Comprehensive geriatric assessment as a morbimortality predictor in patients vulnerable to the chemotherapy treatment

Objectives: to determine the predictive value of the Comprehensive geriatric assessment (CGA) regarding toxicity and mortality in elderly cancer patients classified as vulnerable who were submitted to chemotherapy. Method: A prospective cohort study was performed with data gathered from the database already built by the anchor project and available online. Tables of the frequency of distribution of the studied variables were created. The chi-square test was used in the univariate analysis, and the Fisher test when indicated. The level of significance of 5% were considered and all the tests were applied with a confidence of 95%. Results: The frequency of patients classified as vulnerable by CGA was 40.2%, and the mortality rate in the total number of patients was 37%. The association between nutritional status and mortality (p=0.003) was observed, where most of the denuded patients (51.4%) died during follow-up, and most patients (46.5%) had some type of complication. Conclusion: There was an association between the increase in mortality in patients vulnerable to chemotherapy (p=0,046), when compared to healthy patients. The results of this study follow the literature on the use of CGA can help oncologists and geriatricians in their decision making.Objetivos: O objetivo desse estudo foi determinar o valor preditivo da Avaliação Geriátrica Ampla (AGA) em relação à toxicidade e mortalidade nos pacientes oncológicos idosos classificados como vulneráveis, submetidos à quimioterapia. Método: Foi realizado um estudo de coorte prospectivo com coleta de informações extraídas de banco de dados já construído do projeto ÂNCORA e disponível online. Foram construídas tabelas de distribuição de frequência das variáveis estudadas e na análise univariada foi usado o chi-quadrado e Teste de Fisher, quando indicado. Por fim, considerou-se o nível de significância de 5% e todos os testes foram aplicados com 95% de confiança. Resultados: Em uma amostra total de 254 pacientes, o percentual de mortalidade foi de 37% e de intercorrências foi de 46,5%, sendo infecção a mais frequente. Houve associação entre o déficit nutricional e o aumento da mortalidade (p=0,003). Conclusão: Observou-se associação estatística entre o aumento da mortalidade em pacientes vulneráveis que realizaram quimioterapia (p=0,046), quando comparados aos pacientes saudáveis. Os resultados deste estudo reforçam constatações da literatura como o uso da AGA pode ajudar oncologistas e geriatras em suas tomadas de decisão

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

The campones vulnerabilization in the context of the transposition of the são francisco river: The exile in the Rural Productive Village Baixio dos Grandes (Junco)

Submitted by Ana Beatriz Oliveira ([email protected]) on 2019-06-18T15:35:02Z No. of bitstreams: 1 2018domigues-rc.pdf: 3816411 bytes, checksum: 814f09184390fb3b82db16ec6fb65862 (MD5)Approved for entry into archive by Ana Beatriz Oliveira ([email protected]) on 2019-06-18T15:40:56Z (GMT) No. of bitstreams: 1 2018domigues-rc.pdf: 3816411 bytes, checksum: 814f09184390fb3b82db16ec6fb65862 (MD5)Made available in DSpace on 2019-06-18T15:40:56Z (GMT). No. of bitstreams: 1 2018domigues-rc.pdf: 3816411 bytes, checksum: 814f09184390fb3b82db16ec6fb65862 (MD5) Previous issue date: 2016CNPq.Fundação Oswaldo Cruz. Instituto Aggeu Magalhães. Recife, PE, Brasil.O modelo de desenvolvimento vigente revela padrões globais de crescimento econômico e inserção no mercado internacional. Logo, a transposição das águas do Rio São Francisco é um projeto nacional de infraestrutura hídrica que anuncia a resolução dos problemas de acesso á água de 12 milhões de pessoas e a superação da condenação histórica ao subdesenvolvimento em que, historicamente, o semiárido brasileiro encontra-se submetido. Entretanto, a população camponesa local tem padecido frente ao intenso processo de implantação das obras nos territórios Baixio dos Grandes e Junco - ambos localizados no Município de Cabrobó/PE. As famílias camponesas foram desterritorializadas compulsoriamente de seus antigos territórios e transferidas para a Vila Produtiva Rural Baixio dos Grandes (Junco). Certamente, este estudo de natureza qualitativa, fundamentado na teoria da determinação social da saúde, se preocupa em analisar o processo de vulnerabilização das famílias diretamente atingidas em seus territórios de vida. A intervenção compulsória na vida dessas famílias fez emergir problemas complexos que se intensificam diante da morosidade da etapa de finalização das obras, são eles: a desestabilização do poder territorial, a desconstrução do modo de produção familiar camponês, a descaracterização da identidade camponesa e, por fim, a desvitalização da autonomia – que constrange as possibilidades de escolhas e fragiliza as decisões sobre a própria vida e saúde, vulnerabilizando as famílias camponesas.The current development model reveals global patterns of economic growth and integration into the international market. Therefore, the transposition of the São Francisco River waters is a national water infrastructure design announcing the resolution of water problems will access to 12 million people and overcoming the historic condemnation of underdevelopment in which, historically, the Brazilian semiarid encontra- undergone. However, the local peasant population has suffered against the intense process of implementation of the works in the shoal areas and the Great Reed - both located in the municipality of Cabrobó / PE. Farm families were dispossessed forcibly from their old territories and transferred to Rural Productive Village Baixio the Great (Junco). Certainly, this qualitative study, based on the social determinants of health theory is concerned with analyzing the vulnerabilization process of families directly affected in their territories of life. The compulsory intervention in the lives of these families did emerge complex problems that intensify before the slow pace of completion of the works stage, they are: the destabilization of the territorial power, deconstruction peasant family production mode, the mischaracterization of peasant identity and, Finally, the root canal of autonomy - that constrains the possibilities of choices and weakens decisions about their lives and health, vulnerabilizando peasant families

A vulneração socioambiental advinda do complexo industrial portuário de Suape: a perspectiva dos moradores da Ilha de Tatuoca – Ipojuca/PE

A comunidade tradicional de pescadores artesanais da Ilha de Tatuoca enfrenta intensos conflitos socioambientais, decorrentes das obras de expansão do Complexo Industrial e Portuário de Suape, em Pernambuco. Nos últimos anos, esses conflitos materializam-se em um profundo processo de desterritorialização das famílias e em uma evidente descaracterização da Ilha de Tatuoca, considerada Área de Preservação Permanente (APP). Diante disso, este estudo se preocupa em compreender a percepção e os aspectos subjetivos da população exposta aos conflitos socioambientais, presentes no território. Para tanto, esta pesquisa objetiva analisar o discurso dos moradores da Ilha de Tatuoca sobre o processo de vulneração socioambiental ativo no local

O CUIDADO EM SAÚDE E A EXTENSÃO UNIVERSITÁRIA REFERENCIADOS NA EDUCAÇÃO POPULAR: UMA HISTÓRIA DE CONVIVÊNCIA COM A REALIDADE DO CAMPO

Este relato de experiência conta a história de um projeto de extensão que envolveu o encontro entre profissionais da saúde em formação (residentes em saúde) e famílias camponesas de um assentamento do Movimento dos Trabalhadores Rurais Sem Terra, no município de Moreno/PE, de julho de 2012 a agosto de 2013. Através dessa vivência, referenciada na Educação Popular, foi possível experienciarmos a construção coletiva de outras perspectivas do cuidado, da educação e da formação em saúde, possibilitando o intercâmbio de saberes com a população do campo e os movimentos sociais, fortalecendo a autonomia, a participação social e o cuidado em saúde com base nos conhecimentos populares.

Hypertensive portal colopathy in schistosomiasis mansoni: proposal for a classification

Portal hypertension is a frequent complication of chronic liver disease, detected not only in schistosomiasis, but also in cirrhosis of any etiology. Vascular alterations in the colonic mucosa are a potential source for acute or chronic bleeding and have been observed in patients with portal hypertension. The purpose of this prospective study was to describe and propose a classification for the vascular alterations of portal hypertension in the colonic mucosa among patients with hepatosplenic schistosomiasis mansoni. One or more alterations of portal colopathy were observed in all patients and they were classified according to their intensity, obeying the classification proposed by the authors. Portal colopathy is an important finding in hepatosplenic schistosomiasis and might be the cause of lower gastrointestinal bleeding in patients with severe portal hypertension

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