RESUMEN
AIM: To explain the process taken by Chinese family care partners of older adults in the Greater Toronto Area, Canada, to access health and social services in their communities. The research question was: What mechanisms and structures impact the agency of Chinese family care partners of older adults, in the process of assisting them to access health and social services? DESIGN: This qualitative study was informed by critical realism. METHODS: Chinese family care partners of older adults in the Greater Toronto Area, Canada, were interviewed from August 2020 to June 2021. Transcripts underwent thematic analysis. FINDINGS: Twenty-eight Chinese family care partners expressed a firm commitment to maintain caregiving conditions and to judiciously access health and social services. Their commitment was made up of three parts: (a) legislative and cultural norms of family, work, and society; (b) their perseverance to fill gaps with limited social and financial resources; (c) the quality of their relationship to, and illness trajectory of the older adults. The social structures created tension in how Chinese family care partners made decisions, negotiated resources, and ultimately monitored and coordinated timely access with older adults. CONCLUSION: Participants' commitment and perseverance were conceptualized as "grit," central to their agency to conform to legislative and cultural norms. Moreover, findings support grit's power to motivate and sustain family caregiving, in order for older adults to age in place as long as possible with finite resources. IMPLICATIONS FOR THE PROFESSION: This study highlights the importance of cultural awareness education for nurses, enabling continuity of care at a systems level and for a more resilient healthcare system. IMPACT: Family care partners' grit may be crucial for nurses to harness when together, they face limited access to culturally appropriate health and social services in a system grounded in values of equity and inclusion, as in Canada. REPORTING METHOD: When writing this manuscript, we adhered to relevant EQUATOR guidelines of the Consolidated Criteria for Reporting Qualitative Research (COREQ). PATIENT OR PUBLIC INVOLVEMENT AND ENGAGEMENT: No patient or public involvement.
Asunto(s)
Pueblo Asiatico , Cuidadores , Accesibilidad a los Servicios de Salud , Aceptación de la Atención de Salud , Anciano , Humanos , Pueblo Asiatico/psicología , Canadá/epidemiología , Cuidadores/psicología , China/etnología , Investigación Cualitativa , Aceptación de la Atención de Salud/etnología , Aceptación de la Atención de Salud/psicología , Intención , Ontario/epidemiología , Accesibilidad a los Servicios de Salud/estadística & datos numéricosRESUMEN
Malignant lymphomas represent approximately 5% of all malignant neoplasms of the head and neck. The head and neck region is the second most frequent anatomical site of extra-nodal lymphomas (after the gastrointestinal tract). Most are non-Hodgkin's lymphomas of B-cell lineage, and overall diffuse large B-cell lymphoma is the most common type. They can present in highly variable appearances in different anatomical subsites in the head and neck. There is little literature on their imaging appearances on different imaging methods including ultrasound, magnetic resonance imaging (MRI), computed tomography (CT), and integrated positron-emission tomography (PET)/CT. The review aims to illustrate the presentation of histopathological-proven extra-nodal lymphoma in the head and neck using various imaging methods.
Asunto(s)
Neoplasias de Cabeza y Cuello , Linfoma de Células B Grandes Difuso , Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Humanos , Imagen Multimodal , Cuello , Tomografía Computarizada por Tomografía de Emisión de Positrones , Tomografía Computarizada por Rayos XRESUMEN
INTRODUCTION: Enhanced recovery after surgery (ERAS) practices improve postoperative recovery and reduce postoperative length of stay (LOS) in patients undergoing primary total hip arthroplasty (THA) or total knee arthroplasty (TKA). Our study investigated whether these promising results could be reproduced in a private hospital setting. METHODS: In total, 228 patients were included in the study cohort: the conventional group comprised 117 patients from 2012 to 2014, while the ERAS group comprised 111 patients from 2017 to 2018. All patients had undergone unilateral primary THA or TKA at a private hospital in Hong Kong. The outcome was postoperative LOS; factors affecting LOS were also investigated. RESULTS: No significant differences were found in any baseline parameters between the two groups of patients. The mean LOS was significantly shorter in the ERAS group than in the conventional group (3.28 ± 1.04 vs 5.16 ± 2.06 days, P<0.001). Moreover, a significantly greater proportion of patients could be discharged on or before postoperative day 3 in the ERAS group, compared with the conventional group (77.5% vs 13.7%, P<0.001). A significant difference in LOS was observed between general ward and private ward patients (3.06 ± 0.59 vs 3.66 ± 1.46 days, P=0.003). Sex, age, and nature of surgery (TKA vs THA) did not have significant effects on LOS. CONCLUSIONS: The ERAS practices yielded a significant improvement in postoperative LOS, compared to conventional practices, among patients who underwent unilateral primary THA or TKA in a private hospital.
Asunto(s)
Artroplastia de Reemplazo de Cadera , Artroplastia de Reemplazo de Rodilla , Recuperación Mejorada Después de la Cirugía , Hospitales Privados , Humanos , Tiempo de Internación , Readmisión del Paciente , Complicaciones Posoperatorias/epidemiologíaRESUMEN
PURPOSE: As the designated tertiary referral centre for infectious diseases in Hong Kong, our hospital received the city's first group of patients diagnosed with coronavirus disease 2019 (COVID-19). Herein, we studied the earliest patients admitted to our centre in order to clarify the typical radiological findings, particularly computed tomography (CT) findings, associated with COVID-19. METHODS: From 22 January 2020 to 29 February 2020, 19 patients with confirmed COVID-19 underwent high-resolution or conventional CT scans of the thorax in our centre. The CT imaging findings of these patients with confirmed COVID-19 in Hong Kong were reviewed in this study. RESULTS: Ground-glass opacities (GGO) with peripheral subpleural distribution were found in all patients (100%). No specific zonal predominance was observed. All lobes were involved in 16 (84.2%) patients, focal subsegmental consolidations were observed in 14 (73.7%) patients, and interlobular septal thickening was present in 12 (63.2%) patients. No mediastinal lymph node enlargement, centrilobular nodule, or pleural effusion was detected in any of the patients. Other imaging features present in several patients include bronchial dilatation, bronchial wall thickening, and crazy-paving patterns. CONCLUSIONS: Peripheral subpleural GGO without zonal predominance in the absence of centrilobular nodule, pleural effusion, and lymph node enlargement were consistent findings in patients with confirmed COVID-19. The observed radiological patterns on CT scans can help identify COVID-19 and assess affected patients in the context of the ongoing outbreak.
Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/diagnóstico por imagen , Neumonía Viral/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adulto , Anciano , COVID-19 , Progresión de la Enfermedad , Femenino , Hong Kong , Humanos , Pulmón/diagnóstico por imagen , Pulmón/virología , Masculino , Persona de Mediana Edad , Pandemias , SARS-CoV-2Asunto(s)
Infecciones por Coronavirus , Pandemias , Neumonía Viral , Fibrosis Pulmonar , Tomografía Computarizada por Rayos X/métodos , Betacoronavirus/aislamiento & purificación , COVID-19 , Prueba de COVID-19 , Técnicas de Laboratorio Clínico/métodos , Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Monitoreo Fisiológico/métodos , Neumonía Viral/sangre , Neumonía Viral/complicaciones , Neumonía Viral/diagnóstico , Neumonía Viral/etiología , Neumonía Viral/fisiopatología , Fibrosis Pulmonar/diagnóstico por imagen , Fibrosis Pulmonar/etiología , SARS-CoV-2 , Resultado del TratamientoRESUMEN
Traditional methods used to disseminate educational resources to front-line healthcare staff have several limitations. Social media may increase the visibility of these resources among targeted groups and communities. Our project aimed to disseminate key clinical messages from the National Tracheostomy Safety Project to those caring for patients with tracheostomies or laryngectomies. We commissioned an external media company to design educational material and devise a marketing strategy. We developed videos to communicate recommendations from the safety project and used Facebook, Twitter, YouTube and LinkedIn to deliver these to our target users. We recorded 629,270 impressions over a paid 12-week campaign. Our YouTube channel registered more than a five-fold increase in views and watch time during the campaign as compared with the previous year. Around two-thirds of views across all platforms were from peer-to-peer sharing. We spent £4140 on social media advertising, with each view and click costing £0.02 and £0.67, respectively. This intelligence-led approach using social media is an effective and efficient method to disseminate knowledge on the principles of safe tracheostomy care to front-line clinical staff. Similar strategies may be effective for other patient safety topics, especially when targeting groups that do not use medical journals or other traditional means of dissemination.
Asunto(s)
Difusión de la Información/métodos , Laringectomía , Sistemas de Atención de Punto , Cuidados Posoperatorios/métodos , Teléfono Inteligente , Medios de Comunicación Sociales/estadística & datos numéricos , Traqueostomía , Humanos , Seguridad del Paciente , Reino UnidoAsunto(s)
Disección Aórtica/diagnóstico por imagen , Muerte Súbita Cardíaca/etiología , Pericardio/anomalías , Tomografía Computarizada por Rayos X/efectos adversos , Anciano , Disección Aórtica/complicaciones , Medios de Contraste/efectos adversos , Resultado Fatal , Humanos , Yohexol/efectos adversos , Masculino , Derrame Pleural/etiología , Rotura Espontánea/etiologíaAsunto(s)
Obstrucción de las Vías Aéreas , Traqueostomía , Algoritmos , Urgencias Médicas , Humanos , CuelloAsunto(s)
Neoplasias Ováricas/diagnóstico , Teratoma/diagnóstico , Abdomen Agudo/etiología , Adulto , Femenino , Humanos , Neoplasias Ováricas/complicaciones , Neoplasias Ováricas/diagnóstico por imagen , Peritonitis/etiología , Rotura , Teratoma/complicaciones , Teratoma/diagnóstico por imagen , Tomografía Computarizada por Rayos X , UltrasonografíaRESUMEN
INTRODUCTION: Periprosthetic joint infection after total knee arthroplasty is a serious complication. This study aimed to identify risk factors and bacteriological features associated with periprosthetic joint infection after primary total knee arthroplasty performed at a teaching hospital. METHODS: We reviewed 2543 elective primary total knee arthroplasties performed at our institution from 1993 to 2013. Data were collected from the Hong Kong Hospital Authority's Clinical Data Analysis and Reporting System, the Infection Control Team, and the joint replacement division registry. The association between potential risk factors and periprosthetic joint infection was examined by univariable analysis and multivariable logistic regression. Univariable analyses were also performed to examine the association between potential risk factors and bacteriology and between potential risk factors, including bacteriology, and early-onset infection. RESULTS: The incidence of periprosthetic joint infection in our series was 1.34% (n=34). The incidence of early-onset infection was 0.39% (n=24). Of the periprosthetic joint infections, 29.4% were early-onset infections. In both univariable and multivariable analyses, only rheumatoid arthritis was a significant predictor of periprosthetic joint infection. Methicillin-sensitive Staphylococcus aureus was the most common causative organism. We did not identify any significant association between potential risk factors and bacteriology. Periprosthetic joint infection caused by skin flora was positively associated with early-onset infection but the association was not statistically significant. CONCLUSION: The incidence of periprosthetic joint infection after elective primary total knee arthroplasty performed at our institution from 1993 to 2013 was 1.34%. Rheumatoid arthritis was a significant risk factor for periprosthetic joint infection.
Asunto(s)
Artroplastia de Reemplazo de Rodilla/efectos adversos , Bacterias/aislamiento & purificación , Prótesis de la Rodilla/efectos adversos , Infecciones Relacionadas con Prótesis/etiología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infecciones Relacionadas con Prótesis/epidemiología , Infecciones Relacionadas con Prótesis/microbiología , Estudios Retrospectivos , Factores de RiesgoRESUMEN
The global emergence of carbapenem-resistant Enterobacteriaceae (CRE) presents a significant clinical concern, prompting the WHO to prioritize CRE as a top priority pathogen in their 2017 global antibiotic-resistant bacteria priority list. Due to the fast-depleting antibiotic arsenal, clinicians are now resorting to using once-abandoned, highly toxic antibiotics such as the polymyxins and aminoglycosides, creating an urgent need for new antibiotics. Drug repurposing, the application of an approved drug for a new therapeutic indication, is deemed a plausible solution to this problem. A total of 1,163 FDA-approved drugs were screened for activity against a clinical carbapenem- and multidrug-resistant E. coli isolate using a single-point 10 µM assay. Hit compounds were then assessed for their suitability for repurposing. The lead candidate was then tested against a panel of clinical CREs, a bactericidal/static determination assay, a time-kill assay and a checkerboard assay to evaluate its suitability for use in combination with Tigecycline against CRE infections. Three drugs were identified. The lead candidate was determined to be Zidovudine (azidothymidine/AZT), an oral anti-viral drug used for HIV treatment. Zidovudine was shown to be the most promising candidate for use in combination with Tigecycline to treat systemic CRE infections. Further experiments should involve the use of animal infection models.
Asunto(s)
Antibacterianos/uso terapéutico , Enterobacteriaceae Resistentes a los Carbapenémicos/efectos de los fármacos , Reposicionamiento de Medicamentos , Infecciones por Enterobacteriaceae/tratamiento farmacológico , Escherichia coli/efectos de los fármacos , Minociclina/análogos & derivados , Zidovudina/uso terapéutico , Animales , Farmacorresistencia Bacteriana Múltiple , Infecciones por Enterobacteriaceae/microbiología , Humanos , Ratones , Pruebas de Sensibilidad Microbiana , Minociclina/uso terapéutico , TigeciclinaAsunto(s)
Genes p53 , Mutación , Neoplasias Orofaríngeas/etiología , Infecciones por Papillomavirus/complicaciones , Fumar/efectos adversos , Carcinoma de Células Escamosas de Cabeza y Cuello/etiología , Adulto , Anciano , Anciano de 80 o más Años , Consumo de Bebidas Alcohólicas/efectos adversos , Estudios de Casos y Controles , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Orofaríngeas/genética , Factores de RiesgoRESUMEN
Ice-shelf channels are long curvilinear tracts of thin ice found on Antarctic ice shelves. Many of them originate near the grounding line, but their formation mechanisms remain poorly understood. Here we use ice-penetrating radar data from Roi Baudouin Ice Shelf, East Antarctica, to infer that the morphology of several ice-shelf channels is seeded upstream of the grounding line by large basal obstacles indenting the ice from below. We interpret each obstacle as an esker ridge formed from sediments deposited by subglacial water conduits, and calculate that the eskers' size grows towards the grounding line where deposition rates are maximum. Relict features on the shelf indicate that these linked systems of subglacial conduits and ice-shelf channels have been changing over the past few centuries. Because ice-shelf channels are loci where intense melting occurs to thin an ice shelf, these findings expose a novel link between subglacial drainage, sedimentation and ice-shelf stability.
Asunto(s)
Dolor Abdominal/etiología , Arteria Celíaca/anomalías , Constricción Patológica/diagnóstico , Arteria Celíaca/diagnóstico por imagen , Arteria Celíaca/fisiopatología , Constricción Patológica/diagnóstico por imagen , Constricción Patológica/fisiopatología , Humanos , Masculino , Síndrome del Ligamento Arcuato Medio , Persona de Mediana EdadRESUMEN
INTRODUCTION: The number of patients undergoing total hip replacement surgeries has increased as a result of a rise in the ageing population. This study reviewed the demographics and disease spectrum leading to primary total hip replacement in the Chinese population from 1998 to 2010. METHODS: This case series was conducted in a university teaching hospital in Hong Kong. Data from the prospective joint registry of all patients who underwent primary total hip replacement from January 1998 to December 2010 were reviewed. Patients' age and sex, diagnosis, as well as the Harris Hip Scores before operation and at the last follow-up were described. RESULTS: There were 512 primary total hip replacements performed on 419 patients (43.4% males) during the study period. All had clinical follow-up for at least 2 years. The mean age of the patients was 57.6 (standard deviation, 16.6) years. In males, the main aetiology was osteonecrosis (50.9%), ankylosing spondylitis (19.5%), and post-traumatic arthritis (8.5%). For females, it was osteonecrosis (33.0%), primary osteoarthritis (18.8%), and post-traumatic arthritis (15.8%). Alcohol-induced (52.5%) and idiopathic (40.7%) was the most common cause of osteonecrosis in males and females, respectively. The mean preoperative Harris Hip Score and that at last follow-up was 43.9 (standard deviation, 18.3) and 89.7 (standard deviation, 13.0), respectively. CONCLUSIONS: Osteonecrosis was the most common aetiology leading to total hip replacement although there were different causes in both sexes leading to it. The clinical result in terms of Harris Hip Score was good for all patients who required total hip replacement.