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1.
Am J Occup Ther ; 75(1): 7501205030p1-7501205030p13, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33399051

RESUMO

IMPORTANCE: This systematic review summarizes existing studies on dry needling for spasticity and range of motion (ROM) and discusses its potential for use as an occupational therapy intervention. OBJECTIVE: To examine existing studies on the effects of dry needling on spasticity and ROM. DATA SOURCES: Article citations and abstracts from Scopus, Cochrane Library, PubMed, CINAHL, and a university library search. STUDY SELECTION AND DATA COLLECTION: Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used in abstracting data. Peer-reviewed journal articles published in English between January 2007 and June 2019 were searched. Of 270 identified studies, 10 met the inclusion criteria. Studies were divided into categories on the basis of outcome measures (Modified Modified Ashworth Scale and ROM). Pain outcome measures were excluded because a systematic review addressing this outcome has recently been completed. FINDINGS: Strong evidence was found to support the use of dry needling to decrease spasticity and increase ROM. CONCLUSIONS AND RELEVANCE: This systematic review suggests that dry needling is an effective physical agent modality to decrease spasticity and increase ROM, both of which are potentially beneficial to functional outcomes. WHAT THIS ARTICLE ADDS: This article provides information that may be helpful in determining the appropriateness of dry needling as an occupational therapy intervention.


Assuntos
Agulhamento Seco , Avaliação de Resultados em Cuidados de Saúde , Humanos , Amplitude de Movimento Articular
4.
Curr Opin Anaesthesiol ; 34(1): 1-6, 2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33315643

RESUMO

PURPOSE OF REVIEW: The aim of this review is to provide an overview of the rationale and evidence for nonintubated thoracic surgery and guide clinicians, considering the implementation of nonintubated thoracic surgery, to find an anesthetic approach suitable for their department. RECENT FINDINGS: Based on physiologic considerations alone, nonintubated thoracic surgery would be expected to be an advantageous concept in thoracic anesthesia, especially in patients at high risk for pulmonary complications. Currently existing evidence, however, does not support these claims. Although the feasibility and safety have been repeatedly demonstrated, high-quality evidence showing a significant benefit regarding clinically relevant patient-centered outcomes is not available.Anesthetic approaches to nonintubated thoracic surgery differ significantly; however, they usually concentrate on six main aspects: maintenance of airway patency, respiratory support, analgesia, patient comfort, cough suppression, and conversion techniques. Given the lack of high-quality studies comparing different techniques, evidence-based guidance of clinical decision-making is currently not possible. Until further evidence is available, anesthetic management will depend mostly on local availability and expertise. SUMMARY: In select patients and with experienced teams, nonintubated thoracic surgery can be a suitable alternative to intubated thoracic surgery. Until more evidence is available, however, a general change in anesthetic management in thoracic surgery is not justified.


Assuntos
Anestesia Geral , Anestésicos , Guias como Assunto , Cirurgia Torácica , Humanos , Avaliação de Resultados em Cuidados de Saúde , Seleção de Pacientes , Cirurgia Torácica Vídeoassistida
5.
Brain Behav Immun ; 91: 649-667, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33017613

RESUMO

For the last two decades, researchers have placed hopes in a new era in which a combination of reperfusion and neuroprotection would revolutionize the treatment of stroke. Nevertheless, despite the thousands of papers available in the literature showing positive results in preclinical stroke models, randomized clinical trials have failed to show efficacy. It seems clear now that the existing data obtained in preclinical research have depicted an incomplete picture of stroke pathophysiology. In order to ameliorate bench-to-bed translation, in this review we first describe the main actors on stroke inflammatory and immune responses based on the available preclinical data, highlighting the fact that the link between leukocyte infiltration, lesion volume and neurological outcome remains unclear. We then describe what is known on neuroinflammation and immune responses in stroke patients, and summarize the results of the clinical trials on immunomodulatory drugs. In order to understand the gap between clinical trials and preclinical results on stroke, we discuss in detail the experimental results that served as the basis for the summarized clinical trials on immunomodulatory drugs, focusing on (i) experimental stroke models, (ii) the timing and selection of outcome measuring, (iii) alternative entry routes for leukocytes into the ischemic region, and (iv) factors affecting stroke outcome such as gender differences, ageing, comorbidities like hypertension and diabetes, obesity, tobacco, alcohol consumption and previous infections like Covid-19. We can do better for stroke treatment, especially when targeting inflammation following stroke. We need to re-think the design of stroke experimental setups, notably by (i) using clinically relevant models of stroke, (ii) including both radiological and neurological outcomes, (iii) performing long-term follow-up studies, (iv) conducting large-scale preclinical stroke trials, and (v) including stroke comorbidities in preclinical research.


Assuntos
Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/imunologia , Acidente Vascular Cerebral/fisiopatologia , Animais , Isquemia Encefálica/tratamento farmacológico , Comorbidade , Modelos Animais de Doenças , Humanos , Imunidade/imunologia , Imunidade/fisiologia , Inflamação/imunologia , Neuroproteção/imunologia , Neuroproteção/fisiologia , Avaliação de Resultados em Cuidados de Saúde , Reperfusão/métodos , Reperfusão/tendências
6.
Int J Pharm ; 592: 120028, 2021 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-33166584

RESUMO

The present work aimed to develop an optimized liposomal formulation for enhancing the anti-viral activity of propolis against COVID-19. Docking studies were performed for certain components of Egyptian Propolis using Avigan, Hydroxychloroquine and Remdesivir as standard antivirals against both COVID-19 3CL-protease and S1 spike protein. Response surface methodology and modified injection method were implemented to maximize the entrapment efficiency and release of the liposomal formulation. The optimized formulation parameters were as follow: LMC of 60 mM, CH% of 20% and DL of 5 mg/ml. At those values the E.E% and released % were 70.112% and 81.801%, respectively with nanosized particles (117 ± 11 nm). Docking studies revealed that Rutin and Caffeic acid phenethyl ester showed the highest affinity to both targets. Results showed a significant inhibitory effect of the optimized liposomal formula of Propolis against COVID-3CL protease (IC50 = 1.183 ± 0.06) compared with the Egyptian propolis extract (IC50 = 2.452 ± 0.11), P < 0.001. Interestingly, the inhibition of viral replication of COVID-19 determined by RT_PCR has been significantly enhanced via encapsulation of propolis extract within the liposomal formulation (P < 0.0001) and was comparable to the viral inhibitory effect of the potent antiviral (remdesivir). These findings identified the potential of propolis liposomes as a promising treatment approach against COVID-19.


Assuntos
/tratamento farmacológico , Própole , Replicação Viral/efeitos dos fármacos , Antivirais/administração & dosagem , /virologia , Flavonoides/farmacocinética , Humanos , Lipossomos , Simulação de Acoplamento Molecular/métodos , Avaliação de Resultados em Cuidados de Saúde , Própole/administração & dosagem , Própole/farmacocinética , /isolamento & purificação , Glicoproteína da Espícula de Coronavírus/metabolismo
7.
J Formos Med Assoc ; 120(1 Pt 3): 713-719, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32773262

RESUMO

BACKGROUND: Coronavirus disease-2019 (COVID-19) is a worldwide pandemic. We present the clinical characteristics and outcomes of 28 COVID-19 patients treated in our hospital in Taiwan. METHODS: Patients with COVID-19, confirmed by positive real-time reverse-transcriptase polymerase chain reaction results for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral nucleic acids from oropharyngeal swab specimens between February 4, 2020 and July 6, 2020, were enrolled. Their clinical characteristics and outcomes were reviewed. RESULTS: Seventeen of the 28 patients (60.7%) had pneumonia. The most frequent symptoms were cough (n = 23, 82.1%) and fever (n = 17, 60.7%). The development of pneumonia was associated with age ≥40 years (p < 0.024), body mass index (BMI) ≥25 kg/m2 (p = 0.014), fever (p = 0.007), shortness of breath (p = 0.036), chills ((p = 0.047), and lower platelet counts (<200,000/µL) (p = 0.007). Increased quarantine duration was associated with age ≥40 years (p = 0.026), Charlson index ≥1 (p = 0.037), lower lymphocyte (<1500/uL; p = 0.028) or platelet counts (<200,000/µL) (p = 0.016), lower serum sodium (<140 mEq/L; p = 0.006), and higher C-reactive protein (CRP) level (≥1 mg/dl; p = 0.04). Treatment with hydroxychloroquine or in combination with other medicines did not reduce the quarantine duration. All 28 patients recovered with a median quarantine duration of 27.2 days. CONCLUSION: COVID-19 patients with older age, higher BMI, fever, chills or shortness of breath, lower serum sodium level, lower platelet or lymphocyte count, and higher CRP level may be associated with developing pneumonia or longer quarantine duration.


Assuntos
/métodos , Pneumonia Viral , /isolamento & purificação , Adulto , Fatores Etários , Contagem de Células Sanguíneas/métodos , Índice de Massa Corporal , Proteína C-Reativa/análise , /epidemiologia , /terapia , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/etiologia , Quarentena , Fatores de Risco , Avaliação de Sintomas/métodos , Taiwan/epidemiologia
8.
Environ Pollut ; 268(Pt B): 115713, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-33038573

RESUMO

This study focused on the possible chemo-preventive effects of insect peptide CopA3 on normal human colon cells against the inflammation induced by the toxic environmental pollutant aflatoxin B1 (AFB1). In the study, we used CCD 841 CoN normal human colon cells to investigate the cytotoxic effect induced by AFB1 and elucidated the negative impact of AFB1 exposure on the cell cycle progression. Further, we also carried out the in-vivo experiment, where male BALB/c mice were administrated with AFB1 to induce inflammation associated cancer like phenotype and the dietary effect of CopA3 was evaluated on the early stages of AFB1-induced hepatotoxicity and inflammation in colon tissues. At the initiation stage, CopA3 was given along with water, which significantly decreased the inflammation in the liver and colon of AFB1 exposed mice model. Mice that received CopA3 alone showed enhanced activity of several antioxidant enzymes. In the post treatment stage, the CopA3 dosage remarkably increased the Ki-67 protein expression, indicating the enhancement in cell proliferation event and increased the number of apoptotic cells in colonic crypts, suggesting the capability of CopA3 treatment towards the epithelial cell turnover. Thus, CopA3 treatment shows its potential to inhibit the development of the early stages of AFB1-induced colon inflammation and hepatotoxicity in mice by inhibiting the DNA synthesis of the damaged and inflammatory cell and induced apoptosis for the clearance of damaged cells. Collectively, the results of this study suggest that CopA3 treatment may play a protective role against the mycotoxin induced inflammation.


Assuntos
Aflatoxina B1 , Peptídeos , Aflatoxina B1/toxicidade , Animais , Inflamação/induzido quimicamente , Inflamação/tratamento farmacológico , Inflamação/prevenção & controle , Camundongos , Camundongos Endogâmicos BALB C , Avaliação de Resultados em Cuidados de Saúde
9.
Trials ; 21(1): 1005, 2020 Dec 09.
Artigo em Inglês | MEDLINE | ID: mdl-33298149

RESUMO

BACKGROUND: The peak of the global COVID-19 pandemic has not yet been reached, and many countries face the prospect of a second wave of infections before effective vaccinations will be available. After an initial phase of viral replication, some patients develop a second illness phase in which the host thrombotic and inflammatory responses seem to drive complications. Severe COVID-19 disease is linked to high mortality, hyperinflammation, and a remarkably high incidence of thrombotic events. We hypothesize a crucial pathophysiological role for the contact pathway of coagulation and the kallikrein-bradykinin pathway. Therefore, drugs that modulate this excessive thromboinflammatory response should be investigated in severe COVID-19. METHODS: In this adaptive, open-label multicenter randomized clinical trial, we compare low molecular weight heparins at 50 IU anti-Xa/kg twice daily-or 75 IU anti-Xa twice daily for intensive care (ICU) patients-in combination with aprotinin to standard thromboprophylaxis in hospitalized COVID-19 patients. In the case of hyperinflammation, the interleukin-1 receptor antagonist anakinra will be added on top of the drugs in the interventional arm. In a pilot phase, the effect of the intervention on thrombotic markers (D-dimer) will be assessed. In the full trial, the primary outcome is defined as the effect of the interventional drugs on clinical status as defined by the WHO ordinal scale for clinical improvement. DISCUSSION: In this trial, we target the thromboinflammatory response at multiple levels. We intensify the dose of low molecular weight heparins to reduce thrombotic complications. Aprotinin is a potent kallikrein pathway inhibitor that reduces fibrinolysis, activation of the contact pathway of coagulation, and local inflammatory response. Additionally, aprotinin has shown in vitro inhibitory effects on SARS-CoV-2 cellular entry. Because the excessive thromboinflammatory response is one of the most adverse prognostic factors in COVID-19, we will add anakinra, a recombinant interleukin-1 receptor antagonist, to the regimen in case of severely increased inflammatory parameters. This way, we hope to modulate the systemic response to SARS-CoV-2 and avoid disease progressions with a potentially fatal outcome. TRIAL REGISTRATION: The EU Clinical Trials Register 2020-001739-28 . Registered on April 10, 2020.


Assuntos
/complicações , Inflamação/etiologia , Tromboembolia Venosa/etiologia , Antirreumáticos/administração & dosagem , Antirreumáticos/uso terapêutico , Aprotinina/administração & dosagem , Aprotinina/uso terapêutico , Bélgica/epidemiologia , Bradicinina/efeitos dos fármacos , Bradicinina/metabolismo , /virologia , Cuidados Críticos/estatística & dados numéricos , Quimioterapia Combinada , Feminino , Heparina de Baixo Peso Molecular/administração & dosagem , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Incidência , Inflamação/epidemiologia , Inflamação/metabolismo , Inflamação/prevenção & controle , Proteína Antagonista do Receptor de Interleucina 1/administração & dosagem , Proteína Antagonista do Receptor de Interleucina 1/uso terapêutico , Calicreínas/efeitos dos fármacos , Calicreínas/metabolismo , Masculino , Avaliação de Resultados em Cuidados de Saúde , Índice de Gravidade de Doença , Tromboembolia Venosa/epidemiologia , Tromboembolia Venosa/metabolismo , Tromboembolia Venosa/prevenção & controle
10.
Psychiatr Danub ; 32(3-4): 491-498, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33370758

RESUMO

BACKGROUND: Individuals with certain pre-existing chronic health conditions have been identified as a high-risk group for fatalities of COVID-19. Therefore, it is likely that individuals with chronic diseases may worry during this pandemic to the detriment of their mental health. This study compares the mental health of Bangladeshi adults affected by chronic disease to a healthy, matched control group during the COVID-19 pandemic. SUBJECTS AND METHODS: A matched case-control analysis was performed with data collected from 395 respondents with chronic diseases and 395 controls matched for age, gender, and residence. Inclusion criteria for cases were respondents who self-reported having asthma, cardiovascular disease symptoms and/or diabetes. Respondents were recruited using an online survey, which included the DASS-21 measure to assess symptoms of stress, anxiety, and depression. Chi-square test, t-test, Fisher's exact test and a conditional logistic regression were performed to examine associations among variables. RESULTS: The prevalence of anxiety symptoms and depression symptoms and the level of stress were significantly higher among cases (59%; 71.6%; 73.7%, respectively) than among controls (25.6%; 31.1%; 43.3%, respectively). Chi-square and t-test showed significant associations and differences between having chronic diseases and mental health outcomes. A conditional logistic regression showed that respondents with asthma, diabetes, cardiovascular disease symptoms, or any combination of these diseases had higher odds of exhibiting symptoms of stress, anxiety, and depression than healthy individuals. CONCLUSION: These results underscore a subpopulation vulnerable to mental health consequences during this pandemic and indicate the need for additional mental health resources to be available to those with chronic diseases.


Assuntos
Adulto , Ansiedade , Estudos de Casos e Controles , Doença Crônica , Comorbidade , Depressão , Humanos , Avaliação de Resultados em Cuidados de Saúde , Pandemias
11.
Blood Adv ; 4(24): 6259-6273, 2020 12 22.
Artigo em Inglês | MEDLINE | ID: mdl-33351119

RESUMO

Thrombosis has emerged as an important complication of coronavirus disease 2019 (COVID-19), particularly among individuals with severe illness. However, the precise incidence of thrombotic events remains uncertain due to differences in study design, patient populations, outcome ascertainment, event definitions, and reporting. In an effort to overcome some of these challenges and promote standardized data collection and reporting in clinical studies, the American Society of Hematology Research Collaborative COVID-19 Non-Malignant Hematology Task Force, in collaboration with the International Society on Thrombosis and Haemostasis COVID-19 Task Force, developed sets of data elements in the following domains: venous thromboembolism, myocardial infarction, stroke/transient ischemic attack, peripheral arterial thrombosis, bleeding, laboratory investigations, and antithrombotic therapy. Data elements in each of these domains were developed with 3 levels of detail to facilitate their incorporation into studies evaluating a range of interventions and outcomes. Previously published data elements were included where possible. The use of standardized variables in a range of clinical studies can enhance the quality of data collection, create efficiency, enhance comparison of results across studies, and facilitate future pooling of data sets.


Assuntos
/epidemiologia , Bases de Dados Factuais , Trombose/epidemiologia , Interface Usuário-Computador , Navegador , Anticoagulantes/uso terapêutico , /virologia , Gerenciamento Clínico , Suscetibilidade a Doenças , Humanos , Avaliação de Resultados em Cuidados de Saúde , Vigilância em Saúde Pública , Trombose/diagnóstico , Trombose/etiologia , Trombose/terapia
12.
Clin Cardiol ; 43(12): 1547-1554, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33280140

RESUMO

BACKGROUND: Cardiac injury is common in COVID-19 patients and is associated with increased mortality. However, it remains unclear if reduced cardiac function is associated with cardiac injury, and additionally if mortality risk is increased among those with reduced cardiac function in COVID-19 patients. HYPOTHESIS: The aim of this study was to assess cardiac function among COVID-19 patients with and without biomarkers of cardiac injury and to determine the mortality risk associated with reduced cardiac function. METHODS/RESULTS: This retrospective cohort study analyzed 143 consecutive COVID-19 patients who had an echocardiogram during hospitalization between March 1, 2020 and May 5, 2020. The mean age was 67 ± 16 years. Cardiac troponin-I was available in 131 patients and an increased value (>0.03 ng/dL) was found in 59 patients (45%). Reduced cardiac function, which included reduced left or right ventricular systolic function, was found in 40 patients (28%). Reduced cardiac function was found in 18% of patients without troponin-I elevation, 42% with mild troponin increase (0.04-5.00 ng/dL) and 67% with significant troponin increase (>5 ng/dL). Reduced cardiac function was also present in more than half of the patients on mechanical ventilation or those deceased. The in-hospital mortality of this cohort was 28% (N = 40). Using logistic regression analysis, we found that reduced cardiac function was associated with increased mortality with adjusted odds ratio (95% confidence interval) of 2.65 (1.18 to 5.96). CONCLUSIONS: Reduced cardiac function is highly prevalent among hospitalized COVID-19 patients with biomarkers of myocardial injury and is independently associated with mortality.


Assuntos
/mortalidade , Traumatismos Cardíacos/mortalidade , Troponina I/sangue , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Causas de Morte , Ecocardiografia Doppler de Pulso , Feminino , Traumatismos Cardíacos/sangue , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Estudos Retrospectivos
13.
Ann Acad Med Singap ; 49(10): 756-763, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33283839

RESUMO

INTRODUCTION: With the unprecedented challenges imposed on the modern healthcare system due to the COVID-19 pandemic, innovative solutions needed to be swiftly implemented to maintain clinical oversight on patient care. Telemedicine was introduced in Singapore in community-based haemodialysis (HD) centres to comply with the Ministry of Health's directives on movement restriction of healthcare workers and related measures to minimise the spread of SARS-CoV-2 in healthcare facilities. METHODS: We describe here our experience of 26 community haemodialysis centres in Singapore, analysing clinical audit data, as well as comparing hospitalisation and mortality rates as outcomes in the time frames of pre- and post-introduction of telemedicine. RESULTS: We found that the hospitalisation rate was 13.9% (95% CI: 5.6%-21.5%, P<0.001) lower in the period after telemedicine rounds were introduced. The mortality rates per 100 person-years (95% CI) were 11.04 versus 7.99 in the compared groups, respectively, with no significant increase in mortality during the months when telemedicine was performed. CONCLUSION: Patients received appropriate care in a timely manner, with telemedicine implementation, and such measures did not lead to suboptimal healthcare outcomes. Telemedicine was a successful tool for physician oversight under movement control measures implemented during the COVID-19 pandemic and may continue to prove useful in the 'new normal' era of healthcare delivery for HD patients in community-based dialysis centres, operated by the National Kidney Foundation in Singapore.


Assuntos
Instituições de Assistência Ambulatorial , Hospitalização/estatística & dados numéricos , Falência Renal Crônica/terapia , Diálise Renal , Telemedicina , Idoso , Assistência à Saúde , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade , Avaliação de Resultados em Cuidados de Saúde , Singapura
14.
Braz Oral Res ; 34: e126, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33331392

RESUMO

The coronavirus disease 2019 (COVID-19) outbreak has created unprecedent challenges for healthcare systems worldwide. Oncology services have been reorganized to decrease the risk of nosocomial acquisition of SARS-CoV-2, but changes in treatment pathways and follow-up cancer care can result in patients receiving suboptimal or delayed care. Herein, we describe a cross-sectional nested cohort study conducted to evaluate delays in care for patients with head and neck cancer (HNC) in post-treatment follow-up or palliative care during the COVID-19 pandemic in Northeast Brazil and its impact on health outcomes. Information was extracted from medical records and supplemented by telephone interviews. We compared the following health outcomes: self-perception of anxiety or sadness, fear of COVID-19 infection, cancer-related complications during social isolation, self-medication, diagnosis of COVID-19, and death between patients with and without delayed cancer care. The Mann-Whitney U test was used to compare distributions of continuous variables and the Fisher exact test was used for categorical variables. Thirty-one HNC patients were included in the study, and no case of confirmed SARS-CoV-2 was found. Delayed cancer care due to restriction in health services was reported in 58.1% of cases, and there was no report of telemedicine use during the COVID-19 outbreak. Cancer-related complications during the COVID-19 pandemic were described for most patients (67.7%) and included pain or discomfort, swelling, and dyspnea. Eight (25.8%) patients reported use of prescribed morphine or codeine to manage pain and six (19.4%) patients reported self-medication with over-the-counter (OTC) non-steroidal anti-inflammatory drugs (NSAIDs). We found an association between delayed HNC care and the use of self-medication (p = 0.028). This study indicated that patients with delayed HNC care during the COVID-19 outbreak are more likely to use self-medication with NSAIDs for pain management. Better strategies to follow HNC patients in socioeconomically disadvantaged communities need to be discussed and implemented.


Assuntos
Neoplasias de Cabeça e Pescoço/terapia , Tempo para o Tratamento , Brasil/epidemiologia , Estudos de Coortes , Estudos Transversais , Humanos , Avaliação de Resultados em Cuidados de Saúde , Pandemias
15.
BMJ Open ; 10(12): e041417, 2020 12 02.
Artigo em Inglês | MEDLINE | ID: mdl-33268426

RESUMO

INTRODUCTION: There is a paucity of data that can be used to guide the management of critically ill patients with COVID-19. In response, a research and data-sharing collaborative-The COVID-19 Critical Care Consortium-has been assembled to harness the cumulative experience of intensive care units (ICUs) worldwide. The resulting observational study provides a platform to rapidly disseminate detailed data and insights crucial to improving outcomes. METHODS AND ANALYSIS: This is an international, multicentre, observational study of patients with confirmed or suspected SARS-CoV-2 infection admitted to ICUs. This is an evolving, open-ended study that commenced on 1 January 2020 and currently includes >350 sites in over 48 countries. The study enrols patients at the time of ICU admission and follows them to the time of death, hospital discharge or 28 days post-ICU admission, whichever occurs last. Key data, collected via an electronic case report form devised in collaboration with the International Severe Acute Respiratory and Emerging Infection Consortium/Short Period Incidence Study of Severe Acute Respiratory Illness networks, include: patient demographic data and risk factors, clinical features, severity of illness and respiratory failure, need for non-invasive and/or mechanical ventilation and/or extracorporeal membrane oxygenation and associated complications, as well as data on adjunctive therapies. ETHICS AND DISSEMINATION: Local principal investigators will ensure that the study adheres to all relevant national regulations, and that the necessary approvals are in place before a site may contribute data. In jurisdictions where a waiver of consent is deemed insufficient, prospective, representative or retrospective consent will be obtained, as appropriate. A web-based dashboard has been developed to provide relevant data and descriptive statistics to international collaborators in real-time. It is anticipated that, following study completion, all de-identified data will be made open access. TRIAL REGISTRATION NUMBER: ACTRN12620000421932 (http://anzctr.org.au/ACTRN12620000421932.aspx).


Assuntos
/terapia , Unidades de Terapia Intensiva/estatística & dados numéricos , Sistema de Registros , /mortalidade , Medicina Baseada em Evidências , Saúde Global , Humanos , Estudos Observacionais como Assunto , Avaliação de Resultados em Cuidados de Saúde , Pandemias , Ensaios Clínicos Pragmáticos como Assunto
16.
Front Endocrinol (Lausanne) ; 11: 599255, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33329400

RESUMO

Dysnatremia is associated with increased mortality in patients with community-acquired pneumonia. SARS-COV2 (Severe-acute-respiratory syndrome caused by Coronavirus-type 2) pneumonia can be fatal. The aim of this study was to ascertain whether admittance dysnatremia is associated with mortality, sepsis, or intensive therapy (IT) in patients hospitalized with SARS-COV2 pneumonia. This is a retrospective study of the HOPE-COVID-19 registry, with data collected from January 1th through April 31th, 2020. We selected all hospitalized adult patients with RT-PCR-confirmed SARS-COV2 pneumonia and a registered admission serum sodium level (SNa). Patients were classified as hyponatremic (SNa <135 mmol/L), eunatremic (SNa 135-145 mmol/L), or hypernatremic (SNa >145 mmol/L). Multivariable analyses were performed to elucidate independent relationships of admission hyponatremia and hypernatremia, with mortality, sepsis, or IT during hospitalization. Four thousand six hundred sixty-four patients were analyzed, median age 66 (52-77), 58% males. Death occurred in 988 (21.2%) patients, sepsis was diagnosed in 551 (12%) and IT in 838 (18.4%). Hyponatremia was present in 957/4,664 (20.5%) patients, and hypernatremia in 174/4,664 (3.7%). Both hyponatremia and hypernatremia were associated with mortality and sepsis. Only hyponatremia was associated with IT. In conclusion, hyponatremia and hypernatremia at admission are factors independently associated with mortality and sepsis in patients hospitalized with SARS-COV2 pneumonia. Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT04334291, NCT04334291.


Assuntos
/mortalidade , Mortalidade Hospitalar/tendências , Hipernatremia/fisiopatologia , Hiponatremia/fisiopatologia , Sistema de Registros/estatística & dados numéricos , /isolamento & purificação , Idoso , /virologia , Feminino , Seguimentos , Saúde Global , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida
17.
Hu Li Za Zhi ; 67(6): 70-80, 2020 Dec.
Artigo em Chinês | MEDLINE | ID: mdl-33274428

RESUMO

BACKGROUND & PROBLEMS: Intra-arterial thrombectomy (IAT) is a novel surgery that may restore cerebral blood flow in patients with ischemic stroke and lower the risks of permanent brain damage and disability. Because the process of preoperative preparation for IAT is complicated, error rates for this process have been reported in previous studies to be as high as 100%. Although these errors did not result in serious damage to patients, the risk to patient safety remains. Therefore, reducing the error rate for IAT preoperative preparation is necessary to improve patient safety. PURPOSE: To reduce the rate of IAT preoperative preparation error in an emergency room. RESOLUTION: This project applied healthcare failure mode and effect analysis (HFMEA) to evaluate the potential risks of IAT preoperative preparation in an emergency room. Based on the resultant hazard score, critical preventive measures were adopted, including creating a quick response code consent form, designing order packages, developing a checklist form, modifying stroke operating procedures and policies, planning suitable education content for staffs, developing criteria for evaluating preoperative preparation procedures, and installing vital signs equipment. RESULTS: After implementation of these measures, the hazard scores of 13 out of the 16 potential failure causes decreased to < 8, and the progress rate was 81.3%. The follow-up error rate for preoperative preparation was 0% in October 2019, which fulfilled the goal of this project. CONCLUSIONS: Preoperative preparation for IAT is complicated and time-consuming. In this project, HFMEA was introduced to ensure that preoperative preparation was accomplished in a complete and timely manner. Based on the results, after implementation, preparation work was effectively completed and operations were performed on schedule. Other hospitals may consider using this tool to evaluate potential risks to patient safety and to develop solutions to improve the quality of healthcare processes.


Assuntos
Análise do Modo e do Efeito de Falhas na Assistência à Saúde , Erros de Medicação/prevenção & controle , Cuidados Pré-Operatórios/normas , Acidente Vascular Cerebral/terapia , Trombectomia/estatística & dados numéricos , Terapia Trombolítica/normas , Adulto , Assistência à Saúde , Serviço Hospitalar de Emergência , Humanos , Injeções Intra-Arteriais , Avaliação de Resultados em Cuidados de Saúde/métodos , Período Pré-Operatório , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico , Terapia Trombolítica/efeitos adversos
18.
Arthroscopy ; 36(12): 2998-3000, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33276887

RESUMO

A better understanding of hip-preservation patients lies in our ability to analyze and collect data. Collecting the appropriate outcome measures is required to improve treatments, personalize health care, and drive policy. Current research suggests legacy measures and Patient-Reported Outcomes Measurement Information System (PROMIS) measures can be used in data collection, but which measures are best? PROMIS computer-adaptive tests are an attractive outcome measure source because they allow for low-burden data capture with reduced completion times and limited floor and ceiling effects. PROMIS provides numerous reliable, sensitive, and domain-specific measurements capturing a patient's health outcomes. PROMIS has been shown to correlate with hip and other legacy outcome measures, but because PROMIS is more general than some legacy measures, it may be less responsive. PROMIS measures are applicable across a wide spectrum of health measures for our patients, including hip femoroacetabular impingement, but should not replace the legacy measure of the International Hip Outcome Tool 12. However, PROMIS should still be measured because it may allow greater comparison to studies of other conditions resulting in diminished reporting bias.


Assuntos
Impacto Femoroacetabular , Medidas de Resultados Relatados pelo Paciente , Artroscopia , Humanos , Sistemas de Informação , Avaliação de Resultados em Cuidados de Saúde
19.
Eur Heart J Acute Cardiovasc Care ; 9(8): 817-823, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33222494

RESUMO

AIMS: To determine the frequency and pattern of cardiac complications in patients hospitalised with coronavirus disease (COVID-19). METHODS AND RESULTS: CAPACITY-COVID is an international patient registry established to determine the role of cardiovascular disease in the COVID-19 pandemic. In this registry, data generated during routine clinical practice are collected in a standardised manner for patients with a (highly suspected) severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection requiring hospitalisation. For the current analysis, consecutive patients with laboratory confirmed COVID-19 registered between 28 March and 3 July 2020 were included. Patients were followed for the occurrence of cardiac complications and pulmonary embolism from admission to discharge. In total, 3011 patients were included, of which 1890 (62.8%) were men. The median age was 67 years (interquartile range 56-76); 937 (31.0%) patients had a history of cardiac disease, with pre-existent coronary artery disease being most common (n=463, 15.4%). During hospitalisation, 595 (19.8%) patients died, including 16 patients (2.7%) with cardiac causes. Cardiac complications were diagnosed in 349 (11.6%) patients, with atrial fibrillation (n=142, 4.7%) being most common. The incidence of other cardiac complications was 1.8% for heart failure (n=55), 0.5% for acute coronary syndrome (n=15), 0.5% for ventricular arrhythmia (n=14), 0.1% for bacterial endocarditis (n=4) and myocarditis (n=3), respectively, and 0.03% for pericarditis (n=1). Pulmonary embolism was diagnosed in 198 (6.6%) patients. CONCLUSION: This large study among 3011 hospitalised patients with COVID-19 shows that the incidence of cardiac complications during hospital admission is low, despite a frequent history of cardiovascular disease. Long-term cardiac outcomes and the role of pre-existing cardiovascular disease in COVID-19 outcome warrants further investigation.


Assuntos
/complicações , Cardiopatias/epidemiologia , Hospitalização/tendências , /genética , Síndrome Coronariana Aguda/epidemiologia , Idoso , Fibrilação Atrial/epidemiologia , /virologia , Doença da Artéria Coronariana/epidemiologia , Endocardite Bacteriana/epidemiologia , Feminino , Cardiopatias/mortalidade , Insuficiência Cardíaca/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Miocardite/epidemiologia , Avaliação de Resultados em Cuidados de Saúde , Pericardite/epidemiologia , Embolia Pulmonar/epidemiologia , Sistema de Registros
20.
J Clin Psychiatry ; 81(6)2020 11 24.
Artigo em Inglês | MEDLINE | ID: mdl-33238082

RESUMO

Gabapentin, available as gabapentin and as the prodrug gabapentin enacarbil, is an approved treatment for partial seizures, postherpetic neuralgia, and the restless legs syndrome. Gabapentin has been studied for diverse off-label indications, including alcohol use disorder (AUD). Meta-analyses of randomized controlled trials (RCTs) suggest that gabapentin reduces the severity of alcohol withdrawal symptoms (AWS) as well as the percentage of heavy drinking days in persons with AUD; however, the magnitude of benefit is small, and no benefits are apparent for other drinking outcomes. Furthermore, a recent, large RCT found an extended-release formulation of gabapentin enacarbil ineffective for a wide range of drinking and other outcomes in patients with AUD. Some research suggests that gabapentin may improve drinking outcomes specifically in AUD patients with higher levels of AWS; this may be a result of gabapentin-associated reduction in AWS, precluding AWS-triggered continued drinking. In this context, a recent, large RCT found that gabapentin reduced heavy drinking and increased abstinence, and that these findings were apparent only in patients with higher levels of AWS during the 2 weeks before randomization; disconcertingly, gabapentin appeared to worsen drinking outcomes in the patients with low AWS. Whereas these findings support the conjecture that gabapentin could be considered indicated in AUD patients with high AWS, problems with this RCT and with its findings limit the applicability of the findings to everyday clinical practice. These problems are discussed in detail. It is concluded that, in line with the recommendations of a recent treatment guideline, gabapentin may be considered for patients with AUD only if first line drugs such as naltrexone and acamprosate cannot be used. It may also be worth examining benefits with gabapentin in AUD associated with chronic pain, anxiety, and chronic insomnia because gabapentin is suggested to attenuate these syndromes.


Assuntos
Transtornos Relacionados ao Uso de Álcool/tratamento farmacológico , Antagonistas de Aminoácidos Excitatórios/farmacologia , Gabapentina/farmacologia , Avaliação de Resultados em Cuidados de Saúde , Síndrome de Abstinência a Substâncias/tratamento farmacológico , Adulto , Abstinência de Álcool , Alcoolismo/tratamento farmacológico , Humanos , Hepatopatias Alcoólicas/tratamento farmacológico , Ensaios Clínicos Controlados Aleatórios como Assunto
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