High morbid-mortability and reduced level of osteoporosis diagnosis among elderly people who had hip fractures in São Paulo City

OBJECTIVE: To know the morbid-mortality following an osteoporotic hip fracture in elderly patients living in São Paulo. PATIENTS AND METHODS: This study evaluated prospectively all patient over 60 years admitted in 2 school-hospitals in the city of São Paulo in a following 6-month period due to a osteoporotic proximal femur fracture. All of them filled up the Health Assessment Questionnaire (HAQ) and had their chart reviewed. After 6 months they were re-interviewed. Linear regression analysis was utilized to determine the factors related to functional ability. RESULTS: 56 patients were included (mean age 80.7 ± 7.9 years old, 80.4% females). After the 6-month follow up the mortality rate was 23.2%. Only 30% of the patients returned to their previous activities, and 11.6% became totally dependent. Factors related to worse functional ability after fracture were HAQ before fracture, institutionalization after fracture and age (r² 0.482). The diagnosis of osteoporosis was informed only by 13.9% of them, and just 11.6% received any treatment for that. CONCLUSION: Our results showed the great impact of these fractures on mortality and in the functional ability of these patients. Nevertheless, many of our physicians do not inform the patients about the diagnosis of osteoporosis and, consequently, the treatment of this condition is jeopardized.As fraturas osteoporóticas de fêmur proximal trazem graves conseqüências quanto à morbimortalidade e à qualidade de vida, mas desconhece-se este impacto no Brasil. OBJETIVO: Conhecer a morbimortalidade decorrente deste tipo de fraturas em idosos na cidade de São Paulo. MÉTODOS: Foram incluídos todos os pacientes com mais de 60 anos internados por fraturas de fêmur proximal durante seis meses, em dois hospitais de São Paulo. Os pacientes preencheram o questionário de capacidade funcional (HAQ), tiveram seu prontuário examinado e foram reavaliados após seis meses. Utilizou-se a análise de regressão linear para determinar os fatores relacionados à capacidade funcional. RESULTADOS: Cinqüenta e seis pacientes foram incluídos no estudo (80,7 ± 7,9 anos; 80,4% mulheres). A mortalidade em seis meses foi de 23,2%. Apenas 30% retornaram plenamente às suas atividades prévias e 11,6% tornaram-se completamente dependentes. Os fatores que mais bem conseguiram prever pior capacidade funcional após a fratura foram HAQ pré-fratura, institucionalização pós-fratura e idade (r² 0,482). Somente 13,9% receberam o diagnóstico de osteoporose e 11,6% iniciaram algum tratamento. CONCLUSÕES: Os resultados do presente estudo demonstram o impacto deste tipo de fraturas sobre a mortalidade e a capacidade funcional. Entretanto, a falha médica no diagnóstico e na orientação de tratamento da osteoporose permanece elevada.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaSanta Casa de Misericórdia de São Paulo Departamento de OrtopediaUNIFESP-EPM EPMUNIFESP, EPM, EPMSciEL

Characteristics, Identification, Training, and Perception of Leaders in Respiratory Care.

BACKGROUND: Leadership is critical to high-functioning teams; however, data are lacking for what defines successful respiratory therapist (RT) leadership. Leaders need a wide range of skills to be successful, although the exact characteristics, behaviors, and accomplishments of successful RT leaders are unknown. We performed a survey of respiratory care leaders to evaluate different aspects of RT leadership. METHODS: We developed a survey of RT leaders to examine respiratory care leadership in a variety of professional settings. Different aspects of leadership and the relationships between perceptions of leadership and well-being were assessed. Data analysis was descriptive. RESULTS: We received 124 responses, with a response rate of 37%. Respondents had a median 22 y of RT experience, and 69% were in leadership positions. The most-important skills identified for potential leaders were critical thinking (90%) and people skills (88%). Self-initiated projects (82%), intradepartmental education (71%), and precepting (63%) were noted accomplishments. Reasons for exclusion from leadership included poor work ethic (94%), dishonesty (92%), difficulty getting along with others (89%), unreliable (90%), and not being a team player (86%). Most respondents (77%) agreed American Association for Respiratory Care membership be a requirement for leadership; however, 31% required membership. Integrity (71%) was noted consistently as a characteristic of successful leaders. There was no consensus for behaviors of successful versus unsuccessful leaders or what defines successful leadership. Ninety-five percent of leaders had received some leadership training. Respondents reported that well-being is affected by leadership, departmental culture, peers, and leaders with burnout; 34% of respondents felt people with burnout received good support at their institution, whereas 61% felt maintaining well-being is left to individuals. CONCLUSIONS: Critical thinking and people skills were the most-important skills for potential leaders. Limited consensus existed on characteristics, behaviors, and defined success of leaders. Most respondents agreed leadership influences well-being

Permeate quality, advanced oxidation process treatability, and cost for two concentrate treatment technologies to enhance recovery for potable reuse

Closed circuit reverse osmosis (CCRO) and forward osmosis-RO (FO-RO) were evaluated at a pilot scale to generate additional permeate from RO concentrate – achieving a recovery of 61% for CCRO and 35% for FO-RO – at a full-scale advanced water purification facility. This study assessed permeate water quality, suitability of the permeate for treatment by an ultraviolet-advanced oxidation process (UV-AOP), and cost/footprint for a conceptual 10- or 20-mgd system. Both technologies demonstrated inorganic, organic, and microbiological constituent removal suitable for blending with primary RO permeate. Virus challenge testing with MS coliphage demonstrated ≥3.7-log removal by both technologies. Pilot-scale UV/hydrogen peroxide AOP treatment of CCRO or FO-RO permeate yielded similar performance (∼1.4-log N-nitrosodimethylamine removal and ∼0.5-log 1,4-dioxane removal) as the full-scale UV-AOP that treats the RO permeate from the purification facility. The estimated full-scale total unit cost (capital plus operation and maintenance costs) of product water produced by the two technologies was estimated to range from $0.91 to$1.12 per cubic meter, depending on the design flow rate of RO concentrate treated, and is estimated to be similar between the two technologies given the +50%/–30% expected accuracy of the Class 5 cost estimate. HIGHLIGHTS Reverse osmosis (RO) concentrate treatment from municipal potable reuse to generate purified water is feasible and economical.; Closed circuit reverse osmosis (CCRO) or forward osmosis-RO (FO-RO) permeate was suitable for blending with primary RO permeate.; Spike tests with MS coliphage showed ≥3.7 and ≥6 log removal for CCRO and FO-RO.; UV-AOP treatment of CCRO or FO-RO permeate was effective and consistent.

Enhancing Respiratory Therapists\u27 Well-Being: Battling Burnout in Respiratory Care.

Burnout is a major problem in health care and is associated with adverse sequelae for patients, health care workers, and organizations. Burnout among respiratory therapists (RTs) is as high as 79% and is associated with poor or ineffective leadership, inadequate staffing, high work load, non-leadership position, and work environment. An understanding of burnout is necessary for both staff and leadership to ensure RT well-being. This narrative review will discuss the psychology of burnout, prevalence, drivers, mitigation strategies, and future directions for research

Dupilumab improves lung function responder rates in children with type 2 asthma in the VOYAGE study

Guilbert T, Fiocchi AG, Murphy KR, et al. Dupilumab improves lung function responder rates in children with type 2 asthma in the VOYAGE study. In: ERS International Congress 2023 abstracts. European Respiratory Journal. Vol 62. Sheffield: European Respiratory Society; 2023.Introduction: Persistent lung function impairment in children with asthma is associated with impaired quality of life and risk of exacerbation. In phase 3 LIBERTY ASTHMA VOYAGE (NCT02948959), add-on dupilumab (DPL) was generally well tolerated and significantly reduced the annualized rate of severe exacerbations (AER) and improved lung function in children. Aims and objectives: To evaluate lung function responder rates at Week (Wk)12 and Wk52 of VOYAGE. Methods: Children 6–11 years with uncontrolled, moderate-to-severe, type 2 asthma (baseline [BL] blood eosinophils ≥150 cells/μL or fractional exhaled nitric oxide ≥20 ppb) were randomized to dupilumab 100mg/200mg (based on bodyweight) q2w or volume-matched placebo for 52 wks. Endpoints: least squares mean (LSM) change from BL in % predicted pre-BD FEV1 (ppFEV1) at Wk12 and 52; proportion of patients with ≥10% improvement in ppFEV1 at Wk12 and 52; and AER in those responders. Results: ppFEV1 was significantly improved with DPL vs placebo (PBO) at Wk12 (LSM difference [95% CI] 5.20 [2.14–8.26]; P= 0.0009) and Wk52 (7.79 [4.36–11.22]; P<0.0001). A ≥10% ppFEV1 improvement was achieved at Wk12 in 44.9% (n=106; [38.5–51.5]) vs 31.6% (n=36; [23.2–40.9]; P=0.0173) and at Wk52 in 47.5% (n=112; [40.9–54.0]) vs 28.1% (n=32; [20.1–37.3]; P=0.0006) of patients receiving DPL vs PBO, respectively. DPL vs PBO significantly decreased the AER in patients achieving ≥10% ppFEV1 improvement, 0.304 (n=106; [0.185–0.500]) vs 0.744 (n=36; [0.424–1.308]; P=0.0103), respectively