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1.
Isr Med Assoc J ; 23(8): 534-540, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34392634

RESUMO

BACKGROUND: Diagnosis and treatment of posterior hip pain has increased due to advancements in clinical, anatomical, biomechanical, and related pathological understandings of the hip. Due to its complexity and close anatomical relationship with many osseous, neurovascular, and musculotendinous structures, posterior hip pain must be appropriately categorized based on its origin. Therefore, it is crucial that clinicians are able to determine whether patient complaints are of extra-articular or intra-articular nature so that they can implement the optimal treatment plan. In the current review article, we discussed posterior hip pain with an emphasis on the main differential diagnoses of deep gluteal syndrome, ischiofemoral impingement, and hamstring tear/hamstring syndrome. For the appropriate diagnosis and etiology of posterior hip pain, a thorough and conclusive clinical history is imperative. Physicians should rule out the possibility of spinal involvement by physical examination and if necessary, by magnetic resonance imaging (MRI). Furthermore, because of the vicinity to other, non-orthopedic structures, an obstetric and gynecologic history, general surgery history, and urologic history should be obtained. Following the collection of patient history clinicians should adhere to an established and efficient order of evaluation starting with standing then to seated, supine, lateral, and prone testing. Imaging assessment of posterior hip pain begins with a standard anterior-posterior pelvic radiograph, in addition to frog-leg lateral. MRI is pivotal for assessing soft tissue-related extra-articular causes of hip in patients with posterior hip pain. Non-surgical treatment is preferred in most cases of deep gluteal syndrome, ischiofemoral impingement, pudendal nerve entrapment, and proximal hamstring pathologies. Surgical treatment is saved as a last resort option in cases of failed non-surgical treatment.


Assuntos
Quadril , Medição da Dor/métodos , Dor , Diagnóstico Diferencial , Quadril/diagnóstico por imagem , Quadril/patologia , Quadril/fisiopatologia , Humanos , Dor/diagnóstico , Dor/etiologia , Manejo da Dor/métodos , Planejamento de Assistência ao Paciente , Seleção de Pacientes
2.
J Fam Pract ; 70(5): 229-238, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34410913

RESUMO

Recommendations for care are evolving, with increasingly sophisticated screening and diagnostic tools and a broadening array of treatment options.


Assuntos
Osteoporose/terapia , Medicina de Precisão/métodos , Humanos , Osteoporose/diagnóstico , Planejamento de Assistência ao Paciente , Medicina de Precisão/tendências , Fatores de Risco
3.
Medicine (Baltimore) ; 100(31): e26826, 2021 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-34397846

RESUMO

ABSTRACT: To develop a new prognostic model for the overall survival of patients with clear cell metastatic renal cell carcinoma (mRCC) using Korean Renal Cancer Study Group (KRoCS) database and compared it with 2 renowned prognostic models: the Memorial Sloan Kettering Cancer Center (MSKCC) and the international metastatic renal cell carcinoma database consortium (IMDC) models.Data of 790 patients diagnosed with mRCC and receiving targeted therapy as their first-line treatment were pooled to this study. Data from 4 hospitals (n = 619) were used to develop the new model and those from other 5 hospitals (n = 171) were used for external validation. After detecting prognostic factors in multivariable Cox proportional-hazards regression analysis, patients were classified into 3 risk groups, favorable (0), intermediate (1-2), and poor (3 and more) by the number of prognostic factors.Seven variables such as more than 2 metastasis sites, no prior nephrectomy, Eastern Cooperative Oncology Group performance status ≥2, low hemoglobin, high serum corrected calcium, high neutrophil, high serum alkaline phosphatase were identified as prognostic factors for poor overall survival. Also, risk groups were categorized into 3 groups; median overall survival was 61.1 months in favorable, 26.5 months in intermediate, and 6.8 months in poor group. KRoCS ranked the first in all 3 statistical parameters including akaike information criterion (AIC), concordance index and generalized R2 among other prognostic models.We developed the KRoCS model and validated it externally with demonstrating its superiority over MSKCC and IMDC models. The KRoCS model can provide useful information for counseling patients with clear cell mRCC regarding life-expectancy.


Assuntos
Carcinoma de Células Renais , Expectativa de Vida , Modelos Estatísticos , Terapia de Alvo Molecular/métodos , Planejamento de Assistência ao Paciente/normas , Medição de Risco , Carcinoma de Células Renais/diagnóstico , Carcinoma de Células Renais/mortalidade , Carcinoma de Células Renais/patologia , Carcinoma de Células Renais/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Melhoria de Qualidade , Reprodutibilidade dos Testes , República da Coreia/epidemiologia , Medição de Risco/métodos , Medição de Risco/normas , Fatores de Risco , Análise de Sobrevida
4.
Ann Fam Med ; 19(4): 365-367, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34264842

RESUMO

When the immediate threat of COVID-19 subsides, the future of health care will involve more virtual care. Before the pandemic, patient choice rather than clinician guidance determined which medium (telephone visits, video visits, electronic messaging) was used to receive care. Two media synchronicity theory principles-conveyance and convergence-can create a framework for determining how to choose the right medium of care for the patient. The author describes how it changed their practice and decision making with a patient story that required the use of multiple virtual care options.


Assuntos
COVID-19/prevenção & controle , Comunicação , Telemedicina/métodos , COVID-19/diagnóstico , Pré-Escolar , Tosse/etiologia , Dispneia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Visita a Consultório Médico , Planejamento de Assistência ao Paciente , Preferência do Paciente , SARS-CoV-2 , Sífilis/diagnóstico , Telefone , Envio de Mensagens de Texto , Comunicação por Videoconferência
5.
Artigo em Inglês | MEDLINE | ID: mdl-34209191

RESUMO

Rural US Latina breast cancer patients experience language barriers, health literacy issues, and limited access to health care resources that negatively impact survivorship care. This study explored the challenges to survivorship care for rural Latina breast cancer (BC) patients and approaches to supporting survivorship care plans (SCP) from the stakeholders' perspectives. Data were collected via eight focus groups (n = 40) and individual interviews (n = 4) with Latina BC patients, family caregivers, and health care professionals in a rural US-Mexico Border region. Interviews were audio-taped, transcribed, translated, and analyzed using thematic analysis. Themes related to the patient's SCP challenges included: (1) lack of knowledge of treatment information, (2) lack of proactive health behavior, (3) gaps in information for care coordination, (4) psychological distress, and (5) difficulty retaining health information. Respondents expressed that the SCP document could fill patient information gaps as well as support patient communication with their clinicians and family. Rural BC patients demonstrated an acute need for information and active engagement in their survivorship care. The findings indicate the importance of addressing challenges for survivorship care on multiple dimensions: Cognitive, behavioral, social, and structural. Developing a culturally tailored SCP intervention will be imperative to support survivorship care.


Assuntos
Neoplasias da Mama , Sobrevivência , Neoplasias da Mama/terapia , Feminino , Hispano-Americanos , Humanos , México , Planejamento de Assistência ao Paciente
6.
BMC Health Serv Res ; 21(1): 715, 2021 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-34284783

RESUMO

BACKROUND: Chronic diseases and multimorbidity are common in the ageing population and affect the health related quality of life. Health care resources are limited and the continuity of care has to be assured. Therefore it is essential to find demonstrable tools for best treatment practices for patients with chronic diseases. Our aim was to study the influence of a participatory patient care plan on the health-related quality of life and disease specific outcomes related to diabetes, ischemic heart disease and hypertension. METHODS: The data of the present study were based on the Participatory Patient Care Planning in Primary Care. A total of 605 patients were recruited in the Siilinjärvi Health Center in the years 2017-2018 from those patients who were followed up due to the treatment of hypertension, ischemic heart disease or diabetes. Patients were randomized into usual care and intervention groups. The intervention consisted of a participatory patient care plan, which was formulated in collaboration with the patient and the nurse and the physician during the first health care visit. Health-related quality of life with the 15D instrument and the disease-specific outcomes of body mass index (BMI), low density lipoprotein cholesterol (LDL-C), hemoglobin A1c (HbA1C) and blood pressure were assessed at the baseline and after a one-year follow-up. RESULTS: A total of 587 patients with a mean age of 69 years were followed for 12 months. In the intervention group there were 289 patients (54% women) and in the usual care group there were 298 patients (50% women). During the follow-up there were no significant changes between the groups in health-related quality and disease-specific outcomes. CONCLUSIONS: During the 12-month follow-up, no significant differences between the intervention and the usual care groups were detected, as the intervention and the usual care groups were already in good therapeutic equilibrium at the baseline. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02992431 . Registered 14/12/2016.


Assuntos
Planejamento de Assistência ao Paciente , Qualidade de Vida , Idoso , Doença Crônica , Feminino , Seguimentos , Humanos , Masculino , Assistência ao Paciente , Atenção Primária à Saúde
7.
Cells ; 10(6)2021 06 06.
Artigo em Inglês | MEDLINE | ID: mdl-34204163

RESUMO

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) gave rise to the coronavirus disease 2019 (COVID-19) pandemic. A strong correlation has been demonstrated between worse COVID-19 outcomes, aging, and metabolic syndrome (MetS), which is primarily derived from obesity-induced systemic chronic low-grade inflammation with numerous complications, including type 2 diabetes mellitus (T2DM). The majority of COVID-19 deaths occurs in people over the age of 65. Individuals with MetS are inclined to manifest adverse disease consequences and mortality from COVID-19. In this review, we examine the prevalence and molecular mechanisms underlying enhanced risk of COVID-19 in elderly people and individuals with MetS. Subsequently, we discuss current progresses in treating COVID-19, including the development of new COVID-19 vaccines and antivirals, towards goals to elaborate prophylactic and therapeutic treatment options in this vulnerable population.


Assuntos
Envelhecimento/fisiologia , COVID-19/prevenção & controle , COVID-19/terapia , Quimioprevenção/tendências , Síndrome Metabólica/terapia , Envelhecimento/efeitos dos fármacos , Envelhecimento/imunologia , COVID-19/diagnóstico , COVID-19/epidemiologia , Quimioprevenção/métodos , História do Século XXI , Humanos , Síndrome Metabólica/complicações , Síndrome Metabólica/diagnóstico , Síndrome Metabólica/epidemiologia , Planejamento de Assistência ao Paciente/tendências , Prevalência , Prognóstico , Índice de Gravidade de Doença , Populações Vulneráveis
8.
Head Face Med ; 17(1): 31, 2021 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-34301272

RESUMO

AIM: The aim of this work is to present a digital methodology of a conventional articulator based planning protocol. METHODS: The digital counterpart consists of intra-oral scans (3Shape) and a free available 3D mesh software (Meshmixer, Autodesk). The maxillary position in relation to the reference plane used and the arbitrary hinge axis were determined mathematically from landmarks on cephalometric x-rays and frontal photographs. Distances and angles were calculated to virtually mount the digital jaws in Meshmixer's wold frame. Virtual planning is done by cloning and moving the jaws according to the preliminary surgery plan. The spatial movements of the jaws are measured by attached reference points. RESULTS: This digital approach eliminate the need for articulator hardware and laboratory plaster work. It enables all planning scenarios as they are also possible with conventional plaster-based procedures. The method is time-saving, practical and cost-effective. Standard dimensions of articulators and face-bows have been incorporated in the implementation. This reduction of individual patient values puts the accuracy of the presented method within the range of conventional model surgery. CONCLUSION: Arbitrary planning will continue to have its place in orthognathic surgery, especially when digital methods can improve the overall process. The method presented can be seen as a cost-effective alternative for patients who do not require technically complex planning.


Assuntos
Cirurgia Ortognática , Procedimentos Cirúrgicos Ortognáticos , Cirurgia Assistida por Computador , Humanos , Imageamento Tridimensional , Registro da Relação Maxilomandibular , Planejamento de Assistência ao Paciente , Universidades
9.
Compend Contin Educ Dent ; 42(7): 400-401, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34297595

RESUMO

Digital technologies have fundamentally changed treatment planning, surgical placement, and restoration of dental implants, improving clinical success while saving valuable chairtime. Intraoral scanners (IOS), cone-beam computed tomography (CBCT), 3D implant planning software, and CAD/CAM systems that fabricate surgical guides and provisional and definitive restorations have become standard tools for precise implant placement and ideal restoration design, which are essential for optimal and long-term esthetic and functional success. This article summarizes clinical guidelines for integration of digital technologies in implant dentistry.


Assuntos
Implantes Dentários , Cirurgia Assistida por Computador , Desenho Assistido por Computador , Tomografia Computadorizada de Feixe Cônico , Implantação Dentária Endo-Óssea , Estética Dentária , Planejamento de Assistência ao Paciente
11.
Breast Cancer Res Treat ; 188(1): 317-325, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34095986

RESUMO

PURPOSE: Breast cancer survivors may be at risk for increased rates of emotional distress and poorer quality of life. Survivorship care plans (SCPs) promoting wellness activities may support well-being; however, survivors may not receive or engage in their SCPs. This study aimed to assess receipt and participation in SCP activities as well as barriers to engagement amongst breast cancer survivors. METHODS: Breast cancer survivors (n = 187; 99% female, Mean age = 57.7) consented and completed self-reported assessments of SCP recommendations, engagement and interest in wellness activities, and potential barriers to engagement. RESULTS: A minority of participants recalled receiving an SCP (21%). The most physician recommended (62%) and completed (53%) activity was exercise. Interest in adding other wellness activities to the SCP was high, with reported interest levels of approximately 50% for several activities (e.g., mind body, nutrition, psychotherapy interventions). Fully half reported that having a physician-designed plan would influence participation in activities. The most common reported barriers to SCP activity engagement were lack of time (82%), work/school (65%), and lack of information (65%). CONCLUSION: Few survivors recalled receiving a formal SCP, and lack of information about wellness activities was a commonly reported barrier to participation. Interest in wellness activities was generally high and may indicate the need for more formal prescription or motivation enhancement techniques to promote SCP engagement. There may be a clinical need to emphasize SCP recommendations to enhance recall and increase engagement in wellness activities that may reduce psychological distress and improve quality of life.


Assuntos
Neoplasias da Mama , Sobreviventes de Câncer , Neoplasias , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Planejamento de Assistência ao Paciente , Qualidade de Vida , Sobrevivência
12.
Clin Oral Implants Res ; 32(9): 1052-1060, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34143522

RESUMO

OBJECTIVES: To compare free-hand to computer-assisted implant planning and placement (CAIPP) regarding planned to achieved implant position. MATERIAL AND METHODS: Forty-eight cast/bone models were mounted in mannequin heads. On each side, a tooth gap of different sizes was created. In the test group (T), study implants were placed using a CAD-CAM guide based on virtual planning. In the control (C), free-hand implant placement was performed. After CBCT scanning, the implant position was compared with the planned position. Descriptive statistics were applied, and ANOVA was used to identify differences between groups and gaps. (p < .05). RESULTS: In C, mean lateral deviations at the implant base amounted to 0.7 mm (max. 1.8) (large gap) and 0.49 mm (1.22) (small gap). In T, 0.18 mm (0.49) and 0.24 mm (0.52) were recorded. At the apex, 0.77 mm (2.04) (large gap) and 0.51 mm (1.24) (small gap) were measured in C, and 0.31 mm (0.83)/0.34 mm (0.93) in T. Mean vertical deviations in C measured 0.46 mm (1.26) (large gap) and 0.45 mm (1.7) (small gap). In T, 0.14 mm (0.44) and 0.28 mm (0.78) were recorded. Mean angular deviations of 1.7° (3.2°) were observed in C (large gap) and 1.36° (2.1°) (small gap). In T, mean values were 1.57° (3.3°) and 1.32° (3.4°). Lateral and vertical deviations were significantly different between groups (not gaps), angular between gaps (not groups). CONCLUSIONS: CAIPP protocols showed smaller deviations irrespective of the size of the tooth gap. In C, the gap size had an influence on the error in angulation only.


Assuntos
Implantes Dentários , Cirurgia Assistida por Computador , Desenho Assistido por Computador , Computadores , Tomografia Computadorizada de Feixe Cônico , Implantação Dentária Endo-Óssea , Imageamento Tridimensional , Planejamento de Assistência ao Paciente
13.
N Z Med J ; 134(1536): 113-143, 2021 06 04.
Artigo em Inglês | MEDLINE | ID: mdl-34140718

RESUMO

Constipation is common in young children and results in approximately 350 hospitalisations per 100,000 population for 0-4-year-olds. Constipation can become chronic in more than one-third of those affected. The purpose of this article is to provide an awareness and highlight the care planning, diagnosis and management in paediatric functional constipation. It is intended for general practitioners and those in primary healthcare who may be unfamiliar with functional constipation. Paediatric functional constipation affects the child's physical, psychological and social wellbeing while causing significant stress to the caregiver/whanau. Despite its prevalence, functional constipation is often misdiagnosed and inadequately treated. Functional constipation requires a comprehensive therapeutic plan, including education, behavioural intervention and medication. Pharmacological treatment often causes concern and misapprehension for developing 'dependence', which is unfounded. Children with chronic constipation who do not progress, despite aggressive medical therapy and behavioural modification, may benefit from further assessment with colonic transit or anorectal and colonic manometry. In the future, novel medical, exercise and surgical strategies will have a role in advancing improved outcomes in children who are unresponsive to conventional medical and behavioural interventions. However, this will require more evidence-based guidelines. Unresponsive constipation cases should be included in the care planning of district health boards, which may assist in a multidisciplinary approach to assisting the physical and psychosocial aspects of constipation.


Assuntos
Constipação Intestinal , Planejamento de Assistência ao Paciente , Criança , Pré-Escolar , Constipação Intestinal/diagnóstico , Constipação Intestinal/terapia , Humanos , Manometria , Guias de Prática Clínica como Assunto
14.
Plast Reconstr Surg ; 148(1): 183-192, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34076623

RESUMO

BACKGROUND: Virtual surgical planning and computer-aided design/computer-aided manufacturing (CAD/CAM) for complex head and neck reconstruction has a number of cited advantages over conventional surgical planning, such as increased operative efficiency, fewer complications, improved osseous flap union, immediate osseointegrated dental implant placement, and superior functional and aesthetic outcomes. The authors performed a systematic review and meta-analysis of the available evidence on CAD/CAM maxillofacial reconstruction with the primary purpose of determining which approach is more efficacious. METHODS: In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a PubMed and Embase database search was performed to identify English-language, human-subject studies of CAD/CAM-assisted head and neck reconstruction. All comparative studies were included in a meta-analysis to identify differences in operative time, ischemia time, surgical-site occurrence, microvascular complication, and partial or total flap loss between the two groups. All included studies (comparative and noncomparative) were used in the systematic review, summarizing the various flap characteristics, technical nuances, and functional and aesthetic outcomes. RESULTS: Twelve articles were included in the meta-analysis, representing 277 patients in the CAD/CAM group and 419 patients in the conventional group. CAD/CAM was associated with 65.3 fewer minutes of operating room time (95 percent CI, -72.7 to -57.9 minutes; p < 0.0001) and 34.8 fewer minutes of ischemia time (95 percent CI, -38 to -31.5 minutes; p < 0.0001). There were no significant differences in surgical-site occurrence, nonunion, flap loss, microvascular complications, or hardware-related complications. CONCLUSIONS: CAD/CAM is associated with shorter operating room and ischemia times. There are no significant differences in flap or hardware-related complications between CAD/CAM and conventional surgical planning.


Assuntos
Desenho Assistido por Computador , Neoplasias de Cabeça e Pescoço/cirurgia , Planejamento de Assistência ao Paciente , Procedimentos Cirúrgicos Reconstrutivos/métodos , Ferida Cirúrgica/cirurgia , Ossos Faciais/diagnóstico por imagem , Ossos Faciais/patologia , Ossos Faciais/cirurgia , Fíbula/transplante , Retalhos de Tecido Biológico/transplante , Osso Frontal/diagnóstico por imagem , Osso Frontal/patologia , Osso Frontal/cirurgia , Sobrevivência de Enxerto , Humanos , Modelos Anatômicos , Duração da Cirurgia , Estudos Retrospectivos , Escápula/transplante , Ferida Cirúrgica/diagnóstico por imagem , Resultado do Tratamento
15.
Plast Reconstr Surg ; 148(1): 77e-82e, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34076611

RESUMO

SUMMARY: Advances in virtual surgical planning and three-dimensionally-printed guides have enabled increased precision in vascularized free fibula flap reconstruction of the mandible and valuable preoperative planning. However, virtual surgical planning currently requires high-resolution computed tomographic scans, exposing patients to ionizing radiation. The aim of this study was to determine whether black bone magnetic resonance imaging can be used for accurate surgical planning and three-dimensionally-printed guide creation, thus reducing patient radiation exposure. This study included 10 cadaver heads and 10 cadaver lower extremities. A mock fibula free flap for mandible reconstruction was performed. Five operations were planned with guides created using black bone magnetic resonance imaging, whereas the other five were planned and performed using guides created with computed tomographic scan data. All specimens underwent a postoperative computed tomographic scan, and three-dimensional reconstruction of scans was performed and surgical accuracy to the planned surgery was assessed. Guides created from black bone magnetic resonance imaging demonstrated high accuracy to the surgical plan. There was no statistically significant difference in postoperative deviation from the plan when black bone magnetic resonance imaging versus computed tomographic scanning was used for virtual surgical planning and guide creation. Both modalities led to a postoperative positive or negative deviation from the virtual plan within 0.8 mm. This study demonstrates that virtual surgical planning and three-dimensionally-printed guide creation for free fibula flaps for mandible reconstruction can be performed using black bone magnetic resonance imaging with comparable accuracy to computed tomographic scanning. This could reduce radiation exposure for patients and enable a more streamlined imaging process for head and neck cancer patients.


Assuntos
Fíbula/transplante , Imageamento por Ressonância Magnética , Mandíbula/diagnóstico por imagem , Reconstrução Mandibular/métodos , Planejamento de Assistência ao Paciente , Cadáver , Retalhos de Tecido Biológico/transplante , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Imageamento Tridimensional , Mandíbula/cirurgia , Modelos Anatômicos , Impressão Tridimensional , Exposição à Radiação/efeitos adversos , Tomografia Computadorizada por Raios X , Resultado do Tratamento
16.
Plast Reconstr Surg ; 148(1): 94e-108e, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34181618

RESUMO

LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Describe the evolution of three-dimensional computer-aided reconstruction and its current applications in craniofacial surgery. 2. Recapitulate virtual surgical planning, or computer-assisted surgical simulation, workflow in craniofacial surgery. 3. Summarize the principles of computer-aided design techniques, such as mirror-imaging and postoperative verification of results. 4. Report the capabilities of computer-aided manufacturing, such as rapid prototyping of three-dimensional models and patient-specific custom implants. 5. Evaluate the advantages and disadvantages of using three-dimensional technology in craniofacial surgery. 6. Critique evidence on advanced three-dimensional technology in craniofacial surgery and identify opportunities for future investigation. SUMMARY: Increasingly used in craniofacial surgery, virtual surgical planning is applied to analyze and simulate surgical interventions. Computer-aided design and manufacturing generates models, cutting guides, and custom implants for use in craniofacial surgery. Three-dimensional computer-aided reconstruction may improve results, increase safety, enhance efficiency, augment surgical education, and aid surgeons' ability to execute complex craniofacial operations. Subtopics include image analysis, surgical planning, virtual simulation, custom guides, model or implant generation, and verification of results. Clinical settings for the use of modern three-dimensional technologies include acquired and congenital conditions in both the acute and the elective settings. The aim of these techniques is to achieve superior functional and aesthetic outcomes compared to conventional surgery. Surgeons should understand this evolving technology, its indications, limitations, and future direction to use it optimally for patient care. This article summarizes advanced three-dimensional techniques in craniofacial surgery with cases highlighting clinical concepts.


Assuntos
Desenho Assistido por Computador , Traumatismos Maxilofaciais/cirurgia , Implante de Prótese Maxilofacial/métodos , Desenho de Prótese/métodos , Crânio/cirurgia , Humanos , Imageamento Tridimensional , Traumatismos Maxilofaciais/diagnóstico por imagem , Modelos Anatômicos , Planejamento de Assistência ao Paciente , Impressão Tridimensional , Crânio/diagnóstico por imagem , Tomografia Computadorizada por Raios X
17.
Rev Lat Am Enfermagem ; 29: e3426, 2021.
Artigo em Inglês, Português, Espanhol | MEDLINE | ID: mdl-34037121

RESUMO

OBJECTIVE: to compare the quality of the Nursing process documentation in two versions of a clinical decision support system. METHOD: a quantitative and quasi-experimental study of the before-and-after type. The instrument used to measure the quality of the records was the Brazilian version of the Quality of Diagnoses, Interventions and Outcomes, which has four domains and a maximum score of 58 points. A total of 81 records were evaluated in version I (pre-intervention), as well as 58 records in version II (post-intervention), and the scores obtained in the two applications were compared. The interventions consisted of planning, pilot implementation of version II of the system, training and monitoring of users. The data were analyzed in the R software, using descriptive and inferential statistics. RESULTS: the mean obtained at the pre-intervention moment was 38.24 and, after the intervention, 46.35 points. There was evidence of statistical difference between the means of the pre- and post-intervention groups, since the p-value was below 0.001 in the four domains evaluated. CONCLUSION: the quality of the documentation of the Nursing process in version II of the system was superior to version I. The efficacy of the system and the effectiveness of the interventions were verified. This study can contribute to the quality of documentation, care management, visibility of nursing actions and patient safety.


Assuntos
Sistemas de Apoio a Decisões Clínicas , Processo de Enfermagem , Brasil , Documentação , Humanos , Registros de Enfermagem , Planejamento de Assistência ao Paciente
18.
BMJ Health Care Inform ; 28(1)2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34035049

RESUMO

Unscheduled admissions to hospital place great demands on the use of limited healthcare resources in health systems worldwide. A range of approaches exist to manage demand; however, interventions within hospitals have received less attention, and the evidence base on effectiveness is limited. This study aimed to assess the effectiveness of a novel intervention, implemented in National Health Service Lothian, to reduce the number of unscheduled attendances, and to estimate the impact on hospital admissions, length of hospital stay and overall total acute hospital costs. METHODS: Before and after observational study of an anticipatory care planning intervention targeted among people identified by a prediction algorithm (Scottish Patients at Risk of Readmission and Admission) as being at high risk of future unscheduled hospital admissions. The statistical significance of the difference in outcomes observed before and after implementation of the intervention between August 2014 and July 2015 was tested using difference-in-difference analysis. RESULTS: The intervention was estimated to reduce the number of unscheduled hospital admissions and emergency department (ED) visits by approximately 0.36 (95% CI -0.905 to 0.191) per patient per year (based on 954 and 450 patients in the intervention and control groups, respectively). There was also non-significant reductions in length of hospital stay for unscheduled admissions and hospital costs for ED visits and inpatient care. The overall predicted effect of the intervention for the average participant was a saving of around £2912 (95% CI -7347.0 to 1523.9) per patient per year. CONCLUSION: An anticipatory care planning intervention focused among people judged to be at higher risk of future unscheduled hospital admissions can be effective in reducing the number of unscheduled admissions to hospital and ED visits, and may lead to an overall saving in use of hospital resources.


Assuntos
Serviço Hospitalar de Emergência/organização & administração , Planejamento de Assistência ao Paciente/organização & administração , Medicina Estatal/organização & administração , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Custos Hospitalares , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente , Fatores Socioeconômicos , Reino Unido , Adulto Jovem
19.
Dent Clin North Am ; 65(3): 475-486, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34051926

RESUMO

Endodontics requires radiographic imaging for diagnosis, treatment planning, therapy, and follow-up. Dental radiography allows for the identification of pathologic changes in the periradicular tissues that cannot be visualized by clinical inspection. For the precise execution of endodontic therapy, regular radiographic verification of individual treatment steps is necessary. As a review for clinicians, normal and pathologic findings relevant to Endodontics are presented. Key radiographic imaging techniques, such as the paralleling and bisecting techniques, as well as horizontal and vertical eccentric radiographs, are discussed. The increasing utilization and impact of cone-beam computed tomography providing 3-dimensional volume imaging are reviewed.


Assuntos
Endodontia , Radiologia , Tomografia Computadorizada de Feixe Cônico , Humanos , Planejamento de Assistência ao Paciente , Tratamento do Canal Radicular
20.
Dent Clin North Am ; 65(3): 487-507, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34051927

RESUMO

The scope of oral and maxillofacial surgery treatment and care is very broad, from dentoalveolar surgery, to pathology and reconstruction, to treatment of craniofacial deformities. The effective surgical treatment of patients requires appropriate and accurate diagnostic imaging. The various imaging modalities used in oral and maxillofacial surgery are typically for diagnostic and treatment planning purposes. With the improvements of three-dimensional imaging and software programs, surgical treatment and care have been enhanced with patient-specific guides, hardware, and implants. This article discusses the various imaging modalities used for a variety of typical oral and maxillofacial surgery procedures.


Assuntos
Cirurgia Bucal , Tomografia Computadorizada de Feixe Cônico , Humanos , Imageamento Tridimensional , Planejamento de Assistência ao Paciente , Software
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