Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 41
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
Disabil Rehabil ; : 1-11, 2020 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-32036731

RESUMO

Background: Compared to other patient population groups, the field of amputation research in Canada lacks cohesion largely due to limited funding sources, lack of connection among research scientists, and loose ties among geographically dispersed healthcare centres, research institutes and advocacy groups. As a result, advances in clinical care are hampered and ultimately negatively influence outcomes of persons living with limb loss.Objective: To stimulate a national strategy on advancing amputation research in Canada, a consensus-workshop was organized with an expert panel of stakeholders to identify key research priorities and potential strategies to build researcher and funding capacity in the field.Methods: A modified Delphi approach was used to gain consensus on identifying and selecting an initial set of priorities for building research capacity in the field of amputation. This included an anonymous pre-meeting survey (N = 31 respondents) followed by an in-person consensus-workshop meeting that hosted 38 stakeholders (researchers, physiatrists, surgeons, prosthetists, occupational and physical therapists, community advocates, and people with limb loss).Results: The top three identified research priorities were: (1) developing a national dataset; (2) obtaining health economic data to illustrate the burden of amputation to the healthcare system and to patients; and (3) improving strategies related to outcome measurement in patients with limb loss (e.g. identifying, validating, and/or developing outcome measures). Strategies for moving these priorities into action were also developed.Conclusions: The consensus-workshop provided an initial roadmap for limb loss research in Canada, and the event served as an important catalyst for stakeholders to initiate collaborations for moving identified priorities into action. Given the increasing number of people undergoing an amputation, there needs to be a stronger Canadian collaborative approach to generate the necessary research to enhance evidence-based clinical care and policy decision-making.IMPLICATIONS FOR REHABILITATIONLimb loss is a growing concern across North America, with lower-extremity amputations occurring due to complications arising from diabetes being a major cause.To advance knowledge about limb loss and to improve clinical care for this population, stronger connections are needed across the continuum of care (acute, rehabilitation, community) and across sectors (clinical, advocacy, industry and research).There are new surgical techniques, technologies, and rehabilitation approaches being explored to improve the health, mobility and community participation of people with limb loss, but further research evidence is needed to demonstrate efficacy and to better integrate them into standard clinical care.

2.
CMAJ ; 191(35): E955-E961, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31481423

RESUMO

BACKGROUND: The evolving clinical burden of limb loss secondary to diabetes and peripheral artery disease remains poorly characterized. We sought to examine secular trends in the rate of lower-extremity amputations related to diabetes, peripheral artery disease or both. METHODS: We included all individuals aged 40 years and older who underwent lower-extremity amputations related to diabetes or peripheral artery disease in Ontario, Canada (2005-2016). We identified patients and amputations through deterministic linkage of administrative health databases. Quarterly rates (per 100 000 individuals aged ≥ 40 yr) of any (major or minor) amputation and of major amputations alone were calculated. We used time-series analyses with exponential smoothing models to characterize secular trends and forecast 2 years forward in time. RESULTS: A total of 20 062 patients underwent any lower-extremity amputation, of which 12 786 (63.7%) underwent a major (above ankle) amputation. Diabetes was present in 81.8%, peripheral artery disease in 93.8%, and both diabetes and peripheral artery disease in 75.6%. The rate of any amputation initially declined from 9.88 to 8.62 per 100 000 between Q2 of 2005 and Q4 of 2010, but increased again by Q1 of 2016 to 10.0 per 100 000 (p = 0.003). We observed a significant increase in the rate of any amputation among patients with diabetes, peripheral artery disease, and both diabetes and peripheral artery disease. Major amputations did not significantly change among patients with diabetes, peripheral artery disease or both. INTERPRETATION: Lower-extremity amputations related to diabetes, peripheral artery disease or both have increased over the last decade. These data support renewed efforts to prevent and decrease the burden of limb loss.

5.
J Vasc Surg ; 70(5): 1675-1681.e6, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31126762

RESUMO

OBJECTIVE: The objective was to characterize the growing body of literature regarding nonoperative management of blunt thoracic aortic injury (BTAI). METHODS: A systematic search of MedLine, Embase, and Cochrane Central was completed to identify original articles reporting injury characteristics and outcomes in patients with BTAI managed nonoperatively during their index hospitalization. Article title and abstract screening, full-text review, and data abstraction were performed in duplicate, with discrepancies resolved by a third reviewer. The quality of each study was evaluated using the Oxford Centre for Evidence-Based Levels of Evidence. RESULTS: Of 2162 identified studies, 74 were included and reported on 8606 patients with BTAI who were managed nonoperatively between 1970 and 2016. Only one study was prospective. The median nonoperative sample size per study was 11 patients. The characterization of aortic injury grade differed across studies. Follow-up varied widely from 1 day to 118 months. Injury healing or improvement on follow-up imaging occurred in 34% (226 of 673 patients; reported in 37 studies), most often in the context of grade I intimal injury. Injury progression or requirement for a thoracic endovascular aneurysm repair for injury progression was 7.6% (66 of 873 patients; reported in 46 studies). A total of 37 studies reported aortic-related death, with an overall rate of 4.5% (37 of 827 patients) and a rate of 1% in grade I and II injuries (1 of 153 patients) and 18% in grade III and IV (9 of 50 patients). CONCLUSIONS: An increasing number of reports support nonoperative management of grade I intimal injury, consistent with Society for Vascular Surgery guidelines. However, a retrospective interpretation of the determinants of management, heterogeneous injury characterization, and variable follow-up remain major limitations to the informed use of nonoperative management across all BTAI grades.

6.
BMJ Qual Saf ; 28(11): 901-907, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31127067

RESUMO

BACKGROUND: Events occurring outside the hospital setting are underevaluated in surgical quality improvement initiatives and research. OBJECTIVE: To quantify regional variation in home care nursing following vascular surgery and explore its impact on emergency department (ED) visits and hospital readmission. METHODS: Patients who underwent elective vascular surgery and were discharged directly home were identified from population-based administrative databases for the province of Ontario, Canada, 2006-2015. The index surgeries included carotid endarterectomy, open and endovascular aortic aneurysm repair and bypass for lower extremity peripheral arterial disease. Home care nursing within 30 days of discharge was captured and compared across regions. Using multilevel logistic regression, we characterised the association between home care nursing and the risk of an ED visit or hospital readmission within 30 days of discharge. RESULTS: The cohort included 23 617 patients, of whom 9002 (38%) received home care nursing within 30 days of discharge home. Receipt of nursing care after discharge home varied widely across Ontario's 14 administrative health regions (range 16%-84%), even after accounting for differences in patient case mix. A lower likelihood of an ED visit or hospital readmission within 30 days of discharge was observed among patients who received home care nursing following three of four index surgeries: carotid endarterectomy OR 0.74, 95% CI 0.61 to 0.91; endovascular aortic aneurysm repair OR 0.85, 95% CI 0.72 to 0.99; open aortic aneurysm repair OR 1.06, 95% CI 0.91 to 1.23; bypass for lower extremity peripheral arterial disease OR 0.81, 95% CI 0.72 to 0.92. CONCLUSION: Home care nursing may contribute to reducing ED visits and hospital readmission and is variably prescribed after vascular surgery.

7.
BMJ Case Rep ; 12(5)2019 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-31092488

RESUMO

Penetrating injuries to the internal carotid artery are infrequent but potentially devastating and can be a significant challenge to the operating surgeon. In this article, we present a case of an 11-year-old girl who suffered a serious vascular injury when she fell on a pencil. We also discuss the most up-to-date recommendations concerning the management of zone II injuries to the neck of a paediatric patient.


Assuntos
Lesões das Artérias Carótidas/cirurgia , Lesões do Pescoço/cirurgia , Ferimentos Penetrantes/cirurgia , Lesões das Artérias Carótidas/diagnóstico por imagem , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/cirurgia , Criança , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Lesões do Pescoço/diagnóstico por imagem , Ferimentos Penetrantes/diagnóstico por imagem
8.
Am J Clin Dermatol ; 20(5): 657-667, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30989581

RESUMO

Dermatologists encounter patients with a variety of lower extremity ulcers including those related to venous insufficiency and peripheral arterial disease. Vascular studies, including ankle brachial pressure index, toe pressure, toe brachial index, Doppler arterial waveform, Duplex ultrasonography, and angiography, play an essential role in the prevention, diagnosis, and management of vascular diseases. In fact, dermatologists are often the first medical providers to see patients with complex vascular conditions. Knowledge of the appropriate indications, interpretations, limitations, and advantages of the various vascular studies is critical to the successful and swift management of each patient presenting with a lower extremity ulcer. This study reviews the most commonly ordered arterial and venous studies and discusses the appropriate indications and interpretation of these studies.


Assuntos
Dermatologistas , Úlcera da Perna/etiologia , Doença Arterial Periférica/diagnóstico , Insuficiência Venosa/diagnóstico , Angiografia , Índice Tornozelo-Braço , Artérias/diagnóstico por imagem , Competência Clínica , Humanos , Doença Arterial Periférica/complicações , Ultrassonografia Doppler Dupla , Veias/diagnóstico por imagem , Insuficiência Venosa/complicações
9.
Cochrane Database Syst Rev ; 1: CD012510, 2019 01 26.
Artigo em Inglês | MEDLINE | ID: mdl-30684445

RESUMO

BACKGROUND: Stents are placed in the femoropopliteal arteries for numerous reasons, such as atherosclerotic disease, the need for dissection, and perforation of the arteries, and can become stenosed with the passage of time. When a stent develops a flow-limiting stenosis, this process is known as "in-stent stenosis." It is thought that in-stent restenosis is caused by a process known as "intimal hyperplasia" rather than by the progression of atherosclerotic disease. Management of in-stent restenosis may include performing balloon angioplasty, deploying another stent within the stenosed stent to force it open, and creating a bypass to deliver blood around the stent. The role of drug-eluting technologies, such as drug-eluting balloons (DEBs), in the management of in-stent restenosis is unclear. Drug-eluting balloons might function by coating the inside of stenosed stents with cytotoxic chemicals such as paclitaxel and by inhibiting the hyperplastic processes responsible for in-stent restenosis. It is important to perform this systematic review to evaluate the efficacy of DEB because of the potential for increased expenses associated with DEBs over uncoated balloon angioplasty, also known as plain old balloon angioplasty (POBA). OBJECTIVES: To assess the safety and efficacy of DEBs compared with uncoated balloon angioplasty in people with in-stent restenosis of the femoropopliteal arteries as assessed by criteria such as amputation-free survival, vessel patency, target lesion revascularization, binary restenosis rate, and death. We define "in-stent restenosis" as 50% or greater narrowing of a previously stented vessel by duplex ultrasound or angiography. SEARCH METHODS: The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, and CINAHL databases and the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to November 28, 2017. Review authors also undertook reference checking to identify additional studies. SELECTION CRITERIA: We included all randomized controlled trials that compared DEBs versus uncoated balloon angioplasty for treatment of in-stent restenosis in the femoropopliteal arteries. DATA COLLECTION AND ANALYSIS: Two review authors (AK, WA) independently selected appropriate trials and performed data extraction, assessment of trial quality, and data analysis. The senior review author (AD) adjudicated any disagreements. MAIN RESULTS: Three trials that randomized a combined total of 263 participants met the review inclusion criteria. All three trials examined the treatment of symptomatic in-stent restenosis within the femoropopliteal arteries. These trials were carried out in Germany and Austria and used paclitaxel as the agent in the drug-eluting balloons. Two of the three trials were industry sponsored. Two companies manufactured the drug-eluting balloons (Eurocor, Bonn, Germany; Medtronic, Fridley, Minnesota, USA). The trials examined both anatomical and clinical endpoints. We noted heterogeneity in the frequency of bailout stenting deployment between studies as well as in the dosage of paclitaxel applied by the DEBs. Using GRADE assessment criteria, we determined that the certainty of evidence presented was very low for the outcomes of amputation, target lesion revascularization, binary restenosis, death, and improvement of one or more Rutherford categories. Most participants were followed up to 12 months, but one trial followed participants for up to 24 months.Trial results show no difference in the incidence of amputation between DEBs and uncoated balloon angioplasty. DEBs showed better outcomes for up to 24 months for target lesion revascularization (odds ratio (OR) 0.05, 95% confidence Interval (CI) 0.00 to 0.92 at six months; OR 0.24, 95% CI 0.08 to 0.70 at 24 months) and at six and 12 months for binary restenosis (OR 0.28, 95% CI 0.14 to 0.56 at six months; OR 0.34, 95% CI 0.15 to 0.76 at 12 months). Participants treated with DEBs also showed improvement of one or more Rutherford categories at six and 12 months (OR 1.81, 95% CI 1.02 to 3.21 at six months; OR 2.08, 95% CI 1.13 to 3.83 at 12 months). Data show no clear differences in death between DEBs and uncoated balloon angioplasty. Data were insufficient for subgroup or sensitivity analyses to be conducted. AUTHORS' CONCLUSIONS: Based on a meta-analysis of three trials with 263 participants, evidence suggests an advantage for DEBs compared with uncoated balloon angioplasty for anatomical endpoints such as target lesion revascularization (TLR) and binary restenosis, and for one clinical endpoint - improvement in Rutherford category post intervention for up to 24 months. However, the certainty of evidence for all these outcomes is very low due to the small number of included studies and participants and the high risk of bias in study design. Adequately powered and carefully constructed randomized controlled trials are needed to adequately investigate the role of drug-eluting technologies in the management of in-stent restenosis.


Assuntos
Angioplastia com Balão/métodos , Artéria Femoral , Artéria Poplítea , Stents , Amputação , Angioplastia com Balão/efeitos adversos , Índice Tornozelo-Braço , Constrição Patológica/etiologia , Constrição Patológica/mortalidade , Constrição Patológica/terapia , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Recidiva , Grau de Desobstrução Vascular
11.
J Vasc Surg ; 69(1): 242-248.e1, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-29503005

RESUMO

OBJECTIVE: In the treatment of an infected aorta, open repair and replacement with a rifampin-impregnated Dacron vascular graft decrease the risk of prosthetic graft infections, with several protocols available in the literature. We hypothesize that the same holds true for endovascular aneurysm repair, and after studying and optimizing rifampin solution concentration and incubation period to maximize the coating process of rifampin on Dacron endovascular stent grafts (ESGs), we propose a rapid real-time perioperative protocol. METHODS: Several prepared rifampin solutions, including a negative control solution, were used to coat multiple triplicate sets of Dacron endovascular aortic stent grafts at different but set incubation periods. Rifampin elution from the grafts was studied by spectroscopic analysis. Once an optimized solution concentration and incubation time were determined, the elution of rifampin over time from the graft and the graft's surface characteristics were studied by ultraviolet-visible spectroscopy and atomic force microscopy. RESULTS: All coated ESGs with any concentration of prepared rifampin solution, regardless of incubation time, immediately demonstrated a visible bright orange discoloration and subsequently after elution procedures returned to the original noncolored state. At the 25-minute incubation time (standard flush), there was no statistical difference in the amount of rifampin coated to the ESGs with 10-mg/mL, 30-mg/mL, and 60-mg/mL solutions (0.06 ± 0.01, 0.07 ± 0.05, and 0.044 ± 0.01, respectively; P > .05). This was also true for a 10-minute incubation time (express flush) of 10-mg/mL and 60-mg/mL rifampin solution concentrations (0.04 ± 0.007 and 0.066 ± 0.014, respectively; P = .22). The elution-over-time of coated rifampin ESG, although not statistically significant, did seem to plateau and to reach a steady state by 50 hours and was confirmed by surface characteristics using atomic force microscopy. CONCLUSIONS: Having studied two variables of rifampin coating techniques to Dacron ESGs, the authors propose a rapid real-time perioperative coating protocol by using a 10-mg/mL rifampin solution for a 10-minute incubation period. As rifampin loosely binds to Dacron ESGs by weak intermolecular forces, a rifampin-coated ESG would need to be inserted in a timely fashion to treat the diseased aorta and to deliver its antibiotic affect. A rapid perioperative coating protocol followed by immediate deployment makes our proposed technique especially useful in an urgent and unstable clinical scenario.


Assuntos
Aneurisma Infectado/cirurgia , Antibacterianos/química , Aneurisma Aórtico/cirurgia , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Materiais Revestidos Biocompatíveis , Procedimentos Endovasculares/instrumentação , Rifampina/química , Stents , Aneurisma Infectado/microbiologia , Antibacterianos/administração & dosagem , Aneurisma Aórtico/microbiologia , Liberação Controlada de Fármacos , Cinética , Teste de Materiais , Microscopia de Força Atômica , Polietilenotereftalatos , Desenho de Prótese , Rifampina/administração & dosagem , Espectrofotometria Ultravioleta , Propriedades de Superfície
12.
Ann Surg ; 270(2): 378-383, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-29672398

RESUMO

BACKGROUND: Early readmission to hospital after surgery is an omnipresent quality metric across surgical fields. We sought to understand the relative importance of hospital readmission among all health services received after hospital discharge. OBJECTIVE: The aim of this study was to characterize 30-day postdischarge cost and risk of an emergency department (ED) visit, readmission, or death after hospitalization for elective major vascular surgery. METHODS: This is a population-based retrospective cohort study of patients who underwent elective major vascular surgery - carotid endarterectomy, EVAR, open AAA repair, bypass for lower extremity peripheral arterial disease - in Ontario, Canada, between 2004 and 2015. The outcomes of interest included quality metrics - ED visit, readmission, death - and cost to the Ministry of Health, within 30 days of discharge. Costs after discharge included those attributable to hospital readmission, ED visits, rehab, physician billing, outpatient nursing and allied health care, medications, interventions, and tests. Multivariable regression models characterized the association of pre-discharge characteristics with the above-mentioned postdischarge quality metrics and cost. RESULTS: A total of 30,752 patients were identified. Within 30 days of discharge, 2588 (8.4%) patients were readmitted to hospital and 13 patients died (0.04%). Another 4145 (13.5%) patients visited an ED without requiring admission. Across all patients, over half of 30-day postdischarge costs were attributable to outpatient care. Patients at an increased risk of an ED visit, readmission, or death within 30 days of discharge differed from those patients with relatively higher 30-day costs. CONCLUSION: Events occurring outside the hospital setting should be integral to the evaluation of quality of care and cost after hospitalization for major vascular surgery.


Assuntos
Benchmarking , Procedimentos Cirúrgicos Eletivos/normas , Custos de Cuidados de Saúde , Alta do Paciente/economia , Doença Arterial Periférica/cirurgia , Vigilância da População/métodos , Procedimentos Cirúrgicos Vasculares/normas , Idoso , Custos e Análise de Custo , Procedimentos Cirúrgicos Eletivos/economia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Ontário , Fatores de Tempo , Procedimentos Cirúrgicos Vasculares/economia
13.
Tech Vasc Interv Radiol ; 21(3): 175-180, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30497552

RESUMO

The advent of endovascular technology for treating aortoiliac aneurysms has sometimes necessitated the occlusion of the hypogastric artery to prevent an endoleak or to achieve an adequate distal seal, resulting in significant morbidity for some patients. The use of iliac branch devices, in conjunction with aortic stent grafts, has made it possible to preserve the hypogastric arteries in select patients with suitable anatomy. The purpose of this review will be to discuss the indications for hypogastric preservation during treatment of aortoiliac aneurysms, as well as highlight the key procedural steps and potential technical challenges encountered during this procedure.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/métodos , Prótese Vascular , Procedimentos Endovasculares/métodos , Aneurisma Ilíaco/cirurgia , Estômago/irrigação sanguínea , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Meios de Contraste , Humanos , Aneurisma Ilíaco/diagnóstico por imagem , Imagem Tridimensional , Desenho de Prótese , Ultrassonografia de Intervenção
14.
Can J Surg ; 61(5): 305-310, 2018 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-30246980

RESUMO

Indigenous Canadians experience a disproportionate burden of chronic atherosclerotic diseases, including peripheral artery disease (PAD). Despite an estimated prevalence of 800 000 patients with PAD in Canada, the burden of the disease among Indigenous Canadians is unclear. Available evidence suggests that this population has a higher prevalence of several major risk factors associated with PAD (diabetes, smoking and kidney disease). Unique socioeconomic, geographic and systemic obstacles affecting Indigenous Canadians' health and health care access may worsen chronic disease outcomes. Little is known about the cardiovascular and limb outcomes of Indigenous peoples with PAD. A novel approach via multidisciplinary vascular health teams engaging Indigenous communities in a culturally competent manner may potentially provide optimal vascular care to this population. Further research into the prevalence and outcomes of PAD among Indigenous Canadians is necessary to define the problem and allow development of more ffective initiatives to alleviate the disease burden in this marginalized group.


Assuntos
Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde/etnologia , Índios Norte-Americanos/etnologia , Inuítes , Doença Arterial Periférica/etnologia , Canadá/etnologia , Humanos , Doença Arterial Periférica/complicações , Doença Arterial Periférica/terapia
15.
Surg Innov ; 25(3): 274-279, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29537349

RESUMO

BACKGROUND: Text messaging has become ubiquitous and is being increasingly used within the health care system. The purpose of this study was to understand texting practices for clinical communication among staff surgeons at a large academic institution. METHODS: Staff surgeons in 4 subspecialties (vascular, plastics, urology, and general surgery) were surveyed electronically. RESULTS: A total of 62 surgeons from general surgery (n = 33), vascular surgery (n = 6), plastic surgery (n = 13), and urology (n = 10) completed the study (response rate 30%). When conveying urgent patient-related information, staff surgeons preferred directly calling other staff surgeons (61.5%) and trainees (58.8%). When discussing routine patient information, staff surgeons used email to reach other staff surgeons (54.9%) but preferred texting (62.7%) for trainees. The majority of participants used texting because it is fast (65.4%), convenient (69.2%) and allows transmitting information to multiple recipients simultaneously (63.5%). Most felt that texting enhances patient care (71.5%); however, only half believed that it enhanced trainees' educational experiences. The majority believed that texting identifiable patient information breaches patient confidentiality. CONCLUSIONS: Our data showed high adoption of text messaging for clinical communication among surgeons, particularly with trainees. The majority of surgeons acknowledge security concerns inherent in texting for patient care. Existing mobile communication platforms fail to meet the needs of academic surgeons. Further research should include guidelines related to texting in clinical practice, educational implications of texting, and technologies to better meet the needs of clinicians working in an academic surgical settings.


Assuntos
Assistência ao Paciente/métodos , Cirurgiões/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Mensagem de Texto/estatística & dados numéricos , Adulto , Idoso , Atitude do Pessoal de Saúde , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Smartphone
16.
J Pediatr Surg ; 53(4): 771-774, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28506479

RESUMO

BACKGROUND: To describe the spectrum of noniatrogenic pediatric vascular injuries and their outcomes at a large tertiary pediatric hospital. METHODS: Retrospective review of a prospectively-maintained trauma database, identifying children with noniatrogenic vascular injuries managed between 1994 and 2014. RESULTS: A total of 198 patients were identified. Those patients with a digital or intracerebral vascular injury (92/198) were excluded from further analysis. The remaining 106 patients represented 1.2% of all traumas managed at our institution during the 21-year study period. The majority were male (75%), and between 1 and 12years of age (71% of all patients). Median time from trauma scene to any hospital was 48min (range 0-132), and most patients were transferred from another hospital (64%). Three patients were declared dead upon arrival (3%). Penetrating injuries accounted for most injuries (72%), while blunt injuries accounted for the remainder. Ulnar, radial, or brachial artery trauma accounted for 47% of injuries. Most vessels were treated operatively, by primary repair (49%), vessel ligation (15%), or interposition graft (12%). Fourteen patients (13%) were managed nonoperatively and most patients (74%) experienced no complications in hospital or during follow-up. CONCLUSION: Noniatrogenic pediatric vascular injuries are rare and represent a highly heterogeneous population. Most children recover well, with minimal perioperative complications. LEVEL OF EVIDENCE: IV (case series with no comparison group).


Assuntos
Lesões do Sistema Vascular , Adolescente , Criança , Pré-Escolar , Bases de Dados Factuais , Feminino , Seguimentos , Hospitais Pediátricos , Humanos , Lactente , Recém-Nascido , Masculino , Ontário/epidemiologia , Estudos Retrospectivos , Lesões do Sistema Vascular/diagnóstico , Lesões do Sistema Vascular/epidemiologia , Lesões do Sistema Vascular/etiologia , Lesões do Sistema Vascular/terapia
18.
Blood Purif ; 43(1-3): 218-225, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28114132

RESUMO

In the global scenario, as the prevalence of renal failure and diabetes increases, healing and limb preservation assume increasing clinical importance for patients and healthcare systems. Unfortunately, there continues to be variation in the care delivered to patients at risk of losing a limb based on geography, race, socioeconomic status, and insurance status. There are also a variety of therapeutic approaches to patients with limb-threatening ischemia; 25% undergo primary amputation, 25% undergo medical therapy, and only 50% undergo any attempt at revascularization. Nearly 50% of patients undergoing major amputation have not had a simple diagnostic arteriogram to assess the possibility of limb preservation. The Society of Vascular Surgery and the American Podiatric Medical Association have recognized the benefits of a multidisciplinary approach to limb preservation. Benefits to the patient include rapid assessment, improved healing, and enhanced revascularization. Advantages for the providers include the ability to efficiently manage complex patients with help from the appropriate specialties, an increase in referrals, enhanced identity of the institution, and clinical research and trials. Such a program requires the coordinated effort of physicians, nurses, allied health professionals, and administrators dedicated to the preservation of functional limbs. Beneficial components include identifiable space, a vascular laboratory, hyperbaric oxygen therapy, and protocol-driven care involving diagnostic and therapeutic modalities such as endovascular revascularization, open bypass, and soft tissue reconstruction. Prosthetic expertise is also important to maintain function in those patients for whom amputation is appropriate. But, the key to a program is cooperation and communication among the participants who have a passion for limb preservation. Video Journal Club 'Cappuccino with Claudio Ronco' at http://www.karger.com/?doi=452746.


Assuntos
Isquemia/terapia , Salvamento de Membro/métodos , Amputação/estatística & dados numéricos , Membros Artificiais , Humanos , Salvamento de Membro/estatística & dados numéricos , Procedimentos Cirúrgicos Vasculares/estatística & dados numéricos , Cicatrização
19.
J Surg Educ ; 74(4): 638-643, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28130100

RESUMO

OBJECTIVES: Smartphones have become the most important personal technological device. M-learning is learning through mobile device educational technology. We aim to assess the acceptability of a smartphone learning experience among the vascular trainees and determine if results could inform formal teaching efforts. METHODS: A survey of the vascular trainees at a single center was conducted following a trial of smartphone learning experience. A vascular fellow used a smartphone response system application (Polltogo, Inspirapps Inc.) to send a daily multiple-choice question to the vascular residents for 20 consecutive working days. The application allows for only one attempt from each user, and the answers are registered anonymously. However, each participant receives instant feedback on his/her response by viewing the correct answer after answering each question along with a distribution of answers among other users. RESULTS: A total of 9 trainees participated in the trial, and all of them filled a posttrial survey. All the trainees possessed smartphones. The majority (78%) were not aware of the concept of m-learning. The mobile engagement score (number of answers received divided by total possible answers) was 145/180 (81%). All the trainees were "satisfied" or "very satisfied" with the experience, and the same number stated that they were "likely" or "very likely" to use this technology in the future. The majority (89%) agreed that such an application could assist them in preparing for their board examination. On 3 occasions, 75% or more of the participating trainees answered the multiple-choice question incorrectly, which resulted in addressing the relevant topics in the unit's weekly teaching conference. CONCLUSION: Using smartphones for education is acceptable among the vascular trainees, and the trial of a response system application with instant written feedback represents a novel method for using smartphones for collaborative learning. Such an application can also inform program directors and surgical trainers of their trainees' learning needs.


Assuntos
Educação de Pós-Graduação em Medicina/métodos , Aplicativos Móveis , Smartphone , Procedimentos Cirúrgicos Vasculares/educação , Adulto , Avaliação Educacional , Feminino , Humanos , Internato e Residência , Masculino , Aprendizagem Baseada em Problemas
20.
Ann Vasc Surg ; 38: 293-297, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27522970

RESUMO

BACKGROUND: We propose a novel technique for endovenous treatment of varicose veins (VVs) using combined coil embolization and foam sclerotherapy of the great saphenous vein (GSV). METHODS: A retrospective case-series analysis on patients undergoing fluoroscopically guided coil embolization of the GSV and foam sclerotherapy of the GSV and below-knee varices at a single Canadian center. RESULTS: Twenty-two patients underwent the procedure on 23 legs. Most patients (78.3%) presented for follow-up 57.2 ± 21.9 days postoperatively. Doppler studies demonstrated complete GSV occlusion in all patients. While 3 patients (13.6%) noted skin discoloration overlying the treated VVs, none complained of pain on follow-up or developed leg numbness, deep vein thrombosis, or pulmonary emboli. CONCLUSIONS: Coil embolization and foam sclerotherapy are a novel and effective treatment for VVs that uses existing and readily available angiographic equipment.


Assuntos
Embolização Terapêutica/instrumentação , Veia Safena , Soluções Esclerosantes/administração & dosagem , Tetradecilsulfato de Sódio/administração & dosagem , Varizes/terapia , Idoso , Terapia Combinada , Embolização Terapêutica/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ontário , Flebografia , Estudos Retrospectivos , Veia Safena/diagnóstico por imagem , Soluções Esclerosantes/efeitos adversos , Escleroterapia/efeitos adversos , Índice de Gravidade de Doença , Tetradecilsulfato de Sódio/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia Doppler , Varizes/diagnóstico por imagem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA