Abstract
Objectives
To apply the lupus low disease activity state (LLDAS) definition within a large cohort of patients and to assess the agreement between the LLDAS and the physician’s subjective ...evaluation of lupus activity.
Methods
We conducted a cross-sectional analysis of a prospective multicentre study of SLE patients. We applied the LLDAS and assessed whether there was agreement with the clinical status according to the physician’s opinion.
Results
A total of 508 patients 92% women; mean age 50.4 years (s.d. 3.7) were recruited and 304 (62.7%) patients were in the LLDAS. According to physician assessment, 430 (86.1%) patients were classified as remission or low activity. Overall agreement between both evaluations was 71.4% (95% CI: 70.1, 70.5) with a Cohen’s κ of 0.3 interquartile range (IQR) 0.22–0.37. Most cases (96.1%) in the LLDAS were classified as remission or low activity by the expert. Of the patients who did not fulfil the LLDAS, 126 (70.4%) were classified as having remission/low disease activity. The main reasons for these discrepancies were the presence of new manifestations compared with the previous visit and a SLEDAI 2K score >4, mainly based on serological activity.
Conclusions
Almost two-thirds of SLE patients were in the LLDAS. There was a fair correlation between the LLDAS and the physician’s evaluation. This agreement improves for patients fulfilling the LLDAS criteria. The discordance between both at defining lupus low activity, the demonstrated association of the LLDAS with better outcomes and the fact that the LLDAS is more stringent than the physician’s opinion imply that we should use the LLDAS as a treat-to-target goal.
OBJECTIVETo study the impact of a newly introduced dressing on efficiency and quality of care in routine clinical practice in a Spanish community setting.
DESIGN AND SETTINGAn ambispective ...multicenter observational study was conducted in 24 primary care centers and 6 nursing homes in 4 different Spanish regions. The study was carried out between November 2017 and March 2019.
PATIENTS AND INTERVENTIONA total of 128 wounds in 94 patients (primary care, n = 79; nursing home, n = 15) were analyzed before and 4 weeks after switching to the study dressing.
OUTCOME MEASURESFrequency of dressing changes; secondary outcomes were change in the mean wound area and weekly cost and patient and provider satisfaction.
MAIN RESULTSThe mean number of dressing changes was significantly reduced with the study dressing from 3.14 ± 1.77 changes per week to 1.66 ± 0.87 (P < .001), a 47.1% reduction in frequency. Wound area significantly reduced from 9.90 ± 19.62 cm to 7.10 ± 24.33 cm. In addition, a 58.7% reduction in weekly costs was achieved with the intervention. Patients and providers agreed that their satisfaction with wound care improved.
CONCLUSIONSThe use of the study dressing in routine clinical practice could lead to a major improvement in both efficiency and quality of wound care. Its use could reduce wound care-related costs through improvements in healing and a reduced frequency of dressing changes. It also enhanced the wound care experience from the perspective of both patients and providers.
Introducción: los pacientes sometidos a cirugía bariátrica disminuyen de peso por una mala absorción de los alimentos o por la disminución de la ingesta calórica, pero mantienen sus hábitos de vida ...previos a la intervención. La actividad física es importante para aumentar los beneficios de la cirugía bariátrica y disminuir así el riesgo de enfermedades cardiovasculares y metabólicas, así como la prevención del efecto rebote.Objetivo: analizar de forma objetiva el nivel de actividad física de los pacientes operados de cirugía bariátrica.Métodos: se ha llevado a cabo una búsqueda sistemática y se han seleccionado 10 artículos específicos sobre el tema, siguiendo las directrices PRISMA.Resultados: la mayoría de los estudios realizados a los pacientes sometidos a cirugía bariátrica se efectúan con instrumentos de autoevaluación subjetivos. En esta revisión se han seleccionado 10 trabajos científicos que, además, utilizaron la acelerometría como método objetivo para medir la actividad física.Conclusiones: los pacientes sometidos a cirugía bariátrica aumentan o mantienen sus comportamientos sedentarios, lo que no concuerda con su percepción de la actividad física que afirman llevar a cabo. Es importante valorar no solo el comportamiento sedentario, sino también qué actividad sedentaria tiene mayor prevalencia. Todo ello, para establecer estrategias de intervención frente a esa forma de actuar, disminuyendo así el riesgo de enfermedades cardiovasculares y metabólicas y evitar el efecto rebote.
To determine the dilution titles at antinuclear antibodies (ANA) by indirect immunofluorescence observed in cell substrate HEp-2 and its association with the diagnosis of systemic connective tissue ...disease in ANA test requested by a Rheumatology Unit.
Samples of patients attended for the first time in the rheumatology unit, without prior ANA test, between January 2010 and December 2012 were selected. The dilution titers, immunofluorescence patterns and antigen specificity were recorded. In January 2015 the diagnosis of the patients were evaluated and classified in systemic disease connective tissue (systemic lupus erythematosus, Sjögren's syndrome, systemic sclerosis, undifferentiated connective, antiphospholipid syndrome, mixed connective tissue and inflammatory myophaty) or not systemic disease connective tissue.
A total of 1282 ANA tests requested by the Rheumatology Unit in subjects without previous study, 293 were positive, predominance of women (81.9%). Patients with systemic connective tissue disease were recorded 105, and 188 without systemic connective tissue disease. For 1/640 dilutions the positive predictive value in the connective was 73.3% compared to 26.6% of non-connective, and for values ≥1/1,280 85% versus 15% respectively. When performing the multivariate analysis we observed a positive association between 1/320 dilution OR 3.069 (95% CI: 1.237-7.614; P=.016), 1/640 OR 12.570 (95% CI: 3.659-43.187; P=.000) and ≥1/1,280 OR 42.136 (95% CI: 8.604-206.345; P=.000).
These results show association titles dilution ≥1/320 in ANA's first test requested by a Rheumatology Unit with patients with systemic connective tissue disease. The VPP in these patients was higher than previous studies requested by other medical specialties. This may indicate the importance of application of the test in a targeted way.
La influencia e impacto de los programas educativos en los estilos de vida y particularmente en la salud está reconocido por la literatura, sin embargo, son pocos los estudios que lo sistematizan. ...Con el objetivo de evaluar la efectividad de las intervenciones educativas se realizó esta revisión sistemática siguiendo las directrices PRISMA. Los artículos para ser incluidos se identificaron a través de las bases de datos MEDLINE, LILACS y EMBASE durante los meses de enero a mayo de 2016. Se seleccionaron 24 artículos. El total de sujetos participantes en los estudios evaluados fue de 3 426 y el 58 % fueron no mayores de 17 años. Se constata que este tipo de programa constituye un recurso adecuado para lograr cambios en los estilos de vida, particularmente en las edades tempranas, de igual manera se destaca que aquellas intervenciones que cuentan con el vínculo familiar son altamente efectivas.
Episiotomy rate in active women during pregnancy Raquel Rodríguez-Blanque; Juan Carlos Sánchez-García; María José Menor-Rodríguez ...
Journal of negative & no positive results,
03/2018, Letnik:
3, Številka:
3
Journal Article
Recenzirano
Odprti dostop
Aims: Study the influence of moderate aquatic physical exercise following the SWEP methodology (Study of Water Exercise Pregnant) on the episiotomy rate. Methods and Material: Randomized Clinical ...Trial, with 140 randomized subjects; 129 subjects (Group of Exercises n = 65, Control Group n = 64) completed the requirements of the study. The study began in the 20th week of gestation and ended in week 37. The perinatal results were obtained from the partogram registered in the Paritary Services of the University Hospital Complex of Granada and from the clinical history of each woman. Results: There were no statistically significant differences in the episiotomy rate, although a percentage difference of 10% lower was observed in active women (45.31% vs. 35.4%). The weight of the RN remained within the normal weight range in both groups (2,500 g - 4,000 g), for the GC of 3,460 g (Q1 = 3,207.5 - Q3 = 3,770.0) and for the GE of 3,250 g (Q1 = 2.955.0 - Q3 = 3.572.5) (p = 0.011). In relation to epidural and subdural anesthesia, there are no statistically significant differences between both groups, obtaining 85.9% for CG and 72.3% for EG (p = 0.092). Conclusions: The births of the women who have followed the SWEP methodology have presented a lower rate of episiotomy, although this has not been statistically significant, which is associated with the improvement of the abdominal muscles and better control of the musculature of the pelvic floor.
Eating disorders during pregnancy Raquel Rodriguez-Blanque; Juan Carlos Sánchez-García; María José Menor-Rodríguez ...
Journal of negative & no positive results,
05/2018, Letnik:
3, Številka:
5
Journal Article
Recenzirano
Odprti dostop
A systematic review (SR) was carried out whose main objective was to identify the prevalence of eating disorders during pregnancy. A systematic review of Cohort Studies was carried out, fulfilling ...the criteria of the review protocol Preferred Reporting Items for Systematic reviews and Meta-Analyzes (PRISMA). In the searches, the electronic databases were used, applying the inclusion criteria, Web of Science, Scopus and MEDLINE. We identified 72 articles that met the inclusion criteria. After a series of screenings, which are described below, 9 studies were included in the SR. Once the articles were analyzed, it is observed, as a result of them, that there is a higher prevalence of pregnant women who present eating disorders. This may be due to the greater accessibility to assisted reproduction techniques currently available, where women with previous disorders have access to these techniques. No studies have been found that properly guide health professionals in the prevention, early detection and treatment of eating disorders in pregnancy and puerperium.
La influencia e impacto de los programas educativos en los estilos de vida y particularmente en la salud está reconocido por la literatura, sin embargo, son pocos los estudios que lo sistematizan. ...Con el objetivo de evaluar la efectividad de las intervenciones educativas se realizó esta revisión sistemática siguiendo las directrices PRISMA. Los artículos para ser incluidos se identificaron a través de las bases de datos MEDLINE, LILACS y EMBASE durante los meses de enero a mayo de 2016. Se seleccionaron 24 artículos. El total de sujetos participantes en los estudios evaluados fue de 3 426 y el 58 % fueron no mayores de 17 años. Se constata que este tipo de programa constituye un recurso adecuado para lograr cambios en los estilos de vida, particularmente en las edades tempranas, de igual manera se destaca que aquellas intervenciones que cuentan con el vínculo familiar son altamente efectivas.
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