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    Are the Chicago 3.0 manometric diagnostics consistent with Chicago 4.0?
    (2023)
    Angélica Tobón
    ;
    Albis C Hani
    ;
    Cristiam D Pulgarin
    ;
    Andres F Ardila
    ;
    Oscar M Muñoz
    <jats:title>Summary</jats:title> <jats:p>There is little information on the degree of concordance between the results obtained using the Chicago 3.0 (CCv3.0) and Chicago 4.0 (CCv4.0) protocols to interpret high-resolution manometry (HRM) seeking to determine the value provided by the new swallowing maneuvers included in the last protocol. This is a study of diagnostic tests, evaluating concordance by consistency between the results obtained by the CCv3.0 and CCv4.0 protocols, in patients undergoing HRM. Concordance was assessed with the kappa test. Bland–Altman scatter plots, and Lin’s correlation-concordance coefficient (CCC) were used to assess the agreement between IRP measured with swallows in the supine and seated position or with solid swallows. One hundred thirty-two patients were included (65% women, age 53 ± 17 years). The most frequent HRM indication was dysphagia (46.1%). Type I was the most common type of gastroesophageal junction. The most frequent CCv4.0 diagnoses were normal esophageal motility (68.9%), achalasia (15.5%), and ineffective esophageal motility (IEM; 5.3%). The agreement between the results was substantial (Kappa 0.77 ± 0.05), with a total agreement of 87.9%. Diagnostic reclassification occurred in 12.1%, from IEM in CCv3.0 to normal esophageal motility in CCv4.0. Similarly, there was a high level of agreement between the IRP measured in the supine compared to the seated position (CCC0.92) and with solid swallows (CCC0.96). In conclusion, the CCv4.0 protocol presents a high concordance compared to CCv3.0. In the majority of manometric diagnoses there is no reclassification of patients with provocation tests. However, the more restrictive criteria of CCv4.0 achieve a better reclassification of patients with IEM.</jats:p>
      10Scopus© Citations 1
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    Impacto de los trastornos motores del habla y deglución sobre lacalidad de vida de personas con enfermedad de Parkinson: una revisión sistemática de la literatura
    (2023)
    SEPULVEDA CONTARDO, MIGUEL FRANCISCO
    ;
    Gay-San Martín, Joaquín Emilio
    ;
    Vásquez-Peña, Diego Nicolás
    ;
    Obreque-Faundez, Pilar Valeria
    ;
    Roa-Bustos, Karen Camila
    Scopus© Citations 2  4
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      1  1Scopus© Citations 5
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      1Scopus© Citations 5  3
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    Impact of Evidence‐Based Stroke Care on Patient Outcomes: A Multilevel Analysis of an International Study
    (2019)
    MUÑOZ VENTURELLI, PAULA ANDREA  
    ;
    Xian Li
    ;
    Sandy Middleton
    ;
    Caroline Watkins
    ;
    LAVADOS GERMAIN, PABLO MANUEL  
    <jats:sec xml:lang="en"> <jats:title>Background</jats:title> <jats:p xml:lang="en"> The uptake of proven stroke treatments varies widely. We aimed to determine the association of evidence‐based processes of care for acute ischemic stroke ( <jats:styled-content style="fixed-case">AIS</jats:styled-content> ) and clinical outcome of patients who participated in the HEADPOST (Head Positioning in Acute Stroke Trial), a multicenter cluster crossover trial of lying flat versus sitting up, head positioning in acute stroke. </jats:p> </jats:sec> <jats:sec xml:lang="en"> <jats:title>Methods and Results</jats:title> <jats:p xml:lang="en"> Use of 8 <jats:styled-content style="fixed-case">AIS</jats:styled-content> processes of care were considered: reperfusion therapy in eligible patients; acute stroke unit care; antihypertensive, antiplatelet, statin, and anticoagulation for atrial fibrillation; dysphagia assessment; and physiotherapist review. Hierarchical, mixed, logistic regression models were performed to determine associations with good outcome (modified Rankin Scale scores 0–2) at 90 days, adjusted for patient and hospital variables. Among 9485 patients with AIS, implementation of all processes of care in eligible patients, or “defect‐free” care, was associated with improved outcome (odds ratio, 1.40; 95% CI, 1.18–1.65) and better survival (odds ratio, 2.23; 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> , 1.62–3.09). Defect‐free stroke care was also significantly associated with excellent outcome (modified Rankin Scale score 0–1) (odds ratio, 1.22; 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> , 1.04–1.43). No hospital characteristic was independently predictive of outcome. Only 1445 (15%) of eligible patients with AIS received all processes of care, with significant regional variations in overall and individual rates. </jats:p> </jats:sec> <jats:sec xml:lang="en"> <jats:title>Conclusions</jats:title> <jats:p xml:lang="en"> Use of evidence‐based care is associated with improved clinical outcome in <jats:styled-content style="fixed-case">AIS</jats:styled-content> . Strategies are required to address regional variation in the use of proven <jats:styled-content style="fixed-case">AIS</jats:styled-content> treatments. </jats:p> </jats:sec> <jats:sec xml:lang="en"> <jats:title>Clinical Trial Registration</jats:title> <jats:p xml:lang="en"> <jats:styled-content style="fixed-case">URL</jats:styled-content> : <jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="https://www.clinicaltrials.gov">https://www.clinicaltrials.gov</jats:ext-link> . Unique Identifier: <jats:styled-content style="fixed-case">NCT</jats:styled-content> 02162017. </jats:p> </jats:sec>
      1  8Scopus© Citations 21
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    Scopus© Citations 5  2  1
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      8  1Scopus© Citations 48
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      1Scopus© Citations 33  6
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    Globus Pallidus Internus (GPi) Deep Brain Stimulation for Parkinson’s Disease: Expert Review and Commentary
    (2020)
    Ka Loong Kelvin Au
    ;
    Joshua K. Wong
    ;
    Takashi Tsuboi
    ;
    Robert S. Eisinger
    ;
    Kathryn Moore
      1Scopus© Citations 62
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    Calidad de vida posterior a gastrectomia total laparoscópica versus abierta en cáncer gástrico
    (2022)
    NAVARRETE CABELLO, JORGE ANDRES  
    ;
    Kristel Werner
    ;
    Claudia Meza M
    ;
    Roberto Humeres A
    <jats:p>Introducción: En los últimos años la gastrectomía laparoscópica ha aparecido como una técnica quirúrgica con resultados oncológicos comparables a la técnica abierta, pero existe poca evidencia en cuanto a la calidad de vida postoperatoria de estos pacientes. Objetivo: Evaluar la calidad de vida postoperatoria de pacientes sometidos a gastrectomía total laparoscópica (GTL) en comparación a gastrectomia total abierta (GTA) en cáncer gástrico. Materiales y Método: Estudio retrospectivo, observacional en Hospital Militar de Santiago, entre enero de 2015 y junio de 2020. Se les aplicó 2 encuestas validadas para Chile: EORTC QLQ-30 y EORTC QLQ-OG25. Resultados: Se obtuvieron  60 pacientes; 30 sometidos a GTL y 30 a GTA. Promedio edad fue 66,3 +/-11 años para GTL y 68,2 +/-11 años en GTA (p=0,5). Se obtuvo un score en GTL versus GTA: global 83,3 y 80,2 (p=0,6), sintomático 17,1 y 25,5 (p=0,2) y score funcional 87,9 y 70,9 (p= 0,03). Posterior a eso obtuvimos en funcionalidad GTL versus GTA;  física 92,2 versus GTA 73,1 (p=0,04), emocional 84,1 versus 78,5 (p=0,6), cognitiva 84,9 versus 79,0 (p=0,3) y social 80,9 versus 72,2 (p=0,4). Al analizar síntomas destaco; fatiga 14,6 versus 33,1 (p= 0,04) y dolor 13,4 versus 24,3 (p= 0,05). Finalmente en síntomas digestivos altos obtuvimos en disfagia 0,84 GTL versus 17,3 GTA (p=0,04). Conclusión: La GTL logra resultados comparables a GTA en calidad de vida e incluso ofrece ventajas significativas en funcionalidad física como también en síntomas como dolor, fatiga y disfagia.  </jats:p>
      18Scopus© Citations 1