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1.
Cancer Sci ; 111(1): 253-265, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31785020

RESUMO

FOLFOX (5-fluorouracil, leucovorin and oxaliplatin) is one of the main chemotherapy regimens for colorectal cancer (CRC), but only half of CRC patients respond to this regimen. Using gene expression profiles of 96 metastatic CRC patients treated with FOLFOX, we first selected gene pairs whose within-sample relative expression orderings (REO) were significantly associated with the response to FOLFOX using the exact binomial test. Then, from these gene pairs, we applied an optimization procedure to obtain a subset that achieved the largest F-score in predicting pathological response of CRC to FOLFOX. The REO-based qualitative transcriptional signature, consisting of five gene pairs, was developed in the training dataset consisting of 96 samples with an F-score of 0.90. In an independent test dataset consisting of 25 samples with the response information, an F-score of 0.82 was obtained. In three other independent survival datasets, the predicted responders showed significantly better progression-free survival than the predicted non-responders. In addition, the signature showed a better predictive performance than two published FOLFOX signatures across different datasets and is more suitable for CRC patients treated with FOLFOX than 5-fluorouracil-based signatures. In conclusion, the REO-based qualitative transcriptional signature can accurately identify metastatic CRC patients who may benefit from the FOLFOX regimen.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Colorretais/genética , Estudos de Avaliação como Assunto , Feminino , Fluoruracila/administração & dosagem , Fluoruracila/uso terapêutico , Humanos , Leucovorina/administração & dosagem , Leucovorina/uso terapêutico , Masculino , Pessoa de Meia-Idade , Compostos Organoplatínicos/administração & dosagem , Compostos Organoplatínicos/uso terapêutico , Oxaliplatina/administração & dosagem , Intervalo Livre de Progressão , Transcrição Genética/efeitos dos fármacos , Transcrição Genética/genética , Transcriptoma/efeitos dos fármacos , Transcriptoma/genética
2.
Cancer Sci ; 111(1): 266-278, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31746520

RESUMO

According to cancer genome sequences, more than 90% of cases of pancreatic ductal adenocarcinoma (PDAC) harbor active KRAS mutations. Digital PCR (dPCR) enables accurate detection and quantification of rare mutations. We assessed the dynamics of circulating tumor DNA (ct-DNA) in patients with advanced PDAC undergoing chemotherapy using dPCR. KRAS G12/13 mutation was assayed by dPCR in 47 paired tissue- and ct-DNA samples. The 21 patients were subjected to quantitative ct-DNA monitoring at 4 to 8-week intervals during chemotherapy. KRAS mutation was detected in 45 of those 47 patients using tissue DNA. In the KRAS mutation-negative cases, next-generation sequencing revealed KRAS Q61K and NRAS Q61R mutations. KRAS mutation was detected in 23/45 cases using ct-DNA (liver or lung metastasis, 18/19; mutation allele frequency [MAF], 0.1%-31.7%; peritoneal metastasis, 3/9 [0.1%], locally advanced, 2/17 [0.1%-0.2%]). In the ct-DNA monitoring, the MAF value changed in concordance with the disease state. In the 6 locally advanced cases, KRAS mutation appeared concurrently with liver metastasis. Among the 6 cases with liver metastasis, KRAS mutation disappeared during the duration of stable disease or a partial response, and reappeared at the time of progressive disease. The median progression-free survival was longer in cases in which KRAS mutation disappeared after an initial course of chemotherapy than in those in which it was continuously detected (248.5 vs 50 days, P < .001). Therefore, ct-DNA monitoring enables continuous assessment of disease state and could have prognostic utility during chemotherapy.


Assuntos
DNA Tumoral Circulante/genética , DNA/sangue , Neoplasias Pancreáticas/sangue , Neoplasias Pancreáticas/genética , Adulto , Idoso , Biomarcadores Tumorais/sangue , Carcinoma Ductal Pancreático/sangue , Carcinoma Ductal Pancreático/genética , Carcinoma Ductal Pancreático/patologia , Estudos de Avaliação como Assunto , Feminino , Frequência do Gene/genética , Sequenciamento de Nucleotídeos em Larga Escala/métodos , Humanos , Neoplasias Hepáticas/sangue , Neoplasias Hepáticas/genética , Neoplasias Hepáticas/patologia , Neoplasias Pulmonares/sangue , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Mutação/genética , Pâncreas/patologia , Neoplasias Pancreáticas/patologia , Prognóstico , Intervalo Livre de Progressão
5.
BJOG ; 127(2): 193-201, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31469215

RESUMO

OBJECTIVE: To characterise the bladder microbiota of continent adult women. DESIGN: Cross-sectional study of adult women who contributed catheterised urine samples, completed validated symptom questionnaires, and provided demographic data. SETTING: US academic medical centre. POPULATION: Well-characterised continent adult women. METHODS: Participants contributed symptoms questionnaires, demographic data, and catheterised urine samples that were analysed by enhanced urine culture methodology and 16S rRNA gene sequencing. MAIN OUTCOME MEASURES: Associations between demographics and microbial community state structures (urotypes, defined by the dominant taxon of each specimen). RESULTS: The bladder microbiota (urobiome) of a control group of 224 continent women were characterised, demonstrating variability in terms of urotype. The most common urotype was Lactobacillus (19%), which did not differ with any demographic. In contrast, the Gardnerella (P < 0.001) and Escherichia (P = 0.005) urotypes were more common in younger and older women, respectively. CONCLUSIONS: For urobiome research, enhanced culture methods and/or DNA sequencing are the preferred techniques for bacterial detection. The interpretation of clinical tests, such as the standard urine culture, should incorporate the knowledge that some women have Gardnerella or Escherichia urotypes without evidence of any clinical disorder. Clinical care strategies should preserve or restore the beneficial effects of the native urobiome, as disruption of that microbial community could result in unintended vulnerability to uropathogen invasion or opportunistic pathogen overgrowth. Longitudinal studies of urobiome responses to therapies should be encouraged. TWEETABLE ABSTRACT: In continent adult women bladder microbiome composition differs by age, with relevance for clinical practice.


Assuntos
Microbiota/genética , Bexiga Urinária/microbiologia , Sistema Urinário/microbiologia , Urina/microbiologia , Adulto , Estudos Transversais , Estudos de Avaliação como Assunto , Feminino , Humanos , Lactobacillus/genética , Microbiota/fisiologia , Pessoa de Meia-Idade , RNA Ribossômico 16S , Análise de Sequência de DNA , Bexiga Urinária/fisiologia
6.
Estud. Interdiscip. Psicol ; 10(3): 3-25, dez. 2019.
Artigo em Português | LILACS | ID: biblio-1049787

RESUMO

Pesquisas recentes na área educacional têm evidenciado altas taxas de reprovação e evasão no Ensino Superior. Estudiosos afirmam que o problema pode estar relacionado às dificuldades de aprendizagem dos alunos no contexto acadêmico. A autorregulação da aprendizagem é uma perspectiva amplamente investigada pelo seu potencial em auxiliar os estudantes a aprender melhor. O presente trabalho objetivou analisar a produção científica de artigos sobre programas de intervenção em aprendizagem autorregulada no Ensino Superior, publicados em âmbitos nacional e internacional, no período de 2004 a 2016. Os resultados revelaram o impacto positivo que os programas exerceram no fortalecimento da capacidade de aprender a aprender dos universitários. Os programas de intervenção, em sua maioria, foram realizados em cursos extraclasses, com grupos grandes de alunos e dados coletados por meio de instrumentos de autorrelato. Observou-se um maior número de pesquisas realizadas internacionalmente, com o predomínio do ensino de estratégias no aprendizado de língua estrangeira (AU).


Assuntos
Autoeficácia , Educação Superior , Capacitação Profissional , Estudos de Avaliação como Assunto
7.
Medicine (Baltimore) ; 98(51): e17897, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31860947

RESUMO

Parkinson disease (PD) is the second most common neurodegenerative disease which affects population older than 65 years. Tremor represents one of the main symptomatic triads in PD, particularly in rest state.We enrolled 41 idiopathic PD patients, to validate the assessment of tremor symptoms.To be enrolled in the study, patients had to fulfill the movement disorder society clinical diagnostic criteria for PD.We used an innovative home-made, low-cost device, able to quantify the frequency and amplitude of rest tremor and stress conditionOur results confirmed the presence of tremor during muscular effort in a significant number of patients and the influence of emotional stress.We suppose that this new device should be validated in clinical practice as a support of differential diagnosis and therapeutic management of PD patients.


Assuntos
Técnicas Biossensoriais/instrumentação , Doença de Parkinson/complicações , Doença de Parkinson/diagnóstico , Tremor/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Técnicas Biossensoriais/métodos , Estudos de Coortes , Intervalos de Confiança , Desenho de Equipamento , Estudos de Avaliação como Assunto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Neurodegenerativas/diagnóstico , Doenças Neurodegenerativas/tratamento farmacológico , Estudos Retrospectivos , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Tremor/etiologia
8.
BMC Complement Altern Med ; 19(1): 277, 2019 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-31640688

RESUMO

BACKGROUND: Clinical Practice Guidelines (CPGs) play an important role in clinical practice, and they require appropriate evaluation, especially in application. This study explores the application evaluation method of CPGs for Traditional Chinese Medicines (TCM). It uses the Analytic Hierarchy Process (AHP) and clinical cases to evaluate the consistency between CPGs of TCM and clinical practice. METHODS: To evaluate the consistency between CPGs of TCM and clinical cases, a 3-level AHP construction was built. Weightings were calculated by collecting questionnaires according to AHP theory. To test the evaluation system, a retrospective study was performed. The study evaluated the China Association of Chinese Medicine's Guidelines for Diagnosis and Treatment of Common Internal Diseases in Chinese Medicine Diseases of Modern Medicine (CPGs of DTCID) (ZYYXH/T50-135-2008). A total of 150 cases were involved. The evaluation system was used to assess the consistency between CPGs of DTCID and clinical cases of angina pectoris. RESULTS: The results showed that the overall consistency between CPGs of DTCID and the 150 cases was 42.32 ± 6.94%, ranging from 35.21 to 63.37%. The overall consistency was not affected by age, gender, type of angina pectoris, condition of percutaneous coronary intervention (PCI), or angina classification as determined by the Canadian Cardiovascular Society. The consistencies of each index were as follows: Diagnosis of TCM, 100%; Diagnosis of Western medicine, 100%; Syndrome classification, 38.25 ± 4.40%; Syndrome key point, 34.17 ± 8.15%; TCM Decoction, 31.08 ± 23.64%; TCM particular treatment, 7.92 ± 19.13%; and Recuperation and prevention, 0. The most frequent syndromes were qi-deficiency, phlegm and blood stasis (n = 124) (82.7%). The overall consistency of qi-deficiency, turbid phlegm and blood stasis was lower than the overall consistency of the group without that syndrome. The difference was statistically significant (P < 0.05). 42 cases (28%) applied the TCM decoction recommended by CPGs of DTCID. Of these, Gualouxiebaibanxia decoction was applied in 34 cases. Wendan decoction, the most frequently used, was applied in 64 cases (42.7%). CONCLUSION: This study indicates that the AHP system can perform quantitative evaluation of consistency between TCM CPG and clinical practice. It also found the factors affecting the application of TCM CPGs and might indicate the need for revisions of CPGs.


Assuntos
Medicina Tradicional Chinesa/normas , Guias de Prática Clínica como Assunto/normas , Adulto , Idoso , Tratamento Farmacológico , Medicamentos de Ervas Chinesas/uso terapêutico , Estudos de Avaliação como Assunto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
9.
Codas ; 31(5): e20180102, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31664367

RESUMO

PURPOSE: verify the perception of Care Network users for People with Disabilities in Minas Gerais regarding the quality of care. METHODS: This is an observational, descriptive and cross-sectional study of 871 informants, users and caregivers of Care Network for People with Disabilities in Minas Gerais. Interviews were carried out based on three instruments, the User Interview Roadmap and Brazil's Economic Classification Criteria for sociodemographic, clinical and care characterization, as well as the Quality of Care Scale to assess the quality of care for the interviewees. RESULTS: the majority of users were male, single, unworked and had income of a minimum wage. A higher proportion of elementary school is incomplete, white in color, with household income greater than one and up to two minimum wages. The average age of 98.9% of the users was 28.6 years, of which 50.0% was up to 14 years. The majority reported having a type of disability with no associated comorbidity. Regarding the quality of care referred to, at least a quarter of the interviewees evaluated negatively the Access, Social Needs and Received Information axes. CONCLUSION: It will be necessary to improve the waiting time to receive care and also the services offer where the user resides, to facilitate access to consultations, to contribute intersectorally in leisure and social activities and to improve communication with users to increase the quality of care.


Assuntos
Pessoas com Deficiência/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Adolescente , Adulto , Brasil , Cuidadores , Estudos Transversais , Estudos de Avaliação como Assunto , Feminino , Humanos , Masculino , Características de Residência , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
10.
BMC Health Serv Res ; 19(1): 664, 2019 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-31521155

RESUMO

BACKGROUND: Health workers (HWs) providing routine immunization (RI) services play a crucial role in influencing vaccine uptake, a key determinant of improved immunization coverage. Over the years, Training Needs Assessments (TNAs) have not been routinely utilized in Nigeria to determine unmet needs of health workers offering immunization services and what approaches should be adopted to meet their training needs. The objective was to assess the level of Expanded Program on Immunization (EPI) knowledge among RI service providers and tutors in pre-service institutions in three Nigerian states, to identify unfulfilled training needs and their implications. It also sought HWs perception on a pilot training approach, where tutors will be used for in-service training. METHODS: TNA survey tools were designed to obtain knowledge-based information on the fundamental EPI concepts through key informant interviews and focus group discussions with 90 HWs and 27 pre-service tutors. Quantitative data was also obtained, hence utilizing a mixed method approach for the study. RESULTS: In spite of several previous trainings, HWs knowledge on basic immunization concepts including Reaching Every Ward (REW) strategy was varied and suboptimal. 83% of the HWs could not differentiate between the live attenuated and killed vaccines. In addition, pre-service tutors knowledge of fundamental EPI concepts, as well as HW perception of the new training approach also varied across the states. CONCLUSION: TNAs are valuable in determining specific training approaches to improve HWs skills needed to implement strategies required to increase vaccine uptake. However, EPI managers must be mindful of contextual factors beyond training needs such as finance and security, that can affect HW performance.


Assuntos
Pessoal de Saúde/educação , Programas de Imunização , Vacinação/estatística & dados numéricos , Estudos de Avaliação como Assunto , Grupos Focais , Humanos , Determinação de Necessidades de Cuidados de Saúde , Nigéria/epidemiologia
11.
Molecules ; 24(16)2019 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-31430992

RESUMO

Plum pomace, an agro-industrial waste product has received attention due to the worldwide popularity of plums. During convection, the content of flavan-3-ols decrease, except drying at 90 °C, whereas the content of i.e., chlorogenic, 3-p- and 4-p-coumaroylquinic acids, quercetin rutinoside, and galactoside was observed to increase along with the increase in process temperature. The highest content of all identified polyphenols was found in plum pomace powders obtained using a combination of convective at 90 °C and microwave vacuum drying (MVD) at 120 W, whereas the highest retention of the group consisted of phenolic acids, flavonols, and anthocyanins was noted when CD 70 °C/MVD 120 W was used, pointing to a strong influence of the type of polyphenols on their changes caused by drying. The correlations between TEAC ABTS and the sum of flavonoids (r = 0.634) and anthocyanins (r = 0.704) were established. The multiple regression analysis showed that polyphenol content was more strongly affected by drying time than by maximum temperature, whereas antioxidant capacity was more influenced by maximum temperature of sample than by drying time.


Assuntos
Antioxidantes/química , Polifenóis/química , Prunus domestica/química , Antocianinas/química , Dessecação/métodos , Estudos de Avaliação como Assunto , Flavonoides/química , Flavonóis/química , Frutas/química , Temperatura Alta , Hidroxibenzoatos/química
12.
BMC Health Serv Res ; 19(1): 579, 2019 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-31419972

RESUMO

BACKGROUND: Clean Cut is a six month, multi-modal, adaptive intervention aimed at reducing surgical infections through improving six critical perioperative processes: 1) handwashing/skin preparation, 2) surgical gown/drape integrity, 3) antibiotic administration, 4) instrument sterility, 5) gauze counts, and 6) WHO Surgical Safety Checklist use. The aim of this study was to elucidate themes across Clean Cut implementation sites in Ethiopia to improve implementation at future hospitals. METHODS: We conducted semi-structured interviews of 20 clinicians involved in Clean Cut at four hospitals. Participation was limited to Clean Cut team members and included surgeons, anesthetists, operating room (OR) nurses, ward nurses, OR managers, quality improvement personnel, and hospital administrators. Audio recordings were transcribed and coded using qualitative software. A codebook was inductively and iteratively derived between two researchers, tested for inter-rater reliability, and applied to all transcripts. We conducted thematic analysis to derive our final qualitative results. RESULTS: The interviews revealed barriers and facilitators to the implementation of Clean Cut, as well as strategies for future implementation sites. Key barriers included material resource limitations, feelings of job burden, existing gaps in infection prevention education, and communication errors during data collection. Common facilitators included strong hospital leadership support, commitment to improved patient outcomes, and organized Clean Cut training sessions. Future strategies include resource assessments, creating a sense of responsibility among staff, targeted training sessions, and incorporating new standards into daily routine. CONCLUSIONS: The findings of this study highlight the importance of engaging hospital leadership, providers and staff in quality improvement programs, and understanding their work contexts. The identified barriers and facilitators will inform future initiatives in the field of perioperative infection prevention.


Assuntos
Fidelidade a Diretrizes , Melhoria de Qualidade/organização & administração , Infecção da Ferida Cirúrgica/prevenção & controle , Lista de Checagem , Etiópia/epidemiologia , Estudos de Avaliação como Assunto , Feminino , Humanos , Masculino , Guias de Prática Clínica como Assunto , Infecção da Ferida Cirúrgica/epidemiologia
13.
BMC Health Serv Res ; 19(1): 576, 2019 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-31419977

RESUMO

BACKGROUND: Affordability and availability of quality medicines to all its citizens has been a key priority area for South Africa since democracy in 1994. In order to introduce transparency in the private market the government introduced the Single Exit Price (SEP) for medicines in 2004, for all prescription medicines, comprising of a fixed ex-factory price with a logistics fee component (and value added tax) for medicines sold to all purchasers other than the State. This is complemented with a provision for an annual regulated maximum percentage increase. The study evaluates the impact of the SEP on a basket of originator medicines, in terms of costs, immediate price reductions and projected price reductions. METHOD: This is an analytical, quantitative study. A basket of medicines was selected, based on the WHO/HAI list, and adapted to include registered medicines in South Africa. Prices of 50 originator medicines were assessed from 1999 to 2014 in terms of the single exit price and the changes in prices in accordance with legislation using a time series analysis methodology. RESULTS: Of the 50 originator medicines investigated 35 showed a statistically significant change in level. For the Global Core list, the percentage change ranged from 2.45-39.12% (mean = 19.87%, SD = 10.62%, IQR = 10.2%). The range for the Regional Core list was 1.77-42.17% (mean = 23.38%, SD = 12.43%, IQR = 15.65%). The Supplementary list was 11.68-55.86% (mean = 22.97%, SD = 16.26%, IQR = 17.34). This study indicates that the SEP regulation had an impact on medicine pricing in South Africa in both the short and long term. Most medicines investigated showed a smaller yearly increase in price compared to before regulations due to the controlled pricing environment introduced by Government. CONCLUSION: This study provides evidence of the impact of medicine pricing intervention from a middle-income country, and other developing countries looking at introducing medicine price controls can draw useful lessons.


Assuntos
Custos de Medicamentos/estatística & dados numéricos , Indústria Farmacêutica/economia , Medicamentos sob Prescrição/economia , Comércio/economia , Custos e Análise de Custo , Estudos de Avaliação como Assunto , Humanos , Análise de Séries Temporais Interrompida , Medicamentos sob Prescrição/provisão & distribução , África do Sul/epidemiologia
14.
J Surg Oncol ; 120(4): 573-577, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31373010

RESUMO

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a T-cell neoplasm that arises in the capsule around breast implants. While an association with implants has been proposed, no causal link has been identified and the pathophysiology and natural history of BIA-ALCL remain unknown. A literature review of 391 articles was performed to assess the current understanding of BIA-ALCL and to provide a balanced and unbiased view of the current controversy surrounding the disease.


Assuntos
Implantes de Mama/efeitos adversos , Neoplasias da Mama/cirurgia , Linfoma Anaplásico de Células Grandes/etiologia , Neoplasias da Mama/etiologia , Estudos de Avaliação como Assunto , Feminino , Humanos
15.
Eur J Radiol ; 118: 51-57, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31439258

RESUMO

PURPOSE: To test the potential impact of pharmacokinetic parameters, derived from DCE-MRI analysis, on the diagnostic performance of PI-RADSv.2 classification in prostate lesions characterization. METHOD: Among patients who underwent multiparametric prostate MRI (mpMRI) (January 2016-March 2018) followed by histological evaluation (targeted biopsies/prostatectomy), 103 men were retrospectively selected. For each patient the index lesion was identified and pharmacokinetic parameters (Ktrans, Kep, Ve, Vp) were assessed. MRI diagnostic performance in the detection of significant tumors [Gleason Score (GS)≥7] was assessed, considering PI-RADS≥3 as positive. RESULTS: GS ≥ 7 (n = 59) showed higher Ktrans (p < 0.01) and Kep (p = 0.01) compared to GS < 7. At ROC curve analysis, a Ktrans cut-off of 191 × 10-3/min was identified to predict the presence of GS ≥ 7 (AUC:0.75; sensitivity:95%; specificity:61%). Sensitivity and PPV of mpMRI using PI-RADSv.2 were 98% and 61%. Reclassifying PI-RADS≥3 lesions according to Ktrans cut-off, 22 false positives were shifted to true negatives with 3 false negative findings; PPV raised to 79%. Appling Ktrans cut-off to PI-RADS 3 lesions of peripheral zone (n = 18), 12 true negatives, 4 true positives, 2 false positives were identified. CONCLUSIONS: Despite its high sensitivity prostate mpMRI generates many false positive cases: Ktrans in addition to PIRADS v.2 seems to improve MRI-PPV and may help in avoiding redundant biopsies.


Assuntos
Meios de Contraste/farmacocinética , Aumento da Imagem/métodos , Imagem por Ressonância Magnética/métodos , Neoplasias da Próstata/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Estudos de Avaliação como Assunto , Reações Falso-Positivas , Humanos , Masculino , Pessoa de Meia-Idade , Próstata/diagnóstico por imagem , Próstata/patologia , Neoplasias da Próstata/patologia , Curva ROC , Sistemas de Informação em Radiologia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade
16.
BMC Health Serv Res ; 19(1): 541, 2019 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-31375099

RESUMO

BACKGROUND: The raising of disability and chronic illness burden among European population is calling for a new paradigm of care, focused on primary health care interventions. Engage-In-Caring is a novel multicomponent intervention clearly dedicated to improve family caregiver engagement in the care of patients with complex care needs, by supporting them to develop a stronger consciousness of their role, needs and skills. METHOD: Engage-In-Caring intervention's efficacy and feasibility have been evaluated through a single arm pre-post observational pilot study settled in Rome. A qualitative phase, consisting of literature analysis of caregivers' unmet needs and a final revision from an experts' group, led to the structuration of the intervention, following the Caregiver Health Engagement Model (CHE-Model). Afterwards, a quantitative phase allowed understanding the feasibility of the intervention through Kruskal-Wallis test on a sample of 47 caregivers. RESULTS: Results showed a reduction of the physical burden (Chi Squared = 6,483; p = .01) perceived by the caregivers and increase of the health literacy (Chi Squared = 3,560; p = .059) after the intervention. CONCLUSIONS: Feasibility tests on caregivers of patients with complex care needs are promising: this pilot study suggests a first effectiveness evidence, particularly concerning aspects related to burden perception and improvements in health literacy. Randomised controlled trials on larger samples are needed.


Assuntos
Cuidadores/psicologia , Doença Crônica , Pessoas com Deficiência , Determinação de Necessidades de Cuidados de Saúde , Efeitos Psicossociais da Doença , Estudos de Avaliação como Assunto , Humanos , Itália , Projetos Piloto , Apoio Social
17.
Br J Radiol ; 92(1101): 20190365, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31368776

RESUMO

There are numerous challenges to identifying, developing and implementing quantitative techniques for use in clinical radiology, suggesting the need for a common translational pathway. We developed the quantitative neuroradiology initiative (QNI), as a model framework for the technical and clinical validation necessary to embed automated segmentation and other image quantification software into the clinical neuroradiology workflow. We hypothesize that quantification will support reporters with clinically relevant measures contextualized with normative data, increase the precision of longitudinal comparisons, and generate more consistent reporting across levels of radiologists' experience. The QNI framework comprises the following steps: (1) establishing an area of clinical need and identifying the appropriate proven imaging biomarker(s) for the disease in question; (2) developing a method for automated analysis of these biomarkers, by designing an algorithm and compiling reference data; (3) communicating the results via an intuitive and accessible quantitative report; (4) technically and clinically validating the proposed tool pre-use; (5) integrating the developed analysis pipeline into the clinical reporting workflow; and (6) performing in-use evaluation. We will use current radiology practice in dementia as an example, where radiologists have established visual rating scales to describe the degree and pattern of atrophy they detect. These can be helpful, but are somewhat subjective and coarse classifiers, suffering from floor and ceiling limitations. Meanwhile, several imaging biomarkers relevant to dementia diagnosis and management have been proposed in the literature; some clinically approved radiology software tools exist but in general, these have not undergone rigorous clinical validation in high volume or in tertiary dementia centres. The QNI framework aims to address this need. Quantitative image analysis is developing apace within the research domain. Translating quantitative techniques into the clinical setting presents significant challenges, which must be addressed to meet the increasing demand for accurate, timely and impactful clinical imaging services.


Assuntos
Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Demência/diagnóstico , Demência/patologia , Imagem por Ressonância Magnética/métodos , Neuroimagem/métodos , Estudos de Avaliação como Assunto , Humanos
18.
Lancet Psychiatry ; 6(9): 778-785, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31296444

RESUMO

Developed in collaboration with WHO Department of Mental Health and Substance Abuse, this study (conducted in India, the UK, and the USA) integrated feedback from mental health service users into the development of the chapter on mental, behavioural, and neurodevelopmental disorders for ICD-11. The ICD-11 will be used for health reporting from January, 2022. As a reporting standard and diagnostic classification system, ICD-11 will be highly influential by informing policy, clinical practice, and research that affect mental health service users. We report here the first study to systematically seek and collate service user perspectives on a major classification and diagnostic guideline. Focus groups were used to collect feedback on five diagnoses: depressive episode, generalised anxiety disorder, schizophrenia, bipolar type 1 disorder, and personality disorder. Participants were given the official draft diagnostic guidelines and a parallel lay translation. Data were then thematically analysed, forming the basis of co-produced recommendations for WHO, which included features that could be added or revised to better reflect lived experience and changes to language that was confusing or objectionable to service users. The findings indicated that an accessible lay language version of the ICD-11 could be beneficial for service users and their supporters.


Assuntos
Grupos Focais/métodos , Classificação Internacional de Doenças/normas , Transtornos Mentais/diagnóstico , Serviços de Saúde Mental/organização & administração , Organização Mundial da Saúde/organização & administração , Transtornos de Ansiedade/classificação , Transtornos de Ansiedade/diagnóstico , Transtorno Bipolar/classificação , Transtorno Bipolar/diagnóstico , Transtorno Depressivo/classificação , Transtorno Depressivo/diagnóstico , Estudos de Avaliação como Assunto , Feminino , Guias como Assunto , Humanos , Índia/epidemiologia , Masculino , Transtornos Mentais/classificação , Transtornos Mentais/psicologia , Serviços de Saúde Mental/normas , Transtornos da Personalidade/classificação , Transtornos da Personalidade/diagnóstico , Esquizofrenia/classificação , Esquizofrenia/diagnóstico , Reino Unido/epidemiologia , Estados Unidos/epidemiologia
19.
BMC Health Serv Res ; 19(1): 520, 2019 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-31340819

RESUMO

BACKGROUND: Large-scale, national eHealth services, such as the summary care record (SCR) and electronic prescriptions (e-prescriptions), have been implemented by project managers as Norwegian health authority initiatives. Few studies have been conducted on the large-scale implementation of eHealth services and the relationship between the implementers' work and the use of the tools in healthcare practices. Hence, there was a need to determine the project work with a focus on changes in practice. This study explores the implementation of the SCR and e-prescriptions from the perspective of project managers; how does the implementation work by project managers relate to institutional practices in large-scale initiatives? METHODS: Twenty-two semi-structured interviews were held with project managers in 2016 and 2018 and were recorded, transcribed, and coded according to the content. The analytical concepts of the "project" and "practice" were used to focus on tensions between the dimensions of time connecting historically established social practice and in situ actions. RESULTS: The eHealth initiatives were demonstrated to have been implemented as a part of the national strategy and achieved through close collaboration with the Norwegian Directorate of eHealth (NDE). Tensions arose in relation to task-oriented actions during the implementation of the project and the daily management thereafter. Further, the work tasks of the project managers were related to the dissemination of the tools while, in practice, the tools were related to actual use by professionals. The implementation of several projects simultaneously created tensions between the implementation of a tool and a specific practice, as well as between tools. CONCLUSION: The objectives set out by the project managers in relation to their work should be viewed as temporary, whereas a long-term objective should apply to the use of the tools. Hence, the work of implementing eHealth initiatives might call for a renewed definition of the empirical object. Identifying factors that affect uptake, such as gaps between the intended use of an object and in situ actions or historically established activities, might expedite the future success of national eHealth initiatives. The social aspect of institutional practice has a direct bearing on the potential of a project to be implemented successfully.


Assuntos
Prescrição Eletrônica , Implementação de Plano de Saúde/organização & administração , Prática Institucional , Telemedicina/organização & administração , Pessoal Administrativo , Registros Eletrônicos de Saúde , Estudos de Avaliação como Assunto , Humanos , Entrevistas como Assunto , Noruega , Inovação Organizacional
20.
Complement Ther Med ; 45: 205-210, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31331562

RESUMO

BACKGROUND: An increasing number of people in the Republic of Georgia use complementary and alternative medicine (CAM). CAM has long been practiced in the country, but is not currently part of the formal medical system. The aim of this study was to explore patients' CAM use and their perspectives of CAM complementation of existing services in Georgia's health care system. METHODOLOGY: We conducted a qualitative study exploring patient needs and wants by performing in-depth, contextual interviews with patients using CAM. We recruited participants at CAM clinics and collected data until we reached saturation. A thematic analysis involving line by line coding explored perspectives and allowed us to formulate recommendations of CAM integration in Georgia. RESULTS: Study participants voiced that they pursued cure beyond symptom relief; their disappointment in that regard with conventional medicine in Georgia directed them towards CAM as a safe and effective care setting. Most sought natural approaches as a sustained approach to their health and perceived CAM as empathetic therapeutic and preventive space. Participants were in favor of integration of CAM with conventional health services through government support and regulation. They saw coverage of payments for CAM visits and treatments as important aspect for an effective and sustainable integration. CONCLUSION: Patients favor an integration of CAM into Georgia's current healthcare systems to ensure CAM's broad availability as well as effective regulation and financing, including coverage by health insurance.


Assuntos
Terapias Complementares/economia , Assistência à Saúde/economia , Assistência à Saúde/métodos , Adulto , Idoso , Estudos de Avaliação como Assunto , Feminino , República da Geórgia , Humanos , Masculino , Pessoa de Meia-Idade
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