RESUMO
Introduction: Colorectal cancer is the third most common malignant neoplasm worldwide, with ~ 150 thousand new cases each year. Screening policies have brought significant progress due to the possibility of early diagnosis and polyp resection. Therefore, there is a need for continuous evaluation of the quality of colonoscopies based on well-established criteria in the literature. Materials and Methods: The present retrospective study assesses the quality of colonoscopies performed at a tertiary hospital, comparing resident physicians with their preceptors. A total of 422 preceptor exams and 115 resident exams were evaluated, with a comparison of the adenoma detection rate, cecal intubation rate, examination time, and bowel preparation quality. Results: The adenoma detection rate in the exams performed by preceptors was of 46.9%, while in those performed by residents, it was of 35.2% (p = 0.038). The cecal intubation rate was of 98.6% in the preceptor group and of 94.8% in the resident group (p = 0.025). The median total examination time was of 13 minutes and 42 seconds in the preceptor group and of 19 minutes and 22 seconds in the resident group (p < 0.005). Conclusion: During their training, resident physicians perform an adequate number of colonoscopies, which enables them to achieve adenoma detection rates, cecal intubation and examination times within the limits proposed by the literature. (AU)
Assuntos
Humanos , Masculino , Feminino , Qualidade da Assistência à Saúde , Colonoscopia , Cuidados Pré-Operatórios , Neoplasias Colorretais/diagnóstico , Estudos Retrospectivos , Corpo Clínico HospitalarRESUMO
Introdução: A expansão das opções terapêuticas para pacientes oncológicos nos últimos anos leva ao aumento na probabilidade de intercorrências ao longo do tratamento. Portanto, as emergências oncológicas têm se tornado ainda mais frequentes. A síndrome de lise tumoral (SLT) é uma emergência oncológica de grande importância clínica que merece atenção de todo médico. Métodos: este capítulo é uma revisão dos artigos sobre SLT das principais revistas de clínica médica da biblioteca virtual MEDLINE e é um protocolo baseado nos guidelines internacionais mais recentes. Resultados: A SLT ocorre a partir da lise das células tumorais e dos distúrbios metabólicos associados ao conteúdo intracelular extravasado, que resultam em alterações laboratoriais metabólicas e clínicas. Para manejo adequado dos pacientes de risco, deve ser feita a estratificação desses pacientes em baixo, intermediário e alto risco de desenvolvimento de SLT. Conclusão: O principal aspecto para êxito no manejo de pacientes com SLT aguda é manter um alto índice de suspeição e de vigilância, identificando pacientes de alto risco e instituindo hidratação e terapia medicamentosa imediatamente.
Introduction: The expansion on therapeutic possibilities for oncologic patients in the last years leads to an increase on the probability of intercurrences along the clinical course. Therefore, oncologic emergencies are becoming more frequent. Tumor Lysis Syndrome (TLS) is an oncologic emergency of great clinical importance that deserves every physician's attention. Methods: This chapter is a review of the major clinical articles on Medline Database Regarding TLS and a protocol based on the most recent international guidelines. Results: Once tumor cells experience lysis, discharge of intracellular content can cause different metabolic disturbances, that result in laboratory disorders or, even further, in clinical presentation. Conclusion: The key aspect on management of acute TLS is maintaining high clinical suspicion and surveillance to identify patients on high risk of developing TLS and to establish hydration and pharmacological therapy immediately.