Feasibility and efficacy of a multidisciplinary palliative approach in patients with advanced interstitial lung disease. A pilot randomised controlled trial.

INTRODUCTION AND OBJECTIVES: Interstitial lung diseases (ILDs) encompass a heterogeneous group of parenchymal lung disorders which have a significant burden on quality of life and exercise. The primary purpose of this randomised pilot trial performed in advanced ILD was to determine the feasibility and efficacy of a multidisciplinary palliative care approach (including physiotherapist, psychologist, pulmonologists, and palliative care doctors) to relieve patients' symptoms of dyspnoea, depression measured with the Center for Epidemiological Studies-Depression (CES-D) scale and quality-of-life (QoL) at 6 and 12 months. MATHERIALS AND METHODS: Fifty patients with confirmed interstitial lung disease at computed tomography (CT) scan and advanced disease were enrolled at our clinic. Patients were randomised to usual care group vs intervention group; in the intervention group, patients were scheduled to meet a physiotherapist, a psychologist, a palliative care doctor, and a pulmonologist specialized in ILD care. Data on dyspnoea, cough, quality of life and depression were recorded; patients in the intervention group were also tested to assess lower body flexibility and strength. RESULTS: Both groups showed a worsening in dyspnoea during the time course of the trial, but the Borg scale was less in the intervention group at 6 and 12 months. A similar trend was observed also for the CES-D scale. No differences were observed for the other scales. CONCLUSIONS: A multi-disciplinary palliative care intervention in patients with advanced fibrosing interstitial lung disease is feasible and effective. TRIAL REGISTRATION: NCT02929966 on ClinGovTrial.

Occupational and individual risk factors for dysphonia in teachers.

BACKGROUND: In recent decades several groups of researchers have been interested in describing and understanding vocal morbidity in teachers in order to explain the large number of teachers diagnosed with dysphonia and account for the absenteeism attributed to vocal disability. AIMS: To determine the proportion of teachers who reported a diagnosis of dysphonia and measure associations between individual and contextual factors and the event of interest. METHODS: Teachers were recruited from the city of Belo Horizonte and invited to complete a web-based institutional intranet questionnaire. RESULTS: In total, 649 teachers responded; 32% (CI 28.5-35.5) reported that they had received a physician diagnosis of dysphonia. This prevalence was significantly higher among female teachers (prevalence ratio (PR) 2.33; CI 1.41-3.85), and groups who reported limited technical resources and equipment (PR 1.56; CI 1.14-2.15), a diagnosis of gastritis (PR 1.59; CI 1.28-1.98), not being summoned for an annual physician examination (PR 0.47; CI 0.32-0.68), or absenteeism (PR 1.39; CI 1.06-1.81). CONCLUSIONS: The high prevalence of dysphonia in teachers was not associated with any individual variables, except for sex and comorbidity (diagnosis of gastritis). Limited technical resources and equipment were associated with dysphonia and suggests policy change is important in preventing dysphonia.

Diltiazem improves left ventricular systolic function following acute myocardial infarction treated with streptokinase. The Calcium Antagonist in Reperfusion Study (CARES) Group.

The role of diltiazem on left ventricular systolic function was analyzed in 101 patients with acute myocardial infarction treated with streptokinase, being obtained, for the total of the population, higher LV global ejection fraction (p = 0.022), LV regional shortening (p = 0.046) and LV global shortening (p = 0.064) for the treated group, relative to the placebo group; the p values were, respectively, 0.005, 0.009, and 0.012, for patients that achieved TIMI-3 antegrade coronary flow. It is concluded that diltiazem is useful as adjuvant to streptokinase, especially when antegrade coronary blood flow TIMI-3 is obtained.

[The basic ideas about the use of the Swan-Ganz catheter]. / Noções básicas sobre o uso do cateter de Swan-Ganz.

The haemodinamic monitorization through the Swan-Ganz catheter is a valuable source in the assistance of the critically ill patient. This work is a review on the importance, indication, skills and nursing care in order to use this source.