Avaliação da qualidade de vida de pacientes com trauma craniencefálico

The assessment of a patient's perception of health-related quality of life (QOL) may reflect the effects of a disease or treatment on the patient's daily life satisfaction and well-being. The purpose of this study was to evaluate self-reported quality of life in traumatic brain injury patients, by using the WHOQOL-bref, and search for correlations between questionnaire scores and patients' social-demographic and clinic characteristics. Participants were 120 patients with brain damage who finished a rehabilitation program at AACD (Association for Assistance to Disabled Children). Data were statistically analysed. Mean scores at all WHOQOL-bref domains and mean global scores were above 60 points (0-to-100 scale). Moderate correlations were found between global QOL and educational level (pA percepção de qualidade de vida relacionada à saúde de um paciente com doença crônica, quando avaliada, pode refletir quanto os efeitos de uma doença ou tratamento exercem sobre a vida diária, o nível de satisfação e bem-estar. O objetivo aqui foi avaliar a qualidade de vida de indivíduos com trauma craniencefálico (TCE), por meio do instrumento WHOQOL-bref, e verificar possíveis associações com características sociodemográficas e clínicas dos pacientes. Participaram 120 pacientes com TCE que concluíram um programa de reabilitação na Associação de Assistência à Criança Deficiente. Os dados foram tratados estatisticamente. O escore médio em todos os domínios e o escore global foram superiores a 60 pontos (em escala de 0 a 100). Correlações moderadas foram encontradas entre qualidade de vida global e os níveis educacional (

Apecificazione, apicogenesi e procedure endodontiche rigenerative : revisione della letteratura

RiassuntoObiettivoPresentare le alternative terapeutiche per la gestione degli apici immaturi e l'evoluzione delle tecniche e dei materiali utilizzati.Materiali e metodiÈ stata effettuata una ricerca della letteratura in Medline™ limitata agli studi su esseri umani pubblicati negli ultimi 10 anni, con sequenza appropriata di parole chiave.RisultatiNelle tecniche di apicogenesi e apecificazione utilizzando idrossido di calcio o MTA si riscontra una buona percentuale di successo clinico. Le recenti procedure rigenerative pongono dei dubbi sul futuro dell'apecificazione anche in elementi non vitali.ConclusioniL'idrossido di calcio risulta il gold standard tra i materiali utilizzati in elementi immaturi. Nuove tecnologie stanno promuovendo un interesse crescente per strategie atte a mantenere o addirittura ripristinare la vitalità pulpare.SummaryObjectiveTo present the terapheutical approach to the management of the immature apex and the evolution of materials and techniques.Materials and methodsA Medline™ search was performed limited to human studies published in the last 10 years. The keywords searched were apexogenesis, apexification, pulp regeneration, revascularization.ResultsApexogenesis and apexification techniques using Calcium hydroxide or MTA give a good success rate. Recent regeneration procedures may put into discussion the opportunity of apexification in non vital elements.ConclusionsCalcium hydroxide is the gold standard material used for immature teeth. New technologies are promoting incoming interest for strategies of vitality preservation and pulp regeneration

ELECtric Tibial nerve stimulation to Reduce Incontinence in Care homes: protocol for the ELECTRIC randomised trial

Background Urinary incontinence (UI) is highly prevalent in nursing and residential care homes (CH) and profoundly impacts on residents’ dignity and quality of life. Care homes predominantly use absorbent pads to contain UI rather than actively treat the condition. Transcutaneous posterior tibial nerve stimulation (TPTNS) is a non-invasive, safe, low-cost intervention with demonstrated effectiveness for reducing UI in adults. However, the effectiveness of TPTNS to treat UI in older adults living in care homes is not known. The ELECTRIC Trial aims to establish if a programme of TPTNS is a clinically effective treatment for UI in care home residents and investigate the associated costs and consequences. Methods This is a pragmatic, multicentre, placebo controlled randomised parallel group trial comparing effectiveness of TPTNS (target n=250) with sham stimulation (target n=250) in reducing volume of UI in CH residents. CH residents (men and women) with self- or staff- reported UI of more than once per week are eligible to take part, including those with cognitive impairment. Outcomes will be measured at 6, 12 and 18 weeks post randomisation using the following measures: 24-hour pad weight tests (PWT), post void residual urine (bladder scans), Patient Perception of Bladder Condition (PPBC), Minnesota Toileting Skills Questionnaire (MTSQ) and Dementia Quality of Life (DEMQOL). Economic evaluation based on a bespoke Resource Use Questionnaire will assess the costs of providing a programme of TPTNS. A concurrent process evaluation will investigate fidelity to the intervention and influencing factors and qualitative interviews will explore the experiences of TPTNS from the perspective of CH residents, family members, CH staff and managers. Discussion TPTNS is a non-invasive intervention that has demonstrated effectiveness in reducing UI in adults. The ELECTRIC Trial will involve CH staff delivering TPTNS to residents and establish whether TPTNS is more effective than sham stimulation for reducing the volume of UI in CH residents. Should TPTNS be shown to be an effective and acceptable treatment for UI in older adults in CHs, it will provide a safe, low-cost and dignified alternative to the current standard approach of containment and medication. Trial registration Clinical Trials.gov. NCT03248362. Registered on 14/08/2017. https://clinicaltrials.gov/ ISRCTN, ISRCTN 98415244. Registered on 25/04/2018. https://www.isrctn.com

Epidemiological profile of patients with amiotrophic lateral sclerosis accompanied in the Associação de Assistência à Criança Deficiente

Amyotrophic Lateral Sclerosis (ALS) is a neurodegenerative disease characterized by irreversible loss of motor neurons in the spinal cord, brainstem and cerebral cortex, leading to muscle atrophy, spasticity and consequently death. Objective: To verify the prevalence of ALS in the Associação de Assistência à Criança Deficiente (AACD) – Ibirapuera’s unit and to characterize the individuals affected by the disease during the rehabilitation process, in order to draw an epidemiological profile of this population. Methods: This is a retrospective study, based on information contained in medical records, referring to a study conducted during the period from January 2008 to January 2018, being a data search guided by a resource developed for this study. Results: The prevalence of patients with ALS in the treatment of neuromuscular diseases is 11.6%. The profile of these patients is slightly higher in white females, with a mean age of 59 years, with systemic arterial hypertension being the most common comorbidity. The most common ALS was sporadic, and Riluzole was the most commonly used drug. There was great variability of physiotherapeutic objectives and an increase in the use of non-invasive mechanical ventilation. There was no association between the presence of gait in the last evaluation and the time of the patient in physical therapy. Conclusion: The objectives are in agreement with the literature, as well as it cites the importance of knowing the population better to have a multidisciplinary approach more suitable for these patients.A Esclerose Lateral Amiotrófica (ELA) é uma doença neurodegenerativa caracterizada por perda irreversível dos neurônios motores da medula espinal, tronco encefálico e córtex cerebral, levando à atrofia muscular, espasticidade e consequentemente à morte. Objetivo: Verificar a prevalência da ELA na Associação de Assistência à Criança Deficiente (AACD) – Unidade Ibirapuera e caracterizar os indivíduos acometidos quanto à evolução da doença durante o processo de reabilitação, a fim de traçar um perfil epidemiológico desta população. Métodos: Trata-se de um estudo retrospectivo, baseado em informações contidas em prontuário, referentes a pacientes que realizaram reabilitação durante o período de janeiro de 2008 a janeiro de 2018, sendo a busca pelos dados guiada a partir de formulário desenvolvido exclusivamente para este estudo. Resultados: A prevalência dos pacientes com ELA em tratamento na clínica de doenças neuromusculares é de 11,6%. O perfil desses pacientes é ligeiramente maior do sexo feminino de cor branca, com uma média de idade de 59 anos, sendo a hipertensão arterial sistêmica a comorbidade mais encontrada. A forma de ELA mais frequente foi a esporádica, e o medicamento mais utilizado foi o Riluzole. Houve grande variabilidade de objetivos fisioterapêuticos e aumento do uso da ventilação mecânica não invasiva. Não houve associação entre a presença de marcha na última avaliação e o tempo do paciente em fisioterapia. Conclusão: Os objetivos estão de acordo com a literatura, bem como demonstram a importância de conhecermos melhor a população para termos uma abordagem multidisciplinar mais adequada para estes pacientes