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2.
Rev. Hosp. Ital. B. Aires (2004) ; 40(1): 34-38, mar. 2020. tab
Artigo em Espanhol | LILACS | ID: biblio-1102292

RESUMO

Las mujeres han sido tratadas por décadas con testosterona intentando aliviar una gran variedad de síntomas con riesgos y beneficios inciertos. En la mayoría de los países, la testosterona se prescribe "off-label", de modo que las mujeres están utilizando compuestos y dosis ideadas para tratamientos en hombres. En este sentido, varias sociedades médicas de distintos continentes adoptaron recientemente por consenso una toma de posición sobre los beneficios y potenciales riesgos de la terapia con testosterona en la mujer, explorar las áreas de incertidumbre e identificar prácticas de prescripción con potencial de causar daño. Las recomendaciones con respecto a los beneficios y riesgos de la terapia con testosterona se basan en los resultados de ensayos clínicos controlados con placebo de al menos 12 semanas de duración. A continuación se comentan las recomendaciones. (AU)


There are currently no clear established indications for testosterone replacement therapy for women. Nonetheless, clinicians have been treating women with testosterone to alleviate a variety of symptoms for decades with uncertainty regarding its benefits and risks. In most countries, testosterone therapy is prescribed off-label, which means that women are using testosterone formulations or compounds approved for men with a modified dose for women. Due to these issues, there was a need for a global Consensus Position Statement on testosterone therapy for women based on the available evidence from placebo randomized controlled trials (RCTs). This Position Statement was developed to inform health care professionals about the benefits and potential risks of testosterone therapy intended for women. The aim of the Consensus was to provide clear guidance as to which women might benefit from testosterone therapy; to identify symptoms, signs, and certain conditions for which the evidence does not support the prescription of testosterone; to explore areas of uncertainty, and to identify any prescribing practices that have the potential to cause harm. (AU)


Assuntos
Humanos , Feminino , Idoso , Testosterona/uso terapêutico , Pós-Menopausa/efeitos dos fármacos , Depressores do Apetite/efeitos adversos , Fenitoína/efeitos adversos , Placebos/administração & dosagem , Psicotrópicos/efeitos adversos , Tamoxifeno/efeitos adversos , Testosterona/administração & dosagem , Testosterona/análise , Testosterona/efeitos adversos , Testosterona/farmacologia , Fármacos Cardiovasculares/efeitos adversos , Indometacina/efeitos adversos , Hormônio Liberador de Gonadotropina/efeitos adversos , Pós-Menopausa/fisiologia , Ensaios Clínicos Controlados como Assunto , Antagonistas Colinérgicos/efeitos adversos , Anticoncepcionais Orais/efeitos adversos , Disfunções Sexuais Psicogênicas/etiologia , Disfunções Sexuais Psicogênicas/terapia , Danazol/efeitos adversos , Consenso , Inibidores da Aromatase/efeitos adversos , Uso Off-Label , Inibidores do Fator Xa/efeitos adversos , Anfetaminas/efeitos adversos , Antagonistas dos Receptores Histamínicos/efeitos adversos , Antagonistas de Androgênios/efeitos adversos , Androgênios/fisiologia , Cetoconazol/efeitos adversos , Entorpecentes/efeitos adversos
4.
Rev. Asoc. Méd. Argent ; 132(4): 9-14, dic. 2019.
Artigo em Espanhol | LILACS | ID: biblio-1087165

RESUMO

Obligatoriedad de investigar el uso de alcohol y drogas en todo el personal de áreas vinculadas al transporte de pasajeros, sea cual fuere el medio de transporte. El resultado obligatorio requerido debe ser cero alcohol y test de drogas negativos. Luego de la existencia del consentimiento informado y explicitación de la política en la materia, el personal con una toma positiva de alcohol o drogas será retirado definitivamente de su función. (AU)


Mandatory requirement to investigate the use of alcohol and drugs in all personnel working in areas related to all passenger transportation. The mandatory required result should be "0" alcohol and negative drugs tests. After having confirmed consent of the given information as well as a proper explanation of the policy related to this matter, in case of drug or alcohol positive result, the personnel will be ceased in their function. (AU)


Assuntos
Humanos , Segurança , Consumo de Bebidas Alcoólicas , Acidentes de Trânsito/prevenção & controle , Transtornos Relacionados ao Uso de Substâncias , Uso de Medicamentos , Dirigir sob a Influência/prevenção & controle , Saúde do Trabalhador , Consenso , Dirigir sob a Influência/legislação & jurisprudência
6.
Rev. cir. (Impr.) ; 71(4): 307-317, ago. 2019. tab
Artigo em Espanhol | LILACS | ID: biblio-1058277

RESUMO

INTRODUCCIÓN: Una de las vías de acceso a la cavidad abdominal es la laparotomía media, siendo uno de los riesgos más temidos las complicaciones postoperatorias, las cuales pueden disminuirse con difusión de una adecuada técnica quirúrgica. OBJETIVO: Generar un consenso de expertos con pasos clave para realizar una laparotomía media supra-infraumbilical, a través de la metodología Delphi. MATERIALES Y MÉTODO: Por medio de una revisión de la literatura se extrajo el detalle de 37 pasos considerados en el procedimiento, organizado en secciones de preparación, apertura y cierre, siendo evaluados por un grupo de cirujanos de 7 hospitales docentes de Chile, mediante una encuesta online. RESULTADOS: El consenso se alcanzó en dos rondas, con 28 de los 37 pasos extraídos de la literatura, considerados importantes o muy importantes para la enseñanza de la técnica. Discusión: De los 28 pasos identificados como importantes, existe un alto grado de acuerdo para la preparación y apertura de una laparotomía, a diferencia del cierre en el cual no se observa una preferencia clara entre el cierre en una o varias capas entre el peritoneo y la fascia, debiendo analizarse en cada caso específico. CONCLUSIÓN: La identificación de 28 pasos estandarizados constituye un aporte en los programas de formación de residentes y en el desarrollo de modelos de simulación adecuados para la replicación del procedimiento. El aprendizaje correcto de la técnica basado en evidencia es fundamental para disminuir el riesgo de complicaciones asociadas, especialmente en el postoperatorio.


INTRODUCTION: Traditionally, the main surgical technique to access the abdominal cavity has been midline incision laparotomy, being postoperative complications a main concern. Proper teaching-learning methods could help improving the success of this procedure. AIM: Establish an expert's consensus throughout the Delphi Methodology regarding the main steps that need to be considered in a midline laparotomy. MATERIALS AND METHOD: Literature review was conducted, 37 steps were identified and grouped in 3 sections; preparation of the skin, opening incision, and closure. These steps were evaluated online by surgeons of 7 teaching hospitals in Chile. RESULTS: Consensus was reached in two rounds, 28 of the 37 steps were identified as important or very important for the procedure. DISCUSSION: There is a high level of agreement in steps related to preparation of the skin and opening incision. However, there is not a consensus regarding closure of the peritoneum and fascia in one or more layers, being a case to case decision. CONCLUSIONS: Establishment of 28 standardized steps constitutes a contribution to resident teaching programs and the development of simulation materials as an active learning strategy. Satisfactory learning outcomes have a direct impact in the success of the procedure and a lower rate of complications.


Assuntos
Humanos , Técnica Delfos , Consenso , Laparotomia/educação , Laparotomia/métodos , Procedimentos Cirúrgicos Operatórios/educação
7.
rev. cuid. (Bucaramanga. 2010) ; 10(2): e651, mayo-ago. 2019. tab
Artigo em Português | LILACS, BDENF - Enfermagem, COLNAL | ID: biblio-1059197

RESUMO

Resumo Introdução A Artroplastia Total de Quadril se apresenta como um procedimento eficaz para a diminuição da dor em articulações e para a melhora funcional das pessoas. Objetivo Selecionar resultados e indicadores da Nursing Outcomes Classification (NOC) e construir definições conceituais e operacionais, para avaliação da dor de pacientes após Artroplastia Total de Quadril. Materiais e Métodos Estudo de consenso entre especialistas. As definições foram construídas baseadas na literatura e experiência dos autores. Estabeleceu-se um consenso de 100% para o conteúdo do instrumento das definições conceituais e operacionais do resultado de enfermagem. Resultados Foi selecionado o resultado de enfermagem Nível de dor, com onze indicadores, a mencionar: Dor relatada, Duração dos episódios de dor, Expressões faciais de dor, Agitação, Irritabilidade, Encolhimento, Diaforese, Náusea, Frequência respiratória, Frequência do pulso radial e Pressão arterial. Cada um dos onze indicadores foi definido conceitual e operacionalmente. Discussão e Conclusões A seleção desse resultado e de seus indicadores, assim como a construção das definições podem favorecer a aplicação da NOC com maior fidedignidade nessa população, além de aprimorar a assistência e contribuir no aperfeiçoamento da classificação.


Abstract Introduction Total Hip Arthroplasty (THA) is an effective procedure to relieve joint pain and to provide functional improvement in patients. Objective Based on the outcomes and indicators from the Nursing Outcomes Classification (NOC), this study aims to create conceptual and operational definitions to assess pain in patients undergoing Total Hip Arthroplasty. Materials and Methods Consensus study among experts. Definitions were based on literature review and author experience. Complete agreement was found on instrument content in relation to the conceptual and operational definitions from nursing outcomes. Results The nursing outcome 'pain level' was selected which had eleven indicators, being notable the self-reported pain, duration of pain episodes, facial expressions of pain, agitation, irritability, muscle contraction, diaphoresis, nausea, respiratory rate, heart rate at the radial point and blood pressure. Discussion and conclusions The selection of this outcome and its indicators as well as the creation of definitions might benefit the NOC application in a more reliable manner over that population, apart from improving assistance and helping adjust this classification.


Resumen Introducción La Artroplastia Total de Cadera se presenta como un procedimiento eficaz para disminuir el dolor en las articulaciones y para alcanzar la mejora funcional de las personas. Objetivo Seleccionar resultados e indicadores de la Nursing Outcomes Classification (NOC) y construir definiciones conceptuales y operacionales para la valoración del dolor de los pacientes que son sometidos a una Artroplastia Total de Cadera. Materiales y Métodos Estudio de consenso entre especialistas. Las definiciones se construyeron con base en la literatura y en la experiencia de los autores. Se estableció un consenso de 100% para el contenido del instrumento con respecto a las definiciones conceptuales y operacionales del resultado de la enfermería. Resultados Se escogió el resultado de enfermería Nivel de dolor, con once indicadores, de los cuales vale la pena destacar: Dolor reportado, Duración de los episodios de dolor, Expresiones faciales de dolor, Agitación, Irritabilidad, Encogimiento, Diaforesis, Náuseas, Frecuencia respiratoria, Frecuencia del pulso radial y Presión arterial. Cada uno de los once indicadores se definió conceptual y operativamente. Discusión y Conclusiones La selección de este resultado y de sus indicadores, así como la construcción de las definiciones pueden favorecer la aplicación de la NOC de manera más fidedigna en esa población, además de mejorar la asistencia y contribuir a perfeccionar la clasificación.


Assuntos
Humanos , Masculino , Feminino , Medição da Dor , Artroplastia de Quadril , Consenso , Terminologia Padronizada em Enfermagem
8.
Fisioter. Pesqui. (Online) ; 26(2): 151-157, abr.-jun. 2019. tab
Artigo em Português | LILACS | ID: biblio-1012138

RESUMO

RESUMO A isquemia crítica de membro inferior (ICMI) gera impacto nos sistemas de saúde, na qualidade de vida e funcionalidade dos indivíduos diagnosticados. Entretanto, há pouca evidência científica que permita fundamentar a intervenção fisioterapêutica para pacientes internados por ICMI. O objetivo desse estudo foi elaborar um consenso de especialistas sobre a fisioterapia intra-hospitalar para pacientes com ICMI. Para tal, foi utilizado o método Delphi. Um painel de especialistas foi formado por 18 fisioterapeutas que representavam 85,7% da equipe de um hospital de referência em cirurgia vascular. Foram consideradas, para o consenso, as respostas com valor mínimo de concordância de 70% e média ou mediana ≥3,1 na escala Likert. Os questionários abordaram itens da avaliação, objetivos e condutas fisioterapêuticas nas fases pré e pós-cirurgia de revascularização. Definiram-se como itens essenciais a avaliação de sintomas, função cognitiva, musculoesquelética e cardiorrespiratória. Controle da dor, redução de edemas, ganho de amplitude de movimento, deambulação e educação em saúde são objetivos no pré-operatório e o ganho de força muscular na fase pós-operatória. Exercícios passivo, assistido, ativo livre e circulatório, incluindo os membros superiores, estão indicados antes e após as cirurgias. Educação em saúde e deambulação com redução de peso em área de lesão plantar são essenciais em todo o período de internação. A eletroanalgesia foi preconizada no pré-operatório e a elevação do membro inferior e exercícios resistidos no pós-operatório.


RESUMEN La isquemia crítica de miembro inferior (ICMI) afecta a los sistemas de salud y la calidad de vida y funcionalidad de los individuos diagnosticados. Sin embargo, hay poca evidencia científica que fundamente la intervención fisioterapéutica para pacientes internados por ICMI. El objetivo de este estudio fue elaborar un consenso de especialistas sobre la fisioterapia intrahospitalaria para pacientes con ICMI. Para ello, se utilizó el método Delphi. Se formó un panel de expertos con 18 fisioterapeutas que representaban el 85,7% del equipo de un hospital de referencia en cirugía vascular. Se consideraron, para el consenso, las respuestas con un valor mínimo de concordancia del 70% y media o mediana ≥3,1 en la escala Likert. Los cuestionarios abordaron ítems de evaluación, objetivos y conductas fisioterapéuticas en las fases pre y poscirugía de revascularización. Se definieron como elementos esenciales la evaluación de síntomas y las funciones cognitiva, musculoesquelética y cardiorrespiratoria. En el preoperatorio, control del dolor, reducción de edemas, ganancia de amplitud de movimiento, deambulación y educación en salud son los objetivos; en la fase posoperatoria, la ganancia de fuerza muscular. Los ejercicios pasivos, asistidos, activos libres y circulatorios, incluidos los miembros superiores, se indican antes y después de las cirugías. La educación en salud y la deambulación con reducción de peso en el área de lesión plantar son esenciales en todo el período de internación. La electroanalgesia fue preconizada en el preoperatorio; y, en el postoperatorio, elevación del miembro inferior y ejercicios resistidos.


ABSTRACT Critical limb ischemia (CLI) is a disease with a great burden for the healthcare system, patient's functionality and quality of life. However, there is little evidence to guide intrahospital physical therapy programs for patients with CLI. Thus, this study aimed to provide an expert consensus on intrahospital physiotherapeutic care for CLI patients. An expert panel was made up with 18 experienced physical therapists, which represented 85.7% of physical therapists from a reference vascular surgery team in a university hospital. The Delphi method was used to produce a consensus, considering a minimum agreement of 70% and a mean or median score in the Likert scale ≥3.1. The questionnaires included items related to assessment, goals and physiotherapeutic interventions prior and after revascularization. A consensus was reached on assessing symptoms, cognitive, articular, musculoskeletal and cardiorespiratory functions. Pain control, edema drainage, range of motion gain, walking incentive and health education are goals in the pre-operatory and the muscular strengthening in postoperatory phase. In both phases there was a consensus on the use of passive, active-assisted and active exercises, including upper limb exercises. Walking and therapeutic education are essential during the hospitalization period with offloading practices in area of plantar ulcer. Electroanalgesia should be used in preoperative phase and resisted exercises and lower limb elevation at postoperatory.


Assuntos
Humanos , Modalidades de Fisioterapia , Extremidade Inferior/fisiopatologia , Doença Arterial Periférica/reabilitação , Isquemia/reabilitação , Procedimentos Cirúrgicos Vasculares , Protocolos Clínicos , Inquéritos e Questionários , Extremidade Inferior/cirurgia , Consenso , Assistência Hospitalar , Fisioterapeutas
9.
Rev. colomb. cancerol ; 23(2): 45-55, abr.-jun. 2019. tab
Artigo em Espanhol | LILACS | ID: biblio-1042751

RESUMO

Resumen Antecedentes: La radioterapia de intensidad modulada (IMRT) es una técnica avanzada que se usa ampliamente a nivel mundial; sin embargo, su uso adecuado en nuestro país requiere ser revisado. Objetivo: Actualizar un protocolo clínico (PC) basado en evidencia que contiene las indicaciones clínicas para la utilización de la técnica IMRT en el tratamiento de las patologías oncológicas tratadas más frecuentemente en el servicio de oncología radioterápica del Instituto Nacional de Cancerología (INC) - Colombia. Métodos: La elaboración de este documento fue realizada por un equipo multidisciplinario empleando un manual nacional para el desarrollo de PC. Se realizó una búsqueda sistemática de la literatura, seguido por la selección de los artículos relevantes y su evaluación utilizando las herramientas apropiadas. La evidencia fue resumida, contextualizada y empleada para generar las recomendaciones mediante un consenso formal tipo RAND/UCLA. Resultados: Se generaron indicaciones para el uso de la IMRT en pacientes con alguno de los siguientes tipos de cáncer: próstata y pene, cabeza y cuello, piel, sistema nervioso central, mama, sarcomas de tejidos blandos, pulmón, gastrointestinal, ginecológico y urgencias oncológicas. Conclusiones: En el periodo 2014 a 2017 ha surgido escasa evidencia sobre el impacto de la IMRT en desenlaces relacionados con la supervivencia y la calidad de vida y por tanto el uso de la IMRT sigue siendo en pacientes seleccionados.


Abstract Background: Intensity-Modulated Radiation Therapy (IMRT) is an advanced technique which has been put into service in several clinical settings around the world; however, its proper use in Colombia requires to be revisited. Aim: To update an evidence-based clinical care protocol (CCP) that contains clinical recommendations for using IMRT in order to treat the most common oncological malignancies seen in the Radiotherapy Unit of the Instituto Nacional de Cancerología - Colombia. Methods: The elaboration of this CCP was undertaken by a multidisciplinary team who abided by a domestic CCP-development handbook. Briefly, a systematic search of literature was conducted; afterwards, relevant papers were selected and evaluated using appropriate appraisal tools; finally, evidence was summarized, contextualized, and used for generating the recommendations through a formal consensus approach (RAND/UCLA). Results: We established a handful of recommendations for using the IMRT technique in patients with any of the following types of cancer: prostate & penis, head & neck, skin, central nervous system, breast, soft tissue sarcoma, lung, gastrointestinal, and gynecologic, as well as oncologic emergencies. Conclusions: During the period 2014 - 2017, few evidence has emerged about the impact of IMRT on outcomes related to survival and quality of life; therefore, IMRT use still remains in selected patients.


Assuntos
Humanos , Protocolos Clínicos , Radioterapia de Intensidade Modulada , Radioterapia (Especialidade) , Consenso , Neoplasias
10.
Arch. argent. pediatr ; 117(2): 94-104, abr. 2019. ilus, tab
Artigo em Inglês, Espanhol | LILACS, BINACIS | ID: biblio-1001160

RESUMO

La asimetría de la longitud de los miembros inferiores es una afección en la cual la longitud de una pierna difiere de la contralateral, motivo de consulta frecuente en el consultorio del pediatra y del ortopedista infantil. El objetivo de nuestro trabajo fue desarrollar recomendaciones de seguimiento, planificación prequirúrgica y tratamiento de niños con asimetría de la longitud de los miembros inferiores mediante el consenso de expertos. Material y métodos. Se utilizó el método Delphi. Un grupo coordinador seleccionó el panel de expertos, diseñó y analizó cada una de las rondas de consulta. Los cuestionarios semiestructurados fueron enviados por correo electrónico en forma personalizada. Se estableció como criterio de consenso un acuerdo entre los expertos > 80 %. En cada una de las rondas, se reformularon los aspectos no consensuados y se agregaron nuevos sugeridos en la ronda anterior. Se consideró como medida de estabilidad para concluir la consulta cuando más del 70 % de los expertos no modificó su opinión en rondas sucesivas. Resultados. Participaron del consenso 8 expertos en ortopedia y 6 en diagnóstico por imágenes. Luego de 3 rondas de consulta, se logró el consenso en 39 recomendaciones referentes a seguimiento, planificación prequirúrgica y tratamiento. Fueron reagrupadas en 32 recomendaciones finales. Conclusiones. Estas son las primeras recomendaciones para el seguimiento de niños con asimetría de la longitud de los miembros inferiores mediante el consenso de expertos.


Leg length discrepancy is when the length of one leg is different from the other, and is a common reason for consultation at the pediatrician's and pediatric orthopedist's office. The objective of this study was to develop recommendations for the follow-up, pre-surgical planning, and treatment of children with leg length discrepancy based on expert consensus. Material and methods. The Delphi method was used. A coordinating group selected a panel of experts, designed and analyzed each of the rounds of consultations. Semistructured questionnaires were sent by personalized e-mail. Agreement among experts ≥ 80 % was established as the criterion for consensus. At each round of consultation, non-consensual aspects were reformulated and new aspects suggested in the previous round were included. A measure of stability to conclude the consultation was determined when more than 70 % of experts sustained their opinion in successive rounds. Results. Eight experts in orthopedics and six experts in imaging studies participated. After three rounds of consultations, consensus was reached in terms of 39 recommendations for follow-up, pre-surgical planning, and treatment. These were reorganized into 32 final recommendations. Conclusions. These are the first recommendations for the follow-up of children with leg length discrepancy agreed by expert consensus.


Assuntos
Humanos , Criança , Adolescente , Técnica Delfos , Guia de Prática Clínica , Extremidade Inferior , Consenso
11.
An. bras. dermatol ; 94(2,supl.1): 7-19, Mar.-Apr. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1011087

RESUMO

Abstract: Hidradenitis suppurativa is a chronic immune mediated disease of universal distribution that causes great damage to the quality of life of the affected individual, whose prevalence is estimated at 0.41% in the Brazilian population. The objective of this work was update on physiopathogenesis, diagnosis and classification of hidradenitis suppurativa and to establish therapeutic recommendations in the Brazilian reality. It was organized as a work group composed of eight dermatologists from several institutions of the country with experience in the treatment of hidradenitis suppurativa and carried out review on the topic. Recommendations were elaborated and voted by modified Delphi system and statistical analysis of the results was performed. The Brazilian consensus on the clinical approach of hidradenitis suppurativa had the support of the Brazilian Society of Dermatology.


Assuntos
Humanos , Hidradenite Supurativa/terapia , Consenso , Sociedades Médicas , Índice de Gravidade de Doença , Brasil , Hidradenite Supurativa/diagnóstico , Dermatologia
12.
An. bras. dermatol ; 94(2,supl.1): 48-55, Mar.-Apr. 2019.
Artigo em Inglês | LILACS | ID: biblio-1011089

RESUMO

Abstract: Dermatitis herpetiformis and linear IgA bullous dermatosis are autoimmune diseases that present with pruritic urticarial papules and plaques, with formation of vesicles and blisters of subepidermal location, mediated by IgA antibodies. Mucosal lesions are present only in linear IgA bullous dermatosis. The elaboration of this consensus consisted of a brief presentation of the different aspects of these dermatoses and, above all, of an updated literature review on the various therapeutic options that were discussed and compared with the authors' experience, aiming at the treatment orientation of these diseases in Brazil. Dermatitis herpetiformis is a cutaneous manifestation of celiac disease, and can be controlled with a gluten-free diet and dapsone. On the other hand, linear IgA bullous dermatosis arises spontaneously or is triggered by drugs, and can be controlled with dapsone, but often requires the association of systemic corticosteroids and eventually immunosuppressants.


Assuntos
Humanos , Consenso , Dermatose Linear Bolhosa por IgA/tratamento farmacológico , Prognóstico , Sociedades Médicas , Brasil , Dermatite Herpetiforme/terapia , Corticosteroides/uso terapêutico , Dapsona/uso terapêutico , Dermatologia , Dieta Livre de Glúten/métodos , Anti-Inflamatórios
13.
An. bras. dermatol ; 94(2,supl.1): 56-66, Mar.-Apr. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1011090

RESUMO

Abstract: Background: Urticarias are frequent diseases, with 15% to 20% of the population presenting at least one acute episode in their lifetime. Urticaria are classified in acute ( ≤ 6 weeks) or chronic (> 6 weeks). They may be induced or spontaneous. Objectives: To verify the diagnostic and therapeutic recommendations in chronic spontaneous urticaria (CSU), according to the experience of Brazilian experts, regarding the available guidelines (international and US). Methods: A questionnaire was sent to Brazilian experts, with questions concerning diagnostic and therapeutic recommendations for CSU in adults. Results: Sixteen Brazilian experts answered the questionnaire related to diagnosis and therapy of CSU in adults and data were analyzed. Final text was written, considering the available guidelines (International and US), adapted to the medical practices in Brazil. Diagnostic work up in CSU is rarely necessary. Biopsy of skin lesion and histopathology may be indicated to rule out other diseases, such as, urticarial vasculitis. Other laboratory tests, such as complete blood count, CRP, ESR and thyroid screening. Treatment of CSU includes second-generation anti-histamines (sgAH) at licensed doses, sgAH two, three to fourfold doses (non-licensed) and omalizumab. Other drugs, such as, cyclosporine, immunomodulatory drugs and immunosuppressants may be indicated (non-licensed and with limited scientific evidence). Conclusions: Most of the Brazilian experts in this study partially agreed with the diagnostic and therapeutic recommendations of the International and US guidelines. They agreed with the use of sgAH at licensed doses. Increase in the dose to fourfold of sgAH may be suggested with restrictions, due to its non-licensed dose. Sedating anti-histamines, as suggested by the US guideline, are indicated by some of the Brazilian experts, due to its availability. Adaptations are mandatory in the treatment of CSU, due to scarce or lack of other therapeutic resources in the public health system in Brazil, such as omalizumab or cyclosporine.


Assuntos
Humanos , Adulto , Urticária/diagnóstico , Urticária/tratamento farmacológico , Consenso , Sociedades Médicas , Urticária/prevenção & controle , Índice de Gravidade de Doença , Brasil , Doença Crônica , Antialérgicos/uso terapêutico , Ciclosporinas/uso terapêutico , Antagonistas dos Receptores Histamínicos H1 não Sedativos/uso terapêutico , Dermatologia , Omalizumab/uso terapêutico , Imunossupressores/uso terapêutico
14.
An. bras. dermatol ; 94(2,supl.1): 33-47, Mar.-Apr. 2019. graf
Artigo em Inglês | LILACS | ID: biblio-1011091

RESUMO

Abstract: Bullous pemphigoid, mucous membrane pemphigoid and epidermolysis bullosa acquisita are subepidermal autoimmune blistering diseases whose antigenic target is located at the basement membrane zone. Mucous membrane pemphigoid and epidermolysis bullosa acquisita can evolve with cicatricial mucosal involvement, leading to respiratory, ocular and/or digestive sequelae with important morbidity. For each of these dermatoses, a literature review covering all therapeutic options was performed. A flowchart, based on the experience and joint discussion among the authors of this consensus, was constructed to provide treatment orientation for these diseases in Brazil. In summary, in the localized, low-risk or non-severe forms, drugs that have immunomodulatory action such as dapsone, doxycycline among others may be a therapeutic option. Topical treatment with corticosteroids or immunomodulators may also be used. Systemic corticosteroid therapy continues to be the treatment of choice for severe forms, especially those involving ocular, laryngeal-pharyngeal and/or esophageal mucosal involvement, as may occur in mucous membrane pemphigoid and epidermolysis bullosa acquisita. Several immunosuppressants are used as adjuvant alternatives. In severe and recalcitrant cases, intravenous immunoglobulin is an alternative that, while expensive, may be used. Immunobiological drugs such as rituximab are promising drugs in this area. Omalizumab has been used in bullous pemphigoid.


Assuntos
Humanos , Epidermólise Bolhosa Adquirida/tratamento farmacológico , Penfigoide Mucomembranoso Benigno/tratamento farmacológico , Penfigoide Bolhoso/tratamento farmacológico , Consenso , Prognóstico , Sociedades Médicas , Brasil , Epidermólise Bolhosa Adquirida/diagnóstico , Penfigoide Mucomembranoso Benigno/diagnóstico , Penfigoide Bolhoso/diagnóstico , Corticosteroides/uso terapêutico , Dermatologia , Imunossupressores/uso terapêutico , Anti-Inflamatórios/uso terapêutico
15.
An. bras. dermatol ; 94(2,supl.1): 67-75, Mar.-Apr. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1011092

RESUMO

Abstract: BACKGROUND: Atopic dermatitis is a highly prevalent inflammatory and pruritic dermatosis with a multifactorial etiology, which includes skin barrier defects, immune dysfunction, and microbiome alterations. Atopic dermatitis is mediated by genetic, environmental, and psychological factors and requires therapeutic management that covers all the aspects of its complex pathogenesis. OBJECTIVES: The aim of this article is to present the experience, opinions, and recommendations of Brazilian dermatology experts regarding the therapeutic management of atopic dermatitis. METHODS: Eighteen experts from 10 university hospitals with experience in atopic dermatitis were appointed by the Brazilian Society of Dermatology to organize a consensus on the therapeutic management of atopic dermatitis. The 18 experts answered an online questionnaire with 14 questions related to the treatment of atopic dermatitis. Afterwards, they analyzed the recent international guidelines on atopic dermatitis of the American Academy of Dermatology, published in 2014, and of the European Academy of Dermatology and Venereology, published in 2018. Consensus was defined as approval by at least 70% of the panel. RESULTS/CONCLUSION: The experts stated that the therapeutic management of atopic dermatitis is based on skin hydration, topical anti-inflammatory agents, avoidance of triggering factors, and educational programs. Systemic therapy, based on immunosuppressive agents, is only indicated for severe refractory disease and after failure of topical therapy. Early detection and treatment of secondary bacterial and viral infections is mandatory, and hospitalization may be needed to control atopic dermatitis flares. Novel target-oriented drugs such as immunobiologicals are invaluable therapeutic agents for atopic dermatitis.


Assuntos
Humanos , Consenso , Dermatite Atópica/tratamento farmacológico , Sociedades Médicas , Terapia Ultravioleta , Índice de Gravidade de Doença , Brasil , Administração Tópica , Corticosteroides/uso terapêutico , Dermatologia , Inibidores de Calcineurina/uso terapêutico , Anti-Infecciosos/uso terapêutico , Anti-Inflamatórios/uso terapêutico
16.
An. bras. dermatol ; 94(2,supl.1): 20-32, Mar.-Apr. 2019. graf
Artigo em Inglês | LILACS | ID: biblio-1011093

RESUMO

Abstract: Pemphigus are intraepidermal autoimmune bullous dermatoses that occur with lesions on the skin and / or mucous membranes. The most frequent types are pemphigus vulgaris and pemphigus foliaceus (classic and endemic). This consensus aims to present a complete and updated review of the treatment of these two more frequent forms of pemphigus, based on the literature and the personal experience of the authors. In moderate and severe cases of pemphigus vulgaris and foliaceus, systemic corticosteroid therapy (prednisone or prednisolone) is the treatment of choice. Adjuvant drugs, usually immunosuppressive drugs (azathioprine, mycophenolate mofetil, methotrexate, cyclophosphamide) may be prescribed as corticosteroid sparers in refractory cases or with contraindications to corticosteroids to minimize side effects. In severe and nonresponsive cases, corticosteroids in the form of intravenous pulse therapy, immunoglobulin and plasmapheresis / immunoadsorption can be administered. Immunobiological drugs, particularly rituximab, appear as a promising alternative. For milder cases, smaller doses of oral corticosteroid, dapsone and topical corticosteroids are options. At the end flowcharts are presented as suggestions for a therapeutic approach for patients with pemphigus vulgaris and pemphigus foliaceus.


Assuntos
Humanos , Pênfigo/tratamento farmacológico , Consenso , Prognóstico , Sociedades Médicas , Índice de Gravidade de Doença , Brasil , Quimioterapia Adjuvante , Corticosteroides/uso terapêutico , Dermatologia , Imunossupressores/uso terapêutico
18.
An. bras. dermatol ; 94(1): 62-75, Jan.-Feb. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-983728

RESUMO

Abstract: Background: Acne in women is often associated with anxiety and depression, and may persist from adolescence as well as manifest for the first time in adulthood. Genetic and hormonal factors contribute to its etiopathogenesis, and maintenance treatment is required, usually for years, due to its clinical evolution. Objective: To develop a guide for the clinical practice of adult female acne. Methods: A team of five experts with extensive experience in acne conducted a literature review of the main scientific evidence and met to discuss the best practices and personal experiences to develop a guide containing recommendations for the clinical practice of adult female acne. Results: The group of specialists reached consensus on the main guidelines for clinical practice, providing detailed recommendations on clinical picture, etiopathogenesis, laboratory investigation and treatment of adult female acne. Conclusion: Different from teenage acne, adult female acne presents some characteristics and multiple etiopathogenic factors that make its management more complex. This guide provides recommendations for best clinical practices and therapeutic decisions. However, the authors consider that additional studies are needed in order to provide more evidence for adult female acne to be better understood.


Assuntos
Humanos , Feminino , Adulto , Acne Vulgar/etiologia , Acne Vulgar/tratamento farmacológico , Qualidade de Vida , Sebo , Fatores de Risco , Guias de Prática Clínica como Assunto , Consenso , Fármacos Dermatológicos/uso terapêutico , Androgênios , Antibacterianos/uso terapêutico
20.
Rev. gaúch. enferm ; 40(spe): e20180311, 2019. graf
Artigo em Português | LILACS | ID: biblio-1004097

RESUMO

Resumo OBJETIVO Descrever a elaboração e validação de um checklist como estratégia de administração segura de medicamentos. MÉTODO Estudo de validação por consenso de especialistas conduzido de janeiro a junho de 2018 em um Centro de Pesquisa Clínica de um hospital universitário. O checklist foi validado por três enfermeiros assistenciais, dois técnicos de enfermagem, um farmacêutico, dois enfermeiros professores e um médico professor, todos com ampla experiência na administração de medicamentos e em pesquisa clínica. Para a lista final foi considerado consenso de 100% entre os especialistas. RESULTADOS Elaborou-se um guia composto por seis itens a serem checados pela equipe assistencial antes, durante e após a administração de medicamentos de Pesquisa Clínica. CONCLUSÃO A validação do checklist forneceu elementos norteadores para a prevenção de comportamentos que podem levar ao risco de eventos adversos e também permitiu que as equipes assistenciais buscassem estratégias seguras de cuidado na administração de medicamentos.


Resumen OBJETIVO Describir la elaboración y validación de un checklist como estrategia de administración segura de medicamentos. MÉTODO Estudio de validación por consenso de especialistas conducido de enero a junio/2018 en Centro de Investigación Clínica de un hospital universitario. El checklist fue validado por tres enfermeros asistenciales, dos técnicos de enfermería, un farmacéutico, dos enfermeros profesores y un médico profesor todos con amplia experiencia en administración y supervisión de medicamentos y investigación clínica. Para la lista final se consideró consenso del 100% entre los expertos. RESULTADOS Elaboró ​​un guía compuesto por seis ítems a ser chequeados por el equipo asistencial antes, durante y después de la administración de medicamentos de Investigación Clínica. CONCLUSIÓN La validación del checklist proporcionó elementos orientadores para la prevención de comportamientos que pueden llevar al riesgo de eventos adversos y también permitió a los equipos asistenciales buscar estrategias seguras de cuidado en la administración de medicamentos.


Abstract OBJECTIVE To describe the elaboration and validation of a checklist as a strategy for safe drug administration. METHOD It is a Validation study by consensus of experts conducted from January to June 2018, in a Clinical Research Center of a university hospital. The checklist was validated by three nurses, two nursing technicians, a pharmacist, two nurse teachers and one medical teacher, all with extensive experience in drug administration and in clinical research. For the final version of the checklist, a consensus of 100% was considered. RESULTS A guide was prepared consisting of six items to be checked by the care team before, during and after administration of Clinical Research drugs. CONCLUSION The validation of the checklist provided guiding elements for the prevention of behaviors that could lead to the risk of adverse events and also allowed the care teams to seek safe strategies of care in drug administration.


Assuntos
Humanos , Preparações Farmacêuticas/administração & dosagem , Sujeitos da Pesquisa , Sistemas de Identificação de Pacientes , Brasil , Consenso , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Lista de Checagem , Segurança do Paciente , Administração Intravenosa , Equipamento de Proteção Individual , Hospitais Universitários , Injeções Subcutâneas , Erros de Medicação/prevenção & controle , Sistemas de Medicação no Hospital/organização & administração , Recursos Humanos de Enfermagem no Hospital
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