6 research outputs found
Estudo descritivo de uma população de pacientes com transtornos do sono em ambulatĂłrio privado no Distrito Federal com ĂȘnfase na prevalĂȘncia das queixas de sonolĂȘncia e fadiga
Dissertação (mestrado)âUniversidade de BrasĂlia, Programa de PĂłs-Graduação em CiĂȘncias MĂ©dicas, 2011.OBJETIVO: Estudar população de pacientes ambulatoriais com transtornos de sono com relação Ă frequĂȘncia das queixas de sonolĂȘncia e fadiga, verificando a existĂȘncia de possĂvel diferença dessas queixas entre as doenças estudadas e entre gĂȘneros, avaliando a existĂȘncia de fatores que possam promover essas queixas nesta população. METODOLOGIA: foram estudados 980 prontuĂĄrios eletrĂŽnicos de pacientes de ambos os sexos, em um ambulatĂłrio privado de Medicina do Sono em BrasĂlia-DF, entre janeiro de 2008 e maio de 2010. Foram considerados elegĂveis os pacientes com os seguintes diagnĂłsticos: narcolepsia, sĂndrome da apnĂ©ia obstrutiva do sono (SAOS), insĂŽnia e sĂndrome das pernas inquietas (SPI). Para tal foram utilizados: Escala de SonolĂȘncia de Epworth (ESE), Escala de Pichot (EP), Escala de Mallampati (EMa), Ăndice de ApnĂ©ia-hipopnĂ©ia (IAH) e Ăndice de Massa CorpĂłrea (IMC). RESULTADOS: 214 pacientes foram incluĂdos sendo 114 (53,3%) do sexo masculino e 100 (46,7%) do sexo feminino, com mĂ©dia de idade de 49 anos (variando de 17 a 85 anos) sendo que 69 (32,2%) apresentaram fadiga associada Ă sonolĂȘncia; 46 (21,5%) apresentaram apenas sonolĂȘncia sem fadiga; 39 (18,2%) sĂł fadiga sem sonolĂȘncia e 60 (28,0%) nĂŁo apresentaram nenhum dos sintomas. A ESE teve mĂ©dia de 11,2±5,9 e a EP de 16,2±8,7. A EMa teve como moda estatĂstica o tipo III (29,9%). O IAH apresentou valor mĂ©dio de 30,8±22,8 (variando de 0 a 105). O IMC, com mĂ©dia de 29,0±4,4, variou de 19,1 a 41,8. A distribuição por doenças mostrou insĂŽnia com 76 pacientes (35,5%); SPI com 27 (12,6%); narcolepsia com 4 (1,9%) e SAOS com 107 (50,0%). Todas as doenças apresentaram nĂveis de sonolĂȘncia e fadiga distintos entre si (p<0,01 e p=0,02, respectivamente). A anĂĄlise de correlação de Pearson entre a ESE e EP foi positiva (R=14% p=0,02). As mulheres apresentaram mais fadiga que os homens (p<0,01), mas nĂŁo existiram diferenças na sonolĂȘncia (p=0,82). Pacientes com mais de 49 anos foram mais sonolentos que os mais jovens (p<0,05). As mulheres com insĂŽnia foram mais fadigadas do que os homens do mesmo grupo (p=0,02). CONCLUSĂO: As queixas de sonolĂȘncia e fadiga foram muito frequentes na população com transtornos do sono, apresentando-se como sintomas importantes e diretamente proporcionais a serem avaliados rotineiramente na prĂĄtica clĂnica. A fadiga foi mais prevalente no sexo feminino, mas nĂŁo houve diferenças significativas da sonolĂȘncia entre gĂȘneros. A presença de SPI mostrou-se um fator agravante da fadiga nos pacientes com transtornos do sono. Considerando os achados deste trabalho fica evidente a necessidade de otimizar o tratamento medicamentoso, biomĂ©dico e psicossocial da fadiga nos transtornos do sono. ______________________________________________________________________________ ABSTRACTOBJECTIVE: To evaluate a population of patients with sleep disorders in relation to the frequency of sleepiness and fatigue, checking for possible differences in complaints between the diseases studied and genders. The existence of factors that could lead to these complaints in this population was also investigated. METHODS: We studied 980 electronic records of patients of both genders in a private clinic of sleep medicine in Brasilia (Federal District) between January 2008 and May 2010. Patients with the following diagnosis were considered eligible: narcolepsy, obstructive sleep apnea syndrome (OSAS), insomnia and restless legs syndrome (RLS). To this purpose, the following were used: Epworth Sleepiness Scale (ESS), Pichot's Scale (PS), Mallampati Scale (MSca), apnea-hypopnea index (AHI) and body mass index (BMI). RESULTS: 214 patients were included in the study, of which 114 (53.3%) were male and 100 (46.7%), female. The mean age was 49 years (ranging from 17 to 85 years); 69 patients (32.2%) presented fatigue associated with sleepiness, 46 (21.5%) showed only sleepiness and 39 (18.2%), only fatigue. Sixty (60) patients (28.0%) showed no symptoms. ESS and PS had a mean of 11.2 ± 5.9 and 16.2 ± 8.7, respectively. Mallampati class III was the most common (29.9%). AHI showed a mean value of 30.8 ± 22.8 (ranging from 0 to 105). BMI had a mean of 29.0 ± 4.4 and ranged from 19.1 to 41.8. Distribution by disease showed 76 patients with insomnia (35.5%), 27 patients with RLS (12.6%), 4 patients with narcolepsy (1.9%) and 107 patients with OSAS (50.0%). All the diseases had distinct levels of sleepiness and fatigue (p <0.01 and p = 0.02, respectively). The analysis of Pearson's correlation between ESS and PS was positive (R = 14% p = 0.02). Women showed more fatigue than men (p <0.01), but there were no gender-related differences in sleepiness (p = 0.82). Patients over 49 years old were sleepier than younger patients (p <0.05). Women with insomnia were more fatigued than men in the same group (p = 0.02). CONCLUSION: Complaints of sleepiness and fatigue were very common in the population with sleep disorders. The great importance of these symptoms indicated the need for a routine assessment in clinical practice. Fatigue was more prevalent in women, but there were no significant gender-related differences in sleepiness. The presence of RLS was shown to be an aggravating factor of fatigue in patients with sleep disorders. The findings of this study indicate the need to optimize the biomedical, psychosocial and drug treatment of fatigue in sleep disorders
A Pilot Study of the Breath Stacking Technique Associated with Respiratory Muscle Endurance Training in Patients with Amyotrophic Lateral Sclerosis: Videofluoroscopic Findings in the Upper Airway
Introduction: Bulbar impairment represents a hallmark feature of amyotrophic lateral sclerosis (ALS) that significantly impacts survival and quality of life. Respiratory complications arise because of the weakness of the upper airway and respiratory muscles leading to respiratory failure, impaired swallowing, and reduced airway safety. Breath stacking and respiratory muscle endurance training are techniques that have been described to improve respiratory and bulbar function in patients with ALS. Considering the above, a respiratory technique named TR3 was developed. This study aimed to measure the acute effects of this technique on the upper airway through videofluoroscopy and to assess its clinical trial feasibility in patients with ALS. Material andmethods: In this cross-sectional study, we enrolled participants diagnosed with ALS to perform a single session of TR3. Epidemiological data and baseline assessments were collected. The assessments included kinematics from videofluoroscopy measuring the retropalatal airspace size, the size of the narrowest airway, and the pharyngeal area during rest and TR3. Results: Eight participants were included. During TR3, an acute increase of 15% was observed in the retropalatal airspace size (t = 5.14, p < 0.01), a 123% increase was observed in the size of the narrowest airway (t = â4.18, p < 0.001), and a 277% increase was observed in the pharyngeal area (t = â5.34, p < 0.001). Conclusions: During the intervention, TR3 showed acute effects in increasing pharyngeal constriction, pharyngeal expansion, retropalatal airspace size, and post-lingual narrowest airway size and is feasible for a larger research program. A clinical trial (NCT04226144) is already being conducted to assess the chronic therapeutic effects of this technique and its impact on the clinical evolution of ALS
The use of natural language processing in palliative care research: A scoping review
Background: Natural language processing has been increasingly used in palliative care research over the last 5 years for its versatility
and accuracy.
Aim: To evaluate and characterize natural language processing use in palliative care research, including the most commonly used
natural language processing software and computational methods, data sources, trends in natural language processing use over time,
and palliative care topics addressed.
Design: A scoping review using the framework by Arksey and OâMalley and the updated recommendations proposed by Levac et al.
was conducted.
Sources: PubMed, Web of Science, Embase, Scopus, and IEEE Xplore databases were searched for palliative care studies that utilized
natural language processing tools. Data on study characteristics and natural language processing instruments used were collected
and relevant palliative care topics were identified.
Results: 197 relevant references were identified. Of these, 82 were included after full-text review. Studies were published in 48
different journals from 2007 to 2022. The average sample size was 21,541 (median 435). Thirty-two different natural language
processing software and 33 machine-learning methods were identified. Nine main sources for data processing and 15 main palliative
care topics across the included studies were identified. The most frequent topic was mortality and prognosis prediction. We also
identified a trend where natural language processing was frequently used in analyzing clinical serious illness conversations extracted
from audio recordings.
Conclusions: We found 82 papers on palliative care using natural language processing methods for a wide-range of topics and sources
of data that could expand the use of this methodology. We encourage researchers to consider incorporating this cutting-edge research
methodology in future studies to improve published palliative care data.info:eu-repo/semantics/publishedVersio
A pilot study of the breath stacking technique associated with respiratory muscle endurance training in patients with amyotrophic lateral sclerosis: videofluoroscopic findings in the upper airway
Introduction: Bulbar impairment represents a hallmark feature of amyotrophic lateral sclerosis (ALS) that significantly impacts survival and quality of life. Respiratory complications arise because of the weakness of the upper airway and respiratory muscles leading to respiratory failure, impaired swallowing, and reduced airway safety. Breath stacking and respiratory muscle endurance training are techniques that have been described to improve respiratory and bulbar function in patients with ALS. Considering the above, a respiratory technique named TR3 was developed. This study aimed to measure the acute effects of this technique on the upper airway through videofluoroscopy and to assess its clinical trial feasibility in patients with ALS.Material and methods: In this cross-sectional study, we enrolled participants diagnosed with ALS to perform a single session of TR3. Epidemiological data and baseline assessments were collected. The assessments included kinematics from videofluoroscopy measuring the retropalatal airspace size, the size of the narrowest airway, and the pharyngeal area during rest and TR3.Results: Eight participants were included. During TR3, an acute increase of 15% was observed in the retropalatal airspace size (t = 5.14, p < 0.01), a 123% increase was observed in the size of the narrowest airway (t = â4.18, p < 0.001), and a 277% increase was observed in the pharyngeal area (t = â5.34, p < 0.001).Conclusions: During the intervention, TR3 showed acute effects in increasing pharyngeal constriction, pharyngeal expansion, retropalatal airspace size, and post-lingual narrowest airway size and is feasible for a larger research program. A clinical trial (NCT04226144) is already being conducted to assess the chronic therapeutic effects of this technique and its impact on the clinical evolution of ALS
The quality of life among Otorhinolaryngology residents in Distrito Federal (Brazil) A qualidade de vida entre os residentes de Otorrinolaringologia do Distrito Federal
Otorhinolaryngology residents' quality of life must be investigated during medical residency. Work-related factors impacting their lives, such as depression, sleep deprivation and excessive work load may impact the well-being of these individuals. OBJECTIVE: To assess and discuss the quality of life of Otorhinolaryngology Resident Physicians in Distrito Federal (Reuni-ORL). MATERIALS AND METHODS: Cross-sectional study, the quality of life of each individual was assessed by means of a questionnaire specifically designed for this purpose - Whoqol-bref, proposed by the WHO. RESULTS: Males had better psychological scores when compared to females (p= 0. 013). Mean scores comparison among the years in residency were statistically significant only in the psychological domain when comparing the first and second years (p=0. 046), in which 2nd-year residents had the higher scores. CONCLUSIONS: Despite constant changes to the ENT program (Reuni-ORL) in the Distrito Federal, aiming at improving work and training conditions for residents, there still is a psychological burden in their first year of residencyA qualidade de vida dos residentes de otorrinolaringologia precisa ser estudada ao longo da residĂȘncia mĂ©dica. Fatores decorrentes deste trabalho, como depressĂŁo, privação do sono e excessiva carga horĂĄria, podem interferir no bem-estar destes indivĂduos. OBJETIVO: Avaliar e discutir a qualidade de vida dos mĂ©dicos residentes de Otorrinolaringologia do Distrito Federal (Reuni-ORL). MATERIAIS E MĂTODOS: Sob a forma de estudo transversal, a avaliação da qualidade de vida de cada participante foi realizada por meio de um questionĂĄrio especĂfico para este fim, o Whoqol-bref, proposto pela OMS. RESULTADOS: O sexo masculino apresentou pontuação melhor no domĂnio psicolĂłgico com relação ao sexo feminino (p= 0,013). A comparação das mĂ©dias de pontuação entre os anos de residĂȘncia foram estatisticamente significativas apenas no domĂnio psicolĂłgico em relação ao primeiro e segundo ano (p=0,046), na qual os R2 apresentaram a pontuação maior. CONCLUSĂO: Apesar de constantes adaptaçÔes do programa da Reuni-ORL no Distrito Federal, visando melhorias das condiçÔes de trabalho e de estudo de seus residentes, ainda hĂĄ o desgaste psicolĂłgico do primeiro ano de residĂȘnci
Comparison between breath stacking technique associated with expiratory muscle training and breath stacking technique in amyotrophic lateral sclerosis patients : protocol for randomized single blind trial
Introduction
Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease affecting both upper and lower motor neurons, and lead to respiratory failure. Strategies are suggested to respiratory management in ALS patients, as the breath stacking and Expiratory muscle training (EMT), which have been used as aid to assist cough in neuromuscular disorders. However, the randomized controlled trials performed in ALS patients have not investigated the addiction of EMT together breath stacking in this population. This trial aims to determine if breath stacking plus EMT is more effective than breath stacking alone to decrease the decline rate on the inspiratory/expiratory muscle strength, FVC and voluntary PCF in ALS patients.
Methods
This parallel-group, assessor-blinded randomized controlled trial, powered for superiority, aims to assess pulmonary function, respiratory muscle strength, peak cough flow as primary outcomes. Forty-two participants are being recruited referral neuromuscular disease center at Brasilia, Brazil. Following baseline testing, participants are randomized using concealed allocation, to receive either: a) breath stacking technique alone or b) breath stacking technique plus EMT.
Conclusion
There is a lack of evidence regarding the benefit of EMT plus breath stacking in ALS patients. This trial will contribute to evidence currently being generated in national and international trials by implementing and evaluating a respiratory therapy program including two components not yet combined in previous research, for people with ALS involving longer-term follow-up of outcomes. This trial is ongoing and currently recruiting.Faculdade UnB CeilĂąndia (FCE)Curso de Fisioterapia (FCE-FISIO