Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

Experiences With and Attitudes Toward Death and Dying Among Homeless Persons

BACKGROUND: Homeless persons face many barriers to health care, have few resources, and experience high death rates. They live lives of disenfranchisement and neglect. Few studies have explored their experiences and attitudes toward death and dying. Unfortunately, studies done in other populations may not apply to homeless persons. Exploring these experiences and attitudes may provide insight into life, health care, and end-of-life (EOL) concerns of this population. OBJECTIVE: To explore the experiences and attitudes toward death and dying among homeless persons. DESIGN: Qualitative study utilizing focus groups. PARTICIPANTS: Fifty-three homeless persons recruited from homeless service agencies. MEASUREMENTS: In-depth interviews, which were audiotaped and transcribed. RESULTS: We present seven themes, some of which are previously unreported. Homeless persons described many significant experiences with death and dying, and many participants suffered losses while very young. These encounters influenced participants’ attitudes toward risks and risky behavior: e.g., for some, these experiences provided justification for high-risk behaviors and influenced their behaviors while living on the streets. For others, they may be associated with their homelessness. Finally, these experiences informed their attitudes toward death and dying as well as EOL care; homeless persons believe that care will be poor at the EOL. CONCLUSIONS: Findings from this study have implications for addressing social services, health promotion, prevention, and EOL care for homeless persons, as well as for others who are poor and disenfranchised

Enhancement strategies for transdermal drug delivery systems: current trends and applications

Transdermal drug delivery systems have become an intriguing research topic in pharmaceutical technology area and one of the most frequently developed pharmaceutical products in global market. The use of these systems can overcome associated drawbacks of other delivery routes, such as oral and parenteral. The authors will review current trends, and future applications of transdermal technologies, with specific focus on providing a comprehensive understanding of transdermal drug delivery systems and enhancement strategies. This article will initially discuss each transdermal enhancement method used in the development of first-generation transdermal products. These methods include drug/vehicle interactions, vesicles and particles, stratum corneum modification, energy-driven methods and stratum corneum bypassing techniques. Through suitable design and implementation of active stratum corneum bypassing methods, notably microneedle technology, transdermal delivery systems have been shown to deliver both low and high molecular weight drugs. Microneedle technology platforms have proven themselves to be more versatile than other transdermal systems with opportunities for intradermal delivery of drugs/biotherapeutics and therapeutic drug monitoring. These have shown that microneedles have been a prospective strategy for improving transdermal delivery systems. Graphical abstract: [Figure not available: see fulltext.]</p

A variação da acuidade visual durante esforços físicos em atletas com baixa visão, participantes de seleção brasileira de atletismo The visual acuity variability during physical efforts in low vision athletes from the athletics Brazilian team

INTRODUÇÃO E OBJETIVO: Esta pesquisa teve como objetivo avaliar o comportamento da acuidade visual em atletas com baixa visão, durante um protocolo de esforço contínuo. Pesquisas apontam que a acuidade visual apresenta variações de rendimento quando submetida a esforços físicos em sujeitos sem deficiência visual. MÉTODO: A população estudada foi composta por seis pessoas, praticantes de atletismo e integrantes da seleção brasileira em provas de pista. No primeiro dia aplicou-se o teste de esforço físico progressivo, realizado em esteira. No segundo dia realizou-se o teste de esforço contínuo, o qual foi dividido em três níveis, cada um com 15 minutos de duração e 30 minutos de intervalo entre eles. Como delimitador das intensidades aplicadas utilizaram-se os resultados obtidos no teste de físico progressivo (60% do VE pico, limiar de VE e 90% do VE pico). A aferição da acuidade visual aconteceu antes, durante e após cada nível de intensidade no protocolo de esforço contínuo. O teste t de Student foi utilizado para a análise estatística (p < 0,05). RESULTADOS: A acuidade visual apresentou, nos três níveis de esforço, queda de seu desempenho. A variação entre os resultados da aferição da acuidade visual estática inicial e a mensuração da mesma variável ao final da fase de corrida foi de 44,5% no primeiro nível, 52,5% no segundo e 60% no terceiro nível. Os resultados apresentaram maior degradação do componente visual durante as aferições dinâmicas. As fases de recuperação que sucediam os níveis de esforço mais intensos tiveram os melhores resultados da acuidade visual, após o déficit encontrado durante o exercício. CONCLUSÃO: Pode-se inferir que nessa população específica ocorre queda da acuidade visual durante o esforço. Tal fato implica a necessidade de a classificação esportiva ser direcionada para avaliar a funcionalidade visual de cada atleta com baixa visão durante o esforço físico, já que tais variações podem ocorrer durante o mesmo.<br>INTRODUCTION AND OBJECTIVE: This study had as an objective to evaluate the visual acuity behavior in athletes with low vision, during a continuous effort protocol. Researches point out that visual acuity presents performance varieties when submitted to physical efforts in subjects without visual impairment. METHOD: The studied population was composed by six peoples, who practiced athletics and were part of the Brazilian team in track events. The progressive physical effort test was applied on the first day in a treadmill. On the second day the continuous effort test was applied, which was divided in three levels, each one had a 15 and 30 minutes break between them. To determine the intensities, the results obtained in the progressive physical effort test (60% of VE peak, limiar VE and 90% VE peak) were used. The visual acuity was measured before, during and after each level of intensity in the continuous effort protocol. The t Student test was used for statistics analysis (p < 0.05). RESULTS: The visual acuity presented a decrease in the three levels of effort in its performance. The variety between the initial static visual acuity measure results and the measurement of the same variable in the end of the running phase was 44.5% in the first level, 52.5% in the second and 60% in the third level. The results presented higher degradation of the visual component during the dynamic measurements. The recuperation phases, which succeeded the most intense levels of effort, had the results of the visual acuity, after the deficit found during the exercise. CONCLUSION: It can be inferred that in this specific population there is a decrease in the visual acuity during the effort. This fact implies on the necessity of the visual sportive classification being directed to evaluate the visual functionality of each athlete with low vision during the physical effort, since these varieties can occur during it