Próximo 16 de enero, miércoles tenemos....
http://wellbe.me/blog/The-Surgery-Waiting-Room-and-Patient-Anxiety?goback=%2Egde_1170817_member_201872826
The Surgery Waiting Room and Patient Anxiety
7
Submitted by James.Dias on Wed, 06/27/2012 - 21:35
Dr. Kevin Campbell recently blogged about being on the other side of a surgery, in the dreaded waiting room. He noted four things:
Unoccupied time feels longer than occupied time
Anxiety makes waits seem longer
Uncertain waits seem longer than known finite waits
Solo waits seem longer than group waits
I'll focus on #2 here. Much has been written about patient anxiety before surgery. Mathews et al (1981) suggested patients who undergo surgery experience acute psychological distress in the pre-operative period.
Anxiety is usually reduced by knowledge. So the more information you can arm a patient and their caregivers with before the big day, the more comfortable they should feel during the actual event. If they have benefited from proactive patient education, then they will know all the procedure steps going on behind those closed doors.
MJ Pritchard recently wrote in Reducing anxiety in elective surgical patients: "Effective communication is the cornerstone of good healthcare yet it can be a difficult skill to master. Poor communication can have serious consequences for patients and cause irreparable damage to the nurse-patient relationship... Communication tools should be straightforward, easy to use and flexible."
The Wellbe.me Patient Guidance System allows patients to include their caregivers in on their treatment plans so they can be informed and help with the process. Communication between the doctor, patient and the patient's trusted home caregivers is vitally important to good outcomes.
James.Dias's blog
ABOUT THE AUTHOR
Founder & Chief Executive Officer
http://well.blogs.nytimes.com/2013/01/07/needed-more-attention-to-boys-development/?src=me&ref=general
18 AND UNDER
JANUARY 7, 2013
Needed: More Attention to Boys’ Development
By PERRI KLASS, M.D.
Joyce Hesselberth
18 AND UNDER
Dr. Perri Klass on family health.
When you learn how to examine the female reproductive system in medical school, you generally work with a professional surrogate patient, and there is often a humiliating moment when you try to palpate the ovaries only to be told, in no uncertain terms, that you are way off-target. At such a moment, the male reproductive system seems quite simple and accessible.
Yet simple it is not. Recent research suggests that we should be paying closer attention to male development, not just to help boys understand and care for a particularly sensitive and vulnerable part of their anatomy — but also to help answer larger questions about what is happening to boys and their growth.
As part of examining every baby boy, pediatricians check for a relatively common condition known as cryptorchidism, which means a hidden or secret testicle. Between 3 and 5 percent of newborn boys have at least one testicle that fails to descend into the scrotum, with a higher incidence inpremature babies.
In cases of cryptorchidism, the testicle may descend of its own accord during the first months after birth. If it doesn’t, there’s an operation,orchiopexy, that releases it into the scrotum. Most surgeons prefer to operate when the boy is about a year old. If the testicle remains in the abdomen, where the body temperature is higher, germ cells don’t mature properly and future sperm production and fertility are at risk.
Doctors also worry about those undescended testicles because of a link to cancer down the line. A major new analysis published this month in The Archives of Disease in Childhood found that boys born with undescended testicles have three times the usual risk of developing testicular cancer. Boys who had this problem at birth need to know about it as they grow up, and need to learn how to do regular testicular self-exams.
“The message for parents is get them seen and checked by a specialist,” said Dr. Robert Carachi, professor of surgical pediatrics at the University of Glasgow and one of the authors of the study. “Adolescent men should be examining themselves. If there’s swelling or enlargement, get it checked early.”
Regular self-exams for all — that is, for those not at higher risk of cancer — are not currently recommended because they can cause anxiety and have not been shown to improve outcomes in boys or men who aren’t at particular risk.
Pediatricians discuss other risks with boys who play sports, and we urge them to wear proper protection, a message that is sometimes lost, and not just on adolescents.
For all their protective equipment, professional football players, for example, tend not to wear protective cups to shield their genitals from the dangers on the field. According to Dr. Stephen G. Rice, director of the Jersey Shore Sports Medicine Center in Neptune, N.J., cups are rarely worn in soccer and football, where the players must change direction frequently as they run, as opposed to baseball, where most of the running is in a straight line.
“For a lot of sports, it’s going to get in the way,” said Dr. Rice, who was one of the lead authors of the 2012 American Academy of Pediatrics policy statement on how to keep children safe when playing baseball and softball. The statement recommended cups for all participants. “Baseball is the exception because of how hard the ball is and how fast it comes,” he said. “It’s random chance, nothing to do with your skill level.”
An injury from a flying baseball can cause excruciating pain, and learning to take responsibility for protecting yourself is part of maturity. And there is new evidence, also related to the testicular exam, that the pace of maturity may be shifting in disturbing ways for boys, as it is for girls. As boys grow toward puberty, the first invisible changes brought on by the hormonal signals occur in the testicles. They begin to grow and enlarge. Compared with the physical development of girls, these modest increases in testicular volume are not really noticeable to parents, or even to the boys themselves, said Marcia E. Herman-Giddens, adjunct professor of maternal and child health at the University of North Carolina.
But a 2012 study of 4,131 boys by Dr. Herman-Giddens and her colleagues found that subtle testicular enlargement, which signals the onset of puberty, is happening earlier than seen in previous studies. The changes could be measured, on average, by the age of 10. Over all, the researchers concluded, male puberty seems to be beginning 6 months to 2 years earlierthan it used to.
Dr. Herman-Giddens was also one of the lead authors on the comparable study published in 1997 that caused an uproar by suggesting that female puberty was coming earlier. Some of the factors thought to be associated with earlier female puberty — obesity, diet changes, chemicals in the environment that affect hormones — may be at work in boys, too, but the mechanisms aren’t understood.
Dr. Herman-Giddens said there was much less media attention to the news about puberty in boys, pointing out that the early changes in males — in particular the enlargement of the testicles — are much less visible than early breast development is in girls. But parents — and fourth- and fifth-grade teachers — need to be aware that relatively young boys may be dealing with the confusions and hormonal effects of early puberty.
“The sex hormones and especially testosterone are increasing in the boy’s body, and that’s what’s making the testes start to grow and that’s going to have an effect on the boy’s behavior,” Dr Herman-Giddens said. “Judgment, other aspects of psychological maturity — that’s not happening any faster.”
These subtle physiological changes tell us something more: that boyhood itself may be changing in ways we don’t completely understand, and that we need to be attentive to helping boys and young men take care of themselves as they grow.
A version of this article appeared in print on 01/08/2013, on page D5 of the NewYork edition with the headline: Needed: More Attention to Boys’ Development.
http://www.rrhhdigital.com/ampliada.php?id=89679&sec=45&goback=%2Egde_3089472_member_202233918
Combinar ejercicio físico e intelectual y mantener las relaciones sociales ayuda a preservar la memoria
Actualizado Domingo 06/01/2013 01:17
EP
RRHH Digital Ejercitarse intelectualmente, hacer diariamente ejercicio físico, mantener las relaciones sociales y seguir la dieta mediterránea ayuda a no perder la memoria, especialmente cuando se llega a la vejez. Y es que, diversos estudios han mostrado que entre el 30 y el 50 por ciento de los mayores de 65 años sufren olvidos cotidianos como, por ejemplo, los nombres de personas.
No obstante, esta pérdida de memoria también afecta a la población más joven. De hecho, las investigaciones señalan que al menos una de cada cuatro personas de entre 25 años y 35 años está preocupada por "olvidos inexplicables". Un porcentaje que asciende al 35 por ciento en las personas de más de 40 años.
Así lo ha explicado a Europa Press la neuropsicóloga Gema Mejuto quien participa en un taller de memoria organizado por la Fundación Vianorte-Laguna en el Hospital Centro de Cuidados Laguna de Madrid y que tiene como objetivo ayudar a las personas a mantener la memoria activa.
Al llegar a una cierta edad las conexiones neuronales se van debilitando provocando que "ciertas partes del cerebro" se vayan desconectando y produzcan la aparición de ciertos tipos de demencia que, en muchas ocasiones, conllevan una pérdida de memoria.
Entre los olvidos más frecuentes se encuentran la llamada 'punta de lengua' que es cuando no salen las palabras más comunes --le ocurre a casi el 94% de los mayores--, el olvido de los nombres de personas --al 94%--, las dificultades para aprender una nueva habilidad --76%-- o cuando no se recuerda de lo que se acaba de decir --76%--.
Ahora bien, según ha explicado Mejuto, estos olvidos comienzan a ser preocupantes cuando se convierten en habituales y duran más de seis meses. En estos casos, la experta ha recomendado que, además de acudir a talleres como el que organiza la Fundación, el afectado vaya a un médico para que le realice un diagnóstico.
Por todo ello, la neuropsicóloga ha insistido en la necesidad de que, sobre todo, las personas mayores de 65 años realicen ejercicios intelectuales que refuercen la memoria y, por tanto, las conexiones neuronales y que, además, se entrenen físicamente dado que este ejercicio tiene repercusiones "muy positivas en el funcionamiento cerebral".
Además, Mejuto ha subrayado la importancia que tienen las relaciones sociales recordando que las sociedades "más abiertas" tienen menos problemas de demencia y ha insistido en los beneficios que aporta al cerebro la dieta mediterránea basada en el pescado azul, en las frutas y en las verduras.
Comparación de I-Gel 2.5. con ML Proseal en niños anestesiados y paralizados para cirugía electiva
Comparison of Size 2.5 i-gel™ with Proseal LMA™ in Anaesthetised, Paralyzed Children Undergoing Elective Surgery.
Mitra S, Das B, Jamil SN.
Department of Anaesthesiology, Jawaharlal Nehru Medical College, A.M.U., Aligarh, India.
N Am J Med Sci. 2012 Oct;4(10):453-7. doi: 10.4103/1947-2714.101983.
Abstract
BACKGROUND: The newest variation of i-gel is its pediatric version. This novel supraglottic airway device has the added advantage of a drain tube. In this study, we compared the effectiveness of size 2.5 i-gel with size 2.5 ProSeal LMA. AIMS: This study was designed to investigate the usefulness of the size 2.5 i-gel compared with the ProSeal laryngeal mask airway (PLMA) of the same size in anesthetized, paralyzed children. MATERIALS AND METHODS: Sixty ASA grade I - II patients undergoing elective surgery were included in this prospective study and were randomly assigned to the i-gel and PLMA groups (30 patients in each group). A size 2.5 supraglottic airway was inserted according to the assigned group. We assessed the ease of insertion, hemodynamic data, oropharyngeal sealing pressure, and postoperative complications. RESULTS: There were no differences in the demographic and hemodynamic data, success rates for the first attempt of insertion, or postoperative airway morbidity among the two groups. The airway leak pressure of the i-gel group (27.12 ± 1.69 cm H(2)O) was significantly higher than that of the PLMA group (22.75 ± 1.46 cm H(2)O). CONCLUSION: Hemodynamic parameters, ease of insertion and postoperative complications were comparable between the i-gel and PLMA, but the nairway sealing pressure was significantly higher in the i-gel group.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3482775/
Comparación del dispositivo perilaríngeo Cobra con la ML flexible en términos de estabilidad del dispositivo y características de ventilación en cirugía oftalmológica en niños
Comparison of Cobra perilaryngeal airway (CobraPLA™) with flexible laryngeal mask airway in terms of device stability and ventilation characteristics in pediatric ophthalmic surgery.
Sunder RA, Sinha R, Agarwal A, Perumal BC, Paneerselvam SR.
Department of Anaesthesiology and Intensive Care, Rajendra Prasad Institute of Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
J Anaesthesiol Clin Pharmacol. 2012 Jul;28(3):322-5. doi: 10.4103/0970-9185.98324.
Abstract
BACKGROUND: Supraglottic airway devices play an important role in ophthalmic surgery. The flexible laryngeal mask airway (LMA™) is generally the preferred airway device. However, there are no studies comparing it with the Cobra perilaryngeal airway (CobraPLA™) in pediatric ophthalmic procedures. AIMS: To analyze the intraoperative device stability and ability to maintain normocarbia of CobraPLA™ and compare it to that with flexible LMA™. MATERIALS AND METHODS: Ninety children of American Society for Anesthesiologists physical status 1 and 2, aged 3-15 years scheduled for elective ophthalmic surgeries were randomly assigned to either the CobraPLA™ or the flexible LMA™ group. After placement of each airway device, oropharyngeal leak pressure (OLP) was noted. Adequate seal of the devices was confirmed at an inspired pressure of 15 cm H(2)O and pressure-controlled ventilation was initiated. Device displacement was diagnosed if there was a change in capnograph waveform, audible or palpable gas leak, change in expired tidal volume to <8 ml/kg, end-tidal carbon-dioxide persistently >6 kPa, or need to increase inspired pressure to >18 cm H(2)O to maintain normocarbia. RESULTS: Demographic data, duration, and type of surgery in both the groups were similar. A higher incidence of intraoperative device displacement was noted with the CobraPLA™ in comparison to flexible LMA™ (P < 0.001). Incidence of displacement was higher in strabismus surgery (7/12). Insertion characteristics and ventilation parameters were comparable. The OLP was significantly higher in CobraPLA™ group (28 ± 6.8 cm H(2)O) compared to the flexible LMA™ group (19.9 ± 4.5 cm H(2)O) (P < 0.001). Higher surgeon dissatisfaction (65.9%) was seen in the CobraPLA™ group. CONCLUSION: The high incidence of device displacement and surgeon dissatisfaction make CobraPLA™ a less favorable option than flexible LMA™ in ophthalmic surgery.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3409940/
Dispositivos supraglóticos en niños
Supraglottic airway devices in children.
Ramesh S, Jayanthi R.
Department of Anaesthesia, Senior Consultants, Kanchi Kamakoti Childs Trust Hospital, Chennai, Tamil Nadu, India.
Indian J Anaesth. 2011 Sep;55(5):476-82. doi: 10.4103/0019-5049.89874.Abstract
Modern anaesthesia practice in children was made possible by the invention of the endotracheal tube (ET), which made lengthy and complex surgical procedures feasible without the disastrous complications of airway obstruction, aspiration of gastric contents or asphyxia. For decades, endotracheal intubation or bag-and-mask ventilation were the mainstays of airway management. In 1983, this changed with the invention of the laryngeal mask airway (LMA), the first supraglottic airway device that blended features of the facemask with those of the ET, providing ease of placement and hands-free maintenance along with a relatively secure airway. The invention and development of the LMA by Dr. Archie Brain has had a significant impact on the practice of anaesthesia, management of the difficult airway and cardiopulmonary resuscitation in children and neonates. This review article will be a brief about the clinical applications of supraglottic airways in children.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3237147/
Comparación de tres dispositivos supraglóticos en niños anestesiados paralizados para cirugía electiva
Comparison of three supraglottic devices in anesthetised paralyzed children undergoing elective surgery.
Das B, Mitra S, Jamil SN, Varshney RK.
Department of Anaesthesiology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India.
Saudi J Anaesth. 2012 Jul;6(3):224-8. doi: 10.4103/1658-354X.101212.
Abstract
CONTEXT: The newest variation of the i-gel supraglottic airway is a pediatric version. AIMS: This study was designed to investigate the usefulness of the size 2 i-gel compared with the ProSeal laryngeal mask airway (PLMA) and classic laryngeal mask airway (cLMA) of the same size in anesthetized, paralyzed children. SETTINGS AND DESIGN: A prospective, randomized, single-blinded study was conducted in a tertiary care teaching hospital. METHODS: Ninety ASA grade I-II patients undergoing lower abdominal, inguinal and orthopedic surgery were included in this prospective study. The patients were randomly assigned to the i-gel, PLMA and cLMA groups (30 patients in each group). Size 2 supraglottic airway was inserted according to the assigned group. We assessed ease of insertion, hemodynamic data, oropharyngeal sealing pressure and postoperative complications. RESULTS: There were no differences in the demographic and hemodynamic data among the three groups. The airway leak pressure of the i-gel group (27.1±2.6 cmH(2)O) was significantly higher than that of the PLMA group (22.73±1.2 cmH(2)O) and the cLMA group (23.63±2.3 cmH(2)O). The success rates for first attempt of insertion were similar among the three devices. There were no differences in the incidence of postoperative airway trauma, sore throat or hoarse cry in the three groups. CONCLUSIONS: Hemodynamic parameters, ease of insertion and postoperative complications were comparable among the i-gel, PLMA and cLMA groups, but airway sealing pressure was significantly higher in the i-gel group.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3498659/
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Uso del tubo laríngeo por paramédicos noruegos fuera del hospital durante paro cardiaco
Laryngeal tube use in out-of-hospital cardiac arrest by paramedics in Norway.
Sunde GA, Brattebø G, Odegården T, Kjernlie DF, Rødne E, Heltne JK.
Scand J Trauma Resusc Emerg Med. 2012 Dec 18;20(1):84.
Abstract
ABSTRACT: BACKGROUND: Although there are numerous supraglottic airway alternatives to endotracheal intubation, it remains unclear which airway technique is optimal for use in prehospital cardiac arrests. We evaluated the use of the laryngeal tube (LT) as an airway management tool among adult out-of-hospital cardiac arrest (OHCA) patients treated by our ambulance services in the Haukeland and Innlandet hospital districts. METHODS: Post-resuscitation forms and data concerning airway management in 347 adult OHCA victims were retrospectively assessed with regard to LT insertion success rates, ease and speed of insertion and insertion-related problems. RESULTS: A total of 402 insertions were performed on 347 OHCA patients. Overall, LT insertion was successful in 85.3% of the patients, with a 74.4% first-attempt success rate. In the minority of patients (n = 46, 13.3%), the LT insertion time exceeded 30 seconds. Insertion-related problems were recorded in 52.7% of the patients. Lack of respiratory sounds on auscultation (n = 100, 28.8%), problematic initial tube positioning (n = 85, 24.5%), air leakage (n = 61, 17.6%), vomitus/aspiration (n = 44, 12.7%), and tube dislocation (n = 17, 4.9%) were the most common problems reported. Insertion difficulty was graded and documented for 95.4% of the patients, with the majority of insertions assessed as being "Easy" (62.5%) or "Intermediate" (24.8%). Only 8.1% of the insertions were considered to be "Difficult". CONCLUSIONS: We found a high number of insertion related problems, indicating that supraglottic airway devices offering promising results in manikin studies may be less reliable in real-life resuscitations. Still, we consider the laryngeal tube to be an important alternative for airway management in prehospital cardiac arrest victims.
http://www.sjtrem.com/content/pdf/1757-7241-20-84.pdf
Laicos puede colocar con éxitos los dispositivos supraglóticos con tres minutos de entrenamiento. Comparación en cuatros maniquís diferentes
Laypersons can successfully place supraglottic airways with 3 minutes of training. A comparison of four different devices in the manikin.
Schälte G, Stoppe C, Aktas M, Coburn M, Rex S, Schwarz M, Rossaint R, Zoremba N.
Department of Anesthesiology, University Hospital Aachen, Aachen, Germany. gschaelte@ukaachen.de
Scand J Trauma Resusc Emerg Med. 2011 Oct 24;19:60. doi: 10.1186/1757-7241-19-60.
Abstract
INTRODUCTION: Supraglottic airway devices have frequently been shown to facilitate airway management and are implemented in the ILCOR resuscitation algorithm. Limited data exists concerning laypersons without any medical or paramedical background. We hypothesized that even laymen would be able to operate supraglottic airway devices after a brief training session. METHODS: Four different supraglottic airway devices: Laryngeal Mask Classic (LMA), Laryngeal Tube (LT), Intubating Laryngeal Mask (FT) and CobraPLA (Cobra) were tested in 141 volunteers recruited in a technical university cafeteria and in a shopping mall. All volunteers received a brief standardized training session. Primary endpoint was the time required to definitive insertion. In a short questionnaire applicants were asked to assess the devices and to answer some general questions about BLS. RESULTS: The longest time to insertion was observed for Cobra (31.9 ± 27.9 s, range: 9-120, p < 0.0001; all means ± standard deviation). There was no significant difference between the insertion times of the other three devices. Fewest insertion attempts were needed for the FT (1.07 ± 0.26), followed by the LMA (1.23 ± 0.52, p > 0.05), the LT (1.36 ± 0.61, p < 0.05) and the Cobra (1.45 ± 0.7, p < 0.0001). Ventilation was achieved on the first attempt significantly more often with the FT (p < 0.001) compared to the other devices. Nearly 90% of the participants were in favor of implementing supraglottic airway devices in first aid algorithms and classes. CONCLUSION: Laypersons are able to operate supraglottic airway devices in manikin with minimal instruction. Ventilation was achieved with all devices tested after a reasonable time and with a high success rate of > 95%. The use of supraglottic airway devices in first aid and BLS algorithms should be considered.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3213203/pdf/1757-7241-19-60.pdf
Experiencia inicial con el dispositivo supraglótico I-gel por residentes en pacientes pediátricos
Initial experience of the i-gel supraglottic airway by the residents in pediatric patients.
Abukawa Y, Hiroki K, Ozaki M.
Department of Anesthesia and Critical Care, Tokyo Women's Medical University, Tokyo, Japan. yukako1@rg8.so-net.ne.jp
J Anesth. 2012 Jun;26(3):357-61. doi: 10.1007/s00540-011-1322-1. Epub 2012 Feb 7.Abstract
PURPOSE: Insertion of a laryngeal mask airway (LMA) is occasionally difficult in children because of their anatomical features and variations. A new single-use supraglottic airway device, the i-gel airway, was recently introduced. The objective of this study was to show the initial experience of the i-gel airway device by the residents for pediatric patients. METHODS: With approval from the local ethics committee and parental informed consent, 70 children undergoing minor surgery in the supine position, ASA score I-II, were investigated. Exclusion included patients having thoracic, neurosurgical, spine, and otolaryngological procedures. Patients were divided into three groups: group 1 was airway size 1.5 for patients weighing 5-12 kg, group 2 was size 2 for 10-25 kg, and group 3 was size 2.5 for those weighing 25-35 kg. The following seven characteristics were evaluated: (1) ease of the i-gel and gastric tube insertion; (2) leak pressure; (3) tidal volume/body weight at leak pressure point; (4) fiberscope score; (5) insertion time; (6) hypoxia rate (laryngospasm); and (7) coughing and trace of bleeding. RESULTS: The overall insertion success rate and the success rate at first attempt were 99% and 94%, respectively. Gastric tube insertions were easy in all patients. The overall leak pressure was 23 ± 5 cmH(2)O. The tidal volume per body weight was 24 ± 10 ml/kg. A good view of the fiberscope was achieved in 79%. In group 1 (size 1.5), one failed insertion, two dislocations, and one dysphonia were observed. Hypoxia rate was 1%. There was no case with coughing and trace of bleeding. CONCLUSION: These results show that the i-gel airway is a safe and effective device for use by residents who do not have experience with insertion of a pediatric LMA. However, using size 1.5, special caution should be taken to protect the infant airway, similar to what has been previously reported for other airway devices.
http://link.springer.com/content/pdf/10.1007%2Fs00540-011-1322-1
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
'El despertar de la escritura femenina española' en la Biblioteca ...
Diario Siglo XXI
La Biblioteca Nacional de España (BNE) inaugura este mes tres nuevas exposiciones: 'La Biblioca', 'El despertar de la escritura femenina española' y 'De pasadizo a pasadizo. Las casas de la BibliotecaNacional', además de ofrecer nuevos talleres y ...
Ver todos los artículos sobre este tema »
Biblioteca y Museo retomaron actividades con normalidad| Metro ...
según JDuarte
De esta forma, tanto la Biblioteca municipal, ubicada en las calles 10 de Agosto, entre Pedro Carbo y Chile; y el Museo, situado en Sucre, entre Pedro Carbo y Chile, están atendiendo normalmente. El horario de atención en la Biblioteca es ...
Metro Ecuador - Noticias de Quito...
¿problemas con biblioteca? - Yahoo! Respuestas
Encuentra las respuestas de la pregunta ¿problemas con biblioteca?, Otros - Computadoras en Yahoo! Respuestas. Descubre respuestas de las más diversas ...
espanol.answers.yahoo.com/question/index?qid...
Biblioteca csd
Hemos descargado su libro que pasa a formar parte de la colección de libros electrónicos que forman el fondo de la Biblioteca del CSD. A través del Catálogo.
www.slideshare.net/fernandozaplanaconsulting/biblioteca-csd
¿como Solucionar el problema _except_hadler4_commom de la ...
Encuentra las respuestas de la pregunta ¿como Solucionar el problema _except_hadler4_commom de la biblioteca de vinculos dinamicos en WinXP?, ...
espanol.answers.yahoo.com/question/index?qid...
Usuario:Paribanú Freitas/Biblioteca - Wikipedia, la enciclopedia libre
Usuario:Paribanú Freitas/Biblioteca. De Wikipedia, la enciclopedia libre. < Usuario:Paribanú Freitas. Saltar a: navegación, búsqueda ...
es.wikipedia.org/wiki/Usuario:Paribanú_Freitas/Biblioteca
La Biblioteca Nacional ampliará su horario en el 2013 - articulo_tuanix
A partir del 07 de enero de este año se amplía en dos horas más de funcionamiento de la bibliotecaEncuentre las últimas noticias de Costa Rica y el mundo en ...
noticias.kolbi.msn.com/articulo_tuanix.aspx?cp-documentid...
Iniciamos el ciclo 2013 del seminario se Pediatria Ciberpeds-Conapeme
en su 6o año consecutivo con un record de asistencias on y off line de mas de 15mil en un año, gracias por tu preferencia y asistir a nuestro seminario.
Estimado Pediatra te invito al Seminario de Pediatría, Cirugía Pediátrica y Lactancia Materna. El día 2o de Enero 2013 las 21hrs (Centro, México DF, Guadalajara y Lima Perú) a la Conferencia: “Soluciones práctica s para problemas comunes de lactancia” por el “la ILBCL Graciela Hess Carrillo .” Instructora de Lactancia, de la Cd de México. La sesión inicia puntualmente las 21 hrs.
Para entrar a la Sala de Conferencia:
1.- hacer click en la siguiente liga, o cópiala y escríbela en tu buscador
http://connectpro60196372.adobeconnect.com/soluciones_lactancia/
2.- “Entra como Invitado” Escribes tu nombre y apellido en el espacio en blanco
3.- Hacer click en el espacio que dice “Entrar en la Sala”
5.- A disfrutar la conferencia 6.- Recomendamos que dejes tu Nombre Completo, Correo electrónico y que participes.
Henrys
Dr. Enrique Mendoza López
Webmaster: CONAPEME
Coordinador Nacional: Seminario Ciberpeds-Conapeme
Av La clinica 2520-310
Colonia Sertoma ,Mty N.L. México
CP 64710
Tel-Fax 52 81 83482940 y 52 81 81146053
Celular 8183094806
www.conapeme.org
www.pediatramendoza.com
enrique@pediatramendoza.com
emendozal@yahoo.com.mx
Colegio Mexicano de Ortopedia y Traumatología: Fisioterapia na Tendinite da Pata de Ganso: Fisioterapia na Tendinite da Pata de Ganso Fuente: http://ortopedia.facafisioterapia.net/2013/01/fisioterapia-na-tendinite-da-pata-de...
Fisioterapia na Tendinite da Pata de Ganso
Fuente: http://ortopedia.facafisioterapia.net/2013/01/fisioterapia-na-tendinite-da-pata-de.html
Tendinite comum no meio desportivo, a tendinite da pata de ganso ocorre geralmente por excesso de uso, overuse, sobrecarga e esforço repetitivo. Um estresse biomecânico, provocado por um joelho valgo ou varo, pé pronado ou supinado pode ser um fator preditivo. Pancadas na região também podem provocar a lesão, associando com a bursite da pata de ganso.
Clinicamente, é difícil distinguir qual estrutura está afetada, se é o tendão ou a bursa. A literatura revela que, na maioria dos casos, o problema é de origem bursal. A inflamação da bursa (bursite) pode resultar de um trauma agudo na parte medial do joelho ou por overuse (sobrecarga), na qual há uma fricção repetitiva da bursa entre a tíbia e os tendões devido a estresses em valgo ou uso excessivo dos isquiotibiais, principalmente naqueles que tem um encurtamento dos músculos posteriores da coxa. É comum ocorrer nos esportes que exigem mudanças rápidas e bruscas de direção.
A Influência da técnica de energia muscular na tendinite da pata de ganso.
Tratamento Convencional
Tratamento
• Fase aguda: crioterapia, ultra-som no modo pulsátil, laser e tens, podem ser recursos da eletrotermofoterapia que se aplicam bem ao quadro clínico do paciente. Quando a dor for diminuindo, incluir: exercícios suaves de alongamentos para os referidos músculos (semitendíneo, grácil e sartório), bem como exercícios de fortalecimento, com carga leve e progressiva. Na fase de resolução, incluir exercícios proprioceptivos (sensório-motores) específicos e, exercícios funcionais para retorno breve à prática desportiva. O uso de antiinflamatórios, é um recurso que deve ser utilizado também, de acordo com orientação e critério médico.
• Fase crônica: Calor, ultra-som no modo contínuo, laser como cicatrizante, são recursos benéficos. Entretanto, os exercícios de alongamentos, exercícios de fortalecimento muscular, exercícios proprioceptivos e funcionais são fundamentais no processo de recuperação deste paciente. Bandagens funcionais podem ser utilizadas, bem como palmilhas específicas, caso haja alguma alteração biomecânica que justifique. Em geral, é auto-limitada (melhora com ou sem tratamento), mas o tratamento fisioterapêutico acelera e evita recidivas do quadro clínico.
Técnicas de Energia Muscular
A técnica de energia muscular é um método da terapia manual desenvolvida por Fred Mitchell. Pode ser utilizada amplamente em um espectro diverso de disfunções vivenciadas constantemente por fisioterapeutas como, por exemplo: dor miofascial, lombalgia e fibromialgia.
A técnica de energia muscular com relaxamento pós-isométrico (TEM/RPI) é um método manipulativo no qual o indivíduo utiliza ativamente seus músculos a partir de uma posição controlada em uma direção específica contra uma força contrária, a fim de restituir a mobilidade articular e reduzir quadros álgicos decorrentes do espasmo muscular. Baseia-se no fato de que, após uma contração préalongamento de um músculo retraído, esse músculo irá relaxar como resultado da inibição autogênica e será alongado mais facilmente.
Pode ser aplicada para alongar músculos encurtados, fortalecer músculos enfraquecidos e mobilizar articulações com mobilidade restrita.
A figura representa os efeitos fisiológicos da técnica de energia muscular.
A Influência da Técnica de Energia Muscular na Tendinite da Pata de Ganso.
A técnica de energia muscular pode proporcionar uma reabilitação eficiente, acelerada e podendo ainda prevenir futuras lesões. Além de tratarmos a parte afetada "os tendões" poderemos trabalhar a musculatura, a articulação e todo o conjunto e de maneira global promover a saúde do sistema locomotor . A Pata de Ganso é uma importante estrutura anatômica para o membro inferior e que se comprometida pode alterar o funcionamento de outras estruturas por exemplo o joelho. Lembrando que o tratamento tanto convencional quanto a Técnica de Energia muscular só serão efetivos se ou fatores que desencadeiam a lesão forem cessados. Essa Técnica é indicada a pacientes com sintomatologia dolorosa do sistema locomotor mas que apresentem atividade articular normal, porém musculatura encurtada ou com espasmo. Sendo assim mais uma eficiente técnica para utilizarmos no tratamento tanto da Pata de Ganso quanto em outras patologias do sistema locomotor.
www.smo.edu.mx
Colegio Mexicano de Ortopedia y Traumatología A.C.
World Trade Center México, Montecito #38, col. Nápoles
piso 25, oficinas 23 a 27, C.P. 03810, México, D.F.
Tel y Fax ( ) (55) 9000 2790 al 94
El Colegio Mexicano de Ortopedia y Traumatología, A.C., tiene el agrado de presentarles su proyecto anual la “XXVII Jornada Nacional de Ortopedia, 58° Reunión anual”, que se llevará a cabo en el bello puerto de Acapulco del 1° al 5 de mayo del 2013.
Nuestra sede, Hotel Acapulco Princess nos proporcionará el cupo y la comodidad que requiere nuestro grupo, con la ventaja de que el hospedaje y las actividades serán en el mismo recinto proporcionando facilidades y seguridad así como innumerables actividades recreativas, sol y playa. Esto constituye el lugar adecuado para compartir con nuestra familia todas las experiencias que estamos planeado para la ortopedia Nacional e Internacional.
Se está preparando un nutrido programa académico, con la participación de profesores nacionales e internacionales de reconocido prestigio, trabajando en conjunto con el profesionalismo de los Titulares de Capítulo de Especialización del Colegio y con el entusiasmo del Comité de Damas se esta organizando un atractivo programa socio-cultural para acompañantes.
Para este evento contaremos con la asistencia de la Federación Europea de Sociedades de Ortopedia y Traumatología (EFORT) quien impartirá cursos instruccionales. Tendremos como sociedad invitada a la Sociedad Española de Ortopedia y Traumatología (SECOT) estamos seguros de que con su entusiasmo y experiencia aportarán gran calidad a nuestras actividades académicas. La unión de la Ortopedia Latinoamericana es una de las metas de nuestro Colegio, es por eso que hemos invitado a Venezuela y Guatemala como países participantes.
Las actividades sociales se están planeando para que otorguen una verdadera convivencia entre nosotros y con innumerables sorpresas que constituirán eventos de primera calidad. Contaremos con la exposición de la industria farmacéutica y de empresas fabricantes y distribuidores de equipo, material e insumos necesarios en el quehacer de nuestra especialidad. Mi mayor interés con ustedes es que esta Jornada les sea de gran provecho profesional y que sean parte del éxito de este gran evento.
Queda pues una invitación abierta a la Ortopedia Nacional a que nos acompañen a este trascendente evento que abrirá sus puertas a todos por igual y espera recibirlos con los brazos abiertos como el inicio de la nueva era de Unidad y CalidadCordialmente,
Dr. Salvador Oscar Rivero Boschert
Presidente CMO
Sedación bajo los estándares de JCI
Sedation under JCI standard.
Kweon TD.
Department of Anesthesiology and Pain Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Korean J Anesthesiol. 2011 Sep;61(3):190-4. Epub 2011 Sep 23.
Abstract
The practice of anesthesia and sedation continues to expand beyond the operating room and now includes the gastroenterology suite, magnetic resonance imaging suites, and the cardiac catheterization laboratory. Non-anesthesiologists frequently administer sedation, in part because of a lack of available anesthesiologists and economic aspect, which emphasizes the safety of sedation. The Joint Commission International (JCI) set a standard responding to this issue indicating that qualified individuals who have drug and monitoring knowledge as well as airway management skills can only administer sedating agents. In Korea, the Ministry of Health and Welfare developed new sedation standards for hospital evaluation, which is similar to the JCI standards. This review intends to help with the understanding of the JCI sedation standard and compare it to the Korean sedation standard
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3198177/pdf/kjae-61-190.pdf
Manejo de niños sometidos a procedimiento dolorosos en el departamento de urgencias por no anestesiólogos
Management of children undergoing painful procedures in the emergency department by non-anesthesiologists.
Shavit I, Hershman E.
Department of Pediatric Emergency, Meyer Children's Hospital, Rambam Medical Center, Haifa, Israel. i_shavit@rambam.health.gov.il
Isr Med Assoc J. 2004 Jun;6(6):350-5.
Abstract
The treatment of acute pain and anxiety in children undergoing therapeutic and diagnostic procedures in the emergency department has improved dramatically in recent years. The availability of non-invasive monitoring devices and the use of short-acting sedative and analgesic medications enable physicians to conduct safe and effective sedation and analgesia treatment. In today's practice of pediatric emergency medicine, sedation and analgesia has been considered as the standard of care for procedural pain. In most pediatric emergency departments throughout North America, "procedural sedation and analgesia" treatment is being performed by non-anesthesiologists (qualified emergency physicians and nurses). In 2003, the Israel Ministry of Health published formal guidelines for pediatric sedation by non-anesthesiologists; this important document recognizes for the first time the need for pediatric sedation and analgesia outside the operating room. We describe the basic principles of procedural sedation and analgesia in children and urge physicians working in pediatric emergency rooms in Israel to expand their knowledge and be more involved in the treatment of pediatric procedural pain.
http://www.ima.org.il/imaj/ar04jun-9.pdf
Incidencia y naturaleza de efectos adversos durante sedación/anestesia pediátrica con propofol fuera del quirófano
The incidence and nature of adverse events during pediatric sedation/anesthesia with propofol for procedures outside the operating room: a report from the Pediatric Sedation Research Consortium.
Cravero JP, Beach ML, Blike GT, Gallagher SM, Hertzog JH; Pediatric Sedation Research Consortium.
Department of Anesthesiology and Pediatrics, Dartmouth Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756-0001, USA. Joseph.Cravero@Hitchcock.Org
Anesth Analg. 2009 Mar;108(3):795-804.
Abstract
OBJECTIVE: We used a large database of prospectively collected data on pediatric sedation/anesthesia outside the operating room provided by a wide range of pediatric specialists to delineate the nature and frequency of adverse events associated with propofol-based sedation/anesthesia care. PATIENTS AND METHODS: Data were collected by the Pediatric Sedation Research Consortium, a collaborative group of institutions dedicated to improving sedation/anesthesia care for children internationally. Members prospectively enrolled consecutive patients receiving sedation or sedation/anesthesia for procedures. The primary inclusion criterion was the need for some form of sedation/anesthesia to perform a diagnostic or therapeutic procedure outside the operating room. There were no exclusion criteria. Data on demographics, primary illness, coexisting illness, procedure performed, medications used, procedure and recovery times, medication doses outcomes of anesthesia, airway interventions and adverse events were collected and reported using web-based data collection tool. For this study, we evaluated all instances where propofol was used as the primary drug in the sedation/anesthesia technique. RESULTS: Thirty-seven locations submitted data on 49,836 propofol sedation/anesthesia encounters during the study period from July 1, 2004 until September 1, 2007. There were no deaths. Cardiopulmonary resuscitation was required twice. Aspiration during sedation/anesthesia occurred four times. Less serious events were more common with O(2) desaturation below 90% for more than 30 s, occurring 154 times per 10,000 sedation/anesthesia administrations. Central apnea or airway obstruction occurred 575 times per 10,000 sedation/anesthesia administrations. Stridor, laryngospasm, excessive secretions, and vomiting had frequencies of 50, 96, 341, and 49 per 10,000 encounters, respectively. Unexpected admissions (increases in levels of care required) occurred at a rate of 7.1 per 10,000 encounters. In an unadjusted analysis, the rate of pulmonary adverse events was not different for anesthesiologists versus other providers. CONCLUSIONS: We report the largest series of pediatric propofol sedation/anesthesia for procedures outside the operating room. The data indicate that propofol sedation/anesthesia is unlikely to yield serious adverse outcomes in a collection of institutions with highly motivated and organized sedation/anesthesia services. However, the safety of this practice is dependent on a system's ability to manage less serious events. We propose that our data suggest variables for training and credentialing providers of propofol sedation/anesthesia and the system characteristics that promote safe use of this drug.
http://www.anesthesia-analgesia.org/content/108/3/795.full.pdf
Sedación balanceada con propofol administrada por no anestesiólogos: la primera experiencia Italiana
Balanced propofol sedation administered by nonanesthesiologists: The first Italian experience.
Repici A, Pagano N, Hassan C, Carlino A, Rando G, Strangio G, Romeo F, Zullo A, Ferrara E, Vitetta E, Ferreira Dde P, Danese S, Arosio M, Malesci A.
Department of Gastroenterology, IRCCS Istituto Clinico Humanitas, Via Manzoni 56 20089 Rozzano, Milan, Italy. alessandro.repici@humanitas.it
World J Gastroenterol. 2011 Sep 7;17(33):3818-23.
Abstract
AIM: To assess the efficacy and safety of a balanced approach using midazolam in combination with propofol, administered by non-anesthesiologists, in a large series of diagnostic colonoscopies. METHODS: Consecutive patients undergoing diagnostic colonoscopy were sedated with a single dose of midazolam (0.05 mg/kg) and low-dose propofol (starter bolus of 0.5 mg/kg and repeated boluses of 10 to 20 mg). Induction time and deepest level of sedation, adverse and serious adverse events, as well as recovery times, were prospectively assessed. Cecal intubation and adenoma detection rates were also collected. RESULTS: Overall, 1593 eligible patients were included. The median dose of propofol administered was 70 mg (range: 40-120 mg), and the median dose of midazolam was 2.3 mg (range: 2-4 mg). Median induction time of sedation was 3 min (range: 1-4 min), and median recovery time was 23 min (range: 10-40 min). A moderate level of sedation was achieved in 1561 (98%) patients, whilst a deep sedation occurred in 32 (2%) cases. Transient oxygen desaturation requiring further oxygen supplementation occurred in 8 (0.46%; 95% CI: 0.2%-0.8%) patients. No serious adverse event was observed. Cecal intubation and adenoma detection rates were 93.5% and 23.4% (27.8% for male and 18.5% for female, subjects), respectively. CONCLUSION: A balanced sedation protocol provided a minimalization of the dose of propofol needed to target a moderate sedation for colonoscopy, resulting in a high safety profile for non-anesthesiologist propofol sedation.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181443/pdf/WJG-17-3818.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
