JOAQUIM EDSON VIEIRA
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Cirurgia, Faculdade de Medicina - Docente
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/08 - Laboratório de Anestesiologia, Hospital das Clínicas, Faculdade de Medicina
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/08 - Laboratório de Anestesiologia, Hospital das Clínicas, Faculdade de Medicina
8 resultados
Resultados de Busca
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- Assessment of a digital game as a neuropsychological test for postoperative cognitive dysfunction(2022) LUCATELLI, André; GOULART, Ananaira Alves; SILVEIRA, Paulo Sergio Panse; SIQUEIRA, José de Oliveira; CARMONA, Maria José Carvalho; PEREIRA, Valéria Fontenelle Angelim; VALENTIN, Livia Stocco Sanches; VIEIRA, Joaquim EdsonAbstract Objective: Postoperative cognitive dysfunction may result from worsening in a condition of previous impairment. It causes greater difficulty in recovery, longer hospital stays, and consequent delay in returning to work activities. Digital games have a potential neuromodulatory and rehabilitation effect. In this study, a digital game was used as a neuropsychological test to assess postoperative cognitive dysfunction, with preoperative patient performance as control. Methods: It was a non-controlled study, with patients selected among candidates for elective non-cardiac surgery, evaluated in the preand postoperative periods. The digital game used has six phases developed to evaluate selective attention, alternating attention, visuoperception, inhibitory control, short-term memory, and long-term memory. The digital game takes about 25 minutes. Scores are the sum of correct answers in each cognitive domain. Statistical analysis compared these cognitive functions preand post-surgery using a generalized linear mixed model (ANCOVA). Results: Sixty patients were evaluated, 40% male and 60% female, with a mean age of 52.7 ± 13.5 years. Except for visuoperception, a reduction in post-surgery scores was found in all phases of the digital game. Conclusion: The digital game was able to detect decline in several cognitive functions postoperatively. As its completion is faster than in conventional tests on paper, this digital game may be a potentially recommended tool for assessing patients, especially the elderly and in the early postoperative period.
- Comparison of digital games as a cognitive function assessment tool for current standardized neuropsychological tests(2022) GOULART, Ananaira Alves; LUCATELLI, André; SILVEIRA, Paulo Sergio Panse; SIQUEIRA, José de Oliveira; PEREIRA, Valéria Fontanelle Angelim; CARMONA, Maria José Carvalho; VALENTIN, Livia Stocco Sanches; VIEIRA, Joaquim EdsonAbstract Objective: Cognitive dysfunction may occur postoperatively. Fast and efficient assessment of Postoperative Cognitive Dysfunction (POCD) can minimize loss of quality of life, and therefore, a study comparing a digital game with standard neuropsychological tests to assess executive, mnemonic, and attention functions to evaluate POCD seems to be relevant both for research and clinical practice. Methods: A battery of standardized tests and a digital game (MentalPlus®) were administered to 60 patients at the Central Institute of Hospital das Clínicas in São Paulo (36 women and 24 men), with ages between 29 and 82 years, preand post-surgery performed under anesthesia. Correlation and linear regression model were used to compare the scores obtained from the standardized tests to the scores of the six executive and cognitive functions evaluated by the game (shortand long-term memory, selective and alternating attention, inhibitory control, and visual perception). Results: After correlation analysis, a statistically significant result was found mainly for the correlation between the scores from the phase of the digital game assessing the visuoperception function and the scores from the A and B cards of the Stroop Test (p < 0.001, r = 0.99 and r = 0.64, respectively), and the scores from TMTA (p = 0.0046, r = 0.51). We also found a moderate correlation between the phase of the game assessing short-memory function and VVLT (p < 0.001, r = 0.41). No statistically significant correlations were found for the other functions assessed. Conclusion: The digital game provided scores in agreement with standardized tests for evaluating visual perception and possibly short-term memory cognitive functions. Further studies are necessary to verify the correlation of other phases of the digital game with standardized tests assessing cognitive functions.
- Latex sensitization in patients with myelomeningocele undergoing urological procedures: prevalence and associated factors(2016) SOARES, Iracy Silvia Correa; GALVAO, Clovis Eduardo Santos; CARMONA, Maria Jose Carvalho; VANE, Matheus Facchini; VIEIRA, Joaquim Edson
- Intraoperative pulmonary hyperdistention estimated by transthoracic lung ultrasound: A pilot study(2020) TONELOTTO, Bruno; PEREIRA, Sergio Martins; TUCCI, Mauro Roberto; VAZ, Diogo Florenzano; VIEIRA, Joaquim Edson; MALBOUISSON, Luiz Marcelo; GAY, Frederick; SIMOES, Claudia Marquez; CARMONA, Maria Jose Carvalho; MONSEL, Antoine; AMATO, Marcelo Brito; ROUBY, Jean-Jacques; JR, Jose Otavio Costa AulerIntroduction: Transthoracic lung ultrasound can assess atelectasis reversal and is considered as unable to detect associated hyperdistention. In this study, we describe an ultrasound pattern highly suggestive of pulmonary hyperdistention. Methods: Eighteen patients with normal lungs undergoing lower abdominal surgery were studied. Electrical impedance tomography was calibrated, followed by anaesthetic induction, intubation and mechanical ventilation. To reverse posterior atelectasis, a recruitment manoeuvre was performed. Positive-end expiratory pressure (PEEP) titration was then obtained during a descending trial - 20, 18, 16, 14, 12, 10, 8, 6 and 4 cmH(2)O. Ultrasound and electrical impedance tomography data were collected at each PEEP level and interpreted by two independent observers. Spearman correlation test and receiving operating characteristic curve were used to compare lung ultrasound and electrical impedance tomography data. Results: The number of horizontal A lines increased linearly with PEEP: from 3 (0, 5) at PEEP 4 cmH(2)O to 10 (8, 13) at PEEP 20 cmH(2)O. The increase number of A lines was associated with a parallel and significant decrease in intercostal space thickness (p = 0.001). The lung ultrasound threshold for detecting pulmonary hyperdistention was defined as the number of A lines counted at the PEEP preceding the PEEP providing the best respiratory compliance. Six A lines was the median threshold for detecting pulmonary hyperdistention. The area under the receiving operating characteristic curve was 0.947. Conclusions: Intraoperative transthoracic lung ultrasound can detect lung hyperdistention during a PEEP descending trial. Six or more A lines detected in normally aerated regions can be considered as indicating lung hyperdistention.
- Factor structure and psychometric properties of the Dispositional Resilience Scale among Brazilian adult patients(2016) SOLANO, Joao Paulo Consentino; BRACHER, Eduardo Sawaya Botelho; FAISAL-CURY, Alexandre; ASHMAWI, Hazem Adel; CARMONA, Maria Jose Carvalho; NETO, Francisco Lotufo; VIEIRA, Joaquim EdsonObjective: Verifying the psychometrics of a Brazilian version of the Dispositional Resilience Scale (DRS-15). Methods: Cross-cultural adaptation was done interviewing 65 adult patients. Validation was evaluated by application of the Lipp Brazilian Stress Symptoms Inventory (ISSL), Self-Report Questionnaire (SRQ), and other measuresto 575 participants from the psychiatric ambulatories (for borderline personality, anxiety or post-traumatic stress disorders) and non-psychiatric ambulatories (chronic pain, pre-anesthetic consultation and companions for the latter). Temporal stability was verified with 123 participants. Results: Exploratory factor analysis yielded a three-factor solution. Psychometrics were acceptable (alpha coefficient, 0.71; intraclass correlation coefficient, 0.81). Correlations with the ISSL, SRQ and other measures were noted except for factor 3. In the psychiatric sample, hardiness scores of borderline patients were lower than those of patients with anxiety disorders. Conclusion: This version of the DRS-15 exhibited good reliability in a sample of Brazilian patients; validity was confirmed in two of the scale factors.
- Factor structure and psychometric properties of the Connor-Davidson resilience scale among Brazilian adult patients(2016) SOLANO, Joao Paulo Consentino; BRACHER, Eduardo Sawaya Botelho; FAISAL-CURY, Alexandre; ASHMAWI, Hazem Adel; CARMONA, Maria Jose Carvalho; LOTUFO NETO, Francisco; VIEIRA, Joaquim EdsonCONTEXT AND OBJECTIVE: Personal resilience is associated with several mental health outcomes. The Connor-Davidson resilience scale (CD-RISC) is a widely used self-report measurement of resilience. This study aimed to investigate the reliability and validity of a Brazilian Portuguese version of the CD-RISC. DESIGN AND SETTING: Cross-sectional validation study carried out in the outpatient clinics of a public university hospital. METHODS: The cross-cultural adaptation followed established guidelines and involved interviews with 65 adults in psychiatric and non-psychiatric outpatient clinics at a teaching hospital. Validation was assessed through concurrent application of the Lipp Brazilian Stress Symptom Inventory (ISSL), Self-Report Questionnaire (SRQ), Sheehan Disability Scales (SDS) and Chronic Pain Grade (CPG) to 575 patients at the same setting. Temporal stability was verified through a second application to 123 participants. RESULTS: Factor analysis identified four factors, named tenacity, adaptability-tolerance, reliance on support from outside and intuition. The alpha coefficient of 0.93 and intraclass correlation coefficient of 0.84 indicated good internal consistency and temporal stability. Significant correlations between this version of the CD-RISC and the ISSL, SRQ, SDS and CPG were noted. The patients at the outpatient clinic for borderline personality had resilience scores that were significantly lower than those of the patients at the general anxiety or post-traumatic stress outpatient clinics. CONCLUSION: This Brazilian Portuguese version of the Connor-Davidson resilience scale exhibited adequate reliability and validity among a sample of Brazilian adult patients.
- Plasmatic catecholamines after neuraxial labour analgesia: A randomised controlled trial comparing epidural versus combined spinal-epidural(2022) SANTOS, Shirley Andrade; FERNANDES, Hermann Dos Santos; NANI, Fernando Souza; BARTILOTTI, Andreza Gonzaga; FRANCISCO, Rossana Pulcineli Vieira; CARMONA, Maria Jose Carvalho; BLIACHERIENE, Fernando; VIEIRA, Joaquim EdsonBackground: Combined spinal-epidural technique (CSE) for labour analgesia has been associated with fetal bradycardia and uterine hypertonia when compared with epidural analgesia (EA), possibly due to a decrease in epinephrine levels following neuraxial anaesthesia. However, there are no recent studies comparing plasmatic catecholamines levels between those two techniques. This study aimed to compare CSE versus EA regarding pre- and post-analgesia catecholamines levels, uterine tone and fetal heart rate.Patients and methods: Randomised clinical trial with 47 labouring patients divided in two groups (CSE and EA). Primary outcome was plasmatic catecholamine measurements before and after neuraxial block. Secondary outcomes were fetal heart rate changes, uterine hypertonia, hypotension episodes, pain relief and fetal outcomes. Results: For CSE group, the median decrease of plasmatic epinephrine was 0 pg/mL [(-) 480-(+) 41] and for norepinephrine was -21 pg/mL [(-) 2507-(+) 94]. For EA group, the median decrease for epinephrine was 0 pg/mL [(-) 326-(+) 15] and for norepinephrine was -5 pg/mL [(-) 190-(+76)]. There were no differences between groups (p = 0.96 and p = 0.63 for epinephrine and norepinephrine, respectively). There were no differences for secondary outcomes.Conclusions: There was no evidence of a more significant decrease of catecholamines with CSE when compared with EA. Catecholamines decrease theory may not be valid for modern labour analgesia techniques. ⠃C 2022 Socie acute accent te acute accent franc , aise d'anesthe acute accent sie et de re acute accent animation (Sfar).
- Predictors of major complications after elective abdominal surgery in cancer patients(2018) SIMOES, Claudia M.; CARMONA, Maria J. C.; HAJJAR, Ludhmila A.; VINCENT, Jean-Louis; LANDONI, Giovanni; BELLETTI, Alessandro; VIEIRA, Joaquim E.; ALMEIDA, Juliano P. de; ALMEIDA, Elisangela P. de; RIBEIRO JR., Ulysses; KAULING, Ana L.; TUTYIA, Celso; TAMAOKI, Lie; FUKUSHIMA, Julia T.; AULER JR., Jose O. C.Background: Patients undergoing abdominal surgery for solid tumours frequently develop major postoperative complications, which negatively affect quality of life, costs of care and survival. Few studies have identified the determinants of perioperative complications in this group. Methods: We performed a prospective observational study including all patients (age > 18) undergoing abdominal surgery for cancer at a single institution between June 2011 and August 2013. Patients undergoing emergency surgery, palliative procedures, or participating in other studies were excluded. Primary outcome was a composite of 30-day all-cause mortality and infectious, cardiovascular, respiratory, neurologic, renal and surgical complications. Univariate and multiple logistic regression analyses were performed to identify predictive factors for major perioperative adverse events. Results: Of a total 308 included patients, 106 (34.4%) developed a major complication during the 30-day follow-up period. Independent predictors of postoperative major complications were: age (odds ratio [OR] 1.03 [95% CI 1.01-1.06], p = 0.012 per year), ASA (American Society of Anesthesiologists) physical status greater than or equal to 3 (OR 2.61 [95% CI 1.33-5.17], p = 0.003), a preoperative haemoglobin level lower than 12 g/dL (OR 2.13 [95% CI 1.21-4.07], p = 0.014), intraoperative use of colloids (OR 1.89, [95% CI 1.03-4.07], p = 0.047), total amount of intravenous fluids (OR 1.22 [95% CI 0.98-1.59], p = 0.106 per litre), intraoperative blood losses greater than 500 mL (2.07 [95% CI 1.00-4.31], p = 0.043), and hypotension needing vasopressor support (OR 4.68 [95% CI 1.55-27.72], p = 0.004). The model had good discrimination with the area under the ROC curve being 0.80 (95% CI 0.75-0.84, p < 0.001). Conclusions: Our findings suggest that a perioperative strategy aimed at reducing perioperative complications in cancer surgery should include treatment of preoperative anaemia and an optimal fluid strategy, avoiding fluid overload and intraoperative use of colloids.