RESUMEN
Importance: The effects of intensive care unit (ICU) visiting hours remain uncertain. Objective: To determine whether a flexible family visitation policy in the ICU reduces the incidence of delirium. Design, Setting and Participants: Cluster-crossover randomized clinical trial involving patients, family members, and clinicians from 36 adult ICUs with restricted visiting hours (<4.5 hours per day) in Brazil. Participants were recruited from April 2017 to June 2018, with follow-up until July 2018. Interventions: Flexible visitation (up to 12 hours per day) supported by family education (n = 837 patients, 652 family members, and 435 clinicians) or usual restricted visitation (median, 1.5 hours per day; n = 848 patients, 643 family members, and 391 clinicians). Nineteen ICUs started with flexible visitation, and 17 started with restricted visitation. Main Outcomes and Measures: Primary outcome was incidence of delirium during ICU stay, assessed using the CAM-ICU. Secondary outcomes included ICU-acquired infections for patients; symptoms of anxiety and depression assessed using the HADS (range, 0 [best] to 21 [worst]) for family members; and burnout for ICU staff (Maslach Burnout Inventory). Results: Among 1685 patients, 1295 family members, and 826 clinicians enrolled, 1685 patients (100%) (mean age, 58.5 years; 47.2% women), 1060 family members (81.8%) (mean age, 45.2 years; 70.3% women), and 737 clinicians (89.2%) (mean age, 35.5 years; 72.9% women) completed the trial. The mean daily duration of visits was significantly higher with flexible visitation (4.8 vs 1.4 hours; adjusted difference, 3.4 hours [95% CI, 2.8 to 3.9]; P < .001). The incidence of delirium during ICU stay was not significantly different between flexible and restricted visitation (18.9% vs 20.1%; adjusted difference, -1.7% [95% CI, -6.1% to 2.7%]; P = .44). Among 9 prespecified secondary outcomes, 6 did not differ significantly between flexible and restricted visitation, including ICU-acquired infections (3.7% vs 4.5%; adjusted difference, -0.8% [95% CI, -2.1% to 1.0%]; P = .38) and staff burnout (22.0% vs 24.8%; adjusted difference, -3.8% [95% CI, -4.8% to 12.5%]; P = .36). For family members, median anxiety (6.0 vs 7.0; adjusted difference, -1.6 [95% CI, -2.3 to -0.9]; P < .001) and depression scores (4.0 vs 5.0; adjusted difference, -1.2 [95% CI, -2.0 to -0.4]; P = .003) were significantly better with flexible visitation. Conclusions and Relevance: Among patients in the ICU, a flexible family visitation policy, vs standard restricted visiting hours, did not significantly reduce the incidence of delirium. Trial Registration: ClinicalTrials.gov Identifier: NCT02932358.
Asunto(s)
Delirio/prevención & control , Familia/psicología , Unidades de Cuidados Intensivos/organización & administración , Visitas a Pacientes , Ansiedad , Brasil , Agotamiento Profesional , Cuidados Críticos/psicología , Estudios Cruzados , Depresión , Femenino , Educación en Salud , Hospitalización , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Factores de TiempoRESUMEN
Per- and polyfluoroalkyl substances (PFAS) are ubiquitous, synthetic anthropogenic chemicals known to infiltrate and persist in biological systems as a result of their stability and bioaccumulation potential. This study investigated 15 PFAS, including short-chain carboxylic and sulfonic acids, and their presence in a threatened herbivore, the West Indian manatee (Trichechus manatus). Seven of the 15 PFAS examined were detected in manatee plasma. Perfluorooctanesulfonic acid (PFOS) (ranging from 0.13 to 166â¯ng/g ww) and perfluorononanoic acid (PFNA) (ranging from 0.038 to 3.52â¯ng/g ww) were detected in every manatee plasma sample examined (nâ¯=â¯69), with differing medians across sampling sites in Florida, Crystal River (nâ¯=â¯39), Brevard County (nâ¯=â¯18), Everglades National Park (nâ¯=â¯8), and four samples (nâ¯=â¯4) from Puerto Rico. With an herbivorous diet and long life-span, the manatee provides a new perspective to monitoring PFAS contamination.
Asunto(s)
Ácidos Alcanesulfónicos/sangre , Monitoreo del Ambiente/métodos , Fluorocarburos/sangre , Ríos/química , Trichechus manatus/sangre , Contaminantes Químicos del Agua/sangre , Animales , Ácidos Grasos , Florida , Puerto RicoRESUMEN
INTRODUCTION AND HYPOTHESIS: The objective of this study is to determine the association between the POPQ and a simplified version of the POPQ. METHODS: This was an observational study. The subjects with pelvic floor disorder symptoms underwent two exams: a POPQ exam and a simplified POPQ. To compare with the simplified POPQ, vaginal segments of the POPQ exam were defined using points Ba, Bp, C, and D. Primary outcome was the association between the overall ordinal stages from each exam. RESULTS: One hundred forty-three subjects with mean age of 56 +/- 13 years. Twenty three subjects were status post-hysterectomy. The Kendall's tau-b statistic for overall stage was 0.80, for the anterior vaginal wall the Kendall's tau-b was 0.71, for the posterior vaginal wall segment the Kendall's tau-b was 0.71, for the cervix the Kendall's tau-b was 0.88, for the posterior fornix/vaginal cuff the Kendall's tau-b was 0.85. CONCLUSIONS: There is substantial association between the POPQ and a simplified version of the POPQ.
Asunto(s)
Clasificación/métodos , Prolapso de Órgano Pélvico/clasificación , Adulto , Anciano , Argentina , Brasil , Dinamarca , Femenino , Humanos , Cooperación Internacional , Persona de Mediana Edad , TailandiaRESUMEN
The study of biomarkers by immunohistochemistry (IHC) for cervical cancer and intraepithelial lesions is a promising field. However, manual interpretation of IHC and reproducibility of the scoring systems can be highly subjective. In this article, we present a novel and simple computer-assisted IHC interpretation method based on cyan-magenta-yellow-black (CMYK) color format, for tissues with diaminobenzidine cytoplasmatic staining counterstained with methyl green. This novel method is more easily interpreted than previous computer-assisted methods based on red-green-blue (RGB) color format and presents a strong correlation with the manual H-score. It is simple, objective, and requires only low-cost software and minimal computer skills. Briefly, a total of 67 microscopic images of cervical carcinoma, normal cervix, and negative controls were analyzed in Corel Photo Paint X3 software in CMYK and RGB color format, and compared with manual H-score IHC assessments. The clearest and best positive correlation with the H-score was obtained using the image in CMYK color format and crude values of magenta color (Spearman correlation coefficient=0.84; agreement of 93.33%, P<0.001). To obtain this value, only 3 steps were necessary: convert the image to CMYK format, select the area of interest for analysis, and open the color histogram tool to visualize the magenta value.
Asunto(s)
Biomarcadores de Tumor/análisis , Procesamiento de Imagen Asistido por Computador/métodos , Inmunohistoquímica , Programas Informáticos , Neoplasias del Cuello Uterino/diagnóstico , Colorantes/análisis , Femenino , HumanosRESUMEN
BACKGROUND: Project SAFE, a gender- and culture-specific cognitive-behavioral intervention, was one of the few interventions to have demonstrated a significant reduction in sexually transmitted infections in a randomized, controlled trial. GOAL: We evaluated intervention efficacy in 379 Mexican Americans and 170 African Americans; and in a subset of 477 women, explored ethnic differences in the relationships over time between attitudes/beliefs about relationships, reported sexual behavior, and infection. STUDY DESIGN: Women were questioned intensively at baseline, 6, and 12 months. We used stratified analyses and multivariate regression to evaluate ethnic differences and the role of behavior in explaining ethnic differences in infection. RESULTS: African Americans had higher overall infection rates (29.0% vs. 18.3%) than Mexican Americans, but the intervention efficacy was similar (odds ratios, 0.58 and 0.54, respectively). African Americans reported more douching after sex, less mutual monogamy, and more rapid partner turnover. However, Mexican Americans appeared slightly more likely to have sex with an untreated partner, and there was no difference in risky sex. African Americans reported greater difficulty finding partners and reported attitudes more compatible with nonmonogamy. CONCLUSIONS: Despite substantial ethnic differences in attitudes/beliefs, behaviors, and infection rates, the intervention had a comparable impact on both Mexican American and African American.