6 research outputs found
Management of distributed data in distributed environments
No full textElectrical Engineering, Mathematics and Computer Scienc
The TMJ Troubles and Their Nutritional Consequences
No full textThe term temporomandibular disorder (TMD) refers to a heterogeneous group of pathologies affecting the stomatognathic system, characterized by pain and functional limitation within the temporomandibular joint (TMJ) area, the muscles of mastication, and the related structures. TMDs are considered the most common cause of orofacial pain of nondental origin and are currently included within the musculoskeletal disorders. They are characterized by a classically described triad of clinical signs: muscle and/or TMJ pain; TMJ sounds; and restriction, deviation, or deflection of the mouth opening path. TMD symptoms have always been considered to have a broad prevalence peak between 20 and 40 years of age, with a lower prevalence in younger and older people. For specific TMD conditions, distinct peaks were recently identified in patient populations: one around the age of 30 years for subjects with disc displacements and another over the age of 50 years for inflammatory-degenerative joint disorders. The etiology of TMD is complex, multifactorial and consistent with the biopsychosocial model of illness. Negative emotional states such as depression and anxiety are known contributing factors to TMD.
Clinical studies agree that chronic medical conditions have strong negative effects on quality of life.
TMD that run a chronic course are more likely associated with psychological and somatic complaints as well as sleep disturbances. Stressful and dynamic academic, work or family environments can also sufficiently.
The most common symptoms observed in patients with temporomandibular disorders are: chronic pain; loss of energy; activity restriction (inability) of physical ailments and emotional disorders; emotional state; general health problems; anxiety/depression; voice changes; taste changes, discomfort when eating, owing to limited mandibular opening and pain and discomfort with biting and chewing. Consequently, painful TMD may affect dietary intake and nutritional status.
Management of painful TMD is multifaceted and involves pharmacologic, physical, and cognitive behavior and dietary therapies. There is a lack of evidence‐based dietary guidelines for patients that clinicians can use to assess and manage diet and nutritional well-being in patients with this disorder. The Author presents recommendations to guide clinicians on how to help the neglected patients with painful TMD improve the quality of their diets and avoid or minimize eating-related pain.
The areas of discussion will include reviewing the following: potential impact of painful TMD on eating and nutritional status; potential role of diet and nutrition in the TMD management; and dietary guidance for patients with TMD
Narrative vignettes and online enquiry in researching therapist accounts of practice with children in schools : an analysis of the methodology
No full textThis article reviews a research methodology which uses a qualitative, narrative approach to online, in-depth analysis of vignettes. The research sought to investigate the ways in which dramatherapists, based in different countries, understood the nature of therapeutic change in their work with children. The article describes the approach to the generation of data through the internet by a combination of vignettes, aMSN messenger and email. It reports on the approach taken to the analysis of data with samples from the findings. Participants kept a diary of their response to the research and the article draws on this within its analysis of the methodology
36-month clinical outcomes of patients with venous thromboembolism: GARFIELD-VTE
No full textBackground: Venous thromboembolism (VTE), encompassing both deep vein thrombosis (DVT) and pulmonary embolism (PE), is a leading cause of morbidity and mortality worldwide.Methods: GARFIELD-VTE is a prospective, non-interventional observational study of real-world treatment practices. We aimed to capture the 36-month clinical outcomes of 10,679 patients with objectively confirmed VTE enrolled between May 2014 and January 2017 from 415 sites in 28 countries.Findings: A total of 6582 (61.6 %) patients had DVT alone, 4097 (38.4 %) had PE +/- DVT. At baseline, 98.1 % of patients received anticoagulation (AC) with or without other modalities of therapy. The proportion of patients on AC therapy decreased over time: 87.6 % at 3 months, 73.0 % at 6 months, 54.2 % at 12 months and 42.0 % at 36 months. At 12-months follow-up, the incidences (95 % confidence interval [CI]) of all-cause mortality, recurrent VTE and major bleeding were 6.5 (7.0-8.1), 5.4 (4.9-5.9) and 2.7 (2.4-3.0) per 100 person-years, respectively. At 36-months, these decreased to 4.4 (4.2-4.7), 3.5 (3.2-2.7) and 1.4 (1.3-1.6) per 100 person-years, respectively. Over 36-months, the rate of all-cause mortality and major bleeds were highest in patients treated with parenteral therapy (PAR) versus oral anti-coagulants (OAC) and no OAC, and the rate of recurrent VTE was highest in patients on no OAC versus those on PAR and OAC. The most frequent cause of death after 36-month follow-up was cancer (n = 565, 48.6 %), followed by cardiac (n = 94, 8.1 %), and VTE (n = 38, 3.2 %). Most recurrent VTE events were DVT alone (n = 564, 63.3 %), with the remainder PE, (n = 236, 27.3 %), or PE in combination with DVT (n = 63, 7.3 %).Interpretation: GARFIELD-VTE provides a global perspective of anticoagulation patterns and highlights the accumulation of events within the first 12 months after diagnosis. These findings may help identify treatment gaps for subsequent interventions to improve patient outcomes in this patient population
The management of acute venous thromboembolism in clinical practice - study rationale and protocol of the European PREFER in VTE Registry
No full textBackground: Venous thromboembolism (VTE) is a major health problem, with over one million events every year in Europe. However, there is a paucity of data on the current management in real life, including factors influencing treatment pathways, patient satisfaction, quality of life (QoL), and utilization of health care resources and the corresponding costs. The PREFER in VTE registry has been designed to address this and to understand medical care and needs as well as potential gaps for improvement. Methods/design: The PREFER in VTE registry was a prospective, observational, multicenter study conducted in seven European countries including Austria, France Germany, Italy, Spain, Switzerland, and the UK to assess the characteristics and the management of patients with VTE, the use of health care resources, and to provide data to estimate the costs for 12 months treatment following a first-time and/or recurrent VTE diagnosed in hospitals or specialized or primary care centers. In addition, existing anticoagulant treatment patterns, patient pathways, clinical outcomes, treatment satisfaction, and health related QoL were documented. The centers were chosen to reflect the care environment in which patients with VTE are managed in each of the participating countries. Patients were eligible to be enrolled into the registry if they were at least 18 years old, had a symptomatic, objectively confirmed first time or recurrent acute VTE defined as either distal or proximal deep vein thrombosis, pulmonary embolism or both. After the baseline visit at the time of the acute VTE event, further follow-up documentations occurred at 1, 3, 6 and 12 months. Follow-up data was collected by either routinely scheduled visits or by telephone calls. Results: Overall, 381 centers participated, which enrolled 3,545 patients during an observational period of 1 year. Conclusion: The PREFER in VTE registry will provide valuable insights into the characteristics of patients with VTE and their acute and mid-term management, as well as into drug utilization and the use of health care resources in acute first-time and/or recurrent VTE across Europe in clinical practice. Trial registration: Registered in DRKS register, ID number: DRKS0000479
Incidence and predictors of post-thrombotic syndrome in patients with proximal DVT in a real-world setting: findings from the GARFIELD-VTE registry
No full text<jats:title>Abstract</jats:title><jats:p>Although substantial progress has been made in the pathophysiology and management of the post-thrombotic syndrome (PTS), several aspects still need clarification. Among them, the incidence and severity of PTS in the real world, the risk factors for its development, the value of patient’s self-evaluation, and the ability to identify patients at risk for severe PTS. Eligible participants (n = 1107) with proximal deep-vein thrombosis (DVT) from the global GARFIELD-VTE registry underwent conventional physician’s evaluation for PTS 36 months after diagnosis of their DVT using the Villalta score. In addition, 856 patients completed a Villalta questionnaire at 24 months. Variable selection was performed using stepwise algorithm, and predictors of severe PTS were incorporated into a multivariable risk model. The optimistic adjusted c-index was calculated using bootstrapping techniques. Over 36-months, 27.8% of patients developed incident PTS (mild in 18.7%, moderate in 5.7%, severe in 3.4%). Patients with incident PTS were older, had a lower prevalence of transient risk factors of DVT and a higher prevalence of persistent risk factors of DVT. Self-assessment of overall PTS at 24 months showed an agreement of 63.4% with respect to physician’s evaluations at 36 months. The severe PTS multivariable model provided an optimistic adjusted c-index of 0.68 (95% CI 0.59–0.77). Approximately a quarter of DVT patients experienced PTS over 36 months after VTE diagnosis. Patient’s self-assessment after 24 months provided added value for estimating incident PTS over 36 months. Multivariable risk analysis allowed good discrimination for severe PTS.</jats:p>
