Subject(s)
Chylothorax , Fistula , Thoracic Duct , Thyroid Gland/surgery , Adult , Chylothorax/etiology , Female , Fistula/etiology , Humans , Lymphography , Thoracic Duct/surgeryABSTRACT
No disponible
Subject(s)
Humans , Male , Young Adult , Neuroblastoma/surgery , Retroperitoneal Neoplasms/surgery , Neuroblastoma/pathology , Retroperitoneal Neoplasms/pathology , Tomography, X-Ray Computed , Adrenal Glands/pathologyABSTRACT
BACKGROUND: There could be important failures in clinical data and plan records that potentially influence the surgical care process. OBJECTIVE: To complete a quality of care improvement cycle on the surgical care process in the General Surgery ward rounds. Structured quality criteria were measured, in order to identify major deficiencies, to implement improvement measures and to reassess the quality of surgical care process. Furthermore, we'll value the viability the implementation of a structured registration system and nutritional assessment method. METHOD: Comparative quality study (n = 60) before-after the setting of several improvement measures derived from the analysis of the surgical care process. Evaluated criteria were the information received by the patient, adequate recording of the clinical course and plan of care established by the surgeon in the Electronic Health Record, recording of patient's weight and size and nutritional assessment. Informative sessions, subjective, objective, assessment, plan notes on the electronic clinical record and a nutritional assessment test were implemented. RESULTS: There was a significant improvement in all measured criteria (information, data records and nutritional assessment). CONCLUSION: Simple organizational measures allow a significant improvement in the information process, clinical records and malnutrition risk detection in a surgical ward.
ANTECEDENTES: Podrían existir carencias en el registro de datos relevantes del proceso asistencial de hospitalización quirúrgica. OBJETIVO: Completar un ciclo de mejora de la calidad del proceso asistencial quirúrgico en una planta de cirugía. Mediremos unos criterios de calidad estructurados, identificando las principales deficiencias, implementando medidas de mejora y reevaluando la calidad del proceso asistencial quirúrgico. Además, se valora la viabilidad de la implantación de un sistema nemotécnico de registro de actividad y de un método de evaluación nutricional. MÉTODO: Estudio comparativo (n = 60) antes-después del establecimiento de medidas de mejora basadas en el análisis del proceso asistencial quirúrgico. Los criterios evaluados fueron la información recibida por el paciente, el registro de la evolución clínica y el plan de cuidado establecido por el cirujano en la historia clínica, el registro de peso y talla, y la valoración nutricional. Se realizaron sesiones informativas e implementación electrónica de la nota SOAP (subjetive, objetive, assessment, plan) y de un test de valoración nutricional. RESULTADOS: Hubo mejoría significativa en todos los criterios medidos (información, registro y evaluación nutricional). CONCLUSIÓN: Algunas medidas sencillas permiten una mejoría importante en la información, la evaluación nutricional y el registro del proceso asistencial en una planta de cirugía.
Subject(s)
Quality Improvement , Surgical Procedures, Operative/standards , Cross-Sectional Studies , General Surgery , Hospital Departments , HumansABSTRACT
No disponible
Subject(s)
Humans , Endocrine Surgical Procedures/instrumentation , Parathyroid Glands/surgery , Thyroid Gland/surgery , Equipment DesignSubject(s)
Carcinoma, Renal Cell , Carcinoma , Humans , Kidney Neoplasms , Pattern Recognition, Visual , Repression, PsychologyABSTRACT
No disponible
Subject(s)
Humans , Male , Female , Thyroid Neoplasms , Carcinoma/surgery , Prognosis , Incidental Findings , Neoplasm Metastasis/therapyABSTRACT
Antecedentes y objetivo: El cáncer tiroideo puede manifestarse clínicamente por la presencia de un nódulo cervical, o constituir un hallazgo casual en el estudio histológico de la glándula extirpada con diagnóstico, a priori, benigno. El objetivo del presente estudio fue estudiar las diferencias clínicas, de manejo quirúrgico y curso evolutivo entre los tumores tiroideos incidentales y los tumores detectados clínicamente. Material y métodos: Estudio retrospectivo de pacientes intervenidos por enfermedad tiroidea, ya fuese benigna o maligna, en el período comprendido entre enero de 2000 y marzo de 2014. De 1.415 pacientes que se sometieron a algún tipo de cirugía tiroidea se identificaron un total de 264 neoplasias, de las cuales 170 fueron incidentales. Se realizó comparación entre carcinomas incidentales versus no incidentales. Además, entre los incidentales se compararon los casos cuya indicación quirúrgica fue enfermedad de Graves frente a bocio multinodular. Resultados: Los carcinomas incidentales presentaron estadios más precoces y requirieron cirugía menos agresiva. No se observaron diferencias en las complicaciones quirúrgicas entre ambos grupos, aunque tanto la mortalidad como las tasas de recidiva fueron notablemente mayores en el grupo de no incidentales (4,4% vs 0% y 13,2% vs 4,8% respectivamente). Los carcinomas desarrollados sobre enfermedad de Graves no mostraron diferencias respecto al resto de los tumores incidentales, respecto a complicaciones, mortalidad o recidiva tras la cirugía. Conclusiones: El cáncer tiroideo en estadios iniciales presenta mayor supervivencia y mejor respuesta al tratamiento quirúrgico (AU)
Background and objective: Thyroid cancer may be clinically evident as a tumor mass in the neck or as a histopathological incidental finding after thyroid surgery for an apparent benign condition. Our objective was to assess the differences in clinical signs, surgical management, and course between incidental and clinically diagnosed thyroid tumors. Methods: A retrospective study was conducted on patients operated on for benign or malignant thyroid disease from January 2000 to March 2014. Among the 1415 patients who underwent any thyroid surgery, 264 neoplasms were found, of which 170 were incidental. A comparison was made of incidental versus non-incidental carcinomas. Among incidental carcinomas, cases whose indication for surgery was Graves disease were compared to those with multinodular goiter. Results: Incidental carcinomas were in earlier stages and required less aggressive surgery. There were no differences in surgical complications between incidental and clinical tumors, but mortality and relapses were markedly higher in non-incidental cancers (4.4% vs 0% and 13.2% vs 4.8% respectively). Carcinomas developing on Graves disease showed no differences from all other incidental tumors in terms of complications, mortality, or relapse after surgery. Conclusions: Early stage thyroid cancer has better survival and prognosis after surgical treatment (AU)
Subject(s)
Humans , Thyroid Neoplasms/diagnosis , Thyroid Carcinoma, Anaplastic/diagnosis , Incidental Findings , Prognosis , Early Detection of CancerABSTRACT
BACKGROUND AND OBJECTIVE: Thyroid cancer may be clinically evident as a tumor mass in the neck or as a histopathological incidental finding after thyroid surgery for an apparent benign condition. Our objective was to assess the differences in clinical signs, surgical management, and course between incidental and clinically diagnosed thyroid tumors. METHODS: A retrospective study was conducted on patients operated on for benign or malignant thyroid disease from January 2000 to March 2014. Among the 1415 patients who underwent any thyroid surgery, 264 neoplasms were found, of which 170 were incidental. A comparison was made of incidental versus non-incidental carcinomas. Among incidental carcinomas, cases whose indication for surgery was Graves' disease were compared to those with multinodular goiter. RESULTS: Incidental carcinomas were in earlier stages and required less aggressive surgery. There were no differences in surgical complications between incidental and clinical tumors, but mortality and relapses were markedly higher in non-incidental cancers (4.4% vs 0% and 13.2% vs 4.8% respectively). Carcinomas developing on Graves' disease showed no differences from all other incidental tumors in terms of complications, mortality, or relapse after surgery. CONCLUSIONS: Early stage thyroid cancer has better survival and prognosis after surgical treatment.
Subject(s)
Adenocarcinoma, Follicular/epidemiology , Carcinoma, Papillary/epidemiology , Thyroid Neoplasms/epidemiology , Thyroidectomy , Adenocarcinoma, Follicular/diagnosis , Adenocarcinoma, Follicular/surgery , Adult , Carcinoma, Papillary/diagnosis , Carcinoma, Papillary/surgery , Comorbidity , Female , Goiter, Nodular/epidemiology , Goiter, Nodular/surgery , Graves Disease/epidemiology , Graves Disease/surgery , Humans , Incidental Findings , Male , Middle Aged , Postoperative Complications/epidemiology , Prognosis , Retrospective Studies , Thyroid Neoplasms/diagnosis , Thyroid Neoplasms/surgeryABSTRACT
No disponible
Subject(s)
Humans , Female , Middle Aged , Trachea/injuries , Thyroidectomy/adverse effects , Graves Disease/surgery , Graves Ophthalmopathy/diagnosis , Postoperative ComplicationsABSTRACT
No disponible
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Humans , Female , Aged , Intestinal Perforation/etiology , Colonoscopy , Colonic Neoplasms/diagnosis , Risk Factors , Iatrogenic DiseaseABSTRACT
No disponible
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Adult , Humans , Male , Horner Syndrome/etiology , Neck Injuries/complications , Suicide, Attempted , Wounds, Stab/complicationsABSTRACT
Las vías clínicas son planes detallados de asistencia aplicables al tratamiento de pacientes con variaciones en la práctica y un curso clínico predecible. Sin pretender sustituir el juicio clínico de los profesionales, buscan una mejora en la efectividad y la eficiencia. La vía clínica que presentamos es el resultado del trabajo colaborativo de las Secciones de Cirugía Endocrina y Gestión de Calidad de la Asociación Española de Cirujanos, que intenta aportar un marco para normalizar la realización de la tiroidectomía. Junto con documentos habituales de toda vía clínica (matriz temporal, hoja de variaciones e información, indicadores de evaluación, encuesta de satisfacción), incluye una revisión de la evidencia científica en torno a diferentes aspectos del pre, intra y posoperatorio de esta intervención, la más frecuentemente realizada en cirugía endocrina. Entre otros, analiza la profilaxis antibiótica y antitrombótica, la preparación preoperatoria en hipertiroidismo, la neuromonitorización intraoperatoria, los sistemas para hemostasia intraoperatoria y el tratamiento de la hipocalcemia posoperatoria
Clinical pathways are care plans applicable to patient care procedures that present variations in practice and a predictable clinical course. They are designed not as a substitute for clinical judgment, but rather as a means to improve the effectiveness and efficiency of the procedures. This clinical pathway is the result of a collaborative work of the Sections of Endocrine Surgery and Quality Management of the Spanish Association of Surgeons. It attempts to provide a framework for standardizing the performance of thyroidectomy, the most frequently performed operation in endocrine surgery. Along with the usual documents of clinical pathways (temporary matrix, variance tracking and information sheets, assessment indicators and a satisfaction questionnaire) it includes a review of the scientific evidence around different aspects of pre, intra and postoperative management. Among others, antibiotic and antithrombotic prophylaxis, preoperative preparation in hyperthyroidism, intraoperative neuromonitoring and systems for obtaining hemostasis are included, along with management of postoperative hypocalcemia
