Acta Medica Port
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Elderly drug therapy needs special care considering physiopathological alterations of this age group that increase the risk of adverse drug events occurrence and due to the high number of drugs used. Several tools have been created, as tables of drugs and groups of drugs to be avoided in patients 65 years old and over. Beers Criteria of 2002 update is the most used tool. ⋯ The Portuguese operationalization of the Beers Criteria allows the creation of a tool that helps prescribers to choose drugs and doses for a safer prescription to the elderly. These adapted tables allow benchmarking among studies assessing inappropriateness of use of drugs in different countries using Beers Criteria.
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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.