Exploring disaster preparedness in an obstetric unit in a district hospital in the Western Cape Province.

BACKGROUND: Research on disaster preparedness in public hospitals is limited, and specialised units such as obstetric departments need to be even more prepared when rendering health care to vulnerable populations. Disasters can be natural, such as floods due to human interventions, sinkholes due to mining, or pandemic occurrences, such as the recent COVID-19 pandemic. Research on disaster preparedness is limited, and even more so in specialised units such as obstetrics and evacuating a ward of maternal and neonatal patients present unique challenges. Being prepared for any disaster is the only assurance of effective patient healthcare during a disaster. This study explored and described nurses' knowledge and attitudes regarding preparedness for a disaster in an obstetric unit in a public institution. The study aimed to make recommendations to improve disaster preparedness in an obstetric ward based on the nurses' knowledge and attitudes. METHODS: This study utilised an exploratory, descriptive qualitative design within a contextual approach. The data were acquired through individual interviews that were done using a semi-structured interview schedule. An observational walkabout was performed with the unit manager to validate interviewee responses. The study employed purposive sampling with a sample size of 17 nurses (N = 32, n = 17) and a response rate of 53%. The interviews were transcribed verbatim, and later, the data underwent analysis using theme analysis and a co-coder. RESULTS: The results indicate that the participants demonstrate an awareness of disaster terminology but need more assertiveness in executing the institutional disaster policy. The results illustrate that more frequent training, disaster rehearsals, and simulations should be implemented to improve disaster readiness. Strategies are recommended to enhance preparedness for a disaster in the obstetric unit. CONCLUSION: The study findings recommend more education and training opportunities that should be regularly instilled as a practice within the obstetric ward. More disaster drills and simulation exercises should be performed to ensure confidence in disaster preparedness. Obstetric staff of all levels should be involved with policymaking and disaster plan development.

Aplicação clínica do IPS e. max na confecção de coroa e faceta metal free

Objetivo: Demonstrar a utilização do sistema cerâmico IPS e.max, através de caso clínico onde foi confeccionado uma faceta e uma coroa metal free. Material e métodos: A busca constante por uma estética e função satisfatórias, aliada a necessidade dos profissionais em prover tratamentos duradouros, faz da utilização de coroas metal free uma excelente alternativa.Entre os vários sistemas metal-free, o IPS e.max, é composto por cerâmica vítrea à base de dissilicato de lítio, bastante versátil e que,de acordo com a literatura vem apresentando ótimos resultados em relação a sua performance clínica, por reproduzir com naturalidade e beleza a estrutura dentária, acentuando suas propriedades mecânicas e estéticas. Resultados: Com o avanço dos sistemas cerâmicos, dispensando a necessidade da estrutura metálica como reforço em função dos problemas estéticos inerentes, e que dificultam a passagem de luz nas coroas metalo-cerâmicas convencionais, especialmente em dentes anteriores, ocorre a melhor indicação para o uso de sistemas livres de metal. Conclusão: Restaurações indiretas totalmente em cerâmica otimiza a estética requerida pelo paciente, melhorando sua aparência facial e aumentando sua autoestima

Efeito da hidroterapia na qualidade de vida de mulheres mastectomizadas / The Effects of Hydrotherapy in the Quality of Life of Women Undergoing Mastectomy

Introdução: O diagnóstico de câncer e todo o processo da doença são vividos pelo paciente e sua famíliacomo um momento de intensa angústia, sofrimento e ansiedade. No câncer de mama, além disso, encontram-se outras angústias ligadas à feminilidade, maternidade e sexualidade, já que o seio é um órgão de simbolismopara a mulher. A mastectomia é um procedimento cirúrgico muito utilizado no tratamento do câncer de mama,a qual, no entanto, pode causar complicações físicas e emocionais para a paciente, no qual a fisioterapia podeatuar. Assim, o objetivo do estudo foi verificar o efeito da hidroterapia, que é um recurso fisioterapêutico, naqualidade de vida de mulheres mastectomizadas. Metodologia: Participaram do estudo 3 mulheres submetidasà mastectomia, as quais responderam o questionário de qualidade de vida SF-36 antes e após realizarem 10sessões de hidroterapia. Resultados: Houve melhora da capacidade funcional, aspecto físico, vitalidade easpecto emocional. Já os componentes dor, aspectos sociais e saúde mental mantiveram-se iguais; e ocomponente estado geral de saúde apresentou piora. Conclusão: A hidroterapia é eficaz na reabilitação depacientes mastectomizadas, pois proporciona benefícios físicos e funcionais, auxilia na melhora do estadoemocional das pacientes, e consequentemente, na qualidade de vida destas.

Introduction: Cancer diagnosis and the disease process are experienced by the patient and his/her family asa moment of the intense anguish, suffering and anxiety. Moreover, in breast cancer there are other anguishesassociated to womanliness, maternity, and sexuality, once the breast is an organ with a certain symbolism forwomen. The excision of the breast is a very common surgical proceeding performed in the treatment of breastcancer. Nevertheless, it can cause physical and emotional complications for the patient, opening space forphysical therapists to act upon. Thus, the objective of this study was to verify the effect of the hydrotherapy,which is a physiotherapeutic tool, in the quality of life of women who have their breast removed. Methodology:Three women underwent mastectomy. They have answered the SF-36 life’s quality questionnaire before andafter 10-hydrotherapy sessions. Results: There was improvement of the functional capacity, physical andemotional aspects, and vitality. The components of pain, socials aspects, and mental health remained thesame; the general health condition component became aggravated. Conclusion: The hydrotherapy is effectivein the rehabilitation of patients undergoing excision of the breast because it provides functional and physicalbenefits, helps in the recovery of the patients’ emotional condition, and consequently, in their quality of life.

High-sensitivity C-reactive protein at different stages of atherosclerosis: results of the INVADE study.

Evidence on the role of high-sensitivity C-reactive protein (hsCRP) at different stages of atherosclerosis is limited. We therefore analyzed the relationship between hsCRP and measures of subclinical and advanced atherosclerosis in a population-based sample of the INVADE study (n = 3,092, >55 years). The parameters of interest were IMT, ABI, and the stage of atherosclerosis. Differences between participants with normal and pathological hsCRP were analyzed by t test for independent samples or Fishers' exact test. Differences of hsCRP between IMT quartiles, ABI quartiles, and different stages of atherosclerosis were analyzed by one-way ANOVA. Adjusted stepwise multiple linear regression analysis (IMT and ABI) and adjusted analysis of variance (stage of atherosclerosis) were performed, including significant baseline parameters as covariates. ANOVA showed significant differences of hsCRP among IMT quartiles, ABI quartiles, and patients with and without atherosclerosis. The adjusted analyses confirmed that the effects of IMT, ABI, and atherosclerosis on hsCRP were independent from other significant baseline parameters, but did not yield a significant difference between subclinical and advanced stages of atherosclerosis. The present analysis indicates an independent relationship between hsCRP and both IMT and ABI as measures of subclinical atherosclerosis. The comparison of subclinical and advanced stages of atherosclerosis yielded no significant difference, indicating that hsCRP is sensitive to identify vascular risk patients, but not suited to monitor progression of the disease.

High-sensitivity C-reactive protein is independently associated with early carotid artery progression in women but not in men: the INVADE Study.

BACKGROUND AND PURPOSE: High-sensitivity C-reactive protein (hsCRP) is known to be associated with atherosclerosis and cardiovascular events. Limited information exists regarding the importance of sex differences for the association between hsCRP and the progression of early stages of atherosclerosis. Therefore, we investigated the effect of hsCRP on early carotid atherosclerosis progression and major vascular risk factors in men and women. METHODS: We analyzed the data of INVADE (intervention project on cerebrovascular diseases and dementia in the community of Ebersberg, Bavaria), a prospective, population-based study. In addition to common risk factors, measurements of carotid intima-media-thickness and hsCRP were performed at baseline and after 2 years. RESULTS: Complete baseline data were available for 3387 subjects including 2001 women, and complete follow-up data were available for 2346 subjects. Within this study population, women were older and had higher systolic blood pressure and cholesterol levels. The prevalence of smoking and ischemic heart disease was more frequent in men. The baseline carotid intima-media-thickness was significantly higher in men compared with women (0.82 mm; 95% CI, 0.812 to 0.834 mm versus 0.77 mm; 95% CI, 0.763 to 0.779 mm; P<0.0001). Carotid intima-media-thickness progression after risk factor adjustment was significantly associated with hsCRP in women (P=0.006) but not in men (P=0.39). CONCLUSIONS: The association between hsCRP and progression of early carotid atherosclerosis shows sex differences. In further studies analyzing the role of inflammation for cardiovascular diseases and atherosclerosis, these sex differences should be considered.

Combined effects of hemoglobin A1c and C-reactive protein on the progression of subclinical carotid atherosclerosis: the INVADE study.

BACKGROUND AND PURPOSE: Glycohemoglobin (hemoglobin A1c [HbA1c]) and high-sensitivity C-reactive protein (hsCRP) are risk indicators for atherosclerosis. Limited information exists regarding the combined effects of inflammation and hyperglycemia. We investigated the joint effects of both parameters on early carotid atherosclerosis progression and major vascular events in diabetic and nondiabetic subjects. METHODS: We analyzed the data of INVADE (Intervention Project on Cerebrovascular Diseases and Dementia in the Community of Ebersberg, Bavaria), a prospective, population-based study conducted in 3534 subjects (mean age, 69 years). In addition to common risk factors, measurements of carotid intima-media thickness (IMT), hsCRP, and HbA1c were performed at baseline and after 2 years of follow-up. RESULTS: For the entire population, IMT progression was significantly related to HbA1c (P=0.003) but not to hsCRP (P=0.06) after risk factor adjustment. The interaction hsCRPxHbA1c was highly significant (P=0.001), and the most pronounced IMT progression was seen in subjects with both parameters in the fourth quartiles compared with subjects with both parameters in the first quartiles (0.028 [0.025, 0.031] versus 0.012 mm/year [0.007, 0.019]; P=0.0013). We observed a significant joint effect of HbA1c and hsCRP on IMT progression in the diabetic (n=882) as well as the nondiabetic subgroup (n=2652). Subjects with HbA1c and hsCRP in the upper 2 quartiles had an increased risk for new vascular events (adjusted hazard ratio in diabetics: 4.3 [1.8, 7.3]; P=0.001; nondiabetics: 2.9 [1.6, 4.7]; P=0.001). CONCLUSIONS: The combination of hyperglycemia and inflammation is associated with an advanced early carotid atherosclerosis progression and an increased risk of new vascular events in diabetic as well as nondiabetic subjects.