Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 146
Filtrar
1.
Menopause ; 2024 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-38595168
3.
J Pers Soc Psychol ; 2024 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-38271021

RESUMO

Whom do we perceive as more powerful and prefer to give power to: Those who have self-control or those who lack it? Past theory and research provide divergent predictions. Low self-control can be seen as a form of disinhibition, and disinhibition has been associated with greater power. However, high self-control can be seen as a form of agency, which is associated with greater power. Across seven studies, we found that individuals who exhibited high self-control were seen as more powerful, and given more power, than individuals who exhibited low self-control. This result held when the low or high self-control behavior was chosen either quickly or slowly (Studies 3 and 4), and when exhibiting low versus high self-control entailed the same action but different goals (Studies 5 and 6). Study 6 demonstrated important implications of our findings for goal setting: People were perceived as more powerful and given more power when they had a modest goal but exceeded it than when they had an ambitious goal but failed to meet it, even though in both cases they performed the same action. A meta-analysis of our mediation results showed that people perceived individuals higher in self-control as more assertive and competent, which was associated with greater power perception and then with greater power conferral. Perceived competence also directly mediated the effect of self-control on power conferral. The current research addresses a theoretical debate in the power literature and contributes to a better understanding of how power is perceived and accrued. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

4.
Adv Ther ; 41(1): 198-214, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37882884

RESUMO

INTRODUCTION: Vosoritide is the first precision medical therapy approved to increase growth velocity in children with achondroplasia. Sharing early prescribing experiences across different regions could provide a framework for developing practical guidance for the real-world use of vosoritide. METHODS: Two meetings were held to gather insight and early experience from experts in Europe, the Middle East, and the USA. The group comprised geneticists, pediatric endocrinologists, pediatricians, and orthopedic surgeons. Current practices and considerations for vosoritide were discussed, including administration practicalities, assessments, and how to manage expectations. RESULTS: A crucial step in the management of achondroplasia is to determine if adequate multidisciplinary support is in place. Training for families is essential, including practical information on administration of vosoritide, and how to recognize and manage injection-site reactions. Advocated techniques include establishing a routine, empowering patients by allowing them to choose injection sites, and managing pain. Patients may discontinue vosoritide if they cannot tolerate daily injections or are invited to participate in a clinical trial. Clinicians in Europe and the Middle East emphasized the importance of assessing adherence to daily injections, as non-adherence may impact response and reimbursement. Protocols for monitoring patients receiving vosoritide may be influenced by regional differences in reimbursement and healthcare systems. Core assessments may include pubertal staging, anthropometry, radiography to confirm open physes, the review of adverse events, and discussion of concomitant or new medications-but timing of these assessments may also differ regionally and vary across institutions. Patients and families should be informed that response to vosoritide can vary in both magnitude and timing. Keeping families informed regarding vosoritide clinical trial data is encouraged. CONCLUSION: The early real-world experience with vosoritide is generally positive. Sharing these insights is important to increase understanding of the practicalities of treatment with vosoritide in the clinical setting.


Assuntos
Acondroplasia , Peptídeo Natriurético Tipo C , Criança , Humanos , Peptídeo Natriurético Tipo C/uso terapêutico , Atenção à Saúde , Manejo da Dor , Acondroplasia/tratamento farmacológico
5.
Nicotine Tob Res ; 2023 Dec 10.
Artigo em Inglês | MEDLINE | ID: mdl-38071660

RESUMO

INTRODUCTION: Embedded smoking cessation support within lung cancer screening is recommended in the UK; however, little is known about why individuals decline smoking cessation support in this setting. This study identified psychosocial factors that influence smoking cessation and quit motivation among those who declined support for quitting smoking alongside lung cancer screening. METHODS: Qualitative interviews conducted between August 2019 - April 2021 with thirty adults with a smoking history, recruited from the Yorkshire Lung Screening Trial. Participants had declined smoking cessation support. Verbatim interview transcripts were thematically analysed. RESULTS: Fifty percent of participants were male and the majority were from the most deprived groups. Participants reported low motivation and a variety of barriers to stopping smoking. Participants described modifiable behavioural factors that influenced their quit motivation including self-efficacy, perceived effectiveness of stop-smoking services including smoking cessation aids, risk-minimising beliefs, lack of social support, absence of positive influences on smoking and beliefs about smoking/smoking cessation. Broader contextual factors included social isolation and stigma, COVID-19 and comorbid mental and physical health conditions that deterred smoking cessation. CONCLUSIONS: To encourage engagement in smoking cessation support during lung cancer screening, interventions should seek to encourage positive beliefs about the effectiveness of smoking cessation aids and increase confidence in quitting as part of supportive, person-centred care. Interventions should also acknowledge the wider social determinants of health among the lung screening-eligible population. IMPLICATIONS: This study provides an in-depth understanding of the beliefs surrounding smoking and smoking cessation and further potential psychosocial factors that influence those attending lung cancer screening. Many of the barriers to smoking cessation found in the present study are similar to those outside of a lung screening setting however this work offers an understanding of potential facilitators that should be considered in future lung screening programmes.

6.
Mol Pharm ; 20(11): 5763-5777, 2023 11 06.
Artigo em Inglês | MEDLINE | ID: mdl-37800667

RESUMO

The structural investigation of amorphous pharmaceuticals is of paramount importance in comprehending their physicochemical stability. However, it has remained a relatively underexplored realm primarily due to the limited availability of high-resolution analytical tools. In this study, we utilized the combined power of X-ray pair distribution functions (PDFs) and solid-state nuclear magnetic resonance (ssNMR) techniques to probe the molecular packing of amorphous posaconazole and its amorphous solid dispersion at the molecular level. Leveraging synchrotron X-ray PDF data and employing the empirical potential structure refinement (EPSR) methodology, we unraveled the existence of a rigid conformation and discerned short-range intermolecular C-F contacts within amorphous posaconazole. Encouragingly, our ssNMR 19F-13C distance measurements offered corroborative evidence supporting these findings. Furthermore, employing principal component analysis on the X-ray PDF and ssNMR data sets enabled us to gain invaluable insights into the chemical nature of the intermolecular interactions governing the drug-polymer interplay. These outcomes not only furnish crucial structural insights facilitating the comprehension of the underlying mechanisms governing the physicochemical stability but also underscore the efficacy of synergistically harnessing X-ray PDF and ssNMR techniques, complemented by robust modeling strategies, to achieve a high-resolution exploration of amorphous structures.


Assuntos
Imageamento por Ressonância Magnética , Polímeros , Raios X , Espectroscopia de Ressonância Magnética/métodos , Polímeros/química , Preparações Farmacêuticas , Difração de Raios X
7.
MCN Am J Matern Child Nurs ; 48(5): 244-251, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37574692

RESUMO

BACKGROUND: Late preterm infants are infants born between 34 and 36 6/7 weeks gestation. Compared to term infants, late preterm infants are at increased risk for breastfeeding difficulties, hypoglycemia, hyperbilirubinemia, and hypothermia due to their relative physiologic and metabolic immaturity. PROBLEM: Medical record reviews performed at a level III maternal and newborn hospital in central Illinois revealed only 64% of late preterm infants admitted to the newborn nursery received care per the unit late preterm infant policy. The aim of this quality improvement project was to increase nurse adherence to the policy to 80%. METHODS: Between May 2022 and September 2022, several interventions were implemented for maternal-child nurses and support clinicians: an education offering, creation of a late preterm infant-specific breastfeeding log, and electronic medical record updates. Post-intervention medical record reviews measured policy adherence through documentation of feeding sessions, hypoglycemia, hypothermia, and hyperbilirubinemia. Descriptive statistics were performed to determine improvement. RESULTS: Nurse adherence to the late preterm infant policy increased to 90% over the period of the project. CLINICAL IMPLICATIONS: Late preterm infant care protocols should be in place in all newborn nurseries. Late preterm infant policy adherence can be supported through electronic medical record prompts, use of a late preterm infant-specific breastfeeding log, and continuing education.


Assuntos
Hipoglicemia , Hipotermia , Lactente , Feminino , Recém-Nascido , Humanos , Recém-Nascido Prematuro , Hipotermia/prevenção & controle , Idade Gestacional , Aleitamento Materno , Hiperbilirrubinemia
8.
Psychiatr Rehabil J ; 46(1): 53-54, 2023 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-36809016

RESUMO

Viewing the Substance Abuse and Mental Health Services Administration's recovery principles through an antiracist lens has guided the authors' vision of recovery-oriented systems for all. In this brief letter, they present some considerations arising from their application of recovery principles to areas affected by racial bias. They are also identifying best practices for incorporating micro and macro antiracism efforts into recovery-oriented health care. These are important steps in promoting recovery-oriented care, but there is much more to do. (PsycInfo Database Record (c) 2023 APA, all rights reserved).


Assuntos
Transtornos Mentais , Recuperação da Saúde Mental , Serviços de Saúde Mental , Transtornos Relacionados ao Uso de Substâncias , Veteranos , Humanos , Antirracismo
9.
Avicenna J Med ; 12(4): 178-181, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36570427

RESUMO

Background Subcutaneous lidocaine injection and topical EMLA cream are both used to control lumbar puncture (LP) pain; however, local analgesia usage is not standardized. Methods We conducted a prospective, single-blinded, randomized-controlled crossover trial comparing the two modalities in reducing LP pain. Pediatric patients requiring serial LPs were randomly assigned to receive EMLA cream or lidocaine injection prior to LP. On the subsequent LP, analgesia was defaulted to the other agent. Pain was assessed using the Wong-Baker FACES Pain Rating Scale pre-procedure: 30 to 60 minutes post-LP, and 24 hours post-procedure. Results Ten patients were included in the analysis (median age: 5.5 years). Pain ratings at 1 and 24 hours post-LP did not differ between the two strategies ( p = 0.79). No adverse local reactions were reported for either agent. Conclusion Accordingly, both lidocaine and EMLA cream provided effective LP pain control.

10.
BMC Pulm Med ; 22(1): 478, 2022 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-36522781

RESUMO

BACKGROUND: Optimising smoking cessation services within a low radiation-dose computed tomography (LDCT) lung cancer screening programme has the potential to improve cost-effectiveness and overall efficacy of the programme. However, evidence on the optimal design and integration of cessation services is limited. We co-developed a personalised cessation and relapse prevention intervention incorporating medical imaging collected during lung cancer screening. The intervention is designed to initiate and support quit attempts among smokers attending screening as part of the Yorkshire Enhanced Stop Smoking study (YESS: ISRCTN63825779). Patients and public were involved in the development of an intervention designed to meet the needs of the target population. METHODS: An iterative co-development approach was used. Eight members of the public with a history of smoking completed an online survey to inform the visual presentation of risk information in subsequent focus groups for acceptability testing. Three focus groups (n = 13) were conducted in deprived areas of Yorkshire and South Wales with members of the public who were current smokers or recent quitters (within the last year). Exemplar images of the heart and lungs acquired by LDCT, absolute and relative lung cancer risk, and lung age were shown. Data were analysed thematically, and discussed in stakeholder workshops. Draft versions of the intervention were developed, underpinned by the Extended Parallel Processing Model to increase self-efficacy and response-efficacy. The intervention was further refined in a second stakeholder workshop with a patient panel. RESULTS: Individual LDCT scan images of the lungs and heart, in conjunction with artistic impressions to facilitate interpretation, were considered by public participants to be most impactful in prompting cessation. Public participants thought it important to have a trained practitioner guiding them through the intervention and emphasising the short-term benefits of quitting. Presentation of absolute and relative risk of lung cancer and lung age were considered highly demotivating due to reinforcement of fatalistic beliefs. CONCLUSION: An acceptable personalised intervention booklet utilising LDCT scan images has been developed for delivery by a trained smoking cessation practitioner. Our findings highlight the benefit of co-development during intervention development and the need for further evaluation of effectiveness.


Supporting patients to stop smoking when they attend lung cancer screening will improve the overall benefit and value for money of the service. This study developed a booklet containing pictures of a person's own lungs and heart taken during a lung cancer screening scan. The booklet shows areas of damage to the heart and lungs caused by smoking, delivered alongside positive messages to build confidence to stop smoking and let patients know about the benefits of stopping smoking. To develop the booklet, we worked with members of public who currently or used to smoke. Eight members of public completed a survey asking about the best ways to present information about risk. Thirteen members of the public took part in focus groups to co-develop the booklet. One workshop with academic and healthcare professionals and one workshop with a public involvement panel were held to develop and finalise the booklet. Members of the public said they wanted information about the short-term benefits of quitting smoking, and that coloured drawings next to the scan picture would help them to understand what the scan picture meant. Having someone specially trained to guide them through the booklet was considered important. Being told about their risk for lung cancer in the future was off-putting and might discourage a quit attempt. We have co-developed a booklet to support people to quit smoking when they go for lung cancer screening. The booklet is currently being tested to see whether it can support people to quit smoking.


Assuntos
Neoplasias Pulmonares , Abandono do Hábito de Fumar , Humanos , Abandono do Hábito de Fumar/métodos , Detecção Precoce de Câncer , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/prevenção & controle , Fumantes , Fumar/efeitos adversos , Fumar/terapia
11.
BMJ Open ; 12(10): e063280, 2022 10 12.
Artigo em Inglês | MEDLINE | ID: mdl-36223970

RESUMO

INTRODUCTION: Rapid diagnostic centres (RDCs) are being implemented across the UK to accelerate the assessment of vague suspected cancer symptoms. Targeted behavioural interventions are needed to augment RDCs that serve socioeconomically deprived populations who are disproportionately affected by cancer, have lower cancer symptom awareness and are less likely to seek help for cancer symptoms. The aim of this study is to assess the feasibility and acceptability of delivering and evaluating a community-based vague cancer symptom awareness intervention in an area of high socioeconomic deprivation. METHODS AND ANALYSIS: Intervention materials and messages were coproduced with local stakeholders in Cwm Taf Morgannwg, Wales. Cancer champions will be trained to deliver intervention messages and distribute intervention materials using broadcast media (eg, local radio), printed media (eg, branded pharmacy bags, posters, leaflets), social media (eg, Facebook) and attending local community events. A cross-sectional questionnaire will include self-reported patient interval (time between noticing symptoms to contacting the general practitioner), cancer symptom recognition, cancer beliefs and barriers to presentation, awareness of campaign messages, healthcare resource use, generic quality of life and individual and area-level deprivation indicators. Consent rates and proportion of missing data for patient questionnaires (n=189) attending RDCs will be measured. Qualitative interviews and focus groups will assess intervention acceptability and barriers/facilitators to delivery. ETHICS AND DISSEMINATION: Ethical approval for this study was given by the London-West London & GTAC Research Ethics (21/LO/0402). This project will inform a potential future controlled study to assess intervention effectiveness in reducing the patient interval for vague cancer symptoms. The results will be critical to informing national policy and practice regarding behavioural interventions to support RDCs in highly deprived populations.


Assuntos
Neoplasias , Qualidade de Vida , Estudos Transversais , Estudos de Viabilidade , Humanos , Neoplasias/diagnóstico , Encaminhamento e Consulta
12.
Home Healthc Now ; 40(4): 209-213, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35777942

RESUMO

Professional development is essential for the ongoing professional growth of nurses and ensures employers and patients that staff have current knowledge in the field. But what happens when there's no budget for professional development? This quality improvement project describes the use of a nurse champion intervention for a professional development program for perinatal home health nurses at a nonprofit health organization. A nurse champion mentors and advocates for nurse colleagues during a change project. In this case, the nurse champion partnered with nurse educators from the supporting hospital and instituted a program to provide regular professional development content to perinatal home health nurses. Results showed their level of confidence in providing prenatal, labor and delivery, and early pediatric education improved. Level of confidence in providing postpartum education stayed the same, and level of confidence in providing neonatal intensive care unit education decreased. The Nurse Champion Education Program was a budget-friendly solution that fostered professional nursing development. Although this intervention was applied to a specific population, all home health nurses could benefit from a nurse champion education model in their professional setting.


Assuntos
Enfermeiros de Saúde Comunitária , Criança , Feminino , Humanos , Recém-Nascido , Mentores
13.
Cureus ; 14(5): e25426, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35769684

RESUMO

Hypophosphatasia (HPP) is a rare genetic condition that can manifest from the prenatal period to adulthood. Clinical presentation is characterized by six major forms. HPP can be complex and debilitating. A two-year-old male with a past medical history of HPP presented to our emergency room with a non-displaced supracondylar fracture after minor trauma. Non-accidental trauma was considered in addition to inadequate medical control of his HPP. He was referred to our multidisciplinary clinic and asfotase alfa was increased to an appropriate dose. A multidisciplinary approach is the standard of care for the management of children with HPP, allowing for routine evaluation by tertiary specialists. This includes medication dosing surveillance with serum studies and imaging. Enzyme replacement therapy, appropriately dosed by considering weight and laboratory values, may reduce orthopedic complications. A multidisciplinary team's surveillance of patients with HPP ensures proper medication management, decreases the likelihood of bony injury and encourages continued patient follow-up.

14.
Sci Total Environ ; 832: 155152, 2022 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-35413353

RESUMO

Surface urban heat islands (SUHIs) are an important socio-environmental problem associated with large cities, such as the Santiago Metropolitan Area (SMA), in Chile. Here, we analyze daytime and nighttime variations of SUHIs for each season of the year during the period 2000-2020. To evaluate socioeconomic inequities in the distribution of SUHIs, we establish statistical relationships with socioeconomic status, land price, and urban vegetation. We use the MODIS satellite images to obtain the land surface temperatures and the normalized difference vegetation index (NDVI) through the Google Earth Engine platform. The results indicate more intense SUHIs during the nighttime in the eastern sector, coinciding with higher socioeconomic status and larger green areas. This area during the day is cooler than the rest of the city. The areas with lower and middle socioeconomic status suffer more intense SUHIs (daytime and nighttime) and match poor environmental and urban qualities. These results show the high segregation of SMA. Urban planning is subordinated to land prices with a structure maintained over the study period. The lack of social-climate justice is unsustainable, and such inequalities may be exacerbated in the context of climate change. Thus, these results can contribute to the planning of the SMA.


Assuntos
Monitoramento Ambiental , Temperatura Alta , Chile , Cidades , Monitoramento Ambiental/métodos , Fatores Socioeconômicos
15.
Int Urogynecol J ; 33(12): 3383-3390, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-35441854

RESUMO

INTRODUCTION AND HYPOTHESIS: Vulvovaginal symptoms following perineal laceration may be worsened by atrophy related to decreased estrogen. Our objective was to evaluate the effect of local estrogen therapy in this setting. METHODS: We conducted a single-center, pilot, randomized, placebo-controlled trial of local estradiol in primiparous women with a second-degree or greater perineal laceration following a term vaginal delivery. Participants were randomized to twice weekly estradiol or placebo cream from delivery through 3 months postpartum. The primary outcome was a validated measure of vulvovaginal symptoms at 12 weeks postpartum. Secondary outcomes included measures of perineal pain, quality of life, sexual function, ease of use, likelihood of continued use, and adverse events. RESULTS: We planned to enroll 70 women; however, due to human subjects research restrictions related to the COVID-19 pandemic, enrollment was stopped early. A total of 59 women were randomized, 31 to the estradiol group and 28 to the placebo group. Nearly all participants (95%) were followed through 12 weeks with suggestion of marginal improvement in Vulvar Assessment Scale scores [-0.10; 90% CI = (-0.20, 0.01)] in those randomized to estradiol compared to placebo. Local estradiol was not associated with improvement in other measures, and only one non-serious adverse event was observed. CONCLUSIONS: In primiparous women with a perineal laceration, use of local estradiol showed minimal clinical benefit in vulvovaginal atrophy and related symptoms but appears to be acceptable and safe for postpartum use. Larger adequately powered trials enrolling a diverse group of postpartum women are needed to affirm these findings.


Assuntos
COVID-19 , Lacerações , Feminino , Humanos , Qualidade de Vida , Pandemias , Projetos Piloto , Estrogênios , Estradiol , Atrofia/tratamento farmacológico , Período Pós-Parto , Dor Pélvica
16.
Subst Abuse Treat Prev Policy ; 17(1): 24, 2022 03 28.
Artigo em Inglês | MEDLINE | ID: mdl-35346260

RESUMO

BACKGROUND: This meta-ethnography investigates how young adults describe their tobacco use, smoking identities and pathways into and out of regular smoking, to inform future smoking prevention and harm reduction interventions. METHODS: Eight databases were systematically searched using keywords and indexed terms. Studies were included if they presented qualitative data from young adults aged 16-25 reporting smoking histories and/or smoking identities from countries culturally similar to the UK. A systematic and rigorous meta-ethnographic approach was employed, consistent with Noblit and Hare's methodology. RESULTS: Thirty papers were included. Reasons stated for taking up smoking and becoming a smoker included alleviating stress, transforming one's identity, and coping with the transition to further education, employment or leaving home. Many used smoking to aid acceptance within new peer groups, particularly when alcohol was present. Smoking was also perceived as an act of resistance and a coping mechanism for those with marginalised identities. Barriers to quitting smoking included young adults' minimisation or denial of the health risks of smoking and not identifying with "being a smoker". CONCLUSIONS: This meta-ethnography may provide a blueprint to inform the development of health and wellbeing interventions designed specifically for young adults. Smoking cessation interventions should be co-designed with young adults based on their perceived needs, resonant with their desire to quit in the future at key milestones. Harm reduction interventions should address the social aspect of addiction, without reinforcing stigma, particularly for those with marginalised identities.


Assuntos
Abandono do Hábito de Fumar , Fumar , Adolescente , Adulto , Antropologia Cultural , Humanos , Fumar/epidemiologia , Abandono do Hábito de Fumar/métodos , Fumar Tabaco , Uso de Tabaco , Adulto Jovem
17.
J Cataract Refract Surg ; 48(3): 288-297, 2022 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-34269326

RESUMO

PURPOSE: To compare the effectiveness and safety of the TECNIS Symfony intraocular lens (IOL; ZXR00) with the TECNIS 1-piece monofocal IOL (ZCB00). SETTING: 15 sites in the United States. DESIGN: Prospective, randomized, patient-masked/evaluator-masked clinical trial. METHODS: Randomized participants received either the ZXR00 or ZCB00 IOL bilaterally. The 6-month postoperative outcomes included monocular and binocular distance, intermediate, and near visual acuity (VA), spherical equivalent refraction and refractive cylinder, spectacle wear, and visual symptoms. RESULTS: Overall, 299 patients were implanted with a study IOL (ZXR00 IOL, n = 148; ZCB00 IOL control, n = 151). At the 6-month follow-up, mean binocular uncorrected distance VA was comparable between ZXR00 and ZCB00 IOL recipients (P = .1011). The ZXR00 IOL group had significantly better mean binocular uncorrected intermediate VA and uncorrected near VA (both P < .0001) than the ZCB00 IOL group. The mean binocular distance-corrected intermediate VA and distance-corrected near VA were also better in the ZXR00 IOL group (both P < .0001). More ZXR00 IOL recipients reported wearing spectacles none of the time or a little of the time for overall vision at 6 months compared with the ZCB00 IOL group (85.0% vs 59.9%, P < .0001). In the ZXR00 IOL-implanted patients, low incidence rates of night glare (mild to moderate, 2.7%), halo (mild to moderate, 13.6%; severe, 2.7%), and starbursts (mild to moderate, 7.5%; severe, 1.4%) were reported. CONCLUSIONS: The TECNIS Symfony IOL provided comparable distance vision and improved uncorrected and distance-corrected intermediate and near vision, along with decreased spectacle wear and low incidence rates of dysphotopsia, compared with the TECNIS 1-piece monofocal IOL.


Assuntos
Lentes Intraoculares , Facoemulsificação , Humanos , Implante de Lente Intraocular , Satisfação do Paciente , Estudos Prospectivos , Desenho de Prótese , Refração Ocular , Visão Binocular
18.
Int Urogynecol J ; 33(7): 1897-1905, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-33881603

RESUMO

INTRODUCTION AND HYPOTHESIS: We aimed to evaluate the safety of same-day discharge (SDD) compared with next-day discharge (NDD) after prolapse surgery on a national level hypothesizing that readmission and complication rates after SDD would not be higher than NDD. METHODS: We performed a retrospective cohort study using the National Surgical Quality Improvement Program database including 2014-2018. Current Procedural Terminology (CPT) codes were used to identify minimally invasive apical suspensions or obliterative procedures. Exclusion criteria were length of stay > 1 day, unrelated concomitant procedures, serious medical comorbidities, American Society of Anesthesiologists (ASA) Class >2, and complication during index admission. The primary outcome was 30-day readmission, and secondary outcomes included 30-day complications. RESULTS: 12,583 were included in analysis. SDD rate was 16.7%. The majority of women were white (91%) with a mean age of 59 years and mean body mass index of 28 kg/m². Medical comorbidities were similar between the SDD and NDD groups. Overall incidence of 30-day readmission was 1.7%. SDD had lower odds of 30-day readmission than NDD (aOR 0.63, 95% CI 0.41-0.98). SDD had lower odds of 30-day complications but this failed to reach statistical significance (aOR 0.67, 95% CI 0.44-1.03). CONCLUSIONS: In this cohort, 30-day readmission and complication rates were not higher after SDD compared to NDD in women undergoing minimally-invasive apical suspension or obliterative procedures. We interpret these findings carefully given study limitations but believe our findings support the safety of SDD after minimally invasive apical suspension or obliterative procedures in a low-risk population.


Assuntos
Alta do Paciente , Prolapso de Órgão Pélvico , Feminino , Humanos , Tempo de Internação , Pessoa de Meia-Idade , Readmissão do Paciente , Prolapso de Órgão Pélvico/complicações , Prolapso de Órgão Pélvico/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos
19.
AAPS PharmSciTech ; 22(7): 228, 2021 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-34435280

RESUMO

Bedaquiline is used to treat multi-resistant tuberculosis in adults. The fumarate salt is commercially available and used in the product Sirturo. To provide open access to bedaquiline molecule once the patent on the chemical substance expires, new salts were screened. This work offers additional information on the bedaquiline system, as new salts may present better pharmacokinetic properties. The current studies focus on the attempted isolation of the acetate, benzoate, benzenesulfonate, hydrobromide, succinate, hydrochloride, tartrate, lactate, maleate, malate, and mesylate salts of bedaquiline. Potential salts were screened using a unique combination of conventional screening, and small-scale experiments supplemented by crystallographic analysis and infrared microspectroscopy. Salts were prepared on a larger scale by dissolving 1:1 ratios of the individual salt formers and bedaquiline base (30 mg, 0.055 mmol) in different solvents and allowing the solutions to evaporate or crystallize. X-ray diffraction (XRD) techniques and spectroscopic and thermal analyses were employed to characterize the salts. The benzoate and maleate salts were selected as lead candidates after reviewing preliminary characterization data. To determine the most stable forms for the leads, a polymorph screen was conducted using solvents of various polarities. These salt screens successfully generated five new salts of bedaquiline, namely, benzoate, maleate, hydrochloride, besylate, and mesylate. The existence of these salts was confirmed by powder XRD, proton NMR, and IR spectroscopies. TGA and DSC thermal analysis along with hot-stage optical microscopy were further used to characterize the salts. The polymorph screen conducted on the salts suggested the absence of additional polymorphs at 1 g scale.


Assuntos
Diarilquinolinas , Sais , Pós , Solubilidade , Difração de Raios X
20.
Artigo em Inglês | MEDLINE | ID: mdl-34299859

RESUMO

BACKGROUND: Several countries have documented the relationship between long-term exposure to air pollutants and epidemiological indicators of the COVID-19 pandemic, such as incidence and mortality. This study aims to explore the association between air pollutants, such as PM2.5 and PM10, and the incidence and mortality rates of COVID-19 during 2020. METHODS: The incidence and mortality rates were estimated using the COVID-19 cases and deaths from the Chilean Ministry of Science, and the population size was obtained from the Chilean Institute of Statistics. A chemistry transport model was used to estimate the annual mean surface concentration of PM2.5 and PM10 in a period before the current pandemic. Negative binomial regressions were used to associate the epidemiological information with pollutant concentrations while considering demographic and social confounders. RESULTS: For each microgram per cubic meter, the incidence rate increased by 1.3% regarding PM2.5 and 0.9% regarding PM10. There was no statistically significant relationship between the COVID-19 mortality rate and PM2.5 or PM10. CONCLUSIONS: The adjusted regression models showed that the COVID-19 incidence rate was significantly associated with chronic exposure to PM2.5 and PM10, even after adjusting for other variables.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , COVID-19 , Poluentes Atmosféricos/análise , Poluição do Ar/efeitos adversos , Poluição do Ar/análise , Chile/epidemiologia , Exposição Ambiental/efeitos adversos , Exposição Ambiental/análise , Humanos , Incidência , Mortalidade , Pandemias , Material Particulado/análise , SARS-CoV-2
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...