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1.
BMJ ; 366: l4912, 2019 08 23.
Artigo em Inglês | MEDLINE | ID: mdl-31444168

RESUMO

The studyFeatherstone K, Northcott A, Harden J, et al. Refusal and resistance to care by people living with dementia being cared for within acute hospital wards: an ethnographic study. Health Serv Deliv Res 2019;7.This study was funded by the National Institute for Health Research Health Services and Delivery Research Programme (project number 13/10/80).To read the full NIHR Signal, go to https://discover.dc.nihr.ac.uk/content/signal-000779/understanding-dementia-care-in-hospitals.


Assuntos
Demência/enfermagem , Demência/psicologia , Hospitalização , Cooperação do Paciente , Inglaterra , Humanos , Relações Profissional-Paciente , Medicina Estatal/normas , País de Gales
4.
Pan Afr Med J ; 33: 28, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31384343

RESUMO

Poor compliance with therapy is frequently encountered in most of patients with chronic diseases. It increases the risk of morbi-mortality and healthcare costs. Patients on chronic haemodialysis often have poor compliance with treatment. This study aims to assess the level of compliance with treatment in our patients on chronic hemodialysis and to identify the predictive factors of poor compliance with treatment. We conducted a cross-sectional study at the Oujda Hospital in November 2011. The compliance with treatment was measured using a questionnaire: the compliance evaluation test (CET) assessed the compliance with medication treatment and diet. A rate of 85% was retained arbitrarily as a threshold for good compliance with treatment. Patient in a zone of partial adherence had a rate between 57% and 85% while a lower rate (57%) indicated poor compliance with treatment. Different demographic and clinicobiologic parameters were analyzed and predictive factors for good and poor compliance with treatment were identified. Our study involved 101 patients on chronic haemodialysis; the sex ratio was 1.2, the average age of patients was 15.6 years. CET showed that 23.4% of patients had good compliance with treatment, 39.4% partial compliance with treatment and 37.2% poor compliance with treatment. Statistical analysis showed that poor compliance with treatment was associated with a lower socio-economic and intellectual status, with co-morbidities and with long term hemodialysis. Good compliance with treatment was observed in very old patients helped by a third person, taking a reduced number of medications, with a higher intellectual level.


Assuntos
Dieta/normas , Adesão à Medicação/estatística & dados numéricos , Cooperação do Paciente/estatística & dados numéricos , Diálise Renal/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
5.
Stud Health Technol Inform ; 264: 30-34, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31437879

RESUMO

Non-compliance situations happen when patients do not follow their prescriptions and take actions that lead to potentially harmful situations. Although such situations are dangerous, patients usually do not report them to their physicians. Hence, it is necessary to study other sources of information. We propose to study online health fora. The purpose of our work is to explore online health fora with supervised classification and information retrieval methods in order to identify messages that contain drug non-compliance. The supervised classification method permits detection of non-compliance with up to 0.824 F-measure, while the information retrieval method permits detection non-compliance with up to 0.529 F-measure. For some fine-grained categories and new data, it shows up to 0.65-0.70 Precision.


Assuntos
Armazenamento e Recuperação da Informação , Internet , Cooperação do Paciente , Humanos , Aprendizado de Máquina , Médicos
6.
Einstein (Sao Paulo) ; 17(4): eAO4696, 2019 Aug 22.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31460617

RESUMO

OBJECTIVE: To determine the frequency of drug therapy problem in the treatment of patients with tuberculosis and HIV/AIDS. METHODS: Data were obtained through a cross-sectional study conducted between September 2015 and December 2016 at a reference hospital in infectious diseases in Belo Horizonte (MG), Brazil. Sociodemographic, clinical, behavioral and pharmacotherapeutic variables were evaluated through a semi-structured questionnaire. Drug-related problems of pharmaceutical care were classified using the Pharmacotherapy Workup method. Factors associated with indication, effectiveness, safety and compliance drug therapy problem were assessed through multiple logistic regression. RESULTS: We evaluated 81 patients, and 80% presented at least one drug therapy problem, with indication and adherence drug therapy problem being the most frequent. The factors associated with drug therapy problem were age, marital status, new case, ethnicity, time of HIV diagnosis and time to treat tuberculosis. CONCLUSION: The frequency of drug therapy problem in coinfected patients was high and the identification of the main drug therapy problem and associated factors may lead the multiprofessional health team to ensure the use of the most indicated, effective, safe and convenient medicines for the patients clinical condition. Tuberculosis and HIV/AIDS coinfected individuals aged over 40 years are more likely to have drug therapy problems during treatment; in that, the most frequente are those that signal toward need of medication for an untreated health condition and non-compliance to treatment. Thus, older patients, unmarried or married, who have treated tuberculosis before, with a shorter time to tuberculosis treatment and longer time to diagnose HIV/AIDS, should receive special attention and be better followed by a multiprofessional health team because they indicate a higher chance of presenting Problems related to the use of non-adherent drugs.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Antituberculosos/administração & dosagem , Cooperação do Paciente/estatística & dados numéricos , Medicamentos sob Prescrição/normas , Tuberculose/tratamento farmacológico , Adulto , Antituberculosos/efeitos adversos , Estudos Transversais , Feminino , Humanos , Masculino , Encaminhamento e Consulta , Fatores Socioeconômicos
7.
Stud Health Technol Inform ; 262: 71-74, 2019 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-31349268

RESUMO

Although adherence is a key factor for successful treatment of chronic diseases, only about 50% of patients achieve good adherence. However, health enabling technologies and gamification offer new possibilities to enhance patient's motivation. In physical rehabilitation, various applications exist. As these often stress a specific part of the rehabilitation process, we introduce a six-step new holistic approach to apply game design elements in the entire rehabilitation process, while focusing on patients with musculoskeletal diseases of the shoulder.


Assuntos
Doenças Musculoesqueléticas , Cooperação do Paciente , Ombro , Doença Crônica , Assistência à Saúde , Comportamentos Relacionados com a Saúde , Humanos , Doenças Musculoesqueléticas/reabilitação , Jogos de Vídeo
8.
Stud Health Technol Inform ; 262: 324-327, 2019 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-31349333

RESUMO

This study aims at assessing the relationship between social determinants of health (SDH) and dental care utilization compliance in a student dental clinic. Electronic dental records (EDR) were queried based on visit codes and evaluated using descriptive and inferential statistics, and binary logistic regression. Overall, characteristics of 16,474 visits were analyzed to identify potential predictors of appointment compliance. Factors affecting compliance with treatment plans prescribed at comprehensive care visits were identified in a cohort of 6,105 patients. Determinants of compliance with a comprehensive care visit following triage visits were analyzed in a cohort of 5491 patients. Results indicated that certain patient characteristics were associated with either increased or decreased compliance with dental care utilization. We concluded that EDR can be instrumental in identifying patterns of care utilization and determinants of patient compliance based on SDH.


Assuntos
Big Data , Assistência Odontológica , Clínicas Odontológicas , Aceitação pelo Paciente de Cuidados de Saúde , Cooperação do Paciente , Estudos de Coortes , Humanos , Estudantes
9.
Pan Afr Med J ; 32: 216, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31312327

RESUMO

Introduction: African studies have reported high rates of loss to follow up (LTFU) among children in HIV care and treatment centres. Factors associated with LTFU may vary across populations. Few studies have been conducted among HIV infected children in care in rural areas of Kenya. Methods: this involved children aged less than 15 years on follow up at Kangundo Level 4 Hospital HIV clinic from January 2010 to December 2015. We obtained sociodemographic and clinical information from patient files and electronic databases. Univariate and multivariate regression analyses were conducted to identify factors predictive of LTFU. Results: a total of 261 HIV-infected children were followed up. The mean age was 10.0 years (IQR, 7-13) and median CD4 count of 582cells/ul (IQR 314-984). By December 2015, 171 children (65.5%) remained in active care, 32 (12.3%) transferred out, 13 (5%) died, while 45 (17.2%) were classified as LTFU. Out of the 45 children presumed as LTFU, we traced 44 out of the 45 children (98%) and found that their actual current status was as follows: 33 of the 44 children (75.0%) had dropped out of care (true LTFU). Factors strongly predictive of LTFU included low caregiver level of education (HR 2.3, 1.9-3.9, P = 0.001), WHO stage I and II at enrolment (HR 1.6, 1.4-2.1, P = 0.05). Conclusion: LTFU of HIV infected children was common with an incidence of 32.9 per 1000 child years and occurred early in treatment and risk factors included poverty, low caregiver education, male child and early HIV disease stage.


Assuntos
Infecções por HIV/terapia , Perda de Seguimento , Cooperação do Paciente/estatística & dados numéricos , População Rural/estatística & dados numéricos , Adolescente , Instituições de Assistência Ambulatorial , Contagem de Linfócito CD4 , Cuidadores/estatística & dados numéricos , Criança , Pré-Escolar , Estudos Transversais , Escolaridade , Feminino , Seguimentos , Infecções por HIV/epidemiologia , Humanos , Lactente , Quênia , Masculino , Pobreza , Análise de Regressão , Fatores de Risco , Fatores Sexuais
10.
JAMA ; 322(1): 49-56, 2019 07 02.
Artigo em Inglês | MEDLINE | ID: mdl-31265099

RESUMO

Importance: California implemented 3 interventions to increase uptake of vaccines. In 2014, Assembly bill 2109 tightened requirements for obtaining a personal belief exemption. A 2015 campaign provided educational materials to school staff on the proper application of conditional admission for kindergartners who were not up to date on required vaccinations. In 2016, Senate bill 277 eliminated personal belief exemptions. Prior research has not evaluated these 3 interventions together with regard to the vaccination status of students. Objective: To assess the changes in the yearly rates of kindergartners who were not up to date on required vaccinations who were entering school during the period of the interventions, by focusing on geographic clustering and the potential contacts of these kindergartners. Design, Setting, and Participants: Observational study that used cross-sectional school-entry data from 2000-2017 to calculate the rates of kindergartners attending California schools who were not up to date on required vaccinations. Exposures: Assembly bill 2109, a conditional admission education program, and Senate bill 277. Main Outcomes and Measures: The primary outcome was the yearly rate of kindergartners without up-to-date vaccination status. The secondary outcomes were (1) the modified aggregation index, which was used to assess the potential within-school contacts among kindergartners without up-to-date vaccination status, (2) the number of geographic clusters of schools with rates for kindergartners without up-to-date vaccination status that were higher than the rates for schools located outside the cluster, and (3) the number of schools located inside the geographic clusters. Results: In California between 2000 and 2017, 9 323 315 children started attending kindergarten and 721 593 were not up to date on required vaccinations. Prior to the interventions, the statewide rate of kindergartners without up-to-date status for required vaccinations increased from 7.80% during 2000 to 9.84% during 2013 and then decreased after the interventions to 4.87% during 2017. The percentage chance for within-school contact among kindergartners without up-to-date vaccination status decreased from 26.02% during 2014 to 4.56% (95% CI, 4.21%-4.99%) during 2017. During 2012-2013, there were 124 clusters that contained 3026 schools with high rates of kindergartners without up-to-date vaccination status. During 2014-2015, there were 93 clusters that contained 2290 schools with high rates of kindergartners without up-to-date vaccination status. During 2016-2017, there were 110 clusters that contained 1613 (95% CI, 1565-1691) schools. Conclusions and Relevance: In California, statewide legislative and educational interventions were associated with a decrease in the yearly rates of kindergartners without up-to-date vaccination status. These interventions also were associated with reductions in the number of schools inside the clusters with high rates of kindergartners without up-to-date vaccination status and the potential for contact among these kindergartners.


Assuntos
Cooperação do Paciente/estatística & dados numéricos , Vacinação/legislação & jurisprudência , Vacinação/estatística & dados numéricos , California , Criança , Pré-Escolar , Estudos Transversais , Humanos
11.
J Assoc Physicians India ; 67(4): 30-34, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31299835

RESUMO

Introduction: Dengue fever management is guided by WHO guideline, the recent one being 2009; however, compliance to the guideline is difficult to assess and in India there is no data on it. The present study, a longitudinal pre-post interventional quality improvement study, was done to determine the compliance to the guideline on dengue patients before and after resident physicians' training during two peak seasons and their impact on survival. Methods: This study was conducted in a tertiary health care centre in North India over 18 months. Data of hospitalized patients who admitted with dengue fever diagnosis in a peak season was collected in the form of quality indicators as described by the WHO-2009 guideline on dengue. Resident physicians were then given appropriate training about the guideline during the off season. Data of new dengue patients in next peak season after resident training was collected and compared with the baseline by standard statistical tests. Results: The post-intervention compliances of all components increased (total mean score by giving one point to each of the quality indicators reached 7.9 from 6.4). The compliance to individual indicator also increased: the admission criteria (baseline, 44% to post-intervention, 52%, p = 0.37), classification criteria (91.7% to 96%, p = 0.33), correct staging/triage (42.9% to 86%, p <0.001), vitals monitoring (85.7% to 92%, p = 0.28), correct usage of bolus fluids (34.3% to 69.5%, p <0.001), crystalloid as choice of fluid (100% in both groups), proper fluid titration (26.2% to 56%, p <0.001), hematocrit monitoring (95.2% to 98%, p = 0.42), platelet transfusion when indicated (65.5% to 58%, p = 0.39), antibiotic use when required (61.5% to 80%, p = 0.03), and discharge criteria (100% in both groups). The mortality decreased from 7.1% (baseline) to zero (post-intervention). The median duration of hospital stay also reduced by 1 day. Conclusion: The study affirms that the compliance to WHO guideline on dengue management in India can be further improved by regular physician training on the guideline. Simultaneously, this educational intervention not only improves patient outcomes but also direct proper resource utilization especially platelet transfusion and antibiotic use. Furthermore, every hospital/institute should have an internal quality improvement program like this to improve the management of dengue patients. Future studies are needed to understand various barriers to 100% implementation of the guideline.


Assuntos
Dengue/terapia , Cooperação do Paciente , Melhoria de Qualidade , Fidelidade a Diretrizes , Guias como Assunto , Hospitais , Humanos , Índia , Organização Mundial da Saúde
12.
Medicine (Baltimore) ; 98(28): e16242, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305402

RESUMO

The real-world cure rates for hepatitis C (HCV) with direct-acting antivirals (DAAs) based on intention-to-treat (ITT) analysis may be lower than reported in the literature because of non-compliance.To determine whether patients treated in a structured outpatient HCV clinic (SHC) had higher compliance and treatment success rates compared to those treated in general hepatology clinics (GHC).In this study, we compared the treatment and compliance success rates of 488 and 840 patients treated in the SHC and GHC, respectively. The SHC required a pre-treatment clinic visit when patients picked up their initial medication, and received detailed education of the treatment plan and follow-up. In the GHC, the medications were delivered to patients' homes, and there was less formal education. Compliance success was defined as a combination of treatment completion and obtaining at least 1 post-treatment viral load at week 4 or 12. Treatment success was defined as either SVR4 or SVR12.Fifty of 488 (10.3%) patients from the SHC and 163 of 840 (19.4%) patients from the GHC were lost to follow-up (P < .0001). sustained virological response (SVR) rates were similar in compliant patients in both the SHC (419/438, 95.6%) and GHC (642/677, 94.8%), but treatment success rates by intention to treat (ITT) (overall 79.9%) were higher in SHC compared to GHC (85.9% vs 76.4%, P < .0001). Multivariate analysis showed that female patients (P = .01), older age (P = .0005), treatment in SHC (OR 1.7, 95% CI 1.2, 2.3, P = .0008), and sofosbuvir/simeprevir compared to sofosbuvir/ledipasvir had higher odds of compliance success; elbasvir/grazoprevir or dasabuvir/ombitasvir/paritaprevir/ritonavir had lower odds of compliance success compared to sofosbuvir/ledipasvir. Female patients (P = .02), older age (P < .0001), previous treatment (P = .03), treatment in SHC (OR 1.7, 95% CI 1.2, 2.3, P = .0008), and sofosbuvir/ledipasvir compared to sofosbuvir/velpatasvir, sofosbuvir, or elbasvir/grazoprevir had higher odds of treatment success. With 1:1 matching, the SHC group still had significantly higher odds than the GHC group of achieving treatment and compliance success.Our study shows that the effectiveness of HCV treatment could be improved by coordinating treatment in a structured HCV clinic.


Assuntos
Antivirais/uso terapêutico , Assistência à Saúde/métodos , Hepatite C/tratamento farmacológico , Assistência Ambulatorial , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Estudos Retrospectivos , Especialização , Resultado do Tratamento
13.
Transplant Proc ; 51(5): 1563-1567, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31155193

RESUMO

BACKGROUND: There is little information about living donor long-term follow-up among Brazilian living donors. The aim of this study was to evaluate the main outcomes among living donors and to measure their adherence to regular medical appointments. METHODS: This is a Brazilian single-center cohort study that included 397 living donors with 87.1 months of follow-up and measured adherence to clinical appointments. Before 2010, the appointments were scheduled only spontaneously; after that an approach was structured to check the returns of donors, who were monitored actively. We also evaluated long-term outcomes such as survival and chronic kidney disease development and, secondarily, the incidences of hypertension, diabetes mellitus (DM), and dyslipidemia after donation. RESULTS: The donors' adherence to annual clinical appointments was 75.8% (54.7% of them presenting annual regularity). Before 2010 the adherence was lower than 40%; 10-year cumulative incidences of hypertension, DM, and dyslipidemia were 20.4%, 5.7%, and 23.5%, respectively. The crude mortality was 1% and 10-year donor survival was 98.5%. The incidence of chronic kidney disease 5 years after donation was 19%, with 16.4% of patients staged in 3a and 2.6% in 3b. CONCLUSION: A structured approach to check donor returns to long-term clinical appointments has doubled the adherence to visits returns (compared to historical data). We identified lower incidence of arterial hypertension and DM among donors as compared with the incidence of arterial hypertension and DM in the Brazilian general population, but the 5-year chronic kidney disease incidence was considered high, taking into consideration data that have been published in the last years.


Assuntos
Assistência ao Convalescente , Transplante de Rim , Doadores Vivos , Nefrectomia/efeitos adversos , Cooperação do Paciente , Adulto , Agendamento de Consultas , Brasil , Estudos de Coortes , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/etiologia , Feminino , Humanos , Hipertensão/epidemiologia , Hipertensão/etiologia , Incidência , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/etiologia , Masculino , Pessoa de Meia-Idade
14.
Sante Publique ; Vol. 31(1): 61-70, 2019 January February.
Artigo em Francês | MEDLINE | ID: mdl-31210518

RESUMO

INTRODUCTION: In order to limit the risk of food allergies, it is recommended to begin complementary feedings for infants between the ages of 4 and 6 months old. The objective of this study is to describe how complementary feedings are carried out until the age of 1 year old and to analyze criteria, especially socio-economic, that influence compliance with recommendations. METHODS: This observational and descriptive quantitative study lasted from November 21st, 2016 to February 21st, 2017 and took place in 10 doctor's offices around the city of Saint-Etienne. Anonymous surveys were distributed to the mothers of children aged between 12 and 47 months old inclusive, born at term, and with a weight above 2.5 kg. RESULTS: More than 2/3rds of the 163 children included started complementary feedings between 4 and 6 months old. Gluten (P = 0.02) and meat (P = 0.016) were introduced later and infant formulas (P = 0.005) were stopped sooner when the mother's education level was low. The average number of fruit and vegetables was smaller when the mother had a low socio-economic level or if she was multiparous. At the age of one, fewer than 20% of the children had consumed fat content rich in omega-3. At the same age, 70% had consumed egg and 12.3% nuts, which are some of the major allergens. CONCLUSION: These outcomes show the need for general practitioners to inform parents, especially those with a low socio-economic level, about early food introduction, including allergens.


Assuntos
Ingestão de Alimentos/fisiologia , Alimentos Infantis , Cooperação do Paciente/estatística & dados numéricos , Pré-Escolar , Feminino , Humanos , Lactente , Fenômenos Fisiológicos da Nutrição do Lactente , Produtos da Carne , Mães/estatística & dados numéricos , Fatores Socioeconômicos , Verduras
15.
Medicine (Baltimore) ; 98(24): e15967, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31192935

RESUMO

BACKGROUND: Traditional medicine is widely used for patients with primary insomnia, but the studies showed inconsistent results. We performed a meta-analysis of randomized controlled trials (RCTs) to evaluate the effectiveness of Chinese herbal medicine (CHM) versus placebo for primary insomnia patients. METHODS: The electronic databases including PubMed, EmBase, Cochrane library, and China National Knowledge Infrastructure were searched to identify the RCTs published from inception till July 2018. The summary weighted mean difference (WMD) with its 95% confidence interval (CI) for Pittsburgh sleep quality index (PSQI), sleep onset latency, total sleep duration, Athens insomnia scale (AIS), and sleep efficiency were calculated using random-effects model. RESULTS: Fifteen RCTs comprising 1500 patients were finally included in the meta-analysis. Overall, patients who received CHM had lower levels of PSQI (WMD: -2.36; 95% CI: -4.02 to -0.70; P = .005), sleep onset latency (WMD: -11.54; 95% CI: -20.55 to -2.54; P = .012), and AIS (WMD: -0.59; 95% CI: -0.97 to -0.22; P = .002) as compared with placebo. Moreover, the summary WMDs of CHM versus placebo were associated with higher total sleep duration (WMD: 0.79; 95% CI: 0.56-1.02; P < .001), and sleep efficiency (WMD: 9.72; 95% CI: 6.49-12.96; P < .001). The treatment effect on PSQI might be affected by publication year, sample size, mean age, percentage male, diagnostic tool, duration of insomnia, treatment duration, and study quality. CONCLUSION: The findings of this meta-analysis indicated that CHM could significantly improve the symptoms of insomnia than placebo for patients with primary insomnia.


Assuntos
Medicamentos de Ervas Chinesas/uso terapêutico , Distúrbios do Início e da Manutenção do Sono/tratamento farmacológico , Adulto , China , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
16.
Stud Health Technol Inform ; 261: 174-178, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31156111

RESUMO

The paper deals with using a machine-learning algorithm for patient adherence level determination. For this purpose, we developed a neural network using the Python language, Keras library, and PyCharm platform. We analyzed different medical data collected from medical staff, patient interviews, and measurements preprocessed using a fuzzy Mamdani algorithm. After analysing 369 records we received 79.4% of accuracy.


Assuntos
Lógica Fuzzy , Aprendizado de Máquina , Cooperação do Paciente , Algoritmos , Humanos , Redes Neurais (Computação)
17.
J Shoulder Elbow Surg ; 28(6S): S124-S130, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31196505

RESUMO

BACKGROUND: The primary objective was to assess whether a patient's early postoperative quality of life (QOL) correlates with the retear rate following single-tendon double-row rotator cuff repair. METHODS: We performed a secondary analysis of a randomized clinical trial of 58 patients who underwent single-tendon arthroscopic rotator cuff repair of full-thickness tears performed by a single surgeon. Patients were randomized to an early- or delayed-motion protocol. At 6 months, all patients underwent magnetic resonance imaging to assess whether the rotator cuffs were intact or retorn. QOL was assessed preoperatively and at 3 weeks, 6 weeks, 12 weeks, 6 months, and 12 months postoperatively using the Western Ontario Rotator Cuff (WORC) index. RESULTS: After 6 months of rehabilitation, 41 patients (71%) had intact rotator cuff repairs whereas 17 (29%) had full-thickness tears. Patients with torn rotator cuffs at 6 months postoperatively had significantly lower WORC scores at 6 weeks postoperatively (P = .041). Patients with greater improvements in QOL perioperatively (preoperative WORC score minus 6-week postoperative WORC score > 264.5) were more likely to have full-thickness tears by 6 months postoperatively. Compliant patients assigned to the delayed-motion protocol had a failure rate of 11% (2 of 19) compared with 38% (15 of 39) in the noncompliant and early-motion protocol patients (P < .01). Overall, patients who were noncompliant with the shoulder immobilizer were 8.2 times more likely to have a failed repair on magnetic resonance imaging (P = .01). CONCLUSIONS: Patients with better QOL shortly after arthroscopic rotator cuff repair were more likely to have retears by 6 months.


Assuntos
Artroscopia/métodos , Cooperação do Paciente , Qualidade de Vida , Lesões do Manguito Rotador/reabilitação , Lesões do Manguito Rotador/cirurgia , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Período Pós-Operatório , Ensaios Clínicos Controlados Aleatórios como Assunto , Recidiva , Estudos Retrospectivos , Lesões do Manguito Rotador/diagnóstico por imagem , Resultado do Tratamento
18.
Transplant Proc ; 51(5): 1362-1364, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31076153

RESUMO

BACKGROUND: Dietary restriction of protein, salt, and energy is recommended to prevent lifestyle related diseases, proteinuria, and graft dysfunction in kidney transplant patients. It is useful if the patients can evaluate meal components by themselves for each meal. PATIENTS AND METHODS: A total of 26 maintenance-phase kidney transplant patients were included in the study. The mean age, sex, body mass index, number of years post-transplantation, creatinine clearance, and 24-hour urinary excretion (24 UE) of protein were recorded on a medical chart. Estimated daily protein and salt oral intake were calculated from 24 UE of nitrogen and sodium, respectively. We compared these laboratory results and patients' self-reported dietary intake using a smartphone-based recipe nutrition calculator (SRNC). RESULTS: Estimated daily protein and salt oral intake calculated from 24 UE of nitrogen and sodium were 55.4 ± 12.9 g/d and 8.5 ± 3.1 g/d, respectively. Estimated daily protein and salt oral intake measured by SRNC were 52.4 ± 13.8 g/day and 6.5 ± .9 g/day, respectively. The results of estimated daily protein and salt oral intake measured by SRNC were correlated to those calculated from 24 UE (R2 = .287 and .217, respectively). CONCLUSIONS: The results of estimated daily protein and salt oral intake measured by SRNC were correlated to those calculated from 24 UE in maintenance-phase kidney transplant patients. SRNC was useful as a measurement modality to evaluate the adherence to dietary guidance. Dietary therapy for these patients may have the potential to improve kidney graft function and survival.


Assuntos
Dieta , Transplante de Rim , Cooperação do Paciente , Autorrelato , Smartphone , Adulto , Proteínas na Dieta , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Cloreto de Sódio na Dieta
19.
Yonsei Med J ; 60(6): 570-577, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31124341

RESUMO

PURPOSE: Allergen-specific immunotherapy (AIT) is known to be the only therapeutic modality to alter the natural course of allergic diseases. However, at least 3 years of treatment is recommended for achieving long-term disease modifying effect. This study aimed to investigate factors associated with immunotherapy non-adherence in real practice. MATERIALS AND METHODS: We retrospectively reviewed medical records of patients who were diagnosed with allergic rhinitis, asthma, or atopic dermatitis, and received AIT to common allergens such as house dust mite and/or pollens from January 2007 to August 2014. In this study, non-adherence was defined as not completing 3 years of AIT. RESULTS: Among 1162 patients enrolled, 228 (19.6%) failed to complete 3 years of AIT. In multivariate analysis, age less than 20 years [odds ratio (OR) 3.11, 95% confidence interval (CI) 1.70-5.69] and 20 to 40 years (OR 2.01, 95% CI 1.17-3.43), cluster build-up (OR 1.78, 95% CI 1.05-3.02) and ultra-rush build-up schedules (OR 5.46, 95% CI 2.40-12.43), and absence of visit to other departments in the same hospital (OR 1.87, 95% CI 1.05-3.32) were independently associated with immunotherapy non-adherence. Disease duration of 5-10 years was negatively associated with non-adherence compared to shorter disease duration of less than 5 years (OR 0.61, 95% CI 0.40-0.94). Although male sex and commercial product of AIT, Tyrosine S®, compared to Novo-Helisen® were non-adherent factors in univariate analysis, no statistical significances were identified in multivariate analysis. CONCLUSION: Various factors are associated with immunotherapy adherence affecting the utility of immunotherapy. Clinicians should be aware of factors associated with adherence to maximize the utility of allergen-specific subcutaneous immunotherapy.


Assuntos
Alérgenos/imunologia , Dessensibilização Imunológica , Cooperação do Paciente , Tela Subcutânea/patologia , Adolescente , Adulto , Idoso , Alérgenos/administração & dosagem , Animais , Criança , Pré-Escolar , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Estudos Retrospectivos , Adulto Jovem
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