ABSTRACT
Abstract To evaluate the effectiveness of an anticoagulation protocol adapted in a mobile application (appG) for patients using warfarin. This was a cluster randomized controlled clinical trial carried out in basic health centers of Ijui, RS, Brazil, between April and October 2017. The appG was installed on the cell phones of all physicians belonging to the intervention group. Primary outcomes were bleeding and thrombosis, and secondary outcomes were changes in the dose of warfarin, use of new drugs, drug interactions, search for health services, and remaining on the target international normalized ratio. Thirty-three patients belonging to 11 basic health centers were included in this study. From these, 15 patients were in the intervention group which used the appG, and 18 were in the control group. After 6 months, patients in the appG group had fewer bleeding events (7% versus 50%, p-value=0.028) and a lower weekly dose of warfarin (29.3 ± 9.7 mg versus 41.7 ± 12.5 mg, p-value=0.030) when compared to the control group. The anticoagulation protocol adapted in a mobile app reduced bleeding in patients using warfarin.
Subject(s)
Physicians , Warfarin/adverse effects , Monitoring, Ambulatory/instrumentation , Cell Phone/instrumentation , Mobile Applications/classification , Patients , Health Centers , Reference DrugsABSTRACT
SUMMARY Parkinson's disease is the second most common neurodegenerative disease, with an estimated prevalence of 41/100,000 individuals affected aged between 40 and 49 years old and 1,900/100,000 aged 80 and over. Based on the essentiality of ascertaining which wearable devices have clinical literary evidence and with the purpose of analyzing the information revealed by such technologies, we conducted this scientific article of integrative review. It is an integrative review, whose main objective is to carry out a summary of the state of the art of wearable devices used in patients with Parkinson's disease. After the review, we retrieved 8 papers. Of the selected articles, only 3 were not systematic reviews; one was a series of cases and two prospective longitudinal studies. These technologies have a very rich field of application; however, research is still necessary to make such evaluations reliable and crucial to the well-being of these patients.
RESUMO A doença de Parkinson figura como a segunda doença neurodegenerativa mais comum. Sua prevalência é estimada de 41 por 100.000 pessoas entre 40 e 49 anos a 1.900 por 100.000 pessoas com 80 anos ou mais. Baseando-se na essencialidade de averiguar os dispositivos vestíveis que possuem evidências clínicas literárias e com o objetivo de analisar as informações reveladas por tais tecnologias, temos a construção deste artigo científico de revisão integrativa. Trata-se de uma revisão integrativa que tem como principal objetivo realizar um sumário do estado da arte de dispositivos vestíveis utilizados em pacientes com doença de Parkinson. Após realizada a revisão, obtiveram-se oito artigos. Pode-se observar que dos artigos selecionados, apenas três não eram revisões sistemáticas, sendo um deles uma série de casos e outros dois, estudos longitudinais prospectivos. A utilização dessas tecnologias possui um campo muito rico para atuar, contudo ainda são necessárias pesquisas para que tais avaliações sejam fidedignas e cruciais para o bem-estar desses pacientes.
Subject(s)
Humans , Parkinson Disease/physiopathology , Wearable Electronic Devices , Monitoring, Ambulatory/instrumentation , Monitoring, Physiologic/instrumentationABSTRACT
La poligrafía respiratoria realizada en el domicilio es un método útil para el diagnóstico del síndrome de apneas del sueño cuando se indica en individuos con alto riesgo y cumple un mínimo de requerimientos técnicos de calidad. Cuando se interpreta junto a una evaluación integral del sueño permite acortar las listas de espera, reservar los estudios de mayor complejidad para casos difíciles o dudosos y acercar el laboratorio de sueño al domicilio, lo que permite la valoración respiratoria del sueño en un ámbito más natural con condiciones similares a las habituales del paciente cuando se dispone a dormir. Los avances tecnológicos han significado una notable disminución del tamaño, peso y costo de los equipos registradores que pueden ser usados en la cama del paciente y conectarse con equipos de tratamiento (CPAP o dispositivos de ventilación). Asimismo, han supuesto mayor acceso al diagnóstico en pequeñas unidades menos dotadas de recursos técnicos, lo que ha ampliado el horizonte diagnóstico del médico neumonólogo. La polisomnografía sigue siendo muy importante para definir con certeza los casos dudosos y continúa siendo el método patrón que debe ser tomado para valorar los avances de los nuevos y más accesibles métodos de estudio de las enfermedades respiratorias durante el sueño.
The respiratory polygraphy (RP) is a useful method for the diagnosis of sleep apnea when it is indicated in high risk patients and meets basic technical requirements for quality. When RP is interpreted in conjunction with a comprehensive evaluation of sleep, it shortens waiting lists approaching the sleep laboratory to the home, and allows the assessment of respiratory performance during sleep in a more natural environment under usual conditions similar to those when the patient is ready to sleep. Technological developments have brought a considerable reduction in size and weightand in the costs of the recording devices, which can be used bedside and connected to therapeutics devices (CPAP or non invasive ventilator). Also, they have increased the accessibility to diagnostic process of small units with limited technical resources expanding the diagnostic horizon of the pulmonologist. The polygraphy or polysomnography is still very important to define with certainty doubtful cases and it is the standard method which should be taken to assess the progress of new accessible methods for the study of these diseases.
Subject(s)
Polysomnography/instrumentation , Sleep Apnea Syndromes/diagnosis , Monitoring, Ambulatory/instrumentationABSTRACT
CONTEXT: Gastroesophageal reflux disease is one of the most common digestive diseases and an important cause of distress to patients. Diagnosis of this condition can require ambulatory pH monitoring. OBJECTIVES: To determine the diagnostic yield of a wireless ambulatory pH monitoring system of 48-hours, recording to diagnose daily variability of abnormal esophageal acid exposure and its symptom association. METHODS: A total of 100 consecutive patients with persistent reflux symptoms underwent wireless pH capsule placement from 2004 to 2009. The wireless pH capsule was deployed 5 cm proximal to the squamocolumnar junction after lower esophageal sphincter was manometrically determined. The pH recordings over 48-h were obtained after uploading data to a computer from the receiver that recorded pH signals from the wireless pH capsule. The following parameters were analyzed: (1) percentual time of distal esophageal acid exposure; (2) symptom association probability related to acid reflux. The results between the first and the second day were compared, and the diagnostic yield reached when the second day monitoring was included. RESULTS: Successful pH data over 48-h was obtained in 95 percent of patients. Nearly one quarter of patients experienced symptoms ranging from a foreign body sensation to chest pain. Forty-eight hours pH data analysis was statistically significant when compared to isolated analysis of day 1 and day 2. Study on day 2 identified seven patients (30.4 percent) that would be missed if only day 1 was analyzed. Three patients (18.7 percent) out of 16 patients with normal esophageal acid exposure on both days, showed positive symptom association probability, which generated an increase in diagnostic yield of 43.4 percent. CONCLUSION: Esophageal pH monitoring with wireless capsule is safe, well tolerated, does not require sedation. The extended 48-h period of study poses an increased yield to diagnose gastroesophageal reflux disease patients.
CONTEXTO: A doença do refluxo gastroesofágico é uma das doenças digestivas mais comuns e importante causa de desconforto para os pacientes. O diagnóstico desta condição clínica pode requerer monitoramento ambulatorial do pH esofágico. OBJETIVOS: Determinar o espectro diagnóstico do sistema de monitoramento ambulatorial do pH esofágico com cápsula telemétrica por um período de 48 horas no diagnóstico da variabilidade diária da exposição ácida anormal e sua associação com sintomas. MÉTODOS: Foram incluídos 100 pacientes adultos, consecutivos, com sintomas relacionados com a doença do refluxo gastroesofágico, que realizaram pHmetria com cápsula telemétrica por 48 horas entre 2004 e 2009. A cápsula foi posicionada e implantada a 5 cm da borda superior do esfíncter esofágico inferior, definida pela manometria esofágica. Foram analisados os seguintes parâmetros: (1) tempos percentuais de exposição ácida no esôfago distal; (2) probabilidade de associação dos sintomas com o refluxo ácido. Foram comparados os resultados entre o 1º e o 2º dia de monitoramento, assim como o eventual ganho diagnóstico obtido após a inclusão do 2º dia no monitoramento. RESULTADOS: Sucesso na obtenção dos dados do pH esofágico durante 48 horas foi obtido em 95 por cento dos pacientes. Aproximadamente 25 por cento dos pacientes apresentaram sintomas relacionados à implantação da cápsula, variando entre sensação de presença de corpo estranho à dor torácica. A análise dos resultados do estudo de 48 horas mostrou-se estatisticamente significante quando comparada com as análises isoladas do dia 1 e do dia 2. O estudo do dia 2 identificou sete pacientes (30.4 por cento) que teriam sido perdidos se somente o dia 1 fosse analisado. Três pacientes (18.7 por cento) dos 16 pacientes com exposição ácida normal no esôfago distal em ambos os dias, apresentaram probabilidade de associação com o sintoma positivo, que gerou incremento no ganho diagnóstico com este método diagnóstico de 43.4 por cento. CONCLUSÕES: O monitoramento do pH esofágico com a cápsula telemétrica é seguro, bem tolerado e não requer sedação. A extensão do período de estudo para 48 horas representa significativo aumento no ganho diagnóstico em pacientes com doença do refluxo gastroesofágico.
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Capsule Endoscopy/instrumentation , Esophageal pH Monitoring/instrumentation , Esophagoscopy/instrumentation , Gastroesophageal Reflux/diagnosis , Monitoring, Ambulatory/instrumentation , Capsule Endoscopy/adverse effects , Capsule Endoscopy/methods , Esophageal pH Monitoring/adverse effects , Esophagoscopy/adverse effects , Esophagoscopy/methods , Monitoring, Ambulatory/adverse effects , Monitoring, Ambulatory/methods , Retrospective StudiesABSTRACT
Freezing of gait (FOG) can be assessed by clinical and instrumental methods. Clinical examination has the advantage of being available to most clinicians; however, it requires experience and may not reveal FOG even for cases confirmed by the medical history. Instrumental methods have an advantage in that they may be used for ambulatory monitoring. The aim of the present study was to describe and evaluate a new instrumental method based on a force sensitive resistor and Pearson's correlation coefficient (Pcc) for the assessment of FOG. Nine patients with Parkinson's disease in the "on" state walked through a corridor, passed through a doorway and made a U-turn. We analyzed 24 FOG episodes by computing the Pcc between one "regular/normal" step and the rest of the steps. The Pcc reached ±1 for "normal" locomotion, while correlation diminished due to the lack of periodicity during FOG episodes. Gait was assessed in parallel with video. FOG episodes determined from the video were all detected with the proposed method. The computed duration of the FOG episodes was compared with those estimated from the video. The method was sensitive to various types of freezing; although no differences due to different types of freezing were detected. The study showed that Pcc analysis permitted the computerized detection of FOG in a simple manner analogous to human visual judgment, and its automation may be useful in clinical practice to provide a record of the history of FOG.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Freezing Reaction, Cataleptic/physiology , Gait Disorders, Neurologic/etiology , Gait Disorders, Neurologic/physiopathology , Monitoring, Ambulatory/instrumentation , Parkinson Disease/complications , Video Recording/methods , Monitoring, Ambulatory/methods , Parkinson Disease/physiopathologyABSTRACT
The increasing device implantations to treat cardiovascular diseases such as arrhytmias and heart failures, aging of the population, and the growing number of patients with access to new therapies as well as the wider access to health systems are the reasons why the number of new implantations carried out each year is rising. Hence, we should have an equipment that can control these patients at a distance, making the follow-up closer. The answer to this enormous challenge is the remote monitoring of these devices. Biotronik is a pioneer in this task and since 2001 it has been comercializing pacemakers and portable wireless monitors (CardioMessenger). Currently, there are more than 100,000 installed systems. Thanks to the continuous and completely automatized follow-up, as well as the wireless net, the system integrity can be confirmed, and then proceed to adjust the therapies in an optimized manner according to each patient's needs; also take action to prevent the development of some arrhytmias, or even the evolution of a heart failure. Likewise, the system can improve the clynical efficiency of the treatment and help to economize to the Ministry of Healthcare.
Subject(s)
Humans , Heart Diseases , Monitoring, Ambulatory , Equipment Design , Heart Diseases , Monitoring, Ambulatory/instrumentationABSTRACT
Continuous ambulatory blood pressure monitoring is a diagnostic technique devised as a consequence of the great variations in blood pressure measurements. It allows multiple daily measurements, nocturnal monitoring, avoids the stress of blood pressure measurements, gives a picture of pressure behavior during 24 hours and reduces observer related errors. The equipment used must be accurate and validated using international protocols. Accepted indications for continuous ambulatory blood pressure monitoring are white coat hypertension, episodic hypertension, resistance to medications and assessment of symptoms or autonomic dysfunction. Other indications with less clear cut usefulness, are high risk cardiac, renal or pregnant patients and an accurate blood pressure control. We describe equipment calibration, elements that must be considered in the reports, result interpretation and conclusions. Normal blood pressure ranges for children and pregnant women are also reported