Identificando las trayectorias de cambio terapéutico en psicoterapia breve en pacientes chilenos / Identifying trajectories of therapeutic change in brief psychotherapy in Chilean outpatients

Antecedentes: identificar subgrupos de pacientes que demuestren diferentes trayectorias de cambio terapéutico durante psicoterapia en contextos realistas es relevante para el desarrollo de procesos terapéuticos personalizados y efectivos. Objetivos: El presente estudio tuvo como objetivos (a) identificar trayectorias de cambios terapéutico en pacientes chilenos (b) explorar variables que puedan predecir la probabilidad de pertenecer a ciertas trayectorias y (c) examinar si estas diferentes trayectorias desembocan en distintos resultados terapéuticos. Método: se llevaron a cabo análisis de modelos de crecimientos mixto (Growth Mixture Modeling - GMM) y regresiones logísticas multinominales en una muestra de 400 pacientes chilenos recibiendo psicoterapia en un centro de salud mental privado. Resultados: se identificaron tres trayectorias de cambio terapéutico (a) disfunción inicial moderada con leve deterioro, (b) disfunción inicial leve con cambio favorable y (c) disfunción inicial severa con rápido cambio favorable. La edad de los pacientes fue considerada un factor predictor de trayectoria significativa, sugiriendo una peor prognosis para pacientes de mayor edad. Además, todas las trayectorias fueron predictoras del resultado terapéutico. Conclusiones: estos resultados pueden ser utilizados para desarrollar intervenciones enfocadas en el paciente, basadas en las trayectorias de cambio que exhiban.

Background: Identifying subgroups of patients that may show distinct trajectories of change during psychotherapy in realistic settings is relevant for the development of personalized therapeutic processes. Aims: The present study sought to (a) identify trajectories of change in Chilean patients; (b) explore variables that may predict the likelihood of belonging to certain trajectories; and (c) examine whether these different trajectories result in differences in treatment outcomes. Method: Growth mixture modeling (GMM) and multinomial logistic regression analysis were carried out on the data of 400 patients receiving psychotherapy at a private outpatient clinic in Chile. Results: Three trajectories of change were identified: (a) moderate initial dysfunction with slight deterioration, (b) mild initial dysfunction with favorable change, and (c) high initial dysfunction with rapid favorable change. Patient's age was found to be a significant predictor of trajectory assigned, suggesting a poorer prognosis for older patients. Moreover, the trajectories were significant predictors of treatment outcome. Conclusions: These results can be used to develop patient-specific therapeutic interventions based on the trajectories they exhibit.

Measurement of equivalence using a patient-reported daily pain diary across three smartphone devices

Background:Patient-reported outcomesplay an essential role in evaluating the results of clinical trials. As technological advances are made throughout the industry, pharmaceutical sponsors’ ability to collect field-based patient data has greatly increased. Recently, many clinical trials areutilizing varying modes of data capture in order to enable maximum flexibility. Given the regulatory concern over the equivalence of mixed modes of administration, the need to research the use of varying devices is essential.Methods:This study reviewedthree handheld smartphone devices for conceptual equivalence and conducted usability for standard questions used in a daily pain diary. Out of ten participants, 7 were females and 3 were males with age ranging from27-70 years, diagnosed with chronic painor fibromyalgia, completed the same pain diary on three different smartphone devices.Results:Overall, participants reported no differences between these three smartphone devices and found the presentation of the diary content to be similar, if not identical, on all three devices. Conclusions: Device type had no impact on the presentation of the diary content or participants’ understanding of the diary questions

Surgical outcomes of 14 consecutive bilateral cleft lip patients treated with a modified version of the Millard and Manchester methods

BACKGROUND: Bilateral cleft lip deformity is much more difficult to correct than unilateral cleft lip deformity. The complexity of the deformity and the sensitive relationships between the arrangement of the muscles and the characteristics of the external lip necessitate a comprehensive preoperative plan for management. The purpose of this study was to evaluate the repair of bilateral cleft lip using the Byrd modification of the traditional Millard and Manchester methods. A key component of this repair technique is focused on reconstruction of the central tubercle. METHODS: Fourteen patients with mean age of 5.7 months presented with bilateral cleft lip deformity and were operated on using a modification of the Millard and Manchester techniques. Patients with a very wide cleft lip and protruded or rotated premaxilla were excluded from this study. We analyzed 30 normal children for a comparison with our patients in terms of anthropometric measurements. RESULTS: By the end of the follow-up period (between 9 and 19 months), all our patients had obtained a full central segment with adequate white roll in the central segment and a deep gingivolabial sulcus, and we obtained nearly normal anthropometric measurements in comparison with age-matched normal children. CONCLUSIONS: We recommend this modified technique for the treatment of bilateral cleft lip deformity.

Low concentration continuous femoral nerve block improves analgesia and functional outcomes after total knee arthroplasty in spinal anesthesia

BACKGROUND: Total knee arthroplasty (TKA) is associated with severe pain postoperatively. Femoral nerve block is commonly used for pain control after TKA. This study investigated whether continuous femoral nerve block (CFNB) can improve postoperative analgesia and functional outcome as compared to intravenous patient controlled analgesia (PCA) in patients with TKA. METHODS: We reviewed the electronic medical records of patients who underwent TKA with spinal anesthesia between March 2014 and February 2015. In Group IV, postoperative pain was managed by IV-PCA. Group CFNB received CFNB-PCA via a device. Thirty patients were enrolled per group. Patient outcomes were assessed by analgesia, functional outcomes, and health-related quality of life factors. RESULTS: Additional analgesics and additional nerve block for adequate pain control were significantly more frequent in the IV than CFNB group (P = 0.015 and P = 0.012, respectively). Range of motion up to 105 degrees was prolonged in the IV group than CFNB group (P = 0.013). EuroQol five dimensions score was improved in the CFNB group than IV group postoperative 3 weeks (P = 0.003). The incidence of transfusion due to postoperative bleeding was significantly frequent in the IV group than CFNB group (P = 0.042). CONCLUSIONS: Postoperative low concentration continuous femoral nerve block for analgesia after TKA improves analgesia, functional outcomes, and incidence of transfusion without falling risk.

Bone-anchored titanium implants for auricular rehabilitation: case report and review of literature / Implantes osseointegrados de titânio para reabilitação auricular: relato de caso e revisão da literatura

CONTEXT AND OBJECTIVE: Osseointegrated implants have acquired an important role in the prosthetic rehabilitation of patients with craniofacial defects. The main indications are lack of local tissue for autogenous reconstruction, previous reconstruction failure and selection of this technique by the patient. This paper presents a clinical case and discusses indications and advantages of the osseointegrated implant technique for retention of auricular prostheses. TYPE OF STUDY: Case report, Universidade Federal de São Paulo (UNIFESP). METHODS: A female patient received three auricular implants after surgical resection of a hemangioma in her left ear. The time taken for osseointegration of the temporal bone was three months. After fabrication of the implant-retained auricular prosthesis, the patient was monitored for 12 months. RESULTS: The clinical parameters evaluated showed good postoperative healing, healthy peri-implant tissue, good hygiene and no loss of implants. Good hygiene combined with thin and immobile peri-implant soft tissues resulted in minimal complications. Craniofacial implant integration appears to be site-dependent; increasing age affects osseointegration in the temporal bone. The frequency of adverse skin reactions in peri-implant tissues is generally low. CONCLUSION: The surgical technique for rehabilitation using implant-retained auricular prostheses seems to be simple. It is associated with low rates of adverse skin reactions and long-term complications. Prostheses anchored by osseointegrated implants seem to provide better retention than do prostheses supported on spectacle frames, less risk of discoloration through the use of adhesives and better esthetic results than do prostheses anchored in the surgical cavity

CONTEXTO E OBJETIVO: Os implantes osseointegrados adquiriram papel importante na reabilitação protética de pacientes com defeitos craniofaciais. As principais indicações são ausência local de tecidos para reconstrução autógena, falha anterior de reconstrução e opção do paciente. Este artigo apresenta um caso clínico e discute as indicações e vantagens da técnica de implantes osseointegrados para a retenção de próteses auriculares. TIPO DE ESTUDO E LOCAL: Relato de caso clínico, Universidade Federal de São Paulo (UNIFESP). MÉTODOS: Paciente do sexo feminino recebeu três implantes na região auricular após ressecção cirúrgica de hemangioma na orelha esquerda. O tempo de osseointegração no osso temporal foi de três meses. Após a confecção de prótese auricular implanto-suportada, a paciente foi observada por 12 meses. RESULTADOS: Os parâmetros clínicos analisados mostraram boa cicatrização pós-operatória, saúde dos tecidos adjacentes ao implante, boa higiene e nenhuma perda de implantes. A boa higiene combinada a pouca espessura e imobilidade dos tecidos moles perimplantares resulta em poucas complicações. A integração dos implantes craniofaciais parece variar conforme o local, e a idade avançada afeta a osseointegração no osso temporal. A frequência de reações adversas cutâneas nos tecidos perimplantares é geralmente baixa. CONCLUSÃO: A técnica cirúrgica para a reabilitação com próteses auriculares implanto-suportadas parece ser simples e está associada a baixos índices de reações cutâneas adversas e complicações no longo prazo. As próteses ancoradas por implantes osseointegrados parecem proporcionar melhor retenção do que as próteses suportadas nas armações de óculos, menor possibilidade de descoloração pelo uso de adesivos e melhores resultados estéticos do que as próteses ancoradas na cavidade cirúrgica.

Outcome evaluation on rebuilding stove and health education in preventing coal-burning fluorosis and arsenic poisoning in Shaanxi Province / 中国地方病学杂志

Objective To evaluate the effects of rebuilding stove and health education on preventing coal-burning fluorosis and arsenic poisoning in Shaanxi in 2005.Methods According to "Scheme of Impmving Stove in Preventing Coal-burning Fluorosis and Arsenic Poisoning of Shaanxi in 2005",the initial meeting was convened,while liability contracts were signed,leading and technical guiding groups were established,professional training was carried out.On the basis of the epidemiologic data,stoves were improved in 7 chosen counties in Ankang and Hanzhong City where the health education in several modalities was carried out.The project was checked and accepted when the work was completed.Thirty children in fourth grade were randomly selected in one primary school of each county.Fifleen adults aged 16 years old were chosen randomly in each village in each country.They were asked to answer the questionnaire about the health knowledge.Results There were 955 322 stoves improved in 7 countries in Ankang and Hanzhong City accounting for rebuilding stove was 100%(95 322/95 314).The awareness rates of health knowledge were 88%(444/508)in the adults and 100%(210/210)in children.Conclusions The government mangement leadership,the cooperation between the related departments, the participation of residents and the assufance of fund are the essentials in long lasting control of endemic diseases.

Development of moving darkroom and the value of X-rays photographing in the endemic fluorosis areas / 中国地方病学杂志

Objective To discuss the value of moving darkroom and accompanying X-rays protective shield in endemic fluorosis areas.Methods Using moving and fixed darkrooms,the X-rays photos of the forearms and shanks of the 320 persons were developed in the endemic fluorosis areas,while the time for development and installing-uninstalling films was documented.The films develpoed in the darkroom were evaluated for the quality.Results Among the 320 films develpoed in the moving darkroom,the 268 had fingerprints,47 had scratches,298 were in good quality(93.13%),while in the fixed darkroom,the figure was correspondingly 735,384,227(70.93%);The moving darkroom increased excellent film rate significantly than fixed darkroom(χ2=53.43,P＜0.01),The detectable rate of skelelal fluorosis and degree Ⅰ skelelal fluorosis were highter than that in the fixed darkroom did (χ2=10.34,χ2=9.56,P＜0.01).Conclusions The films developed in moving darkroom have superior quality and higher diagnostic value,so it is important to use moving X-rays photographing in ecdemic fluorosis areas.