Dosificación de tratamiento en terapia vestibular para lesiones vestibulares periféricas: una revisión / Treatment dosage in vestibular therapy for peripheral vestibular lesions: a review

La terapia vestibular ha mostrado una evolución constante hacia la práctica basada en evidencia principalmente en los últimos años, sin embargo, actualmente no existe consenso sobre la dosificación de tratamiento necesaria para generar resultados deseados en los usuarios. Por ello, el presente estudio pretende analizar la evidencia científica sobre la dosificación de tratamiento en la terapia vestibular para patologías vestibulares periféricas y su impacto en la práctica clínica. Se realizó una búsqueda bibliográfica en las bases de datos PubMed y Cochrane Library de acuerdo a términos claves. Los estudios incluidos fueron ensayos clínicos, revisiones sistemáticas y metaanálisis, publicados desde el año 2009 y realizado en seres humanos. Se encontraron 60 artículos relacionados con los términos claves utilizados, de los cuales 52 fueron eliminados por cumplir con los criterios de exclusión. Existe escasa literatura sobre la dosificación de tratamiento en terapia vestibular, demostrando formatos de aplicación muy disímiles. Resulta complejo establecer estándares para la dosis terapéutica producto de la heterogeneidad de las patologías vestibulares.

Recently, vestibular rehabilitation therapy has shown constant development towards evidence-based practice, however, at the present time, there is lack of consensus about treatment dosage needed to produce the desired results for the users. Therefore, the present study aimed to analyze scientific evidence relating to treatment dosage of vestibular rehabilitation therapy for peripheral vestibular pathologies, and its impact on clinical practice. We conducted a bibliographic search in PubMed, and Cochrane Library according to previously defined MeSH terms. Included studies were clinical trials, systematic revisions, and meta-analyses, that were published since 2009, and conducted with human participants. The initial search yielded 60 articles related to the MeSH terms chosen, from which 52 were eliminated according to exclusion criteria. There is a scarce number of scientific articles regarding treatment dosage, and also a heterogeneous application format. It is a complex task to establish standards regarding therapeutic doses, mainly due to the heterogeneity of vestibular pathologies.

Avaliação do Programa de Treinamento para Memória de Trabalho em Idosos / Evaluation of the Working Memory Training Program for the Elderly

RESUMO Objetivo Verificar os benefícios do Treinamento de Memória de Trabalho em DVD para idosos. Método Participaram do estudo 16 voluntários com idade superior a 60 anos (média etária de 67,43 anos) sem queixas de perda auditiva, problemas neurológicos ou psiquiátricos, avaliados inicialmente com o MEEM e posteriormente com a avaliação específica para memória de trabalho. Em seguida, os quatro participantes que não tinham disponibilidade para comparecer à Universidade formaram o grupo controle e os doze restantes foram incluídos no grupo experimental. O grupo experimental foi exposto aos três DVDs que compõem o primeiro conjunto de exercícios e reavaliado com o teste específico para memória de trabalho em intervalos regulares. O grupo controle também foi submetido às reavaliações nos mesmos períodos do grupo experimental. Resultados Enquanto o grupo controle não apresentou qualquer alteração nas avaliações, o desempenho no teste de memória do grupo experimental melhorou significativamente após a apresentação dos DVDs. Além disso, o grupo experimental relatou os benefícios do treinamento para suas atividades cotidianas. Conclusão O estudo demonstra os benefícios do Treinamento de Memória de Trabalho em DVD para idosos, que se revela uma ferramenta promissora para novos estudos longitudinais com populações maiores.

ABSTRACT Purpose To investigate the benefits of the Working Memory Training on DVD for the elderly. Methods Sixteen volunteers aged over 60 years (67.43 years on average), without hearing loss complaint nor neurological or psychiatric disorders participated in this study. All participants were evaluated by the MMSE and a dedicated working memory assessment. Among these, four participants, unable to go to the University formed the control group, while the other twelve were included in the experimental group. The participants in the experimental group were exposed to the first three DVDs with exercises, having been periodically reassessed by the dedicated working memory assessment. The control group participants were submitted only to the reassessments at the same periods as the experimental group. Results The assessments of the control group did not present any changes, while those in the experimental group significantly improved their results after exposure to the DVDs. Moreover, the experimental group participants reported the benefits of the training for their daily life activities. Conclusion The present study demonstrates the benefits of the Working Memory Training on DVD for the elderly. These results indicate that the cognitive working memory training may be a promising tool for new longitudinal studies with larger populations.

Efficacy of Computerized Cognitive Behavioral Therapy in Individuals with Non-Cardiac Chest Discomfort : Review and Suggestions for a New Protocol

Since non-cardiac chest discomfort (NCCD) can result in substantial healthcare burden and lower quality of life, interventions such as cognitive behavioral therapy (CBT) have been investigated for the relief of NCCD. In this review, we aimed to summarize the evidence on the efficacy of the CBT for the treatment of NCCD while introducing a newly-developed computerized CBT program for NCCD. Studies applying CBT to individuals with NCCD were searched for from both English and Korean electronic databases. Among 37 studies, 11 randomized controlled trials, 4 case-control studies, 1 case series, and 2 review articles were eligible for this review. Efficacy of conventional CBT for NCCD was shown in a series of studies as most of them reported improved symptom severity of NCCD or NCCD-related anxiety. However, a substantial variability existed among these studies in participants, treatment procedures and durations. High attrition rates were also reported in these studies on conventional CBT. Computerized CBT could be an alternative to the conventional CBT as it can be standardized and more easily accessible, but it was only reported in one previous study. In addition to the literature review, we presented a newly-developed computerized CBT program for NCCD which may overcome some of the limitations of conventional CBT. A computerized CBT could be an alternative treatment of NCCD, however, need further studies on its usefulness.

Adolescents' Attitudes and Intentions toward Help-Seeking and Computer-Based Treatment for Depression

OBJECTIVE: Many depressed adolescents do not seek professional help despite there being evidence-based treatments for depression, such as cognitive behavioral therapy or computer-based therapy. To increase professional help-seeking behavior in depressed adolescents, it is necessary to positively change help-seeking attitudes. This study aimed to explore the effect of sub-groups of help-seeking attitudes, gender, and depression level on adolescents' help-seeking intentions and their perceptions of computer-based psychotherapy. METHODS: Participants were 246 adolescents aged 13–18 years recruited from six middle and high schools in South Korea. Measures were self-administered questionnaires, and included the Patient Health Questionnaire-9, the Attitudes Toward Seeking Professional Psychological Help Scale, the Intention to Seek Counseling Inventory, Preferences for Depression Treatment, and the Perceptions of Computerized Therapy Questionnaire. RESULTS: Help-seeking intentions were positively related with female gender and the recognition of the need for help. A higher level of confidence in therapists was related to high preference for computer-based therapy and face-to-face therapy. Adolescents with more severe depression were more likely to prefer pharmacotherapy. The perceptions of computer-based therapy were more positive in male adolescents, and in adolescents with a higher level of confidence in therapists yet a lower level of interpersonal openness. CONCLUSION: To promote adolescents' help-seeking behavior, improvement of the recognition of the need for help is required, especially among male adolescents. Computer-based therapy provides an alternative for male adolescents with high confidence in therapists yet low interpersonal openness. Consideration of the help-seeking attitudes and gender is needed when providing therapeutic intervention to depressed adolescents.

Computerized cognitive training in children and adolescents with attention deficit/hyperactivity disorder as add-on treatment to stimulants: feasibility study and protocol description / Treinamento cognitivo para crianças e adolescentes com transtorno de déficit de atenção/hiperatividade como tratamento complementar aos psicoestimulantes: estudo de viabilidade e descrição de protocolo

Abstract Background Cognitive training has received increasing attention as a non-pharmacological approach for the treatment of attention deficit/hyperactivity disorder (ADHD) in children and adolescents. Few studies have assessed cognitive training as add-on treatment to medication in randomized placebo controlled trials. The purpose of this preliminary study was to explore the feasibility of implementing a computerized cognitive training program for ADHD in our environment, describe its main characteristics and potential efficacy in a small pilot study. Methods Six ADHD patients aged 10-12-years old receiving stimulants and presenting residual symptoms were enrolled in a randomized clinical trial to either a standard cognitive training program or a controlled placebo condition for 12 weeks. The primary outcome was core ADHD symptoms measured using the Swanson, Nolan and Pelham Questionnaire (SNAP-IV scale). Results We faced higher resistance than expected to patient enrollment due to logistic issues to attend face-to-face sessions in the hospital and to fill the requirement of medication status and absence of some comorbidities. Both groups showed decrease in parent reported ADHD symptoms without statistical difference between them. In addition, improvements on neuropsychological tests were observed in both groups - mainly on trained tasks. Conclusions This protocol revealed the need for new strategies to better assess the effectiveness of cognitive training such as the need to implement the intervention in a school environment to have an assessment with more external validity. Given the small sample size of this pilot study, definitive conclusions on the effects of cognitive training as add-on treatment to stimulants would be premature.

Resumo Introdução O treinamento cognitivo tem recebido atenção especial como abordagem não medicamentosa para o tratamento do transtorno de déficit de atenção/hiperatividade (TDAH) em crianças e adolescentes. Poucos estudos avaliaram o treinamento cognitivo como abordagem complementar à medicação em ensaios clínicos randomizados controlados por placebo. O objetivo deste estudo foi explorar a viabilidade para a implementação de um programa de treinamento cognitivo computadorizado, descrever suas características principais e potencial eficácia em um pequeno estudo piloto. Métodos Seis pacientes com TDAH entre 10-12 anos de idade, em uso de psicoestimulantes e apresentando sintomas residuais, foram recrutados e randomizados para um dos dois grupos (treinamento cognitivo ou placebo) por 12 semanas. O desfecho principal foram os sintomas nucleares do TDAH avaliados através do Questionário de Swanson, Nolan e Pelham (SNAP-IV). Resultados Encontramos maior resistência do que a esperada no recrutamento dos pacientes em função de problemas logísticos para atender às sessões presenciais no hospital assim como para preencherem os critérios de status medicamentoso e ausência de algumas comorbidades. Ambos os grupos apresentaram diminuição nos escores dos sintomas de TDAH reportados pelos pais, mas sem diferença estatística entre eles. Além disso, foi observada melhora nos testes neuropsicológicos em ambos os grupos - principalmente nas tarefas treinadas pelo programa. Conclusão Este protocolo revelou a necessidade de novas estratégias para melhor avaliar a eficácia do treinamento cognitivo tal como a necessidade de implementar a intervenção no ambiente escolar a fim de obter uma avaliação com maior validade externa. Devido ao pequeno tamanho amostral deste estudo, conclusões definitivas sobre os efeitos do treinamento cognitivo como abordagem complementar aos psicoestimulantes seriam prematuras.

Proposta de um programa de intervenção fonoaudiológica para crianças disfluentes: guia prático para fonoaudiólogos e pais / Proposal of a speech-language intervention program for children with dysfluency: a practical guide for speech therapists and parents

A fluência refere-se ao fluxo contínuo e suave de produção de fala, porém, quando ocorre a ruptura deste fluxo de fala têm-se o que chamamos de disfluências (alterações da fluência), que variam em maior ou menor grau, dependendo do dia, da emoção envolvida e do domínio sobre o tema da conversação. O que diferencia uma disfluência comum de todos os falantes de uma disfluência gaga é a quantidade de rupturas da fala e a capacidade individual para a pronta recuperação do equilíbrio entre os dois processamentos. Geralmente, percebe-se que um indivíduo apresenta a gagueira (disfluência) já na infância, sendo assim é imprescindível que esta criança realize tratamento fonoaudiológico, de modo que há diversas abordagens terapêuticas e programas fonoadiológicos para este tratamento, porém, independentemente de qual programa ou abordagem terapêutica o fonoaudiólogo optar, se os pais não forem bem orientados e engajados pelo terapeuta para participarem ativamente do processo de intervenção, o progresso deste provavelmente será mais lentificado e desmotivador. O objetivo deste trabalho foi elaborar, implementar e analisar dois programas voltados para crianças disfluentes, sendo um programa de intervenção para as crianças e outro programa de intervenção para o fonoaudiólogo aplicar com os pais. Os participantes da pesquisa foram seis pais de seis crianças disfluentes, com faixa etária de 2 anos e 11 meses a 6 anos e 11 meses, com disponibilidade de participar tanto os pais (grupo de pais) quanto às crianças (terapia fonoaudiológica) do programa completo que foi realizado durante 10 sessões com frequência semanal e duração de 50 minutos cada sessão. Ressalta-se que o programa de pais e crianças foram correlacionados. Foram aplicados protocolos e avaliações pré e pós-intervenção do programa supracitado, de modo que estes dados foram analisados por meio de uma análise estatística comparativa, utilizando-se os testes de Wilcoxon, Mcnemar e NVivo. Nos resultados foi possível observar que, quando comparadas as avaliações pré e pós-intervenção do grupo de pais, houve melhora estatisticamente significante nas características do temperamento que os pais percebiam em seus filhos. Em relação às crianças foi observado que houve uma melhora no grau de severidade da gagueira; em relação ao perfil da fluência ocorreu uma diminuição significativa das disfluências gagas e, quando comparados os sentimentos das crianças em relação à sua fala na pós-intervenção, os sentimentos negativos que na pré-intervenção foram elencados numa maior frequência apareceram numa frequência menor de palavras na pós-intervenção. Portanto, o estudo propôs o uso de um programa que permitisse uma intervenção concomitante na área de fluência de pais e filhos, além de propor o uso de protocolos e questionários que podem ser utilizados como instrumentos para a avaliação e intervenção na área da fluência. Além disso, mostrou a importância da participação dos pais durante o processo interventivo de seus filhos, permitindo que participem ativamente da intervenção fonoaudiológica, compreendam a gagueira e se instrumentalizem sobre quais atividades podem realizar no ambiente doméstico de forma a promover a melhora da fluência de seus filhos.(AU)

Fluency refers to the continuous and smooth flow of speech production, but when the speech flow ruptures we have what we call disfluencies (changes in fluency), which vary to a greater or lesser degree depending on the day , The emotion involved and the mastery over the subject of the conversation. What differentiates a common disfluency from all speakers of a gaga dysfluency is the amount of speech disruption and the individual capacity for the prompt recovery of balance between the two processes. It is generally perceived that an individual presents with stuttering (dysfluency) already in childhood, so it is imperative that this child perform speech-language therapy, so that there are several therapeutic approaches and phonoadiological programs for this treatment, however, regardless of which program or Therapeutic approach the speech-language pathologist will choose, if the parents are not well oriented and engaged by the therapist to participate actively in the intervention process, the progress of the intervention will probably be slower and demotivating. The objective of this work was to elaborate, implement and analyze two programs aimed at children with disfluentes, being an intervention program for the children and another intervention program for the phonoaudiologist to apply with the parents. The participants of the study were six parents of six disfluentes children, ranging in age from 2 years and 11 months to 6 years and 11 months, with the participation of both the parents (parents group) and the children (speech therapy) of the complete program Which was performed during 10 sessions with weekly frequency and duration of 50 minutes each session. It is noteworthy that the program of parents and children were correlated. Pre- and post-intervention protocols and evaluations of the aforementioned program were applied, so that these data were analyzed through a comparative statistical analysis, using the Wilcoxon, Mcnemar and NVivo tests. In the results it was possible to observe that, when comparing the pre- and post-intervention evaluations of the parents group, there was a statistically significant improvement in the temperament characteristics that the parents perceived in their children. Regarding the children, it was observed that there was an improvement in the severity degree of stuttering; In relation to the fluency profile, there was a significant decrease in gut disfluencies, and when the children's feelings were compared with their speech in the postintervention, the negative feelings that in the preintervention were listed at a higher frequency appeared at a lower frequency of words In post-intervention. Therefore, the study proposed the use of a program that allows a concomitant intervention in the area of fluency of parents and children, besides proposing the use of protocols and questionnaires that can be used as instruments for evaluation and intervention in the area of fluency. In addition, he showed the importance of parental participation during the intervention process of their children, allowing them to participate actively in speech therapy intervention, understand stuttering and to instrumentalize what activities they can perform in the home environment in order to promote the improvement of their children's fluency.(AU)

Protótipo de aplicativo para terapia vocal: análise por pares / Prototype app for voice therapy: a peer review

RESUMO Objetivo A terapia fonoaudiológica vocal promove mudanças de hábitos relacionados à voz do paciente, assim como sua reabilitação. O fonoaudiólogo pode utilizar desde materiais como figuras até recursos eletrônicos e de informática como instrumentos facilitadores durante esse processo. A tecnologia móvel é atrativa, interativa e presente em tempo quase integral na rotina de parte da população e apresenta-se crescente na área da saúde. Desenvolver um protótipo de aplicativo para terapia vocal, submetê-lo à análise por pares e aprimorar o protótipo inicial a partir das apreciações. Método foi desenvolvido um protótipo do aplicativo Q-Voz com base nas Diretrizes de Interface Humana da Apple. O protótipo foi analisado por sete fonoaudiólogos que atuam na área de voz e, a partir das apreciações, foram realizadas melhorias no produto. Resultados todos os recursos do aplicativo foram considerados muito satisfatórios pela maioria dos avaliadores. Todos os avaliadores consideraram o aplicativo muito útil; referiram acreditar que os pacientes terão mais facilidade em realizar mudanças no comportamento vocal com o aplicativo que sem ele; que usariam esse aplicativo com seus pacientes disfônicos em reabilitação; e consideraram que o aplicativo apresenta ferramentas úteis para o autogerenciamento vocal. A partir das sugestões, foram realizadas seis melhorias no protótipo. Conclusão o protótipo do Aplicativo Q-Voz desenvolvido foi avaliado por sete fonoaudiólogos e aprimorado. Todos os avaliadores afirmaram que usariam o aplicativo com seus pacientes em reabilitação, o que indica que o Aplicativo Q-Voz para dispositivos móveis pode ser considerado uma ferramenta auxiliar para a terapia fonoaudiológica vocal.

ABSTRACT Purpose Voice speech therapy promotes changes in patients’ voice-related habits and rehabilitation. Speech-language therapists use a host of materials ranging from pictures to electronic resources and computer tools as aids in this process. Mobile technology is attractive, interactive and a nearly constant feature in the daily routine of a large part of the population and has a growing application in healthcare. To develop a prototype application for voice therapy, submit it to peer assessment, and to improve the initial prototype based on these assessments. Methods a prototype of the Q-Voz application was developed based on Apple's Human Interface Guidelines. The prototype was analyzed by seven speech therapists who work in the voice area. Improvements to the product were made based on these assessments. Results all features of the application were considered satisfactory by most evaluators. All evaluators found the application very useful; evaluators reported that patients would find it easier to make changes in voice behavior with the application than without it; the evaluators stated they would use this application with their patients with dysphonia and in the process of rehabilitation and that the application offers useful tools for voice self-management. Based on the suggestions provided, six improvements were made to the prototype. Conclusion the prototype Q-Voz Application was developed and evaluated by seven judges and subsequently improved. All evaluators stated they would use the application with their patients undergoing rehabilitation, indicating that the Q-Voz Application for mobile devices can be considered an auxiliary tool for voice speech therapy.

Virtual reality exposure using three-dimensional images for the treatment of social phobia

Objective: To test a potential treatment for social phobia, which provides exposure to phobia-inducing situations via computer-generated, three-dimensional images, using an open clinical trial design. Methods: Twenty-one patients with a DSM-IV diagnosis of social phobia took part in the trial. Treatment consisted of up to 12 sessions of exposure to relevant images, each session lasting 50 minutes. Results: Improvements in social anxiety were seen in all scales and instruments used, including at follow-up 6 months after the end of treatment. The average number of sessions was seven, as the participants habituated rapidly to the process. Only one participant dropped out. Conclusion: This study provides evidence that exposure to computer-generated three-dimensional images is relatively inexpensive, leads to greater treatment adherence, and can reduce social anxiety. Further studies are needed to corroborate these findings.

Computador-internet nas práticas de estudo contemporâneas: uma pesquisa com estudantes de psicologia / Internet-computer in contemporary study practices: a research with psychology students / Ordenador-internet en las prácticas de estudio contemporáneas: una investigación con estudiantes de psicología

O artigo objetiva investigar como está sendo realizado o estudo na contemporaneidade. Segue dois caminhos. Inicialmente opera uma inflexão no campo dos estudos sobre o estudo. Ao invés de conceber o estudo como entidade objetiva e naturalizada propõe, com a ajuda das abordagens construtivistas da cognição, como as de J. Piaget, L.Vigotski, F. Varela e H. Maturana e dos trabalhos de M. Foucault e R. Chartier, analisar o problema a partir da noção de práticas de estudo. O estudo passa a ser resultado das ações concretas dos estudantes, deixando de ser concebido como atividade mental supostamente invariante, voltada para aquisição de um saber. Em seguida, apresenta e discute uma pesquisa de campo, na qual foram entrevistados 15 estudantes de Psicologia do primeiro ao nono período de quatro instituições de ensino superior do município do Rio de Janeiro, sendo duas públicas e duas privadas. As entrevistas seguiram a técnica da entrevista de explicitação. A conclusão aponta para a importância do uso do computador-internet nas práticas de estudo contemporâneas e analisa alguns de seus efeitos, como a grande quantidade de informação, o estudo em circulação, a fragmentação e composição de partes e a coexistência do estudo com o texto digital e impresso...

This paper aims at investigating how study is being accomplished in contemporaneity. It follows two main paths: Initially, it operates an inflection in the study field of studies. Instead of conceiving study as an objective and naturalized entity, it proposes to analyze the issue from notions of practices of study, with the support of constructivist approaches of cognition such as those by J. Piaget, L.Vygotski, F. Varela and H. Maturana, as well as the work of M. Foucault and R. Chartier. The study becomes the result of concrete actions of students, instead of being conceived as an allegedly invariant mental activity aiming at knowledge acquisition. Secondly, it presents and discusses a field research in which fifteen psychology students were interviewed. The interviewees belong to four different institutions from the city of Rio de Janeiro, two public and two private, where they were between the 1st and 9th semesters. Interviews were carried out following the explanation technique. The conclusion points out the importance of the use of internet-computer in contemporary study practices, and analyzes some of its effects, such as the great amount of information, the study in circulation, the fragmentation and composition of parts, and the coexistence of study with the digital and printed texts...

El artículo tiene el objetivo de investigar cómo se realiza el estudio en el mundo contemporáneo. Toma dos caminos: De inicio realiza una inflexión en el campo de los estudios sobre el estudio. En vez de entender el estudio como una entidad objetiva y natural propone, con ayuda de abordajes constructivistas de la cognición como los de J. Piaget, L. Vygotski, F. Varela y H. Maturana, y de los trabajos de M. Foucault, R. Chartier, analizar el problema partiendo del concepto de prácticas de estudio. El estudio empieza a ser entendido como resultado de las acciones concretas de los estudiantes, dejando de ser comprendido como actividad mental supuestamente invariable, orientada para obtener un saber. Después presenta y discute una investigación de campo, en la que se entrevistaron a 15 estudiantes de psicología del 1º al 9º período de cuatro universidades de la capital de Río de Janeiro, siendo dos públicas y dos privadas. Las entrevistas siguieron la técnica de entrevista de explicitación. La conclusión indica la importancia del uso del ordenador-internet en prácticas de estudio contemporáneas y analiza algunos de sus efectos: la gran cantidad de informaciones, el estudio en circulación, la fragmentación y composición de partes y la coexistencia del estudio con el texto digital e impreso...

Virtual Environment: assistance in nursing care for the deaf based on the protocol of Primary Care / Ambiente virtual: apoyo al servicio de enfermería para los sordos basado en el protocolo de atención básica / Ambiente virtual: auxílio ao atendimento de enfermagem para surdos com base no protocolo de atenção básica

Objective: Presenting a Virtual Environment (VE) based on the Protocol of Treatment of Hypertension and Diabetes Mellitus type 2, used in Primary Care for evaluation of dietary habits in nursing consultations. Method: An experimental study applied by two nurses and a nurse manager, in a sample of 30 deaf patients aged between 30 and 60 years. The environment was built in Visual Basic NET and offered eight screens about feeding containing food pictures, videos in Libras (Brazilian sign language) and audio. The analysis of the VE was done through questionnaires applied to patients and professionals by the Poisson statistical test. Results: The VE shows the possible diagnostics in red, yellow, green and blue colors, depending on the degree of patients’ need. Conclusion: The environment obtained excellent acceptance by patients and nurses, allowing great interaction between them, even without an interpreter. The time in consultation was reduced to 15 minutes, with the preservation of patient privacy.

Objetivo: Presentar un Ambiente Virtual (AV) basado en el Protocolo de Tratamiento de la Hipertensión Arterial y de la Diabetes Mellitus tipo 2 aplicado en la Atención Básica, en la evaluación de los hábitos alimentarios en la consulta de enfermería. Método: Estudio experimental aplicado por dos enfermeros y un gestor en una muestra de 30 pacientes sordos entre 30 y 60 años. El ambiente se desarrolló en Visual Basic Net. Éste ofreció ocho cuadros con preguntas sobre la alimentación del paciente que contenían figuras de alimentos, videos en lenguaje de señas y audio. El análisis del AV fue realizado por medio de la prueba estadística de Poisson de los cuestionarios aplicados a los pacientes y profesionales. Resultados: Al final del procedimiento, el ambiente presenta el posible diagnóstico con un mensaje en la pantalla en color rojo, amarillo, verde o azul, dependiendo del grado de necesidad del paciente. Conclusión: El ambiente obtuvo una excelente aceptación por parte de los pacientes y enfermeros, posibilitando una óptima interacción entre estos, incluso sin un intérprete. La consulta se redujo a 15 minutos, con la mantención de la privacidad del paciente.

Objetivo: Apresentar um Ambiente Virtual (AV), baseado no Protocolo de Tratamento da Hipertensão Arterial e do Diabetes Mellitus tipo 2, aplicado na Atenção Básica, em avaliação de hábitos alimentares na consulta de enfermagem. Método: Estudo experimental aplicado por dois enfermeiros e um gestor, em uma amostra de 30 pacientes surdos com idade entre 30 e 60 anos. Construído em Visual Basic Net, o ambiente ofereceu oito telas sobre alimentação contendo figuras alimentícias, vídeos em libras e áudio. A análise do AV foi feita em questionários aplicados aos pacientes e profissionais por meio do teste estatístico Poisson. Resultados: Apresenta o possível diagnóstico nas cores vermelha, amarela, verde e azul, dependendo do grau de necessidade do paciente. Conclusão: O ambiente obteve excelente aceitação pelos pacientes e enfermeiros, possibilitando ótima interação entre eles, mesmo sem intérprete. A consulta foi reduzida para 15 minutos, com a preservação da privacidade do paciente.




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Effectiveness and safety of computer-controlled periodontal ligament injection system in endodontic access to the mandibular posterior teeth / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate the effectiveness and safety of a computer-controlled periodontal ligament (PDL) injection system to the local soft tissues as the primary technique in endodontic access to mandibular posterior teeth in patients with irreversible pulpitis.</p><p><b>METHODS</b>A total of 162 Chinese patients who had been diagnosed with irreversible pulpitis in their mandibular posterior teeth without acute infection or inflammation in the periodontal tissues were enrolled in this clinical study. The patients were divided into 3 groups according to the position of the involved tooth: the premolar group (PM, n=38), first molar group (FM, n=66), and second molar group (SM, n=58). All the patients received computer-controlled PDL injection with 4% articaine and 1:100 000 epinephrine. Immediately after the injection, endodontic access was performed, and the degree of pain during the treatment was evaluated by the patients using Visual Analogue Scale for pain. The success rates were compared among the 3 groups. The responses of local soft tissues were evaluated 3-8 days and 3 weeks after the procedure.</p><p><b>RESULTS</b>The overall success rate was 76.5%. There was a significant difference in success rates among the PM, FM, and SM groups (92.1%, 53.0%, 93.1%, respectively; χ² = 34.3, P<0.01). Both the PM and SM groups showed higher success rates than that of the FM group (v=1, χ² = 16.73, P<0.01; v=1, χ² = 24.5, P<0.01). No irreversible adverse effects on the periodontal soft tissues at the injection sites were observed in the follow-up visits in any of the groups.</p><p><b>CONCLUSION</b>The computer-controlled PDL injection system demonstrates both satisfactory anesthetic effects and safety in local soft tissues as primary anesthetic technique in endodontic access to the mandibular posterior teeth in patients with irreversible pulpitis.</p>

Application of three-dimensional technology in assessment of burn area and treatment strategy of burns / 中华烧伤杂志

Accurate area assessment of a burn injury and its treatment according to its depth of injury are the foundation of burn treatment due to its complexity, and various techniques and methods have been employed to solve these problems for many years. As the demand of modern medicine calls for individualized and precise therapeutic measures, it is clear that the traditional diagnostic and treatment measures are insufficient. The flourishing development of three-dimensional (3D) technology seems to provide new research approaches and technical opporturities for burn surgery. A series of techniques such as 3D model, 3D scanning, and 3D printing may be promising in advancing burn surgery through basic research to achieve rational clinical applications in the future. In this paper, the applications and achievements of 3D technology in burn surgery in recent years are summarized.

Tecnología asistiva: propuesta de terapia ocupacional para aumentar el desempeño ocupacional de un usuario con parálisis cerebral / Assitive technology: propurse of occupational teraphy for increase occupational performance of user with cerebral palsy

El presente estudio de caso ha sido confeccionado para la obtención del título profesional de Terapeuta Ocupacional, en el marco del examen de pre-título exigido por la Universidad de Chile. Su objetivo es fomentar el uso de la tecnología asistiva como herramienta de intervención para la inclusión de personas con discapacidad, enmarcar las competencias que debe disponer el profesional en su utilización y fomentar su uso como complemento al enfoque tradicional de rehabilitación. Se expone el proceso de evaluación e intervención de un joven con diagnóstico de parálisis cerebral, con compromiso motor severo e intelectual leve, alto nivel de dependencia y escasas oportunidades de ejercer su autonomía. La experiencia es llevada a cabo en una institución de rehabilitación física infanto-juvenil de la Región Metropolitana, específicamente en una unidad de tecnología asistiva durante el año 2012. Engloba principalmente el proceso de evaluación y acceso al rdenador e instauración de un sistema inicial de comunicación aumentativa. Se concluye que la intervención realizada complementa los enfoques tradicionales de rehabilitación para fomentar la independencia, autonomía y desempeño ocupacional. Se visualiza la escasa sistematización de prácticas en Chile y se propone fomentar su desarrollo como un área de especialidad dentro de la Terapia Ocupacional.

This paper has been made in order to obtain the professional qualification of Occupational Therapist, an examination of prequalification required by Universidad de Chile. It aims to promote the use of assistive technology as a tool of intervention for the inclusion of people with disabilities, framing the competencies must have the professional in their use and encourage its use as a complement to the traditional approach of rehabilitation. It describes the process of assessment and intervention of a youth with cerebral palsy with severe motor and mild intellectual commitment, high dependency and limited opportunities to exercise their autonomy. The experience is held at an institution of child and adolescent physical rehabilitation of the metropolitan region, specifically assistive technology unit during 2012. It covers mainly the evaluation process and access to the computer and setting up an initial system of augmentative communication. Conclude that interventions complement traditional rehabilitation approaches to promote independence, autonomy and occupational performance. Displays the scarce systematization of practices in Chile intends to promote its development as a specialty area within Occupational Therapy.

Effects of different types of auditory temporal training on language skills: a systematic review

Previous studies have investigated the effects of auditory temporal training on language disorders. Recently, the effects of new approaches, such as musical training and the use of software, have also been considered. To investigate the effects of different auditory temporal training approaches on language skills, we reviewed the available literature on musical training, the use of software and formal auditory training by searching the SciELO, MEDLINE, LILACS-BIREME and EMBASE databases. Study Design: Systematic review. Results: Using evidence levels I and II as the criteria, 29 of the 523 papers found were deemed relevant to one of the topics (use of software - 13 papers; formal auditory training - six papers; and musical training - 10 papers). Of the three approaches, studies that investigated the use of software and musical training had the highest levels of evidence; however, these studies also raised concerns about the hypothesized relationship between auditory temporal processing and language. Future studies are necessary to investigate the actual contribution of these three types of auditory temporal training to language skills. .

The use of the virtual reality as intervention tool in the postoperative of cardiac surgery / O uso da realidade virtual como ferramenta complementar no pós-operatório de cirurgia cardíaca

INTRODUCTION: Cardiac surgery has been the intervention of choice in many cases of cardiovascular diseases. Susceptibility to postoperative complications, cardiac rehabilitation is indicated. Therapeutic resources, such as virtual reality has been helping the rehabilitational process. The aim of the study was to evaluate the use of virtual reality in the functional rehabilitation of patients in the postoperative period. METHODS: Patients were randomized into two groups, Virtual Reality (VRG, n = 30) and Control (CG, n = 30). The response to treatment was assessed through the functional independence measure (FIM), by the 6-minute walk test (6MWT) and the Nottingham Health Profile (NHP). Evaluations were performed preoperatively and postoperatively. RESULTS: On the first day after surgery, patients in both groups showed decreased functional performance. However, the VRG showed lower reduction (45.712.3) when compared to CG (35.0612.09, P<0.05) in first postoperative day, and no significant difference in performance on discharge day (P>0.05). In evaluating the NHP field, we observed a significant decrease in pain score at third assessment (P<0.05). These patients also had a higher energy level in the first evaluation (P<0.05). There were no differences with statistical significance for emotional reactions, physical ability, and social interaction. The length of stay was significantly shorter in patients of VRG (9.410.5 days vs. 12.2 1 0.9 days, P<0.05), which also had a higher 6MWD (319.9119.3 meters vs. 263.5115.4 meters, P<0.02). CONCLUSION: Adjunctive treatment with virtual reality demonstrated benefits, with better functional performance in patients undergoing cardiac surgery.

INTRODUÇÃO: A cirurgia cardíaca tem sido a intervenção de escolha em muitos casos de doenças cardiovasculares. Pela susceptibilidade a complicações pós-operatórias, a reabilitação cardíaca é indicada. Recursos terapêuticos, como a realidade virtual, tem favorecido o processo reabilitacional. O objetivo do estudo foi avaliar o uso da realidade virtual na reabilitação funcional de pacientes pós-cirurgia cardíaca. MÉTODOS: Os pacientes foram randomizados em dois grupos, Realidade Virtual (GRV, n=30) e Grupo Controle (GC, n=30). A resposta ao tratamento foi avaliada por meio do Questionário de Medida de Independência Funcional (MIF), Teste de caminhada de 6 minutos e do Perfil de Saúde de Nottingham (PSN). Os questionários foram aplicados no pré e pós-operatório. RESULTADOS: No primeiro dia de pós-operatório, os pacientes de ambos os grupos demonstraram diminuição do desempenho funcional. No entanto, essa perda foi menor no GRV (45,712,3) em relação ao GC (35,0612,09, P<0,05), sem diferença significativa no momento da alta hospitalar (P>0,05). Na avaliação do PSN, foi observada menor intensidade da dor no terceiro momento de avaliação no GRV (P<0,05). Esses pacientes também apresentaram maior nível de energia na primeira avaliação (P<0,05). Não foram encontradas diferenças com significância estatística para reações emocionais, habilidade física e interação social. O tempo de internação foi significativamente menor nos pacientes do GRV (P<0,05), que também apresentaram maior distância percorrida no TC6 (319,9119,3 metros vs. 263,5115,4 metros, P<0,02). CONCLUSÃO: O tratamento com a realidade virtual foi eficaz em proporcionar melhor desempenho funcional pós-operatório.

Computer-assisted sperm analysis for assessing sperm mobility parameters in in vitro fertilization / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the association of sperm mobility parameters assessed by computer-assisted sperm analysis (CASA) with the rates of normal fertilization, oocyte cleavage and excellent embryos in in vitro fertilization (IVF) cycles.</p><p><b>METHODS</b>A total of 288 infertile women undergoing IVF cycles patients were divided into two groups according to the normal fertilization rate (≥50% and <50%), cleavage rate (≥90% and <90%), or excellent embryo rates (≥50% and <50%). The means of the sperm motility parameters analyzed by CASA twice before oocyte retrieval were recorded and analyzed using t-test in relation to the rates of normal fertilization, cleavage and excellent embryos in IVF cycles.</p><p><b>RESULTS</b>The mean curvilinear velocity (VCL), average path velocity (VAP), and amplitude of lateral head displacement (ALH) were significantly higher in women with a normal fertilization rate of ≥50% than in those with a normal fertilization rate of <50% (P<0.05). Women with an oocyte cleavage rate of ≥90% had significantly higher VCL and VAP than those with a cleavage rate of <90% (P<0.05). The VCL, straight line velocity (VSL), VAP, linearity, straightness, wobble coefficient, ALH, or beat-cross frequency showed no significant differences between women with excellent embryo rates of ≥50% and <50% (P>0.05).</p><p><b>CONCLUSION</b>The sperm motility parameters assessed using CASA are associated with normal fertilization and oocyte cleavage rates but not with excellent embryo rate in IVF cycles.</p>

Dosimetria comparativa de braquiterapia de próstata com sementes de I-125 e Pd-103 via SISCODES/MCNP / Comparative dosimetry of prostate brachytherapy with I-125 and Pd-103 seeds via SISCODES/MCNP

OBJETIVO: O presente artigo visa apresentar um estudo dosimétrico comparativo de braquiterapia de próstata com sementes de I-125 e Pd-103. MATERIAIS E MÉTODOS: Um protocolo adotado para ambos os implantes com 148 sementes foi simulado em um fantoma tridimensional heterogêneo de pelve por meio dos códigos SISCODES/MCNP5. Histogramas dose-volume na próstata, bexiga e reto, índices de doses D10, D30, D90, D0,5cc, D2cc e D7cc, e representações de distribuição espacial de dose foram avaliados. RESULTADOS: A atividade inicial de cada semente de I-125, para que D90 seja equivalente à dose de prescrição, foi calculada em 0,42 mCi, e de Pd-103, em 0,94 mCi. A dose máxima na uretra foi 90% e 108% da dose de prescrição para I-125 e Pd-103, respectivamente. A D2cc para I-125 foi 30 Gy no reto e 127 Gy na bexiga, e para Pd-103 foi 29 Gy no reto e 189 Gy na bexiga. A D10 no osso do púbis foi 144 Gy para I-125 e 66 Gy para Pd-103. CONCLUSÃO: Os resultados indicam que os implantes de Pd-103 e I-125 puderam depositar a dose prescrita no volume alvo. Entre os achados, observou-se excessiva exposição de radiação nos ossos da pelve, principalmente no protocolo com I-125.

OBJECTIVE: The present paper is aimed at presenting a comparative dosimetric study of prostate brachytherapy with I-125 and Pd-103 seeds. MATERIALS AND METHODS: A protocol for both implants with 148 seeds was simulated on a heterogeneous three-dimensional pelvic phantom by means of the SISCODES/MCNP5 codes. Dose-volume histograms on prostate, rectum and bladder, dose indexes D10, D30, D90, D0.5cc, D2cc and D7cc, and representations of the spatial dose distribution were evaluated. RESULTS: For a D90 index equivalent to the prescription dose, the initial activity of each I-125 seed was calculated as 0.42 mCi and of Pd-103 as 0.94 mCi. The maximum dose on the uretra was 90% and 108% of the prescription dose for I-125 and Pd-103, respectively. The D2cc for I-125 was 30 Gy on the rectum and 127 Gy on the bladder; for Pd-103 was 29 Gy on the rectum and 189 Gy on the bladder. The D10 on the pubic bone was 144 Gy for I-125 and 66 Gy for Pd-103. CONCLUSION: The results indicate that Pd-103 and I-125 implants could deposit the prescribed dose on the target volume. Among the findings of the present study, there is an excessive radiation exposure of the pelvic bones, particularly with the I-125 protocol.

Proposed computerized protocol for epidemiological study of patients undergoing microsurgery of the larynx

Introduction: The merging of medicine with information technology facilitates the retrieval of stored data, aiding the conduct of research with greater scientific rigor. Studies in the field of otorhinolaryngology, specifically in the area of laryngology and voice, are of fundamental importance, since 70% of the economically active need their voice to work. Objective: To create a computerized protocol of the diseases of the larynx, apply and validate it, and use it to evaluate patients undergoing laryngoscopic microsurgery of the larynx. Method: We created a database of ENT diseases through a literature review of textbooks and scientific articles. Next, we computerized the data and incorporated it into the SINPE©, creating a master protocol (ENT diseases) and a specific protocol (laryngeal diseases). Data were collected prospectively from patients undergoing laryngeal microsurgery in the ENT Hospital of Paraná. The collected data were analyzed with graphs through the SINPE© Analyzer module. Results: We evaluated 245 patients aged 9-79 years, and determined that 36.61% (93 patients) underwent surgery for the presence of polyps on the vocal folds, 12.6% (32) underwent surgery for papillomatosis, and 11.83% (29) underwent surgery for intracordal cysts. Conclusions: The creation of an electronic database of clinical ENT diseases was feasible. We were also able to implement and validate the protocol. The database may be released to physicians involved in clinical data collection and retrieval of information to conduct scientific research in an organized manner. The most common laryngeal disorders identified were polyps, papilloma, and intracordal cysts...

Uso de programas de terapia cognitivo conductual computarizada para la prevención y tratamiento de depresión en adolescentes / Use of computerized cognitive behavioral therapy programs for the prevention and treatment of depression in adolescents

La terapia cognitivo conductual computarizada (TCC-c) ha demostrado ser efectiva en depresión en adultos. En adolescentes la investigación en esta área es aún limitada. El objetivo de este trabajo es revisar la literatura sobre el uso de programas de TCC-c para la prevención y tratamiento de depresión en adolescentes. Se realizó una búsqueda en las bases de datos PubMed, LILACS y SciELO. Diez estudios que corresponden a seis diferentes programas fueron analizados. Los programas varían en extensión y grado de contacto con los profesionales. En general, los estudios reportaron buena aceptabilidad y reducción de la sintomatología depresiva. Sin embargo, en su mayoría hubo una alta tasa de abandono. La evidencia preliminar sugiere que la TCC-c es una alternativa útil en la prevención y tratamiento de la depresión en adolescentes. Faltan estudios que apunten a mejorar la adherencia y eficacia de programas con TCC-c.

Computerized cognitive behavioral therapy (cCBT) is a demonstrated effective therapy for depression in the adult population. In the adolescent population, however, little research has been done. The objective of this study is to review the literature about the use of cCBT programs to prevent and treat depression in adolescents. A search was done in the databases PubMed, LILACS, and SciELO. In the end, ten studies, corresponding to six different programs, were analyzed. The programs varied in length and degree of contact with professionals. In general, the studies reported good acceptance and reduced depressive symptomatology; however, the majority of the studies had a high rate of dropouts. Preliminary evidence suggests that cCBT is a useful alternative in the prevention and treatment of depression in adolescents, but additional studies must be done to show improved cCBT program adherence and efficacy.