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1.
Medicine (Baltimore) ; 98(51): e18149, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31860962

RESUMO

RATIONALE: Retroperitoneal schwannomas are very rare and may grow very close to major abdominal vessels. Since the surgical approach to the retroperitoneal space may be complex due to surrounding vital organs, including major vessels, laparoscopic surgery is challenging and has only been recently adopted. Here, we report a case of laparoscopic resection of a large retroperitoneal schwannoma attached to large vital vessels. PATIENT CONCERNS: A 62-year-old woman presented with a chief complaint of pain in the lower right limb with consequent claudication, which had lasted for approximately 1 year. DIAGNOSES: Magnetic resonance imaging revealed a solid oval mass measuring 45 × 32 × 39 mm, located medially to the right iliopsoas muscle at the level of the intersomatic space between the 5th lumbar vertebra and the 1st sacral vertebra. This mass was inhomogeneously hypointense in T2 due to the presence of cystic areas, with intense and inhomogeneous contrast enhancement, compatible with the diagnosis of a schwannoma. The mass compressed the inferior caval vein near its bifurcation and the right common iliac vein, anteriorly dislocating the ipsilateral iliac arterial axis. INTERVENTIONS: A multidisciplinary team skilled in vascular and pelvic laparoscopy was involved. The patient underwent laparoscopic surgery via an anterior transperitoneal approach with right adnexectomy and radical excision of the tumor. The surgery lasted 120 minutes without intraoperative complications. Blood loss was less than 100 mL. The histologic diagnosis was a benign Schwannoma; grade I according to World Health Organization classification. OUTCOMES: The postoperative course was uneventful. At the 10-month follow-up, the patient had no recurrences and was asymptomatic. LESSONS: Laparoscopic removal of large retroperitoneal schwannomas, even if attached to major vital vessels, is feasible and safe when performed by experienced surgeons.


Assuntos
Laparoscopia/métodos , Neurilemoma/diagnóstico , Neurilemoma/cirurgia , Neoplasias Retroperitoneais/diagnóstico , Neoplasias Retroperitoneais/cirurgia , Veia Cava Inferior/patologia , Idoso , Biópsia por Agulha , Feminino , Seguimentos , Humanos , Imuno-Histoquímica , Comunicação Interdisciplinar , Extremidade Inferior , Dor Musculoesquelética/diagnóstico , Dor Musculoesquelética/etiologia , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Neurilemoma/diagnóstico por imagem , Doenças Raras , Neoplasias Retroperitoneais/diagnóstico por imagem , Medição de Risco , Resultado do Tratamento
2.
RECIIS (Online) ; 13(4): 887-895, out.-dez. 2019. ilus
Artigo em Português | LILACS | ID: biblio-1047673

RESUMO

Este relato objetiva apresentar o processo de desenvolvimento de um material escrito e ilustrado voltado para o dentista atuante em Unidades de Terapia intensiva, bem como os motivos e justificativas que levaram à decisão de sua necessidade. O cirurgião-dentista tem ampliado sua área de atuação e, por isso, necessita de materiais didáticos que forneçam uma base para essa nova forma de pensar a Odontologia, com um caráter integral e multiprofissional. Por não haver contato dos cirurgiões-dentistas com o ambiente hospitalar durante a graduação, salvo raras exceções, o material didático nesta área foi planejado para abranger desde os conhecimentos básicos até situações que envolvem maior conhecimento para a tomada de decisão. A metodologia utilizada foi o levantamento bibliográfico e a montagem de material escrito na forma de manual, além da produção e tratamento de fotografias ilustrativas, obtidas em um Hospital Universitário durante o processo de cuidado odontológico de pacientes críticos.


This report aims to present the process of developing a written and illustrated material for the dentist in intensive care units, as well as the reasons and justifications that led to the decision of their need. The dental surgeon has expanded his area of practice and, therefore, needs didactic materials that provide a basis for this new way of thinking about Dentistry, with an integral and multiprofessional character. Due to the lack of contact between dental surgeons and the hospital environment during graduation, with few exceptions, the teaching material in this area was designed to cover everything from basic knowledge to situations involving greater knowledge for decision making. The methodology used was the bibliographical survey and the assembly of written material in manual form, as well as the production and treatment of illustrative photographs obtained at a University Hospital during the dental care process of critical patients.


Este relato tiene como objetivo presentar el proceso de desarrollo de un material escrito e ilustrado orientado hacia el dentista actuante en Unidades de Terapia intensiva, así como los motivos y justificaciones que llevaron a la decisión de su necesidad. El cirujano-dentista ha ampliado su área de actuación y, por eso, necesita materiales didácticos que proveen una base para esa nueva forma de pensar la Odontología, con un carácter integral y multiprofesional. Por no haber contacto de los cirujanos-dentistas con el ambiente hospitalario durante la graduación, salvo raras excepciones, el material didáctico en esta área fue planeado para abarcar desde los conocimientos básicos hasta situaciones que involucran mayor conocimiento para la toma de decisión. La metodología utilizada fue el levantamiento bibliográfico y el montaje de material escrito en la forma de manual, además de la producción y tratamiento de fotografías ilustrativas, obtenidas en un Hospital Universitario durante el proceso de cuidado odontológico de pacientes críticos.


Assuntos
Humanos , Materiais de Ensino , Desenvolvimento de Pessoal , Comunicação Interdisciplinar , Equipe Hospitalar de Odontologia , Dicionários Odontológicos como Assunto , Assistência Odontológica , Contenção de Riscos Biológicos , Serviços de Saúde Bucal , Odontólogos , Fotografia , Unidades de Terapia Intensiva
5.
Rev Sci Tech ; 38(1): 261-270, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31564724

RESUMO

The convergence of humans, animals and our shared environment results in a dynamic in which the health of each group is inextricably linked. Taking into account the fact that the majority of emerging pathogens (e.g. highly pathogenic avian influenza [HPAI], severe acute respiratory syndrome coronavirus, Nipah virus, Middle East respiratory syndrome coronavirus) are zoonotic diseases, Egypt has established a national One Health coordination mechanism. The primary purpose of this mechanism is to provide a comprehensive, strategic approach to concurrent and future health challenges that are facing public and animal heath, including environmental impacts. In this way, the public health, animal health and environment sectors can improve disease mitigation measures, develop stronger and more stable public and animal health services, promote effective national communication strategies and improve One Health collaboration among all relevant sectors. In Egypt, the Food and Agriculture Organization of the United Nations (FAO) and the World Health Organization (WHO) currently assist in hosting the country's Four-Way Linking Task Force with the participation of the convening Ministries (Ministry of Health and Population, Ministry of Environment, and Ministry of Agriculture and Land Reclamation [MOALR] - through the General Organisation for Veterinary Services and the MOALR's laboratories). In the context of the Emerging Pandemic Threats 2 Program, funded by the United States Agency for International Development (USAID), FAO plans to assist Egypt in establishing a robust, multidisciplinary and multisectoral One Health system. This system is based on the solid foundation of the Four-Way Linking Platform, which combines information from four functional streams - epidemiology, laboratories, and animal and human health. Egypt's platform will involve all sectors concerned with HPAI control and combine all stakeholders in an integrated, holistic approach to improve the detection of, response to and control of any threats at the human- animal-environment interface in Egypt.


Assuntos
Controle de Doenças Transmissíveis , Colaboração Intersetorial , Saúde Única , Animais , Controle de Doenças Transmissíveis/tendências , Egito , Humanos , Comunicação Interdisciplinar , Nações Unidas , Zoonoses/prevenção & controle
9.
Recurso educacional aberto em Espanhol | ID: oer-3856

RESUMO

Material visual de 41 páginas, desarrollado en formato ppt que desarrolla el tipo de comunicación que debe utilizarse en las informaciones de los recursos humanos en salud sobre el estado de salud de los pacientes, a fin de mantener una apropiada relación profesional.


Assuntos
Comunicação Interdisciplinar
11.
Urologiia ; (4 ()): 36-38, 2019 Sep.
Artigo em Russo | MEDLINE | ID: mdl-31535796

RESUMO

Currently, thorough understanding of multidisciplinary approach is required in all areas of healthcare, including education, science and practice. This article is dedicated to the actual problem of interdisciplinary communications in current educational process in the Medical University.


Assuntos
Comunicação Interdisciplinar , Urologia/educação , Currículo , Assistência à Saúde , Educação Médica , Avaliação Educacional , Humanos
16.
Handchir Mikrochir Plast Chir ; 51(4): 284-294, 2019 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-31412390

RESUMO

BACKGROUND: The introduction of free tissue transfers has revolutionized reconstructive purposes. This is particularly important after extensive traumas, profound infections and tumor resections. Nevertheless, independent plastic surgery centers are not available at 11 of 35 university hospitals in Germany. The purpose of this study was to demonstrate the importance of reconstructive microsurgery at a university hospital in interdisciplinary cooperation on the basis of cases treated in one year. METHODS: In 2018, 47 patients at one site underwent 50 microvascular free flap reconstructions. The data were retrospectively screened for patients' demographics, comorbidities, perioperative and postoperative details, interdisciplinary context, hospitalization, complications, and final outcomes. RESULTS: Fifty free tissue flap transfers were performed after complex traumas (23.4 %), infections (25.5 %), tumor resections (42.6 %), PAD (4.2 %) and secondary lymphoedema (4.2 %). In 76.6 % of the patients, microsurgical reconstruction was performed in interdisciplinary cooperation (trauma surgery: 19.1 %, neurosurgery: 19.1 %, thoracic surgery: 4.3 %, heart surgery: 2.1 %, vascular surgery: 2.1 %, orthopedics: 25.5 %, internal medicine: 4.3 %), with 89.2 % involving at least two different departments. Postoperatively, 43.2 % of the free flaps were treated on a non-plastic surgical ward. CONCLUSION: Reconstructive plastic surgery is of central importance in the treatment of complex surgical defect reconstructions after tumor resections, infections or traumas. Also plastic surgery contributes substantially to the treatment of complications occurring in other specialties. For those reasons, an independent and adequately staffed department of plastic surgery should be available at all clinics of maximum care, especially at all 35 university hospitals in Germany. As this is currently not the standard of care in Germany, changes are required.


Assuntos
Hospitais Universitários , Comunicação Interdisciplinar , Microcirurgia , Procedimentos Cirúrgicos Reconstrutivos , Cirurgia Plástica , Alemanha , Humanos , Estudos Retrospectivos
17.
J Urol ; 202(3): 475-483, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31412438

RESUMO

PURPOSE: Renal colic is common and CT (computerized tomography) is frequently utilized when the diagnosis of kidney stone is suspected. CT is accurate, but exposes patients to ionizing radiation and has not been shown to alter either interventional approaches or hospital admission rates. This multi-organizational transdisciplinary collaboration sought evidence-based, multispecialty consensus on optimal imaging across different clinical scenarios in patients with suspected renal colic in the acute setting. MATERIALS AND METHODS: In conjunction with the ACEP (American College of Emergency Physicians®) E-QUAL (Emergency Quality Network) we formed a nine-member panel with three physician representatives each from the ACEP, the ACR® (American College of Radiology) and the AUA (American Urological Association). A systematic literature review was used as the basis for a 3-step modified Delphi process to seek consensus on optimal imaging in 29 specific clinical scenarios. RESULTS: From an initial search yielding 6,337 records there were 232 relevant articles of acceptable evidence quality to guide the literature summary. At the completion of the Delphi process consensus, agreement was rated as perfect in 15 (52%), excellent in 8 (28%), good in 3 (10%) and moderate in 3 (10%) of the 29 scenarios. There were no scenarios where at least moderate consensus was not reached. CT was recommended in 7 scenarios (24%) with ultrasound in 9 (31%) and no further imaging needed in 13 (45%). CONCLUSIONS: Evidence and multispecialty consensus support ultrasound or no further imaging in specific clinical scenarios, with reduced-radiation dose CT to be employed when CT is needed in patients with suspected renal colic.


Assuntos
Consenso , Cólica Renal/diagnóstico por imagem , Sociedades Médicas/normas , Tomografia Computadorizada por Raios X/normas , Ultrassonografia/normas , Técnica Delfos , Medicina de Emergência/normas , Humanos , Comunicação Interdisciplinar , Radiologia/normas , Tomografia Computadorizada por Raios X/efeitos adversos , Estados Unidos , Urologia/normas
18.
Surg Clin North Am ; 99(5): 885-898, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31446916

RESUMO

This article provides an overview of key palliative care considerations for management of patients with wounds and ostomies. Ostomy formation is indicated for a variety of intestinal conditions. Specifics of ostomy management, impact on quality of life, and patient perspectives can be complicated. Wound ostomy and continence nursing professionals play a central role in the successful management of this patient population.


Assuntos
Colostomia , Ileostomia , Humanos , Comunicação Interdisciplinar , Cuidados Paliativos , Medicina Paliativa , Qualidade de Vida , Especialidades de Enfermagem , Derivação Urinária
19.
Med. clín (Ed. impr.) ; 153(3): 93-99, ago. 2019. graf, tab
Artigo em Inglês | IBECS | ID: ibc-183430

RESUMO

Background and objective: The objective of the study was to evaluate the effects of a multidisciplinary intervention on the outcomes of polypathological patients (PP). Methods: A multicenter quasi-experimental pre-post study with a 12-month follow up was performed. In-hospital, at discharge and outpatient clinics patients who met criteria of PP between March 2012 and October 2013 were included. The multidisciplinary approach was defined by 11 interventions performed by general practitioners, internal medicine physicians, team care nurses and hospital pharmacists. The primary outcome was reduction in the number of hospital admissions and days of hospitalization. Secondary outcomes included mortality and the effects of 11 interventions on mortality. Results: 420 patients were included. Mean patient age was 77.3 (SD: 8.90) and average number of PP defining categories was 2.99 (SD: 1.00). Number of hospital admissions and days of hospitalization decreased significantly after intervention: 1.52 (SD: 1.35) versus 0.82 (SD: 1.29), p<0.001, and 13.77 (SD: 15.20) versus 7.21 (SD: 12.90), p<0.001 respectively. 12-month mortality was 37.7%. PP who failed to receive a structured medical visit from the internal medicine physician and educational workshops from the team care nurses had a higher risk of exitus in the next 12 months, HR: 1.68; 95% CI: 1.15-2.46, p=0.007 and HR: 2.86; 95% CI: 1.92-4.27, p<0.001, respectively. Conclusions: This multidisciplinary intervention reduced the risk of PP hospital admission and days of hospitalization. Educational workshop programs for PP and their caregivers and structured IM medical visits were associated with improvements of survival


Introducción y objetivo: El objetivo del estudio fue evaluar los resultados en salud tras la implantación de una intervención multidisciplinar a pacientes pluripatológicos (PP). Metodología: Se realizó un estudio multicéntrico antes-después cuasi-experimental, con seguimiento a 12 meses. Se incluyeron pacientes que cumplían los criterios de PP entre marzo de 2012 y octubre de 2013, tanto en el ámbito hospitalario como en atención primaria. El enfoque multidisciplinar fue definido por 11 intervenciones realizadas por médicos de familia, médicos internistas, enfermeras y farmacéuticos hospitalarios. El resultado fundamental fue la reducción en el número de ingresos hospitalarios y días de hospitalización al año de seguimiento. Los resultados secundarios incluyeron la mortalidad y los efectos de las intervenciones sobre la misma. Resultados: Se incluyeron 420 pacientes. La edad media de los pacientes fue de 77,3 (DE: 8,90) y la media de categorías definitorias de PP fue de 2,99 (DE: 1,00). El número de ingresos hospitalarios y los días de hospitalización disminuyeron significativamente después de la intervención: 1,52 (DE: 1,35) versus 0,82 (DE: 1,29), p<0,001 y 13,77 (DE: 15,20) versus 7,21 (DE: 12,90), p<0,001, respectivamente. La mortalidad a los 12 meses fue del 37,7%. Los PP que no recibieron la visita médica estructurada del médico internista tras la inclusión y los talleres educativos de las enfermeras tuvieron un mayor riesgo de exitus en los 12 meses de seguimiento, HR: 1,68; IC del 95%: 1,15-2,46, p=0,007 y HR: 2,86; IC del 95%: 1,92-4,27, p<0,001, respectivamente. Conclusiones: Esta intervención multidisciplinaria reduce el riesgo de ingreso y los días de ingreso hospitalario en PP. Los programas de talleres educativos para PP y sus cuidadores, y las visitas médicas estructuradas por parte de medicina interna se asociaron con una mayor supervivencia


Assuntos
Humanos , Masculino , Idoso , Pesquisa Interdisciplinar , Múltiplas Afecções Crônicas/epidemiologia , Hospitalização , Doença Crônica/terapia , Equipe de Assistência ao Paciente , Serviços de Saúde , Planejamento de Assistência ao Paciente/organização & administração , Comunicação Interdisciplinar
20.
Toxicol Lett ; 314: 164-171, 2019 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-31330168

RESUMO

In routine regulatory toxicology studies, the anatomic pathology endpoints are frequently the most significant element of the study data. They may profoundly influence subsequent clinical development and use of a test article, with implications for both human safety and for the fate of key commercial assets. Unfortunately (in common with other perceptual medical specialties), anatomic pathology data are also among the most subjective endpoints in regulatory toxicology studies - a challenge magnified by the fact that not only the diagnostic data but the anatomic pathologist's interpretation of it in their narrative report represent raw data within a regulated study (United States Federal Register, 1987). A strategy for minimizing and managing the risk of misdiagnosis/misinterpretation of pathology data is critical for any preclinical toxicology development program and is a collaborative approach between study directors, study monitors and toxicologists and toxicologic pathologists. The article provides a basic understanding of the sources of error and limitations of anatomic pathology evaluation, a starting point for troubleshooting and a basis for a sound management strategy. It describes common reasons for unexpected or inconsistent pathology findings and sets out to provide a framework for toxicologists to approach commissioning and critically evaluating their pathology data, and for identifying situations where additional third-party advice and review may be justified.


Assuntos
Confiabilidade dos Dados , Avaliação Pré-Clínica de Medicamentos/métodos , Microscopia , Patologia/métodos , Toxicologia/métodos , Animais , Comportamento Cooperativo , Humanos , Comunicação Interdisciplinar , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Medição de Risco , Fluxo de Trabalho
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