公务员人群阻塞性睡眠呼吸暂停筛查、干预的新模式及其影响因素

目的:探讨公务员人群阻塞性睡眠呼吸暂停（obstructive sleep apnea,OSA）筛查、干预的新模式及其影响因素。方法:入选2017年9—12月在广东省一公务员单位门诊部进行年度体检的在职公务员1 241例,对其先进行柏林问卷筛查OSA高危患者,然后采用3型便携式睡眠监测（home sleep testi...     

Motivational interviewing adherence tools: A scoping review investigating content validity

ObjectiveWe sought to understand the content validity of Motivational Interviewing (MI)as a concept and the relative emphasis of specific MI aspects by assessing MI adherence measures.MethodWe followed PRISMA guidelines for scoping reviews. Twenty-eight adherence measures were identified. From these, 407 specific MI adherence codes were extracted and submitted to content analysis.ResultsFifteen MI themes emerged, 13 focused on clinician behaviors and 2 on client responses. Four themes (OARS, MI Spirit, evoking motivation, and MI-inconsistent behaviors) accounted for 72% of all codes. No other theme (e.g., preventing/responding to resistance, engaging ambivalence) accounted for more than 6% of codes. One measure assessed 11 of 15 themes; on average, 5.68 themes were assessed with a mean of 14.54 questions per measure. Process and psychometric characteristics of the measures are described.Conclusions/Practice ImplicationsMI adherence measures agree about the importance of certain aspects of MI but lag behind current research and best skill practice. Considerable variance exists in assessing MI nuances and specific behaviors, suggesting questions about what constitutes MI in practice settings and what should be taught. Importantly, most measures focused only on the counselor’s behavior, missing the impact of MI on the client.     

Tromboembolismo pulmonar agudo: adecuación del manejo de pacientes según las guías de práctica clínica en el servicio de urgencias

Background and aimsTo evaluate the frequency of acute pulmonary embolism, the use of clinical probability scores, and the appropriateness of the management of patients for whom computed tomography angiography (CTA) was requested from the emergency department for suspected acute pulmonary embolism.Materials and methodsThis was a retrospective observational study of CTA studies requested from the emergency department to rule out acute pulmonary embolism. We analyzed clinical variables and the explicit use of clinical probability scores. We determined the appropriateness of management according to the Wells Score and Geneva Score and the simplified versions of these two scores, calculated retrospectively.ResultsWe included 534 patients (52.8% women; mean age, 73 years). The frequency of acute pulmonary embolism was 23.0% and the Wells Score was explicitly used in 15.2%. The appropriateness of the management varied depending on the clinical probability score used to assess it (54.5%-75.8%) and on whether the standard D-dimer or age-adjusted D-dimer was used.ConclusionsThe failure to use the Wells Scores in all cases does not necessarily imply inappropriate management, and the performance of global clinical judgment can be similar to that of clinical probability scores; however, specific studies are necessary to confirm this hypothesis.     

[Translated article] Tirbanibulin: review of its novel mechanism of action and how it fits into the treatment of actinic keratosis

Actinic keratosis (AK), a skin condition characterized by the proliferation of atypical keratinocytes, can progress to squamous cell carcinoma. Existing treatments are effective but cause high rates of local skin reactions. Tirbanibulin, one of the treatments under development for AK, is a novel synthetic drug with powerful in vitro and in vivo antiproliferative and antitumor effects. Its efficacy in this setting was recently demonstrated in 2 phase 3 clinical trials. We review tirbanibulin’s mechanism of action based on the current literature and several unpublished preclinical studies. We also review treatments available for AK and discuss how tirbanibulin, with its novel mechanism of action, fits into the therapeutic landscape.     

Brazilian Portuguese version of the Mediterranean diet scale: Translation procedures and measurement properties

Background and aimThe Mediterranean Diet Scale (MDS) is a questionnaire with characteristics which can contribute to the multidimensional assessment of patients with diabetes mellitus (DM) by the multidisciplinary team, as well as to evaluate the effect of specific educational and nutritional interventions. The aim of this study was to translate and perform a cross-cultural adaptation of a Canadian MDS and analyze the measurement properties of the Brazilian Portuguese version of the Mediterranean Diet Scale (MDS-Brazil) in individuals with DM in Brazil.MethodsThis was a cross-sectional study. The analyzed measurement properties were the internal consistency, floor and ceiling effects, reproducibility, and construct validity. The inclusion criteria were diagnosis of DM type 1 or type 2, literate, outpatients, and without eating restrictions.ResultsOf the 160 volunteers included in this study, 30 participated in pretesting, and another 130 (57.7% women, 74.6% DM type 2, 56.55 ± 14.88 years) agreed to participate in the evaluation stage of the measurement properties. All items were cross-culturally adapted. A factor analysis (KMO = 0.555 and X² = 137.22; p < 0.001) extracted five factors, with no floor or ceiling effects, Cronbach's alpha = 0.42, and reproducibility ICC = 0.75.ConclusionsThe cross-cultural adaptation was performed maintaining the equivalences. The MDS-Brazil measurement properties showed substantial reproducibility, low internal consistency, and fair correlations of construct validity in patients with DM.     

Recommendations for the assessment and optimization of adherence to disease-modifying drugs in chronic inflammatory rheumatic diseases: A process based on literature reviews and expert consensus

Background

Adherence to treatment is a key issue in chronic inflammatory rheumatic diseases (CIRDs).

Heart failure is associated with non-adherence to pharmacotherapy in elderly with type 2 diabetes mellitus in public health system Brazilians

The rising prevalence of T2DM poses a serious threat to human health and the viability of many health care systems around the world. Non-adherence to therapeutic in the T2DM is high, and Brazilian studies of public heath for to identify new variables are scares. The present study explored cardiovascular consequences associated with compliance and non-adherence among T2DM in Brazilian patients seeking medical care in Brazilian basic health unit clinics.MethodsThis is a cross-sectional study carried out in a city the interior of Sao Paulo state, with patients with T2DM, being municipal PHS users. Data were collected from the computerized system of the municipality for a one single researcher and patient records, and analyzed using the IBM SPSS v.18 statistical package. The response variables was categorized in adherent MGT (>80) and non-adherent MGT (≤80).ResultsThe mean age of patients was 63.6 ± 9.5 with predominance for the sex male 66.4% and 42% of patients with T2DM do not adherence to treatment. We found an associated odds ratio (OR) = 2.3 (1.1–5.1) between heart failure and non-adherence in patients with T2DM.ConclusionHeart failure is a factor associated with non-adherence to treatment in patients with T2DM and in the practice clinical, the screening for heart failure and interventions may improve adherence to pharmacotherapy.     

The pharmacy care plan service: Evaluation and estimate of cost-effectiveness

Background

The UK Community Pharmacy Future group developed the Pharmacy Care Plan (PCP) service with a focus on patient activation, goal setting and therapy management.