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by Carol Kotliar, Lisandro Olmos, Martín Koretzky, Ricardo Jauregui, Tomás Delía, Oscar Cingolani
ObjectiveTo evaluate the effectiveness of the Mental Training Tech 24.5 (MTT24.5) cognitive stimulation program, designed to enhance cognitive performance and neuroplasticity in healthy adults.
BackgroundCognitive decline is a significant concern in aging populations, with research suggesting that neuroplasticity and cognitive reserve can be enhanced through targeted cognitive training. The MTT24.5 program aims to stimulate brain function through a combination of new knowledge acquisition (DATA) and learning techniques (TECHS), organized into a systematic algorithm. This approach may offer a novel way to prevent or mitigate age-related cognitive decline.
DesignPilot clinical study, active-controlled, open randomization.
SettingAdults from the general population with no clinical cognitive deterioration, recruited from three sites within the Autonomous City of Buenos Aires and its metropolitan area.
Participants120 volunteers were enrolled, of which 76 participants (56 in the intervention group, 20 in the control group) met the study requirements and selected a site closest to their residence.
MethodsThe MTT24.5 program consists of 12 weekly in-person sessions (totaling 24.5 hours), during which participants learned 40 knowledge units (DATA) and 100 learning techniques (TECHS). These were organized into binomials, where each unit of DATA was paired with 3–4 TECHS. Pre- and post-intervention assessments included medical history, lifestyle factors, cognitive reserve scale, Addenbrooke’s Cognitive Examination-Revised (ACE-R), and Mini-Mental State Examination (MMSE).
ResultsThe mean age was 59 years for both groups. Baseline ACE-R scores were comparable (91.3). The global cognitive score increased by 4.6 points (5%) in the intervention group compared to a decrease of 0.5 points in the control group (p Conclusions
The MTT24.5 program, based on a systematic algorithm for acquiring new knowledge and skills, significantly enhances cognitive reserve and overall cognitive performance, particularly in individuals with lower baseline cognitive scores. These findings suggest that structured cognitive stimulation could play a critical role in preventing cognitive decline and promoting cognitive health in healthy adults. Given the promising results, future studies involving larger populations and long-term follow-up are essential to validate these effects and explore the potential for mitigating age-related cognitive decline and enhancing quality of life.
RegistrationThe study was registered in accordance with local regulations at the National Council for Scientific and Technological Research (CONICET) – Institute of Biomedical Research (BIOMED), and also in the National Ethics Committee, and at clinicaltrials.gov (NCT06549517).
Neonatal haemochromatosis, considered to be a gestational alloimmune liver disease (NH-GALD), is a rare but serious disease that results in fulminant hepatic failure. The recurrence rate of NH-GALD in a subsequent infant of a mother with an affected infant is 70%–90%. Recently, antenatal maternal high-dose intravenous immunoglobulin (IVIG) therapy has been reported as being effective for preventing recurrence of NH-GALD in a subsequent infant. However, no clinical trial has been conducted to date.
This is a multicentre open-label, single-arm study of antenatal maternal high-dose IVIG therapy in pregnant women with a history of documented NH in a previous offspring. The objective of this study is to evaluate the efficacy and safety of antenatal maternal high-dose IVIG therapy in preventing or reducing the severity of alloimmune injury to the fetal liver.
The clinical trial is being performed in accordance with the Declaration of Helsinki. The trial protocol was approved by the Clinical Research Review Board at four hospitals. Before enrolment, written informed consent would be obtained from eligible pregnant women. The results are expected to be published in a scientific journal.
28 October 2024, V.8.0.
jRCT1091220353.
To determine the prevalence of MARSI associated with peripherally inserted central venous catheters (PICCs) in oncology and haematology patients, analyse the type of injury and identify risk factors.
A prospective descriptive study was conducted from 9 June 2021 to 8 February 2022. The study population was oncology and haematology patients with a PICC. The variables to be studied included the presence of MARSI in relation to PICC maintenance, injury type, time to onset, mean healing time, and type of treatment received. A descriptive analysis of the entire sample was performed. Chi-square and Student's t-test or Mann–Whitney U-tests were used to identify risk factors, depending on the nature of the variables.
The sample studied was 342 PICCs inserted in 309 patients, 49% (n = 169) women, and the mean overall age was 62.12 years (SD: 12.33). Seventy-six per cent were oncology and 24% haematology patients. The prevalence of MARSI was 32% (n = 111). The most common type of injury was erythema in 39% (n = 42). The mean duration of the lesion was 20.90 days (SD: 31.44). Alkylating agents, among others, were identified as a risk factor.
The results indicate a high prevalence of MARSI. In agreement with the literature, mechanical injuries are the most frequent, and some antineoplastic treatments are a risk factor. This study may help to identify areas for improvement and design strategies for the prevention and treatment of MARSI.
This study has implications for clinical practice, as it helps to identify areas for improvement and the most relevant clinical practice guideline recommendations to avoid this adverse event.
No patient or public contribution.
To evaluate whether remdesivir is associated with cardiac adverse events (CAEs), addressing concerns raised by basic experiments, clinical case reports and observational studies.
Systematic review and meta-analysis.
MEDLINE and Embase, searched from January 2020 to December 2023.
Randomised controlled trials (RCTs) comparing remdesivir with placebo or standard care in patients with COVID-19, with a primary focus on cardiac safety.
We included RCTs that evaluated the safety of remdesivir in patients with COVID-19 . Eligible studies were those that compared remdesivir with placebo or standard care in adult patientsCOVID-19 . Inclusion criteria emphasised safety outcomes, particularly CAEs, as primary endpoints.
Two reviewers independently extracted data. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-Harms guidelines. Risk of bias (RoB) was assessed using the Cochrane Collaboration tool. A random-effects model was used for data synthesis. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was applied to assess the certainty of evidence. The primary outcome was the incidence of any CAEs, defined as a composite of all reported cardiac-related harms. Secondary outcomes included specific CAEs such as arrhythmias, heart failure and myocardial disorders.
We identified 1698 studies, of which seven RCTs met the inclusion criteria, comprising a total of 4566 participants. The RoB was assessed across multiple domains, with four RCTs showing low risk and three showing moderate risk in specific areas. Pooled analysis revealed no significant association between remdesivir use and CAEs (RR=0.84, 95% CI: 0.68 to 1.04, p=0.118). Subgroup analyses showed consistent findings across different patient demographics and comorbidities. GRADE assessment indicated moderate certainty for overall CAEs, low certainty for arrhythmias and heart failure (due to imprecision and study-level bias), and very low certainty for myocardial disorders (due to small sample size and indirectness).
Contrary to preliminary concerns and case reports, our meta-analysis found no evidence of a statistically significant association between remdesivir and CAEs among patients with COVID-19 . These findings provide reassurance to clinicians regarding the safety profile of remdesivir in this patient population, supporting its use as an antiviral therapy in the treatment of COVID-19. Further research is warranted to validate these findings and to clarify whether remdesivir may have a neutral or potentially protective effect on cardiac outcomes.
CRD42022383647.
Clinical trials are needed to advance interventions such as chemoprevention that have potential to reduce the risk of malignant transformation in individuals with oral potentially malignant disorders. We explored the perspectives of those screened or invited to join an early phase clinical trial (the SAVER trial: Sodium valproate for the epigenetic reprogramming of high-risk oral epithelial dysplasia). Our objectives were to inform the SAVER trial while it was ongoing and to provide insights for future trials and chemoprevention therapy development more broadly.
Qualitative study involving audio-recorded, semistructured interviews. Analysis of transcribed interviews drew on thematic approaches.
Five UK-based sites involved in SAVER.
Purposive sample of individuals (n=20) with suspected or diagnosed oral epithelial dysplasia (OED) who were approached about SAVER.
Most interviewees readily accepted that OED warranted preventive treatment and were positive about the potential of chemoprevention. However, they were often concerned about the side effects of the trial medication, and together with a dislike of biopsies and a perception that the trial might disadvantage treatment, these concerns made some hesitant to participate in SAVER. Interviewees indicated that the communication of staff influenced their understanding and experience of the trial and identified several opportunities for enhancing these aspects.
In indicating that individuals at risk of malignant transformation are accepting of chemoprevention in principle, our findings are supportive of future research on chemoprevention for this group. The findings also draw attention to the crucial role of communication in recruitment to chemoprevention trials. We provide recommendations to support staff during recruitment and enhance individuals’ experience of the trial.
ISRCTN12448611; Pre-results.
by Ĺubomír Skladaný, Daniela Žilinčanová, Michal Žilinčan, Stanislav Okapec, Filip Danček, Svetlana Adamcová-Selčanová, Michal Kukla, Tomáš Koller
Background and aimsHepatic venous pressure gradient (HVPG) is a strong surrogate of severity and outcome but its relative prognostic value in metabolic dysfunction-associated steatotic liver disease (MASLD) and alcohol-associated liver disease (ALD) is yet to be clarified. We compared HVPG in MASLD with ALD and other etiologies according to cirrhosis complications.
Patients and methodsIn our cirrhosis registry RH7, we identified patients with data on HVPG and scrutinized them against the etiology of advanced chronic liver disease (ACLD) (MASLD, ALD, Other) and specific complications of ACLD such as variceal bleeding or ascites. We excluded patients with advanced malignancies and less than 6 months of follow-up.
ResultsWe enrolled 220 patients with ALD, MASLD, and Other etiology in 128, 52, and 40 cases, respectively; te median age was 57, 60, and 52 years (P = 0.09); the proportion of females was 31, 67, and 55%, respectively (P 10 mmHg).
ConclusionIn our cirrhosis registry study of hospitalized patients with ACLD, baseline HVPG measured for accepted indications differed according to the etiology of dACLD: patients with ALD had the highest values followed by MASLD and Other etiologies. Importantly, when looked at from the point of view of complications, the treshold for clinically significant portal hypertension remained fixed at the level recommended by BAVENO Consensus - 10 mm Hg irrespective of etiology.
by Akiyo Sasaki-Otomaru, Kyoko Saito, Kotaro Yamasue, Osamu Tochikubo, Yuka Kanoya
Wearable devices have the potential to promote a healthy lifestyle; however, studies on the use of wearable devices in monitoring health in older adults are limited. We aimed to investigate the relationship of sleep and activity data with health status among older adults. Fifty-five community-dwelling older adults were asked to wear a wristwatch-type wearable device (the Pulsense [PS]) and measure home blood pressure (HBP) over a period of 5–7 consecutive days. Deep-sleep duration, physical and mental activity duration, and body-movement duration were obtained from PS data using special software. We also collected data on demographics and physical and mental health status. We found that the body-movement duration in women was longer than that in men. Among men, body-movement duration was strongly and negatively correlated with the Kihon Checklist (KCL) score. It also showed moderate correlations with the Geriatric Depression score, physical functioning, bodily pain, vitality, social function, and role emotional scores from the Medical Outcomes Survey Short Form-8 questionnaire, as well as with hand-grip strength. There was no significant correlation between monitoring data and health status in women. In the multiple linear regression analysis, body-movement duration was negatively associated with age and the KCL score. KCL is a common questionnaire for screening frailty in Japan. Our results showed that body-movement duration was negatively associated with age and the KCL score, suggesting the potential of PS in guiding personalized health management of older community-dwelling adults with risks of frailty.To analyse the effectiveness of an active ageing intervention modality through peer mentoring.
A quasi-experimental research study is carried out through three groups, one control (educational workshops on active ageing given by professionals) and two experimental (workshops given by peers with digital or face-to-face exposure).
All groups share duration (7 weeks) and content, modifying the route of exposure. The effectiveness of the model is measured through the variables of physical health, mental health and social support. Loneliness and the need for care are also controlled for.
The total sample consists of n = 209 people aged over 60 living in a rural context, of which n = 12 form the volunteer/mentor group. Active ageing interventions show an improvement in the perception of physical and mental health among people in need of some form of care, with all three modalities being equally effective. The impact on social support is analysed by controlling for the loneliness and social participation variable; in these cases, the face-to-face experimental group of peers is more effective than the others.
The peer-to-peer methodology is as effective as the traditional methodology with a practitioner in maintaining and improving health perception, and the face-to-face methodology with peers is more useful in fostering social support among people experiencing loneliness.
Peer mentoring is presented as a good strategy to improve social support for older people and to combat loneliness.
To address the prevention of dependency through the promotion of active ageing. Peer mentoring is confirmed to have a significant impact on social support and could be a socio-educational tool applicable to older people experiencing loneliness.
This study has adhered to JBI guidelines. JBI critical appraisal checklist for quasi-experimental studies has been used.
Volunteer mentors contributed to the design and delivery of the workshops.
To study the effects of virtual reality (VR) on pain perception among a paediatric population while being vaccinated. We will also investigate the effects of VR on the fear experienced by children during the vaccination procedure, as well as parental satisfaction levels.
Many studies, for example, in the fields of oncology, dermatology or plastic surgery, have described the benefits of using VR to reduce the perception of pain among paediatric populations. These results are encouraging, but their main limitations were the small sample sizes they included or their methodological design.
This will be a randomised clinical trial.
SPIRIT guidelines were followed to report this protocol, and we will use the CONSORT and CONSORT-EHEALTH guidelines to report the randomised clinical trial. The sample will comprise 148 children aged 3–14 years who will come for vaccination at the Tres Forques Health Center. The participants will be randomly allocated into intervention group (VR; n = 74) or (the control group standard-of-care; n = 74) at a 1:1 ratio. The intervention group will view experiences with a VR headset as a distraction measure. The study variables will be the level of pain and fear perceived by the child during vaccination, parental satisfaction with the vaccination procedure, and sociodemographic and vaccination variables.
The start of the study is planned for September 2020, and the results will be expected in September 2021.
This study aims to identify what measures reduce pain and fear in children during vaccination, which in turn, can help to improve the degree of parental satisfaction with these procedures.
Vaccination is an independent function of the nursing profession. Identifying which distraction measures reduce the perception of pain and fear in the paediatric population will not only improve children's experiences but will also improve the satisfaction of both parents and children, thus increasing the degree of compliance with the vaccination schedule.
To determine the effect of immersive virtual reality (VR) on perceived pain and fear in children during vaccination and parental satisfaction with the procedure.
Virtual reality can reduce the perception of pain by children but only three studies have analysed its use during vaccination to date; these had small sample sizes and imperfect methodological designs.
A randomised controlled clinical trial.
One hundred and sixty participants from the Tres Forques Health Center were randomly assigned to the intervention group (IG) (n = 82) in which distraction with immersive VR was used during the vaccination, while standard distraction techniques were used for the control group (n = 80). The primary outcome was pain (Wong–Baker FACES). Secondary outcomes included (Children's Fear Scale) and parental satisfaction with the vaccination procedure. Chi-squared tests were used for qualitative variables, relationships between quantitative variables were tested with Spearman correlations, and Mann–Whitney U- or Student t-tests were employed to assess the relationship between quantitative and qualitative variables.
Compared to the controls, the children in the IG reported significantly less pain and fear, while parental satisfaction was significantly higher. Reported pain and fear did not differ according to the sex of the patient. Child age was not linked to fear but was related to pain: the younger the patient, the greater the pain they described.
Immersive VR effectively controlled pain and fear in children during vaccination and increased parent satisfaction with the vaccination process. Patient sex did not influence the level of pain and fear but age did.
Improving vaccination experiences can reduce perceived pain and fear in children and increase parent satisfaction, thereby enhancing vaccination schedule adherence and improving group immunity.
The CONSORT Statement for non-pharmacological randomised clinical trials were followed.
To provide a snapshot of the current use of oral nutritional supplements, its association with inpatient characteristics, and with a focus on the role of nursing monitoring of food intake and implementing nutritional interventions for patients with low intake.
Retrospective cohort study.
The study collected data from a hospital database regarding oral nutritional supplement initiation and variables of patients hospitalised in internal medicine departments, who did not receive enteral or parenteral nutrition.
Of the 5155 admissions, 1087 fulfilled the inclusion criteria (47% female; mean age, 72.4 ± 14.6 years; mean length of stay, 14.6 ± 11.4 days). Sufficient food intake reporting was noted in 74.6% of the patients; of these 17% had decreased intake. Oral nutritional supplements and non-oral nutritional supplements groups did not differ in terms of sex, age, length of stay, Charlson Comorbidity Index, proportion of nursing reports, and absence of intake monitoring. Oral nutritional supplements were initiated in 31.9% of patients with a Malnutrition Universal Screening Tool score ≥2 and in 34.6% with decreased food intake. On multivariable analysis, hypoalbuminemia (adjusted odds ratio, 3.70), decreased food intake (adjusted odds ratio, 3.38), Malnutrition Universal Screening Tool score ≥2 (adjusted odds ratio, 2.10), and age <70 years (adjusted odds ratio, 1.56) were significantly associated with oral nutritional supplements use.
The prevalence of oral nutritional intervention was suboptimal in patients at risk of malnutrition during acute hospitalisation, although decreased food intake and Malnutrition Universal Screening Tool score ≥2 independently increased the probability of oral nutritional supplements initiation.
Understanding the clinical practice and nursing impact of care management in relation to nutritional intervention can assist in reviewing and improving patient care.
This study informs clinical management and influences nursing practice standards related to assessing, monitoring, and managing malnutrition risk.
The study impacts the quality of care for patients at risk of malnutrition.
We adhered to the STROBE Checklist for cohort studies.
No Patient or Public Contribution.
To describe how family members of critically ill patients experienced the COVID-19 visiting restrictions in Sweden.
In Sweden, the response to COVID-19 was less invasive than in many other countries. However, some visiting restrictions were introduced for intensive care units, with local variations. Although there is a growing body of literature regarding healthcare professionals' and family caregivers' perspectives on visiting restriction policies, there may be inter-country differences, which remain to be elucidated.
This study has a qualitative descriptive design. Focus group interviews with 14 family members of patients treated for severe COVID-19 infection were conducted. The interviews took place via digital meetings during the months after the patients' hospital discharge. Qualitative content analysis was used to interpret the interview transcripts. Reporting of the study followed the COREQ checklist.
Two categories—dealing with uncertainty and being involved at a distance—described family members' experiences of coping with visiting restrictions during the COVID-19 pandemic. These restrictions were found to reduce family members' ability to cope with the situation. Communication via telephone or video calls to maintain contact was appreciated but could not replace the importance of personal contact.
Family members perceived that the visiting restriction routines in place during the COVID-19 pandemic negatively influenced their ability to cope with the situation and to achieve realistic expectations of the patients' needs when they returned home.
This study suggests that, during the COVID-19 pandemic, the visiting restrictions were experienced negatively by family members and specific family-centred care guidelines need to be developed for use during crises, including the possibility of regular family visits to the ICU.
None in the conceptualisation or design of the study.
Objetivo principal: Analizar la importancia de los cuidados emocionales y las carencias que ha ocasionado la Pandemia de la COVID-19 en los últimos 6 meses. Metodología: Es una reflexión tras un relato estructurado entre tres enfermeras, dos de ella implicadas en los cuidados durante la pandemia de la COVID. Resultados principales: Se ha priorizado el cuidado físico, y se ha secundarizado el bienestar emocional debido a factores como la pérdida de las visitas familiares, la falta de las cuidadoras (TAE) habituales, falta de personal en enfermería profesional. Conclusión principal: La pandemia ha afectado a los Residentes de forma que se aprecian carencias cognitivas y socioafectivas. La epidemia durante estos seis meses nos ha demostrado que no es suficiente tener una residencia: de amplios espacios, edificio sostenible, limpio y con un buen equipo, ya que el cuidado emocional no se ha sabido y/o podido cubrir de forma adecuada.
Existen millones de personas cooperando internacionalmente en zonas con situaciones críticas. Concurre la posibilidad de que se produzca un choque cultural en estas personas que cooperan, el cual, pueda modificar sus capacidades profesionales y ocasionarles un fuerte impacto emocional. Quetzal, la informante, ha sido médica cooperante durante 10 años en diferentes territorios del mundo, y en su relato desvela la forma en la que el choque cultural se produce y cómo trata de gestionarlo. Se ha realizado un estudio con metodología cualitativa a través del relato biográfico. Se han recogido datos en la entrevista semiestructurada de la informante que fueron clasificados en torno al choque cultural, las situaciones críticas producidas, la información previa y el afrontamiento del choque. Los resultados giran en torno a las vivencias que se producen en la cooperación de la informante, su adaptación psicológica en el momento y su manera de asimilarlo con el paso del tiempo. Se considera la posibilidad de una formación emocional avanzada para convertir el choque cultural en un proceso con un desenlace positivo para las personas que cooperan.
Justificación. El Síndrome de Apneas-Hipoapneas durante el Sueño (SAHS) y su potencial vinculación con el cáncer ha generado un amplio interés en los últimos años. Objetivo. El principal objetivo es conocer y comparar la tasa de incidencia de tumores en pacientes con SAHS respecto de la población general. Metodología. Estudio retrospectivo de una cohorte de pacientes diagnosticados de SAHS entre 2004 y 2008 en un área de salud realizando el seguimiento hasta el año 2014. Resultados principales. De los 1239 sujetos, 94 fueron diagnosticados de cáncer incidente du-rante el seguimiento. En comparación con la población general mayor de 18 años, la tasa de incidencia fue similar entre los pacientes hombres con SAHS (RME 1,06; IC 95% 0,84-1,32) y ligeramente inferior en el caso de las mujeres de la muestra (RME 0,90; IC 95% 0,50-1,63). Conclusión. Al ajustar la tasa de incidencia de cáncer en pacientes con SAHS por edad y sexo, esta no es mayor que en la población general.
Rev Enferm;41(3): 210-216, mar. 2018. graf. [Artículo]
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