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En la actualidad, la Cirugía Mayor Ambulatoria está ampliamente aceptada en la comunidad quirúrgica. Ya no es la alternativa, sino la indicación primaria para muchos procesos quirúrgicos, y en tal sentido hoy constituye una línea estratégica clave de nuestro sistema sanitario al evidenciarse que hasta el 70–75 % de los procesos quirúrgicos son susceptibles de ambulatorización. Esto se sustenta en los múltiples beneficios que la CMA ha demostrado tanto para los pacientes y familiares como para el sistema sanitario. Existe una muy importante variabilidad entre hospitales. Las infraestructuras y recursos destinados a la práctica de la CMA difieren de un hospital a otro, desde la existencia de Unidades específicas de nueva creación en diversos hospitales hasta la ausencia de recursos definidos para CMA y sin circuitos concretos en otros centros, haciendo difícil la progresión de la CMA. Sirva de ejemplo la cirugía de la hernia inguinal como procedimiento básico en Cirugía General para su resolución en régimen ambulatorio; mientras que en algunas comunidades está en torno al 70 % en otras no llega al 25 %. Esta enorme versatilidad que define en su conjunto la práctica de la CMA deberá tender a Este completo Manual de Cirugía Mayor Ambulatoria, en el que han participado múltiples especialistas y residentes de Anestesia y Cirugía General, aborda desde la perspectiva actual y de modo muy completo los diversos aspectos clínicos y de gestión que configuran la Unidad homogeneizarse mediante el interés real y la implicación de las instituciones sanitarias, aplicando criterios diferenciadores de las diversas modalidades de gestión quirúrgica: cirugía menor, CMA, cirugía de recuperación prolongada, cirugía de corta estancia, etc., pues las necesidades organizativas y estructurales, la cuantificación de cada una de estas modalidades y su consumo de recursos son distintos. Aplicando además directrices comunes, requisitos básicos y elementos de incentivación profesional en todos los centros para la práctica de la CMA. Y exigiendo el cumplimiento de los criterios de calidad básicos y resultados. La iniciativa de editar este Manual de Cirugía Mayor Ambulatoria por parte de los Dres/as. Turiño Luque, Moreno Góngora, Martínez Férriz y Sedeño Martín, del Hospital Regional Universitario de Málaga, constituye un magnífico ejemplo a seguir en todas las Unidades de Cirugía Mayor Ambulatoria y es una muestra más del interés de esta Unidad en el desarrollo correcto de esta modalidad de gestión de los pacientes quirúrgicos. La decisión de elaborar este manual contribuye sin duda a disminuir la variabilidad en la práctica de la CMA. Si bien, en todos los Servicios de Cirugía General es importante la protocolización de su actividad, en las Unidades de CMA es imprescindible, pues en ellas confluyen muy distintos actores, especialidades y estamentos.
Cardiothoracic Surgery in the Elderly: Evidence Based Practice is an important and timely book that reflects the thoughtful work of pioneers in geriatric surgery. It encompasses their knowledge related to geriatric surgery, and their reflections and guidance on the rapidly accumulating knowledge related to improving the health and surgical care of seniors. This book provides a scholarly review of the constantly expanding knowledge base about cardiovascular and thoracic surgery in seniors. The book follows a logical sequence covering general aspects of care, cardiac surgery and thoracic surgery. Chapters are focused on common, devastating and often missed complications of surgical care in the seniors. These include delirium, depression, pressure sores, functional losses, incontinence, volume depletion and asymptomatic or atypical complications -myocardial infarction, post-operative diarrhea, urinary track infections and pneumonia. Each is expertly reviewed. Strategies to help the surgeons and the surgical team anticipate, recognize and effectively prevent or manage such problems are discussed and the evidence basis for such strategies is provided. Cardiothoracic Surgery in the Elderly: Evidence Based Practice is particularly timely and the first to review the substantial body of knowledge that has been developed in recent years related to geriatric cardiothoracic surgical problems. It catalogs well the expanding knowledge basis for achieving successful surgical outcomes in the very old. It provides a most useful resources for cardiovascular thoracic surgeons in training and those already in practice.
This book presents current evidence in an Enhanced Recovery Programme context, and provides a common sense approach to using the array of available analgesia techniques appropriately in major abdominal surgery. Current pain relief options are discussed, many of which have been described only in the last ten years. Topics covered range from the now widespread use of portable ultrasound machines to an appreciation of the value of some older drugs in a new context. Analgesia for Major Abdominal Surgery is aimed at anesthetists, acute pain teams, and acute pain nurses, as well as colorectal, hepatobiliary, urological and gynecological surgeons.
This edition of the Manual of Neonatal Care has been completely updated and extensively revised to reflect the changes in fetal, perinatal, and neonatal care that have occurred since the sixth edition. This portable text covers current and practical approaches to evaluation and management of conditions encountered in the fetus and the newborn, as practiced in high volume clinical services that include contemporary prenatal and postnatal care of infants with routine, as well as complex medical and surgical problems. Written by expert authors from the Harvard Program in Neonatology and other major neonatology programs across the United States, the manual’s outline format gives readers rapid access to large amounts of valuable information quickly. The Children’s Hospital Boston Neonatology Program at Harvard has grown to include 57 attending neonatologists and 18 fellows who care for more than 28,000 newborns delivered annually. The book also includes the popular appendices on topics such as common NICU medication guidelines, the effects of maternal drugs on the fetus, and the use of maternal medications during lactation. Plus, there are intubation/sedation guidelines and a guide to neonatal resuscitation on the inside covers that provide crucial information in a quick and easy format.
Every healthcare organization can learn from Seattle Children‘s continuous improvement process, but this book is not an operator‘s manual. Instead, it is a challenge to everyone concerned with healthcare to reexamine deeply held assumptions. While it is commonly believed that improved quality, access, and safety, and an improved bottom line are mut
This book is the first of a new series which will present the proceedings of the newly established Nestlé Nutrition Workshop Series: Clinical & Performance Programme aimed at adult nutrition. Undernutrition is a common phenomenon in elderly people, and malnutrition reaches significant levels in those being in hospital, nursing homes or home care programs. Consequences of malnutrition often go unrecognised owing to the lack of specific validated instruments to assess nutritional status in frail elderly persons. The Mini Nutritional Assessment (MNA) provides a single, rapid assessment of nutritional status in the elderly of different degrees of independence, allowing the prevalence of protein-energy malnutrition to be determined and to evaluate the efficacy of nutritional intervention and strategies. Easy, quick and economical to perform, it enables staff to check the nutritional status of elderly people when they enter hospitals or institutions and to monitor changes occurring during their stay. Moreover, the MNA is predictive of the cost of care and length of stay in hospital. This publication will be of immense assistance to heads of geriatric teaching units, teachers in nutrition, clinicians general practitioners and dieticians, enabling them to better detect, recognise and start treatment of malnutrition in the elderly.