RESUMO
Background Complex percutaneous coronary intervention (PCI) is associated with higher ischemic risk, which can be mitigated by long-term dual antiplatelet therapy (DAPT). However, concomitant high bleeding risk (HBR) may be present, making it unclear whether short- or long-term DAPT should be prioritized. Objectives This study investigated the effects of ischemic (by PCI complexity) and bleeding (by PRECISE-DAPT [PRE dicting bleeding Complications in patients undergoing stent Implantation and Sub sequent Dual Anti Platelet Therapy] score) risks on clinical outcomes and on the impact of DAPT duration after coronary stenting. Methods Complex PCI was defined as ≥3 stents implanted and/or ≥3 lesions treated, bifurcation stenting and/or stent length >60 mm, and/or chronic total occlusion revascularization. Ischemic and bleeding outcomes in high (≥25) or non-high (<25) PRECISE-DAPT strata were evaluated based on randomly allocated duration of DAPT. Results Among 14,963 patients from 8 randomized trials, 3,118 underwent complex PCI and experienced a higher rate of ischemic, but not bleeding, events. Long-term DAPT in non-HBR patients reduced ischemic events in both complex (absolute risk difference: −3.86%; 95% confidence interval: −7.71 to +0.06) and noncomplex PCI strata (absolute risk difference: −1.14%; 95% confidence interval: −2.26 to −0.02), but not among HBR patients, regardless of complex PCI features. The bleeding risk according to the Thrombolysis In Myocardial Infarction scale was increased by long-term DAPT only in HBR patients, regardless of PCI complexity. Conclusions Patients who underwent complex PCI had a higher risk of ischemic events, but benefitted from long-term DAPT only if HBR features were not present. These data suggested that when concordant, bleeding, more than ischemic risk, should inform decision-making on the duration of DAPT. (AU)
Assuntos
Humanos , Doenças Cardiovasculares/prevenção & controle , Avaliação Nutricional , Alimentos, Dieta e NutriçãoRESUMO
OBJECTIVE: The purpose of this study was to determine the effectiveness of oral support on feeding efficiency in preterm infants who were identified by the medical team as poor feeders. METHOD: Thirteen premature infants between 34 and 40 weeks' postconceptional age were selected from a group of infants at Children's Hospital and Medical Center in Seattle, Washington. They were fed twice within a 26-hr period, once with oral support and once without. The order of occurrence of these two conditions was randomly selected without replacement to assure that an equal number of both conditions occurred during the first feed. Only the first 2 min of the feed were used in data analysis. RESULTS: A statistically significant difference (z = -2.62, p < .01, two-tailed) in volume intake occurred between the oral support condition (M = 10.9 cc) and the no oral support condition (M = 4.8 cc). CONCLUSION: This study validates the use of oral support as an effective treatment technique to enhance sucking efficiency in preterm infants.
Assuntos
Alimentação com Mamadeira/instrumentação , Transtornos da Alimentação e da Ingestão de Alimentos/reabilitação , Doenças do Prematuro/reabilitação , Modalidades de Fisioterapia/métodos , Comportamento de Sucção/fisiologia , Transtornos da Alimentação e da Ingestão de Alimentos/fisiopatologia , Feminino , Humanos , Recém-Nascido , Doenças do Prematuro/fisiopatologia , Masculino , Contração Muscular/fisiologia , Estimulação FísicaRESUMO
The advancement of medical technology has produced an increased number of surviving neonates. Occupational therapists and physical therapists working in neonatal intensive care units and follow-up clinics are faced with the challenge of providing early assessment and treatment for this relatively new population of infants. The purpose of this article is to review selected infant motor evaluation instruments used by therapists and to preview those currently being developed. An overview of the historical background of infant neuromotor testing is provided, followed by a review of the Infant Neurological International Battery (Ellison, Horn, & Browning, 1985) and the Neonatal Neurobehavioral Examination (Morgan, Koch, Lee, & Aldag, 1988). Two infant motor tests currently being developed, the Chandler Movement Assessment of Infants Screening Test and the Miller Infant and Toddler Test (both of which, at the time of this writing, are unpublished) are described. Updated information on the psychometric properties and the clinical usefulness of these new infant neuromotor tests can assist therapists in selecting reliable and valid measures in their clinical practice.
