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Ghaderi, Iman. "Toward excellence as the standard for medical practice variation in documentation and surgeons' opinion in the breast clinic." Thesis, McGill University, 2004. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=18196.
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Recently, there has been a growing movement toward an Electronic Health Record (EHR) to improve quality of care. The paper-based medical record is still the primary source of information in today’s medical practice. In order to design the EHR, knowledge with regard to the current medium of documentation is required. In the MUHC Cedars Breast Clinic, 112 medical records for 7 surgeons were audited to determine what was recorded in the initial visits between year 2002 and 2003. A Likert scale questionnaire was developed and included 46 questions derived from the chart review. It was introduced to assess their opinions on important variables in managing breast patients. The correlation between the medical records and surgeons’ opinions was then sought. The majority of data points had a low rate of documentation with wide variation; breast cancer risk factors were recorded in less than one third of charts. Family history and physical examinations had relatively high rates of documentation. The survey showed a considerable variation among surgeons’ opinions. Surgeons reported that they addressed 63% of all data points (29 of 46 questions) very often/always. There was weak correlation between what each surgeon records and what he/she thinks is important.Récemment, il y a eu un mouvement grandissant vers le dossier électronique de santé (EHR) pour améliorer la qualité du soin. Le dossier médical sur papier est toujours la source primaire d'information dans la pratique en matière, aujourd'hui. Afin de concevoir EHR, la connaissance en ce qui concerne le milieu courant de la documentation est exigée. Dans la Clinique du sein de l'Institut des cèdres du CUSM, 112 disques médicaux pour 7 chirurgiens ont été apurés pour déterminer ce qui est enregistré dans les visites initiales en l'année 2002 et l'année 2003. Un questionnaire de balance de Likert comprenant 46 questions dérivées des dossiers a été présenté pour évaluer leur avis sur des variables importantes dans les patients de gestion de sein. La corrélation entre ces deux a été cherchée. La majorité de points de repères a eu un bas taux de documentation avec une grande variation; des facteurs de risque de cancer de sein ont été enregistrés dans moins d'un tiers de dossiers. Les antécédents familiaux et les examens physiques ont eu des taux relativement élevés de documentation. L'aperçu a montré une variation considérable parmi l'opinion des chirurgiens. Les chirurgiens ont rapporté qu'ils ont adressé 63% de points de repères (29 de 46 questions) très souvent/toujours. Il y avait corrélation faible entre ce que chaque chirurgien enregistre et quel il/elle pense est important. fr
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Rekman, Janelle. "The Development of a Workplace-Based Surgical Clinic Assessment Tool." Thesis, Université d'Ottawa / University of Ottawa, 2016. http://hdl.handle.net/10393/34234.
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Purpose of Study: Workplace-based assessment is an opportunity for a learner to be assessed in their community of practice by an expert rater. The challenges and biases brought into this assessment relationship are complex. A shift towards Competency Based Medical Education in post-graduate residency education has triggered consideration of how to implement feasible assessment tools for the operating room, the in-patient ward, and the outpatient clinic. Competent performance in outpatient clinic is vital to surgical practice, yet no assessment tool currently exists to assess daily performance of technical and nontechnical skills of surgery residents. This project describes the development of a competency-based assessment tool, the Ottawa Clinic Assessment Tool (OCAT).
Research Question: How does the OCAT demonstrate validity for measurement of surgical resident performance in clinic?
Method: A consensus group of experts was gathered to generate ideas reflective of a competent ‘generalist’ surgeon in clinic. An entrustability anchor scale was developed. A six-month pilot study of the OCAT was conducted in orthopedics, general surgery and obstetrics and gynecology with quantitative and qualitative evidence of validity collected. Two subsequent feedback sessions, and a survey for staff and residents evaluated the OCAT for clarity and utility.
Results: The OCAT was developed as a 13-item tool, with a global assessment item and 2 short answers questions. 44 staff surgeons completed 132 OCAT assessments of 79 residents. Psychometric data was collected as evidence of internal structure validity and relations with other variables. Analysis of feedback indicated the rating scale was practical and useful for surgeons and residents.
Conclusions & Contribution to the Research Field: Surgical programs will require a daily clinic assessment tool to help define resident competency progression. Multiple sources of validity evidence collected in this pilot project demonstrate that the OCAT can measure resident clinic competency in a valid and feasible manner.
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Benscoter, Dan T. "Ventilation Reconciliation: Improving the Accuracy of Documented Home Ventilator Settings in a Pediatric Home Ventilator Clinic." University of Cincinnati / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=ucin155421301584871.
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Berg, Katarina. "Postoperative recovery in daysurgery : Evaluation of psychometric properties and clinical usefulness of a questionnaire in day surgery." Licentiate thesis, Linköping University, Linköping University, Nursing Science, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-59515.
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Background: Day surgery has increased during recent decades in many countries and represents approximately 50% of surgical procedures performed in Sweden. Day surgery implies that the patient is admitted and operated on during the same day and discharged without an overnight stay at the surgery unit. Undergoing a day surgical procedure thereby means that the major part of the postoperative recovery takes place in the patient’s home, leaving the patient and his/her supportive network responsible for the postoperative care. Day surgery also implies that health care professionals have to adapt to outpatient care and find valid measurements for monitoring a patient’s recovery progress after discharge.
Aims: The aim of Study I was to evaluate the psychometric properties of a translated version of the Post-discharge Surgical Recovery (PSR) scale in a Swedish day surgery sample in terms of data quality, internal consistency, dimensionality and responsiveness. The aim of Study II was to describe postoperative recovery on postoperative days 1, 7 and 14 after different orthopaedic day surgical procedures, as well as to identify possible predictors associated with postoperative recovery two weeks after surgery.
Methods: Six-hundred and seven patients who had undergone an orthopaedic surgical procedure (n=358), general surgery (n=182) or gynaecological surgery (n=67) were included. To assess postoperative recovery, the PSR scale and the emotional state, physical comfort and physical independency dimensions of the Quality of Recovery-23 (QoR-23) were used. In addition, patients’ background data and self ratings of their ability to work or handle usual business and general health were obtained. Data were collected preoperatively and on postoperative days 1, 7 and 14. In Study I data quality and internal consistency were evaluated using descriptive statistics, correlation analyses and Cronbach’s alpha. The dimensionality was determined using an exploratory factor analysis, and the responsiveness was evaluated through the standardized response mean (SRM) and the area under the receiver operating characteristics curve (AUC). In Study II, patients’ postoperative recovery and general health were compared over time using Friedmann’s ANOVA and between surgical groups of patients using the Kruskal-Wallis test. To determine predictors of recovery, a multiple linear regression analysis was performed with the PSR score on postoperative day 14 as the dependent variable.
Results: In Study I, two items were deleted from the Swedish version of the PSR scale. This was based on several low inter-item (<0.30) and item-total correlations (<0.40) and substantial ceiling effects (65%). After the deletion of two items, the Cronbach’s coefficient alpha was 0.90 and the average interitem correlation was 0.44. According to the factor analysis, a single dimension was found explaining the common variance to 44%. The SRM (1.14) indicated a robust ability to detect changes in recovery. The AUC was 0.60 for the entire scale, but varied (0.58-0.81) when the PSR score on postoperative day 1 was categorized into three intervals. In Study II, the shoulder patients experienced significantly lower postoperative recovery and general health one and two weeks after surgery (p<0.001). Significant predictors of recovery on postoperative day 14 were age, perceived health and emotional status on postoperative day 1 and type of surgery, and explained the dependent variable to 33%.
Conclusions: The Swedish version of the PSR scale seems to be a consistent and valid instrument for the assessment of postoperative recovery at home in Sweden. The recovery process for orthopaedic day surgery patients differs, with shoulder surgery patients in particular showing poor recovery, which could be considered when day surgery patient education programmes are developed.
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Stene, Hurtsén Anna. "Clinical skills and teaching in Surgery at undergraduate level. Comparison between two newly started medical schools." Thesis, Örebro universitet, Institutionen för medicinska vetenskaper, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-48396.
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Watson, Hugh Robert. "Methodology of clinical trials of adjuvant medical therapy in peripheral bypass surgery : a critical reappraisal following a large prospective trial." Thesis, University of Bath, 2000. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.323578.
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Dahroug, Bassem. "Micro-Robotic Cholesteatoma Surgery : clinical requirements analysis and image-based control under constraints." Thesis, Bourgogne Franche-Comté, 2018. http://www.theses.fr/2018UBFCD016/document.
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Une maladie appelée cholestéatome affecte l'oreille moyenne, en absence de traitement, elle pourrait conduire à des complications graves. Le seul traitement dans la pratique médicale actuelle est une procédure chirurgicale. Les incidences de cholestéatome résiduelle ou récurrente sont élevés et le patient doit subir plus d'une intervention chirurgicale. Par conséquent, un système robotique original a été proposé pour d'éliminer l'incidence du cholestéatome résiduel en enlevant efficacement toutes les cellules infectées de la première intervention chirurgicale, et de faire une chirurgie moins invasive. Ainsi, ce manuscrit montre les différents défis auxquels fait face le chirurgien à travers une telle micro-procédure. Il est également défini le cahier de charge pour la réalisation d'un système futuriste dédié à la chirurgie du cholestéatome. En outre, un contrôleur est proposé comme un première étape vers le système idéal. Un tel contrôleur permet de guider un outil chirurgical rigide afin de suivre un chemin de référence sous les contraintes du trou d'incision. Le contrôleur proposé peut guider soit un outil droit, soit un outil courbe. En effet, le contrôleur proposé est une commande de haut niveau qui es formulé dans l'espace de tâche (ou espace Cartésien). Ce contrôleur est une couche modulaire qui peut être ajoutée à différentes structures robotiques. Le contrôleur proposé a montré de bons résultats en termes de précision tout en étant évalué sur un robot parallèle et un robot en sérieA disease called cholesteatoma affects the middle ear, in the absence of treatment, it could lead to serious complications. The only treatment in current medical practice is a surgical procedure. Incidences of residual or recurrent cholesteatoma are high and the patient may have more than one surgical procedure. Therefore, a novel robotic system was proposed to eliminate the incidence of residual cholesteatoma by removing efficiently all infected cells from the first surgery, and make a less invasive surgery. Thus, this manuscript shows the different challenges that face the surgeon through such a micro-procedure. It also is specified the requirements for achieving a futuristic system dedicated to cholesteatoma surgery. In addition, a controller is proposed as a first step toward the ideal system. Such a controller allows to guide a rigid surgical tool for following a reference path under the constraints of the incision hole. The proposed controller can guide either a straight tool or a curved one. Indeed, the proposed controller is a high level control which is formulated in the task-space (or Cartesian-space). This controller is a modular layer which can be added to different robotics structures. The proposed controller showed a good results in term of accuracy while assessed on a parallel robot and a serial one
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Nyoka-Mokgalong, Simangele Cecilia. "A retrospective audit of the clinical value of routine chest radiographs in the first 24 hours after cardiac surgery using medical records." Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/20682.
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Routine postoperative chest radiography after cardiac surgery is a common practice, although studies, both prospective and retrospective, conducted in their majority outside Africa, have shown that these chest radiographs are of low clinical value, mainly due to limited impact on patient management. Following cardiac surgery and admission to ICU, chest radiographs are obtained in order to ensure proper position of all invasive devices such as endotracheal tubes, invasive catheters as well as nasograstric tubes, and to exclude possibility of a pneumothorax, atelectasis, infiltrates, and other potential respiratory complications associated with ventilatory support. Following cardiac surgery, there are other elements that require assessment: mediastinum (for widening due to bleeding), pleural space (for presence of fluid or air) and cardiovascular system (for presence of signs of failure). Specific to cardiac surgery is the post-operative pulmonary dysfunction (PPD), where systemic inflammatory response due to cardiopulmonary bypass is the main culprit [Milot J et al, 2001] - leading to acute lung injury. Over and above the usual cardiovascular diseases that require surgical intervention, in Sub-Saharan Africa, inflammatory and infective conditions such as pulmonary tuberculosis, pulmonary hydatid disease, and pulmonary complications of HIV infection, are very prevalent. These pre-existing lung pathologies predispose patients to postoperative pulmonary complications after cardiac surgery. This audit investigates the role and importance of bedside chest X-rays in post operative care of cardiac surgery patients that come from a population group where lung pathology is quite prevalent.
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Bucuvic, Edwa Maria [UNESP]. "Evolução de pacientes clínicos e cirúrgicos com injúria renal aguda." Universidade Estadual Paulista (UNESP), 2009. http://hdl.handle.net/11449/92153.
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A Injúria Renal Aguda (IRA) é uma patologia complexa, de etiologias múltiplas e variáveis, sem consenso em sua definição, apresentando uma alta mortalidade e aumento de incidência nas últimas décadas. Este trabalho tem como objetivo avaliar a evolução de pacientes com IRA por Necrose Tubular Aguda internados em enfermarias clínica e cirúrgica do Hospital das Clínicas da Faculdade de Medicina de Botucatu – UNESP . Trata-se de estudo coorte retrospectivo, onde foram avaliados 477 pacientes maiores de 18 anos, sendo 278 provenientes da enfermaria de clínica médica (Grupo Clínica Médica: GCM) e 199 da enfermaria de gastroenterologia cirúrgica (Grupo Gastro-Cirurgia: GGC), no período de janeiro de 2001 a dezembro de 2008. IRA foi definida de acordo com os valores de creatinina sérica, conforme proposto pelo Acute Kidney Injury Network (AKIN). A média de idade da população estudada foi de 65,5 ± 16,2 com predomínio de homens (62%) e com idade > 60 anos (65,2%). Diabetes mellitus (DM) ocorreu em 61,9%, hipertensão arterial (HA) em 44,4% e doença renal crônica em 21,9%. Os grupos estudados foram semelhantes em diversas características clínicas e laboratoriais. Óbito ocorreu em 58% no GCM e 75,4% no GGC (p=0,0002). Após análise multivariada, foram variáveis associadas ao óbito a necessidade de diálise, internação em UTI, idade > 60 anos e tempo de acompanhamento nefrológico. No GCM a internação em UTI e a necessidade de diálise estiveram associadas ao óbito, o mesmo ocorrendo, no GGC, em relação à necessidade de diálise, presença de sepse, creatinina sérica basal e tempo de acompanhamento nefrológico. Não houve diferença na recuperação renal entre os sobreviventes de ambos os grupos, mas a sobrevida do GCM foi maior que do GGC. Como conclusões, este trabalho mostra que a evolução dos pacientes com IRA provenientes de enfermarias clínica...
Acute Kidney Injury (AKI) is a multicausal complex syndrome without consensus about its definition, it presents high mortality rate and its incidence has been growing over the last decades. This study aims to evaluate the outcome of AKI patients caused by acute tubular necrosis admitted in clinical and surgical units of Botucatu Medical School University Hospital – UNESP. This is a retrospective cohort study with 477 adult patients, 278 of them from the clinical unit (Clinical Unit Group: CUG) and 199 from the surgical unit (Surgical Unite Group: SUG), were observed from January 2001 to December 2008. AKI was defined according to serum creatinine levels as proposed by Acute Kidney Injury Network (AKIN). The mean age was 65.5 ± 162 years. The majority of the patients were males (62%) older than 60 years (65.2%). Diabetes mellitus was diagnosed in 61.9%, high blood pressure in 44.4% and chronic kidney disease 21.8% of the patients. CUG and SUG were similar on clinical and laboratory basal characteristics. Death occurred 58% of CUG and 75.4% of SUG patients (p=0,0002). For the total cohort, dialysis requirement, critical care unit admission, age > 60 years and lower attendance time by nephrologists were significant and independently associated to death risk. In CUG critical care unit admission and dialysis requirement were significant and independently associated to death risk while among SUG patients dialysis requirement, sepsis, basal creatinine and lower attendance time by nephrologists were independent predictor of death. The IntroduçãIntrodução 11 survival probability was significantly higher in the CUG and the renal function recovery rate was similar between groups. In conclusion, the outcome of AKI patients hospitalized in clinical or surgical units was similar to previous reports. However, the lower survival among surgical patients reinforces the necessity of an early... (Complete abstract click electronic access below)
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Bucuvic, Edwa Maria. "Evolução de pacientes clínicos e cirúrgicos com injúria renal aguda /." Botucatu, 2009. http://hdl.handle.net/11449/92153.
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Orientador: André Luiz BalbiBanca: Daniela Ponce
Banca: Márcia Cristina da Silva Magro
Acompanha 1 CD-ROM
Resumo: A Injúria Renal Aguda (IRA) é uma patologia complexa, de etiologias múltiplas e variáveis, sem consenso em sua definição, apresentando uma alta mortalidade e aumento de incidência nas últimas décadas. Este trabalho tem como objetivo avaliar a evolução de pacientes com IRA por Necrose Tubular Aguda internados em enfermarias clínica e cirúrgica do Hospital das Clínicas da Faculdade de Medicina de Botucatu - UNESP . Trata-se de estudo coorte retrospectivo, onde foram avaliados 477 pacientes maiores de 18 anos, sendo 278 provenientes da enfermaria de clínica médica (Grupo Clínica Médica: GCM) e 199 da enfermaria de gastroenterologia cirúrgica (Grupo Gastro-Cirurgia: GGC), no período de janeiro de 2001 a dezembro de 2008. IRA foi definida de acordo com os valores de creatinina sérica, conforme proposto pelo Acute Kidney Injury Network (AKIN). A média de idade da população estudada foi de 65,5 ± 16,2 com predomínio de homens (62%) e com idade > 60 anos (65,2%). Diabetes mellitus (DM) ocorreu em 61,9%, hipertensão arterial (HA) em 44,4% e doença renal crônica em 21,9%. Os grupos estudados foram semelhantes em diversas características clínicas e laboratoriais. Óbito ocorreu em 58% no GCM e 75,4% no GGC (p=0,0002). Após análise multivariada, foram variáveis associadas ao óbito a necessidade de diálise, internação em UTI, idade > 60 anos e tempo de acompanhamento nefrológico. No GCM a internação em UTI e a necessidade de diálise estiveram associadas ao óbito, o mesmo ocorrendo, no GGC, em relação à necessidade de diálise, presença de sepse, creatinina sérica basal e tempo de acompanhamento nefrológico. Não houve diferença na recuperação renal entre os sobreviventes de ambos os grupos, mas a sobrevida do GCM foi maior que do GGC. Como conclusões, este trabalho mostra que a evolução dos pacientes com IRA provenientes de enfermarias clínica... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: Acute Kidney Injury (AKI) is a multicausal complex syndrome without consensus about its definition, it presents high mortality rate and its incidence has been growing over the last decades. This study aims to evaluate the outcome of AKI patients caused by acute tubular necrosis admitted in clinical and surgical units of Botucatu Medical School University Hospital - UNESP. This is a retrospective cohort study with 477 adult patients, 278 of them from the clinical unit (Clinical Unit Group: CUG) and 199 from the surgical unit (Surgical Unite Group: SUG), were observed from January 2001 to December 2008. AKI was defined according to serum creatinine levels as proposed by Acute Kidney Injury Network (AKIN). The mean age was 65.5 ± 162 years. The majority of the patients were males (62%) older than 60 years (65.2%). Diabetes mellitus was diagnosed in 61.9%, high blood pressure in 44.4% and chronic kidney disease 21.8% of the patients. CUG and SUG were similar on clinical and laboratory basal characteristics. Death occurred 58% of CUG and 75.4% of SUG patients (p=0,0002). For the total cohort, dialysis requirement, critical care unit admission, age > 60 years and lower attendance time by nephrologists were significant and independently associated to death risk. In CUG critical care unit admission and dialysis requirement were significant and independently associated to death risk while among SUG patients dialysis requirement, sepsis, basal creatinine and lower attendance time by nephrologists were independent predictor of death. The IntroduçãIntrodução 11 survival probability was significantly higher in the CUG and the renal function recovery rate was similar between groups. In conclusion, the outcome of AKI patients hospitalized in clinical or surgical units was similar to previous reports. However, the lower survival among surgical patients reinforces the necessity of an early... (Complete abstract click electronic access below)
Mestre
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Risso, Ashley, and Ashley Risso. "Assessing The Clinical Utility of Non-Depolarizing Cardioplegia & The Challenge Of Evidence-Based Decision Making in an Anecdotal Age of Cardioplegia Comparative Research." Thesis, The University of Arizona, 2016. http://hdl.handle.net/10150/620839.
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PART I Background: For over forty years, depolarizing, hyperkalemic cardioplegia solutions have served as the standard of care for cardiac surgery. While effective in inducing cardiac arrest, potassium-based solutions are associated with an array of negative consequences, such as coagulopathies, conduction dysfunction, inflammation, coronary vasoconstriction, myocardial edema, and ischemic injury. Adenosine-lidocaine-magnesium, a non-depolarizing, non-potassium-containing solution, has recently entered the clinical arena. Animal research suggests that this agent may provide a method of diastolic arrest that is as effective as potassium-based cardioplegia but with improved protective benefits.Purpose: The aim is to assess the safety and efficacy of adenosine-lidocaine-magnesium as a cardioplegia solution in terms of overall patient outcomes.Methodology: In June 2014, Banner University Medical Center Tucson became the first American institution to adopt the use of PolarShot (ALM)--adenosine-lidocaine-magnesium - as a cardioplegia solution. This one-year, retrospective study compares patients receiving adenosine-lidocaine-magnesium to those receiving high-potassium/low-potassium cardioplegia during adult cardiac surgery. Cases compared in this study include isolated coronary artery bypass, isolated aortic/mitral valve repair/replacement, and combination coronary artery bypass/valve replacement surgery only. A propensity-weighted regression model was used for analysis to determine whether or not cardioplegia treatment affected clinical outcome. To assess overall clinical outcome, major morbidity and mortality and post-procedural length of stay were chosen as primary endpoints. Results: In terms of treatment (adenosine-magnesium-lidocaine vs. high-potassium/low-potassium), no statistically significant difference was found between groups in regard to major morbidity and mortality event occurrences nor was a significant difference found between post-procedural length of stay. Discussion: After comparing postoperative outcomes between cardioplegia treatment groups, PolarShot (ALM) cardioplegia produced postoperative outcomes that were statistically similar to those of high-potassium/low-potassium cardioplegia. The confidence in these results is limited by low case volume, surgical case variability, and retrospective nature of this study. Conclusion: According to this propensity-weighted regression model, PolarShot (ALM) cardioplegia appears to be a safe and effective alternative to traditional potassium-based cardioplegia for the purpose of adult cardiac surgery. More research, including prospective randomized trials, is necessary to confirm or deny the findings of this study. PART II Background: Historically, surgical cardioplegia compounding was accomplished by filling patient-tailored prescriptions on-demand. Modern day compounding has become a manufacturing process to improve quality and accommodate physician demand. Additionally, sterile compounding standards have become more stringent, further necessitating a standardized compounding approach. In 2013, scrutiny of sterile drug compounding increased with passage of the Drug Quality and Security Act (DQSA) and subsequent Federal Drug Administration oversight. This federal mandate requires all compounded sterile preparations distributed by 503B Outsourcing Facilities be tested for potency, stability, and sterility. To accomplish this, compounders must significantly reduce batched formula variability. Purpose: A review of 2014 sales data from a large 503B outsourcing facility and cardioplegia compounder will be conducted. The study will identify solution differences and detail its findings. The aim of this study is to assess cardioplegia variability on a national level. Methodology: Results will be summarized by cardioplegia strategy (Buckberg, high-potassium/low-potassium, crystalloid, del Nido, Adenocaine, and microplegia), dilution strategy (4:1 blood-crystalloid, 8:1 blood-crystalloid, 1:4 crystalloid-blood, all-blood, and all-crystalloid), formula constituents (base solutions, additives, buffers), potassium concentrations. Any observed patterns in formula usage will also be reported, geographical or otherwise. Results / Discussion: Based on institutional use, high-potassium/low-potassium (two-solution) multidose strategy was the most common. Based on solutions ordered, the most common cardioplegia ingredient was potassium chloride, present in almost ninety percent (89.64%) of all units sold. After looking at potassium content, extensive variability was noted in terms of potassium added to the bag (undiluted) and potassium to-be delivered (post-dilutional). Additionally, unique solution formulations identified in multiple institutions were often found in neighboring states or within a single state. Conclusion: The results of this analysis illustrate the extent to cardioplegia formula variability nationwide. Variability exists in both methodology and formulation on a state-to-state, institution-to-institution, even across-single-institution basis. This formula customization appears to be institution- and surgeon-specific, suggesting empirical influence in formula adaptation. Formula standardization may be necessary to combat the compounded issue of formula customization moving forward.
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Angus, Jennifer Michelle. "A Study of Clinical Outcomes Using Serum Albumin and Percentage of Weight Loss following Nutritional Intervention in Post-Operative Bariatric Patients." Digital Commons @ East Tennessee State University, 2007. https://dc.etsu.edu/etd/2144.
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The purpose of this study was to determine if post-operative serum albumin and percentage of weight loss improved in patients who received formalized pre-operative nutrition counseling. Nutrition intervention was measured quantitatively. A retrospective review of records was conducted on 77 RYGB patients (68 female subjects and 9 male subjects), ages 21-64, during January 2001 through January 2006.
The results indicated that patients who received pre-operative nutrition intervention had better clinical outcomes of serum albumin than those with no nutrition intervention from a registered dietitian. However, outcomes regarding percentage of weight loss varied. Both pre-operatively and at the 3 month post-operative visit the weight of subjects who received nutrition intervention seemed to be increasing by the 6 month post-operative visit the subjects with no nutrition intervention had lost more weight.
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Strock, Cynthia Lynn. "The impact of electronic clinical reminders on medication trends and six-month survival after coronary artery bypass graft surgery in the Veterans Healthcare Administration /." Connect to full text via ProQuest. Limited to UCD Anschutz Medical Campus, 2007.
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Thesis (Ph.D. in Clinical Science) -- University of Colorado Denver, 2007.Typescript. Includes bibliographical references (leaves 86-91). Free to UCD affiliates. Online version available via ProQuest Digital Dissertations;
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Alsousou, Joseph. "Platelet rich plasma in regenerative tendon repair mechanobiological interactions and clinical application." Thesis, University of Oxford, 2013. http://ora.ox.ac.uk/objects/uuid:2692c00e-0c0d-4096-8daa-c00ad47fd03d.
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Tendon injury prevalence in both athletic and occupational settings is on the increase. Tendon healing properties are poor, despite the complex biological process triggered by the injury, which makes those injuries incapacitating for months. A significant proportion of these injuries remain difficult to treat, and many patients suffer from decreased performance and longstanding sequelae. While mechanical stabilization has been a hallmark of tendon surgical management, orthobiologics are playing an increasing role in optimizing tendon healing. Platelet rich Plasma (PRP), which is a volume of autologous plasma having platelet concentration above baseline, has been suggested as an accelerant orthobiological agent rich in supraphysiological concentration of growth factors. However, strong evidence of its mode of action and of its clinical efficacy is lacking. The purpose of this thesis is to identify the role of PRP in tendon regeneration in in-vitro and clinical studies. Firstly, the viability and biological components of clinically-prepared PRP were studied in novel experiments. This PRP was used in linked in-vitro studies to investigate the possible mechanism of PRP effect on the injured Achilles tendon cells and tissues. Cell count, viability, proliferation and DNA content were studied. The clinical application of PRP in Achilles tendon rupture was assessed in a randomised clinical pilot study using a combination of PROMs, objective outcome measures and a novel imaging modality called functional ultrasound elastography. This non-invasive technique was developed in a healthy-tendons volunteer study and its feasibility in ruptured tendons was assessed in the pilot trial. In another unique study, the immunohistochemical response to PRP was assessed in biopsies taken under US guidance at week 6 and compared to control to explore the possible mechanism of PRP effects. The findings confirmed that PRP is a viable activatable autologous blood product rich in growth factors. The results also confirmed that leukocytes and platelets are present in very high concentration with reversal of lymphocyte neutrophil ratio. Elastography volunteer study confirmed that FUSE is feasible using clinically applicable ultrasound scan. The improved algorithm allowed visualisation of localised strain within the studied tissues. The clinical application of PRP in Achilles tendon rupture revealed positive efficacy signal that PRP led to faster healing, improved pain and earlier restoration of function. However, the findings of this pilot trial were indicative and not confirmative. Immunohistochemistry analysis showed that PRP enhanced the maturity of the healing tendon tissues by promoting better collagen I deposition, improved Collagen III/Collagen I ratio, reduced cellularity, better vascular structure and higher GAGs content when compared with control. The finding may explain the clinical improvement observed in these patients at week 6 onwards. Linked in-vitro studies showed that autologous PRP with its cellular components, which include platelets, leukocytes and erythrocytes, has the ability to stimulate tendon cell migration to the injury site and stimulate proliferation in the injured human tendon. Additionally, it may maintain tissue viability in the hypoxic environment that follows tendon injury. Promoting migration and proliferation of cells and maintain tissue viability may play an important role to accelerate tendon healing. The findings of this project has informed the design of a phase II large multi-centre randomised controlled trial and helped secure major funding from the National Institute of Health Research (NIHR). This trial will set the scene for PRP use in tendon treatment.
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Liu, Chaomei. "Traditional Chinese medical clinic system." CSUSB ScholarWorks, 2004. https://scholarworks.lib.csusb.edu/etd-project/2517.
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The Chinese Medical Clinic System is designed to help acupuncturists and assistants record and store information. This system can maintain and schedule appointments and view patient diagnoses effectively. The system will be implemented on a desktop PC connected to the internet to facilitate the acupuncturists record of information.
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Viberga, Ilze. "The Clinical Appearance of Pelvic Inflammatory Disease in Relation to Use of Intrauterine Device in Latvia : A Study with Special Emphasis on Factors Influencing the Clinical Course of PID in IUD Users." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis, 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-6458.
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Petasne, Nijamkin Monica. "Impact of a Comprehensive Nutrition and Lifestyle Education Intervention on Body Weight and Health-Related Outcomes in Morbidly-Obese Hispanic-Americans Following Laparoscopic Roux-En Y Gastric Bypass." FIU Digital Commons, 2010. http://digitalcommons.fiu.edu/etd/301.
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As morbid obesity increasingly affects Hispanic-Americans, the incidence of Roux-en-Y gastric bypass procedures (RYGB) among this population rises. Prospective research on the impact of postoperative educational interventions focused on Hispanic-Americans is needed to prevent premature weight loss plateau, weight regain, nutritional deficiencies, and relapse of obesity-related comorbidities. This randomized-controlled study evaluated the impact of a comprehensive nutrition and lifestyle education intervention (6 biweekly postoperative sessions that incorporated motivational strategies for behavioral change) as compared to a non-comprehensive approach (printed guidelines for healthy lifestyle). The variables to consider are body weight, obesity-related comorbidities (depression, diabetes, dyslipidemia, and others), nutrient status, physical activity, and eating habits in 144 morbidly-obese adult Hispanic-Americans 6 to 12 months following RYGB. Patients were randomly assigned to either the comprehensive intervention (n=72) or the comparison group (n=72). Participants (mean age 44.5 ± 13.5 years) were mainly Cuban-born females (83.3%). Intervention sessions attendance was 64%. At 12 months, both groups lost weight significantly, but those in the comprehensive intervention experienced greater excess weight loss than those in the comparison group (80% vs. 64% from preoperative excess weight, P<.001). Intervention participants were significantly more involved in physical activity (+ 14 min/week vs. – 4 min/week), had decreased depression, joint illness, and required less medication for comorbidities than comparison participants. Additionally, those in the comprehensive intervention had sustained supplement intake experiencing less folate deficiency (P=.014). The non-comprehensive intervention group significantly decreased their protein and supplement intake compared to the intervention group. Patients in the comprehensive intervention had significantly better eating habits reflected by fewer episodes of dumping syndrome, constipation, and night eating, than those in the comparison group who reported greater eating in response to negative emotions (P=.003). These findings support the importance of a comprehensive educational approach to achieve more effective weight reduction and health-related outcomes to prevent relapse of obesity-related comorbidities and nutritional deficiencies in Hispanic-Americans 6 to 12 months following RYGB.
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Stephenson, Melanie K. "Safety-Net Medical Clinic Behavioral Health Integration." Wright State University Professional Psychology Program / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=wsupsych152767560332411.
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Welleford, Andrew. "Autologous Peripheral Nerve Grafts to the Brain for the Treatment of Parkinson's Disease." UKnowledge, 2019. https://uknowledge.uky.edu/neurobio_etds/23.
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Parkinson’s disease (PD) is a disorder of the nervous system that causes problems with movement (motor symptoms) as well as other problems such as mood disorders, cognitive changes, sleep disorders, constipation, pain, and other non-motor symptoms. The severity of PD symptoms worsens over time as the disease progresses, and while there are treatments for the motor and some non-motor symptoms there is no known cure for PD. Thus there is a high demand for therapies to slow the progressive neurodegeneration observed in PD. Two clinical trials at the University of Kentucky College of Medicine (NCT02369003, NCT01833364) are currently underway that aim to develop a disease-modifying therapy that slows the progression of PD. These clinical trials are evaluating the safety and feasibility of an autologous peripheral nerve graft to the substantia nigra in combination with Deep Brain Stimulation (DBS) for the treatment of PD. By grafting peripheral nerve tissue to the Substantia Nigra, the researchers aim to introduce peripheral nerve tissue, which is capable of functional regeneration after injury, to the degenerating Substantia Nigra of patients with PD. The central hypothesis of these clinical trials is that the grafted tissue will slow degeneration of the target brain region through neural repair actions of Schwann cells as well as other pro-regenerative features of the peripheral nerve tissue.
This dissertation details analysis of the peripheral nerve tissue used in the above clinical trials with respect to tissue composition and gene expression, both of injury-naive human peripheral nerve as well as the post-conditioning injury nerve tissue used in the grafting procedure. RNA-seq analysis of sural nerve tissue pre and post-conditioning show significant changes in gene expression corresponding with transdifferentiation of Schwann cells from a myelinating to a repair phenotype, release of growth factors, activation of macrophages and other immune cells, and an increase in anti-apoptotic and neuroprotective gene transcripts. These results reveal in vivo gene expression changes involved in the human peripheral nerve injury repair process, which has relevance beyond this clinical trial to the fields of Schwann cell biology and peripheral nerve repair. To assess the neurobiology of the graft post-implantation we developed an animal model of the grafting procedure, termed Neuro-Avatars, which feature human graft tissue implanted into athymic nude rats. Survival and infiltration of human graft cells into the host brain were shown using immunohistochemistry of Human Nuclear Antigen. Surgical methods and outcomes from the ongoing development of this animal model are reported. To connect the results of these laboratory studies to the clinical trial we compared the severity of motor symptoms before surgery to one year post-surgery in patients who received the analyzed graft tissue. Motor symptom severity was assessed using the Unified Parkinson’s Disease Rating Scale Part III. Finally, the implications and future directions of this research is discussed. In summary, this dissertation advances the translational science cycle by using clinical trial findings and samples to answer basic science questions that will in turn guide future clinical trial design.
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Greenhowe, Jennifer. "Stem and progenitor cells in wound healing." Thesis, University of Oxford, 2014. http://ora.ox.ac.uk/objects/uuid:87a9a7a1-b595-458a-913f-64497174f988.
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As more patients with large body surface area burns are surviving and requiring reconstructive surgery, there is a necessity for advances in the provision of bioengineered alternatives to autologous skin cover. The aims of this Thesis are to identify feasible source tissues of Endothelial Colony Forming Cells and Mesenchymal Stem/Stromal Cells for microvascular network formation in vitro with three-dimensional dermal substitute scaffolds. The working hypothesis is that pre-vascularised dermal scaffolds will result in better quality scarring when used with split thickness skin grafts. Human umbilical cord blood, peripheral blood and adipose tissue were collected and processed with ethical approval and informed consent. Samples were cultured to form endothelial outgrowth colonies and confluent Mesenchymal Stem/Stromal Cells, which were characterised using flow cytometry and expanded in vitro. Mesenchymal Stem/Stromal Cell multipotency was confirmed with tri-lineage mesenchymal differentiation. Primary cells were tested in a two-dimensional tubule formation co-culture assay and differences assessed using a proangiogenic antibody array. Tubule formation was tested in four different acellular dermal substitute scaffolds; Integra® Dermal Regeneration Template, Matriderm®, Neuskin-F® and De-cellularised Human Cadaveric Dermis. Umbilical cord blood was the most reliable source of Endothelial Colony Forming Cells, the yield of which could be predicted from placental weight. Microvasculature dissected free from adipose tissue was a reliable source of Mesenchymal Stem/Stromal Cells which supported significantly more tubule formation than Mesenchymal Stem/Stromal Cells from whole adipose tissue. Microvasculature Mesenchymal Stem/Stromal Cells secreted significantly higher levels of the proangiogenic hormone leptin, and addition of exogenous leptin to the tubule formation assay resulted in significantly increased tubule formation. Microvasculature was cultured in all four of the scaffolds tested, but depth of penetration was limited to 100µm. The artificial oxygen carrier perfluorocarbon was shown to increase two-dimensional tubule formation and may be useful in further three-dimensional scaffolds studies to improve microvascular penetration.
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Ukah, Fidelia. "Conducting a Needs Assessment at Outpatient Medical Clinic." Thesis, Walden University, 2015. http://pqdtopen.proquest.com/#viewpdf?dispub=3732467.
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Colorectal cancer is one of the most common cancers in the United States and confronting its challenges has remained a problem to the United States health sector, especially among outpatient clinics. Guided by health belief model, the purpose of this needs assessment was to identify patients age 50 and older in outpatient clinic located in a large metropolitan city in Texas who should receive information on the need for colorectal cancer screening based on their risk for developing colorectal cancer as outlined by American Cancer Society. A sample of 70 charts of patients age 50-75 years was randomly selected and audited using descriptive statistics. Among the patients aged 50-75 years attending the outpatient clinic, 25.7% were African Americans, 71.4% were Hispanic, and 2.9% were Caucasians; 42.9% were male and 57.1% were female. The rate of colorectal cancer screening was 12.9%, a rate that is lower than the rate for all Texans, which was 54.1% - 59.2%. CRC screening was ordered for 62.9% of all patients; 24.2% of clinic patients were identified as being at high risk for colorectal cancer. The low rate of screening may hamper early detection of colorectal cancer in outpatient clinics setting. It is recommended that the outpatient clinic develop intensive campaign to increase patient awareness about the need for and benefits of colorectal cancer screening, especially for those at high risk for developing colorectal cancer. The findings of this study may raise awareness on the chasm in quality of health care availability and provide insight on colorectal cancer and its prevention.
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Canby, James B., Kenneth J. Euske, and Douglas O. Moses. "Cost reporting at a Navy Branch Medical Clinic." Thesis, Monterey, California: Naval Postgraduate School, 1993. http://hdl.handle.net/10945/24140.
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Ukah, Fidelia Ijeuru. "Conducting a Needs Assessment at Outpatient Medical Clinic." ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/1630.
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Colorectal cancer is one of the most common cancers in the United States and confronting its challenges has remained a problem to the United States health sector, especially among outpatient clinics. Guided by health belief model, the purpose of this needs assessment was to identify patients age 50 and older in outpatient clinic located in a large metropolitan city in Texas who should receive information on the need for colorectal cancer screening based on their risk for developing colorectal cancer as outlined by American Cancer Society. A sample of 70 charts of patients age 50-75 years was randomly selected and audited using descriptive statistics. Among the patients aged 50-75 years attending the outpatient clinic, 25.7% were African Americans, 71.4% were Hispanic, and 2.9% were Caucasians; 42.9% were male and 57.1% were female. The rate of colorectal cancer screening was 12.9%, a rate that is lower than the rate for all Texans, which was 54.1% - 59.2%. CRC screening was ordered for 62.9% of all patients; 24.2% of clinic patients were identified as being at high risk for colorectal cancer. The low rate of screening may hamper early detection of colorectal cancer in outpatient clinics setting. It is recommended that the outpatient clinic develop intensive campaign to increase patient awareness about the need for and benefits of colorectal cancer screening, especially for those at high risk for developing colorectal cancer. The findings of this study may raise awareness on the chasm in quality of health care availability and provide insight on colorectal cancer and its prevention.
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Davies, Brian. "Medical robotics." Thesis, Imperial College London, 1995. http://hdl.handle.net/10044/1/8795.
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Simões, Pedro Miguel Fernandes. "Postoperative delirium after curative surgery for cancer." Dissertação, 2018. https://hdl.handle.net/10216/112364.
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Simões, Pedro Miguel Fernandes. "Postoperative delirium after curative surgery for cancer." Master's thesis, 2018. https://hdl.handle.net/10216/112364.
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Tseng, Fan-Ping, and 曾繁萍. "Crafting a “Professional” for Surgery in Medical Institutions：Surgical Assistants and Their Emerging Identity in Clinical Teamwork." Thesis, 2015. http://ndltd.ncl.edu.tw/handle/5uj447.
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碩士國立陽明大學
科技與社會研究所
103
The study investigates how surgical assistants acquire their professional identity, skills and recognition through collaborative works with other medical professionals in surgical teamwork. Guided by studies from sociology of profession, medical sociology, and science, technology and society studies (STS) with ethnographic work done at a local teaching hospital in I-Lan county, this study questions the meaning of "being a professional" as surgical assistants by looking into their work and the bodily skill they acquire via everyday practice. This study has three major findings. First, instead of a specific body of knowledge that construct the core of a profession, surgical assistants acquire their profession by drilling surgical skills via the acumination of clinical experience. It is achieved by an idiosyncratic style of "learning by doing" than any institutional training. Second, following closely the interactions among clinical members in surgeries, this study argues that the professional identity of surgical assistants cannot be separated from their cooperative skills performed in operations. This relational, dynamic identity emerges in two ways. Surgical assistants affirm their professional existence by working with other clinical professionals in working. The closer the cooperation is made, the stronger interpersonal trust is established. Meanwhile, the institutional practice in hospital settings grants essential trust for surgical assistants to work with surgeons. This institutional trust grows as their performance improves. Third, upon the introduction of hospital accreditation system, surgical assistants are now required to have nursing licenses to work in hospitals. Even so, this policy does not settle the identity problems of surgical assistants but intensify their professional anxiety. For some of them, "being an unfit professional" makes them more uneasy than "being of no profession." This study tries to capture this unstable professional status. It finds that surgical assistants do not disappear by being "absorbed" into another profession; by acting out differences when interacting with nurses, they seek for achieving wider recognition that rightly reflect their everyday life and work.
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Reis, Pedro José Vinhais Domingues Videira. "Prediction models for adverse outcomes in vascular surgery." Tese, 2021. https://hdl.handle.net/10216/131807.
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Oliveira, João Pedro Ferreira Lusquinhos de. "Quality of Recovery After Surgery for Cancer Treatment." Dissertação, 2017. https://hdl.handle.net/10216/104223.
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Reis, Pedro José Vinhais Domingues Videira. "Prediction models for adverse outcomes in vascular surgery." Doctoral thesis, 2021. https://hdl.handle.net/10216/131807.
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Oliveira, João Pedro Ferreira Lusquinhos de. "Quality of Recovery After Surgery for Cancer Treatment." Master's thesis, 2017. https://hdl.handle.net/10216/104223.
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Costa, João Pedro Mestre da. "Predicting mortality in surgery for complicated intra-abdominal infections." Dissertação, 2016. https://repositorio-aberto.up.pt/handle/10216/90146.
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Martins, Rita Ferreira da Costa. "Home-based self recovery protocol for Rotator Cuff surgery." Dissertação, 2016. https://repositorio-aberto.up.pt/handle/10216/83816.
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Mata, Sara Maria Oliveira Santos Gil. "Predictors of laparoscopic antireflux surgery failure: a systematic review." Dissertação, 2016. https://repositorio-aberto.up.pt/handle/10216/89564.
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Ribeiro, Juliana Catarina Almeida. "Tissue Engineering in Plastic Surgery - What Has Been Done." Dissertação, 2020. https://hdl.handle.net/10216/128921.
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Engenharia tecidular aplica princípios de engenharia e de ciências da vida para o desenvolvimento de substitutos biológicos funcionais. A crescente escassez de tecidos para cirurgias de reconstrução desafiantes torna essencial o papel do cirurgião plástico na investigação e desenvolvimento destes constructos e no seu uso subsequente.
Esta monografia tem como objetivos resumir os princípios de engenharia tecidular, atualizar nas suas aplicações e desenvolvimentos recentes, abordar as suas limitações e possíveis direções futuras desta entusiasmante nova área da medicina.
Uma pesquisa bibliográfica foi realizada via MEDLINE, em outubro de 2019, usando os termos "tissue engineering" AND "plastic surgery", tal como um scan da bibliografia dos artigos selecionados. Os artigos incluídos abordavam engenharia tecidular e cirurgia plástica e apresentavam relevância clínica. A pesquisa foi restrita a estudos em humanos, porém estudos animais considerados clinicamente pertinentes também foram incluídos. A linguagem foi restringida para Inglês e Português.
Esta revisão abordou os usos de engenharia tecidular em lesões cutâneas, defeitos craniocervicais, defeitos músculo-esqueléticos, lesões de nervos periféricos, defeitos de estruturas vasculares e o uso de tecido adiposo.
A investigação em engenharia tecidular está a aumentar exponencialmente, porém, apesar de já existirem produtos clinicamente disponíveis, uma aplicação clínica abrangente permanece uma esperança. São necessários mais estudos longitudinais que respondam aos problemas pendentes para que se torne uma realidade.The field of tissue engineering applies principles of engineering and life sciences for the development of functional biologic substitutes. The increasing need of tissue for challenging reconstructive surgeries places plastic surgeons' involvement as vital in the research and development of engineered constructs and subsequent use. This narrative review aims to summarize tissue engineering principles, to update on its current uses and breakthroughs, to approach its current limitations and possible future directions for this exciting new medicine's area. A MEDLINE literature search was conducted in October 2019 with the terms "tissue engineering"[Title/Abstract] AND "plastic surgery"[Title/Abstract], and included studies' reference lists were scanned. The articles included were about tissue engineering and plastic surgery, and had clinical pertinence. The search was restricted for human studies, however animal studies considered pertinent for this review were also included. Language was restricted to English and Portuguese. This revision addressed tissue engineering's uses in skin lesions, craniocervical defects, musculoskeletal defects, peripheral nerves lesions, vascular tissue defects and adipose tissue uses. Research in tissue engineering is increasing exponentially, however, and although there are already several engineered constructs available, its widespread clinical application is still a hope. More long-term studies that answer outstanding issues are needed in order for that to become reality.
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Martins, Rita Ferreira da Costa. "Home-based self recovery protocol for Rotator Cuff surgery." Master's thesis, 2016. https://repositorio-aberto.up.pt/handle/10216/83816.
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Costa, João Pedro Mestre da. "Predicting mortality in surgery for complicated intra-abdominal infections." Master's thesis, 2016. https://repositorio-aberto.up.pt/handle/10216/90146.
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Mata, Sara Maria Oliveira Santos Gil. "Predictors of laparoscopic antireflux surgery failure: a systematic review." Master's thesis, 2016. https://repositorio-aberto.up.pt/handle/10216/89564.
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Ribeiro, Juliana Catarina Almeida. "Tissue Engineering in Plastic Surgery - What Has Been Done." Master's thesis, 2020. https://hdl.handle.net/10216/128921.
Full textAbstract:
Engenharia tecidular aplica princípios de engenharia e de ciências da vida para o desenvolvimento de substitutos biológicos funcionais. A crescente escassez de tecidos para cirurgias de reconstrução desafiantes torna essencial o papel do cirurgião plástico na investigação e desenvolvimento destes constructos e no seu uso subsequente.
Esta monografia tem como objetivos resumir os princípios de engenharia tecidular, atualizar nas suas aplicações e desenvolvimentos recentes, abordar as suas limitações e possíveis direções futuras desta entusiasmante nova área da medicina.
Uma pesquisa bibliográfica foi realizada via MEDLINE, em outubro de 2019, usando os termos "tissue engineering" AND "plastic surgery", tal como um scan da bibliografia dos artigos selecionados. Os artigos incluídos abordavam engenharia tecidular e cirurgia plástica e apresentavam relevância clínica. A pesquisa foi restrita a estudos em humanos, porém estudos animais considerados clinicamente pertinentes também foram incluídos. A linguagem foi restringida para Inglês e Português.
Esta revisão abordou os usos de engenharia tecidular em lesões cutâneas, defeitos craniocervicais, defeitos músculo-esqueléticos, lesões de nervos periféricos, defeitos de estruturas vasculares e o uso de tecido adiposo.
A investigação em engenharia tecidular está a aumentar exponencialmente, porém, apesar de já existirem produtos clinicamente disponíveis, uma aplicação clínica abrangente permanece uma esperança. São necessários mais estudos longitudinais que respondam aos problemas pendentes para que se torne uma realidade.The field of tissue engineering applies principles of engineering and life sciences for the development of functional biologic substitutes. The increasing need of tissue for challenging reconstructive surgeries places plastic surgeons' involvement as vital in the research and development of engineered constructs and subsequent use. This narrative review aims to summarize tissue engineering principles, to update on its current uses and breakthroughs, to approach its current limitations and possible future directions for this exciting new medicine's area. A MEDLINE literature search was conducted in October 2019 with the terms "tissue engineering"[Title/Abstract] AND "plastic surgery"[Title/Abstract], and included studies' reference lists were scanned. The articles included were about tissue engineering and plastic surgery, and had clinical pertinence. The search was restricted for human studies, however animal studies considered pertinent for this review were also included. Language was restricted to English and Portuguese. This revision addressed tissue engineering's uses in skin lesions, craniocervical defects, musculoskeletal defects, peripheral nerves lesions, vascular tissue defects and adipose tissue uses. Research in tissue engineering is increasing exponentially, however, and although there are already several engineered constructs available, its widespread clinical application is still a hope. More long-term studies that answer outstanding issues are needed in order for that to become reality.
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Liang, Ying, and 梁穎. "THE QUALITY OUTCOMES AND MEDICAL CARE EXPENDITURE OF THE CLINICAL PATHWAYS APPLICATION FOR BREAST CANCER SURGERY PATIENTS." Thesis, 2002. http://ndltd.ncl.edu.tw/handle/90785386839209273200.
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碩士國立台北護理學院
醫護管理研究所
90
The purpose of this study is to evaluate the result of quality and the medical care expenditure in the clinical pathways application for breast cancer surgery patients. The period of hospitalization（length of stay）, medical care expenditure cost reduction and the 14 day-readmission rate were obtained from 3 phase. It representing phase 0（before the implementing clinical pathways）, phase 1（initial phase）, phase 2（mature phase）. The total individual cases in our study were459. The data were analyzed to compare the difference of quality result and the medical care expenditure in 3 schedules. The result shows the length of stay (hospitalization period) was from an average of 11 days to 5 days. The 14 day readmission case in our research was 29 cases 8 cases happened before and 21 cases were after the clinical pathways application, follow up by 29 cases, we found 26 cases were planed admission for advance treatment. So we need improve our discharge plan and teaching method-the drainage tube, wound care. Breast cancer patient care must follow up by long term. The expenditure of medical care were tremendous decrease, from an average N.T.$77,500 to 44,500, per case reduction is about N.Y.$33,000, the breast cancer patient’s hospitalization were shorter and the reduction of medical care expenditure cost. It. was proved by implementing clinical pathways surgery. And 14 day-readmission rate does not increase.
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Hsieh, Ya-Ping, and 謝雅萍. "An Comparative Analysis of Medical Resource use and Clinical Outcome of Beating Heart Coronary Artery Bypass Surgery." Thesis, 2010. http://ndltd.ncl.edu.tw/handle/2ntfv2.
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碩士長榮大學
醫務管理學系(所)
98
Background — Off-pump coronary artery bypass graft surgery (OPCAB) has been performed for many years. The best approach myocardial revascularization remains controversial. Comparative analysis of medical resource use and clinical outcome of beating heart coronary bypass surgery by using a longitudinal health insurance database 2005(LHIID2005) of the national health insurance research database(NHIRD). Methods and Results — From January 2005 to November 2008, 588 patients received isolated myocardial revascularization in Taiwan. Among them , 150 underwent OPCAB(off-pump group), and 438 cardiopulmonary bypass(CPB)(on-pump group). We analyzed eleven preoperative variables, including the preoperative underline diseases. Multivariable logistic regression was used to identify independent predicators of outcomes. OPCAB and CPB patients had similar demographics. The in-hospitals mortality of (13.47% vs 7.33% ；P=0.0452) and postoperative dialysis((2.74% vs 2.0%；p=0.6199) found no significant different between CPB and OPCAB. However, OPCAB had shorter hospital stays (16.4 vs 19.3 days ；P<0.05) and lower ICU stays (6.8 vs 4.9 days；P<0.05). Furthermore, the hospital costs of the OPCAB group was significantly lower than that of CPB group(433990 vs 334272；p<0.0001) Conclusions —OPCAB does not produce lower postoperative mortality or postoperative of dialysis rate than CPB. However, it can reduced length of hospital stay and cost of hospitalization. Key words: ■CPB: cardiopulmonary bypass ■OPCAB: off-pump coronary artery bypass ■ICU: intensive care unit
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Chen, Chien-Hua, and 陳建華. "Trends in Medical Cosmetic Markets across the Taiwan Strait and the Development Opportunities of Plastic Surgery Clinics in Taiwan." Thesis, 2014. http://ndltd.ncl.edu.tw/handle/06457991199750577469.
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碩士國立臺灣大學
財務金融組
102
Over the past twenty years, the global medical cosmetic industry has experienced a period of high growth period. After the financial crisis, in stead of US and European, China and Latin America is growing to main market. Asia has become the world''s most potential for tourism medical services market, the annual growth rate has reached 15% -20%, the South Korean government is more committed significant resources to fully support medical tourism to promote the effectiveness of excellence, 2011 medical services for the country earned about $ 200 million in foreign exchange earnings, medical tourists reached 120,000 visitors However, due to highly economic development of Mainland in recent years, medical cosmetic market is growing rapidly, about 3000000 people receive plastic surgery every year, the annual growth rate is about 10%, better than the world''s 6%. Since 2012 New Year''s day, the Government agreed mainland tourists to visit Taiwan for healthy examinations and medical cosmetil purpose,Taiwan owns several advantages to develop Cross-Strait tourism medical cosmetic industry, including of the similar language and culture,superior medical service level but reasonable inexpensive price and short travelling time. We think that China''s tourism medical cosmetical industry will bring enormous business opportunities for Taiwan. In recent years, Taiwan''s medical cosmetic industry is vigorous development, medical cosmetic clinics mushrooming established up to 1800 in Taiwan,, it evolved into the strongly competitive market.Medical cosmetic clinics in Taiwan had to find the solutions to overcome these challenges, so the authors propose a project that a small-scale plastic surgery clinics in Taiwan how to develop Cross-Strait tourism medical cosmetic business, how to improve the quality of medical cosmetical services for people from the mainland!
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Azevedo, Joana Araújo de. "Association between patient's expectations and real outcomes for degenerative spine surgery." Dissertação, 2020. https://hdl.handle.net/10216/128696.
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Objetivo: O objetivo deste estudo passa por comparar as expectativas dos pacientes antes da cirurgia a patologia degenerativa da coluna com a sua perceção dos resultados e identificar os principais fatores que se correlacionam com expectativas superiores e o seu cumprimento. A questão do nosso estudo baseia-se na possibilidade de as expectativas pré-cirúrgicas dos pacientes poderem predizer os resultados reais da cirurgia.
Métodos: Para a nossa análise foram considerados doentes consecutivos submetidos a cirurgia espinhal por patologia degenerativa no nosso centro hospitalar entre Agosto de 2018 e Maio de 2019. As expectativas expressas pelos pacientes foram registadas usando o questionário de expectativas para cirurgia espinhal cervical ou lombar e foram comparadas com o mesmo instrumento três meses após a cirurgia. Os resultados relatados pelo paciente foram avaliados usando o questionário COMI antes e após a cirurgia.
Resultados: Foram analisados 120 pacientes. A média do score de expectativas relatadas pelos pacientes foi de 82.87%±14.57% e o score pós-operatório foi significativamente mais baixo, com uma média de 60.5±20.6% (p<0.001). Na análise multivariada, apenas Cirurgia prévia e Duração dos sintomas mantiveram a sua relação com as expectativas pré-operatórias e apenas Tipo de cirurgia se correlacionou com o Rácio de expectativas. Melhoria no score COMI após a cirurgia foi observada em 85% dos pacientes, mas somente em 14% é que as expectativas foram igualadas ou superadas.
Conclusão: As expectativas pré-operatórias foram significativamente mais altas, mas os resultados pós-cirúrgicos foram menos otimistas. Expectativas mais baixas e uma perceção de sucesso menor após a cirurgia podem ser antecipadas em alguns pacientes tendo em conta características pré-operatórias. Apesar de 85% dos pacientes melhorarem após a cirurgia, as suas expectativas não foram cumpridas na maioria dos casos.Purpose: The aim of this study is to compare patient's expectations before surgery for degenerative spine disease to postoperative perceived outcomes and identify main factors that correlate with higher expectations and their fulfillment. The study question is whether patient's pre-surgical expectations can predict actual outcomes. Methods: Consecutive patients submitted to degenerative spine surgery between August 2018 and May 2019 in our spine center were enrolled. Patient's expressed expectations were recorded using the Lumbar/Cervical Spine Surgery Expectations Survey and compared to the same instrument, three months after surgery. Patient reported outcomes were evaluated using the COMI questionnaire before and after surgery. Results: A total of 120 patients were analyzed. The mean score of expectations reported by patients was 82.87%±14.57% and post-surgical score was significantly lower, 60.5±20.6% (p<0.001). In a multivariate analysis, only a history of spine surgery and a longer duration of symptoms were associated with low pre-surgical expectations. Lumbar surgery was associated to a lower ratio between postoperative and preoperative Expectations Survey scores. An improvement on the COMI score after surgery was achieved in 85% of the patients, but only 14% reported that their expectations were matched or exceeded. Conclusion: The pre-surgical expectations were significatively high, but the post-surgical results were less optimistic. Lower expectations and lower perceived success after surgery can be anticipated on some patients based on preoperative features. Although 85% of patients improved after surgery, their expectations weren't met in most cases.
44
Xu, José Chen. "Incisional Hernia in hepatobiliary and pancreatic surgery - incidence and risk factors." Dissertação, 2018. https://hdl.handle.net/10216/112222.
Full text
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Oliveira, João Pedro Figueiredo. "Remodelling adversely impacts arrhythmic outcome following isolated aortic valve replacement surgery." Dissertação, 2020. https://hdl.handle.net/10216/128770.
Full textAbstract:
Introdução: A Fibrilhação Auricular (AF) é a arritmia mais comum com outcomes clínicos adversos. A substituição da válvula aórtica é uma das cirurgias cardíacas mais frequentemente realizadas, ainda assim a evidência sobre arritmias neste contexto é escassa. Pretendemos avaliar a ocorrência de AF durante os primeiros 9 meses após substituição isolada da válvula aórtica e os seus preditores clínicos, analíticos e ecocardiográficos.
Métodos: Foram incluídos 379 doentes com estenose aórtica severa sem história prévia de fibrilhação auricular que foram submetidos a substituição isolada da válvula aórtica durante dois anos. Utilizamos regressão logística para encontrar preditores independentes associados ao desenvolvimento de AF durante o seguimento e identificar doentes de elevado risco. Realizamos uma comparação ente dados ecocardiográficos pré e pós-operatórios, com uso de testes t de amostras emparelhadas e Wilcoxon sign rank.
Resultados: Encontramos uma prevalência de diabetes, de AF pós-operatória (POAF) diâmetro da aurícula esquerda significativamente mais elevados no grupo de doentes que desenvolveu AF. POAF durante o internamento hospitalar e o diâmetro da aurícula esquerda (LAD) durante o seguimento foram preditores independentes de AF durante o seguimento. Não encontramos diferenças entre grupos ao comparar medidas ecocardiográficas pré e pós-operatórias exceto no caso do diâmetro tele-diastólico do ventrículo esquerdo (LVED) que não diminuiu de forma significativa após cirurgia no grupo de doentes que desenvolveu AF durante o seguimento e da espessura do septo interventricular que mostrou uma tendência para diminuir apenas no grupo que permaneceu em ritmo sinusal.
Conclusão: POAF e LAD indexado são preditores de AF aos 9 meses após cirurgia de substituição isolada da válvula aórtica em doentes com estenose aórtica sem história pré-operatória de AF. O diâmetro LVED não diminuiu de forma significativa na avaliação durante o seguimento em doentes que desenvolveram AF, possivelmente refletindo remodelagem ventricular adversa.Background: Atrial fibrillation (AF) is the most common arrhythmia with adverse clinical outcomes. Aortic valve replacement is one of the most frequently performed cardiac surgeries, although there is scarce evidence on arrhythmic outcomes. We aimed to evaluate AF during the first 9 months post- isolated aortic valve replacement surgery and its clinical, analytical and echocardiographic predictors. Methods: 379 severe aortic stenosis patients with no prior atrial fibrillation who underwent isolated aortic valve replacement surgery during two years were included in our study. Logistic regression was used to find independent factors associated with follow-up AF and identify patients at high risk. We performed a comparison between pre- and postoperative echocardiographic data (baseline and follow-up) using paired sample t tests and Wilcoxon sign rank. Results: Postoperative AF (POAF), diabetes, and follow-up indexed left atrium diameter (LAD) were significantly higher in the group of patients developing AF. We found POAF during hospital stay and left atrium diameter at follow-up were independent predictors of AF at follow-up. No differences were found between groups when comparing baseline and follow-up echocardiographic data except for indexed left ventricle end-diastolic diameter (LVED), which failed to decrease after surgery in the AF group, and indexed interventricular septum thickness, which showed a tendency to decrease only in patients remaining in sinus rhythm. Conclusions: POAF and indexed LAD independently predicted AF at 9 months following isolated aortic valve replacement surgery in aortic stenosis patients with no preoperative AF history. LVED diameter did not decrease significantly at follow-up in AF patients, possibly reflecting adverse ventricular remodelling
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Azevedo, Joana Araújo de. "Association between patient's expectations and real outcomes for degenerative spine surgery." Master's thesis, 2020. https://hdl.handle.net/10216/128696.
Full textAbstract:
Objetivo: O objetivo deste estudo passa por comparar as expectativas dos pacientes antes da cirurgia a patologia degenerativa da coluna com a sua perceção dos resultados e identificar os principais fatores que se correlacionam com expectativas superiores e o seu cumprimento. A questão do nosso estudo baseia-se na possibilidade de as expectativas pré-cirúrgicas dos pacientes poderem predizer os resultados reais da cirurgia.
Métodos: Para a nossa análise foram considerados doentes consecutivos submetidos a cirurgia espinhal por patologia degenerativa no nosso centro hospitalar entre Agosto de 2018 e Maio de 2019. As expectativas expressas pelos pacientes foram registadas usando o questionário de expectativas para cirurgia espinhal cervical ou lombar e foram comparadas com o mesmo instrumento três meses após a cirurgia. Os resultados relatados pelo paciente foram avaliados usando o questionário COMI antes e após a cirurgia.
Resultados: Foram analisados 120 pacientes. A média do score de expectativas relatadas pelos pacientes foi de 82.87%±14.57% e o score pós-operatório foi significativamente mais baixo, com uma média de 60.5±20.6% (p<0.001). Na análise multivariada, apenas Cirurgia prévia e Duração dos sintomas mantiveram a sua relação com as expectativas pré-operatórias e apenas Tipo de cirurgia se correlacionou com o Rácio de expectativas. Melhoria no score COMI após a cirurgia foi observada em 85% dos pacientes, mas somente em 14% é que as expectativas foram igualadas ou superadas.
Conclusão: As expectativas pré-operatórias foram significativamente mais altas, mas os resultados pós-cirúrgicos foram menos otimistas. Expectativas mais baixas e uma perceção de sucesso menor após a cirurgia podem ser antecipadas em alguns pacientes tendo em conta características pré-operatórias. Apesar de 85% dos pacientes melhorarem após a cirurgia, as suas expectativas não foram cumpridas na maioria dos casos.Purpose: The aim of this study is to compare patient's expectations before surgery for degenerative spine disease to postoperative perceived outcomes and identify main factors that correlate with higher expectations and their fulfillment. The study question is whether patient's pre-surgical expectations can predict actual outcomes. Methods: Consecutive patients submitted to degenerative spine surgery between August 2018 and May 2019 in our spine center were enrolled. Patient's expressed expectations were recorded using the Lumbar/Cervical Spine Surgery Expectations Survey and compared to the same instrument, three months after surgery. Patient reported outcomes were evaluated using the COMI questionnaire before and after surgery. Results: A total of 120 patients were analyzed. The mean score of expectations reported by patients was 82.87%±14.57% and post-surgical score was significantly lower, 60.5±20.6% (p<0.001). In a multivariate analysis, only a history of spine surgery and a longer duration of symptoms were associated with low pre-surgical expectations. Lumbar surgery was associated to a lower ratio between postoperative and preoperative Expectations Survey scores. An improvement on the COMI score after surgery was achieved in 85% of the patients, but only 14% reported that their expectations were matched or exceeded. Conclusion: The pre-surgical expectations were significatively high, but the post-surgical results were less optimistic. Lower expectations and lower perceived success after surgery can be anticipated on some patients based on preoperative features. Although 85% of patients improved after surgery, their expectations weren't met in most cases.
47
Xu, José Chen. "Incisional Hernia in hepatobiliary and pancreatic surgery - incidence and risk factors." Master's thesis, 2018. https://hdl.handle.net/10216/112222.
Full text
48
Oliveira, João Pedro Figueiredo. "Remodelling adversely impacts arrhythmic outcome following isolated aortic valve replacement surgery." Master's thesis, 2020. https://hdl.handle.net/10216/128770.
Full textAbstract:
Introdução: A Fibrilhação Auricular (AF) é a arritmia mais comum com outcomes clínicos adversos. A substituição da válvula aórtica é uma das cirurgias cardíacas mais frequentemente realizadas, ainda assim a evidência sobre arritmias neste contexto é escassa. Pretendemos avaliar a ocorrência de AF durante os primeiros 9 meses após substituição isolada da válvula aórtica e os seus preditores clínicos, analíticos e ecocardiográficos.
Métodos: Foram incluídos 379 doentes com estenose aórtica severa sem história prévia de fibrilhação auricular que foram submetidos a substituição isolada da válvula aórtica durante dois anos. Utilizamos regressão logística para encontrar preditores independentes associados ao desenvolvimento de AF durante o seguimento e identificar doentes de elevado risco. Realizamos uma comparação ente dados ecocardiográficos pré e pós-operatórios, com uso de testes t de amostras emparelhadas e Wilcoxon sign rank.
Resultados: Encontramos uma prevalência de diabetes, de AF pós-operatória (POAF) diâmetro da aurícula esquerda significativamente mais elevados no grupo de doentes que desenvolveu AF. POAF durante o internamento hospitalar e o diâmetro da aurícula esquerda (LAD) durante o seguimento foram preditores independentes de AF durante o seguimento. Não encontramos diferenças entre grupos ao comparar medidas ecocardiográficas pré e pós-operatórias exceto no caso do diâmetro tele-diastólico do ventrículo esquerdo (LVED) que não diminuiu de forma significativa após cirurgia no grupo de doentes que desenvolveu AF durante o seguimento e da espessura do septo interventricular que mostrou uma tendência para diminuir apenas no grupo que permaneceu em ritmo sinusal.
Conclusão: POAF e LAD indexado são preditores de AF aos 9 meses após cirurgia de substituição isolada da válvula aórtica em doentes com estenose aórtica sem história pré-operatória de AF. O diâmetro LVED não diminuiu de forma significativa na avaliação durante o seguimento em doentes que desenvolveram AF, possivelmente refletindo remodelagem ventricular adversa.Background: Atrial fibrillation (AF) is the most common arrhythmia with adverse clinical outcomes. Aortic valve replacement is one of the most frequently performed cardiac surgeries, although there is scarce evidence on arrhythmic outcomes. We aimed to evaluate AF during the first 9 months post- isolated aortic valve replacement surgery and its clinical, analytical and echocardiographic predictors. Methods: 379 severe aortic stenosis patients with no prior atrial fibrillation who underwent isolated aortic valve replacement surgery during two years were included in our study. Logistic regression was used to find independent factors associated with follow-up AF and identify patients at high risk. We performed a comparison between pre- and postoperative echocardiographic data (baseline and follow-up) using paired sample t tests and Wilcoxon sign rank. Results: Postoperative AF (POAF), diabetes, and follow-up indexed left atrium diameter (LAD) were significantly higher in the group of patients developing AF. We found POAF during hospital stay and left atrium diameter at follow-up were independent predictors of AF at follow-up. No differences were found between groups when comparing baseline and follow-up echocardiographic data except for indexed left ventricle end-diastolic diameter (LVED), which failed to decrease after surgery in the AF group, and indexed interventricular septum thickness, which showed a tendency to decrease only in patients remaining in sinus rhythm. Conclusions: POAF and indexed LAD independently predicted AF at 9 months following isolated aortic valve replacement surgery in aortic stenosis patients with no preoperative AF history. LVED diameter did not decrease significantly at follow-up in AF patients, possibly reflecting adverse ventricular remodelling
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Amarante, Ana Carolina Domingues de Oliveira Rodrigues. "Hiatal hernia recurrence after open surgery - a systematic review regarding risk factors." Dissertação, 2021. https://hdl.handle.net/10216/134515.
Full textAbstract:
Introdução
As hérnias do hiato ocorrem principalmente devido a fragilidade da membrana frenoesofágica e de outras estruturas próximas, como os pilares do diafragma. Isto resulta na migração intratorácica através do hiato esofágico de uma porção do tubo digestivo, o que acarreta um risco aumentado de complicações como refluxo, esofagite ou mesmo estrangulamento. A reparação cirúrgica é efetuada tradicionalmente por cirurgia aberta ou, mais recentemente, de forma minimamente invasiva. Os fatores que determinam a recorrência das hérnias do hiato após cirurgia aberta não estão ainda completamente esclarecidos.
Métodos
Seguindo as guidelines PRISMA, realizou-se uma revisão sistemática da literatura incidindo nos fatores de recorrência da hérnia do hiato após cirurgia aberta. Recorreu-se a duas bases de dados de referências, a Medline e a Scopus.
Resultados
Identificaram-se um total de 1070 referências. Após exclusão de duplicados, artigos não disponíveis ou irrelevantes, analisaram-se qualitativamente 18 artigos.
Discussão
Vários estudos consideram o impacto do tipo de apresentação (urgente, não urgente), um maior IMC, idade ou o tipo de cirurgia (com ou sem procedimento antirefluxo associado). Contudo, ainda não foi encontrada uma associação entre estes fatores e o aumento do risco de recorrência. Um estudo descreve uma associação entre complicações graves de refluxo e o maior risco de recorrência. Não existe uniformidade na definição de recorrência nem como a diagnosticar.
Conclusão
Os determinantes da recorrência após reparação aberta da hérnia do hiato permanecem controversos. Demonstra-se a necessidade de estudos prospetivos que permitam uma compreensão mais aprofundada com melhor evidência sobre as causas de recorrência da hérnia do hiato e como esta pode ser prevenida.Introduction Due to fragility of phrenoesophageal membrane and nearby structures such as diaphragmatic crura (among other causes), hiatal hernias can develop. This results in intrathoracic migration of a portion of the digestive tube through the esophageal hiatus, with added risk of complications such as reflux, esophagitis, or even strangulation. This surgical repair can be performed traditionally with open surgery or, more recently, by minimal invasive surgery. The factors that determine hiatal hernia recurrence after open repair are not yet well understood. Methods Following the PRISMA guidelines, we performed a systematic review of literature regarding risk factors for recurrence after open surgery for hiatal hernia repair. We used both Medline and Scopus libraries. Results We identified a total of 1070 records. After exclusion of duplicates, unavailable and non-relevant articles, we included 18 studies in our qualitative analysis. Discussion Several studies consider the role of acute presentation, higher patient BMI, older age, or the type of surgery with or without a reflux procedure. However, a lack of significant association between these factors and a higher recurrence risk remains. A significant association was found between serious reflux complications the risk of recurrence, in one study. There is also a lack of consensus regarding what constitutes a recurrence, and how to diagnose it. Conclusion The factors related to the recurrence of hiatal hernia after open repair remain controversial. There is a need for prospective studies that allow for a more comprehensive understanding specially with better evidence on why hernias recur and how can this be prevented.
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Brito, Helena Martins de. "Obesity and Cancer: the profile of a population who underwent bariatric surgery." Dissertação, 2021. https://hdl.handle.net/10216/134497.
Full textAbstract:
Introdução: A obesidade é um fator de risco importante para a incidência e mortalidade por cancro. O número de pessoas com obesidade que realizam cirurgia bariátrica está a aumentar, mas o impacto deste procedimento no risco de cancro ainda não é completamente compreendido.
Métodos: Realizámos um estudo coorte retrospetivo unicêntrico para caracterizar a ocorrência de cancro nos doentes que foram submetidos a cirurgia bariátrica entre janeiro de 2010 e dezembro de 2018. Para os casos de cancro identificados após a realização da cirurgia bariátrica, realizámos uma análise de sobrevivência livre de cancro ao longo dos anos após cirurgia. Realizámos também uma análise transversal de características demográficas e clínicas à data da cirurgia, comparando os doentes com e sem diagnóstico de cancro.
Resultados: Dos 2578 doentes que realizaram cirurgia bariátrica, 117 (4,5%) tiveram um diagnóstico de cancro. 59 casos foram diagnosticados antes da cirurgia e os restantes 58 casos foram identificados após a intervenção bariátrica. A prevalência de cancro foi maior no género feminino (4,9%) que no género masculino (2,7%). O cancro da tiróide e o cancro da mama foram os mais frequentes antes e após a cirurgia bariátrica, respetivamente. Em média, os doentes com diagnóstico de cancro eram mais velhos (49,0 vs 43,3 anos, p<0,001) e com menor escolaridade (7,4 vs 8,6 anos, p=0,002).
Conclusão: Neste estudo, quase a todos os casos de cancro identificados são cancros que têm relação com a obesidade. No futuro, são necessários estudos prospetivos para aumentar o conhecimento atual relativo ao perfil de risco de cancro em doentes que realizam cirurgia bariátrica.Introduction: Obesity is a significant risk factor for cancer incidence and mortality. The number of patients with obesity who undergo bariatric surgery is increasing but the impact of such procedure on the risk of cancer is not completely understood yet. Methods: We conducted a retrospective unicentric cohort study to characterize the occurrence of cancer in the patients who underwent bariatric surgery from January 2010 to December 2018. For the cases of cancer identified after bariatric surgery, we performed a cancer-free survival analysis over time. We also performed a cross-sectional analysis of demographic and clinical characteristics by the time of surgery and compared patients with or without a cancer diagnosis. Results: Of the 2578 patients who underwent bariatric surgery, 117 patients (4.5%) had a cancer diagnosis. 59 cases were diagnosed before surgery and the remaining 58 cases happened after the bariatric procedure. The prevalence of cancer was bigger in women (4.9%) than among men (2.7%). Thyroid and breast cancer were the most frequent before and after bariatric surgery, respectively. On average, patients with cancer diagnosis were older (49.0 vs 43.3 years, p<0.001) and with lower educational level (7.4 vs 8.6 years, p=0.002). Conclusion: In this study, almost all cases of cancer identified were of obesity-related cancers. Further prospective studies are needed to extend the current knowledge on the cancer risk profile in patients who undergo bariatric surgery.