Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 74.804
Filtrar
1.
BMC Health Serv Res ; 21(1): 685, 2021 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-34247604

RESUMO

BACKGROUND: In sub-Saharan Africa, there is increasing mortality and morbidity of adolescents due to poor linkage, retention in HIV care and adherence to antiretroviral therapy (ART). This is a result of limited adolescent-centred service delivery interventions. This cost-effectiveness and feasibility study were piggybacked on a cluster-randomized trial that assessed the impact of an adolescent-centred service delivery intervention. The service delivery intervention examined the impact of an incentive scheme consisting of conditional economic incentives and motivational interviewing on the health outcomes of adolescents living with HIV in Nigeria. METHOD: A cost-effectiveness analysis from the healthcare provider's perspective was performed to assess the cost per additional patient achieving undetected viral load through the proposed intervention. The cost-effectiveness of the incentive scheme over routine care was estimated using the incremental cost-effectiveness ratio (ICER), expressed as cost/patient who achieved an undetectable viral load. We performed a univariate sensitivity analysis to examine the effect of key parameters on the ICER. An in-depth interview was conducted on the healthcare personnel in the intervention arm to explore the feasibility of implementing the service delivery intervention in HIV treatment hospitals in Nigeria. RESULT: The ICER of the Incentive Scheme intervention compared to routine care was US$1419 per additional patient with undetectable viral load. Going by the cost-effectiveness threshold of US$1137 per quality-adjusted life-years suggested by Woods et al., 2016, the intervention was not cost-effective. The sensitivity test showed that the intervention will be cost-effective if the frequency of CD4 count and viral load tests are reduced from quarterly to triannually. Healthcare professionals reported that patients' acceptance of the intervention was very high. CONCLUSION: The conditional economic incentives and motivational interviewing was not cost-effective, but can become cost-effective if the frequency of HIV quality of life indicator tests are performed 1-3 times per annum. Patients' acceptance of the intervention was very high. However, healthcare professionals believed that sustaining the intervention may be difficult unless factors such as government commitment and healthcare provider diligence are duly addressed. TRIAL REGISTRATION: This trial is registered in the WHO International Clinical Trials Registry through the WHO International Registry Network ( PACTR201806003040425 ).


Assuntos
Fármacos Anti-HIV , Infecções por HIV , Entrevista Motivacional , Adolescente , Fármacos Anti-HIV/uso terapêutico , Análise Custo-Benefício , Estudos de Viabilidade , Infecções por HIV/tratamento farmacológico , Humanos , Motivação , Nigéria , Avaliação de Resultados em Cuidados de Saúde , Qualidade de Vida
2.
J Infus Nurs ; 44(4): 199-202, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34197349

RESUMO

The emergence of the coronavirus disease 2019 (COVID-19) virus has increased in patients with acute respiratory distress syndrome (ARDS). The use of prone positioning during COVID-19-associated ARDS has led to improved oxygenation and decreased mortality. Extended hours of proning may delay or prevent traditional approaches to central vascular access, such as jugular, subclavian, or femoral cannulation. A peripherally inserted central catheter (PICC) is a viable option for prone patients. This article presents a PICC placement in a 56-year-old man with COVID-19 ARDS who required 20- to 24-hour prone positioning during his care in the intensive care unit. Insertion of a PICC while the patient is prone expedites lifesaving medications and infusions without waiting for the patient to be stable enough to be turned to the supine position.


Assuntos
COVID-19 , Enfermagem Cardiovascular , Cateterismo Periférico , Decúbito Ventral , COVID-19/complicações , COVID-19/terapia , Teste para COVID-19 , Estudos de Viabilidade , Febre/etiologia , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Síndrome do Desconforto Respiratório/complicações , Síndrome do Desconforto Respiratório/terapia
3.
Curr Oncol ; 28(3): 2248-2259, 2021 06 17.
Artigo em Inglês | MEDLINE | ID: mdl-34204531

RESUMO

Patients awaiting cancer treatment were classified as "vulnerable" and advised to shield to protect themselves from exposure to coronavirus during the pandemic. These measures can negatively impact patients. We sought to establish the feasibility and effects of a telehealth-delivered home-based prehabilitation program during the pandemic. Eligible patients were referred from multiple centers to a regional prehabilitation unit providing home-based prehabilitation. The enrolled patients received telehealth-delivered prehabilitation prior to surgery and/or during non-surgical cancer treatment, which included personalized training exercises, dietary advice, medical optimization therapies, and psychological support. The primary outcome was to investigate the feasibility of our program. The secondary outcome was to investigate the relationship between our program and patient-reported outcomes (PROs). The patients completed two questionnaires (the EQ-5D-3L and the FACIT-Fatigue Scale) pre- and post-intervention. A total of 182 patients were referred during the study period. Among the 139 (76%) patients that were enrolled, 100 patients completed the program, 24 patients have still to complete, and 15 have discontinued. A total of 66 patients were able to return completed questionnaires. These patients were recruited from colorectal, urology, breast, and cardiothoracic centers. The patients significantly improved their self-perceived health (p = 0.001), and fatigue (p = 0.000). Home-based prehabilitation is a feasible intervention. The PROs improved post-intervention.


Assuntos
COVID-19/epidemiologia , Neoplasias/terapia , Telemedicina/métodos , Idoso , Inglaterra , Exercício Físico , Estudos de Viabilidade , Feminino , Grupos Focais , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/psicologia , Medicina de Precisão/métodos , Cuidados Pré-Operatórios , Exercício Pré-Operatório , Estudos Prospectivos , Qualidade de Vida , Resultado do Tratamento
4.
Nat Commun ; 12(1): 4203, 2021 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-34244519

RESUMO

Alternative splicing generates differing RNA isoforms that govern phenotypic complexity of eukaryotes. Its malfunction underlies many diseases, including cancer and cardiovascular diseases. Comparative analysis of RNA isoforms at the genome-wide scale has been difficult. Here, we establish an experimental and computational pipeline that performs de novo transcript annotation and accurately quantifies transcript isoforms from cDNA sequences with a full-length isoform detection accuracy of 97.6%. We generate a searchable, quantitative human transcriptome annotation with 31,025 known and 5,740 novel transcript isoforms ( http://steinmetzlab.embl.de/iBrowser/ ). By analyzing the isoforms in the presence of RNA Binding Motif Protein 20 (RBM20) mutations associated with aggressive dilated cardiomyopathy (DCM), we identify 121 differentially expressed transcript isoforms in 107 cardiac genes. Our approach enables quantitative dissection of complex transcript architecture instead of mere identification of inclusion or exclusion of individual exons, as exemplified by the discovery of IMMT isoforms mis-spliced by RBM20 mutations. Thereby we achieve a path to direct differential expression testing independent of an existing annotation of transcript isoforms, providing more immediate biological interpretation and higher resolution transcriptome comparisons.


Assuntos
Processamento Alternativo , Cardiomiopatia Dilatada/genética , Miócitos Cardíacos/patologia , Proteínas de Ligação a RNA/genética , RNA-Seq/métodos , Sistemas CRISPR-Cas/genética , Cardiomiopatia Dilatada/patologia , Diferenciação Celular/genética , Linhagem Celular , Estudos de Viabilidade , Edição de Genes , Humanos , Células-Tronco Pluripotentes Induzidas , Proteínas Mitocondriais/genética , Anotação de Sequência Molecular , Proteínas Musculares/genética , Mutação , Isoformas de RNA/genética , RNA Guia/genética
5.
JSLS ; 25(2)2021.
Artigo em Inglês | MEDLINE | ID: mdl-34248330

RESUMO

Objective: To investigate outcomes and ascertain the safety and efficacy on patients having total laparoscopic hysterectomy (TLH), stratified by body mass index (BMI), focusing on high-BMI patients. Methods: This was a retrospective cohort study that reviewed 2,266 patients with benign gynecologic diagnoses, early cervical, endometrial, and ovarian carcinoma from September 1996 to October 2017. BMI was from 14.5 to 74.2 and were classified as normal or underweight (<24.9); overweight (25.0-29.9); class I obese (>30.0-34.9); class II obese (35-39.9); or class III obese (>40.0). All patients underwent TLH. Results: Patients' characteristics were similar across all BMI classes except for age, postoperative pathological diagnoses, and whether a cystoscopy was performed. Surgical duration, and estimated blood loss were similar across BMI classes. Overweight and obese class III patients had lower odds of staying >1 day compared to patients of normal BMI (OR = 0.65, P = .015). Obese class II patients had fewer complications compared to normal BMI patients (OR = 0.27, P = .013), but patients from other high BMI categories did not show any difference compared to patients with normal BMI. The rate of unplanned laparotomy was statistically, but not clinically, higher in obese class III patients (1.8% versus .7%, P = 0.011), most often due to large fibroids. The mean reoperation rate was 2.7%, with the lowest rate (.5%) among obese class II patients, and the highest rate (3.9%) among the normal BMI patients. Conclusion: TLH is feasible and safe for obese women, regardless of BMI. Obesity is not a contraindication to good outcomes from laparoscopic surgery.


Assuntos
Doenças dos Genitais Femininos/cirurgia , Histerectomia/efeitos adversos , Laparoscopia/efeitos adversos , Obesidade/complicações , Complicações Pós-Operatórias/etiologia , Adulto , Idoso , Índice de Massa Corporal , Contraindicações de Procedimentos , Estudos de Viabilidade , Feminino , Doenças dos Genitais Femininos/complicações , Humanos , Histerectomia/métodos , Laparoscopia/métodos , Laparotomia , Pessoa de Meia-Idade , Sobrepeso/complicações , Estudos Retrospectivos , Resultado do Tratamento
6.
JSLS ; 25(2)2021.
Artigo em Inglês | MEDLINE | ID: mdl-34248332

RESUMO

Introduction: Perioperative outcomes of bariatric surgery in patients with super super obesity (SSO) (BMI ≥ 60 kg/m2) merit further investigation. Methods: A retrospective review was conducted of patients with SSO who underwent surgery from Jun 2005 through Jun 2018 at a Metabolic and Bariatric Surgery Center of Excellence. Quantitative demographic data was summarized using descriptive statistics; categorical variables were compared using Fisher's exact test. Results: Two hundred fourteen procedures were performed, of which 208 were eligible for inclusion. Majority were female (65.4%). The mean age and BMI was 43 (17-68 years) and 65.9 kg/m2 (60 95 kg/m2), respectively. Comorbidities included: obstructive sleep apnea (74%), hypertension (59%), gastro-esophageal reflux disease (43%), osteoarthritis (41%), and diabetes mellitus (30%). Surgical approach: 97 Roux-en-Y gastric bypasses (46%), 88 laparoscopic sleeve gastrectomies (42%), and 23 adjustable gastric bands (11%). Additional subset included: primary (87%), conversion (7.7%), and revision (5.3%); majority being laparoscopic (75%) and robotic (24%). Complications via Clavien-Dindo classification: one Grade I, one Grade II, three Grade IIIa, three Grade IIIb, and three Grade IVa. Thirty-day events: 11 complications (5.3%; one leak [0.5%], one deep vein thrombosis [0.5%]), six re-admissions (3%), four re-operations (2%): repair of staple-line leak, repair of incisional hernia, uterine dilation and curettage, and cholecystectomy. No mortalities occurred. Complications occurred in 14.8% of conversion/revision cases, 3.9% in primary cases (p = 0.0395) with no difference observed between laparoscopic (4.5%) and robotic (6.1%) modalities (p = 0.7051). Conclusion: Bariatric surgery is feasible in patients with SSO. Revision procedures may increase risk of operative complications.


Assuntos
Cirurgia Bariátrica/estatística & dados numéricos , Índice de Massa Corporal , Obesidade Mórbida/cirurgia , Complicações Pós-Operatórias/epidemiologia , Adolescente , Adulto , Idoso , Cirurgia Bariátrica/métodos , Comorbidade , Estudos de Viabilidade , Feminino , Gastrectomia/métodos , Gastrectomia/estatística & dados numéricos , Derivação Gástrica/métodos , Derivação Gástrica/estatística & dados numéricos , Humanos , Laparoscopia/métodos , Laparoscopia/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/fisiopatologia , Complicações Pós-Operatórias/etiologia , Reoperação/métodos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
7.
JSLS ; 25(2)2021.
Artigo em Inglês | MEDLINE | ID: mdl-34248340

RESUMO

Background: Minimally invasive surgery is currently a preferred treatment for symptomatic ovarian cyst(s), with single-site techniques, such as transumbilical laparoendoscopic single-site surgery (TU-LESS) and transvaginal laparoendoscopic single-site surgery (TV-LESS), gaining increasing popularity. Although both methods have delivered positive outcomes, there is currently limited literature directly comparing TU-LESS and TV-LESS. Objectives: This study had two primary objectives: (1) to evaluate the safety and feasibility of TV-LESS and TU-LESS for the treatment of ovarian cysts and (2) to compare the surgical and postoperative outcomes of the two procedures. Method: This was a prospective observational clinical analysis of 81 patients with a diagnosis of benign ovarian cyst with indication for TV-LESS or TU-LESS. Surgeries were performed at a tertiary hospital between February 1, 2018 and January 31, 2020. Patients were divided into TV-LESS (n = 40) and TU-LESS groups (n = 40), with one excluded due to severe pelvic adhesive disease. Demographics, operation outcomes, and follow-up details were compared. Results: All 80 patients underwent uncomplicated procedures. The two groups were demographically matched (except age), with no difference in operation time, intra-operative blood loss, hemoglobin loss, and hospitalization costs (P > 0.05). However, TV-LESS patients had significantly faster time to ambulation (P < 0.001), faster time to return of bowel function (P < 0.001), less postoperative pain level (P < 0.001), and shorter length of hospital stay (P < 0.001). The cosmetic scores at 1, 4, and 24 weeks after surgery were also higher for the TV-LESS group. Conclusion: Our preliminary experience suggested that TU-LESS and TV-LESS are both feasible and safe for ovarian cystectomy and salpingo-oophorectomy. However, TV-LESS may provide three main advantages including: (1) fewer postoperative complications (i.e. incisional hernia); (2) less postoperative pain; and (3) improved cosmetic satisfaction.


Assuntos
Laparoscopia/métodos , Cistos Ovarianos/cirurgia , Ovariectomia/métodos , Umbigo/cirurgia , Vagina/cirurgia , Adulto , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Estudos de Viabilidade , Feminino , Humanos , Tempo de Internação , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Resultado do Tratamento
8.
Sensors (Basel) ; 21(13)2021 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-34203571

RESUMO

The increased use of sensor technology has been crucial in releasing the potential for remote rehabilitation. However, it is vital that human factors, that have potential to affect real-world use, are fully considered before sensors are adopted into remote rehabilitation practice. The smart sensor devices for rehabilitation and connected health (SENDoc) project assesses the human factors associated with sensors for remote rehabilitation of elders in the Northern Periphery of Europe. This article conducts a literature review of human factors and puts forward an objective scoring system to evaluate the feasibility of balance assessment technology for adaption into remote rehabilitation settings. The main factors that must be considered are: Deployment constraints, usability, comfort and accuracy. This article shows that improving accuracy, reliability and validity is the main goal of research focusing on developing novel balance assessment technology. However, other aspects of usability related to human factors such as practicality, comfort and ease of use need further consideration by researchers to help advance the technology to a state where it can be applied in remote rehabilitation settings.


Assuntos
Tecnologia de Sensoriamento Remoto , Tecnologia , Idoso , Europa (Continente) , Estudos de Viabilidade , Humanos , Reprodutibilidade dos Testes
9.
Glob Heart ; 16(1): 42, 2021 06 08.
Artigo em Inglês | MEDLINE | ID: mdl-34211828

RESUMO

Background: QTc prolongation is an adverse effect of COVID-19 therapies. The use of a handheld device in this scenario has not been addressed. Objectives: To evaluate the feasibility of QTc monitoring with a smart device in COVID-19 patients receiving QTc-interfering therapies. Methods: Prospective study of consecutive COVID-19 patients treated with hydroxychloroquine ± azithromycin ± lopinavir-ritonavir. ECG monitoring was performed with 12-lead ECG or with KardiaMobile-6L. Both registries were also sequentially obtained in a cohort of healthy patients. We evaluated differences in QTc in COVID-19 patients between three different monitoring strategies: 12-lead ECG at baseline and follow-up (A), 12-lead ECG at baseline and follow-up with the smart device (B), and fully monitored with handheld 6-lead ECG (group C). Time needed to obtain an ECG registry was also documented. Results: One hundred and eighty-two COVID-19 patients were included (A: 119(65.4%); B: 50(27.5%); C: 13(7.1%). QTc peak during hospitalization did significantly increase in all groups. No differences were observed between the three monitoring strategies in QTc prolongation (p = 0.864). In the control group, all but one ECG registry with the smart device allowed QTc measurement and mean QTc did not differ between both techniques (p = 0.612), displaying a moderate reliability (ICC 0.56 [0.19-0.76]). Time of ECG registry was significantly longer for the 12-lead ECG than for handheld device in both cohorts (p < 0.001). Conclusion: QTc monitoring with KardiaMobile-6L in COVID-19 patients was feasible. Time of ECG registration was significantly lower with the smart device, which may offer an important advantage for prevention of virus dissemination among healthcare providers.


Assuntos
COVID-19/tratamento farmacológico , Eletrocardiografia/métodos , Síndrome do QT Longo/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/efeitos adversos , Antivirais/efeitos adversos , Azitromicina/efeitos adversos , Combinação de Medicamentos , Eletrocardiografia/instrumentação , Inibidores Enzimáticos/efeitos adversos , Estudos de Viabilidade , Feminino , Humanos , Hidroxicloroquina/efeitos adversos , Síndrome do QT Longo/induzido quimicamente , Lopinavir/efeitos adversos , Masculino , Pessoa de Meia-Idade , Sistemas Automatizados de Assistência Junto ao Leito , Estudos Prospectivos , Reprodutibilidade dos Testes , Ritonavir/efeitos adversos , SARS-CoV-2
10.
Adv Mind Body Med ; 35(3): 20-30, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34237026

RESUMO

Context: Opioid use disorder (OUD) involves excessive use of opioids-such as heroin, morphine, fentanyl, codeine, oxycodone, and hydrocodone-leading to major health, social, and economic consequences. Yoga lifestyle interventions have been found to be useful as adjunct therapies in management of substance use disorders and chronic pain conditions. Objective: The research team intended to develop, validate, and test for feasibility a yoga program for OUD patients that could reduce opiate withdrawal symptoms-such as pain, fatigue, low mood, anxiety and sleep disturbances-and cravings associated with drugs. Design: The research team first performed a literature review of traditional and contemporary yoga texts, such as Hatha Yoga Pradipika and Light on Yoga, as well as modern scientific literature in the following search engines-Google Scholar, PubMed, and PsychInfo, using the keywords yoga, pranayama, hatha yoga, relaxation. meditation, substance use, addiction, impulsivity, craving, sleep quality, and fatigue. Using the information obtained, the team developed a yoga program and designed a pilot study that used the program. Setting: The study took place in the Department of Integrative Medicine at the National Institute of Mental Health and Neurosciences (NIMHANS) in Bangalore, India. Participants: Participants in the pilot study were 8 inpatients, 6 males and 2 females, who were on opioid agonist treatment (buprenorphine) for OUD. Intervention: The intervention was the yoga program previously validated by the research team. In the pilot study, participants were taught a one-hour, yoga-based intervention, with sessions occurring once per day, for 10 sessions. Outcome Measures: For validation, 13 experts scored the yoga program that the research team had developed and gave suggestions for each yogic practice for use during the acute phase of withdrawal and the maintenance phase respectively. A content validity ratio (CVR) was calculated from their scoring, and the research team made changes to the program base on the scoring and suggestions. For the pilot study, assessments occurred at baseline and postintervention. The participants' yoga performance was rated by the yoga trainer on a yoga performance assessment scale (YPA). Other measurements included: (1) the Clinical Opiate Withdrawal Scale (COWS), (2) the Hamilton's anxiety rating scale (HAM-A), (3) the Hamilton's depression rating scale (HAM-D), (4) buprenorphine dosage, (5) the Clinical Global Impression Severity (CGI-S) scale, (6) a visual analog scale (VAS) for pain, (7) sleep quality (latency and duration), and (8) the module's safety. Results: Four practices were removed from the program due to CVR scores below the cutoff, and one practice was found not to be feasible (Kapalabhati). Two categories of yoga modules emerged: (1) for the acute symptomatic phase (40 minutes) and (2) for the maintenance phase (one hour). Practices were added or excluded based on the phase. Conclusions: The yoga module that was developed for reducing withdrawal symptoms and cravings in OUD patients was found to be safe, feasible, and potentially useful as an adjunct therapy to conventional treatment.


Assuntos
Meditação , Transtornos Relacionados ao Uso de Opioides , Ioga , Estudos de Viabilidade , Feminino , Humanos , Índia , Masculino , Transtornos Relacionados ao Uso de Opioides/terapia , Projetos Piloto
11.
Artigo em Inglês | MEDLINE | ID: mdl-34204871

RESUMO

BACKGROUND: mobile applications (apps) facilitate cancer pain ecological momentary assessment (EMA) and provide more reliable data than retrospective monitoring. The aims of this study are (a) to describe the status of persons with cancer pain when assessed ecologically, (b) to analyze the utility of clinical alarms integrated into the app, and (c) to test the feasibility of implementing an app for daily oncological pain monitoring. METHODS: in this feasibility study, 21 patients (mean age = 56.95 years, SD = 10.53, 81.0% men) responded to an app-based evaluation of physical status (baseline and breakthrough cancer pain (BTcP)) and mental health variables (fatigue, mood, and coping) daily during 30 days. RESULTS: cancer pain characterization with the app was similar to data from the literature using retrospective assessments in terms of BTcP duration and perceived medication effectiveness. However, BTcP was less frequent when evaluated ecologically. Pain, fatigue, and mood were comparable in the morning and evening. Passive coping strategies were the most employed daily. Clinical alarms appear to be useful to detect and address adverse events. App implementation was feasible and acceptable. CONCLUSION: apps reduce recall bias and facilitate a rapid response to adverse events in oncological care. Future efforts should be addressed to integrate EMA and ecological momentary interventions to facilitate pain self-management via apps.


Assuntos
Dor do Câncer , Aplicativos Móveis , Neoplasias , Dor do Câncer/diagnóstico , Dor do Câncer/terapia , Avaliação Momentânea Ecológica , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Estudos Retrospectivos , Smartphone
12.
Artigo em Inglês | MEDLINE | ID: mdl-34206050

RESUMO

(1) A climate change awareness-action gap still prevails in our society, with individuals showing significant social inertia regarding environmental issues. The communication on climate change is pointed out as one of the causes of the social inertia; (2) Following an action-oriented transformation research, the main goal of this study was to ascertain the feasibility of an action-based communication intervention, based on the participants' exposure to a post climate-related disaster scenario. The feasibility of the action-based communication intervention was assessed in a focus group meeting, whose content was qualitatively analysed; (3) The results of this study demonstrate that action-based communication interventions are feasible to trigger an attitude transformation, catalysed by the experiential processing of climate change and by the affect arousal; (4) This study comes to contribute to a transformation of the climate change communication praxis, by highlighting the urgency to shift the for a new paradigm of communicating climate change, in which the affect and the experiential processing should account for conveying environment-related information in order to promote society's climate action.


Assuntos
Mudança Climática , Desastres , Comunicação , Estudos de Viabilidade , Humanos , Motivação
13.
Trials ; 22(1): 440, 2021 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-34243806

RESUMO

The COVID-19 pandemic has posed challenges to the conduct of clinical trials. Strategies for overcoming common challenges to non-COVID-19 trial continuation have been reported, but this literature is limited to pharmacological intervention trials from high-income settings. The purpose of this paper is to expand the literature to include a low- and middle-income country perspective. We describe the challenges posed by COVID-19 for a randomised feasibility trial of a psychological intervention for adolescents in Cape Town, South Africa, and lessons learned when implementing strategies to facilitate trial continuation in this context. We used a Plan-Do-Study-Act cycle method to explore whether our adaptations were having the desired effect on trial accrual and retention. We found that stakeholder engagement, trial coordination and team communication need to be intensified while testing these procedural changes. We learned that strategies found to be effective in high-income countries required significant adaptation to our resource-constrained setting. The detailed documentation of extraneous influences, procedural changes and trial process information was essential to guiding decisions about which adaptations to retain. This information will be used to examine the potential impact of these changes on study outcomes. We hope that these reflections will be helpful to other trialists from low- and middle-income countries grappling with how to minimise the impact of public health emergencies on their research. TRIAL REGISTRATION: The trial is registered with the Pan African Clinical Trials Registry (PACTR20200352214510). Registered 28 February 2020.   https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=9795 .


Assuntos
COVID-19 , Adolescente , Estudos de Viabilidade , Humanos , Pandemias , Intervenção Psicossocial , SARS-CoV-2 , África do Sul
14.
Trials ; 22(1): 471, 2021 Jul 21.
Artigo em Inglês | MEDLINE | ID: mdl-34289893

RESUMO

BACKGROUND: Surgical site infection is the most common complication of abdominal surgery, with a global impact on patients and health systems. There are no tools to identify wound infection that are validated for use in the global setting. The overall aim of the study described in this protocol is to evaluate the feasibility and validity of a remote, digital pathway for wound assessment after hospital discharge for patients in low- and middle-income countries (LMICs). METHODS: A multi-centre, international, mixed-methods study within a trial, conducted in two stages (TALON-1 and TALON-2). TALON-1 will adapt and translate a universal reporter outcome measurement tool (Bluebelle Wound Healing Questionnaire, WHQ) for use in global surgical research (SWAT store registration: 126) that can be delivered over the telephone. TALON-2 will evaluate a remote wound assessment pathway (including trial retention) and validate the diagnostic accuracy of this adapted WHQ through a prospective cohort study embedded within two global surgery trials. Embedded community engagement and involvement activities will be used to optimise delivery and ensure culturally attuned conduct. TALON-1 and TALON-2 are designed and will be reported in accordance with best practice guidelines for adaptation and validation of outcome measures, and diagnostic test accuracy studies. DISCUSSION: Methods to identify surgical site infection after surgery for patients after hospital discharge have the potential to improve patient safety, trial retention, and research efficiency. TALON represents a large, pragmatic, international study co-designed and delivered with LMIC researchers and patients to address an important research gap in global surgery trial methodology.


Assuntos
Países em Desenvolvimento , Infecção da Ferida Cirúrgica , Estudos de Viabilidade , Humanos , Estudos Prospectivos , Infecção da Ferida Cirúrgica/diagnóstico , Inquéritos e Questionários , Telefone , Cicatrização
15.
Front Public Health ; 9: 661615, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34291025

RESUMO

Background: Mathematical models are powerful tools to study COVID-19. However, one fundamental challenge in current modeling approaches is the lack of accurate and comprehensive data. Complex epidemiological systems such as COVID-19 are especially challenging to the commonly used mechanistic model when our understanding of this pandemic rapidly refreshes. Objective: We aim to develop a data-driven workflow to extract, process, and develop deep learning (DL) methods to model the COVID-19 epidemic. We provide an alternative modeling approach to complement the current mechanistic modeling paradigm. Method: We extensively searched, extracted, and annotated relevant datasets from over 60 official press releases in Hubei, China, in 2020. Multivariate long short-term memory (LSTM) models were developed with different architectures to track and predict multivariate COVID-19 time series for 1, 2, and 3 days ahead. As a comparison, univariate LSTMs were also developed to track new cases, total cases, and new deaths. Results: A comprehensive dataset with 10 variables was retrieved and processed for 125 days in Hubei. Multivariate LSTM had reasonably good predictability on new deaths, hospitalization of both severe and critical patients, total discharges, and total monitored in hospital. Multivariate LSTM showed better results for new and total cases, and new deaths for 1-day-ahead prediction than univariate counterparts, but not for 2-day and 3-day-ahead predictions. Besides, more complex LSTM architecture seemed not to increase overall predictability in this study. Conclusion: This study demonstrates the feasibility of DL models to complement current mechanistic approaches when the exact epidemiological mechanisms are still under investigation.


Assuntos
COVID-19 , Aprendizado Profundo , China , Estudos de Viabilidade , Humanos , Pandemias , SARS-CoV-2
16.
Trials ; 22(1): 456, 2021 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-34271984

RESUMO

BACKGROUND: Non-suicidal self-injury (NSSI) has a lifetime prevalence of 17% in adolescents in the general population and up to 74% in adolescents with psychiatric disorders. NSSI is one of the most important predictors of later suicidal behaviour and death by suicide. The TEENS feasibility trial was initiated to assess the feasibility and safety of Internet-based Emotion Regulation Individual Therapy for Adolescents (ERITA) as an add-on to treatment as usual in 13-17-year-old patients with NSSI referred to the Child and Adolescent Mental Health Services. METHODS: The TEENS feasibility trial is a randomised clinical trial with a parallel-group design. The trial intervention is an 11-week online therapy which is tested as an add-on to treatment as usual versus treatment as usual. The primary feasibility outcomes are the fraction of participants who (1) completed 12 weeks of follow-up interview or assessment, (2) consented to inclusion and randomisation out of all eligible participants, and (3) were compliant with the experimental intervention, assessed as completion of at least six out of eleven modules in the programme. Since this is a feasibility trial, we did not predefine a required sample size. The exploratory clinical outcome, the frequency of NSSI episodes, assessed using Deliberate Self-Harm Inventory - Youth version (DSHI-Y), at the end of intervention, is planned to be the future primary outcome in a larger pragmatic definitive randomised clinical trial. After completion of the feasibility trial, blinded data will be analysed by two independent statisticians blinded to the intervention, where 'A' and 'B' refer to the two groups. A third party will compare these reports, and discrepancies will be discussed. The statistical report with the analyses chosen for the manuscript is being tracked using a version control system, and both statistical reports will be published as a supplementary material. Based on the final statistical report, two blinded conclusions will be drawn by the steering group. DISCUSSION: We present a pre-defined statistical analysis plan for the TEENS feasibility trial, which limits bias, p-hacking, data-driven interpretations. This statistical analysis plan is accompanied by a pre-programmed version-controlled statistical report with simulated data, which increases transparency and reproducibility. TRIAL REGISTRATION: ClinicalTrials.gov NCT04243603 . Registered on 28 January 2020.


Assuntos
Regulação Emocional , Intervenção Baseada em Internet , Comportamento Autodestrutivo , Adolescente , Criança , Estudos de Viabilidade , Humanos , Reprodutibilidade dos Testes , Comportamento Autodestrutivo/diagnóstico , Comportamento Autodestrutivo/terapia , Resultado do Tratamento
17.
Nat Commun ; 12(1): 4419, 2021 07 20.
Artigo em Inglês | MEDLINE | ID: mdl-34285208

RESUMO

Electroadhesion, i.e., adhesion induced by an electric field, occurs between non-sticky cationic and anionic hydrogels. Here, we demonstrate electroadhesion between cationic gels and animal (bovine) tissues. When gel and tissue are placed under an electric field (DC, 10 V) for 20 s, the pair strongly adhere, and the adhesion persists indefinitely thereafter. Applying the DC field with reversed polarity eliminates the adhesion. Electroadhesion works with the aorta, cornea, lung, and cartilage. We demonstrate the use of electroadhesion to seal cuts or tears in tissues or model anionic gels. Electroadhered gel-patches provide a robust seal over openings in bovine aorta, and a gel sleeve is able to rejoin pieces of a severed gel tube. These studies raise the possibility of using electroadhesion in surgery while obviating the need for sutures. Advantages include the ability to achieve adhesion on-command, and moreover the ability to reverse this adhesion in case of error.


Assuntos
Hidrogéis/administração & dosagem , Procedimentos Cirúrgicos sem Sutura/métodos , Ferimentos e Lesões/cirurgia , Testes de Impedância Acústica , Adesividade , Animais , Aorta/cirurgia , Bovinos , Estudos de Viabilidade , Humanos , Hidrogéis/química , Teste de Materiais , Resistência ao Cisalhamento
18.
Nat Commun ; 12(1): 4416, 2021 07 20.
Artigo em Inglês | MEDLINE | ID: mdl-34285220

RESUMO

In multicellular organisms, expression profiling in spatially defined regions is crucial to elucidate cell interactions and functions. Here, we establish a transcriptome profiling method coupled with photo-isolation chemistry (PIC) that allows the determination of expression profiles specifically from photo-irradiated regions of interest. PIC uses photo-caged oligodeoxynucleotides for in situ reverse transcription. PIC transcriptome analysis detects genes specifically expressed in small distinct areas of the mouse embryo. Photo-irradiation of single cells demonstrated that approximately 8,000 genes were detected with 7 × 104 unique read counts. Furthermore, PIC transcriptome analysis is applicable to the subcellular and subnuclear microstructures (stress granules and nuclear speckles, respectively), where hundreds of genes can be detected as being specifically localised. The spatial density of the read counts is higher than 100 per square micrometre. Thus, PIC enables high-depth transcriptome profiles to be determined from limited regions up to subcellular and subnuclear resolutions.


Assuntos
Perfilação da Expressão Gênica/métodos , Regulação da Expressão Gênica no Desenvolvimento , Análise Espacial , Transcriptoma/genética , Animais , Encéfalo/crescimento & desenvolvimento , Embrião de Mamíferos , Estudos de Viabilidade , Técnicas Genéticas , Células HeLa , Humanos , Masculino , Camundongos , Células NIH 3T3 , Oligodesoxirribonucleotídeos/química , Oligodesoxirribonucleotídeos/genética , Oligodesoxirribonucleotídeos/efeitos da radiação , Transcrição Reversa/efeitos da radiação , Transcriptoma/efeitos da radiação , Raios Ultravioleta
19.
Artigo em Chinês | MEDLINE | ID: mdl-34304516

RESUMO

Objective:To explore the value of indocyanine green(ICG) combined with methylene blue in the identification of sentinel lymph nodes(SLNs) in patients diagnosed with papillary thyroid microcarcinoma(PTMC). Methods:Ninety patients were enrolled and were randomized into group A and group B with 45 patients in each group. ICG combined with methylene blue were injected into the thyroid in group A, and only methylene blue were injected into thyroid in group B. Blue-stained or fluorescent nodes observed using near-infrared fluorescence imaging systems were defined as SLNs. After SLNs were removed, central lymph nodes(CLNs) dissection was completed in both groups. The pathological data and postoperative outcomes were compared between two groups. Results:There were significantly more SLNs(2.93/2.17) and CLNs(4.51/3.89) were dissected in group A than in group B(P<0.05). There were no significant differences in sensitivity, accuracy and the false-negative rate according the SLNs in two groups(P>0.05), but group A has higher sensitivity and accuracy rates, and lower false-negative rate. There were no significant differences in the amount of blood loss, the amount of lymphatic drainage, and incidence of hoarseness and lymphatic leakage in two groups(P>0.05). In group A, the operating time was longer, and the rate of hypoparathyroidism was lower(P<0.05). Conclusion:Sentinel lymph nodes biopsy using ICG combined with methylene blue is feasible and safe for SLNs identification in PTMC patients. It is also clinically significant for the parathyroid gland protection.


Assuntos
Linfonodo Sentinela , Carcinoma Papilar , Corantes , Estudos de Viabilidade , Humanos , Verde de Indocianina , Linfonodos/diagnóstico por imagem , Azul de Metileno , Biópsia de Linfonodo Sentinela , Neoplasias da Glândula Tireoide
20.
Artigo em Chinês | MEDLINE | ID: mdl-34304530

RESUMO

Objective:To evaluate the feasibility and efficacy of a thyroid cartilage window resection(TCWR) technique for transoral CO2 laser resection of early glottic cancer with involvement of the anterior commissure. Methods:Twenty-one patient who underwent a TCWR technique for transoral CO2 laser resection early glottic carcinoma involving the anterior commissure, were retrospectively analyzed. Indices including margin status, perioperative comorbidities, voice outcomes, local control rate and recurrence free survival, were assessed. Results:All 21 patients underwent a TCWR technique for resection, the organ preservation rate and negative margin achieved 100%. The local control rate achieved 100%. For two patients with subglottic involvement(9.5%), regional recurrence with confirmation of a positive pre-laryngeal lymph node was subsequently observed; and the 5 years recurrence free survival was 90.5%. Postoperative granulomas were detected in all 21 patients in 4 weeks postoperatively, 13 of which(61.9%) spontaneously disappeared; whereas the remaining 8 patients(38.1%) demonstrated consistent presence of granuloma more than 12 weeks and underwent an additional surgical extirpation under topical anesthesia. Despite the laryngeal web developed in all 21 patients, no dyspnea and laryngeal stenosis occurred at the time of analysis. By comparison with preoperative baseline, postoperative self-assessment voice demonstrated a significant improvement(P=0.01), while objective voice indices were not significantly altered(P>0.05). Conclusion:TCWR technique is a valuable means for transoral CO2 laser resection of early glottic laryngeal cancer involving the anterior commissure, with favorable voice quality and seemingly low comorbidities, which can effectively improve the safety of the anterior resection margin.


Assuntos
Carcinoma de Células Escamosas , Neoplasias Laríngeas , Terapia a Laser , Lasers de Gás , Carcinoma de Células Escamosas/cirurgia , Estudos de Viabilidade , Glote/cirurgia , Humanos , Neoplasias Laríngeas/cirurgia , Microcirurgia , Recidiva Local de Neoplasia/cirurgia , Estudos Retrospectivos , Cartilagem Tireóidea
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...