154 research outputs found

    The legal aspects involving repetitive strain injuries (RSI)

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    In order to have a good patient-physician relationship, besides practicing a fair and updated technical medicine, the physician is obligated to have knowledge of and follow the laws, rules and regulations, which grant specific rights to some and delegate obligations to others. The physician is responsible for writing legal statements based on information from medical records. These declarations will serve as important documents, upon which public or private entities will base their decision on granting rights or delegating obligations. This article stresses the importance of adequate physician decision making capacity when it comes to access the patient's needs within the working environment. It also emphasizes the seriousness of reaching an optimal treatment plan, in order to prevent expected complications. Our objective is to promote the practice of medicine within the current law, giving directions to the reader on where to obtain this information. Physicians have to keep themselves updated not only regarding the technical aspects of the profession. The current knowledge of local, state and national laws, rules, and regulations is also of paramount importance.No relacionamento entre médico e paciente, além da boa prática da medicina, o médico está obrigado a conhecer e cumprir as leis, normas e convenções que podem garantir direitos a uns e gerar obrigações a outros, com base nas informações criadas e perenizadas em prontuários, atestados e pareceres, que servirão de referência às decisões de entidades públicas ou privadas na concessão ou na recusa de direitos e deveres legais. Apontamos como os médicos devem se comportar em relação aos pacientes e aos aspectos legais dentro desse cenário ocupacional, no sentido de adequar a conduta e prevenir eventuais dissabores, aos quais estamos expostos. Nossa ideia é chamar a atenção para a necessidade da prática médica dentro das normas legais, orientando onde buscar a respectiva informação. O médico não pode estar alheio à evolução da medicina, nem às atualizações permanentes das leis, normas e convenções da região em que atua.INSSCRM-PRJustiça Federal da 3ª Região/SPUniversidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM)UNIFESP, EPMSciEL

    Quasideterministic generation of maximally entangled states of two mesoscopic atomic ensembles by adiabatic quantum feedback

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    We introduce an efficient, quasideterministic scheme to generate maximally entangled states of two atomic ensembles. The scheme is based on quantum nondemolition measurements of total atomic populations and on adiabatic quantum feedback conditioned by the measurements outputs. The high efficiency of the scheme is tested and confirmed numerically for ideal photodetection as well as in the presence of losses.Comment: 7 pages, 6 figures, title changed, revised version published on Phys. Rev

    Klippel-Feil syndrome. When using fiberoptic bronchoscopy guide, a case report

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    Klippel-Feil syndrome is a rare disease with congenital musculoskeletal condition characterized by faulty segmentation of cervical vertebrae and consists of cervical vertebra fusions with limitation of head movements, short neck and low posterior hairline. In several cases the syndrome is associated with cardiovascular malformations. Patients affected by Klippel-Feil syndrome could be an anesthetic challenge, not only during cardiac surgery. We are presenting a case of Klippel-Feil Syndrome in an adult patient, who was operated on for a pulmonary valve insufficiency in a previously corrected Tetralogy of Fallot Syndrome. We are going to discuss the features of this rare syndrome

    Ultrasonography for the diagnosis of tendinitis and electromyography for the diagnosis of peripheral neuropathy and upper limb radiculopathy: rheumatologists' perspectives

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    OBJECTIVE: To ascertain the value ascribed by Brazilian rheumatologists to ultrasonography (US) for diagnosing tendinitis and to electromyography (EMG) for diagnosing peripheral neuropathy and upper limb radiculopathy. MATERIAL AND METHODS: In total, 165 rheumatologists answered an anonymous survey (sent via the internet) concerning the two exams, with respect to the following characteristics: reliability, diagnostic accuracy, the importance and necessity of these tests for diagnostic RESULTS: The study revealed that most of the rheumatologists recognised that these exams are operator-dependent, that clinicians do not rely entirely on the results, that these exams are not mandatory for the diagnoses listed, and that professionals who perform these exams should be better trained to provide reliable results. CONCLUSIONS: The Brazilian rheumatologists believe the following: the results of these exams should be interpreted with caution and are not definitive for diagnosis; musculoskeletal US and EMG should be performed by trained professionals; and there must be better preparation of the professionals who perform these exams.OBJETIVO: Averiguar o valor que os reumatologistas brasileiros conferem ao exame de ultrassonografia para o diagnóstico de tendinite e ao exame de eletroneuromiografia para o diagnóstico da neuropatia periférica e da radiculopatia dos membros superiores. MATERIAL E MÉTODOS: No total, 165 reumatologistas responderam a uma pesquisa de opinião anônima (enviada pela internet), sobre diversas situações relativas aos dois exames, no que diz respeito aos seguintes questionamentos: confiabilidade, precisão no diagnóstico, importância e necessidade desses exames para confirmação diagnóstica e credibilidade e treinamento dos profissionais que executam os exames. RESULTADOS: O estudo revelou que a maioria dos reumatologistas reconhece que esses exames são operador-dependentes, que não confia integralmente nos resultados observados, que tais exames não são imperativos para os diagnósticos elencados, e que os profissionais que executam esses exames deveriam ser mais bem treinados para fornecer resultados mais confiantes. CONCLUSÃO: Para os reumatologistas brasileiros, os resultados desses exames devem ser interpretados com cautela e não são definitivos para o diagnóstico; a ultrassonografia musculoesquelética e a eletroneuromiografia devem ser realizadas por profissionais capacitados; deve haver melhor preparo dos executores desses exames em nosso meio.Universidade Federal de São Paulo (UNIFESP)Hospital de Base do Distrito Federal Serviço de ReumatologiaUniversidade de BrasíliaJustiça Federal Seção Judiciária de São PauloJustiça Federal do Paraná Seção Judiciária do ParanáUNIFESPSciEL

    Robot-assisted kidney transplantation with regional hypothermia using grafts with Multiple Vessels After Extracorporeal Vascular Reconstruction: results from the European Association of Urology Robotic Urology Section Working Group

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    Background: Kidney transplantation using grafts with multiple vessels (GMVs) is technically demanding and may be associated with increased risk of complications or suboptimal graft function. To date, no studies have reported on robot-assisted kidney transplantation (RAKT) using GMVs. Objective: To report our experience with RAKT using GMVs from living donors, focusing on technical feasibility and early postoperative outcomes. Design, setting, and participants: We reviewed the multi-institutional, prospectively collected European Association of Urology (EAU) Robotic Urology Section (ERUS)-RAKT database to select consecutive patients undergoing RAKT from living donors using GMVs between July 2015 and January 2018. Patients undergoing RAKT using grafts with single vessels (GSVs) served as controls. In case of GMVs, ex vivo vascular reconstruction techniques were performed during bench surgery according to the case-specific anatomy. Intervention: RAKT with regional hypothermia. Outcome measurements and statistical analysis: Intraoperative outcomes and early (30 d) postoperative complications and functional results were the main study endpoints. Multivariable logistic regression analysis evaluated potential predictors of suboptimal renal function at 1 mo. Results and limitations: Overall, 148 RAKTs were performed during the study period. Of these, 21/148 (14.2%) used GMVs; in all cases, single arterial and venous anastomoses could be performed after vascular reconstruction. Median anastomoses and rewarming times did not differ significantly between the GMV and GSV groups. Total and cold ischemia times were significantly higher in the GMV cohort (112 vs 88 min, p = 0.004 and 50 vs 34 min, p = 0.003, respectively). Overall complication rate and early functional outcomes were similar among the two groups. No major intra-or postoperative complications were recorded in the GMV cohort. At multivariable analysis, use of GMVs was not significantly associated with suboptimal renal function at 1 mo. Small sample size and short follow-up represent the main study limitations. Conclusions: RAKT using GMVs from living donors is technically feasible and achieved favorable perioperative and short-term functional outcomes. Larger studies with longer follow-up are needed to confirm our findings. Patient summary: In this study, we evaluated for the first time in literature the results of RAKT from living donors using kidneys with multiple arteries and veins. We found that, in experienced centers, RAKT using kidneys with multiple vessels is feasible and achieves optimal results in terms of postoperative kidney function with a low number of postoperative complications. (C) 2018 European Association of Urology. Published by Elsevier B.V. All rights reserved
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