Effect of laparoscopic handle size on surgical performance: A randomized crossover trial.

Laparoscopic instrument handles design and dimensions are crucial to determine the configuration of surgeons' hand grip and, therefore, can have a deleterious effect on overall surgical efficiency and surgeons' comfort. The aim of this study is to investigate the impact of laparoscopic handle size and hand surface area on surgical task performance. A single-blind, randomized crossover trial was carried out with 29 novice medical students. Participants performed three simulated tasks in "black box" simulators using two scissor-type handles of different sizes. Surgical performance was assessed by the number of errors and time required to complete each task. Hand anthropometric data were measured using a 3D scanner. Execution time was significantly higher when cutting and suturing tasks were performed with the smaller handle. In addition, hand surface area was positively correlated with peg transfer task time when performed with the standard handle and was correlated with cutting task time in small and standard handle groups. We also found positive correlations between execution time and the number of errors executed by larger-handed participants. Our findings indicate that laparoscopic handle size and hand area influence surgical performance, highlighting the importance of considering hand anthropometry variances in surgical instrument design.

Satisfaction of Health Professionals Regarding the Short Binasal Prong Used as a Non-Invasive Ventilation Interface in Neonatology.

Purpose: To evaluate the health professionals' satisfaction regarding the short binasal prong used in Neonatal Intensive Care Units (NICU), evaluate the difficulties related to its use, and present possible improvements in the design of this device. Patients and Methods: Observational, cross-sectional study with prospective data collection carried out in the NICU of a public hospital in southern Brazil. This research was presented into two stages. In the first stage, the Quebec User Evaluation of Satisfaction with Assistive Technology was applied with 90 health professionals to evaluate the satisfaction regarding the short binasal prong. In the second stage, the health professional's experiences and difficulties in using the binasal prongs in 14 newborns (NBs) that required non-invasive ventilation was collected. The short binasal prongs used was the Fanem® brand and the CPAP circuit was Gabisa Medical International (GMI®). Finally, improvements and recommendations were presented to optimize the device's design. Results: The mean score of the health professionals' satisfaction with short binasal prongs was 3.8 ± 0.6. Ease of adjustment (3.27) and dimensions (3.62) variables had the worst scores. The main difficulties pointed out by health professionals were: circuit disconnection (57.1%), the size of the prong did not correspond to NBs' anatomical characteristics (35.7%), air leakage (21.4%), and difficulty in fixing and positioning the prong in the NB (14.28%). The improvements suggested were: appropriate prong sizes based on the anatomical characteristics of the NBs; adjustable distance between insertion and base catheters; manufactured with malleable material, however not easily foldable; curved and adjustable insertion catheters and functional system of tracheas' connection. Conclusion: The dissatisfaction of health professionals with the dimensions and prongs adjustments and the difficulties faced in clinical practice indicate the need for improvements in these interfaces. The recommendations presented in this study may contribute to optimizing the design of the binasal prong in the future.

Cardiopulmonary resuscitation in the prone position: a systematic review of case series/reports / Reanimação cardiopulmonar em posição prona: uma revisão sistemática de séries/relatos de casos

Abstract Introduction The prone position is frequently adopted for surgical or critically ill patients in intensive care. Cardiorespiratory arrest in these patients may pose an operational challenge, in which delays resulting from mobilization to the supine position culminate in worse outcomes. Objective To provide clinical insight based on the synthesis of evidence from reports or case series on reverse cardiopulmonary resuscitation (reverse CPR) in surgical patients or invasive ventilatory support in severe acute respiratory distress syndrome. Methods This is a systematic review of reports or case series in PubMed, Scopus, Embase, and Google Scholar databases, in addition to a search of the gray literature. Case reports published in any language, reporting at least one case of prone cardiopulmonary resuscitation in patients of any age and in any care context, were considered eligible. Results Thirteen studies of fourteen cases of successful reverse resuscitation were retrieved. Three patients died within 30 days, while the others survived without complications or neurological sequelae. Conclusion Despite limited evidence to support clinical decision-making, prone resuscitation appears to be a feasible alternative in exceptional circumstances, where patient mobilization may result in additional harm, delay or interrupt advanced life support (compressions, high-quality early chest surgery, and defibrillation) or incur occupational risks to the health team.

Resumo Introdução A posição prona é um procedimento frequente de cuidados intensivos para pacientes cirúrgicos ou doentes graves. A ocorrência de parada cardiorrespiratória nestes pacientes pode representar um desafio operacional, no qual atrasos relacionados à mobilização para decúbito dorsal implicam em piores desfechos. Objetivo Oferecer um insight clínico a partir da síntese das evidências oriundas de relatos ou séries de casos sobre a utilização de reanimação cardiopulmonar reversa em pacientes cirúrgicos ou em suporte ventilatório invasivo na síndrome do desconforto respiratório agudo grave. Métodos Trata-se de uma revisão sistemática de relatos ou séries de casos condu-zida nas bases de dados PubMed, Scopus, Embase e Google Scholar, além de busca na literatura cinzenta. Foram considerados elegíveis relatos de caso publicados em qualquer idioma, que reportaram pelo menos um caso de reanimação cardiopulmonar em posição prona em pacientes de qualquer idade e em qualquer contexto de atendimento. Resultados Foram recuperados treze estudos que relataram quatorze casos de reanimação reversa bem-sucedidos. Três pacientes faleceram em um intervalo de 30 dias, enquanto os demais sobreviveram sem complicações ou sequelas neurológicas. Conclusão Apesar de evidências limitadas para suportar a tomada de decisão clínica, a reanimação em posição prona parece ser uma alternativa factível em circunstâncias excepcionais, nas quais a mobilização do paciente pode resultar em dano adicional, atrasar ou interromper o suporte avançado de vida (compressões torácicas precoces de alta qualidade e a desfibrilação) ou, ainda, incorrer em riscos ocupacionais à equipe de saúde.

Thermal changes in the sacral region with different mattresses used in the prevention of pressure injuries.

BACKGROUND: Pressure Injury (PI) is a severe health problem that affects millions of people. As a preventive strategy for high-risk ICU patients, the appropriate selection of a support surface is essential for preventing PI, along with risk assessment and repositioning. Increasing skin temperature has been associated with a higher susceptibility to PI development. OBJECTIVE: This study aimed to evaluate thermal variations related to skin pressure in the sacral area of healthy individuals lying on three different mattresses models (standard, inflatable air, and egg crate). DESIGN: Experimental study. MAIN OUTCOMES: Initially, a survey was performed to identify the mattresses models most used in four public university hospitals and preventive strategies adopted. And then, an experimental study was conducted with a non-probabilistic sample involving 28 individuals of both sexes, aged 18-35 years old. The volunteers were immobilized for 2 h, and temperature variations in the sacral region were obtained by acquiring thermal images. RESULTS: A significant difference was not found in the temperature recorded on the three mattresses models before the experiment. However, there were significant differences at the 1st and 31st minute (p < 0.001). The lowest temperature values were identified in the air inflatable mattress. Post-hoc comparisons revealed a significant difference between standard or egg crate mattresses and the inflatable air model. CONCLUSION: The inflatable air mattress should be considered for preventing pressure injury in ICU patients since the temperature had returned to the initial value (pre-test) after the 31st min. In addition to the appropriate selection surface, risk assessment and positioning are essential to PI prevention strategies.

Effects of hydrotherapy and tactile-kinesthetic stimulation on weight gain of preterm infants admitted in the Neonatal Intensive Care Unit

Abstract Objective: The present study aimed to evaluate the effects of hydrotherapy and tactile-kinesthetic stimulation on the birth weight of preterm infants admitted in the Neonatal Intensive Care Unit. Method: It was a randomized controlled trial, without blinding, in which 44 preterm infants of both sexes with gestational age between 32 and 34 weeks were included into two groups: hydrotherapy group (n = = 22) and tactile-kinesthetic stimulation group (n = 22). Weight gain was the parameter assessed daily. Results: In the tactile-kinesthetic stimulation group there was a variation in weight gain, but without significant difference (p = 0,43). However, in the hydrotherapy group, it was observed that increased weight gain started from the 2nd day (p < 0,001). Conclusions: Hydrotherapy group presented significantly increased weight after the interventions, indicating that this technique can interfere with weight gain in preterm infants.

Effects of hydrotherapy and tactile-kinesthetic stimulation on weight gain of preterm infants admitted in the Neonatal Intensive Care Unit.

OBJECTIVE: The present study aimed to evaluate the effects of hydrotherapy and tactile-kinesthetic stimulation on the birth weight of preterm infants admitted in the Neonatal Intensive Care Unit. METHOD: It was a randomized controlled trial, without blinding, in which 44 preterm infants of both sexes with gestational age between 32 and 34 weeks were included into two groups: hydrotherapy group (n = = 22) and tactile-kinesthetic stimulation group (n = 22). Weight gain was the parameter assessed daily. RESULTS: In the tactile-kinesthetic stimulation group there was a variation in weight gain, but without significant difference (p = 0,43). However, in the hydrotherapy group, it was observed that increased weight gain started from the 2nd day (p < 0,001). CONCLUSIONS: Hydrotherapy group presented significantly increased weight after the interventions, indicating that this technique can interfere with weight gain in preterm infants.

Correlation of End-Tidal Carbon Dioxide with Arterial Carbon Dioxide in Mechanically Ventilated Neonates: A Scoping Review.

Monitoring CO2 levels in intubated neonates is highly relevant in the face of complications associated with altered CO2 levels. Thus, this review aims to present the scientific evidence in the literature regarding the correlation between arterial carbon dioxide measured by non-invasive methods in newborns submitted to invasive mechanical ventilation. The search was carried out from January 2020 to January 2021, in the Scopus, Medline, The Cochrane Library, Web of Science, CINAHL and Embase databases. Also, a manual search of the references of included studies was performed. The main descriptors used were: "capnography," "premature infant," "blood gas analysis," and "mechanical ventilation." As a result, 221 articles were identified, and 18 were included in this review. A total of 789 newborns were evaluated, with gestational age between 22.8 and 42.2 weeks and birth weight between 332 and 4790 g. Capnometry was the most widely used non-invasive method. In general, the correlation and agreement between the methods evaluated in the studies were strong/high. The birth weight did not influence the results. The gestational age of fewer than 37 weeks implied, in its majority, a moderate correlation and agreement. Therefore, we can conclude that there was a predominance of a strong correlation between arterial blood gases and non-invasive methods, although there are variations found in the literature. Even so, the results were promising and may provide valuable data for future studies, which are necessary to consolidate non-invasive methods as a reliable and viable alternative to arterial blood gasometry.

Relação entre capacidade funcional, estado nutricional e variáveis sociodemográficas de idosos institucionalizados / Relationship between functional capacity, nutritional status and sociodemographic variables of institutionalized older adults

Resumo Objetivo Analisar a relação entre a capacidade funcional, o estado nutricional e as variáveis sociodemográficas de idosos residentes em instituições de longa permanência. Método Trata-se de um estudo transversal conduzido com 82 idosos institucionalizados. Para a coleta de dados foram aplicados o Índice de Barthel para avaliação do grau de independência no desempenho das atividades básicas de vida diária e a Mini Avaliação Nutricional (MNA) para a avaliação do estado nutricional dos idosos. Os dados foram coletados em cinco instituições de longa permanência situadas na região Sul do Brasil. Análises de regressão logística ordinal foram realizadas para verificar as associações dos fatores contextuais com a capacidade funcional dos idosos institucionalizados Resultados A maioria dos participantes apresentou independência total no desempenho das atividades de vida diária (39,0%) e estado nutricional deficiente (59,8%). A análise de regressão ordinal multivariada demonstrou que idosos institucionalizados com maiores escores na avaliação nutricional estão associados com melhores indicadores de capacidade funcional (RC=1,33; IC 95%=1,15 a 1,54; p<0,001). Não se encontrou associação entre escolaridade, lesões por pressão, índice de massa corpórea e a capacidade funcional. Conclusão O estado nutricional é um importante preditor para a dependência de idosos institucionalizados.

Abstract Objective To analyze the relationship between functional capacity, nutritional status, and sociodemographic variables of older adults living in long-term care facilities. Method This is a cross-sectional study conducted with 82 institutionalized older adults. For data collection, we used the Barthel Index to assess the degree of independence in the performance of basic activities of daily living and the Mini Nutritional Assessment (MNA) to assess the nutritional status of older adults. Data were collected in five geriatric long-term care facilities located in southern Brazil. Ordinal regression analyses were performed to identify associations between contextual social factors, and nutritional status with the functional capacity of institutionalized older adults. Results Most participants showed complete independence in performing activities of daily living (39.0%) and poor nutritional status (59.8%). The multivariate ordinal regression analysis showed that older adults with higher scores in the nutritional assessment are associated with better indicators of functional capacity (OR=1.33; 95% CI=1.15 to 1.54; p<0.001). We did not find an association between educational level, pressure injuries, body mass index, and functionality. Conclusion Nutritional status is a significant predictor for dependency in institutionalized older adults.

Parachuting harnesses comparative evaluation on energy distribution grids.

This research aims to make a comparative evaluation of three different parachuting harnesses to work at heights in the energy industry, from the electricians' point of view concerning these products under the optics of usability and ergonomic principles, and mainly justified by the high quantity of injuries at the energy industry due to high falls. According to its main target, this field research is classified as exploratory-descriptive transversal viewing study and, considering this perspective, the study was developed in four steps. Research results have enlightened the weakest spots and the potential improvement opportunities of these products, developed to assure safety of the work at heights to the energy industry, according to the opinion of the users. Still, results point that, regardless of the model, these devices have adapting issues to fulfill the electrical sector user's needs.