Perceptual evaluation of tracheoesophageal speech: Is it a reliable tool.

Perceptual voice evaluation is a common clinical tool for rating the severity of vocal quality impairment. It has been used in research as a gold standard for comparison with acoustic and aerodynamics measurements. Nevertheless, it has disadvantages in the form of being time‑consuming, a group of raters is needed and last but not the least it is a subjective manner of evaluation. Intraobserver and interobserver reliability is an important issue in perceptual evaluations. Different perceptual scales have been developed to describe the quality of a patient’s voice but none is internationally accepted. Although not entirely comprehensive, perceptual evaluations will be used as a standard against which other measures will be evaluated. Data were collected by conducting a computer‑aided search of the MED‑LINE and PUBMED databases, supplemented by hand searches of key journals. More than 50 articles in the last three decades on the topic have been reviewed out of which approximately 31 were found to be relevant to this article.

Atención del dolor en el paciente politraumatizado en el Hospital Militar Central "Dr. Carlos J. Finlay" / Pain management in the multi-trauma patient in ¨Dr Carlos J. Finlay¨ central military hospital

INTRODUCCIÓN: los traumatismos se han relacionado siempre con el dolor como síntoma acompañante que influye negativamente en la evolución del paciente. OBJETIVO: valorar la atención a los pacientes politraumatizados en lo referente a la evaluación y tratamiento del dolor. MÉTODO: se realizó un estudio observacional, retrospectivo, de corte transversal, de enero a diciembre de 2013, en una muestra de 60 pacientes que ingresaron con diagnóstico de politrauma, en el Hospital Militar Central "Dr. Carlos J. Finlay". Se emplearon como descriptores estadísticos medidas de resumen de los datos cualitativos (razones y proporciones). RESULTADOS: el 83,3 % de los pacientes refirió dolor al menos una vez durante el ingreso; en 51,7 % se le evaluó el síntoma, utilizando la escala verbal simple en el 26,7 %; en el resto no se usó ninguna escala. Los antinflamatorios no esteroideos se indicaron en todos los casos, con gran variabilidad en relación a las dosificaciones e intervalos de administración. Fue escasa el uso de opioides (6,7 %), ketamina (3,4 %), anestésicos locales (3,4 %) y coadyuvantes (1,7 %). Prevaleció la indicación a demanda, administrándose la analgesia en este grupo en el 46,7 %. No se evaluó la reducción del dolor en el 50 % de los casos en que se administró la analgesia, constatándose su reducción solo en el 42,9 %. En el 91,7 % de la muestra se valoró el tratamiento como inadecuado. CONCLUSIONES: la evaluación y el tratamiento analgésico son inadecuados, confirmando la necesidad de implementar estrategias para mejorar el control del dolor en el trauma.

INTRODUCTION: trauma has been related always with pain as an accompanist symptom that affects negatively the evolution of the patient. This work aspire to value the attention to polytrauma patient refers to evaluation and treatment of the pain. METHODS: an observational, retrospective, transversal study was made, since January until December of 2013. The sample was 60 patients received in "Dr. Carlos J. Finlay" Military Central Hospital with polytrauma. Stadistics measures descriptors were employed (reasons and proportions). RESULTS: the 83.3 % of the patients reports pain, at least one time during the intern; only 56.0 % of these were evaluated; in 51.7 % of the sample were evaluated the symptom; in 26.7 % of the sample was used a verbal scale; the rest of the patients were no evaluated. In all of cases were used non-steroids anti-inflammatory drugs, with doses and administration intervals vary. The use of opioids (6.7 %), ketamina (3.4 %), local anesthesics (3.4 %) and support drugs (1.7 %) were poor. Prevail the demand indication (88.3 %), using indicate analgesia in 46.7 % of the sample. The reduction of pain was evaluated in 50.0 % of cases that received analgesia; verify it only in 42.9 % of patients. In 91.7 % of the sample was valued the treatment as inadecuated. CONCLUTIONS: the evaluation and treatment of pain is deficient, confirm the necessity of implement strategies of properties actuations.

Enfermedad de parkinson: criterios diagnósticos, factores de riesgo y de progresión, y escalas de valoración del estadio clínico / Parkinson's disease: diagnostic criteria, risk factors and progression, and assessment scales clinical stage

La enfermedad de Parkinson es la segunda enfermedad degenerativa más común en el mundo después del Alzheimer. En Colombia hay una prevalencia estimada de 4,7 (IC95%: 2,2 a 8,9) por 1,000 habitantes y se detecta con mayor frecuencia en personas mayores de 60 años, lo que representa un alto costo para las familias y para el sistema de salud. Actualmente se utilizan para el diagnóstico los criterios del Banco de Cerebros del Reino Unido, sin embargo, hay otros criterios que pueden ser útiles para proyectos de investigación. Se ha demostrado que hay múltiples factores de riesgo y de progresión asociados con la enfermedad, y que deben tenerse en cuenta durante la evaluación clínica, la cual debería siempre realizarse en conjunto con las escalas de seguimiento.

Parkinson's disease is the second most common degenerative disease in the world after Alzheimer's disease. Colombia has an estimated prevalence of 470 (95% CI 2.2 to 8.9) per 1,000 people, more frequently found in people over 60 years, which represents a high financial burden imposed on families and health care system. The criteria currently used for the diagnostic are those compiled in the Brain Bank of the UK; however, other criteria may be useful for research. There are multiple risk and progression factors which have been proven to have an association with parkinson's disease, and that should be considered during clinical assessment, which should always be carried out additionally with follow scales.

Estimulação de nervos periféricos no tratamento das síndromes dolorosas crônicas / Peripheral nerve stimulation to treat chronic painful syndromes

JUSTIFICATIVA E OBJETIVOS: O uso da estimulação elétrica de nervos periféricos para o tratamento da dor crônica constitui um armamentário neurocirúrgico utilizado há bastante tempo, sendo uma modalidade indicada no tratamento das síndromes dolorosas de caráter neuropático, juntamente com outras formas de neuroestimulação: estimulação elétrica da coluna dorsal e a estimulação cerebral profunda. O objetivo deste estudo foi analisar a relevância da estimulação nervosa periférica no tratamento das síndromes dolorosas crônicas. CONTEÚDO: A principal indicação é a dor neuropática crônica, intensa, refratária ao tratamento conservador. Apresenta, contudo, necessidade de a área acometida ter uma distribuição anatômica definida e relacionada ao nervo periférico no qual se deseja realizar a estimulação. Deve-se perceber também sinais de comprometimentoobjetivo do nervo. É necessária a realização de teste de neuroestimulação entre 7 e 10 dias previamente ao implante definitivo e deve-se obter melhora de pelo menos 50% da dor em escalas de avaliação específicas. Existem duas formas de implante de eletrodo em nervos periféricos: abordagem cirúrgica direta e técnica percutânea. Após o teste ser completado, é realizado o implante do sistema de gerador permanente. CONCLUSÃO: O uso da estimulação de nervos periféricos no tratamento das síndromes dolorosas crônicas tem mostrado resultados promissores. O desenvolvimento de novos materiais é extremamente necessário para a evolução da técnica e o tratamento dessas síndromes dolorosas crônicas. Nesse sentido, novas próteses estão sendo desenvolvidas e uma das características de implante mais viável para uso no sistema nervoso periférico seria uma prótese de baixo perfil, com bateria já implantada com os eletrodos e recarregável.

BACKGROUND AND OBJECTIVES: Peripheral nerve stimulation to treat chronic pain is a neurosurgical armamentarium used for a long time, being indicated to treat neuropathic painful syndromes together with other types of nerve stimulation: dorsal column electric stimulation and deep cerebral stimulation. This study aimed at analyzing the relevance of peripheral nerve stimulation to treat chronic painful syndromes. CONTENTS: Primary indication is severe chronic neuropathic pain refractory to conservative treatment. However, the affected area needs to have a defined anatomic distribution and related to the peripheral nerve to be stimulated. One should also notice signs of objective involvement of the nerve. A nerve stimulation test shall be performed from 7 to 10 days prior to the final implant and pain must improve at least 50% according to specific evaluation scales. There are two methods to implant electrodes in peripheral nerves: direct surgical approach and percutaneous technique. After the test, the implant with permanent generator is performed. CONCLUSION: Peripheral nerve stimulation to treat chronic painful syndromes has shown promising results. The development of new materials is extremely necessary for the technical evolution and treatment of chronic painful syndromes. In this sense, new prostheses are being developed and one feature of a more feasible implant to be used in the peripheral nervous system would be low profile prosthesis with already implanted and rechargeable battery.

Escalas de satisfação com o atendimento às doenças cardiovasculares: CARDIOSATIS usuário e equipe / Satisfaction scales with health care to cardiovascular diseases: CARDIOSATIS patient and team

A satisfação é uma importante medida da qualidade da atenção, da adesão ao tratamento e uso adequado dos serviços de saúde. O objetivo foi construir as escalas para avaliar a satisfação da equipe médica e de usuários com o atendimento às emergências cardiovasculares oferecido por um projeto de telemedicina. A construção das escalas seguiu os padrões internacionais para criação de instrumentos incluindo a definição operacional do construto satisfação e sua dimensionalidade; a operacionalização dos itens; a realização de pré-teste e o estudo piloto. A revisão de literatura, os grupos focais e discussão com especialistas delimitaram as áreas a serem incluídas nas escalas e a elaboração das questões. A escala CARDIOSATIS-Equipe é composta por quinze itens e a escala CARDIOSATIS-Usuário, por onze, pontuados em escala tipo Likert de cinco pontos, incluindo questões abertas. Englobam informações sobre satisfação com a estrutura física, recursos humanos, capacidade de resolutividade, atenção e cuidados oferecidos pelo serviço, além da satisfação com o atendimento recebido/prestado. As escalas CARDIOSATIS têm mostrado fácil compreensão e aceitação pela equipe médica e pacientes. Resultados preliminares mostraram boas características de validade e confiabilidade dos instrumentos.

Satisfaction is an important measure of quality care, of adherence to the treatment and adequate use of health services. The objective here is to build two scales which evaluates team' and patients' satisfaction with cardiovascular disease treatment provided through a distance telecardiology project. The procedure followed international standards for development of measure instruments, including operational definition of satisfaction contents and its area for evaluation; item definition; pre-test and pilot study. The literature review, focal groups and discussion with specialists had delimited the domains to be included in the scales and the elaboration of its items. The CARDIOSATIS-Team included 15 items and the CARDIOSATIS-Patient included 11. Satisfaction was measured through a five-point Likert scale. The scales' items comprised satisfaction with physical structure, human resources, capacity of resolution, attention and care offered by the service and the satisfaction with the received/given care. The scales also included open questions. CARDIOSATIS scales have showed to be an easy and accessible instrument very well accepted by medical team and patients. Preliminary results presented good characteristics of validity and reliability.