RESUMO
OBJECTIVE: To determine the validity of the five-level TRIPED-GM pediatric triage system. METHODS: Unicentric, observational, descriptive, cross-sectional study of 485 patients aged 0-16 years in the pediatric emergency department of the HGU Gregorio Marañon. Two measures of validity were used: a direct measure calculated by the sensitivity and specificity obtained based on the number of infratriages and overtriages of the priorities given by classification nurses compared with a panel of experts and another indirect measure by the length of stay, the resources consumed and the percentage of income for each priority level. RESULTS: 10 patients were incorrectly classified, 4 (0.8%) were considered infratriages and 6 (1.2%) overtriages. The results showed a sensitivity of 99.45% (95% CI 96.5-99.97%) and a specificity of 99.01% (95% CI 96.9-99.7%) for high priorities (P2 and P3) and 98.99% (95% CI 96.8-99.6%) and 98.4% (95% CI 96.84-99.74%) respectively for low priorities (P4 and P5). The quadratic weighted Kappa index was 0.96 (95% CI 0.94-0.98; p = 0.0000). Resource consumption showed moderate Spearman correlation coefficients as the priority level increased. The percentage of admissions and the need for observation increased as the priority level p = 0,000 increased, not requiring observation or admitting any patients with priority 5. CONCLUSIONS: The TRIPED-GM pediatric triage system is valid for use in emergency departments with similar patients.
Assuntos
Serviço Hospitalar de Emergência , Triagem , Criança , Estudos Transversais , Hospitalização , Humanos , Sensibilidade e EspecificidadeRESUMO
Background Nowadays, the wrist is not limited to a dorsal visualization; the joint can be thought of as a "box," which can be visualized from almost every perspective. The purpose of this study was to describe a new volar central portal for the wrist, following three principles: a single incision that allows access to both the radiocarpal and midcarpal joints, centered on the lunate, with the volar structures at risk protected not only by retractors, but also by tendons. Description of Technique The incision begins in the distal wrist crease and extended 1.5 cm proximally up to the proximal wrist crease, following the axis of the third intermetacarpal space. The flexor superficialis tendons are identified and retracted toward the radial side. Next, the fourth and fifth flexor digitorum profundus tendons are retracted toward the ulnar side, while the third and second tendons are retracted toward the radial side. The volar central midcarpal portal is performed under direct vision just over the anterior horn of the lunate through the Poirier space. The volar central radiocarpal portal is created under the lunate through the interval between the ulnocarpal ligaments and the short radioulnar ligament. Methods An anatomical study was performed on 14 cadaver specimens. Two data were recorded: iatrogenic injuries of the structures at risk and the distances to the structures at risk. Results The median (interquartile range [IQR]) distances from the volar central radiocarpal portal to the median nerve, palmar cutaneous branch of the median nerve, and ulnar neurovascular bundle were 10.5 (7.8-15.0), 18.5 (15.8-20.3), and 7.0 (5.0-10.5) mm, respectively. The median (IQR) distances from the volar central midcarpal portal to the median nerve, palmar cutaneous branch of the median nerve, and ulnar neurovascular bundle were 7.0 (4.8-10.3), 16.0 (14.8-19.0), and 4.5 (3.8-9.0) mm, respectively. No iatrogenic injuries were observed. Conclusion The volar central portal is reproducible and safe. The risk of iatrogenic injury is low. The capsule is pierced through one of its thinner portions, and both the radiocarpal and midcarpal joints can be inspected through one single incision.
RESUMO
La artroscopia es una herramienta mínimamente invasiva que permite evaluar y tratar prácticamente cualquier articulación del organismo. La posibilidad de visión directa de la reducción de las fracturas intraarticulares del radio distal por artroscopia es cada vez de uso más extendido gracias a los nuevos materiales adaptados a las articulaciones más pequeñas. Describimos en este trabajo la técnica, las indicaciones y los resultados obtenidos en aquellas fracturas de extremidad distal del radio tratadas por artroscopia
Arthroscopy is a minimally invasive tool that allows the evaluation and treatment of practically any body joint. Direct visualization of the reduction of intraarticular fractures of the distal radius by means of arthroscopy is increasingly common, thanks to the introduction of new materials adapted to smaller body joints. We describe the technique, indications and results obtained with distal radial fractures subjected to arthroscopic treatment
Assuntos
Humanos , Fraturas do Rádio/cirurgia , Artroscopia/métodos , Consolidação da Fratura , Dor Pós-Operatória/epidemiologia , Recuperação de Função FisiológicaRESUMO
El artículo recoge dos experiencias prácticas de educación para el ocio y tiempo libre llevadas a cabo en la Fundación Síndrome de Down de Cantabria a lo largo de una década: el taller de teatro y las convivencias de verano. Se exponen los objetivos planteados para estas actividades y algunos de los aspectos característicos de ambas: su carácter motivador, su perspectiva social, su enfoque educativo y especialmente su vinculación directa con la realidad. Ofrecen tantas posibilidades, que pueden ser presentadas como ejemplo ideal de actividades formativas para el tiempo libre de niños y jóvenes con síndrome de Down
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