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Comparison of the effects of high-flow nasal cannula and bilevel positive airway pressure treatments as respiratory physiotherapy interventions for children with asthma exacerbation: a randomized clinical trial. 高流量鼻插管和双水平气道正压疗法作为呼吸理疗干预措施对哮喘加重儿童的效果比较:随机临床试验。
IF 1.1 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-08-26 eCollection Date: 2024-01-01 DOI: 10.31744/einstein_journal/2024AO0588
Maisi Muniz Cabral David, Evelim Leal de Freitas Dantas Gomes, Carla Lima Feitoza Cavassini, Josiane Germano Luiz, Dirceu Costa

Objective: A high-flow nasal cannula is a practical and safe instrument that can be used for children with asthma exacerbation and promotes beneficial outcomes such as improved asthma severity scores and reduced hospitalization durations, salbutamol use, and oxygen use. To evaluate and compare the efficacy of high-flow nasal cannula treatment and that of bilevel positive airway pressure treatment as respiratory physiotherapy interventions for pediatric patients who are hospitalized because of asthma exacerbation.

Methods: During a randomized clinical trial, treatment was performed using a high-flow nasal cannula and bilevel positive airway pressure for hospitalized children with asthma. After randomization, data regarding lung function, vital signs, and severity scores (pulmonary index, pediatric asthma severity, and pediatric asthma scores) were collected.

Results: Fifty patients were included in this study (25 in the Bilevel Group and 25 in the high-flow nasal cannula group). After 45 minutes of therapy, an improvement in the forced expiratory volume in 1 second was observed. The high-flow nasal cannula group required fewer days of oxygen (O2) use, used fewer bronchodilators (number of salbutamol puffs), and required shorter hospitalization periods than the Bilevel Group (6.1±1.9 versus 4.3±1.3 days; 95% confidence interval, -5.0 to -0.6).

Conclusion: A high-flow nasal cannula is a viable option for the treatment of asthma exacerbation because it can reduce the hospitalization period and the need for O2 and bronchodilators. Additionally, it is a safe and comfortable treatment modality that is as effective as bilevel positive airway pressure.ClinicalTrials.gov Identifier: NCT04033666.

目的:高流量鼻插管是一种实用、安全的工具,可用于哮喘加重的儿童,并能促进改善哮喘严重程度评分、缩短住院时间、减少沙丁胺醇用量和氧气用量等有益结果。目的:评估和比较高流量鼻插管治疗和双水平气道正压治疗作为呼吸理疗干预措施对因哮喘加重而住院的儿童患者的疗效:在一项随机临床试验中,使用高流量鼻插管和双水平气道正压对住院的哮喘患儿进行了治疗。随机分组后,收集有关肺功能、生命体征和严重程度评分(肺指数、小儿哮喘严重程度和小儿哮喘评分)的数据:本研究共纳入了 50 名患者(25 名在双水平组,25 名在高流量鼻插管组)。治疗 45 分钟后,1 秒钟用力呼气量有所改善。与 Bilevel 组相比,高流量鼻插管组需要使用氧气(O2)的天数更少,使用的支气管扩张剂(沙丁胺醇吸入量)更少,住院时间更短(6.1±1.9 天对 4.3±1.3 天;95% 置信区间,-5.0 到 -0.6):高流量鼻插管是治疗哮喘加重的可行方案,因为它可以缩短住院时间,减少对氧气和支气管扩张剂的需求。此外,它还是一种安全舒适的治疗方式,与双水平气道正压一样有效:NCT04033666。
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引用次数: 0
Influence of IL-β, IL-1RN, and TNF-α variants on the risk of acetylsalicylic acid-induced upper gastrointestinal bleeding: a case-control study. IL-β、IL-1RN 和 TNF-α 变异对乙酰水杨酸诱发上消化道出血风险的影响:一项病例对照研究。
IF 1.1 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-08-26 eCollection Date: 2024-01-01 DOI: 10.31744/einstein_journal/2024AO0746
Marcela Forgerini, Cleslei Fernando Zanelli, Sandro Roberto Valentini, Patrícia de Carvalho Mastroianni

Objective: Forgerini et al. investigated the role of seven genetic variants in the risk of upper gastrointestinal bleeding as an adverse drug reaction. In 289 participants (50 cases and 189 controls), the presence of seven variants in the IL-1β, IL-1RN, and TNF-α genes was not associated with susceptibility to acetylsalicylic acid-induced upper gastrointestinal bleeding. The use of acetylsalicylic acid, even in low doses, may be associated with the onset of upper gastrointestinal bleeding as an idiosyncratic response. Considering the role of the genetic background in inter-individual responses to pharmacotherapy, we aimed to investigate the role of seven variants in the TNF-α, IL-β, and IL-1RN genes in association with the risk of upper gastrointestinal bleeding in users of low-dose acetylsalicylic acid for the prevention of cardiovascular events.

Methods: A case-control study was conducted in a Brazilian hospital complex. The Case Group comprised patients diagnosed with upper gastrointestinal bleeding who were administered a low dose of acetylsalicylic acid (n=50). Two Control Groups were recruited: 1) low-dose acetylsalicylic acid users without gastrointestinal complaints and under the supervision of a cardiologist (n=50) and 2) healthy controls (n=189). Sociodemographic, clinical, pharmacotherapeutic, and lifestyle data were recorded through face-to-face interviews. Genomic DNA from all participants was genotyped for rs16944 and rs1143634 (IL-β gene), rs4251961 (IL-1RN gene), and rs1799964, rs1799724, rs361525, and rs1800629 (TNF-α gene).

Results: No significant difference was noted in the genotypic frequencies of TNF-α, IL-β, and IL-1RN variants between the Case and Control Groups of low-dose acetylsalicylic acid users (p>0.05). The frequency of rs1800629 genotypes (TNF-α gene) differed significantly between the Case Group and healthy controls (p=0.003). None of the evaluated variants were associated with a risk of upper gastrointestinal bleeding.

Conclusion: This study aimed to explore pharmacogenomics biomarkers in low-dose acetylsalicylic acid users. Our data suggest that the presence of IL-1β, IL-1RN, and TNF-α variants was not associated with an increased risk of upper gastrointestinal bleeding.

研究目的Forgerini 等人研究了七种基因变异在药物不良反应性上消化道出血风险中的作用。在 289 名参与者(50 例病例和 189 例对照)中,IL-1β、IL-1RN 和 TNF-α 基因中的 7 个变体与乙酰水杨酸诱发上消化道出血的易感性无关。使用乙酰水杨酸,即使是小剂量,也可能与上消化道出血的发生有关,这是一种特异性反应。考虑到遗传背景在个体间对药物治疗反应中的作用,我们旨在研究 TNF-α、IL-β 和 IL-1RN 基因中的 7 个变异与低剂量乙酰水杨酸使用者上消化道出血风险的相关性:在巴西一家综合医院开展了一项病例对照研究。病例组包括确诊为上消化道出血并服用低剂量乙酰水杨酸的患者(50 人)。招募了两个对照组:1)低剂量乙酰水杨酸使用者,但无胃肠道不适症状,并接受心脏科医生的指导(人数=50);2)健康对照组(人数=189)。通过面对面访谈记录了社会人口学、临床、药物治疗和生活方式数据。对所有参与者的基因组 DNA 进行了 rs16944 和 rs1143634(IL-β 基因)、rs4251961(IL-1RN 基因)以及 rs1799964、rs1799724、rs361525 和 rs1800629(TNF-α 基因)的基因分型:结果:低剂量乙酰水杨酸使用者病例组和对照组的TNF-α、IL-β和IL-1RN变体的基因型频率无明显差异(P>0.05)。rs1800629基因型(TNF-α基因)的频率在病例组和健康对照组之间存在显著差异(p=0.003)。所评估的变异均与上消化道出血风险无关:本研究旨在探索低剂量乙酰水杨酸使用者的药物基因组学生物标志物。我们的数据表明,IL-1β、IL-1RN 和 TNF-α 变异的存在与上消化道出血风险的增加无关。
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引用次数: 0
Clinical outcomes and direct cost analysis of rotator cuff repair surgery. 肩袖修复手术的临床效果和直接成本分析。
IF 1.1 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-08-23 eCollection Date: 2024-01-01 DOI: 10.31744/einstein_journal/2024GS0473
Rafael Pierami, Eliane Antonioli, Isabela Queiros Castro, Paula Fairbanks, Felipe Giorgi Manente, Mario Lenza

Objective: The purpose of this study was to evaluate the clinical and functional outcomes in patients who underwent surgical treatment for rotator cuff tears using open and arthroscopic techniques, and to evaluate the direct costs involved.

Methods: Retrospective cohort study with analysis of the data of patients who were referred to two private hospitals in Sao Paulo, Brazil for surgical repair of the rotator cuff from January 2018 to September 2019. Clinical outcomes were assessed using functional scores (SPADI and QuickDASH) and a quality of life questionnaire (EuroQoL). Procedure costs were calculated relative to each hospital's costliest procedure.

Results: Data from 362 patients were analyzed. The mean patient age was 57 years (SD= 10.46), with a slight male predominance (53.9%). Arthroscopic procedures were more common than open procedures (95.6% versus 4.4%). Significant clinical improvement was reported in 84.8% of the patients. The factors associated with increased surgery costs were arthroscopic technique (increase of 29.2%), age (increase of 0.6% per year), and length of stay (increase of 18.9% per day of hospitalization).

Conclusion: Rotator cuff repair surgery is a highly effective procedure, associated with favorable clinical outcomes and improvement in life quality, and low rates of complications. Arthroscopic surgery tends to be costlier than open surgery.

研究目的本研究旨在评估采用开放式和关节镜技术进行肩袖撕裂手术治疗的患者的临床和功能预后,并评估所涉及的直接费用:回顾性队列研究,分析2018年1月至2019年9月期间转诊至巴西圣保罗两家私立医院进行肩袖手术修复的患者数据。临床结果采用功能评分(SPADI 和 QuickDASH)和生活质量问卷(EuroQoL)进行评估。手术成本按照每家医院最昂贵的手术计算:结果:分析了 362 名患者的数据。患者平均年龄为 57 岁(SD= 10.46),男性略占多数(53.9%)。关节镜手术比开放手术更常见(95.6% 对 4.4%)。据报告,84.8%的患者临床症状明显改善。与手术费用增加相关的因素包括关节镜技术(增加29.2%)、年龄(每年增加0.6%)和住院时间(每天增加18.9%):结论:肩袖修复手术是一种非常有效的手术,临床效果良好,生活质量得到改善,并发症发生率低。关节镜手术的费用往往高于开放手术。
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引用次数: 0
Perspectives of primary care providers regarding multicancer early detection panels. 初级保健提供者对多癌症早期检测小组的看法。
IF 1.1 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-08-23 eCollection Date: 2024-01-01 DOI: 10.31744/einstein_journal/2024AO0771
Benjamin E Ueberroth, Richard J Presutti, Alyssa McGary, Mitesh J Borad, Neera Agrwal

Objective: Multicancer early detection panels have recently become available to patients with healthcare provider prescriptions and available funds. These tests utilize circulating tumor DNA (ctDNA) to screen more than 50 cancers using a single blood sample. However, perspectives and data on how the deployment of these tests may impact the practices of primary care providers in terms of implementation, interpretation, documentation, and costs are limited. This study aimed to assess the perspectives of primary care providers regarding the integration of multicancer early detection panels into clinical practice.

Methods: We used a survey to assess the opinions and perspectives of primary care providers, including physicians, nurse practitioners, and physician assistants, across a multistate, tertiary healthcare system. We used a single form consisting of novel questions on familiarity with multi-cancer early detection panels, cost, healthcare equity, documentation, medicolegal, and other concerns. The subgroup analysis was consistent with stratification based on familiarity with ctDNA-based tests and their roles in clinical practice.

Results: Most respondents were unfamiliar with multicancer early detection panels and had not used ctDNA-based tests. Most primary care providers suggested that they would reorder multicancer early detection panel testing at 1- to 5-year intervals and prefer subspecialists for both ordering multicancer early detection panels as well as interpreting their results. Relative concerns differed between physicians and nonphysicians.

Conclusion: The integration of multicancer early detection panels into primary care practice requires careful planning and consideration for the management of increased clinical load, interpretation of results, and cost management.

目的:最近,只要有医疗机构的处方和可用资金,患者就可以获得多种癌症早期检测面板。这些检测利用循环肿瘤 DNA(ctDNA),通过单份血液样本筛查 50 多种癌症。然而,关于这些检测的应用会在实施、解释、记录和成本方面对初级保健提供者的实践产生何种影响的观点和数据却很有限。本研究旨在评估初级医疗服务提供者对将多癌症早期检测面板纳入临床实践的看法:方法:我们通过一项调查来评估一个多州三级医疗保健系统中初级医疗服务提供者(包括医生、执业护士和医生助理)的意见和观点。我们使用了一份单一的表格,其中包含一些新颖的问题,涉及对多种癌症早期检测面板的熟悉程度、成本、医疗保健公平性、文件记录、医疗法律及其他问题。亚组分析根据对基于ctDNA的检测及其在临床实践中的作用的熟悉程度进行了分层:结果:大多数受访者对多癌症早期检测面板并不熟悉,也未使用过基于 ctDNA 的检测。大多数初级保健提供者表示,他们会每隔 1 到 5 年重新订购多癌早期检测样本,并倾向于由亚专科医生订购多癌早期检测样本和解释检测结果。医生和非医生的相对关注点有所不同:结论:将多癌基因早期检测整合到初级保健实践中需要仔细规划,并考虑如何处理增加的临床负荷、结果解释和成本管理。
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引用次数: 0
Inhaled nitric oxide in moderate-to-severe COVID-19 acute respiratory distress syndrome: a retrospective cohort study. 吸入一氧化氮治疗中重度 COVID-19 急性呼吸窘迫综合征:一项回顾性队列研究。
IF 1.1 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-08-16 eCollection Date: 2024-01-01 DOI: 10.31744/einstein_journal/2024AO0578
Lucas Eduardo Benthien Santos, Camila Campos Grisa Padovese, Isabela Belarmino Oliveira de Castro, Rodrigo Carneiro Franco, Ana Paula Pires Bolsoni Okuda, Mariana Resende Bustamante, Luciana Gioli-Pereira

Objective: In this study, we present the findings from a cohort of patients with COVID-19 with acute respiratory distress syndrome who underwent standard therapy, including prone positioning, with or without adjunctive inhalation of nitric oxide. Our investigation sought to determine whether inhaled nitric oxide administration yielded clinical enhancement in this population. Remarkably, nitric oxide administration elevated the PaO2/FiO2 ratio, which is indicative of improved oxygenation. Despite this improvement, discernible mortality benefits did not emerge in association with the inhaled nitric oxide treatment. To evaluate the responsiveness of COVID-19 acute respiratory distress syndrome patients to inhaled nitric oxide as part of their standard therapy.

Methods: This retrospective cohort study included critically ill adult patients with confirmed COVID-19 treated between March 2020 and May 2021. Eligible patients with moderate-to-severe acute respiratory distress syndrome due to COVID-19 were subsequently categorized into two groups based on inhaled nitric oxide use throughout their stay in the intensive care unit. The primary endpoints were overall mortality and improvement in oxygenation parameters 6 hours after inhaled nitric oxide use.

Results: A total of 481 patients admitted to the intensive care unit due to COVID-19 acute respiratory distress syndrome were screened, 105 of which were included. Among the 105 patients, inhaled nitric oxide therapy was used in 33 patients, will 72 did not undergo inhaled nitric oxide therapy. No significant difference in mortality was observed between the groups (67% for the treatment and 82% for the no-treatment groups respectively, p=0.173). Among the patients who used inhaled nitric oxide, 17 (51%) were considered responsive to therapy. There was no significant difference in the length of stay in the intensive care unit (p=0.324) or total hospitalization time (p=0.344).

Conclusion: Inhaled nitric oxide rescue therapy improved oxygenation in patients with COVID-19 with moderate-to-severe acute respiratory distress syndrome but did not affect mortality.

研究目的在本研究中,我们介绍了一组 COVID-19 急性呼吸窘迫综合征患者的研究结果,这些患者接受了包括俯卧位在内的标准治疗,同时吸入或不吸入一氧化氮。我们的调查旨在确定吸入一氧化氮是否能改善这类患者的临床症状。值得注意的是,吸入一氧化氮后,PaO2/FiO2 比值升高,这表明氧合情况有所改善。尽管情况有所改善,但吸入一氧化氮治疗并未带来明显的死亡率改善。目的:评估 COVID-19 急性呼吸窘迫综合征患者对作为标准疗法一部分的吸入一氧化氮的反应:这项回顾性队列研究纳入了 2020 年 3 月至 2021 年 5 月期间接受治疗的确诊 COVID-19 的成年重症患者。根据患者在重症监护病房住院期间吸入一氧化氮的情况,将符合条件的 COVID-19 中重度急性呼吸窘迫综合征患者分为两组。主要终点是总死亡率和吸入一氧化氮 6 小时后氧合参数的改善情况:共筛查了 481 名因 COVID-19 急性呼吸窘迫综合征入住重症监护室的患者,其中 105 人被纳入研究。在这 105 名患者中,33 人使用了吸入一氧化氮疗法,72 人未使用吸入一氧化氮疗法。两组患者的死亡率无明显差异(治疗组和未治疗组的死亡率分别为 67%和 82%,P=0.173)。在使用吸入一氧化氮的患者中,有 17 人(51%)被认为对治疗有反应。在重症监护室的住院时间(P=0.324)和总住院时间(P=0.344)方面没有明显差异:结论:吸入一氧化氮抢救疗法可改善中重度急性呼吸窘迫综合征 COVID-19 患者的氧合情况,但不会影响死亡率。
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引用次数: 0
Hernia 3D training model: a new inguinal hernia 3D-printed simulator. 疝气三维训练模型:新型腹股沟疝气三维打印模拟器。
IF 1.1 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-08-16 eCollection Date: 2024-01-01 DOI: 10.31744/einstein_journal/2024AO0620
Paulo Henrique Fogaça de Barros, Camila Scivoletto Borges, Caroline Petersen da Costa Ferreira, Bruno de Lucia Hernani, Iron Pires Abreu Neto, Luciano Tastaldi, Leandro Totti Cavazzola

Objective: Barros et al. demonstrated a 3D printed model that exhibits anatomical representativeness, low cost, and scalability. The model was created based on subtraction data obtained from computed tomography scans. Images were modeled and reconstructed in 3D to display the male inguinal region, typically viewed using a laparoscopic approach. To evaluate the functionality and quality of the anatomical representation of the hernia 3D training model.

Methods: A model was created based on subtraction data derived from computed tomography scans of the pelvic bones and lumbar spine using the Blender 3.2.2 software program. Images were modeled and reconstructed in 3D to display the male inguinal region, typically viewed using a laparoscopic approach. Polylactic acid plastic was used to print the model. Some structures were made using ethylene vinyl acetate to enable possible material replacement and model reutilization. Thirty surgeons with various training levels were invited to use the model. Transabdominal inguinal hernioplasty was performed by simulating the same steps as those of a laparoscopic surgery, and the surgeons answered a questionnaire regarding the simulation.

Results: Twenty-eight surgeons responded, seven of whom were experts in the treatment of abdominal wall hernias. The model was deemed easy to use, realistic, and anatomically precise, establishing it as a valuable supplement to minimally invasive surgery training.

Conclusion: The evaluation of this 3D model was favorable, as it accurately depicted the inguinal region anatomically, while also proving to be cost-effective for training purposes. The model could be a good option, particularly beneficial for training surgeons at the beginning of their careers.

目的Barros 等人展示了一种三维打印模型,该模型具有解剖代表性、低成本和可扩展性。该模型是根据计算机断层扫描获得的减影数据创建的。对图像进行了建模和三维重建,以显示男性腹股沟区域,通常使用腹腔镜方法进行观察。评估疝气三维训练模型的解剖表示功能和质量:方法:使用 Blender 3.2.2 软件程序,根据骨盆骨和腰椎的计算机断层扫描数据创建模型。对图像进行建模和三维重建,以显示男性腹股沟区域,通常使用腹腔镜方法进行观察。聚乳酸塑料用于打印模型。部分结构使用乙烯-醋酸乙烯制造,以便进行材料更换和模型再利用。30 名受过不同培训的外科医生受邀使用该模型。通过模拟与腹腔镜手术相同的步骤进行经腹腹股沟疝成形术,外科医生回答了有关模拟的问卷:结果:28 名外科医生作了答复,其中 7 人是治疗腹壁疝的专家。该模型被认为易于使用、逼真、解剖精确,是微创手术培训的重要补充:结论:对该三维模型的评价是好的,因为它准确地描述了腹股沟区域的解剖结构,同时也证明了它在培训方面的成本效益。该模型可能是一个不错的选择,尤其有利于培训刚开始工作的外科医生。
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引用次数: 0
Appropriate Delivery Project: Impact of Simulation Training on the Increase in Vaginal Births in Hospitals in Brazil. 适当分娩项目:模拟培训对提高巴西医院阴道分娩率的影响。
IF 1.1 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-08-09 eCollection Date: 2024-01-01 DOI: 10.31744/einstein_journal/2024AO0783
Mariana Santos Alecrim Molina, Eduardo Cordioli, Thomaz Bittencourt Couto, Joyce Kelly Silva Barreto, Rita de Cássia Sanchez

Objective: This study aimed to analyze the relationship between the participation of professionals in simulation-based training and an increase in the rate of vaginal deliveries.

Methods: This retrospective observational study analyzed professionals' participation in high-fidelity simulation training during the pilot phase of the Appropriate Delivery Project, spanning from May 21, 2015 to May 21, 2016, along with the rates of vaginal deliveries across various hospitals. Data for participation by nurses and physicians were examined using a gamma distribution model to discern the predictors influencing the changes in the percentage of vaginal births.

Results: Data from 27 hospitals involved in the project were analyzed. A total of 339 healthcare professionals, including 147 nurses and 192 doctors, underwent the simulation-based training. During the pilot test, the percentage of vaginal births increased from 27.8% to 36.1%, which further increased to 39.8% in the post-intervention period, particularly when the participation rate of nurses exceeded the median.

Conclusion: This study suggests that simulation-based training is a valuable strategy for achieving positive changes in obstetric practice, specifically an increase in the rate of vaginal births. These findings underscore the potential advantages of incorporating simulation training into improvement initiatives, as evidenced by the correlation between higher training adoption rates and substantial and sustained enhancements in vaginal birth rates.

目的:本研究旨在分析专业人员参加模拟培训与提高阴道分娩率之间的关系:本研究旨在分析专业人员参与模拟培训与阴道分娩率提高之间的关系:这项回顾性观察研究分析了专业人员在适宜分娩项目试点阶段(2015 年 5 月 21 日至 2016 年 5 月 21 日)参与高保真模拟培训的情况,以及各家医院的阴道分娩率。我们使用伽马分布模型对护士和医生的参与数据进行了研究,以找出影响阴道分娩比例变化的预测因素:对参与项目的 27 家医院的数据进行了分析。共有 339 名医护人员接受了模拟培训,其中包括 147 名护士和 192 名医生。在试点测试期间,阴道分娩的比例从 27.8% 增加到 36.1%,在干预后进一步增加到 39.8%,尤其是当护士的参与率超过中位数时:本研究表明,模拟培训是实现产科实践积极变化的重要策略,尤其是提高阴道分娩率。这些发现强调了将模拟培训纳入改进措施的潜在优势,较高的培训采用率与阴道分娩率的大幅持续提高之间的相关性就证明了这一点。
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引用次数: 0
Rapid cycle deliberate practice versus postsimulation debriefing in pediatric cardiopulmonary resuscitation training: a randomized controlled study. 儿科心肺复苏培训中的快速循环刻意练习与模拟后汇报:随机对照研究。
IF 1.1 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-08-09 eCollection Date: 2024-01-01 DOI: 10.31744/einstein_journal/2024AO0825
Laila Pinto Coelho, Sylvia Costa Lima Farhat, Rafael da Silva Giannasi Severini, Ana Carolina Amarante Souza, Katharina Reichmann Rodrigues, Fernanda Paixão Silveira Bello, Claudio Schvartsman, Thomaz Bittencourt Couto

Objective: Simulation plays an important role in cardiopulmonary resuscitation training. Comparing postsimulation debriefing with rapid cycle deliberate practice could help determine the best simulation strategy for pediatric cardiopulmonary resuscitation training among pediatric residents.

Methods: This is a single-blind, prospective, randomized controlled study. First- and second year pediatric residents were enrolled and randomized into two groups (1:1 ratio): rapid cycle deliberate practice group (intervention) or postsimulation debriefing group (control). They participated in two rounds of simulated pediatric cardiopulmonary arrest to assess the simulated pediatric cardiopulmonary resuscitation performance gain (round 1) and retention after a 5-6 week washout period (round 2). Scenarios were video-recorded and analyzed by blinded evaluators. The main outcome was the time to initiation of chest compressions. Secondary outcomes included time to recognize a cardiopulmonary arrest, time to recognize a shockable rhythm, time to defibrillation, time to initiation of chest compressions after defibrillation, and chest compression fraction.

Results: Sixteen groups participated in the first round and fifteen groups in the second one. Time to intiation of chest compressions decreased from preintervention scenario to the round 1 testing scenario and increased from round 1 to round 2 testing scenario. However, no interaction effects nor group effects were observed (p=0.885 and p=0.329, respectively). There were no significant differences between the two groups regarding the secondary outcomes.

Conclusion: Despite an overall improvement in simulated pediatric cardiopulmonary resuscitation performance, we did not observe significant differences between the two groups regarding the analyzed variables. The decline in simulated pediatric cardiopulmonary resuscitation performance after 5 weeks suggests the need for shorter time intervals between training sessions.

目的:模拟在心肺复苏培训中发挥着重要作用。比较模拟后汇报与快速循环刻意练习有助于确定儿科住院医师进行儿科心肺复苏培训的最佳模拟策略:这是一项单盲、前瞻性、随机对照研究。第一和第二年的儿科住院医师被纳入并随机分为两组(1:1 比例):快速循环刻意练习组(干预组)或模拟后汇报组(对照组)。他们参加了两轮模拟小儿心肺复苏,以评估模拟小儿心肺复苏性能的提高(第一轮)和5-6周冲洗期后的保持率(第二轮)。情景由盲人评估员进行录像和分析。主要结果是开始胸外按压的时间。次要结果包括识别心肺骤停的时间、识别可电击心律的时间、除颤时间、除颤后开始胸外按压的时间和胸外按压分数:结果:16 个小组参加了第一轮比赛,15 个小组参加了第二轮比赛。从干预前情景到第一轮测试情景,开始胸外按压的时间有所缩短,而从第一轮到第二轮测试情景,开始胸外按压的时间有所延长。然而,没有观察到交互效应或组别效应(分别为 p=0.885 和 p=0.329)。在次要结果方面,两组之间没有明显差异:结论:尽管模拟儿科心肺复苏的表现总体上有所改善,但我们没有观察到两组之间在分析变量方面存在显著差异。模拟小儿心肺复苏术的表现在 5 周后有所下降,这表明有必要缩短训练课程之间的间隔时间。
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引用次数: 0
Inflammation and all-cause mortality in patients undergoing peritoneal dialysis. 腹膜透析患者的炎症和全因死亡率。
IF 1.1 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-08-09 eCollection Date: 2024-01-01 DOI: 10.31744/einstein_journal/2024AO0627
Wander Valadares de Oliveira Júnior, Luciane Teixeira Passos Giarola, Letícia Gonçalves Resende Ferreira, Isabella Viana Gomes Schettini, Sylvia Dias Turani, Arlindo Ribeiro de Oliveira, Maria Aparecida Silva Marinho, Sérgio Wyton Lima Pinto, Melina Barros-Pinheiro, Roberta Carvalho de Figueiredo, Danyelle Romana Alves Rios

Objective: This study aimed to evaluate inflammatory biomarkers in patients undergoing peritoneal dialysis and investigate their association with all-cause mortality or transfer to hemodialysis.

Methods: This prospective cohort study included 43 patients undergoing peritoneal dialysis. Plasma levels of cytokines were measured using flow cytometry and capture enzyme-linked immunosorbent assay. Biomarkers were categorized based on their respective median values. Survival analysis was conducted using the Kaplan-Meier estimator, considering two outcomes: all-cause mortality and transfer to hemodialysis.

Results: After adjusting for confounding factors, plasma levels above the median of the levels of CCL2 and plasma, as well as below the median of TNF-α, and the median of dialysate IL-17 levels, were associated with an increased risk of experiencing the specified outcomes after approximately 16 months of follow-up.

Conclusion: These findings suggest that inflammatory biomarkers may be a valuable tool for predicting all-cause mortality and transfer to hemodialysis in patients undergoing peritoneal dialysis.

目的本研究旨在评估腹膜透析患者的炎症生物标志物,并调查其与全因死亡率或转为血液透析的关系:这项前瞻性队列研究纳入了 43 名接受腹膜透析的患者。采用流式细胞术和捕获酶联免疫吸附测定法测量血浆中的细胞因子水平。根据生物标志物各自的中位值对其进行分类。采用卡普兰-梅耶估计法进行生存分析,考虑了两种结果:全因死亡率和转入血液透析:结果:调整混杂因素后,血浆中 CCL2 和血浆水平高于中位值、TNF-α 低于中位值、透析液 IL-17 水平高于中位值与随访约 16 个月后出现特定结果的风险增加有关:这些研究结果表明,炎症生物标志物可能是预测腹膜透析患者全因死亡率和转入血液透析的重要工具。
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引用次数: 0
Mortality, hospitalizations, and persistence of symptoms in the outpatient setting of the first COVID-19 wave in Brazil: results of SARS-Brazil cohort study. 巴西第一波 COVID-19 门诊病例中的死亡率、住院率和持续症状:SARS 巴西队列研究结果。
IF 1.1 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-08-09 eCollection Date: 2024-01-01 DOI: 10.31744/einstein_journal/2024AO0652
Henrique Andrade Rodrigues Fonseca, Adriano Jose Pereira, Ricardo Kenji Nawa, Viviane Aparecida Rodrigues Sant'Anna, Tatiana Ferreira de Almeida, Hélio Penna Guimarães, Alexandre Pereira Tognon, Lucas Miranda Marques, Lucas Santana Coelho da Silva, Rafaela de Souza Bittencourt, Camila Pachêco Gomes, Priscila de Aquino Martins, Aryadne Lyrio de Oliveira, Eveline Pipolo Milan, Frederico Toledo Campos Dall'Orto, Conrado Roberto Hoffman Filho, Guacyra Almeida, Fábio Barlem Hohmann, Diogo Duarte Fagundes Moia, Luciana Pereira Almeida Piano, Felipe Pinheiro Machado, Ronaldo Vicente Pereira Soares, Lucas Petri Damiani, Silvia Regina Lamas Assis, Edson Amaro Junior, Luiz Vicente Rizzo, Otávio Berwanger

Objective: To evaluate deaths, hospitalizations, and persistence of symptoms in patients with COVID-19 after infection in an outpatient setting during the first COVID-19 wave in Brazil.

Methods: This prospective cohort was between April 2020 and February 2021. Hospitalized or non-hospitalized COVID-19 patients until five days after symptom onset were included. The outcomes measured were incidence of death, hospitalization, and persistence of more than two symptoms 60 days after discharge.

Results: Out of 1,198 patients enrolled in the study, 66.7% were hospitalized. A total of 289 patients died (1 [0.3%] non-hospitalized and 288 [36%] hospitalized). At 60 days, patients non-hospitalized during admission had more persistent symptoms (16.2%) compared to hospitalized (37.1%). The COVID-19 severity variables associated with the persistence of two or more symptoms were increased age (OR= 1.03; p=0.015), respiratory rate at hospital admission (OR= 1.11; p=0.005), length of hospital stay of more than 60 days (OR= 12.24; p=0.026), and need for intensive care unit admission (OR= 2.04; p=0.038).

Conclusion: COVID-19 survivors who were older, tachypneic at admission, had a hospital length of stay >60 days, and were admitted to the intensive care unit had more persistent symptoms than patients who did not require hospitalization in the early COVID-19 waves.ClinicalTrials.gov Identifier: NCT04479488.

摘要评估巴西第一次 COVID-19 浪潮期间门诊感染 COVID-19 患者的死亡、住院和症状持续情况:这项前瞻性队列研究的时间跨度为 2020 年 4 月至 2021 年 2 月。方法:该前瞻性队列在 2020 年 4 月至 2021 年 2 月期间进行,纳入了症状出现五天前住院或未住院的 COVID-19 患者。测量结果为死亡、住院和出院后60天仍有两个以上症状的发生率:在 1198 名参与研究的患者中,66.7% 的患者住院治疗。共有 289 名患者死亡(1 人[0.3%]未住院,288 人[36%]住院)。入院 60 天后,非住院患者的持续症状(16.2%)多于住院患者(37.1%)。与两种或两种以上症状持续存在相关的 COVID-19 严重性变量包括:年龄增加(OR= 1.03;p=0.015)、入院时呼吸频率增加(OR= 1.11;p=0.005)、住院时间超过 60 天(OR= 12.24;p=0.026)以及需要入住重症监护室(OR= 2.04;p=0.038):结论:COVID-19幸存者中年龄较大、入院时呼吸急促、住院时间超过60天、入住重症监护室的患者比COVID-19早期波段中无需住院的患者症状更顽固:NCT04479488。
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