RESUMEN
Background: The American Case Manager Association defines Case Management, in Lifestyle Medicine perspective, a collaborative practice between all the actors involved in the care process. The goal of this review was to evaluate the Nurse Case Manager role in Type 2 Diabetes patients, analyzing the quali/quan-titative data related to Nurse Case Management programs in Lifestyle Medicine view. Study design and Methods: Three independent operators were involved in two distinct phases, applying the Prisma method, specifics PICOS and research strategies from PubMed and Cinahl. The first part integrated a Cochrane systematic review on the Specialist Nurses in Diabetes Mellitus, while the second part evaluated the Nurse Case Manager interventions in Lifestyle Medicine view. Results: The first part includes 13 studies and the second 6. The glycemic control was improved in the Nurse Case Manager groups in Lifestyle Medicine perspective. Good results were appreciated in secondary outcomes: lipid profile, Body Mass Index, quality of life and stress management. The results for the management of self-care and adherence to Lifestyle Medicine programs are encouraging. Conclusions: It emerged unequivocally that, taking care and supporting the diabetic subject, leads to significant benefits in the general health and to reduction of possible complications. After the Covid-19 Pandemic, the Nurse Case Manager Lifestyle Medicine could represent a valid alternative of health management for the improvement of care in Type 2 Diabetic patients.
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COVID-19 , Gestores de Casos , Diabetes Mellitus Tipo 2 , Diabetes Mellitus Tipo 2/terapia , Humanos , Estilo de Vida , Pandemias , Calidad de VidaRESUMEN
BACKGROUND: Fine Needle Aspiration Cytology (FNAC) is a well established and widely used method for both a preliminary and sometime final non-invasive pathologic diagnosis. FNAC is a simple and inexpensive diagnostic tool and should represent the standard of care in developing and resource-poor countries while maintaining its diagnostic usefulness in developed and advanced ones. METHODS: The concordance between preoperative FNAC and final histology was evaluated in 168 patients operated on at the Otorhinolaryngology Unit, "A. Murri" Hospital, Fermo (Italy), from January 2012 to October 2016, including thyroid cases, salivary glands and cervical masses. RESULTS: The percentages of correct diagnosis provided by FNAC were good in all groups of pathologies and in accordance with the mean data of the literature. In particular the kappa statistic for the degree of agreement between FNAC and definitive histology (good > 0.6 and excellent > 0.8) was 0.74 for the thyroid, 0.83 for the parotid and 0.71 for both the submandibular and the cervical masses. DISCUSSION: Thy 3 group is still the most challenging for a successful FNAC diagnostic prediction. Especially in the developed and advanced countries, both the immediate review of the smear with its repetition, if needed, and the aspiration performed under CT/MRI guidance, when necessary, seem to further empower FNAC diagnostic resolution and should be pursued. Being routinely used for more than 40 years, FNAC is still a valuable and cost-effective tool to distinguish between cases that don't need any treatment, cases to be treated medically and those that require surgical excision. In the Authors' opinion every institution should periodically review its data in order to monitor and assess the accuracy of its diagnostic activity.
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Enfermedades de las Glándulas Salivales/diagnóstico , Enfermedades de la Tiroides/diagnóstico , Neoplasias del Cuello Uterino/diagnóstico , Adulto , Biopsia con Aguja Fina , Femenino , Cabeza/patología , Cabeza/cirugía , Humanos , Italia , Masculino , Persona de Mediana Edad , Cuello/patología , Cuello/cirugía , Estudios Retrospectivos , Enfermedades de las Glándulas Salivales/patología , Enfermedades de la Tiroides/patología , Neoplasias del Cuello Uterino/patologíaRESUMEN
PURPOSE: The aim of this paper is to report on the implementation of new guidelines on the use of injectable iodinated contrast media (ICM) at our workplace and specific protocols for the preparation of patients at risk. MATERIALS AND METHODS: Operators received training with continuing medical education (CME) credits. The new documentation (patient history/screening form and informed consent form) is available on the hospital Web site and requests serum creatinine determination with estimation of glomerular filtration rate (GFR) for every patient. Additional tests are required for high-risk patients only. RESULTS: Attendance rates were 57.2% among referring physicians and 74.5% among Radiology Department personnel. The Cockcroft-Gault formula was used to estimate GFR in adults. The main problem encountered in the implementation process was that referring physicians failed to evaluate the GFR in 80% of patients, with low GFR being discovered in the Radiology Department on the day of examination in 20% of patients, resulting in a need to reschedule the examination. CONCLUSIONS: Although not an easy task, implementation of the new guidelines for ICM use is both feasible and necessary. An additional refresher training course for personnel and GFR evaluation of the patient on referral are indispensable to ensure proper preparation of patients at increased risk of adverse reactions to ICM.
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Medios de Contraste/normas , Yodo , Medios de Contraste/administración & dosificación , Medios de Contraste/efectos adversos , Creatinina/sangre , Educación Médica Continua , Tasa de Filtración Glomerular , Guías como Asunto , Humanos , Inyecciones , Yodo/efectos adversos , Radiología/educación , Derivación y ConsultaAsunto(s)
Acromegalia/complicaciones , Acromegalia/psicología , Trastornos Mentales/etiología , Calidad de Vida/psicología , Acromegalia/tratamiento farmacológico , Adenoma/tratamiento farmacológico , Adenoma/etiología , Adenoma/psicología , Antineoplásicos/uso terapéutico , Conducta/efectos de los fármacos , Cognición/fisiología , Hormona de Crecimiento Humana/sangre , Humanos , Trastornos Mentales/tratamiento farmacológico , Péptidos Cíclicos/uso terapéutico , Neoplasias Hipofisarias/tratamiento farmacológico , Neoplasias Hipofisarias/etiología , Neoplasias Hipofisarias/psicología , Somatostatina/análogos & derivados , Somatostatina/uso terapéuticoRESUMEN
The aim of this study was to evaluate body composition and metabolic features in women with nonhypersecretory adrenal cortical incidentaloma (AI) and women with Cushing's syndrome (CS) compared with healthy control (C) women matched for age, menopausal status, and body mass index. We examined 15 females with CS, 22 with AI, and 20 C. We evaluated anthropometric, hormonal, and metabolic parameters in all subjects. Body composition was measured by dual-energy x-ray absorptiometry for total body (TB); in addition, abdominal fat was measured between L2 and L4 vertebrae. Women with CS and AI were overweight; waist to hip ratio mean values showed that women with CS and AI had a central fat distribution. TB fat was significantly higher in CS than in C women, however, AI women also had high fat values. Abdominal fat was significantly more increased in CS than in AI and C women. Eighty percent of CS women and 50% of AI women were hypertensive. High density lipoprotein cholesterol levels were lower and triglyceride levels were higher in CS and AI women than in C. The area under the curve for glucose after oral glucose tolerance test was significantly higher in CS and AI than in C. AI had urinary free cortisol values slightly higher than C and than the normal range. In conclusion, these data indicate that AI are at an intermediate state between normal and pathological. These alterations suggest that a subtle cortisol hypersecretion is probably present in AI and it may be the factor promoting alterations of body composition and metabolic parameters.
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Neoplasias de las Glándulas Suprarrenales/metabolismo , Composición Corporal/fisiología , Síndrome de Cushing/metabolismo , Absorciometría de Fotón , Tejido Adiposo/metabolismo , Adulto , Envejecimiento/metabolismo , Presión Sanguínea/fisiología , Índice de Masa Corporal , Glándulas Endocrinas/metabolismo , Femenino , Prueba de Tolerancia a la Glucosa , Humanos , Metabolismo de los Lípidos , Menopausia/fisiología , Persona de Mediana Edad , Estudios Prospectivos , Ácido Úrico/metabolismoRESUMEN
We report an unusual case of renovascular hypertension in a 16-year-old boy with primary antiphospholipid syndrome (PAPS), admitted to our clinic for severe drug-resistant hypertension and hypokalemia. Hormonal investigation revealed secondary aldosteronism and positive captopril test for renovascular disease. Aortography confirmed the occlusion of the left renal artery. After nephrectomy, normalization of blood pressure and secondary aldosteronism occurred. Presently the patient remains in good health, receiving warfarin anticoagulant therapy. PAPS is defined by the presence of antiphospholipid antibodies and recurrent thrombosis. Arterial thrombosis (29%) appears to be less prevalent than venous thrombosis. Thrombotic microangiopathy of the kidney is frequently observed but renal artery occlusion, as seen in our patient, is unusual.