https://drive.google.com/open?id=0Bzvh1YCvy_7eRHo0MnduOElQQVE
Basant-se en normatives anteriors, les comunitats autònomes han de desenvolupar un conjunt d’actuacions tendents a la implantació i la gestió de la formació sanitària especialitzada, com són: informar i traslladar les sol·licituds d’acreditació d’unitats docents; definir els criteris de constitució i adscripció de les comissions de docència a un centre o una unitat docent, determinar-ne la dependència funcional, la composició i les funcions,com també la coordinació d’actuacions de les comissions existents; vetllar perquè les unitats docents reuneixin les condicions per al compliment de les seves finalitats; regular els procediments per a la designació, el reconeixement, la incentivació i l’avaluació periòdica dels caps d’estudi de formació especialitzada; regular els procediments per al nomenament i l’acreditació periòdica dels tutors o els sistemes de reconeixement específic de l’acció tutorial; autoritzar les rotacions externes i les sol·licituds de canvi excepcional d’especialitat del personal resident, o informar sobre les estades formatives d’estrangers.
Per aixó s'han publicat ja:
Ordre SLT/337/2013, de 20 de desembre
Regula el procediment per a l’acreditació de tutors d’especialistes en formació de les especialitats de medicina.
Decret 119/2014, de 5 d’agost
De reestructuració del Departament de Salut, estableix a favor de la Direcció General de Planificació i Recerca en Salut, les funcions d’establir i dirigir les polítiques en l’àmbit de la planificació de necessitats de professionals i de l’ordenació professional, de la formació en matèria de salut i del desenvolupament professional, i també les funcions d’autoritat sanitària corresponents a l’acreditació i la certificació de professionals sanitaris i de les activitats de formació que aquests desenvolupin.
I ara aquest DECRET 165/2015, de 21 de juliol, de formació sanitària especialitzada a Catalunya:
Aquest Decret té per objecte l’ordenació del sistema de formació sanitària especialitzada a Catalunya, de conformitat amb la legislació bàsica de l’Estat en aquesta materia.
divendres, 24 de juliol del 2015
diumenge, 12 d’abril del 2015
Dues de Maluc.
1.- Fractures en el pacient gran.
He repassat els instruments anglesos i escocessos per el maneig de les fractures de maluc arrel d’un article ( Common contraindications and interactions of drugs in orthopaedic practice, JBJS Br., VOL. 97B, No. 4, APRIL 2015) sobre el tractament farmacològic mes freqüent en la nostre especialitat on s’indica la possibilitat de tractar el dolor de les fractures de maluc amb bloqueig anestèsic regional encara que insisteixen que aquest no ha de substituir mai una operació el mes aviat possible.
Per qui tingui de fer un treball de fractures de maluc en el vell o reflexionar sobre com les tracten i quins mitjans utilitzen a les illes per el seu control-estudi... aquesta info. pot ser molt interessant.
A part en el NICE trobareu un ppt interesant com a model de presentació del tema.
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The National Hip Fracture Database
Part of the Falls and Fragility Fracture Audit Programme
NICE National institute for health and care excellence
Hip fracture: The management of hip fracture in adults
NICE Pathways – Mapping our guidance
Documents en PDF:
THE CARE OF PATIENTS WITH FRAGILITY FRACTURE ( 2007)
Management of hip fracture in older people A national clinical guideline (Escòcia, 2009)
Hip Fracture Database. National report 2013 ( GB, 2013)
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2.- Pròtesi de maluc longevitat
Survivorship of the cementless Spotorno femoral component in patients under 50 years of age at a mean follow-up of 18.4 years.Biemond, J. E.; Venkatesan, S.; van Hellemondt, G. G. The Bone & Joint Journal ISSN: 2049-4394 (C) 2015 All Rights Reserved.The Journal of Bone and Joint Surgery, Inc. Issue: Volume 97-B(2) pgs. 145-288 February 2015 pág. 160-163
DOI: 10.1302/0301-620X.97B2.34926
dijous, 28 d’agost del 2014
Ferides tractades amb cura de pressio negativa
Clinical Relevance: NPWT may be harmful to skeletal muscle after compartment syndrome requiring fasciotomy and local wound care.
Acute
compartment syndrome is a limb-threatening condition. As pressure rises
inside a muscle fascial compartment, capillary perfusion pressure falls
and causes cellular hypoxia. Untreated, the cascade of hypoxia,
microvascular dysfunction, and increased capillary permeability results
in irreversible ischemic injury. Prompt fasciotomy is the ideal
treatment. Many patients who undergo fasciotomy require delayed
skin-grafting and have long-term functional impairment1.
Recently,
negative-pressure wound therapy (NPWT) has been used on fasciotomy
wounds. The results of this practice are variable. Some authors have
reported decreased wound size2 and a shorter time to wound closure3, but a recent randomized controlled trial showed a longer time to wound closure and an increased need for skin grafts with NPWT4.
To
our knowledge, no one has examined NPWT effects on the underlying
skeletal muscle. NPWT increases microvascular circulation around the
wound5-8,
and this may be beneficial after ischemia. We assessed NPWT effects on
skeletal muscle cellular morphology at different time points after
compartment syndrome in an animal model and attempted to determine
whether regional differences in fiber recovery occurred. The primary
outcome that we investigated was the cross-sectional area occupied by
normal-appearing muscle fibers and other cellular morphologies. A
secondary outcome was the change in muscle weight as a marker of
intramuscular fluid accumulation. We hypothesized that NPWT would
improve muscle fiber regeneration after an acute compartment syndrome
and would decrease muscle weight by enhancing edema clearance.
La bibliografia pot ser interessant x si heu de presentar algun cas tractat amb aquest tipus de cura oclusiva-aspirativa
Artrosi post meniscectomia
Tots els llibres diuen que la meniscectomia va seguida de una artropatia degenerativa. Aqui un exemple:
pág. 1649-1654
DOI: 10.1302/0301-620X.94B12.30562
Pengas, I. P.; Assiotis, A.; Nash, W.; Hatcher, J.; Banks, J.; McNicholas, M. J.
AB
: We continued a prospective longitudinal follow-up study of 53
remaining patients who underwent open total meniscectomy as adolescents
and who at that time had no other intra-articular pathology of the knee.
Their clinical, radiological and patient-reported outcomes are
described at a mean follow-up of 40 years (33 to 50). The cohort of
patients who had undergone radiological evaluation previously after 30
years were invited for clinical examination, radiological evaluation and
review using two patient-reported outcome measures.
A total of seven patients (13.2%) had already undergone total knee
replacement at the time of follow-up. A significant difference was
observed between the operated and nonoperated knee in terms of range of
movement and osteoarthritis of the tibiofemoral joint, indicating a
greater than fourfold relative risk of osteoarthritis at 40 years
postoperatively. All patients were symptomatic as defined by the Knee
Injury and Osteoarthritis Outcome Score.
This study represents the longest follow-up to date and it can be
concluded that meniscectomy leads to symptomatic osteoarthritis of the
knee later in life, with a resultant 132-fold increase in the rate of
total knee replacement in comparison to their geographical and
age-matched peers.
(C) 2012 British Editorial Society of Bone and Joint Surgery |
dissabte, 17 de maig del 2014
Acetabular fractures in patients > 55 years...
Acetabular fractures in patients aged > 55 years: A SYSTEMATIC REVIEW OF THE LITERATURE.
The Bone & Joint Journal 96-B 2014 pág. 157-163
DOI: 10.1302/0301-620X.96B2.32979
Daurka, J. S.; Pastides, P. S.; Lewis, A.; Rickman, M.; Bircher, M. D.
Review
AB : The increasing prevalence of osteoporosis in an ageing population has contributed to older patients becoming the fastest-growing group presenting with acetabular fractures. We performed a systematic review of the literature involving a number of databases to identify studies that included the treatment outcome of acetabular fractures in patients aged > 55 years. An initial search identified 61 studies; after exclusion by two independent reviewers, 15 studies were considered to meet the inclusion criteria. All were case series. The mean Coleman score for methodological quality assessment was 37 (25 to 49). There were 415 fractures in 414 patients. Pooled analysis revealed a mean age of 71.8 years (55 to 96) and a mean follow-up of 47.3 months (1 to 210). In seven studies the results of open reduction and internal fixation (ORIF) were presented: this was combined with simultaneous hip replacement (THR) in four, and one study had a mixture of these strategies. The results of percutaneous fixation were presented in two studies, and a single study revealed the results of non-operative treatment. With fixation of the fracture, the overall mean rate of conversion to THR was 23.1% (0% to 45.5%). The mean rate of non-fatal complications was 39.8% (0% to 64%), and the mean mortality rate was 19.1% (5% to 50%) at a mean of 64 months (95% confidence interval 59.4 to 68.6; range 12 to 143). Further data dealing with the classification of the fracture, the surgical approach used, operative time, blood loss, functional and radiological outcomes were also analysed. This study highlights that, of the many forms of treatment available for this group of patients, there is a trend to higher complication rates and the need for further surgery compared with the results of the treatment of acetabular fractures in younger patients.
The Bone & Joint Journal 96-B 2014 pág. 157-163
DOI: 10.1302/0301-620X.96B2.32979
Daurka, J. S.; Pastides, P. S.; Lewis, A.; Rickman, M.; Bircher, M. D.
Review
AB : The increasing prevalence of osteoporosis in an ageing population has contributed to older patients becoming the fastest-growing group presenting with acetabular fractures. We performed a systematic review of the literature involving a number of databases to identify studies that included the treatment outcome of acetabular fractures in patients aged > 55 years. An initial search identified 61 studies; after exclusion by two independent reviewers, 15 studies were considered to meet the inclusion criteria. All were case series. The mean Coleman score for methodological quality assessment was 37 (25 to 49). There were 415 fractures in 414 patients. Pooled analysis revealed a mean age of 71.8 years (55 to 96) and a mean follow-up of 47.3 months (1 to 210). In seven studies the results of open reduction and internal fixation (ORIF) were presented: this was combined with simultaneous hip replacement (THR) in four, and one study had a mixture of these strategies. The results of percutaneous fixation were presented in two studies, and a single study revealed the results of non-operative treatment. With fixation of the fracture, the overall mean rate of conversion to THR was 23.1% (0% to 45.5%). The mean rate of non-fatal complications was 39.8% (0% to 64%), and the mean mortality rate was 19.1% (5% to 50%) at a mean of 64 months (95% confidence interval 59.4 to 68.6; range 12 to 143). Further data dealing with the classification of the fracture, the surgical approach used, operative time, blood loss, functional and radiological outcomes were also analysed. This study highlights that, of the many forms of treatment available for this group of patients, there is a trend to higher complication rates and the need for further surgery compared with the results of the treatment of acetabular fractures in younger patients.
Sempre surt a la sessio de trauma , Tractament funcional de les fractures de olecranon? Mostra molt petita?
Non-surgical functional treatment for displaced olecranon fractures in the elderly.
The Bone & Joint Journal 96-B 2014 pág. 530-534
DOI: 10.1302/0301-620X.96B4.33339
Gallucci, G. L.; Piuzzi, N. S.; Slullitel, P. A. I.; Boretto, J. G.; Alfie, V. A.; Donndorff, A.; De Carli, P.
AB : We retrospectively evaluated the clinical and radiological outcomes of a consecutive cohort of patients aged > 70 years with a displaced fracture of the olecranon, which was treated non-operatively with early mobilisation. We identified 28 such patients (27 women) with a mean age of 82 years (71 to 91). The elbow was initially immobilised in an above elbow cast in 90[degrees] of flexion of the elbow for a mean of five days. The cast was then replaced by a sling. Active mobilisation was encouraged as tolerated. No formal rehabilitation was undertaken. At a mean follow-up of 16 months (12 to 26), the mean ranges of flexion and extension were 140[degrees] and 15[degrees] respectively. On a visual analogue scale of 1 (no pain) to 10, the mean pain score was 1 (0 to 8). Of the original 28 patients 22 developed nonunion, but no patients required surgical treatment.
We conclude that non-operative functional treatment of displaced olecranon fractures in the elderly gives good results and a high rate of satisfaction
The Bone & Joint Journal 96-B 2014 pág. 530-534
DOI: 10.1302/0301-620X.96B4.33339
Gallucci, G. L.; Piuzzi, N. S.; Slullitel, P. A. I.; Boretto, J. G.; Alfie, V. A.; Donndorff, A.; De Carli, P.
AB : We retrospectively evaluated the clinical and radiological outcomes of a consecutive cohort of patients aged > 70 years with a displaced fracture of the olecranon, which was treated non-operatively with early mobilisation. We identified 28 such patients (27 women) with a mean age of 82 years (71 to 91). The elbow was initially immobilised in an above elbow cast in 90[degrees] of flexion of the elbow for a mean of five days. The cast was then replaced by a sling. Active mobilisation was encouraged as tolerated. No formal rehabilitation was undertaken. At a mean follow-up of 16 months (12 to 26), the mean ranges of flexion and extension were 140[degrees] and 15[degrees] respectively. On a visual analogue scale of 1 (no pain) to 10, the mean pain score was 1 (0 to 8). Of the original 28 patients 22 developed nonunion, but no patients required surgical treatment.
We conclude that non-operative functional treatment of displaced olecranon fractures in the elderly gives good results and a high rate of satisfaction
Quina via millor en les protesi de Maluc?
Patient-reported outcome is influenced by surgical approach in total hip replacement: A STUDY OF THE SWEDISH HIP ARTHROPLASTY REGISTER INCLUDING 42 233 PATIENTS:
The Bone & Joint Journal 96-B 2014 pág. 590-596 DOI: 10.1302/0301-620X.96B5.32341
Lindgren, J. V.; Wretenberg, P.; Karrholm, J.; Garellick, G.; Rolfson, O.
AB : The effects of surgical approach in total hip replacement on health-related quality of life and long-term pain and satisfaction are unknown. From the Swedish Hip Arthroplasty Register, we extracted data on all patients that had received a total hip replacement for osteoarthritis through either the posterior or the direct lateral approach, with complete pre- and one-year post-operative Patient Reported Outcome Measures (PROMs). A total of 42 233 patients met the inclusion criteria and of these 4962 also had complete six-year PROM data. The posterior approach resulted in an increased mean satisfaction score of 15 (SD 19) vs 18 (SD 22) (p < 0.001) compared with the direct lateral approach. The mean pain score was 13 (SD 17) vs 15 (SD 19) (p < 0.001) and the proportion of patients with no or minimal pain was 78% vs 74% (p < 0.001) favouring the posterior approach. The patients in the posterior approach group reported a superior mean EQ-5D index of 0.79 (SD 0.23) vs 0.77 (SD 0.24) (p < 0.001) and mean EQ score of 76 (SD 20) vs 75 (SD 20) (p < 0.001). All observed differences between the groups persisted after six years follow-up. Although PROMs after THR in general are very good regardless of surgical approach, the results indicate that some patients operated by the direct lateral approach report an inferior outcome compared with the posterior approach. The large number of procedures and the seemingly sustained differences make it likely these findings are clinically relevant.
The Bone & Joint Journal 96-B 2014 pág. 590-596 DOI: 10.1302/0301-620X.96B5.32341
Lindgren, J. V.; Wretenberg, P.; Karrholm, J.; Garellick, G.; Rolfson, O.
AB : The effects of surgical approach in total hip replacement on health-related quality of life and long-term pain and satisfaction are unknown. From the Swedish Hip Arthroplasty Register, we extracted data on all patients that had received a total hip replacement for osteoarthritis through either the posterior or the direct lateral approach, with complete pre- and one-year post-operative Patient Reported Outcome Measures (PROMs). A total of 42 233 patients met the inclusion criteria and of these 4962 also had complete six-year PROM data. The posterior approach resulted in an increased mean satisfaction score of 15 (SD 19) vs 18 (SD 22) (p < 0.001) compared with the direct lateral approach. The mean pain score was 13 (SD 17) vs 15 (SD 19) (p < 0.001) and the proportion of patients with no or minimal pain was 78% vs 74% (p < 0.001) favouring the posterior approach. The patients in the posterior approach group reported a superior mean EQ-5D index of 0.79 (SD 0.23) vs 0.77 (SD 0.24) (p < 0.001) and mean EQ score of 76 (SD 20) vs 75 (SD 20) (p < 0.001). All observed differences between the groups persisted after six years follow-up. Although PROMs after THR in general are very good regardless of surgical approach, the results indicate that some patients operated by the direct lateral approach report an inferior outcome compared with the posterior approach. The large number of procedures and the seemingly sustained differences make it likely these findings are clinically relevant.
Al final acces des de casa a les revistes
Hola a tots -es. Us deixo aqui tambe el enllaç a la intranet per accedir tambe a les revistes on-line de la biblioteca
Pel qui arribeu un cop activat el link https://extranet.tauli.cat/intracspt/ i identificar-vos amb el nik i pasword del hospital s'obrira directament la intranet i alli es questio d'anar a la botonera esquerra a
Recerca, innovació, docència i formació...d'alli a
Biblioteca i despres a ....
Revistes on line:
ARTHROSCOPY
FOOT & ANKLE INTERNATIONAL
INJURY
INJURY extra
INTERNATIONAL JOURNAL OF SHOULDER SURGERY
INTERNET JOURNAL OF ORTHOPEDIC SURGERY
JOURNAL OF BONE & JOINT SURGERY (AMERICAN)
JOURNAL OF BONE & JOINT SURGERY (BRITISH) des de 2013: The Bone & Joint Journal
JOURNAL OF FOOT & ANKLE RESEARCH
JOURNAL OF HAND SURGERY (AMERICAN VOLUME)
JOURNAL OF HAND SURGERY (EUROPEAN VOLUME)
JOURNAL OF ORTHOPAEDIC RESEARCH
JOURNAL OF PEDIATRIC ORTHOPAEDICS
JOURNAL OF SHOULDER & ELBOW SURGERY
JOURNAL OF TRAUMA AND ACUTE CARE SURGERY
TECHNIQUES IN HAND & UPPER EXTREMITY SURGERY
Pel qui arribeu un cop activat el link https://extranet.tauli.cat/intracspt/ i identificar-vos amb el nik i pasword del hospital s'obrira directament la intranet i alli es questio d'anar a la botonera esquerra a
Recerca, innovació, docència i formació...d'alli a
Biblioteca i despres a ....
Revistes on line:
ARTHROSCOPY
FOOT & ANKLE INTERNATIONAL
INJURY
INJURY extra
INTERNATIONAL JOURNAL OF SHOULDER SURGERY
INTERNET JOURNAL OF ORTHOPEDIC SURGERY
JOURNAL OF BONE & JOINT SURGERY (AMERICAN)
JOURNAL OF BONE & JOINT SURGERY (BRITISH) des de 2013: The Bone & Joint Journal
JOURNAL OF FOOT & ANKLE RESEARCH
JOURNAL OF HAND SURGERY (AMERICAN VOLUME)
JOURNAL OF HAND SURGERY (EUROPEAN VOLUME)
JOURNAL OF ORTHOPAEDIC RESEARCH
JOURNAL OF PEDIATRIC ORTHOPAEDICS
JOURNAL OF SHOULDER & ELBOW SURGERY
JOURNAL OF TRAUMA AND ACUTE CARE SURGERY
TECHNIQUES IN HAND & UPPER EXTREMITY SURGERY
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