Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 3.149
Filtrar
1.
PLoS One ; 15(7): e0235510, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32645046

RESUMO

INTRODUCTION: Acquired brain injury (ABI) leads to cognitive deficits in a great variety of cognitive functions. Interventions aimed at reducing such deficits include the use of computer-based cognitive interventions. The present work synthetizes and quantitively analyses the effect of computer-based cognitive interventions in ABI. METHODS: PubMed, Scopus, Web of Science, ProQuest and Ovid databases were searched for randomized controlled trials (RCT) addressing this issue. A total number of 8 randomized-controlled trials were included for systematic review and meta-analysis. Univariate meta-analyses were conducted for every cognitive function, producing aggregates when a study contributed more than one effect size per cognitive domain. RESULTS: Random-effects meta-analyses showed an improvement of Visual and Verbal working memory, while other domains like Attention, Processing speed, Executive functions and Memory were not benefited by the interventions. CONCLUSIONS: Computer-based cognitive interventions might be a beneficial intervention for ABI population to improve Visual and Verbal working memory, although no effect was found in other cognitive domains. Implications and possible future directions of the research are discussed.


Assuntos
Lesões Encefálicas Traumáticas/terapia , Reabilitação Neurológica/métodos , Terapia Assistida por Computador/métodos , Atenção , Lesões Encefálicas Traumáticas/reabilitação , Função Executiva , Humanos , Memória de Curto Prazo , Ensaios Clínicos Controlados Aleatórios como Assunto , Jogos de Vídeo
2.
Cochrane Database Syst Rev ; 5: CD011898, 2020 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-32413166

RESUMO

BACKGROUND: Many people with schizophrenia do not achieve satisfactory improvements in their mental state, particularly the symptom of hearing voices (hallucinations), with medical treatment. OBJECTIVES: To examine the effects of Avatar Therapy for people with schizophrenia or related disorders. SEARCH METHODS: In December 2016, November 2018 and April 2019, the Cochrane Schizophrenia Group's Study-Based Register of Trials (including registries of clinical trials) was searched, review authors checked references of all identified relevant reports to identify more studies and contacted authors of trials for additional information. SELECTION CRITERIA: All randomised clinical trials focusing on Avatar Therapy for people with schizophrenia or related disorders. DATA COLLECTION AND ANALYSIS: We extracted data independently. For binary outcomes, we calculated risk ratio (RR) and 95% confidence intervals (CI), on an intention-to-treat basis. For continuous data, we estimated the mean difference (MD) between groups and 95% CIs. We employed a fixed-effect model for analyses. We assessed risk of bias for included studies and created 'Summary of findings' tables using GRADE. Our main outcomes of interest were clinically important change in; mental state, insight, global state, quality of life and functioning as well as adverse effects and leaving the study early. MAIN RESULTS: We found 14 potentially relevant references for three studies (participants = 195) comparing Avatar Therapy with two other interventions; treatment as usual or supportive counselling. Both Avatar Therapy and supportive counselling were given in addition (add-on) to the participants' normal care. All of the studies had high risk of bias across one or more domains for methodology and, for other risks of bias, authors from one of the studies were involved in the development of the avatar systems on trial and in another trial, authors had patents on the avatar system pending. 1. Avatar Therapy compared with treatment as usual When Avatar Therapy was compared with treatment as usual average endpoint Positive and Negative Syndrome Scale - Positive (PANSS-P) scores were not different between treatment groups (MD -1.93, 95% CI -5.10 to 1.24; studies = 1, participants = 19; very low-certainty evidence). A measure of insight (Revised Beliefs about Voices Questionnaire; BAVQ-R) showed an effect in favour of Avatar Therapy (MD -5.97, 95% CI -10.98 to -0.96; studies = 1, participants = 19; very low-certainty evidence). No one was rehospitalised in either group in the short term (risk difference (RD) 0.00, 95% CI -0.20 to 0.20; studies = 1, participants = 19; low-certainty evidence). Numbers leaving the study early from each group were not clearly different - although more did leave from the Avatar Therapy group (6/14 versus 0/12; RR 11.27, 95% CI 0.70 to 181.41; studies = 1, participants = 26; low-certainty evidence). There was no clear difference in anxiety between treatment groups (RR 5.54, 95% CI 0.34 to 89.80; studies = 1, participants = 19; low-certainty evidence). For quality of life, average Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form (QLESQ-SF) scores favoured Avatar Therapy (MD 9.99, 95% CI 3.89 to 16.09; studies = 1, participants = 19; very low-certainty evidence). No study reported data for functioning. 2. Avatar Therapy compared with supportive counselling When Avatar Therapy was compared with supportive counselling (all short-term), general mental state (Psychotic Symptom Rating Scale (PSYRATS)) scores favoured the Avatar Therapy group (MD -4.74, 95% CI -8.01 to -1.47; studies = 1, participants = 124; low-certainty evidence). For insight (BAVQ-R), there was a small effect in favour of Avatar Therapy (MD -8.39, 95% CI -14.31 to -2.47; studies = 1, participants = 124; low-certainty evidence). Around 20% of each group left the study early (risk ratio (RR) 1.06, 95% CI 0.59 to 1.89; studies = 1, participants = 150; moderate-certainty evidence). Analysis of quality of life scores (Manchester Short Assessment of Quality of Life (MANSA)) showed no clear difference between groups (MD 2.69, 95% CI -1.48 to 6.86; studies = 1, participants = 120; low-certainty evidence). No data were available for rehospitalisation rates, adverse events or functioning. AUTHORS' CONCLUSIONS: Our analyses of available data shows few, if any, consistent effects of Avatar Therapy for people living with schizophrenia who experience auditory hallucinations. Where there are effects, or suggestions of effects, we are uncertain because of their risk of bias and their unclear clinical meaning. The theory behind Avatar Therapy is compelling but the practice needs testing in large, long, well-designed, well-reported randomised trials undertaken with help from - but not under the direction of - Avatar Therapy pioneers.


Assuntos
Alucinações/terapia , Esquizofrenia/terapia , Terapias em Estudo/métodos , Terapia de Exposição à Realidade Virtual/métodos , Adulto , Ansiedade/etiologia , Viés , Intervalos de Confiança , Feminino , Humanos , Análise de Intenção de Tratamento , Masculino , Saúde Mental , Razão de Chances , Pacientes Desistentes do Tratamento/psicologia , Pacientes Desistentes do Tratamento/estatística & dados numéricos , Transtornos Psicóticos/terapia , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Recidiva , Psicologia do Esquizofrênico , Terapias em Estudo/efeitos adversos , Terapia Assistida por Computador/métodos
3.
J Med Internet Res ; 22(3): e15172, 2020 03 23.
Artigo em Inglês | MEDLINE | ID: mdl-32202505

RESUMO

BACKGROUND: Pregnant women with symptoms of depression or anxiety often do not receive adequate treatment. In view of the high incidence of these symptoms in pregnancy and their impact on pregnancy outcomes, getting treatment is of the utmost importance. A guided internet self-help intervention may help to provide more women with appropriate treatment. OBJECTIVE: This study aimed to examine the effectiveness of a guided internet intervention (MamaKits online) for pregnant women with moderate to severe symptoms of anxiety or depression. Assessments took place before randomization (T0), post intervention (T1), at 36 weeks of pregnancy (T2), and 6 weeks postpartum (T3). We also explored effects on perinatal child outcomes 6 weeks postpartum. METHODS: This randomized controlled trial included pregnant women (<30 weeks) with depressive symptoms above threshold (ie, Center for Epidemiological Studies Depression scale [CES-D] >16) or anxiety above threshold (ie, Hospital Anxiety and Depression Scale-Anxiety subscale [HADS-A] >8) or both of them. Participants were recruited via general media and flyers in prenatal care waiting rooms or via obstetricians and midwives. After initial assessment, women were randomized to (1) MamaKits online in addition to treatment as usual or (2) treatment as usual (control condition). MamaKits online is a 5-week guided internet intervention based on problem solving treatment. Guidance was was provided by trained students pursuing a Master's in Psychology. Outcomes were based on a Web-based self-report. Women in the control condition were allowed to receive the intervention after the last assessment (6 weeks postpartum). RESULTS: Of the 159 included women, 79 were randomized to MamaKits online, 47% (79/37) of whom completed the intervention. Both groups showed a substantial decrease in affective symptoms on the CES-D, HADS-A, and Edinburgh Postnatal Depression Scale over time. In the intervention group, affective symptoms decreased more than that in the control group, but between-group effect sizes were small to medium (Cohen d at T3=0.45, 0.21, and 0.23 for the 3 questionnaires, respectively) and statistically not significant. Negative perinatal child outcomes did not differ between the 2 groups (χ21=0.1; P=.78). Completer analysis revealed no differences in outcome between the treatment completers and the control group. The trial was terminated early for reasons of futility based on the results of an interim analysis, which we performed because of inclusion problems. CONCLUSIONS: Our study did show a significant reduction in affective symptoms in both groups, but the differences in reduction of affective symptoms between the intervention and control groups were not significant. There were also no differences in perinatal child outcomes. Future research should examine for which women these interventions might be effective or if changes in the internet intervention might make the intervention more effective. TRIAL REGISTRATION: Netherlands Trial Register NL4162; https://tinyurl.com/sdckjek.


Assuntos
Ansiedade/terapia , Depressão/terapia , Internet/normas , Terapia Assistida por Computador/métodos , Adulto , Feminino , Humanos , Gravidez
4.
PLoS One ; 15(3): e0229379, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32187236

RESUMO

OBJECTIVE: To determine if an internet-based mind/body program would lead to participants experiencing infertility (1) being willing to be recruited and randomized and (2) accepting and being ready to engage in a fertility-specific intervention. Secondary exploratory goals were to examine reduced distress over the course of the intervention and increased likelihood to conceive. METHODS: This was a pilot randomized controlled feasibility trial with a between-groups, repeated measure design. Seventy-one women self-identified as nulliparous and meeting criteria for infertility. Participants were randomized to the internet-based version of the Mind/Body Program for Fertility or wait-list control group and asked to complete pre-, mid- and post-assessments. Primary outcomes include retention rates, number of modules completed, and satisfaction with intervention. Secondary exploratory outcomes sought to provide preliminary data on the impact of the program on distress (anxiety and depression) and self-reported pregnancy rates relative to a quasi-control group. RESULTS: The retention, adherence, and satisfaction rates were comparable to those reported in other internet-based RCTs. Although time between pre- and post-assessment differed between groups, using intent-to-treat analyses, women in the intervention group (relative to the wait-list group) had significant reduction in distress (anxiety, p = .003; depression, p = .007; stress, p = .041 fertility-social, p = .018; fertility-sexual, p = .006), estimated as medium-to-large effect sizes (ds = 0.45 to 0.86). The odds of becoming pregnant was 4.47 times higher for the intervention group participants as compared to the wait-list group, OR 95% CI [1.56, 12.85], p = .005 and occurred earlier. The findings suggest that the research design and program specific to this population are feasible and acceptable. Replication efforts with an active control group are needed to verify distress reduction and conception promotion findings.


Assuntos
Transtornos de Ansiedade/terapia , Depressão/terapia , Infertilidade Feminina/psicologia , Internet/estatística & dados numéricos , Terapias Mente-Corpo/métodos , Estresse Psicológico/terapia , Terapia Assistida por Computador/métodos , Adulto , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Educação de Pacientes como Assunto , Projetos Piloto , Grupos de Autoajuda
5.
J Clin Neurosci ; 72: 93-97, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31937503

RESUMO

Multiple sclerosis (MS) is characterized by central nervous system lesions that lead to neurological dysfunctions including fatigue, depression and anxiety. MS is affecting almost 2.3 million people around the world, with the significant highest prevalence in the North America. MS also affects different cognitive abilities, such as attention, memory and executive functions. Furthermore, a significant impairment in verbal fluency and naming abilities in patients with MS has been reported. RehaCom, is a software that has improvement effects on cognitive functions. The goal of this research is to investigate the effect of treatment with RehaCom on verbal performance in patients with MS. To select the participants, 60 patients with MS who referred to our clinic were chosen randomly and divided into Control (n = 30) and Experimental (n = 30) groups. The participants in the experimental group were treated by RehaCom software for 10 sessions during 5 weeks (2 sessions per week and each session was 1 h). Controlled Oral Word Association Test (COWAT) and California Verbal Learning Test - Second Edition (CVLT-II), were used to assess verbal performance (verbal fluency, and verbal learning and memory) at weeks 0 (baseline), 5 (post-test) and 10 (follow-up). The results showed that, treatment with RehaCom improved verbal performance in patient with MS, at both post-test and follow-up stages. In conclusion, treatment with RehaCom cognitive rehabilitation software can improve verbal fluency, and verbal learning and memory in patient with MS, possibly by affecting the brain regions involved in language performance.


Assuntos
Cognição/fisiologia , Memória/fisiologia , Esclerose Múltipla/terapia , Software , Terapia Assistida por Computador/métodos , Aprendizagem Verbal/fisiologia , Adulto , Atenção/fisiologia , Função Executiva/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/psicologia , Testes Neuropsicológicos , Distribuição Aleatória , Resultado do Tratamento
6.
Anesth Analg ; 130(2): 382-390, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31306243

RESUMO

BACKGROUND: Many hospitals have implemented surgical safety checklists based on the World Health Organization surgical safety checklist, which was associated with improved outcomes. However, the execution of the checklists is frequently incomplete. We reasoned that aviation-style computerized checklist displayed onto large, centrally located screen and operated by the anesthesia provider would improve the performance of surgical safety checklist. METHODS: We performed a prospective before and after observational study to evaluate the effect of a computerized surgical safety checklist system on checklist performance. We created checklist software and translated our 4-part surgical safety checklist from wall poster into an aviation-style computerized format displayed onto a large, centrally located screen and operated by the anesthesia provider. Direct observers recorded performance of the first part of the surgical safety checklist that was initiated before anesthetic induction, including completion of each checklist item, provider participation and distraction level, resistance to use of the checklist, and the time required for checklist completion before and after checklist system implementation. We compared trends of the proportions of cases with 100% surgical safety checklist completion over time between pre- and postintervention periods and assessed for a jump at the start of intervention using segmented logistic regression model while controlling for potential confounding variables. RESULTS: A total of 671 cases were observed before and 547 cases were observed after implementation of the computerized surgical safety checklist system. The proportion of cases in which all of the items of the surgical safety checklist were completed significantly increased from 2.1% to 86.3% after the computerized checklist system implementation (P < .001). Before computerized checklist system implementation, 488 of 671 (72.7%) cases had <75% of checklist items completed, whereas after a computerized checklist system implementation, only 3 of 547 (0.5%) cases had <75% of checklist items completed. CONCLUSIONS: The implementation of a computerized surgical safety checklist system resulted in an improvement in checklist performance.


Assuntos
Anestesia/normas , Lista de Checagem/normas , Competência Clínica/normas , Pessoal de Saúde/normas , Procedimentos Cirúrgicos Operatórios/normas , Terapia Assistida por Computador/normas , Adulto , Idoso , Anestesia/métodos , Aviação/normas , Lista de Checagem/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Salas Cirúrgicas/métodos , Salas Cirúrgicas/normas , Estudos Prospectivos , Procedimentos Cirúrgicos Operatórios/métodos , Terapia Assistida por Computador/métodos
7.
Phys Ther ; 100(2): 217-224, 2020 02 07.
Artigo em Inglês | MEDLINE | ID: mdl-31680158

RESUMO

In the wake of globalization, proliferation of digital technologies (DTs) is rapidly changing many activities across sectors, including influencing health to "go digital." Harnessing opportunities of DTs can be a pathway for delivery of health services, such as community-based rehabilitation (CBR) to the vulnerable groups of populations, particularly those in countries with low resources where health systems are weak and experiencing a deficit of trained health workers necessary to effectively deliver a full spectrum of health services. This perspective explored how some DTs can be leveraged in delivery of CBR services in rural and remote areas of countries with low resources. This is described based on information access and exchange, social satisfaction, shortages of rehabilitation workforce, professional development, and capacity building. However, since seizing advantages of DTs can inevitably be associated with spillovers and limitations, including needs prioritization, skills and language limitations, internet addiction and censorship issues, professionalism and ethical dilemmas, and sustainability, if proper measures are not taken, a caution is made. Moreover, as DTs are revolutionizing various activities across sectors, including health, this is not meant as a substitute for traditional health care activities, including those delivered through CBR, but rather to augment their delivery in settings with low resources and elsewhere.


Assuntos
Serviços de Saúde Comunitária/métodos , Países em Desenvolvimento , Pessoas com Deficiência/reabilitação , Redes Sociais Online , Terapia Assistida por Computador/métodos , Acesso à Informação , Comportamento Aditivo/epidemiologia , Fortalecimento Institucional , Barreiras de Comunicação , Alfabetização Digital , Educação Continuada/métodos , Troca de Informação em Saúde , Pessoal de Saúde/estatística & dados numéricos , Humanos , Internacionalidade , Intervenção Baseada em Internet , Idioma , Satisfação Pessoal , Papel Profissional , Controle Social Formal , Desenvolvimento Sustentável
8.
Women Health ; 60(1): 99-112, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31057080

RESUMO

Postpartum depression (PD) is a frequently occurring disorder that affects the cognitive, emotional and social development of a mother after childbirth. Online cognitive-behavioral therapy (OCBT) is used as therapy for PD symptomatology, but no clear evidence is available about its effectiveness. The goal of this meta-analysis was to identify, synthesize and analyze the empiric studies regarding the OCBT effectiveness for PD. A search for indexed articles and unpublished theses between 2000 and 2017 was made in Google Scholar, Proquest, ScienceDirect, APA PsycNet, Cochrane, SpringerLink, Medline, PubMed and Dissertations Abstract International. Six studies were selected based on the following eligibility criteria: (1) papers published in English, (2) papers about PD, (3) papers that empirically investigated the effectiveness of OCBT for PD, and (4) papers comparing an experimental group with a control group. Exclusion criteria included investigations of PD for: (1) mothers diagnosed with another severe disorder and (2) mothers with deceased children and (3) women with an age below 18 years old. This meta-analytic study identified a moderate significant size-effect (d = - 0.54, 95% CI [-0.716; -0.423]) of the OCBTs in reducing PD, and practical implications and limitations are discussed.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Depressão Pós-Parto/terapia , Terapia Assistida por Computador/métodos , Feminino , Humanos
10.
Cornea ; 39(1): 56-62, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31356422

RESUMO

PURPOSE: To evaluate custom fast cross-linking (cfCXL) treatment of keratoconus. METHODS: "Custom fast cross-linking" or "cfCXL" is a keratoconus treatment algorithm featuring no epithelial disruption, 15 minutes of corneal presoaking with a riboflavin-vitamin E TPGS solution, and a 370-nm ultraviolet A radiation beam centered on the most highly curved corneal region. Ultraviolet A radiation beam fluence, total energy, and exposure time are significantly less than those in the Dresden protocol. In this study, refraction, spectacle-corrected distance visual acuity, Kmax, and corneal hysteresis were monitored in 81 eyes of 81 patients for 7 years with 100% follow-up. Pretreatment Kmax and patient age averaged 53.01 ± 4.87 D and 25.9 ± 4.7 years, respectively. RESULTS: Average refractive cylinder magnitude was reduced by 26.1% at 1 month postoperatively and by 44.2% at 7 years postoperatively. Logarithm of the minimum angle of resolution average spectacle-corrected distance visual acuity (best spectacle-corrected distance visual acuity) improved from +0.26 ± 0.34 (20/36.4) to +0.15 ± 0.23 (20/28.25), +0.05 ± 0.20 (20/22.4), and +0.06 ± 0.20 (20/22.96) at 1 month, 1 year, and 7 years postoperatively, respectively. Best spectacle-corrected distance visual acuity improved in 54.3%, 74.1%, 84.0%, 87.7%, 84.0%, 84.0%, and 82.7% of patients at postoperative months 1, 3, 6, 12, 24, 48, and 84, respectively. Kmax did not increase in 96.3% of patients at 1 month, 97.5% at 1 year, and 98.8% at 7 years postoperatively, with average corneal apex flattening at 1 month and 7 years of -2.79 ± 1.70 D and -4.00 ± 2.40 D, respectively. CONCLUSIONS: Custom fast cross-linking, epi-on, rapid, narrowed beam apex-centered treatment of keratoconus with riboflavin-vitamin E TPGS produced a significant, rapid, and lasting cone progression stoppage, astigmatism reduction, and visual acuity improvement.


Assuntos
Colágeno/uso terapêutico , Córnea/diagnóstico por imagem , Paquimetria Corneana/métodos , Topografia da Córnea/métodos , Reagentes para Ligações Cruzadas/uso terapêutico , Ceratocone/tratamento farmacológico , Fotoquimioterapia/métodos , Adulto , Feminino , Seguimentos , Humanos , Ceratocone/patologia , Masculino , Fármacos Fotossensibilizantes/uso terapêutico , Estudos Prospectivos , Refração Ocular , Riboflavina/uso terapêutico , Terapia Assistida por Computador/métodos , Fatores de Tempo , Raios Ultravioleta , Acuidade Visual
11.
Am J Med ; 133(6): 750-756.e2, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31862329

RESUMO

PURPOSE: The purpose of this research was to evaluate the impact of an outpatient computerized advisory clinical decision support system (CDSS) on adherence to guideline-recommended treatment for heart failure, atrial fibrillation, and hyperlipidemia. METHODS: Twenty care teams (109 clinicians) in a primary care practice were cluster-randomized to either access or no access to an advisory CDSS integrated into the electronic medical record. For patients with an outpatient visit, the CDSS determined if they had heart failure with reduced ejection fraction, hyperlipidemia, or atrial fibrillation; and if so, was the patient receiving guideline-recommended treatment. In the intervention group, an alert was visible in the medical record if there was a discrepancy between current and guideline-recommended treatment. Clicking the alert displayed the treatment discrepancy and recommended treatment. Outcomes included prescribing patterns, self-reported use of decision aids, and self-reported efficiency. The trial was conducted between May 1 and November 15, 2016, and incorporated 16,310 patient visits. RESULTS: The advisory CDSS increased adherence to guideline-recommended treatment for heart failure (odds ratio [OR] 7.6, 95% confidence interval [CI], 1.2, 47.5) but had no impact in atrial fibrillation (OR 0.94, 95% CI 0.15, 5.94) or hyperlipidemia (OR 1.1, 95% CI 0.6, 1.8). Clinicians with access to the CDSS self-reported greater use of risk assessment tools for heart failure (3.6 [1.1] vs 2.7 [1.0], mean [standard deviation] on a 5-point scale) but not for atrial fibrillation or hyperlipidemia. The CDSS did not impact self-assessed efficiency. The overall usage of the CDSS was low (19%). CONCLUSIONS: A computerized advisory CDSS improved adherence to guideline-recommended treatment for heart failure but not for atrial fibrillation or hyperlipidemia.


Assuntos
Doenças Cardiovasculares/terapia , Sistemas de Apoio a Decisões Clínicas , Terapia Assistida por Computador , Fibrilação Atrial/terapia , Feminino , Fidelidade a Diretrizes , Insuficiência Cardíaca/terapia , Humanos , Hiperlipidemias/terapia , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde/métodos , Terapia Assistida por Computador/métodos
12.
Actas esp. psiquiatr ; 47(6): 236-246, nov.-dic. 2019. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-188261

RESUMO

La depresión es, desde hace ya unos años, un problema de salud pública a nivel mundial reconocido por la OMS. La prevalencia actual de esta patología, en los servicios de Atención Primaria, se estima en 19,5% a nivel mundial y en 20,2% en España. Además, las políticas y protocolos de intervención actuales están suponiendo unos importantes costes, tanto personales como económicos, para las personas que padecen este trastorno, así como para la sociedad en general. Por otro lado, los índices de recaídas tras las intervenciones farmacológicas que se aplican actualmente y la falta de una atención especializada eficaz en los servicios de salud mental, ponen de relieve la necesidad de desarrollar nuevas estrategias terapéuticas más accesibles y coste-efectivas. En esta línea, una de las propuestas que se están investigando en diferentes partes del mundo es el diseño y evaluación de protocolos terapéuticos aplicados a través de las Tecnologías de la Información y la Comunicación, especialmente, a través de internet y de programas de ordenador. Por ello, el objetivo de este trabajo es presentar la situación actual de la atención en España respecto a la utilización de estas intervenciones para el tratamiento de la depresión en Atención Primaria. La conclusión principal es que, aunque existe evidencia científica sobre la eficacia de estos programas, todavía existen barreras importantes que dificultan su implantación en el sistema público, y, por otro lado, la necesidad de desarrollar estudios de implementación que faciliten la transición de la investigación a la práctica clínica


Currently, depression is a global health problem recognized by the WHO. The prevalence of this pathology in Primary Care is estimated at 19.5% worldwide, and 20.2% in Spain. In addition, the current intervention policies and protocols involve significant costs, both personal and economic, for people suffering from this disorder, as well as for society in general. On the other hand, the relapse rates after pharmacological interventions that are currently applied and the lack of effective specialized attention in mental health services reflect the need to develop new therapeutic strategies that are more accessible and profitable. Therefore, one of the proposals that are being investigated in different parts of the world is the design and evaluation of therapeutic protocols applied through Information and Communication Technologies, especially through the Internet and computer programs. The objective of this work was to present the current situation in Spain regarding the use of these interventions for the treatment of depression in Primary Care. The main conclusion is that although there is scientific evidence on the effectiveness of these programs, there are still important barriers that hinder their application in the public system, and also the need to develop implementation studies that facilitate the transition from research to clinical practice


Assuntos
Humanos , Terapia Cognitivo-Comportamental/métodos , Acesso à Internet , Atenção Primária à Saúde , Telemedicina/métodos , Terapia Assistida por Computador/métodos , Terapia Cognitivo-Comportamental/economia , Estilo de Vida , Atenção Plena , Ensaios Clínicos Controlados Aleatórios como Assunto , Sorriso/psicologia , Espanha , Telemedicina/economia , Terapia Assistida por Computador/economia
13.
Actas Esp Psiquiatr ; 47(6): 236-46, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31869424

RESUMO

Currently, depression is a global health problem recognized by the WHO. The prevalence of this pathology in Primary Care is estimated at 19.5% worldwide, and 20.2% in Spain. In addition, the current intervention policies and protocols involve significant costs, both personal and economic, for people suffering from this disorder, as well as for society in general. On the other hand, the relapse rates after pharmacological interventions that are currently applied and the lack of effective specialized attention in mental health services reflect the need to develop new therapeutic strategies that are more accessible and profitable. Therefore, one of the proposals that are being investigated in different parts of the world is the design and evaluation of therapeutic protocols applied through Information and Communication Technologies, especially through the Internet and computer programs. The objective of this work was to present the current situation in Spain regarding the use of these interventions for the treatment of depression in Primary Care. The main conclusion is that although there is scientific evidence on the effectiveness of these programs, there are still important barriers that hinder their application in the public system, and also the need to develop implementation studies that facilitate the transition from research to clinical practice.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Depressão/terapia , Intervenção Baseada em Internet , Atenção Primária à Saúde , Terapia Assistida por Computador/métodos , Terapia Cognitivo-Comportamental/economia , Transtorno Depressivo Maior/terapia , Humanos , Intervenção Baseada em Internet/economia , Estilo de Vida , Atenção Plena , Ensaios Clínicos Controlados Aleatórios como Assunto , Sorriso/psicologia , Espanha , Telemedicina/economia , Telemedicina/métodos , Terapia Assistida por Computador/economia
15.
Medicine (Baltimore) ; 98(42): e17632, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626148

RESUMO

This study retrospectively analyzed the feasible effectiveness of ultrasound-guided acupotomy (USGAP) for the treatment of frozen shoulder (FS). A total of 36 patients with FS were analyzed in this retrospective study. All 36 patients received extracorporeal shock-wave therapy (ESWT). In addition, 18 of them also underwent USGAP intervention and were assigned to a treatment group, while the other 18 patients did not receive such intervention and were assigned to a control group. The primary efficacy endpoint was pain intensity, as measured by the Numeric Rating Scale (NRS). The secondary efficacy endpoint was assessed by the score of shoulder pain and disability index (SPADI). Furthermore, the adverse events were also documented during the treatment period. All efficacy endpoints were measured after the treatment. After treatment, patients who received USGAP exerted better efficacy endpoints in pain relief, as measured by NRS scale (P < .01), and shoulder disorders, as evaluated by SPADI (P < .01), than subjects who did not receive USGAP. Additionally, no adverse events occurred in either group. The results of this study indicated that USGAP may be used for the treatment of FS effectively. More studies are still needed to warrant the present results.


Assuntos
Terapia por Acupuntura/métodos , Bursite/terapia , Tratamento por Ondas de Choque Extracorpóreas/métodos , Terapia Assistida por Computador/métodos , Ultrassonografia/métodos , Bursite/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Retrospectivos , Resultado do Tratamento
16.
NeuroRehabilitation ; 45(2): 285-290, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31498141

RESUMO

BACKGROUND: Parkinson's disease (PD) is a neurodegenerative disease due to dopamine deficiency in the basal ganglia, leading to motor symptoms such as bradykinesia, tremor, stiffness, and postural instability. This disease may also be associated with a broad spectrum of non-motor symptoms. More than 24% of patients with PD have one or more cognitive symptoms. OBJECTIVE: To evaluate the effects of computer-assisted cognitive rehabilitation (CACR) in Parkinson's disease (PD). METHODS: Sixty patients with PD were enrolled in this study and were randomly divided into control group (CG) and experimental group (EG). Each participant was evaluated at the beginning (T0) and at the end of training (T1). The CG underwent standard cognitive training (SCT) while EG performed CACR using the ERICA platform, aimed at improving several cognitive domains. In both the group, each training consisted of 3 sessions a week, each of these lasting sixty minutes, for eight weeks. RESULTS: Although both the groups had significant improvement after CR, we observed more significant changes in the EG, especially concerning attention, orientation and visual-spatial domains. CONCLUSIONS: Our data demonstrate that CACR is more effective than SCT in improving visual-spatial and executive deficits, in patients affected by PD.


Assuntos
Cognição , Função Executiva , Reabilitação Neurológica/métodos , Doença de Parkinson/reabilitação , Comportamento Espacial , Terapia Assistida por Computador/métodos , Atenção , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reabilitação Neurológica/instrumentação , Terapia Assistida por Computador/instrumentação
17.
J Nerv Ment Dis ; 207(11): 951-957, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31503184

RESUMO

We explored the adherence to a home-delivered, computer-based, cognitive remediation protocol in a first-episode psychosis outpatient cohort. Seventeen patients underwent a cognitive training protocol for 6 months using an online platform accessible from their home under the supervision of a qualified neuropsychologist. Neuropsychological, psychopathological, and functional data were collected at baseline and postintervention, whereas qualitative appraisal of the intervention was assessed monthly. Overall, participants' evaluation of the program was positive. This was reflected in a good adherence rate with 12 (70%) of 17 patients completing 80% of the prescribed sessions. Exploratory analysis revealed significant improvements in sustained attention (p = 0.020) and verbal memory (p = 0.018). A decrease in negative symptoms and an improvement on the Clinical Global Impression were also found (p = 0.009). We believe these are encouraging results to further explore the adopted delivery approach, which could facilitate access to cognitive training earlier and to a larger group of patients.


Assuntos
Remediação Cognitiva/métodos , Intervenção Baseada em Internet , Internet , Transtornos Psicóticos/psicologia , Transtornos Psicóticos/terapia , Terapia Assistida por Computador/métodos , Adolescente , Adulto , Remediação Cognitiva/tendências , Feminino , Humanos , Internet/tendências , Intervenção Baseada em Internet/tendências , Masculino , Testes Neuropsicológicos , Projetos Piloto , Transtornos Psicóticos/diagnóstico , Terapia Assistida por Computador/tendências , Adulto Jovem
18.
Psychiatry Res Neuroimaging ; 292: 41-46, 2019 10 30.
Artigo em Inglês | MEDLINE | ID: mdl-31521942

RESUMO

Previous studies have reported that cognitive remediation therapy (CRT) improves cognitive deficits in patents with schizophrenia. However, few studies have focused on the underlying structural alterations in the brain following Vocational Cognitive Ability Training by the Japanese Cognitive Rehabilitation Program for Schizophrenia (VCAT-J). In this study, we analyzed changes in diffusion tensor imaging parameters in 31 patients with schizophrenia after 12 weeks of intervention consisting of standard treatment alone or standard treatment plus VCAT-J, in order to determine the effect of the latter on white matter microstructural plasticity. Cognitive function was evaluated using the Japanese version of the Brief Assessment of Cognition in Schizophrenia (BACS-J) scale. The CRT group exhibited significant improvements in verbal fluency and composite BACS-J scores, relative to the treatment-as-usual (TAU) group. In addition, the CRT group exhibited significantly increased fractional anisotropy (FA) values, along with significantly decreased radial (RD) and mean diffusivity (MD) values, in the posterior lobe of the left cerebellum. Changes in RD and MD values were negatively correlated with changes in BACS-J composite scores. These suggest that VCAT-J might mediate improvements in myelin sheath composition in the posterior lobe of the left cerebellum, which may have been associated with improvements in cognitive function.


Assuntos
Cerebelo/diagnóstico por imagem , Disfunção Cognitiva/diagnóstico por imagem , Remediação Cognitiva/métodos , Esquizofrenia/diagnóstico por imagem , Terapia Assistida por Computador/métodos , Adulto , Cerebelo/fisiologia , Cognição/fisiologia , Disfunção Cognitiva/psicologia , Disfunção Cognitiva/terapia , Imagem de Difusão por Ressonância Magnética/métodos , Imagem de Tensor de Difusão/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Esquizofrenia/terapia , Psicologia do Esquizofrênico
19.
Curr Cardiol Rep ; 21(10): 127, 2019 09 13.
Artigo em Inglês | MEDLINE | ID: mdl-31520271

RESUMO

PURPOSE OF REVIEW: The goal of this paper is to review present knowledge regarding preventive and antitachycardia pacing algorithms, aimed to reduce atrial fibrillation (AF) burden in patients when pacing is indicated. RECENT FINDINGS: Reactive antitachycardia pacing (ATP), the new generation of ATP, is significantly associated with a reduced risk of AF. In patients with indication for pacing and history of AF, pacemakers endowed with atrial preventive pacing and atrial ATP combined with managed ventricular pacing proved superior to standard dual-chamber pacing. Managed ventricular pacing is an algorithm that minimizes unnecessary right ventricular pacing. Progression to persistent AF is prevented by ventricular pacing minimization in patients with normal PR interval. The synergistic effect of pacemakers that combine atrial preventive pacing with reactive ATP and with algorithms that minimize ventricular pacing can reduce AF incidence and decrease the combined endpoint of permanent AF, hospital admissions, and mortality.


Assuntos
Fibrilação Atrial/terapia , Bradicardia/terapia , Estimulação Cardíaca Artificial/métodos , Marca-Passo Artificial , Terapia Assistida por Computador/métodos , Algoritmos , Fibrilação Atrial/complicações , Fibrilação Atrial/mortalidade , Bradicardia/complicações , Bradicardia/mortalidade , Estimulação Cardíaca Artificial/efeitos adversos , Átrios do Coração , Humanos , Resultado do Tratamento
20.
J Autism Dev Disord ; 49(12): 5047-5062, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31512152

RESUMO

Individuals with autism spectrum disorders (ASD) often present with difficulty in sustaining engagement, attention, and have disruptive behavior in classroom settings. Without appropriate intervention, these challenging behaviors often persist and negatively impact educational outcomes. Self-monitoring is a well-supported evidence-based practice for addressing challenging behaviors and improving pro-social behaviors for individuals with ASD. Self-monitoring procedures utilizing a handheld computer-based technology is an unobtrusive and innovative way of implementing the intervention. A withdrawal design was employed to assess the effectiveness of a technologically-delivered self-monitoring intervention (I-Connect) in improving on-task and task completion behaviors and decreasing disruptive behavior with four adolescents with ASD. Results demonstrated improvements in on-task and task completion behaviors across all four participants and disruptive behavior improved for two participants.


Assuntos
Transtorno Autístico/reabilitação , Terapia Comportamental/métodos , Computadores de Mão , Terapia Assistida por Computador/métodos , Adolescente , Terapia Comportamental/instrumentação , Feminino , Humanos , Masculino , Comportamento Problema , Comportamento Social , Terapia Assistida por Computador/instrumentação
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA