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1.
J Korean Med Sci ; 36(1): e13, 2021 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-33398947

RESUMO

BACKGROUND: The impact of coronavirus disease 2019 (COVID-19) has profoundly affected education, with most universities changing face-to-face classes to online formats. To adapt to the COVID-19 pandemic situation, we adopted a blended learning approach to anatomy instruction that included online lectures, pre-recorded laboratory dissection videos, and 3D anatomy applications, with condensed offline cadaver dissection. METHODS: We aimed to examine the learning outcomes of a newly adopted anatomy educational approach by 1) comparing academic achievement between the blended learning group (the 2020 class, 108 students) and the traditional classroom learning group (the 2019 class, 104 students), and 2) an online questionnaire survey on student preference on the learning method and reasons of preference. RESULTS: The average anatomy examination scores of the 2020 class, who took online lectures and blended dissection laboratories, were significantly higher than those of the 2019 class, who participated in an offline lecture and dissection laboratories. The questionnaire survey revealed that students preferred online lectures over traditional large group lecture-based teaching because it allowed them to acquire increased self-study time, study according to their individual learning styles, and repeatedly review lecture videos. CONCLUSION: This study suggests that a blended learning approach is an effective method for anatomy learning, and the advantage may result from increased self-directed study through online learning.


Assuntos
Anatomia/educação , /epidemiologia , Sucesso Acadêmico , Cadáver , Instrução por Computador , Humanos , Aprendizagem , Avaliação de Resultados em Cuidados de Saúde
2.
Medicine (Baltimore) ; 100(1): e24020, 2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33429767

RESUMO

BACKGROUND: To explore the influence of the early path nursing on life quality and the neurological function recovery in the intracerebral hemorrhage (ICH) patients. METHODS: The experiment was implemented from January 2018 to October 2020 at the First Affiliated Hospital of Soochow University. The experiment was granted through the Research Ethics Committee of the First Affiliated Hospital of Soochow University (2017033). In this experiment, the criteria for inclusion includes: hemorrhagic stroke diagnosed via the MRI or head CT; over 18 years of age; patients with motor dysfunction; The Glasgow Coma Scale > 12. The patients with these symptoms will be excluded: severe cognitive impairment; ischemic stroke; onset time > 3 days; and severe complications. The scale used for the evaluation the neurological function is the American Stroke Scale. This scale contains a total of eleven items, that is, the movements of upper and lower limb, the consciousness level, gaze, visual field, etc. Other outcomes include patient satisfaction and complications. RESULTS: Evaluation the neurological function and quality of life will be shown in Table 1. CONCLUSION: The early path nursing can promote the neurological function recovery in the ICH patients. TRIAL REGISTRATION NUMBER: researchregistry6327.


Assuntos
Hemorragia Cerebral/enfermagem , Protocolos Clínicos , Doenças do Sistema Nervoso/prevenção & controle , Adolescente , Adulto , Hemorragia Cerebral/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/enfermagem , Avaliação de Resultados em Cuidados de Saúde , Ensaios Clínicos Controlados Aleatórios como Assunto , Recuperação de Função Fisiológica , Fatores de Tempo
3.
Isr Med Assoc J ; 23(1): 33-37, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33443340

RESUMO

BACKGROUND: Injuries to the anterior cruciate ligament (ACL) are common and complete tears often fail to heal. ACL reconstruction is considered the surgical gold standard of care for ACL injuries in young active patients. OBJECTIVES: To determine the corresponding morphological and histological features of the torn ACL in different time periods after injury. METHODS: The study included 28 remnant specimens of torn ACLs from patients who had ACL reconstruction surgery of the knee. The remnant pathology was evaluated by its morphology during arthroscopy and by histopathologic measurements. RESULTS: At surgery there were three progressive and distinct morphological tear patterns. The first pattern was noticed within the first 3 months from injury and showed no scar tissue. The second pattern appeared later and was characterized by the appearance of scar tissue with adhesion to the femoral wall. The third pattern was characterized by adhesion of the ACL remnant to the posterior cruciate ligament. The histological changes of the first morphological pattern showed abundance of blood vessels and lymphocytes at the torn femoral end with few irregular collagen fibers. The second and third tear patterns showed decrement in the number of blood vessels and lymphocytes with longitudinally oriented collagen fibers. CONCLUSIONS: The morphological features of the ACL remnant in the first 3 months after injury showed no scar tissue and its histological features had the characteristics of a reparative phase. This phase was followed by a prolonged remodeling phase that ended with attachment of the remnant to the posterior cruciate ligament.


Assuntos
Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior , Cicatriz , Articulação do Joelho , Efeitos Adversos de Longa Duração , Aderências Teciduais , Adulto , Reconstrução do Ligamento Cruzado Anterior/efeitos adversos , Reconstrução do Ligamento Cruzado Anterior/métodos , Artroscopia/métodos , Cicatriz/diagnóstico por imagem , Cicatriz/etiologia , Feminino , Tecido de Granulação/irrigação sanguínea , Tecido de Granulação/patologia , Humanos , Articulação do Joelho/irrigação sanguínea , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/patologia , Efeitos Adversos de Longa Duração/diagnóstico por imagem , Efeitos Adversos de Longa Duração/etiologia , Masculino , Avaliação de Resultados em Cuidados de Saúde , Período Pós-Operatório , Fatores de Tempo , Aderências Teciduais/diagnóstico por imagem , Aderências Teciduais/etiologia
5.
Am J Occup Ther ; 75(1): 7501205030p1-7501205030p13, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33399051

RESUMO

IMPORTANCE: This systematic review summarizes existing studies on dry needling for spasticity and range of motion (ROM) and discusses its potential for use as an occupational therapy intervention. OBJECTIVE: To examine existing studies on the effects of dry needling on spasticity and ROM. DATA SOURCES: Article citations and abstracts from Scopus, Cochrane Library, PubMed, CINAHL, and a university library search. STUDY SELECTION AND DATA COLLECTION: Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used in abstracting data. Peer-reviewed journal articles published in English between January 2007 and June 2019 were searched. Of 270 identified studies, 10 met the inclusion criteria. Studies were divided into categories on the basis of outcome measures (Modified Modified Ashworth Scale and ROM). Pain outcome measures were excluded because a systematic review addressing this outcome has recently been completed. FINDINGS: Strong evidence was found to support the use of dry needling to decrease spasticity and increase ROM. CONCLUSIONS AND RELEVANCE: This systematic review suggests that dry needling is an effective physical agent modality to decrease spasticity and increase ROM, both of which are potentially beneficial to functional outcomes. WHAT THIS ARTICLE ADDS: This article provides information that may be helpful in determining the appropriateness of dry needling as an occupational therapy intervention.


Assuntos
Agulhamento Seco , Avaliação de Resultados em Cuidados de Saúde , Humanos , Amplitude de Movimento Articular
6.
Curr Opin Anaesthesiol ; 34(1): 1-6, 2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33315643

RESUMO

PURPOSE OF REVIEW: The aim of this review is to provide an overview of the rationale and evidence for nonintubated thoracic surgery and guide clinicians, considering the implementation of nonintubated thoracic surgery, to find an anesthetic approach suitable for their department. RECENT FINDINGS: Based on physiologic considerations alone, nonintubated thoracic surgery would be expected to be an advantageous concept in thoracic anesthesia, especially in patients at high risk for pulmonary complications. Currently existing evidence, however, does not support these claims. Although the feasibility and safety have been repeatedly demonstrated, high-quality evidence showing a significant benefit regarding clinically relevant patient-centered outcomes is not available.Anesthetic approaches to nonintubated thoracic surgery differ significantly; however, they usually concentrate on six main aspects: maintenance of airway patency, respiratory support, analgesia, patient comfort, cough suppression, and conversion techniques. Given the lack of high-quality studies comparing different techniques, evidence-based guidance of clinical decision-making is currently not possible. Until further evidence is available, anesthetic management will depend mostly on local availability and expertise. SUMMARY: In select patients and with experienced teams, nonintubated thoracic surgery can be a suitable alternative to intubated thoracic surgery. Until more evidence is available, however, a general change in anesthetic management in thoracic surgery is not justified.


Assuntos
Anestesia Geral , Anestésicos , Guias como Assunto , Cirurgia Torácica , Humanos , Avaliação de Resultados em Cuidados de Saúde , Seleção de Pacientes , Cirurgia Torácica Vídeoassistida
8.
Sci Total Environ ; 760: 144036, 2021 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-33348162

RESUMO

The excessively warm weather, especially in cities, can lead to several adverse impacts, including heat-related mortality, becoming an increasingly important public health issue. Previous studies on heat-related mortality have assessed risk factors at the municipal scale, missing the intra-urban variability in heat risk and vulnerability. The knowledge of the spatial intra-variability can help to design spatially targeted measures to better protect citizens' health. Through hot spot analysis, we identified the neighbourhood-scale spatial pattern of heat-related cardiorespiratory mortality in the elderly, during the yearly warmest five months of a three years period. Potential associations between spatial variability in heat-related mortality and several independent factors in each neighbourhood were investigated and their predictions. Two approaches were adopted: one is eminently statistical, using Generalized Linear Models (GLM) and another using Geographically Weighted Regression (GWR). This new recent regression technique is increasing in international attention on spatial modelling. The spatial model explains about 60% of the spatial variations in elderly's heat-related cardiorespiratory mortality. The two-analyses produced an overlapping set of predictor variables, with emphasis on the elderly, vegetation cover and employment. The results also show that the areas where heat-related mortality is high, are also the areas where the number of deaths is higher than expected. These neighbourhoods should be considered as the most vulnerable to heat-related mortality. We concluded that studying human health outcomes at neighbourhood-scale is relevant for public health heat-related plans. Essential suggestions are provided to decision-making support and city planners designing strategies to reduce heat-related mortality.


Assuntos
Temperatura Alta , Tempo (Meteorologia) , Idoso , Cidades , Humanos , Mortalidade , Avaliação de Resultados em Cuidados de Saúde , Características de Residência
10.
J Dermatolog Treat ; 32(1): 56-63, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31696745

RESUMO

Objectives: To describe ixekizumab treatment patterns, all-cause healthcare utilization, and costs among psoriasis patients.Methods: Adults diagnosed with psoriasis having ≥1 ixekizumab claim were selected from MarketScan® databases between March 01, 2016 and July 31, 2017. Patients were continuously enrolled for ≥6 months prior and ≥3 months after the index date (first ixekizumab claim) and followed until inpatient death, end of enrollment, or end of data. Treatment patterns included persistence, switching, and re-initiation. All-cause utilization and costs were reported per-patient-per-month (PPPM).Results: 801 patients (mean age 49 years; 55.8% male; median follow-up 201 days) were included. Among all patients, 87.4% were persistent (mean (median) duration 86 (75) days) Of the 12.6% of patients who discontinued ixekizumab, 11.9% re-initiated and 6.9% switched treatments. Mean (median) time to switching was 208 (206) days. Mean number of all-cause inpatient admissions and physician office visits PPPM were 0.01 and 0.72, respectively. Mean total cost PPPM was $8,371, of which pharmacy comprised $7,792. Ixekizumab costs, $7,079, occurred primarily during induction and were paid predominantly by health plans ($6,810 [96.2%]).Conclusion: Most (87.4%) ixekizumab users remained persistent during follow-up. Pharmacy was the primary driver of total healthcare costs, with the majority covered by health plans and <4% as patient out-of-pocket expense.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Fármacos Dermatológicos/uso terapêutico , Custos de Cuidados de Saúde , Aceitação pelo Paciente de Cuidados de Saúde , Psoríase/tratamento farmacológico , Adulto , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Psoríase/patologia , Psoríase/psicologia , Estudos Retrospectivos
11.
Psychiatr Danub ; 32(3-4): 491-498, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33370758

RESUMO

BACKGROUND: Individuals with certain pre-existing chronic health conditions have been identified as a high-risk group for fatalities of COVID-19. Therefore, it is likely that individuals with chronic diseases may worry during this pandemic to the detriment of their mental health. This study compares the mental health of Bangladeshi adults affected by chronic disease to a healthy, matched control group during the COVID-19 pandemic. SUBJECTS AND METHODS: A matched case-control analysis was performed with data collected from 395 respondents with chronic diseases and 395 controls matched for age, gender, and residence. Inclusion criteria for cases were respondents who self-reported having asthma, cardiovascular disease symptoms and/or diabetes. Respondents were recruited using an online survey, which included the DASS-21 measure to assess symptoms of stress, anxiety, and depression. Chi-square test, t-test, Fisher's exact test and a conditional logistic regression were performed to examine associations among variables. RESULTS: The prevalence of anxiety symptoms and depression symptoms and the level of stress were significantly higher among cases (59%; 71.6%; 73.7%, respectively) than among controls (25.6%; 31.1%; 43.3%, respectively). Chi-square and t-test showed significant associations and differences between having chronic diseases and mental health outcomes. A conditional logistic regression showed that respondents with asthma, diabetes, cardiovascular disease symptoms, or any combination of these diseases had higher odds of exhibiting symptoms of stress, anxiety, and depression than healthy individuals. CONCLUSION: These results underscore a subpopulation vulnerable to mental health consequences during this pandemic and indicate the need for additional mental health resources to be available to those with chronic diseases.


Assuntos
Adulto , Ansiedade , Estudos de Casos e Controles , Doença Crônica , Comorbidade , Depressão , Humanos , Avaliação de Resultados em Cuidados de Saúde , Pandemias
12.
Medicine (Baltimore) ; 99(52): e23810, 2020 Dec 24.
Artigo em Inglês | MEDLINE | ID: mdl-33350767

RESUMO

BACKGROUND: Percutaneous coronary intervention with the new generation drug eluting stents (DES) is 1 among the revascularization procedures required to treat patients with coronary artery disease (CAD). Since late stent thrombosis and silent myocardial infarction are highly associated with type 2 diabetes mellitus (T2DM), an analysis comparing the newer generation DES in this specific subgroup of patients would be scientifically relevant.In this analysis, we aimed to systematically compare the cardiovascular outcomes observed with the ultrathin bioresorbable polymer sirolimus eluting stents (SES) versus thin, durable polymer everolimus eluting stents (EES) following percutaneous coronary intervention in patients with T2DM. METHODS: Through online databases, relevant studies comparing ultrathin bioresorbable polymer SES versus the durable polymer EES were carefully searched. The cardiovascular outcomes were assessed during a follow-up time period of 1 year and more than 1 year (1-5 years) respectively. This meta-analysis was carried out by the latest version of the RevMan software. Following analysis, the results were represented by odds ratios (OR) with 95% confidence intervals (CI). RESULTS: A total number of 1967 patients with T2DM were included in this analysis. During a 1 year follow-up time period, target lesion failure (TLF) (OR: 0.59, 95% CI: 0.34-1.02; P = .06, target vessel revascularization (TVR) (OR: 0.97, 95% CI: 0.55-1.70; P = .91) and target lesion revascularization (TLR) (OR: 0.91, 95% CI: 0.44-1.87; P = .79) were similarly observed with ultrathin bioresorbable polymer SES versus the thin, durable polymer EES in these patients with T2DM. Other cardiovascular outcomes including myocardial infarction (MI), major adverse cardiac events, all-cause mortality (OR: 0.72, 95% CI: 0.37-1.40; P = .34), cardiac death and stent thrombosis (OR: 0.85, 95% CI: 0.45-1.62; P = .63) were also similarly observed with these 2 types of new stents. During a follow-up time period above 1 year (1-5 years), still no significant difference was observed in TLF, TVR, TLR, major adverse cardiac events, MI, all-cause mortality, cardiac death and stent thrombosis (OR: 0.62, 95% CI: 0.33-1.16; P = .14). CONCLUSIONS: The ultrathin bioresorbable polymer SES were similar to the durable polymer EES in these patients with T2DM. These 2 types of new generation stents were comparable in terms of cardiovascular outcomes. Hence, they might be recommended in patients with T2DM. Upcoming trials should be able to confirm this hypothesis.


Assuntos
Implantes Absorvíveis/efeitos adversos , Doenças Cardiovasculares/epidemiologia , Doença da Artéria Coronariana/cirurgia , Diabetes Mellitus Tipo 2/complicações , Stents Farmacológicos/efeitos adversos , Everolimo/farmacologia , Intervenção Coronária Percutânea/instrumentação , Sirolimo/farmacologia , Doença da Artéria Coronariana/complicações , Humanos , Imunossupressores/farmacologia , Avaliação de Resultados em Cuidados de Saúde
13.
Medicine (Baltimore) ; 99(52): e23818, 2020 Dec 24.
Artigo em Inglês | MEDLINE | ID: mdl-33350768

RESUMO

ABSTRACT: There have been increasing calls for clinicians to document social determinants of health (SDOH) in electronic health records (EHRs). One potential source of SDOH in the EHRs is in the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) Z codes (Z55-Z65). In February 2018, ICD-10-CM Official Guidelines for Coding and Reporting approved that all clinicians, not just the physicians, involved in the care of a patient can document SDOH using these Z codes.To examine the utilization rate of the ICD-10-CM Z codes using data from a large network of EHRs.We conducted a retrospective analysis of EHR data between 2015 to 2018 in the OneFlorida Clinical Research Consortium, 1 of the 13 Clinical Data Research Networks funded by Patient-Centered Outcomes Research Institute. We calculated the Z code utilization rate at both the encounter and patient levels.We found a low rate of utilization for these Z codes (270.61 per 100,000 at the encounter level and 2.03% at the patient level). We also found that the rate of utilization for these Z codes increased (from 255.62 to 292.79 per 100,000) since the official approval of Z code reporting from all clinicians by the American Hospital Association Coding Clinic and ICD-10-CM Official Guidelines for Coding and Reporting became effective in February 2018.The SDOH Z codes are rarely used by clinicians. Providing clear guidelines and incentives for documenting the Z codes can promote their use in EHRs. Improvements in the EHR systems are probably needed to better document SDOH.


Assuntos
Registros Eletrônicos de Saúde , Classificação Internacional de Doenças , Determinantes Sociais da Saúde , Registros Eletrônicos de Saúde/normas , Registros Eletrônicos de Saúde/estatística & dados numéricos , Fidelidade a Diretrizes/organização & administração , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Avaliação de Resultados em Cuidados de Saúde/métodos , Avaliação de Resultados em Cuidados de Saúde/normas , Melhoria de Qualidade , Estados Unidos , Revisão da Utilização de Recursos de Saúde
14.
Medicine (Baltimore) ; 99(52): e23831, 2020 Dec 24.
Artigo em Inglês | MEDLINE | ID: mdl-33350770

RESUMO

ABSTRACT: The International Society on Thrombosis and Haemostasis (ISTH) scoring system has been used for diagnosing overt disseminated intravascular coagulation (DIC). However, the cut-off points of fibrin-related markers remain unclear. The ability of the ISTH DIC score and Multiple Organ Dysfunction (MODS) score to predict mortality in cases of exertional heat illness (EHI) was tested. In the process, 3 different D-dimer cut-off values for diagnosing overt DIC were evaluated.Data were obtained on the first day of hospitalization for 76 patients with EHI. The DIC score was calculated according to the ISTH scoring system using 3 D-dimer cut-off values.In predicting mortality, methods 1 and 2 had the same sensitivity and specificity, which were 85% and 73.2%, respectively. The sensitivity for method 3 was 70%. Furthermore, the specificity of the DIC score for method 3 was 89%, which was higher than that of the other 2 methods. The correlation coefficients of the DIC and MODS scores of these 3 methods were 0.757, 0.748, and 0.756, respectively. For the prediction of mortality, the area under the receiver operating characteristic (ROC) curve for the DIC scores of these 3 methods was 0.838, 0.842, and 0.85, respectively. Furthermore, the area under the ROC curve of the MODS score was 0.927.The DIC score had a certain predictive power of a poor outcome of EHI patients, but this was not better than the MODS score. The present data may serve as a reference in selecting the appropriate D-dimer cut-off point for the ISTH DIC score.


Assuntos
Coagulação Intravascular Disseminada , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Transtornos de Estresse por Calor , Escores de Disfunção Orgânica , Adulto , China , Coagulação Intravascular Disseminada/sangue , Coagulação Intravascular Disseminada/diagnóstico , Feminino , Transtornos de Estresse por Calor/sangue , Transtornos de Estresse por Calor/diagnóstico , Transtornos de Estresse por Calor/mortalidade , Humanos , Masculino , Avaliação de Resultados em Cuidados de Saúde/métodos , Valor Preditivo dos Testes , Prognóstico , Curva ROC , Projetos de Pesquisa/normas , Sensibilidade e Especificidade
15.
Medicine (Baltimore) ; 99(52): e23902, 2020 Dec 24.
Artigo em Inglês | MEDLINE | ID: mdl-33350789

RESUMO

BACKGROUND: Idiopathic facial nerve palsy (Bells palsy) is the most common acute mono-neuropathy which lack of effective treatments. Kinesitherapy as an alternative therapeutic approach was widely used in clinical. But the effects on Bells palsy outcome are still debated. METHODS: The aim of this study is to systematically review the therapeutic efficacy of kinesitherapy for Bells palsy. Database including PubMed, EMBASE, Cochrane Library, Chinese Biomedical database (CBM), Chinese National Knowledge Infrastructure (CNKI), Chinese Science and Technology Periodical database (VIP) and WangFang database will be searched to collect randomized controlled trails (RCTs) on kinesitherapy for Bells palsy from inception to Nov 2020. The therapeutic effects based on recovery rate, House-Brackmann (H-B) facial classification system, Sunny brook face grading system and adverse events after the treatment will be marked as the primary outcomes. RevMan V.5.3 software will be used to calculate the data synthesis as well as to perform meta-analysis if the results are appropriate. RESULTS: The literature will provide a high-quality synthesis of current evidence of kinesitherapy for Bells palsy from various comprehensive assessment, including the recovery rate, H-B facial classification, Sunny brook face scores, adverse events rate, Facial disability index (FDI), residual symptoms 6 months after onset, incomplete recovery rate after 1 year. CONCLUSION: The systematic review will provide up-to-date evidence to assess kinesitherapy for Bells palsy. PROSPERO REGISTRATION NUMBER: PROSPERO CRD42020215109.


Assuntos
Paralisia de Bell/terapia , Terapia por Exercício/métodos , Cinesiologia Aplicada/métodos , Humanos , Metanálise como Assunto , Avaliação de Resultados em Cuidados de Saúde , Projetos de Pesquisa , Revisões Sistemáticas como Assunto
16.
Medicine (Baltimore) ; 99(52): e23921, 2020 Dec 24.
Artigo em Inglês | MEDLINE | ID: mdl-33350796

RESUMO

ABSTRACT: To analyze the efficacy of arthrodesis with Ilizarov external fixator for the treatment of end-stage ankle osteoarthritis.This retrospective study included 88 patients with end-stage (stage-3) ankle osteoarthritis according to Morrey-Wiedeman classification who underwent arthrodesis with Ilizarov external fixator from January 2016 to January 2019. There were 47 males and 41 females with a mean age of (57.21 ±â€Š7.12) years old (range 49-76). Outcomes were measured by the American Orthopaedic Foot and Ankle society (AOFAS) Ankle Hindfoot Scale, Visual Analog Scale (VAS) pain scores, complications, subjective satisfaction, ankle function, correction of deformity, and complications.With an average follow-up of (13.50 ±â€Š5.41) months (range 10-21), all 88 patients returned for final follow-up. All patients achieved bony healing with a success rate of 100%. Mean postoperative healing time (3.56 ±â€Š1.04) months (range 3-6). Two patients developed sinus tract infection, delayed healing in 1 patient, and 2 patients had pain and swelling again in the ankle joint. No serious complications occurred in other patients. All the patients evaluated with the VAS scores and AOFAS scores at final follow-up showed significant improvement (P < .05). Through imaging analysis, medical tibial talar angle (MTTA) improved from (85.76 ±â€Š6.01) degrees to (88.98 ±â€Š1.35) degrees postoperative. Lateral talar station (LTS) decreased from (5.32 ±â€Š3.81) mm to (2.71 ±â€Š2.62) mm after operation (P < .05). The overall satisfaction of patients is 88.64%.In the treatment of end-stage ankle osteoarthritis, arthrodesis with Ilizarov external fixator can achieve good radiological and clinical outcomes with low prevalence of ankle joint malalignment and high fusion rates and satisfaction.


Assuntos
Articulação do Tornozelo , Artrodese , Osteoartrite , Complicações Pós-Operatórias , Articulação do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/patologia , Articulação do Tornozelo/cirurgia , Artrodese/efeitos adversos , Artrodese/instrumentação , Artrodese/métodos , China/epidemiologia , Progressão da Doença , Fixadores Externos , Feminino , Humanos , Técnica de Ilizarov , Masculino , Pessoa de Meia-Idade , Osteoartrite/diagnóstico , Osteoartrite/fisiopatologia , Osteoartrite/cirurgia , Avaliação de Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Radiografia/métodos , Estudos Retrospectivos
17.
Ned Tijdschr Geneeskd ; 1642020 11 19.
Artigo em Holandês | MEDLINE | ID: mdl-33332036

RESUMO

OBJECTIVE: Hospitalization for corona virus disease 2019 (COVID-19) may be followed by complications after discharge. We aimed to evaluate mortality, readmission rate, and readmission characteristics after hospitalization with COVID-19. DESIGN: A retrospective cohort study METHODS: Inclusion of all patients hospitalized for COVID-19 between March 1, 2020, and June 1, 2020 in Zuyderland Medical Centre, The Netherlands. Main outcome measures were mortality and readmission after hospitalization. Univariate and multivariate regression analysis were performed to identify risk factors for death and readmission. RESULTS: A total of 769 patients hospitalized with COVID-19 (mean age 70 ± 14 years; 39% female) were included in the study. In-hospital mortality was 22.4% , as such 596 patients were discharged alive and followed after discharge with a median of 80 days (IQR 66-91). Total mortality after discharge was 6.4% (n=38) and readmission rate was 11.7% (n=70). Main reasons for readmission were respiratory insufficiency (31%), arterial and venous thrombotic events (16%) or related to a chronic comorbidity (14%). Mortality rates were higher in older patients and patients who experienced delirium during hospital stay. Risk factors for readmission were male sex, discharge to a long-term care facility and COPD. CONCLUSION: 1 out of 6 COVID-19 positive patients died or was readmitted after discharge. This shows an ongoing vulnerability of COVID-19 patients. Physicians and policy makers should consider this high rate when making decisions on discharge, hospital-capacity planning, and patient monitoring after discharge.


Assuntos
Readmissão do Paciente/estatística & dados numéricos , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Insuficiência Respiratória , Trombose Venosa , Idoso , /fisiopatologia , Estudos de Coortes , Comorbidade , Feminino , Humanos , Masculino , Mortalidade , Países Baixos/epidemiologia , Avaliação de Resultados em Cuidados de Saúde , Alta do Paciente , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/mortalidade , Insuficiência Respiratória/terapia , Fatores de Risco , Trombose Venosa/etiologia , Trombose Venosa/mortalidade , Trombose Venosa/terapia
18.
Braz Oral Res ; 34: e126, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33331392

RESUMO

The coronavirus disease 2019 (COVID-19) outbreak has created unprecedent challenges for healthcare systems worldwide. Oncology services have been reorganized to decrease the risk of nosocomial acquisition of SARS-CoV-2, but changes in treatment pathways and follow-up cancer care can result in patients receiving suboptimal or delayed care. Herein, we describe a cross-sectional nested cohort study conducted to evaluate delays in care for patients with head and neck cancer (HNC) in post-treatment follow-up or palliative care during the COVID-19 pandemic in Northeast Brazil and its impact on health outcomes. Information was extracted from medical records and supplemented by telephone interviews. We compared the following health outcomes: self-perception of anxiety or sadness, fear of COVID-19 infection, cancer-related complications during social isolation, self-medication, diagnosis of COVID-19, and death between patients with and without delayed cancer care. The Mann-Whitney U test was used to compare distributions of continuous variables and the Fisher exact test was used for categorical variables. Thirty-one HNC patients were included in the study, and no case of confirmed SARS-CoV-2 was found. Delayed cancer care due to restriction in health services was reported in 58.1% of cases, and there was no report of telemedicine use during the COVID-19 outbreak. Cancer-related complications during the COVID-19 pandemic were described for most patients (67.7%) and included pain or discomfort, swelling, and dyspnea. Eight (25.8%) patients reported use of prescribed morphine or codeine to manage pain and six (19.4%) patients reported self-medication with over-the-counter (OTC) non-steroidal anti-inflammatory drugs (NSAIDs). We found an association between delayed HNC care and the use of self-medication (p = 0.028). This study indicated that patients with delayed HNC care during the COVID-19 outbreak are more likely to use self-medication with NSAIDs for pain management. Better strategies to follow HNC patients in socioeconomically disadvantaged communities need to be discussed and implemented.


Assuntos
Neoplasias de Cabeça e Pescoço/terapia , Tempo para o Tratamento , Brasil/epidemiologia , Estudos de Coortes , Estudos Transversais , Humanos , Avaliação de Resultados em Cuidados de Saúde , Pandemias
19.
PLoS One ; 15(12): e0242962, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33382746

RESUMO

OBJECTIVE: The Da Qing Diabetes Prevention program (DQDP) was a randomized lifestyle modification intervention conducted in 1986 for the prevention and control of type 2 diabetes in individuals with impaired glucose tolerance. The current study estimated long-term cost-effectiveness of the program based on the health utilities from the Chinese population. METHODS: A Markov Monte Carlo model was developed to estimate the impact of the intervention from the healthcare system perspective. The analysis was run over 30-year and lifetime periods and costs were estimated respectively as health management service costs. Baseline characteristics and intervention effects were assessed from the DQDP. Utilities and costs were generated from relevant literature. The outcome measures were program cost per quality-adjusted life-years (QALYs) gained and incremental cost-effectiveness ratio (ICER) of the intervention. Sensitivity analyses and threshold analyses were performed. RESULTS: Using a 30-year horizon, the intervention strategy was cost-saving and was associated with better health outcomes (increase of 0.74 QALYs per intervention participant). Using a lifetime horizon, the intervention strategy was cost-saving and was associated with additional 1.44 QALYs. Sensitivity analyses showed that the overall ICER was most strongly influenced by the hazard ratio of cardiovascular disease event. CONCLUSIONS: The Da Qing lifestyle intervention in a Chinese population with impaired glucose tolerance is likely to translate into substantial economic value. It is cost-saving over a 30-year time and lifetime frame.


Assuntos
Análise Custo-Benefício , Diabetes Mellitus Tipo 2/prevenção & controle , Estilo de Vida , Cadeias de Markov , Método de Monte Carlo , Prevenção Primária/economia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde
20.
Medicine (Baltimore) ; 99(50): e23165, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327234

RESUMO

BACKGROUND: Although several researchers have analyzed the dental identity of patients experience with corrective methods using fixed and removable appliances, the consequences stay debatable. This meta-analysis intended to verify whether the periodontal status of removable appliances is similar to that of the conventional fixed appliances. METHODS: Relevant literature was retrieved from the database of Cochrane library, PubMed, EMBASE, and CNKI until December 2019, without time or language restrictions. Comparative clinical studies assessing periodontal conditions between removable appliances and fixed appliances were included for analysis. The data was analyzed using the Stata 12.0 software. RESULTS: A total of 13 articles involving 598 subjects were selected for this meta-analysis. We found that the plaque index (PLI) identity of the removable appliances group was significantly lower compared to the fixed appliances group at 3 months (OR = -0.57, 95% CI: -0.98 to -0.16, P = .006) and 6 months (OR = -1.10, 95% CI: -1.60 to -0.61, P = .000). The gingival index (GI) of the removable appliances group was lower at 6 months (OR = -1.14, 95% CI: -1.95 to -0.34, P = .005), but the difference was not statistically significant at 3 months (OR = -0.20, 95% CI: -0.50 to 0.10, P = .185) when compared with that of the fixed appliances group. The sulcus probing depth (SPD) of the removable appliances group was lower compared to the fixed appliances group at 3 months (OR = -0.26, 95% CI: -0.52 to -0.01, P = .047) and 6 months (OR = -0.42, 95% CI: -0.83 to -0.01, P = .045). The shape of the funnel plot was symmetrical, indicating no obvious publication bias in the Begg test (P = .174); the Egger test also indicated no obvious publication bias (P = .1). CONCLUSION: Our meta-analysis demonstrated that malocclusion patients treated with the removable appliances demonstrated a better periodontal status as compared with those treated with fixed orthodontic appliances. However, the analyses of more numbers of clinical trials are warranted to confirm this conclusion.


Assuntos
Má Oclusão/terapia , Aparelhos Ortodônticos Fixos/efeitos adversos , Aparelhos Ortodônticos Removíveis/efeitos adversos , Doenças Periodontais/etiologia , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Má Oclusão/classificação , Má Oclusão/diagnóstico , Pessoa de Meia-Idade , Desenho de Aparelho Ortodôntico/tendências , Aparelhos Ortodônticos/provisão & distribução , Avaliação de Resultados em Cuidados de Saúde , Doenças Periodontais/epidemiologia , Índice Periodontal , Ensaios Clínicos Controlados Aleatórios como Assunto
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