O IMPACTO DO OLHAR DIFERENCIADO DO PROFISSIONAL DE SAÚDE NO PROCESSO SAÚDE-DOENÇA: RELATO DE EXPERIÊNCIA PET / THE IMPACT OF THE HEALTH PROFESSIONAL'S DIFFERENT VIEW ON THE HEALTH-DISEASE PROCESS: PET EXPERIENCE REPORT

Objective Persistent post-COVID symptoms are estimated to occur in up to 10% of patients who have had COVID-19. These lingering symptoms may persist for weeks to months after resolution of the acute illness. This study aimed to add insight into our understanding of certain post-acute conditions and clinical findings. The primary purpose was to determine the persistent post COVID impairments prevalence and characteristics by collecting post COVID illness data utilizing Patient-Reported Outcomes Measurement Information System (PROMIS®). The resulting measures were used to assess surveyed patients physical, mental, and social health status. Methods A cross-sectional study and 6-months Mayo Clinic COVID recovered registry data were used to evaluate continuing symptoms severity among the 817 positive tested patients surveyed between March and September 2020. The resulting PROMIS® data set was used to analyze patients post 30 days health status. The e-mailed questionnaires focused on fatigue, sleep, ability to participate in social roles, physical function, and pain. Results The large sample size (n = 817) represented post hospitalized and other managed outpatients. Persistent post COVID impairments prevalence and characteristics were determined to be demographically young (44 years), white (87%), and female (61%). Dysfunction as measured by the PROMIS® scales in patients recovered from acute COVID-19 was reported as significant in the following domains: ability to participate in social roles (43.2%), pain (17.8%), and fatigue (16.2%). Conclusion Patient response on the PROMIS® scales was similar to that seen in multiple other studies which used patient reported symptoms. As a result of this experience, we recommend utilizing standardized scales such as the PROMIS® to obtain comparable data across the patients’ clinical course and define the disease trajectory. This would further allow for effective comparison of data across studies to better define the disease process, risk factors, and assess the impact of future treatments.

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Health-Related Quality of Life of Patients with Multiple Sclerosis in Oman – A CrossSectional Study

Oman Medical Journal ◽

10.5001/omj.2021.109 ◽

2021 ◽

Author(s):

Jansirani Natarajan ◽

Mickael Antoine Joseph ◽

Abdullah Al Asmi ◽

Gerald Amandu Matua ◽

Jaber Al Khabouri ◽

...

Keyword(s):

Quality Of Life ◽

Multiple Sclerosis ◽

Disease Process ◽

Well Being ◽

Health Related Quality ◽

Related Quality ◽

Health Related ◽

The Impact ◽

Disease Specific

Objectives: Multiple sclerosis is a disabling neurological disorder with significant negative effects on patients’ quality of life. Despite the increased prevalence of multiple sclerosis in Arabian Gulf countries in recent years, no study has assessed the impact of multiple sclerosis on the healthrelated quality of life of Omani patients. Therefore, the objectives of the current study was to assess the impact of multiple sclerosis on the health-related quality of life of Omani patients using the validated disease-specific self-administered MusiQoL instrument. Methods: A cross-sectional descriptive study was carried out between April and December 2019 on 177 Omani patients with multiple sclerosis attending two major hospitals in Oman. Patients’ health-related quality of life was assessed using the validated disease-specific self-administered MusiQoL instrument. Results: Majority (51.4%) of the patients had poor HRQOL and 48.6% had moderate HRQOL. We found that being older than 30 years, a female, married, separated, widowed, or divorced, and having visual and sleep problems had poorer health-related quality of life. Among the different health-related quality of life components, relationship with the healthcare system and relationship with family and friends were the most affected because of the disease process. Our results also showed that psychological well-being and coping domains of MusiQoL questionnaires are significantly reduced in females as compared to males. Conclusion: Understanding the health-related quality of life of Omanis with multiple sclerosis provides valuable knowledge that could help optimize the management of this disease.

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The Disease Process, Diagnosis and Treatment of Invasive Cervical Resorption: A Review

Dentistry Journal ◽

10.3390/dj8030064 ◽

2020 ◽

Vol 8 (3) ◽

pp. 64

Author(s):

Olivia Rotondi ◽

PhiAnh Waldon ◽

Sahng G. Kim

Keyword(s):

Computed Tomography ◽

Calcium Silicate ◽

Disease Process ◽

Protective Layer ◽

Root Surface ◽

Cone Beam ◽

Current Status ◽

Process Diagnosis ◽

Factors Associated ◽

The Impact

Invasive cervical resorption (ICR) is a localized, subepithelial, supra-osseous resorptive process of the tooth. Although there are several predisposing factors associated with ICR, its etiology and pathogenesis are poorly understood. The damage to the protective layer on the external root surface appears to allow for the attachment of clastic cells and initiate the resorptive process, which is confined by the inner protective pericanalar resorption-resistant sheet surrounding the root canal space. The use of cone-beam computed tomography (CBCT) is recommended for the diagnosis and assessment of a resorptive lesion. Based on the thorough evaluation of the size and location of the ICR lesion using CBCT, surgical or nonsurgical treatment can be chosen to address the source of the resorption. This review discusses the current status of knowledge regarding the biology of ICR lesions as well as their external or internal treatment using hydraulic calcium silicate-based materials. Future clinical outcome studies are necessary to evaluate the impact of hydraulic calcium silicate-based materials on the healing of ICR lesions.

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The Integration of Adult Acute Care Surgeons into Pediatric Surgical Care Models Supplements the Workforce without Compromising Quality of Care

The American Surgeon ◽

10.1177/000313481508100916 ◽

2015 ◽

Vol 81 (9) ◽

pp. 854-858 ◽

Cited By ~ 5

Author(s):

Rudy J. Judhan ◽

Raquel Silhy ◽

Kristen Statler ◽

Mija Khan ◽

Benjamin Dyer ◽

...

Keyword(s):

Length Of Stay ◽

Acute Care ◽

Tertiary Care ◽

Disease Process ◽

Pediatric Care ◽

Care Hospital ◽

Late Night ◽

General Surgeons ◽

The Impact

Acute care of children remains a challenge due to a shortage of pediatric surgeons, particularly in rural areas. In our institutional norm, all cases in patients age six and older are managed by dedicated general surgeons. The provision of care to these children by these surgeons alleviates the impact of such shortages. We conducted a five-year retrospective analysis of all acute care pediatric surgical cases performed in patients aged 6 to 17 years by a dedicated group of adult general surgeons in a rural tertiary care hospital. Demographics, procedure, complications, outcomes, length of stay, and time of consultation/operation were obtained via chart review. Elective, trauma related, or procedures performed by a pediatric surgeon were excluded. Descriptive statistics are reported. A total of 397 cases were performed by six dedicated general surgeons during the study period. Mean age was 11.5 ± 3.1 years. In all, 100 (25.2%) were transferred from outlying facilities and 52.6 per cent of consultations/operations occurred at night (7P–7A), of which 33.2 per cent occurred during late night hours (11P–7A). On weekends, 34.0 per cent occurred. Appendectomy was the most commonly performed operation (n = 357,89.9%), of which 311 were laparoscopic (87.1%). Others included incision/drainage (4.5%), laparoscopic cholecystectomy (2.0%), bowel resection (1.5%), incarcerated hernia (0.5%), small bowel obstruction (0.5%), intraabdominal abscess drainage (0.3%), resection of intussusception (0.3%), Graham patch (0.3%), and resection omental torsion (0.3%). Median length of stay was two days. Complications occurred in 23 patients (5.8%), of which 22(5.5%) were the result of the disease process. These results parallel those published by pediatric surgeons in this age group and for the diagnoses treated. Models integrating dedicated general surgeons into pediatric call rotations can be designed such that quality of pediatric care is maintained while providing relief to an overburdened pediatric surgical workforce.

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Outcomes of β-Hemolytic Streptococcal Necrotizing Skin and Soft-tissue Infections and the Impact of Clindamycin Resistance

Clinical Infectious Diseases ◽

10.1093/cid/ciaa976 ◽

2020 ◽

Author(s):

Dara L Horn ◽

Emma A Roberts ◽

Jolie Shen ◽

Jeannie D Chan ◽

Eileen M Bulger ◽

...

Keyword(s):

Soft Tissue ◽

Disease Process ◽

Patient Characteristics ◽

Routine Care ◽

Limb Loss ◽

Streptococcal Toxic Shock Syndrome ◽

Soft Tissue Infections ◽

Surgical Wound ◽

Resistance Patterns ◽

The Impact

Abstract Background β-Hemolytic streptococci are frequently implicated in necrotizing soft-tissue infections (NSTIs). Clindamycin administration may improve outcomes in patients with serious streptococcal infections. However, clindamycin resistance is growing worldwide, and resistance patterns in NSTIs and their impact on outcomes are unknown. Methods Between 2015 and 2018, patients with NSTI at a quaternary referral center were followed up for the outcomes of death, limb loss, and streptococcal toxic shock syndrome. Surgical wound cultures and resistance data were obtained within 48 hours of admission as part of routine care. Risk ratios for the association between these outcomes and the presence of β-hemolytic streptococci or clindamycin-resistant β-hemolytic streptococci were calculated using log-binomial regression, controlling for age, transfer status, and injection drug use–related etiology. Results Of 445 NSTIs identified, 85% had surgical wound cultures within 48 hours of admission. β-Hemolytic streptococci grew in 31%, and clindamycin resistance was observed in 31% of cultures. The presence of β-hemolytic streptococci was associated with greater risk of amputation (risk ratio, 1.80; 95% confidence interval, 1.07–3.01), as was the presence of clindamycin resistance among β-hemolytic streptococci infections (1.86; 1.10–3.16). Conclusions β-Hemolytic streptococci are highly prevalent in NSTIs, and in our population clindamycin resistance was more common than previously described. Greater risk of limb loss among patients with β-hemolytic streptococci—particularly clindamycin-resistant strains—may portend a more locally aggressive disease process or may represent preexisting patient characteristics that predispose to both infection and limb loss. Regardless, these findings may inform antibiotic selection and surgical management to maximize the potential for limb salvage.

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Nitrosative Stress Biomarkers in the Non-Stimulated and Stimulated Saliva, as well as Gingival Crevicular Fluid of Patients with Periodontitis: Review and Clinical Study

Antioxidants ◽

10.3390/antiox9030259 ◽

2020 ◽

Vol 9 (3) ◽

pp. 259 ◽

Cited By ~ 7

Author(s):

Joanna Toczewska ◽

Tomasz Konopka ◽

Anna Zalewska ◽

Mateusz Maciejczyk

Keyword(s):

Oral Cavity ◽

Nitrosative Stress ◽

Gingival Crevicular Fluid ◽

Disease Process ◽

Primary Source ◽

Diagnostic Methods ◽

Periodontal Tissues ◽

Crevicular Fluid ◽

The Impact ◽

Gingival Fluid

Diagnosis of periodontopathy is complex and includes defining the cause, type, stage, and grade of periodontitis. Therefore, alternative diagnostic methods are sought to indicate the progression of inflammation or to determine the effectiveness of therapy. Gingival crevicular fluid (GCF) biomarkers can be particularly useful because they most likely reflect the disease process of the periodontal tissues. However, the difficulty of collecting GCF for testing is the reason for the limited use in diagnostics. Because periodontitis is the primary source of nitrogen free radicals in the oral cavity, the aim of the study was to evaluate the biomarkers of nitrosative stress (nitric oxide, peroxynitrite, and S-nitrosothiols) in GCF, non-stimulated and stimulated saliva of 90 patients with periodontitis. The study group was divided into two subgroups, depending on the stage of the disease severity. We showed a significantly higher concentration of all assessed biomarkers in the non-stimulated and stimulated saliva of patients with periodontitis. However, significant changes in GCF has been shown only for peroxynitrite. The studied biomarkers did not correlate with clinical periodontal status, which probably results from their short-duration activity and the impact on a few factors in the oral cavity. Saliva and gingival fluid are not very useful in the differential diagnosis of periodontitis.

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Perforated Appendicitis: An Unintended Consequence During the Coronavirus-19 Pandemic

Military Medicine ◽

10.1093/milmed/usaa527 ◽

2020 ◽

Author(s):

Andrew W Wang ◽

James Prieto ◽

Daniel S Ikeda ◽

Paul R Lewis ◽

Emily M Benzer ◽

...

Keyword(s):

Acute Appendicitis ◽

Disease Process ◽

Perforated Appendicitis ◽

The United States ◽

Military Hospital ◽

Symptom Duration ◽

Delayed Presentation ◽

Historical Cohort ◽

Surgical Conditions ◽

The Impact

ABSTRACT Background The coronavirus disease 2019 (COVID-19) pandemic has had major clinical impact across the globe. Delayed presentation for medical emergencies has been noted by the medical community. There has been limited reporting on the impact for the care for emergent surgical conditions. We sought to describe the effect of the global pandemic on the presentation and outcomes for the most common urgent general surgery disease process, acute appendicitis. Methods We performed a retrospective review of patients admitted to the United States Naval Hospital Okinawa during the COVID-19 pandemic, from January 2020 to May 2020 (COVID cohort), and compared them to a historical cohort (pre-COVID cohort) over the prior 2 years. Demographics, clinical presentation data, and interventions were collected. Results Of the 80 patients with appendicitis, 20% presented perforated. Most patients were male (71%), presented with 1 day of symptoms and had a length of stay of 1 to 2 days. Comparing groups, 13% of the pre-COVID group vs. 31% of the COVID cohort presented perforated (P = .04), with a symptom duration of 1.6 vs. 2.7 days before presentation (P = .075), respectively. Conclusions The COVID-19 pandemic and the global systematic response has impacted unrelated medical and surgical conditions. At our overseas military hospital with minimal disease burden, we observed a delay in presentation for acute appendicitis with a higher incidence of perforation. Patients should be empowered to continue to seek care for urgent and emergent medical and surgical conditions so that they are not harmed by fear of COVID-19 rather than by COVID-19 itself.

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A Neurosurgeon's Guide to Cognitive Dysfunction in Adult Glioma

Neurosurgery ◽

10.1093/neuros/nyaa400 ◽

2020 ◽

Author(s):

Ramin A Morshed ◽

Jacob S Young ◽

Arlena A Kroliczek ◽

Mitchel S Berger ◽

David Brang ◽

...

Keyword(s):

Cognitive Dysfunction ◽

Disease Process ◽

High Grade Glioma ◽

Cognitive Outcomes ◽

Therapeutic Interventions ◽

Contextual Understanding ◽

Network Disruption ◽

Neurocognitive Tasks ◽

The Impact

Abstract Cognitive decline is common among patients with low- and high-grade glioma and can significantly impact quality of life. Although cognitive outcomes have been studied after therapeutic interventions such as surgery and radiation, it is important to understand the impact of the disease process itself prior to any interventions. Neurocognitive domains of interest in this disease context include intellectual function and premorbid ability, executive function, learning and memory, attention, language function, processing speed, visuospatial function, motor function, and emotional function. Here, we review oncologic factors associated with more neurocognitive impairment, key neurocognitive tasks relevant to glioma patient assessment, as well as the relevance of the human neural connectome in understanding cognitive dysfunction in glioma patients. A contextual understanding of glioma-functional network disruption and its impact on cognition is critical in the surgical management of eloquent area tumors.

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Scanning Laser Ophthalmoscope in the Management of Age-related Macular Degeneration

European Ophthalmic Review ◽

10.17925/eor.2012.06.04.242 ◽

2012 ◽

Vol 06 (04) ◽

pp. 242

Author(s):

Nicole K Scripsema ◽

and Richard B Rosen ◽

◽

...

Keyword(s):

Macular Degeneration ◽

Fundus Autofluorescence ◽

Disease Process ◽

Scanning Laser Ophthalmoscope ◽

Age Related Macular Degeneration ◽

Scanning Laser ◽

Functional Changes ◽

Age Related ◽

The Impact ◽

Improved Methods

Recent advances in retinal imaging have improved the evaluation and prognostication of age-related macular degeneration. The development and modification of the scanning laser ophthalmoscope (SLO) has played a pivotal role in our understanding of the disease. SLO has led to improved methods of visualising characteristics of the disease, such as drusen and alterations in autofluorescence, and also provided a platform for the quantification of structural and functional changes occurring as a result of the disease process. This article provides a review of the current literature on the impact and clinical utility of SLO devices for infrared viewing, fundus autofluorescence, microperimetry, and as integraded multimodal imaging systems such as optical coherence tomography and SLO.

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The Emergence of the Person in Dementia Research

Ageing and Society ◽

10.1017/s0144686x9700665x ◽

1997 ◽

Vol 17 (5) ◽

pp. 597-607 ◽

Cited By ~ 116

Author(s):

MURNA DOWNS

Keyword(s):

Support Groups ◽

Sense Of Self ◽

Medical Model ◽

Disease Process ◽

People With Dementia ◽

Dementia Research ◽

The Individual ◽

And Coping ◽

Person With Dementia ◽

The Impact

The purpose of this review is to identify and explore the emerging attention being paid to the individual in dementia research. Following a brief introduction, the review will examine literature which recognises three aspects of the person with dementia: the individual's sense of self; the person's rights; and the value to be gained from a concern with the perspectives of people with dementia. To date the medical model has dominated dementia research. This model tends to reduce the person with dementia to his/her neurobiology or neuropsychology (Cotrell and Schulz 1993). The experience and manifestation of dementia has been attributed solely to the disease process, with a consequent neglect of the psychosocial context surrounding the individual (Lyman 1989). Research on the psychosocial aspects of dementia has concentrated on family carers. Keady (1996) provides a useful categorisation of this research into the following topics: gender and coping style; marital relationships and the impact of dementia; access to information and services; participation in and effectiveness of support groups; adjustment and circumstances surrounding admission into care; and perception of own health needs. No literature focuses on people with dementia.

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