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1.
J. Health Biol. Sci. (Online) ; 10(1): 1-4, 01/jan./2022.
Article in English | LILACS | ID: biblio-1369163

ABSTRACT

Introduction: One of the challenges of maxillofacial surgery is the rehabilitation of patients with severe bone loss, using implant-supported prostheses. This challenge is based on the small remaining bone structure, and on the need to reconstruct the structure for the rehabilitation with autogenous or exogenous grafts. Case report: We report the case of a patient with severe maxillary atrophy, where a skullcap graft was performed associated with implant placement and prosthetic completion 14 months after the start of treatment. Final considerations: We demonstrate clinical safety for the use of extraoral grafts without complications, representing a good alternative treatment for this group of patients.


Introdução: um dos desafios da cirurgia bucomaxilofacial é a reabilitação de pacientes com perda óssea severa, utilizando próteses implantossuportadas. Este desafio baseia-se na pequena estrutura óssea remanescente e na necessidade de reconstrução da estrutura para a reabilitação com enxertos autógenos ou exógenos. Relato de caso: Relatamos o caso de um paciente com atrofia maxilar grave, onde foi realizado enxerto de calota craniana associado à instalação de implante, com finalização protética 14 meses após o início do tratamento. Consideracoes finais: Demonstramos segurança clínica para o uso de enxertos extrabucais sem complicações, representando uma boa alternativa de tratamento para este grupo de pacientes.


Subject(s)
Mandible , Patients , Prostheses and Implants , Atrophy , Skull , Surgery, Oral , Jaw, Edentulous
2.
J. Health Biol. Sci. (Online) ; 10(1): 1-4, 01/jan./2022.
Article in English | LILACS | ID: biblio-1369172

ABSTRACT

Introduction: It is reported a case of a 57-year-old woman with multiple psychiatric hospitalizations, during which different diagnostic hypotheses and therapeutic procedures were proposed. Case report: After analyzing the patient's clinical records, the medical team proposed a diagnosis of Schizoaffective Disorder. This disorder presents a high risk of recurrent hospitalizations and high costs associated with therapeutic and follow-up withdrawal, yet there is limited data to assess the post-discharge critical periods. Final considerations: Further research in this area is required to adopt effective therapeutic strategies, reduce the probability of hospital admissions, improve prognosis, and lessen associated financial costs.


Introdução: é relatado o caso de uma mulher de 57 anos com múltiplas hospitalizações psiquiátricas, durante as quais diferentes hipóteses diagnósticas e terapêuticas associadas foram propostas. Relato do caso: Após análise dos registos clínicos, a equipa médica propôs o diagnóstico de Perturbação Esquizoafetiva. Esta Perturbação apresenta um elevado risco de re-internamento, para além do custo associado ao abandono do seguimento clínico e terapêutico. Porém, não existem dados suficientes que avaliem os períodos pós-alta. Consideracoes finais: Portanto, tornam-se necessárias pesquisas mais amplas na área para adotar estratégias terapêuticas eficazes, reduzir a probabilidade de re-internamento, melhorar o prognóstico e minimizar os custos financeiros associados.


Subject(s)
Psychotic Disorders , Patients , Prognosis , Therapeutics , Women
3.
J. Health Biol. Sci. (Online) ; 10(1): 1-4, 01/jan./2022. ilus
Article in Portuguese | LILACS | ID: biblio-1368288

ABSTRACT

Introdução: Osteogênese Imperfeita (OI) é uma doença genética rara com fragilidade óssea. A classificação inclui muitos tipos. Além do risco de recorrência, o manejo pode variar com o tipo de OI. Relato do caso: Apresentamos um paciente do sexo masculino nascido com 39 semanas, de pais não consanguíneos e saudáveis. A hidrocefalia foi diagnosticada no pré-natal. Com 50 dias de vida, detectamos muitas fraturas e calos ósseos. O teste molecular identificou uma deleção em homozigose do éxon 4 do gene WNT1. Considerações finais: Concluímos que o caso apresentado tinha características clínicas de OI XV, e o teste molecular foi fundamental para o diagnóstico preciso e aconselhamento genético.


Introduction: Osteogenesis Imperfecta (OI) is a rare genetic disease with bone fragility. The classification includes many types. In addition, the risk of a recurrence, the management can vary with the kind of OI. Case report: We report a male patient born at 39 weeks from non-consanguineous healthy parents. The patient was diagnosed with Hydrocephalus at prenatal. At 50 days of life, we detected many fractures and bone calluses. The molecular test identified a homozygous deletion of exon 4 of the WNT1 gene. Final considerations: We conclude this case had clinical features of OI XV, and the molecular test was fundamental for the precise diagnosis and the genetic counseling.


Subject(s)
Osteogenesis Imperfecta , Osteogenesis , Patients , Prenatal Care , Sex , Infant, Premature , Fractures, Bone , Genetic Counseling , Genetics , Genetic Diseases, Inborn , Hydrocephalus , Men
4.
Narrat Inq Bioeth ; 12(1): 53-76, 2022.
Article in English | MEDLINE | ID: mdl-35912609

ABSTRACT

The purpose of this mixed-methods retrospective study was to characterize the linguistic and narrative properties of texts generated by hospitalized pediatric patients who are experiencing significant illnesses. These young writers voluntarily participated in a narrative intervention through a program at a children's hospital that serves diverse urban and rural populations. The primary aim was to use interpretive theoretical analysis and linguistic analysis to test the following hypotheses: (1) hospital-generated texts have linguistic characteristics consistent with texts written to improve health outcomes; (2) stories told by pediatric patients through poetry and prose can be classified using Frank's illness narrative types, serving as a starting point to situate caregivers into the pediatric writer's world in a moment in time; (3) pediatric stories are authentic stories that yield important insights about patients and their relationships with others despite lacking formal narrative elements (e.g., plot) and form.


Subject(s)
Caregivers , Narration , Child , Hospitals, Pediatric , Humans , Patients , Retrospective Studies
5.
Rev Lat Am Enfermagem ; 30: e3617, 2022.
Article in Portuguese, English, Spanish | MEDLINE | ID: mdl-35920541

ABSTRACT

OBJECTIVE: analyze the falls of adult hospitalized patients and their repercussions on the Nursing worker as the second victim. METHOD: an exploratory, descriptive and qualitative study conducted in two stages - identification of falls with moderate to severe damage and the modeling of falls using the software Functional Resonance Analysis Method; and analysis of the repercussions on the worker as the second victim by means of semi-structured interviews submitted to Content Analysis, with 21 Nursing workers. RESULTS: a total of 447 falls of adult patients were identified, 12 of which with moderate to severe damage, occurred in the absence of the companion, while using sleep inducing, hypotensive or muscle strength altering medications. The modeling identified 22 functions related to the Standard Operating Procedure, to the fall prevention protocol and to the post-event actions. Of these, eight presented variability in their execution. In the second step, the categories "The complexity of care to prevent falls" and "Feelings of the second victim" emerged. CONCLUSION: falls are complex phenomena and prevention requires involvement of the patient, family and multi-professional team. The professionals involved are second victims and experience feelings of guilt, fear, anguish and helplessness. This study can contribute to the multi-professional spirit and to the early approach to second victims.


Subject(s)
Accidental Falls , Nursing Staff , Accidental Falls/prevention & control , Adult , Emotions , Humans , Patients , Qualitative Research
6.
An. Fac. Cienc. Méd. (Asunción) ; 55(2): 59-67, 20220801.
Article in Spanish | LILACS | ID: biblio-1380431

ABSTRACT

Introducción: Los niños con quemaduras tienen un manejo complejo por lo cual el uso de la membrana amniótica como una cobertura temporal es un método válido para su implementación. Objetivos: Demostrar el uso de la membrana amniótica como cobertura temporal en pacientes pediátricos con quemaduras de segundo grado superficiales y profundas internados en el Centro Nacional de Quemaduras y Cirugías Reconstructivas (CENQUER), en julio y diciembre del 2021. Materiales y métodos: Estudio descriptivo de tipo retrospectivo mediante la revisión de casos clínicos-quirúrgicos de los pacientes pediátricos que ingresaron por diagnóstico de quemadura de segundo grado superficial y profundo en el CENQUER, durante el período comprendido entre julio y diciembre del 2021, donde se aplicó́ membrana amniótica humana. Resultados: Población de 14 pacientes, 11 provenían del departamento central y 3 del interior del país, con un promedio de 13% (R: 3%-25,5%) de superficie corporal quemada (SCQ) todos con quemaduras en promedio 7% tipo AB y 6% tipo ABB, 7 ingresaron con una gravedad moderada, 4 graves y 3 leves; 7 del sexo masculino y 7 del femenino , con un rango de edades entre 8 meses y 11 años cuya media fue de 4 años y una mediana de 7 años, con respecto al peso un promedio de 18 kg al ingreso % (R: 9-35 kg), las causas de las lesiones fueron 12 por escaldadura por agua caliente (85 %) y 2 por escaldadura con comida; 10 pacientes presentaron internación en sala y en la Unidad de terapia intensiva Pediátrica (UTIP) 4 pacientes, el promedio de tiempo transcurrido desde la quemadura a la consulta fueron de 7 hs (R: 1-48 hs), las regiones anatómicas que se cubrieron fueron: 4 pacientes en miembros superiores y tórax anterior (28 %), 2 exclusivamente en tórax anterior (16 %), 4 solo en miembros superiores (28 %), 4 en miembros inferiores (28 %), a los que se les colocó amnios por única ocasión en 10 pacientes a las 24 hs de la internación y en 4 pacientes a las 48 hs de internación, se utilizó antobioticoterapia parenteral en 3 pacientes y 11 pacientes no necesitaron antibioticoterapia parenteral, no se presentaron complicaciones en ninguno de los pacientes y tuvieron un promedio de internación de 8 días (R: 3- 16 días). Conclusión: El uso de membrana amniótica humana en pacientes quemados son favorables para los pacientes pediátricos; como demuestra en el estudio el menor uso de antibioticoterapia parenteral por la cobertura rápida de las heridas causadas por las quemaduras y el menor número de días de internación.


Introduction: Children with burns have a complex management for which the use of the amniotic membrane as a temporary cover is a valid method for its implementation. Objectives: Demonstrate the use of the amniotic membrane as temporary coverage in pediatric patients with superficial and deep second-degree burns admitted to the National Center for Burns and Reconstructive Surgery (CENQUER), in July and December 2021. Materials and methods: Descriptive retrospective study through the review of clinical-surgical cases of pediatric patients who were admitted due to a diagnosis of superficial and deep second-degree burns in the CENQUER, during the period between July and December 2021, where human amniotic membrane was applied. Results: Population of 14 patients, 11 came from the central department and 3 from the interior of the country, with an average of 13% (R: 3%-25.5%) of burned body surface area (SCQ), all with average 7% AB type burns. and 6% type ABB, 7 admitted with moderate severity, 4 severe and 3 mild; 7 males and 7 females, with an age range between 8 months and 11 years, whose average was 4 years and a median of 7 years, with respect to weight an average of 18 kg at admission % (R: 9- 35 kg), the causes of the injuries were 12 due to scalding due to hot water (85%) and 2 due to scalding with food; 10 patients were hospitalized in the ward and in the Pediatric Intensive Care Unit (PICU) 4 patients, the average time elapsed from the burn to the consultation was 7 hours (R: 1-48 hours), the anatomical regions that were covered were: 4 patients in the upper limbs and anterior thorax (28%), 2 exclusively in the anterior thorax (16%), 4 only in the upper limbs (28%), 4 in the lower limbs (28%), who received amnios for a single occasion in 10 patients at 24 hours of hospitalization and in 4 patients at 48 hours of hospitalization, parenteral antibiotic therapy was used in 3 patients and 11 patients did not need parenteral antibiotic therapy, there were no complications in any of the patients and they had an average hospital stay of 8 days (R: 3-16 days). Conclusion: The use of human amniotic membrane in burn patients is favorable for pediatric patients; As shown in the study, the lower use of parenteral antibiotic therapy due to the rapid coverage of wounds caused by burns and the lower number of days of hospitalization.


Subject(s)
Burns , Patients , Intensive Care Units, Pediatric , Amnion , Amnion/drug effects
8.
BMC Neurol ; 22(1): 245, 2022 Jul 05.
Article in English | MEDLINE | ID: mdl-35790912

ABSTRACT

BACKGROUND: Patient involvement in discharge planning of patients with stroke can be accomplished by providing personalized outcome information and promoting shared decision-making. The aim of this study was to develop a patient decision aid (PtDA) for discharge planning of hospitalized patients with stroke. METHODS: A convergent mixed methods design was used, starting with needs assessments among patients with stroke and health care professionals (HCPs). Results of these assessments were used to develop the PtDA with integrated outcome information in several co-creation sessions. Subsequently, acceptability and usability were tested to optimize the PtDA. Development was guided by the International Patient Decision Aids Standards (IPDAS) criteria. RESULTS: In total, 74 patients and 111 HCPs participated in this study. A three-component PtDA was developed, consisting of: 1) a printed consultation sheet to introduce the options for discharge destinations, containing information that can be specified for each individual patient; 2) an online information and deliberation tool to support patient education and clarification of patient values, containing an integrated "patients-like-me" model with outcome information about discharge destinations; 3) a summary sheet to support actual decision-making during consultation, containing the patient's values and preferences concerning discharge planning. In the acceptability test, all qualifying and certifying IPDAS criteria were fulfilled. The usability test showed that patients and HCPs highly appreciated the PtDA with integrated outcome information. CONCLUSIONS: The developed PtDA was found acceptable and usable by patients and HCPs and is currently under investigation in a clinical trial to determine its effectiveness.


Subject(s)
Patient Discharge , Stroke , Decision Support Techniques , Health Personnel , Humans , Patients , Stroke/therapy
9.
Article in English | MEDLINE | ID: mdl-35805231

ABSTRACT

(1) Background: The discussion on how to reduce the health costs of chronic disease patients has become an important public health issue. Limited research has been conducted on how chronic disease patients' medical choice of public and private medical institutions affect health costs. (2) Methods: This study used the panel data composed of the China Health and Retirement Longitudinal Survey (CHARLS) from 2011 to 2018, adopted the quasi-natural experimental research method, and set up a control group and an experimental group that chose public medical institutions and private medical institutions, to analyze the association between the medical choice and health costs of chronic disease patients. (3) Results: Compared with chronic disease patients who chose private medical institutions, patients who chose public medical institutions increased their total cost by 44.9%, total out-of-pocket cost by 22.9%, and decreased the total out-of-pocket ratio by 0.117%, total drug cost out-of-pocket ratio by 0.075%, and drug cost ratio by 0.102%. (4) Conclusions: According to the triple principal-agent relationships, the resource advantages given by the government to public medical institutions, the salary incentive system of medical institutions, and the information asymmetry advantage held by physicians may be important factors for the increase in health costs for chronic disease patients.


Subject(s)
Health Expenditures , Physicians , Aged , Chronic Disease , Drug Costs , Humans , Middle Aged , Patients
10.
Jt Dis Relat Surg ; 33(2): 406-413, 2022.
Article in English | MEDLINE | ID: mdl-35852201

ABSTRACT

OBJECTIVES: This study aims to comparatively evaluate early to mid-term clinical results of case-matched patient groups of primary repairs with dynamic intraligamentary stabilization (DIS) or all-inside anterior cruciate ligament (ACL) reconstruction (ACLR) by an independent group. PATIENTS AND METHODS: Between March 2015 and September 2018, a total of 16 patients operated for ACL injuries with the repair technique were retrospectively identified. Cases were stratified by treatment: DIS technique versus all-inside ACLR and matched at a ratio of 1:2. The ACLR patients were selected from a patient group with an injury-to-operation time interval of fewer than three months. A total of 32 patients were included in the all inside ACLR group. Pre-injury and postoperative International Knee Documentation Committee (IKDC) subjective score, Tegner and Lysholm scores had been obtained. Additionally, ACL-Return to Sport after Injury (ACL-RSI) scale scores, clinical results, and complications were noted. RESULTS: One (6%) patient in the DIS group and two (6%) patients in the ACLR group were lost-to-follow-up and, for a total of 45 patients, 15 in the DIS group and 30 in the ACLR group, were included in the study. The mean postoperative follow-up was 50.8±13.5 months and 48.2±11.4 months in the DIS and ACLR groups, respectively. The Tegner, Lysholm, and IKDC subjective scores were non-significantly different between the groups at any time points. The ACL-RSI scale scores were significantly higher at six (p<0.001) and 12 (p=0.01) months in the repair group. The pivot-shift test was negative in all cases postoperatively. One re-rupture occurred in each group. The reoperation rate at any cause was 25% for the repair and 10% for the ACLR group. CONCLUSION: Primary ACL repair using the DIS technique provides a similar clinical outcome to these by an all-inside ACLR technique in moderately active patients. The DIS technique is reliable and reproducible, and associated with an early and speedier psychological recovery in a carefully selected, non-athlete patient group as observed by an independent group.


Subject(s)
Anterior Cruciate Ligament Injuries , Anterior Cruciate Ligament Reconstruction , Patients , Surgical Procedures, Operative , Adaptation, Psychological , Anterior Cruciate Ligament Injuries/surgery , Anterior Cruciate Ligament Reconstruction/methods , Exercise/statistics & numerical data , Humans , Patients/psychology , Retrospective Studies , Surgical Procedures, Operative/methods , Treatment Outcome
11.
Alerta (San Salvador) ; 5(2): 98-103, jul. 22, 2022. ilus
Article in Spanish | LILACS, BISSAL | ID: biblio-1379909

ABSTRACT

Se expone el caso de un paciente de 19 años, sin antecedentes médicos, con historia de traumatismo en el muslo derecho, que tuvo acortamiento, edema, rotación del miembro inferior derecho y dolor. En la radiografía se identificó una fractura en el tercio proximal de fragmentos múltiples de la diáfisis con engrosamiento y reacción perióstica que generaron una sospecha de un tumor óseo. La resonancia magnética confirmó una neoplasia ósea de características malignas en el tercio superior del fémur con destrucción de la cortical e invasión del canal endomedular sin signos de lesiones metastásicas. La biopsia confirmó el diagnóstico de sarcoma de Ewing localizado. El manejo intrahospitalario consistió en antiinflamatorios e inmovilización del miembro inferior derecho por 21 días. Luego, recibió tres ciclos de quimioterapia con el esquema para sarcoma de Ewing fase I. Además, se indicó terapia física, tratamiento ambulatorio con analgésico, radioterapia y finalmente se practicará la resección parcial de cadera. Se evidenció disminución del edema local, control del dolor con medicamentos orales y recuperación de la movilidad, aunque mantuvo la limitación funcional del miembro inferior derecho que imposibilita la bipedestación y la deambulación


A 19-year-old patient, with no previous medical history, with a history of trauma to the right thigh, presented with shortening, edema, rotation of the right lower limb and pain. Radiography identified a fracture in the proximal third of multiple fragments of the diaphysis with thickening and periosteal reaction that generated a suspicion of a bone tumor. MRI confirmed a bone neoplasm of malignant characteristics in the upper third of the femur with destruction of the cortex and invasion of the end medullary canal without signs of metastatic lesions. The biopsy confirmed the diagnosis of localized Ewing's sarcoma. The intrahospital management consisted of anti-inflammatory drugs and immobilization of the right lower limb for 21 days. Then, she received three cycles of chemotherapy with the Ewing sarcoma phase 1 scheme. In addition, physical therapy, outpatient treatment with analgesic, radiotherapy and finally partial hip resection was indicated. There was a decrease in local edema, pain control with oral medications, mobility was recovered, although the functional limitation of the right lower limb was maintained, making it impossible to stand and walk


Subject(s)
Sarcoma, Ewing , Wounds and Injuries , Fractures, Bone , Patients , Biopsy , Bone and Bones , El Salvador
12.
Nursing (Säo Paulo) ; 25(290): 8127-8136, julho.2022.
Article in English, Portuguese | LILACS, BDENF - Nursing | ID: biblio-1379895

ABSTRACT

Objetivo. Identificar a associação entre as necessidades, ansiedade e depressão em familiares de pacientes internados em Unidade de Terapia Intensiva. Método. Revisão integrativa da literatura, utilizando bases de dados, LILACS, MedLine, BDENF, PubMed, EMBASE, SCOPUS, CINAHL e Web of Science, no período de 2007 a 2019, nos idiomas português, inglês e espanhol. Resultado. A amostra final foi composta por 15 artigos. Desses, a maioria oriundos de pesquisas quantitativas 60% (9) e os demais 40% (6) de pesquisas qualitativas. Ansiedade e depressão foram abordadas em 66,7% (10) dos artigos, enquanto as necessidades em 33,3% (5) deles. Conclusão. Foi possível identificar a falta de comunição sobre o estado do familiar internado em uma Unidade de Terapia Intensiva gerada nos familiares sintomas de medo, angustia, ansiedade e consequentemente depressão. Portanto, é imperativo o norteamento de ações e intervenções acolhedoras, proporcionando melhor atenção ao familiar e contribuindo com a saúde desses familiares.(AU)


Objective. To identify the association between needs, anxiety and depression in family members of patients hospitalized in the Intensive Care Unit. Method. Integrative literature review, using databases LILACS, MedLine, BDENF, PubMed, EMBASE, SCOPUS, CINAHL and Web of Science, from 2007 to 2019, in Portuguese, English and Spanish. Result. The final sample consisted of 15 articles. Of these, the majority came from quantitative research, 60% (9) and the remaining 40% (6) from qualitative research. Anxiety and depression were addressed in 66.7% (10) of the articles, while needs were addressed in 33.3% (5) of them. Conclusion. It was possible to identify the lack of communication about the state of the family member hospitalized in an Intensive Care Unit generated in the family members with symptoms of fear, anguish, anxiety and consequently depression. Therefore, it is imperative to guide welcoming actions and interventions, providing better care for the family member and contributing to the health of these family members.(AU)


Objetivo. Identificar la asociación entre necesidades, ansiedad y depresión en familiares de pacientes internados en la Unidad de Cuidados Intensivos. Método. Revisión integrativa de la literatura, utilizando las bases de datos LILACS, MedLine, BDENF, PubMed, EMBASE, SCOPUS, CINAHL y Web of Science, de 2007 a 2019, en portugués, inglés y español. Resultado. La muestra final estuvo compuesta por 15 artículos. De estos, la mayoría provino de investigación cuantitativa, el 60% (9) y el 40% restante (6) de investigación cualitativa. La ansiedad y la depresión fueron abordadas en el 66,7% (10) de los artículos, mientras que las necesidades fueron abordadas en el 33,3% (5) de ellos. Conclusión. Se pudo identificar la falta de comunicación sobre el estado del familiar internado en una Unidad de Cuidados Intensivos generada en los familiares con síntomas de miedo, angustia, ansiedad y consecuentemente depresión. Por lo tanto, es imperativo orientar acciones e intervenciones de acogida, brindando una mejor atención al familiar y contribuyendo a la salud de estos familiares.(AU)


Subject(s)
Anxiety , Patients , Family , Depression , Intensive Care Units
13.
Acta Biomed ; 93(3): e2022071, 2022 Jul 01.
Article in English | MEDLINE | ID: mdl-35775766

ABSTRACT

BACKGROUND AND AIM: Proximal femur fractures (PFFs) are among the most common fractures, especially in the elderly population. A PFF often represents a life-changing event. Their dramatic effects are attributable not only to the massive hemorrhages caused by the fracture, but also to the high risk of dramatic complications. These risks are supposed to be even higher for patients under oral anticoagulant treatment. In this study we evaluated how oral anticoagulant therapy effected patient's prognosis.   Methods:Ours was a case-control review of over-65 patients treated surgically for proximal femur fractures between 2013 and 2019. Cases were divided in 2 groups depending if they were (Group A) or were not (Group B) under oral anticoagulant therapy at the moment of hospitalization.   Results:200 cases were included in our study: 100 in Group A and 100 in Group B. Surgical delay was significantly higher for cases under oral anticoagulant treatment compared to the other cases. Group A cases were transfused with a significantly higher frequency and with more blood units compared to Group B (p=0.0300; p=0.013). Combined cardiological and vascular complications occurred in 21 cases (10.5%), being significantly more common in Group A (16) than Group B (5), as testified by a chi-square test (P=0.011).   Conclusions:Cases under oral anticoagulant therapy are frail patients with a higher risk to develop massive hemorrhages after an hip fracture. For this reason, it is mandatory to achieve an early stabilization of patient's clinical conditions and then perform surgery as soon as possible.


Subject(s)
Femoral Fractures , Hip Fractures , Administration, Oral , Aged , Anticoagulants/therapeutic use , Hip Fractures/surgery , Humans , Patients
14.
BMJ ; 378: o1672, 2022 07 06.
Article in English | MEDLINE | ID: mdl-35793828

Subject(s)
Patient Safety , Patients , Face , Humans
15.
Proc Natl Acad Sci U S A ; 119(27): e2007717119, 2022 Jul 05.
Article in English | MEDLINE | ID: mdl-35749352

ABSTRACT

The healthcare workforce in the United States is becoming increasingly diverse, gradually shifting society away from the historical overrepresentation of White men among physicians. However, given the long-standing underrepresentation of people of color and women in the medical field, patients may still associate the concept of doctors with White men and may be physiologically less responsive to treatment administered by providers from other backgrounds. To investigate this, we varied the race and gender of the provider from which White patients received identical treatment for allergic reactions and measured patients' improvement in response to this treatment, thus isolating how a provider's demographic characteristics shape physical responses to healthcare. A total of 187 White patients experiencing a laboratory-induced allergic reaction interacted with a healthcare provider who applied a treatment cream and told them it would relieve their allergic reaction. Unbeknownst to the patients, the cream was inert (an unscented lotion) and interactions were completely standardized except for the provider's race and gender. Patients were randomly assigned to interact with a provider who was a man or a woman and Asian, Black, or White. A fully blinded research assistant measured the change in the size of patients' allergic reaction after cream administration. Results indicated that White patients showed a weaker response to the standardized treatment over time when it was administered by women or Black providers. We explore several potential explanations for these varied physiological treatment responses and discuss the implications of problematic race and gender dynamics that can endure "under the skin," even for those who aim to be bias free.


Subject(s)
Delivery of Health Care , Patients , Physician-Patient Relations , Race Factors , Whites , Delivery of Health Care/ethnology , Female , Humans , Hypersensitivity/therapy , Male , Ointments/administration & dosage , Patients/psychology , Physicians , Sex Factors , United States , Whites/psychology
16.
Clin Chest Med ; 43(2): 287-303, 2022 06.
Article in English | MEDLINE | ID: mdl-35659026

ABSTRACT

Sleep deficiency is a common problem in the hospital setting. Contributing factors include preexisting medical conditions, illness severity, the hospital environment, and treatment-related effects. Hospitalized patients are particularly vulnerable to the negative health effects of sleep deficiency that impact multiple organ systems. Objective sleep measurement is difficult to achieve in the hospital setting, posing a barrier to linking improvements in hospital outcomes with sleep promotion protocols. Key next steps in hospital sleep promotion include improvement in sleep measurement techniques and harmonization of study protocols and outcomes to strengthen existing evidence and facilitate data interpretation across studies.


Subject(s)
Patients , Sleep , Humans
17.
Plast Reconstr Surg ; 150(2): 438-445, 2022 08 01.
Article in English | MEDLINE | ID: mdl-35674659

ABSTRACT

SUMMARY: The surgical treatment of gender incongruence with gender-affirming surgery requires a sophisticated understanding of the substantial diversity in patient expectations and desired outcomes. There are patients with gender incongruence who desire surgical intervention to achieve the conventional bodily configuration typical for cisgender men and women and those who desire surgery without the goal of typical cisgender presentation. Proper communication regarding diverse expectations poses a challenge to those unfamiliar with the nuances of this heterogeneous population; such difficulties have led to mistakes during patient care. Based on the lessons learned from these experiences, the authors provide conceptual recommendations with specific examples to account for cultural context and conceptions of gender within surgical practice and scientific research.


Subject(s)
Communication , Gender Dysphoria , Professional-Patient Relations , Sex Reassignment Surgery , Female , Gender Dysphoria/surgery , Humans , Male , Motivation , Patients/psychology
18.
AORN J ; 116(1): 34-44, 2022 07.
Article in English | MEDLINE | ID: mdl-35758742

ABSTRACT

Family-centered care is an important aspect of perioperative nursing, especially during the perioperative waiting period that separates patients from their families or significant others. However, there is a lack of understanding on what waiting means to family members or significant others. In this hermeneutic phenomenological study, we explored the lived experiences of family members waiting for surgical patients. We identified a shared experience during waiting that we called a "time to focus on self." We identified five supporting themes that shaped this meaning of waiting: the environment, activities, communication, expectations, and feelings. The perioperative waiting experience may be a necessary time of self-reflection and self-care for family members when responsibilities for loved ones are temporarily on hold. Perioperative nurses can provide family-centered interventions to address the physical and emotional needs of individuals who are waiting and improve their experience.


Subject(s)
Communication , Family , Emotions , Humans , Patients , Qualitative Research
19.
Invest. educ. enferm ; 40(2): 161-178, 15 de junio 2022. tab, ilus
Article in English | LILACS, BDENF - Nursing, COLNAL | ID: biblio-1379633

ABSTRACT

Objective. To understand the experiences and perceptions of care dyads (person and caregiver) when having a permanent discharge ostomy. Methods. Meta-synthesis that followed the ENTREQ standards and was registered in PROSPERO CRD42020221755; It was developed in three phases: (i). Search for studies in academic search engines, with MeSH terms: [(Patients) AND (Ostomy)) AND (Caregivers)], including qualitative primary studies published between 2000 and 2020; (ii). Assessment of the methodological quality with the CORE-Q instrument and the credibility of qualitative findings under the guidelines of the Johanna Briggs Institute; and (iii). Comparative analysis according to the guidelines by Sandelowski and Barroso. Results. The work identified 664 studies; in screening, 35 passed to full-text analysis; 22 to methodological quality evaluation; and 10 to meta-synthesis. The study found 43 qualitative findings that constituted four categories: dyads perform instrumental and emotional care; ambivalent family caregiving feelings and actions; assertive and effective family care; and rejection of bodily changes and sexual dysfunction. These categories constitute the central meta-theme: "The dyads experience a life rupture, which is restored in a sea of ambivalent emotions and learning; at the same time, affective, instrumental and assertive care is constructed". Conclusions: People who experience having a permanent discharge ostomy express their rejection to the change in bodily image, alterations in sexual life and as a couple. Caregivers and families are the main source of support by being facilitators in self-care, through relationships of mutuality and reciprocity.


Objetivo. Comprender las experiencias y percepciones de las díadas del cuidado (persona y cuidador) al tener una ostomía de eliminación. Métodos. Meta-síntesis que siguió los estándares ENTREQ y contó con registro en PROSPERO CRD42020221755. Se desarrolló en tres fases: (i) Búsqueda de estudios en buscadores académicos, con términos MeSH: [(Patients) AND (Ostomy)) AND (Caregivers)], incluyendo estudios primarios cualitativos publicados entre los años 2000 al 2020; (ii) Valoración de la calidad metodológica con instrumento CORE-Q y de credibilidad de hallazgos cualitativos bajo lineamientos del JBI; y (iii) Análisis comparativo según los lineamientos los autores Sandelowski y Barroso. Resultados. Se identificaron 664 estudios; en el cribado 35 pasaron a análisis de texto completo, 22 a evaluación de calidad metodológica y 10 a meta-síntesis. Se identificaron 43 hallazgos cualitativos que constituyeron 4 categorías: las díadas desarrollan el cuidado instrumental y emocional; sentimientos y acciones de cuidado familiar ambivalentes; cuidado familiar asertivo y eficaz; y rechazo a los cambios corporales y disfunción sexual. Estas categorías constituyen el meta-tema central: "Las díadas viven una ruptura de vida, la cual se restaura en un mar de emociones y aprendizajes ambivalentes; a la vez, se construye un cuidado afectivo, instrumental y asertivo". Conclusión. Las personas que vivencian el tener una ostomía permanente de eliminación, expresan el rechazo al cambio en la imagen corporal, alteraciones en la vida sexual y de pareja. Los cuidadores y las familias se constituyen como la fuente principal de apoyo al ser facilitadores en el autocuidado, por medio de relaciones de mutualidad y reciprocidad.


Objetivo. Compreender as vivências e percepções das díades de cuidado (pessoa e cuidador) ao ter uma estomia de descarte. Métodos. Meta-síntese que seguiu os padrões do ENTREQ e foi registrada no PROSPERO CRD42020221755. Foi desenvolvido em três fases: (i) Busca de estudos em buscadores acadêmicos, com termos MeSH: [(Pacientes) AND (Ostomia)) AND (Cuidadores)], incluindo estudos qualitativos primários publicados entre 2000 e 2020; (ii) Avaliação da qualidade metodológica com o instrumento CORE-Q e credibilidade dos achados qualitativos sob as diretrizes do JBI; e (iii) Análise comparativa segundo as orientações dos autores Sandelowski e Barroso. Resultados. 664 estudos foram identificados; na triagem, 35 passaram para análise de texto completo, 22 para avaliação da qualidade metodológica e 10 para metassíntese. Foram identificados 43 achados qualitativos que constituíram 4 categorias: as díades desenvolvem o cuidado instrumental e emocional; sentimentos e ações ambivalentes de cuidado familiar; cuidado familiar assertivo e eficaz; e rejeição de alterações corporais e disfunção sexual. Essas categorias constituem o meta-tema central: "As díades vivem uma pausa na vida, que se restabelece em um mar de emoções e aprendizados ambivalentes; Ao mesmo tempo, constrói-se o cuidado afetivo, instrumental e assertivo". Conclusão. As pessoas que vivenciam uma estomia de remoção permanente expressam rejeição à mudança na imagem corporal, alterações na vida sexual e com o parceiro. Os cuidadores e as famílias constituem-se como principal fonte de apoio por serem facilitadores no autocuidado, por meio de relações de mutualidade e reciprocidade.


Subject(s)
Humans , Patients , Perception , Ostomy , Nursing , Caregivers
20.
Eur J Med Genet ; 65(8): 104550, 2022 Aug.
Article in English | MEDLINE | ID: mdl-35750159

ABSTRACT

PURPOSE: Individuals with Down syndrome have an increased prevalence of various medical conditions across the lifespan; multidisciplinary Down syndrome specialty clinics can address these needs. However, the caregiver-perceived purpose of bringing their loved one to a Down syndrome specialty clinic has not been investigated. METHODS: Retrospective review of electronic intake forms, completed prior to visits at MGH's Down Syndrome Program, was completed. Caregiver concerns were coded and analyzed by visit type (new patient vs follow-up), age, gender, and race. RESULTS: Information from 722 unique patients (53.6% male) across 1,526 visits from 2014 to 2021 were reviewed resulting in 3,762 concerns. Caregivers of children with Down syndrome ages 0-4, and 13-39 reported a top concern of health maintenance which includes establishing patient care and preventative measures. Behavior was the top concern for caregivers of children with Down syndrome ages 5-12. For adults with Down syndrome, ages 40 years or older, neurologic considerations, including regression and dementia, was the top caregiver concern. Across the entire sample, the top three concerns did not vary by gender. CONCLUSION: The top concerns of caregivers of individuals with Down syndrome fluctuate across the lifespan. Growing multidisciplinary specialty clinics for Down syndrome may use these findings to ensure that caregivers' concerns are addressed and improve patient experience.


Subject(s)
Caregivers , Down Syndrome , Adult , Child , Child, Preschool , Down Syndrome/epidemiology , Down Syndrome/therapy , Female , Humans , Infant, Newborn , Male , Patients , Retrospective Studies
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