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1.
Br J Dermatol ; 171(6): 1318-25, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24980543

RESUMO

This report provides a summary of the third meeting of the Harmonising Outcome Measures for Eczema (HOME) initiative held in San Diego, CA, U.S.A., 6-7 April 2013 (HOME III). The meeting addressed the four domains that had previously been agreed should be measured in every eczema clinical trial: clinical signs, patient-reported symptoms, long-term control and quality of life. Formal presentations and nominal group techniques were used at this working meeting, attended by 56 voting participants (31 of whom were dermatologists). Significant progress was made on the domain of clinical signs. Without reference to any named scales, it was agreed that the intensity and extent of erythema, excoriation, oedema/papulation and lichenification should be included in the core outcome measure for the scale to have content validity. The group then discussed a systematic review of all scales measuring the clinical signs of eczema and their measurement properties, followed by a consensus vote on which scale to recommend for inclusion in the core outcome set. Research into the remaining three domains was presented, followed by discussions. The symptoms group and quality of life groups need to systematically identify all available tools and rate the quality of the tools. A definition of long-term control is needed before progress can be made towards recommending a core outcome measure.


Assuntos
Ensaios Clínicos como Assunto , Dermatite Atópica/terapia , Humanos , Assistência de Longa Duração , Avaliação de Resultados da Assistência ao Paciente , Qualidade de Vida , Resultado do Tratamento
2.
Clin Radiol ; 61(7): 535-44, 2006 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-16784938

RESUMO

In recent years there has been a marked increase in the incidence of pseudomembranous colitis (PMC). PMC is more common in patients over 65 years of age and can cause significant morbidity. The purpose of this article is to review the imaging features of PMC on plain radiography, sonography, computed tomography (CT), scintigraphy and magnetic resonance imaging (MRI). It is important to recognize the imaging findings of PMC using different imaging methods and encourage urgent confirmation of the diagnosis serologically, as the differential includes other fulminant colitides for which colectomy may be the required. Awareness of the spectrum of imaging findings of PMC can help radiologists make the primary or incidental diagnosis of PMC.


Assuntos
Enterocolite Pseudomembranosa/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
3.
Sci Total Environ ; 314-316: 289-302, 2003 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-14499538

RESUMO

Stream water concentrations of the faecal coliform group of sanitary indicator bacteria were monitored in the Newmills Burn, a small agriculturally intensive tributary of the River Don in Aberdeenshire. The results indicated that during its passage through the catchment, stream water became significantly contaminated with faecal coliform bacteria from the main agricultural land use inputs of livestock grazing and organic waste applications. Point sources of faecal coliform bacteria in terms of farmyard runoff, however, also appeared to be important in contributing to the spatial pattern of contamination. Significant temporal variation was observed in response to the hydrological behaviour of the catchment. Higher flows and more frequent washout of stored bacteria in winter and spring months led to lower faecal coliform concentrations than were detected during the summer. Maximum faecal coliform concentrations were measured during rainfall events and the varying responses associated with these helped to identify the importance of different sources of bacteria in the catchment and the mechanisms transferring them. The overall impact on the water quality of the Newmills Burn was considered as having a potentially serious threat to the health of downstream recreational users of the River Don, as well as to the large proportion of the local population who rely on private water supplies.


Assuntos
Enterobacteriaceae , Microbiologia da Água , Poluentes da Água/análise , Agricultura , Animais , Animais Domésticos , Monitoramento Ambiental , Fezes/microbiologia , Humanos , Saúde Pública , Medição de Risco , Escócia , Estações do Ano , Movimentos da Água
4.
Clin Rehabil ; 17(2): 174-80, 2003 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-12625658

RESUMO

BACKGROUND: There is often strong clinical resistance to patients self-propelling a wheelchair post stroke as this is believed to produce immediate increases in abnormal posture and movement. Research to support this viewpoint is limited. OBJECTIVE: To begin investigation of the immediate effects of self-propulsion on symmetrical sitting. DESIGN: Replicated single-case studies ABABA. SETTING: Movement analysis laboratory. SUBJECTS: Four patients, a maximum of eight weeks post stroke and six age-matched healthy volunteers. INTERVENTIONS: Subjects sat in the wheelchair during the A phases and self-propelled forwards during the B phases. The Manchester Active Position Seat (consists of 68 force transducers which transmit data at 10 Hz) measured the magnitude of peak force and the position of peak force on both sides of the seat. The mean symmetry index and standard deviation for each study phase were calculated and graphed for each subject. Interpretation was by visual inspection. RESULTS: Only one stroke patient and one volunteer increased asymmetry of magnitude of peak force following the two periods of self-propulsion. Only one of the stroke patients increased asymmetry of position of peak force following self-propulsion compared with three of the healthy volunteers. CONCLUSIONS: These results raise the hypothesis that self-propulsion early post stroke might not produce immediate detrimental effects on seated symmetry.


Assuntos
Movimento/fisiologia , Equilíbrio Postural/fisiologia , Postura/fisiologia , Reabilitação do Acidente Vascular Cerebral , Cadeiras de Rodas , Idoso , Estudos de Casos e Controles , Humanos , Pessoa de Meia-Idade , Propriocepção/fisiologia , Transdutores de Pressão
5.
Clin Radiol ; 56(8): 670-3, 2001 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-11467870

RESUMO

AIM: Oral contrast media are commonly given prior to computed tomography (CT) examination of the upper abdomen. Although positive oral contrast media are normally used, there is increasing interest in using negative agents such as water and less commonly fat density products. The aim of this study was to compare a positive oral contrast medium, water, and a diluted emulsion of arachis oil Calogen, a fat density food supplement) for assessment of the upper abdomen. MATERIALS AND METHODS: Seventy-one patients referred for upper abdominal CT were randomized to receive either 500 ml water, 2% sodium diatrizoate or a dilute suspension of Calogen. The CT images were scored independently by three radiologists. Distension and anatomical identification was assessed for the stomach, duodenum and jejunum; with anatomical identification recorded for the pancreas, retroperitoneum, liver, gallbladder and spleen. RESULTS: Dilute Calogen produced a significant improvement (P < 0.01) in distension and anatomical visualization of the stomach and proximal duodenum. Only minimal differences were demonstrated between the three contrast media for visualization of more distal small bowel or identification of the other upper abdominal viscera. Significantly more artifacts were caused by positive contrast media than with the Calogen mixture. CONCLUSION: A dilute suspension of Calogen as an oral contrast medium is recommended when disease is suspected within the stomach or proximal duodenum.


Assuntos
Meios de Contraste , Óleos Vegetais , Radiografia Abdominal/métodos , Tomografia Computadorizada por Raios X/métodos , Artefatos , Diatrizoato , Duodeno/diagnóstico por imagem , Humanos , Óleo de Amendoim , Estômago/diagnóstico por imagem , Água
8.
Am Fam Physician ; 63(4): 663-72, 677-8, 2001 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-11237081

RESUMO

Onychomycosis accounts for one third of fungal skin infections. Because only about one half of nail dystrophies are caused by fungus, the diagnosis should be confirmed by potassium hydroxide preparation, culture or histology before treatment is started. Newer, more effective antifungal agents have made treating onychomycosis easier. Terbinafine and itraconazole are the therapeutic agents of choice. Although the U.S. Food and Drug Administration has not labeled fluconazole for the treatment of onychomycosis, early efficacy data are promising. Continuous oral terbinafine therapy is most effective against dermatophytes, which are responsible for the majority of onychomycosis cases. Intermittent pulse dosing with itraconazole is as safe and effective as short-term continuous therapy but more economical and convenient. With careful monitoring, patients treated with the newer antifungal agents have a good chance of achieving relief from onychomycosis and its complications.


Assuntos
Antifúngicos/uso terapêutico , Onicomicose/tratamento farmacológico , Adulto , Antifúngicos/economia , Criança , Ensaios Clínicos como Assunto , Terapia Combinada , Diagnóstico Diferencial , Custos de Medicamentos , Interações de Medicamentos , Fluconazol/uso terapêutico , Humanos , Itraconazol/uso terapêutico , Naftalenos/uso terapêutico , Onicomicose/classificação , Onicomicose/diagnóstico , Onicomicose/economia , Educação de Pacientes como Assunto , Recidiva , Materiais de Ensino , Terbinafina , Falha de Tratamento
9.
J Am Dent Assoc ; 132(2): 163-70; quiz 223-4, 2001 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-11217588

RESUMO

BACKGROUND: The authors undertook a study to determine the prevalence in dentists of abnormal sensory nerve conduction and/or symptoms of carpal tunnel syndrome, or CTS, the most common nerve entrapment syndrome. METHODS: In a cross-sectional study, dentists (n = 1,079) were screened during the American Dental Association's Annual Health Screening Program in 1997 and 1998 by means of standard electrodiagnostic measures in the dominant hand and a self-reported symptom questionnaire. The authors diagnosed a median mononeuropathy from a 0.5- or 0.8-millisecond, or ms, prolongation of the median sensory-evoked peak latency compared to the ulnar latency. They diagnosed CTS if the subject also had accompanying symptoms of numbness, tingling or pain. RESULTS: Thirteen percent of screened dentists were diagnosed with a median mononeuropathy (using a 0.5-ms prolongation as the criterion), but only 32 percent of these had symptoms consistent with CTS (4.8 percent overall). When the 0.8-ms prolongation was used as the electrodiagnostic criterion, only 2.9 percent (overall) were diagnosed with CTS. People with diabetes, rheumatoid arthritis and obesity were more likely to have a median mononeuropathy. CONCLUSIONS: The prevalence of symptoms consistent with CTS in the dominant hand among dentists was higher than the prevalence in the general population. However, when electrodiagnostic confirmation is added, the prevalence of CTS was nearly the same as that among the general population. CLINICAL IMPLICATIONS: Early recognition of CTS can lead to more effective management. Education regarding ergonomic risk factors can be an effective preventive measure.


Assuntos
Síndrome do Túnel Carpal/epidemiologia , Odontologia , Doenças Profissionais/epidemiologia , Adulto , Síndrome do Túnel Carpal/diagnóstico , Distribuição de Qui-Quadrado , Estudos Transversais , Odontólogos , Diagnóstico Diferencial , Eletrodiagnóstico , Ergonomia , Feminino , Humanos , Masculino , Neuropatia Mediana/diagnóstico , Neuropatia Mediana/epidemiologia , Pessoa de Meia-Idade , Doenças Profissionais/diagnóstico , Prevalência , Fatores Sexuais , Inquéritos e Questionários , Suécia/epidemiologia , Estados Unidos/epidemiologia
11.
Otolaryngol Head Neck Surg ; 122(4): 477-81, 2000 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-10740164

RESUMO

This study investigated the relationship between external and middle ear factors and hearing screening results by automated auditory brain stem response (ABR) and transient-evoked otoacoustic emissions (EOAEs). The ears of 200 healthy newborns aged 5 to 48 hours underwent screening by ABR and EOAE, followed by otoscopic examination. The pass rates for ABR and EOAE were 91% and 58.5%, respectively. On otoscopic examination, 28% (112/400) ears had occluding vernix obscuring the view of the tympanic membrane. Cleaning of vernix was successfully performed in all but 2 ears that had occluding vernix. Cleaning of vernix significantly increased the pass rates of all 400 ears for ABR and EOAE to 96% and 69%. Decreased tympanic membrane mobility was found in 22.7% (90/396) of ears that were evaluated otoscopically. Decreased tympanic membrane mobility had a significant effect on EOAE screening; only 33.4% of ears passed EOAE testing. Decreased tympanic membrane mobility did not significantly affect pass rates for ABR screening; 95% of these ears passed the automated ABR screen. Implications for newborn hearing screening are discussed.


Assuntos
Cerume , Potenciais Evocados Auditivos do Tronco Encefálico , Triagem Neonatal , Otite Média com Derrame/fisiopatologia , Emissões Otoacústicas Espontâneas , Humanos , Recém-Nascido , Membrana Timpânica/fisiologia
12.
Radiology ; 212(2): 594-7, 1999 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-10429723

RESUMO

Ultrasonography-guided percutaneous biopsy was performed with local anesthesia and an 18-gauge needle in 10 patients with bowel-wall lesions. All patients underwent clinical review within 1 month. Biopsy was diagnostic in all patients. There were no complications, and all patients tolerated the procedure well. The technique appears to be safe and had an excellent diagnostic yield in our series.


Assuntos
Biópsia por Agulha/métodos , Intestinos/patologia , Ultrassonografia de Intervenção , Feminino , Humanos , Intestinos/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Agulhas
14.
Expert Opin Investig Drugs ; 8(3): 211-27, 1999 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-15992073

RESUMO

The production of recombinant proteins in plants is reviewed with a particular focus on plant-derived vaccines and antibodies for human healthcare. Issues relating to foreign gene expression, such as protein yield, localisation and glycosylation are also considered. Emphasis is placed on reporting progress with preclinical and clinical evaluation of plant-derived vaccines and antibodies. An assessment is made of the likely future direction of research and development in this area.

15.
J Biomed Mater Res ; 42(2): 303-11, 1998 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-9773827

RESUMO

Biodegradable barrier films were made by coagulating a solution of poly(DL-lactide) in N-methyl-2-pyrrolidone on porous polyethylene pads wetted with saline solution. The semisolid films were cut into 10 x 10 mm barriers and implanted subcutaneously in rabbits. At monthly intervals, the polymer implant sites were compared histologically to those implanted with USP negative control plastic. The polymer films were retrieved from the surrounding tissue, dried, weighed, and the changes in molecular weight determined using gel permeation chromatography. The molecular weight of the polymer decreased at a relatively constant rate over 5 months; however, no significant mass loss occurred until 5 months postimplantation. Also, no distinct histological differences were noted between the polymer barrier and the control plastic sites until 6 months when histiocytes and multinucleated giant cells showed a modest increase around fragmented polymer films. Similar barrier films also were fitted over naturally occurring buccal dehiscence defects in beagle dogs and the tissue sites compared histologically at 6 months to sham-operated control sites. New bone and dense connective tissues closely approximated segments of the remaining polymer and demonstrated the biocompatibility of the biodegradable films. Histomorphometric analyses of treated sites compared to sham controls showed that the polymer barrier is effective in promoting bone and cementum regeneration in periodontal defects in dogs.


Assuntos
Materiais Biocompatíveis/normas , Membranas Artificiais , Polímeros , Animais , Biodegradação Ambiental , Cães , Coelhos , Cicatrização
16.
Manag Care Interface ; 11(9): 67-9, 75, 1998 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-10187590

RESUMO

Nonadherence is a significant medical problem in the United States, leading to excessive morbidity, mortality, and medical costs. In the conclusion to this two-part article, the authors describe a pilot study involving 311 patients taking an angiotensin-converting enzyme inhibitor that evaluates the principal factors for nonadherence to pharmaceutical therapy in patients with congestive heart failure.


Assuntos
Inibidores da Enzima Conversora de Angiotensina/administração & dosagem , Tratamento Farmacológico/psicologia , Enalapril/administração & dosagem , Insuficiência Cardíaca/tratamento farmacológico , Cooperação do Paciente , Medição de Risco , Centros Médicos Acadêmicos , Adulto , Idoso , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ambulatório Hospitalar , Avaliação de Processos (Cuidados de Saúde) , Distribuição Aleatória , Estados Unidos
17.
J Am Pharm Assoc (Wash) ; 38(4): 469-79, 1998 Jul-Aug.
Artigo em Inglês | MEDLINE | ID: mdl-9707957

RESUMO

OBJECTIVE: To review the use of combination therapy versus monotherapy in hypertension, and to review seven major antihypertensive combinations in regard to their pharmacologic actions and appropriateness. DATA SOURCES: Literature was identified through a MEDLINE search from January 1985 to December 1997. Search terms included hypertension, blood pressure, combination therapy, diuretics, beta-receptor antagonists, calcium channel antagonists, angiotensin-converting enzyme inhibitors (ACEIs). Major hypertension texts were also reviewed for information on combination therapy. STUDY SELECTION: Clinical studies focusing primarily on blood pressure control with combinations of antihypertensive medications. DATA EXTRACTION: Data were evaluated with respect to study design, clinical outcomes, and use of antihypertensive classes commonly seen in practice. DATA SYNTHESIS: Combination therapy in hypertension is often required because many patients cannot be controlled on one drug alone. Available data demonstrate that ACEIs plus diuretics or calcium channel blockers (CCBs) produce synergistic effects on blood pressure. Beta-blockers plus diuretics or CCBs produce additive effects, as does the rarer combination of diltiazem plus a dihydropyridine CCB. Ineffective combinations include beta-blockers plus ACEIs and dihydropyridine CCBs plus diuretics, although there are specific clinical circumstances where these combinations may be used. CONCLUSION: When used appropriately, certain combinations of antihypertensives can effectively control blood pressure and minimize side effects. The pharmacist who understands and applies the pharmacology of these antihypertensives can help prescribers make rational decisions in selecting combination therapy.


Assuntos
Anti-Hipertensivos/uso terapêutico , Hipertensão/tratamento farmacológico , Pressão Sanguínea/efeitos dos fármacos , Quimioterapia Combinada , Humanos , Falha de Tratamento
18.
Manag Care Interface ; 11(8): 58-60, 1998 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-10182240

RESUMO

Nonadherence is a significant medical problem in the United States, leading to excessive morbidity, mortality, and medical costs. In this first installment of a two-part article, the authors review the literature and discuss the effects of the problem, with particular reference to patients with congestive heart failure.


Assuntos
Insuficiência Cardíaca/tratamento farmacológico , Cooperação do Paciente , Fármacos Cardiovasculares/administração & dosagem , Efeitos Psicossociais da Doença , Gerenciamento Clínico , Esquema de Medicação , Insuficiência Cardíaca/economia , Humanos , Autoadministração , Estados Unidos
19.
Pharmacotherapy ; 18(2): 404-7, 1998 Mar-Apr.
Artigo em Inglês | MEDLINE | ID: mdl-9545163

RESUMO

A 77-year-old man who had taken ranitidine for several years for dyspepsia was prescribed alternative therapy with famotidine 20 mg twice/day. He subsequently developed mental status changes, with confusion, disorientation, and nightmares. The symptoms dissipated after he discontinued famotidine for 2 days. He rechallenged himself and experienced return of the symptoms shortly thereafter, with additional visual hallucinations. His therapy was changed to lansoprazole, and his symptoms again disappeared and have not recurred. Case reports of central nervous system effects with other histamine2 antagonists have been published. Eight cases occurred with famotidine, all of which were in hospitalized patients receiving intravenous famotidine. We believe this is the first report of mental status changes in an ambulatory patient taking oral famotidine. The elderly may be particularly susceptible to such changes.


Assuntos
Antiulcerosos/efeitos adversos , Famotidina/efeitos adversos , Transtornos Mentais/induzido quimicamente , Idoso , Antiulcerosos/administração & dosagem , Antiulcerosos/uso terapêutico , Confusão/induzido quimicamente , Sonhos/efeitos dos fármacos , Dispepsia/tratamento farmacológico , Famotidina/administração & dosagem , Famotidina/uso terapêutico , Humanos , Masculino , Orientação/efeitos dos fármacos
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