ABSTRACT
Resumo As tecnologias da informação e comunicação têm influência cada vez maior na área da saúde, sendo o aumento significativo do recurso à teleconsulta um reflexo disso. Os benefícios que essa modalidade de prestação de serviços de saúde ocasiona são inquestionáveis, a começar pelo facto de auxiliarem a enfrentar os desafios contemporâneos que assolam os sistemas de saúde em todo o mundo. Todavia, a sua crescente utilização vem sublinhar a importância de salvaguardar questões éticas relacionadas com a autonomia, equidade, privacidade e qualidade da relação entre o utente e o profissional de saúde. Este artigo pretende estimular uma reflexão acerca dos desafios éticos que se colocam antes, durante e após o uso da teleconsulta, com o intuito de otimizar e modelar a sua utilização.
Abstract Information and communication Technologies are increasingly present in health care, as exemplified by the recourse to remote consultation. Such care delivery modality brings unquestionable benefits, such as helping to face the contemporary challenges plaguing health systems worldwide. But its ever-increasing use underlines the importance of safeguarding ethical issues related to autonomy, equity, privacy, and the quality of the user-professional relations. This paper reflects on the ethical challenges presented before, during, and after remote consultation as to optimize and shape its use.
Resumen Las tecnologías de la información y la comunicación tienen una influencia cada vez mayor en el área de la salud, y esto lleva a un aumento significativo en el uso de la teleconsulta. Muchos son los beneficios de esta modalidad de prestación de servicios sanitarios, comenzando por el hecho de que ayudan a abordar los desafíos contemporáneos que afectan a los sistemas de salud en todo el mundo. Sin embargo, su uso creciente destaca la importancia de salvaguardar las cuestiones éticas relacionadas con la autonomía, la equidad, la privacidad y la calidad de la relación entre el paciente y el profesional de la salud. Este artículo pretende incitar a una reflexión sobre los desafíos éticos que surgen antes, durante y después del uso de la teleconsulta, con el fin de optimizarlo y modelarlo.
Subject(s)
Ethics, MedicalABSTRACT
Abstract Purpose: To validate the comparative measurements of intraocular pressure performed with IcarePRO tonometer (IPT) in relation to Goldmann applanation tonometer (GAT) and non-contact tonometer (NCT), as well as to evaluate the influence of central corneal thickness (CCT) on these values. Methods: This was a prospective and comparative study conducted during 6 months in the Department of Ophthalmology, Hospital de Braga, Portugal. The study population comprised two groups: healthy adults and adults with primary open angle glaucoma (POAG). The IOP values were obtained by the three tonometers and the order of execution was randomly selected. CCT values were obtained by ultrasonic pachymetry. Results: A total of 168 eyes (74 with diagnosis of POAG and 94 healthy) of 84 patients were included in this study. The mean IOP values obtained by IPT, GAT and NCT were 17.36±3.78 mmHg; 14.59±3.32 mmHg; and 17.04±4.01 mmHg, respectively. The comparison between IPT and NCT did not reveal statistically significant differences in the two groups studied. However, statistically significant differences were obtained between IPT and GAT values (p <0.001). The IOP values, recorded by all the tonometers, were significantly and positivily correlated with the CCT (p <0.001). Conclusion: IOP readings measured by IPT are comparable with those obtained by NCT, but higher than those obtained by the GAT. CCT values are correlated with IOP measurements with IPT, as it does in GAT and NCT, and should be always taken into consideration.
Resumo Objetivo: Validar os valores de pressão intraocular (IOP) realizados com o tonômetro IcarePRO (IPT) em relação ao tonômetro de aplanação de Goldmann (GAT) e tonômetro de sopro (NCP), assim como avaliar a influência da espessura central da córnea (CCT) nesses valores. Métodos: Estudo prospectivo e comparativo realizado durante 6 meses consecutivos no Departamento de Oftalmologia do Hospital de Braga, Portugal. A população estudada compreendeu dois grupos: adultos saudáveis e adultos com glaucoma primário de ângulo aberto (POAG). Os valores de IOP foram obtidos pelos três tonômetros e a ordem de execução foi selecionada aleatoriamente. Os valores de CCT foram obtidos por paquimetria ultrassônica. Resultados: Um total de 168 olhos (74 com diagnóstico de POAG e 94 saudáveis) de 84 pacientes foram incluídos neste estudo. Os valores médios de IOP obtidos pelo IPT, GAT e NCT foram de 17.36±3.78 mmHg; 14.59±3.32 mmHg; e 17.04±4.01 mmHg, respectivamente. A comparação entre IPT e NCT não revelou as diferenças estatisticamente significativas nos dois grupos estudados. No entanto, foram obtidas diferenças estatisticamente significativas entre os valores registados pelo IPT em comparação ao GAT (p <0.001). Os valores de IOP, medidos por todos os tonômetros, foram significativamente correlacionados com a CCT (p <0.001). Conclusão: As leituras de PIO medidas pelo IPT são comparáveis às obtidas pelo NCT, mas superiores às obtidas pelo GAT. Os valores de CCT estão correlacionados com medidas de IOP, tal como acontece com o GAT e NCT, pelo que devem ser levados em considerados.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Tonometry, Ocular/instrumentation , Tonometry, Ocular/methods , Intraocular Pressure/physiology , Comparative Study , Glaucoma, Open-Angle/diagnosis , Prospective StudiesABSTRACT
It has been shown previously that high glucose causes direct and acute endothelial dysfunction in non-diabetic isolated rabbit kidney. This study assessed whether exercise training is able to maintain normal renal vascular endothelial function despite high glucose exposure. Animals were pen confined (SED) or treadmill trained over a 12-week period (ExT). Kidneys isolated from SED and ExT rabbits were continuously perfused ex vivo during 3 h with Krebs-Henseleit solutions containing normal (5.5 mm) or high (15 mm) concentrations of d-glucose. In the SED 5.5 group, acetylcholine (ACh) induced dose-related vasodilator responses, reaching the maximum of 41+/- 2% (n=10; P<0.05). In the kidneys perfused with high concentrations of glucose (SED 15), endothelium-dependent vasodilation was significantly blunted. Maximal relaxation in the presence of 15 mm glucose was of 19 +/- 2%, which was significantly different from the SED 5.5 group (41+/- 2%, n=10, P<0.01). In the ExT 5.5 group, ACh-induced vasodilation was significantly enhanced when compared with the SED 5.5 group, reaching the maximum of (52+/- 2%, n=10, P<0.05). Moreover, the exposure of the renal circulation of ExT animals to high glucose did not change endothelium-dependent vasodilation induced by ACh (46+/- 3%, n=6), when compared with the ExT 5.5 group. Finally, exercise training prevented the deleterious effects of high glucose on endothelial-dependent renal vasodilation (SED 15: 19+/- 2% vs. ExT 15: 46+/- 3%; P<0.05). It is concluded that exercise training protects the rabbit renal circulation against endothelial dysfunction elicited by acute exposure to moderately elevated glucose levels, corresponding to the postprandial glycemia of diabetes type 2 patients under treatment. The enhanced renal vasodilator reserve elicited by exercise training turns out to be a response that protects the kidney from the deleterious effects of glycemic peaks.