Manual de exercícios fisioterapêuticos para pacientes submetidos a transplante de células tronco hematopoiéticas

O estudo consiste da elaboração de um manual de exercícios fisioterapêuticos para pacientes adolescentes e adultos submetidos a transplante de células tronco hematopoiéticas (TCTH). O TCTH é um procedimento complexo, onde o paciente recebe uma infusão de medula óssea de um doador (aparentado ou não aparentado) ou de uma autodoação (autólogo). A realização de exercício físico no período do transplante (antes, durante e após) pode auxiliar na melhora da força muscular e na resistência à fadiga, possibilitando melhor qualidade de vida destes indivíduos. A construção de um manual é uma oportunidade para uniformizar e oficializar as condutas no cuidado ao paciente, com o auxílio de todos envolvidos (profissionais e pacientes). Um estudo qualitativo foi desenvolvido através de metodologia específica sobre construção de manuais educativos em saúde, seguindo algumas etapas para sua elaboração: definição e seleção dos conteúdos, adaptação da linguagem, inclusão das ilustrações, elaboração do manual piloto, qualificação do manual (painel de profissionais da saúde), layout do manual. O manual será disponibilizado de forma impressa ou digital. O estudo foi realizado de maio de 2019 a maio de 2020, após a aprovação do CEP. O projeto foi financiado com recurso próprio do pesquisador.The study consists of the elaboration of a manual of physical therapy exercises for patients teenagers and adults undergoing hematopoietic stem cell transplantation (HSCT). HSCT is a complex procedure where the patient receives an infusion of bone marrow from a donor (related and unrelated) or from a self-donation (autologous). Performing physical exercise during the transplant period (before, during and after) can help improve muscle strength, fatigue resistance, enabling better quality of life for these individuals. The construction of a manual is an opportunity to standardize and officialize the conducts in patient care, with the help of all involved (professionals and patients). A qualitative study was developed through a specific methodology on the construction of educational manuals in health, following the steps for its elaboration: definition and selection of contents, language adaptation, inclusion of illustrations, preparation of the pilot manual, qualification of the manual (panel of health professionals), layout of the manual. The manual will be made available in print or digital form. The study was conducted from May 2019 to May 2020, after the approval of the CEP. The project was financed with the researcher's own resources

Functional capacity, lung function, and muscle strength in patients undergoing hematopoietic stem cell transplantation : a prospective cohort study

Objective/Background: Hematopoietic stem cell transplantation (HSCT) is a treatment for benign and malignant hematological diseases. These aggressive treatments cause reduced levels of physical activity, decreased lung function, and worse quality of life. Alterations in pulmonary function tests before HSCT are associated with the risk of respiratory failure and early mortality. The objective of this study was to evaluate functional capacity and lung function before and after HSCT and identify the predictors of mortality after 2 years. Methods: A prospective cohort study was carried out with individuals with oncohematological diseases. The evaluations were carried out in two moments during hospitalization and at hospital discharge. Follow-up was carried out after 48 months. Assessments were carried out on 34 adults, using spirometry, manovacuometry, 6-Minute Walk Test (6MWT), Handgrip Strength Test, and 30-Second Chair Stand Test (30-s CST). Results: There was a statistically significant reduction for the variables in forced vital capacity, forced expiratory volume predicted in the 1st second, Tiffeneau index, handgrip strength, and distance covered (% predicted) on the 6MWT (p < .05). There was a significant difference in the 30-s CST when individuals were compared according to the type of transplant. We found that a 10% reduction in the values of maximum inspiratory pressure (MIP) can predict an increased risk for mortality. Conclusions: Individuals undergoing HSCT have reduced functional capacity, lung function, and muscle strength during the hospitalization phase. Reduction in the values of MIP increases the risk of nonrelapse mortality

Manual de exercícios fisioterapêuticos para pacientes submetidos a transplante de células tronco hematopoiéticas

O estudo consiste da elaboração de um manual de exercícios fisioterapêuticos para pacientes adolescentes e adultos submetidos a transplante de células tronco hematopoiéticas (TCTH). O TCTH é um procedimento complexo, onde o paciente recebe uma infusão de medula óssea de um doador (aparentado ou não aparentado) ou de uma autodoação (autólogo). A realização de exercício físico no período do transplante (antes, durante e após) pode auxiliar na melhora da força muscular e na resistência à fadiga, possibilitando melhor qualidade de vida destes indivíduos. A construção de um manual é uma oportunidade para uniformizar e oficializar as condutas no cuidado ao paciente, com o auxílio de todos envolvidos (profissionais e pacientes). Um estudo qualitativo foi desenvolvido através de metodologia específica sobre construção de manuais educativos em saúde, seguindo algumas etapas para sua elaboração: definição e seleção dos conteúdos, adaptação da linguagem, inclusão das ilustrações, elaboração do manual piloto, qualificação do manual (painel de profissionais da saúde), layout do manual. O manual será disponibilizado de forma impressa ou digital. O estudo foi realizado de maio de 2019 a maio de 2020, após a aprovação do CEP. O projeto foi financiado com recurso próprio do pesquisador.The study consists of the elaboration of a manual of physical therapy exercises for patients teenagers and adults undergoing hematopoietic stem cell transplantation (HSCT). HSCT is a complex procedure where the patient receives an infusion of bone marrow from a donor (related and unrelated) or from a self-donation (autologous). Performing physical exercise during the transplant period (before, during and after) can help improve muscle strength, fatigue resistance, enabling better quality of life for these individuals. The construction of a manual is an opportunity to standardize and officialize the conducts in patient care, with the help of all involved (professionals and patients). A qualitative study was developed through a specific methodology on the construction of educational manuals in health, following the steps for its elaboration: definition and selection of contents, language adaptation, inclusion of illustrations, preparation of the pilot manual, qualification of the manual (panel of health professionals), layout of the manual. The manual will be made available in print or digital form. The study was conducted from May 2019 to May 2020, after the approval of the CEP. The project was financed with the researcher's own resources

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit