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1.
BMJ Open ; 10(2): e034304, 2020 Feb 16.
Artigo em Inglês | MEDLINE | ID: mdl-32066608

RESUMO

INTRODUCTION: Patellar tendinopathy is a degenerative disease of the patellar tendon, which affects athletes from a variety of sports, and is especially predominant in sports involving high-impact jumping. The aim of this study is to determine the additional effect of two interventions combined with eccentric exercise and compare which one is the most effective at short-term and long-term follow-up for patients with patellar tendinopathy. METHODS AND ANALYSIS: This study is a randomised controlled trial with blinded participants. Measurements will be carried out by a specially trained blinded assessor. A sample of 57 patients with a medical diagnosis of patellar tendinopathy will participate in this study and will be divided into three treatment groups. Eligible participants will be randomly allocated to receive either: (a) treatment group with percutaneous needle electrolysis, (b) treatment group with dry needling or (c) treatment group with placebo needling. In addition, all groups will perform eccentric exercise. Functionality and muscle strength parameters, pain, ultrasound appearances and patient perceived quality of life shall be evaluated using the Victorian Institute of Sports Assessment for patellar (VISA-P), jump tests, Visual Analogue Scale, ultrasound images and Short Form-36 (SF-36), respectively. Participants will be assessed at baseline, at 10 weeks and at 22 weeks after baseline. The expected findings will allow us to advance in the treatment of this injury, as they will help determine whether a needling intervention has additional effects on an eccentric exercise programme and whether any of the needling modalities is more effective than the other. ETHICS AND DISSEMINATION: This protocol has been approved by the Ethics Committee of Aragon (N° PI15/0017). The trial will be conducted in accordance with the Declaration of Helsinki. TRIAL REGISTRATION NUMBER: NCT02498795.

3.
BMJ Open ; 10(2): e032668, 2020 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-32051307

RESUMO

BACKGROUND: Musculoskeletal (MSK) pain is the primary contributor to disability worldwide. There is a growing consensus that MSK pain is a recurrent multifactorial condition underpinned by health and lifestyle factors. Studies suggest that education on work-related pain and individualised advice could be essential and effective for managing persistent MSK pain. OBJECTIVE: The objective of this scoping review was to map the existing educational resources for work-related MSK (WRMSK) pain, and the effects of implementing educational strategies in the workplace on managing WRMSK pain. METHODS: This scoping review assessed original studies that implemented and assessed education as a strategy to manage WMSK pain. Literature search strategies were developed using thesaurus headings (ie, MeSH and CINAHL headings) and free-text search including words related to MSK in an occupational setting. The search was carried out in PubMed, CINAHL, Cochrane Library and Web of Science in the period 12-14 February 2019. RESULTS: A total of 19 peer-reviewed articles were included and the study design, aim and outcomes were summarised. Of the 19 peer-reviewed articles, 10 randomised controlled trial (RCT) studies assessed the influence of education on work-related MSK pain. Many studies provided a limited description of the education material and assessed/used different methods of delivery. A majority of studies concluded education positively influences work-related MSK pain. Further, some studies reported additive effects of physical activity or ergonomic adjustments. CONCLUSIONS: There is a gap in knowledge regarding the best content and delivery of education of material in the workplace. Although beneficial outcomes were reported, more RCT studies are required to determine the effects of education material as compared with other interventions, such as exercise or behavioural therapy.

4.
Dalton Trans ; 48(38): 14367-14382, 2019 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-31532408

RESUMO

Pt(ii) complexes cis-N,N-[PtCl(C^N)(N'^C'H)], where C^N represents a monocyclometalated 2,6-diaryl- or 2-arylpyridine ligand and N'^C'H is an N-coordinated 2-arylpyridine, are selectively obtained from bridge-cleavage reactions of dimers [Pt2(µ-Cl)2(C^N)2] with excess N'^C'H at room temperature; isolation and characterization of derivatives of this kind is reported for the first time. Oxidation with PhICl2 affords Pt(iv) complexes [PtCl2(C^N)(C'^N')], bearing two cyclometalated ligands in an unsymmetrical arrangement. The abstraction of the two chlorides using AgOTf at 120 °C in the presence of an additional 2-arylpyridine ligand leads to mer isomers of tris-cyclometalated Pt(iv) complexes if C^N derives from a 2-arylpyridine, whereas it results in a reductive C-C coupling if C^N is a monocyclometalated 2,6-diarylpyridine. Complexes [PtCl2(C^N)(C'^N')] show phosphorescence in frozen PrCN glasses arising from essentially 3LC excited states localized on the cyclometalated ligand with the lowest π-π* transition energy. The combined photophysical data and computational results substantiate a variable degree of MLCT admixture into the emitting state depending on the atom trans to the metalated carbon of the chromophoric ligand (Cl or N), which has an appreciable effect on the characteristics of the observed luminescence.

5.
Phys Rev Lett ; 123(9): 097601, 2019 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-31524450

RESUMO

Complex systems, which consist of a large number of interacting constituents, often exhibit universal behavior near a phase transition. A slowdown of certain dynamical observables is one such recurring feature found in a vast array of contexts. This phenomenon, known as critical slowing-down, is well studied mostly in thermodynamic phase transitions. However, it is less understood in highly nonequilibrium settings, where the time it takes to traverse the phase boundary becomes comparable to the timescale of dynamical fluctuations. Using transient optical spectroscopy and femtosecond electron diffraction, we studied a photoinduced transition of a model charge-density-wave (CDW) compound LaTe_{3}. We observed that it takes the longest time to suppress the order parameter at the threshold photoexcitation density, where the CDW transiently vanishes. This finding can be captured by generalizing the time-dependent Landau theory to a system far from equilibrium. The experimental observation and theoretical understanding of dynamical slowing-down may offer insight into other general principles behind nonequilibrium phase transitions in many-body systems.

6.
Phys Rev Lett ; 123(4): 047204, 2019 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-31491278

RESUMO

We report broadband microwave absorption spectroscopy of the layered antiferromagnet CrCl_{3}. We observe a rich structure of resonances arising from quasi-two-dimensional antiferromagnetic dynamics. Because of the weak interlayer magnetic coupling in this material, we are able to observe both optical and acoustic branches of antiferromagnetic resonance in the GHz frequency range and a symmetry-protected crossing between them. By breaking rotational symmetry, we further show that strong magnon-magnon coupling with large tunable gaps can be induced between the two resonant modes.

7.
Adv Mater ; 31(37): e1806603, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31353629

RESUMO

Phonon polaritons in van der Waals materials reveal significant confinement accompanied with long propagation length: important virtues for tasks pertaining to the control of light and energy flow at the nanoscale. While previous studies of phonon polaritons have relied on relatively thick samples, here reported is the first observation of surface phonon polaritons in single atomic layers and bilayers of hexagonal boron nitride (hBN). Using antenna-based near-field microscopy, propagating surface phonon polaritons in mono- and bilayer hBN microcrystals are imaged. Phonon polaritons in monolayer hBN are confined in a volume about one million times smaller than the free-space photons. Both the polariton dispersion and their wavelength-thickness scaling law are altered compared to those of hBN bulk counterparts. These changes are attributed to phonon hardening in monolayer-thick crystals. The data reported here have bearing on applications of polaritons in metasurfaces and ultrathin optical elements.

8.
Sci Adv ; 5(6): eaav1493, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31214647

RESUMO

The massless Dirac electron transport in graphene has led to a variety of unique light-matter interaction phenomena, which promise many novel optoelectronic applications. Most of the effects are only accessible by breaking the spatial symmetry, through introducing edges, p-n junctions, or heterogeneous interfaces. The recent development of direct synthesis of lateral heterostructures offers new opportunities to achieve the desired asymmetry. As a proof of concept, we study the photothermoelectric effect in an asymmetric lateral heterojunction between the Dirac semimetallic monolayer graphene and the parabolic semiconducting monolayer MoS2. Very different hot-carrier cooling mechanisms on the graphene and the MoS2 sides allow us to resolve the asymmetric thermalization pathways of photoinduced hot carriers spatially with electrostatic gate tunability. We also demonstrate the potential of graphene-2D semiconductor lateral heterojunctions as broadband infrared photodetectors. The proposed structure shows an extreme in-plane asymmetry and provides a new platform to study light-matter interactions in low-dimensional systems.

9.
Eur J Heart Fail ; 21(11): 1353-1365, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31127677

RESUMO

OBJECTIVE: To compare the clinical characteristics and outcomes of patients with acute heart failure (AHF) according to clinical profiles based on congestion and perfusion determined in the emergency department (ED). METHODS AND RESULTS: Overall, 11 261 unselected AHF patients from 41 Spanish EDs were classified according to perfusion (normoperfusion = warm; hypoperfusion = cold) and congestion (not = dry; yes = wet). Baseline and decompensation characteristics were recorded as were the main wards to which patients were admitted. The primary outcome was 1-year all-cause mortality; secondary outcomes were need for hospitalisation during the index AHF event, in-hospital all-cause mortality, prolonged hospitalisation, 7-day post-discharge ED revisit for AHF and 30-day post-discharge rehospitalisation for AHF. A total of 8558 patients (76.0%) were warm + wet, 1929 (17.1%) cold + wet, 675 (6.0%) warm + dry, and 99 (0.9%) cold + dry; hypoperfused (cold) patients were more frequently admitted to intensive care units and geriatrics departments, and warm + wet patients were discharged home without admission. The four phenotypes differed in most of the baseline and decompensation characteristics. The 1-year mortality was 30.8%, and compared to warm + dry, the adjusted hazard ratios were significantly increased for cold + wet (1.660; 95% confidence interval 1.400-1.968) and cold + dry (1.672; 95% confidence interval 1.189-2.351). Hypoperfused (cold) phenotypes also showed higher rates of index episode hospitalisation and in-hospital mortality, while congestive (wet) phenotypes had a higher risk of prolonged hospitalisation but decreased risk of rehospitalisation. No differences were observed among phenotypes in ED revisit risk. CONCLUSIONS: Bedside clinical evaluation of congestion and perfusion of AHF patients upon ED arrival and classification according to phenotypic profiles proposed by the latest European Society of Cardiology guidelines provide useful complementary information and help to rapidly predict patient outcomes shortly after ED patient arrival.

10.
Eur J Intern Med ; 65: 69-77, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31076345

RESUMO

BACKGROUND: Little is known about the prevalence and impact of risk of malnutrition on short-term mortality among seniors presenting with acute heart failure (AHF) in emergency setting. The objective was to determine the impact of risk of malnutrition on 30-day mortality risk among older patients who attended in Emergency Departments (EDs) for AHF. MATERIAL AND METHODS: We performed a secondary analysis of the OAK-3 Registry including all consecutive patients ≥65 years attending in 16 Spanish EDs for AHF. Risk of malnutrition was defined by the Mini Nutritional Assessment Short Form (MNA-SF) < 12 points. Unadjusted and adjusted logistic regression models were used to assess the association between risk of malnutrition and 30-day mortality. RESULTS: We included 749 patients (mean age: 85 (SD 6); 55.8% females). Risk of malnutrition was observed in 594 (79.3%) patients. The rate of 30-day mortality was 8.8%. After adjusting for MEESSI-AHF risk score clinical categories (model 1) and after adding all variables showing a significantly different distribution among groups (model 2), the risk of malnutrition was an independent factor associated with 30-day mortality (adjusted OR by model 1 = 3.4; 95%CI 1.2-9.7; p = .020 and adjusted OR by model 2 = 3.1; 95%CI 1.1-9.0; p = .033) compared to normal nutritional status. CONCLUSIONS: The risk of malnutrition assessed by the MNA-SF is associated with 30-day mortality in older patients with AHF who were attended in EDs. Routine screening of risk of malnutrition may help emergency physicians in decision-making and establishing a care plan.

11.
Adv Mater ; 31(18): e1900251, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30907483

RESUMO

Unlike conventional plasmonic media, polaritonic van der Waals (vdW) materials hold promise for active control of light-matter interactions. The dispersion relations of elementary excitations such as phonons and plasmons can be tuned in layered vdW systems via stacking using functional substrates. In this work, infrared nanoimaging and nanospectroscopy of hyperbolic phonon polaritons are demonstrated in a novel vdW heterostructure combining hexagonal boron nitride (hBN) and vanadium dioxide (VO2 ). It is observed that the insulator-to-metal transition in VO2 has a profound impact on the polaritons in the proximal hBN layer. In effect, the real-space propagation of hyperbolic polaritons and their spectroscopic resonances can be actively controlled by temperature. This tunability originates from the effective change in local dielectric properties of the VO2 sublayer in the course of the temperature-tuned insulator-to-metal phase transition. The high susceptibility of polaritons to electronic phase transitions opens new possibilities for applications of vdW materials in combination with strongly correlated quantum materials.

12.
Rev. esp. cardiol. (Ed. impr.) ; 72(3): 198-207, mar. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-182641

RESUMO

Introducción y objetivos: En los servicios de urgencias hospitalarios(SUH), la escala MEESSI estratifica a los pacientes diagnosticados de insuficiencia cardiaca aguda(ICA) según su riesgo de mortalidad a 30 días. Se valida la escala de riesgo MEESSI en una nueva cohorte de pacientes para evaluar su precisión al estratificar el riesgo y compararla en diferentes entornos. Métodos: Se incluyó a los pacientes consecutivos diagnosticados de ICA en 30 SUH durante enero y febrero de 2016. Se calculó la puntuación MEESSI de cada paciente. El estadístico C midió la capacidad discriminatoria para predecir la mortalidad a 30 días del modelo MEESSI completo y los modelos secundarios. Se realizaron comparaciones entre los subgrupos de pacientes de hospitales universitarios y comunitarios, de SUH con actividad alta, media o baja y de SUH que reclutaron o que no reclutaron a pacientes de la cohorte original de derivación de la escala MEESSI. Resultados: Se analizó a 4.711 pacientes (hospitales universitarios/comunitarios: 3.811/900; SUH alta/media/baja actividad: 2.695/1.479/537; SUH participantes/no participantes en el estudio de derivación original:3.892/819). La distribución de pacientes según las categorías de riesgo de la escala MEESSI fue: 1.673 (35,5%) de bajo riesgo, 2.023 (42,9%) de riesgo intermedio, 530 (11,3%) de alto riesgo y 485 (10,3%) de muy alto riesgo, con mortalidades a 30 días del 2,0, el 7,8, el 17,9 y el 41,4% respectivamente. El estadístico C para el modelo completo fue 0,810 (IC95%, 0,790-0,830) y varió de 0,731 a 0,785 para los modelos secundarios. La capacidad discriminatoria de la escala de riesgo MEESSI fue similar entre los subgrupos de hospitales, entre SUH de distinta actividad y entre hospitales reclutadores originales y nuevos. Conclusiones: La escala MEESSI estratifica con éxito a los pacientes con ICA en los SUH según el riesgo de muerte a 30días, lo cual puede ayudar en urgencias a la toma de decisiones sobre el destino de estos pacientes


Introduction and objectives: The MEESSI scale stratifies acute heart failure (AHF) patients at the emergency department (ED) according to the 30-day mortality risk. We validated the MEESSI risk score in a new cohort of Spanish patients to assess its accuracy in stratifying patients by risk and to compare its performance in different settings. Methods: We included consecutive patients diagnosed with AHF in 30 EDs during January and February 2016. The MEESSI score was calculated for each patient. The c-statistic measured the discriminatory capacity to predict 30-day mortality of the full MEESSI model and secondary models. Further comparisons were made among subgroups of patients from university and community hospitals, EDs with high-, medium-or low-activity and EDs that recruited or not patients in the original MEESSI derivation cohort. Results: We analyzed 4711 patients (university/community hospitals: 3811/900; high-/medium-/low-activity EDs: 2695/1479/537; EDs participating/not participating in the previous MEESSI derivation study: 3892/819). The distribution of patients according to the MEESSI risk categories was: 1673 (35.5%) low risk, 2023 (42.9%) intermediate risk, 530 (11.3%) high risk and 485 (10.3%) very high risk, with 30-day mortality of 2.0%, 7.8%, 17.9%, and 41.4%, respectively. The c-statistic for the full model was 0.810 (95%CI, 0.790-0.830), ranging from 0.731 to 0.785 for the subsequent secondary models. The discriminatory capacity of the MEESSI risk score was similar among subgroups of hospital type, ED activity, and original recruiter EDs. Conclusions: The MEESSI risk score successfully stratifies AHF patients at the ED according to the 30-day mortality risk, potentially helping clinicians in the decision-making process for hospitalizing patients


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Insuficiência Cardíaca/classificação , Risco Ajustado/métodos , Tratamento de Emergência/métodos , Qualidade da Assistência à Saúde/classificação , Serviço Hospitalar de Emergência/estatística & dados numéricos , Fatores de Risco , Índice de Gravidade de Doença
13.
PM R ; 11(10): 1077-1082, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-30734521

RESUMO

BACKGROUND: In patients with stroke, hemiplegic shoulder pain can be a major problem. One source of shoulder pain can be myofascial trigger points (MTrPs). OBJECTIVE: To determine the prevalence of myofascial trigger points (MTrPs) and the correlation between MTrPs and pain and function in patients presenting with shoulder pain following a stroke. DESIGN: Cross-sectional study. SETTING: Department of Physical Therapy. PATIENTS: Fifty patients with stroke with shoulder pain. INTERVENTION: Not applicable. MAIN OUTCOME MEASUREMENTS: The prevalence of the MTrPs located in infraspinatus, supraspinatus, teres minor, and upper trapezius was studied, using the diagnosis criteria recommended by Simons et al. The pressure pain threshold was also evaluated. Pain and function were assessed with the Visual Analogue Scale (VAS) and the Disability of the Arm, Shoulder and Hand (DASH) scale, respectively. RESULTS: The prevalence of latent MTrPs was 68%, 92%, 40%, and 62% for supraspinatus, infraspinatus, teres minor, and upper trapezius muscle, respectively. The prevalence of active MTrPs was 34%, 50%, 12%, and 20% for supraspinatus, infraspinatus, teres minor, and upper trapezius muscle, respectively. Pain was moderately correlated with the prevalence of latent MTrPs (r = 0.35; P = .01) and active MTrPs (r = 0.31; P = .03) in the supraspinatus muscle. Disability was measured with the DASH scale and was moderately correlated with latent MTrPs in the infraspinatus (r = 0.31; P = .03) and active MTrPs of the supraspinatus (r = 0.32; P = .02). CONCLUSIONS: This study shows that the prevalence of MTrPs is high in patents following a stroke. MTrPs in this population are moderately associated with pain and function. LEVEL OF EVIDENCE: II.

14.
Chemistry ; 25(23): 6014-6025, 2019 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-30807669

RESUMO

The synthesis, structure, and photophysical properties of luminescent PtIV complexes that combine cyclometalated 1,2,3-triazolylidene and bi- or terdentate 2,6-diarylpyridine ligands are reported. The targeted complexes represent the first examples of PtIV species with a cyclometalated mesoionic aryl-NHC ligand. They exhibit moderate or weak emissions in fluid solution at 298 K arising from 3 LC states, which become very intense in poly(methyl methacrylate) (PMMA) matrices at 298 K. DFT and TD-DFT calculations confirm that the chromophoric ligand is the cyclometalated 2,6-diarylpyridine and show that the aryl-NHC ligand exerts a beneficial effect on the emission efficiencies of these derivatives by increasing the energy of deactivating LMCT excited states with respect to comparable PtIV complexes with cyclometalated 2-arylpyridine ligands.

15.
Emergencias (Sant Vicenç dels Horts) ; 31(1): 5-14, feb. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-182430

RESUMO

Objetivo: Investigar la tasa de eventos adversos en pacientes con insuficiencia cardiaca aguda (ICA) clasificados de bajo riesgo por la escala MEESSI y dados de alta desde urgencias, la capacidad discriminativa de dicha escala para estos eventos en dichos pacientes y las variables asociadas. Método: Se estratificó el riesgo de los pacientes del Registro EAHFE (cohortes 2-5) mediante la escala MEESSI y se analizaron los clasificados de bajo riesgo dados de alta desde urgencias. Se investigó la mortalidad por cualquier causa a 30 días (M-30d), la revisita a urgencias por ICA a 7 días (REV-7d) y la revisita a urgencias u hospitalización por ICA a 30 días (REV-H-30d). Se calculó el área bajo la curva (ABC) de la característica operativa del receptor (COR) de la escala MEESSI para estos eventos. Se analizó la relación entre 42 variables y RV-7d y RV-H-30d mediante regresión logística multivariable. Resultados: Se incluyeron 1028 pacientes. La M-30d fue 1,6% (IC 95%: 0,9-2,5), la REV-7d fue 8,0% (6,4-9,8) y la REV-H-30d fue 24,7% (22,1-25,7). El ABC ROC de la puntuación MEESSI para discriminar estos eventos adversos fue 0,69 (0,58-0,80), 0,56 (0,49-0,63) y 0,54 (0,50-0,59), respectivamente. Se asociaron con RV-7d: tratamiento diurético crónico (OR 2,45; 1,01-5,98), hemoglobina < 110 g/L (1,68; 1,02-2,75) y tratamiento diurético intravenoso en urgencias (0,53; 0,31-0,90). Se asociaron con REV-H-30d: arteriopatía periférica (1,74; 1,01-3,00), episodios previos de ICA (1,42; 1,02-1,98), tratamiento crónico con inhibidores de receptores mineralocorticoides (1,71; 1,09-2,67), índice de Barthel en urgencias < 90 puntos (1,48; 1,07-2,06) y tratamiento diurético intravenoso en urgencias (0,58; 0,40-0,84). Conclusiones: Los pacientes con ICA de bajo riesgo dados de alta desde urgencias presentan tasas de eventos adversos cercanas a los estándares recomendados internacionalmente. La escala MEESSI, diseñada para predecir M-30d, tiene escasa capacidad predictiva para REV-7d y REV-H-30d en los pacientes de bajo riesgo. Este estudio describe otros factores asociados a tales eventos


Objective: To determine the rate of adverse events in patients with acute heart failure (AHF) who were discharged from the emergency department (ED) after classification as low risk according to MEESSI score (multiple risk estimate based on the Spanish ED scale), to analyze the ability of the score to predict events, and to explore variables associated with adverse events. Methods: Patients in the EAHFE registry (Epidemiology of Acute Heart Failure in EDs) were stratified according to risk indicated by MEESSI score in order to identify those considered at low risk on discharge. All-cause 30-day mortality and revisits related to AHF within 7 days and 30 days were recorded. The area under the receiver operating characteristic curve (AUC) was calculated for the MEESSI score's ability to predict these events. Associations between 42 variables and 7-day and 30-day revisits to the ED were analyzed by multivariable logistic regression. Results: A total of 1028 patients were included. The 30-day mortality rate was 1.6% (95% CI, 0.9%-2.5%). The 7-day and 30-day revisit rates were 8.0% (95% CI, 6.4%-9.8%) and 24.7% (95% CI, 22.1%-25.7%), respectively. The AUCs for MEESSI score discrimination between patients with and without these outcomes were as follows: 30-day mortality, 0.69 (95% CI, 0.58-0.80); 7-day revisiting, 0.56 (95% CI, 0.49-0.63); and 30-day revisiting, 0.54 (95% CI, 0.50-0.59). Variables associated with 7-day revisits were long-term diuretic treatment (odds ratio [OR], 2.45; 95% CI, 1.01-5.98), hemoglobin concentration less than 110 g/L (OR, 1.68; 95% CI, 1.02-2.75), and intravenous diuretic treatment in the ED (OR, 0.53; 95% CI, 0.31-0.90). Variables associated with 30-day revisits were peripheral artery disease (OR, 1.74; 95% CI, 1.01-3.00), prior history of an AHF episode (OR, 1.42; 95% CI, 1.02-1.98), long-term mineralocorticoid receptor antagonist treatment (OR, 1.71; 95% CI, 1.09-2.67), Barthel index less than 90 points in the ED (OR, 1.48; 95% CI, 1.07-2.06), and intravenous diuretic treatment in the ED (OR, 0.58; 95% CI, 0.40-0.84). Conclusions: Patients with AHF who are at low risk for adverse events on discharge from our EDs have event rates that are near internationally recommended targets. The MEESSI score, which was designed to predict 30-day mortality, is a poor predictor of 7-day or 30-day revisiting in these low-risk patients. We identified other factors related to these events


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Serviço Hospitalar de Emergência/normas , Insuficiência Cardíaca/diagnóstico , Alta do Paciente/normas , Índice de Gravidade de Doença , Seguimentos , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/terapia , Hospitalização/estatística & dados numéricos , Modelos Logísticos , Razão de Chances , Estudos Retrospectivos
16.
Emergencias (Sant Vicenç dels Horts) ; 31(1): 27-35, feb. 2019. ilus, graf, tab
Artigo em Espanhol | IBECS | ID: ibc-182433

RESUMO

Objetivos: Demostrar la eficacia de una intervención integral en la transición de cuidados (Plan de Alta Guiado Multinivel, PAGM) para disminuir eventos adversos a 30 días en ancianos frágiles con insuficiencia cardiaca aguda (ICA) dados de alta desde servicios de urgencias (SU) y validar los resultados de dicha intervención en condiciones reales. Método: Se seleccionarán pacientes mayores de 70 años frágiles con diagnóstico principal de ICA dados del alta a su domicilio desde SU. La intervención consistirá en aplicar un PAGM: 1) lista de verificación sobre recomendaciones clínicas y activación de recursos; 2) programación de visita precoz; 3) transmisión de información a atención primaria; 4) hoja de instrucciones al paciente por escrito. Fase 1: ensayo clínico con asignación al azar por conglomerados emparejado. Se asignará de forma aleatoria 10 SU (N = 480) al grupo de intervención y 10 SU (N = 480) al grupo de control. Se compararán los resultados entre grupo de intervención y control. Fase 2: estudio cuasi-experimental. Se realizará la intervención en los 20 SU (N = 300). Se comparará los resultados entre la fase 1 y 2 del grupo de intervención y entre la fase 1 y 2 del grupo de control. La variable principal de resultado es compuesta (revisita a urgencias u hospitalización por ICA o mortalidad de origen cardiovascular) a los 30 días del alta. Conclusiones: El estudio valorará la eficacia y factibilidad de una intervención integral en la transición de cuidados para reducir resultados adversos a 30 días en ancianos frágiles con ICA dados de alta desde los SU


Objectives: To demonstrate the efficacy of a system for comprehensive care transfer (Multilevel Guided Discharge Plan [MGDP]) for frail older patients diagnosed with acute heart failure (AHF) and to validate the results of MGDP implementation under real clinical conditions. The MGDP seeks to reduce the number of adverse outcomes within 30 days of emergency department (ED) discharge. Method: We will enroll frail patients over the age of 70 years discharged home from the ED with a main diagnosis of AHF. The MGDP includes the following components: 1) a checklist of clinical recommendations and resource activations, 2) scheduling of an early follow-up visit, 3) transfer of information to the primary care doctor, and 4) written instructions for the patient. Phase 1 of the study will be a matched-pair cluster-randomized controlled trial. Ten EDs will be randomly assigned to the intervention group and 10 to the control group. Each group will enroll 480 patients, and the outcomes will be compared between groups. Phase 2 will be a quasi-experimental study of the intervention in 300 new patients enrolled by the same 20 EDs. The outcomes will be compared to those for each Phase-1 group. The main endpoint at 30 days will be a composite of 2 outcomes: revisits to an ED and/for hospitalization for AHF or cardiovascular death. Conclusions: The study will assess the efficacy and feasibility of comprehensive MGDP transfer of care for frail older AHF patients discharged home


Assuntos
Humanos , Assistência ao Convalescente/métodos , Idoso Fragilizado , Insuficiência Cardíaca/terapia , Planejamento de Assistência ao Paciente , Transferência de Pacientes , Alta do Paciente , Doença Aguda , Lista de Checagem , Protocolos Clínicos , Serviço Hospitalar de Emergência , Seguimentos , Insuficiência Cardíaca/mortalidade , Hospitalização , Análise por Pareamento , Estudos Prospectivos , Projetos de Pesquisa
17.
J Orthop Surg Res ; 14(1): 31, 2019 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-30683124

RESUMO

BACKGROUND: Both manual therapy techniques and dry needling have shown to be effective treatment options for the treatment of plantar heel pain; however, in recent years, other techniques based on dry needling (DN), such as percutaneous needle electrolysis (PNE), have also emerged. Currently, PNE is being used in clinical practice to manage myofascial trigger points, despite the lack of studies comparing the effects of this technique over dry needling. Therefore, the aim of this randomized controlled study is to compare the effectiveness of DN versus PNE for improving the level of pain experienced by patients suffering from plantar heel pain provoked by myofascial trigger points. METHODS: A randomized controlled trial will be conducted with blinded participants and outcome assessors. A sample of 94 patients with a medical diagnosis of plantar heel pain will be recruited and divided into two treatment groups. Eligible participants will be randomly allocated to either (a) treatment group with DN and a self-stretching home program or (b) treatment group with PNE and a self-stretching home program. Each group will receive one treatment session per week over a period of 4 weeks. The primary outcome measure will be the pain subscale of the Foot Health Status Questionnaire. The secondary outcome measures will be a visual analogue scale for pain (average and highest level of pain experienced during the previous 48 h; level of pain immediately after the treatment session) and health-related quality of life (assessed using the EuroQoL-5 dimensions). Cost-effectiveness data will be extracted based on the EuroQoL-5 dimensions. Follow-up measurements will take place at baseline and at 4, 8, 12, 26, and 52 weeks. DISCUSSION: The justification for this trial is the need to improve current understanding regarding the effectiveness of treatments targeting the rehabilitation of plantar heel pain. This study will be the first randomized controlled trial to directly compare the effectiveness of DN and PNE combined with a specific stretching program for the treatment of plantar heel pain provoked by myofascial trigger points. TRIAL REGISTRATION: Clinical Trials NCT03236779. Registered at clinicaltrials.gov 2 August 2017.


Assuntos
Terapia por Acupuntura/métodos , Eletrólise/métodos , Fasciíte Plantar/terapia , Agulhas , Manejo da Dor/métodos , Medição da Dor/métodos , Terapia por Acupuntura/instrumentação , Adulto , Método Duplo-Cego , Eletrólise/instrumentação , Fasciíte Plantar/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/instrumentação , Estudos Prospectivos , Resultado do Tratamento , Adulto Jovem
18.
Nat Nanotechnol ; 14(2): 120-125, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30598526

RESUMO

Quantum coherence and control is foundational to the science and engineering of quantum systems1,2. In van der Waals materials, the collective coherent behaviour of carriers has been probed successfully by transport measurements3-6. However, temporal coherence and control, as exemplified by manipulating a single quantum degree of freedom, remains to be verified. Here we demonstrate such coherence and control of a superconducting circuit incorporating graphene-based Josephson junctions. Furthermore, we show that this device can be operated as a voltage-tunable transmon qubit7-9, whose spectrum reflects the electronic properties of massless Dirac fermions travelling ballistically4,5. In addition to the potential for advancing extensible quantum computing technology, our results represent a new approach to studying van der Waals materials using microwave photons in coherent quantum circuits.

19.
Emergencias ; 31(1): 5-14, 2019 02.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30656867

RESUMO

OBJECTIVES: To determine the rate of adverse events in patients with acute heart failure (AHF) who were discharged from the emergency department (ED) after classification as low risk according to MEESSI score (multiple risk estimate based on the Spanish ED scale), to analyze the ability of the score to predict events, and to explore variables associated with adverse events. METHODS: Patients in the EAHFE registry (Epidemiology of Acute Heart Failure in EDs) were stratified according to risk indicated by MEESSI score in order to identify those considered at low risk on discharge. All-cause 30-day mortality and revisits related to AHF within 7 days and 30 days were recorded. The area under the receiver operating characteristic curve (AUC) was calculated for the MEESSI score's ability to predict these events. Associations between 42 variables and 7-day and 30-day revisits to the ED were analyzed by multivariable logistic regression. RESULTS: A total of 1028 patients were included. The 30-day mortality rate was 1.6% (95% CI, 0.9%-2.5%). The 7-day and 30-day revisit rates were 8.0% (95% CI, 6.4%-9.8%) and 24.7% (95% CI, 22.1%-25.7%), respectively. The AUCs for MEESSI score discrimination between patients with and without these outcomes were as follows: 30-day mortality, 0.69 (95% CI, 0.58-0.80); 7-day revisiting, 0.56 (95% CI, 0.49-0.63); and 30-day revisiting, 0.54 (95% CI, 0.50-0.59). Variables associated with 7-day revisits were long-term diuretic treatment (odds ratio [OR], 2.45; 95% CI, 1.01-5.98), hemoglobin concentration less than 110 g/L (OR, 1.68; 95% CI, 1.02-2.75), and intravenous diuretic treatment in the ED (OR, 0.53; 95% CI, 0.31-0.90). Variables associated with 30-day revisits were peripheral artery disease (OR, 1.74; 95% CI, 1.01-3.00), prior history of an AHF episode (OR, 1.42; 95% CI, 1.02-1.98), long-term mineralocorticoid receptor antagonist treatment (OR, 1.71; 95% CI, 1.09-2.67), Barthel index less than 90 points in the ED (OR, 1.48; 95% CI, 1.07-2.06), and intravenous diuretic treatment in the ED (OR, 0.58; 95% CI, 0.40-0.84). CONCLUSION: Patients with AHF who are at low risk for adverse events on discharge from our EDs have event rates that are near internationally recommended targets. The MEESSI score, which was designed to predict 30-day mortality, is a poor predictor of 7-day or 30-day revisiting in these low-risk patients. We identified other factors related to these events.


Assuntos
Serviço Hospitalar de Emergência/normas , Insuficiência Cardíaca/diagnóstico , Alta do Paciente/normas , Índice de Gravidade de Doença , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/terapia , Hospitalização/estatística & dados numéricos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Prognóstico , Recidiva , Sistema de Registros , Estudos Retrospectivos , Medição de Risco , Espanha
20.
Emergencias ; 31(1): 27-35, 2019 02.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30656870

RESUMO

OBJECTIVES: To demonstrate the efficacy of a system for comprehensive care transfer (Multilevel Guided Discharge Plan [MGDP]) for frail older patients diagnosed with acute heart failure (AHF) and to validate the results of MGDP implementation under real clinical conditions. The MGDP seeks to reduce the number of adverse outcomes within 30 days of emergency department (ED) discharge. MATERIAL AND METHODS: We will enroll frail patients over the age of 70 years discharged home from the ED with a main diagnosis of AHF. The MGDP includes the following components: 1) a checklist of clinical recommendations and resource activations, 2) scheduling of an early follow-up visit, 3) transfer of information to the primary care doctor, and 4) written instructions for the patient. Phase 1 of the study will be a matched-pair cluster-randomized controlled trial. Ten EDs will be randomly assigned to the intervention group and 10 to the control group. Each group will enroll 480 patients, and the outcomes will be compared between groups. Phase 2 will be a quasi-experimental study of the intervention in 300 new patients enrolled by the same 20 EDs. The outcomes will be compared to those for each Phase-1 group. The main endpoint at 30 days will be a composite of 2 outcomes: revisits to an ED and/for hospitalization for AHF or cardiovascular death. CONCLUSION: The study will assess the efficacy and feasibility of comprehensive MGDP transfer of care for frail older AHF patients discharged home.


Assuntos
Assistência ao Convalescente/métodos , Idoso Fragilizado , Insuficiência Cardíaca/terapia , Planejamento de Assistência ao Paciente , Alta do Paciente , Transferência de Pacientes , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Lista de Checagem , Protocolos Clínicos , Serviço Hospitalar de Emergência , Feminino , Seguimentos , Insuficiência Cardíaca/mortalidade , Hospitalização , Humanos , Masculino , Análise por Pareamento , Estudos Prospectivos , Projetos de Pesquisa
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