Estudo de campo de verificação metrológica de termómetros clínicos timpânicos

Avaliação da variação da temperatura corporal, e a monitorização da mesma é bastante importante na prática clínica sendo, por vezes, a base de muitas decisões clínicas. Atualmente, os termómetros digitais, em particular os timpânicos são amplamente utilizados, em contexto hospitalar e domiciliário. Muitos estudos têm sido efetuados para determinar a validade das medições obtidas através de termómetros timpânicos. Os defensores destes termómetros afirmam que, se forem utilizados de forma adequada e periodicamente calibrados, a avaliação da temperatura corporal com este tipo de termómetros é eficaz, cómoda, rápida, pouco invasiva emais higiénica reduzindo o número de infeções cruzadas (FarnellMaxwell &Tan, Rhodes& Philips, 2005). A Metrologia como a ciência das medições e suas aplicações ((VIM1: 2.2) (INSTITUTO PORTUGUÊS DA QUALIDADE, 2012)), abrange todos os aspetos teóricos e práticos que asseguram a exatidão e precisão exigida num processo, procurando garantir a qualidade de produtos e serviços através da calibração de instrumentos de medição e da realização de ensaios, sendo a base fundamental para a competitividade das empresas. Só após o ano 1990, com a publicação dos resultados doHarvardMedical Practice Study (T A BRENNAN, 2004), sobre adventos adversos na área da saúde, começaram a surgir preocupação com o risco do uso de equipamentos e instrumentos sem a adequada avaliação metrológica. Neste estudo concluiu-se que 3,7 % dos pacientes hospitalizados sofriam eventos adversos devido ao uso inadequado de equipamento médico, sendo que 13,6% destes eram mortais. Pegando nesta realidade e sabendo que o não controlo de Equipamento de Monitorização e Medição é uma das causas de obtenção de 36%de não conformidades - 7.6 (NP EN ISO 9001:2008), em Auditorias da Qualidade em Serviços de Saúde (Luís Marinho – Centro Hospitalar São João), fez todo o sentido o estudo e trabalho desenvolvido. Foi efetuado um estudo, no que se refere a normalização em vigor e verificou-se que a nível metrológico muito trabalho terá que ser realizado no serviço nacional de saúde por forma este fornecer o suporte material fiável ao sistema de medições, essencial aos mais diversos sectores da saúde. Sabendo-se que os ensaios/calibrações são necessários e não são negligenciáveis na estrutura de custos das instituições de saúde, e por isso são vistas como mais uma fonte de despesas, é intenção com a realização deste trabalho, contribuir em parte para superação deste tema. Este trabalho passou pela execução/realização de um procedimento de calibração para termómetros timpânicos, tendo a necessidade de desenvolver/projetar um corpo negro. A amostra em estudo é constituída por cinco termómetros timpânicos hospitalares em uso dos diferentes serviços do CHSJ2, seleccionados completamente ao acaso. Um termómetro clínico no mínimo terá que ser calibrado a temperatura 35 ºC e 42 ºC. A calibração deverá ser realizada anualmente e por entidade acreditada. O erro máximo admissível é de ± 0,2 ºC (nas condições ambientais de funcionamento). Sem a confirmação metrológica, não é possível garantir a qualidade do produto ou serviço. A Metrologia na área da saúde desperta a exigência por produtos e serviços de qualidade. Esta tencionará ser encarada como um pilar de sustentabilidade para a qualidade na saúde, sendo absolutamente necessária a implementação de novos procedimentos e atitudes.

Safety and occlusion rates of surgical treatment of unruptured intracranial aneurysms: a systematic review and meta-analysis of the literature from 1990 to 2011.

BACKGROUND AND PURPOSE: Surgical clipping of unruptured intracranial aneurysms (UIAs) has recently been challenged by the emergence of endovascular treatment. We performed an updated systematic review and meta-analysis on the surgical treatment of UIAs, in an attempt to determine the aneurysm occlusion rates and safety of surgery in the modern era. METHODS: A detailed protocol was developed prior to conducting the review according to the Cochrane Collaboration guidelines. Electronic databases spanning January 1990-April 2011 were searched, complemented by hand searching. Heterogeneity was assessed using I(2), and publication bias with funnel plots. Surgical mortality and morbidity were analysed with weighted random effect models. RESULTS: 60 studies with 9845 patients harbouring 10 845 aneurysms were included. Mortality occurred in 157 patients (1.7%; 99% CI 0.9% to 3.0%; I(2)=82%). Unfavourable outcomes, including death, occurred in 692 patients (6.7%; 99% CI 4.9% to 9.0%; I(2)=85%). Morbidity rates were significantly greater in higher quality studies, and with large or posterior circulation aneurysms. Reported morbidity rates decreased over time. Studies were generally of poor quality; funnel plots showed heterogeneous results and publication bias, and data on aneurysm occlusion rates were scant. CONCLUSIONS: In studies published between 1990 and 2011, clipping of UIAs was associated with 1.7% mortality and 6.7% overall morbidity. The reputed durability of clipping has not been rigorously documented. Due to the quality of the included studies, the available literature cannot properly guide clinical decisions.

Concordance entre les interventions de l’infirmière et de médecins spécialistes dans la prise en charge des fractures de fragilisation

Introduction. L’ostéoporose est une maladie chronique habituellement asymptomatique jusqu’à ce qu’il y ait fracture de fragilisation (FF). Ces fractures engendrent des coûts importants dont une partie pourrait être évitée par la prise en charge de ces patients pour l’ostéoporose. L’implantation d’un programme de prévention des fractures subséquentes géré par des infirmières en orthopédie pourrait permettre de parer à ces problèmes. Objectifs. L’objectif principal de ce projet était de déterminer si une infirmière peut gérer de façon efficace et sécuritaire un service de liaison pour fracture. Méthode. Les décisions cliniques d’infirmières entre 2010 et 2012 pour 525 patients d’un service de liaison pour fracture à l’étude ont été évaluées par deux médecins spécialistes indépendants avec expertise dans les soins pour l’ostéoporose. Résultats. Les infirmières ont pu identifier la totalité des sujets à risque et référer 26.7% de ceux-ci à un spécialiste. L’accord entre chacun des évaluateurs et les infirmières était de >97%. Les évaluateurs ont donné les mêmes réponses à >96% pour chaque type de décision et le niveau d’accord inter-juge était presque parfait (AC1 >0.960). Aucune référence n’a été jugée inutile. Les comorbidités majeures ont toutes été prises en charge. Conclusion. L’accord élevé entre les décisions cliniques des infirmières et des médecins évaluateurs démontre que la prise en charge par une infirmière est sécuritaire et recommandable pour les patients avec FF. Ce type d’intervention pourrait contribuer à résoudre les problèmes d’accessibilité aux soins chez les patients avec fragilité osseuse, ainsi qu’à diminuer le fardeau économique que représente le traitement des FF pour la société.

La bioéthique et les conflits armés : la réflexion éthique des médecins militaires

Le but de la recherche est d’étudier les tensions éthiques que peuvent vivre les médecins militaires, qui doivent agir à la fois comme soignants, militaires (même s’ils sont non combattants) et parfois comme acteurs humanitaires. Parmi la littérature sur l’éthique de la médecine militaire, les dilemmes la concernant sont souvent présentés comme le fruit de pressions réelles ou perçues provenant de l’institution militaire, des règles, codes, lois ou de politiques, ceci afin de détourner le médecin de son but premier, soit l’intérêt du patient. Pour mieux comprendre les défis éthiques auxquels sont confrontés les médecins militaires canadiens et comment ceux-ci les traitent, la recherche utilise une approche de bioéthique empirique. À partir d’une analyse de la littérature, nous examinons les dilemmes éthiques des médecins militaires, le concept de profession, ainsi que les codes d’éthique (médicaux et militaires) canadiens. L’expérience éthique est ensuite explorée à partir d’entrevues semi-directives effectuées auprès de quatorze médecins militaires ayant participé à des missions opérationnelles, notamment à Kandahar en Afghanistan, entre 2006 et 2010. Les résultats, tant conceptuels qu’empiriques, nous indiquent que plusieurs nuances s’imposent. Tout d’abord, les médecins militaires canadiens ne vivent pas les dilemmes tels qu’ils sont présentés dans la littérature, ni en nombre ni en fréquence. Ils sont conscients qu’ils doivent à la fois tenir compte de l’intérêt du patient et du bien commun, mais n’en ressentent pas pour autant un sentiment de double loyauté professionnelle. De plus, ils ont l’impression de partager l’objectif de la mission qui est de maintenir la force de combat. Des distinctions s’imposent aussi entre les médecins eux-mêmes, dans la conception qu’ils se font de leur profession, ainsi que dans les contextes (opération ou garnison), selon le type de travail qu’ils exercent (généraliste ou spécialiste). Les principaux défis éthiques rapportés portent sur les inégalités de soins entre les soldats de la coalition et les victimes locales (soldats et civils), ainsi que sur le manque de ressources, engendrant des décisions cliniques éprouvantes. Un résultat étonnant des entrevues est la présence de deux groupes distincts au plan de l’identification professionnelle. Huit médecins militaires se considèrent avant tout comme médecin, alors que les six autres ne sont pas arrivés à accorder une priorité à l’une ou l’autre des professions. Ces deux groupes se différencient également sur d’autres plans, comme le nombre et le type de défis éthiques identifiés, ainsi que les mécanismes de résolution des dilemmes utilisés. Malgré les formations éthiques offertes par l’institution, des lacunes subsistent dans la capacité d’identification des expériences éthiques et des valeurs impliquées, de même que des mécanismes de résolution utilisés. Compte tenu du faible échantillonnage, ces résultats sont difficilement généralisables. Néanmoins, ils peuvent nous inspirer au niveau théorique en faisant ressortir le caractère multidimensionnel de la médecine militaire, ainsi qu’au niveau pratique en nous permettant de suggérer des éléments de formation facilitant la réflexion éthique des médecins militaires.

Costos asociados al soporte nutricional enteral en la unidad de cuidados intensivos, revisión de literatura

Objetivo:Describir los costos asociados al soporte nutricional enteral en pacientes adultos hospitalizados en Unidades de Cuidados Intensivos (UCI), Metodología: La elaboración de este documento se realizó en una búsqueda exhaustiva de acuerdo a las especificaciones y recomendaciones de la revisión de literatura, en MEDLINE, PUBMED, SCIENCE DIRECT, EBSCO por considerarse como bases de datos reconocidas por contener artículos de mayor fiabilidad y más usadas en el ámbito académico. Se evidencio en los 70 artículosel cumplimiento de los criterios de inclusión, enel cual se realizó un análisis de costos en el manejo del soporte nutricional enteral y se identificó la importancia del manejo de la nutrición en pacientes adultos del servicio de UCI. Resultados: De tal manera la importancia del soporte nutricional enteral, en su proceso precoz se identifica la reducción de costos y de recursos que se puede manejar ante el paciente crítico. Dentro de este marco se resalta que el soporte nutricional enteral debe ser la primera opción en paciente. Conclusión:La nutrición enteral considerada un modelo de innovación al soporte nutricional en las últimas décadas, ha evolucionado contribuyendo una adecuada alternativa de intervención y sin efectos adversos clínicos relevantes, que además mejoran la calidad de vida y contribuyen a la toma de decisiones clínicas basadas en la evidencia y en los análisis de costes con el uso racional de los recursos, así mismo, es una práctica costo- efectiva,con componente de costo- beneficio para el usuario al mejorar calidad de vida, obteniendo mayores beneficios a un menor costo.

Haematological and biochemical reference intervals for farmed channel catfish

The reference intervals for biochemical variables and red blood cell indices of healthy intensively bred channel catfish Ictalurus punctatus were determined. The blood variables were determined using standardized clinical methods. The reference intervals (25th and 75th percentiles) were established using a non-parametric method. Reference intervals for plasma glucose, serum total protein, sodium, potassium, calcium, magnesium, chloride concentration, primary and secondary red blood cell indices were established. The haematological and biochemical reference intervals established may allow important clinical decisions about channel catfish. (c) 2007 the Authors Journal compilation (C) 2007 the Fisheries Society of the British Isles.

Comparison of Two Methodologies for CD4+T Lymphocytes Relative Counting on Immune Monitoring of Patients with Human Immunodeficiency Virus

Considering that counting the percentage of CD4 T lymphocytes can add prognostic information regarding patients infected with HIV, the aim of this study was to evaluate the percentage values of CD4+ T lymphocytes from 81 patients determined by flow cytometry and estimated by flow cytometry in conjunction with a hematology counter. Means were compared through the Student's t-test. Pearson's correlation was determined, and the agreement between results was tested by Bland-Altman. The level of significance was P < 0.05. It was found a significantly higher mean difference between the relative values of CD4+ T lymphocytes to the hematologic counter (P < 0.05), for all strata studied. Positive and significant correlations (P < 0.01) were found between the strata CD4 < 200 cells/mL (r = 0.93), between 200 and 500 cells/mL (r = 0.65), and >500 cells/mL (r = 0.81). The limits of agreement were 1.0 +/- 3.8% for the stratum of CD4 < 200 cells/mL, approximately 2.2 +/- 13.5% for the stratum of CD4 between 200 and 500 cells/mL, and approximately 6.2 +/- 20.4% for the stratum > 500 cells/mL. The differences in the percentages of CD4+ T lymphocytes obtained by different methodologies could lead to conflict when used in clinical decisions related to the treatment and care of people infected with HIV.

Mapeamento das revistas científicas de medicina disponíveis no Portal de Periódicos da Capes que publicam revisões sistemáticas

Pós-graduação em Bases Gerais da Cirurgia - FMB

Mapeamento das evidências do grupo de odontologia da Colaboração Cochrane pra condutas em saúde

Pós-graduação em Bases Gerais da Cirurgia - FMB

Odontologia baseada em evidências: otimizando a prática e a pesquisa

Clinical decisions in dentistry are often based on the knowledge obtained during graduation, clinical experience, information shared with colleagues and professor, textbooks, seminars, conferences and continuing education courses. However, it is necessary to know if this information is derived from scientifically validated researches since too much information may complicate this process. Initially in medicine and later in other health areas a method which enables a critical evaluation of scientific papers related to a specific issue and also, whenever it is possible, an evaluation of the results by meta-analysis,was developed by Cochrane in order to reduce the bias towards all information obtained. The aim of this work is to present some aspects of the Evidence Based Dentistry (EBD) and to show how this methodology can be used to better substantiate scientifically the clinical decision of the dentist and improve researches design with scientific validity. The paper discusses editorial trends focused on the EBD, shows the differences between a systematic and a conventional review, describes data about Cochrane and the advantages of scientific evidence synthesis and the implications of EBD for clinical practice and research as well as recommendation grades and evidence levels of general scientific studies.

Recomendações para prevenção clínica: aspectos relevantes em idosos

The American Academy of Family Physicians (AAFP) released a summary of the “Recommendations for Clinical Preventive Services”. It is a publication based on “Recommendations for Clinical Preventive Services” published by the United States Preventive Services Task Force (USPSTF). These recommendations are provided only as an aid to physicians in making clinical decisions about the care of their patients. They reflect the clinic references existing at the time of publication. But its only should be used with the clear understanding that continued research may result in new knowledge and consequently there is a need for updates. Some recommendations of the USPSTF are important in clinical practice with the elderly.

Assessment of depression in medical patients: a systematic review of the utility of the beck depression inventory-II

To perform a systematic review of the utility of the Beck Depression Inventory for detecting depression in medical settings, this article focuses on the revised version of the scale (Beck Depression Inventory-II), which was reformulated according to the DSM-IV criteria for major depression. We examined relevant investigations with the Beck Depression Inventory-II for measuring depression in medical settings to provide guidelines for practicing clinicians. Considering the inclusion and exclusion criteria seventy articles were retained. Validation studies of the Beck Depression Inventory-II, in both primary care and hospital settings, were found for clinics of cardiology, neurology, obstetrics, brain injury, nephrology, chronic pain, chronic fatigue, oncology, and infectious disease. The Beck Depression Inventory-II showed high reliability and good correlation with measures of depression and anxiety. Its threshold for detecting depression varied according to the type of patients, suggesting the need for adjusted cut-off points. The somatic and cognitive-affective dimension described the latent structure of the instrument. The Beck Depression Inventory-II can be easily adapted in most clinical conditions for detecting major depression and recommending an appropriate intervention. Although this scale represents a sound path for detecting depression in patients with medical conditions, the clinician should seek evidence for how to interpret the score before using the Beck Depression Inventory-II to make clinical decisions

Development of original analytical methods for the therapeutic drug monitoring of CNS druges: Antipsychotics, Antidepressants and Anxiolytics-hypnotics

Great strides have been made in the last few years in the pharmacological treatment of neuropsychiatric disorders, with the introduction into the therapy of several new and more efficient agents, which have improved the quality of life of many patients. Despite these advances, a large percentage of patients is still considered “non-responder” to the therapy, not drawing any benefits from it. Moreover, these patients have a peculiar therapeutic profile, due to the very frequent application of polypharmacy, attempting to obtain satisfactory remission of the multiple aspects of psychiatric syndromes. Therapy is heavily individualised and switching from one therapeutic agent to another is quite frequent. One of the main problems of this situation is the possibility of unwanted or unexpected pharmacological interactions, which can occur both during polypharmacy and during switching. Simultaneous administration of psychiatric drugs can easily lead to interactions if one of the administered compounds influences the metabolism of the others. Impaired CYP450 function due to inhibition of the enzyme is frequent. Other metabolic pathways, such as glucuronidation, can also be influenced. The Therapeutic Drug Monitoring (TDM) of psychotropic drugs is an important tool for treatment personalisation and optimisation. It deals with the determination of parent drugs and metabolites plasma levels, in order to monitor them over time and to compare these findings with clinical data. This allows establishing chemical-clinical correlations (such as those between administered dose and therapeutic and side effects), which are essential to obtain the maximum therapeutic efficacy, while minimising side and toxic effects. It is evident the importance of developing sensitive and selective analytical methods for the determination of the administered drugs and their main metabolites, in order to obtain reliable data that can correctly support clinical decisions. During the three years of Ph.D. program, some analytical methods based on HPLC have been developed, validated and successfully applied to the TDM of psychiatric patients undergoing treatment with drugs belonging to following classes: antipsychotics, antidepressants and anxiolytic-hypnotics. The biological matrices which have been processed were: blood, plasma, serum, saliva, urine, hair and rat brain. Among antipsychotics, both atypical and classical agents have been considered, such as haloperidol, chlorpromazine, clotiapine, loxapine, risperidone (and 9-hydroxyrisperidone), clozapine (as well as N-desmethylclozapine and clozapine N-oxide) and quetiapine. While the need for an accurate TDM of schizophrenic patients is being increasingly recognized by psychiatrists, only in the last few years the same attention is being paid to the TDM of depressed patients. This is leading to the acknowledgment that depression pharmacotherapy can greatly benefit from the accurate application of TDM. For this reason, the research activity has also been focused on first and second-generation antidepressant agents, like triciclic antidepressants, trazodone and m-chlorophenylpiperazine (m-cpp), paroxetine and its three main metabolites, venlafaxine and its active metabolite, and the most recent antidepressant introduced into the market, duloxetine. Among anxiolytics-hypnotics, benzodiazepines are very often involved in the pharmacotherapy of depression for the relief of anxious components; for this reason, it is useful to monitor these drugs, especially in cases of polypharmacy. The results obtained during these three years of Ph.D. program are reliable and the developed HPLC methods are suitable for the qualitative and quantitative determination of CNS drugs in biological fluids for TDM purposes.

Technical innovations for the diagnosis and the rehabilitation of motor and perceptive impairments of the child with Cerebral Palsy

The treatment of the Cerebral Palsy (CP) is considered as the “core problem” for the whole field of the pediatric rehabilitation. The reason why this pathology has such a primary role, can be ascribed to two main aspects. First of all CP is the form of disability most frequent in childhood (one new case per 500 birth alive, (1)), secondarily the functional recovery of the “spastic” child is, historically, the clinical field in which the majority of the therapeutic methods and techniques (physiotherapy, orthotic, pharmacologic, orthopedic-surgical, neurosurgical) were first applied and tested. The currently accepted definition of CP – Group of disorders of the development of movement and posture causing activity limitation (2) – is the result of a recent update by the World Health Organization to the language of the International Classification of Functioning Disability and Health, from the original proposal of Ingram – A persistent but not unchangeable disorder of posture and movement – dated 1955 (3). This definition considers CP as a permanent ailment, i.e. a “fixed” condition, that however can be modified both functionally and structurally by means of child spontaneous evolution and treatments carried out during childhood. The lesion that causes the palsy, happens in a structurally immature brain in the pre-, peri- or post-birth period (but only during the firsts months of life). The most frequent causes of CP are: prematurity, insufficient cerebral perfusion, arterial haemorrhage, venous infarction, hypoxia caused by various origin (for example from the ingestion of amniotic liquid), malnutrition, infection and maternal or fetal poisoning. In addition to these causes, traumas and malformations have to be included. The lesion, whether focused or spread over the nervous system, impairs the whole functioning of the Central Nervous System (CNS). As a consequence, they affect the construction of the adaptive functions (4), first of all posture control, locomotion and manipulation. The palsy itself does not vary over time, however it assumes an unavoidable “evolutionary” feature when during growth the child is requested to meet new and different needs through the construction of new and different functions. It is essential to consider that clinically CP is not only a direct expression of structural impairment, that is of etiology, pathogenesis and lesion timing, but it is mainly the manifestation of the path followed by the CNS to “re”-construct the adaptive functions “despite” the presence of the damage. “Palsy” is “the form of the function that is implemented by an individual whose CNS has been damaged in order to satisfy the demands coming from the environment” (4). Therefore it is only possible to establish general relations between lesion site, nature and size, and palsy and recovery processes. It is quite common to observe that children with very similar neuroimaging can have very different clinical manifestations of CP and, on the other hand, children with very similar motor behaviors can have completely different lesion histories. A very clear example of this is represented by hemiplegic forms, which show bilateral hemispheric lesions in a high percentage of cases. The first section of this thesis is aimed at guiding the interpretation of CP. First of all the issue of the detection of the palsy is treated from historical viewpoint. Consequently, an extended analysis of the current definition of CP, as internationally accepted, is provided. The definition is then outlined in terms of a space dimension and then of a time dimension, hence it is highlighted where this definition is unacceptably lacking. The last part of the first section further stresses the importance of shifting from the traditional concept of CP as a palsy of development (defect analysis) towards the notion of development of palsy, i.e., as the product of the relationship that the individual however tries to dynamically build with the surrounding environment (resource semeiotics) starting and growing from a different availability of resources, needs, dreams, rights and duties (4). In the scientific and clinic community no common classification system of CP has so far been universally accepted. Besides, no standard operative method or technique have been acknowledged to effectively assess the different disabilities and impairments exhibited by children with CP. CP is still “an artificial concept, comprising several causes and clinical syndromes that have been grouped together for a convenience of management” (5). The lack of standard and common protocols able to effectively diagnose the palsy, and as a consequence to establish specific treatments and prognosis, is mainly because of the difficulty to elevate this field to a level based on scientific evidence. A solution aimed at overcoming the current incomplete treatment of CP children is represented by the clinical systematic adoption of objective tools able to measure motor defects and movement impairments. A widespread application of reliable instruments and techniques able to objectively evaluate both the form of the palsy (diagnosis) and the efficacy of the treatments provided (prognosis), constitutes a valuable method able to validate care protocols, establish the efficacy of classification systems and assess the validity of definitions. Since the ‘80s, instruments specifically oriented to the analysis of the human movement have been advantageously designed and applied in the context of CP with the aim of measuring motor deficits and, especially, gait deviations. The gait analysis (GA) technique has been increasingly used over the years to assess, analyze, classify, and support the process of clinical decisions making, allowing for a complete investigation of gait with an increased temporal and spatial resolution. GA has provided a basis for improving the outcome of surgical and nonsurgical treatments and for introducing a new modus operandi in the identification of defects and functional adaptations to the musculoskeletal disorders. Historically, the first laboratories set up for gait analysis developed their own protocol (set of procedures for data collection and for data reduction) independently, according to performances of the technologies available at that time. In particular, the stereophotogrammetric systems mainly based on optoelectronic technology, soon became a gold-standard for motion analysis. They have been successfully applied especially for scientific purposes. Nowadays the optoelectronic systems have significantly improved their performances in term of spatial and temporal resolution, however many laboratories continue to use the protocols designed on the technology available in the ‘70s and now out-of-date. Furthermore, these protocols are not coherent both for the biomechanical models and for the adopted collection procedures. In spite of these differences, GA data are shared, exchanged and interpreted irrespectively to the adopted protocol without a full awareness to what extent these protocols are compatible and comparable with each other. Following the extraordinary advances in computer science and electronics, new systems for GA no longer based on optoelectronic technology, are now becoming available. They are the Inertial and Magnetic Measurement Systems (IMMSs), based on miniature MEMS (Microelectromechanical systems) inertial sensor technology. These systems are cost effective, wearable and fully portable motion analysis systems, these features gives IMMSs the potential to be used both outside specialized laboratories and to consecutive collect series of tens of gait cycles. The recognition and selection of the most representative gait cycle is then easier and more reliable especially in CP children, considering their relevant gait cycle variability. The second section of this thesis is focused on GA. In particular, it is firstly aimed at examining the differences among five most representative GA protocols in order to assess the state of the art with respect to the inter-protocol variability. The design of a new protocol is then proposed and presented with the aim of achieving gait analysis on CP children by means of IMMS. The protocol, named ‘Outwalk’, contains original and innovative solutions oriented at obtaining joint kinematic with calibration procedures extremely comfortable for the patients. The results of a first in-vivo validation of Outwalk on healthy subjects are then provided. In particular, this study was carried out by comparing Outwalk used in combination with an IMMS with respect to a reference protocol and an optoelectronic system. In order to set a more accurate and precise comparison of the systems and the protocols, ad hoc methods were designed and an original formulation of the statistical parameter coefficient of multiple correlation was developed and effectively applied. On the basis of the experimental design proposed for the validation on healthy subjects, a first assessment of Outwalk, together with an IMMS, was also carried out on CP children. The third section of this thesis is dedicated to the treatment of walking in CP children. Commonly prescribed treatments in addressing gait abnormalities in CP children include physical therapy, surgery (orthopedic and rhizotomy), and orthoses. The orthotic approach is conservative, being reversible, and widespread in many therapeutic regimes. Orthoses are used to improve the gait of children with CP, by preventing deformities, controlling joint position, and offering an effective lever for the ankle joint. Orthoses are prescribed for the additional aims of increasing walking speed, improving stability, preventing stumbling, and decreasing muscular fatigue. The ankle-foot orthosis (AFO), with a rigid ankle, are primarily designed to prevent equinus and other foot deformities with a positive effect also on more proximal joints. However, AFOs prevent the natural excursion of the tibio-tarsic joint during the second rocker, hence hampering the natural leaning progression of the whole body under the effect of the inertia (6). A new modular (submalleolar) astragalus-calcanear orthosis, named OMAC, has recently been proposed with the intention of substituting the prescription of AFOs in those CP children exhibiting a flat and valgus-pronated foot. The aim of this section is thus to present the mechanical and technical features of the OMAC by means of an accurate description of the device. In particular, the integral document of the deposited Italian patent, is provided. A preliminary validation of OMAC with respect to AFO is also reported as resulted from an experimental campaign on diplegic CP children, during a three month period, aimed at quantitatively assessing the benefit provided by the two orthoses on walking and at qualitatively evaluating the changes in the quality of life and motor abilities. As already stated, CP is universally considered as a persistent but not unchangeable disorder of posture and movement. Conversely to this definition, some clinicians (4) have recently pointed out that movement disorders may be primarily caused by the presence of perceptive disorders, where perception is not merely the acquisition of sensory information, but an active process aimed at guiding the execution of movements through the integration of sensory information properly representing the state of one’s body and of the environment. Children with perceptive impairments show an overall fear of moving and the onset of strongly unnatural walking schemes directly caused by the presence of perceptive system disorders. The fourth section of the thesis thus deals with accurately defining the perceptive impairment exhibited by diplegic CP children. A detailed description of the clinical signs revealing the presence of the perceptive impairment, and a classification scheme of the clinical aspects of perceptual disorders is provided. In the end, a functional reaching test is proposed as an instrumental test able to disclosure the perceptive impairment. References 1. Prevalence and characteristics of children with cerebral palsy in Europe. Dev Med Child Neurol. 2002 Set;44(9):633-640. 2. Bax M, Goldstein M, Rosenbaum P, Leviton A, Paneth N, Dan B, et al. Proposed definition and classification of cerebral palsy, April 2005. Dev Med Child Neurol. 2005 Ago;47(8):571-576. 3. Ingram TT. A study of cerebral palsy in the childhood population of Edinburgh. Arch. Dis. Child. 1955 Apr;30(150):85-98. 4. Ferrari A, Cioni G. The spastic forms of cerebral palsy : a guide to the assessment of adaptive functions. Milan: Springer; 2009. 5. Olney SJ, Wright MJ. Cerebral Palsy. Campbell S et al. Physical Therapy for Children. 2nd Ed. Philadelphia: Saunders. 2000;:533-570. 6. Desloovere K, Molenaers G, Van Gestel L, Huenaerts C, Van Campenhout A, Callewaert B, et al. How can push-off be preserved during use of an ankle foot orthosis in children with hemiplegia? A prospective controlled study. Gait Posture. 2006 Ott;24(2):142-151.

Reporting completeness of abstracts of systematic reviews published in leading dental specialty journals

The aim of this study was to investigate the reporting completeness of systematic review (SR) abstracts in leading dental specialty journals. Electronic and supplementary hand searching were undertaken to identify SRs published in seven dental specialty journals and in the Cochrane Database of Systematic Reviews. Abstract reporting completeness was evaluated using a checklist derived from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (prisma) guidelines. Descriptive statistics followed by univariate and multivariate analyses were conducted. Two-hundred and eighteen SR abstracts were identified. Reporting of interventions (94%), objectives (96%), data sources (81%), eligibility criteria (77%), and conclusions (97%) was adequate in the majority of reviews. However, inadequate reporting of participants (18%), results (42%), effect size (14%), level of significance (60%), and trial registration (100%) was commonplace. The mean overall reporting score was 79.1% (95% CI, 77.6-80.6). Only journal of publication was a significant predictor of overall reporting, with inferior results for all journals relative to Cochrane reviews, with scores ranging from -4.3% (95% CI, -8.74 to 0.08) to -35.6% (95% CI, -42.0 to -24.3) for the International Journal of Prosthodontics and the British Journal of Oral and Maxillofacial Surgery, respectively. Improved reporting of dental SR abstracts is needed and should be encouraged, as these abstracts may underpin influential clinical decisions.