jueves, 16 de febrero de 2017

Estado actual de las herramientas de capacitación basadas en la simulación en la cirugía ortopédica: una revisión sistemática.



Current Status of Simulation-based Training Tools in Orthopedic Surgery: A Systematic Review.

Fuente
Este artículo es originalmente publicado en:
De:
2017 Feb 7. pii: S1931-7204(17)30008-9. doi: 10.1016/j.jsurg.2017.01.005. [Epub ahead of print]
Todos los derechos reservados para:
Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.
Abstract
OBJECTIVE:
To conduct a systematic review of orthopedic training and assessment simulators with reference to their level of evidence (LoE) and level of recommendation.
DESIGN:
Medline and EMBASE library databases were searched for English language articles published between 1980 and 2016, describing orthopedic simulators or validation studies of these models. All studies were assessed for LoE, and each model was subsequently awarded a level of recommendation using a modified Oxford Centre for Evidence-Based Medicine classification, adapted for education.
RESULTS:
A total of 76 articles describing orthopedic simulators met the inclusion criteria, 47 of which described at least 1 validation study. The most commonly identified models (n = 34) and validation studies (n = 26) were for knee arthroscopy. Construct validation was the most frequent validation study attempted by authors. In all, 62% (47 of 76) of the simulator studies described arthroscopy simulators, which also contained validation studies with the highest LoE.
CONCLUSIONS:
Orthopedic simulators are increasingly being subjected to validation studies, although the LoE of such studies generally remain low. There remains a lack of focus on nontechnical skills and on cost analyses of orthopedic simulators.
Resumen
OBJETIVO:
Realizar una revisión sistemática de simuladores ortopédicos de entrenamiento y evaluación con referencia a su nivel de evidencia (LoE) y nivel de recomendación.

DISEÑO:
Medline y EMBASE bibliotecas de bases de datos se buscaron artículos en idioma Inglés publicado entre 1980 y 2016, que describe simuladores ortopédicos o estudios de validación de estos modelos. Todos los estudios fueron evaluados para LoE, y cada modelo se adjudicó posteriormente un nivel de recomendación utilizando un modificado Oxford Center for Evidence-Based Medicine clasificación, adaptado para la educación.

RESULTADOS:
Un total de 76 artículos que describen simuladores ortopédicos cumplieron con los criterios de inclusión, 47 de los cuales describieron al menos un estudio de validación. Los modelos más comúnmente identificados (n = 34) y los estudios de validación (n = 26) fueron para artroscopia de rodilla. La validación de la construcción fue el estudio de validación más frecuente de los autores. En total, el 62% (47 de 76) de los simuladores describieron simuladores de artroscopia, que también contenían estudios de validación con la mayor LoE.

CONCLUSIONES:
Los simuladores ortopédicos están cada vez más sujetos a estudios de validación, aunque la EE de dichos estudios generalmente sigue siendo baja. Sigue habiendo una falta de enfoque en habilidades no técnicas y en análisis de costos de simuladores ortopédicos.
Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.
Palabras clave:
Habilidades interpersonales y de comunicación; Atención al paciente; Aprendizaje y Mejoramiento Basados en la Práctica; cirugía Ortopédica; simulación; revisión sistemática; formación
KEYWORDS:
Interpersonal and Communication Skills; Patient Care; Practice-Based Learning and Improvement; orthopedic surgery; simulation; systematic review; training
PMID: 28188003   DOI:  
[PubMed – as supplied by publisher]

Dolor en niños / Pain in children

Febrero 16, 2017. No. 2602



  



Intervenciones psicológicas basadas en la evidencia para el manejo del dolor crónico pediátrico: nuevas direcciones en la investigación y la práctica clínica.
Evidence-Based Psychological Interventions for the Management of Pediatric Chronic Pain: New Directions in Research and Clinical Practice.
Children (Basel). 2017 Feb 4;4(2). pii: E9. doi: 10.3390/children4020009.
Abstract
Over the past 20 years our knowledge about evidence-based psychological interventions for pediatric chronic pain has dramatically increased. Overall, the evidence in support of psychological interventions for pediatric chronic pain is strong, demonstrating positive psychological and behavioral effects for a variety of children with a range of pain conditions. However, wide scale access to effective psychologically-based pain management treatments remains a challenge for many children who suffer with pain. Increasing access to care and reducing persistent biomedical biases that inhibit attainment of psychological services are a central focus of current pain treatment interventions. Additionally, as the number of evidence-based treatments increase, tailoring treatments to a child or family's particular needs is increasingly possible. This article will (1) discuss the theoretical frameworks as well as the specific psychological skills and strategies that currently hold promise as effective agents of change; (2) review and summarize trends in the development of well-researched outpatient interventions over the past ten years; and (3) discuss future directions for intervention research on pediatric chronic pain.
KEYWORDS: child; chronic pain; empirically supported; evidence-based; parent; pediatric; psychological intervention

Validación de la escala de Satisfacción de Adolescentes con Manejo Postoperatorio del Dolor - Escoliosis idiopática (SAP-S).
Validation of the scale on Satisfaction of Adolescents with Postoperative pain management - idiopathic Scoliosis (SAP-S).
J Pain Res. 2017 Jan 11;10:137-143. doi: 10.2147/JPR.S124365. eCollection 2017.
Abstract
BACKGROUND: Spinal fusion is a common orthopedic surgery in children and adolescents and is associated with high pain levels postoperatively. If the pain is not well managed, negative outcomes may ensue. To our knowledge, there is no measure in English that assesses patient's satisfaction with postoperative pain management following idiopathic scoliosis surgery. The aim of the present study was to assess the psychometric properties of the satisfaction subscale of the English version of the Satisfaction of Adolescents with Postoperative pain management - idiopathic Scoliosis (SAP-S) scale. METHODS: Eighty-two participants aged 10-18 years, who had undergone spinal fusion surgery, fully completed the SAP-S scale at 10-14 days postdischarge. Construct validity was assessed through a principal component analysis using varimax rotation. RESULTS: Principal component analysis indicated a three-factor structure of the 13-item satisfaction subscale of the SAP-S scale. Factors referred to satisfaction regarding current medication received (Factor 1), actions taken by nurses and doctors to manage pain (Factor 2) and information received after surgery (Factor 3). Cronbach's alpha was 0.91, showing very good internal consistency. Data on satisfaction and clinical outcomes were also reported. CONCLUSION: The SAP-S is a valid and reliable measure of satisfaction with postoperative pain management that can be used in both research and clinical settings to improve pain management practices. Although it was developed and validated with adolescents who had undergone spinal fusion surgery, it can be used, with further validation, to assess adolescents' satisfaction with pain management in other postoperative contexts.
KEYWORDS: adolescents; orthopedics; pain management; postoperative pain; satisfaction; scoliosis

Práctica actual y avances recientes en el manejo del dolor pediátrico
Current practice and recent advances in pediatric pain management
A. CHIARETTI, F. PIERRI *, P. VALENTINI, I. RUSSO*, L. GARGIULLO, R. RICCARDI*
European Review for Medical and Pharmacological Sciences 2013; 17(Suppl 1): 112-126
Abstract
 BACKGROUND: Differently from the adult patients, in pediatric age it is more difficult to assess and treat efficaciously the pain and often this symptom is undertreated or not treated. In children, selection of appropriate pain assessment tools should consider age, cognitive level and the presence of eventual disability, type of pain and the situation in which it is occurring. Improved understanding of developmental neurobiology and paediatric analgesic drugs pharmacokinetics should facilitate a better management of childhood pain. AIM: The objective of this review is to discuss current practice and recent advances in pediatric pain management. METHODS: Using PubMed we conducted an extensive literature review on pediatric pain assessment and commonly used analgesic agents from January 2000 to January 2012. CONCLUSIONS: A multimodal analgesic regimen provides better pain control and functional outcome in children. Cooperation and communication between the anaesthesiologist, surgeon, and paediatrician are essential for successful anaesthesia and pain management. Key Words: Pain, Pain assessment, Analg
5to curso internacional Anestesiologia cardiotoracica_ vascular_ ecocardiografia y circulaci_n extracorporea.


Curso sobre Anestesia en Trasplantes, Cirugía abdominal, Plástica, Oftalmología y Otorrinolaringología.
Committee for European Education in Anaesthesiology (CEEA) 
y el Colegio de Anestesiólogos de León A.C.
Abril 7-9, 2017, León Guanajuato, México

Informes  (477) 716 06 16, kikinhedz@gmail.com
Regional Anesthesiology and Acute Pain Medicine Meeting
April 6-8, 2017, San Francisco, California, USA
ASRA American Society of Regional Anesthesia and Pain Medicine
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Anestesiología y Medicina del Dolor

52 664 6848905

Copyright © 2015

Instabilidad traumática del codo – Dislocación fractura del cúbito proximal


http://www.mihombroycodo.com.mx/academia/instabilidad-traumatica-del-codo-dislocaciones-proximales-de-la-fractura-del-cubito/

Traumatic Elbow Instability – Proximal Ulna Fracture Dislocations


Fuente
Este artículo es originalmente publicado en:

https://youtu.be/fhdHCtmaJEQ


De y Todos los derechos reservados para:

Courtesy:
Saqib Rehman MD
Director of Orthopaedic Trauma
Temple University
Philadelphia
Pennsylvania
USA
www.orthoclips.com


Publicado el 21 ene. 2017
Narrated, annotated lecture 3 of 3 on traumatic elbow instability (proximal ulna fracture dislocations) from the OTA resident lecture series (narrated by Saqib Rehman, MD), from Orthoclips.com.
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Efectos de la fatiga en la cadera en corredores con síndrome de la bandeleta iliotibial (ITBS)


The effects of fatigue on lower extremity kinematics, kinetics and joint coupling in symptomatic female runners with iliotibial band syndrome

Fuente
Este artículo es originalmente publicado en:
De:
Clin Biomech (Bristol, Avon). 2016 Nov;39:84-90. doi: 10.1016/j.clinbiomech.2016.09.012. Epub 2016 Sep 30.
Todos los derechos reservados para:
Copyright © 2016 Elsevier Ltd. All rights reserved.
Efectos de la fatiga en la cadera en corredores con ITBS
El síndrome de la bandeleta iliotibial (ITBS) es la segunda lesión más frecuente en corredores. El dolor está localizado habitualmente en la cara lateral de la rodilla. Las alteraciones de la cinemática que se han mencionado en relación al ITBS son: incremento de la aducción de la cadera y rotación interna de la rodilla durante la carrera. Estudios previos han mencionado también la posibilidad de la falta de coordinación en la cadera y la rodilla, que puede conducir a cambios cinemáticos en la extremidad inferior. El propósito del siguiente estudio fue determinar los efectos de la fatiga en la cinemática de la cadera, y los patrones de acoplamiento articular en corredores con ITBS comparado con sujetos sanos.
Los corredores con ITBS mostraron un incremento de los ángulos de aducción durante la fase de apoyo. Se ha sugerido que los corredores con ITBS alteran su marcha de tal modo que el pico del ángulo de aducción de cadera disminuye. Se midió una diferencia de 18’5% entre el grupo con ITBS y los controles sanos. No se encontró diferencia en la abducción o la rotación interna de cadera.
Otro factor que se ha sugerido como contribuyente al ITBS es la debilidad abductora de cadera: la fatiga de los rotadores externos y abductores puede alterar la cinemática de la carrera. Sin embargo, no parece que la debilidad de la musculatura abductora sea la causa del ITBS, ya que la fatiga de esta musculatura no estaría solo presente en forma de aumento de la aducción de cadera, sino también en un incremento de la rotación interna durante la fase de apoyo. Esto no se observó en este estudio.
Como limitación de este estudio observamos que se hizo correr a los sujetos a una velocidad fija y durante una distancia muy corta, lo cual podría automáticamente haber alterado su mecánica de carrera.
De: Brown et al., 39 Clin Biomech (2017) 84-90. Todos los derechos reservados: Elsevier Ltd. . Pincha aquí para acceder al resumen.. Traducido por Francisco Jimeno Serrano.
AbstractBACKGROUND:
Altered hip and knee kinematics and joint coupling have been documented in runners with iliotibial band syndrome. Symptoms often present themselves after several minutes of running, yet the effect of fatigue warrants further exploration. The purpose of this study was to determine the effect of a run to fatigue in runners with iliotibial band syndrome, as compared to healthy controls.
METHODS:
Twenty uninjured and 12 female runners with iliotibial band syndrome performed a treadmill run to fatigue. Prior-to and following a run to fatigue, overground running data were collected. Variables of interest included stance phase: peak hip adduction and internal rotation, peak hip abductor and external rotator joint moments and frontal-sagittal plane hip and knee joint coupling.
FINDINGS:
Fatigue resulted in decreased peak hip adduction angles in injured runners. Fatigue did not affect injured runners differently than controls with respect to the remaining variables. Coupling differences did not exist between healthy and injured runners with respect to the loading or propulsive phases of stance.
INTERPRETATION:
While clinicians often strengthen hip abductor muscles and provide gait re-training to decrease stance phase hip adduction, our results suggest that, when exerted, female runners with iliotibial band syndrome independently modify their running gait to decrease hip adduction, potentially as a result of pain. Fatigue did not have an effect on the remaining study variables. It is possible that reducing the length of the iliotibial band through minimizing hip adduction reduces pain, but the other variables examined are not sensitive to this phenomenon.
Copyright © 2016 Elsevier Ltd. All rights reserved.
KEYWORDS:
Fatigue; Hip; Running injury; Vector coding
PMID: 27718393  DOI:  
[PubMed – in process]