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1.
Medicine (Baltimore) ; 98(38): e16655, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567931

RESUMO

In this study, we first reported of a modified hybrid fixation method in expansive open-door laminoplasty (EOLP) in order to reduce medical costs. The purpose of the present study is to compare the surgical outcomes and cost-effectiveness of the modified fixation with all levels miniplate fixation in EOLP for multilevel cervical spondylotic myelopathy.Data of 67 patients who underwent EOLP from July 2015 to June 2016 were retrospectively analyzed, with 33 in the modified group and 34 in the all miniplate group based on their surgical approaches. Laminae were kept open with alternate levels miniplate and anchor fixation in the modified group, while with all levels miniplate fixation in the all miniplate group. Medical costs and clinical results including Japanese Orthopedic Association (JOA) scores, Visual Analogue Scale (VAS) scores and occurrences of complications were investigated and compared between the 2 groups. After evaluation on X-ray, CT, and MRI, radiographic data reflecting cervical alignments, spinal canal enlargement and spinal cord decompression were collected and compared within each group and between the 2 groups.After a follow-up period of about 18 months, no significant differences in operation time, intraoperative blood loss, complication rates, VAS scores, neurological recovery rates and postoperative hospital stays were observed between the 2 groups. However, EOLP with the modified fixation costed less. When comparing the 2 groups, cervical curvature index (CCIs) which reflected cervical alignments and anteroposterior diameters (APDs) reflecting spinal canal enlargement at all the follow-ups had no significant differences. Postoperative open angles which reflected spinal cord decompression of C4 and C6 were significantly smaller in the modified group. However, that difference was no longer detected at the final follow-up. Within each group, APDs increased significantly after surgery. However, no significant differences in CCIs and open angles at different follow-ups were observed in each group.Compared with all miniplate fixation, the modified hybrid fixation in EOLP showed almost the same clinical and radiographic results. However, the modified hybrid fixation method could reduce costs.


Assuntos
Placas Ósseas , Vértebras Cervicais/cirurgia , Laminoplastia/métodos , Espondilose/cirurgia , Adulto , Idoso , Desenho de Equipamento , Feminino , Humanos , Laminoplastia/economia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Espondilose/diagnóstico por imagem , Resultado do Tratamento , Escala Visual Analógica
2.
Medicine (Baltimore) ; 98(39): e17105, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574809

RESUMO

We aimed to determine the accuracy and failure of OAK device, an automated screening, for the assessment of fall risk in a prospective cohort of healthy adults aged over 65 years. The algorithm for fall risk assessment of the centers for disease control and prevention (CDC) was used as reference standard. Of the 183 individuals recruited, the CDC algorithm classified 80 as being at moderate/high risk and 103 at low risk of falling. OAK device failure incidence was 4.9% (confidence interval [CI] upper limit 7.7%), below the preset threshold for futility-early termination of the study (i.e., not above 15%). The OAK device showed a sensitivity of 84% and a specificity of 67% (receiver operating characteristic [ROC] area 82%; 95% confidence interval [CI] 76-88%), not reaching the preplanned target sensitivity (not lower than 85%). Diagnostic accuracy was not far from the sensitivity levels similar to those obtained with other fall risk assessment. However, some limitations can be considered.ClinicalTrials.gov identifier: NCT02655796.


Assuntos
Acidentes por Quedas , Teste de Esforço/métodos , Programas de Rastreamento/métodos , Medição de Risco/métodos , Idoso , Desenho de Equipamento , Falha de Equipamento , Teste de Esforço/instrumentação , Feminino , Humanos , Masculino , Programas de Rastreamento/instrumentação , Estudos Prospectivos , Curva ROC , Sensibilidade e Especificidade
3.
Medicine (Baltimore) ; 98(39): e17317, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574862

RESUMO

INTRODUCTION: Stroke is the principal cause of impairment in the motor function and gait of adults. One of the resources used in rehabilitation to optimize gait is a prescription of ankle-foot orthosis (AFO), and the most prescribed AFOs are Fixed AFO and Articulated AFO; however, it is not known which of these options is more effective for these individuals. The aim of this study is to evaluate the impact of different types of ankle-foot orthosis functional mobility and dynamic balance in stroke patients. METHODS: Prospective randomized controlled clinical trial with 2 parallel groups will be conducted, and the aim is to recruit 50 patients with stroke diagnosis within 1 year, who indicated that they use both types of orthotics, who had a previous Rankin score less than or equal to 3, and who obtained AFO orthosis through the Hospital Clinics at the Botucatu Medical School (HCBMS) São Paulo, Brazil. After a specific evaluation by a physiotherapist, the patient will receive 1 of the AFO types via randomization. After 30 days, the patient will be reevaluated. The primary outcomes will be balance and mobility, which will be evaluated by the Time Up Go Test (TUG) and Tinetti's Scale of Mobility and Balance (TSMB). The secondary outcomes will be quality of life and the levels of anxiety and depression, which will be evaluated with the European (5D) Quality of Life Scale (Euroqol) and Hospital Anxiety and Depression Scale (HADS). Group allocation will be not concealed because the blinding of participants and of therapists that provide intervention is not possible, and all analyses will be based on an intention-to-treat principle. This study was approved by the Human Research Ethics Committee of the São Paulo State University UNESP, number 2.367.953. The results will be published in relevant journal. DISCUSSION: The results of this study will contribute to clinical practice by identifying the type of AFO orthosis that is more suitable for this condition, helping to standardize prescription of these orthoses by professionals, and guiding future research studies on this subject, which is still incompletely defined in the literature. TRIAL REGISTRATION: RBR-6SF2VV (March 5, 2018).


Assuntos
Tornozelo/fisiopatologia , Órtoses do Pé/normas , Transtornos Neurológicos da Marcha , Qualidade de Vida , Reabilitação do Acidente Vascular Cerebral , Adulto , Articulação do Tornozelo/fisiopatologia , Fenômenos Biomecânicos , Desenho de Equipamento , Feminino , Transtornos Neurológicos da Marcha/etiologia , Transtornos Neurológicos da Marcha/terapia , Humanos , Masculino , Equilíbrio Postural , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Acidente Vascular Cerebral/complicações , Reabilitação do Acidente Vascular Cerebral/instrumentação , Reabilitação do Acidente Vascular Cerebral/métodos , Reabilitação do Acidente Vascular Cerebral/psicologia
5.
Zhonghua Shao Shang Za Zhi ; 35(8): 624-625, 2019 Aug 20.
Artigo em Chinês | MEDLINE | ID: mdl-31474048

RESUMO

Children with burns often have uncooperative behaviors such as crying and struggling when changing dressing because of pain and fear, which affects dressing change of medical staff and increases the psychological burden of the family members of children and dressing change personnel. In order to solve the above problems, the author's team designs and makes the mobile soothing screen for pediatric dressing change. Dressing change personnel are isolated from the children's sight through the screen's shielding function, and the children's favorite program showed on the tablet computer attracts the children's attention. The wound dressing change is completed by using the disposal window on the screen, which has good clinical application effects.


Assuntos
Bandagens , Queimaduras , Enfermagem Pediátrica/métodos , Criança , Desenho de Equipamento , Medo , Humanos , Dor Processual/prevenção & controle , Cooperação do Paciente
6.
Zhonghua Shao Shang Za Zhi ; 35(8): 626-628, 2019 Aug 20.
Artigo em Chinês | MEDLINE | ID: mdl-31474049

RESUMO

At present, there are many monitoring devices for vital signs parameters for clinical selection, but urine monitoring has not received enough attention. The traditional manual visual measurement, intermittent measurement of urine pH value, and other methods are still in use, so the authors designed a multifunctional urine bag. The urine bag can set up an alarm system per unit time according to patient's age and condition as well as set up urine pH value detection area in hard plastic measuring bottle. This device can not only accurately monitor urine volume per unit time, but also hopefully realize the alarm automation of abnormal urine volume per unit time, as well as real-time dynamic monitoring of urine pH value. It is helpful for medical staff to make accurate judgment on patients' condition changes, to guide the formulation and modification of clinical treatment plans, and to reduce the workload of clinical nursing staff to a certain extent.


Assuntos
Desenho de Equipamento , Coleta de Urina/instrumentação , Humanos , Monitorização Fisiológica
7.
Cancer Radiother ; 23(6-7): 761-764, 2019 Oct.
Artigo em Francês | MEDLINE | ID: mdl-31471254

RESUMO

The arrival of new hybrid radiotherapy machines with MRI or PET is announced as a milestone in radiotherapy management. Based on recent literature, we will describe the contribution of each of these modalities and the technological challenges that have already been or are still to be addressed.


Assuntos
Desenho de Equipamento , Imagem por Ressonância Magnética Intervencionista/instrumentação , Imagem Multimodal/métodos , Aceleradores de Partículas , Tomografia por Emissão de Pósitrons/instrumentação , Radioterapia Guiada por Imagem/instrumentação , Humanos , Imagem por Ressonância Magnética Intervencionista/tendências , Imagem Multimodal/tendências , Tomografia por Emissão de Pósitrons/tendências , Radioterapia Guiada por Imagem/tendências
8.
J Biol Regul Homeost Agents ; 33(3 Suppl. 1): 51-61, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31538450

RESUMO

This study is to compare the cleaning effectiveness of two Ni-Ti files systems. Thirty single-rooted human teeth were selected and two NiTi rotary systems were used. Group A: canal shaping with ProTaper® Universal (Dentsply Tulsa Dental Specialties, Tulsa, OK) (PTU); Group B: (n=15) canal shaping with Mtwo Ni-Ti instruments (Sweden and Martina, Padova, Italy) and apical finishing with Mtwo Apical Ni-Ti instruments (Sweden and Martina, Padova, Italy). The amount of debris and smear layer were quantified on a basis of a numerical evaluation scale. The data established for scoring the debris and the smear layer was recorded separately and statistically analysed using the Kruskal-Wallis test. No significant differences were found for debris. Mtwo instruments resulted in significantly less smear layer (P less than 0.05) compared with ProTaper® Universal. Under the conditions of this study, Mtwo resulted in significantly less smear layer compared with canal preparation with ProTaper® Universal.


Assuntos
Desenho de Equipamento , Microscopia Eletrônica de Varredura , Preparo de Canal Radicular/instrumentação , Camada de Esfregaço , Humanos , Técnicas In Vitro , Titânio
9.
J Appl Oral Sci ; 27: e20180689, 2019 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-31411264

RESUMO

OBJECTIVE: The aim of this study was to evaluate the root canal preparation and apical enlargement of molar root canals with rotary or reciprocating heat-treated nickel-titanium (NiTi) instruments, by using micro-computed tomography (micro-CT). METHODOLOGY: Mesial root canals (n=48) of mandibular molars, with a curvature between 20° and 40°, were prepared with ProDesign Logic (PDL) 25.01 and 25.06 in rotary motion, or ProDesign R (PDR) 25.06 in reciprocating motion (PDR). Apical enlargement was performed with PDL35.01 and PDL35.05 or PDR35.05. Scanning with 9 µm resolution was performed before and after preparation, and, after apical enlargement, by using micro-CT. The percentage of volume increase, debris and untouched root canal surface, transportation, centralization and preparation time were analyzed. ANOVA and Tukey or Kruskall-Wallis and Dunn statistical tests were conducted (α=.05). RESULTS: PDL promoted a higher apical percentage of volume increase, and lower percentage of debris and untouched root canal surface than PDR 25.06 preparation in entire canal and in all thirds (P<.05). Apical enlargement with PDL 35.05 and PDR 35.05 produced a higher percentage of volume increase in the apical region in relation to the initial preparation (P<.05). PDR 35.05 and PDL 35.05 showed similar results in relation to percentage of debris and untouched root canal surface in entire canal and in all thirds (P>.05). Centralization and transportation showed no difference (P>.05). PDR required less time to perform preparation and apical enlargement (P<.05). CONCLUSIONS: The apical enlargement 35.05 with CM heat-treatment instruments using reciprocating and rotary motion reduced the percentage of debris and untouched root canal surface, without causing deviations or procedural errors. The protocol of greater apical enlargement favors the cleaning of the root canals in both kinematics. Preparation by the reciprocating system was faster than by the rotary system.


Assuntos
Instrumentos Odontológicos , Cavidade Pulpar/diagnóstico por imagem , Níquel , Preparo de Canal Radicular/instrumentação , Titânio , Análise de Variância , Cavidade Pulpar/anatomia & histologia , Desenho de Equipamento , Temperatura Alta , Humanos , Teste de Materiais , Valores de Referência , Reprodutibilidade dos Testes , Estatísticas não Paramétricas , Propriedades de Superfície , Microtomografia por Raio-X
10.
Medicine (Baltimore) ; 98(33): e16869, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415423

RESUMO

RATIONALE: Precise lung isolation technique with visual confirmation is essential for thoracic surgeries to create a safe and clear surgical field. However, in certain situations, such as when patients have massive pulmonary secretion or when the fiberoptic bronchoscopy (FOB) is not applicable, lung isolation has been performed blindly. PATIENT CONCERN: A 52-year-old woman, whose airway was unable to visualize with FOB due to massive pulmonary secretion, was presented for bilateral sequential lung transplantation. Extracorporeal membranous oxygenation, tracheostomy, and mechanical ventilation were applied to the patient for 39 days preoperatively as a bridge for lung transplantation. DIAGNOSIS: Patient was diagnosed with an idiopathic pulmonary fibrosis and obesity. INTERVENTION: Initially, height-based blind positioning with a conventional double-lumen endobronchial tube (DLT) failed to ventilate the patient properly, and the confirmation of DLT positioning with FOB was impossible due to massive pulmonary secretion. Therefore, a novel DLT (ANKOR DLT) that has one more cuff, located at a point between the distal opening of the tracheal lumen and the starting point of bronchial cuff, than conventional DLT was used for the lung isolation in the patient. OUTCOMES: After the completion of lung graft, FOB finding showed that the ANKOR DLT was optimally positioned at the tracheobronchial tree of the patient, and its depth was 2.5 cm shallower than that of the conventional tube. LESSONS: ANKOR DLT would be a feasible choice to achieve successful blind lung isolation when the use of FOB is impossible to achieve the optimal lung isolation.


Assuntos
Broncoscopia/instrumentação , Fibrose Pulmonar Idiopática/cirurgia , Intubação Intratraqueal/métodos , Ventilação Monopulmonar/métodos , Desenho de Equipamento , Feminino , Humanos , Fibrose Pulmonar Idiopática/complicações , Transplante de Pulmão/instrumentação , Transplante de Pulmão/métodos , Pessoa de Meia-Idade , Obesidade/complicações
11.
J Vasc Access ; 20(5): 457-460, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31416409

RESUMO

Long peripheral catheters are 6-15 cm peripheral dwelling catheters that are inserted via a catheter-over-needle or direct Seldinger (catheter-over-guidewire) technique. When inserted in the upper extremity, the distal tip terminates before reaching the axilla, typically no further than the mid-upper arm. This is distinct from a midline catheter, which is inserted via a modified Seldinger technique and terminates at the axilla. The nomenclature of this catheter is confusing and inconsistent. We have identified over a dozen labels in the literature, all describing the same device. These include '15 cm catheter', 'catheter inserted with a Seldinger method', 'extended dwell/midline peripheral catheter', 'Leaderflex line', 'long catheter', 'long IV catheter', 'long peripheral cannula', 'long peripheral catheter', 'long peripheral venous catheter', 'long polyurethane catheter', 'midline cannula', 'mini-midline', 'peripheral intravenous catheter', 'Seldinger catheter', 'short midline catheter', 'short long line' and 'ultrasound-guided peripheral intravenous catheter'. The purpose of this editorial is to achieve some level of standardisation in the nomenclature of this device. Is it time to address the confusion? We suggest adopting 'long peripheral catheter'. However, we encourage discussion and debate in reaching a consensus.


Assuntos
Cateterismo Periférico/instrumentação , Cateteres de Demora/classificação , Terminologia como Assunto , Extremidade Superior/irrigação sanguínea , Dispositivos de Acesso Vascular/classificação , Consenso , Desenho de Equipamento , Humanos
12.
High Blood Press Cardiovasc Prev ; 26(4): 339-344, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31385256

RESUMO

INTRODUCTION: Opportunistic screening of atrial fibrillation is a valuable approach to the identification of subjects with unknown or non-symptomatic atrial fibrillation (AF) with the potential of reducing the burden of ischemic stroke in the population. AIM: To evaluate the feasibility of a large-scale screening for atrial fibrillation using a blood pressure monitor (MicrolifeAFIB) endowed with a validated algorithm able to detect AF calculating the irregularity of interval times between heartbeats. METHODS: In this cross-sectional study conducted in 74 pharmacies in Verona participated 3071 people aged 50 years or more. In 6 months, information about drugs, previous diagnoses of cardiovascular diseases, anthropometric and demographic data was recorded, together with the measurement of blood pressure and cardiac rhythm by using the MicrolifeAFIB device. Pharmacists also collected anthropometric and demographic data of the participants, along with information concerning their personal history of cardiovascular disease and the use of antihypertensive and antithrombotic agents. All those who were positive at the screening for atrial fibrillation were referred to their family doctor. RESULTS: The screening revealed 98 subjects (3.2%) positive for AF; 44 of these reported a previous diagnosis of AF and were treated with anticoagulants (77%) or with antiplatelet agents (7%). By logistic regression analysis, age, male sex and heart failure were independently associated with positivity for AF. Association between positive test and previous stroke/TIA was found in the 54 subjects without a previous diagnosis of AF (9% had a previous stroke/TIA). CONCLUSIONS: Opportunistic screening for atrial fibrillation in the pharmacies is feasible and allows to identify a number of subjects with silent, non-previously diagnosed AF, therefore is potentially useful in large-scale projects aimed at the prevention of cardiovascular morbidity and mortality.


Assuntos
Fibrilação Atrial/diagnóstico , Determinação da Pressão Arterial/instrumentação , Serviços Comunitários de Farmácia , Frequência Cardíaca , Programas de Rastreamento/instrumentação , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/fisiopatologia , Pressão Sanguínea , Estudos Transversais , Eletrocardiografia , Desenho de Equipamento , Estudos de Viabilidade , Feminino , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico
14.
Chem Commun (Camb) ; 55(69): 10288-10291, 2019 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-31396601

RESUMO

A simple nanopore modification and sensing strategy was developed for the detection of miRNAs. This preparation and sensing approach provides a quick, simple and facile tool for the detection of specific biomolecules with high sensitivity and selectivity, and may find a wide range of applications in bio-analysis.


Assuntos
Ouro/química , Ácidos Nucleicos Imobilizados/química , MicroRNAs/análise , Nanoporos/ultraestrutura , Técnicas Biossensoriais/instrumentação , Desenho de Equipamento , Hibridização de Ácido Nucleico
15.
Asia Pac J Ophthalmol (Phila) ; 8(4): 330-334, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31385820

RESUMO

BACKGROUND: A near vision game has been developed for the autostereoscopic screen of the Nintendo 3DS console. Ease of use and time for testing by non-English-speaking patients was not known. METHODS: Adult and pediatric patients in a remote Burma clinic were compared with US military staff with each performing conventional near acuity, Stereo Fly, and Ishihara color in addition to PDI Check game, so results could be correlated and timed. RESULTS: Seventeen Burma adults (aged 19-58), 20 Burma children (aged 7-15), and 14 US military staff (aged 21-36) completed the testing. Conventional testing correlated with PDI Check for stereo (P < 0.001), acuity oculo dexter (P < 0.01), acuity oculo sinister (P < 0.01). For visual acuity and stereopsis, the intraclass coefficient was 0.55 [95% confidence interval (CI) 0.28-0.72] and 0.62 (95% CI 0.41-0.77) respectively, but with few color deficient cases color was 0.30 (95% CI -0.05 to 0.60). The time in seconds to complete near vision testing with PDI Check (172 ±â€Š27, overall; 198 ±â€Š34, Burma; 99 ±â€Š20, military) was significantly (25% ±â€Š18%) briefer than conventional testing (226 ±â€Š31, overall; 270 ±â€Š34, Burma; 126 ±â€Š20, military). The Burma patients took significantly longer than the military staff (234 ±â€Š25 vs 112 ±â€Š14, P < 0.01). Time for Burma children did not differ from Burma adults for PDI (109 ±â€Š47 vs 217 ±â€Š54, P = 0.42) and for conventional testing (266 ±â€Š51 vs 275 ±â€Š52, P = 0.80). CONCLUSIONS: Non-English-speaking Burma children and adults were able to reliably perform 3 types of near vision testing with a Nintendo 3DS game 25% quicker than the 2 to 3 minutes for conventional methods. They were slower than experienced US military staff adults.


Assuntos
Percepção de Profundidade/fisiologia , Jogos de Vídeo , Transtornos da Visão/diagnóstico , Seleção Visual/instrumentação , Acuidade Visual , Adolescente , Adulto , Criança , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mianmar/epidemiologia , Prevalência , Estudos Prospectivos , Reprodutibilidade dos Testes , Transtornos da Visão/epidemiologia , Adulto Jovem
16.
J Nanobiotechnology ; 17(1): 86, 2019 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-31387581

RESUMO

BACKGROUND: Controllable and multiple DNA release is critical in modern gene-based therapies. Current approaches require complex assistant molecules for combined release. To overcome the restrictions on the materials and environment, a novel and versatile DNA release method using a nano-electromechanical (NEMS) hypersonic resonator of gigahertz (GHz) frequency is developed. RESULTS: The micro-vortexes excited by ultra-high frequency acoustic wave can generate tunable shear stress at solid-liquid interface, thereby disrupting molecular interactions in immobilized multilayered polyelectrolyte thin films and releasing embedded DNA strands in a controlled fashion. Both finite element model analysis and experiment results verify the feasibility of this method. The release rate and released amount are confirmed to be well tuned. Owing to the different forces generated at different depth of the films, release of two types of DNA molecules with different velocities is achieved, which further explores its application in combined gene therapy. CONCLUSIONS: Our research confirmed that this novel platform based on a nano-electromechanical hypersonic resonator works well for controllable single and multi-DNA release. In addition, the unique features of this resonator such as miniaturization and batch manufacturing open its possibility to be developed into a high-throughput, implantable and site targeting DNA release and delivery system.


Assuntos
DNA/química , Nanoestruturas/química , Polieletrólitos/química , Acústica/instrumentação , Fenômenos Biofísicos , Desenho de Equipamento , Análise de Elementos Finitos , Técnicas de Transferência de Genes , Terapia Genética/métodos , Membranas Artificiais , Propriedades de Superfície
17.
Codas ; 31(4): e20180171, 2019 Aug 15.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31433039

RESUMO

PURPOSE: To comparatively analyze the NAL-NL2 and DSL v5.0a prescriptive methods according to the hearing aids individualized programming for the elderly with hearing loss. METHODS: The study included 60 elderly individuals with hearing loss, who underwent RECD (Real Ear to Coupler Difference) measurement and hearing aids individualized programming by NAL-NL2 and DSL v5.0a prescriptive methods. The performance verification for each prescription was performed using REAR measurements (Real Ear Aided Response), SII calculation (Speech Intelligibility Index) and HINT (Hearing In Noise Test). The comparative statistical analysis was performed using the paired t-test. RESULTS: The NAL-NL2 method presented a better performance in the REAR evaluation in low and high frequency bands for medium and loud intensity input sounds, in the high frequency range for low intensity input sounds, and in the SII calculation for soft input sounds. The DSL v5.0a presented better results in the REAR evaluation in medium frequencies for medium input sounds, in low and medium frequencies for soft input sounds, in the SII calculation for medium and loud input sound, and in the HINT test in silent and noisy situations. CONCLUSION: The findings of this study point to an equivalent performance between the DSL v5.0a and NAL-NL2 procedures in the adaptation of hearing aids in the elderly with hearing loss. The amplification calculated by DSL v5.0a provided better speech perception in silence.


Assuntos
Auxiliares de Audição/normas , Inteligibilidade da Fala , Percepção da Fala , Idoso , Idoso de 80 Anos ou mais , Audiometria/métodos , Limiar Auditivo , Desenho de Equipamento , Feminino , Perda Auditiva Neurossensorial , Humanos , Masculino , Pessoa de Meia-Idade , Preferência do Paciente
19.
Int Braz J Urol ; 45(4): 658-670, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31397987

RESUMO

PURPOSE: To critically review all literature concerning the cost-effectiveness of flexible ureteroscopy comparing single-use with reusable scopes. MATERIALS AND METHODS: A systematic online literature review was performed in PubMed, Embase and Google Scholar databases. All factors potentially affecting surgical costs or clinical outcomes were considered. Prospective assessments, case control and case series studies were included. RESULTS: 741 studies were found. Of those, 18 were duplicated and 77 were not related to urology procedures. Of the remaining 646 studies, 59 were considered of relevance and selected for further analysis. Stone free and complication rates were similar between single-use and reusable scopes. Operative time was in average 20% shorter with digital scopes, single-use or not. Reusable digital scopes seem to last longer than optic ones, though scope longevity is very variable worldwide. New scopes usually last four times more than refurbished ones and single-use ureterorenoscopes have good resilience throughout long cases. Longer scope longevity is achieved with Cidex and if a dedicated nurse takes care of the sterilization process. The main surgical factors that negatively impact device longevity are lower pole pathologies, large stone burden and non-use of a ureteral access sheath. We have built a comprehensive fi nancial costeffective decision model to fl exible ureteroscope acquisition. CONCLUSIONS: The cost-effectiveness of a fl exible ureteroscopy program is dependent of several aspects. We have developed a equation to allow a literature-based and adaptable decision model to every interested stakeholder. Disposable devices are already a reality and will progressively become the standard as manufacturing price falls.


Assuntos
Reutilização de Equipamento/economia , Ureteroscópios/economia , Ureteroscopia/economia , Análise Custo-Benefício , Desenho de Equipamento , Reutilização de Equipamento/estatística & dados numéricos , Humanos , Duração da Cirurgia , Ureteroscópios/normas , Ureteroscópios/estatística & dados numéricos , Ureteroscopia/instrumentação , Ureteroscopia/estatística & dados numéricos
20.
Cancer Radiother ; 23(6-7): 625-629, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31447346

RESUMO

Recent technological developments in linear accelerators (linacs) and their imaging systems have made it possible to routinely perform stereotactic radiotherapy (SRT) treatments. To ensure the security and quality of the treatments, national and international recommendations have been written. This review focuses on the recommendations of the report 91 of the International Commission on Radiation Units (ICRU) on stereotactic treatments with small photon beams and proposes to answer the question of the eligibility of the commercially available accelerators for the treatment of extra-cranial SRT (SBRT). The ICRU 91 report outlines important features needed to respect the constraints, which are high intensity photon beam, integrated image-guidance, high mechanical accuracy of the linac, multileaf collimator with reduced leaf width, bundled motion management and bundled 6 Dimensional "robotic" couch tabletop. Most of the contemporary linacs meet these recommendations, in particular, stereotactic dedicated linacs, or modern gantry-based linacs equipped with 3 dimensional cone-beam CT imaging and 2D-stereoscopic planar imaging. Commercially available ring-based linacs have some limitations: they offer only coplanar treatments, and couch movements are limited to translations and, some have limited imaging equipment and no ability to manage intrafraction motion. However, for performing SBRT, non-coplanar irradiations are not mandatory, contrarily to intracranial stereotactic irradiations. Furthermore, patients' rotations can be corrected, thanks to real-time adaptive radiotherapy available on MRI-linacs. Finally, significant improvements are expected in the short term to compensate the weaknesses of the current devices.


Assuntos
Fidelidade a Diretrizes , Agências Internacionais/normas , Neoplasias/radioterapia , Aceleradores de Partículas/normas , Radiocirurgia/instrumentação , Desenho de Equipamento/normas , Humanos , Imobilização/instrumentação , Fótons/uso terapêutico , Garantia da Qualidade dos Cuidados de Saúde , Radiocirurgia/métodos , Radiocirurgia/normas , Radioterapia Guiada por Imagem/normas
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