1
|
Arns B, Horvath JDC, Rech GS, Sesin GP, Agani CAJO, da Rosa BS, Dos Santos TM, Brochier LSB, Cavalcanti AB, Tomazini BM, Pereira AJ, Veiga VC, Nascimento GM, Kalil AC, Zavascki AP. A Randomized, Open-Label, Non-inferiority Clinical Trial Assessing 7 Versus 14 Days of Antimicrobial Therapy for Severe Multidrug-Resistant Gram-Negative Bacterial Infections: The OPTIMISE Trial Protocol. Infect Dis Ther 2024; 13:237-250. [PMID: 38102448 PMCID: PMC10828314 DOI: 10.1007/s40121-023-00897-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 11/23/2023] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION Shorter courses of antimicrobials have been shown to be non-inferior to longer, "traditional" duration of therapies, including for some severe healthcare-associated infections, with a few exceptions. However, evidence is lacking regarding shorter regimes against severe infections by multidrug-resistant Gram-negative bacteria (MDR-GNB), which are often caused by distinct strains and commonly treated with second-line antimicrobials. In the duratiOn of theraPy in severe infecTIons by MultIdrug-reSistant gram-nEgative bacteria (OPTIMISE) trial, we aim to assess the non-inferiority of 7-day versus 14-day antimicrobial therapy in critically ill patients with severe infections caused by MDR-GNB. METHODS This is a randomized, multicenter, open-label, parallel controlled trial to assess the non-inferiority of 7-day versus 14-day of adequate antimicrobial therapy for intensive care unit (ICU)-acquired severe infections by MDR-GNB. Adult patients with severe infections by MDR-GNB initiated after 48 h of ICU admission are screened for eligibility. Patients are eligible if they proved to be hemodynamically stable and without fever for at least 48 h on the 7th day of adequate antimicrobial therapy. After consenting, patients are 1:1 randomized to discontinue antimicrobial therapy on the 7th (± 1) day or to continue for a total of 14th (± 1) days. PLANNED OUTCOMES The primary outcome is treatment failure, defined as death or relapse of infection within 28 days after randomization. Non-inferiority will be achieved if the upper edge of the two-tailed 95% confidence interval of the difference between the clinical failure rate in the 7-day and the 14-day group is not higher than 10%. CONCLUSION The OPTIMISE trial is the first randomized controlled trial specifically designed to assess the duration of antimicrobial therapy in patients with severe infections by MDR-GNB. TRIAL REGISTRATION ClinicalTrials.gov, NCT05210387. Registered on 27 January 2022. Seven Versus 14 Days of Antibiotic Therapy for Multidrug-resistant Gram-negative Bacilli Infections (OPTIMISE).
Collapse
Affiliation(s)
- Beatriz Arns
- Responsabilidade Social-PROADI, Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
- Infectious Diseases and Infection Control Service, Hospital Moinhos de Vento, 910 Ramiro Barcelos St, Porto Alegre, RS, 90035-000, Brazil
| | | | - Gabriela Soares Rech
- Responsabilidade Social-PROADI, Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
| | | | | | | | | | | | | | | | | | | | | | - Andre C Kalil
- University of Nebraska Medical Center, Omaha, NE, USA
| | - Alexandre P Zavascki
- Infectious Diseases and Infection Control Service, Hospital Moinhos de Vento, 910 Ramiro Barcelos St, Porto Alegre, RS, 90035-000, Brazil.
- Department of Internal Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
| |
Collapse
|
2
|
Trott G, Scolari FL, Rover MM, da Silva MMD, de Souza D, dos Santos RDRM, Schardosim RFDC, Rech GS, de Mesquita J, Estivalete GP, Freitas HJM, Itaqui CR, Kozesinski-Nakatani AC, Biolo A, Marcolino MS, Barreto BB, Schvartzman PR, Antonio ACP, Robinson CC, Falavigna M, Polanczyk CA, Rosa RG. Long-term Health-Related Quality of Life and Outcomes after Hospitalization for COVID-19 in Brazil: Post-COVID Brazil 1 Study Protocol. Arq Bras Cardiol 2023; 120:e20230378. [PMID: 37991122 PMCID: PMC10697686 DOI: 10.36660/abc.20230378] [Citation(s) in RCA: 1] [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: 06/07/2023] [Revised: 08/01/2023] [Accepted: 08/16/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND The long-term impact of hospitalization for COVID-19 on patients' physical, mental, and cognitive health still needs further assessment. OBJECTIVES This study aims to evaluate factors associated with quality of life and cardiovascular and non-cardiovascular outcomes 12 months after hospitalization for COVID-19. METHODS This prospective multicenter study intends to enroll 611 patients hospitalized due to COVID-19 (NCT05165979). Centralized telephone interviews are scheduled to occur at three, six, nine, and 12 months after hospital discharge. The primary endpoint is defined as the health-related quality-of-life utility score assessed by the EuroQol-5D-3L (EQ-5D-3L) questionnaire at 12 months. Secondary endpoints are defined as the EQ-5D-3L at three, six and nine months, return to work or education, persistent symptoms, new disabilities in instrumental activities of daily living, cognitive impairment, anxiety, depression, and post-traumatic stress symptoms, major cardiovascular events, rehospitalization, as well as all-cause mortality at 3, 6, 9, and 12 months after SARS-CoV-2 infection. A p-value <0.05 will be assumed as statistically significant for all analyses. RESULTS The primary endpoint will be presented as the frequency of the EQ-5D-3L score 12 months after COVID-19 hospitalization. A sub-analysis to identify possible associations of independent variables with study outcomes will be presented. CONCLUSIONS This study will determine the impact of COVID-19 on the quality of life and cardiovascular and non-cardiovascular outcomes of hospitalized patients 12 months after discharge providing insights to the public health system in Brazil.
Collapse
Affiliation(s)
- Geraldine Trott
- Escritório de Projetos de PesquisaHospital Moinhos de VentoPorto AlegreRSBrasil Escritório de Projetos de Pesquisa – Hospital Moinhos de Vento , Porto Alegre , RS – Brasil
| | - Fernando Luis Scolari
- Escritório de Projetos de PesquisaHospital Moinhos de VentoPorto AlegreRSBrasil Escritório de Projetos de Pesquisa – Hospital Moinhos de Vento , Porto Alegre , RS – Brasil
- Divisão de CardiologiaHospital Moinhos de VentoPorto AlegreRSBrasil Divisão de Cardiologia do Hospital Moinhos de Vento , Porto Alegre , RS – Brasil
| | - Marciane Maria Rover
- Escritório de Projetos de PesquisaHospital Moinhos de VentoPorto AlegreRSBrasil Escritório de Projetos de Pesquisa – Hospital Moinhos de Vento , Porto Alegre , RS – Brasil
- Divisão de CardiologiaHospital Moinhos de VentoPorto AlegreRSBrasil Divisão de Cardiologia do Hospital Moinhos de Vento , Porto Alegre , RS – Brasil
| | - Mariana Motta Dias da Silva
- Escritório de Projetos de PesquisaHospital Moinhos de VentoPorto AlegreRSBrasil Escritório de Projetos de Pesquisa – Hospital Moinhos de Vento , Porto Alegre , RS – Brasil
| | - Denise de Souza
- Escritório de Projetos de PesquisaHospital Moinhos de VentoPorto AlegreRSBrasil Escritório de Projetos de Pesquisa – Hospital Moinhos de Vento , Porto Alegre , RS – Brasil
| | - Rosa da Rosa Minho dos Santos
- Escritório de Projetos de PesquisaHospital Moinhos de VentoPorto AlegreRSBrasil Escritório de Projetos de Pesquisa – Hospital Moinhos de Vento , Porto Alegre , RS – Brasil
| | - Raíne Fogliati de Carli Schardosim
- Escritório de Projetos de PesquisaHospital Moinhos de VentoPorto AlegreRSBrasil Escritório de Projetos de Pesquisa – Hospital Moinhos de Vento , Porto Alegre , RS – Brasil
| | - Gabriela Soares Rech
- Escritório de Projetos de PesquisaHospital Moinhos de VentoPorto AlegreRSBrasil Escritório de Projetos de Pesquisa – Hospital Moinhos de Vento , Porto Alegre , RS – Brasil
| | - Juliana de Mesquita
- Escritório de Projetos de PesquisaHospital Moinhos de VentoPorto AlegreRSBrasil Escritório de Projetos de Pesquisa – Hospital Moinhos de Vento , Porto Alegre , RS – Brasil
| | - Gabriel Pozza Estivalete
- Escritório de Projetos de PesquisaHospital Moinhos de VentoPorto AlegreRSBrasil Escritório de Projetos de Pesquisa – Hospital Moinhos de Vento , Porto Alegre , RS – Brasil
| | - Hellen Jordan Martins Freitas
- Escritório de Projetos de PesquisaHospital Moinhos de VentoPorto AlegreRSBrasil Escritório de Projetos de Pesquisa – Hospital Moinhos de Vento , Porto Alegre , RS – Brasil
| | - Carolina Rothmann Itaqui
- Escritório de Projetos de PesquisaHospital Moinhos de VentoPorto AlegreRSBrasil Escritório de Projetos de Pesquisa – Hospital Moinhos de Vento , Porto Alegre , RS – Brasil
| | - Amanda Christina Kozesinski-Nakatani
- Unidade de Terapia IntensivaHospital Santa Casa de CuritibaCuritibaPRBrasil Unidade de Terapia Intensiva – Hospital Santa Casa de Curitiba , Curitiba , PR – Brasil
| | - Andreia Biolo
- Escritório de Projetos de PesquisaHospital Moinhos de VentoPorto AlegreRSBrasil Escritório de Projetos de Pesquisa – Hospital Moinhos de Vento , Porto Alegre , RS – Brasil
- Divisão de CardiologiaHospital Moinhos de VentoPorto AlegreRSBrasil Divisão de Cardiologia do Hospital Moinhos de Vento , Porto Alegre , RS – Brasil
- Instituto Nacional de Avaliação de Tecnologias em SaúdeUniversidade Federal do Rio Grande do SulPorto AlegreRSBrasil Instituto Nacional de Avaliação de Tecnologias em Saúde – Universidade Federal do Rio Grande do Sul , Porto Alegre , RS – Brasil
| | - Milena Soriano Marcolino
- Departamento de Medicina InternaFaculdade de MedicinaUniversidade Federal de Minas GeraisBelo HorizonteMGBrasil Departamento de Medicina Interna da Faculdade de Medicina da Universidade Federal de Minas Gerais , Belo Horizonte , MG – Brasil
| | - Bruna Brandão Barreto
- Departamento de Medicina Interna e Apoio DiagnósticoFaculdade de Medicina da BahiaUniversidade Federal da BahiaSalvadorBABrasil Departamento de Medicina Interna e Apoio Diagnóstico , Faculdade de Medicina da Bahia , Universidade Federal da Bahia , Salvador , BA – Brasil
- Unidade de Terapia IntensivaHospital da Mulher – Maria Luzia Costa dos SantosSalvadorBABrasil Unidade de Terapia Intensiva – Hospital da Mulher – Maria Luzia Costa dos Santos , Salvador , BA – Brasil
| | - Paulo Roberto Schvartzman
- Divisão de CardiologiaHospital Moinhos de VentoPorto AlegreRSBrasil Divisão de Cardiologia do Hospital Moinhos de Vento , Porto Alegre , RS – Brasil
| | - Ana Carolina Peçanha Antonio
- Unidade de Terapia IntensivaHospital de Clínicas de Porto AlegrePorto AlegreRSBrasil Unidade de Terapia Intensiva – Hospital de Clínicas de Porto Alegre , Porto Alegre , RS – Brasil
| | - Caroline Cabral Robinson
- Escritório de Projetos de PesquisaHospital Moinhos de VentoPorto AlegreRSBrasil Escritório de Projetos de Pesquisa – Hospital Moinhos de Vento , Porto Alegre , RS – Brasil
| | - Maicon Falavigna
- Instituto Nacional de Avaliação de Tecnologias em SaúdeUniversidade Federal do Rio Grande do SulPorto AlegreRSBrasil Instituto Nacional de Avaliação de Tecnologias em Saúde – Universidade Federal do Rio Grande do Sul , Porto Alegre , RS – Brasil
- Unidade de PesquisaInova MedicalPorto AlegreRSBrasil Unidade de Pesquisa – Inova Medical , Porto Alegre , RS – Brasil
| | - Carisi Anne Polanczyk
- Escritório de Projetos de PesquisaHospital Moinhos de VentoPorto AlegreRSBrasil Escritório de Projetos de Pesquisa – Hospital Moinhos de Vento , Porto Alegre , RS – Brasil
- Divisão de CardiologiaHospital Moinhos de VentoPorto AlegreRSBrasil Divisão de Cardiologia do Hospital Moinhos de Vento , Porto Alegre , RS – Brasil
- Instituto Nacional de Avaliação de Tecnologias em SaúdeUniversidade Federal do Rio Grande do SulPorto AlegreRSBrasil Instituto Nacional de Avaliação de Tecnologias em Saúde – Universidade Federal do Rio Grande do Sul , Porto Alegre , RS – Brasil
| | - Regis Goulart Rosa
- Escritório de Projetos de PesquisaHospital Moinhos de VentoPorto AlegreRSBrasil Escritório de Projetos de Pesquisa – Hospital Moinhos de Vento , Porto Alegre , RS – Brasil
- Serviço de Medicina InternaHospital Moinhos de VentoPorto AlegreRSBrasil Serviço de Medicina Interna – Hospital Moinhos de Vento , Porto Alegre , RS – Brasil
| |
Collapse
|
3
|
Schneider D, Rosa RG, dos Santos RDRM, Fogazzi DV, Rech GS, da Silva DB, Terres MDS. Effects of participation in interdisciplinary rounds in the intensive care unit on family satisfaction: A cross-sectional study. Crit Care Sci 2023; 35:203-208. [PMID: 37712810 PMCID: PMC10406414 DOI: 10.5935/2965-2774.20230274-en] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 03/20/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVE To investigate whether family participation in intensive care unit interdisciplinary bedside rounds affects family satisfaction. METHODS A cross-sectional study was conducted at a 56-bed, adult, mixed intensive care unit of a tertiary hospital in Southern Brazil. From May to June 2019, family members of patients who stayed in the intensive care unit for at least 48 hours were invited to participate in the study at the time of patient discharge. The main exposure variable was participation in intensive care unit bedside rounds during the intensive care unit stay. Family satisfaction was assessed by using the Brazilian version of the Family Satisfaction in the Intensive Care Unit questionnaire. RESULTS Of the 234 screened individuals, 118 were included. Eleven participants withdrew consent. A total of 107 individuals were assessed; 58 (54%) reported being present during bedside rounds, and 49 (46%) reported never being present. General satisfaction and satisfaction with the decision-making process were higher among families who were present during rounds than among families who were not (p = 0.01 and p = 0.007, respectively). CONCLUSION The presence during interdisciplinary rounds was associated with improved general satisfaction and satisfaction with the decision-making aspect. This outcome indicates that efforts must be directed to conduct studies with more robust methodologies to confirm this association.
Collapse
Affiliation(s)
- Daniel Schneider
- Universidade Federal de Ciências da Saúde de Porto
Alegre - Porto Alegre (RS), Brazil
| | | | | | | | | | | | | |
Collapse
|
4
|
Rosa RG, Cavalcanti AB, Azevedo LCP, Veiga VC, de Souza D, Dos Santos RDRM, Schardosim RFDC, Rech GS, Trott G, Schneider D, Robinson CC, Haubert TA, Pallaoro VEL, Brognoli LG, de Souza AP, Costa LS, Barroso BM, Pelliccioli MP, Gonzaga J, Studier NDS, Dagnino APA, Neto JDM, da Silva SS, Gimenes BDP, Dos Santos VB, Estivalete GPM, Pellegrino CDM, Polanczyk CA, Kawano-Dourado L, Tomazini BM, Lisboa TC, Teixeira C, Zampieri FG, Zavascki AP, Gersh BJ, Avezum Á, Machado FR, Berwanger O, Lopes RD, Falavigna M. Association between acute disease severity and one-year quality of life among post-hospitalisation COVID-19 patients: Coalition VII prospective cohort study. Intensive Care Med 2023; 49:166-177. [PMID: 36594987 PMCID: PMC9808680 DOI: 10.1007/s00134-022-06953-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/05/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE To assess the association between acute disease severity and 1-year quality of life in patients discharged after hospitalisation due to coronavirus disease 2019 (COVID-19). METHODS We conducted a prospective cohort study nested in 5 randomised clinical trials between March 2020 and March 2022 at 84 sites in Brazil. Adult post-hospitalisation COVID-19 patients were followed for 1 year. The primary outcome was the utility score of EuroQol five-dimension three-level (EQ-5D-3L). Secondary outcomes included all-cause mortality, major cardiovascular events, and new disabilities in instrumental activities of daily living. Adjusted generalised estimating equations were used to assess the association between outcomes and acute disease severity according to the highest level on a modified ordinal scale during hospital stay (2: no oxygen therapy; 3: oxygen by mask or nasal prongs; 4: high-flow nasal cannula oxygen therapy or non-invasive ventilation; 5: mechanical ventilation). RESULTS 1508 COVID-19 survivors were enrolled. Primary outcome data were available for 1156 participants. At 1 year, compared with severity score 2, severity score 5 was associated with lower EQ-5D-3L utility scores (0.7 vs 0.84; adjusted difference, - 0.1 [95% CI - 0.15 to - 0.06]); and worse results for all-cause mortality (7.9% vs 1.2%; adjusted difference, 7.1% [95% CI 2.5%-11.8%]), major cardiovascular events (5.6% vs 2.3%; adjusted difference, 2.6% [95% CI 0.6%-4.6%]), and new disabilities (40.4% vs 23.5%; adjusted difference, 15.5% [95% CI 8.5%-22.5]). Severity scores 3 and 4 did not differ consistently from score 2. CONCLUSIONS COVID-19 patients who needed mechanical ventilation during hospitalisation have lower 1-year quality of life than COVID-19 patients who did not need mechanical ventilation during hospitalisation.
Collapse
Affiliation(s)
- Regis Goulart Rosa
- Hospital Moinhos de Vento, Rua Ramiro Barcelos, 630, 10º Andar, Sala 1007, Porto Alegre, RS, 90660-020, Brazil. .,Brazilian Research in Intensive Care Network (BRICNet), São Paulo, SP, Brazil. .,Research Unit, INOVA Medical, Porto Alegre, RS, Brazil.
| | - Alexandre Biasi Cavalcanti
- Brazilian Research in Intensive Care Network (BRICNet), São Paulo, SP, Brazil.,Hcor Research Institute, Hospital Do Coração, São Paulo, SP, Brazil
| | - Luciano César Pontes Azevedo
- Brazilian Research in Intensive Care Network (BRICNet), São Paulo, SP, Brazil.,Hospital Sírio-Libanês, 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
| | - Denise de Souza
- Hospital Moinhos de Vento, Rua Ramiro Barcelos, 630, 10º Andar, Sala 1007, Porto Alegre, RS, 90660-020, Brazil
| | | | | | - Gabriela Soares Rech
- Hospital Moinhos de Vento, Rua Ramiro Barcelos, 630, 10º Andar, Sala 1007, Porto Alegre, RS, 90660-020, Brazil
| | - Geraldine Trott
- Hospital Moinhos de Vento, Rua Ramiro Barcelos, 630, 10º Andar, Sala 1007, Porto Alegre, RS, 90660-020, Brazil
| | - Daniel Schneider
- Hospital Moinhos de Vento, Rua Ramiro Barcelos, 630, 10º Andar, Sala 1007, Porto Alegre, RS, 90660-020, Brazil
| | - Caroline Cabral Robinson
- Hospital Moinhos de Vento, Rua Ramiro Barcelos, 630, 10º Andar, Sala 1007, Porto Alegre, RS, 90660-020, Brazil
| | - Tainá Aparecida Haubert
- Hospital Moinhos de Vento, Rua Ramiro Barcelos, 630, 10º Andar, Sala 1007, Porto Alegre, RS, 90660-020, Brazil
| | | | - Liége Gregoletto Brognoli
- Hospital Moinhos de Vento, Rua Ramiro Barcelos, 630, 10º Andar, Sala 1007, Porto Alegre, RS, 90660-020, Brazil
| | - Ana Paula de Souza
- Hospital Moinhos de Vento, Rua Ramiro Barcelos, 630, 10º Andar, Sala 1007, Porto Alegre, RS, 90660-020, Brazil
| | - Lauren Sezerá Costa
- Hospital Moinhos de Vento, Rua Ramiro Barcelos, 630, 10º Andar, Sala 1007, Porto Alegre, RS, 90660-020, Brazil
| | - Bruna Machado Barroso
- Hospital Moinhos de Vento, Rua Ramiro Barcelos, 630, 10º Andar, Sala 1007, Porto Alegre, RS, 90660-020, Brazil
| | | | - Janine Gonzaga
- Hospital Moinhos de Vento, Rua Ramiro Barcelos, 630, 10º Andar, Sala 1007, Porto Alegre, RS, 90660-020, Brazil
| | - Nicole Dos Santos Studier
- Hospital Moinhos de Vento, Rua Ramiro Barcelos, 630, 10º Andar, Sala 1007, Porto Alegre, RS, 90660-020, Brazil
| | | | - Juliana de Mesquita Neto
- Hospital Moinhos de Vento, Rua Ramiro Barcelos, 630, 10º Andar, Sala 1007, Porto Alegre, RS, 90660-020, Brazil
| | - Sabrina Souza da Silva
- Hospital Moinhos de Vento, Rua Ramiro Barcelos, 630, 10º Andar, Sala 1007, Porto Alegre, RS, 90660-020, Brazil
| | - Bruna Dos Passos Gimenes
- Hospital Moinhos de Vento, Rua Ramiro Barcelos, 630, 10º Andar, Sala 1007, Porto Alegre, RS, 90660-020, Brazil
| | | | | | | | - Carisi Anne Polanczyk
- Hospital Moinhos de Vento, Rua Ramiro Barcelos, 630, 10º Andar, Sala 1007, Porto Alegre, RS, 90660-020, Brazil.,Cardiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.,National Institute for Health Technology Assessment, IATS/CNPq, Porto Alegre, RS, Brazil
| | | | - Bruno Martins Tomazini
- Brazilian Research in Intensive Care Network (BRICNet), São Paulo, SP, Brazil.,Hcor Research Institute, Hospital Do Coração, São Paulo, SP, Brazil.,Hospital Sírio-Libanês, São Paulo, SP, Brazil
| | - Thiago Costa Lisboa
- Brazilian Research in Intensive Care Network (BRICNet), São Paulo, SP, Brazil.,PPG Ciências Pneumológicas UFRGS, Porto Alegre, RS, Brazil.,Intensive Care Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - 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
| | - Fernando Godinho Zampieri
- Brazilian Research in Intensive Care Network (BRICNet), São Paulo, SP, Brazil.,Hcor Research Institute, Hospital Do Coração, São Paulo, SP, Brazil.,Academic Research Organization, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Alexandre Prehn Zavascki
- Hospital Moinhos de Vento, Rua Ramiro Barcelos, 630, 10º Andar, Sala 1007, Porto Alegre, RS, 90660-020, Brazil.,Infectious Diseases and Infection Control Service, Hospital Moinhos de Vento, Porto Alegre, RS, Brazil.,Internal Medicine Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Bernard J Gersh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Álvaro Avezum
- International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brazil
| | - Flávia Ribeiro Machado
- Brazilian Research in Intensive Care Network (BRICNet), São Paulo, SP, Brazil.,Department of Anesthesiology, Pain and Intensive Care, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Otavio Berwanger
- Academic Research Organization, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | | | - Maicon Falavigna
- Hospital Moinhos de Vento, Rua Ramiro Barcelos, 630, 10º Andar, Sala 1007, Porto Alegre, RS, 90660-020, Brazil.,Research Unit, INOVA Medical, Porto Alegre, RS, Brazil.,National Institute for Health Technology Assessment, IATS/CNPq, Porto Alegre, RS, Brazil
| |
Collapse
|
5
|
Melnick R, Rech GS, Rech RS, Faustino-Silva DD. Factors Associated with Tobacco Cessation in Primary Health Care. Int Arch Otorhinolaryngol 2021; 25:e551-e556. [PMID: 34737826 PMCID: PMC8558959 DOI: 10.1055/s-0040-1722164] [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: 04/16/2020] [Accepted: 11/08/2020] [Indexed: 12/04/2022] Open
Abstract
Introduction
Cigarettes are the main cause of preventable death in the world, and primary health care services can contribute to the management of this habit.
Objective
To describe and analyze the factors associated with tobacco cessation in groups of smokers in primary health care.
Methods
The present is a cross-sectional study conducted in 12 primary health care units from July 2016 to May 2017. We investigated sociodemographic and health variables, as well as smoking characteristics and different interventions for tobacco cessation, with the outcome being studied and analyzed after the fourth group care session.
Results
We evaluated 329 smokers, of which 182 quit smoking after the fourth interview. Most of the individuals who quit smoking were women (
n
= 121, 66.5%), with a monthly income of 2 to 5 minimum wages (
n
= 88, 77.9%). After the multivariable analysis, we observed that tobacco cessation was significantly associated with depression (prevalence ratio [PR] = 1.11; 95% confidence interval [95%CI] = 1.02 to 1.22), as well as with belonging to the groups which used as approaches motivational interviewing (PR = 1.21; 95%CI = 1.13 to 2.01), patches (PR = 1.36; 95%CI = 1.24 to 1.48), and bupropion (PR = 1.16; 95%CI = 1.03 to 1.31).
Conclusion
Primary health care is the ideal site for the reduction of smoking rates, given that different technologies may be applicable and useful for tobacco cessation. The comprehensiveness and longitudinal care offered in primary care may provide opportunities for health professionals to understand which is the best technology for each health system user, thus contributing to personalized care.
Collapse
Affiliation(s)
- Ricardo Melnick
- Graduate Program in Assessment and Production of Technologies for the SUS (PPGATSUS), Grupo Hospitalar Conceição (GHC), Porto Alegre, RS, Brazil
| | - Gabriela Soares Rech
- Mathematics and Statistics Institute, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Rafaela Soares Rech
- Graduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Daniel Demétrio Faustino-Silva
- Graduate Program in Assessment and Production of Technologies for the SUS (PPGATSUS), Grupo Hospitalar Conceição (GHC), Porto Alegre, RS, Brazil
| |
Collapse
|
6
|
Giordani NE, Robinson CC, Westphal GA, Rosa RG, Sganzerla D, Cavalcanti AB, Machado FR, Azevedo LCP, Bozza FA, Teixeira C, de Andrade J, Franke CA, Guterres CM, Madalena IC, Rohden AI, da Silva SS, Andrighetto LV, Rech GS, Gimenes BDP, Hammes LS, Pontes DFS, Meade MO, Falavigna M. Statistical analysis plan for a cluster-randomised trial assessing the effectiveness of implementation of a bedside evidence-based checklist for clinical management of brain-dead potential organ donors in intensive care units: DONORS (Donation Network to Optimise Organ Recovery Study). Trials 2020; 21:540. [PMID: 32552839 PMCID: PMC7298918 DOI: 10.1186/s13063-020-04457-1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 05/25/2020] [Indexed: 11/28/2022] Open
Abstract
Background The quality of clinical care of brain-dead potential organ donors may help reduce donor losses caused by irreversible or unreversed cardiac arrest and increase the number of organs donated. We sought to determine whether an evidence-based, goal-directed checklist for donor management in intensive care units (ICUs) can reduce donor losses to cardiac arrest. Methods/design The DONORS study is a multicentre, cluster-randomised controlled trial with a 1:1 allocation ratio designed to compare an intervention group (goal-directed checklist for brain-dead potential organ donor management) with a control group (standard ICU care). The primary outcome is loss of potential donors due to cardiac arrest. Secondary outcomes are the number of actual organ donors and the number of solid organs recovered per actual donor. Exploratory outcomes include the achievement of relevant clinical goals during the management of brain-dead potential organ donors. The present statistical analysis plan (SAP) describes all primary statistical procedures that will be used to evaluate the results and perform exploratory and sensitivity analyses of the trial. Discussion The SAP of the DONORS study aims to describe its analytic procedures, enhancing the transparency of the study. At the moment of SAP subsmission, 63 institutions have been randomised and were enrolling study participants. Thus, the analyses reported herein have been defined before the end of the study recruitment and database locking. Trial registration ClinicalTrials.gov, NCT03179020. Registered on 7 June 2017.
Collapse
Affiliation(s)
- Natalia Elis Giordani
- Research Projects Office, Hospital Moinhos de Vento (HMV), Rua Ramiro Barcelos, 910, Porto Alegre, RS, 90035-001, Brazil. .,Postgraduate Programme in Epidemiology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
| | - Caroline Cabral Robinson
- Research Projects Office, Hospital Moinhos de Vento (HMV), Rua Ramiro Barcelos, 910, Porto Alegre, RS, 90035-001, Brazil
| | - Glauco Adrieno Westphal
- Research Projects Office, Hospital Moinhos de Vento (HMV), Rua Ramiro Barcelos, 910, Porto Alegre, RS, 90035-001, Brazil.,Hospital Municipal São José, Joinville, SC, Brazil.,Centro Hospitalar Unimed, Joinville, SC, Brazil
| | | | - Daniel Sganzerla
- Research Projects Office, Hospital Moinhos de Vento (HMV), Rua Ramiro Barcelos, 910, Porto Alegre, RS, 90035-001, Brazil
| | | | - Flávia Ribeiro Machado
- Department of Anaesthesiology, Pain and Intensive Care, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | | | - Fernando Augusto Bozza
- Department of Critical Care and Postgraduate Programme in Translational Medicine, D'Or Institute for Research and Education, Rio de Janeiro, RJ, Brazil.,Evandro Chagas National Institute of Infectious Diseases, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, RJ, Brazil
| | - Cassiano Teixeira
- Department of Internal Medicine and Postgraduate Programme in Rehabilitation Science, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Joel de Andrade
- Organ Procurement Organisation of Santa Catarina (OPO/SC), Florianópolis, SC, Brazil
| | - Cristiano Augusto Franke
- Adult Intensive Care Unit, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.,Trauma Intensive Care Unit, Hospital de Pronto de Socorro (HPS), Porto Alegre, RS, Brazil
| | - Cátia Moreira Guterres
- Research Projects Office, Hospital Moinhos de Vento (HMV), Rua Ramiro Barcelos, 910, Porto Alegre, RS, 90035-001, Brazil
| | - Itiana Cardoso Madalena
- Research Projects Office, Hospital Moinhos de Vento (HMV), Rua Ramiro Barcelos, 910, Porto Alegre, RS, 90035-001, Brazil
| | - Adriane Isabel Rohden
- Research Projects Office, Hospital Moinhos de Vento (HMV), Rua Ramiro Barcelos, 910, Porto Alegre, RS, 90035-001, Brazil
| | - Sabrina Souza da Silva
- Research Projects Office, Hospital Moinhos de Vento (HMV), Rua Ramiro Barcelos, 910, Porto Alegre, RS, 90035-001, Brazil
| | - Luiza Vitelo Andrighetto
- Research Projects Office, Hospital Moinhos de Vento (HMV), Rua Ramiro Barcelos, 910, Porto Alegre, RS, 90035-001, Brazil
| | - Gabriela Soares Rech
- Research Projects Office, Hospital Moinhos de Vento (HMV), Rua Ramiro Barcelos, 910, Porto Alegre, RS, 90035-001, Brazil
| | - Bruna Dos Passos Gimenes
- Research Projects Office, Hospital Moinhos de Vento (HMV), Rua Ramiro Barcelos, 910, Porto Alegre, RS, 90035-001, Brazil
| | | | | | - Maureen O Meade
- Department of Medicine and Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Maicon Falavigna
- Research Projects Office, Hospital Moinhos de Vento (HMV), Rua Ramiro Barcelos, 910, Porto Alegre, RS, 90035-001, Brazil.,Postgraduate Programme in Epidemiology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| |
Collapse
|