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1.
Dysphagia ; 2024 Jul 03.
Artículo en Inglés | MEDLINE | ID: mdl-38958706

RESUMEN

Aspiration detected in the fiberoptic endoscopy evaluation of swallowing (FEES) has been inconsistently associated with pneumonia, with no evidence of the risk of pneumonia from other alterations in swallowing safety detected in FEES. We conducted a dynamic, ambidirectional cohort study involving 148 subjects at risk of dysphagia in a tertiary university hospital. Our aim was to determine the risk of pneumonia attributed to alterations in swallowing safety detected during FEES. We used multivariate negative binomial regression models to adjust for potential confounders. The incidence density rate (IR) of pneumonia in patients with tracheal aspiration of any consistency was 26.6/100 people-years (RR 7.25; 95% CI: 3.50-14.98; P < 0.001). The IR was 19.7/100 people-years (RR 7.85; 95% CI: 3.34-18.47; P < 0.001) in those with laryngeal penetration of any consistency and 18.1/100 people-years (RR 6.24; 95% CI: 2.58-15.09; P < 0.001) in those with pharyngeal residue of any consistency. When adjusted for aspiration, the association of residue and penetration with pneumonia disappeared, suggesting that their risk of pneumonia is dependent on the presence of aspiration and that only aspiration is independently associated with pneumonia. This increased risk of pneumonia was significant in uni- and multivariate negative binomial regression models. We found an independently increased risk of pneumonia among patients with dysphagia and aspiration detected during FEES. Alterations in the oral and pharyngeal phases of swallowing, without aspiration, did not increase the risk of pneumonia.

2.
Clin Obstet Gynecol ; 66(1): 4-13, 2023 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-36162089

RESUMEN

In the U.S., disparities in the healthcare workforce have led to inadequate health outcomes in communities of historically underserved groups. To address the lack of resources and opportunities in health career education for historically underserved group students, Project MED was established. The mission is to expose high school students to the breadth of opportunities in the healthcare field and to prepare students for successful careers in healthcare. Through 3 main pillars-Learn, Lead, and Launch-Project MED has developed a robust repository of 20 workshops, recruited and trained eight mentors, and curated a database of ≥100 opportunities for over 50 students.


Asunto(s)
Medicina , Grupos Minoritarios , Humanos , Atención a la Salud , Grupos Minoritarios/educación , Tecnología
3.
Artículo en Inglés | MEDLINE | ID: mdl-39380586

RESUMEN

Objective: This study aims to evaluate the clinical outcomes of surgical management for placenta accreta spectrum in a Latin American reference hospital specializing in this condition. The evaluation involves a comparison between surgeries performed on an emergent and scheduled basis. Methods: A retrospective cohort study was conducted on patients with placenta accreta spectrum who underwent surgery between January 2011 and November 2021 at a hospital in Colombia, using data from the institutional PAS registry. The study included patients with intraoperative and/or histological confirmation of PAS, regardless of prenatal suspicion. Clinical outcomes were compared between patients who had emergent surgeries and those who had scheduled surgeries. Descriptive analysis involved summary measures and the Shapiro-Wilk test for quantitative variables, with comparisons made using Pearson's Chi-squared test and the Wilcoxon rank sum test, applying a significance level of 5%. Results: A total of 113 patients were included, 84 (74.3%) of them underwent scheduled surgery, and 29 (25.6%) underwent emergency surgery. The emergency surgery group required more transfusions (72.4% vs 48.8%, p=0.047). Patients with intraoperative diagnosis of placenta accreta spectrum (21 women, 19.5%) had a greater volume of blood loss than patients taken into surgery with known presence of placenta accreta spectrum (3500 ml, IQR 1700 - 4000 vs 1700 ml, IQR 1195-2135. p <0.001). Conclusion: Patients with placenta accreta spectrum undergoing emergency surgery require transfusions more frequently than those undergoing scheduled surgery.


Asunto(s)
Placenta Accreta , Humanos , Femenino , Placenta Accreta/cirugía , Embarazo , Estudios Retrospectivos , Adulto , Colombia , Urgencias Médicas , Histerectomía , Transfusión Sanguínea/estadística & datos numéricos , Cesárea
4.
Am J Obstet Gynecol MFM ; 6(6): 101333, 2024 06.
Artículo en Inglés | MEDLINE | ID: mdl-38458362

RESUMEN

BACKGROUND: Placenta accreta spectrum is a serious condition associated with significant maternal morbidity and even mortality. The recommended treatment is hysterectomy. An alternative is 1-step conservative surgery, which involves the en bloc resection of the myometrium affected by placenta accreta spectrum along with the placenta, followed by uterine reconstruction. Currently, there are no studies comparing the 2 techniques in the setting of a randomized controlled trial. OBJECTIVE: We performed a prospectively registered multicenter randomized controlled trial comparing hysterectomy with 1-step conservative surgery. The aim was to collect feasibility and clinical outcomes of the 2 techniques in women assigned to hysterectomy or 1-step conservative surgery. In addition to assessing participants' willingness to be randomized, we also collected data on intraoperative blood loss, transfusion requirement, serious adverse event, and other clinical outcomes. STUDY DESIGN: Sixty women with strong antenatal suspicion of placenta accreta spectrum were assigned randomly to either hysterectomy (n=31) or 1-step conservative surgery (n=29). RESULTS: During a 20-month period, 60 of the 64 eligible patients (93.7%) underwent randomization. Intention-to-treat analysis showed that the clinical outcomes for 1-step conservative surgery were comparable to those of hysterectomy (median intraoperative blood loss, 1740 mL [interquartile range, 1010-2410] vs 1500 mL [interquartile range, 1122-2753]; odds ratio, 1 [1-1]; P=.942; median duration of surgery, 135 minutes [interquartile range, 111-180] vs 155 minutes [interquartile range, 120-185]; odds ratio, 0.99 [0.98-1]; P=.151; transfusion rate, 58.6% vs 61.3%; odds ratio, 0.96 [0.83-1.76]; P=.768; and adverse event rate, 17.2% vs 9.7%; odds ratio, 1.77 [0.43-10.19]; P=.398; respectively). In the subgroup of women with type 1 class on topographic classification, all participants allocated to 1-step surgery had successful outcomes, which were superior to those of hysterectomy. This was evidenced by the shorter surgery duration (median, 125 [interquartile range, 98-128] vs 180 [129-226] minutes; P=.002), lower transfusion rates (46.2% vs 82.4%), and fewer units of red blood cells transfused (median, 1 [interquartile range, 1-1.8] vs 3 [interquartile range, 2-4] units; P=.007). CONCLUSION: A randomized controlled trial comparing 2 surgical techniques for the treatment of placenta accreta spectrum is feasible. One-step conservative repair is a valid alternative to hysterectomy in the large majority of cases, but this can only be ascertained following intraoperative surgical staging. El resumen está disponible en Español al final del artículo.


Asunto(s)
Pérdida de Sangre Quirúrgica , Estudios de Factibilidad , Histerectomía , Placenta Accreta , Humanos , Femenino , Placenta Accreta/cirugía , Histerectomía/métodos , Histerectomía/estadística & datos numéricos , Embarazo , Adulto , Pérdida de Sangre Quirúrgica/estadística & datos numéricos , Pérdida de Sangre Quirúrgica/prevención & control , Tratamiento Conservador/métodos , Tratamiento Conservador/estadística & datos numéricos , Transfusión Sanguínea/estadística & datos numéricos , Transfusión Sanguínea/métodos , Resultado del Tratamiento , Estudios Prospectivos , Cesárea/métodos , Cesárea/estadística & datos numéricos , Cesárea/efectos adversos
5.
Artículo en Inglés | MEDLINE | ID: mdl-39016241

RESUMEN

OBJECTIVE: To evaluate the utility of low-cost simulation models to teach surgical techniques for placenta accreta spectrum (PAS), included in a multimodal education workshop for PAS. METHODS: This was an observational, survey-based study. Participants were surveyed before and after the use of low-fidelity mannequins to simulate two surgical techniques for PAS (one-step conservative surgery [OSCS] and modified subtotal hysterectomy [MSTH]), within a multimodal educational workshop. The workshops included pre-course preparation, didactics, simulated practice of the techniques using low-cost models, and viewing live surgery. RESULTS: Six OSCS/MSTH training workshops occurred across six countries and a total of 270 participants were surveyed. The responses of 127 certified obstetricians and gynecologists (OB-GYNs) were analyzed. Participants expressed favorable impressions of all components of the simulated session. Perceived anatomical simulator fidelity, scenario realism, educational component effectiveness, and self-assessed performance improvement received ratings of 4-5 (positive end of the Likert scale) from over 90% of respondents. When asked about simulation's role in technique comprehension, comfort level in technique performance, and likelihood of recommending this workshop to others, more than 75% of participants rated these aspects with a score of 4-5 (positively) on the five-point scale. CONCLUSION: Low-cost simulation, within a multimodal education strategy, is a well-accepted intervention for teaching surgical techniques for PAS.

6.
PLoS One ; 18(7): e0288247, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-37428730

RESUMEN

Mesocarnivores play a key role in ecosystem dynamics through the regulation of prey populations and are sensitive to environmental changes; thus, they are often considered good model organisms for conservation planning. However, data regarding the factors that influence the habitat use of threatened small wild felids such as the Andean tiger cat (Leopardus tigrinus pardinoides) are scarce. We conducted a two-year survey with 58 camera trap stations to evaluate the determinants of Andean tiger cat habitat use in three protected areas in the Middle Cauca, Colombia. We developed site occupancy models and found that Andean tiger cat habitat use increased with leaf litter depth at intermediate elevations and far from human settlements. Through conditional cooccurrence models, we found that Andean tiger cat habitat use was invariant to the presence of prey or potential intraguild competitors and killers/predators, but its detectability increased when they were present and detected. This suggests that Andean tiger cats may be more likely to be detected in sites with high prey availability. We found that Andean tiger cats preferred sites with deep leaf litter, which is a particular feature of cloud forests that provides suitable conditions for ambush hunting and hiding from intraguild enemies. Our results showed that Andean tiger cats avoided human settlements, which may minimize potential mortality risks in those areas. Moreover, the restricted use of middle elevations by Andean tiger cats suggested that they could be used as a sentinel species to track the effects of climate change since their suitable habitat is likely to be projected upward in elevation. Future conservation actions must be focused on identifying and mitigating human-related threats close to the Andean tiger cat habitat while preserving microhabitat conditions and the existing networks of protected areas.


Asunto(s)
Felidae , Tigres , Animales , Humanos , Ecosistema , Colombia , Bosques , Felidae/fisiología
8.
Rev. bras. ginecol. obstet ; Rev. bras. ginecol. obstet;46: e, 2024. tab
Artículo en Inglés | LILACS-Express | LILACS | ID: biblio-1576081

RESUMEN

Abstract Objective This study aims to evaluate the clinical outcomes of surgical management for placenta accreta spectrum in a Latin American reference hospital specializing in this condition. The evaluation involves a comparison between surgeries performed on an emergent and scheduled basis. Methods A retrospective cohort study was conducted on patients with placenta accreta spectrum who underwent surgery between January 2011 and November 2021 at a hospital in Colombia, using data from the institutional PAS registry. The study included patients with intraoperative and/or histological confirmation of PAS, regardless of prenatal suspicion. Clinical outcomes were compared between patients who had emergent surgeries and those who had scheduled surgeries. Descriptive analysis involved summary measures and the Shapiro-Wilk test for quantitative variables, with comparisons made using Pearson's Chi-squared test and the Wilcoxon rank sum test, applying a significance level of 5%. Results A total of 113 patients were included, 84 (74.3%) of them underwent scheduled surgery, and 29 (25.6%) underwent emergency surgery. The emergency surgery group required more transfusions (72.4% vs 48.8%, p=0.047). Patients with intraoperative diagnosis of placenta accreta spectrum (21 women, 19.5%) had a greater volume of blood loss than patients taken into surgery with known presence of placenta accreta spectrum (3500 ml, IQR 1700 - 4000 vs 1700 ml, IQR 1195-2135. p <0.001). Conclusion Patients with placenta accreta spectrum undergoing emergency surgery require transfusions more frequently than those undergoing scheduled surgery

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