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1.
Clin Orthop Surg ; 16(3): 422-429, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38827768

RESUMO

Background: The Coronal Plane Alignment of the Knee (CPAK) classification system has been developed as a comprehensive system that describes 9 coronal plane phenotypes based on constitutional limb alignment and joint line obliquity (JLO). Due to the characteristics of Asian populations, which show more varus and wider distribution in lower limb alignment than other populations, modification of the boundaries of the arithmetic hip-knee-ankle angle (aHKA) and JLO should be considered. The purpose of this study was to determine the knee phenotype in a Korean population based on the original CPAK and modified CPAK classification systems. Methods: We reviewed prospectively collected data of 500 healthy and 500 osteoarthritic knees between 2021 and 2023 using radiographic analysis and divided them based on the modified CPAK classification system by widening the neutral boundaries of the aHKA to 0° ± 3° and using the actual JLO as a new variable. Using long-leg standing weight-bearing radiographs, 6 radiographic parameters were measured to evaluate the CPAK type: the mechanical HKA angle, medial proximal tibial angle (MPTA), lateral distal femoral angle (LDFA), aHKA, JLO, and actual JLO. Results: From 2 cohorts of 1,000 knees, the frequency distribution representing all CPAK types was different between the healthy and arthritic groups. The most common categories were type II (38.2%) in the healthy group and type I (53.8%) in the arthritic group based on the original CPAK classification. The left and upward shift in the distribution of knee phenotypes in the original classification was corrected evenly after re-establishing the boundaries of a neutral aHKA and the actual JLO. According to the modified CPAK classification system, the most common categories were type II (35.2%) in the healthy group and type I (38.0%) in the arthritic group. Conclusions: Although the modified CPAK classification corrected the uneven distribution seen when applying the original classification system in a Korean population, the most common category was type I in Korean patients with osteoarthritic knees in both classification systems. Furthermore, there were different frequencies of knee phenotypes among healthy and arthritic knees.


Assuntos
Articulação do Joelho , Osteoartrite do Joelho , Fenótipo , Radiografia , Humanos , República da Coreia , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Articulação do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/classificação , Adulto , Estudos Prospectivos , Povo Asiático
2.
JMIR Mhealth Uhealth ; 12: e53964, 2024 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-38832585

RESUMO

Background: Due to aging of the population, the prevalence of aortic valve stenosis will increase drastically in upcoming years. Consequently, transcatheter aortic valve implantation (TAVI) procedures will also expand worldwide. Optimal selection of patients who benefit with improved symptoms and prognoses is key, since TAVI is not without its risks. Currently, we are not able to adequately predict functional outcomes after TAVI. Quality of life measurement tools and traditional functional assessment tests do not always agree and can depend on factors unrelated to heart disease. Activity tracking using wearable devices might provide a more comprehensive assessment. Objective: This study aimed to identify objective parameters (eg, change in heart rate) associated with improvement after TAVI for severe aortic stenosis from a wearable device. Methods: In total, 100 patients undergoing routine TAVI wore a Philips Health Watch device for 1 week before and after the procedure. Watch data were analyzed offline-before TAVI for 97 patients and after TAVI for 75 patients. Results: Parameters such as the total number of steps and activity time did not change, in contrast to improvements in the 6-minute walking test (6MWT) and physical limitation domain of the transformed WHOQOL-BREF questionnaire. Conclusions: These findings, in an older TAVI population, show that watch-based parameters, such as the number of steps, do not change after TAVI, unlike traditional 6MWT and QoL assessments. Basic wearable device parameters might be less appropriate for measuring treatment effects from TAVI.


Assuntos
Substituição da Valva Aórtica Transcateter , Dispositivos Eletrônicos Vestíveis , Humanos , Substituição da Valva Aórtica Transcateter/instrumentação , Substituição da Valva Aórtica Transcateter/estatística & dados numéricos , Substituição da Valva Aórtica Transcateter/métodos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Masculino , Feminino , Estudos Prospectivos , Dispositivos Eletrônicos Vestíveis/estatística & dados numéricos , Dispositivos Eletrônicos Vestíveis/normas , Idoso de 80 Anos ou mais , Idoso , Estenose da Valva Aórtica/cirurgia , Inquéritos e Questionários , Qualidade de Vida/psicologia
3.
Front Public Health ; 12: 1308867, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38832225

RESUMO

Background: Perinatal depression affects the physical and mental health of pregnant women. It also has a negative effect on children, families, and society, and the incidence is high. We constructed a cost-utility analysis model for perinatal depression screening in China and evaluated the model from the perspective of health economics. Methods: We constructed a Markov model that was consistent with the screening strategy for perinatal depression in China, and two screening strategies (screening and non-screening) were constructed. Each strategy was set as a cycle of 3 months, corresponding to the first trimester, second trimester, third trimester, and postpartum. The state outcome parameters required for the model were obtained based on data from the National Prospective Cohort Study on the Mental Health of Chinese Pregnant Women from August 2015 to October 2016. The cost parameters were obtained from a field investigation on costs and screening effects conducted in maternal and child health care institutions in 2020. The cost-utility ratio and incremental cost-utility ratio of different screening strategies were obtained by multiplicative analysis to evaluate the health economic value of the two screening strategies. Finally, deterministic and probabilistic sensitivity analyses were conducted on the uncertain parameters in the model to explore the sensitivity factors that affected the selection of screening strategies. Results: The cost-utility analysis showed that the per capita cost of the screening strategy was 129.54 yuan, 0.85 quality-adjusted life years (QALYs) could be obtained, and the average cost per QALY gained was 152.17 yuan. In the non-screening (routine health care) group, the average cost was 171.80 CNY per person, 0.84 QALYs could be obtained, and the average cost per QALY gained was 205.05 CNY. Using one gross domestic product per capita in 2021 as the willingness to pay threshold, the incremental cost-utility ratio of screening versus no screening (routine health care) was about -3,126.77 yuan, which was lower than one gross domestic product per capita. Therefore, the screening strategy was more cost-effective than no screening (routine health care). Sensitivity analysis was performed by adjusting the parameters in the model, and the results were stable and consistent, which did not affect the choice of the optimal strategy. Conclusion: Compared with no screening (routine health care), the recommended perinatal depression screening strategy in China is cost-effective. In the future, it is necessary to continue to standardize screening and explore different screening modalities and tools suitable for specific regions.


Assuntos
Análise Custo-Benefício , Árvores de Decisões , Depressão , Cadeias de Markov , Programas de Rastreamento , Humanos , Feminino , Gravidez , China , Programas de Rastreamento/economia , Depressão/diagnóstico , Depressão/economia , Estudos Prospectivos , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/economia , Adulto , Anos de Vida Ajustados por Qualidade de Vida
4.
BMC Endocr Disord ; 24(1): 79, 2024 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-38834991

RESUMO

BACKGROUND: Research on Metabolic Associated Fatty Liver Disease (MAFLD) is still in its early stages, with few studies available to identify and predict effective indicators of this disease. On the other hand, early diagnosis and intervention are crucial to reduce the burden of MAFLD. Therefore, the aim of this research was to investigate the effectiveness of eleven anthropometric indices and their appropriate cut-off values as a non-invasive method to predict and diagnose MAFLD in the Iranian population. METHODS: In this cross-sectional study, we analyzed baseline data from the Hoveyzeh Cohort Study, a prospective population-based study conducted in Iran that enrolled a total of 7836 subjects aged 35 to 70 years from May 2016 through August 2018. RESULTS: The optimal cut-off values of anthropometric indices for predicting MAFLD risk were determined for waist circumference(WC) (102.25 cm for males and 101.45 cm for females), body mass index (BMI) (27.80 kg/m2 for males and 28.75 kg/m2 for females), waist-to-hip ratio (WHR) (0.96 for both males and females), waist-to-height ratio (WHtR) (0.56 for males and 0.63 for females), body adiposity index (BAI) (23.24 for males and 32.97 for females), visceral adiposity index (VAI) (1.64 for males and 1.88 for females), weight-adjusted waist index (WWI) (10.63 for males and 11.71 for females), conicity index (CI) (1.29 for males and 1.36 for females), body roundness index (BRI) (4.52 for males and 6.45 for females), relative fat mass (RFM) (28.18 for males and 44.91 for females) and abdominal volume index (AVI) (18.85 for males and for 21.37 females). VAI in males (sensitivity: 77%, specificity: 60%, Youden's Index: 0.37) and RFM in females (sensitivity: 76%, specificity: 59%, Youden's Index: 0.35) were found to have higher sensitivity and specificity compared to other anthropometric indices. Furthermore, anthropometric indices demonstrated statistically significant correlations with various hepatic and cardiometabolic indices. Among these, the strongest positive correlations were observed between WC, BMI, BAI, BRI, and AVI with the Hepatic Steatosis Index (HSI), TyG-BMI, and TyG-WC, as well as between VAI and the Atherogenic Index of Plasma (AIP), Lipid Accumulation Product (LAP), Cardiometabolic Index (CMI), and the Triglyceride and Glucose (TyG) Index. CONCLUSION: Anthropometric indices are effective in predicting MAFLD risk among Iranian adults, with WWI, VAI, and RFM identified as the strongest predictors. The proposed cutoff values could serve as a straightforward and non-invasive methods for the early diagnosis of MAFLD.


Assuntos
Antropometria , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Estudos Transversais , Antropometria/métodos , Irã (Geográfico)/epidemiologia , Idoso , Estudos Prospectivos , Índice de Massa Corporal , Relação Cintura-Quadril , Circunferência da Cintura , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Hepatopatia Gordurosa não Alcoólica/diagnóstico , Fatores de Risco , Prognóstico , Adiposidade , Síndrome Metabólica/diagnóstico , Síndrome Metabólica/epidemiologia , Seguimentos
5.
Arch Gynecol Obstet ; 310(1): 609-614, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38836926

RESUMO

OBJECTIVE: To investigate the superiority of transrectal high-frequency ultrasound (TRUS) in precise assessment of middle compartment prolapse in comparison with routine transperineal ultrasound (TPUS). METHODS: Prospectively analyzed and compared detection rates of entire cervical length and uterine descent on TPUS and TRUS in 101 patients with pelvic organ prolapse (POP). RESULTS: Detection rates of entire cervix on TRUS were significantly higher than those on TPUS both at rest and during Valsalva maneuver (90.10% VS 49.50%, 92.08% VS 9.90% respectively, both p < 0.05). Uterine descent was able to be evaluated in 92.08% of patients by TRUS and in 5.94% of patients by TPUS, which was statistically significant (p < 0.05). The interobserver repeatability for the measurements of anterior lip, cervical canal and posterior lip on TRUS was excellent. The mean lengths of anterior lip, cervical canal and posterior lip were significantly increased during Valsalva maneuver than those measured at rest (p < 0.05). And mean length of anterior lip was longer than posterior lip both at rest and during Valsalva (p < 0.05). CONCLUSION: TRUS can significantly raise detection rates of entire cervix, and make the direct evaluation of uterine descent feasible. TRUS can be used as a complementary method to TPUS to attain more comprehensive and accurate presurgical imaging information in middle compartment prolapse patients.


Assuntos
Prolapso de Órgão Pélvico , Ultrassonografia , Manobra de Valsalva , Humanos , Feminino , Pessoa de Meia-Idade , Prolapso de Órgão Pélvico/diagnóstico por imagem , Ultrassonografia/métodos , Estudos Prospectivos , Idoso , Adulto , Colo do Útero/diagnóstico por imagem
6.
BMJ Open Qual ; 13(2)2024 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-38839395

RESUMO

OBJECTIVES: In many countries, the healthcare sector is dealing with important challenges such as increased demand for healthcare services, capacity problems in hospitals and rising healthcare costs. Therefore, one of the aims of the Dutch government is to move care from in-hospital to out-of-hospital care settings. An example of an innovation where care is moved from a more specialised setting to a less specialised setting is the performance of an antenatal cardiotocography (aCTG) in primary midwife-led care. The aim of this study was to assess the budget impact of implementing aCTG for healthy pregnant women in midwife-led care compared with usual obstetrician-led care in the Netherlands. METHODS: A budget impact analysis was conducted to estimate the actual costs and reimbursement of aCTG performed in midwife-led care and obstetrician-led care (ie, base-case analysis) from the Dutch healthcare perspective. Epidemiological and healthcare utilisation data describing both care pathways were obtained from a prospective cohort, survey and national databases. Different implementation rates of aCTG in midwife-led care were explored. A probabilistic sensitivity analysis was conducted to estimate the uncertainty surrounding the budget impact estimates. RESULTS: Shifting aCTG from obstetrician-led care to midwife-led-care would increase actual costs with €311 763 (97.5% CI €188 574 to €426 072) and €1 247 052 (97.5% CI €754 296 to €1 704 290) for implementation rates of 25% and 100%, respectively, while it would decrease reimbursement with -€7 538 335 (97.5% CI -€10 302 306 to -€4 559 661) and -€30 153 342 (97.5% CI -€41 209 225 to -€18 238 645) for implementation rates of 25% and 100%, respectively. The sensitivity analysis results were consistent with those of the main analysis. CONCLUSIONS: From the Dutch healthcare perspective, we estimated that implementing aCTG in midwife-led care may increase the associated actual costs. At the same time, it might lower the healthcare reimbursement.


Assuntos
Orçamentos , Cardiotocografia , Tocologia , Humanos , Feminino , Países Baixos , Gravidez , Tocologia/estatística & dados numéricos , Tocologia/economia , Tocologia/métodos , Cardiotocografia/métodos , Cardiotocografia/estatística & dados numéricos , Cardiotocografia/economia , Cardiotocografia/normas , Orçamentos/estatística & dados numéricos , Orçamentos/métodos , Adulto , Estudos Prospectivos , Cuidado Pré-Natal/estatística & dados numéricos , Cuidado Pré-Natal/economia , Cuidado Pré-Natal/métodos
7.
J Prev Alzheimers Dis ; 11(3): 710-720, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38706287

RESUMO

BACKGROUND: The potential for greenness as a novel protective factor for Alzheimer's disease (AD) requires further exploration. OBJECTIVES: This study assesses prospectively and longitudinally the association between precision greenness - greenness measured at the micro-environmental level, defined as the Census block - and AD incidence. DESIGN: Older adults living in consistently high greenness Census blocks across 2011 and 2016 were compared to those living in consistently low greenness blocks on AD incidence during 2012-2016. SETTING: Miami-Dade County, Florida, USA. PARTICIPANTS: 230,738 U.S. Medicare beneficiaries. MEASUREMENTS: U.S. Centers for Medicare and Medicaid Services Chronic Condition Algorithm for AD based on ICD-9 codes, Normalized Difference Vegetation Index, age, sex, race/ethnicity, neighborhood income, and walkability. RESULTS: Older adults living in the consistently high greenness tertile, compared to those in the consistently low greenness tertile, had 16% lower odds of AD incidence (OR=0.84, 95% CI: 0.76-0.94, p=0.0014), adjusting for age, sex, race/ethnicity, and neighborhood income. Age, neighborhood income and walkability moderated greenness' relationship to odds of AD incidence, such that younger ages (65-74), lower-income, and non-car dependent neighborhoods may benefit most from high greenness. CONCLUSIONS: High greenness, compared to low greenness, is associated with lower 5-year AD incidence. Residents who are younger and/or who reside in lower-income, walkable neighborhoods may benefit the most from high greenness. These findings suggest that consistently high greenness at the Census block-level, may be associated with reduced odds of AD incidence at a population level.


Assuntos
Doença de Alzheimer , Humanos , Doença de Alzheimer/epidemiologia , Feminino , Idoso , Masculino , Florida/epidemiologia , Estudos Longitudinais , Estados Unidos/epidemiologia , Incidência , Idoso de 80 Anos ou mais , Características da Vizinhança , Medicare/estatística & dados numéricos , Características de Residência , Estudos Prospectivos
8.
Clin Transplant ; 38(5): e15321, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38716774

RESUMO

INTRODUCTION & OBJECTIVES: To evaluate ureteral stent removal (SR) using a grasper-integrated disposable flexible cystoscope (giFC-Isiris ®, Coloplast ®) after kidney transplantation (KT), with a focus on feasibility, safety, patient experience, and costs. MATERIAL AND METHODS: All consecutive KT undergoing SR through giFC were prospectively enrolled from January 2020 to June 2023. Patient characteristics, KT and SR details, urine culture results, antimicrobial prescriptions, and the incidence of urinary tract infections (UTI) within 1 month were recorded. A micro-cost analysis was conducted, making a comparison with the costs of SR with a reusable FC and grasper. RESULTS: A total of 136 KT patients were enrolled, including both single and double KT, with 148 stents removed in total. The median indwelling time was 34 days [26, 47]. SR was successfully performed in all cases. The median preparation and procedure times were 4 min [3,5]. and 45 s[30, 60], respectively. The median Visual Analog Scale (VAS) score was 3 [1, 5], and 98.2% of patients expressed willingness to undergo the procedure again. Only one episode of UTI involving the graft (0.7%) was recorded. Overall, the estimated cost per SR procedure with Isiris ® and the reusable FC was 289.2€ and 151,4€, respectively. CONCLUSIONS: This prospective series evaluated the use of Isiris ® for SR in a cohort of KT patients, demonstrating feasibility and high tolerance. The UTI incidence was 0.7% within 1 month. Based on the micro-cost analysis, estimated cost per procedure favored the reusable FC.


Assuntos
Cistoscopia , Remoção de Dispositivo , Equipamentos Descartáveis , Estudos de Viabilidade , Transplante de Rim , Stents , Humanos , Feminino , Masculino , Transplante de Rim/economia , Pessoa de Meia-Idade , Stents/economia , Remoção de Dispositivo/economia , Estudos Prospectivos , Seguimentos , Equipamentos Descartáveis/economia , Cistoscopia/economia , Cistoscopia/métodos , Cistoscopia/instrumentação , Complicações Pós-Operatórias , Centros de Atenção Terciária , Prognóstico , Adulto , Ureter/cirurgia , Infecções Urinárias/etiologia , Infecções Urinárias/economia , Custos e Análise de Custo
9.
PLoS One ; 19(5): e0302878, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38722844

RESUMO

BACKGROUND: Despite the high prevalence of mental health difficulties in children and young people with long-term health conditions (LTCs), these difficulties and experiences are often overlooked and untreated. Previous research demonstrated the effectiveness of psychological support provided via a drop-in mental health centre located in a paediatric hospital. The aim of this prospective non-randomised single-arm multi-centre interventional study is to determine the clinical effectiveness of drop-in mental health services when implemented at paediatric hospitals in England. METHODS: It is hypothesised that families who receive psychological interventions through the drop-in services will show improved emotional and behavioural symptoms. Outcomes will be measured at baseline and at 6-month follow-up. The primary outcome is the difference in the total difficulties score on the Strengths and Difficulties Questionnaire (SDQ) reported by parent or child at 6 months. Secondary outcomes include self and parent reported Paediatric Quality of Life Inventory (PedsQL), self-reported depression (PHQ-9) and anxiety measures (GAD-7) and family satisfaction (CSQ-8). DISCUSSION: This trial aims to determine the clinical effectiveness of providing psychological support in the context of LTCs through drop-in mental health services at paediatric hospitals in England. These findings will contribute to policies and practice addressing mental health needs in children and young people with other long-term health conditions. TRIAL REGISTRATION: ISRCTN15063954, Registered on 9 December 2022.


Assuntos
Hospitais Pediátricos , Serviços de Saúde Mental , Humanos , Criança , Adolescente , Serviços de Saúde Mental/organização & administração , Estudos Prospectivos , Qualidade de Vida , Masculino , Feminino , Inglaterra , Família/psicologia , Inquéritos e Questionários , Depressão/terapia , Depressão/epidemiologia , Ansiedade/terapia , Ansiedade/psicologia , Saúde Mental , Pré-Escolar
10.
PLoS One ; 19(5): e0298897, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38722980

RESUMO

To estimate the economic and financial viability of a pig farm in central sub-tropical Mexico within a 5-year planning horizon, a Monte Carlo simulation model was utilized. Net returns were projected using simulated values for the distribution of input and product processes, establishing 2021 as base scenario. A stochastic modelling approach was employed to determine the economic and financial outlook. The findings reveal a panorama of economic and financial viability. Net income increased by 555%, return on assets rose from 3.36% in 2022 to 11.34% in 2026, and the probability of decapitalization dropped from 58% to 13%, respectively in the aforesaid periods. Similarly, the probability of obtaining negative net income decreased from 40% in 2022 to 18% in 2026. The technological, productive, and economic management of the production unit allowed for a favorable scenario within the planning horizon. There is a growing interest in predicting the economic sectors worth investing in and supporting, considering their economic and development performance. This research offers both methodological and scientific evidence to demonstrate the feasibility of establishing a planning schedule and validating the suitability of the pork sector for public investment and support.


Assuntos
Fazendas , México , Animais , Suínos , Fazendas/economia , Modelos Econômicos , Criação de Animais Domésticos/economia , Método de Monte Carlo , Estudos Prospectivos , Renda
11.
BMJ Open ; 14(5): e084918, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38692732

RESUMO

INTRODUCTION: A prototype lateral flow device detecting cytokine biomarkers interleukin (IL)-1α and IL-1ß has been developed as a point-of-care test-called the Genital InFlammation Test (GIFT)-for detecting genital inflammation associated with sexually transmitted infections (STIs) and/or bacterial vaginosis (BV) in women. In this paper, we describe the rationale and design for studies that will be conducted in South Africa, Zimbabwe and Madagascar to evaluate the performance of GIFT and how it could be integrated into routine care. METHODS AND ANALYSIS: We will conduct a prospective, multidisciplinary, multicentre, cross-sectional and observational clinical study comprising two distinct components: a biomedical ('diagnostic study') and a qualitative, modelling and economic ('an integration into care study') part. The diagnostic study aims to evaluate GIFT's performance in identifying asymptomatic women with discharge-causing STIs (Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Trichomonas vaginalis (TV) and Mycoplasma genitalium (MG)) and BV. Study participants will be recruited from women attending research sites and family planning services. Several vaginal swabs will be collected for the evaluation of cytokine concentrations (ELISA), STIs (nucleic acid amplification tests), BV (Nugent score) and vaginal microbiome characteristics (16S rRNA gene sequencing). The first collected vaginal swab will be used for the GIFT assay which will be performed in parallel by a healthcare worker in the clinic near the participant, and by a technician in the laboratory. The integration into care study aims to explore how GIFT could be integrated into routine care. Four activities will be conducted: user experiences and/or perceptions of the GIFT device involving qualitative focus group discussions and in-depth interviews with key stakeholders; discrete choice experiments; development of a decision tree classification algorithm; and economic evaluation of defined management algorithms. ETHICS AND DISSEMINATION: Findings will be reported to participants, collaborators and local government for the three sites, presented at national and international conferences, and disseminated in peer-reviewed publications.The protocol and all study documents such as informed consent forms were reviewed and approved by the University of Cape Town Human Research Ethics Committee (HREC reference 366/2022), Medical Research Council of Zimbabwe (MRCZ/A/2966), Comité d'Ethique pour la Recherche Biomédicale de Madagascar (N° 143 MNSAP/SG/AMM/CERBM) and the London School of Hygiene and Tropical Medicine ethics committee (LSHTM reference 28046).Before the start, this study was submitted to the Clinicaltrials.gov public registry (NCT05723484). TRIAL REGISTRATION NUMBER: NCT05723484.


Assuntos
Biomarcadores , Infecções Sexualmente Transmissíveis , Vaginose Bacteriana , Humanos , Feminino , Vaginose Bacteriana/diagnóstico , Estudos Prospectivos , Biomarcadores/análise , Infecções Sexualmente Transmissíveis/diagnóstico , Estudos Transversais , Testes Imediatos , Estudos de Viabilidade , Interleucina-1alfa/metabolismo , Interleucina-1alfa/análise , Interleucina-1beta/análise , Adulto , Citocinas/metabolismo , Citocinas/análise , África do Sul , Zimbábue , Estudos Observacionais como Assunto , Estudos Multicêntricos como Assunto
12.
BMJ Open ; 14(5): e085115, 2024 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-38760050

RESUMO

INTRODUCTION: DNA-informed prescribing (termed pharmacogenomics, PGx) is the epitome of personalised medicine. Despite international guidelines existing, its implementation in paediatric oncology remains sparse. METHODS AND ANALYSIS: Minimising Adverse Drug Reactions and Verifying Economic Legitimacy-Pharmacogenomics Implementation in Children is a national prospective, multicentre, randomised controlled trial assessing the impact of pre-emptive PGx testing for actionable PGx variants on adverse drug reaction (ADR) incidence in patients with a new cancer diagnosis or proceeding to haematopoetic stem cell transplant. All ADRs will be prospectively collected by surveys completed by parents/patients using the National Cancer Institute Pediatric Patient Reported [Ped-PRO]-Common Terminology Criteria for Adverse Events (CTCAE) (weeks 1, 6 and 12). Pharmacist will assess for causality and severity in semistructured interviews using the CTCAE and Liverpool Causality Assessment Tool. The primary outcome is a reduction in ADRs among patients with actionable PGx variants, where an ADR will be considered as any CTCAE grade 2 and above for non-haematological toxicities and any CTCAE grade 3 and above for haematological toxicities Cost-effectiveness of pre-emptive PGx (secondary outcome) will be compared with standard of care using hospital inpatient and outpatient data along with the validated Childhood Health Utility 9D Instrument. Power and statistics considerations: A sample size of 440 patients (220 per arm) will provide 80% power to detect a 24% relative risk reduction in the primary endpoint of ADRs (two-sided α=5%, 80% vs 61%), allowing for 10% drop-out. ETHICS AND DISSEMINATION: The ethics approval of the trial has been obtained from the Royal Children's Hospital Ethics Committee (HREC/89083/RCHM-2022). The ethics committee of each participating centres nationally has undertaken an assessment of the protocol and governance submission. TRIAL REGISTRATION NUMBER: NCT05667766.


Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Farmacogenética , Humanos , Criança , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Neoplasias/tratamento farmacológico , Neoplasias/genética , Estudos Multicêntricos como Assunto , Medicina de Precisão/economia , Transplante de Células-Tronco Hematopoéticas
13.
PLoS One ; 19(5): e0298727, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38768104

RESUMO

Cardiac output (CO) is one of the primary prognostic factors evaluated during the follow-up of patients treated for pulmonary hypertension (PH). It is recommended that it be measured using the thermodilution technique during right heart catheterization. The difficulty to perform iterative invasive measurements on the same individual led us to consider a non-invasive option. The aims of the present study were to assess the agreement between CO values obtained using bioreactance (Starling™ SV) and thermodilution, and to evaluate the ability of the bioreactance monitor to detect patients whose CO decreased by more than 15% during follow-up and, accordingly, its usefulness for patient monitoring. A prospective cohort study evaluating the performance of the Starling™ SV monitor was conducted in patients with clinically stable PH. Sixty patients referred for hemodynamic assessment were included. CO was measured using both the thermodilution technique and bioreactance during two follow-up visits. A total of 60 PH patients were included. All datasets were available at the baseline visit (V0) and 50 of them were usable during the follow-up visit (V1). Median [IQR] CO was 4.20 l/min [3.60-4.70] when assessed by bioreactance, and 5.30 l/min [4.57-6.20] by thermodilution (p<0.001). The Spearman correlation coefficient was 0.51 [0.36-0.64], and the average deviation on Bland-Altman plot was -1.25 l/min (95% CI [-1.48-1.01], p<0.001). The ability of the monitor to detect a variation in CO of more than 15% between two follow-up measurements, when such variation existed using thermodilution, was insufficient for clinical practice (AUC = 0.54, 95% CI [0.33-0.75]).


Assuntos
Débito Cardíaco , Hipertensão Pulmonar , Termodiluição , Humanos , Débito Cardíaco/fisiologia , Feminino , Masculino , Hipertensão Pulmonar/fisiopatologia , Hipertensão Pulmonar/diagnóstico , Pessoa de Meia-Idade , Termodiluição/métodos , Seguimentos , Estudos Prospectivos , Idoso , Reprodutibilidade dos Testes , Monitorização Fisiológica/métodos , Cateterismo Cardíaco , Adulto
14.
Anaesthesiol Intensive Ther ; 56(1): 77-82, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38741447

RESUMO

INTRODUCTION: Malnutrition in surgical patients remains a common issue affecting the perioperative period. Oesophageal cancer is a disease associated with one of the highest malnutrition rates. Assessment of patient nutritional status remains a challenge due to limited validated tools. Novel parameters to identify malnourished patients and the effectiveness of preoperative nutritional intervention might improve treatment results in the perioperative period. MATERIAL AND METHODS: This was a prospective, observational, single-centre study of patients scheduled for elective oesophagectomy. The primary aim of this study was to establish the correlation between neutrophil reactivity intensity (NEUT-RI) and neutrophil granularity intensity (NEUT-GI) and patients' nutritional status. We divided patients into nutritional responders (R group) and nutritional non-responders (NR group) defined as regaining at least 25% of the maximum preoperative body weight loss during the preoperative period. RESULTS: The R group had significantly shorter intensive care unit (ICU) stays: 5.5 (4-8) vs. 13 (7-31) days ( P = 0.01). It resulted in a lower cost of ICU stays in the R group: 4775.2 (3938.9-7640.7) vs. 12255.8 (7787.6-49108.7) euro in the NR group ( P = 0.01). Between the R group and the NR group, we observed statistically significant differences in both preoperative NEUT-RI (48.6 vs. 53.4, P = 0.03) and NEUT-GI (154.6 vs. 159.3, P = 0.02). Apart from the T grade, the only preoperative factor associated with reduced mortality was the nutritional responsiveness: 11.1% vs. 71.4% ( P = 0.008). CONCLUSIONS: Preoperative nutritional responsiveness affects neutrophil intensity indexes and reduces in-hospital mortality and costs associated with hospital stay. Further research is required to determine the correlation between novel neutrophil parameters and patients' nutritional status.


Assuntos
Procedimentos Cirúrgicos Eletivos , Neoplasias Esofágicas , Esofagectomia , Mortalidade Hospitalar , Neutrófilos , Estado Nutricional , Humanos , Estudos Prospectivos , Masculino , Feminino , Neoplasias Esofágicas/cirurgia , Neoplasias Esofágicas/mortalidade , Pessoa de Meia-Idade , Idoso , Neutrófilos/metabolismo , Desnutrição , Tempo de Internação , Unidades de Terapia Intensiva
15.
BMC Geriatr ; 24(1): 440, 2024 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-38769502

RESUMO

BACKGROUND: The World Health Organization (WHO) published the Integrated Care for Older People (ICOPE) framework to help healthcare providers cope with the population aging crisis. However, the relevant evidence on the demands of older people and the compensatory capacity of the environment is limited. This study reports for the first time the level of the ICOPE demand in Western China that includes the impact of geographic accessibility of medical resources (GAMR) on ICOPE demand and the potential mechanism of health status. METHODS: A cross-sectional questionnaire survey was conducted among 1200 adults aged 60 years and older selected through multi-stage stratified cluster sampling to obtain relevant data, including ICOPE demand, health status, and GAMR. Propensity score matching (PSM) was used to analyze the impact of GAMR on ICOPE demand among older people and those with different health statuses. RESULTS: Among the prospective research participants, 1043 were eligible for the study. The mean score of ICOPE demand among all participants was 3.68 (standard deviation [SD] = 0.78). After adjusting for covariates between high and low GAMR groups (1:1 match), ICOPE demand was significantly higher in the low GAMR group than in the high GAMR group (average treatment effect on the treated [ATT] = 0.270, p < 0.05). For both good and poor self-rated health status, the ICOPE demand of the low GAMR group was significantly higher than that in the high GAMR group (ATT = 0.345, p < 0.05; ATT = 0.190, p < 0.05). For chronic diseases, the ICOPE demand of older people with multimorbidity in the low GAMR group was significantly higher than that in the high GAMR group (ATT = 0.318, p < 0.01). CONCLUSIONS: The older population in Western China has a relatively high demand for ICOPE. Low GAMR is a key factor in ICOPE demand growth in this region. It accelerates demand release for both older people with multimorbidity and self-perceptions of health.


Assuntos
Prestação Integrada de Cuidados de Saúde , Acessibilidade aos Serviços de Saúde , Nível de Saúde , Humanos , Estudos Transversais , Idoso , China/epidemiologia , Masculino , Feminino , Pessoa de Meia-Idade , Necessidades e Demandas de Serviços de Saúde/tendências , Idoso de 80 Anos ou mais , Inquéritos e Questionários , Recursos em Saúde , Serviços de Saúde para Idosos , Estudos Prospectivos
16.
Home Healthc Now ; 42(3): 150-160, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38709581

RESUMO

Submaximal functional tests of endurance are ubiquitous in clinical practice. This investigation compared cardiovascular responses, perceived exertion, and performance measures following the completion of three self-paced, 2-minute, functional tests of endurance. A pilot prospective, observational, cross-sectional design with 16 community-dwelling older participants compared heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), rating of perceived exertion (RPE), and performance measures following the completion of three randomly allocated self-paced activities. The three activities included 2 minutes of stepping in standing (2MSTD), 2 minutes of seated stepping (2MSIT), and a 2-minute walk test (2MWT). A within-subjects repeated measures ANOVA analyzed differences in change scores for cardiovascular and RPE responses. Pearson's correlations assessed associations in performance measures between the three tests. Standing stepping compared to seated stepping produced statistically higher change scores in HR, SBP, DBP, and RPE (p < .05). Further, 2MSTD revealed statistically higher SBP and RPE scores compared to 2MWT (p < .05). Large and moderate correlations were observed between number of steps completed in sitting and standing (r = 0.83, p < .01) and between standing steps and distance walked (r = 0.56, p = .02), respectively. This pilot investigation informs home care physical therapists that 2 minutes of self-paced stepping in standing produced the greatest change scores in all cardiovascular and perceived exertion responses. No significant differences were noted in HR between self-paced walking and standing stepping, and between standing and seated stepping. For patients unable to walk or step in standing, self-paced seated stepping may be a viable alternative.


Assuntos
Tolerância ao Exercício , Frequência Cardíaca , Serviços de Assistência Domiciliar , Humanos , Masculino , Feminino , Idoso , Estudos Transversais , Estudos Prospectivos , Tolerância ao Exercício/fisiologia , Projetos Piloto , Frequência Cardíaca/fisiologia , Teste de Esforço/métodos , Pressão Sanguínea/fisiologia , Idoso de 80 Anos ou mais
18.
Pediatr Crit Care Med ; 25(5): e239-e245, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38695703

RESUMO

OBJECTIVES: To adapt and develop a reliable and easily administered outcome measure of physical and respiratory function in critically ill children in the PICU. DESIGN: Modified Delphi study to adapt the Chelsea Critical Care Physical Assessment (CPAx) tool for use in children 2-18 years old, with subsequent prospective testing in a single-center cohort. SETTING: Single-center tertiary PICU. SUBJECTS: Delphi process in 27 panelists (including physiotherapists, occupational therapists, and pediatric intensivists from seven countries from January 2018 to March 2018). Cohort study in 54 patients admitted to PICU for greater than 24 hours over a 3-month period (April 2018 to June 2018), with median age 5.5 years (interquartile range [IQR], 3-12.75 yr), 33 of 54 male, and 38 of 54 invasively ventilated. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Three Delphi iterations were required to reach greater than or equal to 80% consensus in all the children's CPAx (cCPAx) items. In the subsequent cohort study, six physiotherapists used the cCPAx tool and scored 54 participants, with a total 106 observations. The median cCPAx tool score was 14.50 (IQR, 3-25) out of a possible total of 50. Inter-rater reliability for 30 randomly selected participants was excellent (intraclass correlation coefficient, 0.998). Completion rate of cCPAx in the 54 patients occurred in 78 of 106 occasions (74%). CONCLUSIONS: The cCPAx tool content that was developed using Delphi methodology provided a feasible and clinically relevant tool for use in assessing physical morbidity in PICU patients 2-18 years old. Overall, the cCPAx scores were low, demonstrating low levels of physical function and high levels of immobility during PICU care.


Assuntos
Cuidados Críticos , Técnica Delphi , Unidades de Terapia Intensiva Pediátrica , Humanos , Pré-Escolar , Masculino , Adolescente , Criança , Feminino , Cuidados Críticos/métodos , Estudos Prospectivos , Estado Terminal/terapia , Reprodutibilidade dos Testes , Exame Físico/métodos , Desempenho Físico Funcional
19.
Trends Hear ; 28: 23312165241242235, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38738302

RESUMO

The objective of this project was to establish cutoff scores on the tinnitus subscale of the Tinnitus and Hearing Survey (THS) using a large sample of United States service members (SM) with the end goal of guiding clinical referrals for tinnitus evaluation. A total of 4,589 SM undergoing annual audiometric surveillance were prospectively recruited to complete the THS tinnitus subscale (THS-T). A subset of 1,304 participants also completed the Tinnitus Functional Index (TFI). The original 5-point response scale of the THS (THS-T16) was modified to an 11-point scale (THS-T40) for some participants, to align with the response scale of the TFI. Age, sex, hearing loss, and self-reported tinnitus bother were also recorded. The THS-T was relatively insensitive to hearing, but self-reported bothersome tinnitus was significantly associated with the THS-T40 score. Receiver operating characteristic analysis was used to determine cutoff scores on the THS-T that aligned with recommended cutoff values for clinical intervention on the TFI. A cutoff of 9 on the THS-T40 aligns with a TFI cutoff of 25, indicating a patient may need intervention for tinnitus. A cutoff of 15 aligns with a TFI cutoff of 50, indicating that more aggressive intervention for tinnitus is warranted. The THS-T is a viable tool to identify patients with tinnitus complaints warranting clinical evaluation for use by hearing conservation programs and primary care clinics. The THS-T40 cutoff scores of 9 and 15 provide clinical reference points to guide referrals to audiology.


Assuntos
Zumbido , Humanos , Zumbido/diagnóstico , Feminino , Masculino , Pessoa de Meia-Idade , Idoso , Adulto , Estudos Prospectivos , Estados Unidos , Audição , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Curva ROC , Inquéritos e Questionários , Autorrelato , Audiometria/métodos
20.
Support Care Cancer ; 32(6): 344, 2024 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-38740611

RESUMO

BACKGROUND: Electronic patient-reported outcomes (ePROs) assess patients' health status and quality of life, improving patient care and treatment effects, yet little is known about their use and adherence in routine patient care. AIMS: We evaluated the adherence of invasive breast cancer and ductal carcinoma in situ (DCIS) patients to ePROs follow-up and whether specific patient characteristics are related to longitudinal non-adherence. METHODS: Since November 2016, the Breast Center at Charité - Universitätsmedizin Berlin has implemented an ongoing prospective PRO routine program, requiring patients to complete ePROs assessments and consent to email-based follow-up in the first 12 months after therapy starts. Frequencies and summary statistics are presented. Multiple logistic regression models were performed to determine an association between patient characteristics and non-adherence. RESULTS: Out of 578 patients, 239 patients (41.3%, 95%CI: 37.3-45.5%) completed baseline assessment and all five ePROs follow-up during the first 12 months after therapy. On average, above 70% of those patients responded to the ePROs follow-up assessment. Adherence to the ePROs follow-up was higher during the COVID-19 pandemic than in the time periods before (47.4% (111/234) vs. 33.6% (71/211)). Factors associated with longitudinal non-adherence were younger age, a higher number of comorbidities, no chemotherapy, and a low physical functioning score in the EORTC QLQ-C30 at baseline. CONCLUSIONS: The study reveals moderate adherence to 12-month ePROs follow-up assessments in invasive early breast cancer and DCIS patients, with response rates ranging from 60 to 80%. Emphasizing the benefits for young patients and those with high disease burdens might further increase adherence.


Assuntos
Neoplasias da Mama , Cooperação do Paciente , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Humanos , Feminino , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/psicologia , Neoplasias da Mama/terapia , Pessoa de Meia-Idade , Estudos Longitudinais , Idoso , Estudos Prospectivos , Cooperação do Paciente/estatística & dados numéricos , Adulto , Seguimentos , Carcinoma Intraductal não Infiltrante/terapia , Carcinoma Intraductal não Infiltrante/psicologia , Carcinoma Intraductal não Infiltrante/tratamento farmacológico , COVID-19
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