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1.
Rev. enferm. UERJ ; 28: e35224, jan.-dez. 2020.
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1096015

RESUMO

Objetivo: investigar a atuação dos enfermeiros frente à amamentação cruzada e correlacionar com a atual questão da precarização do trabalho. Método: estudo qualitativo do tipo descritivo com base metodológica de análise do discurso, realizado com seis enfermeiras da Estratégia de Saúde da Família (ESF) por meio de um grupo focal. Resultados: o tema amamentação cruzada é apresentado como um indicador de conflitos ético-profissionais no processo de trabalho, expressando-se nos seguintes aspectos: conhecimento das prescrições de contraindicação, sensação de dificuldade em intervir e transferência à nutriz por qualquer dano à saúde da criança. Considerações finais: no cotejo entre esses resultados e uma organização de trabalho com normas e rotinas institucionalizadas, discutem-se como efeitos da não utilização de técnicas de aconselhamento, a fragilização da autonomia da nutriz, de forma imperceptível, reproduzidas por enfermeiros na assistência.


Objective: to investigate nurses' role related to cross-breastfeeding and to correlate with the current issue of precarious work.Method: descriptive andqualitative study based on methodological discourse analysis, carried out with six nurses from Estratégia de Saúde da Família (ESF) Program through a focus group. Results: cross-breastfeeding topic is presented as an indicator of ethical-professional conflicts in the work process, expressing itself in the following aspects: knowledge of prescriptions of contraindication, feeling of difficulty in intervening and transference to the nursing mother for any harm to the child's health. Final considerations: in the comparison between these results and a work organization with institutionalized norms and routines, we discuss the effects of not using counseling techniques, the fragility of nurses' autonomy, imperceptibly reproduced by nurses in care.


Objetivo: investigar el papel de las enfermeras relacionadas con la lactancia cruzada y su correlación con el tema actual del trabajo precario. Método: estudio descriptivo y cualitativo basado en el análisis metodológico del discurso, realizado con seis enfermeras del Programa Estratégia de Saúse da Familia (ESF) através de un grupo focal. Resultados: el tema de la lactancia cruzada se presenta como un indicador de conflictos ético-profesionales en el proceso de trabajo, expresándose en los siguientes aspectos: conocimiento de prescripciones de contraindicación, sensación de dificultad para intervenir y transferencia a la madre lactante por cualquier daño a la salud del niño Consideraciones finales: en la comparación entre estos resultados y una organización de trabajo con normas y rutinas institucionalizadas, discutimos los efectos de no utilizar técnicas de asesoramiento, la fragilidad de la autonomía de las enfermeras, reproducida imperceptiblemente por las enfermeras bajo cuidado.


Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Qualidade da Assistência à Saúde/ética , Condições de Trabalho , Aleitamento Materno , Papel do Profissional de Enfermagem , Estratégia Saúde da Família , Contraindicações , Relações Trabalhistas , Brasil , Competência Clínica , Grupos Focais , Pesquisa Qualitativa
2.
Rev Prat ; 70(5): 566-568, 2020 May.
Artigo em Francês | MEDLINE | ID: mdl-33058649

RESUMO

Certificate of absence of medical contraindication to the practice of a sport. Doctors are often called by their patients for certificate of absence of medical contraindication to the practice of a sport. They essentially see it as an administrative process, when it is a real reason for medical consultation. Appreciating the aptitude of a person, young or adult, to practice a sport, cannot be done between two doors, or by trying to read in the eyes of the applicant. What does this certificate mean? What is the legal support? Is there a protocol to follow?


Assuntos
Médicos , Esportes , Adulto , Contraindicações , Humanos
3.
Tokai J Exp Clin Med ; 45(3): 131-135, 2020 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-32901901

RESUMO

Retained products of conception (RPOC) refer to the persistence of placental or fetal tissue in the uterus following delivery or miscarriage. RPOC may cause massive postpartum or post-abortion hemorrhage. Arterial embolization (AE) is an effective choice of management for postpartum hemorrhage including RPOC. We report a case of hemorrhagic RPOC, in which uterine artery embolization with transcervical resection did not achieve hemostasis, and laparotomy with uterine compression sutures was subsequently required. The RPOC was apparently fed by an aberrant branch derived from the inferior mesenteric artery (IMA). AE of IMA was not performed because of possible necrosis of the descending colon and rectum. A physician should be aware that AE is not an all-encompassing hemostatic technique for postpartum bleeding, such as with RPOC, and should keep alternatives in mind.


Assuntos
Hemostasia Cirúrgica/métodos , Laparotomia/métodos , Artéria Mesentérica Inferior , Complicações do Trabalho de Parto/etiologia , Complicações do Trabalho de Parto/cirurgia , Placenta Retida/cirurgia , Hemorragia Pós-Parto/etiologia , Hemorragia Pós-Parto/cirurgia , Técnicas de Sutura , Útero/cirurgia , Adulto , Colo/patologia , Contraindicações , Feminino , Humanos , Angiografia por Ressonância Magnética , Necrose , Complicações do Trabalho de Parto/diagnóstico por imagem , Placenta Retida/diagnóstico por imagem , Hemorragia Pós-Parto/diagnóstico por imagem , Gravidez , Reto/patologia , Tomografia Computadorizada por Raios X , Embolização da Artéria Uterina/efeitos adversos
4.
Bull Cancer ; 107(5): 556-564, 2020 May.
Artigo em Francês | MEDLINE | ID: mdl-32414536

RESUMO

As the benefits of physical activity (PA) in oncology field continue to be demonstrated, multiple structures (sports clubs, associations…) develop PA programs and activities to offer cancer patients survivors the opportunity to continue adapted physical activity. Promoted in the 2014-2019 cancer plan as complementary supportive care, the practice of physical activity is legitimized by the 2016 Health Act of the Ministry of Social Affairs and Health, including the amendment 'prescription health sport', by giving it a legislative framework. In this context of development of new PA offers for cancer patients, it seems necessary to determine and evaluate the structures on their capacities to supervise physical activities for this population with specific needs. This article presents the methodological development and validation process of a tool used to characterize the different structures offering physical activity programs for people who have had cancer, and seeks to define the quality criteria that a structure should meet in the current state of knowledge. Ten of these criteria were selected according to a qualitative methodology and the final tool therefore facilitates the identification of quality programs in post-cancer PA, and could be used systematically by both users and professionals as part of the post-cancer care pathway, as well as by the sport-health platforms themselves in the current dynamics of their deployment throughout the national territory.


Assuntos
Sobreviventes de Câncer , Exercício Físico , Promoção da Saúde , Desenvolvimento de Programas , Certificação , Contraindicações , Exercício Físico/fisiologia , França , Promoção da Saúde/legislação & jurisprudência , Promoção da Saúde/métodos , Humanos , Desenvolvimento de Programas/métodos , Esportes
7.
Transfusion ; 60(5): 932-939, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32358832

RESUMO

BACKGROUND: Hemoglobin-Based Oxygen Carriers (HBOCs) can act as an "oxygen bridge" in acute severe anemia when transfusion is indicated, but not possible. We present data on 10 Expanded Access (EA) patients treated with high cumulative doses of Hemopure (HBOC-201), to assess the ability of HBOC-201 to safely treat life threatening anemia in situations where high volumes of product were administered over an extended period of time. STUDY DESIGN AND METHODS: Inclusion in this study required that the patient receive at least 10 units of HBOC-201 between 2014 and 2017 under the FDA-sanctioned EA program. Depending on a patient's geographical location, treatment with HBOC-201 was obtained through either a single patient emergency Investigational New Drug (IND) application, or an intermediate size population IND. Of the 41 patients who were treated during this period, 10 patients received 10 or more units of the product. Data were obtained from medical records. RESULTS: Treatments with HBOC-201 started within 24 hours of signing consent and were administered at an average rate of 1.99 (SD 0.17) units per day over a mean of 8.2 days (SD 2.9), during which patients received on average 16.2 units (SD 5.7 units) of HBOC-201. The median pre-treatment nadir corpuscular hemoglobin (Hb) concentration was 3.3 (SD 0.9) g/dL and post-treatment Hemoglobin was 7.3 (SD 1.7) g/dL. Common side effects included methemoglobinemia, gastrointestinal symptoms, and hypertension. However, no product-related serious adverse events (SAEs) were noted. All patients survived. CONCLUSIONS: Administration of HBOC-201 over an extended period is a feasible and safe oxygen bridge for severely anemic patients who cannot be transfused with RBC.


Assuntos
Anemia/tratamento farmacológico , Transfusão de Sangue , Contraindicações , Hemoglobinas/administração & dosagem , Adulto , Idoso , Anemia/diagnóstico , Anemia/patologia , Estudos de Coortes , Relação Dose-Resposta a Droga , Esquema de Medicação , Feminino , Hemoglobinas/efeitos adversos , Humanos , Assistência de Longa Duração/métodos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores de Tempo , Reação Transfusional/prevenção & controle , Resultado do Tratamento , Adulto Jovem
9.
Praxis (Bern 1994) ; 109(5): 361-366, 2020.
Artigo em Alemão | MEDLINE | ID: mdl-32233766

RESUMO

CME: Hormonal Therapy for Gender Incongruence and Gender Dysphoria Abstract. The discrepancy between the inherited gender and the perceived gender identity is called gender incongruity. In this article the major indications, contraindications and therapeutic steps for gender reassignment surgery and hormonal therapy are discussed and summarized.


Assuntos
Disforia de Gênero , Hormônios , Cirurgia de Readequação Sexual , Contraindicações , Feminino , Disforia de Gênero/tratamento farmacológico , Identidade de Gênero , Hormônios/uso terapêutico , Humanos , Masculino
10.
J Card Surg ; 35(6): 1360-1363, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32333424

RESUMO

BACKGROUND AND AIM: Oral anticoagulation (AC) and percutaneous left atrial appendage (LAA) occlusion are the primary treatment modalities for stroke prevention in atrial fibrillation (AF), but there remains a subset of patients in whom these approaches present excess risk and isolated surgical LAA excision should be considered. We describe a 63-year-old female with AF and recurrent thromboembolic events who presented with an acute intraparenchymal hemorrhage and was found to have an intracardiac thrombus. METHODS: Given contraindications to AC and LAA occlusion, an isolated LAA surgical excision was pursued. RESULTS: She underwent successful surgical LAA excision and has since remained event-free. CONCLUSION: It is important to recall the utility of therapies that have been previously used with success for intracardiac thrombi and still remain as viable options.


Assuntos
Apêndice Atrial/cirurgia , Fibrilação Atrial/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Administração Oral , Anticoagulantes/efeitos adversos , Fibrilação Atrial/complicações , Hemorragia Cerebral/etiologia , Contraindicações , Feminino , Cardiopatias/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Risco , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controle , Trombose/etiologia , Resultado do Tratamento
11.
Hautarzt ; 71(4): 313-323, 2020 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-32162050

RESUMO

In clinical routine, treatment of pregnant women is a recurring challenge. The frequent opacity of current studies, lack of reliable sources of information and the general insecurity of pregnant women towards systemic drug treatment leads to difficult clinical decision making. Potent therapies with sufficient clinical experience in terms of safety of application are available for most diseases seen in pregnancy. After careful evaluation of potential benefits and risks of a therapy, not only the optimal choice of a medical treatment, but also adequate control of clinical symptoms and interdisciplinary care are crucial for a safe pregnancy.


Assuntos
Contraindicações , Prescrições de Medicamentos , Tratamento Farmacológico , Complicações na Gravidez/tratamento farmacológico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Feminino , Humanos , Preparações Farmacêuticas , Gravidez , Medição de Risco , Segurança
12.
J Card Surg ; 35(4): 946-949, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32115770

RESUMO

BACKGROUND: Saphenous vein graft aneurysm (SVGA) is a rare complication after coronary artery bypass grafting; however, it may lead to fatal conditions. A redo sternotomy poses a high risk of injury to the patent graft. CASE REPORT: A 59-year-old man with chest pain was diagnosed with a giant SVGA (67 mm) anastomosed to the right coronary artery (RCA) and compressing the right atrium. Considering the high risk of injury to a patent graft through the sternum, a surgical procedure was planned without redo sternotomy. Through an upper midline abdominal incision, redo bypass grafting was performed to the distal RCA using the right gastroepiploic artery, followed by resection of the aneurysm using the right anterior lateral thoracotomy approach. The postoperative course was uneventful. CONCLUSION: In patients with an SVGA anastomosed to the right coronary system, our surgical strategy may be a useful alternative to redo sternotomy to avoid injury to the patent graft.


Assuntos
Anastomose Cirúrgica/efeitos adversos , Aneurisma/etiologia , Aneurisma/cirurgia , Ponte de Artéria Coronária/efeitos adversos , Ponte de Artéria Coronária/métodos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Veia Safena/cirurgia , Veia Safena/transplante , Esternotomia/métodos , Transplantes/cirurgia , Anastomose Cirúrgica/métodos , Contraindicações , Humanos , Masculino , Pessoa de Meia-Idade , Reoperação/efeitos adversos , Reoperação/métodos , Resultado do Tratamento , Grau de Desobstrução Vascular
14.
Radiologe ; 60(2): 138-143, 2020 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-31989205

RESUMO

BACKGROUND: Despite optimal drug-conservative therapy, a relevant percentage of patients with vertebral compression fractures (WKF) do not experience any relevant improvement in their pain symptoms. Vertebroplasty (VP) and kyphoplasty (KP) are described in the literature as percutaneous interventional procedures for the treatment of WKF. OBJECTIVE: Assessment of the effectiveness of the VP and KP in the treatment of WKF and discussion of the procedures in the context of the current literature. MATERIAL AND METHODS: Presentation of the fundamentals of VP and KP and their further developments. Description of indications and contraindications. Discussion of the current literature and recommendations of the individual professional associations. RESULTS: In patients with vertebral compression fractures, VP or KP of the affected vertebral body leads to a pain reduction in more than 90% of cases. Clinically relevant complications occur in less than 1% of interventions. CONCLUSION: VP and KP are a safe and effective method for treating painful WKF. Optimal patient selection improves the clinical outcome.


Assuntos
Fraturas por Compressão , Cifoplastia , Fraturas da Coluna Vertebral , Vertebroplastia , Contraindicações , Humanos , Fraturas da Coluna Vertebral/cirurgia , Resultado do Tratamento
16.
Medicine (Baltimore) ; 98(51): e18482, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31861030

RESUMO

Allogeneic blood transfusions (ABTs) are common in patients with cancer. The present study investigated the safety of a restrictive ABT strategy in patients with extremity sarcomas.Patients who underwent operations for extremity bone sarcomas between May 2008 and November 2018 were retrospectively reviewed. Clinical outcomes based on hemoglobin concentrations, postoperative infections, and hospital stay were compared between 20 patients who received liberal ABT (control group) and 19 patients who received restrictive ABT (restrictive group). The rates of distant metastasis and death were compared between the groups.The mean number of ABTs was 3.6 ±â€Š3.8 units in the control group and 0.33 ±â€Š0.74 units in the restrictive group (P < .001). Only 3 of 19 patients received transfusions (2 red cell packs each). The hemoglobin levels tended to fall during the first 3 postoperative days but seemed to stabilize within the first postoperative week in both groups. Postoperative surgical site infections only occurred in the patients who received ABTs regardless of the group. The rates of distant metastasis and death were higher in the control group than in the restrictive group (25.0% vs 15.7% and 10.0% vs 0%, respectively), but the differences were not significant.A restrictive ABT strategy may be safely performed in patients with extremity bone sarcomas depending on the intraoperative status and specific characteristics of each patient.


Assuntos
Transfusão de Sangue , Neoplasias Ósseas/cirurgia , Contraindicações , Osteossarcoma/cirurgia , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Transplante Homólogo , Adulto Jovem
17.
Acta Clin Croat ; 58(Suppl 1): 118-123, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31741570

RESUMO

Multiply injured patients with severe chest trauma have different combinations of associated extra thoracic injuries making their treatment complex. Severe pain is a prominent symptom in a vast majority of severe chest injuries and causes deterioration of respiratory function. Epidural analgesia provides efficient pain relief but its use in this group of patients is burdened with complications, contraindications and technical difficulties. We present two cases in which epidural analgesia was successfully used in polytrauma patients with severe chest injuries and hypoxemic respiratory failure, and discuss advantages, possible pitfalls and complications.


Assuntos
Analgesia Epidural , Traumatismo Múltiplo/complicações , Dor/tratamento farmacológico , Traumatismos Torácicos/complicações , Adulto , Analgesia Epidural/efeitos adversos , Contraindicações , Humanos , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Insuficiência Respiratória/etiologia
18.
Arthroscopy ; 35(11): 3047-3048, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31699255

RESUMO

Hip arthroscopy can effectively address cam and pincer impingement by reshaping bone prominences or bone edges. However, hip arthroscopy cannot be used to correct severe bone torsion abnormalities such as acetabular or femoral retroversion. As a result, some surgeons contraindicate hip arthroscopy in patients with femoral retroversion absent correction of the torsion abnormalities. However, recent research has suggested that hip arthroscopy absent osteotomy, with a focus on labral preservation and thorough correction of underlying cam and pincer bony abnormalities, achieves positive outcomes. Still, although femoral retroversion should not be considered a contraindication for hip arthroscopy, patients should be carefully counseled about residual symptoms.


Assuntos
Impacto Femoroacetabular , Acetábulo , Artroscopia , Contraindicações , Fêmur , Humanos
19.
Nutrients ; 11(10)2019 Oct 17.
Artigo em Inglês | MEDLINE | ID: mdl-31627405

RESUMO

Fasting is deeply entrenched in evolution, yet its potential applications to today's most common, disabling neurological diseases remain relatively unexplored. Fasting induces an altered metabolic state that optimizes neuron bioenergetics, plasticity, and resilience in a way that may counteract a broad array of neurological disorders. In both animals and humans, fasting prevents and treats the metabolic syndrome, a major risk factor for many neurological diseases. In animals, fasting probably prevents the formation of tumors, possibly treats established tumors, and improves tumor responses to chemotherapy. In human cancers, including cancers that involve the brain, fasting ameliorates chemotherapy-related adverse effects and may protect normal cells from chemotherapy. Fasting improves cognition, stalls age-related cognitive decline, usually slows neurodegeneration, reduces brain damage and enhances functional recovery after stroke, and mitigates the pathological and clinical features of epilepsy and multiple sclerosis in animal models. Primarily due to a lack of research, the evidence supporting fasting as a treatment in human neurological disorders, including neurodegeneration, stroke, epilepsy, and multiple sclerosis, is indirect or non-existent. Given the strength of the animal evidence, many exciting discoveries may lie ahead, awaiting future investigations into the viability of fasting as a therapy in neurological disease.


Assuntos
Jejum , Doenças do Sistema Nervoso/dietoterapia , Animais , Evolução Biológica , Contraindicações , Ingestão de Energia , Jejum/efeitos adversos , Humanos
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