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1.
Medicine (Baltimore) ; 100(33): e26988, 2021 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-34414978

RESUMO

ABSTRACT: With the declining use of the pulmonary artery catheter (PAC), transesophageal echocardiography (TEE) has become an appealing alternative to obtain pulmonary artery pressure non-invasively using the simplified Bernoulli equation. The validation of this method in the perioperative setting has been scarce with no clear recommendations about which view is the most accurate to estimate right ventricular systolic pressure (RVSP).Therefore, we performed a prospective, observer-blinded, diagnostic test accuracy study to assess the difference in systolic pulmonary artery pressure (sysPAP) measuring both, invasively sysPAP and estimated RVSP with TEE in 3 different views: the mid-esophageal (ME) 4Chamber, the ME right ventricular (RV) inflow-outflow and the ME modified bicaval view.To show a clinically significant difference of at least 10% in RVSP, we included 40 cardiac surgical patients divided into 3 subgroups: Patients with mild to moderate tricuspid regurgitation (TR) and mean PAP <25 mm Hg, patients with mild to moderate TR and mean PAP≥ 25 mm Hg, and patients with severe TR.For the whole cohort, bias of estimated RVSP compared to measured sysPAP was 5.27 mm Hg, precision was 7.96 mm Hg, limits of agreement were -10.66 to 21.19 mm Hg. The best agreement between the 2 methods was found in patients with severe TR and in the ME RV inflow-outflow and the modified bicaval view. Good Doppler signals were available in 35% and 46% in these views, and in 20% in the ME 4 chamber view.The estimation of the sysPAP by TEE cannot be considered reliable in the clinical perioperative setting. Only measurements that provide a full Doppler envelope show sufficient precision to provide accurate estimations.


Assuntos
Ecocardiografia Transesofagiana/métodos , Hipertensão Arterial Pulmonar/classificação , Pesos e Medidas/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Pressão Sanguínea/fisiologia , Ecocardiografia Transesofagiana/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos Testes , Pesos e Medidas/instrumentação
2.
Medicine (Baltimore) ; 100(33): e26998, 2021 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-34414985

RESUMO

BACKGROUND: Early diagnosis as well as treatment is important in management of congenital muscular torticollis (CMT). The purpose of this study was to find an effective physical therapy modality to improve the sternocleidomastoid (SCM) muscle thickness, the ratio of the SCM muscle thickness on the affected side to that on the non-affected side (A/N ratio), and head rotation in infant under 3 months of age diagnosed with CMT. METHODS AND ANALYSIS: A single-blind, randomized clinical trial was conducted. Participants were assigned in one of the 3 study groups through randomization. The treatment was performed 3 times a week for 30 minutes until the head tilt was ≤5 degrees. Group 1 was treated by handling for active or active-assist movement, group 2 was treated with passive stretching, and group 3 was treated with thermotherapy. For general characteristics, a χ2 test and 1-way analysis of variance were used. Intragroup differences were analyzed using a paired t test, and intergroup differences were analyzed using an age-adjusted analysis of covariance. RESULTS: After the intervention, there was no significant difference between groups in terms of SCM thickness on the affected side and A/N ratio (P > .05). Degree of head rotation on the affected side showed significant differences between groups (P < .05), with Group 2 showing significantly better results than group 1 and group 3 (P < .05, both). CONCLUSION: Passive stretching treatment was more effective than other treatments of this study for improvement in degree of head rotation in CMT infants under 3 months of age. TRIAL REGISTRATION: The trial is registered at the Institutional Review Board of Sahmyook University (IRB number, 2-7001793-AB-N-012019103HR) and the Clinical Research Information Service (CRiS; registry number, KCT0004862).


Assuntos
Músculos/fisiopatologia , Modalidades de Fisioterapia/normas , Esterno/fisiopatologia , Torcicolo/congênito , Pesos e Medidas/normas , Humanos , Lactente , Modalidades de Fisioterapia/estatística & dados numéricos , Método Simples-Cego , Torcicolo/complicações , Torcicolo/terapia , Pesos e Medidas/instrumentação
3.
Crit Care ; 25(1): 196, 2021 06 07.
Artigo em Inglês | MEDLINE | ID: mdl-34099028

RESUMO

BACKGROUND: The evaluation of patient effort is pivotal during pressure support ventilation, but a non-invasive, continuous, quantitative method to assess patient inspiratory effort is still lacking. We hypothesized that the concavity of the inspiratory flow-time waveform could be useful to estimate patient's inspiratory effort. The purpose of this study was to assess whether the shape of the inspiratory flow, as quantified by a numeric indicator, could be associated with inspiratory effort during pressure support ventilation. METHODS: Twenty-four patients in pressure support ventilation were enrolled. A mathematical relationship describing the decay pattern of the inspiratory flow profile was developed. The parameter hypothesized to estimate effort was named Flow Index. Esophageal pressure, airway pressure, airflow, and volume waveforms were recorded at three support levels (maximum, minimum and baseline). The association between Flow Index and reference measures of patient effort (pressure time product and pressure generated by respiratory muscles) was evaluated using linear mixed effects models adjusted for tidal volume, respiratory rate and respiratory rate/tidal volume. RESULTS: Flow Index was different at the three pressure support levels and all group comparisons were statistically significant. In all tested models, Flow Index was independently associated with patient effort (p < 0.001). Flow Index prediction of inspiratory effort agreed with esophageal pressure-based methods. CONCLUSIONS: Flow Index is associated with patient inspiratory effort during pressure support ventilation, and may provide potentially useful information for setting inspiratory support and monitoring patient-ventilator interactions.


Assuntos
Capacidade Inspiratória , Respiração Artificial/instrumentação , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Respiração Artificial/métodos , Respiração Artificial/estatística & dados numéricos , Mecânica Respiratória/fisiologia , Pesos e Medidas/instrumentação
4.
Medicine (Baltimore) ; 100(23): e26183, 2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34115001

RESUMO

BACKGROUND: With high diagnostic accuracy, magnetic resonance elastography (MRE) is a noninvasive tool and can be adopted to measure liver stiffness (LS). In this study, meta-analysis was carried out to further evaluate whether LS measured by MRE can predict early recurrence in patients with hepatocellular carcinoma (HCC). METHODS: PUBMED, EMBASE, Web of Science, China National Knowledge Infrastructure, and Cochrane Library database were searched for studies related to LS measured by MRE in the prediction of recurrence in patients with HCC. Survival outcome was estimated by hazard ratios and 95% confidence intervals. Meta-analysis was conducted with the Stata 16.0. RESULTS: The results of this meta-analysis will be submitted to a peer-reviewed journal for publication. CONCLUSION: This study will provide evidence support for LS measured by MRE in predicting the recurrence of HCC. ETHICS AND DISSEMINATION: The private information from individuals will not be published. This systematic review also should not damage participants' rights. Ethical approval is not available. The results may be published in a peer-reviewed journal or disseminated in relevant conferences. OSF REGISTRATION NUMBER: DOI 10.17605/ OSF.IO / SURH3.


Assuntos
Carcinoma Hepatocelular/diagnóstico , Protocolos Clínicos , Técnicas de Imagem por Elasticidade/normas , Fígado/fisiopatologia , Carcinoma Hepatocelular/classificação , Técnicas de Imagem por Elasticidade/instrumentação , Técnicas de Imagem por Elasticidade/métodos , Humanos , Fígado/diagnóstico por imagem , Metanálise como Assunto , Modelos de Riscos Proporcionais , Recidiva , Revisões Sistemáticas como Assunto , Pesos e Medidas/instrumentação , Pesos e Medidas/normas
5.
Fam Syst Health ; 39(1): 29-37, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34014728

RESUMO

Shared decision making (SDM) has been gaining an increasing appeal in providing patient-centered health care, which focuses on patients' needs and values and their active role in making health-related decisions. However, SDM remains difficult to measure because different conceptual definitions have been used in the literature, resulting in different operational definitions and measurement approaches. In addition, traditional measurement approaches, such as self-reports, can fail to capture the dynamic nature of the SDM process. In this paper, we propose using sensor-based measurement (i.e., using sensors to collect objective and automated data in real time) to examine the SDM process to overcome the measurement challenges inherent in more traditional measurement approaches. We also call for further discussion on the role and feasibility of using sensors in studying SDM. Using a few sensors as an example, we discuss benefits and challenges of sensor-based measurement in this area. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
Tomada de Decisão Compartilhada , Relações Profissional-Família , Humanos , Autorrelato , Pesos e Medidas/instrumentação
6.
Rev. bras. ortop ; 56(2): 175-180, Apr.-June 2021. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1251344

RESUMO

Abstract Objective To evaluate knee alignment in the frontal plane and pelvic balance during the step-down test in female and male soccer players. Methods Cross-sectional study carried out with male and female soccer players from under-15 and under-17 teams of a professional club in Southern Brazil. The step-down test was performed, filmed with a video camera, and evaluated according to the angular measurements obtained during movement using the Kinovea software (open source), version 0.8.24. Results The sample consisted of 38 individuals, 19 males and 19 females. Female athletes had a greater varus angle (9.42º ± 1.65º) compared to male athletes (3.91º ± 2.0º; p = 0.04). There was no difference regarding the unilateral pelvic drop between the groups. In addition, the association between the hip-related pelvic drop and the projection angle on the frontal plane of the knee was weak in both genders. Conclusion Even though the pelvic drop was observed in both genders, young female athletes had greater varus knee angles on the step-down test, which require greater attention to minimize the risk of injury.


Resumo Objetivo Avaliar o alinhamento do joelho no plano frontal e o equilíbrio pélvico durante a descida de um degrau comparando atletas de futebol feminino e masculino. Métodos Estudo transversal, realizado com atletas de futebol das categorias sub-15 e sub-17, de ambos os sexos, de um clube profissional do Sul do Brasil. Foi realizado o teste de descida de um degrau, o qual foi filmado por uma câmera de vídeo, e, em sua avaliação, traçaram-se as medidas angulares durante o movimento por meio do software Kinovea (código aberto), versão 0.8.24. Resultados A amostra foi composta por 38 indivíduos, 19 do sexo masculino e 19 do sexo feminino. As atletas do sexo feminino apresentaram maior ângulo em varo (9,42º ± 1,65º) quando comparadas com os atletas masculinos (3,91º ± 2,0º; p = 0,04). Não houve diferença em relação à queda unilateral da pelve (drop pélvico) entre os grupos, e a associação entre o drop pélvico do quadril e o ângulo de projeção no plano frontal do joelho foi fraca em ambos os sexos. Conclusão Apesar de ambos os sexos terem apresentado queda pélvica, as atletas de base do sexo feminino apresentaram maior angulação do joelho em varo no teste de descida do degrau, e necessitam maior atenção para minimizar o risco de lesão.


Assuntos
Humanos , Masculino , Feminino , Pelve , Futebol , Pesos e Medidas , Medidas, Métodos e Teorias , Genu Varum , Atletas , Quadril , Joelho
7.
PLoS One ; 16(4): e0250207, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33861774

RESUMO

Vertical tanks are commonly used appliances for liquids, and its capacity is very important for quantitative liquid ratio and liquid trade. In order to measure the capacity of vertical tanks more conveniently, this paper proposes a vertical tank capacity measurement method based on Monte Carlo Method. The method arranges a plurality of sensor points on the inner surface of the tank, and then performs Monte Carlo tests by generating a large number of random sample points, and finally calculates the capacity by counting the sample points that meet the criterion. The criterion for whether a sample point is located in the tank, which is the core issue, is established with the coordinates of sensor points and the distance between different sensor points along the surface of the tank. The results show that the absolute error of the measurement results of the proposed method does not exceed ±0.0003[m3], and the absolute error of capacity per unit volume has a linear relationship with the height of the vertical tank, and has little effect with the radial size of the vertical tank.


Assuntos
Previsões/métodos , Precisão da Medição Dimensional , Modelos Teóricos , Método de Monte Carlo , Pesos e Medidas
8.
Crit Care ; 25(1): 125, 2021 03 29.
Artigo em Inglês | MEDLINE | ID: mdl-33781307

RESUMO

BACKGROUND: Pulmonary artery thermodilution is the clinical reference method for cardiac output monitoring. Because both continuous and intermittent pulmonary artery thermodilution are used in clinical practice it is important to know whether cardiac output measurements by the two methods are clinically interchangeable. METHODS: We performed a systematic review and meta-analysis of clinical studies comparing cardiac output measurements assessed using continuous and intermittent pulmonary artery thermodilution in adult surgical and critically ill patients. 54 studies with 1522 patients were included in the analysis. RESULTS: The heterogeneity across the studies was high. The overall random effects model-derived pooled estimate of the mean of the differences was 0.08 (95%-confidence interval 0.01 to 0.16) L/min with pooled 95%-limits of agreement of - 1.68 to 1.85 L/min and a pooled percentage error of 29.7 (95%-confidence interval 20.5 to 38.9)%. CONCLUSION: The heterogeneity across clinical studies comparing continuous and intermittent pulmonary artery thermodilution in adult surgical and critically ill patients is high. The overall trueness/accuracy of continuous pulmonary artery thermodilution in comparison with intermittent pulmonary artery thermodilution is good (indicated by a pooled mean of the differences < 0.1 L/min). Pooled 95%-limits of agreement of - 1.68 to 1.85 L/min and a pooled percentage error of 29.7% suggest that continuous pulmonary artery thermodilution barely passes interchangeability criteria with intermittent pulmonary artery thermodilution. PROSPERO registration number CRD42020159730.


Assuntos
Débito Cardíaco/fisiologia , Artéria Pulmonar/fisiopatologia , Termodiluição/instrumentação , Pesos e Medidas/instrumentação , Humanos , Monitorização Fisiológica/instrumentação , Monitorização Fisiológica/métodos , Reprodutibilidade dos Testes , Termodiluição/métodos , Pesos e Medidas/normas
9.
Rev Paul Pediatr ; 39: e2020045, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33656143

RESUMO

OBJECTIVE: To verify the interval of responsiveness to the scales Segmental Assessment of Trunk Control (SATCo-BR), Performance of Upper Limbs (PUL), and Jebsen Taylor Test (JTT) in patients with Duchenne Muscular Dystrophy (DMD). METHODS: We assessed patients with DMD aged 6 to 19 years old and with mini-mental (MMSE) score above 10 points. The assessments were performed individually, in a single session. The upper limb function was performed by PUL and JTT, and trunk control by SATCo-BR. Assessments were repeated six and 12 months after the initial assessment. The repeated-measures analysis of variance model and Bonferroni's multiple comparison method were employed as post hoc analysis; when the ANOVA assumptions were not met, the Friedman test was applied. RESULTS: The sample consisted of 28 patients evaluated in three moments (initial, and six and 12 months after the beginning). There was a time effect for the Upper Limb function performance in the total JTT, and for the subtests, except for subtests 1 and 6, which did not show a difference between the different moments. There was also a time effect for the score of total PUL, proximal PUL, intermediate PUL, and distal PUL. In the SATCo-BR, this effect was observed between the initial and 6 months, and between the initial and 12 months. CONCLUSIONS: The JTT, PUL, and SATCo-BR scales can detect changes over time, and they showed responsiveness to detect the evolution of the disease in the 6-month interval.


Assuntos
Distrofia Muscular de Duchenne/fisiopatologia , Equilíbrio Postural/fisiologia , Tronco/fisiopatologia , Extremidade Superior/fisiopatologia , Pesos e Medidas/normas , Adolescente , Antropometria/métodos , Criança , Progressão da Doença , Humanos , Estudos Longitudinais , Masculino , Testes de Estado Mental e Demência/estatística & dados numéricos , Distrofia Muscular de Duchenne/diagnóstico , Distrofia Muscular de Duchenne/epidemiologia , Desempenho Físico Funcional , Fatores de Tempo , Adulto Jovem
10.
Crit Care ; 25(1): 110, 2021 03 18.
Artigo em Inglês | MEDLINE | ID: mdl-33736672

RESUMO

BACKGROUND: In patients ventilated with tidal volume (Vt) < 8 mL/kg, pulse pressure variation (PPV) and, likely, the variation of distensibility of the inferior vena cava diameter (IVCDV) are unable to detect preload responsiveness. In this condition, passive leg raising (PLR) could be used, but it requires a measurement of cardiac output. The tidal volume (Vt) challenge (PPV changes induced by a 1-min increase in Vt from 6 to 8 mL/kg) is another alternative, but it requires an arterial line. We tested whether, in case of Vt = 6 mL/kg, the effects of PLR could be assessed through changes in PPV (ΔPPVPLR) or in IVCDV (ΔIVCDVPLR) rather than changes in cardiac output, and whether the effects of the Vt challenge could be assessed by changes in IVCDV (ΔIVCDVVt) rather than changes in PPV (ΔPPVVt). METHODS: In 30 critically ill patients without spontaneous breathing and cardiac arrhythmias, ventilated with Vt = 6 mL/kg, we measured cardiac index (CI) (PiCCO2), IVCDV and PPV before/during a PLR test and before/during a Vt challenge. A PLR-induced increase in CI ≥ 10% defined preload responsiveness. RESULTS: At baseline, IVCDV was not different between preload responders (n = 15) and non-responders. Compared to non-responders, PPV and IVCDV decreased more during PLR (by - 38 ± 16% and - 26 ± 28%, respectively) and increased more during the Vt challenge (by 64 ± 42% and 91 ± 72%, respectively) in responders. ∆PPVPLR, expressed either as absolute or as percent relative changes, detected preload responsiveness (area under the receiver operating curve, AUROC: 0.98 ± 0.02 for both). ∆IVCDVPLR detected preload responsiveness only when expressed in absolute changes (AUROC: 0.76 ± 0.10), not in relative changes. ∆PPVVt, expressed as absolute or percent relative changes, detected preload responsiveness (AUROC: 0.98 ± 0.02 and 0.94 ± 0.04, respectively). This was also the case for ∆IVCDVVt, but the diagnostic threshold (1 point or 4%) was below the least significant change of IVCDV (9[3-18]%). CONCLUSIONS: During mechanical ventilation with Vt = 6 mL/kg, the effects of PLR can be assessed by changes in PPV. If IVCDV is used, it should be expressed in percent and not absolute changes. The effects of the Vt challenge can be assessed on PPV, but not on IVCDV, since the diagnostic threshold is too small compared to the reproducibility of this variable. TRIAL REGISTRATION: Agence Nationale de Sécurité du Médicament et des Produits de santé: ID-RCB: 2016-A00893-48.


Assuntos
Pressão Sanguínea/fisiologia , Perna (Membro)/fisiopatologia , Amplitude de Movimento Articular/fisiologia , Volume Sistólico/fisiologia , Veia Cava Inferior/fisiopatologia , Idoso , Distribuição de Qui-Quadrado , Feminino , Humanos , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Curva ROC , Reprodutibilidade dos Testes , Respiração Artificial/métodos , Estatísticas não Paramétricas , Volume de Ventilação Pulmonar/fisiologia , Veia Cava Inferior/diagnóstico por imagem , Pesos e Medidas/instrumentação , Pesos e Medidas/normas
11.
Crit Care ; 25(1): 112, 2021 03 19.
Artigo em Inglês | MEDLINE | ID: mdl-33741036

RESUMO

BACKGROUND: The availability of handheld, noninvasive sublingual video-microscopes allows for visualization of the microcirculation in critically ill patients. Recent studies demonstrate that reduced numbers of blood-perfused microvessels and increased penetration of erythrocytes into the endothelial glycocalyx are essential components of microvascular dysfunction. The aim of this study was to identify novel microvascular variables to determine the level of microvascular dysfunction in sepsis and its relationship with clinical variables. METHODS: This observational, prospective, cross-sectional study included 51 participants, of which 34 critically ill sepsis patients were recruited from intensive care units of a university hospital. Seventeen healthy volunteers served as controls. All participants underwent sublingual videomicroscopy by sidestream darkfield imaging. A new developed version of the Glycocheck™ software was used to quantify vascular density, perfused boundary region (PBR-an inverse variable of endothelial glycocalyx dimensions), red blood cell (RBC) velocity, RBC content, and blood flow in sublingual microvessels with diameters between 4 and 25 µm. RESULTS: A detailed analysis of adjacent diameter classes (1 µm each) of vessels between 4 and 25 µm revealed a severe reduction of vascular density in very small capillaries (5-7 µm), which correlated with markers of sepsis severity. Analysis of RBC velocity (VRBC) revealed a strong dependency between capillary and feed vessel VRBC in sepsis patients (R2 = 0.63, p < 0.0001) but not in healthy controls (R2 = 0.04, p = 0.43), indicating impaired capillary (de-)recruitment in sepsis. This finding enabled the calculation of capillary recruitment and dynamic capillary blood volume (CBVdynamic). Moreover, adjustment of PBR to feed vessel VRBC further improved discrimination between sepsis patients and controls by about 50%. By combining these dynamic microvascular and glycocalyx variables, we developed the microvascular health score (MVHSdynamic™), which decreased from 7.4 [4.6-8.7] in controls to 1.8 [1.4-2.7] in sepsis patients (p < 0.0001) and correlated with sepsis severity. CONCLUSION: We introduce new important diameter-specific quantification and differentiated analysis of RBC kinetics, a key to understand microvascular dysfunction in sepsis. MVHSdynamic, which has a broad bandwidth to detect microvascular (dys-) function, might serve as a valuable tool to detect microvascular impairment in critically ill patients.


Assuntos
Hemodinâmica/fisiologia , Soalho Bucal/irrigação sanguínea , Sepse/complicações , Pesos e Medidas/normas , Adulto , Idoso , Biomarcadores/análise , Estudos Transversais , Feminino , Humanos , Masculino , Microcirculação/fisiologia , Microvasos/anormalidades , Microvasos/fisiopatologia , Pessoa de Meia-Idade , Soalho Bucal/fisiopatologia , Estudos Prospectivos , Pesos e Medidas/instrumentação
12.
Acta méd. colomb ; 46(1): 50-50, ene.-mar. 2021.
Artigo em Espanhol | LILACS, COLNAL | ID: biblio-1278158

RESUMO

El uso de unidades de medida es común en la práctica médica diaria. Una de ellas es el litroy sus derivados, que se utiliza como equivalente de la dimensión física: volumen (es equiparable al decímetro cúbico, dm3).Históricamente, el litro (L) apareció como una medida de «capacidad¼, usado principalmente para describir la cantidad de sustancia líquida o gaseosa que cabe en un recipiente (original-mente fue definido como el volumen ocupado por la masa de un kilogramo de agua pura a 4 °C), mientras que para cuantificar el «volumen¼ de cuerpos sólidos se determinó el metro cúbico (m3). Con el paso del tiempo, estas dos dimensiones, capacidad y volumen, han sido aceptadas como equivalentes, aunque en sentido estricto la primera se refiere a la espaciosidad de un recipiente o contenedor, mientras que la segunda es la magnitud métrica escalar del espacio que ocupa un cuerpo en las tres dimensiones (corpulencia); es decir, no son iguales, pero sí equivalentes, por lo tanto, se pueden utilizar indistintamente para indicar la cantidad de un medicamento o fluido, líquido o gaseoso.


Assuntos
Física , Água Pura , Tempo , Pesos e Medidas
13.
BMC Pregnancy Childbirth ; 21(Suppl 1): 232, 2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-33765959

RESUMO

BACKGROUND: Globally an estimated 20.5 million liveborn babies are low birthweight (LBW) each year, weighing less than 2500 g. LBW babies have increased risk of mortality even beyond the neonatal period, with an ongoing risk of stunting and non-communicable diseases. LBW is a priority global health indicator. Now almost 80% of births are in facilities, yet birthweight data are lacking in most high-mortality burden countries and are of poor quality, notably with heaping especially on values ending in 00. We aimed to undertake qualitative research in a regional hospital in Dar es Salaam, Tanzania, observing birthweight weighing scales, exploring barriers and enablers to weighing at birth as well as perceived value of birthweight data to health workers, women and stakeholders. METHODS: Observations were undertaken on type of birthweight scale availability in hospital wards. In-depth semi-structured interviews (n = 21) were conducted with three groups: women in postnatal and kangaroo mother care wards, health workers involved in birthweight measurement and recording, and stakeholders involved in data aggregation in Temeke Hospital, Tanzania, a site in the EN-BIRTH study. An inductive thematic analysis was undertaken of translated interview transcripts. RESULTS: Of five wards that were expected to have scales, three had functional scales, and only one of the functional scales was digital. The labour ward weighed the most newborns using an analogue scale that was not consistently zeroed. Hospital birthweight data were aggregated monthly for reporting into the health management information system. Birthweight measurement was highly valued by all respondents, notably families and healthcare workers, and local use of data was considered an enabler. Perceived barriers to high quality birthweight data included: gaps in availability of precise weighing devices, adequate health workers and imprecise measurement practices. CONCLUSION: Birthweight measurement is valued by families and health workers. There are opportunities to close the gap between the percentage of babies born in facilities and the percentage accurately weighed at birth by providing accurate scales, improving skills training and increasing local use of data. More accurate birthweight data are vitally important for all babies and specifically to track progress in preventing and improving immediate and long-term care for low birthweight children.


Assuntos
Peso ao Nascer , Recém-Nascido de Baixo Peso , Assistência Perinatal/organização & administração , Pesos e Medidas/instrumentação , Adulto , Confiabilidade dos Dados , Feminino , Idade Gestacional , Sistemas de Informação em Saúde/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Hospitais/estatística & dados numéricos , Humanos , Recém-Nascido , Pessoa de Meia-Idade , Gravidez , Lacunas da Prática Profissional/estatística & dados numéricos , Pesquisa Qualitativa , Tanzânia , Fatores de Tempo , Adulto Jovem
14.
Coluna/Columna ; 20(1): 34-37, Jan.-Mar. 2021. tab
Artigo em Inglês | LILACS | ID: biblio-1154016

RESUMO

ABSTRACT Objective: The Back Pain Functional Scale (BPFS) was designed to evaluate the functional state of individuals with low back pain. The scale consists of twelve items, covering functional aspects of the daily life activities of these individuals. The final score is calculated by summing the responses to each item, the values of which range from 0 to 5, obtaining a total result of 0 to 60 points. Methods: The validation process was developed in accordance with the World Health Organization (WHO) protocol, covering translation, back translation, semantic equivalence, evaluation by specialists from previous stages, pre-test of the tool, and final version. Subsequently, the final version was applied in a sample of 90 individuals and the data obtained were subjected to descriptive statistical analysis, factorial analysis, evaluation of internal consistency, and correlation with other validated tools. Results: The tool was adapted to Brazilian Portuguese, making use of terms to approximate the language of everyday expressions. The final version presented results similar to those from the original version, as demonstrated by the factorial analysis, the internal consistency (Cronbach's alpha: 0.990), and the strong correlation with tools validated for the Portuguese language. Conclusion: The Brazilian version of BPFS proved to be easy to apply and understand, and presented high internal consistency and construct validity similar to that of the original instrument. Level of evidence 1B; Study of adaptation of a valid score.


RESUMO Objetivo: A Escala Funcional de Dor Lombar (EFDL) foi concebida para avaliar o estado funcional de indivíduos acometidos por lombalgia. A escala é constituída por doze itens e abrange aspectos funcionais em atividades de vida diária desses indivíduos. O escore final é calculado pela soma das respostas de cada item, cujo valor varia de 0 a 5, obtendo um resultado total de 0 a 60 pontos. Métodos: O processo de validação foi desenvolvido de acordo com o protocolo da Organização Mundial da Saúde (OMS), abrangendo tradução, retrotradução, equivalência semântica, avaliação de especialistas das etapas anteriores, pré-teste do instrumento e versão final. Na sequência, a versão final foi aplicada em uma amostra de 90 indivíduos e os dados obtidos foram submetidos a análise estatística descritiva, análise fatorial, avaliação da consistência interna e correlação com outros instrumentos validados. Resultados: Realizou-se a adequação do instrumento para o português utilizado no Brasil fazendo uso de termos para aproximar a linguagem das expressões do dia a dia. A versão final apresentou resultados similares à versão original, demonstrados pela análise fatorial, pela consistência interna (alfa de Cronbach: 0,990) e pela correlação forte com instrumentos validados para a língua portuguesa. Conclusões: A versão brasileira da EFDL mostrou ter fácil aplicação e compreensão, apresentou alta consistência interna e similar validade de construto ao instrumento original. Nível de evidência 1B; Estudo de adaptação de um escore válido.


RESUMEN Objetivo: La Escala Funcional de Dolor Lumbar (EFDL) fue concebida para evaluar el estado funcional de individuos acometidos por lumbalgia. La escala está constituida por doce ítems y abarca aspectos funcionales en actividades de la vida diaria de estos individuos. La puntuación final es calculada por la suma de las respuestas de cada ítem, cuyo valor varía de 0 a 5, obteniendo un resultado total de 0 a 60 puntos. Métodos: El proceso de validación fue desarrollado de acuerdo con el protocolo de la Organización Mundial de la Salud (OMS), abarcando traducción, retrotraducción, equivalencia semántica, evaluación de especialistas de las etapas anteriores, test previo del instrumento y versión final. A continuación, la versión final fue aplicada en una muestra de 90 individuos y los datos obtenidos se sometieron a análisis estadístico descriptivo, análisis factorial, evaluación de la consistencia interna y correlación con otros instrumentos validados. Resultados: Se realizó la adecuación del instrumento para el portugués utilizado en Brasil haciendo uso de términos para aproximar el lenguaje a las expresiones de la vida cotidiana. La versión final presentó resultados similares a la versión original, demostrados por el análisis factorial, por la consistencia interna (alfa de Cronbach: 0,990) y correlación fuerte con instrumentos validados para el idioma portugués. Conclusiones: La versión brasileña de la EFDL mostró tener fácil aplicación y comprensión, presentó alta consistencia interna y similar validez de constructo al instrumento original. Nivel de evidencia 1B; Estudio de adaptación de una puntuación válida.


Assuntos
Humanos , Classificação Internacional de Funcionalidade, Incapacidade e Saúde , Inquéritos e Questionários , Dor Lombar , Estudo de Validação , Pesos e Medidas
15.
Lima; Perú. Ministerio de Salud; 20210300. 21 p. tab.
Monografia em Espanhol | MINSAPERÚ | ID: biblio-1151999

RESUMO

El documento contiene las medidas técnicas, administrativas y procedimientos para acceder a los servicios de salud sexual y reproductiva, en el marco de la emergencia sanitaria por la COVID-19.


Assuntos
Atenção , Pesos e Medidas , Registros , Serviços de Saúde Reprodutiva , COVID-19
16.
J Tissue Viability ; 30(2): 222-230, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33612359

RESUMO

INTRODUCTION: Prolonged surgery is a known risk of pressure ulcer formation. Pressure ulcers affect the quality of life, are a significant cause of morbidity and mortality, and pose a burden on the healthcare system. This study aimed to compare the effectiveness of an alternating pressure (AP) overlay with Gel pad against the Gel pad in reducing interface pressure (IP) during prolonged surgery. METHODS: A total of 180 participants from a tertiary hospital were randomized to AP overlay with Gel pad group (n = 90) and Gel pad group (n = 90). Patients were placed supine on the pressure redistributing surfaces, and IP data under the sacrum and ischial tuberosities were collected at an interval of 30 min from 0 min up to a maximum of 570 min. RESULTS: Based on data from 133 participants, the average IPs during all the deflation cycles of the AP overlay (with Gel pad) were significantly lower than the average continuous IP recorded for Gel pad throughout the measuring period (p < 0.001). Only three patients (2.26% of study participants) - Gel pad group (n = 2; 2.99%) and AP overlay with Gel pad group (n = 1; 1.52%) developed post-operative pressure ulcer (p = 0.5687). CONCLUSIONS: The lower IP during deflation cycles of the AP overlay (with Gel pad) suggests its potential effectiveness in preventing pressure ulcer formation in patients undergoing prolonged surgery. The prevention and reduction of pressure ulcers will have a considerable impact on the improved quality of life and cost savings for the patient. The study findings may facilitate the formulation of policies for preventing pressure ulcer development in the perioperative setting.


Assuntos
Leitos/normas , Pressão , Região Sacrococcígea/fisiologia , Adulto , Leitos/efeitos adversos , Leitos/estatística & dados numéricos , Índice de Massa Corporal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Salas Cirúrgicas/estatística & dados numéricos , Complicações Pós-Operatórias/prevenção & controle , Lesão por Pressão/prevenção & controle , Fatores de Risco , Procedimentos Cirúrgicos Operatórios/métodos , Pesos e Medidas/instrumentação
17.
Crit Care ; 25(1): 60, 2021 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-33588912

RESUMO

BACKGROUND: Reverse triggering (RT) is a dyssynchrony defined by a respiratory muscle contraction following a passive mechanical insufflation. It is potentially harmful for the lung and the diaphragm, but its detection is challenging. Magnitude of effort generated by RT is currently unknown. Our objective was to validate supervised methods for automatic detection of RT using only airway pressure (Paw) and flow. A secondary objective was to describe the magnitude of the efforts generated during RT. METHODS: We developed algorithms for detection of RT using Paw and flow waveforms. Experts having Paw, flow and esophageal pressure (Pes) assessed automatic detection accuracy by comparison against visual assessment. Muscular pressure (Pmus) was measured from Pes during RT, triggered breaths and ineffective efforts. RESULTS: Tracings from 20 hypoxemic patients were used (mean age 65 ± 12 years, 65% male, ICU survival 75%). RT was present in 24% of the breaths ranging from 0 (patients paralyzed or in pressure support ventilation) to 93.3%. Automatic detection accuracy was 95.5%: sensitivity 83.1%, specificity 99.4%, positive predictive value 97.6%, negative predictive value 95.0% and kappa index of 0.87. Pmus of RT ranged from 1.3 to 36.8 cmH20, with a median of 8.7 cmH20. RT with breath stacking had the highest levels of Pmus, and RTs with no breath stacking were of similar magnitude than pressure support breaths. CONCLUSION: An automated detection tool using airway pressure and flow can diagnose reverse triggering with excellent accuracy. RT generates a median Pmus of 9 cmH2O with important variability between and within patients. TRIAL REGISTRATION: BEARDS, NCT03447288.


Assuntos
Respiração Artificial/métodos , Trabalho Respiratório/fisiologia , Idoso , Área Sob a Curva , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Respiração com Pressão Positiva/métodos , Respiração com Pressão Positiva/estatística & dados numéricos , Pressão , Curva ROC , Respiração Artificial/estatística & dados numéricos , Mecânica Respiratória/fisiologia , Pesos e Medidas/instrumentação
18.
Crit Care ; 25(1): 64, 2021 02 16.
Artigo em Inglês | MEDLINE | ID: mdl-33593412

RESUMO

BACKGROUND: Acute increases in muscle sonographic echodensity reflect muscle injury. Diaphragm echodensity has not been measured in mechanically ventilated patients. We undertook to develop a technique to characterize changes in diaphragm echodensity during mechanical ventilation and to assess whether these changes are correlated with prolonged mechanical ventilation. METHODS: Diaphragm ultrasound images were prospectively collected in mechanically ventilated patients and in 10 young healthy subjects. Echodensity was quantified based on the right-skewed distribution of grayscale values (50th percentile, ED50; 85th percentile, ED85). Intra- and inter-analyzer measurement reproducibility was determined. Outcomes recorded included duration of ventilation and ICU complications (including reintubation, tracheostomy, prolonged ventilation, or death). RESULTS: Echodensity measurements were obtained serially in 34 patients comprising a total of 104 images. Baseline (admission) diaphragm ED85 was increased in mechanically ventilated patients compared to younger healthy subjects (median 56, interquartile range (IQR) 42-84, vs. 39, IQR 36-52, p = 0.04). Patients with an initial increase in median echodensity over time (≥ + 10 in ED50 from baseline) had fewer ventilator-free days to day 60 (n = 13, median 46, IQR 0-52) compared to patients without this increase (n = 21, median 53 days, IQR 49-56, unadjusted p = 0.03). Both decreases and increases in diaphragm thickness during mechanical ventilation were associated with increases in ED50 over time (adjusted p = 0.03, conditional R2 = 0.80) and the association between increase in ED50 and outcomes persisted after adjusting for changes in diaphragm thickness. CONCLUSIONS: Many patients exhibit increased diaphragm echodensity at the outset of mechanical ventilation. Increases in diaphragm echodensity during the early course of mechanical ventilation are associated with prolonged mechanical ventilation. Both decreases and increases in diaphragm thickness during mechanical ventilation are associated with increased echodensity.


Assuntos
Diafragma/fisiopatologia , Respiração Artificial/estatística & dados numéricos , Pesos e Medidas/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ontário , Avaliação de Resultados em Cuidados de Saúde/métodos , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Reprodutibilidade dos Testes , Respiração Artificial/efeitos adversos , Respiração Artificial/métodos , Ultrassonografia/métodos
19.
Br J Nurs ; 30(2): 90, 2021 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-33529097
20.
PLoS One ; 16(1): e0240462, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33471789

RESUMO

The origins of money and the formulation of coherent weight and measurement systems are amongst the most significant prehistoric developments of the human intellect. We present a method for detecting perceptible standardization of weights and apply this to 5028 Early Bronze Age rings, ribs, and axe blades from Central Europe. We calculate the degree of uniformity on the basis of psychophysics, and quantify this using similarity indexes. The analysis shows that 70.3% of all rings could not be perceptibly distinguished from a ring weighing 195.5 grams, indicating their suitability as commodity money. Perceptive weight equivalence is demonstrated between rings, and a selection of ribs and axe blades. Co-occurrence of these objects evidences their interchangeability. We further suggest that producing copies of rings led to recognition of weight similarities and the independent emergence of a system of weighing in Central Europe at the end of the Early Bronze Age.


Assuntos
Arqueologia/métodos , Comércio/história , Pesos e Medidas/história , Europa (Continente) , História Antiga , Humanos , Pesos e Medidas/normas
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