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1.
Front Public Health ; 10: 865712, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35910893

RESUMO

Background: Zero-time Exercise (ZTEx), a simple strength- and stamina-enhancing physical activity (PA) requiring no extra equipment, can potentially increase PA and fitness. This pilot trial examined the feasibility and potential effectiveness of a smartphone ZTEx intervention to promote PA and fitness in patients with coronary heart disease (CHD). Methods: A parallel-group assessor-blinded pilot randomized controlled trial was conducted on Chinese patients with stable coronary heart disease (CHD) in three cardiology clinics. The experimental group received a 15-min brief individual face-to-face session and a 12-week ZTEx instant messaging with 28 picture e-messages and a smartphone ZTEx application (ZTExApp). The control group received the same duration of individual session and number and format of e-messages, but the content was healthy eating and breathing exercise. The feasibility was assessed based on: attrition rate, usage, response rate and perception of the intervention. The outcome evaluation included primary outcome (PA), fitness, exercise self-efficacy and intention, perceived happiness and health, and quality of life. A linear mixed model was used with intention-to-treat analysis adjusting for sex, age and baseline values. A semi-structured interview was conducted to collect feedback from the experiment group. Results: One hundred thirty-nine patients (mean age 59.8 ± 6.6; 71.2% male) were randomized to the experimental group (n = 70) or control group (n = 69), and 80% (56/70) and 82% (57/69) of patients completed the 12-week follow-up assessment, respectively. The attrition rate was 18.7%. The experimental group reported that ZTEx was feasible to integrate PA into their daily life and appreciated the picture e-messages, and 95% of them sent feedback to us, but only 19.6% (13/70) of the participants entered their PA information into the e-diary of the ZTExApp. The experimental group had a significantly greater increase in time spent walking [mean difference (95% CI): 155.3 (10.1, 300.4), P = 0.04, Cohen's d = 0.34] than the control group. Conclusions: This pilot study showed using a brief ZTEx face-to-face session with picture e-messages empowered patients with CHD to integrate PA into daily life. Future definitive trials with a longer follow-up and a more user-friendly ZTExApp interface are necessary to determine the effectiveness of the smartphone ZTEx intervention in enhancing PA and related outcomes. Trial Registration: The research protocol was registered at the Hong Kong University Clinical Trials Registry (HKUCTR) on 22 Jul 2016 (Study identifier: HKUCTR-2165) and was also retrospectively registered at the National Institutes of Health (identifier number: NCT03464331) on 14 March 2018.


Assuntos
Doença das Coronárias , Smartphone , Idoso , Exercício Físico , Terapia por Exercício , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Qualidade de Vida , Estados Unidos
2.
J Med Internet Res ; 24(8): e37434, 2022 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-35916695

RESUMO

BACKGROUND: New research fields to design social robots for older people are emerging. By providing support with communication and social interaction, these robots aim to increase quality of life. Because of the decline in functioning due to cognitive impairment in older people, social robots are regarded as promising, especially for people with dementia. Although study outcomes are hopeful, the quality of studies on the effectiveness of social robots for the elderly is still low due to many methodological limitations. OBJECTIVE: We aimed to review the methodologies used thus far in studies evaluating the feasibility, usability, efficacy, and effectiveness of social robots in clinical and social settings for elderly people, including persons with dementia. METHODS: Dedicated search strings were developed. Searches in MEDLINE (PubMed), Web of Science, PsycInfo, and CINAHL were performed on August 13, 2020. RESULTS: In the 33 included papers, 23 different social robots were investigated for their feasibility, usability, efficacy, and effectiveness. A total of 8 (24.2%) studies included elderly persons in the community, 9 (27.3%) included long-term care facility residents, and 16 (48.5%) included people with dementia. Most of the studies had a single aim, of which 7 (21.2%) focused on efficacy and 7 (21.2%) focused on effectiveness. Moreover, forms of randomized controlled trials were the most applied designs. Feasibility and usability were often studied together in mixed methods or experimental designs and were most often studied in individual interventions. Feasibility was often assessed with the Unified Theory of the Acceptance and Use of Technology model. Efficacy and effectiveness studies used a range of psychosocial and cognitive outcome measures. However, the included studies failed to find significant improvements in quality of life, depression, and cognition. CONCLUSIONS: This study identified several shortcomings in methodologies used to evaluate social robots, resulting in ambivalent study findings. To improve the quality of these types of studies, efficacy/effectiveness studies will benefit from appropriate randomized controlled trial designs with large sample sizes and individual intervention sessions. Experimental designs might work best for feasibility and usability studies. For each of the 3 goals (efficacy/effectiveness, feasibility, and usability) we also recommend a mixed method of data collection. Multiple interaction sessions running for at least 1 month might aid researchers in drawing significant results and prove the real long-term impact of social robots.


Assuntos
Demência , Robótica , Adulto , Idoso , Demência/psicologia , Demência/terapia , Estudos de Viabilidade , Humanos , Qualidade de Vida , Interação Social
3.
Anal Chim Acta ; 1221: 340152, 2022 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-35934382

RESUMO

The aqueous solution extracted from raw bile juice is composed primarily of bile salts, with lower levels of bilirubin and its derivatives. Among them, the bilirubin and bilirubin-derived metabolites are the only surface-enhanced Raman scattering (SERS)-active components. An analytical scheme indirectly responsive and able to utilize all bile components, including SERS-inactive bile salts, was explored for SERS-based discrimination of gallbladder (GB) polyp and GB cancer. Initially, the surface of a SERS substrate (Au nanodendrite on Ni foil (AuND@NiF)) was covered with an alkanethiol molecule to generate a SERS signal and attract bile components by mutual interaction. For more effective recognition of bile components, 4 independent substrates covered with 4 different alkanethiols with various functional groups (SH(CH2)2CH3, SH(CH2)2NH2, SH(CH2)2COOH, and SH(CH2)2OH) were prepared. The SERS peaks of each substrate clearly varied on interaction with pure bile components as well as aqueous bile samples, and the SERS peaks in each substrate were individually characteristic. When the principal component (PC) scores of spectra obtained using the SH(CH2)2CH3- and SH(CH2)2OH-covered substrates were combined, the k-Nearest Neighbor-based discrimination accuracy was 100%, superior to those (90.6-96.9%) using individual substrates. The use of complementary bile component-induced spectral information provided by the two substrates was responsible for accurate discrimination. On the other hand, when bare AuND@NiF recognizing only SERS-active bilirubin derivatives was used, discrimination was unsatisfactory (accuracy: 75.0%).


Assuntos
Neoplasias da Vesícula Biliar , Nanopartículas Metálicas , Bile/química , Ácidos e Sais Biliares/análise , Bilirrubina/análise , Estudos de Viabilidade , Neoplasias da Vesícula Biliar/diagnóstico , Humanos , Nanopartículas Metálicas/química , Análise Espectral Raman , Água/análise
4.
BMC Pediatr ; 22(1): 475, 2022 08 05.
Artigo em Inglês | MEDLINE | ID: mdl-35931968

RESUMO

BACKGROUND: High-intensity interval training (HIIT) is an effective strategy for improving a variety of health outcomes within the school setting. However, there is limited research on the implementation of school-based HIIT interventions and the integration of HIIT within the Health and Physical Education (HPE) curriculum. The aims of the Making a HIIT study are to: 1) describe the methodology and evaluate the feasibility of co-designing HIIT workouts with students and teachers in HPE; 2) determine the effect of co-designed HIIT workouts on cardiorespiratory and muscular fitness, and executive function; 3) understand the effect of co-design on students' motivation, enjoyment, and self-efficacy towards the workouts; and 4) evaluate the implementation of the intervention. METHODS: Three schools will participate. Within each school, three different groups will be formed from Year 7 and 8 classes: 1) Co-Designers; 2) HIIT Only; and 3) Control. The study will include two phases. In phase one, Group 1 will co-design HIIT workouts as part of the HPE curriculum using an iterative process with the researcher, teacher, and students as collaborators. This process will be evaluated using student discussions, student surveys, and teacher interviews. In phase two, Groups 1 and 2 will use the co-designed 10-minute HIIT workouts in HPE for 8-weeks. Group 3 (control) will continue their regular HPE lessons. All students will participate in cardiorespiratory fitness, muscular fitness, and executive function assessments before and after the HIIT program or control period. Students will complete questionnaires on their motivation, enjoyment, and self-efficacy of the workouts. Differences between groups will be assessed using linear regressions to account for covariates. Heart rate and rating of perceived exertion will be collected during each HIIT session. The implementation will be evaluated using the Framework for Effective Implementation. Ethical approval was granted by the University of Queensland Human Research Ethics Committee and other relevant bodies. DISCUSSION: This study will be the first to co-design HIIT workouts with teachers and students within the HPE curriculum. As this study relies on co-design, each HIIT workout will differ, which will add variability between HIIT workouts but increase the ecological validity of the study. TRIAL REGISTRATION: ACTRN, ACTRN12622000534785, Registered 5 April 2022 - Retrospectively registered, https://www.anzctr.org.au/ACTRN12622000534785.aspx.


Assuntos
Treinamento Intervalado de Alta Intensidade , Estudos de Viabilidade , Treinamento Intervalado de Alta Intensidade/métodos , Humanos , Educação Física e Treinamento , Serviços de Saúde Escolar , Estudantes
5.
PLoS One ; 17(8): e0272363, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35925938

RESUMO

This work presents an economic analysis that illustrates the feasibility and the possible benefits related to the replacement of internal combustion vehicles (ICVs)by electric vehicles (EVs) public transportation in medium-sized cities. According to the current operating conditions, we calculate the cost of operating internal combustion vehicles and compare them with a selected EV with approximately the same passenger capacity. We calculate the CO2 emissions in both cases. Moreover, for the case of EV, we analyze two scenarios: 1) Use the grid to charge the EV and 2) a grid-connected photovoltaic system using the available land in the store terminals. The net present value (NPV) indicates the feasibility of two EV replacement scenarios: EV fleet using energy from the grid and EV fleet with a PV system energy generation interconnected to the grid. The economic analysis considers the different prices of electricity according to the existing tariff schemes in Mexico. Due to the electricity generation mix in Mexico, in the case of CO2 emissions, the reduction is not as expected in the only grid connection; but a PV system reduces more than 30% CO2. This analysis was carried out for two medium-sized cities: Morelia, Michoacán, and Cuernavaca, Morelos, both in Mexico.


Assuntos
Dióxido de Carbono , Eletricidade , Cidades , Estudos de Viabilidade , Humanos , México , Veículos Automotores , Emissões de Veículos/análise
6.
Sci Rep ; 12(1): 13285, 2022 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-35918378

RESUMO

Percutaneous laser discectomy is one common and effective treatment for cervical radicular pain. Currently, the surgery is performed with blind cannulation technique, mainly relies on the experience of surgeon. However, it still remains unsafe and difficult to reach the target. As an alternative, ultrasound-guided cannulation provides visualization of important structures, thus increasing the precision and safety. The primary goal of this study is to report the detail of the ultrasound-guided technique in the percutaneous laser cervical discectomy. The secondary purpose is to evaluate the feasibility of the novel therapy. This is a single center, feasibility study conducted in one teaching hospital. Thirteen intervertebral discs in 9 patients presented with cervical radicular pain. Accuracy of the cannulation with ultrasonic guidance was confirmed by the anterior-posterior and lateral view of fluoroscopy. We compared the pain severity pre- and post-treatment with Visual Analogue Score (VAS), and functional improvement was assessed with the modified Macnab Criteria and Neck Disability Index (NDI) respectively. Ultrasonic short-axis was used to scan the cervical nerve root, and its transition was used to identify the distinct intervertebral space. Following the recognition of targeted cervical level, the ultrasound probe was moved medially for the visualization of the surface of the cervical vertebrae. In plane cannulation was then applied to avoid the injury of the vessels. The location of cannula was confirmed by the fluoroscopic imaging. Low-power laser was set for the cervical disc ablation in this cohort. The majority of the surgical sites maintained in the C5/6 level (38%), and 31% for the C6/7 level respectively. Despite the distinct cervical level, the tip of needle was properly placed near by the targeted intervertebral disc in all participants, which was confirmed by the imaging of fluoroscopy. We did not observe any obvious complications during the procedure. The mean VAS decreased from 7.6 ± 1.1 to 2.3 ± 2.7 one month after discharge, and 2.1 ± 2.6 at the last follow-up (median duration of nine months). All patients reported significant improvement of NDI up to last follow-up (p = 0.011). Meanwhile, the good to excellent rate was reported in 8 of 9 patients (89%) according to the modified Macnab Criteria. The finding of this feasibility assessment indicates the ultrasound-based cannulation technique is capable of guiding the cannulation for the percutaneous laser discectomy. It may facilitate identifying the corresponding site of cervical intervertebral disc and prevent the damage of vessel.


Assuntos
Deslocamento do Disco Intervertebral , Radiculopatia , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Discotomia/efeitos adversos , Estudos de Viabilidade , Humanos , Deslocamento do Disco Intervertebral/cirurgia , Lasers , Cervicalgia/complicações , Radiculopatia/complicações , Radiculopatia/diagnóstico por imagem , Radiculopatia/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Ultrassonografia de Intervenção/efeitos adversos
7.
Sci Rep ; 12(1): 13518, 2022 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-35934715

RESUMO

In the present work, the photogalvanic cells have been studied with respect to the photo-stability and the long-term use of the electrolyte based on crude aqueous spinach extract sensitizer for solar energy harvesting. Further, the nature of chemical components present in the old and photo-decayed electrolyte and their current generation capacity has also not been investigated so far otherwise it is of much significance for durable use of the same electrolyte in cells. In earlier studies, the steady-state photo-generation of current for about two hours from crude spinach extract-based cell has been shown during illumination. But, the data for only two hours of the steady-state current generation is not sufficient to show the feasibility of working with photogalvanic cells. Therefore, to fill this research gap of lack of characterization of sensitizers' molecules of crude spinach extract and lack of study on long-term use of this electrolyte (crude spinach extract-surfactant-reductant-alkali-water), the present extensive study has been done. The observed spectrum of crude spinach extract resembles that of chlorophyll-protein complex showing it is the main chemical component in extract absorbing light. A strong acid adversely affects the extract's photogalvanics and high pH is friendly to the physiological and photogalvanic activity of the extract. The spectra of illuminated and very old crude spinach extract-NaOH-Sodium lauryl sulfate (NaLS)-Fructose photogalvanic electrolyte solution show negligible absorbance (540-700 nm) and zero absorbance (at 700 nm) suggesting the absence of chlorophyll due to its photo-degradation. When this photo-degraded electrolyte is again illuminated, the power output obtained is nearly equal to that for the first time illuminated fresh electrolyte. The observed current at zero time and after 2641 h from the same electrolyte used in long term is 50 mA cm-2 and 40 mA cm-2, respectively. It means that the fresh crude spinach extract, as well as the photo-degraded extract at high pH, are almost equally capable of power generation.


Assuntos
Clorofila , Spinacia oleracea , Clorofila/metabolismo , Eletrólitos , Estudos de Viabilidade , Spinacia oleracea/química , Água
8.
Eur J Psychotraumatol ; 13(2): 2101765, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35936870

RESUMO

Background: Given the prevalence of post-traumatic stress disorder (PTSD), particularly among military personnel, new treatment approaches are needed. One may be virtual relaxation interventions, especially 360-degree nature videos, since studies have demonstrated their relaxation effects for healthy participants. If these relaxation effects can be reproduced in patients with PTSD, they may offer a viable tool to reduce distress and hyperarousal. Objective: This research protocol describes a planned study that will examine the relaxation effects of 360-degree nature videos for patients with PTSD. It will also investigate whether these relaxation effects differ depending on the hardware immersion level (head-mounted display [HMD] vs. PC screen) in comparison to a control condition in which patients only listen to natural sounds and do not view a video. Finally, the effect of each intervention's dose duration (five vs. ten minutes) will be explored. Method: A counterbalanced, randomised, controlled, within-subject experiment will be conducted (sample size N = 36). Only soldiers aged 18 years or older with a primary diagnosis of PTSD will be included. Those with psychosis, substance dependence, a change in psychiatric medication within the last month, suicidal intent, and motion sickness will be excluded. All patients will experience the HMD, PC, and control conditions once for five or ten minutes. Self-reported relaxation measures will be collected before and after, and patients' skin conductance level, heart rate, and heart rate variability will be assessed during each condition. Semi-structured interviews will be conducted to examine the patients' experiences in detail. Conclusions: This feasibility study will provide initial evidence of whether viewing 360-degree nature videos via HMD or PC screen is relaxing for patients with PTSD and whether the effects are greater compared with the control condition. The study will also validate the dose duration and thereby informing a subsequent confirmatory interventional trial. Trial registration: DRKS00020277. HIGHLIGHTS: This randomised controlled feasibility study will examine whether 360-degree nature videos are a suitable relaxation intervention for military personnel with post-traumatic stress disorder.


Introducción: Dada la prevalencia del trastorno de estrés postraumático (TEPT), particularmente entre militares, se necesitan nuevos enfoques de tratamiento. Uno podría ser intervenciones de relajación virtual, especialmente videos de naturaleza de 360-grados, ya que los estudios han demostrado sus efectos de relajación para participantes sanos. Si estos efectos de relajación pueden reproducirse en pacientes con TEPT, podrían ofrecer una herramienta viable para reducir la angustia y la hiperalerta.Objetivo: Este protocolo de investigación describe un estudio planificado que examinará los efectos de relajación con videos de naturaleza de 360-grados, para pacientes con TEPT. También investigará de qué manera estos efectos de relajación difieren dependiendo del nivel de inmersión del hardware (pantalla montada en la cabeza [HMD] vs. pantalla de PC) en comparación con una condición de control en la que los pacientes solo escuchan los sonidos de la naturaleza y no ven un video. Finalmente, el efecto de la duración de la dosis de cada intervención (cinco vs diez minutos) será explorados.Método: Se llevará a cabo un experimento contrabalanceado, aleatorizado, controlado e intrasujeto (tamaño de muestra N = 36). Solo serán incluidos los soldados de 18 años o más con un diagnóstico primario de TEPT. Serán excluidos aquellos con psicosis, dependencia de sustancias, un cambio en la medicación psiquiátrica en el último mes y quienes presenten ideación suicida o cinetosis (mareo de movimiento). Todos los pacientes experimentarán las condiciones de HMD, PC y control una vez durante cinco o diez minutos. Las mediciones de relajación autoreportadas se recopilarán antes y después y el nivel de conductancia de la piel de los pacientes, la frecuencia cardíaca y la variabilidad de la frecuencia cardíaca se evaluarán durante cada condición. Se realizarán entrevistas semiestructuradas para examinar las experiencias de los pacientes en detalle.Conclusiones: Este estudio de factibilidad proporcionará evidencia inicial de si visualizar videos de naturaleza de 360-grados a través de HMD o la pantalla de la PC es relajante para los pacientes con TEPT, y si los efectos son mayores comparados con la condición de control. El estudio también validará la duración de la dosis y operacionalización de los puntos de termino, informando así un ensayo interventivo confirmatorio posterior.


Assuntos
Militares , Terapia de Relaxamento , Transtornos de Estresse Pós-Traumáticos , Estudos de Viabilidade , Humanos , Prevalência , Ensaios Clínicos Controlados Aleatórios como Assunto , Relaxamento , Transtornos de Estresse Pós-Traumáticos/terapia
9.
BMC Pulm Med ; 22(1): 302, 2022 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-35941622

RESUMO

BACKGROUND: Pulmonary rehabilitation is recommended for most patients with chronic obstructive pulmonary disease (COPD). Accordingly, the aim of this study was to explore the feasibility of devising a pulmonary rehabilitation program for patients with COPD in a low resource setting (Jaffna, Sri Lanka) and to observe its effects. METHODS: Non-randomized controlled feasibility trial of ambulatory patients with COPD attending the pulmonary outpatient clinic of the Jaffna Teaching Hospital, Northern Province, Sri Lanka. Age-matched patients were allocated alternatively to an intervention group or to a control group. Twice weekly, for six weeks, patients in the intervention group attended pulmonary rehabilitation sessions consisting of supervised stretching, aerobic and strengthening exercises, and patient-education. Before and at the conclusion of the study, all patients performed incremental shuttle walking test (ISWT), 6-min walk test (6MWT) and completed the Medical Research Council (MRC) dyspnea scale, COPD assessment test (CAT), chronic COPD questionnaire (CCQ), and hospital anxiety depression scale (HADS). RESULTS: 204 patients with COPD (94% males) were identified at screening; 136 (66.7%) were eligible for pulmonary rehabilitation and 96 patients (47%) consented to participate. Of these, 54 patients (53 males) eventually participated in the study (42 patients were discouraged to participate by family members or friends); 40 patients (20 in the rehabilitation group and 20 patients in the control group) completed the study. Baseline characteristics of the intervention group and the control group were similar. 95% of patients in the intervention group adhered to regular home training exercises (self-reported diary). At post assessment, only the intervention group experienced clinically-meaningful improvements in symptoms and exercise capacity. CONCLUSION: A simple and clinically beneficial pulmonary rehabilitation program for patients with COPD can be effectively implemented in a low resource setting. However, there is a need for educating patients and the local community on the benefits of pulmonary rehabilitation to enhance uptake. Retrospective Trial Registration date and number: 16/04/2021, ISRCTN10069208.


Assuntos
Doença Pulmonar Obstrutiva Crônica , Qualidade de Vida , Terapia por Exercício , Estudos de Viabilidade , Feminino , Humanos , Masculino , Estudos Retrospectivos , Sri Lanka
10.
BMC Surg ; 22(1): 308, 2022 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-35948902

RESUMO

BACKGROUND: Natural orifice specimen extraction surgery (NOSES) has the advantages of less postoperative pain, fast bowel function recovery, reduced hospital stay and better cosmetic effects. In our centre, anterior resection of rectal cancer with preservation of the left colonic artery (LCA) was performed using NOSES. The feasibility, safety and short-term clinical efficacy of the technique were discussed. METHODS: A retrospective analysis was performed on 19 patients who underwent laparoscopic anterior resection of rectal cancer with left colonic artery preservation and natural orifice specimen extraction in the Gastrointestinal Surgery Center of Sichuan Cancer Hospital from September 2018 to December 2019. General information about the patients, perioperative data and short-term postoperative results were analysed. RESULTS: All operations were completed smoothly, with an average operation duration of 304.36 ± 45.04 min, intraoperative bleeding of 76.31 ± 61.12 ml, first time off bed of 14.42 ± 3.56 h, first time to anus exhaust of 15.26 ± 8.92 h, first time to liquid diet of 2.94 ± 1.12 days, and average postoperative stay of 10.21 ± 3.13 days. Two patients developed temporary intestinal obstruction, and one patient developed pulmonary infection. All of them recovered well after active supportive treatment and were successfully discharged. CONCLUSION: Laparoscopic NOSES for rectal cancer with left colon artery preservation is safe and feasible, with satisfactory short-term results, and is worthy of further clinical investigation.


Assuntos
Laparoscopia , Cirurgia Endoscópica por Orifício Natural , Neoplasias Retais , Artérias , Colo , Estudos de Viabilidade , Humanos , Laparoscopia/métodos , Neoplasias Retais/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
11.
Korean J Radiol ; 23(8): 794-802, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35914744

RESUMO

OBJECTIVE: To evaluate the feasibility of single-shot whole thoracic time-resolved MR angiography (TR-MRA) to identify the feeding arteries of pulmonary arteriovenous malformations (PAVMs) and reperfusion of the lesion after embolization in patients with multiple PAVMs. MATERIALS AND METHODS: Nine patients (8 females and 1 male; age range, 23-65 years) with a total of 62 PAVMs who underwent percutaneous embolization for multiple PAVMs and were subsequently followed up using TR-MRA and CT obtained within 6 months from each other were retrospectively reviewed. All imaging analyses were performed by two independent readers blinded to clinical information. The visibility of the feeding arteries on maximum intensity projection (MIP) reconstruction and multiplanar reconstruction (MPR) TR-MRA images was evaluated by comparing them to CT as a reference. The accuracy of TR-MRA for diagnosing reperfusion of the PAVM after embolization was assessed in a subgroup with angiographic confirmation. The reliability between the readers in interpreting the TR-MRA results was analyzed using kappa (κ) statistics. RESULTS: Feeding arteries were visible on the original MIP images of TR-MRA in 82.3% (51/62) and 85.5% (53/62) of readers 1 and 2, respectively. Using the MPR, the rates increased to 93.5% (58/62) and 95.2% (59/62), respectively (κ = 0.760 and 0.792, respectively). Factors for invisibility were the course of feeding arteries in the anteroposterior plane, proximity to large enhancing vessels, adjacency to the chest wall, pulsation of the heart, and small feeding arteries. Thirty-seven PAVMs in five patients had angiographic confirmation of reperfusion status after embolization (32 occlusions and 5 reperfusions). TR-MRA showed 100% (5/5) sensitivity and 100% (32/32, including three cases in which the feeding arteries were not visible on TR-MRA) specificity for both readers. CONCLUSION: Single-shot whole thoracic TR-MRA with MPR showed good visibility of the feeding arteries of PAVMs and high accuracy in diagnosing reperfusion after embolization. Single-shot whole thoracic TR-MRA may be a feasible method for the follow-up of patients with multiple PAVMs.


Assuntos
Malformações Arteriovenosas , Embolização Terapêutica , Veias Pulmonares , Adulto , Idoso , Angiografia , Fístula Arteriovenosa , Malformações Arteriovenosas/diagnóstico por imagem , Malformações Arteriovenosas/terapia , Embolização Terapêutica/métodos , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Pulmonar/anormalidades , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/patologia , Veias Pulmonares/anormalidades , Veias Pulmonares/diagnóstico por imagem , Veias Pulmonares/patologia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
12.
Front Endocrinol (Lausanne) ; 13: 926021, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35923626

RESUMO

Background: Latent Autoimmune Diabetes in Adults (LADA) constitutes around 10% of all diabetes. Many LADA patients gradually lose their insulin secretion and progress to insulin dependency. In a recent trial BALAD (Behandling Av LADa) early insulin treatment compared with sitagliptin failed to preserve insulin secretion, which deteriorated in individuals displaying high levels of antibodies to GAD (GADA). These findings prompted us to evaluate a treatment that directly affects autoimmunity. Intra-lymphatic GAD-alum treatment has shown encouraging results in Type 1 diabetes patients. We therefore tested the feasibility of such therapy in LADA-patients (the GADinLADA pilot study). Material and Methods: Fourteen GADA-positive (>190 RU/ml), insulin-independent patients 30-70 years old, with LADA diagnosed within < 36 months were included in an open-label feasibility trial. They received an intra-nodal injection of 4 µg GAD-alum at Day 1, 30 and 60 plus oral Vitamin D 2000 U/d from screening 30 days before (Day -30) for 4 months if the vitamin D serum levels were below 100 nmol/L (40 ng/ml). Primary objective is to evaluate safety and feasibility. Mixed Meal Tolerance Test and i.v. Glucagon Stimulation Test at baseline and after 5 and 12 months are used for estimation of beta cell function. Results will be compared with those of the recent BALAD study with comparable patient population. Immunological response is followed. Results: Preliminary results show feasibility and safety, with almost stable beta cell function and metabolic control during follow-up so far (5 months). Conclusions: Intra-lymphatic GAD-alum treatment is an option to preserve beta cell function in LADA-patients. An ongoing trial in 14 LADA-patients show feasibility and safety. Clinical and immunological responses will determine how to proceed with future trials.


Assuntos
Diabetes Mellitus Tipo 1 , Intolerância à Glucose , Diabetes Autoimune Latente em Adultos , Adulto , Idoso , Compostos de Alúmen , Estudos de Viabilidade , Intolerância à Glucose/tratamento farmacológico , Glutamato Descarboxilase/uso terapêutico , Humanos , Insulina/metabolismo , Diabetes Autoimune Latente em Adultos/tratamento farmacológico , Pessoa de Meia-Idade , Projetos Piloto , Vitamina D/uso terapêutico
13.
Front Cell Infect Microbiol ; 12: 757200, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35928207

RESUMO

Aspergillosis remains difficult to diagnose in animals. Laboratory-based assays are far less developed than those for human medicine, and only few studies have been completed to validate their utility in routine veterinary diagnostics. To overcome the current limitations, veterinarians and researchers have to propose alternative methods including extrapolating from human diagnostic tools and using innovative technology. In the present overview, two specific examples were complementarily addressed in penguins and dolphins to illustrate how is challenging the diagnosis of aspergillosis in animals. Specific focus will be made on the novel application of simple testing in blood based on serological assays or protein electrophoresis and on the new information garnered from metabolomics/proteomics to discover potential new biomarkers. In conclusion, while the diagnostic approach of aspergillosis in veterinary medicine cannot be directly taken from options developed for human medicine, it can certainly serve as inspiration.


Assuntos
Aspergilose , Golfinhos , Spheniscidae , Animais , Aspergilose/diagnóstico , Aspergilose/veterinária , Estudos de Viabilidade , Humanos , Proteômica
14.
BMJ Open ; 12(8): e059115, 2022 08 04.
Artigo em Inglês | MEDLINE | ID: mdl-35926994

RESUMO

OBJECTIVE: When novel devices are used 'in human' for the first time, their optimal use is uncertain because clinicians only have experience from preclinical studies. This study aimed to investigate factors that might optimise use of the Odon Device for assisted vaginal birth. DESIGN: We undertook qualitative case studies within the ASSIST Study, a feasibility study of the Odon Device. Each 'case' was defined as one use of the device and included at least one of the following: observation of the attempted assisted birth, and an interview with the obstetrician, midwife or woman. Data collection and thematic analysis ran iteratively and in parallel. SETTING: Tertiary referral National Health Service maternity unit in the Southwest of England. PARTICIPANTS: Women requiring a clinically indicated assisted vaginal birth. INTERVENTION: The Odon Device, an innovative device for assisted vaginal birth. PRIMARY AND SECONDARY OUTCOME MEASURES: Determining the optimal device technique, device design and defining clinical parameters for use. RESULTS: Thirty-nine cases involving an attempted Odon-assisted birth were included in this study, of which 19 resulted in a successful birth with the device. Factors that improved use included optimisation of device technique, device design and clinical parameters for use. Technique adaptations included: applying the device during, rather than between, contractions; having a flexible approach to the application angle; and deflating the air cuff sooner than originally proposed. Three design modifications were proposed involving the deflation button and sleeve. Although use of the device was found to be appropriate in all fetal positions, it was considered contraindicated when the fetal station was at the ischial spines. CONCLUSIONS: Case study methodology facilitated the acquisition of rapid insights into device function in clinical practice, providing key insights regarding use, design and key clinical parameters for success. This methodology should be considered whenever innovative devices are introduced into clinical practice. TRIAL REGISTRATION NUMBER: ISRCTN10203171.


Assuntos
Extração Obstétrica , Tocologia , Estudos de Viabilidade , Feminino , Humanos , Parto , Gravidez , Medicina Estatal
15.
Neurosurg Focus ; 52(6): E3, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35921180

RESUMO

OBJECTIVE: To increase access to health interventions and healthcare services for patients in resource-constrained settings, strategies such as telemedicine must be implemented for the allocation of medical resources across geographic boundaries. Telecollaboration is the dominant form of surgical telemedicine. In this study, the authors report and evaluate a novel mobile internet-based mixed-reality interactive telecollaboration (MIMIT) system as a new paradigm for telemedicine and validate its clinical feasibility. METHODS: The application of this system was demonstrated for long-distance, real-time collaboration of neuroendoscopic procedures. The system consists of a local video processing workstation, a head-mounted mixed-reality display device, and a mobile remote device, connected over mobile internet (4G or 5G), allowing global point-to-point communication. Using this system, 20 cases of neuroendoscopic surgery were performed and evaluated. The system setup, composite video latency, technical feasibility, clinical implementation, and future potential business model were analyzed and evaluated. RESULTS: The MIMIT system allows two surgeons to perform complex visual and verbal communication during the operation. The average video delay time is 184.25 msec (range 160-230 msec) with 4G mobile internet, and 23.25 msec (range 20-26 msec) with 5G mobile internet. Excellent image resolution enabled remote neurosurgeons to visualize all critical anatomical structures intraoperatively. Remote instructors could easily make marks on the surgical view; then the composite image, as well as the audio conversation, was transferred to the local surgeon. In this way, a real-time, long-distance collaboration can occur. This system was used for 20 neuroendoscopic surgeries in various cities in China and even across countries (Boston, Massachusetts, to Jingzhou, China). Its simplicity and practicality have been recognized by both parties, and there were no technically related complications recorded. CONCLUSIONS: The MIMIT system allows for real-time, long-distance telecollaborative neuroendoscopic procedures and surgical training through a commercially available and inexpensive system. It enables remote experts to implement real-time, long-distance intraoperative interaction to guide inexperienced local surgeons, thus integrating the best medical resources and possibly promoting both diagnosis and treatment. Moreover, it can popularize and improve neurosurgical endoscopy technology in more hospitals to benefit more patients, as well as more neurosurgeons.


Assuntos
Neuroendoscopia , Telemedicina , Estudos de Viabilidade , Humanos , Internet , Neurocirurgiões
16.
Neurosurg Focus ; 52(6): E7, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35921185

RESUMO

OBJECTIVE: Healthcare digitization has led to increasing tablet-based apps to improve diagnostics, self-discipline, and well-being in patients. Moreover, patient-reported outcome measures are crucial for optimized treatment, with superior applicability if independent from patient visits. Whereas most uses cover health maintenance, only a few studies have focused on cognitive testing in neurosurgical patients despite its nature as one of the most integrative outcome measures in neurooncology. METHODS: The authors performed a prospective single-center feasibility study including neurosurgical patients affected by intraaxial tumors and healthy subjects, testing cognitive function by using a digitized app-based approach and conventional paper-and-pencil (PP) tests. Healthy subjects underwent follow-up testing for retest reliability. RESULTS: The authors included 24 patients with brain tumor and 10 healthy subjects, all of whom completed both tests. Equivalent mean performance results were found in the tablet-based digital app and PP counterparts; whereas the digital approach had shorter test duration in patients (29.9 minutes for PP vs 21.9 minutes for app, p = 0.019) and in the healthy cohort (23.2 minutes for PP vs 16.4 minutes for app, p = 0.003), patients with brain tumor scored lower when both test strategies were applied. Results were consistent in healthy subjects after a median of 3 months. CONCLUSIONS: Cognitive function assessment is feasible using a digitized tablet-based app, with equivalent results to those of PP tests in healthy subjects and patients with brain tumor. Thus, this approach allows much closer follow-up independent of patient visits and might provide a viable option to improve patient follow-ups.


Assuntos
Neoplasias Encefálicas , Aplicativos Móveis , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/cirurgia , Estudos de Viabilidade , Humanos , Testes Neuropsicológicos , Estudos Prospectivos , Reprodutibilidade dos Testes
17.
Neurosurg Focus ; 52(6): E4, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35921190

RESUMO

OBJECTIVE: Telemedicine technology has been developed to allow surgeons in countries with limited resources to access expert technical guidance during surgical procedures. The authors report their initial experience using state-of-the-art wearable smart glasses with wireless capability to transmit intraoperative video content during spine surgery from sub-Saharan Africa to experts in the US. METHODS: A novel smart glasses system with integrated camera and microphone was worn by a spine surgeon in Dar es Salaam, Tanzania, during 3 scoliosis correction surgeries. The images were transmitted wirelessly through a compatible software system to a computer viewed by a group of fellowship-trained spine surgeons in New York City. Visual clarity was determined using a modified Snellen chart, and a percentage score was determined on the smallest line that could be read from the 8-line chart on white and black backgrounds. A 1- to 5-point scale (from 1 = unrecognizable to 5 = optimal clarity) was used to score other visual metrics assessed using a color test card including hue, contrast, and brightness. The same scoring system was used by the group to reach a consensus on visual quality of 3 intraoperative points including instruments, radiographs (ability to see pedicle screws relative to bony anatomy), and intraoperative surgical field (ability to identify bony landmarks such as transverse processes, pedicle screw starting point, laminar edge). RESULTS: All surgeries accomplished the defined goals safely with no intraoperative complications. The average download and upload connection speeds achieved in Dar es Salaam were 45.21 and 58.89 Mbps, respectively. Visual clarity with the modified white and black Snellen chart was 70.8% and 62.5%, respectively. The average scores for hue, contrast, and brightness were 2.67, 3.33, and 2.67, respectively. Visualization quality of instruments, radiographs, and intraoperative surgical field were 3.67, 1, and 1, respectively. CONCLUSIONS: Application of smart glasses for telemedicine offers a promising tool for surgical education and remote training, especially in low- and middle-income countries. However, this study highlights some limitations of this technology, including optical resolution, intraoperative lighting, and internet connection challenges. With continued collaboration between clinicians and industry, future iterations of smart glasses technology will need to address these issues to stimulate robust clinical utilization.


Assuntos
Óculos Inteligentes , Países em Desenvolvimento , Estudos de Viabilidade , Humanos , Coluna Vertebral/cirurgia , Tanzânia
18.
South Med J ; 115(8): 639-644, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35922053

RESUMO

OBJECTIVES: Telesimulation, in which learners and evaluators use technology to connect remotely to simulation-based learning activities, is effective for skills and decision-making review. Historical models in which learners are colocated with the simulation equipment have inherent issues, especially for emergency medical services (EMS) providers. This feasibility study placed the evaluators in the simulation center, whereas the learners were at a distance steering the scenario evolution through telehealth technologies. METHODS: Volunteer EMS providers across South Carolina with varying levels of training and experience completed difficult airway management scenarios focused on clinical decision making. The program consisted of pre- and postexperience examinations, a lecture, and increasingly complicated simulations using high-fidelity mannequins that were facilitated by local trainers under the direction of remote trainees. Audio and video content, including vital signs and cardiac monitoring, were live streamed. Participants worked in two-person teams with lead providers on each scenario clinically assessing and managing cases of anaphylaxis. Data were collected from the simulations using Laerdal software, as well as examination and survey results. RESULTS: A total of 24 participants completed all of the elements of the training. Trends toward improvement in times to bag-mask ventilation and initial epinephrine administration were noted. Average cognitive test scores increased by 9.6%, and learners reported improved comfort with simulation (75%, P ≥ 0.0001) and videoconferencing (83%, P ≥ 0.0001). They also reported high degrees of comfort with intubation (73.3%) following the training. CONCLUSIONS: This method of telesimulation appears to be a viable addition to continuing EMS education and may address access issues for some providers.


Assuntos
Serviços Médicos de Emergência , Manequins , Manuseio das Vias Aéreas , Estudos de Viabilidade , Humanos , South Carolina
19.
Zhongguo Yi Liao Qi Xie Za Zhi ; 46(4): 433-437, 2022 Jul 30.
Artigo em Chinês | MEDLINE | ID: mdl-35929161

RESUMO

This paper studies the necessity of the current legislation on the supervision of medical devices in China from the perspectives of strengthening administration according to law, protecting public health, perfecting the legal system of medicine and promoting the development of the medical device industry. This study analyzes and summarizes the legislative experiences and forms in the field of medical device regulation in the United States, the European Union, Japan and other countries and regions, at present, the conditions of carrying out the legislation of medical device supervision in China are quite mature, and some policy suggestions are put forward for the enactment of the law of medical device management in China.


Assuntos
Equipamentos e Provisões , Legislação de Dispositivos Médicos , União Europeia , Estudos de Viabilidade , Indústrias , Estados Unidos , United States Food and Drug Administration
20.
Anaesthesia ; 77(9): 999-1009, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35915923

RESUMO

Acute kidney injury is common after cardiac surgery. Vasoplegic hypotension may contribute to kidney injury, and different vasopressors may have variable effects on kidney function. We conducted a double-blind, randomised feasibility trial comparing peri-operative angiotensin-2 with noradrenaline. We randomly allocated 60 patients at two centres to a blinded equipotent angiotensin-2 or noradrenaline infusion intra-operatively and for up to 48 h postoperatively, titrated to mean arterial pressure of 70-80 mmHg. Primary feasibility outcomes included consent rate, protocol adherence, infusion duration, mean arterial pressure maintenance in the target range and major adverse outcomes. Secondary outcomes included kidney injury rate. The consent rate was 47%. Protocol adherence was 100% in the angiotensin-2 group and 94% in the noradrenaline group. Study drug duration was median (IQR [range]) 217 (160-270 [30-315]) vs. 185 (135-301 [0-480]) min (p = 0.78) min intra-operatively, and 5 (0-16 [0-48]) vs. 14.5 (4.8-29 [0-48]) hours (p = 0.075) postoperatively for angiotensin-2 and noradrenaline, respectively. The mean arterial pressure target was achieved postoperatively in 25 of 28 (89%) of the angiotensin-2 group and 27 of 32 (84%) of the noradrenaline group. One participant had a stroke, one required extracorporeal support and three required renal replacement therapy, all in the noradrenaline group (p = 0.99, p = 0.99 and p = 0.1). Acute kidney injury occurred in 7 of 28 in the angiotensin-2 group vs. 12 of 32 patients in the noradrenaline group (p = 0.31). This pilot study suggests that a trial comparing angiotensin-2 with noradrenaline is feasible. Its findings justify further investigations of angiotensin-2 in cardiac surgery.


Assuntos
Injúria Renal Aguda , Procedimentos Cirúrgicos Cardíacos , Injúria Renal Aguda/etiologia , Angiotensina II , Método Duplo-Cego , Estudos de Viabilidade , Humanos , Norepinefrina/uso terapêutico , Projetos Piloto
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