Clinical Application of Exercise Stress Echocardiography in an Outpatient Pediatric Population.

Background: Exercise stress echocardiography (ESE) is commonly employed in adults, but its applicability in pediatric populations remains to be clarified. Methods: A total of 309 consecutive children (C), with a mean age of 14.1 ± 2.6 years (range 6-17 years), underwent treadmill ESE starting in 2002. They were divided into two groups: Group I comprised 258 children, including 237 with symptoms related to exercise (such as chest pain, fatigue, lipothymia/syncope, or one aborted sudden death), 15 with electrocardiogram (ECG) abnormalities, and 6 with a positive ECG stress test showing ST changes. Group II consisted of 10 asymptomatic children whose parents requested routine screening, 11 with symptoms unrelated to exercise, 12 with a family history of sudden death, and 17 with known pathologies (including 10 with hypertrophic cardiomyopathy, 2 with aortic coarctation, and the remainder with various conditions, such as Cortriatriatum sinister, pulmonary stenosis, subaortic stenosis, bicuspid aortic valve, left ventricular hypertrophy related to arterial hypertension, and aortic switch operation). Regional wall motion abnormalities (RWMAs) and transvalvular or intraventricular (IVG) gradients were assessed using 2D and continuous-wave Doppler, respectively, in all cases. Results: The success rate was 100% (309/309). Stress-induced RWMAs were observed in two children. A significant IVG (>30 mmHg) was detected in 101 out of the 258 children (39%) in Group I, who presented with exercise-related symptoms, ECG abnormalities, or positive stress ECG. In Group I, the odds ratio (OR) of ESE reproducing the symptoms in children with IVG compared to those without IVG was 8.22 (95% CI: 4.84-13.99, p < 0.001). Conclusions: Treadmill ESE is both feasible and safe for pediatric populations. RWMAs demonstrated limited utility in our cohort of children, while IVG induced by exercise was frequently observed in symptomatic children.

Exercise stress echocardiography: Where are we now?

Exercise stress echocardiography (ESE) is a widely used diagnostic test in cardiology departments. ESE is mainly used to study patients with coronary artery disease; however, it has increasingly been used in other clinical scenarios including valve pathology, congenital heart disease, hypertrophic and dilated cardiomyopathies, athlete evaluations, diastolic function evaluation, and pulmonary circulation study. In our laboratories, we use an established methodology in which cardiac function is evaluated while exercising on a treadmill. After completing the exercise regimen, patients remain in a standing position or lie down on the left lateral decubitus, depending on the clinical questions to be answered for further evaluation. This method increases the quality and quantity of information obtained. Here, we present the various methods of exercise stress echocardiography and our experience in many clinical arenas in detail. We also present alternatives to ESE that may be used and their advantages and disadvantages. We review recent advances in ESE and future directions for this established method in the study of cardiac patients and underline the advantage of using a diagnostic tool that is radiation-free.

Children's Understanding of Informed Assents in Research Studies.

The assent procedure reflects an effort to enable the minor to understand, to the degree they are capable of, what their participation in the decision making process would involve. AIMS: To evaluate the minors' ability to understand the information provided to them when obtaining assent and to evaluate the opinion of the parents regarding the importance of asking the child's assent. METHODS: The sample included a total of 52 minors aged between 10 and 17 years who underwent exercise echocardiogram. The Quality of Informed Consent is divided into two parts: Part A was used to measure objective understanding and part B to measure subjective understanding. RESULTS: The results show that the minors have a high capacity to understand the information given to them when asking for assent. A positive relationship was found between the two parts of the questionnaire. No statistically significant relationship was found between age and sex and part A and part B or between both age groups (<14 years old and ≥14 years old) and the measure. In the case of the parents, 96.6% of parents consider assent as an advantage for the child's acceptance of health care. The opinion of the parents is not related to the age, sex or level of schooling. CONCLUSION: Minors showed a substantial level of understanding regarding the information provided to them. The parents considered the implementation of assent fundamental to the child's acceptance of health care.

Perspetiva da famíliasobre as implicações do uso de ventilação mecânica não-invasiva em casa / Family perspective about home non-invasive ventilation implications

Several studies have demonstrated that non-invasive home mechanical ventilation is a therapy that brings benefits to people with type 2 respiratory failure and their family. The objective of this study is to explore the implications of non-invasive home ventilation for the user's family. An exploratory desc riptive study with quantitative qualitative nature in 10 families using noninvasive home ventilation. Mainly, they are nuclear families (8) belonging to the middle class (7). The data were collected through a semi-structured interview, with a data collection instrument that integrated sociodemographic issues and two open questions related to the participants' perspective on the implications of non-invasive home ventilation for the family. They were processed with descriptive statistics and content analysis. From the narratives, three categories emerged: maladjustment, benefits and family process. They are divided into eight subcategories that describe the issues related to the use of non-invasive home ventilation: discomfort, sleep impairment, silence, crisis reduction, role interaction, dynamic relationship, coping and communication. The results demonstrate that non-invasive mechanical ventilation has implications for the users ́ families, can be a stress cause, bring benefits and cause changes in the family process

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A perceção dos enfermeiros face à identificação da necessidade de cuidados de enfermagem nas famílias reconstruídas, com filhos adolescentes / The perception of nurses to identify the need for nursing care in reconstituted families with adolescent children

The Perception of Nurses to Identify the Need for Nursing Care in Reconstituted Families with Adolescent Children.Abstract: Family health nursing aims to promote the empowerment of families in the development of competencies, fostering a healthy living of their processes of change, throughout the life cycle. With respect to these families, dysfunctions can occur due to family coexistence and overlapping of parental roles over the adolescent. In this context the MDAIF arises, aiming to guide the action of nurses, proposing diagnoses and interventions, from the needs identified. The aim was to analyze nurses' perception of the need for nursing care in reconstituted families with adolescent children. Descriptive and exploratory study, of a qualitative nature, whose participants were nurses who perform functions in primary health care. A questionnaire was used, applied in 2018, with an open question in which the participants were asked to describe strategies for identifying nursing care needs in rebuilt families with adolescent children. For data analysis, content analysis was used, and three categories emerged: "Family Assessment", focused essentially on observation, interviewing and data collection; the "Context of the evaluation", predominating the functional unit, within the scope of the nursing consultation; and "Referential", the MDAIF being the theoretical and operative support for clinical decision making. In the identification of nursing care needs, the family assessment stands out as a methodology valued by nurses. These results may contribute to the development of formative processes, within the framework of family assessment, leading to the improvement of the quality of care

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A perceção dos enfermeirosrelativamente ao seu grau de competência para a prestação de cuidados de enfermagem às famílias reconstruídas, com filhos adolescentes, na área de atenção satisfação conjugal / The perception of nurses regarding their degree of competence to provide nursing care to reconstituted families, with adolescent children, in the area of attention 'conjugal satisfaction'

The Perception of Nurses Regarding their Degree of Competence to Provide Nursing Care to Reconstituted Families, with Adolescent Children, in the Area of Attention "Conjugal Satisfaction". Abstract: The family has undergone numerous modifications and adaptations, with the formation of new family identities, which require nurses to identify possible problems. The aim of this study was to analyse nurses' perceptions regarding the degree of competence to provide nursing care to reconstituted families, with adolescent children, in the area of attention marital satisfaction. Descriptive and exploratory study, of a quantitative nature. 25 primary care nurses participated. An online questionnaire was used, Lickert type, where the participants were asked to indicate their perception about the level of competence to provide nursing care in these families, in the domain of conjugal satisfaction. Of the 25 nurses, 15 considered themselves competent to carry out the identification of needs, formulate diagnoses and plan nursing interventions, 8 are between incompetent and poorly qualified; in the implementation of interventions, 14 considered competent and 9 incompe-tent or have little competence; regarding to the evaluation of the interventions, 13 consider themselves competent and 10, incompetent or not competent. Thus, 35% of the sample considered not to have the necessary skills to provide care in the context of marital satisfaction, which indicates the need for greater investment in the development of formative processes in the context of marital satisfaction, leading to the improvement of the quality of care and the development of research to identify health gains arising from nurses' interventions

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Stress-induced intraventricular gradients in symptomatic athletes during upright exercise continuous wave Doppler echocardiography.

The development of significant intraventricular gradients (IVGs) during exercise has been described anecdotally in athletes. However, the prevalence and clinical effect of this observation are unclear. In addition, the most appropriate exercise technique (upright vs semisupine) for eliciting IVGs also remains unknown. The present study had 2 main aims: (1) to identify the prevalence of exercise IVGs in athletes whose preparticipation cardiovascular screening result for sports practice, according to the European Society of Cardiology guidelines, was positive; and (2) to evaluate the influence of performing exercise echocardiography, as described, on the detection of IVGs. We enrolled 139 consecutive athletes (135 amateurs and 4 professionals, mean age 22 ± 9.9 years; 30 women) who underwent treadmill exercise echocardiography. In each athlete, the IVG was evaluated by continuous wave Doppler during 5 conditions: left lateral decubitus at rest; upright at rest; upright at peak treadmill exercise; upright in the recovery phase; and left lateral decubitus in the recovery phase. All patients had normokinetic regional wall motion at rest and during exercise. According to the detection of IVG during treadmill echocardiography (IVG was considered significant if >30 mm Hg at rest or >50 mm Hg during/after exercise), 2 groups were identified: a group (n = 52), with significant IVG and a group (n = 87) without significant IVG. The IVG was greater in the upright position, both at rest (only 2 athletes from group with IVG) and after exercise (52 athletes, all from group with IVG). The IVG was lower in the recovery phase in the left lateral decubitus position (55 ± 15 mm Hg in 30 athletes, all from group with IVG) than in the upright position in the recovery phase (95 ± 35 mm Hg in 52 athletes, all from group with IVG) and at peak exercise (66 ± 24 mm Hg in 41 athletes from group with IVG). We observed systolic anterior movement of the mitral valve in 33 of the 52 athletes in the group with IVG and in none of the athletes in the group without IVG. In conclusion, in athletes, exercise-induced symptoms and/or ischemia-like electrocardiographic signs are often associated with significant IVG, developing in the absence of wall motion abnormalities. IVG was more evident during post-treadmill upright imaging.

Efficacy of beta-blocker therapy in symptomatic athletes with exercise-induced intra-ventricular gradients.

BACKGROUND: Upright exercise stress echocardiography (SE) induces significant intraventricular gradient (IVG) and systolic anterior motion (SAM) in a large proportion of symptomatic athletes, who may therefore benefit from a negative inotropic therapy.The purpose of the present study was to assess the effect of chronic oral ß blocker therapy on the occurrence of exercise-induced IVG and mitral valve SAM, in symptomatic athletes. METHODS: We enrolled 35 symptomatic athletes (age = 23 ± 11 years) with IVG (>30 mmHg) during SE off therapy. All repeated SE on chronic oral beta-blocker therapy (atenolol up to 50 mg, bisoprolol up to 10 mg, or metoprolol up to 100 mg daily according to physician-driven choice). RESULTS: On therapy, there was during SE a reduction in IVG (35 off vs 17 on beta blocker, p < 0.01), decrease of IVG (102 ± 34 mmHg off vs 69 ± 24 mmHg on beta blocker, p < 0.01), peak heart rate (178 ± 15 bpm off vs 157 ± 9 bpm on beta blocker), SAM (24 off vs 9 on beta blocker, p < 0.001), symptoms during SE (17 off vs 2 on beta blocker p < 0.001), ST segment depression (13 off vs 2 on beta blocker, p < 0.001). CONCLUSIONS: In athletes with positive screening on medical evaluation for sports practice and IVG on exertion, treatment with oral beta blockers improved symptoms in the large majority of patients. Symptomatic benefit was mirrored by objective evidence of improvement of echocardiographic signs of obstruction (IVG and SAM) and reduction of ischemia-like electrocardiographic changes.

Impact of colorectal cancer on patient and family: implications for care.

The quality of life of a colorectal cancer patient and his family is deeply modified when faced with this diagnosis as a result of physical and psychological changes induced by it. The aim of this study was to identify and assess the impact of colorectal cancer patients and their families. The study was a descriptive cross-sectional study and the sample consisted of 153 patients and 96 informal caregivers. In terms of quality of life, those patients who had a stoma reported lower overall quality of life, lower body image, poorer health related quality of life and poor social activity when compared with colorectal cancer patients who had no stoma. The stoma patients also had significantly higher depression and anxiety level were related to the caregivers' burden. The caregivers of stoma patients had more depression and anxiety when compared with the caregivers of non-stoma patients. To sum up, it seems unquestionable that the presence of a stoma significantly alters the patients' quality of life, psychological morbidity, sexuality and body image. The stoma patients' caregivers also suffer from high levels of anxiety and depression.