MENGATASI NYERI TRIGEMINAL NEURALGIA DENGAN AKUPUNKTUR DI KLINIK AKUPUNKTUR MANDIRI “E” MALANG

Nyeri trigeminal neuralgia dirasakan sebagai sensasi sakit di wajah yang datang secara tiba-tiba dan menyebar ke area rahang, pipi dan dahi. Terapi farmakologis medis dan bedah yang ada cukup efektif dalam banyak kasus, tetapi untuk sejumlah besar pasien kurang memuaskan bahkan gagal memberikan perbaikan. Tindakan lanjutan berupa operasi sering terjadi komplikasi dan kambuhan berulang. Terapi akupunktur telah lama memiliki reputasi dalam membantu berbagai sindrom nyeri dan dilaporkan efektif untuk kasus nyeri trigeminal neuralgia. Penelitian ini dilakukan dengan tujuan untuk mengetahui pengaruh terapi akupunktur terhadap intensitas nyeri pasien trigeminal neuralgia di klinik akupunktur mandiri “E” Malang. Metode. Penelitian ini menggunakan desain Pre-Experimental Design dengan Pre-Test and Post-Test Design. Semua pasien trigeminal neuralgia yang datang berobat ke Klinik Akupunktur Mandiri “E” Malang pada tanggal 1-30 April 2019 sebanyak 10 orang dijadikan sebagai sampel. Pengukuran nyeri penggunakan skala nyeri Bourbanis. Teknik analisis data menggunakan uji Tanda Wilcoxon. Hasil. Terbukti signifikan ada pengaruh terapi akupunktur terhadap intensitas nyeri pasien trigeminal neuralgia di klinik akupunktur mandiri ”E” Malang. Diskusi. Memasukkan jarum akupunktur ke titik akupunktur menghasilkan sensasi de-qi, yang dapat menggairahkan semua serat aferen dari jaringan otot. Keuntungan akupunktur dibandingkan tindakan obat dan bedah adalah tidak ada risiko reaksi alergi yang mengancam jiwa dan tanpa komplikasi. Kesimpulan. Dari hasil di atas dapat dinyatakan bahwa terapi dengan jarum akupunktur dapat mengatasi nyeri trigeminal neuralgia dengan aman.

Electroacupuncture and Transcutaneous Electrical Nerve Stimulation Induced Sensations in Bell’s Palsy Patients: A Quantitative Current Intensity Analysis

BackgroundThe intensity of electrical acupoint stimulation such as electroacupuncture (EA) and transcutaneous electrical nerve stimulation (TENS) is regulated by the observation of skin shivering or the participant’s comfort response. However, the specific intensity and spatial scope following EA or TENS stimulation are unclear.ObjectiveThis study aimed to test the stimulatory current intensities of lower and upper sensation thresholds in TENS- and EA-based treatment of Bell’s palsy patients. Also, the spatial scope of the stimulation at these current intensities was simulated and measured quantitatively.MethodsA total of 19 Bell’s palsy patients were recruited. Six acupoints on the affected side of the face were stimulated by TENS and EA successively at 30-min intervals. During the stimulation, the current intensity was regulated gradually from 0 to 20 mA, and we simultaneously measured the lower (sensory) and upper (tolerability) sensations. After the treatment by TENS and EA, the modified Chinese version of the Massachusetts General Hospital Acupuncture Sensation Scales (C-MMASS) was applied to survey the de-qi sensations during stimulation. Additionally, we analyzed the correlation between current intensities and C-MMASS and comfort scores. Finite element models were established to depict the spatial distribution of electric field gradients at the lower and upper thresholds.ResultsThe mean sensory and tolerability thresholds of TENS were 3.91–4.37 mA and 12.33–16.35 mA, respectively. The median sensory and tolerability thresholds of EA were 0.2 mA and 2.0–3.2 mA, respectively. We found a significant correlation between total C-MMASS scores and the current intensities at the tolerability threshold of TENS. The finite element model showed that the activated depths of TENS and EA at the lower threshold were 3.8 and 7 mm, respectively, whereas those at the upper threshold were both 13.8 mm. The cross-sectional diameter of the activated area during TENS was 2.5–4 times larger than that during EA.ConclusionThis pilot study provided a method for exploring the current intensity at which the de-qi sensations can be elicited by TENS or EA. The finite element analysis potentially revealed the spatial scope of the electrical stimulation at a specific current intensity.

Acupuncture at the P6 Acupoint to Prevent Postoperative Pain after Craniotomy: A Randomized, Placebo-Controlled Study

Objective. Acute pain management after craniotomy can be challenging. Previous studies have shown inadequate pain control following the procedure. Oral medication can sometimes be delayed by postoperative nausea, and use of anesthetics may impair the assessment of brain function. We conducted this prospective study to evaluate the effect of acupuncture at the P6 acupoint on postoperative pain, nausea, and vomiting in patients undergoing craniotomy. Methods. The authors conducted a randomized, placebo-controlled trial among 120 patients scheduled for craniotomy under general anesthesia. 120 patients were randomly assigned into an acupuncture group or a sham acupuncture group. All patients received standardized anesthesia and analgesia treatment. Acupuncture was executed in the recovery room after surgery. For the acupuncture group, the P6 points on each wrist were punctured perpendicularly to a depth of 20 mm. Needles were retained for 30 min and stimulated every 10 min to maintain the De-Qi sensation. For the sham acupuncture group, sham points on each wrist were punctured perpendicularly to a depth of 5 mm. Needles were retained for 30 min with no stimulation during the duration. The postoperative pain scores, PONV, and dose of tramadol were assessed 24 h, 48 h, and 72 h after surgery. Results. A total of 117 patients completed the study. There was no statistically significant difference in baseline data between the two groups ( P > 0.05 ). The VAS pain score of the acupuncture group was lower than that of the sham acupuncture group, and this difference was statistically significant ( P = 0.002 ). There was no difference in pain scores between the two groups during 0–24 h and 48–72 h ( P > 0.05 ). The incidence of vomiting in the acupuncture group was lower than that in the sham acupuncture group during the 0–24 h period (13.8% vs. 28.8%, P = 0.048 ). There was no difference in vomiting, however, during the 24–72 h period ( P > 0.05 ). No significant differences were found in the degree of nausea and the dose of tramadol between the two groups at either time point in the acupuncture group and sham acupuncture group. Conclusion. The use of acupuncture at the P6 acupoint in neurosurgery patients did result in significantly lower pain scores and reduction in the incidence of vomiting after craniotomy. There were no significant side effects. Acupuncture at the P6 acupoint was well tolerated and safe in this patient population.

Ação da acupuntura no sintoma de fogachos em mulheres após câncer de mama: revisão integrativa

Objetivo: Investigar evidências, na literatura, acerca da ação da acupuntura no sintoma de fogachos em mulheres, após câncer de mama e estabelecer um protocolo para o tratamento dessa condição. Método: Revisão integrativa, conduzida em agosto de 2019. Utilizaram-se bases de dados nacionais e internacionais. Resultados: Foram encontradas 288 pesquisas e 11 foram incluídas no estudo. A acupuntura demonstrou resultados positivos sobre os sintomas de fogachos. Não há padronização no tratamento, porém um possível protocolo foi proposto: realização da acupuntura sistêmica ou eletroacupuntura nos acupontos Baço 6, Fígado 3, Rim 3, Circulação sexo 6, Vaso concepção 4, Bexiga 23 e Vaso Governador 20, agulhas sistêmicas que devem ser manipuladas até obter a sensação De qi, 10 sessões, uma ou duas vezes por semana, com retenção das agulhas nos acupontos em aproximadamente 25 minutos. Conclusão: a acupuntura parece ser uma intervenção efetiva para o tratamento e controle dos fogachos em mulheres, após câncer de mama e consiste em uma opção terapêutica a qual o enfermeiro pode executar de maneira autônoma e independente em todos os níveis de atenção. Torna-se necessária a realização de ensaios clínicos randomizados com a utilização do protocolo proposto a fim de validá-lo.

Inteligência fluida como preditora do desempenho acadêmico em Língua Portuguesa e Matemática

A presente pesquisa correlacionou dados provenientes da aplicação do teste de Inteligência BPR-5 com uma avaliação escolar de matemática e língua portuguesa em uma amostra de 679 alunos do nono ano do ensino fundamental de quatro escolas de uma rede particular de ensino. Os resultados dessas avaliações se mostraram fortemente correlacionados e estatisticamente significativos com escores dos testes de QI (r =,58, p < 0,01), evidenciando elevadas cargas em Inteligência Fluida (Gf). Uma análise longitudinal (5° ao 9° ano) foi aplicada através do Modelo de Curva de Crescimento Latente que investigou a média da variância inicial (intercepto) e a média de crescimento (slope) no desempenho acadêmico (DA) dos sujeitos, em dois modelos (com e sem a variável independente BPR), com o objetivo de investigar a capacidade preditiva de Gf no DA. Quando inserida a variável BPR, seu impacto no intercepto foi estimado em 20,288 e no slope, 6,381. Essas estimativas indicam o acréscimo no desempenho inicial e no crescimento no DA em razão de cada ponto a mais no escore em BPR. A diferença entre o intercepto e o slope foi negativa e estatisticamente significativa (-224,156, p < 0,01), sinalizando que os sujeitos que apresentaram desempenho inicial mais baixo no DA, obtiveram um crescimento maior no período avaliado. Assim, a capacidade preditiva de Gf sobre o DA foi demonstrada, corroborando os resultados da literatura.

Barriers to and Enablers of Implementation of High-Value Interventions by Renal Pharmacists: A Qualitative Study Informed by the Theoretical Domains Framework

ABSTRACTBackground: Previous studies have shown that patients with chronic kidney disease who are followed by a renal clinical pharmacist have improved clinical outcomes. In 2016, a consensus list of quality indicator drug therapy problems (QI-DTPs) was developed by renal clinical pharmacists to help prioritize which renal patients should receive interventions. Before QI-DTP interventions can be implemented in clinical practice, barriers to and enablers of their use need to be identified, to allow development of strategies to overcome the barriers and apply the enablers.Objective: To identify modifiable barriers to and enablers of implementation of renal QI-DTP interventions by renal clinical pharmacists.Methods: In this exploratory qualitative descriptive study, one-on-one, semistructured, audio-recorded telephone interviews were conducted with renal clinical pharmacists to identify the barriers to and enablers of implementation of renal QI-DTP interventions. The interviews consisted of questions developed according to the Theoretical Domains Framework.Results: Interviews were conducted with 13 renal pharmacists from across Canada. The main barriers to implementation of renal QI-DTP interventions that participants identified were knowledge gaps, prioritization, and nephrologist acceptance. The main enablers identified were training, colleague support, and better patient care.Conclusion: Three barriers to and three enablers of implementation of renal QI-DTP interventions were identified. These barriers and enablers can be used to help with pharmacist education and to optimize the care that pharmacists provide to renal patients.RÉSUMÉContexte : Des études précédentes démontrent une amélioration des résultats cliniques de patients souffrant d’une maladie rénale chronique, qui sont suivis par un pharmacien clinicien en néphrologie. En 2016, des pharmaciens cliniciens en néphrologie ont mis au point une liste consensuelle des indicateurs de qualité des problèmes de pharmacothérapie (QI-DTP) pour les aider à prioriser les patients souffrant d’une insuffisance rénale, qui doivent subir une intervention. Avant de mettre en place ces QI-DTP en pratique clinique, on doit déterminer les éléments qui entravent et facilitent leur utilisation pour pouvoir élaborer des stratégies visant à surmonter les obstacles et à appliquer les éléments facilitateurs.Objectif :Déterminer les éléments modifiables qui entravent et facilitent la mise en place des QI-DTP par les pharmaciens cliniciens en néphrologie lors d’interventions rénales.Méthodes : Dans cette étude exploratoire, descriptive et qualitative, des entretiens téléphoniques individuels, semi structurés et enregistrés ont été menés auprès de pharmaciens cliniciens en néphrologie pour determiner les éléments qui entravent et facilitent la mise en place de QI-DTP lors d’interventions rénales. Les entretiens consistaient en des questions préparées selon le Theoretical Domains Framework.Résultats : Les entretiens ont été menés auprès de 13 pharmaciens en néphrologie de partout au Canada. Les principaux éléments entravant la mise en place de QI-DTP lors d’interventions rénales déterminées par les participants étaient : le manque de connaissances, la priorisation et l’acception des néphrologues. Les principaux éléments facilitant la tâche étaient : la formation, le soutien des collègues et de meilleurs soins offerts aux patients.Conclusion : Trois éléments entravant et trois éléments facilitant la mise en place de QI-DTP lors d’interventions rénales ont été déterminés. Ils peuvent être utilisés pour contribuer à la formation du pharmacien et pour optimiser les soins offerts aux patients qui souffrent d’insuffisance rénale.

Free abelian group actions on normal projective varieties: submaximal dynamical rank case

Let X be a normal projective variety of dimension n and G an abelian group of automorphisms such that all elements of $G\setminus \{\operatorname {id}\}$ are of positive entropy. Dinh and Sibony showed that G is actually free abelian of rank $\le n - 1$ . The maximal rank case has been well understood by De-Qi Zhang. We aim to characterize the pair $(X, G)$ such that $\operatorname {rank} G = n - 2$ .

Contribution of Pharmacy Practice Residents to Resolution of Drug Therapy Problems for Patients: RES-DTP Study

ABSTRACTBackground: Canadian pharmacy practice residency programs promote development of key competencies for direct patient care resulting in resolution of drug therapy problems (DTPs), which is 1 of 8 national clinical pharmacy key performance indicators. There are no Canadian data on the contribution of residents to resolution of DTPs, including DTPs for priority diseases covered in disease-state education modules (PD-DTPs) or quality indicator DTPs (QI-DPTs), as assessed through application of evidence-based interventions proven to reduce morbidity, mortality, or health resource utilization. Objective: To describe the contribution of pharmacy practice residents to direct patient care using 3 process-of-care measures: resident-resolved DTPs, PD-DTPs, and QI-DTPs. Methods: This prospective, observational single-group study was conducted across 5 rotation sites within the authors’ health authority from September 2, 2013, to June 13, 2014. The primary outcome was number of DTPs resolved. The secondary outcomes were number of PD-DTPs resolved; number of QI-DTPs resolved; numbers of DTPs, PD-DTPs, and QI-DTPs resolved over time; and residents’ satisfaction with electronic tracking of resolved DTPs (in terms of training, usability, efficiency, and time requirements). Results: Four residents completed a total of twenty-one 4-week rotations and resolved a total of 1201 DTPs. Of these, 620 (52%) were PD-DTPs and 479 (40%) were QI-DTPs. Overall, the number of interventions increased for rotations 1–3, decreased for rotations 4 and 5, and increased again for rotation 6. The median score for all questions in all domains of the satisfaction survey was 4 out of 5 (“agree”). Conclusions: Pharmacy practice residents were resolving DTPs, PD-DTPs, and QI-DTPs for patients and were contributing significantly to direct patient care. On the basis of literature evidence, the number and type of interventions observed in this study would be expected to improve clinical and health economic outcomes for patients.RÉSUMÉContexte : Les programmes de résidence canadiens en pratique pharma-ceutique encouragent le développement de compétences clés relatives aux soins directs offerts aux patients. Ces compétences entraîneront la résolu-tion des problèmes de pharmacothérapie (DTP), l’un des huit indicateurs clés nationaux de rendement relatifs à la pharmacie clinique. Il n’existe pas de données canadiennes portant sur la contribution des résidents à la résolution des problèmes de pharmacothérapie, notamment ceux relatifs aux maladies prioritaires (PD-DTP) couverts dans les modules d’éducation sur les problèmes de santé, ou les indicateurs de qualité des DTP (QI-DPT), évalués au moyen d’interventions fondées sur des données scientifiques dont il a été prouvé qu’elles réduisaient la morbidité, la mortalité ou l’utilisation des ressources sanitaires. Dans une étude, les intervenants avaient des opinions divergentes concernant la contribution des résidents à la résolution des DTP, des PD-DTP et des QI-DTP.Objectif : Décrire la contribution des résidents dans le cadre de la pratique pharmaceutique des soins directs offerts aux patients à l’aide de trois mesures spécifiques du processus des soins : DTP, PD-DTP et QI-DTP résolus par les résidents. Méthodes : Cette étude prospective par observation portant sur un seul groupe a été menée dans cinq sites de rotation compris dans la sphère d’autorité sanitaire des auteurs, du 2 septembre 2013 au 13 juin 2014. Le résultat principal était le nombre de DTP résolus. Les résultats sec-ondaires étaient les suivants : nombre de PD-DTP résolus; nombre de QI-DTP résolus; nombre de DTP, de PD-DTP et de QI-DTP résolus avec le temps; et la satisfaction des résidents à l’égard du suivi électronique de leurs DTP résolus (en termes de formation, de facilité d’utilisation, d’efficacité et d’exigences en matière de temps). Résultats : Quatre résidents ont effectué un total de 21 rotations de quatre semaines et ont résolu 1201 DTP. De ceux-ci, 620 (52 %) étaient des PD-DTP et 479 (40 %), des QI-DTP. Les interventions générales ont augmenté de la 1re à la 3e rotation; elles ont diminué à la 4e et à la 5e rotation; elles ont à nouveau augmenté à la 6e rotation. Le score moyen de toutes les questions posées dans l’enquête de satisfaction, tous domaines confondus, était de 4 sur 5 (ou « d’accord »).Conclusions : Les résidents en pratique pharmaceutique résolvaient les DTP, les PD-DTP et les QI-DTP des patients et contribuaient de manière significative aux soins directs aux patients. Sur base de la documentation, on pourrait s’attendre à ce que le nombre et le type d’interventions observées dans cette étude améliorent les résultats cliniques et sanitaires des patients.

(Re)Significações no Processo de Avaliação do Sujeito Jovem e Adulto com Deficiência Intelectual

RESUMO Este artigo objetiva problematizar o processo de avaliação do sujeito com Deficiência Intelectual (DI) e seus efeitos em termos de definição, de classificação e de diagnósticos produzidos sobre a DI. As discussões propostas partem de uma análise referente às diferentes abordagens presentes nos manuais da Associação Americana de Deficiência Intelectual e de Desenvolvimento (AAIDD, 2010 e AAMR, 2006) e suas (re)significações. Procuramos colocar sob tensionamento discursos utilizados para delimitar quem são os sujeitos com DI; que características os constituem; que comportamentos os caracterizam; que potencialidades em termos de aprendizagens eles possuem e que apoios necessitam no contexto educacional. Em articulação com tais análises, apresentamos os dados produzidos no projeto “As contribuições do Rio Grande do Sul para a validação da Escala de Intensidade de Suporte - SIS no Brasil”. Amparadas teoricamente nas discussões socioantropológicas propostas por Lev S. Vigotski, tomamos tais dados como elementos para a construção de uma análise que nos possibilite indicar que faz-se possível (e necessário) um olhar para a DI que não parta dos indicadores de QI, historicamente responsável pela delimitação da DI em níveis de severidade, cujas possibilidades de desenvolvimento passaram a ser antecipadamente indicadas pelos diagnósticos clínicos. Nesse sentido, entendemos que, ao deslocarmos a ênfase do diagnóstico do QI para os sistemas de apoio, passamos a perceber um sujeito produzido nas práticas culturais, cujas possibilidades de desenvolvimento e aprendizagem não são exclusivamente determinadas pelos seus aspectos biológicos, mas, sim e principalmente, pelas interações sociais que ele estabelece ao longo de seu desenvolvimento.