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1.
Plast Reconstr Surg ; 147(5): 1087-1095, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33835086

RESUMO

BACKGROUND: The coronavirus disease of 2019 (COVID-19) pandemic has widely affected rhinosurgery, given the high risk of contagion and the elective nature of the aesthetic procedure, generating many questions on how to ensure safety. The Science and Research Committee of the Rhinoplasty Society of Europe aimed at preparing consensus recommendations on safe rhinosurgery in general during the COVID-19 pandemic by appointing an international panel of experts also including delegates of The Rhinoplasty Society. METHODS: A Zoom meeting was performed with a panel of 14 international leading experts in rhinosurgery. During 3.5 hours, four categories of questions on preoperative safety measures in private practice and outpatient clinics, patient assessment before and during surgery, and legal issues were presented by four chairs and discussed by the expert group. Afterward, the panelists were requested to express an online, electronic vote on each category and question. The panel's recommendations were based on current evidence and expert opinions. The resulting report was circulated in an iterative open e-mail process until consensus was obtained. RESULTS: Consensus was obtained in several important points on how to safely restart performing rhinosurgery in general. Preliminary recommendations with different levels of agreement were prepared and condensed in a bundle of safety measures. CONCLUSION: The implementation of the panel's recommendations may improve safety of rhinoplasty by avoiding operating on nondetected COVID-19 patients and minimizing severe acute respiratory syndrome coronavirus 2 virus spread in outpatient clinics and operating rooms.


Assuntos
/prevenção & controle , Controle de Infecções/normas , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Cuidados Pré-Operatórios/normas , Rinoplastia/normas , Instituições de Assistência Ambulatorial/organização & administração , Instituições de Assistência Ambulatorial/normas , Procedimentos Cirúrgicos Ambulatórios/normas , /transmissão , Congressos como Assunto , Consenso , Procedimentos Cirúrgicos Eletivos/normas , Humanos , Controle de Infecções/organização & administração , Pandemias/prevenção & controle , Cirurgiões , Comunicação por Videoconferência
2.
Medicine (Baltimore) ; 100(12): e25151, 2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-33761684

RESUMO

ABSTRACT: In 2014, the American College of Cardiology/American Heart Association (ACC/AHA) released guidelines for ordering pre-operative echocardiograms in patients undergoing non-cardiac surgery. The purpose of this study is to determine if pre-operative echocardiograms ordered prior to fragility hip fracture repair are ordered according to these guidelines, change anesthetic management or affect patient outcomes. In addition, we attempted to evaluate the efficacy of the ACC/AHA guidelines.We conducted a 4-year retrospective chart review of acute fragility hip fractures at a single institution. Charts were reviewed to determine which patients met criteria for a pre-operative echocardiogram. Within this group we then compared patients who received a pre-operative echocardiogram to those who did not. Comparisons were made with regard to time to surgery, changes from standard anesthetic management, major adverse cardiac events, length of hospital stay, and 1-year mortality. We also examined which patients received postoperative echocardiograms and the incidence of adverse cardiac events in this group.Of 402 patients, 87 (22%) had ACC/AHA indications for pre-operative echocardiogram, and 42 (48%) of them received one. The indication to order a pre-operative echocardiogram in stable heart failure or valve disease patients if their last echo was greater than 1 year was only followed 23% of the time. In the pre-operative echocardiogram group, anesthetic management was adjusted more frequently (P = .025), and average time to surgery was greater (P < .001). The incidence of a major adverse cardiac event was 10% in the ACC/AHA echocardiogram indicated group and 3% in the non-indicated echocardiogram group. An equal number of echocardiograms were completed postoperatively as were completed under ACC/AHA pre-operative guidelines. Sixty-seven percent of the postoperative echocardiograms did not have ACC/AHA pre-operative indications.Our data demonstrates that pre-operative echocardiograms for "stable heart failure and valvular disease with greater than 1 year from last echocardiogram" is infrequently performed without significant adverse cardiac outcomes. Pre-operative echocardiography was associated with more anesthetic adjustments and longer time to surgery. Postoperative echocardiograms were done for cardiopulmonary complications. Studies need to examine and refine clinical parameters that would improve the selection of patients who would benefit from pre-operative echocardiograms.


Assuntos
Ecocardiografia/normas , Cardiopatias/prevenção & controle , Fraturas do Quadril/diagnóstico por imagem , Fraturas por Osteoporose/diagnóstico por imagem , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios/normas , Idoso de 80 Anos ou mais , Feminino , Fixação de Fratura/efeitos adversos , Fixação de Fratura/normas , Fidelidade a Diretrizes/estatística & dados numéricos , Cardiopatias/epidemiologia , Cardiopatias/etiologia , Fraturas do Quadril/cirurgia , Humanos , Incidência , Masculino , Fraturas por Osteoporose/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Medição de Risco
4.
J Orthop Surg Res ; 16(1): 103, 2021 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-33531037

RESUMO

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic is the largest global event in recent times, with millions of infected people and hundreds of thousands of deaths worldwide. Colombia has also been affected by the pandemic, including by the cancellation of medically necessary surgical procedures that were categorized as nonessential. The objective of this study was to show the results of the program implemented in two institutions in Bogotá, Colombia, in April 2020 to support the performance of elective essential and nonessential low- and medium-complexity orthopedic surgeries during the mitigation phase of the COVID-19 pandemic, which involved a presurgical clinical protocol without serological or molecular testing. METHODS: This was a multicenter, observational, retrospective, descriptive study of a cohort of patients who underwent elective orthopedic surgery at two institutions in the city of Bogota, Colombia, in April 2020. We implemented a preoperative clinical protocol that did not involve serological or molecular tests; the protocol consisted of a physical examination, a survey of symptoms and contact with confirmed or suspected cases, and presurgical isolation. We recorded the types of surgeries, the patients' scores on the medically necessary, time-sensitive (MeNTs) scale, the presence of signs, symptoms, and mortality associated with COVID-19 developed after the operation. RESULTS: A total of 179 patients underwent orthopedic surgery. The average age was 47 years (Shapiro-Wilk, P = 0.021), and the range was between 18 and 81 years. There was a female predominance (61.5%). With regard to the types of surgeries, 86 (48%) were knee operations, 42 (23.5%) were hand surgeries, 34 (19%) were shoulder surgeries, and 17 (9.5%) were foot and ankle surgeries. The average MeNTs score was 44.6 points. During the 2 weeks after surgery, four patients were suspected of having COVID-19 because they developed at least two symptoms associated with the disease. The incidence of COVID-19 in the postoperative period was 2.3%. Two (1.1%) of these four patients visited an emergency department where RT-PCR tests were performed, and they tested negative for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). No patients died or were hospitalized for symptoms of COVID-19. CONCLUSION: Through the implementation of a presurgical clinical protocol consisting of a physical examination; a clinical survey inquiring about signs, symptoms, and epidemiological contact with suspected or confirmed cases; and presurgical isolation but not involving the performance of molecular or serological diagnostic tests, positive results were obtained with regard to the performance of low- and medium-complexity elective orthopedic surgeries in an early stage of the COVID-19 pandemic. LEVEL OF EVIDENCE: IV.


Assuntos
/diagnóstico , Procedimentos Cirúrgicos Eletivos/métodos , Procedimentos Ortopédicos/métodos , Cuidados Pré-Operatórios/métodos , Inquéritos e Questionários , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Procedimentos Cirúrgicos Eletivos/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/normas , Cuidados Pré-Operatórios/normas , Estudos Retrospectivos , Adulto Jovem
5.
Medicine (Baltimore) ; 100(1): e24143, 2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33429790

RESUMO

ABSTRACT: There is no established protocol regarding the timing of administration of antiemetics in patients undergoing total knee arthroplasty (TKA). The purpose of this study was to determine whether preoperative, rather than postoperative administration of an antiemetic could reduce postoperative nausea and vomiting (PONV) in patients undergoing TKA, and whether there was a difference in postoperative pain, patient satisfaction and complications after TKA between the 2 different administration times.The included patients (N = 101) either received intravenous administration of the ramosetron 1 hour before surgery (N = 50) or at the end of surgery (N = 51) consecutively order. The incidence of PONV and the frequency of rescue medicine use were recorded until 48 hours postoperatively. The severity of postoperative pain and patient satisfaction were assessed using the visual analogue scale. The incidence of complications associated with use of antiemetic was assessed.Preoperative administration of ramosetron did not decrease PONV during the first 48 hours. There was no significant difference in the incidence of nausea and vomiting, use of rescue antiemetics, and the severity of nausea (P > .05). Postoperative pain, satisfaction scores, and the incidence of complications were not different between the 2 groups (P > .05).Preoperative administration of ramosetron did not show clinical advantage in reducing POVN, postoperative pain and improving patient satisfaction. However, the outcomes of complications were not inferior to those of postoperative administration. Therefore, under the current protocol of multimodal therapies, timing of administration of pre-emptive antiemetic did not have significant effect on PONV.


Assuntos
Antieméticos/uso terapêutico , Náusea e Vômito Pós-Operatórios/prevenção & controle , Cuidados Pré-Operatórios/normas , Fatores de Tempo , Adulto , Antieméticos/administração & dosagem , Antieméticos/farmacologia , Benzimidazóis/farmacologia , Benzimidazóis/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/efeitos adversos , Manejo da Dor/métodos , Medição da Dor/métodos , Náusea e Vômito Pós-Operatórios/tratamento farmacológico , Cuidados Pré-Operatórios/métodos , Cuidados Pré-Operatórios/estatística & dados numéricos , República da Coreia
6.
Plast Reconstr Surg ; 147(1): 111e-122e, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-33370068

RESUMO

LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Understand the available donor sites for autologous breast reconstruction. 2. Describe the advantages and limitations of each donor site. 3. Provide a rational, algorithmic preoperative evaluation and approach for patients seeking autologous breast reconstruction. 4. Develop an effective postoperative monitoring system to minimize complications and maximize salvage of microvascular thromboses. SUMMARY: Breast reconstruction remains at the heart of the field of plastic and reconstructive surgery, and it is continuously evolving. Tremendous advances in breast implant technology and supplemental products, particularly acellular dermal matrices, have revolutionized breast reconstruction in the modern era. However, microvascular free flap breast reconstruction has also witnessed profound advancements with exceptionally high success rates, with the ability to provide the most durable and natural breast reconstruction. Although the pendulum oscillates between prosthesis-based reconstruction and autologous tissue, the present synopsis will focus on autologous free flap breast reconstruction from an historical perspective, recent advancements in microsurgery, and the future of autologous breast reconstruction.


Assuntos
Mamoplastia/métodos , Complicações Pós-Operatórias/prevenção & controle , Guias de Prática Clínica como Assunto , Retalhos Cirúrgicos/transplante , Coleta de Tecidos e Órgãos/normas , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/genética , Neoplasias da Mama/cirurgia , Feminino , Aconselhamento Genético , Humanos , Mamoplastia/efeitos adversos , Mamoplastia/normas , Mastectomia/efeitos adversos , Anamnese , Recidiva Local de Neoplasia/diagnóstico , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/genética , Obesidade/epidemiologia , Seleção de Pacientes , Exame Físico/normas , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Cuidados Pré-Operatórios/métodos , Cuidados Pré-Operatórios/normas , Medição de Risco/métodos , Medição de Risco/normas , Fatores de Risco , Retalhos Cirúrgicos/efeitos adversos , Tempo para o Tratamento/normas , Coleta de Tecidos e Órgãos/efeitos adversos , Coleta de Tecidos e Órgãos/métodos , Resultado do Tratamento
8.
Curr Opin Anaesthesiol ; 33(6): 740-745, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33027074

RESUMO

PURPOSE OF REVIEW: Preoperative fasting guidelines are generalized to elective procedures and usually do not distinguish between the ambulatory and inpatient setting. Prevalence of aspiration is low while prolonged preoperative fasting is common clinical reality. Recently, changes in preoperative fasting guidelines have been widely discussed. RECENT FINDINGS: Rates of prolonged clear fluid fasting (>4 h) prior to surgery are reported in up to 80% of patients with mean fasting duration of up to 16 h and beyond. Prolonged fasting may result in adverse effects such as intraoperative hemodynamic instability, postoperative delirium, patient discomfort, and extended hospital length of stay. Liberal approaches allowing clear fluids up to 1 h prior to anesthesia or until premedication/call to the operating room have shown no increase in adverse events among children. Various anesthesia societies now encourage clear fluid intake up to 1 h prior to pediatric elective anesthesia. Similar reports in the adult cohort are scarce. SUMMARY: Allowing sips of water until call to the operating room may help reducing prolonged preoperative fasting and improving patient comfort while keeping a flexibility in operating room schedule. The feasibility and safety of a liberal clear fluid fasting regimen among adults undergoing elective anesthesia needs to be evaluated in future studies.


Assuntos
Anestesia/efeitos adversos , Procedimentos Cirúrgicos Eletivos/normas , Complicações Pós-Operatórias/prevenção & controle , Guias de Prática Clínica como Assunto , Cuidados Pré-Operatórios/normas , Aspiração Respiratória de Conteúdos Gástricos/prevenção & controle , Jejum , Humanos , Pré-Medicação
10.
Gastroenterology ; 159(5): 1935-1948.e5, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32735862
12.
Surgery ; 168(3): 426-433, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32611515

RESUMO

INTRODUCTION: Guidelines recommend early endoscopic retrograde cholangiopancreatography for the management of acute cholangitis, but the definition of the term "early" remains debatable. This study analyzed national trends in the timing of endoscopic retrograde cholangiopancreatography and identified the ideal time to perform preoperative endoscopic retrograde cholangiopancreatography in patients with acute cholangitis. METHODS: The 2005 to 2016 National Inpatient Sample was used to identify patients undergoing cholecystectomy for acute cholangitis. Severity of cholangitis was defined using the 2013 Tokyo Grading Criteria, where Tokyo grade III patients were defined as having organ dysfunction and non-Tokyo grade III patients were defined as grades I and II. Multivariable regressions (accounting for patient and hospital characteristics) were used to identify the timing of preoperative endoscopic retrograde cholangiopancreatography associated with the least mortality risk. RESULTS: Of 91,051 patients undergoing cholecystectomy for cholangitis, 55% underwent preoperative endoscopic retrograde cholangiopancreatography: 24% of patients received endoscopic retrograde cholangiopancreatography on the day of admission, 41% on hospital day 2, and the use of endoscopic retrograde cholangiopancreatography decreased gradually thereafter. Mortality rates remained under 1% if endoscopic retrograde cholangiopancreatography was performed during the first 3 days and increased as endoscopic retrograde cholangiopancreatography was performed during days 4 to 7 (P < .001). On multivariable regression, endoscopic retrograde cholangiopancreatography performed >72 hours after admission was associated with increased mortality (adjusted odds ratio 1.80, P = .01). Receiving endoscopic retrograde cholangiopancreatography P > 72 hours increased risk of death among Tokyo grade III patients (adjusted odds ratio 1.88, P = .01). Overall, during the study period, the utilization of preoperative endoscopic retrograde cholangiopancreatography for all grades of acute cholangitis increased from 39% of patients in 2005 to 51% in 2016 (P < .001). CONCLUSION: There has been an increase in the use of endoscopic retrograde cholangiopancreatography for acute cholangitis. Although endoscopic retrograde cholangiopancreatography on the day of admission was not associated with a decrease in mortality in patients with Tokyo grade III disease, endoscopic retrograde cholangiopancreatography within 72 hours of hospitalization was associated with decreased in-hospital mortality.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica/tendências , Colangite/cirurgia , Colecistectomia/tendências , Cuidados Pré-Operatórios/tendências , Esfinterotomia Endoscópica/tendências , Tempo para o Tratamento/tendências , Doença Aguda/mortalidade , Doença Aguda/terapia , Idoso , Idoso de 80 Anos ou mais , Colangiopancreatografia Retrógrada Endoscópica/normas , Colangite/diagnóstico , Colangite/mortalidade , Colecistectomia/normas , Feminino , Mortalidade Hospitalar , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Cuidados Pré-Operatórios/métodos , Cuidados Pré-Operatórios/normas , Estudos Retrospectivos , Índice de Gravidade de Doença , Esfinterotomia Endoscópica/normas , Análise de Sobrevida , Fatores de Tempo , Tempo para o Tratamento/normas , Estados Unidos/epidemiologia
13.
United European Gastroenterol J ; 8(7): 798-803, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32615871

RESUMO

Since December 2019, a novel coronavirus disease, COVID-19, has occurred in China and has spread around the world rapidly. As an acute respiratory infectious disease, COVID-19 has been included in type B infectious diseases and managed according to the standard of type A infectious disease in China. Given the high risk of COVID-19 infection during endoscopic procedures via an airborne route, the Chinese Society of Digestive Endoscopy issued a series of recommendations to guide the endoscopy works in China during the pandemic. To the best of our knowledge, no new infectious case of COVID-19 resulting from endoscopic procedures has been reported in China to date. Here, these recommendations are integrated to provide guidance about the prevention of COVID-19 for endoscopists. The recommendations include advice about postponing non-urgent endoscopies, excluding the possibility of COVID-19 in patients undergoing endoscopy, protection of medical staff from coronavirus infection, and cleaning of endoscopy centres.


Assuntos
Infecções por Coronavirus/prevenção & controle , Endoscopia Gastrointestinal/normas , Controle de Infecções/organização & administração , Pandemias/prevenção & controle , Equipamento de Proteção Individual/normas , Pneumonia Viral/prevenção & controle , Guias de Prática Clínica como Assunto , Betacoronavirus/isolamento & purificação , Betacoronavirus/patogenicidade , China/epidemiologia , Técnicas de Laboratório Clínico/normas , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Endoscopia Gastrointestinal/instrumentação , Contaminação de Equipamentos/prevenção & controle , Gastroenterologia/métodos , Gastroenterologia/normas , Gastroenteropatias/diagnóstico , Gastroenteropatias/terapia , Pessoal de Saúde/normas , Humanos , Controle de Infecções/instrumentação , Controle de Infecções/normas , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Salas Cirúrgicas/normas , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Cuidados Pré-Operatórios/normas , Sociedades Médicas/normas
14.
Gastroenterology ; 159(5): 1962-1964, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32682767
16.
Oral Oncol ; 107: 104835, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32505553

Assuntos
Betacoronavirus/isolamento & purificação , Técnicas de Laboratório Clínico/normas , Infecções por Coronavirus/prevenção & controle , Neoplasias de Cabeça e Pescoço/cirurgia , Procedimentos Cirúrgicos Otorrinolaringológicos/normas , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Oncologia Cirúrgica/normas , Idoso , Betacoronavirus/genética , Betacoronavirus/patogenicidade , Técnicas de Laboratório Clínico/estatística & dados numéricos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Reações Falso-Negativas , Feminino , Humanos , Controle de Infecções/instrumentação , Controle de Infecções/normas , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Itália/epidemiologia , Masculino , Nasofaringe/cirurgia , Nasofaringe/virologia , Procedimentos Cirúrgicos Otorrinolaringológicos/estatística & dados numéricos , Equipamento de Proteção Individual/normas , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Cuidados Pré-Operatórios/instrumentação , Cuidados Pré-Operatórios/normas , Cuidados Pré-Operatórios/estatística & dados numéricos , RNA Viral/isolamento & purificação , Centros de Atenção Terciária/estatística & dados numéricos , Tempo para o Tratamento
17.
Otolaryngol Head Neck Surg ; 163(2): 307-315, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32482131

RESUMO

OBJECTIVE: Limited research exists on the coronavirus disease 2019 (COVID-19) pandemic pertaining to otolaryngology-head and neck surgery (OHNS). The present study seeks to understand the response of OHNS workflows in the context of policy changes and to contribute to developing preparatory guidelines for perioperative management in OHNS. STUDY DESIGN: Retrospective cohort study. SETTING: Pediatric and general adult academic medical centers and a Comprehensive Cancer Center (CCC). SUBJECTS AND METHODS: OHNS cases from March 18 to April 8, 2020-the 3 weeks immediately following the Ohio state-mandated suspension of all elective surgery on March 18, 2020-were compared with a 2019 control data set. RESULTS: During this time, OHNS at the general adult and pediatric medical centers and CCC experienced 87.8%, 77.1%, and 32% decreases in surgical procedures as compared with 2019, respectively. Aerosol-generating procedures accounted for 86.8% of general adult cases, 92.4% of pediatric cases, and 62.0% of CCC cases. Preoperative COVID-19 testing occurred in 7.1% of general adult, 9% of pediatric, and 6.9% of CCC cases. The majority of procedures were tiers 3a and 3b per the Centers for Medicare & Medicaid Services. Aerosol-protective personal protective equipment (PPE) was worn in 28.6% of general adult, 90% of pediatric, and 15.5% of CCC cases. CONCLUSION: For OHNS, the majority of essential surgical cases remained high-risk aerosol-generating procedures. Preoperative COVID-19 testing and intraoperative PPE usage were initially inconsistent; systemwide guidelines were developed rapidly but lagged behind recommendations of the OHNS department and its academy. OHNS best practice standards are needed for preoperative COVID-19 status screening and PPE usage as we begin national reopening.


Assuntos
Betacoronavirus , Técnicas de Laboratório Clínico/normas , Infecções por Coronavirus/diagnóstico , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Otorrinolaringopatias/cirurgia , Pneumonia Viral/diagnóstico , Cuidados Pré-Operatórios/estatística & dados numéricos , Adulto , Aerossóis , Idoso , Criança , Pré-Escolar , Procedimentos Cirúrgicos Eletivos/legislação & jurisprudência , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Ohio , Otolaringologia , Pandemias , Guias de Prática Clínica como Assunto , Cuidados Pré-Operatórios/normas , Estudos Retrospectivos , Risco
18.
Enferm. clín. (Ed. impr.) ; 30(3): 176-184, mayo-jun. 2020. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-196683

RESUMO

INTRODUCCIÓN: Los cuidados proporcionados a las personas ostomizadas son cruciales para su evolución y rehabilitación. Las Guías de práctica clínica de la Registered Nurses' Association of Ontario recogen las intervenciones enfermeras con mayor evidencia en el cuidado del paciente ostomizado. El objetivo del estudio es analizar el impacto en los cuidados y los resultados de salud de los pacientes tras la implantación de la guía Cuidado y manejo de la ostomía. MÉTODO: Estudio cuasiexperimental pre-post test en todos los pacientes a los que se les realizó una ostomía digestiva o urológica en 8 Centros Comprometidos con la Excelencia en Cuidados® donde se implanta la guía para el cuidado y manejo de la ostomía, desde 2012 hasta 2018. Se analizaron y compararon variables clínicas de proceso y de resultados en salud en 3 períodos de tiempo. Se realizó un análisis descriptivo y se compararon las proporciones entre períodos, mediante Chi cuadrado, aplicando la corrección de Yates, considerando un nivel de confianza del 95%. RESULTADOS: La educación preoperatoria pasó del 36,7 al 47,3% (p < 0,05); el marcaje de la ostomía, del 25,2 al 33,8% (p < 0,05); la evaluación postoperatoria, del 94,8 al 59% (p < 0,05); la educación postoperatoria, del 75,5 al 91,9% (p < 0,05); las complicaciones en la piel periestomal, del 16,6 al 10,9% (p < 0,05), y las complicaciones en la ostomía, del 21,8 al 27,9% (p < 0,05). CONCLUSIONES: La implantación de la guía para el cuidado y manejo de la ostomía produjo mejoras en los cuidados preoperatorios, el marcaje del estoma y en las complicaciones de la piel periestomal


INTRODUCTION: Care provided to ostomized people is crucial in their progress and rehabilitation. The Registered Nurses' Association of Ontario clinical practice guidelines include greatest evidence nursing interventions for ostomized patient care. The aim of the study is to analyze the impact on patients' care and health outcomes after Care and management of ostomy guideline implementation. METHOD: Pre-post quasi-experimental study, carried out in all patients who underwent a digestive or urological ostomy in 8 centres of Best Practices Spotlight Organization® where the ostomy care and management guideline was implanted from 2012 to 2018. Clinical, process and health outcome variables were analyzed and compared in 3 periods of time. Descriptive analysis and comparison of proportions between the periods was performed, using Chi square, applying Yates correction, considering a 95% confidence interval. RESULTS: Preoperative education went from 36.7 to 47.3% (P<.05); stoma site marking from 25.2 to 33.8% (P<.05); postoperative evaluation from 94.8 to 59% (P<.05); postoperative education from 75.5 to 91.9% (P<.05); peristomal skin complications from 16.6 to 10.9% (P<.05), and ostomy complications from 21.8 to 27.9% (P<.05). CONCLUSIONS: The implementation of the ostomy care and management improved preoperative care, stoma site marking and peristomal skin complications


Assuntos
Humanos , Enfermagem no Consultório/normas , Implementação de Plano de Saúde/normas , Estomia/enfermagem , Estomia/normas , Guias de Prática Clínica como Assunto/normas , Resultado do Tratamento , Cuidados de Enfermagem/normas , Intervalos de Confiança , Cuidados Pré-Operatórios/normas , Cuidados Pós-Operatórios/normas , Estomia/estatística & dados numéricos
20.
Spine (Phila Pa 1976) ; 45(10): 641-648, 2020 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-32358304

RESUMO

STUDY DESIGN: A prospective cohort study. OBJECTIVE: This study aimed to investigate the relationship between preoperative cervical sagittal alignment and postoperative kyphosis in patients with cervical spondylotic myelopathy (CSM) and to determine the cut-off angle for predicting the postlaminoplasty kyphosis. SUMMARY OF BACKGROUND DATA: There have been several reports describing a cervical kyphosis after laminoplasty. However, there has been no study on the cut-off angle for predicting the postoperative kyphosis in a large series of patients with CSM. METHODS: A total of 1025 consecutive patients with CSM (642 men and 383 women; mean age, 64.4 yr; range, 23-93 yrs) who underwent laminoplasty were included. The average follow-up period was 30.0 months. Radiography was performed before the surgery and at final follow-up. The cervical alignment with neutral view was measured by using the Cobb method. An alignment of C2-7 lordotic angle more than 0° was defined as lordosis and C2-7 lordotic angle less than 0° was defined as kyphosis. The incidence of postoperative kyphosis was evaluated on lateral radiographs. RESULTS: In all patients, the mean C2-7 alignment in the neutral position was 11.5° lordotic before surgery and 14.2° lordotic at final follow-up. In the patient without preoperative kyphotic alignment, receiver operating characteristic curve of preoperative C2-7 lordotic angle showed 7° as a predictor for the postlaminoplasty kyphosis (area under the curve  = 0.75, P < 0.0001). Among the preoperatively 720 patients with lordosis more than 7°, postoperative kyphosis was observed in 20 patients (2.8%), whereas in the preoperatively 191 patients with lordosis less than 7°, postoperative kyphosis was seen in 28 patients (14.7%). CONCLUSION: The cut-off value of preoperative C2-7 lordotic angle for predicting the postlaminoplasty kyphosis was 7° in CSM patient without preoperative kyphotic alignment. LEVEL OF EVIDENCE: 3.


Assuntos
Vértebras Cervicais/diagnóstico por imagem , Cifose/diagnóstico por imagem , Laminoplastia/tendências , Cuidados Pré-Operatórios/normas , Doenças da Medula Espinal/diagnóstico por imagem , Espondilose/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Vértebras Cervicais/cirurgia , Feminino , Seguimentos , Humanos , Cifose/cirurgia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Cuidados Pré-Operatórios/métodos , Estudos Prospectivos , Doenças da Medula Espinal/cirurgia , Espondilose/cirurgia , Adulto Jovem
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