Electronic swallowing intervention package to support swallowing function in patients with head and neck cancer: development and feasibility study

Background: Many patients undergoing treatment for head and neck cancer (HNC) experience significant swallowing difficulties, and there is some evidence that swallowing exercises may improve outcomes, including quality of life. This feasibility study developed an evidence-based, practical Swallowing Intervention Package (SiP) for patients undergoing chemo-radiotherapy (CRT) for HNC. As part of the study, an electronic version of SiP (e-SiP) was concurrently developed to support patients to self-manage during treatment. This paper reports on the e-SiP component of this work. Objective: To develop and conduct preliminary evaluation of an electronic support system (e-SiP) for patients undergoing CRT for head and neck cancer. Methods: The study involved health professionals and patients who were undergoing CRT for head and neck cancer. The scoping stage of e-SiP development involved investigated the potential usefulness of e-SiP, exploring how e-SiP would look and feel and what content would be appropriate to provide. Patient and carer focus groups and a health professionals’ consensus day were used as a means of data gathering around potential e-SiP content. A repeat focus group looked at an outline version of e-SIP and informed the next stage of its development around requirements for tool. This was followed by further development and a testing stage of e-SiP involved the coding of a prototype which was then evaluated using a series of steering group meetings, semi-structured interviews with both patients and health care professionals, and analysis of e-SiP log data. Results: Feedback from focus groups and health professional interviews was very positive and it was felt e-SiP use would support and encourage patients in conducting their swallowing exercises. However, of the ten patients offered e-SIP, only two opted to use it. For these patients, aspects of the e-SIP application were considered useful, in particular the ease of keeping a diary of exercises performed. Interviews with users and non-users suggested significant barriers to its use. Most significantly the lack of flexibility of platform on which e-SiP could be accessed appeared a dominant factor in deterring e-SiP use. Conclusions: Results suggest a need for further research to be conducted around the implementation of e-SiP. This involves evaluating how e-SiP can be better integrated into usual care, and through patient training and staff engagement, can be seen as a beneficial tool to help support patients in conducting swallowing exercises

Impact of Vitamin D Supplementation on Arterial Vasomotion, Stiffness and Endothelial Biomarkers in Chronic Kidney Disease Patients

Background: Cardiovascular events are frequent and vascular endothelial function is abnormal in patients with chronic kidney disease (CKD). We demonstrated endothelial dysfunction with vitamin D deficiency in CKD patients; however the impact of cholecalciferol supplementation on vascular stiffness and vasomotor function, endothelial and bone biomarkers in CKD patients with low 25-hydroxy vitamin D [25(OH)D] is unknown, which this study investigated. Methods: We assessed non-diabetic patients with CKD stage 3/4, age 17–80 years and serum 25(OH)D ,75 nmol/L. Brachial artery Flow Mediated Dilation (FMD), Pulse Wave Velocity (PWV), Augmentation Index (AI) and circulating blood biomarkers were evaluated at baseline and at 16 weeks. Oral 300,000 units cholecalciferol was administered at baseline and 8-weeks. Results: Clinical characteristics of 26 patients were: age 50614 (mean61SD) years, eGFR 41611 ml/min/1.73 m2, males 73%, dyslipidaemia 36%, smokers 23% and hypertensives 87%. At 16-week serum 25(OH)D and calcium increased (43616 to 84629 nmol/L, p,0.001 and 2.3760.09 to 2.4260.09 mmol/L; p = 0.004, respectively) and parathyroid hormone decreased (10.868.6 to 7.464.4; p = 0.001). FMD improved from 3.163.3% to 6.163.7%, p = 0.001. Endothelial biomarker concentrations decreased: E-Selectin from 566662123 to 525662058 pg/mL; p = 0.032, ICAM-1, 3.4560.01 to 3.1061.04 ng/mL; p = 0.038 and VCAM-1, 54633 to 42633 ng/mL; p = 0.006. eGFR, BP, PWV, AI, hsCRP, von Willebrand factor and Fibroblast Growth Factor-23, remained unchanged. Conclusion: This study demonstrates for the first time improvement of endothelial vasomotor and secretory functions with vitamin D in CKD patients without significant adverse effects on arterial stiffness, serum calcium or FGF-23. Trial Registration: ClinicalTrials.gov NCT0200571

O agravamento dos transtornos de ansiedade em profissionais de saúde no contexto da pandemia da COVID-19 / The aggravation of anxiety disorders in healthcare professionals in the context of COVID-19 pandemic

INTRODUÇÃO: Desde fevereiro de 2020 o mundo vive o contexto de pandemia pelo novo coronavírus, o SARS-COV-2, causador da COVID-19. Essa doença tem provocado diversos impactos na população, em especial nos profissionais da saúde, expostos cotidianamente a situações estressantes. Nesse contexto, o objetivo do presente estudo é analisar parte do conhecimento produzido a respeito do agravamento de transtornos ansiosos em profissionais de saúde no contexto da pandemia de COVID-19. METODOLOGIA: Foram realizadas buscas nas bases de dados PubMed, ACCESSSS e SciELO utilizando os descritores “ansiedade”, “profissional de saúde”, “coronavírus”, “prevalência”, “saúde mental” e “agravamento”. Foram incluídos artigos em inglês, português e espanhol publicados a partir de janeiro de 2020. RESULTADOS: Foram selecionados 20 artigos que se adequavam ao tema proposto abordando o contexto em questão. DISCUSSÃO: Estudos mostraram o aumento da incidência de ansiedade, depressão, insônia e estresse nos profissionais da saúde, em especial os que atuam na linha de frente de combate ao coronavírus. Variáveis como gênero, idade, condições ambientais e familiares, tempo de experiência e comorbidades prévias se mostraram de grande importância no desenvolvimento desses transtornos. CONCLUSÃO: Observou-se a grande influência do contexto pandêmico no desenvolvimento e agravo de transtornos psicológicos, em especial os ansiosos, nos profissionais da saúde

Reflexões sobre o acolhimento de profissionais de saúde na pandemia

O presente artigo tem como objetivo, por meio de um relato de experiência, compartilhar reflexões a respeito das ações de um projeto de extensão realizado em 2020 com o intuito de fortalecer trabalhadores de saúde durante a pandemia da Covid-19. Estudantes de psicologia, psicólogos residentes e uma docente participaram da experiência, oferecendo acolhimento psicológico a treze trabalhadoras de instituições públicas de saúde, em sua maioria profissionais da enfermagem, que buscaram o projeto por demanda espontânea. Durante os encontros, estimulou-se a análise do cotidiano do trabalho e dos mecanismos de enfrentamento individuais e coletivos, metodologia baseada na Ergologia. Os temas convergentes nos acolhimentos foram: senso de responsabilidade, sentimento de culpa e sofrimento no trabalho; risco de contaminação, distanciamento social e estigmas; gestão do trabalho e humanização do cuidado. Por fim, considera-se a importância do projeto para o suporte e reflexão crítica das trabalhadoras sobre os processos de trabalho

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

One health, une seule santé

One Health, « Une seule santé », est une stratégie mondiale visant à développer les collaborations interdisciplinaires pour la santé humaine, animale et environnementale. Elle promeut une approche intégrée, systémique et unifiée de la santé aux échelles locale, nationale et mondiale, afin de mieux affronter les maladies émergentes à risque pandémique, mais aussi s'adapter aux impacts environnementaux présents et futurs. Bien que ce mouvement s’étende, la littérature en français reste rare. Traduit de l’anglais, coordonné par d’éminents épidémiologistes et s'appuyant sur un large panel d' approches scientifiques rarement réunies autour de la santé, cet ouvrage retrace les origines du concept et présente un contenu pratique sur les outils méthodologiques, la collecte de données, les techniques de surveillance et les plans d’étude. Il combine recherche et pratique en un seul volume et constitue un ouvrage de référence unique pour la santé mondiale

Removal of Methylene Blue in aqueous solutions by Electrocoagulation process: Adsorption, Kinetics, studies

The purpose of this study is to understand the mechanism driving the removal of methylene blue through electrocoagulation process. Experiments were carried out using iron as anode and cathode in a batch electrochemical cell operated in a monopolar configuration. The effects of operating parameters (initial pH, current density, initial dye concentration and energy consumption) on the removal of methylene blue from solution were investigated. The results showed that the optimum removal efficiency of 93.2% was achieved for a current density of 9.66 mA/cm2, optimal pH of 8±0.01 with a specific energy consumption of 7.451 kWh/m3. Afterwards, first and second-order rate equations were successively applied to study adsorption kinetics models. On top of usual correlation coefficients (r2), statistical test Chi-square (χ2) were applied to evaluate goodness of fit and consequently find out the best kinetic model. Results showed that MB adsorption process onto iron hydroxides formed in aqueous solution during electrocoagulation treatment followed a second-order kinetic