RESUMEN
BACKGROUND: The demand for chat messaging apps for communication between physicians, therapists and patients is increasing. The expectations for this form of communication and uncertainties regarding introduction and use are heterogeneous. OBJECTIVE: The implementation of chat messengers in the care of patients with Parkinson's disease should be facilitated by recommendations regarding introduction and usage. METHODS: Semi-structured interviews with neurologists and physiotherapists were conducted to capture the expectations and needs regarding the use of chat messengers. From the data analysis, recommendations were derived. RESULTS: The expectations for technical functionality exceeded the chat messenger functions. This concerns, e.g., the connection of the chat messenger to the electronic patient file. There is a great deal of uncertainty, particularly when it comes to the applicable General Data Protection Regulations (GDPR). The recommendations relating to the use of chat messengers, data protection aspects, the design of such tools and methodological considerations can help to implement the tool as an additional communication channel. CONCLUSION: Practical recommendations regarding functionality, the use of chat messengers in everyday life and in relation to data protection are derived from the results. By improving knowledge, physicians and therapists can contribute to the successful establishment of chat messengers as an additional communication tool.
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Aplicaciones Móviles , Enfermedad de Parkinson , Enfermedad de Parkinson/terapia , Humanos , Neurólogos , Alemania , Actitud del Personal de Salud , Relaciones Médico-Paciente , FisioterapeutasRESUMEN
BACKGROUND: The establishment of healthy eating habits in children at school and in family life is very important for preventing obesity in children. AIMS: To know the habits of late-breakfast in a scholar population, the prevalence of overweight and obesity, and establish healthy dietary habits through the late-breakfast. METHODS: A prospective interventional study was performed in a school group. Children from 10 to 13 years-old were included. The study had three phases: pre-intervention (anthropometric assessment and questionnaire of late-breakfast frequency), intervention (parents and teachers received information about "the importance of proper nutrition in school" focused on the transcendence of a healthy and balanced diet that includes a suitable late-breakfast every day at school, and the students received the late-breakfast during two weeks that included milk, fruit and a traditional sandwich), and post-intervention (questionnaire of late-breakfast frequency). RESULTS: Frequency of overweight was 10.6% and obesity 2.6%. After the intervention the proportion of children who had late-breakfast increased by 9.2%, and the kind of food which they ate changed. CONCLUSION: Dietary habits can be modified in a scholar population with an easy nutritional intervention.
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Conducta Alimentaria , Adolescente , Índice de Masa Corporal , Niño , Dieta , Femenino , Humanos , Masculino , Obesidad/prevención & control , Sobrepeso/prevención & control , Estudios Prospectivos , Instituciones Académicas , Estudiantes , Encuestas y CuestionariosRESUMEN
Introducción: La implantación de hábitos alimentarios saludables en la población infantil en el ámbito escolar y familiar es de gran importancia para la prevención de la obesidad infanto-juvenil. Objetivos: Conocer los hábitos de almuerzo de una población escolar, su prevalencia de sobrepeso y obesidad así como instaurar hábitos dietéticos saludables y educar nutricionalmente a ésta para mejorar las costumbres alimentarias a través de un almuerzo saludable. Métodos: Se realizó un estudio prospectivo de intervención en escolares. Se incluyeron niños de 10-13 años. El estudio se llevó a cabo en 3 fases: preintervención (valoración antropométrica y cuestionario de frecuencia de almuerzo y de alimentos consumidos), intervención (charlas formativas al profesorado y los padres sobre «la importancia de una correcta alimentación en el escolar», enfocadas en la trascendencia de una alimentación sana y equilibrada que incluyese un almuerzo saludable diariamente en el escolar y entrega del almuerzo durante dos semanas a los alumnos que incluía lácteos, fruta y bocadillo tradicional), postintervención (cuestionario de frecuencia de almuerzo y de alimentos consumidos). Resultados: La frecuencia de sobrepeso fue del 10,6% y de obesidad del 2,6%. Tras la intervención se produjo un incremento del 9,2% de individuos que almorzaban y una modificación de los alimentos consumidos. Conclusión: La modificación de los hábitos dietéticos del almuerzo de los escolares es posible con campañas sencillas de intervención nutricional (AU)
Background: The establishment of healthy eating habits in children at school and in family life is very important for preventing obesity in children. Aims: To know the habits of late-breakfast in a scholar population, the prevalence of overweight and obesity, and establish healthy dietary habits through the late-breakfast. Methods: A prospective interventional study was performed in a school group. Children from 10 to 13 years-old were included. The study had three phases: pre-intervention (anthropometric assessment and questionnaire of late-breakfast frequency), intervention (parents and teachers received information about «the importance of proper nutrition in school» focused on the transcendence of a healthy and balanced diet that includes a suitable late-breakfast every day at school, and the students received the late-breakfast during two weeks that included milk, fruit and a traditional sandwich), and post-intervention (questionnaire of late-breakfast frequency). Results: Frequency of overweight was 10.6% and obesity 2.6%. After the intervention the proportion of children who had late-breakfast increased by 9.2%, and the kind of food which they ate changed. Conclusion: Dietary habits can be modified in a scholar population with an easy nutritional intervention (AU)
Asunto(s)
Humanos , Masculino , Femenino , Niño , Conducta Alimentaria , Obesidad/prevención & control , EstudiantesRESUMEN
The use of iodine contrast agents during angiography can put patients at risk. The replacement of angiography through duplex ultrasound methods would, therefore, be of great interest. Even when duplex sonography is used however, an x-ray angiography is often performed afterwards to verify the diagnosis. This causes complications in an unacceptable number of patients. The safety of duplex ultrasound sonography diagnosis can be improved by using low-risk Doppler contrast agents. Slow blood flow through vessels with a high degree stenosis and intracerebral flow can be more easily and accurately detected using these agents. However, amplification of the Doppler echo alters the measurements during both high and low flow, so that the flow rate cannot be recorded very precisely. Our goal was to study the effect of a contrast agent on velocity measurements with color-coded Doppler ultrasonography and on pulsed, one-goal measurements. We used a laser-Doppler-anemometer (LDA) with high temporal and spatial resolution as a reference method to compare the measurements.
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Arterias Carótidas/diagnóstico por imagen , Medios de Contraste/efectos adversos , Modelos Cardiovasculares , Ultrasonografía Doppler en Color/métodos , Velocidad del Flujo Sanguíneo , Humanos , RadiografíaRESUMEN
Polychlorinated biphenyls (PCBs) released by bottom sediments were determined by experiments in which the sediments were artificially resuspended using sediment contaminated with PCBs in a particle entrainment simulator (PES). Sediment cores, spiked with PCBs, were collected from the Housatonic River in Connecticut and run in the PES at simulated shear stresses from 0 to 0.6 N m(-2). Experimental results from these simulations have shown that mean concentration of PCBs in the solid phase for sites with high volatile organic carbon (VOC) were significantly greater than samples with low VOC; the reverse was true for the water phase. In addition, on a mass load basis, the amount of PCBs found in sediment increased when shear stresses were increased from 0 to 0.6 N m(-2), beyond which shear stress did not affect mass loads in the water column. Partition coefficients (Kp) were determined from PES sediment and water data for the following congeners: PCB 28, PCB 52, PCB 101, PCB 138, PCB 153, PCB 180. Kp was determined to be inversely proportional to total suspended solids (TSS), but directly proportional to chlorine content of the congener. Because of the strong influence of TSS and VOC concentrations on Kp values, agitation of samples using a PES better simulated real environmental conditions when compared to jar studies where no agitation was employed. Therefore, a device like the PES is more appropriate in obtaining Kp that would be found under real stream flow conditions when compared to the traditional way of measuring Kp using the jar study technique.
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Contaminantes Ambientales/análisis , Sedimentos Geológicos/química , Modelos Teóricos , Bifenilos Policlorados/análisis , Contaminantes del Agua/análisis , Monitoreo del Ambiente/instrumentación , Monitoreo del Ambiente/métodos , Tamaño de la Partícula , VolatilizaciónRESUMEN
In vitro studies with the transprosthetic drainage system (TDS) have revealed a reduction in intrafemoral pressure in cemented total hip prosthesis. The aim of the present study was to establish whether the incidence of fat embolic syndrome (FES) is also reduced. Ten patients underwent standardized cemented total hip replacement using TDS under standardized general anaesthesia. The usual peri-operative monitoring measures were extended to include cardiopulmonary monitoring (pulmonary artery catheter, intra-arterial blood pressure) and two-dimensional transoesophageal echocardiography. Previous studies had reported an increased risk for fat embolic syndrome with conventional, and even with vacuum cementing techniques. Our recorded cardiopulmonary data and the data provided by two-dimensional transoesophageal echocardiography show a significant reduction in pulmonary embolism with TDS. This technique can be recommended in particular for high-risk patients (osteoporosis, elderly patients) and the implantation of long femoral stems. On the basis of the clinical data, a new femoral stem allowing the use of the TDS technique is being developed.
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Artroplastia de Reemplazo de Cadera/instrumentación , Drenaje/instrumentación , Embolia Grasa/prevención & control , Complicaciones Intraoperatorias/prevención & control , Embolia Pulmonar/prevención & control , Cementos para Huesos , Humanos , Diseño de Prótesis , Factores de RiesgoRESUMEN
In this study, the anti-inflammatory actions of the peroxisome proliferator-activated receptor (PPAR)-gamma agonists 15-deoxy-delta 12,14-prostaglandin J2 (15-d-delta 12,14-PGJ2) and troglitazone have been examined. Treatment of RAW 264.7 cells and CD-1 mouse peritoneal macrophages with lipopolysaccharide (LPS) + interferon-gamma (IFN-gamma) results in inducible nitric oxide synthase (iNOS), inducible cyclooxygenase (COX-2) and interleukin-1 (IL-1) expression, increased production of nitric oxide, and the release of IL-1. In a concentration-dependent manner, 15-d-delta 12,14-PGJ2 inhibits each of these proinflammatory actions of LPS + IFN-gamma, with half-maximal inhibition at approximately 0.5 microg/ml and complete inhibition at 1-5 microg/ml. The inhibitory actions of 15-d-delta 12,14-PGJ2 on LPS + IFN-gamma-induced inflammatory events are not associated with the inhibition of iNOS enzymatic activity or macrophage cell death, but appear to result from an inhibition of iNOS and IL-1 transcription. In addition, the anti-inflammatory actions of 15-d-delta 12,14-PGJ2 are not limited to peritoneal macrophages, as 15-d-delta 12,14-PGJ2 prevents TNF-alpha + LPS-induced resident islet macrophage expression of IL-1beta and beta-cell expression of iNOS stimulated by the local release of IL-1 in rat islets. 15-d-delta 12,14-PGJ2 appears to be approximately 10-fold more effective at inhibiting resident islet macrophage activation (in response to TNF + LPS) than IL-1-induced nitrite production by beta-cells. Two mechanisms appear to be associated with the antiinflammatory actions of both 15-d-delta 12,14-PGJ2 and troglitazone: 1) the direct inhibition of cytokine- and endotoxin-stimulated iNOS and IL-1 transcription; and 2) the inhibition of IL-1 signaling, an event associated with PPAR-gamma agonist-induced activation of the heat shock response (as assayed by heat shock protein 70 expression). These findings indicate that the PPAR-gamma agonists, troglitazone and the J series of prostaglandins, are potent anti-inflammatory agents that prevent cytokine- and endotoxin-stimulated activation of peripheral and resident tissue macrophages and cytokine-induced iNOS expression by beta-cells by the inhibition of transcriptional activation and induction of the heat shock response.
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Antiinflamatorios/farmacología , Cromanos/farmacología , Prostaglandina D2/análogos & derivados , Tiazoles/farmacología , Tiazolidinedionas , Animales , Línea Celular , Citocinas/farmacología , Calor , Interferón gamma/antagonistas & inhibidores , Interferón gamma/farmacología , Interleucina-1/metabolismo , Lipopolisacáridos/antagonistas & inhibidores , Lipopolisacáridos/farmacología , Macrófagos Peritoneales/metabolismo , Masculino , Ratones , Ratones Endogámicos , Óxido Nítrico Sintasa/antagonistas & inhibidores , Óxido Nítrico Sintasa de Tipo II , Nitritos/metabolismo , Prostaglandina D2/farmacología , Ratas , Ratas Sprague-Dawley , Choque/enzimología , TroglitazonaRESUMEN
A 2-year-old spayed female domestic shorthair cat was referred for evaluation of rapidly progressive lameness of the right hind limb, which was paralyzed. Histologic examination of biopsy specimens revealed pyogranulomatous inflammation affecting the sciatic, common peroneal, and tibial nerves, and slender, beaded, acid-fast bacilli within macrophages, nerve fibers, and degenerate axons. A diagnosis of mycobacterial neuritis was made and the cat was treated with clofazimine and enrofloxacin for extended periods. Treatment was partially effective; the goal of returning normal function to the limb was not achieved, but disease progression was halted and the cat remained a viable pet.
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Enfermedades de los Gatos/microbiología , Fluoroquinolonas , Infecciones por Mycobacterium/diagnóstico , Mycobacterium/efectos de los fármacos , Neuritis/veterinaria , Alanina Transaminasa/sangre , Fosfatasa Alcalina/sangre , Animales , Antiinfecciosos/uso terapéutico , Antiinflamatorios no Esteroideos/uso terapéutico , Biopsia/veterinaria , Enfermedades de los Gatos/diagnóstico , Enfermedades de los Gatos/tratamiento farmacológico , Gatos , Clofazimina/uso terapéutico , Diagnóstico Diferencial , Enrofloxacina , Femenino , Miembro Posterior/fisiopatología , Histocitoquímica , Cojera Animal/diagnóstico , Cojera Animal/tratamiento farmacológico , Infecciones por Mycobacterium/tratamiento farmacológico , Neuritis/diagnóstico , Neuritis/tratamiento farmacológico , Neuritis/microbiología , Parálisis/veterinaria , Quinolonas/uso terapéutico , Nervio Ciático/patologíaAsunto(s)
Adenoma/veterinaria , Neoplasias Cerebelosas/veterinaria , Enfermedades de los Perros/diagnóstico , Neoplasias Mamarias Animales/diagnóstico , Meningioma/veterinaria , Neoplasias Primarias Múltiples/veterinaria , Otitis Externa/veterinaria , Adenoma/complicaciones , Adenoma/diagnóstico , Animales , Neoplasias Cerebelosas/complicaciones , Neoplasias Cerebelosas/diagnóstico , Perros , Femenino , Imagen por Resonancia Magnética/veterinaria , Neoplasias Mamarias Animales/complicaciones , Meningioma/complicaciones , Meningioma/diagnóstico , Neoplasias Primarias Múltiples/complicaciones , Examen Neurológico/veterinaria , Otitis Externa/complicaciones , Otitis Externa/diagnósticoRESUMEN
Fat embolic phenomena during cemented and non-cemented total hip arthroplasty occur even during the preparation of the femoral canal. This should be avoided in order to reduce the rate of fat embolic syndrome. In the present prospective study we demonstrate the benefit of cannulated awls and rasps in the reduction of fat embolic phenomena by means of transoesophageal echocardiography and extended cardiopulmonary monitoring. Two groups of 5 patients each with identical surgical procedures were treated either with cannulated (group 1) or with closed (group 2) awls and rasps. In group 1 no macroemboli but three embolic showers grades 1 and 2 were seen. In contrast to these findings, three macroemboli and four embolic showers grades 1 and 3 were demonstrated in group 2. We recommend cannulated awls and rasps for the preparation of the femoral canal in cemented and non-cemented total hip arthroplasty. They are a simple and inexpensive aid to avoid fat embolic syndrome.
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Artroplastia de Reemplazo de Cadera/instrumentación , Embolia Grasa/prevención & control , Complicaciones Posoperatorias/prevención & control , Humanos , Estudios ProspectivosRESUMEN
UNLABELLED: We assessed the analgesic efficacy of postoperative epidural ropivacaine 0.1% with and without sufentanil 1 microgram/mL in this prospective, randomized, single-blinded study of 30 ASA physical status I-III patients undergoing elective total hip replacement. Lumbar epidural block using 0.75% ropivacaine was combined with either propofol sedation or general anesthesia for surgery. After surgery, the epidural infusion was commenced. Fifteen patients in each group received either an epidural infusion of 0.1% ropivacaine with 1 microgram/mL sufentanil (R + S) or 0.1% ropivacaine without sufentanil (R) at a rate of 5-9 mL/h. All patients had access to i.v. piritramide via a patient-controlled analgesia device. The R + S group consumed six times less piritramide over a 48-h infusion period than the R group (median 12.7 vs 73.0 mg; P < 0.001). Motor block was negligible for the study duration in both groups. Patient satisfaction was excellent. The incidence of adverse events, such as nausea, was similar. We conclude that a continuous epidural infusion of 0.1% ropivacaine with 1 microgram/mL sufentanil is more effective than ropivacaine alone in treating pain after elective hip replacement without motor block. IMPLICATIONS: This is the first randomized study comparing the efficacy of the epidural combination of ropivacaine 0.1% and sufentanil 1 microgram/mL versus plain ropivacaine 0.1% in treating pain after hip replacement. We found that ropivacaine 0.1% and sufentanil 1 microgram/mL led to a sixfold reduction in opioid requirements after total hip replacement by producing a negligible motor block.
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Amidas/administración & dosificación , Analgesia Epidural , Analgésicos Opioides/administración & dosificación , Anestésicos Locales/administración & dosificación , Artroplastia de Reemplazo de Cadera , Dolor Postoperatorio/terapia , Sufentanilo/administración & dosificación , Adulto , Anciano , Anciano de 80 o más Años , Amidas/efectos adversos , Analgesia Epidural/efectos adversos , Analgesia Controlada por el Paciente , Analgésicos Opioides/efectos adversos , Anestésicos Locales/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Pirinitramida , Estudios Prospectivos , Ropivacaína , Método Simple Ciego , Sufentanilo/efectos adversosRESUMEN
BACKGROUND: Since the introduction of the closed-chest minimally invasive heart surgery using the Port-Access system a variety of monitoring techniques including fluoroscopy, transesophageal echocardiography (TEE) and invasive pressure measurements have been described. We investigated whether or not single TEE is feasible for perioperative monitoring of the placement, localization and proper function of the endovascular cardiopulmonary bypass (CPB) devices. METHODS: Fifty-one patients (35 mitral valve repair or replacement [MVR], 8 coronary artery bypass grafting [CABG], 5 atrial septal defects [ASD] and 3 left atrial myxoma) were subjected to Port-Access surgery (PAS). Intraoperative Omniplane-TEE (2D- and color-flow Doppler techniques) was used as the leading monitoring device for correct positioning of the endopulmonary vent catheter and the venous cannula, and for the visualization of the guide wire and the endoaortic occlusion catheter (Endoclamp). After balloon inflation, its proper positioning and function during endo-aortic occlusion, sufficient delivery of cardioplegia into the coronary ostia, absence of leakage flow and adequate venting were controlled. Left and right radial artery catheters as well as aortic root pressure measurements served as controls. Additional fluoroscopy was used as standby device. RESULTS: In 46 patients (90.1%) sufficient perioperative monitoring was provided by single TEE. In five cases additional intermittent fluoroscopy was necessary for correct positioning of the guide wire (CABG) and the Endoclamp (three MVR and one ASD). Dislocation of the Endoclamp into the left ventricle was observed once but was successfully corrected by TEE guidance. Weaning from CPB and de-airing were easily guided with TEE. We did not observe balloon-mediated aortic injury or aortic valve dysfunction, and myocardial recovery from CPB was uneventful. All cases of MVRs showed sufficient results (68% without evidence of regurgitation, 32% showed residual mitral valve incompetence of less than grade II). Neither perivalvular leakage (MV-replacement) nor shunt- (residual ASD) flow were detectable. CONCLUSIONS: We recommend single TEE as a safe and effective on-line imaging device for monitoring the endovascular CPB system during PAS. Fluoroscopy with its potential risk for the patients and the staff due to x-ray exposure should only be used in the presence of peripheral vascular disease or when echocardiographic imaging is insufficient.
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Puente Cardiopulmonar , Ecocardiografía Transesofágica , Cardiopatías/cirugía , Procedimientos Quirúrgicos Mínimamente Invasivos , Monitoreo Intraoperatorio , Toracoscopía , Cardiopatías/diagnóstico por imagen , Humanos , Complicaciones Posoperatorias/diagnóstico por imagen , Sensibilidad y Especificidad , Ultrasonografía Doppler en ColorRESUMEN
It has been speculated that high pressure implantation may improve the results of coronary stenting. However, this method bears the risk of persistent dissection and may increase late lumen loss. Presently, there is no consensus about the optimal stent implantation technique with the regard to balloon size and pressure. To elucidate this question an experimental study was performed in a coronary stenosis model. 3.5 mm Multi-Link (ML) stents were implanted in 3.3 mm silicone rubber tubes containing 50% concentric narrowings. Three implantation techniques were applied: 1. The standard technique using the conventional ML delivery system with a compliant balloon (ML-ST). 2. A new deployment method with a high pressure delivery system (ML-HP). 3. "Focal postdilation" using the ARC catheter, which has a special balloon with an inner compliant and an outer non-compliant section (ML-ARC). For comparison, the Palmaz-Schatz stent was implanted by using a high pressure balloon. Stent expansion was imaged by magnification radiography. Minimal lumen diameter within the stent (MLD) and the lumen diameter outside the stent (BD) were measured after dilations with 6, 9, 12, 15, 18, and 21 atm. The relation of the BD to the MLD was used as an index of vessel trauma. The results lead to the following conclusions: 1. A complete apposition to the vessel wall for a balloon/vessel relation of 1.1:1 could not be reached with pressures below 9-15 atm. The increase of the pressure beyond 15 atm resulted only in a minimal additional lumen. 2. Compared to the Palmaz-Schatz stent the recoil of the ML stent was significantly lower. 3. For all three implantation techniques the ML-ARC showed the best results with the maximal dilation of the stenotic vessel-area and the minimal expansion of the vessel outside the stent.
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Angioplastia Coronaria con Balón/instrumentación , Angiografía Coronaria/instrumentación , Modelos Cardiovasculares , Magnificación Radiográfica/instrumentación , Stents , Diseño de Equipo , Análisis de Falla de Equipo , Humanos , Técnicas In VitroRESUMEN
A 2-year-old 2-kg female Maltese dog was referred for treatment of dirofilariosis and mild caval syndrome characterized by hemolysis and lethargy. Ultrasonography revealed worms within the caudal vena cava, right auricle, right ventricle, and pulmonary artery. Because of the mild clinical signs and small size of the dog, jugular venotomy was not performed, and treatment with sodium caparsolate was instituted. A markedly adverse reaction was noticed on initial injection, characterized by cardiac and respiratory arrest. Further treatment with sodium caparsolate was discontinued. Because of progression of the dog's condition surgical removal of heartworms was elected. A modified surgical approach to the right atrium was performed, using a cannula introduced through a pursestring placed in the wall of the right auricle. This technique allowed almost complete removal of heartworms with minimal blood loss. Postoperative ultrasonography revealed a single heart-worm remaining in the distal portion of the left pulmonary artery, but it was subsequently absorbed.