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1.
Medicine (Baltimore) ; 98(44): e17752, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689831

RESUMO

Dispatcher assisted cardiopulmonary resuscitation (DACPR) by Emergency medical services has been shown to improve rates of early out of hospital cardiac arrest (OHCA) recognition and early cardiopulmonary resuscitation (CPR) for OHCA. This study measures the impact of introducing DACPR on OHCA recognition, CPR rates and on patient outcomes in a pilot region in Kuwait.EMS treated OHCA data over 10 months period (February 21-December 31, 2017) before and after the intervention was prospectively collected and analyzed.Comprehensive DACPR in the form of: a standardized dispatch protocol, 1-day training package and quality assurance and improvement measures were applied to Kuwait EMS central Dispatch unit only for pilot region. Primary outcomes: OHCA recognition rate, CPR instruction rate, and Bystander CPR rate. Secondary outcome: survival to hospital discharge.A total of 332 OHCA cases from the EMS archived data were extracted and after exclusion 176 total OHCA cases remain. After DACPR implementation OHCA recognition rate increased from 2% to 12.9% (P = .037), CPR instruction rate increased from 0% to 10.4% (P = .022); however, no significant change was noted for bystander CPR rates or prehospital return of spontaneous circulation. Also, survival to hospital discharge rate did not change significantly (0% before, and 0.8% after, P = .53)In summary, DACPR implementation had positive impacts on Kuwait EMS system operational outcomes; early OHCA recognition and CPR instruction rates in a pilot region of Kuwait. Expanding this initiative to other regions in Kuwait and coupling it with other OHCA system of care interventions are needed to improve OHCA survival rates.


Assuntos
Reanimação Cardiopulmonar/educação , Operador de Emergência Médica/educação , Serviços Médicos de Emergência/métodos , Parada Cardíaca Extra-Hospitalar/terapia , Idoso , Reanimação Cardiopulmonar/métodos , Feminino , Implementação de Plano de Saúde , Humanos , Kuweit , Masculino , Pessoa de Meia-Idade , Alta do Paciente/estatística & dados numéricos , Projetos Piloto , Avaliação de Programas e Projetos de Saúde , Estudos Prospectivos , Resultado do Tratamento
2.
Medicine (Baltimore) ; 98(45): e17502, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702610

RESUMO

AIM: Our objective is to assess the effects of epinephrine for out of hospital cardiac arrest. BACKGROUND: Cardiac arrest was the most serious medical incidents with an estimated incidence in the United States of 95.7 per 100,000 person years. Though epinephrine improved coronary and cerebral perfusion, improving a return of spontaneous circulation, potentially harmful effects on the heart lead to greater myocardial oxygen demand. Concerns about the effect of epinephrine for out-of-hospital cardiac arrest were controversial and called for a higher argument to determine whether the effects of epinephrine is safe and effective for shor and long terms outcomes. METHOD: Searching databases consist of all kinds of searching tools, such as Medline, the Cochrane Library, Embase, PubMed, etc. All the included studies should meet our demand of this meta-analysis. In the all interest outcomes blow we take the full advantage of STATA to assess, the main measure is Risk Ratio (RR) with 95% confidence, the publication bias are assessed by Egger Test. RESULT: In current systematic review and meta-analysis of randomized trials investigating epinephrine for out of hospital cardiac arrest, we found that epinephrine was associated with a significantly higher likelihood of ROSC (RR = 3.05, I = 23.1%, P = .0001) and survival to hospital discharge (RR = 1.40, I = 36.3%, P = .008) compared with non-adrenaline administration. Conversely, epinephrine did not increase CPC 1 or 2 (RR = 1.15, I = 40.5%, P = .340) and hospital admission (RR = 2.07, I = 88.2%, P = .0001). CONCLUSION: In conclusion, in this systematic review and meta-analysis involving studies, the use of epinephrine resulted in a significantly higher likelihood of survival to hospital discharge and ROSC than the non-epinephrine administration, but, there was no significant between group difference in the rate of a favorable neurologic outcome.


Assuntos
Epinefrina/uso terapêutico , Parada Cardíaca Extra-Hospitalar/tratamento farmacológico , Idoso , Epinefrina/efeitos adversos , Hospitalização , Humanos , Pessoa de Meia-Idade , Razão de Chances , Alta do Paciente , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
3.
J Surg Oncol ; 120(8): 1456-1461, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31680250

RESUMO

BACKGROUND AND OBJECTIVES: Remifentanil infusion is used as an intraoperative anesthetic for thyroidectomy, but has been associated with acute opioid tolerance and hyperalgesia. A national shortage of remifentanil provided an opportunity to study postoperative pain in patients undergoing thyroidectomy. METHODS: Retrospective review of prospectively collected data from an outpatient surgery center. Primary analysis compared patients treated before and after remifentanil shortage. RESULTS: Median postoperative opioid consumption was 20 morphine milligram equivalents (MMEs) among those treated in the high-dose period and 15 MMEs in the low-dose period. Remifentanil/weight received was a significant predictor of requiring a postoperative narcotic (P = .006). Total non-remifentanil narcotics administered were equivalent but patients in the low dose period received higher amounts of intraoperative long-acting narcotics. CONCLUSIONS: Remifentanil infusion for thyroid surgery is associated with higher postoperative pain and postoperative narcotics requirement. While a hyperalgesia state is possible, shifting of longer-acting narcotics from intraoperative to postoperatively is also supported.


Assuntos
Analgésicos Opioides/administração & dosagem , Uso de Medicamentos/estatística & dados numéricos , Dor Pós-Operatória/tratamento farmacológico , Remifentanil/administração & dosagem , Tireoidectomia , Adulto , Procedimentos Cirúrgicos Ambulatórios , Feminino , Humanos , Infusões Intravenosas , Cuidados Intraoperatórios , Masculino , Pessoa de Meia-Idade , Medição da Dor , Alta do Paciente , Período Pós-Operatório , Estudos Retrospectivos
6.
Rev Lat Am Enfermagem ; 27: e3197, 2019 Oct 14.
Artigo em Português, Inglês, Espanhol | MEDLINE | ID: mdl-31618390

RESUMO

OBJECTIVE: to analyze the in-hospital complications of prolonged hospital stay in patients with ischemic stroke or transient ischemic attack, admitted to the stroke unit of a tertiary hospital. METHOD: this is an evaluative correlational study. All first-ever ischemic stroke or transient ischemic attack patients admitted were retrospectively analyzed. During hospital stay, the predictors of long-term hospitalization considered were: 1) clinical complications (pneumonia, urinary tract infection, pressure damage and deep vein thrombosis), and 2) neurological complications (malignant ischemic stroke and symptomatic hemorrhagic transformation). RESULTS: 353 patients were discharged in the study period. Mean age was 64.1±13.7 years old and 186 (52.6%) were men. The mean time of hospital stay was 13.7±14.3 days. Pneumonia (25.3±28.8 days, p<0.001), urinary tract infection (32.9±45.2 days, p<0.001) and malignant stroke (29.1±21.4 days, p<0.001) increased significantly the length of hospital stay compared to patients without any complications (11.2±7.1 days). CONCLUSION: this study showed that three complications delayed hospital discharge in patients admitted in a stroke unit, two preventable ones: pneumonia and urinary tract infection. More intense measures to avoid them should be included in the performance indicators to reduce the length of hospital stay in stroke units.


Assuntos
Hospitalização/estatística & dados numéricos , Ataque Isquêmico Transitório/prevenção & controle , Tempo de Internação/estatística & dados numéricos , Acidente Vascular Cerebral/prevenção & controle , Fatores Etários , Idoso , Correlação de Dados , Complicações do Diabetes/complicações , Feminino , Humanos , Hipertensão/complicações , Ataque Isquêmico Transitório/complicações , Masculino , Pessoa de Meia-Idade , Alta do Paciente/estatística & dados numéricos , Pneumonia/complicações , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/complicações , Reabilitação do Acidente Vascular Cerebral/estatística & dados numéricos , Centros de Atenção Terciária/estatística & dados numéricos , Infecções Urinárias/complicações
7.
Gan To Kagaku Ryoho ; 46(10): 1587-1590, 2019 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-31631145

RESUMO

A 74-year-old man with aspiration pneumonia was admitted in the internal medicine department. CT revealed progressive carcinoma of RS-Ra, which became the focus of intervention after the pneumonia was treated. After having been allowed temporary discharge, the patient was rehospitalized for surgical operation and rehabilitation. During the perioperative period of cancer patients, we use body distribution data for teaching and environment setting, which is a useful tool in rehabilitation. Rectal cancer was observed after hospitalization for pneumonia, presenting an interesting case. Therefore, care needs to be taken as body pressure distribution may be modified by comorbidity.


Assuntos
Pneumonia Aspirativa , Neoplasias Retais , Idoso , Hospitalização , Humanos , Masculino , Alta do Paciente , Pneumonia Aspirativa/complicações , Neoplasias Retais/complicações
8.
Lakartidningen ; 1162019 Oct 07.
Artigo em Sueco | MEDLINE | ID: mdl-31593289

RESUMO

The medical and nursing care of preterm infants has improved over the last decades, including the involvement of parents in the daily care. Previously parents could only visit a few scheduled hours per day but today most neonatal units in Sweden strive to let the parents be the primary caregivers, with the right to stay at the unit during the entire hospitalization period. Despite this development, there is still need for a number of improvements, not only in the neonatal care but also during the complicated pregnancy.


Assuntos
Terapia Intensiva Neonatal/organização & administração , Poder Familiar , Nascimento Prematuro , Papel (figurativo) , Aleitamento Materno , Continuidade da Assistência ao Paciente , Pai , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Serviços de Saúde Materna/organização & administração , Mães , Alta do Paciente , Educação de Pacientes como Assunto , Gravidez , Apoio Social , Suécia
10.
Einstein (Sao Paulo) ; 18: eAO4871, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31664324

RESUMO

OBJECTIVE: To analyze, from the pharmacotherapy perspective, the factors associated to visits of older adults to the emergency department within 30 days after discharge. METHODS: A cross-sectional study carried out in a general public hospital with older adults. Emergency department visit was defined as the stay of the older adult in this service for up to 24 hours. The complexity of drug therapy was determined using the Medication Regimen Complexity Index. Potentially inappropriate drugs for use in older adults were classified according to the American Geriatric Society/Beers criteria of 2015. The outcome investigated was the frequency of visits to the emergency department within 30 days of discharge. Multivariate logistic regression was performed to identify the factors associated with the emergency department visit. RESULTS: A total of 255 elderly in the study, and 67 (26.3%) visited emergency department within 30 days of discharge. Polypharmacy and potentially inappropriate medications for older adults did not present a statistically significant association. The diagnosis of heart failure and Medication Regimen Complexity Index >16.5 were positively associated with emergency department visits (OR=2.3; 95%CI: 1.04-4.94; p=0.048; and OR=2.1; 95%CI: 1.11-4.02; p=0.011), respectively. Furthermore, the diagnosis of diabetes mellitus and chronic kidney disease were protection factors for the outcome (OR=0.4; 95%CI: 0.20-0.73; p=0.004; and OR=0.3; 95%CI: 0.13-0.86; p=0.023). CONCLUSION: The diagnosis of heart failure and Medication Regimen Complexity Index >16.5 were positively associated with the occurrence of an emergency department visit within 30 days of discharge.


Assuntos
Prescrições de Medicamentos/estatística & dados numéricos , Tratamento Farmacológico/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Insuficiência Cardíaca/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Polimedicação , Fatores de Tempo
11.
Einstein (Sao Paulo) ; 18: eAO4877, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31664332

RESUMO

OBJECTIVE: To analyze the frequency of use of potentially inappropriate medication prescribed to elderly at hospital discharge from a public hospital, considering the Brazilian Consensus on Potentially Inappropriate Medication for Elderly, and to identify the associated factors. METHODS: Patients aged ≥60 years, admitted in clinical and geriatric units of a public hospital were invited to participate in the study. The information about the use of medicines was collected from the patient's electronic record and through telephone contact. The Brazilian Consensus on Potentially Inappropriate Medication for Elderly was used to classify the medication, regardless of the clinical condition. RESULTS: A total of 255 elders were included in this study. The frequency of use of potentially inappropriate medication by elderly was 58.4%. The potentially inappropriate medication use in elderly was positively associated with the presence of depression (odds ratio of 2.208) and polypharmacy (odds ratio of 2.495). The hospitalization in a geriatric unit showed an inverse association with the potentially inappropriate medication use in elderly (odds ratio of 0.513). CONCLUSION: The frequency of potentially inappropriate medication prescription to elderly upon hospital discharge was high. The presence of depression and polypharmacy were directly associated with use of potentially inappropriate medication in the elderly. Admission to the geriatric clinic has become a protection factor for the use of potentially inappropriate medication in elderly. Strategies to improve the elderly pharmacotherapy should implemented aiming at healthcare quality and safety in the transition of care.


Assuntos
Serviços de Saúde para Idosos/estatística & dados numéricos , Prescrição Inadequada/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Lista de Medicamentos Potencialmente Inapropriados , Idoso , Idoso de 80 Anos ou mais , Brasil , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polimedicação
13.
Z Gerontol Geriatr ; 52(Suppl 4): 222-228, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31620876

RESUMO

BACKGROUND: Risk stratification of older patients in the emergency department (ED) is seen as a promising and efficient solution for handling the increase in demand for geriatric emergency medicine. Previously, the predictive validity of commonly used tools for risk stratification, such as the identification of seniors at risk (ISAR), have found only limited evidence in German geriatric patient samples. Given that the adverse outcomes in question, such as rehospitalization, nursing home admission and mortality, are substantially associated with cognitive impairment, the potential of the short portable mental status questionnaire (SPMSQ) as a tool for risk stratification of older ED patients was investigated. OBJECTIVE: To estimate the predictive validity of the SPMSQ for a composite endpoint of adverse events (e.g. rehospitalization, nursing home admission and mortality). METHOD: This was a prospective cohort study with 260 patients aged 70 years and above, recruited in a cardiology ED. Patients with a likely life-expectancy below 24 h were excluded. Follow-up examinations were conducted at 1, 3, 6 and 12 month(s) after recruitment. RESULTS: The SPMSQ was found to be a significant predictor of adverse outcomes not at 1 month (area under the curve, AUC 0.55, 95% confidence interval, CI 0.46-0.63) but at 3 months (AUC 0.61, 95% CI 0.54-0.68), 6 months (AUC 0.63, 95% CI 0.56-0.70) and 12 months (AUC 0.63, 95% CI 0.56-0.70) after initial contact. CONCLUSION: For longer periods of observation the SPMSQ can be a predictor of a composite endpoint of adverse outcomes even when controlled for a range of confounders. Its characteristics, specifically the low sensitivity, make it unsuitable as an accurate risk stratification tool on its own.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Avaliação Geriátrica , Programas de Rastreamento/métodos , Admissão do Paciente/estatística & dados numéricos , Medição de Risco/métodos , Idoso , Cuidados Críticos , Feminino , Serviços de Saúde para Idosos , Hospitalização , Humanos , Masculino , Alta do Paciente/estatística & dados numéricos , Estudos Prospectivos , Medição de Risco/normas
14.
J Urol ; 202(6): 1143-1149, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31483713

RESUMO

PURPOSE: Skeletal muscle and fat mass indexes have emerged as easily obtained, objective and useful tools to assess susceptibility to unfavorable postoperative outcomes. We examined the association between skeletal muscle and fat mass indexes, and the discharge disposition after radical cystectomy. MATERIALS AND METHODS: In a retrospectively collected, single institution cohort we studied patients who underwent radical cystectomy with pelvic lymphadenectomy of primary, nonmetastatic muscle invasive bladder cancer between 2009 and 2015. Included patients had undergone adequate axial computerized tomography at the L3 level within 90 days prior to surgery. Skeletal muscle and fat mass indexes were measured on preoperative computerized tomography and relationships to the outcomes of interest were analyzed. Multivariable logistic regression analysis was performed to assess the effect of the skeletal muscle and fat mass indexes on the discharge disposition while controlling for age, comorbidities, complications and previous neoadjuvant chemotherapy. RESULTS: A total of 136 patients met study inclusion criteria. The median skeletal muscle index among women and men in our study cohort was 36.4 and 47.6 cm2/m2, respectively. On multivariable logistic regression analysis a decreased skeletal muscle index (OR 0.94, 95% CI 0.90-0.98) and an increased fat mass index (OR 1.24, 95% CI 1.04-1.48) were associated with greater odds of discharge to a facility. Higher skeletal muscle to fat mass index ratios were also associated with greater odds of discharge to a facility (OR 1.69, 95% CI 1.22-2.44). Study limitations include the retrospective design and unknown confounders. CONCLUSIONS: Low skeletal muscle and high fat compositions are independent predictors of discharge to a facility after radical cystectomy of nonmetastatic muscle invasive bladder cancer.


Assuntos
Tecido Adiposo/diagnóstico por imagem , Cistectomia , Músculo Esquelético/diagnóstico por imagem , Alta do Paciente/estatística & dados numéricos , Tomografia Computadorizada por Raios X , Neoplasias da Bexiga Urinária/cirurgia , Idoso , Comorbidade , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Excisão de Linfonodo , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Estadiamento de Neoplasias , Estudos Retrospectivos , Neoplasias da Bexiga Urinária/patologia
16.
J Assoc Physicians India ; 67(8): 14-18, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31562710

RESUMO

Background: Intracerebral Hemorrhage (ICH) is one of the most common causes of morbidity and mortality worldwide accounting for 10-15 % of all strokes types. ICH score is a validated tool to predict mortality and morbidity at 30 day follow up period. Objective: : To prospectively evaluate the predictive utility of ICH score in patients presenting with Acute ICH on discharge,30 days and 60 days follow-up period. Design: Prospective observational study. Materials and Method: This study was conducted in the Department of Neurology, Government Medical College, Kota, Rajasthan, India from January 2016 to August 2016. 120 consecutive patients presenting with acute ICH were studied. Data collected included demographics, clinical parameters, cranial Computed Tomography(CT) findings and ICH score on presentation. Primary outcome was defined as mortality/morbidity during hospitalisation, on discharge, 30 days and 60 days follow-up. Modified Rankin score (mRS) was used to assess the outcome. Statistical analysis used: SPSS 19 statistical software. Results: Of the total 120 patients with Acute ICH(108 supratentorial and 12 infratentorial) studied, 48(40%) patients died during hospitalisation. Mean age was 66.9 ± 13.5 Years. Hydrocephalus, midline shift and IV extension on presenting CT scan was observed in 20 (16.6%), 44 (36.6%) and 48 (40%)patients respectively. The independent predictors of increased mortality with statistical significance (p<0.001) were presence of vomiting, seizures, loss of consciousness, lower GCS (≤ 8), higher ICH score and ventilator requirement. Statistically significant (p≤0.001) radiological features associated with mortality included infratentorial location, presence of hydrocephalus,higher midline shift (58.3% vs 22.2% OR=2.6), intraventricular extension of hematoma and a higher baseline hematoma volume. ICH score on admission was significantly (p<0.001) positively correlated with the mRS score on discharge (R=0.667), 1 month (R=0.66) and 2 months (R=0.765) follow-up. Conclusion: ICH Score is a useful tool to predict outcome during hospitalisation, on discharge, 1 month and 2 month follow-up. We suggest that ICH score assessment and documentation should become standard procedure in acute care and follow up of patients with Intracerebral Hemorrhage.


Assuntos
Hemorragia Cerebral/epidemiologia , Alta do Paciente , Idoso , Idoso de 80 Anos ou mais , Seguimentos , Humanos , Índia , Pessoa de Meia-Idade , Estudos Prospectivos
17.
Health Qual Life Outcomes ; 17(1): 149, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31481073

RESUMO

BACKGROUND: Religious beliefs and practices influence coping mechanisms and quality of life in patients with various chronic illnesses. However, little is known about the influence of religious practices on changes in health-related quality of life (HRQOL) among hospital survivors of an acute coronary syndrome (ACS). The present study examined the association between several items assessing religiosity and clinically meaningful changes in HRQOL between 1 and 6 months after hospital discharge for an ACS. METHODS: We recruited patients hospitalized for an ACS at six medical centers in Central Massachusetts and Georgia (2011-2013). Participants reported making petition prayers for their health, awareness of intercessory prayers by others, and deriving strength/comfort from religion. Generic HRQOL was assessed with the SF-36®v2 physical and mental component summary scores. Disease-specific HRQOL was evaluated using the Seattle Angina Questionnaire Quality of Life subscale (SAQ-QOL). We separately examined the association between each measure of religiosity and the likelihood of experiencing clinically meaningful increase in disease-specific HRQOL (defined as increases by ≥10.0 points) and Generic HRQOL (defined as increases by ≥3.0 points) between 1- and 6-months post-hospital discharge. RESULTS: Participants (n = 1039) were, on average, 62 years old, 33% were women, and 86% were non-Hispanic White. Two-thirds reported praying for their health, 88% were aware of intercessions by others, and 85% derived strength/comfort from religion. Approximately 42, 40, and 26% of participants experienced clinically meaningful increases in their mental, physical, and disease-specific HRQOL respectively. After adjustment for sociodemographic, psychosocial, and clinical characteristics, petition (aOR:1.49; 95% CI: 1.09-2.04) and intercessory (aOR:1.72; 95% CI: 1.12-2.63) prayers for health were associated with clinically meaningful increases in disease-specific and physical HRQOL respectively. CONCLUSIONS: Most ACS survivors in a contemporary, multiracial cohort acknowledged praying for their health, were aware of intercessory prayers made for their health and derived strength and comfort from religion. Patients who prayed for their health and those aware of intercessions made for their health experienced improvement in their generic physical and disease-specific HRQOL over time. Healthcare providers should recognize that patients may use prayer as a coping strategy for improving their well-being and recovery after a life-threatening illness.


Assuntos
Síndrome Coronariana Aguda/psicologia , Qualidade de Vida , Religião e Medicina , Sobreviventes/psicologia , Adaptação Psicológica , Idoso , Estudos de Casos e Controles , Feminino , Georgia , Humanos , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Estudos Prospectivos , Inquéritos e Questionários
18.
Spec Care Dentist ; 39(6): 593-602, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31490570

RESUMO

AIMS: This prospective observational study set out to assess patients' oral health knowledge, oral health related quality of life (OHRQoL) and status immediately posttherapy, and adherence with oral health behaviors posttreatment with radiotherapy for head and neck cancer (HaNC). METHODS: A prospective observational study post HaNC therapy. At time one (T1), prior to discharge to primary dental care, oral health knowledge, OHRQoL, and status were assessed and dental health advice was delivered. At time two (T2), four weeks postdischarge, patients' adherence with dental health advice was reassessed. RESULTS: Thirty people postradiotherapy were recruited (mean age 58.9, SD ± 8.4). Twenty-three (77%) were men. Thirteen (45%) respondents reported they were not informed about the side effects of radiotherapy. On discharge to primary care, 20 (67%) of the respondents rated their oral health as fair or worse, while 47% were displeased with dental appearance. Respondents reported a mean of 8.6 impacts (SD ± 5.3) on OHRQoL. Five (17%) and two (7%) patients had an established or a new osteoradionecrosis, respectively, and 16 patients (53%) had greater than two new carious teeth. One month postdischarge (T2), adherence with dental advice was high, 93% were registered with a primary care dentist and all brushed their teeth daily. CONCLUSION: Within the limitations of this study in a single-center, adherence with oral health advice was high. However, participants felt they received little preparatory information about side effects and impacts of radiotherapy on oral and dental health, and how to maintain oral health after radiotherapy.


Assuntos
Neoplasias de Cabeça e Pescoço , Saúde Bucal , Assistência Odontológica , Humanos , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Atenção Primária à Saúde , Estudos Prospectivos , Qualidade de Vida
19.
Chin J Physiol ; 62(4): 166-174, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31535632

RESUMO

Although force steadiness varies with visuospatial information, accountable motor unit (MU) behaviors are not fully understood. This study investigated the modulation of MU discharges and force-discharge relation due to variations in the spatial resolution of visual feedback, with a particular focus on discharge variability among MUs. Fourteen young adults produced isometric force at 10% of maximal voluntary contraction (MVC) through index abduction, under the conditions of force trajectory displayed with low visual gain (LVG) and high visual gain (HVG). Together with smaller and more complex force fluctuations, HVG resulted in greater variabilities of the mean interspike interval and discharge irregularity among MUs than LVG did. Estimated via smoothening of a cumulative spike train of all MUs, global discharge rate was tuned to visual gain, with a more complex global discharge rate and a lower force-discharge relation in the HVG condition. These higher discharge variabilities were linked to larger variance of the common drive received by MUs for regulation of muscle force with higher visuospatial information. In summary, higher visuospatial information improves force steadiness with more complex force fluctuations, underlying joint effects of low-pass filter property of the musculotendon complex and central modulation of discharge variability among MUs.


Assuntos
Neurônios Motores , Potenciais de Ação , Eletromiografia , Humanos , Contração Muscular , Músculo Esquelético , Alta do Paciente
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