Acta Medica Port
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A retrospective analyses of patients submitted to surgery on a day basis was made through our database. The goal of the study was to identify risk factors of postoperative vomiting associated to day surgery. 2115 patients operated between January 2003 and November 2004 on our day surgery unit were included. 70 patients (3,3%) suffered at least on episode of postoperative vomiting. Several factors were analysed: age, sex, surgical speciality, ASA physical status, anaesthetic technique and the duration of anesthesia. ⋯ Logistic regression was then used to identify the multivariate association strength of these factors. The female sex (Odds ratio =4,94) and the duration of anesthesia when longer than 180 minutes (Odds ratio =8,13), had been associated to a higher incidence of postoperative vomiting, while loco-regional technique (Odds ratio = 0,15) and sedation with local anaesthesia (Odds ratio =0,09) had been associated with a lower incidence. Authors evidence the importance of the identification of postoperative vomiting risk factors that will allow us to establish better guidelines on postoperative nausea and vomiting prophylaxis in these patients and to improve the quality of our clinical care and the satisfaction of our patients.
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Ankle injuries are the most frequently encountered injuries in clinical practice. They are often managed by general practicians, and not only by orthopaedic or physiatric physicians. This injury is usually non-complicated, but some care should be taken to assure an adequate management and to exclude severe lesions. ⋯ Surgical reconstruction may be necessary, in cases that develop chronic functional instability, and especially in athletes with high demands on ankle joint stability. The purpose of this article is to review the biomechanics, clinical examination, diagnosis, management and secondary prevention of ankle sprains. We discuss the use and benefit of different modalities and outline a three-phase intervention program of rehabilitation based on recent guidelines.
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Although perioperative pain is multifactorial, there are two main factors on which we can act upon: the central sensitization - using opioid analgesics - and the peripheral nociceptive stimulus - by means of a peripheral nerve block. The use of these techniques for anesthesia and post-operative analgesia is increasingly frequent in orthopaedic surgery because they provide excellent sensitive and motor block and offer advantages over other types of analgesia concerning pain relief and early mobilization in the post-operative period. We present a clinical case in which we made a continuous sciatic block (popliteal approach) in a fourteen years old girl with a Hyperactivivity Syndrome and Mental Re-tardation proposed for a club foot corrective surgery, allowing an effective perioperative analgesia with minimum side effects and a quick return to her familiar environment.
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Health Related Quality of Life (HRQoL) is an essential factor for cancer patients, particularly in the evaluation of the care's. Most of the information that health care providers have is given by the patient. Family can also provide information about them, appealed or not and the quality of such information isn't studied for Portuguese population. The aim of this study was to examine whether proxies can provide useful information on HRQoL of cancer patients. ⋯ The results suggest that proxies only provide valid and useful information about cancer patients QoL for QLQ-C30 domains where the agreement between QoL's responses were high and the means diferrence not significant. For using a HRQoL instrument taking into account as source the proxy, is necessary to recognize the agreement of the HRQoL's domains of the instrument. In this case, for several domains of QLQ-C30 the means difference was statistically significant, so, the instrument should be used with caution for physical and emotional functioning, global QoL fatigue, pain, diarrhoea and total QoL. Proxies are a frequent and a mandatory source of information about patient's status, particularly in palliative care. On a clinical point of view, the knowledge of these differences is very important for that such information be ponderous and contextualized in order to improve better care to the patients.
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As we enter the 21st century, growth of the elderly population, the costs of care, and the advances of medical science and technology will continue to have an impact on the patient-physician relationship. Transformation of the health care system will also raise ethical issues inherent to changing roles. The special nature of Alzheimer's patients and the natural course of their disease require special care on the part of physicians to meet the ethical challenges and establish medical goals, in conjunction with their patients and their families. ⋯ Finally, comfort is the last and the most important goal of care in late stages of dementia, using appropriate medical strategies and eliminating aggressive interventions (cardiopulmonary resuscitation, acute care setting, tube feeding and antibiotic treatment). The future work will focus on promoting more evidence-based decision-making on treatment and guidelines for prognostic information. Physician must be knowledgeable about broadly intersecting medical, legal, finance and ethics, underlying the long-term management of dementia.