O conceito de “story” na ética da saúde

The article proposes and defends the thesis that in the ethics of health the concept of story is of utmost importance. With regard to the various meanings that the term covers, the author defines it as .a “narratable story of a country, a specialized area, a family, or of an individual”: each person has their own story. And this story, in its turn, presents a tight correlation with the stories of other people, environments and nations, within which we exist and with whom we relate. For the ethics of health, the concept of story challenges doctors and patients to seek to responsibly understand the individual story of each person in treatment, doing justice to their specific reality, as well as to its relation with the larger story that involves everyone in similar pasts, present and futures. The limit of the concept is expressed by phrases such as the one that follows: “Mere narrative and interiorization of what is narrated does not automatically lead to the essence of the things, however real the narration may be”. That is why the ethics of health cannot prescind from auxiliary sciences, such as Psychotherapy, for example, among others.El artículo propone y defiende la tesis de que en la ética de la salud el concepto de story es de suma importancia. A pesar de los varios significados que el término puede abarcar, el autor lo define como siendo “una historia narrable de un país, de un área especializada, de una familia, de un individuo”: cada persona tiene y es su propia story. Y esta, por su vez, presenta estrecha correlación con las historias de otras personas, ambientes y pueblos, dentro de los cuales existimos y nos relacionamos. Para la ética de la salud, el concepto de story desafía médicos y pacientes a procurar entender con responsabilidad la story individual de cada persona en tratamiento, haciendo valer su realidad específica, así como también, la relación de esta realidad con la story mayor, que envuelve a todos en un pasado, presente y futuro semejantes. El límite del concepto es expresado por frases como esta: “Mera narrativa e interiorización del narrador no llevan automáticamente a la esencia de las cosas, por más real que sea lo narrado, la story”. Por ello, la ética de la salud no puede prescindir de ciencias auxiliares, a ejemplo de la psicoterapia, entre otras.O artigo propõe e defende a tese de que na ética da saúde o conceito de story é de suma importância. A despeito dos vários significados que o termo pode abranger, o autor o define como sendo “uma história narrável de um país, de uma área especializada, de uma família, de um indivíduo”: cada pessoa tem e é sua própria story. E esta, por sua vez, apresenta estreita correlação com as histórias de outras pessoas, ambientes e povos, dentro dos quais existimos e nos relacionamos. Para a ética da saúde, o conceito de story desafia médicos e pacientes a procurarem entender com responsabilidade a story individual de cada pessoa em tratamento, fazendo jus à sua realidade específica, bem como a relação desta com a story maior, que envolve a todos num passado, presente e futuro semelhantes. O limite do conceito é expressado por frases como a que segue: “Mera narrativa e interiorização do narrado não levam automaticamente à essência das coisas, por mais real que seja o narrado, a story”. Por isso, a ética da saúde não pode prescindir de ciências auxiliares, a exemplo da psicoterapia, entre outras

Impact of different antithrombotics on the microcirculation and viability of perforator-based ischaemic skin flaps in a small animal model

The effects of antithrombotic drugs on random and free flap survival have been investigated in the past, but the experimental and clinical results are not in agreement. A perforator-based critical ischaemia model was used to evaluate the effects of different perioperatively administered pharmaceutical agents on tissue ischaemia and to assess the potential additional haemorheological or vasodilative effects of antithrombotics on flap microcirculation. Combined laser Doppler flowmetry and remission spectroscopy revealed an increase in certain microcirculation parameters in most groups in comparison with saline controls, and these changes correlated with flap survival. Clopidogrel and hirudin significantly improved the amount of viable flap tissue in comparison with controls, while unfractioned heparin had a negative effect on flap survival. Low molecular weight heparin, aspirin, pentoxifylline, and hydroxyethyl starch had no impact on the amount of viable flap tissue. A higher complication rate was observed in all experimental groups, but only clopidogrel had a negative impact on the flap viability. Our results add to the body of evidence supporting the conclusion that perioperative antithrombotic treatment improves flap survival. Clopidogrel and hirudin are effective pharmacological agents that significantly increased the viability of perforator-based skin flaps in rats, but at a higher risk of postoperative bleeding

Impact of different antithrombotics on the microcirculation and viability of perforator-based ischaemic skin flaps in a small animal model

The effects of antithrombotic drugs on random and free flap survival have been investigated in the past, but the experimental and clinical results are not in agreement. A perforator-based critical ischaemia model was used to evaluate the effects of different perioperatively administered pharmaceutical agents on tissue ischaemia and to assess the potential additional haemorheological or vasodilative effects of antithrombotics on flap microcirculation. Combined laser Doppler flowmetry and remission spectroscopy revealed an increase in certain microcirculation parameters in most groups in comparison with saline controls, and these changes correlated with flap survival. Clopidogrel and hirudin significantly improved the amount of viable flap tissue in comparison with controls, while unfractioned heparin had a negative effect on flap survival. Low molecular weight heparin, aspirin, pentoxifylline, and hydroxyethyl starch had no impact on the amount of viable flap tissue. A higher complication rate was observed in all experimental groups, but only clopidogrel had a negative impact on the flap viability. Our results add to the body of evidence supporting the conclusion that perioperative antithrombotic treatment improves flap survival. Clopidogrel and hirudin are effective pharmacological agents that significantly increased the viability of perforator-based skin flaps in rats, but at a higher risk of postoperative bleeding

Oral rehabilitation and associated quality of life following mandibular reconstruction with free fibula flap: a cross-sectional study

IntroductionMandibular reconstruction with the free fibula flap (FFF) has become a standardized procedure. The situation is different with oral rehabilitation, so the purpose of this study was to investigate the frequency of implant placement and prosthetic restoration. Additionally, the patients’ situation, motivation, and treatment course were structurally assessed.Materials and methodsAll cases between January 2013 and December 2018 that underwent mandibular reconstruction in our department with a free fibula flap and gave written informed consent to participate were interviewed with two structured questionnaires about their restoration and quality of life. Additionally, medical records, general information, status of implants and therapy, and metric analyses of the inserted implants were performed.ResultsIn total 59 patients were enrolled and analyzed in this monocentric study. Overall, oral rehabilitation was achieved in 23.7% at the time of investigation. In detail, implants were inserted in 37.3% of patients and showed an 83.3% survival of dental implants. Of these implanted patients, dental implants were successfully restored with a prosthetic restoration in 63.6. Within this subgroup, satisfaction with the postoperative aesthetic and functional result was 79.9% and with the oral rehabilitation process was 68.2%. Satisfaction with the implant-borne prosthesis was 87.5%, with non-oral-squamous-cell-carcinoma patients being statistically significantly more content with the handling (p=0.046) and care (p=0.031) of the prosthesis.DiscussionDespite the well-reconstructed bony structures, there is a need to increase the effort of achieving oral rehabilitation, especially looking at the patient’s persistent motivation for the procedure

Facilitating CAD/CAM nasoalveolar molding therapy with a novel click-in system for nasal stents ensuring a quick and user-friendly chairside nasal stent exchange

Nasoalveolar molding (NAM) aims to improve nasal symmetry with a nasal stent in cleft lip and palate (CLP) patients. When plates have to be exchanged because of dentoalveolar growth or cleft reduction, the nasal stent has to be mounted onto a new plate. This procedure elongates visiting hours for patients and parents or requires second treatment sessions. This study introduces a quick-lock additive manufacturing solution for chairside nasal stent exchange called RapidNAM. A novel taping retention pin has been designed that enables nasal stent insertion. Patients with unilateral CLP were included in this study. Plaster models were digitalized and measured by two independent observers. Two methods of CAD/CAM-molding therapies were compared: (i) conventional adhesion of a nasal stent (CAD/CAM NAM);(ii) quick-lock system in which the nasal stent was transferred to another plate (RapidNAM). CAD/CAM NAM and its refinement RapidNAM significantly increased the cleft-side nasal height and tilted the nose towards symmetry. The quick-lock system minimizes wire adaptations, since the preexisting stent can be reused. The new nasal stent development seems a feasible solution to minimize visiting hours but with clinically satisfactory results. This new nasal stent system combines traditional elements of NAM with CAD/CAM-technology

NAM—help or burden? Intercultural evaluation of parental stress caused by nasoalveolar molding: a retrospective multi-center study

Objectives Nasoalveolar molding (NAM) was developed to facilitate easier treatment and better outcomes for cleft lip and palate (CLP) patients. The aim of this study was to investigate the parental burden and possible intercultural differences of this treatment modality, which is often argued to burden parents to an extraordinary amount. Materials and methods Standardized questionnaires (available in English, Mandarin, and German) with 15 non-specific and 14 NAM-specific items to be retrospectively answered by Likert scales by parents of unilateral CLP patients with completed NAM treatment. Results The parents of 117 patients from two treatment centers in Taiwan and Germany were included. A very high level of overall satisfaction was found in both countries with significant intercultural differences in prenatal parent information, feeding problems, dealing with 3rd party’s perception, and experienced personal effort. Conclusion NAM is an effective treatment tool for children’s CLP deformities and their caregivers in overcoming the feeling of helplessness. Intercultural differences may be due to infrastructural reasons, cultural attitudes and habits, or different public medical education. Clinical relevance In addition to facilitating easier surgical treatment, NAM can be seen as a powerful coping strategy for parents dealing with a CLP deformity of their child and does not seem to burden them extraordinarily

Teologi Pemberitaan Firman Allah : Mengapa Kita Harus Berkhotbah ?

Jakartaxi, 192 p.; 21 c

A Theology of proclamation

Richmond190 p.; 21 c