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sábado, 23 de septiembre de 2017

Sismos y huracanes / Earthquakes and hurricanes

Septiembre 23, 2017. No. 2820





No obstante la destrucción en muchos sitios de México por los huracanes y los sismos recientes, nuestro país sigue recuperándose gracias a millares de muestras solidarias de apoyo entre cada mexicano y personas allende de nuestras fronteras que, trabajando codo con codo, han ido rescatando a cientos de personas donde la muerte se hacía inminente.
Tenemos una sola meta y el camino para alcanzarla está lleno de sonrisas, apoyos y obstáculos. México está de pie, y en esta ocasión más unido que nunca. Mil gracias por darnos su apoyo.

Despite the destruction in many places of Mexico due to recent hurricanes and earthquakes, our country continues to recover thanks to thousands of solidarity samples of support between each Mexican and people beyond our borders who, working side by side, have been rescuing hundreds of people where death was imminent.
We have only one goal and the way to reach it is full of smiles, supports and obstacles. Mexico is standing, and this time more united than ever. Thank you for giving us your help.

Apesar da destruição em muitos lugares do México devido a furacões e terremotos recentes, nosso país continua a recuperar graças a milhares de amostras solidárias de apoio entre cada mexicano e pessoas além de nossas fronteiras que, trabalhando lado a lado, estão resgatando centenas de pessoas onde a morte era iminente.
Temos apenas um objetivo e a maneira de alcançá-lo é cheia de sorrisos, apoios e obstáculos. O México está de pé, e desta vez mais unido do que nunca. Obrigado por nos dar sua ajuda.

En dépit de la destruction dans de nombreux endroits du Mexique en raison des récents ouragans et tremblements de terre, notre pays continue de se remettre grâce à des milliers d'échantillons de solidarité entre chaque Mexicain et des personnes au-delà de nos frontières qui, travaillant côte à côte, ont sauvé des centaines des personnes où la mort était imminente.
Nous n'avons qu'un seul objectif et la façon de l'atteindre est pleine de sourires, de soutiens et d'obstacles. Le Mexique est debout, et cette fois plus unis que jamais. Merci de nous avoir donné votre aide.

Enlaces para donar / Links to donate
Respuestas tempranas de la unidades de terapia intensiva durante los desastres mayores. De las experiencias del gran terremoto en Japón
EARLY STAGE RESPONSES OF INTENSIVE CARE UNITS DURING MAJOR DISASTERS: FROM THE EXPERIENCES OF THE GREAT EAST JAPAN EARTHQUAKE.
Abstract
Fukushima J Med Sci. 2015;61(1):32-7. doi: 10.5387/fms.2014-35. Epub 2015 May 3.
The present study investigated the role of intensive care units (ICU) during disasters, including the responses of our ICU following the Great East Japan Earthquake on March 11, 2011. Our ICU comprises 8 beds for postoperative inpatients and those with rapidly deteriorating conditions; 20 beds in an emergency unit for critically ill patients; and 17 beds for neonates. It is important to secure empty beds when a major disaster occurs, as was the case after the Great Hanshin Earthquake, due to the resulting large numbers of trauma patients. Therefore, each ICU section cooperated to ensure sufficient space for admissions following the Great East Japan Earthquake. However, unlike the Great Hanshin Earthquake, securing beds was ultimately unnecessary due to the nature of the recent disaster, which also consisted of a subsequent tsunami and nuclear accident. Therefore, air quality monitoring was required on this occasion due to the risk of environmental radioactive pollution from the nuclear disaster causing problems with artificial respiration management involving atmospheric air. The variability in damage arising during different disasters thus requires a flexible response from ICUs that handle seriously ill patients.
Evacuación de una UCI neonatal en un desastre. Lecciones del huracán Sandy
Evacuation of a neonatal intensive care unit in a disaster: lessons from Hurricane Sandy.
Pediatrics. 2014 Dec;134(6):e1662-9. doi: 10.1542/peds.2014-0936. Epub 2014 Nov 10.Abstract
NICU patients are among those potentially most vulnerable to the effects of natural or man-made disaster on a medical center. The published data on evacuations of NICU patients in the setting of disaster are sparse. In October of 2012, New York University Langone Medical Center was evacuated during Hurricane Sandy in the setting of a power outage secondary to a coastal surge. In this setting, 21 neonates were safely evacuated from the medical center's NICU to receiving hospitals within New York City in a span of 4.5 hours. Using data recorded during the evacuation and from staff debriefings, we describe the challenges faced and lessons learned during both the power outage and vertical evacuation. From our experience, we identify several elements that are important to the functioning of an NICU in a disaster or to an evacuation that may be incorporated into future NICU-focused disaster planning. These include a clear command structure, backups (personnel, communication, medical information, and equipment), establishing situational awareness, regional coordination, and flexibility as well as special attention to families and to the availability of neonatal transport resources.
KEYWORDS: Hurricane Sandy; NICU; disaster preparedness; neonates; neonatology; power outage; vertical evacuation
Evacuación de la UCI: cuidado de los enfermos críticos y heridos durante pandemias y desastres: Declaración de consenso de CHEST.
Evacuation of the ICU: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement.
Chest. 2014 Oct;146(4 Suppl):e44S-60S. doi: 10.1378/chest.14-0735.
Abstract
BACKGROUND: Despite the high risk for patient harm during unanticipated ICU evacuations, critical care providers receive little to no training on how to perform safe and effective ICU evacuations. We reviewed the pertinent published literature and offer suggestions for the critical care provider regarding ICU evacuation. The suggestions in this article are important for all who are involved in pandemics or disasters with multiple critically ill or injured patients, including front-line clinicians, hospital administrators, and public health or government officials. METHODS: The Evacuation and Mobilization topic panel used the American College of Chest Physicians (CHEST) Guidelines Oversight Committee's methodology to develop seven key questions for which specific literature searches were conducted to identify studies upon which evidence-based recommendations could be made. No studies of sufficient quality were identified. Therefore, the panel developed expert opinion-based suggestions using a modified Delphi process. RESULTS: Based on current best evidence, we provide 13 suggestions outlining a systematic approach to prepare for and execute an effective ICU evacuation during a disaster. Interhospital and intrahospital collaboration and functional ICU communication are critical for success. Pre-event planning and preparation are required for a no-notice evacuation. A Critical Care Team Leader must be designated within the Hospital Incident Command System. A three-stage ICU Evacuation Timeline, including (1) no immediate threat, (2) evacuation threat, and (3) evacuation implementation, should be used. Detailed suggestions on ICU evacuation, including regional planning, evacuation drills, patient transport preparation and equipment, patient prioritization and distribution for evacuation, patient information and tracking, and federal and international evacuation assistance systems, are also provided. CONCLUSIONS: Successful ICU evacuation during a disaster requires active preparation, participation, communication, and leadership by critical care providers. Critical care providers have a professional obligation to become better educated, prepared, and engaged with the processes of ICU evacuation to provide a safe continuum of critical care during a disaster.

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Anestesiología y Medicina del Dolor

52 664 6848905
Publicado por Bibliomanazteca en 15:29 0 comentarios
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Artroplastia reversa de hombro en pacientes con artritis reumatoide: una revisión sistemática


Reverse Shoulder Arthroplasty in Patients with Rheumatoid Arthritis: A Systematic Review

Fuente
Este artículo es originalmente publicado en:
De:
2017 Sep;9(3):325-331. doi: 10.4055/cios.2017.9.3.325. Epub 2017 Aug 4.
Todos los derechos reservados para:
Received 2016 Jun 30; Accepted 2017 Jun 4.
© 2017 by The Korean Orthopaedic AssociationThis is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract
BACKGROUND:
There are limited data available regarding the results of reverse shoulder arthroplasty (RSA) in patients with rheumatoid arthritis (RA). We performed a systematic review of the literature to investigate the radiological and clinical outcomes after RSA in patients with RA.
CONCLUSIONS:
RSA in RA showed similar short- to mid-term results without higher complication rates as compared to RSA in cuff tear arthropathy. Although RSA can be considered a reliable treatment option in patients with RA, further large-scale studies are required to determine the long-term survival of the implant.
KEYWORDS:
Complication; Outcome; Reverse shoulder arthroplasty; Rheumatoid arthritis
Resumen
ANTECEDENTES:
Hay pocos datos disponibles sobre los resultados de la artroplastia reversa de hombro (RSA) en pacientes con artritis reumatoide (AR). Se realizó una revisión sistemática de la literatura para investigar los resultados radiológicos y clínicos después de RSA en pacientes con AR.
CONCLUSIONES:
RSA en la AR mostraron resultados similares a corto y mediano plazo sin mayores tasas de complicaciones en comparación con RSA en la artropatía del desgarro del manguito. Aunque RSA puede considerarse una opción de tratamiento confiable en pacientes con AR, se requieren estudios adicionales a gran escala para determinar la supervivencia a largo plazo del implante.
PALABRAS CLAVE:
Complicación; Resultado; Artroplastia reversa del hombro; Artritis reumatoide
PMID:  28861200  PMCID:  PMC5567028   DOI:   10.4055/cios.2017.9.3.325
#Artroplastia reversa del hombro#Artritis reumatoide
Publicado por Bibliomanazteca en 15:25 0 comentarios
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Revisión a la Artroplastia Total de Hombro Reversa Restablece la Estabilidad para Pacientes con Prótesis de Hombro Inestable.


Revision to Reverse Total Shoulder Arthroplasty Restores Stability for Patients With Unstable Shoulder Prostheses.

Fuente
Este artículo es publicado originalmente en:
De:
2017 Aug 28. doi: 10.1007/s11999-017-5429-z. [Epub ahead of print]
Todos los derechos reservados para:

Copyright information

© The Association of Bone and Joint Surgeons® 2017

Abstract
BACKGROUND:
Instability after shoulder arthroplasty remains a complication with limited salvage options. Reoperation for instability with anatomic designs has led to high rates of persistent instability, therefore we aimed to evaluate the use of RSA for treatment of prosthetic instability.
QUESTIONS/PURPOSES:
(1) After revision shoulder arthroplasty to a reverse prosthesis (RSA), what is the survivorship free from dislocations at 2 and 5 years? (2) What factors are associated with dislocations? (3) What is the survivorship free from revision after revision to RSA? (4) From preoperation to postrevision to RSA, what are the clinical outcomes-the proportion of patients with moderate to severe pain, shoulder elevation and external rotation ROM, American Shoulder and Elbow Surgeons scores, and Simple Shoulder Test scores?
CONCLUSIONS:
Revision RSA for prosthetic instability after shoulder arthroplasty is associated with reasonable implant survival and few complications. Approximately one in seven patients will have a recurrent dislocation. In patients with persistent instability or with risk factors for instability, consideration should be given for use of larger glenospheres and increasing the lateral offset at the time of RSA.


Resumen
ANTECEDENTES:
La inestabilidad después de la artroplastia del hombro sigue siendo una complicación con limitadas opciones de rescate. La reintervención de la inestabilidad con diseños anatómicos ha conducido a altas tasas de inestabilidad persistente, por lo tanto, se trató de evaluar el uso de RSA para el tratamiento de la inestabilidad protésica.
PREGUNTAS / PROPÓSITOS:
(1) Después de una artroplastia de hombro de revisión a una prótesis inversa (RSA), ¿cuál es la supervivencia libre de dislocaciones a los 2 y 5 años? (2) ¿Qué factores están asociados con las dislocaciones? (3) ¿Cuál es la supervivencia libre de revisión después de la revisión a RSA? (4) De la preoperación a la postratamiento a RSA, ¿cuáles son los resultados clínicos-la proporción de pacientes con dolor moderado a severo, elevación del hombro y ROM de rotación externa, los resultados de American Shoulder and Elbow Surgeons y los resultados de Simple Shoulder Test?
CONCLUSIONES:
Revisión RSA para la inestabilidad protésica después de la artroplastia del hombro se asocia con una supervivencia razonable implante y pocas complicaciones. Aproximadamente uno de cada siete pacientes presentará una dislocación recurrente. En pacientes con inestabilidad persistente o con factores de riesgo de inestabilidad, se debe tener en cuenta el uso de glenosferas mayores y aumentar el desplazamiento lateral en el momento de RSA.
PMID:   28849539    DOI:  
#artroplastia del hombro#artroplastia#artroplastia reversa de hombro#dislocación recurrente
Publicado por Bibliomanazteca en 15:10 0 comentarios
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