1
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Tomazini BM, Nassar AP, Lisboa TC, Azevedo LCPD, Veiga VC, Catarino DGM, Fogazzi DV, Arns B, Piastrelli FT, Dietrich C, Negrelli KL, Jesuíno IDA, Reis LFL, Mattos RRD, Pinheiro CCG, Luz MN, Spadoni CCDS, Moro EE, Bueno FR, Sampaio CSJC, Silva DP, Baldassare FP, Silva ACA, Veiga T, Barbante L, Lambauer M, Campos VB, Santos E, Santos RHN, Laranjeiras LN, Valeis N, Santucci E, Miranda TA, Patrocínio ACLD, Carvalho AD, Sousa EMCD, Sousa AHFD, Malheiro DT, Bezerra IL, Rodrigues MB, Malicia JC, Silva SSD, Gimenes BDP, Sesin GP, Zavascki AP, Sganzerla D, Medeiros GS, Santos RDRMD, Silva FKR, Cheno MY, Abrahão CF, Oliveira Junior HAD, Rocha LL, Nunes Neto PA, Pereira VC, Paciência LEM, Bueno ES, Caser EB, Ribeiro LZ, Fernandes CCF, Garcia JM, Silva VDFF, Santos AJD, Machado FR, Souza MAD, Ferronato BR, Urbano HCDA, Moreira DCA, Souza-Dantas VCD, Duarte DM, Coelho J, Figueiredo RC, Foreque F, Romano TG, Cubos D, Spirale VM, Nogueira RS, Maia IS, Zandonai CL, Lovato WJ, Cerantola RB, Toledo TGP, Tomba PO, Almeida JRD, Sanches LC, Pierini L, Cunha M, Sousa MT, Azevedo B, Dal-Pizzol F, Damasio DDC, Bainy MP, Beduhn DAV, Jatobá JDVN, Moura MTFD, Rego LRDM, Silva AVD, Oliveira LP, Sodré Filho ES, Santos SSD, Neves IDL, Leão VCDA, Paes JLL, Silva MCM, Oliveira CDD, Santiago RCB, Paranhos JLDR, Wiermann IGDS, Pedroso DFF, Sawada PY, Prestes RM, Nascimento GC, Grion CMC, Carrilho CMDDM, Dantas RLADM, Silva EP, Silva ACD, Oliveira SMBD, Golin NA, Tregnago R, Lima VP, Silva KGND, Boschi E, Buffon V, Machado AS, Capeletti L, Foernges RB, Carvalho ASD, Oliveira Junior LCD, Oliveira DCD, Silva EM, Ribeiro J, Pereira FC, Salgado FB, Deutschendorf C, Silva CFD, Gobatto ALN, Oliveira CBD, Dracoulakis MDA, Alvaia NOS, Souza RMD, Araújo LLCD, Melo RMVD, Passos LCS, Vidal CFDL, Rodrigues FLDA, Kurtz P, Shinotsuka CR, Tavares MB, Santana IDV, Gavinho LMDS, Nascimento AB, Pereira AJ, Cavalcanti AB. IMPACTO-MR: a Brazilian nationwide platform study to assess infections and multidrug resistance in intensive care units. Rev Bras Ter Intensiva 2022; 34:418-425. [PMID: 36888821 PMCID: PMC9987010 DOI: 10.5935/0103-507x.20220209-pt] [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: 06/07/2022] [Accepted: 10/19/2022] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To describe the IMPACTO-MR, a Brazilian nationwide intensive care unit platform study focused on the impact of health care-associated infections due to multidrug-resistant bacteria. METHODS We described the IMPACTO-MR platform, its development, criteria for intensive care unit selection, characterization of core data collection, objectives, and future research projects to be held within the platform. RESULTS The core data were collected using the Epimed Monitor System® and consisted of demographic data, comorbidity data, functional status, clinical scores, admission diagnosis and secondary diagnoses, laboratory, clinical, and microbiological data, and organ support during intensive care unit stay, among others. From October 2019 to December 2020, 33,983 patients from 51 intensive care units were included in the core database. CONCLUSION The IMPACTO-MR platform is a nationwide Brazilian intensive care unit clinical database focused on researching the impact of health care-associated infections due to multidrug-resistant bacteria. This platform provides data for individual intensive care unit development and research and multicenter observational and prospective trials.
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Affiliation(s)
- Bruno M Tomazini
- Hospital Sírio-Libanês - São Paulo (SP), Brasil.,Brazilian Research in Intensive Care Network (BRICNet) - São Paulo (SP), Brasil
| | - Antonio Paulo Nassar
- Brazilian Research in Intensive Care Network (BRICNet) - São Paulo (SP), Brasil.,Hospital Israelita Albert Einstein - São Paulo (SP), Brasil.,Hospital A. C. Camargo Cancer Center - São Paulo (SP), Brasil
| | - Thiago Costa Lisboa
- Brazilian Research in Intensive Care Network (BRICNet) - São Paulo (SP), Brasil.,Instituto de Pesquisa, HCor-Hospital do Coração - São Paulo (SP), Brasil
| | - Luciano César Pontes de Azevedo
- Hospital Sírio-Libanês - São Paulo (SP), Brasil.,Brazilian Research in Intensive Care Network (BRICNet) - São Paulo (SP), Brasil
| | - Viviane Cordeiro Veiga
- Brazilian Research in Intensive Care Network (BRICNet) - São Paulo (SP), Brasil.,BP - A Beneficência Portuguesa de São Paulo - São Paulo (SP), Brasil
| | | | | | - Beatriz Arns
- Hospital Moinhos de Vento - Porto Alegre (RS), Brasil
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Thabata Veiga
- Instituto de Pesquisa, HCor-Hospital do Coração - São Paulo (SP), Brasil
| | - Leticia Barbante
- Instituto de Pesquisa, HCor-Hospital do Coração - São Paulo (SP), Brasil
| | - Marianne Lambauer
- Instituto de Pesquisa, HCor-Hospital do Coração - São Paulo (SP), Brasil
| | | | - Elton Santos
- Instituto de Pesquisa, HCor-Hospital do Coração - São Paulo (SP), Brasil
| | | | | | - Nanci Valeis
- Instituto de Pesquisa, HCor-Hospital do Coração - São Paulo (SP), Brasil
| | - Eliana Santucci
- Instituto de Pesquisa, HCor-Hospital do Coração - São Paulo (SP), Brasil
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Flávia Ribeiro Machado
- Brazilian Research in Intensive Care Network (BRICNet) - São Paulo (SP), Brasil.,Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo - São Paulo (SP), Brasil
| | - Maria Aparecida de Souza
- Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo - São Paulo (SP), Brasil
| | | | | | | | - Vicente Cés de Souza-Dantas
- Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro - Rio de Janeiro (RJ), Brasil
| | - Diego Meireles Duarte
- Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro - Rio de Janeiro (RJ), Brasil
| | - Juliana Coelho
- BP - A Beneficência Portuguesa de São Paulo - São Paulo (SP), Brasil
| | | | | | | | - Daniel Cubos
- Hospital e Maternidade São Luiz Itaim - São Paulo (SP), Brasil
| | | | | | - Israel Silva Maia
- Brazilian Research in Intensive Care Network (BRICNet) - São Paulo (SP), Brasil.,Hospital Nereu Ramos - Florianópolis (SC), Brasil
| | | | - Wilson José Lovato
- Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo - Ribeirão Preto (SP), Brasil
| | - Rodrigo Barbosa Cerantola
- Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo - Ribeirão Preto (SP), Brasil
| | | | | | | | | | | | | | | | - Bruna Azevedo
- Fundação Hospitalar São Francisco de Assis - Belo Horizonte (MG), Brasil
| | - Felipe Dal-Pizzol
- Brazilian Research in Intensive Care Network (BRICNet) - São Paulo (SP), Brasil.,Hospital São José - Criciúma (SC), Brasil
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Cintia Magalhães Carvalho Grion
- Brazilian Research in Intensive Care Network (BRICNet) - São Paulo (SP), Brasil.,Hospital Universitário, Universidade Estadual de Londrina - Londrina (PR), Brasil
| | | | | | - Eliane Pereira Silva
- Hospital Universitário Onofre Lopes, Universidade Federal do Rio Grande do Norte - Natal (RN), Brasil
| | | | | | | | | | - Valéria Paes Lima
- Hospital Universitário de Brasília, Universidade de Brasília - Brasília (DF), Brasil
| | | | - Emerson Boschi
- Hospital Geral de Caxias do Sul - Caxias do Sul (RS), Brasil
| | - Viviane Buffon
- Hospital Geral de Caxias do Sul - Caxias do Sul (RS), Brasil
| | | | | | | | | | | | | | | | | | | | | | - Caroline Deutschendorf
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil
| | - Cristofer Farias da Silva
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil
| | | | | | | | | | | | | | | | | | | | | | - Pedro Kurtz
- Brazilian Research in Intensive Care Network (BRICNet) - São Paulo (SP), Brasil.,Instituto Estadual do Cérebro Paulo Niemeyer - Rio de Janeiro (RJ), Brasil
| | - Cássia Righy Shinotsuka
- Brazilian Research in Intensive Care Network (BRICNet) - São Paulo (SP), Brasil.,Instituto Estadual do Cérebro Paulo Niemeyer - Rio de Janeiro (RJ), Brasil
| | | | | | | | | | - Adriano J Pereira
- Brazilian Research in Intensive Care Network (BRICNet) - São Paulo (SP), Brasil.,Hospital Israelita Albert Einstein - São Paulo (SP), Brasil
| | - Alexandre Biasi Cavalcanti
- Brazilian Research in Intensive Care Network (BRICNet) - São Paulo (SP), Brasil.,Instituto de Pesquisa, HCor-Hospital do Coração - São Paulo (SP), Brasil
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2
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Tomazini BM, Nassar Jr AP, Lisboa TC, de Azevedo LCP, Veiga VC, Catarino DGM, Fogazzi DV, Arns B, Piastrelli FT, Dietrich C, Negrelli KL, Jesuíno IDA, Reis LFL, de Mattos RR, Pinheiro CCG, Luz MN, Spadoni CCDS, Moro EE, Bueno FR, Sampaio CSJC, Silva DP, Baldassare FP, Silva ACA, Veiga T, Barbante L, Lambauer M, Campos VB, Santos E, Santos RHN, Laranjeiras LN, Valeis N, Santucci E, Miranda TA, do Patrocínio ACL, de Carvalho A, de Sousa EMC, de Sousa AHF, Malheiro DT, Bezerra IL, Rodrigues MB, Malicia JC, da Silva SS, Gimenes BDP, Sesin GP, Zavascki AP, Sganzerla D, Medeiros GS, dos Santos RDRM, Silva FKR, Cheno MY, Abrahão CF, de Oliveira Junior HA, Rocha LL, Nunes Neto PA, Pereira VC, Paciência LEM, Bueno ES, Caser EB, Ribeiro LZ, Fernandes CCF, Garcia JM, Silva VDFF, dos Santos AJ, Machado FR, de Souza MA, Ferronato BR, Urbano HCDA, Moreira DCA, de Souza-Dantas VC, Duarte DM, Coelho J, Figueiredo RC, Foreque F, Romano TG, Cubos D, Spirale VM, Nogueira RS, Maia IS, Zandonai CL, Lovato WJ, Cerantola RB, Toledo TGP, Tomba PO, de Almeida JR, Sanches LC, Pierini L, Cunha M, Sousa MT, Azevedo B, Dal-Pizzol F, Damasio DDC, Bainy MP, Beduhn DAV, Jatobá JDVN, de Moura MTF, Rego LRDM, da Silva AV, Oliveira LP, Sodré Filho ES, dos Santos SS, Neves IDL, Leão VCDA, Paes JLL, Silva MCM, de Oliveira CD, Santiago RCB, Paranhos JLDR, Wiermann IGDS, Pedroso DFF, Sawada PY, Prestes RM, Nascimento GC, Grion CMC, Carrilho CMDDM, Dantas RLADM, Silva EP, da Silva AC, de Oliveira SMB, Golin NA, Tregnago R, Lima VP, da Silva KGN, Boschi E, Buffon V, Machado AS, Capeletti L, Foernges RB, de Carvalho AS, de Oliveira Junior LC, de Oliveira DC, Silva EM, Ribeiro J, Pereira FC, Salgado FB, Deutschendorf C, da Silva CF, Gobatto ALN, de Oliveira CB, Dracoulakis MDA, Alvaia NOS, de Souza RM, de Araújo LLC, de Melo RMV, Passos LCS, Vidal CFDL, Rodrigues FLDA, Kurtz P, Shinotsuka CR, Tavares MB, Santana IDV, Gavinho LMDS, Nascimento AB, Pereira AJ, Cavalcanti AB. IMPACTO-MR: a Brazilian nationwide platform study to assess infections and multidrug resistance in intensive care units. Rev Bras Ter Intensiva 2022; 34:418-425. [PMID: 36888821 PMCID: PMC9987010 DOI: 10.5935/0103-507x.20220209-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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 10/19/2022] [Indexed: 12/20/2023] Open
Abstract
OBJECTIVE To describe the IMPACTO-MR, a Brazilian nationwide intensive care unit platform study focused on the impact of health care-associated infections due to multidrug-resistant bacteria. METHODS We described the IMPACTO-MR platform, its development, criteria for intensive care unit selection, characterization of core data collection, objectives, and future research projects to be held within the platform. RESULTS The core data were collected using the Epimed Monitor System® and consisted of demographic data, comorbidity data, functional status, clinical scores, admission diagnosis and secondary diagnoses, laboratory, clinical, and microbiological data, and organ support during intensive care unit stay, among others. From October 2019 to December 2020, 33,983 patients from 51 intensive care units were included in the core database. CONCLUSION The IMPACTO-MR platform is a nationwide Brazilian intensive care unit clinical database focused on researching the impact of health care-associated infections due to multidrug-resistant bacteria. This platform provides data for individual intensive care unit development and research and multicenter observational and prospective trials.
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Affiliation(s)
- Bruno M Tomazini
- Hospital Sírio-Libanês - São Paulo (SP),
Brazil
- Brazilian Research in Intensive Care Network (BRICNet) - São
Paulo (SP), Brazil
| | - Antonio Paulo Nassar Jr
- Brazilian Research in Intensive Care Network (BRICNet) - São
Paulo (SP), Brazil
- Hospital Israelita Albert Einstein - São Paulo (SP),
Brazil
- Hospital A. C. Camargo Cancer Center - São Paulo (SP),
Brazil
| | - Thiago Costa Lisboa
- Brazilian Research in Intensive Care Network (BRICNet) - São
Paulo (SP), Brazil
- Research Institute, HCor-Hospital do Coração - São Paulo (SP),
Brazil
| | - Luciano César Pontes de Azevedo
- Hospital Sírio-Libanês - São Paulo (SP),
Brazil
- Brazilian Research in Intensive Care Network (BRICNet) - São
Paulo (SP), Brazil
| | - Viviane Cordeiro Veiga
- Brazilian Research in Intensive Care Network (BRICNet) - São
Paulo (SP), Brazil
- BP - A Beneficência Portuguesa de São Paulo -
São Paulo (SP), Brazil
| | | | | | - Beatriz Arns
- Hospital Moinhos de Vento - Porto Alegre (RS), Brazil
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Thabata Veiga
- Research Institute, HCor-Hospital do Coração - São Paulo (SP),
Brazil
| | - Leticia Barbante
- Research Institute, HCor-Hospital do Coração - São Paulo (SP),
Brazil
| | - Marianne Lambauer
- Research Institute, HCor-Hospital do Coração - São Paulo (SP),
Brazil
| | | | - Elton Santos
- Research Institute, HCor-Hospital do Coração - São Paulo (SP),
Brazil
| | | | | | - Nanci Valeis
- Research Institute, HCor-Hospital do Coração - São Paulo (SP),
Brazil
| | - Eliana Santucci
- Research Institute, HCor-Hospital do Coração - São Paulo (SP),
Brazil
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Flávia Ribeiro Machado
- Brazilian Research in Intensive Care Network (BRICNet) - São
Paulo (SP), Brazil
- Hospital São Paulo, Escola Paulista de Medicina,
Universidade Federal de São Paulo - São Paulo (SP), Brazil
| | - Maria Aparecida de Souza
- Hospital São Paulo, Escola Paulista de Medicina,
Universidade Federal de São Paulo - São Paulo (SP), Brazil
| | | | | | | | - Vicente Cés de Souza-Dantas
- Hospital Universitário Clementino Fraga Filho, Universidade
Federal do Rio de Janeiro - Rio de Janeiro (RJ), Brazil
| | - Diego Meireles Duarte
- Hospital Universitário Clementino Fraga Filho, Universidade
Federal do Rio de Janeiro - Rio de Janeiro (RJ), Brazil
| | - Juliana Coelho
- BP - A Beneficência Portuguesa de São Paulo -
São Paulo (SP), Brazil
| | | | | | | | - Daniel Cubos
- Hospital e Maternidade São Luiz Itaim - São Paulo
(SP), Brazil
| | | | | | - Israel Silva Maia
- Brazilian Research in Intensive Care Network (BRICNet) - São
Paulo (SP), Brazil
- Hospital Nereu Ramos - Florianópolis (SC), Brazil
| | | | - Wilson José Lovato
- Hospital das Clínicas, Faculdade de Medicina de
Ribeirão Preto, Universidade de São Paulo - Ribeirão Preto
(SP), Brazil
| | - Rodrigo Barbosa Cerantola
- Hospital das Clínicas, Faculdade de Medicina de
Ribeirão Preto, Universidade de São Paulo - Ribeirão Preto
(SP), Brazil
| | | | | | | | | | | | | | | | - Bruna Azevedo
- Fundação Hospitalar São Francisco de Assis -
Belo Horizonte (MG), Brazil
| | - Felipe Dal-Pizzol
- Brazilian Research in Intensive Care Network (BRICNet) - São
Paulo (SP), Brazil
- Hospital São José - Criciúma (SC),
Brazil
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Cintia Magalhães Carvalho Grion
- Brazilian Research in Intensive Care Network (BRICNet) - São
Paulo (SP), Brazil
- Hospital Universitário, Universidade Estadual de Londrina -
Londrina (PR), Brazil
| | | | | | - Eliane Pereira Silva
- Hospital Universitário Onofre Lopes, Universidade Federal
do Rio Grande do Norte - Natal (RN), Brazil
| | | | | | | | | | - Valéria Paes Lima
- Hospital Universitário de Brasília, Universidade de
Brasília - Brasília (DF), Brazil
| | | | - Emerson Boschi
- Hospital Geral de Caxias do Sul - Caxias do Sul (RS),
Brazil
| | - Viviane Buffon
- Hospital Geral de Caxias do Sul - Caxias do Sul (RS),
Brazil
| | | | | | | | | | | | | | | | | | | | | | - Caroline Deutschendorf
- Hospital de Clínicas de Porto Alegre, Universidade Federal
do Rio Grande do Sul - Porto Alegre (RS), Brazil
| | - Cristofer Farias da Silva
- Hospital de Clínicas de Porto Alegre, Universidade Federal
do Rio Grande do Sul - Porto Alegre (RS), Brazil
| | | | | | | | | | | | | | | | | | | | | | - Pedro Kurtz
- Brazilian Research in Intensive Care Network (BRICNet) - São
Paulo (SP), Brazil
- Instituto Estadual do Cérebro Paulo Niemeyer - Rio de
Janeiro (RJ), Brazil
| | - Cássia Righy Shinotsuka
- Brazilian Research in Intensive Care Network (BRICNet) - São
Paulo (SP), Brazil
- Instituto Estadual do Cérebro Paulo Niemeyer - Rio de
Janeiro (RJ), Brazil
| | | | | | | | | | - Adriano J Pereira
- Brazilian Research in Intensive Care Network (BRICNet) - São
Paulo (SP), Brazil
- Hospital Israelita Albert Einstein - São Paulo (SP),
Brazil
| | - Alexandre Biasi Cavalcanti
- Brazilian Research in Intensive Care Network (BRICNet) - São
Paulo (SP), Brazil
- Research Institute, HCor-Hospital do Coração - São Paulo (SP),
Brazil
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Machline-Carrion MJ, Soares RM, Damiani LP, Campos VB, Sampaio B, Fonseca FH, Izar MC, Amodeo C, Pontes-Neto OM, Santos JY, Gomes SPDC, Saraiva JFK, Ramacciotti E, Barros E Silva PGDM, Lopes RD, Brandão da Silva N, Guimarães HP, Piegas L, Stein AT, Berwanger O. Effect of a Multifaceted Quality Improvement Intervention on the Prescription of Evidence-Based Treatment in Patients at High Cardiovascular Risk in Brazil: The BRIDGE Cardiovascular Prevention Cluster Randomized Clinical Trial. JAMA Cardiol 2020; 4:408-417. [PMID: 30942842 DOI: 10.1001/jamacardio.2019.0649] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Importance Studies have found that patients at high cardiovascular risk often fail to receive evidence-based therapies in community practice. Objective To evaluate whether a multifaceted quality improvement intervention can improve the prescription of evidence-based therapies. Design, Setting, and Participants In this 2-arm cluster randomized clinical trial, patients with established atherothrombotic disease from 40 public and private outpatient clinics (clusters) in Brazil were studied. Patients were recruited from August 2016 to August 2017, with follow-up to August 2018. Data were analyzed in September 2018. Interventions Case management, audit and feedback reports, and distribution of educational materials (to health care professionals and patients) vs routine practice. Main Outcomes and Measures The primary end point was prescription of evidence-based therapies (ie, statins, antiplatelet therapy, and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers) using the all-or-none approach at 12 months after the intervention period in patients without contraindications. Results Of the 1619 included patients, 1029 (63.6%) were male, 1327 (82.0%) had coronary artery disease (843 [52.1%] with prior acute myocardial infarction), 355 (21.9%) had prior ischemic stroke or transient ischemic attack, and 197 (12.2%) had peripheral vascular disease, and the mean (SD) age was 65.6 (10.5) years. Among randomized clusters, 30 (75%) were cardiology sites, 6 (15%) were primary care units, and 26 (65%) were teaching institutions. Among eligible patients, those in intervention clusters were more likely to receive a prescription of evidence-based therapies than those in control clusters (73.5% [515 of 701] vs 58.7% [493 of 840]; odds ratio, 2.30; 95% CI, 1.14-4.65). There were no differences between the intervention and control groups with regards to risk factor control (ie, hyperlipidemia, hypertension, or diabetes). Rates of education for smoking cessation were higher among current smokers in the intervention group than in the control group (51.9% [364 of 701] vs 18.2% [153 of 840]; odds ratio, 11.24; 95% CI, 2.20-57.43). The rate of cardiovascular mortality, acute myocardial infarction, and stroke was 2.6% for patients from intervention clusters and 3.4% for those in the control group (hazard ratio, 0.76; 95% CI, 0.43-1.34). Conclusions and Relevance Among Brazilian patients at high cardiovascular risk, a quality improvement intervention resulted in improved prescription of evidence-based therapies. Trial Registration ClinicalTrials.gov identifier: NCT02851732.
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Affiliation(s)
| | | | | | | | - Bruna Sampaio
- HCor Research Institute, Hospital do Coração, São Paulo, São Paulo, Brazil
| | | | | | - Celso Amodeo
- Instituto Dante Pazzanese de Cardiologia, São Paulo, São Paulo, Brazil
| | | | | | | | | | | | | | - Renato D Lopes
- Brazilian Clinical Research Institute, São Paulo, São Paulo, Brazil.,Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Nilton Brandão da Silva
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | | | | | - Airton T Stein
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Otávio Berwanger
- HCor Research Institute, Hospital do Coração, São Paulo, São Paulo, Brazil
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Machline-Carrion MJ, Soares RM, Damiani LP, Campos VB, Sampaio B, Yamashita J, Fonseca FH, Izar MC, Amodeo C, Pontes-Neto OM, de Melo Barros PG, Lopes RD, Brandão da Silva N, Guimarães HP, Piegas L, Stein AT, Berwanger O. Rationale and design for a cluster randomized quality-improvement trial to increase the uptake of evidence-based therapies for patients at high cardiovascular risk: The BRIDGE-Cardiovascular Prevention trial. Am Heart J 2019; 207:40-48. [PMID: 30415082 DOI: 10.1016/j.ahj.2018.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 10/03/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Translating evidence into clinical practice in the management of high cardiovascular risk patients is challenging. Few quality improvement interventions have rigorously evaluated their impact on both patient care and clinical outcomes. OBJECTIVES The main objectives are to evaluate the impact of a multifaceted educational intervention on adherence to local guidelines for the prescription of statins, antiplatelets and angiotensin converting enzyme inhibitors or angiotensin II receptor blockers for high cardiovascular risk patients, as well as on the incidence of major cardiovascular events. DESIGN We designed a pragmatic two arm cluster randomized trial involving 40 clusters. Clusters are randomized to receive a multifaceted quality improvement intervention or to routine practice (control). The multifaceted intervention includes: reminders, care algorithms, training of a case manager, audit and feedback reports, and distribution of educational materials to health care providers. The primary endpoint is the adherence to combined evidence-based therapies (statins, antiplatelet therapy and angiotensin converting enzyme inhibitors or angiotensin receptor blockers) at 12 months after the intervention period in patients without contra-indications for these medications. All analyses follow the intention-to-treat principle and take the cluster design into account using linear mixed logistic regression modeling. SUMMARY If proven effective, this multifaceted intervention would have wide utility as a means of promoting optimal usage of evidence-based interventions for the management of high cardiovascular risk patients.
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Abstract
BACKGROUND AND OBJECTIVE Laser hair removal is a relatively new procedure. Our purpose was to study the efficacy and safety of a high-power, pulsed diode laser array for removing unwanted hair. METHODS A total of 38 subjects were treated with a prototype of the 800-nm diode laser system. Fluences ranging from 10 to 40 J/cm(2) (mean, 33.4 J/cm(2)) were used and 1 to 4 treatments (mean, 2.7) were performed. Evaluation of hair loss was performed at least 4 months after the last treatment (mean, 8.7 months) by a blinded assessment of clinical photographs. RESULTS A total of 59% of the subjects had only sparse hair regrowth at the final follow-up. Higher fluences and multiple treatments produced greater long-term efficacy. Transient pigmentary changes occurred in 29% of the subjects and were more common in darker skin types IV to VI (P =. 047). CONCLUSION The 800-nm diode laser is an efficient and safe technique for hair reduction. Adverse pigmentary effects occur, but are transient.
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Affiliation(s)
- V B Campos
- Wellman Laboratories of Photomedicine, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA
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6
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Abstract
BACKGROUND AND OBJECTIVE Although several studies on laser-assisted hair removal have been published, data on long-term follow-up are few. The present study investigated the long-term efficacy and safety of normal-mode ruby laser pulses on hair removal. STUDY DESIGN/MATERIALS AND METHODS The normal-mode ruby laser (Epilaser; 694 nm, 3 msec) was used to treat a wide range of body sites in 51 volunteers. The mean follow-up after the last treatment was 8.37 months. RESULTS Sixty-three percent of the patients had sparse regrowth. The mean fluence used was 46.5 J/cm(2) in patients who had sparse hair regrowth and 39.3 J/cm(2) in patients who had moderate hair regrowth (P = 0.0127). Transient pigmentary changes occurred most frequently in patients with skin type 4. CONCLUSION The normal-mode ruby laser is an efficient and safe method for long-term hair reduction, especially in fair-skinned individuals with dark hair. Higher fluences produce greater long-term efficacy. Adverse effects are minimal and transient.
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Affiliation(s)
- V B Campos
- Wellman Laboratories of Photomedicine, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA
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Lin TY, Dierickx CC, Campos VB, Farinelli WA, Rosenthal J, Anderson RR. Reduction of regrowing hair shaft size and pigmentation after ruby and diode laser treatment. Arch Dermatol Res 2000; 292:60-7. [PMID: 10749557 DOI: 10.1007/s004030050011] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Laser pulses which selectively damage pigmented hair follicles are a useful treatment for hypertrichosis. Clinically, regrowing hairs are often thinner and lighter after treatment. In this study, hair shaft diameter and optical transmission (700 nm) were measured before and after ruby (694 nm) and diode (800 nm) laser irradiation. Hair was collected from 47 and 41 subjects treated with ruby (0.3 ms and 3 ms) and diode (10-20 ms) lasers, respectively. "Responders" were defined as subjects with significant long-term hair loss as determined by hair counts at 9 and/or 12 months after treatment. In ruby laser responders (34/47), regrowing hairs were significantly both thinner (decreased diameter) and lighter (increased transmission). In "nonresponders" (13/47), regrowing hairs were lighter, but not thinner. The regrowing hair shaft absorption coefficient (as calculated assuming Beer's law) was significantly decreased by 0.3 ms ruby laser treatment, but was not changed by 3 ms ruby laser or diode laser treatment. After diode laser treatment, 38 of the 41 subjects were responders and regrowing hairs were both thinner and lighter. These results show that laser treatments can affect structural recovery (size of hair), follicular pigmentation (hair absorption coefficient), or both. Regrowth of thinner hair (decreased shaft diameter) occurs in conjunction with actual loss of hair. After long pulses (3 ms ruby; diode), regrowing hair was thinner and also lighter to an extent related to the decrease in hair diameter. In contrast, short ruby laser pulses (0.3 ms) appeared to be capable of inhibiting follicular pigmentation per se, in addition to affecting the hair diameter. This may account for the complete regrowth of lighter hair in "nonresponders" treated with 0.3 ms pulses. Laser-induced reduction in hair diameter and/or pigmentation are both long-term responses which confer cosmetic benefits in addition to actual hair loss.
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Affiliation(s)
- T Y Lin
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA
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Manuskiatti W, Dierickx CC, González S, Lin TY, Campos VB, González E, Anderson RR. Laser hair removal affects sebaceous glands and sebum excretion: a pilot study. J Am Acad Dermatol 1999; 41:176-80. [PMID: 10426885 DOI: 10.1016/s0190-9622(99)70045-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND During laser-assisted hair removal, sebaceous glands closely associated with hair follicles might also be affected. OBJECTIVE We investigated the effect of the long-pulsed ruby laser on sebaceous glands. METHODS Sebum excretion rates (SERs) of 16 subjects were measured quantitatively by means of sebum-absorbent tape and analyzed by means of image analysis techniques on laser-treated sites, compared with adjacent untreated areas. Evaluation was done at an average of 9 months (range, 4.5 to 12 months) after the last treatment. Histologic examinations were performed on 3 representative subjects before treatment, immediately after treatment, and 9 months after the last treatment. RESULTS Significant increases in SERs were observed in 11 of 16 subjects (68.75%). Three subjects (18.75%) showed lower SERs, whereas 2 subjects (12.5%) demonstrated no difference in SERs between treated and untreated areas. Biopsy specimens showed an apparent reduction in sebaceous gland size. Specimens taken immediately after laser irradiation revealed sporadic damage to sebaceous glands. CONCLUSION In some patients a variable but statistically significant increase in sebum excretion occurs 4 to 12 months after ruby-laser hair removal treatment at high fluences. A reduction in sebaceous gland sizes on laser-treated areas was observed. We hypothesize that decreased resistance to sebum outflow may explain this result, following miniaturization or absence of hair shaft after ruby laser treatment. Further study is needed to assess mechanisms for this interesting response.
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Affiliation(s)
- W Manuskiatti
- Dr Manuskiatti is currently affiliated with the Department of Dermatology, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Borges AN, Hipólito O, Campos VB. Electron correlation effects in screened hydrogenic impurity states in many-valley semiconductors. Phys Rev B Condens Matter 1995; 52:1724-1728. [PMID: 9981238 DOI: 10.1103/physrevb.52.1724] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Campos VB. LO-phonon emission by hot electrons in one-dimensional semiconductor quantum wires. Phys Rev B Condens Matter 1994; 49:1867-1874. [PMID: 10010984 DOI: 10.1103/physrevb.49.1867] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Campos VB. Low-temperature thermal relaxation of electrons in one-dimensional nanometer-size structures. Phys Rev B Condens Matter 1993; 47:3728-3733. [PMID: 10006476 DOI: 10.1103/physrevb.47.3728] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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Campos VB, Stroscio MA. Phonon-confinement effect on electron energy loss in one-dimensional quantum wires. Phys Rev B Condens Matter 1992; 46:3849-3853. [PMID: 10004110 DOI: 10.1103/physrevb.46.3849] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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Campos VB. Hot-electron relaxation in semiconductor quantum wires: Bulk-LO-phonon emission. Phys Rev B Condens Matter 1992; 45:3898-3901. [PMID: 10001993 DOI: 10.1103/physrevb.45.3898] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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