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BACKGROUND: Physical inactivity is prevalent among hospitalized patients and the daytime spent lying should be utilised for exercise. However, implementing new interventions in hospitals' complex daily routines is difficult and requires a participatory approach. OBJECTIVE: Exploring clinical settings and clinicians' perspectives regarding exercise in hospitalized patients to gauge the potential of further development of an in-bed training device and to formulate development goals. METHODS: A User-Centered Design approach was employed, consisting of work shadowing and focus groups with physiotherapists and nurses. Content and network analyses of the focus group data were performed. Personas were then developed and used to create clinical scenarios. RESULTS: Some clinicians perceived in-bed exercise counterproductive, while others recognized potential for unsupervised training. The most important design characteristics appeared to be a small size, low weight and simplicity of use to facilitate storage, transportation, and administration, respectively. The scenarios revealed that the device's use could increase the physical activity time by 1.4%, although it would also increase the working time of clinicians. CONCLUSION: The study highlighted the difficulties in developing a usable training device but encouraged the authors to pursue their efforts under the strict condition of following the formulated development goals.
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OBJECTIVE: This study aims to establish best practices and guidelines to ensure that experimental research utilizing Postmortem Human Subjects (PMHS) for injury prevention adheres to relevant ethical principles, which are also commonly accepted in research involving human tissues and living subjects. Furthermore, it reviews existing literature to underscore the pivotal role of PMHS testing in evaluating the efficacy of safety systems, with a particular focus on airbag performance. METHODS: This paper conducts an examination of the primary ethical principles governing human subject research as outlined in the Declaration of Helsinki (1965) and traces their evolution up to the latest framework proposed by the Council for International Organizations of Medical Sciences (CIOMS) in 2002. Input was solicited from international experts and laboratories experienced in PMHS testing to understand how these ethical principles are implemented in practice. This is complemented by a comprehensive review of literature that assesses the contribution of PMHS testing to airbag performance enhancements in frontal impacts. RESULTS: The findings underscore the importance of informed consent from donors or their next-of-kin, as highlighted in CIOMS declarations, to ensure the ethical integrity of the donation process in line with international standards. The study also finds it customary for an independent review board to evaluate the research methodology and the necessity of employing PMHS tissue over alternative methods, such as computational models or crash test dummies. Despite various national regulations on human subject participation and living tissue research, no specific legal framework governing PMHS tissue use was identified. The systematic literature review revealed that PMHS testing has been crucial in identifying potential injury mechanisms not detected by Anthropomorphic Test Devices (ATD), significantly contributing to the enhancement of computer human body models and the biofidelity of crash test dummies. CONCLUSION: The International Council on the Biomechanics of Injury (IRCOBI) recognizes the need to provide guidance for research involving human cadaveric tissue to be conducted with the highest ethical standards. This study proposes five recommendations to ensure adherence to these ethical principles in PMHS testing, highlighting the paramount importance of obtaining informed consent and securing independent committee approval. Moreover, IRCOBI emphasizes that until a thorough understanding of tissue damage tolerance levels is achieved and human surrogates, such as ATDs or Human Body Models (HBM), reach full biofidelity, the use of human cadavers remains indispensable for developing effective injury prevention strategies and measures.
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INTRODUCTION: Non-small cell lung cancer (NSCLC) survivors suffer from impaired physical and psychological functioning and reduced health-related quality of life (HRQoL) that persist after active treatment ends. Sustaining rehabilitation benefits, promoting a healthy lifestyle and facilitating self-management at home require a multifaceted aftercare programme. We aim to investigate the effect of a 12-week digital lifestyle intervention on HRQoL and lifestyle-related outcomes in NSCLC survivors after completion of inpatient rehabilitation. METHODS AND ANALYSIS: QUAlity of life in LUng CAncer Survivors (QUALUCA) is a multicentre randomised controlled trial that follows a hybrid type 1 design. We randomly allocate participants in a 1:1 ratio to the intervention group (digital lifestyle intervention) or the control group (standard care) using block randomisation stratified by tumour stage and study site. Four accredited Swiss inpatient rehabilitation centres recruit participants. Key inclusion criteria are a diagnosis of NSCLC, an estimated life expectancy of ≥6 months and access to a smartphone or tablet. The 12-week intervention comprises physical activity, nutrition and breathing/relaxation, delivered through a mobile application (app). The primary outcome is the change in HRQoL from baseline (1 week after rehabilitation) to follow-up (3 months after baseline), assessed by the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30). Secondary outcomes include body mass index, self-reported physical activity, exercise capacity, risk of low protein intake, appetite, psychological distress, cancer-related fatigue, enablement and self-rated health. Explanatory outcomes in the intervention group include app usability, acceptability, appropriateness, and feasibility of the intervention, experiences and satisfaction with the intervention, and app usage data. We aim to enrol 88 participants. For the main statistical analysis, we will use analysis of covariance, adjusted for baseline measures, stratification variables, age and sex. ETHICS AND DISSEMINATION: The Ethics Committees of the Canton of Zurich (lead), the Canton of Bern and Northwest and Central Switzerland approved the study (2023-00245). We will disseminate study results to researchers, health professionals, study participants and relevant organisations, and through publications in international peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT05819346.
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Carcinoma de Pulmón de Células no Pequeñas , Neoplasias Pulmonares , Humanos , Calidad de Vida , Pacientes Internos , Suiza , Sobrevivientes , Estilo de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Estudios Multicéntricos como AsuntoRESUMEN
Background: Tackling physical inactivity represents a key global public health challenge. Strategies to increase physical activity (PA) are therefore warranted. Despite the rising availability of digital interventions (DIs), which offer tremendous potential for PA promotion, there has been inadequate attention to the special needs of older adults. Objective: The aim was to investigate community-dwelling older adults' needs, requirements, and preferences toward DIs to promote PA. Methods: The target population of this cross-sectional study was community-dwelling older adults (≥60 years old) within German-speaking Switzerland. Potential respondents were informed about the study and sent a link to a self-developed and self-administered online survey by our cooperating institutions. Results: Overall, 922 respondents who completed the online survey were included in the final analysis. The mean age of the sample was 72 years (SD 6.4, range 60-98). The preferred delivery mode of DIs to promote PA was a website (428/922, 46.4%) and 80.3% (740/922) preferred video-based structures. Most respondents expressed the need for personal access, personal goals, personal messages, and a personal contact in case of problems or questions (585/817, 71.6%; 546/811, 67.3%; 536/822, 65.2%; 536/822, 65.2%). Memory training, psychological wellbeing, and nutrition were mainly rated as relevant additional content of DIs to promote PA (690/849, 81.2%; 661/845, 78.2%, 619/849, 72.9%). Conclusion: Community-dwelling older adults may be willing to use DIs to promote PA in the long term, but this study identified particular needs and requirements in terms of design, technological realization, delivery mode, support, and individualization/personalization among the sample. Our results can inform future developments of DIs to promote PA specifically tailored to older adults. However, caution is warranted in interpreting the findings due to the sample's high PA and education levels.
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Differences in injury risk between females and males are often reported in field data analysis. The aim of this study was to investigate the differences in kinematics and injury risks between average female and male anthropometry in two exemplary use cases. A simulation study comprising the newly introduced VIVA+ human body models (HBM) was performed for two use cases. The first use case relates to whiplash associated disorders sustained in rear impacts and the second to femur fractures in pedestrians impacted by passenger cars as field data indicates that females have higher injury risk compared to males in these scenarios. Detailed seat models and a generic vehicle exterior were used to simulate crash scenarios close to those currently tested in consumer information tests. In the evaluations with one of the vehicle seats and one car shape the injury risks were equal for both models. However, the risk of the average female HBM for whiplash associated disorders was 1.5 times higher compared to the average male HBM for the rear impacts in the other seat and 10 times higher for proximal femur fractures in the pedestrian impacts for one of the two evaluated vehicle shapes.. Further work is needed to fully understand trends observed in the field and to derive appropriate countermeasures, which can be performed with the open source tools introduced in the current study.
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Fracturas Óseas , Lesiones por Latigazo Cervical , Heridas y Lesiones , Humanos , Masculino , Femenino , Accidentes de Tránsito , Automóviles , Simulación por Computador , Lesiones por Latigazo Cervical/epidemiología , Lesiones por Latigazo Cervical/etiología , Fenómenos Biomecánicos , Heridas y Lesiones/epidemiología , Heridas y Lesiones/etiologíaRESUMEN
AIM: To describe the experiences of patients and relatives with any form of restraints in somatic acute care hospitals. DESIGN: Qualitative explorative design. METHODS: Qualitative research methods were used. Participants were recruited through clinical nursing specialists in participating departments of a university hospital between June and August 2020. Individual interviews were conducted and analysed using content analysis. RESULTS: Four interviews with patients and five interviews with relatives were conducted with a mean duration of 25 min. The following three topics emerged in the analysis as important: What was perceived as restraints, Assessing the experiences of restraint use on a continuum, and Lack of information about restrictive measures. Patients and relatives defined restraint very broadly and assessed the experiences of restraint on a continuum from positive to negative, with a more critical view from patients. Relatives clearly seemed to approve of the use of restraints in acute care hospitals because it provided them with a sense of security. In general, there seemed to be a lack of information about the use of restraint and its effects on patients and relatives alike. CONCLUSION: The involvement of patients and relatives in the decision-making process about restraint use seems to be low. Healthcare professionals need to be better educated to be able to pass on adequate information and to involve patients and their relatives adequately in all processes of restraint use. However, when relatives are involved in decision-making as proxies for patients, it is important to consider that patients' and relatives' opinions on restraints may differ. PATIENT OR PUBLIC CONTRIBUTION: Patients and relatives agreed to participate in the study and shared their experiences with us.
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Actitud , Personal de Salud , Humanos , Investigación Cualitativa , Restricción Física/efectos adversos , HospitalesRESUMEN
BACKGROUND: Electronic patient-reported outcome measures (ePROMs) are useful tools to assess care needs of patients diagnosed with cancer and to monitor their symptoms along the illness trajectory. Studies regarding the application of ePROMs by advanced practice nurses (APNs) specialized in sarcoma care and the use of such electronic measures for care planning and assessing quality of care are lacking. OBJECTIVE: To explore the potential of ePROMs in clinical practice for assessing the patient's quality of life, physical functionality, needs, and fear of progression, as well as distress and the quality of care in sarcoma centers. METHODS: A multicenter longitudinal pilot study design was chosen. Three sarcoma centers with and without APN service located in Switzerland were included. The instruments EQ-5D-5L, Pearman Mayo Survey of Needs, the National Comprehensive Cancer Network Distress Thermometer, PA-F12, and Toronto Extremity Salvage Score were used as ePROMs. Data were analyzed descriptively. RESULTS: Overall, 55 patients participated in the pilot study; 33 (60%) received an intervention by an APN, and 22 (40%) did not. Patients in sarcoma centers with APN service reported overall higher scores in quality of life and functional outcome. The number of needs and distress level were lower in sarcoma centers with APN service. No differences were found with respect to patients' fear of progression. CONCLUSIONS: Most of the ePROMs proved to be reasonable in clinical practice. PA-F12 has shown low clinical relevance. IMPLICATIONS FOR PRACTICE: Using ePROMs appears to be reasonable to obtain clinically relevant patient information and to evaluate the quality of care in sarcoma centers.
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This study investigated whether enteral nutrition by early tube feeding led to changes in clinical parameters compared to tube feeding after 24 h. Starting on 1 January 2021, and following the latest update of the ESPEN guidelines on enteral nutrition, patients with percutaneous endoscopic gastrostomy (PEG) received tube feeding 4 h after tube insertion. An observational study was conducted to analyze whether the new scheme affected patient complaints, complications, or hospitalization duration compared to the previous procedure of tube feeding starting after 24 h. Clinical patient records from one year before and one year after the introduction of the new scheme were examined. A total of 98 patients were included, and of those 47 received tube feeding 24 h after tube insertion, and 51 received tube feeding 4 h after tube insertion. The new scheme did not influence the frequency or severity of patient complaints or complications related to tube feeding (all p-values > 0.05). However, the study showed that the length of stay in hospital was significantly shorter when following the new scheme (p = 0.030). In this observational cohort study an earlier start of tube feeding did not produce any negative consequences but did reduce the duration of hospitalization. Therefore, an early start, as suggested in the recent ESPEN guidelines, is supported and recommended.
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Nutrición Enteral , Gastrostomía , Humanos , Nutrición Enteral/métodos , Gastrostomía/métodos , Hospitalización , Hospitales , Estudios RetrospectivosRESUMEN
Healthcare professionals often feel challenged by complex patients and the associated care needs during care transition. Interprofessional collaboration (IPC) is considered an effective approach in such situations. However, a fragmented healthcare system can limit IPC. This study explored experiences of Swiss healthcare professionals regarding complex patient care transition and the potential of IPC. Professionals from nursing, medicine, psychology, physiotherapy, dietetics and nutrition, social service, occupational therapy, and speech therapy were included. A qualitative between-method triangulation design was applied, with two focus group discussions and ten individual interviews. The combination of different data-collection methods allowed us to explore complex patient care transition and to systematically add perspectives of healthcare professionals from different care settings. Three main themes were identified: (1) Participants described their vision of an ideal complex patient care transition, i.e., the status they would like to see implemented; (2) participants reported challenges in complex patient care transition as experienced today; and (3) participants suggested ways to improve complex patient care transition by IPC. This study highlighted that healthcare professionals regarded IPC as an effective intervention to improve complex patient care transition. It emerged that sustainable implementation of IPC across care organizations is currently limited in Switzerland. In the absence of strong and direct promotion of IPC by the healthcare system, professionals in clinical practice can further promote IPC by finding hands-on solutions to overcome organizational boundaries.
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PURPOSE: In Switzerland, about one in three children is born by caesarean section (CS). For many women, this means a restricted birth experience, limited observation of the birth process and a restricted involvement. We evaluated an extended gentle CS protocol, which offered early intraoperative skin-to-skin contact and the possibility of observing the delivery of the baby from the abdomen through a transparent drape. METHODS: This is a cross-sectional study incorporating data from a purposely tailored questionnaire and clinical routine data. The extended gentle CS protocol was compared with the gentle CS, which does not allow the possibility of observing the delivery. Data were collected online and analysed by multivariable regression for quantitative data and content analysis for all text responses to open questions, respectively. RESULTS: 193 women completed the questionnaire. Of these, 154 had a gentle CS and 39 had an extended gentle CS. Multivariable regression did not reveal a statistically significant difference for extended gentle CS with regard to satisfaction with childbirth, mother-to-child bonding, or breastfeeding duration. Nevertheless, early intraoperative skin-to-skin contact was associated with the fulfilment of birth expectations. Furthermore, most women who experienced an extended gentle CS would prefer the same procedure for any potential future CS. CONCLUSIONS: Although our study showed no statistically significant difference in satisfaction from using a transparent drape, most women expressed a preference for this technique. We recommend that the option of an extended gentle CS should be offered to all women for whom CS is indicated.
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Cesárea , Transmisión Vertical de Enfermedad Infecciosa , Femenino , Embarazo , Humanos , Cesárea/métodos , Estudios Transversales , Parto , Encuestas y CuestionariosRESUMEN
BACKGROUND: Quantitative and qualitative procedures are necessary components of instrument development and assessment. However, validation studies conventionally emphasise quantitative assessments while neglecting qualitative procedures. Applying both methods in a mixed methods design provides additional insights into instrument quality and more rigorous validity evidence. Drawing from an extensive review of the methodological and applied validation literature on mixed methods, we showcase our use of mixed methods for validation which applied the quality criteria of congruence, convergence, and credibility on data collected with an instrument measuring interprofessional collaboration in the context of Swiss healthcare, named the Swiss Instrument for Evaluating Interprofessional Collaboration. METHODS: We employ a convergent parallel mixed methods design to analyse quantitative and qualitative questionnaire data. Data were collected from staff, supervisors, and patients of a university hospital and regional hospitals in the German and Italian speaking regions of Switzerland. We compare quantitative ratings and qualitative comments to evaluate the quality criteria of congruence, convergence, and credibility, which together form part of an instrument's construct validity evidence. RESULTS: Questionnaires from 435 staff, 133 supervisors, and 189 patients were collected. Analysis of congruence potentially provides explanations why respondents' comments are off topic. Convergence between quantitative ratings and qualitative comments can be interpreted as an indication of convergent validity. Credibility provides a summary evaluation of instrument quality. These quality criteria provide evidence that questions were understood as intended, provide construct validity, and also point to potential item quality issues. CONCLUSIONS: Mixed methods provide alternative means of collecting construct validity evidence. Our suggested procedures can be easily applied on empirical data and allow the congruence, convergence, and credibility of questionnaire items to be evaluated. The described procedures provide an efficient means of enhancing the rigor of an instrument and can be used alone or in conjunction with traditional quantitative psychometric approaches.
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Exactitud de los Datos , Atención a la Salud , Humanos , Suiza , Reproducibilidad de los Resultados , Encuestas y Cuestionarios , PsicometríaRESUMEN
BACKGROUND: Patient-reported outcome measures (PROMs) are tools to screen a population, to monitor the subjective progress of a therapy, to enable patient-centred care and to evaluate the quality of care. The QUALITOUCH Activity Index (AI) is such a tool, used in physiotherapy. This study aimed to provide reference values for expected AI outcomes. METHODS: A large data set uniting clinical routine data and AI outcomes was generated; it consisted of data of 11,948 patients. For four defined diagnoses, i.e. chronic lower back pain, tibia posterior syndrome, knee joint osteoarthritis and shoulder impingement, the AI responses related to the dimensions "maximum pain level" and "household activity" were analyzed. Reference corridors for expected AI outcomes were derived as linear trend lines representing the mean, 1st and 3rd quartile. RESULTS: Reference corridors for expected AI outcomes are provided. For chronic lower back pain, for example, the corridor indicates that the initial average AI value related to maximum pain of 49.3 ± 23.8 points on a visual analogue scale (VAS multiplied by factor 10) should be improved by a therapeutic intervention to 36.9 ± 23.8 points on a first follow-up after four weeks. CONCLUSIONS: For four exemplary diagnoses and two dimensions of the AI, one related to pain and one related to limitations in daily activities, reference corridors of expected therapeutic progress were established. These reference corridors can be used to compare an individual performance of a patient with the expected progress derived from a large data sample. Data-based monitoring of therapeutic success can assist in different aspects of planning and managing a therapy.
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BACKGROUND: Stromal components surrounding epithelial cancer cells seem to play a pivotal role during epithelial-to-mesenchymal transition (EMT), tumor invasion, and metastases. To identify the molecular mechanisms underlying tumor-stroma interactions may yield novel therapeutic targets for prostate cancer. METHODS: Gene expression profile of prostate-cancer associated fibroblast (PCAF) and prostate non-cancer associated fibroblast (PNAF) cells isolated from radical prostatectomy was performed by Illumina, analyzed, and further processed by Ingenuity®: IPA® software. qRT-PCR was performed on an independent set of 17 PCAF, 12 PNAF, and 12 fibroblast cell lines derived from patients with benign prostatic hyperplasia (BPHF). RESULTS: Using microarray analysis, we found six upregulated genes and two downregulated genes in PCAFs compared to PNAFs. To validate microarray results, we performed qRT-PCR for the most significantly regulated genes involved in the modulation of proliferation and androgen resistance on an independent set of PNAF, PCAF, and BHPF samples. We confirmed the increased expression of SCARB1, MAPK3K1, and TGF-ß as well as the decreased expression of S100A10 in PCAFs compared to PNAFs and BPHFs. CONCLUSIONS: These results provide strong evidence that the observed changes in the gene expression profile of PCAFs can contribute to functional alteration of adjacent prostate cancer cells.
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There are few programs available aimed at preventing short- and long-term negative consequences after preterm birth and covering the entire care continuum. The "Transition to Home (TtH)" model is such a program, offering structured, individual support for families with preterm infants before and after hospital discharge. This study gathers and examines the parents' views of receiving support from an interprofessional team under the TtH model of care during hospitalization and after discharge. Using a qualitative explorative design, 39 semi-structured interviews with parents were analyzed thematically. From this analysis, three main themes were identified: (1) TtH and the relevance of continuity of care; (2) Enhancement of parents' autonomy and self-confidence; (3) Perception of interprofessional collaboration. Within these themes, the most relevant aspects identified were continuity of care and the appointment of a designated health care professional to anchor the entire care continuum. Emotional support complemented by non-medical approaches, along with strength-based and family resource-oriented communication, also emerged as key aspects. Continuous, family-centered care and well-organized interprofessional collaboration promote the well-being of the family after a premature birth. If the aspects identified in this study are applied, the transition from hospital to home will be smoothened for the benefit of affected families.
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Nacimiento Prematuro , Consejo , Femenino , Personal de Salud , Humanos , Lactante , Recién Nacido , Recien Nacido Prematuro , Embarazo , Investigación CualitativaRESUMEN
BACKGROUND: Early mobilization is important to improve critically ill patients' outcomes, but barriers to its implementation are common. A suitable in-bed device to exercise patients' legs might facilitate early mobilization. OBJECTIVE: The aim of this study was to develop an in-bed leg press that would facilitate early mobilization and enhance strength training of patients in acute care settings. METHODS: A user-centered design approach was applied to develop the device. The process was assessed by different instruments: the system usability scale (SUS) questionnaire, the Kano model questionnaire and interviews with end-users. RESULTS: Through several iterations of a user-centered design process, the prototype of an in-bed leg press was developed and tested. The assessment, based on SUS, Kano and interviews, indicates high usability and demonstrates the advantages of a user-centered design process. CONCLUSIONS: An interprofessional user-centered design approach was successfully implemented to develop a medical device. The early involvement of end-users resulted in a design that already shows a high degree of production readiness. The resulting device fulfilled all core requirements from a therapeutic point of view and included key features related to its practical use.
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Pierna , Diseño Centrado en el Usuario , Terapia por Ejercicio , Humanos , Nigeria , Encuestas y CuestionariosRESUMEN
AIM: The focus was to explore the perceptions and experiences of healthcare workers with respect to the use of restraints in acute care hospitals. DESIGN: The study followed a qualitative design. METHODS: Three topic-based focus group interviews were conducted, involving 19 participants from the fields of nursing, physical therapy and medicine. For data collection and analysis, the method of mapping techniques for rapid qualitative data analysis was used. After discussing and validating the individual mind maps, all data were condensed to identify the key findings. RESULTS: Participants described restraints as safety measures for the patients. The implementation of most restraints was led by nurses. The use of restraints differed significantly, even in the interprofessional team. Attitudes and experiences were the main determinants for restraint use. Nurses asked for more discussion about restraints in the team, for more support at an interprofessional level and for better guidelines to help with the decision-making process.
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Personal de Salud , Restricción Física , Atención a la Salud , Hospitales , Humanos , Investigación CualitativaRESUMEN
INTRODUCTION: A reduction in restraint use is recommended for all health care settings. For this purpose, local or national quality measurement and improvement initiatives have been implemented in various countries, primarily in the mental health and long-term care settings. However, restraints are also frequently used in the somatic acute care hospital setting, and strong variations in their prevalence rates have been reported. Therefore, the aim of this study was to reanalyse existing data on restraint use in Swiss hospitals in order to assess the potential of restraint use as a national quality indicator for the hospital setting. METHODS: Using a cross-sectional, multicentre design, data were collected between 2016 and 2018 as part of the ANQ"s (Swiss National Association for Quality Development in Hospitals and Clinics) "falls and pressure ulcers" national prevalence measurement in acute care hospitals in Switzerland. The hospitals measured restraint use on a voluntary basis in addition to falls and pressure ulcers. All medical specialities and patients aged 18 and over who gave their informed consent were included in the measurement. Descriptive and multilevel regression analyses were performed using institutional, ward and patient-level data relating to restraint use. RESULTS: The sample consisted of 18,938 inpatients from 55 hospitals. The 30-day prevalence rate of patients with at least one restraint was 10.2% (n = 1933). The risk-adjusted hospital comparison revealed that hospitals in Switzerland differ significantly in their restraint use, even after adjusting for patient characteristics. In total, 10 hospitals used restraints significantly less and 12 used them significantly more than the national average. CONCLUSION: Restraint use varies significantly between Swiss hospitals: 40% of all hospitals used restraints either significantly more or significantly less often than the average. In comparison to the other quality indicators, this is a very high value, indicating potential for improvements in the quality of care. Since restraint use is associated not only with quality of care, but also with human rights, these large differences seem questionable from a professional, ethical and legal point of view. Clearer and binding regulations in combination with monitoring and benchmarking of restraint use in hospitals, such as with a national quality indicator, seem necessary. These would help to ensure that restraint use is in alignment with professional values, as well as ethical and legal requirements.
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Análisis de Datos , Indicadores de Calidad de la Atención de Salud , Adolescente , Adulto , Estudios Transversales , Hospitales , Humanos , Restricción FísicaRESUMEN
BACKGROUND: Judo is a popular combat sport with a high risk of injury. To date, information on injuries in non-competitive and amateur judo is sparse. Injuries in Swiss judo have not been recorded systematically. The objective of this project was to develop an injury surveillance system for judo. Such a system not only provides a possibility for the systematic monitoring of injuries, but also allows for the planning and assessing of strategies for injury prevention. METHODS: A survey was conducted to obtain an overview of injuries sustained in Swiss judo. The results served as a basis to develop and implement a database with a web interface, which is called injury surveillance system. Several judo athletes tested the new system in a trial. RESULTS: Amateur judokas provided 34.2â% of the answers of the survey. Upper extremity injuries, especially of the shoulder, were most frequently reported, followed by lower extremity injuries, particularly of the knee. In due consideration of the results and experiences gained from the survey, the SJISS (Swiss Judo Injury Surveillance System) was established. SJISS is a web-based injury surveillance system designed for Swiss judo. CONCLUSION: This is the first system developed to provide an ongoing and systematic recording of injuries in Swiss judo. The system allows for injury monitoring and may serve as a starting point for developing and evaluating injury prevention programmes.
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Traumatismos en Atletas , Traumatismos de la Pierna , Artes Marciales , Atletas , Traumatismos en Atletas/epidemiología , Humanos , Traumatismos de la Pierna/epidemiologíaRESUMEN
In hospitals, patient attendants are often necessary in order to closely monitor patients with high risk of self-endangering actions and reactions. However, such additional monitoring of patients is associated with high costs. In this paper, we describe a technical infrastructure for monitoring the patient's activities, which helps to assess whether an attendant should be requested. It was central to for us to use non-invasive sensors and to exploit a variety of patient data such as heart rate, micro-activity and oxygen saturation.
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Asignación de Recursos , Frecuencia Cardíaca , Humanos , Monitoreo FisiológicoRESUMEN
BACKGROUND: Tumor-infiltrating lymphocytes (TIL) play an important role in the pathogenesis of renal cell carcinoma. Characterization of TIL requires efficient isolation procedures, especially in early stage disease when the tumor is of small in size. Conventional methods for isolating TIL are based on enzymatic tissue digestion, most frequently with collagenase. Collagenase isolation is limited by poor cell recovery, altered expression of cell-surface molecules, and impaired TIL-functionality. To overcome these limitations, we developed and optimized conditions for a robust collagenase-free mechanical procedure for improved isolation of TIL from renal cell carcinoma samples. METHODS: TIL from tumor samples and T cells from peripheral blood were collected from 12 patients undergoing partial or radical nephrectomy. Samples were subjected to an enzymatic reference protocol and to a newly established mechanical isolation protocol. After viability staining, TIL-subpopulations were quantified and phenotyped by immunohistochemistry and flow-cytometric analysis, and were compared to characteristics of peripheral blood T cells. As a marker for TIL-functionality, T-cell cytokine induction was quantified after polyclonal stimulation. RESULTS: We show that this new technique is rapid and allows identification of CD4 and CD8 T-cell subpopulations including CD4, CD8, and regulatory T cells expressing anergy markers such as programmed death-1 (PD-1) or B- and T-lymphocyte attenuator. When compared to the reference protocol involving collagenase digestion, the yield of TIL after mechanical isolation was higher and the expression of cell-surface markers was better preserved. Moreover, although antitumor activity was not assessed, mechanically isolated TIL are at least equally functional as T cells from peripheral blood, as polyclonal stimulation induced cytokines such as interferon-γ and tumor necrosis factor-α in both TIL and T cells from peripheral blood. CONCLUSION: The mechanical procedure may be applied as a robust and rapid alternative to collagenase digestion for isolation of high amounts of phenotypically and functionally intact TIL from fresh tumor samples.