Objetivos: Avaliar o papel da turbinectomia inferior parcial endoscópica (TIPE) na rinosseptoplastia primária sobre os desfechos de qualidade de vida, complicações e tempo cirúrgico. Delineamento: Ensaio clínico pragmático, randomizado, duplo-cego em um centro único e de grupos paralelos. Métodos: Indivíduos maiores de 16 anos, com queixas estéticas e obstrução nasal, candidatos à rinosseptoplastia primária, avaliados entre março de 2014 e maio de 2015, em um Hospital Terciário Universitário no Brasil. Pacientes elegíveis foram randomizados para receberem ou não TIPE concomitantemente à cirurgia. Desfechos: Diferença absoluta dos escores pré e pós-operatórios em qualidade de vida específica, pela aplicação dos questionários Nasal Obstruction Symptom Evaluation Portuguese (NOSE-p) e Rhinoplasty Outcome Evaluation (ROE), e geral, através de aplicação do World Health Organization Quality of Life (WHOQOL)-breve. Os desfechos eram cegados e acessados somente três meses após a cirurgia. O protocolo foi registrado no ClinicalTrials.gov (NCT02231216). Resultados: 50 pacientes foram incluídos, maioria caucasiana com rinite alérgica com sintomas moderados a severos. A média de idade foi 36 (±14,5) anos. Os escores de qualidade de vida específicos e gerais melhoraram independentemente da intervenção TIPE (p < 0,001). ANCOVA foi aplicada para controlar potenciais fatores confundidores. Não houve divergência entre a diferença absoluta nos pacientes submetidos ou não a TIPE nos escores NOSE-p (-50,5 vs. -47,6; p=0,723); ROE (47 vs. 44,8; p= 0,742) e todos os domínios do WHOQOL-breve (p > 0,05). Não houve diferença entre os grupos sobre a presença de complicações. O tempo cirúrgico foi maior no grupo TIPE (212 minutos ± 7,8 vs. 159,1 ± 5,6; p ˂ 0,001). Conclusão: A redução das conchas inferiores através da TIPE durante a rinosseptoplastia primária não melhorou, em curto prazo, a qualidade de vida geral nem específica. O uso de TIPE aumenta o tempo cirúrgico consideravelmente, sem adicionar benefício aos escores avaliados. Não houve diferença na incidência de complicações no pós-operatório, sugerindo a segurança da técnica. / Objectives/Hypothesis: To evaluate the impact of endoscopic partial inferior turbinectomy (EPIT) associated with primary Rhinoseptoplasty on quality of life outcomes (QOL), complications, and surgical duration. Study Design: Randomized clinical trial. Methods: Individuals with nasal obstruction aged ≥ 16 years who were candidates for functional and aesthetics primary Rhinoseptoplasty were evaluated from March 2014 through May 2015 at a tertiary university hospital in Brazil. Eligible participants were randomly allocated to rhinoseptoplasty with or without EPIT. Outcomes: Absolute change (postoperative –preoperative) in the following QOL scores: Nasal Obstruction Symptom Evaluation-Portuguese (NOSE-p), Rhinoplasty Outcome Evaluation (ROE) and World Health Organization Quality of Life (WHOQOL)-bref (to measure general QOL). Outcomes were blindly assessed 3 months postoperatively. The protocol was registered at ClinicalTrials.gov (NCT02231216). Results: Fifty patients were studied. Most were Caucasian and had moderate/severe allergic rhinitis symptoms. Mean age was 36 (±14.5) years. Rhinoseptoplasty was associated with improvement in all QOL scores irrespective of turbinate intervention (P <0.001). ANCOVA was conducted to control for potential confounders. There was no difference between the groups in absolute score changes for NOSE-p (-50.5 vs. -47.6; P=0.723); ROE (47 vs. 44.8; P = 0,742), and all WHOQOL-bref score domains (P >0.05). There were no differences between the groups regarding presence of the complications. Surgical duration was higher in the EPIT group (212 minutes ± 7.8 vs. 159.1 ± 5.6; p ˂ 0.001). Conclusions: Turbinate reduction through EPIT during primary rhinoseptoplasty did not improve short-term general and specific QOL outcomes. The use of EPIT increases surgical time considerably without improving QOL scores. There was no difference in postoperative incidence of complications, suggesting that EPIT is a safe technique.

A confecção de próteses totais envolve uma série de procedimentos técnicos complexos. No entanto, a simplificação dessa sequência de procedimentos pode ser tão eficazes quanto os convencionais, mas com menor gasto de tempo e recursos. O objetivo deste estudo foi quantificar os custos envolvidos com a confecção de próteses totais com um método simplificado em comparação a um convencional. A amostra foi formada por pacientes desdentados totais solicitando tratamento com próteses totais duplas, que foram divididos aleatoriamente em dois grupos: o Grupo S recebeu próteses totais confeccionadas por um método simplificado, enquanto que o Grupo C recebeu próteses confeccionadas convencionalmente. Os custos diretos e indiretos de cada procedimento foram calculados por participante, incluindo sessões imprevistas. O estudo foi realizado com 19 e 21 participantes nos grupos S e C, respectivamente, e comparações entre os dois grupos foram feitas por meio dos testes de Mann-Whitney e t de Student (&alpha;=0,05). A confecção das próteses demandou do operador um tempo mediano de 173,2 e 284,5 min. para os grupos S e C, respectivamente, enquanto os tempos para o auxiliar foram 46,6 e 61,7 min. (diferenças significantes, P<0,05). Os grupos não diferiram significantemente na fase de ajustes pós-instalação. O grupo S também apresentou valores menores que C durante a fase de confecção, mas não durante os ajustes, para custos com materiais empregados e tempo despendido pelo paciente. No total, o método simplificado reduziu o custo direto do tratamento em 34,9%. Conclui-se que o método simplificado é menos oneroso ao paciente e sistema de saúde, quando comparado a um protocolo convencional para a reabilitação do paciente edentado. / Complete denture fabrication involves a series of complex technical procedures. Nevertheless, simplified methods may be as effective as conventional ones albeit the lower use of time and resources. The aim of this study is to quantify the costs of complete denture fabrication by means of a simplified method compared with a conventional protocol. A sample of edentulous patients needing conventional maxillary and mandibular complete dentures was randomly divided into: group S, which received dentures fabricated by means of a simplified method, and group C, which received conventionally fabricated dentures. We calculated direct and indirect costs for each participant including unscheduled procedures. This study assessed 19 and 20 participants allocated in groups S and C, respectively, and comparisons between groups were conducted by means of the Mann-Whitney and Students t test (&alpha;=0,05). Complete denture fabrication demanded median time periods of 173,2 and 284,5 min from the operator for groups S and C respectively, and 46.6 and 61.7 min from the dental assistant (significant differences, P<0.05). There was no difference between groups regarding postinsertion adjustments. Group S also showed lower values than C during the fabrication stage, but not during adjustments, for costs with materials and time spent by patients. In summary, the simplified method reduced direct treatment costs in 34.9%. It can be concluded that the simplified method is less costly for patients and health system when compared with a conventional protocol for the rehabilitation of edentulous patients.

A sede é definida como o desejo de beber água. É considerada um sintoma multifatorial, pois o estímulo proporcionado pode ser influenciado pela necessidade de hidratação, ou seja, normalizar os níveis de volemia e osmolaridade plasmática, ou pode ser desencadeado por diferentes fatores pessoais e culturais do indivíduo. O objetivo do estudo foi comparar a intensidade e o desconforto da sede em pacientes no período pré-operatório, após vinte minutos da degustação do picolé mentolado com a sede de pacientes que receberam o cuidado usual. Trata-se de ensaio clínico aleatorizado com tratamento em paralelo, prospectivo e monocêntrico. A amostra do estudo foi composta de 40 pacientes cirúrgicos no período pré-operatório, os quais foram alocados em dois grupos, sendo 20 no grupo controle e 20 no grupo experimental. O paciente alocado no grupo controle (cuidado usual) recebeu as orientações dadas pela equipe de saúde, conforme rotina da instituição de saúde. O paciente alocado no grupo experimental recebeu um picolé mentolado, com, no mínimo, três horas de antecedência do horário programado para o procedimento cirúrgico. Para a coleta de dados elaborou-se instrumento, o qual foi submetido a validação de face e conteúdo por cinco juízes. A intensidade e o desconforto da sede foram os desfechos primários mensurados. A intensidade da sede foi mensurada por meio da Escala Numérica (zero sem sede e dez a pior sede que a pessoa já sentiu), e o desconforto da sede pela Escala de Desconforto da Sede Perioperatória (pontuação varia de zero a 14 pontos, sendo que 14 corresponde ao desconforto mais intenso relacionado com a sede). As médias de intensidade da sede inicial foram diferentes entre os grupos investigados, sendo 5,3 (dp 1,8) para o grupo controle, e 6,6 (dp 1,6) para o grupo experimental (p=0,02). As médias relativas ao desconforto inicial da sede também foram discrepantes, 5,2 (dp 2,9) para o grupo controle, e 8,0 (dp 3,7) para o grupo experimental (p<0,001). Os resultados do ensaio clínico aleatorizado evidenciaram significativamente a diminuição da intensidade e do desconforto da sede de pacientes, após vinte minutos da degustação do picolé mentolado com a sede de pacientes que receberam o cuidado usual (p<0,001 para os dois desfechos). O picolé mentolado mostrou-se como estratégia viável para o manejo da sede em paciente no período pré-operatório. As evidências geradas na condução do estudo podem auxiliar, na tomada de decisão da equipe de saúde, acarretando a melhoria do cuidado prestado ao paciente, por meio da implementação de estratégia de fácil aplicação e barata para o manejo da sede. Outro aspecto relevante consiste na produção de conhecimento sobre a problemática, escasso tanto no cenário nacional, quanto internacional / Thirst is defined as the desire of drinking water. It is also considered a multifactorial symptom for two plausible reasons. The first refers to the provided stimulus that may be influenced for the hydration need. To put it differently, such necessity seeks to balance the volume levels and the plasmatic osmolarity. The second one is justified due to it is initiated by the person\'s various personal and cultural factors. This investigation aimed at comparing the intensity and discomfort that thirst caused in patients. The period analyzed refers to the preoperative twenty minutes after the patients ate the mentholated popsicle in comparison to patients who received the usual assistance. This randomized clinical trial was carried out with a parallel, prospective, and monocentric treatment. The sample had 40 surgical patients within the perioperative period. They were divided into two groups, namely: 20 belonged to the control group and 20 belonged to the experimental one. The patients placed into the former received the expected assistance from the health team. Regarding the patients placed into the latter, they received one mentholated popsicle at least three hours before the surgical arranged time. The data collecting tool developed was submitted to five judges\' face and content validation. The intensity and discomfort of thirst were the measured primary findings. The former was measured by using the Numeral Scale in which the number zero represents no thirst and the number ten, the most intense thirst the patients reported they have ever felt. The latter was evaluated by applying the Discomfort Scale of Preoperative Thirst whose pointing may vary from zero to fourteen. In such scale, the occurrence of fourteen corresponds to the most considerable discomfort the patients reported they have ever experienced. In terms of intensity of thirst, the initial averages were different regarding both investigated groups, scored 5,3 (dp 1,8) to the control one and 6,6 (dp 1,6) to the experimental one (p=0,02). The averages concerning the thirst initial discomfort also presented discrepancy, scored 5,2 (dp 2,9) to the first group and 8,0 (dp 3,7) to the second one (p<0,001). The results of this randomized clinical trial significantly evince the decrease of thirst intensity and discomfort on patients who ate the mentholated popsicle in comparison to the ones who received the usual assistance (p<0,001 to both outcomes). The mentholated popsicle seemed to be a feasible strategy to assist patients in the preoperative period. The evidences produced throughout the investigation may support decision makings by the health team and, consequently, improve the patient\'s given support. It might happen by the implementation of an inexpensive and effortless application of such strategy. Moreover, another relevant aspect concerns to the knowledge production due to the features this study shed lights on, which sparse in both national and international scenarios

acase@tulane.edu

The analysis of variance technique is probably the most popular statistical technique used for testing hypotheses and estimating parameters. Eisenhart presents two classes of problems solvable by the analysis of variance and the assumption underlying each class. Cochran lists the assumptions and also discusses the consequences when these assumptions are not met. It is evident that if all the assumptions are not satisfied, the confidence placed in any result obtained in this manner is adversely affected to varying degrees according to the extent of the violation. One of the assumptions in the analysis of variance procedures is that of uncorrelated errors. The experimenter may not always meet this conditions because of economical or environmental reasons. In fact, Wilk questions the validity of the assumption of uncorrelated errors in any physical situation. For example, consider an experiment over a sequence of years. A correlation due to years may exist, no matter what randomization technique is used, because the outcome of the previous year determines to a great extent the outcome of this year. Another example would be the case of selecting experimental units from the same source, such as, sampling students with the same background or selecting units from the same production process. This points out the fact that the condition such as background, or a defect in the production process may have forced a correlation among the experimental units. Problems of this nature frequently occur in Industrial, Biological, and Psychological experiments.

Os mecanismos fisiológicos de detecção e controle da sede no paciente cirúrgico idoso ocorrem de forma diferenciada do que em adultos e crianças o que justifica o investimento na condução de estudos sobre estratégias que podem proporcionar alívio deste sintoma com o uso de temperatura fria e volume pequeno. O objetivo do estudo foi comparar a intensidade e o desconforto da sede de pacientes idosos que degustaram o picolé mentolado com a sede de pacientes idosos que receberam o cuidado usual, no pós-operatório imediato. Trata-se de ensaio clínico randomizado em paralelo com dois grupos, realizado em sala de recuperação pós-anestésica de hospital público de ensino no sul do Brasil. A amostra foi composta de 50 pacientes idosos em pós-operatório imediato, os quais foram alocados em dois grupos, sendo 25 no grupo controle e 25 no grupo experimental, sem perda de seguimento. Os critérios de inclusão foram: pacientes com idade >= 60 anos; estar em jejum; verbalizar sede e ter sido aprovado na avaliação do Protocolo de Segurança no Manejo da Sede. Os pacientes com restrições à ingesta ou deglutição, bem como os que autorreferiram alergia à menta, foram excluídos. Os pacientes alocados no grupo controle receberam o cuidado usual de rotina da instituição, onde o estudo foi conduzido, que consiste na manutenção do jejum. Já os pacientes alocados no grupo experimental receberam um picolé mentolado de 20 ml. Os desfechos primários de interesse foram a intensidade e o desconforto da sede, sendo que ambos foram avaliados inicialmente (T0) e novamente (T1) após 20 minutos da intervenção ou cuidado usual. A intensidade da sede foi mensurada por meio da Escala Numérica (zero significa nenhuma sede e 10 a maior sede já vivenciada pelo paciente), e o desconforto da sede pela Escala de Desconforto da Sede Perioperatória (pontuação de zero a 14 pontos, sendo zero a ausência de desconforto e 14 corresponde ao desconforto mais intenso relacionado à sede). A mediana da intensidade e do desconforto da sede inicial (T0) foi de 6,0 para os participantes alocados no grupo experimental, e 5,0 para a intensidade e 6,0 para o desconforto da sede para os participantes alocados no grupo controle. Para a comparação das mudanças nos escores da Escala Numérica e da Escala de Desconforto da Sede Perioperatória entre o grupo experimental e o grupo controle (valor final menos valor inicial), o teste de Mann-Whitney foi empregado para diferenças de medianas. Os resultados do ensaio clínico randomizado demonstraram que houve diminuição estatisticamente significante na intensidade (p<0,001) e no desconforto da sede (p<0,001) dos pacientes cirúrgicos idosos, após vinte minutos da degustação do picolé mentolado quando comparados à intensidade e desconforto da sede dos pacientes que receberam o cuidado usual, no pósoperatório imediato. Considerando a escassez de evidências sobre estratégias para manejo da sede do paciente cirúrgico idoso, o picolé mentolado é uma estratégia inovadora e segura, podendo se tornar método de escolha para uso na prática clínica / Physiological mechanisms of detection and control of thirst in the elderly surgical patient occur differently than in adults and children, which justifies the investment in conducting studies on strategies that can provide relief of this symptom with use of cold temperature and small volume. The aim of the study was to compare thirst intensity and discomfort of elderly patients who savoured mentholated popsicle with thirst of elderly patients who received the usual care in the immediate postoperative period. This is a randomized controlled clinical trial in parallel with two groups, conducted in a post anesthesia care unit of a public teaching hospital in southern Brazil. The sample consisted of 50 elderly patients in the immediate postoperative period, who were allocated in two groups, 25 in the control and 25 in the experimental group, without follow-up losses. Inclusion criteria were: patients aged >= 60 years; being fasting; verbalize thirst and having been approved in the assessment of Safety Protocol of Thirst Management. Patients with restrictions to ingestion or swallowing, as well as those who self-referred peppermint allergy, were excluded. Patients assigned to the control group received usual routine care of the institution where the study was conducted, which consists in maintenance of fasting. Patients assigned to the experimental group received a 20 ml mentholated popsicle. Primary outcomes of interest were thirst intensity and discomfort, both of which were assessed initially (T0) and again (T1) after 20 minutes of the intervention or usual care. Thirst intensity was measured using a Numerical Scale (zero means no thirst and 10 the greatest thirst ever experienced by patient), and thirst discomfort by Perioperative Thirst Discomfort Scale (score of zero to 14 points, being zero the absence of discomfort and 14 corresponds to the most intense discomfort related to thirst). Median of initial thirst intensity and discomfort (T0) was 6.0 for the participants assigned to the experimental group, 5.0 for thirst intensity and 6.0 for thirst discomfort for the participants assigned to the control group. Mann-Whitney test was used evaluating differences in medians, comparing changes in Numerical Scale and in Perioperative Thirst Discomfort Scale between the experimental group and the control group (final value minus initial value). Results of the randomized clinical trial demonstrated that there was a statistically significant decrease in thirst intensity (p <0.001) and discomfort (p <0.001) of elderly surgical patients, after twenty minutes of tasting the mentholated popsicle when compared to thirst intensity and discomfort of the patients who received the usual care, in the immediate postoperative period. Considering the shortage of evidence on strategies for thirst management of elderly surgical patient, mentholated popsicle is an innovative and safe strategy, and may become a method of choice for use in clinical practice

Training studies involving competitive runners and road cyclists have shown substantial gains in sprint and endurance performance when sessions of high-intensity interval training were added to their usual training in the competitive phase of a season. Further research has shown large performance benefits in sprint and endurance power (7 - 9%) when cyclists combined explosive single-leg jumps with cycling-specific high-intensity interval training during a competitive season. The aim of the present study was to assess the contribution of the jumps to the gains in performance in competitive cyclists in a randomized control trial.The training protocol for the control group was based on previous experimental work in which the control group (n=8) completed cycle specific interval training followed by a series of explosive single-leg jumps. The experimental group (n=7) carried out the same cycle specific interval training but did not participate in the explosive single-leg jumps. While the current study did not use a true control group, the investigation was carried out in the knowledge that a combination of high intensity interval cycling and explosive single-leg jumps causes changes positive changes in performance. Participants took part in 10 x 30-min sessions consisting four sets of high intensity intermittent cycling (4 x 30-s maximum efforts at 50 - 60 min-1 alternating with 30-s recovery). Between each set of 4 x 30 s sprints the control (ballistic) group carried out one set of explosive single-leg jumps (20 for each leg), while the experimental (continuous) group cycled for 20 s at 50 - 60 min-1.Before and after the training period all cyclists completed an incremental peak power test for assessment of VO2max, lactate threshold, exercise economy and peak power, a 30 s Wingate sprint test and a 20 km time-trial. Relative to the control group the percent mean changes (±90% confidence limits) in the experimental group were: power at 4-mM lactate, -4.2 (±6.3); VO2max, -3.1 (±3.7); mean time-trial power, -0.7 (± 4.7); peak incremental power, -1.7; (±5.0); power at 80% max heart rate, -2.8; (±5.6); Wingate peak power, -4.2; (±7.8). We conclude that high-intensity training may improve performance but the combination of high-intensity training and explosive resistance training in the competitive phase is likely to produce greater gains in trained cyclists than high intensity cycling alone.

<p>As evidenced by several trials, cognitive behavior therapy (CBT) is a highly effective treatment for Panic disorder with or without agoraphobia (PD). However, therapists are short in supply, and patients with agoraphobia may not seek therapy due to fear of leaving their homes or traveling certain distances. A major challenge therefore is to increase the accessibility and affordability of evidence-based psychological treatments.</p><p>This thesis is based on five studies; three treatment studies set up as randomized controlled trails (RCT), one prevalence study, and one study testing the equivalence of an Internet-administered diagnostic assessment tool with a clinician-administered interview.</p><p>Study I showed that the Swedish 12-month PD prevalence is consistent with findings in most other parts of the Western world (2.2%; CI 95% 1.0%-3.4%). There was a significant sex difference, with a greater prevalence for women (3.6%) compared to men (0.7%).</p><p>Study II showed that the validity of the computerized diagnostic interview (CIDI-SF) was generally low. However, the agoraphobia and obsessive-compulsive disorder modules had good specificity and sensitivity, respectively.</p><p>The three RCTs showed, directly or indirectly, that Internet-based self-help is superior to a waiting-list. When 10 individual weekly sessions of CBT for PD was compared with a 10-module self-help program on the Internet, the results suggest that Internet-administered self-help, plus minimal therapist contact via e-mail, is as effective as traditional individual CBT (80% vs. 67% no longer met criteria for panic disorder; composite within-group effect size was Cohen’s <i>d</i>= 0.78 vs. 0.99). One-year follow-up confirmed the results (92% vs. 88% no longer met criteria for panic disorder; <i>d</i>= 0.80 vs. 0.93). The results generally provide evidence to support the continued use and development of Internet-distributed self-help programs.</p>

The increasing popularity of traditional Chinese medicine (TCM) therapies as health care options warrants thorough examination of the efficacy and safety evidence around these therapies. This thesis explores the intersection of TCM and fatigue using two rigorous methodologies: systematic reviews (SRs) and a randomized controlled clinical trial (RCT). In order to inform the development of an RCT of acupuncture for infectious mononucleosis (mono), a common condition with no known cure, characterized by profound fatigue, we examined the literature on TCM treatment of mono as well as another fatigue condition, idiopathic chronic fatigue (ICF). Additionally, we investigated the literature on the safety of pediatric acupuncture. SRs of TCM efficacy in mono and ICF determined that although clinical trials exist, methodological flaws compromised their validity. In particular, studies published as RCTs were found to lack proper randomization. Inclusion of these studies in the SRs would have been inappropriate and demonstrates the importance of verifying RCT methods. We also present the results of the first known SR of pediatric acupuncture safety. This review was comprehensive, including a large number of databases and publications in any language. Synthesis of the results from those studies that included a denominator produced mild adverse event estimates of 16.3/100 (95% CI 11.221.5) per patient, for RCTs, and 6.3/100 (95% CI 4.97.7) per patient, for cohort studies, with a combined estimate of 7.8/100 (95% CI 6.49.2) per patient. We developed and conducted an RCT of acupuncture for mono, although limitations to recruitment resulted in the enrolment of only three participants. The primary result of the small sample size was to restrict the determination of treatment effect, however, successful implementation of other elements is informative to further research in this area. In addition, we determined the local 5-year Monospot positive incidence rate to be 1.11/1000 (95% CI 0.953.2) for all ages and 5.46/1000 (95% CI 0.8910.0) for the 15-25 year old group. This dissertation examined the evidence around TCM and fatigue and provides recommendations that are aimed at increasing the value of research and the safety and efficacy of practice in this area.

Aim:To investigate the differences, if any, between tooth-anchored maxillary expansion (TME) and bone-anchored maxillary expansion (BME) in terms of the produced longitudinal dentoskeletal changes -and the stability of these changes- in adolescents with maxillary constriction. Methods:Sixty two suitable subjects were randomly assigned to one of three groups: (1) TME group; (2) BME group; (3) Control group. Lateral cephalograms, posteroanterior cephalograms, and dental casts were obtained at baseline and at three post-expansion time points. Records from all time points were analyzed. Results:There were no clinically significant differences between the TME and BME groups at any data collection time point. Both showed initial increases in dentoskeletal widths and dental tipping which were subsequently largely lost to relapse in the absence of retention. Conclusion:There are no clinically significant differences in the dentoskeletal changes -or the stability of these changes- produced by TME and BME in adolescents with maxillary constriction.