Navigating complexity: The Supera's triumph in femoropopliteal lesions.

INTRODUCTION: The femoropopliteal sector endovascular treatment is particularly challenging due to its high tortuosity and torsional forces. Better results are still needed to ensure the long-term patency of stenting in this area. The Supera stent appears to change this paradigm. METHODS: This single-center retrospective cohort study aims to evaluate the efficacy and safety of femoropopliteal stenting with Supera in a real-world population. Seventy-nine patients were treated between January 2015 and December 2020, and the results are reported with a median follow-up of 28 months. RESULTS: Indications for revascularization were chronic limb-threatening ischemia with tissue loss (73.6%) or ischemic rest pain (17.7%) and claudication (7.6%). Thirty-six patients (45.6%) were classified as GLASS stage III according to the Global Limb Anatomic Staging System, with 65.8% and 30.4% in grades 3 and 4 of femoropopliteal and infrapopliteal sectors, respectively. The 36-month primary, primary-assisted, and secondary patency rates were 68.6%, 72.0%, and 79.0%, respectively, with an amputation-free survival rate of 86.6%. There was no significant difference between primary patency rates in GLASS stages I-II compared with GLASS stage III (36-month primary patency rates of 72% vs 63% respectively, p = 0.342) nor in amputation-free survival (88% vs 84%, p = 0.877). After adjusting for potential confounders, only the stent conformation significantly affected the primary patency rates, with a higher hazard of reintervention for the elongated (HR = 3.179; p = 0.36; CI 1.081-9.347) and the compressed (HR = 3.014; p = 0.42; CI 1.039-8.746) forms. CONCLUSIONS: The 36-month patency of the Supera stents in our real-world cohort was similar to other reported series. The GLASS stage did not interfere with the stent patency, proving it is a good choice even in the most adverse anatomy patients. Only the non-nominal stent conformation affected the primary patency rates in our patients.

Development and characterization of nanostructured lipid carriers for cannabidiol delivery.

This study evaluated the physicochemical characteristics of nanostructured lipid carriers (NLCs) as a potential vehicle for cannabidiol (CBD), a lipophilic molecule with great potential to promote health benefits. NLCs were produced using hemp seed oil and fully-hydrogenated soybean oil at different proportions. The emulsifiers evaluated were soybean lecithin (SL), Tween 80 (T80) and a mixture of SL:T80 (50:50). CBD was tested in the form of CBD-rich extract or isolate CBD, to verify if it affects the NLCs characteristics. Based on particle size and polydispersity, SL was considered the most suitable emulsifier to produce the NLCs. All lipid proportions evaluated had no remarkable effect on the physicochemical characteristics of NLCs, resulting in CBD-loaded NLCs with particle size below 250 nm, high CBD entrapment efficiency and CBD retention rate of 100% for 30 days, demonstrating that NLCs are a suitable vehicle for both CBD-rich extract or isolate CBD.

Use of a Paclitaxel Drug-Eluting Stent for the Treatment of Hemodialysis Access Outflow Stenosis.

PURPOSE: To evaluate the outcomes and durability of drug-eluting stents (DESs) for the treatment of hemodialysis access outflow stenosis. MATERIAL AND METHODS: A single-center retrospective analysis was conducted of all patients with hemodialysis vascular access outflow stenosis treated with a paclitaxel-coated DES (Eluvia; Boston Scientific, Marlborough, Massachusetts) between January 2020 and July 2022. A total of 34 DESs were implanted to treat outflow stenosis in 32 patients. Primary target lesion patency after stent deployment was the main outcome. Comparison between the time interval free from target lesion reintervention (TLR) after previous plain balloon angioplasty (PBA) and that after stent deployment for the same target lesion was considered a secondary outcome. RESULTS: The primary patency at 6, 12, and 18 months was 63.1%, 47.6%, and 41.7%, respectively. The secondary patency rate was 100% at 18 months. The median time interval free from TLR increased from 4.1 to 11.9 months (P < .001). No adverse events were observed during the median follow-up period of 387 days. CONCLUSIONS: The patency rates after use of DES for hemodialysis access outflow stenosis were comparable with results for drug-coated balloons and stent grafts, addressing recoil and minimizing the risk of jailing by a covered stent.

Experiences with remote communication in adult intensive care units during the COVID-19 pandemic: a systematic review protocol.

OBJECTIVE: The objective of this review is to explore the lived experiences of critically ill adults, their families, or health care professionals with remote communication in intensive care units (ICUs) during the COVID-19 pandemic. INTRODUCTION: Family visiting restrictions in ICUs during the COVID-19 pandemic imposed significant challenges to communication between critically ill adults, their families, and the health care team. Evidence shows that several communication strategies were developed and implemented in ICUs during the COVID-19 pandemic to promote family engagement; however, the experiences of critically ill adults, their families, and health care professionals with these strategies are scattered across primary qualitative studies. INCLUSION CRITERIA: This review will consider qualitative studies that include critically ill adults, their families, or health care professionals, focusing on their experiences with remote communication strategies in ICUs during the COVID-19 pandemic. METHODS: This review will be conducted in accordance with JBI methodology. The search strategy will aim to locate both published and unpublished qualitative studies in English, Spanish, and Portuguese. Studies published after January 2020 will be included. Study selection, critical appraisal, and data extraction will be performed independently by 2 reviewers. Data will be presented in narrative format and synthesized using the JBI meta-aggregation process. A ConQual Summary of Findings will be presented. REVIEW REGISTRATION: PROSPERO CRD42022383603.

Effective VTE prophylaxis with enoxaparin after elective THR or TKR: a retrospective observational study.

Background: Orthopedic patients are at the highest risk for venous thromboembolism (VTE). Nowadays, with VTE prophylaxis as a routine in patients undergoing total hip replacement (THR) and total knee replacement (TKR), fatal pulmonary embolism (PE) is rare and the rates of symptomatic VTE within 3 months dropped to 1.3%-10%, compared with the rates of 50%-70% before VTE prophylaxis implementation. In this study, we aim to evaluate the VTE prophylaxis and incidence in patients who underwent THR and TKR in Centro Hospitalar Universitário de Santo António (CHUdSA). Methods: We included 483 patients who underwent elective THR or TKR in CHUdSA from March 2019 to February 2020 and who were under enoxaparin as a VTE prophylaxis drug. All data related to prescribed enoxaparin were collected from the nationwide common electronic drug prescription system (PEM). Results: Of the 483 eligible patients, 192 (39.75%) underwent elective THR and 291 (60.25%) underwent TKR. Enoxaparin was prescribed for 31.86 ± 5.98 and 30.28 ± 5.97 days, on average, for the THR and TKR groups, respectively (P = .005). Patients completed, on average, 29.38 ± 8.12 days and 28.20 ± 7.32 days of VTE prophylaxis with enoxaparin in the THR and TKR groups, respectively (P = .098). The incidence of VTE was approximately 3.13% and 0.69% in the THR and TKR groups, respectively (P = .064). Conclusion: In CHUdSA, we usually prescribe enoxaparin 40 mg once daily for up to 35 days for VTE prophylaxis after THR or TKR. High therapeutic compliance rates resulted in very few events.

Study protocol of a prospective single-arm multicenter clinical study to assess the safety and performance of the aXess hemodialysis graft: The pivotal study.

BACKGROUND: Arteriovenous grafts (AVGs) are used for patients deemed unsuitable for the creation of an autogenous arteriovenous fistula (AVF) or unable to await maturation of the AVF before starting hemodialysis. However, AVGs are prone to infection and thrombosis resulting in low long-term patency rates. The novel aXess Hemodialysis Graft consists of porous polymeric biomaterial allowing the infiltration by cells and the growth of neotissue, while the graft itself is gradually absorbed, ultimately resulting in a fully functional natural blood vessel. The Pivotal Study will examine the long-term effectiveness and safety of the aXess Hemodialysis Graft. METHODS: The Pivotal Study is a prospective, single-arm, multicenter study that will be conducted in 110 subjects with end-stage renal disease who are not deemed suitable for the creation of an autogenous vascular access. The primary efficacy endpoint will be the primary patency rate at 6 months. The primary safety endpoint will be the freedom from device-related serious adverse events at 6 months. The secondary endpoints will include the procedural success rate, time to first cannulation, patency rates, the rate of access-related interventions to maintain patency, the freedom from device-related serious adverse events and the rate of access site infections. Patients will be followed for 60 months. An exploratory Health Economic and Outcomes Research sub-study will determine potential additional benefits of the aXess graft to patients, health care institutions, and reimbursement programs. DISCUSSION: The Pivotal study will examine the long-term performance and safety of the aXess Hemodialysis Graft and compare the outcome measures with historical data obtained with other graft types and autogenous AVFs. Potential advantages may include superior long-term patency rates and lower infection rates versus currently available AVGs and a shorter time to first cannulation compared to an autologous AVF. As such, the aXess Hemodialysis Graft may fulfill an unmet clinical need in the field of hemodialysis access.

Outflow Rescue of Elbow-Blockade Forearm Arteriovenous Fistulas: Outcomes of Open Surgical Techniques.

BACKGROUND: Venous scarring at the elbow is a common problem that can cause early and late forearm arteriovenous fistula (AVF) dysfunction in hemodialysis patients. However, any effort to prolong the long-term patency of distal vascular accesses could benefit the patient's survival, maximizing the use of restricted venous patrimony. This study aims to report a single-center experience in the recovery of distal autologous AVF with venous outflow obstruction at the elbow using different surgical techniques. METHODS: Retrospective observational study of all patients treated at a single vascular access center from January 2011 to March 2022, with dysfunctional forearm AVFs presenting with outflow stenosis or occlusions at the elbow treated by open surgery, using 3 different surgical techniques. Demographics and clinically relevant data were collected. Evaluated endpoints included primary, assisted primary, and secondary patency rates at 1 and 2 years. RESULTS: Twenty-three patients with elbow-blocked outflow forearm AVFs have been treated with a mean age of 64 ± 15 years. The majority (96%) had a radiocephalic fistula. The median time from vascular access creation to intervention was 34.5 months (12-216 months). A total of 24 procedures have been performed using 3 different surgical techniques for bypassing the obstructed venous outflow at the elbow. Technical success was achieved in 96% of the surgically treated patients. Primary and secondary patency rates at 1 year were 67.4% and 89.4%, respectively, and 52.9% and 82.0% at 2 years, with a median follow-up of 19 months (6-92 months). CONCLUSIONS: AVFs outflow stenosis or occlusions at the elbow not amenable to endovascular therapy could lead to vascular access abandonment. Our study demonstrates multiple surgical solutions to avoid this adverse outcome. Elbow venous outflow surgical reconstruction seems effective for distal vascular access preservation. Close surveillance is essential for timely endovascular treatment of newly developed stenosis at the venous drainage.

3000 Kidney Transplants: How We Did It.

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Brachial Vein Transposition Versus Arteriovenous Graft - Two-year Results.

BACKGROUND: Proper vascular access is essential for effective hemodialysis. There are three main access modalities: arte- riovenous fistula (AVF), arteriovenous graft (AVG), and central venous catheter. AVF has better patency and fewer complications, with lower morbidity and mortality rates. Some patients have limited superficial venous patrimony, and the best vascular access remains undetermined, with AVG and brachial vein transposition (BVT) representing upper limb alternatives. Our aim is to inves- tigate BVT and AVG followed by our institution regarding patency and need for intervention. METHODS: This paper is based on a retrospective analysis of BVT and AVG followed/intervened our center between 2014 and 2018. To primary outcome was to define and compare patency rates for each group. Primary failure and need for reinterven- tion were considered secondary outcomes. RESULTS: There was no statistically significant difference between primary and secondary patency in both groups. BVT has a higher post-intervention primary patency and fewer interventions due to thrombosis, despite the overall number of inter- ventions per patient similar to AVG. CONCLUSIONS: Despite the absence of a statistically significant difference in secondary patency and the need for reinter- vention between BVT and AVG, thrombosis-free time is higher in the BVT group. Overall, BVT is a valid access option that should be considered in patients with no other autogenous access alternative in upper limbs.

A Retrospective Cohort Study on Diabetic Foot Disease: Ascertainment of Ulcer Locations by Age Group.

Background and aims Diabetic foot ulcer location is a known independent predictor for cure with a better healing gradient proximal to distal. Although advanced age is one of the main factors associated with greater diabetic foot ulcer severity, there are no studies evaluating diabetic foot ulcer location specifically in the elderly population in an outpatient setting. This study evaluated diabetic foot ulcer location and age-group interactions in diabetic foot presentation. Methods A retrospective cohort study including adult patients with diabetic foot ulcers observed on their first visit to our center's Diabetic Foot Unit in 2018, divided into younger adults (YA) (18 to 64 years) and older adults (OA) (≥65 years). Results A total of 435 patients were included in the study with 159 (36.6%) in the YA, and 276 (63.4%) in the OA group. Neuro-ischemic diabetic foot ulcers were more frequent in the OA group (71.4% vs 43.4%, p<0.001). The number of patients with a history of diabetic foot ulcers was lower in the OA group (18.1% vs 25.2%, p=0.03). A smaller proportion of forefoot diabetic foot ulcers (74.9% vs 86.2%, p=0.007) and plantar location diabetic foot ulcers (9.4% vs 24.5%, p<0.001) occurred in the OA group. By univariate logistic regression analysis, we found two associations with older age: proximal (odds ratio (OR) 2.09 (1.23-3.53), p=0.006), and non-plantar (OR 3.13 (1.82-5.37), p<0.001) diabetic foot ulcer location. After adjusting for potential confounders in a multivariate analysis, older age lost the association to more proximal (OR 1.72 (0.94-3.15), p=0.081) and non-plantar (OR 1.78 (0.83-3.77), p=0.133) diabetic foot ulcer location. Conclusions There are essential age differences in diabetic foot ulcer presentation. The OA group more frequently presents neuro-ischemic diabetic foot ulcers with more proximal and non-plantar locations.

Psychoeducational interventions to promote adolescents' mental health literacy in schools: Identifying theory for the development of a complex intervention.

TOPIC: The concept of mental health literacy (MHL) was defined as the knowledge and beliefs about mental disorders that help in their recognition, management, or prevention. The complexity of interventions to promote adolescents' MHL requires that they be investigated through a process of development, feasibility/piloting, evaluation, and implementation, according to Medical Research Council (MRC) Framework. PURPOSE: This article aimed to identify the theory that supports the development of a psychoeducational intervention to promote adolescents' MHL in schools, possibly to be developed by mental health and psychiatric nurses. SOURCES USED: Journal articles, books, reports, and regulations. CONCLUSIONS: This theory allows us to design a psychoeducational intervention to promote adolescents' MHL in schools and supports the subsequent phases of the MRC Framework.

Radio-cephalic fistula recovered with drainage to median basilic vein by straightening of the forearm cephalic vein: A case report.

The distal arteriovenous fistula (AVF) has less complications and better patency than the proximal fistula, when it works properly. The complications of outflow of the fistula are complex, and it is necessary to analyze all solutions to solve the problem. We introduce a novel approach to solve outflow problems of a radio-cephalic AVF by straightening of the forearm cephalic vein with drainage into the median basilic vein.

Acceptability and Feasibility of the ProLiSMental Psychoeducational Intervention to Promote Adolescents' Mental Health Literacy on Anxiety in a School Context.

The ProLiSMental psychoeducational intervention intends to promote adolescents' mental health literacy on anxiety, facilitating their access, understanding, evaluation, and use of effective mental health information. This study aimed to assess the acceptability and feasibility of that intervention in a school context and improve its content, structure, and procedure. A convenience sample of seventeen participants has been recruited: eleven students (mean age = 14.09 years, SD = 0,30) and six education and health professionals (mean age = 53.00 years, SD = 4,05). High levels of acceptability and feasibility of the ProLiSMental psychoeducational intervention were observed and important improvements were made.

Ruptured arteriovenous fistula pseudoaneurysm treatment by balloon-assisted direct percutaneous thrombin injection.

We present the case of a male patient on hemodialysis with a ruptured pseudoaneurysm in a brachiocephalic arteriovenous fistula (AVF) and with edema and pain in the right arm attended to in the emergency department. An ultrasonographic scan identified a ruptured pseudoaneurysm with hemorrhagic infiltration of the arm muscular tissues. We performed a percutaneous ultrasound-guided thrombin injection with an angioplasty balloon inflated in the lumen of the AVF achieving the pseudoaneurysm thrombosis. After 6 months of follow-up, the patient's arteriovenous access remains functional. Percutaneous ultrasound-guided thrombin injection assisted by an angioplasty balloon may be a good alternative to surgical intervention in the treatment of symptomatic growing pseudoaneurysms of the arteriovenous fistula with the benefit of preserving the vascular access.

Escala de Posicionamento Face à Adaptação à Reforma: avaliação da validade e fiabilidade / Positioning Scale for Adaptation to Retirement: validity and reliability assessment / Escala de posicionamiento ante la jubilación: evaluación de la validez y la fiabilidad

Resumo Enquadramento: A avaliação do posicionamento face à adaptação à reforma constitui um relevante indicador do estado de saúde, numa das mais críticas transições da vida ocorridas na idade adulta. Objetivo: Validar a Escala de Posicionamento Face à Adaptação à Reforma (EPFAR). Metodologia: Estudo metodológico de validação de escala efetuado com amostra aleatória de 115 recém-aposentados portugueses. Avaliou-se a qualidade do instrumento de medida. Para avaliar a validade de constructo procedeu-se a uma análise fatorial exploratória e a fiabilidade avaliou-se através da consistência interna. Resultados: Os fatores retidos levaram a considerar uma solução com 4 fatores explicativa na globalidade de 56,41% da variância. A análise de consistência interna realizou-se com recurso ao alfa de Cronbach, tendo os resultados apurados para a totalidade dos itens da escala apresentado um ( = 0,90. Conclusão: A EPFAR constitui um instrumento válido e fiável para avaliar o posicionamento face à reforma.

Abstract Background: Assessing individuals' positioning regarding their adaptation to retirement is a relevant indicator of health status in one of the most critical life transitions occurring in adulthood. Objective: To validate the Positioning Scale for Adaptation to Retirement (EPFAR). Methodology: Methodological study of scale validation carried out with a random sample of 115 Portuguese retirees. The quality of the instrument was assessed. An exploratory factor analysis assessed construct validity, and an internal consistency analysis assessed reliability. Results: The retained factors resulted in a 4-factor solution that explained 56.41% of the variance. The internal consistency analysis was performed using Cronbach's alpha, and the results obtained for all items of the scale revealed an ( = 0.90. Conclusion: The EPFAR is a valid and reliable instrument for assessing individuals' positioning towards retirement.

Resumen Marco contextual: La evaluación del posicionamiento ante la adaptación a la jubilación constituye un indicador relevante del estado de salud en una de las transiciones vitales más críticas de la edad adulta. Objetivo: Validar la Escala de Posicionamiento de Adaptación a la Jubilación (EPFAR). Metodología: Estudio metodológico de validación de la escala realizado con una muestra aleatoria de 115 portugueses recién jubilados. Se evaluó la calidad del instrumento de medida. Para evaluar la validez de constructo se realizó un análisis factorial exploratorio y se evaluó la fiabilidad mediante la consistencia interna. Resultados: Los factores retenidos llevaron a considerar una solución con 4 factores que explicaba el 56,41% de la varianza. El análisis de consistencia interna se realizó mediante el alfa de Cronbach, y los resultados de todos los ítems de la escala mostraron un ( = 0,90. Conclusión: La EPFAR constituye un instrumento válido y fiable para evaluar el posicionamiento ante la jubilación.

Adolescents' Empowerment for Mental Health Literacy in School: A Pilot Study on ProLiSMental Psychoeducational Intervention.

Adolescence is a critical life phase for mental health and anxiety an emerging challenge for adolescents. Psychoeducational interventions to promote mental health literacy (MHL) on anxiety in adolescents are needed. This study aimed to test the primary outcome of a future full-scale trial: improvement of adolescents' anxiety MHL components on recognition, prevention strategies, and self-help strategies. A sample of 38 adolescents, 24 (63.2%) females and 14 (36.8%) males, with an average age of 14.50 years (SD = 0.89) participated in this study. Each class was allocated to the intervention group (IG, n = 21) or the waiting list control group (WLCG, n = 17) with single-blinded randomization. MHL was assessed using the QuALiSMental. The ProLiSMental psychoeducational intervention consists of four or eight weekly sessions of 90 or 45 min for adolescents, using different active pedagogical methods and techniques. There also are initial and final sessions with adolescents, legal guardians, and teachers. There was a significant improvement with a small to relatively strong effect size in many dimensions of anxiety MHL components. This study suggests the progression to the full-scale trial and values the important role of mental health and psychiatric nurses in the adolescents' empowerment for MHL in schools.

Intervenção psicoeducacional promotora da literacia em saúde mental de adolescentes na escola: estudo com grupos focais / Psychoeducational intervention to promote mental health literacy among adolescents at school: a focus groups study / Intervención psicoeducativa para promover la alfabetización en salud mental de los adolescentes en la escuela: estudio con grupos focales

Resumo Enquadramento: Estudos nacionais e internacionais evidenciam reduzida literacia em saúde mental (LSM) dos adolescentes sobre a ansiedade e a necessidade de serem desenvolvidas intervenções psicoeducacionais em contexto escolar. Objetivo: Identificar as componentes de uma intervenção psicoeducacional de promoção da LSM sobre a ansiedade para adolescentes em contexto escolar. Metodologia: Realizou-se um estudo exploratório, descritivo e de natureza qualitativa, recorrendo a 2 grupos focais e à análise de conteúdo. No primeiro grupo focal, participaram 6 profissionais de saúde ou da educação e, no segundo, 6 adolescentes do 9º ano de escolaridade. Resultados: Foram identificadas as componentes de uma intervenção psicoeducacional de promoção da LSM sobre a ansiedade para adolescentes em contexto escolar, que contribuíram para o seu desenho preliminar, integrando 4 sessões de 90 minutos, com diferentes métodos e técnicas pedagógicas. Conclusão: Este estudo contribuiu para o desenho preliminar da intervenção psicoeducacional "ProLiSMental", que pretende capacitar os adolescentes para o acesso, a compreensão e a utilização de informação útil que os ajude na prevenção, no reconhecimento e na gestão da ansiedade.

Abstract Background: National and international studies have revealed low mental health literacy (MHL) on anxiety among adolescents and the need to develop psychoeducational interventions at schools. Objective: To identify the components of a psychoeducational intervention to promote MHL on anxiety among adolescents in the school context. Methodology: An exploratory, descriptive, and qualitative study was conducted using 2 focus groups and the content analysis technique. Six health or education professionals participated in the first focus group, and 6 9th-grade adolescents participated in the second focus group. Results: The components of a psychoeducational intervention to promote MHL on anxiety among adolescents in the school context were identified, contributing to its preliminary design. The intervention consists of 4 90-minute sessions using different pedagogical methods and techniques. Conclusion: This study contributed to the preliminary design of the "ProLiSMental" psychoeducational intervention, which aims to enable adolescents to access, understand, and use relevant information that helps them to prevent, recognize, and manage anxiety.

Resumen Marco contextual: Estudios nacionales e internacionales muestran la escasa alfabetización en salud mental de los adolescentes respecto a la ansiedad y la necesidad de desarrollar intervenciones psicoeducativas en entornos escolares. Objetivo: Identificar los componentes de una intervención psicoeducativa para promover la alfabetización en salud mental (LSM en portugués) sobre la ansiedad de los adolescentes en el contexto escolar. Metodología: Se llevó a cabo un estudio exploratorio, descriptivo y de naturaleza cualitativa mediante 2 grupos focales y un análisis de contenido. En el primer grupo focal, participaron 6 profesionales de la salud o de la educación y, en el segundo, 6 adolescentes del 9.º grado de escolaridad. Resultados: Se identificaron los componentes de una intervención psicoeducativa de promoción de la LSM sobre la ansiedad en adolescentes en el contexto escolar, que contribuyeron a su diseño preliminar e incluyeron 4 sesiones de 90 minutos, con diferentes métodos y técnicas pedagógicas. Conclusión: Este estudio contribuyó al diseño preliminar de la intervención psicoeducativa "ProLiSMental", cuyo objetivo es capacitar a los adolescentes para acceder, comprender y utilizar información útil que les ayude a prevenir, reconocer y gestionar la ansiedad.