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1.
J Cardiothorac Surg ; 19(1): 315, 2024 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-38824517

RESUMEN

BACKGROUND: Post-operative atrial fibrillation (POAF) occurs in up to 40% of patients following coronary artery bypass grafting (CABG) and is associated with a higher risk of stroke and mortality. This study investigates how POAF may be mitigated by epicardial placement of aseptically processed human placental membrane allografts (HPMAs) before pericardial closure in CABG surgery. This study was conducted as a pilot feasibility study to collect preliminary for a forthcoming multi-center randomized controlled trial. METHODS: This retrospective observational study of patients undergoing CABG surgery excluded patients with pre-operative heart failure, chronic kidney disease, or a history of atrial fibrillation. The "treatment" group (n = 24) had three HPMAs placed epicardially following cardiopulmonary bypass decannulation but before partial pericardial approximation and chest closure. The only difference in clinical protocol for the control group (n = 54) was that they did not receive HPMA. RESULTS: HPMA-treated patients saw a significant, greater than four-fold reduction in POAF incidence compared to controls (35.2-8.3%, p = 0.0136). Univariate analysis demonstrated that HPMA treatment was associated with an 83% reduction in POAF (OR = 0.17, p = 0.0248). Multivariable analysis yielded similar results (OR = 0.07, p = 0.0156) after controlling for other covariates. Overall length of stay (LOS) between groups was similar, but ICU LOS trended lower with HPMA treatment (p = 0.0677). Post-operative inotrope and vasopressor requirements were similar among groups. There was no new-onset post-operative heart failure, stroke, or death reported up to thirty days in either group. CONCLUSIONS: Epicardial HPMA placement can be a simple intervention at the end of CABG surgery that may provide a new approach to reduce post-operative atrial fibrillation by modulating local inflammation, possibly reducing ICU and hospital stay, and ultimately improving patient outcomes.


Asunto(s)
Fibrilación Atrial , Puente de Arteria Coronaria , Placenta , Complicaciones Posoperatorias , Humanos , Fibrilación Atrial/prevención & control , Fibrilación Atrial/cirugía , Fibrilación Atrial/etiología , Puente de Arteria Coronaria/métodos , Puente de Arteria Coronaria/efectos adversos , Femenino , Proyectos Piloto , Masculino , Estudios Retrospectivos , Persona de Mediana Edad , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/epidemiología , Anciano , Embarazo , Aloinjertos , Pericardio , Estudios de Factibilidad
2.
Clin Orthop Surg ; 16(3): 506-516, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38827756

RESUMEN

Background: The gait analysis method that has been used in clinical practice to date is an optical tracking system (OTS) using a marker, but a markerless gait analysis (MGA) system is being developed because of the expensive cost and complicated examination of the OTS. To apply this MGA clinically, a comparative study of the MGA and OTS methods is necessary. The purpose of this study was to evaluate the compatibility between the OTS and the MGA methods and to evaluate the usefulness of the MGA system in actual clinical settings. Methods: From March 2021 to August 2021, 14 patients underwent gait analysis using the OTS and MGA system, and the spatiotemporal parameters and kinematic results obtained by the 2 methods were compared. To evaluate the practicality of the MGA system in an actual clinical setting, MGA was performed on 14 symptomatic children with idiopathic toe walking, who had been treated with a corrective cast, and the pre-cast and post-cast results were compared. For the OTS, the Motion Analysis Eagle system was used, and for MGA, DH Walk was used. Results: The spatiotemporal parameters showed no significant difference between the OTS and MGA system. The joint angle graphs of the kinematics along the sagittal plane showed similar shapes as a whole, with particularly high correlations in the hip and knee (pelvis: 29.4%, hip joint: 96.7%, knee joint: 94.9%, and ankle joint: 68.5%). A quantified comparison using the CORrelation and Analysis (CORA) score also showed high similarity between the 2 methods. The MGA results of pre-cast application and post-cast removal for children with idiopathic toe walking showed a statistically significant improvement in ankle dorsiflexion after treatment (p < 0.001). Conclusions: MGA showed a good correlation with the conventional OTS in terms of spatiotemporal parameters and kinematics. We demonstrated that ankle sagittal kinematics improved after treatment by corrective cast in children with idiopathic toe walking using the MGA method. Thus, after the improvement of a few limitations, the MGA system may soon be able to be clinically applied.


Asunto(s)
Estudios de Factibilidad , Análisis de la Marcha , Humanos , Análisis de la Marcha/métodos , Niño , Masculino , Femenino , Fenómenos Biomecánicos , Adolescente , Marcha/fisiología , Preescolar
3.
Water Sci Technol ; 89(10): 2812-2822, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38822616

RESUMEN

The sequential extraction routes of biogenic materials from sewage sludge (SS) were investigated. Physical methods (ultrasound, heating) and chemical methods (sodium hydroxide, sodium carbonate) were used to extract extracellular polymeric substances (EPS) and alginate-like extracellular polymers (ALEs) from SS. The residues after extraction were further subjected to physical methods (heating) and chemical methods (sulfuric acid, sodium hydroxide) for protein extraction. A comparison was made between sequential extraction routes and direct extraction of biomaterials from sludge in terms of extraction quantity, material properties, and applicability. The results showed that sequential extraction of biomaterials is feasible. The highest extraction quantities were obtained when using sodium carbonate for EPS and ALE extraction and sodium hydroxide for protein, reaching 449.80 mg/gVSS, 109.78 mg/gVSS, and 5447.08 mg/L, respectively. Sequential extraction procedures facilitate the extraction of biomaterials. Finally, suitable extraction methods for different application scenarios were analyzed.


Asunto(s)
Aguas del Alcantarillado , Aguas del Alcantarillado/química , Hidróxido de Sodio/química , Fraccionamiento Químico/métodos , Carbonatos/química , Estudios de Factibilidad
4.
JMIR Res Protoc ; 13: e53454, 2024 Jun 04.
Artículo en Inglés | MEDLINE | ID: mdl-38833279

RESUMEN

BACKGROUND: Natural hazards are increasing in frequency and intensity due to climate change. Many of these natural disasters cannot be prevented; what may be reduced is the extent of the risk and negative impact on people and property. Research indicates that the 2019-2020 bushfires in Australia (also known as the "Black Summer Bushfires") resulted in significant psychological distress among Australians both directly and indirectly exposed to the fires. Previous intervention research suggests that communities impacted by natural hazards (eg, earthquakes, hurricanes, and floods) can benefit from interventions that integrate mental health and social support components within disaster preparedness frameworks. Research suggests that disaster-affected communities often prefer the support of community leaders, local services, and preexisting relationships over external supports, highlighting that community-based interventions, where knowledge stays within the local community, are highly beneficial. The Community-Based Disaster Mental Health Intervention (CBDMHI) is an evidence-based approach that aims to increase disaster preparedness, resilience, social cohesion, and social support (disaster-related help-seeking), and decrease mental health symptoms, such as depression and anxiety. OBJECTIVE: This research aims to gain insight into rural Australian's recovery needs post natural hazards, and to enhance community resilience in advance of future fires. Specifically, this research aims to adapt the CBDMHI for the rural Australian context and for bushfires and second, to assess the acceptability and feasibility of the adapted CBDMHI in a rural Australian community. METHODS: Phase 1 consists of qualitative interviews (individual or dyads) with members of the target bushfire-affected rural community. Analysis of these data will include identifying themes related to disaster preparedness, social cohesion, and mental health, which will inform the adaptation. An initial consultation phase is a key component of the adaptation process and, therefore, phase 2 will involve additional discussion with key stakeholders and members of the community to further guide adaptation of the CBDMHI to specific community needs, building on phase 1 inputs. Phase 3 includes identifying and training local community leaders in the adapted intervention. Following this, leaders will co-deliver the intervention. The acceptability and feasibility of the adapted CBDMHI within the community will be evaluated by questionnaires and semistructured interviews. Effectiveness will be evaluated by quantifying psychological distress, resilience, community cohesion, psychological preparedness, and help-seeking intentions. RESULTS: This study has received institutional review board approval and commenced phase 1 recruitment in October 2022. CONCLUSIONS: The study will identify if the adapted CBDMHI is viable and acceptable within a village in the Northern Tablelands of New South Wales, Australia. These findings will inform future scale-up in the broader rural Australian context. If this intervention is well received, the CBDMHI may be valuable for future disaster recovery and preparedness efforts in rural Australia. These findings may inform future scale-up in the broader rural Australian context. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/53454.


Asunto(s)
Planificación en Desastres , Estudios de Factibilidad , Población Rural , Incendios Forestales , Humanos , Proyectos Piloto , Australia , Planificación en Desastres/organización & administración , Planificación en Desastres/métodos , Servicios Comunitarios de Salud Mental/organización & administración , Servicios Comunitarios de Salud Mental/métodos , Salud Mental , Masculino , Femenino , Incendios/prevención & control
5.
Arch Esp Urol ; 77(4): 331-337, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38840274

RESUMEN

BACKGROUND: This study aimed to assess the feasibility, safety, and efficacy of an endoscopic parapelvic renal cyst (PRC) incision using flexible ureterorenoscopy (fURS). MATERIAL AND METHODS: We retrospectively reviewed data concerning 16 patients in whom PRC incisions had been performed using fURS between January 2016 and January 2022. Two patients were excluded from the study owing to a lack of follow-up information. The cysts of all the patients were evaluated preoperatively by computed tomography. The patients' age, gender, cyst size, presenting symptoms, postoperative complications, and pre- and post-treatment visual analogue scale (VAS) scores were evaluated. Surgical success was defined as a reduction of more than half of the cyst size in the sixth postoperative month. RESULTS: A total of 14 patients were included in this study. The patients' mean age was 52.6 ± 8.8 years, and the mean cyst size was 69.1 ± 15.5 mm. Twelve (85.7%) patients presented with flank pain. Clavien-Dindo grade 1 complications were observed in two patients (14.3%), and grade 2 complications were observed in one (7.1%). The median VAS scores were significantly lower after treatment than before in patients who presented with flank pain (2 (1-2.8) vs 8 (7-8), respectively; p = 0.002). Surgical success rate was detected in 11 patients (78.6%) six months after the treatment. CONCLUSIONS: Endoscopic incision of the PRC is a feasible treatment modality with high success rates and low complication rates. However, multicentre studies with larger populations and longer follow-ups are needed to evaluate the lasting effects.


Asunto(s)
Estudios de Factibilidad , Enfermedades Renales Quísticas , Ureteroscopía , Humanos , Persona de Mediana Edad , Femenino , Masculino , Estudios Retrospectivos , Ureteroscopía/efectos adversos , Ureteroscopía/métodos , Enfermedades Renales Quísticas/cirugía , Enfermedades Renales Quísticas/diagnóstico por imagen , Resultado del Tratamiento , Pelvis Renal/cirugía , Adulto , Ureteroscopios , Anciano , Diseño de Equipo
6.
Langenbecks Arch Surg ; 409(1): 176, 2024 Jun 07.
Artículo en Inglés | MEDLINE | ID: mdl-38847886

RESUMEN

BACKGROUND: No single technique of remnant pancreas reconstruction after pancreaticoduodenectomy (PD) has been demonstrated to be superior to the others in the prevention of post-operative pancreatic fistula (POPF), and the accumulation of surgical experience is closely related to the quality of this anastomosis. The aim of the current study was to evaluate the feasibility and patient outcomes of a simplified technique involving a single-layer continuous pancreaticojejunostomy (PJA) with Falciform ligament reinforcement that can be used with all types of pancreases. METHODS: A single-centre and single-surgeon study was performed. One hundred consecutive patients undergoing pancreatic resection with subsequent PJA using a novel technique performed by a single surgeon were included in the study. Patient demographics, pre-operative treatments, risk factors for POPF, and post-operative morbidity and mortality and long-term patient outcome were prospectively recorded and reported. RESULTS: From March 2018 to March 2022, 59 male and 41 female patients were included. 91 patients underwent PD for malignancy with 32 receiving neoadjuvant treatment. 59 patients were classified as intermediate/high risk for POPF according to validated fistula prediction models. There were 12 POPF Type B and 2 POPF Type C. The overall morbidity rate was 16% with no 90-day mortality. 3 patients underwent reoperation. The median length of hospitalisation was 12.6 days and 82% of eligible patients commenced and completed adjuvant chemotherapy. CONCLUSION: Single-layer continuous dunking PJA with Falciform ligament reinforcement is a simplified and feasible method for PJA with a low associated complication rate.


Asunto(s)
Fístula Pancreática , Neoplasias Pancreáticas , Pancreaticoduodenectomía , Pancreatoyeyunostomía , Complicaciones Posoperatorias , Humanos , Masculino , Femenino , Persona de Mediana Edad , Pancreatoyeyunostomía/métodos , Pancreatoyeyunostomía/efectos adversos , Anciano , Pancreaticoduodenectomía/métodos , Pancreaticoduodenectomía/efectos adversos , Neoplasias Pancreáticas/cirugía , Neoplasias Pancreáticas/patología , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Fístula Pancreática/prevención & control , Fístula Pancreática/etiología , Adulto , Pancreatectomía/métodos , Pancreatectomía/efectos adversos , Estudios de Factibilidad , Resultado del Tratamiento
7.
Support Care Cancer ; 32(7): 416, 2024 Jun 07.
Artículo en Inglés | MEDLINE | ID: mdl-38847962

RESUMEN

PURPOSE: The aim of this prospective study was to evaluate the tolerance and feasibility of using virtual reality headsets with patients during interventional radiology procedures. MATERIAL AND METHOD: In this single-center prospective study, the use of a virtual reality headset in addition to the usual analgesic and anxiolytic treatment was proposed to all patients presenting in the interventional radiology department from December 2020 to June 2022. Exclusion criteria were as follows: (1) patients with whom it was not possible to communicate (2) epileptic patients, (3) non-verbal patients, and (4) pregnant women. The main objective was to evaluate the safety of the procedure by screening complications during and after the procedure. The second objective was to evaluate feasibility, as defined by the number of patients using the helmet until the end of the procedure. Effectiveness (patient's self-evaluation of pain and anxiety), comfort, satisfaction, emotions felt, sense of security, and feeling of immersion were also evaluated. Caregivers completed a feedback questionnaire. RESULTS: Virtual reality headsets were offered to 100 patients, 9 of whom declined. Procedures were achieved in 93.5% of cases: 6/91 patients removed the headset before the end of the procedure. There were minor adverse events in 2/85 (2.3%) procedures (discomfort and nausea) and no major adverse events. 93.9% of patients found an overall benefit, and 90.2% would recommend virtual reality to another patient. 94.4% of caregivers were satisfied with the virtual reality equipment. The mean pain level was 2.5 ± 2.7 before the procedure, 3.3 ± 2.5 during the procedure, and 1.6 ± 2.7 after the procedure. Mean anxiety scores were 4.6 ± 2.9 before the procedure, 3.1 ± 2.7 during the procedure, and 1.1 ± 1.9 after the procedure. CONCLUSION: The use of virtual reality technology as a complement to traditional therapy for procedures under local anesthesia is feasible and safe in interventional radiology and can be beneficial for pain and anxiety management.


Asunto(s)
Estudios de Factibilidad , Realidad Virtual , Humanos , Femenino , Estudios Prospectivos , Masculino , Persona de Mediana Edad , Adulto , Ansiedad/etiología , Ansiedad/prevención & control , Anciano , Radiología Intervencionista/métodos , Encuestas y Cuestionarios , Satisfacción del Paciente
8.
J Orthop Surg Res ; 19(1): 339, 2024 Jun 08.
Artículo en Inglés | MEDLINE | ID: mdl-38849964

RESUMEN

BACKGROUND: Continuous peripheral nerve blocks are widely used for anesthesia and postoperative analgesia in lower limb surgeries. The authors aimed to develop a novel continuous sacral plexus block procedure for analgesia during total knee arthroplasty. METHODS: The study comprised two stages. In Stage I, the authors built upon previous theories and technological innovations to develop a novel continuous sacral plexus block method, ultrasound-guided continuous parasacral ischial plane block (UGCPIPB) and subsequently conducted a proof-of-concept study to assess its effectiveness and feasibility. Stage II involved a historical control study to compare clinical outcomes between patients undergoing this new procedure and those receiving the conventional procedure. RESULTS: The study observed a 90% success rate in catheter placement. On postoperative day (POD) 1, POD2, and POD3, the median visual analog scale (VAS) scores were 3 (range, 1.5-3.5), 2.5 (1.6-3.2), and 2.7 (1.3-3.4), respectively. Furthermore, 96.3% of the catheters remained in place until POD3, as confirmed by ultrasound. The study revealed a significant increase in skin temperature and peak systolic velocity of the anterior tibial artery on the blocked side compared with those on the non-blocked side. Complications included catheter clogging in one patient and leakage at the insertion site in two patients. In Stage II, the novel technique was found to be more successful than conventional techniques, with a lower catheter displacement rate than the conventional procedure for continuous sciatic nerve block. CONCLUSION: UGCPIPB proved to be an effective procedure and safe for analgesia in total knee arthroplasty. CHINESE CLINICAL TRIAL REGISTRY NUMBER: ChiCTR2300068902.


Asunto(s)
Artroplastia de Reemplazo de Rodilla , Bloqueo Nervioso , Dolor Postoperatorio , Prueba de Estudio Conceptual , Ultrasonografía Intervencional , Humanos , Dolor Postoperatorio/prevención & control , Dolor Postoperatorio/etiología , Artroplastia de Reemplazo de Rodilla/métodos , Bloqueo Nervioso/métodos , Masculino , Femenino , Anciano , Ultrasonografía Intervencional/métodos , Persona de Mediana Edad , Plexo Lumbosacro/diagnóstico por imagen , Estudios de Factibilidad , Manejo del Dolor/métodos , Anciano de 80 o más Años , Isquion/diagnóstico por imagen , Dimensión del Dolor
9.
Brain Behav ; 14(6): e3581, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38849985

RESUMEN

BACKGROUND: To the creation of mutual aid relationships among people with cognitive decline is important in aging societies. This study aimed to develop and examine the feasibility of a GO Program in which older adults, with experience in playing GO, support the learning of GO by older adults with cognitive decline and other barriers to social participation, which in turn reduces social isolation and creates opportunities for older adults to use their role. METHODS: This single-arm intervention study was conducted in Tokyo, Japan. Introductory GO classes were held for 10 participants who had never played GO (beginners) and 10 participants who had (supporters) once a week for an hour, for a total of 12 sessions. Supporters and beginners were paired to solve problems and play games. We assessed the feasibility of the program and its effects on mental health social network, and cognitive function. RESULTS: Cognitive test scores were at the mild cognitive Impairment level for beginners as well as for supporters. Satisfaction with the program was high, with an overall class attendance rate of 99.1% and none leaving the program. No significant changes were observed over time for beginners in each measurement; however, there was a significant improvement in the Mini Mental State Examination-Japanese scores for supporters (p < .05). CONCLUSIONS: The results suggest that this program could contribute to the creation of mutual aid relationships among older adults with cognitive decline; even if they have mildly declined cognitive function, they can still play an active role in society. Moreover, creating such opportunities may positively impact cognitive function.


Asunto(s)
Disfunción Cognitiva , Demencia , Participación Social , Humanos , Proyectos Piloto , Anciano , Femenino , Masculino , Anciano de 80 o más Años , Estudios de Factibilidad , Apoyo Social
10.
Trials ; 25(1): 363, 2024 Jun 06.
Artículo en Inglés | MEDLINE | ID: mdl-38840160

RESUMEN

BACKGROUND: Patient participation in treatment decision making is a pillar of recovery-oriented care and is associated with improvements in empowerment and well-being. Although demand for increased involvement in treatment decision-making is high among veterans with serious mental illness, rates of involvement are low. Collaborative decision skills training (CDST) is a recovery-oriented, skills-based intervention designed to support meaningful patient participation in treatment decision making. An open trial among veterans with psychosis supported CDST's feasibility and demonstrated preliminary indications of effectiveness. A randomized control trial (RCT) is needed to test CDST's effectiveness in comparison with an active control and further evaluate implementation feasibility. METHODS: The planned RCT is a hybrid type 1 trial, which will use mixed methods to systematically evaluate the effectiveness and implementation feasibility of CDST among veterans participating in a VA Psychosocial Rehabilitation and Recovery Center (PRRC) in Southern California. The first aim is to assess the effectiveness of CDST in comparison with the active control via the primary outcome, collaborative decision-making behavior during usual care appointments between veterans and their VA mental health clinicians, and secondary outcomes (i.e., treatment engagement, satisfaction, and outcome). The second aim is to characterize the implementation feasibility of CDST within the VA PRRC using the Practical Robust Implementation and Sustainability Model framework, including barriers and facilitators within the PRRC context to support future implementation. DISCUSSION: If CDST is found to be effective and feasible, implementation determinants gathered throughout the study can be used to ensure sustained and successful implementation at this PRRC and other PRRCs and similar settings nationally. TRIAL REGISTRATION: ClinicalTrials.gov NCT04324944. Registered on March 27, 2020. Trial registration data can be found in Appendix 1.


Asunto(s)
Participación del Paciente , Trastornos Psicóticos , Ensayos Clínicos Controlados Aleatorios como Asunto , Veteranos , Humanos , Trastornos Psicóticos/terapia , Trastornos Psicóticos/psicología , Veteranos/psicología , Conducta Cooperativa , Toma de Decisiones Clínicas , Relaciones Médico-Paciente , Toma de Decisiones Conjunta , Estados Unidos , Estudios de Factibilidad , California , Toma de Decisiones , United States Department of Veterans Affairs
11.
J Neuroeng Rehabil ; 21(1): 94, 2024 Jun 05.
Artículo en Inglés | MEDLINE | ID: mdl-38840208

RESUMEN

BACKGROUND: Many individuals with neurodegenerative (NDD) and immune-mediated inflammatory disorders (IMID) experience debilitating fatigue. Currently, assessments of fatigue rely on patient reported outcomes (PROs), which are subjective and prone to recall biases. Wearable devices, however, provide objective and reliable estimates of gait, an essential component of health, and may present objective evidence of fatigue. This study explored the relationships between gait characteristics derived from an inertial measurement unit (IMU) and patient-reported fatigue in the IDEA-FAST feasibility study. METHODS: Participants with IMIDs and NDDs (Parkinson's disease (PD), Huntington's disease (HD), rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), primary Sjogren's syndrome (PSS), and inflammatory bowel disease (IBD)) wore a lower-back IMU continuously for up to 10 days at home. Concurrently, participants completed PROs (physical fatigue (PF) and mental fatigue (MF)) up to four times a day. Macro (volume, variability, pattern, and acceleration vector magnitude) and micro (pace, rhythm, variability, asymmetry, and postural control) gait characteristics were extracted from the accelerometer data. The associations of these measures with the PROs were evaluated using a generalised linear mixed-effects model (GLMM) and binary classification with machine learning. RESULTS: Data were recorded from 72 participants: PD = 13, HD = 9, RA = 12, SLE = 9, PSS = 14, IBD = 15. For the GLMM, the variability of the non-walking bouts length (in seconds) with PF returned the highest conditional R2, 0.165, and with MF the highest marginal R2, 0.0018. For the machine learning classifiers, the highest accuracy of the current analysis was returned by the micro gait characteristics with an intrasubject cross validation method and MF as 56.90% (precision = 43.9%, recall = 51.4%). Overall, the acceleration vector magnitude, bout length variation, postural control, and gait rhythm were the most interesting characteristics for future analysis. CONCLUSIONS: Counterintuitively, the outcomes indicate that there is a weak relationship between typical gait measures and abnormal fatigue. However, factors such as the COVID-19 pandemic may have impacted gait behaviours. Therefore, further investigations with a larger cohort are required to fully understand the relationship between gait and abnormal fatigue.


Asunto(s)
Fatiga , Estudios de Factibilidad , Marcha , Fatiga Mental , Enfermedades Neurodegenerativas , Caminata , Humanos , Masculino , Femenino , Persona de Mediana Edad , Fatiga/diagnóstico , Fatiga/fisiopatología , Fatiga/etiología , Caminata/fisiología , Anciano , Fatiga Mental/fisiopatología , Fatiga Mental/diagnóstico , Enfermedades Neurodegenerativas/complicaciones , Enfermedades Neurodegenerativas/fisiopatología , Enfermedades Neurodegenerativas/diagnóstico , Marcha/fisiología , Dispositivos Electrónicos Vestibles , Enfermedades del Sistema Inmune/complicaciones , Enfermedades del Sistema Inmune/diagnóstico , Adulto , Acelerometría/instrumentación , Acelerometría/métodos
12.
PLoS One ; 19(6): e0303532, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38843189

RESUMEN

Avocados are an important economic crop of Hawaii, contributing to approximately 3% of all avocados grown in the United States. To export Hawaii-grown avocados, growers must follow strict United States Department of Agriculture Animal and Plant Health Inspection Service (USDA-APHIS) regulations. Currently, only the Sharwil variety can be exported relying on a systems approach, which allows fruit to be exported without quarantine treatment; treatments that can negatively impact the quality of avocados. However, for the systems approach to be applied, Hawaii avocado growers must positively identify the avocados variety as Sharwil with APHIS prior to export. Currently, variety identification relies on physical characteristics, which can be erroneous and subjective, and has been disputed by growers. Once the fruit is harvested, variety identification is difficult. While molecular markers can be used through DNA extraction from the skin, the process leaves the fruit unmarketable. This study evaluated the feasibility of using near-infrared spectroscopy to non-destructively discriminate between different Hawaii-grown avocado varieties, such as Sharwil, Beshore, and Yamagata, Nishikawa, and Greengold, and to positively identify Sharwil from the other varieties mentioned above. The classifiers built using a bench-top system achieved 95% total classification rates for both discriminating the varieties from one another and positively identifying Sharwil while the classifier built using a handheld spectrometer achieved 96% and 96.7% total classification rates for discriminating the varieties from one another and positively identifying Sharwil, respectively. Results from chemometric methods and chemical analysis suggested that water and lipid were key contributors to the performance of classifiers. The positive results demonstrate the feasibility of NIR spectroscopy for discriminating different avocado varieties as well as authenticating Sharwil. To develop robust and stable models for the growers, distributors, and regulators in Hawaii, more varieties and additional seasons should continue to be added.


Asunto(s)
Persea , Espectroscopía Infrarroja Corta , Persea/química , Hawaii , Espectroscopía Infrarroja Corta/métodos , Estudios de Factibilidad , Frutas/química
13.
BMC Med Educ ; 24(1): 636, 2024 Jun 06.
Artículo en Inglés | MEDLINE | ID: mdl-38844972

RESUMEN

BACKGROUND: General practitioner interns need to acquire the expected clinical, communication, personal and professional competencies. Internship evaluations use qualitative evaluation tables to assess competency acquisition. However, there is no standardised evaluation table used in France. Some faculties use the exhaustive, precise, and manageable Exceler evaluation tool. We aim to evaluate opinions of General practice interns in Brest about the acceptability and feasibility of using the Exceler evaluation tool to monitor competency acquisition during internships. METHODS: This qualitative study used intern focus groups. Six-open ended questions with optional follow-up questions were asked. Cards from the Dixit® game were used to guide and facilitate discussion. Open, axial, then integrative analysis of the verbatim was performed. RESULTS: This is the first study to evaluate intern opinions about GP internship evaluations using focus groups. Participants felt that the quality of existing evaluations was insufficient, and it was difficult to monitor their progress. Adapting evaluations to individual profiles and backgrounds seemed necessary. Exceler appeared to be a possible solution due to its content validity, flexibility of use and accessibility. However, there were comments about possible modifications. CONCLUSIONS: Analysing opinions of tutors, supervisors and other practice centers could help identify potential barriers and reveal solutions to facilitate its implementation and use. TRIAL REGISTRATION: Not applicable.


Asunto(s)
Competencia Clínica , Estudios de Factibilidad , Grupos Focales , Medicina General , Internado y Residencia , Investigación Cualitativa , Humanos , Internado y Residencia/normas , Competencia Clínica/normas , Medicina General/educación , Evaluación Educacional/métodos , Masculino , Femenino , Adulto , Francia , Actitud del Personal de Salud
14.
JMIR Aging ; 7: e54128, 2024 May 06.
Artículo en Inglés | MEDLINE | ID: mdl-38845403

RESUMEN

Background: Advance care planning (ACP) is a process that involves patients expressing their personal goals, values, and future medical care preferences. Digital applications may help facilitate this process, though their use in older adults has not been adequately studied. Objective: This pilot study aimed to evaluate the reach, adoption, and usability of Koda Health, a web-based patient-facing ACP platform, among older adults. Methods: Older adults (aged 50 years and older) who had an active Epic MyChart account at an academic health care system in North Carolina were recruited to participate. A total of 2850 electronic invitations were sent through MyChart accounts with an embedded hyperlink to the Koda platform. Participants who agreed to participate were asked to complete pre- and posttest surveys before and after navigating through the Koda Health platform. Primary outcomes were reach, adoption, and System Usability Scale (SUS) scores. Exploratory outcomes included ACP knowledge and readiness. Results: A total of 161 participants enrolled in the study and created an account on the platform (age: mean 63, SD 9.3 years), with 80% (129/161) of these participants going on to complete all steps of the intervention, thereby generating an advance directive. Participants reported minimal difficulty in using the Koda platform, with an overall SUS score of 76.2. Additionally, knowledge of ACP (eg, mean increase from 3.2 to 4.2 on 5-point scale; P<.001) and readiness (eg, mean increase from 2.6 to 3.2 on readiness to discuss ACP with health care provider; P<.001) significantly increased from before to after the intervention. Conclusions: This study demonstrated that the Koda Health platform is feasible, had above-average usability, and improved ACP documentation of preferences in older adults. Our findings indicate that web-based health tools like Koda may help older individuals learn about and feel more comfortable with ACP while potentially facilitating greater engagement in care planning.


Asunto(s)
Planificación Anticipada de Atención , Estudios de Factibilidad , Humanos , Proyectos Piloto , Masculino , Femenino , Persona de Mediana Edad , Anciano , North Carolina , Intervención basada en la Internet , Internet , Encuestas y Cuestionarios
15.
Cancer Med ; 13(11): e7347, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38845476

RESUMEN

BACKGROUND: With the increasing use of daratumumab (DARA)-containing regimens for multiple myeloma (MM) patients in China, the standard infusion time of DARA is long, with the potential for infusion-related reactions (IRRs) and increased hospitalization and use of resources. Shortening the duration of DARA infusion helps to optimize the hospital stay and enhance the patient treatment experience. The current, commonly used 90-min rapid DARA infusion regimen may not be applicable to Chinese MM patients, and therefore, we explored a new 110-min rapid DARA infusion regimen aimed at reducing the treatment burden on patients to guarantee therapeutic safety. METHODS: MM inpatients treated with the DARA regimen were divided into two groups according to the number of times the DARA regimen was used: a standard infusion regimen for patients treated with the first two doses of DARA and a 110-min rapid infusion regimen for patients treated with more than two doses of DARA. Anti-allergy medications were routinely administered prior to the start of DARA infusion, patient consent, and authorization was obtained for all treatments, and statistical evaluation of the results was conducted via descriptive analyses, one-way ANOVA and chi-square tests. RESULTS: A total of 129 patients were included in this study: 68 in the standard infusion group, with 121 DARA infusions, and 129 in the rapid infusion group (patients who participated in the standard infusion subsequently participated in the rapid infusion), with 738 DARA infusions. The incidence of IRRs was 27.27% (36/121) in the standard infusion group and 1.35% (10/738) in the rapid infusion group, which were significantly different (p < 0.001). The incidence of IRRs after rapid infusion in other studies was <6%. The incidence of grade 1 IRRs in the rapid infusion group was 0.81% (6/738), the incidence of grade 2 IRRs was 0.54% (4/738), and there were no IRRs above grade 3; age, sex, and underlying disease had no effect on the choice of infusion method (p > 0.05). The mean infusion time after the occurrence of IRRs was also shorter in the rapid infusion group than in the standard infusion group (F = 24.781, p < 0.001). CONCLUSION: The 110-min rapid infusion DARA regimen is feasible and safe for use in Chinese MM patients.


Asunto(s)
Anticuerpos Monoclonales , Estudios de Factibilidad , Mieloma Múltiple , Humanos , Mieloma Múltiple/tratamiento farmacológico , Masculino , Femenino , Persona de Mediana Edad , Anticuerpos Monoclonales/administración & dosificación , Anticuerpos Monoclonales/efectos adversos , Anticuerpos Monoclonales/uso terapéutico , Infusiones Intravenosas , Anciano , China , Adulto , Antineoplásicos/administración & dosificación , Antineoplásicos/efectos adversos , Antineoplásicos/uso terapéutico , Factores de Tiempo , Anciano de 80 o más Años , Resultado del Tratamiento , Pueblos del Este de Asia
16.
J Safety Res ; 89: 269-287, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38858051

RESUMEN

INTRODUCTION: Advancements in the modern construction industry have contributed to the development of a range of technology-based interventions to improve the safety behavior of front-line construction workers. Notwithstanding the extensive research on safety behavior, there is still a paucity of research on assessing technology interventions of safety behavior to provide an overview of their strengths and limitations. The present study aims to bridge this gap in the literature and identify the main trends of research. METHOD: A systematic review and critical content analysis are adopted to capture an overview of the state of knowledge on safety behavior technologies. As a result of searching Scopus, Web of Science, and Google Scholar databases in the period from Jan 2010 to Feb 2023, a total of 359 potential studies went through the systematic screening process and finally, 48 representative studies were selected followed by an assessment of the feasibility and applicability of the safety behavior technologies. RESULTS: It was found that safety behavior technology is characterized by seven technologies including virtual-reality simulation (T1), eye-tracking technology (T2), prediction modeling of safety behavior (T3), computer-based training (T4), drone/sensor-based hazard monitoring (T5), vision-based behavior monitoring (T6), and real-time positioning (T7). CONCLUSIONS: This research improves understanding of the status of safety behavior technologies and provides a critical review of their feasibility from the perspective of four assessment criteria including application, limitation, benefit, and feasibility. PRACTICAL APPLICATIONS: The categorizations of technologies add value to the body of knowledge in terms of generic requirements for their implementation and adaptation on construction sites.


Asunto(s)
Industria de la Construcción , Estudios de Factibilidad , Administración de la Seguridad , Humanos , Administración de la Seguridad/métodos , Salud Laboral , Tecnología
17.
BMJ Open ; 14(6): e081837, 2024 Jun 04.
Artículo en Inglés | MEDLINE | ID: mdl-38834321

RESUMEN

OBJECTIVE: We aimed to evaluate the feasibility and utility of an unsupervised testing mechanism, in which participants pick up a swab kit, self-test (unsupervised) and return the kit to an on-campus drop box, as compared with supervised self-testing at staffed locations. DESIGN: University SARS-CoV-2 testing cohort. SETTING: Husky Coronavirus Testing provided voluntary SARS-CoV-2 testing at a university in Seattle, USA. OUTCOME MEASURES: We computed descriptive statistics to describe the characteristics of the study sample. Adjusted logistic regression implemented via generalised estimating equations was used to estimate the odds of a self-swab being conducted through unsupervised versus supervised testing mechanisms by participant characteristics, including year of study enrolment, pre-Omicron versus post-Omicron time period, age, sex, race, ethnicity, affiliation and symptom status. RESULTS: From September 2021 to July 2022, we received 92 499 supervised and 26 800 unsupervised self-swabs. Among swabs received by the laboratory, the overall error rate for supervised versus unsupervised swabs was 0.3% vs 4%, although this declined to 2% for unsupervised swabs by the spring of the academic year. Results were returned for 92 407 supervised (5% positive) and 25 836 unsupervised (4%) swabs from 26 359 participants. The majority were students (79%), 61% were female and most identified as white (49%) or Asian (34%). The use of unsupervised testing increased during the Omicron wave when testing demand was high and stayed constant in spring 2022 even when testing demand fell. We estimated the odds of using unsupervised versus supervised testing to be significantly greater among those <25 years of age (p<0.001), for Hispanic versus non-Hispanic individuals (OR 1.2, 95% CI 1.0 to 1.3, p=0.01) and lower among individuals symptomatic versus asymptomatic or presymptomatic (0.9, 95% CI 0.8 to 0.9, p<0.001). CONCLUSIONS: Unsupervised swab collection permitted increased testing when demand was high, allowed for access to a broader proportion of the university community and was not associated with a substantial increase in testing errors.


Asunto(s)
Prueba de COVID-19 , COVID-19 , SARS-CoV-2 , Manejo de Especímenes , Humanos , COVID-19/diagnóstico , COVID-19/epidemiología , Femenino , Masculino , Adulto , Universidades , Prueba de COVID-19/métodos , Prueba de COVID-19/estadística & datos numéricos , Persona de Mediana Edad , Adulto Joven , Manejo de Especímenes/métodos , Estudios de Cohortes , Washingtón/epidemiología , Autoevaluación , Adolescente , Anciano , Pandemias , Estudios de Factibilidad
18.
PLoS One ; 19(6): e0303098, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38857243

RESUMEN

Type 1 diabetes mellitus (T1DM) is an autoimmune disease characterized by the dysfunctional metabolism of carbohydrates, fats, and proteins caused by impaired insulin secretion and insulin resistance. This study investigated the feasibility of using point shear wave elastography (pSWE) of the pancreas by comparing the shear wave velocity (SWV) measurements of three anatomical areas in patients with T1DM and healthy volunteers. This study included 30 patients with T1DM (9 male, 21 female) and 23 healthy controls (11 men, 12 women). Two experienced certified operators performed the examinations and took the SWV measurements. The mean SWV of the entire pancreas parenchyma differed significantly between patients and controls (1.1 ± 0.29 and 0.74 ± 0.19 m/s, respectively; p ≤ 0.001). Moreover, the SWVs of the pancreatic segments were significantly different in patients and controls; the mean SWV values of the pancreas head, body, and tail (respectively) in patients vs. controls were 0.99 ± 0.36 vs. 0.76 ± 0.26 m/s (p = 0.012), 1.1 ± 0.52 vs. 0.74 ± 0.23 (p ≤ 0.001), and 1.0 ± 0.34 vs. 0.73 ± 0.28 (p ≤ 0.001). This study confirmed the feasibility of quantifying pancreas tissue stiffness with pSWE and revealed that patients with T1DM had higher pancreas tissue stiffness than controls. Further studies are required to determine the potential value of pSWE as a screening tool in patients with prediabetes.


Asunto(s)
Diabetes Mellitus Tipo 1 , Diagnóstico por Imagen de Elasticidad , Estudios de Factibilidad , Páncreas , Humanos , Diagnóstico por Imagen de Elasticidad/métodos , Masculino , Femenino , Adulto , Diabetes Mellitus Tipo 1/diagnóstico por imagen , Diabetes Mellitus Tipo 1/fisiopatología , Páncreas/diagnóstico por imagen , Páncreas/patología , Páncreas/metabolismo , Persona de Mediana Edad , Voluntarios Sanos , Estudios de Casos y Controles
19.
Front Public Health ; 12: 1352815, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38859900

RESUMEN

Background: Firearm-related suicide is the second leading cause of pediatric firearm death. Lethal means counseling (LMC) can improve firearm safe-storage practices for families with youth at risk of suicide. Objectives: This study aims to evaluate the feasibility of pediatric emergency department (ED) behavioral mental health (BMH) specialists providing LMC to caregivers of youth presenting with BMH complaints and to test for changes in firearm safety practices, pre-post ED LMC intervention, as measures of preliminary efficacy. Methods: Prospective pilot feasibility study of caregivers of youth presenting to a pediatric ED with BMH complaints. Caregivers completed an electronic survey regarding demographics and firearm safe-storage knowledge/practices followed by BMH specialist LMC. Firearm owners were offered a free lockbox and/or trigger lock. One-week follow-up surveys gathered self-reported data on firearm safety practices and intervention acceptability. One-month interviews with randomly sampled firearm owners collected additional firearm safety data. Primary outcomes were feasibility measures, including participant accrual/attrition and LMC intervention acceptability. Secondary outcomes included self-reported firearm safety practice changes. Feasibility benchmarks were manually tabulated, and Likert-scale acceptability responses were dichotomized to strongly agree/agree vs. neutral/disagree/strongly disagree. Descriptive statistics were used for univariate and paired data responses. Results: In total, 81 caregivers were approached; of which, 50 (81%) caregivers enrolled. A total of 44% reported having a firearm at home, 80% completed follow-up at one week. More than 80% affirmed that ED firearm safety education was useful and that the ED is an appropriate place for firearm safety discussions. In total, 58% of participants reported not having prior firearm safety education/counseling. Among firearm owners (n = 22), 18% reported rarely/never previously using a safe-storage device, and 59% of firearm owners requested safe storage devices.At 1-week follow-up (n = 40), a greater proportion of caregivers self-reported asking about firearms before their child visited other homes (+28%). Among firearm owners that completed follow-up (n = 19), 100% reported storing all firearms locked at one week (+23% post-intervention). In total, 10 caregivers reported temporarily/permanently removing firearms from the home. Conclusion: It is feasible to provide LMC in the pediatric ED via BMH specialists to families of high-risk youth. Caregivers were receptive to LMC and reported finding this intervention useful, acceptable, and appropriate. Additionally, LMC and device distribution led to reported changes in safe storage practices.


Asunto(s)
Servicio de Urgencia en Hospital , Estudios de Factibilidad , Armas de Fuego , Prevención del Suicidio , Humanos , Armas de Fuego/estadística & datos numéricos , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Masculino , Estudios Prospectivos , Adolescente , Proyectos Piloto , Niño , Cuidadores/estadística & datos numéricos , Cuidadores/psicología , Adulto , Encuestas y Cuestionarios , Consejo
20.
J Rehabil Med ; 56: jrm17738, 2024 06 11.
Artículo en Inglés | MEDLINE | ID: mdl-38860715

RESUMEN

OBJECTIVE: To assess the feasibility of backward cycling for people with Parkinson's disease. Secondary objectives were to assess changes in gait and balance following a 6-week program. DESIGN: A single-group prospective pre-test, post-test study with 1-month follow-up. SUBJECTS/PATIENTS: Twenty-six people with Parkinson's disease (mean age: 69 (7.74) years, gender: 83% males, time since diagnosis: 6 (4.44) years). METHODS: Participants pedaled backward on a stationary bicycle for 30 minutes at moderate intensity twice a week for 6 weeks. Feasibility was assessed by acceptability, suitability, and burden. Data collected at pre- and post-intervention with 1-month follow-up included backward stepping response variables, forward/backward gait variables, Mini-Balance Evaluation Systems Test (MBT), and 6 Minute Walk Test. RESULTS: There was a high retention rate (95.8%) and adherence rate (100%) with one adverse event and minimal burden. Significant improvements were seen in step count and excursion distance during backward stepping responses, forward and backward gait velocity, forward step length, and the Mini-BESTest. CONCLUSION: Backward cycling was a feasible intervention for people with Parkinson's disease, demonstrating low burden with high retention and adherence rates, and it is a safe exercise with the potential for benefits in gait and balance variables.


Asunto(s)
Ciclismo , Terapia por Ejercicio , Estudios de Factibilidad , Enfermedad de Parkinson , Equilibrio Postural , Humanos , Enfermedad de Parkinson/rehabilitación , Enfermedad de Parkinson/fisiopatología , Masculino , Femenino , Anciano , Ciclismo/fisiología , Equilibrio Postural/fisiología , Terapia por Ejercicio/métodos , Estudios Prospectivos , Persona de Mediana Edad , Marcha/fisiología , Resultado del Tratamiento
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