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1.
San Salvador; MINSAL; dic. 10, 2021. 49 p. ilus.
Non-conventional in Spanish | LILACS, BISSAL | ID: biblio-1353185

ABSTRACT

El manual de procedimientos orienta los procesos a ejecutar en el desarrollo de las actividades que el profesional de odontología debe realizar, esto permite delimitar la responsabilidad de ejecución en los diferentes procedimientos de acuerdo al nivel de atención en salud, facilitar la realización de los mismos y consecuentemente contribuir a mejorar la calidad de la atención


The procedures manual guides the processes to be carried out in the development of the activities that the dental professional must carry out, this allows defining the responsibility of execution in the different procedures according to the level of health care, facilitating the realization of the same and consequently contribute to improving the quality of care


Subject(s)
Quality of Health Care , Dentistry , Standard of Care , Health Status , Methods
2.
Rev. argent. salud publica ; 13(Suplemento COVID-19): 1-9, 2021.
Article in Spanish | LILACS, BINACIS, ARGMSAL | ID: biblio-1349367

ABSTRACT

INTRODUCCIÓN: En Argentina, como en el resto de Latinoamérica, el sistema de salud está fragmentado; los mecanismos de coordinación (MC) entre niveles de atención son un insumo para su mejora. El objetivo fue analizar, como parte del proyecto EQUITY LA II, el conocimiento y uso de MC entre niveles de atención en médicos de atención primaria (AP) y especializada (AE) en la red de Salud Municipal de Rosario, y sus cambios entre 2015 y 2017. MÉTODOS: Se realizó un estudio transversal con aplicación del cuestionario COORDENA Argentina a médicos de AP y AE. Se encuestó a 350 médicos en 2015 y a 352 en 2017. Las variables fueron nivel de conocimiento, frecuencia, finalidad y dificultades en el uso de los MC de información (MCI): hoja de referencia/contrarreferencia-interconsulta (HR/CR), informe de alta hospitalaria, teléfono; y los MC de gestión clínica (MCGC): guías de práctica clínica (GPC) y reuniones conjuntas. Se efectuó un análisis comparativo entre años y niveles. RESULTADOS: En 2015 la mayoría conocía MCI, aunque hubo diferentes porcentajes de uso según niveles de atención. Los MCGC eran menos conocidos, pero muy usados entre quienes los conocían. Hubo cambios significativos en 2017: disminuyó el envío de CR y el uso del teléfono en AP, y aumentó el conocimiento de reuniones conjuntas y de GPC (solo entre AP). DISCUSIÓN: Existen diferencias en la implementación de MC entre niveles. La adecuación al contexto local es clave para lograr una efectiva y eficiente implementación.


Subject(s)
Argentina , Quality of Health Care , Standard of Care
3.
Saúde Soc ; 30(1): e200380, 2021.
Article in Portuguese | LILACS | ID: biblio-1252192

ABSTRACT

Resumo A humanização do cuidado tem sido um desafio presente no campo da saúde em geral e no Sistema Único de Saúde brasileiro. O objetivo deste artigo é discutir o constructo sociológico de cuidado emancipador. Enquanto o cuidado tem forte identificação com o senso comum e com os conhecimentos tácitos, a prática clínica biomédica associou-se ao conhecimento científico resultante de uma ruptura epistemológica racionalista. O cuidado emancipador é uma hibridização entre senso comum e conhecimento científico, ou cuidado e clínica, sustentado pelo posicionamento ético-político do profissional, para a substituição da heteronomia pela autonomia no processo de saúde-doença-cuidado. A intencionalidade deste artigo é apresentar uma perspectiva inovadora sobre a discussão do cuidado, que não é nova, trazendo algumas referências históricas, não com o propósito de desenvolver uma análise epocalista ou cronológica. O objetivo é alargar o espaço de reflexões sobre os cuidados heterônomos como um evento hegemônico da cultura contemporânea, bem como ampliar os debates sobre as possibilidades de construção de práticas de cuidado que privilegiem a autonomia das pessoas e apontem para a sua emancipação. Conclui-se que o conceito de cuidado emancipador pode fazer avançar uma segunda ruptura epistemológica com o desenvolvimento de práticas emancipadoras no processo saúde-doença-cuidado.


Abstract The humanization of care has been a present challenge in the field of health in general and in the Brazilian Unified Health System. The purpose of this article is to discuss the sociological construct of emancipating care. While care is strongly identified with common sense and tacit knowledge, biomedical clinical practice has been associated with scientific knowledge resulting from a rationalist epistemological rupture. Emancipatory care is a hybridization between common sense and scientific knowledge, or care and clinic, supported by the professional's ethical-political position, to replace heteronomy with autonomy in the health-disease-care process. The purpose of this article is to present an innovative perspective on the discussion of care, which is not new, bringing some historical references, not with the purpose of developing an epochalist or chronological analysis. The objective is to expand the space for reflections on heteronomous care as a hegemonic event in contemporary culture, as well as to expand the debates on the possibilities of building care practices that privilege people's autonomy and point to their emancipation. It is concluded that the concept of emancipating care can advance a second epistemological rupture with the development of emancipating practices in the health-disease-care process.


Subject(s)
Humans , Male , Female , Sociology, Medical , Unified Health System , Public Health , Culture , Humanization of Assistance , Standard of Care , Healthcare Models
4.
SMAD, Rev. eletrônica saúde mental alcool drog ; 16(3): 33-43, jul.-set. 2020. ilus
Article in Portuguese | LILACS, INDEXPSI | ID: biblio-1150189

ABSTRACT

OBJETIVO: avaliar a efetividade de uma intervenção para redução de estresse baseada em Mindfulness em aspectos relacionados à Qualidade de Vida, Atenção Plena e Estresse Percebido, em estudantes de graduação e pós-graduação em enfermagem. MÉTODO: aplicados instrumentos de avaliação para a construção de uma linha basal e posteriormente a amostra foi submetida a um Programa de Redução de Estresse e aumento da Qualidade de Vida baseado em Mindfulness, formatado em encontros semanais por oito semanas. RESULTADOS: após a intervenção, houve diminuição do nível de Estresse Percebido, aumento do nível de Atenção Plena e melhora da Qualidade de Vida em âmbito psicológico. CONCLUSÃO: intervenções baseadas em Mindfulness se mostram efetivas e podem constituir um importante recurso para o gerenciamento do estresse e melhora na Qualidade de Vida dos estudantes.


OBJECTIVE: to evaluate the effectiveness of an intervention to reduce stress based on Mindfulness in aspects related to Quality of Life, Mindfulness and Perceived Stress in undergraduate and postgraduate students of Nursing. METHOD: evaluation instruments were applied to establish baseline data, and the sample was subsequently submitted to a Mindfulness Based Stress Reduction and Quality of Life, formatted eight consecutive weeks. RESULTS: after the intervention, there was a decrease in the level of Perceived Stress, increase in the level of Mindfulness and improvement of the Quality of Life in the psychological area. CONCLUSION: interventions based in Mindfulness are effective and can offer important resources for managing stress and improving the Quality of Life of students.


OBJETIVO: evaluar la efectividad de una intervención para reducción de estrés basada en Mindfulness en relación a la Calidad de Vida, Atención Plena y Estrés Percibido, en universitarios y estudiantes de postgrado de Enfermería. MÉTODO: previamente se aplicaron instrumentos de evaluación para la construcción de una línea basal y posteriormente la muestra fue sometida a un Programa de Reducción de Estrés y aumento de la Calidad de Vida basado en Mindfulness, constituído de encuentros semanales, durante ocho semanas consecutivas. RESULTADOS: se observó que después de la intervención, hubo disminución del nivel de Estrés Percibido, aumento del nivel de Atención Plena y mejora de la Calidad de Vida en ámbito psicológico. CONCLUSIÓN: intervencones basadas en Mindfulness se muestran efectivas y pueden constituir un importante recurso para manejar el estrés y mejorar la Calidad de Vida de los estudiantes.


Subject(s)
Humans , Male , Female , Quality of Life , Students, Nursing , Effectiveness , Standard of Care , Mindfulness , Health Resources
5.
Rev. colomb. cancerol ; 24(2): 80-87, abr.-jun. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1144324

ABSTRACT

Resumen Objetivo: Describir las características sociodemográficas y clínicas de los pacientes adultos con diagnóstico de cáncer atendidos en el Hospital Universitario San José (HUSJ) de Popayán, Colombia. Métodos: Estudio observacional con datos rutinarios de cáncer que incluyó pacientes mayores de 18 años atendidos entre 2012 y 2017 en los servicios de urgencias y hospitalización con diagnóstico de cáncer, según el Manual CIE 10 (Clasificación Internacional de Enfermedades, décima versión) en el HUSJ. Se aplicó una estrategia de muestreo aleatorio simple con afijación proporcional por años y se analizaron de forma descriptiva y gráfica. Resultados: Se incluyeron 245 pacientes. El 51% de los cuales correspondió al género femenino y la mediana de edad fue de 64 años. El cáncer más frecuente en ambos sexos fue el de estómago, seguido por el cáncer de ovario y cérvix en mujeres y por el cáncer de próstata, de tejido sanguíneo y de médula ósea en hombres. Los tipos histológicos de cáncer registrados en la mayoría de los pacientes fueron los carcinomas y adenocarcinomas. En el 36,7% de los pacientes se documentó la presencia de metástasis. La mortalidad durante la última hospitalización fue del 20% y el 12% de los pacientes requirieron remisión a otro nivel de atención superior. Conclusión: Los resultados de este estudio muestran similitudes con el comportamiento de la enfermedad en el país, con excepción del cáncer ginecológico. Adicionalmente, aporta información valiosa tanto a nivel regional como a la institución y crea conciencia de la necesidad de la implementación y mantenimiento de registros hospitalarios de cáncer.


Abstract Objective: To describe the socio-demographic and clinical characteristics of adult cancer patients who received treatment at the San José University Hospital (HUSJ) in Popayán, Colombia. Methods: Observational study with routine cancer data, which included patients aged over 18 years, who received treatment between 2012 and 2017 in the emergency and hospitalization departments, with cancer diagnosis according to the ICD Manual 10 (International Statistical Classification of Diseases, tenth revision) in the HUSJ. It was applied a simple random sampling strategy, with proportional allocation by years, and they were analyzed descriptively and graphically. Results: 245 patients were included, 51% of which corresponded to female gender; median age, 64 years. The most frequent cancer in both sexes was stomach cancer, followed by ovary cancer and cervix cancer in women; and cancer of the prostate, blood tissue, and bone marrow in men. The histological types of cancer registered in most of the patients were carcinomas and adenocarcinomas. The presence of metastases was documented in 36.7% of the patients. The mortality during the last hospitalization was 20%; and 12% of patients required referral to another higher level of care. Conclusion: The results of this study show similarities with the behavior of the disease in the country, with the exception of gynecological cancer. Additionally, it provides valuable information both regionally and at institution level, as well as it raises awareness of the need for the implementation and maintenance of hospital cancer records.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Young Adult , Standard of Care , Hospitals, University , Neoplasms/epidemiology , Colombia/epidemiology
6.
SMAD, Rev. eletrônica saúde mental alcool drog ; 16(2): 25-33, abr.-jun. 2020. ilus, tab
Article in Portuguese | LILACS, INDEXPSI | ID: biblio-1127295

ABSTRACT

OBJETIVO: analisar a relação entre o nível de atenção plena e o uso problemático de álcool e drogas em pessoas em situação de rua. MÉTODO: foi realizado um estudo de corte transversal com 40 usuários de um serviço de convivência de adultos em situação de rua ou de abrigamento. Eles foram entrevistados utilizando-se as escalas MAAS (Mindful Attention Awareness Scale ou Escala de Consciência e Atenção Mindfulness, em português), CAGE (acrônimo referente às suas quatro perguntas em inglês: Cut down, Annoyde by criticims, Guilty e Eye-opener) e AUDIT (Alcohol Use Disorders Identification Test), além de um questionário sociodemográfico. RESULTADOS: evidenciam alta prevalência de abuso de substâncias nessa amostra e mostraram correlação negativa entre o uso problemático de álcool e drogas e o nível de atenção plena, o que indica que baixos níveis de mindfulness podem ser um fator de risco para a população adicta. CONCLUSÃO: o uso de meditação em intervenções com essa população é sugerido.


OBJECTIVE: to analyze the relationship between mindfulness traits and problematic use of alcohol and other drugs. METHODS: a cross-sectional study was conducted with 40 users of a coexistence service for adults living in the streets or shelters. They answered, during an interview, the MAAS scale (Mindful Attention Awareness Scale), CAGE (Cut down, Annoyde by criticims, Guilty and Eye-opener) and AUDIT (Alcohol Use Disorders Identification Test), as well as a sociodemographic questionnaire. RESULTS: high prevalence of substance abuse in this sample, and a negative correlation between the problematic use of alcohol and drugs and the level of mindfulness, which may indicate that low levels of mindfulness may be a risk factor for the addicted population. CONCLUSION: the use of meditation in interventions with this population is suggested.


OBJETIVO: analizar la relación entre el nivel de atención plena y el uso problemático de alcohol y drogas en personas en situación de calle. MÉTODO: estudio de corte transversal con 40 usuarios de un servicio de convivencia de adultos en situación de calle o de refugio. Contestaron, durante una entrevista, las escalas MAAS (Mindful Attention Awareness Scale), CAGE (Cut down, Annoyde by criticims, Guilty and Eye-opener) y AUDIT (Alcohol Use Disorders Identification Test), así como un cuestionario sociodemográfico. RESULTADOS: alta prevalencia de abuso de sustancias en esta muestra y mostraron una correlación negativa entre el uso problemático de alcohol y drogas y el nivel de atención plena, lo que indica que bajos niveles de mindfulness pueden ser un factor de riesgo para la población adicta. CONCLUSION: se sugiere el uso de meditación en intervenciones con esa población.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Awareness , Tobacco Use Disorder , Homeless Persons , Surveys and Questionnaires , Risk Factors , Substance-Related Disorders , Shelter , Alcoholism , Consumption of Tobacco-Derived Products , Standard of Care , Mindfulness
7.
Article in English | WPRIM | ID: wpr-811216

ABSTRACT

OBJECTIVE: To compare patient survival outcomes between completion hysterectomy and conventional surveillance in locally advanced adenocarcinoma of the cervix after concurrent chemoradiotherapy (CCRT).METHODS: Patients with adenocarcinoma of the cervix after CCRT were identified in a tertiary academic center database from 2004 to 2018. Patients received completion hysterectomy or surveillance after CCRT. We compared the progression-free survival (PFS) and overall survival (OS) between the patients with or without adjuvant hysterectomy. Surgery features, operative complications, and pathologic characteristics were documented. Patient outcomes were also analyzed according to clinicopathologic factors.RESULTS: A total of 78 patients were assigned to completion surgery and 97 to surveillance after CCRT. The PFS was better in the surgery group compared to the CCRT only group, at 3 years the PFS rates were 68.1% and 45.2%, respectively (hazard ratio [HR]=0.46; 95% confidence interval [CI]=0.282–0.749; p=0.002). Adjuvant surgery was also associated with a higher rate of OS (HR=0.361; 95% CI=0.189–0.689; p=0.002), at 3 years, 87.9% and 67%, respectively. Tumor stage, size, lymph-vascular space invasion (LVSI), lymphadenopathy were associated with PFS but not with OS. Hysterectomy specimens revealed 64.1% (50/78) of the patients had pathologic residual tumor. Patients age less than 60, tumor size over 4 cm, stage IIB and persistent residual disease after CCRT were most likely to benefit from hysterectomy. Hysterectomy was associated with a lower rate of locoregional recurrence but did not reach statistical significance (5.13% vs. 13.5%, p=0.067).CONCLUSION: Completion hysterectomy after CCRT was associated with better survival outcome compared with the current standard of care.


Subject(s)
Adenocarcinoma , Cervix Uteri , Chemoradiotherapy , Disease-Free Survival , Female , Humans , Hysterectomy , Lymphatic Diseases , Neoplasm, Residual , Recurrence , Standard of Care , Uterine Cervical Neoplasms
10.
Rev. colomb. psiquiatr ; 48(4): 222-231, oct.-dic. 2019. tab, graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1098947

ABSTRACT

RESUMEN Introducción: La somnolencia diurna excesiva (SDE) puede llegar a interferir en el desempeño académico y profesional, debido a que las personas afectadas tienden a quedarse dormidas en situaciones que exigen un alto nivel de atención. Los estudiantes de Medicina representan una población en riesgo de SDE, dada la exigencia académica de numerosas horas de estudio, debido al gran número de créditos por asignatura contenidos en el plan de estudios del programa académico, las prácticas docentes asistenciales y los turnos nocturnos, que pueden generar privación o déficit acumulado del sueño. Por esta razón, es importante estimar la prevalencia de SDE y los factores asociados en estudiantes de Medicina de una institución de educación superior (IES) de Bucaramanga, con el objetivo de implementar estrategias de prevención primaria que disminuyan la presentación de este problema y mejoren la calidad de vida y el desempeño académico de los estudiantes. Material y métodos: Estudio transversal analítico observacional, con una muestra poblacional de 458 estudiantes de Medicina matriculados en el segundo semestre de 2015 en la Universidad Autónoma de Bucaramanga (UNAB), quienes respondieron a 4 cuestionarios: variables sociodemográficas, escala de somnolencia de Epworth, índice de calidad del sueño de Pittsburg (ICSP) e índice de higiene del sueño (IHS). Se realizó el análisis bivariable y multivariable en busca de asociación con SDE. Resultados: Los estudiantes tenían una media de edad de 20,3 arios; de los 458 encuestados, el 62,88% eran mujeres. Se estableció que el 80,75% de los participantes tenían SDE y el 80,55%, una percepción negativa de la calidad del sueño (OR = 1,91;IC95%, 1,11-3,29; p = 0,019). En el análisis multivariable, se encontró que el hecho de estar cursando ciencias clínicas disminuye el riesgo de SDE respecto a quienes estaban cursando el ciclo básico. Además, se observó que una puntuación > 15 en el IHS aumenta de manera significativa el riesgo de padecer SDE. Conclusiones: Aunque es frecuente encontrar SDE en los estudiantes de Medicina, solo un pequeño porcentaje de ellos sufren la forma severa de este trastorno del sueño. Estar cursando asignaturas del ciclo básico se asocia con mayor riesgo de SDE, por lo cual es importante que los comités curriculares de las IES evalúen regularmente la cantidad de horas de trabajo supervisado e independiente que realizan los estudiantes de Medicina. Finalmente, es importante emprender campañas orientadas a mejorar la percepción de riesgo sobre el uso de bebidas energizantes de los estudiantes universitarios y realizar, desde el ingreso al programa académico, recomendaciones sobre los hábitos de higiene del sueño.


ABSTRACT Introduction: Excessive daytime sleepiness (EDS) can interfere with academic and professional performance, as affected individuals tend to fall asleep in situations that demand a high level of alertness. Medical students are often a population at risk of suffering from EDS due to the demanding number of study hours, the significant number of credits per subject in the academic curriculum, practical teaching sessions and hospital night shifts, which can lead to sleep deprivation or sleep debt. It is for these reasons that it is important to estimate the prevalence of EDS and its associated factors in medical students of a Higher Education Institution (HEI) in Bucaramanga, in order to implement early prevention strategies to reduce the occurrence of this problem and to improve the students' quality of life and academic performance. Material and methods: An observational, cross-sectional analytical study with a population sample of 458 medical students enrolled in the second semester of 2015 at the Universidad Autonomade Bucaramanga (UNAB), who completed four questionnaires: Sociodemographic Variables, Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index and Sleep Hygiene Index (SHI). A bivariate and multivariate analysis was performed to identify any correlations with EDS. Results: Mean student age was 20.3 years and 62.88% of the 458 respondents were women. We were able to establish that 80.75% of participants suffered from EDS and 80.55% had a negative perception of their sleep quality (OR=1.91; 95% CI, 1.11-3.29; p =0.019). In the multivariate analysis, it was found that the risk of EDS is lower in the clinical sciences than in the basic cycle. Furthermore, it was noted that a score higher than 15 in the Sleep Hygiene Index significantly increases the risk of suffering from EDS. Conclusions: Although EDS is very common in medical students, only a small percentage present the most severe form of this sleep disorder. Being enrolled in basic cycle subjects is associated with a higher risk of suffering EDS, so it is important for the curriculum committees of higher education institutions to regularly evaluate the number of hours of supervised and independent work performed by medical students. Finally, it is important to implement campaigns aimed at improving university students' perception of the risk of taking energy drinks and to establish sleep hygiene recommendations from the start of the academic programme.


Subject(s)
Humans , Male , Female , Adult , Sleep Wake Disorders , Students, Medical , Sleep Hygiene , Sleepiness , Perception , Quality of Life , Sleep , Sleep Deprivation , Stress, Psychological , Work , Work Hours , Risk , Multivariate Analysis , Higher Education Institutions , Standard of Care , Energy Drinks
11.
Rev. bras. ter. intensiva ; 31(4): 561-570, out.-dez. 2019. tab
Article in Portuguese | LILACS | ID: biblio-1058048

ABSTRACT

RESUMO O programa de transplante de fígado teve início em nosso centro em 1992, e pacientes em pós-operatório de transplante hepático ainda são admitidos à unidade de terapia intensiva. Uma curva de aprendizado do médico intensivista teve então início, com aquisição de habilidades e estabelecimento de uma prática específica. Contudo, muitos dos conceitos se modificaram com o tempo, o que conduziu a uma melhora nos cuidados proporcionados a esses pacientes. A abordagem prática varia entre diferentes centros de transplante de fígado, segundo especificidades locais. Assim, ensejamos apresentar nossa prática para estimular o debate entre diferentes equipes dedicadas, o que tem potencial de permitir a introdução de novas ideias e, possivelmente, melhorar o padrão de cuidados em cada instituição.


ABSTRACT The liver transplant program in our center started in 1992, and post-liver transplant patients are still admitted to the intensive care unit. For the intensive care physician, a learning curve started then, skills were acquired, and a specific practice was established. Throughout this time, several concepts changed, improving the care of these patients. The practical approach varies between liver transplant centers, according to local specificities. Hence, we wanted to present our routine practice to stimulate the debate between dedicated teams, which can allow the introduction of new ideas and potentially improve each local standard of care.


Subject(s)
Humans , Postoperative Care/methods , Liver Transplantation/methods , Critical Care/methods , Postoperative Care/standards , Postoperative Period , Clinical Competence , Critical Care/standards , Standard of Care , Intensive Care Units
13.
Journal of Stroke ; : 231-240, 2019.
Article in English | WPRIM | ID: wpr-766240

ABSTRACT

Endovascular recanalization therapy (ERT) has been a standard of care for patients with acute ischemic stroke due to large artery occlusion (LAO) within 6 hours after onset, since five landmark ERT trials conducted by 2015 demonstrated its clinical benefit. Recently, two randomized clinical trials demonstrated that ERT, even in the late time window of up to 16 hours or 24 hours after last known normal time, improved the outcome of patients who had a target mismatch, defined as either clinical-core mismatch or perfusion-core mismatch, which prompted the update of national guidelines in several countries. Accordingly, to provide evidence-based and up-to-date recommendations for ERT in patients with acute LAO in Korea, the Clinical Practice Guidelines Committee of the Korean Stroke Society decided to revise the previous Korean Clinical Practice Guidelines of Stroke for ERT. For this update, the members of the writing group were appointed by the Korean Stroke Society and the Korean Society of Interventional Neuroradiology. After thoroughly reviewing the updated evidence from two recent trials and relevant literature, the writing members revised recommendations, for which formal consensus was achieved by convening an expert panel composed of 45 experts from the participating academic societies. The current guidelines are intended to help healthcare providers, patients, and their caregivers make well-informed decisions and to improve the quality of care regarding ERT. The ultimate decision for ERT in a particular patient must be made in light of circumstances specific to that patient.


Subject(s)
Arteries , Caregivers , Cerebral Infarction , Consensus , Health Personnel , Humans , Korea , Mechanical Thrombolysis , Reperfusion , Standard of Care , Stroke , Writing
14.
Article in English | WPRIM | ID: wpr-763603

ABSTRACT

BACKGROUND: Traditionally, conservative management with an offloading orthosis, such as total contact cast (TCC), has been the standard of care for midfoot Charcot arthropathy. Considering complications of TCC and surgery, we treated midfoot Charcot arthropathy without TCC in our patients. The purpose of this study was to report clinical and radiological outcomes of conservative management of midfoot Charcot arthropathy. METHODS: A total of 34 patients (38 feet) who were diagnosed as having midfoot Charcot arthropathy between 2006 and 2014 were included. Patients started full weight bearing ambulation in a hard-soled shoe immediately after diagnosis. Outcomes such as progression of arch collapse, bony prominence, ulcer occurrence, limb amputation, and changes in Charcot stage were evaluated. RESULTS: Of 38 feet, arch collapse was observed in four while progression of bottom bump of the midfoot was observed in five feet. Foot ulcers related to bony bumps were found in two feet. CONCLUSIONS: Conservative treatment without restriction of ambulation is recommended for midfoot Charcot arthropathy because it is rarely progressive, unlike hindfoot-ankle arthropathy. In some cases, simple bumpectomy can be required to prevent catastrophic infection.


Subject(s)
Amputation , Arthropathy, Neurogenic , Diagnosis , Extremities , Foot , Foot Ulcer , Humans , Orthotic Devices , Shoes , Standard of Care , Ulcer , Walking , Weight-Bearing
15.
Clinical Endoscopy ; : 220-225, 2019.
Article in English | WPRIM | ID: wpr-763439

ABSTRACT

Endoscopic transpapillary biliary drainage is the current standard of care for unresectable hilar malignant biliary obstruction (MBO) and bilateral metal stent placement is shown to have longer patency. However, technical and clinical failure is possible and percutaneous transhepatic biliary drainage (PTBD) is sometimes necessary. Endoscopic ultrasound-guided biliary drainage (EUS-BD) is increasingly being reported as an alternative rescue procedure to PTBD. EUS-BD has a potential advantage of not traversing the biliary stricture and internal drainage can be completed in a single session. Some approaches to bilateral biliary drainage for hilar MBO under EUS-guidance include a bridging method, hepaticoduodenostomy, and a combination of EUS-BD and transpapillary biliary drainage. The aim of this review is to summarize data on EUS-BD for hilar MBO and to clarify its advantages over the conventional approaches such as endoscopic transpapillary biliary drainage and PTBD.


Subject(s)
Constriction, Pathologic , Drainage , Endosonography , Methods , Standard of Care , Stents
16.
Article in English | WPRIM | ID: wpr-762851

ABSTRACT

Median sternotomy is the most popular approach in cardiac surgery. Post-sternotomy wound complications are rare, but the occurrence of a deep sternal wound infection (DSWI) is a catastrophic event associated with higher morbidity and mortality, longer hospital stays, and increased costs. A literature review was performed by searching PubMed from January 1996 to August 2017 according to the guidelines in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The following keywords were used in various combinations: DSWI, post-sternotomy complication, and sternal reconstruction. Thirty-nine papers were included in our qualitative analysis, in which each aspect of the DSWI-related care process was analyzed and compared to the actual standard of care. Plastic surgeons are often involved too late in such clinical scenarios, when previous empirical treatments have failed and a definitive reconstruction is needed. The aim of this comprehensive review was to create an up-to-date operative flowchart to prevent and properly treat sternal wound infection complications after median sternotomy.


Subject(s)
Length of Stay , Mortality , Plastics , Reconstructive Surgical Procedures , Software Design , Standard of Care , Sternotomy , Sternum , Surgeons , Thoracic Surgery , Wound Infection , Wounds and Injuries
17.
Annals of Coloproctology ; : 242-248, 2019.
Article in English | WPRIM | ID: wpr-762332

ABSTRACT

PURPOSE: Currently, neoadjuvant chemoradiation (CRT) followed by total mesorectal resection is considered the standard of care for treating locally advanced rectal cancer. This study aimed to investigate the efficacy and feasibility of adding induction chemotherapy to neoadjuvant CRT in locally advanced rectal cancer. METHODS: This phase-II clinical trial included 54 patients with newly diagnosed, locally advanced (clinical T3–4 and/or N1–2, M0) rectal cancer. All patients were treated with 3 cycles of preoperative chemotherapy using the XELOX (capecitabine + oxaliplatin) regimen before and after a concurrent standard long course of CRT (45–50.4 Gy) followed by standard radical surgery. Pathologic complete response (PCR) rate and toxicity were the primary and secondary end-points, respectively. RESULTS: The study participants included 37 males and 17 females, with a median age of 59 years (range, 20–80 years). Twenty-nine patients (54%) had clinical stage-II disease, and 25 patients (46%) had clinical stage-III disease. Larger tumor size (P = 0.006) and distal rectal location (P = 0.009) showed lower PCR compared to smaller tumor size and upper rectal location. Pathologic examinations showed significant tumor regression (6.1 ± 2.7 cm vs. 1.9 ± 1.8 cm, P < 0.001) with 10 PCRs (18.5%) compared to before the intervention. The surgical margin was free of cancer in 52 patients (96.3%). Treatment-related toxicities were easily tolerated, and all patients completed their planned treatment without interruption. Grade III and IV toxicities were infrequent. CONCLUSION: The addition of induction chemotherapy to neoadjuvant CRT is an effective and well-tolerated treatment approach in patients with rectal cancer.


Subject(s)
Drug Therapy , Female , Humans , Induction Chemotherapy , Male , Neoadjuvant Therapy , Polymerase Chain Reaction , Rectal Neoplasms , Standard of Care
18.
Article in English | WPRIM | ID: wpr-762296

ABSTRACT

The current standard of care for treating patients with locally advanced rectal cancer includes preoperative chemoradiation therapy (PCRT) followed by a total mesorectal excision and postoperative adjuvant chemotherapy. A subset of these patients has achieved a pathologic complete response (pCR) and they have shown improved disease-free and overall survival compared to non-pCR patients. Thus, many efforts have been made to achieve a higher pCR through PCRT. In this review, results from various ongoing and recently completed clinical trials that are being or have been conducted with an aim to improve tumor response by modifying therapy will be discussed.


Subject(s)
Chemotherapy, Adjuvant , Disease-Free Survival , Humans , Polymerase Chain Reaction , Rectal Neoplasms , Standard of Care
19.
Article in English | WPRIM | ID: wpr-762008

ABSTRACT

Acute limb ischemia (ALI) represents one of the most common emergent scenarios encountered by a vascular specialist. Despite expedient revascularization, high rates of limb loss are reported along with high mortality rates which are second only to ruptured abdominal aortic aneurysms. Surgical revascularization is standard of care. Endovascular techniques as an alternative have emerged to be appropriate first line therapy when addressing the threatened limb. We review the etiology and classification of ALI and current endovascular techniques and evidence to date in the management of patients acutely presenting with extremity ischemia.


Subject(s)
Aortic Aneurysm, Abdominal , Classification , Embolism and Thrombosis , Endovascular Procedures , Extremities , Humans , Ischemia , Mortality , Peripheral Arterial Disease , Specialization , Standard of Care
20.
Article in English | WPRIM | ID: wpr-761954

ABSTRACT

Although recent advances in molecular targeted therapy and immuno-oncology have revolutionized the landscape of lung cancer therapeutics, cytotoxic chemotherapy remains an essential component of lung cancer treatment. Extensive evidence has demonstrated the clinical benefit of chemotherapy, either alone or in combination with other treatment modalities, on survival and quality of life of patients with early and advanced lung cancer. Combinational approaches with other classes of anti-neoplastic agents and new drug-delivery systems have revealed promising data and are areas of active investigation. Chemotherapy is recommended as a standard of care in patients that have progressed after tyrosine kinase inhibitors or immune checkpoint inhibitors. Chemotherapy remains the fundamental means of lung cancer management and keeps expanding its clinical implication. This review will discuss the current position and future role of chemotherapy, and specific consideration for its clinical application in the era of precision medicine.


Subject(s)
Drug Therapy , Humans , Immunotherapy , Lung Neoplasms , Lung , Molecular Targeted Therapy , Precision Medicine , Protein-Tyrosine Kinases , Quality of Life , Standard of Care
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