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Stud Health Technol Inform ; 264: 512-515, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31437976


Medicine has evolved considerably in recent decades in part thanks to information and communication technologies in health (ICTs). However, face-to-face consultations continue to be the predominant model, since alternatives such as telemedicine are still the subject of debate. On the other hand, in some very specific specialties, centralization is relevant, mainly due to the low frequency and prevalence of diseases, as well as the need to have highly specialized professionals, causing problems in terms of accessibility and costs for the health system. In this study we have analyzed the first consultations to an orthopedics oncology service at a tertiary institution and performed an analysis of economic costs was carried out between 2 possible scenarios: face-to-face consultations versus telemedicine. Analyzing the 2 scenarios, there would be a cost-benefit in the use of telemedicine leading to a decrease in healthcare cost between 12.2% and 72%.

Agendamento de Consultas , Telemedicina , Comunicação , Análise Custo-Benefício , Ortopedia
Implement Sci ; 14(1): 78, 2019 08 09.
Artigo em Inglês | MEDLINE | ID: mdl-31399105


BACKGROUND: Advanced physiotherapist-led services have been embedded in specialist orthopaedic and neurosurgical outpatient departments across Queensland, Australia, to ameliorate capacity constraints. Simulation modelling has been used to inform the optimal scale and professional mix of services required to match patient demand. The context and the value of simulation modelling in service planning remain unclear. We aimed to examine the adoption, context and costs of using simulation modelling recommendations to inform service planning. METHODS: Using an implementation science approach, we undertook a prospective, qualitative evaluation to assess the use of discrete event simulation modelling recommendations for service re-design and to explore stakeholder perspectives about the role of simulation modelling in service planning. Five orthopaedic and neurosurgical services in Queensland, Australia, were selected to maximise variation in implementation effectiveness. We used the consolidated framework for implementation research (CFIR) to guide the facilitation and analysis of the stakeholder focus group discussions. We conducted a prospective costing analysis in each service to estimate the costs associated with using simulation modelling to inform service planning. RESULTS: Four of the five services demonstrated adoption by inclusion of modelling recommendations into proposals for service re-design. Four CFIR constructs distinguished and two CFIR constructs did not distinguish between high versus mixed implementation effectiveness. We identified additional constructs that did not map onto CFIR. The mean cost of implementation was AU$34,553 per site (standard deviation = AU$737). CONCLUSIONS: To our knowledge, this is the first time the context of implementing simulation modelling recommendations in a health care setting, using a validated framework, has been examined. Our findings may provide valuable insights to increase the uptake of healthcare modelling recommendations in service planning.

Assistência Ambulatorial/normas , Assistência à Saúde/normas , Ciência da Implementação , Modelos Organizacionais , Neurocirurgia/normas , Ortopedia/normas , Pacientes Ambulatoriais , Técnicas de Planejamento , Melhoria de Qualidade , Grupos Focais , Necessidades e Demandas de Serviços de Saúde , Humanos , Pesquisa Qualitativa , Queensland
Rev. Eugenio Espejo ; 13(1): 45-52, Ene-Jul. 2019.
Artigo em Espanhol | LILACS | ID: biblio-1006780


La forma en que se manejan los problemas biomecánicos en niños constituye un tema contro-versial en el campo de la rehabilitación física. Se desarrolló un proceso investigativo con el objetivo de: describir la evolución de un grupo de pacientes pediátricos mayores de dos años diagnosticados con pie plano atendidos en consulta de fisioterapia en la ciudad de Riobamba; la que fue de tipo observacional descriptivo, de corte longitudinal, cuya población de estudio estuvo constituida por las fichas de control, evaluación y valoración de 30 niños mayores de 2 años que acudieron a consulta de fisioterapia acompañados de un tutor legal por presentar signos de alteraciones de la huella plantar (pie plano). Se observó un predominio de los pacien-tes con edades comprendidas entre cuatro y cinco años, para un 33 y 27% respectivamente. El 93% de los participantes presentó alteraciones de la huella plantar comprobada mediante medi-ción utilizando el plantígrafo, pero el 53% tuvo pie plano fisiológico. Luego de aplicados los ejercicios de Risser, los datos reflejaron una elevación de la cifra de huella plantar normal hasta el 33% y una disminución en el grado de afectación en el 35% de los niños diagnosticados. Los resultados de la recuperación fueron ratificados mediante el análisis del desgaste del calzado en los pacientes pediátricos en cuestión.

The way how biomechanical problems are handled is a controversial topic in the field of physi-cal rehabilitation. This is a research was carried out in order to describe the evolution of a group of pediatric patients over two years of age diagnosed with flat feet treated in a physiotherapy consultation in the city of Riobamba. This research was of observational descriptive type and longitudinal-cut. The study population consisted of the control, evaluation and assessment cards of 30 children over 2 years of age who attended a physiotherapy consultation accompanied by a legal guardian to show signs of alterations in the footprint (flat foot). A predominance of patients between four and five years of age with 33% and 27% respectively was observed. 93% of the participants presented alterations of the footprint checked by the means of a machine for measu-ring foot plant, but 53% had physiological flat feet. After applying the Risser exercises, the data was reflected in the figure of normal footprint up to 33%, and a decrease of affectation in 35% of the children diagnosed. The results of the recovery were confirmed through the analysis of footwear wear in the pediatric patients in question.

Masculino , Feminino , Pré-Escolar , Deformidades do Pé , Pé Chato , Doenças Musculoesqueléticas , Ortopedia , Medicina Física e Reabilitação , Criança
Artigo em Russo | MEDLINE | ID: mdl-31251851


The article presents analysis of mortality because of injuries, poisonings and other consequences of impact of external causes in able-bodied population of the Russian Federation. In 2016, the study identified 18 subjects of the Russian Federation, where these causes of death occupied first rank, leaving behind mortality of blood circulatory system diseases. The optimization of medical care of persons injured by external causes should be implemented by three main directions: traumatological orthopedic one with organization of traumatological centers; сombustiological one with organization of burn centers; toxicological one with organization of toxicological centers. The established differences in mortality rates between subjects of the Russian Federation testify the necessity of complex and substantive measures of organizing and developing medical care support of persons injured by external causes, considering climatic geographic features of regions, as well as availability of "endemic" zones within the territories of subjects that will make it possible to propose valid recommendations related to organization of new centers and optimization of routing of patients based on actual operating medical organizations and their structural subdivisions.

Doenças Cardiovasculares , Mortalidade/tendências , Ortopedia , Traumatologia , Doenças Cardiovasculares/mortalidade , Humanos , Federação Russa
J Pediatr Orthop ; 39(Issue 6, Supplement 1 Suppl 1): S6-S9, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31169639


In a traditional view, the natural history of a condition or a disease tells us of the adult consequences of that entity, be it benign or otherwise. This knowledge then provides guidance as to who needs treatment, and allows us to assess whether our treatments alter an otherwise adverse natural history in a positive way without introducing iatrogenic complications. However, in the new paradigm for health care delivery of value-based care, we need to be able to express natural history in additional terms of burden of disease. This is something that lawmakers and people who pay for health care can understand and has a comparative value. It also serves as a benchmark to show the effectiveness of interventions aimed at reducing disease burden. In this paper, I will discuss why this POSNA symposium is important and make some recommendations on directions where we as individuals and as a professional society should be putting in our efforts and resources.

Progressão da Doença , Custos de Cuidados de Saúde , Política de Saúde , Doenças Musculoesqueléticas/economia , Doenças Musculoesqueléticas/terapia , Adulto , Assistência à Saúde/economia , Humanos , Doenças Musculoesqueléticas/complicações , Ortopedia , Seleção de Pacientes , Pediatria
Wiad Lek ; 72(5 cz 1): 914-917, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31175795


OBJECTIVE: Introduction: Despite the development of dental science and the introduction of modern methods of treatment of dental diseases into practice that allow solving the most difficult clinical situations, the level of dental morbidity remains high. The decrease in the level of dental health negatively affects the state of general somatic health, causing social maladaptation, which in general is negatively reflected at the level of country's socio-economic development. The aim of our research is a comparative analysis of the provision of orthopedic care to the adult population of Ukraine on the basis of officially published statistical data of the Ministry of Health of Ukraine. PATIENTS AND METHODS: Materials and methods: For the analysis, the officially published statistical data of the Ministry of Health of Ukraine and the Centre for Medical Statistics of the Ministry of Health of Ukraine have been selected. CONCLUSION: Conclusions: A comparative analysis of the provision of orthopaedic dental care to the adult population of Ukraine has shown a change in the quantitative indicators of manufactured orthopaedic constructions both by years and by regions. Coordination of dental care and the introduction of an effective system of monitoring the state of dental health in all parts of the medical and diagnostic process and the necessary forms of statistical reporting will contribute to the creation of an effective system for assessing the quality of dental care.

Ortopedia , Assistência à Saúde , Assistência Odontológica , Humanos , Morbidade , Ucrânia
J Pediatr Orthop ; 39(6): 306-313, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31169751


BACKGROUND: Distal radius fractures are the most common injury in the pediatric population. The purpose of this study was to determine the variation among pediatric orthopaedic surgeons when diagnosing and treating distal radius fractures. METHODS: Nine pediatric orthopaedic surgeons reviewed 100 sets of wrist radiographs and were asked to describe the fracture, prescribe the type of treatment and length of immobilization, and determine the next follow-up visit. κ statistics were performed to assess the agreement with the chance agreement removed. RESULTS: Only fair agreement was present when diagnosing and classifying the distal radius fractures (κ=0.379). There was poor agreement regarding the type of treatment that would be recommended (κ=0.059). There was no agreement regarding the length of immobilization (κ=-0.004).Poor agreement was also present regarding when the first follow-up visit should occur (κ=0.088), whether or not new radiographs should be obtained at the first follow-up visit (κ=0.133), and if radiographs were necessary at the final follow-up visit (κ=0.163). Surgeons had fair agreement regarding stability of the fracture (κ=0.320).A subgroup analysis comparing various traits of the treatment immobilization showed providers only had a slight level of agreement on whether splint or cast immobilization should be used (κ=0.072). There was poor agreement regarding whether long-arm or short-arm immobilization should be prescribed (κ=-0.067).Twenty-three of the 100 radiographs were diagnosed as a torus/buckle fracture by all 9 surgeons. κ analysis performed on all the treatment and management questions showed that each query had poor agreement. CONCLUSIONS: The interobserver reliability of diagnosing pediatric distal radius fractures showed only fair agreement. This study demonstrates that there is no standardization regarding how to treat these fractures and the length of immobilization required for proper fracture healing. Better classification systems of distal radius fractures are needed that standardize the treatment of these injuries. LEVEL OF EVIDENCE: Level II.

Ortopedia/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Fraturas do Rádio , Adulto , Criança , Humanos , Imobilização/métodos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Radiografia/estatística & dados numéricos , Fraturas do Rádio/diagnóstico , Fraturas do Rádio/terapia , Reprodutibilidade dos Testes , Contenções
Rev. Asoc. Argent. Ortop. Traumatol ; 84(2): 197-198, jun. 2019.
Artigo em Espanhol | LILACS | ID: biblio-1006194

Ortopedia , Médicos
J Biol Regul Homeost Agents ; 33(2 Suppl. 1): 103-117, 2019 Mar-Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31169010


DNA holds genetic information in the nucleus of eukaryotic cells; and has three different functions: replication, storage of hereditary information, and regulation of cell division. Most studies described the association of single nucleotide polymorphism (SNP) to common orthopaedics diseases and the susceptibility to develop musculoskeletal injuries. Several mutations are associated with osteoporosis, musculoskeletal ailments and other musculoskeletal deformity and conditions. Several strategies, including gene therapy and tissue engineering with mesenchymal stem cells (MSC), have been proposed to enhance healing of musculoskeletal tissues. Furthermore, a recent technique has revolutionized gene editing: clustered regulatory interspaced short palindromic repeat (CRISPR) technology is characterized by simplicity in target design, affordability, versatility, and high efficiency, but needs more studies to become the preferred platform for genome editing. Predictive genomics DNA profiling allows to understand which genetic advantage, if any, may be exploited, and why a given rehabilitation protocol can be more effective in some individual than others. In conclusion, a better understanding of the genetic influence on the function of the musculoskeletal system and healing of its ailments is needed to plan and develop patient specific management strategies.

Sistemas CRISPR-Cas , Edição de Genes , Doenças Musculoesqueléticas/genética , Ortopedia , Repetições Palindrômicas Curtas Agrupadas e Regularmente Espaçadas , Perfil Genético , Humanos , Sistema Musculoesquelético , Polimorfismo de Nucleotídeo Único , Engenharia Tecidual
Invest. educ. enferm ; 37(2): [E07], 15-06-2019. Fig 1, Tab 1, Tab 2
Artigo em Inglês | LILACS, COLNAL | ID: biblio-1007626


Abstract Objective. This work was conducted to determine the effectiveness of a nursing intervention, based on the motivational interview, to diminish preoperative anxiety in patients programmed for knee replacement surgery. Methods. Preventive type controlled and randomized clinical trial, on a sample of 56 patients programmed for knee replacement surgery in a clinic in Girardot (Colombia). Random assignment was made: an intervention group (n=28) and a control group (n=28). The six-question Amsterdam Preoperative Anxiety and Information Scale was applied before and after the intervention. The scale has a total score ranging from 5 to 30; the higher the score, the greater the preoperative anxiety. The nursing intervention was conducted in three sessions of motivational interview each lasting 40 min, during the six weeks prior to the surgical procedure; the control group received conventional management of education in the health institution. Results. The mean score of preoperative anxiety was equal in the pre-intervention evaluation in both groups (19.76 in the experimental versus 22.02 in the control =22.02; p<0.226), while during the post-intervention, the anxiety score was lower in the intervention group compared with the control group (15.56 and 20.30, respectively; p<0.013). Conclusion. Nursing intervention based on the motivational interview was effective in diminishing preoperative anxiety in patients programmed for knee replacement surgery.

Resumen Objetivo. Determinar la efectividad de una intervención de enfermería basada en la entrevista motivacional, para disminuir la ansiedad preoperatoria en pacientes programados para cirugía de reemplazo de rodilla. Métodos. Ensayo clínico controlado y aleatorizado tipo preventivo, en una muestra de 56 pacientes programados para cirugía de remplazo de rodilla en una clínica en Girardot (Colombia). Se asignaron en forma aleatoria: un grupo de intervención (n=28) y un grupo de control (n=28). Antes y después de la intervención, se aplicó la escala de seis preguntas, APAIS (The Amsterdam Preoperative Anxiety and Information Scale), la cual tiene un puntaje total que va de 5 a 30: a más puntaje, mayor la ansiedad preoperatoria. La intervención de enfermería se desarrolló en 3 sesiones de entrevista motivacional con una duración de 40 minutos, durante las 6 semanas anteriores a la realización del procedimiento quirúrgico. El grupo de control recibió el manejo convencional de educación en la institución de salud. Resultados. La media del puntaje de ansiedad preoperatoria fue igual en la evaluación preintervención en los dos grupos (19.76 en el experimental versus 22.02 en el control = 22.02; p<0.226), mientras que en la posintervención el puntaje de ansiedad fue menor en el grupo de intervención comparado con el grupo control (15.56 y 20.30, respectivamente; p<0.013). Conclusión. La intervención de enfermería basada en la entrevista motivacional fue efectiva en la disminución de la ansiedad preoperatoria en pacientes programados para cirugía de reemplazo de rodilla.

Resumo Objetivo. Determinar a efetividade de uma intervenção de enfermagem baseada na entrevista motivacional, para diminuir a ansiedade pré-operatória em pacientes programados para cirurgia de prótese de joelho. Métodos. Ensaio clínico controlado e aleatorizado tipo preventivo, numa amostra de 56 pacientes programados para cirurgia de prótese de joelho numa clínica em Girardot (Colômbia). Foram designados em forma aleatória: um grupo de intervenção (n=28) e um grupo de controle (n=28). Se aplicou antes e depois da intervenção, a escala de seis perguntas, APAIS (The Amsterdam Preoperative Anxiety and Information Scale), a qual tem uma pontuação total que vá de 5 a 30 a mais pontuação, é maior a ansiedade pré-operatório. A intervenção de enfermagem se desenvolvimento em 3 sessões de entrevista motivacional com uma duração de 40 minutos, durante as 6 semanas anteriores à realização do procedimento cirúrgico; o grupo de controle recebeu o manejo convencional de educação na instituição de saúde. Resultados. A média da pontuação de ansiedade pré-operatória foi igual na avaliação préintervenção nos dois grupos (19.76 no experimental versus 22.02 no controle = 22.02; p<0.226), enquanto que na pós-intervenção a pontuação de ansiedade foi menor no grupo de intervenção comparado com o grupo controle (15.56 e 20.30, respectivamente; p<0.013). Conclusão. A intervenção de enfermagem baseada na entrevista motivacional foi efetiva na diminuição da ansiedade pré-operatória em pacientes programados para cirurgia de prótese de joelho.

Humanos , Ortopedia , Enfermagem Perioperatória , Grupos Controle , Artroplastia do Joelho , Entrevista Motivacional
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde | ID: lis-LISBR1.1-46495


Um novo site, totalmente reformulado, acaba de ser lançado pela SBOT-SP. Através desta nova ferramenta, os ortopedistas terão acesso a um conteúdo atualizado relacionado a regional, com informações de eventos, cursos e novidades. Para a população, fizemos um espaço com informações relacionadas a Ortopedia, com textos sobre doenças e tratamentos, além de uma ferramenta exclusiva de busca de ortopedistas. Através dela, o paciente poderá encontrar um profissional qualificado com o título de especialista em Ortopedia e Traumatologia, o TEOT. Navegue agora mesmo no novo site da SBOT-SP! Mais moderno e funcional, ele pode ser acessado de qualquer dispositivo.

Ortopedia , Traumatologia
J Surg Orthop Adv ; 28(1): 10-17, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31074731


Citation calculations measure academic influence. This study sought to analyze highly cited shoulder arthroplasty articles and determine the best measure to assess their impact. Scopus identified the 50 most cited articles, and each was analyzed for citation number, authors, institution, country of origin, and journal of publication. SPSS 23 was used for descriptive statistics, and a Pearson correlation coefficient assessed the relationship between citation measures. The results revealed an average citation count of 259 ± 108 and a citation density (citation count/years since publication) of 18 ± 10 annually. Most articles originated in the United States (31) and France (9). Twelve surgeons were included on three or more articles. Forty-one studies were clinically based. Finally, correlation was demonstrated between citation count and citation density (r = 0.486, p < .001). In conclusion, this study revealed the trends of highly cited shoulder arthroplasty articles and found citation count and citation density to be acceptable measures of academic influence. (Journal of Surgical Orthopaedic Advances 28(1):10-17, 2019).

Artroplastia do Ombro , Fator de Impacto de Revistas , Ortopedia , Editoração , Artroplastia , Estados Unidos
J Surg Orthop Adv ; 28(1): 53-57, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31074738


All patients undergoing open reduction and internal fixation of a distal radius fracture (DRF) between the years 2010 and 2015 were isolated from the National Surgical Quality Improvement Program database. Patient demographics, respective surgical volume, outcome variables, and complications were extracted. The primary outcomes were surgical time, hospital length of stay, and unplanned reoperation. A total of 6691 patients were included in the study, the majority of whom were treated by orthopaedic surgeons. While there were no significant differences in baseline demographics between the patients treated by orthopaedic and plastic surgeons, the overall operative time was significantly less for DRFs fixed by orthopaedic surgeons. While there was a significant difference for extra-articular fractures, this difference increased significantly for complex intra-articular fractures. Additionally, hospital length of stay was significantly shorter for patients treated by orthopaedic surgeons. To produce well-rounded, technically skilled surgeons, plastic surgery programs should incorporate fixation principles into their training programs. (Journal of Surgical Orthopaedic Advances 28(1):53-57, 2019).

Fixação Interna de Fraturas , Cirurgiões Ortopédicos , Ortopedia , Fraturas do Rádio , Cirurgia Plástica , Fixação de Fratura , Fixação Interna de Fraturas/educação , Humanos , Ortopedia/educação , Rádio (Anatomia) , Fraturas do Rádio/cirurgia , Cirurgia Plástica/educação , Resultado do Tratamento
Braz J Med Biol Res ; 52(5): e7748, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31038576


Posterior long-segment spinal fusion may lead to proximal junctional kyphosis (PJK). The present study sought to identify the appropriate fusion levels required in order to prevent PJK using finite element analysis. A finite element model was constructed based on the whole-spine computed tomography findings of a healthy adult. Nine commonly used posterior spinal fusion methods were selected. Stress on the annulus fibrosis fibers, the posterior ligamentous complex, and the vertebrae after various spinal fusions in the upright position were compared. This study was divided into two groups: non-fusion and fusion. In the former, the stress between the T10 and the upper thoracic vertebrae was higher. Comparing thoracic and lumbar segments in the fusion group, the peak stress values of the upper instrumented vertebrae (UIV) were mainly observed in T2 and L2 whilst those of the UIV+1 were observed in T10 and L2. After normalization, the peak stress values of the UIV and UIV+1 were located in T2 and L2. Similarly, the peak stress values of the annulus fibrosus at the upper adjacent level were on T10 and L2 after normalization. However, the peak stress values of the interspinal/supraspinal complex forces were concentrated on T11, T12, and L1 after normalization whilst the peak stress value of the pedicle screw was on T2. Controversy remains over the fusion of T10, and this study simulated testing conditions with gravitational loading only. However, further assessment is needed prior to reaching definitive conclusions.

Cifose/cirurgia , Ortopedia/métodos , Fusão Vertebral/instrumentação , Fenômenos Biomecânicos , Humanos , Imagem Tridimensional , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Escoliose/cirurgia , Fusão Vertebral/métodos