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1.
AORN J ; 88(4): 587-600; quiz 601-4, 2008 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-18942237

RESUMO

Requests for plastic surgery procedures that alter one's body image are on the rise. To ensure the best possible outcome, patients who request a combined procedure (eg, abdominoplasty and liposuction) must meet certain criteria to be eligible for surgery. It is critically important for patients to understand that these surgeries are not weight-reduction procedures, and they must be prepared to make lifestyle changes to ensure long-lasting results. These procedures are performed in a variety of facilities (eg, surgeons' offices, surgery centers, hospitals). Perioperative nurses must have a basic knowledge and understanding of abdominoplasty and liposuction and the special requirements and potential complications involved with these procedures.


Assuntos
Abdome/cirurgia , Lipectomia/métodos , Obesidade/cirurgia , Enfermagem de Centro Cirúrgico/métodos , Imagem Corporal , Humanos , Estilo de Vida , Lipectomia/efeitos adversos , Lipectomia/enfermagem , Avaliação em Enfermagem , Registros de Enfermagem , Obesidade/enfermagem , Obesidade/psicologia , Aceitação pelo Paciente de Cuidados de Saúde , Educação de Pacientes como Assunto , Seleção de Pacientes , Assistência Perioperatória/métodos , Assistência Perioperatória/enfermagem , Pré-Medicação/métodos , Pré-Medicação/enfermagem , Terapia por Ultrassom/métodos , Terapia por Ultrassom/enfermagem , Agentes Molhantes/uso terapêutico
2.
Plast Reconstr Surg ; 121(3): 93e-101e, 2008 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-18317091

RESUMO

BACKGROUND: Safety in office-based surgery remains of paramount importance. Accordingly, many consider Advanced Cardiac Life Support training a critical component of safety preparation for office-based surgery. A survey was recently designed and distributed to assess the experience and attitudes of board-certified plastic surgeons toward Advanced Cardiac Life Support training. METHODS: A two-page, 14-question survey was mailed to the 4581 members of the American Society of Plastic Surgeons. The anonymous survey consisted of multiple choice questions eliciting status of Advanced Cardiac Life Support certification, use of office-based surgery, experience with adverse cardiac and respiratory events, and opinions on mandating Advanced Cardiac Life Support training. RESULTS: The total number of surveys returned was 1461 (32 percent). Current Basic Life Support and Advanced Cardiac Life Support certification was 65.6 percent and 44.9 percent, respectively. Over the past 10 years, 29 percent of plastic surgeons participated in a cardiac or respiratory arrest, and 43.9 percent of these surgeons acted as the code leader; 60.2 percent of plastic surgeons felt Advanced Cardiac Life Support certification should be required, but only 26 percent of these felt it should be mandated to maintain board certification. CONCLUSIONS: Historically, Advanced Cardiac Life Support and facility accreditation were strongly recommended but often not required for office-based surgery. The American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery have taken steps to increase patient safety, mandating that outpatient plastic surgery only be performed at accredited facilities. Many credentialing organizations are now escalating the requirements for Advanced Cardiac Life Support/Basic Life Support certification.


Assuntos
Suporte Vital Cardíaco Avançado/educação , Suporte Vital Cardíaco Avançado/normas , Procedimentos Cirúrgicos Ambulatórios/normas , Certificação/normas , Cirurgia Plástica/normas , Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Certificação/estatística & dados numéricos , Pesquisas sobre Serviços de Saúde , Humanos , Segurança , Cirurgia Plástica/efeitos adversos , Estados Unidos
3.
Plast Reconstr Surg ; 120(7): 2095-100, 2007 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-18090781

RESUMO

The legal system depends on the medical expert for evidence. Doctors readily complain about frivolous cases that go to trial, yet a lawyer cannot bring a frivolous claim to trial without a physician expert witness stating that the claim is not frivolous. An insurance company cannot raise premiums without medical expert witnesses servicing the increasing litigation against the insured. Physicians must look to themselves as a major contributor to rising malpractice insurance costs. For without the physician expert witness, no medical malpractice lawsuit can take place. It is the expert physician, not the attorneys or insurance companies, who defines "meritless" and "frivolous" and who ultimately controls the courts' medical malpractice caseload.


Assuntos
Prova Pericial/tendências , Imperícia , Papel do Médico , Prova Pericial/economia , Prova Pericial/legislação & jurisprudência , Prova Pericial/normas , Honorários e Preços , Humanos , Seguro de Responsabilidade Civil/economia , Licenciamento em Medicina/normas , Imperícia/economia , Imperícia/legislação & jurisprudência , Imperícia/tendências , Motivação , Assistência ao Paciente/economia , Governo Estadual , Estados Unidos
4.
Plast Reconstr Surg ; 119(3): 48e-66e, 2007 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-17312476

RESUMO

LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Explain what governmental regulations control the labeling and distribution of herbal supplements. 2. List the more commonly used supplements and their reported benefits. 3. List the possible postoperative complications from consumption of the more commonly used herbal supplements. 4. Explain the preoperative management of patients using herbal supplements. 5. Know additional resources to consult when unanswered questions arise. BACKGROUND: The American public spends over $5 billion per year on herbal supplements, and approximately 20 percent of all Americans use prescription medications concurrently with herbal supplements. As the number of people who take alternative medicines rises, there is growing awareness among health care providers of the need to become educated and to educate their patients on the effects that such supplementation may have on their health. As plastic surgeons, we have an added responsibility to become informed because of potential adverse interactions with other medications and anesthesia in the elective surgical patient. METHODS: Literature regarding commonly encountered herbal supplements and vitamins was reviewed and summarized to include reported indications for use and potential adverse effects and interactions specific to the perioperative patient. RESULTS: Abundant literature exists regarding herbal supplementation, but very little scientific evidence exists to advocate the use of the majority of supplements available on the market. In addition, little is known about the positive and negative interactions that these supplements are capable of producing, and those interactions that are known are based on case reports. CONCLUSIONS: With the lack of quality scientific studies to support the efficacy of most herbal products available and the limited regulation of these products by the government, health care providers are faced with a significant public health dilemma. This article provides a brief overview of information published on commonly encountered herbal supplements and vitamins taken by plastic surgery patients.


Assuntos
Suplementos Nutricionais , Fitoterapia , Preparações de Plantas , Complicações Pós-Operatórias/induzido quimicamente , Cirurgia Plástica , Vitaminas , Suplementos Nutricionais/efeitos adversos , Interações Ervas-Drogas , Humanos , Fitoterapia/efeitos adversos , Preparações de Plantas/efeitos adversos , Vitaminas/efeitos adversos
5.
Plast Reconstr Surg ; 119(1): 157-74, 2007 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-17255670

RESUMO

BACKGROUND: Deep vein thrombosis is a known serious complication of surgical procedures and a significant cause of morbidity and mortality. Plastic surgeons' management of the risk of deep vein thrombosis and current information regarding deep vein thrombosis incidence rates are limited. A survey was designed and mailed to plastic surgeons to collect data on the patterns of practice with regard to deep vein thrombosis in patients undergoing plastic surgery procedures. METHODS: A comprehensive self-administered, anonymous survey was mailed to 1557 plastic surgeons in March of 2003. RESULTS: A total of 334 completed responses were available for analysis. Subsets of surgeons do not use any deep vein thrombosis prophylaxis: 16.4 percent who perform face lifts; 21.3 percent who perform liposuction; and 8.7 percent who perform a combined abdominoplasty-liposuction procedure. Only 48.7 percent of surgeons performing face lifts, 43.7 percent of surgeons performing liposuction, and 60.8 percent performing a combined procedure use deep vein thrombosis prophylaxis all the time. CONCLUSIONS: These results demonstrate a need for educational efforts and guidelines to direct clinical practice in line with evidence-based data concerning plastic surgery procedures and deep vein thrombosis. Plastic surgeons should be aware of the potential and real risks of deep vein thrombosis and procedures for prevention and treatment to reduce morbidity and mortality associated with deep vein thrombosis in all plastic surgery patients.


Assuntos
Fibrinolíticos/uso terapêutico , Padrões de Prática Médica , Cirurgia Plástica , Trombose Venosa/prevenção & controle , Humanos , Inquéritos e Questionários , Trombose Venosa/epidemiologia
7.
Plast Reconstr Surg ; 117(7 Suppl): 1e-S-32e-S, 2006 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-16801750

RESUMO

Understanding wound healing today involves much more than simply stating that there are three phases: inflammation, proliferation, and maturation. Wound healing is a complex series of reactions and interactions among cells and "mediators." Each year, new mediators are discovered and our understanding of inflammatory mediators and cellular interactions grows. This article will attempt to provide a concise overview on wound healing and wound management.


Assuntos
Cicatrização/fisiologia , Ferimentos e Lesões/terapia , Divisão Celular , Cicatriz/prevenção & controle , Humanos , Inflamação , Ferimentos e Lesões/patologia , Ferimentos e Lesões/fisiopatologia
8.
Plast Reconstr Surg ; 117(7 Suppl): 6S-11S, 2006 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-16799371

RESUMO

Since the caveman, man has been tending to his wounds. Wound care evolved from magical incantations, potions, and ointments, to a systematic text of wound care and surgery from Hippocrates and Celsus. These advances were lost after the fall of the Roman Empire. In Europe, the Middle Ages were a regression of wound care back to potions and charms. It was'nt until the time of large armies using muskets and cannons that surgical wound care emerged again. This article will briefly highlight major milestones in wound care.


Assuntos
Infecção da Ferida Cirúrgica/história , Cicatrização/fisiologia , Ferimentos e Lesões/história , Animais , História do Século XVI , História do Século XVII , História do Século XVIII , História do Século XIX , História Antiga , História Medieval , Humanos , Medicina Militar/história , Infecção da Ferida Cirúrgica/terapia , Cicatrização/efeitos dos fármacos , Ferimentos e Lesões/fisiopatologia , Ferimentos e Lesões/terapia
9.
Plast Reconstr Surg ; 117(7 Suppl): 12S-34S, 2006 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-16799372

RESUMO

Understanding wound healing today involves much more than simply stating that there are three phases: "inflammation, proliferation, and maturation." Wound healing is a complex series of reactions and interactions among cells and "mediators." Each year, new mediators are discovered and our understanding of inflammatory mediators and cellular interactions grows. This article will attempt to provide a concise report of the current literature on wound healing by first reviewing the phases of wound healing followed by "the players" of wound healing: inflammatory mediators (cytokines, growth factors, proteases, eicosanoids, kinins, and more), nitric oxide, and the cellular elements. The discussion will end with a pictorial essay summarizing the wound-healing process.


Assuntos
Hemostasia/imunologia , Mediadores da Inflamação/imunologia , Inflamação/imunologia , Neovascularização Fisiológica/imunologia , Cicatrização/imunologia , Proliferação de Células , Células/imunologia , Quimiotaxia/imunologia , Colágeno/fisiologia , Citocinas/imunologia , Eicosanoides/imunologia , Proteínas da Matriz Extracelular/imunologia , Humanos , Óxido Nítrico/imunologia , Fatores de Tempo , Cicatrização/fisiologia
10.
Plast Reconstr Surg ; 117(6): 1738-49, 2006 May.
Artigo em Inglês | MEDLINE | ID: mdl-16651945

RESUMO

BACKGROUND: Liposuction is the most common cosmetic operation performed. To the authors' knowledge, no report has examined patients' attitudes and postoperative opinions, lifestyle changes, weight gain changes, and satisfaction with their liposuction procedure in general and by specific site. The authors report on data from a survey provided to patients by two plastic surgeons at the University of Texas Southwestern Medical Center at Dallas. METHODS: Six hundred questionnaires were mailed to all patients who had liposuction surgery performed between 1999 and 2003. There were 108 undeliverable surveys; 209 completed surveys were returned (34.8 percent of 600 and 42.5 percent of 492 surveys). Data were analyzed using the chi-square test. A p value of less than 0.05 was considered significant. RESULTS: The majority of patients (80 percent) were satisfied with their results. Fifty-three percent thought that their appearance was either "excellent" or "very good." With regard to satisfaction by site treated, 60 percent or more of the responders were "very satisfied" or "satisfied" with their results. Weight gain was reported in 43 percent of the responders, with 56 percent of them gaining between 5 and 10 pounds 6 months after their surgery. Fat return was reported in 65 percent of the responders. The abdomen was the most common location for fat return. As a group, 79.7 percent would have the procedure again and 86 percent would recommend the procedure to family or friends. Approximately 75 percent of responders described their postoperative discomfort as mild to moderate, with 60 percent indicating that their discomfort lasted less than 7 days (39.8 percent indicated their pain lasted longer than 7 days); 83 percent indicated that they only needed to use narcotics for 7 days of less. When responders were divided into groups, the great majority of patients were satisfied with the surgery and their results. CONCLUSIONS: Despite postoperative pain, fat return, and weight gain, patients were willing to have the procedure again and recommend it to others. Those patients who were unsatisfied and were less likely to refer patients were those who had the lowest opinion of their appearance.


Assuntos
Estilo de Vida , Lipectomia/psicologia , Satisfação do Paciente , Abdome , Analgésicos Opioides/uso terapêutico , Imagem Corporal , Feminino , Seguimentos , Humanos , Lipectomia/estatística & dados numéricos , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/epidemiologia , Satisfação do Paciente/estatística & dados numéricos , Recidiva , Inquéritos e Questionários , Texas , Fatores de Tempo , Resultado do Tratamento , Ganho de Peso
11.
Plast Reconstr Surg ; 117(4): 61e-80e, 2006 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-16582768

RESUMO

LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Discern the importance of the physician's office administrative capacity. 2. Recognize the necessity of a system for quality assessment. 3. Assess which procedures are safe in the office-based setting. 4. Know the basic steps to properly evaluate patients for office-based plastic surgery. BACKGROUND: At least 44,000 Americans die annually as a result of preventable medical errors. Medical mistakes are the eighth leading cause of death in the United States, costing between $54.6 billion and $79 billion, or 6 percent of total annual national health care expenditures. Office-based procedures comprise a 10-fold increase in risk for serious injury or death as compared with an ambulatory surgical facility. METHODS: This article reviews the literature on office-based patient safety issues. It places special emphasis on the statements and advisories published by the American Society of Plastic Surgeons' convened Task Force on Patient Safety in Office-Based Settings. This article stresses areas of increased patient safety concern, such as deep vein thrombosis prophylaxis and liposuction surgery. RESULTS: The article divides patient safety in health care delivery into three broad categories. First, patient safety starts with emphasis at the administrative level. The physician or independent governing body must develop a system of quality assessment that functions to minimize preventable errors and report outcomes and errors. Second, the clinical aspects of patient safety require that the physician evaluate whether the procedure(s) and the patient are proper for the office setting. Finally, this article gives special attention to liposuction, the most frequently performed office-based plastic surgery procedure. CONCLUSIONS: Patient safety must be every physician's highest priority, as reflected in the Hippocratic Oath: primum non nocere ("first, do no harm"). In the office setting, this priority requires both administrative and clinical emphasis. The physician who gives the healing touch of quality care must always have patient safety as the foremost priority.


Assuntos
Procedimentos Cirúrgicos Ambulatórios , Lipectomia , Garantia da Qualidade dos Cuidados de Saúde , Procedimentos Cirúrgicos Reconstrutivos , Gestão da Segurança , Procedimentos Cirúrgicos Ambulatórios/normas , Anestesia/normas , Sedação Consciente , Serviços Médicos de Emergência , Jejum , Humanos , Consentimento Livre e Esclarecido , Lipectomia/efeitos adversos , Lipectomia/normas , Registros Médicos , Alta do Paciente , Guias de Prática Clínica como Assunto , Cuidados Pré-Operatórios , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/normas , Fatores de Risco , Trombose Venosa/prevenção & controle
12.
Plast Reconstr Surg ; 114(7): 1945-52; discussion 1953, 2004 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-15577373

RESUMO

Patients need to have realistic expectations for a long-term successful body contour result. There are four key elements for long-term successful improvement in body contour, and the patient is responsible for the first three: exercise, a proper diet, and other positive lifestyle changes; and successful body contouring. An extensive survey requesting information about the procedures, areas of liposuction, lifestyle habits, and satisfaction was mailed to 600 patients who had liposuction surgery performed between 1999 and 2003. One hundred and eight surveys were undeliverable and 209 completed surveys were returned (34.8 percent of 600 mailed surveys and 42.5 percent of 492 delivered surveys). Data were analyzed by a binary logistic regression with backward elimination. Weight gain (versus no weight gain) was used as the dependent variable. The results showed that regardless of whether the patient did or did not gain weight, both groups reported being very satisfied (30 percent and 48 percent, respectively) or satisfied (43 percent and 34 percent, respectively) with their procedure. Among the weight gain patients, 72 percent would still have the procedure again, compared with 82 percent of responders who did not gain weight. When asked if they would recommend the procedure to family or friends, 90 percent of responders who did not gain weight would recommend the procedure whereas only 74 percent of responders who did gain weight would recommend the procedure (p < 0.001). Among those patients who gained weight, only 29 percent thought their appearance was excellent or good (compared with 79 percent of those who did not gain weight). Among the 57 percent of patients who did not gain weight, 35 percent report exercising more postoperatively (compared with only 10 percent in the weight gain group, p = 0.002) and 50 percent report eating a healthier diet (22 percent in the weight gain group report eating a healthier diet, p = 0.002). In the weight gain group, 67 percent report no change in their diet regimen and only 17 percent thought their productivity increased (compared with 25 percent among the no weight gain group, p = 0.002). Successful body contouring surgery requires a patient to embrace positive lifestyle habits. The results of this survey have been used to create a quantitative decision-making framework or a "road map" for patients and plastic surgeons to use for navigating toward successful long-term results.


Assuntos
Lipectomia/estatística & dados numéricos , Satisfação do Paciente/estatística & dados numéricos , Vestuário/estatística & dados numéricos , Humanos , Estilo de Vida , Vigilância da População , Período Pós-Operatório , Estados Unidos , Ganho de Peso
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