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1.
Rev. neurol. (Ed. impr.) ; 75(5): 117-122, Septiembre 1, 2022.
Artigo em Espanhol | IBECS | ID: ibc-207868

RESUMO

Introducción: La miastenia gravis (MG) se caracteriza por debilidad del músculo esquelético, que es la presentación inicial más común, debilidad ocular con ptosis asimétrica y diplopía binocular. Alrededor del 19-50% de las gestantes con MG experimentará un empeoramiento de la enfermedad. El objetivo de este artículo fue revisar la información actual respecto a la interrelación entre la MG y el embarazo, así como su abordaje. Desarrollo: Se realizó una búsqueda bibliográfica en bases de datos como PubMed, ScienceDirect, SciELO, Google Scholar y medRxiv. Se incluyeron artículos originales, de revisión, series e informes de casos comprendidos entre 2013 y 2022. Conclusiones: La MG no afectaría significativamente al embarazo; sin embargo, el embarazo puede exacerbar la enfermedad, principalmente durante el primer trimestre o después del parto. El abordaje de la gestante con MG debe ser multidisciplinario e implica el ajuste del tratamiento farmacológico y un seguimiento constante.(AU)


Introduction: Myasthenia gravis is characterized by skeletal muscle weakness, the most common initial presentation includes ocular weakness with asymmetric ptosis and binocular diplopia. Around 19-50% of pregnant women with myasthenia gravis will experience a worsening of the disease. The objective of this article was to review the current information regarding the interrelation between MG and pregnancy; as well as its approach. Development: Bibliographic search in databases such as PubMed, ScienceDirect, SciELO, Google Scholar and medRxiv. Original articles, reviews, series and case reports between 2013 and 2022 are included. Conclusions: Myasthenia gravis would not significantly effects on pregnancy; however, pregnancy can exacerbate the disease, especially during the first trimester or after delivery. The approach to pregnant women with myasthenia gravis must be multidisciplinary and involves the adjustment of pharmacological treatment and constant monitoring.(AU)


Assuntos
Humanos , Feminino , Gravidez , Gravidez , Complicações na Gravidez , Farmacologia Clínica , Gerenciamento Clínico , Parto Obstétrico , Miastenia Gravis/complicações , Miastenia Gravis/diagnóstico , Miastenia Gravis/terapia , Bases de Dados Bibliográficas , Neurologia
2.
Sci Rep ; 12(1): 15708, 2022 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-36127404

RESUMO

The lack of generalizability of deep learning approaches for the automated diagnosis of pathologies in Wireless Capsule Endoscopy (WCE) has prevented any significant advantages from trickling down to real clinical practices. As a result, disease management using WCE continues to depend on exhaustive manual investigations by medical experts. This explains its limited use despite several advantages. Prior works have considered using higher quality and quantity of labels as a way of tackling the lack of generalization, however this is hardly scalable considering pathology diversity not to mention that labeling large datasets encumbers the medical staff additionally. We propose using freely available domain knowledge as priors to learn more robust and generalizable representations. We experimentally show that domain priors can benefit representations by acting in proxy of labels, thereby significantly reducing the labeling requirement while still enabling fully unsupervised yet pathology-aware learning. We use the contrastive objective along with prior-guided views during pretraining, where the view choices inspire sensitivity to pathological information. Extensive experiments on three datasets show that our method performs better than (or closes gap with) the state-of-the-art in the domain, establishing a new benchmark in pathology classification and cross-dataset generalization, as well as scaling to unseen pathology categories.


Assuntos
Endoscopia por Cápsula , Diagnóstico por Computador , Gastroenteropatias , Endoscopia por Cápsula/métodos , Gerenciamento Clínico , Gastroenteropatias/diagnóstico por imagem , Gastroenteropatias/terapia , Humanos
3.
J Surg Oncol ; 126(5): 913-920, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36087077

RESUMO

Spine metastases are a significant source of morbidity in oncology. Treatment of these spine metastases largely remains palliative, but advances over the past 50 years have improved the effectiveness of interventions for preserving functional status and obtaining local control while minimizing morbidity. While the field began with conventional external beam radiation as the primary treatment modality, a series of paradigm shifts and technological advances in the 2000s led to a change in treatment patterns. These advances allowed for an increased role of surgical decompression of neural elements, a shift in the stereotactic capabilities of radiation oncologists, and an improved understanding of the radiobiology of metastatic disease. The result was improved local control while minimizing treatment morbidity. These advances fit within the larger framework of metastatic spine tumor management known as the Neurologic, Oncologic, Mechanical, and Systemic disease decision framework. This dynamic framework takes into account the neurological function of the patient, the radiobiology of their tumor, their degree of mechanical instability, and their systemic disease control and treatment options to help determine appropriate interventions based on the individual patient. Herein, we describe the 50-year evolution of metastatic spine tumor management and the impact of various advances on the field.


Assuntos
Radiocirurgia , Neoplasias da Coluna Vertebral , Terapia Combinada , Descompressão Cirúrgica , Gerenciamento Clínico , Humanos , Neoplasias da Coluna Vertebral/patologia
4.
Sante Publique ; 34(1): 87-96, 2022.
Artigo em Francês | MEDLINE | ID: mdl-36102095

RESUMO

INTRODUCTION: One of the main recommendations to improve chronic asthmatic patients' adhesion to their treatment is the implementation of a coordinated care pathway aiming at facilitating disease management by the patient while meeting his needs and expectations. PURPOSE OF RESEARCH: To study through a critical literature review and a short survey how this care pathway can be set up and adapted to the Belgian context. RESULTS: A model including the three healthcare levels in Belgium was developed. The first level is mainly formed by general practitioners while the second and third are centralized around a structure called asthma clinic. This latter would provide a full asthma assessment, its chronic follow-up and treatment for severe asthma. Roles of healthcare professionals working with the asthmatic patient were identified and described. This model is discussed in the light of the present Belgian situation according to different plans: asthma management, effective interdisciplinary communication, advanced nurse practitioner's role implementation. CONCLUSION: Although the Belgian context is currently not suitable enough for allowing this new nursing function to arise, our model lays the foundations of a system which is adapted to complexity of Belgium, follows from validated experiences on international scene, and offers an answer to chronic asthmatic patient's needs and expectations.


Assuntos
Asma , Asma/terapia , Bélgica , Procedimentos Clínicos , Gerenciamento Clínico , Humanos , Inquéritos e Questionários
5.
Front Public Health ; 10: 977563, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36117598

RESUMO

Background: Post-retirement migrants are rapidly increasing in China, but the impact of internal migration on hospitalization among older adults remains under-researched. Understanding this impact is essential for health policies development and improvement. This study aims to identify the most vulnerable population, evaluate the association between migration and hospitalization, and discuss potential causes of the association. Methods: 14,478 older adults were extracted from the 2018 to 2019 Chinese Longitudinal Healthy Longevity Survey (CLHLS) database and divided into four groups according to migration experience and age at migration: non-migrants, pre-adulthood migrants, pre-retirement migrants, and post-retirement migrants. Post-retirement migrants were key research subjects. We employed Pearson's chi-square test to compare group differences in outcome and covariates, and multivariate logistic regression analysis to examine the association between migration and hospitalization by regions and chronic conditions. Results: Significant intergroup differences were observed in demographic characteristics, socioeconomic factors, health habits, and health-related factors. Post-retirement migrants displayed following characteristics: female predominance (61.6%; 1,472/2,391), tending toward urban areas (80.9%; 1,935/2,391), and the highest prevalence rate of chronic disease (46.7%; 1,116/2,391). Urban migrants in eastern China were more likely to be hospitalized (OR = 1.65; 95% CI: 1.27-2.15), especially those who were diagnosed with chronic disease (OR = 1.51; 95% CI: 1.04-2.19) or with unconfirmed chronic conditions (OR = 1.98; 95% CI: 1.36-2.89). Conclusions: Internal migration is associated with the hospitalization of post-retirement migrants moving to eastern China. Improved chronic disease management and early interventions might lower the hospitalization. Effective policies should be formulated to reduce the disparity in primary care services across China, thereby facilitating the access of migrants to these services.


Assuntos
Migrantes , Adulto , Idoso , China/epidemiologia , Doença Crônica , Gerenciamento Clínico , Feminino , Hospitalização , Humanos , Masculino
6.
Indian J Ophthalmol ; 70(8): 2825-2834, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35918922

RESUMO

Blindness due to primary angle-closure glaucoma (PACG) can be reduced significantly if the ongoing angle-closure process is arrested at an early stage. Various treatments such as laser peripheral iridotomy (LPI), iridoplasty, and clear lens extraction (CLE) have been advocated as first-line therapy for primary angle-closure (PAC), PACG, and high-risk cases of primary angle-closure suspect (PACS). EAGLE study, propagated the effectiveness of CLE over LPI for the management of primary angle closure and have sparked controversy regarding the role of LPI as a first line procedure. Randomized controlled trials (RCT), systematic reviews, and meta-analyses of RCTs done on the same question provide us with a solid base for creating guidelines/modules for our day-to-day clinical practice. A systematic review was conducted, searching several databases, including PubMed, Cochrane Library, EMBASE, and ClinicalTrials.gov, for the last 16 years (January 2005-December 2021) for RCTs with data published related to primary angle-closure disease (PACD). The search strategy included the following terms: "Primary Angle Closure disease," "Primary Angle Closure Glaucoma," "Primary Angle Closure," "Primary Angle Closure Suspect," "clear lens extraction," "laser iridotomy," "laser peripheral iridotomy," "argon laser peripheral iridoplasty," "selective laser trabeculoplasty," "trabeculectomy," "randomized control trial," and "meta-analysis of randomized control trial." In this review, we will discuss recently published RCTs (within the last 16 years) for the management of PACD and their clinical implications in day-to-day practice.


Assuntos
Glaucoma de Ângulo Fechado , Terapia a Laser , Trabeculectomia , Gerenciamento Clínico , Glaucoma de Ângulo Fechado/cirurgia , Humanos , Pressão Intraocular , Iridectomia/métodos , Iris/cirurgia , Terapia a Laser/métodos
7.
Swiss Med Wkly ; 152: w30197, 2022 07 18.
Artigo em Inglês | MEDLINE | ID: mdl-35925612

RESUMO

AIMS OF THE STUDY: Little is known about the quality of diabetes management of patients with type 2 diabetes mellitus (T2DM) in Swiss primary care. Based on the recommendations of the National Council Quality Assurance Programme, an interprofessional working group of the Swiss Society of Endocrinology and Diabetology (SSED) established population-based national criteria for good disease management of T2DM in primary health care (the diabetes score). The objective of this study was to assess whether the implementation of these criteria improve diabetes management in primary care. METHODS: The diabetes score comprises eight criteria including three biometric measurements, two lifestyle-specific items and screening of three diabetes-associated complications. Practices can evaluate adherence to the criteria based on a point system, with the recommended aim to achieve ≥70/100 points. Group practices and single practices were included in this study and started implementing the SSED criteria in January 2018. The resulting score was compared with data retrospectively obtained for 2017. The primary endpoint was the overall change in Diabetes Score between 2017 and 2018 at each practice, further stratified by practice type. The absolute effect on individual diabetes score criteria was assessed by pooling all patient-level data. RESULTS: Nine practices (six single and three group) participated in the study. In 2017 and 2018, the primary care practices treated 727 and 704 patients with T2DM, respectively, of whom 676 were treated both years. Around half of the patients were cared for in group practices and half in single practices. Between 2017 and 2018 the median (interquartile range) diabetes score improved from 40 (35, 65) to 55 (45, 70; p = 0.078). One practice (single) obtained a score ≥70 in 2017, three practices (all single) achieved this target in 2018. Pooling patient-level data, we observed a significant absolute improvement in the following criteria: number of regular diabetes check ups, body mass index, glycated haemoglobin, blood pressure, low density lipoprotein cholesterol and screenings for diabetes-associated complications (all p <0.05). However, the extent of the improvements were often insufficient to reach the prefixed targets of the diabetes score criteria on the practice level. CONCLUSION: Overall, the implementation of the SSED criteria in the current setting led to a modest, nonsignificant improvement of the diabetes score. Only three (all single practices) out of the nine practices reached the recommended 70-point target, indicating that further strategies are needed to improve diabetes care in primary care practice. Trial registration: ClinicalTrials.gov (ID NCT04216875).


Assuntos
Diabetes Mellitus Tipo 2 , Diabetes Mellitus Tipo 2/terapia , Gerenciamento Clínico , Hemoglobina A Glicada/análise , Humanos , Atenção Primária à Saúde/métodos , Estudos Retrospectivos
9.
Medicine (Baltimore) ; 101(31): e29805, 2022 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-35945723

RESUMO

Disease management programs (DMPs) have shown great potential for optimizing care of chronically ill patients, thereby improving health outcomes and patient satisfaction. This had led to an overall reduction in healthcare costs. Longer life expectancy has led to increased utilization of healthcare facilities, which may lead to a rise in costs. DMPs are an effective means of improving care and compliance and ultimately curbing inappropriate resource utilization. The present study reviews different definitions proposed for disease management, its components, the evidence behind it, and the conditions for success. It also examines heart failure management as an example of a DMP, exploring the complexity surrounding implementation of guideline-based approaches in patient care. A literature search on DMPs was conducted using PubMed, MEDLINE, and Google Scholar, including heart failure management programs from articles published from 2000 to 2020. This reviewed emphasized on the management of important biomarkers and cardiovascular indicators such as glycemic levels, urine output to improve efficacy of disease management programme during patient treatment. The review concluded that diseases like heart failure can be combat by improving the quality of care for patients and reducing the burden on the public healthcare system. Moreover, DMPs have proved to be an effective way of improving care and compliance with treatment.


Assuntos
Gerenciamento Clínico , Insuficiência Cardíaca , Doença Crônica , Custos de Cuidados de Saúde , Insuficiência Cardíaca/terapia , Humanos , Cooperação do Paciente
10.
J Korean Med Sci ; 37(31): e243, 2022 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-35942556

RESUMO

BACKGROUND: A chronic disease management program was implemented in April 2012 to lower out-of-pocket costs for repeat visits to the same clinic. The aim of this study was to investigate the association between participating in this program and the onset of complications among patients with hypertension using whole-nation claims data. METHODS: We used National Health Insurance Service data (2011-2018) and patients with newly detected hypertension from 2012 to 2014 were selected. Chronic disease management program reduces the out-of-pocket expenses of consultation fee from 30% to 20% when patients enroll in this program by agreeing to visit the same clinic for the treatment of hypertension or diabetes. As the dependent variable, acute myocardial infarction (MI), stroke, chronic kidney disease (CKD), and heart failure (HF) were selected. For analysis, cox proportional hazards model was used. RESULTS: Total participants were 827,577, among which 102,831(12.6%) subjects participated in the chronic disease management. Participants of the chronic disease management program were more likely to show lower hazard ratios (HRs) than those of non-participants in terms of all complications (MI: HR, 0.75; 95% confidence interval [CI], 0.68-0.82; stroke: HR, 0.75; 95% CI, 0.72-0.78; CKD: HR, 0.90; 95% CI, 0.85-0.96; HF: HR, 0.56; 95% CI, 0.52-0.61). CONCLUSION: The results showed that participants of the chronic disease management program were less likely to have hypertension complications compared to non-participants. Enhancing the participation rate may be related to better outcomes and reducing medical expenses among patients with chronic diseases.


Assuntos
Insuficiência Cardíaca , Hipertensão , Infarto do Miocárdio , Insuficiência Renal Crônica , Acidente Vascular Cerebral , Gerenciamento Clínico , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/terapia , Humanos , Hipertensão/complicações , Infarto do Miocárdio/complicações , Infarto do Miocárdio/terapia , Modelos de Riscos Proporcionais , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/terapia , Fatores de Risco
11.
Epidemics ; 40: 100622, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36041286

RESUMO

African swine fever (ASF), caused by the African swine fever virus (ASFV), is highly virulent in domestic pigs and wild boar (Sus scrofa), causing up to 100% mortality. The recent epidemic of ASF in Europe has had a serious economic impact and poses a threat to global food security. Unfortunately, there is no effective treatment or vaccine against ASFV, limiting the available disease management strategies. Mathematical models allow us to further our understanding of infectious disease dynamics and evaluate the efficacy of disease management strategies. The ASF Challenge, organised by the French National Research Institute for Agriculture, Food, and the Environment, aimed to expand the development of ASF transmission models to inform policy makers in a timely manner. Here, we present the model and associated projections produced by our team during the challenge. We developed a stochastic model combining transmission between wild boar and domestic pigs, which was calibrated to synthetic data corresponding to different phases describing the epidemic progression. The model was then used to produce forward projections describing the likely temporal evolution of the epidemic under various disease management scenarios. Despite the interventions implemented, long-term projections forecasted persistence of ASFV in wild boar, and hence repeated outbreaks in domestic pigs. A key finding was that it is important to consider the timescale over which different measures are evaluated: interventions that have only limited effectiveness in the short term may yield substantial long-term benefits. Our model has several limitations, partly because it was developed in real-time. Nonetheless, it can inform understanding of the likely development of ASF epidemics and the efficacy of disease management strategies, should the virus continue its spread in Europe.


Assuntos
Vírus da Febre Suína Africana , Febre Suína Africana , Febre Suína Africana/epidemiologia , Febre Suína Africana/prevenção & controle , Animais , Gerenciamento Clínico , Europa (Continente)/epidemiologia , Sus scrofa , Suínos
12.
Molecules ; 27(15)2022 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-35897928

RESUMO

Exploration of nanoparticles (NPs) for various biological and environmental applications has become one of the most important attributes of nanotechnology. Due to remarkable physicochemical properties, silver nanoparticles (AgNPs) are the most explored and used NPs in wide-ranging applications. Also, they have proven to be of high commercial use since they possess great chemical stability, conductivity, catalytic activity, and antimicrobial potential. Though several methods including chemical and physical methods have been devised, biological approaches using organisms such as bacteria, fungi, and plants have emerged as economical, safe, and effective alternatives for the biosynthesis of AgNPs. Recent studies highlight the potential of AgNPs in modern agricultural practices to control the growth and spread of infectious pathogenic microorganisms since the introduction of AgNPs effectively reduces plant diseases caused by a spectrum of bacteria and fungi. In this review, we highlight the biosynthesis of AgNPs and discuss their applications in plant disease management with recent examples. It is proposed that AgNPs are prospective NPs for the successful inhibition of pathogen growth and plant disease management. This review gives a better understanding of new biological approaches for AgNP synthesis and modes of their optimized applications that could contribute to sustainable agriculture.


Assuntos
Nanopartículas Metálicas , Prata , Antibacterianos/farmacologia , Bactérias , Gerenciamento Clínico , Fungos , Nanopartículas Metálicas/química , Doenças das Plantas/prevenção & controle , Extratos Vegetais/química , Plantas , Estudos Prospectivos , Prata/química
13.
Medicine (Baltimore) ; 101(28): e29797, 2022 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-35838997

RESUMO

To explore the effect of the interdisciplinary chronic disease management (CDM) model on patients with hypertension. In this intervention study, the subjects were divided into CDM and control groups. Blood pressure control was monitored in both groups. After 1 year of follow-up, the endpoint events of patients and their knowledge, confidence, and behavior in response to the disease were assessed. When compared with the control group, patients in the CDM group obtained higher scores for self-perception and management assessment, and their blood pressure control was also better after discharge. The quality of life and the satisfaction level of patients in the control group were lower than those in the CDM group, while the unplanned readmission rate, incidence of complications, and the average length of hospital stay in the control group were higher than those in the CDM group. CDM model was beneficial to blood pressure control in hypertensive patients. It had also improved the quality of life and the satisfaction level of the hypertensive patients. Our study highlights the importance of the CDM model in the prognosis of hypertensive patients.


Assuntos
Hipertensão , Autogestão , Doença Crônica , Estudos de Coortes , Gerenciamento Clínico , Humanos , Hipertensão/terapia , Qualidade de Vida
14.
Prev Med ; 161: 107154, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35817161

RESUMO

Large number of people with non-communicable diseases (NCDs) face barriers to adequate healthcare in humanitarian settings. We conducted a systematic literature review in MEDLINE/PubMed, Web of Science, EMBASE/DARE, Cochrane, and grey literature from 1990 to 2021 to evaluate effective strategies in addressing NCDs (diabetes, cardiovascular diseases, COPD, cancer) in humanitarian settings. From 2793 articles, 2652 were eliminated through title/abstract screening; 141 articles were reviewed in full; 93 were eliminated for not meeting full criteria. Remaining 48 articles were reviewed qualitatively to assess populations, settings, interventions, outcome, and efficacy and effectiveness; 38 studies addressed treatments, 9 prevention, and 7 epidemiology. Prevention studies broadly addressed capacity-building. Treatment and epidemiology studies largely addressed hypertension and diabetes. Interventions included web-based/mobile health strategies, pharmacy-level interventions, portable imaging, and capacity building including physical clinics, staff training, forging collaborations, guideline development, point-of-care labs, health promotion activities, EMR, and monitoring interventions. Collaboration between academia and implementing agencies was limited. Models of care were largely not well-described and varied between studies due to contextual constraints. Barriers to interventions included financial, logistical, organizational, sociocultural, and security. Cancer care is significantly understudied. Simplified care models adapted to contexts and program evaluations of implemented strategies could address gaps in applied research. Inherent challenges in humanitarian settings pose unavoidable perils to evidence generation which requires a shift in research mindset to match aspirations with practicality, research collaborations at the inception of projects, reworking of desired conventional level of research evidence considering resource-intense constraints (HR, time, cost), and adapted research tools, methods, and procedures.


Assuntos
Diabetes Mellitus , Hipertensão , Doença Crônica , Diabetes Mellitus/prevenção & controle , Gerenciamento Clínico , Humanos , Hipertensão/prevenção & controle , Avaliação de Programas e Projetos de Saúde
15.
Annu Rev Phytopathol ; 60: 259-282, 2022 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-35790244

RESUMO

Bacterial diseases are a constant threat to crop production globally. Current management strategies rely on an array of tactics, including improved cultural practices; application of bactericides, plant activators, and biocontrol agents; and use of resistant varieties when available. However, effective management remains a challenge, as the longevity of deployed tactics is threatened by constantly changing bacterial populations. Increased scrutiny of the impact of pesticides on human and environmental health underscores the need for alternative solutions that are durable, sustainable, accessible to farmers, and environmentally friendly. In this review, we discuss the strengths and shortcomings of existing practices and dissect recent advances that may shape the future of bacterial disease management. We conclude that disease resistance through genome modification may be the most effective arsenal against bacterial diseases. Nonetheless, more research is necessary for developing novel bacterial disease management tactics to meet the food demand of a growing global population.


Assuntos
Infecções Bacterianas , Praguicidas , Bactérias , Produção Agrícola , Gerenciamento Clínico , Humanos
16.
Semin Arthritis Rheum ; 56: 152072, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-35872394

RESUMO

OBJECTIVE: Social networking has been shown to improve health outcomes in certain patient populations. While patients with rheumatoid arthritis (RA) increasingly use social networking to communicate with peers, the effects of these interactions are largely unknown. METHODS: In a randomized controlled trial, we compared RA patients who participated in a social networking group moderated by peer leaders and who had access to a static website offering RA materials with a control group, who only had access to the website. The primary outcomes were patients' RA knowledge, self-efficacy and empowerment. Secondary outcomes included participation in desired health behaviors, and satisfaction with peer support, among others. Follow-up assessments were conducted at 3 and 6 months. Participants who never signed in were excluded from the primary analysis. RESULTS: 105 participants were randomized to each group. Mean age was 52 (±12.4) and 92.4% were females. Knowledge scores improved in both groups, but only in the control group the differences observed at 3 and 6 months were significant (p≤0.02). Self-efficacy scores also improved in both groups, but only the differences observed at 6 months in the Facebook group were significant (p=0.02). When comparing groups, at 3 months the knowledge improvements observed in the control group were greater compared with those observed in the Facebook group (mean difference 0.4 versus 0.1; respectively, p=0.03). No other differences were observed in secondary outcomes between the 2 groups, except in peer support satisfaction. The Facebook® group reported greater peer support satisfaction in 3 out 5 subscales compared with the control group (p≤0.04). CONCLUSION: Peer support satisfaction was higher in participants using an online social network, but this was not translated into greater disease knowledge or empowerment.


Assuntos
Artrite Reumatoide , Rede Social , Artrite Reumatoide/terapia , Doença Crônica , Gerenciamento Clínico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
17.
Arch. pediatr. Urug ; 93(1): e307, jun. 2022. tab
Artigo em Espanhol | LILACS, BNUY, UY-BNMED | ID: biblio-1383648

RESUMO

Introducción: el síndrome de Turner es una enfermedad genética caracterizada por la pérdida total o parcial de un cromosoma X, siendo sus características fundamentales la talla baja, la disgenesia gonadal y hallazgos fenotípicos característicos. Tiene una amplia variabilidad en su forma de presentación. Grandes estudios epidemiológicos muestran que la morbilidad aumenta en mujeres con este síndrome, debido a una amplia gama de enfermedades asociadas, sobre todo cardiovasculares, que eleva la mortalidad de manera significativa. Objetivo: realizar una revisión de la literatura, en base a la presentación de un caso clínico, para recabar información sobre las ultimas pautas de manejo y presentar los nuevos objetivos de tratamiento. Conclusiones: el diagnóstico temprano es fundamental, y tiene características propias y criterios de sospecha según la etapa en la que se efectúa, el reto actual en el manejo de estas pacientes consiste en la formación de un equipo médico multidisciplinario, conformado por una amplia gama de especialistas para el adecuado seguimiento, con el fin de disminuir las complicaciones y ayudar a que la paciente alcance sus objetivos para una vida plena. Se presenta el caso de una paciente con síndrome de Turner vista por el equipo médico en el Hospital Pediátrico del Centro Hospitalario Pereira Rossell, Montevideo-Uruguay.


Introduction: Turner's syndrome is a genetic disease characterized by total or partial loss of an X chromosome, its main features being low height, gonadal dysgenesis and characteristic phenotypic findings. It has a wide variability in its form of presentation. Large epidemiological studies show that morbidity increases in women with this syndrome, due to a wide range of associated diseases, especially cardiovascular disease, which significantly raises mortality. Objectives: to carry out a review of the literature, based on a clinical case in order to gather information regarding the latest treatment guidelines and present the new treatment goals. Conclusions: early diagnosis is essential, and has its own characteristics and suspicion criteria according to the stage in which it is carried out. The present challenge regarding the management of these patients consists of the training of a multidisciplinary medical team made up of a wide range of specialists able to carry out proper follow-up, in order to reduce complications and help the patient live a full life. We present a case of a patient with Turner's syndrome assisted at the Pereira Rossell Hospital Center in Montevideo-Uruguay.


Introdução: a síndrome de Turner é uma doença genética caracterizada pela perda total ou parcial de um cromossomo X, sendo suas características fundamentais de baixa estatura, disgenesia gonadal e achados fenotípicos característicos. Tem uma ampla variabilidade em sua forma de apresentação. Consideráveis (grandes, amplos, extensos) estudos epidemiológicos mostram que a morbidade aumenta em mulheres com essa síndrome, devido a uma ampla gama de doenças associadas, especialmente cardiovasculares, o que aumenta significativamente a mortalidade. Objetivos: realizar uma revisão da literatura, a partir da apresentação de um caso clínico, reunir informações sobre as últimas diretrizes de tratamento e apresentar os novos objetivos do tratamento. Conclusões: o diagnóstico precoce é fundamental, e possui características próprias e critérios de suspeita de acordo com a etapa em que é realizado, o desafio atual na gestão desses pacientes consiste na formação de uma equipe médica multidisciplinar, formada por uma ampla gama de especialistas para o acompanhamento adequado, a fim de reduzir complicações e ajudar a paciente a alcançar uma vida plena. Apresentamos o caso de uma paciente com síndrome de Turner atendido pela equipe médica do Hospital Pediátrico do Centro Hospitalar Pereira Rossell, Montevidéu-Uruguai.


Assuntos
Humanos , Feminino , Pré-Escolar , Síndrome de Turner/diagnóstico , Síndrome de Turner/tratamento farmacológico , Hormônio do Crescimento Humano/administração & dosagem , Gerenciamento Clínico , Diagnóstico Precoce
18.
Sensors (Basel) ; 22(11)2022 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-35684847

RESUMO

Several illnesses that are chronic and acute are becoming more relevant as the world's aging population expands, and the medical sector is transforming rapidly, as a consequence of which the need for "point-of-care" (POC), identification/detection, and real time management of health issues that have been required for a long time are increasing. Biomarkers are biological markers that help to detect status of health or disease. Biosensors' applications are for screening for early detection, chronic disease treatment, health management, and well-being surveillance. Smart devices that allow continual monitoring of vital biomarkers for physiological health monitoring, medical diagnosis, and assessment are becoming increasingly widespread in a variety of applications, ranging from biomedical to healthcare systems of surveillance and monitoring. The term "smart" is used due to the ability of these devices to extract data with intelligence and in real time. Wearable, implantable, ingestible, and portable devices can all be considered smart devices; this is due to their ability of smart interpretation of data, through their smart sensors or biosensors and indicators. Wearable and portable devices have progressed more and more in the shape of various accessories, integrated clothes, and body attachments and inserts. Moreover, implantable and ingestible devices allow for the medical diagnosis and treatment of patients using tiny sensors and biomedical gadgets or devices have become available, thus increasing the quality and efficacy of medical treatments by a significant margin. This article summarizes the state of the art in portable, wearable, ingestible, and implantable devices for health status monitoring and disease management and their possible applications. It also identifies some new technologies that have the potential to contribute to the development of personalized care. Further, these devices are non-invasive in nature, providing information with accuracy and in given time, thus making these devices important for the future use of humanity.


Assuntos
Dispositivos Eletrônicos Vestíveis , Idoso , Biomarcadores , Gerenciamento Clínico , Nível de Saúde , Humanos , Monitorização Fisiológica
19.
Int J Mol Sci ; 23(12)2022 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-35743024

RESUMO

Hashimoto's thyroiditis (HT) is the most common autoimmune disease and the leading cause of hypothyroidism, in which damage to the thyroid gland occurs due to the infiltration of lymphocytes. It is characterized by increased levels of antibodies against thyroid peroxidase and thyroglobulin. In this review, we present the metabolic profile, the effectiveness of micronutrient supplementation and the impact of dietary management in patients with HT. For this current literature review, the databases PubMed, Cochrane, Medline and Embase were reviewed from the last ten years until March 2022. This article provides a comprehensive overview of recent randomized controlled trials, meta-analyses, and clinical trials. Many patients with HT, even in the euthyroid state, have excess body weight, metabolic disorders, and reduced quality of life. Due to frequent concomitant nutritional deficiencies, the role of vitamin D, iodine, selenium, magnesium, iron and vitamin B12 is currently debated. Several studies have underlined the benefits of vitamin D and selenium supplementation. There is still no specific diet recommended for patients with HT, but a protective effect of an anti-inflammatory diet rich in vitamins and minerals and low in animal foods has been suggested. There is insufficient evidence to support a gluten-free diet for all HT patients. Pharmacotherapy, along with appropriate nutrition and supplementation, are important elements of medical care for patients with HT. The abovementioned factors may decrease autoantibody levels, improve thyroid function, slow down the inflammatory process, maintain proper body weight, relieve symptoms, and prevent nutritional deficiencies and the development of metabolic disorders in patients with HT.


Assuntos
Doença de Hashimoto , Desnutrição , Selênio , Peso Corporal , Dieta , Gerenciamento Clínico , Humanos , Qualidade de Vida , Vitamina D , Vitaminas
20.
Crit Care Nurs Clin North Am ; 34(2): 173-180, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35660231

RESUMO

During Bachelor of Science in Nursing (BSN) program education, student nurses are introduced to topics such as patient care across health care settings, health promotion, research, safety and quality, technology, and leadership in the health care system. As one of the most common diseases in the population, heart failure (HF) is covered throughout the BSN curriculum. There are various educational strategies used by nursing schools to ensure BSN students possess the necessary leadership skills and are prepared for providing HF patient care in care management settings. Strategies include active learning education delivery models, case studies, role play, and interactive games.


Assuntos
Bacharelado em Enfermagem , Insuficiência Cardíaca , Estudantes de Enfermagem , Gerenciamento Clínico , Insuficiência Cardíaca/terapia , Humanos , Liderança
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