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ABSTRACT Objective To assess knowledge on sudden infant death syndrome (SIDS) prevention among postpartum women who received prenatal care in public and private services in Rio Grande, Rio Grande do Sul, Brazil, in 2019. Methods A cross-sectional study was conducted with postpartum women who gave birth in that municipality in 2019; the outcome was the indication of incorrect sleeping position (side/supine position) to prevent SIDS; the chi-square test was used to compare proportions between those who underwent prenatal care in public and private services. Results Among all 2,195 postpartum women, 67.7% (95%CI 65.7;69.6) were unaware of the position that prevents SIDS, 71.6% were public care service users; 77.8% of them feared choking/suffocation; 1.9% were informed about SIDS during prenatal care; doctors/nurses (70.5%) and grandmothers (65.1%) were influential regarding the baby's sleeping position. Conclusion Most postpartum women were unaware of the sleeping position that prevents SIDS, especially those receiving care in the public sector; in general, this subject is not discussed in prenatal care.
RESUMEN Objetivo Evaluar el conocimiento sobre la prevención del síndrome de muerte súbita del lactante (SMSL) entre puérperas que realizaron prenatal en servicios públicos y privados en Rio Grande, Rio Grande do Sul, Brasil, en 2019. Métodos Estudio transversal, con puérperas que dieron a luz en Rio Grande, en 2019; el resultado consistió en la indicación de posición incorrecta para dormir (lado/supino) para prevenir el SMSL; utilizando chi-cuadrado, se compararon las proporciones entre mujeres que recibieron atención prenatal en servicios públicos y privados. Resultados Entre las 2.195 puérperas, 67,7% (IC95% 65,7;69,6) desconocían como se previene el SMSL, estando el 71,6%, en la red pública; 77,8% temía asfixiarse/ahogarse; el 1,9% fue informado sobre el SMSL durante el prenatal; los médicos(as)/enfermeros(as) (70,5%) y los abuelos (65,1%) influyeron en la posición para dormir del bebé. Conclusión La mayoría de las puérperas desconocían la posición que previene el SMSL, especialmente en la red pública; en general, este tema no está cubierto en la atención prenatal.
RESUMO Objetivo Avaliar o conhecimento sobre prevenção da síndrome da morte súbita do lactente (SMSL) entre puérperas com pré-natal realizado nos serviços público e privado de Rio Grande, Rio Grande do Sul, Brasil, 2019. Métodos Estudo transversal, com puérperas do município; seu desfecho constituiuse da indicação de posição incorreta para dormir (decúbito lateral ou dorsal), visando prevenir a SMSL; utilizou-se o teste qui-quadrado para comparar proporções do desfecho e de exposição entre puérperas que realizaram pré-natal nos serviços público e privado. Resultados De 2.195 puérperas, 67,7% (IC95% 65,7;69,6), majoritariamente atendidas na rede pública (71,6%), desconheciam a posição preventiva da SMSL; 77,8% temiam engasgo/afogamento; 1,9% foram informadas sobre SMSL no pré-natal; médicos(as)/enfermeiros(as) (70,5%) e avós (65,1%) mostraram-se influentes na decisão sobre como posicionar o bebê adormecido. Conclusão A maioria das puérperas, especialmente as atendidas na rede pública, desconhecia a posição que previne SMSL; geralmente, o tema não é abordado no pré-natal.
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Prone positioning in percutaneous nephrolithotomy is more and more being replaced by supine positioning now a days for its various benefits. This is a prospective study which does Comparative study on percutaneous nephrolithotomy in supine versus prone position and their various outcomes were analysed. There were totally 100 patients included in the study with 50 patients each group (supine versus prone). 57 were male and 43 female patients. Age ranging from 18 to 70 years. Right side stones were 58 and left side was 42. Age, gender and side of stones were similar between two groups. Stone burden were 2.6cm and 2.9cm for supine and prone group respectively. But average operating time were 63.5 minutes ( 35 to 120 minutes) for supine group versus 80 minutes ( 45 to 160 minutes) for prone group. fluoroscopy time was 18.9 minutes for supine group versus 29.4 minutes for prone group. Clearance rate in our study were pretty good in both groups around 90% in both groups (90% vs 88%). five had complications in form of sepsis and bleeding requiring blood transfusion in both groups. Five in supine group and six in prone group required second procedures. Thus Supine percutaneous nephrolithotomy group had significant advantage in terms of less operative duration and less fluoroscopy time than prone percutaneous nephrolithotomy . The stone clearance and complication rates were similar in both the groups.
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【Objective】 To evaluate the efficacy and safety of percutaneous nephrolithotomy in Galdakao-modified supine Valdivia (GMSV) position and prone position in the treatment of renal calculi. 【Methods】 PubMed, Embase and Cochrane Library databases were searched systematically to identify all eligible studies. Literature collected were screened and data were extracted by three authors independently. RevMan5.4 software was used for Meta-analysis. 【Results】 A total of 9 articles were enrolled, including 7 randomized controlled studies and 2 case-control studies, with a total of 1 690 patients. The results of Meta-analysis showed that compared with the prone position group, the GMSV group had shorter hospital stay (WMD:-9.04, 95%CI:-16.85--1.22, P=0.02), shorter intraoperative radiation exposure (WMD:-1.23, 95%CI:-1.98--0.48, P=0.001), lower rate of complications (RR:0.72, 95%CI:0.59-0.88, P=0.001), but there were no significant differences in operation time, primary stone clearance rate, postoperative hemoglobin loss, blood transfusion rate, fever rate and non-tubulization rate. 【Conclusion】 Compared with percutaneous nephrolithotomy in prone position, percutaneous nephrolithotomy in GMSV position has the comparable stone clearance rate, but has significant advantages in hospital stay, intraoperative radiation time, and overall complications. It is safe for the treatment of renal stones and upper ureteral stones.
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Abstract Background The efficacy and safety profiles of prone ventilation among intubated Coronavirus Disease 2019 (COVID-19) patients remain unclear. The primary objective was to examine the effect of prone ventilation on the ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (PaO2/FiO2) in intubated COVID-19 patients. Methods Databases of MEDLINE, EMBASE and CENTRAL were systematically searched from inception until March 2021. Case reports and case series were excluded. Results Eleven studies (n = 606 patients) were eligible. Prone ventilation significantly improved PaO2/FiO2 ratio (studies: 8, n = 579, mean difference 46.75, 95% CI 33.35‒60.15, p < 0.00001; evidence: very low) and peripheral oxygen saturation (SpO2) (studies: 3, n = 432, mean difference 1.67, 95% CI 1.08‒2.26, p < 0.00001; evidence: ow), but not the arterial partial pressure of carbon dioxide (PaCO2) (studies: 5, n = 396, mean difference 2.45, 95% CI 2.39‒7.30, p= 0.32; evidence: very low), mortality rate (studies: 1, n = 215, Odds Ratio 0.66, 95% CI 0.32‒1.33, p= 0.24; evidence: very low), or number of patients discharged alive (studies: 1, n = 43, Odds Ratio 1.49, 95% CI 0.72‒3.08, p= 0.28; evidence: very low). Conclusion Prone ventilation improved PaO2/FiO2 ratio and SpO2 in intubated COVID-19 patients. Given the substantial heterogeneity and low level of evidence, more randomized- controlled trials are warranted to improve the certainty of evidence, and to examine the adverse events of prone ventilation.
Subject(s)
Humans , Respiratory Distress Syndrome, Newborn , COVID-19/therapy , Oxygen , Respiration, Artificial , Prone PositionABSTRACT
SUMMARY OBJECTIVE: The aim of this study was to evaluate the predictive factors for success following percutaneous nephrolithotomy in the supine position. METHODS: Patients who underwent percutaneous nephrolithotomy in the supine position from June 2011 to October 2018 were evaluated. Age, sex, body mass index, the American Society of Anesthesiologists physical status classification, hemoglobin level, number of previous surgeries, stone size, and the Guy's Stone Score were analyzed. Success was considered if no fragments were observed on the computed tomography scan on the first postoperative day. Univariate and multivariate analyses were performed to determine significant parameters. RESULTS: We evaluated 961 patients; of them, 483 (50.2%) underwent previous stone-related surgery, and 499 (51.9%) had Guy's Stone Score 3 or 4. The overall success rate in a single procedure was 40.7%, and complication rate was 13.7%. The univariate analysis showed that the maximum diameter of the stone (25.10±10 mm; p<0.001), previous percutaneous nephrolithotomy (OR 0.52; p<0.001), number of previous percutaneous nephrolithotomy (OR 0.15; p<0.001), the Guy's Stone Score (OR 0.28; p<0.001), and the number of tracts (OR 0.32; p<0.001) were significant. In the multivariate analysis, the number of previous percutaneous nephrolithotomy (OR 0.54; p<0.001) and the Guy's Stone Score (OR 0.25; p<0.001) were statically significant. CONCLUSIONS: Guy's Stone Score and the number of previous percutaneous nephrolithotomy are predictors of success with the supine position. Complex cases and with previous percutaneous interventions may require technical improvements to achieve higher stone-free rates.
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Objective:To investigate the optimal lengths of supine position after first lumber puncture for school-aged children with acute leukemia.Methods:From January 2020 to December 2021, a total of 152 children with acute leukemia who underwent first lumbar puncture were randomly divided into 1h group, 2 h group, 3 h group and 4 h group, there were 38 cases in each group. The lengths of supine position after lumber puncture were 1 h, 2 h, 3 h and 4 h in the 1h group, 2 h group, 3 h group and 4 h group, respectively. The effects of different lengths of supine position on headache, low back pain, comfort and postoperative complications were observed.Results:Finally, 38 cases were enrolled in the 1 h group, 36 cases in the 2 h group, 38cases in the 3 h group and 34 cases in the 4 h group. The scores of low back pain, sleep comfort, lying position comfort, emotional comfort as well as the incidence of limb numbness in the 1 h group were (1.71 ± 0.56), (1.95 ± 0.87), (2.74 ± 1.06), (2.63 ± 0.79), 5.3%(2/38), in the 2 h group were (1.61 ± 0.27), (2.08 ± 0.81), (2.92 ± 1.34), (2.86 ± 0.80), 2.8%(1/36), which were significant lower than those of in the 3 h group (2.32 ± 1.12), (2.92 ± 1.34), (3.71 ± 1.11), (3.55 ± 1.25), 21.1%(8/38) and 4 h group(2.74 ± 1.42), (3.06 ± 1.37), (3.85 ± 1.50), (3.88 ± 0.81), 23.5%(8/34), F=6.81 to 14.06, χ2=10.84, all P<0.05. The amount of cerebrospinal fluid exudation in 1 h group was (0.33±0.09) g, which was significantly higher than that in 2 h group(0.27±0.08) g, 3 h group (0.27±0.10) g and 4 h group (0.24±0.09) g, the difference was significant ( F=5.82, P<0.05). The incidence of pressure injury in 1 h group, 2 h group and 3 h group were 0, 2.0%(1/36), 7.9%(3/38), which were significantly lower than that in the 4 h group 23.5%(8/34), χ2=15.39, P<0.05. There was no significant difference in pain scores among the 4 groups ( P>0.05). Conclusion:Two hours for supine position after first lumber puncture does not increase cerebrospinal fluid exudation in children with acute leukemia, and effectively alleviate low back pain, improve the comfort degree.
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ABSTRACT Objective To evaluate the displacement of nerve structures according to the decubitus position of the patient in a magnetic resonance imaging (MRI) study. Methods MRI was performed at a radiology clinic in 20 patients in dorsal and right lateral decubitus. The measurement considered was the shortest distance between the dura mater and the medial wall of the pedicle. Results The largest measurement was 11.6 mm in left lateral decubitus, 12.2 mm in right lateral decubitus, 10.5 mm in right dorsal decubitus, and 9.2 mm in left dorsal decubitus. In some patients the space between the medial wall of the pedicle and the dura mater was larger when in lateral decubitus, while in others when in dorsal decubitus. The mean displacement of the measurements on the left was 1.14 mm and on the right 1.355 mm. Conclusions The structures moved on average little more than 1 mm in the positions studied. The positioning of the patient for surgery does not change the space to be approached, being the surgeon's choice according to his learning curve. Level of evidence II; Prospective study of lower quality.
RESUMO Objetivo Avaliar o deslocamento das estruturas nervosas conforme o decúbito do paciente em um estudo de Ressonância Nuclear Magnética (RNM). Métodos Foram realizadas RNM em 20 pacientes em uma clínica de radiologia em decúbito dorsal e lateral direito. A medida considerada será a menor distância entre a dura-máter e a parede medial do pedículo. Resultados A maior medida em decúbito lateral esquerdo foi 11,6 mm, em decúbito lateral direito foi 12,2 mm, em decúbito dorsal direito foi 10,5 mm e no esquerdo, 9,2 mm. O espaço entre a parede medial do pedículo é maior em decúbito lateral em alguns pacientes e, em outros, em decúbito dorsal. O deslocamento médio das medidas à esquerda foi 1,14 mm e à direita 1,355 mm. Conclusões As estruturas se deslocaram, em média, pouco mais de 1 mm nas posições estudadas. O posicionamento do paciente na cirurgia não muda o espaço a ser abordado, sendo de escolha do cirurgião, conforme a sua curva de aprendizado. Nível de evidência II; Estudo prospectivo de menor qualidade .
RESUMEN Objetivo Evaluar el desplazamiento de las estructuras nerviosas conforme al decúbito del paciente en un estudio de Resonancia Nuclear Magnética (RNM). Métodos Fueron realizadas RNM en 20 pacientes en una clínica de radiología en decúbito dorsal y lateral derecho. La medida considerada será la menor distancia entre la duramadre y la pared medial del pedículo. Resultados La mayor medida en decúbito lateral izquierdo fue 11,6 mm, en decúbito lateral derecho fue 12,2 mm, en decúbito dorsal derecho fue 10,5 mm y en el izquierdo, 9,2 mm. El espacio entre la pared medial del pedículo es mayor en decúbito lateral en algunos pacientes y, en otros, en decúbito dorsal. El desplazamiento promedio de las medidas a la izquierda fue 1,14 mm y a la derecha de 1,355 mm. Conclusiones Las estructuras se desplazaron, en promedio, poco más de 1 mm en las posiciones estudiadas. El posicionamiento del paciente en la cirugía no cambia el espacio a ser abordado, siendo la elección del cirujano conforme a su curva de aprendizaje. Nivel de evidencia II; Estudio prospectivo de menor calidad.
Subject(s)
Humans , Low Back Pain , Magnetic Resonance Imaging , Supine Position , Patient PositioningABSTRACT
Many individuals prefer using a pillow under their head when they sleep or read or use hand held electronic devices in recumbent position. Changes in position of the head with respect to the neck in supine posture may occur depending on the use of a pillow or height of the pillow used. This alteration of head and neck position might have an effect on pulmonary ventilation. The Peak Expiratory Flow Rate (PEFR) is one of the tests to assess pulmonary functions and PEFR can be performed easily and rapidly with the help of Wright’s Mini Peak Flowmeter. This study was undertaken to see the effect of variations in neck position on peak expiratory flow rate in supine posture in young healthy adults. METHODSA cross sectional study was carried out on 150 apparently healthy medical students of both sexes in the age group of 18 - 21 years. PEFR values were recorded using Wright’s Mini Peak Flow Meter. The subjects were asked to lie down in supine position on a wooden couch and recording of the peak expiratory flow rate was performed, initially by placing the subject’s head directly on the wooden couch and then by keeping the head on a pillow of 5 cm height. RESULTSData was analysed using paired ‘T’ Test and the p value of less than 0.05 was considered as statistically significant. We found that the mean PEFR value obtained using a pillow of 5 cm height under the head was more than the mean PEFR value obtained without using the pillow and the change in mean PEFR values was statistically significant (Table 1). CONCLUSIONSAfter comparing the mean PEFR values in the supine position with and without use of a pillow, we found that mean PEFR value was significantly higher when PEFR test was performed with use of a low height pillow (5 cm) under the head. From the result of this study, we conclude that pulmonary ventilation is better when the head and neck are supported with a low height pillow in supine posture.
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ABSTRACT Purpose: This study aims to compare the anatomical success rates of vitrectomy and SF6 gas tamponade for macular hole surgery with and without postoperative face-down posturing. Methods: This was an observational, longitudinal, and retrospective case series analysis. The study included 52 eyes from 52 patients who underwent pars plana vitrectomy with trypan blue-assisted internal limiting membrane peeling and 25% SF6 tamponade for stages 2, 3, and 4 macular holes. After surgery, all patients were provided with a postoperative postural regimen: 31 patients were instructed not to maintain face-down posturing, whereas 21 were instructed to maintain face-down posturing for 7 days. The primary outcome measure was the macular hole closure rate. Statistical analysis was performed using Epi Info 7.1. Results: A total of 47 (90.3%) patients achieved hole closure. The nonface-down posturing group and face-down posturing group obtained closure rates of 90.3% and 90.4%, respectively; these rates were not significantly different. Statistical analysis revealed that no significant differences existed in sex, age, hole duration, hole stage, preoperative visual acuity, or postoperative visual acuity between the two groups. Conclusion: Our results suggest that macular hole surgery with the use of short duration gas (SF6) is safe and effective and that maintaining a postural orientation of nonface-down posturing is also safe. However, these recommendations should be assessed further in a prospective and randomized study to comprehensively delineate the associated benefits and risks.
RESUMO Objetivos: Comparar as taxas de sucesso anatômico da vitrectomia e tamponamento de gás SF6 na cirurgia de buraco macular com e sem a postura pronada pós-operatória. Métodos: Foi realizado um estudo observacional, longitudinal e retrospectivo de séries de casos. O estudo incluiu 52 olhos de 52 pacientes submetidos à vitrectomia posterior via pars-plana com peeling de membrana limitante interna auxiliada por azul trypan e tamponamento com gás SF6 a 25% para os estágios 2, 3 e 4 dos buracos maculares. Após a cirurgia, todos os pacientes foram orientados a manter um regime postural pós-operatório: 31 pacientes foram orientados a não realizar posição pronada de cabeça, enquanto 21 foram orientados a manter uma pronada pós-operatória por 7 dias. O objetivo principal foi a análise da taxa de fechamento do buraco macular. A análise estatística foi realizada usando Epi-Info 7.1. Resultados: Um total de 47 (90,3%) pacientes obtiveram fechamento do buraco macular. O grupo de postura não pronada e o grupo de postura pronada obtiveram taxas de fechamento de 90,3%, e 90,4%, respectivamente; essas taxas não foram significativamente diferentes. A análise estatística revelou que não houve diferenças significativas relacionadas ao gênero, idade, duração do buraco macular, estágio do buraco macular, acuidade visual corrigida pré e pós-operatória entre os dois grupos. Conclusão: Nossos resultados sugerem que a cirurgia para buraco macular com o uso de gás de curta duração (SF6) é segura e eficaz e que a manutenção de uma orientação pós-operatória de não-pronada também é segura. No entanto, essas recomendações devem ser avaliadas em um estudo prospectivo e randomizado para delinear de forma abrangente os riscos e benefícios associados.
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Humans , Retinal Perforations , Fluorocarbons , Retinal Perforations/surgery , Vitrectomy , Prospective Studies , Retrospective Studies , Treatment Outcome , Prone PositionABSTRACT
BACKGROUND: The posterolateral approach is the most commonly used surgical approach for total hip arthroplasty. In recent years, total hip replacement by direct anterior approach has been applied in clinic gradually, and has achieved good treatment outcomes. OBJECTIVE: To compare the clinical efficacy of the direct anterior approach in supine position and the posterolateral approach in supine position for total hip arthroplasty. METHODS: Ninety patients undergoing unilateral primary total hip arthroplasty at Baoding Municipal First Center Hospital from April 2015 to April 2019 were included, including 35 males and 55 females, aged 35-70 years. The patients were divided into direct anterior approach group (n=45) and posterolateral approach group (n=45) by the random number table method. Postoperative follow-up was used to evaluate the Harris hip scores, Visual Analogue Scale scores, initial fixation mass of prosthesis and safe range of the cup. The study was approved by the Ethics Committee of Baoding Municipal First Center Hospital. RESULTS AND CONCLUSION: (1) Ninety patients were followed up for 3-51 months, with an average 14 months. There were 2 cases of intraoperative great trochanteric fracture, 1 case of femoral lateral cutaneous nerve injury, 4 cases of femoral nerve injury, and 20 cases of tensor fascia lata injury. No such complications occurred in the posterolateral approach group. (2) The direct anterior approach group showed significant superior outcomes compared with the posterolateral approach group in the Harris hip scores and Visual Analogue Scale scores at 1 month after surgery (P 0.05). (3) In the direct anterior approach group, the femoral prosthesis of 44 hips was in neutral position, and 1 hip was in varus position. The initial fixation quality of all prosthesis was excellent. In the posterolateral approach group, the femoral prosthesis of 43 hips was in neutral position, 2 hips were in varus position and all prosthesis initial fixation quality was excellent. No significant difference was found between two groups (P > 0.05). (4) The ratio of acetabular cups in the safety range of Lewinnek in the direct anterior approach group was higher than that in the posterolateral approach group (100%, 82%, P < 0.05). (5) These results imply that compared with the posterolateral approach, direct anterior approach in supine position for total hip arthroplasty can significantly reduce postoperative pain, promote postoperative early rapid recovery, obtain more accurate angle of the acetabular prosthesis, and be more conducive to the equalization of both lower limbs. It is a safe and reliable approach. However, direct anterior approach has certain technical difficulty and needs a learning curve. And there are some complications different from other approaches.
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ABSTRACT Purpose We aimed to compare the outcomes of supine and prone miniaturized percutaneous nephrolithotomy (m-PNL) in the treatment of lower pole, middle pole and renal pelvic stones. Materials and Methods 54 patients who performed supine m-PNL between January 2017 and March 2018 and 498 patients who performed prone m-PNL between April 2015 and January 2018 were included in the study. Of the 498 patients, 108 matching 1: 2 in terms of age, gender, body mass index, American Association of Anesthesiology score, stone size, stone localization and hydronephrosis according to the supine m-PNL group were selected as prone m-PNL group. The patients with solitary kidney, upper pole stone, urinary system anomaly or skeletal malformation and pediatric patients (<18 years old) were excluded from the study. The success was defined as 'complete stone clearance' and was determined according to the 1st month computed tomography. Results The operation time and fluoroscopy time in supine m-PNL was significantly shorter than prone m-PNL group (58.1±45.9 vs. 80.1±40.0 min and 3.0±1.7 min vs. 4.9±4.5 min, p=0.025 and p=0.01, respectively). When post-operative complications were compared according to the modified Clavien-Dindo classification, overall and subgroup complication rates were comparable between groups. There was no significant difference between the groups in terms of the success rates (supine m-PNL; 72.2%, prone m-PNL; 71.3%, p=0.902). Conclusions Supine m-PNL procedure is more advantageous in terms of operation time and fluoroscopy time in the treatment of lower pole, middle pole and renal pelvic stones.
Subject(s)
Humans , Male , Female , Adult , Kidney Calculi/surgery , Supine Position , Prone Position , Patient Positioning/methods , Nephrolithotomy, Percutaneous/methods , Fluoroscopy/methods , Kidney Calculi/pathology , Reproducibility of Results , Treatment Outcome , Matched-Pair Analysis , Statistics, Nonparametric , Operative Time , Kidney Pelvis/surgery , Middle AgedABSTRACT
Objective To investigate the influence of the length of time of supine ultrasound examination on the parameters of umbilical artery blood flow in the late pregnant fetus. Methods From February 2019 to June 2019,the ultrasound data of 93 pregnant women with the third-trimester pregnant were analyzed retrospectively. Fetal umbilical artery systolic／diastolic ( S／D ) ratio, resistance index ( RI ), pulsatility index ( PI ) and fetal heart rate ( HR ) were acquired at the beginning of the ultrasound examination and those after the routine ultrasound examination ( the examination of fetal, placenta and amniotic fluid). Forty-seven pregnant women from 29 to 31 weeks of gestation were assigned to around 30-week gestation group,while 46 pregnant women from 35 to 37 weeks of gestation were assigned to around 36-week gestation group. Sixty-five pregnant women with normal S／D ratio at the beginning were assigned to the initial normal group,while 28 pregnant women with abnormal S／D ratio at the beginning were assigned to the initial abnormal group. Fetal umbilical artery S／D ratio,RI,PI and HR at the beginning of the ultrasound and after the routine ultrasound examination were compared using paired sample test within around 30-week gestation group, around 36-week gestation group, initial normal and initial abnormal group, respectively. Results There was no significant difference in fetal umbilical artery S／D,RI PI and HR in the pregnant women at around 30-week gestation(all P＞0. 05). RI before the 36 week pregnant group was 0. 56 ±0. 05,and increased to 0. 58±0. 05 after the routine examination (t＝－2. 190,P＝0. 034). The S／D,RI and Pi of umbilical artery increased from 2. 36±0. 31,0. 57±0. 06,and 0. 84±0. 11 to 2. 50±0. 42,0. 59±0. 06, and 0. 88±0. 14 in the initial normal group ( t＝－3. 087,－3. 002,－2. 287,respectively; P＝0. 003,0. 004, 0. 025,respectively),of which 16 S／D increased to abnormal; the RI of umbilical artery increased from 0. 67 in the initial abnormal group ( 28 women ) after routine examination ) . The difference was statistically significant (t＝2. 616,P＝0. 014) . The ratio of S／D decreased to normal after routine examination in the initial abnormal group ( 14／28), which was higher than that in the initial normal group ( 16 ／ 65) . The difference was statistically significant ( χ2 ＝5. 771, P＜0. 05) . Conclusion Umbilical artery blood flow parameters should be measured at the beginning of the ultrasound examination in the third-trimester pregnant women. Umbilical artery Doppler ultrasound should be performed repeatedly if the pregnant woman has abnormal S／D ratio at the beginning of the examination.
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Objective To explore the effect of curved supine position to prevent pressure ulcer and comfort experience in postoperative fracture patients. Methods A total of one hundred and seventy-eight leg fracture patients who underwent operating in hospital were randomly divided into study group and control group (89 patients in each group). Conventional prevention and nursing method was given in the control group, based on the control group, curved supine position nursing method was carried out in the study group. The incidence of pressure ulcer, main compressed parts, pressure ulcers risk score and comfort degree in two groups were compared during hospitalization. Results The incidence of pressure ulcer in the study group (1.1％,1/89) was significantly lower than in the control group (7.9％,7/89), the difference was statistically significant between two groups (χ2=4.712, P=0.030). The scores of Kolcaba General Comfort Questionnaire (GCQ) in two groups showed a time-dependent manner, the physical, psycho-spiritual, environmental scores in the study were higher than in the control group at 13:00, 17:00 and 20:00. Meanwhile, the scores of socio-cultural were higher than in the control group at 17:00 and 20:00, the difference was statistically significant between two groups (P<0.05). Conclusion Curved supine position canreduce the incidence of pressure ulcer as well as promote comfort experience in postoperative fracture patients.
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The tilted supine position has been evaluated to be one of the significantly effective approaches to prevent bedsore of the patients in the bedridden state. Thus, it has deeply positive influences that in view of dynamics this study explores how the position works. Based on the anatomical theories, this study formulates the human dynamic model. Furthermore, the dynamic simulation of three usual postures in tilted supine position including lying on back, lying with one knee bent and lying with the upper and lower limb on one side lifted is carried out. Therefore, the changes of the three driving forces named as chest force, waist force and thigh force in the tilted supine position can be observed. In order to verify the validity of this simulation, this study obtains the electromyogram measurements of ectopectoralis, external obliques and thigh muscles which are respectively close to the chest, waist and thigh by conducting the human force measurements experiment. The result revealed that in terms of range and trend, the experimental data and simulation's data were consistent. In conclusion, the changes of these muscles in the supine position movements are researched efficiently by both this experiment and the dynamic simulation. Besides, the result is crucially key to find the mechanism of human's tilted supine position movements.
Subject(s)
Humans , Biomechanical Phenomena , Electromyography , Models, Anatomic , Movement , Muscle, Skeletal , Physiology , Posture , Supine PositionABSTRACT
ABSTRACT Purpose: To evaluate the impact of the patient position on the outcomes of PCNL among patients with complex renal stones. Material and Methods: From July 2011 to July 2014, we collected prospective data of consecutive patients who underwent PCNL. We included all patients with complex stones (Guy's Stone Score 3 or 4 (GSS) based on a CT scan) and divided them based on the position used during PCNL (prone or supine). The variables analyzed were gender, age, body mass index, ASA score, stone diameter, GSS, number of punctures, calyx puncture site, intercostal access and patient positioning. Complications were graded according to the modified-Clavien Classification. Success was considered if fragments ≤ 4mm were observed on the first postoperative day CT scan. Results: We analyzed 240 (46.4%) of 517 PCNL performed during the study period that were classified as GGS 3-4. Regarding patient positions, 21.2% were prone and 79.8% were supine. Both groups were comparable, although intercostal access was more common in prone cases (25.5% vs 10.5%; p=0.01). The success rates, complications, blood transfusions and surgical times were similar for both groups; however, there were significantly more visceral injuries (10.3% vs 2.6%; p=0.046) and sepsis (7.8% vs 2.1%; p=0.042) in prone cases. Conclusion: Supine or prone position were equally suitable for PCNL with complex stones and did not impact the success rates. However, supine position was associated with fewer sepsis cases and visceral injuries.
Subject(s)
Humans , Male , Female , Nephrostomy, Percutaneous/methods , Kidney Calculi/surgery , Supine Position , Prone Position , Patient Positioning/methods , Nephrostomy, Percutaneous/adverse effects , Tomography, X-Ray Computed , Prospective Studies , Retrospective Studies , Treatment Outcome , Patient Positioning/adverse effects , Middle AgedABSTRACT
Objetivo: Verificar a sensibilidade do frequencímetro Polar® RS800CX na variação postural a partir da frequência cardíaca (FC) e parâmetros da variabilidade da FC (VFC). Método: Homens jovens (n=20) saudáveis tiveram registradas as medidas de FC e dos intervalos R-R da VFC (RRi) nos domínios do tempo (RRi, RMSSD, pNN50) e da frequência (LF, HF e LF.HF-1) utilizando o Polar® RS800CX. Resultados: Diferenças (p<0,05) foram encontradas para Posição Supina (PS) 5' e PS10' vs. Posição Ortostática (PO) 5' e PO10' para FC (61,1±1,1 e 61,0±1,3 bpm vs. 79,5±3,9 e 80,8±3,5 bpm), RRi (990,0±19,9 e 994,5±23,2 ms vs. 787,4±34,0 e 768,6±30,1 ms), rMSSD (70,5±8,4 e 71,1±8,5 ms vs. 32,2±3,4 e 30,7±3,7 ms), pNN50 (41,1±6,0 e 46,3±5,3% vs. 15,4±2,5 e 14,3±2,6%), LF (52,3±6,4 e 55,4±6,5 n.u. vs. 82,0±4,2 e 80,7±4,8 n.u.), HF (47,7±6,4 e 44,6±6,5 n.u. vs. 18,0±4,2 e 19,3±4,8 n.u.) e LF.HF-1 (2,9±0,8 e 3,1±0,8 vs. 14,1±2,9 e 14,3±3,1). Conclusão: O frequencímetro Polar® RS800CX se apresentou sensível a variações na postura corporal.
Purpose: To determine the sensitivity of the frequency meter Polar® RS800CX in postural maneuver from the heart rate (HR) and HR variability (HRV) parameters. Method: Young (n=20) healthy men had registered HR and RR intervals (RRi) measurements in the time domain (RRi, RMSSD, pNN50) and frequency (LF, HF and LF.HF-1) using the Polar® RS800CX. Results: Differences were found to supine position (SUP) 5 'and SUP10' vs. standing position (STP) 5 'and STP10' in HR (61.1 ± 1.1 and 61.0 ± 1.3 bpm vs. 79.5 ± 3.9 and 80.8 ± 3.5 bpm), RRi (990.0 ± 19.9 and 994.5 ± 23,2 ms vs. 787.4 ± 34.0 ms and 768.6 ± 30.1 ms), rMSSD (70.5 ± 8.4 and 71.1 ± 8.5 ms vs. 32.2 ± 3.4 and 30.7 ± 3.7 ms), pNN50 (41.1 ± 6 0 and 46.3 ± 5.3% vs. 15.4 ± 2.5 and 14.3 ± 2.6%), LF (52.3 ± 6.4 and 55.4 ± 6.5 n.u. vs. 82.0 ± 4.2 and 80.7 ± 4.8 n.u), HF (47.7 ± 6.4 and 44.6 ± 6.5 n.u. vs. 18.0 ± 4.2 and 19.3 ± 4.8 n.u.) and LF.HF-1 (2.9 ± 0.8 and 3.1 ± 0.8 vs. 14.1 ± 2.9 and 14.3 ± 3.1). Conclusion: The frequency meter RS800CX Polar® appeared sensitive to variations in body posture.
Subject(s)
Humans , Male , Adult , Young Adult , Heart Rate Determination/instrumentationABSTRACT
Resumo Este estudo teve por objetivo conhecer a opinião das mães e identificar os fatores associados à intenção de colocar o bebê para dormir em decúbito dorsal em Rio Grande, RS. Foi aplicado questionário padronizado a todas as mães que tiveram filho nas duas únicas maternidades, entre 01/01 a 31/12/2010, e que residiam neste município. Utilizou-se teste do qui-quadrado para comparar proporções e regressão de Poisson, com ajuste robusto da variância na análise multivariável. A medida de efeito utilizada foi razão de prevalências (RP). Dentre as 2.395 (97,2% do total) mães entrevistadas, 20,5% (IC95%: 18,4%-21,6%) manifestaram intenção de colocar o bebê para dormir de barriga para cima. Esta intenção variou de 11% (IC95%: 8,1-13,7), entre mães com três ou mais filhos, a 35% (IC95% 31,1-40,2), entre aquelas com 12 anos ou mais de escolaridade. Após analise ajustada, mães de menor idade, de maior escolaridade e renda familiar, que realizaram pré-natal na rede privada, ou que tiveram três ou mais filhos, apresentaram RP significativamente maior para colocar o bebê para dormir de barriga para cima, em relação às demais. Campanhas de incentivo a esta prática devem priorizar mães de pior nível socioeconômico, de maior idade e que realizam pré-natal em unidades básicas de saúde.
Abstract This study aimed to identify mother's opinion on infant sleep position and the factors associated with the intention to place the infant in the supine position in the municipality of Rio Grande, Southern Brazil. A standardized questionnaire was applied to all mothers residing in this municipality who gave birth to a child in the only two local maternity wards from January 1 to December 31, 2010. Chi-square test was used to compare proportions, along with a Poisson regression with robust adjustment in the multivariate analysis. The effect measure used was prevalence ratio (PR). Of the 2,395 mothers interviewed (972% of the total), 20.5% (95%CI: 18.4%-21.6%) intended to place the newborn to sleep in the supine position. This prevalence varied from 11% (95%CI: 8.1-13.7) for mothers with three or more children to 35% (CI95%: 31.1-40.2) among those with 12 or more years of schooling. After adjusted analysis, younger mothers with higher education and household income who performed prenatal care in the private system or who have had three or more children had significantly higher PR to place the baby to sleep in the supine position compared to others. Campaigns encouraging this practice should focus primarily on older mothers of lower socioeconomic level and performing prenatal care in PHC facilities.
Subject(s)
Humans , Infant, Newborn , Adult , Young Adult , Sleep/physiology , Supine Position , Infant Care/methods , Mothers/statistics & numerical data , Prenatal Care/methods , Socioeconomic Factors , Brazil , Poisson Distribution , Multivariate Analysis , Age Factors , Intention , Educational Status , Income , Mothers/psychologyABSTRACT
Introducción: El síndrome de apnea e hipopnea obstructiva del sueño (SAHOS) es un problema de salud pública común, en donde la posición al dormir tiene influencias fisiológicas importantes en el patrón de sueño. Objetivo: Establecer la severidad según índice de apnea hipopnea del sueño en los pacientes con síndrome obstructivo del sueño posicional (supino) y no posicional (no supino) en el Hospital Universitario Clínica San Rafael entre el 1 de enero de 2014 al 31 de diciembre de 2017. Diseño: Estudio observacional descriptivo de corte transversal. Metodología: Se tomaron datos registrados en las historias clínicas de los pacientes que asistieron al Hospital Universitario Clínica San Rafael. El tamaño de la muestra fue de 88 personas de ambos sexos, en edades entre 18 y 90 años. Resultados: La distribución por género fue de 55 hombres (62,5%) y 33 mujeres (37,5%) de los cuales 47(53.4%) fueron SAHOS posicional y 41(46.6%) SAHOS no posicional. El peso promedio de las mujeres es de 71 kg y en hombres de 81 kg, la estatura es 1,58 cm y 1.67 respectivamente presentándose índices de masa corporal altos, en promedio de 28 para los dos géneros. La edad promedio es de 53 años para mujeres y de 46 años para hombres. Se encontró una asociación estadísticamente significativa entre la severidad y SAHOS posicional (Fischer exact p=0.018), en donde el SAHOS severo está asociado con apnea no posicional, mientras que el SAHOS leve tiende a corresponder a la apnea posicional. Conclusiones: En nuestro estudio se evidenció que el SAHOS más severo está asociado a la apnea no posicional, mientras que el SAHOS menos severo tiende a corresponder a la apnea posicional.
Introduction: Obstructive sleep apnea and hypopnea syndrome (OSAHS) is a common public health problem, where the sleeping position has important physiological influences on the sleep pattern. Objective: To establish the severity according to the index of hypopnea sleep apnea in patients with positional (supine) and non-positional (non-supine) sleep obstructive syndrome in the San Rafael Clinical University Hospital from January 1, 2014 to December 31, 2017. Design: Cross-sectional study. Methods: Recorded data of patients that attend the outpatient service of the San Rafael Clinical University Hospital has been taken for the study. The simple size was 88 people of both sexes, with ages between 18 and 90 years. Results: The distribution by gender was 55 men (62.5%) and 33 women (37.5%) of which 47(53.4%) were positional OSAS and 41(46.6%) non-positional OSAS The average weight of women is 71 kg and in men of 81 kg, the height is 1.58 cm and 1.67 cm respectively, with high body mass indexes, on average 28 for both genders. The average age is 53 for women and 46 for men. A statistically significant association was found between severity and positional OSAS (Fischer exact p = 0.018), where severe OSAS is associated with non-positional apnea, while mild OSAS corresponds to positional apnea. Conclusions: In our study it was evidenced that the most severe OSAS is associated to the non-positional apnea, while the less severe OSAS tends to correspond to the positional apnea.
Subject(s)
Humans , Sleep Apnea, Obstructive , Supine Position , Sleep Disorders, IntrinsicABSTRACT
Objective To explore the feasibility and safety of integrated intensity-modulated radiation therapy (IMRT) technology applied in craniospinal irradiation in a supine position. Methods The patients were fixed in a supine position using thermoplastic mask and vacuum mat. Three isocenters with a fixed interval of 20-25 cm were adopted according to the height of patients. A total of 13 beams with a length of 2-3 cm in the overlapping region were included in the treatment plan. Fixed jaw technique was employed and overall calculation was performed by the inverse optimization method. The γ-passing rate and absolute point dose verification were performed for three isocenters and two overlapping regions. Cone-beam CT (CBCT) images were scanned for three isocenters before treatment. The setup error of each isocenter in the x,y and z directions of the same coordinate system was recorded and overall analysis was conducted. Results Among 28 patients,the γ-passing rate (%) of three isocenters and two overlapping regions was 99. 36%, 99. 60%,99. 75%,94. 77% and 95. 09%,whereas the absolute point dose verification error was 1. 56%,-1. 56%,0. 52%,-0. 76% and -1. 68%,respectively. Twenty-eight patients received 162 groups of IGRT with 486 setup errors from the CBCT images. The average deviation in the x, y and z direction for three isocenters (neck,chest and abdomen) was 0. 17 mm,0. 10 mm,0. 02 mm,0. 06 mm,0. 04 mm,0. 46 mm, 0. 19 mm, 0. 26 mm and 0. 41 mm, respectively. Conclusions The integrated IMRT techniques for craniospinal irradiation in a supine position is feasible and safe,which is worthy of clinical application.
ABSTRACT
Objective To investigate the changes of amplitude of T wave and ST segment between the supine and orthostatic electrocardiogram in children and adolescents with postural tachycardia syndrome (POTS). Methods A total of 74 children and adolescents diagnosed as POTS by head-up tilt test (HUTT),who complained of unexplained dizziness,headache,syncope or other symptoms,were chosen as POTS group. A total of 64 children and adolescents who did the health check in our child health clinic were selected as control group by age and sex in the same period. All the cases in this study came from the syncope specialized clinic or inpatient department of the Second Xiangya Hospital,Central South University,from August 2013 to January 2016. The heart rate and the 12-lead T-wave and ST-segment amplitude of the supine and orthostatic electrocardiogram were measured by software and manual intervention. Results (1) Com-pared with supine electrocardiogram,the heart rate of orthostatic electrocardiogram of POTS group increased [(105. 2 ± 16. 3) times/ min vs. (83. 8 ± 18. 0) times/ min,t = - 7. 598,P < 0. 01],the T-wave amplitude decreased in lead Ⅰ[(0. 28 ± 0. 14) mV vs. (0. 33 ± 0. 11) mV,t = 2. 598,P < 0. 05],Ⅱ[(0. 28 ± 0. 12) mV vs. (0. 39 ± 0. 13) mV,t = 5. 340,P < 0. 01],Ⅲ[(0. 00 ± 0. 19) mV vs. (0. 07 ± 0. 11) mV,t = 3. 041, P < 0. 01],aVF[(0. 14 ± 0. 13) mV vs. (0. 23 ± 0. 11) mV,t = 4. 505,P < 0. 01],V4 [(0. 33 ± 0. 21) mV vs. (0. 51 ± 0. 23) mV,t = 4. 938,P < 0. 01],V5 [(0. 37 ± 0. 10) mV vs. (0. 50 ± 0. 15) mV,t = 7. 764,P <0. 01] and V6 [(0. 25 ± 0. 10) mV vs. (0. 37 ± 0. 10) mV,t = 7. 538,P < 0. 01],the T-wave amplitude in-creased in lead aVR[( - 0. 27 ± 0. 11) mV vs. ( - 0. 36 ± 0. 10) mV,t = - 5. 023,P < 0. 01],and the ST-segment amplitude increased in lead V 5 [(0. 07 ± 0. 04) mV vs. (0. 06 ± 0. 04) mV,t = - 2. 309,P < 0. 05]. (2) Compared with control group,the difference of heart rate of POTS group increased [( - 21. 4 ± 14. 0) times/ min vs. ( - 10. 7 ± 11. 4)times/ min,t = 4. 875,P < 0. 01],and the difference of T-wave amplitude in-creased in lead Ⅰ[(0. 05 ± 0. 10) mV vs. ( - 0. 01 ± 0. 15) mV,t = - 3. 161,P < 0. 01],Ⅱ[(0. 11 ± 0. 12) mV vs. (0. 07 ± 0. 12) mV,t = - 2. 243,P < 0. 05],V4 [(0. 18 ± 0. 18) mV vs. (0. 07 ± 0. 20) mV,t =- 3. 282,P < 0. 01],V5 [(0. 18 ± 0. 11) mV vs. (0. 14 ± 0. 13) mV,t = - 2. 013,P < 0. 05] and V6 [(0. 13 ± 0. 08) mV vs. (0. 08 ± 0. 10) mV,t = - 3. 364,P < 0. 01],and the difference of T-wave amplitude in-creased significant in lead aVR[( - 0. 09 ± 0. 08) mV vs. ( - 0. 03 ± 0. 08) mV,t = 4. 109,P < 0. 01]. (3) Logistic regression analysis:the difference of heart rate and T-wave amplitude in lead V5 and V6 on supine and orthostatic electrocardiogram was statistically valuable for the diagnosis of POTS (P < 0. 05). (4) Diag-nostic test evaluation:when the difference of heart rate ≥15 times/ min,of T-wave amplitude in lead V5 and lead V 6≥ 0. 10 mV separately,on supine and orthostatic electrocardiogram at the same time,the sensitivity of the diagnosis of POTS was 37. 8％ and the specificity was 81. 3％ . (5)The follow-up of children and adoles-cents with POTS showed no significant difference of T-wave amplitude and ST-segment amplitude on ortho-static and supine ECG comparing to the initial diagnosis,regardless of the type of HUTT reaction remained or turned negative (P >0. 05). Conclusion The difference of heart rate and of T-wave amplitude in lead V5 and V6 are valuable for the diagnosis of POTS in children and adolescents.