Dissertations / Theses on the topic 'ORTHOPEDIC SURGEN'
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1
Chang, Ta-Cheng. "Simulation Assisted Robotic Orthopedic Surgery in Femoroacetabular Impingement." Scholarly Repository, 2011. http://scholarlyrepository.miami.edu/oa_dissertations/618.
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Femoroacetabular impingement (FAI) has been increasingly recognized as a cause of early hip osteoarthritis. FAI is characterized by pathologic contact between the femur and acetabular rim during hip join movement, caused by morphological abnormalities. Arthroscopic technique has become increasingly popular for FAI surgical treatment because of its minimal invasiveness. However, it involves cumbersome procedures and over- or under-resection are likely to occur. To tackle this issue, robot-assisted FAI arthroscopy is a well suited approach because it results in high accuracy and reproducible surgical outcomes. This dissertation provides new approaches and methods for the current challenges in the development of robot-assisted FAI arthroscopy. The study has three objectives: 1) to develop a robust calibration method for the A-mode ultrasound probe used for noninvasive bone registration, 2) to develop a bone registration simulator for verifying the registration accuracy and consistency for any given registration point-pattern, and 3) to develop a hip range of motion simulation system that returns the virtual range of motion and determines the bone resection volume. Carefully designed calibration procedures and simulation experiments have been conducted during the study of this research. From the experimental results, the developed ultrasound calibration method successfully reduces the registration errors and is proved to be robust. The results from the registration simulator indicate that the pattern with widely distributed points lead to better registration accuracy and consistency. The hip range of motion simulation system results in acceptable accuracy and successfully generates the resection volume. With further modifications, the ultrasound probe can be successfully calibrated with the developed method, and will be applied for noninvasive bone registration. The registration simulator can also be served as a useful tool for determining the optimized registration point-pattern, which can lead to reduced surgical trauma and registration time. Finally, the developed range of motion simulation system can allow the surgeon to evaluate the surgical outcome and to determine the resection volume even before the surgery begins. To conclude, this dissertation provides useful approaches, methods, and software for developing robot-assisted FAI arthroscopy.
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Steen, Alexander, and Marcus Widegren. "3D Visualization for Pre-operative Planning of Orthopedic Surgery." Thesis, Linköpings universitet, Medie- och Informationsteknik, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-94556.
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This report presents a master thesis on 3D visualization for pre-operation planning of orthopedic surgery done for Sectra Medical Systems AB. The focus is on visualizing clinically relevant data for planning a Total Hip Replacement (THR). The thesis includes a pre-study and the implementation of a prototype using the Sectra IDS7 workstation.
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Lee, Goonhee. "Selective laser sintering of calcium phosphate materials for orthopedic implants /." Digital version accessible at:, 1997. http://wwwlib.umi.com/cr/utexas/main.
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Yeung, Wai-kwok Kelvin, and 楊偉國. "Development of a novel spinal implant for progressive scoliosis correction." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2004. http://hub.hku.hk/bib/B30696823.
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揚偉國 and Wai-kwok Kelvin Yeung. "Gradual scoliosis correction by use of a superelastic alloy." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2001. http://hub.hku.hk/bib/B31225469.
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Ribbans, W. J. "Aspects of orthopaedic surgical research with emphasis on surgery in haemophilia and immunocompromised patients." Thesis, University of South Wales, 2003. https://pure.southwales.ac.uk/en/studentthesis/aspects-of-orthopaedic-surgical-research-with-emphasis-on-surgery-in-haemophiia-and-immunocompromised-patients(9675c37c-5ce7-46a4-936b-ec5caa3fcc57).html.
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Ninety-three publications have been presented from the last 22 years. This body of work represents an opus of publications from the author's own medical qualification, in 1980, until the present day. They vary from short abstracts representing research presentations at scientific meetings through to major multi-centre international studies and significant contributions to medical texts. They are accompanied by an overview, which details original contributions to medical knowledge and superior methodology, reinforced by calculation of a citations index, which demonstrates the impact of such research on the medical community. The overview has chosen to collate the output into four main clusters of which Haemophilia represents the largest numerically, with forty-seven contributions, and the most significant scientifically. The other three groups represent Infection, including HIV and Hepatitis, Trauma and its sequelae, and General Surgery and Orthopaedics. Contributions on the issues of surgery on HIV positive Haemophilic patients, the more general problems surrounding surgical intervention in Haemophilia, and the natural history of Orthopaedic pathology in these patients has been the area where it is felt the most significant contribution has been made. Papers have been published demonstrating the generally positive clinical and economic outcomes following different forms of joint replacement in Haemophilia. However, the markedly increased infection risks following joint replacement in HIV positive Haemophilic patients has been highlighted in the largest paper published on the subject, combining the results from many different countries. In contrast, by access to historical laboratory specimens, it has been shown that Orthopaedic surgical interventions have not adversely affected the natural history of HIV in terms of immune competence. A number of papers have been published on the subject of the natural history of ankle arthropathy in Haemophilia - an area under investigated in the past. A critical review of accepted scoring systems in Haemophilia has been published with a more scientifically evaluated system suggested in its stead. The Infection section has developed from the initial interests in the problems encountered in Haemophilia. Further work has been undertaken evaluating protective gloves designed to minimise injury to staff during high risk procedures and the more general exposure to HIV and Hepatitis in general Orthopaedic practice. The Trauma section presents a number of varied papers in terms of publication type and subject matter. The randomised prospective paper on intertrochanteric fractures of the hip, demonstrating no advantage in outcome following a more technically difficult surgical procedure, is an important contribution to the iterature. The first paper published on the pathology demonstrated by CT following an initial shoulder dislocation has been a similarly influential publication - as demonstrated by its citation count. The final section on General Surgery and Orthopaedics provides a catholic collection of publications reflecting a number of surgical interests and career appointments. One paper from this group was particularly influential. It evaluated the outcomes of knee arthroscopy as a day case procedure and it was an mportant contribution at its time, as witnessed by its widespread acceptance as normal practice sixteen years later.
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Nysjö, Johan. "Interactive 3D Image Analysis for Cranio-Maxillofacial Surgery Planning and Orthopedic Applications." Doctoral thesis, Uppsala universitet, Avdelningen för visuell information och interaktion, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-301180.
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Modern medical imaging devices are able to generate highly detailed three-dimensional (3D) images of the skeleton. Computerized image processing and analysis methods, combined with real-time volume visualization techniques, can greatly facilitate the interpretation of such images and are increasingly used in surgical planning to aid reconstruction of the skeleton after trauma or disease. Two key challenges are to accurately separate (segment) bone structures or cavities of interest from the rest of the image and to interact with the 3D data in an efficient way. This thesis presents efficient and precise interactive methods for segmenting, visualizing, and analysing 3D computed tomography (CT) images of the skeleton. The methods are validated on real CT datasets and are primarily intended to support planning and evaluation of cranio-maxillofacial (CMF) and orthopedic surgery. Two interactive methods for segmenting the orbit (eye-socket) are introduced. The first method implements a deformable model that is guided and fitted to the orbit via haptic 3D interaction, whereas the second method implements a user-steered volumetric brush that uses distance and gradient information to find exact object boundaries. The thesis also presents a semi-automatic method for measuring 3D angulation changes in wrist fractures. The fractured bone is extracted with interactive mesh segmentation, and the angulation is determined with a technique based on surface registration and RANSAC. Lastly, the thesis presents an interactive and intuitive tool for segmenting individual bones and bone fragments. This type of segmentation is essential for virtual surgery planning, but takes several hours to perform with conventional manual methods. The presented tool combines GPU-accelerated random walks segmentation with direct volume rendering and interactive 3D texture painting to enable quick marking and separation of bone structures. It enables the user to produce an accurate segmentation within a few minutes, thereby removing a major bottleneck in the planning procedure.
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Truhlář, Jindřich. "Evaluation of the Wi-Fi technique for use in a navigated orthopedic surgery." Master's thesis, Vysoké učení technické v Brně. Fakulta elektrotechniky a komunikačních technologií, 2012. http://www.nusl.cz/ntk/nusl-219668.
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Following text focuses on use of wireless technologies in OrthoPilot navigation system developed by B.Braun company. Description of OrthoPilot software is followed by overview of available wireless technologies highlighting their both advantages and disadvantages. Practical part consists of two main parts, mostly dealing with electronic circuits. First part describes development process of camera-wireless printed circuit board which substitutes currently used RS-422 cable connection between PC and stereo camera. Part of this chapter covers programming in C++ in order to make interface compatible with the rest of current OrthoPilot software. Second bigger part deals with remote controller development using prototyping board mikroMedia for XMEGA. Besides electrical circuits design, chapter describes also software part - microcontroller programming in C language. Thesis is concluded by discussing system limitations and ideas for future development.
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Pennington, Brandy Paige. "The Impact of Prealbumin on Postoperative Length of Stay in Elderly Orthopedic Patients." Digital Commons @ East Tennessee State University, 2005. https://dc.etsu.edu/etd/1019.
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The purpose of this research was to evaluate whether serum prealbumin levels would serve as a predictor of hospital length of stay for elderly orthopedic patients who underwent hip replacement surgery. The study consisted of a set of 54 patients admitted to a hospital in Bristol, Tennessee. Patients with depleted prealbumin levels, low to low/normal prealbumin levels, or normal prealbumin levels were analyzed. Data collected from a retrospective chart review included: age, length of stay, serum glucose, sodium, potassium, hematocrit, hemoglobin, BUN, creatinine, WBC, prealbumin, and post operative diet consumption. Data were analyzed using analysis of variance for treatment effects. Because of the limited size of the data set, probabilities approaching p<0.10 were considered and levels of p<0.05 were considered significant. The research failed to show a significant relationship between prealbumin levels at admission and length of patient stay during post-operative recovery.
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Young, Nancy, and J. G. Wright. "Measuring Pediatric Physical Function." Lippincott, Williams & Wilkins, 1995. https://zone.biblio.laurentian.ca/dspace/handle/10219/111.
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Most pediatric orthopaedic interventions are intended to improve or preserve physical function, yet their outcomes have been assessed using primarily surrogate measures (e.g., radiographic indices) that may not accurately represent patients'function. Physical function may be more appropriately measured with activity-based scales, but these have been infrequently applied in surgical studies. The purpose of this study was to identify existing activity-based physical-function scales appropriate for pediatric orthopaedics, to present criteria useful for scale selection, and to discuss the special problems of measuring physical function in children. Twenty-one scales relevant to pediatric orthopaedics are described according to their target population, purpose, method of administration, content, and quality of standardization. These scales have been further classified according to a new taxonomy. The unique aspects of measuring physical function in children are discussed and include the effect of age and development, method of reporting, and question formats. Standardized measures of physical function based on physical-activity ability exist and should be used more frequently to assess pediatric orthopaedic interventions
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Sharifi, Husham. "Cost Effectiveness Analysis in Orthopaedic Surgery." Yale University, 2010. http://ymtdl.med.yale.edu/theses/available/etd-03302010-163307/.
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The purpose of this thesis was to explore the use of cost effectiveness for interventions in orthopaedics. This was done through three cost effectiveness articles that have been published by the author. In each of these articles, similar methodologies were used. Decision models were constructed for cost-effectiveness analyses of competing orthopaedic interventions. Outcome probabilities and effectiveness values were derived from the literature. Effectiveness was expressed in quality adjusted life years gained. Cost data were compiled and verified from either hospital cost data or from Medicare data. Costs and utilities were discounted in accord with the United States Panel on Cost Effectiveness in Health and Medicine. Principal outcome measures were average incremental costs, incremental effectiveness, incremental quality-adjusted life years, and, in the case of one article, net health benefits. In particular the articles compared the following: 1. Core decompression versus conservative management for osteonecrosis of the hip as a way to delay hip replacement; 2. Total knee arthroplasty versus unicompartmental knee arthroplasty; and 3. Periacetabular osteotomy versus total hip arthroplasty for a young adult with developmental dysplasia of the hip. The more cost effective intervention was identified in each case, along with implications of the results for clinical and operative decision-making. Cost effectiveness was found to be a useful tool in orthopaedic surgery under limited circumstances of either scarce data on new interventions or the need to use more resources to achieve greater effectiveness. It also can provide excellent insight into ways to direct future clinical research.
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Mcfaddin, Marie O. "Adaptive customization new design opportunities in orthopedics, driven by the merging of imaging and surgery /." Connect to this title online, 2007. http://etd.lib.clemson.edu/documents/1181669299/.
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Dias, Luis Gustavo Gosuen Gonçalves [UNESP]. "Desenvolvimento e aplicação clínica de haste intramedular bloqueada angulada no tratamento de fraturas tibiais em cães." Universidade Estadual Paulista (UNESP), 2009. http://hdl.handle.net/11449/101146.
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dias_lggg_dr_jabo.pdf: 2151686 bytes, checksum: 192fc332d876bb868c167e3bd4402379 (MD5)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)
As fraturas de tíbia em cães representam 20% das que ocorrem em ossos longos. Vários métodos são utilizados nas osteossínteses desse osso, contudo, atualmente as hastes bloqueadas vêm ganhando espaço, especialmente por suas vantagens biomecânicas quando comparadas às demais técnicas. O presente trabalho teve por objetivo desenvolver e avaliar o uso de haste intramedular bloqueada angulada para fraturas tibiais em cães, visando minimizar erros de bloqueio de parafusos e consequentemente problemas na consolidação óssea. Hastes anguladas, de aço inoxidável da série 316L, foram confeccionadas nos diâmetros de 5, 6, 7 e 8 mm, com comprimentos variados. Num período de 17 meses, ocorreu a implantação destas em 15 cães com fratura de tíbia. As avaliações clínica e radiográfica ocorreram no pré e pós-operatório imediato e a cada 30 dias até completar quatro meses. Clinicamente, a recuperação da função do membro se deu no período médio de 10 dias após a cirurgia. Em três animais, utilizou-se além da haste angulada e parafusos, pinos de Schanz como bloqueio (fixador externo), que posteriormente foram retirados. Radiograficamente verificou-se consolidação óssea em média de 70 dias de pós-operatório. A haste intramedular bloqueada angulada mostrou-se eficaz como método de osteossíntese em fraturas tibiais de cães.
In dogs, tibial fractures account for approximately 20% of all long bone fractures. Different methods of fracture repair are used in this bone; however, interlocking nails have gained popularity in recent years owing to its biomechanical advantages when compared to other techniques. The present study aimed to develop and to evaluate the usefulness of an angulated interlocking nail model in tibial fractures of dogs to minimize blocking errors arising from inaccurate bolt stabilization, responsible for generation osseous consolidation. Angulated stainless steel pins from series 316L were manufactured with 5, 6, 7 and 8 mm of diameter, and variable length. During 17 months, pins were implanted in 15 dogs with tibial fracture. Clinical and radiographic findings were recorded on preoperative and on the immediate postoperative period, and every 30 days, until the last recheck, 4 months latter. Clinically, animals recovered the hind function on an average of 10 days after surgery. In three dogs, in addition to the angulated interlocking nail and bolts, scat pins (external fixator) were used. Radiographically, bone consolidation was evident on an average of 70 days of postoperative period. The angulated interlocking nail is a feasible method to repair tibial fractures of dogs.
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D'Urso, Paul Steven. "Stereolithographic biomodelling in surgery /." [St. Lucia, Qld.], 1998. http://www.library.uq.edu.au/pdfserve.php?image=thesisabs/absthe17881.pdf.
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Godwin, Ellen M. "Long-term effect of single event multiple level orthopedic surgery on the functional classification of children with cerebral palsy." NSUWorks, 2005. http://nsuworks.nova.edu/hpd_pt_stuetd/29.
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Bartolozzi, IV Arthur R. "The Forest for the Trees: Using Big Data to Improve Preoperative Assessment and Risk Stratification in Pediatric Orthopedic Surgery." Thesis, Harvard University, 2017. http://nrs.harvard.edu/urn-3:HUL.InstRepos:32676123.
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This thesis uses the Kid’s Inpatient Database to analyze surgical epidemiology, clinical outcomes, LOS, and total costs for two major pediatric surgeries. The goal is to establish clinically meaningful identifiers of risk, complexity, and variation in management both for improving preoperative assessment and understanding demographic determinants of health.
Chapter 1 focused on open hip reduction for the treatment of DDH. This has become more expensive despite shorter hospital stay over time. It is also a longer, more costly experience for children who have reached walking age particularly those over 3 years old. Other patient factors including: developmental delay, ethnicity and insurance, hospital factors, and surgical management contribute to increased LOS and total charges. Despite the conclusions above a more detailed cost-analysis at an institutional level is necessary to identify how the above variables interact with each other.
Chapter 2 investigated the pediatric neuromuscular population undergoing primary spinal fusions. Analyses of urinary function and anemia in addition to CCC scoring can be conducted preoperatively to determine likelihood of complications and LOS. Complications are strongly associated with both LOS and total charges and were lower at high volume centers. Additional factors including hospital size, patient race, anterior/posterior surgery, and BMP use were associated with higher charges. We presented individual prediction models for grouping patients by risk for long LOS and high cost.
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Chow, Lop-keung Raymond. "Clinical morbidity of resorbable plates and screws for internal fixation in orthognathic surgery." Click to view the E-thesis via HKUTO, 2003. http://sunzi.lib.hku.hk/hkuto/record/B31954285.
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Parker, Trevor Wayne. "Functional outcome and complications after treatment of moderate to severe slipped upper femoral Epiphysis with a modified Dunn procedure." Thesis, Stellenbosch : University of Stellenbosch, 2010. http://hdl.handle.net/10019.1/5447.
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Abele, Alexander. "Acculan System : The next generation of a Surgical Power Tool." Thesis, Umeå universitet, Designhögskolan vid Umeå universitet, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-162815.
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Orthopedic surgery is dangerous, especially for the surgeon! Tool failures belong to the ten most frequent causes of operation delays. Nowadays, hospitals are pressured to optimize procedures and lower costs. Especially, orthopedic surgery is physically demanding for the ergonomics of the surgeon and tools wear out more quickly. Could the evolution of a surgical power tool be used in these scenarios to ease and support the surgeons work, increase the efficiency and flexibility of usage and at the same time offer more control and knowledge about the condition of the tools?
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Azevedo, Marcela Padilha Facetto. "Infecções cirúrgicas em ortopedia causadas por micobactérias de crescimento rápido: revisão integrativa da literatura." Universidade de São Paulo, 2012. http://www.teses.usp.br/teses/disponiveis/7/7139/tde-23082012-160610/.
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As micobacterioses são doenças causadas por micobactérias não tuberculosas pertencentes ao gênero Mycobacterium. As infecções por micobactéria de crescimento rápido (MCR) estão fortemente relacionadas às falhas nos processos de limpeza, desinfecção e esterilização de produtos médicos. Objetiva-se, analisar a ocorrência de infecções de sítio cirúrgico, por MCR, em pacientes submetidos a procedimentos ortopédicos, por meio de revisão integrativa; caracterizar as infecções de sítio cirúrgico (ISC) por MCR; verificar a presença de fatores que possam explicar as infecções de sítio cirúrgico por MCR. Como método utilizou-se a revisão integrativa, a qual contém as seguintes etapas: elaboração da questão da pesquisa; estabelecimento de critérios de inclusão e exclusão; definição das informações a serem extraídas do estudo; avaliação dos estudos incluídos; interpretação dos resultados e apresentação da revisão. No resultado foram encontrados 21 artigos, a maioria publicada no idioma inglês, e dois em francês, variando quanto ao continente e país de origem de edição. O tempo entre a cirurgia e o início dos sintomas foi mencionado para os 34 (100%) pacientes, mas a análise foi feita para 33 pacientes, pois se considerou apenas o primeiro episódio de infecção por MCR. O tempo médio para o diagnóstico da ISC foi de 653,6 dias (93 semanas), desvio padrão ±1.343 dias (192 semanas), mediana de 80 dias (11,4 semanas) e moda de 90 dias (três meses). Quanto aos sinais e sintomas relatados pelos pacientes, os mais prevalentes foram: dor (61,8%), secreção (50,0%), edema (41,2%), febre (41,2%), eritema (26,5%), fístula (20,6%), calor (14,7%), tremor (5,9%), abscesso (5,9%) e hematoma (3,0%). Em relação às intervenções cirúrgicas efetuadas nos pacientes, após o diagnóstico de ISC, a mais frequente foi a antibioticoterapia (100%), remoção de prótese total (50,0%), drenagem (41,2%), debridamento cirúrgico (41,2%), irrigação (23,5%), revisão cirúrgica (17,6%) troca da prótese total (8,8%), remoção de componentes da prótese (8,8%) e reimplante da prótese (2,9%). A identificação do(s) agente(s) etiológico(s) da(s) ISCs não seguiu uma metodologia de rotina, o que pode influenciar na confiabilidade do resultado, principalmente quanto à espécie do agente etiológico. Quanto à espécie de MCR isoladas dos sítios de infecção constatamos que M.fortuitum foi a mais prevalente; tendo sido isolados também M.chelonae, M.abscessus, M.goodii, M.smegmatis, M.farcinogenes e M.wolinskyi. Em relação às fontes investigadas, tem-se: provavelmente de origem iatrogênica, hábito do médico residente de ortopedia, presente nas cirurgias, de utilizar a hidromassagem antes de operar; componentes líquidos ou pó do cimento metilmetacrilato ou a prótese metálica; injeções de cortisona por sinovite crônica, durante cinco anos, antes da cirurgia; sistema de ar condicionado ou a solução de imersão para enxágue da prótese; sabão na água, onde foi realizada a imersão do pé (recomendação do podólogo); parafuso bioabsorvível utilizado na cirurgia; injeções intra-articulares de dexametasona; no entanto, nenhuma delas pode ser confirmada. Quando feito o teste de senbilidade observou-se que as cepas apresentavam em torno de 80% de sensibilidade à amicacina, claritromicina e ciprofloxacina.The mycobacteriosis is a disease caused by nontuberculous mycobacteria belonged to the Mycobacterium genus. Infections due to rapidly growing mycobacteria (RGM) are strongly related to failures in the processes of cleaning, disinfection and sterilization of medical products. The objective is to analyze the occurrence of surgical site infections by RGM in patients undergoing orthopedic procedures through integrative review; to characterize the surgical site infections (SSI) by RGM; and to verify the presence of factors that may explain the surgical site infections by RGM. The method was the integrative review, which includes the following steps: elaboration of the research question; establishment of inclusion and exclusion criteria; definition of information to be extracted from the study; assessment of the included studies; interpretation of results; and presentation of the review. 21 articles were found, mostly published in English and two in French, varying considering the continent and country of the origin of the article. The time between surgery and onset of symptoms was reported by 34 (100%) patients, but the analysis was performed for 33 patients because it was considered only the first episode of infection by RGM. The average time to diagnosis of SSI was 653.6 days (93 weeks), standard deviation ± 1343 days (192 weeks), median of 80 days (11.4 weeks) and mode of 90 days (three months). The most prevalent signs and symptoms reported by patients were: pain (61.8%), secretion (50.0%), edema (41.2%), fever (41.2%), erythema (26.5%), fistula (20.6%), heat (14.7%), tremor (5.9%), abscess (5.9%) and hematoma (3.0%). Regarding surgical interventions performed in patients after diagnosis of SSI, the most frequent was antibiotic therapy (100%), removal of dentures (50.0%), drainage (41.2%), surgical debridement (41.2%), irrigation (23.5%), surgical revision (17.6%), replacement of dentures (8.8%), removal of the prosthetic components (8.8%), and reimplantation of the prosthesis (2.9%). The identification of etiological agent(s) of SSI did not follow a routine methodology, which can influence the reliability of the results, especially regarding the kind of etiologic agent. Related to the kind of isolated RGM of the infection sites, it was found that M.fortuitum was the most prevalent; being also isolated the M.chelonae, M.abscessus, M.goodii, M.smegmatis, M.farcinogenes and M.wolinskyi. Regarding the sources investigated: probably from iatrogenic origin, it is habits of residents in orthopedics during surgeries to use hydromassage before operating; liquid components or cement powder of methylmethacrylate or metal prosthesis; cortisone injections for chronic synovitis during 5 years before surgery; air conditioning system or soaking solution to rinse the denture; soap in the water, where it was accomplished the immersion foot (podiatrist\'s recommendation); bioabsorbable screws used in surgery; intraarticular injections of dexamethasone; however, none of them can be confirmed. When the sensitivity test was done, it was observed that the strains had approximately 80% of sensitivity to amikacin, clarithromycin, ciprofloxacin. Quando feito o teste de senbilidade observou-se que as cepas apresentavam em torno de 80% de sensibilidade à amicacina, claritromicina e ciprofloxacina.
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Wheeler, Anthony J. "Procedural Rates, Economic Costs, and Geographic Variation of Primary and Revision Lumbar Total Disc Replacement." DigitalCommons@USU, 2013. https://digitalcommons.usu.edu/etd/1764.
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Lumbar degenerative disc disease is a remarkably common condition among patients presenting with chronic low back pain and physical disability. When a surgical treatment option is warranted, patients now have the option of undergoing lumbar total disc replacement (TDR), a relatively new procedure that is designed to replace lumbar fusion, the traditional surgical intervention for degenerative disc disease. The lumbar TDR procedure has demonstrated clinical efficacy equivalent to that of lumbar fusion, although concern remains about the longevity, safety, and costs related to the procedure. These issues were addressed in three separate observational studies using administrative claims data. The first study estimated the revision burden and economic revision burden of lumbar TDR. The second study examined the lumbar TDR hybrid procedure, where both a lumbar TDR and lumbar fusion are performed simultaneously. No observational data have been reported on the frequency, cost, and diagnostic indications related to the TDR hybrid procedure. The third study mapped the geographic variation of procedural rates of lumbar TDR. Previous research has found substantial geographic variation in lumbar spine surgery rates and a similar analysis of lumbar TDR variation has yet to be reported. The present series of studies found the revision burden and economic revision burden of lumbar TDR to be similar to data reported for this procedure from the mid-2000s, though the overall occurrence of the procedure appears to have declined. The economic revision burden made this a lower-cost procedure than lumbar fusion, with a tradeoff in terms of revision burden being higher for lumbar TDR. The lumbar TDR hybrid procedure was found to make up approximately 16% of the total number of TDR procedures, involving much higher costs than a single-level TDR procedure. Finally, geographic variation of the procedural rate of lumbar TDR varied dramatically across the U.S., surpassing the variation observed in lumbar fusion surgery. Limitations of the observational data used in these studies are described. Recommendations for future observational research are offered as well. Finally, implications for these studies on practice guidelines and reimbursement policies are provided.
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Chow, Lop-keung Raymond, and 周立強. "Clinical morbidity of resorbable plates and screws for internal fixation in orthognathic surgery." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2003. http://hub.hku.hk/bib/B31954285.
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Barros, Luciano Pereira de [UNESP]. "Estudo experimental e comparativo entre as técnicas de pino em cavilha com fio fluorcarbono monofilamentar e colocefalectomia para estabilização coxofemoral em cães." Universidade Estadual Paulista (UNESP), 2009. http://hdl.handle.net/11449/89093.
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barros_lp_me_jabo.pdf: 894125 bytes, checksum: 291c2da790713462f8653ad7c1ce412f (MD5)No presente trabalho comparou-se, experimentalmente, duas técnicas: a estabilização coxofemoral com pino em cavilha ou “toggle pin” e a colocefalectomia. Foram utilizados 16 cães, machos ou fêmeas, distribuidos em dois grupos: o de Pino (GP) e o Colocefalectomia (GC), os quais foram separados em 4 subgrupos: animais com peso superior e, inferior ou igual a 15 kg. Avaliou-se o tempo de cirurgia, o grau de atrofia muscular, a deambulação e a dor, além de presença ou não de alterações radiograficas da articulação. O tempo cirúrgico, devido a maior complexidade da técnica do pino, foi menor no GC. A técnica do GP foi melhor quanto à recuperação do membro, apresentando menor atrofia muscular
On the present assay was compared experimentally between two techniques: hip joint stabilization with toggle pin and hip joint stabilization with head of the femur. Were used 16 dogs, female or male, distributed in 2 groups: the pin group (GP) and head of the femur group (GC), the groups were distributed in 4 subgroups: by weight equal, more or less than 15kg. Evaluating the time of surgery, and the notch of muscle atrophy, wander around the pain and also with the presence or not of alterations on the joint radiograph. The time of surgery is longer in the technique of pin than on the group GC, because the technique of pin had more complexity. So the technical of the group GP was better on the recovery member, which presented less muscle atrophy
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Lazo-Langner, Alejandro. "Comparing strategies for thromboprophylaxis in major orthopedic surgery using an estimation of net risk-benefit through probabilistic simulation A clinical cost-effectiveness study." Thesis, University of Ottawa (Canada), 2007. http://hdl.handle.net/10393/27874.
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Clinical decisions should take into account the clinical risk and benefit of a new intervention compared to the reference treatment. A method was developed to compare multiple competing interventions using a clinical cost-effectiveness approach. A meta-analysis was conducted to estimate the clinical cost (major bleeding) and benefit (averted venous thromboembolism) of thromboprophylaxis with different anticoagulants in orthopedic surgery. The increment in cost and benefit of anticoagulants compared to placebo were calculated using replications of the values obtained through Monte Carlo simulations. Net clinical benefit was calculated for each replication across a range of risk acceptance values (risk-benefit acceptability threshold). Multiple anticoagulants were compared by calculating the probability that each agent had of achieving the highest net clinical benefit. The preferred anticoagulants varied depending on risk acceptance, type of surgery, bleeding and thrombosis definitions, and timing of anticoagulant initiation. This method allowed comparing multiple interventions in the absence of randomized trials.
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Osborne, Michelle. "EXPLORATION OF THE RELATIONSHIP BETWEEN PAIN INTENSITY, COMFORT LEVEL AND PATIENT SATISFACTION AMONG ORTHOPEDIC PATIENTS FOLLOWING KNEE SURGERY ON POSTOPERATIVE DAY ONE." Case Western Reserve University Doctor of Nursing Practice / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=casednp1430142885.
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Hooks, Heather E. "Effects of Music Intervention on the Patient’s Perception of Pain After Knee Replacement Surgery." Digital Commons @ East Tennessee State University, 2014. https://dc.etsu.edu/etd/2321.
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The purpose of this study was to determine whether therapeutic music affects the patient’s perception of pain, postoperative day 1 after knee replacement surgery in an inpatient hospital. In addition to the patient’s pain levels, the study was an analysis of the quantity of opioids the patient was requested, the length of stay, and the physiological parameters, which included blood pressure, heart rate, respiratory rate, and oxygen saturation. Sixty knee replacement patients were randomly placed in the music group or the quiet group. The Faces Pain Scale Revised with Numeric Rating Scale was used to measure pain levels. Statistical analysis between the music group and the quiet group indicated a significant difference in patient’s pain levels (F = .298; p = .037). Study results support music decreasing patient’s perception of pain. Nurses can suggest music intervention to decrease pain with this patient population knowing evidence based practice supports the efficiency of music.
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Charras, Guillaume Thomas. "Digital Image-Based Finite Element Modeling (DIBFEM) : validation and application to biological structures." Thesis, Georgia Institute of Technology, 1998. http://hdl.handle.net/1853/17765.
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Amir, Nili S. "Frequency of Complications Following Spinal Fusion in Children with Cerebral Palsy." eScholarship@UMMS, 2020. https://escholarship.umassmed.edu/gsbs_diss/1070.
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Background:
Neuromuscular Scoliosis is a frequent complication of Cerebral Palsy that requires surgical management including spinal fusion. The objective of this observational study was to describe differences in the frequency of postoperative complications in children with Cerebral Palsy following spinal fusion surgery compared to children with Idiopathic Scoliosis.
Methods:
The 2016 Kids’ Inpatient Database was queried to identify pediatric patients (old) with concurrent diagnoses of Cerebral Palsy and Neuromuscular Scoliosis undergoing spinal fusion surgery. Cases were compared to children without Cerebral Palsy and with a diagnosis of Idiopathic Scoliosis undergoing the same procedure. Fitted Poisson regression analysis with robust variance was performed to estimate relative risks in the frequency of various clinical complications while adjusting for several potentially confounding variables of importance.
Results:
A total of 660 cases and 5,244 comparators were identified. Compared to children with Idiopathic Scoliosis, children with Cerebral Palsy were younger (13.6 vs. 14.3 years), more likely to be male (54% vs. 23%), and more likely to have had governmental insurance (52% vs. 32%). They also had longer hospital lengths of stay (8 days vs. 4 days). After adjusting for a number of potentially confounding sociodemographic and clinical variables, children with Cerebral Palsy were more likely to have postoperative pulmonary, gastrointestinal, and surgical complications, receive blood transfusions, and be admitted to the ICU.
Conclusions:
Children with Cerebral Palsy have an increased risk of complications following spinal fusion surgery leading to longer hospital stays. These results further inform surgical decision-making and anticipatory guidance for these children and their caregivers.
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Salazar, Garcia Fátima. "Temperatura, Oximetría Cerebral y Disfunción Cognitiva Postoperatoria (DCPO) en pacientes intervenidos de Prótesis Total de Rodilla (PTR) con anestesia intradural. Estudio prospectivo." Doctoral thesis, Universitat de Barcelona, 2015. http://hdl.handle.net/10803/398949.
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Introducción: La Disfunción cognitiva postoperatoria (DCPO) tiene una alta incidencia en pacientes de cirugía ortopédica. Durante la anestesia y la cirugía se produce un descenso progresivo de la temperatura. Esta hipotermia tiene efectos deletéreos pero también puede tener un efecto protector cerebral. Nosotros planteamos la hipótesis que la temperatura perioperatoria puede tener un impacto sobre la aparición de DCPO.
Por otro lado, la monitorización de la saturación regional cerebral de oxígeno (SrO2) puede reflejar un desequilibrio de la oxigenación cerebral intraoperatoria y alertar de una disfunción cerebral. Nuestro objetivo fue explorar la potencial utilidad de los valores de la rSO2 como signo de alerta para el desarrollo de diferentes tipos de decline en la función psicológica postoperatoria.
Métodos: Hemos incluido 150 pacientes mayores de 65 años de edad programados para intervenirse de prótesis total de rodilla con anestesia intradural, randomizados para recibir cuidado estándar (abrigo con capa de sábanas) o ser calentados activamente. Una evaluación neurocognitiva (11 subtests) fue realizada preoperatoriamente, al cuarto día (3 subtests) y a los 3 meses (10 subtests). Un grupo control de 55 pacientes no quirúrgicos realizaron el mismo test en los tiempos equivalentes. La DCPO fue definida como un descenso de la puntuación individual de más de 2 desviaciones estándar (SDs) por debajo del basal en al menos 2 subtests o 2SDs en la z-score combinada, en ambos casos ajustando por los cambios del grupo control.
Para el análisis observacional de la SrO2 bilateral intraoperatorios fueron elegidos como puntos de corte un valor absoluto de rSO2 <50% o una reducción >20% o >25% por debajo del valor basal. Como la valoración era de los dos hemisferios, se reagruparon las pruebas neuropsicológicas para analizar un declive más específico: función memoria y función ejecutiva, usando la misma definición estadística.
Aparte se usaron escalas para la valoración de síntomas psicológicos: ansiedad, depresión, quejas subjetivas de pérdida de memoria y concentración.
Resultados: La temperatura timpánica descendió por debajo de 35ºC en 88% de los pacientes de cuidado estándar; 25.3% de los pacientes calentados activamente tuvieron una temperatura ≥ 36ºC. Al cuarto día, 3.2% de los pacientes del grupo con cuidado estándar y 19.4% de los pacientes del grupo calentado activamente padecieron DCPO (P= 0.0058). A los 3 meses, no hubo diferencia entre los dos grupos (grupo estándar, 14,3%; grupo calentado, 6,5%) con tres subtests (P= 0.2440) ni con 10 subtests (grupo estándar, 20,6%; grupo calentado, 22,6%).
No se observaron diferencias en los valores basales de SrO2; La SrO2 descendió significativamente en todos los pacientes durante la cirugía (P<0.0001). 75 pacientes (60%) no presentaron signos de decline cognitivo o síntomas psicológicos. 21 pacientes (16.8%) tuvieron decline de memoria, 3 pacientes (2.4%) tuvieron decline VM-EF, y 33 pacientes (26.4%) presentaron síntomas psicológicos. Los valores de la SrO2 en los hemisferios derecho e izquierdo fueron en los pacientes que presentaron decline de memoria (media [SD] izda-dcha ratio de 95.03 [8.51] vs 101.29 [6.7] para pacientes sin
cambios, P = 0.0012). La diferencia media dcha-izda en los valores de rSO2 fue también significativa en estos pacientes (−2.87% [4.73%], más bajos en el derecho, P = 0.0034).
Conclusiones: La hipotermia mantenida en los pacientes del grupo que no fue calentado activamente ha tenido un efecto protector de la DCPO a los 4 días de la IQ. La temperatura >36ºC constituyó un factor de riesgo de DCPO a los 4 días y 3 meses del postoperatorio.
La detección de una tendencia a la asimetría en los valores de rSO2 puede alertarnos de un posible decline de memoria en el postoperatorio. La presencia de síntomas psicológicos y decline de memoria fueron comunes tres meses después de la artroplastia total de rodilla en nuestros pacientes > 65 años.Background: Post-operative cognitive dysfunction (POCD) can affect 30% of orthopedic surgery patients. We hypothesized that perioperative temperature has an impact on POCD. Bilateral regional brain oxygen saturation (rSO2) trends, reflecting intraoperative brain oxygen imbalance, could warn of brain dysfunction such as memory decline, alterations in executive function or subjective complaints. Methods: We included 150 patients over 65 years of age scheduled for total knee replacement under spinal anesthesia. They were randomized to receive standard care (sheet cover) or active warming. Demographic, hemodynamic and bilateral rSO2 intraoperative values were recorded. An absolute rSO2 value of <50% or a reduction of >20% or >25% below baseline were chosen as relevant cutoffs. Neurocognitive assessment (11 subtests) was performed pre-operatively and at day 4 (three subtests) and 3 months (10 subtests). A control group of 55 nonsurgical patients took the same tests at equivalent times. POCD was defined as an individual score decrease of more than 2 standard deviations (SDs) below the baseline on at least two subtests or 2 SDs in the combined z-score, in both cases using control-adjusted changes. Results: Tympanic temperature declined below 35ºC in 88% of standard-care patients; 25.3% of warmed patients had a temperature ≥36ºC. On day 4, 3.2% of standard care patients and 19.4% of warmed patients had POCD (P=0.0058). At 3 months, there were no differences (standard care, 14.3%; warmed, 6.5% (P=0.2440). We observed no differences in baseline rSO2 values; rSO2 decreased significantly in all patients during surgery (P < 0.0001). Seventy-five patients (60%) had no sign of cognitive decline or psychological symptoms. Twenty-one patients (16.8%) had memory decline, 3 (2.4%) had VM-EF decline, and 33 (26.4%) had psychological symptoms. Left and right rSO2 values were asymmetric in patients who had memory decline (mean [SD] left-right ratio of 95.03 [8.51] vs 101.29 [6.7] for patients with no changes, P = 0.0012). The mean right-left difference in rSO2 was also significant in these patients (−2.87% [4.73%], lower on the right, P = 0.0034). Conclusions: Perioperative warming was associated with a higher incidence of cognitive dysfunction at 4 days. A temperature >36ºC constituted a risk factor for POCD at 4 days and at 3 months. Detection of a trend to asymmetry in rSO2 values can warn of possible postoperative onset of memory decline. Psychological symptoms and memory decline were common three months after knee replacement.
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Dias, Luis Gustavo Gosuen Gonçalves. "Desenvolvimento e aplicação clínica de haste intramedular bloqueada angulada no tratamento de fraturas tibiais em cães /." Jaboticabal : [s.n.], 2009. http://hdl.handle.net/11449/101146.
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Orientador: João Guilherme Padilha FilhoBanca: Jorge Luiz Oliveira Costa
Banca: Cássio Ricardo Auada Ferrigno
Banca: Paola Castro Moraes
Banca: Julio Carlos Canola
Resumo: As fraturas de tíbia em cães representam 20% das que ocorrem em ossos longos. Vários métodos são utilizados nas osteossínteses desse osso, contudo, atualmente as hastes bloqueadas vêm ganhando espaço, especialmente por suas vantagens biomecânicas quando comparadas às demais técnicas. O presente trabalho teve por objetivo desenvolver e avaliar o uso de haste intramedular bloqueada angulada para fraturas tibiais em cães, visando minimizar erros de bloqueio de parafusos e consequentemente problemas na consolidação óssea. Hastes anguladas, de aço inoxidável da série 316L, foram confeccionadas nos diâmetros de 5, 6, 7 e 8 mm, com comprimentos variados. Num período de 17 meses, ocorreu a implantação destas em 15 cães com fratura de tíbia. As avaliações clínica e radiográfica ocorreram no pré e pós-operatório imediato e a cada 30 dias até completar quatro meses. Clinicamente, a recuperação da função do membro se deu no período médio de 10 dias após a cirurgia. Em três animais, utilizou-se além da haste angulada e parafusos, pinos de Schanz como bloqueio (fixador externo), que posteriormente foram retirados. Radiograficamente verificou-se consolidação óssea em média de 70 dias de pós-operatório. A haste intramedular bloqueada angulada mostrou-se eficaz como método de osteossíntese em fraturas tibiais de cães.
Abstract: In dogs, tibial fractures account for approximately 20% of all long bone fractures. Different methods of fracture repair are used in this bone; however, interlocking nails have gained popularity in recent years owing to its biomechanical advantages when compared to other techniques. The present study aimed to develop and to evaluate the usefulness of an angulated interlocking nail model in tibial fractures of dogs to minimize blocking errors arising from inaccurate bolt stabilization, responsible for generation osseous consolidation. Angulated stainless steel pins from series 316L were manufactured with 5, 6, 7 and 8 mm of diameter, and variable length. During 17 months, pins were implanted in 15 dogs with tibial fracture. Clinical and radiographic findings were recorded on preoperative and on the immediate postoperative period, and every 30 days, until the last recheck, 4 months latter. Clinically, animals recovered the hind function on an average of 10 days after surgery. In three dogs, in addition to the angulated interlocking nail and bolts, scat pins (external fixator) were used. Radiographically, bone consolidation was evident on an average of 70 days of postoperative period. The angulated interlocking nail is a feasible method to repair tibial fractures of dogs.
Doutor
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Barros, Luciano Pereira de. "Estudo experimental e comparativo entre as técnicas de pino em cavilha com fio fluorcarbono monofilamentar e colocefalectomia para estabilização coxofemoral em cães /." Jaboticabal : [s.n.], 2009. http://hdl.handle.net/11449/89093.
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Orientador: Cintia Lúcia ManiscalcoBanca: Paola Castro Moraes
Banca: Gustavo Garkalns de Souza Oliveira
Resumo: No presente trabalho comparou-se, experimentalmente, duas técnicas: a estabilização coxofemoral com pino em cavilha ou "toggle pin" e a colocefalectomia. Foram utilizados 16 cães, machos ou fêmeas, distribuidos em dois grupos: o de Pino (GP) e o Colocefalectomia (GC), os quais foram separados em 4 subgrupos: animais com peso superior e, inferior ou igual a 15 kg. Avaliou-se o tempo de cirurgia, o grau de atrofia muscular, a deambulação e a dor, além de presença ou não de alterações radiograficas da articulação. O tempo cirúrgico, devido a maior complexidade da técnica do pino, foi menor no GC. A técnica do GP foi melhor quanto à recuperação do membro, apresentando menor atrofia muscular
Abstract: On the present assay was compared experimentally between two techniques: hip joint stabilization with toggle pin and hip joint stabilization with head of the femur. Were used 16 dogs, female or male, distributed in 2 groups: the pin group (GP) and head of the femur group (GC), the groups were distributed in 4 subgroups: by weight equal, more or less than 15kg. Evaluating the time of surgery, and the notch of muscle atrophy, wander around the pain and also with the presence or not of alterations on the joint radiograph. The time of surgery is longer in the technique of pin than on the group GC, because the technique of pin had more complexity. So the technical of the group GP was better on the recovery member, which presented less muscle atrophy
Mestre
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Brady, Patrick. "Cephalometric analysis of adolescents with severe Class II Division 1 malocclusions treated surgically and non-surgically." Thesis, University of Iowa, 2016. https://ir.uiowa.edu/etd/3052.
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Introduction: Class II Division 1 malocclusions are characterized by a retrusive mandible and prominent upper incisors. Despite Class II malocclusions being one of the most frequently treated cases in orthodontists' office, there is no uniform consensus in the orthodontic community on the best treatment modality and biomechanical approach to use in treating patients with Class II malocclusions.
Purpose: This paper examines the end-of-treatment outcomes of severe Class II Division I malocclusion patients treated with surgical versus non-surgical approaches.
Study Design: This is a retrospective study of consecutively treated severe Class II Division I patients at the University of Iowa. Initial and deband lateral cephalometric radiographs were compared between 45 non-surgical and 21 surgical patients. All patients that were debanded between the ages of 13 to 19 years were included. Multivariable regression analyses were used to examine differences in outcomes between treatment groups.
Results: Following adjustment for patient level confounders (age, gender, and race), those treated surgically had better end of treatment cephalometric outcomes. Those treated surgically had a more balanced skeletal profile, greater reduction in overjet, and improvement in ANB angle (p
Conclusion: Orthodontic treatment in conjunction with orthognathic surgery is a more ideal treatment for patients with severe Class II Division I malocclusion. When treated surgically, a greater amount of overjet can be reduced while keeping lower incisors in a more stable position in bone.
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Wang, Lejing Verfasser], Nassir [Akademischer Betreuer] [Navab, Russel H. [Akademischer Betreuer] Taylor, and Ekkehard [Akademischer Betreuer] Euler. "Novel techniques for integrating video augmented X-ray imaging into orthopedic and trauma surgery / Lejing Wang. Gutachter: Nassir Navab ; Russel H. Taylor ; Ekkehard Euler. Betreuer: Nassir Navab." München : Universitätsbibliothek der TU München, 2012. http://d-nb.info/1031550534/34.
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Hogaboam, Liliya Stepanivna. "Assessment of Technology Adoption Potential of Medical Devices: Case of Wearable Sensor Products for Pervasive Care in Neurosurgery and Orthopedics." PDXScholar, 2018. https://pdxscholar.library.pdx.edu/open_access_etds/4205.
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Information and communication technologies hope to revolutionize the healthcare industry with innovative and affordable solutions with a focus on pervasive care. Wearable sensors products can provide monitoring in a natural environment with a constant stream of information, enriching healthcare practices and enabling better pervasive care.
Wearable sensor technologies could monitor patients' mobility, gait, tremor, daily activity and other health indicators in real time that could allow for simple, non-invasive, tracking of spine care that may lead to increased patient engagement, integration, feedback, post-surgery analysis, monitoring of patient's condition, patient's data extraction and analysis and possibly aiding in better diagnosis, intervention, adherence to treatment for the betterment of quality of care.
This research focuses on the assessment of technology adoption potential of medical devices particular to tracking the mobility of patients of neurosurgery and orthopedics.
Wearable medical devices that track the mobility of patients after spinal procedures could help surgeons in providing post-operative care, analysis of treatment outcomes and patient mobility. The assessment of those devices by physicians is a complex process associated with various perspectives and criteria.
Therefore, the objective of this research is to assess the potential for technology adoption of those wearable medical devices through development of a hierarchical decision-making model (HDM) that incorporates the relevant perspectives and criteria encompassing the needs of hospital neurological surgery and orthopedics departments.
The proposed research builds on an existing body of knowledge researched through literature review and background of the field and expands the health technology assessment field by implementation of a holistic, comprehensive and multi-perspective approach to technology assessment in wearable sensor products adoption for pervasive care in neurosurgery and orthopedics.
The Hierarchical Decision Model (HDM) approach is used to break the problem down into hierarchical levels and then calculate the alternatives using pairwise comparison scales and a judgment quantification technique. Inconsistencies, disagreement, sensitivity and scenario analysis are performed as well. HDM research software is created with Ruby and R to facilitate the computation of some of these important model parameters to higher precision than is available in current statistical analysis software packages or extensions targeted for decision making. Patient perspective dominates as the main perspective for the technology adoption potential of wearable devices for pervasive care in neurosurgery and orthopedics, followed by technical and financial perspectives. Valedo, a wearable device aimed to relieve back pain through exercises, motivation and mobility tracking, received the highest ranking for adoption potential, while other devices also received high relative scores. The framework could serve as a supplementary technology assessment tool and could be tested in other settings: private, small clinic etc. with the experts and special needs of physicians in particular healthcare departments.
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Chang, Yen Yin [UNESP]. "Comparação entre o ponto P6 (NEIGUAM), ondansetron e da associação de ambos na prevenção de náuseas e vômitos em cirurgia ortopédica de membros inferiores sob bloqueio subaracnoideo." Universidade Estadual Paulista (UNESP), 2013. http://hdl.handle.net/11449/106000.
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chang_yy_dr_botfm.pdf: 574285 bytes, checksum: ec51866cadcc3a8299ccb843ebe9f34d (MD5)O estudo teve por objetivo avaliar náuseas e vômitos no pós-operatório (NVPO) com utilização da acupuntura com eletroestimulação do ponto P6 (Neiguam) comparado ao grupo fármaco Ondansetron e ao grupo da associação da eletroacupuntura com o Ondansetron. Trata-se de um estudo clínico prospectivo randomizado realizado em pacientes ortopédicos submetidos a cirurgias de membros inferiores com bloqueio subaracnóideo com morfina, realizado no período de maio de 2010 a dezembro de 2011 no Hospital Universitário Getúlio Vargas e Fundação Hospital Adriano Jorge, em Manaus – Amazonas. Foram incluídos no estudo 90 pacientes, sendo 30 pacientes no grupo Ondansetron G (O); os pacientes receberam o fármaco Ondansetron 8 mg EV na indução anestésica; 30 pacientes no grupo acupuntura G (A), os pacientes na SRPA receberam, antes do procedimento cirúrgico, eletroestimulação durante 30 minutos de 10 Hz dos pontos P6 (Neiguam) e IG11 (Quchi) – ponto neutro; e 30 pacientes no grupo Ondansetron e acupuntura G (OA), onde receberam ambas técnicas, a farmacológica e a não farmacológica. Foram avaliadas número de ocorrências de NV (náuseas e vômitos) com relatos preenchidos em protocolo próprio por avaliadores independentes em três momentos distintos: no período perioperatório na sala de cirurgia, nas primeiras 2 horas durante o período na SRPA e nas 24 horas durante a permanência na enfermaria. Para as variáveis quantitativas foi realizada a análise de variância no delineamento inteiramente ao acaso e para as variáveis qualitativas foi realizado o teste Exato de Fisher. O nível de significância utilizado foi de 5%. Foram randomizados 96 pacientes ≥ 18 anos ASA I e II, excluídos seis pacientes por violarem o protocolo; dos 90 pacientes incluídos, 19 eram do sexo feminino e 71 do sexo masculino. Os...
The study aims at evaluating the postoperative nauseas and vomiting (PONV) with utilization of acupuncture with electrostimulation of point P-6 (Neiguam) compared to the group of drug Ondansetron and the group of association of electroacupuncture with Ondansetron. It is a randomized, prospective, clinical study carried out in orthopedic patients undergone surgeries of lower limbs with subarachnoid block with morphine, carried out in the period from May, 2010 to December, 2011 in the Hospital Universitário Getúlio Vargas and Fundação Hospital Jorge in Manaus – Amazonas; 90 patients were enrolled in the study, being 30 patients in the Ondansetron group G (O), the patients received the drug Ondansetron 8 mg EV in the anesthesia induction; 30 patients in the acupuncture group G (A), the patients in SRPA received before the surgical procedure, electrostimulation during 30 minutes of 10 Hz of points P6 (Neiguam) and IG11 (Quchi) – neutral point; and 30 patients in the Ondansetron and acupuncture group G (OA) where the patients received both techniques, the pharmacological one and the non-pharmacological one. The number of occurrences of NV (nausea and vomiting) was evaluated with reports completed in suitable protocol by independent evaluators in three distinct moments: in the peri-operative period in the surgery room, in the first 2 hours during the period in SRPA and in the 24 hours during the stay in the nursing ward. For the quantitative variables the analysis of variance in the completely randomized design was carried out and for the qualitative variables the Fisher’s Exact test was carried out. The significance level used was 5%. 96 patients > 18 years old ASA I and II were randomized, and 6 patients were excluded due to protocol violation; of the 90 included patients, 19 were female and 71 were male. The anthropometric... (Complete abstract click electronic access below)
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Joss, Brendan Keith. "Clinical and biomechanical outcomes following unicondylar knee arthroplasty with Preservation fixed and mobile bearing tibial components." University of Western Australia. School of Surgery and Pathology, 2007. http://theses.library.uwa.edu.au/adt-WU2007.0079.
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[Truncated abstract] Unicondylar knee arthroplasty (UKA) has re-emerged as a successful treatment option for isolated single compartment tibio-femoral joint osteoarthritis. However despite its increasing use, controversy still remains over fixed or mobile bearing tibial components, as there is a lack to prospective randomised studies reported in the literature. In addition, the theoretical advantages of the mobile bearing for knee kinematics, kinetics and clinical outcome have not been evaluated in vivo. The aim of this research study was to explore the clinical and biomechanical outcomes of the fixed and mobile bearing UKA. . . . When the results for the both studies were combined, utilising the Preservation and MG fixed bearing prostheses, there was a significant relationship between knee adduction moment, and a poor prognosis predicted from RSA. Those patients with translation or rotation of the tibial component in any direction above 1mm and 1.5 degrees respectively were considered to have a poor prognosis for long term fixation. Of the 28 patients, the 8 patients considered to have a poor prognosis, had increased knee adduction moments post-surgery (mean difference = 1.66Nm.kg-1, p = 0.007). There was no difference between the groups for knee flexion moment (mean difference 0.16Nm.kg-1, p = 0.844). Pre-surgery gait was unable to predict the post-surgery outcome, due to the significant changes in gait from pre- to post-surgery. Care must taken when implanting the Preservation mobile bearing prosthesis, as long term outcome is questionable. The mobile bearing prosthesis also produced the worst clinical outcome, however the theoretical advantages of the mobile bearing does not affect gait. Gait analysis is a useful tool to identify patient who are overloading their prosthesis, leading to potential early failure. Identification of these gait patterns can allow for early intervention to reduce joint load, and possible extend the longevity of the prosthesis.
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Chang, Yen Yin. "Comparação entre o ponto P6 (NEIGUAM), ondansetron e da associação de ambos na prevenção de náuseas e vômitos em cirurgia ortopédica de membros inferiores sob bloqueio subaracnoideo/." Botucatu, 2013. http://hdl.handle.net/11449/106000.
Full textAbstract:
Orientador: Norma Sueli Pinheiro MódoloBanca: José Reinaldo Cerqueira Braz
Banca: Guilherme Antonio Moreira de Barros
Banca: Eduardo Toshiyuki Moro
Banca: Angélica de Fátima de Assunção Braga
Resumo: O estudo teve por objetivo avaliar náuseas e vômitos no pós-operatório (NVPO) com utilização da acupuntura com eletroestimulação do ponto P6 (Neiguam) comparado ao grupo fármaco Ondansetron e ao grupo da associação da eletroacupuntura com o Ondansetron. Trata-se de um estudo clínico prospectivo randomizado realizado em pacientes ortopédicos submetidos a cirurgias de membros inferiores com bloqueio subaracnóideo com morfina, realizado no período de maio de 2010 a dezembro de 2011 no Hospital Universitário Getúlio Vargas e Fundação Hospital Adriano Jorge, em Manaus - Amazonas. Foram incluídos no estudo 90 pacientes, sendo 30 pacientes no grupo Ondansetron G (O); os pacientes receberam o fármaco Ondansetron 8 mg EV na indução anestésica; 30 pacientes no grupo acupuntura G (A), os pacientes na SRPA receberam, antes do procedimento cirúrgico, eletroestimulação durante 30 minutos de 10 Hz dos pontos P6 (Neiguam) e IG11 (Quchi) - ponto neutro; e 30 pacientes no grupo Ondansetron e acupuntura G (OA), onde receberam ambas técnicas, a farmacológica e a não farmacológica. Foram avaliadas número de ocorrências de NV (náuseas e vômitos) com relatos preenchidos em protocolo próprio por avaliadores independentes em três momentos distintos: no período perioperatório na sala de cirurgia, nas primeiras 2 horas durante o período na SRPA e nas 24 horas durante a permanência na enfermaria. Para as variáveis quantitativas foi realizada a análise de variância no delineamento inteiramente ao acaso e para as variáveis qualitativas foi realizado o teste Exato de Fisher. O nível de significância utilizado foi de 5%. Foram randomizados 96 pacientes ≥ 18 anos ASA I e II, excluídos seis pacientes por violarem o protocolo; dos 90 pacientes incluídos, 19 eram do sexo feminino e 71 do sexo masculino. Os... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: The study aims at evaluating the postoperative nauseas and vomiting (PONV) with utilization of acupuncture with electrostimulation of point P-6 (Neiguam) compared to the group of drug Ondansetron and the group of association of electroacupuncture with Ondansetron. It is a randomized, prospective, clinical study carried out in orthopedic patients undergone surgeries of lower limbs with subarachnoid block with morphine, carried out in the period from May, 2010 to December, 2011 in the Hospital Universitário Getúlio Vargas and Fundação Hospital Jorge in Manaus - Amazonas; 90 patients were enrolled in the study, being 30 patients in the Ondansetron group G (O), the patients received the drug Ondansetron 8 mg EV in the anesthesia induction; 30 patients in the acupuncture group G (A), the patients in SRPA received before the surgical procedure, electrostimulation during 30 minutes of 10 Hz of points P6 (Neiguam) and IG11 (Quchi) - neutral point; and 30 patients in the Ondansetron and acupuncture group G (OA) where the patients received both techniques, the pharmacological one and the non-pharmacological one. The number of occurrences of NV (nausea and vomiting) was evaluated with reports completed in suitable protocol by independent evaluators in three distinct moments: in the peri-operative period in the surgery room, in the first 2 hours during the period in SRPA and in the 24 hours during the stay in the nursing ward. For the quantitative variables the analysis of variance in the completely randomized design was carried out and for the qualitative variables the Fisher's Exact test was carried out. The significance level used was 5%. 96 patients > 18 years old ASA I and II were randomized, and 6 patients were excluded due to protocol violation; of the 90 included patients, 19 were female and 71 were male. The anthropometric... (Complete abstract click electronic access below)
Doutor
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Alievi, Marcelo Meller. "Implante ósseo cortical alógeno conservado em mel na reconstrução de falha óssea diafisária em fêmur de cães." Universidade Federal de Santa Maria, 2006. http://repositorio.ufsm.br/handle/1/4070.
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Fourteen adult mongrel dogs were used to evaluate the honey preserved cortical allografts in the repair of diaphyseal femoral defect. The allografts were inserted into a 5cm segmental defect created in the mid-diaphysis of the right femur in each dog. The bones were stabilized with a 3.5mm dynamic compression plate and eight 3.5mm bone screws. Each dog was examined daily to evaluate complications and weight-bearing of the operated limb. Radiographs of the right femur were taken postsurgically and once every 15 days for the next three months. Following this, radiographs were taken once per month until the end of the research. Each two animals were euthanized after 30, 60, 90, 120, 180, 270, and 360 days. The right femur was harvested and prepared for histological evaluation. Nineteen (79.17%) of the twenty-four host-graft interfaces were radiographically healing (union). The mean time to allograft incorporation was 67.10 days (range, 45-90 days). There was no statistical difference in the allograft incorporation time between proximal and distal host-graft interfaces. It was observed Bacillus contamination in three honey samples, however, in allografts it was not verified. Good incorporation of donor graft by bone was observed histologically. Initially, there were osteoclastic activity increases in graft surfaces, and after bone formation. Complications observed were nonunion, allograft fracture, and allograft resorption. We conclude that despite the complications, honey preserved cortical allografts are a viable options to bone reconstruction.O objetivo do presente estudo foi avaliar a utilização de implante ósseo cortical alógeno conservado em mel na reconstrução de falha óssea segmentar em fêmur de cães. Foi realizada uma falha óssea de 5cm na região diafisária do fêmur direito de 14 cães adultos, sendo utilizado um implante ósseo cortical alógeno conservado em mel para a sua reconstrução. O implante foi estabilizado no leito receptor por meio de uma placa de compressão dinâmica e oito parafusos corticais de 3,5mm. Os animais foram avaliados clinicamente, verificando-se o seu estado geral, o aspecto da ferida cirúrgica e o grau de deambulação. Radiografias do fêmur direito foram realizadas no pós-operatório imediato e quinzenalmente, até o 90 dia de pós-operatório. A partir desse período, as avaliações foram mensais até os 360 dias de pós-operatório. Dois animais foram submetidos à eutanásia aos 30, 60, 90, 120, 180, 270 e 360 dias de pós-operatório, sendo o fêmur direito retirado e encaminhado para exame histológico. A porcentagem de incorporação das interfaces foi de 79,17%, e o tempo médio necessário para a incorporação foi de 67,10 dias, variando entre 45 e 90 dias. Não foi verificada diferença significativa entre o tempo de incorporação das interfaces proximal e distal. Na análise bacteriológica, foi verificado Bacillus spp. em três amostras de mel, porém, não houve crescimento bacteriano nas amostras obtidas dos implantes ósseos. Histologicamente foi verificada adequada união entre as interfaces, com atividade osteoclástica na periferia do implante seguida por osteoblástica e formação de matriz óssea. As principais complicações verificadas foram não-união, fratura e reabsorção intensa do implante. Apesar das complicações, é possível concluir que o implante ósseo cortical alógeno conservado em mel é uma opção viável para a reconstrução óssea.
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Mondino, Ludimila Nunes Zini. "Avaliação do risco de hipotensão arterial durante a indução de raquianestesia em pacientes tratados cronicamente com fármacos antihipertensivos." Niterói, 2017. https://app.uff.br/riuff/handle/1/3294.
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A Raquianestesia com bupivacaína isobárica 0,5% (BP) é amplamente utilizada para cirurgia ortopédica de artroplastia primária de quadril (AQ), e a hipotensão Arterial é uma das complicações mais freqüentes desta técnica. O objetivo deste estudo foi quantificar a incidência de hipotensão arterial em pacientes submetidos à AQ e identificar fatores de risco independentes associados ao aumento da incidência de hipotensão após a indução da raquianestesia. Estudo de caso-controle, realizado com a análise de 937 (100%) registros de anestesia de pacientes de ambos os sexos, com uso de BP e idade igual ou superior a 40 anos. De acordo com os critérios pré-definido de "hipotensão arterial" (diminuição da pressão arterial média (PAM) maior que 30% do valor da PAM na pré-indução ou quando a PAM for inferior a 70mmHg), o evento foi detectado em 35,3% (n = 284) dos pacientes incluídos na análise. O risco relativo para hipotensão em pacientes que usam inibidores da ECA ou diuréticos é de 1,66 e 1,63 vezes, respectivamente. Por análise multivariada, idade (OR-1,034), hipertensão arterial (OR-2,44) e / ou diabetes melittus (OR- 17,14) foram independentemente associados com a ocorrência de hipotensão durante a indução da raquianestesia.
Spinal anesthesia with isobaric bupivacaine 0,5% (BP) is widely used for orthopedic surgery of primary hip arthroplasty (AQ), and the hypotension is one of the most frequent complications of this technique. The goal of this study was to quantify the incidence of hypotension in patients undergoing AQ and identify independent risk factors associated with increased incidence of hypotension after induction of anesthesia. Case-Control study was conducted, with the analysis of 937 (100%) anesthesia records of patients of both sexes, use of BP and age equal or greater than 40 years. According to the predefined criteria of "hypotension" (decrease > 30% of Mean arterial blood preassure (MAP) in the pre-induction or when MAP <70 mmHg), the event was detected in 35.3% (n = 284) of the patients included in the analysis. The relative risk for hypotension in patients who use ACE inhibitors or diuretics is 1.66 and 1.63 times respectively. By multivariate analysis, age (OR-1,034), hypertension (OR-2,44) and/or presence of diseases diabetes (OR-17,14) were independently associated with the occurrence of hypotension during induction of anesthesia.
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Sjöling, Mats. "Experiences of abandonment and anonymity among arthroplastic surgery patients in the perioperative period : some issues concerning communication, pain and suffering." Umeå : Kirurgisk och perioperativ vetenskap, 2005. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-509.
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Gouvea, Aline Silva. "Avaliação de microplacas de titânio em fraturas de tibiotarso em pombos domésticos (Colimba livia)." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2010. http://hdl.handle.net/10183/25021.
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Entre os problemas cirúrgicos das aves, as fraturas são os de maior prevalência. Em virtude das variações no tamanho, peso, anatomia óssea peculiar, alta incidência de fraturas complicadas e às diferentes demandas funcionais entre espécies e indivíduos, não foi possível estabelecer ainda um método ideal de osteossíntese para os ossos longos das aves. Por isso, diversos estudos têm sido realizados buscando um método adequado para as diferentes necessidades desses animais. Microplacas de titânio comumente utilizadas em cirurgias maxilofaciais de humanos foram empregadas recentemente na osteossíntese de aves, porém com poucos resultados disponíveis. O objetivo do presente estudo foi avaliar a utilização das microplacas de titânio no tratamento de fraturas experimentais de tibiotarso em pombos domésticos (Columba livia). Foram utilizadas 30 aves, adultas, machos e fêmeas, com 7 meses de idade, pesando entre 400 a 500 gramas, oriundas do Biotério Central da Universidade Federal de Santa Catarina (UFSC). Os animais foram separados aleatoriamente em 3 grupos de dez animais, sendo que no grupo 1 foi utilizado uma microplaca de titânio com 6 furos e espaçador central, no grupo 2 com 8 furos sem espaçador central e no grupo 3 com 8 furos com espaçador central. Após avaliação clínica, as aves foram submetidas a osteotomia médio-diafisária no tibiotarso direito para colocação das diferentes configurações de microplaca de titânio, sendo fixadas com microparafusos de titânio com 7mm de comprimento. Os animais foram avaliados clinica e radiograficamente até os 90 dias de pós-operatório. Após esse período, foi realizada eutanásia em 2 animais de cada grupo. Em todos animais foi observado a consolidação óssea, no grupo 1 o tempo médio e o desvio padrão foram 32,9±9,9; no grupo 2 30,8±6,7 e no grupo 3 26,6±6,4 dias, não havendo diferença estatística entre os grupos. O envergamento do implante foi a complicação mais frequente. A configuração da microplaca resultou em diferença estatística significativa em relação a deambulação e ao grau de envergamento nos diferentes grupos. Sendo que no grupo 3 houve maior precocidade no apoio do membro e menor grau de envergamento em relação aos outros grupos. Histologicamente foi verificado formação de calo ósseo em todos animais e presença de tecido ósseo ao redor da microplaca e microparafusos. Apesar das complicações observadas as microplacas de titânio são uma opção para osteossíntese de tibiotarso em aves de médio porte.Among the surgical problems in birds, the fractures are the most prevalent. Due to variations in size, weight, peculiar bone anatomy, high incidence of complicated fractures and the functional demands of different species and individuals, is not possible yet to establish an ideal method for osteosynthesis of long bones in birds. Therefore, several studies have been conducted looking for a suitable method for the different needs of these animals. Titanium microplates commonly used in human maxillofacial surgery have been recently employed in osteosynthesis of birds, but with few results available. The aim of this study was to evaluate the use of titanium microplates in the treatment of tibiotarsus fractures in pigeons (Columba livia) 30 birds were used, adult males and females, with 7 months old, weighing from 400 to 500 that came from the Animal Center Facility of the Federal University of Santa Catarina (UFSC). The animals were divided into 3 groups with ten animals each. In group 1 a titanium microplate with 6 holes and a central spacer were used; in group 2 a titanium microplate with 8 holes without a spacer in the center; in group 3 a titanium microplate with 8 holes with central spacer. After clinical evaluation, the birds were submitted to mid-diaphyseal osteotomy in the right bone for placement of different configurations of the titanium plate, and fixed with titanium microscrews 7mm long. The animals were evaluated clinically and radiographically until 90 days postoperatively. After this period, euthanasia was performed in 2 animals from each group. In all animals was observed bone healing and in group 1 the mean and standard deviation were 32.9 ± 9.9, in group 2 30.8 ± 6.7 in group 3 26.6 ± 6.4 days, not having statistical difference in healing time between groups. The bending of the implant was the most common complication. The configuration of the plate resulted in a statistically significant difference in relation to walking and the degree of bending in different groups. Moreover, in group 3 there was higher precocity in the member suppor and a lower degree of bending in relation to other groups. Histologically it was verified the formation of the callus in all animals and the presence of bone tissue around the plate and microscrews. Despite the complications of titanium microplates, they are an option for osteosynthesis of tibiotarsus in birds of medium size.
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BARAÚNA, JÚNIOR Durval. "Técnica de interligação extracapsular femoro-fabelo-tibial na ruptura do ligamento cruzado cranial em cães – achados clínicos e radiográficos." Universidade Federal Rural de Pernambuco, 2006. http://www.tede2.ufrpe.br:8080/tede2/handle/tede2/5337.
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Durval Barauna Junior.pdf: 734474 bytes, checksum: 741df0e4a7b2278f3858f4d6f5cb23db (MD5)Made available in DSpace on 2016-08-15T15:51:58Z (GMT). No. of bitstreams: 1 Durval Barauna Junior.pdf: 734474 bytes, checksum: 741df0e4a7b2278f3858f4d6f5cb23db (MD5) Previous issue date: 2006-02-16
Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES
Cranial cruciate ligament rupture (CCLR) is a common disease in dogs that cause joint instability resulting in lameness and rapid development of degenerative joint disease (DJD). The aim of this work was evaluate the results of a new technique of restoration of joint femur-fabelo-tibial stability for the treatment of spontaneous CCLR in dogs, using for this purpose clinical and radiographic features. Sixteen joint of fifteen dogs were operated, six male and nine female, with weight between 2.3 to 53.0 kg (median 8.4 kg) and age between 1 year and 10 months to 11years (mean 6.1± 2.8 years), miscellaneous breed and that the interval between the suspect of lesion by the owners and the surgical procedures varied between 3 to 365 days (mean 123 ±131.5 days), were submitted to the surgical correction though the extracapsular femur-fabelo-tibial interconnection technique. The tibial compression radiographs and the distal displacement of the popliteal sesamóide were 100 per cent efficient and sensitive to the diagnostic of CCLR. In anyone of the sixteen operated joint were observed difficulty or intra-operative complication. In 3 dogs were observed discreet instability (until 2mm) in the cranial drawer test and the tibial compression test, until 180 days; however these dogs didn’t show any damage in the functional evaluation in this period. In another three operated joints a discreet degree of cranial drawer remains until the 30º day, disappearing completely at 90 days. After 30 days of the surgery all the animals showed a improvement (P≤0.05) in the evaluated parameters, with progressive improvement until the 90 days after the surgical. There was no more change statistically significant, although observed clinical improvement until 180 days, when all the animals showed complete functional recovery. The increase (90 and 180 days) in the thigh perimeter weren’t statistically significant. Among 20 joints evaluated (operated or non operated) radiographically between 0 and 180 day, the evolution of degenerative changes was seen in 90 per cent of joints. It was possible conclude that the extracapsular femur-fabelo-tibial interconnection technique evaluated in this experiment is efficient in the immediate stabilization of joint with CCLR, offering functional recovery for reduce the cranial displacement and internal rotation of the tibia, however it not arrest the osteoarthritis progression. Secondarily it can be conclude that: the nylon strands despite its elasticity and plastic deformation can produce a discreet clinical instability, it continue been a good option for joint stabilization because of its low cost, feasibility of sterilization, no production of fistulous tracts and disposability of different diameters with variable resistance adequate for the animal size. Thick strands of difficult management can be arrest through by crimp clamp system with relative facility. Another important conclusion is that like the radiographic tibial compression test, the orthopedic evaluation with tibial compression test and cranial drawer test is 100 per cent efficient in the diagnosis of CCLR, in dogs.
A ruptura do ligamento cruzado cranial (RLCC) é uma afecção comum em cães, geradora de instabilidade do joelho, resultando em claudicação e rápido desenvolvimento de doença articular degenerativa. O objetivo deste trabalho foi avaliar os resultados de uma nova técnica de reconstituição da estabilidade da articulação femoro-tíbio-patelar, como forma de tratamento da RLCC espontânea em cães, utilizando para isto avaliações clínicas e radiográficas. Foram operados 16 joelhos de 15 cães afetados, sendo seis machos e nove fêmeas, com peso variando entre 2.3 a 53.0 kg (mediana 8.4 kg), idades entre um ano e 10 meses a 11 anos (média 6.1 ± 2.8 anos), de raças variadas e onde o intervalo entre a suspeita da lesão por parte dos proprietários e os procedimentos cirúrgicos variaram entre três a 365 dias, (média 123 ± 131.5 dias), que foram submetidos à correção cirúrgica através da técnica de interligação extracapsular femoro-fabelo-tibial. O exame radiográfico sob teste de compressão tibial e a avaliação do deslocamento distal do sesamóide do poplíteo foram 100% eficientes e sensíveis, para o diagnóstico da RLCC. Em nenhum dos 16 joelhos operados foram observadas dificuldades ou complicações trans-operatórias. Em três cães foi observada instabilidade discreta (até 2mm) no movimento de gaveta cranial (MGC) e no teste de compressão tibial, até 180 dias; entretanto estes cães não apresentaram prejuízos na avaliação funcional neste mesmo período. Em outros três joelhos operados um grau discreto de MGC permaneceu até o trigésimo dia desaparecendo completamente no retorno aos 90 dias. Aos 30 dias após a cirurgia todos os animais apresentavam uma melhora (P≤ 0.05) nos parâmetros avaliados, com progressão da melhora até os 90 dias após a cirurgia, a partir daí não houve mais modificação estatisticamente significante, embora tenha sido observada melhora clínica até os 180 dias, quando todos os animais apresentaram plena recuperação funcional. Os incrementos (90 e 180 dias) no perímetro da coxa não foram estatisticamente significantes. Dos 20 joelhos avaliados (operados e não operados) radiograficamente nos dias zero e 180, a evolução das alterações degenerativas foi observada em 90% destes. Foi possível concluir que a técnica de interligação extracapsular femoro-fabelo-tibial avaliada neste experimento é eficiente na estabilização imediata da articulação com RLCC, oferecendo recuperação funcional ao reduzir o deslocamento cranial e a rotação interna da tíbia, porém que não impede a progressão da osteoartrite. Secundariamente pode-se concluir que: o fio de náilon, apesar da sua elasticidade e deformação plástica poder produzir uma discreta instabilidade clinica, este continua sendo uma boa opção para estabilização articular em virtude do seu baixo custo, facilidade de esterilização, não produzir tratos fistulosos, possuir diferentes diâmetros com resistências variadas adequadas ao tamanho do animal. Fios grossos de difícil manuseio podem ser presos através de grampos tubulares com relativa facilidade. Outra conclusão importante é que assim como o exame radiográfico sob o teste de compressão tibial, o exame ortopédico com testes de compressão tibial e de movimento de gaveta cranial é 100% eficiente no diagnóstico da RLCC, em cães.
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Sadloňová, Lujza. "Mezinárodní marketingový mix společnosti vstupující na zahraniční trh." Master's thesis, Vysoké učení technické v Brně. Fakulta podnikatelská, 2021. http://www.nusl.cz/ntk/nusl-443116.
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The diploma thesis focuses on the issue of the international marketing mix of a Czech company entering the German market. It specifies the motives and forms of entering the foreign market and defines the individual components of the international marketing mix. It contains a suggestion for a suitable form of entry, elaboration of an international marketing mix of the company and based on a survey of competitive prices of selected products, it recommends choosing a suitable pricing strategy when entering a foreign market.
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Nioti, Antonia Evgenia. "Additive Manufacturing in Orthopedics and Craniomaxillofacial Surgery for the Development of High-risk Custom-made Implants : A Qualitative Study of Implementation Factors from a Multi-stakeholder Perspective." Thesis, Uppsala universitet, Industriell teknik, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-424980.
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Additive manufacturing (AM) has enabled the possibility for the hospitals to become their own implant producers developing implants that are tailored to patient’s anatomy. Despite the enormous potential of custom-made implants there are challenges that complicate the implementation of them into clinical practice. The aim of this research is to (1) identify the main driving forces and barriers for the delivery of custom-made implants; (2) explore staff stakeholder views and practices related to the implementation of AM in surgery for the development of custom-made implants; (3) formulate recommendations on how to cope with the implementation challenges. The research method was an explorative qualitative study consisted of a literature review on the challenges of custom-made implants in clinical applications coupled with the collection and inductive analysis of empirical data. The empirical study was based on ten semi-structured interviews conducted among both domestic and international hospital managers medical doctors and research engineers. The consolidated framework for implementation research (CFIR) was utilized for data collection. Using the five domains of CFIR, the following results were obtained: (1) Characteristics of individuals: Most research participants indicated a positive attitude towards the innovation expressing self-efficacy to its use; (2) Intervention characteristics: Custom-made implants were perceived to have a relative advantage in surgical practice due to their high degree of observability and geometrical adaptability providing increased surgical quality, perfect patient fit and better understanding of pathologies. However, high implementation costs, low degree of trialability and high degree of complexity in the development process were regarded as drawbacks of the innovation; (3) Outer setting: the regulatory uncertainty and lack of reimbursement limit the accessibility of custom-made implants to low income populations; (4) Inner setting: scarcity of resources, staff resistance to change, insufficient management support, communication difficulties, limited access to educational materials and training opportunities as well as lack of time and innovative capacity were regarded by the majority of participants as implementation barriers; (5) Process: central for the success of implementation is the need for a coherent implementation plan and evaluation process as well as the engagement of key stakeholders such as hospital managers, payers, regulatory and implementation advisors. This dissertation proffers a deeper understanding of the implementation issues related to custom-made implants and offers preliminary recommendations on how to cope with implementation impediments through the use of Rogers diffusion of innovation coupled with concepts from the field of organizational change and innovation management including Clayton’s disruptive innovation.
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Castro, Patricia Ferreira de. "Afecções cirúrgicas em aves: estudo retrospectivo." Universidade de São Paulo, 2010. http://www.teses.usp.br/teses/disponiveis/10/10137/tde-09022011-144207/.
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As aves representam a grande maioria das espécies da fauna silvestre mantidas como animais de companhia em nosso meio e respondem diretamente pela crescente demanda pelo atendimento médico veterinário. O avanço na área da anestesiologia viabilizou a realização de procedimentos cirúrgicos mais longos e complexos e contribuiu para o desenvolvimento e aprimoramento da técnica operatória em aves, contudo, dados nacionais de casuística relacionados às afecções cirúrgicas de aves ainda são inexistentes. Assim, este estudo avaliou retrospectivamente as operações realizadas em aves no Serviço de Cirurgia de Pequenos Animais do Hospital Veterinário da Faculdade de Medicina Veterinária e Zootecnia da Universidade de São Paulo, entre janeiro de 2000 a junho de 2008, com o objetivo de identificar as afecções cirúrgicas, apresentar sua ocorrência e distribuição de freqüência segundo as ordens e espécies acometidas, avaliar as técnicas operatórias empregadas e comparar os dados obtidos com os achados da literatura. De um total de 90 operações realizadas para diagnóstico e/ou tratamento de afecções, 27 foram ortopédicas e 63 de tecidos moles. Quanto ao percentual de operações ortopédicas realizadas segundo as diferentes ordens, observou-se: Psittaciformes 85,19%, Piciformes 7,41%, Anseriformes 3,70% e Falconiformes 3,70%. Para as operações de tecidos moles os psitaciformes representaram 92,06%, columbiformes 3,17%, passeriformes 3,17% e anseriformes 1,59%. Entre os tipos de afecções ortopédicas encontradas as fraturas apresentaram a maior ocorrência (88,89%), seguidas de luxação (3,70%), avulsão traumática de extremidade (3,70%) e artrite/osteomielite (3,70%), o membro pélvico foi o mais acometido e o tibiotarso o osso mais fraturado. Dentre as afecções cirúrgicas de tecidos moles as neoplasias apresentaram a maior ocorrência (30,16%), seguida das neoformações cutâneas ou de anexos não neoplásicos (17,46%), neoformações cutâneas sem diagnóstico (7,94%), distocia (7,94%), fístula de papo (7,94%), hérnia abdominal (4,76%), sinusite (4,76%), gangrena de extremidade de membros (3,17%), perfuração de esôfago (3,17%), prolapso de cloaca (3,17%), Necrose avascular de dígito (1,59%), ferida na região da quilha (1,59%), perfuração de cavidade celomática (1,59%), neoformação em cavidade celomática sem diagnóstico (1,59%), corpo estranho em trato gastrointestinal (1,59%) e otite (1,59%). O lipoma foi a neoplasia e o cáseo a neoformação não neoplásica mais freqüentes. A distribuição das afecções cirúrgicas segundo as espécies acometidas mostrou o grupo dos papagaios, representado em sua maioria por espécies do gênero Amazona, como prevalente. A fixação interna com pino intramedular foi a técnica operatória mais utilizada nas afecções cirúrgicas ortopédicas e apresentou elevado índice de retorno à função para tratamento das fraturas. A exérese foi a técnica operatória mais utilizada nas afecções cirúrgicas de tecidos moles e mostrou índices elevados de cura e baixa ocorrência de recidivas. O conhecimento das afecções cirúrgicas e das espécies de aves mais acometidas, bem como dos resultados obtidos com as técnicas operatórias empregadas, acrescentam informações para aqueles que já atuam nesta área e servem como indicador de estudo para futuros cirurgiões de avesBirds represent one of the main wildlife species kept as pets in our country and respond directly by the growing demand for health care veterinarian. Advancement in the field of anesthesiology has enabled the surgical procedures longer and more complex and contributed to the development and refinement of surgical technique in birds. However, national data series related to surgical disorders in birds are still poor. This study assessed retrospectively the avian operations at the Service of Small Animal Surgery - Veterinary Hospital of the School of Veterinary Medicine and Animal Science of the University of São Paulo, from January 2000 to June 2008. The focus was to identify the surgical disorders, occurrence and frequency distribution according to orders and species affected, also we evaluated the surgical techniques employed and compared the results with the literature findings. A total of 90 operations were performed for diagnosis or treatment of surgical disorders. Of these 27 were orthopedic and 63 soft tissue surgeries. Considering the orthopedic surgeries performed according to orders we observed: Psittaciformes 85,19%, Piciformes 7,41%, Anseriformes 3,70% and Falconiformes 3,70%. And for the soft tissues operations the Psittaciformes represented 92,06%, Columbiformes 3,17%, Passeriformes 3,17% and Anseriformes 1,59%. Fractures presented the highest incidence among orthopedic disorders (88,89%), followed by luxation (3,70%), traumatic avulsion of the end (3,70%) and arthritis/osteomyelitis (3,70%). The pelvic limb was the most affected member and the tibiotarsus was the most commonly fractured bone. Among the surgical disorders of soft tissue, neoplasms accounted for 30,16%, followed by cutaneous neoformation or annexes nonneoplastic (17,46%), cutaneous neoformations undiagnosed (7,94%), dystocia (7,94%), fistula crop (7,94%), abdominal hernia (4,76%), sinusitis (4,76%), gangrene of the extremity members (3,17%), esophageal perforation (3,17%), prolapse of cloaca (3,17%), \"avascular necrosis of digit (1,59%), wound in the region of the keel (1,59%), perforation of the coelomic cavity (1,59%), neoformation in the coelomic cavity without a diagnosis (1,59%), foreign body in the gastrointestinal tract (1,59%) and otitis (1,59%). Lipoma and caseous were the most frequent cancer and non-neoplastic neoformation observed, respectively. The distribution of surgical disorders according to species affected showed that the \"group of parrots\", mainly represented by species of Amazonas genus, was prevalent. Internal fixation with intramedullary pin was the technique most often used in orthopedic surgical disorders and showed a high rate of recovery of limb function. The excision was the technique mostly used in the surgical disorders of soft tissue and presented high rates of cure and low recurrence. Knowledge of surgical and bird species most affected, and the results obtained with the surgical techniques employed, add information for those who works in this area and will be an indicator for future surgeons of birds
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Гортинська, Олена Миколаївна, Елена Николаевна Гортинская, Olena Mykolaivna Hortynska, О. В. Калінкевич, and Г. О. Логвинюк. "In-vitro деградація нової двохфазної ГАП/ТКФ кераміки." Thesis, Сумський державний університет, 2016. http://essuir.sumdu.edu.ua/handle/123456789/44893.
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CHIORATTO, Ricardo. "Exame radiográfico transoperatório na cirurgia ortopédica de cães e gatos." Universidade Federal Rural de Pernambuco, 2010. http://www.tede2.ufrpe.br:8080/tede2/handle/tede2/5831.
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Submitted by (edna.saturno@ufrpe.br) on 2016-11-03T12:20:51Z
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The use of radiographic visualization of static procedure using, are guiding means to transoperatory implantation of orthopedic element, especially where direct visualization is not possible. The aim of this study was verify, the provents of the transoperatory radiographic procedure in surgery of bone fractures, of dogs and cats. A total of 100 animals, 81 dogs and 19 cats with bone fractures, were used. The first x-ray was obtained after the surgeon had reduced the fracture and/or positioned the metal implants. From the analysis of this transsurgical exam and osseous estructures, if the metalic implants and bone reductions were in absolute accuracy with the principles of orthopedic surgery, the surgeon would conclude the surgery, but if these were not in appropriate place, the necessary arrangements had to be made to relocate it in the right place, and thus more transoperatory radiographic exams were made up the observation of the perfect alignment, positioning or coaptation of fractures and the correct placement of orthopedic implants .It was found that after the transoperatory radiographic examination additional adjustments were necessary for repositioning of metallicimplants and/or bone structures in 95% of procedures. In view of the results, we can conclude that the use of transoperatory radiographic examination in orthopedic surgery of dogs and cats, regardless of the surgeon, animal species or fractured bone is important on the final result of the reductions and stabilizations of fractures, allowing greater efficiency in the placement of the osseous fragments and surgical implants. More specifically in the closed stabilizations or through minimal invasive approach, with the insertion of intramedullary pins and in the cominutive and obliquous type located in the humerus, tibia and calcaneus.
A utilização de imagem radiográfica estática durante o procedimento cirúrgico é um meio de orientação transoperatória que proporciona maior precisão na colocação de implantes ortopédicos, bem como a avaliação do grau de coaptação e estabilização dos fragmentos da fratura, principalmente nas reduções fechadas, onde a visualização direta não é possível. Este trabalho teve como objetivo verificar a utilidade do exame radiográfico transoperatório na cirurgia reparadora de fraturas, previamente diagnosticadas, em cães e gatos. Foram utilizados 100 animais, 81 cães e 19 gatos, com fraturas ósseas, sendo obtido o primeiro exame radiográfico logo após o cirurgião ter reduzido à fratura e posicionado os implantes metálicos. A partir da análise dos exames transoperatórios, se os implantes metálicos e as reduções ósseas estivessem em absoluta exatidão com os princípios da cirurgia ortopédica, o cirurgião concluiria a cirurgia; caso contrário seriam tomadas as providências necessárias para reposicioná-los corretamente, devendo-se assim realizar mais exames radiográficos transoperatórios até a observação do perfeito alinhamento, aposicionamento ou coaptação dasfraturas e a apropriada localização dos implantes ortopédicos. Foi verificado que após o primeiro exame radiográfico transoperatório foram necessários ajustes adicionais para reposicionamento dos implantes metálicos e ou estruturas ósseas em 95% dos procedimentos. Pode-se concluir que a utilização desse exame em ortopedia de cães e gatos, independente da espécie é importante, no resultado final das reduções e estabilizações de fraturas, por possibilitar uma maior precisão no posicionamento dos fragmentos ósseos e dos implantes, principalmente nas estabilizações fechadas ou por abordagem minimamente invasiva, com inserção de pinos intramedulares, e nas do tipo oblíqua e cominutiva e nas situadas no úmero, tíbia e calcâneo.
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Ballesteros, Betancourt José Roberto. "Estudio biomecánico comparativo de diferentes técnicas de reparación de las lesiones del flexor digitorum profundus en la zona I de la mano." Doctoral thesis, Universitat de Barcelona, 2019. http://hdl.handle.net/10803/669887.
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INTRODUCCIÓN:
La reinserción mediante la técnica de “pullout” de Bunnell modificada se ha considerado la técnica de referencia para la reparación de las lesiones tendinosas del tendón flexor de los dedos en la zona 1. La técnica ideal sería una que no requiriera más incisiones en la pulpa, no creara una conexión externa o dañara la matriz ungueal. Finalmente, si es posible: un procedimiento simple, reproducible y rentable. Con esto en mente, Teo publicó una técnica alternativa para la reinserción del tendón. En este estudio comparamos las propiedades biomecánicas entre la técnica de sutura intraósea de Teo y la técnica de “pullout” de Bunnell modificada en un modelo de cadáver criopreservado después de realizar la reinserción del tendón en la falange.
MATERIAL Y MÉTODO:
Se asignaron aleatoriamente 36 dedos de cadáveres criopreservados a tres grupos (Teo, Bunnell y grupo de control). Se sometieron a un protocolo de carga cíclica de 2 a 15 N de tensión a 25 mm/min, durante 500 ciclos. La formación de distanciamiento en el sitio de reparación se evaluó cada 100 ciclos y finalmente, las muestras se sometieron a un protocolo de carga hasta el fallo. Se generaron gráficos de desplazamiento de carga para calcular el distanciamiento de la reparación, la fuerza necesaria para generar un distanciamiento de 2 mm, el desplazamiento bajo 20 N de tensión, la fuerza máxima necesaria para el fallo del sistema y la rigidez del sistema.
RESULTADOS:
El desplazamiento después de 500 cargas cíclicas fue significativamente menor en el grupo de Teo (9.33 mm [SD 1.76]) que en el grupo de Bunnell (13.81 mm [SD 2.08]). El grupo de Teo requirió una tensión de 75.5 N [SD 12.5] para la ruptura del sistema, mientras que el grupo de Bunnell requirió 57.3 N [SD 5.4].
CONCLUSIONES:
El grupo Teo presentó un 30% menos de distanciamiento en el protocolo de carga cíclica en comparación con la técnica de “pullout” modificada de Bunnell. Para el fallo de la sutura de Teo, fue necesario aplicar un 31% más de carga en comparación con la técnica de Bunnell.BACKGROUND: Surgical repair by fixation into the phalanx is the usual method in the treatment of lesions of the deep flexor tendon in zone 1 of the hand. A wide variety of techniques have been described for the repair, including the Bunnell pullout technique and its modifications; by fixation with one or two suture anchor and combinations of transosseous and anchor sutures. In vitro cyclic testing and a load to failure test were used to compare the repair of a flexor digitorum profundus tendon using the transosseous technique of Teo or a modified Bunnell 2-strand pullout technique using a braided polyester suture. METHODS: Thirty-six fresh-frozen cadaveric fingers were divides randomly into 2 repair groups and a control group: a transosseous technique of Teo with 3-0 braided polyester suture or a modified Bunnell technique with a 3-0 braided polyester suture, and a control group with the flexor intact. After repair, the samples and the control group were loaded cyclically from 2 to 15 N at 25 mm/min, for a total of 500 cycles. Gap formation at the tendon-bone interface and grip-to-grip distance were assessed every 100 cycles. Specimens were tested to failure at the end of 500 cycles. RESULTS: Teo group had approximately a 30% smaller gap every 100 cycles and needed 30% more energy to obtain a 2 mm gap than the modified Bunnell group. Displacement after 500 cyclic loads was significantly lower in the Teo group (9.33 mm [SD 1.76]) than in the Bunnell group (13.81 mm [SD 2.08]) . CONCLUSION: We have found statistical significant biomechanical differences in failure loads and displacements between the two repair technique after rupture of the profundus flexor tendon. For the failure of the Teo suture, it was necessary to apply 31% more load than the Bunnell technique.
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Closa, Rusinés Conxita. "La Rehabilitació domiciliària: Anàlisi en l’artroplàstia total de genoll." Doctoral thesis, Universitat de Barcelona, 2017. http://hdl.handle.net/10803/482235.
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Encara que majoritàriament la rehabilitació després d’una artroplàstia total de genoll es duu a terme a l’ambulatori o a l’hospital, en els ultims anys, diferents estudis suggereixen que la rehabilitació domiciliària pot representar una alternativa possible a aquesta pràctica clinica habitual. D’aquesta manera, es posa de manifest un interès creixent per fer tractaments de rehabilitació fora de les institucions hospitalàries o ambulatòries convencionals.
Malgrat tot, el seu cost-efectivitat comparatiu encara no és del tot conegut, tant pel que fa a l’impacte econòmic com al model asistencial més idoni per a la seva implementació.
Per tot això, en aquesta tesi s’analitza si l’atenció domiciliària de rehabilitació en pacients aguts post hospitalització per artroplàstia total de genoll permet una major efectivitat i una bona resposta clínica en termes de reducció de dependència, rigidesa, dolor i millora de la
seva capacitat funcional, aixi com una major eficiència amb un estalvi significatiu de costos.
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Ito, Natália Ayres Pontual. "Orientações na alta hospitalar a partir das necessidades sentidas por pacientes submetidos à cirurgia ortopédica." Pontifícia Universidade Católica de São Paulo, 2017. https://tede2.pucsp.br/handle/handle/20076.
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Submitted by Filipe dos Santos (fsantos@pucsp.br) on 2017-05-08T11:34:28Z
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The discharge planning is based on the needs of the patient, including their learning needs, covering the period from admission to discharge, with a multi-professional approach. Among the nurses' activities, discharge planning is an important step in the systematization of nursing care. This study aimed identify the orientation needs felt by orthopedic surgical patients at hospital discharge, to know the patients´ feelings about receiving orthopedic discharge, to know the patients' perceptions of the guidelines received at discharge, to identify the professional involved in the process of orientation of discharge and to contribute to the construction of guideline to be made available to the patient and his family in the moment of discharge. Twenty patients submitted to orthopedic surgery participated in an oral interview, which was recorded in audio, guided by a script of guiding questions and a form with clinical and socio-demographic data. The content of the interviews was organized according to the reference of the Discourse of the Collective Subject and for the analysis and interpretation of these data the content analysis in thematic analysis mode was used. OREM Self-Care Theory was used for the categorization of orientation needs. Clinical and socio-demographic data were analyzed according to the frequency of their variables. The results showed that the profile of the participants is composed mainly of men, aged between 18 and 45 years, married and with full secondary education. The SUS was the prevalent health agreement and osteosynthesis was the most frequent procedure. Happiness was the main feeling related to hospital discharge. The most mentioned doubts and orientation needs were all about rehabilitation, illness/accident insurance and recovery time. The guidelines were based on universal self-care requisites (feeding, hydration, hygiene, dressing protection), health deviation in self-care requisites (rehabilitation, rest, dressing, movement, return, hand positioning, medication, intercurrence, treatment of another fracture) and developmental self-care requisites (recovery time). The guidelines were offered mainly by a physician, accompanied or not by a nurse, evidencing the absence of systematization in the discharge planning and the predominantly clinical focus of these guidelines. The survey of the orientation needs of the interviewees supported the elaboration of infographic to advise the verbal guidelines offered at the time of discharge and to be consulted at home. Our expectation that the results of the study contribute to the professionals involved in the discharge process, so that they may rethink their practices considering, above all, the systematized discharge plan
O planejamento de alta se dá a partir das necessidades do paciente, incluindo suas necessidades de aprendizado, abrangendo o período compreendido entre o momento da admissão até o momento da alta hospitalar, com abordagem multiprofissional. Dentre as atividades do enfermeiro, o planejamento de alta é etapa importante da sistematização da assistência de enfermagem. O estudo teve como objetivos conhecer os sentimentos de pacientes submetidos a cirurgia ortopédica ao receber alta hospitalar, identificar as necessidades de orientação sentidas por esses pacientes, conhecer suas percepções sobre as orientações recebidas durante a alta hospitalar, identificar o (s) profissional (is) envolvidos no processo da orientação de alta e construir coletivamente um material didático a ser disponibilizado ao paciente e sua família no momento de alta. Foram sujeitos da pesquisa 20 pacientes submetidos à cirurgia ortopédica que participaram de uma entrevista oral, gravada em áudio, orientada por um roteiro de questões norteadoras e de um formulário com dados clínicos e sócio demográficos. O conteúdo das entrevistas foi organizado segundo o referencial do Discurso do Sujeito Coletivo e para análise e interpretação desses dados foi utilizada a análise de conteúdo, modalidade análise temática. Para a categorização das necessidades de orientação foi utilizada a Teoria do Autocuidado de OREM. Os dados clínicos e sócio demográficos foram analisados segundo a frequência de suas variáveis. Os resultados mostraram que o perfil dos participantes é composto majoritariamente de homens, com idade entre 18 e 45 anos, casados e com ensino médio completo. O SUS foi o convênio de saúde prevalente assim como as osteossínteses foram os procedimentos mais frequentes. Felicidade foi o principal sentimento relacionado a alta hospitalar. As dúvidas e necessidades de orientação mais referidas foram alusivas a reabilitação, auxílio doença/seguro por acidente e tempo de recuperação. As orientações recebidas versaram sobre requisitos de autocuidado universais (alimentação, hidratação, higiene, proteção do curativo), requisitos de autocuidado nos desvios de saúde (reabilitação, repouso, curativo, movimentação, retorno, posicionamento da mão, medicação, intercorrência, tratamento de outra fratura) e requisitos de autocuidado desenvolvimentista (tempo de recuperação). As orientações foram ofertadas principalmente pelo médico, em conjunto ou não com o enfermeiro evidenciando a ausência de sistematização no planejamento de alta e o enfoque predominantemente clínico dessas orientações. O levantamento das necessidades de orientação dos entrevistados subsidiou a construção de um infográfico para assessorar as orientações verbais ofertadas no momento da alta e para ser consultado em casa. Esperamos que os resultados do estudo contribuam para que os profissionais envolvidos no processo de alta repensem suas práticas considerando, sobretudo, o planejamento sistematizado de alta