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2.
Compend Contin Educ Dent ; 41(1): 42-49, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31895580

RESUMO

Radiation therapy for patients with head and neck cancer can have damaging effects on oral health, including reduced salivary flow. In this case report, a 58-year-old patient had previously undergone radiation therapy for stage II squamous cell carcinoma of the larynx. Symptoms of xerostomia persisted, and her dentition suffered as a result. Problems included moderate to severe loss of tooth structure; erosive pitting lesions on the cusp tips of posterior teeth; and attrition throughout her dentition, particularly in the anterior. To achieve the esthetic, functional, and biomechanical goals of the case, treatment involved the use of both full-coverage, cohesively retained restorations and feldspathic veneers, depending on the amount of adequate enamel available for adhesion, along with limited orthodontic therapy. Additionally, the patient was instructed on how to stimulate salivary flow post-treatment.


Assuntos
Dentição , Neoplasias de Cabeça e Pescoço , Esmalte Dentário , Estética Dentária , Feminino , Humanos , Pessoa de Meia-Idade , Sobreviventes
3.
Forensic Sci Int ; 306: 110062, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31786514

RESUMO

The renowned work of Clyde Snow and the development of the Equipo Argentino de Anthropología Forense (EAAF) team has inspired the use of forensic anthropological and archaeological skills in human rights interventions around the world. Whether for medico-legal intervention and acquisition of evidence or humanitarian repatriation and identification of human remains, forensic expertise has garnered attention in the global arena. Arguably fulfilling evidentiary and psychosocial needs, there has been growing interest in this post-conflict redress. However, as part of the critique of these interventions, scholars and practitioners have pointed out - primarily in medico-legal investigations - a lack of sensitization of local communities regarding forensic work, increasing the potential for re-traumatization, unrealistic expectations, or an unintentional increase in political tensions. Research regarding forensic intervention and human remains have permeated social sciences, peace and conflict studies, and science and technology studies, revealing both intentional and unintentional impacts of forensic sciences after mass violence. In an effort to mitigate negative impacts of medico-legal or humanitarian interventions, the research described here sought to sensitize communities in Uganda about forensic methods. Findings from this study suggest that sensitization is necessary and desired, and that a multi-step approach can assist in managing expectations.


Assuntos
Conflitos Armados , Antropologia Forense/organização & administração , Sobreviventes/psicologia , Altruísmo , Arqueologia , Recursos Audiovisuais , Sepultamento , Relações Comunidade-Instituição , Grupos Focais , Antropologia Forense/educação , Direitos Humanos , Humanos , População Rural , Uganda
4.
J Oncol Pharm Pract ; 26(1): 36-42, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30885081

RESUMO

PURPOSE: The objective of this study is to determine demographic, clinical, and pharmaceutical factors that are associated with longer endocrine therapy usage duration. METHODS: South Carolina Central Cancer Registry incidence data linked with South Carolina Medicaid prescription claims and administrative data were used. The study included a sample (N = 1399) of female South Carolina Medicaid recipients with hormone receptor-positive breast cancer diagnosed between 2000 and 2012 who filled at least one ET prescription. A series of multiple regression models were built to explore the association of demographic, clinical, and pharmaceutical factors with the endocrine therapy usage duration. RESULTS: Multiple linear regression analysis showed that none of the demographic or clinical factors tested were significantly associated with the endocrine therapy usage duration. However, the type of endocrine therapy taken as well as receipt of the prescriptions that could have been used to alleviate side-effects (adrenals, nonsteroidal anti-inflammatory agents, anti-inflammatory agents, and vitamins) were significantly associated. CONCLUSION: Our study highlights the potential value of concurrent prescriptions for improving the endocrine therapy usage duration, with an optimal intervention point before 14 months post ET initiation. This work informs further research needed to test pharmacologic interventions that may significantly increase the endocrine therapy duration as well as other nonpharmacologic strategies for side-effect management.


Assuntos
Antineoplásicos Hormonais/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/epidemiologia , Medicaid/tendências , Sobreviventes , Adulto , Inibidores da Aromatase/uso terapêutico , Neoplasias da Mama/diagnóstico , Quimioterapia Adjuvante/tendências , Esquema de Medicação , Feminino , Humanos , Pessoa de Meia-Idade , South Carolina/epidemiologia , Tamoxifeno/uso terapêutico , Estados Unidos/epidemiologia , Adulto Jovem
5.
J Surg Res ; 245: 516-522, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31450039

RESUMO

BACKGROUND: A necrotizing soft-tissue infection (NSTI) is a rare but severe infection with a high mortality rate of 12%-20%. Diagnosing is challenging and often delayed. Treatment consists of surgical debridement of all necrotic tissue and administration of antibiotics. Despite adequate treatment, survivors are often left with extensive wounds, resulting in mutilating scars and functional deficits. Both the disease and the subsequent scars can negatively influence the health-related quality of life (HRQoL). The present study was performed to contribute to the knowledge about HRQoL in patients after NSTI. METHODS: We retrospectively identified patients treated for NSTI in a tertiary center in the Netherlands. Patient and treatment characteristics were collected and patients were asked to fill in a Short Form 36 questionnaire. RESULTS: Forty-six patients with a diagnosis of NSTI were identified. Twenty-eight (61%) were male and mean age was 57 y. Thirty-nine patients (80%) survived. Thirty-one (84%) of the survivors returned the questionnaire after a median follow-up of 4.1 y (interquartile range [IQR], 2.4-5.9 y). Statistically significantly decreased scores when compared to the Dutch reference values were observed for the Short Form 36 domains, physical functioning, role-physical functioning, general health, and the combined Physical Component Score. No differences were observed for the other five domains or for the Mental Component Score. CONCLUSIONS: This study confirms that NSTI negatively affects HRQoL as reported by the patient, especially on the physical domains. To learn more about HRQoL in patients after NSTI, studies in larger groups with a more disease-specific questionnaire should be performed. LEVEL OF EVIDENCE: Level 3, prognostic and epidemiological.


Assuntos
Fasciite Necrosante/cirurgia , Gangrena de Fournier/cirurgia , Gangrena Gasosa/cirurgia , Qualidade de Vida , Infecções dos Tecidos Moles/cirurgia , Adulto , Desbridamento/efeitos adversos , Fasciite Necrosante/complicações , Fasciite Necrosante/psicologia , Feminino , Gangrena de Fournier/complicações , Gangrena de Fournier/psicologia , Gangrena Gasosa/complicações , Gangrena Gasosa/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Tratamento de Ferimentos com Pressão Negativa/efeitos adversos , Países Baixos , Período Pós-Operatório , Estudos Retrospectivos , Infecções dos Tecidos Moles/complicações , Infecções dos Tecidos Moles/psicologia , Inquéritos e Questionários/estatística & dados numéricos , Sobreviventes/psicologia , Sobreviventes/estatística & dados numéricos
6.
Disasters ; 44(1): 85-102, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31231844

RESUMO

After the Great East Japan Earthquake and Tsunami, volunteers participated in the recovery of lost photographs. This effort-which we call the Picturescue Movement-subsequently began to organise photograph restoration gatherings. We conducted field research during the gatherings in Noda, one of the tsunami-stricken areas. We have also carried out research on restoration gatherings in the city of Rikuzentakata. A comparison of findings across these two localities identifies two approaches to photograph restoration gatherings: 'aiming' and 'staying'. The aiming approach, employed in Rikuzentakata, emphasises returning photographs to their owners quickly, whereas the latter approach, used in Noda, is one in which volunteers stay with survivors for some time and encourage them to recall the past at their own pace. We conclude that the staying approach is more likely than the aiming approach to promote disaster recovery among survivors.


Assuntos
Desastres , Fotografação , Socorro em Desastres/organização & administração , Sobreviventes/psicologia , Tsunamis , Humanos , Japão
7.
Orv Hetil ; 161(1): 26-32, 2020 Jan.
Artigo em Húngaro | MEDLINE | ID: mdl-31884810

RESUMO

Introduction: Cytokeratin-18 (CK-18) is releasing into the blood during systemic cell death due to ischemia-reperfusion injury after cardiac arrest. Its caspase-cleaved form is specific to apoptosis. Previous investigations proved their prognostic value in different conditions. We firstly investigated the prognostic value of these markers after cardiac arrest. Method: Plasma samples of 40 resuscitated patients were collected 6, 24, and 72 hours after successful resuscitation to determine the marker concentrations. We investigated the association of the markers with the 30-day mortality, neurological outcome, circumstances of the cardiac arrest, laboratory and physical parameters. Results: Resuscitated patients had highly elevated CK-18 levels (3842 vs. 242; 559; 1644 ng/L) and decreased caspase-cleaved CK-18/CK-18 ratio (0.14 vs. 0.58; 0.22; 0.24) compared to healthy subjects, septic and postoperative patients suggesting severe grade of cell death, mainly necrosis. Neither the marker concentrations nor their kinetics showed difference between survivors and non-survivors. They did not show association with the length of the resuscitation, the initial rhythm or the neurological outcome either. CK-18 decreased in patients with good renal function in contrast to patients with renal failure. Significant negative correlation was observed between the 6-hour cytokeratin-18 and hemoglobin concentrations (r = -0.400, p<0.01), while the 30-day survival was associated with lower hemoglobin levels. Conclusion: Surprisingly the biomarkers did not show prognostic value among resuscitated population. The outcome is probably not determined by the complete cell damage, but the loss of a small group of cells with critical role and the reserve capacity of the patient. Orv Hetil. 2020; 161(1): 26-32.


Assuntos
Morte Celular , Parada Cardíaca/sangue , Queratina-18/sangue , Biomarcadores/sangue , Reanimação Cardiopulmonar , Parada Cardíaca/mortalidade , Humanos , Valor Preditivo dos Testes , Prognóstico , Análise de Sobrevida , Sobreviventes
9.
Nurs Clin North Am ; 54(4): 569-584, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31703782

RESUMO

Human trafficking is the intentional exploitation of vulnerable individuals for the personal gain of the exploiter and is now recognized as an emerging public health care priority. Health care providers are well positioned to identify and assist trafficked individuals as well as those who may be at risk for exploitation. Trauma informed care is essential to identify victims and evaluate the impact of traumatic stress while highlighting survivors' strengths and supporting their resiliency. Human trafficking demographics, including mental and physical health problems, health considerations, risk factors, screening, implications for practice, and national resources, are reviewed.


Assuntos
Assistência à Saúde , Medicina Baseada em Evidências , Tráfico de Pessoas/estatística & dados numéricos , Sobreviventes/psicologia , Adulto , Criança , Pessoal de Saúde , Tráfico de Pessoas/psicologia , Humanos , Serviços de Saúde Mental , Saúde Pública
12.
BMC Health Serv Res ; 19(1): 763, 2019 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-31660961

RESUMO

BACKGROUND: The aim of this study was to estimate the mean cost per caregiver of informal care during the first year after myocardial infarction event in France. METHODS: We used the Handicap-Santé French survey carried out in 2008 to obtain data about MI survivors and their caregivers. After obtaining the total number of informal care hours provided by caregiver during the first year after MI event, we estimated the value of informal care using the proxy good method and the contingent valuation method. RESULTS: For MI people receiving informal care, an annual mean cost was estimated at €12,404 (SD = 13,012) with the proxy good method and €12,798 (SD = 13,425) with the contingent valuation method per caregiver during the first year after myocardial infarction event. CONCLUSIONS: The present study suggests that informal care should be included more widely in economic evaluations in order not to underestimate the cost of diseases which induce disability.


Assuntos
Cuidadores/economia , Análise Custo-Benefício , Infarto do Miocárdio/terapia , Assistência ao Paciente/economia , Idoso , Cuidadores/estatística & dados numéricos , Pessoas com Deficiência/estatística & dados numéricos , Feminino , França , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Sobreviventes/estatística & dados numéricos
16.
BMC Public Health ; 19(1): 1408, 2019 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-31664985

RESUMO

BACKGROUND: Burden is well documented among carers of stroke survivors, yet current evidence is insufficient to determine if any strategies reduce this negative outcome. Existing interventions for carers of stroke survivors typically involve supporting carers according to their individual needs through face-to-face interactions and provision of information including workbooks or educational guides. To date, no interventions have been developed using a method which systematically incorporates evidence, behaviour change theories, and stakeholder involvement to change the behaviours of carers and relevant individuals who support carers. This study aimed to develop a programme plan for a theory and evidence-based intervention to reduce burden in carers of stroke survivors. METHODS: Informed by evidence from two systematic reviews and 33 qualitative interviews, the first four stages of Intervention Mapping were used to guide the intervention development process: 1) needs assessment; 2) identifying outcomes and objectives; 3) selecting theoretical methods and practical applications; and 4) creating a programme plan. Structured and facilitated involvement from stakeholders, including carers, researchers, and professionals from health and community services was integral to the intervention development process. Stakeholders helped to prioritise the focus of the intervention, develop the goals, outcomes and objectives for the programme, and generate and refine intervention ideas. RESULTS: Stakeholders prioritised the need for carers to feel prepared before and during the transition from hospital to home as key to reducing burden. The proposed intervention 'Preparing is Caring' targets this need and involves providing and signposting carers to relevant information and support for practical and emotional needs. This is to be delivered before, during, and immediately after the stroke survivor's transition from hospital to home by a person taking on a single point of contact role. It is comprised of multiple theory-based components including: training packages for information and support providers working with carers and wider staff teams, plus elements to support carers to feel prepared. CONCLUSIONS: We have developed a comprehensive programme plan for a multiple-component, theory and evidence informed behaviour change intervention aimed at preparing carers before and during the transition from hospital to home. Future work is required to refine, implement and evaluate the Preparing is Caring intervention.


Assuntos
Cuidadores/psicologia , Efeitos Psicossociais da Doença , Acidente Vascular Cerebral/terapia , Sobreviventes , Cuidado Transicional/organização & administração , Humanos , Pesquisa Qualitativa , Revisão Sistemática como Assunto
17.
Medicine (Baltimore) ; 98(39): e17307, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574859

RESUMO

To investigate the cognitive and psychological outcomes of pediatric allogeneic HSCT survivors in China.A total of 135 3 to 18 years old children and adolescents who underwent allo-HSCT and survived at least 3 months post-HSCT were recruited and completed the assessments. Cognitive and psychological functions were assessed via age-appropriate standardized measures. Clinical information was extracted from the medical records.Forty one 3 to 6 years old children completed Psychological Questionnaires for 3 to 6 years Children. The scores of 21(51.2%) children in cognitive development dimension, 18(43.9%) in motor development dimension, 16(39.0%) in language development and social development dimension, 15(36.6%) in emotion and will dimension and 14(34.1%) in living habits dimension were less than the standard. Fifty six 8 to 16 years old children and adolescents completed the Depression Self-rating Scale for Children and 9 (16.1%) of these met the criteria of depression. Sixty nine 7 to 16 years old children and adolescents completed the screening for Child Anxiety Related Disorders and 7 (10.1%) of these met the criteria of anxiety, especially social phobia and school phobia. Eighty nine 6 to 18 years old children and adolescents completed the Symptom Checklist-90 and 43.8% to 77.5% of these experienced mild symptoms like obsession-compulsion (77.5%), hostility (64%), and interpersonal sensitivity (60.7%). Children treated with total body irradiation (TBI) showed more cognitive impairments like motor deficits than those without TBI. Also older children and adolescents had more symptoms like psychoticism.These findings demonstrated cognitive and psychological late effects of pediatric allo-HSCT survivors in a single center in China and highlighted that the survivors conditioned with TBI had more cognitive impairments and older children and adolescents had more symptoms. Early intervention in these children and adolescents might minimize the cognitive losses and psychological effects.


Assuntos
Ansiedade , Disfunção Cognitiva , Depressão , Transplante de Células-Tronco Hematopoéticas , Complicações Pós-Operatórias , Qualidade de Vida , Adolescente , Ansiedade/diagnóstico , Ansiedade/etiologia , Ansiedade/prevenção & controle , Criança , Pré-Escolar , China/epidemiologia , Cognição , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/prevenção & controle , Depressão/diagnóstico , Depressão/etiologia , Depressão/prevenção & controle , Intervenção Médica Precoce/métodos , Feminino , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Transplante de Células-Tronco Hematopoéticas/métodos , Humanos , Masculino , Destreza Motora , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/prevenção & controle , Técnicas Psicológicas , Sobreviventes/psicologia
18.
Dis Colon Rectum ; 62(11): 1294-1304, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31567919

RESUMO

BACKGROUND: Despite the increasing number of younger individuals diagnosed with colon and rectal cancer, research on the long-term disease-specific health-related quality of life of younger (<50 years) survivors of colon and rectal cancer is scarce. OBJECTIVE: Our study aimed to compare disease-specific functional deficits and symptoms of survivors of colon and rectal cancer 5 to 16 years postdiagnosis, stratified by age at diagnosis and by sex. DESIGN: This is a cross-sectional study. SETTING: We used data from the population-based CAncEr Survivorship-A multi-Regional study in collaboration with 5 population-based German cancer registries. PATIENTS: Survivors of colon and rectal cancer were included in the study. MAIN OUTCOME MEASURES: Respondents completed the disease-specific European Organization for Research and Treatment of Cancer Quality of Life colorectal cancer module. Age at diagnosis categories were <50, 50 to 59, 60 to 69, and ≥70 years. Least square mean health-related quality of life scores, derived from linear regression, were adjusted for sex, education, time since diagnosis, cancer site, cancer stage, and treatment, where appropriate. RESULTS: The sample comprised 697 survivors of colon cancer and 479 survivors of rectal cancer. In general, survivors of colon and rectal cancer diagnosed at <50 years of age reported lower functioning and higher symptom burden in comparison with survivors diagnosed at an older age. When stratified by sex, female survivors of colon cancer tended to report more concerns with hair loss but fewer sexual problems when compared with male survivors of colon cancer of the same age. Female survivors of rectal cancer in all age groups tended to report lower levels of sexual interest than male survivors of rectal cancer of the same age. LIMITATIONS: This was a cross-sectional study with findings that could be biased toward healthier long-term survivors. The generalizability of results is limited to survivors diagnosed before 2005. CONCLUSIONS: Our results suggest that supportive care for survivors of colon and rectal cancer to improve their self-management of symptoms should be adapted according to cancer type, age at diagnosis, and sex. See Video Abstract at http://links.lww.com/DCR/B29. LA EDAD AL DIAGNÓSTICO Y EL GÉNERO ESTÁN ASOCIADOS CON DÉFICITS A LARGO PLAZO EN LA CALIDAD DE VIDA RELACIONADA CON LA SALUD ESPECíFICA DE LA ENFERMEDAD DE LOS SOBREVIVIENTES DE CÁNCER DE COLON Y RECTO: UN ESTUDIO BASADO EN LA POBLACIÓN:: A pesar del creciente número de individuos jóvenes diagnosticados con cáncer de colon y recto, la investigación sobre la calidad de vida relacionada con la salud específica de la enfermedad a largo plazo de los sobrevivientes de cáncer de colon y recto jóvenes (<50 años) es escasa.Nuestro estudio tuvo como objetivo comparar los déficits funcionales específicos de la enfermedad y los síntomas de los sobrevivientes de cáncer de colon y recto 5-16 años después del diagnóstico, estratificados por edad al momento del diagnóstico y por género.Transversal.Utilizamos datos del estudio Supervivencia de CAncEr basada en la población: Un estudio multirregional en colaboración con cinco bases de datos alemanas de cáncer basados en la población.Sobrevivientes de cáncer de colon y recto.Los encuestados respondieron el módulo de calidad de vida específica para la enfermedad en cáncer colorrectal de la Organización Europea para la Investigación y Tratamiento del Cáncer. Las categorías de edad al diagnóstico fueron <50, 50-59, 60-69 y ≥70 años. Los puntajes de CVRS (calidad de vida relacionada a la salud) medios mínimos cuadrados, derivados de la regresión lineal, se ajustaron por género, educación, tiempo desde el diagnóstico, sitio del cáncer, etapa del cáncer y tratamiento, cuando apropiado.La muestra comprendió 697 y 479 sobrevivientes de cáncer de colon y de recto, respectivamente. En general, los sobrevivientes de cáncer de colon y recto diagnosticados con <50 años de edad reportaron una menor funcionalidad y una mayor carga de síntomas en comparación con los sobrevivientes diagnosticados a una edad más avanzada. Cuando se estratificaron por género, las mujeres sobrevivientes de cáncer de colon tendieron a informar más preocupaciones sobre la pérdida de cabello pero menos problemas sexuales en comparación con los hombres sobrevivientes de colon de la misma edad. Las mujeres sobrevivientes de cáncer rectal en todos los grupos de edad tendieron a informar niveles más bajos de interés sexual que los hombres sobrevivientes de cáncer rectal de la misma edad.Estudio transversal con hallazgos que podrían estar sesgados hacia sobrevivientes a largo plazo más saludables. La generalización de los resultados se limitó a los sobrevivientes diagnosticados antes de 2005.Nuestros resultados sugieren que los cuidados de soporte para los sobrevivientes de cáncer de colon y recto para mejorar su automanejo de síntomas deben adaptarse según el tipo de cáncer, la edad en el momento del diagnóstico y el género. Vea el resumen en video en http://links.lww.com/DCR/B29.


Assuntos
Neoplasias Colorretais , Efeitos Psicossociais da Doença , Desempenho Físico Funcional , Qualidade de Vida , Sobreviventes , Tempo , Idoso , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/patologia , Neoplasias Colorretais/psicologia , Neoplasias Colorretais/terapia , Estudos Transversais , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Assistência ao Paciente/métodos , Fatores Sexuais , Sobreviventes/psicologia , Sobreviventes/estatística & dados numéricos
19.
Dis Colon Rectum ; 62(11): 1305-1315, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31567924

RESUMO

BACKGROUND: Delayed initiation of adjuvant chemotherapy negatively impacts long-term survival in patients with colorectal cancer. Colorectal enhanced recovery protocols result in decreased complications and length of stay; however, the impact of enhanced recovery on the timing of adjuvant chemotherapy remains unknown. OBJECTIVE: This study aimed to identify factors associated with on-time delivery of adjuvant chemotherapy after colorectal cancer surgery, hypothesizing that implementation of an enhanced recovery protocol would result in more patients receiving on-time chemotherapy. DESIGN: This was a retrospective cohort study comparing the rate of on-time adjuvant chemotherapy delivery after colorectal cancer resection before and after implementation of an enhanced recovery protocol. SETTINGS: The study was conducted at a large academic medical center. PATIENTS: All of the patients who underwent nonemergent colorectal cancer resections for curative intent from January 2010 to June 2017, excluding patients who had no indication for adjuvant chemotherapy, had received preoperative systemic chemotherapy, or did not have medical oncology records available were included. MAIN OUTCOME MEASURES: Patients before and enhanced recovery were compared, with the rate of on-time adjuvant chemotherapy delivery as the primary outcome. Adjuvant chemotherapy delivery was considered on time if initiated ≤8 weeks postoperatively, and treatment was considered delayed or omitted if initiated >8 weeks postoperatively (delayed) or never received (omitted). Multivariable logistic regression identified predictors of on-time chemotherapy delivery. RESULTS: A total of 363 patients met inclusion criteria, with 189 patients (52.1%) undergoing surgery after enhanced recovery implementation. Groups differed in laparoscopic approach and median procedure duration, both of which were higher after enhanced recovery. Significantly more patients received on-time chemotherapy after enhanced recovery implementation (p = 0.007). Enhanced recovery was an independent predictor of on-time adjuvant chemotherapy (p = 0.014). LIMITATIONS: The study was limited by its retrospective and nonrandomized before-and-after design. CONCLUSIONS: Enhanced recovery was associated with receiving on-time adjuvant chemotherapy. As prompt initiation of adjuvant chemotherapy improves survival in colorectal cancer, future investigation of long-term oncologic outcomes is necessary to evaluate the potential impact of enhanced recovery on survival. See Video Abstract at http://links.lww.com/DCR/B21. LA IMPLEMENTACIÓN DE UN PROTOCOLO DE RECUPERACIÓN ACELERADA SE ASOCIA CON EL INICIO A TIEMPO DE QUIMIOTERAPIA ADYUVANTE EN CÁNCER COLORRECTAL:: El inicio tardío de la quimioterapia adyuvante afecta negativamente la supervivencia a largo plazo en pacientes con cáncer colorrectal. Los protocolos de recuperación acelerada colorrectales dan lugar a una disminución de las complicaciones y la duración de estancia hospitalaria; sin embargo, el impacto de la recuperación acelerada en el momento de inicio de quimioterapia adyuvante sigue siendo desconocido.Este estudio tuvo como objetivo identificar los factores asociados con la administración a tiempo de la quimioterapia adyuvante después de la cirugía de cáncer colorrectal, con la hipótesis de que la implementación de un protocolo de recuperación acelerada daría lugar a que más pacientes reciban quimioterapia a tiempo.Estudio de cohorte retrospectivo que compara la tasa de administración de quimioterapia adyuvante a tiempo después de la resección del cáncer colorrectal antes y después de la implementación de un protocolo de recuperación acelerada.Centro médico académico grande.Todos los pacientes que se sometieron a resecciones de cáncer colorrectal no emergentes con intención curativa desde enero de 2010 hasta junio de 2017, excluyendo a los pacientes que no tenían indicación de quimioterapia adyuvante, que recibieron quimioterapia sistémica preoperatoria o no tenían registros médicos de oncología disponibles.Los pacientes se compararon antes y después de la implementación de la recuperación acelerada, con la tasa de administración de quimioterapia adyuvante a tiempo como el resultado primario. La administración de quimioterapia adyuvante se consideró a tiempo si se inició ≤8 semanas después de la operación, y el tratamiento se consideró retrasado / omitido si se inició> 8 semanas después de la operación (retrasado) o nunca fue recibido (omitido). La regresión logística multivariable identificó predictores de administración de quimioterapia a tiempo.363 pacientes cumplieron con los criterios de inclusión, con 189 (52.1%) pacientes sometidos a cirugía después de la implementación de recuperación acelerada. Los grupos difirieron en el abordaje laparoscópico y la duración media del procedimiento; ambos factores fueron mayores después de la recuperación acelerada. Significativamente más pacientes recibieron quimioterapia a tiempo después de la implementación de recuperación acelerada (p = 0.007). La recuperación acelerada fue un factor predictivo independiente de quimioterapia adyuvante a tiempo (p = 0.014).Diseño retrospectivo, tipo ¨antes y después¨ no aleatorizado.La recuperación acelerada se asoció con la recepción de quimioterapia adyuvante a tiempo. Debido a que el inicio rápido de la quimioterapia adyuvante mejora la supervivencia en el cáncer colorrectal, en el futuro será necesario investigar los resultados oncológicos a largo plazo para evaluar el impacto potencial de la recuperación acelerada en la supervivencia. Vea el Resumen en Video en http://links.lww.com/DCR/B21.


Assuntos
Antineoplásicos/uso terapêutico , Quimioterapia Adjuvante/métodos , Colectomia/reabilitação , Neoplasias Colorretais , Complicações Pós-Operatórias/prevenção & controle , Recuperação de Função Fisiológica/efeitos dos fármacos , Sobreviventes/estatística & dados numéricos , Tempo para o Tratamento , Protocolos Clínicos/normas , Colectomia/métodos , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/patologia , Neoplasias Colorretais/reabilitação , Neoplasias Colorretais/terapia , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tempo para o Tratamento/normas , Tempo para o Tratamento/estatística & dados numéricos , Estados Unidos/epidemiologia
20.
Medicine (Baltimore) ; 98(38): e17128, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567951

RESUMO

BACKGROUND: Post-stroke brain damage, which affects the central control of respiration, leads to various respiratory disorders. They can be caused by the weakening of the respiratory muscles and chest movements, which can indirectly contribute to an impairment of the ventilation function. The aim of the study is an objective assessment of the effect of a single-session intervention of respiratory stimulation through Proprioceptive Neuromuscular Facilitation (PNF) on chosen respiratory parameters and the following comparison of these changes with a group in which positioning was used (intra- and intergroup comparison). METHODS: This was a randomized interventional study evaluating the respiratory parameters depending on the applied respiratory stimulation in patients after ischemic stroke. The patients qualified to participate in the study were randomly assigned to 1 of 2 groups: PNF-treated group - in which respiratory stimulation through PNF was used, PNF untreated group - in which positioning was used. The research procedure consisted of several stages. First, an interview was conducted with each participant and basic data was collected. Then, spirometry was conducted, after which each patient underwent a single-session intervention according to their assigned group. Finally, the patients were given another spirometry examination. The main outcomes will be to compare the results of a spirometry test (FVC, FEV1, FEV1/ FVC%, PEF) before and after single-session intervention and between groups. RESULTS: Based on the inclusion and exclusion criteria for the study, 60 patients took part in the measurement. The values of FEV1/FVC% were higher in PNF-treated group than in PNF-untreated group, if the post-intervention measures (P = .04) are considered. The difference between the pre- and post-intervention results of the FEV1/FVC% values in PNF-untreated group was substantially lower than in PNF-treated group (P = .001). CONCLUSION: A single application of respiratory stimulation through PNF positively affect air flow in the respiratory tract. Application of PNF stimulation contributed to an increase in the FEV1/FVC% parameter. However, no positive changes were noted in the other parameters, which would provide proof of the beneficial effect of facilitation on the respiratory system function.


Assuntos
Isquemia Encefálica/complicações , Exercícios de Alongamento Muscular/métodos , Respiração , Músculos Respiratórios , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/complicações , Idoso , Isquemia Encefálica/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Músculos Respiratórios/fisiopatologia , Acidente Vascular Cerebral/terapia , Sobreviventes
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