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1.
Trials ; 22(1): 277, 2021 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-33849611

RESUMO

BACKGROUND: Effective team communication, coordination, and situational awareness (SA) by team members are critical components to deliver optimal cardiopulmonary resuscitation (CPR). Complexity of care during CPR, involvement of numerous providers, miscommunication, and other exogenous factors can all contribute to negatively influencing patient care, thus jeopardizing survival. We aim to investigate whether an mHealth supportive tool (the Interconnected and Focused Mobile Apps on patient Care Environment [InterFACE]) developed as a collaborative platform to support CPR providers in real-time and share patient-centered information would increase SA during pediatric CPR. METHODS: We will conduct a prospective, cluster randomized controlled trial by groups of 6 participants in a tertiary pediatric emergency department (33,000 consultations/year) with pediatric physicians and nurses. We will compare the impact of the InterFACE tool with conventional communication methods on SA and effective team communication during a standardized pediatric in-hospital cardiac arrest and a polytrauma high-fidelity simulations. Forty-eight participants will be randomized (1:1) to consecutively perform two 20-min video-recorded scenarios using either the mHealth tool or conventional methods. The primary endpoint is the SA score, measured with the Situation Awareness Global Assessment Technique (SAGAT) instrument. Enrollment will start in late 2020 and data analysis in early 2021. We anticipate that the intervention will be completed by early 2021 and study results will be submitted in mid 2021 for publication. DISCUSSION: This clinical trial will assess the impact of a collaborative mHealth tool on increasing situational awareness and effective team communication during in-hospital pediatric resuscitation. As research in this area is scarce, the results generated by this study may become of paramount importance in improving the care of children receiving in-hospital CPR, in the era of increasing communication technology. TRIAL REGISTRATION: ClinicalTrials.gov NCT04464603 . Registered on 9 July 2020.

2.
RMD Open ; 7(1)2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33811177

RESUMO

OBJECTIVE: To explore the effect of apps measuring patient-reported outcomes (PROs) on patient-provider interaction in the rheumatic diseases in an observational setting. METHODS: Patients in the Swiss Clinical Quality Management in Rheumatic Diseases Registry were offered mobile apps (iDialog and COmPASS) to track disease status between rheumatology visits using validated PROs (Rheumatoid Arthritis Disease Activity Index-5 score, Bath Ankylosing Spondylitis Disease Activity Index score, Routine Assessment of Patient Index Data-3 score and Visual Analogue Scale score for pain, disease activity and skin symptoms). We assessed two aspects of patient-provider interaction: shared decision making (SDM) and physician awareness of disease fluctuations. We used logistic regressions to compare outcomes among patients who (1) used an app and discussed app data with their physician (app+discussion group), (2) used an app without discussing the data (app-only group) or (3) did not use any app (non-app users). RESULTS: 2111 patients were analysed, including 1799 non-app users, 150 app-only users and 162 app+discussion users (43% male; with 902 patients with rheumatoid arthritis, 766 patients with axial spondyloarthritis and 443 patients with psoriatic arthritis). App users were younger than non-app users (mean age of 47 vs 51 years, p<0.001). Compared with non-app users, the app+discussion group rated their rheumatologist more highly in SDM (OR 1.7, 95% CI 1.1 to 2.4) and physician awareness of disease fluctuations (OR 2.0, 95% CI 1.3 to 3.1). This improvement was absent in the app-only group. CONCLUSION: App users who discussed app data with their rheumatologist reported more favourably on patient-provider interactions than app users who did not and non-app users. Apps measuring PROs may contribute little to patient-provider interactions without integration of app data into care processes.

3.
BMC Pulm Med ; 21(1): 103, 2021 Mar 24.
Artigo em Inglês | MEDLINE | ID: mdl-33761909

RESUMO

BACKGROUND: Lung auscultation is fundamental to the clinical diagnosis of respiratory disease. However, auscultation is a subjective practice and interpretations vary widely between users. The digitization of auscultation acquisition and interpretation is a particularly promising strategy for diagnosing and monitoring infectious diseases such as Coronavirus-19 disease (COVID-19) where automated analyses could help decentralise care and better inform decision-making in telemedicine. This protocol describes the standardised collection of lung auscultations in COVID-19 triage sites and a deep learning approach to diagnostic and prognostic modelling for future incorporation into an intelligent autonomous stethoscope benchmarked against human expert interpretation. METHODS: A total of 1000 consecutive, patients aged ≥ 16 years and meeting COVID-19 testing criteria will be recruited at screening sites and amongst inpatients of the internal medicine department at the Geneva University Hospitals, starting from October 2020. COVID-19 is diagnosed by RT-PCR on a nasopharyngeal swab and COVID-positive patients are followed up until outcome (i.e., discharge, hospitalisation, intubation and/or death). At inclusion, demographic and clinical data are collected, such as age, sex, medical history, and signs and symptoms of the current episode. Additionally, lung auscultation will be recorded with a digital stethoscope at 6 thoracic sites in each patient. A deep learning algorithm (DeepBreath) using a Convolutional Neural Network (CNN) and Support Vector Machine classifier will be trained on these audio recordings to derive an automated prediction of diagnostic (COVID positive vs negative) and risk stratification categories (mild to severe). The performance of this model will be compared to a human prediction baseline on a random subset of lung sounds, where blinded physicians are asked to classify the audios into the same categories. DISCUSSION: This approach has broad potential to standardise the evaluation of lung auscultation in COVID-19 at various levels of healthcare, especially in the context of decentralised triage and monitoring. TRIAL REGISTRATION: PB_2016-00500, SwissEthics. Registered on 6 April 2020.


Assuntos
Auscultação/métodos , /diagnóstico , Aprendizado Profundo , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Estudos de Casos e Controles , Regras de Decisão Clínica , Protocolos Clínicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Medição de Risco , Triagem , Adulto Jovem
4.
Semin Arthritis Rheum ; 51(2): 339-346, 2021 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-33601189

RESUMO

OBJECTIVE: To describe the characteristics and long-term outcomes of patients with granulomatosis with polyangiitis (GPA) from the French Vasculitis Study Group database. METHODS: Patients' clinical and laboratory characteristics, Birmingham Vasculitis Activity Score (BVAS)-assessed disease activity, malignancies, opportunistic infections, and vital status were collected at diagnosis and each visit. Estimated probabilities and predictors of overall (OS) and relapse-free survival (RFS) were analyzed by Cox regression. RESULTS: We enrolled 795 newly diagnosed patients, followed for a median of 3.5 years. Initial clinical manifestations involved ear, nose & throat (ENT; 80%), lungs (68%) and kidneys (56%). Among the 728 available ELISA results, 75.0% were PR3-ANCA-positive, 16.5% MPO-ANCA-positive and 62 (8.5%) ANCA-negative. Relapses occurred in 394 (50%) patients, involving ≥1 organ(s) affected at onset in 179 (46%), mainly ENT, lungs and kidneys, with mean BVAS 10.2 points below that at diagnosis (p<0.001). Five- and 10-year RFS rates were 37% and 17%, respectively. PR3-ANCA-positivity independently predicted relapse (p = 0.05) and prolonged survival (p = 0.038). OS-but not RFS-improved significantly over time (p<0.001); 10-year OS reached 88.2% (95% CI 83.9 to 92.7) for the 660 patients diagnosed after 2000. Infections were the main causes of death. Malignancy or opportunistic infection each occurred in ≤5% of the patients. CONCLUSION: Survival has improved dramatically over the last decades but the high relapse rate remains a major concern for GPA patients, once again stressing the need for therapeutic strategy optimization to lower it. PR3-ANCA-positivity was associated with increased probability of relapse and survival.

5.
Artigo em Inglês | MEDLINE | ID: mdl-33502443

RESUMO

OBJECTIVES: To analyse the predictive value of anti-carbamylated protein (anti-CarP) and anti-peptidyl-arginine deiminase type-3 (anti-PAD3) antibodies, alone or in combination with rheumatoid factors (RFs) and anti-citrullinated protein antibodies (ACPA), to identify patients at high risk of developing severe rheumatoid arthritis (RA) outcomes. METHODS: Patients within the « Swiss Clinical Quality Management ¼ registry with a biobank sample were tested for RFs, ACPA, anti-CarP, and anti-PAD3 antibodies. We examined the association of each autoantibody with DAS28, HAQ and radiographic damage (Ratingen) at baseline and longitudinally. RESULTS: Analyses included 851 established RA patients and 516 disease controls [axial spondyloarthritis (axSpA = 320) and psoriatic arthritis (PsA = 196)]. Anti-CarP and anti-PAD3 antibodies were respectively present in 22.4% and 10.7% of the whole RA population, and in 13.2% and 3.8% of the RF and ACPA double seronegative patients. At baseline, RA patients with anti-PAD3 had higher DAS28 (4.2 vs 3.7; p = 0.005) and significantly more radiographic damage (14.9 vs 8.8; p = 0.02) than anti-PAD3 negative patients. In ACPA negative subgroup, baseline Ratingen scores were significantly higher in anti-PAD3 positive patients (p = 0.01). The combination of anti-PAD3, RF IgM, and ACPA was associated with significantly higher baseline radiographic scores than the double seropositive group (p = 0.04). The presence of any two of the previous autoantibodies was associated with significantly greater radiographic progression over 10 years than if all were absent (p = 0.02). There were no differences on RA outcome measures with regards to anti-CarP. CONCLUSIONS: Anti-PAD3 antibodies are associated with higher disease activity and joint damage scores in RA patients.

6.
Artigo em Inglês | MEDLINE | ID: mdl-33512428

RESUMO

OBJECTIVES: To examine whether serum antibodies against selected periodontal pathogens are associated with early symptoms of rheumatoid arthritis (RA) development in healthy individuals at risk of developing the disease. METHODS: Within an ongoing study cohort of first-degree relatives of patients with RA (RA-FDRs), we selected four groups corresponding to specific preclinical phases of RA development (n = 201). (1) RA-FDR controls without signs and symptoms of arthritis nor RA-related autoimmunity (n = 51); (2) RA-FDRs with RA-related autoimmunity (n = 51); (3) RA-FDRs with inflammatory arthralgias without clinical arthritis (n = 51); (4) RA-FDRs who have presented at least one swollen joint ("unclassified arthritis") (n = 48). Groups were matched for smoking, age, sex and shared epitope status. The primary outcome was IgG serum levels against five selected periodontal pathogens and one commensal oral species assessed using validated-in-house ELISA assays. Associations between IgG measurements and preclinical phases of RA development were examined using Kruskal-Wallis or Mann-Whitney tests (α = 0.05). RESULTS: None of the IgGs directed against individual periodontal pathogens significantly differed between the four groups of RA-FDRs. Further analyses of cumulated IgG levels into bacterial clusters representative of periodontal infections, revealed significantly higher IgG titers against periodontopathogens in anti-citrullinated protein antibodies (ACPA)-positive RA-FDRs (p = 0.015). Current smoking displayed a marked trend towards reduced IgG titers against periodontopathogens. CONCLUSION: Our results do not suggest an association between serum IgG titers against individual periodontal pathogens and specific preclinical phases of RA development. However, associations between cumulative IgG titers against periodontopathogens and the presence of ACPAs suggest a synergistic contribution of periodontopathogens to ACPA development.

7.
Int J Nurs Stud ; 115: 103869, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33517081

RESUMO

OBJECTIVES: To investigate 1) whether care-related regrets (regret intensity, number of recent regrets) are associated with sick leave, independently of personality traits, perceived safety climate, and physical activity; and 2) whether these associations were mediated or moderated by coping strategies. METHODS: Using a longitudinal international observational study (ICARUS), data were collected by the means of a weekly web survey. Descriptive and generalized estimation equations were performed. RESULTS: A total of 276 newly practicing healthcare professionals (nurses, physicians, others) from 11 countries were included in this study. The average proportion of weeks with at least one day of sick leave was 3.2%. Nurses' sick leave increased with number of care-related regrets (Relative Risk [RR]=1.52; 95% Confidence Interval [CI]=[1.18; 1.95], p=.001), while physicians' sick leave increased with intensity of care-related regret (RR=1.21; 95%CI=[1.00; 1.21], p=.049). Coping was associated with lower risk of sick leave for nurses (RR problem-focused strategies = 0.53; 95%CI=[0.37; 0.74], p=.001, and RRphysical activity=0.68; 95%CI:[0.54; 0.85], p<.001), but not for physicians. Nevertheless, the association of regret with sick leave remained significant even when adjusting for coping. Finally, this study did not find evidence of moderation by the coping strategies. CONCLUSION: Regrets are associated with increased risks of sick leave, even in young healthcare professionals. Use of coping strategies partially mediated these associations in nurses. The results of this study should be used to inform interventions to reduce emotional burdens and enhance protective coping strategies.

8.
Artigo em Inglês | MEDLINE | ID: mdl-32810263

RESUMO

OBJECTIVES: RF and ACPA are used as diagnostic tools and their presence has been associated with clinical response to some biologic DMARDs (bDMARDs) in RA. This study compared the impact of seropositivity on drug discontinuation and effectiveness of bDMARDs in patients with RA, using head-to-head comparisons in a real-world setting. METHODS: We conducted a pooled analysis of 16 observational RA registries. Inclusion criteria were a diagnosis of RA, initiation of treatment with rituximab (RTX), abatacept (ABA), tocilizumab (TCZ) or TNF inhibitors (TNFis) and available information on RF and/or ACPA status. Drug discontinuation was analysed using Cox regression, including drug, seropositivity, their interaction, adjusting for concomitant and past treatments and patient and disease characteristics and accounting for country and calendar year of bDMARD initiation. Effectiveness was analysed using the Clinical Disease Activity Index evolution over time. RESULTS: Among the 27 583 eligible patients, the association of seropositivity with drug discontinuation differed across bDMARDs (P for interaction <0.001). The adjusted hazard ratios for seropositive compared with seronegative patients were 1.01 (95% CI 0.95, 1.07) for TNFis, 0.89 (0.78, 1.02)] for TCZ, 0.80 (0.72, 0.88) for ABA and 0.70 (0.59, 0.84) for RTX. Adjusted differences in remission and low disease activity rates between seropositive and seronegative patients followed the same pattern, with no difference in TNFis, a small difference in TCZ, a larger difference in ABA and the largest difference in RTX (Lundex remission difference +5.9%, low disease activity difference +11.6%). CONCLUSION: Seropositivity was associated with increased effectiveness of non-TNFi bDMARDs, especially RTX and ABA, but not TNFis.

9.
J Oral Maxillofac Surg ; 78(12): 2280.e1-2280.e10, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32659275

RESUMO

PURPOSE: Although orbital blowout fractures are common, there is no consensus with respect to treatment decision making and long-term outcome. The purpose of this study was to evaluate the association between inferior rectus muscle (IRM) displacement and fracture size and the surgical repair decisions and clinical outcomes in patients with blowout fractures (BOFs). PATIENTS AND METHODS: We designed a prospective cohort study and enrolled all patients who presented to the University Hospital of Geneva for evaluation of a BOF. The primary predictor variables were the IRM grade, measuring the severity of downward displacement of the IRM relative to the level of the fracture's edge (mild [grade I], moderate [grade II], or severe [grade III]), and fracture size. The primary outcome was surgical repair. The secondary outcomes were post-trauma diplopia (at baseline and at 10 days) and persistent annoying diplopia and/or enophthalmos considered independently or as a composite outcome. Other study variables included demographic and injury-related parameters. Descriptive, bivariate, and multiple logistic regression statistics were computed, and the significance level was set at P ≤ .05. RESULTS: The sample was composed of 108 patients with a mean age of 46.8 ± 23 years; 73.1% were men. The IRM grade was associated with surgical repair (P < .001), post-trauma diplopia (P < .001), and the composite outcome (P = .003). Fracture size was associated with enophthalmos (P = .03) and the composite outcome (P = .009). In the adjusted model, only IRM grades II and III were associated with the decision for surgical repair (P < .001). CONCLUSIONS: The results of this study suggest that the IRM grade, unlike fracture size, may be a valid measurement in surgical decision making, as well as in determining BOF severity, as evidenced by the correlation between the IRM grade and surgical repair, as well as clinical outcome.

10.
PLoS One ; 15(7): e0235032, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32614831

RESUMO

BACKGROUND: This study aimed to evaluate the feasibility of a new biplanar low-dose X-ray device for facial skeletal imaging. METHODS: We evaluated 48 biplanar radiographs from 12 patients (posteroanterior/lateral), originally taken for a scoliosis examination with a biplanar low-dose X-ray device. For this study, the images were further evaluated for the perceptibility of 38 facial skeleton landmarks. To determine the reliability and reproducibility of perceptibility, two independent observers determined the landmarks twice, during a time interval of at least two weeks. RESULTS: Both interoperator and intraoperator reliability were excellent for all landmarks [intraclass correlation coefficient (ICC) > 0.92]. CONCLUSIONS: The biplanar low-dose X-ray device demonstrated good feasibility for precisely assessing the anatomical landmarks of the facial skeleton. Given its excellent precision, the biplanar low-dose X-ray device data sets should be forwarded from the treating orthopedic surgeon or neurosurgeon to the orthodontist or dentist for further assessment in their field.


Assuntos
Ossos Faciais/diagnóstico por imagem , Adolescente , Adulto , Idoso , Estudos de Viabilidade , Humanos , Pessoa de Meia-Idade , Doses de Radiação , Radiografia , Raios X , Adulto Jovem
11.
Laryngoscope ; 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32678921

RESUMO

OBJECTIVES: To report descriptive statistics for minor parotidectomy complications. METHODS: A systematic review was performed, selecting 235 studies for analysis. The incidence of complications was tabulated, and descriptive statistics calculated. Outlier studies, 1 standard deviation above the mean, were reexamined to determine potential causal factors for each complication. All studies were examined for statistically significant differences for any potential causal factor. RESULTS: The pooled incidence of minor complications reported were hematoma 2.9% (95% confidence interval [CI]: 2.4-3.5), wound infection 2.3% (95% CI: 1.8-2.9), sialocele 4.5% (95% CI: 3.5-5.7), salivary fistula 3.1% (95% CI: 2.6-3.7), flap necrosis 1.7% (95% CI: 1.1-2.5), scar issues 3.6% (95% CI: 2.4-5.4), numbness 33.9% (95% CI: 25.6-43.4), and deformity 11.8 (95% CI: 6.9-19.5). Implants result in more wound complications, such as hematoma, sialocele, or salivary fistula. Sialocele and salivary fistula appear more frequently after less extensive parotid surgery, whereas hematoma, wound infections, flap necrosis, and aesthetic considerations are worse with more extensive resections. CONCLUSIONS: Minor parotidectomy complications are more frequent than generally assumed and related to certain factors that should be investigated. Laryngoscope, 2020.

12.
J Craniomaxillofac Surg ; 48(8): 772-778, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32680671

RESUMO

PURPOSE: The objective of this study was to investigate the effect of temporomandibular intra-articular corticosteroid injections (IACS) on pain and mouth opening in children with juvenile idiopathic arthritis (JIA) with temporomandibular joint (TMJ) involvement. METHODS: Systematic review and meta-analysis methodology was used, beginning with a comprehensive literature search using MEDLINE, PubMed, EMBASE, Web of Science, and the Cochrane library. The population in question was pediatric patients with a JIA diagnosis and TMJ involvement; the intervention was IACS injections to treat TMJ arthritis; a strict control group was not considered necessary; the outcome was clinical signs of improvement of the TMJ arthritis based on pain and mouth opening capacity (MIO). Data on pain and MIO were extracted from the selected studies, and the methodological quality of studies was assessed according to the ROBINS-I tool. Results from the different studies were combined to calculate the pooled proportion with 95% confidence intervals (CIs) for pain resolution, and pooled mean differences with 95% CIs for improvement in MIO. Heterogeneity of the results among studies was tested using I2 statistics. RESULTS: The initial search yielded a total of 330 articles; 11 of these were selected for inclusion in the review. 325 participants were included from the combined studies, with the mean age of participants ranging from 5.3 to 13.6 years. Between 24 and 137 TMJs were selected for each of the studies. The pooled proportion of patients with pain resolution following IACS injection was 78% (95% CI: 59-90%), with large heterogeneity (I2 = 62%). The pooled gain in MIO following IACS injection was 4.38 mm (95% CI: 2.76-6.00), also with high heterogeneity (I2 = 67%). CONCLUSIONS: The results suggest that in children diagnosed with JIA with TMJ involvement, IACS injections can help in reducing reported pain and improving mouth opening capacity, albeit with an important variation between studies.


Assuntos
Artrite Juvenil , Adolescente , Corticosteroides/uso terapêutico , Criança , Pré-Escolar , Humanos , Injeções Intra-Articulares , Imagem por Ressonância Magnética , Boca , Dor , Articulação Temporomandibular
13.
Multivariate Behav Res ; : 1-20, 2020 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-32363935

RESUMO

This article proposes a dynamical system modeling approach for the analysis of longitudinal data of self-regulated homeostatic systems experiencing multiple excitations. It focuses on the evolution of a signal (e.g., heart rate) before, during, and after excitations taking the system out of its equilibrium (e.g., physical effort during cardiac stress testing). Such approach can be applied to a broad range of outcomes such as physiological processes in medicine and psychosocial processes in social sciences, and it allows to extract simple characteristics of the signal studied. The model is based on a first order linear differential equation with constant coefficients defined by three main parameters corresponding to the initial equilibrium value, the dynamic characteristic time, and the reaction to the excitation. Assuming the presence of interindividual variability (random effects) on these three parameters, we propose a two-step procedure to estimate them. We then compare the results of this analysis to several other estimation procedures in a simulation study that clarifies under which conditions parameters are accurately estimated. Finally, applications of this model are illustrated using cardiology data recorded during effort tests.

14.
Qual Life Res ; 29(9): 2593-2604, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32436111

RESUMO

PURPOSE: The self-rated health (SRH) item is frequently used in health surveys but variations of its form (wording, response options) may hinder comparisons between versions over time or across surveys. The objectives were to determine (a) whether three SRH forms are equivalent, (b) the form with the best construct validity and (c) the best coding scheme to maximize equivalence across forms. METHODS: We used data from 58,023 respondents of the Swiss Health Survey. Three SRH forms were used. Response options varied across forms and we explored four coding schemes (two considering SRH as continuous, two as dichotomous). Construct validity of the SRH was assessed using 34 health predictors to estimate the explained variance. RESULTS: Distributions of response options were similar across SRH forms, except for the "good" and "very good" options ("good" in form 1: 58.6%, form 2: 65.0% and form 3: 44.1%). Explained variances differed across SRH forms, with form 3 providing the best overall explained variance, regardless of coding schemes. The linear coding scheme maximised the equivalence across SRH forms. CONCLUSION: The three SRH forms were not equivalent in terms of construct validity. Studies examining the evolution of SRH over time with surveys using different forms should use the linear coding scheme to maximise equivalence between SRH forms.


Assuntos
Inquéritos Epidemiológicos/métodos , Qualidade de Vida/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes
15.
J Card Surg ; 35(7): 1492-1497, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32436655

RESUMO

BACKGROUND: A new, self-contained, digital, continuous pump-driven chest drainage system is compared in a randomized control trial to a traditional wall-suction system in cardiac surgery. METHODS: One hundred and twenty adult elective cardiac patients undergoing coronary artery bypass graft and/or valve surgery were randomized to the study or control group. Both groups had similar pre/intra-operative demographics: age 67.8 vs 67.0 years, Euroscore 2.3 vs 2.2, and body surface area 1.92 vs 1.91 m2 . Additionally, a satisfaction assessment score (0-10) was performed by 52 staff members. RESULTS: Given homogenous intra-operative variables, total chest-tube drainage was comparable among groups (566 vs 640 mL; ns), but the study group showed more efficient fluid collection during the early postoperative phase due to continuous suction (P = .01). Blood, cell saver transfusions and postoperative hemoglobin values were similar in both groups. The study group experienced drain removal after 29.8 vs 38.4 hours in the control group (ns). Seven crossovers from the Study to the Control group were registered but no patient had drain-related complications. The Personnel Satisfaction Assessment scored above 5 for all questions asked. CONCLUSIONS: The new, digital, chest drainage system showed better early drainage of the chest cavity and was as reliable as conventional systems. Quicker drain removal might impact on intensive care unit (ICU) stay and reduce costs. Additional advantages are portable size, battery operation, patient mobility, noiseless function, digital indications and alarms. The satisfaction assessment of the new system by the staff revealed a higher score when compared to the traditional wall suction chest drainage system.


Assuntos
Ponte de Artéria Coronária , Valvas Cardíacas/cirurgia , Cuidados Pós-Operatórios/instrumentação , Sucção/instrumentação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Redução de Custos , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Segurança , Sucção/economia , Cavidade Torácica , Adulto Jovem
16.
Rheumatology (Oxford) ; 59(11): 3468-3478, 2020 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-32375176

RESUMO

OBJECTIVES: In SLE, heterogeneous clinical expression and activity may reflect diverse pathogenic and/or effector mechanisms. We investigated SLE heterogeneity by assessing the expression of three gene sets representative of type I IFN (IFN-I), polymorphonuclear neutrophil (PMN) and plasmablast (PB) signatures in a well-characterized, multidisciplinary cohort of SLE patients. We further assessed whether individual gene products could be representative of these three signatures. METHODS: Whole blood, serum and clinical data were obtained from 140 SLE individuals. Gene expression was assessed by NanoString technology, using a panel of 37 probes to compute six IFN-I, one PMN and one PB scores. Protein levels were measured by ELISA. RESULTS: Depending on the score, 45-50% of SLE individuals showed high IFN-I gene expression. All six IFN-I scores were significantly associated with active skin involvement, and two of six were associated with arthritis. IFN-induced Mx1 protein (MX1) level was correlated with IFN-I score (P < 0.0001) and associated with a similar clinical phenotype. In all, 25% of SLE individuals showed high PMN gene expression, associated with SLE fever, serositis, leukopoenia and glucocorticoid use. PB gene expression was highly affected by immunosuppressant agents, with no association with SLE features. Combined IFN-I and PMN gene scores were significantly associated with high disease activity and outperformed anti-dsDNA and anti-C1q autoantibody and complement levels for predicting SLE activity. CONCLUSION: IFN-I and PMN gene scores segregate with distinct SLE clinical features, and their combination may identify high disease activity. MX1 protein level performed similar to IFN-I gene expression.

17.
Arthritis Res Ther ; 22(1): 105, 2020 05 06.
Artigo em Inglês | MEDLINE | ID: mdl-32375861

RESUMO

BACKGROUND: Calprotectin (S100A8/S100A9 protein) is known as a damage-associated molecular pattern (DAMP) protein and reflects mainly neutrophil activation. Serum calprotectin levels might be a good alternative to acute-phase protein as a biomarker in inflammatory rheumatic diseases. The aim of this study is to investigate the association of serum calprotectin with disease activity and severity in rheumatoid arthritis (RA), axial spondyloarthritis (axSpA), and psoriatic arthritis (PsA). METHODS: Serum calprotectin was measured in patients with RA, axSpA, and PsA from the prospective Swiss Clinical Quality Management (SCQM) registry. Asymptomatic first-degree relatives of RA patients were used as healthy controls (HC). Outcomes included swollen joint count (SJC), Disease Activity Score (DAS), Health Assessment questionnaire (HAQ), joint radiographs, and ultrasound power Doppler (USPD) score for RA; Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score (ASDAS) and coxitis for axSpA; and SJC and Disease Activity Index for PSoriatic Arthritis (DAPSA) for PsA. Comparison of outcomes by calprotectin quartile levels was performed using Kruskal-Wallis tests for continuous outcomes or trend tests for categorical outcomes. RESULTS: A total of 1729 subjects [RA = 969, axSpA = 451, PsA = 237, and HC = 72] were included. Median levels of serum calprotectin were higher in each disease group compared to HC (p < 0.01). In RA patients, all clinical outcomes were statistically different between quartiles of serum calprotectin, indicating an association between calprotectin levels and higher disease activity (SJC, DAS, and USPD scores) and severity (joint radiographs and HAQ). In axSpA, an association between calprotectin levels and ASDAS score (p < 0.01) and prevalence of coxitis (p = 0.02) was observed. For PsA patients, SJC and DAPSA did not differ across calprotectin quartiles. CONCLUSIONS: This large study supports the association of serum calprotectin levels with disease activity in both RA and axSpA, but not in PsA.

18.
PLoS One ; 15(5): e0233471, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32469916

RESUMO

INTRODUCTION: Pressure ulcer is a frequent complication in patients hospitalized in nursing homes and has a serious impact on quality of life and overall health. Moreover, ulcer treatment is highly expensive. Several studies have shown that pressure ulcer prevention is cost-effective. Audit and feedback programmes can help improve professional practices in pressure ulcer prevention and thus reduce their occurrence. The aim of this study was to analyze, with a prospective longitudinal study, the effectiveness of an audit and feedback programme at 1- and 2-year follow-up for reducing pressure ulcer prevalence and enhancing adherence to preventive practices in nursing homes. METHODS: Pressure ulcer point prevalence and preventive practices were measured in 2015, 2016 and 2017 in nursing homes of the Canton of Geneva (Switzerland). Oral and written feedback was provided 2 months after every survey to nursing home reference nurses. RESULTS: A total of 27 nursing homes participated in the programme in 2015 and 2016 (4607 patients) and 15 continued in 2017 (1357 patients). Patients were mostly females, with mean age > 86 years and median length of stay about 2 years. The programme significantly improved two preventive measures: patient repositioning and anti-decubitus bed or mattress. It also reduced acquired pressure ulcers prevalence in nursing homes that participated during all 3 years (from 4.5% in 2015 to 2.9% in 2017, p 0.035), especially in those with more patients with pressure ulcers. CONCLUSION: Audit and feedback is relatively easy to implement at the regional level in nursing homes and can enhance adherence to preventive measures and reduce pressure ulcers prevalence in the homes.


Assuntos
Instituição de Longa Permanência para Idosos , Casas de Saúde , Lesão por Pressão/prevenção & controle , Programas Médicos Regionais , Idoso , Idoso de 80 Anos ou mais , Custos e Análise de Custo , Feminino , Instituição de Longa Permanência para Idosos/economia , Humanos , Estudos Longitudinais , Masculino , Auditoria de Enfermagem/economia , Casas de Saúde/economia , Lesão por Pressão/epidemiologia , Lesão por Pressão/enfermagem , Prevalência , Estudos Prospectivos , Programas Médicos Regionais/economia , Programas Médicos Regionais/estatística & dados numéricos , Programas Médicos Regionais/tendências , Suíça/epidemiologia
19.
J Pain Res ; 13: 745-754, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32346307

RESUMO

Purpose: Physical dysfunction in chronic low back pain patients is influenced by psychological variables rather than by pain severity. Assessing personality traits may help clinicians address the complexity of patients' experiences and design treatments that target these vulnerabilities. This study aimed to identify the distinguishing personality traits of a cohort of patients with disabling chronic low back pain and to determine associations between those traits and fear-avoidance beliefs, depressive, and anxious moods. Patients and Methods: This cross-sectional study included 102 chronic low back pain patients (57% male), who failed standard management and were referred to a multidisciplinary rehabilitation program. All patients completed the five domains of the NEO Personality Inventory (NEO PI)-Revised (Neuroticism, Extraversion, Openness to experience, Agreeableness and Conscientiousness), the Tampa Scale for Kinesiophobia (TSK), and the Hospital Anxiety and Depression Scale (HADS). One-sample t-test was used to compare sample personality means with average population norms. Association between the five personality domains with TSK and HADS was assessed using Pearson's correlation, adjusted for patient demographics and pain-related variables. Linear regression was used to estimate associations adjusted for covariates. Results: Both men and women had significantly lower scores in the Openness to experience domain and significantly higher scores in the Conscientiousness domain than the general population norms. After adjusting for covariates, Neuroticism was associated with higher fear-avoidance, depression and anxiety scores. Conversely, Extraversion and Openness to experience negatively correlated with depression scores. Extraversion also inversely correlated with fear-avoidance. Conscientiousness negatively correlated with depression and anxiety after adjustment. Conclusion: Patients with disabling chronic low back pain show personality characteristics that deviate significantly from the normal population norms but do not reach maladaptive forms of personality disorders. Clinicians would benefit from assessing patients' personality traits to address protective and risk factors for psychological distress, particularly in difficult-to-treat, highly disabled low back pain patients.

20.
Artigo em Inglês | MEDLINE | ID: mdl-31898726

RESUMO

AIMS: Sneddon's syndrome (SS) may be classified as antiphospholipid positive (aPL+) or negative (aPL- SS). An association between Libman-Sacks (LS) endocarditis and strokes has been described in aPL+ patients. To describe cardiac involvement in aPL- SS and assess the potential association between LS endocarditis and severity or recurrence of neurological symptoms. METHODS AND RESULTS: This longitudinal cohort study included aPL- SS patients followed in our departments between 1991 and June 2018. All patients underwent transthoracic 2D and Doppler echocardiography at diagnosis. Follow-up echocardiography was performed annually and the potential relationship between LS endocarditis development and neurovascular relapse as well as long-term cardiac worsening was prospectively assessed. We included 61 patients [52 women; median age 45 (range 24-60)]. For valvular involvement, 36 (59%) patients showed leaflet thickening; 18 (29.5%) had LS endocarditis at baseline. During a median follow-up of 72 months, LS endocarditis developed in eight (17.4%) patients, and 13 (28.3%) showed significant worsening of their cardiac status, including two who needed valvular replacement. After adjusting for baseline antithrombotic treatment regimen, neither the presence of LS endocarditis at baseline nor development during follow-up was associated with neurological relapse [hazard ratio (HR): 1.06, 95% confidence interval (CI): 0.33-4.74, P = 0.92] and [HR: 0.38, 95% CI: 0.02-1.89, P = 0.31], respectively. CONCLUSION: A long-term follow-up is needed to detect cardiac complications in aPL- SS. No change in neurological relapse was observed in patients presenting LS endocarditis occurrence during follow-up without any modification in antithrombotic treatment. Further research is necessary to assess the usefulness of treatment escalation in these patients.

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