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1.
J. Health Biol. Sci. (Online) ; 10(1): 1-5, 01/jan./2022. ilus
Article in English | LILACS | ID: biblio-1370898

ABSTRACT

Introduction: The use of computers, tablets, and cell phones with the Internet by people with quadriplegia from spinal cord injuries is much lower when compared to the general population. The quality of life of these people can be substantially improved through access to these technologies, which would allow a quadriplegic to take advantage of the rapid evolution of information and communication. Many of these individuals have the function of preserved neck and mouth muscles, and it is possible to manipulate intraoral devices as an adaptation tool. Case Report: We report an intraoral device installation in a patient with quadriplegia, a victim of a firearm accident, who had a great desire to reuse the tablet for internet access. A device made of acrylic resin, similar to a myorelaxant plate, was designed to allow the use of a computer that was comfortable and at the same time, the patient could talk and not harm the dental structures. The person responsible agreed to participate in the research and signed the consent form. In addition, the work was submitted to an ethics committee. Considerations: The ideal intra-oral device for patient rehabilitation should be inexpensive, easy to adapt and promote muscle relaxation besides allowing the patient to expand their abilities and digitally increase their autonomy for society.


Introdução: O uso de computadores, tablets e celulares com internet por pessoas com tetraplegia por lesão medular é muito menor quando comparado à população geral. A qualidade de vida dessas pessoas pode ser, substancialmente, melhorada por meio do acesso a essas tecnologias, o que permitiria aos tetraplégicos aproveitar a rápida evolução da informação e da comunicação. Muitos desses indivíduos têm a função de músculos cervicais e bucais preservados, sendo possível a manipulação de dispositivos intraorais como ferramenta de adaptação. Relato de Caso: Relatamos a instalação de um dispositivo intraoral em um paciente com tetraplegia, vítima de acidente com arma de fogo, que tinha grande desejo de reutilizar o tablet para acesso à internet. Um dispositivo feito de resina acrílica, semelhante a uma placa miorrelaxante, foi projetado para permitir o uso de um computador que fosse confortável e, ao mesmo tempo, o paciente pudesse falar e não prejudicar as estruturas dentárias. O responsável concordou em participar da pesquisa e assinou o termo de consentimento. Além disso, o trabalho foi submetido a um comitê de ética. Considerações: O dispositivo intraoral ideal para a reabilitação do paciente deve ser barato, de fácil adaptação e promover o relaxamento muscular, além de permitir que o paciente amplie suas habilidades e aumente sua autonomia pessoal, digitalmente para a sociedade.


Subject(s)
Digital Inclusion , Social Inclusion , Quadriplegia , Computers , Disabled Persons , Communication , Adaptation to Disasters , Personal Autonomy
2.
Arq. bras. oftalmol ; 85(5): 443-449, Sept.-Oct. 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1403439

ABSTRACT

ABSTRACT Purpose: To evaluate the vision quality by measuring the objective light scatter index and objective optical quality parameters (Strehl Ratio and Modulation Transfer Function) in patients with emmetropia and ametropia. Methods: This prospective, cross-sectional study included 408 eyes. The ametropic group comprised of eyes with best-corrected visual acuity of 0.0 logMAR or better and present at least a refractive error of ≥0.25 D. Patients underwent slit lamp examination, visual acuity, refraction, and vision quality using the HD Analyzer. Results: The mean objective light scatter indices were 0.62 ± 0.63, 0.77 ± 0.70, 0.74 ± 0.30, 0.93 ± 0.55, and 0.85 ± 0.61, and mean Strehl Ratio and Modulation Transfer Function scores were 38.17 ± 10.4, 37.37 ± 10.06, 29.84 ± 9.71, 33.2 ± 12.11, and 33.13 ± 10.09 in emmetropes, myopia, hyperopia, spherical equivalent of ≥0, and spherical equivalent of <0, respectively. Differences in all variables were significant between emmetropic and corrected hyperopic and between spherical equivalent of ≥0, and spherical equivalent of <0 eyes (p<0.05). Conclusion: In spectacle-corrected conditions (with trial frames), emmetropic and simple myopic eyes had significantly better vision quality compared to hyperopic and astigmatic eyes. The clinical significance of these results should be investigated in further studies.


RESUMO Objetivo: Avaliar a qualidade óptica medindo o índice de dispersão objetiva de luz e os parâmetros de qualidade óptica objetiva (Razão de Strehl e Função de Transferência de Modulação) em indivíduos com emetropia e ametropia. Métodos: Estudo prospectivo, transversal, incluindo 408 olhos. O grupo ametrópico era de olhos com melhor acuidade visual corrigida de 0,0 logMAR ou melhor e apresentando, pelo menos, um erro refrativo de 0,25 D ou mais. Os pacientes foram submetidos a exame com lâmpada de fenda, acuidade visual, refração e qualidade óptica com o HD Analyzer. Resultados: O índice de dispersão objetiva de luz médio foi de 0,62 ± 0,63, 0,77 ± 0,70, 0,74 ± 0,30, 0,93 ± 0,55, 0,85 ± 0,61 e a média da Razão de Strehl e de Função de Transferência de Modulação foram 38,17 ± 10,4, 37,37 ± 10,06, 29,84 ± 9,71, 33,2 ± 12,11 e 33,13 ± 10,09 em olhos emetrópicos, míopes, hipermétropes, equivalente esférico ≥0 e equivalente esférico <0 respectivamente. Foram encontradas diferenças significativas em todas as variáveis entre olhos emetrópicos e com hipermetropia corrigida, equivalente esférico ≥ 0 e equivalente esférico <0 (p<0,05). Conclusão: Em condições com lentes corrigidas (com armações de prova), os olhos emetrópicos e com miopia simples apresentaram qualidade óptica significativamente melhor em comparação com os olhos hipermétropes e astigmáticos. O significado clínico destes resultados deve ser estudado posteriormente.

3.
Int. arch. otorhinolaryngol. (Impr.) ; 26(3): 339-347, July-Sept. 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1405123

ABSTRACT

Abstract Introduction In the literature, evidence is lacking on the predictive value of druginduced sleep endoscopy (DISE) for oral appliance treatment (OAT). Objectives The aim of the present study is to evaluate whether DISE with concomitant mandibular advancement maneuver can predict failure of OAT. Methods An observational retrospective study including patients diagnosed with obstructive sleep apnea (OSA) who previously received OAT. Results of DISE were analyzed in a group with documented OAT failure (apnea-hypopnea index [AHI] >10 events/hour or < 50% reduction) and a group with OAT benefit (AHI <10 events/hour or >50% reduction). The upper airway was assessed using the velum, oropharynx, tongue base, epiglottis (VOTE) classification. Additionally, a mandibular advancement maneuver, manually protruding the mandible by performing a jaw thrust, was performed to mimic the effect of OAT. Results The present study included 50 patients with OAT failure and 20 patients with OAT benefit. A subgroup analysis of patients with OAT failure and an AHI <30events/hour included 26 patients. In the OAT failure group, 74% had a negative jaw thrust maneuver. In the subgroup with an AHI <30 events/hour, 76.9% had a negative jaw thrust maneuver. In the OAT benefit group, 25% had a negative jaw thrust maneuver (p< 0.001). Conclusions A negative jaw thrust maneuver during DISE can be a valuable predictor for OAT failure, independent of AHI. Drug-induced sleep endoscopy should be considered as a diagnostic evaluation tool before starting OAT.

4.
JBES ; 14(Suplemento 2)20220800.
Article in Portuguese, English | LILACS-Express | LILACS | ID: biblio-1412729

ABSTRACT

Objetivo: Consolidar as informações de aspectos regulatórios, de desenvolvimento e implicações para avaliação dos dispositivos médicos personalizados. Métodos: Foram realizadas buscas nas agências internacionais de avaliação de tecnologias e consulta aos documentos de harmonização sanitária e estudos públicos de análise de impacto regulatório realizados por agências regulatórias de diversos países. Resultados: Ainda não há evidências científicas robustas sobre a eficácia e a segurança de dispositivos impressos em 3D; isso significa que o paciente deve ser suficientemente informado para poder dar consentimento válido. A quantidade e a qualidade atuais das evidências e as características exclusivas dessas tecnologias podem apresentar desafios na realização de avaliações de tecnologias abrangentes. Conclusão: O uso dos dispositivos médicos personalizados impressos em 3D tem grande potencial no setor de saúde, especialmente nos tratamentos de condições específicas de pacientes em que não há tecnologias comercialmente disponíveis, porém o estado da evidência pode ser uma barreira para sua adoção nos serviços de saúde. De forma a viabilizar o intercâmbio de informações e contribuir para a pesquisa colaborativa, a adoção de termo comum nos estudos é imprescindível. A falta de consenso sobre a terminologia pode apresentar desafios para a elaboração de estudos de avaliação de tecnologias que realizam buscas dependentes de estratégias de pesquisa e revisão da literatura, como avaliações econômicas e revisões sistemáticas.


Objective: Consolidate information on regulatory aspects, development and implications for the evaluation of personalized medical devices. Methods: Searches were carried out in international technology assessment agencies, consultation of health harmonization documents, public studies of regulatory impact analysis carried out by regulatory agencies from different countries. Results: There is still no robust scientific evidence on the efficacy and safety of 3D printed devices, which means that the patient must be sufficiently informed to be able to give valid consent. The current quantity and quality of evidence and the unique characteristics of these technologies can present challenges in conducting comprehensive technology assessments. Conclusion: The use of personalized 3D printed medical devices has great potential in the healthcare sector, especially in the treatment of specific patient conditions where there are no commercially available technologies, but the state of evidence can be a barrier to their adoption in healthcare services. In order to facilitate the exchange of information and contribute to collaborative research, the adoption of a common term in the studies is imperative. The lack of consensus on terminology can present challenges for the development of technology assessment studies that perform searches dependent on research strategies and literature review, such as economic evaluations and systematic reviews.

5.
Article in Spanish | LILACS-Express | LILACS, CUMED | ID: biblio-1410310

ABSTRACT

El desarrollo de vacunas contra la COVID-19 ha constituido una de las principales prioridades de la comunidad científica global. Hasta la fecha, múltiples vacunas han sido aprobadas para uso por numerosos países y la Organización Mundial de la Salud ha incluido algunas de estas en su programa de listado de uso de emergencia. El presente trabajo ofrece información sobre estos aspectos y analiza el reto colosal que ha representado para el sector regulatorio enfrentarse al creciente desarrollo de vacunas contra la COVID-19, asegurando su calidad, seguridad y eficacia. De igual forma, se abordan los nuevos enfoques en el desarrollo de los ensayos clínicos, o modificaciones en los procedimientos regulatorios existentes, que han sido cuidadosamente adaptados por las agencias reguladoras, sin perder su capacidad de escrutinio y la integridad de la evaluación científico-regulatoria(AU)


The development of anti-COVID-19 vaccines has been one of the main priorities of the global scientific community. To date, multiple vaccines have been approved for use by numerous countries, and the World Health Organization has already included some of these in its emergency use listing program. This paper offers information on these aspects and analyzes the colossal challenge that facing the growing development of vaccines against COVID-19 has represented for the regulatory sector, ensuring their quality, safety and efficacy. Similarly, new approaches in the development of clinical trials are addressed, or modifications in existing regulatory procedures that have been carefully adapted by regulatory agencies, without losing their scrutiny capacity and the integrity of the scientific-regulatory evaluation(AU)


Subject(s)
Humans , Male , Female , Clinical Trial , Medical Device Legislation , COVID-19 Vaccines/therapeutic use , Vaccines , Cuba
6.
Rev. APS ; 25(1): 58-69, 25/07/2022.
Article in Portuguese | LILACS | ID: biblio-1393528

ABSTRACT

O Dispositivo Intrauterino (DIU) é um método contraceptivo que encontra vários entraves para a ampliação da sua oferta na Atenção Primária à Saúde (APS). Uma das principais barreiras à sua inserção é a falta de treinamento dos profissionais. Por isso, o presente estudo tem como objetivo descrever as dificuldades encontradas nos procedimentos de inserção do DIU na Atenção Primária e os fatores associados a essa dificuldade. Foi feita a tentativa de realizar a inserção do DIU nas Unidades Básicas de Saúde (UBS) em 152 mulheres em idade reprodutiva. Os dados foram coletados através de um questionário estruturado em amostragem não-probabilística por conveniência. A idade média das mulheres foi de 27 anos e 26,3% (40) dos procedimentos foram considerados com algum grau de dificuldade. O escore médio de dor foi maior nos procedimentos que apresentaram dificuldade, sendo de 4,59 e de 5,7 nas inserções sem e com dificuldade, respectivamente (p<0.0001). A média de tempo de formado entre os médicos que tiveram dificuldade foi de 33,5 meses e entre aqueles que não tiveram dificuldade foi de 64 meses (p< 0,0001). Entre as dificuldades, a mais referida foi o momento de realizar a histerometria. Outras dificuldades também foram encontradas: identificar e pinçar o colo uterino e identificar posição uterina.


The Intrauterine Device (IUD) is a contraceptive method that faces several obstacles to expanding its offer in Primary Health Care. One of the main barriers to its insertion is the lack of training of professionals. Therefore, this study aims to describe the difficulties found in IUD insertion procedures in Primary Care and the factors associated with this difficulty. An attempt was made to insert the IUD in the Basic Health Units in 152 women of reproductive age. Data were collected through a structured questionnaire in non-probabilistic convenience sampling. The mean age of women was 27 years and 26.3% (40) of the procedures were considered to have some degree of difficulty. The mean pain score was higher in procedures that presented difficulty, being 4.59 and 5.7 in insertions without and with difficulty, respectively (p<0.0001). The average time since graduation among physicians who had difficulty was 33.5 months and among those who had no difficulty, it was 64 months (p<0.0001). Among the difficulties, the most mentioned was the time to perform the hysterometry. Other difficulties were also encountered: identifying and clamping the cervix and identifying the uterine position


Subject(s)
Primary Health Care , Intrauterine Devices
7.
Säo Paulo med. j ; 140(3): 505-508, May-June 2022. tab, graf
Article in English | LILACS | ID: biblio-1377380

ABSTRACT

ABSTRACT BACKGROUND: Severe pulmonary arterial hypertension (PAH) is a contraindication for heart transplantation (HT). It has been correlated with increased early and late mortality, mainly associated with right ventricular failure. Ventricular assistance devices (VADs) can promote reduction of intracardiac pressures and consequent reduction of PAH over the medium and long terms, thus enabling future candidature for HT. The diminution of early pulmonary pressure within this scenario remains unclear. OBJECTIVE: To evaluate the reduction of PAH and correlate data from right catheterization with the earliness of this reduction. DESIGN AND SETTING: Cross-sectional study in a general hospital in São Paulo, Brazil. METHODS: This was a retrospective analysis on the medical records of patients undergoing VAD implantation in a single hospital. Patients for whom VAD had been indicated as a bridge to candidature for HT due to their condition of constant PAH were selected. RESULTS: Four patients with VADs had constantly severe PAH. Their mean pulmonary artery systolic pressure (PASP) before VAD implantation was 66 mmHg. Over the 30-day period after the procedure, all the patients evolved with a drop in PASP to below 60 mmHg. Their new average was 36 mmHg, which was a drop of close to 50% from baseline values. The one-year survival of this sample was 100%. CONCLUSION: VAD implantation can reduce PAH levels. Early reduction occurred in all patients. Thus, use of VAD is an important bridge tool for enabling candidature for HT among patients with constantly severe PAH.


Subject(s)
Humans , Pulmonary Arterial Hypertension/surgery , Hypertension, Pulmonary/surgery , Pulmonary Artery , Brazil , Cross-Sectional Studies , Retrospective Studies
8.
Article in Portuguese, English | LILACS-Express | LILACS | ID: biblio-1411771

ABSTRACT

Objetivo: Avaliar os índices de hospitalização, mortalidade e custos associados à doença pulmonar obstrutiva crônica (DPOC) após mudança do Protocolo de Atenção à Saúde da Secretaria do Distrito Federal (SES-DF) em 2018 por um medicamento da mesma classe terapêutica, porém em dispositivo inalatório diferente. Métodos: Foi realizado um estudo observacional, transversal, em uma coorte de pacientes adultos internados em dois períodos específicos: gosto/2017 a julho/2018 (MAT 1 ­ vigência do Protocolo antigo) e agosto/2018 a julho/2019 (MAT 2 ­ vigência do novo Protocolo). Foram avaliados pacientes internados com diagnóstico principal de DPOC de acordo com a Classificação Estatística Internacional de Doenças e Problemas Relacionados com a Saúde Versão 10 (CID-10) estabelecida pelo protocolo de atenção à saúde e registrada no Datasus. Os desfechos avaliados foram número de internações, mortalidade e custos totais associados à internação por DPOC. Resultados: Após análise dos dados relacionados à DPOC, a comparação entre MAT 1 (agosto/2017 a julho/2018) e MAT 2 (agosto/2018 a julho/2019) resultou no aumento na ocorrência de importantes desfechos: +131,3% no número de internações com passagens em unidade de terapia intensiva (UTI) (n = 16 no MAT 1 vs. n = 37 no MAT 2, p < 0,01), +101,0% na frequência de internações com passagem em UTI sobre o total de internações (2,4% no MAT 1 vs. 4,8% no MAT 2, p = 0,01), +566,7% nos óbitos de pacientes internados em UTI (n = 3 no MAT 1 vs. n = 20 no MAT 2, p < 0,01) e +52,9% nos custos totais de internação (R$ 828.761 no MAT 1 vs. R$ 1.267.318 no MAT 2, p = 0,03). Conclusão: Durante os períodos analisados, houve aumento no uso de UTI, na mortalidade em UTI e nos custos totais relacionados à DPOC. A atualização do protocolo alterou tanto o dispositivo inalatório (névoa suave para pó seco) quanto a molécula (tiotrópio para glicopirrônio) e poderia ser um dos fatores responsáveis por esses desfechos, no entanto as limitações desta análise observacional não podem determinar um impacto causal da mudança do protocolo, pois outras variáveis também podem ter levado às diferenças descritas.


Objective: Evaluate the rates of hospitalization, mortality and costs associated with chronic obstructive pulmonary disease (COPD) before and after the change in COPD Treatment Protocol of State Health Secretariat of Distrito Federal (SES-DF). Methods: An observational, cross-sectional study was conducted in a cohort of hospitalized adult patients in two specific periods: August/2017 to July/2018 (MAT 1 ­ old version of Protocol in place) and August/2018 to July/2019 (MAT 2 - after the new Protocol version). Hospitalized patients with COPD as primary diagnosis according to International Statistical Classification of Diseases and Related Health Problems Version 10 (ICD-10) established by COPD Treatment Protocol and registered in DATASUS database were evaluated. The outcomes assessed were the number of hospitalizations, mortality and total costs ssociated with COPD hospitalizations. Results: After analyzing the data related to COPD, the comparison between MAT 1 (August/2017 to July/2018) and MAT 2 (August/2018 to July/2019) periods resulted in an increase in the occurrence of relevant outcomes: +131.3% in the number of hospitalizations with intensive care unit (ICU) admissions (n = 16 in MAT 1 vs. n = 37 in MAT 2, p < 0.01), +101.0% in the frequency of hospitalizations with ICU admissions over total number of hospitalizations (2.4% in MAT 1 vs. 4.8% in MAT 2, p = 0.01), +566.7% in deaths of patients admitted in ICU (n = 3 in MAT 1 vs. n = 20 in MAT 2, p < 0.01), +52.9% in total costs associated with COPD hospitalizations (R$ 828,761 in MAT 1 vs. R$ 1,267,318 in MAT 2, p = 0.03). Conclusion: During the analyzed periods, an increase in ICU usage, mortality in ICU and total costs related to COPD was observed. The update in the protocol switched the inhaler device (from soft mist to dry powder) and also the molecule (tiotropium to glycopyrronium) and could be potentially one of the factors responsible for these endpoints, however the limitations of this observational analysis cannot determine a causal impact of the protocol change as other variables could also have led to the differences described.

9.
Rev. bras. cir. cardiovasc ; 37(2): 194-199, Apr. 2022. tab
Article in English | LILACS-Express | LILACS | ID: biblio-1376520

ABSTRACT

Abstract Introduction: The purpose of this study was to investigate the feasibility and superiority of using the WeChat platform for midterm clinical follow-up of children who underwent transthoracic device closure for ventricular septal defects (VSDs). Methods: Ninety children with VSDs who underwent transthoracic device closure were divided into a WeChat follow-up group (WFU group) and an outpatient follow-up group (OFU group). The patients were followed up via WeChat or at an outpatient clinic three months and one year after discharge. The incidences of adverse events, associated complications, costs and time spent, loss to follow-up rate, medication adherence, and overall satisfaction were recorded. Results: There was no statistically significant difference in the incidence of adverse events or postoperative complications between the two groups. Also, the loss to follow-up rate was similar between them. Compared with the OFU group, there were significant statistical advantages in the WFU group regarding the total time and cost spent, medication adherence, and satisfaction. Conclusion: The use of the WeChat platform in midterm clinical follow-up of children who underwent transthoracic device closure for VSDs has the advantages of reducing financial and time burdens, facilitating high medication adherence, and leading to high satisfaction.

10.
Rev. bras. ortop ; 57(2): 289-294, Mar.-Apr. 2022. tab, graf
Article in English | LILACS | ID: biblio-1387991

ABSTRACT

Abstract Objective To present an innovative device that applies the double centrifugation method to obtain platelet-rich plasma (PRP), assessing whether there was an effective increase in the concentration of platelets. Method Ten volunteers underwent blood collection. The samples were separated in 20 ml syringes, sealed and subjected to the double centrifugation protocol at 1,100 revolutions per minute (rpm) for 15 minutes, resulting in the separation of red blood cells, plasma with platelets, and leukocytes. Then, 10 ml syringes were added to remove 9 ml, respecting the "buffy coat" parameter, collecting 8 ml above and 1 ml below for the second centrifugation and transferring again to the 20 ml syringe. The plasma was again centrifuged at 1,550 rpm for 10 minutes; as a result, it was divided into two parts: at the top, consisting of low platelet plasma (LPP), and at the bottom, by the platelet button. Part of the LPP was discarded, leaving only 3 ml with the platelet button. The cells were then counted. Results This innovative device was able to increase the concentration of platelets by almost three times compared with the baseline. In addition, the preparation time for the PRP was adequate, lasting only 35 to 40 minutes. Conclusions Platelet-rich plasma was successfully obtained by the double centrifuge protocol, allowing its clinical use. In addition, obtaining through the presented device promotes greater applicability in the preparation of PRP in specific centers, furthermore, being a quick and economical way to obtain PRP.


Resumo Objetivo Apresentar um dispositivo inovador que aplique o método de centrifugação dupla para obter plasma rico em plaquetas (PRP), avaliando se houve um aumento efetivo na concentração de plaquetas. Método Dez voluntários foram submetidos a coleta de sangue. As amostras foram separadas em seringas de 20 mL, seladas e submetidas ao protocolo de centrifugação dupla a 1.100 revoluções por minuto (rpm) por 15 minutos, resultando na separação de hemácias, plasma com plaquetas e leucócitos. Em seguida, foram adicionadas seringas de 10 mL para remover 9 mL, tendo como parâmetro a "buffy coat", coletando 8 mL acima e 1 mL abaixo para a segunda centrifugação e transferindo novamente para a seringa de 20 mL. O plasma foi novamente centrifugado a 1.550 rpm por 10 minutos; como resultado, foi dividido em duas partes: na parte superior, consistindo em plasma pobre em plaquetas (PPP), e na parte inferior, pelo botão plaquetário. Parte do PPP foi descartada, restando apenas 3 mL com o botão de plaquetas. As células foram então contadas. Resultados Este dispositivo inovador foi capaz de aumentar a concentração de plaquetas em quase 3 vezes relação a linha de base. Além disso, o tempo de preparo do PRP foi adequado, com duração de apenas 35 a 40 minutos. Conclusões O PRP foi obtido com sucesso pelo protocolo de centrifugação dupla, permitindo seu uso clínico. Além disso, a obtenção através do dispositivo apresentado promove maior aplicabilidade no preparo do PRP em centros específicos, além de ser, uma forma rápida e econômica de obter PRP.


Subject(s)
Humans , Health Profile , Blood Platelets , Platelet-Rich Plasma , Blood Buffy Coat , Equipment and Supplies
11.
Rev. bras. med. fam. comunidade ; 17(44): 3099, 20220304. tab, graf
Article in Portuguese | LILACS, ColecionaSUS | ID: biblio-1399861

ABSTRACT

Introdução: A inserção do dispositivo intrauterino é uma competência esperada para o médico generalista. No entanto, esse método encontra muitas barreiras ao ser inserido nas unidades básica de saúde, como a falta de treinamento dos profissionais e o medo que as mulheres têm de sentir dor. Objetivo: Avaliar a intensidade da dor durante o procedimento de inserção do dispositivo intrauterino realizado por médicos generalistas em unidades básicas de saúde na região metropolitana de João Pessoa e sua associação com fatores sociodemográficos, aspectos clínicos da mulher e formação médica. Métodos: Estudo transversal e descritivo, com dados coletados em 16 unidades básicas de saúde nos municípios de Conde, Caaporã, João Pessoa e Sapé, no intervalo de março a outubro de 2019. A coleta de dados foi realizada por entrevista individual com questionário estruturado, e a dor foi graduada pela escala visual analógica. Os dados foram analisados utilizando-se os testes de Mann-Whitney e χ². Resultados: Participaram do estudo 139 mulheres com idade mínima de 14 e máxima de 47 anos, cuja média de dor foi de 5,5 para aquelas que estavam menstruadas e de 4,6 para as que não estavam. A dor leve esteve presente em 20,1%, a dor moderada em 38% e dor intensa em 31,7%. Histerometria acima de 7 cm, histórico de uso de anti-inflamatórios na menstruação e de dismenorreia estiveram mais presentes em quem referiu dor intensa (p<0,001). Quanto à qualificação do médico que insere o dispositivo intrauterino, não houve significância estatística na correlação de dor intensa com o fato de ele ser residente (p=0,268), com o tempo de formatura (p=0,080) nem com a dificuldade técnica encontrada (p=0,065). Conclusões: A dor foi considerada pela maioria das mulheres como moderada, sendo uma oferta e um procedimento viável de ser ensinado e inserido na Atenção Primária à Saúde.


Introduction: The insertion of the intrauterine device is an expected competence for the general practitioner. However, this method faces many barriers to be inserted in health centers such as the lack of professionals' training and women's fear of feeling pain. Objective: To evaluate the intensity of pain during the intrauterine device insertion procedure performed by general practitioners in health centers in the metropolitan region of João Pessoa and its association with sociodemographic factors, clinical aspects of women, and medical training. Methods: This is a cross-sectional and descriptive study, based on data collected from 16 health centers in the cities of Conde, Caaporã, João Pessoa, and Sapé (state of Paraíba, Brazil) from March to October 2019. Data collection was carried out by individual interview with a structured questionnaire and pain was rated by the Visual Analog Scale. Data were analyzed using Mann-Whitney Test and Pearson's Chi-square Test. Results: The study included 139 women aged between 14 and 47 years, whose mean pain was 5.5 for those who were menstruating and 4.6 for those who were not. Mild pain was present in 20.1%; moderate pain, in 38%; and intense pain, in 31.7%. Hysterometry above 7cm, history of use of anti-inflammatory drugs during menstruation, and dysmenorrhea were more present in those who reported intense pain (p<0.001). Regarding the qualification of the physician who inserts the intrauterine device, there was no statistical significance in the correlation of intense pain with being a resident (p=0.268), time since graduation (p=0.080), or technical difficulty encountered (p=0.065). Conclusions: Therefore, pain was mostly considered as moderate, and IUD insertion is a feasible offer and procedure to be taught and implemented in Primary Health Care.


Introducción: La inserción del dispositivo intrauterino es una competencia esperada por el médico de cabecera. Sin embargo, este método enfrenta muchas barreras para insertarse en las unidades básicas de salud, como la falta de formación de los profesionales y el miedo que tienen las mujeres a sentir dolor. Objetivo: Evaluar la intensidad del dolor durante el procedimiento de inserción del dispositivo intrauterino realizado por médicos generales en unidades básicas de salud de la Región Metropolitana João Pessoa y su asociación con factores sociodemográficos, aspectos clínicos de la mujer y formación médica. Métodos: Estudio transversal y descriptivo, con base en datos recolectados en 16 unidades básicas de salud en los municipios de Conde, Caaporã, João Pessoa y Sapé en el rango de marzo a octubre de 2019. La recolección de datos se realizó mediante entrevista individual a través de un cuestionario estructurado y el dolor fue graduado por la Escala Visual Analógica. Los datos se analizaron mediante la prueba de Mann Whitney y la prueba de χ². Resultados: El estudio incluyó a 139 mujeres entre 14 y 47 años, cuyo dolor medio fue de 5,5 para las que estaban menstruando y de 4,6 para las que no. El dolor leve estuvo presente en el 20,1%, dolor moderado en el 38% y "dolor significativo" en el 31,7%. La histerometría por encima de 7 cm, el antecedente de uso de antiinflamatorios durante la menstruación y la dismenorrea fueron más presentes en las que informaron de "dolor significativo" (p<0,001). En cuanto a la calificación del médico que inserta el dispositivo intrauterino, no hubo significación estadística en la correlación del dolor significativo con ser residente (p=0,268), con el tiempo desde egreso (p=0,080) o con la dificultad técnica encontrada (p=0,065). Conclusión: Por tanto, el dolor se consideró mayoritariamente como moderado, siendo una oferta y un procedimiento viable para ser enseñado e insertado en la Atención Primaria de Salud.


Subject(s)
Pain , Primary Health Care , Intrauterine Devices
12.
J. coloproctol. (Rio J., Impr.) ; 42(1): 7-13, Jan.-Mar. 2022. tab, ilus
Article in English | LILACS | ID: biblio-1375752

ABSTRACT

Objective: To develop and validate a brochure to guide health professionals in properly dressing and undressing the personal protective equipment (PPE) used in the SARS-CoV-2 pandemic. Methods: To develop the brochure, an integrative literature review was conducted after searching the following databases: SciELO, LILACS, and MEDLINE. The brochure was evaluated by 38 health professionals (nurses, physical therapists, and doctors) employing the Delphi technique. The results were analyzed using the Content Validity Index. Results: In the first evaluation cycle, the items in the brochure were considered by the panel of experts as ranging from "unsuitable" to "totally adequate". After the appropriate corrections suggested by the experts, the brochure once again was sent to the second evaluation cycle, in which all items were rated as "adequate" or "totally adequate." The result is a Content Validity Index of 1.0. Conclusion: The present study allowed the development of a brochure and its validation by consensus among the evaluation group. The developed and validated brochure presents the reliability of the technique of dressing and undressing the PPE used by health professionals during the pandemic of COVID-19. This information contributes to the management of assistance with quality and safety for the frontline workers and patients. (AU)


Subject(s)
Pamphlets , Health Personnel , COVID-19/prevention & control , Delphi Technique , Equipment and Supplies , Personal Protective Equipment
13.
Rev. bras. cir. cardiovasc ; 37(1): 74-79, Jan.-Feb. 2022. tab
Article in English | LILACS-Express | LILACS | ID: biblio-1365534

ABSTRACT

Abstract Introduction: The objective of this study was to investigate the effect of mivacurium in the application of fast-track anesthesia for transthoracic device closure of ventricular septal defects (VSDs) in children. Methods: The data of 108 children who underwent transthoracic device closure of VSDs from December 2018 to June 2020 were recorded and analyzed. All children were divided into group M (mivacurium group, n=55) and group C (cisatracurium group, n=53) according to the different muscle relaxant drug used. Results: No statistically significant differences in general preoperative data, intraoperative hemodynamic changes, or the incidence of adverse reactions were noted between the two groups (P>0.05). However, the intubation condition rating of children in group M was better than that in group C. The onset time, duration of clinical action and recovery index of the muscle relaxant, postoperative mechanical ventilation duration, and length of intensive care unit stay in group M were significantly lower than those in group C (P<0.05). Conclusion: It is safe and feasible to use mivacurium as a muscle relaxant in children undergoing fast-track cardiac anesthesia during transthoracic device closure of VSDs.

14.
J. Transcatheter Interv ; 30: eA202202, 20220101. ilus; tab
Article in English, Portuguese | LILACS-Express | LILACS | ID: biblio-1396024

ABSTRACT

Tecnologias mais avançadas, drogas melhores e profissionais mais experientes contribuíram para desfechos otimizados das intervenções coronarianas percutâneas complexas. As complicações com impacto significativo na sobrevida do paciente e alto custo para o sistema de saúde não foram totalmente eliminadas pelos procedimentos modernos de intervenções coronarianas percutâneas. Os procedimentos preventivos e a experiência do operador são as únicas formas de se evitarem os efeitos colaterais graves das intervenções coronarianas percutâneas. As dissecções, o fechamento abrupto da artéria, a perfuração coronariana, o non-reflow, a embolia gasosa, a deformação do stent, a embolização do dispositivo e o aprisionamento da ogiva de aterectomia rotacional são algumas das complicações abordadas neste artigo.


More advanced technology, better drugs and more experienced operators have contributed to improved complex percutaneous coronary intervention outcomes. Complications with significant impact on patient survival and healthcare costs have not been completely eliminated by modern percutaneous coronary intervention procedures. Professional expertise and consistent preventive procedures are the only ways to avoid severe side effects of percutaneous coronary intervention. Dissections, abrupt arterial closure, coronary perforation, no-reflow, air embolism, stent deformation, device embolization, and rotating atherectomy burr entrapment are some of the periprocedural complications covered in this article.

15.
Article in Chinese | WPRIM | ID: wpr-939762

ABSTRACT

This paper studies the necessity of the current legislation on the supervision of medical devices in China from the perspectives of strengthening administration according to law, protecting public health, perfecting the legal system of medicine and promoting the development of the medical device industry. This study analyzes and summarizes the legislative experiences and forms in the field of medical device regulation in the United States, the European Union, Japan and other countries and regions, at present, the conditions of carrying out the legislation of medical device supervision in China are quite mature, and some policy suggestions are put forward for the enactment of the law of medical device management in China.


Subject(s)
Equipment and Supplies , European Union , Feasibility Studies , Industry , Medical Device Legislation , United States , United States Food and Drug Administration
16.
Article in Chinese | WPRIM | ID: wpr-939761

ABSTRACT

The evolution throughout the whole supervision history of Class II/III safety and effectiveness related NMPA submission dossier requirements was studied in this study, meanwhile elaborating the revolution progress of clinical evaluation domestically. The relationship between submission dossier requirements and Essential Principles of Safety and Performance of Medical Devices as well as IMDRF relevant documents was deeply analyzed and illustrated, in order to comprehensively understanding the background and future reform direction of NMPA submission dossier requirements under the background of the government's deepening reform of medical device evaluation and approval system strategy.


Subject(s)
China , Device Approval , Humans
17.
Article in English | WPRIM | ID: wpr-939598

ABSTRACT

In 2019, cardiovascular disease (CVD) accounted for 46.74% and 44.26% of all deaths in rural and urban areas, respectively. Two out of every five deaths were due to CVD. It is estimated that about 330 million patients suffer from CVD in China. The number of patients suffering from stroke, coronary heart disease, heart failure, pulmonary heart disease, atrial fibrillation, rheumatic heart disease, congenital heart disease, lower extremity artery disease and hypertension are 13.00 million, 11.39 million, 8.90 million, 5.00 million, 4.87 million, 2.50 million, 2.00 million, 45.30 million, and 245.00 million, respectively. Given that China is challenged by the dual pressures of population aging and steady rise in the prevalence of metabolic risk factors, the burden caused by CVD will continue to increase, which has set new requirements for CVD prevention and treatment and the allocation of medical resources in China. It is important to reduce the prevalence through primary prevention, increase the allocation of medical resources for CVD emergency and critical care, and provide rehabilitation services and secondary prevention to reduce the risk of recurrence, re-hospitalization and disability in CVD survivors. The number of people suffering from hypertension, dyslipidemia and diabetes in China has reached hundreds of millions. Since blood pressure, blood lipids, and blood glucose levels rise mostly insidiously, vascular disease or even serious events such as myocardial infarction and stroke often already occured at the time of detection in this population. Hence, more strategies and tasks should be taken to prevent risk factors such as hypertension, dyslipidemia, diabetes, obesity, and smoking, and more efforts should be made in the assessment of cardiovascular health status and the prevention, treatment, and research of early pathological changes.


Subject(s)
Cardiovascular Diseases/etiology , China/epidemiology , Diabetes Mellitus , Dyslipidemias , Humans , Hypertension/epidemiology , Myocardial Infarction , Risk Factors , Stroke/epidemiology
18.
Chinese Journal of Radiology ; (12): 68-73, 2022.
Article in Chinese | WPRIM | ID: wpr-932485

ABSTRACT

Objective:To explore the feasibility of three-dimensional CT axial sequence assisted volumetric measurement (CTAS) in evaluating atrial septal defect (ASD).Methods:The patients with single secundum ASD who successfully underwent interventional therapy in Fuwai Hospital from January 2016 to December 2019 were retrospectively collected. The patients underwent coronary CT angiography (CTA) before and on the second day after closures, and DSA examinations during operation. A total of 52 cases met the inclusion conditions, among them, there were 37 patients with large defects which had deficient inferior rims ≤3 mm, and 15 patients with severe pulmonary arterial hypertension that occluded with fenestrated ASD occluder. The CT data of patients before and after operation were reconstructed by CTAS. Then the anatomical structure of ASD before the operation was evaluated, including the long diameter and short diameter of ASD, and the CT three-dimensional volume diameter of ASD was calculated by using the equivalent circle conversion formula of ellipse. The waist diameter of occluder and rims of the ASD were measured after occlusion on postoperative CT three-dimensional volume reconstruction images. Meanwhile, the deployed occluder waist dimension was measured in DSA examination during the operation by simulating the balloon measurement of ASD. Lastly, paired t-test and consistency analysis were carried out among the values of parameters. Results:Before operation, the equivalent circle diameter of ASD was (32.3±5.4) mm measured by CTAS. After ASD occlusion, the size of the waist dimension measured by DSA and CTAS were (32.5±4.9) mm and (32.6±4.9) mm. There were no significant differences between them ( P>0.05). There were also no significant differences for each rims of the ASD pre and post operation on CTAS except for the inferior rims and the total length of atrial septum in superior-inferior direction ( P>0.05). Conclusion:As an alternative to balloon sizing, CTAS can be used as a reference standard to conduct ASD interventional treatment.

19.
Article in Chinese | WPRIM | ID: wpr-932343

ABSTRACT

Objective:To compare the clinical efficacy between a bidirectional-traction reduction device and a traction table in the treatment of femoral neck fracture with femoral neck system (FNS).Methods:A retrospective study was conducted in the 46 patients with femoral neck fracture who had been treated at Department of Orthopedics, The First Central Hospital of Baoding from January 2020 to January 2021. There were 19 males and 27 females, aged from 30 to 64 years (average, 47.1 years). According to the Garden classification, 29 cases were type Ⅲ and 17 type Ⅳ. By the reduction method, the patients were assigned into an observation group ( n=24) in which the reduction was assisted by a bidirectional-traction reduction device and a control group ( n=22) in which the reduction was assisted by a traction table. FNS fixation was conducted in both groups. The 2 groups were compared in terms of operation time, reduction time, fluoroscopy frequency, intraoperative blood loss, femoral neck shortening at immediate postoperation and 12 months postoperation, Harris scores of the affected hip at 3, 6, and 12 months postoperation, and incidence of lower extremity venous thrombosis. Results:There were no significant differences in age, gender or fracture type between the 2 groups, showing they were comparable ( P>0.05). The observation group needed significantly less operation time [57.5 (54.0, 64.5) min], reduction time [(16.3±3.0) min] and fluoroscopy frequency [(20.5±4.6) times] than the control group did [85.0 (71.3, 92.0) min, (21.0±6.0) min and (29.7±4.7) times, respectively] (all P<0.05). There was no significant difference in intraoperative blood loss between 2 groups ( P>0.05). All patients were followed up for 12 to 22 months (average, 15.5 months). There was no significant difference in femoral neck shortening between the 2 groups at immediate postoperation or 12 months postoperation ( P>0.05). The Harris score of the affected hip in the observation group was significantly better than that in the control group at 3 months after surgery ( P<0.05), but such a significant difference was not observed at 6 or 12 months postoperation ( P>0.05). The incidence of thrombotic complications in the observation group (12.5%, 3/24) was significantly lower than that in the control group (40.9%, 9/22) ( P<0.05). Conclusions:In the FNS treatment of femoral neck fracture, compared with a traction table, reduction assisted by a bidirectional-traction reduction device is more advantageous because it is simpler and less time-consuming, incurs less fluoroscopy and leads to better early functional recovery of the affected hip and lower incidence of thrombotic complications.

20.
Article in Chinese | WPRIM | ID: wpr-932318

ABSTRACT

Objective:To explore the feasibility and advantages and disadvantages of local anesthesia for TiRobot-assisted removal of sacroiliac screws by comparison with general anesthesia for TiRobot-assisted removal of sacroiliac screws.Methods:A retrospective study was performed in 39 patients with posterior pelvic ring fracture-dislocation who had undergone removal of percutaneous sacroiliac screws after fracture union from January 2017 to December 2020 at Department of Orthopaedic Surgery, Hospital Affiliated to Chengdu University. Their sacroiliac screws were removed with TiRobot assistance under local anesthesia (LA group) or general anesthesia (GA group). In the LA group of 18 cases, there were 10 males and 8 females, aged (43.3 ± 8.4) years (from 25 to 58 years); in the GA group of 21 cases, there were 12 males and 9 females, aged (44.9 ± 9.0) years (from 23 to 60 years). The 2 groups were compared in terms of time for planning screw removal path, fluoroscopy frequency, fluoroscopy time, operation time, anesthesia time, anesthesia cost, postoperative visual analogue scale (VAS) and postoperative ambulation time.Results:There was no statistically significant difference in baseline data between the 2 groups, showing comparability ( P>0.05). Follow-ups revealed grade A wound healing in all patients. There were no significant differences between the 2 groups in time for planning screw removal path, fluoroscopy frequency, fluoroscopy time or operation time ( P>0.05). The anesthesia time [(41.6 ± 8.3) min], anesthesia cost [(653.5 ± 102.6) yuan] and postoperative ambulation time [(2.6 ± 0.6) h] in the LA group were significantly less than those in the GA group [(52.3 ± 9.5) min, (2,475.6 ± 261.8) yuan and (8.7 ± 2.4) h] while the VAS score in the former group (3.8 ± 1.5) was significantly higher than that in the latter group (2.5 ± 1.3) (all P<0.05). Conclusions:It is feasible to use local anesthesia for TiRobot-assisted removal of sacroiliac screws. In TiRobot-assisted removal of sacroiliac screws, compared with general anesthesia, local anesthesia may lead to shorter anesthesia time, lower anesthesia cast and shorter ambulation time, but the patients need to be compliant enough.

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