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BACKGROUND: Obesity distorts airways and slightly complicates intubations in adults, but whether obesity complicates pediatric intubations remains unclear. We, therefore, tested the primary hypothesis that increasing age- and sex-specific body mass index (BMI) percentile is associated with difficult intubation, defined as >1 intubation attempt. METHODS: We conducted a retrospective analysis of pediatric patients between 2 and 18 years of age who had noncardiac surgery with oral endotracheal intubation. We assessed the association between BMI percentile and difficult intubation, defined as >1 intubation attempt, using a confounder-adjusted multivariable logistic regression model. Secondarily, we assessed whether the main association depended on preoperative substantial airway abnormality status or age group. RESULTS: A total of 9339 patients were included in the analysis. Median [quartiles] age- and sex-specific BMI percentile was 70 [33, 93], and 492 (5.3%) patients had difficult intubation. There was no apparent association between age- and sex-specific BMI percentile and difficult intubation. The estimated odds ratio (OR) for having difficult intubation for a 10-unit increase in BMI percentile was 0.98 (95% confidence interval [CI], 0.95-1.005) and was consistent across the 3 age groups of early childhood, middle childhood, and early adolescence (interaction P = .53). Patients with preoperative substantial airway abnormalities had lower odds of difficult intubation per 10-unit increase in BMI percentile, with OR (95% CI) of 0.83 (0.70-0.98), P = .01. CONCLUSIONS: Age- and sex-specific BMI percentile was not associated with difficult intubation in children between 2 and 18 years of age. As in adults, obesity in children does not much complicate intubation.
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Obesidade Infantil , Masculino , Adulto , Feminino , Adolescente , Humanos , Criança , Pré-Escolar , Índice de Massa Corporal , Estudos Retrospectivos , Estudos de Coortes , Intubação Intratraqueal/efeitos adversosRESUMO
OBJECTIVE: To determine the cost-effectiveness of 2 strategies for post-discharge suicide prevention, an Enhanced Contact intervention based on repeated in-person and telephone contacts, and an individual 2-month long problem-solving Psychotherapy program, in comparison to facilitated access to outpatient care following a suicide attempt. METHODS: We conducted a cost-effectiveness analysis based on a decision tree between January and December 2019. Comparative effectiveness estimates were obtained from an observational study conducted between 2013 and 2017 in Madrid, Spain. Electronic health care records documented resource use (including extra-hospital emergency care, mortality, inpatient admission, and disability leave). Direct cost data were derived from Madrid's official list of public health care prices. Indirect cost data were derived from Spain's National Institute of Statistics. RESULTS: Both augmentation strategies were more cost-effective than a single priority outpatient appointment considering reasonable thresholds of willingness to pay. Under the base-case scenario, Enhanced Contact and Psychotherapy incurred, respectively, 2,340 and 6,260 per averted attempt, compared to a single priority appointment. Deterministic and probabilistic sensitivity analyses showed both augmentation strategies to remain cost-effective under several scenarios. Enhanced Contact was slightly cost minimizing in comparison to Psychotherapy (base-case scenario: -196 per averted attempt). CONCLUSIONS: Two post-discharge suicide prevention strategies based on Enhanced Contact and Psychotherapy were cost-effective in comparison to a single priority appointment. Increasing contacts between suicide attempters and mental health-care providers was slightly cost minimizing compared to psychotherapy.
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Assistência ao Convalescente , Alta do Paciente , Análise Custo-Benefício , Humanos , Psicoterapia , Tentativa de SuicídioRESUMO
The severe acute respiratory syndrome coronavirus 2 (coronavirus disease 2019 [COVID-19]) pandemic has challenged medical systems and clinicians globally to unforeseen levels. Rapid spread of COVID-19 has forced clinicians to care for patients with a highly contagious disease without evidence-based guidelines. Using a virtual modified nominal group technique, the Pediatric Difficult Intubation Collaborative (PeDI-C), which currently includes 35 hospitals from 6 countries, generated consensus guidelines on airway management in pediatric anesthesia based on expert opinion and early data about the disease. PeDI-C identified overarching goals during care, including minimizing aerosolized respiratory secretions, minimizing the number of clinicians in contact with a patient, and recognizing that undiagnosed asymptomatic patients may shed the virus and infect health care workers. Recommendations include administering anxiolytic medications, intravenous anesthetic inductions, tracheal intubation using video laryngoscopes and cuffed tracheal tubes, use of in-line suction catheters, and modifying workflow to recover patients from anesthesia in the operating room. Importantly, PeDI-C recommends that anesthesiologists consider using appropriate personal protective equipment when performing aerosol-generating medical procedures in asymptomatic children, in addition to known or suspected children with COVID-19. Airway procedures should be done in negative pressure rooms when available. Adequate time should be allowed for operating room cleaning and air filtration between surgical cases. Research using rigorous study designs is urgently needed to inform safe practices during the COVID-19 pandemic. Until further information is available, PeDI-C advises that clinicians consider these guidelines to enhance the safety of health care workers during airway management when performing aerosol-generating medical procedures. These guidelines have been endorsed by the Society for Pediatric Anesthesia and the Canadian Pediatric Anesthesia Society.
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Manuseio das Vias Aéreas/métodos , Anestesiologia/métodos , Infecções por Coronavirus/terapia , Intubação Intratraqueal/métodos , Pediatria/métodos , Pneumonia Viral/terapia , Adolescente , Anestesia/métodos , Anestesiologia/normas , COVID-19 , Criança , Pré-Escolar , Consenso , Guias como Assunto , Humanos , Lactente , Recém-Nascido , Controle de Infecções , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Intubação Intratraqueal/normas , Pandemias , Pediatria/normasRESUMO
BACKGROUND: People who suffer a first episode of psychosis experience higher levels of distress and suffering. Early intervention programs combine pharmacological and psychosocial strategies that include different components, such as cognitive-behavioural therapy, psychosocial interventions, medication adherence, family psychoeducation, counselling, etc. Among the complementary approaches, mindfulness-based interventions help participants to cultivate a radical acceptance of their psychotic experiences within a person-centered framework. They show promising results for people with longer duration of psychosis, but there is still no evidence for people who have recently experienced their first episode of psychosis. METHODS: The present parallel-group, single-blind (evaluator), randomised (1:1 ratio), controlled (versus active comparator), superiority, clinical trial will compare the effectiveness of SocialMIND on social functioning as measured by the Personal and Social Performance (PSP) scale. The active comparator will be a psychoeducational multicomponent intervention (PMI) that incorporates elements of early intervention programs that are effective for people who have suffered a first episode of psychosis. Both SocialMIND and PMI encompass eight weekly sessions, four bi-weekly sessions, and five monthly sessions. Changes in primary and secondary outcomes will be measured after weekly (8th week), bi-weekly (16th week) and monthly sessions (56th week), and 3 months after completing the intervention (68th week). Secondary outcomes include symptoms of psychosis, anxiety and depression, as well as indicators of general functioning. Tertiary outcomes are measures of social cognition, neurocognition, mindfulness, and indicators of inflammation and oxidative stress. A final sample of 80 participants is proposed to detect clinically significant differences in social functioning. DISCUSSION: This is the first mindfulness-based social cognition training for people with psychosis. SocialMIND aims to generate changes in the real-life functioning of people who have experienced a first episode of psychosis, and to be at least as effective as a psychoeducational multicomponent program. Adherence to the interventions is a common problem among young people with psychosis, so several difficulties are anticipated, and some methodological issues are discussed. TRIAL REGISTRATION: The trial was registered in ClinicalTrials.gov in October 2018 (NCT03309475).
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Terapia Cognitivo-Comportamental/métodos , Atenção Plena/métodos , Educação de Pacientes como Assunto/métodos , Psicoterapia/métodos , Transtornos Psicóticos/terapia , Adulto , Cognição , Estudos de Equivalência como Asunto , Feminino , Humanos , Masculino , Transtornos Psicóticos/psicologia , Método Simples-Cego , Comportamento Social , Resultado do TratamentoRESUMO
INTRODUCTION: This study evaluates the degree of compliance and effectiveness of the ARSUIC Suicide Risk Care Program. ARSUIC seeks to reduce the relapse risk that follows a suicide attempt by scheduling a high priority outpatient visit following hospital discharge. METHOD: Hospital-based retrospective study conducted between years 2012 and 2015. We included every suicide attempt treated at the La Paz University Hospital's mental healthcare resources network. We estimated the time between hospital discharge and the first outpatient visit; the proportion of visits that fulfill the program's objective - a follow-up within a maximum of 7 days; the suicide attempt rate; and the percentage of attempts corresponding to relapses, by study year. RESULTS: After program deployment, median time between discharge and the first visit decreased from 8.5 to 6 days, and the percentage of visits that fulfill the program's objective increased from 32 to 48.5%. Between years 2012 and 2015, the suicide attempt rate per person and year decreased from 1.20 to 1.08 and the proportion of attempts corresponding to relapses from 26.6% to 12.8%. CONCLUSION: Implementing the ARSUIC Program lowered the time between discharge and the first outpatient visit following a suicide attempt. The proportion of suicide attempts due to relapses and the suicide attempt rate per person decreased progressively. The program fulfilment proportion was under 50%, suggesting between-user differences regarding their effective access to the program.
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Desenvolvimento de Programas , Tentativa de Suicídio/prevenção & controle , Adulto , Feminino , Humanos , Masculino , Avaliação de Programas e Projetos de Saúde , Recidiva , Estudos Retrospectivos , Risco , Espanha , Tentativa de Suicídio/estatística & dados numéricos , Fatores de TempoRESUMO
BACKGROUND: Clinical evidence shows that pediatric anesthesia patients are subject to a higher rate of life-threatening medical errors than their adult counterparts. Medication error in adult anesthesia is estimated to occur to 1 in 133 anesthetic administrations, but such a figure has not been determined for pediatric anesthesia patients. Individual studies of medication error in pediatric anesthesia have ranged from rates of 0.01% to 1.92% of anesthetic uses. The present study is a systematic review that employs a meta-analytic estimate to determine the rate of medication error in pediatric anesthesia. METHODS: A systematic review of the literature on pediatric anesthesia medication error was conducted using Medline, Cochrane Database, PROSPERO, and Clinicaltrials.gov. A meta-analytic estimate was used to determine the medication error rate for all of the included studies. Subgroup sensitivity analysis was used to evaluate possible sources of heterogeneity in included studies. RESULTS: Of the 433 initially screened records, 13 studies met inclusion criteria. Meta-analytic estimate of medication error rate across all studies was 0.08% (95% CI 0.05%-0.10%), or 1 out of 1250 anesthetics. Ten different countries were represented in the studies. Sample size of anesthetics reported on ranged from 296 to 2 316 635. Data collecting periods ranged from 3 months to 15 years. Six included studies individually reported higher rates of medication error in patients under 1 year of age. CONCLUSION: The present systematic review revealed a medication error rate of 1 per 1250 anesthetic administrations in pediatric anesthesia. This result is significantly lower than would be expected given reported rates of medication error in adult anesthesia, which raises questions regarding the validity of research methods and reporting of medication error in pediatric anesthesia. Future investigations of medication error should employ methodologies other than self-reporting of error, such as retrospective chart review.
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Anestesia/estatística & dados numéricos , Erros de Medicação/estatística & dados numéricos , Pediatria/estatística & dados numéricos , Anestésicos/administração & dosagem , Criança , Estudos de Coortes , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos RetrospectivosRESUMO
INTRODUCTION: Persistent post-COVID olfactory dysfunction continues to be studied due to the controversy in its pathophysiology and neuroimaging. MATERIALS AND METHODS: The patients had confirmed mild COVID-19 infection with olfactory dysfunction of more than one month of evolution and they were compared to controls with normal olfaction, assessed using the Sniffin' Sticks Olfactory Test and underwent brain, magnetic resonance imaging (MRI) of the olfactory bulb and olfactory function. RESULTS: A total of 8 patients and 2 controls participated. The average age of the patients was 34.5 years (SD 8.5), and that of the controls was 28.5 (SD 2.1). The average score in the patients' olfactory test was 7.9 points (SD 2.2). In brain and olfactory bulb MRI tests, no morphological differences were found. When evaluated by functional MRI, none of the patients activated the entorhinal area in comparison to the controls, who did show activation at this level. Activation of secondary olfactory areas in cases and controls were as follows: orbitofrontal (25% vs 100%), basal ganglia (25% vs 50%) and insula (38% vs 0%) respectively. CONCLUSIONS: There were no observed morphological changes in the brain MRI. Unlike the controls, none of the patients activated the entorhinal cortex in the olfactory functional MRI.
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Objective: This study aims to assess the impact of integrating ATLAS 2030 into the conventional therapy regimen for children with Cerebral Palsy (CP) compared to conventional therapy alone regarding gross motor function, range of motion (ROM) and spasticity. Design: A non-randomized controlled trial conducted in outpatient rehabilitation settings and special education schools, following the recommendations by the Consolidated Standards of Reporting Trials (CONSORT) statement. Participants: Thirty children with CP divided into intervention and control groups. Intervention: The intervention group received three months of therapy (twice per week) with the ATLAS 2030 device in addition to their standard therapy, while the control group underwent standard therapy alone. Main outcome measure: Gross motor function assessed using the Gross Motor Function Measure of 88 items (GMFM-88). Secondary outcomes: Spasticity, measured by the Modified Ashworth Scale (MAS), and ROM of the lower limbs. Results: Statistically significant differences were observed between groups, in favour the intervention group, in both the GMFM-88 total score and dimension A, B and D. Similar findings were noted for spasticity and ROM, demonstrating significant improvements in the intervention group. Conclusion: ATLAS 2030 proves to be a safe and valuable tool for the rehabilitation of children with CP, showing improvements in motor function, spasticity and ROM.
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OBJECTIVE: To describe a novel dissector device useful in laparoscopy, better definition of anatomic structures to have a better dissection, separation, and cleaning of the structures. METHOD: The endoscopic dissector DisePad was designed and developed at the experimental surgery department of Centro Médico Nacional 20 de Noviembre, and properly patented at Instituto Mexicano de la Propiedad Industrial (title 3512). RESULTS: The tip of the device is the most important component, by its direct contact with the different tissues, consists of a cotton-polyester black cloth impregnated with a special gel immersed into a hot saline solution. Once soaked the tip maintains the solution temperature on itself. CONCLUSIONS: This device has been used in 364 laparoscopic procedures demonstrating, its utility to visualize, separate and clean anatomical structures without thermal lesion, tear, hemorrhage or visceral perforation.
OBJETIVO: Describir un nuevo dispositivo disector en laparoscopia, con una mejor definición de las estructuras anatómicas para obtener una mejor disección,separación y limpieza de las estructuras. MÉTODO: El disector endoscópico DisePad fue diseñado y desarrollado en el servicio de cirugía experimental del Centro Médico Nacional 20 de Noviembre, y patentado ante el Instituto Mexicano de la Propiedad Industrial (registro n.º 3512). RESULTADOS: El componente más importante del disector es la punta que tiene contacto con los tejidos: es una tela de algodón-poliéster negra impregnada en un gel (patentado) que, al ser sumergido en un termo con solución salina caliente, permite retener la temperatura. CONCLUSIONES: Este dispositivo ha sido utilizado en 364 procedimientos quirúrgicos por vía laparoscópica y ha demostrado ser útil para visualizar, separar y limpiar estructuras anatómicas sin producir daño por lesión térmica, desgarre, hemorragia ni perforación visceral.
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Desenho de Equipamento , Laparoscopia , Laparoscopia/instrumentação , Humanos , Dissecação/instrumentaçãoRESUMO
INTRODUCTION: Post-COVID olfactory dysfunction continues to be studied due to the controversy of the mechanisms involved. The aim was to investigate the olfactory dysfunctions in association with other post-COVID symptoms. MATERIAL AND METHODS: Observational, descriptive and single-center study. The patients had confirmed mild COVID-19 and subjective olfactory dysfunction of more than a month of evolution, which was assessed by Sniffin' Sticks Olfactory Test. RESULTS: A total of 86 patients participated. The mean age was 37.2 years (SD 9.82). 70.9% reported parosmia and 46.5% symptoms of brain fog. A pathological test result was obtained in 72.1% of the participants. The most failed pen was 11 (apple) in 76.7%. Anosmia of pen 15 (anise) was reported more frequently in 24.4% and cacosmia of pen 9 (garlic) in 27.9%. We observed a significant association between patients who reported parosmias and brain fog (RR 2.18; p=0.018), also between parosmia and phantosmia (RR 6.042; p<0.001). CONCLUSION: There is some pathological selectivity for certain test pens, a higher prevalence of cognitive symptoms and many patients with combined parosmia and brain fog.
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COVID-19 , Transtornos do Olfato , Adulto , Humanos , COVID-19/complicações , Transtornos do Olfato/diagnóstico , Transtornos do Olfato/epidemiologia , Transtornos do Olfato/etiologia , Prevalência , OlfatoRESUMO
Introduction: Post-COVID olfactory dysfunction continues to be studied due to the controversy of the mechanisms involved. The aim was to investigate the olfactory dysfunctions in association with other post-COVID symptoms. Material and methods: Observational, descriptive and single-center study. The patients had confirmed mild COVID-19 and subjective olfactory dysfunction of more than a month of evolution, which was assessed by Sniffin' Sticks Olfactory Test. Results: A total of 86 patients participated. The mean age was 37.2 years (SD 9.82). 70.9% reported parosmia and 46.5% symptoms of brain fog. A pathological test result was obtained in 72.1% of the participants. The most failed pen was 11 (apple) in 76.7%. Anosmia of pen 15 (anise) was reported more frequently in 24.4% and cacosmia of pen 9 (garlic) in 27.9%. We observed a significant association between patients who reported parosmias and brain fog (RR 2.18; p = 0.018), also between parosmia and phantosmia (RR 6.042; p < 0.001). Conclusion: There is some pathological selectivity for certain test pens, a higher prevalence of cognitive symptoms and many patients with combined parosmia and brain fog.
Introducción: La alteración olfatoria post-COVID continúa en estudio por la controversia sobre los mecanismos implicados. El objetivo de este estudio es caracterizar las alteraciones olfatorias y su relación con otros síntomas post-COVID. Material y métodos: Estudio unicéntrico, observacional y descriptivo. Los pacientes tuvieron infección por COVID-19 leve confirmada y disfunción olfatoria subjetiva de más de un mes de evolución, evaluada con el Sniffin' Sticks Olfatory Test. Resultados: Se seleccionaron 86 pacientes. La edad media fue de 37,2 años (DE 9,82). El 70,9% refirieron parosmia y el 46,5% niebla mental. Se obtuvo un test patológico en el 72,1% de los participantes. El lápiz más fallado fue el número 11 (manzana), en el 76,7%. La anosmia fue reportada más frecuentemente con el lápiz 15 (anís) y la cacosmia con el lápiz 9 (ajo) en el 27,9%. Observamos una asociación significativa entre pacientes que refieren parosmias y niebla mental (RR 2,18; p = 0,018) y entre parosmia y fantosmia (RR 6,042; p < 0,001). Conclusión: Se observa anosmia y cacosmia selectiva para algunos olores testados. Hay una alta prevalencia de síntomas cognitivos, más frecuentes en pacientes con parosmia.
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Grafting is the preferred treatment for severe skin burns. Frequently, allogeneic tissue is the only transient option for wound coverage, but their use risks damage to surrounding tissues. MicroRNAs have been associated with acute rejection of different tissues/organs. In this study, we analyzed the expression of miR-31, miR-155, and miR-221 and associate it with graft tolerance or rejection using a murine full-thickness skin transplantation model. Recipient animals for the syngeneic and allogeneic groups were BALB/c and C57BL/6 mice, respectively; donor tissues were obtained from BALB/c mice. After 7 days posttransplantation (DPT), the recipient skin and grafts in the syngeneic group maintained most of their structural characteristics and transforming growth factor (TGF)-ß1 and TGF-ß3 expression. Allografts were rejected early (Banff grades II and IV at 3 and 7 DPT, respectively), showing damage to the skin architecture and alteration of TGF-ß3 distribution. miRNAs skin expression changed in both mouse strains; miR-31 expression increased in the recipient skin of syngeneic grafts relative to that of allogeneic grafts at 3 and 7 DPT (P < .05 and P < .01, respectively); miR-221 expression increased in the same grafts at 7 DPT (P < .05). The only significant difference between donor tissues was observed for miR-155 expression at 7 DPT which was associated with necrotic tissue. Only miR-31 and miR-221 levels were increased in the blood of BALB/c mice that received syngeneic grafts after 7 DPT. Our data suggest that local and systemic miR-31 and miR-221 overexpression are associated with graft tolerance.
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Queimaduras , Transplante de Células-Tronco Hematopoéticas , MicroRNAs , Animais , Queimaduras/genética , Queimaduras/cirurgia , Rejeição de Enxerto , Sobrevivência de Enxerto , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Endogâmicos C57BL , MicroRNAs/genética , Transplante de Pele , Fator de Crescimento Transformador beta3 , Tolerância ao TransplanteRESUMO
Peripheral blood mononuclear cells (PBMCs) contain a cell fraction of mononuclear progenitor cells (MPCs), which own significant angiogenic potential. Autologous transplant of PBMC and/or platelet-rich plasma (PRP) promotes endothelial cells differentiation in experimental lower limb ischemia, which is considered a safe and effective strategy to support revascularization, either in animal models or clinical trials. In addition, thrombin has been proposed to enrich biological scaffolds, hence increasing MPC viability after intramuscular administration, whereas proangiogenic mediators such as vascular endothelial growth factor (VEGF), tumor necrosis factor alpha (TNF-α), inhibitor of the plasminogen activator-1 (PAI-1), and chemokine (CXCL1; GRO-α) participate in the endothelial response to ischemia, through their proangiogenic effects over endothelial cells proliferation, survival, migration, endothelial integrity maintenance, and physiologic vascular response to injury. In the present study, we describe the effect of autologous PBMCs transplant and PRP, either with or without thrombin, over proangiogenic mediators (measured by enzyme-linked immunosorbent assay) and revascularization response (angiographic vascular pattern at 30 days after vascular occlusion) in a rat model of lower limb ischemia. The group treated with PBMC + PRP significantly induced PAI-1, an effect that was prevented by the addition of thrombin. Furthermore, treatment with PBMC + PRP + thrombin resulted in the induction of VEGF. GRO-α showed a sensitive induction of all proangiogenic mediators. All treatments significantly stimulated revascularization, according to angiographic assessment, whereas higher effect was observed with PBMC + PRP treatment (p < .0001). In conclusion, autologous PBMC transplant stimulates revascularization during experimental ischemia of the lower limb, whereas particular effects over proangiogenic and fibrinolytic mediators may be attributed to PBMCs and its combination with PRP and thrombin.
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Indutores da Angiogênese/farmacologia , Isquemia/terapia , Leucócitos Mononucleares/transplante , Extremidade Inferior/irrigação sanguínea , Neovascularização Fisiológica/efeitos dos fármacos , Animais , Autoenxertos , Masculino , Ratos , Ratos WistarRESUMO
OBJECTIVE: To determine the comparative effectiveness of 3 real-practice preventive programs aimed at lowering the relapse risk following a suicide attempt: a single priority appointment with an outpatient psychiatrist, an enhanced contact intervention, and an individual psychotherapy program. METHODS: This observational study was conducted in a sample of 1,492 suicide attempters from 3 catchment areas in Madrid, Spain, between 2013 and 2017. Relapse was defined as an emergency department return after a new attempt within a 1-year follow-up. Kaplan-Meier survival functions were obtained by intervention, and Cox proportional hazard regression models were used to estimate unadjusted and adjusted risks of relapse by intervention. Sex- and age-stratified analyses were also conducted. Covariates were age, sex, history of suicide attempts, history of psychiatric disorders, main ICD-10 psychiatric diagnostic groups, medical comorbidities, and family support. RESULTS: A total of 133 subjects (8.9%) relapsed. The psychotherapy group had a lower presence of known risk factors for suicide attempt. Individual psychotherapy and enhanced contact were more effective than a single priority appointment at reducing suicide reattempt, with a 40% lower relapse risk in adjusted models. Results did not differ after sex and age stratification. CONCLUSIONS: In a naturalistic clinical setting, patients exposed to individual psychotherapy or an enhanced contact intervention had a similar, lower relapse risk than the single priority appointment group.
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Agendamento de Consultas , Psicoterapia , Prevenção Secundária/métodos , Tentativa de Suicídio/prevenção & controle , Adulto , Fatores Etários , Feminino , Humanos , Masculino , Recidiva , Fatores de Risco , Fatores SexuaisRESUMO
PURPOSE: To analyse the possible morphologic and positional changes of the mandibular condyles after orthognathic surgery. MATERIAL AND METHODS: A prospective cohort study was performed. Patients with mandibular retrognathism were surgically treated to advance the mandible. The study group included seventeen patients (34 condyles) treated with sagittal split osteotomies alone (4 patients) or in combination with maxillary osteotomies (13 patients). Only condyles located on the mandibular side that advance during surgery were studied, therefore only 25 condyles entered this prospective study. Beside it, a group of 6 patients undergoing maxillary surgery as only procedure, maxillary group, was also studied to determinate the influence of maxillary surgery on condylar displacement. Computed tomographies and lateral cephalometric radiographs were performed two weeks before surgery and one year after the surgical procedures. Different variables which analyse the position and morphology of the mandible were studied. The data obtained were analysed statistically by computing R2 values. RESULTS: In the maxillary group they were small displacements in magnitude and not significant. In the study group, 8 condyles showed morphological changes with alteration on reference points. In the remainder 17 condyles different displacements were noted after surgery. Several of these positional changes were predictable and did not affect postoperative mandibular stability. CONCLUSIONS: condylar displacements that occur after sagittal split osteotomies for mandibular advancement show significant correlation with the degree of mandibular advancement and can be defined by mathematical formulae. Maxillary osteotomies do not seem to influence condylar position when bimaxillary procedures take place.
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Avanço Mandibular/métodos , Côndilo Mandibular/anatomia & histologia , Côndilo Mandibular/cirurgia , Osteotomia Sagital do Ramo Mandibular/métodos , Retrognatismo/cirurgia , Adulto , Cefalometria , Feminino , Humanos , Masculino , Côndilo Mandibular/diagnóstico por imagem , Pessoa de Meia-Idade , Estudos Prospectivos , Retrognatismo/diagnóstico por imagem , Retrognatismo/patologia , Tomografia Computadorizada por Raios X , Adulto JovemAssuntos
COVID-19 , Transtornos do Olfato , Humanos , Transtornos do Olfato/etiologia , SARS-CoV-2 , OlfatoRESUMO
STUDY OBJECTIVE: To assess professionalism in anesthesiology residents, it is important to obtain evaluations from people with whom they interact on daily basis. The purpose of this study was to evaluate the effect of a Multisource feedback (MSF) on resident's professional behavior and to assess the effect of faculty feedback on resident performance. DESIGN: This study was a two-group randomized clinical trial. SETTING: Residents were recruited from Cleveland Clinic Children's Hospital. PATIENTS: Participants included twenty eight residents doing a two-month rotation in Pediatric Anesthesia. INTERVENTIONS: Multisource feedback questionnaires were developed and then validated using face and content validity. Residents were randomly assigned to a feedback group or a control group. Both groups received the MSF evaluation. Only the group assigned to feedback had a 'coaching meeting' every month creating strategies for improvement. MEASUREMENTS: MSF questionnaires were validated using a face validation and expert content validity. The effect of MSF on a professionalism questionnaire was assessed using analysis of covariance and linear mixed effects regression models. MAIN RESULTS: Observed test-retest agreement was greater than 0.90 for all items, with more than half of kappa statistics greater than 0.50. Cronbach's alpha was 0.71.The MSF increased the self-assessment score with an estimated effect of 0.21 (95% CI 0.06, 0.37), P=.015. There was no detected effect on patient family evaluation, with mean difference (CI) in change from baseline of 0.03 (-0.15, 0.21), P=.77, faculty evaluation, 0.21 (-0.02, 0.44), P=.08, or coworker evaluation 0.13 (-0.11, 0.37). CONCLUSIONS: Our new multi-source feedback questionnaire to assess professionalism had good reliability and internal consistency. Using our validated questionnaire we assessed the effect of a monthly feedback to improve professionalism in anesthesia residents. While we did see improvement in anesthesiology residents' self-assessment, we did not see a similar effect on patient family, faculty or coworker evaluations.
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Anestesiologia/educação , Retroalimentação , Internato e Residência , Profissionalismo , Humanos , Reprodutibilidade dos Testes , Autoavaliação (Psicologia) , Inquéritos e QuestionáriosRESUMO
The synthesis of four amphiphilic organometallic complexes with the general formula RC = M(CO)5NH(CH2)15CH3, where R is a ferrocenyl 2(a-b) or a phenyl 4(a-b) group as a donor moiety and a Fischer carbene of chromium (0) or tungsten (0) as an acceptor group, are reported. These four push-pull systems formed Langmuir (L) monolayers at the air-water interface, which were characterized by isotherms of surface pressure versus molecular area and compression/expansion cycles (hysteresis curves); Brewster angle microscopic images were also obtained. By using the Langmuir-Blodgett (LB) method, molecular monolayers were transferred onto glass substrates forming Z-type multilayers. LB films were characterized through ultraviolet-visible spectroscopy, atomic force microscopy and X-ray diffraction techniques. Results indicated that films obtained from 2b complex [(Ferrocenyl)(hexadecylamine)methylidene] pentacarbonyl tungsten (0) are the most stable and homogeneous; due to their properties, these materials may be incorporated into organic electronic devices.