Feasibility of total hip arthroplasty in cerebral palsy patients: a systematic review on clinical outcomes and complications.

PURPOSE: Total hip arthroplasty (THA) is a successful treatment for hip osteoarthritis secondary to hip dysplasia. However, the reported rate of complications following THA in the settings of neuromuscular diseases is high. This systematic review aimed to analyze the indications, functional outcomes and surgical failures of primary THA in cerebral palsy (CP) patients. METHODS: MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews were searched, and all clinical studies focusing on THA in patients with CP from inception through March 2020 were included. The methodological quality was assessed with Guo et al.'s quality appraisal checklist for case series and case-control studies, while cohort and prospective studies were evaluated with a modified version of the Downs and Black's quality assessment checklist. RESULTS: The initial search returned 69 studies out of which 15, including 2732 THAs, met the inclusion criteria. The most frequent indication for THA was dislocated painful hip for which previous non-operative treatment had failed. Complications presented in 10 to 45% of cases. The most frequently reported complication was dislocation (1-20%), followed by component loosening (0.74-20%). Aseptic component loosening was the most frequent cause of revision surgery, followed by dislocation and periprosthetic fracture. Mean implant survival at ten years was 84% (range 81-86%). CONCLUSION: The available literature suggests that although THA is a beneficial procedure in CP patients, it has a higher rate of complications and worse implant survival than the general population.

[Isolated elbow dislocation in pediatric patients: non-operative treatment and complications associated with an infrequent pathology. Series of 4 cases]. / Luxaciones puras de codo en pacientes pediátricos: tratamiento conservador y complicaciones asociadas a una patología poco prevalente. Serie de 4 casos.

Even though the elbow is the most often dislocated joint in children, this injury accounts for 3-6 % of elbow pathology. Dislocations without associated fractures are extremely rare. They result from a fall onto an outstretched hand. The patient is always referred with a painful joint, movement impairment and even clinical deformity. Acute treatment aims to achieve quick reduction and adequate joint stability, avoiding neurovascular injuries. We sought to analyze the functional outcomes and the complications after non-operative treatment. Our 4 patients Luxaciones puras de codo en pacientes pediátricos: tratamiento conservador y complicaciones asociadas a una patología poco prevalente. Serie de 4 casos Isolated elbow dislocation in pediatric patients: non-operative treatment and complications associated with an infrequent pathology. Series of 4 cases had excellent functional results at the latest follow-up, and one of them suffered from a median nerve palsy without further consequences. In our experience, these injuries presented excellent outcomes and we would like to highlight the importance of a quick and precise neurovascular examination with the possibility of non-surgical management of nerve injuries. A short period of immobilization with early rehabilitation should be indicated to avoid joint stiffness.

Si bien el codo es la articulación más frecuentemente luxada en niños, representa el 3-6 % de las lesiones en ese sitio. Las luxaciones sin fracturas asociadas son muy raras y son producto de una caída con el codo en extensión. El paciente consulta por dolor, impotencia funcional y deformidad evidente. La finalidad del tratamiento es restaurar la congruencia articular, lograr estabilidad y minimizar los riesgos de posibles lesiones neurovasculares. Se presentan 4 pacientes tratados con manejo conservador con excelentes resultados funcionales, incluso aquel que presentó una neuropraxia del mediano con restitución ad integrum. Según nuestra experiencia, suelen ser lesiones con buena evolución. Se destaca la importancia de un rápido y preciso examen neurovascular, optando, de ser posible, por una conducta expectante ante las lesiones nerviosas. Se resalta la indicación de una inmovilización acotada con movilización temprana que evite rigidez del codo.

Luxaciones puras de codo en pacientes pediátricos: tratamiento conservador y complicaciones asociadas a una patología poco prevalente. Serie de 4 casos / Isolated elbow dislocation in pediatric patients: non-operative treatment and complications associated with an infrequent pathology. Series of 4 cases

Si bien el codo es la articulación más frecuentemente luxada en niños, representa el 3-6 % de las lesiones en ese sitio. Las luxaciones sin fracturas asociadas son muy raras y son producto de una caída con el codo en extensión. El paciente consulta por dolor, impotencia funcional y deformidad evidente. La finalidad del tratamiento es restaurar la congruencia articular, lograr estabilidad y minimizar los riesgos de posibles lesiones neurovasculares.Se presentan 4 pacientes tratados con manejo conservador con excelentes resultados funcionales, incluso aquel que presentó una neuropraxia del mediano con restitución ad integrum.Según nuestra experiencia, suelen ser lesiones con buena evolución. Se destaca la importancia de un rápido y preciso examen neurovascular, optando, de ser posible, por una conducta expectante ante las lesiones nerviosas. Se resalta la indicación de una inmovilización acotada con movilización temprana que evite rigidez del codo.

Even though the elbow is the most often dislocated joint in children, this injury accounts for 3-6 % of elbow pathology. Dislocations without associated fractures are extremely rare. They result from a fall onto an outstretched hand. The patient is always referred with a painful joint, movement impairment and even clinical deformity. Acute treatment aims to achieve quick reduction and adequate joint stability, avoiding neurovascular injuries.We sought to analyze the functional outcomes and the complications after non-operative treatment. Our 4 patien had excellent functional results at the latest follow-up, and one of them suffered from a median nerve palsy without further consequences.In our experience, these injuries presented excellent outcomes and we would like to highlight the importance of a quick and precise neurovascular examination with the possibility of non-surgical management of nerve injuries. A short period of immobilization with early rehabilitation should be indicated to avoid joint stiffness

O trabalho gerencial da enfermagem: conhecimento de profissionais enfermeiros sobre suas competências gerenciais / The nursing managerial work: professional nurses knowledge about their skills management / El trabajo de enfermería gerencial: conocimiento profesional de enfermeras con sus habilidades de gestión

Objetivo: conhecer as competências do enfermeiro no campo da gestão nas instituições públicas de saúde. Método: estudo descritivo e observacional com abordagem qualitativa desenvolvido em instituições públicas de saúde de Teresina-PI, Brasil. Participaram 12 gerentes de enfermagem selecionados de acordo com os critérios de inclusão. Para a coleta de dados aplicou-se questionário semiestruturado e analisou-se pela Técnica de análise de conteúdo. Resultados: observou-se que a ideia de coordenação, controle e continuidade do serviço está enraizada nos pensamentos de quase todos os enfermeiros que participaram do estudo quando o assunto é gerência em enfermagem, contudo, destaca-se uma preocupação crescente, presente nos depoimentos, na procura da qualidade na assistência de Enfermagem. Conclusão: os gerentes de enfermagem apesar de não dominarem as teorias administrativas, demonstraram conhecimento suficiente sobre administração hospitalar, o que lhes permitem um bom desempenho gerencial.(AU)

Objective: to know the skills of nurses in the field of management in public health institutions. Method: A descriptive, observational study with qualitative approach developed in public health institutions of Teresina, PI, Brazil. Twelve nursing managers were selected in accordance with the inclusion criteria. For data collection was applied semi-structured questionnaire. For data analysis, was used content analysis technique. Results: it was observed that the idea of coordination, control and service continuity is rooted in the thoughts of almost all the nurses in the study, when it comes to management in nursing. However, there is a growing concern in demand for nursing care quality. Conclusion: nursing managers, despite not dominating administrative theories, demonstrated sufficient knowledge of hospital administration, which allowed them a good managerial performance.(AU)

Objetivo: conocer las habilidades de las enfermeras en el campo de la gestión de las instituciones de salud pública. Método: Estudio descriptivo, observacional con enfoque cualitativo desarrollado en las instituciones de salud pública de Teresina, PI, Brasil. Participaron 12 gerentes de enfermería seleccionados de acuerdo con los criterios de inclusión. Para la recolección de los datos se aplicó cuestionario semi-estructurado y analizados por la técnica de análisis de contenido. Resultados: se observó que la idea de la coordinación, el control y la continuidad del servicio tiene sus raíces en el pensamiento de casi todas las enfermeras en el estudio cuando se trata de la gestión en enfermería, sin embargo, existe una preocupación cada vez mayor, presente en las declaraciones, en la demanda de calidad en los cuidados de enfermería. Conclusión: los responsables de enfermería a pesar de no dominan las teorías administrativas demostrado un conocimiento suficiente de la administración del hospital, lo que les hace una buena gestión de rendimiento permiten.(AU)

Análise sobre as políticas públicas de enfrentamento a violência contra o idoso / Assessment of the public policies to cope with violence against the elderly / Análisis de las políticas públicas de enfrentamiento a la violencia contra las personas mayores

Objetivo: refletir sobre as políticas públicas de enfrentamento a violência contra o idoso no Brasil. Método: estudo descritivo de cunho teórico-reflexivo, com prévia revisão da literatura especializada na temática. As informações foram analisadas possibilitando com que emergissem como pontos norteadores de reflexão, dois eixos temáticos: Epidemiologia da violência contra a pessoa idosa e Políticas públicas de enfrentamento a violência contra idosos no Brasil. Resultados: evidencia-se que o Brasil, atualmente possui suficientes recursos legais para o enfrentamento da violência contra o idoso. Contudo, apenas a produção de instrumentos legais não é suficiente para mudar a situação de violência a que está submetida a população idosa no país. Conclusão: a violência contra pessoa idosa constitui, portanto, uma violação dos Direitos Humanos e requer ações estratégicas por parte do poder público e da sociedade, tanto no âmbito da prevenção quanto do enfrentamento, a fim de resgatar e garantir a dignidade desse segmento.(AU)

Objective: to reflect on the public policies to cope with violence against the elderly in Brazil. Method: Descriptive theoretical-reflexive study, with previous review of the literature specialized on the topic. The information was assessed, and brought up two theme axis as reflexion guides: Epidemiology of the violence against the elderly and Public policies to cope with violence against the elderly in Brazil. Results: it is shown that Brazil currently has sufficient legal resources to cope with violence against the elderly. However, only producing legal instruments is not enough to change the violence situation to which the elderly population in country is submitted. Conclusion: violence against elderly constitutes, therefore, a Human Rights violation and requires strategic actions by the public power and the society, in prevention and coping areas, in order to rescue and ensure the dignity of this segment.(AU)

Objetivo: reflexionar sobre las políticas públicas de enfrentamiento a la violencia contra las personas mayores en Brasil. Método: estudio descriptivo de cuño teórico-reflexivo, con previa revisión de la literatura especializada en el tema. Las informaciones se analizaron, posibilitando la emergencia de puntos rectores de reflexión, dos ejes temáticos: Epidemiologia de la violencia contra la persona mayor y las políticas públicas de enfrentamiento a violencia contra las personas mayores en Brasil. Resultados: se evidencia que Brasil, en la actualidad, dispone de recursos legales suficientes para el enfrentamiento de la violencia contra las personas mayores. Sin embargo, apenas la producción de instrumentos legales no es suficiente para cambiar la situación de violencia a que está sujeta da populación anciana en el país. Conclusión: la violencia contra la persona mayor constituye, así, una violación de los Derechos Humanos e requiere acciones estratégicas de lo poder público e de la sociedad, en materia de prevención y enfrentamiento, con el fin de rescatar y garantir la dignidad de este segmento.(AU)