Difficult‐to‐control asthma management through the use of a specific protocol

The present study is a critical review of difficult‐to‐control asthma, highlighting the characteristics and severity of the disease. It also presents a protocol for the management of patients with this asthma phenotype. The protocol, which was based on relevant studies in the literature, is described and analyzed

Fluticasone furoate nasal spray in the treatment of allergic rhinitis

Allergic rhinitis (AR) is a prevalent disease with great morbidity and significant societal and economic burden. Intranasal corticosteroids are recommended as first-line therapy for patients with moderate-to-severe disease, especially when nasal congestion is a major component of symptoms. To compare the efficacy and safety profile of different available intranasal corticosteroids for the treatment of AR, it is important to understand their different structures and pharmacokinetic and pharmacodynamic properties. Knowledge of these drugs has increased tremendously over the last decade. Studies have elucidated mechanisms of action, pharmacologic properties, and the clinical impact of these drugs in allergic respiratory diseases. Although the existing intranasal corticosteroids are already highly efficient, the introduction of further improved formulations with a better efficacy/safety profile is always desired. Fluticasone furoate nasal spray is a new topical corticosteroid, with enhanced-affinity and a unique side-actuated delivery device. As it has high topical potency and low potential for systemic effects, it is a good candidate for rhinitis treatment

Conceptual framework for research and clinical practice concerning cardiovascular health-related behaviors

OBJETIVO: presentar el marco conceptual basado en el modelo PRECEDE, concebido para orientar la investigación y la práctica clínica de las enfermeras para el seguimiento clínico de pacientes cardíacos. MÉTODO: La base conceptual, así como los diseños metodológicos de los estudios implicados en el marco conceptual son discutidos. Además, la contextualización del modelo se ilustra en el seguimiento clínico de los pacientes hipertensos. Ejemplos de las etapas de planificación de la intervención de acuerdo con el protocolo intervention mapping son proporcionados. RESULTADOS: Se observó que la utilización del marco conceptual permitió guiar coherentemente y racionalmente los pasos de diagnóstico relacionados con el consumo excesivo de sal entre hipertensos, así como el desarrollo y la evaluación de las intervenciones específicas dirigidas a este comportamiento nutricional. CONCLUSIÓN: El uso del marco conceptual propuesto permite una mayor comprensión de los comportamientos de salud implicados en el desarrollo y progresión de los factores de riesgo cardiovascular, así como se muestra una propuesta interesante para las intervenciones de enfermería con mayores posibilidades de éxito. El uso ampliado de este modelo puede ser un medio factible para mejorar la salud cardiovascular de los pacientes incluidos en el Sistema Nacional de Salud.OBJECTIVE: To present a conceptual framework based on the PRECEDE model conceived to guide research and the clinical practice of nurses in the clinical follow-up of patients with cardiovascular diseases. METHOD: The conceptual bases as well as the study designs used in the framework are discussed. The contextualization of the proposed structure is presented in the clinical follow-up of hypertensive patients. Examples of the intervention planning steps according to the intervention mapping protocol are provided. RESULTS: This conceptual framework coherently and rationally guided the diagnostic steps related to excessive salt intake among hypertensive individuals, as well as the development and assessment of specific interventions designed to change this eating behavior. CONCLUSION: The use of this conceptual framework enables a greater understanding of health-related behaviors implied in the development and progression of cardiovascular risk factors and is useful in proposing nursing interventions with a greater chance of success. This model is a feasible strategy to improve the cardiovascular health of patients cared for by the Brazilian Unified Health System.OBJETIVO: apresentar a estrutura conceitual baseada no modelo PRECEDE, para guiar a pesquisa e a prática clínica do enfermeiro, na abordagem do paciente cardiopata ao longo de seu seguimento clínico. MÉTODO: as bases conceituais, assim como os desenhos metodológicos de pesquisa, implicados na estrutura conceitual, são abordados. A seguir, a contextualização da estrutura proposta é ilustrada no seguimento clínico de pacientes hipertensos, com incorporação das etapas de planejamento de intervenções, segundo o protocolo intervention mapping. RESULTADOS: constata-se que a utilização dessa estrutura conceitual permitiu guiar, de modo coerente e racional, as etapas diagnósticas relacionadas ao consumo excessivo de sal entre os hipertensos, bem como norteou o desenvolvimento e avaliação de intervenções específicas para mudança desse comportamento alimentar. CONCLUSÃO: a utilização da estrutura conceitual proposta permite compreensão mais ampla dos comportamentos em saúde, implicados no desenvolvimento e progressão dos fatores de risco cardiovascular, assim como revela-se um caminho interessante para a proposição de intervenções de enfermagem, com maior chance de sucesso. O emprego dessa estrutura, de modo ampliado, pode constituir um meio factível para melhorar a saúde cardiovascular dos pacientes atendidos pelo Sistema Único de Saúde

Comorbidities in Severe Asthma: Frequency of Rhinitis, Nasal Polyposis, Gastroesophageal Reflux Disease, Vocal Cord Dysfunction and Bronchiectasis

OBJECTIVES: Severe asthma is found in approximately 10% of patients with asthma. Some factors associated with worse asthma control include rhinitis, gastroesophageal reflux disease, vocal cord dysfunction (VCD), nasal polyposis and bronchiectasis. Therefore, we evaluated the prevalence of these illnesses in patients with severe asthma. METHODS: We conducted a retrospective analysis of data obtained from electronic medical records of patients with severe asthma between January 2006 and June 2008. Symptoms of rhinitis and gastroesophageal reflux disease were evaluated as well as intolerance to nonsteroidal anti-inflammatory drugs. We evaluated the results of esophagogastroduodenoscopy, videolaryngoscopy and CT scans of the chest in order to confirm gastroesophageal reflux disease, nasal polyposis, vocal cord dysfunction and bronchiectasis. RESULTS: We evaluated 245 patients. Rhinitis symptoms were present in 224 patients (91.4%); 18 (7.3%) had intolerance to nonsteroidal anti-inflammatory drugs, and 8 (3.3%) had nasal polyposis. Symptoms of gastroesophageal reflux disease were reported for 173 (70.6%) patients, although the diagnosis of gastroesophageal reflux disease was confirmed based on esophagogastroduodenoscopy or laryngoscopy findings in just 58 (33.6%) patients. Vocal cord dysfunction was suspected in 16 (6.5%) and confirmed through laryngoscopy in 4 (1.6%). The patient records provided CT scans of the chest for 105 patients, and 26 (24.8%) showed bronchiectasis. DISCUSSION: Rhinitis and gastroesophageal reflux disease were the most common comorbidities observed, in addition to bronchiectasis. Therefore, in patients with severe asthma, associated diseases should be investigated as the cause of respiratory symptoms and uncontrolled asthma

Analysis of action plans and coping plans for reducing salt consumption among women with hypertension

This cross-sectional study, based in implementation intention theory, describes action plans developed by women with hypertension (n=49) to add no more than 4g of salt per day to food and to reduce consumption of salty foods, as well as describing the barriers perceived and the coping strategies adopted for putting the action plans into practice. The plans were categorized according to similarities and were submitted to frequency analysis. The majority of the action and coping plans had to do with the effectuation of the behavior involving adding up to 4g of salt per day per person to food. The action strategies were aimed at quantifying the salt added, and the main obstacles were related to the reduced palatability of the food made with less salt. The coping plans have to do with preparing foods separately and to using natural seasonings instead of salt. This data can help the nurse to design activities for clinical education, with a view to reducing salt consumption among patients who prepare their own food.Este estudio transversal, basado en la teoría Implementation Intentions, describe los planes de acción desarrollados por las mujeres hipertensas (n=49) para añadir hasta 4g de sal/día a los alimentos y comer menos alimentos salados, así como las barreras percibidas y estrategias de afrontamiento para llevar a cabo los planes de acción. Los planes fueron agrupados como la similitud y la sometieron a un análisis de frecuencia. La mayor parte de los planes se refiere a la eficacia de la conducta de añadir a los alimentos 4g/sal/día/persona. Los planos de acción estaban dirigidos a la cuantificación de la sal y los principales obstáculos estaban relacionados con disminución de la palatabilidad de los alimentos bajos en sal. Estrategias de afrontamiento fueron dirigidos a preparar la comida por separado y en uso de especias naturales. Estos datos pueden ayudar a la enfermera en la dirección de las actividades clínicas y educativas.Este é um estudo transversal, baseado na teoria Implementation Intentions, cujo objetivo foi descrever planos de ação desenvolvidos por mulheres hipertensas (n=49) para adicionar, no máximo, 4g de sal/dia aos alimentos e reduzir o consumo de alimentos salgados, bem como barreiras percebidas e estratégias de enfrentamento para efetivar os planos de ação. Os planos foram categorizados quanto à similaridade e submetidos à análise de frequência. A maioria dos planos de ação e enfrentamento de obstáculos referiu-se à efetivação do comportamento para adicionar, no máximo, 4g/sal/dia/pessoa aos alimentos. As estratégias de ação foram voltadas para a quantificação do sal adicionado, e os principais obstáculos foram relacionados à menor palatabilidade dos alimentos com menos sal. Os planos de enfrentamento apontaram para o preparo, em separado, dos alimentos e uso de temperos naturais em substituição ao sal. Esses dados podem auxiliar o enfermeiro para direcionar atividades clinicoeducativas, visando a redução de consumo de sal entre pacientes que preparam sua alimentação

Análisis de los planes de acción y planes para hacer frente a los obstáculos a la reducción de la ingesta de sal en las mujeres hipertensas

This cross-sectional study, based in implementation intention theory, describes action plans developed by women with hypertension (n=49) to add no more than 4g of salt per day to food and to reduce consumption of salty foods, as well as describing the barriers perceived and the coping strategies adopted for putting the action plans into practice. The plans were categorized according to similarities and were submitted to frequency analysis. The majority of the action and coping plans had to do with the effectuation of the behavior involving adding up to 4g of salt per day per person to food. The action strategies were aimed at quantifying the salt added, and the main obstacles were related to the reduced palatability of the food made with less salt. The coping plans have to do with preparing foods separately and to using natural seasonings instead of salt. This data can help the nurse to design activities for clinical education, with a view to reducing salt consumption among patients who prepare their own food.Este é um estudo transversal, baseado na teoria Implementation Intentions, cujo objetivo foi descrever planos de ação desenvolvidos por mulheres hipertensas (n=49) para adicionar, no máximo, 4g de sal/dia aos alimentos e reduzir o consumo de alimentos salgados, bem como barreiras percebidas e estratégias de enfrentamento para efetivar os planos de ação. Os planos foram categorizados quanto à similaridade e submetidos à análise de frequência. A maioria dos planos de ação e enfrentamento de obstáculos referiu-se à efetivação do comportamento para adicionar, no máximo, 4g/sal/dia/pessoa aos alimentos. As estratégias de ação foram voltadas para a quantificação do sal adicionado, e os principais obstáculos foram relacionados à menor palatabilidade dos alimentos com menos sal. Os planos de enfrentamento apontaram para o preparo, em separado, dos alimentos e uso de temperos naturais em substituição ao sal. Esses dados podem auxiliar o enfermeiro para direcionar atividades clinicoeducativas, visando a redução de consumo de sal entre pacientes que preparam sua alimentação.Este estudio transversal, basado en la teoría Implementation Intentions, describe los planes de acción desarrollados por las mujeres hipertensas (n=49) para añadir hasta 4g de sal/día a los alimentos y comer menos alimentos salados, así como las barreras percibidas y estrategias de afrontamiento para llevar a cabo los planes de acción. Los planes fueron agrupados como la similitud y la sometieron a un análisis de frecuencia. La mayor parte de los planes se refiere a la eficacia de la conducta de añadir a los alimentos 4g/sal/día/persona. Los planos de acción estaban dirigidos a la cuantificación de la sal y los principales obstáculos estaban relacionados con disminución de la palatabilidad de los alimentos bajos en sal. Estrategias de afrontamiento fueron dirigidos a preparar la comida por separado y en uso de especias naturales. Estos datos pueden ayudar a la enfermera en la dirección de las actividades clínicas y educativas.48649

L’activation de l’intention visant à réduire la consommation de sel chez les patients atteints d’insuffisance cardiaque : un essai contrôlé randomisé

Introduction: An Implementation Intention strategy might be effective in transforming a positive intention to reduce salt intake into effective action among heart-failure patients. Objective: To assess the potential efficacy of an Implementation Intention intervention to reduce salt intake among heart-failure patients. Methods: Randomized controlled trial. The 60 heart-failure patients recruited were first randomized into 2 groups: an experimental group (EG) and a control group (CG). The study population was further broken down into 4 groups depending on whether the individuals prepared their own meals: 2 individual groups (EG-Individual and CG-Individual); and 2 collaborative groups, involving the patient and a social referent (EG-Collaborative and CG- Collaborative). The experimental groups developed action and coping plans based on the Implementation Intention. Total salt intake was calculated through discretionary salt, sodium-food frequency questionnaires, and 24-hour recall, obtained at the baseline (T0) and at the 2-month follow-up (T3). Results: 56 patients ended the follow-up. A reduction in the total salt intake was observed in the EGs (Individual and Collaborative) compared to baseline (5.04g/day vs. 12.21g/day for the EG-Individual (p≤0.001); 4.79g/day vs. 11.43g/day for the EG-Collaborative; p≤0.001). The multivariate analysis showed that the 2 EGs had lower salt intake at T3 than the 2 CGs (95% CI 4.19-9.29 for individual groups vs. 95% CI 4.84-10.22 for collaborative groups). There were no differences between the 2 EGs (95% CI –2.77 to 2.41). The total variance explained (R2) by these comparisons was 0.70. Discussion and conclusion: This study suggests that Implementation Intention might be effective in reducing salt intake among heart-failure patients, either individually or collaboratively. Further research testing mediator and moderator effects of the psychosocial variables are recommended.Introduction : La stratégie de l’Activation de l’Intention peut constituer une intervention efficace pour réduire la consommation de sel chez les patients atteints d’insuffisance cardiaque (IC). Objectif : Évaluer l’efficacité potentielle d’une intervention basée sur l’Activation de l’Intention pour réduire la consommation de sel chez les patients atteints d’IC. Méthodes : Essai contrôlé randomisé. Les 60 patients atteints d’IC recrutés ont été randomisés en deux groupes : Expérimental (GE) et Contrôle (GC). Ensuite, selon que les individus préparaient leurs propres repas ou qu’un référent social était responsable de cette préparation, ils ont été répartis en GE-Individuel, GC-Individuel et en GE-Collaboratif, GC-Collaboratif. La consommation de sel a été mesurée à partir du sel discrétionnaire, du questionnaire de fréquence de consommation de sodium et du rappel de 24 heures, et ce au temps de référence (T0) et au suivi à 2 mois (T3). Résultats : 56 patients ont complété le suivi. Une réduction de l’apport total en sel a été observée dans les GE (Individuel et Collaboratif) comparativement à T0 (GE-Individuel : 5,04g/jour vs 12,21g/jour ; GE-Collaboratif : 4,79g/jour vs 11,43g/jour, p≤0.001). L’analyse multivariée a montré que les GE ont présenté une plus faible consommation de sel à T3 que les GC (95% IC 4,19-9,29 pour les groupes individuels vs 95% IC 4,84-10,22 pour les groupes collaboratifs). Aucune différence n’a été constatée entre les GE (95% IC –2,77 à 2,41). La variance totale (R2) expliquée par ces comparaisons était de 0,70. Discussion et conclusion : L’Activation de l’Intention peut être efficace pour réduire la consommation de sel chez les patients atteints d’IC, individuellement ou en collaboration avec un référent social. D’autres recherches testant les effets médiateurs et modérateurs des variables psychosociales sont recommandées

Longwall Shield Recovery Using Mobile Roof Supports

Longwall mining has gained the reputation as being the safest extraction method in underground coal mines. However, one of the most difficult tasks associated with longwall mining is moving the face once a panel is completed. Based on Mine Safety and Health Administration (MSHA) fatality reports since 1996, longwall face recovery operations have claimed the lives of 5 U.S. miners and have resulted in numerous injuries. Recovery operations can be hazardous because they involve moving large pieces of equipment in very confined spaces. They are also conducted in highly stressed ground conditions due to front abutment loads generated by panel extraction. Shield removal is the most hazardous operation during face recovery because miners are constantly exposed to the unpredictable gob edge. To protect the miners, one or more walking shields, cribbing and/or other supplemental roof and standing supports are typically employed as breaker line supports as each shield is removed. At the Harris No. 1 Mine in southern WV, mobile roof supports (MRS\u2019s) have been used in lieu of traditional walking shields on 17 face moves since 1997. MRS\u2019s are shield-like support units mounted on crawler tracks and are commonly used during room-and-pillar retreat mining operations. For longwall recovery, the two biggest advantages that MRS\u2019s have over traditional walking shields are that they are remotely controlled and are highly maneuverable. MRS\u2019s have contributed to safer shield recovery and shorter move times at the Harris No. 1 Mine. This paper will address both the safety and the operational issues associated with MRS usage during shield recovery. It will also discuss new developments, including the use of the inherently safer battery powered MRS\u2019s, which have been recently certified by the Mine Safety and Health Administration.2007736

Analysis Of Action Plans And Coping Plans For Reducing Salt Consumption Among Women With Hypertension.

This cross-sectional study, based in implementation intention theory, describes action plans developed by women with hypertension (n=49) to add no more than 4g of salt per day to food and to reduce consumption of salty foods, as well as describing the barriers perceived and the coping strategies adopted for putting the action plans into practice. The plans were categorized according to similarities and were submitted to frequency analysis. The majority of the action and coping plans had to do with the effectuation of the behavior involving adding up to 4g of salt per day per person to food. The action strategies were aimed at quantifying the salt added, and the main obstacles were related to the reduced palatability of the food made with less salt. The coping plans have to do with preparing foods separately and to using natural seasonings instead of salt. This data can help the nurse to design activities for clinical education, with a view to reducing salt consumption among patients who prepare their own food.20486-9

Clinical features of hereditary angioedema and warning signs (H4AE) for its identification

Objectives: The study describes a case series of hereditary angioedema with C1 Inhibitor Deficiency (C1INH-HAE) in order to corroborate six clinical warning signs “HAAAAE (H4AE)” to enable early identification of this disease. Methods: The authors analyzed the C1INH-HAE cohort to analyze the clinical aspects of the present study's patients and corroborate the six clinical warning signs of the Hereditary Angioedema Brazilian Guidelines. Data regarding demographics, the onset of disease, time to diagnosis, frequency of attacks per year, organs involved, triggers, crisis duration and their outcomes, and disease treatment were collected. Then the authors developed an acronym, H4AE, to help healthcare professionals remember the warning signs. Results: The authors included 98 patients in the study, with a mean age of 38.1 years, 67.3% being female, and 75.3% with a family history of HAE. HAE diagnosis was delayed, on average, 13.7 years after its initial manifestation. Exploratory laparotomy was reported by 26.9%, and orotracheal intubation by 21.3% of the present study's patients; 61.3% and 30.3% of them were admitted at least once in the hospital and in the intensive care unit, respectively. The authors constructed an acronym “H4AE” with the six warning signs of HAE: Hereditary, recurrent Angioedema, Abdominal pain, Absence of urticaria, Absence of response to antihistamines, Estrogen association. Conclusion: C1INH-HAE is still underdiagnosed and associated with high morbidity. The study showed clinical features of this disease, corroborating the warning signs, which may be useful in raising awareness and improving the diagnosis of C1INH-HAE. The authors suggest the acronym “H4AE” to remind the warning signs