Carotid-body modulation through meditation in stage-I hypertensive subjects: Study protocol of a randomized and controlled study.

Adjunctive therapy for hypertension is in high demand for clinical research. Therefore, several meta-analyses have provided sufficient evidence for meditation as an adjunct therapy, without being anchored on reliable physiological grounds. Meditation modulates the autonomic nervous system. Herein, we propose a hierarchical-dependent effect for the carotid body (CB) in attenuating blood pressure (BP) and ventilatory variability (VV) fine-tuning due to known nerve connections between the CB, prefrontal brain, hypothalamus, and solitary tract nucleus. The aim of this exploratory study was to investigate the role of CB in the possible decrease in BP and changes in VV that could occur in response to meditation. This was a prospective, single-center, parallel-group, randomized, controlled clinical trial with concealed allocation. Eligible adult subjects of both sexes with stage 1 hypertension will be randomized into 1 of 2 groups: transcendental meditation or a control group. Subjects will be invited to 3 visits after randomization and 2 additional visits after completing 8 weeks of meditation or waiting-list control. Thus, subjects will undergo BP measurements in normoxia and hyperoxia, VV measurements using the Poincaré method at rest and during exercise, and CB activity measurement in the laboratory. The primary outcome of this study was the detection of changes in BP and CB activity after 8 weeks. Our secondary outcome was the detection of changes in the VV at rest and during exercise. We predict that interactions between hyperoxic deactivation of CB and meditation; Will reduce BP beyond stand-alone intervention or alternatively; Meditation will significantly attenuate the effects of hyperoxia as a stand-alone intervention. In addition, VV can be changed, partially mediated by a reduction in CB activity. Trial registration number: ReBEC registry (RBR-55n74zm). Stage: pre-results.

Pulmonary Arterial Pressure Changes Under Dobutamine Stress Echocardiography in Non-Anemic Iron Deficient COPD Subjects.

Purpose: Non-anemic iron deficiency (NAID) is common in COPD, and could induce functional/structural changes in the pulmonary vascular bed. Thus, we aimed to study, during resting and ambient oxygen conditions, the systolic pulmonary arterial pressure (sPAP) changes during dobutamine stress echocardiography (DSE) for NAID+ compared to NAID- subjects with COPD. Patients and Methods: We analyzed 24 patients with COPD and evaluated their clinical parameters, including lung function and serum iron profile, followed by the changes in the sPAP under DSE. Results: Ten subjects with NAID+ were compared with fourteen NAID- subjects for sPAP measurement. At baseline, only left atrial volume was significantly different between groups (30±4 vs 23±5 mL*m2), respectively (p-value=0.002). For the right side, tricuspid annular plane systolic excursion (TAPSE) was similar between-groups (22±2 vs 20±4, p-value >0.05), at baseline. The sPAP (mmHg) changes were also not significantly different between groups (pre 32±14 vs peak 48±14 for NAID+ and pre 29±7 vs peak 43±10 for NAID-, Group p-value=0.400, Time p-value <0.0001, and Interaction p-value=0.606). Conclusion: COPD subjects with NAID do not show increased sPAP responses during DSE, compared with iron-replete subjects.

Inspiratory Muscle Training Potentiates the Beneficial Effects of Proportional Assisted Ventilation on Exertional Dyspnea and Exercise Tolerance in COPD: A Proof-of-Concept Randomized and Controlled Trial.

During pulmonary rehabilitation, a subset of subjects with COPD requires adjunct therapy to achieve high-intensity training. Both noninvasive ventilation (NIV) and inspiratory muscle training (IMT) are available to assist these subjects. We aimed to prime the respiratory muscles before NIV with IMT, anticipating additive effects for maximal exercise tolerance (Tlim) and dyspnea/leg fatigue relief throughout the exercise as primary outcomes. Changes in the respiratory pattern were secondary outcomes. COPD subjects performed a total of four identical constant work rate tests on a cycle ergometer at 75% of maximum work rate, under control ventilation (SHAM, 4 cm H2O) or proportional assisted ventilation (PAV, individually adjusted), before and after 10 sessions of high-intensity IMT (three times/week) during 30 days. Two-way RM ANOVA with appropriate corrections were performed. Final analysis in nine subjects showed improved Tlim (Δ = 111 s) and lower minute-ventilation (Δ = 4 L.min-1) at exhaustion, when comparing the IMT effects within the PAV modality (p = 0.001 and p = 0.036, respectively) and improved Tlim for PAV vs. SHAM (PAV main-effect, p = 0.001; IMT main-effect, p = 0.006; PAV vs. IMT interaction, p = 0.034). In addition, IMT + PAV association, compared to PAV alone, resulted in lower respiratory frequency (IMT main-effect, p = 0.009; time main-effect, p < 0.0001; IMT vs. time interaction, p = 0.242) and lower inspiratory time related to duty cycle (IMT main-effect, p = 0.018; time main-effect, p = 0.0001; IMT vs. time interaction, p = 0.004) throughout exercise. The addition of IMT prior to a PAV-supported aerobic bout potentiates exercise tolerance and dyspnea relief and induces favourable changes in ventilatory pattern in severe COPD during high-intensity training (Brazilian Registry of Clinical Trials, number RBR-6n3dzz).

Validação de conteúdo de uma tecnologia educacional sobre saúde do homem / Validación de contenido de una tecnología educativa sobre la salud del hombre / Content validation of an educational technology about mens health

Objetivo: validar o conteúdo da tecnologia educacional "Saúde do Homem: dicas para uma vida saudável". Método: trata-se de estudo metodológico de validação de conteúdo com juízes especialistas. Aplicou-se um questionário validado que utiliza a escala do tipo Likert. O instrumento avalia três blocos de aspectos: objetivos, estrutura e apresentação, relevância. Utilizou-se a estatística descritiva para a obtenção do índice de validade de conteúdo. Participaram nove juízes-especialistas. Resultados: O índice de validade de conteúdo por blocos foi de 0,84, 0,73, 0,84. O índice geral foi de 0,78. As sugestões dos juízes contribuíram para a revisão da tecnologia educacional e foram consideradas e incluídas na versão final. Conclusão: validou-se o manual como tecnologia educacional para disseminar informações relevantes para a população masculina e também ser um dispositivo mediador de práticas educativas da equipe multidisciplinar, principalmente para o enfermeiro, podendo contribuir positivamente na qualidade de vida da população do sexo masculino.

Objetivo: validar el contenido de la tecnología educativa "Salud del Hombre: consejos para una vida saludable". Método: estudio metodológico de validación de contenido con jueces expertos. Se aplicó un cuestionario validado utilizando la escala Likert. El instrumento evalúa tres bloques de aspectos: objetivos; estructura y presentación; relevancia. Se utilizaron estadísticas descriptivas para obtener el índice de validez de contenido. Participaron nueve jueces expertos. Resultados: el índice de validez de contenido por bloques fue de 0.84, 0.73, 0.84. El índice general fue de 0,78. Las sugerencias de los jueces contribuyeron a la revisión de la tecnología educativa y fueron consideradas e incluidas en la versión final. Conclusión: el manual fue validado como una tecnología educativa para difundir información relevante a la población masculina y también como un dispositivo mediador para las prácticas educativas del equipo multidisciplinario,-especialmente para las enfermeras, lo que puede contribuir positivamente a la calidad de vida de la población masculina.

Objective: to validate the content of the educational technology "Men's Health: tips for a healthy life". Method: this is a methodological study of content validation with expert judges. A validated questionnaire was applied using the Likert scale. The instrument assesses three blocks of aspects: objectives, structure and presentation, relevance. Descriptive statistics were used to obtain the content validity index. Nine expert judges participated. Results: the content validity index by blocks was 0.84, 0.73, 0.84. The overall index was 0.78. The judges' suggestions contributed to the review of the educational technology and were considered and included in the final version. Conclusion: the manual was validated as an educational technology to disseminate relevant information to the male population and also to be a mediating device for educational practices of the multidisciplinary team, especially for nurses, which can positively contribute to the quality of life of the male population.

Is Inspiratory Muscle Weakness a Determinant of Endurance Exercise Tolerance During NIV-Supported Exercise in Patients With COPD?

PURPOSE: Previous research has reported that inspiratory muscle weakness is critical to decreased exercise tolerance and exercise tolerance improves with 10 cmH2O pressure support ventilation in patients with chronic obstructive pulmonary disease (COPD). The purpose of this study was to evaluate the effects of proportional assist ventilation (PAV) and continuous positive airway pressure (CPAP) compared with sham on exercise tolerance in patients with and without inspiratory muscle weakness. METHODS: In a prospective design, 12 of 54 patients were eligible after clinical and comprehensive lung function evaluation, including maximum inspiratory pressure (MIP) measurement. Using baseline measures, participants were divided into 2 age-matched groups that differed in regard to MIP (Group 1, MIP <60 cmH2O, and Group 2, MIP ≥60 cmH2O). Each participant performed 3 constant work rate tests with noninvasive support (PAV, CPAP, sham) in random order on different days at 80% of maximal incremental power. RESULTS: During the endurance tests, heart rate, peripheral oxygen saturation (SpO2), dyspnea perception scale, and exercise tolerance were measured. There were no significant differences between groups for heart rate, SpO2, dyspnea perception, or exercise tolerance during PAV, CPAP, or sham-supported exercise (P > .05 for all). CONCLUSIONS: In this small representative group of patients with COPD, inspiratory muscle weakness was not a determining factor of performance during CPAP or PAV-supported aerobic exercise.

CPAP and EPAP elicit similar lung deflation in a non-equivalent mode in GOLD 3-4 COPD patients.

INTRODUCTION: Lung hyperinflation is associated with inspiratory muscle strength reduction, nocturnal desaturation, dyspnea, altered cardiac function and poor exercise capacity in advanced COPD. OBJECTIVES: We investigated the responses of inspiratory capacity (IC) and inspiratory muscle strength (PImax), comparing continuous positive airway pressure (CPAP) and expiratory positive airway pressure (EPAP) with the main hypothesis that there would be similar effects on lung deflation. METHODS: Eligible patients were submitted to 10 cmH2 O CPAP and EPAP on different days, under careful ECG (HR) and peripheral oxygen saturation (SpO2 ) monitoring. RESULTS: Twenty-one eligible COPD patients were studied (13 male/8 female, FEV1 % predicted of 36.5 ± 9.8). Both CPAP and EPAP demonstrated significant post-pre (Δ) changes for IC and PImax, with mean ΔIC for CPAP and EPAP of 200 ± 100 mL and 170 ± 105 mL (P = .001 for both) in 13 and 12 patients (responders) respectively. There were similar changes in % predicted IC and PImax (∼7%, P = .001 for both) for responders and poor responder/non-responder agreement depending on CPAP/EPAP mode (Kappa = .113, P = .604). There were no differences in CPAP and EPAP regarding intensity of lung deflation (P =.254) and no difference was measured regarding HR (P = .235) or SpO2 (P = .111). CONCLUSIONS: Both CPAP and EPAP presented a similar effect on lung deflation, without guaranteeing that the response to one modality would be predictive of the response to the other.

Burnout e Qualidade de Vida em uma Residência Multiprofissional: um Estudo Longitudinal de Dois Anos / Burnout and Quality of Life on a Multi-professional Residency: a Two-Year Longitudinal Study

RESUMO O processo de formação dos profissionais da saúde constitui um desafio a gestores e educadores devido à complexidade de estimular ao mesmo tempo habilidades profissionais, interpessoais e humanísticas do aluno. Os programas de Residências Multiprofissionais em Saúde (RMS) apresentam caráter de vanguarda em nosso país ao incentivarem práticas multiprofissionais ativas e participativas na atenção em saúde. Neste estudo, investigamos os níveis de estresse e qualidade de vida dos acadêmicos durante os dois anos em que se encontravam em uma RMS. O cenário de prática envolveu assistência de alta complexidade a pacientes críticos. Durante os dois anos, constatamos aumento no nível de estresse dos acadêmicos, intimamente relacionado à queda na qualidade de vida. Diversos fatores físicos e psíquicos estão vinculados aos resultados, que devem gerar discussões nos núcleos docentes estruturantes de cada residência na proposição de medidas acolhedoras aos alunos.

ABSTRACT The training process for health professionals constitutes a challenge for managers and educators since the procedures for stimulating professional, interpersonal, and human skills stand on a complex basis. Multi-professional Residence Programs (MRP) are somewhat cutting-edge in Brazil, based on the fact that they encourage active and participative multidisciplinary practices in health care. It was in this context that this study investigated student stress and quality of life during the two years spent on an MRP, with the practical scenario involving highly complex assistance administered to critically ill patients. Over the course of the two years, we were able to identify an increase in student stress levels, strongly related to a decrease in their quality of life. Many physical and psychological factors are linked to the results, and should generate debate within the academic structuring cores of each residence on measures which may be taken to better foster student welfare.

Surface cleaning effectiveness in a walk-in emergency care unit: Influence of a multifaceted intervention.

BACKGROUND: Cleaning of surfaces is essential in reducing environmental bioburdens and health care-associated infection in emergency units. However, there are few or no studies investigating cleaning surfaces in these scenarios. Our goal was to determine the influence of a multifaceted intervention on the effectiveness of routine cleaning of surfaces in a walk-in emergency care unit. METHODS: This prospective, before-and-after interventional study was conducted in 4 phases: phase I (situational diagnosis), phase II (implementation of interventions-feedback on results, standardization of cleaning procedures, and training of nursing staff), phase III (determination of the immediate influence of interventions), and phase IV (determination of the late influence of interventions). The surfaces were sampled before and after cleaning by visual inspection, adenosine triphosphate bioluminescence assay, and microbiologic culture. RESULTS: We sampled 240 surfaces from 4 rooms. When evaluated by visual inspection and adenosine triphosphate bioluminescence, there was a progressive reduction of surfaces found to be inadequate in phases I-IV (P < .001), as well as in culture phases I-III. However, phase IV showed higher percentages of failure by culture than phase I (P = .004). CONCLUSIONS: The interventions improved the effectiveness of cleaning. However, this effect was not maintained after 2 months.

Use of vitamins C and E as a prophylactic therapy to prevent postoperative atrial fibrillation.

Oxidative stress has been strongly involved in the underlying mechanism of atrial fibrillation, particularly in the arrhythmia occurring in patients undergoing cardiac surgery with extracorporeal circulation (postoperative atrial fibrillation). The ischemia/reperfusion injury thus occurring in the myocardial tissue contributes to the development of tissue remodeling, thought to be responsible for the functional heart impairment. Consequently, structural changes due to the cardiac tissue biomolecules attack by reactive oxygen and/or nitrogen species could account for functional changes in ion channels, transporters, membrane conductance, cytosolic transduction signals, and other events, all associated with the occurrence of arrhythmic consequences. The lack of success and significant side effects of anti-arrhythmic drugs have given rise to attempts aimed to develop alternative novel pharmacologic treatments. On this line, the biological properties of the antioxidant vitamins C and E suggest that they could decrease the vulnerability of the heart to the oxidative damage. Nevertheless, very few studies to assess their anti-arrhythmic effects have been reported in humans. The clinical and experimental evidence supporting the view that the pharmacological use of antioxidant vitamins could contribute to prevent postoperative atrial fibrillation is presented.

Prevention of atrial fibrillation following cardiac surgery: basis for a novel therapeutic strategy based on non-hypoxic myocardial preconditioning.

Atrial fibrillation is the most common complication of cardiac surgical procedures performed with cardiopulmonary bypass. It contributes to increased hospital length of stay and treatment costs. At present, preventive strategies offer only suboptimal benefits, despite improvements in anesthesia, surgical technique, and medical therapy. The pathogenesis of postoperative atrial fibrillation is considered to be multifactorial. However oxidative stress is a major contributory factor representing the unavoidable consequences of ischemia/reperfusion cycle occurring in this setting. Considerable evidence suggests the involvement of reactive oxygen species (ROS) in the pathogenic mechanism of this arrhythmia. Interestingly, the deleterious consequences of high ROS exposure, such as inflammation, cell death (apoptosis/necrosis) or fibrosis, may be abrogated by a myocardial preconditioning process caused by previous exposure to moderate ROS concentration known to trigger survival response mechanisms. The latter condition may be created by n-3 PUFA supplementation that could give rise to an adaptive response characterized by increased expression of myocardial antioxidant enzymes and/or anti-apoptotic pathways. In addition, a further reinforcement of myocardial antioxidant defenses could be obtained through vitamins C and E supplementation, an intervention also known to diminish enzymatic ROS production. Based on this paradigm, this review presents clinical and experimental evidence supporting the pathophysiological and molecular basis for a novel therapeutic approach aimed to diminish the incidence of postoperative atrial fibrillation through a non-hypoxic preconditioning plus a reinforcement of the antioxidant defense system in the myocardial tissue.