ABSTRACT
Antecedentes y objetivoAnalizar la cicatrización mediante ecografía y el seguimiento funcional a mediano plazo de pacientes con roturas parciales bursales del manguito rotador (RPBMR) con reparación in situ sin acromioplastia.Materiales y métodosSe evaluaron 62 pacientes. Se realizó la medición del rango de movimiento y la puntuación en el score American Shoulder and Elbow Surgeons (ASES). El dolor se registró usando una escala visual análoga (EVA). Se valoró ecográficamente la reparación con un mínimo de seguimiento de 5 años.ResultadosLa edad promedio fue de 57,2 años (rango de 44 a 77 años) y el seguimiento promedio, de 7 años (rango de 5 a 9 años). Todos los parámetros del rango de movimiento activo mejoraron significativamente (p<0,0001). El puntaje de ASES mejoró de 46,5 a 90,2 y los puntajes EVA mejoraron de 6,5 a 1,73 (p<0,0001). Un total de 56 pacientes (90%) realizaron control ecográfico al final del seguimiento; 51 presentaron integridad del tendón (91%) en la ecografía. Cinco pacientes presentaron re-roturas (9%); 3 tuvieron una re-rotura completa del tendón (5%) y 2 una re-rotura parcial (4%). No hubieron diferencias funcionales o del rango de movilidad significativas entre aquellos pacientes con el tendón intacto y los que presentaron re- roturas.ConclusionesA mediano plazo, la reparación in situ artroscópica de RPBMR demostró excelentes resultados funcionales en la mayoría de los pacientes con baja tasa de complicaciones. Estos mantienen un alto índice de cicatrización en el tiempo.(AU)
Background and purposeThe purpose of this study was to analyze midterm functional outcomes and tendon integrity in patients treated with in situ arthroscopic repair of Partial Bursal Rotator Cuff Tears (PBRCTs) without acromioplasty.Materials and methodsSixty two patients were included. Clinical assessment consisted of glenohumeral range of motion measurement and the American Shoulder and Elbow Surgeons (ASES) score. Pain was rated by using a visual analog scale (VAS). A postoperative ultrasound image control was performed at a minimum 5 years follow up to assess tendon integrity.ResultsMean age was 57.2 years (range, 4477 years) and mean follow up was 7 years (range of 59 years). Significant improvements in range of motion, functional outcomes and pain were observed postoperatively (P<.0001). The ASES score improved from 46.5 to 90.2; and the VAS improved from 6.5 to 1.73 (P<.0001). Fifty six patients (90%) performed ultrasound evaluation at the end of follow up. Fifty-one patients (91%) presented tendon integrity on ultrasound. Five patients presented re-tears (9%). Three patients (5%) had a complete tendon re-tear and two patients (4%) had a partial re-tear. No difference in range of motion or functional outcomes were found between patients with intact tendon and those who had re-tears.ConclusionsIn the midterm follow up, arthroscopic in situ repair PBRCTs without acromioplasty showed excellent functional outcomes and high healing rates in most patients with low complication rates.(AU)
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Outcome Assessment, Health Care , Arthroscopes , Rotator Cuff/surgery , Rotator Cuff Injuries , Range of Motion, Articular , Shoulder Injuries , Ultrasonography , Traumatology , OrthopedicsABSTRACT
Background and purposeThe purpose of this study was to analyze midterm functional outcomes and tendon integrity in patients treated with in situ arthroscopic repair of Partial Bursal Rotator Cuff Tears (PBRCTs) without acromioplasty.Materials and methodsSixty two patients were included. Clinical assessment consisted of glenohumeral range of motion measurement and the American Shoulder and Elbow Surgeons (ASES) score. Pain was rated by using a visual analog scale (VAS). A postoperative ultrasound image control was performed at a minimum 5 years follow up to assess tendon integrity.ResultsMean age was 57.2 years (range, 4477 years) and mean follow up was 7 years (range of 59 years). Significant improvements in range of motion, functional outcomes and pain were observed postoperatively (P<.0001). The ASES score improved from 46.5 to 90.2; and the VAS improved from 6.5 to 1.73 (P<.0001). Fifty six patients (90%) performed ultrasound evaluation at the end of follow up. Fifty-one patients (91%) presented tendon integrity on ultrasound. Five patients presented re-tears (9%). Three patients (5%) had a complete tendon re-tear and two patients (4%) had a partial re-tear. No difference in range of motion or functional outcomes were found between patients with intact tendon and those who had re-tears.ConclusionsIn the midterm follow up, arthroscopic in situ repair PBRCTs without acromioplasty showed excellent functional outcomes and high healing rates in most patients with low complication rates.(AU)
Antecedentes y objetivoAnalizar la cicatrización mediante ecografía y el seguimiento funcional a mediano plazo de pacientes con roturas parciales bursales del manguito rotador (RPBMR) con reparación in situ sin acromioplastia.Materiales y métodosSe evaluaron 62 pacientes. Se realizó la medición del rango de movimiento y la puntuación en el score American Shoulder and Elbow Surgeons (ASES). El dolor se registró usando una escala visual análoga (EVA). Se valoró ecográficamente la reparación con un mínimo de seguimiento de 5 años.ResultadosLa edad promedio fue de 57,2 años (rango de 44 a 77 años) y el seguimiento promedio, de 7 años (rango de 5 a 9 años). Todos los parámetros del rango de movimiento activo mejoraron significativamente (p<0,0001). El puntaje de ASES mejoró de 46,5 a 90,2 y los puntajes EVA mejoraron de 6,5 a 1,73 (p<0,0001). Un total de 56 pacientes (90%) realizaron control ecográfico al final del seguimiento; 51 presentaron integridad del tendón (91%) en la ecografía. Cinco pacientes presentaron re-roturas (9%); 3 tuvieron una re-rotura completa del tendón (5%) y 2 una re-rotura parcial (4%). No hubieron diferencias funcionales o del rango de movilidad significativas entre aquellos pacientes con el tendón intacto y los que presentaron re- roturas.ConclusionesA mediano plazo, la reparación in situ artroscópica de RPBMR demostró excelentes resultados funcionales en la mayoría de los pacientes con baja tasa de complicaciones. Estos mantienen un alto índice de cicatrización en el tiempo.(AU)
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Outcome Assessment, Health Care , Arthroscopes , Rotator Cuff/surgery , Rotator Cuff Injuries , Range of Motion, Articular , Shoulder Injuries , Ultrasonography , Orthopedics , TraumatologyABSTRACT
BACKGROUND AND PURPOSE: The purpose of this study was to analyze midterm functional outcomes and tendon integrity in patients treated with in situ arthroscopic repair of Partial Bursal Rotator Cuff Tears (PBRCTs) without acromioplasty. MATERIALS AND METHODS: Sixty two patients were included. Clinical assessment consisted of glenohumeral range of motion measurement and the American Shoulder and Elbow Surgeons (ASES) score. Pain was rated by using a visual analog scale (VAS). A postoperative ultrasound image control was performed at a minimum 5 years follow up to assess tendon integrity. RESULTS: Mean age was 57.2 years (range, 44-77 years) and mean follow up was 7 years (range of 5-9 years). Significant improvements in range of motion, functional outcomes and pain were observed postoperatively (P<.0001). The ASES score improved from 46.5 to 90.2; and the VAS improved from 6.5 to 1.73 (P<.0001). Fifty six patients (90%) performed ultrasound evaluation at the end of follow up. Fifty-one patients (91%) presented tendon integrity on ultrasound. Five patients presented re-tears (9%). Three patients (5%) had a complete tendon re-tear and two patients (4%) had a partial re-tear. No difference in range of motion or functional outcomes were found between patients with intact tendon and those who had re-tears. CONCLUSIONS: In the midterm follow up, arthroscopic in situ repair PBRCTs without acromioplasty showed excellent functional outcomes and high healing rates in most patients with low complication rates.
ABSTRACT
BACKGROUND: The use of plate fixation to treat displaced midshaft clavicular fractures in adults reduces complications and residual shoulder disability. New features of the precontoured locking plates have been shown to reduce the need for hardware removal in adults. There is a lack of studies evaluating surgical fixation of displaced clavicular fractures with precontoured plates in adolescents. We evaluate outcomes and complications of adolescents with displaced midshaft clavicular fractures treated with precontoured locking plates. MATERIALS AND METHODS: 40 adolescents with displaced midshaft clavicular fractures were surgically treated from January 2010 to May 2017. Outcomes were evaluated using the Constant score, the 11- item version of the Disabilities of Arm, Shoulder and Hand (QuickDASH) questionnaires, and radiographs, and a visual analog scale. Return-to-sport rate, level achieved, and complications were recorded. RESULTS: Mean follow-up was 50 months (18 - 108 months). Constant, Quick-DASH, and visual analog scale scores were 95.6, 2.8 and 0.5 points, respectively. 100% of adolescents returned to sports at the same level they had before injury. Mean time to return was 69 days and 95% of patients were able to return before 12 weeks. Complication rate was 12.5%, 3 patients (7.5%) required hardware removal. CONCLUSIONS: Adolescents with displaced midshaft clavicular fractures treated with precontoured locking plates exhibited satisfactory outcomes and low complication rate. Compared to other reports, this study had lower rates, anatomic plates might reduce hardware-related complications.
ABSTRACT
There is good scientific rationale to support the use of growth factors to promote musculoskeletal tissue regeneration. However, the clinical effectiveness of platelet-rich plasma (PRP) and other blood-derived products has yet to be proven. Characterization and reporting of PRP preparation protocols utilized in clinical trials for the treatment of musculoskeletal disease is highly inconsistent, and the majority of studies do not provide sufficient information to allow the protocols to be reproduced. Furthermore, the reporting of blood-derived products in orthopaedics is limited by the multiple PRP classification systems available, which makes comparison of results between studies challenging. Several attempts have been made to characterize and classify PRP; however, no consensus has been reached, and there is lack of a comprehensive and validated classification. In this annotation, we outline existing systems used to classify preparations of PRP, highlighting their advantages and limitations. There remains a need for standardized universal nomenclature to describe biological therapies, as well as a comprehensive and reproducible classification system for autologous blood-derived products. Cite this article: Bone Joint J 2019;101-B:891-896.
Subject(s)
Guided Tissue Regeneration/methods , Musculoskeletal Diseases/therapy , Orthopedic Procedures/methods , Platelet-Rich Plasma , Consensus , Humans , Practice Guidelines as Topic , Terminology as TopicABSTRACT
The diet of shredder chironomid larvae depends on the local and temporal conditions of the food resources. We analysed the gut content of shredder chironomid larvae that colonised the leaf litter of three riparian species: Hedychium coronarium, Pteridium arachnoideum and Magnolia ovata. We hypothesised that the differences in the decomposition rates of leaf litter species influence the consumption of plant tissue by shredder chironomid taxa over time. We incubated perforated bottles with each leaf species within four low-order streams during 1st, 3rd, 7th, 22nd, 36th, 55th and 85th day of exposure. We used an analysis of covariance (ANCOVA) to compare differences in the percentage of AFDM (ash-free dry mass) and AOM (amorphous organic matter) among leaf litter species. To verify differences in the larvae abundance, we used a general linear model, and to test if there were feeding preferences for AFDM and AOM, we used the adapted Paloheimo selectivity index. Magnolia ovata presented a higher quantity of AOM followed by H. coronarium and P. arachnoideum. Pteridium arachnoideum showed a higher AFDM followed by H. coronarium and M. ovata. The larvae abundance was different among plant species and varied significantly with AFDM and AOM quantities. The consumption of plant tissue by shredder chironomid differed temporarily and among riparian species, where facultative or strict shredders showed strong association with different leaf litter species. The amount of AFDM and AOM in plant tissues explained these differences. We highlighted that shredder chironomids displayed an important role as co-participants in the decomposition process.
Subject(s)
Chironomidae/physiology , Feeding Behavior , Food Chain , Plant Leaves , Animals , Brazil , Larva/physiology , Magnolia , Pteridium , Rivers , ZingiberaceaeABSTRACT
OBJECTIVE: The aim of this study was to report the short-term results and complications of partial humeral head resurfacing (HemiCup®) in patients treated by avascular necrosis. MATERIAL AND METHODS: Between 2010 and 2014, 9 patients who underwent partial resurfacing of humeral head were evaluated. All the patients were treated by avascular necrosis. The mean follow-up was 44 months (minimum 24 months). The average age was 47 years (range 32-57 years). The patients were evaluated clinically and radiologically. Complications were reported. RESULTS: The patients had a significant improvement in functional scores and mobility between the pre-operative and last follow-up control. The Constant score improved from 35 to 79 points (P<.001), ASES score improved from 31 to 76 points (P<.001), forward flexion and external rotation improved from 101 to 150° (P<.001), and from 24 to 45° (P<.001), respectively. One patient presented symptomatic glenoid wear during follow-up, requiring revision surgery. CONCLUSION: In our patients treated by avascular necrosis, the partial resurfacing of humeral head (HemiCup®) demonstrated a significant improvement in functional scores and mobility with an average follow-up of 44 months.
Subject(s)
Arthroplasty, Replacement, Shoulder/methods , Hemiarthroplasty/methods , Humeral Head/surgery , Osteonecrosis/surgery , Adult , Arthroplasty, Replacement, Shoulder/instrumentation , Female , Follow-Up Studies , Hemiarthroplasty/instrumentation , Humans , Male , Middle Aged , Shoulder Prosthesis , Treatment OutcomeABSTRACT
PURPOSE: Burn patients may encounter social barriers and stigmatization. The objectives of this study were to adapt the Social Comfort Questionnaire (SCQ) into Brazilian Portuguese and to assess the psychometric properties of the adapted version. METHODS: Cross-cultural adaptation of the 8 items of the SCQ followed international guidelines. We interviewed 240 burn patients and verified the SCQ internal consistency, test-retest reliability and construct validity, correlating the scores with depression [Beck Depression Inventory (BDI)], affect/body image and interpersonal relationships [Burns Specific Health Scale-Revised (BSHS-R)] and self-esteem [Rosenberg's Self-Esteem Scale (RSES)]. We also performed a confirmatory factor analysis (CFA). RESULTS: The cross-cultural adaptation resulted in minor semantic modifications to the original SCQ version. After CFA, a reduced 6-item version showed satisfactory fit to the one-factor model (RMSEA = 0.05, CFI = 0.99, TLI = 0.99). Cronbach alpha's was 0.80, and test-retest intraclass correlation coefficient was 0.86. The final version presented a strong negative correlation with depression (BDI), and strong positive correlations with affect/body image (BSHS-R), interpersonal relationships (BSHS-R) and self-esteem (RSES) (all p < 0.001). CONCLUSION: The results showed that the SCQ Brazilian Portuguese adapted version complies with the validity and reliability criteria required for an instrument assessing social comfort in Brazilian burn patients. The Brazilian version yields a single score that is easy to interpret and well understood by patients.
Subject(s)
Burns/psychology , Cross-Cultural Comparison , Psychometrics/instrumentation , Quality of Life/psychology , Adult , Brazil , Female , Humans , Male , Patient Comfort , Psychometrics/methods , Reproducibility of Results , Surveys and Questionnaires , SurvivorsABSTRACT
PURPOSE: By using a combination of qualitative and quantitative methods, the focus of this study was to describe the changes associated with burns on the lives of Brazilian burn victims during the rehabilitation phase, and to investigate possible associations between the changes in work reported by the participants and the percentage of total body surface area burnt, and the body areas affected by the injury. METHOD: Participants were 18 years of age or older, who had been discharged from hospitalisation between 6 months and 1 year before the interview, or who underwent reconstructive surgery during the previous year, or who were under outpatient follow-up awaiting reconstructive surgery. Data were collected by means of semi-structured interviews. RESULTS: Thirty-eight of the 44 participants (86.4%) reported some type of changes associated with the burn injury, the treatment, or both, regarding the following aspects: work, leisure, relationships, religious ties, educational activities and habits (smoking, using alcohol and drugs and dressing style). The data showed a statistically significant association between burns on at least one of the upper limbs (with or without hands) and changes in work. CONCLUSIONS: Some of the aspects mentioned by the participants, such as work and leisure activities, need to be further researched in order to improve our understanding of the impact that these changes causes in the person's life.
Subject(s)
Burns/rehabilitation , Cost of Illness , Life Change Events , Quality of Life , Adaptation, Psychological , Adolescent , Adult , Aged , Brazil , Burns/psychology , Female , Humans , Interviews as Topic , Male , Middle Aged , Social Support , Young AdultABSTRACT
The objective of this ethnographic study was to investigate the cultural meanings reported by 25 relatives of burned patients about their loved one's impending hospital discharge. Data were collected by means of participant observation and semi-structured interviews conducted during hospital visiting hours, and support group meetings with relatives. The following inter-related phases were considered in the analysis process: reading of the material and data reduction (selection of data using the objective of the study as a guide), data display, conclusion outlining, and verification. Following this process, the data were coded and similar codes were grouped into categories. It was found that the relatives of burned patients felt afraid when faced with the prospect of hospital discharge. Their descriptions reveal the family's feelings and attitudes in face of other people's reactions, and in face of the patient's own reactions in the context of possible changes in their social roles.
Subject(s)
Burns/psychology , Family/psychology , Adolescent , Adult , Attitude to Health , Burns/rehabilitation , Child , Child, Preschool , Culture , Fear/psychology , Female , Guilt , Humans , Infant , Male , Patient Discharge , Perception , Prejudice , ShameABSTRACT
The present investigation is a descriptive study, with a retrospective, ex-post facto, design. The objectives of this study were to characterize the body image changes in patients with burn sequellae, through the critical incident technique and to identify and categorize critical incidents, comparing them to the characteristics defined by the Taxonomy of the North American Nursing Diagnoses Association (NANDA) for the body image disturbance nursing diagnosis. Thirty-five patients were interviewed. Two types of critical incidents were identified: 'facing the mirror'--the moment the patient looks at himself/herself and notices the changes in his/her body, and 'facing other people'--the moment the patient becomes aware that he/she calls the attention of others. Associated with the perceptions of changes in their bodies, the patients reported feelings of fear (19), rebellion (18) and shame (12). They also presented coping mechanisms of denial (12), rationalization (7), minimization (7) and repression (2). NANDA's body image disturbance diagnosis was identified in all patients.
Subject(s)
Body Image , Burns/psychology , Task Performance and Analysis , Adolescent , Adult , Anger , Fear/psychology , Female , Humans , Male , Middle Aged , Retrospective Studies , ShameABSTRACT
This study aimed at investigating the cultural meanings attributed by relatives to their participation in the process of delivering care to burned people; identifying the care strategies focused on by relatives during their participation in the care process. Data were collected by means of semi-structured interviews with 25 relatives of burned patients admitted in a Unit for Burned and by participant observation. The results of this study show that the perspective of giving care to a burned person has two dimensions: a physical dimension and a moral one; and generates mainly fear.
Subject(s)
Burns/nursing , Home Nursing , Adolescent , Adult , Child , Cultural Characteristics , Family , Female , Humans , MaleABSTRACT
This is a retrospective study that analyzed the nursing notations in a Specialized Unit which develops the care to the patient based on Nursing Process. The data were collected through two promptuaries utilizing instrument constructed for this purpose. Aspects which valuate appearance and content were considered in the analysis. The nursing assistant was distinguished in the results considering the bigger number of extensive and not very specific notations, and in the registrations achieved by the nurse, it was observed a bigger number of legible and objective notations. By expressing the Nursing work, greater investments must be made to become more objective and full the nursing notations.
Subject(s)
Nursing Process , Nursing Records/standards , Retrospective StudiesABSTRACT
Aiming at valuing the use of strategies such as teaching and learning methods, the relaxation technique and coping are described in a case study concerning a hospitalized HIV-positive person presenting the Acquired Immuno-Defficiency Syndrome (AIDS). The Conceptual Model proposed by Dorothéia Orem (OREM, 1985), Risner's proposal for the conduction of diagnostic thinking and the Nursing Diagnostic Unifying System proposed by NANDA (NANDA, 1996) were use as theoretical framework. Among the identified diagnoses, three were selected in order to exemplify the planning, implementation and process evaluation phases.
Subject(s)
HIV Infections/nursing , Nursing Process , HumansABSTRACT
This ethnographic study aimed at understanding the cultural meaning that nursing professionals working at a Burns Unit attribute to the nursing process as well as at identifying the factors affecting the implementation of this methodology. Data were collected through participant observation and semi-structured interviews. The findings indicate that, to the nurses from the investigated unit, the nursing process seems to be identified as bureaucratic management. Some factors determining this perception are: the way in which the nursing process has been taught and interpreted, routine as a guideline for nursing activity, and knowledge and power in the life-world of the Burns Unit.
Subject(s)
Burn Units , Burns/nursing , Skin/injuries , Anthropology, Cultural , Humans , Nursing Staff, HospitalABSTRACT
The goals of the study were to understand the cultural meaning that the nursing team and burn patients attribute to burn pain. Participant observations were carried out during one year at a Burn Unit. Semi-structured interviews with four nurses, five nursing auxiliaries and 12 patients were recorded. The burn pain is understood by nurses as physical and emotional pain. For professionals and patients, bath and dressing changes are stressful. For patients, burn pain is terrible and they can not explain it. However, they feel they should hold it up.
Subject(s)
Attitude of Health Personnel , Burnout, Professional/psychology , Burns/complications , Nursing Staff/psychology , Pain/nursing , Pain/psychology , Stress, Psychological/psychology , Humans , Nursing Methodology Research , Pain/etiology , Surveys and QuestionnairesABSTRACT
This study aimed at analyzing the costs of material used in the occlusive dressings of burn patients. The subjects of the study were patients over the age of 18 years who were admitted to the Burns Unit of the Ribeirão Preto Medical School Clinical Hospital, University of São Paulo-Brazil, from 15 January to 11 September 1998. Data were collected concerning the costs and duration of bathing and dressing of these patients. We concluded that there was a positive relation between the real costs of the materials used and the percentage of the body surface burned. In addition, there was a positive correlation between the number of staff involved in care and the size of the burns. There was no significant difference between the cost of materials used in dressings for burns of different depths.
Subject(s)
Burns/economics , Burns/therapy , Occlusive Dressings/economics , Adolescent , Adult , Aged , Brazil , Burn Units , Burns/diagnosis , Cost-Benefit Analysis , Evaluation Studies as Topic , Female , Health Care Costs , Humans , Injury Severity Score , Male , Middle Aged , ProbabilityABSTRACT
The aim of this study was to identify the nursing diagnoses that are more frequent in patients in immediate post-operative period. Data were collected and recorded on specially cards, through evaluation of 28 patients in the first two hours after the admission of the patient. The nursing diagnoses were set by one of the authors, based on Taxonomy I, proposed by North American Nursing Diagnosis Association--NANDA. The diagnoses that occurred mostly were: Risk for injury (100.0%), Risk for infection (92.8%), Sensory perceptual alterations (89.2%), Risk for aspiration (82.1%), Impaired physical mobility (71.4%), Impaired tissue integrity (82.1%) and Hypothermia (67.8%).
Subject(s)
Nursing Diagnosis , Postoperative Complications/nursing , Humans , Perioperative Nursing , Postoperative Care , Postoperative Complications/diagnosisABSTRACT
This study aimed at reporting the incidence of the hepatitis C virus as well as the prevention and control measures adopted in an hemodialysis unit. It is a prospective study developed with patients attended from September 1996 to December 1998 in an hemodialysis unit. The consultations from September 1996 to December 1996 were considered the control group and the ones from January 1997 to December 1998 the intervention group. Regarding the period of the control group, the routine of the unit was organized based on the regulation 2042 that systematizes the services of renal therapy. In the subsequent period, complementary measures were implemented. From 1997 to 1998, authors observed the reduction in the number of cases of hepatitis C.
Subject(s)
Hepatitis C/epidemiology , Ambulatory Care Facilities , Hepatitis C/immunology , Hepatitis C/prevention & control , Hepatitis C Antibodies/blood , Humans , Incidence , Program Development , Renal Dialysis , Seroepidemiologic StudiesABSTRACT
This study aimed at identifying nursing diagnoses presented by mothers with a hospitalized preterm child in an NICU by the use of King's Conceptual System and Taxonomy I of NANDA's nursing diagnoses. The case-study methodology was applied to 35 puerperal women. Eight diagnoses were identified, the frequency of which was over 50%, as follows: Risk of Infection, Risk of Injury, Impaired Tissue Integrity, Altered Health Maintenance, Risk of Inefficient Breast-feeding; Risk of Altered Parent/Infant Attachment; Fear; Parental Role Conflict and Impaired Social Interaction.
