RESUMO
La présente étude visait à documenter l'implantation de l'Accompagnement-citoyen personnalisé d'intégration communautaire (APIC), lors duquel des bénévoles soutiennent la participation sociale d'aînés, dans des organismes communautaires en identifiant les facteurs favorables et défavorables ainsi que ses conditions essentielles. Soutenu par un devis qualitatif descriptif de type recherche clinique, une rencontre et six entretiens semi-dirigés ont été réalisés afin de documenter cette implantation dans six organismes communautaires Åuvrant en milieu urbain au Québec (Canada). Selon les six coordonnatrices de l'APIC, les cinq directeurs généraux et l'agente de recherche, le principal facteur favorable est la conviction des responsables de l'implantation en la valeur ajoutée de l'intervention, incluant sa concordance avec la mission et les valeurs des organismes et les besoins de la population qu'ils desservent. Les facteurs défavorables sont principalement la répartition aléatoire et le temps accordé pour l'implantation. Ces résultats permettront de mieux guider l'implantation de l'APIC à plus grande échelle.
Assuntos
Ciclofosfamida , Humanos , Canadá , QuebequeRESUMO
The authors present the case of an 87-year-old woman who developed a delayed onset of subcutaneous emphysema post-operatively. We discuss the causative factors - in this case, presumed injury to her hypo-pharynx during a reportedly uneventful endotracheal intubation, the investigations and the management of this rare complication.
RESUMO
OBJECTIVE: To compare outcomes between long posterior flap (LPF) and skew flap (SF) amputation over a 13 year period. METHODS: This was a retrospective observational cohort study. Consecutive patients undergoing a LPF or SF below knee amputation (BKA) over a 13 year period at one hospital were identified. Both techniques were performed regularly, depending on tissue loss and surgeon preference. The primary outcome was surgical revision of any kind. Secondary outcomes included revision to above knee amputation (AKA), length of hospital stay (LOS), and mortality. A smaller cohort of patients who were alive and unilateral below knee amputees were contacted to ascertain prosthetic use and functional status. RESULTS: In total, 242 BKAs were performed in 212 patients (125 LPF and 117 SF; median follow up 25.8 months). Outcomes for the two groups were equivalent for surgical revision of any kind (27 LPF vs. 31 SF; p = .37), revision to an AKA (18 LPF vs. 14 SF; p = .58), LOS (29 days for LPF vs. 28 days for SF; p = .83), and median survival (23.9 months for LPF vs. 28.8 months for SF; p = .89). Multivariable analysis found amputation type had no effect on any outcome. Functional scores from a smaller cohort of 40 unilateral amputees who were contactable demonstrated improved outcomes with the LPF vs. the SF (p = .038). CONCLUSION: Both techniques appear equivalent for rates of surgical residual limb failure. Functional outcomes may be better with the LPF.
