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Esta pesquisa utilizou a revisão sistemática com o objetivo de identificar os principais tratamentos da fístula faringocutânea após a laringectomia total e elaborar recomendações para as intervenções de enfermagem na assistência ao paciente submetido a laringectomia total, com a complicação fístula faringocutânea. Foram previamente localizados 1007 estudos, dos quais foram selecionados 37 estudos publicados em periódicos científicos indexados no Pubmed, Biomednet, Cinahl, Cochrane Library, MEDLINE e LILACS, desses 17 (46%) abordavam o tratamento da fístula faringocutânea, após laringectomia total, 10 (27%) discutiam os fatores de risco e os outros 10 (27%) as complicações após a laringectomia total. A análise desses artigos revelou que o delineamento da pesquisa predominante nos estudos foi o retrospectivo com 88,5%, e 11,5% prospectivos. A média de tempo de acompanhamento foi de 8,8 anos e a incidência de fístula faringocutânea, após a laringectomia total variou entre 8,7% e 27,0%, envolvendo um total de 635 pacientes. Os fatores de risco estudados pelos pesquisadores foram: radioterapia pré-operatória, técnica cirúrgica, traqueostomia pré-operatória, estadiamento do tumor, febre, doenças crônicas, vômito, nível de hemoglobina e reinício da alimentação oral, formando subgrupos com um número menor de pacientes e, conseqüentemente obtiveram percentuais individuais maiores de incidência da fístula faringocutânea, quando comparados com o índice geral de fístula proveniente da amostra inicial do estudo. O tratamento conservador e cirúrgico da fístula tem por finalidade preservar e restaurar a região lesada e envolve um processo complexo, dinâmico e sistêmico. Esta complicação aumentou o período de internação e de cicatrização, com médias de 28 e de 36 dias respectivamente. O tratamento predominante é ainda o conservador que implica cuidados higiênicos intensivos e o tratamento da ferida. O planejamento da assistência de enfermagem alicerçado em conhecimentos e habilidades técnico-científicas acerca do tratamento de feridas aliadas à dimensão psicossocial resultarão em intervenções de maior qualidade.A incorporação de conhecimentos oriundos da prática baseada em evidências na prática clínica, trará maior consistência à atuação do enfermeiro no cuidado do laringectomizado total e portador de fístula faringocutânea. / This research carried out a systematic review aimed at identifying the main treatments of pharyngocutaneous fistula after total laryngectomy and at elaborating recommendations for nursing interventions in care delivered to patients submitted to total laryngectomy, including the pharyngocutaneous fistula complication. In advance, 1007 studies were found, out of which we selected 37 studies published in scientific journals indexed in Pubmed, Biomednet, Cinahl, Cochrane Library, MEDLINE and LILACS. Among these, 17 (46%) dealt with the treatment of pharyngocutaneous fistula after total laryngectomy, 10 (27%) discussed the risk factors and the other 10 (27%) were about complications after total laryngectomy. The analysis of these articles revealed that the predominant research orientation was retrospective (88.5%) and 11.5% corresponded to prospective studies. Average follow-up time was 8.8 years and the occurrence of pharyngocutaneous fistula after total laryngectomy varied from 8.7% to 27.0%, involving 635 patients in total. Analyzed risk factors were: pre-operative radiotherapy, surgical technique, pre-operative tracheostomy, tumor stage, fever, chronic disease, vomiting, hemoglobin level and restarting oral feeding. These constitute subgroups with a lower number of patients which, consequently, obtained higher individual percentage values for the occurrence of pharyngocutaneous fistula in comparison with the general fistula rate from the initial study sample. The conservative and surgical treatment of fistula aims to preserve and restore the injured region and involves a complex, dynamic and systemic process. This complication increased the internment and healing periods, with an average duration of 28 and 36 days respectively. The conservative treatment still predominates and implies intensive hygienic care and wound treatment. The planning of nursing care, based on technical-scientific knowledge and abilities related to wound treatment, in association with the psychosocial dimension, will result in higher-quality interventions. Incorporating evidence-based knowledge into clinical practice will offer greater consistency to nursing actions in caring for patients after total laryngectomy who suffer from pharyngocutaneous fistula.

Objetivos - A Neurografia por ressonância magnética (RM) tem sido usada para avaliar estruturas nervosas (nervos e plexos nervosos) por proporcionar melhor contraste entre essas estruturas e os tecidos circundantes. O objetivo deste estudo é investigar a reprodutibilidade do uso da neurografia pela técnica de difusão por ressonância magnética (DW-MR) para avaliar o plexo lombar no planejamento de artrodese com acesso lateral transpsoas. Outro objetivo é avaliar se a frequência em que os ramos do plexo lombar são encontrados nas diferentes zonas nos interespaços L3-4 e L4-5 é alterada quando do uso de diferentes espessuras de retratores cirúrgicos. Métodos Noventa e quatro pacientes (188 plexos lombares) com dor lombar e doenças degenerativas da coluna foram submetidos a DW-MR do plexo lombar relativa aos espaços discais L3-4 e L4-5, e terço superior do corpo vertebral de L5. As imagens foram reconstruídas no plano axial, com cortes de alta resolução de 10 mm de espessura sobre o espaço discal e de 22 mm em L3-4 e L4-5, simulando a zona de trabalho de retratores usados de rotina no acesso transpsoas. As posições da raiz de L4 e do nervo femoral foram analisadas em relação ao disco L4-5 e confirmadas nos planos sagitais. Radiologista e um cirurgião de coluna experiente realizaram as avaliações das imagens de forma às cegas e independente. Para aferir o grau de concordância intra e interobservadores aplicamos o teste de Kappa. Resultados. O plexo lombar foi identificado com êxito em todos os pacientes. Em L3-4, todos, os componentes do plexo (exceto o nervo genitofemoral) foram localizados no quadrante mais posterior do espaço discal (zona IV), exceto em um caso. As raízes de L3 e de L4 coalesceram-se no nervo femoral abaixo do espaço discal L4-5 em todos os sujeitos. Variação lado a lado foi observada, estando o plexo localizado na zona IV em 86,2% pacientes à direita e 78,7 % à esquerda. No terço superior de L5, o plexo foi encontrado na zona III em 27,7 % à direita e em 36,2% à esquerda; e na zona II em 4,3% à direita e em 2,1% à esquerda. Encontramos uma concordância substancial intra e interobservadores (com valores de Kappa entre 0,6 e 0,79, para o índice de concordância intra e interobservador, nos grupos de 10 e 22 mm em ambos os lados). Conclusão: O mapeamento pré-operatório do plexo lombar por meio da neurografia por DW-MR se mostrou reprodutível intra e intraobservadores e, portanto, tem potencial para melhorar o perfil de segurança dos procedimentos por acesso lateral. / Purpose - Magnetic resonance (MR) neurography has been used to evaluate entire nerves and nerve bundles by providing better contrast between the nerves and the surrounding tissues. The purpose of the study was to validate diffusion-weighted MR (DW-MR) neurography in visualizing the lumbar plexus during preoperative planning of lateral transpsoas surgery. Methods - Ninety-four (188 lumbar plexuses) spine patients underwent a DW-MR examination of the lumbar plexus in relation to the L34 and L45 disc spaces and superior third of the L5 vertebral body. Images were reconstructed in the axial plane using high-resolution Maximum Intensity projection (MIP) overlay templates at the disc space and L34 and L45 interspaces. 10 and 22 mm MIP templates were chosen to mimic the working zone of standard lateral access retractors. The positions of the L4 nerve root and femoral nerve were analyzed relative to the L45 disc in axial and sagittal planes. Third-party radiologist and a senior spine surgeon performed the evaluations, with inter- and intraobserver testing performed (Kappa test). Results - In all subjects, the plexus was successfully mapped. At L34, in all but one case, the components of the plexus (except the genitofemoral nerve) were located in the most posterior quadrant (zone IV). The L3 and L4 roots coalesced into the femoral nerve below the L45 disc space in all subjects. Side-to-side variation was noted, with the plexus occurring in zone IV in 86.2 % right and only 78.7 % of left sides. At the superior third of L5, the plexus was found in zone III in 27.7 % of right and 36.2 % of left sides; and in zone II in 4.3 % right and 2.1 % left sides. Significant inter- and intraobserver agreement was found. (Kappa test values ranging from 0,6 to 0,79, for intra and interobserver concordance index, in 10 and 22 mm groups, both sides). Conclusions - By providing the surgeon with a preoperative roadmap of the lumbar plexus, DW-MR may improve the safety profile of lateral access procedures.

Objective: To investigate the association between hospital investment in human resources variables and patient safety, specifically after surgery adverse events in Florida hospitals. We performed the analysis to identify the association of after surgery complication rates with full time equivalent employees (FTEs) per admission and per patient day, expenses per admission and per patient day and, the percent of total operating expense accounted for by payroll expenses. Design: A cross sectional analysis using inpatient hospital discharge data and financial data from seventy short-term general hospitals, both for-profit and not-for-profit. Methods: Discharge data from year 2000 was obtained from Agency for Health Care Administration (AHCA). This data was used to calculate Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators (PSIs) related to after surgery complications in 840,945 hospital discharge records from 70 short-term general hospitals across the state of Florida. The predictor variables include: payroll expenditures per admission, payroll expenditures per patient day, personnel (FTE) per admission, personnel (FTE) per patient day and payroll expense as a percent of total operating expenses. Main outcome measures: Nine patient safety indicators defined by AHQR and specific to after surgery complications: complications of anesthesia, foreign body left during procedure, postoperative hemorrhage or hematoma, postoperative physiologic and metabolic derangement, postoperative pulmonary embolism or deep vein thrombosis, postoperative respiratory failure, postoperative sepsis, postoperative wound dehiscence. Results: Patient safety indicator rate showed an inverse relationship with the percent of total operating expense represented by payroll, Personnel per patient day and personnel per admission. The patient safety indicators showing significant relationship with hospital human resource characteristics are postoperative hemorrhage or hematoma (p=0.0002), postoperative hip fracture (p<0.0001), and postoperative sepsis (p=0.0371). Conclusion: Human resource investment is positively related to favorable outcomes, although the effect varies across the type of outcomes.

Objective: To recognize the difference of patient care offered by primary care family physician, internist and generalist, according to the incidence rate of the acute complications, time to event interval of the chronic complications and the cost of OPD, admission and emergency care. Method: The first diagnosed diabetes patients were extracted from the National Health Insurance database, utilizing data from 2001 to 2007 to fit the criteria. Patients with catastrophic illness and who attended to the primary care clinic less than 20% of total OPD visits were excluded. The incidence rate of DM acute complications such as hypoglycemia, NKHS and DKA, and the time to event interval of DM chronic complications such as CAD, stroke, DM nephropathy, DM retinopathy, polyneuropathy and DM peripheral artery disease were investigated. Furthermore, the cost of OPD visit, emergency care and hospital admission was also evaluated. Result: The patients cared by primary care family physician tended to get hypoglycemia more frequently, but less likely to get hyperglycemic complications including both DKA and NKHS.The family physician did not recognize the large vessel complications well but can effectively control the diabetic neuropathy and diabetic nephropathy. Compare to those cared by internist, the patients cared by family physician have the lower expense on diabetic related OPD visit, but a little higher on emergency and admission. Totally, the patients cared by family physician have the lowest cost compared to internist and generalist, but without significant difference. Conclusion: The cost of OPD visit was significantly lower in patient cared by primary care family physician compared to internist without sacrifice the quality of care. Further study was necessary due to the limitation of the application of secondary database.

Bakgrunn: Økning i BMI og immigrasjon til Norge medfører nye utfordringer og det må settes fokus på å bekjempe ulikheter innen helse for mor og barn. I dag utgjør pakistanske immigranter en av de største minoritetsgruppene i Norge. Målet for denne studien er å undersøke forekomst av pregravid body mass index (BMI) og noen sosiodemografiske faktorers påvirkning på operative forløsninger (keisersnitt, vakuum, og tang) blant Norske og Pakistanske førstegangsfødende kvinner i Groruddalen, Norge. Metode: Populasjonsbasert kohort undersøkelse av 146 norske og 39 pakistanske kvinner som går til svangerskapskontroll på helsestasjoneri Groruddalen og deres fødsler ved Oslo universitetssykehusHF, Ullevål og Akershus universitetssykehus HF i Norge. Resultat: Pakistanske kvinner haddelavere pre-gravid BMI enn norske kvinner (22.1 og 24.6, p &lt;0.05). En lavere andel pakistanske kvinner hadde utdannelse&gt; 9år (79.5%) enn norske kvinner (96.6%, p&lt;0.05) og en lavere andel arbeidet utenfor hjemmet, 66.5 % kontra 95.2%, p&lt;0.05. I tillegg var pakistanske kvinneryngre (M=26.4, SD=4.0 år) sammenlignet med norske kvinner(M=29.7, SD=4.4 år, p&lt;0.05). Nyfødte barn av pakistanske kvinnerveide 339 gram mindre, med en gjennomsnittlig fødselsvekt på 3181 gram,i forhold til de norske nyfødte på 3520 gram (p &lt;0.05). Det varingen signifikant forskjell i operative forløsninger blant pakistanske kvinner med 31.6% og norske kvinnermed 27.9 %, p=0.805. Uavhengig av etnisitet hadde variabelen mors alder OR=1.106 (CI95:1.017 til 1.203) og svangerskapets lengde i dager OR= 0.951 (CI95:0.908 til 0.997) sammenheng med operative forløsninger i denne studien. Detnyfødte barnets vekt OR=1.001 (CI95:1.000 til 1.002) varmuligens et grensetilfelle. Konklusjon: Studien viser sosiodemografiske forskjeller mellom norske og pakistanske kvinner i Groruddalen, Norge. Pakistanske kvinner haddelavere BMI, lavere utdanningslengde, færrearbeidet utenfor hjemmet, de varyngre når de fødte sitt første barn og de fødtebarn med lavere vektenn norske kvinner. Det varikke forskjell i andel operative forløsninger mellom norske og pakistanske kvinner. Uavhengig av etnisitet haddekvinnenes alder og svangerskapets lengde påvirkning på operativ forløsning / Background: Elevated body mass index(BMI) and increased immigration pose challenges that demand a new focus on health inequalities for mothers and children. Currently, Pakistani immigrants are among the largest minority groups in Norway.This study aimed to determine the prevalence of pre-pregnancy BMI and the impact of different sociodemographic factors on operative (caesarean section, vacuum and forceps) deliveries among Norwegian and Pakistani nulliparous women in Groruddalen, Norway. Methods: This population-based cohort study included 146 Norwegian and 39 Pakistani women attending Child Health Clinics in Groruddalen and delivering at Oslo University Hospital and Ullevål and Akershus University Hospital, Norway. Results: Compared to Norwegian women, pre-pregnancy BMI was lower in Pakistani women (24.6 and 22.1, respectively; p &lt; .05). Further, education level was &gt; 9 years lower in Pakistani versus Norwegian women (79.5 % and 96.6 %, respectively; p &lt; .05) and fewer Pakistani women work outside the home (66.5 % and 95.2 %, respectively; p &lt; .05). Compared to Norwegian women (M = 29.7 years, SD = 4.4 years, p &lt;.05), Pakistani women were younger (M = 26.4 years, SD = 4.0 years) when they delivered their first child. Moreover, Pakistani infants weighed 339 g less (average birth-weight = 3181 g) compared to Norwegian infants (3520 g; p&lt; 0.05). We observed no significant difference in operative delivery among the Pakistaniversus Norwegian women (31.6 % and 27.9 %, respectively; p = 0.805). Regardless of ethnicity, variable maternal age (OR=1.106 [CI 95: 1.017 to 1.203]) and gestational age (OR=0.951 [CI 95: 0.908 to 0.997]) associated with operative delivery in this study.Newborn weight (OR=1.001 [CI 95: 1.000 to 1.002]) was considered borderline. Conclusion: This study revealedsociodemographic differences between Norwegian and Pakistani women undergoing operative delivery in Groruddalen, Norway. Compared to Norwegian women, Pakistani women had lower BMI and lower educational attainment. Fewer Pakistani women worked outside the home and they were younger when they delivered theirfirst child. Additionally, the birth weight of Pakistani babies delivered was lower than Norwegian newborns. We observed no difference in the proportion of operative deliveries between Norwegian and Pakistani women. Regardless of ethnicity, women’s chronological and gestational age affect operative delivery. / <p>ISBN 978-91-86739-64-5</p>

Tyrimo tikslas: nustatyti infekcinių komplikacijų rizikos veiksnius ir jų kontrolės valdymo mechanizmą artroskopinių operacijų metu. Tyrimo metodai. Anketinė apklausa, stebėjimo tyrimas operacinėje, dokumentinė analizė ir statistinė analizė. Anketavimui buvo naudojami klausimynai, o stebėjimo tyrimui – kriterijai, įtakojantys infekcijų kontroliavimą operacijų metu. Tiriamieji. Tyrimas vyko 2013 m. sausio – balandžio mėnesiais. Jo metu buvo sudarytos dvi tiriamųjų grupės (anketinis tyrimas) ir atliktas operacinės personalo stebėjimo tyrimas. Pirmąją grupę sudarė 6 (85,7 proc.) Ortopedijos traumatologijos skyriuje dirbantys chirurgai. Antrąją grupę tiriamųjų sudarė Ortopedijos traumatologijos skyriaus operacinėje 14 (93,3 proc.) dirbančių operacinės slaugytojų. Stebėjimo tyrimo metu operuojant pacientus, buvo stebima operacinėje dirbančių chirurgų ir operacinės slaugytojų veiksmai, kurie įtakoja infekcijos kontrolės valdymą. Šio tyrimo metu išoperuotas 51 pacientas. Operacijos atliktos LSMUL KK Ortopedijos traumatologijos klinikoje Ortopedijos traumatologijos skyriaus operacinėje. Po operacijų pacientai gulėjo LSMUL KK Ortopedijos klinikoje Ortopedijos traumatologijos skyriuje. Rezultatai. Palygintos chirurgų ir operacinės slaugytojų žinios apie infekcijos kontrolės valdymą, nustatyti operacinio personalo judėjimo ypatumai artroskopinių operacijų metu bei įvertinta chirurgų ir operacinės slaugytojų nuomonė apie veiksnius, kurie padėtų valdyti infekcijų riziką. Išvados... [toliau žr. visą tekstą] / Aim of research: to identify risk factors for infectious complications and the control mechanism during arthroscopic surgery. Research methods: A questionnaire, an observational study at operating, documentary analysis and statistical analysis. Question forms were used in questionnaires; whereas the criteria that influence infection controls during operations were used for the observation research. Research. The study took place in January – April, 2013. Two groups of persons under investigation (questionnaire survey) have been formed and the operating personnel tracking study was carried out. The first group consisted of 6 surgeons (85.7 percent) working at Orthopedics and Traumatology departments. The second group consisted of 14 (93.3 percent) Orthopedics and Traumatology department surgery nurses. Infection control management practices of operating surgeons and nurses that make an influence on infection controls have been monitored on surgery patients. 51 patients underwent surgeries in the course of this study. Surgeries were made at Orthopedic Traumatology Clinics of Orthopedics and Traumatology Department at LUHS Kaunas Clinics. After surgery, the patient were staying at Orthopedic Traumatology Department of LUHS Kaunas Clinics Orthopedic Clinic. Results. A comparison of infection control management knowledge between surgeons and surgery nurses was made, movement characteristics of operational staff during arthroscopic surgeries were identified and the infection... [to full text]

Information technology [IT] that enables electronic access to patient health records has been widely recognized as a promising means to improve the quality of care for patients with chronic diseases, and reduce health care costs through better health information delivery and encouragement of self-management. IT applied to assist chronic disease management is inadequately studied in Canadian health care settings. This thesis describes the development and modest pilot implementation of an electronic tool, the Diabetes Complication Surveillance System [DCSS]. The DCSS was conceived as a self-monitoring tool that facilitates regular checks on conditions of diabetes patients, including acute and long-term complications. The DCSS is relatively unusual, as it facilitates glycemic control and also allows patients to address the long-term complications of diabetes. The development of the DCSS involved literature reviews and consultations with clinician experts. Questionnaire results from the pilot provided positive feedback.

Information technology [IT] that enables electronic access to patient health records has been widely recognized as a promising means to improve the quality of care for patients with chronic diseases, and reduce health care costs through better health information delivery and encouragement of self-management. IT applied to assist chronic disease management is inadequately studied in Canadian health care settings. This thesis describes the development and modest pilot implementation of an electronic tool, the Diabetes Complication Surveillance System [DCSS]. The DCSS was conceived as a self-monitoring tool that facilitates regular checks on conditions of diabetes patients, including acute and long-term complications. The DCSS is relatively unusual, as it facilitates glycemic control and also allows patients to address the long-term complications of diabetes. The development of the DCSS involved literature reviews and consultations with clinician experts. Questionnaire results from the pilot provided positive feedback.

The dispute over interruption is one of the most intensive and most controversial political and ethical discussions in today{\crq}s modern civilization. It includes a great number of opposed, controversial opinions and attitudes both in the sphere of medicine and on the political or ethical ground. I have selected the topic of this work on the base of personal interest in the issue of termination of pregnancy, because this issue bears the basic questions and attitudes of man to the existence of the individual. Today the issue of interruption is sharply polarized into two controversial rivalling groups, i.e. the ``pro-life{\crqq} movement and the ``pro-choice{\crqq} movement. The dispute over termination of pregnancy has been becoming more and more topical issue not only in the Czech Republic but also in the world. The aim of this work was to map the attitudes of students not only of graduation classes of selected sanitary secondary schools to the issue of interruption and to compare the mapped attitudes of students of the Faculty of Health and Social Studies and of the Theological Faculty of the University of South Bohemia with the attitudes of respondents of graduation classes of the selected sanitary secondary schools to the issue of interruption. On the base of this aim, two hypotheses were stated in the research part of the work. After that, the questionnaire investigation was performed, for which a structured questionnaire had been elaborated. The questionnaire was filled out by fifty respondents of the Faculty of Health and Social Studies and fifty respondents of the theological Faculty of the University of South Bohemia of České Budějovice. On the base of that investigation, one of the hypotheses was not confirmed. Available literature and current Internet sources were used for the theoretical and for the practical part of the work. The work should serve primarily to the students themselves and to other readers as a modest data source for this extensive issue, and the research part of this work could be used as a small summary both for laymen and for professionals teaching at universities and high schools, so that they have the possibility to look at the issue of interruption from the point of view of the students, future professionals and workers of different areas.