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2022 ◽  
Author(s):  
RAUL RIBEIRO DE ANDRADE ◽  
◽  
OLAVO BARBOSA DE OLIVEIRA NETO ◽  
JOÃO GUSTAVO ROCHA PEIXOTO DOS SANTOS ◽  
CÉLIO FERNANDO DE SOUSA RODRIGUES ◽  
...  

Review question / Objective: What is the effectiveness of Early Tracheostomy compared with Late Tracheostomy Or Prolonged Orotracheal Intubation in Traumatic Brain Injury? Condition being studied: Traumatic Brain Injury (TBI) is every traumatic anatomical ou functional injury that affects brain, skull and/or vessels related to them. TBI is a public health problem that involves over 50 million people per year in Worldwide. Information sources: PUBLISHED DATABASES (Medline by PUBMED, Lilacs, Central-Cochrane, Scopus by Elsevier, Web Of Science e Embase by Elsevier) NON-PUBLISHED (Open Grey by Sigle; Clinical Trial Register at the International Clinical Trials Registry Platform) (Referencies of the selected studies).


Author(s):  
Aurea Gabriela Pereira Rodrigues ◽  
Gabriel Gomes Vilar de Sousa ◽  
Werena Lisboa de Jesus ◽  
Suellen Alessandra Soares de Moraes

A tendinopatia do calcâneo (TC) é uma condição dolorosa e disfuncional, recorrente em indivíduos ativos e sedentários. A etiologia da TC é incerta, e tratamentos clínicos nem sempre são eficazes, o que merece atenção da comunidade científica quanto ao emprego racional de recursos terapêuticos com melhor evidência científica. A presente revisão objetivou descrever as principais abordagens fisioterapêuticas aplicadas no tratamento da TC. A busca dos artigos foi realizada entre janeiro e outubro de 2018 nas bases de dados PubMed, PEDro, Bireme e Cochrane Controlled Trial Register, limitada aos últimos cinco anos. Foram consideradas para esta revisão os artigos disponíveis na íntegra, em inglês, com Qualis de A1 até B2 na área de avaliação 21, e que utilizassem a fisioterapia como intervenção terapêutica. Foram excluídos artigos de metanálise e aqueles associados a mais de um tipo de intervenção sem os devidos controles. De 4.198 artigos, apenas 18 foram elegíveis, sendo 12 estudos experimentais em modelo animal e 6 ensaios clínicos. Os estudos experimentais mostraram vantagens na redução da dor e inflamação ao usar a fotobiomodulação como terapia única, bem como associado a outras terapias. Já a estimulação mecânica e a mobilização tecidual foram vantajosas quanto às propriedades biomecânicas e histológicas dos tendões lesionados. Nos ensaios clínicos, foram observadas melhorias nos escores de dor, mobilidade, função e força muscular em todas as abordagens terapêuticas, embora o exercício terapêutico excêntrico seja a abordagem mais recorrente. As abordagens fisioterapêuticas para o tratamento da TC com melhor evidência científica compreendem a fotobiomodulação e a estimulação mecânica por mobilizações e exercícios, sendo fortemente recomendadas para a prática clínica.


2021 ◽  
Author(s):  
Annemarie Klingenstein ◽  
Aylin Garip-Kuebler ◽  
Daniel R Muth ◽  
Christoph Hintschich

Abstract Purpose: To compare gluteal wound healing after dermis fat graft (DFG) implantation in patients with and without local application of kinesiotapes.Methods: In this prospective, single-center analysis, 16 patients who underwent DFG implantation were randomized in two groups. Wound healing was compared 4-6 weeks after therapy and 3 months later (after application of 2 cycles of kinesiotaping for 2-3 weeks in the case and no specific therapy in the control group). Demographic data, patient content and wound healing were assessed. Scarring was graded (0-3) by evaluation of photodocumentation by 2 blinded, independent observers.Results: Mean scar grading by both observers decreased from 2.31±0.48 to 1.13±0.72 in the case and from 2.38±0.52 to 1.44±0.50 in the control group with interobserver-agreement on scar grading being substantial to almost perfect in both groups. Scar length decreased significantly in both groups (p=0.008). Scar prominence decreased in 2/3 of cases in the case and 1/3 in the control group. Scar coloring significantly improved in the case group alone (p=0.031).Conclusion: No functionally impairing or painful scar developed. No adverse effects occurred after kinesiotaping. Gluteal scars shortened significantly over time and were significantly paler in the case group. Kinesiotaping could prevent hypertrophic scarring or keloid formation.Trial registration number: DRKS00023111; trial register: Deutsches Register Klinischer Studien (www.drks.de), retrospectively registered


BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e052494
Author(s):  
Nicole E Billingy ◽  
Vashti N M F Tromp ◽  
Evalien Veldhuijzen ◽  
Jose Belderbos ◽  
Neil K Aaronson ◽  
...  

IntroductionLung cancer and its treatment cause a wide range of symptoms impacting the patients’ health-related quality of life (HRQoL). The use of patient-reported outcomes (PRO) to monitor symptoms during and after cancer treatment has been shown not only to improve symptom management but also to improve HRQoL and overall survival (OS). Collectively, these results favour implementation of PRO-symptom monitoring in daily clinical care. However, these promising outcomes have been obtained under trial conditions in which patients were selected based on stringent inclusion criteria, and in countries with a dissimilar healthcare system than in the Netherlands.The primary aim of the SYMptom monitoring with Patient-Reported Outcomes using a web application among patients with Lung cancer in the Netherlands (SYMPRO-Lung) study is to evaluate the effect of PRO-symptom monitoring during and after lung cancer treatment on HRQoL in daily clinical practice. Secondary objectives include assessing the effect of PRO-symptom monitoring on progression-free survival, OS, the incidence and grade of PRO symptoms, medication adherence, implementation fidelity and cost-effectiveness.Methods and analysisThe SYMPRO-Lung study is a prospective, multicentre trial with a stepped wedge cluster randomised design. Study participants (n=292 intervention, n=292 controls) include patients with lung cancer (stages I–IV) starting treatment with surgery, systemic treatment, targeted treatment and/or radiotherapy.Every participating centre will consecutively switch from the control period to the intervention period, in which patients report their symptoms weekly via an online tool. In the intervention group, we evaluate two alert approaches: the active and reactive approach. If the symptoms exceed a predefined threshold, an alert is sent to the healthcare provider (active approach) or to the patient (reactive approach). Both the control and intervention group complete HRQoL questionnaires at 4 time points: at baseline, 15 weeks, 6 months and 1-year post treatment). Differences in HRQoL between the groups will be compared using linear mixed modelling analyses, accounting for within-centre clustering, potential time effects and confounding.Ethics and disseminationThe study protocol was approved by the Institutional Review Board and the Medical Ethics Committee of the Amsterdam UMC (under number NL 68440.029.18) and the institutional review boards of the participating study sites. The dissemination of the results will be conducted through publication in peer-reviewed journals and through scientific conferences.Trial registration numberTrial register identifier: Netherlands Trial register Trial NL7897. Date of registration: 24 July 2019. https://www.trialregister.nl/trial/7897.


2021 ◽  
Author(s):  
Joachim Risse ◽  
Karsten Szeder ◽  
Ann-Kristin Schubert ◽  
Thomas Wiesmann ◽  
Hanns-Christian Dinges ◽  
...  

Abstract Background:Double lumen tube (DLT) intubation is the most commonly used technique for lung separation. Bronchial blockers (BB) are an alternative, especially for difficult airways. The EZ-bronchial blocker (EZB) is the newest device of the BB family. Methods:A randomised, controlled trial was conducted in 80 patients undergoing elective thoracic surgery using DLT or SLT plus EZB for lung separation (German Clinical Trial Register DRKS00014816). The objective of the study was to compare the clinical performance of EZB with DLT. Primary endpoint was total time to successful lung separation. Secondary endpoints were time subsections, quality of lung collapse, difficulty of intubation, any complications during the procedure, incidence of objective trauma of the oropharynx and supraglottic space and intubation-related subjective symptoms.Results:74 patients were included, DLT group (n = 38), EZB group (n = 36). Median total time for lung separation [IQR] in DLT group was 234 seconds [207 to 294] versus 298 seconds [243 to 369] in EZB group (P=0.007). Quality of lung collapse was equal in both groups, DLT group 89.5% were excellent vs. 83.3 % in the EZB group (P=0.444). Inadequate lung collapse in five patients of the EZB group resulted in unsuccessful repositioning attempts and secondary DLT placement. Endoscopic examinations revealed significantly more carina trauma (P=0.047) and subglottic haemorrhage (P=0.047) in the DLT group. Additionally, postoperative subjective symptoms (sore throat, hoarseness) were more common in the DLT group, as were speech problems.Conclusions:Using the EZB results in prolonged lung separation compared to DLT, prima facie with equal quality of lung collapse for the thoracic surgeon. Five crossover cases demonstrated the superiority of the use of left-sided DLT especially in the indication for EZB for a right open thoracotomy or right video-assisted thoracoscopic surgery (VATS). Using the EZB showed only little evidence for reducing objective airway trauma e.g. less carina trauma as well as subjective complaints.Trial registration:German Clinical Trial Register DRKS00014816, prospectively registered on 07.06.2018https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00014816


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Eva S. van den Ende ◽  
◽  
Bo Schouten ◽  
Marjolein N. T. Kremers ◽  
Tim Cooksley ◽  
...  

Abstract Background Truly patient-centred care needs to be aligned with what patients consider important, and is highly desirable in the first 24 h of an acute admission, as many decisions are made during this period. However, there is limited knowledge on what matters most to patients in this phase of their hospital stay. The objective of this study was to identify what mattered most to patients in acute care and to assess the patient perspective as to whether their treating doctors were aware of this. Methods This was a large-scale, qualitative, flash mob study, conducted simultaneously in sixty-six hospitals in seven countries, starting November 14th 2018, ending 50 h later. One thousand eight hundred fifty adults in the first 24 h of an acute medical admission were interviewed on what mattered most to them, why this mattered and whether they felt the treating doctor was aware of this. Results The most reported answers to “what matters most (and why)?” were ‘getting better or being in good health’ (why: to be with family/friends or pick-up life again), ‘getting home’ (why: more comfortable at home or to take care of someone) and ‘having a diagnosis’ (why: to feel less anxious or insecure). Of all patients, 51.9% felt the treating doctor did not know what mattered most to them. Conclusions The priorities for acutely admitted patients were ostensibly disease- and care-oriented and thus in line with the hospitals’ own priorities. However, answers to why these were important were diverse, more personal, and often related to psychological well-being and relations. A large group of patients felt their treating doctor did not know what mattered most to them. Explicitly asking patients what is important and why, could help healthcare professionals to get to know the person behind the patient, which is essential in delivering patient-centred care. Trial registration NTR (Netherlands Trial Register) NTR7538.


Author(s):  
Gwen R. Teesing ◽  
Jan Hendrik Richardus ◽  
Vicki Erasmus ◽  
Mariska Petrignani ◽  
Marion P. G. Koopmans ◽  
...  

Abstract We investigated whether an intervention to improve hand hygiene compliance in nursing homes changed glove use. Hand hygiene compliance increased, but substitution of hand hygiene with gloves did not decrease. We observed a reduction of inappropriately unchanged gloves after exposure to body fluids. Clinical trials identifier: Netherlands Trial Register, trial NL6049 (NTR6188): https://www.trialregister.nl/trial/6049.


2021 ◽  
Vol 11 ◽  
Author(s):  
Martine J. van Bennekom ◽  
Pelle P. de Koning ◽  
Martin J. Gevonden ◽  
M. Soemiati Kasanmoentalib ◽  
Damiaan Denys

Background: Symptoms of obsessive-compulsive disorder (OCD) are often underreported by patients and mainly triggered in the patients private domain, making it harder for clinicians to recognize OCD. Virtual reality (VR) can be used to assess OCD symptoms in the clinician's office. We developed a VR game in order to provoke subjective and physiological OCD symptoms. We hypothesize that (1) the VR game provokes more OCD symptoms in patients compared to healthy controls, (2) performing virtual compulsions leads to a reduction in emotional responses in OCD patients and that (3) the severity of VR game provoked symptoms correlates with severity of OCD symptoms.Methods: Participants played the VR game on a laptop while physiological measures were recorded simultaneously. We measured emotional responses, virtual compulsions and physiological arousal in response to our VR game in 26 OCD patients and 26 healthy controls. We determined correlations between emotional responses, virtual compulsions and OCD severity.Results: We found higher levels of VR-provoked anxiety (U = 179.5, p = 0.004) and virtual compulsions in OCD patients compared to healthy controls (p = 0.001). There was a significant reduction in emotional responses after performing virtual compulsions in the OCD patients. The emotional responses and virtual compulsions did not correlate significantly with Y-BOCS scores. A baseline difference between patients and healthy controls was found in heart rate variability (HRV), but no significant change in HRV, heartrate and skin conductance was found during the VR gameConclusions: Our study clearly shows our OCD VR game is capable of provoking more anxiety and virtual compulsions in patients with OCD compared to healthy controls. Providing a direct patient-rated measurement in the clinicians room, the VR game could help in assessing core OCD symptoms and recognizing OCD.Clinical Trial Registry Number: Netherlands Trial Register NTR5935.


2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Dafeng Liu ◽  
Yong Wang ◽  
Bennan Zhao ◽  
Lijuan Lan ◽  
Yaling Liu ◽  
...  

Abstract Background A dysregulated host immune response is common in patients with COVID-19. Aim In this study, we aimed to define the characteristics of lymphocyte subsets and their relationship with disease progression in COVID-19 patients with or without diabetes mellitus (DM). Methods The baseline peripheral lymphocyte subsets were compared between 55 healthy controls and 95 patients with confirmed COVID-19, and between severe and non-severe COVID-19 patients with or without DM. Results The prevalence of DM in the COVID-19 group was 20%, and patients with severe COVID-19 had a higher prevalence of DM than those with non-severe disease (P = 0.006). Moreover, a significantly poor prognosis and a higher rate of severity were found in those with DM relative to those without DM (P = 0.001, 0.003). Generally, all lymphocytes and subsets of lymphocytes, especially B and T cells, were significant reduced in COVID-19 patients, particularly in those with DM. Patients with severe COVID-19 and DM had the lowest lymphocyte counts compared with those with severe COVID-19 without DM, and those with non-severe COVID-19 with or without DM. Partially decreased lymphocyte subsets, age and DM were closely related to disease progression and prognosis. Conclusions These findings provide a reference for clinicians that immunomodulatory treatment may improve disease progression and prognosis of COVID-19 patients, especially those with severe disease with DM. Trial registration Chinese Clinical Trial Register ChiCTR2000034563


2021 ◽  
Author(s):  
Jonne J. Sikkens ◽  
David T.P. Buis ◽  
Edgar J.G. Peters ◽  
Mireille Dekker ◽  
Michiel Schinkel ◽  
...  

AbstractBACKGROUNDIt is unclear how, when and where health care workers (HCW) working in hospitals are infected with SARS-CoV-2.METHODSProspective cohort study comprising 4-weekly measurement of SARS-CoV-2 specific antibodies and questionnaires from March to June 2020. We compared SARS-CoV-2 incidence between HCW working in Covid-19 patient care, HCW working in non-Covid-19 patient care and HCW not in patient care. Phylogenetic analyses of SARS-CoV-2 samples from patients and HCW were performed to identify potential transmission clusters.RESULTSWe included 801 HCW: 439 in the Covid-19 patient care group, 164 in the non-Covid-19 patient care group and 198 in the no patient care group. SARS-CoV-2 incidence was highest in HCW working in Covid-19 patient care (13.2%), as compared with HCW in non-Covid-19 patient care (6.7%, hazard ratio [HR] 2.2, 95% confidence interval [CI] 1.2 to 4.3) and in HCW not working in patient care (3.6%, HR 3.9, 95% CI 1.8 to 8.6). Within the group of HCW caring for Covid-19 patients, SARS-CoV-2 cumulative incidence was highest in HCW working on Covid-19 wards (25.7%), as compared with HCW working on intensive care units (7.1%, HR 3.6, 95% CI 1.9 to 6.9), and HCW working in the emergency room (8.0%, HR 3.3, 95% CI 1.5 to 7.1). Phylogenetic analyses on Covid-19 wards identified multiple potential HCW-to-HCW transmission clusters while no patient-to-HCW transmission clusters were identified.CONCLUSIONSHCW working on Covid-19 wards are at increased risk for nosocomial SARS-CoV-2 infection, with an important role for HCW-to-HCW transmission.(Funded by the Netherlands Organization for Health Research and Development ZonMw & the Corona Research Fund Amsterdam UMC; Netherlands Trial Register number NL8645)


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