Early progressive mobilization is a safe strategy in the intensive care unit (ICU), however, it is still considered challenging by the inherent barriers and poor adherence to early mobilization protocol. The aim of this study was to evaluate the effectiveness of a quality improvement (QI) multifaceted strategy with implementation of a specific visual tool, the “mobility clock”, in reducing non-compliance with the institutional early mobilization (EM) protocol in adult ICUs. A single-center QI with a retrospective before-after comparison study was conducted using data from medical records and hospital electronic databases. Patients from different periods presented similar baseline characteristics. After the QI strategy, a decline in “non-compliance” with the protocol was observed compared to the previous period (10.11% vs. 26.97%, p < 0.004). The proportion of patients walking was significantly higher (49.44% vs. 29.21%, p < 0.006) and the ICU readmission rate was lower in the “after” period (2.25% vs. 11.24%; p = 0.017). The multifaceted strategy specifically designed considering institutional barriers was effective to increase out of bed mobilization, to reduce the “non-compliance” rate with the protocol and to achieve a higher level of mobility in adult ICUs of a tertiary hospital.
| Introduction: Systemic ArterialHypertension is one of the main causes for the development of cardiovascular diseases, and blood pressure control is the best alternative for its prevention. Objective: To evaluate the prevalence of uncontrolled arterial hypertension and its associated factors in patients from primary health care units. Methods: A cross-sectional study with hypertensive individuals from Health Units of the Cabula-Beirú Health District in the city of Salvador, Bahia, from March to July 2013. Bivariate and multivariate analyses using Odds Ratio (OR) were performed. The magnitude of the association between the variables and uncontrolled hypertension was estimated by the calculation of the odds ratio (95% CI) and logistic regression. The data were analised by the software Stata and the project was approved by the Ethics Committee in Research of the State University of Bahia. Results: Were included 297 hypertensive patients aged 18-87 years. Of these, 159 (53.5%) had uncontrolled hypertension. Low education level (OR=1,71; CI95%: 1,02 -2,86) and family income (OR=4,09; CI95%: 1,03 -15,21), black or brown skin color (OR=2,64; CI95%:0,97 -6,32) and obesity (OR=2,37; CI95%: 1,09 -5,17) were associated with poor blood pressure control. The presence of concomitant diabetes (OR=0,56; CI95%: 0,34 -0,95) was a protective factor. Conclusion: The results suggest a high prevalence of uncontrolled hypertension and its association with social factors, life habits and concomitant pathologies. The knowledge of these characteristics may provide more specific planning of health promotion and prevention actions for these subgroups in Primary Health Care.
BackgroundRepetitive peripheral nerve sensory stimulation (RPSS) is a potential add-on intervention to motor training for rehabilitation of upper limb paresis after stroke. Benefits of RPSS were reported in subjects in the chronic phase after stroke, but there is limited information about the effects of this intervention within the 1st weeks or months. The primary goal of this study is to compare, in a head-to-head proof-of-principle study, the impact of a single session of suprasensory vs. subsensory RPSS on the upper limb motor performance and learning in subjects at different phases after stroke subacute and chronic phases and mild upper limb motor impairments after stroke. In addition, we examine the effects of RPSS on brain perfusion, functional imaging activation, and γ-aminobutyric acid (GABA) levels. Subjects with mild upper limb motor impairments will be tested with MRI and clinical assessment either at an early (7 days to 3 months post-stroke) or at a chronic (>6 months) stage after stroke.MethodsIn this multicenter, randomized, parallel-group, proof-of-principle clinical trial with blinded assessment of outcomes, we compare the effects of one session of suprasensory or subsensory RPSS in patients with ischemic or hemorrhagic stroke and upper limb paresis. Clinical assessment and MRI will be performed only once in each subject (either at an early or at a chronic stage). The primary outcome is the change in performance in the Jebsen–Taylor test. Secondary outcomes: hand strength, cerebral blood flow assessed with arterial spin labeling, changes in the blood oxygenation level-dependent (BOLD) effect in ipsilesional and contralesional primary motor cortex (M1) on the left and the right hemispheres assessed with functional MRI (fMRI) during a finger-tapping task performed with the paretic hand, and changes in GABA levels in ipsilesional and contralesional M1 evaluated with spectroscopy. The changes in outcomes will be compared in four groups: suprasensory, early; subsensory, early; suprasensory, chronic; and subsensory, chronic.DiscussionThe results of this study are relevant to inform future clinical trials to tailor RPSS to patients more likely to benefit from this intervention.Trial RegistrationNCT03956407.
Background The ABCDE bundle in critical care is recommended to reduce long-term consequences of intensive care unit (ICU) and to promote better outcomes for the patients. Early progressive mobilization, represented as letter “E”, despite of had been proposed as a safe strategy in intensive care unit, it is still considered challenging by the inherent ICU barriers and poor adherence to early mobilization protocol. Recently, the letter “F” was incorporated into the bundle, representing the patient’s family participation, which can optimize care and patient’s recovery. The aim of this study was to evaluate the effectiveness to improve the adherence to the early mobilization protocol after a quality improvement multifaceted strategy which resulted in the development of a specific visual tool, the “mobility clock”, in order to involve in the process beyond the healthcare professionals the patients, and family members. Methods A single-center before-after study was conducted using data from medical records or hospital electronic databases. A sample size of 88 patients per period was calculated to verify a reduction by 10% on the non-compliance rate with the institutional early mobilization protocol. Results Patients from different periods presented similar baseline characteristics. After the intervention, a decline in non-compliance with the protocol was observed compared to the previous period (10.11% vs. 26.97%, p < 0.004). Regarding mobility landmarks, the proportion of patients walking was significantly higher in the “after” period (49.44% vs. 29.21%, p < 0.006). The ICU readmission rate was lower on the “after” period (2.25% vs. 11.24%; p = 0.017). Conclusions The multifaceted strategy specifically designed to the institutional barriers was effective in increasing adherence to early mobilization protocol causing an increasing in the out of bed mobilization rate in the adult ICU of a tertiary hospital.
INTRODUÇAO: Os fatores de risco cardiovascular existentes durante a infância e adolescência tendem a se manter e influenciar a condição de saúde na vida adulta, portanto, as doenças cardiovasculares tratam-se igualmente de um problema de cunho infanto-juvenil. OBJETIVO: Estimar a prevalência de pré-hipertensão, hipertensão arterial e demais fatores de risco cardiovascular em escolares da rede pública. MÉTODOS: Foi realizado um estudo transversal com adolescentes de 14 a 19 anos regularmente matriculados em escolas públicas na cidade do Salvador, Bahia, entre agosto de 2014 a maio de 2015. Foram coletados dados antropométricos, clínicos, relativos a hábitos de vida e fatores de risco. Análises bivariadas e multivariadas utilizando a regressão logística foram utilizadas. A magnitude da associação entre estas e a pressão arterial elevada foi estimada pelo cálculo do Odds Ratio e IC95%%. Utilizou-se o Stata (V. 12.0) e o projeto foi aprovado pelo CEP/UNEB. RESULTADOS: Foram incluídos 160 escolares, dentre estes, 24,4% apresentavam níveis tensionais elevados. Idade entre 14 a 15 anos (OR 0,32; IC95% = 0,13 – 0,75), Acanthosis Nigricans (AN) (OR= 4,5; IC95% = 1,01 – 19,8) e atividades sedentárias inferiores a 2 horas diárias (OR = 0,35; IC95% = 0,14 – 0,84) se mostraram associados com PA elevada. CONCLUSÕES: Os resultados apontam elevada prevalência de valores alterados de PA, que a presença de AN se configura como importante fator de risco, que idade mais jovem e tempo menor que 2 horas de inatividade física representam fatores de proteção. Espera-se contribuir para um rastreamento mais efetivo dos fatores de risco cardiovascular em adolescentes.INTRODUCTION: Cardiovascular risk factors that exist during childhood and adolescence tend to maintain and influence health condition in adulthood, therefore, cardiovascular diseases are also an infant juvenile issue. OBJECTIVE: To estimate the prevalence of prehypertension, hypertension and others cardiovascular risk factors in students from public schools. METHODS: A cross-sectional study of adolescents aged 14 to 19 years regularly attending public schools was conducted in the city of Salvador, Bahia, from august 2014 to may 2015. Anthropometric, clinical, related to life habits and risk factors data were collected. Bivariate and multivariate analyses using logistic regression were used. The magnitude of the association between them and high blood pressure was estimated by calculating the Odds Ratio and IC95%. Stata (V. 12.0) was used and the project was approved by the CEP / UNEB. RESULTS: 160 students were included, among these, 24.4 % had high blood pressure (BP) levels. Aged 14-15 years (OR 0.32 , 95% CI 0.13 to 0.75), Acanthosis Nigricans (AN) ( OR = 4.5 , 95% CI 1.01 to 19.8 ) and sedentary activities less than 2 hours per day (OR = 0.35 , 95% CI 0.14 to 0.84 ) were associated with high BP. CONCLUSIONS: The results indicate high prevalence of altered values of BP, that the presence of AN is configured as an important risk factor, that younger age and less than two hours of physical inactivity represent protective factors. It is expected to contribute to a more effective screening of risk factors in adolescents.
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