RESUMO

PURPOSE: To investigate the influence of different denture-bearing conditions on the masticatory function and patient-reported outcome measures (PROMs) of complete denture wearers. METHODS: Sixty edentulous patients were selected and allocated into two groups according to the American College of Prosthodontics' (ACP) classification: non-atrophic (NAT) (Classes I and II) (n = 24) and atrophic (AT) (Classes III and IV) (n = 36). All patients received new complete dentures (CDs). The objective variables (masticatory performance and swallowing threshold) were assessed as well as the PROMs (oral health-related quality of life (OHIP-EDENT), patient satisfaction) and quality of the prosthesis, at baseline (using the old CD) and after 4 months new prostheses use. Data were analyzed by Mann-Whitney test followed by the Generalized Equations Estimation (GEE), linear regression and Chi-square test. RESULTS: Higher masticatory performance was observed in the NAT group (p < .05) for both time points, baseline and after 4 months. However, compared to baseline, both groups showed significant masticatory improvement after 4 months (p < .05). Satisfaction and overall quality of life improved after 4 months with no difference between groups (p > .05). Regarding the quality of the CD, baseline results were significantly (p < .05) lower in the AT group, but after 4 months, no significant differences were found between groups and in intragroup analysis (p > .05). CONCLUSIONS: The denture-bearing conditions seems to impact masticatory function, but the PROMs are barely affected.

Assuntos

RESUMO

OBJECTIVE: This study aimed to evaluate the "Value-Based Healthcare" concept of an integrated palliative care (PC) program in Bogotá, Colombia, through the measurement of health outcomes and care costs in the last 3 months of life. METHODS: A multicenter, retrospective cohort study that included patients ≥18 years old who died in 2020 due to medical conditions amenable to PC. The measured health outcomes included pain, wellbeing, comfort, quality of life (QOL), and satisfaction. We analyzed the behavior of overall care costs during the last 3 months of the patients' lives and controlled for the effect of exposure to the program, considering the disease type and insurance coverage, using a linear regression model, nearest-neighbor matching, and sensitivity analysis. RESULTS: Among patients exposed to the program, the mean pain score was 2.1/10 (± 1.3) and wellbeing was rated at 3.5/10 (± 1.0), comfort at 1.6/24 (± 1.3), QOL at 3.6/5.0 (± 0.17), and satisfaction at 9.3/100 (± 0.15). The positive changes in these scores were greater for patients who remained in the program for over 3 months. Cost reduction was demonstrated in the last 90 days of life, with statistically significant and chronologically progressive savings during the last 30 days of life exceeding 5 million pesos per patient (P < .05). CONCLUSIONS: This study demonstrated the success of PC in reducing pain, improving wellbeing and QOL, providing comfort, and ensuring high levels of satisfaction. Moreover, PC is an effective value-based healthcare strategy and can significantly enhance the efficiency of healthcare services by reducing end-of-life healthcare costs.

Assuntos

RESUMO

ABSTRACT The CONVINCE study, recently published in the New England Journal of Medicine, reveals a groundbreaking 23% reduction in the relative risk of all-cause mortality among end-stage kidney patients undergoing high convective volume hemodiafiltration. This significant finding challenges the conventional use of high-flux hemodialysis and offers hope for improving outcomes in chronic kidney disease patients. While some controversies surround the study's findings, including concerns about generalizability and the causes of death, it is essential to acknowledge the study's design and its main outcomes. The CONVINCE study, part of the HORIZON 2020 project, enrolled 1360 patients and demonstrated the superiority of hemodiafiltration in reducing all-cause mortality overall, as well as in specific patient subgroups (elderly, short vintage, non-diabetic, and those without cardiac issues). Interestingly, it was shown that hemodiafiltration had a protective effect against infection, including COVID-19. Future research will address sustainability, dose scaling effects, identification of subgroups especially likely to benefit and cost-effectiveness. However, for now, the findings strongly support a broader adoption of hemodiafiltration in renal replacement therapy, marking a significant advancement in the field.

RESUMO O estudo CONVINCE, publicado recentemente no New England Journal of Medicine, revela uma redução inovadora de 23% no risco relativo de mortalidade por todas as causas entre pacientes renais em estágio terminal submetidos à hemodiafiltração de alto volume de convecção. Esse achado significativo desafia o uso convencional da hemodiálise de alto fluxo e oferece esperança de melhoria dos desfechos em pacientes com doença renal crônica. Embora algumas controvérsias cerquem os achados do estudo, incluindo preocupações sobre a generalização e as causas de óbito, é essencial reconhecer o desenho do estudo e seus principais desfechos. O estudo CONVINCE, parte do projeto HORIZON 2020, inscreveu 1.360 pacientes e demonstrou a superioridade da hemodiafiltração na redução da mortalidade por todas as causas em geral, bem como em subgrupos específicos de pacientes (idosos, HD de curta duração, não diabéticos e aqueles sem problemas cardíacos). Curiosamente, demonstrou-se que a hemodiafiltração teve um efeito protetor contra infecções, incluindo a COVID-19. Pesquisas futuras abordarão sustentabilidade, efeitos de escalonamento da dose, identificação de subgrupos especialmente propensos a se beneficiar e a relação custo-benefício. No entanto, por ora, os achados apoiam fortemente uma adoção mais ampla da hemodiafiltração na terapia renal substitutiva, marcando um avanço significativo na área.

RESUMO

OBJECTIVE: To overview the literature to answer the following question: "What is the performance of different therapies on wound healing and postoperative discomfort after palatal ASTG removal?" METHODS: SRs that evaluated the wound healing (WH), postoperative pain, bleeding, and analgesic consumption of patients submitted to de-epithelialized/free gingival grafts (FGG) or subepithelial connective tissue grafts (SCTG) removed from the palate were included. The searches were conducted on six white and two gray databases up to December 2023. Methodological quality was evaluated through AMSTAR 2. The synthesis of results was described as a narrative analysis. RESULTS: Ten SRs (involving 25 randomized clinical trials) related to low-level laser therapy (LLLT) (3), platelet-rich fibrin (PRF) (4), cyanoacrylate tissue adhesives (CTA) (2), and ozone therapy (OT) (1) were included in this overview. All techniques demonstrated improvements in WH. LLT, PRF, and CTA reduced pain and analgesic consumption. PRF and CTA reduced bleeding. Regarding methodological quality, the SRs were classified as critically low (2), low (5), moderate (2), or high quality (1). CONCLUSIONS: In SRs related to LLLT, PRF, CTA, and OT, the use of different therapies after palatal ASTG removal improved WH and postoperative discomfort. Due to the studies' low methodological quality and high heterogeneity, data should be interpreted with caution. CLINICAL RELEVANCE: The present overview compiles the evidence of SRs related to different therapies for WH and patients' postoperative experience and reveals that different treatments can significantly improve the clinical outcomes of patients who require ASTG removal for periodontal or peri-implant surgeries. REGISTRATION: PROSPERO registration number: CRD42022301257.

Assuntos

RESUMO

Introduction: In Brazil, approximately 5% are born with a congenital disorder, potentially fatal without surgery. This study aims to evaluate the relationship between gastrointestinal congenital malformation (GICM) mortality, health indicators, and socioeconomic factors in Brazil. Methods: GICM admissions (Q39-Q45) between 2012 and 2019 were collected using national databases. Patient demographics, socioeconomic factors, clinical management, outcomes, and the healthcare workforce density were also accounted for. Pediatric Surgical Workforce density and the number of neonatal intensive care units in a region were extracted from national datasets and combined to create a clinical index termed 'NeoSurg'. Socioeconomic variables were combined to create a socioeconomic index termed 'SocEcon'. Simple linear regression was used to investigate if the temporal changes of both indexes were significant. The correlation between mortality and the different indicators in Brazil was evaluated using Pearson's correlation coefficient. Results: Over 8 years, Brazil recorded 12804 GICM admissions. The Southeast led with 6147 cases, followed by the Northeast (2660), South (1727), North (1427), and Midwest (843). The North and Northeast reported the highest mortality, lowest NeoSurg, and SocEcon Index rates. Nevertheless, mortality rates declined across regions from 7.7% (2012) to 3.9% (2019), a 51.7% drop. The North and Midwest experienced the most substantial reductions, at 63% and 75%, respectively. Mortality significantly correlated with the indexes in nearly all regions (p<0.05). Conclusion: Our study highlights the correlation between social determinants of health and GICM mortality in Brazil, using two novel indexes in the pediatric population. These findings provide an opportunity to rethink and discuss new indicators that could enhance our understanding of our country and could lead to the development of necessary solutions to tackle existing challenges in Brazil and globally.

RESUMO

BACKGROUND: Biliary atresia (BA) is the most common indication for pediatric liver trans plantation, although portoenterostomy is usually performed first. However, due to the high failure rate of portoenterostomy, liver transplantation has been advocated as the primary procedure for patients with BA. It is still unclear if a previous portoenterostomy has a negative impact on liver transplantation outcomes. AIM: To investigate the effect of prior portoenterostomy in infants un dergoing liver transplantation for BA. METHODS: This was a retrospective cohort study of 42 pediatric patients with BA who underwent primary liver transplantation from 2013 to 2023 at a single tertiary center in Brazil. Patients with BA were divided into two groups: Those under going primary liver transplantation without portoenterostomy and those undergoing liver transplantation with prior portoenterostomy. Continuous variables were compared using the Student's t-test or the Kruskal-Wallis test, and categorical variables were compared using the χ2 or Fisher's exact test, as appropriate. Multivariable Cox regression analysis was performed to determine risk factors for portal vein thrombosis. Patient and graft survival analyses were conducted with the Kaplan-Meier product-limit estimator, and patient subgroups were compared using the two-sided log-rank test. RESULTS: Forty-two patients were included in the study (25 [60%] girls), 23 undergoing liver transplantation without prior portoenterostomy, and 19 undergoing liver transplantation with prior portoenterostomy. Patients with prior portoenterostomy were older (12 vs 8 months; P = 0.02) at the time of liver transplantation and had lower Pediatric End-Stage Liver Disease scores (13.2 vs 21.4; P = 0.01). The majority of the patients (35/42, 83%) underwent living-donor liver transplantation. The group of patients without prior portoenterostomy appeared to have a higher incidence of portal vein thrombosis (39 vs 11%), but this result did not reach statistical significance. Prior portoenterostomy was not a protective factor against portal vein thrombosis in the multivariable analysis after adjusting for age at liver transplantation, graft-to-recipient weight ratio, and use of vascular grafts. Finally, the groups did not significantly differ in terms of post-transplant survival. CONCLUSION: In our study, prior portoenterostomy did not significantly affect the outcomes of liver transplantation.

RESUMO

Objective: This is a retrospective cohort study to analyze the long-term outcomes of thoracolumbar spine fracture patients who underwent minimally invasive percutaneous fixation. Methods: The cases of 17 patients with thoracolumbar spine fractures who had percutaneous fixation between 2009 and 2011 were the subject of a retrospective analysis. Clinical and radiographic variables were collected. For the clinical evaluation the questionnaires SF-36 and Oswestry were used. Radiographic parameters were evaluated using fracture's classification based on Magerls's criteria, the fractured vertebra's wedging angle, and the affected segment's segmental Cobb angle. The measures were made at different stages: before surgery, immediately after surgery, one year later, and at a late follow-up (5 years later). Trauma associated injuries, post-surgical and implant related complications were among the additional information taken into account. Results: The SF-36 questionnaire showed averages above 63,5% in all domains in the late postoperative data (from 5 years after the surgery). Oswestry questionnaire answers showed minimal or no physical limitations in 80% of the patients with a mean score of 10,8%±10,5. The average preoperative Cobb angle value was 5,53° ± 13,80° of kyphosis, the immediate postoperative 2,18° ± 13,38° of kyphosis, one year postoperative 5,26 ± 13,95° of kyphosis, and the late follow-up 8,78° ± 15,06° of kyphosis. The mean correction was 3,35°, and mean loss of correction was 6,6°. There were no complications observed, no case of neurological deficit, infection or implant failure occurred. Conclusion: Thoracolumbar vertebrae fractures can be surgically treated with positive late clinical and radiological outcomes and low complication rates using a minimally invasive percutaneous method.

RESUMO

PURPOSE: To investigate the test-retest reliability and construct validity of the LCADL scale applied via online form in individuals after hospitalization for COVID-19. METHODS: Methodological study. After hospitalization for COVID-19 individuals completed the LCADL via online form at two separate times. They also answered the post-COVID-19 Functional Status Scale (PCFS), dyspnea, fatigue, and health perception scales, modified Medical Research Council (MRCm), Short Form Health Survey 36 (SF-36). Hospitalization data were collected from the individual's medical record. RESULTS: 104 individuals participated in the study (57 men, 45.2 ± 11.9 years). The LCADL showed moderately to high test-retest reliability (ICC: 0.73-0.86; p < 0.001), there was no difference in scores between test and retest (p > 0.05), the mean difference between the applications was smaller than the standard error of measurement and the internal consistency was adequate (Cronbach's α = 0.70-0.94). In addition, it demonstrated adequate construct validity, showing correlations with PCFS, dyspnea perception, fatigue and health scales, mMRC, SF-36, and length of stay in the Intensive Care Unit (p < 0.05). The LCADL as percentage of the total score presented a significant floor effect (25%). CONCLUSION: The LCADL applied online was reliable and valid for assessing limitations due to dyspnea in ADL in individuals after hospitalization for COVID-19.

The London Chest Activity of Daily Living Scale applied online is a method of evaluation of dyspnea-related ADL limitations that is valid and reliable after hospitalization for COVID-19 and can be used both in the telerehabilitation environment and in-person rehabilitation;The online form provides a more sustainable means of data storage, since no paper is needed, and saves time during in-person rehabilitation.

RESUMO

OBJECTIVES: To translate, cross-culturally adapt, validate, verify the reliability and estimate the minimal detectable change (MDC) of the UEFI to Brazilian Portuguese (UEFI-Br) for burns. METHODS: The study was carried out with 131 Brazilian burn cases at two time points, at discharge and at the first outpatient follow-up (15-21 days after discharge) in a Burn Treatment Center. The adaptation process of the UEFI was based on international recommendations. The Burn Specific Health Scale-Brief-Br (BSHS-B-Br) was also applied in order to analyze construct validity of the UEFI-Br and distribution-based methods were used to estimate its MDC. RESULTS: Intra- and inter-rater reliability were good with ICC of 0.986 (CI 95 %: 0.98-0.99) and 0.969 (CI 95 %: 0.955-0.979), respectively, at discharge and 0.997 (CI 95 %: 0.996-0.998) and 0.987 (CI 95 %: 0.981-0.991), respectively, at the first outpatient follow-up appointment. We found good internal consistency with Cronbach's α values of 0.987 and 0.996, respectively, at the two times. The SEM was 4.42 and 2.31 at the first and second time points, respectively. The UEFI-Br scores demonstrated strong correlation with the Burn Specific Health Scale-Brief-Br (BSHS-B-Br) function domain scores (r = 0.87-0.90). No significant correlation was found between UEFI-Br scores and participants' characteristics. The MDC of the UEFI-Br lies between 11 and 13 points. CONCLUSION: The Brazilian version of the UEFI-Br, a useful tool to assess upper limb function and disability, is a valid and reliable tool for use with Brazilian burn survivors. The MDC for the instrument was determined to be 11-13 points.

Assuntos

RESUMO

Abstract Objective: This is a retrospective cohort study to analyze the long-term outcomes of thoracolumbar spine fracture patients who underwent minimally invasive percutaneous fixation. Methods: The cases of 17 patients with thoracolumbar spine fractures who had percutaneous fixation between 2009 and 2011 were the subject of a retrospective analysis. Clinical and radiographic variables were collected. For the clinical evaluation the questionnaires SF-36 and Oswestry were used. Radiographic parameters were evaluated using fracture's classification based on Magerls's criteria, the fractured vertebra's wedging angle, and the affected segment's segmental Cobb angle. The measures were made at different stages: before surgery, immediately after surgery, one year later, and at a late follow-up (5 years later). Trauma associated injuries, postsurgical and implant related complications were among the additional information taken into account. Results: The SF-36 questionnaire showed averages above 63,5% in all domains in the late postoperative data (from 5 years after the surgery). Oswestry questionnaire answers showed minimal or no physical limitations in 80% of the patients with a mean score of 10,8% ± 10,5. The average preoperative Cobb angle value was 5,53º ± 13,80º of kyphosis, the immediate postoperative 2,18º ± 13,38º of kyphosis, one year postoperative 5,26 ± 13,95º of kyphosis, and the late follow-up 8,78º ± 15,06º of kyphosis. The mean correction was 3,35º, and mean loss of correction was 6,6º. There were no complications observed, no case of neurological deficit, infection or implant failure occurred. Conclusion: Thoracolumbar vertebrae fractures can be surgically treated with positive late clinical and radiological outcomes and low complication rates using a minimally invasive percutaneous method.

Resumo Objetivo: Este é um estudo de coorte retrospectivo para analisar os desfechos em longo prazo de pacientes com fratura da coluna toracolombar submetidos à fixação percutânea minimamente invasiva. Métodos: Os casos de 17 pacientes com fraturas da coluna toracolombar submetidos à fixação percutânea entre 2009 e 2011 foram objeto de análise retrospectiva. Variáveis clínicas e radiográficas foram coletadas. A avaliação clínica foi baseada nos questionários SF-36 e Oswestry. Os parâmetros radiográficos foram avaliados de acordo com a classificação de fratura baseada nos critérios de Magerls, o ângulo de cunha da vértebra fraturada e o ângulo de Cobb do segmento acometido. As medidas foram feitas em diferentes momentos: antes da cirurgia, imediatamente após a cirurgia, um ano depois e no acompanhamento tardio (cinco anos depois). Lesões associadas a traumas, complicações pós-cirúrgicas e relacionadas a implantes também foram consideradas. Resultados: O questionário SF-36 apresentou médias acima de 63,5% em todos os domínios no período pós-operatório tardio (a partir de cinco anos após a cirurgia). As respostas do questionário Oswestry mostraram limitações físicas mínimas ou nulas em 80% dos pacientes, com pontuação média de 10,8% ± 10,5%. O valor médio do ângulo de Cobb foi de 5,53º± 13,80º de cifose no período pré-operatório, 2,18º ± 13,38º de cifose no pós-operatório imediato, 5,26 ±13,95º de cifose no pós-operatório de um ano e de 8,78º ± 15,06º de cifose no período pós-operatório tardio. A correção média foi de 3,35º e a perda média de correção foi de 6,6º. Não foram observadas complicações, casos de déficit neurológico, infecções ou falhas do implante. Conclusão: As fraturas das vértebras toracolombares podem ser tratadas cirurgicamente com desfechos clínicos e radiológicos tardios positivos e baixas taxas de complicações usando um método percutâneo minimamente invasivo.

Assuntos

RESUMO

ABSTRACT Introduction: The literature presents several scientifically validated and cross-culturally adapted questionnaires in the area of orthopedics and Sports Medicine scientifically validated and cross-culturally adapted. However, they are anatomically specific, and do not consider the specific needs of athletes. The "4-Domain PROM for Orthopedic and Sports Medicine" (4-Domain Sports PROM) is the first questionnaire, in the literature (International Journal of Sports Medicine - 2021), designed to assess athletes and highly active sports practitioners, and their specificities. physical and psychological. It comprises four domains: athlete without injury, after sports injury, expectation of treatment, athlete's assessment of the treatment received. Objectives: This work aims to carry out the translation and cross-cultural adaptation (TCA) to the Portuguese language. Methods: The questionnaire was self-administered by 50 participants, regular physical and sports activities practitioners. The translation and cultural adaptation process involved six steps: translation; synthesis; back translation; pre-test; review by the Expert Committee, clinical application and author approval of the original version. The Equivalence of translation and relevance of questionnaire items were evaluated. RESULTS: The Portuguese version of the 4-DOMAIN SPORTS PROM had a translation equivalence of 0.94, and item relevance was 0.98, while the percentage of agreement between patients for understanding was 0.98. Conclusion: The translation and cross-cultural adaptation of the 4 Domain Sports PROM into the Portuguese version proved to be understandable and reproducible in all questionnaire domains (agreement above 90% and content validity index of 100%) to assess the treatment of the population of athletes and regular sports practitioners. Level of Evidence II; A cross-sectional qualitative study.

RESUMEN Introducción: La literatura presenta varios cuestionarios científicamente validados y transculturalmente adaptados en el área de la ortopedia y Medicina del Deporte. Sin embargo, son anatómicamente específicos y no consideran las necesidades específicas de los atletas. El "4-Domain PROM for Orthopaedic and Sports Medicine" (4-Domain Sports PROM) es el primer cuestionario, en la literatura (International Journal of Sports Medicine - 2021), diseñado para evaluar atletas y practicantes de deportes altamente activos, y sus especificidades físicas y psicológicas. Comprende cuatro dominios: atleta sin lesión, después de una lesión deportiva, expectativa de tratamiento, evaluación del atleta sobre el tratamiento recibido. Objetivos: El objetivo de este trabajo es realizar la traducción y adaptación transcultural (TCA) a la lengua portuguesa. Métodos: El cuestionario fue autoadministrado por 50 participantes, practicantes habituales de actividades físicas y deportivas. El proceso de traducción y adaptación cultural involucró seis pasos: traducción; síntesis; traducción inversa; prueba previa; revisión por el comité de expertos; aplicación clínica y aprobación del autor de la versión original. Se evaluaron la equivalencia de traducción y la relevancia de los ítems del cuestionario. Resultados: La versión portuguesa del 4-DOMAIN SPORTS PROM tuvo una equivalencia de traducción de 0,94 y la relevancia de los ítems fue de 0,98, mientras que el porcentaje de acuerdo entre los pacientes para la comprensión fue de 0,98. Conclusión: La traducción y adaptación transcultural del 4-DOMAIN SPORTS PROM al portugués amplía las posibilidades de evaluar los diferentes momentos que involucran el tratamiento de lesiones deportivas, ya que este cuestionario fue diseñado para capturar datos sobre la percepción de los pacientes antes de la lesión, después de la lesión, expectativa y evaluación del trato recibido en deportistas y practicantes habituales de actividad física. Nivel de Evidencia II; Estudio Cualitativo Transversal.

RESUMO Introdução: A literatura apresenta diversos questionários cientificamente validados e adaptados transculturalmente na área de na Ortopedia e Medicina Esportiva validados cientificamente e adaptados transculturalmente. Entretanto, eles são anatomicamente específicos, e não consideram as necessidades especificas dos atletas. O "4-Domain PROM for Orthopedic and Sports Medicine" (4-Domain Sports PROM) é o primeiro questionário, na literatura (International Journal of Sports Medicine - 2021), concebido para avaliar atletas e praticantes de esportes altamente ativos, e suas especificidades físicas e psicológicas. Ele compreende quatro domínios: atleta sem lesão, após lesão esportiva, expectativa do tratamento, avaliação do atleta sobre o tratamento recebido. Objetivos: O objetivo deste trabalho é realizar a tradução e a adaptação transcultural (TCA) à língua portuguesa. Métodos: O questionário foi autoadministrado por 50 participantes, praticantes regulares de atividades físicas e esportivas. O processo de tradução e adaptação cultural envolveu seis etapas: tradução; síntese; retrotradução; pré-teste; revisão pelo comitê de experts; aplicação clínica e aprovação do autor da versão original. Foi avaliado a Equivalência da tradução e relevância de itens do questionário. Resultados: A versão em português do 4-DOMAIN SPORTS PROM apresentou equivalência da tradução de 0,94 e relevância dos itens foi de 0,98, enquanto a porcentagem de concordância entre os pacientes para compreensão foi de 0,98. Conclusão: A tradução e adequação cultural do 4-DOMAIN SPORTS PROM para língua portuguesa mostrou-se compreensível e reprodutibilidade adequada em todos os domínios do questionário (concordância acima de 90% e Índice de Validade de Conteúdo de 100%) para avaliar o tratamento de população de indivíduos atletas e praticantes regulares de esportes. Nível de Evidência II; Estudo Qualitativo Transversal.

RESUMO

OBJETIVO: Determinar la asociación entre la carga laboral de enfermería, gravedad del paciente, y mortalidad en una unidad de pacientes críticos (UPC) de un hospital público en Chile. METODOLOGÍA: Estudio retrospectivo, correlacional, que analizó fichas clínicas de pacientes de una UPC. Se recolectaron variables demográficas, clínicas, gravedad de paciente (APACHE II) y carga de trabajo de enfermería (TISS-28) al ingreso del paciente. Se realizaron análisis descriptivos y bivariados. Se utilizaron regresiones logísticas para identificar las variables asociadas a mortalidad en la UPC y hospitalaria. RESULTADOS: Se incluyeron 311 pacientes con una mediana de 7 días (RIQ=9,5) de estadía en la UPC. Un 48,9% ingreso desde el servicio de urgencia y un 25,7% tuvo un diagnostico neurológico. El puntaje TISS-28 se asoció positivamente con el del APACHE II (r=0,359, p<0,001) y los días de estadía en UPC (r=0,146, p<0,05). En los modelos de regresión, la mortalidad en UPC estuvo asociada con el puntaje APACHE II (OR=1,109, p<0,001) y el TISS-28 (OR=0,955, p<0,05). Los puntajes de APACHE II y TISS-28 no se asociaron significativamente con la mortalidad hospitalaria. CONCLUSIÓN: Una mayor gravedad del paciente critico se asoció con un aumento en la carga de trabajo de enfermería. La mortalidad en UPC se asoció negativamente con la carga de trabajo en enfermería, pero positivamente con la gravedad de paciente. La carga de trabajo de enfermería es una variable relevante en el desenlace del paciente crítico por lo que debe evaluarse regularmente y de este modo, asegurar dotaciones que respondan a las demandas asistenciales del paciente en la UPC.

OBJECTIVE: To determine the association among nursing workload, patient severity of illness, and mortality in an intensive care unit (ICU) of a public hospital in Chile. METHODS: Retrospective, correlational study that analyzed clinical records of ICU patients. Demographic, clinical, severity of illness (APACHE II), and nursing workload (TISS-28) variables were collected upon patient admission. Descriptive and bivariate analyses were performed. Logistic regressions were used to identify the variables associated with ICU and hospital mortality. RESULTS: 311 patients with a median of 7 days (IQR = 9.5) of stay at the ICU were included; 48.9% were admitted from the emergency department and 25.7% had a neurological diagnosis. The TISS-28 score was positively associated with the APACHE II score (r =0.359, p < 0.001) and ICU length of stay (r =0.146, p < 0.05). Deceased patients presented a higher APACHE II score than the survivors during their ICU stay (p < 0.001) and in the hospital (p < 0.01). In the regression models, ICU mortality was associated with the APACHE II (OR = 1.109, p < 0.001) and the TISS-28 (OR = 0.955, p < 0.05) score. APACHE II and TISS-28 scores were not significantly associated with hospital mortality. CONCLUSIONS: A greater severity of illness was associated with an increase in the nursing workload. Mortality in critical patient units was negatively associated with nursing workload, but positively associated with patient severity of illness. Nursing workload is a relevant variable in the outcome of the critically ill patient and must be regularly evaluated to ensure there are sufficient resources to respond to the ICU patient's care demands.

RESUMO

Introduction:  Non-adherence in kidney transplants is diversely defined. Immunosuppression non-adherence (INA) is the most used definition and has been associated with graft loss and acute rejection. But INA assesses only one fraction of adherence. Therefore, we analyzed the association of a holistic non-adherence definition with transplant outcomes and compared its prediction performance with other definitions. Methods:  We retrospectively included 739 kidney recipients between 2019 and 2021. We evaluated holistic non-adherence (HNA), suboptimal-immunosuppressor levels (SIL), appointment non-adherence (ANA), procedure non-adherence (PNA) and INA. The main outcomes were graft loss, graft rejection, and mortality. A backward logistic regression was performed estimating adjusted and un-adjusted odds ratio (OR) for each outcome. Finally, we compared the non-adherence definitions' prediction for the main outcomes using the area under the curve. Results: HNA was present in 28.7% of patients. Non-adherent patients had an adjusted OR of 2.66 (1.37-5.15) for mortality, 6.44 for graft loss (2.71-16.6), and 2.28 (1.15-4.47) for graft rejection. INA and PNA presented a moderate discrimination for graft loss and HNA and ANA mild-to-moderate discrimination for graft loss and death. Conclusion: Holistic non-adherence was associated with worst outcomes in kidney recipients and had a significant prediction performance for graft loss and mortality.

RESUMO

Avaliar os resultados clínicos de serviços de gerenciamento da terapia medicamentosa (GTM) oferecidos a pessoas vivendo com HIV (PVHIV) em uma unidade de dispensação de medicamentos brasileira. O estudo foi dividido em uma etapa transversal (etapa I), que avaliou o fator associado à identificação de dois ou mais problemas relacionados ao uso de medicamentos (PRM) na avaliação inicial; e uma etapa quasi- experimental (etapa II), realizada com um único grupo de pacientes para avaliar desfechos clínicosForam acompanhadas 52 PVHIV. A média de idade foi de 60±11,3 anos (min. = 29; máx. =78). A presença de dislipidemia (OR=5,38; IC 95%=1,61-17,97; p=0,006) e o uso de sete ou mais medicamentos (OR=4,28; IC 95%=1,32-13,88; p=0,015) foram fatores associados a identificação de dois ou mais PRM. Foi demonstrada uma diferença significativa entre os valores iniciais e finais de pressão arterial sistólica, carga viral do HIV, contagem de células T CD4+ e triglicerídeos (p<0,05). O serviço de GTM favoreceu os desfechos clínicos positivos.

To assess the clinical outcomes of comprehensive medication management (CMM) services offered to people living with HIV (PLHIV) at a Brazilian Antiretroviral Medication Dispensing Unit. The study was divided into a cross-sectional stage (stage I), to evaluate associated factor with the identification of two or more drug therapy problems (DTP) in the initial assessment; and a quasi-experimental stage (stage II), conducted with a single group of PLHIV to evaluate clinical outcomes. A total of 52 PLHIV, with 60±11.3 years of age were followed up. In stage I, the presence of dyslipidemia (OR=5.38; 95%CI=1.61-17.97) and the use of seven or more medications (OR=4.28; 95% CI=1.32-13.88) were factors associated with the identification of DTP. In stage II, a significant difference was demonstrated between the initial and final values of systolic blood pressure, triglycerides, HIV viral load and CD4+T-cells count (p<0,05). The CMM service favored positive clinical outcomes.

RESUMO

In this retrospective study, we aimed to evaluate the effects of the neurotrophic compound Cerebrolysin on executive, cognitive, and functional performance in patients with traumatic brain injury (TBI) with a highly severe disability level. A total of 44 patients were included in the study, with 33 patients in the control group and 11 patients in the interventional group who received intravenous infusions of 30 mL Cerebrolysin. Both groups received standard rehabilitation therapy following the rehabilitation protocol for patients with TBI at Hospital Clínico Mutual de Seguridad. Functional and cognitive scales were evaluated at baseline, at four months, and at the endpoint of the intervention therapy at seven months (on average). The results revealed a significant improvement in the Cerebrolysin-treated group compared to the control group. Specifically, patients who received Cerebrolysin showed a moderate residual disability and a significant reduction in the need for care. Concerning the promising results and considering the limitations of the retrospective study design, we suggest that randomized controlled studies be initiated to corroborate the positive findings for Cerebrolysin in patients with moderate to severe brain trauma.

Assuntos

RESUMO

Considerando o ciclo das Políticas públicas, o planejamento e a avaliação são elementos cruciais, favorecendo organização e julgamento de valor a respeito de uma intervenção ou sobre qualquer um dos seus componentes, envolvendo tanto quem faz uso dos serviços como quem produz os mesmos. Na perspectiva da melhoria da assistência prestada à mulher e ao recém-nascido na porta de entrada dos serviços de atenção materno-infantis, é realizado o Acolhimento com Classificação de Risco Obstétrico que cursa como uma ferramenta de apoio à tomada de decisão clínica que tem como intuito a identificação da paciente crítica ou mais grave, permitindo um atendimento de maneira rápida e segura de acordo com o potencial de risco, com base nas evidências científicas existentes. Objetivo: Realizar uma reflexão teórica acerca dos avanços e limitações relacionados aoplanejamento e avaliação dos serviços deAcolhimento com Classificação de RiscoObstétrico.Metodologia:Trata-se de um estudo de caráter descritivo, em formato de artigo de reflexão, em que foram definidas duas dimensões categóricas que retratam o contexto do planejamento e avaliação dos serviços de Acolhimento com Classificação de RiscoObstétrico.Resultados:Percebemos que ainda é possível identificar muitas arestas no planejamento e na qualidade da prestação deste tipo de serviço, principalmente no que diz respeito à garantia da integralidade e do cuidado de acordo com as necessidades da mulher.Conclusões:Para que uma articulação entre os diferentes atores seja alcançada são necessárias estratégias de planejamento que tornem viável buscar a qualidade assistencial e que deem condições de avaliar essa assistência prestada (AU).

Considering the cycle of Public Policies, planning and evaluation are crucial elements, favoring organization and judgment of valuesregarding an intervention or any of its components, involving both those who use the services and those who produce them. With a view toimproving the care provided to women and newborns at the entranceto maternal and child care services, the Reception with Obstetric Risk Classification iscarried out as a tool to support clinical decision-making which aims to identify critical or more severe patients, allowing a quick and safe care according to the risk potential, based on existing scientific evidence.Objective:To carry out a theoretical reflection on the advances and limitations related to the planning and evaluation of Reception serviceswith Obstetric Risk Classification.Methodology:This is a descriptive study, in the form of a reflection article, in which two categorical dimensions were defined and that portray the context of planning and evaluation of Reception serviceswith Obstetric Risk Classification.Results:We realized that it is still possible to identify many edges in the planning and quality of the provision of this type of service, especially with regard to ensuring comprehensiveness and care according to the needs of women.Conclusions:In order to achieved thearticulation between the different actors, it is necessary to plan strategies that make it feasible to seek care quality and that provide conditions for evaluating this assistance provided (AU).

Considerando el ciclo de las Políticas Públicas, la planificación y la evaluación son elementos cruciales, favoreciendo la organización y el juicio de valor sobre una intervención o cualquiera de sus componentes, involucrando tanto a quienes utilizan los servicios como a quienes los producen. Con el objetivode mejorar la asistenciabrindadaa lasmujeresy recién nacidosen elingresoa los servicios de atención materno-infantil, se realiza laAcogidacon Clasificación de Riesgo Obstétrico como una herramienta de apoyo a la toma de decisiones clínicas que tiene como objetivo identificar las pacientes más graves, permitiendo una atención rápida y segura de acuerdo al potencial de riesgo, segúnla evidencia científica existente.Objetivo: Realizar una reflexión teórica sobre los avances y limitaciones relacionados con la planificación y evaluación de los servicios de Acogida con Clasificación de Riesgo Obstétrico.Metodología:Se trata de un estudio descriptivo, en forma de artículo de reflexión, en el que se definieron dos dimensiones categóricas que retratan el contexto de planificación y evaluación de los servicios de Acogida con Clasificación de Riesgo Obstétrico. Resultados: Percibimos que aún es posible identificar muchas asperezasen la planificación y calidad de la prestación de este tipo de servicio, especialmente en lo que se respectaa garantizar la integralidad y la atención acorde a las necesidades de las mujeres. Conclusiones: Para que se logre una articulación entre los diferentes actores, son necesarias estrategias de planificación que viabilicen la búsqueda de la calidad de la atención y que proporcionen condiciones para evaluar esta asistencia brindada (AU).

Assuntos

RESUMO

OBJECTIVE: The purpose of this study was to assess feasibility, reliability, and validity of a new performance-based test, the Shoulder Performance Activity Test (SPAT). METHODS: People with shoulder pain (n = 93) and without shoulder pain (n = 43) were included. The SPAT consists of overhead reach, hand behind head, and hand behind back tasks, each performed with 20 repetitions and rated by time, pain, and effort. The SPAT scores were summed for time, pain, and effort, and a total score across the 3 tasks. Feasibility was assessed by the percentage of SPAT task completion, test-retest reliability by intraclass correlation coefficient (ICC), standard error measurement, minimal detectable change, and known-groups construct validity by comparing between groups (shoulder pain and no pain) and between shoulders in those with pain. RESULTS: All participants performed the 3 SPAT tasks. The ICC was 0.74-0.91, and the minimal detectable change was 3.1-4.7 for task scores and 10.0 points for the total score. Individuals with pain presented higher tasks and total scores compared with those without pain. The moderate/severe pain group had higher scores than the low pain and no shoulder pain groups, and the low pain group had higher scores than the no pain group. Scores were higher in the involved shoulder compared with the uninvolved shoulder. CONCLUSION: The SPAT is a feasible and reliable performance-based test for use in patients with shoulder pain and can differentiate between individuals with and without pain, among different levels of pain, and between involved and uninvolved shoulders. IMPACT: The SPAT provides a standardized method for clinicians to assess shoulder functional performance tasks, which can enable a comprehensive assessment of shoulder disability and clinical decision making. The error metrics can be used to determine meaningful changes in performance.

Assuntos

RESUMO

OBJECTIVE: To assess the effect of physical therapy on cancer-related fatigue (CRF) during cytotoxic anticancer treatment. METHODS: Systematic review with meta-analysis of randomized clinical trials published from 2010 to 2021 (EMBASE, MEDLINE, PEDro; SciELO, and LILACS). Studies assessing the effect of supervised physical therapy (IG) for the management of CRF on adults undergoing anticancer treatment compared with a control group (CG) covering usual care or any uncontrolled practice, such as recommendations about exercise and health education, were included in this review. RESULTS: A total of 22 studies were included in the SR and 21 in the meta-analysis, resulting in 1.992 individuals (CG = 973 and IG = 1.019). There was a reduction in general fatigue [SMD = - 0.69; 95%CI (- 1.15, - 0.22) p < 0.01; I2 = 87%; NNT = 3], with greater weight attributed to combined exercise (44%). Physical fatigue also reduced [SMD = - 0.76; 95%CI (- 1.13, - 0.39) p < 0.01; I2 = 90%; NNT = 2], with greater weight for resistance exercise (50%) and greater effect with combined exercise [SMD = - 1.90; 95%CI (- 3.04, - 0.76) p < 0.01; I 2 = 96%]. There was reduction in general fatigue with moderate intensity (74%) [SMD = - 0.89; 95%CI (- 1.61, - 0.17) p < 0.02; I2 = 90%] and physical fatigue [SMD = - 1.00; 95%CI (- 1.54, - 0.46) p < 0.01; I2 = 92%], while high intensity reduced only general fatigue [SMD = - 0.35; 95%CI (- 0.51, - 0.20) p < 0.01; I2 = 0%]. The number of overall and weekly sessions has been shown to contribute to the reduction of CRF. CONCLUSION: Physical rehabilitation with moderate intensity promoted greater relief of general and physical fatigue. Even after controlling for high heterogeneity, the quality of evidence, summarized in GRADE, was considered moderate for general fatigue and low for physical fatigue.

Assuntos

RESUMO

PURPOSE: The aim was to apply the Advanced Nursing Process and demonstrating procedures of surgical positioning, as well as to show the participating the Nursing Outcomes Classification findings in order to translate the knowledge on specific preventive perioperative positioning into practice, the review of clinical protocols and nursing care plan. METHODS: The methods used include case report about knowledge translation by applying training modalities, review and adaptation of clinical protocols and examination of nursing care plans. FINDINGS: One hundred and nine healthcare providers attended the training, including nurses and nursing technicians working in the surgical center and the outpatient surgical center of the hospital chosen for this study. The surgical positioning protocols were revised based on the evidence described in the literature and the main surgical guidelines. The review of care registered in the institution's electronic system for the nursing prescription stage of the diagnosis Risk of perioperative positioning injury was based on the review on evidence on risk factors, the main guidelines in the area and the interventions suggested by Nursing Intervention Classification. The electronic system had registered 14 cares for this diagnosis, and after the review, one care was excluded and eight new cares were included, totaling 21 cares. CONCLUSION: Nursing teams play a prominent role in positioning patients for surgery, protecting them in a moment of extreme vulnerability, thus making knowledge about the fundamental elements of surgical positioning essential. This emphasizes the importance of training, and of reviewing protocols and records of procedures that promote safety to patients and care teams. IMPLICATION FOR NURSING PRACTICE: The translation of knowledge about the Advanced Nursing Process in the perioperative area contributes to the refinement of classifications and standardization of language in this scenario, subsidizing an evidence-based clinical practice.

OBJETIVO: O objetivo foi aplicar o Processo de Enfermagem Avançado e demonstrar procedimentos de posicionamento cirúrgico, bem como mostrar aos participantes os achados da Nursing Outcomes Classification para traduzir na prática o conhecimento específico sobre prevenção no posicionamento perioperatóriontivo, bem como a revisão de protocolos clínicos e do plano de cuidados de enfermagem. MÉTODOS: Relato de caso sobre tradução do conhecimento por meio da aplicação de modalidades de treinamento, revisão e adaptação de protocolos clínicos e análise de planos de cuidados de enfermagem. RESULTADOS: 109 profissionais de enfermagem participaram do treinamento, incluindo enfermeiros e técnicos de enfermagem que atuam no centro cirúrgico e no centro cirúrgico ambulatorial do hospital escolhido para este estudo. Os protocolos de posicionamento cirúrgico foram revisados com base nas evidências descritas na literatura e nas principais diretrizes cirúrgicas. A revisão dos cuidados registrados no sistema eletrônico da instituição para a etapa de prescrição de enfermagem do diagnóstico Risco de lesão por posicionamento perioperatório foi baseada na revisão das evidências sobre os fatores de risco, as principais diretrizes da área e as intervenções sugeridas pela Nursing Intervention Classification. O sistema eletrônico tinha 14 cuidados cadastrados para este diagnóstico, e após a revisão, um cuidado foi excluído e oito novos cuidados foram incluídos, totalizando 21 cuidados. CONCLUSÃO: A equipe de enfermagem tem papel de destaque no posicionamento do paciente para a cirurgia, protegendo-o em um momento de extrema vulnerabilidade, tornando imprescindível o conhecimento sobre os elementos fundamentais do posicionamento cirúrgico. Ressalta-se a importância do treinamento e da revisão de protocolos e registros de procedimentos que promovem a segurança do paciente e da equipe assistencial. IMPLICAÇÃO PARA A PRÁTICA DE ENFERMAGEM: A tradução do conhecimento sobre o Processo de Enfermagem Avançado na área perioperatória contribui para o refinamento das classificações e padronização da linguagem neste cenário, subsidiando uma prática clínica baseada em evidências.

Assuntos

RESUMO

Calls for refining the understanding of depression beyond diagnostic criteria have been growing in recent years. We examined the prevalence and relevance of DSM and non-DSM depressive symptoms in two Brazilian school-based adolescent samples with two commonly used scales, the Patient Health Questionnaire (PHQ-A) and the Mood and Feelings Questionnaire (MFQ). We analyzed cross-sectional data from two similarly recruited samples of adolescents aged 14-16 years, as part of the Identifying Depression Early in Adolescence (IDEA) study in Brazil. We assessed dimensional depressive symptomatology using the PHQ-A in the first sample (n = 7720) and the MFQ in the second sample (n = 1070). We conducted network analyses to study symptom structure and centrality estimates of the two scales. Additionally, we compared centrality of items included (e.g., low mood, anhedonia) and not included in the DSM (e.g., low self-esteem, loneliness) in the MFQ. Sad mood and worthlessness items were the most central items in the network structure of the PHQ-A. In the MFQ sample, self-hatred and loneliness, two non-DSM features, were the most central items and DSM and non-DSM items in this scale formed a highly interconnected network of symptoms. Furthermore, analysis of the MFQ sample revealed DSM items not to be more frequent, severe or interconnected than non-DSM items, but rather part of a larger network of symptoms. A focus on symptoms might advance research on adolescent depression by enhancing our understanding of the disorder.

Assuntos