Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 3.143
Filtrar
1.
Medicine (Baltimore) ; 98(25): e16171, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31232975

RESUMO

PURPOSE: To determine the relationship between anterior chamber depth (ACD) and percent endothelial cell loss (ECL) after Descemet Stripping Automated Endothelial Keratoplasty (DSAEK). METHOD: In 78 eyes receiving triple procedure (DSAEK combined with cataract extraction and posterior chamber intraocular lens (PCIOL) implantation), ACD was measured preoperatively with an intraocular lens (IOL) Master and ECL was calculated with specular microscopy at 6 months, 1, 2, 3, and 4 years postoperatively. ACD and ECL from all 78 eyes were compared using correlation analysis and students t test. Eyes were then separated into 2 groups based on ACD, group 1 with ACD < 3mm and group 2 with ACD ≥ 3mm. Students t test was then performed to compare group 1 and group 2 ECL at 6 months, 1, 2, 3, and 4 years postoperative. RESULTS: Mean ACD for all 78 eyes was 2.93 ±â€Š0.43 mm. Mean ECL was 32.7%, 27.6%, 29.6%, 32.5%, and 37.2% at 6 months, 1, 2, 3, and 4 years. No significant correlation between ACD and ECL was observed at any time point for the combined analysis of 78 eyes (P > .05). At 2 and 4 years postoperative, mean ECL was 32.6% ±â€Š16.1% and 43.0% ±â€Š23.2% in eyes with ACD < 3mm and 25.3% ±â€Š13.0% and 29.6% ±â€Š18.2% in eyes with ACD ≥ 3 mm (P = .041 at 2 years and .008 at 4 years). CONCLUSION: ACD and ECL were not directly correlated; however, there may be a threshold ACD in which shallower anterior chambers preoperatively result in greater donor ECL over time.


Assuntos
Perda de Células Endoteliais da Córnea/classificação , Transplante de Córnea/efeitos adversos , Epitélio Posterior/lesões , Pesos e Medidas , Adulto , Idoso , Idoso de 80 Anos ou mais , Distribuição de Qui-Quadrado , Perda de Células Endoteliais da Córnea/fisiopatologia , Transplante de Córnea/métodos , Epitélio Posterior/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Facoemulsificação/efeitos adversos , Estudos Retrospectivos
2.
Nursing (Säo Paulo) ; 22(251)abr.2019.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-998874

RESUMO

Objetiva-se analisar as escalas de Acidente Vascular Encefálico (AVE) utilizadas durante o pré e pós-diagnóstico. Revisão bibliográfica simples, descritiva e interdisciplinar nas bases de dados SciELO, Pubmed, LILACS e Biblioteca Virtual em Saúde. Foram utilizados como critério de inclusão artigos em inglês, espanhol e português entre 2011 e 2017, dentre esses foram selecionados assunto ao tema proposto. Segundo as pesquisas, foram selecionados artigos os quais mostram escalas que auxilia na identificação dos sinais e sintomas, auxilia na avaliação do paciente com AVE Hemorrágico, avalia o estado neurológico e classifica o comprometimento funcional do paciente. Com base na confiabilidade e critérios de avaliação das escalas validadas pela American Stroke Asssociation, Cincinnati, LAPSS e NIHSS são as mais aplicadas por serem específicas devidos aos itens que confirmam os sinais clínicos apresentados por pacientes com suspeita de AVE.(AU)


The aim of this study was to analyze the Stroke scales used during pre and post-diagnosis. Simple, descriptive and interdisciplinary bibliographic review in the databases SciELO, Pubmed, LILACS and Virtual Health Library were used as inclusion criteria articles in English, Spanish and Portuguese between 2011 and 2017, among which were selected subject to the proposed theme. According to the researches, articles were selected which show scales that aid in the identification of signs and symptoms, assist in the evaluation of the patient with hemorrhagic stroke, evaluate the neurological status and classify the functional impairment of the patient. Based on the reliability and evaluation criteria of the scales validated by the American Stroke Asssociation, Cincinnati, LAPSS and NIHSS are the most applied because they are specific due to items that confirm the clinical signs presented by patients suspected of having stroke.(AU)


Se pretende analizar las escalas de Accidente Vascular Encefálico (AVE) utilizadas durante el pre y post-diagnóstico. sencillo, descriptivo e interdisciplinar revisión de la literatura en las bases de datos SciELO, PubMed, lilas y Biblioteca Virtual en Salud. Fue utilizado como criterio para artículos de inclusión en Inglés, español y portugués entre 2011 y 2017, entre estos se seleccionaron sujetos a la temática propuesta. Según las encuestas, se seleccionaron artículos que muestran escalas que auxilia en la identificación de los signos y síntomas, auxilia en la evaluación del paciente con AVE Hemorrágico, evalúa el estado neurológico y clasifica el compromiso funcional del paciente. En base a la confiabilidad y criterios de evaluación de las escalas validadas por American Stroke Assocation, Cincinnati, LAPSS y NIHSS, son las más aplicadas por ser específicas debidas a los ítems que confirman los signos clínicos presentados por pacientes con sospechas de AVE.(AU)


Assuntos
Humanos , Fatores de Risco , Acidente Vascular Cerebral , Exame Neurológico , Pesos e Medidas
3.
World J Emerg Surg ; 14: 4, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30740139

RESUMO

Background: Early diagnosis of acute compartment syndrome (ACS) of the leg is essential to improve the outcome. Direct invasive measurement is currently recommended to measure intracompartmental pressure. A non-invasive and reproducible means of making the diagnosis would be a step forward. The purpose of this exploratory study was to investigate the feasibility of non-invasive ultrasound-guided angle measurement as a surrogate of increased pressure in a model of ACS. Methods: A model of ACS was generated by infusion of saline into the anterior compartment of the leg of human cadavers to incrementally increase the intracompartmental pressure from 10 to 100 mmHg. In 40 legs (20 cadavers), the angle (TFA, tibia-fascia angle) between the anterolateral cortex of the tibia and the fascia of the anterior compartment was measured at each 10 mmHg pressure increase using ultrasound in a standardized transversal plane. A multilevel linear regression model was used to estimate intracompartmental pressure from delta TFA (ΔTFA). Results: TFA (mean [± SD]) increased from 61.0° (± 12.0°) at 10 mmHg up to 81.1° (± 11.1°) at 100 mmHg compartment pressure. Each increase ΔTFA by one degree was associated with an increase in pressure by 3.9 mmHg (95% CI, 3.8-4.0, p < 0.001). Conclusions: We found that intracompartmental pressure of the anterior compartment of the calf can be well estimated by ultrasound-based ΔTFA in this post mortem experiment. Our findings indicate that non-invasive TFA measurement is feasible and it is reasonable that this will hold true in real life, but the findings are too preliminary to be used in clinical practice now.


Assuntos
Síndromes Compartimentais/classificação , Ultrassonografia/normas , Pesos e Medidas/instrumentação , Idoso , Idoso de 80 Anos ou mais , Cadáver , Feminino , Humanos , Perna (Membro)/diagnóstico por imagem , Perna (Membro)/fisiopatologia , Masculino , Ultrassonografia/métodos , Pesos e Medidas/normas
4.
Wound Manag Prev ; 65(1): 36-41, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30724748

RESUMO

Wound area measurements provide an objective assessment of wound healing; however, most commonly used measurement techniques are imprecise. PURPOSE: A new portable 3-dimensional (3D) wound measurement device was tested against laser- and hand-measurement methods. METHODS: A retrospective comparative analysis was conducted to analyze the difference in wound measurements using records of patients seen at the University of Miami Hospital (Miami, FL) outpatient wound healing clinic between November 2017 and February 2018 who had wounds of various etiologies measured using 3 different techniques during a single visit: the 3D device, a laser-assisted wound measurement device (laser), and standard hand measurements. Patients with circumferential wounds were excluded (the laser and 3D devices are incapable of assessing these wounds). Differences were compared using paired t tests. RESULTS: The wounds ranged in area from 0.8 cm² (hand measurements) and 0.2 cm² (3D and laser devices) to 100.94 cm², 61.9 cm², and 65 cm² by hand measurement, 3D, and laser device, respectively. Among the 23 wounds measured, the majority (16) were venous ulcers. No statistically significant difference was noted between the 3D measurements compared with the laser (P = .340). Statistically significant differences in the measurements between the 3D device and hand measurements (P = .008) and the laser device and hand measurements (P = .006) were found. CONCLUSION: Measurements of the 3D device appear analogous to laser devices, making it an alternative tool for clinicians interested in monitoring wound progression. Because the 3D device has the capacity to examine wound volume, prospective comparative trials should be used to examine the accuracy and precision of the device to measure volume.


Assuntos
Mãos/patologia , Imagem Tridimensional/métodos , Exame Físico/instrumentação , Pesos e Medidas/instrumentação , Cicatrização , Idoso , Estudos de Coortes , Desenho de Equipamento/normas , Feminino , Humanos , Imagem Tridimensional/normas , Imagem Tridimensional/tendências , Lasers , Masculino , Pessoa de Meia-Idade , Exame Físico/métodos , Estudos Prospectivos , Estudos Retrospectivos
5.
J Emerg Med ; 56(4): 371-377, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30709606

RESUMO

BACKGROUND: Guidelines recommend placing a cervical collar (c-collar) until spinal injury is excluded. Previous studies have shown that c-collar placement increases intracranial pressure (ICP), which can worsen outcomes for trauma patients who are at risk of increased ICP. Head of bed elevation (HBE) has been found to decrease ICP. However, there is no consensus in the literature for the optimal degree of HBE to decrease ICP. OBJECTIVE: We aimed to find an optimal HBE degree to decrease ICP to its baseline values in healthy volunteers with increased ICP caused by c-collar. METHODS: This is a randomized controlled and blinded study performed in healthy volunteers. Two sonographers measured the optic nerve sheath diameter (ONSD) of each subject's eyes separately for different time points. Then, we calculated a mean ONSD value for five time points: before c-collar placement (T0), 5 and 20 min in supine position after c-collar placement (T5 and T20), and 5 and 20 min after HBE (T25 and T40). We randomized the subjects into three groups of HBE: 15, 30, and 45°, and compared the mean ONSD values among groups. RESULTS: All groups were similar with regard to baseline demographics and ONSD measurements before HBE. We found significant increases in mean ONSD values at T5 and at T20 caused by the c-collar. Thirty and forty-five degrees of HBE for 20 min decreased ONSD to its baseline values. The inter-rater reliability of the sonographers was > 0.9. CONCLUSIONS: Our results show that c-collar increases ONSD in healthy volunteers. Elevating the head of the bed 30 and 45° for 20 min decreased ONSD to baseline values.


Assuntos
Imobilização/instrumentação , Nervo Óptico , Adulto , Análise de Variância , Traumatismos Craniocerebrais/classificação , Traumatismos Craniocerebrais/patologia , Feminino , Voluntários Saudáveis/estatística & dados numéricos , Humanos , Imobilização/normas , Masculino , Estudos Prospectivos , Reprodutibilidade dos Testes , Ultrassonografia/métodos , Pesos e Medidas/instrumentação
6.
Work ; 62(1): 21-26, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30636746

RESUMO

BACKGROUND: Measurement of hand exertion is very important to quantify the risk of Work-related Musculoskeletal Disorders (WMSDs) in manufacturing fields. Although a direct measurement is the most accurate way to quantify physical load, it is expensive and time consuming. To solve this limitation, a subjective self-report method has been proposed as a possible alternative. OBJECTIVE: The purpose of this study was to analyze the accuracy of subjective perception for grip force exertions associated with handedness (dominant and non-dominant hands). METHODS: A total of nine healthy adults participated in this study. All participants were asked to exert hand grip forces for randomly selected target force levels without any information about the actual target force levels. Then, participants were also asked to rate the subjective perception of their exertion level using % Maximum Voluntary Contraction (MVC) after each hand grip force exertion. RESULTS: The trend of subjective perception for various target force levels was different according to the handedness. In the case of the dominant hand, participants tend to rate less MVC levels (under-estimation) than the actual target force levels at lower than 50% MVC, whereas they tend to rate more MVC levels (over-estimation) than the actual target force levels at higher than 50% MVC, respectively. In case of non-dominant hand, generally participants showed over-estimate for all levels of MVCs in this study. CONCLUSIONS: According to the results of this study, subjective perception of exertion showed different patterns on the handedness (S-shape for dominant hand vs. over-estimation for non-dominant hand) for various target force levels. Therefore, it would be necessary to apply different criteria for each hand to evaluate subjective perception of hand grip exertion tasks.


Assuntos
Lateralidade Funcional/classificação , Força da Mão/fisiologia , Voluntários Saudáveis/psicologia , Percepção , Adulto , Autoavaliação Diagnóstica , Feminino , Lateralidade Funcional/fisiologia , Humanos , Masculino , Pesos e Medidas
7.
Enferm. foco (Brasília) ; 10(1): 87-92, jan. 2019. tab
Artigo em Português | BDENF - Enfermagem | ID: bde-34581

RESUMO

Objetivo: discutir a aplicabilidade do Nursing Activities Score (NAS) à luz da teoria do conforto, relacionando a abrangência das áreas do cuidado descrita neste instrumento aos contextos de conforto propostos na teoria de Kolcaba. Metodologia: estudo teórico, de análise crítica, fundamentado nos princípios da teoria do conforto de Kolcaba. Reflexão: as atividades avaliadas pelo NAS são congruentes com os contextos de conforto propostos na teoria de Kolcaba, podendo contribuir para a promoção do conforto. Nota-se, no entanto, que há menor número de itens para avaliar os contextos socioculturais, psicoespirituais e ambientais. A maioria das atividades valoriza as necessidades orgânicas e biológicas dos pacientes. Conclusão: apesar das atividades do NAS mostrarem-se equivalentes com os contextos de conforto propostos por Kolcaba, não se pode afirmar que os cuidados prestados serão integralmente condizentes aos pressupostos da teoria, necessitando de estudos posteriores para validação clínica. (AU)


Objective: To discuss the applicability of the Nursing Activities Score (NAS) in the light of the Comfort Theory, relating the range of care areas described in this instrument to the comfort contexts proposed in Kolcaba’s theory. Methodology: theoretical study, critical analysis, based on the principles of Kolcaba comfort theory. Reflection: the activities evaluated by the NAS are congruent with the contexts of comfort proposed in the Kolcaba theory, and can contribute to the promotion of comfort. It is noted, however, that there are fewer items to evaluate the sociocultural, psycho-spiritual and environmental contexts. Most activities value the organic and biological needs of patients. Considerations: Although the activities of the NAS are consistent with the comfort contexts proposed by Kolcaba, it cannot be said that the care provided will be fully compatible with the theoretical assumptions, requiring further studies for clinical validation. (AU)


Objetivo: discutir la aplicabilidad del Nursing Activity Score (NAS) a la luz de la Teoría del Confort, relacionando el alcance de las áreas del cuidado descrito en este instrumento a los contextos de confort propuestos en la teoría de Kolcaba. Metodología: estudio teórico, de análisis crítico, fundamentado en los principios de la teoría del confort de Kolcaba. Reflexión: las actividades evaluadas por el NAS son congruentes con los contextos de confort propuestos en la teoría de Kolcaba, pudiendo contribuir a la promoción del confort. Se observa, sin embargo, que hay menor número de ítems para evaluar los contextos socioculturales, psicoespiritual y ambiental. La mayoría de las actividades valoran las necesidades orgánicas y biológicas de los pacientes. Consideraciones: a pesar de que las actividades del NAS se muestran congruentes con los contextos de confort propuestos por Kolcaba, no se puede afirmar que los cuidados prestados sean íntegramente concordantes a los presupuestos de la teoría, necesitando estudios posteriores para validación clínica. (AU)


Assuntos
Humanos , Masculino , Feminino , Teoria de Enfermagem , Administração de Recursos Humanos , Pesos e Medidas , Enfermagem
9.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1015601

RESUMO

Objetivo: Identificar o risco de quedas nos pacientes em observação em um serviço de emergência, por meio da aplicação da Escala de Quedas de Morse. Métodos: Estudo quantitativo, com dados transversais do tipo descritivo, desenvolvido com 30 pacientes internados em um serviço de emergência do Rio Grande do Sul. Os dados foram coletados, entre junho e julho/2018, pela aplicação da Escala de Quedas de Morse. Nas primeiras 12 horas de internação os pacientes foram analisados pela estatística descritiva simples. Resultados: Dos 30 pacientes, 15 eram do sexo feminino e 15 do masculino, com idade entre 30 e 83 anos. Destes, 16 (53,33%) apresentaram alto, 07 (23,33%) médio e 07 (23,33%) baixo risco para quedas. Os fatores de risco mais encontrados foram: terapia endovenosa, diagnóstico secundário e marcha. Conclusão: Os dados representam um alerta aos enfermeiros para o diagnóstico precoce do risco de quedas, prescrição e implementação dos cuidados pela equipe de enfermagem. Assim como a necessidade de implantação de protocolos de prevenção de quedas no serviço de emergência e a realização da avaliação do risco de quedas, diariamente, pelo enfermeiro como uma ferramenta para garantir um cuidado seguro


Objective: To identify the risk of falls in patients under observation in an emergency service, through the application of the Morse Falls Scale. Methods: A quantitative study with descriptive cross-sectional data was developed with 30 patients in emergency service in Rio Grande do Sul. Data were collected from June to July 2018. In the first 12 hours of hospitalization, patients were analyzed by simple descriptive statistics. Results: Of the 30 patients, 15 were female and 15 male, aged between 30 and 83 years. A total of 16 patients (53.33%) presented a high risk of falling, while 07 (23.33%) presented medium risk and 07 presented (23.33%) low risk. The most common risk factors were: intravenous therapy, secondary diagnosis, and gait. Conclusion: The results represent an alert to nurses for the early diagnosis of the risk of falls, prescription, and implementation of care by the nursing team. Furthermore, there is a need to implement protocols for the prevention of falls in the emergency service and to perform fall risk assessments by nurses on a daily basis as a tool to ensure safe care.


Objetivo: Identificar el riesgo de caídas en los pacientes en observación en un servicio de emergencia, por medio de la aplicación de la Escala de Caídas de Morse. Métodos: Estudio cualitativo, descriptivo, desarrollado con 30 pacientes internados en un servicio de emergencia de Rio Grade del Sur. Datos recolectados entre junio y julio de 2018, por medio de la aplicación de la Escala de Caídas de Morse. Las primeras 12 horas de internación de los pacientes fueron analizadas por la estadística descriptiva simple. Resultados: De los 30 pacientes, 15 eran del sexo femenino y 15, masculino, con edad entre 30 y 83 años. De estos, 16 (53,33%) presentaron alto, 07 (23,33%) promedio y 07 (23,33%), bajo riesgo para caídas. Los factores de riesgo más encontrados fueron: terapia endovenosa, diagnóstico secundario y marcha. Conclusión: Los datos representan una alerta a los enfermeros para el diagnóstico precoz del riesgo de caídas, prescripción e implementación de los cuidados por el equipo de enfermería. Así como la necesidad de implantación de protocolos de prevención de caídas en el servicio de emergencia y la realización de la evaluación del riesgo de caídas, a diario, por el enfermero como una herramienta para garantizar un cuidado seguro


Assuntos
Humanos , Masculino , Feminino , Pesos e Medidas , Acidentes por Quedas , Enfermagem , Emergências
10.
Appl Ergon ; 75: 178-183, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30509525

RESUMO

OBJECTIVE: Compare the effectiveness of light, medium and heavy weight Police expandable batons from a performance and a user perception perspective. RATIONALE: Police Officers are required to control combative individuals using less lethal tactics in proportion to the threat they face. Officers need to deliver sufficient force quickly and accurately. As such, it is important to select batons that are optimal for both performance and user experience. METHODS: Eleven active-duty New York Police Department Officers completed static and dynamic strike testing followed by a questionnaire. Six baton types were tested using different weights and lengths. RESULTS: Peak force, dynamic task speed and accuracy were similar between baton types. Peak impulse, forearm muscle activity, and discomfort were higher with the heaviest baton. CONCLUSIONS: Lighter batons can deliver sufficient force to control assailants while imposing lower ergonomic costs and being preferable to the user with no impact on speed or accuracy.


Assuntos
Desenho de Equipamento/psicologia , Ergonomia , Polícia/psicologia , Análise e Desempenho de Tarefas , Percepção de Peso , Adulto , Humanos , Masculino , New York , Percepção , Inquéritos e Questionários , Pesos e Medidas
11.
Endocrinol. diabetes nutr. (Ed. impr.) ; 65(7): 409-417, ago.-sept. 2018. tab
Artigo em Inglês | IBECS | ID: ibc-176127

RESUMO

Background: A long-term diabetic complication, fatigue, which is a direct result of treatment and psychological processes, is a common symptom in diabetic individuals. Aims: To determine the reliability and validity of Functional Assessment of Chronic Illness Treatment-Fatigue Scale in Turkish patients with type 2 diabetes. Study design: A methodological study. Methods: The sample consisted of 133 patients with type 2 diabetes who agreed to participate in the study and met the criteria for the study. Data were collected using the descriptive information form prepared by the researcher and the Scale obtained from FACIT System. The research data were collected by face-to-face interviews with the patients. Language and content validity of the Turkish version of the Scale was provided, Cronbach's Alpha coefficient, test-retest analysis and item analysis methods were used as reliability analysis. Results: The total Cronbach Alpha coefficient of the scale was found to be 0.92. According to the results of factor analysis, unlike the original scale, two sub-dimensions emerged in the Turkish version of the scale. Conclusions: As a result of the validity and reliability analysis of the FACIT-Fatigue Scale, it can be said that it provides psychometric measures that can be used to determine the level of fatigue of type 2 diabetes patients in Turkish society


Antecedentes: La fatiga, una complicación a largo plazo de la diabetes que es consecuencia directa del tratamiento y de procesos psicológicos, es un síntoma frecuente en los diabéticos. Objetivos: Determinar la fiabilidad y la validez de la escala de fatiga de la valoración funcional del tratamiento de enfermedades crónicas (FACIT) en pacientes turcos con diabetes tipo 2. Diseño del estudio: Estudio metodológico. Métodos: La muestra constaba de 133 pacientes con diabetes tipo 2 que aceptaron participar y cumplían los criterios del estudio. Se recogieron datos mediante el impreso informativo descriptivo preparado por el investigador y la escala obtenida del sistema FACIT. Los datos se recogieron en entrevistas personales con los pacientes. Se informa de la validez del idioma y el contenido de la versión turca de la escala, y se utilizaron el coeficiente alfa de Cronbach, el análisis prueba-reprueba y métodos de análisis de ítems para analizar la fiabilidad. Resultados: El coeficiente alfa total de Cronbach de la escala era 0,92. Según los resultados del análisis de factores, a diferencia de la escala original, en la versión turca de la escala surgieron 2 subdimensiones. Conclusiones: Basándose en el resultado de los análisis de validez y fiabilidad de la escala de fatiga de la FACIT, puede afirmarse que proporciona medidas psicométricas que pueden emplearse para determinar el grado de fatiga de los pacientes con diabetes tipo 2 en la sociedad turca


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Fadiga , Doença Crônica/tratamento farmacológico , Pesos e Medidas , Reprodutibilidade dos Testes , Diabetes Mellitus Tipo 2/complicações , Turquia , Inquéritos e Questionários , Reprodutibilidade dos Testes/métodos
12.
Med. clín (Ed. impr.) ; 151(4): 136-140, ago. 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-173864

RESUMO

Fundamento y objetivos: Determinar la utilidad de la estratificación pronóstica empírica para identificar a pacientes con tromboembolia de pulmón (TEP) aguda sintomática y bajo riesgo de complicaciones precoces. Pacientes y métodos: Este estudio incluyó a un total de 154 pacientes consecutivos diagnosticados de TEP aguda sintomática en un hospital universitario terciario. Comparamos la capacidad pronóstica de la escala clínica Pulmonary Embolism Severity Index (PESI), la escala PESI simplificada (PESIs) y la evaluación empírica de: 1) 2médicos adjuntos (uno con y otro sin experiencia en el manejo de pacientes con TEP); 2) un residente de cuarto año de Neumología; 3) un residente de tercer año de Neumología, y 4) un residente de segundo año de Neumología. El evento primario de mal pronóstico fue la mortalidad por todas las causas durante el primer mes después del diagnóstico de la TEP. Resultados: Durante los primeros 30 días después del diagnóstico de la TEP se produjo el fallecimiento de 13 pacientes (8,4%; intervalo confianza [IC] del 95%, 4,1-12,8%). Hubo una tendencia (no estadísticamente significativa) a clasificar más pacientes de bajo riesgo mediante la escala PESI o la evaluación empírica que con la escala PESIs (36,4, 31,3 y 28,6%, respectivamente). No se produjo ningún evento en el grupo de pacientes de bajo riesgo según la escala PESIs. Se detectó una mayor eficacia pronóstica de la estratificación empírica conforme mayor fue la experiencia clínica de los evaluadores (84,6 vs. 92,3%; p = 0,049). Conclusiones: La escala PESIs es la herramienta más eficaz para identificar pacientes con TEP aguda sintomática y bajo riesgo de muerte por todas las causas durante el primer mes de seguimiento. La evaluación pronóstica empírica realizada por médicos experimentados no es menos eficaz que la realizada mediante escalas estandarizadas


Background and objective: To determine the accuracy of clinical gestalt to identify patients with acute symptomatic pulmonary embolism (PE) at low-risk for short-term complications. Patients and methods: This study included a total of 154 consecutive patients diagnosed with acute symptomatic PE in a tertiary university hospital. We compared the prognostic accuracy of the Pulmonary Embolism Severity Index (PESI), the simplified PESI (sPESI), and clinical gestalt of 1) 2senior physicians (one with and one without experience in the management of patients with PE), 2) a fourth-year resident of Pneumology, 3) a third-year resident of Pneumology, and 4) a second-year resident of Pneumology. The primary outcome was all-cause mortality during the first month after the diagnosis of PE. Results: Thirty-day all-cause mortality was 8.4% (13/154; 8.4%; 95% confidence interval [CI], 4.1-12.8%). The PESI and clinical gestalt classified more patients as low-risk, compared to the sPESI (36.4%, 31.3% y 28.6%, respectively). There were no deaths in the sPESI low-risk category (negative predictive value 100%). Prognostic accuracy increased with increasing experience (84.6 vs. 92.3%; P=.049). Conclusions: The sPESI showed the best accuracy at correctly identifying low-risk patients with acute symptomatic PE. Clinical gestalt is not inferior to standardized clinical prediction rules to prognosticate patients with acute PE


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Embolia Pulmonar/mortalidade , Pesos e Medidas , Prognóstico , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/complicações , Enoxaparina/administração & dosagem , Vitamina K/antagonistas & inibidores
13.
Rev. bras. ortop ; 53(4): 441-447, July-Aug. 2018. tab, graf
Artigo em Inglês | LILACS | ID: biblio-959166

RESUMO

ABSTRACT Objective: To evaluate the correlation between the UCLA and Constant-Murley scores in the surgical treatment of rotator cuff tears and proximal humeral fractures (PHF). Methods: Retrospective study evaluating patients submitted to arthroscopic rotator cuff repair and surgical treatment of PHF with 2-year follow-up. Patients were evaluated by the UCLA and Constant-Murley scores in the preoperative period for the rotator cuff repairs, and 3, 6, 12 and 24 months after surgery for both diagnoses. Pearson's correlation coefficient (r) was calculated to measure the degree of correlation between the two clinical scales. Results: We evaluated 109 patients: 54 with rotator cuff tear and 55 with PHF. Twenty-four months after surgical treatment, the scores according to the UCLA and Constant-Murley scores were 32.6 ± 4.0 and 85.0 ± 12.0 for the rotator cuff tears and 30.3 ± 5.3 and 73.8 ± 13.9 for the PHF, demonstrating significant improvements in both, in relation to the initial evaluation (p < 0.001). The scales demonstrated high correlation (r = 0.88, p < 0.001). The scores obtained in the two scales showed high or very high correlation in all the postoperative clinical evaluations (r = 0.79-0.91, p < 0.001). The correlation was high in the preoperative evaluation (r = 0.73, p < 0.001). Conclusion: The UCLA and Constant-Murley scores presented high or very high correlation in the evaluation of surgical treatment of rotator cuff tears and PHF. The correlation in the preoperative evaluation was high.


RESUMO Objetivo: Avaliar a correlação entre as escalas da UCLA e de Constant-Murley no tratamento cirúrgico de roturas do manguito rotador e de fraturas da extremidade proximal do úmero (FEPU). Métodos: Estudo retrospectivo, que avaliou pacientes submetidos ao reparo do manguito rotador por via artroscópica e tratamento cirúrgico de FEPU com dois anos de seguimento. Os pacientes foram avaliados pelas escalas da UCLA e de Constant-Murley no período pré-operatório nas roturas do manguito rotador e após seis, 12 e 24 meses da cirurgia em ambos os diagnósticos. O coeficiente de correlação de Pearson (r) foi calculado para medir o grau de correlação entre as duas escalas clínicas. Resultados: Avaliamos 109 pacientes, 54 com rotura do manguito rotador e 55 com FEPU. Após 24 meses do tratamento cirúrgico, as pontuações pelas escalas da UCLA e da Constant-Murley foram de 32,6 ± 4,0 e 85,0 ± 12,0 nas roturas do manguito rotador e 30,3 ± 5,3 e 73,8 ± 13,9 nas FEPU, com melhoria significativa em ambas em relação à avaliação inicial (p < 0,001). As escalas demostraram alta correlação (r = 0,88, p < 0,001). Em todas as avaliações clínicas pós-operatórias as pontuações obtidas nas duas escalas se correlacionaram de modo alto ou muito alto (r = 0,79 a 0,91, p < 0,001). No pré-operatório a correlação foi alta (r = 0,73, p < 0,001). Conclusão: As escalas da UCLA e de Constant-Murley apresentam uma correlação alta ou muito alta na avaliação do tratamento cirúrgico das roturas do manguito rotador e das FEPU. No pré-operatório a correlação é alta.


Assuntos
Humanos , Masculino , Feminino , Artroscopia , Reabilitação , Ombro , Fraturas do Ombro , Pesos e Medidas , Manguito Rotador
14.
Clin Obes ; 8(4): 258-264, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29852523

RESUMO

Having access to a scale is essential for individuals to engage in self-weighing; however, few studies examine scale access, particularly among low-income individuals. Our objectives were to (i) determine how many public housing residents have access to a scale and (ii) describe their self-weighing habits. We conducted a cross-sectional survey of public housing residents in Baltimore, MD, from August 2014 to August 2015. Participants answered questions about their access to a scale ('yes'/'no') and daily self-weighing habits ('no scale/never or hardly ever' vs. 'some/about half/much of the time/always'). We used t-tests or chi-square tests to examine the association of scale access with respondent characteristics. Overall, 266 adults participated (48% response rate). Mean age was 45 years with 86% women, 95% black and 54% with obesity. Only 32% had access to a scale; however, 78% of those with this access reported engaging in some self-weighing. Residents who lacked access to a scale were younger (P = 0.03), and more likely to be unemployed/disabled (P = 0.01) or food insecure (P < 0.01). While few public housing residents have access to a scale, those who do report daily self-weighing with some regularity. Financial hardship may influence scale access in this population, as potential proxies of this status were associated with no scale access.


Assuntos
Manutenção do Peso Corporal , Acesso aos Serviços de Saúde , Habitação Popular , Pesos e Medidas/instrumentação , Adulto , Idoso , Índice de Massa Corporal , Estudos Transversais , Feminino , Hábitos , Humanos , Masculino , Pessoa de Meia-Idade , Pobreza , Habitação Popular/economia , Recursos Humanos
15.
PLoS One ; 13(5): e0197589, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29791462

RESUMO

Patterns in within-day hive weight data from two independent datasets in Arizona and California were modeled using piecewise regression, and analyzed with respect to honey bee colony behavior and landscape effects. The regression analysis yielded information on the start and finish of a colony's daily activity cycle, hive weight change at night, hive weight loss due to departing foragers and weight gain due to returning foragers. Assumptions about the meaning of the timing and size of the morning weight changes were tested in a third study by delaying the forager departure times from one to three hours using screen entrance gates. A regression of planned vs. observed departure delays showed that the initial hive weight loss around dawn was largely due to foragers. In a similar experiment in Australia, hive weight loss due to departing foragers in the morning was correlated with net bee traffic (difference between the number of departing bees and the number of arriving bees) and from those data the payload of the arriving bees was estimated to be 0.02 g. The piecewise regression approach was then used to analyze a fifth study involving hives with and without access to natural forage. The analysis showed that, during a commercial pollination event, hives with previous access to forage had a significantly higher rate of weight gain as the foragers returned in the afternoon, and, in the weeks after the pollination event, a significantly higher rate of weight loss in the morning, as foragers departed. This combination of continuous weight data and piecewise regression proved effective in detecting treatment differences in foraging activity that other methods failed to detect.


Assuntos
Abelhas , Meio Ambiente , Animais , Conjuntos de Dados como Assunto , Feminino , Modelos Biológicos , Análise de Regressão , Pesos e Medidas
16.
Enferm. foco (Brasília) ; 9(2): 55-61, mai. 2018. tab
Artigo em Português | BDENF - Enfermagem | ID: bde-34069

RESUMO

Feridas afetam a integridade da pele, e quando não prevenidas ou tratadas podem levar a complicações decorrentes da integridade da pele prejudicada, especialmente em Unidades de Terapia Intensiva (UTIs). Atualmente, as escalas de predição de risco disponíveis para esta avaliação e validadas para o português são as de Braden, Waterlow e Norton. Objetivo: determinar qual a escala mais acurada para a avaliação de pacientes criticamente enfermos. Metodologia: Trata-se de uma revisão integrativa, cuja questão norteadora foi: qual escala para predição de risco para LP, disponível e validada para o português é mais acurada para estimar o risco de LP em pacientes criticamente enfermos internados na UTI? A busca dos estudos foi realizada na BVS, PubMed/MedLine e CINAHL. Resultados: Foram encontrados 134 artigos, elegíveis 123 e incluídos 18 na revisão. Conclusão: Os resultados apontam a necessidade da realização de estudos nesta área. (AU)


Wounds affect skin integrity, and when not prevented or treated can lead to complications resulting from impaired skin integrity, especially in intensive care units (ICUs). Currently, the prediction of risk scales available for this evaluation and validated for the Portuguese are Braden, Waterlow and Norton. Objective: to determine what the more accurate scale for the assessment of critically ill. Methodology: it is an integrative review, whose guiding question was: which to scale for risk prediction for LP, available and validated to Portuguese is more accurate for estimating the risk of LP in critically ill hospitalized in ICU? The search of the studies was held at the BVS, PubMed/MedLine and CINAHL. Results: found 134 items, 123 and included 18 eligible in the review. Conclusion: the results show the need of carrying out studies in this area. (AU)


Las heridas afectan la integridad de la piel y cuando no prevenido o Tratado pueden conducir a las complicaciones resultantes de la integridad de la piel deteriorada, especialmente en unidades de cuidados intensivos (UCI). Actualmente, la predicción de las escalas de riesgo disponibles para esta evaluación y validadas para los portugueses son Braden, Waterlow y Norton. Objetivo: determinar la escala que más precisa para la evaluación de estado crítico. Metodología: ¿ es un examen integrador, cuyo rector era: que a la escala de predicción de riesgo de LP, disponible y validado al portugués es más exacta para estimar el riesgo de LP en críticamente enfermos hospitalizados en UCI? La búsqueda de los estudios se realizó en la BVS, PubMed/MedLine y CINAHL. Resultados: elegibles 18 134 artículos encontrados, 123 e incluido en la revisión. Conclusión: los resultados muestran la necesidad de llevar a cabo estudios en esta área. (AU)


Assuntos
Humanos , Masculino , Feminino , Lesão por Pressão , Unidades de Terapia Intensiva , Cuidados Críticos , Pesos e Medidas , Pacientes
17.
J Pediatr Orthop ; 38(5): e292-e295, 2018 May/Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29521936

RESUMO

BACKGROUND: In adults, a relative "safe zone" for lateral approaches to the elbow has been well described in efforts to reduce iatrogenic injury, typically a minimum of 6 cm proximal to the lateral epicondyle. To avoid iatrogenic injury to the radial nerve intraoperatively, we investigated the distance of the nerve from the distal humeral physis in children. METHODS: All patients who had axial and coronal T1-weighted magnetic resonance imagings of the humerus and elbow between 2005 and 2015 were eligible. Patients were excluded if there was any pathology causing significant alteration to the normal anatomy of the distal humerus or surrounding soft tissue. The axial cut in which the radial nerve was positioned along a line passing through the center of the humerus in the transverse plane was identified, and the location of the nerve was marked. This axial cut was cross-referenced with the corresponding coronal view. The distance along the lateral edge of the humerus in a straight line from the marked location of the radial nerve to the distal humeral physis was measured. RESULTS: In total, 21 magnetic resonance imagings of 20 patients met the inclusion criteria. The mean distance of the radial nerve proximally from the distal humeral physis was as follows by age group: below 1-year old=1.7 cm (range, 1.2 to 2.5 cm); 1 to 2-years old=2.8 cm (range, 1.8 to 3.2 cm); 4 to 5-years old=5.3 cm (range, 5.1 to 5.5 cm); 6-years old and above=7.3 cm (range, 6.0 to 9.2 cm). For below 6-years old, when age was multiplied by 1 cm to define a predicted safe zone all radial nerves were found proximal to this. All patients 6 years and above had measurements that fell into the adult range of >6 cm, whereas no patients below 6-years old had measurements in this range. CONCLUSIONS: The distance of the radial nerve proximally from the distal humeral physis can be safely approximated for children below 6 years of age by multiplying patient age in years by 1 cm. By the age of 6 the distance of the radial nerve falls within the adult range (>6 cm). LEVEL OF EVIDENCE: Level III.


Assuntos
Articulação do Cotovelo , Úmero , Complicações Intraoperatórias , Nervo Radial , Fatores Etários , Criança , Pré-Escolar , Articulação do Cotovelo/inervação , Articulação do Cotovelo/patologia , Articulação do Cotovelo/cirurgia , Feminino , Lâmina de Crescimento , Humanos , Úmero/patologia , Úmero/cirurgia , Lactente , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/prevenção & controle , Imagem por Ressonância Magnética/métodos , Masculino , Tamanho do Órgão , Nervo Radial/lesões , Nervo Radial/patologia , Pesos e Medidas
18.
Rev. pesqui. cuid. fundam. (Online) ; 10(1): 167-172, jan.-mar. 2018. tab
Artigo em Inglês, Português | LILACS | ID: biblio-908430

RESUMO

Objetivos: para evaluar el nivel de esperanza de vida y rastrear los riesgos perfil sociodemográfico, sociales y de salud de las personas mayores. Métodos: Estudio transversal realizado en la Universidad Open Mayores (Unati) de Vitória, con una muestra de 52 personas de edad avanzada, con el cuestionario de la caracterización del perfil y la Escala de Esperanza de Herth. Resultados: Se realizaron análisis descriptivos. Prevalecido las mujeres (86,5%), con edades entre 65 y 75 años (26,9% de la muestra), casadas y viudas (38,4%), el 82,6% con enfermedad crónica diagnosticada y esperanza con una puntuación media total de 35,88 (± 4,42). Esta puntuación tenía un índice de esperanza de identificar alta, satisfactoria. Conclusión: Se evidenció la importancia de los grupos comunitarios en la tercera edad y la esperanza se vio como una posible salida del ciclo de sufrimiento y evaluado como una comodidad a las personas de edad, antes de la esencialidad de un envejecimiento saludable, la dignidad y la autonomía.


Objetivos: avaliar o nível de esperança de vida e traçar o perfil sociodemográfico, de saúde e riscos sociais dos idosos. Métodos: Estudo transversal, realizado na Universidade Aberta á Terceira Idade (UnATI) de Vitória/ES, com amostra de 52 idosos, com aplicação do questionário da caracterização do Perfil e da Escala de Esperança de Herth. Resultados: Foram realizadas análises descritivas. Prevaleceu o sexo feminino (86,5%), idosos com 65 a 75 anos (26,9% da amostra), casados e viúvos (38,4 %), 82,6% com doença crônica diagnosticada e a esperança com escore médio total de 35,88 (± 4,42). Este escore se apresentou alto, identificando índice de esperança satisfatório. Conclusão: Evidenciou a importância de grupos de convivência na Terceira Idade e a esperança foi encarada como uma possível saída do ciclo do sofrimento e avaliada como um conforto para a população idosa, perante a essencialidade de um envelhecer com saúde, dignidade e autonomia.


Objectives: to evaluate the level of life expectancy and trace the socio-demographic profile, health and social risks of the elderly. Methods: Cross sectional study, held in the Open University for the Elderly (UnATI), in the city of Vitória/ES, with a sample of 52 elderly, who answered the questionnaire of profile characterizing and The Herth Hope Scale. Results: Descriptive analyzes were performed. Prevailed females (86.5 %), elderly with 65-75 years (26.9 % of the sample), married and widowed (38.4%), 82.6 % with chronic diagnosed disease and the hope had an average total score of 35.88 (± 4.42). This score was high, identifying satisfactory hope indices. Conclusion: It was showed the importance of community groups in the Third Age and the hope was seen as a possible escape from suffering cycle and evaluated as a comfort to the elderly population, before the essentiality of a healthy aging, dignity and autonomy.


Assuntos
Masculino , Feminino , Humanos , Idoso , Promoção da Saúde , Educação de Pacientes como Assunto , Expectativa de Vida Ajustada à Qualidade de Vida , Centros Comunitários para Idosos/tendências , Centros Comunitários para Idosos , Brasil , Universidades , Pesos e Medidas
19.
Rev Bras Enferm ; 71(2): 322-328, 2018 Mar-Apr.
Artigo em Inglês, Português | MEDLINE | ID: mdl-29412289

RESUMO

OBJECTIVE: To validate calf circumference as a technology for assessing muscle mass in the elderly. METHOD: Cross-sectional study with 132 elderly people from Goiânia, Goiás, Brazil. Decreased muscle mass was determined by the skeletal muscle mass index (IME) using Dual Energy X-Ray Absortometry (DEXA). The cutoff circumferences (CC) cutoff points to indicate muscle mass decrease were estimated by ROC curve, sensitivity, specificity and accuracy. RESULTS: The most accurate cut-off points for detecting decreased muscle mass in the elderly were 34 cm for men (sensitivity: 71.5%, specificity: 77.4%) and 33 cm for women (sensitivity: 80.0%; specificity: 84.6%). CONCLUSION: CC can be used as a measure for early identification of muscle mass decrease in routine evaluations of the elderly in primary care.


Assuntos
Extremidade Inferior/patologia , Músculo Esquelético/patologia , Reprodutibilidade dos Testes , Pesos e Medidas/instrumentação , Idoso , Idoso de 80 Anos ou mais , Antropometria/instrumentação , Antropometria/métodos , Composição Corporal/fisiologia , Brasil , Estudos Transversais , Feminino , Humanos , Extremidade Inferior/anatomia & histologia , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/anatomia & histologia , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/normas , Curva ROC
20.
Rev. pesqui. cuid. fundam. (Online) ; 10(1): 167-172, jan.-mar. 2018.
Artigo em Inglês, Português | BDENF - Enfermagem | ID: bde-32259

RESUMO

Objetivos: Para evaluar el nivel de esperanza de vida y rastrear los riesgos perfil sociodemográfico, sociales y de salud de las personas mayores. Métodos: Estudio transversal realizado en la Universidad Open Mayores (Unati) de Vitória, con una muestra de 52 personas de edad avanzada, con el cuestionario de la caracterización del perfil y la Escala de Esperanza de Herth. Resultados: Se realizaron análisis descriptivos. Prevalecido las mujeres (86,5%), con edades entre 65 y 75 años (26,9% de la muestra), casadas y viudas (38,4%), el 82,6% con enfermedad crónica diagnosticada y esperanza con una puntuación media total de 35,88 (± 4,42). Esta puntuación tenía un índice de esperanza de identificar alta, satisfactoria. Conclusión: Se evidenció la importancia de los grupos comunitarios en la tercera edad y la esperanza se vio como una posible salida del ciclo de sufrimiento y evaluado como una comodidad a las personas de edad, antes de la esencialidad de un envejecimiento saludable, la dignidad y la autonomía.(AU)


Objetivos: Avaliar o nível de esperança de vida e traçar o perfil sociodemográfico, de saúde e riscos sociais dos idosos. Métodos: Estudo transversal, realizado na Universidade Aberta á Terceira Idade (UnATI) de Vitória/ES, com amostra de 52 idosos, com aplicação do questionário da caracterização do Perfil e da Escala de Esperança de Herth. Resultados: Foram realizadas análises descritivas. Prevaleceu o sexo feminino (86,5%), idosos com 65 a 75 anos (26,9% da amostra), casados e viúvos (38,4 %), 82,6% com doença crônica diagnosticada e a esperança com escore médio total de 35,88 (± 4,42). Este escore se apresentou alto, identificando índice de esperança satisfatório. Conclusão: Evidenciou a importância de grupos de convivência na Terceira Idade e a esperança foi encarada como uma possível saída do ciclo do sofrimento e avaliada como um conforto para a população idosa, perante a essencialidade de um envelhecer com saúde, dignidade e autonomia.(AU)


Objectives: To evaluate the level of life expectancy and trace the socio-demographic profile, health and social risks of the elderly. Methods: Cross sectional study, held in the Open University for the Elderly (UnATI), in the city of Vitória/ES, with a sample of 52 elderly, who answered the questionnaire of profile characterizing and The Herth Hope Scale. Results: Descriptive analyzes were performed. Prevailed females (86.5 %), elderly with 65-75 years (26.9 % of the sample), married and widowed (38.4%), 82.6 % with chronic diagnosed disease and the hope had an average total score of 35.88 (± 4.42). This score was high, identifying satisfactory hope indices. Conclusion: It was showed the importance of community groups in the Third Age and the hope was seen as a possible escape from suffering cycle and evaluated as a comfort to the elderly population, before the essentiality of a healthy aging, dignity and autonomy.(AU)


Assuntos
Humanos , Masculino , Feminino , Idoso , Expectativa de Vida Ajustada à Qualidade de Vida , Centros Comunitários para Idosos/tendências , Centros Comunitários para Idosos , Promoção da Saúde , Educação de Pacientes como Assunto , Pesos e Medidas , Universidades , Brasil
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA