Systematic Appraisal of the American College of Rheumatology Clinical Practice Guidelines.

OBJECTIVE: Because the American College of Rheumatology (ACR) practice guidelines affect the United States' and international treatment practice, we used the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument to characterize the quality of the guidelines and to identify potential areas for improvement. METHODS: Using the six quality domains in the AGREE II online tool, four reviewers assessed the practice guidelines available at the ACR website and the immediately previous version to summarize the domain scores for each guideline and examine trends over time. RESULTS: As of April 2016, the ACR website listed nine guidelines, four with immediate previous versions. Based on AGREE II, the minimum and maximum for each domain (with higher being better) of the current guidelines were 78-99 for Scope and Purpose, 57-99 for Stakeholder Involvement, 87- 96 for Rigor of the Methodology, 83-99 for Clarity of Presentation, 49-78 for Applicability, 69-85 for Editorial Independence, and 71-96 overall. Over time, although the average domain quality of the guidelines improved for all, the Applicability and Editorial Independence domains had the least amount of improvement. For the four guidelines with previous versions, the mean (SD) absolute improvements for each domain were 18 (±11) for Scope and Purpose, 13 (±8) for Stakeholder Involvement, 38 (±22) for Rigor of the Methodology, 25 (±15) for Clarity of Presentation, 22 (±12) for Applicability, 24 (±17) for Editorial Independence, and 31 (±5) overall. CONCLUSION: Based on the AGREE II instrument, the ACR guidelines have achieved high quality over the past 16 years. The Applicability and Editorial Independence domains have the greatest potential for future improvement.

Perfil sociodemográfico e comportamental de gestantes adolescentes de uma maternidade de referência / Sociodemographic and behavioral profile of teens pregnant of a reference maternity

Objetivo: analisar o perfil sociodemográfico e comportamental das gestantes adolescentes de uma maternidade de referência. Metodologia: trata-se de um estudo descritivo com abordagem quantitativa e do tipo corte transversal, realizado em uma maternidade pública estadual localizada em uma capital do nordeste brasileiro. A coleta de dados ocorreu em junho e julho de 2015, mediante formulário estruturado, aplicado a 31 adolescentes, que realizavam pré-natal de Alto risco na Maternidade referida, após aprovação do Comitê de Ética e Pesquisa da Universidade Federal do Piauí com parecer 1.028.570. Resultados: segundo os aspectos sociodemográficos e comportamentais, observou-se predominância de adolescentes gestantes em união estável (54,8%), tinham ensino fundamental incompleto (54,8%), com renda familiar de até 01 salário mínimo (51,6%), procedentes de Teresina (64,5%), que iniciou a vida sexual entre 11 e 14 anos de idade (51,6%), que teve um parceiro sexual (41,9%) e que utilizavam métodos contraceptivos (80,6%). Conclusão: dentre os fatores sociodemográficos das adolescentes, os mais representativos foram: a idade materna, escolaridade e renda familiar. A caracterização comportamental é permeada por um início precoce das atividades sexuais, associado com uso incorreto de métodos contraceptivos.

Objective: to analyze the sociodemographic and behavioral profile of adolescent pregnant women in a reference maternity hospital. Methodology: this is a descriptive study with a quantitative and cross-sectional approach, carried out in a state public maternity hospital located at a capital city of northeastern Brazil. Data collection took place in June and July 2015, using a structured form, applied to 31 adolescents who underwent high-risk prenatal care at the referred Maternity Hospital, after approval of the Ethics and Research Committee of the Federal University of Piauí, with opinion 1.028. 570. Results: according to sociodemographic and behavioral aspects, there was a predominance of pregnant adolescents in a stable union (54.8%), incomplete elementary school (54.8%), family income up to 01 minimum wage (51.6%), from Teresina (64.5%), who started the sexual life between 11 and 14 years old (51.6%), who had a sexual partner (41.9%) and who used contraceptive methods (80, 6%). Conclusion: among the sociodemographic factors of the adolescents, the most representative was maternal age, schooling and family income. Behavioral characterization is permeated by an early onset of sexual activities, associated with incorrect use of contraceptive methods.

Percepção do pai sobre a sua presença durante o processo parturitivo / The father's perception on his presence during the parturitive process

Objetivo: descrever a percepção do pai sobre sua presença durante o processo parturitivo. Método: estudo qualitativo, descritivo, constituído de nove pais acompanhantes, em um Centro de Parto Normal institucionalizado em uma maternidade pública de referência. A coleta de dados ocorreu por meio da entrevista direta e individualizada, com roteiro semiestruturado, gravada e transcrita na íntegra. Utilizou-se a técnica de Análise de Conteúdo na modalidade Análise de Categorias. Resultados: a análise dos dados possibilitou emergir as categorias << Concepção do pai/acompanhante sobre sua presença durante o processo de parto >>, << Sentimentos expressos pelo pai/acompanhante durante o período expulsivo >> e << Envolvimento do pai/acompanhante no processo parturitivo >>. Conclusão: os pais reconheceram o acompanhamento às companheiras em trabalho de parto como positivo, pois puderam contribuir proporcionando-lhes apoio, segurança, confiança, conforto e bem-estar físico e emocional.(AU)

A vivência de adolescentes assistidas por enfermeiros obstetras durante o processo de parturição / La experiencia de adolescentes asistidas por enfermeros obstétricos durante el proceso de parto / The experience of adolescents assisted by obstetric nurses during parturition

Objetivos: descrever a vivência de adolescentes durante o processo de parturição e a atuação da enfermagem obstétrica com base nos depoimentos das adolescentes e discutir à luz da literatura pertinente. Método: pesquisa descritiva, exploratória, de natureza qualitativa, com dez puérperas adolescentes do alojamento conjunto da Maternidade de Referência Estadual do Piauí, mediante entrevista semi estruturada analisada com os preceitos da análise temática. Resultados: permitiu identificar o aflorar de sentimentos e sensações das adolescentes no processo parturitivo como a dor e a satisfação de ver o filho e a inserção de tecnologias não invasivas de alívio da dor utilizadas pelos enfermeiros obstetras. Conclusão: As adolescentes reconheceram os benefícios das tecnologias não invasivas de alívio da dor para a redução do tempo do trabalho de parto e a importância da atuação do enfermeiro obstetra.

Objectives: to describe the experience of adolescents in the process of parturition and the performance of obstetrical nursingbased on the testimonies of adolescents and discussing in the light of the relevant literature. Method: descriptive, exploratory,qualitative study, with ten teenage mothers from the rooming at State Reference Maternity of Piauí, through semi-structuredinterviews analyzed with the principles of thematic analysis. Results: it was identified the flourishing of feelings and sensations ofteenagers in the birth process as pain and pleased to see the child and the inclusion of non-invasive technologies of pain relief usedby midwives. Conclusion: Adolescents recognized the benefits of non-invasive technologies of pain relief for reduction of labor timeand the importance of the role of the obstetrician nurse.

Objetivos: describir la experiencia de los adolescentes en el proceso de parto y el rendimiento de enfermería obstétrica en base alos testimonios de los adolescentes y discuten a la luz de la literatura relevante. Metodo: Estudio descriptivo, exploratorio, cualitativo, con diez madres adolescentes desde el alojamiento conjunto de maternidad Estado de Piauí de referencia, a través de entrevistas semiestructuradas analizadas con los principios del análisis temático. Resultados: identifican el florecimiento desentimientos y sensaciones de los adolescentes en el proceso de nacimiento como el dolor y el placer de ver al niño y la inclusiónde tecnologías de alivio del dolor no invasivo utilizado por una comadrona. Conclusión: Los adolescentes reconocen los beneficios de las tecnologías no invasivas de alivio del dolor para la reducción del tiempo de trabajo y la importancia del papel de la enfermera obstetra.

Treatment of vascular activity secondary to atypical choroidal nevus using intravitreal bevacizumab.

OBJECTIVE: To report the optical coherence tomography (OCT) findings of 27 eyes treated with intravitreal bevacizumab for intraretinal and subretinal vascular activity associated with atypical choroidal nevi. METHODS: This was an Internal Review Board-approved retrospective review of 27 eyes of 27 patients with choroidal nevus treated for secondary vascular activity with intravitreal injections of bevacizumab, performed by a single surgeon (TGM) at the Bascom Palmer Eye Institute. All patients were rigorously evaluated before the procedure and followed thereafter with ophthalmic examinations, refractive analysis, fundus photos, optical coherence tomography (OCT), and ocular echography. Patient demographics, tumor characteristics, dates of bevacizumab injections, and spectral-domain (SD)-OCT findings at each injection were recorded. Macular edema was graded as per SD-OCT findings for the initial and final visit. RESULTS: The mean age was 66.6 years (range, 40-86 years), with ten males and 17 females. Mean, median, and range baseline best corrected visual acuity (BCVA) were 20/53, 20/40, and 20/20-4/200, respectively. After a mean follow up of 29 months, the final BCVA mean, median, and range were 20/50, 20/40, and 20/20-20/400, respectively. The final BCVA ranged from 20/20 to 20/25 in nine eyes, while only six eyes had an initial BCVA within the same range. All patients demonstrated OCT findings of vascular activity suggestive of choroidal neovascularization (CNV). Initial SD-OCT findings included intraretinal cysts in eleven eyes, intraretinal fluid in six eyes, subretinal fluid in 14 eyes, pigment epithelial detachment in six eyes, epiretinal membrane in five eyes, and subretinal neovascularization in 14 eyes. On fundus photos, four eyes presented retinal hemorrhage. A mean of eight (range of 1-31) intravitreal bevacizumab (1.25 mg/0.05 cc) injections were given in all cases. A total of 37% (10/27) of eyes had complete or partial regression of vascular activity. The mean initial OCT classification for macular edema was 3 and a mean grade of 3 was maintained at the final follow-up OCT. All 27 choroidal nevi remained stable, and there were no adverse effects from the bevacizumab injections. CONCLUSION: To our knowledge, this is the largest published case series of eyes treated with intravitreal bevacizumab for vascular activity associated with choroidal nevus. Intravitreal bevacizumab seems to be effective in the treatment of CNV secondary to choroidal nevus, and OCT can be a useful tool in the follow up of these patients, to assess the regression of CNV and to monitor macular edema.

Microincisional vitrectomy for retinal detachment in I-125 brachytherapy-treated patients with posterior uveal malignant melanoma.

PURPOSE: To analyze functional and anatomical outcomes following 23/25(+) gauge microincisional pars plana vitrectomy surgery (MIVS) in patients with radiation-related retinal detachment after successful 125-iodine (I-125) brachytherapy treatment for malignant uveal melanoma. PATIENTS AND METHODS: Retrospective case series of 102 consecutive eyes of 102 patients with history of uveal melanoma treated with I-125 brachytherapy that underwent MIVS at the Bascom Palmer Eye Institute. All cases were evaluated for surgical complications and local tumor control. Extended follow-up included Snellen's best-corrected visual acuity, intraocular pressure evaluation, quantitative echography, indirect ophthalmoscopy, and fundus imaging with optical coherence tomography/wide-field photography. RESULTS: All patients had radiation-related complications, including retinal detachment (102 eyes), vasculopathy (91 eyes), optic neuropathy (32 eyes), and/or vitreous hemorrhage (8 eyes). Sixty-seven patients had vitreoretinal traction. Average follow-up after MIVS was 19.5 months, and from plaque removal was 57.7 months. Interval from plaque to MIVS was 38.1 months. Initial visual acuity was 20/258, which improved to 20/101 at 1 month, 20/110 at 3 months, 20/116 at 6 months, and 20/113 at 12 months (P < 0.05). No eyes required enucleation. Melanoma-related mortality was 0.9% (1/102). There was no intra- or extraocular tumor dissemination, and no tumor recurrence. CONCLUSION: MIVS was effective in improving visual function and anatomy in patients with radiation-related retinal detachment. Tumors decreased in size and there was no evidence of recurrence or tumor dissemination. This combined procedure addresses the modifiable causes of visual loss in patients with previously treated malignant uveal melanoma and has the potential to enhance their visual function.

Retinoblastoma treatment: utilization of the glycolytic inhibitor, 2-deoxy-2-fluoro-D-glucose (2-FG), to target the chemoresistant hypoxic regions in LH(BETA)T(AG) retinal tumors.

PURPOSE: To analyze the effect of the glycolytic inhibitor 2-deoxy-2-fluoro-d-glucose (2-FG) on tumor burden, hypoxia, and blood vessels in LH(BETA)T(AG) retinal tumors. METHODS: Seventeen-week-old LH(BETA)T(AG) retinal tumor eyes (n = 36) were treated with 2-FG and analyzed at 1 day and 1 week post a single treatment, and 1 day post a biweekly treatment for 3 weeks. Tumor sections were analyzed for hypoxia, tumor burden, and vasculature. To assess tumor burden, sections were processed for standard hematoxylin-eosin (H&E) staining. Immunofluorescent techniques were used to stain for new and mature blood vessels. RESULTS: Hypoxia and tumor burden reduction are significantly different between the treatment schedules used (P < 0.001). Eyes treated with 2-FG for 3 weeks showed a significant decrease in hypoxia (P = 0.001) and tumor burden (P = 0.009); whereas those treated with one injection and evaluated at 1 day and 1 week postinjection did not show a decrease in either hypoxia (P = 0.373 and P = 0.782, respectively) or tumor burden (P = 0.203 and P = 0.836, respectively). When evaluating the spatial distribution of hypoxic regions in the different areas of the tumor, 2-FG showed a differential effect on hypoxia depending on the area. Hypoxia was most decreased in the base of the treated eyes with a 95% reduction (P < 0.001). CONCLUSIONS: This is the first study to elucidate that 2-FG treatment in retinoblastoma produces an impact on hypoxia and a concomitant decrease on tumor burden. In this study, the authors validate their previous studies by revealing that glycolytic inhibitors effectively target hypoxia in retinoblastoma tumors. The future application of 2-FG as an adjuvant treatment to standard chemotherapy may enhance the treatment of retinoblastoma.

Conhecimento de mulheres em idade fértil sobre o papiloma vírus humano

O Papiloma Vírus Humano (HPV) é um agente de transmissão sexual que se manifesta através de lesões conhecidas como condiloma acuminado e que predispõe ao câncer de colo uterino. O estudo tem por objetivo analisar o conhecimento de mulheres em idade fértil sobre o HPV. Utilizouse a abordagem qualitativa e por meio de entrevista semiestruturada. O cenário da investigação foi um hospital de referência em oncologia em Teresina, Piauí, Nordeste do Brasil. A análise resultou em três categorias, sendo uma delas iluminada pelo referencial de Orem, o HPV e o autocuidado: sentimentos inerentes à descoberta da doença. Nos resultados, evidenciou-se a fragilidade do conhecimento dos sujeitos sobre a doença, ressaltando-se a importância da realização do exame como principal forma de autocuidado...

The Human Papilloma Virus (HPV) is a sexually transmitted agent that manifests itself in lesions known as condyloma acuminata and predisposes to cancer of the cervix. The objective of this study is the knowledge of women at childbearing age on HPV. We used a qualitative approach and by means of semi-structured interview. The scenary of this investigation was an oncology referral hospital in Teresina/Piauí/Northeast of Brazil. The analysis resulted in three categories, one of which is illuminated by reference Orem, HPV and self-care, feelings related to the discovery of the disease. The results showed the fragility of the subjects’ knowledge about the disease. However, it was stressed the importance of the examination as the primary form of self-care...

El Virus del Papiloma Humano (HPV) es un agente de transmisión sexual que se manifiesta en lesiones conocidas como condiloma acuminado y predispone al cáncer de cuello del útero. El objetivo de este estudio, el conocimiento de las mujeres en edad fértil sobre el HPV. Se utilizó un enfoque cualitativo y por medio de entrevista semi-estructurada. La configuración de esta investigación fue un hospital de referencia de oncología en Teresina-PI. El análisis resultó en tres categorías, una de ellas está iluminada por referencia Orem, el HPV y el cuidado personal, los sentimientos relacionados con el descubrimiento de la enfermedad. Los resultados mostraron la fragilidad de los temas del conocimiento sobre la enfermedad. Sin embargo, se destacó la importancia del examen como la principal forma de auto-cuidado...

Frequent prosthesis refitting to prevent implant exposure in patients with retinoblastoma.

PURPOSE: To examine the effects of prosthesis refitting on porous orbital implant exposure in 100 patients who underwent enucleation for retinoblastoma. METHODS: Parameters analyzed included patient's age at enucleation, gender, implant type, frequency of prosthesis adjustment, and use of chemotherapy or radiation. The main outcome measures consisted of the condition of the fornices, condition of the implant (including conjunctival thinning), and condition and functioning ability of the prosthesis. RESULTS: Increased frequency of visits with the ocularist and number of prosthesis adjustments and refits significantly improved the condition of the implant, fornices, and prosthesis. The patient's age at enucleation, gender, and use of chemotherapy or radiation did not have a significant effect on any of the outcome variables. The condition of the implant was significantly better for porous polyethylene than hydroxyapatite implants (P = .024). No implant exposures were observed. CONCLUSION: Frequent adjustments and refits by the ocularist are significantly associated with a reduced rate of conjunctival thinning and complete avoidance of implant exposure in patients undergoing enucleation for retinoblastoma. These findings are particularly significant for this population, which historically has demonstrated a high rate of implant exposure.

Intravitreal injection analysis at the Bascom Palmer Eye Institute: evaluation of clinical indications for the treatment and incidence rates of endophthalmitis.

OBJECTIVE: To report the incidence of endophthalmitis, in addition to its clinical and microbiological aspects, after intravitreal injection of vascular-targeting agents. METHODS: A retrospective review of a consecutive series of 10,142 intravitreal injections of vascular targeting agents (bevacizumab, ranibizumab, triamcinolone acetonide, and preservative-free triamcinolone acetonide) between June 1, 2007 and January 31, 2010, performed by a single service (TGM) at the Bascom Palmer Eye Institute. RESULTS: One case of clinically-suspected endophthalmitis was identified out of a total of 10,142 injections (0.009%), presenting within three days of injection of bevacizumab. The case was culture-positive for Staphylococcus epidermidis. Final visual acuity was 20/40 after pars plana vitrectomy surgery. CONCLUSIONS: In this series, the incidence of culture-positive endophthalmitis after intravitreal injection of vascular agents in an outpatient setting was very low. We believe that following a standardized injection protocol, adherence to sterile techniques and proper patient follow-up are determining factors for low incidence rates.