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1.
Artículo en Inglés | MEDLINE | ID: mdl-34040680

RESUMEN

Background and aim: The current COVID-19 pandemic scenario has driven surgical departments to a transformation.The worldwide spread of the disease has led to a public health quarantine where health care professionals are at high risk of infection. In this context, telemedicine has been promoted and scaled up to reduce the risk of transmission. This study aims to demonstrate that a combined framework based on telematics and in-person clinical encounter not only ensures medical care but the safety of healthcare professionals and patients. Material and method: Descriptive observational study on the follow-up of patients during the COVID19 Pandemic, combining telephone and traditional. Results: A total of 5031 telephone calls were made, differentiating between medical referrals, specialised primary care visits, and outpatient consultation.They were classified as successful, required an in-person visit, or no successful telephone contact. Furthermore, we divided them into 2 groups: resolved and unresolved.53% of all telematic visits were successful. Conclusions: Telematic medical systems are a feasible option in a orthopedics department and an interesting resource to preserve once the pandemic is resolved. Future lines of research should be opened to improve system success, analyze its cost-effectiveness ratio, and correct any legal conflicts that may exist.


Asunto(s)
Cuidados Posteriores/métodos , Control de Infecciones/métodos , Ortopedia/métodos , Cuidados Posoperatorios/métodos , Consulta Remota/métodos , Teléfono , Cuidados Posteriores/estadística & datos numéricos , Estudios de Factibilidad , Política de Salud , Accesibilidad a los Servicios de Salud , Humanos , Ortopedia/estadística & datos numéricos , Evaluación de Procesos y Resultados en Atención de Salud , Pandemias , Cuidados Posoperatorios/estadística & datos numéricos , Consulta Remota/estadística & datos numéricos , España/epidemiología
2.
Surg Clin North Am ; 101(3): 427-441, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-34048763

RESUMEN

Esophageal cancer is the eighth most common cancer worldwide, and its incidence has been increasing over the past several decades. Esophagectomy currently is the standard of care for more advanced early esophageal cancer and should be performed at centers of excellence with high volumes, appropriate supportive staff, and multidisciplinary expertise.


Asunto(s)
Adenocarcinoma/cirugía , Carcinoma de Células Escamosas/cirugía , Neoplasias Esofágicas/cirugía , Esofagectomía/métodos , Procedimientos Quirúrgicos Robotizados/métodos , Adenocarcinoma/diagnóstico , Adenocarcinoma/patología , Cuidados Posteriores/métodos , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/patología , Neoplasias Esofágicas/diagnóstico , Neoplasias Esofágicas/patología , Humanos , Estadificación de Neoplasias , Cuidados Posoperatorios/métodos , Resultado del Tratamiento
3.
Medicine (Baltimore) ; 100(17): e25670, 2021 Apr 30.
Artículo en Inglés | MEDLINE | ID: mdl-33907134

RESUMEN

BACKGROUND: Baduanjin, as an ancient Chinese exercise, is beneficial to both physical and mental health. Moreover, researchers discovered that Baduanjin has effects on the recovery of postoperative breast cancer patients. Yet, nobody focused on the systematic review, which can provide convincing evidence to verify the effect of Baduanjin in breast cancer patients. Therefore, our study will conduct a systematic review to fill in the blank, besides we will offer new evidence for clinical workers. METHODS: PubMed, Embase.com, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang, and SinoMed will be used for literature search, retrieve time is up to June 1, 2021. We will include randomized controlled trials that evaluate the effects of Baduanjin on postoperative rehabilitation for breast cancer patients. Two independent researchers will perform study selection and data extraction. The risk of bias will be assessed by the Cochrane bias assessment tool. We will use funnel plot and Egger test to evaluate publication bias. Stata 13.0, as a necessary software, will be used to perform statistical analysis. Also, we will utilize subgroup analyses and sensitivity analyses to explore the sources of heterogeneity. RESULTS: The results of this study will be published in a peer-reviewed journal. CONCLUSION: Evidence that adequately assesses the effect of Baduanjin in the recovery of breast cancer patients will be confirmed through this systematic review. Our study will offer a guideline for clinical workers, besides we will supply a new way for the rehabilitation of breast cancer patients.


Asunto(s)
Neoplasias de la Mama/rehabilitación , Mastectomía/rehabilitación , Cuidados Posoperatorios/métodos , Qigong/métodos , Adulto , Neoplasias de la Mama/cirugía , Femenino , Humanos , Metaanálisis como Asunto , Ensayos Clínicos Controlados Aleatorios como Asunto , Proyectos de Investigación , Revisiones Sistemáticas como Asunto , Resultado del Tratamiento
4.
Phys Med Rehabil Clin N Am ; 32(2): 319-353, 2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-33814061

RESUMEN

Telehealth visits result in high-quality care, with high patient and provider satisfaction. Strong evidence suggests that virtual physical therapy is noninferior to conventional face-to-face physical therapy for a variety of musculoskeletal disorders. Postoperative telerehabilitation has a strong positive effect on clinical outcomes, and the increased intensity telerehabilitation programs offer is a promising option for patients. Studies demonstrate effective virtual postoperative management. The novel coronavirus disease 2019 pandemic has led to improved reimbursement for telehealth visits and accelerated widespread implementation of telemedicine. This article establishes experience and evidence-based practice guidelines for conducting telemedicine visits, with emphasis on the virtual physical examination.


Asunto(s)
Enfermedades Musculoesqueléticas/terapia , Dolor Musculoesquelético/terapia , Examen Físico/métodos , Cuidados Posoperatorios/métodos , Telemedicina/métodos , /epidemiología , Accesibilidad a los Servicios de Salud , Humanos , Enfermedades Musculoesqueléticas/fisiopatología , Dolor Musculoesquelético/fisiopatología , Terapia Ocupacional , Pandemias , Satisfacción del Paciente , Modalidades de Fisioterapia
5.
J Surg Oncol ; 123(6): 1414-1422, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33831256

RESUMEN

Systemic chemotherapy improves the survival of patients who undergo pancreatectomy, but whether chemotherapy should be delivered before or after surgery remains debated. At The University of Texas MD Anderson Cancer Center, localized pancreatic ductal adenocarcinoma (PDAC) has been preferentially treated with preoperative therapy-a practice supported by a robust history of institutional and national trials. In the following review, we discuss the historical use of perioperative therapy, our experience with it at MD Anderson Cancer Center and internationally, and the future of treatment and trials for PDAC.


Asunto(s)
Carcinoma Ductal Pancreático/tratamiento farmacológico , Carcinoma Ductal Pancreático/cirugía , Neoplasias Pancreáticas/tratamiento farmacológico , Neoplasias Pancreáticas/cirugía , Quimioterapia Adyuvante , Ensayos Clínicos Fase III como Asunto , Humanos , Terapia Neoadyuvante , Pancreatectomía/métodos , Cuidados Posoperatorios/métodos , Cuidados Preoperatorios/métodos , Ensayos Clínicos Controlados Aleatorios como Asunto
6.
Radiol Clin North Am ; 59(3): 335-347, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33926681

RESUMEN

Diffusion MR imaging exploits the diffusion properties of water to generate contrast between normal tissue and pathology. Diffusion is an essential component of nearly all brain tumor MR imaging examinations. This review covers the important clinical applications of diffusion weighted imaging in the pretreatment diagnosis and grading of brain tumors and assessment of treatment response. Diffusion imaging improves the accuracy of identifying treatment-related effects that may mimic tumor improvement or worsening. Fiber tractography models of eloquent white matter pathways are generated using diffusion tensor imaging. A practical and concise tractography guide is provided for anyone new to preoperative surgical mapping.


Asunto(s)
Neoplasias Encefálicas/diagnóstico por imagen , Imagen de Difusión por Resonancia Magnética/métodos , Cuidados Posoperatorios/métodos , Cuidados Preoperatorios/métodos , Encéfalo/diagnóstico por imagen , Neoplasias Encefálicas/cirugía , Imagen de Difusión Tensora/métodos , Humanos
7.
Pan Afr Med J ; 38: 80, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33889246

RESUMEN

Introduction: chronic subdural hematoma (cSDH) is not uncommon in sub-Saharan Africa and has a striking morbidity and mortality if not managed adequately. With the limited number of neurosurgeons in resource poor countries, general surgeons should be trained in the skills of craniotomy and burr-hole craniostomy. Methods: we conducted a retrospective review of all medical records of patients with cSDH, who underwent flap craniotomy at the Choithrams Memorial Hospital, Sierra Leone, between January 2016 and March 2018. The case notes, operative records and computerized axial tomography (CT) scans were reviewed and all pertinent data extracted. All patients were jointly managed post operatively by medical (neurological) and surgical teams in an intensive care unit. Results: a total of 23 patients had surgical drainage of the chronic subdural hematoma. The mean age of the patients was 65.8 years (ranging from 54-78) with a male: female ratio of 3: 2: 1. The main predisposing risk factors were head trauma (60.9%) and antiplatelet medications (21.7%). Hypertension was the most common comorbidity, followed by diabetes mellitus. Ten (62.5%) out of sixteen patients referred for Head CT-scan by the primary physicians, had an initial missed clinical diagnosis until computerized tomography (CT) scan confirmation report of chronic subdural hematoma (cSDH) was obtained. Flap craniotomy under general anesthesia with a subdural drainage left in situ (100%) was done for all patients. Mean duration of Intensive Care Unit (ICU) admission was 10.6 days (range 6-16 days). Twenty-one (91.3%) patients made a full recovery. There was no mortality. Conclusion: flap craniotomy for cSDH was safely performed by a traumatologist/general surgeon in a developing country where there is no neuro-surgical service. The outcome of the patients was favorable as there was co-management with the surgical and medical team.


Asunto(s)
Craneotomía/métodos , Drenaje/métodos , Hematoma Subdural Crónico/cirugía , Colgajos Quirúrgicos , Anciano , Femenino , Hematoma Subdural Crónico/diagnóstico por imagen , Humanos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Cuidados Posoperatorios/métodos , Estudios Retrospectivos , Factores de Riesgo , Sierra Leona , Tomografía Computarizada por Rayos X , Resultado del Tratamiento
8.
Med Sci Monit ; 27: e929814, 2021 Apr 22.
Artículo en Inglés | MEDLINE | ID: mdl-33883543

RESUMEN

BACKGROUND Treating advanced finger joint contractures from Dupuytren disease remains a challenge. We evaluated the effectiveness of a skeletal distraction device versus alternative treatment options. MATERIAL AND METHODS We analyzed the surgical treatment of contracted finger joints in stage III and stage IV Dupuytren's disease over a 10-year period. Data were obtained from inpatient and outpatient medical records, including postoperative clinical examinations and extended Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire scores. Complications of infection, postoperative pain, and wound healing disorders were recorded. RESULTS A total of 79 patients (83 hands) were assigned to 2 treatment groups. Patients in group 1 underwent an initial open transection of the main fibrous cord, Z-plasty, distraction with the Erlangen external distraction device, and fasciectomy. The distraction period was 13 to 81 days (mean 31 days). Group 2 underwent a conventional single-stage fasciectomy and arthrolysis. DASH scores and subjective patient satisfaction were lower in group 1 (20.7/33%) than in group 2 (10.3/50%). However, the staged approach of group 1 to treat proximal interphalangeal joint contractures in the long term (improvement >40%) was more effective than the approach of group 2 (>33%). Distraction device pin infections occurred in 20% of hands. Postoperative pain and complex regional pain syndrome type I occurred in 25% of hands in group 1 and 3% in group 2. CONCLUSIONS A screw thread driven external fixation device is useful in end-stage Dupuytren's finger joint contractures. It is indicated when joint contractures are advanced and simple arthrolysis is insufficient.


Asunto(s)
Contractura de Dupuytren/cirugía , Equipos y Suministros , Articulaciones de los Dedos/fisiología , Procedimientos Ortopédicos/métodos , Cuidados Posoperatorios/métodos , Adulto , Anciano , Anciano de 80 o más Años , Tornillos Óseos , Progresión de la Enfermedad , Fijadores Externos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Rango del Movimiento Articular , Resultado del Tratamiento
9.
J Cardiothorac Surg ; 16(1): 44, 2021 Mar 23.
Artículo en Inglés | MEDLINE | ID: mdl-33757537

RESUMEN

BACKGROUND: Chest tubes are routinely used after cardiac surgery to evacuate shed mediastinal blood. Incomplete chest drainage due to chest tube clogging can lead to retained blood after cardiac surgery. This can include cardiac tamponade, hemothorax, bloody effusions and postoperative atrial fibrillation (POAF). Prior published non randomized studies have demonstrated that active tube clearance (ATC) of chest tubes can reduce retained blood complications prompting the ERAS Cardiac Society guidelines to recommend this modality. OBJECTIVE: A randomized prospective trial to evaluate whether an ATC protocol aimed at improving chest tube patency without breaking the sterile field could efficiently reduce complications related to retained blood after cardiac surgery. METHODS: This was a pragmatic, single-blinded, parallel randomized control trial held from November 2015 to June 2017 including a 30-day post index surgery follow-up. The setting was two academic centers affiliated with the Université de Montréal School of Medicine; the Montreal Heart Institute and the Hôpital du Sacré-Coeur de Montréal. Adult patients admitted for non-emergent coronary bypass grafting and/or valvular heart surgery through median sternotomy, in sinus rhythm for a minimum of 30 days prior to the surgical intervention were eligible for inclusion. In the active tube clearance group (ATC), a 28F PleuraFlow device was positioned within the mediastinum. In the standard drainage group, a conventional chest tube (Teleflex Inc.) was used. Other chest tubes were left at the discretion of the operating surgeon. RESULTS: A total of 520 adult patients undergoing cardiac surgery were randomized to receive either ATC (n = 257) or standard drainage (n = 263). ATC was associated with a 72% reduction in re-exploration for bleeding (5.7% vs 1.6%, p = .01) and an 89% reduction in complete chest tube occlusion (2% vs 19%, p = .01). There was an 18% reduction in POAF between the ATC and control group that was not statistically significant (31% vs 38%, p = .08). CONCLUSIONS AND RELEVANCE: In this RCT, the implementation of active clearance of chest tubes reduced re-exploration and chest tube clogging in patients after cardiac surgery further supporting recommendations to consider this modality postoperatively. TRIAL REGISTRATION: Clinical Trials NCT02808897 . Retrospectively registered 22 June 2016.


Asunto(s)
Procedimientos Quirúrgicos Cardíacos/efectos adversos , Tubos Torácicos , Drenaje/métodos , Cuidados Posoperatorios/métodos , Complicaciones Posoperatorias/terapia , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Método Simple Ciego
10.
J Clin Neurosci ; 86: 260-266, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33775339

RESUMEN

PURPOSE: The Controlling Nutritional Status (CONUT) Score, a new parameter that reflects the immuno-nutritional status, has been closely associated with prognosis in many cancer types. However, the prognostic significance of the CONUT score in Glioblastoma Multiforme (GBM) is not known. In this study, we aimed to show the prognostic significance of the CONUT score in the postoperative period in patients with GBM. METHODS: 120 patients followed up with GBM were included in the study, retrospectively. According to the receiver operating characteristic (ROC) curve analysis, the optimal cut-off values were determined for the CONUT score, and the patients were divided into low (<2.5) and high (≥2.5) CONUT groups. Systemic immune inflammation index (SII), prognostic nutritional index (PNI), and neutrophil-lymphocyte ratio (NLR) were grouped according to the cut-off point of 1111, 46.5, and 4.48, respectively. Cox regression analyzes were used to assess their prognostic significance for progression-free survival (PFS) and overall survival (OS). RESULTS: The high CONUT score group was found to have worse PFS and OS than the low CONUT score group (p < 0.001, p < 0.001). In univariate analysis, age, gender, comorbidity, CONUT score, SII, PNI, NLR were found to be significant for both PFS and OS. In multivariate analysis, only age and CONUT score were found as independent prognostic factors for both PFS (p: 0.040, p < 0,001) and OS (p: 0,041, p < 0,001). CONCLUSION: The CONUT score in the postoperative period in patients with GBM is an independent prognostic parameter that predicts progression and survival.


Asunto(s)
Neoplasias Encefálicas/cirugía , Glioblastoma/cirugía , Evaluación Nutricional , Estado Nutricional/fisiología , Cuidados Posoperatorios/tendencias , Anciano , Neoplasias Encefálicas/diagnóstico por imagen , Femenino , Glioblastoma/sangre , Glioblastoma/diagnóstico por imagen , Humanos , Linfocitos/metabolismo , Masculino , Persona de Mediana Edad , Neutrófilos/metabolismo , Cuidados Posoperatorios/métodos , Curva ROC , Estudios Retrospectivos
11.
Medicine (Baltimore) ; 100(8): e24936, 2021 Feb 26.
Artículo en Inglés | MEDLINE | ID: mdl-33663131

RESUMEN

BACKGROUND: Anterior cruciate ligament reconstruction (ACLR) is the primary treatment for patients with anterior cruciate ligament (ACL) injury. Successful postoperative rehabilitation is imperative for their recovery. This protocol details the methods that will be used to systematically analyze the efficacy of acupuncture and herbal medicine for postoperative care following ACLR. METHODS AND ANALYSIS: Randomized controlled trials will be searched in the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, MEDLINE/PubMed, Chinese National Knowledge Infrastructure, Japan Medical Abstracts Society, and 7 Korean databases (Oriental Medicine Advanced Searching Integrated System, Korean National Assembly Digital Library, Korean Association of Medical Journal Editors, Korean Studies Information Service System, Korean Traditional Knowledge Portal, National Digital Science Library, and Database Periodical Information Academic). The risk of bias will be assessed using the Cochrane assessment tool of risk of bias. The studies that are selected after checking for eligibility will be quantitatively analyzed as a meta-analysis. The primary outcome will be the scores of pain scales, and the secondary outcomes will be the range of motion of the knee, severity of the swelling, and parameters about the knee joint function. ETHICS AND DISSEMINATION: Ethical approval is not required for this protocol because it does not include patient data. The findings of this review will be disseminated through peer-reviewed publications or conference presentations. REGISTRATION NUMBER: DOI 10.17605/OSF.IO/ZY2W8 (https://osf.io/zy2w8).


Asunto(s)
Terapia por Acupuntura/métodos , Reconstrucción del Ligamento Cruzado Anterior/rehabilitación , Medicamentos Herbarios Chinos/uso terapéutico , Humanos , Metaanálisis como Asunto , Cuidados Posoperatorios/métodos , Revisiones Sistemáticas como Asunto
12.
A A Pract ; 15(3): e01419, 2021 Mar 08.
Artículo en Inglés | MEDLINE | ID: mdl-33684080

RESUMEN

The risk of aerosol transmission has been a key factor for the rapid dissemination of the coronavirus pandemic. Transportation of coronavirus disease 2019 (COVID-19)-infected patients with active air leaks could expose unprotected health care personnel and other patients to aerosolized viral particles. We devised a way to avoid aerosolization while the chest tube drain is on water seal. It involves placing an Ultipor100 viral filter on the suction port of the drain system as well as sealing off the safety valve. This mechanism allows positive pressure from an air leak to escape while on water seal while trapping viral particles.


Asunto(s)
/terapia , Portador Sano/prevención & control , Tubos Torácicos/efectos adversos , Manejo de la Enfermedad , Invenciones/tendencias , Cuidados Posoperatorios/tendencias , /epidemiología , Portador Sano/epidemiología , Humanos , Cuidados Posoperatorios/métodos
13.
Medicine (Baltimore) ; 100(10): e24979, 2021 Mar 12.
Artículo en Inglés | MEDLINE | ID: mdl-33725867

RESUMEN

RATIONALE: Advanced signet ring cell (SRC) carcinoma has a worse prognosis. Therefore, early diagnosis and prevention is particularly important; SRC tumors have lower R0 resection rate and are thought to be less chemosensitive than non-SRCC. Consequently, a novel postoperative adjuvant treatment is urgently needed to improve clinical outcomes. PATIENT CONCERNS: A 41-year-old female with advanced gastric SRC carcinoma was treated with radical gastrectomy and oxaliplatin-based regimen for 6 cycles after surgery. She was suspected of recurrence with the high level of carbohydrate antigen (CA) 72-4. DIAGNOSES: The gastroscopy revealed SRC carcinoma of gastric antrum and poorly differentiated adenocarcinoma in some areas. The diagnosis of postoperative pathology report was gastric cancer with stage III C (T4a, N3a, M0). INTERVENTIONS: The level of CA72-4 rapidly increased during the 2 follow-up after the completion of conventional treatment, ex vivo-cultured allogeneic natural killer (NK) cell infusion was offered to prevent recurrence. OUTCOMES: Intravenous injections of NK cells combination with surgical treatment and chemotherapy showed therapeutic effects in this patient with possible relapse. The patient remained disease-free 46 months after the infusion of NK cells until the latest follow-up. LESSONS: CA72-4 appeared to be the most sensitive and specific marker in the gastric cancer patient, and the high level of CA72-4 may indicate the risk of recurrence. This case report provide rationale for NK cell infusion following the rapid increase of CA72-4 to prevent recurrence.


Asunto(s)
Carcinoma de Células en Anillo de Sello/terapia , Gastrectomía , Células Asesinas Naturales/trasplante , Cuidados Posoperatorios/métodos , Neoplasias Gástricas/terapia , Adulto , Antígenos de Carbohidratos Asociados a Tumores/sangre , Antígenos de Carbohidratos Asociados a Tumores/inmunología , Carcinoma de Células en Anillo de Sello/diagnóstico , Carcinoma de Células en Anillo de Sello/inmunología , Carcinoma de Células en Anillo de Sello/patología , Terapia Combinada/métodos , Femenino , Humanos , Estadificación de Neoplasias , Pronóstico , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/inmunología , Neoplasias Gástricas/patología , Trasplante Homólogo , Resultado del Tratamiento
14.
Medicine (Baltimore) ; 100(12): e24776, 2021 Mar 26.
Artículo en Inglés | MEDLINE | ID: mdl-33761639

RESUMEN

BACKGROUND: Postoperative complications after abdominal surgery are high, and there is no reliable intervention program to prevent them. Some studies have pointed out that early postoperative activities have advantages in preventing the occurrence of complications, but lack of evidence-based basis. The purpose of this study is to systematically evaluate the effect of nursing intervention is guiding early postoperative activities on the rapid recovery of patients undergoing abdominal surgery. METHODS: China National Knowledge Infrastructure, Wanfang, China Science and Technology Journal Database and Chinese Biomedical Database, PubMed, Embase, Web of Science and the Cochrane Library will be searched by computer, and a randomized controlled study is conducted on early participation in exercise programs after abdominal surgery from the establishment of the database to January 2021. The language is limited to English and Chinese. The quality of the included study is independently extracted and the literature quality is evaluated by 2 researchers, and the included literature is analyzed by Meta using RevMan5.3 software. RESULTS: This study will evaluate the effect of nursing intervention is guiding early postoperative activities on the rapid rehabilitation of patients undergoing abdominal surgery through the indexes of postoperative quality of life score, the incidence of complications, mortality, length of stay and so on. CONCLUSION: This study will provide reliable evidence-based basis for establishing a reasonable and effective postoperative activity guidance program for patients undergoing abdominal surgery. ETHICS AND DISSEMINATION: Private information from individuals will not be published. This systematic review also does not involve endangering participant rights. Ethical approval will not be required. The results may be published in a peer-reviewed journal or disseminated at relevant conferences. OSF REGISTRATION NUMBER: DOI 10.17605/OSF.IO/59MD4.


Asunto(s)
Abdomen/cirugía , Atención de Enfermería/métodos , Cuidados Posoperatorios/métodos , Complicaciones Posoperatorias/epidemiología , Procedimientos Quirúrgicos Operativos/rehabilitación , Mortalidad Hospitalaria , Humanos , Incidencia , Tiempo de Internación , Metaanálisis como Asunto , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Procedimientos Quirúrgicos Operativos/efectos adversos , Revisiones Sistemáticas como Asunto , Factores de Tiempo , Resultado del Tratamiento
15.
Bone Joint J ; 103-B(2): 294-298, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33517721

RESUMEN

AIMS: The aim of this study was to determine the immediate post-fixation stability of a distal tibial fracture fixed with an intramedullary nail using a biomechanical model. This was used as a surrogate for immediate weight-bearing postoperatively. The goal was to help inform postoperative protocols. METHODS: A biomechanical model of distal metaphyseal tibial fractures was created using a fourth-generation composite bone model. Three fracture patterns were tested: spiral, oblique, and multifragmented. Each fracture extended to within 4 cm to 5 cm of the plafond. The models were nearly-anatomically reduced and stabilized with an intramedullary nail and three distal locking screws. Cyclic loading was performed to simulate normal gait. Loading was completed in compression at 3,000 N at 1 Hz for a total of 70,000 cycles. Displacement (shortening, coronal and sagittal angulation) was measured at regular intervals. RESULTS: The spiral and oblique fracture patterns withstood simulated weight-bearing with minimal displacement. The multifragmented model had early implant failure with breaking of the distal locking screws. The spiral fracture model shortened by a mean of 0.3 mm (SD 0.2), and developed a mean coronal angulation of 2.0° (SD 1.9°) and a mean sagittal angulation of 1.2° (SD 1.1°). On average, 88% of the shortening, 74% of the change in coronal alignment, and 75% of the change in sagittal alignment occurred in the first 2,500 cycles. No late acceleration of displacement was noted. The oblique fracture model shortened by a mean of 0.2 mm (SD 0.1) and developed a mean coronal angulation of 2.4° (SD 1.6°) and a mean sagittal angulation of 2.6° (SD 1.4°). On average, 44% of the shortening, 39% of the change in coronal alignment, and 79% of the change in sagittal alignment occurred in the first 2,500 cycles. No late acceleration of displacement was noted. CONCLUSION: For spiral and oblique fracture patterns, simulated weight-bearing resulted in a clinically acceptable degree of displacement. Most displacement occurred early in the test period, and the rate of displacement decreased over time. Based on this model, we offer evidence that early weight-bearing appears safe for well reduced oblique and spiral fractures, but not in multifragmented patterns that have poor bone contact. Cite this article: Bone Joint J 2021;103-B(2):294-298.


Asunto(s)
Ambulación Precoz , Fijación Intramedular de Fracturas/métodos , Cuidados Posoperatorios/métodos , Fracturas de la Tibia/cirugía , Fenómenos Biomecánicos , Clavos Ortopédicos , Tornillos Óseos , Fijación Intramedular de Fracturas/instrumentación , Fijación Intramedular de Fracturas/rehabilitación , Humanos , Modelos Anatómicos , Tibia/lesiones , Tibia/fisiología , Tibia/cirugía , Fracturas de la Tibia/rehabilitación , Soporte de Peso
16.
Bone Joint J ; 103-B(2): 279-285, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33517738

RESUMEN

AIMS: Pin-site infection remains a significant problem for patients treated by external fixation. A randomized trial was undertaken to compare the weekly use of alcoholic chlorhexidine (CHX) for pin-site care with an emollient skin preparation in patients with a tibial fracture treated with a circular frame. METHODS: Patients were randomized to use either 0.5% CHX or Dermol (DML) 500 emollient pin-site care. A skin biopsy was taken from the tibia during surgery to measure the dermal and epidermal thickness and capillary, macrophage, and T-cell counts per high-powered field. The pH and hydration of the skin were measured preoperatively, at follow-up, and if pin-site infection occurred. Pin-site infection was defined using a validated clinical system. RESULTS: Out of 116 patients who were enrolled in the study, 23 patients (40%) in the CHX group and 26 (44%) in the DML group had at least one bad or ugly pin-site infection. This difference was not statistically significant (p = 0.71). There was no significant relationship between pH or hydration of the skin and pin-site infection. The epidermal thickness was found to be significantly greater in patients who had a pin-site infection compared with those who did not (p = 0.01). Skin irritation requiring a change of treatment occurred in four patients (7%) using CHX, and none using DML. CONCLUSION: We found no significant difference in the incidence of pin-site infection between the CHX and DML treatment groups. Dermol appeared to offer a small but significant advantage in terms of tolerability. We did not find a significant association between patient or treatment related factors and pin-site infection. It is therefore difficult to make specific recommendations based upon these results. The use of either cleaning agent appears to be appropriate. Cite this article: Bone Joint J 2021;103-B(2):279-285.


Asunto(s)
Clavos Ortopédicos/efectos adversos , Emolientes/uso terapéutico , Fijadores Externos/efectos adversos , Fijación de Fractura/instrumentación , Cuidados Posoperatorios/métodos , Infecciones Relacionadas con Prótesis/prevención & control , Fracturas de la Tibia/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antiinfecciosos Locales/uso terapéutico , Clorhexidina/uso terapéutico , Femenino , Estudios de Seguimiento , Fijación de Fractura/métodos , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Infecciones Relacionadas con Prótesis/epidemiología , Método Simple Ciego , Resultado del Tratamiento , Adulto Joven
17.
Medicine (Baltimore) ; 100(7): e23950, 2021 Feb 19.
Artículo en Inglés | MEDLINE | ID: mdl-33607762

RESUMEN

BACKGROUND: Gastric cancer (GC) is the most common malignant tumors in the world and surgical resection remains the primary treatment for it. Postoperative patients often suffer from gastrointestinal dysfunction as the most common side effects of surgery for GC patients. Acupuncture has a regulatory effect on gastrointestinal function. We conducted this study to assess the effectiveness of acupuncture on the restoration of gastrointestinal function of postoperative patients with GC. METHODS: Seven electronic databases will be searched from inception to November 2020 to identify any relevant study: Medline, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), China National Knowledge Infrastructure (CNKI), Wanfang Database, Chinese Biomedical Literature Database (CBM), and Chinese Scientific Journal Database (VIP database). No restriction on time and language. The primary outcome measure will be the Time to First Flatus and secondary outcome measures include the time of first defecation and the quality of life (QOL) and the number of patients with abdominal distention. We will use EndNote V.9.1 to screen the eligible literature and the I2 statistic to assess heterogeneity in the included studies. The meta-analysis will be conducted using the Review Manager (RevMan) software (V.5.3). RESULTS: Our study aims to systematically assess whether the pooled effects of currently available trials prove effects of acupuncture in improving gastrointestinal function of patients with GC in the postoperative period. CONCLUSION: This study will conduct an evaluation about the efficacy of acupuncture for the recovery of gastrointestinal function of patients with GC in the postoperative period, making up for the lack of relevant clinical evidence. INPLASY REGISTRATION NUMBER: INPLASY2020110066.


Asunto(s)
Terapia por Acupuntura/métodos , Cuidados Posoperatorios/métodos , Neoplasias Gástricas/cirugía , Humanos , Metaanálisis como Asunto , Revisiones Sistemáticas como Asunto
18.
JAMA Netw Open ; 4(2): e210254, 2021 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-33635329

RESUMEN

Importance: Preoperative and postoperative exercise interventions are commonly used in patients with total hip arthroplasty despite a lack of established efficacy. Objective: To explore clinical outcomes associated with exercise training before and after hip arthroplasty. Data Sources: PubMed, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, EMBASE, and Google Scholar were searched from their inception to March 2020. Reference lists of included trials and related reviews were also searched. Study Selection: Randomized clinical trials of land-based exercise interventions before or after total hip arthroplasty were included. Data Extraction and Synthesis: This systematic review and meta-analysis is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Data extraction was independently performed in duplicate. Random-effects meta-analyses with restricted maximum likelihood were performed for pooling the data. Main Outcomes and Measures: The primary prespecified outcome was self-reported physical function. Secondary prespecified outcomes were self-reported pain intensity, quality of life, gait speed, lower body muscle strength, lower body flexibility, anxiety, hospital length of stay, and adverse events. Results: A total of 32 randomized clinical trials with 1753 patients were included in the qualitative synthesis, and 26 studies with 1004 patients were included in the meta-analysis. Compared with usual care or no or minimal intervention, postoperative exercise training was not associated with improved self-reported physical function, with a moderate level of certainty, at 4 weeks (standardized mean difference [SMD], 0.01; 95% CI, -0.18 to 0.20), 12 weeks (SMD, -0.08; 95% CI, -0.23 to 0.07) and 26 weeks (SMD, -0.04; 95% CI, -0.31 to 0.24) postoperatively, and low level of certainty at 1 year after surgical treatment (SMD, 0.01; 95% CI, -0.09 to 0.12). For preoperative exercise interventions, there was no association of exercised training with self-reported physical function compared with the control at the 12-week (SMD, -0.14; 95% CI, -0.61 to 0.32) or 1-year follow-ups (SMD, 0.01; 95% CI, -0.37 to 0.40) with very low certainty, and no association with length of stay (mean difference, -0.21; 95% CI, -0.74 to 0.31) at moderate certainty. Results for postoperative hip muscle strength were rated at very low certainty, with no statistical significance. Meta-analysis could not be performed for other outcomes. Conclusions and Relevance: This systematic review and meta-analysis found low- to moderate-quality evidence that postoperative exercise interventions were not associated with improved self-reported physical function compared with usual care or no or minimal intervention. Furthermore, there was very low-quality evidence that preoperative exercise programs were not associated with higher self-reported physical function and hospital length of stay compared with usual care or no or minimal intervention.


Asunto(s)
Artroplastia de Reemplazo de Cadera/rehabilitación , Terapia por Ejercicio/métodos , Osteoartritis de la Cadera/cirugía , Ansiedad/psicología , Humanos , Tiempo de Internación , Fuerza Muscular , Osteoartritis de la Cadera/fisiopatología , Osteoartritis de la Cadera/psicología , Dolor , Rendimiento Físico Funcional , Cuidados Posoperatorios/métodos , Complicaciones Posoperatorias/epidemiología , Calidad de Vida , Rango del Movimiento Articular , Velocidad al Caminar
19.
Medicine (Baltimore) ; 100(4): e24502, 2021 Jan 29.
Artículo en Inglés | MEDLINE | ID: mdl-33530274

RESUMEN

BACKGROUND: This systematic review protocol aims to provide evidence of the efficacy and safety of acupuncture on postoperative recovery and extubation time. METHODS: The following 11 electronic databases will be searched from inception: The Cochrane Database of Systematic Reviews, MEDLINE, EMBASE, AMED, CINAHL, 1 Chinese database (CNKI), and 5 Korean databases (OASIS, DBpia, RISS, KISS, NDSL). Only randomized controlled trials of acupuncture treatment for postoperative recovery after surgery will be included for review. The selection of the studies, data extraction, and management will be performed independently by 3 researchers. Methodological quality, including the risk of bias, will be assessed using the Cochrane risk of bias assessment tool. RESULTS AND CONCLUSIONS: Our systematic review will provide evidence of the efficacy of acupuncture on postoperative recovery and extubation time. This evidence will provide useful information to practitioners and patients in the field of surgery and complementary medicine. PROSPERO REGISTRATION NUMBER: 2020 CRD42020168411.


Asunto(s)
Terapia por Acupuntura/métodos , Cuidados Posoperatorios/métodos , Extubación Traqueal , Humanos , Metaanálisis como Asunto , Revisiones Sistemáticas como Asunto
20.
Cancer Radiother ; 25(2): 200-205, 2021 Apr.
Artículo en Francés | MEDLINE | ID: mdl-33546996

RESUMEN

It is proposed to delineate the anatomo-clinical target volumes of primary tumor (CTV-P) in ethmoid cancers treated with post-operative radiotherapy. This concept is based on the use of radioanatomy and the natural history of cancer. It is supported by the repositioning of the planning scanner with preoperative imaging for the replacement of the initial GTV and the creation of margins around it extended to the microscopic risk zones according to the anatomical concept. This article does not discuss the indications of external radiotherapy but specifies the volumes to be delineated if radiotherapy is considered.


Asunto(s)
Hueso Etmoides , Planificación de la Radioterapia Asistida por Computador/métodos , Neoplasias Craneales/radioterapia , Hueso Etmoides/anatomía & histología , Hueso Etmoides/diagnóstico por imagen , Humanos , Imagen por Resonancia Magnética , Cuidados Posoperatorios/métodos , Neoplasias Craneales/diagnóstico por imagen , Neoplasias Craneales/cirugía , Tomografía Computarizada por Rayos X
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