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1.
Codas ; 34(2): e20200324, 2022.
Article in Portuguese, English | MEDLINE | ID: mdl-35019077

ABSTRACT

PURPOSE: To present Myofunctional Orofacial Clinical History Instructive and Protocol belonging to the MMBGR Protocol - Infants and Preschoolers, including the adaptation and validation of content and appearance. METHODS: Validation, descriptive and cross-sectional study. Adaptation based on the MBGR Protocol, based on theoretical studies and the authors' experience. Infants between 6 and 23 months of age and preschoolers between 24 and 71 months were considered. Consent and consensus of the version adapted by the authors (original and current) was obtained. The appearance and content of the new instrument were analyzed by 10 speech therapists specialized in Orofacial Motricity. We performed two analysis rounds. First: an electronic form containing dichotic questions (yes / no), with justification for negative answers; Content Validity Index and Exact Binomial Test; Second: 5 points-Likert scale. RESULTS: We produced an unprecedented instructional and adapted Clinical History protocol maintaining 23 age group related items. We excluded information from 7 items and included information in 8. Initially, we achieved agreement in 70% instructional specialist items by at least 70% of the specialists; and 64% of Clinical History items, by at least 90% of specialists. In the second round, there were 100% of "I totally agree" responses from the experts. CONCLUSION: "Instructive" and "Myofunctional Clinical History, Orofacial" had validity of content and appearance concluded, and together with the "Clinical Examination" they integrate the "Protocol MMBGR - Infants and Preschoolers", being able to contribute to clinical practice and research in Motricity Orofacial area in the age group between 6 months and 5 years and 11 months of age.


OBJETIVO: Apresentar Instrutivo e Protocolo de História Clínica Miofuncional Orofacial pertencentes ao Protocolo MMBGR - Lactentes e Pré-escolares, incluindo adaptação e validação do conteúdo e aparência destes. MÉTODO: Estudo tipo validação, descritivo e transversal. Adaptação a partir do Protocolo MBGR, fundamentada em estudos teóricos e experiência dos autores. Considerados lactentes entre 6 e 23 meses de vida e pré-escolares entre 24 e 71 meses. Obtido consentimento e consenso da versão adaptada pelos autores (originais e atuais). Analisados aparência e conteúdo do novo instrumento por 10 fonoaudiólogos especialistas em Motricidade Orofacial. Realizadas duas rodadas de análise: Primeira com formulário eletrônico contendo questões dicóticas (sim/não), com espaço para justificar as respostas negativas; calculado Índice de Validade de Conteúdo e Teste Binomial Exato; e Segunda com escala Likert 5 posições. RESULTADOS: Produzido instrutivo inédito e adaptado o Protocolo de História Clínica, com manutenção de 23 itens pertinentes à faixa etária em questão. Excluídas informações em 7 itens e acrescidas em 8 itens. Inicialmente obteve-se concordâncias de 70% do instrutivo, por pelo menos 70% dos especialistas; e 64% dos itens da História Clínica, por ao menos 90% dos especialistas. Obteve-se na segunda rodada 100% de respostas "Concordo totalmente" dos especialistas. CONCLUSÃO: "Instrutivo" e "História Clínica Miofuncional Orofacial" tiveram validade de conteúdo e aparência concluída, e junto ao "Exame Clínico" integram o "Protocolo MMBGR - Lactentes e Pré-escolares", com potencial contribuição para atuação clínica e na pesquisa em Motricidade Orofacial na faixa etária de 6 meses a 5 anos e 11 meses de idade.


Subject(s)
Facial Muscles , Child, Preschool , Clinical Protocols , Cross-Sectional Studies , Humans , Infant
2.
Codas ; 34(2): e20210024, 2022.
Article in Portuguese, English | MEDLINE | ID: mdl-35019078

ABSTRACT

PURPOSE: To verify the immediate effects of different doses of photobiomodulation on maximum lip pressure. METHODS: Experimental, randomized and triple-blind study. The sample consisted of 23 women and 17 men, age between 18 and 33 years old (average 23.18 years old, SD=2.1), distributed in four groups: CG (control group), G1, G4 and G7. The maximum pressure was assessed with the Iowa Oral Performance Instrument (IOPI). The bulb was placed between the lips and the participants were instructed to press it as strong as possible. Infrared LASER (808 nm), manufactured by DMC, Therapy EC model, 100 mW of power output, was applied. The doses tested were 1 J (G1), 4 J (G4) and 7 J (G7), applied at six points of the orbicularis oris muscle. In the CG there was no intervention. The evaluation procedures were repeated after the LASER application. The results were analyzed with a significance level of 95%. RESULTS: The maximum lip pressure increased significantly only in the group irradiated with 7 J. CONCLUSION: Low level LASER therapy with 7 J dose promoted changes in the performance of the orbicularis oris muscle in the maximum pressure task.


OBJETIVO: Verificar os efeitos imediatos da fotobiomodulação sobre a pressão máxima dos lábios para diferentes doses. MÉTODO: Estudo experimental, randomizado e triplo cego. A amostra foi composta por 23 mulheres e 17 homens com idade entre 18 e 33 anos (média 23,18 anos, DP=2,1), divididos em quatro grupos: GC (grupo controle), G1, G4 e G7. A pressão máxima foi avaliada com o Iowa Oral Performance Instrument (IOPI). O bulbo foi posicionado entre os lábios e os participantes foram orientados a pressioná-lo com a maior força possível. Aplicou-se o LASER infravermelho (808 nm) da marca DMC, modelo Therapy EC, 100 mW de potência. As doses testadas foram 1 J (G1), 4 J (G4) e 7 J (G7) aplicadas em seis pontos do músculo orbicular da boca. No GC não houve intervenção. Após a aplicação do LASER, foram repetidos os procedimentos de avaliação. Os resultados foram analisados com nível de significância de 95%. RESULTADOS: A pressão máxima de lábios aumentou significativamente apenas no grupo irradiado com 7 joules. CONCLUSÃO: O LASER de baixa intensidade na dose de 7 J promoveu mudanças no desempenho do músculo orbicular da boca em tarefa de pressão máxima.


Subject(s)
Lip , Low-Level Light Therapy , Adolescent , Adult , Clinical Protocols , Facial Muscles , Female , Humans , Male , Young Adult
3.
J Surg Oncol ; 125(1): 69-74, 2022 Jan.
Article in English | MEDLINE | ID: mdl-34897709

ABSTRACT

Investigator-initiated trials (IITs) are clinical trials in which the clinician is both the sponsor and the investigator. IITs have also been developed to test strategies designed to optimize existing therapies or treatment approaches that may not be supported by industry sponsors or may be too novel to gain the consensus to be supported by cooperative groups. The role of the investigator is comprehensive and includes protocol development, securing funding for the administration of the trial, recruitment and monitoring of subjects, and assurance for the protection of human subjects. We will briefly review the importance of surgeons in developing IITs and provide insights into logistical barriers from conception to completion of the trial.


Subject(s)
Pancreatic Neoplasms/therapy , Clinical Protocols , Clinical Trials as Topic , Humans , Pancreatic Neoplasms/surgery , Surgical Oncology
4.
Ann Otol Rhinol Laryngol ; 131(1): 12-26, 2022 Jan.
Article in English | MEDLINE | ID: mdl-33779296

ABSTRACT

OBJECTIVE: To analyze trends in otolaryngology consultations and provide algorithms to guide management during the COVID-19 pandemic. METHODS: A retrospective cohort study at a single institution tertiary care hospital. A total of 95 otolaryngology consultations were performed from March 1, 2020 to April 26, 2020 (COVID-era) and 363 were performed from September 1, 2019 to February 29, 2020 (pre-COVID-era) at the UPMC Oakland campus. Data collected included patient demographics, COVID-19 status, reason for consult, location of consult, type of consult, procedures performed, need for surgical intervention, length of hospital stay and recommended follow up. RESULTS: Patient populations in the pre-COVID-era and COVID-era were similar in terms of their distribution of demographics and chief complaints. Craniofacial trauma was the most common reason for consultation in both periods, followed by vocal fold and airway-related consults. We saw a 21.5% decrease in the rate of consults seen per month during the COVID-era compared to the 6 months prior. Review of trends in the consult workflow allowed for development of several algorithms to safely approach otolaryngology consults during the COVID-19 pandemic. CONCLUSIONS: Otolaryngology consultations provide valuable services to inpatients and patients in the emergency department ranging from evaluation of routine symptoms to critical airways. Systematic otolaryngology consult service modifications are required in order to reduce risk of exposure to healthcare providers while providing comprehensive patient care.


Subject(s)
Algorithms , COVID-19 , Otolaryngology , Otorhinolaryngologic Diseases , Referral and Consultation/trends , Adolescent , Adult , Aged , Aged, 80 and over , Clinical Protocols , Cohort Studies , Female , Hospitals, University , Humans , Male , Middle Aged , Otorhinolaryngologic Diseases/diagnosis , Otorhinolaryngologic Diseases/therapy , Pennsylvania , Retrospective Studies , Young Adult
5.
Multimedia | Multimedia Resources | ID: multimedia-9547

ABSTRACT

O vídeo fala sobre a atuação da Atenção Primária no enfrentamento a COVID-19. Além disso traz recomendações para adequação das Equipes de saúde no enfrentamento a Pandemia.


Subject(s)
Primary Health Care , COVID-19 , Local Health Strategies , Clinical Protocols , Patient Care Management
6.
Article in English | PAHO-IRIS | ID: phr-55295

ABSTRACT

[ABSTRACT]. Objective. To identify factors affecting compliance with follow-up during treatment in confirmed malaria patients at two health centers in Haiti. Methods. A prospective observational study of malaria patients undergoing treatment over a six-week period. Patients’ return visits (follow-up visits) to the health centers for consultation in accordance with the physicians’ requests were recorded and used to determine compliance. Socioeconomic data were obtained from patient enrollment questionnaires and through post-treatment interviews. The management practices and procedures at the health centers to retain patients were also reviewed. Descriptive statistics and Spearman’s rank correlation were used to identify significant factors, which were used as variables in a logistic regression model. Results. Sixty-eight percent of the malaria patients completed follow-up, with higher compliance being recorded in the larger, more established health center of Leogane (67%) than Cite Soleil (33%). The patient socioeconomic profiles differed between the two health center locations by level of education, religious diversity, household size, and percentage of married individuals. Crude logistic regression analyses identified health center location (OR = 0.179 [95% CI 0.064, 0.504]) and household size (OR = 1.374 [95% CI 1.056, 1.787]) to be associated with compliance. The adjusted model only identified health center location (OR = 0.226 [95% CI 0.056, 0.918]) as significantly associated with compliance. Conclusion. Although patients’ household size may be important according to the crude logistic regression analysis, in the adjusted analysis the site location of the health center where patients receive treatment was identified as the only important factor associated with follow-up compliance in malaria patients during treatment in Haiti. This information might be helpful to improve treatment outcomes and contribute to the monitoring of antimalarial resistance in Haiti.


[RESUMEN]. Objetivo. Determinar los factores que afectan el cumplimiento del seguimiento durante el tratamiento de los pacientes con malaria confirmada en dos centros de salud de Haití. Métodos. Se llevó a cabo un estudio observacional prospectivo de los pacientes con malaria que recibían tratamiento a lo largo de un período de seis semanas. Se registraron las consultas subsiguientes de los pacientes a los centros de salud (consultas de seguimiento) de acuerdo con la solicitud de los médicos, que se emplearon para determinar el cumplimiento. Se obtuvieron los datos socioeconómicos de los cuestionarios del registro de pacientes y mediante entrevistas postratamiento. También se examinaron las prácticas y los procedimientos de gestión del centro de salud para promover la retención de los pacientes. Se emplearon estadísticas descriptivas y la correlación de rangos de Spearman para determinar los factores significativos, que se usaron como variables en un modelo de regresión logística. Resultados. El 68% de los enfermos de malaria completaron el seguimiento. El mayor cumplimiento se registró en el centro de salud más grande y de mayor prestigio de Léogâne (67%) en comparación con el centro de Cité Soleil (33%). Los perfiles socioeconómicos de los pacientes difirieron entre las dos ubicaciones del centro de salud en lo concerniente al nivel de escolaridad, diversidad religiosa, tamaño del hogar y porcentaje de personas casadas. Los análisis crudos de regresión logística determinaron que había una asociación entre la ubicación del centro de salud (OR = 0,179 [IC de 95 % 0,064, 0,504]) y el tamaño del hogar (OR = 1,374 [IC de 95 % 1,056, 1,787]) con el cumplimiento. En el modelo ajustado se encontró que solo la ubicación del centro de salud (OR = 0,226 [IC de 95 % 0,056, 0,918]) estaba significativamente relacionada con el cumplimiento. Conclusión. Aunque el tamaño del hogar de los pacientes podría ser importante según el análisis crudo de regresión logística, en el análisis ajustado se determinó que la ubicación del centro de salud en que los pacientes reciben el tratamiento era el único factor importante asociado con el cumplimiento de seguimiento de los pacientes con malaria en tratamiento en Haití. Es posible que esta información sea útil para mejorar los resultados del tratamiento y contribuir al seguimiento de la resistencia a los antimaláricos en Haití.


[RESUMO]. Objetivo. Identificar os fatores que afetam a adesão ao seguimento durante o tratamento da malária em pacientes com diagnóstico confirmado em dois centros de saúde no Haiti. Métodos. Estudo observacional prospectivo de pacientes com malária em tratamento durante um período de seis semanas. Os retornos dos pacientes (consultas de seguimento) aos centros de saúde para consulta, conforme solicitado pelos médicos, foram registrados e usados para determinar a adesão. Os dados socioeconômicos foram obtidos a partir dos cadastros dos pacientes e por meio de entrevistas pós-tratamento. As práticas e procedimentos de gestão para reter pacientes no centro de saúde também foram analisados. Foram utilizadas estatísticas descritivas e correlação de Spearman para identificar fatores significativos, que foram então incluídos como variáveis em um modelo de regressão logística. Resultados. Sessenta e oito por cento dos pacientes com malária concluíram o seguimento. A adesão foi superior no centro de saúde maior e mais estabelecido de Léogâne (67%) do que no de Cité Soleil (33%). Os perfis socioeconômicos dos pacientes nos dois centros de saúde divergiram em relação à escolaridade, diversidade religiosa, tamanho da família e porcentagem de indivíduos casados. As análises de regressão logística brutas identificaram a localização do centro de saúde (OR = 0,179 [IC 95% 0,064; 0,504]) e o número de residentes no domicílio (OR = 1,374 [IC 95% 1,056; 1,787]) como fatores associados à adesão. O modelo ajustado identificou apenas a localização do centro de saúde (OR = 0,226 [IC 95% 0,056; 0,918]) como fator significativamente associado à conformidade. Conclusão. Embora o número de residentes no domicílio dos pacientes possa ser importante de acordo com a análise de regressão logística bruta, na análise ajustada a localização do centro de saúde onde os pacientes receberam tratamento foi identificada como o único fator importante associado à adesão ao seguimento em pacientes com malária durante o tratamento no Haiti. Essas informações podem ser úteis para melhorar os desfechos do tratamento e contribuir para o monitoramento da resistência aos antimaláricos no Haiti.


Subject(s)
Malaria, Falciparum , Clinical Protocols , Patient Compliance , Therapeutics , Haiti , Malaria, Falciparum , Clinical Protocols , Patient Compliance , Therapeutics , Haiti , Malaria, Falciparum , Patient Compliance , Therapeutics
7.
PLoS One ; 16(12): e0261302, 2021.
Article in English | MEDLINE | ID: mdl-34937068

ABSTRACT

BACKGROUND: Despite our ageing populations, elderly patients are underrepresented in clinical research, and ageing research is often separate from that of Parkinson's disease (PD). To our knowledge, no previous study has focused on the most elderly ('old-old', age ≥ 85 years) patients with PD to reveal how age directly influences PD clinical progression. OBJECTIVE: We compared the clinical characteristics and pharmacological profiles, including complications of levodopa treatment, disease progression, disabilities, and comorbidities of the old-old with those of comparable younger ('young-old', age 60-75 years) PD patients. In addition, within the old-old group, we compared those with a short disease duration (< 10 years at the time of diagnosis) to those with a long disease duration ≥10 years to investigate whether prognosis was related to disease progression or aging. METHODS: This single-centre, case-control study compared 60 old-old to 92 young-old PD patients, matched for disease duration. Patients in the old-old group were also divided equally (30:30) into two subgroups (short and long disease duration) with the same mean age. We compared the groups based on several clinical measures using a conditional logistic regression. RESULTS: By study design, there were no differences between age groups when comparing disease duration, however, the proportion of men decreased with age (p = 0.002). At a comparable length of PD duration of 10 years, the old-old PD patients predominantly had significantly greater postural instability and gait disturbance (p = 0.006), higher motor scope of the Unified Parkinson's Disease Rating Scale (UPDRS-III, p<0.0001), and more advanced Hoehn & Yahr (H&Y) stage (p<0.0001). The Non-Motor Symptoms Questionnaire (NMSQuest) score was also significantly higher among the old-old (p<0.0001) compared to the young-old patients. Moreover, the distribution of NMS also differed between ages, with features of gastrointestinal problems (p<0.0001), urinary problems (p = 0.004), sleep disturbances and fatigue (p = 0.032), and cognitive impairment (p<0.0001) significantly more common in the old-old group, whereas sexual problems (p = 0.012), depression, and anxiety (p = 0.032) were more common in the young-old. No differences were found in visual hallucinations, cerebrovascular disease, and miscellaneous domains. While young-old PD patients received higher levodopa equivalent daily doses (p<0.0001) and developed a significant greater rate of dyskinesia (p = 0.002), no significant difference was observed in the rate of wearing-off (p = 0.378). Old-old patients also had greater disability, as measured by the Schwab and England scale (p<0.0001) and had greater milestone frequency specifically for dementia (p<0.0001), wheelchair placement (p<0.0001), nursing home placement (p = 0.019), and hospitalisation in the past 1 year (p = 0.05). Neither recurrent falls (p = 0.443) nor visual hallucinations (p = 0.607) were documented significantly more often in the old-old patients. CONCLUSIONS: Age and disease duration were independently associated with clinical presentation, course, and progression of PD. Age was the main predictor, but disease duration also had a strong effect, suggesting that factors of the ageing process beyond the disease process itself cause PD in the most elderly to be more severe.


Subject(s)
Aging/physiology , Antiparkinson Agents/therapeutic use , Levodopa/therapeutic use , Parkinson Disease/drug therapy , Parkinson Disease/pathology , Age Factors , Aged , Aged, 80 and over , Case-Control Studies , Clinical Protocols , Comorbidity , Disease Progression , Geriatrics , Humans , Middle Aged , Patient Acuity , Thailand
8.
Georgian Med News ; (320): 111-115, 2021 Nov.
Article in English | MEDLINE | ID: mdl-34897055

ABSTRACT

Aluminum phosphide (AlP) has been known for more than 80 years as an effective pesticide for grain protection, but also as a suicidal agent used for human self-poisoning. Phosphine gas released in contact with stomach acid after oral ingestion of AlP is responsible for its toxicity. The poison affects all systems, so the mortality rate is quite high, especially after deliberate ingestions. We report the first case of severe AlP poisoning seen in our institution with a fatal outcome and furthermore, we present literature review on existing and newer treatment options. A 35-year-old woman with a history of epilepsy was admitted to the University Clinic for Toxicology in Skopje two hours after deliberate ingestion of one tablet of phostoxin (AlP). The first signs of poisoning were vomiting and abdominal pain, leukocytosis, prolonged PT, as well as inverted T waves in D3, AVF and left precordial leads on ECG. After developing respiratory failure and hypotension she was transferred to the intensive care unit (ICU). Her blood pressure was 80/40 mmHg, pulse rate 120/min. Laboratory findings showed signs of hepatic lesion, rhabdomyolysis and renal failure (AST 2267.42 U/L, ALT 2102.26 U/L, CPK 1334.81U/L, blood urea nitrogen 23.03 mmol/L, creatinine 211.9 µmol/L). Arterial blood gas analyses showed metabolic acidosis (pO2 9.6 kPa, pCO2 4.14 kPa, pH 7.15, bicarbonate 11 mmol/L, BE -15). The patient was placed on mechanical ventilation. Despite fluid supplementation, intensive therapy and inotropic support, hemodynamic instability worsened and cardiopulmonary resuscitation was performed three times. Unfortunately, the patient had a fatal outcome on the fourth day of intoxication. Solid formulations of AlP are very toxic. One tablet of phostoxin containing 3 grams of AlP is sufficient for the progression of life-threatening symptoms and fatal outcome. In the absence of antidote and elucidated mechanisms of toxicity, the key to treatment is rapid decontamination and initiation of resuscitation measures.


Subject(s)
Acidosis , Pesticides , Adult , Antidotes , Blood Gas Analysis , Clinical Protocols , Female , Humans , Review Literature as Topic
9.
Prog Orthod ; 22(1): 49, 2021 Dec 22.
Article in English | MEDLINE | ID: mdl-34935091

ABSTRACT

BACKGROUND: To detect the optimal timing of intervention based on different cervical vertebral maturation stage (CS1-2 vs. CS3-4) for the treatment of Class III malocclusion with early Class III protocol. METHODS: A total sample of 43 patients (23 females, 20 males) ranging between 7 and 13 years of age with dentoskeletal Class III malocclusion treated with the modified SEC III (Splints, Elastic and Chincup) protocol divided into two groups based on the cervical vertebral maturation stages (CS1-2 and CS3-4) was included in this retrospective observational longitudinal study. Patient compliance was assessed using a 2-point Likert scale. Statistical comparisons between the two groups were performed with independent sample t tests. RESULTS: No statistically significant differences for any of the cephalometric variables describing the baseline dentoskeletal features were found between the two groups except for the mandibular unit length that was significantly greater in the pubertal group (P = 0.005). The modified SEC III protocol produced favorable sagittal outcomes in both groups, whereas no statistically significant T1-T2 changes were found between the CS1-2 and CS3-4 groups for any of the angular and linear measurements. No significant differences were found in the prevalence rates of the degree of collaboration between the two groups (P = 1.000). CONCLUSIONS: No significant differences between prepubertal and pubertal patients were found in the sagittal and vertical dentoskeletal changes with the modified SEC III protocol. Thus, this early Class III treatment produced similar favorable effects in growing subjects regardless of the cervical vertebral maturation stages from CS1 to CS4.


Subject(s)
Malocclusion, Angle Class III , Malocclusion, Angle Class II , Cephalometry , Clinical Protocols , Female , Humans , Longitudinal Studies , Male , Malocclusion, Angle Class III/therapy , Mandible , Observational Studies as Topic , Retrospective Studies
10.
Can J Surg ; 64(6): E578-E587, 2021.
Article in English | MEDLINE | ID: mdl-34728523

ABSTRACT

BACKGROUND: Enhanced Recovery After Surgery (ERAS) and prehabilitation programs are evidence-based and patient-focused, yet meaningful patient input could further enhance these interventions to produce superior patient outcomes and patient experiences. We conducted a qualitative study with patients who had undergone colorectal surgery under ERAS care to determine how they prepared for surgery, their views on prehabilitation and how prehabilitation could be delivered to best meet patient needs. METHODS: We conducted semistructured interviews with adult patients who had undergone colorectal surgery under ERAS care within 3 months after surgery. Patients were enrolled between April 2018 and June 2019 through purposive sampling from 1 hospital in Alberta. The interview transcripts were analyzed independently by a researcher and a trained patient-researcher using inductive thematic analysis. RESULTS: Twenty patients were interviewed. Three main themes were identified. First, waiting for surgery: patients described fear, anxiety, isolation and deterioration of their mental and physical states as they waited passively for surgery. Second, preparing would have been better than just waiting: patients perceived that a prehabilitation program could prepare them for their operation if it addressed their emotional and physical needs, provided personalized support, offered home strategies, involved family and included surgical expectations (both what to expect and what is expected of them). Third, partnering with patients: preoperative preparation should occur on a continuum that meets patients where they are at and in a partnership that respects patients' expertise and desired level of engagement. CONCLUSION: We identified several patient priorities for the preoperative period. Integrating these priorities within ERAS and prehabilitative programs could improve patient satisfaction, experiences and outcomes. Actively engaging patients in their care might alleviate some of the anxiety and fear associated with waiting passively for surgery.


Subject(s)
Colorectal Surgery , Enhanced Recovery After Surgery , Patient Participation , Patient Preference , Preoperative Exercise , Adult , Aged , Aged, 80 and over , Alberta , Clinical Protocols , Colorectal Surgery/psychology , Female , Humans , Male , Middle Aged , Patient Education as Topic , Patient Participation/psychology , Patient Preference/psychology , Preoperative Exercise/psychology , Qualitative Research , Social Support
11.
Ital J Pediatr ; 47(1): 221, 2021 Nov 06.
Article in English | MEDLINE | ID: mdl-34742330

ABSTRACT

BACKGROUND: With the gradual resumption of sports activities after the lock-down period for coronavirus pandemic, a new problem is emerging: Allow all athletes to be able to return to compete after SARS-CoV-2 infection in total safety. Several protocols have been proposed for healed athletes but all of them have been formulated for the adult population. The aim of the present study is to evaluate the adequacy of Italian practical recommendations for return-to-paly, in order to exclude cardiorespiratory complications due to COVID-19 in children and adolescents. METHODS: Between April 2020 and January 2021 the Italian Sports Medical Federation formulated cardiorespiratory protocols to be applied to athletes recovered from SARS-CoV-2 infection. The protocols take into account the severity of the infection. Protocols include lung function tests, cardiopulmonary exercise test, echocardiographic evaluation, blood chemistry tests. RESULTS: From September 2020 to February 2021, 45 children and adolescents (aged from 9 to 18 years; male = 26) with previous SARS-CoV-2 infection were evaluated according to the protocols in force for adult. 55.5% of the subjects (N = 25) reported an asymptomatic infection; 44.5% reported a mild symptomatic infection. Results of lung function test have exceeded the limit of 80% of the theoretical value in all patients. The cardiorespiratory capacity of all patients was within normal limits (average value of maximal oxigen uptake 41 ml/kg/min). No arrhythmic events or reduction in the ejection fraction were highlighted. CONCLUSION: The data obtained showed that, in the pediatric population, mild coronavirus infection does not cause cardiorespiratory complications in the short and medium term. Return to play after Coronavirus infection seems to be safe but it will be necessary to continue with the data analysis in order to modulate and optimize the protocols especially in the pediatric field.


Subject(s)
COVID-19/complications , Return to Sport , Adolescent , Age Factors , COVID-19/physiopathology , COVID-19/therapy , Cardiorespiratory Fitness , Child , Clinical Protocols , Female , Humans , Italy , Male , Recovery of Function , Respiratory Function Tests , Time Factors
12.
Front Immunol ; 12: 716940, 2021.
Article in English | MEDLINE | ID: mdl-34745094

ABSTRACT

At present, the global COVID-19 epidemic is still in a state of anxiety, and increasing the cure rate of critically ill patients is an important means to defeat the virus. From an immune perspective, ARDS driven by an inflammatory storm is still the direct cause of death in severe COVID-19 patients. Although some experience has been gained in the treatment of COVID-19, and intensive COVID-19 vaccination has been carried out recently, it is still effective to save lives to develop more effective programs to alleviate the inflammatory storm and ARDS in patients with SARS-CoV-2 or emerging variants of SARS-CoV-2. In reorganizing the ARDS-related inflammatory storm formation program in COVID-19 patients, we highlighted the importance of the vicious circle of inflammatory cytokines and inflammatory cell death, which is aggravated by blood circulation to form multi-system inflammation. Summarizes the interlocking and crisscrossing of inflammatory response and inflammatory cell death mechanisms including NETs, pyrolysis, apoptosis and PANoptosis in severe COVID-19. More importantly, in response to the inflammatory storm formation program we described, and on the premise of following ethical and clinical experimental norms, we propose a three-dimensional integrated program for future research based on boosting antiviral immune response at the initial stage, inhibiting inflammatory cytokine signaling at the exacerbation stage and inhibiting cell death before it's worse to prevent and alleviate ARDS.


Subject(s)
COVID-19 Vaccines/immunology , COVID-19/immunology , SARS-CoV-2/physiology , Animals , COVID-19/therapy , Clinical Protocols , Cytokine Release Syndrome , Humans , Immunity , Immunomodulation , Inflammation , Signal Transduction
13.
PLoS One ; 16(11): e0259590, 2021.
Article in English | MEDLINE | ID: mdl-34793490

ABSTRACT

BACKGROUND: Public health services and systems research is under-developed in Canada and this is particularly the case with respect to research on local public health unit operational functioning and capacity. The purpose of this paper is to report on a study that will collect retrospective information on the local public health response to COVID-19 throughout Canada between 2020 and 2021. METHODS/DESIGN: The goal of the study is to develop and implement a study framework that will collect retrospective information on the local public health system response to the COVID-19 pandemic in Canada. This study will involve administering a mixed-method survey to Medical Health Officers/Medical Officers of Health in every local and regional public health unit across the country, followed by a process of coding and grouping these responses in a consistent and comparable way. Coded responses will be assessed for patterns of divergent or convergent roles and approaches of local public health across the country with respect to interventions in their response to COVID-19. The Framework Method of thematic analysis will be applied to assess the qualitative answers to the open-ended questions that speak to public health policy features. DISCUSSION: The strengths of the study protocol include the engagement of Medical Health Officers/Medical Officers of Health as research partners and a robust integrated knowledge translation approach to further public health services and systems research in Canada.


Subject(s)
COVID-19/epidemiology , Pandemics/prevention & control , Public Health/statistics & numerical data , Canada/epidemiology , Clinical Protocols , Humans , Retrospective Studies , Surveys and Questionnaires
14.
Surg Clin North Am ; 101(6): 995-1006, 2021 Dec.
Article in English | MEDLINE | ID: mdl-34774277

ABSTRACT

Enhanced recovery after surgery (ERAS) protocols are comprehensive perioperative care pathways designed to mitigate the physiologic stressors associated with surgery and, in turn, improve clinical outcomes and lead to health care cost savings. Although individual components may differ, ERAS protocols are typically organized as multimodal care "bundles" that, when followed closely and in their entirety, are meant to generate amplified cumulative benefits. This manuscript examines some of the critical components, describes some areas where the science is weak (but dogma may be strong), and provides some of the evidence or lack thereof behind components of a standard ERAS protocol.


Subject(s)
Enhanced Recovery After Surgery , Pain, Postoperative/drug therapy , Patient Care Bundles , Postoperative Complications/prevention & control , Clinical Protocols/standards , Enhanced Recovery After Surgery/standards , Humans , Pain, Postoperative/therapy , Patient Care Bundles/economics , Patient Care Bundles/standards , Perioperative Care/economics , Perioperative Care/standards , Postoperative Complications/etiology , Postoperative Complications/therapy
15.
Am Fam Physician ; 104(5): 493-499, 2021 Nov 01.
Article in English | MEDLINE | ID: mdl-34783494

ABSTRACT

End-stage renal disease (ESRD) is diagnosed when kidney function is no longer adequate for long-term survival without kidney transplantation or dialysis. Primary care clinicians should refer people at risk of ESRD to nephrology to optimize disease management. Kidney transplantation typically yields the best patient outcomes, although most patients are treated with dialysis. The decision to initiate dialysis is best made through shared decision-making. Because most patients with ESRD elect to receive hemodialysis, the preservation of peripheral veins is important for those with stage III to V chronic kidney disease. A palliative approach to ESRD is a reasonable alternative to dialysis, particularly for individuals with limited life expectancy, with severe comorbid conditions, or who wish to avoid medical interventions. For patients with ESRD, vaccination against seasonal influenza, tetanus, hepatitis B, human papillomavirus (through 26 years of age), and Streptococcus pneumoniae is advised. Routine cancer screening for patients not receiving kidney transplantation is discouraged. Controlling blood pressure in patients receiving dialysis improves mortality. Volume control through adequate dialysis and sodium restriction can help optimize hypertension treatment in these patients. Insulin is the preferred treatment for patients with ESRD and diabetes mellitus requiring medication. Patients should be monitored for signs of protein-energy wasting and malnutrition. Clinicians must be aware of the many medical complications associated with ESRD.


Subject(s)
Decision Making, Shared , Kidney Failure, Chronic , Kidney Transplantation/methods , Palliative Care/methods , Patient Care Management/methods , Renal Dialysis/methods , Clinical Protocols , Humans , Kidney Failure, Chronic/diagnosis , Kidney Failure, Chronic/surgery , Kidney Failure, Chronic/therapy , Monitoring, Physiologic/methods , Noncommunicable Diseases/therapy , Palliative Care/psychology , Patient Care Planning
16.
Isr Med Assoc J ; 23(11): 685-689, 2021 Nov.
Article in English | MEDLINE | ID: mdl-34811981

ABSTRACT

BACKGROUND: Toward the end of 2019, the coronavirus disease-2019 (COVID-19) pandemic began to create turmoil for global health organizations. The illness, caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), spreads by droplets and fomites and can rapidly lead to life-threatening lung disease, especially for the old and those with health co-morbidities. Treating orthopedic patients, who presented with COVID-19 while avoiding nosocomial transmission, became of paramount importance. OBJECTIVES: To present relevant methods for pandemic control and hospital accommodation with emphasis on orthopedic surgery. METHODS: We searched search PubMed and Google Scholar electronic databases using the following keywords: COVID-19, SARS-CoV-2, screening tools, personal protective equipment, and surgery triage. RESULTS: We included 25 records in our analysis. The recommendations from these records were divided into the following categories: COVID-19 disease, managing orthopedic surgery in the COVID-19 era, general institution precautions, triage of orthopedic surgeries, preoperative assessment, surgical room setting, personal protection equipment, anesthesia, orthopedic surgery technical precautions, and department stay and rehabilitation. CONCLUSIONS: Special accommodations tailored for each medical facility, based on disease burden and available resources can improve patient and staff safety and reduce elective surgery cancellations. This article will assist orthopedic surgeons during the COVID-19 medical crisis, and possibly for future pandemics.


Subject(s)
COVID-19 , Infection Control , Orthopedic Procedures , COVID-19/epidemiology , COVID-19/prevention & control , Clinical Protocols , Disease Transmission, Infectious/prevention & control , Global Health , Humans , Infection Control/methods , Infection Control/organization & administration , Operating Rooms/organization & administration , Organizational Innovation , Orthopedic Procedures/methods , Orthopedic Procedures/standards , Orthopedic Procedures/trends , Personal Protective Equipment , SARS-CoV-2 , Triage/organization & administration
18.
São Paulo; SES/SP; nov. 2021. 56 p. tab, ilus, graf, mapas.
Non-conventional in Portuguese | LILACS, Coleciona SUS, Sec. Est. Saúde SP, CONASS, SESSP-CTDPROD, Sec. Est. Saúde SP, SESSP-ACVSES | ID: biblio-1344584
19.
J Appl Clin Med Phys ; 22(11): 165-171, 2021 Nov.
Article in English | MEDLINE | ID: mdl-34609051

ABSTRACT

PURPOSE: To implement and validate a beam current transformer as a passive monitoring device on a pulsed electron beam medical linear accelerator (LINAC) for ultra-high dose rate (UHDR) irradiations in the operational range of at least 3 Gy to improve dosimetric procedures currently in use for FLASH radiotherapy (FLASH-RT) studies. METHODS: Two beam current transformers (BCTs) were placed at the exit of a medical LINAC capable of UHDR irradiations. The BCTs were validated as monitoring devices by verifying beam parameters consistency between nominal values and measured values, determining the relationship between the charge measured and the absorbed dose, and checking the short- and long-term stability of the charge-absorbed dose ratio. RESULTS: The beam parameters measured by the BCTs coincide with the nominal values. The charge-dose relationship was found to be linear and independent of pulse width and frequency. Short- and long-term stabilities were measured to be within acceptable limits. CONCLUSIONS: The BCTs were implemented and validated on a pulsed electron beam medical LINAC, thus improving current dosimetric procedures and allowing for a more complete analysis of beam characteristics. BCTs were shown to be a valid method for beam monitoring for UHDR (and therefore FLASH) experiments.


Subject(s)
Electrons , Radiation Monitoring , Clinical Protocols , Humans , Particle Accelerators , Radiometry , Radiotherapy Dosage
20.
Alzheimers Res Ther ; 13(1): 172, 2021 10 11.
Article in English | MEDLINE | ID: mdl-34635149

ABSTRACT

Cognitive complaints in the absence of objective cognitive impairment, observed in patients with subjective cognitive decline (SCD), are common in old age. The first step to postpone cognitive decline is to use techniques known to improve cognition, i.e., cognitive enhancement techniques.We aimed to provide clinical recommendations to improve cognitive performance in cognitively unimpaired individuals, by using cognitive, mental, or physical training (CMPT), non-invasive brain stimulations (NIBS), drugs, or nutrients. We made a systematic review of CMPT studies based on the GRADE method rating the strength of evidence.CMPT have clinically relevant effects on cognitive and non-cognitive outcomes. The quality of evidence supporting the improvement of outcomes following a CMPT was high for metamemory; moderate for executive functions, attention, global cognition, and generalization in daily life; and low for objective memory, subjective memory, motivation, mood, and quality of life, as well as a transfer to other cognitive functions. Regarding specific interventions, CMPT based on repeated practice (e.g., video games or mindfulness, but not physical training) improved attention and executive functions significantly, while CMPT based on strategic learning significantly improved objective memory.We found encouraging evidence supporting the potential effect of NIBS in improving memory performance, and reducing the perception of self-perceived memory decline in SCD. Yet, the high heterogeneity of stimulation protocols in the different studies prevent the issuing of clear-cut recommendations for implementation in a clinical setting. No conclusive argument was found to recommend any of the main pharmacological cognitive enhancement drugs ("smart drugs", acetylcholinesterase inhibitors, memantine, antidepressant) or herbal extracts (Panax ginseng, Gingko biloba, and Bacopa monnieri) in people without cognitive impairment.Altogether, this systematic review provides evidence for CMPT to improve cognition, encouraging results for NIBS although more studies are needed, while it does not support the use of drugs or nutrients.


Subject(s)
Cognitive Dysfunction , Quality of Life , Acetylcholinesterase , Brain , Clinical Protocols , Cognition , Health Services , Humans , Systematic Reviews as Topic
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