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1.
Urol Int ; 92(3): 306-9, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24334874

RESUMO

OBJECTIVES: To assess the preoperative urodynamic predictors of urinary incontinence (UI) 1 year after robot-assisted radical prostatectomy (RARP) and to design a nomogram capable of predicting its occurrence. MATERIALS AND METHODS: Our prospective study included 58 previously continent patients who underwent RARP, in most cases, bilateral nerve-sparing and bladder neck preservation. A urodynamic examination including a urethral pressure profile was performed preoperatively. Multivariate analysis was used to assess the predictors for the need to use 1 or more pads/day and a nomogram was constructed. RESULTS: There was a 20.6% incidence of UI at 1 year after RARP. Bladder compliance, maximum urethral closure pressure and the development of bladder outlet obstruction, correlated well with the incidence of UI on the multivariate analysis (p = 0.043, 0.001, and 0.05, respectively). CONCLUSION: Bladder compliance <27.8 ml/cm H2O, maximum urethral closure pressure <50.3 cm H2O and the bladder outlet obstruction are independent urodynamic factors correlating with UI after RARP. The new nomogram can objectively predict a patient likelihood of requiring 1 or more pads/day 1 year after RARP with a good accuracy.


Assuntos
Técnicas de Apoio para a Decisão , Prostatectomia/efeitos adversos , Robótica , Cirurgia Assistida por Computador/efeitos adversos , Uretra/fisiopatologia , Incontinência Urinária/etiologia , Urodinâmica , Idoso , Humanos , Tampões Absorventes para a Incontinência Urinária , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Nomogramas , Valor Preditivo dos Testes , Cuidados Pré-Operatórios , Pressão , Estudos Prospectivos , Prostatectomia/métodos , Medição de Risco , Fatores de Risco , Resultado do Tratamento , Bexiga Urinária/fisiopatologia , Incontinência Urinária/fisiopatologia , Incontinência Urinária/terapia
2.
Rev Panam Salud Publica ; 33(1): 1-7, 2013 Jan.
Artigo em Espanhol | MEDLINE | ID: mdl-23440151

RESUMO

OBJECTIVE: To develop recommendations for the design and implementation of adverse event notification systems based on the experiences of the Latin American countries. METHODS: Employing the qualitative Metaplán methodology, proposals were obtained from 17 experts on adverse event notification systems from Argentina, Brazil, Chile, Colombia, Cuba, Mexico, and Peru and three from the Pan American Health Organization. The characteristics, scope, barriers and constraints, data entry method, type of analysis, and information feedback on adverse event notification systems were reviewed and how to involve professionals in this process was discussed. The proposals were prioritized through an analysis of the responses, debate, and collective deliberation. RESULTS: A total of 73 recommendations were obtained on the characteristics that adverse event notification systems should have and 90 on barriers and constraints. There was agreement that legal security for professionals, a culture of safety in health facilities, incentives, a nimble system for providing professionals with results, and a single taxonomy are key to the successful implementation of adverse event notification systems, which must endeavor to protect patient safety in order to improve health care. CONCLUSIONS: Adverse event notification systems must be tailored to the needs of each health center. They exist to enable the health system to learn from experience. Confidentiality, anonymity, voluntary participation, a single taxonomy, and legal security for professionals are critical elements of adverse event notification systems.


Assuntos
Sistemas de Informação Hospitalar/normas , Segurança do Paciente/normas , Guias como Assunto , Humanos , América Latina , Inquéritos e Questionários
3.
Rev. panam. salud pública ; 33(1): 1-7, ene. 2013. tab
Artigo em Espanhol | LILACS | ID: lil-666277

RESUMO

OBJETIVO: Elaborar recomendaciones para diseñar e implantar sistemas de notificación (SN) de eventos adversos en base a las experiencias de los países latinoamericanos. MÉTODOS: Mediante la metodología cualitativa Metaplán se recogieron propuestas a partir de la experiencia de 17 expertos nacionales en SN (de Argentina, Brasil, Chile, Colombia, Cuba, México y Perú) y 3 expertos de la Organización Panamericana de la Salud. Se analizaron las características, el alcance, las barreras y las limitaciones, el método de registro de datos, el tipo de análisis y el retorno de la información relacionada con los SN, y se discutió cómo involucrar a los profesionales en este proceso. Mediante el análisis de las respuestas y el discurso y la ponderación colectiva se priorizaron las propuestas. RESULTADOS: Se recogieron 73 recomendaciones sobre las características que deben poseer los SN y 90 sobre las barreras y limitaciones. Existió acuerdo en que la seguridad jurídica de los profesionales, la cultura de seguridad del establecimiento de salud, los incentivos, un sistema ágil para proporcionar resultados a los profesionales y una taxonomía unificada son temas clave para implantar con éxito un SN. Los SN deben dirigirse a generar mecanismos de seguridad para mejorar la atención sanitaria. CONCLUSIONES: Los SN deben ajustarse a las necesidades de cada centro. La oportunidad para aprender de la propia experiencia es la razón de ser de los SN. La confidencialidad, el anonimato, la voluntariedad, la taxonomía unificada y la seguridad jurídica de los profesionales son elementos cruciales de los SN.


OBJECTIVE: To develop recommendations for the design and implementation of adverse event notification systems based on the experiences of the Latin American countries. METHODS: Employing the qualitative Metaplán methodology, proposals were obtained from 17 experts on adverse event notification systems from Argentina, Brazil, Chile, Colombia, Cuba, Mexico, and Peru and three from the Pan American Health Organization. The characteristics, scope, barriers and constraints, data entry method, type of analysis, and information feedback on adverse event notification systems were reviewed and how to involve professionals in this process was discussed. The proposals were prioritized through an analysis of the responses, debate, and collective deliberation. RESULTS: A total of 73 recommendations were obtained on the characteristics that adverse event notification systems should have and 90 on barriers and constraints. There was agreement that legal security for professionals, a culture of safety in health facilities, incentives, a nimble system for providing professionals with results, and a single taxonomy are key to the successful implementation of adverse event notification systems, which must endeavor to protect patient safety in order to improve health care. CONCLUSIONS: Adverse event notification systems must be tailored to the needs of each health center. They exist to enable the health system to learn from experience. Confidentiality, anonymity, voluntary participation, a single taxonomy, and legal security for professionals are critical elements of adverse event notification systems.


Assuntos
Humanos , Sistemas de Informação Hospitalar/normas , Segurança do Paciente/normas , Guias como Assunto , América Latina , Inquéritos e Questionários
4.
Urol Int ; 90(1): 31-5, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23207744

RESUMO

OBJECTIVES: Urinary incontinence (UI) still remains one of the major functional complications after robot-assisted radical prostatectomy (RARP). As the cause for UI is multifactorial, it is quite difficult to make a prediction preoperatively. Considering intraoperative and postoperative risk factors, besides the preoperative ones, we designed an incontinence prediction model, administered 1 month after the surgery, in order to identify incontinent patients at 1 year. PATIENTS AND METHODS: We retrospectively reviewed 244 patients who underwent RARP at our institution. Only 209 patients had sufficient data, a 1-year follow-up and were continent preoperatively. The association of UI with the risk factors was assessed by univariable and multivariable regression models. RESULTS: There was a 17.2% global UI rate at 1 year after RARP. Only age-adjusted Charlson comorbidity index, erectile function assessed by International Index of Erectile Function-5, prostate volume, nerve-sparing status and 24-hour urine loss at 1 month correlated with UI (p = 0.032, 0.009, 0.031, 0.018 and <0.001, respectively). The accuracy of the prediction model of UI was 92.8% (c-index), with an area under the curve of 91.9%. CONCLUSION: Age-adjusted Charlson comorbidity index, International Index of Erectile Function-5, prostate volume, nerve-sparing status and 24-hour urine loss at 1 month after RARP can predict an individual's risk of UI at 1 year after RARP with good accuracy. Further external validation is required in order to generalize the use of this model.


Assuntos
Técnicas de Apoio para a Decisão , Laparoscopia/efeitos adversos , Prostatectomia/efeitos adversos , Robótica , Incontinência Urinária/etiologia , Fatores Etários , Área Sob a Curva , Comorbidade , Disfunção Erétil/etiologia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Nomogramas , Seleção de Pacientes , Prostatectomia/métodos , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
6.
Rev. Soc. Boliv. Pediatr ; 52(2): 67-77, 2013. ilus
Artigo em Espanhol | LILACS-Express | ID: lil-738265

RESUMO

Objetivo. Elaborar recomendaciones para diseñar e implantar sistemas de notificación (SN) de eventos adversos en base a las experiencias de los países latinoamericanos. Métodos. Mediante la metodología cualitativa Meta-plán se recogieron propuestas a partir de la experiencia de 17 expertos nacionales en SN (de Argentina, Brasil, Chile, Colombia, Cuba, México y Perú) y 3 expertos de la Organización Panamericana de la Salud. Se analizaron las características, el alcance, las barreras y las limitaciones, el método de registro de datos, el tipo de análisis y el retorno de la información relacionada con los SN, y se discutió cómo involucrar a los profesionales en este proceso. Mediante el análisis de las respuestas y el discurso y la ponderación colectiva se priorizaron las propuestas. Resultados. Se recogieron 73 recomendaciones sobre las características que deben poseer los SN y 90 sobre las barreras y limitaciones. Existió acuerdo en que la seguridad jurídica de los profesionales, la cultura de seguridad del establecimiento de salud, los incentivos, un sistema ágil para proporcionar resultados a los profesionales y una taxonomía unificada son temas clave para implantar con éxito un SN. Los SN deben dirigirse a generar mecanismos de seguridad para mejorar la atención sanitaria. Conclusiones. Los SN deben ajustarse a las necesidades de cada centro. La oportunidad para aprender de la propia experiencia es la razón de ser de los SN. La confidencialidad, el anonimato, la voluntariedad, la taxonomía unificada y la seguridad jurídica de los profesionales son elementos cruciales de los SN.


Objective. To develop recommendations for the design and implementation of adverse event notification systems based on the experiences of the Latin American countries. Methods. Employing the qualitative Metaplán methodology, proposals were obtained from 17 experts on adverse event notification systems from Argentina, Brazil, Chile, Colombia, Cuba, Mexico, and Peru and three from the Pan American Health Organization. The characteristics, scope, barriers and constraints, data entry method, type of analysis, and information feedback on adverse event notification systems were reviewed and how to involve professionals in this process was discussed. The proposals were prioritized through an analysis of the responses, debate, and collective deliberation. Results. A total of 73 recommendations were obtained on the characteristics that adverse event notification systems should have and 90 on barriers and constraints. There was agreement that legal security for professionals, a culture of safety in health facilities, incentives, a nimble system for providing professionals with results, and a single taxonomy are key to the successful implementation of adverse event notification systems, which must endeavor to protect patient safety in order to improve health care. Conclusions. Adverse event notification systems must be tailored to the needs of each health center. They exist to enable the health system to learn from experience Confidentiality, anonymity, voluntary participation, a single taxonomy, and legal security for professionals are critical elements of adverse event notification systems.

9.
Gac. méd. Méx ; 131(5/6): 513-25, sept.-dic. 1995. ilus, tab
Artigo em Espanhol | LILACS | ID: lil-174084

RESUMO

El Modelo Operativo de Servicios de Atención Primaria a la Salud, surgió como una necesidad de brindar Servicios de Salud a una población de pobreza extrema y sin seguridad social, ubicada en le Municipio de Chimalhuacán, en el Estado de México. El presente artículo describe los aspectos conceptuales, de organización y de operación de un modelo innovador, cuya característica principal es su reorganización funcional, al incorporar a técnicos en atención primaria previamente capacitados, para brindar atención sobre los problemas de salud prioritarios de la región. La unidad básica de organización de este modelo, es el Módulo Básico de Atención Primaria, formado por un médico y cinco técnicos, con capacidad para atender potencialmente a 15 mil habitantes. Este modelo ofrece una alternativa para utilizar óptimamente los recursos humanos disponibles y la infraestructura existente. Por último, se destaca la importancia del seguimiento de la supervisión y de la evaluación del modelo


Assuntos
Atenção Primária à Saúde/organização & administração , Educação em Saúde , Medicina/organização & administração , Medicina de Família e Comunidade/organização & administração , Níveis de Atenção à Saúde , Sistemas de Saúde
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