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1.
Bone Joint J ; 102-B(8): 1010-1015, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32731826

RESUMO

AIMS: Responsiveness and ceiling effects are key properties of an outcome score. No such data have been reported for the original English version of the International Hip Outcome Tool 12 (iHOT-12) at a follow-up of more than four months. The aim of this study was to identify the responsiveness and ceiling effects of the English version iHOT-12 in a series of patients undergoing hip arthroscopy for intra-articular hip pathology at a minimum of one year postoperatively. METHODS: A total of 171 consecutive patients undergoing hip arthroscopy with a diagnosis of femoroacetabular impingement (FAI) under the care of a single surgeon between January 2013 and March 2017 were included. iHOT-12 and EuroQol 5D-5L (EQ-5D-5L) scores were available pre- and postoperatively. Effect size and ceiling effects for the iHOT-12 were calculated with subgroup analysis. RESULTS: A total of 122 patients (71.3%) completed postoperative PROMs scores with median follow-up of 24.3 months (interquartile range (IQR) 17.2 to 33.5). The median total cohort iHOT-12 score improved significantly from 31.0 (IQR 20 to 58) preoperatively to 72.5 (IQR 47 to 90) postoperatively (p < 0.001). The effect size (Cohen's d) was 1.59. In all, 33 patients (27%) scored within ten points (10%) of the maximum score and 38 patients (31.1%) scored within the previously reported minimal clinically important difference (MCID) of the maximum score. Furthermore, nine (47%) male patients aged < 30 years scored within 10% of the maximum score and ten (53%) scored within the previously reported MCID of the maximum score. CONCLUSION: There is a previously unreported ceiling effect of the iHOT-12 at a minimum one-year follow-up which is particularly marked in young, male patients following hip arthroscopy for FAI. This tool may not have the maximum measurement required to capture the true outcome following this procedure. Cite this article: Bone Joint J 2020;102-B(8):1010-1015.


Assuntos
Artroscopia/métodos , Impacto Femoroacetabular/diagnóstico , Medição da Dor , Medidas de Resultados Relatados pelo Paciente , Amplitude de Movimento Articular/fisiologia , Adulto , Estudos de Coortes , Feminino , Impacto Femoroacetabular/cirurgia , Seguimentos , Articulação do Quadril/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Diferença Mínima Clinicamente Importante , Cuidados Pós-Operatórios/métodos , Cuidados Pré-Operatórios/métodos , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Pesos e Medidas
3.
Medicine (Baltimore) ; 99(17): e19816, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32332625

RESUMO

Anatomical differences of unilateral percutaneous kyphoplasty (PKP) between transverse process-pedicle approach (TPPA) and conventional transpedicular approach (CTPA) are not well discussed. To investigate the anatomical distinctions of unilateral PKP between TPPA and CTPA, we have discussed the unilateral PKP through a 3-dimensional-computed tomography database.Five hundred lumbar spines from 100 patients have been retrospectively collected and unilateral CTPA and TPPA were simulated. Distance between the entry point and the midline of the vertebral body (DEM), the puncture inclination angle (PIA), and the success rate (SR) of puncture were measured and compared.The male presented with significantly larger DEM than the female. The TPPA group presented with larger DEM than the CTPA group according to different level, the difference was 1.5 ±â€Š1.1 mm to 3.8 ±â€Š2.3 mm. The PIAs in the TPPA group were larger than that in the CTPA group. The SR including 1 side SR and bilateral SR was 72.0% in the CTPA group and 98.0% in the TPPA group. Compared with CTPA group, the SR in TPPA group was significantly higher for L1 to L4 no matter in the left, right side and female patients.The TPPA group presented with more lateral entry point, larger PIAs and higher SRs than that in the CTPA group. PKP surgery through a TPPA was safer and could provide a more symmetrical distribution of bone cement than the CTPA group.


Assuntos
Cifoplastia/métodos , Cifoplastia/normas , Vértebras Lombares/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Cifoplastia/classificação , Cifoplastia/estatística & dados numéricos , Vértebras Lombares/fisiopatologia , Masculino , Pessoa de Meia-Idade , Fraturas por Osteoporose/cirurgia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Resultado do Tratamento , Pesos e Medidas/instrumentação
4.
Medicine (Baltimore) ; 99(17): e19955, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32332680

RESUMO

The aim of this study was to identify any changes that occur in the retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GC-IPL) in patients with exudative age-related macular degeneration (AMD) during treatment with anti-vascular endothelial growth factor (VEGF) injections.Patients were enrolled in this retrospective study if they had exudative AMD, had received at least 3 injections of ranibizumab or aflibercept, and had a minimum of 12 months of follow-up. We analyzed the changes in the RNFL and GC-IPL using spectral-domain optical coherence tomography in rescan mode.Fifty-two eyes of 52 patients who had been treated with repeated anti-VEGF injections for exudative AMD were included. At the final visit, there was no significant between-group difference in best-corrected visual acuity or intraocular pressure. There was a significant decrease in central macular thickness in all groups (P < .05). There was a decrease in RNFL thickness that was only statistically significant in the ranibizumab group and when the ranibizumab or aflibercept groups were combined (P = .036 and .044, respectively). The thickness of the GC-IPL layer was significantly decreased in the aflibercept and total group (P = .035 and P = .048, respectively).The thicknesses of the RNFL and GC-IPL decreased in patients with exudative AMD who underwent repeated anti-VEGF injections.


Assuntos
Degeneração Macular/tratamento farmacológico , Retina/patologia , Fatores de Crescimento do Endotélio Vascular/uso terapêutico , Pesos e Medidas , Idoso , Idoso de 80 Anos ou mais , Inibidores da Angiogênese/farmacologia , Inibidores da Angiogênese/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ranibizumab/farmacologia , Ranibizumab/uso terapêutico , Receptores de Fatores de Crescimento do Endotélio Vascular/uso terapêutico , Proteínas Recombinantes de Fusão/farmacologia , Proteínas Recombinantes de Fusão/uso terapêutico , Retina/fisiopatologia , Estudos Retrospectivos , Estatísticas não Paramétricas , Fatores de Crescimento do Endotélio Vascular/farmacologia
5.
Medicine (Baltimore) ; 99(9): e19311, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32118756

RESUMO

BACKGROUND: A core outcome set (COS) is an agreed minimum set of outcomes that should be reported in all clinical trials in specific areas of health care. A considerable amount of trials did not report essential outcomes or outcomes measurement methods, which makes it challenging to evaluate the efficacy and safety of treatment strategies for pressure injury (PI) and produced significant heterogeneity of reported outcomes. It is necessary to develop a COS, which can be used for clinical trials in PI treatment. METHODS/DESIGN: The development of this COS will be guided by an advisory group composed of clinicians, senior nurses, patients, and methodologists. We will search six databases and 2 registry platforms to identify currently reported PI treatment outcomes and outcome measurement instruments in randomized controlled trials, meta-analysis, and systematic reviews. We will also conduct a semi-structured interview with clinicians, nurses, and adult PI patients to collect their opinions on important outcomes. Each outcome of the initial list generated from systematic review and interviews will be scored and reach a consensus through two rounds of international Delphi survey with all key stakeholders. A face-to-face consensus meeting with key stakeholders will be conducted to finish a final COS and recommend measurement instruments for each outcome. RESULTS: We will develop a COS that should be reported in future clinical trials to evaluate the effectiveness of PI treatment. DISCUSSION: The COS will follow current guidance to develop a high-quality COS in the field of PI treatment to reduce heterogeneity in trial reporting, facilitate valid comparisons of new therapies, and improve the quality of clinical trials.


Assuntos
Ensaios Clínicos como Assunto/instrumentação , Pesos e Medidas/instrumentação , Protocolos Clínicos , Ensaios Clínicos como Assunto/métodos , Técnica Delfos , Determinação de Ponto Final/métodos , Determinação de Ponto Final/tendências , Humanos , Projetos de Pesquisa
6.
Rev. bras. ortop ; 55(1): 88-94, Jan.-Feb. 2020. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1092672

RESUMO

Abstract Objective To evaluate possible connections between the weight and height of patients submitted to total knee arthroplasty (TKA), with the length, width and area of the anterior cruciate ligament (ACL) fovea, as verified during surgery. Methods A total of 33 proximal tibial joint surfaces, obtained from TKA tibial sections of 33 patients, were used in the present study. The ACL was resected with a delicate scalpel to expose the ACL tibial fovea. Then the periphery of this fovea was delimited with a marker pen by means of small dots. Each piece was photographed, and the ACL tibial fovea length, width, and area were measured with the ImageJ (National Institutes of Health, Bethesda, MD, USA) software. Statistical analysis studied the correlation between anthropometrics data of the patients and the measurements of the ACL tibial fovea. Results The ACL tibial fovea length, width, and area were, respectively, 11.7 ± 2.0 mm, 7.1 ± 1.4 mm and 151.3 ± 22.2 mm2. There was a statistically significant relationship between the height of the patients and the width of the ACL tibial fovea. The width of the ACL fovea could be predicted by the formula: width = 107 . 294 − 133 . 179 × height + 44 . 009 × squared height. Conclusion The height of the patients may predict the width of the ACL tibial fovea, and therefore, may allow surgeons to choose the more adequate graft for each patient in ACL reconstruction.


Resumo Objetivo Avaliar possíveis relações entre o peso e altura de pacientes submetidos à artroplastia total do joelho com o comprimento, largura e área da fóvea do ligamento cruzado anterior, verificados na cirurgia. Métodos Um total de 33 superfícies articulares tibias proximais, obtidas nos cortes tibiais de artroplastia total do joelho de 33 pacientes, foram utilizadas no presente estudo. O ligamento cruzado anterior foi dissecado cuidadosamente e ressecado com bisturi delicado, para expor sua fóvea. Depois, a periferia dessa fóvea foi demarcada por pequenos pontos, com um marcador. Cada peça foi fotografada e as medições do comprimento, largura e área da fóvea tibial do ligamento cruzado anterior foram feitas com o programa ImageJ (National Institutes of Health, Bethesda, MD, EUA). A análise estatística avaliou a correlação entre os dados antropométricos dos pacientes com as medidas da fóvea tibial do ligamento cruzado anterior. Resultados O comprimento, a largura e a área médios da fóvea tibial do ligamento cruzado anterior foram, respectivamente 11,7 ± 2,0 mm, 7,1 ± 1,4 mm e 151,3 ± 22,2 mm2. Houve relação estatisticamente significativa entre a altura dos pacientes e a largura da fóvea tibial do ligamento cruzado anterior. A largura da fóvea do ligamento cruzado anterior pôde ser predita pela fórmula: largura = 107 , 294 − 133 , 179 × altura + 44 , 009 × altura ao quadrado. Conclusão A altura dos pacientes pôde a prever a largura da fóvea tibial do ligamento cruzado anterior e, assim, pode ajudar os cirurgiões escolher o enxerto mais adequado para cada paciente, nas reconstruções do ligamento cruzado anterior.


Assuntos
Humanos , Masculino , Feminino , Artroplastia , Tíbia , Pesos e Medidas , Medidas, Métodos e Teorias , Ligamento Cruzado Anterior/anatomia & histologia , Artroplastia do Joelho , Joelho
7.
Fisioter. Pesqui. (Online) ; 27(1): 78-84, jan.-mar. 2020. tab
Artigo em Português | LILACS | ID: biblio-1090417

RESUMO

RESUMO O objetivo deste estudo foi traduzir e adaptar a escala de utilidade clínica de Tyson e Connell para o português brasileiro, além de avaliar sua confiabilidade interexaminador e intraexaminador. O processo de tradução e adaptação transcultural foi desenvolvido em cinco estágios: tradução; síntese das traduções; retrotradução; avaliação pelo comitê de especialistas; e teste da versão pré-final. Para avaliação da confiabilidade intra e interexaminador da escala, 20 instrumentos de avaliação foram analisados de forma independente por dois examinadores (confiabilidade interexaminador). Além disso, um dos examinadores fez todas as avaliações, em dois momentos distintos, com um intervalo de 30 dias entre uma e outra (confiabilidade intraexaminador). A tradução e a adaptação transcultural foram realizadas de forma sistemática, seguindo os critérios propostos, de modo que houve apenas pequenas alterações em dois itens para tornar a escala mais útil a todos os instrumentos disponíveis na literatura. Em relação à confiabilidade interexaminador da escala de utilidade clínica de Tyson e Connell-Brasil, o valor encontrado foi CCI=0,85 (IC 95%, 0,79-0,87), enquanto para a confiabilidade intraexaminador o resultado foi CCI=0,89 (IC 95%, 0,85-0,93). Os resultados deste processo indicaram adequado grau de equivalência semântica, conceitual e cultural. Além disso, as medidas de confiabilidade intra e interexaminadores foram consideradas adequadas. Esses achados demonstraram que a escala é adequada para avaliar a utilidade clínica de instrumentos de avaliação comumente utilizados em pacientes. Dessa forma, deve ser incorporada na prática clínica e em pesquisas para a escolha do melhor instrumento.


RESUMEN O objetivo deste estudo foi traduzir e adaptar a escala de utilidade clínica de Tyson e Connell para o português brasileiro, além de avaliar sua confiabilidade interexaminador e intraexaminador. O processo de tradução e adaptação transcultural foi desenvolvido em cinco estágios: tradução; síntese das traduções; retrotradução; avaliação pelo comitê de especialistas; e teste da versão pré-final. Para avaliação da confiabilidade intra e interexaminador da escala, 20 instrumentos de avaliação foram analisados de forma independente por dois examinadores (confiabilidade interexaminador). Além disso, um dos examinadores fez todas as avaliações, em dois momentos distintos, com um intervalo de 30 dias entre uma e outra (confiabilidade intraexaminador). A tradução e a adaptação transcultural foram realizadas de forma sistemática, seguindo os critérios propostos, de modo que houve apenas pequenas alterações em dois itens para tornar a escala mais útil a todos os instrumentos disponíveis na literatura. Em relação à confiabilidade interexaminador da escala de utilidade clínica de Tyson e Connell-Brasil, o valor encontrado foi CCI=0,85 (IC 95%, 0,79-0,87), enquanto para a confiabilidade intraexaminador o resultado foi CCI=0,89 (IC 95%, 0,85-0,93). Os resultados deste processo indicaram adequado grau de equivalência semântica, conceitual e cultural. Além disso, as medidas de confiabilidade intra e interexaminadores foram consideradas adequadas. Esses achados demonstraram que a escala é adequada para avaliar a utilidade clínica de instrumentos de avaliação comumente utilizados em pacientes. Dessa forma, deve ser incorporada na prática clínica e em pesquisas para a escolha do melhor instrumento.


ABSTRACT This study aimed to translate and adapt the Clinical Utility Scale of Tyson and Connell into Brazilian Portuguese, in addition to evaluating intra- and inter-rater reliability. The process of cross-cultural translation and adaptation was developed in five stages: translation, synthesis of translations, retro translation, evaluation by the committee of experts and testing of the pre-final version. To evaluate the intra- and inter-rater reliability of the Clinical Utility Scale of Tyson and Connell, 20 assessment instruments were independently assessed by two examiners (inter-rater reliability). In addition, one of the examiners performed all assessments at two different times with a 30-day interval (intra-rater reliability). The translation and cross-cultural adaptation were performed in a systematic way, following the proposed criteria, and only minor changes in two items were necessary to make the scale more useful to all instruments currently available in the literature. Regarding the inter-rater reliability of the Clinical Utility Scale of Tyson and Connell, the value found was ICC=0.85 (IC 95%, 0,79-0,87), while for intra-rater reliability the result was ICC=0,89 (IC 95%, 0,85-0,93). The results of this process indicated an adequate degree of semantic, conceptual and cultural equivalence. In addition, intra- and inter-rater reliability measures were considered adequate. These findings have shown the scale is adequate to assess the clinical utility of evaluation instruments usually applied to patients. Therefore, it must be incorporated into clinical practice and research when choosing the best evaluation instrument to be used.


Assuntos
Tradução , Pesos e Medidas/instrumentação , Análise Custo-Benefício/métodos , Avaliação da Deficiência , Exame Físico/instrumentação , Reprodutibilidade dos Testes , Gerenciamento Clínico , Transtornos das Habilidades Motoras/diagnóstico , Limitação da Mobilidade
8.
Bioresour Technol ; 296: 122285, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31715557

RESUMO

This study investigated pilot-scale production of xylo-oligosaccharides (XOS) and fermentable sugars from Miscanthus using steam explosion (SE) pretreatment. SE conditions (200 °C; 15 bar; 10 min) led to XOS yields up to 52 % (w/w of initial xylan) in the hydrolysate. Liquid chromatography-mass spectrometry demonstrated that the solubilised XOS contained bound acetyl- and hydroxycinnamate residues, physicochemical properties known for high prebiotic effects and anti-oxidant activity in nutraceutical foods. Enzymatic hydrolysis of XOS-rich hydrolysate with commercial endo-xylanases resulted in xylobiose yields of 380 to 500 g/kg of initial xylan in the biomass after only 4 h, equivalent to ~74 to 90 % conversion of XOS into xylobiose. Fermentable glucose yields from enzymatic hydrolysis of solid residues were 8 to 9-fold higher than for untreated material. In view of an integrated biorefinery, we demonstrate the potential for efficient utilisation of Miscanthus for the production of renewable sources, including biochemicals and biofuels.


Assuntos
Vapor , Açúcares , Hidrólise , Oligossacarídeos , Pesos e Medidas
9.
Bioresour Technol ; 296: 122344, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31708387

RESUMO

In this work, a pilot-scale low dissolved oxygen (DO) composite biological system (LDOCBS) composed of an anoxic rotating biological contactor (RBC) and four aeration tanks with gradient aeration was used to treat landfill leachate for 88 d. The maximum removals of 85.65%, 99.92% and 84.06% for chemical oxygen demand (COD), ammonia (NH4+-N) and total nitrogen (TN) were achieved, respectively. The three-dimensional exaction and emission matrix (3D-EEM) fluorescence spectroscopy revealed that the biodegradability of leachate was significantly improved by the LDOCBS. Mass balance calculations showed that the COD removal and denitrification process mainly occurred in RBC while 1# contributed primarily to nitrification. High-throughput sequencing analysis indicated that denitrifying bacteria with highly relative abundances of 46.45%-53.81% played key roles in organic degradation and nitrogen removal. This work could add some guiding insights into the cost-efficient treatment of landfill leachate by the composite biological system.


Assuntos
Microbiota , Poluentes Químicos da Água , Reatores Biológicos , Desnitrificação , Nitrogênio , Oxigênio , Pesos e Medidas
10.
Water Sci Technol ; 80(6): 1042-1052, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31799948

RESUMO

This study assessed the nutrient flows and the economic viability of a farm-scale grass biorefinery concept for a pig farm. Grass silage was separated into liquid and solid fractions; the liquid fraction was used as pig feed and the solid fraction was directed to biogas production together with pig slurry. The addition of grass to the farm's crop rotation and its use in feed and biogas production slightly increased the share of nitrogen (N) circulating within the farm (by 2%), thus decreasing phosphorus circulation by 3%. Despite the positive effect on N balance, the economy of the farm-scale concept had challenges. However, upgrading biogas to vehicle fuel and selling it on farm was more economically viable than combined heat and power production. The proposed concept could be economically viable with a slight increase in the price of vehicle fuel, a moderate increase in the price of the grass liquid fraction, or better optimization of the system, starting with grass cultivation and processing. Moreover, profitable production could also be reached by increasing the scale of production by increasing farm size or by two or more farms working together.


Assuntos
Biocombustíveis , Poaceae , Animais , Fazendas , Fósforo , Suínos , Pesos e Medidas
11.
Water Sci Technol ; 80(6): 1185-1195, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31799962

RESUMO

In this study, a full-scale survey was conducted of a sludge landfill that had been sealed for 10 years to investigate sludge properties, leachate characteristics and microbial community structure. Vertical distribution of sludge and leachate pollutants in the landfill site showed that the sludge and soluble pollutants in the leachate were both distributed almost evenly even after long-term anaerobic digestion, and higher concentrations of soluble pollutants and richness of microbial community were observed at the middle layer. Compared to dewatered excess sludge generated from the activated sludge process before landfill, landfill sludge had a much lower organic content (28.1%), smaller particle size and worse dewaterability. Compared to municipal waste landfill, sludge landfill generated leachate with a lower concentration of organic substances, and comparable concentrations of nitrogenous and phosphorus pollutants. Bacterial community analysis by Illumina MiSeq sequencing showed that Proteobacteria, Firmicutes, Chloroflexi, Actinobacteria and Bacteroidetes were the major phyla, and some new genera (Methylocystaceae, Mariniphaga and Aminicenantes) were enriched in the sludge landfill. Archaeal community analysis showed that aceticlastic methanogenesis by Methanosaeta and Methanosarcina was the main pathway for methane production in the sludge landfill, in contrast to waste landfill with hydrogenotrophic methanogenesis as the main pathway.


Assuntos
Microbiota , Poluentes Químicos da Água , Esgotos , Inquéritos e Questionários , Instalações de Eliminação de Resíduos , Pesos e Medidas
12.
Health Promot Chronic Dis Prev Can ; 39(12): 323-332, 2019 Dec.
Artigo em Inglês, Francês | MEDLINE | ID: mdl-31825785

RESUMO

INTRODUCTION: The 10-item Social Provisions Scale (SPS-10) has been implemented to measure social support in a number of national surveys in Canada. The objective of this study was to reduce the SPS-10 to a brief, five-item scale (SPS-5), while maintaining adequate measurement properties. METHODS: Data from individuals aged 18 years and older who responded to the Social Provisions Scale module in the Canadian Community Health Survey 2012 Mental Health Focus cycle (CCHS 2012 MH) and the Canadian Community Health Survey 2017 Annual cycle (CCHS 2017) were analyzed. We used exploratory factor analysis and item-to-total correlations from the CCHS 2012 MH data to choose items. A correlation analysis between the SPS-5, SPS-10 and related positive mental health (PMH) constructs were used to assess the criterion-related validity of the SPS-5 compared to the SPS-10. A confirmatory factor analysis using data from the CCHS 2017 was conducted to confirm the factor structure of the SPS­5. RESULTS: The SPS-5 showed high internal consistency (Cronbach's alpha of 0.88) and similar correlations as the SPS-10 with related PMH constructs. The SPS-5 and SPS-10 were also very highly correlated (r = 0.97). The confirmatory factor analysis demonstrated that a single factor model of the SPS-5 fit the data well. The SPS-5 and SPS-10 yield similar estimates of high social support, of 92.7 and 91.5%, respectively. CONCLUSION: The new SPS-5 demonstrated adequate measurement properties, and functioned in a similar manner to the SPS-10, supporting a reduced version of the Scale. The SPS-5 is a feasible and valid alternative to the SPS-10 that could be used to reduce respondent burden on national health surveys.


Assuntos
Inquéritos Epidemiológicos , Saúde da População/estatística & dados numéricos , Saúde Pública , Apoio Social , Canadá/epidemiologia , Análise Fatorial , Feminino , Inquéritos Epidemiológicos/métodos , Inquéritos Epidemiológicos/normas , Humanos , Masculino , Pessoa de Meia-Idade , Psicometria/métodos , Psicometria/normas , Saúde Pública/métodos , Saúde Pública/estatística & dados numéricos , Inquéritos e Questionários , Pesos e Medidas/normas
13.
Rev. bras. ortop ; 54(6): 709-713, Nov.-Dec. 2019. tab
Artigo em Inglês | LILACS | ID: biblio-1057958

RESUMO

Abstract Objective To measure the cost of simultaneous total knee arthroplasty, as well as the costs of total and intensive care unit (ICU) length of stay, perioperative complications and need for blood transfusion compared to the costs of unilateral procedure in a referral hospital, in Federal District, Brazil. Method The present article is a retrospective study analyzing the medical records of patients admitted for unilateral or bilateral total knee arthroplasty, performed between June 2011 and March 2017. Seventy-four medical records were included in the study for evaluation of data such as total cost of the procedure, comorbidities, complications, days of hospitalization, and need for blood transfusion. Results A significantly higher incidence of deep vein thrombosis (DVT) was found in unilateral procedures. Compared to the other data, no statistically significant differences were found in the relative costs or in the need for blood transfusion. Conclusion There was no increase in the cost or in complications when comparing the simultaneous bilateral knee joint replacement procedure with the unilateral procedure, which corroborates most of the literature.


Resumo Objetivo Medir o custo das artroplastias totais de joelho simultâneas, assim como o tempo de internação total e em unidade de tratamento intensivo (UTI), complicações perioperatórias e necessidade de hemotransfusão comparativamente ao procedimento unilateral, num hospital de referência, no Distrito Federal, Brasil. Método O presente artigo trata-se de um estudo retrospectivo de análise dos prontuários de pacientes admitidos para a realização de artroplastia total de joelho uni ou bilateral realizadas entre junho de 2011 e março de 2017. Foram incluídos para o estudo 74 prontuários de pacientes para avaliação de dados como custo total do procedimento, comorbidades, complicações, dias de internação e necessidade de hemotransfusão. Resultados Uma incidência significativamente maior de trombose venosa profunda (TVP) foi encontrada nos procedimentos unilaterais. Em relação aos outros dados não foram encontradas diferenças estatisticamente significantes nos custos relativos, nem na necessidade de hemotransfusão. Conclusão Não houve aumento nos custos nem nas complicações do procedimento de substituição articular bilateral do joelho num mesmo momento em relação ao procedimento unilateral, corroborando com a maioria da literatura.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Complicações Pós-Operatórias , Pesos e Medidas , Incidência , Estudos Retrospectivos , Morbidade , Artroplastia do Joelho , Custos e Análise de Custo , Joelho , Tempo de Internação
14.
Med. UIS ; 32(3): 19-25, Sep.-Dec. 2019. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1114973

RESUMO

Resumen La terapia con oxígeno a largo plazo mejoró la supervivencia de los pacientes con enfermedad pulmonar obstructiva crónica. Las medidas propuestas en las guías clínicas para evaluar la indicación y seguimiento de esta terapia son la presión arterial de oxígeno y la saturación arterial de oxígeno. Se ha generalizado el uso de la oximetría de pulso, pero la información para determinar si estas medidas son intercambiables es insuficiente. El objetivo es revisar los fundamentos fisiológicos de las variables relacionadas con la oxigenación y sus formas de medición. En la evaluación del paciente con patología respiratoria, la saturación de pulso es una ayuda clínica valiosa, sin embargo, sus limitaciones no le permiten, en ciertos rangos, reemplazar la valoración directa en sangre arterial (gasometría arterial) de la saturación arterial y la presión arterial de oxígeno, para determinar la indicación de la oxigenoterapia. MÉD.UIS.2019;32(3):19-25


Abstract Long-term oxygen therapy improves the survival of patients with chronic obstructive pulmonary disease. Measures proposed in clinical clinics to evaluate the indication and monitoring of arterial blood pressure therapy and arterial oxygen saturation. The use of pulse oximetry has been widespread, but the information to determine if these measures are interchangeable is insufficient. The objective is to review the physiological foundations of variables related to oxygenation and their forms of measurement. In the assessment of the patient with respiratory pathology, pulse saturation is a valuable clinical aid., however, its limitations do not allow, in certain ranges, to replace direct arterial blood pressure (arterial blood gas) measurement of arterial saturation and arterial oxygen pressure, to determine the indication of oxygen therapy. MÉD.UIS.2019;32(3):19-25


Assuntos
Humanos , Oximetria , Doença Pulmonar Obstrutiva Crônica , Oxigênio , Oxigenoterapia , Patologia , Pacientes , Pressão , Pulso Arterial , Sobrevida , Terapêutica , Pesos e Medidas , Sangue , Gasometria , Pneumologia , Oxigenação , Monitoramento , Pressão Arterial , Sobrevivência
15.
Medicina (Kaunas) ; 56(1)2019 Dec 25.
Artigo em Inglês | MEDLINE | ID: mdl-31881780

RESUMO

Background and Objectives: Rugby players engage in demanding, high loading muscular activity in the spine. Study of the abdominal wall architecture in female rugby athletes is relevant to the possible muscular asymmetry secondary to sport practice and the relationship between the abdominal wall and the pelvic floor muscles. Activation of the transversus abdominis (TrAb) generates an increase in the bladder neck muscle. Moreover, an increased interrecti distance (IRD) is related to urinary incontinence and has a higher prevalence in athletic women. The aim of the present study was to compare and quantify, with ultrasound imaging (USI), the thickness of the transversus abdominis (TrAb), external oblique (EO), internal oblique (IO), rectus abdominis (RA), and interrecti distance (IRD) in female rugby players versus non-athletic women in order to improve upon existing knowledge about abdominal wall configuration in female athletes. Materials and Methods: A sample of 32 women was recruited at the Universidad Europea Research Lab and divided in two groups: a rugby group (n = 16) and a non-athletic women group (n = 16). The thickness of the TrAb, EO, IO, RA, and IRD were assessed by USI in both groups. Results: There were statistically significant differences for the ultrasound evaluation thickness of the right TrAb (p = 0.011; d = 0.10), EO (p = 0.045; d = 0.74), IO (p = 0.003; d = 1.32), and RA (p = 0.001; d = 1.38) showing a thickness increase for the rugby group with respect to the control group. For the IRD thickness, there were no significant differences (p > 0.05) between groups. Conclusions: An increased TrAb, IO, EO, and RA thickness may be shown in female rugby players versus non-athletic women. Nevertheless, statistically relevant differences were not found for the IRD between both groups.


Assuntos
Parede Abdominal , Futebol Americano/fisiologia , Músculos , Comportamento Sedentário , Músculos Abdominais/crescimento & desenvolvimento , Músculos Abdominais/fisiologia , Músculos Abdominais Oblíquos/crescimento & desenvolvimento , Músculos Abdominais Oblíquos/fisiologia , Adulto , Índice de Massa Corporal , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos , Reto do Abdome/crescimento & desenvolvimento , Reto do Abdome/fisiologia , Ultrassonografia/métodos , Pesos e Medidas/instrumentação
16.
Anesth Analg ; 129(6): 1549-1556, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31743174

RESUMO

BACKGROUND: Frequent hand hygiene by anesthesia personnel may be an important factor in reducing contamination of IV lines and medication access ports and may reduce hospital-acquired infections. Measurement of hand hygiene frequency at the individual clinician level by direct observation or electronic devices is cumbersome and expensive. We developed and validated a simple method for estimating hand hygiene frequency by individual anesthesia providers and utilized it in a quality improvement initiative to increase hand hygiene use. METHODS: Pump-style, alcohol-based hand hygiene container weight at the anesthesia work station was measured before and after each surgical operation and converted to estimated number of accesses (pumps) per hour. Video observation was used to validate the estimated hand hygiene use. A quality improvement initiative utilized periodic measurement of hand hygiene frequency via the validated method, and incorporated individual provider feedback, email reminders, monthly departmental performance reports, and reminders in the electronic anesthesia record. Segmented linear regression was used to evaluate the effect of the intervention on hand hygiene use. RESULTS: Delivered product per pump was consistent for containers at least half-full and averaged (mean ± SD) 0.92 ± 0.13 g per pump. Video observation in 26 cases showed a strong correlation between observed hand hygiene episodes and estimated hand hygiene use frequency based on weight change of the container (linear regression, R = 0.97, P < .0001). Median hand hygiene frequency was near 0 at baseline but increased progressively throughout the intervention period (segmented linear regression, overall R = 0.76, P < .0001; change of intercept or mean hand hygiene after initiation of intervention [parameter estimate ± SE] [0.970 ± 0.29], P = .0008). CONCLUSIONS: A low-cost, simple method for measuring individual anesthesia clinician use of hand hygiene intraoperatively based on container weight change is feasible and sufficiently accurate to support a quality improvement initiative to increase its use.


Assuntos
Anestesiologistas , Atitude do Pessoal de Saúde , Desinfecção das Mãos , Higienizadores de Mão , Conhecimentos, Atitudes e Prática em Saúde , Controle de Infecções/métodos , Padrões de Prática Médica , Melhoria de Qualidade , Indicadores de Qualidade em Assistência à Saúde , Humanos , Reprodutibilidade dos Testes , Fatores de Tempo , Gravação em Vídeo , Pesos e Medidas
17.
Medicina (Kaunas) ; 55(11)2019 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-31731397

RESUMO

Background and Objectives: Accurate breast tumor sizing is very important in treatment planning; as a result, ultrasound (US) plays an important role in diagnosing breast masses, due to its non-magnified image and its availability. The continuous change in the disease pathogenesis of breast cancer and tremendous advances in US imaging technology require the continuous evaluation of this imaging modality. In this study, our aim was to determine the accuracy of US in measuring the size of breast mass, and if there is an influence of the different pathological types on this accuracy. Materials and Methods: This study contained 66 specimens of breast masses that underwent surgical excision and pathological examination of the resected masses; the mean difference between the size taken by US and the size taken by pathology was calculated to the patients as a whole and for each tumor type in this study. Results: The result was that US underestimates the size of the tumor by 0.5 cm for all pathological types, and the US size is in agreement with the pathology size. Conclusions: US is an accurate method in measuring breast lesions with a degree of underestimation that may be related to many factors such as the tumor type, size, and margins. Complementary MRI is recommended in case of ILC and architectural distortion.


Assuntos
Neoplasias da Mama/classificação , Ultrassonografia Mamária/métodos , Pesos e Medidas/normas , Adulto , Idoso , Neoplasias da Mama/patologia , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Estudos Retrospectivos , Pesos e Medidas/instrumentação
18.
Crit Care ; 23(1): 346, 2019 11 06.
Artigo em Inglês | MEDLINE | ID: mdl-31694692

RESUMO

BACKGROUND: Excessive respiratory muscle effort during mechanical ventilation may cause patient self-inflicted lung injury and load-induced diaphragm myotrauma, but there are no non-invasive methods to reliably detect elevated transpulmonary driving pressure and elevated respiratory muscle effort during assisted ventilation. We hypothesized that the swing in airway pressure generated by respiratory muscle effort under assisted ventilation when the airway is briefly occluded (ΔPocc) could be used as a highly feasible non-invasive technique to screen for these conditions. METHODS: Respiratory muscle pressure (Pmus), dynamic transpulmonary driving pressure (ΔPL,dyn, the difference between peak and end-expiratory transpulmonary pressure), and ΔPocc were measured daily in mechanically ventilated patients in two ICUs in Toronto, Canada. A conversion factor to predict ΔPL,dyn and Pmus from ΔPocc was derived and validated using cross-validation. External validity was assessed in an independent cohort (Nanjing, China). RESULTS: Fifty-two daily recordings were collected in 16 patients. In this sample, Pmus and ΔPL were frequently excessively high: Pmus exceeded 10 cm H2O on 84% of study days and ΔPL,dyn exceeded 15 cm H2O on 53% of study days. ΔPocc measurements accurately detected Pmus > 10 cm H2O (AUROC 0.92, 95% CI 0.83-0.97) and ΔPL,dyn > 15 cm H2O (AUROC 0.93, 95% CI 0.86-0.99). In the external validation cohort (n = 12), estimating Pmus and ΔPL,dyn from ΔPocc measurements detected excessively high Pmus and ΔPL,dyn with similar accuracy (AUROC ≥ 0.94). CONCLUSIONS: Measuring ΔPocc enables accurate non-invasive detection of elevated respiratory muscle pressure and transpulmonary driving pressure. Excessive respiratory effort and transpulmonary driving pressure may be frequent in spontaneously breathing ventilated patients.


Assuntos
Ventilação não Invasiva/métodos , Pressão , Pesos e Medidas/instrumentação , Trabalho Respiratório/fisiologia , Lesão Pulmonar Aguda/fisiopatologia , Lesão Pulmonar Aguda/prevenção & controle , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/métodos , Respiração Artificial/métodos , Músculos Respiratórios/lesões , Músculos Respiratórios/fisiopatologia , Pesos e Medidas/normas
19.
Phys Ther Sport ; 40: 238-243, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31634782

RESUMO

OBJECTIVES: To quantify the effects of medicine ball mass (1 kg, 1.5 kg, 2 kg) on the intensity of 90°/90° plyometric throwing exercise. STUDY DESIGN: Controlled laboratory study. SETTING: Biomechanics laboratory. PARTICIPANTS: Fifteen physically active collegiate aged men. MAIN OUTCOME MEASURES: Kinematics of the upper extremity were collected during completion of eight to ten repetitions of 90°/90° plyometric throwing exercise with three different mass medicine balls. Four parameters, medicine ball release and contact momentum, time-to-rebound, and contact time, were computed for each selected repetition and used for statistical analysis. RESULTS: Ball mass did not significantly influence time-to-rebound (P = .718) and had a small (less than 0.05s) effect on ball contact time (P = .039). Ball release momentum was significantly greater (P < .001, 67-123% greater) than ball contact momentum. Medicine ball mass significantly increased both ball release (34-35%) and ball contact (45-67%) momentum however the effect was significantly greater for ball release momentum (P = .005). CONCLUSIONS: These results document the effects of increasing medicine ball mass during 90°/90° plyometric throwing exercise and provide evidence for designing upper extremity plyometric training programs. Based on ball contact momentum being less than ball release momentum, as well as ball mass having greater influence on ball release velocity, we suggest that 90°/90° plyometric throwing exercise is a safe exercise.


Assuntos
Exercício Pliométrico , Equipamentos Esportivos , Pesos e Medidas , Adulto , Fenômenos Biomecânicos , Humanos , Masculino , Extremidade Superior , Adulto Jovem
20.
Medicina (Kaunas) ; 55(10)2019 Oct 18.
Artigo em Inglês | MEDLINE | ID: mdl-31635406

RESUMO

Background and Objectives: It has been established that body position can play an important role in intraocular pressure (IOP) fluctuation. IOP has been previously shown to increase significantly when lying down, relative to sitting; this type of investigation has not been extensively reported for the standing (ST) position. Therefore, this study aims to look for eventual significant IOP changes while ST, sitting, and lying down. MATERIALS AND METHODS: An Icare PRO was used to measure the IOP of 120 eyes of 60 healthy individuals, with age ranging from 21 to 55 years (mean 29.22 ± 9.12 years), in sitting, supine and ST positions; IOP was measured again, 5 minutes after standing (ST-5m). RESULTS: Mean IOP difference between sitting and ST position was 0.39 ± 1.93 mmHg (95% CI: 0.04 to 0.74 mmHg) (p = 0.027); between sitting and ST-5m, it was -0.48 ± 1.79 mmHg (95% CI: -0.8 to -0.16 mmHg) (p = 0.004); between the sitting and supine position, it was -1.16±1.9 mmHg (95% CI: -1.5 to -0.82 mmHg) (p < 0.001); between the supine and ST position, it was 1.55 ± 2.04 mmHg (95% CI: 1.18 to 1.92 mmHg) (p < 0.001); between supine and ST-5m, it was 0.68 ± 1.87 mmHg (95% CI: 0.34 to 1.02 mmHg) (p < 0.001); and between ST-5m and ST, it was 0.94 ± 1.95 mmHg (95% CI: 0.58 to 1.29 mmHg) (p < 0.001). Mean axial eye length was 24.45 mm (95% CI: 24.22 to 24.69 mm), and mean central corneal thickness was 535.30 µm (95% CI: 529.44 to 541.19 µm). CONCLUSION: Increased IOP in the ST-5m position suggests that IOP measurements should be performed in this position too. The detection of higher IOP values in the ST-5m position than in the sitting one, may explain the presence of glaucoma damage or progression in apparently normal-tension or compensated patients.


Assuntos
Pressão Intraocular/fisiologia , Posição Ortostática , Tonometria Ocular/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesos e Medidas/instrumentação
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