The SPIKES protocol does not influence the tolerance or effectiveness of intra-articular corticosteroid injection in the knees of osteoarthritis patients: A prospective, controlled, randomized single-blinded trial.

BACKGROUND: Patient user embracement involves behaviours of including and listening to the patient, appreciating their complaints, and identifying their needs, whether individual or collective. The aim of this study was to evaluate the influence of a user embracement protocol (SPIKES protocol) for patients with knee osteoarthritis (OA) immediately before intra-articular injection (IAI) relative to procedure tolerance and its effectiveness in the immediate, short and medium terms. METHODS: This was a randomized controlled trial. Patients received IAIs with triamcinolone hexacetonide (40 mg) preceded or not by the SPIKES protocol. The outcomes measured were: visual analogue scale for pain at rest, pain on movement and joint swelling; morning stiffness; Western Ontario McMaster Universities Index Functional Questionnaire (WOMAC); pain catastrophizing scale; McGill pain questionnaire; SF-36 questionnaire on quality of life; Trace State Anxiety Inventory (IDATE); and a Timed Up and Go functional test. RESULTS: One hundred patients were randomized in the user embracement group (n = 50) or the control group (n = 50); 89% were women and 60% white, mean age was 67.1 (±7.3) years, and mean disease time was 6.3 (±6.2) years. No statistically significant differences were found between the groups for any variables at pre-procedure time, nor did the groups differ in their tolerance to the procedure or during the 12 weeks of follow up for any evaluated variables. CONCLUSIONS: No benefit was identified by applying a user embracement protocol to patients with knee OA prior to IAI with corticosteroid, neither to tolerance at the time of the procedure nor to its effectiveness in the immediate, short, and medium terms.

The SPIKES protocol does not influence the tolerance or effectiveness of intra-articular corticosteroid injection in the knees of osteoarthritis patients: A prospective, controlled, randomized single-blinded trial

BACKGROUND: Patient user embracement involves behaviours of including and listening to the patient, appreciating their complaints, and identifying their needs, whether individual or collective. The aim of this study was to evaluate the influence of a user embracement protocol (SPIKES protocol) for patients with knee osteoarthritis (OA) immediately before intra-articular injection (IAI) relative to procedure tolerance and its effectiveness in the immediate, short and medium terms. METHODS: This was a randomized controlled trial. Patients received IAIs with triamcinolone hexacetonide (40 mg) preceded or not by the SPIKES protocol. The outcomes measured were: visual analogue scale for pain at rest, pain on movement and joint swelling; morning stiffness; Western Ontario McMaster Universities Index Functional Questionnaire (WOMAC); pain catastrophizing scale; McGill pain questionnaire; SF-36 questionnaire on quality of life; Trace State Anxiety Inventory (IDATE); and a Timed Up and Go functional test. RESULTS: One hundred patients were randomized in the user embracement group (n = 50) or the control group (n = 50); 89% were women and 60% white, mean age was 67.1 (±7.3) years, and mean disease time was 6.3 (±6.2) years. No statistically significant differences were found between the groups for any variables at pre-procedure time, nor did the groups differ in their tolerance to the procedure or during the 12 weeks of follow up for any evaluated variables. CONCLUSIONS: No benefit was identified by applying a user embracement protocol to patients with knee OA prior to IAI with corticosteroid, neither to tolerance at the time of the procedure nor to its effectiveness in the immediate, short, and medium terms.

Análise da qualidade das córneas doadas e do intervalo entre óbito, enucleação e preservação após a implantação de novas normas técnicas e sanitárias em Banco de Olhos Universitário / Comparative analysis of the donor cornea quality and of the interval between death and preservation before and after new sanitary and technique rules in a University Eye Bank

OBJETIVO: Comparar o intervalo entre o óbito e a enucleação (ΔT-O-E), entre a enucleação e a preservação (ΔT-E-P) e a qualidade da córnea antes e após a implantação de novas normas técnicas e sanitárias baseadas na Resolução RDC 347. MÉTODOS: Estudo retrospectivo em que foram avaliados os prontuários dos doadores de córnea do Banco de Tecidos Oculares da Santa Casa de São Paulo, 2 anos antes e 2 anos depois da implementação de novas normas sanitárias. RESULTADOS: Foi observado aumento do número absoluto de 205 para 374 doadores após as mudanças adotadas. Não foi observada diferença estatisticamente significante no Δt-O-E e ΔT-E-P antes e após as mudanças implantadas. Do total de 1.105 córneas doadas, foi observado 388 córneas doadas antes das mudanças e 717 córneas doadas após as mudanças implementadas. Foi observado aumento estatisticamente significante da graduação da qualidade da córnea doada de 1,76 ± 0,90 para 1,94 ± 0,88 após a implementação das novas normas da Resolução. CONCLUSÃO: Após as mudanças técnicas e sanitárias exigidas pela Resolução 347, houve grande aumento no número de córneas doadas, captadas e preservadas. O Banco de Tecidos Oculares não diminuiu os ΔT O-E e ΔT E-P. A qualidade da córnea apresentou-se inferior após as mudanças realizadas no setor.

PURPOSE: To compare the interval between death and enucleation (ΔT-O-E), between enucleation and preservation (ΔT-E-P) and the quality of the cornea before and after the implantation of new technique and sanitary rules. METHODS: A retrospective study that evaluated the records of cornea donors in Sao Paulo's Santa Casa Eye Tissue Bank 2 years before and 2 years after the implementation new sanitary rules. RESULTS: An increase was observed in the absolute number of 205 to 374 donors following the adopted changes. There was no statistically significant difference in Δt-O-E and ΔT-E-P before and after the implemented changes. Of the total of 1,105 donor corneas, 388 donor corneas were observed before the changes and 717 donor corneas after the implemented changes. We observed a statistically significant increase in grading of donor cornea quality from 1.76 ± 0.90 to 1.94 ± 0.88 after the implementation of new standards of resolution. CONCLUSION: After the changes required by Resolution 347, there was a large increase in the number of donated, taken and preserved corneas. The BTO has not diminished the ΔT O-E and ΔT E-P. Cornea quality presented itself lower after the new rules.

[Comparative analysis of the donor cornea quality and of the interval between death and preservation before and after new sanitary and technique rules in a University Eye Bank]. / Análise da qualidade das córneas doadas e do intervalo entre óbito, enucleação e preservação após a implantação de novas normas técnicas e sanitárias em Banco de Olhos Universitário.

PURPOSE: To compare the interval between death and enucleation (ΔT-O-E), between enucleation and preservation (ΔT-E-P) and the quality of the cornea before and after the implantation of new technique and sanitary rules. METHODS: A retrospective study that evaluated the records of cornea donors in Sao Paulo's Santa Casa Eye Tissue Bank 2 years before and 2 years after the implementation new sanitary rules. RESULTS: An increase was observed in the absolute number of 205 to 374 donors following the adopted changes. There was no statistically significant difference in Δt-O-E and ΔT-E-P before and after the implemented changes. Of the total of 1,105 donor corneas, 388 donor corneas were observed before the changes and 717 donor corneas after the implemented changes. We observed a statistically significant increase in grading of donor cornea quality from 1.76 ± 0.90 to 1.94 ± 0.88 after the implementation of new standards of resolution. CONCLUSION: After the changes required by Resolution 347, there was a large increase in the number of donated, taken and preserved corneas. The BTO has not diminished the ΔT O-E and ΔT E-P. Cornea quality presented itself lower after the new rules.

Análise crítica dos 10 anos de regulamentação da lei de transplante nº 9434 / Critical review of the 10 years since the regulation of transplant law No 9034

Desde a antiguidade, o interesse do homem pelo seu corpo e pelo dos outros pode ser comprovado através de escritos filosóficos, teológicos, médicos e de enfermagem, que documentam os cuidados, as experiências e as curiosidades do homem em relação aos tecidos do corpo humano, segmento corporal ou órgão em particular, nos diversos períodos históricos. O transplante (TX) é um procedimento cirúrgico que consiste na substituição de um órgão ou de um tecido doente (receptor) por outro saudável de outra pessoa viva ou morta (doador). O presente objetivo é avaliar a legislação vigente relativa aos transplantes de órgãos, tecidos e partes do corpo (lei 9434/97), juntamente com outras Resoluções e Protocolos, analisando suas aplicabilidades e suas controvérsias. Este trabalho foi desenvolvido através de revisão bibliográfica, em que foram considerados materiais existentes e pertinentes ao tema em estudo. A lei 9434, relativa aos transplantes de órgãos, tecidos e partes do corpo, foi utilizada como base para análise. Da mesma forma a definição de morte encefálica e implicações de seu contexto foram empregadas para discussão respeitando-se a Resolução do CfM 1480/97 - Resultados e Discussão da lei de Transplante: a) Apesar da exigência da lei, nem sempre é possível a realização de todos os testes de triagem por dificuldades que o sistema apresenta e muitas vezes por falta de recursos financeiros e equipamentos devidos; b) O Brasil opera em sistema altruístico e voluntário, no qual os pacientes ou suas fammas podem escolher entre doar ou não os órgãos após a morte. E muito importante que a pessoa que deseja doar seus órgãos após sua morte comunique à sua famma. Existe grande diferença entre as pessoas que são favoráveis à doação e o percentual daqueles que realmente a consentem; c) Sobre o paciente incapaz como potencial doador, acreditamos que se a autorização puder ser decidida apenas por quem tiver a guarda legal, isso facilitaria em muito os meios para doação...