The effectiveness of goal-directed care to reduce loss of brain-dead potential donors to cardiac arrest is unclear.
To evaluate the effectiveness of an evidence-based, goal-directed checklist in the ...clinical management of brain-dead potential donors in the intensive care unit (ICU).
The Donation Network to Optimize Organ Recovery Study (DONORS) was an open-label, parallel-group cluster randomized clinical trial in Brazil. Enrollment and follow-up were conducted from June 20, 2017, to November 30, 2019. Hospital ICUs that reported 10 or more brain deaths in the previous 2 years were included. Consecutive brain-dead potential donors in the ICU aged 14 to 90 years with a condition consistent with brain death after the first clinical examination were enrolled. Participants were randomized to either the intervention group or the control group. The intention-to-treat data analysis was conducted from June 15 to August 30, 2020.
Hospital staff in the intervention group were instructed to administer to brain-dead potential donors in the intervention group an evidence-based checklist with 13 clinical goals and 14 corresponding actions to guide care, every 6 hours, from study enrollment to organ retrieval. The control group provided or received usual care.
The primary outcome was loss of brain-dead potential donors to cardiac arrest at the individual level. A prespecified sensitivity analysis assessed the effect of adherence to the checklist in the intervention group.
Among the 1771 brain-dead potential donors screened in 63 hospitals, 1535 were included. These patients included 673 males (59.2%) and had a median (IQR) age of 51 (36.3-62.0) years. The main cause of brain injury was stroke (877 57.1%), followed by trauma (485 31.6%). Of the 63 hospitals, 31 (49.2%) were assigned to the intervention group (743 48.4% brain-dead potential donors) and 32 (50.8%) to the control group (792 51.6% brain-dead potential donors). Seventy potential donors (9.4%) at intervention hospitals and 117 (14.8%) at control hospitals met the primary outcome (risk ratio RR, 0.70; 95% CI, 0.46-1.08; P = .11). The primary outcome rate was lower in those with adherence higher than 79.0% than in the control group (5.3% vs 14.8%; RR, 0.41; 95% CI, 0.22-0.78; P = .006).
This cluster randomized clinical trial was inconclusive in determining whether the overall use of an evidence-based, goal-directed checklist reduced brain-dead potential donor loss to cardiac arrest. The findings suggest that use of such a checklist has limited effectiveness without adherence to the actions recommended in this checklist.
ClinicalTrials.gov Identifier: NCT03179020.
O Projeto Nutrition UP 65 tem como objetivo a redução de desigualdades nutricionais nas pessoas idosas em Portugal, através da melhoria do conhecimento do seu estado nutricional e da capacitação de ...profissionais de saúde para lidar com o estado nutricional de pessoas idosas. Para atingir esse objetivo, foi realizado um estudo de âmbito nacional com uma amostra de 1500 pessoas com ≥ 65 anos, representativa da estrutura da população idosa portuguesa quanto ao sexo, idade, região geográfica e nível educacional. Os resultados do estudo permitiram a identificação das necessidades educativas dos profissionais de saúde, pessoas idosas, cuidadores e outros agentes sociais. Foi organizada uma rede de voluntários entre estudantes e alumni da Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, com o objetivo de ministrar formação em alimentação saudável e preparação de alimentos a pessoas idosas, cuidadores e preparadores de alimentos. Entre janeiro de 2016 e abril de 2017, inscreveram-se 56 voluntários, realizaram-se 48 sessões a 1654 pessoas idosas e a 257 cuidadores e preparadores de alimentos em 44 instituições. Distribuíram-se cerca de 3500 materiais a diversos públicos-alvo. A avaliação dos resultados da rede foi efetuada qualitativamente através da análise dos relatórios dos voluntários. A maioria (63%) reportou dificuldades de aceitação das formações por parte das instituições contactadas e, por outro lado, 88% referiram como aspeto mais positivo a interação com as pessoas idosas. A análise da motivação dos voluntários através dos formulários de inscrição revelou que a maior parte tinha uma motivação profissional (65,4%) e que a motivação pessoal estava inversamente relacionada com o número de sessões conduzidas (p<0,05). Os resultados sugerem que esta iniciativa poderá ser facilmente replicável e exequível para intervenções comunitárias a curto prazo.
The aim of this study was to evaluate the short- and long-term treatment effects of rapid maxillary expansion (RME) on the soft tissue facial profile of subjects treated with a modified acrylic-hyrax ...device. The sample comprised 10 males and 10 females in the mixed dentition. Their average age was 9.3 years ± 10 months pre-treatment (T1), with a narrow maxilla and posterior crossbite, treated with a modified fixed maxillary expander with an occlusal splint. Lateral cephalometric radiographs obtained at T1, immediately post-expansion (T2), and after retention (T3) were used to determine possible changes in the soft tissue facial profile. The means and standard deviations for linear and angular cephalometric measurements were analysed statistically using analysis of variance and Tukey's test (α = 0.05). The measurements at T2 differed significantly from those at T1 and T3. However, RME did not produce any statistically significant alteration (P > 0.05) in the soft tissue profile for any of the cephalometric landmarks evaluated when compared at T1 and T3. The use of a fixed expander associated with an occlusal splint did not cause significant alterations in the soft tissue facial profile at T3. This modified device is effective for preventing the adverse vertical effects of RME such as an increase anterior face height in patients with a crossbite.
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