RESUMO
No disponible
Assuntos
Humanos , Competência Profissional , Educação Médica , Avaliação Educacional , Serviços de Saúde , Descrição de CargoRESUMO
BACKGROUND: Laparoscopic splenectomy (LS) is a well accepted approach for the treatment of multiple hematologic diseases. Single port access splenectomy (SPAS) emphasizes the concept of surgery through one small incision. The reduced port access splenectomy (RPAS) entails the use of fewer trocars of smaller sizes. The aim of this study was to compare the clinical outcomes after LS, SPAS, and RPAS, and to analyze the aesthetic result and patient satisfaction. METHODS: We included patients who underwent LS (group 1, n = 15), SPAS (group 2, n = 8), and RPAS (group 3, n = 10) between June 2008 and February 2012, whose final spleen weight was less of 500 g. The outcome parameters analyzed were operative time, need of additional trocars, blood loss, blood transfusion, weight of the spleen, postoperative complications, and duration of hospital stay. To evaluate the cosmetic result, patients were asked to take the Body Image Questionnaire. RESULTS: Patients in group 3 were younger than group 1. Operative time was significantly longer in group 2 compared to groups 1 and 3 (83 ± 19 vs. 131 ± 43 vs. 81 ± 22 min, p = 0.01). There was no need to convert to open surgery in any group, nor were there differences in intra- or postoperative outcome. There were no differences between the groups in relation to the analgesic requirements. Twenty-two out of the 33 patients answered the questionnaire. There was a significant advantage in group 2 and 3 in the body image index with respect to group 1. There were no differences between groups 2 and 3 (7.3 ± 2.8 vs. 5.8 ± 1.3 vs. 5.1 ± 0.4, p < 0.02). CONCLUSIONS: RPAS is a good alternative to LS and SPAS. It improves the aesthetic results as compared to LS, whereas minimizes the technical challenges faced with SPAS.
Assuntos
Laparoscopia/métodos , Esplenectomia/métodos , Analgésicos/uso terapêutico , Anemia Hemolítica Autoimune/patologia , Anemia Hemolítica Autoimune/psicologia , Anemia Hemolítica Autoimune/cirurgia , Transfusão de Sangue/estatística & dados numéricos , Imagem Corporal , Feminino , Humanos , Laparoscopia/psicologia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Tamanho do Órgão , Dor Pós-Operatória/prevenção & controle , Satisfação do Paciente , Estudos Prospectivos , Púrpura Trombocitopênica Idiopática/patologia , Púrpura Trombocitopênica Idiopática/psicologia , Púrpura Trombocitopênica Idiopática/cirurgia , Esplenectomia/psicologia , Inquéritos e Questionários , Resultado do TratamentoRESUMO
INTRODUCTION: Since reliable information is scarce to describe continuing medical education (CME) and revalidation in Europe, we carried out a survey in 5 selected countries (France, Germany, Italy, Spain, and the United Kingdom). METHODS: A tested questionnaire was sent to 2 experts per country (except in Germany), during August-September 2004. RESULTS: In the analyzed countries medical societies, medical associations, and employers are the main CME providers. Pharmaceutical industry sponsorship accounts on the average for more than 50% of the CME financing in those countries. In all 5 countries, CME accreditation systems exist; the national health authorities and medical associations are mainly responsible for them. In France, Italy, and Germany CME is mandatory; in Spain and the United Kingdom it is voluntary. CME credits/points are mainly used for professional career purposes. Revalidation systems have not been introduced in any of these countries, although in the United Kingdom it is being introduced as part of a relicensing process. DISCUSSION: Recommendations for the implementation of a European system of CME/CPD harmonization are made by the authors.
Assuntos
Competência Clínica/normas , Educação Médica Continuada , Médicos/normas , Acreditação , Coleta de Dados , Indústria Farmacêutica , Europa (Continente) , Apoio FinanceiroRESUMO
No disponible
Assuntos
Educação Médica Continuada/ética , Educação Médica Continuada/história , Educação Médica Continuada/métodos , Acreditação , Acreditação/história , Acreditação/métodos , Acreditação/normas , Educação Médica Continuada/legislação & jurisprudência , Educação Médica Continuada/organização & administração , Educação Médica Continuada/estatística & dados numéricos , Acreditação/ética , Acreditação/legislação & jurisprudência , Acreditação/organização & administraçãoRESUMO
Se presentan 6 pacientes con enfermedad de Hirschprung, tratados en los Hospitales San Pedro de Pasto y San José de la Universidad del Rosario a quienes se les practicó Z anastomosis con la técnica de Ikeda como tratamiento de elección obteniéndose como resultado una marcada disminución en las complicaiones y un sinnúmero de ventajas sobre las técnicas clásicas existentes
