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Use of removable support boot versus cast for early mobilisation after ankle fracture surgery: cost-effectiveness analysis and qualitative findings of the Ankle Recovery Trial (ART)

Por: Baji · P. · Barbosa · E. C. · Heaslip · V. · Sangar · B. · Tbaily · L. · Martin · R. · Docherty · S. · Allen · H. · Hayward · C. · Marques · E. M. R.
Objectives

To estimate the cost-effectiveness of using a removable boot versus a cast following ankle fracture from the National Health Service and Personal Social Services (NHS+PSS) payer and societal perspectives and explore the impact of both treatments on participants’ activities of daily living.

Design

Cost-effectiveness analyses and qualitative interviews performed alongside a pragmatic multicentre randomised controlled trial.

Setting

Eight UK NHS secondary care trusts.

Participants

243 participants (60.5% female, on average 48.2 years of age (SD 16.4)) with ankle fracture. Qualitative interviews with 16 participants. Interventions removable air boot versus plaster cast 2 weeks after surgery weight bearing as able with group-specific exercises.

Primary and secondary outcome measures

Quality-adjusted life years (QALYs) estimated from the EQ-5D-5L questionnaire, costs and incremental net monetary benefit statistics measured 12 weeks after surgery, for a society willing-to-pay £20 000 per QALY.

Results

Care in the boot group cost, on average, £88 (95% CI £22 to £155) per patient more than in the plaster group from the NHS+PSS perspective. When including all societal costs, the boot saved, on average, £676 per patient (95% CI –£337 to £1689). Although there was no evidence of a QALY difference between the groups (–0.0020 (95% CI –0.0067 to 0.0026)), the qualitative findings suggest participants felt the boot enhanced their quality of life. Patients in the boot felt more independent and empowered to take on family responsibilities and social activities.

Conclusions

While the removable boot is slightly more expensive than plaster cast for the NHS+PSS payer at 12 weeks after surgery, it reduces productivity losses and the need for informal care while empowering patients. Given that differences in QALYs and costs to the NHS are small, the decision to use a boot or plaster following ankle surgery could be left to patients’ and clinicians’ preferences.

Trial registration number

ISRCTN15497399, South Central—Hampshire A Research Ethics Committee (reference 14/SC/1409).

Integrating factors associated with complex wound healing into a mobile application: Findings from a cohort study

Abstract

Complex, chronic or hard-to-heal wounds are a prevalent health problem worldwide, with significant physical, psychological and social consequences. This study aims to identify factors associated with the healing process of these wounds and develop a mobile application for wound care that incorporates these factors. A prospective multicentre cohort study was conducted in nine health units in Portugal, involving data collection through a mobile application by nurses from April to October 2022. The study followed 46 patients with 57 wounds for up to 5 weeks, conducting six evaluations. Healing time was the main outcome measure, analysed using the Mann–Whitney test and three Cox regression models to calculate risk ratios. The study sample comprised various wound types, with pressure ulcers being the most common (61.4%), followed by venous leg ulcers (17.5%) and diabetic foot ulcers (8.8%). Factors that were found to impair the wound healing process included chronic kidney disease (U = 13.50; p = 0.046), obesity (U = 18.0; p = 0.021), non-adherence to treatment (U = 1.0; p = 0.029) and interference of the wound with daily routines (U = 11.0; p = 0.028). Risk factors for delayed healing over time were identified as bone involvement (RR 3.91; p < 0.001), presence of odour (RR 3.36; p = 0.007), presence of neuropathy (RR 2.49; p = 0.002), use of anti-inflammatory drugs (RR 2.45; p = 0.011), stalled wound (RR 2.26; p = 0.022), greater width (RR 2.03; p = 0.002), greater depth (RR 1.72; p = 0.036) and a high score on the healing scale (RR 1.21; p = 0.001). Integrating the identified risk factors for delayed healing into the assessment of patients and incorporating them into a mobile application can enhance decision-making in wound care.

Perceived quality of life and associated factors in long COVID syndrome among older Brazilians: A cross‐sectional study

Abstract

Aims and objectives

This paper aims to: (a) determine the personal, sociodemographic, clinical, behavioural, and social characteristics of older Brazilians with clinical evidence of long COVID; (b) evaluate perceived quality of life and determine its association with personal, sociodemographic, behavioural, clinical and social variables; and (c) assess significant predictors of high perceived QoL.

Background

Given the inherent vulnerabilities of the ageing process, the older people are an at-risk group for both contagion of SARS-CoV-2 and the perpetuation of residual symptoms after infection, the so-called long COVID or post-COVID syndrome.

Design

A cross-sectional survey design using the STROBE checklist.

Methods

Brazilian older people with long COVID syndrome (n = 403) completed a phone survey measuring personal, sociodemographic, behavioural, clinical, and social characteristics, and perceived Quality of Life (QoL). Data were collected from June 2021–March 2022. A multiple linear regression model was performed to identify salient variables associated with high perceived QoL.

Results

The mean age of participants was 67.7 ± 6.6 years old. The results of the multivariate regression model showed that race, home ownership, daily screen time, musculoskeletal and anxiety symptoms, and work situation were the significant predictors of QoL among COVID-19 survivors.

Conclusions

Knowledge about the persistence of physical, emotional, and social symptoms of COVID-19 can help nurses and other healthcare providers to improve the management of survivors, bringing benefits to the whole society.

Relevance to clinical practice

Given the novelty of long-COVID and its heterogeneous trajectory, interventions focusing on the repercussions and requirements unique to more vulnerable older persons should be developed and these aspects should be included in public health recommendations and policymakers' concerns.

Patient or Public Contribution

No patient or public contribution was required to design, to outcome measures or undertake this research. Patients/members of the public contributed only to the data collection.

Preventing chronic malnutrition in children under 2 years in rural Angola (MuCCUA trial): protocol for the economic evaluation of a three-arm community cluster randomised controlled trial

Por: Martin-Canavate · R. · Custodio · E. · Trigo · E. · Romay-Barja · M. · Herrador · Z. · Aguado · I. · Ramirez · F. · Faria · L. M. · Silva-Gerardo · A. · Lima · J. C. · Iraizoz · E. · Marques · T. · Vargas · A. · Gomez · A. · Puett · C. · Molina · I.
Introduction

Chronic malnutrition is a serious problem in southern Angola with a prevalence of 49.9% and 37.2% in the provinces of Huila and Cunene, respectively. The MuCCUA (Mother and Child Chronic Undernutrition in Angola) trial is a community-based randomised controlled trial (c-RCT) which aims to evaluate the effectiveness of a nutrition supplementation plus standard of care intervention and a cash transfer plus standard of care intervention in preventing stunting, and to compare them with a standard of care alone intervention in southern Angola. This protocol describes the planned economic evaluation associated with the c-RCT.

Methods and analysis

We will conduct a cost-efficiency and cost-effectiveness analysis nested within the MuCCUA trial with a societal perspective, measuring programme, provider, participant and household costs. We will collect programme costs prospectively using a combined calculation method including quantitative and qualitative data. Financial costs will be estimated by applying activity-based costing methods to accounting records using time allocation sheets. We will estimate costs not included in accounting records by the ingredients approach, and indirect costs incurred by beneficiaries through interviews, household surveys and focus group discussions. Cost-efficiency will be estimated as cost per output achieved by combining activity-specific cost data with routine data on programme outputs. Cost-effectiveness will be assessed as cost per stunting case prevented. We will calculate incremental cost-effectiveness ratios comparing the additional cost per improved outcome of the different intervention arms and the standard of care. We will perform sensitivity analyses to assess robustness of results.

Ethics and dissemination

This economic evaluation will provide useful information to the Angolan Government and other policymakers on the most cost-effective intervention to prevent stunting in this and other comparable contexts. The protocol was approved by the República de Angola Ministério da Saúde Comité de Ética (27C.E/MINSA.INIS/2022). The findings of this study will be disseminated within academia and the wider policy sphere.

Trial registration number

ClinicalTrials.gov Registry (NCT05571280).

Use of Nile tilapia (<i>Oreocromis niloticus</i>) processing residues in the production of pâtés with the addition of oregano (<i>Origanum vulgare</i>) essential oil

by Marcos Antonio Matiucci, Iza Catarini dos Santos, Natallya Marques da Silva, Patricia Daniele Silva dos Santos, Gislaine Gonçalves Oliveira, Stefane Santos Corrêa, Elder dos Santos Araujo, Rafaela Said, Jaqueline Ferreira Silva, Ana Paula Sartório Chambó, Talita Aparecida Ferreira de Campos, Oscar Oliveira Santos, Claudete Regina Alcalde, Maria Luiza Rodrigues de Souza, Andresa Carla Feihrmann

The effect of the use of Nilo tilapia filleting residues in the production of pâtés with the addition of oregano essential oil stored for 90 days at 4 °C was evaluated. For that, 5 treatments were performed as follows: TSA—control treatment; TES with the addition of sodium erythorbate; and formulation TOE1 with 600 ppm oregano essential oil; TOE2 with 1000 ppm essential oil; and TOE3 with 1400 ppm essential oil. The pâtés showed adequate technological and physicochemical characteristics and microbiological counts within the legislation standards. No significant differences were observed in the luminosity of the pâté formulations during storage, and the addition of oil contributed to the increase in a* values and stability of b* values. Regarding the lipid and protein oxidation, TOE3 showed lower values at the end of the shelf-life. The addition of essential oil did not affect the hardness and cohesiveness of the products. The fatty acids in greater amounts in the samples were linoleic, oleic, palmitic, and stearic acids. The analysis of biogenic amines indicated that only the treatments with the highest amounts of sodium erythorbate (TES and TOE1) showed losses of spermidine. It was observed that decreasing the inclusion of sodium erythorbate and increasing the inclusion of oregano essential oil resulted in a drop in cadaverine values. A total of 46 volatile compounds were detected in the samples with the highest amount of free fatty acids and all the formulations were well accepted sensorially.

Aprendizaje generado a partir de la pandemia COVID-19 en enfermeros

Introducción: La enfermería brasileña parece haber alcanzado importantes niveles de aprendizaje durante la pandemia, no solo por la necesidad de controlar la circulación del nuevo coronavirus y cuidar a los enfermos. Objetivo: Conocer los aprendizajes generados a partir de la pandemia de COVID-19 entre las enfermeras. Métodos: estudio exploratorio y cualitativo, realizado en agosto y septiembre de 2021, con enfermeros de tercer nivel de salud que estuvieron en primera línea durante la pandemia, en el Estado de Mato Grosso, Brasil. Se realizaron entrevistas individuales, a partir de preguntas orientadoras. Para el análisis de los datos se utilizó el discurso del sujeto colectivo. Resultados: Como aprendizajes generados, los participantes señalaron aspectos profesionales (teórico/práctico), así como aspectos personales (reflejo del valor del ser humano, familia y realización profesional). Conclusión: Los aprendizajes proporcionados por la pandemia, si bien contribuye a la percepción de que ante la inseguridad y la incertidumbre es posible aprender y desarrollarse, enfatiza la condición de fortaleza del enfermero, que inicialmente durante la pandemia se vio debilitado, pero que se potenció la sensibilidad a nuevos descubrimientos, confrontaciones y fortalecimiento de sus recursos individuales y colectivos.

Application of ventilator-associated events (VAE) in ventilator-associated pneumonia (VAP) notified in Brazil (IMPACTO MR-PAV): a protocol for a cohort study

Por: Nascimento · G. M. · Gomes Rodrigues · D. L. · Mangas Catarino · D. G. · Piastrelli · F. T. · Cheno · M. Y. · Braz · K. C. C. · Oliveira Alves · L. B. · Avezum · A. · Veiga · V. C. · Zavascki · A. P. · Tomazini · B. · Besen · B. · Pereira · A. J. · Marques de Pinho · A. P. N. · De
Introduction

Certain criteria for ventilator-associated events (VAE) definition might influence the type of an event, its detection rate and consequently the resource expenditure in intensive care unit. The Impact of Infections by Antimicrobial-Resistant Microorganisms - Ventilator-Associated Pneumonia (IMPACTO MR-PAV) aims to evaluate the incidence and diagnostic accuracy of ventilator-associated pneumonia (VAP) using the current criteria for VAP surveillance in Brazil versus the VAE criteria defined by the US National Healthcare Safety Network-Center for Diseases Control and Prevention (CDC) criteria.

Methods and analysis

The study will be conducted in around 15 centres across Brazil from October 2022 to December 2023. Trained healthcare professionals will collect data and compare the incidence of VAP using both the current criteria for VAP surveillance in Brazil and the VAE criteria defined by the CDC. The accuracy of the two criteria for identifying VAP will also be analysed. It will also characterise other events associated with mechanical ventilation (ventilator-associated condition, infection-related ventilator-associated complication) and adjudicate VAP reported to the Brazilian Health Regulatory Agency (ANVISA) using current epidemiological diagnostic criteria.

Ethics and dissemination

This study was approved by the Institutional Review Board under the number 52354721.0.1001.0070. The study’s primary outcome measure will be the incidence of VAP using the two different surveillance criteria, and the secondary outcome measures will be the accuracy of the two criteria for identifying VAP and the adjudication of VAP reported to ANVISA. The results will contribute to the improvement of VAP surveillance in Brazil and may have implications for other countries that use similar criteria.

Trial registration number

NCT05589727; Clinicaltrials.gov.

Fatigue and resilience in Master’s and PhD students in the Covid-19 pandemic in Brazil: A cross-sectional study

by Izabel Alves das Chagas Valóta, Rafael Rodrigo da Silva Pimentel, Ana Paula Neroni Stina Saura, Rodrigo Marques da Silva, Ana Lucia Siqueira Costa Calache, Marcelo José dos Santos

The aim of this study was to analyze levels of fatigue and resilience of Brazilian graduate students during the COVID-19 pandemic and to determine whether there is an association between fatigue and resilience and sociodemographic and academic factors. Data were analyzed using descriptive and inferential statistics, and it was discovered that the variables associated with higher levels of resilience were age; having children; being retired; receiving income above five minimum wages; having had greater problems in other phases of the research schedule; coming from private universities; being from the north of Brazil; studying the area of Health; and having their research schedule unaffected during the pandemic. On the other hand, lack of resilience was associated with not having children; being less well-off financially; being younger; being a woman; studying in a public university; and having to postpone part of the research during the pandemic. The conclusion of the study indicated the need for graduate programs to design strategies to deal with fatigue and promote resilience in Master’s and PhD students.

Percepción de estudiantes de enfermería sobre la formación pedagógica en la pre- vención de la Sintomatología Musculoesquelética: estudio cualitativo

La formación de los estudiantes en la educación superior y específicamente en la licen-
ciatura en enfermería ha sido objeto de estudio por parte de los profesores. Es parte de la práctica
de enfermería respetar el proceso de toma de decisiones del estudiante y brindarle el derecho a la
información, promoviendo la adquisición de competencias que le permitan tomar decisiones res-
ponsables para su futuro. El objetivo de esta investigación fue conocer la perspectiva de los estu-
diantes de enfermería, en cuanto a su participación en la formación pedagógica sobre los síntomas
musculoesqueléticos. Sé realizó un estudio cualitativo, exploratorio y descriptivo mediante el mé-
todo de grupos focales con seis estudiantes de enfermería. El análisis cualitativo se realizó según
Bardin y el mapa mental se realizó con el software FreeMind®.Los estudiantes revelaron satisfac-
ción con el interés real en su aprendizaje con la reflexión sobre la adquisición de habilidades en
cuanto al conocimiento sobre los síntomas musculoesqueléticos y la necesidad del pensamiento crí-
tico en la profesión de enfermería.

Notificaciones de lesiones de piel en un Hospital Universitario

Objetivo: Analizar las notificaciones de lesiones de piel en un hospital universitario. Método: Estudio descriptivo, realizado en un hospital universitario, localizado en Salvador, Bahia, Brasil, con datos secundarios de notificaciones de incidentes. Fueron investigadas características sociodemográficas de los pacientes con lesiones de piel y características de las lesiones notificas en los años 2016 y 2017. Los datos fueron recolectados entre los meses de septiembre 2018 y mayo 2019 y el estudio respetó los principios éticos de investigación. Resultados: Fueron notificados 96 casos de lesión de piel. La mayoría fue adquirida en la hospitalización (89,58%), siendo frecuente la lesión por presión (77,08%), en la región sacra o glútea (61,46%), con pérdida de piel (54,17%), en grado leve (89,58%) y que prolongaron la hospitalización (7,29%). Conclusión: A pesar de ser realizada evaluación del riesgo para lesión, en más de la mitad de las notificaciones se observa que el tipo más prevalente fue la lesión por presión.

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