diferencial , Feminino , Humanos
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