Tunneled Versus Non-Tunneled Peripherally Inserted Central Catheter and Their Effects on Reducing Combined or Isolated Outcomes (Obstruction, Infection, Thrombosis, and Dislodgement): Multicenter Randomized Clinical Trial

The aim of this multicenter randomized clinical trial is to compare the tunneling technique of PICC insertion with the non-tunneled insertion technique in the incidence of the combined or isolated outcome of catheter-related bloodstream primary infection, thrombosis, obstruction, and accidental dislodgement in the adult population within a period of up to 30 days.

开始日期2024-05-06

申办/合作机构

Hospital de Clínicas de Porto Alegre HCPA

[+2]

NCT05673226

/ Recruiting临床2/3期IIT

Organosilane for Surface Cleaning in Intensive Care Units: A Cluster Randomized, Controlled, Crossover, Clinical Trial

The purpose of this study is to evaluate if surface disinfection with organosilane associated with traditional cleaning reduces the incidence of healthcare-associated infections (HAIs) in intensive care units when compared with traditional cleaning alone.

开始日期2023-11-06

申办/合作机构

Hospital Israelita Albert Einstein

[+5]

NCT05996861

/ RecruitingN/AIIT

Multidisciplinary Protocol for Best Pracrice in Sleep for Critically Ill Patients

Sleep is essential for health and well-being. The quality of sleep impacts physical and cognitive aspects, including memory, immune system, and neuroendocrine function, with abnormalities associated with cardiovascular changes, neuropsychiatric disorders, and mortality. Additionally, sleep disorders are related to an increased incidence of delirium in Intensive Care Units (ICUs). Routines to control environmental factors in ICUs seem to have an impact on reducing the incidence of acute brain dysfunction - delirium - and could help prevent sleep disturbances in critically ill patients. This study aims to demonstrate an improvement in sleep quality in critically ill patients through the reduction of the Richards-Campbell Sleep Questionnaire score and propose a package of measures to improve sleep practices in ICU-admitted patients.

开始日期2023-03-20

申办/合作机构

Hospital Moinhos de Vento

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2025-02-01·Journal of Intensive Care Medicine

Telemedicine Rounding Support for Public Health System Pediatric Intensive Care Units in Brazil can Improve Outcomes

Article

作者: Fröhlich, Guilherme Carey ; Cabral, Felipe Cezar ; Moreira, Taís de Campos ; Matte, Maria Cristina Cotta ; Constant, Hilda Maria Rodrigues Moleda ; Crivella, Carina Galves ; da Cunha, Luciane Gomes ; Pires, Aristóteles de Almeida ; Chagas, Maria Eulália Vinadé ; Guerra, Luciano Remião ; Krauzer, João Ronaldo Mafalda ; Jacovas, Vanessa Cristina

There are discrepancies in resources and expertise available between pediatric intensive care units (PICUs) in Brazil that likely significantly impact the clinical outcomes of patients. The goal of this study was to evaluate the impact of telemedicine rounding support in two public PICUs located in the North and Northeast regions of Brazil. Our intervention involves telehealth rounds connecting two “level II” PICUs with specialist doctors from a hospital of recognized excellence. A before-and-after study was carried out to evaluate telemedicine's impact on PICUs between December 2018 and July 2019. Nine hundred and forty patients were evaluated during this period (426 pre-telemedicine, 514 post-telemedicine). The intervention occurred through telerounds between the command center and the ICUs assisted by telemedicine. In unit A, the implementation of telemedicine reduced the mortality rate from 18.86% to 9.29%, while in unit B, it decreased from 10.76% to 9.72%. There was no change in the median length of stay in unit A, but in unit B, it increased from 6 to 8 days. Logistic regression analysis confirmed a significant reduction in mortality in unit A (odds ratio (OR) 0.50; 95% confidence interval (CI) 0.29-0.86). The study found a positive correlation between adherence to telemedicine recommendations and mortality reduction across both units. This suggests that telemedicine can effectively improve outcomes in PICUs, particularly in regions with limited health-care resources.

2025-02-01·Current Opinion in Neurology

Acute stroke care in low and middle-income countries

Article

作者: Matuja, Sarah Shali ; Martins, Sheila Cristina Ouriques

Purpose of reviewThe purpose of this article is to discuss the global impact of stroke, the disparities and barriers to implement stroke care, and the global efforts to improve access to acute treatments in low and middle-income countries (LMICs).Recent findingsDisparities in access to stroke care are influenced by socioeconomic inequalities, geographic disparities, and limited healthcare infrastructure, particularly in LMICs. Effective stroke care requires a coordinated approach involving emergency services, rapid diagnosis, timely treatment, and early rehabilitation. However, there are significant delays in implementing evidence-based practices, particularly in areas where stroke care resources are scarce.Key barriers include geographic disparities, economic constraints, insufficient healthcare infrastructure, low public awareness, and weak policy frameworks. Addressing these challenges requires strengthening health systems, promoting universal health coverage, enhancing public and healthcare provider education, leveraging technology like telemedicine, and fostering international collaboration. Global efforts, including initiatives by the World Stroke Organization, focus on improving stroke care through infrastructure development, workforce training, and policy advocacy.SummaryThese recommended strategies aim to make stroke care accessible and effective for everyone, regardless of location or socioeconomic status, ultimately helping to reduce the global burden of stroke.

2025-01-01·NEJM Evidence

Long-Term Cognitive Safety of Achieving Very Low LDL Cholesterol with Evolocumab

Article

作者: Zavitz, Kenton ; Keech, Anthony ; Wang, Bei ; Monsalvo, Maria Laura ; Im, KyungAh ; Atar, Dan ; Sabatine, Marc S. ; Giugliano, Robert P. ; Mach, François ; Kurtz, Christopher E. ; Ott, Brian R. ; Zimerman, André ; O’Donoghue, Michelle L. ; Ran, Xinhui

BACKGROUNDConcerns persist regarding the cognitive safety of achieving very low levels of low-density lipoprotein (LDL) cholesterol. Although short-term studies are reassuring, the long-term cognitive effects of sustained exposure to very low LDL cholesterol levels through combined proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibition and statin therapy remain unknown.METHODSThis prospective study enrolled a subset of adults with atherosclerotic cardiovascular disease who had completed a neurocognitive substudy (EBBINGHAUS) of a placebo-controlled randomized trial of evolocumab (FOURIER) and were eligible for a long-term open-label extension. The objective of this current study was to assess the long-term effect of evolocumab on cognitive function. Cognitive function was assessed annually, and the primary end point was change from baseline in executive function within each group, measured using the spatial working memory strategy index score (range, 4-28), with lower scores indicating better performance.RESULTSA total of 473 patients out of the 1974 patients in the parent EBBINGHAUS study were enrolled and additionally followed for a median of 5.1 years (maximum follow-up since original random assignment 7.2 years). The median age was 62 years; 70% were male, and 91% were White. At 12 weeks into the open-label extension period, median LDL cholesterol across the overall population was 35 mg/dl (interquartile range, 21-55 mg/dl). Treatment with evolocumab was not associated with a change in executive function during the open-label extension in either patients who were originally randomly assigned to and continued evolocumab (mean±standard deviation of 0.1±2.8, P=0.49) or patients originally randomly assigned to placebo who then started on evolocumab (-0.1±2.5, P=0.64). At the final study visit, executive function scores were similar between randomly assigned groups (17.5±3.7 and 17.3±3.7, respectively).CONCLUSIONSExposure to very low levels of LDL cholesterol, achieved via PCSK9 inhibition and statin therapy, was not associated with cognitive impairment through long-term follow-up. Further studies are needed to assess the generalizability to adults at higher risk of dementia.

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