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1.
Cochrane Database Syst Rev ; 4: CD012866, 2021 04 08.
Artigo em Inglês | MEDLINE | ID: mdl-33831222

RESUMO

BACKGROUND: There is great global variation in the sleeping arrangements for healthy newborn infants. Bed sharing is a type of sleeping practice in which the sleeping surface (e.g. bed, couch or armchair, or some other sleeping surface) is shared between the infant and another person. The possible physiological benefits include better oxygen and cardiopulmonary stability, fewer crying episodes, less risk of hypothermia, and a longer duration of breastfeeding. On the other hand, the most important harmful effect of bed sharing is that it may increase the risk of sudden infant death syndrome (SIDS). Studies have found conflicting evidence regarding the safety and efficacy of bed sharing during infancy. OBJECTIVES: To evaluate the efficacy and safety of bed sharing, started during the neonatal period, on breastfeeding status (exclusive and total duration of breastfeeding), incidence of SIDS, rates of hypothermia, neonatal and infant mortality, and long-term neurodevelopmental outcomes. SEARCH METHODS: We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL 2020, Issue 7) in the Cochrane Library; MEDLINE via PubMed (1966 to 23 July 2020), CINAHL (1982 to 23 July 2020), and LILACS (1980 to 23 July 2020). We also searched clinical trials databases, and the reference lists of retrieved articles, for randomised controlled trials (RCTs) and quasi-RCTS. SELECTION CRITERIA: We planned to include RCTs or quasi-RCTs (including cluster-randomised trials) that included term neonates initiated on bed sharing within 24 hours of birth (and continuing to bed share with the mother in the first four weeks of life, followed by a variable time period thereafter), and compared them to a 'no bed sharing' group. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures as recommended by Cochrane. We planned to use the GRADE approach to assess the certainty of evidence. MAIN RESULTS: Our search strategy yielded 6231 records. After removal of duplicate records, we screened 2745 records by title and abstract. We excluded 2739 records that did not match our inclusion criteria. We obtained six full-text studies for assessment. These six studies did not meet the eligibility criteria and were excluded. AUTHORS' CONCLUSIONS: We did not find any studies that met our inclusion criteria. There is a need for RCTs on bed sharing in healthy term neonates that directly assess efficacy (i.e. studies in a controlled setting, like hospital) or effectiveness (i.e. studies conducted in community or home settings) and safety. Future studies should assess outcomes such as breastfeeding status and risk of SIDS. They should also include neonates from high-income countries and low- and middle-income countries, especially those countries where bed sharing is more prevalent because of cultural practices (e.g. Asian countries).


Assuntos
Leitos , Cuidado do Lactente/métodos , Nascimento a Termo , Humanos , Lactente , Recém-Nascido
2.
Artigo em Inglês | MEDLINE | ID: mdl-33807963

RESUMO

(1) Background: Pressure ulcers in the hospital setting occurring within 72 h after surgery are called perioperative pressure injuries. The aim of this study was to provide data for the prevention of perioperative pressure injuries following the use of pressure-relieving overlays by measuring the interface pressures and subjective comfort. (2) Methods: This study is based on a repeated measures design. The subjects included 30 healthy volunteers aged 18 to 57 years. Interface pressures of the sacrum and both heels were measured in the supine position, and the subjective comfort was evaluated with visual analog scale after applying polyurethane foam, gel pad, and egg crate foam for relief. (3) Results: The pressures in the sacrum and both heels were the lowest with polyurethane foam, and the subjective comfort was the highest. (4) Conclusions: Inexpensive polyurethane foam with satisfactory pressure relief is recommended as an overlay for surgical patients.


Assuntos
Mesas Cirúrgicas , Lesão por Pressão , Adolescente , Adulto , Leitos , Voluntários Saudáveis , Calcanhar , Humanos , Extremidade Inferior , Pessoa de Meia-Idade , Lesão por Pressão/prevenção & controle , Adulto Jovem
3.
PLoS One ; 16(3): e0248161, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33705453

RESUMO

The first case of the novel coronavirus in Brazil was notified on February 26, 2020. After 21 days, the first case was reported in the second largest State of the Brazilian Amazon. The State of Pará presented difficulties in combating the pandemic, ranging from underreporting and a low number of tests to a large territorial distance between cities with installed hospital capacity. Due to these factors, mathematical data-driven short-term forecasting models can be a promising initiative to assist government officials in more agile and reliable actions. This study presents an approach based on artificial neural networks for the daily and cumulative forecasts of cases and deaths caused by COVID-19, and the forecast of demand for hospital beds. Six scenarios with different periods were used to identify the quality of the generated forecasting and the period in which they start to deteriorate. Results indicated that the computational model adapted capably to the training period and was able to make consistent short-term forecasts, especially for the cumulative variables and for demand hospital beds.


Assuntos
/epidemiologia , Leitos , Brasil/epidemiologia , Previsões , Hospitalização , Humanos , Modelos Estatísticos , Redes Neurais de Computação , Pandemias , /isolamento & purificação
4.
Artigo em Inglês | MEDLINE | ID: mdl-33671358

RESUMO

Buckwheat husks are used in many therapeutic products such as pillows, mattresses, seats, etc. This material is proposed by producers for example for discopathy, back pain and head vasomotor disorders. Our studies evaluated the impact of using cotton mattresses with buckwheat husk fillings on people's health condition. The main research was carried out on the group of 60 people divided into 3 groups (1-people with skeletal system problems, 2-people spending a lot of time lying with the probability of pressure ulcer formation and 3-healthy people). In addition, different tests have been carried out on the possibility of colonization of mattresses by fungi, bacteria and arthropod pests, and rheological, chemical and flammability tests. The research material in the form of buckwheat husks was tested in a diverse way. All tests indicate high usefulness of husks for therapeutic activity. This material was contaminated with fungi, bacteria and pests at a very low level, related to the natural colonization of buckwheat nuts during harvest and storage. The quality of the husks was also confirmed in rheological, chemical and flammability studies. Finally, this has also been confirmed in surveys conducted on people with health problems. The analyses show that the buckwheat husk is an excellent material that can be used to fill prophylactic mattresses. This has been confirmed by the results of laboratory tests and opinions of respondents using mattresses filled with buckwheat husk.


Assuntos
Fagopyrum , Roupas de Cama, Mesa e Banho , Leitos , Fungos , Humanos , Nozes
5.
Sensors (Basel) ; 21(3)2021 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-33540669

RESUMO

Heart rate monitoring is the predominant quantitative health indicator of a newborn in the delivery room. A rapid and accurate heart rate measurement is vital during the first minutes after birth. Clinical recommendations suggest that electrocardiogram (ECG) monitoring should be widely adopted in the neonatal intensive care unit to reduce infant mortality and improve long term health outcomes in births that require intervention. Novel non-contact electrocardiogram sensors can reduce the time from birth to heart rate reading as well as providing unobtrusive and continuous monitoring during intervention. In this work we report the design and development of a solution to provide high resolution, real time electrocardiogram data to the clinicians within the delivery room using non-contact electric potential sensors embedded in a neonatal intensive care unit mattress. A real-time high-resolution electrocardiogram acquisition solution based on a low power embedded system was developed and textile embedded electrodes were fabricated and characterised. Proof of concept tests were carried out on simulated and human cardiac signals, producing electrocardiograms suitable for the calculation of heart rate having an accuracy within ±1 beat per minute using a test ECG signal, ECG recordings from a human volunteer with a correlation coefficient of ~ 87% proved accurate beat to beat morphology reproduction of the waveform without morphological alterations and a time from application to heart rate display below 6 s. This provides evidence that flexible non-contact textile-based electrodes can be embedded in wearable devices for assisting births through heart rate monitoring and serves as a proof of concept for a complete neonate electrocardiogram monitoring system.


Assuntos
Leitos , Eletrocardiografia , Monitorização Fisiológica , Dispositivos Eletrônicos Vestíveis , Eletrodos , Humanos , Recém-Nascido , Têxteis
6.
Acta Neurochir (Wien) ; 163(4): 879-884, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33515122

RESUMO

BACKGROUND: Holographic neuronavigation has several potential advantages compared to conventional neuronavigation systems. We present the first report of a holographic neuronavigation system with patient-to-image registration and patient tracking with a reference array using an augmented reality head-mounted display (AR-HMD). METHODS: Three patients undergoing an intracranial neurosurgical procedure were included in this pilot study. The relevant anatomy was first segmented in 3D and then uploaded as holographic scene in our custom neuronavigation software. Registration was performed using point-based matching using anatomical landmarks. We measured the fiducial registration error (FRE) as the outcome measure for registration accuracy. A custom-made reference array with QR codes was integrated in the neurosurgical setup and used for patient tracking after bed movement. RESULTS: Six registrations were performed with a mean FRE of 8.5 mm. Patient tracking was achieved with no visual difference between the registration before and after movement. CONCLUSIONS: This first report shows a proof of principle of intraoperative patient tracking using a standalone holographic neuronavigation system. The navigation accuracy should be further optimized to be clinically applicable. However, it is likely that this technology will be incorporated in future neurosurgical workflows because the system improves spatial anatomical understanding for the surgeon.


Assuntos
Realidade Aumentada , Holografia/métodos , Neuronavegação/métodos , Sistemas de Identificação de Pacientes/métodos , Software , Leitos , Feminino , Humanos , Masculino
7.
Acta Paediatr ; 110(6): 1835-1841, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33314307

RESUMO

AIM: Many countries lack monitoring of infant sleep practices, despite associations with sudden infant death. We studied sleep positions, bed-sharing and breastfeeding in a new birth cohort. METHODS: Data were obtained from a prospective, population-based cohort study of children born in western Sweden in 2018. The parents of 9,465 six-month-old infants, via postal questionnaires, were asked about their infants' sleeping positions at three and six months, including where they slept and any bed-sharing arrangements. The data were compared with our earlier 2003-2004 birth cohort. RESULTS: Questionnaires were completed by the parents of 3,590 (38%) infants. At three months, 54% of the infants slept in a separate cot in their parents' room. A further 43% slept in their parents' bed: 42% in baby nests and 42% in close contact with their parents. At six months, 33% bed-shared, compared with 20% in 2003-2004 (p < 0.001). Bed-sharing was positively associated with breastfeeding (odds ratio at three months: 1.5-2.8, 95% confidence interval: 1.1-4.5). CONCLUSION: Most infants slept in separate cots during the first three months. However, bed-sharing showed an increasing trend and baby nests were popular. Bed-sharing was positively associated with breastfeeding, but the association may not be causal.


Assuntos
Aleitamento Materno , Morte Súbita do Lactente , Leitos , Criança , Estudos de Coortes , Feminino , Humanos , Lactente , Cuidado do Lactente , Estudos Prospectivos , Sono , Morte Súbita do Lactente/epidemiologia , Inquéritos e Questionários , Suécia/epidemiologia
8.
Chemosphere ; 262: 127680, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32763572

RESUMO

Fe (II) biooxidation has recently gained significant interest. It plays a key role in a number of environmental and industrial processes such as bioleaching, acid mine drainage treatment, desulphurization of sour gases, and coal desulphurization. In this work, a three-dimensional CFD model for gas-liquid flow in a lab-scale packed-bed biooxidation reactor is used. The reactor is randomly packed with spherical particles, and the particles are covered with Leptospirillum ferrooxidans biofilm for Fe (II) biooxidation. A modified Jodrey-Tory algorithm is used to generate random packing with actual porosity of 0.42, and biofilm layer with constant thickness is considered over the particles. A simplified Eulerian-Eulerian model is used to obtain detailed flow field. The concentration profile in the reactor and the conversion of Fe (II) from the present simulations are obtained and validated using experimental data reported in the literature. The results of the study indicate that about three-quarters of the conversion occurs in the upper half of the reactor and Fe (II) concentration on the biofilm surface at the lower quarter of the reactor does not exceed 5 mM (The inlet concentration is 89.6 mM). The findings reveal that rate-limiting phenomena may vary in different parts of the reactor. The results obtained through the simulations represent advantages for the design and optimization of packed-bed biofilm reactors.


Assuntos
Bactérias/metabolismo , Reatores Biológicos , Leitos , Biofilmes , Simulação por Computador
9.
Chemosphere ; 263: 127920, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32822936

RESUMO

Arsenic (As) and selenium (Se) pollution caused by coal combustion is receiving increasing concerns. The environmental impacts of As/Se are determined not only by stack emission but also by leaching process from combustion byproducts. For a better control of As/Se emission from As/Se-enriched coal combustion, this study investigated the migration and emission behavior of As/Se in a circulating fluidized bed (CFB) power plant equipped with fabric filter (FF) and wet flue gas desulfurization (WFGD) system. The results demonstrated that arsenic was both enriched in bottom ash (41.4-47.6%) and fly ash (52.4-58.6%), while selenium was mainly captured by fly ash (73.9-83.4%). Limestone injection into furnace promoted As/Se retention in ash residues. Arsenic was mainly converted into arsenate in high-temperature regions and partly trapped in bottom ash as arsenite. In contrast, selenium capture mainly occurred in low-temperature flue gas by the formation of selenite, because of the poor thermal stability of most selenite. Triplet-tank method can totally remove arsenic in WFGD wastewater. And 18.4-58.7% of selenium was removed, resulting from the precipitation of Se4+ anions with highly soluble Se6+ anions remaining in wastewater. The concentrations of As and Se in the stack emission were 0.25-1.02 and 0.96-2.24 µg/m3, receptively. The CFB boiler equipped with FF + WFGD was shown to provide good control of the As/Se emission into the atmosphere. Leaching tests suggested that more attention should be paid to As leachability from fly ash/gypsum, and Se leachability from gypsum/sludge.


Assuntos
Poluentes Atmosféricos/análise , Arsênico/análise , Centrais Elétricas , Selênio/análise , Atmosfera , Leitos , Carbonato de Cálcio , Sulfato de Cálcio , Carvão Mineral/análise , Cinza de Carvão/química , Monitoramento Ambiental , Gases
10.
Chemosphere ; 263: 127974, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32828060

RESUMO

CaCr2O4 (Cr (III)), mainly generated through the decomposition of CaCrO4 (Cr (VI)), is a significant intermediate for toxic Cr (VI) formation during solid fuel combustion. In this study, the formation, oxidation and sulfation kinetics of CaCr2O4 were analyzed to forecast the potential of CaCr2O4 oxidation during co-firing of coal and solid waste in a circulating fluidized bed boiler. The results indicated that the formation and oxidation of CaCr2O4 were fitted to a single step nucleation and growth model while CaCr2O4 sulfation was fitted to a shrinking core model. CaCr2O4 formation through CaCrO4 decomposition was favored in oxygen-lean atmosphere and considerably suppressed in the presence of oxygen. In contrast, CaCr2O4 oxidation was mainly determined by the contacts between CaCr2O4 and CaSO4/CaO, which influenced not only oxidation rates but also the product species. Moreover, the oxidation reactivity of CaCr2O4 was higher in the presence of CaO than that of CaSO4. On the other hand, CaCr2O4 sulfation can occur more easily than CaCr2O4 oxidation, the reaction rate of which was deeply affected by sulfate product layer. Findings in this study suggested that spraying calcium in furnace for desulphurization may increase the risk of CaCr2O4 oxidation. Measures including the adjustment of Ca/S ratio in blended fuel (with added limestone) and operating conditions (such as temperature and local atmosphere) in co-firing system could be taken to control CaCr2O4 formation and oxidation.


Assuntos
Cromo/química , Carvão Mineral/análise , Eliminação de Resíduos/métodos , Resíduos Sólidos , Leitos , Cromo/análise , Cinza de Carvão , Oxirredução , Oxigênio , Sulfatos , Temperatura
11.
Water Res ; 188: 116467, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-33068909

RESUMO

Environmental contamination with fertilizers is threatening biodiversity in many ecosystems due to nitrate-based eutrophication. One opportunity for a cost-efficient nitrate elimination are denitrification beds in which a microbial community thrives under anoxic conditions with polymeric plant material as a carbon and an electron source. Incoming nitrate is used as electron acceptor and reduced to molecular nitrogen. Projects realizing denitrification beds in field scale are sparse and robust data on their efficiency throughout the year mostly not available. This study analyzed the nitrate elimination efficiency and microbiology of a 216 m3 denitrification bed over the time course of more than three years. Phylogenetic as well as transcriptomic analysis revealed that the reactor contained a biofilm community growing on the surface of the wood chips and a planktonic community. Both differed in composition but their variance was affected only to a minor extend by seasonal temperature changes. Cellulose degradation was mainly conducted by the biofilm population while denitrification was mostly conducted by the planktonic community. Methanogens were detectable only to a very minor extend. Using online data from the nitrate concentration of in- and outflowing water as well as a hydrological model to predict the water inflow, it was possible to establish a process model that sufficiently describes the denitrification process. This model clearly indicates that the denitrification efficiency is mostly impacted by temperature and hydraulic retention time. It also suggests that the simple design of the denitrification bed most likely leads to different flow paths through the reactor depending on the volumetric flow rate. This study allows for the first time a robust estimation of the necessary reactor size for nitrate removal in a moderate continental climate setting. It also suggests how future denitrification beds could be improved for better performance.


Assuntos
Reatores Biológicos , Desnitrificação , Leitos , Biocatálise , Nitratos , Nitrogênio , Filogenia
12.
Water Res ; 188: 116547, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-33126002

RESUMO

Membrane bioreactor (MBR) is an advantageous technology for wastewater treatment. However, efficient nutrient removal and membrane fouling mitigation remain major challenges in its applications. In this study, an electroconductive moving bed membrane bioreactor (EcMB-MBR) was proposed for simultaneous removal of organics and nutrients from domestic wastewater. The EcMB-MBR was composed of a submerged MBR, filled with electrodes and free-floating conductive media. Conductive media were introduced to reduce energy consumption in an electrochemical MBR, to improve nitrogen removal, and to mitigate membrane fouling. The results showed that COD, total nitrogen, and total phosphorus removal was up to 97.1 ± 1.4%, 88.8 ± 4.2%, and 99.0 ± 0.9%, respectively, in comparison with those of 93.4 ± 1.5%, 65.2 ± 5.3%, and 20.4 ± 11.3% in a conventional submerged MBR. Meanwhile, a total membrane resistance reduction of 26.7% was obtained in the EcMB-MBR. The optimized operating condition was determined at an intermittent electricity exposure time of 10 min-ON/10 min-OFF, and a direct current density of 15 A/m2. The interactions between electric current and conductive media were explored to understand the working mechanism in this proposed system. The conductive media reduced 21% of the electrical resistivity in the mixed liquor at a selected packing density of 0.20 (v/v). The combination of electrochemical process and conductive media specially enhanced the reduction of nitrate-nitrogen (NO3--N) through hybrid bio-electrochemical denitrification processes. These mechanisms involved with electrochemically assisted autotrophic denitrification by autotrophic denitrifying bacteria. As a result, 5.2% of NO3--N remained in the effluent of EcMB-MBR in comparison with that of 29.5% in the MBR. Membrane fouling was minimized via both mechanical scouring and electrochemical decomposition/precipitation of organic/particulate foulants. Furthermore, a preliminary cost analysis indicated that an additional operating cost of 0.081 USD/m3, accounting for 10 - 30% increment of the operating cost of a conventional MBR, was needed to enhance the nitrogen and phosphorus removal correspondingly in the EcMB-MBR.


Assuntos
Membranas Artificiais , Águas Residuárias , Leitos , Reatores Biológicos , Custos e Análise de Custo , Membranas , Nitrogênio , Eliminação de Resíduos Líquidos
13.
Cochrane Database Syst Rev ; 12: CD013217, 2020 12 21.
Artigo em Inglês | MEDLINE | ID: mdl-33348423

RESUMO

BACKGROUND: The prevalence of substance use, both prescribed and non-prescribed, is increasing in many areas of the world. Substance use by women of childbearing age contributes to increasing rates of neonatal abstinence syndrome (NAS). Neonatal opioid withdrawal syndrome (NOWS) is a newer term describing the subset of NAS related to opioid exposure. Non-pharmacological care is the first-line treatment for substance withdrawal in newborns. Despite the widespread use of non-pharmacological care to mitigate symptoms of NAS, there is not an established definition of, and standard for, non-pharmacological care practices in this population. Evaluation of safety and efficacy of non-pharmacological practices could provide clear guidance for clinical practice. OBJECTIVES: To evaluate the safety and efficacy of non-pharmacological treatment of infants at risk for, or having symptoms consistent with, opioid withdrawal on the length of hospitalization and use of pharmacological treatment for symptom management. Comparison 1: in infants at risk for, or having early symptoms consistent with, opioid withdrawal, does non-pharmacological treatment reduce the length of hospitalization and use of pharmacological treatment? Comparison 2: in infants receiving pharmacological treatment for symptoms consistent with opioid withdrawal, does concurrent non-pharmacological treatment reduce duration of pharmacological treatment, maximum and cumulative doses of opioid medication, and length of hospitalization? SEARCH METHODS: We used the standard search strategy of Cochrane Neonatal to search CENTRAL (2019, Issue 10); Ovid MEDLINE; and CINAHL on 11 October 2019. We also searched clinical trials databases and the reference lists of retrieved articles for randomized controlled trials (RCTs), quasi-RCTs, and cluster trials. SELECTION CRITERIA: We included trials comparing single or bundled non-pharmacological interventions to no non-pharmacological treatment or different single or bundled non-pharmacological interventions. We assessed non-pharmacological interventions independently and in combination based on sufficient similarity in population, intervention, and comparison groups studied. We categorized non-pharmacological interventions as: modifying environmental stimulation, feeding practices, and support of the mother-infant dyad. We presented non-randomized studies identified in the search process narratively. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. We used the GRADE approach to assess the certainty of evidence. Primary outcomes in infants at risk for, or having early symptoms consistent with, opioid withdrawal included length of hospitalization and pharmacological treatment with one or more doses of opioid or sedative medication. Primary outcomes in infants receiving opioid treatment for symptoms consistent with opioid withdrawal included length of hospitalization, length of pharmacological treatment with opioid or sedative medication, and maximum and cumulative doses of opioid medication. MAIN RESULTS: We identified six RCTs (353 infants) in which infants at risk for, or having symptoms consistent with, opioid withdrawal participated between 1975 and 2018. We identified no RCTs in which infants receiving opioid treatment for symptoms consistent with opioid withdrawal participated. The certainty of evidence for all outcomes was very low to low. We also identified and excluded 34 non-randomized studies published between 2005 and 2018, including 29 in which infants at risk for, or having symptoms consistent with, opioid withdrawal participated and five in which infants receiving opioid treatment for symptoms consistent with opioid withdrawal participated. We identified seven preregistered interventional clinical trials that may qualify for inclusion at review update when complete. Of the six RCTs, four studies assessed modifying environmental stimulation in the form of a mechanical rocking bed, prone positioning, non-oscillating waterbed, or a low-stimulation nursery; one study assessed feeding practices (comparing 24 kcal/oz to 20 kcal/oz formula); and one study assessed support of the maternal-infant dyad (tailored breastfeeding support). There was no evidence of a difference in length of hospitalization in the one study that assessed modifying environmental stimulation (mean difference [MD) -1 day, 95% confidence interval [CI) -2.82 to 0.82; 30 infants; very low-certainty evidence) and the one study of support of the maternal-infant dyad (MD -8.9 days, 95% CI -19.84 to 2.04; 14 infants; very low-certainty evidence). No studies of feeding practices evaluated the length of hospitalization. There was no evidence of a difference in use of pharmacological treatment in three studies of modifying environmental stimulation (typical risk ratio [RR) 1.00, 95% CI 0.86 to 1.16; 92 infants; low-certainty evidence), one study of feeding practices (RR 0.92, 95% CI 0.63 to 1.33; 49 infants; very low-certainty evidence), and one study of support of the maternal-infant dyad (RR 0.50, 95% CI 0.13 to 1.90; 14 infants; very low-certainty evidence). Reported secondary outcomes included neonatal intensive care unit (NICU) admission, days to regain birth weight, and weight nadir. One study of support of the maternal-infant dyad reported NICU admission (RR 0.50, 95% CI 0.13 to 1.90; 14 infants; very low-certainty evidence). One study of feeding practices reported days to regain birth weight (MD 1.10 days, 95% CI 2.76 to 0.56; 46 infants; very low-certainty evidence). One study that assessed modifying environmental stimulation reported weight nadir (MD -0.28, 95% CI -1.15 to 0.59; 194 infants; very low-certainty evidence) and one study of feeding practices reported weight nadir (MD -0.8, 95% CI -2.24 to 0.64; 46 infants; very low-certainty evidence). AUTHORS' CONCLUSIONS: We are uncertain whether non-pharmacological care for opioid withdrawal in newborns affects important clinical outcomes including length of hospitalization and use of pharmacological treatment based on the six included studies. The outcomes identified for this review were of very low- to low-certainty evidence. Combined analysis was limited by heterogeneity in study design and intervention definitions as well as the number of studies. Many prespecified outcomes were not reported. Although caregivers are encouraged by experts to optimize non-pharmacological care for opioid withdrawal in newborns prior to initiating pharmacological care, we do not have sufficient evidence to inform specific clinical practices. Larger well-designed studies are needed to determine the effect of non-pharmacological care for opioid withdrawal in newborns.


Assuntos
Tempo de Internação , Entorpecentes/efeitos adversos , Síndrome de Abstinência Neonatal/terapia , Leitos , Aleitamento Materno , Planejamento Ambiental , Humanos , Hipnóticos e Sedativos/uso terapêutico , Equipamentos para Lactente , Recém-Nascido , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Síndrome de Abstinência Neonatal/tratamento farmacológico , Berçários para Lactentes , Tratamento de Substituição de Opiáceos/métodos , Posicionamento do Paciente/métodos , Decúbito Ventral , Ensaios Clínicos Controlados Aleatórios como Assunto
14.
Artigo em Inglês | MEDLINE | ID: mdl-33218133

RESUMO

The global outbreak of COVID-19 has caused worrying concern amongst the public and health authorities. The first and foremost problem that many countries face during the outbreak is a shortage of medical resources. In order to investigate the impact of a shortage of hospital beds on the COVID-19 outbreak, we formulated a piecewise smooth model for describing the limitation of hospital beds. We parameterized the model while using data on the cumulative numbers of confirmed cases, recovered cases, and deaths in Wuhan city from 10 January to 12 April 2020. The results showed that, even with strong prevention and control measures in Wuhan, slowing down the supply rate, reducing the maximum capacity, and delaying the supply time of hospital beds all aggravated the outbreak severity by magnifying the cumulative numbers of confirmed cases and deaths, lengthening the end time of the pandemic, enlarging the value of the effective reproduction number during the outbreak, and postponing the time when the threshold value was reduced to 1. Our results demonstrated that establishment of the Huoshenshan, Leishenshan, and Fangcang shelter hospitals avoided 22,786 people from being infected and saved 6524 lives. Furthermore, the intervention of supplying hospital beds avoided infections in 362,360 people and saved the lives of 274,591 persons. This confirmed that the quick establishment of the Huoshenshan, Leishenshan Hospitals, and Fangcang shelter hospitals, and the designation of other hospitals for COVID-19 patients played important roles in containing the outbreak in Wuhan.


Assuntos
Leitos/provisão & distribução , Infecções por Coronavirus/epidemiologia , Número de Leitos em Hospital/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Betacoronavirus , China/epidemiologia , Humanos , Pandemias
15.
J Healthc Eng ; 2020: 8857553, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33029339

RESUMO

Data envelopment analysis (DEA) is a powerful nonparametric engineering tool for estimating technical efficiency and production capacity of service units. Assuming an equally proportional change in the output/input ratio, we can estimate how many additional medical resource health service units would be required if the number of hospitalizations was expected to increase during an epidemic outbreak. This assessment proposes a two-step methodology for hospital beds vacancy and reallocation during the COVID-19 pandemic. The framework determines the production capacity of hospitals through data envelopment analysis and incorporates the complexity of needs in two categories for the reallocation of beds throughout the medical specialties. As a result, we have a set of inefficient healthcare units presenting less complex bed slacks to be reduced, that is, to be allocated for patients presenting with more severe conditions. The first results in this work, in collaboration with state and municipal administrations in Brazil, report 3772 beds feasible to be evacuated by 64% of the analyzed health units, of which more than 82% are moderate complexity evacuations. The proposed assessment and methodology can provide a direction for governments and policymakers to develop strategies based on a robust quantitative production capacity measure.


Assuntos
Leitos/provisão & distribução , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Hospitais , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Leitos/estatística & dados numéricos , Betacoronavirus , Engenharia Biomédica , Brasil/epidemiologia , Infecções por Coronavirus/tratamento farmacológico , Eficiência Organizacional/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Humanos , Determinação de Necessidades de Cuidados de Saúde , Alocação de Recursos , Estatísticas não Paramétricas
16.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 4059-4062, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018890

RESUMO

For more convenient use in sleep monitoring than conventional electrocardiogram (ECG) measurement systems, a mattress that could measure ECG signal and ballistocardiogram (BCG) signal through clothes was designed. Three electrodes made of silver fiber conductive fabric were embedded in this mattress, which make it very comfortable and it does not disturb user's sleep. In addition to the mattress, the proposed system contains a signal acquisition module, and a data transmission module and a user interface. To reduce the effect of surrounding electromagnetic radiation to the two signal sensing electrodes, two equipotential shielding layers are placed under them respectively. The proposed system was verified by an experiment of ECG signal and BCG signal measurement, where reference ECG signal was measured by Ag/AgCl electrodes synchronously. The result shows that both ECG signal and BCG signal were measured by the proposed system through clothes successfully. Compared with the reference signal, both R-R intervals and J-J intervals extracted have high correlation coefficients, which are 0.988 and 0.963 respectively, and also have small errors (the root mean square errors are 3.64ms and 6.39ms respectively). Furthermore, the proposed system may be used to measure blood pressure indirectly based on ECG signal and BCG signal measured directly.


Assuntos
Balistocardiografia , Leitos , Eletrocardiografia , Eletrodos , Têxteis
17.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 4063-4066, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018891

RESUMO

The ballistocardiography is a technique that measures the heart rate from the mechanical vibrations of the body due to the heart movement. In this work a novel noninvasive device placed under the mattress of a bed estimates the heart rate using the ballistocardiography. Different algorithms for heart rate estimation have been developed.


Assuntos
Balistocardiografia , Leitos , Acelerometria , Frequência Cardíaca , Movimento
18.
Epidemiol Serv Saude ; 29(4): e2020391, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32997068

RESUMO

In view of the need to manage and forecast the number of Intensive Care Unit (ICU) beds for critically ill COVID-19 patients, the Forecast UTI open access application was developed to enable hospital indicator monitoring based on past health data and the temporal dynamics of the Coronavirus epidemic. Forecast UTI also enables short-term forecasts of the number of beds occupied daily by COVID-19 patients and possible care scenarios to be established. This article presents the functions, mode of access and examples of uses of Forecast UTI, a computational tool intended to assist managers of public and private hospitals within the Brazilian National Health System by supporting quick, strategic and efficient decision-making.


Assuntos
Ocupação de Leitos/estatística & dados numéricos , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Número de Leitos em Hospital/estatística & dados numéricos , Unidades de Terapia Intensiva/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Software , Leitos/provisão & distribução , Brasil/epidemiologia , Tomada de Decisões , Previsões , Humanos , Pandemias , Design de Software
19.
Cochrane Database Syst Rev ; 7: CD012362, 2020 07 07.
Artigo em Inglês | MEDLINE | ID: mdl-32639053

RESUMO

BACKGROUND: Head position during care may affect cerebral haemodynamics and contribute to the development of germinal matrix-intraventricular haemorrhage (GM-IVH) in very preterm infants. Turning the head toward one side may occlude jugular venous drainage while increasing intracranial pressure and cerebral blood volume. It is suggested that cerebral venous pressure is reduced and hydrostatic brain drainage improved if the infant is cared for in the supine 'head midline' position. OBJECTIVES: To assess whether head midline position is more effective than other head positions for preventing (or preventing extension) of GM-IVH in very preterm infants (< 32 weeks' gestation at birth). SEARCH METHODS: We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 9), MEDLINE via PubMed (1966 to 12 September 2019), Embase (1980 to 12 September 2019), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982 to 12 September 2019). We searched clinical trials databases, conference proceedings, and reference lists of retrieved articles. SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing caring for very preterm infants in a supine head midline position versus a prone or lateral decubitus position, or undertaking a strategy of regular position change, or having no prespecified position. We included trials enrolling infants with existing GM-IVH and planned to assess extension of haemorrhage in a subgroup of infants. We planned to analyse horizontal (flat) versus head elevated positions separately for all body positions. DATA COLLECTION AND ANALYSIS: We used standard methods of Cochrane Neonatal. For each of the included trials, two review authors independently extracted data and assessed risk of bias. The primary outcomes were GM-IVH, severe IVH, and neonatal death. We evaluated treatment effects using a fixed-effect model with risk ratio (RR) for categorical data; and mean, standard deviation (SD), and mean difference (MD) for continuous data. We used the GRADE approach to assess the certainty of evidence. MAIN RESULTS: Three RCTs, with a total of 290 infants (either < 30 weeks' gestational age or < 1000 g body weight), met the inclusion criteria. Two trials compared supine midline head position versus head rotated 90° with the cot flat. One trial compared supine midline head position versus head rotated 90° with the bed tilted at 30°. We found no trials that compared supine versus prone midline head position. Meta-analysis of three trials (290 infants) did not show an effect on rates of GM-IVH (RR 1.11, 95% confidence interval (CI) 0.78 to 1.56; I² = 0%) and severe IVH (RR 0.71, 95% CI 0.37 to 1.33; I² = 0%). Neonatal mortality (RR 0.49, 95% CI 0.25 to 0.93; I² = 0%; RD -0.09, 95% CI -0.16 to -0.01) and mortality until hospital discharge (typical RR 0.50, 95% CI 0.28 to 0.90; I² = 0%; RD -0.10, 95% CI -0.18 to -0.02) were lower in the supine midline head position. The certainty of the evidence was very low for all outcomes because of limitations in study design and imprecision of estimates. We identified one ongoing study. AUTHORS' CONCLUSIONS: We found few trial data on the effects of head midline position on GM-IVH in very preterm infants. Although meta-analyses suggest that mortality might be reduced, the certainty of the evidence is very low and it is unclear whether any effect is due to cot tilting (a co-intervention in one trial). Further high-quality RCTs would be needed to resolve this uncertainty.


Assuntos
Hemorragia Cerebral Intraventricular/prevenção & controle , Cabeça , Doenças do Prematuro/prevenção & controle , Posicionamento do Paciente/métodos , Decúbito Dorsal , Leitos , Hemorragia Cerebral Intraventricular/epidemiologia , Hemorragia Cerebral Intraventricular/etiologia , Circulação Cerebrovascular/fisiologia , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/epidemiologia , Doenças do Prematuro/etiologia , Viés de Publicação , Ensaios Clínicos Controlados Aleatórios como Assunto , Retinopatia da Prematuridade/epidemiologia , Rotação
20.
Gastroenterol. hepatol. (Ed. impr.) ; 43(6): 310-321, jun.-jul. 2020. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-193513

RESUMO

INTRODUCCIÓN: El impacto clínico de la elevación de la cabecera de la cama en pacientes con enfermedad por reflujo gastroesofágico es incierto, por inconsistencia y limitaciones metodológicas en estudios previos. PACIENTES Y MÉTODOS: Ensayo clínico controlado aleatorizado unicéntrico simple-ciego cruzado 2x2, en 39 pacientes con enfermedad por reflujo gastroesofágico tratados farmacológicamente. La intervención fue elevar la cabecera de la cama a 20 cm de altura durante 6 semanas y luego a dormir sin inclinación otras 6 semanas, con un lavado de 2 semanas entre períodos. El desenlace primario fue el cambio ≥ 10% de la puntuación RDQ y los desenlaces secundarios fueron el cambio ≥ 10% de la puntuación SF-36, preferencia del paciente y frecuencia de eventos adversos. RESULTADOS: 27 (69,2%) pacientes que utilizaron la intervención cumplieron el desenlace primario, vs. 13 (33,3%) pacientes en el grupo control (RR: 2,08; IC95%: 1,19 - 3,61). No se encontró efecto en la puntuación SF-36 (RR: 1,11; IC95%: 0,47 - 2,60). La preferencia por la intervención fue del 77,1% y la proporción de eventos adversos fue del 54,0%. CONCLUSIÓN: La elevación de la cabecera de la cama redujo los síntomas de reflujo, pero no tuvo efecto en la calidad de vida. Por un balance riesgo-beneficio no óptimo, se requieren estudios adicionales antes de recomendar esta intervención (IBELGA, identificador ClinicalTrials.gov NCT02706938)


BACKGROUND: The clinical impact of head-of-bed elevation in patients with gastro-oesophageal reflux disease is unclear, because of inconsistency and methodological limitations of previous studies. PATIENTS AND METHODS: A randomised single-blind single-centre controlled clinical trial with a 2x2 cross-over design, in 39 pharmacologically treated patients with gastro-oesophageal reflux disease. Active intervention was to use a head-of-bed-elevation of 20cm for 6 weeks and then to sleep without inclination for 6 additional weeks, with a wash-out of 2 weeks between periods. The primary outcome was a change ≥ 10% in RDQ score and secondary outcomes were a change ≥ 10% in SF-36 score, patient preference and frequency of adverse events. RESULTS: 27 (69.2%) patients who used the intervention reached the primary outcome vs 13 (33.3%) patients in the control group (RR: 2.08; 95 CI%: 1.19 - 3.61). No effect was found in SF-36 score (RR: 1.11; 95% CI: 0.47 - 2.60). Preference favouring the intervention was 77.1% and adverse event proportion was 54.0%. CONCLUSION: Head-of-bed elevation improved reflux symptoms but there was no effect on quality of life. The finding of a non-optimal risk-benefit ratio warrants additional studies before this intervention can be recommended (IBELGA, ClinicalTrials.gov identifier NCT02706938)


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Refluxo Gastroesofágico/prevenção & controle , Posicionamento do Paciente/métodos , Leitos , Postura , Método Simples-Cego , Qualidade de Vida , Inquéritos e Questionários
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