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1.
Ann Otol Rhinol Laryngol ; 129(2): 181-190, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31631687

RESUMO

OBJECTIVES: Tracheostomy care in leading pediatric hospitals is both multidisciplinary and comprehensive, including generalized care protocols and thorough family training programs. This level of care is more difficult in resource-limited settings lacking developed healthcare infrastructure and tracheostomy education among nursing and resident staff. The objective of this study was to improve pediatric tracheostomy care in resource-limited settings. METHODS: In collaboration with a team of otolaryngologists, respiratory therapists, tracheostomy nurses, medical illustrators, and global health educators, image-based tracheostomy education materials and low-cost tracheostomy care kits were developed for use in resource-limited settings. In addition, a pilot study was conducted, implementing the image-based tracheostomy pamphlet, manual suctioning device and low-cost ambulatory supply kit ("Go-Bags"), within a low-fidelity simulated training course for nurses and residents in Kigali, Rwanda. RESULTS: An image-based language and literacy-independent tracheostomy care manual was created and published on OPENPediatrics, an open-access online database of clinician-reviewed learning content. Participants of the training program pilot study reported the course to be of high educational and practical value, and described improved confidence in their ability to perform tracheostomy care procedures. CONCLUSIONS: Outpatient tracheostomy care may be improved upon by implementing image-based tracheostomy care manuals, locally-sourced tracheostomy care kits, and tailored educational material into a low-fidelity simulated tracheostomy care course. These materials were effective in improving technical skills and confidence among nurses and residents. These tools are expected to improve knowledge and skills with outpatient tracheostomy care, and ultimately, to reduce tracheostomy-related complications.


Assuntos
Cuidados Pós-Operatórios/normas , Melhoria de Qualidade , Traqueostomia , Assistência Ambulatorial , Criança , Feminino , Recursos em Saúde , Humanos , Masculino , Projetos Piloto , Ruanda , Traqueostomia/educação , Traqueostomia/instrumentação
2.
Ceska Gynekol ; 84(5): 376-385, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31826636

RESUMO

OBJECTIVE: To summarize current knowledge of the ERAS protocol in gynecologic oncology surgery. DESIGN: Review article. SETTINGS: Department of Obstetrics and Gynecology, University Hospital Ostrava, Ostrava, Department of Obstetrics and Gynecology, University of Ostrava, Ostrava. METHODS: Literature review, PubMed and Medline databases were used to search relevant literature from 1995 to 2019. CONCLUSION: ERAS (Enhanced Recovery after Surgery) is a perioperative treatment program based on evidence-based medicine. Guidelines consist of pre-operative, perioperative and post-operative care items. Implementation of the ERAS protocol leads to a decrease in complications up to 40% and a reduction in hospitalization by up to 30%, thereby reducing overall costs without increasing the number of rehospitalizations. Multidisciplinary cooperation not only with anesthesiologists and consultant surgeons, but also with nutritional specialists and nurses is crucial.


Assuntos
Neoplasias dos Genitais Femininos/cirurgia , Procedimentos Cirúrgicos em Ginecologia/normas , Assistência Perioperatória/normas , Cuidados Pós-Operatórios/normas , Guias de Prática Clínica como Assunto , Cuidados Pré-Operatórios/normas , Medicina Baseada em Evidências , Feminino , Procedimentos Cirúrgicos em Ginecologia/métodos , Ginecologia , Humanos , Complicações Pós-Operatórias
3.
Am Surg ; 85(9): 1044-1050, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31638522

RESUMO

Enhanced recovery after surgery (ERAS) may improve patients' postoperative course. Our center implemented the ERAS protocol for the colorectal service in 2016, and then expanded to multiple service lines over the course of 1.5 years. Our aim was to determine whether broad implementation of ERAS protocols across different service lines could improve patient care. All ERAS patients from 2018 were captured prospectively. For each service line using ERAS, one full year of data preceding ERAS was compared. ERAS service lines included colorectal, gynecology laparoscopic, gynecology open, hepatopancreaticobiliary, urology - nephrectomy and cystectomy, spinal fusion, cardiac surgery-coronary artery bypass grafting. ERAS and pre-ERAS services were compared based on length of stay (LOS), complications, readmission, and mortality rates. In addition, hospital costs were collected during this time frame. ERAS protocols significantly decreased LOS for colorectal, gynecology, and spine. Complications were significantly decreased in colorectal, gynecology, urology, and spine. Readmissions did not significantly increase in any service line except spine. There was no significant change in mortality. ERAS proved to save the hospital 1847 days and cost saving of almost $5 million in 2018. Implementing ERAS broadly improved patient outcomes (LOS, complications, readmission, and mortality) while providing cost savings to the hospital.


Assuntos
Protocolos Clínicos , Procedimentos Cirúrgicos Eletivos/economia , Procedimentos Cirúrgicos Eletivos/normas , Custos Hospitalares , Cuidados Pós-Operatórios/economia , Cuidados Pós-Operatórios/normas , Melhoria de Qualidade , Mortalidade Hospitalar , Humanos , Tempo de Internação/economia , Readmissão do Paciente/economia , Complicações Pós-Operatórias/economia , Complicações Pós-Operatórias/prevenção & controle
6.
Geriatr Psychol Neuropsychiatr Vieil ; 17(3): 234-242, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31251213

RESUMO

Enhanced recovery after surgery (ERAS) is an evident advance in the management of patients. Its feasibility and its effectiveness have been little analyzed in elderly's orthopedics. The aim of this systematic review of the literature was to analyze the feasibility (realization of classic ERAS items) and the efficiency (length of stay, morbidity and mortality) of ERAS in the elderly during total arthroplasty hip. MATERIALS AND METHODS: A bibliographic search was performed with PubMed, Medline, CINAHL, Cochrane and Embase, using keywords "total hip arthroplasty", "orthopedics surgery", "fast track", "enhanced recovery after surgery", and" elderly ". Seventy-two articles were listed and 47 fully analyzed by 2 independent authors. RESULTS: Thirty-two articles were selected. All the articles demonstrated ERAS feasibility in the elderly. The most frequently performed items were: preoperative information, spinal anesthesia and local or regional anesthetic infiltrations, multimodal analgesia with opioids sparing. Early stand-up is desirable but more difficult to achieve than in younger. Compared with traditional management, ERAS decreases the average length of stay without increasing complications, re-admissions and mortality rates. Medico-economic analyzes would be in favor of a reduction in the overall cost. The elderly's adherence to ERAS program depends on information's quality provided at the time of the consultation. CONCLUSION: The application of ERAS program in total hip arthroplasty in the elderly is feasible and efficient to reduce hospital stay and morbidity without increasing the complication rates. Protocols must be adapted to the particularities of this population.


Assuntos
Idoso , Artroplastia de Quadril/reabilitação , Idoso de 80 Anos ou mais , Humanos , Tempo de Internação , Cuidados Pós-Operatórios/normas , Cuidados Pós-Operatórios/tendências , Recuperação de Função Fisiológica
7.
Medicine (Baltimore) ; 98(18): e15513, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31045842

RESUMO

INTRODUCTION: Over the last few decades, the concepts of minimally invasive surgery and enhanced recovery after surgery (ERAS) protocols have been introduced into the field of total joint arthroplasty (TJA), and tranexamic acid (TXA) has been widely used in TJA. Modern-day surgical techniques and perioperative care pathways of TJA have experienced unexpected improvements. Recently, the necessity of the practice of ordering routine postoperative laboratory tests for patients undergoing primary TJA has been challenged, especially in the context of implementation of ERAS protocols in TJA. These studies have consistently suggested that routine postoperative laboratory tests are not necessary in modern-day primary, unilateral total hip arthroplasty (THA) or total knee arthroplasty (TKA), and laboratory tests after surgery should only be obtained for patients with risk factors. However, it remains unclear whether routine postoperative laboratory tests after THA and TKA remains justified in the Chinese patient population. Therefore, we developed this study to address this issue. METHODS AND ANALYSIS: This retrospective cohort study will include adult patients who underwent primary unilateral THA or TKA and received multimodal perioperative care pathways according to ERAS protocols. The following patient data will be collected from the electronic medical record system: patients' demographics, preoperative and postoperative laboratory values, operation time, intraoperative blood loss, TXA use, tourniquet use, postoperative length of stay, and any medical intervention directly related to abnormal laboratory values. The main study outcomes are the incidence of acute anemia requiring transfusion and incidence of hypoalbuminemia requiring albumin supplementation. The secondary outcomes are the rates of acute kidney injury, incidence of abnormal serum sodium level, incidence of abnormal serum potassium level, and incidence of abnormal serum calcium level. These clinical data will be analyzed to determine the incidence of abnormal postoperative laboratory values following primary unilateral THA and TKA; to clarify the frequency of any medical intervention directly related to abnormal postoperative laboratory values; and to identify risk factors that predispose patients to have abnormal postoperative laboratory results. STUDY REGISTRATION: Chinese Clinical Trial Registry (http://www.chictr.org.cn): ChiCTR1900020690.


Assuntos
Artroplastia de Quadril/reabilitação , Artroplastia do Joelho/reabilitação , Técnicas de Laboratório Clínico/normas , Cuidados Pós-Operatórios/normas , Complicações Pós-Operatórias/diagnóstico , Adulto , Anemia/diagnóstico , Anemia/epidemiologia , Anemia/etiologia , Antifibrinolíticos/uso terapêutico , Artroplastia de Quadril/estatística & dados numéricos , Artroplastia do Joelho/estatística & dados numéricos , Técnicas de Laboratório Clínico/métodos , Protocolos Clínicos/normas , Feminino , Humanos , Hipoalbuminemia/diagnóstico , Hipoalbuminemia/epidemiologia , Hipoalbuminemia/etiologia , Incidência , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios/métodos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Projetos de Pesquisa , Estudos Retrospectivos , Fatores de Risco , Ácido Tranexâmico/uso terapêutico
8.
J Orthop Surg Res ; 14(1): 110, 2019 Apr 24.
Artigo em Inglês | MEDLINE | ID: mdl-31014377

RESUMO

PURPOSE: To analyze the cause of failure of the primary surgery for complex tibial plateau fractures and to define the therapeutic strategy of the revision surgery for the same. METHODS: Twenty-one cases with failure of primary surgery for complex tibial plateau fractures were treated in our hospital from January 2012 to September 2016. There were 13 males and 8 females with an average age of 39.4 years (ranged between 27 and 58 years). Patients presented with different types of complex tibial plateau fractures like Schatzker type V (n=9), VI (n=12), type 41.C1 (n=9), type 41.C2 (n=6), and type 41.C3 (n=6). The therapeutic strategy for revision surgery in individual patients was decided following careful analysis and accurate assessment of the causes of failure of the primary surgery. All the patients were followed-up with Rasmussen radiographic scores and Hospital for Special Surgery (HSS) knee scores. RESULTS: All 21 patients underwent clinical and radiological examination after a mean follow-up time of 32.6 months. The average time of fracture healing was 4.5 months (ranged between 3 and 6 months). During the last follow-up, the mean range of motion of knee extension was 2.3° and knee flexion was 123.8°. The mean radiological Rasmussen score was 15.6 points, with an overall success rate of 85.7%. The average HSS knee score was 84.3 points, with an overall success rate of 80.9%. CONCLUSION: The common reasons for the failure of primary surgery of complex tibial plateau fractures were inadequate experience of the surgeon, inaccurate diagnosis and management, improper selection of implants, and poor surgical techniques. The key factors to succeed revision surgery were adequate preoperative evaluation, accurate intraoperative procedures, and proper postoperative rehabilitation. LEVEL OF EVIDENCE: Level IV, case series, treatment study.


Assuntos
Erros de Diagnóstico/prevenção & controle , Monitorização Intraoperatória/métodos , Cuidados Pós-Operatórios/métodos , Reoperação/métodos , Fraturas da Tíbia/diagnóstico por imagem , Fraturas da Tíbia/cirurgia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória/normas , Cuidados Pós-Operatórios/normas , Estudos Retrospectivos , Falha de Tratamento
9.
In Vivo ; 33(3): 669-674, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31028183

RESUMO

Enhanced recovery after surgery or 'fast-track' methods are evidence-based protocols designed to standardize post-operative medical care, improve patient outcomes, promote early recovery, and reduce healthcare expenditure. Fast-track surgery is a multifunctional concept involving pre-, peri- and post-operative measures aiming to reduce the length of hospital stay and morbidity and complication rates, following elective abdominal surgery. Through the optimization of peri-operative care and the recovery process in adherence to these fast-track protocols, improved outcomes are reached, surgical trauma and post-operative stress are reduced, with less surgical pain, reduced complications, and shorter length of hospital stay. Fast-track care requires a multidisciplinary collaboration of all healthcare professionals, as well as a high rate of protocol compliance and a good organizational structure. Despite the existing evidence of the benefits of fast-track protocols in a variety of surgical procedures and the similar outcomes of laparoscopic colonic surgery compared to open surgery, clear evidence of the benefits of fast-track care after laparoscopic colonic surgery is yet to be clearly demonstrated.


Assuntos
Cuidados Pós-Operatórios , Recuperação de Função Fisiológica , Colectomia/efeitos adversos , Colectomia/métodos , Feminino , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Masculino , Avaliação de Resultados da Assistência ao Paciente , Cuidados Pós-Operatórios/métodos , Cuidados Pós-Operatórios/normas , Fatores de Tempo
11.
BMC Musculoskelet Disord ; 20(1): 97, 2019 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-30832636

RESUMO

BACKGROUND: More personalized implant designs for total knee arthroplasty might optimize the clinical outcome after surgery. One of these personalized implant designs is the Persona knee implant system (Zimmer Biomet, Warsaw, Indiana, USA). The primary objective of this study was to determine patient reported outcomes and implant survivorship of the Persona Knee system used in primary total knee arthroplasty, up to two years after surgery. METHODS: From November 2013 to July 2016 consecutive patients undergoing primary total knee arthroplasty were enrolled in a prospective observational cohort study at three centers. Preoperatively, at 6 weeks, 6 months, 1 and 2 years after surgery, patients completed the Knee Injury and Osteoarthritis Outcome Score (KOOS), the Oxford Knee Score (OKS), the Knee Society Score (KSS, 2011, modified version) and the EQ-5D. Adverse Events were captured, assessed for relationship to device, and recorded in the study database. Furthermore, physical functioning was assessed by the orthopedic surgeon. Repeated measures analyses were performed on PROM scores. Kaplan Meier was used to calculate survivorship of the Persona Knee Implant System. RESULTS: A total of 146 total knee arthroplasties were performed. 61% (89/146) of the patients were female and mean age was 64.7 (± 6.9) years. Two years after surgery, one patient had a revision of the polyethylene insert because of a periprosthetic joint infection. Therefore, the Kaplan-Meier survival estimate at 2 years was 0.99 (0.95-1.00 95% CI). OKS increased from 22.1 (95% CI 20.9-23.3) to 41.8 (95% CI 40.6-43.1) two years after surgery. Furthermore, all other PROMs also increased from before surgery to 2 year postoperatively. CONCLUSION: The Persona Knee implant is safe and effective and the clinical results up to two years after surgery are promising. PROMs results are very good; pain, function and quality of life all improved greatly after TKA. Further studies are needed to determine the long term clinical performance of the Persona prosthesis. TRIAL REGISTRATION: Clinicaltrials.gov ( NCT02337244 ). Registered June 1st, 2015. Retrospectively registered.


Assuntos
Artroplastia do Joelho/instrumentação , Artroplastia do Joelho/tendências , Prótese do Joelho/tendências , Medidas de Resultados Relatados pelo Paciente , Cuidados Pós-Operatórios/tendências , Idoso , Artroplastia do Joelho/normas , Estudos de Coortes , Feminino , Seguimentos , Humanos , Prótese do Joelho/normas , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios/normas , Estudos Prospectivos , Fatores de Tempo
12.
Anesthesiology ; 131(2): 426-437, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30860985

RESUMO

Over the past decade, failure to rescue-defined as the death of a patient after one or more potentially treatable complications-has received increased attention as a surgical quality indicator. Failure to rescue is an appealing quality target because it implicitly accounts for the fact that postoperative complications may not always be preventable and is based on the premise that prompt recognition and treatment of complications is a critical, actionable point during a patient's postoperative course. Although numerous patient and macrosystem factors have been associated with failure to rescue, there is an increasing appreciation of the key role of microsystem factors. Although failure to rescue is believed to contribute to observed hospital-level variation in both surgical outcomes and costs, further work is needed to delineate the underlying patient-level and system-level factors preventing the timely identification and treatment of postoperative complications. Therefore, the goals of this narrative review are to provide a conceptual framework for understanding failure to rescue, to discuss various associated patient- and system-level factors, to delineate the reasons it has become recognized as an important quality indicator, and to propose future directions of scientific inquiry for developing effective interventions that can be broadly implemented to improve postoperative outcomes across all hospitals.


Assuntos
Cuidados Pós-Operatórios/normas , Complicações Pós-Operatórias/prevenção & controle , Indicadores de Qualidade em Assistência à Saúde/normas , Mortalidade Hospitalar , Humanos , Cuidados Pós-Operatórios/tendências , Indicadores de Qualidade em Assistência à Saúde/tendências , Falha de Tratamento
13.
Rev Esp Salud Publica ; 932019 02 19.
Artigo em Espanhol | MEDLINE | ID: mdl-30773531

RESUMO

Skin to skin contact (SSC) between mother and child immediately after birth is now considered to be an indicator of good clinical practice as it offers multiple benefits for both: it reduces stress levels of the mother, it facilitates affective bonding, breastfeeding and the newborns adaptation to extra-uterine life. However, in the vast majority of hospitals, mother and child are separated until complete recovery following a caesarean section, which can be several hours. In this article the advantages of SSC after a caesarean section, were analyzed, as well as the main difficulties in order to carry it out, which include maternal or neonatal instability and the reticence of the professionals themselves. An actuation procedure model is detailed, for its implementation in a safe manner and that at the same time, contribute to humanize the birth.


Assuntos
Cesárea , Método Canguru/métodos , Cuidados Pós-Operatórios/métodos , Feminino , Humanos , Recém-Nascido , Método Canguru/psicologia , Método Canguru/normas , Relações Mãe-Filho , Cuidados Pós-Operatórios/psicologia , Cuidados Pós-Operatórios/normas , Gravidez
14.
Gynecol Oncol ; 153(2): 271-276, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30808516

RESUMO

OBJECTIVE: To assess early recovery of physical health after robotic minimally invasive surgery (RMIS) for early-stage endometrial cancer using the European Organisation of Research and Treatment of Cancer Computer Adaptive Test Core questionnaire (EORTC CAT Core). The EORTC CAT Core provides individualised measurements while maintaining comparability. A hypothesis of individual complete recovery to baseline within three post-surgical weeks was evaluated. METHODS: Ninety-four women who underwent RMIS for early-stage endometrial cancer were included consecutively. The EORTC CAT Core was distributed before surgery and prospectively every week during the first post-operative month. Repeated measures models were fitted for each of the four domains (physical functioning, role function, fatigue, and pain) and tested for impact of age, ASA score, minor/major surgery, and the individual baseline scores (poorest, intermediate, best). RESULTS: Women with the lowest physical functioning, lowest role function, highest fatigue level, and highest pain level at baseline all recovered within three weeks. Women with the highest physical functioning, highest role function, lowest level of fatigue, and lowest level of pain at baseline did not reach their individual baselines within the first post-operative month but had the most favourable domain-scores three weeks post-operatively. CONCLUSION: The individual woman's physical health baseline score is predictive for her postoperative recovery following RMIS for early-stage endometrial cancer. Women with the best physical health had the best postoperative functions and lowest level of symptoms; however their recovery to baseline was prolonged. Computer adaptive testing may be a valuable tool for individualised pre-operative information and supportive care during surveillance.


Assuntos
Neoplasias do Endométrio/cirurgia , Histerectomia/efeitos adversos , Qualidade de Vida , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Salpingo-Ooforectomia/efeitos adversos , Idoso , Feminino , Humanos , Histerectomia/métodos , Pessoa de Meia-Idade , Cuidados Pós-Operatórios/métodos , Cuidados Pós-Operatórios/normas , Período Pós-Operatório , Procedimentos Cirúrgicos Robóticos/métodos , Salpingo-Ooforectomia/métodos , Fatores de Tempo , Resultado do Tratamento
15.
World J Gastroenterol ; 25(7): 744-776, 2019 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-30809078

RESUMO

With the digestive endoscopic tunnel technique (DETT), many diseases that previously would have been treated by surgery are now endoscopically curable by establishing a submucosal tunnel between the mucosa and muscularis propria (MP). Through the tunnel, endoscopic diagnosis or treatment is performed for lesions in the mucosa, in the MP, and even outside the gastrointestinal (GI) tract. At present, the tunnel technique application range covers the following: (1) Treatment of lesions originating from the mucosal layer, e.g., endoscopic submucosal tunnel dissection for oesophageal large or circular early-stage cancer or precancerosis; (2) treatment of lesions from the MP layer, per-oral endoscopic myotomy, submucosal tunnelling endoscopic resection, etc.; and (3) diagnosis and treatment of lesions outside the GI tract, such as resection of lymph nodes and benign tumour excision in the mediastinum or abdominal cavity. With the increasing number of DETTs performed worldwide, endoscopic tunnel therapeutics, which is based on DETT, has been gradually developed and optimized. However, there is not yet an expert consensus on DETT to regulate its indications, contraindications, surgical procedure, and postoperative treatment. The International DETT Alliance signed up this consensus to standardize the procedures of DETT. In this consensus, we describe the definition, mechanism, and significance of DETT, prevention of infection and concepts of DETT-associated complications, methods to establish a submucosal tunnel, and application of DETT for lesions in the mucosa, in the MP and outside the GI tract (indications and contraindications, procedures, pre- and postoperative treatments, effectiveness, complications and treatments, and a comparison between DETT and other operations).


Assuntos
Consenso , Doenças do Sistema Digestório/cirurgia , Ressecção Endoscópica de Mucosa/normas , Complicações Pós-Operatórias/prevenção & controle , Endoscópios Gastrointestinais , Ressecção Endoscópica de Mucosa/efeitos adversos , Ressecção Endoscópica de Mucosa/instrumentação , Ressecção Endoscópica de Mucosa/métodos , Humanos , Seleção de Pacientes , Cuidados Pós-Operatórios/métodos , Cuidados Pós-Operatórios/normas , Complicações Pós-Operatórias/etiologia , Cuidados Pré-Operatórios/métodos , Cuidados Pré-Operatórios/normas , Resultado do Tratamento
16.
Int J Gynecol Cancer ; 29(1): 181-187, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30640702

RESUMO

OBJECTIVES: This survey assessed the implementation of enhanced recovery after surgery (ERAS) for patients undergoing surgery for advanced ovarian cancer in three European cooperative study groups in Scandinavia, Italy, and Austria. The aim was to evaluate the landscape for future trials on ERAS pathways in ovarian cancer, because high-level evidence for such interventions is lacking. METHODS: In July 2017, a web-based questionnaire (SurveyMonkey Inc, Palo Alto, CA, USA) was sent to centers conducting surgery for advanced ovarian cancer within the Nordic Society of Gynecologic Oncology (NSGO), Mario Negri Gynecologic Oncology Group (MaNGO) and other Italian institutions, and the Association for Gynecologic Oncology Austria (AGO Austria) (n = 100). The survey covered all aspects of an ERAS pathway including surgery, nursing, and anesthesia. We herein report on the survey findings relating to surgery, including nursing care issues; however, anesthesiologic issues will be discussed in a separate report. RESULTS: The overall response rate was 62%. Only a third of the centers in Italy and Austria follow a written ERAS protocol compared with 60% of the Scandinavian centers. Only a minority of centers have completely abandoned bowel preparation, with the highest proportion in Scandinavia (36%). Two hours of fasting for fluids before surgery is routinely practiced in Scandinavia and Austria (67-57%, respectively), but not in Italy (5%). Carbohydrate loading is routinely administered only in Scandinavia (67%). Peritoneal drainage is used by 22% routinely and by 61% in cases of bowel resection/lymphadenectomy/peritonectomy. Early feeding with a light diet on day 0 or 1 is the standard of care in Scandinavia and Austria, but not in Italy. CONCLUSIONS: The degree of implementation of ERAS protocols varies across and within cooperative groups. The centralization of ovarian cancer care seems to facilitate standardization of peri-operative protocols. Currently, the high heterogeneity in patterns of care may challenge an international approach to a clinical trial.


Assuntos
Adenocarcinoma/cirurgia , Procedimentos Clínicos/normas , Neoplasias Ovarianas/cirurgia , Neoplasias Peritoneais/cirurgia , Cuidados Pós-Operatórios/normas , Padrões de Prática Médica/normas , Cuidados Pré-Operatórios/normas , Adenocarcinoma/patologia , Áustria , Feminino , Humanos , Itália , Neoplasias Ovarianas/patologia , Neoplasias Peritoneais/patologia , Prognóstico , Inquéritos e Questionários
17.
Strahlenther Onkol ; 195(6): 482-495, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30610355

RESUMO

PURPOSE: The aim of this retrospective study was to evaluate the clinical outcome of a previously defined low-risk patient population with completely resected (R0) squamous cell carcinoma of the oral cavity, oropharynx, larynx (pT1-3, pN0-pN2b), hypopharynx (pT1-2, pN0-pN1), and the indication for postoperative radio(chemo)therapy. PATIENTS AND METHODS: According to predefined criteria, 99 patients with head and neck squamous cell carcinoma (SCC) who were treated at our institution from January 1, 2005 to December 31, 2014, were available for analysis. The Kaplan-Meier method was used for calculating survival and incidence rates. For univariate comparative analysis, the log-rank test was used for analyzing prognostic clinicopathologic parameters. RESULTS: Median follow-up was 67 months. Cumulative overall (OS) and disease-free survival (DFS) were 97.9%/94.7%/88.0% and 96.9%/92.6%/84.7% after 1, 2, and 5 years, respectively. Cumulative incidence of loco-regional recurrence (LRR), distant metastases (DM), and second cancer (SC) were 1.0%/1.0%/4.9%, 0.0%/3.4%/5.8%, and 2.1%/4.2%/13.1%, respectively. In univariate comparative analysis, location of the primary tumor in the oropharynx was a significant predictor for increased OS (p = 0.043) and DFS (p = 0.048). CONCLUSION: Considering the low disease relapse rates and high rates of therapy-induced late side effects, as well as the increased risk of developing SC, a prospective multicentric trial investigating de-escalation of radiotherapy in this clearly defined low-risk patient population was started and is still recruiting patients (DIREKHT-Trial, NCT02528955).


Assuntos
Carcinoma de Células Escamosas/radioterapia , Quimiorradioterapia Adjuvante/métodos , Neoplasias Otorrinolaringológicas/radioterapia , Dosagem Radioterapêutica , Radioterapia de Intensidade Modulada/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , Quimiorradioterapia Adjuvante/normas , Terapia Combinada/mortalidade , Terapia Combinada/normas , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias Otorrinolaringológicas/mortalidade , Neoplasias Otorrinolaringológicas/patologia , Neoplasias Otorrinolaringológicas/cirurgia , Cuidados Pós-Operatórios/métodos , Cuidados Pós-Operatórios/normas , Dosagem Radioterapêutica/normas , Radioterapia de Intensidade Modulada/normas , Estudos Retrospectivos , Padrão de Cuidado/normas
20.
Am J Surg ; 217(6): 1112-1115, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30343874

RESUMO

BACKGROUND: Although good sleep during hospitalization may promote positive outcomes, some patients and clinicians may have concerns about nursing interventions designed to reduce night-time sleep disturbances. METHODS: A randomized prospective trial of an intervention to promote sleep was conducted with stable, post-operative oncology patients. Eligible patients were randomized to receive usual nursing care overnight or sleep-promoting interventions. RESULTS: All thirty-seven surgeons in the organization agreed to let their qualified patients participate. One hundred and forty-four patients met the study criteria. Of those, 117 (81%) consented to participate, while 27 (19%) declined. The primary reason for non-enrollment was wanting to be checked on throughout the night (n = 21, 78%). There were no adverse events during the study period. Patients' perceptions of pain and nausea control among the two groups were equivalent. CONCLUSION: An intervention to decrease sleep disturbances can be safely executed in a post-operative population while maintaining adequate symptom management.


Assuntos
Segurança do Paciente , Cuidados Pós-Operatórios/métodos , Complicações Pós-Operatórias/prevenção & controle , Privação do Sono/prevenção & controle , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos Clínicos , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Assistência Centrada no Paciente/métodos , Assistência Centrada no Paciente/normas , Cuidados Pós-Operatórios/normas , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Qualidade da Assistência à Saúde , Privação do Sono/etiologia , Resultado do Tratamento , Adulto Jovem
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