Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 8.805
Filtrar
Mais filtros








Filtros aplicados
  • Temas
    • Promover a ampliação da oferta de serviços da atenção especializada (remover)
Intervalo de ano de publicação
1.
Rev. bras. ortop ; 57(4): 619-628, Jul.-Aug. 2022. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1394868

RESUMO

Abstract Objective The treatment of Colles fracture can deform the wrist. Some studies claim the resulting deformity rarely hinders daily activities, whereas others report the opposite; thus, anatomical reduction is desirable. Our objective was to analyze the anatomical and functional results of Colles fracture to find out the values of individual parameters corresponding to the best functional outcome. Methods The present prospective study included 70 elderly patients with Colles fracture. All patients were managed conservatively. The anatomical parameters were evaluated by measuring dorsal angulation, radial inclination, and radial height, and they were assessed as per Stewart et al. The functional result was assessed by the Mayo wrist score. The results were analyzed using the chi-squared test of association, and a p-value < 0.001 was considered statistically significant and to examine strengths of associations; we computed odds ratios (ORs) with 95% confidence intervals (CI). Results Excellent and good results were obtained in 68.5% of the cases anatomically and 78.5% functionally, which was statistically significant (p= 0.0009). Out of the three anatomical parameter dorsal angulation < 10° and loss of radial inclination < 9° showed statistically significant association with functional results (p= 0.0006), but loss of radial height < 6 mm did not (p= 0.0568), which became significant when loss of radial height was kept < 4 mm (p= 0.00062). Conclusion Fractures with anatomical reduction have better functional results. The acceptable borderline anatomical parameters for obtaining excellent or good functional results are dorsal angulation < 10°, loss of radial inclination < 9°, and loss of radial height < 4 mm.


Resumo Objetivo O tratamento da fratura de Colles pode deformar o pulso. Alguns estudos afirmam que essa deformidade raramente dificulta as atividades diárias, enquanto outros relatam o contrário; assim, a redução anatômica é desejável. Nosso objetivo foi analisar os resultados anatômicos e funcionais da fratura de Colles para descobrir os valores de parâmetros individuais correspondentes ao melhor desfecho funcional. Métodos Este estudo prospectivo incluiu 70 pacientes idosos com fratura de Colles. Todos os pacientes foram tratados de forma conservativa. Os parâmetros anatômicos foram a angulação dorsal, a inclinação radial e a altura radial, avaliados de acordo com Stewart et al. O resultado funcional foi avaliado segundo a tabela de pontuação de pulso Mayo. Os resultados foram analisados por meio do teste de associação do qui-quadrado, considerando o valor de p< 0,001 estatisticamente significativo. A força das associações foi analisada por razões de possibilidades com intervalos de confiança de 95%. Resultados Excelentes e bons resultados anatômicos e funcionais foram obtidos em 68,5% e 78,5% dos casos, respectivamente, com diferença estatística significativa (p= 0,0009). Dos três parâmetros anatômicos, a angulação dorsal inferior a 10° e a perda da inclinação radial inferior a 9° apresentaram associação estatisticamente significativa com os resultados funcionais (p= 0,0006), mas não a perda de altura radial inferior a 6 mm (p= 0,0568); no entanto, a perda da altura radial inferior a 4 mm foi associada de forma significativa aos desfechos funcionais (p= 0,00062). Conclusão As fraturas com redução anatômica apresentam melhores desfechos funcionais. Os parâmetros anatômicos limítrofes aceitáveis para a obtenção de resultados funcionais excelentes ou bons são angulação dorsal inferior a 10°, perda da inclinação radial inferior a 9° e perda da altura radial inferior a 4 mm.


Assuntos
Humanos , Idoso , Idoso de 80 Anos ou mais , Anormalidades Congênitas , Atividades Cotidianas , Distribuição de Qui-Quadrado , Estudos Prospectivos , Fraturas Ósseas , Fratura-Luxação/cirurgia
4.
Rehabil Nurs ; 47(4): 147-159, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35701986

RESUMO

INTRODUCTION: The use of exergames has become an increasingly frequent intervention in rehabilitation, referred to as a fun and motivating activity that involves patients. This systematic review aimed to evaluate the effectiveness of exergames in the rehabilitation of the shoulder joint compared to other types of care. METHODS: We performed a systematic review and GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) evidence synthesis. The search was conducted using the following databases: MEDLINE, CINAHL, SPORTDiscus, SCOPUS, SciELO, Psychology and Behavioral Sciences Collection, Cochrane Central Register of Controlled Trials, and PEDRo. Databases were searched from the first record until July 2021. Randomized controlled trials using exergames as an intervention were included. RESULTS: The search resulted in 1,048 records. A total of 10 articles published between 2013 and 2020 met inclusion criteria and were reviewed for this study. A positive impact was observed in using exergames to increase shoulders' range of motion, namely, extension, flexion, abduction, internal and external rotation, and functionality postinjury. CONCLUSIONS: The results of this review provide evidence of the benefits of exergames in shoulder joint rehabilitation. However, more robust clinical trials need to be developed that assess the effectiveness of using exergames as a complement to traditional rehabilitation and assess participants' degree of satisfaction, motivation, and adherence.


Assuntos
Jogos Eletrônicos de Movimento , Lesões do Ombro , Humanos , Amplitude de Movimento Articular
5.
Ciênc. Saúde Colet. (Impr.) ; 27(5): 1919-1928, maio 2022. tab
Artigo em Português | LILACS-Express | LILACS | ID: biblio-1374982

RESUMO

Resumo O objetivo deste artigo é verificar a associação raça/cor e acesso a serviços de reabilitação pós-AVC. Estudo transversal de base populacional com 966 adultos (≥18 anos) pós-AVC, respondentes da Pesquisa Nacional de Saúde. Desfecho, acesso à reabilitação, e exposição (raça/cor) foram coletados de modo autorreferido. Variáveis sociodemográficas, histórico clínico, plano de saúde e limitação pós-AVC foram considerados para o ajuste. Regressão de Poisson com estimativa de variância robusta foi utilizada para estimar a associação nas análises bruta e ajustada. Da amostra total, 51,8% são autodeclarados negros ou outras raças, 61,4% demandam por reabilitação, sendo que apenas 20% têm acesso ao serviço de reabilitação. Dificuldade em acessar reabilitação foi referida por 57,5% dos autodeclarados amarelos ou indígenas, 43% dos negros, e 35,4% dos brancos. Na análise ajustada, negros têm 4% menos acesso à reabilitação se comparados com seus pares brancos (RP 1,04, IC95% 1,00-1,08). Pessoas da raça amarela ou indígena 17% menos acesso que brancos (RP 1,17, IC95% 1,13-1,20). No Brasil, autodeclarados negros, amarelos, indígenas e outros têm pior acesso à reabilitação pós-AVC quando comparados aos autodeclarados brancos, apontando iniquidades raciais na reabilitação em sobreviventes de AVC.


Abstract This article aims to verify the association between race/skin color and access to post-stroke rehabilitation services. It is a cross-sectional population-based study including 966 post-stroke adults (≥18 years) that responded to the National Health Survey (PNS). The outcome, access to rehabilitation, and exposure (race/skin color) were collected in a self-reported manner. Socio-demographic variables, clinical history, healthcare plan and post-stroke limitation were considered for the adjustment. Poisson regression with robust variance estimation was used to estimate the association in the crude and adjusted analyses. Based on the sample, 51.8% are self-declared black and 61.4% require rehabilitation, with only 20% having access to the rehabilitation service. Difficulty in accessing rehabilitation was reported by 57.5% of other self-declared races, 43% blacks, and 35.4% whites. In the adjusted analysis, 4% of self-declared black (PR 1.04, CI95%1.00-1.08) and 17% of self-declared yellow and indigenous (PR 1.17, IC95%1.13-1.20) have less access to rehabilitation than their white peers. In Brazil, self-declared black and yellow and indigenous people have worst access to post-stroke rehabilitation in comparison with self-declared white people, highlighting racial inequities in rehabilitation in stroke survivors.

6.
Nurs Crit Care ; 2022 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-35641018

RESUMO

Inadequate nutrition can lead to increased morbidity and mortality for mechanically ventilated children in the paediatric intensive care unit (PICU). Enteral feeding can either be delivered by gravity bolus (intermittent) feeding or continuously via a pump and in UK PICUs variable practice exists. This evidence-based review therefore aimed to examine the evidence surrounding the two feeding methods for ventilated children, to determine whether one provides better enteral nutrition. Four papers were included, three randomized controlled trials and a systematic review, which provide conflicting evidence. There is some suggestion that bolus feeding may be superior in medical children on PICU to achieve their energy and protein goals faster, however, the clinical significance of the results is questionable and further research is needed to identify whether one method of feeding can impact on patient outcomes.

7.
Clin Rehabil ; 36(8): 999-1015, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35481421

RESUMO

OBJECTIVE: To evaluate the efficacy and safety of pulmonary rehabilitation for exercise tolerance and quality of life improvement in idiopathic pulmonary fibrosis. METHODS: We searched PubMed, Cochrane Library, Embase, Web of Science, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Wanfang Database, and Chongqing VIP for randomized controlled trials that compared pulmonary rehabilitation with usual care for idiopathic pulmonary fibrosis. The risk of bias and certainty of evidence were assessed using Cochrane Collaboration's Risk of Bias tool and the Grading of Recommendations, Assessment, Development and Evaluation criteria. RESULTS: Eleven trials in total with 549 participants. Compared with usual care, pulmonary rehabilitation significantly increased 6-minute walking distance (mean difference: 35.2m, 95% confidence intervals: 25.4m-44.9m; ten trials; 447 participants; moderate), decreased the St George's Respiratory Questionnaire total scores (mean difference: -9.11, 95% confidence intervals: -10.78 to -7.43; six trials; 303 participants; moderate), and reduced the modified Medical Research Council scores were lower (mean difference: -0.76, 95% confidence intervals: -1.25 to -0.27; three trials; 196 participants; low). Improvements were noted in forced vital capacity percent-predicted (mean difference: 4.88, 95% confidence intervals: 2.67 to 7.10; four trials; 214 participants; moderate) and diffusing capacity for carbon monoxide (mean difference: 4.71, 95% confidence intervals: 0.96 to 8.46; six trials; 358 participants; low). CONCLUSIONS: Pulmonary rehabilitation may significantly improve exercise tolerance and quality of life in idiopathic pulmonary fibrosis patients, but the quality of evidence was low to moderate. Large sample, multicenter, randomized controlled trials are needed to verify the efficacy and safety of pulmonary rehabilitation.


Assuntos
Fibrose Pulmonar Idiopática , Doença Pulmonar Obstrutiva Crônica , China , Tolerância ao Exercício , Humanos , Fibrose Pulmonar Idiopática/diagnóstico , Fibrose Pulmonar Idiopática/reabilitação , Estudos Multicêntricos como Assunto , Doença Pulmonar Obstrutiva Crônica/reabilitação , Qualidade de Vida , Capacidade Vital
8.
Valencia; Clin. transplant; Mar. 18, 2022. 26 p.
Não convencional em Inglês | BIGG | ID: biblio-1363981

RESUMO

Malnutrition is a known risk factor for postoperative morbidity and mortality in patients awaiting liver transplantation (LT). Malnutrition is a potentially reversible risk factor, though there are no clear guidelines on the best mechanism for an improvement. It also remains unclear if preoperative nutritional interventions have benefits to post-transplant outcomes for transplant recipients. Primary objective: To identify if preoperative optimization of nutritional status is associated with improved short-term outcomes after LT. Secondary Objectives: To determine if preoperative improvement of malnutrition improves short-term outcomes after LT, as well as, if weight loss in obese patients affects short-term outcomes after LT. Ovid MEDLINE, Embase, Scopus, Google Scholar, and Cochrane Central. Systematic review following PRISMA guidelines and recommendations using the GRADE approach derived from an international expert panel. POSPERO Protocol ID: CRD42021237450 3851 records were identified in searching the databases, 3843 records were excluded by not fulfilling eligibility criteria. Seven full-text articles were included for the final analysis of which three were randomized controlled trials, one was prospective observational studies, and three were retrospective observational studies. No appreciable difference in mortality, post-transplant complication rate was noted across the studies. Length of stay (LOS) was noted to be shorter in two observational studies of Vitamin D deficiency in liver transplant patients. We have made a weak recommendation supporting pre-transplant nutritional supplementation due to possible benefit in reducing LOS as well as the lack of harms (Quality of Evidence low | Grade of Recommendation; Weak). No effective conclusions were reached for the secondary objectives due to the conflicting evidence.


Assuntos
Humanos , /tratamento farmacológico , Transplante de Fígado/normas , Desnutrição/prevenção & controle , Vitamina D/uso terapêutico
9.
Arq. gastroenterol ; 59(1): 129-136, Jan.-Mar. 2022. tab, graf
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1374439

RESUMO

ABSTRACT Background Deceased donor liver transplantation (DDLT) is the first choice, but living donor transplantation (LDLT) is an alternative to be considered in special situations, such as lack of donated organs and emergencies. So far, there is no consensus on which transplantation method provides better survival and fewer complications, which is still an open point for discussion. Methods This meta-analysis compared the 1, 3, and 5-year patient and graft survival rates of LDLT and DDLT. We included studies published from April-2009 to June-2021 and adopted the generic model of the inverse of variance for the random effect of hazard ratios. The adequacy of the studies was determined using the Newcastle-Ottawa Scale — NOS (WELLS). Results For patient survival analysis, we included a total of 32,258 subjects. We found a statistically significant better survival for the LDLT group at 1, 3 and 5 years, respectively: 1.35 HR (95%CI 1.10—1.66, P=0.005), 1.26 HR (95%CI 1.09—1.46, P=0.002) and 1.27 HR (95%CI 1.09—1.48, P=0.002). Our meta-analysis evaluated a total of 21,276 grafts. In the overall analysis, the 1-year survival was improved in favor of the LDLT group (1.36 HR, 95%CI 1.16—1.60, P<0.0001), while the 3-year survival (1.13 HR, 95%CI 0.96—1.33, P<0.13), and 5 (0.99 HR, 95%CI 0.74—1.33, P<0.96), did not differ significantly. Conclusion This metanalysis detected a statistically significant greater 1-, 3- and 5-years patient survival favoring LDLT compared to DDLT as well as a statistically significant difference better 1-year graft survival favoring the LDLT group.


RESUMO Contexto O transplante de fígado com doador falecido é a primeira escolha, mas o transplante de doador vivo é uma alternativa a ser considerada em situações especiais, como falta de órgãos doados e emergências. Até o momento, não há consenso sobre qual método de transplante proporciona melhor sobrevida e menos complicações, sendo, ainda, um ponto em aberto para discussão. Métodos Esta meta-análise comparou as taxas de sobrevida de pacientes e enxertos de 1, 3 e 5 anos de transplante de doador vivo e transplante de fígado com doador falecido. Incluímos estudos publicados de abril de 2009 a junho de 2021 e adotamos o modelo genérico do inverso da variância para o efeito aleatório das razões de risco. A adequação dos estudos foi determinada por meio da Escala de Newcastle-Ottawa — NOS (WELLS). Resultados Para análise de sobrevida do paciente, incluímos um total de 32.258 indivíduos. Encontramos uma melhor sobrevida estatisticamente significativa para o grupo de transplante de fígado de doador vivo em 1, 3 e 5 anos, respectivamente: 1,35 HR (IC95% 1,10—1,66, P=0,005), 1,26 HR (IC95% 1,09—1,46, P=0,002) e 1,27 HR (IC95% 1,09—1,48, P=0,002). Nossa meta-análise avaliou um total de 21.276 enxertos. Na análise geral, a sobrevida em 1 ano foi melhorada em favor do grupo de transplante de doador vivo (1,36 HR, IC95% 1,16—1,60, P<0,0001), enquanto a sobrevida em 3 anos (1,13 HR, IC95% 0,96—1,33, P<0,13) e 5 (0,99 HR, IC95% 0,74—1,33, P<0,96), não diferiram significativamente. Conclusão Esta meta-análise detectou uma sobrevida estatisticamente significativa maior do paciente em 1, 3 e 5 anos favorecendo o transplante de doador vivo em comparação com o transplante de fígado com doador falecido, bem como uma diferença estatisticamente significativa melhor na sobrevida do enxerto em 1 ano favorecendo o grupo de transplante de doador vivo.

10.
Medwave ; 22(2): e002118, mar.2022. tab
Artigo em Inglês, Espanhol | LILACS | ID: biblio-1366391

RESUMO

Contexto La hemofilia es un trastorno hemorrágico de la coagulación que ocurre en uno de cada 5000 nacimientos masculinos. Los pacientes con hemofilia A grave no tratados tienen complicaciones hemorrágicas, incluyendo sangrados articulares y menor sobrevida. El emicizumab es un anticuerpo monoclonal aprobado por los Estados Unidos para la profilaxis rutinaria de pacientes pediátricos y adultos con hemofilia A grave con inhibidores del factor VIII de coagulación. Objetivos Realizar un estudio de costo-efectividad de la profilaxis con emicizumab para niños y adultos con hemofilia A grave, en comparación con el actual manejo de esos pacientes en el Ministerio de Salud y el Seguro Social de Salud de Perú. Metodología Se modeló la transición del paciente entre estados médicos con la metodología de Markov y se estimó a lo largo de su vida costos y efectos incrementales de emicizumab comparados con el actual manejo. Se estimó el impacto presupuestario de emicizumab proyectando costos netos anuales y su valor presente a cinco años. Resultados Emicizumab generaría ahorros en el Ministerio de Salud entre 14,6 y 16,0 por niño y 11,8 por adulto, en US$ millones actuales, y en el Seguro Social de Salud de 12,8 a 14,9 por niño y 40,1 por adulto. Además, se generan ganancias en efectividad, medidas en años de vida ajustados por calidad, de 0,36 por niño y 0,56 por adulto y de 0,25 por niño y 0,36 por adulto en esas respectivas instituciones. El impacto presupuestario sería un ahorro anual neto, en US$ millones, de 12,8 y 15,0 en esas entidades. Conclusión El actual manejo de la enfermedad es muy costoso y con resultados de salud inferiores a los posibles con emicizumab. Este fármaco produciría grandes ahorros y mejor salud. Ambas entidades debieran implementar protocolos para la profilaxis y tratamiento de la hemofilia y financiarla con presupuesto propio.


Settings Hemophilia is a coagulation disorder that occurs in one in 5000 male births. Patients with untreated severe hemophilia A have hemorrhagic complications, including joint bleeds and decreased survival. Emicizumab is a monoclonal antibody approved by the United States for routine prophylaxis of pediatric and adult patients with severe hemophilia A with factor VIII inhibitors. Objectives To perform a cost-effectiveness study of emicizumab prophylaxis for children and adults with severe hemophilia A compared with the current disease management in the Peruvian Ministry of Health and Social Security Health Insurance. Methods The patient transition between medical states was modeled with Markov methodology, and the lifetime costs and incremental effects of emicizumab compared to current management were estimated. The budgetary impact of emicizumab was estimated by projecting annual net costs and its five-year present value. Results In the Ministry of Health, emicizumab would generate savings between 14.6 and 16.0 per child and 11.8 per adult, in current US$ million. Social Security Health Insurance savings would be 12.8 to 14.9 per child and 40.1 per adult. In addition, this strategy would generate effectiveness gains, measured in quality-adjusted life-years, of 0.36 per child and 0.56 per adult and 0.25 per child, and 0.36 per adult in those respective institutions. The budgetary impact would be a net annual saving of 12.8 and 15.0 US$ million in those entities. Conclusions The current management of hemophilia A is very costly and has health outcomes inferior to those possible with emicizumab. This drug would produce significant savings and better patient health. The Ministry of Health and Social Health Insurance should implement hemophilia prophylaxis and treatment protocols and finance this drug.


Assuntos
Humanos , Masculino , Criança , Adulto , Hemofilia A/complicações , Hemofilia A/tratamento farmacológico , Peru , Fator VIII/uso terapêutico , Análise Custo-Benefício , Anticorpos Biespecíficos , Anticorpos Monoclonais Humanizados , Hemorragia/etiologia
11.
Rev. bras. cir. cardiovasc ; 37(1): 7-12, Jan.-Feb. 2022. tab, graf
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1365528

RESUMO

Abstract Introduction: In minimally invasive mitral valve repair, right minithoracotomy is the most widely performed method, providing a good view of the mitral valve. But regarding other techniques and although it offers limited visualization, the periareolar access is a less traumatic alternative. This study's purpose is to compare in-hospital outcomes in patients who underwent video-assisted minimally invasive mitral valve repair via right minithoracotomy and periareolar access. Methods: This is a retrospective observational study including 37 patients (> 18 years old), without previous right thoracic surgery, who underwent their primary mitral valve repair, with indication for minimally invasive video-assisted approach (via right minithoracotomy or periareolar access), between January 2018 and August 2019. Patients' medical records were consulted to collect demographics data, operative details, and in-hospital outcomes. Results: Twenty-one patients underwent right minithoracotomy, and 16 were operated via periareolar access. The mean patients' age was 62±12 years in the right minithoracotomy group and 61±9 years in the periareolar access group (P=0.2). There are no significant differences in incision length, cardiopulmonary bypass time, aortic cross-clamping time, hematocrit, amount of chest tube drainage, and intensive care unit and in-hospital length of stay. Time to extubation presented significant differences between the right minithoracotomy and the periareolar access group (4.85 hours vs. 5.62 hours, respectively) (P=0.04). Conclusion: In this study, we found similar results in the two applied surgical techniques, except for the time to extubation.

12.
Brasília; CONITEC; fev. 2022.
Não convencional em Português | BRISA/RedTESA, BRISA/RedTESA | ID: biblio-1368907

RESUMO

INTRODUÇÃO: A fibrose cística (FC) é uma doença genética autossômica recessiva rara que pode estar presente em todos os grupos étnicos, mas predomina na população caucasiana. Ocorre por mutação em um gene que codifica a proteína reguladora de condução transmembrana da FC (CFTR), cuja deficiência ou ausência ocasiona a desidratação e o aumento da viscosidade das secreções mucosas, favorecendo obstrução das vias aéreas, ductos intrapancreáticos, ductos seminíferos e vias biliares. É uma doença multissistêmica, que acomete principalmente os sistemas respiratório e digestivo, sendo o comprometimento pulmonar o responsável pela maior morbimortalidade dos portadores. O acúmulo de muco espesso nas vias respiratórias inferiores e a presença de reação inflamatória local são as características chave da sua fisiopatogenia. O pulmão torna-se cronicamente infectado por bactérias e os ciclos repetidos de inflamação e remodelação na evolução da doença levam à doença obstrutiva crônica e irreversível. O Protocolo Clínico e Diretrizes Terapêuticas (PCDT) de FC atual do Ministério da Saúde (MS), de 2017, preconiza tratamento tradicional com a remoção das secreções das vias aéreas com alfadornase, visando melhorar a função pulmonar, diminuir a frequência das exacerbações respiratórias, melhorar a qualidade de vida e a hiperinsuflação pulmonar; Recomenda também o uso de tobramicina inalatória, para a manutenção ou melhora da função pulmonar, redução da contagem de colônias de Pseudomonas aeruginosa no escarro e redução das internações. TECNOLOGIA: Ventilação não invasiva (VNI). PERGUNTA: VNI é uma opção terapêutica adjuvante segura e eficaz para o tratamento da fibrose cística associada a insuficiência respiratória avançada? EVIDÊNCIAS CIENTÍFICAS: Com bas


Assuntos
Humanos , Fibrose Cística/terapia , Doença Pulmonar Obstrutiva Crônica/terapia , Ventilação não Invasiva/instrumentação , Serviços de Assistência Domiciliar/provisão & distribuição , Sistema Único de Saúde , Brasil , Análise Custo-Benefício
13.
Brasília; CONITEC; fev. 2022.
Não convencional em Português | BRISA/RedTESA, BRISA/RedTESA | ID: biblio-1369036

RESUMO

INTRODUÇÃO: A OI é uma doença genética caracterizada por fragilidade óssea e fraturas recorrentes por mínimo trauma, além de deformidades de ossos longos e, nos casos mais graves, consequente incapacidade funcional para deambulação. Além do tratamento medicamentoso para aumentar densidade mineral óssea, cirurgias ortopédicas com inserção de dispositivos intramedulares são indicadas para corrigir as deformidades e estabilizar as fraturas. Entre estes dispositivos implantáveis disponíveis estão: fios (Kirschner ou Steinmann) e hastes (flexíveis ou extensíveis). Com o objetivo de alinhar os ossos longos prevenindo e corrigindo curvaturas que propiciem fraturas, a escolha por haste extensível, também chamada telescópica, para criança ou adolescente ainda em fase de crescimento se justifica por sua capacidade de se estender, acompanhando o crescimento ósseo e, possivelmente, reduzindo o número de revisões cirúrgicas para substituição do implante. Contudo, apesar da evolução das hastes extensíveis ao longo dos anos, chegando ao atual modelo Fassier Duval (FD), complicações pós-operatórias podem ocorrer e demandar revisão cirúrgica, assim como ocorre com as hastes e os dispositivos não extensíveis. TECNOLOGIA: Hastes intramedulares telescópicas (extensíveis). PERGUNTA: O uso de hastes intramedulares telescópicas (extensíveis, tipo Fassier Duval) é seguro e eficaz para correção de deformidades ósseas, redução das incidências de fraturas, revisões e complicações cirúrgicas, além de incremento dos resultados de


Assuntos
Criança , Adolescente , Dispositivos de Fixação Ortopédica , Aparelhos Ortopédicos , Osteogênese Imperfeita/fisiopatologia , Desenvolvimento Infantil , Desenvolvimento do Adolescente , Fraturas Ósseas/prevenção & controle , Fixação de Fratura/métodos , Sistema Único de Saúde , Brasil , Análise Custo-Benefício/economia
14.
Säo Paulo med. j ; 140(1): 108-114, Jan.-Feb. 2022. tab
Artigo em Inglês | LILACS | ID: biblio-1357455

RESUMO

ABSTRACT BACKGROUND: Cardiac rehabilitation (CR) barriers are well-understood in high-resource settings. However, they are under-studied in low-resource settings, where access is even poorer and the context is significantly different, including two-tiered healthcare systems and greater socioeconomic challenges. OBJECTIVE: To investigate differences in characteristics of patients attending publicly versus privately funded CR and their barriers to adherence. DESIGN AND SETTING: Observational, cross-sectional study in public and private CR programs offered in Brazil. METHODS: Patients who had been attending CR for ≥ 3 months were recruited from one publicly and one privately funded CR program. They completed assessments regarding sociodemographic and clinical characteristics and the CR Barriers Scale. RESULTS: From the public program, 74 patients were recruited, and from the private, 100. Participants in the public program had significantly lower educational attainment (P < 0.001) and lower socioeconomic status (P < 0.001). Participants in the private program had more cognitive impairment (P = 0.015), and in the public program more anxiety (P = 0.001) and depressive symptoms (P = 0.008) than their counterparts. Total barriers among public CR participants were significantly higher than those among private CR participants (1.34 ± 0.26 versus 1.23 ± 0.15/5]; P = 0.003), as were scores on 3 out of 5 subscales, namely: comorbidities/functional status (P = 0.027), perceived need (P < 0.001) and access (P = 0.012). CONCLUSION: Publicly funded programs need to be tailored to meet their patients' requirements, through consideration of educational and psychosocial matters, and be amenable to mitigation of patient barriers relating to presence of comorbidities and poorer health status.


Assuntos
Humanos , Reabilitação Cardíaca , Brasil , Estudos Transversais , Atenção à Saúde
15.
Clin Implant Dent Relat Res ; 24(1): 105-115, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35043577

RESUMO

OBJECTIVE: To estimate the prevalence of spin and completeness of reporting of systematic reviews with metanalysis (SRMAs) in implant dentistry. STUDY DESIGN AND SETTING: Inclusion criteria were SRMAs of randomized clinical trials of implant dentistry on survival, success, or failure rates in humans, with no language restriction. Three databases were searched from inception to May 2021. Main outcomes were prevalence of spin (primary outcome) and completeness of reporting (secondary outcome) in abstracts and full texts. RESULTS: We identified 2481 SRMAs and 45 unique manuscripts were included. There was a low presence of spin in the abstracts and full text, except for adverse events, in which 51.1% (in the abstract) failed to mention any adverse event for summarized interventions. There was an adequate report of SRMAs in the full text except for prospective register (33.3% not reported). However, there was an incomplete report for most items in the abstract considering PRISMA-A checklist. CONCLUSION: In general, the included SRMAs presented a (a) low prevalence of spin (except for adverse events in the abstract); (b) adequate completeness of reporting in the full text (except for prospective register); and (c) incomplete report for most items in the abstracts.


Assuntos
Implantes Dentários , Lista de Checagem , Bases de Dados Factuais , Implantes Dentários/efeitos adversos , Humanos
16.
Int J Orthop Trauma Nurs ; 44: 100917, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35033981

RESUMO

INTRODUCTION: Exergames are a fun, engaging, and interactive form of exercise that has been used in rehabilitation. This systematic review aimed to evaluate the effectiveness of exergames compared to usual rehabilitation after anterior cruciate ligament reconstruction. METHOD: We performed a Systematic Review and GRADE evidence synthesis. The PRISMA guidelines for systematic reviews were followed. MEDLINE® (Medical Literature Analysis and Retrieval System Online), CINAHL® (Cumulative Index to Nursing and Allied Health Literature), SPORTDiscus, SCOPUS, SciELO (Scientific Electronic Library Online), Cochrane Central Register of Controlled Trials, and PEDro (Physiotherapy Evidence Database) were searched from their first record to May 2021. Randomised controlled trials using exergames as an intervention were included. RESULTS: Initial literature searches yielded 794 non-duplicated records. After exclusion based on title, abstract, and full text review, five articles were included for analysis. Compared with the control group, the participants in the exergames group showed differences in proprioception and flexion angle difference. CONCLUSION: Although there is no conclusive evidence that favours exergames over traditional rehabilitation, they did not aggravate the effects of rehabilitation. Nonetheless, exergames can be safe and motivating.


Assuntos
Lesões do Ligamento Cruzado Anterior , Lesões do Ligamento Cruzado Anterior/cirurgia , Exercício Físico , Terapia por Exercício , Humanos , Amplitude de Movimento Articular
17.
Revista Pesquisa em Fisioterapia ; 12(1)20220114. tab, ilus
Artigo em Inglês, Português | LILACS-Express | LILACS | ID: biblio-1373680

RESUMO

INTRODUÇÃO: A doença causada pelo Novo Coronavírus (SARS-CoV-2), gerou um fluxo crescente de pacientes infectados que necessitaram de atenção especializada em terapia intensiva, impactando sobremaneira o Sistema de Saúde, repercutindo de forma direta na experiência de Fisioterapeutas Intensivistas, profissionais fundamentais nessa assistência. OBJETIVO: Verificar modificações na prática clínica do fisioterapeuta intensivista durante a Pandemia de COVID-19 e identificar desafios enfrentados durante assistência aos pacientes infectados. MATERIAIS E MÉTODOS: Trata-se de um estudo de campo, exploratório, transversal e quantitativo, realizado de fevereiro a abril de 2021, com fisioterapeutas intensivistas de dois hospitais públicos (um municipal e outro estadual) da cidade de Fortaleza. Foi realizado um cálculo do fluxo de fisioterapeutas atuantes nessas unidades, estimando-se uma amostra de 71 profissionais para compor o estudo. Participaram da pesquisa os Fisioterapeutas Intensivistas que realizaram assistência a pacientes com COVID-19 e que possuíam vínculo com os referidos hospitais. Foram excluídos os fisioterapeutas na função de residentes, estagiários e preceptores presentes. Para coleta de dados utilizou-se formulário on-line viabilizado pela plataforma Google Forms, composto por perguntas objetivas relacionadas aos dados do profissional, infecção destes por COVID-19, presença de fatores de risco, modificações na prática clínica durante assistência, desafios enfrentados, situações vivenciadas e segurança durante atendimento ao paciente crítico com COVID-19. Os dados foram tabulados através do Software Statistical Package for the Social Sciences (SPSS), versão 20.0. Utilizou-se estatística descritiva com frequências absolutas e relativas. RESULTADOS: Participaram do estudo 59 fisioterapeutas intensivistas atuantes na linha de frente contra a COVID-19; destes, 40,6% foram infectados pelo vírus SARS-CoV-2. As principais modificações relatadas foram melhora no manejo da ventilação mecânica (86,4%) e melhor integração com equipe multidisciplinar (62,7%). Dentre os desafios enfrentados durante a assistência, o contexto completamente novo (89,9%) e o testemunho de experiências dolorosas de pacientes (76,3%) foram os mais marcantes. CONCLUSÃO: A pandemia proporcionou aos fisioterapeutas intensivistas novos desafios e modificações na prática clínica, requerendo atualização, implantação de novas práticas e maior interação em equipe multidisciplinar.


INTRODUCTION: The disease caused by the New Coronavirus (SARS-CoV-2) generated a growing flow of infected patients who needed specialized care in intensive care, greatly impacting the Health System, directly impacting the experience of Intensive Care Physiotherapists fundamental professionals in this assistance. OBJECTIVE: To verify changes in the clinical practice of the intensive care physical therapist during the COVID-19 Pandemic and to identify challenges faced during the care of infected patients. MATERIALS AND METHODS: That is an exploratory, transversal, and quantitative field research carried out from February to April 2021, with intensive care physical therapists from two public hospitals (one municipal and one state) in the city of Fortaleza. A calculation of the flow of physiotherapists working in these units was performed, estimating a sample of 71 professionals to compose the study. The Intensivist Physiotherapists who helped patients with COVID-19 and linked with the hospitals participated in the research. Physiotherapists in the role of residents, trainees, and preceptors present were excluded. For data collection, an online form made possible by the Google Forms platform was used, composed of objective questions related to the professional's data, their infection by COVID-19, presence of risk factors, changes in clinical practice during care, challenges faced, situations experienced and safety during critical patient care with COVID-19. Data were tabulated using the Software Statistical Package for the Social Sciences (SPSS), version 20.0. Descriptive statistics with absolute and relative frequencies were used. RESULTS: 59 intensive care physical therapists working on the front line against COVID-19 participated in the study; of these, 40.6% were infected with the SARS-CoV-2 virus. Improvement in the management of mechanical ventilation (86.4%) and better integration with the multidisciplinary team (62.7%) were the main changes reported. Among the challenges faced during care, the completely new context (89.9%) and witnessing painful experiences of patients (76.3%) were the most striking. CONCLUSION: The Pandemic provided intensive care physical therapists with new challenges and changes in clinical practice, requiring updating, implementation of new practices, and greater interaction in a multidisciplinary team.

18.
Online braz. j. nurs. (Online) ; 21(supl.2): e20226557, 21 janeiro 2022. ilus
Artigo em Inglês, Espanhol, Português | LILACS, BDENF - Enfermagem | ID: biblio-1373349

RESUMO

OBJETIVO: apresentar um panorama sobre o processo de tomada de decisões ético-profissionais em situações de excepcionalidade no início da pandemia da Covid-19. MÉTODO: trata-se de uma revisão de escopo, incluindo documentos publicados entre dezembro/2019 a julho/2020 nas seguintes bases de dados: Google Acadêmico, PubMed, Scopus, Scielo, CINAHL e BVS. Adotou-se o PRISMA-ScR Checklist para apresentação da revisão. RESULTADOS: foram selecionados 28 documentos, organizados em cinco categorias: Requisito Técnico-Médico-Científico, Justiça e Equidade, Histórico de Saúde, Comissão para Tomada de Decisão Compartilhada e Quadro Respiratório Grave. CONCLUSÃO: os critérios indicados para priorizar o processo de atenção direcionado a pacientes graves com Covid-19 foram: parâmetros técnico-médico-científico, gravidade do quadro clínico, maior idade, ser profissional da saúde, presença de doenças de base incurável, realização de sorteio e pacientes com maior probabilidade de sobrevivência.


OBJECTIVE: to present an overview of the ethical-professional decision-making process in exceptional situations at the beginning of the COVID-19 pandemic. METHOD: this is a scoping review, including documents published between December 2019 and July 2020 in the following databases: Google Scholar, PubMed, Scopus, SciELO, CINAHL and BVS. The PRISMA-ScR Checklist was adopted to present the review. RESULTS: a total of 28 documents were selected, organized into five categories: Technical-Medical-Scientific Requirement, Justice and Equality, Health History, Commission for Shared Decision-Making and Severe Respiratory Condition. CONCLUSION: the criteria indicated to prioritize the care process targeted at critically-ill patients with COVID-19 were as follows: technical-medical-scientific parameters; severity of the clinical condition; older age; being a health professional; presence of incurable underlying diseases; carrying out draws; and patients with a higher survival probability.


OBJETIVO: presentar un panorama del proceso de toma de decisiones ético-profesionales en situaciones excepcionales al comienzo de la pandemia de Covid-19. MÉTODO: se trata de una revisión de alcance, que incluye documentos publicados entre diciembre de 2019 y julio de 2020 en las siguientes bases de datos: Google Scholar, PubMed, Scopus, Scielo, CINAHL y BVS. Se adoptó la PRISMA-ScR Checklist para presentar la revisión. RESULTADOS: fueron seleccionados 28 documentos, organizados en cinco categorías: Requerimiento Médico Científico Técnico, Justicia y Equidad, Historial de Salud, Comisión para la Toma de Decisiones Compartidas y Cuadro Respiratorio Grave. CONCLUSIÓN: los criterios señalados para priorizar el proceso de atención dirigido a pacientes críticos con Covid-19 fueron: parámetros médicos científicos técnicos, gravedad del cuadro clínico, mayor edad, ser profesional de la salud, presencia de enfermedades de base incurables, realizar sorteos y pacientes con mayor probabilidad de supervivencia.


Assuntos
Humanos , Ocupação de Leitos , Bioética , Pessoal de Saúde , Tomada de Decisão Clínica , COVID-19 , Unidades de Terapia Intensiva , Assistência Integral à Saúde , Gravidade do Paciente
19.
Jt Comm J Qual Patient Saf ; 48(2): 101-107, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34840129

RESUMO

BACKGROUND: This study was conducted to measure the impact of a volunteer "Transition Guide" on patient experience and psychological stress during the transition from ICUs to general medical and surgical wards. METHODS: Between July 2017 and February 2020, medical and surgical patients from nine ICUs at a single tertiary care hospital were accompanied by a uniquely trained volunteer Transition Guide to aid them at the time of transfer to general medical/surgical wards, when available. If a Transition Guide was not available, they were transferred without one. The following day, patients were surveyed with a tool assessing overall satisfaction, multiple aspects in the domain of communication, and psychological stress associated with the transition process. When available, family members and ward nurses who admitted patients from the ICU were surveyed. RESULTS: Target enrollment was 300 patients in each group. Due to COVID-19 and institutional restrictions on volunteers, only 264 underwent transfer with a Guide, while 305 transferred without one. Of all patients approached, 95% with a Guide and 96% without a Guide completed the survey. Patients who were accompanied by a Transition Guide reported a better overall transition, better communication, greater understanding, better resolution of concerns, and less stress than those who did not have a Transition Guide (p < 0.05 for all). CONCLUSION: Among a cohort of formerly critically ill patients subsequently transferred to general medical and surgical wards, the presence of a volunteer Transition Guide significantly improved patient experience, enhanced patient communication and understanding, and reduced stress associated with the transfer process. Hospitals may consider this expanded and specialized role for volunteerism in the health care setting to improve patient-centered outcomes.


Assuntos
COVID-19 , Transferência de Pacientes , Humanos , Unidades de Terapia Intensiva , Estudos Prospectivos , SARS-CoV-2 , Voluntários
20.
Clin Rehabil ; 36(3): 331-341, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34841917

RESUMO

OBJECTIVE: Determine efficacy of the novel WiiNWalk intervention on walking-related outcomes in older adults with lower limb amputation. DESIGN: Multi-site, parallel, evaluator-masked randomized controlled trial. SETTING: Home-setting in three Canadian cities. PARTICIPANTS: Community-dwelling lower limb prosthesis users over 50 years of age. INTERVENTIONS: The WiiNWalk group (n = 38) used modified Wii Fit activities for prosthetic rehabilitation. The attention control group (n = 33) used Big Brain Academy: Wii Degree, comprising of cognitive activities. Both groups completed a 4-week supervised phase with three 1-h sessions/week in groups of three overseen by a clinician via videoconferencing and a 4-week unstructured and unsupervised phase. MAIN MEASURES: Primary outcome was walking capacity (2 min walk test); secondary outcomes were balance confidence (activities-specific balance confidence scale), dynamic balance (four-step square test), and lower limb functioning (short physical performance battery). Outcomes were compared across time points with repeated measures analysis of covariance, adjusting for baseline and age. RESULTS: Mean age was 65.0 (8.4) years, with 179.5 (223.5) months post-amputation and 80% transtibial amputation. No group difference in a 2 min walk test with an effect size: 1.53 95% CI [-3.17, 6.23] m. Activities balance confidence was greater in the WiiNWalk group by 5.53 [2.53, 8.52]%. No group difference in the four-step square test -0.16 [-1.25, 0.92] s, nor short physical performance battery 0.48 [-0.65, 1.61]. A post-hoc analysis showed the greatest difference in balance confidence immediately after an unsupervised phase. CONCLUSIONS: The WiiNWalk intervention improved balance confidence, but not walking-related physical function in older adult lower limb prosthesis users. Future rehabilitation games should be specific to the amputation context.Clinical Trial Registration number, NCT01942798.


Assuntos
Membros Artificiais , Telerreabilitação , Idoso , Amputação , Canadá , Humanos , Extremidade Inferior/cirurgia , Equilíbrio Postural , Caminhada
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA