Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 25.563
Filtrar
1.
Psicol. conduct ; 25(1): 99-109, ene.-abr. 2020. mapas, tab, ilus
Artículo en Inglés | IBECS | ID: ibc-162156

RESUMEN

Youth social withdrawal has raised clinical concerns, and prevention of withdrawal behavior is important yet difficult. While human evaluation of withdrawal behavior can be subjective, technology provides objective measurement for withdrawal behavior. This study aims to examine the association between withdrawal behaviors (home-stay and non-communication) and mental health status (stress, depression and loneliness). The open-access StudentLife dataset, including the location and conversation information derived from the sensor data, stress levels, and pre- and post-questionnaires of depression (PHQ-9) and loneliness (RULS) of 47 college students over 10 weeks was used. Multilevel modeling and functional regression were employed for data analysis. Daily duration of home-stay was negatively associated with daily stress levels, and the interaction effect of daily duration of home-stay and non-communication were positively associated with daily stress levels and changes in PHQ-9 and RULS scores. Smartphone data is useful to provide adjunct information to the professional clinical judgement and early detection on withdrawal behavior


El aislamiento social de los jóvenes ha generado preocupaciones clínicas y prevenir estos comportamientos es importante pero difícil. Aunque la evaluación del aislamiento puede ser subjetiva, la tecnología proporciona medidas objetivas de este comportamiento. El objetivo de este estudio es examinar la asociación entre los comportamientos de aislamiento (permanecer en casa y no comunicarse) y el estado de la salud mental (estrés, depresión y soledad). Se utilizó la base de datos de libre acceso StudentLife, incluyendo información sobre la ubicación y la conversación registrada por un sensor de datos, los niveles de estrés y medidas de autoinforme pre y pos sobre depresión (PHQ-9) y soledad (RULS) de 47 estudiantes universitarios durante 10 semanas. Para el análisis de datos se utilizaron modelos multinivel y la regresión funcional. La duración diaria de la permanencia en casa estaba negativamente asociada con los niveles diarios de estrés y el efecto de interacción de la duración diaria de la permanencia en casa y la falta de comunicación estaban positivamente relacionados con los niveles diarios de estrés y los cambios en las puntuaciones en PHQ-9 y RULS. Los datos del teléfono inteligente son útiles para obtener información complementaria al juicio clínico profesional y para la detección temprana de los comportamientos de aislamiento


Asunto(s)
Humanos , Aislamiento Social/psicología , Soledad/psicología , Depresión/psicología , Psicometría/instrumentación , Estrés Psicológico/psicología , Diagnóstico Precoz , Medios de Comunicación Sociales , Factores de Riesgo , Tecnología de la Información , Comunicación
3.
Braz J Med Biol Res ; 53(3): e9614, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32159613

RESUMEN

The global burden of chronic kidney disease (CKD) is rapidly increasing with a projection of becoming the 5th most common cause of years of life lost globally by 2040. CKD is a major cause of catastrophic health expenditure. The costs of dialysis and transplantation consume up to 3% of the annual healthcare budget in high-income countries. However, the onset and progression of CKD is often preventable. In 2020, the World Kidney Day campaign highlights the importance of preventive interventions - be it primary, secondary, or tertiary. This article focuses on outlining and analyzing measures that can be implemented in every country to promote and advance CKD prevention. Primary prevention of kidney disease should focus on the modification of risk factors and addressing structural abnormalities of the kidney and urinary tracts, as well as exposure to environmental risk factors and nephrotoxins. In persons with pre-existing kidney disease, secondary prevention, including blood pressure optimization and glycemic control, should be the main goal of education and clinical interventions. In patients with advanced CKD, management of co-morbidities such as uremia and cardiovascular disease is a highly recommended preventative intervention to avoid or delay dialysis or kidney transplantation. Political efforts are needed to proliferate the preventive approach. While national policies and strategies for non-communicable diseases might be present in a country, specific policies directed toward education and awareness about CKD screening, management, and treatment are often lacking. Hence, there is an urgent need to increase the awareness of preventive measures throughout populations, professionals, and policy makers.


Asunto(s)
Carga Global de Enfermedades , Equidad en Salud , Accesibilidad a los Servicios de Salud , Insuficiencia Renal Crónica/epidemiología , Diagnóstico Precoz , Política de Salud , Promoción de la Salud , Humanos , Tamizaje Masivo/economía , Servicios Preventivos de Salud/métodos , Insuficiencia Renal Crónica/diagnóstico , Insuficiencia Renal Crónica/prevención & control , Factores de Riesgo
4.
Rev Soc Bras Med Trop ; 53: e20190457, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32130325

RESUMEN

INTRODUCTION: Chagas disease is one of the most common diseases in Latin America and heart involvement is the main cause of death. This study aimed to determine differences in tissue Doppler imaging (TDI) parameters in the assessment left and right ventricular function in patients with the indeterminate form of Chagas disease compared to those in healthy controls. METHODS: We compared 194 patients with the indeterminate form of Chagas disease to 72 age-matched healthy individuals. We considered p-values <0.05 to be statistically significant. RESULTS: TDI analysis of the right ventricular (RV) showed lengthened isovolumic relaxation time (IRT) and higher RV index of myocardial performance (RIMP) and left ventricle (LV) index of myocardial performance (LIMP) in the Chagas group than in the control group, indicating RV and LV systolic and diastolic myocardial damage. TDI analysis of the myocardial velocities of the interventricular septum and the lateral wall of the LV also showed a systolic and diastolic myocardial damage. CONCLUSIONS: The study results demonstrated early LV systolic and diastolic myocardial damage in the RV and LV in patients with the indeterminate form of Chagas disease by TDI. These early findings of RV and LV dysfunction may help identify patients who will progress to heart failure during the disease course. TDI should be included in initial patient evaluations because it allows adequate follow-up and treatment.


Asunto(s)
Enfermedad de Chagas/fisiopatología , Corazón/fisiopatología , Disfunción Ventricular Izquierda/fisiopatología , Adulto , Estudios de Casos y Controles , Enfermedad de Chagas/diagnóstico por imagen , Diagnóstico Precoz , Ecocardiografía , Ecocardiografía Doppler , Femenino , Corazón/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Disfunción Ventricular Izquierda/diagnóstico por imagen
5.
Medicine (Baltimore) ; 99(11): e19292, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32176054

RESUMEN

BACKGROUND: The aim of the study was to provide a theoretical basis for the early diagnosis and prediction of acute altitude sickness, to provide a better entry mode for healthy people from plain areas to plateau areas, and to preliminarily clarify the possible mechanism of this approach. METHODS: We measured endothelin-1 (ET-1), asymmetric dimethylarginine (ADMA), vascular endothelial growth factor (VEGF), nitric oxide (NO), and hypoxia-inducible factor 1 (HIF-1) levels in each sample and determined flow-mediated dilation (FMD) values using a portable OMRON color Doppler with a 7.0- to 12.0-MHz linear array probe. We used the Lewis Lake score to diagnose acute mountain sickness (AMS) and to stratify the disease severity. RESULTS: We found no cases of AMS at any of the studied elevation gradients. We found significant differences in FMD values between individuals when at 400 m above sea level and when at 2200, 3200, and 4200 m above sea level (P < .05) but found no significant differences among those at 2200, 3200, and 4200 m. Our variance analysis showed that serum ET-1, VEGF, ADMA, NO, and HIF-1 levels in individuals at ≥3000 m and those at subplateau and plain areas (<3000 m) significantly differed (P < .05). The level of these factors also significantly differed between individuals at elevation gradients of plateau areas (3260 m vs 4270 m) (P < .05). We found no significant differences in serum ET-1, VEGF, and ADMA levels between individuals at the plateau (2260 m) and plain (400 m) areas (P > .05). NO and HIF-1 levels were significantly different in serum samples from individuals between the plateau (2260 m) and plain (400 m) areas (P < .05). However, with increasing altitude, the NO level gradually increased, whereas ET-1, ADMA, VEGF, and HIF-1 levels showed a decreasing trend. With the increase of altitude, there is no correlation between the trend of FMD and hematologic-related factors such as VEGF, NO, and HIF-1. CONCLUSION: A healthy young male population ascending to a high-altitude area experiences a low incidence of AMS. Entering an acute plateau exposure environment from different altitude gradients may weaken the effect of acute highland exposure on vascular endothelial dysfunction in healthy individuals. Changes in serum ET-1, VEGF, ADMA, NO, and HIF-1 levels in healthy young men may be related to the body's self-regulation and protect healthy individuals from AMS. A short stay in a subplateau region may initiate an oxygen-free preconditioning process in healthy individuals, thereby protecting them from AMS. Noninvasive brachial artery endothelial function test instead of the detection of invasive hematologic-related factors for early diagnosis and prediction of the occurrence and severity of acute high-altitude disease is still lack of sufficient theoretical basis.


Asunto(s)
Mal de Altura/sangre , Altitud , Endotelina-1/sangre , Factor 1 Inducible por Hipoxia/sangre , Factor A de Crecimiento Endotelial Vascular/sangre , Enfermedad Aguda , Adulto , Mal de Altura/diagnóstico , Análisis de Varianza , Biomarcadores/sangre , China , Diagnóstico Precoz , Voluntarios Sanos , Humanos , Masculino , Personal Militar , Óxido Nítrico/sangre , Valores de Referencia , Sensibilidad y Especificidad , Adulto Joven
6.
Medicine (Baltimore) ; 99(10): e19419, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32150093

RESUMEN

Although early detection and intervention may improve the outcome of the congenital cytomegalovirus (cCMV) infection, few studies assessed the real-world clinical practice for cCMV patients. We analyzed medical claims data to assess the patterns of diagnoses and medical care for cCMV patients.We used a subset of medical claims database (JMDC Claims Database) in Japan, covering 207,547 newborns between April 2010 and March 2017 and observed for at least 6 months. The diagnosis of cCMV and related symptoms and sequelae and medical care, including essential examinations and antiviral treatment, were identified using standardized codes.Overall, we identified 53 (25.5 per 100,000 newborns) cCMV patients diagnosed within 6 months after birth; of these, 83% were diagnosed within 1 month and 68% had at least 1 cCMV-related symptom at birth. Objective hearing tests and fundus examinations were performed within 6 months in 60% and 30% of patients, respectively. Antivirals were prescribed in 26% of patients. During the observation period (median = 33 months), sensorineural hearing loss (49%) and developmental problems (28%) were commonly identified as cCMV-related sequelae. The proportions of the patients continuously followed up with objective hearing tests up to 36 months were 30% in total and 56% in antiviral-treated patients, respectively.The cCMV patients did not necessarily receive a timely diagnosis nor continuous follow-ups in usual clinical practice. Although the universal screening for cCMV may, if implemented, facilitate early diagnosis, it should be accompanied by strategic follow-up plans to support timely interventions.


Asunto(s)
Infecciones por Citomegalovirus/diagnóstico , Tamizaje Neonatal , Antivirales/uso terapéutico , Infecciones por Citomegalovirus/complicaciones , Infecciones por Citomegalovirus/congénito , Infecciones por Citomegalovirus/tratamiento farmacológico , Bases de Datos Factuales , Diagnóstico Precoz , Femenino , Pérdida Auditiva Sensorineural/complicaciones , Humanos , Recién Nacido , Revisión de Utilización de Seguros/estadística & datos numéricos , Japón , Masculino
7.
Medicine (Baltimore) ; 99(10): e19185, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32150056

RESUMEN

To investigate the characteristics of spiral computed tomography (CT), positron emission tomography-computed tomography (PET/CT) and clinical manifestations of talaromycosis to improve the diagnostic level and deepen its recognition in radiology.Radiological, clinical, and pathological manifestations of 15 patients of non-HIV talaromycosis confirmed by bronchofiberscope lung biopsy and/or abscess puncture fluid culture and/or blood culture and/or sputum culture were analyzed retrospectively. All patients underwent chest CT, among them, six had a brain MRI, and six had a PET/CT scan before treatment.On plain CT scan, there were multiple patches and massive consolidation in 6 patients, multiple patchy consolidations and patchy ground-glass opacities in 3 patients, solitary or multiple nodules and masses in 3 patients, multiple cavities and small nodules in 3 patients. Multiple lymphadenectasis appeared in bilateral hila, mediastinum, and neck in 10 patients. In contrast CT scan, the parenchyma of the lesions had a slight enhancement in 10 patients, moderate enhancement in 3 patients, obvious enhancement in 2 patients. Seven cases had bone destruction and hyperplasia, cranial involvement in 1 patient and liver involvement in 3 patients, respectively. On PET/CT, five patients showed elevated standard uptake value (SUV).The radiological manifestations of non-HIV talaromycosis show multiple consolidations, ground-glass opacities, multiple nodules or masses in bilateral lungs, deep-seated enlarged lymph nodes and bone destruction in multiple systems. The final diagnosis should be based on the culture of talaromycosis.


Asunto(s)
Enfermedades Pulmonares Fúngicas/diagnóstico por imagen , Micosis/diagnóstico por imagen , Adolescente , Adulto , Anciano , Biopsia , Niño , Preescolar , Diagnóstico Diferencial , Diagnóstico Precoz , Femenino , Fluorodesoxiglucosa F18 , Infecciones por VIH , Humanos , Lactante , Enfermedades Pulmonares Fúngicas/microbiología , Enfermedades Pulmonares Fúngicas/patología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Micosis/microbiología , Micosis/patología , Tomografía Computarizada por Tomografía de Emisión de Positrones , Radiofármacos , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Adulto Joven
8.
Zhonghua Jie He He Hu Xi Za Zhi ; 43(3): 167-170, 2020 Mar 12.
Artículo en Chino | MEDLINE | ID: mdl-32164079

RESUMEN

In December 2019, the outbreak of novel coronavirus (2019-nCoV) in Wuhan, China, attracting attention worldwidely. The novel coronavirus has the characteristics of rapid transmission, atypical clinical symptoms, and easy to affect both lungs, leading to missed diagnosis and misdiagnosis, as well as difficult to detection and assessment at early stage. Fever, cough, myalgia, weakness, dyspnea and imagings may be helpful for the early detection of novel coronavirus pneumonia. At the same time, the rate of disease progression, fever, CT manifestations, hypoxia degree, age, basic diseases, and laboratory indicators can also be used to evaluate the severity of the novel coronavirus pneumonia.


Asunto(s)
Infecciones por Coronavirus/diagnóstico , Brotes de Enfermedades , Diagnóstico Precoz , Neumonía Viral/diagnóstico , China/epidemiología , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/epidemiología , Tos/etiología , Errores Diagnósticos , Disnea/etiología , Fiebre/etiología , Humanos , Mialgia/etiología , Neumonía Viral/complicaciones , Neumonía Viral/tratamiento farmacológico , Neumonía Viral/epidemiología , Neumonía Viral/etiología
9.
Adv Exp Med Biol ; 1213: 107-120, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32030666

RESUMEN

At medical checkups or mass screenings, the fundus examination is effective for early detection of systemic hypertension, arteriosclerosis, diabetic retinopathy, etc. In most cases, ophthalmologists and physicians grade retinal images by the condition of the blood vessels, lesions. However, human observation does not provide quantitative results, thus blood vessel analysis is an important process in determining hypertension and arteriosclerosis, quantitatively. This chapter describes the latest automated blood vessel extraction using the deep convolution neural network (DCNN). Diabetic retinopathy is a common cardiovascular disease and a major factor in blindness. Therefore, early detection of diabetic retinopathy is very important to preventing blindness. A microaneurysm is an initial sign of diabetic retinopathy, and much research has been conducted for microaneurysm detection. This chapter also describes diabetic retinopathy detection and automated microaneurysm detection using the DCNN.


Asunto(s)
Aprendizaje Profundo , Retinopatía Diabética/diagnóstico por imagen , Retinopatía Diabética/complicaciones , Diagnóstico Precoz , Fondo de Ojo , Humanos , Microaneurisma/complicaciones , Microaneurisma/diagnóstico por imagen
10.
JAMA ; 323(8): 764-785, 2020 02 25.
Artículo en Inglés | MEDLINE | ID: mdl-32096857

RESUMEN

Importance: Early identification of cognitive impairment may improve patient and caregiver health outcomes. Objective: To systematically review the test accuracy of cognitive screening instruments and benefits and harms of interventions to treat cognitive impairment in older adults (≥65 years) to inform the US Preventive Services Task Force. Data Sources: MEDLINE, PubMed, PsycINFO, and Cochrane Central Register of Controlled Trials through January 2019, with literature surveillance through November 22, 2019. Study Selection: Fair- to good-quality English-language studies of cognitive impairment screening instruments, and pharmacologic and nonpharmacologic treatments aimed at persons with mild cognitive impairment (MCI), mild to moderate dementia, or their caregivers. Data Extraction and Synthesis: Independent critical appraisal and data abstraction; random-effects meta-analyses and qualitative synthesis. Main Outcomes and Measures: Sensitivity, specificity; patient, caregiver, and clinician decision-making; patient function, quality of life, and neuropsychiatric symptoms; caregiver burden and well-being. Results: The review included 287 studies with more than 280 000 older adults. One randomized clinical trial (RCT) (n = 4005) examined the direct effect of screening for cognitive impairment on patient outcomes, including potential harms, finding no significant differences in health-related quality of life at 12 months (effect size, 0.009 [95% CI, -0.063 to 0.080]). Fifty-nine studies (n = 38 531) addressed the accuracy of 49 screening instruments to detect cognitive impairment. The Mini-Mental State Examination was the most-studied instrument, with a pooled sensitivity of 0.89 (95% CI, 0.85 to 0.92) and specificity of 0.89 (95% CI, 0.85 to 0.93) to detect dementia using a cutoff of 23 or less or 24 or less (15 studies, n = 12 796). Two hundred twenty-four RCTs and 3 observational studies including more than 240 000 patients or caregivers addressed the treatment of MCI or mild to moderate dementia. None of the treatment trials were linked with a screening program; in all cases, participants were persons with known cognitive impairment. Medications approved to treat Alzheimer disease (donepezil, galantamine, rivastigmine, and memantine) improved scores on the ADAS-Cog 11 by 1 to 2.5 points over 3 months to 3 years. Psychoeducation interventions for caregivers resulted in a small benefit for caregiver burden (standardized mean difference, -0.24 [95% CI, -0.36 to -0.13) over 3 to 12 months. Intervention benefits were small and of uncertain clinical importance. Conclusions and Relevance: Screening instruments can adequately detect cognitive impairment. There is no empirical evidence, however, that screening for cognitive impairment improves patient or caregiver outcomes or causes harm. It remains unclear whether interventions for patients or caregivers provide clinically important benefits for older adults with earlier detected cognitive impairment or their caregivers.


Asunto(s)
Disfunción Cognitiva/diagnóstico , Demencia/diagnóstico , Tamizaje Masivo , Anciano , Cuidadores , Disfunción Cognitiva/terapia , Demencia/tratamiento farmacológico , Diagnóstico Precoz , Humanos , Vida Independiente , Tamizaje Masivo/efectos adversos , Pruebas Neuropsicológicas , Guías de Práctica Clínica como Asunto , Sensibilidad y Especificidad
11.
JAMA ; 323(8): 757-763, 2020 02 25.
Artículo en Inglés | MEDLINE | ID: mdl-32096858

RESUMEN

Importance: Dementia (also known as major neurocognitive disorder) is defined by a significant decline in 1 or more cognitive domains that interferes with a person's independence in daily activities. Dementia affects an estimated 2.4 to 5.5 million individuals in the United States, and its prevalence increases with age. Objective: To update its 2014 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a review of the evidence on screening for cognitive impairment, including mild cognitive impairment and mild to moderate dementia, in community-dwelling adults, including those 65 years or older residing in independent living facilities. Population: This recommendation applies to community-dwelling older adults 65 years or older, without recognized signs or symptoms of cognitive impairment. Evidence Assessment: The USPSTF concludes that the evidence is lacking, and the balance of benefits and harms of screening for cognitive impairment cannot be determined. Recommendation: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for cognitive impairment in older adults. (I statement).


Asunto(s)
Disfunción Cognitiva/diagnóstico , Demencia/diagnóstico , Tamizaje Masivo , Anciano , Disfunción Cognitiva/terapia , Demencia/terapia , Diagnóstico Precoz , Humanos , Vida Independiente , Tamizaje Masivo/efectos adversos , Pruebas Neuropsicológicas , Sensibilidad y Especificidad
13.
Brain Nerve ; 72(2): 131-136, 2020 Feb.
Artículo en Japonés | MEDLINE | ID: mdl-32036338

RESUMEN

More accurate and early diagnoses of neurodegenerative diseases are required to establish disease-modifying therapies. Obtaining a clear diagnosis of multiple system atrophy (MSA), a neurodegenerative disease, can be challenging because MSA has a number of clinical subtypes and many other diseases, known as mimics, are characterized by symptoms that are similar to those of MSA. This paper discusses the factors that make the clinical diagnosis of MSA difficult. Additionally, this paper introduces an attempt at the new clinical diagnostic criteria establishment in accord with recent clinical trials.


Asunto(s)
Atrofia de Múltiples Sistemas , Diagnóstico Precoz , Humanos , Atrofia de Múltiples Sistemas/diagnóstico , Atrofia de Múltiples Sistemas/terapia
14.
Isr Med Assoc J ; 22(2): 94-99, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32043326

RESUMEN

BACKGROUND: Internal thoracic impedance (ITI) measurement is a sensitive method for detecting preclinical pulmonary edema and pleural effusion. OBJECTIVES: To investigate the efficacy of this non-invasive method for detecting early pleural effusion among geriatric patients and to monitor increased ITI during its resolution. METHODS: This prospective, controlled study was conducted between July 2012 and August 2015. The study comprised 70 patients aged 65 to 94 years; and 39 of the patients had pleural effusion. ITI was measured continuously with a RS-207 monitor. The predictive value of ITI monitoring was determined based on a total of eight measurements taken at 12-hour intervals over 84 hours. RESULTS: As a result of medical treatment, the median ITI of the study group increased from 31 (interquartile range [IQR] 28-33 ohms) to 41 ohms (IQR 38-41 ohms; P < 0.001) compared to non-significant changes in the control group. Average respiratory rate (per minute) in the study group decreased from 29 (IQR 28-34) to 19 (IQR 18-20). CONCLUSIONS: ITI monitoring is efficient for diagnosis and for ongoing clinical evaluation of the treatment of elderly patients with pleural effusion. Timely treatment may prevent serious complications of effusions avoiding extended hospitalization.


Asunto(s)
Pletismografía de Impedancia/métodos , Derrame Pleural , Anciano , Diagnóstico Precoz , Femenino , Evaluación Geriátrica/métodos , Humanos , Israel , Masculino , Monitoreo Fisiológico/métodos , Derrame Pleural/diagnóstico , Derrame Pleural/etiología , Derrame Pleural/fisiopatología , Pruebas en el Punto de Atención , Recurrencia , Reproducibilidad de los Resultados
15.
Rev Med Suisse ; 16(682): 361-364, 2020 Feb 19.
Artículo en Francés | MEDLINE | ID: mdl-32073771

RESUMEN

Epidemiological trends in congenital toxoplasmosis and CMV are extremely divergent. While there were only 39 cases of congenital toxoplasmosis in Switzerland between 1982 and 2015, there was an equivalent number of cases of congenital CMV, 38 in total, in 2017 alone. Serological screening for toxoplasmosis was logically abandoned in Switzerland in 2008. Regarding CMV, there is no recommendation for serological screening or neonatal screening in Switzerland, whereas early diagnosis can improve prognosis through the rapid initiation of antiviral treatment. The epidemiological data generated by sentinel surveillance of congenital CMV infections in Switzerland may or may not justify such a measure in our country in the future.


Asunto(s)
Infecciones por Citomegalovirus/congénito , Infecciones por Citomegalovirus/epidemiología , Toxoplasmosis Congénita/epidemiología , Infecciones por Citomegalovirus/diagnóstico , Infecciones por Citomegalovirus/tratamiento farmacológico , Diagnóstico Precoz , Humanos , Recién Nacido , Tamizaje Neonatal , Suiza/epidemiología , Toxoplasmosis Congénita/diagnóstico , Toxoplasmosis Congénita/tratamiento farmacológico
16.
Vasc Health Risk Manag ; 16: 11-25, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32021224

RESUMEN

Familial hypercholesterolemia (FH) is a frequent disorder associated with premature atherosclerotic cardiovascular disease. Different clinical diagnosis criteria are available, and cost of genetic testing has been reduced in the last years; however, most cases are not diagnosed worldwide. Patients with FH are at high cardiovascular risk and the risk can be reduced with lifelong lifestyle and pharmacological treatment. Statins and ezetimibe are available as generic drugs in most countries reducing the cost of treatment. However, the use of high-intensity statins combined with ezetimibe and PCSK9 inhibitors, if necessary, is low for different reasons that contribute to a high number of patients not reaching LDL-C targets according to guidelines. On the other hand, cardiovascular risk varies greatly in families with FH; therefore, risk stratification strategies including cardiovascular imaging is another element to consider for improving care and management of FH. There are numerous barriers depending on the awareness, knowledge, perception of risk, management and care of patients living with FH that impact in the diagnosis and treatment of the disorder. In this contemporary review, we analyze different barriers in the diagnosis and care of patients to improve patients' care and prevention of atherosclerotic cardiovascular disease and describe recent advances and strategies to improve the gaps in the care of FH, including global collaboration and advocacy.


Asunto(s)
Enfermedades Cardiovasculares/prevención & control , Colesterol/sangre , Prestación Integrada de Atención de Salud , Hiperlipoproteinemia Tipo II/diagnóstico , Hiperlipoproteinemia Tipo II/terapia , Tamizaje Masivo , Mejoramiento de la Calidad , Indicadores de Calidad de la Atención de Salud , Biomarcadores/sangre , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/etiología , Diagnóstico Precoz , Predisposición Genética a la Enfermedad , Pruebas Genéticas , Humanos , Hiperlipoproteinemia Tipo II/sangre , Hiperlipoproteinemia Tipo II/genética , Fenotipo , Valor Predictivo de las Pruebas , Pronóstico , Medición de Riesgo , Factores de Riesgo
17.
BMC Surg ; 20(1): 5, 2020 Jan 06.
Artículo en Inglés | MEDLINE | ID: mdl-31906993

RESUMEN

BACKGROUND: The purpose of this study is to identify perioperative marker predicting postoperative surgical site infection (SSI) including with anastomotic leakage (AL) in curative colon cancer patients, laparoscopically. METHODS: In total, 135 colon cancer patients (stage I-III) undergoing curative laparoscopic surgery between January 2004 and December 2013 were enrolled in this study. We collected data on clinicopathological factors, laboratory data on pre and postoperative day 3 (POD3) and tumor markers levels to assess the relation to surgical site infection (SSI) including with anastomotic leakage (AL). RESULTS: SSI and AL occurred in 16 cases (5.6%) and 4 cases (3%), respectively. SSI and AL were not association with clinicopathological factors. Within laboratory data and tumor markers preoperatively, high neutrophil counts were significantly associated with SSI (P < 0.05) and AL (P < 0.01), respectively. Area under curves (AUC) of SSI and AL were 0.656 and 0.854, respectively. In addition, high neutrophil counts on POD3 also were significantly associated with SSI (P < 0.01) and AL (P < 0.01), respectively. Area under curves (AUC) of SSI and AL were 0.747 and 0.832, respectively. CONCLUSION: Neutrophil count on pre and POD3 are potentially valuable indicators of SSI including with AL in colon cancer patients undergoing curative surgery laparoscopically.


Asunto(s)
Colectomía/efectos adversos , Neoplasias del Colon/cirugía , Diagnóstico Precoz , Laparoscopía/efectos adversos , Neutrófilos/patología , Infección de la Herida Quirúrgica/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Recuento de Leucocitos , Masculino , Persona de Mediana Edad , Pronóstico , Factores de Riesgo , Infección de la Herida Quirúrgica/sangre
18.
Hu Li Za Zhi ; 67(1): 4-5, 2020 Feb.
Artículo en Chino | MEDLINE | ID: mdl-31960390

RESUMEN

Disease progression often differs among patients. According to study findings, changes in vital signs, blood oxygen saturation, and consciousness are each related closely to acute deterioration in disease status (Sutherasan et al., 2018). The early warning system (EWS) is a predictive approach to detecting deterioration in disease condition based on the observation of slight variations in patient vital signs and clinical symptoms (Smith et al., 2014). Most patients experience changes in specific physiological variables before experiencing a cardiac arrest. The implementation of a comprehensive EWS facilitates the early identification and prevention of serious adverse events such as unexpected cardiac arrest and death, and may help reduce the risk of other unexpected events as well (Gerry et al., 2017). For medical team members, the use of EWS not only permits the detection of changes in patient condition at an early stage but also allows healthcare workers to respond more proactively and effectively. Moreover, EWS has been shown to improve communication, increase cooperation, and strengthen personal responsibility among healthcare workers (Burns et al., 2018). In summary, implementing EWS allows the prompt initiation of appropriate patient treatment and helps improve patient-care outcomes. While recognizing the importance of incorporating EWS into patient care in clinical and home-based institutions as an important strategy to protecting the lives of patients, appropriate standardized warning systems must be tailored to address different disease characteristics. Changes in patient condition are traditionally addressed through nursing assessment followed by physician notification and response. However, this process may be affected by factors such as assessment accuracy, cultural differences, confidence, and past experiences that may result in decision-making errors (Wood, Chaboyer, & Carr, 2019). The integration of EWS and medical informatics technology is expected to reduce the risks of human-interpretation-related omissions and errors (Downey, Tahir, Randell, Brown, & Jayne, 2017). Although the use of medical informatics technology to enhance EWS remains in its infancy, this will certainly be one of the future trends in patient care. The articles in this issue, in addition to introducing EWS, elucidate the current application of EWS in clinical critical conditions and introduce how informatics technology is being combined in home EWS applications. These articles comprise a rich body of information on EWS that may referenced in clinical nursing care, home care, education, and research.


Asunto(s)
Deterioro Clínico , Diagnóstico Precoz , Paro Cardíaco/prevención & control , Humanos , Signos Vitales
19.
Hu Li Za Zhi ; 67(1): 6-11, 2020 Feb.
Artículo en Chino | MEDLINE | ID: mdl-31960391

RESUMEN

Related studies in the literature indicate that over half (50-84%) of patients exhibit physiological variations 6 hours before experiencing cardiac arrest. Early warning systems improve the ability of medical teams to detect patient deterioration and then immediately treat sudden cardiac arrest during patient hospitalization. This article aims to strengthen general understanding among clinical medical staffs of the early warning system. Understanding the reasons and motivations for establishing this system is expected to help readers better distinguish the physiological monitoring indicators of this system and its importance in terms of improving patient safety. In particular, using the system to identify patients at risk levels of medium or higher will help facilitate their timely transfer to an intensive care unit for appropriate monitoring and care. This article further explores the application of early warning systems in nursing to help nurses understand their professional roles and responsibilities as members of the rapid-response team. Finally, information in this article teaches medical staffs how to avoid unanticipated cardiac arrest events, create a comprehensive patient safety environment, and improve the quality of medical care.


Asunto(s)
Deterioro Clínico , Diagnóstico Precoz , Paro Cardíaco/prevención & control , Equipo Hospitalario de Respuesta Rápida/organización & administración , Humanos , Rol de la Enfermera
20.
Hu Li Za Zhi ; 67(1): 19-24, 2020 Feb.
Artículo en Chino | MEDLINE | ID: mdl-31960393

RESUMEN

Monitoring the current and ongoing health status of patients with critical illnesses is an important function in critical care. Science-based assessments permit the early detection of deterioration in patient condition and the early implementation of medical care interventions. In this article, the empirical literature on this topic is reviewed and common early warning systems used currently and previously to detect deterioration in critically ill patients, including the disease severity assessment system, the early warning scoring tool, and the sequential organ failure assessment, are introduced. It is hoped that nursing staffs in acute and intensive care units use the information in this article to apply and validate early warning systems in order to improve the care and prognosis of critically ill patients.


Asunto(s)
Deterioro Clínico , Enfermedad Crítica , Diagnóstico Precoz , Humanos
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA