Browsing by Author "Vasconcelos, M."
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- Patient-physician discordance in assessment of adherence to inhaled controller medication: a cross-sectional analysis of two cohortsPublication . Jácome, C.; Pereira, A.; Almeida, R.; Ferreira-Magalhães, Manuel; Couto, M.; Araujo, L.; Pereira, M.; Correia, M.; Loureiro, C.; Catarata, M.; Maia Santos, L.; Pereira, J.; Ramos, B.; Lopes, C.; Mendes, A.; Cidrais Rodrigues, J.; Oliveira, G.; Aguiar, A.; Afonso, I.; Carvalho, J.; Arrobas, A.; Coutinho Costa, J.; Dias, J.; Todo Bom, A.; Azevedo, J.; Ribeiro, C.; Alves, M.; Leiria Pinto, P.; Neuparth, N.; Palhinha, A.; Gaspar Marques, J.; Pinto, N.; Martins, P.; Todo Bom, F.; Alvarenga Santos, M.; Gomes Costa, A.; Silva Neto, A.; Santalha, M.; Lozoya, C.; Santos, N.; Silva, D.; Vasconcelos, M.; Taborda-Barata, L.; Carvalhal, C.; Teixeira, M.; Alves, R.; Moreira, A.; Sofia Pinto, C.; Morais Silva, P.; Alves, C.; Câmara, R.; Coelho, D.; Bordalo, D.; Fernandes, R.; Ferreira, R.; Menezes, F.; Gomes, R.; Calix, M.; Marques, A.; Cardoso, J.; Emiliano, M.; Gerardo, R.; Nunes, C.; Câmara, R.; Ferreira, J.; Carvalho, A.; Freitas, P.; Correia, R.; Fonseca, J.Objective: We aimed to compare patient's and physician's ratings of inhaled medication adherence and to identify predictors of patient-physician discordance. Design: Baseline data from two prospective multicentre observational studies. Setting: 29 allergy, pulmonology and paediatric secondary care outpatient clinics in Portugal. Participants: 395 patients (≥13 years old) with persistent asthma. Measures: Data on demographics, patient-physician relationship, upper airway control, asthma control, asthma treatment, forced expiratory volume in one second (FEV1) and healthcare use were collected. Patients and physicians independently assessed adherence to inhaled controller medication during the previous week using a 100 mm Visual Analogue Scale (VAS). Discordance was defined as classification in distinct VAS categories (low 0-50; medium 51-80; high 81-100) or as an absolute difference in VAS scores ≥10 mm. Correlation between patients' and physicians' VAS scores/categories was explored. A multinomial logistic regression identified the predictors of physician overestimation and underestimation. Results: High inhaler adherence was reported both by patients (median (percentile 25 to percentile 75) 85 (65-95) mm; 53% VAS>80) and by physicians (84 (68-95) mm; 53% VAS>80). Correlation between patient and physician VAS scores was moderate (rs=0.580; p<0.001). Discordance occurred in 56% of cases: in 28% physicians overestimated adherence and in 27% underestimated. Low adherence as assessed by the physician (OR=27.35 (9.85 to 75.95)), FEV1 ≥80% (OR=2.59 (1.08 to 6.20)) and a first appointment (OR=5.63 (1.24 to 25.56)) were predictors of underestimation. An uncontrolled asthma (OR=2.33 (1.25 to 4.34)), uncontrolled upper airway disease (OR=2.86 (1.35 to 6.04)) and prescription of short-acting beta-agonists alone (OR=3.05 (1.15 to 8.08)) were associated with overestimation. Medium adherence as assessed by the physician was significantly associated with higher risk of discordance, both for overestimation and underestimation of adherence (OR=14.50 (6.04 to 34.81); OR=2.21 (1.07 to 4.58)), while having a written action plan decreased the likelihood of discordance (OR=0.25 (0.12 to 0.52); OR=0.41 (0.22 to 0.78)) (R2=44%). Conclusion: Although both patients and physicians report high inhaler adherence, discordance occurred in half of cases. Implementation of objective adherence measures and effective communication are needed to improve patient-physician agreement.
- Síndrome de Miller Fisher numa criançaPublication . Gomes, D.; Leite, F.; Andrade, N.; Vasconcelos, M.; Robalo, C.; Fineza, I.Introdução: O síndrome de Miller Fisher, variante do síndrome de Guillain-Barré, é uma doença desmielinizante inflamatória aguda, que é rara em idade pediátrica. O seu diagnóstico é baseado na tríade oftalmoplegia, ataxia e arreflexia. Em cerca de metade dos casos está descrita uma intercorrência infecciosa precedendo os sintomas neurológicos em cinco a dez dias. Caso clínico: Os autores relatam o caso de uma criança de cinco anos de idade com disartria, ataxia e oftalmoplegia após episódio de gastroenterite aguda na semana prévia ao início da sintomatologia. À observação apresentava disartria, parésia bilateral do VI par, fraqueza muscular distal (de predomínio nos membros direitos) com ausência dos reflexos osteotendinosos aquilianos. A investigação analítica e imagiológica inicial não revelou alterações. O resultado do electromiografia foi compatível com poliradiculoneuropatia subaguda. O diagnóstico de síndrome Miller Fisher foi efectuado após exclusão de outras etiologias. A evolução clínica foi favorável, sem insuficiência respiratória ou outras complicações, com melhoria gradual dos défices neurológicos. Houve recuperação da ataxia ao fim de quatro semanas e da oftalmoplegia três meses após o diagnóstico. Conclusões: O síndrome Miller Fisher é extremamente raro em idade pediátrica e constitui um desafi o diagnóstico neste grupo etário. O prognóstico é habitualmente favorável. A propósito deste caso são discutidos os principais diagnósticos diferenciais. ABSTRACT Background: Miller Fisher syndrome, a variant of Guillain-Barré syndrome, is an acute inflammatory demyelinating disease that is rare in children. The diagnosis is based on the triad of ophthalmoplegia, ataxia and areflexia. In about half of the cases there is an infectious complication preceding neurologic symptoms in five to ten days. Case report: We describe the case of a five year-old boy who presented with a three-day history of diplopia, dysarthria and gait disturbance following an acute gastroenteritis. On examination he was found to have ataxia, areflexia and ophthalmoplegia. The laboratorial and imaging investigations were normal. The results of electromyogram were consistent with subacute polyradiculoneuropathy. The diagnosis of Miller Fisher syndrome was made after the exclusion of other conditions. The clinical outcome was favorable without respiratory failure or other complications, with gradual improvement of neurological deficits. Ataxia was restored in four weeks and ophthalmoplegia improved three months later. Conclusions: Miller Fisher syndrome is extremely rare in children and is a diagnostic challenge at those ages. Outcome is usually good. This report outlines the frequency of Miller Fisher syndrome and lists the differential diagnoses that should be considered.