Defectos visuales no corregidos y su relación con molestias musculo esqueléticas en cuello y espalda alta

Objective: To determine the prevalence of uncorrected ocular anomalies and its association with cervicalgias in a group of workers in the industrial sector. Methodology: Descriptive, correlational, cross-sectional study of 83 workers in the production area of ​​a lamp factory in Cali, 2011. Surveys of demographic, labor and previous visual defects were carried out. Undetected visual defects were evaluated with Snellen E optotype and direct internal and external examination to detect structural abnormalities. The presence of musculoskeletal pain in the neck and upper back was evaluated with the Nordic questionnaire. Results: The predominant visual defect was presbyopia (43.4%). The most prevalent musculoskeletal symptom was neck pain (44.6%). A significant association was found between having some visual defect and neck pain (P = 0.041). Conclusions: A relationship was found between visual defects and musculoskeletal discomfort in the neck. Periodic visual examinations are recommended to avoid the appearance of musculoskeletal disease.Objetivo: Determinar la prevalencia de anomalías oculares no corregidas y su asociación con cervicalgias en grupo de trabajadores del sector industrial. Metodología: Estudio descriptivo, correlacional, de corte transversal en 83 trabajadores del área de producción de una fábrica de lámparas en Cali, año 2011. Se realizaron encuestas de datos demográficos, laborales y defectos visuales previos. Los defectos visuales no detectados se evaluaron con, optotipo Snellen E y examen directo interno y externo para detección de anomalías estructurales. La presencia de dolor osteomuscular en cuello y espalda alta se evaluó con el cuestionario nórdico. Resultados: El defecto visual predominante fue presbicia (43,4%). El síntoma osteomuscularde mayor prevalencia fue dolor de cuello (44,6%). Se encontró una asociación significativa entre tener algún defecto visual y dolor en cuello (P=0,041). Conclusiones: Se encontró una relación entre los defectos visuales y molestias osteomusculares en cuello. Se recomienda realizar exámenes visuales periódicos para evitar la aparición de enfermedad osteomusculares

Defectos Visuales No Corregidos y Su Relación con Molestias Musculoesqueleticas en Cuello y Espalda Alta.

Introduction: Visual disorders are common in most of the general and working population. If not detected in a timely manner may end in organic and socio-occupational sequelae. The aim of this study was to determine the prevalence of uncorrected ocular abnormalities and their association with cervical pain group of industrial workers. Methodology: Descriptive, correlational, crosssectional study of 83 workers in the production area of a lamp factory in Cali, Colombia. Demographic surveys, employment data and previous visual defects data were collected. Undetected visual defects were assessed with Snellen E optotype and internal and external direct examination for the detection of structural abnormalities. The presence of musculoskeletal pain in neck and upper back was assessed with the Nordic questionnaire. Results: The predominant visual defect was presbyopia (43,4%). The most prevalent symptom was neck pain (44,6%). A significant association between having a visual defect and neck pain (P=0,041) was found. Conclusions: We found a significant relationship between visual defects and musculoskeletal discomfort in the neck was found. It is recommended to set up regular eye examinations to prevent the occurrence of musculoskeletal diseases.Las patologías visuales son frecuentes en la mayor parte de población general y laboral. De no detectarse oportunamente pueden terminar en secuelas orgánicas y socio-laborales. El objetivo de este trabajo fue determinar la prevalencia de anomalías oculares no corregidas y su asociación con cervicalgias en grupo de trabajadores del sector industrial. Metodología: Estudio descriptivo, correlacional, de corte transversal en 83 trabajadores del área de producción de una fábrica de lámparas en Cali, año 2011. Se realizaron encuestas de datos demográficos, laborales y defectos visuales previos. Los defectos visuales no detectados se evaluaron con, optotipo Snellen E y examen directo interno y externo para detección de anomalías estructurales. La presencia de dolor osteomuscular en cuello y espalda alta se evaluó con el cuestionario nórdico. Resultados: El defecto visual predominante fue presbicia (43,4%). El síntoma osteomuscularde mayor prevalencia fue dolor de cuello (44,6%). Se encontró una asociación significativa entre tener algún defecto visual y dolor en cuello (P=0,041). Conclusiones: Se encontró una relación entre los defectos visuales y molestias osteomusculares en cuello. Se recomienda realizar exámenes visuales periódicos para evitar la aparición de enfermedad osteomusculares

Defectos visuales no corregidos y su relación con molestias musculo esqueléticas en cuello y espalda alta

Objective: To determine the prevalence of uncorrected ocular anomalies and its association with cervicalgias in a group of workers in the industrial sector. Methodology: Descriptive, correlational, cross-sectional study of 83 workers in the production area of ​​a lamp factory in Cali, 2011. Surveys of demographic, labor and previous visual defects were carried out. Undetected visual defects were evaluated with Snellen E optotype and direct internal and external examination to detect structural abnormalities. The presence of musculoskeletal pain in the neck and upper back was evaluated with the Nordic questionnaire. Results: The predominant visual defect was presbyopia (43.4%). The most prevalent musculoskeletal symptom was neck pain (44.6%). A significant association was found between having some visual defect and neck pain (P = 0.041). Conclusions: A relationship was found between visual defects and musculoskeletal discomfort in the neck. Periodic visual examinations are recommended to avoid the appearance of musculoskeletal disease.Objetivo: Determinar la prevalencia de anomalías oculares no corregidas y su asociación con cervicalgias en grupo de trabajadores del sector industrial. Metodología: Estudio descriptivo, correlacional, de corte transversal en 83 trabajadores del área de producción de una fábrica de lámparas en Cali, año 2011. Se realizaron encuestas de datos demográficos, laborales y defectos visuales previos. Los defectos visuales no detectados se evaluaron con, optotipo Snellen E y examen directo interno y externo para detección de anomalías estructurales. La presencia de dolor osteomuscular en cuello y espalda alta se evaluó con el cuestionario nórdico. Resultados: El defecto visual predominante fue presbicia (43,4%). El síntoma osteomuscularde mayor prevalencia fue dolor de cuello (44,6%). Se encontró una asociación significativa entre tener algún defecto visual y dolor en cuello (P=0,041). Conclusiones: Se encontró una relación entre los defectos visuales y molestias osteomusculares en cuello. Se recomienda realizar exámenes visuales periódicos para evitar la aparición de enfermedad osteomusculares

Candida bloodstream infections in intensive care units: analysis of the extended prevalence of infection in intensive care unit study

Item does not contain fulltextOBJECTIVES: To provide a global, up-to-date picture of the prevalence, treatment, and outcomes of Candida bloodstream infections in intensive care unit patients and compare Candida with bacterial bloodstream infection. DESIGN: A retrospective analysis of the Extended Prevalence of Infection in the ICU Study (EPIC II). Demographic, physiological, infection-related and therapeutic data were collected. Patients were grouped as having Candida, Gram-positive, Gram-negative, and combined Candida/bacterial bloodstream infection. Outcome data were assessed at intensive care unit and hospital discharge. SETTING: EPIC II included 1265 intensive care units in 76 countries. PATIENTS: Patients in participating intensive care units on study day. INTERVENTIONS: None. MEASUREMENT AND MAIN RESULTS: Of the 14,414 patients in EPIC II, 99 patients had Candida bloodstream infections for a prevalence of 6.9 per 1000 patients. Sixty-one patients had candidemia alone and 38 patients had combined bloodstream infections. Candida albicans (n = 70) was the predominant species. Primary therapy included monotherapy with fluconazole (n = 39), caspofungin (n = 16), and a polyene-based product (n = 12). Combination therapy was infrequently used (n = 10). Compared with patients with Gram-positive (n = 420) and Gram-negative (n = 264) bloodstream infections, patients with candidemia were more likely to have solid tumors (p < .05) and appeared to have been in an intensive care unit longer (14 days [range, 5-25 days], 8 days [range, 3-20 days], and 10 days [range, 2-23 days], respectively), but this difference was not statistically significant. Severity of illness and organ dysfunction scores were similar between groups. Patients with Candida bloodstream infections, compared with patients with Gram-positive and Gram-negative bloodstream infections, had the greatest crude intensive care unit mortality rates (42.6%, 25.3%, and 29.1%, respectively) and longer intensive care unit lengths of stay (median [interquartile range]) (33 days [18-44], 20 days [9-43], and 21 days [8-46], respectively); however, these differences were not statistically significant. CONCLUSION: Candidemia remains a significant problem in intensive care units patients. In the EPIC II population, Candida albicans was the most common organism and fluconazole remained the predominant antifungal agent used. Candida bloodstream infections are associated with high intensive care unit and hospital mortality rates and resource use

Candida bloodstream infections in intensive care units: analysis of the extended prevalence of infection in intensive care unit study

To provide a global, up-to-date picture of the prevalence, treatment, and outcomes of Candida bloodstream infections in intensive care unit patients and compare Candida with bacterial bloodstream infection. DESIGN: A retrospective analysis of the Extended Prevalence of Infection in the ICU Study (EPIC II). Demographic, physiological, infection-related and therapeutic data were collected. Patients were grouped as having Candida, Gram-positive, Gram-negative, and combined Candida/bacterial bloodstream infection. Outcome data were assessed at intensive care unit and hospital discharge. SETTING: EPIC II included 1265 intensive care units in 76 countries. PATIENTS: Patients in participating intensive care units on study day. INTERVENTIONS: None. MEASUREMENT AND MAIN RESULTS: Of the 14,414 patients in EPIC II, 99 patients had Candida bloodstream infections for a prevalence of 6.9 per 1000 patients. Sixty-one patients had candidemia alone and 38 patients had combined bloodstream infections. Candida albicans (n = 70) was the predominant species. Primary therapy included monotherapy with fluconazole (n = 39), caspofungin (n = 16), and a polyene-based product (n = 12). Combination therapy was infrequently used (n = 10). Compared with patients with Gram-positive (n = 420) and Gram-negative (n = 264) bloodstream infections, patients with candidemia were more likely to have solid tumors (p < .05) and appeared to have been in an intensive care unit longer (14 days [range, 5-25 days], 8 days [range, 3-20 days], and 10 days [range, 2-23 days], respectively), but this difference was not statistically significant. Severity of illness and organ dysfunction scores were similar between groups. Patients with Candida bloodstream infections, compared with patients with Gram-positive and Gram-negative bloodstream infections, had the greatest crude intensive care unit mortality rates (42.6%, 25.3%, and 29.1%, respectively) and longer intensive care unit lengths of stay (median [interquartile range]) (33 days [18-44], 20 days [9-43], and 21 days [8-46], respectively); however, these differences were not statistically significant. CONCLUSION: Candidemia remains a significant problem in intensive care units patients. In the EPIC II population, Candida albicans was the most common organism and fluconazole remained the predominant antifungal agent used. Candida bloodstream infections are associated with high intensive care unit and hospital mortality rates and resource use

Stress neuropeptide levels in adults with chest pain due to coronary artery disease: potential implications for clinical assessment

: Substance P (SP) and neuropeptide Y (NPY) are neuropeptides involved in nociception. The study of biochemical markers of pain in communicating critically ill coronary patients may provide insight for pain assessment and management in critical care. Purpose of the study was to to explore potential associations between plasma neuropeptide levels and reported pain intensity in coronary critical care adults, in order to test the reliability of SP measurements for objective pain assessment in critical care

Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study

International audienceBackground: Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation. Methods: WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109. Findings: Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0–4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2–6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital. Interpretation: In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates. Funding: European Society of Intensive Care Medicine, European Respiratory Society

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P &lt; 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)