ABSTRACT
Introducción: la obstrucción del intestino delgado (SBO) es una presentación común en cualquier unidad de cirugía general. Sin embargo, su diagnóstico y manejo preoperatorio a menudo pueden ser difíciles debido a sus múltiples causas. La obstrucción intestinal pequeña secundaria a la impactación de bezoar es considerablemente infrecuente, con una frecuencia reportada de aproximadamente 0.4% a 4%. La incidencia de bezoar como causa de obstrucción intestinal es baja. El método complementario con la mayor sensibilidad y especificidad continúa siendo CT del abdomen y la pelvis con contraste oral e intravenoso. El tratamiento debe ser quirúrgico. Modificar la dieta junto con el manejo de los trastornos es la mejor forma de prevención.
Introduction: Small Bowel Obstruction (SBO) is a common presentation in any general surgery unit. However, its diagnosis and preoperative management can often be difficult due to its multiple causes. Small bowel obstruction secondary to bezoar impaction is considerably uncommon, with a reported frequency of about 0.4% to 4%. The incidence of bezoar as a cause of intestinal obstruction is low. The complementary method with the highest sensitivity and specificity continues to be CT of the abdomen and pelvis with oral and intravenous contrast. Treatment must be surgical. Modifying the diet along with managing the disorders is the best form of prevention
Subject(s)
Humans , Female , Aged , Bezoars/surgery , Preoperative Care/methods , Diet , Abdomen, Acute/diagnosis , Intestinal Obstruction/surgeryABSTRACT
Introducción: La interacción enfermera-paciente durante el período preoperatorio permite el afronte intraoperatorio y posoperatorio, pero no se hace por desidia o por sobrecarga laboral. Objetivo: Describir las reflexiones en torno a la interacción enfermera-paciente durante el período preoperatorio en un hospital público. Métodos: Investigación cualitativa descriptiva, realizada en el Hospital Belén en Lambayeque, Perú, durante abril y mayo del 2020. La población fueron 20 enfermeras experimentadas en atención preoperatoria. Se realizó muestreo no probabilístico, por técnica de bola de nieve que saturó con ocho enfermeras. Los datos se recolectaron con entrevista semiestructurada por llamada telefónica, y fueron procesadas mediante análisis de contenido. Resultados: Tres categorías: a) Elementos indispensables en la interacción: empatía y comunicación terapéutica, b) Interacción para valorar y cuidar de la dimensión emocional, espiritual y física del paciente en el preoperatorio, c) Beneficios de la interacción para la recuperación en el posoperatorio basados en la educación al paciente y su familia. Conclusiones: La interacción enfermera-paciente se inicia a través de la empatía que siente la enfermera y la confianza que genera en el paciente, lo que favorece la comunicación terapéutica, esencial para valorar y cuidar de las necesidades emocionales, espirituales y físicas previa a la intervención quirúrgica. Asimismo, la educación sanitaria al paciente y al familiar es fundamental para el cumplimiento de las indicaciones en el posoperatorio, de manera que haya una recuperación exitosa. Sin embargo, se necesita adecuada dotación del personal de enfermería y comunicación asertiva entre el equipo de salud y la familia(AU)
Introduction: Nurse-patient interaction during the preoperative period allows intraoperative and postoperative coping, but is not done out of idleness or work overload. Objective: To describe the reflections about nurse-patient interaction during the preoperative period in a public hospital. Methods: Descriptive and qualitative research carried out at Belén Hospital in Lambayeque, Peru, during April and May 2020. The study population consisted of twenty nurses experienced in preoperative care. Nonprobabilistic sampling was done, using the "snowball" technique, permitting to identify eight nurses and thus reach saturation. The data were collected with a semistructured interview by telephone call and processed by content analysis. Results: Three categories emerged: a) indispensable elements for interaction: empathy and therapeutic communication; b) interaction to value and care for the emotional, spiritual and physical dimensions of the patient in the preoperative period; and c) benefits of interaction for recovery in the postoperative period based on patient and family education. Conclusions: Nurse-patient interaction starts through the empathy felt by the nurse and the trust that thus produced in the patient, which favors therapeutic communication, essential to value and care for the emotional, spiritual and physical needs prior to surgery. Likewise, health education to the patient and family is essential to comply with postoperative indications, in view of a successful recovery. However, an adequate nursing staff and assertive communication between the health care team and the family are needed(AU)
Subject(s)
Humans , Surgical Procedures, Operative , Preoperative Care , Preoperative Period , Nurse-Patient Relations , Patient Care Team , Qualitative ResearchABSTRACT
Abstract Currently, intracapsular femoral neck fracture (IFNF) is still a great challenge for orthopedists. In spite of the progress that has been made, a high mortality rate persists in the first year, especially in Brazil, where there is no awareness that such fractures in elderly patients should be treated as amedical emergency. The present article seeks to provide an update on the preoperative, surgical, and postoperative approaches.
Resumo Atualmente, a fratura intracapsular do colo femoral (FICF) ainda é um grande desafio para os ortopedistas. Apesar dos grandes avanços feitos, persiste uma grande taxa de mortalidade no primeiro ano, sobretudo no Brasil, onde não há uma conscientização de que tais fraturas nos pacientes idosos devemser tratadas como uma urgênciamédica. O presente artigo busca fornecer uma atualização das condutas pré-operatórias, cirúrgicas e pós-operatórias.
Subject(s)
Humans , Aged , Postoperative Care , Preoperative Care , Femoral Neck Fractures/surgery , Hip Fractures/surgery , Hip Fractures/rehabilitationABSTRACT
Introduction Fluorescence guidance with 5-aminolevulinic acid (5-ALA) is a safe and reliable tool in total gross resection of intracranial tumors, especially malignant gliomas and cases of metastasis. In the present retrospective study, we have analyzed 5-ALA-induced fluorescence findings in different central nervous system (CNS) lesions to expand the indications of its use in differential diagnoses. Objectives To describe the indications and results of 5-ALA fluorescence in a series of 255 cases. Methods In 255 consecutive cases, we recorded age, gender, intraoperative 5-ALA fluorescence tumor response, and 5-ALA postresection status, as well the complications related to the method. Postresection was classified as '5-ALA free' or '5-ALA residual'. The diagnosis of histopathological tumor was established according to the current classification of the World Health Organization (WHO). Results There were 195 (76.4%) 5-ALA positive cases, 124 (63.5%) of whom underwent the '5-ALA free' resection. The findings in the positive cases were: 135 gliomas of all grades; 19 meningiomas; 4 hemangioblastomas; 1 solitary fibrous tumor; 27 metastases; 2 diffuse large B cell lymphomas; 2 cases of radionecrosis; 1 inflammatory disease; 2 cases of gliosis; 1 cysticercosis; and 1 immunoglobulin G4-related disease.
Subject(s)
Brain Neoplasms/surgery , Surgery, Computer-Assisted/methods , Aminolevulinic Acid , Microscopy, Fluorescence/methods , Postoperative Care , Brain Neoplasms/pathology , Preoperative Care , Retrospective Studies , Neuronavigation/methods , Cerebrum/surgery , Cerebrum/pathology , Intraoperative Care , Latin America/epidemiologyABSTRACT
Introducción: El avance en los disímiles tratamientos y habilidades profesionales en torno a la intervención quirúrgica en el continente americano va aparejado al desarrollo que existe en Europa, y Cuba no queda exenta de los progresos alcanzados hasta la actualidad. Objetivo: Diagnosticar las insuficiencias en el desarrollo de las habilidades profesionales de los cirujanos generales, en la atención preoperatoria mediata. Métodos: Se realizó una investigación cuasi - experimental de 60 médicos especialistas y residentes, encargados de la atención preoperatoria mediata en el Hospital General Docente Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba, desde diciembre de 2019 hasta mayo de 2021, para lo cual se conformaron 2 grupos: A (de estudio) y B (de control), con 30 integrantes cada uno. Se analizaron las variables seleccionadas y se definieron las dimensiones para demostrar la correspondencia con los indicadores de dichas variables. Resultados: Existió un predominio del sexo masculino en ambos grupos y de las edades entre 15 - 44 años (83,3 % en el grupo A y 90,0 % en el B). Las dimensiones más afectadas en orden decreciente fueron: superación, cognitiva, científico - investigativa y axiológica. La triangulación de los instrumentos arrojó que la variable desempeño profesional se encontraba con un nivel de afectación alto. Conclusiones: Las indagaciones teóricas y empíricas para la caracterización del estado actual de los cirujanos generales permitieron determinar, que existían insuficiencias en todas las dimensiones exploradas, lo cual dificultó el desarrollo de las habilidades profesionales relacionadas con la atención preoperatoria mediata.
Introduction: The advance in the dissimilar treatments and professional skills around the surgical intervention in the American continent goes together with the development that exists in Europe, and Cuba is not exempt of the progresses reached until the present time. Objective: To diagnose the inadequacies in the development of the general surgeons professional skills, in the mediate preoperative care. Methods: A quasi-experimental investigation of 60 specialist doctors and residents, in charge of the mediate preoperative care was carried out in Dr. Juan Bruno Zayas Alfonso Teaching General Hospital from Santiago de Cuba, from December, 2019 to May, 2021, for which 2 groups were conformed: A (study group) and B (control group), with 30 members each one. The selected variables were analyzed and the dimensions to demonstrate the correspondence with the indicators of these variables were defined. Results: There was prevalence of the male sex in both groups and the 15 - 44 age group (83.3 % in group A and 90.0 % in group B). The most affected dimensions in decreasing order were: training, cognitive, scientific - investigative and axiological. The triangulation of the instruments showed that the variable professional performance was in a high level of affectation. Conclusion: The theoretical and empiric investigations for the characterization of the current state of the general surgeons allowed to determine that inadequacies existed in all the explored dimensions, which made difficult the development of the professional skills related to the mediate preoperative care.
Subject(s)
Professional Competence , Preoperative Care , Surgeons , SpecializationABSTRACT
Abstract Preoperative anemia is a common finding. Preoperative allogeneic transfusion, iron therapy, vitamin supplementation and erythropoietin therapy are the current management strategies for preoperative anemia. Previous reviews regarding erythropoietin were limited to specialties, provided little evidence regarding the benefits and risks of erythropoietin in managing preoperative anemia and included non-anemic patients. The purpose of our systematic review was to determine the role of erythropoietin solely in preoperatively anemic patients and to investigate the complications of this treatment modality to produce a guideline for preoperative management of anemic patients for all surgical specialties. The PubMed/Medline, Google Scholar, and Cochrane Library were searched for randomized trials evaluating the efficacy of erythropoietin in preoperative anemia. The risk ratio (RR) and standardized mean difference (SMD) was used to pool the estimates of categorical and continuous outcomes, respectively. Allogeneic transfusion and complications and the 90-day mortality were the primary outcomes, while the postoperative change in hemoglobin, bleeding in milliliters and the number of red blood cell (RBC) packs transfused were the secondary outcomes. Results: Eight studies were included, comprising 734 and 716 patients in the erythropoietin group and non-erythropoietin group, respectively. The pooled estimate by RR for allogeneic transfusion was 0.829 (p = 0.049), while complications and the 90-day mortality were among the 1,318 (p = 0.18) patients. Conclusion: Preoperative erythropoietin provides better outcomes, considering the optimization of preoperative anemia for elective surgical procedures. The benefits of erythropoietin are significantly higher, compared to the control group, while the risks remain equivocal in both groups. We recommend preoperative erythropoietin in anemic patients.
Subject(s)
Humans , Erythropoietin , Anemia , Blood Transfusion , Preoperative Care , Iron Compounds/therapeutic useABSTRACT
OBJETIVO: Mapear a produção de conhecimento a respeito das recomendações para o preparo pré-operatório de qualquer tipo de cirurgia cardíaca, eletiva ou de urgência, de pacientes com idade superior a 18 anos em unidades de internação hospitalar. MÉTODO: Revisão de escopo realizada em dezembro de 2020, em 11 fontes de dados, seguindo as recomendações do Instituto Joanna Briggs, com análise de dados descritiva. RESULTADOS: Foram selecionados e caracterizados 27 estudos, identificando-se como principais recomendações pré-operatórias de cirurgia cardíaca: a educação pré-operatória, medicações, escalas para estratificação de risco pós-operatório, treinamento muscular inspiratório e realização de exames. CONCLUSÃO: As recomendações apresentaram eficácia na estabilidade hemodinâmica, atenuação do medo e ansiedade do paciente quanto à cirurgia, de arritmias, internação hospitalar, taxa de mortalidade e complicações pós-operatórias.
OBJECTIVE: To map the production of knowledge regarding the recommendations for the preoperative preparation of any type of cardiac surgery, whether elective or urgent, of patients over 18 years old in hospitalization units. METHOD: A scoping review carried out in December 2020 in 11 data sources, following the Joanna Briggs Institute recommendations, with descriptive data analysis. RESULTS: A total of 27 studies were selected and characterized, identifying the following as the main preoperative recommendations for cardiac surgeries: preoperative education, medications, scales for postoperative risk stratification, inspiratory muscle training and tests. CONCLUSION: The recommendations presented efficacy in hemodynamic stability, attenuation of the patient's fear and anxiety regarding the surgery, of the number of arrhythmias and hospitalizations, of the mortality rate and of postoperative complications.
OBJETIVO: Mapear la producción de conocimiento sobre las recomendaciones para la preparación preoperatoria de cualquier tipo de cirugía cardiaca, electiva o urgente, de pacientes mayores de 18 años en unidades de hospitalización. MÉTODO: Revisión de alcance realizada en diciembre de 2020, en 11 fuentes de datos, siguiendo las recomendaciones del Instituto Joanna Briggs, con análisis descriptivo de datos. RESULTADOS: Se seleccionaron y caracterizaron 27 estudios, las principales recomendaciones preoperatorias para cirugía cardiaca que se identificaron son: educación preoperatoria, medicamentos, escalas para estratificación de riesgo postoperatorio, entrenamiento de músculos inspiratorios y exámenes. CONCLUSIÓN: Las recomendaciones fueron efectivas para mejorar la estabilidad hemodinámica, disminuir el miedo y la ansiedad del paciente por la cirugía, las arritmias, el tiempo de estancia hospitalaria, la tasa de mortalidad y las complicaciones postoperatorias.
Subject(s)
Humans , Adult , Middle Aged , Aged , Aged, 80 and over , Cardiovascular Surgical Procedures , Thoracic Surgery , Preoperative Care , Inpatient Care Units , HospitalizationABSTRACT
ABSTRACT Objective: to map, in the scientific literature, the use of audiovisual aids as an educational strategy during the preoperative period of cardiac surgery. Method: a scoping review following the Joanna Briggs Institute methodology. Two independent reviewers analyzed the studies, applying the exclusion and inclusion criteria in the search by the audiovisual aid, cardiac surgery and preoperative care variables, including those that answered the research question. Results: final sample of nine studies, where the most used audiovisual aids were videos followed by apps, used because they are easily accessible and democratic. Such tools in health education optimize the team's time and promote patient education, improving the postoperative period, in addition to reducing risks and improving adherence to the treatment. Conclusion: it was possible to map the audiovisual aids used in the health education of surgical patients, such as videos, apps and information systems. These tools facilitate Nursing guidelines in the preoperative period of cardiac surgeries, increasing the patient's knowledge about the surgery.
RESUMEN Objetivo: mapear en la literatura científica el uso de recursos audiovisuales como estrategia educativa durante el período preoperatorio de cirugías cardíacas. Método: revisión de alcance que siguió la metodología del Instituto Joanna Briggs. Dos revisores independientes analizaron los estados, aplicando los criterios de exclusión e inclusión en la búsqueda por medio de las siguientes variables: recurso audiovisual, cirugía cardíaca y cuidados preoperatorios, incluyéndose los que respondían a la pregunta de la investigación. Resultados: la muestra final estuvo compuesta por nueve estudios, en los que los recursos audiovisuales más utilizados fueron los vídeos seguidos de aplicaciones, usados por ser de fácil acceso y democráticos. Estas herramientas de educación en salud optimizan el tiempo del equipo y promueven la educación del paciente, mejorando así el período postoperatorio, además de reducir riesgos y mejorar la adhesión al tratamiento. Conclusión: fue posible mapear los recursos audiovisuales utilizados en la educación en salud de los pacientes quirúrgicos, como ser vídeos, aplicaciones y sistemas de información. Estas herramientas facilitan las pautas orientadoras de la Enfermería en el período preoperatorio de cirugías cardíacas, incrementando así el conocimiento de los pacientes sobre las cirugías.
RESUMO Objetivo: mapear na literatura científica a utilização de recurso audiovisual como estratégia educativa durante o pré-operatório de cirurgia cardíaca. Método: revisão de escopo seguindo a metodologia do Instituto Joanna Briggs. Dois revisores independentes analisaram os estudos, aplicando os critérios de exclusão e inclusão na busca pelas variáveis recurso audiovisual, cirurgia cardíaca e cuidados pré-operatórios, tendo sido incluídos aqueles que respondiam à questão de pesquisa. Resultados: amostra final de nove estudos, nos quais os recursos audiovisuais mais utilizados foram os vídeos seguidos de aplicativos, usados por serem de fácil acesso e democráticos. Essas ferramentas na educação em saúde otimizam o tempo da equipe e promovem a educação do paciente, melhorando o pós-operatório. Além de reduzir riscos e melhorar a adesão ao tratamento. Conclusão: foi possível mapear os recursos audiovisuais utilizados na educação em saúde dos pacientes cirúrgicos, como vídeos, aplicativos e sistemas de informações. Essas ferramentas são facilitadoras das orientações de enfermagem no pré-operatório de cirurgia cardíaca, aumentando o conhecimento do paciente sobre a cirurgia.
Subject(s)
Humans , Audiovisual Aids , Thoracic Surgery , Preoperative Care , Educational Technology , Cardiac Surgical Procedures , Postoperative Period , Preoperative PeriodABSTRACT
ABSTRACT Introduction: the botulinum toxin A (BTA) has been used to achieve a chemical component separation, and it has been used with favorable outcomes for the repair of complex ventral hernia (CVH) with and without loss of domain (LD). The aim of this study is to describe our early experience with the chemical component separation in the United Sates. Methods: a retrospective observational study of all patients who underwent ventral hernia repair for CVH with or without LD between July 2018 and June 2020. Preoperative BTA was injected in all patients via sonographic guidance bilaterally, between the lateral muscles to achieve chemical denervation before the operation. Patient demographics, anatomical location of the hernia, perioperative data and postoperative data are described. Results: 36 patients underwent this technique before their hernia repair between July 2018 to June 2020. Median age was 62 years (range 30-87). Median preoperative defect size was 12cm (range 6-25) and median intraoperative defect size was 13cm (range 5-27). Median preoperative hernia sac volume (HSV) was 1338cc (128-14040), median preoperative abdominal cavity volume (ACV) was 8784cc (5197-18289) and median volume ration (HSV/ACV) was 14%. The median OR time for BTA administration was 45 minutes (range 28-495). Seroma was the most common postoperative complication in 8 of the patients (22%). Median follow up was 43 days (range 0-580). Conclusion: preoperative chemical component separation with BTA is a safe and effective adjunct to hernia repair in CVH repairs where a challenging midline fascial approximation is anticipated.
RESUMO Introdução: a toxina botulínica A (TBA) tem sido usada para alcançar a separação química dos componentes, com resultados favoráveis para o reparo de hérnias ventrais complexas (HVC) com ou sem perda de domínio (PD). O objetivo deste estudo é descrever nossa experiência inicial com a separação química dos componentes nos Estados Unidos. Métodos: estudo retrospectivo observacional com todos os pacientes submetidos a reparo de hérnia ventral complexa com ou sem PD entre julho de 2018 e junho de 2020. A TBA pré-operatória foi injetada em todos os pacientes, guiada por ultrassonografia, bilateralmente entre os músculos laterais para alcançar a denervação química antes da operação. Dados demográficos dos pacientes, local da hérnia, dados peri-operatórios e pós-operatórios são descritos. Resultados: 36 pacientes foram submetidos a esta técnica antes do reparo da hérnia. A idade mediana foi 62 anos (30-87). O tamanho mediano pré-operatório do defeito herniário foi 12cm (6-25) e o defeito mediano intra-operatorio foi 13cm (5-27). O volume mediano do saco herniário pré-operatório foi 1.338mL (128-14.040), o volume mediano da cavidade abdominal pré-operatório foi 8.784 (5.197-18.289) mL e a razão dos volumes foi 14%. A duração mediana da operação para aplicação da TBA foi 45 minutos (28-495). O seroma foi a complicação mais comum no pós-operatório, em oito pacientes (22%). O seguimento pós-operatório mediano foi de 43 dias (0-580). Conclusão: a separação pré-operatória de componentes com TBA é tratamento adjuvante seguro e eficaz em reparos de HVC em que aproximação da fáscia é antecipadamente desafiadora.
Subject(s)
Humans , Adult , Aged , Aged, 80 and over , Botulinum Toxins, Type A/therapeutic use , Abdominal Wall/surgery , Neuromuscular Agents/therapeutic use , Preoperative Care , New York , Abdominal Muscles/surgery , Herniorrhaphy , Hernia, Ventral/surgery , Middle AgedABSTRACT
Las artroplastias de cadera y rodilla son estrategias que han demostrado ser efectivas en el tratamiento de la patología degenerativa articular. El reemplazo articular mejora la calidad de vida de la mayoría de los pacientes cuando el tratamiento conservador falla. Sin embargo, estas son cirugías mayores que conllevan un riesgo significativo de complicaciones, incluyendo la necesidad de una revisión. El propósito de este artículo es analizar los factores de riesgo modificables del paciente antes de la cirugía, a fin de disminuir el riesgo de complicaciones posoperatorias. Estudios recientes han descripto ciertos factores de riesgo modificables, inherentes al paciente y que incrementan la posibilidad de complicaciones posoperatorias luego de un reemplazo articular de cadera o rodilla. Estos incluyen obesidad, malnutrición, tabaquismo, diabetes, anemia, deficiencia de vitamina D, consumo de opioides, artropatías inflamatorias, insuficiencia renal crónica y colonización por estafilococco meticilino-resistente. Si conseguimos optimizar estas condiciones durante el preoperatorio, reduciremos el riesgo de complicaciones posoperatorias. Nivel de Evidencia: IV
Hip and knee arthroplasties are well-known effective strategies for joint osteoarthritis. Joint replacement reliably improves quality of life for most patients when non-operative measures have failed. However, these are major surgeries that carry significant risks, including the need for revision surgery. The purpose of this article is to discuss preoperative modifiable risks parameters of the patient prior to joint replacement to decrease complication risks. Recent studies have described several modifiable factors that increase the risk of postoperative complications following hip and knee replacement. These include obesity, malnutrition, tobacco use, diabetes, anaemia, vitamin D deficiency, opioid use, inflammatory arthropathy, kidney chronic insufficiency and meticilin-resistant staphylococci colonization. If we achieve preoperative optimization of these conditions, we should minimize the risk of adverse outcomes. Level of Evidence: IV
Subject(s)
Preoperative Care , Arthroplasty, Replacement, Hip , Arthroplasty, Replacement, Knee , Preoperative PeriodABSTRACT
Existen múltiples opciones de tratamientos para las rupturas masivas irreparables posterosuperiores del manguito rotador. Describiremos la transferencia del trapecio inferior con aumentación utilizando semitendinoso y recto interno autólogos, bajo asistencia. De esta manera devolvemos el balance muscular y restablecemos las cuplas de fuerza para la correcta movilidad del hombro afectado. Esta técnica se realiza con dos incisiones y tres portales artroscópicos: la primera para la toma del recto interno y semitendinoso en la rodilla del mismo lado del hombro afectado (aumentación), y la segunda en la escápula para la toma del trapecio inferior y para el pasaje de los tendones al espacio subacromial y posterior fijación con anclas sin nudo
In massive irreparable posterosuperior rotator cuff ruptures, there are several options for treatment. We will describe the transfer of the lower trapezius muscle tendon augmented with semitendinosus and gracillis tendons autologous, under arthroscopic assistance. In this way, muscular balance is restored for correct shoulder mobility. This technique is performed with two incisions and three arthroscopic portals, the first for harvest of the gracillis and semitendinosus tendons, in the knee on the same side of the affected shoulder (augmentation) and the second in the scapula for the harvest of the lower trapezius muscle tendon, and for passage to the subacromial, and fixation with knotless anchors
Subject(s)
Humans , Male , Tendon Transfer/methods , Transplantation, Autologous/methods , Rotator Cuff Injuries/surgery , Preoperative Care , Treatment Outcome , Hamstring Tendons/transplantation , Rotator Cuff Injuries/rehabilitationABSTRACT
Purpose: Simultaneous pancreas-kidney transplantation (SPKT) brings several benefits for insulin-dependent type-1 diabetic patients associated with end-stage renal disease (ESRD). However, data on psychological outcomes for the waiting list and the transplanted patients are still lacking. Methods: Using the psychological Beck inventories of anxiety (BAI) and depression (BDI), 39 patients on the waiting list were compared to 88 post-transplanted patients who had undergone SPKT. Results: Significant differences were found regarding depression (p = 0.003) but not anxiety (p = 0.161), being the pretransplant patients more vulnerable to psychological disorders. Remarkable differences were observed relative to the feeling of punishment (p < 0.001) and suicidal thoughts (p = 0.008) between the groups. It was observed that patients who waited a longer period for the transplant showed more post-transplant anxiety symptoms due to the long treatment burden (p = 0.002). Conclusions: These results demonstrated the positive impact of SPKT on psychological aspects related to depression when comparing the groups. The high number of stressors in the pretransplant stage impacts more severely the psychosocial condition of the patient.
Subject(s)
Humans , Anxiety/diagnosis , Postoperative Care/psychology , Preoperative Care/psychology , Kidney Transplantation/psychology , Pancreas Transplantation/psychology , Depression/diagnosis , Quality of Life , Cross-Sectional StudiesABSTRACT
At present, nasal abnormalities is often classified from different perspectives, such as the alar-columella relationship, nasal base width, and the condition of alar hyperplasia. However, due to the impact of race and region, different people may be applied to different classification methods, resulting in different clinical diagnosis and treatments. So far, there is no unified standard for alar deformity classification to guide clinical treatment. In alar-columella relationship, the retracted ala and the hanging columella, hanging ala and retracted columella are easily confused. According to the classification of nasal base width, it is easy to confuse the alar flare with wide alar base. Therefore, the accurate preoperative evaluation of the nasal ala and the selection of appropriate clinical treatments for different abnormalities are beneficial for surgeons to achieve perfect rhinoplasty results.
Subject(s)
Cleft Lip , Humans , Hyperplasia , Nasal Septum/surgery , Nose , Preoperative Care , Rhinoplasty/methodsABSTRACT
For elective surgery of colorectal cancer, current evidence supports preoperative mechanical bowel preparation combined with oral antibiotics. Meanwhile, for patients with varied degrees of intestinal stenosis, individualized protocol is required to avoid adverse events. We hereby summarize recent high-quality evidences and updates of guidelines and consensus, and recommend stratified bowel preparation based on the clinical practice of our institute as follows. (1) For patients with unimpaired oral intake, whose tumor can be passed by colonoscopy, mechanical bowel preparation and oral antibiotics are given. (2) For patients without symptoms of bowel obstruction but with impaired oral intake or incomplete colonoscopy due to tumor-related stenosis, small-dosage laxative is given for several days before surgery, and oral antibiotics the day before surgery. (3) For patients with bowel obstruction, mechanical bowel preparation or enema is not indicated. We proposed this evidence-based, individualized protocol for preoperative bowel preparation for the reference of our colleagues, in the hope of improving perioperative outcomes and reducing adverse events.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Colorectal Neoplasms/drug therapy , Constriction, Pathologic/etiology , Elective Surgical Procedures/adverse effects , Humans , Preoperative Care/methods , Surgical Wound Infection/etiologyABSTRACT
Uma relação contínua e independente é observada entre pressão arterial (PA) e incidência de acidente vascular cerebral, infarto do miocárdio, morte súbita, insuficiência cardíaca, doença arterial periférica e doença renal. A importância de um controle rígido da PA na prevenção de eventos cardiovasculares a longo prazo está bem estabelecida e baseada em fortes evidências, contudo, ainda não há um embasamento robusto no período perioperatório. Apesar das poucas evidências de que o aumento da PA no período perioperatório afete o resultado cirúrgico, a hipertensão não controlada neste contexto continua sendo uma das principais razões para a suspensão de cirurgias. Pacientes hipertensos estão mais susceptíveis a instabilidade hemodinâmica, arritmias cardíacas, isquemia miocárdica, complicações neurológicas e renais no pós-operatório. A escolha do tipo de monitorização da PA em pacientes com hipertensão não controlada varia em função do risco do paciente devido à sua patologia prévia e risco cardiovascular, bem como do risco do tipo de intervenção cirúrgica.Serão revisados os principais aspectos da avaliação do risco cirúrgico, as implicações clínicas, assim como a abordagem do paciente hipertenso no período perioperatório.
A continuous and independent relationship is found between blood pressure (BP) and the incidence of stroke, myocardial infarction, sudden death, heart failure, peripheral arterial disease, and kidney disease. The importance of strict BP control in the prevention of long-term cardiovascular events is well established and based on strong evidence, however, there is still no robust basis for the perioperative period. Despite the little evidence that the increase in BP in the perioperative period affects the surgical outcome, uncontrolled hypertension in this context remains one of the main reasons for the suspension of surgeries. Hypertensive patients are more susceptible to hemodynamic instability, cardiac arrhythmias, myocardial ischemia, neurological and renal complications in the postoperative period. The choice of the type of BP monitoring in patients with uncontrolled hypertension varies depending on the patient's risk due to their previous pathology and cardiovascular risk, as well as the risk of the type of surgical intervention. The main aspects of surgical risk assessment will be reviewed, the clinical implications, as well as the approach of the hypertensive patient in the perioperative period.
Subject(s)
Humans , Surgical Procedures, Operative , Preoperative Care , HypertensionABSTRACT
El trasplante renal es considerado como la mejor alternativa de tratamiento sustitutivo para la enfermedad renal crónica terminal (ERCT)1, es el procedimiento quirúrgico que consiste en reemplazar un riñón sano de un donante vivo o cadavérico a una persona con diagnóstico de ERCT, que ayuda a mejorar su calidad de vida, la reinserción a sus actividades sociales, físicas, emocionales, laborales y sexuales. La Organización Nacional de Trasplantes de España (ONT) en el año 2018, reportó que en la Unión Europea se realizaron 21 102 y en Latinoamérica 12 806 trasplantes renales2, en Ecuador el Ministerio de Salud Pública (MSP) en los años 2007-2020 reportó un total de 1 6153, le correspondió al Hospital de Especialidades Carlos Andrade Marín (HECAM) el 32% del total de trasplantes renales realizados entre el periodo 2007-20184. La evaluación del potencial receptor es realizada por un equipo multidisciplinario con formación académica, experiencia certificada en los diferentes procesos y acreditados por el Instituto Nacional de Donación y Trasplantes (INDOT)5. Los cuidados de enfermería enmarcados en esta ruta, son especializados e integrales, que incluyen los períodos pre operatorio, pos trasplante inmediato y temprano al incorporar además un proceso educativo entre enfermera, paciente y familia/ cuidador, con el fin de preservar la sobrevida del injerto.
Renal transplantation is considered the best alternative replacement treatment for end-stage chronic kidney disease (ESRD)1, it is the surgical procedure that consists of replacing a healthy kidney from a living or cadaveric donor to a person diagnosed with ESRD, which helps to improve their quality of life, reintegration to their social, physical, emotional, work and sexual activities. The National Transplant Organization of Spain (ONT) in 2018, reported that In the European Union 21 102 and in Latin America 12 806 renal transplants were performed2, in Ecuador the Ministry of Public Health (MSP) in the years 2007-2020 reported a total of 1 6153, corresponded to the Carlos Andrade Marín Specialties Hospital (HECAM) 32% of the total number of renal transplants performed between 2007-20184. The evaluation of the potential recipient is performed by a multidisciplinary team with academic training, certified experience in the different processes and accredited by the National Institute of Donation and Transplantation (INDOT)5. The nursing care framed in this route is specialized and comprehensive, including the pre-operative, immediate post-transplant and early post-transplant periods, incorporating an educational process between nurse, patient and family/caregiver, in order to preserve graft survival.
Subject(s)
Humans , Postoperative Care/nursing , Perioperative Nursing , Preoperative Care/nursing , Kidney Transplantation/nursing , Graft Survival , Nursing Care , Postoperative Complications/prevention & control , Nursing Records , Patient-Centered Care , Nurse's Role , Renal Insufficiency, Chronic/surgeryABSTRACT
Abstract Objective: The purpose of this study was to explore the clinical effect of preoperative health education based on the WeChat platform for parents of children with simple congenital heart disease. Methods: In this study, participants were randomly divided into an intervention group (WeChat group, n=40) and a control group (leaflet group, n=40) in our center. All parents were required to complete the Family Caregiver Task Inventory (FCTI) on the first visit and the Zarit Burden Interview (ZBI) and FCTI before the operation. Clinical, family and relevant data from children and parents were collected and subsequently analyzed. Results: Before the operation, the FCTI score and the ZBI score in the WeChat group were significantly lower than those in the control group (P=0.010, P=0.027, respectively). Compared to the FCTI score on the first visit, the preoperative status score was significantly lower in the WeChat group (P=0.008). The rate of loss to follow-up and complications in the WeChat group was also significantly lower than in the control group (P=0.003). Conclusion: Preoperative health education assisted by the WeChat platform for parents of children with simple congenital heart disease can effectively improve the parents' care ability and reduce the burden of care, preoperative complications and the rate of loss to follow-up.
Subject(s)
Humans , Child , Parents , Heart Defects, Congenital/surgery , Preoperative Care , Health Education , Prospective StudiesABSTRACT
The SARS-CoV-2 virus affects all age groups. According to the Colombian National Institute of Health, by November 5, 2020, nearly 83,698 children under 18 years of age had been infected by the virus in Colombia. The probability of viral transmission in this age group is similar to that found in adults, even in asymptomatic individuals 1,2. The World Health Organization has advocated social distancing, hand washing and the use of face masks as effective measures to mitigate contagion, and healthcare institutions have implemented measures for the protection of patients and healthcare workers in order to cope with this "new normal" at work 3-5. In accordance with national and international recommendations, our institution has implemented a new preoperative care protocol during the COVID-19 pandemic.
El virus SARS-CoV-2 afecta a todos los grupos de edad. Según el Instituto Nacional de Salud de Colombia, al 5 de noviembre de 2020, cerca de 83.698 niños menores de 18 años habían sido infectados por el virus en Colombia. La probabilidad de transmisión viral en este grupo de edad es similar a la encontrada en adultos, incluso en individuos asintomáticos 1 , 2 . La Organización Mundial de la Salud ha abogado por el distanciamiento social, el lavado de manos y el uso de mascarillas como medidas efectivas para mitigar el contagio, y las instituciones de salud han implementado medidas para la protección de pacientes y trabajadores de la salud para hacer frente a esta "nueva normalidad" en el trabajo. 3 - 5. De acuerdo con las recomendaciones nacionales e internacionales, nuestra institución ha implementado un nuevo protocolo de atención preoperatoria durante la pandemia de COVID-19.
Subject(s)
Humans , Child , Viruses , Risk , Pandemics , SARS-CoV-2 , Preoperative Care , Hand Disinfection , Health Personnel , Delivery of Health Care , Physical Distancing , COVID-19 , Health FacilitiesABSTRACT
Introducción: Una de las tareas básicas en las investigaciones es la realización de herramientas con contenidos acordes con el tema que se desea estudiar, lo cual puede solucionarse mediante los criterios de expertos, que permiten la confección de instrumentos confiables y su aplicabilidad en las ciencias biomédicas. Objetivo: Describir los resultados del proceso de selección de expertos para la validación teórica de los instrumentos utilizados en la estrategia de superación profesional de los cirujanos en el periodo preoperatorio mediato. Métodos: Se realizó un estudio cualitativo y cuantitativo en el Hospital General Docente Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba, desde diciembre de 2019 hasta marzo de 2021. El universo estuvo constituido por 25 expertos, a quienes se les aplicó el test de autovaloración y el método Delphi. Resultados: Se halló que 17 (68,0 %) doctores en ciencias obtuvieron coeficiente de competencia alto y 6 (24,0 %) medio, los cuales fueron seleccionados para validar los instrumentos y el programa docente de la investigación. Los expertos consideraron que en dichos instrumentos existió suficiencia claridad, coherencia y relevancia. A pesar de que no alcanzaron la calificación máxima, todos obtuvieron entre 3 y 4 puntos, por lo que no se realizaron cambios en los ítems. Conclusiones: La validación del contenido de los instrumentos sirvió para fortalecer las herramientas utilizadas en la investigación, la experiencia en la actividad profesional y en la función científico - investigativa.
Introduction: One of the basic tasks in the investigations is the realization of tools with contents according to the topic that is wanted to study, which can be solved by means of the experts criteria that allow the making of reliable instruments and their implementation in the biomedical sciences. Objective: To describe the results of the experts selection process for the theoretical validation of the instruments used in the strategy of the surgeons professional training during the mediate preoperative period. Methods: A qualitative and quantitative study was carried out at Dr. Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba, from December, 2019 to March, 2021. The universe was constituted by 25 experts to whom the self-appraisal test and Delphi method were applied. Results: It was found that 17 (68.0 %) doctors in science obtained high competence coefficient and 6 (24.0 %) mean competence coefficient, which were selected to validate the instruments and the teaching program of investigation. The experts considered that in this instruments existed sufficiency, clarity, coherence and relevance. Although they didn't reach the maximum qualification, all of them obtained between 3 and 4 points, reason why changes in the items were not carried out. Conclusion: The validation of the instruments content was good to strengthen the tools used in the investigation, the experience in the professional activity and in the scientist - investigative function.
Subject(s)
Professional Competence , Preoperative Care , Validation Study , Specialization , Surgeons/educationABSTRACT
Abstract Preoperative planning (PP) is critical to ensure a successful outcome in orthopaedic trauma surgery. Since it was first described thirty years ago, no modifications have been made to the original preoperative planning (OPP) technique, which was written by hand using pen and paper. We believe that the use of presentation software (such as Microsoft PowerPoint, Microsoft Corp., Redmond, WA, US) can ease, improve and update the OPP and complement three-dimensional PP. The objective of the present paper is to describe our method for PP using a presentation software (PS).
Resumo O planejamento pré-operatório (PP) é fundamental para garantir um resultado bemsucedido na cirurgia de trauma ortopédico. Desde que foi descrita pela primeira vez há trinta anos, não foram feitas modificações na técnica de planejamento pré-operatório original (PPO), que foi escrita à mão usando caneta e papel. Acreditamos que o uso de um software de apresentação (como o Microsoft PowerPoint, Microsoft Corp., Redmond, WA, EUA) pode facilitar, melhorar e atualizar o PPO e complementar o PP tridimensional. O objetivo deste artigo é apresentar nosso método de PP por meio de software de apresentação (SA).