Diagnosis and management of hyponatraemia: AGREEing the guidelines

Hyponatraemia is a common electrolyte disorder associated with significant complications and controversies regarding its optimal management. Clinical practice guidelines and consensus statements have attempted to provide clinicians with evidence-based diagnostic and treatment strategies for hyponatraemia. Recently published guidance documents differ in their methods employed to review the quality of available evidence. Nagler et al. used the Appraisal of Guideline for Research and Evaluation (AGREE II) instrument in a systematic review of guidelines and consensus statements for the diagnosis and management of hyponatraemia. Nagler and colleagues highlighted the variability in methodological rigour applied to guideline development and inconsistencies between publications in relation to management of hyponatraemia (including the recommended rate of correction of a low serum sodium concentration). These differences could cause confusion for practising physicians managing patients with hyponatraemia.

Common causes and current guidelines

Chronic cough is a common and disabling symptom. Recent guidelines have attempted to provide direction in the clinical management of cough in both primary and secondary care. They have also provided a critical review of the available literature and identified gaps in current knowledge. Despite this they have been criticized for a reliance on a low quality evidence base. In this review, we summarize the current consensus on the clinical management of chronic cough and attempt to rationalize this based on recent evidence. We have also provided an overview of the likely pathophysiological mechanisms responsible for cough and highlighted areas, where knowledge deficits exist and suggest directions for future research. Such progress will be critical in the search for new and effective treatments for cough.

Design guidelines for developing customised serious games for parkinson's disease rehabilitation using bespoke game sensors

The research presented in this paper proposes a set of design guidelines in the context of a Parkinson's Disease (PD) rehabilitation design framework for the development of serious games for the physical therapy of people with PD. The game design guidelines provided in the paper are informed by the study of the literature review and lessons learned from the pilot testing of serious games designed to suit the requirements of rehabilitation of patients with Parkinson's Disease. The proposed PD rehabilitation design framework employed for the games pilot testing utilises a low-cost, customized and off-the-shelf motion capture system (employing commercial game controllers) developed to cater for the unique requirement of the physical therapy of people with PD. Although design guidelines have been proposed before for the design of serious games in health, this is the first research paper to present guidelines for the design of serious games specifically for PD motor rehabilitation.

Rules and Stereoelectronic Guidelines for the Anionic Nucleophilic Displacement of Furanoside and Furanose O-sulfonates

Rules for predicting anionic S_N2 displacement viability in furanose and furanoside sulfonates are presented

Medical consensus, guidelines, and position papers: A policy for the ECFS

The terms consensus, guideline and position paper are sometimes employed as if they were interchangeable, but the purpose of such documents and the robustness of advice vary as the evidence base does not have the same depth in each. The Board of the European Cystic Fibrosis Society deemed it to be helpful to provide a short commentary on the definition of these terms, on their interconnections and on how ECFS considers them in documents endorsed by the society.

Practical guidelines: Lung transplantation in patients with cystic fibrosis

There are no European recommendations on issues specifically related to lung transplantation (LTX) in cystic fibrosis (CF). The main goal of this paper is to provide CF care team members with clinically relevant CF-specific information on all aspects of LTX, highlighting areas of consensus and controversy throughout Europe. Bilateral lung transplantation has been shown to be an important therapeutic option for end-stage CF pulmonary disease. Transplant function and patient survival after transplantation are better than in most other indications for this procedure. Attention though has to be paid to pretransplant morbidity, time for referral, evaluation, indication, and contraindication in children and in adults. This review makes extensive use of specific evidence in the field of lung transplantation in CF patients and addresses all issues of practical importance. The requirements of pre-, peri-, and postoperative management are discussed in detail including bridging to transplant and postoperative complications, immune suppression, chronic allograft dysfunction, infection, and malignancies being the most important. Among the contributors to this guiding information are 19 members of the ECORN-CF project and other experts. The document is endorsed by the European Cystic Fibrosis Society and sponsored by the Christiane Herzog Foundation. 

WHO guidelines for a healthy diet and mortality from cardiovascular disease in European and American elderly: the CHANCES project

BACKGROUND: Cardiovascular disease (CVD) represents a leading cause of mortality worldwide, especially in the elderly. Lowering the number of CVD deaths requires preventive strategies targeted on the elderly.

OBJECTIVE: The objective was to generate evidence on the association between WHO dietary recommendations and mortality from CVD, coronary artery disease (CAD), and stroke in the elderly aged ≥60 y.

DESIGN: We analyzed data from 10 prospective cohort studies from Europe and the United States comprising a total sample of 281,874 men and women free from chronic diseases at baseline. Components of the Healthy Diet Indicator (HDI) included saturated fatty acids, polyunsaturated fatty acids, mono- and disaccharides, protein, cholesterol, dietary fiber, and fruit and vegetables. Cohort-specific HRs adjusted for sex, education, smoking, physical activity, and energy and alcohol intakes were pooled by using a random-effects model.

RESULTS: During 3,322,768 person-years of follow-up, 12,492 people died of CVD. An increase of 10 HDI points (complete adherence to an additional WHO guideline) was, on average, not associated with CVD mortality (HR: 0.94; 95% CI: 0.86, 1.03), CAD mortality (HR: 0.99; 95% CI: 0.85, 1.14), or stroke mortality (HR: 0.95; 95% CI: 0.88, 1.03). However, after stratification of the data by geographic region, adherence to the HDI was associated with reduced CVD mortality in the southern European cohorts (HR: 0.87; 95% CI: 0.79, 0.96; I(2) = 0%) and in the US cohort (HR: 0.85; 95% CI: 0.83, 0.87; I(2) = not applicable).

CONCLUSION: Overall, greater adherence to the WHO dietary guidelines was not significantly associated with CVD mortality, but the results varied across regions. Clear inverse associations were observed in elderly populations in southern Europe and the United States.

Practice guidelines in clinical psychology: An uncertain future for a clinical profession

Practice guidelines have long been surrounded by controversy. Despite an almost instinctive outcry against these protocols among many clinicians, current versions provide therapists with considerable freedom in their practice. This paper examines the utility and possible negative evolution of such guidelines.

Design para o futuro: o indivíduo entre o artifício e a natureza

O presente trabalho tem como objectivo contribuir para o aprofundamento de estudos vocacionados para a evolução do mundo material enquanto factor determinante para o futuro do Planeta, do Homem e dos seus artifícios. Sendo o tema central da investigação o Design Industrial enquanto mediador incontornável dessa relação, os conceitos de Design Biónico, de Design Natural, de Biodesign e de Design Simbiótico, assim como as metodologias a si inerentes, assumem-se como protagonistas do estudo desenvolvido. A tese é composta por um primeiro capítulo introdutório onde se define o seu objecto de estudo e se apresentam as linhas condutoras da investigação. O segundo capítulo é dedicado ao enquadramento teórico dos temas a abordar, nomeadamente o conceito de “artifício” considerando os seus tradicionais e novos significados e aplicações e a História do Design Industrial numa perspectiva que considera a evolução da indústria e da disciplina nesse contexto. No terceiro capítulo desenvolve-se a análise das propostas conceptuais e metodológicas dos designers Victor Papanek, Luigi Colani e Paulo Parra, por recurso específico, respectivamente, aos pressupostos inscritos em Design Biónico, Design Natural, Biodesign e Design Simbiótico, perseguindo-se como objectivo a sua sistematização em conteúdos passíveis de contribuírem para novas investigações/aplicações, nomeadamente no âmbito daquilo que a autora designa como Inovação Tecnológica na Concepção e EcoBio-Inovação.

Web 2.0, PC e EFA: impactes de uma oficina de formação de professores

As competências em Tecnologia da Informação e Comunicação (TIC) e o Pensamento Crítico (PC) são duas das linhas orientadoras da Aprendizagem ao Longo da Vida (ALV) que reconhecendo que todos os contextos (informais, não-formais e formais) podem ser de aprendizagem, assumiram no quadro da Educação e Formação de Adultos (EFA), em Portugal, uma expressividade plasmada no Referencial de Competências-Chave de Educação e Formação de Adultos, nível secundário (EFA-NS). Contudo a orientação PC/TIC não tem sido explicitamente conciliada nas práticas de educação e formação de adultos. Neste contexto desenvolveu-se uma Oficina de Formação para professores/formadores de cursos EFA-NS, na qual se trabalhou a integração de ferramentas da Web 2.0 com a infusão de PC em materiais/atividades para cursos EFA-NS. No desenvolvimento da Oficina foram consideradas três vertentes. Primeira, conceções dos professores sobre EFA/TIC e EFA/PC. Segunda, a formação sobre PC/TIC. Terceira, produção e implementação de materiais/atividades com orientação PC/TIC. A componente de trabalho autónomo da Oficina passou essencialmente pela dinâmica de uma comunidade online de nome EF@. O grupo de formação era constituído por 17 professores do ensino secundário, e pela investigadora/formadora, autora deste estudo. Acrescente-se que no conjunto das 10 sessões de trabalho presencial a investigadora/formadora foi coadjuvada por mais três formadores. Estudar os impactes da Oficina no desenvolvimento profissional dos professores, conjuntamente com a avaliação da influência dos materiais/atividades produzidos (na Oficina) no nível de PC dos alunos, assumiram-se como as duas questões de investigação a que este estudo pretendeu dar resposta. Neste sentido estudámos o grupo de professores em formação – estudo de caso – e o grupo de alunos – plano quasi experimental do tipo grupo de controlo/experimental, pré/pós-teste, pelo que o enquadramento da metodologia num estudo misto, predominantemente de natureza qualitativa, foi a adotada. A recolha e o tratamento de dados foram feitos mediante várias técnicas – observação, inquérito, análise e testagem – associadas a diferentes instrumentos: dois questionários, diário de investigador e Teste de Pensamento Crítico – Cornell (Nível X). A análise dos dados recolhidos possibilitou a compreensão de como a Oficina contribui para a reflexão: (i) nas práticas anteriores dos professores; (ii) nas competências adquiridas na Oficina e (iii) nas práticas implementadas. Ao nível do PC dos alunos, podemos dizer que os materiais/atividades produzidos na Oficina influenciaram o nível de PC dos alunos, já que os resultados da média do PC do pós-teste foram estatisticamente significativos para o grupo experimental, quando comparado com a média do PC no grupo de controlo.