Registro de datos sobre riesgo quirúrgico en historias clínicas de Estomatología General Integral / Recording surgical risk data in comprehensive dental care medical records

Introducción: La atención estomatológica integral al paciente de riesgo quirúrgico resulta un reto en la actualidad. El profesional de la estomatología necesita herramientas que permita profundizar en los riesgos quirúrgicos, entre esas herramientas puede contarse la correcta confección de historia clínica. Objetivo: Describir el comportamiento de la confección de historia clínica en los pacientes de riesgo quirúrgico en la Clínica Estomatológica "Salvador Allende". Métodos: Se revisaron 108 historias clínicas de todos los pacientes de riesgo quirúrgico ingresados en la consulta de estomatología general integral en el archivo de la Clínica "Salvador Allende" del municipio Cerro, La Habana, correspondientes a un periodo de tres meses. Resultados: Un 41,6 por ciento de pacientes presentó hipertensión arterial, seguidos de pacientes con dos o más enfermedades (37,0 por ciento). El 56,4 por ciento de las historias clínicas abordó sobre el uso de medicamentos para la enfermedad de base, los restantes acápites tuvieron bajos porcentajes en relación con el completamiento de la información. El 79,6 por ciento de los pacientes de riesgo recibieron tratamiento quirúrgico. Conclusiones: La enfermedad de riesgo más frecuente es la hipertensión arterial seguida por los pacientes con dos o más enfermedades. No se recogen los datos necesarios en la atención del paciente de riesgo quirúrgico y las propuestas plasmadas permitirán realizar cualquier ejercicio de la profesión de manera más eficaz y con menor riesgo(AU)

Introduction: Comprehensive dental care of surgical risk patients is a current challenge. Dental care professionals should have access to tools allowing them to expand their knowledge about possible surgical risks. Appropriately developed medical records are an example of such tools. Objective: To describe the process of development of medical records of surgical risk patients at Salvador Allende dental clinic. Methods: A total 108 medical records were reviewed, corresponding to all the surgical risk patients admitted to the general comprehensive dental care service of Salvador Allende dental clinic in the municipality of Cerro, Havana, in a three months' period. Results: Of the patients studied, 41.6 percent had arterial hypertension, followed by patients with two or more conditions (37.0 percent). It was found that 56.4 percent of the medical records contained information about the use of drugs for the underlying condition. The remaining items exhibited low percentages of data completion. 79.6 percent of the risk patients received surgical treatment. Conclusions: The most common risk condition is arterial hypertension, followed by patients with two or more diseases. The data required for the care of surgical risk patients are not recorded. The proposals put forth will make it possible to perform any professional practice in a more effective manner and with a lower level of risk(AU)

El paciente de riesgo quirúrgico en la carrera de Estomatología / The surgical-risk patient in the Dental Medicine Major

Introducción: La atención estomatológica integral se realiza a través de grupos priorizados. Entre estos se encuentran los pacientes con enfermedades crónicas, que constituyen un riesgo durante los tratamientos estomatológicos quirúrgicos. Por diversas razones, la atención a estos pacientes se dificulta y muchas deficiencias pueden originarse durante el proceso docente. Objetivo: Evaluar los contenidos relacionados con el paciente de riesgo quirúrgico en el plan de estudios D de la carrera de Estomatología. Métodos: Se realizó un análisis de los programas de las asignaturas del plan de estudios vigente. Se revisaron y analizaron documentos como: perfil profesional, modos de actuación, programa de la disciplina integradora y programas de las asignaturas. Se valoraron los contenidos relacionados con el paciente de riesgo quirúrgico, el semestre en que se imparte la asignatura, los objetivos, los temas, el sistema de conocimientos y de habilidades, la denominación del paciente de riesgo quirúrgico y las horas dedicadas en cada programa a este tópico. Se realizaron entrevistas a los profesores, en las que se consideraron los aspectos anteriores. Resultados: Las asignaturas que incorporaron la atención a los pacientes de riesgo quirúrgico correspondieron a la disciplina integradora: Operatoria Clínica, Atención integral a la familia II y Cirugía bucal. El análisis documental realizado y las entrevistas ejecutadas mostraron la existencia de diversos criterios en relación con el paciente que constituye riesgo quirúrgico en las asignaturas abordadas. Conclusiones: Los programas de las asignaturas relacionadas con riesgo quirúrgico presentaron insuficiencias desde el punto de vista didáctico y en ellas no se estudian todos los pacientes de riesgo quirúrgico(AU)

Introduction: Comprehensive dental care is implemented through prioritized groups. Among these are patients with chronic diseases, which constitute a risk during surgical dental treatments. For various reasons, caring for these patients becomes difficult, while many deficiencies can appear during the teaching process. Objective: To assess the contents related to the surgical-risk patient in the D Plan of Studies of the dental medicine major. Methods: An analysis was carried out of the syllabi of the subjects from the current study plan. Documents such as the professional profile, modes of action, the syllabus of the integrative discipline and the syllabi of the programs were reviewed and analyzed. A group of contents were assessed: those related to the surgical-risk patient, the semester in which the subject is taught, the objectives, the topics, the knowledge and skills systems, the name of the surgical-risk patient and the hours allotted to this topic in each syllabus. Interviews were conducted with the professors, in which the above aspects were considered. Results: The subjects that included care for surgical-risk patients belonged to the integrative discipline: Clinical Surgery, Comprehensive Family Care II and Oral Surgery. The document analysis carried out and the interviews conducted showed the existence of various criteria regarding the patient who is at surgical risk in the subjects addressed. Conclusions: The syllabi of the subjects related to surgical risk presented didactic inadequacies, while their study does not include all surgical-risk patients(AU)

Safety and Usefulness of Percutaneous Transhepatic Cholecystoscopy (PTCCS) in High-Risk Surgical Patients Manifesting Acute Cholecystitis / 대한소화기내시경학회지

BACKGROUND/AIMS: The aim of the present study is to identify the diagnostic and therapeutic usefulness of percutaneous transhepatic cholecystoscopic examination (PTCCS) in high-risk surgical patients manifesting acute cholecystitis. METHODS: Between January 1992 and June 1998, 33 consecutive patients who underwent percutaneous transhepatic cholecystostomy (PC) and subsequent PTCCS for the management of acute cholecystitis were included. RESULTS: PC and subsequent PTCCS were successfully accomplished in all of 33 patients. During PTCCS, minor complication (2 of minor bleeding during electrohydraulic lithotripsy, 2 of tube dislodgement and 1 of bile leakage to peritoneum) occurred in five patients. PTCCS revealed 26 cases of gallstones, 3 cases of sludge ball, 3 cases of gallbladder carcinoma and 1 case of clonorchiasis related with acute cholecystitis. Three cases of the gallbladder cancers which were not predicted radiologically were incidentally found during PTCCS. For 26 patients with gallstones, PTCCS and concomitant stone removal were successfully carried out in one to four consecutive sessions (mean 2.2 sessions). Gallstones recurred in three (3/22, 14%) patients during the mean follow-up period of 27 months. All of them remain asymptomatic. CONCLUSIONS: PTCCS may be justified in the management of acute cholecystitis in selected patients with high surgical risk.