Browsing by Issue Date, starting with "2024-02"
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- Comparison of Pain Management Strategies to Reduce Opioid Use Postoperatively in Free Flap Breast Reconstruction: Pain Catheter versus Nerve Block in Addition to Refinements in the Oral Pain Management RegimePublication . Stefansdottir, A; Vieira, L; Johnsen, A; Isacson, D; Rodriguez, A; Mani, MBackground Perioperative management in autologous breast reconstruction has gained focus in recent years. This study compares two pain management protocols in patients undergoing abdominal-based free flap breast reconstruction: a past protocol (PP) and a current protocol (CP)-both intended to reduce opioid consumption postoperatively. The PP entails use of a pain catheter in the abdominal wound and the CP consists of an intraoperative nerve block in addition to refinements in the oral pain management. We hypothesize that the CP reduces opioid consumption compared to PP. Methods From December 2017 to January 2020, 102 patients underwent breast reconstruction with an abdominal-based free flap. Two postoperative pain management strategies were used during the period; from December 2017 to September 2018, the PP was used which entailed the use of a pain catheter with ropivacaine applied in the abdominal wound with continuous distribution postoperatively in addition to paracetamol orally and oxycodone orally pro re nata (PRN). From October 2018 to January 2020, the CP was used. This protocol included a combination of intraoperative subfascial nerve block and a postoperative oral pain management regime that consisted of paracetamol, celecoxib, and gabapentin as well as oxycodone PRN. Results The CP group ( n = 63) had lower opioid consumption compared to the PP group ( n = 39) when examining all aspects of opioid consumption, including daily opioid usage in morphine milligram equivalents and total opioid usage during the stay ( p < 0.001). The CP group had shorter length of hospital stay (LOS). Conclusion Introduction of the CP reduced opioid use and LOS was shorter.
- Classification of Events Contributing to Postneonatal cerebral palsy: Development, reliability, and recommendations for use.Publication . Pudig, Luise; Delobel-Ayoub, Malika; Horridge, Karen; Gergeli, Anja Troha; Sellier, Elodie; Ehlinger, Virginie; Hollody, Katalin; Virella, Daniel; Vik, Torstein; Arnaud, CatherineAim: This paper introduces the Surveillance of Cerebral Palsy in Europe (SCPE) classification of events contributing to postneonatally acquired cerebral palsy, presents its interrater reliability, and describes the cases identified in the SCPE database. Method: The development of the classification, based on literature review and expert discussions, resulted in six main categories and 19 subcategories. The first chronological event designated as the primary event was mainly reported. Interrater reliability was assessed through online exercise providing 24 clinical vignettes representing single/complex pathways. Percent agreement and Gwet's AC1 index of reliability were estimated. Primary events were described using data of 221 children born between 2008 and 2012. Results: Thirty-nine professionals (21 registries) participated in the reliability exercise. Substantial overall agreement was reached (0.75), with some contrast between complex (0.48, moderate agreement) and single events involved (0.89, almost perfect). The distribution of primary events showed that 32.1% were infections (category A), 23.1% head injuries (B), 15.4% related to surgery or medical interventions (C), 13.1% cerebrovascular accidents (D), 9.1% hypoxic brain damaging events of other origins (E), and 7.2% miscellaneous (F). Interpretation: This classification allows all the events involved to be recorded while consistently reporting the primary event, and may be used in different settings. What this paper adds: A standardized classification enables the description of the events contributing to postneonatal cerebral palsy (CP). The first chronological event in complex pathway leading to CP is coded. Category choice and coding of the primary event identify preventable situations. The detailed 2-level classification is easy to use in various settings. Substantial overall interrater reliability shows that main categories can be consistently differentiated.
- Study Protocol for a Randomized Controlled Trial Testing the Efficacy of Emotion Detectives In-Out: a Blended Version of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Portuguese ChildrenPublication . Moreira, Helena; Skvarc, Dave; Gomes-Pereira, Bárbara; Albuquerque, Alzira; Góis, Ana Carolina; Fonseca, Ana; Pereira, Ana Maria; Caiado, Brígida; Paulino, Bruna; Santos, Catarina; Ehrenreich-May, Jill; Canavarro, Maria Cristina; Saraiva, Mariana; Vicente, Vitória Nunes; Pereira, Ana IsabelChildhood emotional disorders (EDs; i.e., anxiety and depressive disorders) are currently a public health concern. Their high prevalence, long-term effects, and profound influence on the lives of children and families highlight the need to identify and treat these disorders as early and effectively as possible. This clinical trial will examine the efficacy of a blended version (i.e., combining face-to-face and online sessions into one treatment protocol) of the Unified Protocol for Children (the "Emotion Detectives In-Out" program). This program is a manualized cognitive-behavioral therapy for the transdiagnostic treatment of EDs in children aged 7 to 12 years that aims to reduce the intensity and frequency of strong and aversive emotional experiences by helping children learn how to confront those emotions and respond to them in more adaptive ways.
- Ganhos da Interdisciplinaridade em Saúde. Estudo de CasoPublication . Varão, S; Espírito Santo, I; Teixeira, BIntrodução: A Insuficiência Cardíaca (IC) é causada por uma anomalia cardíaca, com sinais típicos, recomendando-se uma abordagem interdisciplinar (McDonagh et al., 2021). Um adequado planeamento de alta tem impacto na eficiência e satisfação do doente (Escoval et al., 2010). Objetivos: Evidenciar os ganhos da interdisciplinaridade nos cuidados à pessoa com IC. Material e métodos: Clinicamente, destaca-se miocardiopatia dilatada com IC, NYHA III-IV. Antecedentes: IC com 6 internamentos/ano, insuficiência respiratória global (sob Oxigenioterapia longa duração 1L/m). Na admissão, exame objetivo: dispneia e dificuldade em articular frases, perfil hipertenso, taquicardico, SpO297% sob 3L/m. À auscultação: tons arrítmicos, taquicardíacos, Murmúrios Vesiculares diminuídos nas bases, fervores bibasais. Membros inferiores com edema. Radiografia tórax com aumento do Índice Cardiotorácico e estase nos campos inferiores. Apresentava: 76,8Kg, cansaço a mínimos esforços, dependência elevada nas Atividades Vida diária (AVD), dificuldade na terapêutica. Identificaram-se diagnósticos enfermagem: Dispneia Presente, Posicionar-se/Vestuário dependente grau elevado, Alimentar-se/Higiene/Sanitário/Movimento muscular dependente grau moderado, Gestão do Regime terapêutico comprometida. O doente vive com esposa. Tem 2 filhas, sem disponibilidade para apoio presencial. Reconhecem-se indicadores de risco social: Problema social (Escala Gijón=15), Dependência funcional, desconhecimento dos recursos da comunidade/direitos, iliteracia em saúde e incapacidade familiar de apoio. Admitiu-se o doente no “Plano Integrado de Alta Hospitalar”, informando-se a Unidade de Saúde sobre o internamento. Cumpriu levosimendan. e furosemida. Fez-se desmame de O2 até ao basal. Procedeu-se ao treino de estratégias de conservação de energia, posições de descanso e AVD. Realizou-se exercício aeróbio e desmitificou-se crenças sobre terapêutica. Orientou-se para direitos sociais. Agendou-se conferência familiar. Resultados: Verificou-se que o incumprimento desencadeou a descompensação (dosagens prescritas e administradas diferentes), devido a inadequação da comunicação e por falta de apoio para detetar erros na administração. Definiu-se como plano com a pessoa e família: apoio domiciliário (AVD e medicação) e envolvimento familiar. Enviou-se informação à equipa da Unidade de Saúde que, pós-alta, constatou adesão ao regime terapêutico. O doente foi reavaliado em consulta: maior autonomia e tolerância ao esforço, com consequente ganho em saude e eficácia organizacional. Conclusões: A abordagem interdisciplinar ao doente com IC é impreterível para se evitarem hospitalizações (McDonagh et al., 2021). A aplicação de uma alta integrada em doentes de alto risco clínico/social melhora o planeamento dos cuidados, assegurando a sua continuidade e segurança de cuidados.