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Siqueira Santos MM, Sganzerla D, Pereira IJ, Rosa RG, Granja C, Teixeira C, Azevedo L. Long-Term Mortality and Health-Related Quality of Life After Continuous Versus Intermittent Renal Replacement Therapy in ICU Survivors: A Secondary Analysis of the Quality of Life After ICU Study. J Intensive Care Med 2024:8850666231224392. [PMID: 38196312 DOI: 10.1177/08850666231224392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
Purpose: We assessed long-term outcomes in intensive care unit (ICU) survivors with acute kidney injury (AKI) submitted to intermittent or continuous renal replacement therapy (RRT) for comparisons between groups. Methods: The multicenter prospective cohort study included 195 adult ICU survivors with an ICU stay >72 h in 10 ICUs that had at least one episode of AKI treated with intermittent RRT (IRRT) or continuous RRT (CRRT) during ICU stay. The main outcomes were mortality and health-related quality of life (HRQoL). Hospital readmissions and physical dependence were also assessed. Results: Regarding RRT, 83 (42.6%) patients received IRRT and 112 (57.4%) received CRRT. Despite the similarity regarding sociodemographic characteristics, pre-ICU state of health and type of admission between groups, the risk of death (23.5% vs 42.7%; P < .001), the prevalence of sepsis (60.7%) and acute respiratory distress syndrome (17%) were higher at ICU admission among CRRT patients. The severity of critical illness was higher among CRRT patients, regarding the need for mechanical ventilation (75.0% vs 50.6%, P = .002) and vasopressors (91.1% vs 63.9%, P < .001). One year after ICU discharge, 67 of 195 ICU survivors died (34.4%) and, after adjustment for confounders, there were no significant differences in mortality when comparing IRRT and CRTT patients (34.9% vs 33.9%; P = .590), on HRQoL in both physical (41.9% vs 42.2%; P = .926) and mental dimensions (57.6% vs 56.6%; P = .340), and on the number of hospital readmissions and physical dependence. Conclusions: Our study suggests that among ICU survivors RRT modality (IRRT vs CRRT) in the ICU does not impact long-term outcomes after ICU discharge.
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Affiliation(s)
- Mariana Martins Siqueira Santos
- MEDCIDS - Medicina da Comunidade, Informação e Decisão em Saúde, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS@RISE - Centre for Health Technology and Services Research & Associate Laboratory - Health Research Network, University of Porto, Porto, Portugal
| | | | - Isabel Jesus Pereira
- MEDCIDS - Medicina da Comunidade, Informação e Decisão em Saúde, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
- Polyvalent Intensive Care Medicine Service, Centro Hospitalar de Gaia/Espinho, Vila Nova de Gaia, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
- CriticalMed - Critical Care & Emergency Medicine, CINTESIS - Center for Health Technology and Services Research, University of Porto, Porto, Portugal
| | - Regis Goulart Rosa
- Research Projects Office, Hospital Moinhos de Vento, Porto Alegre, Brazil
- Brazilian Research in Intensive Care Network (BRICNet), São Paulo, Brazil
- Research Unit, INOVA Medical, Porto Alegre, Brazil
| | - Cristina Granja
- Faculty of Medicine, University of Porto, Porto, Portugal
- CriticalMed - Critical Care & Emergency Medicine, CINTESIS - Center for Health Technology and Services Research, University of Porto, Porto, Portugal
- Intensive Care Department, Centro Hospitalar Universitário de São João, Porto, Portugal
- Anaesthesiology Department, Centro Hospitalar Universitário São João, Porto, Portugal
- Department of Surgery and Physiology, Faculdade de Medicina, University of Porto, Porto, Portugal
| | - Cassiano Teixeira
- Brazilian Research in Intensive Care Network (BRICNet), São Paulo, Brazil
- Intensive Care Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Post-Graduation Program in Rehabilitation Sciences, Universidade Federalde Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Luís Azevedo
- MEDCIDS - Medicina da Comunidade, Informação e Decisão em Saúde, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS@RISE - Centre for Health Technology and Services Research & Associate Laboratory - Health Research Network, University of Porto, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
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2
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Santos MMS, Pereira IJ, Cuboia N, Reis-Pardal J, Adrião D, Cardoso T, Aragão I, Santos L, Sarmento A, Rosa RG, Granja C, Teixeira C, Azevedo L. Predictors of early and long-term mortality after ICU discharge in critically ill COVID-19 patients: A prospective cohort study. PLoS One 2023; 18:e0293883. [PMID: 37917761 PMCID: PMC10621933 DOI: 10.1371/journal.pone.0293883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/23/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND To mitigate mortality among critically ill COVID-19 patients, both during their Intensive Care Unit (ICU) stay and following ICU discharge, it is crucial to measure its frequency, identify predictors and to establish an appropriate post-ICU follow-up strategy. METHODS In this multicentre, prospective cohort study, we included 586 critically ill COVID-19 patients. RESULTS We observed an overall ICU mortality of 20.1% [95%CI: 17.1% to 23.6%] (118/586) and an overall hospital mortality of 25.4% [95%CI: 22.1% to 29.1%] (149/586). For ICU survivors, 30 days (early) post-ICU mortality was 5.3% [95%CI: 3.6% to 7.8%] (25/468) and one-year (late) post-ICU mortality was 7.9% [95%CI: 5.8% to 10.8%] (37/468). Pre-existing conditions/comorbidities were identified as the main independent predictors of mortality after ICU discharge: hypertension and heart failure were independent predictors of early mortality; and hypertension, chronic kidney disease, chronic obstructive pulmonary disease and cancer were independent predictors of late mortality. CONCLUSION Early and late post-ICU mortality exhibited an initial surge (in the first 30 days post-ICU) followed by a subsequent decline over time. Close monitoring of critically ill COVID-19 post-ICU survivors, especially those with pre-existing conditions, is crucial to prevent adverse outcomes, reduce mortality and to establish an appropriate follow-up strategy.
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Affiliation(s)
- Mariana M. S. Santos
- MEDCIDS–Medicina da Comunidade, Informação e Decisão em Saúde, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS@RISE–Center for Health Technology and Services Research (CINTESIS) & Health Research Network Associated Laboratory (RISE), University of Porto, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Isabel J. Pereira
- MEDCIDS–Medicina da Comunidade, Informação e Decisão em Saúde, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
- Polyvalent Intensive Care Medicine Service, Centro Hospitalar de Gaia/Espinho—Vila Nova de Gaia, Vila Nova de Gaia, Portugal
- CriticalMed–Critical Care & Emergency Medicine, CINTESIS—Center for Health, Porto, Portugal
| | - Nelson Cuboia
- MEDCIDS–Medicina da Comunidade, Informação e Decisão em Saúde, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS@RISE–Center for Health Technology and Services Research (CINTESIS) & Health Research Network Associated Laboratory (RISE), University of Porto, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Joana Reis-Pardal
- MEDCIDS–Medicina da Comunidade, Informação e Decisão em Saúde, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS@RISE–Center for Health Technology and Services Research (CINTESIS) & Health Research Network Associated Laboratory (RISE), University of Porto, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Diana Adrião
- Polyvalent Intensive Care Medicine Service, Centro Hospitalar de Gaia/Espinho—Vila Nova de Gaia, Vila Nova de Gaia, Portugal
| | - Teresa Cardoso
- Intensive Care Unit (UCIP), Hospital de Santo António, Oporto Hospital Center, University of Oporto, Largo Prof. Abel Salazar, Porto, Portugal
| | - Irene Aragão
- Intensive Care Unit (UCIP), Hospital de Santo António, Oporto Hospital Center, University of Oporto, Largo Prof. Abel Salazar, Porto, Portugal
| | - Lurdes Santos
- CHUSJ-Centro Hospitalar Universitário S. João, Porto, Portugal
- Infectious Diseases Intensive Care Unit-(ID-ICU)- Centro Hospitalar Universitário S. João, Porto, Portugal
- Intensive Care Department, Centro Hospitalar Universitário de São João—Porto, Porto, Portugal
| | - António Sarmento
- CHUSJ-Centro Hospitalar Universitário S. João, Porto, Portugal
- Infectious Diseases Intensive Care Unit-(ID-ICU)- Centro Hospitalar Universitário S. João, Porto, Portugal
- Intensive Care Department, Centro Hospitalar Universitário de São João—Porto, Porto, Portugal
| | - Regis G. Rosa
- Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
- Research Unit, INOVA Medical, Porto Alegre, RS, Brazil
- Brazilian Research in Intensive Care Network (BRICNet), São Paulo, SP, Brazil
| | - Cristina Granja
- Faculty of Medicine, University of Porto, Porto, Portugal
- CriticalMed–Critical Care & Emergency Medicine, CINTESIS—Center for Health, Porto, Portugal
- CHUSJ-Centro Hospitalar Universitário S. João, Porto, Portugal
- Intensive Care Department, Centro Hospitalar Universitário de São João—Porto, Porto, Portugal
- Anaesthesiology Department, Centro Hospitalar Universitário São João, Porto, Portugal
- Department of Surgery and Physiology, Faculdade de Medicina, University of Porto, Porto, Portugal
| | - Cassiano Teixeira
- Brazilian Research in Intensive Care Network (BRICNet), São Paulo, SP, Brazil
- Intensive Care Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
- UFCSPA Medical School, Porto Alegre, RS, Brazil
| | - Luís Azevedo
- MEDCIDS–Medicina da Comunidade, Informação e Decisão em Saúde, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS@RISE–Center for Health Technology and Services Research (CINTESIS) & Health Research Network Associated Laboratory (RISE), University of Porto, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
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3
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Dahlem C, Monteiro C, Mendes E, Martinho J, Oliveira C, Bettencourt M, Coelho M, Neves P, Azevedo L, Granja C. Modulating Influence of State Anxiety on the Effect of Midazolam on Postsurgical Pain. J Clin Med 2023; 12:jcm12072669. [PMID: 37048752 PMCID: PMC10095355 DOI: 10.3390/jcm12072669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/26/2023] [Accepted: 03/29/2023] [Indexed: 04/07/2023] Open
Abstract
Anxiety contributes to postsurgical pain, and midazolam is frequently prescribed preoperatively. Conflicting results have been described concerning the impact of midazolam on pain. This study aims to evaluate the effect of systemic midazolam on pain after open inguinal hernia repair, clarifying its relationship with preoperative anxiety. A prospective observational cohort study was conducted in three Portuguese ambulatory units between September 2018 and March 2020. Variable doses of midazolam were administered. Postsurgical pain was evaluated up to three months after surgery. We enrolled 306 patients and analyzed 281 patients. The mean preoperative anxiety Numeric Rating Scale score was 4 (3) and the mean Surgical Fear Questionnaire score was 22 (16); the mean midazolam dose was 1.7 (1.1) mg with no correlation to preoperative anxiety scores. Pain ≥4 was present in 67% of patients 24 h after surgery and in 54% at seven days; at three months, 27% were classified as having chronic postsurgical pain. Preoperative anxiety correlated to pain severity at all time points. In multivariable regression, higher midazolam doses were associated with less pain during the first week, with no apparent effect on chronic pain. However, subgroup analyses uncovered an effect modification according to preoperative anxiety: the decrease in acute pain occurred in the low-anxiety patients with no effect on the high-anxiety group. Inversely, there was an increase in chronic postsurgical pain in the very anxious patients, without any effect on the low-anxiety group. Midazolam, generally used as an anxiolytic, might impact distinctively on pain depending on anxiety.
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Affiliation(s)
- Caroline Dahlem
- CINTESIS@RISE—Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- Department of Anesthesiology, Centro Hospitalar Entre Douro e Vouga, 4520-211 Santa Maria da Feira, Portugal
| | - Catarina Monteiro
- Department of Anesthesiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, 4434-502 Vila Nova de Gaia, Portugal
| | - Eunice Mendes
- Department of Anesthesiology, Centro Hospitalar e Universitário de Coimbra, 3004-561 Coimbra, Portugal
| | - Joana Martinho
- Department of Rheumatology, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, 1649-028 Lisboa, Portugal
| | - Carmen Oliveira
- CINTESIS@RISE—Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- Department of Anesthesiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, 4434-502 Vila Nova de Gaia, Portugal
| | - Margarida Bettencourt
- Department of Anesthesiology, Centro Hospitalar do Baixo Vouga, EPE, 3810-164 Aveiro, Portugal
| | - Miguel Coelho
- Department of Anesthesiology, Centro Hospitalar do Baixo Vouga, EPE, 3810-164 Aveiro, Portugal
| | - Paula Neves
- Department of Anesthesiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, 4434-502 Vila Nova de Gaia, Portugal
| | - Luís Azevedo
- CINTESIS@RISE—Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - Cristina Granja
- CINTESIS@RISE—Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- Department of Anesthesiology, Centro Hospitalar Universitário de São João, 4200-319 Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
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4
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Paulino MC, Pereira IJ, Costa V, Neves A, Santos A, Teixeira CM, Coimbra I, Fernandes P, Bernardo R, Póvoa P, Granja C. Sedation, analgesia, and delirium management in Portugal: a survey and point prevalence study. Rev Bras Ter Intensiva 2022; 34:227-236. [PMID: 35946653 DOI: 10.5935/0103-507x.20220020-pt] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 02/19/2022] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To establish current Portuguese critical care practices regarding analgesia, sedation, and delirium based on a comparison between the activities reported and daily clinical practice. METHODS A national survey was conducted among physicians invited to report their practice toward analgesia, sedation, and delirium in intensive care units. A point prevalence study was performed to analyze daily practices. RESULTS A total of 117 physicians answered the survey, and 192 patients were included in the point prevalence study. Survey and point prevalence studies reflect a high sedation assessment (92%; 88.5%), with the Richmond Agitated Sedation Scale being the most reported and used scale (41.7%; 58.2%) and propofol being the most reported and used medication (91.4%; 58.6%). Midazolam prescribing was reported by 68.4% of responders, but a point prevalence study revealed a use of 27.6%.Although 46.4% of responders reported oversedation, this was actually documented in 32% of the patients. The survey reports the daily assessment of pain (92%) using standardized scales (71%). The same was identified in the point prevalence study, with 91.1% of analgesia assessment mainly with the Behavioral Pain Scale. In the survey, opioids were reported as the first analgesic. In clinical practice, acetaminophen was the first option (34.6%), followed by opioids. Delirium assessment was reported by 70% of physicians but was performed in less than 10% of the patients. CONCLUSION The results from the survey did not accurately reflect the common practices in Portuguese intensive care units, as reported in the point prevalence study. Efforts should be made specifically to avoid oversedation and to promote delirium assessment.
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Affiliation(s)
- Maria Carolina Paulino
- Unidade de Terapia Intensiva Polivalente, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental - Lisboa, Portugal
| | - Isabel Jesus Pereira
- Departamento de Medicina Intensiva, Centro Hospitalar de Gaia/Espinho - Vila Nova de Gaia, Portugal
| | - Vasco Costa
- Unidade de Terapia Intensiva Polivalente, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental - Lisboa, Portugal
| | - Aida Neves
- Departamento de Medicina Intensiva, Centro Hospitalar Universitário de São João - Porto, Portugal
| | - Anabela Santos
- Serviço de Medicina Intensiva/Anestesiologia, Centro Hospitalar Trás-os-Montes - Alto Douro, Portugal
| | - Carla Margarida Teixeira
- Departamento de Anestesiologia e Medicina Intensiva, Centro Hospitalar Universitário do Porto - Porto, Portugal
| | - Isabel Coimbra
- Departamento de Medicina Intensiva, Centro Hospitalar Universitário de São João - Porto, Portugal
| | - Paula Fernandes
- Departamento de Medicina Intensiva, Centro Hospitalar de Gaia/Espinho - Vila Nova de Gaia, Portugal
| | - Ricardo Bernardo
- Departamento de Anestesiologia, Centro Hospitalar Universitário Lisboa Norte - Lisboa, Portugal
| | - Pedro Póvoa
- Unidade de Terapia Intensiva Polivalente, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental - Lisboa, Portugal
| | - Cristina Granja
- Departamento de Medicina Intensiva, Centro Hospitalar Universitário de São João - Porto, Portugal
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5
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Balan C, Oancea C, Pivec J, Granja C, Jakubek J, Chvátil D, Olšanský V, Chis V. MEASUREMENTS OF SCATTERED RADIATION PRODUCED IN ELECTRON BEAMS USING MINIPIX TIMEPIX3 FLEX. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)01626-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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6
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Oancea C, Balan C, Chvátil D, Granja C, Jakubek J, Olšanský V, Pivec J. TIME-STAMPED MEASUREMENTS OF SINGLE FLASH PULSES OF PRIMARY ELECTRON BEAMS IN WIDE DOSE RANGE AND MICROSECONDS RESOLUTION WITH MINIATURIZED MINIPIX-TIMEPIX3-FLEX CAMERA. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)01589-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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7
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Paulino MC, Pereira IJ, Costa V, Neves A, Santos A, Teixeira CM, Coimbra I, Fernandes P, Bernardo R, Póvoa P, Granja C. Sedation, analgesia, and delirium management in Portugal: a survey and point prevalence study. Rev Bras Ter Intensiva 2022. [PMID: 35946653 PMCID: PMC9354111 DOI: 10.5935/0103-507x.20220020-en] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective To establish current Portuguese critical care practices regarding analgesia, sedation, and delirium based on a comparison between the activities reported and daily clinical practice. Methods A national survey was conducted among physicians invited to report their practice toward analgesia, sedation, and delirium in intensive care units. A point prevalence study was performed to analyze daily practices. Results A total of 117 physicians answered the survey, and 192 patients were included in the point prevalence study. Survey and point prevalence studies reflect a high sedation assessment (92%; 88.5%), with the Richmond Agitated Sedation Scale being the most reported and used scale (41.7%; 58.2%) and propofol being the most reported and used medication (91.4%; 58.6%). Midazolam prescribing was reported by 68.4% of responders, but a point prevalence study revealed a use of 27.6%. Although 46.4% of responders reported oversedation, this was actually documented in 32% of the patients. The survey reports the daily assessment of pain (92%) using standardized scales (71%). The same was identified in the point prevalence study, with 91.1% of analgesia assessment mainly with the Behavioral Pain Scale. In the survey, opioids were reported as the first analgesic. In clinical practice, acetaminophen was the first option (34.6%), followed by opioids. Delirium assessment was reported by 70% of physicians but was performed in less than 10% of the patients. Conclusion The results from the survey did not accurately reflect the common practices in Portuguese intensive care units, as reported in the point prevalence study. Efforts should be made specifically to avoid oversedation and to promote delirium assessment.
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Affiliation(s)
- Maria Carolina Paulino
- Unidade de Terapia Intensiva Polivalente, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental - Lisboa, Portugal
| | - Isabel Jesus Pereira
- Departamento de Medicina Intensiva, Centro Hospitalar de Gaia/Espinho - Vila Nova de Gaia, Portugal
| | - Vasco Costa
- Unidade de Terapia Intensiva Polivalente, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental - Lisboa, Portugal
| | - Aida Neves
- Departamento de Medicina Intensiva, Centro Hospitalar Universitário de São João - Porto, Portugal
| | - Anabela Santos
- Serviço de Medicina Intensiva/Anestesiologia, Centro Hospitalar Trás-os-Montes - Alto Douro, Portugal
| | - Carla Margarida Teixeira
- Departamento de Anestesiologia e Medicina Intensiva, Centro Hospitalar Universitário do Porto - Porto, Portugal
| | - Isabel Coimbra
- Departamento de Medicina Intensiva, Centro Hospitalar Universitário de São João - Porto, Portugal
| | - Paula Fernandes
- Departamento de Medicina Intensiva, Centro Hospitalar de Gaia/Espinho - Vila Nova de Gaia, Portugal
| | - Ricardo Bernardo
- Departamento de Anestesiologia, Centro Hospitalar Universitário Lisboa Norte - Lisboa, Portugal
| | - Pedro Póvoa
- Unidade de Terapia Intensiva Polivalente, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental - Lisboa, Portugal
| | - Cristina Granja
- Departamento de Medicina Intensiva, Centro Hospitalar Universitário de São João - Porto, Portugal
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8
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Moreira-Rosário A, Marques C, Pinheiro H, Araújo JR, Ribeiro P, Rocha R, Mota I, Pestana D, Ribeiro R, Pereira A, de Sousa MJ, Pereira-Leal J, de Sousa J, Morais J, Teixeira D, Rocha JC, Silvestre M, Príncipe N, Gatta N, Amado J, Santos L, Maltez F, Boquinhas A, de Sousa G, Germano N, Sarmento G, Granja C, Póvoa P, Faria A, Calhau C. Gut Microbiota Diversity and C-Reactive Protein Are Predictors of Disease Severity in COVID-19 Patients. Front Microbiol 2021; 12:705020. [PMID: 34349747 PMCID: PMC8326578 DOI: 10.3389/fmicb.2021.705020] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 06/10/2021] [Indexed: 12/15/2022] Open
Abstract
The risk factors for coronavirus disease 2019 (COVID-19) severity are still poorly understood. Considering the pivotal role of the gut microbiota on host immune and inflammatory functions, we investigated the association between changes in the gut microbiota composition and the clinical severity of COVID-19. We conducted a multicenter cross-sectional study prospectively enrolling 115 COVID-19 patients categorized according to: (1) the WHO Clinical Progression Scale-mild, 19 (16.5%); moderate, 37 (32.2%); or severe, 59 (51.3%), and (2) the location of recovery from COVID-19-ambulatory, 14 (household isolation, 12.2%); hospitalized in ward, 40 (34.8%); or hospitalized in the intensive care unit, 61 (53.0%). Gut microbiota analysis was performed through 16S rRNA gene sequencing, and the data obtained were further related to the clinical parameters of COVID-19 patients. The risk factors for COVID-19 severity were identified by univariate and multivariable logistic regression models. In comparison to mild COVID-19 patients, the gut microbiota of moderate and severe patients have: (a) lower Firmicutes/Bacteroidetes ratio; (b) higher abundance of Proteobacteria; and (c) lower abundance of beneficial butyrate-producing bacteria such as the genera Roseburia and Lachnospira. Multivariable regression analysis showed that the Shannon diversity index [odds ratio (OR) = 2.85, 95% CI = 1.09-7.41, p = 0.032) and C-reactive protein (OR = 3.45, 95% CI = 1.33-8.91, p = 0.011) are risk factors for severe COVID-19 (a score of 6 or higher in the WHO Clinical Progression Scale). In conclusion, our results demonstrated that hospitalized patients with moderate and severe COVID-19 have microbial signatures of gut dysbiosis; for the first time, the gut microbiota diversity is pointed out as a prognostic biomarker of COVID-19 severity.
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Affiliation(s)
- André Moreira-Rosário
- Faculdade de Ciências M dicas, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal.,Faculdade de Ciências Médicas, CINTESIS - Center for Health Technology and Services Research, NOVA Medical School, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Cláudia Marques
- Faculdade de Ciências M dicas, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal.,Faculdade de Ciências Médicas, CINTESIS - Center for Health Technology and Services Research, NOVA Medical School, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Hélder Pinheiro
- Faculdade de Ciências M dicas, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal.,Department of Infectious Diseases, Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - João Ricardo Araújo
- Faculdade de Ciências M dicas, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal.,Faculdade de Ciências Médicas, CINTESIS - Center for Health Technology and Services Research, NOVA Medical School, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Pedro Ribeiro
- Centro de Medicina Laboratorial Germano de Sousa, Lisboa, Portugal
| | - Rita Rocha
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,Instituto de Biologia Molecular e Celular (IBMC), Universidade do Porto, Porto, Portugal
| | - Inês Mota
- Faculdade de Ciências M dicas, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal.,Faculdade de Ciências Médicas, CINTESIS - Center for Health Technology and Services Research, NOVA Medical School, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Diogo Pestana
- Faculdade de Ciências M dicas, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal.,Faculdade de Ciências Médicas, CINTESIS - Center for Health Technology and Services Research, NOVA Medical School, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Rita Ribeiro
- Centro de Medicina Laboratorial Germano de Sousa, Lisboa, Portugal
| | - Ana Pereira
- Centro de Medicina Laboratorial Germano de Sousa, Lisboa, Portugal
| | - Maria José de Sousa
- Faculdade de Ciências M dicas, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal.,Centro de Medicina Laboratorial Germano de Sousa, Lisboa, Portugal
| | | | - José de Sousa
- Centro de Medicina Laboratorial Germano de Sousa, Lisboa, Portugal
| | - Juliana Morais
- Faculdade de Ciências M dicas, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal.,Faculdade de Ciências Médicas, CINTESIS - Center for Health Technology and Services Research, NOVA Medical School, Universidade NOVA de Lisboa, Lisboa, Portugal.,Faculdade de Ciências Médicas, Comprehensive Health Research Centre (CHRC), NOVA Medical School, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Diana Teixeira
- Faculdade de Ciências M dicas, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal.,Faculdade de Ciências Médicas, Comprehensive Health Research Centre (CHRC), NOVA Medical School, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Júlio César Rocha
- Faculdade de Ciências M dicas, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal.,Faculdade de Ciências Médicas, CINTESIS - Center for Health Technology and Services Research, NOVA Medical School, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Marta Silvestre
- Faculdade de Ciências M dicas, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal.,Faculdade de Ciências Médicas, CINTESIS - Center for Health Technology and Services Research, NOVA Medical School, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Nuno Príncipe
- Department of Emergency and Intensive Care Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Nuno Gatta
- Department of Emergency and Intensive Care Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - José Amado
- Department of Emergency and Intensive Care Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Lurdes Santos
- Infectious Diseases Service, ID Intensive Care Unit, Faculdade de Medicina, Centro Hospitalar Universitário de São João, Universidade do Porto, Porto, Portugal
| | - Fernando Maltez
- Department of Infectious Diseases, Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - Ana Boquinhas
- Department of Emergency, CUF Infante Santo Hospital, Lisboa, Portugal
| | - Germano de Sousa
- Centro de Medicina Laboratorial Germano de Sousa, Lisboa, Portugal
| | - Nuno Germano
- Polyvalent Intensive Care Unit, Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - Gonçalo Sarmento
- Department of Internal Medicine, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - Cristina Granja
- Faculdade de Ciências Médicas, CINTESIS - Center for Health Technology and Services Research, NOVA Medical School, Universidade NOVA de Lisboa, Lisboa, Portugal.,Department of Anesthesiology, Centro Hospitalar Universitário de São João, Porto, Portugal.,Department of Surgery and Physiology, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Pedro Póvoa
- Faculdade de Ciências M dicas, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal.,Polyvalent Intensive Care Unit, Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal.,Center for Clinical Epidemiology, Research Unit of Clinical Epidemiology, OUH Odense University Hospital, Odense, Denmark
| | - Ana Faria
- Faculdade de Ciências M dicas, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal.,Faculdade de Ciências Médicas, Comprehensive Health Research Centre (CHRC), NOVA Medical School, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Conceição Calhau
- Faculdade de Ciências M dicas, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal.,Faculdade de Ciências Médicas, CINTESIS - Center for Health Technology and Services Research, NOVA Medical School, Universidade NOVA de Lisboa, Lisboa, Portugal
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9
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Cotrim H, Granja C, Carvalho AS, Cotrim C, Martins R. Children's Understanding of Informed Assents in Research Studies. Healthcare (Basel) 2021; 9:healthcare9070871. [PMID: 34356249 PMCID: PMC8307200 DOI: 10.3390/healthcare9070871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/03/2021] [Accepted: 07/07/2021] [Indexed: 11/16/2022] Open
Abstract
The assent procedure reflects an effort to enable the minor to understand, to the degree they are capable of, what their participation in the decision making process would involve. Aims: To evaluate the minors’ ability to understand the information provided to them when obtaining assent and to evaluate the opinion of the parents regarding the importance of asking the child’s assent. Methods: The sample included a total of 52 minors aged between 10 and 17 years who underwent exercise echocardiogram. The Quality of Informed Consent is divided into two parts: Part A was used to measure objective understanding and part B to measure subjective understanding. Results: The results show that the minors have a high capacity to understand the information given to them when asking for assent. A positive relationship was found between the two parts of the questionnaire. No statistically significant relationship was found between age and sex and part A and part B or between both age groups (<14 years old and ≥14 years old) and the measure. In the case of the parents, 96.6% of parents consider assent as an advantage for the child’s acceptance of health care. The opinion of the parents is not related to the age, sex or level of schooling. Conclusion: Minors showed a substantial level of understanding regarding the information provided to them. The parents considered the implementation of assent fundamental to the child’s acceptance of health care.
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Affiliation(s)
- Hortense Cotrim
- Nursing Department, Universidade Atlântica, Fábrica da Pólvora de Barcarena, 2730-036 Barcarena, Portugal
- Correspondence:
| | - Cristina Granja
- Anaesthesiology Department, Centro Hospitalar Universitário São João, 4200-319 Porto, Portugal;
| | - Ana Sofia Carvalho
- Associated Teacher with Aggregation, Institute of Bioethics, University of Portugal, 1649-023 Lisboa, Portugal;
| | - Carlos Cotrim
- Cardiology Department, Hospital da Cruz Vermelha, 1549-008 Lisboa, Portugal;
| | - Rui Martins
- Centro de Estatística e Aplicações da Universidade de Lisboa (CEAUL), Department of Statistics and Operational Research, Faculdade de Ciências, Universidade de Lisboa, 1549-008 Lisboa, Portugal;
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10
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Menezes Fernandes R, Nuñez D, Marques N, Dias CC, Granja C. Surviving cardiac arrest: What happens after admission to the intensive care unit? Rev Port Cardiol 2021; 40:317-325. [PMID: 34187632 DOI: 10.1016/j.repce.2020.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 07/14/2020] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Patients successfully resuscitated from cardiac arrest (CA) are admitted to the intensive care unit (ICU) for post-resuscitation care. These patients' prognosis remains dismal, with only a minority surviving to hospital discharge. Understanding the clinical factors involved in the management of these patients is essential to improve their prognosis. OBJECTIVES To characterize the population admitted after successful reanimation from CA, and to analyze the factors associated with their outcomes. METHODS We performed a retrospective descriptive study of patients admitted to an ICU after CA over a five-year period from January 2014 to December 2018. Demographic factors, CA characteristics, early management, mortality and neurologic outcomes were analyzed. RESULTS A total of 187 patients, median age 67 years, were admitted after CA, of whom 39% suffered out-of-hospital CA; 87% had an initial non-shockable rhythm and the most frequent presumed cause was cardiac (31%). In-hospital mortality was 63%. Significant neurologic dysfunction (cerebral performance category 3 or 4) was seen in 31% of survivors at hospital discharge. Non-immediate initiation of basic life support (BLS), higher Simplified Acute Physiology Score II score and longer relative duration of vasopressor support were independent predictors of in-hospital mortality, while shockable rhythms were associated with improved survival. Higher Glasgow coma scale at ICU discharge and shorter length of ICU stay were predictors of better neurologic outcome. CONCLUSION This study highlights the positive prognostic impact of shockable rhythms, and confirms the importance of immediate initiation of BLS and prompt defibrillation, supporting the need for better training both outside and inside hospitals.
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Affiliation(s)
- Raquel Menezes Fernandes
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal; Algarve Biomedical Center, Faro, Portugal.
| | - Daniel Nuñez
- Intensive Care Department, Centro Hospitalar Universitário do Algarve, Portugal; Medical and Biomedical Department, University of Algarve, Portugal; Algarve Biomedical Center, Faro, Portugal
| | - Nuno Marques
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal; Medical and Biomedical Department, University of Algarve, Portugal; Algarve Biomedical Center, Faro, Portugal
| | - Cláudia Camila Dias
- CINTESIS - Center for Health Technology and Services Research, Portugal; MEDCIDS - Department of Community Medicine, Information and Health Decision, Faculty of Medicine of Porto, Portugal
| | - Cristina Granja
- CINTESIS - Center for Health Technology and Services Research, Portugal; Anesthesiology Department, Centro Hospitalar Universitário São João, Porto, Portugal; Surgery and Physiology Department, Faculty of Medicine of Porto, Porto, Portugal
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11
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Menezes Fernandes R, Nuñez D, Marques N, Dias CC, Granja C. Surviving cardiac arrest: What happens after admission to the intensive care unit? Rev Port Cardiol 2021; 40:317-325. [PMID: 33812706 DOI: 10.1016/j.repc.2020.07.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 06/02/2020] [Accepted: 07/14/2020] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Patients successfully resuscitated from cardiac arrest (CA) are admitted to the intensive care unit (ICU) for post-resuscitation care. These patients' prognosis remains dismal, with only a minority surviving to hospital discharge. Understanding the clinical factors involved in the management of these patients is essential to improve their prognosis. OBJECTIVES To characterize the population admitted after successful reanimation from CA, and to analyze the factors associated with their outcomes. METHODS We performed a retrospective descriptive study of patients admitted to an ICU after CA over a five-year period from January 2014 to December 2018. Demographic factors, CA characteristics, early management, mortality and neurologic outcomes were analyzed. RESULTS A total of 187 patients, median age 67 years, were admitted after CA, of whom 39% suffered out-of-hospital CA; 87% had an initial non-shockable rhythm and the most frequent presumed cause was cardiac (31%). In-hospital mortality was 63%. Significant neurologic dysfunction (cerebral performance category 3 or 4) was seen in 31% of survivors at hospital discharge. Non-immediate initiation of basic life support (BLS), higher Simplified Acute Physiology Score II score and longer relative duration of vasopressor support were independent predictors of in-hospital mortality, while shockable rhythms were associated with improved survival. Higher Glasgow coma scale at ICU discharge and shorter length of ICU stay were predictors of better neurologic outcome. CONCLUSION This study highlights the positive prognostic impact of shockable rhythms, and confirms the importance of immediate initiation of BLS and prompt defibrillation, supporting the need for better training both outside and inside hospitals.
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Affiliation(s)
- Raquel Menezes Fernandes
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal; Algarve Biomedical Center, Faro, Portugal.
| | - Daniel Nuñez
- Intensive Care Department, Centro Hospitalar Universitário do Algarve, Portugal; Medical and Biomedical Department, University of Algarve, Portugal; Algarve Biomedical Center, Faro, Portugal
| | - Nuno Marques
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal; Medical and Biomedical Department, University of Algarve, Portugal; Algarve Biomedical Center, Faro, Portugal
| | - Cláudia Camila Dias
- CINTESIS - Center for Health Technology and Services Research, Portugal; MEDCIDS - Department of Community Medicine, Information and Health Decision, Faculty of Medicine of Porto, Portugal
| | - Cristina Granja
- CINTESIS - Center for Health Technology and Services Research, Portugal; Anesthesiology Department, Centro Hospitalar Universitário São João, Porto, Portugal; Surgery and Physiology Department, Faculty of Medicine of Porto, Porto, Portugal
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12
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Fernandes RM, Varela ML, Moreno J, Granja C. Effectiveness of Delayed Intrapleural Alteplase Instillation for Infected Residual Traumatic Hemothorax. Case Report. ACTA ACUST UNITED AC 2021; 3:718-721. [PMID: 33585796 PMCID: PMC7864475 DOI: 10.1007/s42399-021-00801-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2021] [Indexed: 11/30/2022]
Abstract
In thoracic trauma, many cases may present with hemothorax, and, of those, a portion can complicate in empyema. These cases can reveal themselves to be of difficult management, particularly in peripheral hospitals with complicated access to thoracic surgery. Intrapleural fibrinolytic instillation can be of use and has been widely reported, mostly in the case of empyema. In the literature, the use of fibrinolytics in hemothorax mostly pertained to the older fibrinolytics, such as streptokinase and urokinase. Recent studies describe the use of alteplase in these patients but mostly in the first days after the trauma, when it becomes clear that the first chest tube is not being effective. We report a case of residual traumatic hemothorax that could not be evacuated after multiple chest tubes placements and was finally cleared after instillation of alteplase late in the course of the disease.
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Affiliation(s)
- Rita Martins Fernandes
- Internal Medicine Department, Internal Medicine 1, Hospital de Faro, Centro Hospitalar Universitário do Algarve, Rua Leão Penedo, 8000-386 Faro, Portugal
| | - Miguel Lourenço Varela
- Intensive Care Medicine 1, Hospital de Faro, Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | - Javier Moreno
- Intensive Care Medicine 1, Hospital de Faro, Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | - Cristina Granja
- Intensive Care Medicine 1, Hospital de Faro, Centro Hospitalar Universitário do Algarve, Faro, Portugal.,CINTESIS - Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Biomedical Sciences and Medicine, University of Algarve, Faro, Portugal
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13
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Stasica P, Baran J, Gajewski J, Granja C, Oancea C, Pawlik-Niedźwiecka M, Rydygier M, Schavi A, Ruciński A. OC-0576: Timepix for characterization of mixed radiation field produced in proton radiotherapy. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00598-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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14
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Varela M, Flores L, Patraquim R, Nunez D, Granja C. A Rare Misdirected Subclavian Venous Catheter to the Neck. Case Rep Acute Med 2020. [DOI: 10.1159/000508701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Placement of a central venous catheter (CVC) is not without complications, one of those being misplacement of the catheter tip. This event is dependent on the patient’s vascular anatomy, hence unexpected misplacements may occur. We describe a case where a right subclavian CVC was inserted uneventfully, but later found to have migrated into a vein coursing through the midline of the neck, for which only three other cases have been reported. The catheter remained functional and was later removed without further complications.
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15
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Rodrigues AI, Martins Fernandes R, Calderón H, Granja C. Pyogenic liver abscess caused by accidental ingestion of a bottle cap. Intern Emerg Med 2019; 14:1167-1168. [PMID: 31209682 DOI: 10.1007/s11739-019-02125-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 06/04/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Ana Isabel Rodrigues
- Internal Medicine Department, Centro Hospitalar Universitário Do Algarve, Hospital de Faro, Faro, Portugal.
| | - Rita Martins Fernandes
- Internal Medicine Department, Centro Hospitalar Universitário Do Algarve, Hospital de Faro, Faro, Portugal
| | - Hugo Calderón
- Emergency and Intensive Care Department, Centro Hospitalar Universitário Do Algarve, Hospital de Faro, Faro, Portugal
| | - Cristina Granja
- Emergency and Intensive Care Department, Centro Hospitalar Universitário Do Algarve, Hospital de Faro, Faro, Portugal
- CINTESIS-Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal
- Departamento de Medicina da Comunidade Informação e Decisão em Saúde ‑ MEDCIDS, Faculty of Medicine of Porto, University of Porto, Porto, Portugal
- Department of Biomedical Sciences and Medicine, University of Algarve, Portugal, Faro, Portugal
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16
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Castro S, Jesus Pereira I, Dias CC, Granja C. Waiting for ICU admission may increase the risk of death-A plea for better resource organization. Acta Anaesthesiol Scand 2019; 63:895-899. [PMID: 30985009 DOI: 10.1111/aas.13375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 02/11/2019] [Accepted: 03/16/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Mortality is high in critically ill patients. In order to study the risk factors associated with mortality in these patients, we conducted an observational retrospective study in the general Intensive Care Unit (ICU) of Faro Hospital. METHODS All patients discharged from the general ICU in the year 2015 were evaluated for inclusion. Mortality was characterized in the first 48 hours of ICU stay, at the time of discharge from ICU, and at discharge from hospital. Collected variables included demographic variables (age), and ICU variables: type of ICU admission (scheduled surgery, urgent surgery, medical and trauma), Simplified Acute Physiology Score (SAPS II), main diagnosis, hospital length of stay (HLS) before ICU (BICULS), in ICU (ICULS) and after ICU (AICULS). RESULTS When comparing survivors with non-survivors, we found that age, disease severity expressed by SAPS II and BICULS were significantly higher in non-survivors. After multivariate regression analysis, BICULS was still significantly associated with mortality in the hospital. CONCLUSION Further studies are needed to characterize whether this longer BICULS is related to non-modifiable prior conditions or whether it is related to delayed ICU admission, which is a modifiable factor.
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Affiliation(s)
- Sílvia Castro
- Intensive Care Unit, Emergency and Intensive Care Department, Faro Hospital Algarve University Hospital Center Faro Portugal
- Algarve Biomedical Center Universidade do Algarve Faro Portugal
| | - Isabel Jesus Pereira
- Intensive Care Unit, Emergency and Intensive Care Department, Faro Hospital Algarve University Hospital Center Faro Portugal
- Algarve Biomedical Center Universidade do Algarve Faro Portugal
- CINTESIS – Center for Health Technology and Services Research Porto Portugal
| | - Cláudia Camila Dias
- CINTESIS – Center for Health Technology and Services Research Porto Portugal
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine University of Porto Porto Portugal
| | - Cristina Granja
- Intensive Care Unit, Emergency and Intensive Care Department, Faro Hospital Algarve University Hospital Center Faro Portugal
- Algarve Biomedical Center Universidade do Algarve Faro Portugal
- CINTESIS – Center for Health Technology and Services Research Porto Portugal
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine University of Porto Porto Portugal
- Medical and Biomedical Department University of Algarve Faro Portugal
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17
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Berger-Estilita J, Granja C, Gonçalves H, Dias CC, Aragão I, Costa-Pereira A, Orwelius L. A new global health outcome score after trauma (GHOST) for disability, cognitive impairment, and health-related quality of life: data from a prospective cross-sectional observational study. Brain Inj 2019; 33:922-931. [PMID: 30810390 DOI: 10.1080/02699052.2019.1581257] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background:Trauma patients experience morbidity related to disability and cognitive impairment that negatively impact their health-related quality of life (HRQoL). We assessed the impact of trauma on disability, cognitive impairment and HRQoL after intensive care in patients with and without traumatic brain injury (TBI) and created a predictive score to identify patients with worse outcome. Methods:We identified 262 patients with severe trauma (ISS>15) admitted to the emergency room of a level 1 trauma center. Patients above 13 years were included. After 6 months, patients were assessed for disability, cognitive impairment, and HRQoL. A global health outcome score after trauma (GHOST) was obtained through the combination of these domains. Logistic regression analysis was considered for the effect of demographic, trauma and hospital factors on global outcome. p > 0.05. Statistics performed with SPSS 23.0. Results:Patients with the worst outcomes were older and had a longer length of Intensive Care Unit (ICU) stay. The effect of gender was found in all "GHOST dimensions". TBI was not significantly associated with worse outcome. Conclusions:No significant differences were seen on disability, cognitive impairment and decreased HRQoL in patients with or without TBI. Our GHOST score showed that female gender, older age, and longer ICU stay were significantly associated with the worst outcome. Abbreviations: AIS: Abbreviated Injury Scale; EQ-5D: EuroQol 5-dimensions; EQ-5D-3L: EuroQol 5-dimensions 3-levels; GCS: Glasgow Coma Scale; GOSE: Glasgow Outcome Scale Extended; HRQoL: Health-Related Quality of Life; ICU: Intensive Care Unit; ISS: Injury Severity Score; MMS: Mini Mental State; NICE: National Institute for Health and Care Excellence; RTS: Revised Trauma Score; TBI: Traumatic brain injury; TRISS: Trauma Injury Severity Score; VAS: Visual Analogue Scale.
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Affiliation(s)
- Joana Berger-Estilita
- a CINTESIS - Center for Health Technology and Services Research, Faculty of Medicine , University of Porto , Porto , Portugal.,b Department of Emergency and Intensive Care Medicine , Algarve University Hospital Centre , Faro , Portugal
| | - Cristina Granja
- a CINTESIS - Center for Health Technology and Services Research, Faculty of Medicine , University of Porto , Porto , Portugal.,b Department of Emergency and Intensive Care Medicine , Algarve University Hospital Centre , Faro , Portugal.,c Department of Biomedical Sciences and Medicine , University of Algarve , Faro , Portugal
| | - Hernâni Gonçalves
- a CINTESIS - Center for Health Technology and Services Research, Faculty of Medicine , University of Porto , Porto , Portugal.,d Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine , University of Porto , Porto , Portugal
| | - Claudia Camila Dias
- a CINTESIS - Center for Health Technology and Services Research, Faculty of Medicine , University of Porto , Porto , Portugal.,d Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine , University of Porto , Porto , Portugal
| | - Irene Aragão
- e Intensive Care Unit, Hospital Santo Antonio , Porto University Hospital Center , Porto , Portugal
| | - Altamiro Costa-Pereira
- a CINTESIS - Center for Health Technology and Services Research, Faculty of Medicine , University of Porto , Porto , Portugal.,d Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine , University of Porto , Porto , Portugal
| | - Lotti Orwelius
- a CINTESIS - Center for Health Technology and Services Research, Faculty of Medicine , University of Porto , Porto , Portugal.,f Department of Intensive Care , County Council of Östergötland , Linköping , Sweden.,g Department of Clinical and Experimental Medicine , Linköping University , Linköping , Sweden
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18
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Viana Coelho M, Jesus Pereira I, Arroyo F, Granja C. Traumatic occipitoatlantal dissociation: high index of suspicion should be kept in mind. Intensive Care Med 2018; 45:1147-1148. [PMID: 30547323 DOI: 10.1007/s00134-018-5494-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 12/03/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Margarida Viana Coelho
- Internal Medicine Department, Hospital de Faro, Centro Hospitalar Universitário Do Algarve, Faro, Portugal.
| | - Isabel Jesus Pereira
- Emergency and Intensive Care Department, Hospital de Faro, Centro Hospitalar Universitário Do Algarve, Faro, Portugal
- CINTESIS-Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Francisco Arroyo
- Emergency and Intensive Care Department, Hospital de Faro, Centro Hospitalar Universitário Do Algarve, Faro, Portugal
| | - Cristina Granja
- Emergency and Intensive Care Department, Hospital de Faro, Centro Hospitalar Universitário Do Algarve, Faro, Portugal
- CINTESIS-Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal
- Departamento de Medicina da Comunidade Informação e Decisão em Saúde - MEDCIDS, Faculty of Medicine of Porto, University of Porto, Porto, Portugal
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19
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Tomandl I, Vacík J, Mora Sierra Y, Granja C, Kraus V. High resolution imaging of 2D distribution of lithium in thin samples measured with multipixel detectors in sandwich geometry. Rev Sci Instrum 2017; 88:023706. [PMID: 28249532 DOI: 10.1063/1.4977217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A method that enables visualization of lateral distribution of Li in thin films is described. The method is based on the simultaneous detection of the reaction products of the 6Li(n,α)t nuclear reaction with thermal neutrons measured with two multipixel detectors in a sandwich geometry with a sample. Here, the principle and basic methodological parameters of the method, including tests with thin polymers with known Li microstructure, are discussed.
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Affiliation(s)
- I Tomandl
- Nuclear Physics Institute, Academy of Sciences of the Czech Republic, CZ-25068 Řež, Czech Republic
| | - J Vacík
- Nuclear Physics Institute, Academy of Sciences of the Czech Republic, CZ-25068 Řež, Czech Republic
| | - Y Mora Sierra
- Institute of Experimental and Applied Physics, Czech Technical University in Prague, CZ-128 00 Prague 2, Czech Republic
| | - C Granja
- Institute of Experimental and Applied Physics, Czech Technical University in Prague, CZ-128 00 Prague 2, Czech Republic
| | - V Kraus
- Institute of Experimental and Applied Physics, Czech Technical University in Prague, CZ-128 00 Prague 2, Czech Republic
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ESICM LIVES 2016: part two. Intensive Care Med Exp 2016. [PMCID: PMC5042923 DOI: 10.1186/s40635-016-0099-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Schuepbach R, De Brito-Ashurst I, Zand F, Sabetian G, Nikandish R, Hagar F, Masjedi M, Maghsudi B, Vazin A, Ghorbani M, Asadpour E, Kao KC, Chiu LC, Hung CY, Chang CH, Li SH, Hu HC, El Maraghi S, Ali M, Rageb D, Helmy M, Marin-Corral J, Vilà C, Masclans JR, Vàzquez A, Martín-Loeches I, Díaz E, Yébenes JC, Rodriguez A, Álvarez-Lerma F, Varga N, Cortina-Gutiérrez A, Dono L, Martínez-Martínez M, Maldonado C, Papiol E, Pérez-Carrasco M, Ferrer R, Nweze K, Morton B, Welters I, Houard M, Voisin B, Ledoux G, Six S, Jaillette E, Nseir S, Romdhani S, Bouneb R, Loghmari D, Aicha NB, Ayachi J, Meddeb K, Chouchène I, Khedher A, Boussarsar M, Chan KS, Yu WL, Marin-Corral J, Vilà C, Masclans JR, Nolla J, Vidaur L, Bonastre J, Suberbiola B, Guerrero JE, Rodriguez A, Coll NR, Jiménez GJ, Brugger SC, Calero JC, Garrido BB, García M, Martínez MP, Vidal MV, de la Torre MC, Vendrell E, Palomera E, Güell E, Yébenes JC, Serra-Prat M, Bermejo-Martín JF, Almirall J, Tomas E, Escoval A, Froe F, Pereira MHV, Velez N, Viegas E, Filipe E, Groves C, Reay M, Chiu LC, Hu HC, Hung CY, Chang CH, Li SH, Kao KC, Ballin A, Facchin F, Sartori G, Zarantonello F, Campello E, Radu CM, Rossi S, Ori C, Simioni P, Umei N, Shingo I, Santos AC, Candeias C, Moniz I, Marçal R, e Silva ZC, Ribeiro JM, Georger JF, Ponthus JP, Tchir M, Amilien V, Ayoub M, Barsam E, Martucci G, Panarello G, Tuzzolino F, Capitanio G, Ferrazza V, Carollo T, Giovanni L, Arcadipane A, Sánchez ML, González-Gay MA, Díaz FJL, López MIR, Zogheib E, Villeret L, Nader J, Bernasinski M, Besserve P, Caus T, Dupont H, Morimont P, Habran S, Hubert R, Desaive T, Blaffart F, Janssen N, Guiot J, Pironet A, Dauby P, Lambermont B, Zarantonello F, Ballin A, Facchin F, Sartori G, Campello E, Pettenuzzo T, Citton G, Rossi S, Simioni P, Ori C, Kirakli C, Ediboglu O, Ataman S, Yarici M, Tuksavul F, Keating S, Gibson A, Gilles M, Dunn M, Price G, Young N, Remeta P, Bishop P, Zamora MDF, Muñoz-Bono J, Curiel-Balsera E, Aguilar-Alonso E, Hinojosa R, Gordillo-Brenes A, Arboleda-Sánchez JA, Skorniakov I, Vikulova D, Whiteley C, Shaikh O, Jones A, Ostermann M, Forni L, Scott M, Sahatjian J, Linde-Zwirble W, Hansell D, Laoveeravat P, Srisawat N, Kongwibulwut M, Peerapornrattana S, Suwachittanont N, Wirotwan TO, Chatkaew P, Saeyub P, Latthaprecha K, Tiranathanagul K, Eiam-ong S, Kellum JA, Berthelsen RE, Perner A, Jensen AEK, Jensen JU, Bestle MH, Gebhard DJ, Price J, Kennedy CE, Akcan-Arikan A, Liberatore AMA, Souza RB, Martins AMCRPF, Vieira JCF, Kang YR, Nakamae MN, Koh IHJ, Hamed K, Khaled MM, Soliman RA, Mokhtar MS, Seller-Pérez G, Arias-Verdú D, Llopar-Valdor E, De-Diós-Chacón I, Quesada-García G, Herrera-Gutierrez ME, Hafes R, Carroll G, Doherty P, Wright C, Vera IGG, Ralston M, Gemmell ML, MacKay A, Black E, Wright C, Docking RI, Appleton R, Ralston MR, Gemmell L, Appleton R, Wright C, Docking RI, Black E, Mackay A, Rozemeijer S, Mulier JLGH, Röttgering JG, Elbers PWG, Spoelstra-de Man AME, Tuinman PR, de Waard MC, Oudemans-van Straaten HM, Mejeni N, Nsiala J, Kilembe A, Akilimali P, Thomas G, Egerod I, Andersson AE, Fagerdahl AM, Knudsen V, Meddeb K, Cheikh AB, Hamdaoui Y, Ayachi J, Guiga A, Fraj N, Romdhani S, Sma N, Bouneb R, Chouchene I, Khedher A, Bouafia N, Boussarsar M, Amirian A, Ziaian B, Masjedi M, Fleischmann C, Thomas-Rueddel DO, Schettler A, Schwarzkopf D, Stacke A, Reinhart K, Filipe E, Escoval A, Martins A, Sousa P, Velez N, Viegas E, Tomas E, Snell G, Matsa R, Paary TTS, Kalaiselvan MS, Cavalheiro AM, Rocha LL, Vallone CS, Tonilo A, Lobato MDS, Malheiro DT, Sussumo G, Lucino NM, Zand F, Rosenthal VD, Masjedi M, Sabetian G, Maghsudi B, Ghorbani M, Dashti AS, Yousefipour A, Goodall JR, Williamson M, Tant E, Thomas N, Balci C, Gonen C, Haftacı E, Gurarda H, Karaca E, Paldusová B, Zýková I, Šímová D, Houston S, D’Antona L, Lloyd J, Garnelo-Rey V, Sosic M, Sotosek-Tokmazic V, Kuharic J, Antoncic I, Dunatov S, Sustic A, Chong CT, Sim M, Lyovarin T, Díaz FMA, Galdó SN, Garach MM, Romero OM, Bailón AMP, Pinel AC, Colmenero M, Gritsan A, Gazenkampf A, Korchagin E, Dovbish N, Lee RM, Lim MPP, Chong CT, Lim BCL, See JJ, Assis R, Filipe F, Lopes N, Pessoa L, Pereira T, Catorze N, Aydogan MS, Aldasoro C, Marchio P, Jorda A, Mauricio MD, Guerra-Ojeda S, Gimeno-Raga M, Colque-Cano M, Bertomeu-Artecero A, Aldasoro M, Valles SL, Tonon D, Triglia T, Martin JC, Alessi MC, Bruder N, Garrigue P, Velly L, Spina S, Scaravilli V, Marzorati C, Colombo E, Savo D, Vargiolu A, Cavenaghi G, Citerio G, Andrade AHV, Bulgarelli P, Araujo JAP, Gonzalez V, Souza VA, Costa A, Massant C, Filho CACA, Morbeck RA, Burgo LE, van Groenendael R, van Eijk LT, Leijte GP, Koeneman B, Kox M, Pickkers P, García-de la Torre A, de la Torre-Prados M, Fernández-Porcel A, Rueda-Molina C, Nuevo-Ortega P, Tsvetanova-Spasova T, Cámara-Sola E, García-Alcántara A, Salido-Díaz L, Liao X, Feng T, Zhang J, Cao X, Wu Q, Xie Z, Li H, Kang Y, Winkler MS, Nierhaus A, Mudersbach E, Bauer A, Robbe L, Zahrte C, Schwedhelm E, Kluge S, Zöllner C, Morton B, Mitsi E, Pennington SH, Reine J, Wright AD, Parker R, Welters ID, Blakey JD, Rajam G, Ades EW, Ferreira DM, Wang D, Kadioglu A, Gordon SB, Koch R, Kox M, Rahamat-Langedoen J, Schloesser J, de Jonge M, Pickkers P, Bringue J, Guillamat-Prats R, Torrents E, Martinez ML, Camprubí-Rimblas M, Artigas A, Blanch L, Park SY, Park YB, Song DK, Shrestha S, Park SH, Koh Y, Park MJ, Hong CW, Lesur O, Coquerel D, Sainsily X, Cote J, Söllradl T, Murza A, Dumont L, Dumaine R, Grandbois M, Sarret P, Marsault E, Salvail D, Auger-Messier M, Chagnon F, Lauretta MP, Greco E, Dyson A, Singer M, Preau S, Ambler M, Sigurta A, Saeed S, Singer M, Sarıca LT, Zibandeh N, Genc D, Gul F, Akkoc T, Kombak E, Cinel L, Akkoc T, Cinel I, Pollen SJ, Arulkumaran N, Singer M, Torrance HD, Longbottom ER, Warnes G, Hinds CJ, Pennington DJ, Brohi K, O’Dwyer MJ, Kim HY, Na S, Kim J, Chang YF, Chao A, Shih PY, Lee CT, Yeh YC, Chen LW, Adriaanse M, Trogrlic Z, Ista E, Lingsma H, Rietdijk W, Ponssen HH, Schoonderbeek JF, Schreiner F, Verbrugge SJ, Duran S, Gommers DAMPJ, van der Jagt M, Funcke S, Sauerlaender S, Saugel B, Pinnschmidt H, Reuter DA, Nitzschke R, Perbet S, Biboulet C, Lenoire A, Bourdeaux D, Pereira B, Plaud B, Bazin JE, Sautou V, Mebazaa A, Constantin JM, Legrand M, Boyko Y, Jennum P, Nikolic M. ESICM LIVES 2016: part one. Intensive Care Med Exp 2016. [PMCID: PMC5042924 DOI: 10.1186/s40635-016-0098-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Kozyrev A, Mitrofanov I, Owens A, Quarati F, Benkhoff J, Bakhtin B, Fedosov F, Golovin D, Litvak M, Malakhov A, Mokrousov M, Nuzhdin I, Sanin A, Tretyakov V, Vostrukhin A, Timoshenko G, Shvetsov V, Granja C, Slavicek T, Pospisil S. A comparative study of LaBr3(Ce(3+)) and CeBr3 based gamma-ray spectrometers for planetary remote sensing applications. Rev Sci Instrum 2016; 87:085112. [PMID: 27587165 DOI: 10.1063/1.4958897] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The recent availability of large volume cerium bromide crystals raises the possibility of substantially improving gamma-ray spectrometer limiting flux sensitivities over current systems based on the lanthanum tri-halides, e.g., lanthanum bromide and lanthanum chloride, especially for remote sensing, low-level counting applications or any type of measurement characterized by poor signal to noise ratios. The Russian Space Research Institute has developed and manufactured a highly sensitive gamma-ray spectrometer for remote sensing observations of the planet Mercury from the Mercury Polar Orbiter (MPO), which forms part of ESA's BepiColombo mission. The Flight Model (FM) gamma-ray spectrometer is based on a 3-in. single crystal of LaBr3(Ce(3+)) produced in a separate crystal development programme specifically for this mission. During the spectrometers development, manufacturing, and qualification phases, large crystals of CeBr3 became available in a subsequent phase of the same crystal development programme. Consequently, the Flight Spare Model (FSM) gamma-ray spectrometer was retrofitted with a 3-in. CeBr3 crystal and qualified for space. Except for the crystals, the two systems are essentially identical. In this paper, we report on a comparative assessment of the two systems, in terms of their respective spectral properties, as well as their suitability for use in planetary mission with respect to radiation tolerance and their propensity for activation. We also contrast their performance with a Ge detector representative of that flown on MESSENGER and show that: (a) both LaBr3(Ce(3+)) and CeBr3 provide superior detection systems over HPGe in the context of minimally resourced spacecraft and (b) CeBr3 is a more attractive system than LaBr3(Ce(3+)) in terms of sensitivities at lower gamma fluxes. Based on the tests, the FM has now been replaced by the FSM on the BepiColombo spacecraft. Thus, CeBr3 now forms the central gamma-ray detection element on the MPO spacecraft.
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Affiliation(s)
- A Kozyrev
- Space Research Institute of the Russian Academy of Sciences (IKI), 84/32 Profsoyuznaya St., Moscow 117997, Russia
| | - I Mitrofanov
- Space Research Institute of the Russian Academy of Sciences (IKI), 84/32 Profsoyuznaya St., Moscow 117997, Russia
| | - A Owens
- European Space Agency, ESTEC, Keplerlaan, 2200 AG Noordwijk, The Netherlands
| | - F Quarati
- AP, RST, FAME, Delft University of Technology, Mekelweg 15, 2629 JB Delft, The Netherlands
| | - J Benkhoff
- European Space Agency, ESTEC, Keplerlaan, 2200 AG Noordwijk, The Netherlands
| | - B Bakhtin
- Space Research Institute of the Russian Academy of Sciences (IKI), 84/32 Profsoyuznaya St., Moscow 117997, Russia
| | - F Fedosov
- Space Research Institute of the Russian Academy of Sciences (IKI), 84/32 Profsoyuznaya St., Moscow 117997, Russia
| | - D Golovin
- Space Research Institute of the Russian Academy of Sciences (IKI), 84/32 Profsoyuznaya St., Moscow 117997, Russia
| | - M Litvak
- Space Research Institute of the Russian Academy of Sciences (IKI), 84/32 Profsoyuznaya St., Moscow 117997, Russia
| | - A Malakhov
- Space Research Institute of the Russian Academy of Sciences (IKI), 84/32 Profsoyuznaya St., Moscow 117997, Russia
| | - M Mokrousov
- Space Research Institute of the Russian Academy of Sciences (IKI), 84/32 Profsoyuznaya St., Moscow 117997, Russia
| | - I Nuzhdin
- Space Research Institute of the Russian Academy of Sciences (IKI), 84/32 Profsoyuznaya St., Moscow 117997, Russia
| | - A Sanin
- Space Research Institute of the Russian Academy of Sciences (IKI), 84/32 Profsoyuznaya St., Moscow 117997, Russia
| | - V Tretyakov
- Space Research Institute of the Russian Academy of Sciences (IKI), 84/32 Profsoyuznaya St., Moscow 117997, Russia
| | - A Vostrukhin
- Space Research Institute of the Russian Academy of Sciences (IKI), 84/32 Profsoyuznaya St., Moscow 117997, Russia
| | - G Timoshenko
- Joint Institute for Nuclear Research, Joliot-Curie 6, Dubna, Moscow Region 141980, Russia
| | - V Shvetsov
- Joint Institute for Nuclear Research, Joliot-Curie 6, Dubna, Moscow Region 141980, Russia
| | - C Granja
- Institute of Experimental and Applied Physics, Czech Technical University in Prague, Horska 3a/22, 12800 Prague 2, Czech Republic
| | - T Slavicek
- Institute of Experimental and Applied Physics, Czech Technical University in Prague, Horska 3a/22, 12800 Prague 2, Czech Republic
| | - S Pospisil
- Institute of Experimental and Applied Physics, Czech Technical University in Prague, Horska 3a/22, 12800 Prague 2, Czech Republic
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Orwelius L, Teixeira-Pinto A, Lobo C, Costa-Pereira A, Granja C. The role of memories on health-related quality of life after intensive care unit care: an unforgettable controversy? Patient Relat Outcome Meas 2016; 7:63-71. [PMID: 27350762 PMCID: PMC4902152 DOI: 10.2147/prom.s89555] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Decreased health-related quality of life (HRQoL) is a significant problem after an intensive care stay and is affected by several known factors such as age, sex, and previous health-state. The objective of this study was to assess the association between memory and self-reported perceived HRQoL of patients discharged from the intensive care unit (ICU). Methods A prospective, multicenter study involving nine general ICUs in Portugal. All adult patients with a length of stay >48 hours were invited to participate in a 6-month follow-up after ICU discharge by answering a set of structured questionnaires, including EuroQol 5-Dimensions and ICU memory tool. Results A total of 313 (52% of the eligible) patients agreed to enter the study. The median age of patients was 60 years old, 58% were males, the median Simplified Acute Physiology Score II (SAPS II) was 38, and the median length of stay was 8 days for ICU and 21 days for total hospital stay. Eighty-nine percent (n=276) of the admissions were emergencies. Seventy-eight percent (n=234) of the patients had memories associated with the ICU stay. Patients with no memories had 2.1 higher chances (P=0.011) of being in the bottom half of the HRQoL score (<0.5 Euro-Qol 5-Dimensions index score). Even after adjusting for pre-admission characteristics, having memories was associated with higher perceived HRQoL (adjusted odds ratio =2.1, P=0.022). Conclusion This study suggests that most of the ICU survivors have memories of their ICU stay. For the ICU survivors, having memories of the ICU stay is associated with a higher perceived HRQoL 6 months after ICU discharge.
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Affiliation(s)
- Lotti Orwelius
- Department of Health Information and Decision Sciences, Faculty of Medicine of Porto, Porto, Portugal; CINTESIS - Centre for Research in Health Technologies and Health Systems, Faculty of Medicine of Porto, Porto, Portugal; Department of Intensive Care, Linköping University, County Council of Östergötland, Linköping, Sweden; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Armando Teixeira-Pinto
- CINTESIS - Centre for Research in Health Technologies and Health Systems, Faculty of Medicine of Porto, Porto, Portugal; Screening and Test Evaluation Program, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Cristina Lobo
- CINTESIS - Centre for Research in Health Technologies and Health Systems, Faculty of Medicine of Porto, Porto, Portugal
| | - Altamiro Costa-Pereira
- Department of Health Information and Decision Sciences, Faculty of Medicine of Porto, Porto, Portugal; CINTESIS - Centre for Research in Health Technologies and Health Systems, Faculty of Medicine of Porto, Porto, Portugal
| | - Cristina Granja
- Department of Health Information and Decision Sciences, Faculty of Medicine of Porto, Porto, Portugal; CINTESIS - Centre for Research in Health Technologies and Health Systems, Faculty of Medicine of Porto, Porto, Portugal; Department of Emergency and Intensive Care Medicine, Algarve Hospital Centre, Algarve, Portugal; Department of Biomedical Sciences and Medicine, University of Algarve, Algarve, Portugal
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Granja C, Nassar Junior AP. Reply to: Neurological outcome after cardiac arrest: cold and dark issues [editorial]. Rev Bras Ter Intensiva 2016; 28:211-2. [PMID: 27410421 PMCID: PMC4943065 DOI: 10.5935/0103-507x.20160040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Cristina Granja
- Departamento de Ciências Biomédicas e Medicina, Universidade do Algarve, Faro, Portugal
| | - Antonio Paulo Nassar Junior
- Disciplina de Emergências Clínicas, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Barbosa S, Ilchenko A, Carmo A, Fernandes F, Nascimento S, Granja C. What we say to families of intensive care unit patients - do they understand? Intensive Care Med Exp 2015. [PMCID: PMC4797614 DOI: 10.1186/2197-425x-3-s1-a471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Jančář A, Kopecký Z, Dressler J, Veškrna M, Matěj Z, Granja C, Solar M. Pulse-shape discrimination of the new plastic scintillators in neutron–gamma mixed field using fast digitizer card. Radiat Phys Chem Oxf Engl 1993 2015. [DOI: 10.1016/j.radphyschem.2015.05.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Affiliation(s)
- Cristina Granja
- Departamento de Ciências Biomédicas e Medicina, Universidade do Algarve, Faro, PT
| | - Pedro Póvoa
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, PT
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Abstract
Kounis Syndrome (KS) is the contemporary occurrence of Acute Coronary Syndromes (ACS) with an allergic or hypersensitivity reaction. This syndrome has been reported in association with a variety of drugs, food, insect stings, environmental exposures and medical conditions. Cases of KS seem to be more often encountered in everyday clinical practice than anticipated. It is believed that the lack of awareness of this association may lead to underreporting. We report a case of KS secondary to diclofenac intake.
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Vaz A, Eusebio M, Antunes A, Sousa A, Perez P, Ornelas R, Granja C, Guerreiro H. Mortality in patients with cirrhosis admitted to the ICU: time to rethink strategies? Crit Care 2015. [PMCID: PMC4472825 DOI: 10.1186/cc14465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Granja C, Nassar Junior AP. Neurological outcome after cardiac arrest: cold and dark issues. Rev Bras Ter Intensiva 2015; 27:305-6. [PMID: 26761464 PMCID: PMC4738812 DOI: 10.5935/0103-507x.20150051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Cristina Granja
- Department of Biomedical Sciences and Medicine,
Universidade do Algarve - Faro, Portugal
- Corresponding author: Cristina Granja, Departamento de
Emergência, Urgência e Cuidados Intensivos do Centro
Hospitalar do Algarve, Rua Leão Penedo Faro 8000-000 - Portugal.
E-mail:
| | - Antonio Paulo Nassar Junior
- Discipline of Clinical Emergency, Hospital das
Clínicas, Faculdade de Medicina, Universidade de São Paulo -
São Paulo (SP), Brazil
- Adult Intensive Care Unit, A.C. Camargo Cancer Center
- São Paulo (SP), Brazil
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Varela AV, Vala P, Dykyy M, Almeida R, Arduán J, Gonçalves A, Pereira MA, Hubert I, Granja C. CENTRAL VENOUS CATHETER-RELATED BLOODSTREAM INFECTION - PREVENTION, RECORDS AND AUDITING. Intensive Care Med Exp 2015. [PMCID: PMC4797797 DOI: 10.1186/2197-425x-3-s1-a887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Duro C, Granja C, Castro S, Cardoso A, Mestre S. OUTCOMES OF CRITICAL PATIENTS WITH TRACHEOSTOMY: PROPOSAL OF A DECANNULATION PROTOCOL. Intensive Care Med Exp 2015. [PMCID: PMC4798444 DOI: 10.1186/2197-425x-3-s1-a933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Granja C, Almada-Lobo B, Janela F, Seabra J, Mendes A. An optimization based on simulation approach to the patient admission scheduling problem using a linear programing algorithm. J Biomed Inform 2014; 52:427-37. [DOI: 10.1016/j.jbi.2014.08.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 07/18/2014] [Accepted: 08/15/2014] [Indexed: 10/24/2022]
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Caicedo I, Granja C, Gómez B, Hartmann B, Martisikova M, Pospisil S. Characterization of secondary radiation in ion beam therapy using synchronized timepix detectors with a mixed pixel operation mask. Phys Med 2014. [DOI: 10.1016/j.ejmp.2014.07.217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Estilita J, Dias CC, Costa-Pereira A, Granja C, Arag±o I, Orwelius L. Is the Golden hour important? Looking at disability and health-related quality of life in a Portuguese trauma registry. Crit Care 2014. [PMCID: PMC4068875 DOI: 10.1186/cc13253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Gwosch K, Hartmann B, Jakubek J, Granja C, Soukup P, Jäkel O, Martišíková M. Non-invasive monitoring of therapeutic carbon ion beams in a homogeneous phantom by tracking of secondary ions. Phys Med Biol 2013; 58:3755-73. [DOI: 10.1088/0031-9155/58/11/3755] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Granja C, Póvoa P, Lobo C, Teixeira-Pinto A, Carneiro A, Costa-Pereira A. The predisposition, infection, response and organ failure (Piro) sepsis classification system: results of hospital mortality using a novel concept and methodological approach. PLoS One 2013; 8:e53885. [PMID: 23349756 PMCID: PMC3548822 DOI: 10.1371/journal.pone.0053885] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Accepted: 12/04/2012] [Indexed: 12/18/2022] Open
Abstract
Introduction PIRO is a conceptual classification system in which a number of demographic, clinical, biological and laboratory variables are used to stratify patients with sepsis in categories with different outcomes, including mortality rates. Objectives To identify variables to be included in each component of PIRO aiming to improve the hospital mortality prediction. Methods Patients were selected from the Portuguese ICU-admitted community-acquired sepsis study (SACiUCI). Variables concerning the R and O component included repeated measurements along the first five days in ICU stay. The trends of these variables were summarized as the initial value at day 1 (D1) and the slope of the tendency during the five days, using a linear mixed model. Logistic regression models were built to assess the best set of covariates that predicted hospital mortality. Results A total of 891 patients (age 60±17 years, 64% men, 38% hospital mortality) were studied. Factors significantly associated with mortality for P component were gender, age, chronic liver failure, chronic renal failure and metastatic cancer; for I component were positive blood cultures, guideline concordant antibiotic therapy and health-care associated sepsis; for R component were C-reactive protein slope, D1 heart rate, heart rate slope, D1 neutrophils and neutrophils slope; for O component were D1 serum lactate, serum lactate slope, D1 SOFA and SOFA slope. The relative weight of each component of PIRO was calculated. The combination of these four results into a single-value predictor of hospital mortality presented an AUC-ROC 0.84 (IC95%:0.81–0.87) and a test of goodness-of-fit (Hosmer and Lemeshow) of p = 0.368. Conclusions We identified specific variables associated with each of the four components of PIRO, including biomarkers and a dynamic view of the patient daily clinical course. This novel approach to PIRO concept and overall score can be a better predictor of mortality for patients with community-acquired sepsis admitted to ICUs.
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Affiliation(s)
- Cristina Granja
- Department of Health Information and Decision Sciences, Faculty of Medicine of Porto, Porto, Portugal.
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Abstract
The objective was to describe Microtron MT25 as a source of neutrons generated by bremsstrahlung induced photonuclear reactions in U and Pb targets. Bremsstrahlung photons were produced by electrons accelerated at energy 21.6 MeV. Spectral fluence of the generated neutrons was calculated with MCNPX code and then experimentally determined at two positions by means of a Bonner spheres spectrometer in which the detector of thermal neutrons was replaced by activation Mn tablets or track detectors CR-39 with a (10)B radiator. The measured neutron spectral fluence and the calculated anisotropy served for the estimation of neutron yield from the targets and for the determination of ambient dose equivalent rate at the place of measurement. Microtron MT25 is intended as one of the sources for testing neutron sensitive devices which will be sent into the space.
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Affiliation(s)
- M Králík
- Czech Metrology Institute, CZ-102 00 Prague 10, Czech Republic.
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Martisikova M, Jakubek J, Gwosch K, Hartmann B, Telsemeyer J, Soukup P, Granja C, Pospisil S, Jaekel O. MO-A-213AB-11: First Experimental Test of Secondary Ion Tracking for the Assessment of Beam Range in a Patient-Like Phantom. Med Phys 2012; 39:3861. [DOI: 10.1118/1.4735763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Gwosch K, Hartmann B, Jakubek J, Granja C, Soukup P, Jaekel O, Martisikova M. SU-D-BRB-02: Investigations of Secondary Ion Distributions in Carbon Ion Therapy Using the Timepix Detector. Med Phys 2012; 39:3614-3615. [DOI: 10.1118/1.4734674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Hartmann B, Gwosch K, Granja C, Jakubek J, Jaekel O, Martisikova M. TU-A-BRB-04: Fragmentation Analysis in Heavy Ion Therapy: A Novel Experimental Approach to Measure Lateral Distributions of Secondary Charged Particles. Med Phys 2012. [DOI: 10.1118/1.4735861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Hartmann B, Granja C, Jakubek J, Jäkel O, Martisikova M. 247 DISTINGUISHING BETWEEN CARBON IONS AND THEIR FRAGMENTS IN THERAPEUTIC ION BEAMS USING THE PIXEL DETECTOR TIMEPIX. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)70214-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Martišíková M, Jakubek J, Granja C, Gwosch K, Hartmann B, Pospíšil S, Jäkel O. 249 INVESTIGATION OF THE TIMEPIX DETECTOR FOR BEAM RANGE VERIFICATION IN ION BEAM THERAPY. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)70216-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Reinhardt S, Granja C, Assmann W, Krejci F. 62 TEST OF DIFFERENT PIXEL DETECTORS FOR LASER-DRIVEN ACCELERATED PARTICLE BEAMS. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)70043-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Granja C, Kraus V, Kopatch Y, Telezhnikov S, Vacik J, Tomandl I, Platkevic M, Pospisil S. Spatial- and Time-Correlated Detection of Fission Fragments. EPJ Web of Conferences 2012. [DOI: 10.1051/epjconf/20122110004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Campello G, Dantas R, Carvalho F, Dias C, Azevedo L, Granja C. Medical emergency teams and massive basic life support training—Impact on mortality. Resuscitation 2010. [DOI: 10.1016/j.resuscitation.2010.09.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Koster RW, Baubin MA, Bossaert LL, Caballero A, Cassan P, Castrén M, Granja C, Handley AJ, Monsieurs KG, Perkins GD, Raffay V, Sandroni C. Basismaßnahmen zur Wiederbelebung Erwachsener und Verwendung automatisierter externer Defibrillatoren. Notf Rett Med 2010; 13:523-542. [PMID: 32214895 PMCID: PMC7087822 DOI: 10.1007/s10049-010-1368-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- R W Koster
- 1_1368Department of Cardiology, Academic Medical Center, Amsterdam, Niederlande
| | - M A Baubin
- 2_1368Department of Anaesthesiology and Critical Care Medicine, University Hospital Innsbruck, Innsbruck, Österreich
| | - L L Bossaert
- 3_1368Department of Critical Care, University of Antwerp, Antwerpen, Belgien
| | - A Caballero
- 4_1368Hospital Universitario Virgen del Rocío, Sevilla, Spanien
| | - P Cassan
- European Reference Centre for First Aid Education, French Red Cross, Paris, Frankreich
| | - M Castrén
- 6_1368Department of Clinical Science and Education, Karolinska Institute, Stockholm, Schweden
| | - C Granja
- 7_1368Emergency and Intensive Medicine Department, Hospital Pedro Hispano, Matosinhos, Porto, Portugal
| | - A J Handley
- 8_1368Colchester Hospital University NHS Foundation Trust, Colchester, Großbritannien
| | - K G Monsieurs
- 9_1368Emergency Department, Ghent University Hospital, Gent, Belgien
| | - G D Perkins
- 10_1368University of Warwick, Warwick Medical School, Warwick, Großbritannien
| | - V Raffay
- Municipal Institute for Emergency Medicine Novi Sad, Novi Sad, AP Vojvodina, Serbien
| | - C Sandroni
- 12_1368Catholic University School of Medicine, Policlinico Universitario Agostino Gemelli, Rom, Italien
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Koster RW, Baubin MA, Bossaert LL, Caballero A, Cassan P, Castrén M, Granja C, Handley AJ, Monsieurs KG, Perkins GD, Raffay V, Sandroni C. European Resuscitation Council Guidelines for Resuscitation 2010 Section 2. Adult basic life support and use of automated external defibrillators. Resuscitation 2010; 81:1277-92. [PMID: 20956051 PMCID: PMC7116923 DOI: 10.1016/j.resuscitation.2010.08.009] [Citation(s) in RCA: 421] [Impact Index Per Article: 30.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Rudolph W Koster
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands.
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Jones C, Bäckman C, Capuzzo M, Egerod I, Flaatten H, Granja C, Rylander C, Griffiths RD. Intensive care diaries reduce new onset post traumatic stress disorder following critical illness: a randomised, controlled trial. Crit Care 2010; 14:R168. [PMID: 20843344 PMCID: PMC3219263 DOI: 10.1186/cc9260] [Citation(s) in RCA: 319] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Revised: 04/28/2010] [Accepted: 09/15/2010] [Indexed: 01/22/2023]
Abstract
Introduction Patients recovering from critical illness have been shown to be at risk of developing Post Traumatic Stress disorder (PTSD). This study was to evaluate whether a prospectively collected diary of a patient's intensive care unit (ICU) stay when used during convalescence following critical illness will reduce the development of new onset PTSD. Methods Intensive care patients with an ICU stay of more than 72 hours were recruited to a randomised controlled trial examining the effect of a diary outlining the details of the patients ICU stay on the development of acute PTSD. The intervention patients received their ICU diary at 1 month following critical care discharge and the final assessment of the development of acute PTSD was made at 3 months. Results 352 patients were randomised to the study at 1 month. The incidence of new cases of PTSD was reduced in the intervention group compared to the control patients (5% versus 13%, P = 0.02). Conclusions The provision of an ICU diary is effective in aiding psychological recovery and reducing the incidence of new PTSD. Trial registration NCT00912613.
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Affiliation(s)
- Christina Jones
- ICU, Whiston Hospital, Warrington Road, Prescot L35 5DR, UK.
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