55 research outputs found
A intervenção dos terapeutas da fala na área oncológica
Com este artigo pretendemos dar ênfase a novas áreas de intervenção dos Terapeutas da Fala, que estão muito para
além das tradicionalmente atribuídas a estes profissionais, decorrentes de diversas intervenções cirúrgicas em indivíduos
portadores de tumores naso-sinusais e oro-faringo-laríngeos, procurando ao mesmo tempo demonstrar que
esta poderá ser mais uma área a explorar por estes profissionais, ao mesmo tempo que se deverá orientar e dirigir o
estudo destes na fase formativa.
With this article we aim to emphasize the Speech Therapists’ new intervention areas, which are far beyond the ones
traditionally attributed to these professionals, deriving not only from various surgical interventions on individuals
with naso-sinusal and oro-pharyngo-laryngeal tumours, seeking simultaneously to demonstrate that this may be
another area to explore by these professionals, at the same time that we should orient and direct their studies during
the training phase
Study, design and development of a modbus master that evaluates the modbus communication between equipments
Data communication is essential in any mechatronic system or product. It allows for devices
to communicate with one another, for a more efficient and self-regulating system. To
effectively rely on the communication between devices, the communication must firsts be
tested and evaluated for errors and correct data transmission. Sensors and sensor data
addresses can easily be switched and when a device is communicating with another, it is
imperative that the correct sensor data is transmitted when a slave device receives a signal to
do so. If this condition is not verified, the master device could be receiving wrong signals and
coincidently sending alerts or warning messages to the user. In more extreme cases the device
can enter an emergency shutdown situation and fail to restart.
The objective of this work is to study, design and develop a software device that allows the
user to simulate, evaluate and verify the Modbus communication between the Platform
Management System (PMS) of a ship and the main equipment on board. The PMS is the
onboard static master device that displays all the received data to the ship’s captain for
analysis. This work focuses in particular on a ship's generators, where the available signals
will be assessed. The signals, stipulated in the equipment’s specification documents, are
transmitted directly from the equipment and are then received by the PMS. The PMS and the
onboard equipment are programmed by various entities, of which, can all make mistakes
while programming and therefor, the sensor and warning names and messages are not
coherent with the corresponding values.info:eu-repo/semantics/publishedVersio
In what way complementary therapies can prevent a neck recurrence in hypopharynx and larynx tumors?
[ES] Ha habido un cambio hacia la utilización preferente de quimioterapia y radioterapia (QTRT)
después de la cirugía contrariamente a la opción de radioterapia (RT) en caso de ganglios
cervicales metastásicos más de 3 cm, presencia de diseminación ganglionar extracapsular,
signos de permeabilización vascular o perineural.
Se realizó un estudio retrospectivo con 100 pacientes con carcinoma epidermoide de la laringe
y/o la hipofaringe avanzado que fueron sometidos a laringectomia o faringolaringectomia con
disección cervical bilateral. Todos tienen ganglios linfáticos positivos para malignidad y tres
años de seguimiento mínimo. 50 de estos pacientes fueron sometidos a RT adyuvante y 50 se
sometieron a QTRT adyuvante.
Los dos grupos son clínicamente similares en la edad (p=0,915), tamaño tumoral (p=0,603) y
dosis de RT administrada (p=0,329), por lo que es posible compararlos. La asociación QTRT
pos-cirugía mostró un mejor control de las metástasis regionales (4% vs 16%, p=0,046). Existe
cierta tendencia a una mayor supervivencia específica de los pacientes que se sometieron a
QTRT adyuvante (66% en 3 años vs 54%), pero no estadísticamente significativa (p=0,154). En
relación con metástasis en la distancia, no mostró ningún efecto protector en los pacientes
sometidos a QTRT adyuvante (18% vs 20%, p=0,5). El único factor predictivo identificado de
mayor riesgo de metástasis es la existencia de invasión extracapsular (77,8%, p=0,04).
La QTRT adyuvante proporciona una protección solamente regional de la enfermedad. Los
pacientes con invasión ganglionar extracapsular deben tener una vigilancia especial para
permitir el diagnóstico precoz de metástasis a distancia e iniciar tratamiento sistémico
adecuado.
[EN] There has been a shift to preferential use of chemotherapy and radiotherapy (CTRT) after
surgery contrary to the choice of radiotherapy (RT) in case of metastatic cervical lymph nodes
larger than 3 cm, presence of extracapsular nodal spread and signs of vascular or perineural
permeability.
We performed a retrospective study of 100 patients with advanced squamous cell carcinoma of
the larynx and / or hypopharynx who underwent laryngectomy or pharyngolaryngectomy and
bilateral neck dissection. Every patients had lymph nodes positive for malignancy and three
years minimum follow-up. 50 of these patients underwent adjuvant RT and 50 underwent
adjuvant CTRT.
The two groups were clinically similar in age (p = 0.915), tumor size (p = 0.603) and RT dose
administered (p = 0.329), making it possible to compare them. The association CTRT
post-surgery showed better control of regional metastases (4% vs 16%, p = 0.046). There was a
trend to higher specific survival of patients who underwent adjuvant CTRT (66% at 3 years vs
54%), but not statistically significant (p = 0.154). In relation to distant metastasis, no protective
effect was shown in patients undergoing adjuvant CTRT (18% vs 20%, p = 0.5). The only
identified predictor of increased risk of metastasis is the presence of extracapsular invasion
(77.8%, p = 0.04).
The adjuvant CTRT only provides better regional protection from the disease. Patients with
extracapsular lymph node invasion must have a special surveillance to allow early diagnosis of
distant metastases and start appropriate systemic treatment
Treatment of Head and Neck Cancer with Photodynamic Therapy with Redaporfin: A Clinical Case Report
Advanced head and neck squamous cell carcinoma, after locoregional treatment and multiple lines of systemic therapies, represents a great challenge to overcome acquired resistance. The present clinical case illustrates a successful treatment option and is the first to describe the use of photodynamic therapy (PDT) with Redaporfin, followed by immune checkpoint inhibition with an anti-PD1 antibody. This patient presented an extensive tumor in the mouth pavement progressing after surgery, radiotherapy, and multiple lines of systemic treatment. PDT with Redaporfin achieved the destruction of all visible tumor, and the sequential use of an immune checkpoint inhibitor allowed a sustained complete response. This case is an example of the effect of this therapeutic combination and may provide the basis for a new treatment modality
Estudo, conceção e avaliação clínica prévia de um dispositivo usado para a redução de espasticidade em indivíduos tetraplégicos
Aproximadamente 70% dos indivíduos com lesão medular sofre de espasticidade, causando frequentemente dificuldades na execução de atividades diárias. Torna-se pertinente tentar desenvolver novas soluções que aumentem a qualidade de vida dos doentes e que minimizem os custos de tratamento. Assim, o objetivo deste trabalho passa por desenvolver um dispositivo que minimize os espasmos nos membros inferiores de indivíduos com lesão medular traumática incompleta, cujo desenvolvimento se sistematizará nos pontos seguintes.info:eu-repo/semantics/publishedVersio
Rhizomucor and Scedosporium Infection Post Hematopoietic Stem-Cell Transplant
Hematopoietic stem-cell transplant recipients are at increased risk of developing invasive fungal infections. This is a major cause of morbidity and mortality. We report a case of a 17-year-old male patient diagnosed with severe idiopathic acquired aplastic anemia who developed fungal pneumonitis due to Rhizomucor sp. and rhinoencephalitis due to Scedosporium apiospermum 6 and 8 months after undergoing allogeneic hematopoietic stem-cell transplant from an HLA-matched unrelated donor. Discussion highlights risk factors for invasive fungal infections (i.e., mucormycosis and scedosporiosis), its clinical features, and the factors that must be taken into account to successfully treat them (early diagnosis, correction of predisposing factors, aggressive surgical debridement, and antifungal and adjunctive therapies)
Recruitment methods and yield rates in a clinical trial of physical exercise for older adults with hypertension—HAEL Study : a study within a trial
Background: Although the prevalence of hypertension is high in older adults, clinical trial recruitment is a challenge. Our main aim was to describe the HAEL Study recruitment methods and yield rates. The secondary objectives were to explore the reasons for exclusion and to describe the characteristics of the enrolled participants. Methods: This is a descriptive study within a trial. The HAEL Study was a Brazilian randomized two-center, parallel trial with an estimated sample of 184 participants. The recruitment strategy was based on four methods: electronic health records, word of mouth, print and electronic flyer, and press media. The yield rate was the ratio of the number of participants who underwent randomization to the total number of volunteers screened, calculated for overall, per recruitment method, by study center and by age group and sex. Additionally, we described the reasons for exclusion in the screening phase, as well as the demographic characteristics of those enrolled. The data are presented in absolute/relative frequencies and mean ± standard deviation. Results: A total of 717 individuals were screened, and 168 were randomized over 32 months. The yield rate was higher for word of mouth (30.1%) in the overall sample. However, press media contributed the most (39.9%) to the absolute number of participants randomized in the trial. The coordinating center and participating center differed in methods with the highest yield ratios and absolute numbers of randomized participants. The main reason for exclusion in the screening phase was due to the physically active status in those intending to participate in the study (61.5%). Out of 220 participants included, 52 were excluded mainly because they did not meet the eligibility criteria (26.9%). Most of the screened volunteers were women (60.2%) age 60–69 years (59.5%), and most of the randomized participants were Caucasian/white Caucasian/white (78.0%). Conclusions: Multiple recruitment methods constituted effective strategies. We observed that approximately one of every four individuals screened was allocated to an intervention group. Even so, there were limitations in obtaining a representative sample of older Brazilian adults with hypertension. Data show an underrepresentation of race and age groups
Recruitment methods and yield rates in a clinical trial of physical exercise for older adults with hypertension—HAEL Study: a study within a trial
Background:
Although the prevalence of hypertension is high in older adults, clinical trial recruitment is a challenge. Our main aim was to describe the HAEL Study recruitment methods and yield rates. The secondary objectives were to explore the reasons for exclusion and to describe the characteristics of the enrolled participants.
Methods:
This is a descriptive study within a trial. The HAEL Study was a Brazilian randomized two-center, parallel trial with an estimated sample of 184 participants. The recruitment strategy was based on four methods: electronic health records, word of mouth, print and electronic flyer, and press media. The yield rate was the ratio of the number of participants who underwent randomization to the total number of volunteers screened, calculated for overall, per recruitment method, by study center and by age group and sex. Additionally, we described the reasons for exclusion in the screening phase, as well as the demographic characteristics of those enrolled. The data are presented in absolute/relative frequencies and mean ± standard deviation.
Results:
A total of 717 individuals were screened, and 168 were randomized over 32 months. The yield rate was higher for word of mouth (30.1%) in the overall sample. However, press media contributed the most (39.9%) to the absolute number of participants randomized in the trial. The coordinating center and participating center differed in methods with the highest yield ratios and absolute numbers of randomized participants. The main reason for exclusion in the screening phase was due to the physically active status in those intending to participate in the study (61.5%). Out of 220 participants included, 52 were excluded mainly because they did not meet the eligibility criteria (26.9%). Most of the screened volunteers were women (60.2%) age 60–69 years (59.5%), and most of the randomized participants were Caucasian/white (78.0%).
Conclusions:
Multiple recruitment methods constituted effective strategies. We observed that approximately one of every four individuals screened was allocated to an intervention group. Even so, there were limitations in obtaining a representative sample of older Brazilian adults with hypertension. Data show an underrepresentation of race and age groups
Measuring adherence to inhaled control medication in patients with asthma: Comparison among an asthma app, patient self‐report and physician assessment
Background
Previous studies have demonstrated the feasibility of using an asthma app to support medication management and adherence but failed to compare with other measures currently used in clinical practice. However, in a clinical setting, any additional adherence measurement must be evaluated in the context of both the patient and physician perspectives so that it can also help improve the process of shared decision making. Thus, we aimed to compare different measures of adherence to asthma control inhalers in clinical practice, namely through an app, patient self-report and physician assessment.
Methods
This study is a secondary analysis of three prospective multicentre observational studies with patients (≥13 years old) with persistent asthma recruited from 61 primary and secondary care centres in Portugal. Patients were invited to use the InspirerMundi app and register their inhaled medication. Adherence was measured by the app as the number of doses taken divided by the number of doses scheduled each day and two time points were considered for analysis: 1-week and 1-month. At baseline, patients and physicians independently assessed adherence to asthma control inhalers during the previous week using a Visual Analogue Scale (VAS 0–100).
Results
A total of 193 patients (72% female; median [P25–P75] age 28 [19–41] years old) were included in the analysis. Adherence measured by the app was lower (1 week: 31 [0–71]%; 1 month: 18 [0–48]%) than patient self-report (80 [60–95]) and physician assessment (82 [51–94]) (p 0.05). There was a moderate correlation between patient self-report and physician assessment (ρ = 0.596, p < 0.001).
Conclusions
Adherence measured by the app was lower than that reported by the patient or the physician. This was expected as objective measurements are commonly lower than subjective evaluations, which tend to overestimate adherence. Nevertheless, the low adherence measured by the app may also be influenced by the use of the app itself and this needs to be considered in future studies.info:eu-repo/semantics/publishedVersio
Geriatric oncology: comparing health related quality of life in head and neck cancer patients
Background: Population ageing is increasing the number of people annually diagnosed with cancer worldwide, once most types of tumours are age-dependent. High-quality healthcare in geriatric oncology requires a multimodal approach and should take into account stratified patient outcomes based on factors other than chronological age in order to develop interventions able to optimize oncology care. This study aims to evaluate the Health Related Quality of Life in head and neck cancer patients and compare the scores in geriatric and younger patients. Methods. Two hundred and eighty nine head and neck cancer patients from the Oncology Portuguese Institute participated in the Health Related Quality of Life assessment. Two patient groups were considered: the geriatric ( 65 years old, n = 115) and the younger (45-60 years old, n= 174). The EORTC QLQ-C30 and EORTC QLQ-H&N35 questionnaires were used. Results: Head and neck cancer patients were mostly males, 77.4% within geriatric group and 91.4% among younger patients group. The most frequent tumour locations were similar in both groups: larynx, oral cavity and oropharynx - base of the tongue. At the time of diagnosis, most of younger male patients were at disease stage III/IV (55.9%) whereas the majority of younger female patients were at disease stage I/II (83.4%). The geriatric patient distribution was found to be similar in any of the four disease stages and no gender differences were observed. We found that age (geriatrics scored generally worse), gender (females scored generally worse), and tumour site (larynx tumours denounce more significant problems between age groups) clearly influences Health Related Quality of Life perceptions. Conclusions: Geriatric oncology assessments signalize age-independent indicators that might guide oncologic geriatric care optimization. Decision-making in geriatric oncology must be based on tumour characteristics and chronological age but also on performance status evaluation, co-morbidity, and patient reported outcomes assessment.info:eu-repo/semantics/publishedVersio
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