660 research outputs found

    Healthcare use in patients with multimorbidity

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    Background: The existence of multiple chronic conditions in the same patient is a public health problem increasingly recognized as relevant to health systems. Individuals with multimorbidity have additional health needs, which imply a heavy burden in healthcare use. It is estimated that between 70% and 80% of the total health expenditure is used with chronic conditions. Patients with multimorbidity are responsible for up to 75% of primary care appointments. These patients are also high hospital users, with up to 14.6 times more risk of hospitalization. Methods: This study analyses the association between healthcare use and multimorbidity in the Portuguese population aged 25-74 years old. The association between socioeconomic variables and healthcare use was studied, based on data from the first Portuguese Health Examination Survey using a logistic regression model, stratified by sex and adjusted for socioeconomic confounding variables. Results: In patients with multimorbidity, there was a greater use of primary healthcare consultations, medical or surgical specialist consultations and hospitalizations. An association was established between female, older age groups and lower educational levels, and increased healthcare use. When adjusted to socioeconomic variables, the likelihood of using healthcare services can be as high as 3.5 times, when compared to patients without chronic conditions. Conclusion: Our results show a greater healthcare use in multimorbidity patients, both in primary and hospital care. The availability of scientific evidence regarding the use of healthcare services by multimorbidity patients may support health policy changes, which could allow a more efficient management of these patients.publishersversionpublishe

    Standardised description of health and social care: A systematic review of use of the ESMS/DESDE (European Service Mapping Schedule/Description and Evaluation of Services and DirectoriEs)

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    Background: Evidence-informed planning and interpretation of research results both require standardised description of local care delivery context. Such context analysis descriptions should be comparable across regions and countries to allow benchmarking and organizational learning, and for research findings to be interpreted in context. The European Service Mapping Schedule (ESMS) is a classification of adult mental health services that was later adapted for the assessment of health and social systems research (Description and Evaluation of Services and DirectoriEs - DESDE). The aim of the study was to review the diffusion and use of the ESMS/DESDE system in health and social care and its impact in health policy and decision-making. Method: We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (1997–2018). Results: Out of 155 papers mentioning ESMS/DESDE, 71 have used it for service research and planning. The classification has been translated into eight languages and has been used by seven international research networks. Since 2000, it has originated 11 instruments for health system research with extensive analysis of their metric properties. The ESMS/DESDE coding system has been used in 585 catchment areas in 34 countries for description of services delivery at local, regional and national levels. Conclusions: The ESMS/DESDE system provides a common terminology, a classification of care services, and a set of tools allowing a variety of aims to be addressed in healthcare and health systems research. It facilitates comparisons across and within countries for evidence-informed planning

    SAT Modulo Linear Arithmetic for Solving Polynomial

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    Polynomial constraint solving plays a prominent role in several areas of hardware and software analysis and verification, e.g., termination proving, program invariant generation and hybrid system verification, to name a few. In this paper we propose a new method for solving non-linear constraints based on encoding the problem into an SMT problem considering only linear arithmetic. Unlike other existing methods, our method focuses on proving satisfiability of the constraints rather than on proving unsatisfiability, which is more relevant in several applications as we illustrate with several examples. Nevertheless, we also present new techniques based on the analysis of unsatisfiable cores that allow one to efficiently prove unsatisfiability too for a broad class of problems. The power of our approach is demonstrated by means of extensive experiments comparing our prototype with state-of-the-art tools on benchmarks taken both from the academic and the industrial world

    Grupos de pesquisa em enfermagem no Brasil: comparação dos perfis de 2006 e 2016

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    RESUMO Objetivos Comparar o perfil dos grupos de pesquisa em Enfermagem cadastrados no Diretório do CNPq em 2006 e 2016. Métodos Estudo descritivo documental. A coleta de dados aconteceu em 2006 e 2016 a partir de consulta parametrizada com o termo Enfermagem no Diretório dos Grupos de Pesquisa, na página online do CNPq, sendo realizada a análise descritiva. Os dados foram organizados em planilha do Excel. Resultados O número de Grupos de Pesquisa aumentou de 251 em 2006 para 617 em 2016, com incremento no número de participantes. Houve redução do número de grupos sem estudantes, embora 22% permaneçam sem participação de alunos de graduação. Conclusões Os grupos de pesquisa em Enfermagem refletem avanços estruturais e políticos na geração de ciência, tecnologia e inovação da área, entretanto ainda deve ser incentivada a participação de alunos de graduação e pesquisadores estrangeiros, bem como a ampliação de recursos tecnológicos e das parcerias interinstitucionais

    Pain and analgesic use associated with skeletal-related events in patients with advanced cancer and bone metastases

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    PURPOSE: Bone metastases secondary to solid tumors increase the risk of skeletal-related events (SREs), including the occurrence of pathological fracture (PF), radiation to bone (RB), surgery to bone (SB), and spinal cord compression (SCC). The aim of this study was to evaluate the impact of SREs on patients' pain, analgesic use, and pain interference with daily functioning. METHODS: Data were combined from patients with solid tumors and bone metastases who received denosumab or zoledronic acid across three identically designed phase 3 trials (N = 5543). Pain severity (worst pain) and pain interference were assessed using the Brief Pain Inventory at baseline and each monthly visit. Analgesic use was quantified using the Analgesic Quantification Algorithm. RESULTS: The proportion of patients with moderate/severe pain and strong opioid use generally increased in the 6 months preceding an SRE and remained elevated, while they remained relatively consistent over time in patients without an SRE. Regression analysis indicated that all SRE types were significantly associated with an increased risk of progression to moderate/severe pain and strong opioid use. PF, RB, and SCC were associated with significantly greater risk of pain interference overall. Results were similar for pain interference with emotional well-being. All SRE types were associated with significantly greater risk of pain interference with physical function. CONCLUSIONS: SREs are associated with increased pain and analgesic use in patients with bone metastases. Treatments that prevent SREs may decrease pain and the need for opioid analgesics and reduce the impact of pain on daily functioning

    Pain and analgesic use associated with skeletal-related events in patients with advanced cancer and bone metastases

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    PURPOSE: Bone metastases secondary to solid tumors increase the risk of skeletal-related events (SREs), including the occurrence of pathological fracture (PF), radiation to bone (RB), surgery to bone (SB), and spinal cord compression (SCC). The aim of this study was to evaluate the impact of SREs on patients' pain, analgesic use, and pain interference with daily functioning. METHODS: Data were combined from patients with solid tumors and bone metastases who received denosumab or zoledronic acid across three identically designed phase 3 trials (N = 5543). Pain severity (worst pain) and pain interference were assessed using the Brief Pain Inventory at baseline and each monthly visit. Analgesic use was quantified using the Analgesic Quantification Algorithm. RESULTS: The proportion of patients with moderate/severe pain and strong opioid use generally increased in the 6 months preceding an SRE and remained elevated, while they remained relatively consistent over time in patients without an SRE. Regression analysis indicated that all SRE types were significantly associated with an increased risk of progression to moderate/severe pain and strong opioid use. PF, RB, and SCC were associated with significantly greater risk of pain interference overall. Results were similar for pain interference with emotional well-being. All SRE types were associated with significantly greater risk of pain interference with physical function. CONCLUSIONS: SREs are associated with increased pain and analgesic use in patients with bone metastases. Treatments that prevent SREs may decrease pain and the need for opioid analgesics and reduce the impact of pain on daily functioning

    Transdermal microconduits by microscission for drug delivery and sample acquisition

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    BACKGROUND: Painless, rapid, controlled, minimally invasive molecular transport across human skin for drug delivery and analyte acquisition is of widespread interest. Creation of microconduits through the stratum corneum and epidermis is achieved by stochastic scissioning events localized to typically 250 μm diameter areas of human skin in vivo. METHODS: Microscissioning is achieved by a limited flux of accelerated gas: 25 μm inert particles passing through the aperture in a mask held against the stratum corneum. The particles scize (cut) tissue, which is removed by the gas flow with the sensation of a gentle stream of air against the skin. The resulting microconduit is fully open and may be between 50 and 200 μm deep. RESULTS: In vivo adult human tests show that microconduits reduce the electrical impedance between two ECG electrodes from approximately 4,000 Ω to 500 Ω. Drug delivery has been demonstrated in vivo by applying lidocaine to a microconduit from a cotton swab. Sharp point probing demonstrated full anaesthesia around the site within three minutes. Topical application without the microconduit required approximately 1.5 hours. Approximately 180 μm deep microconduits in vivo yielded blood sample volumes of several μl, with a faint pricking sensation as blood enters tissue. Blood glucose measurements were taken with two commercial monitoring systems. Microconduits are invisible to the unaided eye, developing a slight erythematous macule that disappears over days. CONCLUSION: Microscissioned microconduits may provide a minimally invasive basis for delivery of any size molecule, and for extraction of interstitial fluid and blood samples. Such microconduits reduce through-skin electrical impedance, have controllable diameter and depth, are fully open and, after healing, no foreign bodies were visible using through-skin confocal microscopy. In subjects to date, microscissioning is painless and rapid

    Desarrollo gradual de las competencias transversales en el grado de farmacia. Metodologías y herramientas de evaluación para el “profesional en formación”

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    Aim: To set different levels of acquisition of some cross-curricular competencies in the Pharmacy Degree and to design and implement methodologies and tools to allow their development and evaluation along the whole curriculum.Matherial and Method: Different active methodologies have been used, and tasks and evaluation rubrics have been prepared to be applied in the different levels defined for the cross-curricular competencies selected: written communication skills, information seeking, and teamwork. Similarly, a student satisfaction survey has been designed in order to evaluate the implementation of the experience.Results: The results obtained in the core subjects of the 1st and 2nd year of the Pharmacy Degree (Physical Chemistry, Immunology and General Microbiology and Parasitology) for the competences of written communication skills, teamwork and information seeking, in levels 1 and 2, have been very successful in terms of the acquisition of competences and in the suitability of the different tasks and evaluation tools proposed.Conclusions: The tools designed to evaluate these cross-curricular competencies can be adapted to any subject and knowledge field, in addition, they allow the student to be aware of the criteria used for his evaluation. The present work has strengthened the formation and development of teaching groups and has eased the coordination among the different subjects of the Pharmacy Degree.Objetivo: Establecer niveles de dominio de algunas competencias transversales del Grado de Farmacia y diseñar e implementar metodologías y herramientas que permitan su desarrollo y evaluación a lo largo de la Titulación.Material y Método: Se han utilizado metodologías activas, diseñado actividades y elaborado rúbricas de evaluación para utilizar en los distintos niveles definidos para las competencias transversales elegidas: comunicación escrita, búsqueda de información y trabajo en equipo. Se ha elaborado una encuesta de satisfacción, que ha permitido valorar la experiencia realizada.Resultados: Los resultados obtenidos en tres asignaturas de primer y segundo curso de Farmacia (Fisicoquímica, Inmunología y Microbiología y Parasitología General) para las competencias de la comunicación escrita, trabajo en equipo y búsqueda de información, en los niveles de dominio 1 y 2, han sido muy positivos en la adquisición de las competencias y en la adecuación de actividades y herramientas de evaluación.Conclusiones: Las herramientas diseñadas, se pueden adaptar a cualquier materia y área de conocimiento para valorar estas competencias transversales, además, permiten al alumno conocer los criterios con los que va a ser evaluado. El presente trabajo ha potenciado la creación y desarrollo de grupos docentes y favorecido la coordinación entre asignaturas de la titulación
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