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1.
Rev. bras. ortop ; 57(1): 96-102, Jan.-Feb. 2022. tab, graf
Article in English | LILACS | ID: biblio-1365751

ABSTRACT

Abstract Objective The primary aim of the present study was to evaluate the long-term outcomes including survivorship of computer navigated distal femoral lateral opening wedge osteotomy (DFLOWO). The secondary aim was to identify the potential factors that may influence its survivorship. Methods A retrospective analysis of prospectively collected data for patients with lateral compartment arthritis who underwent navigated DFLOWO from December 2006 to November 2012 was performed. The International Knee Documentation Committee (IKDC) and Knee Injury and Osteoarthritis Outcome Score (KOOS) scores were analyzed for outcome measures. Conversion to arthroplasty during the follow-up was the end point. Results A total of 19 DFLOWOs were performed in 17 patients with a mean age of 46.6 ± 6.5 years formed the study cohort. The coronal alignment was corrected from a mean of 7.1° (2-11°) valgus to a mean of 2.1° (0.5°-3°) varus. The IKDC scores improved from mean of 39 preoperatively to 53 at the mean long-term follow-up of 9.1 years. The mean KOOS scores at the long-term follow-up were pain 71, symptoms 56, activities of daily living 82, sports and recreation 59, quality of life 43. Survivorship of the DFLOWO was 78.9% at a follow-up of 9.1 years. Presence of ≥ grade 2 according to the International Cartilage Repair Society (ICRS) cartilage degeneration in the medial compartment of the knee and >7° preoperative valgus deformity were strongly correlated with conversion to total knee arthroplasty (TKA) at the long-term follow-up (r= 0.66). ConclusionsComputer navigated DFLOWO has satisfactory clinical outcomes and 79% survivorship in long-term follow-up. Presence of more than ICRS ≥ grade 2 degenerative changes in the medial compartment of knee with > 7° preoperative valgus deformity negatively affects the survivorship of DFLOWO in the long-term follow-up.


Resumo Objetivo O objetivo principal do presente estudo foi avaliar os resultados a longo prazo, incluindo a sobrevivência em Osteotomia Varizante Femoral Distal com Cunha de Abertura Lateral (OVFD-CAL) utilizando navegação computadorizada. O objetivo principal do presente estudo foi avaliar os resultados a longo prazo, incluindo a sobrevivência. Métodos Foi realizada uma análise retrospectiva dos dados coletados prospectivamente de pacientes com artrite do compartimento lateral submetidos a OVFD-CAL por navegação de dezembro de 2006 a novembro de 2012. As pontuações International Knee Documentation Committee (IKDC, na sigla em inglês) e Knee Injury and Osteoarthritis Outcome Score (KOOS, na sigla em inglês) foram analisadas para medição de resultados. Conversão para artroplastia durante o acompanhamento foi o ponto final. Resultados Um total de 19 OVFD-CAL foram realizados em 17 pacientes com média de idade de 46,6 ± 6,5 anos formaram a coorte do estudo. O alinhamento coronal foi corrigido a partir de uma média de 7,1° (2-11°) de valgo para uma média de 2,1° (0,5°-3°) de varo. As pontuações do IKDC melhoraram de uma média pré-operatória de 39 para 53 no acompanhamento de médio de longo prazo de 9,1 anos. Os escores do KOOS no acompanhamento a longo prazo foram: dor 71, sintomas 56, atividades da vida diária 82, esportes e recreação 59, qualidade de vida 43. A sobrevivência do OVFD-CAL foi de 78,9% em um acompanhamento de 9,1 anos. Presença de degeneração da cartilagem segundo a Sociedade Internacional de Reparação de Cartilagem (International Cartilage Repair Society [ICRS, na sigla em inglês])≥ grau 2 no compartimento medial do joelho e deformidade pré-operatória em valgo > 7° fortemente correlacionado com a conversão para artroplastia total do joelho (ATJ) no acompanhamento a longo prazo (r - 0,66). ConclusõesA OVFD-CAL por navegação computadorizada apresentou resultados clínicos satisfatórios e sobrevida de 79% no acompanhamento a longo prazo. Presença de alterações degenerativas ICRS ≥ grau 2 no compartimento medial do joelho com > 7° de deformidade pré-operatória em valgo afeta negativamente a sobrevivência da OVFD-CAL no acompanhamento de longo prazo.


Subject(s)
Humans , Male , Female , Osteoarthritis , Osteotomy , Outcome Assessment, Health Care , Arthroplasty, Replacement, Knee , Surgery, Computer-Assisted , Knee Injuries
2.
Rev. cuba. ortop. traumatol ; 35(2): e258, 2021. ilus
Article in Spanish | LILACS, CUMED | ID: biblio-1357331

ABSTRACT

Introducción: Existe una gran controversia con respecto a la existencia de un abordaje quirúrgico óptimo para artroplastia de cadera. El énfasis actual en la investigación ha sido examinar las posibles diferencias en los resultados funcionales entre el abordaje anterior y el abordaje posterior. Objetivo: Comparar las medidas de resultado informadas por los pacientes sometidos a artroplastia total de cadera, mediante abordajes anterior y posterior. Métodos: Se realiza una búsqueda sobre el tema en la base de datos PubMed entre los años 2010-2020 en inglés con los términos: comparación entre abordaje anterior y abordaje posterior de la cadera, abordaje anterior directo de la cadera, abordaje posterior de la cadera, y resultados de artroplastia de la cadera mediante abordajes anterior y posterior. Análisis y síntesis de la información: El abordaje anterior muestra una mayor mejora en la velocidad de la marcha, la longitud del paso y la simetría de la marcha, en comparación con el abordaje posterior para artroplastia de cadera al mes después de la operación. A los cuatro meses estas características de la marcha no fueron diferentes, pero los resultados de algunas pruebas funcionales fueron superiores en los pacientes intervenidos por abordaje anterior. Conclusiones: La elección del abordaje quirúrgico para artroplastia de cadera debe basarse en los factores del paciente, la preferencia del cirujano y su experiencia(AU)


Introduction: There is great controversy regarding the existence of an optimal surgical approach for hip arthroplasty. The current research emphasis has been to examine the possible differences in functional outcomes between anterior and posterior approaches. Objective: To compare the outcome measures reported by patients undergoing total hip arthroplasty, using anterior and posterior approaches. Methods: A search is carried out on the subject in the PubMed database during the years 2010-2020, in English, with the terms comparison between anterior approach and posterior approach to the hip, direct anterior approach to the hip, posterior approach to the hip, and results of hip arthroplasty using anterior and posterior approaches. Analysis and synthesis of the information: The anterior approach showed greater improvement in gait speed, stride length and gait symmetry, compared to the posterior approach for hip arthroplasty one month after the operation. At four months, these gait characteristics were not different, but the results of some functional tests were superior in patients operated on by anterior approach. Conclusions: The choice of the surgical approach for hip arthroplasty should be based on the patient´s factors, preference of the surgeons and their experience(AU)


Subject(s)
Humans , Outcome Assessment, Health Care , Arthroplasty, Replacement, Hip/methods , Surgical Procedures, Operative/methods , Choice Behavior
3.
Rev. colomb. anestesiol ; 49(4): e300, Oct.-Dec. 2021. tab, graf
Article in English | LILACS, COLNAL | ID: biblio-1341239

ABSTRACT

Abstract Introduction A broad range of practices aimed at improving the effectives and safety of this process have been documented over the past few years. Objective To establish the effectiveness, safety and results of the implementation of these strategies in adult patients in university hospitals. Methodology A review of systematic reviews was conducted, in addition to a database search in the Cochrane Library of Systematic Reviews, Embase, Epistemonikos, LILACS and gray literature. Any strategy aimed at reducing prescription-associated risks was included as intervention. This review followed the protocol registered in the International Prospective Registry of Systematic Reviews (PROSPERO): CRD42020165143. Results 7,637 studies were identified, upon deleting duplicate references. After excluding records based on titles and abstracts, 111 full texts were assessed for eligibility. Fifteen studies were included in the review. Several interventions grouped into 5 strategies addressed to the prescription process were identified; the use of computerized medical order entry systems (CPOE), whether integrated or not with computerized decision support systems (CDSS), was the most effective approach. Conclusions The beneficial effects of the interventions intended to the prescription process in terms of efficacy were identified; however, safety and implementation results were not thoroughly assessed. The heterogeneity of the studies and the low quality of the reviews, preclude a meta-analysis.


Resumen Introducción En los últimos años se han documentado gran variedad de prácticas dirigidas a mejorar la efectividad y la seguridad de este proceso. Objetivo Establecer la efectividad, seguridad y resultados de implementación de estas estrategias en pacientes adultos en hospitales universitarios. Metodología Se realizó una revisión de revisiones sistemáticas. Igualmente, la búsqueda en las bases de datos de la Biblioteca Cochrane de Revisiones Sistemáticas, Medline, Embase, Epistemonikos, LILACS y literatura gris. Se incluyó como intervención cualquier estrategia dirigida a reducir el riesgo asociado a un error de prescripción. Esta revisión siguió el protocolo registrado en el Registro Prospectivo Internacional de Revisiones Sistemáticas (PROSPERO): CRD42020165143. Resultados Se identificaron 7.637 estudios después de eliminar las referencias duplicadas. Después de la exclusión de registros basados en títulos y resúmenes, se evaluaron 111 textos completos para elegibilidad. Se incluyeron quince estudios en la revisión. Se identificaron varias intervenciones agrupadas en 5 estrategias dirigidas al proceso de prescripción, de las cuales el uso de sistemas computarizados de entrada de órdenes médicas (CPOE) integrados o no a sistemas de soporte de decisión computarizados (CDSS) la estrategia más eficaz. Conclusiones Se identificaron efectos benéficos de las intervenciones dirigidas al proceso de prescripción en términos de eficacia; sin embargo, la seguridad y los resultados de implementación no fueron ampliamente evaluados. La heterogeneidad de los estudios y la baja calidad de las revisiones impiden la realización de un metaanálisis.


Subject(s)
Humans , Adult , Middle Aged , Aged , Drug Prescriptions , Preventive Health Services , Hospitals, University , Medication Errors , Outcome Assessment, Health Care , Medical Errors , Electronic Prescribing , Inappropriate Prescribing
4.
Rev. bras. ortop ; 56(6): 796-803, Nov.-Dec. 2021. tab, graf
Article in English | LILACS | ID: biblio-1357140

ABSTRACT

Abstract Objective To evaluate the role of serum alkaline phosphatase (ALP) and ultrasonography (USG) in monitoring the progress of treatment in diaphyseal non-unions. Methods This prospective observational cohort study included adult patients with diaphyseal fractures of major long bones previously treated with internal fixation and eventually resulting in non-union. Following the definitive treatment for non-union, the patients were followed-up periodically for six months, and serial monitoring of the levels of ALP and USG were performed along with radiographs (X-rays) to ascertain the status of the union. Results After an initial rise at seven weeks, ALP levels declined to normal values in fractures which united, whereas they remained high in cases of persistent non-union. Similarly, after an elevation of the vascular resistive index (RI) at around 12 weeks in all the patients, it decreased in cases progressing to union, while it remained persistently high even at 24 weeks in fractures failing to unite. Cases of persistent non-union continued to show hypoechogenic callus at 24 weeks instead of converting into hyperechogenic callus, as observed in cases which progressed to union. Conclusion Significant changes suggestive of union appeared simultaneously on the X-rays, USG and ALP levels during the follow-up. However, a serial examination of the ALP levels and USG during the follow-up gave a hint of the direction of progress in the healing process of fracture non-union. Their role in monitoring the outcome of nonunion is more complimentary than supplementary to the X-rays.


Resumo Objetivo Avaliar o papel da concentração sérica de fosfatase alcalina (FA) e da ultrassonografia no monitoramento do progresso do tratamento da ausência de consolidação em fraturas diafisárias. Métodos Este estudo de coorte observacional prospectivo incluiu pacientes adultos com fraturas diafisárias dos principais ossos longos previamente submetidas a fixação interna sem consolidação. Após o tratamento definitivo, os pacientes foram avaliados periodicamente por seis meses, com realização seriada de ultrassonografia, determinação da concentração de FA e radiografias para verificar a presença de consolidação. Resultados Após um aumento inicial em sete semanas, os níveis de FA voltaram ao valor normal em pacientes com fraturas consolidadas, mas continuaram elevados nos casos de ausência de consolidação. Da mesma forma, após uma elevação do índice de resistência (IR) vascular em cerca de 12 semanas em todos os pacientes, o IR diminuiu nos casos que progrediram para consolidação, mas continuou alto até as 24 semanas em fraturas não consolidadas. Os casos com ausência de consolidação ainda apresentavam calo hipoecogênico às 24 semanas, que não se converteu no calo hiperecogênico observado nos casos que progrediram para consolidação. Conclusão Alterações significativas sugestivas de consolidação foram simultaneamente observadas nas radiografias, na ultrassonografia e na concentração de FA durante o período de acompanhamento. No entanto, a realização seriada de exames da concentração de FA e de ultrassonografia durante o acompanhamento indicou o progresso da consolidação da fratura. Seu papel no monitoramento da ausência de consolidação é mais complementar do que suplementar à radiografia.


Subject(s)
Humans , Male , Female , Bony Callus , Ultrasonography , Outcome Assessment, Health Care , Alkaline Phosphatase , Fractures, Bone/therapy , Fractures, Ununited
5.
Educ. med. super ; 35(2): e2212, 2021. graf
Article in Spanish | LILACS, CUMED | ID: biblio-1286232

ABSTRACT

Introducción: El reciente perfeccionamiento curricular de la carrera de Medicina en la educación superior cubana suscita la búsqueda de alternativas científicas que contribuyan a la sistematización del proceso formativo de la atención médica integral en los servicios de la asistencia sanitaria esencial. Objetivo: Exponer una concepción teórico-metodológica para la formación del modo de actuación atención médica integral desde la disciplina Psicología. Métodos: El proceso investigativo asumió un enfoque metodológico mixto o multimodal, que siguió un diseño mixto explicativo secuencial, en el que se integraron métodos teóricos, empíricos, así como de análisis de la información y procesamiento de los datos. Este se desarrolló en la carrera de Medicina de la Universidad de Ciencias Médicas de Villa Clara entre septiembre de 2016 y enero de 2019, y abarcó los momentos de la exploración, el diseño y la evaluación del resultado científico propuesto. Resultados: Se pudo definir la connotación científica de la concepción teórico-metodológica propuesta, en respuesta a la estructura formal para la formación del modo de actuación atención médica integral y a la forma lógica de su vinculación con la disciplina Psicología. Conclusiones: Se estableció que una concepción teórico-metodológica para la formación del modo de actuación atención médica integral desde la disciplina Psicología debe integrar en su estructura los fundamentos generales que sustentan la lógica interna de esta, y los componentes teórico-conceptual y metodológico-instrumental que definen su organización e implementación práctica(AU)


Introduction: The recent curricular improvement of the medical major in Cuban higher education brings about the search for scientific alternatives that contribute to systematization of the training process for comprehensive medical care in essential healthcare services. Objective: To present a theoretical-methodological conception for the formation of a mode of action in comprehensive medical care from the psychology discipline. Methods: The research process followed a mixed or multimodal methodological approach, under a mixed sequential explanatory design, in which theoretical and empirical methods were integrated, as well as information analysis and data processing. This was developed, between September 2016 and January 2019, in the medical major of Villa Clara University of Medical Sciences, and covered the moments of exploration, design and assessment of the proposed scientific result. Results: It was possible to define the scientific connotation of the proposed theoretical-methodological conception, in response to the formal structure for the formation of a mode of action in comprehensive medical care and the logical way of its link with the psychology discipline. Conclusions: It was established that a theoretical-methodological conception for the formation of a mode of action in comprehensive medical care from the psychology discipline must integrate, into its structure, the general foundations that support its internal logic, as well as the theoretical-conceptual and methodological-instrumental components that define its organization and practical implementation(AU)


Subject(s)
Humans , Medical Care , Education, Higher , Delivery of Health Care/methods , Outcome Assessment, Health Care
6.
Rev. Hosp. Ital. B. Aires (2004) ; 41(2): 52-60, jun. 2021. graf, tab
Article in Spanish | LILACS | ID: biblio-1254374

ABSTRACT

Introducción: el Índice de Movilidad de De Morton® (en inglés De Morton Mobility Index: DEMMI®) es una escala, válida y fiable para evaluar la movilidad funcional del adulto mayor. Objetivo: validar una versión en español para pacientes hospitalizados en una sala general. Material y métodos: traducción y adaptación transcultural, evaluación de la fiabilidad interobservador y validación de criterio explorando la correlación entre los índices DEMMI y Barthel® al ingreso hospitalario y también entre la percepción subjetiva del cambio en la movilidad por parte del propio paciente y la del puntaje DEMMI, y además evaluando la asociación entre este y el grado de acompañamiento requerido en el egreso hospitalario (n = 87). Su consistencia interna fue evaluada mediante los coeficientes de Kuder y Richardson (KR) y de Cronbach (n = 104). Resultados: la correlación entre los puntajes DEMMI y Barthel fue buena (Spearman's Rho = 0,78: p ≤ 0,0001), mientras que la correlación entre la percepción del paciente respecto del cambio en su movilidad y la variación en el puntaje DEMMI fue moderada (Spearman's Rho = 0,50; p < 0,0001). Quienes fueron dados de alta con alto nivel de acompañamiento habían tenido al ingreso un puntaje DEMMI inferior (28,1; IC 95%, 24,9 a 31,3) al de quienes no lo requirieron (48; 44,4 a 53,0). La consistencia interna fue adecuada (KR = 0,827 y Cronbach = 0,745; Pearson's Rho = 0,7885; p < 0,00001). Conclusión: la consistencia interna y la fiabilidad interobservador de la versión en español del puntaje DEMMI son buenas, mientras que sus cambios tienen buena correlación con los percibidos por los propios pacientes. Consideramos que puede ser usado como un elemento más para estimar al momento del ingreso hospitalario, el grado de acompañamiento que requerirán al ser dados de alta. (AU)


Introduction: the De Morton Mobility Index (DEMMI) is a valid and reliable scale to evaluate the functional mobility of the elderly. Aim: validate a Spanish version for hospitalized patients in a general ward. Material and methods: translation and cross-cultural adaptation, evaluation of inter-observer reliability and criterion validation exploring the correlation between DEMMI and Barthel scores at hospital admission and also between the subjective perception of the change in mobility by the patient himself and that of DEMMI score, and also, evaluating the association between DEMMI and the degree of support required at hospital discharge (n = 87). Its internal consistency was evaluated using Kuder-Richardson (KR) and Cronbach (n = 104) coefficients. Results: correlation between DEMMI and Barthel scores was good (Spearman's Rho = 0.78: p < = 0.0001), while correlation between patient's perception of change in mobility and variation in DEMMI score was moderate (Spearman's Rho = 0.50; p < 0.0001). Those discharged with a high level of support had a lower DEMMI score upon admission (28.1; 95% CI 24.9 to 31.3) than those who didn´t require it (48; 44.4 to 53.0). Internal consistency was adequate (KR = 0.827 and Cronbach = 0.745; Pearson's Rho = 0.7885; p < 0.00001). Conclusion: internal consistency and interobserver reliability of the Spanish version of DEMMI score are good, while its changes correlate well with those perceived by the patients themselves. We consider that it can be used as another element to estimate at hospital admission, the degree of support they will require upon discharge. (AU)


Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Geriatric Assessment/methods , Outcome Assessment, Health Care/methods , Patient Discharge , Translating , Activities of Daily Living , Frail Elderly , Mobility Limitation , Hospitalization
7.
Prensa méd. argent ; 107(1): 33-43, 20210000. fig, ilus, taab
Article in Spanish | LILACS, BINACIS | ID: biblio-1362164

ABSTRACT

Introducción: Los labios representan la unidad anatómica principal del tercio inferior de la cara. Por lo tanto, su reconstrucción quirúrgica representa un desafío para el cirujano, quien busca la excelencia en la restauración de las funciones, la estética y la apariencia facial. Muchas técnicas de reconstrucción han sido descriptas, cada una con sus ventajas y desventajas. Objetivos: evaluar los resultados estéticos y funcionales en todos los pacientes operados por lesiones oncológicas de los labios que requirieron colgajos locales, regionales y libres. Diseño: Observacional retrospectivo Lugar de Aplicación: Hospital público de atención terciaria en tumores. Material y Método: 19 pacientes 11 mujeres y 8 hombres, edad media de 65 años (31-77). Se incluyeron todos los pacientes con patología tumoral de los labios, con defectos mayores a un 1/3 del labio. Fueron 10 carcinomas escamosos, 7 carcinomas basocelulares, 1 hemangioma venoso y 1 queratosis actínica. En la resección un paciente requirió una mandibulectomía marginal y otro una maxilectomía parcial. Se le realizó vaciamiento ganglionar a 2 pacientes. Como reconstrucción se realizaron un colgajo bilobulado, 3 colgajos de avance, 1 comisuroplastia con colgajo romboidal , 2 de Abbe-Esländer, 5 de Karapandzic, 2 de mejilla, 1 Bernard-Burow y otro de Fujimori y 3 libres radiales con palmar largo. Todos los pacientes fueron evaluados en el postoperatorio inmediato, enfatizando la vitalidad de los colgajos y la cicatrización y en el postoperatorio tardío resultados funcionales y estéticos. Resultados: Todos los colgajos sobrevivieron. Sufrieron dehiscencia de la herida quirúrgica 4 pacientes. Con respecto a los resultados funcionales, la continencia oral completa fue obtenida en aquellos defectos , que pudieron reconstruirse con colgajos obtenidos del labio residual. Los defectos mayores reconstruídos con colgajos de mejilla, vecindad o especialmente con colgajo libre radial con tendón del palmar largo, obtuvieron muy buenos resultados. Tres pacientes sufrieron microstomía, La inteligibilidad del habla fue satisfactoria en todos. Los resultados estéticos fueron calificados como excelentes especialmente en los colgajos libres. Conclusión: Se han obtenido resultados satisfactorios, tanto funcionales como estéticos, en las reconstrucciones de grandes defectos de labio, con el colgajo microquirúrgico radial utilizando el tendón de palmar largo como un arnés de tensión logrando continencia oral y suspensión adecuada. La elección de uno u otro colgajo va a depender de cada paciente, edad, factores de riesgo y la elección y experiencia de cada cirujano


Subject(s)
Humans , Adult , Middle Aged , Aged , Surgical Procedures, Operative , Surgical Flaps , Lip Neoplasms/surgery , Retrospective Studies , Outcome Assessment, Health Care , Esthetics , Free Tissue Flaps
8.
Rev. medica electron ; 43(1): 2858-2872, tab
Article in Spanish | LILACS, CUMED | ID: biblio-1156780

ABSTRACT

RESUMEN Introducción: el paciente anciano está expuesto a múltiples problemáticas con el envejecimiento que van a condicionar en gran manera su independencia y que de forma obligatoria hay que conocer y tratar de solucionar. Objetivo: evaluar el resultado del tratamiento aplicado a adultos mayores con entidades del sistema osteomioarticular en sala de rehabilitación integral. Materiales y Métodos: se realizó un estudio observacional, descriptivo, de tipo longitudinal de los todos los pacientes de 60 y más años, que acudieron al Centro de rehabilitación integral, quedando la muestra constituida por 920 pacientes tratados en el período comprendido entre enero y diciembre de 2007 con enfermedades del Soma. Resultados: predominó el sexo femenino (59 %) en el grupo de edades de 60 a 69 años (48%). Las afecciones ortopédicas fueron las más frecuentes con el 64 % y dentro de estas, la periartritis escapulo humeral. La electroterapia fue el tratamiento más utilizado (38,4%) de los casos. Dentro de los síntomas que presentaron estos pacientes el que más frecuente se encontró fue el de alteraciones en las funciones tanto al inicio y como posterior al tratamiento aplicado. El 93% de los pacientes resultaron rehabilitados, siendo el 86 % los evaluados de excelente al final de tratamiento aplicado. Conclusiones: los resultados en la atención al adulto mayor fueron excelentes en la gran mayoría de los casos con la aplicación del tratamiento rehabilitador (AU).


SUMMARY Introduction: the elder patient is exposed to multiple problems with ageing that will greatly condition their independence and that we will necessarily have to know and try to solve, using all the available resources within our reach. Objective: to assess the result of the treatment applied to older adults with entities of the osteomyoarticular system in the comprehensive rehabilitation room. Materials and methods: an observational, descriptive, longitudinal study of all the patients aged 60 years and over who attended the Comprehensive Rehabilitation Center was carried out, intentionally the sample stayed formed by 920 patients treated in the period between January and December 2007 with diseases of the OMAS. Results: female sex predominated (59%) in the age group of 60 to 69 years (48%). Orthopedic conditions were the most frequent with 64% and within these, scapular-humeral periarthritis. Electrotherapy was the most used treatment (38.4% of the cases). Among the symptoms that these patients presented, the most frequently found was alterations in functions both at the beginning and after the treatment applied. 93 % of the patients were rehabilitated, resulting outstanding 86 % of the assessed patients at the end pf the treatment. Conclusions: the results of elder people care was outstanding in most of the cases with the rehabilitative treatment application (AU).


Subject(s)
Humans , Aged , Rehabilitation , Population Dynamics , Outcome Assessment, Health Care , Joint Diseases/rehabilitation , Epidemiology, Descriptive , Longitudinal Studies , Observational Study
9.
Rev. bras. ginecol. obstet ; 43(1): 41-45, Jan. 2021. tab
Article in English | LILACS | ID: biblio-1156074

ABSTRACT

Abstract Objective The aim of the present study was to analyze relapse rates and patterns in patients with endometrial cancer with the aim of evaluating the effectiveness of current follow-up procedures in terms of patient survival, as well as the convenience of modifying the surveillance strategy. Methods Retrospective descriptive study including all patients diagnosed with endometrial cancer relapse at the Department of Gynecology and Obstetrics of the Complejo Hospitalario Insular-Materno Infantil de Canarias, between 2005 and 2014. Results Recurrence was observed in 81 patients (10.04% of the sample); 66.7% of them suffered relapse within 2 years and 80.2% within 3 years after the termination of the primary treatment; 41.9% showed distant metastases while the rest corresponded to local-regional (40.7%) or ganglionar (17.4%) relapse; 42% of these were symptomatic; 14 patients showed more than 1 site of relapse. Relapse was detected mainly through symptoms and physical examination findings (54.3%), followed by elevated serummarker levels (29.6%), computed tomography (CT) images (9.9%) and abnormal vaginal cytology findings (6.2%). No differences in global survival were found between patients with symptomatic or asymptomatic relapse. Conclusion Taking into account that the recurrence rate of endometrial cancer is low, that relapse occurs mainly within the first 3 years post-treatment and that symptom evaluation and physical examination are the most effective follow-up methods, we postulate that a modification of the current model of hospital follow-up should be considered.


Subject(s)
Humans , Female , Clinical Protocols/standards , Endometrial Neoplasms/mortality , Carcinoma, Endometrioid/mortality , Neoplasm Recurrence, Local/mortality , Spain , Women's Health Services , Tomography, X-Ray Computed , Retrospective Studies , Outcome Assessment, Health Care , Endometrial Neoplasms/surgery , Endometrial Neoplasms/pathology , Endometrial Neoplasms/diagnostic imaging , Carcinoma, Endometrioid/surgery , Carcinoma, Endometrioid/pathology , Carcinoma, Endometrioid/diagnostic imaging , Disease-Free Survival , Middle Aged , Neoplasm Recurrence, Local/surgery , Neoplasm Recurrence, Local/pathology , Neoplasm Recurrence, Local/diagnostic imaging , Neoplasm Staging
10.
Psicol. soc. (Online) ; 33: e242180, 2021.
Article in Portuguese | LILACS, INDEXPSI | ID: biblio-1356637

ABSTRACT

Resumo Este artigo visa a compreender os projetos de vida formulados por pessoas com experiência de sofrimento psíquico grave e uso abusivo de álcool e outras drogas em processo de desinstitucionalização em saúde mental. Para tal, foi desenvolvido um estudo etnográfico, com finalidade de identificar interações entre operadores de desinstitucionalização, que podem ser entendidos como processos, dinâmicas ou ações que atuam sobre o cotidiano e a inserção social desses sujeitos. Pôde-se verificar que a tessitura desses projetos em direção ao futuro se apresenta como um trabalho de cuidado de si nos termos foucaultianos, em que são manejadas diversas acepções sobre a saúde, tal como concebidas por Fassin (2000).


Resumen El artículo tiene como objetivo comprender los proyectos de vida formulados por personas con experiencia de malestar psicológico severo y abuso de alcohol y otras drogas en el proceso de desinstitucionalización en salud mental. Se desarrolló un estudio etnográfico con el objetivo de identificar interacciones entre operadores de desinstitucionalización, que pueden entenderse como procesos, dinámicas o acciones que actúan sobre la vida cotidiana y la inserción social de estos sujetos. Se pudo comprobar que el tejido de estos proyectos hacia el futuro se presenta como un trabajo de cuidado de sí mismo en los términos foucaultianos, en el que se manejan diferentes significados sobre la salud, tal como lo concibe Fassin (2000).


Abstract This article aims to understand life projects formulated by people with experience of severe psychological distress and abuse of alcohol and other drugs in the process of deinstitutionalization in mental health. To this end, an ethnographic study was developed with the aim of identifying interactions between deinstitutionalization operators, which can be understood as processes, dynamics or actions that act on the daily lives and social insertion of these subjects. We observed that the weaving of these projects towards the future is presented as a work of care of the self in Foucaultian terms, in which different meanings about health are handled, as conceived by Fassin (2000).


Subject(s)
Risk Groups , Mental Health , Deinstitutionalization , Outcome Assessment, Health Care , Projects , Social Stigma
11.
Clin. biomed. res ; 41(1): 84-90, 2021. tab, graf
Article in Portuguese | LILACS | ID: biblio-1255260

ABSTRACT

A bronquiolite é uma infecção viral que pode levar a insuficiência ventilatória, nestes casos a aplicação de ventilação não invasiva é uma opção ao tratamento convencional. O objetivo deste estudo é identificar o desfecho da aplicação de ventilação não invasiva em crianças com bronquiolite. Trata-se de uma revisão da literatura, com busca de artigos nas bases de dados Biblioteca Virtual em Saúde, Cochrane Library, PEDro, Pubmed, Scielo e Science Direct, sem restrição de período, a partir das palavras chave Noninvasive ventilation AND Bronchiolitis. De um total de 1.192 artigos encontrados, 11 foram inclusos no presente estudo, quatro abordaram o desfecho relacionado à aspectos clínicos gerais (aumento no uso de VNI; menor tempo de internação; redução da frequência respiratória e fração inspirada de oxigênio) e sete relataram o índice de sucesso ou falha, e apesar da diferença entre as médias (sucesso 88,5 versus falha 15,1) não houve diferença significativa. Conclui-se que o desfecho de falha tem alta prevalência (11,5%), apesar disso, os estudos encontraram diferentes benefícios advindos do incremento na aplicação de VNI (redução da necessidade de ventilação mecânica invasiva, menor tempo de permanência em UTI, redução da mortalidade, melhora da frequência respiratória e da fração inspirada de oxigênio). (AU)


Bronchiolitis is a viral infection that can lead to ventilatory failure. In such cases, the application of noninvasive ventilation (NIV) is an alternative to conventional treatment. The aim of this study is to identify the outcome of the application of NIV in children with bronchiolitis. This is a literature review whose search for articles included the Virtual Health Library, Cochrane Library, PEDro, PubMed, SciELO, and Science Direct databases, with no date restriction, based on the keywords Noninvasive ventilation AND Bronchiolitis. Of a total of 1192 articles found, 11 were included in the present study. Four addressed the outcome related to general clinical aspects (increased use of NIV, shorter hospital stay, and reduced respiratory rate and inspired oxygen fraction) and seven reported the success or failure rate. Despite the difference between the means (success 88.5 versus failure 15.1) there was no significant difference. In conclusion, the failure outcome has a high prevalence (11.5%); however, studies have found different benefits arising from the increased application of NIV (reduced need for invasive mechanical ventilation, shorter intensive care unit stay, reduced mortality, and improved respiratory rate and inspired oxygen fraction). (AU)


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Bronchiolitis/therapy , Outcome Assessment, Health Care , Noninvasive Ventilation
12.
Texto & contexto enferm ; 30: e20190052, 2021. tab
Article in English | LILACS, BDENF | ID: biblio-1290293

ABSTRACT

ABSTRACT Objective to identify outcome indicators of the multi-professional Diabetes Mellitus care of a reference outpatient service. Method a descriptive study of evaluative nature, according to the health evaluation framework, carried out by documentary analysis of 173 medical charts, from August to October 2018. The variables were analyzed in the Statistical Package for the Social Science (SPSS), version 22.0, by descriptive statistics, as well as the association of variables, with the Chi-square, Mann-Whitney, and Wilcoxon tests being used, considering p-values ≤ 0.05 as statistically significant. Results predominance of older adult women, with a mean diagnosis time of 11.9 years. The tracking of complications due to Diabetes Mellitus occurred in 90.2% of the users, with a prevalence of 68.2%, of which 34.7% were diagnosed in the service. Absenteeism was 21.4%. The systolic and diastolic arterial pressure and total cholesterol parameters were in line with the proposed goals, while glycated hemoglobin (A1c), fasting glycaemia, HDL-c, LDL-c, triglyceride fractions, and BMI did not reach the target range. There was a significant reduction in final A1c, comparing to initial A1c, as well as an increase in the proportions of users who reached the goals in glycemic control. Conclusion a significant improvement in glycemic control, despite the fact that the parameters did not fully meet the goals, ratifying the importance of an effective assistance model for successful care strategies of Diabetes Mellitus.


RESUMEN Objetivo identificar indicadores de resultado de la atención multiprofesional en Diabetes Mellitus en servicio ambulatorio de referencia. Método estudio descriptivo, de carácter evaluativo, según el referencial de evaluación en materia de salud, llevado a cabo mediante análisis documental de 173 fichas, de agosto a octubre de 2018. Las variables fueron analizadas en el Statistical Package for the Social Science (SPSS), versión 22.0, por medio de estadística descriptiva, y de asociación de variables, habiéndose utilizado las pruebas de Chi cuadrado, Mann-Whitney y Wilcoxon, en las cuales se consideró como estadísticamente significativos los valores de p ≤ 0,05. Resultados predominio de mujeres ancianas, con tiempo medio de diagnóstico de 11,9 años. El cribado de complicaciones de la Diabetes Mellitus se produjo en el 90,2% de los usuarios, cuya prevalencia fue del 68,2%, de los cuales el 34,7% fueron diagnosticados en el servicio. El absentismo fue del 21,4%. Los parámetros de presión arterial sistólica y diastólica y colesterol total estuvieron de acuerdo con los objetivos propuestos, mientras que la hemoglobina glucosilada (A1c), glucosa en ayunas, HDL-c, fracciones de LDL-c, triglicéridos e IMC no alcanzaron el rango objetivo. Hubo una reducción significativa en la A1c final, en comparación con la A1c inicial, así como un aumento en la proporción de usuarios que lograron los objetivos de control glucémico. Conclusión mejora significativa del control glicémico, aunque los parámetros no alcancen las metas en su totalidad, hecho que confirma la importancia de contar con un modelo de atención eficaz para garantizar estrategias exitosas en la atención de la Diabetes Mellitus.


RESUMO Objetivo identificar indicadores de resultado da atenção multiprofissional em Diabetes Mellitus de serviço ambulatorial de referência. Método estudo descritivo, de caráter avaliativo, segundo referencial de avaliação em saúde, conduzido pela análise documental de 173 prontuários, de agosto a outubro de 2018. As variáveis foram analisadas no Statistical Package for the Social Science (SPSS), versão 22.0, pela estatística descritiva, bem como associação de variáveis, tendo sido utilizados os testes de qui-quadrado, Mann-Whitney e Wilcoxon, sendo considerados estatisticamente significativos os valores de p ≤ 0,05. Resultados predomínio de mulheres idosas, com tempo médio de diagnóstico de 11,9 anos. O rastreamento de complicações do Diabetes Mellitus ocorreu em 90,2% dos usuários, cuja prevalência foi de 68,2%, das quais 34,7% foram diagnosticadas no serviço. O absenteísmo foi de 21,4%. Os parâmetros de pressão arterial sistólica e diastólica e colesterol total estiveram em conformidade com as metas propostas, ao passo que hemoglobina glicada (A1c), glicemia de jejum, frações HDL-c, LDL-c, triglicerídeos e IMC não atingiram a faixa-alvo. Houve redução significativa da A1c final, em comparação com a A1c inicial, bem como aumento da proporção de usuários que alcançaram as metas de controle glicêmico. Conclusão melhora significativa do controle glicêmico, a despeito de os parâmetros não atingirem as metas em totalidade, ratificando a importância de modelo de assistência efetivo para estratégias exitosas de atenção ao Diabetes Mellitus.


Subject(s)
Humans , Patient Care Team , Health Evaluation , Health Status Indicators , Outcome Assessment, Health Care , Diabetes Mellitus
13.
Esc. Anna Nery Rev. Enferm ; 25(1): e20200155, 2021. tab
Article in Portuguese | LILACS, BDENF | ID: biblio-1133824

ABSTRACT

Resumo Objetivos selecionar os indicadores dos resultados de enfermagem Integridade tissular: pele e mucosas (1101) e Cicatrização de feridas: segunda intenção (1103) da Nursing Outcomes Classification e construir suas definições conceituais e operacionais para a avaliação de pacientes com lesão por pressão. Métodos estudo de consenso de especialistas realizado em hospital universitário em setembro/2018. Participaram no estudo 10 enfermeiros com experiência na utilização da Nursing Outcomes Classification e no cuidado ao paciente com lesão por pressão. A coleta de dados ocorreu por meio de encontro presencial com os especialistas. Resultados Foram selecionados 17 indicadores da Nursing Outcomes Classification para a avaliação do paciente com lesão por pressão, com uma concordância de 100% entre os especialistas. São eles: Branqueamento, Eritema, Sensibilidade, Perfusão tissular, Hidratação/ Descamação, Espessura, Necrose, Odor desagradável na ferida, Pele com bolhas, Pele macerada, Descolamento Sob as bordas da Ferida, Inflamação Da Ferida, Exsudato/Drenagem, Granulação, Tunelamento, Formação de cicatriz e Tamanho da ferida. Conclusão e implicações para a prática os indicadores selecionados permitiram a elaboração de um instrumento que auxiliará na avaliação de pacientes com lesão por pressão de forma acurada. Esse instrumento subsidiará o enfermeiro na tomada de decisão diagnóstica e terapêutica da lesão por pressão.


Resumen Objetivos seleccionar los indicadores de resultados de enfermería Integridad tisular: piel y membranas mucosas (1101) y Cicatrización de heridas: segunda intención (1103) de la Nursing Outcomes Classification, y construir sus definiciones conceptuales y operativas para la evaluación de los pacientes con lesiones por presión. Métodos estudio de consenso de expertos realizado en un hospital universitario en septiembre/2018. Participaron en el estudio diez enfermeras. La recolección de datos se realizó a través de reuniones cara a cara con los especialistas. Resultados Se seleccionaron 17 indicadores de la Nursing Outcomes Classification para la evaluación del paciente con una lesión por presión, con el 100% de acuerdo entre los especialistas. Son ellos: Blanqueamiento, Eritema, Sensibilidad, Perfusión tisular, Hidratación / Descamación, Espesor, Necrosis, Olor desagradable en la herida, Piel con burbujas, Piel macerada, Descamación debajo de los bordes de la herida, Inflamación de la herida, Exudado/Drenaje, Granulación, Túneles, Formación de cicatrices y Tamaño de la herida. Conclusión e implicaciones para la práctica los indicadores seleccionados permitieron la elaboración de un instrumento que ayudará en la evaluación de los pacientes con lesiones por presión. Este instrumento subvencionará a las enfermeras en la toma de decisiones diagnósticas y terapéuticas de la lesión por presión.


Abstract Objectives to select the nursing outcome indicators Tissue integrity: skin and mucous membranes (1101) and Wound healing: second intention (1103) of the Nursing Outcomes Classification, and to construct their conceptual and operational definitions for the evaluation of patients with pressure injuries. Methods expert consensus study conducted at a university hospital in September 2018. Ten nurses with experience in using the Nursing Outcomes Classification and in caring for patients with pressure injuries participated in the study. Data collection took place through face-to-face meetings with the specialists. Results Seventeen indicators from the Nursing Outcomes Classification were selected for the evaluation of patients with pressure injuries, with 100% agreement among the specialists. That's them: Blanching, Erythema, Sensation, Tissue perfusion, Hydration, Thickness, Necrosis, Foul wound odor, Blistered skin, Macerated skin, Undermining, Wound inflammation, Exudate/drainage, Granulation, Tunneling, Scar formation, Decreased wound size. Conclusion and implications for practice the selected indicators allowed the elaboration of an instrument that will assist in the evaluation of patients with pressure injuries in an accurate way. This instrument will assist the nurses in the diagnostic and therapeutic decision making of the pressure injuries.


Subject(s)
Humans , Skin/pathology , Wound Healing , Outcome Assessment, Health Care , Pressure Ulcer/nursing , Standardized Nursing Terminology , Pressure Ulcer/diagnosis , Mucous Membrane/pathology
14.
Arq. odontol ; 57: 46-56, jan.-dez. 2021. ilus, tab
Article in Portuguese | LILACS, BBO | ID: biblio-1223620

ABSTRACT

Objetivo: Avaliar a prevalência de erros radiográficos em radiografias periapicais de uma clínica de Odontopediatria em uma instituição de ensino superior de Teresina-Piauí. Métodos: Tratou-se de estudo transversal retrospectivo. Foram coletados dados sociodemográficos e radiográficos (localização e presença de erros de técnica radiográfica, processamento e armazenamento). As radiografias foram analisadas por um único examinador calibrado (kappa > 0,80). Foi realizada análise descritiva dos dados, teste Qui-Quadrado, razão de prevalência não-ajustadas (RPnãoajust) e intervalos de confiança (IC 95%). Considerou-se significativo valor de p < 0,05. Resultados: Das 208 radiografias analisadas, 187 (89,9%) possuíam algum tipo de erro. O erro mais prevalente foi de técnica radiográfica (n = 115; 55,3%). Entre esses, a radiografia tremida foi o mais frequente (n = 57; 28,4%). O erro de processamento mais frequente foi presença de digitais (n = 37; 17,8%). Todos os erros de armazenamento (n = 89; 100%) estavam relacionados a não identificação do paciente. O erro de técnica esteve associado com os pacientes de idade menor que 5 anos (RPnãoajus = 1,2 IC95% 1,1-1,3) comparando com idade entre 6 e 10 anos. Não houve associação entre tipo de erro radiográfico e a dentição avaliada nas radiografias (p > 0,05). Conclusão: A quantidade de erros detectados neste estudo foi alta e o mais frequente foi quanto à técnica radiográfica mal executada. Todos os erros de armazenamento observados foram devido a não identificação do paciente. Há uma maior frequência de erros de técnica radiográfica em pacientes com menos de 5 anos se comparados aos de 6 a 10 anos.


Aim: To evaluate the prevalence of radiographic errors in periapical radiographs of a pediatric dentistry clinic in a higher education institution in Teresina, Piauí, Brazil. Methods: This work is a retrospective cross-sectional study. Sociodemographic and radiographic data (location and presence of radiographic technique errors, processing, and storage) were collected. The radiographs were analyzed by a single calibrated examiner (kappa > 0.80). Descriptive analysis of the data, chi-square test, unadjusted prevalence ratio (PRnon-adjusted), and confidence intervals (95% CI) were performed. A p-value < 0.05 was considered significant. Results: Of the 208 radiographs analyzed in this study, 187 (89.9%) presented some type of error. The most prevalent error was the radiographic technique (n = 115; 55.3%). Among these, shaky radiography was the most frequent (n = 57; 28.4%). The most frequent processing error was the presence of fingerprints (n = 37; 17.8%). All storage errors (n = 89; 100%) were related to failure to identify the patient. The technical error was associated with patients younger than 5 years of age (PRnon-adjusted = 1.2; 95% CI 1.1-1.3) compared with 6 to 10 years of age. No association was observed between the type of radiographic error and the dentition assessed on the radiographs (p > 0.05). Conclusion: The number of errors detected in this study was high and the most frequent concerned the poorly performed radiographic technique. All storage errors observed in this study were due to the failure to identify the patients. Children under 5 years of age proved to be more prone to technical radiographic errors than those of 6 to 10 years of age.


Subject(s)
Child , Quality Control , X-Rays , Radiography, Dental , Child , Outcome Assessment, Health Care , Pediatric Dentistry , Dental Care for Children , Cross-Sectional Studies
15.
Acta Paul. Enferm. (Online) ; 34: eAPE00753, 2021. graf
Article in Portuguese | LILACS, BDENF | ID: biblio-1278073

ABSTRACT

Resumo Objetivo: Descrever o processo gerencial realizado por enfermeiros em centro cirúrgico. Métodos: Estudo descritivo e exploratório, de abordagem qualitativa, realizado com 10 enfermeiros do centro cirúrgico de um hospital universitário. Os dados coletados no período de setembro a outubro de 2019 por meio de entrevistas individuais semiestruturadas foram analisados com auxílio do software IRaMuTeQ e submetidos à análise temática indutiva. Resultados: A análise de similitude demonstra o protagonismo da equipe de enfermagem do centro cirúrgico e sua relação direta com o cuidado do paciente, enquanto a atuação do enfermeiro se caracteriza por ações predominantemente gerenciais relacionadas à organização do trabalho. Por meio da análise temática indutiva, foram elencadas três categorias relacionadas ao processo gerencial em centro cirúrgico: gestão de pessoas, gestão de recursos materiais e gestão do cuidado. Conclusão: Os achados indicaram que o processo gerencial em centro cirúrgico, segundo os enfermeiros, envolve a necessidade de aprimoramento das competências, bem como do conhecimento das ferramentas gerenciais para a gestão de pessoas, para o gerenciamento de recursos materiais e para a gestão do cuidado.


Resumen Objetivo: Describir el proceso de gestión realizado por enfermeros en el quirófano. Métodos: Estudio descriptivo y exploratorio, de enfoque cualitativo, realizado con 10 enfermeros del quirófano de un hospital universitario. Los datos recopilados durante el período de septiembre a octubre de 2019, mediante entrevistas individuales semiestructuradas, fueron analizados con ayuda del software IRaMuTeQ y sometidos al análisis temático inductivo. Resultados: El análisis de similitudes demuestra el protagonismo del equipo de enfermería del quirófano y su relación directa con el cuidado del paciente, y la actuación del enfermero se caracteriza por acciones predominantemente de gestión relacionadas con la organización del trabajo. Mediante el análisis temático inductivo, se enumeraron tres categorías relacionadas con el proceso de gestión en el quirófano: gestión de personas, gestión de recursos materiales y gestión del cuidado. Conclusión: Los resultados indicaron que el proceso de gestión en el quirófano, según los enfermeros, comprende la necesidad de mejora de las competencias, así como del conocimiento de las herramientas de gestión para la administración de personas, de recursos materiales y del cuidado.


Abstract Objective: To describe the management process performed by nurses in surgicenters. Methods: This is a descriptive, exploratory and qualitative study conducted with 10 nurses in a surgicenters of a university hospital. The data collected from September to October 2019 through semi-structured individual interviews were analyzed with the aid of the IRaMuTeQ software and submitted to inductive thematic analysis. Results: Similarity analysis demonstrates the role of the nursing team in the surgicenters and their direct relationship with patient care, while the role of nurses is characterized by predominantly management actions related to work organization. Through inductive thematic analysis, three categories related to the management process in surgicenters were listed: people management, material resource management and care management. Conclusion: The findings indicated that the management process in surgicenters, according to nurses, involves the need to improve skills, as well as knowledge of tools for managing people, for managing material resources and care.


Subject(s)
Humans , Operating Room Nursing , Professional Competence , Health Services Administration , Practice Management , Nurses , Nursing, Team , Patient Care Team , Personnel Management , Epidemiology, Descriptive , Interviews as Topic , Outcome Assessment, Health Care , Material Resources in Health/organization & administration , Evaluation Studies as Topic , Interpersonal Relations
16.
Asian Journal of Andrology ; (6): 640-647, 2021.
Article in English | WPRIM | ID: wpr-922371

ABSTRACT

To evaluate outcomes between extraperitoneal robotic single-port radical prostatectomy (epR-spRP) and extraperitoneal robotic multiport radical prostatectomy (epR-mpRP) performed with the da Vinci Si Surgical System, comparison was performed between 30 single-port (SP group) and 26 multiport (MP group) cases. Comparisons included operative time, estimated blood loss (EBL), hospital stay, peritoneal violation, pain scores, scar satisfaction, continence, and erectile function. The median operation time and EBL were not different between the two groups. In the SP group, the median operation time of the first 10 patients was obviously longer than that of the latter 20 patients (P < 0.001). The median postoperative hospital stay in the SP group was shorter than that in the MP group (P < 0.001). The rate of peritoneal damage in the SP group was less than that in the MP group (P = 0.017). The pain score and overall need for pain medications in the SP group were lower than those in the MP group (P < 0.001 and P = 0.015, respectively). Patients in the SP group were more satisfied with their scars than those in the MP group 3 months postoperatively (P = 0.007). At 3 months, the cancer control, recovery of erectile function, and urinary continence rates were similar between the two groups. It is safe and feasible to perform epR-spRP using the da Vinci Si surgical system. Therefore, epR-spRP can be a treatment option for localized prostate cancer. Although epR-spRP still has a learning curve, it has advantages for postoperative pain and self-assessed cosmesis. In the absence of the single-port robotic surgery platform, we can still provide minimally invasive surgery for patients.


Subject(s)
Aged , Blood Loss, Surgical/statistics & numerical data , Humans , Male , Middle Aged , Outcome Assessment, Health Care/statistics & numerical data , Perioperative Medicine/statistics & numerical data , Prostatectomy/methods , Prostatic Neoplasms/surgery , Quality Assurance, Health Care/statistics & numerical data , Robotic Surgical Procedures/statistics & numerical data
17.
Asian Journal of Andrology ; (6): 621-626, 2021.
Article in English | WPRIM | ID: wpr-922367

ABSTRACT

This retrospective study demonstrates the clinical outcomes of patients with nonmosaic Klinefelter's syndrome (KS) who underwent preimplantation genetic testing (PGT) with frozen-thawed testicular spermatozoa. Microdissection testicular sperm extraction (micro-TESE) was performed for sperm retrieval. Next-generation sequencing (NGS) was conducted for embryo analysis. A total of 18 couples aged ≤35 years were included, and 22 oocyte retrieval cycles were completed. Euploidy was detected in 29 of 45 (64.4%) embryos. Additionally, the numbers of aneuploid and mosaic embryos detected were 8 (17.8%) and 8 (17.8%), respectively, regardless of a lack of sex chromosome abnormalities. Finally, 13 couples with euploid embryos completed 14 frozen embryo transfer (FET) cycles. Ten couples had clinical pregnancies, and 6 of them had already delivered 5 healthy babies and 1 monozygotic twin. There were also 4 ongoing pregnancies and 2 biochemical pregnancies, but no early pregnancy loss was reported. Based on our results, we speculate that for KS patients, when sperm can be obtained by micro-TESE, the cryopreservation strategy makes the ovarian stimulation procedure more favorable for female partners. The paternal genetic risk of sex chromosome abnormalities in their offspring is extremely low in men with KS. In addition to PGT, the intracytoplasmic sperm injection (ICSI) procedure is comparably effective but more economical for young nonmosaic KS couples. ICSI should be offered as an option for such couples, but monitoring by prenatal genetic diagnosis is recommended.


Subject(s)
Adult , Female , High-Throughput Nucleotide Sequencing/methods , Humans , Klinefelter Syndrome/therapy , Outcome Assessment, Health Care/statistics & numerical data , Ovulation Induction/statistics & numerical data , Pregnancy , Retrospective Studies , Sperm Injections, Intracytoplasmic/methods
18.
Chinese Medical Journal ; (24): 187-193, 2021.
Article in English | WPRIM | ID: wpr-921193

ABSTRACT

BACKGROUND@#In-hospital mortality in patients with coronavirus disease 2019 (COVID-19) is high. Simple prognostic indices are needed to identify patients at high-risk of COVID-19 health outcomes. We aimed to determine the usefulness of the CONtrolling NUTritional status (CONUT) index as a potential prognostic indicator of mortality in COVID-19 patients upon hospital admission.@*METHODS@#Our study design is of a retrospective observational study in a large cohort of COVID-19 patients. In addition to descriptive statistics, a Kaplan-Meier mortality analysis and a Cox regression were performed, as well as receiver operating curve (ROC).@*RESULTS@#From February 5, 2020 to January 21, 2021, there was a total of 2969 admissions for COVID-19 at our hospital, corresponding to 2844 patients. Overall, baseline (within 4 days of admission) CONUT index could be scored for 1627 (57.2%) patients. Patients' age was 67.3 ± 16.5 years and 44.9% were women. The CONUT severity distribution was: 194 (11.9%) normal (0-1); 769 (47.2%) light (2-4); 585 (35.9%) moderate (5-8); and 79 (4.9%) severe (9-12). Mortality of 30 days after admission was 3.1% in patients with normal risk CONUT, 9.0% light, 22.7% moderate, and 40.5% in those with severe CONUT (P < 0.05). An increased risk of death associated with a greater baseline CONUT stage was sustained in a multivariable Cox regression model (P < 0.05). An increasing baseline CONUT stage was associated with a longer duration of admission, a greater requirement for the use of non-invasive and invasive mechanical ventilation, and other clinical outcomes (all P < 0.05). The ROC of CONUT for mortality had an area under the curve (AUC) and 95% confidence interval of 0.711 (0.676-0746).@*CONCLUSION@#The CONUT index upon admission is potentially a reliable and independent prognostic indicator of mortality and length of hospitalization in COVID-19 patients.


Subject(s)
Aged , Aged, 80 and over , COVID-19 , Female , Hospitalization , Hospitals , Humans , Middle Aged , Nutrition Assessment , Nutritional Status , Outcome Assessment, Health Care , Prognosis , Retrospective Studies , SARS-CoV-2
19.
Coluna/Columna ; 19(4): 297-301, Oct.-Dec. 2020. tab, graf
Article in English | LILACS | ID: biblio-1133598

ABSTRACT

ABSTRACT Objective To compare Tokuhashi and Tomita scores in patients with epidural spinal metastasis who underwent surgical treatment. Methods A retrospective evaluation of 103 patients with spinal metastasis and epidural compression who underwent surgical treatment. An analysis was performed of agreement between the survival rates observed in the study sample and the survival rate estimated by the Tomita and Tokuhashi scales. Results The overall accuracy was 39.03% for the Tomita scale and 61.75% for the Tokuhashi scale. Fair agreement (0.38 weighted Cohen's Kappa coefficient) was observed between patient survival and the Tokuhashi score, and slight agreement (0.25 weighted Kappa coefficient) for the Tomita score. The agreement for both scales was higher for patients with less than six months' survival, with general accuracy of 79.17% for the Tomita and 70.59% for the Tokuhashi scoring system. Conclusion There was fair and slight agreement between the Tokuhashi and Tomita scores with patient survival group. The agreement was higher for patients with less than six months' survival. Level of evidence III; Comparative retrospective study.


RESUMO Objetivo Comparar as escalas de Tokuhashi e Tomita em pacientes com metástase epidural da coluna vertebral submetidos a tratamento cirúrgico. Métodos Avaliação retrospectiva de 103 pacientes com metástase da coluna vertebral e compressão epidural submetidos o tratamento cirúrgico. Foi realizada uma análise de concordância entre as taxas de sobrevida observadas na amostra do estudo e as taxas de sobrevida estimada pelas escalas de Tomita e Tokuhashi. Resultados A acurácia geral para a escala Tomita foi de 39,03% e de 61,75% para a escala Tokuhashi. Foi observada concordância razoável (coeficiente Kappa de Cohen ponderado de 0,38) entre a sobrevida do paciente e o escore de Tokuhashi, e concordância baixa (coeficiente Kappa ponderado de 0,25) para o escore de Tomita. A concordância entre as duas escalas foi maior para pacientes com sobrevida inferior a seis meses, com acurácia de 79,17% para a escala Tomita e 70,59% para a escala Tokuhashi. Conclusões Foi observada concordância razoável e baixa entre os escores de Tokuhashi e Tomita no grupo de sobrevida dos pacientes. A concordância foi maior nos pacientes com sobrevida inferior a seis meses. Nível de evidência III; Estudo retrospectivo comparativo.


RESUMEN Objetivo Comparar las escalas de Tokuhashi y Tomita en pacientes con metástasis epidural de la columna vertebral sometidos a tratamiento quirúrgico. Métodos Evaluación retrospectiva de 103 pacientes con metástasis de la columna vertebral y compresión epidural, sometidos a tratamiento quirúrgico. Fue realizado un análisis de concordancia entre las tasas de sobrevida observadas en la muestra del estudio y las tasas de sobrevida estimada por las escalas de Tomita y Tokuhashi. Resultados La precisión general para la escala Tomita fue de 39,03% y de 61,75% para la escala Tokuhashi. Fue observada concordancia razonable (coeficiente Kappa de Cohen ponderado de 0,38) entre la sobrevida del paciente y el score de Tokuhashi, y concordancia baja (coeficiente Kappa ponderado de 0,25) para el score de Tomita. La concordancia entre las dos escalas fue mayor para pacientes con sobrevida inferior a seis meses, con precisión de 79,17% para la escala Tomita y del 70,59% para la escala Tokuhashi. Conclusiones Fue observada concordancia razonable y baja entre los scores de Tokuhashi y Tomita en el grupo de sobrevida de los pacientes. La concordancia fue mayor en los pacientes con sobrevida inferior a seis meses. Nivel de evidencia III; Estudio retrospectivo comparativo.


Subject(s)
Humans , Spinal Neoplasms , Life Expectancy , Outcome Assessment, Health Care , Neoplasm Metastasis
20.
Femina ; 48(12): 739-746, 20201231. ilus, tab
Article in Portuguese | LILACS | ID: biblio-1141184

ABSTRACT

Objetivo: Avaliar os desfechos obstétricos entre grávidas adolescentes e adultas. Métodos: Estudo do tipo transversal não randomizado entre gestantes adolescentes e grávidas adultas em uma maternidade pública de Marabá-Pará. Foram associados desfechos obstétricos entre os dois grupos estudados. Para a análise univariada, foi utilizada a distribuição de frequências relativa e absoluta, e para a análise bivariada, foi utilizado cálculo do risco relativo com intervalo de confiança de 95%. Na comparação das variáveis numéricas, foi o utilizado o teste de ANOVA 1. Resultados: Identificou-se uma relação estatisticamente relevante entre a gravidez na adolescência e o estado civil solteiro, menor escolaridade, realização de menos de seis consultas de pré-natal, parto vaginal, episiotomia, baixo peso do recém-nascido ao nascer e menor perímetro cefálico, quando comparadas com as adultas. Conclusão: A gravidez na adolescência se associa com piores desfechos obstétricos relacionados ao peso ao nascer, perímetro cefálico e realização de episiotomias, o que se associa a fatores como a condição emocional e financeira da mãe e com a baixa cobertura da saúde pública na região amazônica.(AU)


Objective: To evaluate obstetric outcomes among pregnant adolescents and adults. Methods: Non-randomized cross-sectional study among pregnant adolescent and adult pregnant women in a public maternity hospital in Marabá-Pará. Obstetric outcomes were associated between the two groups studied. For a univariate analysis a distribution of relative and absolute frequencies was used and for a bivariate analysis a calculation of relative risk with confidence interval of 95% was used. The ANOVA 1 test was used to compare numerical variables. Results: A statistically relevant association was identified between teenage pregnancy and single marital status, less education, less than six prenatal consultations, vaginal delivery, episiotomy, low birth weight at birth and smaller head circumference when compared to adults. Conclusion: Adolescent pregnancy is associated with worse obstetric outcomes related to birth weight, head circumference and episiotomies, which is associated with factors, such as the mother's emotional and financial condition, and the low public health coverage in the Amazon region.(AU)


Subject(s)
Humans , Female , Pregnancy , Adolescent , Adult , Pregnancy in Adolescence , Pregnancy , Outcome Assessment, Health Care/statistics & numerical data , Maternal Health , Brazil/epidemiology , Medical Records , Cross-Sectional Studies , Risk Factors
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