The genetic epidemiology of joint shape and the development of osteoarthritis

Congruent, low-friction relative movement between the articulating elements of a synovial joint is an essential pre-requisite for sustained, efficient, function. Where disorders of joint formation or maintenance exist, mechanical overloading and osteoarthritis (OA) follow. The heritable component of OA accounts for ~ 50% of susceptible risk. Although almost 100 genetic risk loci for OA have now been identified, and the epidemiological relationship between joint development, joint shape and osteoarthritis is well established, we still have only a limited understanding of the contribution that genetic variation makes to joint shape and how this modulates OA risk. In this article, a brief overview of synovial joint development and its genetic regulation is followed by a review of current knowledge on the genetic epidemiology of established joint shape disorders and common shape variation. A summary of current genetic epidemiology of OA is also given, together with current evidence on the genetic overlap between shape variation and OA. Finally, the established genetic risk loci for both joint shape and osteoarthritis are discussed

Epidemiology and patterns of tracheostomy practice in patients with acute respiratory distress syndrome in ICUs across 50 countries

Background: To better understand the epidemiology and patterns of tracheostomy practice for patients with acute respiratory distress syndrome (ARDS), we investigated the current usage of tracheostomy in patients with ARDS recruited into the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG-SAFE) study. Methods: This is a secondary analysis of LUNG-SAFE, an international, multicenter, prospective cohort study of patients receiving invasive or noninvasive ventilation in 50 countries spanning 5 continents. The study was carried out over 4 weeks consecutively in the winter of 2014, and 459 ICUs participated. We evaluated the clinical characteristics, management and outcomes of patients that received tracheostomy, in the cohort of patients that developed ARDS on day 1-2 of acute hypoxemic respiratory failure, and in a subsequent propensity-matched cohort. Results: Of the 2377 patients with ARDS that fulfilled the inclusion criteria, 309 (13.0%) underwent tracheostomy during their ICU stay. Patients from high-income European countries (n = 198/1263) more frequently underwent tracheostomy compared to patients from non-European high-income countries (n = 63/649) or patients from middle-income countries (n = 48/465). Only 86/309 (27.8%) underwent tracheostomy on or before day 7, while the median timing of tracheostomy was 14 (Q1-Q3, 7-21) days after onset of ARDS. In the subsample matched by propensity score, ICU and hospital stay were longer in patients with tracheostomy. While patients with tracheostomy had the highest survival probability, there was no difference in 60-day or 90-day mortality in either the patient subgroup that survived for at least 5 days in ICU, or in the propensity-matched subsample. Conclusions: Most patients that receive tracheostomy do so after the first week of critical illness. Tracheostomy may prolong patient survival but does not reduce 60-day or 90-day mortality. Trial registration: ClinicalTrials.gov, NCT02010073. Registered on 12 December 2013

Identifying associations between diabetes and acute respiratory distress syndrome in patients with acute hypoxemic respiratory failure: an analysis of the LUNG SAFE database

Background: Diabetes mellitus is a common co-existing disease in the critically ill. Diabetes mellitus may reduce the risk of acute respiratory distress syndrome (ARDS), but data from previous studies are conflicting. The objective of this study was to evaluate associations between pre-existing diabetes mellitus and ARDS in critically ill patients with acute hypoxemic respiratory failure (AHRF). Methods: An ancillary analysis of a global, multi-centre prospective observational study (LUNG SAFE) was undertaken. LUNG SAFE evaluated all patients admitted to an intensive care unit (ICU) over a 4-week period, that required mechanical ventilation and met AHRF criteria. Patients who had their AHRF fully explained by cardiac failure were excluded. Important clinical characteristics were included in a stepwise selection approach (forward and backward selection combined with a significance level of 0.05) to identify a set of independent variables associated with having ARDS at any time, developing ARDS (defined as ARDS occurring after day 2 from meeting AHRF criteria) and with hospital mortality. Furthermore, propensity score analysis was undertaken to account for the differences in baseline characteristics between patients with and without diabetes mellitus, and the association between diabetes mellitus and outcomes of interest was assessed on matched samples. Results: Of the 4107 patients with AHRF included in this study, 3022 (73.6%) patients fulfilled ARDS criteria at admission or developed ARDS during their ICU stay. Diabetes mellitus was a pre-existing co-morbidity in 913 patients (22.2% of patients with AHRF). In multivariable analysis, there was no association between diabetes mellitus and having ARDS (OR 0.93 (0.78-1.11); p = 0.39), developing ARDS late (OR 0.79 (0.54-1.15); p = 0.22), or hospital mortality in patients with ARDS (1.15 (0.93-1.42); p = 0.19). In a matched sample of patients, there was no association between diabetes mellitus and outcomes of interest. Conclusions: In a large, global observational study of patients with AHRF, no association was found between diabetes mellitus and having ARDS, developing ARDS, or outcomes from ARDS. Trial registration: NCT02010073. Registered on 12 December 2013

Spontaneous Breathing in Early Acute Respiratory Distress Syndrome: Insights From the Large Observational Study to UNderstand the Global Impact of Severe Acute Respiratory FailurE Study

OBJECTIVES: To describe the characteristics and outcomes of patients with acute respiratory distress syndrome with or without spontaneous breathing and to investigate whether the effects of spontaneous breathing on outcome depend on acute respiratory distress syndrome severity. DESIGN: Planned secondary analysis of a prospective, observational, multicentre cohort study. SETTING: International sample of 459 ICUs from 50 countries. PATIENTS: Patients with acute respiratory distress syndrome and at least 2 days of invasive mechanical ventilation and available data for the mode of mechanical ventilation and respiratory rate for the 2 first days. INTERVENTIONS: Analysis of patients with and without spontaneous breathing, defined by the mode of mechanical ventilation and by actual respiratory rate compared with set respiratory rate during the first 48 hours of mechanical ventilation. MEASUREMENTS AND MAIN RESULTS: Spontaneous breathing was present in 67% of patients with mild acute respiratory distress syndrome, 58% of patients with moderate acute respiratory distress syndrome, and 46% of patients with severe acute respiratory distress syndrome. Patients with spontaneous breathing were older and had lower acute respiratory distress syndrome severity, Sequential Organ Failure Assessment scores, ICU and hospital mortality, and were less likely to be diagnosed with acute respiratory distress syndrome by clinicians. In adjusted analysis, spontaneous breathing during the first 2 days was not associated with an effect on ICU or hospital mortality (33% vs 37%; odds ratio, 1.18 [0.92-1.51]; p = 0.19 and 37% vs 41%; odds ratio, 1.18 [0.93-1.50]; p = 0.196, respectively ). Spontaneous breathing was associated with increased ventilator-free days (13 [0-22] vs 8 [0-20]; p = 0.014) and shorter duration of ICU stay (11 [6-20] vs 12 [7-22]; p = 0.04). CONCLUSIONS: Spontaneous breathing is common in patients with acute respiratory distress syndrome during the first 48 hours of mechanical ventilation. Spontaneous breathing is not associated with worse outcomes and may hasten liberation from the ventilator and from ICU. Although these results support the use of spontaneous breathing in patients with acute respiratory distress syndrome independent of acute respiratory distress syndrome severity, the use of controlled ventilation indicates a bias toward use in patients with higher disease severity. In addition, because the lack of reliable data on inspiratory effort in our study, prospective studies incorporating the magnitude of inspiratory effort and adjusting for all potential severity confounders are required

Assistência de enfermagem a idosos que realizam cateterismo cardíaco: uma proposta a partir do modelo de adaptação de Calista Roy Asistencia de enfermería a ancianos que realizan cateterismo cardíaco: una propuesta a partir del modelo de adaptación de Calista Roy Nursing care to elderly patients undergoing heart catheterization: a proposal according to the Adaptation model of Calista Roy

O estudo objetivou identificar os diagnósticos de enfermagem de idosos que realizam cateterismo cardíaco, abordando os aspectos psicossociais, segundo a Teoria de Adaptação de Roy. Desenvolveu-se em hospital de pronto-atendimento em cardiologia de Fortaleza-CE, de janeiro a julho de 2005. Utilizou-se entrevista semi-estruturada, com 18 idosos de ambos os sexos, no pré-cateterismo. Na análise reconheceram-se os diagnósticos: alteração na manutenção da saúde, ansiedade, medo e alteração no processo familiar. Como intervenções propõe-se: criar um clima de confiança, antes do exame; escutar e respeitar sentimentos, crenças e valores, orientar quanto ao procedimento. A utilização desta teoria permitiu reconhecer que as pessoas, mediante estímulos, podem desencadear respostas positivas ou negativas, cabendo ao enfermeiro atuar como mediador.<br>El estúdio objetivó identificar los diagnósticos de enfermería abordando los aspectos psico-sociales de los pacientes que realizan cateterismo cardiaco, según la Teoría de Adaptación de Roy. Se desarrolló en la sección de cardiología de un hospital de Fortaleza-CE, de Janeiro a Julio de 2005. Se utilizó la entrevista semi-estructurada, con 18 ancianos, en el pre-cateterismo. En el análisis reconocieron los diagnósticos: alteración en la manutención de la salud, ansiedad, miedo y alteración en el proceso familiar. Entre las acciones se elaboraron las siguientes: crearse un clima de confianza para el paciente después del examen; escuchar y respetar sentimientos, creencias y valores referentes a la situación; orientar el paciente cuanto al procedimiento. La utilización de esta teoría permitió reconocer que las personas, mediante estímulos, pueden desencadenar respuestas ora positivas ora negativas, cabiendo al enfermero actuar como mediador.<br>The study aimed at identifying the nursing diagnoses related to the psychological and social aspects of elderly patients undergoing cardiac catheterization, according to the Adaptation Theory of Calista Roy. It was developed in a cardiology unit in a hospital in Fortaleza, CE, from January to July, 2005. A semi-structured interview was used, with 18 elderly patients, in pre-catheterization period. The analysis identified the nursing diagnoses: alteration in the maintenance of the health, anxiety, fear and alteration in the family process. The nursing actions were: to create a trust climate for the aged before the exam; to listen and to respect feelings faiths and referring values to the situation; to guide the patient with relationships to the procedure. The use of this theory, allowed in recognizing that patients, by means of incentives, can unchain answers some positive times other negative times, fitting to the nurse to act as mediator

Cross-cultural adaptation of the Safety Attitudes Questionnaire - Short Form 2006 for Brazil Cuestionario de actitudes de seguridad: adaptación transcultural del Safety Attitudes Questionnaire - Short Form 2006 para Brasil Questionário Atitudes de Segurança: adaptação transcultural do Safety Attitudes Questionnaire - Short Form 2006 para o Brasil

The objective of this study was to perform a cross-cultural adaptation of the Safety Attitudes Questionnaire - Short Form 2006 for Brazil. The instrument was applied in six hospitals in three regions of Brazil. Content, face, and construct validity was performed. Analysis of the instrument's reliability was performed by verifying the items' internal consistency through Cronbach's alpha. The sample was composed of 1301 professionals working in clinical and surgical wards of six hospitals. Confirmatory analysis showed that the model including 41 items was satisfactory. The Portuguese version presented an alpha of 0.89. The item-total correlations among the domains were moderate to strong, except for the domain Stress Recognition. We concluded that the instrument's version adapted to Portuguese and applied in our sample is valid and reliable.<br>El objetivo de este estudio fue el de adaptación transcultural del cuestionario Actitudes de Seguridad - Short Form 2006 para Brasil. Métodos: El instrumento fue aplicado en seis hospitales en tres regiones del Brasil. Se realizó la validez de contenido, la cara y la construcción. El análisis de confiabilidad del instrumento se realizó mediante el análisis de la consistencia interna de los ítems a través de alfa de Cronbach. Resultados: La muestra del estudio fue compuesto por 1.301 profesionales en salas clínicas y cirugía. El análisis confirmatorio mostró que el ajuste del modelo final de los 41 ítems fue satisfactorio. La versión en portugués del instrumento mostró un alfa de 0,89. Las correlaciones ítem-total entre los dominios se consideran entre moderados y fuertes, con la excepción de dominio Percepción del Estrés. Conclusión: Se concluye, que la versión adaptada del instrumento al portugués se considera válida y fiable en la muestra.<br>O objetivo deste estudo foi realizar a adaptação transcultural do Safety Attitudes Questionnaire - Short Form 2006 para o Brasil. O instrumento foi aplicado em seis hospitais de três Regiões do Brasil. Foi realizada a validade de conteúdo, face e de construto. A análise da confiabilidade do instrumento foi realizada por meio da análise da consistência interna dos itens por meio do alfa de Cronbach. A amostra do estudo foi composta por 1.301 profissionais das enfermarias clínicas e cirúrgicas de seis hospitais. A análise confirmatória mostrou que o ajuste do modelo final dos 41 itens foi considerado satisfatório. Aversão do instrumento em Português apresentou alfa de 0,89. As correlações item/total entre os domínios foram consideradas de moderada a forte, com exceção do domínio percepção do estresse. Conclui-se, portanto, que a versão do instrumento adaptada para o Português é considerada válida e confiável nesta amostra