scholarly journals Operationalization of heart failure patients engagement with mHealth

2021 ◽  
Vol 20 (Supplement_1) ◽  
Author(s):  
I Madujibeya ◽  
A Aroh
Keyword(s):  
Heart Failure ◽  
English Language ◽  
Current Evidence ◽  
Structured Interviews ◽  
System Usage ◽  
Funding Sources ◽  
Comprehensive Search ◽  
Qualitative Measure ◽  
Study Designs ◽  
Usage Data

Abstract Funding Acknowledgements Type of funding sources: None. Introduction The computing and communication features of mobile devices have been leveraged in mobile Health (mHealth) interventions to provide comprehensive and tailored support that may have positive outcomes in patients with heart failure (HF.  However, the effects of the interventions have shown mixed evidence. Considering that patients’ engagement is a prerequisite for the effectiveness of the interventions, understanding how patients engage with the interventions, and the effects of patients’ engagement on HF outcomes may explain the mixed findings. Objective This study aimed to synthesize current evidence on measures of HF patients’ engagement with mHealth interventions, and the effects of the interventions on HF outcomes. Method In accordance with the Arksey and O’Malley framework for scoping review, a comprehensive search of the literature was conducted in 7 databases for relevant studies published in the English language from 2009 to Feb. 2021. The descriptive characteristics of the studies were reported. Thematic analysis was conducted to identify themes that described patients’ engagement in the qualitative studies included in the review. Results The review synthesized 29 studies that operationalized engagement with mHealth interventions in 3665 patients with HF, ranging from a sample of 7 to 1571, with a median of 80 patients. Patients’ engagement with mHealth interventions was measured quantitively based on system usage data (82.7%, 24/29), qualitatively by semi-structured interviews and focus groups (10.3%, 3/29), and by mixed methods or combination of qualitative and system usage data (17.2%, 5/29). System usage data were evaluated using 7 metrics: (1) number of physiological parameters measured (88.5%, 3/26); (2) duration of use or time spent (3.8%, 6/26);  (3) features accessed/screen viewed (11.5%, 3/26); (4) number of HF educational videos viewed (7.7%, 2/26); (5) number of SMS response (3.8%, 1/26); (6) number of HF questionnaire completed (3.8%,  1/26; (7)numbers of logins (5%, 1/19).  There is a lack of consistency in how system usage metrics were reported across the studies; 73.7 % of the studies reported only the descriptive statistics of the System usage data. Intervention usage was the most identified subtheme in the qualitative measure. The effect of patients’ engagement with mHealth interventions on HF-related outcomes was inconclusive. Conclusion The operational definitions of patients’ engagement with mHealth interventions are underreported and lack consistency. The application of inferential analytical methods to the engagement data is extremely limited, which indicates a gap in mHealth research in patients with HF. More research focusing on developing optimal and standardized measures of patients’ engagement that may be applied across different study designs is warranted

Measures of Engagement with mHealth Interventions in Patients with Heart Failure: A Scoping Review (Preprint)

2021 ◽  
Author(s):  
Ifeanyi Madujibeya ◽  
Terry Lennie ◽  
Adaeze Aroh ◽  
Misook L Chung ◽  
Debra Moser
Keyword(s):  
Heart Failure ◽  
Patient Engagement ◽  
English Language ◽  
Exercise Adherence ◽  
Qualitative Studies ◽  
Current Evidence ◽  
Structured Interviews ◽  
System Usage ◽  
Patients With Heart Failure ◽  
Usage Data

BACKGROUND The computing and communication features of mobile devices are increasingly leveraged in mHealth interventions to provide comprehensive and tailored support that may have positive outcomes in patients with heart failure (HF). However, examination of mHealth intervention effectiveness has provided mixed findings. Considering that patient engagement is a prerequisite for the effectiveness of interventions, understanding how patients engage with mHealth interventions, and the effects of patient engagement on HF outcomes may explain the mixed findings. OBJECTIVE Our aim was to synthesize current evidence on measures of patient engagement with mHealth interventions, and the effects of engagement on HF outcomes METHODS A comprehensive search of the literature was conducted in 7 databases for relevant studies published in the English Language from 2009 to September 2021. Descriptive characteristics of studies were reported. Content analysis was conducted to identify themes that described patient engagement with mHealth in the qualitative studies included in the review. RESULTS We synthesized 32 studies that operationalized engagement with mHealth interventions in 4771 patients with HF (67.9% male), ranging from a sample of 7 to 1571, with a median of 53.3 patients. Patient engagement with mHealth interventions was measured only quantitatively based on system usage data (71.8%, 23/32), only qualitatively based on data from semi-structured interviews and focus groups (6.3%, 2/32), and by a combination of both quantitative and qualitative data (21.9%, 7/32). System usage data were evaluated using 6 metrics of engagement: (1) number of physiological parameters transmitted (63.3%, 19/30); (2) number of HF questionnaires completed (6.7%, 2/30); (3) numbers of logins (13.3%, 4/30); (4) number of short message service (SMS) responses (3.3%, 1/30); (5) time spent (16.7%, 5/30); (6) number of features accessed/screen viewed (9.5%, 4/30). There was a lack of consistency in how system usage metrics were reported across the studies. Eighty percent of the studies reported only the descriptive characteristics of the system usage data. Emotional, cognitive, and behavioral domains of patient engagement were identified in qualitative studies. Patient engagement levels ranged from 45% to 100% and decreased over time. The effects of engagement on HF knowledge, self-care, exercise adherence, and HF hospitalizations were inconclusive. CONCLUSIONS The operational definitions of patient engagement with mHealth interventions are underreported and lack consistency. The application of inferential analytical methods to engagement data is extremely limited. More research focused on developing optimal and standardized measures of patient engagement that may be applied across different study designs is warranted.

Ramipril for the Prevention and Treatment of Cardiovascular Disease

2003 ◽  
Vol 37 (3) ◽  
pp. 412-419 ◽  
Author(s):  
April D Vuong ◽  
Laura G Annis
Keyword(s):  
Heart Failure ◽  
Cardiovascular Disease ◽  
Ace Inhibitors ◽  
English Language ◽  
Ace Inhibitor ◽  
Data Extraction ◽  
Left Ventricular ◽  
Current Evidence ◽  
Pubmed Database ◽  
Prevention And Treatment

OBJECTIVE: To evaluate the effectiveness of ramipril in the prevention and treatment of cardiovascular disease and determine its need for inclusion on a formulary. DATA SOURCES: A MEDLINE and PubMed database search was conducted (1987–May 2002). Only journals written in the English language were selected for review. DATA EXTRACTION AND STUDY SELECTION: Articles reporting the use of ramipril in humans were evaluated. Emphasis was placed on randomized, controlled trials assessing efficacy. DATA SYNTHESIS: Ramipril is an angiotensin-converting enzyme (ACE) inhibitor that exerts its effects through inhibition of the renin–angiotensin–aldosterone system. It exhibits a safety profile that is similar to that of other ACE inhibitors and is comparable in cost to the majority of the available agents. Clinical trials have proven the effectiveness of ACE inhibitors in the treatment of hypertension, heart failure, and nephropathy. Ramipril, however, is the only ACE inhibitor currently approved for the prevention of cardiovascular events in high-risk patients without evidence of left-ventricular dysfunction or heart failure, based on the results of the HOPE (Heart Outcomes Prevention Evaluation) trial. Whether this effect is specific to ramipril has yet to be proven. This article emphasizes the major trials involving ramipril including the AIRE (Acute Infarction Ramipril Efficacy), REIN (Ramipril Efficacy in Nephropathy), and HOPE trials. CONCLUSIONS: Although similar to other ACE inhibitors in many aspects, it cannot be assumed that the benefits shown with ramipril in the HOPE trial are a class effect. Ongoing trials should help to clarify this matter. Until this time, current evidence justifies the inclusion of ramipril on a formulary.

scholarly journals Keeping the plates spinning: a qualitative study of the multifaceted role of caregiving in HFpEF

2021 ◽  
Vol 20 (Supplement_1) ◽  
Author(s):  
CR Pearson ◽  
E Khair ◽  
F Forsyth ◽  
E Sowden ◽  
C Deaton
Keyword(s):  
Heart Failure ◽  
Qualitative Study ◽  
Informal Caregivers ◽  
Healthcare Providers ◽  
Support Network ◽  
Structured Interviews ◽  
National Budget ◽  
Funding Sources ◽  
Public Grant ◽  
Caregiver Role

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Institutes of Health Research School for Primary Care Research OnBehalf Optimise HFpEF Background Heart failure with preserved ejection fraction (HFpEF) accounts for 50% of all heart failure cases yet remains poorly understood, diagnosed and managed, which can add complexity to the caregiver role. No study to date has explicitly investigated the experiences of informal caregivers of people with HFpEF. Objective The aim of this study was to explore and understand the role and experiences of informal caregivers of people with HFpEF. Methods and design A qualitative study using semi-structured interviews involving caregivers alone, patients alone or caregiver/patient dyads. The interviews were performed as part of a larger programme of research in HFpEF. Participants were recruited from three regions of England. Interviews were transcribed verbatim and analysed thematically. Results 22 interviews were conducted with a total of 38 participants, 17 of which were informal caregivers. Three inter-related themes were identified: (1) ‘spinning plates’ - the multifaceted nature of informal caregiving: household manager, health manager and motivator; (2) ‘the spinning falters’- the barriers to caregiving: lack of HFpEF awareness, information and support, the burden of multimorbidity, caregiver stress and the caregiver’s health status; (3) ‘keeping the plates spinning’- the facilitators of caregiving: being informed, being appreciated, having a champion (a health care professional that is key to managing the patient’s HFpEF), and engaging a wider support network. Conclusions Informal caregivers play an important role in supporting people with HFpEF. The experience of caregiving to people with HFpEF is similar to HFrEF, but complicated by challenges of poor HFpEF information and support, and the burden of multimorbidity. Healthcare providers should assess the needs of informal caregivers as part of patient care in HFpEF. Caregivers and patients would both benefit from improved information and management of HFpEF and associated multi-morbidities. Helping caregivers ‘keep the plates spinning’ will require innovative approaches and coordination across the care continuum.

Dietary patterns and components to prevent and treat heart failure: a comprehensive review of human studies

2018 ◽  
Vol 32 (1) ◽  
pp. 1-27 ◽  
Author(s):  
Conor P. Kerley
Keyword(s):  
Heart Failure ◽  
Dietary Patterns ◽  
Human Studies ◽  
Current Evidence ◽  
Processed Meats ◽  
Treat Heart Failure ◽  
Comprehensive Search ◽  
Intervention Trials ◽  
Randomised Controlled ◽  
Refined Carbohydrates

AbstractGrowing evidence has emerged about the role of dietary patterns and components in heart failure (HF) incidence and severity. The objective here is to provide a comprehensive summary of the current evidence regarding dietary patterns/components and HF. A comprehensive search of online databases was conducted using multiple relevant keywords to identify relevant human studies. The Dietary Approaches to Stop Hypertension (DASH) and Mediterranean diets have consistently been associated with decreased HF incidence and severity. Regarding specific dietary components, fruit, vegetables, legumes and whole grains appear beneficial. Current evidence suggests that red/processed meats, eggs and refined carbohydrates are harmful, while fish, dairy products and poultry remain controversial. However, there is a notable lack of human intervention trials. The existing but limited observational and interventional evidence from human studies suggests that a plant-based dietary pattern high in antioxidants, micronutrients, nitrate and fibre but low in saturated/trans-fat and Na may decrease HF incidence/severity. Potential mechanisms include decreased oxidative stress, homocysteine and inflammation but higher antioxidant defence and NO bioavailability and gut microbiome modulation. Randomised, controlled trials are urgently required.

Tertiary English-majored Students’ Perceptions toward the Role of Pronunciation in English Language Learning and their Practicing Strategies

2020 ◽  
Vol 6 (2) ◽  
pp. 264-279
Keyword(s):  
Language Learning ◽  
English Language ◽  
Vital Role ◽  
English Language Learning ◽  
Structured Interviews ◽  
Efl Learners ◽  
The University

Accurate pronunciation has a vital role in English language learning as it can help learners to avoid misunderstanding in communication. However, EFL learners in many contexts, especially at the University of Phan Thiet, still encounter many difficulties in pronouncing English correctly. Therefore, this study endeavors to explore English-majored students’ perceptions towards the role of pronunciation in English language learning and examine their pronunciation practicing strategies (PPS). It involved 155 English-majored students at the University of Phan Thiet who answered closed-ended questionnaires and 18 English-majored students who participated in semi-structured interviews. The findings revealed that students strongly believed in the important role of pronunciation in English language learning; however, they sometimes employed PPS for their pronunciation improvement. Furthermore, the results showed that participants tended to use naturalistic practicing strategies and formal practicing strategies with sounds, but they overlooked strategies such as asking for help and cooperating with peers. Such findings could contribute further to the understanding of how students perceive the role of pronunciation and their PPS use in the research’s context and other similar ones. Received 10th June 2019; Revised 12th March 2020; Accepted 12th April 2020

Emerging Cardiac Resynchronisation Therapy Indications

2011 ◽  
Vol 7 (1) ◽  
pp. 29
Author(s):  
Charlotte Eitel ◽  
Gerhard Hindricks ◽  
Christopher Piorkowski ◽  
◽  
◽  
...  
Keyword(s):  
Heart Failure ◽  
Systolic Heart Failure ◽  
Cardiac Resynchronisation Therapy ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Current Evidence ◽  
Class Iii ◽  
Ventricular Ejection Fraction ◽  
Cardiac Resynchronisation ◽  
Resynchronisation Therapy

Cardiac resynchronisation therapy (CRT) is an efficacious and cost-effective therapy in patients with highly symptomatic systolic heart failure and delayed ventricular conduction. Current guidelines recommend CRT as a class I indication for patients with sinus rhythm, New York Heart Association (NYHA) functional class III or ambulatory class IV, a QRS duration ≥120ms, and left ventricular ejection fraction (LVEF) ≤35%, despite optimal pharmacological therapy. Recent trials resulted in an extension of current recommendations to patients with mild heart failure, patients with atrial fibrillation, and patients with an indication for permanent right ventricular pacing with the aim of morbidity reduction. The effectiveness of CRT in patients with narrow QRS, patients with end-stage heart failure and cardiogenic shock, and patients with an LVEF >35% still needs to be proved. This article reviews current evidence and clinical applications of CRT in heart failure and provides an outlook on future developments.

Gender Differences and Their Influences on T2DM Self-Management Among Spanish-Speaking Latinx Immigrants

2021 ◽  
pp. 154041532110117
Author(s):  
Cheryl A. Smith-Miller ◽  
Diane C. Berry ◽  
Cass T. Miller
Keyword(s):  
Gender Differences ◽  
Health Literacy ◽  
English Language ◽  
Educational Achievement ◽  
Self Management ◽  
Structured Interviews ◽  
Health Promoting Behaviors ◽  
History Of ◽  
Health Promoting ◽  
Excessive Alcohol

Introduction: Evidence suggests that gender may influence many aspects of type 2 diabetes (T2DM) self-management (SM) and we posit that limited English language–proficient Latinx immigrants face additional challenges. Methods: Instruments and semi-structured interviews were used to examine gender differences on health literacy, diabetes knowledge, health-promoting behaviors, diabetes, eating and exercise self-efficacy (SE), and T2DM SM practices among a cohort of limited English language–proficient Latinx immigrants. Statistical and qualitative analysis procedures were performed comparing males and females. Results: Thirty persons participated. Males tended to be older, have higher educational achievement, and more financial security than females. Physiologic measures tended worse among female participants. Health literacy and exercise SE scores were similar, but females scored lower on Eating and Diabetes SE. Forty-seven percent ( n= 9) of the women reported a history of gestational diabetes mellitus and a majority of men ( n = 7) cited difficulty with excessive alcohol. Consumption: Males appeared to receive more SM support compared to females. Females more frequently noted how family obligations and a lack of support impeded their SM. Work environments negatively influenced SM practices. Conclusion: Men and women have unique SM challenges and as such require individualized strategies and support to improve T2DM management.

Heart failure in Acute Coronary Syndrome: predictors and prognosis

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
M Santos ◽  
H Santos ◽  
I Almeida ◽  
H Miranda ◽  
C Sa ◽  
...  
Keyword(s):  
Heart Failure ◽  
Artery Bypass ◽  
Study Data ◽  
Multivessel Disease ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Coronary Syndrome ◽  
Funding Sources ◽  
Previous Stroke ◽  
St Elevation

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf on behalf of the Investigators of " Portuguese Registry of ACS " Introduction Heart failure (HF) is a frequent complication of acute coronary syndromes (ACS). Therefore, it is important to access its impact on prognosis and identify patients (pts) with higher risk of HF. Objective To evaluate predictors and prognosis of HF in the setting of ACS. Methods Based on a multicenter retrospective study, data collected from admissions between 1/10/2010 and 4/09/2019. Pts without data on cardiovascular history or uncompleted clinical data were excluded. Pts were divided in 2 groups (G): GA – pts without HF; GB - pts with HF during hospitalization. Results HF occurred in 4003 (15.6%) out of 25718 pts with ACS. GB was older (74 ± 12 vs 65 ± 13, p < 0.001), had more females (36.3% vs 26.2%, p < 0.001), had higher rates of arterial hypertension (78.4% vs 69.3%, p < 0.001), dyslipidaemia (64.4% vs 61.1%. p < 0.001), previous ACS (25.6% vs 19.7%, p < 0.001,), previous HF (16.4% vs 4.1%, p < 0.001), previous stroke (11.9% vs 6.4%, p < 0.001), chronic kidney disease (CKD) (17.1% vs 5.5%, p < 0.001), chronic obstructive pulmonary disease (COPD) (7.8% vs 3.8%, p < 0.001) and longer times from first symptoms to admission (268min vs 238min, p < 0.001). GA had higher rate of smokers (28.4% vs 16.2%, p < 0.001) and higher rate of non-ST-elevation myocardial infarction (MI) (46.5% vs 43.0%, p < 0.001). GB had higher rates of ST-elevation MI (STEMI) (49.2% vs 41.1%, p < 0.001), namely anterior STEMI (58.1% vs 44.9%, p < 0.001). GB had lower blood pressure (130 ± 32 vs 140 ± 28, p < 0.001), higher heart rate (86 ± 23 vs 76 ± 18, p < 0.001), Killip-Kimball class (KKC) ≥2 (63.2% vs 6.7%, p < 0.001), atrial fibrillation (AF) (15.4% vs 5.7%, p < 0.001), left bundle branch block (7.5% vs 3.1%, p < 0.001) and were previously treated with diuretics (39.1% vs 22.1%, p < 0.001), amiodarone (2.2% vs 1.4%, p < 0.001) and digoxin (2.8% vs 0.7%, p < 0.001). GB had higher rates of multivessel disease (66.0% vs 49.5%, p < 0.001) and planned coronary artery bypass grafting (7.3% vs 6.0%, p < 0.001), reduced left ventricle function (72.3% vs 33.4%, p < 0.001) and needed more frequently mechanical ventilation (8.2% vs 0.9%, p < 0.001), non-invasive ventilation (8.7% vs 0.5%, p < 0.001) and provisory pacemaker (4.5% vs 1.0%, p < 0.001). Logistic regression confirmed females (p < 0.001, OR 1.42, CI 1.29-1.58), diabetes (p < 0.001, OR 1.43, CI 1.30-1.58), previous ACS (p < 0.001, OR 1.27, CI 1.10-1.47), previous stroke (p < 0.001, OR 1.35, CI 1.16-1.57), CKD (p < 0.001, OR 1.76, CI 1.50-2.05), COPD (p < 0.001, OR 2.15, CI 1.82-2.54), previous usage of amiodarone (p = 0.041, OR 1.35, CI 1.01-1.81) and digoxin (p < 0.001, OR 2.30, CI 1.70-3.16), and multivessel disease (p < 0.001, OR 1.64, CI 1.67-2.32) were predictors of HF in the setting of ACS. Event-free survival was higher in GA than GB (79.5% vs 58.1%, OR 2.3, p < 0.001, CI 2.09-2.56). Conclusion As expected, HF in the setting of ACS is associated with poorer prognosis. Several features may help predict the HF occurrence during hospitalizations, allowing an earlier treatment.

Living with Heart Failure during the COVID-19 Pandemic: An Interpretative Phenomenological Analysis

2021 ◽  
pp. 105477382110166
Author(s):  
Alessia Martina Trenta ◽  
Davide Ausili ◽  
Rosario Caruso ◽  
Cristina Arrigoni ◽  
Massimo Moro ◽  
...  
Keyword(s):  
Heart Failure ◽  
Coping Strategies ◽  
Lived Experience ◽  
Interpretative Phenomenological Analysis ◽  
Phenomenological Analysis ◽  
Structured Interviews ◽  
Hospital Organization ◽  
Challenging Situation ◽  
And Coping ◽  
Negative Feelings

This study aimed to explore lived experience of patients with heart failure (HF) during the COVID-19 pandemic. A qualitative study was conducted using an interpretative phenomenological analysis (IPA). Data collection performed in March-May 2020, using in-depth, semi-structured interviews on a purposive sample. Data were analyzed according to the IPA methodology, and triangulation, bracketing, journaling, and member checking were used to assure rigor. 14 patients with HF were enrolled, and three main themes described their lived experience during the COVID-19 pandemic: Vulnerability, Hanging in the balance, and Coping strategies. These people felt particularly vulnerable to the novel virus and experienced uncertainty due to hospital organization changes. Because of this, they felt like they were hanging in the balance, experiencing various negative feelings. Nevertheless, they managed to deal with this challenging situation by implementing some peculiar coping strategies. The COVID-19 represents a significant challenge for patients with HF, impacting significantly on their lives.

scholarly journals Improvement of the heart failure patient process for the prevention of new events through tele-education and continuous tele-optimization of the treatment by nursing staff

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
M Perez Serrano ◽  
CNP Carlos Nicolas Perez Garcia ◽  
DEV Daniel Enriquez Vazquez ◽  
MFE Marcos Ferrandez Escarabajal ◽  
JDD Jesus Diz Diaz ◽  
...  
Keyword(s):  
Heart Failure ◽  
Nyha Class ◽  
Randomized Study ◽  
Primary Objective ◽  
Control Group ◽  
Close Monitoring ◽  
Chronic Patients ◽  
Face To Face ◽  
Funding Sources

Abstract Funding Acknowledgements Type of funding sources: None. Introduction patients with heart failure (HF) are especially vulnerable to SAR-CoV-2 infection especially due to their worse prognosis for this disease. Purpose to demonstrate that patients with HF will present similar health outcomes if their education and pharmacological treatment is optimised remotely by a nurse rather than through conventional care. Methods  A single-centre, observational, prospective, non-randomized study was carried out in which two groups were compared. The experimental group had most of their care provided virtually by a nurse who could optimise their medication according to the clinical guides whilst the control group received conventional face-to-face care. During a follow-up period of 6 months, patients included in the study have an initial face-to-face consultation with a cardiologist and an evaluation of the patient where the treatment objectives are established. The rest of the follow-ups were done through videoconsultation with the nurse every 15 days for 6 months where the neurohormonal treatment was optimized and an educational program was carried out with different cardiovascular educational topics. Results   Thirty-seven patients have been included. Sex: 30 men (81.0%) and 7 women (19.0%) Mean age: 67.9 years (12.8). Range 42-87 years. Etiology: 61.2% ischemic and 38.8% non-ischemic mean LVEF at inclusion = 30.2%. A total of 17 patients have completed the study: a 13% average improvement of FEVI, a reduction of NT-proBNP of and improvement in functional heart failure class. The primary objective was to compare the proportion of neurohormonal drugs prescribed, as well as the mean of the maximum doses reached in each after 6 months of follow-up, as well as mean ejection fraction, NYHA class and mean NT-proBNP (Table 1) Conclusions Telemedicine offers us valuable tools that allow us to take care of chronic patients, reducing exposure to the virus as much as possible. Efficient use of virtual tools and human resources makes close monitoring possible. Specialized nursing is a key element in the education, pharmacological optimization and monitoring of these patients. Parámetros analíticos Valores iniciales Valores finales NT-proBNP ( pg/mL) 3469,7 (± 4057,3) 1446,4 (± 1305,2) Creatinina (mg/dL) 1,10 (± 0,24) 1,12 (± 0,39) TFG (mL/min/1,73m2 ) 65,4 (± 21,2) 62,7 (± 23, 6) Potasio (meq /L) 4,5 (± 0,5) 4,6 (± 0,4) Fevi 29,4 % (± 7,2) FEVI 42,7 % (± 9,6)

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