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1.
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde | ID: lis-LISBR1.1-46804

RESUMO

Ministro da Saúde assume presidência do conselho da Stop TB, organização internacional que atua para eliminar a tuberculose. SUS ofertará nova formulação para o tratamento em crianças


Assuntos
Tuberculose , Qualidade de Vida , Tuberculose/prevenção & controle
2.
Z Psychosom Med Psychother ; 65(3): 224-238, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31476994

RESUMO

App-controlled feedback devices can support sustainability of weight loss. Multicentre QUANT-study shows additional weight loss and gain of QoL via multiple feedback-devices in OPTIFAST®52-program Objective: Are three app-controlled feedback devices, tested against a simple pedometer in a weight reduction program, supporting sustainable therapy success and quality of life (QoL)? Methods: In this multi-centre randomised controlled study adults with obesity (n = 89, m = 46.5 years, women n = 54), achieved high weight loss (from 42.7 kg/m² to 35.2 kg/m²) while completing the first three month of the OPTIFAST®52-program. Thereafter the intervention group (IG) used feedback devices (BIA scale, blood pressure monitor, step counter), the control group a mechanical pedometer without app for another year. Intention-to-treat analysis (ITT) and As-treated analysis (AT) were carried out. Results: Feedback devices had a positive effect on fat-loss and secondary study objectives like QoL, leading to a better sustainability of these improvements. Participants in IG (AT for t2-t0) had improvements for Waist-to-Height-ratio (WHtR) and physically and mentally quality of life. Conclusion: The results are presumably based on an increase in self-efficacy and the experience of control. Future studies should be preceded by a pilot study to analyse acceptance problems.


Assuntos
Manutenção do Peso Corporal , Retroalimentação , Aplicativos Móveis , Obesidade/terapia , Qualidade de Vida , Perda de Peso , Programas de Redução de Peso/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
3.
Z Psychosom Med Psychother ; 65(3): 257-271, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31476995

RESUMO

Experience of disease, relationship and sexuality in patients with COPD Objectives: We aimed to determine the impacts of chronic obstructive pulmonary disease (COPD) on the patient's relationship and sexuality. Methods: In a multicentric study 105, 52 of them female, non-selected COPD patients who were married or in a partnership were interviewed about their partnership and sexuality. Results: Average age was 64.1 ± 9.2 years. Patients with a more severe COPD had a lower Self-Illness-Separation (SIS), i. e. they reveal significantly higher burden of suffering. Life satisfaction and satisfaction with partnership, sexuality and sexual intercourse has decreased significantly since the diagnosis (p < 0.05). Desire and frequency to be sexually active have also decreased (p < 0.001). 61 % of the respondents felt increasingly dependent from their partner. Conclusion: The results underline that patients have a stage-dependent emotional distance to their illness, the partnership develops in direction of dependency, and sexuality deteriorates with increasing severity of the COPD. The PRISM test proved to be a great way to illustrate this development and to start a conversation with the patients about it. COPD patients and their partners should be referred to the potential impact of the disease on their partnership and sexuality and should be supported in their potential solutions considering gender-specific aspects.


Assuntos
Casamento/psicologia , Satisfação Pessoal , Doença Pulmonar Obstrutiva Crônica/psicologia , Qualidade de Vida , Sexualidade/psicologia , Idoso , Feminino , Humanos , Entrevistas como Assunto , Pessoa de Meia-Idade
4.
Prax Kinderpsychol Kinderpsychiatr ; 68(6): 488-502, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31480942

RESUMO

Quality of Life and Behavioral Problems of Unaccompanied Minor Refugees in Child Care Facilities Unaccompanied minor refugees (UMR) who arrive in Germany are generally placed in institutional child care facilities. UMR are a very burdened group, however other children and adolescents in institutional care are burdened as well, and their quality of life is often reduced. The aim of the current study was thus to compare quality of life and behavioral problems of UMR in child care facilities with those of other resident adolescents. For a total of 50 UMR, data regarding behavioral problems was available, for 41 UMR ratings on quality of life, both from external assessments. Two parallel comparison samples of other adolescents in the same institutional care facilities were drawn with adolescents with and without a migration background. Results show that in general, UMR show fewer behavioral problems than the other two groups, especially in externalizing behavior. For internalizing behavior, no differences were evident. For quality of life, no differences could be found between the three groups of inhabitants in institutional care. This indicates that the same factors determining quality of life are present in all three groups, but that the underlying mental problems are different in UMR than in other adolescents. Thus, staff in institutional care should possibly work differently with these group of adolescents than with other inhabitants and should be educated respectively.


Assuntos
Cuidado da Criança , Menores de Idade/psicologia , Comportamento Problema , Qualidade de Vida , Refugiados/psicologia , Adolescente , Criança , Cuidado da Criança/organização & administração , Alemanha , Instalações de Saúde , Humanos
5.
Prax Kinderpsychol Kinderpsychiatr ; 68(6): 525-539, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31480945

RESUMO

Quality of Life in Children with Down Syndrome from Parental Point of View Parents of 42 children with Down syndrome (mean age 9 years) report on their child's quality of life (physical, emotional and social domain). The KINDL-R was used as a proxy-report measure. Quality of life correlated negatively with behavioral symptoms (SDQ), but did not vary between children in mainstreamed or special schools. Regression analysis identified the child's behavioral symptoms and parental stress - assessed when the children had reached the age of five - as significant predictors of quality of life assessed four years later.


Assuntos
Síndrome de Down/psicologia , Pais/psicologia , Qualidade de Vida , Inquéritos e Questionários , Criança , Pré-Escolar , Humanos , Procurador , Estresse Psicológico
6.
Zhonghua Yi Xue Za Zhi ; 99(32): 2516-2520, 2019 Aug 27.
Artigo em Chinês | MEDLINE | ID: mdl-31484279

RESUMO

Objective: To evaluate the clinical effects of functional neck dissection (FND) and supraomohyoid neck dissection (SOND) in patients with cN0/N1 oral squamous cell carcinoma (OSCC). Methods: A total of 210 patients with stage cN0/N1 OSCC underwent FND and SOND between January 2012 and May 2015 were retrospectively reviewed, among which, 147 patients were male and 63 were female, with an age range of 23-82 years and mean age of (62.2±10.2) years. There were 112 and 98 patients in FND and SOND groups, respectively. The follow-up data included cervical lymph node metastasis, movement of shoulder joint, great auricular nerve function, recurrence rate of cervical lymph nodes. Results: There was no significant difference in gender, age, tumor location, T stage, N stage, histological grades between the two groups (all P>0.05). Compared to patients in FND group, the activities of shoulder joint and earlobe numbness improved significantly in SOND group. Of the 210 patients, 17 patients (8.1%) had cervical recurrence, with 9 patients (8.0%) in FND group and 8 patients (8.2%) in SOND group. No significant difference was observed for neck recurrence between the two groups (P=0.973). Conclusion: SOND can be safely performed in cN0 or cN1 OSCC patients, which avoids major complications of FND, and improves postoperative quality of life in those patients.


Assuntos
Carcinoma de Células Escamosas , Neoplasias Bucais , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/cirurgia , Feminino , Humanos , Linfonodos , Masculino , Pessoa de Meia-Idade , Neoplasias Bucais/cirurgia , Esvaziamento Cervical , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Qualidade de Vida , Estudos Retrospectivos , Adulto Jovem
7.
Adv Exp Med Biol ; 1148: 279-322, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31482504

RESUMO

Hypophosphatasia (HPP) is an inherited disorder that affects bone and tooth mineralization characterized by low serum alkaline phosphatase. HPP is caused by loss-of-function mutations in the ALPL gene encoding the protein, tissue-nonspecific alkaline phosphatase (TNSALP). TNSALP is expressed by mineralizing cells of the skeleton and dentition and is associated with the mineralization process. Generalized reduction of activity of the TNSALP leads to accumulation of its substrates, including inorganic pyrophosphate (PPi) that inhibits physiological mineralization. This leads to defective skeletal mineralization, with manifestations including rickets, osteomalacia, fractures, and bone pain, all of which can result in multi-systemic complications with significant morbidity, as well as mortality in severe cases. Dental manifestations are nearly universal among affected individuals and feature most prominently premature loss of deciduous teeth. Management of HPP has been limited to supportive care until the introduction of a TNSALP enzyme replacement therapy (ERT), asfotase alfa (AA). AA ERT has proven to be transformative, improving survival in severely affected infants and increasing overall quality of life in children and adults with HPP. This chapter provides an overview of TNSALP expression and functions, summarizes HPP clinical types and pathologies, discusses early attempts at therapies for HPP, summarizes development of HPP mouse models, reviews design and validation of AA ERT, and provides up-to-date accounts of AA ERT efficacy in clinical trials and case reports, including therapeutic response, adverse effects, limitations, and potential future directions in therapy.


Assuntos
Fosfatase Alcalina , Terapia de Reposição de Enzimas , Hipofosfatasia/terapia , Animais , Humanos , Camundongos , Qualidade de Vida
8.
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde | ID: lis-LISBR1.1-46747

RESUMO

A Organização Mundial da Saúde estima que, em 2050, a população mundial com idade superior a 60 anos chegue a 2 bilhões. Isso representa um quinto da população mundial! Com o aumento da estimativa de vida vem um grande desafio: como envelhecer saudável?


Assuntos
Qualidade de Vida , Exercício
9.
Univ. salud ; 21(2): 113-118, mayo-ago. 2019. tab, graf
Artigo em Espanhol | LILACS, COLNAL | ID: biblio-1004848

RESUMO

Resumen Introducción: La calidad de vida se define como un estado de bienestar físico, social, emocional, espiritual, intelectual y ocupacional que le permite al individuo satisfacer apropiadamente sus necesidades; un grado de adaptación a su propia condición y a su medio, en función de su estado de salud, sus carencias y del soporte que recibe para suplirlas. Objetivo: Describir la calidad de vida desde el ámbito social en el que se desarrollan los adultos mayores en el Estado de Guerrero, México. Materiales y métodos: Investigación cuantitativa de corte transversal y analítico, la muestra fue probabilística, se incluyeron 75 adultos mayores de 65 años y más, residentes de asilo, casa de día y localidad rural; el criterio de selección aplicado fue la firma previa del consentimiento informado. Se utilizó el Cuestionario sociodemográfico y Cuestionario de Salud SF-36 versión 2 española Health Survey, constituido por preguntas agrupadas con sus respectivos ítems. Resultados: El 80% de los adultos mayores encuestados manifestó mala calidad de vida. Conclusiones: Los adultos mayores guerrerenses presentan porcentajes altos de problemas físicos, emocionales, y sociales, que dan origen a una mala perspectiva de su salud y vida.


Abstract Introduction: Quality of life is defined as a state of social, emotional, spiritual, intellectual and occupational wellbeing. Quality of life allows individuals to properly satisfy their needs and reach a level of adaptation to their own conditions and environments according to their health status, limitations and the support they receive to supplement them. Objective: To describe the quality of life of elderly adults in the State of Guerrero-Mexico, taking into account the social context where they live. Materials and methods: Quantitative research using a cross-sectional and analytical approach. The sample was probabilistic, with 75 adults older than or equal to 65 years of age, who were residents of asylums, day houses or rural areas. The applied selection criterion was their signature of the informed consent form. We used the sociodemographic questionnaire and the Spanish version 2 of the SF-36 Health Survey questionnaire that contains questions grouped within their respective items. Results: 80% of the older adults manifested a poor quality of life. Conclusions: Elderly adults from Guerrero displayed high percentages of physical, emotional and social problems, which ultimately lead to poor health and life perspectives.


Assuntos
Idoso , Idoso de 80 Anos ou mais , Qualidade de Vida , Adulto , Percepção
10.
Univ. salud ; 21(2): 127-131, mayo-ago. 2019.
Artigo em Espanhol | LILACS, COLNAL | ID: biblio-1004850

RESUMO

Resumen Introducción: El índice de masa corporal (IMC) se asocia inversamente a la frecuencia de exacerbaciones en pacientes con enfermedad pulmonar obstructiva crónica (EPOC); sin embargo, esta puede variar según el contexto. Objetivo: Cuantificar la asociación entre el IMC y la frecuencia de exacerbaciones en pacientes en Santa Marta, Colombia. Materiales y métodos: Estudio transversal de adultos con EPOC. Se calculó el IMC y la frecuencia de exacerbaciones se estimó a partir de la clasificación GOLD de estado global. Resultados: Participaron 292 pacientes entre 49 y 95 años; 61,6% eran hombres. Los IMC se observaron entre 12,8 y 40,2 (media=24,2; DE=4,5) distribuidos en 21 pacientes (7,2%) con desnutrición; 153 (52,4%), saludables; y 118 (40,4%), sobrepeso-obesidad. Un total de 146 pacientes (53,4%) se clasificaron GOLD A o B (exacerbaciones no frecuentes); y 136 pacientes (46,6%), GOLD C o D (exacerbaciones frecuentes). El 85,7% de los pacientes con desnutrición presentaron exacerbaciones frecuentes comparado con 51,6% en pacientes con peso saludable y 33,1% en pacientes con sobrepeso-obesidad (OR=0,18; IC95% 0,05-0,66 para peso saludable y OR=0,08; IC95% 0,02-0,29 para sobrepeso-obesidad frente a desnutrición). Conclusiones: El IMC presenta una relación inversa con la frecuencia de exacerbaciones en pacientes con EPOC de Santa Marta, Colombia.


Abstract Introduction: Body mass index (BMI) is inversely related to the exacerbation frequency in patients with chronic obstructive pulmonary disease (COPD). However, this relationship may vary depending on the context. Objective: To quantify the association of BMI with exacerbation frequency in patients from Santa Marta-Colombia. Materials and methods: A cross-sectional study of adults with COPD. We calculated the BMIs, and the exacerbation frequencies were estimated using the Global initiative for Chronic Obstructive Lung Disease (GOLD) classification. Results: 292 patients aged between 49-95 years were included. From those, 180 (61.6%) were male, 153 (52.4%) were healthy, 21 (7.2%) showed malnutrition, and 118 (40.4%) were overweight/obese patients. The observed IMCs were between 12.8 and 40.2 (median=24.2; SD=4.5). Whereas 156 patients (53,4%) were classified as GOLD A or B (infrequent exacerbations), 136 of them (46.6%) were GOLD C of D (frequent exacerbations). 85,7% of the patients with malnutrition showed frequent exacerbations, compared to both patients with healthy weight (51,6%) and overweight/obese patients (33.1%) (OR=0.18; CI95% 0.05-0.66 for healthy weight and OR=0.08; CI95% 0.02-0.29 for overweight/obesity, both compared to patients with malnutrition). Conclusions: BMI is inversely correlated with exacerbation frequency in patients with COPD from Santa Marta-Colombia.


Assuntos
Doença Pulmonar Obstrutiva Crônica , Qualidade de Vida , Índice de Massa Corporal , Estudos Transversais
11.
Univ. salud ; 21(2): 176-187, mayo-ago. 2019. tab
Artigo em Espanhol | LILACS, COLNAL | ID: biblio-1004856

RESUMO

Resumen Introducción: La Evaluación de Desempeño (ED) permite el desarrollo personal-profesional y contribuye al mejoramiento de la Calidad de Vida Laboral (CVL) del trabajador. Posibilita la identificación de fortalezas, genera procesos de autoevaluación y mejoramiento en el desarrollo organizacional y su competitividad. Objetivo: Definir el concepto de evaluación de desempeño y evaluar sus efectos en la calidad de vida laboral del trabajador en algunos sectores durante los últimos 10 años. Materiales y métodos: Revisión sistemática de la literatura, como estudio integrativo, observacional y retrospectivo, en el cual se combinaron investigaciones que examinan la misma temática. Se revisaron 55 artículos publicados en las bases de datos Redalyc, SciELO, ScienceDirect y Dialnet. Resultados: Se presentan los criterios de selección, definición, relación entre CVL y ED abordados en los sectores de salud, educación y organizacional. Conclusiones: La ED reconoce el aporte del trabajador al logro de los objetivos organizacionales, teniendo en cuenta la productividad, el desarrollo y la CVL de los colaboradores.


Abstract Introduction: A Performance evaluations (PE) promotes personal-professional development and contributes to the improvement of the Quality of Work Life (QWL) of employees. A PE also enables the identification of strengths, generates self-evaluation processes and improves organizational development and competitiveness. Objective: To define the concept of performance evaluation and evaluate its effects on the quality of work life of employees from some sectors, during the last 10 years. Materials and methods: A systematic literature review using an integrative, observational and retrospective approach that included research studies sharing the same scope. We reviewed 55 articles published in databases such as Redalyc, SciELO, ScienceDirect and Dialnet. Results: We present and discuss the selection criteria, definition, and association between QWL and PE related to health, education and organizational sectors. Conclusions: The PE recognizes the contribution of the employee to the achievement of the organizational objectives and it takes into consideration the productivity, development and maintenance of the QWL of coworkers.


Assuntos
Qualidade de Vida , Desempenho Psicomotor , Avaliação Educacional , Descrição de Cargo
12.
Int. j. cardiovasc. sci. (Impr.) ; 32(4): 391-395, July-Aug. 2019. graf
Artigo em Inglês | LILACS | ID: biblio-1012351

RESUMO

Prior statements have recommended restriction from competitive sports participation for all athletes with ICDs. Recent data, however, suggests that many athletes can participate in sports without adverse events. In the ICD Sports Registry, 440 athletes, aged 8-60 years, 77 of which were high-level interscholastic athletes, who had continued to practice sports, were prospectively followed for 4 years, with no deaths or failures to defibrillate during practice, and no injuries related to arrhythmia or shock during sports. Shocks did occur, for ventricular and supraventricular arrhythmias. While more athletes received shocks during physical activity than at rest, there were no differences between competition or practice, versus other physical activity. Programming with higher rate cut-offs and longer durations was associated with fewer inappropriate shocks, with no increase in syncope. Based on this study, current recommendations now state that returning to competition may be considered for an athlete with an ICD. In considering this decision, the underlying disease and type of sport should be discussed, and shared decision-making between doctor, patient, and often family, is critical


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Esportes , Desfibriladores Implantáveis , Atletas , Qualidade de Vida , Esportes , Síncope , Doenças Cardiovasculares/mortalidade , Exercício , Morte Súbita Cardíaca/prevenção & controle , Eletrocardiografia/métodos
13.
Int. j. cardiovasc. sci. (Impr.) ; 32(4): 418-427, July-Aug. 2019. tab, ilus
Artigo em Inglês | LILACS | ID: biblio-1012337

RESUMO

Erectile dysfunction (ED) is a highly prevalent problem that affects the quality of life, prognosis and survival of patients with heart failure (HF). In the management of ED, physical exercise is a therapeutic strategy that reduces disease-related symptoms and optimizes drug use. However, the repercussions of physical exercise on ED in individuals with HF still need to be elucidated. In this sense, the objective of this study was to evaluate the effects of physical exercise on erectile function (EF) in HF patients. This was a systematic review conducted according to PRISMA guidelines. Patients with HF, male and ejection fraction ≤ 45% were submitted to physical exercise of different modalities. The search for scientific articles was conducted in the electronic databases (PubMed, LILACS, Cochrane-Library, Science Direct) from the inception until October 2018, according to the MeSH dictionary descriptors, which were suitable for all databases. Results: Three studies were analyzed, includinng 99 male subjects, age ranging from 53 years (± 7.48) to 58 years (± 12). Seventy subjects were submitted to a physical exercise program and 29 were in the control group. In all studies, physical exercise showed positive results in the management of ED regardless of erectile dysfunction (ED) classification status and intensity of exercise used. It was concluded that physical exercise of different intensities was considered an effective therapeutic intervention to improve EF in individuals with HF and ED


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Idoso , Exercício , Insuficiência Cardíaca/fisiopatologia , Disfunção Erétil , Qualidade de Vida , Volume Sistólico , Idoso , Doenças Cardiovasculares , Aptidão Física , Tratamento Farmacológico
14.
Rev. bras. oftalmol ; 78(4): 233-238, July-Aug. 2019. tab, graf
Artigo em Português | LILACS | ID: biblio-1013691

RESUMO

Resumo Objetivo: Avaliar a relação custo-utilidade do tratamento inicial com laser ou medicamentos do glaucoma primário de ângulo aberto (GPAA) no Brasil, considerando de um lado os custos totais e de outro lado o impacto na qualidade de vida dos pacientes. Métodos: O estudo foi realizado com base em um modelo de Markov, onde uma coorte teórica de portadores de GPAA em estágio inicial foi gerada. Os parâmetros usados no modelo foram obtidos na literatura e incluíram: custos médicos diretos (consultas, exames, tratamento); custos não médicos diretos (gasto com hospedagem, transporte, alimentação, acompanhante); custos indiretos (relacionados à incapacidade para o trabalho); valores de utilidade (qualidade de vida medida em QALY - quality-adjusted life year); e probabilidade de transição entre os estágios de saúde. Três estratégias de tratamento foram testadas no modelo: (1) sem tratamento; (2) tratamento inicial com colírios; (3) tratamento inicial com trabeculoplastia a laser. A medida de desfecho foi a razão de custo-utilidade incremental (RCUI). A robustez do modelo foi testada através de análise de sensibilidade. Resultados: As estratégias (2) e (3) de tratamento inicial do GPAA geraram ganhos em qualidade de vida em relação à (1) no Brasil. Iniciar o tratamento com laser gerou ganho médio de 1 QALY, enquanto que com medicamentos propiciou um ganho de 2 QALYs em média. Dentre as três estratégias testadas, a estratégia (2) foi a custo-efetiva e foi dominante sobre as demais, pois foi ao mesmo tempo a mais barata e a mais efetiva. Conclusão: Tanto a trabeculoplastia a laser quanto os medicamentos como tratamentos primários do GPAA inicial geraram ganhos significativos de qualidade de vida. A estratégia de se iniciar o tratamento com medicações foi custo-efetiva, quando se considera os custos totais. A alternativa de tratamento inicial através de trabeculoplastia a laser não foi custo-efetiva.


Abstract Objective: To evaluate the cost-utility relation of the initial treatment with laser or primary open-angle glaucoma medications (PLA) in Brazil, considering on the one hand the total costs and on the other side the impact on patients' quality of life. Methods: The study was performed based on a Markov model, where a theoretical cohort of early-stage GPAA carriers was generated. The parameters used in the model were obtained in the literature and included: direct medical costs (consultations, examinations, treatment); direct non-medical costs (accommodation, transportation, meals, companions); indirect costs (related to incapacity for work); utility values (quality of life measured in QALY - quality-adjusted life year); and probability of transition between stages of health. Three treatment strategies were tested in the model: (1) without treatment; (2) initial treatment with eye drops; (3) initial treatment with laser trabeculoplasty. The measure of outcome was the incremental cost-utility ratio (RCUI). The robustness of the model was tested through sensitivity analysis. Results: The strategies (2) and (3) of the initial treatment of POAG generated gains in quality of life in relation to (1) in Brazil. Initiating the laser treatment generated an average gain of 1 QALY, whereas with medication it gave a gain of 2 QALYs on average. Among the three strategies tested, strategy (2) was cost-effective and was dominant over the other strategies, since it was at the same time the cheapest and the most effective strategy. Conclusion: Both laser trabeculoplasty and medications as primary treatments of early-stage POAG have generated significant gains in quality of life. The strategy of starting treatment with medications was cost-effective, whereas laser trabeculoplasty strategy was not cost-effective, when non-medical costs (direct and indirect) are included.


Assuntos
Qualidade de Vida , Glaucoma de Ângulo Aberto/tratamento farmacológico , Glaucoma de Ângulo Aberto/terapia , Análise Custo-Benefício , Terapia a Laser , Brasil
15.
Anticancer Res ; 39(8): 4237-4242, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31366511

RESUMO

AIM: To define safety and efficacy of a palliative, short-course accelerated radiation therapy for symptomatic locally advanced primary pelvic cancer. MATERIALS AND METHODS: A phase II trial was planned based on the minimax Simon's two-stage design. A total of 18 Gy in 4.5 Gy/fraction administered twice a day was delivered (SHARON). Pain and quality of life were recorded according to the Visual Analogue self-assessment and the cancer linear analog scales (CLAS), respectively. RESULTS: Twenty-five patients were enrolled in the study. The most frequent baseline symptoms were pain (48%), bleeding (40%), bleeding/pain (8%), and intestinal sub-occlusion (4%). The overall palliative response rate was 96.0%, with a median palliative duration of 6 months. An improvement of quality-of-life indices (well-being, fatigue, and ability to perform daily activities) was noted in 64.0%, 36.0%, and 48.0% of patients, respectively. CONCLUSION: The SHARON regimen was well tolerated and effective in the palliative treatment of patients with locally advanced pelvic cancer. Based on these results, a multicentric prospective phase III trial is ongoing to compare this regimen with traditional 2-week radiotherapy treatment.


Assuntos
Cuidados Paliativos , Neoplasias Pélvicas/radioterapia , Lesões por Radiação/patologia , Radioterapia/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Fracionamento da Dose de Radiação , Feminino , Humanos , Masculino , Dose Máxima Tolerável , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias Pélvicas/patologia , Pelve/patologia , Pelve/efeitos da radiação , Qualidade de Vida , Dosagem Radioterapêutica
16.
Bone Joint J ; 101-B(8): 941-950, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31362549

RESUMO

AIMS: The EuroQol five-dimension (EQ-5D) questionnaire is a widely used multiattribute general health questionnaire where an EQ-5D < 0 defines a state 'worse than death' (WTD). The aim of this study was to determine the proportion of patients awaiting total hip arthroplasty (THA) or total knee arthroplasty (TKA) in a health state WTD and to identify associations with this state. Secondary aims were to examine the effect of WTD status on one-year outcomes. PATIENTS AND METHODS: A cross-sectional analysis of 2073 patients undergoing 2073 THAs (mean age 67.4 years (sd 11.6; 14 to 95); mean body mass index (BMI) 28.5 kg/m2 (sd 5.7; 15 to 72); 1253 female (60%)) and 2168 patients undergoing 2168 TKAs (mean age 69.3 years (sd 9.6; 22 to 91); BMI 30.8 kg/m2 (sd 5.8; 13 to 57); 1244 female (57%)) were recorded. Univariate analysis was used to identify variables associated with an EQ-5D score < 0: age, BMI, sex, deprivation quintile, comorbidities, and joint-specific function measured using the Oxford Hip Score (OHS) or Oxford Knee Score (OKS). Multivariate logistic regression was performed. EQ-5D and OHS/OKS were repeated one year following surgery in 1555 THAs and 1700 TKAs. RESULTS: Preoperatively, 391 THA patients (19%) and 263 TKA patients (12%) were WTD. Multivariate analysis identified preoperative OHS, deprivation, and chronic obstructive pulmonary disease in THA, and OKS, peripheral arterial disease, and inflammatory arthropathy in TKA as independently associated with WTD status (p < 0.05). One year following arthroplasty EQ-5D scores improved significantly (p < 0.001) and WTD rates reduced to 35 (2%) following THA and 53 (3%) following TKA. Patients who were WTD preoperatively achieved significantly (p < 0.001) worse joint-specific Oxford scores and satisfaction rates one year following joint arthroplasty, compared with those not WTD preoperatively. CONCLUSION: In total, 19% of patients awaiting THA and 12% awaiting TKA for degenerative joint disease are in a health state WTD. Although specific comorbidities contribute to this, hip- or knee-specific function, mainly pain, appear key determinants and can be reliably reversed with an arthroplasty. Cite this article: Bone Joint J 2019;101-B:941-950.


Assuntos
Artroplastia de Quadril/psicologia , Artroplastia do Joelho/psicologia , Indicadores Básicos de Saúde , Osteoartrite do Quadril/psicologia , Osteoartrite do Joelho/psicologia , Qualidade de Vida/psicologia , Listas de Espera , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Osteoartrite do Quadril/cirurgia , Osteoartrite do Joelho/cirurgia , Satisfação do Paciente , Resultado do Tratamento , Adulto Jovem
17.
Stud Health Technol Inform ; 264: 1839-1840, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438369

RESUMO

Patient-reported outcomes measure patients' views of their health-related quality of life. With the increasing interest and usage of PRO's in the world, Sheba Medical Center is the pioneer in the field in Israel looking at the potential value in PRO implementation in routine practice as a quality improvement tool together with the opportunity to help drive changes in healthcare delivery. The PRO implementation process involves the multi-disciplinary ward or clinic staff in order to engage them and transform the process into a work routine. The collection methods and usage differ from one clinical area to another and require cultural adaptation in each area. Adjusted reporting and usage during patient encounter assist to improve patient enrolment and provide better and more accurate outcomes for the patient and the medical center.


Assuntos
Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Hospitais , Humanos , Israel
18.
Surg Clin North Am ; 99(5): 815-821, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31446910

RESUMO

Palliative care is an interdisciplinary field that focuses on optimizing quality of life for patients with serious, life-limiting illnesses and includes aggressive management of pain and symptoms; psychological, social, and spiritual support; and discussions of advance care planning, including treatment decision making and complex care coordination. Early palliative care is associated with increased quality of life, decreased symptom burden, decreased health care expenditures, and improved caregiver outcomes. This article discusses integrating interdisciplinary palliative care into surgical practice, and some current models of using and expanding palliative care skill sets in surgery, including training initiatives for both physicians and nurses.


Assuntos
Cuidados Paliativos/organização & administração , Equipe de Assistência ao Paciente , Assistência Perioperatória , Doença Crônica , Humanos , Qualidade de Vida , Assistência Terminal
19.
Surg Clin North Am ; 99(5): 885-898, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31446916

RESUMO

This article provides an overview of key palliative care considerations for management of patients with wounds and ostomies. Ostomy formation is indicated for a variety of intestinal conditions. Specifics of ostomy management, impact on quality of life, and patient perspectives can be complicated. Wound ostomy and continence nursing professionals play a central role in the successful management of this patient population.


Assuntos
Colostomia , Ileostomia , Humanos , Comunicação Interdisciplinar , Cuidados Paliativos , Medicina Paliativa , Qualidade de Vida , Especialidades de Enfermagem , Derivação Urinária
20.
BMC Ophthalmol ; 19(1): 181, 2019 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-31409325

RESUMO

BACKGROUND: Retinitis pigmentosa (RP) are a group of incurable and inherited eye conditions, and the leading cause of inherited blindness in people under the age of 60. The aim of this systematic review and meta-synthesis was to present a comprehensive overview of qualitative papers on experiences and coping strategies of adults living with RP, and how these influence quality of life. METHODS: A pre-registered search strategy was applied in nine databases and 12 articles met eligibility criteria. Studies included were from Australia, Brazil, Ireland, Netherlands, Republic of Korea, United Kingdom, and USA. The overall sample was based on 126 people with RP (ages ranging from 18 to 85; at least 65 female). Principles of meta-ethnography were used to synthesise the articles revealing five higher-level meta-themes. RESULTS: The five higher-level meta-themes were, 1) managing identity: making sense of RP, managing autonomy and independence; 2) living with RP: practical and emotional issues; 3) experiences with healthcare professionals and other social support; 4) adaptive and maladaptive coping strategies; and 5) impact of RP on work and career. A conceptual model was developed by grouping higher-level meta-themes as intra- and inter-individual factors and how they may be implicated with coping strategies and quality of life. CONCLUSIONS: This review established factors that can be explored as potential psychosocial influences in the relationship between coping strategies and quality of life in people with RP. Further understanding of these factors and mechanisms can help inform intervention development to support adaptive coping in living with RP and positively impact quality of life.


Assuntos
Adaptação Psicológica/fisiologia , Qualidade de Vida/psicologia , Retinite Pigmentosa/psicologia , Acuidade Visual , Humanos
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