Sedação consciente em Odontopediatria

O medo e a ansiedade estão estreitamente relacionados com o tratamento dentário e, infelizmente, na população infantil este facto assume uma magnitude aumentada traduzindo-se muitas vezes de forma negativa no comportamento da criança comprometendo ou mesmo inviabilizando a execução do mesmo. O tratamento dentário de pacientes pediátricos com problemas comportamentais pode ser um verdadeiro desafio para o médico dentista e as tradicionais técnicas de controlo comportamental não farmacológicas nem sempre são suficientes para conseguir a cooperação da criança pelo que, em muitos casos, é necessária a associação dos mesmos a técnicas farmacológicas. A sedação consciente é utilizada em odontopediatria como uma técnica de controlo comportamental farmacológica, que visa induzir na criança, um estado mínimo de depressão da consciência, tornando-a passível de cooperar e viabilizando que os tratamentos necessários sejam efectuados com segurança. Existem inúmeros fármacos, técnicas e associações das mesmas que podem ser utilizadas para o efeito sendo que actualmente, em odontopediatria, predomina a prática da sedação consciente inalatória com protóxido de azoto e a utilização de benzodiazepinas como o midazolam. Apesar das muitas técnicas descritas, nenhuma delas é passível de ser administrada a todos os pacientes, pelo para cada caso, tendo em conta todas as particularidades, haverá uma técnica mais adequada. Apesar prática da sedação consciente ser uma mais-valia em odontopediatria, não é isenta de riscos e o médico dentista deve ter formação adequada para a providenciar de forma segura. Diferentes entidades publicaram guidelines que visam orientar a prática segura da sedação e minimizar o risco de incidentes.

Influência do Dynamic Tape na funcionalidade do quadríceps na dor não especifica do joelho do atleta de judô

Introdução: O judô é um esporte que implica uma grande variedade de gestos, ações e aptidões físicas, entre as quais, capacidade de controlo postural, equilíbrio, flexibilidade e força. Quando observada as áreas mais afetas na pratica do judô a região do joelho é das que possui maior incidência. O objetivo deste estudo foi avaliar os efeitos da aplicação do Dynamic Tape (DT), um tape biomecânico, na funcionalidade do quadriceps de atletas de judô masculino com dor não específica no joelho em termos de equilíbrio, força, flexibilidade e dor. Metodologia: A amostra foi constituída por 37 indivíduos, tendo os participantes sido submetidos a testes, primeiramente sem Dynamic Tape (SDT) e posteriormente com Dynamic Tape (CDT). Os testes aplicados foram o Standing Stork Test (SST), o Y Balance Test (YBT), o Four Square Step Test (FSST),o Single Leg Hop Test (SLHT), e o Teste de flexão do membro inferior (TFMI) e o Teste de extensão do membros (TEMI) e a escala numérica de dor (END) no final de todos os testes. Resultados: Não foram observadas diferenças significativas para o teste SST (p=0,6794), porém os teste YBT, SLHT, TFMI, TEMI e END (p<0,0001), assim como FSST (p=0,0026) entre os momentos CDT e SDT demonstraram diferenças estatísticamente significativas, produzindo a aplicação do DT efeitos positivos. Na performance do atleta. Conclusão: A aplicação do DT não foi capaz de melhorar de forma significativa o equilíbrio estático, no então demonstrou influenciar o equilíbrio semi-dinâmico, dinâmico, a flexibilidade e a dor.

Infecções odontogénicas

Introdução: As infecções odontogénicas constituem uma das patologias mais prevalentes e o principal motivo para a procura de cuidados médico-dentários a nível mundial. Todos os Médicos Dentistas deverão mostrar-se aptos a realizar um rápido diagnóstico bem como decidir de forma eficaz, ponderada e devidamente fundamentada qual o tratamento a aplicar a cada caso tendo consciência que a progressão de uma infecção odontogénica é, muitas vezes, imprevisível e um tratamento tardio ou incorrecto poderá acarretar complicações que implicam risco de vida para o paciente ao comprometer os espaços faciais profundos da cabeça e pescoço. Objectivo: Esta dissertação pretende, recorrendo à literatura existente, auxiliar o Médico Dentista no diagnóstico de uma infecção odontogénica e, essencialmente, evidenciar qual o tratamento preconizado ou considerado mais eficaz para este tipo de infecções orais. Materiais e métodos: Para a execução desta revisão da literatura, foi desenvolvida uma pesquisa, entre Janeiro e Junho de 2016, recorrendo à Biblioteca Ricardo Reis da Universidade Fernando Pessoa e à Biblioteca da Faculdade de Medicina Dentária da Universidade do Porto, ao portal “DGS” e às bases de dados electrónicas: PUBMED, SCIENCEDIRECT e Repositório Institucional da Universidade de Barcelona utilizando, para esse fim, as “palavras-chave” estabelecidas. Em suma, na realização da presente dissertação, foram consultadas três obras literárias e 23 artigos científicos. Conclusão: Segundo a literatura analisada, não existe consenso absoluto sobre qual o antibiótico que deverá ser prescrito no tratamento de infecções odontogénicas. A amoxicilina continua a ser referenciada como primeira linha de tratamento e, a necessidade e as vantagens da associação desta ao ácido clavulânico, são evidenciadas por diversos autores. A clindamicina é o antibiótico que se apresenta como segunda linha de tratamento, em casos de alergia aos beta-lactâmicos.

Satisfação dos utentes com o tratamento da dor

A dor constitui atualmente um enorme obstáculo no quotidiano de mihares de pessoas em todo o mundo. Por essa razão, é considerada um problema de saúde pública, não só pelas repercussões individuais que provoca, mas também pelas consequências graves aos níveis social e económico. Desta forma, este estudo pretende examinar a satisfação dos utentes com o tratamento da dor, determinando os fatores sociodemográficos, clínicos e psicossociais (personalidade e espiritualidade) que influenciam essa mesma satisfação. Trata-se de um estudo transversal, descritivo-correlacional e quantitativo. A amostra utilizada é constituída por 78 participantes, com idades compreendidas entre os 30 anos e os 82 anos, correspondendo a uma média de idades de 64,88 anos. A maioria é casada/vive em união de fato e possui graus de escolaridade baixos (1º ciclo). Para se proceder á recolha de dados foi aplicado um questionário, cuja finalidade era a caraterização clinica e sociodemográfica dos participantes. Foram também usadas as seguintes escalas: Escala de satisfação para o tratamento da dor (PTSS), Escala de espiritualidade e o Inventário da personalidade (NEO-FFI-20). Os resultados demonstram que a maioria da amostra apresenta dor crónica, de origem músculo-esquelética e o tratamento farmacológico constitui o tratamento de eleição. A maioria (91%) dos participantes refere estar satisfeita ou muito satisfeita com o atual tratamento para a sua dor. Contudo, a análise dos dados revelou a existência de diferenças estatisticamente significativas entre a variável satisfação em diferentes dimensões com as seguintes variáveis sociodemográficas: género (p= 0.003, idade (p=0.010) e estado civil (p=0.045); clínicas: período temporal da dor (p= 0.013 e p=0.014), tipo de tratamento (p=0.011), programa de reabilitação (p= 0.003 e p= 0.005), seguimento em consulta da dor (p≤ 0.05 em cinco sub-dimensões da escala de satisfação), psicossociais: a personalidade em todas as dimensões com exceção da dimensão neuroticismo, e por fim a espiritualidade global (p= 0.008) e também na sua dimensão crenças (p=0.010). Palavras- chave: dor, satisfação com o tratamento, personalidade, espiritualidade.

Adesão à terapêutica em doentes diabéticos tipo 2: estudo de caso numa farmácia em Almada

Dissertação de Mestrado, Ciências Farmacêuticas, Faculdade de Ciências e Tecnologia, Universidade do Algarve, 2016

Whole body vibration treatments in postmenopausal women can improve bone mineral density:results of a stimulus focussed meta-analysis

Whole body vibration treatment is a non-pharmacological intervention intended to stimulate muscular response and increase bone mineral density, particularly for postmenopausal women. The literature related to this topic is controversial, heterogeneous, and unclear despite the prospect of a major clinical effect. The aim of this study was to identify and systematically review the literature to assess the effect of whole body vibration treatments on bone mineral density (BMD) in postmenopausal women with a specific focus on the experimental factors that influence the stimulus. Nine studies fulfilled the inclusion criteria, including 527 postmenopausal women and different vibration delivery designs. Cumulative dose, amplitudes and frequency of treatments as well as subject posture during treatment vary widely among studies. Some of the studies included an associated exercise training regime. Both randomized and controlled clinical trials were included. Whole body vibration was shown to produce significant BMD improvements on the hip and spine when compared to no intervention. Conversely, treatment associated with exercise training resulted in negligible outcomes when compared to exercise training or to placebo. Moreover, side-alternating platforms were more effective in improving BMD values than synchronous platforms and mechanical oscillations of magnitude higher than 3 g and/or frequency lower than 25 Hz were also found to be effective. Treatments with a cumulative dose over 1000 minutes in the follow-up period were correlated to positive outcomes. Our conclusion is that whole body vibration treatments in elderly women can reduce BMD decline.However, many factors (e.g. amplitude, frequency and subject posture) affect the capacity of the vibrations to propagate to the target site; the adequate level of stimulation required to produce these effects has not yet been defined. Further biomechanical analyses to predict the propagation of the vibration waves along the body and assess the stimulation levels are required.

Nurses knowledge of health effects of dietary fibre

Introduction: Nurses accompany patients throughout their health care to prevent and treat disease, so their knowledge about diet and dietary fibre is key to successful diet therapy, which is an essential part of a patient's non-pharmacological treatment. It is known from the literature that a high proportion of nurses have limited knowledge about diet therapy and about sources of soluble fibre and other foods that can prevent or treat certain diseases. Given the position of nurses as key providers of dietary guidance, and given the health benefits of dietary fibre, we wanted to assess the level of fibre-related knowledge among nurses in Croatia. Material and Methods: Cross-sectional study based on data collected between October 2014 and March 2015 using a survey developed by the CI&DETS Polytechnic Institute in Viseu, Portugal. The survey contains questions about demographic characteristics as well as about knowledge of sources of dietary fibre, recommended daily intake and effects of fibre intake on particular diseases. The study included a total of 369 nurses from two health institutions and one nursing school from Croatia older than 18 years. Differences in knowledge were assessed for significance using the non-parametric Mann-Whitney U test. Possible associations among variables were explored using Spearman's rank correlation. For all statistical analyses, the threshold of significance was defined as P<0.05. Results: The level of knowledge among nurses in Croatia about dietary fibre varied from «undecided» to «partial knowledge». The median for level of knowledge ranged from 3 to 4 with low variability ranging from 0.11 to 0.33. Average levels of knowledge in percentages varied from 57.6% to 82.1%. Nurses with higher education levels showed significantly higher knowledge levels about the influence of dietary fiber intake on the risk of certain diseases (p = 0.007), constipation (p = 0.016), bowel cancer (p = 0.005) and breast cancer (p = 0.039). Conclusion: The level of nurses’ knowledge about dietary fiber is suboptimal. This indicates the need to strengthen nurse education in the areas of diet and diet therapy. Increase the level of knowledge of nurses about nutrition can positively influence the quality of care.

Evidencia sobre la eficacia de cannabinoides en el dolor neuropático oncológico

Contexto: La eficacia de los cannabinoides en el dolor neuropático es desconocida. El control del dolor es determinante en los pacientes ya que genera un impacto negativo en la calidad de vida de los pacientes. Objetivo: El presente trabajo pretende demostrar la evidencia sobre la eficacia de los medicamentos cannabinoides en el control del dolor neuropático oncológico, mediante la evaluación de la literatura disponible. Metodología: Se realizó una revisión sistemática de literatura incluyendo estudios experimentales, observacionales y revisiones sistemáticas en un periodo de 15 años. Se incluyeron todos los estudios desde el años 2000 con evidencia IB según la escala de evidencia de Oxford. Resultados: Cuatro estudios cumplieron criterios para su inclusión, sin embargo la evidencia es baja y no permite recomendar o descartar los cannabinoides como terapia coadyuvante en control del dolor neuropático oncológico. La combinación de THC/CDB (Sativex®) parece ser un medicamento seguro pues no se reportaron muertes asociadas a su uso, sin embargo la presentación de eventos adversos a nivel gastrointestinal y neurológico podría aumentar el riesgo de interacciones medicamentosas y tener un impacto negativo en la calidad de vida de los pacientes oncológicos. Conclusiones: No hay suficiente literatura y la evidencia no es suficiente para recomendar o descartar el uso de los cannabinoides en dolor neuropático oncológico. Futuros estudios deben realizarse para analizar el beneficio de estos medicamentos. Aunque ética y socialmente hay resistencia para el uso de los cannabinoides, actualmente hay una gran discusión política en el mundo y en Colombia para su aceptación como terapia en el control del dolor.

Efecto del consumo concomitante de inhibidores de bomba protones y levotiroxina : revisión sistemática y metaanálisis

Estudios afirman que la acidez gástrica es importante en la absorción de levotiroxina (LT4) con resultados controversiales sobre la interacción entre inhibidores de bomba de protones (IBP) y LT4. El objetivo del estudio fue establecer el efecto del uso concomitante de LT4 e IBP en los niveles de TSH en pacientes adultos con hipotiroidismo primario. Se realizó una revisión sistemática mediante búsqueda en Medline, Embase, Lilacs, Bireme, Scielo, Cochrane y Universidad de York, Access Pharmacy, Google Scholar, Dialnet y Opengray. La búsqueda no se limito por lenguaje. Se evaluó el efecto en la diferencia de medias de TSH luego del consumo de LT4 y luego del consumo concomitante con IBP. Se hizo un metaanálisis, análisis de subgrupos y análisis de sensibilidad utilizando el programa Review Manager 5.3. Se eligieron 5 artículos para el análisis cualitativo y 3 para el metaanálisis. La calidad de los estudios fue buena y el riesgo de sesgos bajo. La diferencia de medias obtenida fue 0.21 mUI/L (IC95%: 0.02-0.40; p=0.03; I2:0%). En el análisis de subgrupos en pacientes mayores de 55 años la diferencia de medias fue 0.21 mUI/L (IC95%: 0.01-0.40; p=0.27; I2:19%). En el análisis de sensibilidad se excluyo el estudio con mayor muestra y la diferencia de medias fue 0.49 mUI/L (IC95%: -0.12 a 1.11; p=0.12; I2:0%). La diferencia de medias de TSH luego del consumo concomitante no se considera clínicamente significativa pues no representa riesgo para el paciente. Son necesarios estudios clínicos aleatorizados y evaluar el efecto en los niveles de T4 libre.

Strategies for managing osteoarthritis

Background Although there are recommendations for the management of osteoarthritis (OA), little is known about how people with OA actually manage this chronic condition. Purpose The aims of this study were to identify the non-pharmacological and pharmacological therapies most commonly used for the management of hip or knee OA, in a community-based sample of adults, and to compare these with evidence-based recommendations. Methods A questionnaire was mailed to 2200 adult members of Arthritis Queensland living in Brisbane, Australia. It included questions about OA symptoms, management therapies and demographic characteristics. Results Of the 485 participants (192 men, 293 women) with hip or knee OA who completed the questionnaire, most had mild to moderate symptoms. Ninety-six percent of participants (aged 27–95 years) reported using at least one non-pharmacological therapy, and 78% reported using at least one pharmacological therapy. The most common currently used non-pharmacological strategy was range-of-motion exercises (men 52%, women 61%, p=0.05) and the most common frequently used pharmacological strategy was glucosamine/chondroitin (men 51%, women 60%, ns). For the most highly recommended strategies, 65% of men and 54% of women had never attended an information/education course (p=0.04), and fewer than half (46% of women and 42% of men, p=0.03) were frequent users of anti-inflammatory agents. Conclusion The findings suggest that many people with knee or hip OA do not follow the most highly endorsed of the OARSI (Osteoarthritis Research Society International) recommendations for management of OA. Health professionals should be encouraged to recommend evidence-based therapies to their patients.

An evaluation of alternative media for pebble matrix filtration using clay balls and recycled crushed glass

Protecting slow sand filters (SSFs) from high-turbidity waters by pretreatment using pebble matrix filtration (PMF) has previously been studied in the laboratory at University College London, followed by pilot field trials in Papua New Guinea and Serbia. The first full-scale PMF plant was completed at a water-treatment plant in Sri Lanka in 2008, and during its construction, problems were encountered in sourcing the required size of pebbles and sand as filter media. Because sourcing of uniform-sized pebbles may be problematic in many countries, the performance of alternative media has been investigated for the sustainability of the PMF system. Hand-formed clay balls made at a 100-yearold brick factory in the United Kingdom appear to have satisfied the role of pebbles, and a laboratory filter column was operated by using these clay balls together with recycled crushed glass as an alternative to sand media in the PMF. Results showed that in countries where uniform-sized pebbles are difficult to obtain, clay balls are an effective and feasible alternative to natural pebbles. Also, recycled crushed glass performed as well as or better than silica sand as an alternative fine media in the clarification process, although cleaning by drainage was more effective with sand media. In the tested filtration velocity range of ð0:72–1:33Þ m=h and inlet turbidity range of (78–589) NTU, both sand and glass produced above 95% removal efficiencies. The head loss development during clogging was about 30% higher in sand than in glass media.

Update on complex nonpharmacological interventions for breathlessness

Purpose of review: The study provides a review of current evidence about the role of complex nonpharmacological strategies in managing the multidimensional components of the breathlessness experience for individuals with life-limiting conditions. Recent findings: Evidence continues to demonstrate the significant impact of breathlessness on patients’ quality of life, day-to-day activity, and physical and psychosocial functioning. Recent evidence also confirms that patients draw on a number of self-initiated actions to cope with breathlessness, although many do not use strategies that are supported by a growing body of evidence from randomized controlled trials. Current literature supports the use of multicomponent, nonpharmacological interventions comprising strategies to improve breathing efficiency and reducing psychological distress to manage breathlessness. However trials of these approaches have mostly been conducted among patients with chronic obstructive pulmonary disease (COPD) or lung cancer, and few studies have investigated the benefits of nonpharmacological for patients in later stages of disease. Further investigation of interventions is required across a broader range of chronic life-limiting conditions. Addressing breathlessness and its co-occurring symptoms (symptom clusters) is also an area for future enquiry. Summary: The experience of breathlessness and strategies adopted by patients to manage the experience highlight the importance of multidimensional approaches to improve outcomes for patients with life-limiting conditions. There is good evidence to support the role of multicomponent, nonpharmacological interventions in reducing breathlessness for patients with COPD and lung cancer, although further studies are required to understand the particular clinical contexts in which such interventions are appropriate.

Letter : anxiety score as a risk factor for radial artery vasospasm during radial interventions : a pilot study

I read with interest the article in Angiology that determined the role of anxiety level on radial artery spasm during transradial coronary angiography.1 As the importance of conducting more randomised controlled trials using anxiolytics to define the relation between anxiety and vasospasm was noted by the authors, I offer the following insights for investigators to consider when conducting such research. While previous research has already identified that moderate procedural sedation and opioid analgesia reduces the incidence of vasospasm,2 the identification of risk factors in the present study is hypothesis generating as to how outcomes might be even further improved. It is possible that selectively applying either even more intensive sedation and analgesia or complementary non-pharmacological stress-reducing therapies, such as music therapy or visualisation and attentive behaviour, to patients ‘at-risk’ of vasospasm (women and those with high levels of anxiety prior to the procedure) might lead to even better patient outcomes...

Supportive and palliative care for lung cancer patients

Lung cancer patients face poor survival and experience co-occurring chronic physical and psychological symptoms. These symptoms can result in significant burden, impaired physical and social function and poor quality of life. This paper provides a review of evidence based interventions that support best practice supportive and palliative care for patients with lung cancer. Specifically, interventions to manage dyspnoea, one of the most common symptoms experienced by this group, are discussed to illustrate the emerging evidence base in the field. The evidence base for the pharmacological management of dyspnoea report systemic opioids have the best available evidence to support their use. In particular, the evidence strongly supports systemic morphine preferably initiated and continued as a once daily sustained release preparation. Evidence supporting the use of a range of other adjunctive non-pharmacological interventions in managing the symptom is also emerging. Interventions to improve breathing efficiency that have been reported to be effective include pursed lip breathing, diaphragmatic breathing, positioning and pacing techniques. Psychosocial interventions seeking to reduce anxiety and distress can also improve the management of breathlessness although further studies are needed. In addition, evidence reviews have concluded that case management approaches and nurse led follow-up programs are effective in reducing breathlessness and psychological distress, providing a useful model for supporting implementation of evidence based symptom management strategies. Optimal outcomes from supportive and palliative care interventions thus require a multilevel approach, involving interventions at the patient, health professional and health service level.

Watermemories : a swimming club for people with dementia

The purpose of this article is to describe the conceptual model and implementation strategies of an evidence-based, aquatic exercise program specifically targeting individuals with dementia—The Watermemories Swimming Club (WSC). Physical exercise not only improves the functional capacity of people with dementia but also has significant effects on other aspects of quality of life such as sleep, appetite, behavioral and psychological symptoms, depression, and falls. Additionally, exercise can improve a person’s overall sense of well-being and positively enhance their sociability. The WSC was designed to increase physical exercise while being easy to implement, safe, and pleasurable. Many challenges were faced along the way, and we discuss how these were overcome. Implications for nurses are also provided.