Agradecemos aos 14 pacientes lesão cerebral que são membros do Cérebro &quot;Amazing&quot; Injury Survivor Grupo de Apoio em Framingham, MA ou serviços ambulatoriais acessando através de Spaulding Rehabilitation Hospital de participantes do estudo que levou a este papel. Financiamento e outros apoios para o estudo foram fornecidos pela Associação Lesão Cerebral de Massachusetts, o Programa Estadual de Saúde Lesão da Reabilitação Massachusetts Comissão, ea Agência de Pesquisa em Qualidade de Saúde e os Institutos Schneider para Política de Saúde na Escola Heller para a Política Social e Gestão, Brandeis University, através de uma bolsa de formação doutoral em investigação de serviços de saúde e análise política.

<ol>
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C., Mauborgne, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Fair+process:+Managing+in+the+knowledge+economy.">Fair process: Managing in the knowledge economy.</a> Harvard Business Review. 75, 65-75 (1997).</li><li>Langlois, J. A., Rutland-Brown, W., Thomas, K. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+incidence+of+traumatic+brain+injury+among+children+in+the+United+States+-+Differences+by+race.">The incidence of traumatic brain injury among children in the United States - Differences by race.</a> Journal of Head Trauma Rehabilitation. 20, 229-238 (2005).</li><li>Langlois, J. A., Rutland-Brown, W., Thomas, K. 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S., Berger, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Brain+injury+survivors:+Narratives+of+rehabilitation+and+healing.">Brain injury survivors: Narratives of rehabilitation and healing.</a> Disability in Society. , (2010).</li><li>Lorenz, L. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Discovering+a+new+identity+after+brain+injury.">Discovering a new identity after brain injury.</a> Sociology of Health &#38; Illness. 32, 862-879 (2010).</li><li>Lorenz, L. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Visual+metaphors+of+living+with+brain+injury:+Exploring+and+communicating+lived+experience+with+an+invisible+injury.">Visual metaphors of living with brain injury: Exploring and communicating lived experience with an invisible injury.</a> Visual Studies. 25, 210-223 (2010).</li><li>Lorenz, L. S., Kolb, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Involving+the+public+through+participatory+visual+methods.">Involving the public through participatory visual methods.</a> Health Expectations. 12, 262-274 (2009).</li><li>Lorenz, L. S., Kolb, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Doing+your+own+PhotoVoice+project:+A+guide.">Doing your own PhotoVoice project: A guide.</a> Brainline [Internet]. , (2009).</li><li>Lorenz, L. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Using+fair+process+to+cross+the+quality+and+health+care+chasm:+Eliciting+the+perspective+of+traumatic+brain+injury+survivors.">Using fair process to cross the quality and health care chasm: Eliciting the perspective of traumatic brain injury survivors.</a> , (2007).</li><li>National Institutes of Health. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Rehabilitation+of+persons+with+traumatic+brain+injury.">Rehabilitation of persons with traumatic brain injury.</a> , (1998).</li><li>Oakley, A., Bendelow, G., Barnes, J., Buchanan, M., Husain, O. A. N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Health+and+cancer+prevention:+Knowledge+and+beliefs+of+children+and+young+people.">Health and cancer prevention: Knowledge and beliefs of children and young people.</a> British Medical Journal. 310, 1029-1033 (1995).</li><li>Prigatano, G. P., Schacter, D. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Awareness of deficit after brain injury: Clinical and theoretical issues. , (1991).</li><li>Prigatano, G. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Work,+love,+and+play+after+traumatic+brain+injury.">Work, love, and play after traumatic brain injury.</a> Bulletin of the Menninger Clinic. 53, 414-431 (1989).</li><li>Prior, L. B. e. l. i. e. f. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=knowledge+and+expertise:+the+emergence+of+the+lay+expert+in+medical+sociology.">knowledge and expertise: the emergence of the lay expert in medical sociology.</a> Sociology of Health &#38; Illness. 25, 41-57 (2003).</li><li>Radley, A., Taylor, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Images+of+recovery:+a+photo-elicitation+study+on+the+hospital+ward.">Images of recovery: a photo-elicitation study on the hospital ward.</a> Qualitative Health Research. 13, 77-99 (2003).</li><li>Heyden, L. B. V. a. n. d. e. r., Blondel, C., Carlock, R. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Fair+process:+Striving+for+justice+in+family+business+family+business.">Fair process: Striving for justice in family business family business.</a> Family Business Review. 18, 1-21 (2005).</li><li>Rich, M., Lamola, S., Gordon, J., Chalfen, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Video+intervention/prevention+assessment:+A+patient-centered+methodology+for+understanding+the+adolescent+illness+experience.">Video intervention/prevention assessment: A patient-centered methodology for understanding the adolescent illness experience.</a> Journal of Adolescent Health. 27, 155-165 (2000).</li><li>Sherry, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> If I only had a brain: Deconstructing brain injury. , (2006).</li><li>Wang, C., Burris, M. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Photovoice:+Concept,+methodology,+and+use+for+participatory+needs+assessment.">Photovoice: Concept, methodology, and use for participatory needs assessment.</a> Health Education &#38; Behavior. 24, 369-387 (1997).</li><li>Yin, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Case study research, design and methods. , (2003).</li></ol>

O primeiro autor oferece treinamentos em photovoice e foto-elicitação através das escolas médicas e outros locais de ensino. O segundo autor não tem nada a revelar.

Entrevistados se tornar parceiros e desempenhar o papel de &quot;co-expert&quot; papel no contexto clínico, quando a sua experiência vivida é procurado apenas o paciente pode realmente saber o que é viver com lesão cerebral e os cuidados relacionados com a experiência. Além disso, a meta de saúde para sobreviventes de lesões cerebrais muitos parece ser a cura, não de recuperação. Recuperação implica um desejo de retornar a um estado pré-lesão. Pacientes recém-feridos podem ser a esperança de se recuperar de seus ferimentos, mas a longo prazo sobreviventes aceitaram que eles não serão capazes de retornar ao seu status anterior. Eles vêem a cura como cognitivas, físicas, emocionais, e até mesmo espiritual (Lorenz 2010a). Eles percebem que continuar a progredir ao longo do tempo, mesmo muitos anos após a sua lesão. Discutir fotografias de suas vidas podem ajudar os pacientes e os médicos para identificar centrada na pessoa áreas de preocupação e reconhecer e apreciar o progresso do paciente ao longo do tempo. Aplicação de um processo justo para os cuidados clínicos dos pacientes significa que estão profundamente engajados, explorando a maneira que sua experiência pode ser melhorada, compreendendo a justificativa para todas as decisões clínicas, e aceitar seu papel e responsabilidade. Processo justo ativa motivação do paciente para aderir a estratégias de reabilitação e tomar medidas para o progresso em sua cura. Quando os prestadores aplicar processo justo aos cuidados clínicos, paciente e prestador de expectativas e objetivos podem ser mais bem alinhada. A fotografia se torna o foco da interação e envolve o profissional, bem como o paciente em explorar a experiência e construir relacionamentos. A relação terapêutica pode ser melhorado. Além disso, de acordo com o Kim e Mauborgne modelo, resultando mudanças de atitude e comportamento pode levar a melhores resultados. Com processo justo, o poder na interação clínica pode tornar-se mais equilibrado que os pacientes sentem que estão sendo ouvidas. Discutir fotografias e seu significado pode ajudar os pacientes a se tornar parte da solução, e não apenas o problema. Uso de câmeras não é a única forma de alcançar um processo justo, e não é uma abordagem para cada paciente ou cada médico. É uma ferramenta e metodologia para envolver os pacientes, melhorar a comunicação em circunstâncias difíceis e alcançar centrada na pessoa cuidado.

using visual and narrative methods to achieve fair process in clinical care

O Instituto de Medicina tem como alvo paciente-centramento como uma área importante de melhoria da qualidade. Uma dimensão importante da paciente-centramento é respeito pelos valores do paciente, preferências e necessidades expressas. No entanto, abordagens específicas para ganhar essa compreensão e traduzi-la a cuidados de qualidade no contexto clínico são escassos. A partir de uma perspectiva da qualidade do paciente não é um conceito simples, mas é melhor entendida em termos de cinco dimensões: resultados técnicos; de tomada de decisão eficiência; conforto e conveniência, informação e apoio emocional e satisfação do paciente como um todo. Falha em considerar a qualidade dessa resultados de cinco pontas perspectiva em foco em resultados médicos, sem considerar os processos centrais para a qualidade do ponto de vista do paciente e vital para alcançar bons resultados. Neste trabalho, defendemos para a aplicação do conceito de processo justo em ambientes clínicos. Processo justo envolve o uso de uma abordagem colaborativa para explorar questões de diagnóstico e tratamentos com pacientes, explicando as razões para as decisões, definição de expectativas sobre os papéis e responsabilidades, e implementar um plano de núcleo e de avaliação contínua. Processo justo abre a porta para trazer expertise paciente para o ambiente clínico e do trabalho de desenvolvimento de metas de saúde e estratégias de atendimento. Este artigo fornece um passo a passo ilustração de uma abordagem inovadora visual, chamado photovoice ou foto-elicitação, para alcançar processo justo no trabalho clínico com sobreviventes lesão cerebral adquirida e outras que vivem com condições crônicas de saúde. Aplicando esta ferramenta visual e metodologia no contexto clínico do paciente irá melhorar provedor de comunicação; envolver pacientes como parceiros na identificação de desafios, pontos fortes, objetivos e estratégias; apoio e avaliação do progresso ao longo do tempo. Pedir aos pacientes para trazer recursos visuais de suas vidas na interacção clínica pode ajudar a iluminar as lacunas no conhecimento clínico, forjar um melhor relacionamento terapêutico com os pacientes que vivem com doenças crónicas, como danos cerebrais, e identificar centrado no paciente objetivos e possibilidades de cura. O processo aqui ilustrado pode ser usado por médicos, (médicos de cuidados primários, terapeutas de reabilitação, neurologistas, neuropsicólogos, psicólogos e outros) que trabalham com pessoas vivendo com doenças crônicas, tais como lesão cerebral adquirida, doença mental, deficiência física, HIV / AIDS, abuso de substâncias ou estresse pós-traumático, e pelos líderes de grupos de apoio para os tipos de pacientes descritos acima e seus familiares ou cuidadores.

Watch this Scientific Journal Video about Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care at JoVE.com

Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care

Este artigo ilustra uma abordagem inovadora visual (photovoice ou foto-elicitação) para alcançar processo justo em cuidados clínicos para os pacientes que vivem com condições crônicas de saúde, iluminar as lacunas no conhecimento clínico, forjar melhores relações terapêuticas, e identificar centrado no paciente objetivos e possibilidades de cura .

Usando métodos visual e narrativa para atingir Processo Fair em Cuidados Clínicos

The Institute of Medicine has targeted patient-centeredness as an important area of quality improvement. A major dimension of patient-centeredness is ...

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23.3K visualizações.  Brandeis University. Este artigo ilustra uma abordagem inovadora visual (photovoice ou foto-elicitação) para alcançar processo justo em cuidados clínicos para os pacientes que vivem com condições crônicas de saúde, iluminar as lacunas no conhecimento clínico, forjar melhores relações terapêuticas, e identificar centrado no paciente objetivos e possibilidades de cura .

Vídeo: Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care

Development of an Audio-based Virtual Gaming Environment to Assist with Navigation Skills in the Blind

Audio-based Environment Simulator (AbES) is virtual environment software designed to improve real world navigation skills in the blind. Using only audio based cues and set within the context of a video game metaphor, users gather relevant spatial information regarding a building's layout. This allows the user to develop an accurate spatial cognitive map of a large-scale three-dimensional space that can be manipulated for the purposes of a real indoor navigation task. After game play, participants are then assessed on their ability to navigate within the target physical building represented in the game. Preliminary results suggest that early blind users were able to acquire relevant information regarding the spatial layout of a previously unfamiliar building as indexed by their performance on a series of navigation tasks. These tasks included path finding through the virtual and physical building, as well as a series of drop off tasks. We find that the immersive and highly interactive nature of the AbES software appears to greatly engage the blind user to actively explore the virtual environment. Applications of this approach may extend to larger populations of visually impaired individuals.

Audio-based Environment Simulator (AbES) is virtual environment software designed to improve real world navigation skills in the blind.

Desenvolvimento de um ambiente de jogo de áudio baseada Virtual para ajudar com habilidades de navegação em Cegos

Audio-based Environment Simulator (AbES) is virtual environment software designed to improve real world navigation skills in the blind. Using only audio ...

Medicina

Dynamic Visual Tests to Identify and Quantify Visual Damage and Repair Following Demyelination in Optic Neuritis Patients

In order to follow optic neuritis patients and evaluate the effectiveness of their treatment, a handy, accurate and quantifiable tool is required to assess changes in myelination at the central nervous system (CNS). However, standard measurements, including routine visual tests and MRI scans, are not sensitive enough for this purpose. We present two visual tests addressing dynamic monocular and binocular functions which may closely associate with the extent of myelination along visual pathways. These include Object From Motion (OFM) extraction and Time-constrained stereo protocols. In the OFM test, an array of dots compose an object, by moving the dots within the image rightward while moving the dots outside the image leftward or vice versa. The dot pattern generates a camouflaged object that cannot be detected when the dots are stationary or moving as a whole. Importantly, object recognition is critically dependent on motion perception. In the Time-constrained Stereo protocol, spatially disparate images are presented for a limited length of time, challenging binocular 3-dimensional integration in time. Both tests are appropriate for clinical usage and provide a simple, yet powerful, way to identify and quantify processes of demyelination and remyelination along visual pathways. These protocols may be efficient to diagnose and follow optic neuritis and multiple sclerosis patients.
In the diagnostic process, these protocols may reveal visual deficits that cannot be identified via current standard visual measurements. Moreover, these protocols sensitively identify the basis of the currently unexplained continued visual complaints of patients following recovery of visual acuity. In the longitudinal follow up course, the protocols can be used as a sensitive marker of demyelinating and remyelinating processes along time. These protocols may therefore be used to evaluate the efficacy of current and evolving therapeutic strategies, targeting myelination of the CNS.

Object From Motion (OFM) and Time-constrained stereo protocols are sensitive tools to identify monocular and binocular dynamic visual function deficits, which are uniquely affected in optic neuritis patients. Furthermore, these tests may be used as quantitative noninvasive tools to assess the extent of myelination along visual pathways.

Testes dinâmicos visuais para identificar e quantificar danos Visual e Reparação Após desmielinização na neurite óptica Pacientes

In order to follow optic neuritis patients and evaluate the effectiveness of their treatment, a handy, accurate and quantifiable tool is required to ...

Catheterization of the Carotid Artery and Jugular Vein to Perform Hemodynamic Measures, Infusions and Blood Sampling in a Conscious Rat Model

The success of a small animal model to study critical illness is, in part, dependent on the ability of the model to simulate the human condition. Intra-tracheal inoculation of a known amount of bacteria has been successfully used to reproduce the pathogenesis of pneumonia which then develops into sepsis. Monitoring hemodynamic parameters and providing standard clinical treatment including infusion of antibiotics, fluids and drugs to maintain blood pressure is critical to simulate routine supportive care in this model but to do so requires both arterial and venous vascular access. The video details the surgical technique for implanting carotid artery and common jugular vein catheters in an anesthetized rat. Following a 72 hr recovery period, the animals will be re-anesthetized and connected to a tether and swivel setup attached to the rodent housing which connects the implanted catheters to the hemodynamic monitoring system. This setup allows free movement of the rat during the study while continuously monitoring pressures, infusing fluids and drugs (antibiotics, vasopressors) and performing blood sampling.

Vascular accesses to measure hemodynamics, provide fluids and perform blood sampling are important to any small animal model study. We present a technique for implanting catheters into the carotid artery and the common jugular vein in an anesthetized rat for connecting to a system to perform monitoring, infusions and sampling.

Cateterismo da artéria carótida e jugular para executar as medidas hemodinâmicas, infusões e Sangue de amostragem em um Rat Consciente Modelo

The success of a small animal model to study critical illness is, in part, dependent on the ability of the model to simulate the human condition. ...

Instillation and Fixation Methods Useful in Mouse Lung Cancer Research

The ability to instill live agents, cells, or chemicals directly into the lung without injuring or killing the mice is an important tool in lung cancer research. Although there are a number of methods that have been published showing how to intubate mice for pulmonary function measurements, none are without potential problems for rapid tracheal instillation in large cohorts of mice. In the present paper, a simple and quick method is described that enables an investigator to carry out such instillations in an efficient manner. The method does not require any special tools or lighting and can be learned with very little practice. It involves anesthetizing a mouse, making a small incision in the neck to visualize the trachea, and then inserting an intravenous catheter directly. The small incision is quickly closed with tissue adhesive, and the mice are allowed to recover. A skilled student or technician can do instillations at an average rate of 2 min/mouse. Once the cancer is established, there is frequently a need for quantitative histologic analysis of the lungs. Traditionally pathologists usually do not bother to standardize lung inflation during fixation, and analyses are often based on a scoring system that can be quite subjective. While this may sometime be sufficiently adequate for gross estimates of the size of a lung tumor, any proper stereological quantification of lung structure or cells requires a reproducible fixation procedure and subsequent lung volume measurement. Here we describe simple reliable procedures for both fixing the lungs under pressure and then accurately measuring the fixed lung volume. The only requirement is a laboratory balance that is accurate over a range of 1 mg&#8211;300 g. The procedures presented here thus could greatly improve the ability to create, treat, and analyze lung cancers in mice.

The goal of this paper is to describe simple methods that will greatly aid in the setup and analysis of mouse lungs with lung cancer or other pathologies. We present 3 protocols to simply and reliably carry out lung instillations, fixation, and lung volume measurements.

Instilação e fixação métodos úteis no mouse Lung Cancer Research

The ability to instill live agents, cells, or chemicals directly into the lung without injuring or killing the mice is an important tool in lung cancer ...

A Simple Mechanical Procedure to Create Limbal Stem Cell Deficiency in Mouse

Limbal stem cell deficiency (LSCD) is a state of malfunction or loss of limbal epithelial stem cells, after which the corneal epithelium is replaced with conjunctiva. Patients suffer from recurrent corneal defects, pain, inflammation, and loss of vision.
Previously, a murine model of LSCD was described and compared to two other models. The goal was to produce a consistent mouse model of LSCD that both mimics the phenotype in humans and lasts long enough to make it possible to study the disease pathophysiology and to evaluate new treatments. Here, the technique is described in more detail.
A motorized tool with a rotating burr has been designed to remove the rust rings from the corneal surface or to smooth the pterygium bed in patients. It is a suitable device to create the desired LSCD model. It is a readily available, easy-to-use tool with a fine tip that makes it appropriate for working on small eyes, as in mice. Its application prevents unnecessary trauma to the eye and it does not result in unwanted injuries, as often is the case with chemical injury models. As opposed to a blunt scraper, it removes the epithelium with the basement membrane. In this protocol, the limbal area was abraded two times, and then the whole corneal epithelium was shaved from limbus to limbus. To avoid stroma injury, care was taken not to brush the corneal surface once the epithelium was already removed.

The following article provides an easy, reproducible technique to effectively create a sustainable mouse model of limbal stem cell deficiency (LSCD). This animal model is useful in testing and comparing the efficacy of treatments for limbal stem cell diseases.

Um procedimento mecânico simples de criar Limbal Deficiência Stem Cell no mouse

Limbal stem cell deficiency (LSCD) is a state of malfunction or loss of limbal epithelial stem cells, after which the corneal epithelium is replaced with ...

A Model to Simulate Clinically Relevant Hypoxia in Humans

In case of apnea, arterial partial pressure of oxygen (pO2) decreases, while partial pressure of carbon dioxide (pCO2) increases. To avoid damage to hypoxia sensitive organs such as the brain, compensatory circulatory mechanisms help to maintain an adequate oxygen supply. This is mainly achieved by increased cerebral blood flow. Intermittent hypoxia is a commonly seen phenomenon in patients with obstructive sleep apnea. Acute airway obstruction can also result in hypoxia and hypercapnia. Until now, no adequate model has been established to simulate these dynamics in humans. Previous investigations focusing on human hypoxia used inhaled hypoxic gas mixtures. However, the resulting hypoxia was combined with hyperventilation and is therefore more representative of high altitude environments than of apnea. Furthermore, the transferability of previously performed animal experiments to humans is limited and the pathophysiological background of apnea induced physiological changes is poorly understood. In this study, healthy human apneic divers were utilized to mimic clinically relevant hypoxia and hypercapnia during apnea. Additionally, pulse-oximetry and Near Infrared Spectroscopy (NIRS) were used to evaluate changes in cerebral and peripheral oxygen saturation before, during, and after apnea.

Hypoxia simulation in humans has usually been performed by inhaling hypoxic gas mixtures. For this study, apneic divers were used to simulate dynamic hypoxia in humans. Additionally, physiological changes in desaturation and re-saturation kinetics were evaluated with non-invasive tools such as Near-Infrared-Spectroscopy (NIRS) and peripheral oxygenation saturation (SpO2).

Um modelo para simular hipóxia clinicamente relevantes em humanos

In case of apnea, arterial partial pressure of oxygen (pO2) decreases, while partial pressure of carbon dioxide (pCO2) increases. To avoid damage to ...

A Clinical Trial Assessing the Safety, Efficacy, and Delivery of Olive-Oil-Based Three-Chamber Bags for Parenteral Nutrition

Limited evidence exists to precisely estimate efficacy and safety differences between parenteral nutrition (PN) prepared using olive-oil-based three-chamber bags (3CBs) and soybean-oil-based compounded bags (CoBs) in hospitalized adult patients. We designed a multicenter, randomized, prospective, open-label, noninferiority protocol to compare the efficacy, safety, and distribution of olive-oil-based 3CBs and soybean-oil-based CoB formulations in adult Chinese patients requiring PN during surgical intervention. Subjects were randomized to receive either one of the study treatments using an interactive voice or web-based recognition system in accordance with the randomization code. Randomization was further stratified based on the study site and surgical category. Both treatment groups received similar amounts of calories and protein. In addition, the two study treatments contained a similar composition of the amino-acid component. The only difference between the two PN formulations was the lipid constitution. The duration of administration of study treatments was a minimum of 5 days up to a maximum of 14 days after the surgical procedure. The primary efficacy endpoint was serum prealbumin levels on day 5 of the study. Noninferiority was proved if the anti-log of the lower bound of the 95% confidence interval (CI) of the treatment difference was at least 0.80. Other efficacy measures included treatment preparation time; duration to achieve tolerability of oral nutrition; associated infectious complications; length of hospitalization; and laboratory assessment of markers of nutrition, inflammation, metabolism, and oxidative stress. A total of 458 patients were enrolled in the study. The results showed that olive-oil-based 3CBs were non-inferior to soybean-based CoBs, besides being well tolerated. The infection rate was found to be significantly lower in the olive-oil-based 3CB group. Thus, this study may be used as a reference for future research on lipid emulsion and 3CBs.

Here, we present a protocol for a study comparing the efficacy, safety, and delivery of olive-oil-based 3CB and soybean-oil-based CoB formulations in adults requiring parenteral nutrition. The results revealed that olive-oil-based 3CBs is non-inferior and well tolerated compared to soybean formulations.

Um ensaio clínico avaliando a segurança, eficácia e entrega de sacos de três câmaras à base de azeite para nutrição parenteral

Limited evidence exists to precisely estimate efficacy and safety differences between parenteral nutrition (PN) prepared using olive-oil-based ...

Observational Study Protocol for Repeated Clinical Examination and Critical Care Ultrasonography Within the Simple Intensive Care Studies

Longitudinal evaluations of critically ill patients by combinations of clinical examination, biochemical analysis and critical care ultrasonography (CCUS) may detect adverse events of interventions such as fluid overload at an early stage. The Simple Intensive Care Studies (SICS) is a research line that focuses on the prognostic and diagnostic value of combinations of clinical variables.
The SICS-I specifically focused on the use of clinical variables obtained within 24 h of acute admission for prediction of cardiac output (CO) and mortality. Its sequel, SICS-II, focuses on repeated evaluations during ICU admission. The first clinical examination by trained researchers is performed within 3 h after admission consisting of physical examination and educated guessing. The second clinical examination is performed within 24 h after admission and includes physical examination and educated guessing, biochemical analysis and CCUS assessments of heart, lungs, inferior vena cava (IVC) and kidney. This evaluation is repeated at days 3 and 5 after admission. CCUS images are validated by an independent expert, and all data is registered in an online secured database. Follow-up at 90 days includes registration of complications and survival status according to patient&#39;s medical charts and the municipal person registry. The primary focus of SICS-II is the association between venous congestion and organ dysfunction.
The purpose of publishing this protocol is to provide details on the structure and methods of this on-going prospective observational cohort study allowing answering multiple research questions. The design of the data collection of combined clinical examination and CCUS assessments in critically ill patients are explicated. The SICS-II is open for other centers to participate and is open for other research questions that can be answered with our data.

<meta charset="utf8"></head><body>Protocolo de Estudo Observacional para Exame Clínico Repetido e Ultrassonografia de Cuidados Intensivos nos Estudos de Terapia Intensiva Simples

Structured protocols are necessary to provide answers on research questions in critically ill patients. The Simple Intensive Care Studies (SICS) provides an infrastructure for repeated measurements in critically ill patients including clinical examination, biochemical analysis and ultrasonography. SICS projects have specific focus but the structure is flexible to other investigations.

Protocolo de Estudo Observacional para Exame Clínico Repetido e Ultrassonografia de Cuidados Intensivos nos Estudos de Terapia Intensiva Simples

Longitudinal evaluations of critically ill patients by combinations of clinical examination, biochemical analysis and critical care ultrasonography (CCUS) ...

Clinical Practice Protocol of Creative Music Therapy for Preterm Infants and Their Parents in the Neonatal Intensive Care Unit

Creative music therapy for preterm infants and their parents (CMT) has emerged as a promising family-integrated early intervention involving communicative musicality to improve infant development, parental well-being, and bonding. It aims at relaxing and nurturing the infant as well as promoting safety and social interaction for the parent-infant dyad. A music therapist specially trained in CMT hums or sings in an infant-directed, improvised, lullaby style continually adjusting to the individual needs, expressions, and breathing pattern of the preterm infant. Based on the principles of family-integrated care, the family is incorporated individually in the therapeutic process, namely by delivering CMT during kangaroo care (KC) and by motivating and facilitating parental vocal interaction with their infant to strengthen the parent-infant bonding. CMT aims at relaxing, stimulating, and coregulating premature infants at a time when many other interventions are still risky and can overwhelm the vulnerable patient group. CMT may be advantageous not by educating and teaching parents, but rather by uncovering the intuitive capacities of parenting that are often overshadowed by the traumatic experience of preterm birth. However, CMT can only be provided when the infants are clinically stable. CMT with parental integration is feasible when parents are available and receptive to participate. This paper presents a detailed protocol on how to use CMT to empower preterm infants and their families.

Creative music therapy for preterm infants and their parents has emerged as a promising family-integrated early intervention. We present a detailed protocol on how to use vocal interaction, humming, or singing to empower preterm infants and their families.

Protocolo de Prática Clínica de Musicoterapia Criativa para Bebês Prematuros e seus pais na Unidade de Terapia Intensiva Neonatal

Creative music therapy for preterm infants and their parents (CMT) has emerged as a promising family-integrated early intervention involving communicative ...