Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 968
Filtrar
1.
FP Essent ; 496: 26-34, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32902244

RESUMO

Coordination of the care of breast cancer survivors between oncology subspecialists and family physicians is critical to achieving optimal health outcomes. Care of survivors includes surveillance for breast cancer recurrence, screening for second malignancies, assessment and management of adverse effects of treatment, and promotion of overall wellness. Adverse effects include hot flushes, depression and anxiety, lymphedema, cognitive impairment, neuropathy, decreased bone health, effects on sexual health, and cardiac dysfunction. Survivorship care plans can help guide care coordination among clinicians. Racial and ethnic disparities also affect outcomes for patients with breast cancer; optimization of survivorship interventions may help address these disparities.


Assuntos
Neoplasias da Mama , Segunda Neoplasia Primária , Humanos , Recidiva Local de Neoplasia , Sobreviventes , Sobrevivência
2.
Arthroscopy ; 36(8): 2275-2278, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32747067

RESUMO

The altered knee joint function and symptomatic state in younger patients after meniscectomy and progressive tibiofemoral arthritis remain an important unsolved treatment dilemma. Meniscal allograft transplantation has evolved as an acceptable treatment because there are few (if any) other options. The procedure is effective in most patients, who experience a decrease in tibiofemoral pain and improved knee function, even allowing a return to light recreational activities. However, biological remodeling of the implant occurs over time, with replacement of the complex circumferential and radial fibers with disorganized collagen tissues and altered cellular and proteoglycan components that affects load bearing and negates chondroprotective function. Positive patient outcomes may still be reported even with the loss of meniscal transplant function on magnetic resonance imaging giving a false-positive survivorship analysis. Repeated surgical procedures are frequent by 10 years. Patients are advised that meniscal allograft transplant surgery, although beneficial in the short term to buy time, is not curative.


Assuntos
Meniscos Tibiais , Sobrevivência , Aloenxertos , Humanos , Articulação do Joelho , Imagem por Ressonância Magnética , Medidas de Resultados Relatados pelo Paciente
3.
Curr Opin Crit Care ; 26(5): 500-507, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32773618

RESUMO

PURPOSE OF REVIEW: Critical illness survivorship is associated with new and worsening physical, cognitive, and emotional status. Survivors are vulnerable to further health set-backs, most commonly because of infection and exacerbation of chronic medical conditions. Awareness of survivors' challenges are important given the anticipated rise in critical illness survivors because of SARS-CoV-2 viral sepsis. RECENT FINDINGS: Studies continue to document challenges of critical illness survivorship. Beyond the cognitive, physical, and mental health sequelae encompassed by postintensive case syndrome, patients commonly experience persistent immunosuppression, re-hospitalization, inability to resume prior employment, and reduced quality of life. Although recommended practices for enhancing recovery from sepsis are associated with better outcomes, only a minority of patients receive all recommended practices. ICU follow-up programs or peer support groups remain important interventions to learn about and address the multifaceted challenges of critical illness survivorship, but there is little evidence of benefit to date. SUMMARY: Survivors of sepsis and critical illness commonly experience impaired health status, reduced quality of life, and inability to return to prior employment. Although the challenges of critical illness survivorship are increasingly well documented, there are relatively few studies on enhancing recovery. Future studies must focus on identifying best practices for optimizing recovery and strategies to promote their implementation.


Assuntos
Estado Terminal , Unidades de Terapia Intensiva , Sobrevivência , Betacoronavirus , Infecções por Coronavirus , Nível de Saúde , Humanos , Pandemias , Pneumonia Viral , Qualidade de Vida , Retorno ao Trabalho
4.
Pediatrics ; 146(Suppl 1): S75-S80, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32737237

RESUMO

Death is defined biologically as the irreversible loss of the functioning of the organism as a whole, which typically occurs after the loss of cardiorespiratory function. In 1968, a Harvard committee proposed that death could also be defined neurologically as the irreversible loss of brain function. Brain death has been considered to be equivalent to cardiorespiratory arrest on the basis of the belief that the brain is required to maintain functioning of the organism as a whole and that without the brain, cardiorespiratory arrest and biological death are both rapid and certain. Over the past 20 years, however, this equivalence has been shown to be false on the basis of numerous cases of patients correctly diagnosed as brain-dead who nevertheless continued to survive for many years. The issue reached national attention with the case of Jahi McMath, a young woman diagnosed as brain-dead after a surgical accident, who survived for almost 5 years, mostly at home, supported with a ventilator and tube feedings. The fact that brain death is not biological death has many implications, notably including the concern that procurement of organs from brain-dead donors may not comply with the so-called dead donor rule, which requires that vital organs be procured from patients only after they are dead. In this article, I conclude with an analysis of options for moving forward and among them advocate for reframing brain death as a "social construct," with implicit societal acceptance that patients diagnosed as brain-dead may be treated legally and ethically the same as if they were biologically dead.


Assuntos
Morte Encefálica , Morte , Parada Cardíaca , Adolescente , Atitude Frente a Morte , Morte Encefálica/diagnóstico , Morte Encefálica/legislação & jurisprudência , Morte Encefálica/fisiopatologia , Feminino , Parada Cardíaca/diagnóstico , Parada Cardíaca/etiologia , Parada Cardíaca/fisiopatologia , História do Século XXI , Humanos , Neuroimagem/métodos , Neurologia/normas , Hemorragia Pós-Operatória/complicações , Guias de Prática Clínica como Assunto , Respiração Artificial , Sobrevivência , Fatores de Tempo , Inconsciência , Estados Unidos
5.
Arthroscopy ; 36(7): 2022-2024, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32624130

RESUMO

Arthroscopic treatment of glenohumeral arthritis is an important option in young or active patients in whom arthroplasty is not desired or ideal. Typically, arthroscopic management is a bridging procedure with the goals of decreasing pain, improving function, and delaying the need for shoulder arthroplasty. Many levels of treatment have been described ranging from simple to complex-from joint lavage to glenohumeral ligament release and loose body removal to comprehensive arthroscopic management, which includes glenohumeral chondroplasty, synovectomy, loose body removal, microfracture, capsular release, humeral osteoplasty, axillary nerve neurolysis, subacromial decompression, and biceps tenodesis. Patient selection and education are essential because patients with end-stage arthritis (<2 mm of joint space) and bony deformity of the glenoid or humerus have less favorable long-term survival. We prefer the comprehensive arthroscopic management approach, although more technically difficult, because it attempts to address the greatest amount of pathology. We believe this permits the maximum likelihood of sustained benefit and avoidance of "heavy metal," with a 60% survival rate at minimum 10-year follow-up.


Assuntos
Metais Pesados , Articulação do Ombro , Artroscopia , Humanos , Úmero , Sobrevivência
10.
Gan To Kagaku Ryoho ; 47(3): 409-412, 2020 Mar.
Artigo em Japonês | MEDLINE | ID: mdl-32381904

RESUMO

The incidence of breast cancer peaks in women in their 40's and 50's. These women may play an important role in their careers, at home, and as a parent, and therefore need a multifaceted support while undergoing treatment. The concept of survivorship, which is focused on the cancer survivors' and their family's quality of life, is important in providing such support. There are many aspects for which support may be necessary, such as treatment decision-making, fertility preservation, child support, management of genetic conditions, and issues of employment. For providing home care services, the necessary care should be given without compromising their daily lives. For example, consideration should be given as to how to spend their last moments in the presence of their children. It is necessary to understand the patient's course of treatment from the beginning, which includes both hospital and home care services, in making the treatment plan together.


Assuntos
Neoplasias da Mama , Sobreviventes de Câncer , Feminino , Saúde Holística , Humanos , Qualidade de Vida , Sobrevivência
11.
Head Neck ; 42(7): 1664-1667, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32358880

RESUMO

With the arrival of the coronavirus disease (SARS-CoV-2) in the United States, care practice paradigms have drastically changed. Data from China suggest that the new virus poses additional risks as case fatality of patients with cancer was higher at 5.6% compared to 2.3% of the general population. There are three proposed major strategies to address care for patients with cancer in this SARS-CoV-2 pandemic with postponing treatment for those with stable cancer, increasing personal protection provisions for patients with cancer, and increasing monitoring if a patient becomes infected with SARS-CoV-2. In this present commentary, we discuss the unique mental health challenges and burdens of patients with head and neck cancer in the times of the SARS-CoV-2 pandemic and approaches to mitigate these stressors through telemedicine to reduce future burdens to the patient and the health care system.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Neoplasias de Cabeça e Pescoço/psicologia , Pneumonia Viral/epidemiologia , Sobrevivência , Ansiedade/etiologia , Depressão/etiologia , Humanos , Pandemias , Qualidade de Vida , Isolamento Social , Apoio Social , Telemedicina , Tempo para o Tratamento
12.
Head Neck ; 42(7): 1668-1673, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32420631

RESUMO

The 2019 Coronavirus Pandemic challenges the delivery of care for patients with head and neck cancer. An important aspect of this care has been the evolution of enhanced survivorship services, which include surveillance for recurring cancer and prevention of second primaries. The application of evidence-based approaches to the identification and management of treatment and tumor-related toxicities has embraced the use of validated patient-reported outcomes instruments, health promotion, and care coordination. In this manuscript, we describe how our multidisciplinary team of survivorship providers has accommodated to the need to provide patients with social distancing while acknowledging the importance of continued care during treatment and through the spectrum of survivorship.


Assuntos
Betacoronavirus , Continuidade da Assistência ao Paciente/organização & administração , Infecções por Coronavirus/epidemiologia , Neoplasias de Cabeça e Pescoço/terapia , Equipe de Assistência ao Paciente , Pneumonia Viral/epidemiologia , Sobrevivência , Quimiorradioterapia , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/reabilitação , Assistência Odontológica , Diagnóstico por Imagem , Humanos , Controle de Infecções , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Avaliação Nutricional , Exposição Ocupacional/prevenção & controle , Pandemias , Medidas de Resultados Relatados pelo Paciente , Pennsylvania/epidemiologia , Equipamento de Proteção Individual , Exame Físico , Modalidades de Fisioterapia , Garantia da Qualidade dos Cuidados de Saúde , Qualidade de Vida , Fonoterapia , Inquéritos e Questionários , Avaliação de Sintomas , Telemedicina
13.
Med. clín (Ed. impr.) ; 154(7): 248-253, abr. 2020. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-190907

RESUMO

OBJETIVO: Determinar si un régimen medicamentoso más simple en pacientes pluripatológicos se asocia con la supervivencia. MÉTODOS: En un estudio de cohortes multicéntrico se incluyeron pacientes pluripatológicos hospitalizados en servicios de medicina interna entre el 1 de marzo y el 30 de junio de 2011. Se excluyeron los reingresos y los fallecidos. Se recogieron datos de edad, sexo, residencia, enfermedad, índices de Charlson, Barthel y Lawton-Brody, Short Portable Mental State Questionnaire, escala de Gijón, número de ingresos en el año previo, delirio, necesidad de cuidador e índice PROFUND. Se calculó la complejidad terapéutica con el Medication Regimen Complexity Index. Se hizo un seguimiento de 4 años. Para determinar los factores asociados con la mortalidad por todas las causas se construyó un modelo de regresión de Cox. RESULTADOS: Se incluyeron 233 pacientes pluripatológicos con una edad media de 79,8 (8,6) años. La puntuación media en el Medication Regimen Complexity Index fue 32 (15,2). A los 4 años fallecieron 161 (72,2%) pacientes, 36 con régimen de medicación más simple. La edad (HR 1,060; IC95% 1,032-1,089; p < 0,001), las neoplasias (HR 2,477; IC95% 1,564-3,923; p < 0,001) y el número de ingresos en el año previo (HR 1,251; IC95% 1,100-1,423; p = 0,001) se asociaron de forma independiente con la mortalidad, y la puntuación del índice de Barthel (HR 0,991; IC95% 0,983-0,998; p < 0,001) y la simplicidad del régimen de medicación (HR 0,634; IC95% 0,414-0,970; p = 0,036) con menor mortalidad. CONCLUSIONES: En los pacientes pluripatológicos los regímenes de medicación más simples se asocian con una menor mortalidad


OBJECTIVE: To determine if a more simplified medication regimen is associated with survival in polypathological patients. METHODS: Multicentre cohort study. We included polypathological patients admitted to internal medicine wards between March 1st and June 30rd, 2011. Patients that died during admission and readmissions were excluded. Data were collected about age, gender, home, comorbidity, Charlson, Barthel and Lawton-Brody indexes, Short Portable Mental State Questionnaire, socio-familial Gijón scale, admissions in the previous year, delirium, need of a caregiver and PROFUND index. The therapy complexity was measured with the Medication Regimen Complexity Index. The follow-up lasted 4-years. To determine the factors associated with mortality we performed a Cox proportional regression model. RESULTS: Overall 223 polypathological patients were included, with a mean age of 79.8 (8.6) years. Mean score in Medication Regimen Complexity Index was 32.0 (15.2). After 4 years, 161 (72.2%) patients died, 36 with a more simplified medication regimen. Age (HR 1.060, 95%CI 1.032-1.089; P<.001), neoplasms (HR 2.477, 95%CI 1.564-3.923; P<.001), and the number of admissions in the previous year (HR 1.251, 95%CI 1.100-1.423; P=.001) were independently associated with 4-year mortality, and Barthel index score (HR .991, 95%CI .983-0.998; P<.001) and a more simplified medication regimen (HR 0.634 95%CI 0.414-.970; p=.036) with lower mortality. CONCLUSIONS: In polypathological patients, the more simplified medication regimens are associated with a lower mortality


Assuntos
Humanos , Feminino , Idoso , Masculino , Idoso de 80 Anos ou mais , Sobrevivência , Estudos de Coortes , Conduta do Tratamento Medicamentoso/normas , Adesão à Medicação , Polimedicação , Múltiplas Afecções Crônicas/tratamento farmacológico , Hospitalização , Conduta do Tratamento Medicamentoso/organização & administração , Estudos Prospectivos , Análise Estatística , Análise de Variância , Readmissão do Paciente
15.
Semin Oncol ; 47(1): 56-64, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32229032

RESUMO

Pediatric cancer is a rare disease with a low annual incidence, which presents a significant challenge in being able to collect enough data to fuel clinical discoveries. Big data registry trials hold promise to advance the study of pediatric cancers by allowing for the combination of traditional randomized controlled trials with the power of larger cohort sizes. The emergence of big data resources and data-sharing initiatives are becoming transformative for pediatric cancer diagnosis and treatment. This review discusses the uses of big data in pediatric cancer, existing pediatric cancer registry initiatives and research, the challenges in harmonizing these data to improve accessibility for study, and building pediatric data commons and other important future endeavors.


Assuntos
Big Data , Oncologia/estatística & dados numéricos , Neoplasias/epidemiologia , Pediatria/estatística & dados numéricos , Fatores Etários , Criança , Bases de Dados Factuais , Humanos , Disseminação de Informação , Informática Médica/métodos , Oncologia/tendências , Neoplasias/diagnóstico , Neoplasias/etiologia , Neoplasias/terapia , Pediatria/tendências , Vigilância em Saúde Pública , Sistema de Registros , Pesquisa , Sobrevivência
17.
Bone Joint J ; 102-B(3): 319-328, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32114810

RESUMO

AIM: There has been a significant reduction in unicompartmental knee arthroplasty (UKA) procedures recorded in Australia. This follows several national joint registry studies documenting high UKA revision rates when compared to total knee arthroplasty (TKA). With the recent introduction of robotically assisted UKA procedures, it is hoped that outcomes improve. This study examines the cumulative revision rate of UKA procedures implanted with a newly introduced robotic system and compares the results to one of the best performing non-robotically assisted UKA prostheses, as well as all other non-robotically assisted UKA procedures. METHODS: Data from the Australian Orthopaedic Association National Joint Arthroplasty Registry (AOANJRR) for all UKA procedures performed for osteoarthritis (OA) between 2015 and 2018 were analyzed. Procedures using the Restoris MCK UKA prosthesis implanted using the Mako Robotic-Arm Assisted System were compared to non-robotically assisted Zimmer Unicompartmental High Flex Knee System (ZUK) UKA, a commonly used UKA with previously reported good outcomes and to all other non-robotically assisted UKA procedures using Cox proportional hazard ratios (HRs) and Kaplan-Meier estimates of survivorship. RESULTS: There was no difference in the rate of revision when the Mako-assisted Restoris UKA was compared to the ZUK UKA (zero to nine months: HR 1.14 (95% CI 0.71 to 1.83; p = 0.596) vs nine months and over: HR 0.66 (95% CI 0.42 to 1.02; p = 0.058)). The Mako-assisted Restoris had a significantly lower overall revision rate compared to the other types of non-robotically assisted procedures (HR 0.58 (95% confidence interval (CI) 0.42 to 0.79); p < 0.001) at three years. Revision for aseptic loosening was lower for the Mako-assisted Restoris compared to all other non-robotically assisted UKA (entire period: HR 0.34 (95% CI 0.17 to 0.65); p = 0.001), but not the ZUK prosthesis. However, revision for infection was significantly higher for the Mako-assisted Restoris compared to the two comparator groups (ZUK: entire period: HR 2.91 (95% CI 1.22 to 6.98; p = 0.016); other non-robotically assisted UKA: zero to three months: HR 5.57 (95% CI 2.17 to 14.31; p < 0.001)). CONCLUSION: This study reports comparable short-term survivorship for the Mako robotically assisted UKA compared to the ZUK UKA and improved survivorship compared to all other non-robotic UKA. These results justify the continued use and investigation of this procedure. However, the higher rate of early revision for infection for robotically assisted UKA requires further investigation. Cite this article: Bone Joint J 2020;102-B(3):319-328.


Assuntos
Artroplastia do Joelho/métodos , Prótese do Joelho , Osteoartrite do Joelho/cirurgia , Sistema de Registros , Procedimentos Cirúrgicos Robóticos/métodos , Sobrevivência , Adulto , Idoso , Idoso de 80 Anos ou mais , Austrália , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Ortopedia , Reoperação , Estudos Retrospectivos , Sociedades Médicas , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
18.
Support Care Cancer ; 28(8): 3481-3484, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32215735

RESUMO

An important aspect of breast cancer survivorship is finding comfortable undergarments that work for women's post-treatment bodies. Patients who undergo mastectomy, including both those who do and do not receive reconstruction, need bras that can accommodate new breast shape, size, and feel, as well as scarring and skin sensitivity. Our research with breast cancer patients and the literature reveal that ready-to-wear bras are inadequate for the variety of patients' needs, and many women lack support and guidance to make decisions about undergarments after cancer. This commentary describes a major quality-of-life challenge for breast cancer survivors and makes recommendations for future research. Healthcare providers need more guidance and resources to be able to help their patients prepare for this aspect of survivorship. New technologies, such as biomechanical modeling, 3D body scanning, and manufacturing techniques, should be pursued in collaboration with patients, healthcare providers, and clothing designers to ease this burden for breast cancer patients.


Assuntos
Neoplasias da Mama/cirurgia , Vestuário/normas , Mastectomia/reabilitação , Neoplasias da Mama/psicologia , Sobreviventes de Câncer , Vestuário/psicologia , Feminino , Humanos , Mastectomia/psicologia , Determinação de Necessidades de Cuidados de Saúde , Preferência do Paciente , Qualidade de Vida , Inquéritos e Questionários , Sobrevivência
20.
Semin Oncol ; 47(1): 23-39, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32197774

RESUMO

With the widespread adoption of multimodality treatment, 5-year survival of children diagnosed with cancer has improved dramatically in the past several decades from approximately 60% in 1970 to greater than 85% currently. As a result, there are an estimated nearly half a million long-term survivors of childhood cancer living in the United States today. However, survivors have, on average, significantly greater serious medical and psychosocial late effects compared with the general population. In this review, we will discuss the current epidemiology of childhood cancer survivorship, including new methods to estimate the burden of late effects and genetic susceptibility toward late effects. We will also review the development of surveillance guidelines for childhood cancer survivors and early toxicity signals from novel agents now being tested and used increasingly to treat pediatric and adult cancers. We conclude with an overview of current models of survivorship care and areas for future research.


Assuntos
Sobreviventes de Câncer , Neoplasias/epidemiologia , Sobrevivência , Criança , Comorbidade , Efeitos Psicossociais da Doença , Predisposição Genética para Doença , Humanos , Incidência , Neoplasias/diagnóstico , Neoplasias/etiologia , Neoplasias/terapia , Vigilância em Saúde Pública , Qualidade de Vida , Fatores Socioeconômicos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA