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1.
Br J Anaesth ; 131(3): 572-585, 2023 09.
Artigo em Inglês | MEDLINE | ID: mdl-37344337

RESUMO

BACKGROUND: Perioperative education should be improved to decrease unfavourable outcomes after lumbar surgery. This trial aimed to compare effectiveness in terms of pain, quality of life, pain cognition, surgical experience, healthcare use, work resumption, and cost-effectiveness of perioperative pain neuroscience education (PPNE) vs traditional biomedical education (perioperative biomedical education [PBE]) in people undergoing surgery for lumbar radiculopathy. METHODS: In this multicentre RCT (ClinicalTrials.gov: NCT02630732), patients undergoing surgery for lumbar radiculopathy in three Belgian hospitals were randomised to receive PPNE or PBE. Both groups received one preoperative and one postoperative one-to-one education session and a booklet (balanced interventions), with an essentially different content (PPNE: biopsychosocial; PBE: biomedical). Pain was the primary outcome (Visual Analogue Scales+quantitative sensory testing). Assessments were at 3 days, 6 weeks, and 6 and 12 months after surgery. RESULTS: Between March 2016 and April 2020, participants were randomly assigned to PPNE (n=58) or PBE (n=62). At 12 months, PPNE did not lead to significantly better pain outcomes, but it did result in more favourable 36-item Short Form Health Survey physical component (additional increase: 46.94; 95% confidence interval [CI]: 14.16-79.73; medium effect), Tampa Scale of Kinesiophobia (additional decrease: 3.15; 95% CI: 0.25-6.04; small effect), and Pain Catastrophising Scale (additional decrease: 6.18; 95% CI: 1.97-10.39; medium effect) scores. Females of the PPNE group showed higher probability for work resumption (95% vs 60% in the PBE group). PPNE was cost-effective compared with PBE (incremental costs: €-2732; incremental quality-adjusted life years: 0.012). CONCLUSIONS: Perioperative pain neuroscience education showed superior clinical and cost-effectiveness than perioperative biomedical education in people undergoing surgery for lumbar radiculopathy. CLINICAL TRIAL REGISTRATION: NCT02630732.


Assuntos
Dor , Radiculopatia , Feminino , Humanos , Análise Custo-Benefício , Qualidade de Vida , Radiculopatia/cirurgia , Período Perioperatório , Manejo da Dor
2.
Pain Med ; 24(2): 139-149, 2023 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-36053220

RESUMO

OBJECTIVE: The present cross-sectional study aims to unravel associations of pain intensity and cognitions with quantitative sensory testing in people scheduled for surgery for lumbar radiculopathy. Additionally, insight will be provided into the presence of dysfunctional nociceptive processing and maladaptive pain cognitions in this population. DESIGN: Cross-sectional study. SETTING: Data from three hospitals in Belgium. SUBJECTS: The final sample comprised 120 participants with lumbar radiculopathy scheduled for surgery, included between March 2016 and April 2019. METHODS: Self-reported pain intensity was assessed on a visual analog scale, and pain cognitions were assessed with self-reported questionnaires (Pain Catastrophizing Scale, Tampa Scale for Kinesiophobia, and Pain Vigilance and Awareness Questionnaire). Quantitative sensory testing (detection thresholds, pain thresholds, temporal summation, and conditioned pain modulation) was evaluated, as well. RESULTS: Evidence was found for the presence of an impaired inhibitory response to nociceptive stimuli and maladaptive pain cognitions in this population. Kinesiophobia was found to be present to a maladaptive degree in the majority of the patients (n = 106 [88%]). Significant, but weak, associations between electrical pain thresholds at the sural nerves and leg pain intensity (sural nerve symptomatic side: r = -0.23; P = 0.01; non-symptomatic side: r = -0.22; P = 0.02) and kinesiophobia levels (sural nerve non-symptomatic side: r = -0.26; P = 0.006) were identified. CONCLUSIONS: Electrical detection thresholds and correlates for endogenous nociceptive facilitation and inhibition were not found to be related to any of the pain cognitions or to pain intensity in people scheduled to undergo surgery for lumbar radiculopathy.


Assuntos
Radiculopatia , Humanos , Medição da Dor , Radiculopatia/cirurgia , Estudos Transversais , Dor , Cognição
3.
Arch Phys Med Rehabil ; 104(2): 277-286, 2023 02.
Artigo em Inglês | MEDLINE | ID: mdl-36037878

RESUMO

OBJECTIVES: To compare prevalence rates of serious and non-serious adverse events after manipulation and mobilization and to identify risk factors of serious and non-serious adverse events following 4 types of manual therapy treatment in patients with neck pain. DESIGN: A prospective cohort study in primary care manual therapy practice. PARTICIPANTS: Patients with neck pain (N=686) provided data on adverse events after 1014 manipulation treatments, 829 mobilization treatments, 437 combined manipulation and mobilization treatments, and 891 treatments consisting of "other treatment modality". INTERVENTIONS: Usual care manual therapy. MAIN OUTCOME MEASURES: A chi-square test was performed to explore differences in prevalence rates. Logistic regression analysis was performed within the 4 treatment groups. A priori we defined associations between patient-characteristics and adverse events of odds ratio (OR)>2 or OR<0.5 as clinically relevant. RESULTS: No serious adverse events, such as cervical artery dissection or stroke, were reported. With regard to non-serious adverse events, we found that these are common after manual therapy treatment: prevalence rates are ranging from 0.3% to 64.7%. We found a statistically significant difference between the 4 types of treatments, detrimental to mobilization treatment. Logistic regression analysis resulted in 3 main predictors related to non-serious adverse events after manual therapy treatment: smoking (OR ranges from 2.10 [95% confidence interval [CI] 1.37-3.11] to 3.33 [95% CI 1.83-5.93]), the presence of comorbidity (OR ranges from 2.32 [95% CI 1.22-4.44] to 3.88 [95% CI 1.62-9.26]), and female sex (OR ranges from 0.22 [95% CI 0.11-0.46] to 0.49 [95% CI 0.28-0.86]). CONCLUSION: There is a significant difference in the occurrence of non-serious adverse events after mobilization compared with manipulation or a combination of manipulation and mobilization. Non-serious adverse events in manual therapy practice are common and are associated with smoking and the presence of comorbidity. In addition, women are more likely to report non-serious adverse events.


Assuntos
Manipulação da Coluna , Manipulações Musculoesqueléticas , Humanos , Feminino , Cervicalgia/epidemiologia , Cervicalgia/terapia , Cervicalgia/etiologia , Estudos Prospectivos , Manipulações Musculoesqueléticas/efeitos adversos , Vértebras Cervicais , Fatores de Risco , Manipulação da Coluna/efeitos adversos
4.
Qual Life Res ; 31(3): 745-757, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34342846

RESUMO

PURPOSE: The primary goal of this study was to compare the health-related quality of life (HRQoL) of people with lumbar radiculopathy to age- and sex-adjusted population norms. Additionally, it aimed to explore the associations between the HRQoL difference scores and measures related to pain cognitions, pain intensity, and endogenous nociceptive modulation. METHODS: Using answers from the Short Form 36-item Health Survey and UK population norms, SF-6D difference scores were calculated. A one-sample t test was used to assess the SF-6D difference scores. Univariate and multivariate regression analyses were used to assess the associations between SF-6D difference scores and pain intensity [Visual Analogue Scale (VAS) for back and leg pain], pain cognitions [Pain Catastrophizing Scale (PCS), Tampa Scale for Kinesiophobia (TSK), Pain Vigilance and Awareness Questionnaire (PVAQ)], and correlates for endogenous nociceptive modulation using quantitative sensory testing. RESULTS: One hundred and twenty people with lumbar radiculopathy scheduled for surgery were included in this study. The mean SF-6D difference score of - 0.26 [SD = 0.09] was found to be significantly less than 0 [95%CI: - 0.27 to - 0.24]. Univariate analyses showed a significant influence from PCS, TSK, and PVAQ on the SF-6D difference scores. The final multivariate regression model included PCS and PVAQ, with only PCS maintaining a statistically significant regression coefficient [b = - 0.002; 95% CI: - 0.004 to - 0.001]. CONCLUSION: People diagnosed with lumbar radiculopathy report significantly lower HRQoL scores when compared with age- and sex-adjusted UK norm values. Even though all examined pain cognitions were found to have a significant association, pain catastrophizing showed the most significant relation to the SF-6D difference scores. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov Identifier No. NCT02630732. Date of registration: November 25, 2015.


Assuntos
Qualidade de Vida , Radiculopatia , Cognição , Humanos , Nociceptividade , Dor , Qualidade de Vida/psicologia , Inquéritos e Questionários
5.
BMC Geriatr ; 22(1): 376, 2022 04 28.
Artigo em Inglês | MEDLINE | ID: mdl-35484488

RESUMO

BACKGROUND: Technology offers opportunities to support older adults with mild cognitive impairments to remain independent and socially connected, but is often not used. Although determinants of technology use among older adults in general are well studied, much less is known about how these factors impact technology use behaviour in cognitively impaired older adults. This study aimed to bridge this gap in research by examining the factors underlying technology use in community-dwelling older adults with mild cognitive impairments. METHODS: We applied a generic qualitative design and used 16 semi-structured interviews to collect data from Belgian (Flemish) community-dwelling older adults diagnosed with Mild Cognitive Impairment or dementia and informal caregivers. To get data from different perspectives, a focus group with professional caregivers was added. We used thematic analysis with an inductive approach to identify and select themes from the data. RESULTS: We identified two themes: introduction of technology and determinants of technology adoption and continued use. Successful technology adoption in cognitively impaired older adults is need-driven and subject to individual, technological and contextual characteristics. Specific for older adults with cognitive impairments are the importance of disease awareness and cognitive ability for adoption and continued use, respectively. Although social support can be a valuable alternative to technology, it is an important facilitator of continued technology use in these older adults. Similarly, integration of technologies in daily routines can buffer discontinuation of technologies. CONCLUSIONS: Future research is encouraged to validate our findings in a postpandemic era and to further develop a novel theoretical framework for technology acceptance among older adults with cognitive impairments. Moreover, identification of crucial determinants as well as strategies to remove use barriers are also important future research tasks. Clinical practice should focus on improving disease awareness to facilitate technology adoption and policies should invest in training and support of professional caregivers and in reimbursement strategies to facilitate implementation of technology in practice.


Assuntos
Disfunção Cognitiva , Tecnologia , Idoso , Cognição , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/terapia , Humanos , Vida Independente , Pesquisa Qualitativa
6.
J Adv Nurs ; 78(9): 2849-2860, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35266191

RESUMO

AIMS: Although there is substantial literature on autonomy of midwifery, the concept remains vague, and what it exactly constitutes is little clear. Attempts to define this have been carried out, but did not result in a communal understanding. The aim of this study therefore was to define a consistent definition of midwifery autonomy in Belgium. DESIGN: A modified Delphi survey with content experts. METHODS: Critical components of the available definitions on midwifery autonomy were retrieved from the literature, and translated into Dutch and French. An online Delphi panel of content expert assessed components of autonomy in midwifery on clarity and relevance between June and October 2021. From the validated components, a preliminary consolidated definition was generated, which was validated in a final Delphi round. RESULTS: After round one, content experts (n = 27) evaluated 10 out of 17 components to be clear and relevant. Two components were judged inappropriate and therefore removed. After further adaptation four additional components were identified appropriate after the second round, and one component after a third Delphi round. Experts' suggestions for improving the clarity and relevance were taken into account. Finally, experts assessed the preliminary definition. After minor modifications the definition of midwifery autonomy in Belgium was confirmed valid. CONCLUSION: We established a communal definition of midwifery autonomy in Belgium, the creation of such a definition results in a joint understanding of the concept of midwifery autonomy. IMPACT: If midwives internationally want to successfully achieve autonomy, a clear understanding of the concept of midwifery autonomy is needed. The consensus definition of midwifery autonomy in Belgium comprises 15 components related to midwives' work content, professionalism and relationship with others. Our definition of midwifery autonomy has the potential to encourage an international dialogue, grounded in a common understanding of autonomy, enabling stakeholders in maternity care to strengthen professional midwifery autonomy.


Assuntos
Serviços de Saúde Materna , Tocologia , Bélgica , Consenso , Técnica Delphi , Feminino , Humanos , Tocologia/métodos , Gravidez
7.
Neurosurg Focus ; 51(2): E8, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34333479

RESUMO

OBJECTIVE: The traditional freehand technique for external ventricular drain (EVD) placement is most frequently used, but remains the primary risk factor for inaccurate drain placement. As this procedure could benefit from image guidance, the authors set forth to demonstrate the impact of augmented-reality (AR) assistance on the accuracy and learning curve of EVD placement compared with the freehand technique. METHODS: Sixteen medical students performed a total of 128 EVD placements on a custom-made phantom head, both before and after receiving a standardized training session. They were guided by either the freehand technique or by AR, which provided an anatomical overlay and tailored guidance for EVD placement through inside-out infrared tracking. The outcome was quantified by the metric accuracy of EVD placement as well as by its clinical quality. RESULTS: The mean target error was significantly impacted by either AR (p = 0.003) or training (p = 0.02) in a direct comparison with the untrained freehand performance. Both untrained (11.9 ± 4.5 mm) and trained (12.2 ± 4.7 mm) AR performances were significantly better than the untrained freehand performance (19.9 ± 4.2 mm), which improved after training (13.5 ± 4.7 mm). The quality of EVD placement as assessed by the modified Kakarla scale (mKS) was significantly impacted by AR guidance (p = 0.005) but not by training (p = 0.07). Both untrained and trained AR performances (59.4% mKS grade 1 for both) were significantly better than the untrained freehand performance (25.0% mKS grade 1). Spatial aptitude testing revealed a correlation between perceptual ability and untrained AR-guided performance (r = 0.63). CONCLUSIONS: Compared with the freehand technique, AR guidance for EVD placement yielded a higher outcome accuracy and quality for procedure novices. With AR, untrained individuals performed as well as trained individuals, which indicates that AR guidance not only improved performance but also positively impacted the learning curve. Future efforts will focus on the translation and evaluation of AR for EVD placement in the clinical setting.


Assuntos
Realidade Aumentada , Drenagem , Humanos , Curva de Aprendizado , Neuronavegação , Imagens de Fantasmas
8.
Pain Med ; 21(3): 538-547, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31165894

RESUMO

OBJECTIVE: When evaluating sensory dysfunctions and pain mechanisms in patients with low back pain (LBP), a specific subgroup of patients with radicular symptoms is often excluded. Comparative studies that evaluate sensory sensitivity in patients with a dominant nociceptive and neuropathic pain component are rarely performed. Therefore, the goal of this study was to examine differences in electrical thresholds and conditioned pain modulation (CPM) between patients with low back-related leg pain (LBRLP) and patients with failed back surgery syndrome (FBSS). DESIGN: Cross-sectional study. SETTING: University Hospital Brussels. SUBJECTS: Twenty-one patients with LBRLP and 21 patients with FBSS were included. METHODS: Electrical detection thresholds (EDTs), electrical pain thresholds (EPTs), and CPM were evaluated on the symptomatic and nonsymptomatic sides. Within- and between-group differences were evaluated for all parameters. RESULTS: No between-group differences were found for EDT and EPT at both sides. On the nonsymptomatic side, a significantly lower CPM effect was found in the FBSS group (P = 0.04). The only significant within-group difference was an increased EDT at the symptomatic side in patients with FBSS (P = 0.01). CONCLUSIONS: LBP patients with a primary neuropathic pain component revealed altered detection sensitivity at the symptomatic side, without severe indications for altered nociceptive processing, compared with LBP patients without a dominant neuropathic pain component. Endogenous modulation is functioning in LBP patients, although it is possible that it might only be functioning partially in patients with a dominant neuropathic pain component.


Assuntos
Condicionamento Psicológico/fisiologia , Síndrome Pós-Laminectomia/fisiopatologia , Dor Lombar/fisiopatologia , Neuralgia/fisiopatologia , Limiar da Dor/fisiologia , Adulto , Estudos Transversais , Feminino , Humanos , Perna (Membro) , Dor Lombar/complicações , Masculino , Pessoa de Meia-Idade , Neuralgia/etiologia , Projetos Piloto
9.
Eur J Public Health ; 30(5): 879-885, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-32577756

RESUMO

BACKGROUND: There is a lack of an up-to-date body of evidence and a comprehensive overview concerning literature on quality indicator (QI) development for dementia care. Therefore, we systematically reviewed recent literature and formulated recommendations for future research. METHODS: PubMed, CINAHL and The Cochrane Library were searched for studies describing QI development or redefinition for dementia care (from first symptoms until admission to long-term care), published from 2008 to May 2019. RESULTS: We included a total of 7 articles, comprising of 107 QIs. The majority of publications originated from Europe. These applied to outpatient care, primary care and end-of-life care. Most QIs referred to care processes. Several care domains were determined by the authors, ranging from screening and assessment to end-of-life care. The methodological quality of the QI sets differed considerably. The QI sets with the best methodological quality were developed using expert evaluation or a Delphi technique. CONCLUSIONS: It can be concluded that a reasonable amount of QIs for assessing and optimizing community dementia care exists, however, further development and methodological improvements of these QIs are necessary. Involvement of people with dementia and caregivers in the development process and a broader focus including community oriented next to medically oriented QIs are examples of potential improvement measures.


Assuntos
Demência , Indicadores de Qualidade em Assistência à Saúde , Demência/diagnóstico , Demência/terapia , Europa (Continente) , Humanos , Atenção Primária à Saúde
10.
J Sports Sci ; 38(1): 86-93, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31707915

RESUMO

The predictive value of the multiple hop test for first-time noncontact lateral ankle sprains. BACKGROUND: Lateral ankle sprains (LAS) are very common sports injuries, cause high health care costs and are associated with postural control deficits. From a preventive point of view, clinicians should dispose valid field tests to identify athletes at risk for a LAS. The aim of this study is to evaluate the predictive value of the multiple hop test (MHT) for first-time noncontact LAS. METHODS: Non-elite athletes (n = 232) performed the MHT at baseline. During a 12-month follow-up period, all noncontact LAS related to health care costs were recorded. Outcomes of the MHT (completion time, balance errors and perceived difficulty) between the injured and uninjured group were compared and odds ratios (OR) and relative risks (RR) were calculated using a logistic regression analysis. RESULTS: Ten first-time noncontact LAS were recorded (4.3%). Injured athletes made significantly more change-in-support strategy (CSS) errors when compared to uninjured athletes (p = .04). The OR of the number of CSS errors was 1.14 (p = .03), the RR 4.1 (p = .04). CONCLUSIONS: Athletes scoring > 12 CSS errors, have a four times increased risk for a first-time noncontact LAS. The MHT is a valid field test to identify athletes at risk for a first-time noncontact LAS.


Assuntos
Traumatismos do Tornozelo/diagnóstico , Traumatismos em Atletas/diagnóstico , Teste de Esforço/métodos , Entorses e Distensões/diagnóstico , Adolescente , Adulto , Traumatismos do Tornozelo/fisiopatologia , Traumatismos em Atletas/fisiopatologia , Feminino , Humanos , Masculino , Equilíbrio Postural/fisiologia , Valor Preditivo dos Testes , Fatores de Risco , Entorses e Distensões/fisiopatologia , Adulto Jovem
11.
Horm Metab Res ; 51(6): 362-366, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31207657

RESUMO

Hypoparathyroidism is a rare endocrine disease with insufficient parathyroid hormone levels. Replacing the missing hormone is not yet a standard therapy. The objective of this retrospective cohort study was to evaluate if the usual therapy regimens of postsurgical hypoparathyroidism with calcitriol have a negative effect on renal function. We performed a chart analysis of patients who were seen in a tertiary care hospital in Brussels, Belgium. A total of 101 subjects were identified as patients with permanent post-surgical hypoparathyroidism, based on the hospital records of patients who underwent a total thyroidectomy between 1996 and 2016, while still being treated with calcitriol. Patients with pre-existing renal insufficiency and/or active malignancy were excluded. The cohort was predominantly female of Caucasian origin. Renal function was evaluated before and after surgery (with a maximum follow-up of 12 years), using the CKD-EPI equation. A multivariate linear regression model was used to correlate renal function decline with the duration of calcitriol therapy, while correcting for the mean calcium phosphate product and age. We found a statistically significant (p=0.027) relationship between the duration of calcitriol treatment and renal function decline at a rate of 1.06 ml/min/1.73 m2 per year of calcitriol therapy. Our study, although being retrospective, is the first one to demonstrate a relationship between the cumulative use of calcitriol therapy and renal function decline.


Assuntos
Calcitriol/efeitos adversos , Agonistas dos Canais de Cálcio/efeitos adversos , Taxa de Filtração Glomerular , Hipoparatireoidismo/cirurgia , Complicações Pós-Operatórias/tratamento farmacológico , Insuficiência Renal/induzido quimicamente , Tireoidectomia/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Prognóstico , Estudos Retrospectivos , Fatores de Tempo , Adulto Jovem
12.
J Med Syst ; 43(11): 327, 2019 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-31646400

RESUMO

Belgium is in a transition phase from paper-based prescriptions to electronic prescriptions (ePrescriptions) during which both the paper and electronic format are valid. Since patients still get a paper proof of the ePrescription, sometimes pharmacists use the ePrescription as paper-based prescription. When the government demands a complete dematerialization, i.e. no more paper-based prescriptions, this will no longer be possible. Therefore, we questioned the frequency and reasons for treating an ePrescription as paper-based. The logged interactions in the national database were used to identify possible reasons. The tarification service Koninklijk Limburgs Apothekers Verbond (KLAV) provided prescriptions of June 2018. KLAV supports tarification for community pharmacies all over Belgium, thereby providing a representative sample for the Belgian community pharmacies. A two-stage cluster random sampling technique was applied to retrieve a subset of 10,000 prescriptions. In this subset we identified 4961 ePrescriptions (49.61%) of which 226 (4.56%, in total 2.26%) were treated as paper-based. Reasons observed for this incorrect handling are (1) non-compliance of the community pharmacist; (2) errors in software or handling of the community pharmacist; (3) errors at the prescriber side or patient tries to fraud; (4) incorrectly revoking the ePrescription; and (5) errors in software of prescriber. The main reasons for treating ePrescriptions as paper-based are non-compliance of the community pharmacist (n = 124, 54.87%) by ignoring its digital nature, and errors in software or handling of the community pharmacist (n = 85, 37.61%). Future research is necessary to investigate user opinions and to measure the impact of introducing ePrescribing in the daily routine.


Assuntos
Atitude do Pessoal de Saúde , Prescrição Eletrônica/normas , Farmacêuticos/psicologia , Bélgica , Prescrições de Medicamentos/normas , Fraude/estatística & dados numéricos , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Erros de Medicação/estatística & dados numéricos , Farmácias/normas , Guias de Prática Clínica como Assunto/normas
13.
Birth ; 45(2): 137-147, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29205463

RESUMO

BACKGROUND: How a woman gives birth can affect her health-related quality of life (HRQoL). This study explored HRQoL at 3 months postpartum in women with a history of one previous cesarean in three European countries. METHODS: A prospective longitudinal survey, embedded within a cluster randomized trial in three countries, exploring women's postnatal HRQoL up to 3 months postpartum. The Short-Form Six-Dimensions (SF-6D) was used to measure HRQoL, and multivariate analyses were used to examine the relationship with mode of birth. RESULTS: Complete data were available from 880 women. Women with a spontaneous vaginal birth had the highest HRQoL scores, whereas women with an emergency repeat cesarean (P = .01) had the lowest. Postnatal readmission of the mother (P = .03), having public health insurance (P = .04), and a low antenatal HRQoL score (P < .01) contributes to poorer HRQoL scores. More specifically, women with a spontaneous vaginal birth had significantly higher HRQoL scores on the vitality dimension compared with women with an emergency repeat cesarean (P = .04). CONCLUSIONS: In women with low-risk factors, repeat cesareans result in a poorer HRQoL compared with vaginal birth. When there are no contraindications for vaginal birth, women with a history of one previous cesarean should be encouraged to give birth vaginally rather than have an elective repeat cesarean.


Assuntos
Recesariana/psicologia , Parto Obstétrico/métodos , Período Pós-Parto/psicologia , Qualidade de Vida , Adulto , Análise por Conglomerados , Parto Obstétrico/psicologia , Europa (Continente) , Feminino , Humanos , Trabalho de Parto/psicologia , Estudos Longitudinais , Análise Multivariada , Gravidez , Estudos Prospectivos , Inquéritos e Questionários
14.
Neuromodulation ; 21(1): 93-100, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29105225

RESUMO

OBJECTIVES: To understand the subjective pain experience of patients, healthcare providers rely heavily on self-reporting. However, to quantify this unique pain experience, objective parameters are not yet available in daily clinical practice. With regard to patients with failed back surgery syndrome (FBSS) treated with spinal cord stimulation (SCS), pain therapists may recover the individual functional information about the patient's posture from the implantable pulse generator (IPG) of the stimulator. The aim of this study is to investigate whether subjective self-reporting is in correlation with the functional capacities of a patient. MATERIALS AND METHODS: Thirty-nine patients with FBSS, treated with SCS were included. The accelerometer in the IPG detects positional changes and provides an objective output of seven functional positions (lying back, lying prone, lying left, lying right, transition, upright, and upright + mobile). The Oswestry Disability Index (ODI), VAS-diary, and the Pittsburgh Sleep Quality Index (PSQI) were assessed to evaluate physical functioning, pain intensities, and subjective sleep quality. Additionally, 21 patients wore a wearable actigraph device to objectify sleep quality. The agreement and Spearman correlations between objective and subjective parameters were assessed. RESULTS: Spearman rank correlations revealed no significant correlations between the ODI (subscales walking, sitting, standing, and sleeping) and the output of the IPG (percentage upright + mobile, transition, upright, and lying, respectively). Sleep parameters measured with the Actiwatch and the PSQI were not in agreement. CONCLUSIONS: This study demonstrated that self-reporting questionnaires do not correlate with the findings of objective measurements. Therefore, we recommend using both subjective and objective parameters when determining treatment options for FBSS patients.


Assuntos
Síndrome Pós-Laminectomia/terapia , Estimulação da Medula Espinal/efeitos adversos , Resultado do Tratamento , Adulto , Idoso , Idoso de 80 Anos ou mais , Dor Crônica/psicologia , Dor Crônica/terapia , Avaliação da Deficiência , Exercício Físico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Sono/fisiologia , Estatísticas não Paramétricas , Inquéritos e Questionários , Adulto Jovem
15.
Infect Dis Obstet Gynecol ; 2017: 6725168, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28260847

RESUMO

Objective. This study aimed to compare the qualitative and quantitative reproducibility of quantitative PCR (qPCR) for Ureaplasma species (Ureaplasma spp.) throughout pregnancy and according to the genital sampling site. Study Design. Between 5 and 14 weeks of gestation (T1), vaginal, fornix, and two cervical samples were taken. Sampling was repeated during the 2nd (T2) and 3rd (T3) trimester in randomly selected T1 positive and negative women. Qualitative and quantitative reproducibility were evaluated using, respectively, Cohen's kappa (κ) and interclass correlation coefficients (ICC) and repeated measures ANOVA on the log-transformed mean number of DNA copies for each sampling site. Results. During T1, 51/127 women were positive for U. parvum and 8 for U. urealyticum (4 patients for both). Sampling was repeated for 44/55 women at T2 and/or T3; 43 (97.7%) remained positive at the three timepoints. κ ranged between 0.83 and 0.95 and the ICC for cervical samples was 0.86. Conclusions. Colonization by Ureaplasma spp. seems to be very constant during pregnancy and vaginal samples have the highest detection rate.


Assuntos
Genitália Feminina/microbiologia , Reação em Cadeia da Polimerase , Cuidado Pré-Natal , Manejo de Espécimes , Ureaplasma/genética , Adulto , DNA Bacteriano/análise , DNA Bacteriano/genética , Feminino , Humanos , Tipagem Molecular/métodos , Tipagem Molecular/normas , Reação em Cadeia da Polimerase/métodos , Reação em Cadeia da Polimerase/normas , Gravidez , Cuidado Pré-Natal/métodos , Cuidado Pré-Natal/normas , Estudos Prospectivos , Reprodutibilidade dos Testes , Manejo de Espécimes/métodos , Manejo de Espécimes/normas , Ureaplasma/isolamento & purificação , Infecções por Ureaplasma/diagnóstico , Infecções por Ureaplasma/microbiologia , Adulto Jovem
16.
J Transl Med ; 14: 95, 2016 Apr 19.
Artigo em Inglês | MEDLINE | ID: mdl-27095081

RESUMO

BACKGROUND: BRAF V600 mutant circulating cell-free tumor DNA (BRAF V600mut ctDNA) could serve as a specific biomarker in patients with BRAF V600 mutant melanoma. We analyzed the value of BRAF V600mut ctDNA from plasma as a monitoring tool for advanced melanoma patients treated with BRAF/MEK inhibitors. METHODS: Allele-specific quantitative PCR analysis for BRAF V600 E/E2/D/K/R/M mutations was performed on DNA extracted from plasma of patients with known BRAF V600 mutant melanoma who were treated with dabrafenib and trametinib. RESULTS: 245 plasma samples from 36 patients were analyzed. In 16 patients the first plasma sample was obtained before the first dosing of dabrafenib/trametinib. At baseline, BRAF V600mut ctDNA was detected in 75 % of patients (n = 12/16). BRAF V600mut ctDNA decreased rapidly upon initiation of targeted therapy (p < 0.001) and became undetectable in 60 % of patients (n = 7/12) after 6 weeks of treatment. During treatment, disease progression (PD) was diagnosed in 27 of 36 patients. An increase of the BRAF V600mut ctDNA copy number and fraction, identified PD with a sensitivity of 70 % (n = 19/27) and a specificity of 100 %. An increase in the BRAF V600mut ctDNA fraction was detected prior to clinical PD in 44 % of cases (n = 12/27) and simultaneously with PD in 26 % of patients (n = 7/27). CONCLUSIONS: Quantitative analysis of BRAF V600mut ctDNA in plasma has unique features as a monitoring tool during treatment with BRAF/MEK inhibitors. Its potential as an early predictor of acquired resistance deserves further evaluation.


Assuntos
DNA de Neoplasias/sangue , Monitoramento de Medicamentos , Melanoma/tratamento farmacológico , Melanoma/secundário , Mutação/genética , Células Neoplásicas Circulantes/metabolismo , Inibidores de Proteínas Quinases/uso terapêutico , Proteínas Proto-Oncogênicas B-raf/genética , Sistema Livre de Células , Progressão da Doença , Feminino , Humanos , Imidazóis/farmacologia , Imidazóis/uso terapêutico , Estimativa de Kaplan-Meier , Masculino , Melanoma/sangue , Melanoma/genética , Pessoa de Meia-Idade , Oximas/farmacologia , Oximas/uso terapêutico , Piridonas/farmacologia , Piridonas/uso terapêutico , Pirimidinonas/farmacologia , Pirimidinonas/uso terapêutico
17.
Eur Radiol ; 26(3): 892-9, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26123408

RESUMO

OBJECTIVE: To retrospectively compare image quality of a lowered dose CT protocol to a standard CT protocol in children with suspicion of craniosynostosis. METHODS: Forty-eight patients (age 0- 35 months), who presented with a cranial deformity underwent cranial 3D CT to assess sutural patency: between 2009 - 2010, 24 patients were imaged with a standard protocol (CTDIvol 32.18 mGy), from 2011-2012, 24 underwent a low dose protocol (0.94 mGy) combined with iterative reconstruction. Image quality was evaluated by both expert reading and objective analysis. Differences were assessed by independent t-test and Mann-Whitney U test, interreader agreement by Cohen's Kappa test. RESULTS: Effective dose of the low dose protocol was 0.08 mSv, corresponding to a reduction of 97 %. Image quality was similar in both groups in terms of overall diagnostic acceptability, objective noise measurements, subjective cranial bone edge sharpness and presence of artefacts. For objective sharpness of cranial bone-brain interface and subjective perception of noise, the images of the low dose protocol were superior. For all evaluated structures, interreader agreement was moderate to almost perfect. CONCLUSION: In the diagnosis of craniosynostosis in children with cranial deformities, a dedicated sub 0.1 mSv cranial 3DCT protocol can be used without loss in image quality. KEY POINTS: 3DCT is used for the diagnosis of craniosynostosis. Imaging protocols should be optimized to minimize radiation exposure to children. Combining 80 kVp with iterative reconstruction can help to reduce dose. A sub 0.1 mSv cranial 3DCT protocol can be used without loss of diagnostic quality.


Assuntos
Craniossinostoses/diagnóstico por imagem , Tomografia Computadorizada Multidetectores/métodos , Artefatos , Pré-Escolar , Feminino , Humanos , Imageamento Tridimensional , Lactente , Recém-Nascido , Masculino , Imagens de Fantasmas , Doses de Radiação , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Estudos Retrospectivos
18.
Eur J Orthod ; 38(2): 212-6, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26409048

RESUMO

INTRODUCTION: The aim of this study was to investigate whether the addition of records can influence intra- and inter-rated agreement on torque choices made to treat a group of patients with various malocclusions. METHODS: Forty-eight patients were presented to five orthodontic specialists in three different occasions. During the first session, the participants were shown only the models and intraoral photos of the patients; extraoral photos were added during the second session, and cephalometric X-rays were further supplemented during the third session. Mean weighted kappa coefficients were calculated to measure agreement. RESULTS: The inter-observer agreement was low with the mean coefficients measured:κ1 = 0.34 (SD ± 0.09), κ2 = 0.57 (SD ± 0.12), and κ3 = 0.54 (SD ± 0.28) for the three attempts, respectively. The mean kappa coefficients for the intra-rater agreement were also low ranging from 0.18 to 0.66 and the mean coefficients were 0.27 (SD ± 0.11) between first and second, and 0.53 (SD ± 0.11) between second and third attempt, respectively. CONCLUSIONS: This study shows that the addition of extraoral photographs, and subsequently cephalograms to plaster models and intraoral photos, does affect intra-, and inter-rater agreement on torque selection. It seems that the addition of extraoral photos plays a more important role in torque selection decisions than lateral cephalograms. Different clinicians do not have a uniform opinion on the size of torque required to treat cases. Further research is required to define rules on torque choices.


Assuntos
Registros Odontológicos , Má Oclusão/terapia , Braquetes Ortodônticos/estatística & dados numéricos , Planejamento de Assistência ao Paciente , Adolescente , Adulto , Cefalometria/estatística & dados numéricos , Criança , Feminino , Humanos , Incisivo/patologia , Masculino , Pessoa de Meia-Idade , Modelos Dentários/estatística & dados numéricos , Variações Dependentes do Observador , Fotografia Dentária/estatística & dados numéricos , Reprodutibilidade dos Testes , Técnicas de Movimentação Dentária/instrumentação , Torque , Adulto Jovem
19.
Ophthalmic Res ; 54(4): 181-94, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26492201

RESUMO

PURPOSE: To investigate the type and severity of acquired colour vision deficiencies (CVDs) in molecularly proven Stargardt disease (STD) and to establish whether a relationship exists between best-corrected visual acuity (BCVA) and full-field electroretinography (ffERG), and the degree of CVD. METHODS: A retrospective, cross-sectional study of 73 patients with a molecularly proven diagnosis of STD, who underwent extensive colour vision evaluation, using pseudo-isochromatic and arrangement tests. Thirteen patients underwent Nagel anomaloscopy. RESULTS: Normal colour vision was found in almost 20% of patients. Red/green (R/G) CVDs increased as BCVA declined. About 45% of all R/G CVDs were of the deutan type, although protan type CVDs became progressively apparent when moving from the high to the low BCVA group. An additional blue/yellow CVD was noted in about 25% of patients. In 10/13 patients, a pseudoprotanomaly was noted on anomaloscopy. Severe CVDs leading to scotopization were noted in patients with low BCVA and/or long-standing disease. No statistically significant differences in ERG results were found between groups with or without a CVD. CONCLUSIONS: The degree and type of colour vision deficiency in STD patients correlate better with BCVA than with ffERG results. The presence of specific CVDs may help to establish a diagnosis of STD. A battery of colour vision tests is required to properly evaluate CVDs in STD.


Assuntos
Defeitos da Visão Cromática/fisiopatologia , Degeneração Macular/congênito , Transportadores de Cassetes de Ligação de ATP/genética , Adulto , Testes de Percepção de Cores , Defeitos da Visão Cromática/diagnóstico , Estudos Transversais , Eletrorretinografia , Feminino , Angiofluoresceinografia , Humanos , Degeneração Macular/diagnóstico , Degeneração Macular/genética , Degeneração Macular/fisiopatologia , Masculino , Análise em Microsséries , Pessoa de Meia-Idade , Mutação , Estudos Retrospectivos , Doença de Stargardt , Acuidade Visual/fisiologia
20.
J Perinat Med ; 43(4): 403-8, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24933627

RESUMO

OBJECTIVE: We conducted a prospective comparative cohort study to determinate the influence of coitus on quantitative fetal fibronectin test results under normal pregnancy conditions. We also compared values obtained in cervical and vaginal secretions. METHODS: In a population of women with normal singleton pregnancies between 22 and 28 weeks gestation, we have performed (cervical and vaginal) quantitative fetal fibronectin tests in two separate groups classified according to timing after coitus (one group of women had intercourse within 24 h before sampling and the control group had intercourse >24 h before sampling). The main outcome measures were the proportion of positive tests in both groups and the correlation between cervical and vaginal values through the Pearson correlation coefficient. RESULTS: Both groups were similar in terms of general characteristics and pregnancy outcomes. The proportions of positive results in the vaginal secretions were 7.5% and 25.0% (P=0.007) in the control and coitus group, respectively. In the cervical secretions, the proportions of positive tests were greater, but not statistically different (39.7% and 40.0%, respectively). The Pearson correlation coefficients were very low (<0.3) indicating poor correlation between both sampling locations. Even if the cervical values were generally greater than the vaginal values, they were lower in 26% of the women. CONCLUSIONS: Coitus definitely interferes with vaginal fetal fibronectin test results. In cervical secretions, the positive rate was so high that coitus had no influence, but cervical sampling in this location should be avoided.


Assuntos
Coito , Fibronectinas/análise , Esfregaço Vaginal , Adulto , Feminino , Humanos , Gravidez , Estudos Prospectivos
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