Effects of exercise training on endothelial and diastolic age-related dysfunctions: a new view of an old problem

Coordination for the Improvement of Higher Level Personnel (CAPES)Fed Univ Sao Paulo UNIFESP EPM, Paulista Sch Med, Pulm Funct & Clin Exercise Physiol Unit, Resp Div, Sao Paulo, BrazilFed Univ Sao Paulo UNIFESP EPM, Paulista Sch Med, Pulm Funct & Clin Exercise Physiol Unit, Resp Div, Sao Paulo, BrazilCAPESWeb of Scienc

Evaluación preoperatoria del paciente neumópata

Background and objectives:In daily clinical practice, pulmonary complications related to surgical procedure are common, increasing the morbidity and mortality of patients. Assessment of the risk of pulmonary complications is an important step in the preoperative evaluation. Thus, we review the most relevant aspects of preoperative assessment of the patient with lung disease.Content:Pulmonary risk stratification depends on clinical symptoms and patient's physical status. Age, preexisting respiratory diseases, nutritional status, and continued medical treatment are usually more important than additional tests. Pulmonary function tests are of great relevance when high abdominal or thoracic procedures are scheduled, particularly when lung resection are considered.Conclusion:Understanding the perioperative evaluation of the potential risk for developing pulmonary complication allows the medical team to choose the adequate anesthetic technique and surgical and clinical care required by each patient, thereby reducing adverse respiratory outcomes.Justificación y objetivo:en la práctica clínica diaria son comunes las complicaciones pulmonares relacionadas con el procedimiento quirúrgico, lo que aumenta la morbimortalidad de los pacientes. La ponderación del riesgo de complicaciones pulmonares es un importante paso en la evaluación preoperatoria. Por lo tanto, hicimos una revisión de los aspectos más relevantes de la evaluación preoperatoria del paciente neumópata.Contenido:la estratificación del riesgo pulmonar depende de los síntomas clínicos y del estado físico del enfermo. La edad, enfermedades respiratorias preexistentes, estado nutricional y tratamiento médico continuado son, generalmente, más importantes que los exámenes complementarios. Los test de función pulmonar tienen una gran relevancia cuando se trata de procedimientos torácicos o abdominales altos, especialmente si se tiene en cuenta la realización de la resección pulmonar.Conclusiones:la comprensión de la evaluación perioperatoria acerca del riesgo para la potencial complicación pulmonar, le permite al equipo médico elegir una adecuada técnica anestésica y cuidados clínicos y quirúrgicos que se adecúen a cada paciente, reduciendo así los resultados respiratorios no favorables.Justificativa e objetivos:Na prática clínica diária, complicações pulmonares relacionadas ao procedimento cirúrgico são comuns, o que aumenta a morbidade e mortalidade dos pacientes. A ponderação do risco de complicações pulmonares é um importante passo da avaliação pré-operatória. Dessa forma, fizemos uma revisão dos aspectos mais relevantes da avaliação pré-operatória do paciente pneumopata.Conteúdo:A estratificação do risco pulmonar depende dos sintomas clínicos e do estado físico do doente. Idade, doenças respiratórias preexistentes, estado nutricional e tratamento médico continuado são, geralmente, mais importantes do que exames complementares. Testes de função pulmonar assumem grande relevância quando procedimentos torácicos ou abdominais alto são propostos, especialmente se considerada a realização de ressecção pulmonar.Conclusões:A compreensão da avaliação perioperatória acerca do risco para potencial complicação pulmonar permite à equipe médica escolher adequada técnica anestésica e cuidados clínicos e cirúrgicos que se adequem a cada paciente, o que reduz, portanto, desfechos respiratórios desfavoráveis.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaHarvard Medical School Massachusetts General HospitalUNIFESP, EPMSciEL

Breaking bad news in neurology: assessing training, perceptions, and preparedness among residency programs in Brazil

ABSTRACT Objective We aimed to evaluate how breaking bad news training was implemented in neurology residency programs in Brazil and to assess the perception and preparedness of trainees and program directors. Methods We performed a cross-sectional descriptive study. Neurology trainees and program directors were recruited from the Brazilian Academy of Neurology registry through convenience sampling. Participants answered a survey evaluating the breaking bad news training at their institution and their preparedness and perception towards the topic. Results We collected 172 responses from 47 neurology institutions from all five socio-demographic regions of Brazil. More than 77% of trainees were dissatisfied with their breaking bad news training, and around 92% of program directors believed their programs required substantial improvement. Approximately 31% of neurology trainees reported never having a lecture about communicating bad news, 66% reported never having a simulated training, and nearly 61% never received feedback regarding their communication abilities. Moreover, 59% of program directors acknowledged that feedback was not a standard practice and nearly 32% reported the absence of any specific training. Conclusion This study suggested that the breaking bad news training in neurology residencies across Brazil is deficient and highlighted challenges to achieve this core competency. Program directors and trainees recognized the importance of the topic, and program directors acknowledged that many factors hinder the ability to implement formal training. Given the relevance of such a skill to patient care, every effort should be made to provide structured training opportunities during residency

Uma Estratégia Simplificada Para A Seleção Da Carga Em Testes De Endurance De Alta Intensidade Para Avaliação De Resposta Terapêutica Em Pacientes Com Dpoc

Time To Limitation (Tlim) In Response To Constant Work Rate (Cwr) Is Sensitive To Interventions In Chronic Obstructive Pulmonary Disease (Copd). Although A Recent European Respiratory Society Taskforce Recommended A Pre-Intervention Test Lasting 3 To 8 Min (Tlim3"-8"), There Is No Simple Method To Select A Cwr Consistently Associated With Tlim3"-8". The Aims Of The Present Study Were To Validate A Pragmatic Strategy To Select A Work Rate (Wr) Associated With Tlim3"-8", And To Assess Reproducibility And Responsiveness Of The Resulting Cwr3"-8" Test. We Assessed 59 Gold Stages Ii " Iv Copd Patients, Who Initially Cycled To Tlim At 75% Peak (Wrpeak). In Case Of Short ( 8 Min, High-Endurance) Tests, Patients Exercised After 60 Min At 50% Or 90%, Respectively. Critical Mechanical Constraints And Limiting Dyspnea At 75% Were Reached Within The Desired Timeframe In 27 "Mid-Endurance" Patients (45.7%). Decreasing Or Increasing Cwr Intensity Slowed Or Hastened, Respectively, The MechaO Tempo De Tolerância (Tlim) Ao Teste Cardiopulmonar De Carga Constante (Tcc) Em Cicloergômetro É Uma Variável Sensível A Intervenções Terapêuticas Em Pacientes Com Dpoc. Embora Uma Diretriz Recente Da European Respiratory Society Tenha Recomendado Que O Tlim Pré-Intervenção Seja De 3 A 8 Minutos (Tlim3"-8"), Não Há Um Método Simples Para Selecionar A Carga Que Deve Ser Aplicada Para Sistematicamente Obtermos O Tlim Dentro Desta Faixa. Nós Avaliamos 59 Pacientes Com Dpoc Gold Ii-Iv Com O Objetivo De Testar Uma Estratégia Pragmática De Seleção Da Carga Que Possibilitasse A Obtenção Do Tlim3"-8" E Resultasse Em Testes Reprodutíveis E Sensíveis A Intervenções. Todos Os Pacientes Realizaram Um Tcc A 75% Da Carga De Pico (Tcc75%) Do Teste Incremental Prévio, Até O Limite Da Tolerância. Em Caso De Testes Curtos (8 Minutos, "Alta Endurance"), Os Pacientes Repetiam O Teste Após 1 Hora Com 50% Ou 90% Da Carga De Pico, Respectivamente. Limitação Ventilatória E Dispneia IntoleDados abertos - Sucupira - Teses e dissertações (2018

Preoperative evaluation of the patient with pulmonary disease

Background and objectives: In daily clinical practice, pulmonary complications related to surgical procedure are common, increasing the morbidity and mortality of patients. Assessment of the risk of pulmonary complications is an important step in the preoperative evaluation. Thus, we review the most relevant aspects of preoperative assessment of the patient with lung disease. Content: Pulmonary risk stratification depends on clinical symptoms and patient's physical status. Age, preexisting respiratory diseases, nutritional status, and continued medical treatment are usually more important than additional tests. Pulmonary function tests are of great relevance when high abdominal or thoracic procedures are scheduled, particularly when lung resection are considered. Conclusion: Understanding the perioperative evaluation of the potential risk for developing pulmonary complication allows the medical team to choose the adequate anesthetic technique and surgical and clinical care required by each patient, thereby reducing adverse respiratory outcomes. Keywords: Anesthesia, Evaluation, Lung, Pneumonectom

Family caregiver burden: the burden of caring for lung cancer patients according to the cancer stage and patient quality of life

ABSTRACT Objective: Patients with lung cancer experience different feelings and reactions, based on their family, social, cultural, and religious backgrounds, which are a source of great distress, not only for the patients but also for their family caregivers. This study aimed to evaluate the impact that lung cancer stage and quality of life (QoL) of lung cancer patients have on caregiver burden. Methods: This was a prospective cross-sectional study. Consecutive patient-caregiver dyads were selected and asked to complete the Hospital Anxiety and Depression Scale and the Medical Outcomes Study 36-item ShortForm Health Survey (SF-36). Family caregivers also completed the Caregiver Burden Scale. Group-based modeling was used in order to identify patients with early- or advanced-stage cancer (IA to IIIA vs. IIIB to IV) plus non-impaired or impaired QoL (SF36 total score > 50 vs. ≤ 50). Patient-caregiver dyads were stratified into four groups: early-stage cancer+non-impaired QoL; advanced-stage cancer+non-impaired QoL; early-stage cancer+impaired QoL; and advanced-stage cancer+impaired QoL. Results: We included 91 patient-caregiver dyads. The majority of the patients were male and heavy smokers. Family caregivers were younger and predominantly female. The burden, QoL, level of anxiety, and level of depression of caregivers were more affected by the QoL of the patients than by their lung cancer stage. The family caregivers of the patients with impaired QoL showed a higher median burden than did those of the patients with non-impaired QoL, regardless of disease stage. Conclusions: Caregiver burden is more affected by patient QoL than by lung cancer stage

Barriers to enrollment in pulmonary rehabilitation in a private hospital in Brazil: a physician survey study

Introduction: Pulmonary rehabilitation (PR) plays a key role in the management of chronic lung diseases, but it remains largely underused worldwide. The aim of this study was to assess clinicians’ knowledge about PR and to identify the barriers they encounter when referring patients with medical insurance to PR in a private hospital in Brazil. Methodology: This was a survey-based cross-sectional study conducted in 2019 at a reference hospital in São Paulo, Brazil. Eligible participants were physicians registered with the following specialties: Internal Medicine, Geriatrics, Cardiology, Pulmonology or Thoracic Surgery. Results: We collected 72 responses. While 99% of participants recognized COPD as a potential indication for PR, interstitial lung disease, bronchiectasis and pulmonary hypertension were less often recognized (75%). Most participants (67%) incorrectly associated PR with lung function improvement, while 28% of cardiologists and 35% of internists/geriatricians failed to recognize benefits on mood disorders. Notably, 18% of participants recommended PR only to patients on supplemental oxygen and 14% prescribed only home physiotherapy, patterns more commonly seen among non-respiratory physicians. The 3 most perceived barriers to referral and adherence were health insurance coverage (79%), transportation to the PR center (63%) and lack of social support (29%). Conclusions: Financial, logistic and social constraints pose challenges to PR enrollment even for patients with premium healthcare insurance plans. Moreover, physician knowledge gaps may be an additional barrier to PR referral and uptake. Providing continued medical education, incorporating automatic reminders in electronic medical records and using telerehabilitation tools may improve PR referral, adherence and ultimately patient care

Family caregiver burden: the burden of caring for lung cancer patients according to the cancer stage and patient quality of life

ABSTRACT Objective: Patients with lung cancer experience different feelings and reactions, based on their family, social, cultural, and religious backgrounds, which are a source of great distress, not only for the patients but also for their family caregivers. This study aimed to evaluate the impact that lung cancer stage and quality of life (QoL) of lung cancer patients have on caregiver burden. Methods: This was a prospective cross-sectional study. Consecutive patient-caregiver dyads were selected and asked to complete the Hospital Anxiety and Depression Scale and the Medical Outcomes Study 36-item ShortForm Health Survey (SF-36). Family caregivers also completed the Caregiver Burden Scale. Group-based modeling was used in order to identify patients with early- or advanced-stage cancer (IA to IIIA vs. IIIB to IV) plus non-impaired or impaired QoL (SF36 total score > 50 vs. ≤ 50). Patient-caregiver dyads were stratified into four groups: early-stage cancer+non-impaired QoL; advanced-stage cancer+non-impaired QoL; early-stage cancer+impaired QoL; and advanced-stage cancer+impaired QoL. Results: We included 91 patient-caregiver dyads. The majority of the patients were male and heavy smokers. Family caregivers were younger and predominantly female. The burden, QoL, level of anxiety, and level of depression of caregivers were more affected by the QoL of the patients than by their lung cancer stage. The family caregivers of the patients with impaired QoL showed a higher median burden than did those of the patients with non-impaired QoL, regardless of disease stage. Conclusions: Caregiver burden is more affected by patient QoL than by lung cancer stage

Highlights from the 2018 European Respiratory Society International Congress: sleep and clinical physiology

The 2018 European Respiratory Society (ERS) International Congress held in Paris, France, served as a platform to discover the latest research on respiratory diseases, the improvement in their treatments and patient care. Specifically, the scientific sessions organised by ERS Assembly 4 provided novel insights into sleep disordered breathing and fresh knowledge in respiratory physiology, stressing its importance to understanding and treating respiratory diseases. This article, divided by session, will summarise the most relevant studies presented at the ERS International Congress. Each session has been written by early career members specialised in the different fields of this interdisciplinary assembly.Peer reviewe