Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 33
Filtrar
Mais filtros










Intervalo de ano de publicação
1.
Mar Pollut Bull ; 135: 521-524, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30301068

RESUMO

The United Arab Emirates fisheries consist of highly diverse fish communities, and the most popular equipment used by fishermen to harvest them is a traditional baited basket fishing trap known locally as "gargoor". Gargoors are dome-shaped traps made from galvanized steel; they have a circular supporting base and a funnel-like entrance. Unintended impacts of gargoors on marine fauna include bycatch of non-target species and, when lost, ghost fishing. However, there is very little information on sea turtle interaction with gargoors. In this paper we present two case reports from the eastern coast of the UAE of green sea turtle strandings associated with gargoor interactions. The first case report describes a turtle that was discovered trapped inside a lost or abandoned gargoor. The second case report describes another turtle that suffered from extensive perforation of the gastrointestinal tract resulting from the ingestion of 32 pieces of rusty gargoor fragments.


Assuntos
Pesqueiros , Tartarugas , Animais , Ingestão de Alimentos , Trato Gastrointestinal/lesões , Emirados Árabes Unidos
2.
Mar Pollut Bull ; 135: 55-61, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30301072

RESUMO

The deleterious effects of marine debris ingestion on marine turtles are well documented in literature globally. In this study, the qualitative and quantitative aspects of marine debris ingested by 14 stranded green sea turtles Chelonia mydas, (Linnaeus, 1758) along the eastern coast of the United Arab Emirates were investigated. The numeric and gravimetric proportions of debris in the esophagus, stomach and intestines were documented following classification of color, presumed sources and Marine Strategy Framework Directive categories and sub-categories. The results show that 85.7% of the specimens examined consumed marine debris. On average, specimens consumed 61.9 ±â€¯17.2 items of 1.0 ±â€¯0.3 g mass. Plastics, particularly white, and transparent thread-like and sheet-like plastics, were the predominant debris ingested. The results reflect a potentially high level of interaction between green sea turtles and anthropogenic marine debris along the Gulf of Oman coast of the UAE.


Assuntos
Conteúdo Gastrointestinal , Plásticos/análise , Tartarugas , Poluentes Químicos da Água/análise , Animais , Ecotoxicologia/métodos , Exposição Ambiental/análise , Água do Mar , Emirados Árabes Unidos , Resíduos
3.
J Pediatr Surg ; 53(8): 1588-1591, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29229479

RESUMO

INTRODUCTION: The development of new surgical approaches for the management of congenital abdominal wall defects may be facilitated by using an animal model. However, because the anatomy of the neonatal abdominal wall has not been described, a suitable model is yet to be identified. We aimed to evaluate and define the neonatal abdominal wall musculature using ultrasound, to be used as a reference to identify an appropriate animal model for the neonatal abdominal wall in the future. METHODS: Infants with a postconceptual age of less than one month weighing between 2 and 3 kg were eligible. With ethical approval, ultrasonography of three abdominal wall locations bilaterally was performed. The depth of the skin to external oblique and the thickness of the three abdominal wall muscles, external oblique (EO), internal oblique (IO) and transversus abdominis (TA), were measured. RESULTS: Ten males and seven females were recruited with median postconceptual age of 36 weeks (IQR 36-38), median postnatal age of 8 days (IQR 3-30) and median weight of 2.35kg (IQR 2.26-2.56). The mean depth of EO from skin was 2.06 mm (± 0.44). The mean thicknesses of the muscles were: EO 1.02 mm (± 0.33), IO 1.16 mm (± 0.39) and TA 1.02 mm (± 0.37). There was no statistical difference between the thickness of EO, IO or TA (p= 0.43). CONCLUSIONS: It is possible to consistently identify and measure the components of the neonatal abdominal wall musculature with ultrasonography. We hope this can aid in developing an appropriate animal model, with the ultimate aim of facilitating innovation in surgical management of neonatal abdominal wall pathology. LEVELS OF EVIDENCE: Study of Diagnostic test, Level IV.


Assuntos
Músculos Abdominais/diagnóstico por imagem , Parede Abdominal/diagnóstico por imagem , Feminino , Humanos , Recém-Nascido , Masculino , Músculo Esquelético/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Ultrassonografia
4.
J Med Imaging Radiat Oncol ; 60(2): 206-9, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26868703

RESUMO

INTRODUCTION: There is little information about the role of the radiologist at multidisciplinary team meetings; in particular their influence on patient management. To evaluate the influence of radiologists on clinical patient management during multidisciplinary meetings. METHODS: Prospective data were collected over a 5-week period from multidisciplinary team meetings across four paediatric clinical domains. Radiological input was recorded for each case discussion, including the type of influence and its potential effect on clinical patient management. RESULTS: One hundred and forty paediatric cases were reviewed. Radiological advice was requested from the radiologist for 25.7% (N = 36) of cases. In 17.9% (N = 25) this advice was judged to have influenced clinical patient management. There were two cases where new imaging findings were discovered. CONCLUSIONS: Radiologists influence clinical patient management during multidisciplinary team meetings primarily by providing differential diagnoses and guidance regarding future imaging, with respect to both the necessity and the modality. Occasionally, when imaging is reviewed at these meetings, new findings are discovered that impact on patient management.


Assuntos
Diagnóstico por Imagem/estatística & dados numéricos , Administração dos Cuidados ao Paciente/estatística & dados numéricos , Equipe de Assistência ao Paciente/estatística & dados numéricos , Pediatria/estatística & dados numéricos , Serviço Hospitalar de Radiologia/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Criança , Pré-Escolar , Processos Grupais , Humanos , Lactente , Recém-Nascido , Comunicação Interdisciplinar , Masculino , New South Wales , Estudos de Casos Organizacionais , Carga de Trabalho
5.
Pain Res Manag ; 20(6): 288-92, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26474380

RESUMO

BACKGROUND: The impact of telephone consultations between pain specialists and primary care physicians regarding the care of patients with chronic pain is unknown. OBJECTIVES: To evaluate the impact of telephone consultations between pain specialists and primary care physicians regarding the care of patients with chronic pain. METHODS: Patients referred to an interdisciplinary chronic pain service were randomly assigned to either receive usual care by the primary care physician, or to have their case discussed in a telephone consultation between a pain specialist and the referring primary care physician. Patients completed a numerical rating scale for pain, the Pain Disability Index and the Short Form-36 on referral, as well as three and six months later. Primary care physicians completed a brief survey to assess their impressions of the telephone consultation. RESULTS: Eighty patients were randomly assigned to either the usual care group or the standard telephone consultation group, and 67 completed the study protocol. Patients were comparable on baseline pain and demographic characteristics. No differences were found between the groups at six months after referral in regard to pain, disability or quality of life measures. Eighty percent of primary care physicians indicated that they learned new patient care strategies from the telephone consultation, and 97% reported that the consultation answered their questions and helped in the care of their patient. DISCUSSION: Most primary care physicians reported that a telephone consultation with a pain specialist answered their questions, improved their patients' care and resulted in new learning. Differences in patient status compared with a usual care control group were not detectable at six-month follow-up. CONCLUSIONS: While telephone consultations are clearly an acceptable strategy for knowledge translation, additional strategies may be required to actually impact patient outcomes.


Assuntos
Dor Crônica/enfermagem , Médicos de Atenção Primária , Encaminhamento e Consulta , Telefone , Resultado do Tratamento , Adulto , Dor Crônica/psicologia , Avaliação da Deficiência , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Medição da Dor , Qualidade de Vida
7.
J Paediatr Child Health ; 50(10): E72-6, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-20626577

RESUMO

AIM: To review the role of gadolinium-enhanced magnetic resonance imaging of the spine in the diagnosis of paediatric Guillain-Barre syndrome and compare it with nerve conduction studies and cerebrospinal fluid analysis. METHODS: A retrospective review of investigations undertaken in children admitted to our institution with acute Guillain-Barre syndrome over a 10-year period was performed. RESULTS: Seven of eight children (88%) displayed post-gadolinium nerve root enhancement consistent with Guillain-Barre syndrome. This compared with supportive nerve conduction studies in 21/24 children (88%) and cerebrospinal fluid protein analysis consistent with the diagnosis in 16/20 children (80%). CONCLUSION: Nerve conduction studies are the recognised 'gold standard' technique for confirming a clinical diagnosis of Guillain-Barre syndrome. In this study, a high positive rate was demonstrated. While more experience is necessary, this study and the literature support gadolinium enhanced magnetic resonance imaging of the spine as a valuable, although not necessarily superior, investigation in the diagnosis of Guillain-Barre syndrome. It may be of particular benefit when specialist neurophysiology expertise is unavailable.


Assuntos
Gadolínio , Síndrome de Guillain-Barré/diagnóstico , Aumento da Imagem , Imagem por Ressonância Magnética/métodos , Coluna Vertebral/patologia , Criança , Estudos de Coortes , Feminino , Seguimentos , Síndrome de Guillain-Barré/líquido cefalorraquidiano , Humanos , Masculino , Condução Nervosa/fisiologia , Exame Neurológico/métodos , Estudos Retrospectivos , Medição de Risco , Sensibilidade e Especificidade , Índice de Gravidade de Doença
8.
J Rheumatol ; 40(8): 1388-93, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23818709

RESUMO

OBJECTIVE: To summarize the development of evidence-based guidelines for the clinical care of persons with fibromyalgia (FM), taking into account advances in understanding of the pathogenesis of FM, new diagnostic criteria, and new treatment options. METHODS: Recommendations for diagnosis, treatment, and patient followup were drafted according to the classification system of the Oxford Centre for Evidence-Based Medicine, and following review were endorsed by the Canadian Rheumatology Association and the Canadian Pain Society. RESULTS: FM is a polysymptomatic syndrome presenting a spectrum of severity, with a pivotal symptom of body pain. FM is a positive clinical diagnosis, not a diagnosis of exclusion, and not requiring specialist confirmation. There are no confirmatory laboratory tests, although some investigation may be indicated to exclude other conditions. Ideal care is in the primary care setting, incorporating nonpharmacologic and pharmacologic strategies in a multimodal approach with active patient participation. The treatment objective should be reduction of symptoms, but also improved function using a patient-tailored treatment approach that is symptom-based. Self-management strategies combining good lifestyle habits and fostering a strong locus of control are imperative. Medications afford only modest relief, with doses often lower than suggested, and drug combinations used according to clinical judgment. There is a need for continued reassessment of the risk-benefit ratio for any drug treatment. Outcome should be aimed toward functioning within a normal life pattern and any culture of disablement should be discouraged. CONCLUSION: These guidelines should provide the health community with reassurance for the global care of patients with FM with the aim of improving patient outcome by reducing symptoms and maintaining function.


Assuntos
Fibromialgia/diagnóstico , Fibromialgia/terapia , Canadá , Humanos , Estilo de Vida , Participação do Paciente , Guias de Prática Clínica como Assunto , Resultado do Tratamento
9.
Pain Res Manag ; 18(3): 119-26, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23748251

RESUMO

BACKGROUND: Recent neurophysiological evidence attests to the validity of fibromyalgia (FM), a chronic pain condition that affects >2% of the population. OBJECTIVES: To present the evidence-based guidelines for the diagnosis, management and patient trajectory of individuals with FM. METHODS: A needs assessment following consultation with diverse health care professionals identified questions pertinent to various aspects of FM. A literature search identified the evidence available to address these questions; evidence was graded according to the standards of the Oxford Centre for Evidence-Based Medicine. Drafted recommendations were appraised by an advisory panel to reflect meaningful clinical practice. RESULTS: The present recommendations incorporate the new clinical concepts of FM as a clinical construct without any defining physical abnormality or biological marker, characterized by fluctuating, diffuse body pain and the frequent symptoms of sleep disturbance, fatigue, mood and cognitive changes. In the absence of a defining cause or cure, treatment objectives should be patient-tailored and symptom-based, aimed at reducing global complaints and enhancing function. Healthy lifestyle practices with active patient participation in health care forms the cornerstone of care. Multimodal management may include nonpharmacological and pharmacological strategies, although it must be acknowledged that pharmacological treatments provide only modest benefit. Maintenance of function and retention in the workforce is encouraged. CONCLUSIONS: The new Canadian guidelines for the treatment of FM should provide health professionals with confidence in the complete care of these patients and improve clinical outcomes.


Assuntos
Fibromialgia , Dor , Canadá , Medicina Baseada em Evidências/legislação & jurisprudência , Fibromialgia/diagnóstico , Fibromialgia/tratamento farmacológico , Humanos , Dor/diagnóstico , Dor/tratamento farmacológico , Exame Físico
11.
Australas J Dermatol ; 54(1): 22-30, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23082725

RESUMO

BACKGROUND/OBJECTIVES: Venous malformations (VM) are an uncommon vascular malformation with an estimated incidence of 1-2 per 10 000 births. The aim was to define the clinical characteristics and management of children with VM and develop a database for future research. METHODS: A retrospective chart review of all children presenting to the Vascular Birth Mark clinic with VM from 2000 to 2011. RESULTS: In total 128 patients were included, of whom 59.4% were female, 78.1% were Caucasian and 56.3% resided in a metropolitan area. Most lesions were noted at birth (64.1%) with an average age when VM was first noticed of 17.1 months. The average age of definitive diagnosis was 65.9 months. Locations most frequently involved were the lower limb (41.4%), face (21.1%), trunk (17.2%) and upper limb (15.6%). The most commonly associated conditions were capillary malformation (28.9%) and lymphatic malformation (28.1%). Magnetic resonance imaging was used in the majority of patients (86.7%) to assess tissue distribution of the lesions. Skin and subcutaneous tissue (61.3%), muscle (49.5%) and joints (11.7%) were most commonly involved. Complications of VM resulted in morbidity in 68.8% of cases, most commonly pain (52.3%), thrombophlebitis (17.2%), bleeding (13.3%) and limb length discrepancy (13.3%). Intervention was employed in 68.0%, most often with sclerotherapy (61.8%), compression garments (43.0%), and endovascular laser (17.2%) and surgical management (13.3%). CONCLUSIONS: Given the frequent association of VM with other vascular lesions, considerable morbidity, and specialised treatment, a multidisciplinary approach to their management in childhood is important and should include dermatology, diagnostic and interventional radiology, haematology, paediatric surgery, physiotherapy and social services.


Assuntos
Malformações Vasculares/diagnóstico , Malformações Vasculares/terapia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Malformações Vasculares/etiologia
12.
Am J Respir Crit Care Med ; 185(8): 862-73, 2012 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-22323305

RESUMO

RATIONALE: Unrecognized airway infection and inflammation in young children with cystic fibrosis (CF) may lead to irreversible lung disease; therefore early detection and treatment is highly desirable. OBJECTIVES: To determine whether the lung clearance index (LCI) is a sensitive and repeatable noninvasive measure of airway infection and inflammation in newborn-screened children with CF. METHODS: Forty-seven well children with CF (mean age, 1.55 yr) and 25 healthy children (mean age, 1.26 yr) underwent multiple-breath washout testing. LCI within and between-test variability was assessed. Children with CF also had surveillance bronchoalveolar lavage performed. MEASUREMENTS AND MAIN RESULTS: The mean (SD) LCI in healthy children was 6.45 (0.49). The LCI was higher in children with CF (7.21 [0.81]; P < 0.001). The upper limit of normal for the LCI was 7.41. Fifteen (32%) children with CF had an elevated LCI. LCI measurements were repeatable and reproducible. Airway infection was present in 17 (36%) children with CF, including 7 (15%) with Pseudomonas aeruginosa. Polymicrobial growth was associated with worse inflammation. The LCI was higher in children with Pseudomonas (7.92 [1.16]) than in children without Pseudomonas (7.02 [0.56]) (P = 0.038). The LCI correlated with bronchoalveolar lavage IL-8 (R(2) = 0.20, P = 0.004) and neutrophil count (R(2) = 0.21, P = 0.001). An LCI below the upper limit of normality had a high negative predictive value (93%) in excluding Pseudomonas. CONCLUSIONS: The LCI is elevated early in CF, especially in the presence of Pseudomonas and airway inflammation. The LCI is a feasible, repeatable, and sensitive noninvasive marker of lung disease in young children with CF.


Assuntos
Líquido da Lavagem Broncoalveolar/microbiologia , Fibrose Cística/diagnóstico , Pneumopatias/diagnóstico , Troca Gasosa Pulmonar/fisiologia , Austrália , Estudos de Casos e Controles , Pré-Escolar , Fibrose Cística/complicações , Diagnóstico Precoce , Feminino , Volume Expiratório Forçado , Humanos , Lactente , Pneumopatias/etiologia , Pneumopatias/microbiologia , Masculino , Infecções por Pseudomonas/diagnóstico , Infecções por Pseudomonas/etiologia , Pseudomonas aeruginosa/isolamento & purificação , Curva ROC , Valores de Referência , Estudos Retrospectivos , Índice de Gravidade de Doença , Estatísticas não Paramétricas
14.
Clin Nucl Med ; 35(9): 743-5, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20706060

RESUMO

A 32-month-old female child with a history of stage IV favorable biology neuroblastoma with a 123-I MIBG (metaiodobenzylguanidine scan) avid adrenal mass, with retroperitoneal nodal extension and bony metastasis, was in complete remission after intense multimodal therapy. Seventeen months after diagnosis a surveillance 123-I MIBG scan showed abnormal tracer uptake in the midzone of the right thorax. Chest x-ray and CT scan confirmed right upper lobe consolidation corresponding to the tracer uptake. Chest x-ray after antibiotics showed resolution of the abnormality. 123-I MIBG scan 3 months later showed no abnormal uptake. False-positive MIBG uptake in pneumonia has not been previously reported.


Assuntos
3-Iodobenzilguanidina/farmacocinética , Neuroblastoma/complicações , Neuroblastoma/diagnóstico por imagem , Pneumonia/complicações , Pneumonia/diagnóstico por imagem , Pré-Escolar , Reações Falso-Positivas , Feminino , Seguimentos , Humanos , Estadiamento de Neoplasias , Neuroblastoma/patologia , Cintilografia , Tomografia Computadorizada por Raios X
15.
Pain Manag Nurs ; 8(3): 130-8, 2007 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-17723930

RESUMO

Methadone treatment in chronic pain patients is still limited owing to misconceptions about addiction, safety, and its unique pharmacokinetic and pharmacodynamic properties. Nevertheless, patients with chronic noncancer pain are frequently treated with methadone at our Pain Centre either as the first opioid of choice, for specific pain conditions, or as a second-line opioid in patients developing tolerance or intractable side effects with other opioids. The aim of this study was to examine whether a nurse case management program of chronic pain patients treated with methadone is feasible and safe in trying to improve patients' care in an ambulatory setting. This program consisted of three phases: initial primary education session, telephone follow-up during methadone titration, and a subsequent maintenance period. The nurse case manager functioned autonomously and when required reported to and consulted the physician. The study included 75 subjects and was done over a nine-month period by completing follow-up questionnaires for every call. Of a total of 194 recorded calls, 41% were unscheduled. Forty-four percent of phone calls resulted in a methadone increase and 11% led to a decrease or cessation of methadone. No patients developed serious morbidity or mortality. Fifty-seven percent of patients were either satisfied or very satisfied with their treatment. A nurse-led case management program of methadone in chronic pain patients can improve patient care in an ambulatory setting.


Assuntos
Analgésicos Opioides/uso terapêutico , Administração de Caso/organização & administração , Metadona/uso terapêutico , Papel do Profissional de Enfermagem , Dor/enfermagem , Idoso , Assistência Ambulatorial , Doença Crônica , Monitoramento de Medicamentos/enfermagem , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação em Enfermagem , Pesquisa em Avaliação de Enfermagem , Dor/diagnóstico , Dor/tratamento farmacológico , Dor/psicologia , Clínicas de Dor , Medição da Dor , Educação de Pacientes como Assunto , Satisfação do Paciente , Autonomia Profissional , Avaliação de Programas e Projetos de Saúde , Estudos Prospectivos , Quebeque
16.
J Plast Reconstr Aesthet Surg ; 60(9): 1039-44, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17467351

RESUMO

INTRODUCTION: There is good evidence for the benefits of bilateral breast reduction (BBR). However, such surgery is often considered cosmetic and is rationed. The NHS Modernisation Agency and the British Association of Plastic Surgeons (as was) have produced national guidelines, but Primary Care Trusts adapt these for local implementation. METHODS: We surveyed the funding criteria for BBR of all 303 Trusts in England. 245 (81%) responded. RESULTS: The NHS guidelines were followed accurately by only 11 Trusts. 198 trusts specified a maximum BMI (range 25 to 32; guideline 30). 187 accepted musculoskeletal symptoms as an indication and 117 accepted intertrigo. 31 required a professionally fitted bra. Many Trusts included other restricting criteria that are not in the NHS guidelines. Some Trusts mentioned the American Society of Plastic Surgeons' guidelines, but did not follow them wholly. CONCLUSIONS: Even with explicit guidelines, considerable variation in local funding criteria exists with resultant inequalities in provision. The so-called 'postcode lottery' of healthcare in the UK is rife within Plastic Surgery. The recent reconfiguration of English Primary Care Trusts provides an excellent opportunity for the rationalisation of BBR provision and to this end we will distribute our findings and the NHS guidelines to the new Trusts and to the National Institute for Health and Clinical Excellence.


Assuntos
Alocação de Recursos para a Atenção à Saúde/normas , Mamoplastia/normas , Seleção de Pacientes , Antropometria , Índice de Massa Corporal , Mama/patologia , Inglaterra , Feminino , Fidelidade a Diretrizes/normas , Pesquisa sobre Serviços de Saúde , Humanos , Mamoplastia/economia , Mamoplastia/psicologia , Guias de Prática Clínica como Assunto , Medicina Estatal/normas
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA