ABSTRACT
Objective To investigate the nursing aides' working experience of private pension institutions,and provide advances of decision-making on targeted pension institution development strategy.Methods 12 nursing aides for the aged were surveyed by using deep half-structural interviews and were recorded,noted during the whole interviews.Data were analyzed by coding step by step.Results The primary feelings of the participants including vocational responsibility was gradually enhanced in the interaction with the elderly,multiple service consciousness was built up during the process of meeting diverse demands of the elderly,standardized training demands formed from servicing in pension institutions.Conclusion Understanding and care are the key factors for the pension caregivers whose multiple service ability should be ascended,and their training should be further standardized.
ABSTRACT
Prevenir el prolapso de la cúpula vaginal, empleando una técnica peroperatoria que consiste en fijar la cúpula vaginal a los ligamentos redondos, en el momento de realizar la intervención. Realizada la histerectomía, se procedió al cierre de la cúpula vaginal con puntos separados en número de 6 a 8 con material no absorbible, dependiendo de la amplitud de la vagina. Los cabos distales son utilizados para anudar horizontalmente los ligamentos redondos. La fijación de las dos paredes del extremo superior de la vagina, garantiza mayor estabilidad de la vagina y menor posibilidad de producir el prolapso de la cúpula y/o de las paredes anterior y posterior de la vagina. Servicio de Ginecología, Hospital Universitario de Caracas. Las 124 pacientes histerectomizadas y controladas anualmente en un lapso entre 2 y 27 años, con un promedio de 7 años, ninguna de ellas presentó prolapso de cúpula vaginal. Las histerectomías se realizaron en el ejercicio privado. En centros asistenciales públicos, es muy difícil hacer seguimiento y evaluar las pacientes, por razones múltiples. La histerectomía ocupa el primer lugar de las intervenciones ginecológicas, esto obliga a realizar la suspensión y fijación de la cúpula vaginal y simultáneamente corregir la patología asociada del aparato genital. El procedimiento que hemos empleado tuvo resultados muy favorables. La calidad de vida de las mujeres intervenidas quirúrgicamente no se desmejoró, como suele suceder cuando se produce el prolapso de la cúpula vaginal
To prevent vaginal vault prolapse, using a preoperative technique to fix the vaginal vault to the round ligaments in total abdominal hysterectomy, and identify associated pathology in the genital area. After hysterectomy, we proceed to the closure of the vaginal vault with interrupted sutures with non-absorbable material, in number of 6-8, depending of the amplitude of the vagina, the distal ends are used to tie horizontally bilateral round ligaments. The setting of the two upper walls of the vagina, ensures greater stability of the vagina and lower possibility of occurrence of prolapse of the dome and/or the anterior and posterior vaginal walls. Servicio de Ginecologia, Hospital Universitario de Caracas The 124 patients undergoing hysterectomy, checked annually over a period of time between 2 and 27 years, with an average of 7 years, neither had vaginal prolapse. Histerectomy is the firstone gynecological operation. It requires making the suspension and fixation of the vaginal vault and simultaneously correct the genital tract associated pathology. The procedure we used had very favorable results. We can not compare our results with other techniques, do to scarse national an international references. The quality of life of women surgically intervened did not deteriorated, as usually happens when there is prolapse of the vaginal vault
Subject(s)
Female , Hysterectomy, Vaginal/methods , Ligaments/transplantation , Gynecologic Surgical Procedures/methods , Uterine Prolapse/surgery , Uterine Prolapse/prevention & controlABSTRACT
PURPOSE: A specialized breast surgeon is important to give comprehensive treatments to breast cancer patients. The purpose of this study was to evaluate the characteristics and treatment results of breast cancer patients in my breast clinic, and to share the experience of clinical management and data base recording and its clinical use. MATERIALS AND METHODS: I had performed 1,018 breast cancer surgeries from Mar. 1992 to Mar. 1998 at the Breast Clinic in Asan Medical Center. RESULTS: The results were as follows; 1,008 cases were female (99.0%), and 10 cases were male (1.0%). The peak incidence was in 40~49 years of age (36.5%), followed by 30~39 years (24.0%) and 50~59 years (23.3%). 647 cases (63.6%) were under the age of 50. The most common operative method was a modified radical mastectomy in 747 cases (73.4%), and breast conserving surgery was performed in 173 cases (17.0%). Immediate breast reconstruction was performed in 63 cases (tissue expander with implant in 50 cases, direct implant in 4 cases, TRAM flap in 8 cases, and LD flap in one case), and SSM (skin-sparing mastectomy) through circumareolar incision was done in 9 cases. According to TNM classificasion, the most common was stage II in 49.2% (501 cases), and the proportion of early-breast cancer (stage 0 and I) was 33.7%. The axillary lymph node metastasis was present in 43.5%. The 5-year overall survival and disease free survival rate was 81.4% and 70.7%. There was no local recurrence in breast conserving surgery by median follow-up of 32 months. CONCLUSION: As a breast surgeon, I have tried to apply the appropriate operation methods according to the patients condition. The survival data was fairly good, and there was no local recurrence after breast conserving surgery yet. Data computerization was very useful for evaluating the characteristics of the patients.