Acute kidney disease and renal recovery : consensus report of the Acute Disease Quality Initiative (ADQI) 16 Workgroup

Consensus definitions have been reached for both acute kidney injury (AKI) and chronic kidney disease (CKD) and these definitions are now routinely used in research and clinical practice. The KDIGO guideline defines AKI as an abrupt decrease in kidney function occurring over 7 days or less, whereas CKD is defined by the persistence of kidney disease for a period of > 90 days. AKI and CKD are increasingly recognized as related entities and in some instances probably represent a continuum of the disease process. For patients in whom pathophysiologic processes are ongoing, the term acute kidney disease (AKD) has been proposed to define the course of disease after AKI; however, definitions of AKD and strategies for the management of patients with AKD are not currently available. In this consensus statement, the Acute Disease Quality Initiative (ADQI) proposes definitions, staging criteria for AKD, and strategies for the management of affected patients. We also make recommendations for areas of future research, which aim to improve understanding of the underlying processes and improve outcomes for patients with AKD

Requirements for Brazilian Outpatient Centers of Excellence in Hidradenitis Suppurativa: Consensus Co-Creative Study

Ericles Andrei Bellei,1 Miriam Emi Makinodan Shirozaki,1 Ana Lia Pradella Puglia,2,3 André Vicente Esteves de Carvalho,4 Barbara Riquena,2,5 Camilla Carlini Vallilo,2,3 Danilo de Barros,6 Erika Yumi Tamashiro,2 Gabriela Cintra,2 Gleison Vieira Duarte,7 Maria Cecília da Matta Rivitti-Machado,8 Renata Ferreira Magalhães,9 Ricardo Figueiredo do Nascimento,2 Roberto Tunala,5 Roberto da Silva,10 Wagner Guimarães Galvão Cesar,11 Felipe Garutti Thies2 1Department of Data, Digital, and Innovation, Novartis, São Paulo, Brazil; 2Immunology Franchise, Novartis, São Paulo, Brazil; 3Department of Scientific Operations, Novartis, São Paulo, Brazil; 4Dermatology, Hospital Moinhos de Ventos de Porto Alegre, Porto Alegre, Brazil; 5Department of Medical Affairs, Novartis, São Paulo, Brazil; 6Dermatology Service, Hospital Irmandade Santa Casa de Curitiba, Curitiba, Brazil; 7Dermatology, Instituto Bahiano de Imunoterapia (IBIS), Salvador, Brazil; 8Hospital das Clínicas da Faculdade de Medicina, University of São Paulo (USP), São Paulo, Brazil; 9School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil; 10Department of Dermatology, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil; 11Dermatology, Hospital Alemão Oswaldo Cruz, São Paulo, BrazilCorrespondence: Ericles Andrei Bellei, Novartis Biociências S.A, 90 Av Prof Vicente Rao, São Paulo, 04706-900, Brazil, Tel +55 1155327122, Email [email protected]: Hidradenitis suppurativa (HS) is a chronic skin condition. Its complexity and impact on patients highlight the need for multidisciplinary care that can address the physical, psychological, and social aspects. Centers of excellence can ideally provide the necessary infrastructure, resources, and expertise to effectively treat HS. However, there are still no consolidated models of centers of excellence in HS, and establishing their foundations is an intricate research challenge. Purposely, design and co-creation as innovation techniques are helpful approaches to this type of research.Methods: In this study, we conducted a co-creation with consensus among HS specialists to propose the criteria and requirements to establish outpatient centers of excellence of HS in Brazil. We followed a linear process with mixed methods in 6 stages.Results: The process resulted in 10 categories for establishing outpatient centers, including their respective requirements, rationale, and classification. The categories include onboarding and welcoming; infrastructure and procedures; infusion therapy; flows and referrals; staffing; disease management; metrics during diagnosis; metrics during treatment; awareness and advocacy; research and education.Discussion: The idealized outpatient centers can play a role in the complete multidisciplinary treatment for HS and advancing the science of healthcare services by providing a focus for research, training, and translation of findings into practice.Keywords: hidradenitis suppurativa, centers of excellence, co-design, consensus, health services research, patient-centered care, community-based participatory research, healthcare innovatio

Avaliação da força de preensão palmar frente à terapia com mobilização neural

INTRODUÇÃO: A mobilização neural é uma técnica que visa a restauração do movimento e da elasticidade do sistema nervoso; contudo, ainda são poucos os estudos que avaliam sua eficácia sobre variáveis clínicas. OBJETIVO: Avaliar a força de preensão palmar em indivíduos submetidos à intervenção com mobilização neural. Metodologia: Estudo cruzado em que compuseram a amostra 20 sujeitos, com média de idade de 19,5 ± 0,92 anos, divididos em dois grupos (G1 e G2) que receberam, a cada semana, uma sessão única de intervenção de forma que o G1 recebeu mobilização neural e o G2 alongamentos convencionais para o supraespinal na primeira semana; o inverso aconteceu na segunda semana, em que o G1 recebeu alongamentos convencionais para o supraespinal e o G2 a mobilização neural. Os alongamentos para o supraespinal serviram apenas como placebo e não impuseram tensão aos nervos em estudo. As mobilizações neurais foram aplicadas nos nervos radial, mediano e ulnar. A força de preensão palmar foi avaliada por meio de um dinamômetro de preensão palmar em vários momentos: antes e imediatamente, 20 minutos e uma hora após cada intervenção. RESULTADOS: Não houve resultados significativos para a mobilização neural, nem para o alongamento. CONCLUSÃO: A mobilização neural não foi eficaz para produzir o aumento da força de preensão palmar em indivíduos saudáveis