ABSTRACT
GENERAL PURPOSE: To review a practical and scientifically sound application of the wound bed preparation model for communities without ideal resources. TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and registered nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After participating in this educational activity, the participant will:1. Summarize issues related to wound assessment.2. Identify a class of drugs for the treatment of type II diabetes mellitus that has been shown to improve glycemia, nephroprotection, and cardiovascular outcomes.3. Synthesize strategies for wound management, including treatment in resource-limited settings.4. Specify the target time for edge advancement in chronic, healable wounds.
Chronic wound management in low-resource settings deserves special attention. Rural or underresourced settings (ie, those with limited basic needs/healthcare supplies and inconsistent availability of interprofessional team members) may not have the capacity to apply or duplicate best practices from urban or abundantly-resourced settings. The authors linked world expertise to develop a practical and scientifically sound application of the wound bed preparation model for communities without ideal resources. A group of 41 wound experts from 15 countries reached a consensus on wound bed preparation in resource-limited settings. Each statement of 10 key concepts (32 substatements) reached more than 88% consensus. The consensus statements and rationales can guide clinical practice and research for practitioners in low-resource settings. These concepts should prompt ongoing innovation to improve patient outcomes and healthcare system efficiency for all persons with foot ulcers, especially persons with diabetes.
Subject(s)
Diabetes Mellitus, Type 2 , Diabetic Foot , Foot Ulcer , Humans , Delphi Technique , Diabetes Mellitus, Type 2/therapy , Diabetic Foot/diagnosis , Diabetic Foot/therapy , Resource-Limited SettingsABSTRACT
Introducción: El tratamiento de las escoliosis de inicio temprano guiado con barras magnéticas permite realizar distracciones no invasivas y ambulatorias. El objetivo de este estudio fue evaluar nuestra primera serie de casos con escoliosis de inicio temprano tratados con el sistema de barras magnéticas. Materiales y Métodos: Se realizó una revisión de casos tratados con el sistema de barras magnéticas entre 2014 y 2018. Se formaron dos grupos: grupo I (procedimientos primarios con barras magnéticas) y grupo II (conversiones de sistema tradicional a barras magnéticas). Resultados: Se evaluó a 19 pacientes. La edad promedio en el momento de la cirugía era de 7 años y 4 meses, con un seguimiento promedio de 2 años y 7 meses. El grupo I tenía 12 pacientes y el grupo II, 7 pacientes. Los valores angulares promedio preoperatorio y posoperatorio inmediato de la escoliosis fueron 62° y 42°, respectivamente; los de cifosis, 49° y 34°, respectivamente. La distancia T1-T12 fue de 160 a 176 mm. La distancia T1-S1 fue de 285 a 317 mm. Hubo una complicación: protrusión del implante e infección, y fue necesario retirar el material (grupo II). Conclusiones: Los resultados preliminares sugieren que es un método seguro y eficaz. Si bien los resultados a corto y mediano plazo son alentadores, persisten algunos desafíos importantes e incógnitas en relación con el comportamiento mecánico del implante en un seguimiento prolongado. Nivel de Evidencia: IV
Introduction: Early onset scoliosis (EOS) treatment with the magnetically controlled growing rod (MCGR) system allows for the use of non-invasive outpatient distractions. The purpose of this study was to assess our first series of EOS patients treated with MCGRs. Materials and methods: We conducted a review of EOS cases treated with MCGRs between 2014 and 2018. The study population was divided into two groups: Group I, patients undergoing primary MCGR insertion; Group II, patients undergoing conversion from conventional growth system to MCGR. Results: The study population consisted of 19 patients. The average age at the time of surgery was 7 years and 4 months, with an average post-operative follow-up of 2 years and 7 months. Group I consisted of 12 patients and Group II of 7 patients. The mean preoperative scoliosis angle was 62° and immediate postoperatively was 42°. The mean preoperative kyphosis angle was 49°and immediate postoperatively was 34°. The average preoperative T1-T12 length was 160mm and immediate postoperatively was 176mm. The average preoperative T1-S1 length was 285mm and immediate postop-eratively was 317mm. There was 1 late complication, an implant protrusion with an associated infection, in a neuropathic scoliosis patient (Group II) who required implant removal. Conclusion: Our preliminary results suggest that the MCGR system is a safe and effective method. Although the short- and medium-term results are encouraging, further studies are warranted to overcome important and unknown challenges regarding the mechanical behavior of the implant in the long term. Nivel de Evidencia: IV
Subject(s)
Child, Preschool , Child , Scoliosis , Treatment Outcome , Orthopedic ProceduresABSTRACT
INTRODUCCIÓN: El cuidado de un familiar dependiente implica un alto riesgo para el cuidador quien se ve propenso a padecer diversas alteraciones. Institutos Teletón a partir del año 2017 implementó el programa Cuidar Cuidándote, que trabaja con cuidadoras de personas dependientes, a través de un acompañamiento domiciliario en actividades de promoción del autocuidado, actividades de respiro y vinculación con la comunidad. OBJETIVO: Evaluar la efectividad del programa "Cuidar Cuidándote" del voluntariado Teletón, en la calidad de vida, sobrecarga y apoyo social de las cuidadoras de niños, niñas y jóvenes en situación de discapacidad con compromiso funcional severo, durante los años 2017 y 2018. METODOLOGÍA: Estudio experimental aleatorizado simple ciego de evaluación de intervención psicosocial en 25 cuidadoras de niños, niñas y adolescentes con discapacidad severa del Instituto Teletón Santiago. Se trabajó en dos grupos, el grupo experimental participó del programa Cuidar Cuidándote recibiendo 13 visitas domiciliarias, y el grupo control no participó del programa, quedando en lista de espera. Para la evaluación de la intervención se realizaron pruebas de calidad de vida, sobrecarga del cuidador y apoyo social percibido antes y después de la intervención. RESULTADOS: Se observó una disminución estadísticamente significativa (promedio de 11,6 puntos en escala de Zarit) en la sobrecarga en cuidadoras de grupo de intervención. No se encontraron diferencias estadísticamente significativas para apoyo social y calidad de vida. CONCLUSIÓN: El programa "Cuidar Cuidándote" logra disminuir el nivel de sobrecarga de las cuidadoras de niños, niñas y adolescentes con discapacidad severa.
INTRODUCTION: Caring for a dependent family member carries a high risk for the caregiver, who is prone to experiencing diverse disorders. In 2017, Teleton introduced the program "Cuidar Cuidándote", which offers in-home services for caregivers assisting dependent family members, providing support in activities to promote self-care, community involvement and respite care. OBJECTIVE: to do an assessment of the effectiveness of "Cuidar Cuidándote" program of Teleton's volunteer team, in terms of quality of life, work overload and social support for caregivers of children and young people with disabilities and severe functional impairment during 2017 and 2018. METHOD: A single-blind randomized experimental study to assess the psychosocial intervention in 25 caregivers of children and teenagers with severe disabilities, users of Instituto Teletón-Santiago. Caregivers were separated in two groups: an experimental group that participated in the "Cuidar Cuidándote" program including 13 home visits, and a control group that received no home visits. the effectiveness of the intervention was measured through different tests, such as quality of life, work overload, and social support as perceived before and after the intervention. RESULTS: A statistically significant reduction in caregiver work overload (average of 11.6 points on the Zarit Scale) was observed in the group of caregivers that received the home visits. No significant differences were observed in terms of social support and quality of life. CONCLUSION: This program achieves a reduction in the level of work overload for caregivers of children and teenagers with severe disabilities.
Subject(s)
Humans , Male , Female , Adolescent , Program Evaluation , Caregivers/psychology , Disabled Persons , Quality of Life/psychology , Social SupportABSTRACT
BACKGROUND: Malaria is a mosquito-borne, lethal disease that affects millions and kills hundreds of thousands of people each year, mostly children. There is an increasing need for models of malaria control. In this paper, a model is developed for allocating malaria interventions across geographic regions and time, subject to budget constraints, with the aim of minimizing the number of person-days of malaria infection. METHODS: The model considers a range of several conditions: climatic characteristics, treatment efficacy, distribution costs, and treatment coverage. An expanded susceptible-infected-recovered compartment model for the disease dynamics is coupled with an integer linear programming model for selecting the disease interventions. The model produces an intervention plan for all regions, identifying which combination of interventions, with which level of coverage, to use in each region and year in a 5-year planning horizon. RESULTS: Simulations using the model yield high-level, qualitative insights on optimal intervention policies: The optimal intervention policy is different when considering a 5-year time horizon than when considering only a single year, due to the effects that interventions have on the disease transmission dynamics. The vaccine intervention is rarely selected, except if its assumed cost is significantly lower than that predicted in the literature. Increasing the available budget causes the number of person-days of malaria infection to decrease linearly up to a point, after which the benefit of increased budget starts to taper. The optimal policy is highly dependent on assumptions about mosquito density, selecting different interventions for wet climates with high density than for dry climates with low density, and the interventions are found to be less effective at controlling malaria in the wet climates when attainable intervention coverage is 60 % or lower. However, when intervention coverage of 80 % is attainable, then malaria prevalence drops quickly in all geographic regions, even when factoring in the greater expense of the higher coverage against a constant budget. CONCLUSIONS: The model provides a qualitative decision-making tool to weigh alternatives and guide malaria eradication efforts. A one-size-fits-all campaign is found not to be cost-effective; it is better to consider geographic variations and changes in malaria transmission over time when determining intervention strategies.
Subject(s)
Computer Simulation , Decision Making, Computer-Assisted , Malaria/prevention & control , Models, Biological , Animals , Anopheles , Climate , Cost-Benefit Analysis , Health Policy , Humans , Insect Vectors , Malaria/economics , Malaria/epidemiology , Mosquito ControlABSTRACT
La granulomatosis con poliangeitis (GPA) es una vasculitis sistémica, granulomatosa, con compromiso de pequeños vasos y presencia de anticuerpos c-ANCA. Ocasionalmente es localizada y es rara su manifestación genitourinaria. Se presenta el caso de una mujer de 68 años con sangrado genital causado por una lesión cervicovaginal verrucosa ulcerada, cuya histopatología descartó malignidad, hongos y TBC, con mala respuesta a antibióticos, ácido tricloro acético y crioterapia. Por recidiva al año se practica histerectomía total y colpectomía parcial, pero reincide al mes acompañada de epistaxis, cuyo estudio pornasofibroscopía e imágenes concluye en una lesión de tipo granulomatosa, agregándose anticuerpo anti PR-3 positivo. Se diagnostica GPA y se trata con ciclofosfamida con buena respuesta. La revisión de la literatura permite concluir que la GPA con localización cervicovaginal es muy poco frecuente, especialmente como manifestación inicial, y se debe considerar en el diagnóstico diferencial con cáncer y otras lesiones granulomatosas localizadas.
Granulomatosis with polyangiitis (GPA) is a systemic vasculitis, granulomatous, with commitment of small vessels and the presence of c-ANCA antibodies. Occasionally it is located and its genitourinary manifestation is rare. Presented the case of a 68 year old woman with genital bleeding caused by a lesion cervicovaginal ulcerated verrucosa, whose histopathology ruled out fungal, malignancy and TBC, with poor response to antibiotics, acid trichloro acetic and cryotherapy. By relapse a year is practiced total hysterectomy and partial colpectomia, but repeated a month accompanied by epistaxis, whose study by nasofibroscopia and images concludes in a type granulomatous lesion, adding antibody anti PR-3 positive. GPA is diagnosed and treated with cyclophosphamide with good response. Review of the literature leads to th conclusion that the GPA with cervico-vaginal location is very rare, especially as an initial manifestation, and should be considered in the diagnosis diferenttial with cancer and other localized granulomatous lesions.
Subject(s)
Humans , Female , Aged , Vaginal Diseases/diagnosis , Vaginal Diseases/drug therapy , Uterine Cervical Diseases/diagnosis , Uterine Cervical Diseases/drug therapy , Granulomatosis with Polyangiitis/diagnosis , Granulomatosis with Polyangiitis/drug therapy , Antibodies, Antineutrophil Cytoplasmic , Cyclophosphamide/therapeutic use , Diagnosis, DifferentialABSTRACT
Phyllodes tumors are rare fibroepithelial neoplasms that account for less than 1% of all breast tumors and are typically found in middle-aged women. Phyllodes tumors that present with hypoglycemia are even rarer. No one morphologic finding is reliable in predicting the clinical behavior of this tumor. Surgery has been the primary mode of treatment to date. However, the extent of resection and the role of adjuvant radiotherapy or chemotherapy are still controversial. Here, we present a challenging case of malignant phyllodes tumor of the breast associated with hypoglycemia, and review the literature regarding clinical findings, pathologic risk factors for recurrence, and treatment recommendations.
