Search

Objectives: After consultations, the physicians perceptions differ from the patients perceptions concerning illness level, cause and nature of the problem and content of the consultation. Agreement on problems requiring follow-up has been associated with a better outcome. The primary aim of this study was to build and validate an instrument that assesses physician-patient agreement in the rheumatology consultation. The secondary objective was to assess agreement association with patient's clinical and sociodemographic data. Materials and Methods: A ten-item questionnaire -"Consultation Assessment Instrument" (CAI) - was developed for this study to assess physician-patient agreement. Ten physicians and 102 patients diagnosed with an inflammatory joint disease under biological therapy were included. The items were evaluated and the index of proportional agreement for the dichotomized answers "agree" (Ppos) and "disagree" (Pneg) was calculated. Results: Consultation satisfaction was the item with the highest agreement. On the opposite end, the item about the explanation of treatment importance was the item with the lowest agreement between patient and physician. Except for one item, the high level of agreement between patient and physician was due to a higher Ppos. Index of proportional agreement was high for 9 of the 10 items (0.816 ≤ Iv <≤ 0.990). Patients with lower disease activity scores had a more positive experience. A good internal consistency was obtained for both patient's and physicians questionnaire (a= 0.88 and a= 0.80, respectively). Conclusions: Both patient and physician showed a positive experience towards rheumatology consultation. Physician-patient agreement was high in the majority of the consultation aspects (mean Iv = 0,93). A good internal consistency was obtained for both patient's and physicians questionnaire. CAI may be useful as a mental checklist in daily practice or as an educational tool for training consultation skills. [ABSTRACT FROM AUTHOR]

Introduction: Shoulder pain is a common cause of consultation in Primary Health Care, and may correspond to up to 30% of the reasons for consultation. Pathology of the rotator cuff is the most common cause of pain. Ultrasound is a valuable diagnostic tool in assessing shoulder disorders; it can be as effective as magnetic resonance imaging. Objective: To determine the predictive factors of response to treatment and ultrasound findings in shoulder pain. Methods: We performed an analysis of the patients' cases sent to the rheumatology consultation with shoulder pain. Every patient had an echography shoulder evaluation, and the rheumatologist decided treatment based on the guidelines for the treatment of shoulder tendinopathies. The use of nonsteroidal anti-inflammatory drugs (NSAIDs) and muscle relaxant medications as well as the following techniques: corticosteroids local injection, barbotage, capsular distension and physiotherapy programs were some of the variables assessed. Posteriorly, the patients were clinically assessed in a follow-up visit. Results: A total of 119 patients were evaluated. There was a statistically significant relationship between the time from the beginning of the symptomatology and treatment response. Diabetes mellitus, arterial hypertension and dyslipidaemia were statistically significantly associated with some rotator cuff lesions and distention of the subscapular bursa. Age was the main predictor of rotator cuff ultrasound findings. Conclusion: In patients with shoulder pain, early intervention positively influences the response to treatment. Thus, it is important that these patients are evaluated more promptly. Some comorbidities seem to be associated with a higher risk of specific rotator cuff lesions. No relationship was found between response to treatment and age, sex, occupation, previous treatments or type of therapy selected. The associations found in this study seem to have clinical implications. Prevention of rotator cuff disease is a matter of major relevance as well as early institution of treatment. [ABSTRACT FROM AUTHOR]

Objectives: Evaluation and characterization of hand function in patients with rheumatoid arthritis (RA) and, secondarily, identification of the use of adaptive equipments. Material and methods: Firstly, a written informed consent was obtained and then an anonymous questionnaire was filled by RA outpatients observed at the rheumatology consultation. Those with no other musculoskeletal or neuromuscular disorders that would determine major functional impairment of hand function were included. Sociodemographic and clinical variables were collected and the Cochin Hand Functional Scale (CHFS) was applied. Classical deformities of hand and/or wrist were observed and recorded by the attending physician. Results: A total of 79 patients were enrolled. In the overall sample, most patients were female (69.60%), with a mean age of 59.72 ± 11.77 years and with a mean diagnosis duration of 11.72 ± 8.29 years. The majority (73.40%) had at least one hand or wrist deformity, the most frequent being atrophy of the interosseous muscles, followed by ulnar deviation of the metacarpophalangeal joints and piano key deformity of the wrist. The mean CHFS score was 17.94 ± 18.26 points with a minimum and maximum value recorded of 0 and 80 points, res pectively. The presence of hand deformities, Health Assessment Questionnaire score (HAQ), hand pain and diagnosis duration were correlated with the CHFS score. Six patients had assistive devices and only in one case it was used to overcome hand's functional impairment. Conclusions:Most patients presented at least one classic RA deformity after a mean diagnosis duration of appro ximately 12 years and under pharmacological treatment. Despite this, most patients scored significantly below CHFS maximum score, but only 18 reported no difficulty in any of the tasks mentioned in the scale. The fact that only a minority of these patients had assistive devices should alert us to the need for a more thorough functional assessment and identification of needs among RA patients. [ABSTRACT FROM AUTHOR]

D***esign-for-X (DfX) approaches are of great importance to support sustainable development of new products, since the goal of DfX practices is to improve life cycle cost, life cycle environmental performance, increase design flexibility, manufacturing efficiency, etc. Therefore DfX supports a better decision-making process whenever a new complex product is being developed. In this work the new Lean Design-for-X (LD f X) approach is presented embracing the principles of Lean Product Development and Modular Design, for a systematic applicability by design engineers and product managers, assessing the effectiveness and efficiency of a given product design. An LD f X index metric, ranging between 0-100%, and original scorecard were created for consistent decision support for the comparison of different design concepts or products, integrating different “X” domains. The approach was applied in a real design study of a machine tool (press-brake), integrating Ecodesign principles, Design for Structural Optimization and Modular Design. [ABSTRACT FROM AUTHOR]

Copyright of Arquivo Brasileiro de Medicina Veterinaria e Zootecnia is the property of Universidade Federal de Minas Gerais, Escola de Veterinaria and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Focal myositis is an acute and localized muscle inflammation of unknown aetiology. The clinical diagnosis is often difficult to obtain, since it can be confused with infections, vascular thrombosis or muscle tumours such as sarcomas. This leads to a significant delay in the diagnosis, resulting in the administration of inappropriate and potentially harmful treatments. We report here a case of recurrent focal myositis in a woman where the diagnosis was only obtained after 6 years, despite multiple hospital admissions. This case reinforces the importance of clinical knowledge and experience to tackle challenging medical scenarios. [ABSTRACT FROM AUTHOR]

The posterior reversible encephalopathy syndrome (PRES) is a clinical-radiological entity characterized by the association of clinical neurological signs (headache, confusion, vision changes, vomiting and seizures) and the typical changes in magnetic resonance imaging of the brain. Its pathogenesis is still poorly defined but seems to imply a vascular and endothelial dysfunction. It occurs more frequently in patients with hypertensive encephalopathy, eclampsia, renal failure and has also been associated with the use of immunosuppressive drugs. The authors present a case of PRES in a young woman with systemic lupus erythematosus with active and severe manifestations of the disease. [ABSTRACT FROM AUTHOR]

Systemic sclerosis is a connective tissue disease characterized by a complex pathogenesis and a multi organ involvement of unknown etiology. Genetic features and environmental factors, as the use of some drugs, influence the onset of the clinical picture. The authors des cribe a case of a patient who developed systemic sclerosis after treatment of melanoma with interferon alfa-2b, a drug rarely implicated in the induction of this disease. [ABSTRACT FROM AUTHOR]