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1.
Orthod Fr ; 92(1): 141-157, 2021 Mar 01.
Artigo em Francês | MEDLINE | ID: mdl-33871366

RESUMO

The gum and the gingival festoon in particular are essential elements of the good periodontal health and the harmony of the smile. How does this engage orthodontics? Orthodontists are directly concerned by the vertical position of the collars which they must consider. More indirectly, they can have an influence on the gum festoon and in particular on the papillae. The analysis of the literature of the undesirable effects of orthodontics on the periodontium is provided but with limited conclusions which do not constitute scientific evidence. It remains very important to analyze them in order to draw a guide of clinical conduct. The vestibular version and the alveolar expansion present risks of gingival recession that must be taken into account. The presence of the papillae responds to precise anatomical conditions that have to be controlled to avoid disastrous black triangles when aligning the teeth. The shape of the teeth is directly involved in these phenomena. Stripping may be an appropriate therapeutic response to prevent or limit these iatrogenic effects. The approach is first of all diagnostic (identification of the shape of the teeth, analysis of the dento-dental disharmony (DDD), evaluation of the amount of stripping and its consequences on the DDD) and then prognostic in order to establish the treatment plan... The author will illustrate this approach by the teachings of the literature and by clinical illustrations of treated cases. The balance of a smile is based on the respect of shapes, anatomical proportions and the conditions necessary for healthy tissue. It is our role to respect them in the project of establishing harmony. The beauty of the smile reflects the patient's own personality: « Orthodontists are the technicians of the semaphore of the soul ¼, Axel Kahn, Journées de l'Orthodontie, 2007.


Assuntos
Estética Dentária , Sorriso , Gengiva , Humanos , Doença Iatrogênica/prevenção & controle , Ortodontistas
2.
Laryngoscope ; 131 Suppl 4: S1-S42, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33729584

RESUMO

OBJECTIVES/HYPOTHESIS: Facial nerve monitoring (FNM) has evolved into a widely used adjunct for many surgical procedures along the course of the facial nerve. Even though majority opinion holds that FNM reduces the incidence of iatrogenic nerve injury, there are few if any studies yielding high-level evidence and no practice guidelines on which clinicians can rely. Instead, a review of the literature and medicolegal cases reveals significant variations in methodology, training, and clinical indications. STUDY DESIGN: Literature review and expert opinion. METHODS: Given the lack of standard references to serve as a resource for FNM, we assembled a multidisciplinary group of experts representing more than a century of combined monitoring experience to synthesize the literature and provide a rational basis to improve the quality of patient care during FNM. RESULTS: Over the years, two models of monitoring have become well-established: 1) monitoring by the surgeon using a stand-alone device that provides auditory feedback of facial electromyography directly to the surgeon, and 2) a team, typically consisting of surgeon, technologist, and interpreting neurophysiologist. Regardless of the setting and the number of people involved, the reliability of monitoring depends on the integration of proper technical performance, accurate interpretation of responses, and their timely application to the surgical procedure. We describe critical steps in the technical set-up and provide a basis for context-appropriate interpretation and troubleshooting of recorded signals. CONCLUSIONS: We trust this initial attempt to describe best practices will serve as a basis for improving the quality of patient care while reducing inappropriate variations. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:S1-S42, 2021.


Assuntos
Eletromiografia/métodos , Nervo Facial/fisiologia , Nervo Facial/cirurgia , Monitorização Intraoperatória/instrumentação , Guias de Prática Clínica como Assunto/normas , Idoso , Lista de Checagem , Análise Custo-Benefício , Traumatismos do Nervo Facial/epidemiologia , Traumatismos do Nervo Facial/prevenção & controle , Feminino , Humanos , Doença Iatrogênica/epidemiologia , Doença Iatrogênica/prevenção & controle , Incidência , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória/métodos , Neurofisiologia/métodos , Neurofisiologia/estatística & dados numéricos , Preceptoria/normas , Qualidade da Assistência à Saúde , Reprodutibilidade dos Testes
3.
Khirurgiia (Mosk) ; (4): 85-91, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33759475

RESUMO

Iatrogenic events made up 1-10% of in-hospital mortality. Currently, iatrogenic vascular injuries are described for almost all surgical areas. Incidence of iatrogenic vascular injuries is gradually increased that is primarily associated with high number of percutaneous endovascular interventions. Surgical treatment of patients with iatrogenic vessel injuries is extremely difficult. This is due to sudden development of this complication, severe clinical state of the patient associated with underlying disease, acute massive blood loss, as well as insufficient experience of surgeon in urgent vascular surgery. Simple lateral or circular suturing is not always possible to restore the vessel integrity. Vascular replacement including non-standard vascular reconstructions are often required. Prevention of iatrogenic vascular injuries is also insufficiently described in the literature. Most manuscripts devoted to iatrogenic vascular injuries are usually represented by case reports or small sample. Thus, it is impossible to identify the main measures for prevention of iatrogenic injury.


Assuntos
Doença Iatrogênica , Lesões do Sistema Vascular , Competência Clínica , Procedimentos Endovasculares/efeitos adversos , Hemorragia/etiologia , Hemorragia/cirurgia , Mortalidade Hospitalar , Humanos , Doença Iatrogênica/prevenção & controle , Procedimentos Cirúrgicos Vasculares/métodos , Procedimentos Cirúrgicos Vasculares/normas , Lesões do Sistema Vascular/etiologia , Lesões do Sistema Vascular/mortalidade , Lesões do Sistema Vascular/cirurgia
4.
Ann R Coll Surg Engl ; 103(2): e56-e58, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33559559

RESUMO

Instrument breakage during orthopaedic procedures is relatively uncommon, but it remains a challenging problem to orthopaedic surgeons. We report a case of a broken guidewire during intramedullary nail fixation of a proximal femur fracture with subtrochanteric extension. We also report a simple yet effective technique for removal of a broken guidewire from the medulla of the proximal femur without causing much iatrogenic trauma.


Assuntos
Fios Ortopédicos/efeitos adversos , Remoção de Dispositivo/métodos , Falha de Equipamento , Fixação Intramedular de Fraturas/efeitos adversos , Fraturas do Quadril/cirurgia , Redução Aberta/efeitos adversos , Idoso de 80 Anos ou mais , Pinos Ortopédicos , Remoção de Dispositivo/efeitos adversos , Fixação Intramedular de Fraturas/instrumentação , Humanos , Doença Iatrogênica/prevenção & controle , Masculino , Redução Aberta/instrumentação
5.
Zhonghua Shao Shang Za Zhi ; 37(3): 213-215, 2021 Mar 20.
Artigo em Chinês | MEDLINE | ID: mdl-33618450

RESUMO

The iatrogenic wound is defined as infection, necrosis, or defect of the skin and deep soft tissue resulting from a medical procedure. At present, the main factors causing iatrogenic wounds include surgery, radiotherapy, interventional therapy, and drugs etc. Iatrogenic wounds are attributed to iatrogenic injuries that are in accordance with ethics, laws, and relevant regulations, and the degree of these injuries is within an acceptable range. Medical staff can reduce the incidence of iatrogenic wounds and the degree of injury by improving medical technology and responsibility in medical procedures. Iatrogenic wounds can be repaired and the patient's physical and mental health can be restored with targeted medical treatment. How to effectively prevent and treat iatrogenic wounds so as to minimize the degree of iatrogenic injuries to patients needs further exploration. To sum up, the purpose to publish this special topic in this issue is to arouse the peer's attention to the prevention and treatment of iatrogenic wounds.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos , Lesões dos Tecidos Moles , Humanos , Doença Iatrogênica/prevenção & controle , Pele , Transplante de Pele , Lesões dos Tecidos Moles/cirurgia
6.
J Laryngol Otol ; 135(2): 134-141, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33536091

RESUMO

OBJECTIVE: This paper describes the construction of portals for electrode placement during cochlear implantation and emphasises the utility of pre-operative temporal bone three-dimensional computed tomography. METHODS: Temporal bone three-dimensional computed tomography was used to plan portal creation for electrode insertion. RESULTS: Pre-operative temporal bone three-dimensional computed tomography can be used to determine the orientation of temporal bone structures, which is important for mastoidectomy, posterior tympanotomy and cochleostomy, and when using the round window approach. CONCLUSION: It is essential to create appropriate portals (from the mastoid cortex to the cochlea) in a step-by-step manner, to ensure the safe insertion of electrodes into the scala tympani. Pre-operative three-dimensional temporal bone computed tomography is invaluable in this respect.


Assuntos
Implante Coclear/métodos , Eletrodos Implantados/efeitos adversos , Osso Temporal/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Cóclea/cirurgia , Implante Coclear/efeitos adversos , Eletrodos Implantados/normas , Humanos , Doença Iatrogênica/prevenção & controle , Imageamento Tridimensional/métodos , Mastoidectomia/métodos , Ventilação da Orelha Média/métodos , Período Pré-Operatório , Janela da Cóclea/cirurgia , Rampa do Tímpano/cirurgia , Osso Temporal/cirurgia
7.
Am J Nurs ; 121(2): 46-52, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33497127

RESUMO

PURPOSE: The purpose of this project was to examine whether initiating a standardized pressure injury (PI) assessment and prevention protocol early in adult patients' ED stay reduces hospital-acquired PIs (HAPIs) in those patients admitted from the ED to acute care inpatient medical units. METHODS: A nurse-led evidence-based practice team studied the problem of increasing HAPIs on four acute care inpatient units and found that, among patients who had been admitted to inpatient care from the ED, longer ED boarding times correlated with a higher rate of HAPIs. ED staff and acute care unit nurses collaborated to develop new protocols to prevent HAPIs in the ED, including staff education and standardized assessments and prevention care for at-risk patients. Data collection was performed at three time periods over approximately two and a half years: baseline, intervention, and postintervention. RESULTS: The incidence rate for HAPIs decreased from 3.56 per 1,000 patient-days at baseline to 1.31 per 1,000 patient-days during the intervention period. This reduction was sustained over the next five months, during which the HAPI incidence rate was 1.53 per 1,000 patient-days. IMPLICATIONS: At a time when ED length of stay is difficult to manage and continues to increase, the use of evidence-based interventions and protocols can reduce the rate of PIs in high-risk patients waiting for hospital admission, leading to a reduction in PI rates and overall hospital costs.


Assuntos
Admissão do Paciente/normas , Lesão por Pressão/prevenção & controle , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , California , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/normas , Serviço Hospitalar de Emergência/estatística & dados numéricos , Humanos , Doença Iatrogênica/prevenção & controle , Tempo de Internação/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos
8.
Curr Urol Rep ; 22(2): 12, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33447905

RESUMO

PURPOSE OF REVIEW: Chronic scrotal content pain (CSCP) is a complex condition with multiple etiologies that requires a thorough understanding of its pathophysiology, workup, and treatment options. We performed a comprehensive and contemporary review to augment our current understanding of CSCP. RECENT FINDINGS: We discuss new advances in CSCP-specific pain questionnaires, modern studies of microscopic spermatic cord denervation and its variations, and novel techniques including electric nerve stimulation and cryoablation in addition to randomized control trials with significant negative findings. We also present literature focusing on the prevention of CSCP secondary to surgical iatrogenic causes. The constantly evolving literature of CSCP has led to the significant evolution in its diagnosis and treatment, from oral medications to salvage options after microscopic spermatic cord denervation. With each advance, we come closer to developing a more thorough, evidence-based algorithm to guide urologists in treatment of CSCP.


Assuntos
Dor Crônica/terapia , Doenças dos Genitais Masculinos/terapia , Escroto , Algoritmos , Dor Crônica/etiologia , Criocirurgia , Denervação/métodos , Terapia por Estimulação Elétrica , Doenças dos Genitais Masculinos/diagnóstico , Doenças dos Genitais Masculinos/etiologia , Humanos , Doença Iatrogênica/prevenção & controle , Masculino , Microcirurgia , Medição da Dor , Dor Pélvica/etiologia , Dor Pélvica/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Dermatopatias/diagnóstico , Dermatopatias/etiologia , Dermatopatias/terapia , Cordão Espermático/inervação , Doenças Testiculares/diagnóstico , Doenças Testiculares/terapia
9.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(1): 14-19, 2021 Jan 15.
Artigo em Chinês | MEDLINE | ID: mdl-33448193

RESUMO

Objective: To summarize the prevention and treatment of iatrogenic medial collateral ligament (MCL) injuries in total knee arthroplasty (TKA). Methods: The relevant literature about iatrogenic MCL injuries in TKA was summarized, and the symptoms, causes, preventions, and treatments were analyzed. Results: Preventions on the iatrogenic MCL injuries in TKA is significantly promoted. With the occurrence of MCL injuries, the femoral avulsion can be fixed with the screw and washer or the suture anchors; the tibial avulsion can be treated with the suture anchors fixation, bone staples fixation, or conservative treatment; the mid-substance laceration can be repaired directly; the autologous quadriceps tendon, semitendinosus tendon, or artificial ligament can be used for the patients with poor tissue conditions or obvious residual gap between the ligament ends; the use of implant with greater constraint can be the last alternative method. Conclusion: No consensus has been reached to the management of iatrogenic MCL injuries in TKA. Different solutions and strategies can be integrated and adopted flexibly by surgeons according to the specific situation.


Assuntos
Artroplastia do Joelho , Ligamento Colateral Médio do Joelho , Artroplastia do Joelho/efeitos adversos , Humanos , Doença Iatrogênica/prevenção & controle , Articulação do Joelho/cirurgia , Ligamentos Articulares , Ligamento Colateral Médio do Joelho/cirurgia , Tíbia/cirurgia
10.
ACS Appl Mater Interfaces ; 13(1): 155-163, 2021 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-33356100

RESUMO

A substantial increase in the risk of hospital-acquired infections (HAIs) has greatly impacted the global healthcare industry. Harmful pathogens adhere to a variety of surfaces and infect personnel on contact, thereby promoting transmission to new hosts. This is particularly worrisome in the case of antibiotic-resistant pathogens, which constitute a growing threat to human health worldwide and require new preventative routes of disinfection. In this study, we have incorporated different loading levels of a porphyrin photosensitizer capable of generating reactive singlet oxygen in the presence of O2 and visible light in a water-soluble, photo-cross-linkable polymer coating, which was subsequently deposited on polymer microfibers. Two different application methods are considered, and the morphological and chemical characteristics of these coated fibers are analyzed to detect the presence of the coating and photosensitizer. To discern the efficacy of the fibers against pathogenic bacteria, photodynamic inactivation has been performed on two different bacterial strains, Staphylococcus aureus and antibiotic-resistant Escherichia coli, with population reductions of >99.9999 and 99.6%, respectively, after exposure to visible light for 1 h. In response to the current COVID-19 pandemic, we also confirm that these coated fibers can inactivate a human common cold coronavirus serving as a surrogate for the SARS-CoV-2 virus.


Assuntos
/virologia , Fármacos Fotossensibilizantes/farmacologia , Polímeros/farmacologia , /prevenção & controle , Escherichia coli/efeitos dos fármacos , Escherichia coli/patogenicidade , Humanos , Doença Iatrogênica/prevenção & controle , Luz , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Staphylococcus aureus Resistente à Meticilina/patogenicidade , Microfibrilas/química , Pandemias , Fármacos Fotossensibilizantes/química , Polímeros/química , Porfirinas/química , Porfirinas/farmacologia , /patogenicidade , Oxigênio Singlete
11.
Zhonghua Nan Ke Xue ; 26(4): 303-308, 2020 Apr.
Artigo em Chinês | MEDLINE | ID: mdl-33351295

RESUMO

Objective: To investigate the preventive effect of local injection of botulinum toxin type A (BTX-A) against iatrogenic anterior urethral stricture (IAUS) in New Zealand male rabbits. METHODS: Sixteen adult New Zealand male rabbits were randomly divided into an experimental and a control group of equal number. The model of IAUS was established in the rabbits by incision of the ventral urethra of the penile segment and electrocoagulation of the urethral mucosa. The rabbits of the experimental group were injected with 10 U of BTX-A solution and those of the control group with 1.0 ml of normal saline into the electrocoagulated submucosa of the urethra. At 30 days after modeling, retrograde urethrography was performed and the scarred urethral tissue harvested for HE and Masson staining. RESULTS: No systemic symptoms of botulinum toxin poisoning were observed in either group of the rabbits. Retrograde urethrography showed statistically significant differences between the control and experimental groups in the diameter of the urethra (ï¼»0.15 ± 0.08ï¼½ vs ï¼»0.50 ± 0.23ï¼½ cm, P < 0.05) and the stenosis ratio (3.68 ± 1.22 vs 1.29 ± 0.15, P < 0.05). Urethrography revealed obvious hyperplasia and contracture of urethral scar with high bulge and narrow urethral cavity, while HE and Masson staining exhibited absence or discontinuity of the urethral epithelium, submucosal fibrosis with infiltration of a large number of fibroblasts, and hyperplasia and thickening of collagen fibers (blue) in the control group. All the changes above were slight and the urethral epithelium was continuous in the experimental group. CONCLUSIONS: Local injection of BTX-A reduced the incidence of iatrogenic anterior urethral stricture after iatrogenic acute heat injury in New Zealand male rabbits.


Assuntos
Toxinas Botulínicas Tipo A/administração & dosagem , Estreitamento Uretral , Animais , Doença Iatrogênica/prevenção & controle , Injeções , Masculino , Coelhos , Distribuição Aleatória , Uretra , Estreitamento Uretral/prevenção & controle
12.
J Med Life ; 13(3): 378-381, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33072211

RESUMO

Although benefiting from an unprecedented technological evolution, contemporary endodontics is still characterized by the recurrence of retreatments, due to the need to solve quite frequent incidents, accidents, or even failures of primary endodontic treatment. This survey aims to assess both the etiology and the prevention methods of one of the most troublesome endodontic iatrogenies: instrument separation during root canal shaping. The multifactorial nature of this occurrence entails identifying and taking into account all the causal and contributing factors. Their significant number and the possible involvement of any of them, starting with the complexity and variability of the root canals and ending with the technical specifications concerning the nickel-titanium rotary instrumentation system being used, highlight the necessity to develop valid guidelines to avert the occurring of such an upsetting situation.


Assuntos
Endodontia , Doença Iatrogênica/prevenção & controle , Preparo de Canal Radicular/instrumentação , Falha de Equipamento , Humanos , Níquel , Titânio
14.
Medisan ; 24(5) ilus
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1135212

RESUMO

La iatrogenia es el daño ocasionado por el profesional de la salud a pacientes, familias u otras personas, de manera no intencional, que puede provocar desde un ligero malestar emocional hasta la propia muerte. Teniendo en cuenta lo anterior se realizó una revisión bibliográfica exhaustiva sobre el tema que recoge aspectos actualizados, a saber: concepto, diferencias entre esta y la mala praxis médica, modalidades de iatrogenia (principalmente la de orden psicológico) y recomendaciones para evitarla, con el objetivo de contribuir a un mejor desempeño de los profesionales de la salud y elevar la calidad de vida de la población.


Iatrogenesis is the damage caused by the health professional to patients, families or other people, in non intentional way, that can cause either a slight emotional distress or death. Keeping this in mind an exhaustive literature review on the topic was carried out that compiles up-to-date aspects: concept, differences between this and the bad medical practice, iatrogenesis modalities (mainly the psychological type) and recommendations to avoid it, aimed at contributing to a better performance of health professionals and elevating the population life quality.


Assuntos
Doença Iatrogênica/prevenção & controle , Doença Iatrogênica/epidemiologia , Qualidade de Vida , Imperícia
15.
Br J Radiol ; 93(1115): 20200465, 2020 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-32783618

RESUMO

Management of musculoskeletal (MSK) tumours has traditionally been delivered by surgeons and medical oncologists. However, in recent years, image-guided interventional oncology (IO) has significantly impacted the clinical management of MSK tumours. With the rapid evolution of relevant technologies and the expanding range of clinical indications, it is likely that the impact of IO will significantly grow and further evolve in the near future.In this narrative review, we describe well-established and new interventional technologies that are currently integrating into the IO armamentarium available to radiologists to treat MSK tumours and illustrate new emerging IO indications for treatment.


Assuntos
Neoplasias Ósseas/terapia , Oncologia/tendências , Neoplasias Musculares/terapia , Antineoplásicos/administração & dosagem , Dor do Câncer/terapia , Terapia Combinada/métodos , Criocirurgia/métodos , Eletroporação/métodos , Potenciais Evocados , Feminino , Fluoroscopia/métodos , Previsões , Fraturas Ósseas/terapia , Ablação por Ultrassom Focalizado de Alta Intensidade , Humanos , Doença Iatrogênica/prevenção & controle , Lipossomos/administração & dosagem , Imagem por Ressonância Magnética Intervencionista/métodos , Masculino , Micro-Ondas/uso terapêutico , Traumatismos dos Nervos Periféricos/etiologia , Traumatismos dos Nervos Periféricos/prevenção & controle , Ablação por Radiofrequência/métodos , Terapia por Radiofrequência/métodos , Radiologia Intervencionista/métodos , Radiologia Intervencionista/tendências , Neoplasias da Coluna Vertebral/terapia , Coluna Vertebral/cirurgia , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia de Intervenção/métodos
16.
J Am Acad Orthop Surg ; 28(16): 651-659, 2020 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-32769716

RESUMO

Hip arthroscopy is rapidly growing as a treatment with good outcomes for pathologic conditions such as femoroacetabular impingement syndrome and labral tears. At the same time, it is one of the most technically challenging and demanding procedures in orthopaedics with a technically demanding skill. The first challenge is to safely access the joint, which requires accurate anatomical knowledge, a strong sense of spatial orientation, and repeated practice. Iatrogenic chondrolabral injury has been reported as the most common complication in hip arthroscopy and most frequently occurs during hip joint access. As such, basic foundations cannot be overstated. These complications can be minimized with adequate patient positioning, reproducible hip joint access techniques, and proper portals placement. Nonetheless, these three points are perhaps the greatest hurdles that orthopaedic surgeons face when entering the hip arthroscopy field. In this review, we outlined a stepwise approach for a safe access to hip arthroscopy.


Assuntos
Artroscopia/métodos , Articulação do Quadril/cirurgia , Posicionamento do Paciente/métodos , Decúbito Dorsal , Artroscopia/efeitos adversos , Impacto Femoroacetabular/cirurgia , Articulação do Quadril/anatomia & histologia , Humanos , Doença Iatrogênica/prevenção & controle , Lesões do Manguito Rotador/cirurgia , Segurança
17.
J Vasc Surg ; 72(4): 1184-1195.e3, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32682063

RESUMO

OBJECTIVE: During the COVID-19 pandemic, central venous access line teams were implemented at many hospitals throughout the world to provide access for critically ill patients. The objective of this study was to describe the structure, practice patterns, and outcomes of these vascular access teams during the COVID-19 pandemic. METHODS: We conducted a cross-sectional, self-reported study of central venous access line teams in hospitals afflicted with the COVID-19 pandemic. To participate in the study, hospitals were required to meet one of the following criteria: development of a formal plan for a central venous access line team during the pandemic; implementation of a central venous access line team during the pandemic; placement of central venous access by a designated practice group during the pandemic as part of routine clinical practice; or management of an iatrogenic complication related to central venous access in a patient with COVID-19. RESULTS: Participants from 60 hospitals in 13 countries contributed data to the study. Central venous line teams were most commonly composed of vascular surgery and general surgery attending physicians and trainees. Twenty sites had 2657 lines placed by their central venous access line team or designated practice group. During that time, there were 11 (0.4%) iatrogenic complications associated with central venous access procedures performed by the line team or group at those 20 sites. Triple lumen catheters, Cordis (Santa Clara, Calif) catheters, and nontunneled hemodialysis catheters were the most common types of central venous lines placed by the teams. Eight (14%) sites reported experience in placing central venous lines in prone, ventilated patients with COVID-19. A dedicated line cart was used by 35 (59%) of the hospitals. Less than 50% (24 [41%]) of the participating sites reported managing thrombosed central lines in COVID-19 patients. Twenty-three of the sites managed 48 iatrogenic complications in patients with COVID-19 (including complications caused by providers outside of the line team or designated practice group). CONCLUSIONS: Implementation of a dedicated central venous access line team during a pandemic or other health care crisis is a way by which physicians trained in central venous access can contribute their expertise to a stressed health care system. A line team composed of physicians with vascular skill sets provides relief to resource-constrained intensive care unit, ward, and emergency medicine teams with a low rate of iatrogenic complications relative to historical reports. We recommend that a plan for central venous access line team implementation be in place for future health care crises.


Assuntos
Cateterismo Venoso Central , Infecções por Coronavirus/terapia , Prestação Integrada de Cuidados de Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde/organização & administração , Doença Iatrogênica/prevenção & controle , Controle de Infecções/organização & administração , Pneumonia Viral/terapia , Betacoronavirus/patogenicidade , Cateterismo Venoso Central/efeitos adversos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Estudos Transversais , Pesquisas sobre Serviços de Saúde , Interações Hospedeiro-Patógeno , Humanos , Doença Iatrogênica/epidemiologia , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Medição de Risco , Fatores de Risco
18.
J Card Surg ; 35(10): 2863-2865, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32720392

RESUMO

BACKGROUND: Cardiac myxomas are common and account for 50% of primary intracardiac tumors. Atypical locations of cardiac myxoma increase the risk of intraoperative iatrogenic injuries. Herein, we report a case of using three-dimensional printing (3D) to facilitate the removal of an atypical cardiac myxoma in a 63-year-old woman. METHODS AND RESULTS: Mass in the high posterior atrial septum was confirmed through imaging. Due to the potential involvement of the mass to surrounding vital structures, 3D printing of the cardiac mass was performed. The tumor was completely resected via median sternotomy and the resulting defect was repaired with the bovine pericardium. The patient had an uncomplicated postoperative course except for the development of sick sinus syndrome. One-year follow-up showed no tumor recurrent. CONCLUSION: 3D printing technology in patients with atypical cardiac tumors enhances our understanding of the extent of the tumor invasion and facilitates planning the operation to avoid intraoperative complications.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/cirurgia , Doença Iatrogênica/prevenção & controle , Complicações Intraoperatórias/prevenção & controle , Modelos Anatômicos , Mixoma/diagnóstico por imagem , Mixoma/cirurgia , Impressão Tridimensional , Animais , Bioprótese , Bovinos , Feminino , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/patologia , Átrios do Coração/cirurgia , Neoplasias Cardíacas/patologia , Septos Cardíacos/diagnóstico por imagem , Septos Cardíacos/cirurgia , Humanos , Pessoa de Meia-Idade , Mixoma/patologia , Invasividade Neoplásica , Pericárdio/transplante , Esternotomia/métodos , Tomografia Computadorizada por Raios X , Resultado do Tratamento
19.
J Paediatr Child Health ; 56(7): 1010-1012, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32568444

RESUMO

Critical care management of patients with COVID-19 has been influenced by a mixture of public, media and societal pressure, as well as clinical and anecdotal observations from many prominent researchers and key opinion leaders. These factors may have affected the principles of evidence-based medicine and encouraged the widespread use of non-tested pharmacological and aggressive respiratory support therapies, even in intensive care units (ICUs). The COVID-19 pandemic has predominantly affected adult populations, while children appear to be relatively spared of severe disease. Notwithstanding, paediatric intensive care (PICU) clinicians may already have been influenced by changes in practices of adult ICUs, and these changes may pose unintended consequences to the vulnerable population in the PICU. In this article, we analyse several potential iatrogenic causes of the detrimental effects of the current pandemic to children and highlight the risks underlying a sudden change of clinical practice.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Estado Terminal/terapia , Medicina Baseada em Evidências , Doença Iatrogênica/prevenção & controle , Pneumonia Viral/terapia , Criança , Infecções por Coronavirus/epidemiologia , Cuidados Críticos , Humanos , Unidades de Terapia Intensiva Pediátrica , Erros Médicos , Pandemias , Pediatria , Pneumonia Viral/epidemiologia
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