Multimorbidity and consultation time: a systematic review

Background Multimorbidity (MM) is one of the major challenges health systems currently face. Management of time length of a medical consultation with a patient with MM is a matter of concern for doctors. Methods A systematic review was performed to describe the impact of MM on the average time of a medical consultation considering the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines. The systematic online searches of the Embase and PubMed databases were undertaken, from January 2000 to August 2018. The studies were independently screened by two reviewers to decide which ones met the inclusion criteria. (Kappa = 0.84 and Kappa = 0.82). Differing opinions were solved by a third person. This systematic review included people with MM criteria as participants (two or more chronic conditions in the same individual). The type of outcome included was explicitly defined – the length of medical appointments with patients with MM. Any strategies aiming to analyse the impact of MM on the average consultation time were considered. The length of time of medical appointment for patients without MM was the comparator criteria. Experimental and observational studies were included. Results Of 85 articles identified, only 1 observational study was included, showing a clear trend for patients with MM to have longer consultations than patients without MM criteria (p < 0.001). Conclusions More studies are required to better assess allocation length-time for patients with MM and to measure other characteristics like doctors’ workload.info:eu-repo/semantics/publishedVersio

Communication in health: a new time

The interface between the fields of health and communication brings together a wide diversity of topics, perspectives and articulations between academic production (scientific content) and its dissemination to the public (health journalism). The development and convergence of communication technologies, the progressive mediatization of society and institutions, the new generation of readers and their ways of consuming health content are some of the examples of the various issues addressed in health communication. The aim of this article is to reflect on the relationship between media and health and its current importance in the production and dissemination of contents, in light of the new information and communication technologies, producing efficient and credible information, directed to different audiences.Fiocruz MS, Fundacao Oswaldo Cruz, Inst Comunicacao Informacao Cient & Tecnol Saude, ICICT, Rio De Janeiro, RJ, BrazilESPM, CIC, Sao Paulo, SP, BrazilUniv Estacio Sa, Rio De Janeiro, RJ, BrazilGNT, Rio De Janeiro, RJ, BrazilEuvejo Com Br, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Escola Paulista Med, Setor Med Adolescente, Sao Paulo, SP, BrazilUniv Estadual Campinas, UNICAMP, Campinas, SP, BrazilUniv Guarulhos, UNG, Guarulhos, SP, BrazilUniv Sao Paulo, Fac Med, Dept Molestias Infecciosas & Parasitarias, Sao Paulo, SP, BrazilCRN3, Conselho Reg Nutr Regiao 3a, Comissao Et, Sao Paulo, SP, BrazilUniv Sao Paulo, Inst Psicol, Programa Posgrad Psicol Clin, Sao Paulo, SP, BrazilUNIFEB, Fundacao Educ Barretos, Barretos, SP, BrazilUniv Sao Paulo, Fac Med, Dept Pediat, Sao Paulo, SP, BrazilCEPPAN, Clin Estudos & Pesquisas Psicanalise Anorexia & B, Sao Paulo, SP, BrazilUniv Sao Paulo, Fac Med, Inst Coracao InCor, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, UNIFESP, Sao Paulo, SP, BrazilUniv Sao Paulo, Sao Paulo, SP, BrazilESPM, Sao Paulo, SP, BrazilUniv Presbiteriana Mackenzie, Sao Paulo, SP, BrazilPUC, Sao Paulo, SP, BrazilUniv Metodista Sao Paulo, Sao Paulo, SP, BrazilUniv Sao Paulo, ECA, Sao Paulo, SP, BrazilEPM, Sao Paulo, SP, BrazilUniv Pantheon Sorbonne, Paris, FranceGen Assembly NYC, New York, NY USAUniv Fed Sao Paulo, Escola Paulista Med, Setor Med Adolescente, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, UNIFESP, Sao Paulo, SP, BrazilUniv Fed São Paulo, EPM, Sao Paulo, SP, BrazilWeb of Scienc

Wild dogs at stake: deforestation threatens the only Amazon endemic canid, the short-eared dog (Atelocynus microtis)

The persistent high deforestation rate and fragmentation of the Amazon forests are the main threats to their biodiversity. To anticipate and mitigate these threats, it is important to understand and predict how species respond to the rapidly changing landscape. The short-eared dog Atelocynus microtis is the only Amazon-endemic canid and one of the most understudied wild dogs worldwide. We investigated short-eared dog habitat associations on two spatial scales. First, we used the largest record database ever compiled for short-eared dogs in combination with species distribution models to map species habitat suitability, estimate its distribution range and predict shifts in species distribution in response to predicted deforestation across the entire Amazon (regional scale). Second, we used systematic camera trap surveys and occupancy models to investigate how forest cover and forest fragmentation affect the space use of this species in the Southern Brazilian Amazon (local scale). Species distribution models suggested that the short-eared dog potentially occurs over an extensive and continuous area, through most of the Amazon region south of the Amazon River. However, approximately 30% of the short-eared dog's current distribution is expected to be lost or suffer sharp declines in habitat suitability by 2027 (within three generations) due to forest loss. This proportion might reach 40% of the species distribution in unprotected areas and exceed 60% in some interfluves (i.e. portions of land separated by large rivers) of the Amazon basin. Our local-scale analysis indicated that the presence of forest positively affected short-eared dog space use, while the density of forest edges had a negative effect. Beyond shedding light on the ecology of the short-eared dog and refining its distribution range, our results stress that forest loss poses a serious threat to the conservation of the species in a short time frame. Hence, we propose a re-assessment of the short-eared dog's current IUCN Red List status (Near Threatened) based on findings presented here. Our study exemplifies how data can be integrated across sources and modelling procedures to improve our knowledge of relatively understudied species

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Multimorbilidade e tempo de consulta: uma revisão sistemática

Trabalho Final do Mestrado Integrado em Medicina apresentado à Faculdade de MedicinaIntrodução: A multimorbilidade (MM) é atualmente um dos principais desafios enfrentados pelos sistemas de saúde a nível internacional e tende a ocupar uma parte considerável da atividade diária dos médicos em todo o mundo. É importante pensar na abordagem médica para lidar com pacientes com MM, a fim de maximizar a qualidade dos serviços prestados pelos serviços nacionais de saúde e, assim, garantir uma melhor qualidade de vida para esses pacientes. Informações sobre o tempo gasto numa consulta médica com pacientes com critérios de MM são essenciais para melhor organizar e fornecer cuidados de saúde. Até onde sabemos, nenhuma revisão anterior resumiu os dados relativos ao impacto da MM na duração média do tempo de consulta.Objetivo: Revisão de todos os estudos experimentais e observacionais que descrevem o impacto de ter MM na duração média de uma consulta médica.Métodos: Esta revisão sistemática foi realizada considerando as diretrizes de Itens Preferenciais de Relatórios para Revisão Sistemática e Meta-análises (PRISMA) para revisões sistemáticas e meta-análises. As pesquisas bibliográficas foram realizadas utilizando as bases de dados Embase e PubMed, desde janeiro de 2000 até agosto de 2018. Os estudos foram selecionados de forma independente por dois investigadores, a fim de selecionar aqueles que cumpriam os critérios de inclusão. (Kappa=0.84 e Kappa=0.82). Opiniões divergentes foram resolvidas por uma terceira pessoa. Esta revisão sistemática incluiu como participantes pacientes com critérios de MM (duas ou mais condições crónicas no mesmo indivíduo). Os artigos selecionados incluíam explicitamente a duração das consultas médicas com pacientes com MM. Quaisquer estratégias que visassem analisar o impacto da MM na duração média do tempo de consulta foram consideradas. Como referência foi considerado o tempo gasto na consulta médica com pacientes sem MM. Foram incluídos tanto estudos experimentais como observacionais. Resultados: Dos 85 artigos identificados, só 1 estudo observacional foi selecionado. O estudo mostra que há uma tendência clara para pacientes com MM necessitarem de consultas mais longas do que aqueles sem MM (p <0,001). A qualidade do artigo foi considerada “Satisfatória”.Conclusão: É imperativo estudar o tempo de consulta com pacientes com MM. Encontrar um tempo maior de consulta indica que é importante repensar e adaptar as listas dos médicos e o planeamento do tempo para poder prestar melhor assistência médica aos pacientes com MM, permitindo que os planos de consulta tenham horários específicos dedicados a esses pacientes e tempo suficiente para todas as tarefas necessárias.Background: Multimorbidity (MM) is one of the major challenges currently facing health systems at the international level and tends to occupy a considerable part of the daily activity of physicians around the world. It is important to think about the medical approach to dealing with patients with multimorbidity in order to maximize the quality of the services provided by national health services, and thus to secure a better quality of life for these patients. Information about the time spent in a medical consultation with a patient with MM criteria is essential to better organize and deliver healthcare. As far as we know, no previous review has summarized the data relating to how having MM affects the length of the average consultation time.Objective: To review all the experimental observational studies that describe the impact of having MM on the average time of a medical consultation.Methods: This systematic review was performed considering the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines for systematic reviews and meta-analysis. The systematic online searches of the Embase and PubMed databases were undertaken, from January 2000 to August 2018. The studies were independently screened by two reviewers to decide which ones met the inclusion criteria. (Kappa=0.84 and Kappa=0.82). Differing opinions were solved by a third person. This systematic review included people with MM criteria as participants (two or more chronic conditions in the same individual). The type of outcome included was explicitly defined – the length of medical appointments with patients with MM criteria. Any strategies aiming to analyse the impact of MM on the average consultation time were considered. The comparator used was the length of time of medical appointment for patients without MM criteria. Experimental and observational studies were included.Results: Of 85 articles identified, only 1 observational study was included. The study shows that there is a clear trend for patients with MM criteria to have longer consultations than patients without MM criteria (p<0.001). The global quality of this study was considered “Satisfactory”.Conclusions: It is imperative to study the consultation time spent on patients with MM criteria. Finding a longer consultation time indicates it is important to rethink and adapt GPs’ lists and time planning to be able to give better medical care to patients with MM by providing agendas that have specific times set aside for these patients and allocating enough time for every task required

Auricular Chromoblastomycosis: A Case Report and Review of Published Literature

Subcutaneous chromoblastomycosis is an infection commonly seen in tropical and subtropical climates, usually caused by trauma with vegetables and often affects the host's lower limbs. We report a case of auricular chromoblastomycosis in a 67-year-old man and discuss the rarity of this clinical manifestation of chromoblastomycosis in the medical literature. in the present case, the etiologic agent was Fonsecaea pedrosoi, the most common agent found in Brazil.Fundacao Tecn Educ Souza Marques Pele Saudavel, Curso Especializacao Dermatol, BR-01326000 São Paulo, BrazilUniversidade Federal de São Paulo, Disciplina Infectol, São Paulo, BrazilUniversidade Federal de São Paulo, Disciplina Infectol, São Paulo, BrazilWeb of Scienc

A critical analysis of Doppler velocimetry in the differential diagnosis of malignant and benign ovarian masses

Objectives: To evaluate the intratumoral reliability of color Doppler parameters and the contribution of Doppler sonography to the gray-scale differential diagnosis of ovarian masses. Methods: An observational study was performed including 67 patients, 15 (22.4%) with malignant ovarian neoplasm and 52 (77.6%) with benign ovarian diseases. We performed the Doppler evaluation in two distinct vessels selected after decreasing the Doppler gain to sample only vessels with higher velocity flow. Doppler measurements were obtained from each identified vessel, and resistive index (RI), pulsatility index (PI), peak systolic velocity (PSV), and end-diastolic velocity (EDV) were measured. Intraclass coefficient of correlation (ICC), sensitivity, specificity, and potential improvement in gray-scale ultrasound performance were calculated. Results: The general ICC were 0.60 (95% CI 0.42- 0.73) for RI, 0.65 (95% CI 0.49- 0.77) for PI, 0.07 (95% CI- 0.17-0.30) for PSV, and 0.19 (95% CI -0.05-0.41) for EDV. The sensitivity and specificity were respectively 84.6% and 86.7% for RI, 69.2% and 93.3% for PI, 80.0% and 65.4% for gray-scale sonography, and 93.3% and 65.4% for gray-scale plus RI (p = 0.013). Conclusions: Gynecologists must be careful in interpreting results from Doppler evaluation of ovarian masses because PSV and EDV present poor intratumoral reliability. The lower RI value, evaluated in at least two distinct sites of the tumor, was able to improve the performance of gray-scale ultrasound in differential diagnosis of ovarian masses