Purpose Dysphagia is a serious extra pulmonary manifestation of chronic obstructive pulmonary disease (COPD). However, the nature of abnormalities in swallowing physiology in COPD has yet to be clearly established. We explored the frequency of swallowing measures outside the healthy reference range in adults with COPD. Method Participants were 28 adults aged 41–79 years (18 men, 20 women) with stable COPD. Disease severity was classified as GOLD (Global Initiative For Chronic Obstructive Lung Disease) Stages 1 (4%), 2 (25%), 3 (53%), and 4 (18%). Participants underwent a videofluoroscopy and swallowed 20% w/v thin barium in, followed by 20% w/v mildly, moderately, and extremely thick barium prepared with a xanthan gum thickener. Blinded duplicate ratings of swallowing safety, efficiency, kinematics, and timing were performed according to the ASPEKT method (Analysis of Swallowing Physiology: Events, Kinematics and Timing). Comparison data for healthy adults aged < 60 years were extracted from an existing data set. Chi-square and Fisher's exact tests compared the frequencies of measures falling < 1 SD / > 1 SD from mean reference values (or < the first or > the third quartile for skewed parameters). Results Participants with COPD did not display greater frequencies of penetration–aspiration, but they were significantly more likely ( p < .05) to display incomplete laryngeal vestibule closure (LVC), longer time-to-LVC, and shorter LVC duration. They also displayed significantly higher frequencies of short upper esophageal sphincter opening, reduced pharyngeal constriction, and pharyngeal residue. Conclusion This analysis reveals differences in swallowing physiology in patients with stable COPD characterized by impaired safety related to the mechanism, timing, and duration of LVC and by impaired swallowing efficiency with increased pharyngeal residue related to poor pharyngeal constriction.
Resumo Objetivo Avaliar a eficácia da intervenção telefônica realizada por enfermeira na diminuição dos escores de ansiedade de pacientes em tratamento radioterápico. Métodos Ensaio clínico randomizado realizado em ambulatório de radioterapia com seguimento de 15 dias. A amostra foi composta por 39 pacientes em tratamento radioterápico (20 no Grupo Intervenção e 19 no Grupo Controle). As intervenções foram realizadas por meio de dois contatos telefônicos. Para coleta de dados, utilizaram-se questionário com questões sociodemográficas e clínicas, e Inventário de Ansiedade Traço-Estado. Os dados foram analisados pelo pacote estatístico Statistical Package for Social Sciences. O teste t de Student para amostras pareadas foi utilizado para comparar os momentos pré e pós-intervenção. Resultados Houve redução significativa dos escores de ansiedade após as ligações telefônicas (p<0,027) para os pacientes do Grupo Intervenção. Conclusão O uso do telefone durante seguimento de 15 dias mostrou-se estratégia eficaz para a diminuição dos escores de ansiedade de pacientes em tratamento radioterápico. Registro Brasileiro de Ensaios Clínicos – REBEC: RBR-8wn8ck
Objetivo: Analisar as características dos neonatos com Síndrome do Desconforto Respiratório (SDR), considerando a via de parto, admitidos em uma Unidade de Terapia Intensiva de um hospital universitário da região central do Rio Grande do Sul. Materiais e métodos: Estudo retrospectivo, realizado no período de abril a maio de 2017, através da análise de prontuários de neonatos com idade gestacional acima de 37 semanas, ambos os sexos, internados no ano de 2016 na Unidade de Terapia Intensiva Neonatal (UTIN) do Hospital Universitário de Santa Maria com CID 10 P22 – Desconforto (angústia) respiratório(a) do recém-nascido. Resultados: A amostra foi constituída por 40 registros de nascimentos (25 do sexo masculino), divididos em parto vaginal (n=11) e cesárea (n=29), representando 27,5% e 72,5%, respectivamente, das internações totais. A média de idade materna foi de 27±7 anos, com uma média de 7±5 consultas pré-natais. Durante o período de internação 65%(n=26) dos 40 neonatos necessitaram de oxigenoterapia. Conclusão: A partir dos resultados obtidos no presente estudo, observamos que a SDR representa 11% das internações ocorridas na UTIN, no ano de 2016. A prevalência, quanto ao tipo de parto, foi de neonatos nascidos de cesariana, sem a presença do trabalho de parto e com idade gestacional de 38 semanas. Descritores: Unidades de Terapia Intensiva Neonatal. Recém-Nascido. Síndrome do Desconforto Respiratório. Cesárea. Parto Normal.
OBJECTIVE: To compare TLC and RV values obtained by the single-breath helium dilution (SBHD) method with those obtained by whole-body plethysmography (WBP) in patients with normal lung function, patients with obstructive lung disease (OLD), and patients with restrictive lung disease (RLD), varying in severity, and to devise equations to estimate the SBHD results. METHODS: This was a retrospective cross-sectional study involving 169 individuals, of whom 93 and 49 presented with OLD and RLD, respectively, the remaining 27 having normal lung function. All patients underwent spirometry and lung volume measurement by both methods. RESULTS: TLC and RV were higher by WBP than by SBHD. The discrepancy between the methods was more pronounced in the OLD group, correlating with the severity of airflow obstruction. In the OLD group, the correlation coefficient of the comparison between the two methods was 0.57 and 0.56 for TLC and RV, respectively (p < 0.001 for both). We used regression equations, adjusted for the groups studied, in order to predict the WBP values of TLC and RV, using the corresponding SBHD values. It was possible to create regression equations to predict differences in TLC and RV between the two methods only for the OLD group. The TLC and RV equations were, respectively, ∆TLCWBP-SBHD in L = 5.264 − 0.060 × FEV1/FVC (r2 = 0.33; adjusted r2 = 0.32) and ∆RVWBP-SBHD in L = 4.862 − 0.055 × FEV1/FVC (r2 = 0.31; adjusted r2 = 0.30). CONCLUSIONS: The correction of TLC and RV results obtained by SBHD can improve the accuracy of this method for assessing lung volumes in patients with OLD. However, additional studies are needed in order to validate these equations.
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