Incontinência urinária: prevalência, classificação e manejo na população adulta

O presente artigo buscou analisar os dados epidemiológicos acerca da Incontinência Urinária na população adulta, abordando sobre os diferentes tipos e classificações, bem como a propedêutica de diagnóstico e tratamento a depender da situação clínica do paciente. Prevalente de forma global, especialmente em idosos e mulheres na pós-menopausa, sua incidência cresce devido ao envelhecimento, obesidade e, principalmente, mediada pela conscientização sobre o tema nos últimos anos, mostrando a gama de condições que podem cursar com essa manifestação clínica. Os quatro principais subtipos incluem incontinência de esforço, de urgência, mista e por transbordamento, cada um com causas e sintomas específicos. Diagnóstico precoce é crucial para prevenir danos renais e preservar a qualidade de vida. Exames como Estudo Urodinâmico são essenciais para o manejo clínico. O tratamento envolve farmacoterapia com onabotulinumtoxina e duloxetina, vitamina D, intervenções cirúrgicas como slings perineais, esfíncter urinário artificial, e medidas comportamentais como micção estimulada e treinamento de hábitos urinários. Equipes de enfermagem desempenham papel vital no manejo hospitalar, enquanto a fisioterapia, incluindo cinesioterapia, é crucial na reabilitação. Essa abordagem holística visa melhorar a qualidade de vida e reduzir o impacto negativo da incontinência urinária na saúde e bem-estar dos pacientes

Impacto do uso excessivo de multitelas no comportamento e saúde mental de crianças e adolescentes

O presente artigo buscou analisar a literatura científica acerca do uso excessivo de multitelas por crianças e adolescentes, relacionando tal contexto com o aparecimento de transtornos psíquicos e comportamentais nessa parcela social. Com os avanços tecnológicos das últimas décadas, houve a ampliação do acesso aos meios midiáticos pela população infantil. O desenvolvimento neurocognitivo desse grupo pode ser prejudicado pelo uso desenfreado de dispositivos eletrônicos. Foi observada a vinculação da exposição precoce às mídias com o aparecimento de sintomas depressivos, desequilíbrio emocional, assim como o aumento de transtornos de ansiedade em crianças e adolescentes. O uso excessivo de telas evidencia o aumento da dificuldade de relacionamentos interpessoais, fato esse agravante para problemas psíquicos. Estudos também comprovam associação significativa do uso de multitelas com sintomas de Transtorno do Déficit de Atenção e Hiperatividade (TDAH). A mediação parental para controle do acesso dos menores, em consonância aos incentivos às interações sociais e brincadeiras ativas, se mostrou eficaz na diminuição de distúrbios na população infantil

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.13Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt