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Aging is a natural phenomenon that is irrevocable. The older adult population is increasing rapidly in India, projected to increase from 6% to nearly 20% in 2050. Clinical conditions found among the elderly that do not fit into discrete disease categories and result from accumulated impairments in multiple systems are called geriatric syndromes. The authors have done a literature search of research papers from indexed and nonindexed journals e databases, Google Scholar, PubMed, and Scopus, Science Direct, Research Gate, and Cochrane. The search terms included were geriatric population, geriatric syndrome, geriatric care, elderly health problem, and comprehensive approach. The management of geriatric syndromes is a challenge to modern geriatric clinical practice. The comprehensive assessment of older adults using standardized tools must be carried out in any healthcare facility to ensure that their needs are met through care and treatment. Evidence-based standards of practice need to be implemented to provide nursing care for dealing with the therapeutic challenges of various geriatric syndromes.
ABSTRACT
Background: Passive case finding leaves a number of tuberculosis (TB) cases unidentified which leads to increased transmission, morbidity, and mortality. Different approaches for case detection are needed to meet the End TB Strategy targets. Materials and methods: Between August 2014 and March 2016, a non-governmental organization (NGO) screened the population in two high burden areas of Mumbai through door-to-door survey, involving private practitioners, engaging community and contact surveys to identify cases early and initiate treatment for TB through a comprehensive approach to active case finding (ACF) in a community. A retrospective analysis of the data collected from this intervention was done. Results: Of 6230 symptomatic (3% of population), 3836 (61.5%) undertook tests, 652 (17%) were diagnosed with TB, and 591 (90.6%) were started on treatment. Through door-to-door survey, private practitioners, contact examination, and community engagement, 59%, 26%, 6.4%, and 8.6% cases were identified. Of these, 64% were females and 29% were of extra-pulmonary TB. Of 581 cases, 444 (76.4%) were successfully treated; 14 (2.4%) died; 7 (1.2%) failed treatment; 46 (7.9%) were drug-resistant TB; 33 (5.6%) lost to follow-up; and 37 (6.1%) were transferred out. Numbers needed to screen are 365, 11, and 20 of community, symptomatic, and household contacts, respectively. Conclusion: A comprehensive approach to active case finding identifies cases early, is feasible, and could be an effective complementary TB case detection strategy.
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Introducción: las Unidades de Mastología son organizaciones que tienen por objetivo abordar la patología mamaria de manera multidisciplinaria e integral. A nivel mundial se han implementado programas para evaluar la calidad de atención a través del cumplimiento de indicadores propuestos por Sociedades Científicas u organismos gubernamentales. Algunos de estos han sido propuestos y revisados por la Sociedad Europea de Mastología (EUSOMA). Objetivo: evaluar la calidad de atención de la Unidad de Mastología del Hospital Juan A. Fernández a través del análisis de una serie de indicadores propuestos por EUSOMA como estándares de calidad de atención en centros de patología mamaria. Material y método: estudio descriptivo retrospectivo analizando la base de datos de las pacientes con cáncer de mama estadios 0 a III operadas entre 2015 y 2019. Se analizaron 25 indicadores de procesos propuestos por EUSOMA en 2017. Se registraron las características de la población, y el porcentaje de pacientes en las cuales se cumple la condición de cada uno de los indicadores. Se registró si el indicador alcanza o supera el mínimo estándar, o si alcanza o supera el valor ideal. Resultados: se evaluaron 284 pacientes. Se observó el cumplimiento de la mayoría de los estándares propuestos (18 de 25), alcanzando o superando en el 25% de los indicadores evaluados el valor ideal. Se lograron alcanzar los estándares de calidad de atención relacionados con el diagnóstico clínico y preoperatorio, caracterización anatomopatológica completa en carcinoma invasor, evaluación multidisciplinaria, tratamiento quirúrgico primario en carcinoma invasor e in situ. Se alcanzaron los objetivos tendientes a evitar el sobretratamiento quirúrgico en carcinoma invasor y en cirugía conservadora en carcinoma in situ. En relación a los tratamientos adyuvantes, se alcanzaron los estándares relacionados con radioterapia post cirugía conservadora y post mastectomía, así como también el tratamiento con hormonoterapia y quimioterapia. El seguimiento de los pacientes se realizó en tiempo en tiempo y forma de acuerdo al indicador establecido. Existen 3 indicadores de calidad obligatorios en los que no se alcanzó el estándar mínimo: se observó la necesidad de mejorar la accesibilidad a los tratamientos antiHer2neu en neoadyuvancia, y de reducir los tiempos de espera al inicio del tratamiento. Conclusiones: se observó el cumplimiento de la mayoría de los estándares propuestos. Dado que existen indicadores obligatorios en los que no se alcanzó el estándar mínimo, los esfuerzos primarios deberán centrarse prioritaria e inicialmente en diseñar una planificación que permita alcanzar estos objetivos, así como también mantener en el tiempo los valores positivos ya alcanzados. Se pone de manifiesto la necesidad de implementar políticas a nivel sanitario nacional que permitan mejorar la accesibilidad a medicación oncológica. A su vez, destacamos la importancia de definir indicadores propios con valores ajustados a las características de nuestro país y mantener una evaluación periódica de la calidad de atención a través de los mismos.
Introduction: Breast Units are organizations that manage Breast Cancer in a comprehensive and multidisciplinary approach. Worlwide, programs have been developed in order to evaluate quality of care through the achievement of certain standards of care that have been proposed by scientific organizations, medical associations or government health departments. Some of these indicators have beeb proposed by the European Society of Breast Cancer Specialist (EUSOMA). Objective: to evaluate quality of care in the Breast Unit at Hospital Juan A Fernández (Buenos Aires, Argentina) through the analysis of a series of indicators described by EUSOMA as standard of care in breast centers. Material and method: we performed a descriptive, retrospective analysis of our database including patients with breast cancer stage 0 to III that wer treated between 2015 and 2019. We studied 25 quality of care process indicators proposed by EUSOMA in 2017. We registered population characteristics and the percentage of patients in which each indicator mínimum requirements were achieved. We also studied whether our results achieved or were beyond the ideal targets for each indicator. Results: a total of 284 patients were evaluated. The mínimum standard of care was achieved in most of the evaluated indicators (18 of 25) and in 25% of these, our results achieved or exce3ded the ideal requirements. The indicators in which the mínimum or ideal standard of care was accomplished were regarding clinical and preoperative diagnosis anatomopathological characterisation in invasive breast cancer, multidisciplinary approach, primary surgical management in invasive and in situ breast cancer, avoidanc of overtreatement in invasive breast cancer and breast conserving therapy in carcinoma in situ. Regarding adjuvant treatment, the standard of care was achieved in radiotherapy after breast conserving surgery and after mastectomy, endocrine therapy and chemotherapy. The follow up timing was according to the indicator. There were 3 mandatory indicators in which the mínimum standards were not achieved and were regarding accesibility to anti Her2neu agents in neoadjuvant setting, and timing form diagnosis to firts treatment. Conclusions: we observed that out Breast Unit achieved most of the quality of care indicators described by EUSOMA. However, there 3 mandatory indicators where the results were below the mínimum. This is why future efforts should be focused on designing and planning new measures that will allow these objectives to be accomplished, as well as maintaining what has already been achived. Our results also show the imperious need to implement national public health pólices that would grant a better accesiblility to oncologic medications. We also analysed the importance of defining our own local quality of care indicators in relation to our health policies and current situation, as well as the importance of a continuous evaluation of quality of care through these indicators.
Subject(s)
Female , Breast Neoplasms , Quality of Health Care , Quality Indicators, Health Care , Medical AuditABSTRACT
La atención médica de las víctimas de delitos sexuales constituye un desafío para el personal de salud. Supone el abordaje integral del paciente, buscando no sólo el resguardo de su salud física y mental, sino también la adecuada ejecución de una valoración pericial de las posibles lesiones y la correcta obtención de evidencia y material biológico. Todas las personas que intervengan en este proceso deben saber reconocer cuál es su función, cuál es el momento ideal para realizar la valoración, el espacio más adecuado, así como qué debe incluir, de modo que la información recabada sirva de herramienta en la resolución del proceso judicial posterior.
The medical care of victims of sexual assault is a challenge for healthcare professionals. It entails a comprehensive approach, looking not only to safeguard the patient's physical and mental health, but also to properly carry out an expert assessment of all possible injuries and obtain evidence and biological material. Every individual involved in this process needs to recognize what their role is, what is the ideal time to perform the assessment, the most suitable space and what they should include in the evaluation, so that the information collected will serve as a tool in resolving the subsequent prosecution.
Subject(s)
Humans , Health Personnel , Medical CareABSTRACT
Exposing sound structure of a subgingivally fractured tooth using orthodontic extrusion is considered to be a conservative way to re-establish biologic width without sacrificing esthetics or jeopardizing periodontal support of neighboring teeth. When a misaligned tooth is traumatically involved, a more comprehensive approach combining tooth extrusion and re-alignment may be necessary for a successful restorative outcome. This case report describes a successful esthetic management of a patient with complicated crown-root fracture on the maxillary right central incisor and pre-existing malocclusion in the maxillary anterior region. Forced eruption along with re-alignment of teeth by orthodontic movement seems to allow re-positioning of the fracture line to a favorable position and correction of crowding, providing a better esthetic result.
Subject(s)
Humans , Crowding , Esthetics , Incisor , Malocclusion , Orthodontic Extrusion , ToothABSTRACT
Type 2 diabetes has become epidemic in the past several decades owing to advancing age, a substantially increased prevalence of obesity and decreased physical activities etc. Achieving & maintaning glycemic level as close to the nondiabetic range as possible through intensive diabetes therapy has been demonstrated to have a powerful beneficial effect on diabetesspecific microvascular complications in type 1 & type 2 diabetes. However, diabetes is associated with a reduced lifespan, largely as a consequence of cardiovascular disease. Unlike type 1 diabetes, current studies have failed to demonstrate a beneficial effect of intensive diabetes therapy on cardiovascular disease in type 2 diabetes. Accordingly, special consideration may now need to be given to high-risk patients with multiple risk factors & heart disease. Therefore, comprehensive approach to the treatment of type 2 diabetes that include the treatment of all of the coexisting risk factors for cardiovascular disease has to be implemented and achieved