Effects of transcranial LED therapy on the cognitive rehabilitation for diffuse axonal injury due to severe acute traumatic brain injury: study protocol for a randomized controlled trial.

BACKGROUND: Photobiomodulation describes the use of red or near-infrared light to stimulate or regenerate tissue. It was discovered that near-infrared wavelengths (800-900 nm) and red (600 nm) light-emitting diodes (LED) are able to penetrate through the scalp and skull and have the potential to improve the subnormal cellular activity of compromised brain tissue. Different experimental and clinical studies were performed to test LED therapy for traumatic brain injury (TBI) with promising results. One of the proposals of this present study is to develop different approaches to maximize the positive effects of this therapy and improve the quality of life of TBI patients. METHODS/DESIGN: This is a double-blinded, randomized, controlled trial of patients with diffuse axonal injury (DAI) due to a severe TBI in an acute stage (less than 8 h). Thirty two patients will be randomized to active coil helmet and inactive coil (sham) groups in a 1:1 ratio. The protocol includes 18 sessions of transcranial LED stimulation (627 nm, 70 mW/cm2, 10 J/cm2) at four points of the frontal and parietal regions for 30 s each, totaling 120 s, three times per week for 6 weeks, lasting 30 min. Patients will be evaluated with the Glasgow Outcome Scale Extended (GOSE) before stimulation and 1, 3, and 6 months after the first stimulation. The study hypotheses are as follows: (1) transcranial LED therapy (TCLT) will improve the cognitive function of DAI patients and (2) TCLT will promote beneficial hemodynamic changes in cerebral circulation. DISCUSSION: This study evaluates early and delayed effects of TCLT on the cognitive rehabilitation for DAI following severe acute TBI. There is a paucity of studies regarding the use of this therapy for cognitive improvement in TBI. There are some experimental studies and case series presenting interesting results for TBI cognitive improvement but no clinical trials. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03281759 . Registered on 13 September 2017.

Burnout syndrome and weekly workload of on-call physicians: cross-sectional study.

CONTEXT AND OBJECTIVES: Burnout syndrome (BS) is characterized by three dimensions: emotional exhaustion, depersonalization and reduced personal fulfillment. The objectives of this study were to evaluate a possible association between BS and weekly workload, and to describe the prevalence of BS and the sociodemographic and occupational profile of on-call physicians in Maceió. DESIGN AND SETTING: Cross-sectional study in intensive care units (ICU) at public and private hospitals in Maceió. METHODS: A self-administered form was used to evaluate sociodemographic characteristics and BS through the Maslach Burnout Inventory (MBI) among 67 on-call physicians at ICUs in Maceió. Pearson's R correlation test was used to compare workload and emotional exhaustion. For other dimensions, Spearman's S test was used (P < 0.05). Other variables were represented by simple frequencies. The 95% confidence interval was calculated for each variable. RESULTS: Among the physicians studied, 55.22% were female and the mean age was 43.9 ± 8.95 years. The mean weekly workload on call was 43.85 ± 24.49 hours. The frequency of high scores in at least one of the three dimensions of MBI was 70.14%. CONCLUSIONS: Despite the high prevalence of BS, especially among physicians who did not practice regular physical activity, our data did not indicate any significant correlation between weekly workload and any of the three dimensions of BS in this sample. The high prevalence of BS draws attention to the importance of investigating other possible causes, in order to prevent and adequately treat it.

Burnout syndrome and weekly workload of on-call physicians: cross-sectional study / Síndrome de burnout e carga horária semanal de trabalho em médicos plantonistas: estudo transversal

CONTEXT AND OBJECTIVES: Burnout syndrome (BS) is characterized by three dimensions: emotional exhaustion, depersonalization and reduced personal fulfillment. The objectives of this study were to evaluate a possible association between BS and weekly workload, and to describe the prevalence of BS and the sociodemographic and occupational profile of on-call physicians in Maceió. DESIGN AND SETTING: Cross-sectional study in intensive care units (ICU) at public and private hospitals in Maceió. METHODS: A self-administered form was used to evaluate sociodemographic characteristics and BS through the Maslach Burnout Inventory (MBI) among 67 on-call physicians at ICUs in Maceió. Pearson's R correlation test was used to compare workload and emotional exhaustion. For other dimensions, Spearman's S test was used (P < 0.05). Other variables were represented by simple frequencies. The 95% confidence interval was calculated for each variable. RESULTS: Among the physicians studied, 55.22% were female and the mean age was 43.9 ± 8.95 years. The mean weekly workload on call was 43.85 ± 24.49 hours. The frequency of high scores in at least one of the three dimensions of MBI was 70.14%. CONCLUSIONS: Despite the high prevalence of BS, especially among physicians who did not practice regular physical activity, our data did not indicate any significant correlation between weekly workload and any of the three dimensions of BS in this sample. The high prevalence of BS draws attention to the importance of investigating other possible causes, in order to prevent and adequately treat it.

CONTEXTO E OBJETIVOS: A síndrome de burnout (SB) caracteriza-se por três dimensões: exaustão emocional, despersonalização e redução da realização pessoal. Os objetivos deste estudo foram avaliar uma possível associação entre SB e carga horária semanal de trabalho, descrever a prevalência de SB e o perfil sócio-demográfico e ocupacional em médicos plantonistas de Maceió. TIPO DE ESTUDO E LOCAL: Estudo transversal em unidades de terapia intensiva (UTI) de hospitais públicos e privados de Maceió. MÉTODOS: Um formulário auto-aplicável foi usado para avaliar características sócio-demográficas e SB através do Maslach Burnout Inventory (MBI) com 67 médicos plantonistas de UTIs de Maceió. Foi realizado teste de correlação R de Pearson entre carga horária e exaustão emocional e, para as demais dimensões, foi utilizado o teste S de Spearman (P < 0,05). Demais variáveis foram representadas por frequência simples. Intervalo de confiança de 95% foi calculado para cada variável. RESULTADOS: Dos médicos estudados, 55,22% eram do sexo feminino, com média de idade de 43,9 ± 8,95 anos. A média da carga horária semanal de plantão foi de 43,85 ± 24,49 horas. A frequência de escores altos em pelo menos uma das dimensões do MBI foi de 70,14%. CONCLUSÕES: Apesar da alta prevalência de SB, especialmente nos médicos que não praticam atividade física regular, nossos dados não indicaram qualquer correlação significativa entre carga horária e qualquer uma das dimensões da SB na amostra. A alta prevalência da SB chama atenção para a importância da pesquisa de outras possíveis causas, para a prevenir e tratar adequadamente.

A qualidade dos ensaios clínicos randomizados publicados no Jornal Vascular Brasileiro / Quality of randomized clinical trials published in the Jornal Vascular Brasileiro

CONTEXTO: A qualidade dos ensaios clínicos randomizados (ECR) define-se como a probabilidade de um estudo planejado gerar resultados sem tendências e que se aproximem da realidade terapêutica. OBJETIVO: Determinar a qualidade dos artigos originais com ECR publicados no Jornal Vascular Brasileiro. MATERIAIS E MÉTODOS: Estudo descritivo transversal com base na busca eletrônica dos artigos originais publicados no Jornal Vascular Brasileiro, entre dezembro de 2004 e setembro de 2009, que tivessem características de ECR. Variável primária: qualidade dos ECR; variáveis secundárias: encaminhamento da pesquisa ao Comitê de Ética em Pesquisa (CEP), utilização do termo de consentimento livre e esclarecido (TCLE), descrição da fonte de fomento, cálculo do tamanho da amostra, teste estatístico utilizado, nível de significância adotado na pesquisa, utilização de estatística descritiva, descrição do intervalo de confiança (IC) e sigilo da alocação. Foram pesquisados dados complementares: número de autores, local de origem e tipo de estudo. Utilizou-se estatística descritiva, cálculo do tamanho da amostra e IC de 95 por cento. RESULTADOS: Entre 114 artigos originais da amostra, 1 foi classificado como ECR, sendo de boa qualidade. Do total, 51 foram encaminhados ao CEP, 41 utilizaram TCLE, em 6 houve descrição do fomento e em 5 houve cálculo do tamanho da amostra. A amostra mostrou distribuição trimodal do número de autores por artigo (4, 5, 6), aparecendo em 20 artigos, cada um dos valores respectivos da moda. São Paulo contribuiu com 48 publicações. O teste do qui-quadrado foi o mais utilizado (38,7 por cento). O nível de significância de 5 por cento foi adotado em 54 artigos, em 90 utilizou-se estatística descritiva e em 18 descreveu-se uso do IC. CONCLUSÃO: Não foi possível determinar a qualidade dos ECR no Jornal Vascular Brasileiro, pois foi encontrado apenas um de boa qualidade.

BACKGROUND: The quality of a randomized clinical trial (RCT) is defined as the likelihood of a planned study to generate unbiased results and approach the therapeutic reality. OBJECTIVE: To determine the quality of the RCT published as original articles in the Jornal Vascular Brasileiro. MATERIALS AND METHODS: A descriptive, cross-sectional study based on electronic search of original articles published in Jornal Vascular Brasileiro between December 2004 and September 2009, which had characteristics of RCT. Primary variable: Quality of RCT; secondary variables: submission to the Ethics in Research Committee (ERC), use of the informed consent form (IC), description of the research funding source, sample size calculation, statistical test, significance level in research, descriptive statistics, description of the confidence interval (CI) and allocation concealment. Additional data: number of authors, place and type of study. Descriptive statistics were used, as well as sample size calculation and the 95 percent CI. RESULTS: Out of the 114 original articles, 1 was classified as RCT and was considered as good quality. Out of the total number of articles, 51 were submitted to the ERC, IC was used in 41, there was description of the grant in 6, and the sample size was calculated in 5. The sample revealed trimodal distribution of the number of authors per article (4, 5, 6), appearing in 20 articles each of the respective values of mode. The state of São Paulo contributed to 48 publications. Chi-square test was the most frequently used statistical method (38.7 percent), the significance level of 5 percent was adopted in 54 articles, descriptive statistics were used in 90 and CI was reported in18 articles. CONCLUSION: It was not possible to determine the quality of RCT in the Jornal Vascular Brasileiro, because only one good quality trial was found.