Purpose: Age-related macular degeneration (AMD) is a leading cause of blindness, particularly in higherincome countries. Although dry AMD accounts for 85% to 90% of AMD cases, a comprehensive understanding of the global dry AMD burden is needed.Methods: A targeted literature review was conducted in PubMed, MEDLINE, Embase, and the Cochrane Database of Systematic Reviews (1995Reviews ( -2019 to identify data on the epidemiology, management, and humanistic and economic burden of dry AMD in adults. A landscape analysis of patientreported outcome (PRO) instruments in AMD was also conducted via searches in PubMed (1995PubMed ( -2019, ClinicalTrials.gov, PROQOLID, PROLABELS, and health technology assessment reports (2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018).Findings: Thirty-seven of 4205 identified publications were included in the review. Dry AMD prevalence was 0.44% globally, varied across ethnic groups, and increased with age. Patients with dry AMD had higher risks of all-cause mortality (hazard ratio [HR] = 1.46; 95% CI, 0.99-2.16) and tobacco-related (HR = 2.86; 95% CI, 1.15-7.09) or cancer deaths (HR = 3.37; 95% CI, 1.56-7.29; P = 0.002) than those without dry AMD. Smoking, increasing age or cholesterol levels, and obesity are key risk factors for developing dry AMD. No treatment guidelines were identified for dry AMD specifically; management focuses on risk factor reduction and use of dietary supplements. In the United States and Italy, direct medical costs and health care resource utilization were lower in patients with dry versus wet AMD. Patients with dry AMD, particularly advanced disease, experienced significant visual function impairment. Dry AMD symptoms included reduced central vision, decreased ability to see at night, increased visual blurriness, distortion of straight lines and text, and faded color vision. Most PRO instruments used in AMD evaluations covered few, if any, of the identified symptoms reported by patients with dry AMD. Although the Quality of Life and Vision Function Questionnaire, 25-item National Eye Institute Vision Function Questionnaire, Low Vision Quality of Life, Impact of Vision Impairment-Very Low Vision, and Functional Reading Independence Index had strong content validity and psychometric properties in patients with dry AMD, they retained limited coverage of salient concepts.Implications: Despite dry AMD accounting for most AMD cases, there are substantial gaps in the published literature, particularly the humanistic and economic burden of disease and the lack of differentiation among dry, wet, or unspecified dry AMD. The significant burden of illness alludes to a high unmet need for tolerable and effective treatment options, as well as PRO instruments with more coverage of dry AMD symptoms and salient concepts. ( Clin Ther.

There appears to be a beneficial impact of PR on PF in certain groups of patients with bronchiectasis. In addition, PR indications and protocols for patients with bronchiectasis may need to be adapted to accommodate specific patients, so that expressive exercise capacity improvement can be achieved.

Introduction No published literature systematically explores the dry age-related macular degeneration (AMD) patient experience. To inform the development of patient-reported outcome measures (PROMs), the important and relevant signs, symptoms, and impacts for patients with dry AMD were identified. Methods A holistic approach was used to capture, define, and organize the signs, symptoms, and impacts that are important to patients with dry AMD. Qualitative evidence was identified through a targeted literature review and clinician ( N = 5) and patient ( N = 20) interviews. The targeted review was expanded to include patients with AMD, as few studies specific to dry AMD were identified. The qualitative evidence was incorporated into a conceptual model that included the signs, symptoms, and impacts of dry AMD affecting the patient experience. Results Twenty-nine articles (dry AMD, N = 5; general AMD, N = 24) exploring health-related quality-of-life evidence in patients with AMD were identified. Concepts identified and included in the preliminary, literature-based model included signs and symptoms related to general vision loss and general impacts (e.g., dependency on others, poor spatial perception/mobility, difficulty reading, emotional affects). No concepts unique to dry AMD were identified. Interviewed clinicians refined the literature-based model. Across all visual acuity severities, ≥ 80% of patients reported difficulty driving, reading, and completing activities of daily living, along with frustration and dependency on others; all patients reported blurred vision. The final model included 35 signs, symptoms, and impacts, with 19 considered salient. Conclusions To better understand the patient experience, we captured, defined, and organized signs, symptoms, and impacts into a dry AMD conceptual model. This model can aid in the development of PROMs reflecting the experience of patients with dry AMD. Supplementary Information The online version contains supplementary material available at 10.1007/s40123-020-00325-y.

A well-functioning arteriovenous fistula offers the most adequate haemodialytic treatment. Complications due to vascular access represent nearly 30% of inpatient hospitalisation (normally due to thrombosis) and are an important cause of morbidity and mortality in such patients.Daily on haemodialysis units, nurses have to make specific interventions and determine specific outcomes for each patient and situation. The puncture of an arteriovenous fistula is one of these situations due to the fact that the correct puncture is a fundamental factor for a good haemodialysis session.Often punctures are accompanied by haemorrhages and frequent loss of blood, with side effects, which we all know, especially a drop in haemoglobin. Knowing how important the blood loss in regular haemodialysis patients is we thought it important to study the puncture technique.We carried out a study of seventeen patients with end-stage renal disease on a regular programme of haemodialysis three times a week, four hours per session and bearers of an arteriovenous fistula as vascular access, for a period of six months. Our goal was to determine which puncture technique would minimise the occurrence of haemorrhages -whether to puncture with the bevel upward or the bevel downward.In our study we punctured all seventeen patients for a period of three months (374 punctures) with the bevel upward and the other three months (374 punctures) the same patients with the bevel downward. 16G needles were used in all punctures.Of the 748 punctures made there was only 27 (3.6%) haemorrhages. In the punctures made with the bevel upward 26 (6.9 %) haemorrhages occurred; of the punctures made with the bevel downward 1 (0.26%) haemorrhage occurred.We can conclude that the bevel downward puncture reduces substantially the occurrence of haemorrhage, minimising blood loss during treatment and also provokes a smaller laceration of the skin. However there are some difficulties with this procedure including greater resistance of the skin to the penetration of the needle. Another difficulty found was in the presence of large veins the position of the needle hindered the maintenance of the blood flow.Despite the difficulties found we conclude that puncture of arteriovenous fistulae with the bevel downward increases the quality of treatment by preventing blood loss during the haemodialysis session. BIBLIOGRAPHY 1. Dauguirdas JT, Ing TS. Handbook of dialysis.

No abstract

Introdução: A Reabilitação Respiratória (RR) integra a componente não farmacológica das principais guidelines clínicas para o controlo e tratamento das doenças respiratórias crónicas. O Enfermeiro de Reabilitação (ER), integrado numa equipa multidisciplinar, concebe, implementa e monitoriza programas de RR onde se inclui o treino do exercício. Sendo o conhecimento disciplinar de enfermagem um dos pilares da decisão clínica e a garantia da qualidade e segurança dos cuidados de enfermagem torna-se relevante conhecer o impacte destes programas, conduzidos por ER, de forma a melhorar a prática clinica. Objetivo: Conhecer o impacte dos programas de RR, conduzidos por enfermeiros, nas pessoas com doença respiratória crónica. Metodologia: Scoping review com metodologia do Joanna Briggs Institute® com recurso a dois revisores independentes. Resultados: incluímos 10 estudos que revelaram que programas de RR conduzidos por enfermeiros de reabilitação aumentam a tolerância ao exercício, a qualidade de vida, a independência funcional e reduzem a dispneia e a ansiedade. Conclusão: A RR realizada por ER em pessoas com doença respiratória crónica é sobreponível à mais recente evidência. Palavras-chave: Treino de exercício, Enfermagem de Reabilitação, Reabilitação Respiratória, Doença respiratória crónica

Summary Continuous Renal Replacement Therapy (CRRT) is frequently used in patients admitted to intensive care units with multiple organ failure and acute renal failure. These patients are prone to developing hypotension making it very difficult to use conventional haemodialysis for their treatment. When compared to conventional haemodialysis CRRT has obvious clinical advantages. These advantages are mostly due to slow volume and uraemic toxin removal leading to better haemodynamic tolerability for such patients. In our unit during the year 2000, 58 patients were submitted to CRRT: 14 of the patients underwent treatment with continuous veno‐venous haemofiltration and 44 were submitted to continuous veno‐venous haemodiafiltration. The mean patient age was 61.7 years (range: 20–87), 36 male and 22 females. Twenty patients (43.1%) had sepsis, 18 (31%) were post open‐heart surgery, 7 (12%) had multiple organ failure, 4 (6.9%) were polytraumatised, 3 (5.2%) were post neurosurgery and 1 (1.8%) was a liver transplant patient. Despite the grave prognosis of these patients, 22 (37.8%) survived and 36 (62.2%) died. Of the patients that survived, 10 (17.2%) recovered renal function and 12 (20.6%) remained on a regular haemodialysis programme. The authors conclude that CRRT seems to be an alternative to conventional haemodialysis for the treatment of those patients with acute renal failure.

This umbrella review aimed to determine the effectiveness of nonpharmacological interventions in pulmonary ventilation and their impact on respiratory function. An individual with impaired ventilation displays visible variations manifested in their respiratory frequency, breathing rhythm ratio (I:E), thoracic symmetry, use of accessory muscles, dyspnea (feeling short of breath), oxygen saturation, diaphragm mobility, minute ventilation, peak flow, walking test, spirometry, Pimax/Pemax, diffusion, and respiratory muscle strength. Any variation in these markers demands the need for interventions in order to duly manage the signs and symptoms and to improve ventilation. Method: Systematic reviews of the literature published in English, Spanish, French, and Portuguese were used, which included studies in which nonpharmacological interventions were used as a response to impaired ventilation in adults in any given context of the clinical practice. The recommendations given by the Joanna Briggs Institute (JBI) for umbrella reviews were followed. This research took place in several databases such as MEDLINE, CINAHL Complete, CINHAL, MedicLatina, ERIC, Cochrane Reviews (Embase), and PubMed. The Joanna Briggs critical analysis verification list was used for the systematic review. The data extraction was performed independently by two investigators based on the data extraction tools of the Joanna Briggs Institute, and the data were presented in a summary table alongside the support text. Results: Forty-four systematic reviews, thirty randomized clinical essays, and fourteen observational studies were included in this review. The number of participants varied between n = 103 and n = 13,370. Fifteen systematic revisions evaluated the effect of isolated respiratory muscular training; six systematic revisions evaluated, in isolation, breathing control (relaxed breathing, pursed-lip breathing, and diaphragmatic breathing exercises) and thoracic expansion exercises; and one systematic review evaluated, in isolation, the positions that optimize ventilation. Nineteen systematic reviews with combined interventions that reinforced the role of education and capacitation while also aiming for their success were considered. The articles analyzed isolated interventions and presented their efficacy. The interventions based on respiratory exercises and respiratory muscular training were the most common, and one article mentioned the efficacy of positioning in the compromisation of ventilation. Combined interventions in which the educational component was included were found to be effective in improving pulmonary function, diffusion, oxygenation, and functional capacity. The outcomes used in each study were variable, leading to a more difficult analysis of the data. Conclusions: The interventions that were the focus of the review were duly mapped. The results suggest that nonpharmacological interventions used to optimize ventilation are effective, with a moderate to high level of evidence. There is a strong foundation for the use of the chosen interventions. The lack of studies on the intervention of “positioning to optimize ventilation” points out the need for a deeper analysis of its effects and for studies with a clear focus. This study supports the decisions and recommendations for the prescription of these interventions to patients with impaired ventilation.