Neuromuscular electrical stimulation improves exercise tolerance in chronic obstructive pulmonary disease patients with better preserved fat-free mass

BACKGROUND: High-frequency neuromuscular electrical stimulation increases exercise tolerance in patients with advanced chronic obstructive pulmonary disease (COPD patients). However, it is conceivable that its benefits are more prominent in patients with better-preserved peripheral muscle function and structure. OBJECTIVE: To investigate the effects of high-frequency neuromuscular electrical stimulation in COPD patients with better-preserved peripheral muscle function. Design: Prospective and cross-over study. METHODS: Thirty COPD patients were randomly assigned to either home-based, high-frequency neuromuscular electrical stimulation or sham stimulation for six weeks. The training intensity was adjusted according to each subject's tolerance. Fat-free mass, isometric strength, six-minute walking distance and time to exercise intolerance (Tlim) were assessed. RESULTS: Thirteen (46.4%) patients responded to high-frequency neuromuscular electrical stimulation; that is, they had a post/pre &#916; Tlim >10% after stimulation (unimproved after sham stimulation). Responders had a higher baseline fat-free mass and six-minute walking distance than their seventeen (53.6%) non-responding counterparts. Responders trained at higher stimulation intensities; their mean amplitude of stimulation during training was significantly related to their fat-free mass (r = 0.65; p<0.01). Logistic regression revealed that fat-free mass was the single independent predictor of Tlim improvement (odds ratio [95% CI] = 1.15 [1.04-1.26]; p<0.05). CONCLUSIONS: We conclude that high-frequency neuromuscular electrical stimulation improved the exercise capacity of COPD patients with better-preserved fat-free mass because they tolerated higher training stimulus levels. These data suggest that early training with high-frequency neuromuscular electrical stimulation before tissue wasting begins might enhance exercise tolerance in patients with less advanced COPD

Estudio retrospectivo de errores de inmunización reportados en un Sistema de Información en línea

Objetivo: analizar los errores de inmunización reportados en un Sistema de Información en línea. Método: estudio retrospectivo realizado con datos del Sistema de Información de Vigilancia de Eventos Adversos Posteriores a la Vacunación. Los errores de inmunización se analizaron con respecto a las características demográficas y el proceso de vacunación. Se calcularon las frecuencias y las tasas de incidencia de errores. Se utilizaron pruebas binomiales y de chi-cuadrado para verificar las diferencias en las proporciones de las variables. Resultados: se analizaron 501 errores, la mayoría con dosis de rutina (92,6%), sin evento adverso posterior a la vacunación (90,6%) y en niños menores de cinco años (55,7%). Los tipos de errores más frecuentes fueron la insuficiencia en la indicación del inmunobiológico (26,9%), el intervalo inadecuado entre las dosis (18,2%) y el error en la técnica de administración (14,2%). La tasa de incidencia de error global fue de 4,05/100.000 dosis aplicadas; las mayores incidencias de las vacunas de rutina fueron para la vacuna contra la rabia humana, el virus del papiloma humano y el triple viral; La tasa de incidencia de errores con los eventos adversos posteriores a la vacunación fue de 0,45/100.000 dosis aplicadas. Conclusión: se encontró que los errores de inmunización son una realidad que deben enfrentar los sistemas de salud, pero se pueden prevenir mediante intervenciones como la adopción de protocolos, checklists y educación permanente en salud.Objetivo: analisar os erros de imunização notificados em um Sistema de Informação on-line. Método: estudo retrospectivo realizado com dados do Sistema de Informação da Vigilância de Eventos Adversos Pós-Vacinação. Os erros de imunização foram analisados com relação às características demográficas e ao processo de vacinação. Foram calculadas frequências e taxas de incidência dos erros. Os testes binomial e qui-quadrado foram utilizados para verificar diferenças nas proporções das variáveis. Resultados: foram analisados 501 erros, a maioria envolvendo doses de rotina (92,6%), sem Evento Adverso Pós-Vacinação (90,6%) e em crianças menores de cinco anos (55,7%). Os tipos de erros mais frequentes foram inadequação na indicação do imunobiológico (26,9%), intervalo inadequado entre doses (18,2%) e erro na técnica de administração (14,2%). A taxa de incidência global de erros foi de 4,05/100.000 doses aplicadas; as maiores incidências das vacinas de rotina foram para vacina antirrábica humana, papiloma vírus humano e tríplice viral; a taxa de incidência de erros com Eventos Adversos Pós-Vacinação foi de 0,45/100.000 doses aplicadas. Conclusão: verificou-se que erros de imunização são uma realidade a ser enfrentada pelos sistemas de saúde, porém são passíveis de prevenção por meio de intervenções como adoção de protocolos, checklists e educação permanente em saúde.Objective: to analyze the immunization errors reported in an online Information System. Method: retrospective study conducted with data from the Adverse Event Following Immunization Surveillance Information System. Immunization errors were analyzed with respect to demographic characteristics and the vaccination process. Frequencies and error incidence rates have been calculated. Binomial and chi-square tests were used to verify differences in the proportions of the variables. Results: 501 errors were analyzed, the majority involving routine doses (92.6%), without Adverse Event Following Immunization (90.6%) and in children under five years old (55.7%). The most frequent types of errors were inadequacy in the indication of the immunobiological (26.9%), inadequate interval between doses (18.2%) and error in the administration technique (14.2%). The overall error incidence rate was 4.05/100,000 doses applied; the highest incidences of routine vaccines were for human rabies vaccine, human papillomavirus and triple viral; the incidence rate of errors with Adverse Events Following Immunization was 0.45/100,000 doses applied. Conclusion: it was found that immunization errors are a reality to be faced by the health systems, but they are amenable to prevention through interventions such as the adoption of protocols, checklists and permanent education in health

Administração de medicamentos, em vias diferentes das prescritas, relacionada à prescrição médica

This study analyzes the influence of medical prescriptions' writing on the occurrence of medication errors in the medical wards of five Brazilian hospitals. This descriptive study used data obtained from a multicenter study conducted in 2005. The population was composed of 1,425 medication errors and the sample included 92 routes through which medication was wrongly administered. The pharmacological classes most frequently involved in errors were cardiovascular agents (31.5%), medication that acts on the nervous system (23.9%), and on the digestive system and metabolism (13.0%). In relation to the prescription items that may have contributed to such errors, we verified that 91.3% of prescriptions contained acronyms and abbreviations; patient information was missing in 22.8%, and 4.3% did not include the date and were effaced. Medication wrong-route administrations are common in Brazilian hospitals and around the world. It is well established that these situations may result in severe adverse events for patients, including death.El objetivo fue analizar la influencia de la redacción de la prescripción médica en los errores de vía de administración ocurridos en la enfermería de clínica médica de cinco hospitales brasileños. Se trata de un estudio descriptivo que utilizó datos de investigación multicéntrica realizada en 2005. La población fue compuesta por 1.425 errores de medicación y la muestra por 92 errores de vía. Las clases farmacológicas más envueltas en el error fueron: 1) las cardiovasculares (31,5%), 2) las drogas que actúan en el sistema nervioso (23,9%), y 3) las que actúan en el sistema digestivo y metabolismo (13,0%). En lo que se refiere a los ítems de la prescripción médica que podrían haber contribuido con los errores de vía, se verificó que 91,3% de las prescripciones contenían siglas/abreviaturas; 22,8% no contenían datos del paciente, y 4,3% no presentaban fecha y contenían raspados. Errores de vía son frecuentes en los hospitales brasileños y alrededor del mundo y se sabe que estas situaciones pueden resultar en eventos adversos severos en los pacientes, incluyendo la muerte.O objetivo foi analisar a influência da redação da prescrição médica nos erros de via de administração, ocorridos em enfermaria de clínica médica de cinco hospitais brasileiros. Estudo descritivo que utilizou dados de pesquisa multicêntrica, realizada em 2005. A população foi composta por 1.425 erros de medicação e a amostra por 92 erros de via. As classes farmacológicas mais envolvidas no erro foram as cardiovasculares (31,5%), drogas que atuam no sistema nervoso (23,9%) e no sistema digestório e metabolismo (13,0%). No que diz respeito aos itens da prescrição médica, que poderiam ter contribuído com os erros de via, verificou-se que 91,3% das prescrições continham siglas/abreviaturas, 22,8% não continham dados do paciente e 4,3% não apresentavam data e continham rasuras. Erros de via são frequentes nos hospitais brasileiros e ao redor do mundo, e se sabe que essas situações podem resultar em eventos adversos severos aos pacientes, incluindo morte

Perfil de medicamentos envueltos en errores de administración: conocer para prevenir

OBJECTIVES: To describe the pharmacological characteristics of medicines involved in administration errors and determine the frequency of errors with potentially dangerous medicines and low therapeutic index, in clinical units of five teaching hospitals, in Brazil. METHODS: Multicentric study, descriptive and exploratory, using the non-participant observation technique (during the administration of 4958 doses of medicines) and the anatomical therapeutic chemical classification (ATC). RESULTS: Of that total, 1500 administration errors were identified (30.3%). The administration of pharmacological groups - ATC (cardiovascular system, nervous system, alimentary tract and metabolism system and anti-infectives for systemic use) showed a higher frequency of errors. In 13.0% of errors were involved potentially dangerous medicines and in 12.2% medicines with low therapeutic index. CONCLUSION: The knowledge of the pharmacological profile could be an important strategy to be used in the prevention medication errors in health institutions.OBJETIVOS: Descrever as características farmacológicas dos medicamentos envolvidos em erros de administração e determinar a frequência desses erros com medicamentos potencialmente perigosos e de baixo índice terapêutico em unidades de clínica médica de cinco hospitais de ensino brasileiros. MÉTODOS: Estudo multicêntrico, descritivo/exploratório utilizando a técnica de observação não participante durante a administração de 4958 doses de medicamentos e a classificação anatômica terapêutica química (ATC). RESULTADOS: Dentre esse total, foram identificados 1500 erros de administração de medicamentos (30,3%). A administração dos fármacos dos grupos ATC - sistema cardiovascular, sistema nervoso, trato alimentar e metabolismo e antinfecciosos de uso sistêmico apresentou maior frequência de erros. Em 13,0% dos erros estavam envolvidos medicamentos potencialmente perigosos e em 12,2% medicamentos de baixo índice terapêutico. CONCLUSÃO: O conhecimento do perfil farmacológico pode ser uma importante estratégia a ser utilizada na prevenção de erros de medicação em instituições de saúde.OBJETIVOS: Describir las características farmacológicas de los medicamentos envueltos en errores de administración y determinar la frecuencia de esos errores en medicamentos potencialmente peligrosos y en los de bajo índice terapéutico, en unidades de clínica médica de cinco hospitales de enseñanza brasileños. MÉTODOS: Estudio multicéntrico, descriptivo-exploratorio utilizando la técnica de observación no participante (durante la administración de 4.958 dosis de medicamentos) y la clasificación anatómica terapéutica química (ATC). RESULTADOS: Fueron identificados 1500 errores de administración de medicamentos (30,3%). La administración de los fármacos de los grupos ATC (sistema cardiovascular, sistema nervioso, sistema digestivo y metabolismo, y, anti-infecciosos) de uso sistémico presentó mayor frecuencia de errores. En 13,0% de los errores estaban envueltos medicamentos potencialmente peligrosos y en 12,2% medicamentos de bajo índice terapéutico. CONCLUSIÓN: El conocimiento del perfil farmacológico puede ser una importante estrategia para prevenir los errores de medicación en las instituciones de salud.FAPESPCNPqCoordenacao de Aperfeicoamento de Pessoal de Nivel Superior (CAPES

Skeletal muscle structure and function in response to electrical stimulation in moderately impaired COPD patients

Study objective: To determine the structural and functional consequences of high-frequency neuromuscular electrical stimulation (hf-NMES) in a group of moderately impaired outpatients with chronic obstructive pulmonary disease (COPD).Design: A prospective, cross-over randomized trial.Setting: An university-based, tertiary center.Patients and materials: Seventeen patients (FEV1 = 49.6 +/- 13.4% predicted, Medical Research Council dyspnoea grades II-III) underwent 6-weeks hf-NMES (50 Hz) and sham stimulation of the quadriceps femoris in a randomized, cross-over design. Knee strength was measured by isokinetic dynamometry (peak torque) and leg muscle mass (LMM) by DEXA; in addition, median cross-sectional area (CSA) of type I and fibres and capillary-fibre ratio were evaluated in the vastus lateralis. the 6-min walking distance (6MWD) was also determined.Universidade Federal de São Paulo, UNIFESP, Pulm Funct & Clin Exercise Physiol Unit, SEFIC,Div Resp Dis,Dept Med, São Paulo, BrazilUniversidade Federal de São Paulo, UNIFESP, Neuromusc Div, São Paulo, BrazilUniv Glasgow, Inst Biomed & Life Sci, Glasgow, Lanark, ScotlandUniversidade Federal de São Paulo, UNIFESP, Pulm Funct & Clin Exercise Physiol Unit, SEFIC,Div Resp Dis,Dept Med, São Paulo, BrazilUniversidade Federal de São Paulo, UNIFESP, Neuromusc Div, São Paulo, BrazilWeb of Scienc

Effects of Inspiratory Muscle Training on Lung Volumes, Respiratory Muscle Strength, and Quality of Life in Patients With Ataxia Telangiectasia

BackgroundAtaxia telangiectasia (AT) is a genetic syndrome caused by a mutation of chromosome 11. the clinical features are cerebellar ataxia, telangiectasia, and progressive loss of muscular coordination, including an inefficient cough secondary to progression of neurological disease.ObjectiveTo evaluate the effects of inspiratory muscle training (IMT) on ventilation, lung volume, dyspnoea, respiratory muscle strength, and quality of life in patients with AT.MethodsA longitudinal study was conducted with 11 AT patients and nine healthy volunteers. Ventilometry, subjective sensation of dyspnoea, maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), and quality of life were assessed before and after a 24-week IMT program. the IMT load used was set at 60% of the MIP, and the training was performed for 20min daily.ResultsPatients with AT had lower height and weight and also had lower respiratory muscle strength and lung volume compared with healthy volunteers. Furthermore, patients with AT showed a significant improvement when pre- and post-IMT were compared for ventilatory pattern: Vt (476.5135ml vs. 583.3 +/- 66ml, P=0.015) and f (23.3 +/- 6rpm vs. 20.4 +/- 4rpm, P=0.018), and VC (1,664 +/- 463ml/kg vs. 2,145 +/- 750ml/kg, P=0.002). IMT also significantly improved the sensation of dyspnoea (median 0.5; minimum 0; maximum 1.0; P=0.022) and respiratory muscle strength: MIP (-22.2 +/- 2cmH(2)O vs. -38 +/- 9cmH(2)O, P<0.001) and MEP (29 +/- 7cmH(2)O vs. 40 +/- 8cmH(2)O, P=0.001). the health and vitality domains of the SF-36 also showed significant improvement (P=0.009 and P=0.014, respectively) post-IMT.ConclusionIMT was effective in improving ventilatory pattern, lung volume, respiratory muscle strength, and the health and vitality domains for quality of life in patients with AT. IMT may be an effective adjunct therapy to drug treatment for patients with AT. Pediatr Pulmonol. 2014; 49:238-244. (c) 2013 Wiley Periodicals, Inc.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Fed Univ São Paulo UNIFESP, Sch Med, Dept Pediat, São Paulo, BrazilFed Univ São Paulo UNIFESP, Dept Med, Div Resp Dis, Pulm Funct & Clin Exercise Physiol Unit, São Paulo, BrazilFed Univ São Paulo UNIFESP, Sch Med, Dept Pediat, São Paulo, BrazilFed Univ São Paulo UNIFESP, Dept Med, Div Resp Dis, Pulm Funct & Clin Exercise Physiol Unit, São Paulo, BrazilWeb of Scienc