Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

Contains fulltext : 172380.pdf (publisher's version ) (Open Access

Influência de características gerais na qualidade de vida de pacientes com doença pulmonar obstrutiva crônica Influence of general clinical parameters on the quality of life of chronic obstructive pulmonary disease patients

INTRODUÇÃO: Não há consenso a respeito dos fatores que influenciam a qualidade de vida nos portadores de doença pulmonar obstrutiva crônica (DPOC). Entretanto, a sua determinação pode nortear abordagens que visem à melhora da qualidade de vida desses pacientes. OBJETIVO: Avaliar fatores que podem interferir na qualidade de vida de pacientes com DPOC selecionados para reabilitação pulmonar. MÉTODO: Foram avaliados vinte e um pacientes com doença pulmonar obstrutiva crônica moderada a grave. Pressão inspiratória máxima (PImax), teste de caminhada de seis minutos (TC6), composição corpórea, função pulmonar, gases sangüíneos, dinamometria de membros superiores, força muscular de quadríceps e questionário de qualidade de vida do Hospital Saint George (SGRQ) foram estudados. RESULTADOS: Foram observadas correlações negativas estatisticamente significativas entre as seguintes variáveis: escore do domínio "Impacto" com o volume expiratório forçado no primeiro segundo (VEF1) (r = -0,68; p = 0,004), relação entre VEF1 e capacidade vital forçada (VEF1/CVF) (r = -0,61; p = 0,014), pico de fluxo expiratório (PFE) (r = -0,53; p = 0,015), TC6 (r = -0,63; p = 0,001) e índice de massa corpórea (IMC) (r = -0,64; p = 0,002); escore do domínio "Atividades" com PImax (r = -0,57; p = 0,007), saturação de O2 (SpO2) (r = -0,52; p = 0,018) e TC6 (r = -0,58; p = 0,007); escore do domínio "Sintomas" com IMC (r = -0,60; p = 0,005); e escore "Total" com VEF1 (r = -0,64; p = 0,01), PFE (r = -0,47; p = 0,033) e IMC (r = -0,57; p = 0,009). A regressão múltipla linear indicou como principais variáveis independentes o IMC, com influência significativa nos domínios sintomas (p = 0,002), impacto (p = 0,009) e no escore total (p = 0,024), e o TC6, com influência significativa nos domínios atividades (p = 0,048) e impacto (p = 0,010). CONCLUSÕES: O IMC e o TC6 tiveram influência nos índices de qualidade de vida. Portanto, estas variáveis devem ser consideradas nas estratégias para melhorar a qualidade de vida de pacientes com doença pulmonar obstrutiva crônica.<br>BACKGROUND: There is currently no consensus regarding which factors influence the quality of life of patients suffering from chronic obstructive pulmonary disease (COPD). However, identifying such factors could orient approaches to improving the quality of the lives of these patients. OBJECTIVE: To evaluate factors that can interfere with quality of life in COPD patients selected for pulmonary rehabilitation. METHODS: Twenty-one patients with moderate to severe COPD were evaluated. Maximal inspiratory pressure (MIP), 6-minute walk test (6MWT), body mass index (BMI), pulmonary function, blood gases, grip strength (measured with a dynamometer), quadriceps strength and St. George's Respiratory Questionnaire (SGRQ) scores were assessed. RESULTS: Statistically significant negative correlations with quality of life were found for the following factors: "impact" scores of: forced expiratory volume in one second (FEV1) (r = -0.68; p = 0.004), FEV1 to forced vital capacity ratio (FEV1/FVC) (r = -0.61; p = 0.014), peak expiratory flow (PEF) (r = -0.53 (p = 0.015), 6MWT (r = -0.63; p = 0.001) and BMI (r = -0.64; p = 0.002); "activity" scores for: MIP (r = -0.57; p = 0.007), baseline arterial oxygen saturation by pulse oximetry (SpO2) (r = -0.52; p = 0.018) and 6MWT (r = -0.58; p = 0.007); "symptom" score for: BMI (r = -0.60; p = 0.005); and "total" scores for: FEV1 (r = -0.64; p = 0.01), PEF (r = -0.47; p = 0.033) and BMI (r = -0.57; p = 0.009). Multiple linear regression revealed the primary factors influencing quality of life to be: BMI, which presented a significant influence on "symptom", "impact" and "total" scores (p = 0.002, p = 0.009 and p = 0.024, respectively); and 6MWT, which had a significant influence on "activity" and "impact" scores (p = 0.048 and p = 0.010, respectively). CONCLUSIONS: The BMI and 6MWT were shown to have an influence on quality of life in the COPD patients studied. Therefore, therapeutic approaches to improving the quality of life of COPD patients should take these indices into consideration

Predictors of changes in sick leave in workers with asthma: a follow-up study.

Contains fulltext : 49216.pdf (publisher's version ) (Closed access)OBJECTIVE: The aim of this prospective study was to investigate predictors of 1-year changes in sick leave in workers with asthma. METHODS: The initial cohort consisted of 111 workers with asthma. One-hundred and one participants completed the follow-up after 1 year. Self-reported sick leave over the past 12 months was reported at baseline and at follow-up. At the start of this study, all participants completed questionnaires on adaptation to functional limitations, psychosocial variables, working conditions, lung function characteristics, disease history characteristics, health complaints and functional limitations, and person characteristics ('potential predictors'). Three multivariate logistic regression models were calculated, with an increase in sick leave, a decrease in sick leave, and stable high sick leave as dependent (outcome) variables, and the potential predictors as independent (explanatory) variables. RESULTS: An increase in sick leave was predicted by a lower level of education and perceiving more functional limitations in activities of daily life. A decrease in sick leave was predicted by spending all energy at work less often and perceiving fewer health complaints in social activities (adaptation criteria 4 and 5). Stable high sick leave was predicted by less job satisfaction, perceiving more support from the employer and perceiving more health complaints in social activities (adaptation criterion 5). Lung function characteristics, or disease history characteristics were not predictive for changes in sick leave in any of the groups. CONCLUSION: We conclude that adaptation to functional limitations played a major role in changes in sick leave in workers with asthma. Lung function characteristics hardly played a role

Sequence and analysis of chromosome 3 of the plant Arabidopsis thaliana

Arabidopsis thaliana is an important model system for plant biologists. In 1996 an international collaboration (the Arabidopsis Genome Initiative) was formed to sequence the whole genome of Arabidopsis and in 1999 the sequence of the first two chromosomes was reported. The sequence of the last three chromosomes and an analysis of the whole genome are reported in this issue. Here we present the sequence of chromosome 3, organized into four sequence segments (contigs). The two largest (13.5 and 9.2 Mb) correspond to the top (long) and the bottom (short) arms of chromosome 3, and the two small contigs are located in the genetically defined centromere. This chromosome encodes 5,220 of the roughly 25,500 predicted protein-coding genes in the genome. About 20% of the predicted proteins have significant homology to proteins in eukaryotic genomes for which the complete sequence is available, pointing to important conserved cellular functions among eukaryotes

Sequence and analysis of chromosome 3 of the plant Arabidopsis thaliana.

Arabidopsis thaliana is an important model system for plant biologists. In 1996 an international collaboration (the Arabidopsis Genome Initiative) was formed to sequence the whole genome of Arabidopsis and in 1999 the sequence of the first two chromosomes was reported. The sequence of the last three chromosomes and an analysis of the whole genome are reported in this issue. Here we present the sequence of chromosome 3, organized into four sequence segments (contigs). The two largest (13.5 and 9.2 Mb) correspond to the top (long) and the bottom (short) arms of chromosome 3, and the two small contigs are located in the genetically defined centromere. This chromosome encodes 5,220 of the roughly 25,500 predicted protein-coding genes in the genome. About 20% of the predicted proteins have significant homology to proteins in eukaryotic genomes for which the complete sequence is available, pointing to important conserved cellular functions among eukaryotes

In-hospital and 6-month outcomes in patients with COVID-19 supported with extracorporeal membrane oxygenation (EuroECMO-COVID): a multicentre, prospective observational study

Background: Extracorporeal membrane oxygenation (ECMO) has been widely used in patients with COVID-19, but uncertainty remains about the determinants of in-hospital mortality and data on post-discharge outcomes are scarce. The aims of this study were to investigate the variables associated with in-hospital outcomes in patients who received ECMO during the first wave of COVID-19 and to describe the status of patients 6 months after ECMO initiation. Methods: EuroECMO-COVID is a prospective, multicentre, observational study developed by the European Extracorporeal Life Support Organization. This study was based on data from patients aged 16 years or older who received ECMO support for refractory COVID-19 during the first wave of the pandemic—from March 1 to Sept 13, 2020—at 133 centres in 21 countries. In-hospital mortality and mortality 6 months after ECMO initiation were the primary outcomes. Mixed-Cox proportional hazards models were used to investigate associations between patient and management-related variables (eg, patient demographics, comorbidities, pre-ECMO status, and ECMO characteristics and complications) and in-hospital deaths. Survival status at 6 months was established through patient contact or institutional charts review. This study is registered with ClinicalTrials.gov, NCT04366921, and is ongoing. Findings: Between March 1 and Sept 13, 2020, 1215 patients (942 [78%] men and 267 [22%] women; median age 53 years [IQR 46–60]) were included in the study. Median ECMO duration was 15 days (IQR 8–27). 602 (50%) of 1215 patients died in hospital, and 852 (74%) patients had at least one complication. Multiorgan failure was the leading cause of death (192 [36%] of 528 patients who died with available data). In mixed-Cox analyses, age of 60 years or older, use of inotropes and vasopressors before ECMO initiation, chronic renal failure, and time from intubation to ECMO initiation of 4 days or more were associated with higher in-hospital mortality. 613 patients did not die in hospital, and 547 (95%) of 577 patients for whom data were available were alive at 6 months. 102 (24%) of 431 patients had returned to full-time work at 6 months, and 57 (13%) of 428 patients had returned to part-time work. At 6 months, respiratory rehabilitation was required in 88 (17%) of 522 patients with available data, and the most common residual symptoms included dyspnoea (185 [35%] of 523 patients) and cardiac (52 [10%] of 514 patients) or neurocognitive (66 [13%] of 512 patients) symptoms. Interpretation: Patient's age, timing of cannulation (<4 days vs ≥4 days from intubation), and use of inotropes and vasopressors are essential factors to consider when analysing the outcomes of patients receiving ECMO for COVID-19. Despite post-discharge survival being favourable, persisting long-term symptoms suggest that dedicated post-ECMO follow-up programmes are required. Funding: None