Plunging when drilling: Effect of using blunt drill bits

Objective: Plunging when drilling can be a detrimental factor in patient care. There is, although, a general lack of information regarding the surgeon's performance in this skill. The aim of this study was to determine the effect that using sharp or blunt instruments had on the drill bit's soft tissue penetration, using a simulator. Materials and Methods: Surgeons taking part in an International Trauma Course were invited to participate. Two groups were defined: experienced and inexperienced surgeons. Twelve holes were drilled in the following order: 3 holes with a sharp drill bit in normal bone (SNB), 3 holes with a sharp drill bit in osteoporotic bone (SOB), 3 holes with a blunt drill bit in normal bone, and 3 holes with a blunt drill bit in osteoporotic bone. Mean values and Student t tests were used for statistical analysis. Results: Thirty-seven surgeons participated, 20 experienced and 17 inexperienced surgeons. Mean plunging depths for SNB, SOB, blunt drill bit in normal bone, and blunt drill bit in osteoporotic bone were, respectively, 5.1, 5.4, 21.1, and 13.9 mm for experienced surgeons and 7.6, 7.7, 22, and 15.9 mm for inexperienced surgeons. Drilling with SNB and with SOB was statistically different, with inexperienced surgeons plunging 2.5 mm (P = 0.31) and 2.6 mm (P = 0.042) deeper, respectively. There was a difference (P less than 0.001) between sharp and blunt drill bits in all drilling conditions for both the groups. Conclusions: Our study showed a significant difference in plunging depth when sharp or bunt drill bit was being used. Surgeons, regardless of their experience level, penetrate over 20 mm in normal bone and over 10 mm in osteoporotic bone. Copyright © 2012 by Lippincott Williams and Wilkins

Evaluación del efecto de un programa basado en mindfulness para el manejo de ansiedad en niños escolarizados

79 Páginas.El objetivo de este estudio fue evaluar el efecto de un programa basado en mindfulness para el manejo de ansiedad de niños escolarizados. El estudio es de tipo cuasi experimental sin grupo control. Participaron 7 estudiantes seleccionados a partir del puntaje obtenido en la Escala de Ansiedad Manifiesta en Niños Revisada (CMAS-R), aplicada para medidas pretest, postest y seguimiento. Los participantes asistieron a por lo menos el 50% de la sesiones. Los resultados sugieren que el programa influyó significativamente en la disminución de la medida de ansiedad total y en las sub-escalas de preocupaciones sociales/concentración y ansiedad fisiológica. En cuanto a la sub-escala de Inquietud/Hipersensibilidad no se observaron cambios estadísticamente significativos

Nutritional Management of Oncological Symptoms: A Comprehensive Review

Throughout their experience of illness and during the course of treatment, a substantial proportion of cancer patients are prone to develop nutritional and/or metabolic disturbances. Additionally, cancer patients often encounter long-term side effects from therapies, which may lead to impaired digestion, nutrient absorption or bowel motility. Therefore, the preservation and maintenance of an optimal and balanced nutritional status are pivotal to achieving a better prognosis, increasing the tolerance and adherence to cancer therapies and improving the overall quality of life. In this context, personalized nutritional programs are essential for addressing conditions predisposing to weight loss, feeding difficulties, digestion problems and intestinal irregularity, with the goal of promoting adequate nutrient absorption and minimizing the detrimental effects of treatment regimens. The focus of this research is to examine the most common clinical conditions and metabolic changes that cancer patients may experience, including stomatitis, xerostomia, diarrhea, nausea, vomiting, dysphagia, sub-occlusion, dysgeusia, dysosmia, anorexia, and cachexia. Furthermore, we present a pragmatic example of a multidisciplinary workflow that incorporates customized recipes tailored to individual clinical scenarios, all while maintaining the hedonic value of the meals

Repairable massive rotator cuff injuries. Current concepts

Las lesiones masivas del manguito de los rotadores son uno de los retos más grandes en la actualidad, principalmente a la hora de definir su tratamiento. Determinar qué constituye una lesión masiva reparable es difícil clínica y radiológicamente, y, por tanto, muchas veces es arbitrario. Los resultados con tratamiento conservador no quirúrgico son poco importantes y hay variabilidad de resultados satisfactorios con el tratamiento quirúrgico. Las imágenes diagnósticas permiten confirmar el diagnóstico de rotura y ayudan a definir eltamano˜ y las características de esta, información necesaria para establecer tanto el plan terapéutico como el pronóstico. El éxito del manejo probablemente está en seleccionar adecuadamente el tipo de paciente y el tratamiento más conveniente de manera individualizada. En la actualidad, las técnicas de reparación han evolucionado hasta el punto de que se puede reparar la mayoría de estas roturas. La patología asociada es frecuente y la rehabilitación de estos pacientes hoy día ya tiene un protocolo definido.Artículo original56-62Massive rotator cuff injuries are one of the biggest challenges today, mainly in defining treatment. Determine which constitutes a massive reparable injury is clinically and radiologically difficult, and therefore is often arbitrary. The results with nonsurgical conservative treatment are inconsistent and there is variability of successful outcomes with surgical treatment. Diagnostic imaging can confirm the diagnosis of rupture, helping to define the size and characteristics of the injurie, information necessary to establish both the treatment plan and prognosis of the injurie. The success of surgery treatment is related to a proper selection of the patient and the most appropriate surgical technique on an individual basis. Currently repair techniques have evolved to a point of being able to repair most of these breakups. Often associated pathology and rehabilitation of these patients already has a defined protocol

Evidence‐based review of treatment options for patients with glottic cancer

Evidence‐based medicine integrates the best available data in decision making, with the goal of minimizing physicians' and patients' subjectivity. In 2006, the American Society of Clinical Oncology edited clinical practice guidelines for the use of larynx preservation strategies. The objective of this review was to evaluate the current levels of evidence for glottic squamous cell carcinoma. Current guidelines for early stage glottic cancer are based on low‐level evidence. Conservation surgery (open or transoral) and radiation therapy are all valid options for T1 and selected T2 lesions. For advanced lesions, surgery and combined chemotherapy and radiation are options. High‐level evidence favors combined chemotherapy and radiation therapy or altered fractionation radiation therapy as nonsurgical strategies for organ preservation, compared with radiation therapy alone. The optimal combination of chemotherapy, targeted therapy, and radiation therapy remains to be demonstrated, however, and for high‐volume tumors, total laryngectomy may still be warranted. © 2011 Wiley Periodicals, Inc. Head Neck, 2011Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/87151/1/21528_ftp.pd