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1.
Medicine (Baltimore) ; 99(33): e21664, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32872030

RESUMO

BACKGROUND: Infantile fever is a common symptom of the pediatric diseases, which is often caused by cold, food accumulation, or other pathogenic factors. Pediatric tuina is regarded as an acceptable non-pharmaceutical therapy for children with optimal effects, which has been widely used for infantile fever around China. But there is still a lack of systematic evaluation and research on its safety and effectiveness during the treatment of infantile fever. Thus the protocol is to collect clinical evidence and demonstrate the efficacy and safety of antipyretic manipulation by pediatric tuina. METHODS: The systematic electronic search will be executed in Cochrane Library (1991-2020.6), EMBASE (1980-2020.6), PubMed (1996-2020.6), WHOICTRP (2004-2020.6), Web of Science (1900-2020.6), CNKI (1994-2020.6), CBM (1994-2020.6), WANFANG (1980-2020.6), and VIP (2000-2020.6) Database. The Review Manager (V.5.3) will be use to assess the risk of bias and data analyses. The methodological quality will be assessed by using the online GRADEpro tool. If the quality of numeric data is favorable, a meta-analysis will be carried out. RESULTS: A high-quality evidence of pediatric tuina for the treatment of infantile fever. CONCLUSION: The systematic review will provide a reliable basis for judging whether pediatric tuina is safe and effective in the treatment of pediatric fever. INPLASY REGISTRATION NUMBER: INPLASY202060032.


Assuntos
Febre/terapia , Medicina Tradicional Chinesa/métodos , Adolescente , Criança , Feminino , Humanos , Masculino , Metanálise como Assunto , Revisões Sistemáticas como Assunto
2.
Epidemiol Infect ; 148: e174, 2020 08 07.
Artigo em Inglês | MEDLINE | ID: mdl-32762783

RESUMO

Coronavirus disease 2019 (COVID-19) is a global health threat. A hospital in Zhuhai adopted several measures in Fever Clinic Management (FCM) to respond to the outbreak of COVID-19. FCM has been proved to be effective in preventing nosocomial cross infection. Faced with the emergency, the hospital undertook creative operational steps in relation to the control and spread of COVID-19, with special focuses on physical and administrative layout of buildings, staff training and preventative procedures. The first operational step was to set up triaging stations at all entrances and then complete a standard and qualified fever clinic, which was isolated from the other buildings within our hospital complex. Secondly, the hospital established its human resource reservation for emergency response and the allocation of human resources to ensure strict and standardised training methods through the hospital for all medical staff and ancillary employees. Thirdly, the hospital divided the fever clinic into partitioned areas and adapted a three-level triaging system. The experiences shared in this paper would be of practical help for the facilities that are encountering or will encounter the challenges of COVID-19, i.e. to prevent nosocomial cross infection among patients and physicians.


Assuntos
Infecções por Coronavirus/terapia , Serviços Médicos de Emergência/métodos , Arquitetura Hospitalar/métodos , Pneumonia Viral/terapia , China/epidemiologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/prevenção & controle , Surtos de Doenças , Serviços Médicos de Emergência/organização & administração , Serviços Médicos de Emergência/normas , Febre/diagnóstico , Febre/etiologia , Febre/terapia , Arquitetura Hospitalar/normas , Humanos , Pandemias/prevenção & controle , Equipamento de Proteção Individual , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Ensino , Fatores de Tempo , Triagem/métodos , Ventilação/normas , Fluxo de Trabalho , Recursos Humanos/organização & administração , Recursos Humanos/normas
3.
Am J Case Rep ; 21: e925779, 2020 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-32790652

RESUMO

BACKGROUND Coronavirus disease 2019 (COVID-19) infection commonly presents as fever, cough, and shortness of breath in adults. Children are thought to have milder respiratory symptoms and to recover more quickly. We describe a new presentation of COVID-19 infection in children consisting of multisystem inflammation with decreased left ventricular function and evidence of lung disease. CASE REPORT Three children presented with fever, conjunctivitis, dry and cracked lips, rash, and/or cervical lymphadenopathy for at least 5 days. Two of these children required mechanical ventilation, and 1 of the 2 needed extracorporeal membrane oxygenation (ECMO) to support cardiorespiratory function. All of these children had moderate to severe hyponatremia and lymphopenia, which is usually seen in COVID-19. They were treated with intravenous immunoglobulin and high-dose aspirin. All of the children recovered. CONCLUSIONS Early recognition of children with multisystem inflammation is important because they are at increased risk for deterioration. Treatment with intravenous immunoglobulin and aspirin was used because this regimen has been shown to be beneficial in vasculitis of Kawasaki disease. The development of shock due to cardiac involvement may require ECMO.


Assuntos
Betacoronavirus , Infecções por Coronavirus/diagnóstico , Pneumonia Viral/diagnóstico , Síndrome de Resposta Inflamatória Sistêmica/virologia , Antipiréticos/uso terapêutico , Aspirina/uso terapêutico , Criança , Pré-Escolar , Conjuntivite/terapia , Conjuntivite/virologia , Infecções por Coronavirus/terapia , Exantema/terapia , Exantema/virologia , Oxigenação por Membrana Extracorpórea , Feminino , Febre/terapia , Febre/virologia , Insuficiência Cardíaca/terapia , Insuficiência Cardíaca/virologia , Humanos , Hiponatremia/terapia , Hiponatremia/virologia , Imunoglobulinas Intravenosas , Linfadenopatia/terapia , Linfadenopatia/virologia , Linfopenia/terapia , Linfopenia/virologia , Masculino , Pandemias , Pneumonia Viral/terapia , Respiração Artificial , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Síndrome de Resposta Inflamatória Sistêmica/terapia , Vasculite/terapia , Vasculite/virologia
4.
J Korean Med Sci ; 35(22): e210, 2020 Jun 08.
Artigo em Inglês | MEDLINE | ID: covidwho-574614

RESUMO

We report a rapidly deteriorating coronavirus disease 2019 (COVID-19) patient, a-58-year-old woman, with severe acute respiratory distress syndrome and shock with hyperpyrexia up to 41.8°C, probably due to the cytokine storm syndrome. Considering extracorporeal membrane oxygenation (ECMO) as the last resort, we applied therapeutic temperature modulation for management of hyperpyrexia. The patient demonstrated rapid improvement in oxygenation and shock after achieving normothermia, and fully recovered from COVID-19 three weeks later. Therapeutic temperature modulation may have successfully offloaded the failing cardiorespiratory system from metabolic cost and hyperinflammation induced by hyperpyrexia. The therapeutic temperature modulation can safely be applied in a specific group of patients with cytokine storm syndrome and hyperpyrexia, which may reduce the number of patients requiring ECMO in the global medical resource shortage.


Assuntos
Infecções por Coronavirus/patologia , Infecções por Coronavirus/terapia , Crioterapia/métodos , Febre/terapia , Pneumonia Viral/patologia , Pneumonia Viral/terapia , Betacoronavirus , Estado Terminal/terapia , Síndrome da Liberação de Citocina/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Pandemias , Choque/terapia
5.
J Korean Med Sci ; 35(22): e210, 2020 Jun 08.
Artigo em Inglês | MEDLINE | ID: mdl-32508069

RESUMO

We report a rapidly deteriorating coronavirus disease 2019 (COVID-19) patient, a-58-year-old woman, with severe acute respiratory distress syndrome and shock with hyperpyrexia up to 41.8°C, probably due to the cytokine storm syndrome. Considering extracorporeal membrane oxygenation (ECMO) as the last resort, we applied therapeutic temperature modulation for management of hyperpyrexia. The patient demonstrated rapid improvement in oxygenation and shock after achieving normothermia, and fully recovered from COVID-19 three weeks later. Therapeutic temperature modulation may have successfully offloaded the failing cardiorespiratory system from metabolic cost and hyperinflammation induced by hyperpyrexia. The therapeutic temperature modulation can safely be applied in a specific group of patients with cytokine storm syndrome and hyperpyrexia, which may reduce the number of patients requiring ECMO in the global medical resource shortage.


Assuntos
Infecções por Coronavirus/patologia , Infecções por Coronavirus/terapia , Crioterapia/métodos , Febre/terapia , Pneumonia Viral/patologia , Pneumonia Viral/terapia , Betacoronavirus , Estado Terminal/terapia , Síndrome da Liberação de Citocina/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Pandemias , Choque/terapia
9.
Arch. argent. pediatr ; 118(2): 89-: I-94, II, abr. 2020. tab, ilus
Artigo em Inglês, Espanhol | LILACS, BINACIS | ID: biblio-1099856

RESUMO

Introducción. La fiebre en pediatría es motivo de consulta frecuente. El objetivo fue evaluar los conocimientos, actitudes y temores de los padres ante la fiebre de sus hijos.Material y métodos. Estudio observacional, analítico, transversal. En 2018, se realizó una encuesta a padres de niños de entre 6 meses y 5 años que asistieron al Hospital de Niños Ricardo Gutiérrez de la Ciudad de Buenos Aires.Se analizó la asociación entre las variables sociodemográficas y los conocimientos, actitudes y temores frente al cuadro febril.Resultados. Se realizaron 201 encuestas. El 56,7 % de los padres consideró que la fiebre era mala para la salud. El 37 % definió fiebre entre 37 °C y 37,5 °C, y el 59 %, 38-38,5 ºC. La media de temperatura considerada grave fue 39,2 °C (desvío estándar 0,69). El 93 % de los cuidadores utilizaba medidas físicas; el 97 % administraba antitérmicos y el 14,5 % los alternaba. Los temores a las consecuencias fueron, en el 82 %, convulsiones; en el 41 %, deshidratación; en el 18 %, daño cerebral y, en el 12 %, muerte. El 86,5 % despertaba a sus hijos para administrarles antitérmico. En el estrato de mayor instrucción materna, fue menor el temor a la fiebre (odds ratio0,5; intervalo de confianza del 95 %: 0,28-0,91).Conclusiones. Un tercio de los encuestados consideró fiebre valores bajos de temperatura. El temor a la fiebre fue elevado y el nivel de instrucción materna podría mitigarlo.


Introduction. In pediatrics, fever is a common reason for consultation. The objective was to assess parental knowledge, behaviors, and fears in the management of fever in their children.Materials and methods. Observational, analytical, cross-sectional study. In 2018, a survey was administered to the parents of children aged 6 months to 5 years who attended Hospital de Niños Ricardo Gutiérrez, in the Autonomous City of Buenos Aires. The association between sociodemographic outcome measures and knowledge, behaviors, and fears in cases of fever was analyzed.Results. A total of 201 surveys were completed: 56.7 % of parents considered that fever was bad for health; 37 % defined fever between 37 °C and 37.5 °C, and 59 %, between 38 °C and 38.5 °C. The mean temperature considered severe was 39.2 °C (standard deviation: 0.69). Physical methods were used by 93 % of caregivers; 97 % administered antipyretic agents, and 14.5 % used alternating agents. Fears of consequences included seizures in 82 %, dehydration in 41 %, brain damage in 18 %, and death in 12 %. Also, 86.5 % woke up their children to give them an antipyretic agent. Among the higher maternal education level, fear of fever was lower (odds ratio: 0.5; 95 % confidence interval: 0.28-0.91).Conclusions. One-third of survey respondents considered low body temperature values as fever. Fear of fever was high, and the level of maternal education may mitigate it.


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Adulto , Conhecimentos, Atitudes e Prática em Saúde , Gerenciamento Clínico , Febre/terapia , Pais , Estudos Transversais , Inquéritos e Questionários , Antipiréticos/uso terapêutico , Febre/diagnóstico
10.
Paediatr Drugs ; 22(3): 243-250, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32342289

RESUMO

Periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) syndrome is characterized by recurrent fever flares accompanied by symptoms and signs forming the disease acronym and alternating with asymptomatic periods. Despite the disease having a generally favorable outcome, with spontaneous remission after a few years, it does have a major impact on the quality of life of the child and his or her relatives. Beside symptomatic medications during fever flares, the most used treatment consists of a single dose of corticosteroids at flare onset to interrupt the attack; fever resolves usually within a few hours, but often with a shorter interval between the attacks. For these patients, colchicine has been shown to decrease the frequency of the flares. Other medications were also reported in case series of patients with PFAPA syndrome. These include the interleukin-1 blocker anakinra to treat flares, cimetidine (which showed no convincing effect), and other drugs with anecdotal use. The pediatrician faces a difficult question: should they wait for spontaneous disease resolution and only treat the flares medically, or should they propose tonsillectomy that may induce remission? Due to the lack of strong evidence, the answer will vary on an individual basis, depending on the impact on the patient's quality of life. The choice of the best therapeutic strategy will be based on the response to the flare-based therapy and on disease severity (quality of life, school performances); long-term data on the remission rate under the different therapeutic strategies are currently missing. More randomized controlled studies are needed to help the treating physician to choose the best therapy, as well as real-life long-term data to evaluate the long-term outcome of children with PFAPA syndrome.


Assuntos
Febre/terapia , Linfadenite/terapia , Faringite/terapia , Qualidade de Vida/psicologia , Estomatite Aftosa/terapia , Pré-Escolar , Feminino , Humanos , Masculino , Síndrome
11.
Geriatr Gerontol Int ; 20(5): 482-487, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32212207

RESUMO

AIM: To examine whether the outcomes of fever treatment through home care differ from those through hospitalized care for older people who regularly receive home care in Japan. METHODS: A retrospective survey of medical record-based data for 679 older people who regularly received home care provided by a clinic in Japan. From these data, 61 fever cases (21 cases treated in the hospital and 40 treated at home and assigned to the hospitalized and home-care groups, respectively) were selected for analysis through a matching process. We compared the two groups in terms of mortality rate at 90 days after fever onset, and concerning changes in respective ranks for "Degree of Independent Living for the Elderly with Disability" and "Degree of Independent Living for the Elderly with Dementia" from immediately before fever onset to 90 days after fever onset. RESULTS: The mortality rate tended to be higher in the hospitalized group than in the home-care group (33% vs. 13%, respectively, P = 0.05). The hospitalized group also had a higher proportion of patients whose disability had worsened (43% vs. 23%, respectively, P = 0.16) and a significantly higher proportion of patients whose dementia had worsened (29% vs. 6%, respectively, P = 0.03). CONCLUSIONS: Our findings suggest that home care is more effective than hospitalized care for treating fever in older people who regularly receive home care in Japan, as it leads to lower mortality and better maintenance of activities of daily living capabilities. Geriatr Gerontol Int 2020; 20: 482-487.


Assuntos
Febre/terapia , Serviços de Assistência Domiciliar/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Febre/mortalidade , Avaliação Geriátrica , Humanos , Japão , Masculino , Estudos Retrospectivos
12.
13.
J Clin Nurs ; 29(5-6): 964-973, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31891200

RESUMO

AIMS AND OBJECTIVES: To explore parents' experiences with paediatric fever to understand their needs for information and support. BACKGROUND: Paediatric fever is a normal part of childhood, and multiple episodes of fever are a common occurrence between infancy and adulthood. Despite this expectation, paediatric fever often sparks fear and anxiety amongst parents. Existing research has primarily focused on measuring parental deficits, so a more in-depth exploration is helpful to understand the complexities of caring for a febrile child. DESIGN: Qualitative descriptive study. METHODS: Purposive sampling of N = 15 parents from a paediatric emergency department presenting with a febrile child. Semi-structured interviews were conducted in-person or via telephone. Thematic analysis was used to understand the data in the light of our research question. Reporting follows the consolidated criteria for reporting qualitative research checklist. RESULTS: We found themes of (a) parental confidence through caregiving tasks, (b) emergent feelings of inadequacy, (i) referrals and limitations of community practice, (c) information needs and (d) information sources. Whereas parents were initially confident accessing information, providing care, making decisions and managing symptoms, new signs/symptoms sparked a change in parents' emotions, coping and behaviour. Parents routinely search for information about paediatric fever and value reliable, accessible resources. CONCLUSIONS: Our findings highlight parents' strengths assessing fever and effectively managing symptoms. We are encouraged by the potential for these results to inform the development of empowering resources to help parents make child health decisions during paediatric fever. RELEVANCE TO CLINICAL PRACTICE: Findings provide an evidence base for researchers, clinicians and policymakers to improve care for paediatric patients and families. Parents want clear, reliable and accessible information about decision points associated with paediatric fever. Resources with an empowerment focus may help parents maintain a sense of control when caring for a febrile child.


Assuntos
Febre/terapia , Pais/psicologia , Adulto , Criança , Pré-Escolar , Tomada de Decisões , Feminino , Febre/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa
14.
J Matern Fetal Neonatal Med ; 33(4): 577-582, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29973085

RESUMO

Introduction: Computed tomography (CT) imaging should be employed judiciously, given its cost, use of intravenous contrast, and ionizing radiation. The aim of this study was to determine the clinical benefit of a CT scan in the evaluation of refractory puerperal fever and to identify the appropriate candidates for its use.Methods: This was a retrospective cohort study conducted in a single tertiary care center between January 2007 to April 2017. Indications for CT scan were refractory postpartum fever of ≥3 days and/or ultrasound findings suggesting complex abdominal fluid collection. Primary outcome was defined as a change in the mode of treatment due to the CT findings. In addition, a multivariate analysis of risk factors for puerperal fever was performed to identify patients who would benefit from the CT scan evaluation.Results: There were 520 women that underwent an abdominal and pelvic CT scan during the study period, 238 (45.7%) met inclusion criteria, 94 (39.5%) had a normal CT scan, and 144 (60.5%) had abnormal findings including 32 (13.4%) cases with pelvic thrombophlebitis and 112 (47%) cases with pelvic fluid collections. Results of the CT changed clinical management in 93 (39.0%) patients, including: switching antibiotics in 24 (10%) patients, adding low molecular weight heparin for 28 (11.8%) patients, and surgical intervention (laparotomy or drainage insertion) in 41 (17.2%) patients. In the regression model, we didn't find any significant risk factors associated with treatment change following the CT scan.Conclusions: Abdominal and pelvic CT scan in women with refractory puerperal fever has a high clinical yield and lead to a change in management in a substantial number of patients.


Assuntos
Febre/diagnóstico por imagem , Infecção Puerperal/diagnóstico por imagem , Adulto , Feminino , Febre/terapia , Humanos , Gravidez , Infecção Puerperal/terapia , Radiografia Abdominal , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
15.
BMC Public Health ; 19(1): 1608, 2019 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-31791291

RESUMO

BACKGROUND: Despite the almost universal adoption of Integrated Management of Childhood Illness (IMCI) guidelines for the diagnosis and treatment of sick children under the age of five in low- and middle-income countries, child mortality remains high in many settings. One possible explanation of the continued high mortality burden is lack of compliance with diagnostic and treatment protocols. We test this hypothesis in a sample of children with severe illness in the Democratic Republic of the Congo (DRC). METHODS: One thousand one hundred eighty under-five clinical visits were observed across a regionally representative sample of 321 facilities in the DRC. Based on a detailed list of disease symptoms observed, patients with severe febrile disease (including malaria), severe pneumonia, and severe dehydration were identified. For all three disease categories, treatments were then compared to recommended case management following IMCI guidelines. RESULTS: Out of 1180 under-five consultations observed, 332 patients (28%) had signs of severe febrile disease, 189 patients (16%) had signs of severe pneumonia, and 19 patients (2%) had signs of severe dehydration. Overall, providers gave the IMCI-recommended treatment in 42% of cases of these three severe diseases. Less than 15% of children with severe disease were recommended to receive in-patient care either in the facility they visited or in a higher-level facility. CONCLUSIONS: These results suggest that adherence to IMCI protocols for severe disease remains remarkably low in the DRC. There is a critical need to identify and implement effective approaches for improving the quality of care for severely ill children in settings with high child mortality.


Assuntos
Administração de Caso/normas , Desidratação/terapia , Febre/terapia , Pneumonia/terapia , Qualidade da Assistência à Saúde , Pré-Escolar , Protocolos Clínicos/normas , República Democrática do Congo , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Encaminhamento e Consulta/normas
16.
Artigo em Inglês | MEDLINE | ID: mdl-31635136

RESUMO

Fever is responsible for 30% of pediatric consultations at primary care services. The aim of this study was to explore the parental approach to fever in children aged between 0 and 12 years old by both health professional and non-health professional parents. A qualitative study based on grounded theory was performed. Focus groups were conducted, segmented by sex, place of residence, and healthcare training, using a triangulated sample (theoretical and snowball sampling) of parents of children aged between 0 and 12 years who were treated for fever at primary care emergency services. The constant comparative method and a process of coding was used for the analysis. The study findings reveal that the health training of parents, their former experience, family pressures, the age of the child, and the parents' work outside the home, all influenced how they approached fever management. These findings could be incorporated into clinical practice to improve care and compliance with fever treatment.


Assuntos
Febre/terapia , Pessoal de Saúde/psicologia , Pais/psicologia , Adulto , Criança , Pré-Escolar , Família , Feminino , Grupos Focais , Humanos , Lactente , Masculino , Pesquisa Qualitativa
17.
J Vet Emerg Crit Care (San Antonio) ; 29(6): 686-689, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31637843

RESUMO

OBJECTIVE: To describe the clinical characteristics of acute chlorfenapyr toxicity in 3 dogs from a single household. CASE SUMMARY: A 4-year-old neutered female Labrador Retriever was presented with severe hyperthermia (42.6°C [108.6°F]). Emergency management consisting of fluid resuscitation, active cooling, general anesthesia, gastric lavage, activated charcoal administration, and intravenous lipid emulsion was started immediately on the suspicion of toxin exposure. The dog developed symptoms following peracute death in 2 other small breed dog housemates. All dogs had a rapid onset of gastrointestinal signs, neurologic signs, and panting. The dog made a rapid and complete recovery and was discharged 48 hours later. Examination of gastric contents collected from the deceased dogs identified the presence of chlorfenapyr. NEW OR UNIQUE INFORMATION PROVIDED: This is the first reported case of chlorfenapyr toxicity in dogs. Previous case reports in human medicine have reported a variable mortality rate, although 1 of 3 dogs described here made a complete recovery. Chlorfenapyr should be considered in cases of suspected toxicity with similar presenting signs.


Assuntos
Doenças do Cão/induzido quimicamente , Piretrinas/toxicidade , Animais , Carvão Vegetal/uso terapêutico , Cães , Emulsões Gordurosas Intravenosas/uso terapêutico , Evolução Fatal , Feminino , Febre/induzido quimicamente , Febre/terapia , Febre/veterinária , Envenenamento
18.
Prehosp Disaster Med ; 34(6): 675-676, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31587666

RESUMO

Immersion of patients in a body bag filled with ice and water is recommended as prehospital management of severe hyperthermia. Experienced paramedics have raised a number of concerns about the use of this technique; particularly, whether cardiac monitoring equipment would remain functional once immersed. This test showed that monitoring equipment does remain functional and provides advice about safety considerations. The test should reassure practitioners that such an approach is feasible.


Assuntos
Febre/terapia , Monitorização Fisiológica , Serviços Médicos de Emergência , Humanos , Gelo , Imersão
19.
Am Heart J ; 217: 23-31, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31473324

RESUMO

BACKGROUND: Less than 500 participants have been included in randomized trials comparing hypothermia with regular care for out-of-hospital cardiac arrest patients, and many of these trials were small and at a high risk of bias. Consequently, the accrued data on this potentially beneficial intervention resembles that of a drug following small phase II trials. A large confirmatory trial is therefore warranted. METHODS: The TTM2-trial is an international, multicenter, parallel group, investigator-initiated, randomized, superiority trial in which a target temperature of 33°C after cardiac arrest will be compared with a strategy to maintain normothermia and early treatment of fever (≥37.8°C). Participants will be randomized within 3 hours of return of spontaneous circulation with the intervention period lasting 40 hours in both groups. Sedation will be mandatory for all patients throughout the intervention period. The clinical team involved with direct patient care will not be blinded to allocation group due to the inherent difficulty in blinding the intervention. Prognosticators, outcome-assessors, the steering group, the trial coordinating team, and trial statistician will be blinded. The primary outcome will be all-cause mortality at 180 days after randomization. We estimate a 55% mortality in the control group. To detect an absolute risk reduction of 7.5% with an alpha of 0.05 and 90% power, 1900 participants will be enrolled. The main secondary neurological outcome will be poor functional outcome (modified Rankin Scale 4-6) at 180 days after arrest. DISCUSSION: The TTM2-trial will compare hypothermia to 33°C with normothermia and early treatment of fever (≥37.8°C) after out-of-hospital cardiac arrest.


Assuntos
Temperatura Corporal , Estudos de Equivalência como Asunto , Hipotermia Induzida/métodos , Parada Cardíaca Extra-Hospitalar/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Causas de Morte , Febre/terapia , Humanos , Estudos Multicêntricos como Assunto , Parada Cardíaca Extra-Hospitalar/mortalidade , Avaliação de Resultados em Cuidados de Saúde , Tamanho da Amostra , Fatores de Tempo
20.
Implement Sci ; 14(1): 87, 2019 09 02.
Artigo em Inglês | MEDLINE | ID: mdl-31477125

RESUMO

BACKGROUND: In the Quality in Acute Stroke Care (QASC) trial undertaken in stroke units (SUs) located in New South Wales (NSW), Australia (2005-2010), facilitated implementation of a nurse-led care bundle to manage fever, hyperglycaemia and swallowing (FeSS protocols) reduced death and disability for patients with stroke. We aimed to determine subsequent adherence to the bundled FeSS processes (reflective of the protocols) between 2013 and 2017 in Australian hospitals, and examine whether changes in adherence to these processes varied based on previous participation in the QASC trial or subsequent statewide scale-up (QASCIP-Quality in Acute Stroke Care Implementation Project) and presence of an SU. METHODS: Cross-sectional, observational study using self-reported organisational survey and retrospective clinical audit data from the National Acute Services Stroke Audit (2013, 2015, 2017). Mixed-effects logistic regression was performed with dependent variables: (1) composite outcome measure reflecting compliance with the FeSS protocols and (2) individual FeSS processes, including the year of audit as an independent variable, adjusted for correlation of outcomes within hospital. Separate models including interaction terms between the year of audit and previous participation in QASC/QASCIP and year of audit and SU were also generated. RESULTS: Hospital participation included the following: 2013-124 hospitals, 3741 cases; 2015-112 hospitals, 4087 cases; and 2017-117 hospitals, 4192 cases. An 80% increase in the odds of receiving the composite outcome in 2017 compared to 2013 was found (2013, 30%; 2017, 41%; OR 1.8; 95% CI 1.6, 2.0; p < 0.001). The odds of FeSS adherence from 2013 to 2017 was greater for hospitals that had participated in QASC/QASCIP relative to those that had not (participated OR 2.1; 95% CI 1.7, 2.7; not participated OR 1.6; 95% CI 1.4, 1.8; p = 0.03). Similar uptake in adherence was evident in hospitals with and without an SU between 2013 and 2017. CONCLUSION: The use of the FeSS protocols within Australia increased from 2013 to 2017 with the inclusion of these care processes in the National Audit. Greater uptake in hospitals previously involved in QASC/QASCIP was evident. Our implementation methods may be useful for other national initiatives for improving access to evidence-based practice.


Assuntos
Transtornos de Deglutição/terapia , Febre/terapia , Hiperglicemia/terapia , Pacotes de Assistência ao Paciente/métodos , Acidente Vascular Cerebral/terapia , Protocolos Clínicos/normas , Estudos Transversais , Prática Clínica Baseada em Evidências , Humanos , New South Wales , Qualidade da Assistência à Saúde , Estudos Retrospectivos
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