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1.
Educ Prim Care ; : 1-9, 2019 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-31851578

RESUMO

Background: Recruitment to General Practitioner (GP) training programmes in the United Kingdom is poor. Colleagues' negative comments about general practice could contribute to this.Aim: To investigate what influences Foundation Year 2 (FY2) doctors in their decisions to choose general practice as a career, and how colleagues' comments about GPs might affect those decisions.Design and Setting: A qualitative study in Southwest England.Method: Thematic analysis of interviews with FY2 doctors.Results: Twenty-four doctors participated. They thought that GPs worked hard and had very varied clinical work. The effect on their career choice depended on their personalities. GP placement experiences significantly influenced their career intentions. The loneliness of working in general practice was a key concern. FY2 doctors thought colleagues' criticisms of GPs did not reflect reality and were outdated. 'Banter' had little effect on career choices.Conclusion: Person-specialty fit and FY2 doctors' experiences of GP work have a significant effect on career choices. Loneliness in their GP work placements is a particular problem that should be addressed. While colleagues' derogatory comments about GPs may affect medical students' views on their career choices, they appear to have little effect on the career decision-making of qualified doctors.Abbreviations: CMT: Core Medical Training; FY2: Foundation Year 2; GP: general practitioner; NHS: National Health Service; UK: United Kingdom.

2.
BMC Med Educ ; 19(1): 313, 2019 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-31429745

RESUMO

Following publication of the original article [1], the authors reported an error in the first paragraph of the 'Results' section.

3.
Int J Equity Health ; 18(1): 113, 2019 07 23.
Artigo em Inglês | MEDLINE | ID: mdl-31337407

RESUMO

BACKGROUND: Homeless people have poor health and mortality indices. Despite this they make poor usage of health services. This study sought to understand why they use health services differently from the domiciled population. METHODS: Ethnographic observations were conducted at several homeless services, in Dublin. This was supplemented with 47 semi-structured interviews with homeless people and two focus groups of homeless people and hospital doctors. A critical-realist approach was adopted for interpretation of the data. RESULTS: Homeless people tended to present late in their illness; default early from treatment; have low usage of primary-care, preventative and outpatient services; have high usage of Emergency and Inpatient services; and poor compliance with medication. They tended to avoid psychiatric services. A number of external barriers were identified. These were classified as physical (distance) administrative (application process for medical care; appointments; queues; the management of addiction in hospital; rules of service; and information providing processes); and attitudinal (stigma; differing attitudes as to appropriate use of services. A new form of barrier, Conversations of Exclusion was identified and described. Internalised barriers were identified which were in nature, either cognitive (fatalistic, denial, deferral to future, presumption of poor treatment or discrimination, self blame and survival cognitions) or emotional (fear; embarrassment, hopelessness and poor self-esteem). Generative mechanisms for these factors were identified which either affected participants prior to homelessness (marginalization causing hopelessness, familial dysfunction, substance misuse, fear of authority, illiteracy; mental health; and poor English) or after becoming homeless (homelessness; ubiquity of premature death; substance misuse; prioritization of survival over health; threat of violence; chaotic nature of homelessness; negative experiences of authority; and stigma. CONCLUSIONS: An explanatory critical realist model integrating the identified generative mechanisms, external and internalised barriers was developed to explain why the Health service Utilization of homeless people differs from the domiciled populations. This new model has implications for health service policy makers and providers in how they design and deliver accessible health services to homeless people.


Assuntos
Atitude Frente a Saúde , Pessoas em Situação de Rua/psicologia , Atenção Primária à Saúde/organização & administração , Autoimagem , Populações Vulneráveis/psicologia , Adulto , Feminino , Grupos Focais , Acesso aos Serviços de Saúde/estatística & dados numéricos , Pessoas em Situação de Rua/estatística & dados numéricos , Humanos , Irlanda , Masculino , Transtornos Mentais/psicologia , Saúde Mental/estatística & dados numéricos , Apoio Social , Inquéritos e Questionários
4.
J Craniofac Surg ; 30(3): 854-859, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31048613

RESUMO

Pediatric facial fractures present and are managed differently than the adult population. This study describes the pattern and mechanism of facial fractures in children and identifies factors associated with need for surgical management. An IRB-approved retrospective chart analysis of all pediatric patients age ≤ 18 years diagnosed with facial fractures at our level 1 trauma center over a 10-year period (January 2006-December 2015) was performed. Demographics, fracture location, mechanism of injury, concomitant head and neck injuries, and surgical management were reviewed. Statistical analysis was then performed comparing surgical and nonsurgical cohorts using univariate and multivariate analyses. One thousand two hundred seventy-four patients were diagnosed with facial fractures. Five hundred seventeen (40.6%) underwent surgical management. Two thousand one hundred seventy-two total facial fractures were recorded. Orbit fractures (29%) were the most commonly recorded, observed in 49% of patients presenting. Increased age was associated with increased odds of surgical management (OR 1.13; 95% CI 1.09-1.16). Mandible (OR 9.28; 95% CI 6.88-12.51) and Le Fort fractures (OR 19.73; 95% CI 9.78-39.77) had increased odds of surgical management. Patients with traumatic brain injury had reduced odds (OR 0.54; 95% CI 0.35-0.83) of surgical management for their facial fractures. Older pediatric patients may be more likely to require surgical management of their facial fractures, especially those with mandible or Le Fort fractures. Patients with traumatic brain injury are likely to sustain life threatening injuries, deferring repair of their facial fractures. Patient education and counseling, as well as predictive models, can be improved to reflect these data.


Assuntos
Fraturas Cranianas , Adolescente , Criança , Pré-Escolar , Humanos , Lactente , Recém-Nascido , Estudos Retrospectivos , Fraturas Cranianas/epidemiologia , Fraturas Cranianas/cirurgia
5.
J Craniofac Surg ; 30(7): 1970-1973, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31107387

RESUMO

INTRODUCTION: Pediatric facial fractures due to intentionally violent mechanisms represent a unique subset of facial fractures. The objective of our research is to identify how violence affects patterns of facial fractures and their management in pediatric patients. METHODS: An IRB approved, retrospective study of our institution's pediatric patients ≤18 years of age who presented with ≥1 facial fracture due to violence from January 2006 to December 2015 was performed. Violence was defined as trauma intended to hurt another or self. Demographics, fractures, mechanism, concomitant injuries, and management were analyzed. RESULTS: The 1274 patients were diagnosed with facial fractures, with 235 of these due to violence (18%). These patients of violence (POV) had 332 fractures, with an average fracture per patient of 1.4 ±â€Š.0.8. The majority (86%) were male, Non-Hispanic African American (35%), and the average age was 15.9 ±â€Š2.8 years. The most common fracture was the mandible (50% of patients) and most common mechanism was assault (76%). The POV were older, male, and of minority race/ethnic groups when compared to patients of non-violence (PONV) (P <0.01). The POV presented with fewer concomitant injuries, were less likely to be admitted to the intensive care unit, and more often surgically managed when compared to the PONV (P <0.01). CONCLUSION: This study represents the largest US, single institution, Level 1 trauma center study of pediatric facial fractures. Pediatric patients with facial fractures due to a violent mechanism represent a distinct category of trauma patients with a unique profile of injuries.


Assuntos
Fraturas Cranianas/epidemiologia , Violência , Adolescente , Criança , Ossos Faciais/lesões , Humanos , Estudos Retrospectivos
6.
BMC Med Educ ; 19(1): 104, 2019 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-30975136

RESUMO

BACKGROUND: Negative comments from senior colleagues about specialties, such as general practice and psychiatry, are known to influence trainees' career choice, but little is known about the extent of this influence or the mechanism by which it works. There have been calls to ban these disparaging comments, also known as 'banter'. This study explored how recently qualified doctors make sense of banter in the context of other experiences and information. METHODS: Semi-structured telephone interviews were conducted with 24 trainee doctors in their second postgraduate year in South West England. Thematic Analysis was used to code the data and organise them into themes. RESULTS: Trainees are commonly exposed to banter about the merits of different specialties and those who work in them, but these messages are not received uncritically and are not perceived to be decisive in determining career choice. The views of senior doctors are assimilated with other experiences and information, as trainees strive to assess their 'fit' with a specialty. While banter is seen as positioning specialties in a status hierarchy, other factors such as work-life balance and feeling 'at home' in a specialty are often believed to be more significant factors in career choice. We posited two theories of banter; the 'propaganda model' and the 'person-specialty fit model,' and found the latter to provide a better understanding of how banter informs career choice. CONCLUSIONS: Banter often comprises stereotypes and caricatures, but despite its biases and distortions, it may still aid career choice. The challenge is not to ban banter, but to provide more accurate and reliable knowledge and experiences of what working life is like in different specialties.


Assuntos
Escolha da Profissão , Médicos , Especialização/estatística & dados numéricos , Apoio ao Desenvolvimento de Recursos Humanos/estatística & dados numéricos , Adulto , Atitude do Pessoal de Saúde , Inglaterra , Feminino , Humanos , Entrevistas como Assunto , Satisfação no Emprego , Masculino , Médicos/psicologia , Pesquisa Qualitativa , Resiliência Psicológica
7.
Lancet Psychiatry ; 6(1): 61-71, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30342864

RESUMO

Terror is a psychological state. Historically, most studies of terrorism focused on its societal purpose and structural consequences rather than mental health effects. That emphasis began to change shortly before the Sept 11, 2001, terrorist attacks. A vast expansion of research into post-traumatic stress disorder accompanied revisions to the classification of mental health disorders. The effect of terrorist incidents on those people now deemed vulnerable, both directly and indirectly, was actively sought. However, a review of more than 400 research articles (mostly published after Sept 11) on the association between terrorism and mental health reached the largely overlooked conclusion that terrorism is not terrorising-at least not in a way that causes a greater than expected frequency of post-traumatic stress disorder than other traumatic events. This conclusion is surprising given the emphasis on the psychological effects of terrorism in political discourse, media commentary, contemporary culture, and academic inquiry. Authorities might prefer to encourage an interpretation of terrorist incidents that highlights fortitude and courage rather than psychological vulnerability.


Assuntos
Adaptação Psicológica , Transtornos de Estresse Pós-Traumáticos/psicologia , Terrorismo/psicologia , História do Século XX , História do Século XXI , Humanos , Ataques Terroristas de 11 de Setembro/história , Terrorismo/história
8.
J Craniomaxillofac Surg ; 44(7): 763-9, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27160339

RESUMO

OBJECTIVE: The study aimed to examine the management and outcomes of mandibular fractures in patients with diabetes mellitus by examining the injury modalities, treatment methods, and complications. METHODS: The study conducted was a retrospective case review of patients admitted to Memorial Hermann Hospital from 2007 to 2011 with diagnoses of diabetes mellitus and mandibular fracture. The electronic medical records were reviewed for patient demographics, injury data, surgery methodology, treatment variables, and complications. RESULTS: Out of the 34 diabetic patients, the average age was 52 with the majority of the fractures being the result of falls, 12 (35.3%). Of the 63 total fractures, 24 (38.1%) fractures were repaired through closed reduction and 39 (61.9%) fractures required open reduction with internal fixation. 17 (50.0%) patients had at least one complication following mandibular fracture repair. The most common complications in this sample population included nerve injury, 7 (20.6%), infection, 7 (20.6%), wound dehiscence with or without hardware exposure, 6 (17.7%), and malocclusion, 5 (14.7%). CONCLUSION: When compared to the limited published data our findings imply that diabetic patients with mandibular fractures present as an older population than commonly seen with mandibular fractures and suggest a higher overall rate of complications.


Assuntos
Complicações do Diabetes , Fraturas Mandibulares/cirurgia , Acidentes por Quedas , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Redução Fechada/efeitos adversos , Fixação Interna de Fraturas/efeitos adversos , Humanos , Fraturas Mandibulares/complicações , Fraturas Mandibulares/etiologia , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
9.
Environ Pollut ; 213: 223-231, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26901074

RESUMO

Over recent decades, efforts have been made to reduce human exposure to atmospheric pollutants including polycyclic aromatic hydrocarbons (PAHs) and polychlorinated biphenyls (PCBs) through emission control and abatement. Along with the potential changes in their concentrations resulting from these efforts, profiles of emission sources may have also changed over such extended timeframes. However relevant data are quite limited in the Southern Hemisphere. We revisited two sampling sites in an Australian city, where the concentration data in 1994/5 for atmospheric PAHs and PCBs were available. Monthly air samples from July 2013 to June 2014 at the two sites were collected and analysed for these compounds, using similar protocols to the original study. A prominent seasonal pattern was observed for PAHs with elevated concentrations in cooler months whereas PCB levels showed little seasonal variation. Compared to two decades ago, atmospheric concentrations of ∑13 PAHs (gaseous + particle-associated) in this city have decreased by approximately one order of magnitude and the apparent halving time (t1/2) was estimated as 6.2 ± 0.56 years. ∑6iPCBs concentrations (median value; gaseous + particle-associated) have decreased by 80% with an estimated t1/2 of 11 ± 2.9 years. These trends and values are similar to those reported for comparable sites in the Northern Hemisphere. To characterise emission source profiles, samples were also collected from a bushfire event and within a vehicular tunnel. Emissions from bushfires are suggested to be an important contributor to the current atmospheric concentrations of PAHs in this city. This contribution is more important in cooler months, i.e. June, July and August, and its importance may have increased over the last two decades.


Assuntos
Monitoramento Ambiental/métodos , Fogo , Bifenilos Policlorados/química , Hidrocarbonetos Policíclicos Aromáticos/química , Austrália , Cidades , Gases/análise , Humanos , Fatores de Tempo
10.
Health (London) ; 19(1): 17-33, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24821926

RESUMO

The UK government is promoting the health benefits of work, in order to change doctors' and patients' behaviour and reduce sickness absence. The rationale is that many people 'off sick' would have better outcomes by staying at work; but reducing the costs of health care and benefits is also an imperative. Replacement of the 'sick note' with the 'fit note' and a national educational programme are intended to reduce sickness-certification rates, but how will these initiatives impact on doctor-patient relationships and the existing tension between the doctor as patient advocate and gate-keeper to services and benefits? This tension is particularly acute for problems like chronic pain where diagnosis, prognosis and work capacity can be unclear. We interviewed 13 doctors and 30 chronic pain patients about their experiences of negotiating medical certification for work absence and their views of the new policies. Our findings highlight the limitations of naïve rationalist approaches to judgements of work absence and fitness for work for people with chronic pain. Moral, socio-cultural and practical factors are invoked by doctors and patients to contest decisions, and although both groups support the fit note's focus on capacity, they doubt it will overcome tensions in the consultation. Doctors value tacit skills of persuasion and negotiation that can change how patients conceptualise their illness and respond to it. Policy-makers increasingly recognise the role of this tacit knowledge and we conclude that sick-listing can be improved by further developing these skills and acknowledging the structural context within which protagonists negotiate sick-listing.


Assuntos
Atitude Frente a Saúde , Dor Crônica/diagnóstico , Clínicos Gerais/psicologia , Relações Médico-Paciente , Licença Médica/economia , Avaliação da Capacidade de Trabalho , Atitude do Pessoal de Saúde , Dor Crônica/economia , Dor Crônica/psicologia , Controle de Custos/métodos , Controle de Custos/normas , Emprego/psicologia , Inglaterra , Clínicos Gerais/normas , Política de Saúde/economia , Política de Saúde/legislação & jurisprudência , Humanos , Entrevistas como Assunto , Negociação , Pacientes/psicologia , Pesquisa Qualitativa , Licença Médica/legislação & jurisprudência , Licença Médica/tendências
11.
J Health Organ Manag ; 28(6): 777-94, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25420356

RESUMO

PURPOSE: The purpose of this paper is to engage stakeholders in the development of a community based chronic pain-management service and identify their different agendas for service design and delivery. DESIGN/METHODOLOGY/APPROACH: Data were collected using the Nominal Group Technique (NGT), a ten-step process that generates qualitative and quantitative data. Seven NGT groups were conducted in the south-west region of the UK, three with General Practitioners and nurses, three with chronic pain patients, and one with Healthcare Commissioners. FINDINGS: The patient agenda for service development focused on process of care issues particularly the need for deep- empathy and emotional support from providers, while professionals prioritised cost-effectiveness. While there was some overlap between agendas they were largely discrete and often contradictory. RESEARCH LIMITATIONS/IMPLICATIONS: - The findings imply service planners will need to make trade-offs between cost-containment and patient satisfaction. The methodology did not allow trade-offs to be put to participants in a structured form. However, such techniques are available, for example, Conjoint Analysis. There may also be value in bringing together patients and professionals in joint focus groups, to see if the gap between their different agendas can be bridged through discussion. ORIGINALITY/VALUE: The findings provide a novel insight into the competing agendas of patients and professionals regarding service development and design which will be of value to service planners and managers as they strive to reconcile these differences.


Assuntos
Atitude do Pessoal de Saúde , Dor Crônica/terapia , Preferência do Paciente , Desenvolvimento de Programas , Inglaterra , Grupos Focais , Medicina Geral , Humanos
12.
Prim Health Care Res Dev ; 15(3): 312-23, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23866920

RESUMO

BACKGROUND: Acceptance and commitment therapy (ACT), a form of cognitive-behavioral therapy, may help meet a need for accessible and cost-effective treatments for chronic pain. ACT has a growing evidence base, but has not yet been tested within general practice settings. AIM: The purpose of the present study was to examine the feasibility of conducting a full-scale randomized controlled trial of ACT in general practice. METHODS: A total of 481 potential participants with chronic pain identified from general practice in southwest England were invited into a treatment trial. Subsequently, 102 (21.2%) of those invited were screened, and 73 (71.6%) of those screened were allocated to ACT plus usual care or usual care alone. The ACT treatment included four, four-hour group-based sessions over two weeks. RESULTS: Twenty-six (70.3%) of the patients allocated to ACT attended three or four sessions. Those who received ACT rated it as credible in a short survey, with Mdn rating 7.0 on a 0-10 scale, across five credibility items. During a post-treatment interview considering 12 aspects of the study from invitation to treatment termination, a median of 79.2% of participants rated the aspects 'acceptable.' Qualitative data from the interviews showed a mixed picture of patient experiences, revealing possible tensions between patients' wishes to avoid discomfort and confusion, and treatment methods that explicitly ask patients to, in essence, 'live with' some discomfort and confusion. CONCLUSIONS: These data suggest that further study of ACT, as a treatment for chronic pain, is feasible in general practice and it may be possible to further optimize the treatment experience.


Assuntos
Terapia de Aceitação e Compromisso/organização & administração , Dor Crônica/terapia , Medicina Geral/organização & administração , Seleção de Pacientes , Psicoterapia de Grupo/organização & administração , Terapia de Aceitação e Compromisso/economia , Terapia de Aceitação e Compromisso/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Dor Crônica/economia , Dor Crônica/psicologia , Análise Custo-Benefício , Inglaterra , Estudos de Viabilidade , Feminino , Medicina Geral/economia , Medicina Geral/métodos , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Avaliação de Programas e Projetos de Saúde , Psicoterapia de Grupo/economia , Psicoterapia de Grupo/métodos , Pesquisa Qualitativa , Adulto Jovem
13.
Int J Health Plann Manage ; 29(1): 52-69, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-23319399

RESUMO

In this methodological paper, we discuss the use of the nominal group technique to facilitate the involvement of people with chronic pain and other stakeholder groups in the design of a community-based pain management programme. On the basis of our experiences of using the technique in a study conducted in the south-west region of the UK, we explore conceptual and logistical issues relating to patient involvement in health service development, discuss political issues relating to the articulation and synthesis of different stakeholder perspectives, and provide a description of how the technique can be applied in the aforementioned context. We conclude that although the nominal group technique is not a panacea for the difficulties encountered in patient involvement, it does offer advantages over other approaches.


Assuntos
Dor Crônica/terapia , Serviços de Saúde Comunitária/organização & administração , Participação do Paciente/métodos , Processos Grupais , Humanos , Política , Desenvolvimento de Programas/métodos , Reino Unido
14.
J Orthop Surg (Hong Kong) ; 21(3): 337-9, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24366796

RESUMO

PURPOSE: To describe and quantify a radiological phenomenon where the distal tibial plafond appears in valgus malalignment in intra-operative fluoroscopy owing to 15 degrees craniocaudal angulation of the X-ray beam. METHODS: The lateral distal tibial angle (LDTA) of 14 male and 9 female skeletally mature patients was measured by a single reviewer using 2 types of anteroposterior radiographs, in which the X-ray beam was projected at 0 (orthogonal to the ankle) and then at 15 (in a craniocaudal direction) degrees. The LDTA was the angle between the long axis of the tibia and a line drawn across the most radiodense part of the tibial plafond. The paired t-test was used to compare the LDTA of the 2 measurements. RESULTS: The mean LDTA on the 0-degree orthogonal radiographs was 89 (range, 87-92) degrees, whereas the mean LDTA on the 15-degree craniocaudal radiographs was 79 (range, 77-81) degrees. The mean difference was 10 degrees (range, 9-12; p<0.0001). In the 15-degree craniocaudal radiographs, the ankle joint appeared to have valgus malalignment. CONCLUSION: During intramedullary nailing of the tibia, the knee is usually flexed and the image intensifier may not swing over far enough. This can result in well-aligned reduction being incorrectly viewed as having valgus malalignment or a varus-malaligned fracture being incorrectly viewed as reduced.


Assuntos
Coxa Valga/diagnóstico por imagem , Fixação Intramedular de Fraturas/métodos , Tíbia/diagnóstico por imagem , Fraturas da Tíbia/diagnóstico por imagem , Adulto , Coxa Valga/etiologia , Coxa Valga/cirurgia , Feminino , Seguimentos , Consolidação da Fratura , Humanos , Masculino , Radiografia , Tíbia/cirurgia , Fraturas da Tíbia/complicações , Fraturas da Tíbia/cirurgia , Adulto Jovem
15.
Br J Gen Pract ; 61(593): e794-800, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22137416

RESUMO

BACKGROUND: Staying in work may benefit patients with chronic pain, but can be difficult for GPs to negotiate with patients and their employers. The new fit note is designed to help this process, but little is known of how it is operating. AIM: To explore GPs' views on the fit note, with particular reference to sickness certification for patients with chronic pain. DESIGN AND SETTING: Qualitative study using semi-structured interviews in eight primary care trusts in south-west England. METHOD: In-depth interviews with 13 GPs. RESULTS: GPs reported that the rationale behind the fit note is sound and that it may help patients with chronic pain to return to work earlier. However, GPs also reported barriers to successful fit note use, including the need to preserve doctor-patient relationships, inconsistent engagement from employers, GPs' lack of specialist occupational health knowledge, issues with fit note training, and whether a new form can achieve cultural shift. CONCLUSION: While doctors agree that good work improves health outcomes, they do not think that fit notes will greatly alter sickness-certification rates without more concerted initiatives to manage the tripartite negotiation between doctor, patient, and employer.


Assuntos
Atitude do Pessoal de Saúde , Certificação , Doença Crônica/terapia , Medicina Geral , Relações Médico-Paciente , Licença Médica , Inglaterra , Feminino , Humanos , Masculino , Médicos de Família/psicologia , Pesquisa Qualitativa , Avaliação da Capacidade de Trabalho
16.
Aesthet Surg J ; 31(7 Suppl): 13S-23S, 2011 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-21908820

RESUMO

Although the principles of burn management are still primarily focused on survival, as advances are realized in resuscitation, nutrition, and wound management, the functional and aesthetic outcomes following burn injury have become increasingly important. Acellular dermal matrix materials, which allow surgeons to minimize skin graft donor site morbidity in the process of repairing injured areas, play a role in addressing these important issues. Many favorable reports have been published, but they are generally characterized by small sample sizes, limited objective testing, and retrospective analysis. There does appear to be some evidence for ADM application in patient populations in whom donor site availability (those with massive burns) or morbidity (children, the elderly) is a concern, but more studies are needed. In this article, the authors discuss the current applications for ADM in burn management, review the existing literature, and present opportunities for future research.


Assuntos
Queimaduras/cirurgia , Colágeno/uso terapêutico , Derme/metabolismo , Idoso , Animais , Materiais Biocompatíveis/metabolismo , Queimaduras/patologia , Criança , Humanos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Transplante de Pele/métodos
17.
Clin Plast Surg ; 36(4): 687-700, 2009 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-19793562

RESUMO

Many patients continue to experience problems long after burn wounds have closed. Contracture and deformity are frequent sequelae of the scar tissue that is formed secondary to thermal trauma. A variety of techniques are available to the burn reconstructive surgeon, ranging from simpler grafting methods to complex free-tissue transfers. In this article, the clinical applications of these procedures are discussed, with examples of management techniques for selected problems commonly encountered by the reconstructive surgeon.


Assuntos
Alopecia/cirurgia , Queimaduras/complicações , Queimaduras/cirurgia , Cicatriz/cirurgia , Contratura/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Alopecia/etiologia , Braço , Axila , Mama , Cicatriz/etiologia , Contratura/etiologia , Feminino , Cabeça , Humanos , Pescoço , Transplante de Pele , Retalhos Cirúrgicos
19.
Qual Health Res ; 17(6): 759-71, 2007 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-17582019

RESUMO

Surgery for esophageal cancer offers the hope of cure but might impair quality of life. The operation removes tumors obstructing the esophagus but frequently leaves patients with eating difficulties, leading to weight loss. Maintaining or increasing body weight is important to many patients, both as a means of returning to "normal" and as a means of rejecting the identity of the terminal cancer patient, but surgery radically alters embodied sensations of hunger, satiety, swallowing, taste, and smell, rendering the previously taken-for-granted experience of eating unfamiliar and alien. Successful recovery depends on patients' learning how to eat again. This entails familiarization with physiological changes but also coming to terms with the social consequences of spoiled identity. The authors report findings from in-depth interviews with 11 esophageal cancer patients, documenting their experiences as they struggle to achieve a process of adaptation that is at once physiological, psychological, and social.


Assuntos
Adaptação Psicológica , Ingestão de Alimentos/fisiologia , Neoplasias Esofágicas/cirurgia , Esofagectomia/efeitos adversos , Transtornos da Alimentação e da Ingestão de Alimentos/etiologia , Estado Nutricional , Idoso , Ingestão de Alimentos/psicologia , Neoplasias Esofágicas/psicologia , Neoplasias Esofágicas/reabilitação , Esofagectomia/psicologia , Transtornos da Alimentação e da Ingestão de Alimentos/reabilitação , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Período Pós-Operatório , Recuperação de Função Fisiológica , Inquéritos e Questionários , Fatores de Tempo , Perda de Peso
20.
Med Health Care Philos ; 9(1): 33-41, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-16645796

RESUMO

There is considerable uncertainty about the implications of the new genetics for health services. These are the enthusiasts who argue that molecular genetics will transform health care and others argue that the scope for genetic interventions is limited. The aim of this paper is to examine some of the questions, tensions and difficulties which face health care providers particularly in developed countries as they try to come to terms with the dilemmas raised by new genetic health care technologies (NGHTs). It identifies questions for research which may help the development of robust and flexible strategies for implementation.


Assuntos
Serviços em Genética , Técnicas Genéticas , Planejamento em Saúde , Política de Saúde , Avaliação da Tecnologia Biomédica , Atitude Frente a Saúde , Pesquisa sobre Serviços de Saúde , Humanos , Reino Unido
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