La figura del fisioterapeuta en obstetrícia: estudi aleatoritzat de l’impacte del massatge perineal durant la primera etapa del part per prevenir-ne el trauma.

La pregunta clínica d’investigació que s’ha plantejat en un inici ha estat: Resulta eficaç el massatge perineal (MP) per reduir-ne el trauma post-part? Després d’haver realitzat una cerca bibliogràfica per revisar la literatura sobre el tema, s’ha vist que ja existeixen publicacions anteriors. Per aquest motiu s’ha definit millor la pregunta en base a la informació aportada per altres estudis, realitzant variacions en quant a l’etapa del part en la qual aplicar la intervenció. La pregunta clínica d’investigació definitiva ha estat: Resulta eficaç el MP aplicat durant la primera etapa del part per reduir-ne el trauma post-part? Es tracta, doncs, d’una pregunta rellevant, nova i factible que naix d’un problema assistencial justificat a continuació. Pregunta estructurada en format P.I.C.O: P (pacient): gestants primípares. I (Intervenció): MP durant la primera etapa del part. C (Comparació): MP durant la primera etapa del part vs. atenció al part de rutina sense MP. O (Resultats): el MP durant la primera fase del part disminueix el risc de trauma perineal (TP) post-part i les conseqüències que aquest comporta. Objectiu: L’objectiu general d’aquest projecte d’investigació és comprovar l’efectivitat del MP durant la primera fase del part per reduir el TP post-part en dones primípares. Metodologia: Projecte d’assaig clínic experimental, probabilístic, aleatori simple amb control concurrent. Consta de dos grups, un grup experimental i un grup control.

The influence of a certain volume of fluid in the lower tear meniscus on intraocular pressure measurements using the non-contact tonometer

Background: Intraocular pressure (IOP) is the pressure inside the eye that helps to maintain the integrity and the suitable form of the ocular globe. Precise and accurate measures of IOP are needed for the diagnosis as well as follow-up of glaucoma. In daily clinical practice, Goldmann applanation tonometer (GAT) and Non-contact tonometer (NCT) are the most common devices for measuring IOP. A close agreement between these methods has been showed, particularly in normotensive patients and a poor agreement, especially when IOP levels are above the normal range. Ophthalmologists have noticed a poor agreement between NCT and GAT, observing that by using NCT and after comparing with GAT, there is an overestimation of IOP readings, and particularly it occurs when the eyes are tearful. Previous studies investigate the effect of tears in Non-contact tonometer readings by the instillation of artificial tears, concluding in one of the studies that the variation was less than 1mmHg and not clinically significant, in contrast with another study which the increases were sadistically significant. Tear menisci are a thin strip of tear fluid located between the bulbar conjunctiva and the eyelid margins. We think that the overestimation of IOP readings using NCT could be due to the presence of a higher volume of tear in the lower tear meniscus which might cause an optical interference in the optoelectronic applanation monitoring system of this deviceObjectives: To research the influence of a certain volume of fluid in the lower tear meniscus on IOP measurements using the NCT in healthy eyes. Moreover, to investigate the agreement between IOP readings obtained by NCT and GAT in the presence and absence of this volume of fluidMethods: The study design will be transversal for diagnostic tests of repeated measures. We will study patients with no ocular pathology and IOP<21mmHg. It will consist in the measurement of IOP using NCT before and after the instillation of COLIRCUSÍ FLUOTEST, used as a volume of fluid in the lower tear meniscus, to observe if there will be differences using the paired t-test. Moreover, we will take IOP measures by GAT in order to know the agreement between these methods after and before the application of these eyedrops, using the ICC (intraclass correlation coefficient) and the Bland-Altmann method