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Rev. Pesqui. (Univ. Fed. Estado Rio J., Online) ; 11(5): 1340-1346, out.-dez. 2019. tab
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1022135


Objective: The study's purpose has been to assess the main limitations reported by heart failure bearing patients. Methods: It is a secondary analysis of an exploratory study with a qualitative approach. This study was performed with 15 patients with heart failure, out of the 167 undergoing ambulatory care, and over the period from March to July 2011. The collection of primary data was based on semi-structured interviews with subsequent analysis according to the Bardin's perspective. The secondary analysis was performed according to the retrospective interpretation strategy. Results: There were female predominance (73.3%); incomplete elementary school (80.2%); hypertensive patients (80.2%); dyslipidemic patients (53.4%); and diabetics patients (33.3%). Concerning the daily limitations, the following stand out: impaired walking, precarious sleep pattern, fatigue, dyspnea, loss of autonomy, dependence on others, poor sleep pattern, low sexual activity. Conclusion: By taking into consideration the heart failure, a chronic disease, it is fundamental for nurses to look for guidelines and strategies that are able to develop the capacity for self-care, prevention and health promotion

Objetivo: Analisar as principais limitações relatadas por pacientes com insuficiência cardíaca. Método: análise secundária de um estudo exploratório, de abordagem qualitativa, realizado com 15 pacientes portadores de insuficiência cardíaca no período de março a julho de 2011, dentre os 167 em atendimento ambulatorial. A coleta de dados primários deu-se a partir de uma entrevista semi-estruturada, com posterior análise de Bardin, e para presente análise secundária foi utilizada como estratégia a interpretação retrospectiva. Resultados: predominância do sexo feminino (73,3%); ensino fundamental incompleto (80,2%); hipertensos (80,2%); dislipidêmicos (53,4%); diabéticos (33,3%). Quanto às limitações no cotidiano, destacam-se: deambulação prejudicada, padrão de sono precário, fadiga, dispneia, perda de autonomia, dependência de terceiros, padrão de sono precário, baixa frequência da atividade sexual. Conclusão: na insuficiência cardíaca, uma doença crônica, é fundamental que o enfermeiro busque por orientações e estratégias, as quais possam desenvolver a capacidade de autocuidado, prevenção e promoção da saúde

Objetivo: Analizar las principales limitaciones relatadas por pacientes con insuficiencia cardiaca. Método: análisis secundario de un estudio exploratorio, de abordaje cualitativo, realizado con 15 pacientes portadores de insuficiencia cardíaca en el período de marzo a julio de 2011, entre los 167 en atención ambulatoria. La recolección de datos primarios se dio a partir de una entrevista semiestructurada, con posterior análisis de Bardin, y para el presente análisis secundario se utilizó como estrategia la interpretación retrospectiva. Resultados: predominio del sexo femenino (73,3%); educación básica incompleta (80,2%); hipertensos (80,2%); dislipidémicos (53,4%); diabéticos (33,3%). En cuanto a las limitaciones en el cotidiano, se destacan: deambulación perjudicada, patrón de sueño precario, fatiga, disnea, pérdida de autonomía, dependencia de terceros, patrón de sueño precario, baja frecuencia de la actividad sexual. Conclusión: en la insuficiencia cardíaca, una enfermedad crónica, es fundamental que el enfermero busque orientaciones y estrategias, que puedan desarrollar la capacidad de autocuidado, prevención y promoción de la salud

Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Autocuidado/instrumentação , Insuficiência Cardíaca/enfermagem , Insuficiência Cardíaca/prevenção & controle , Promoção da Saúde
Rev Bras Enferm ; 72(3): 780-787, 2019 Jun 27.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31269146


OBJECTIVE: to describe the validation of the booklet on self-care with the feet of people with diabetes. METHOD: methodological study, focusing on the validation of a printed booklet. The content and appearance of the booklet was validated by 23 judges divided into three groups: 11 content and appearance, seven technicians and five of the area of design and marketing. The appearance was validated by 30 people with type 2 Diabetes Mellitus. RESULTS: the judges in the nursing area allowed the validation of material with a Content Validity Index (CVI) of 0.99, judges in the area of design and marketing with Suitability Assessment of Materials (SAM) of 99.2% and the target audience with concordance index of 99.4%. CONCLUSION: the educational booklet proved to be valid and reliable educational material to be used in order to promote compliance with self-care with the feet of people with Diabetes Mellitus.

Pé Diabético/terapia , Folhetos , Educação de Pacientes como Assunto/normas , Autocuidado/instrumentação , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/psicologia , Diabetes Mellitus Tipo 2/terapia , Pé Diabético/psicologia , Humanos , Educação de Pacientes como Assunto/métodos , Autocuidado/métodos , Autocuidado/normas , Inquéritos e Questionários , Estudos de Validação como Assunto
N Z Med J ; 132(1497): 21-31, 2019 06 21.
Artigo em Inglês | MEDLINE | ID: mdl-31220062


AIM: To assess whether self-sampling for cervical-cancer screening is acceptable to New Zealand women. METHODS: Maori, Pacific and Asian un- or under-screened women aged 30-69 years were asked to: 1) examine three self-sampling devices; 2) complete a questionnaire on demographics and experiences with the devices; and 3) take a self-sample. Samples were tested 'off-label' using the cobas® 4800 human papillomavirus (HPV) test (Roche Diagnostics NZ). RESULTS: Thirty-one Pacific, 12 Maori, nine Asian and four women of other ethnicities participated (mean age, 39.5 years). Before trying any devices, 78% indicated a preference to self-sample, compared to 22% who preferred a physician-collected sample (PCS). After trying a device (HerSwab™, 91%; Delphi Screener™, 14%; cobas Swab, 13%; 12.5% used >1 device), fewer women (66%) preferred to self-sample next time, fewer (16%) preferred a PCS, while 18% expressed no preference. One of 32 samples with valid results (35 were tested) was positive for HPV 'other' oncogenic types. CONCLUSIONS: This was the first New Zealand study to invite women, including Maori women, to take a self-sample for cervical-cancer screening. The pilot study suggests that un- and under-screened women generally find self-sampling acceptable and all sample types are suitable for use with the cobas HPV test.

Grupos Étnicos , Papillomaviridae/isolamento & purificação , Preferência do Paciente , Autocuidado/instrumentação , Manejo de Espécimes/instrumentação , Esfregaço Vaginal/instrumentação , Adulto , Atitude Frente a Saúde , Detecção Precoce de Câncer , Feminino , Humanos , Pessoa de Meia-Idade , Nova Zelândia , Infecções por Papillomavirus/diagnóstico , Projetos Piloto , Autocuidado/métodos , Manejo de Espécimes/métodos , Inquéritos e Questionários , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/virologia , Esfregaço Vaginal/métodos , Adulto Jovem
Rev Sci Instrum ; 90(4): 043113, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31043035


In order to develop a low-cost wearable electromyography (EMG) sensor system that can be used at home, compacting the data size is studied first to extract potential features via frequency analysis. A low-cost wearable home-use EMG sensor is then developed. Results show the frequency band at 40-60 Hz of tibialis anterior offers significant differences to identify walking problems (p-value < 0.05), which can be used as a detection standard with a smaller data size. More significantly, data sizes are dramatically reduced by 95.06% compared to the original data size. This finding suggests a potential examining method for identifying pathological gait with the compacted data in satisfactory processing time that can be used at home.

Eletromiografia/instrumentação , Análise da Marcha/instrumentação , Autocuidado/instrumentação , Dispositivos Eletrônicos Vestíveis , Adulto , Idoso , Diagnóstico por Computador , Eletromiografia/economia , Desenho de Equipamento , Análise da Marcha/métodos , Humanos , Perna (Membro)/fisiopatologia , Músculo Esquelético/fisiopatologia , Paraplegia/diagnóstico , Paraplegia/fisiopatologia , Autocuidado/economia , Processamento de Sinais Assistido por Computador , Dispositivos Eletrônicos Vestíveis/economia , Tecnologia sem Fio/economia , Tecnologia sem Fio/instrumentação
Photobiomodul Photomed Laser Surg ; 37(1): 4-16, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31050938


Objective: Perform systematic literature review on photobiomodulation (PBM) devices used at home for nonesthetic applications. Background: Home-use PBM devices have been marketed for cosmetic and therapeutic purposes. This is the first systematic literature review for nonesthetic applications. Methods: A systematic literature search was conducted for PBM devices self-applied at home at least thrice a week. Two independent reviewers screened the articles and extracted the data. Treatment dosage appropriateness was compared to the World Association for Laser Therapy (WALT) recommendations. The efficacy was evaluated according to the relevant primary end-point for the specific indication. Results: Eleven studies were suitable. Devices were applied for a range of indications, including pain, cognitive dysfunction, wound healing, diabetic macular edema, and postprocedural side effects, and were mostly based on near-infrared, pulsed light-emitting diodes with dosages within WALT recommendations. Regarding efficacy, studies reported mostly positive results. Conclusions: Home-use PBM devices appear to mediate effective, safe treatments in a variety of conditions that require frequent applications. Conclusive evaluation of their efficacy requires additional, randomized controlled studies.

Terapia com Luz de Baixa Intensidade/instrumentação , Autocuidado/instrumentação , Humanos
Rev. pesqui. cuid. fundam. (Online) ; 11(3): 756-762, abr.-maio 2019. tab
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-987728


Objective: The study's purpose has been to identify the technologies focused on the health education of chronic renal patients aiming to promote the self-care. Methods: It is an integrative review that was performed in the databases LILACS, MEDLINE, SCOPUS, CINAHL and in the COCHRANE Library, where the final sample consisted of 16 articles. Results: The publications occurred between 2008 and 2016, prevailing studies with level III of evidence. The findings showed that the technologies used in health education for the promotion of chronic renal patient self-care used written materials (brochures, booklets and handouts), audiovisuals (videos, website, PowerPoint presentation, soap opera and interactive CD) and educational games as a communication vehicle. Conclusion: Among the articles that brought out these technologies, it was not verified their occurrence in the Brazilian scientific literature, then configuring a knowledge gap in that country

Objetivo: C: Identificar as tecnologias direcionadas para a educação em saúde de pacientes renais crônicos para a promoção do autocuidado. Métodos: Trata-se de uma revisão integrativa realizada nas bases de dados LILACS, MEDLINE, SCOPUS, CINAHL e na Biblioteca COCHRANE, sendo a amostra final composta por 16 artigos. Resultados: As publicações ocorreram entre 2008 e 2016, prevalecendo estudos com nível III de evidência. Os achados mostraram que as tecnologias utilizadas na educação em saúde para a promoção do autocuidado do paciente renal crônico utilizaram materiais escritos (folhetos, livretos e apostilas), audiovisuais (vídeos, website, apresentação de Power point, telenovela e CD interativo) e jogos educacionais como veículo de comunicação. Conclusão: Dentre os artigos que trouxeram essas tecnologias, não foram representantes na literatura cientifica brasileira, configurando-se uma lacuna de conhecimento nesse país

Objetivo: Identificar las tecnologías dirigidas a la educación de la salud en pacientes renales crónicos para promover el autocuidado. Método: Se trata de una revisión integradora llevado a cabo en las bases de datos LILACS, MEDLINE, Scopus, CINAHL y Cochrane Library, y la muestra final de 16 artículos. Resultados: Publicaciones ocurrieron entre 2008 y 2016, los estudios ya existe con las pruebas de nivel III. Los resultados mostraron que las tecnologías utilizadas en la educación sanitaria para la promoción de los materiales renal crónica paciente autocuidado utilizados por escrito (folletos, prospectos y folletos), audiovisuales (videos, sitios web, presentaciones de Power Point, series de televisión y CD interactivo) y juegos educativos como vehículo de comunicación. Conclusión: Entre los artículos que trajeron estas tecnologías no eran representantes en la literatura científica brasileña, la creación de un vacío de conocimiento en este país

Humanos , Masculino , Feminino , Autocuidado/estatística & dados numéricos , Educação em Saúde/métodos , Insuficiência Renal Crônica/terapia , Autocuidado/instrumentação , Educação em Saúde/tendências
PLoS One ; 14(3): e0212904, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30875377


By controlling robots comparable to the human body, people with profound motor deficits could potentially perform a variety of physical tasks for themselves, improving their quality of life. The extent to which this is achievable has been unclear due to the lack of suitable interfaces by which to control robotic body surrogates and a dearth of studies involving substantial numbers of people with profound motor deficits. We developed a novel, web-based augmented reality interface that enables people with profound motor deficits to remotely control a PR2 mobile manipulator from Willow Garage, which is a human-scale, wheeled robot with two arms. We then conducted two studies to investigate the use of robotic body surrogates. In the first study, 15 novice users with profound motor deficits from across the United States controlled a PR2 in Atlanta, GA to perform a modified Action Research Arm Test (ARAT) and a simulated self-care task. Participants achieved clinically meaningful improvements on the ARAT and 12 of 15 participants (80%) successfully completed the simulated self-care task. Participants agreed that the robotic system was easy to use, was useful, and would provide a meaningful improvement in their lives. In the second study, one expert user with profound motor deficits had free use of a PR2 in his home for seven days. He performed a variety of self-care and household tasks, and also used the robot in novel ways. Taking both studies together, our results suggest that people with profound motor deficits can improve their quality of life using robotic body surrogates, and that they can gain benefit with only low-level robot autonomy and without invasive interfaces. However, methods to reduce the rate of errors and increase operational speed merit further investigation.

Pessoas com Deficiência , Transtornos Motores/reabilitação , Robótica/instrumentação , Autocuidado/instrumentação , Realidade Virtual , Computadores , Desenho de Equipamento , Humanos , Internet , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Fatores de Tempo
Medicine (Baltimore) ; 98(9): e14597, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30817577


OBJECTIVE: This study aims to develop an assistive technology-180° rotating feeding spoon that could improve the ability of eating of self-care patients with upper extremity dyskinesia. METHODS: The Brunnstrom 6-stage rating of hemiplegia was adopted. During the different recovery stages of the upper limbs, the patients orally ate using a feeding spoon with a non-rotatory head and a 180° rotating feeding spoon. The ability of these patients to eat by themselves was observed, and the basic activity of daily living (BADL) was assessed using the Barthel index (BI). RESULTS: The Brunnstrom assessment scale was used to analyze the results of the patient's upper limb function examination, and the results revealed that the 180° rotating feeding spoon could assist patients with different degrees of upper limb dysfunction when eating independently. CONCLUSIONS: The 180° rotating feeding spoon can assist patients with upper limb dysfunction when eating independently. For patients with different degrees of upper limb dysfunction, the spoon can provide different degrees of aid.

Utensílios de Alimentação e Culinária , Discinesias/reabilitação , Hemiplegia/complicações , Autocuidado/instrumentação , Equipamentos de Autoajuda , Extremidade Superior , Idoso , Discinesias/etiologia , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
Int J Pediatr Otorhinolaryngol ; 121: 154-156, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30913503


OBJECTIVES: To describe how pediatric tracheostomy emergency supplies and education are standardized with the use of "Go-bags" and to demonstrate how this has impacted tracheostomy-related adverse events. METHODS: A prospective study was completed at an urban pediatric tertiary care center. Standardized "Go-bags" of tracheostomy supplies were provided to pediatric patients with tracheostomy. All caregivers received standardized tracheostomy education. Check lists were used to monitor contents at return visits or admissions. Tracheostomy related adverse events were tracked on all patients with tracheostomy from July 2016 to May 2018, and rates were compared for patients who had received a "Go-bag" to those who had not. RESULTS: 292 "Go-bags" were distributed during the two-year study period. 35% were distributed by inpatient respiratory therapists, 23% by the home ventilation team, and 22% by a tracheostomy clinic nurse. Supply checks have led to more than 185 cases of emergency tracheostomy equipment replacement. 35% of tracheostomy-related adverse event (TRAE) occurred in patients who did not have a "Go-bag", while 22% of TRAEs occurred in patients who had "Go-bags". CONCLUSION: Standardized pediatric tracheostomy care is critical to patient safety, both in and out of the hospital. Standardized tracheostomy "Go-bags" are a simple and efficient method to educate caregivers, improve the quality of care for children with tracheostomy, and ultimately reduce tracheostomy related adverse events.

Cuidadores/educação , Educação de Pacientes como Assunto , Autocuidado/instrumentação , Traqueostomia/educação , Adolescente , Lista de Checagem , Criança , Pré-Escolar , Feminino , Hospitais Pediátricos , Humanos , Lactente , Recém-Nascido , Masculino , Segurança do Paciente , Estudos Prospectivos , Centros de Atenção Terciária , Traqueostomia/efeitos adversos
J Med Vasc ; 44(1): 19-27, 2019 Feb.
Artigo em Francês | MEDLINE | ID: mdl-30770081


OBJECTIVES: At the Paris Saint-Joseph Hospital Group neurovascular unit, the therapeutic patient education program "Treatment of high blood pressure after stroke" involved integrating a vascular physician. The objectives were to include a significant number of patients, to integrate learning self-measurement, and to make an initial analysis of the results concerning patient knowledge, self-measurement practices, adherence to treatment, and control of blood pressure. METHODS: Eighty-six patients under 90 years of age admitted to the neurovascular unit were included in the program between January 1 and October 31, 2017, and participated in an in-hospital educational diagnostic interview followed by an initial session. During this period, 30 patients were reviewed within 3 to 6 months after discharge, with a post-session evaluation for 22 of them. Patient satisfaction was assessed with a questionnaire. A questionnaire was also proposed to the staff. RESULTS: The mean blood pressure of the 22 patients reviewed was on target and they had improved their level of knowledge. The number of sphygmomanometers increased from 5 to 20, but the practice of cycles was not yet mastered. Levels of observed compliance changed little. Patients and paramedics appreciated the program and were convinced of its usefulness. These results do not support a direct effect of therapeutic patient education on blood pressure control, but the observed results are positive and encouraging.

Determinação da Pressão Arterial , Pressão Sanguínea , Hipertensão/terapia , Educação de Pacientes como Assunto , Autocuidado/métodos , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Determinação da Pressão Arterial/instrumentação , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Satisfação do Paciente , Valor Preditivo dos Testes , Autocuidado/instrumentação , Esfigmomanômetros , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia
Rev. pesqui. cuid. fundam. (Online) ; 11(2, n. esp): 289-296, jan. 2019.
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-969394


Objetivo: El objetivo fue identificar las vivencias de adolescentes en el manejo de diabetes mellitus, en relación al autocuidado. Métodos: Fue llevada a cabo investigación descriptiva, predominantemente cualitativa, en hospital de referencia en DM, en Fortaleza-Ce, Brasil. Resultados: Participaron del estudio a través de entrevistas semiestructuradas 14 adolescentes con DM, con edades entre 12-18 años. Las entrevistas fueron sometidas a análisis de contenido para desconexión de las categorías. Del análisis, emergieron tres temas: el primero relacionado con los pacientes que demostraron adherencia al autocuidado; el segundo acerca de los dilemas de ser adolescente con diabetes; y el tercero para actuación de los profesionales de la salud y familia para el adolescente manejar el autocuidado. Conclusiones: Esta investigación con adolescentes con diabetes señaló la importancia del autocuidado con apoyo como herramienta que puede llevarse a la práctica por profesionales y familia, fomentando la adherencia al tratamiento

Objetivo: Conhecer as vivências de adolescentes acerca do autocuidado. Métodos: Estudo qualitativo, entrevistas semiestruturadas foram conduzidas com 14 adolescentes, entre 12 a 18 anos, cadastrados em laboratório de endocrinologia pediátrica na cidade de Fortaleza, CE. Resultados: Com base nos dados desvelados observamos os seguintes enfrentamentos: adesão ao autocuidado; dilemas de ser adolescente com diabetes e ações do profissional de saúde e da família para o autocuidado do adolescente. Conclusão: Esta pesquisa com adolescentes portadores de diabetes demonstrou a importância do autocuidado apoiado como uma ferramenta que poderá ser operacionalizada por profissionais e família, favorecendo a adesão ao tratamento

Objective: This study aimed to identify the adolescents' experiences in the management of diabetes mellitus, regarding self-care. Methods: It is a descriptive research with a predominantly qualitative approach, which was carried out in a referral hospital in the assistance to patients with diabetes mellitus, located in Fortaleza city, Ceará State, Brazil. Fourteen adolescents bearing diabetes mellitus, within an age group from 12 to 18 years old, have participated in the study through semi-structured interviews. Results: The interviews were submitted to content analysis in order to identify the categories. After analysis, the following three thematic categories emerged: the first is related to patients who have demonstrated adherence to self-care; the second regarding the dilemmas of being an adolescent with diabetes; and the third concerning the actions of health professionals and the patients' relatives for the self-care management of adolescents. Conclusion: This research performed with adolescents bearing diabetes has revealed the importance of supported self-care as an instrument that can be worked out by both professionals and family, thus encouraging the treatment adherence

Humanos , Masculino , Feminino , Criança , Adolescente , Autocuidado/estatística & dados numéricos , Diabetes Mellitus Tipo 1/prevenção & controle , Diabetes Mellitus Tipo 1/psicologia , Autocuidado/instrumentação , Diabetes Mellitus Tipo 1/terapia
J Clin Sleep Med ; 14(10): 1791-1796, 2018 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-30353811


STUDY OBJECTIVES: The objective of this study was to evaluate the performance of a miniaturized home sleep apnea test, called NightOwl. The system consists of a sensor placed on the fingertip and a cloud-based analytics software. The sensor acquires accelerometer and photoplethysmographic data. The software derives actigraphy from the former, and blood oxygen saturation and peripheral arterial tone, among other features, from the latter. METHODS: Data of 101 participants who underwent an in-laboratory polysomnography (PSG), while wearing the NightOwl sensor, were collected. In order to establish an external benchmark, all PSG tests were edited by a somnologist of Younes Medical Technologies Ltd. (YMT) after analysis by the Michele Sleep Scoring System (MSSS). The respiratory event index (REI) derived by NightOwl (NightOwl-REI), the apnea-hypopnea index (AHI) derived by Ziekenhuis Oost-Limburg (ZOL-AHI), and the AHI derived by YMT (MSSS-AHI) were compared. RESULTS: The NightOwl-REI had a high correlation with the MSSS-AHI (ρ = .87, P < .001), which was close to the correlation between the ZOL-AHI and MSSS-AHI (ρ = .84, P < .001). The NightOwl-REI and ZOL-AHI had a correlation of .77 (P < .001). After categorization of the AHI, the agreement between the NightOwl-REI and the MSSS-AHI was .812 and the agreement between the ZOL-AHI and MSSS-AHI was .743, after double-labeling near-boundary participants. CONCLUSIONS: The NightOwl-REI achieved a close correlation and REI-categorization with the MSSS-AHI, especially in light of the significant inter-scorer variability of the analysis of the PSG.

Monitorização Ambulatorial/métodos , Autocuidado/métodos , Síndromes da Apneia do Sono/diagnóstico , Acelerometria , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Ambulatorial/instrumentação , Oxigênio/sangue , Fotopletismografia , Polissonografia/instrumentação , Polissonografia/métodos , Autocuidado/instrumentação , Síndromes da Apneia do Sono/fisiopatologia
Eur Spine J ; 27(11): 2862-2874, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30324496


BACKGROUND: Mobile health (mHealth) is emerging as the most convenient way to deliver rehabilitation services remotely, and collect outcomes in real time, thus contributing to disease management by transferring care from hospital to home. It facilitates accessibility to healthcare, enhances patients' understanding of their condition, and their willingness to engage in self-management, giving way to high-quality care to the satisfaction of both patients and healthcare professionals. PURPOSE: The purpose of this study was to examine the effect of using a smartphone app (called Snapcare) on pain and function in patients suffering from chronic low back pain. METHODS: Ninety-three patients with chronic low back pain were recruited and randomly allocated to either the Conventional group (n = 48) receiving a written prescription from the Physician, containing a list of prescribed medicines and dosages, and stating the recommended level of physical activity (including home exercises) or the App group (n = 45) receiving Snapcare, in addition to the written prescription. Pain and disability were assessed at baseline and after 12 weeks of treatment. RESULTS: Both the groups showed significant improvement in pain and disability (p < 0.05). The App group showed a significantly greater decline in disability (p < 0.001). CONCLUSION: Health applications are promising tools for improving outcomes in patients suffering from various chronic conditions. Snapcare facilitated increase in physical activity and brought about clinically meaningful improvements in pain and disability in patients with chronic low back pain. These slides can be retrieved under Electronic Supplementary Material.

Dor Crônica/terapia , Dor Lombar/terapia , Aplicativos Móveis , Autocuidado , Smartphone , Humanos , Autocuidado/instrumentação , Autocuidado/métodos , Telemedicina
J Headache Pain ; 19(1): 98, 2018 Oct 19.
Artigo em Inglês | MEDLINE | ID: mdl-30340460


BACKGROUND: The PRESTO study of non-invasive vagus nerve stimulation (nVNS; gammaCore®) featured key primary and secondary end points recommended by the International Headache Society to provide Class I evidence that for patients with an episodic migraine, nVNS significantly increases the probability of having mild pain or being pain-free 2 h post stimulation. Here, we examined additional data from PRESTO to provide further insights into the practical utility of nVNS by evaluating its ability to consistently deliver clinically meaningful improvements in pain intensity while reducing the need for rescue medication. METHODS: Patients recorded pain intensity for treated migraine attacks on a 4-point scale. Data were examined to compare nVNS and sham with regard to the percentage of patients who benefited by at least 1 point in pain intensity. We also assessed the percentage of attacks that required rescue medication and pain-free rates stratified by pain intensity at treatment initiation. RESULTS: A significantly higher percentage of patients who used acute nVNS treatment (n = 120) vs sham (n = 123) reported a ≥ 1-point decrease in pain intensity at 30 min (nVNS, 32.2%; sham, 18.5%; P = 0.020), 60 min (nVNS, 38.8%; sham, 24.0%; P = 0.017), and 120 min (nVNS, 46.8%; sham, 26.2%; P = 0.002) after the first attack. Similar significant results were seen when assessing the benefit in all attacks. The proportion of patients who did not require rescue medication was significantly higher with nVNS than with sham for the first attack (nVNS, 59.3%; sham, 41.9%; P = 0.013) and all attacks (nVNS, 52.3%; sham, 37.3%; P = 0.008). When initial pain intensity was mild, the percentage of patients with no pain after treatment was significantly higher with nVNS than with sham at 60 min (all attacks: nVNS, 37.0%; sham, 21.2%; P = 0.025) and 120 min (first attack: nVNS, 50.0%; sham, 25.0%; P = 0.018; all attacks: nVNS, 46.7%; sham, 30.1%; P = 0.037). CONCLUSIONS: This post hoc analysis demonstrated that acute nVNS treatment quickly and consistently reduced pain intensity while decreasing rescue medication use. These clinical benefits provide guidance in the optimal use of nVNS in everyday practice, which can potentially reduce use of acute pharmacologic medications and their associated adverse events. TRIAL REGISTRATION: identifier: NCT02686034 .

Transtornos de Enxaqueca/diagnóstico , Transtornos de Enxaqueca/terapia , Autocuidado/instrumentação , Autocuidado/métodos , Estimulação do Nervo Vago/instrumentação , Estimulação do Nervo Vago/métodos , Doença Aguda , Adulto , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento
J Neuromuscul Dis ; 5(4): 419-430, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30282375


BACKGROUND: Loss of pulmonary function is a main cause of early morbidity and mortality in patients with Duchenne muscular dystrophy (DMD). Standard of care guidelines recommend regular assessment of pulmonary function by hospital-based spirometry to detect onset and monitor progression of pulmonary function decline. OBJECTIVE: To assess the feasibility of home-based monitoring of pulmonary function by a hand-held device (HHD) in adolescent and adult patients with DMD over a period of 12 months. METHODS: In the phase III randomized placebo-controlled DELOS trial in 10-18 year old DMD patients, peak expiratory flow (PEF) measurements were collected weekly at home by the patient (assisted by parent/caregiver) using a peak flow meter HHD. Adherence to the use of the HHD was assessed and 12-month changes in PEF as percent of predicted (PEF% p) for the idebenone (N = 31) and the placebo treatment groups (N = 33) from HHD-derived data were compared to results from hospital-based spirometry. RESULTS: A total of 2689 individual HHD assessments were analysed. Overall adherence to the use of the HHD over the course of the 12-month study duration was good (75.9%, SD 21.5%) and PEF% p data obtained at the same day by HHD and standard spirometry correlated well (Spearman's rho 0.80; p < 0.001). Several analysis methods of HHD-derived data for PEF% p consistently demonstrate that idebenone treatment slowed the decline in PEF% p compared to placebo, which supports the statistically significant difference in favour of idebenone for PEF% p measured by standard spirometry. CONCLUSIONS: This study demonstrates that home-based monitoring of pulmonary function in adolescent patients with DMD using a HHD is feasible, provides reliable data compared to hospital-based spirometry and is therefore suitable for use in clinical practice and for clinical trials.

Distrofia Muscular de Duchenne/complicações , Testes de Função Respiratória/instrumentação , Autocuidado/instrumentação , Adolescente , Antioxidantes/uso terapêutico , Criança , Humanos , Masculino , Distrofia Muscular de Duchenne/tratamento farmacológico , Pico do Fluxo Expiratório/efeitos dos fármacos , Testes de Função Respiratória/métodos , Autocuidado/métodos , Ubiquinona/análogos & derivados , Ubiquinona/uso terapêutico
J Spec Oper Med ; 18(3): 75-78, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30222842


BACKGROUND: Exsanguination from limb injury is an important battlefield consideration that is mitigated with the use of emergency tourniquets. The Combat Application Tourniquet (C-A-T®) is the current British military standard tourniquet. METHODS: We tested the self-application of a newer tourniquet system, the Tactical Mechanical Tourniquet (TMT), against self-application of the C-A-T. A total of 24 healthy British military volunteers self-applied the C-A-T and the TMT to their mid thigh in a randomized, sequential manner. Popliteal artery flow was monitored with a portable ultrasound machine, and time until arterial occlusion was measured. Pain scores were also recorded. Results The volunteers allowed testing on their lower limbs (n = 48 legs). The C-A-T was applied successfully to 22 volunteers (92%), and the TMT was successfully applied to 17 (71%). Median time to reach complete arterial occlusion was 37.5 (interquartile range [IQR], 27-52) seconds with the C-A-T, and 35 (IQR, 29-42) seconds with the TMT. The 2.5-second difference in median times was not significant (ρ = .589). The 1-in-10 difference in median pain score was also not significant (ρ = .656). The success or failure of self-application between the two tourniquet models as assessed by contingency table was not significant (p= .137). CONCLUSION: The TMT is effective when self-applied at the mid thigh. It does not offer an efficacy advantage over the C-A-T.

Militares , Autocuidado/instrumentação , Torniquetes , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Medição da Dor , Artéria Poplítea/diagnóstico por imagem , Fluxo Sanguíneo Regional , Coxa da Perna , Estudos de Tempo e Movimento , Torniquetes/efeitos adversos , Ultrassonografia , Reino Unido