Julio F Fiore

University of Melbourne, Melbourne, Victoria, Australia

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Publications (11)18.22 Total impact

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    ABSTRACT: Short-term recovery after colorectal surgery has been traditionally investigated through length of stay (LOS). However, this measure is influenced by several confounding factors. This study aimed to investigate the construct validity and reliability of assessing the time to achieve standardized discharge criteria (time to readiness for discharge, or TRD) as a measure of short-term recovery. In a secondary analysis, we compared sample size requirements for randomized controlled trials (RCTs) using TRD or LOS as outcome measures. Seventy patients participated in the construct validity study and 21 patients participated in the reliability study. TRD was defined as the number of days to achieve discharge criteria previously defined by consensus. Construct validity was investigated by testing six hypothesis based on the assumption that TRD measures short-term recovery. Reliability was calculated by comparing measures of TRD by two independent assessors. Variability estimates (standard deviations) of LOS and TRD were used for sample size calculations. Five of the six hypotheses were supported by the data (p < 0.05). Interobserver reliability was excellent (ICC2.1 = 0.99). Sample size estimations showed that RCTs using TRD as an outcome measure require approximately 23 % less participants compared to RCTs using LOS. The results of this research support the construct-validity and reliability of TRD as a measure of short-term recovery. Using TRD as an alternative to LOS may reduce sample size requirements in future RCTs.
    World Journal of Surgery 10/2013; · 2.23 Impact Factor
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    ABSTRACT: Background and objective: Field exercise tests have been increasingly used for pulmonary risk assessment. The six-min walking distance (6MWD) is a field test commonly employed in clinical practice; however, there is limited evidence supporting its use as a risk assessment method in abdominal surgery. The aim was to assess if the 6MWD can predict the development of post-operative pulmonary complications (PPCs) in patients having upper abdominal surgery (UAS).Methods: This prospective cohort study included 137 consecutive subjects undergoing elective UAS. Subjects performed the 6MWD on the day prior to surgery, and their performance were compared with predicted values of 6MWD (p6MWD) using a previously validated formula. PPCs (including pneumonia, tracheobronchitis, atelectasis with clinical repercussions, bronchospasm and acute respiratory failure) were assessed daily by a pulmonologist blinded to the 6MWD results. 6MWD and p6MWD were compared between subjects who developed PPC (PPC group) and those who did not (no PPC group) using Student's t-test.Results: Ten subjects experienced PPC (7.2%) and no significant difference was observed between the 6MWD obtained in the PPC group and no PPC group (466.0 ± 97.0 m vs 485.3 ± 107.1 m; P = 0.57, respectively). There was also no significant difference observed between groups for the p6MWD (100.7 ± 29.1% vs 90.6 ± 20.9%; P > 0.05).Conclusions: The results of the present study suggest that the six-min walking test is not a useful tool to identify subjects with increased risk of developing PPC following UAS.
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    ABSTRACT: Field exercise tests have been increasingly used for pulmonary risk assessment. The 6-min walking distance (6MWD) is a field test commonly employed in clinical practice; however, there is limited evidence supporting its use as a risk assessment method in abdominal surgery. The aim was to assess if the 6MWD can predict the development of post-operative pulmonary complications (PPCs) in patients having upper abdominal surgery (UAS). This prospective cohort study included 137 consecutive subjects undergoing elective UAS. Subjects performed the 6MWD on the day prior to surgery, and their performance were compared with predicted values of 6MWD (p6MWD) using a previously validated formula. PPCs (including pneumonia, tracheobronchitis, atelectasis with clinical repercussions, bronchospasm and acute respiratory failure) were assessed daily by a pulmonologist blinded to the 6MWD results. 6MWD and p6MWD were compared between subjects who developed PPC (PPC group) and those who did not (no PPC group) using Student's t-test. Ten subjects experienced PPC (7.2%) and no significant difference was observed between the 6MWD obtained in the PPC group and no PPC group (466.0 ± 97.0 m vs. 485.3 ± 107.1 m; P = 0.57, respectively). There was also no significant difference observed between groups for the p6MWD (100.7 ± 29.1% vs. 90.6 ± 20.9%; P > 0.05). The results of the present study suggest that the 6-min walking test is not a useful tool to identify subjects with increased risk of developing PPC following UAS.
    Respirology 05/2012; 17(6):1013-7. · 2.78 Impact Factor
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    ABSTRACT: Standardized discharge criteria are considered valuable to reduce the risk of premature discharge and avoid unnecessary hospital stays. The most appropriate criteria to indicate readiness for discharge after colorectal surgery are unknown. The aim of this study is to achieve an international consensus on hospital discharge criteria for patients undergoing colorectal surgery. Fifteen experts from different countries participated in a 3-round Delphi process. In round 1, experts determined which criteria best indicate readiness for discharge and described specific end points for each criterion. In rounds 2 and 3, experts rated their agreement with the use of a 5-point Likert scale. Consensus was defined when criteria and end points were rated as agree or strongly agree by at least 75% of the experts in round 3. Experts reached consensus that patients should be considered ready for hospital discharge when there is tolerance of oral intake, recovery of lower gastrointestinal function, adequate pain control with oral analgesia, ability to mobilize and self-care, and no evidence of complications or untreated medical problems. Specific end points were defined for each of the criteria. Experts also agreed that after these criteria are achieved, discharge may take place as soon as the patient has adequate postdischarge support and is willing to leave the hospital. If a stoma was constructed, the patient or the patient's family should have received training on stoma care or had outpatient training arranged. The panel comprised mostly experts from developed countries. This may restrict the applicability of these discharge criteria in countries where there are dissimilar health care resources. This Delphi study has provided substantial consensus on discharge criteria for patients undergoing colorectal surgery. We recommend that these criteria be used in clinical practice to guide decisions regarding patient discharge and applied in future research to increase the comparability of study results.
    Diseases of the Colon & Rectum 04/2012; 55(4):416-23. · 3.34 Impact Factor
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    ABSTRACT: The aim of this study was to identify and synthesize the hospital discharge criteria that have been used in the colorectal surgery literature. A systematic literature search was conducted using eight bibliographic databases. Searches were limited to English language journal articles published between January 1996 and October 2009. Primary research applying hospital discharge criteria following colorectal surgery was included. Study selection was made independently by two reviewers. Discharge criteria were extracted from each included study. The 156 studies identified by the search strategy described 70 different sets of criteria to indicate readiness for discharge. The majority of studies applied a combination of three or four criteria; those most frequently cited were tolerance of oral intake (80%), return of bowel function (70%), adequate pain control (44%) and adequate mobility (35%). End-points employed to determine the achievement of criteria were generally poorly defined. A variety of hospital discharge criteria were applied in the colorectal surgery literature. Development of standardized criteria will allow more accurate comparison of results between studies assessing hospital length of stay or other discharge-related outcome measures.
    Colorectal Disease 10/2010; 14(3):270-81. · 2.08 Impact Factor
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    ABSTRACT: Living donor nephrectomy has been a routine surgical procedure that significantly increased the number of organs for patients with end-stage renal disease. Upper abdominal surgeries, especially when performed with an open approach, usually lead to a postoperative reduction in lung volumes and pulmonary compliance, which may predispose to the development of atelectasis and pulmonary mucus retention, important risk factors for postoperative pulmonary infections. This study sought to compare lung function impairment, pain, and the incidence of postoperative pulmonary complications among live nephrectomy donors undergoing either an open donor nephrectomy through an anterior subcostal incision (SC) or a flank incision (FL). Between 2006 and 2008, 110 subjects (44 SC/66 FL) had their pulmonary functions (spirometry) and pain (visual analog scale) evaluated preoperatively as well as on postoperative days 1, 2, 3, and 5. Postoperative pulmonary complications were evaluated daily by a pulmonary physician. A chest radiograph was obtained on postoperative day 2 to evaluate the presence of atelectasis. Both groups were similar before surgery. Patients in both groups showed decreased pulmonary function from day 1 to 3 (P < .05). Subjective pain was increased until day 5 (P < .05) with a higher incidence of atelectasis among 36% FL vs. 25% SC. (P > .05). Living donor nephrectomy through either a flank incision or an anterior subcostal incision showed similar degrees of postoperative pain, decreased lung function, and pulmonary complications.
    Transplantation Proceedings 06/2010; 42(5):1472-5. · 0.95 Impact Factor
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    ABSTRACT: The use of breathing exercises with positive-pressure devices during hospitalization aims to prevent the development of nosocomial pulmonary complications or to facilitate recovery from pulmonary conditions already present. Although this type of intervention has potential benefits and theoretical advantages over more conventional respiratory physiotherapy techniques, the literature on the effects of breathing exercises with positive-pressure is controversial and inconsistent. To evaluate the extension of the use of breathing exercises with positive-pressure devices by physiotherapists in São Paulo, Brazil. A list of hospitals located in the city of São Paulo was obtained through the Municipal Secretary of Health. Physiotherapists at 43 hospitals were surveyed about their use of exercises with positive-pressure devices in: patients after abdominal, thoracic, and cardiac surgery; patients with chronic obstructive pulmonary disease; patients with pneumonia; and patients with neuromuscular disease. 120 physiotherapists responded to the questionnaire. All the respondents used breathing exercises with positive-pressure devices in their clinical practice, with all types of patients addressed in the questionnaire. The devices most frequently used were continuous positive airway pressure (78%) and intermittent positive-pressure breathing (73%). The most frequently cited indications for positive-pressure breathing exercises were atelectasis and oxygenation impairment. Despite a lack of evidence of benefit from breathing exercises with positive-pressure in the hospital setting, this type of intervention is used extensively in clinical practice for a wide variety of patients and conditions.
    Respiratory care 06/2010; 55(6):719-24. · 2.03 Impact Factor
  • American Thoracic Society 2009 International Conference, May 15-20, 2009 • San Diego, California; 04/2009
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    ABSTRACT: To evaluate the influence of pleural drainage on the distance covered on the six-minute walk test, pain intensity and vital capacity in patients submitted to pulmonary resection. Thirteen consecutive patients from the Thoracic Surgery Infirmary of Hospital São Paulo, Brazil, submitted to closed pleural drainage (0.5-in multiperforated chest tube) in the postoperative period following pulmonary resection (lobectomy, segmentectomy and pulmonary nodule resection) were evaluated. The decision for chest tube removal followed clinical criteria defined by the surgical team, who did not participate in the study. Vital capacity, pain intensity (using a visual analog pain scale) and the distance covered on the six-minute walk test were determined 30 min prior to and 30 min after the removal of the chest tube. The statistical analysis was performed using paired t-tests, and the level of significance was set at 0.05. After the removal of the chest tube, the visual analog scale pain scores were significantly lower (3.46 cm vs. 1.77 cm; p = 0.001) and the distance covered on the six-minute walk test was significantly higher (374.34 m vs. 444.62 m; p = 0.03). Vital capacity prior to and after chest tube removal was not significantly affected (2.15 L and 2.25 L, respectively; p = 0.540). The results of the present study suggest that the presence of a chest tube is a factor significantly associated with postoperative pain and functional limitation in patients submitted to pulmonary resection.
    Jornal brasileiro de pneumologia: publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia 01/2009; 34(12):1003-7.
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    ABSTRACT: Directed cough maneuvers are often included in physiotherapy management aimed at preventing postoperative pulmonary complications after open heart surgery, but there is little scientific evidence of the effectiveness of directed cough maneuvers. We conducted a randomized intra-subject crossover trial to evaluate the effect of thoracic support (patient holds his or her hands over the incision) and maximal inspiration on cough peak expiratory flow (CPEF), cough expiratory volume (CEV), and incision pain during cough in the early period after open heart surgery. Cough evaluation was undertaken on the first and second morning after surgery. On both measurement days the subject did a baseline cough (baseline cough 1) then, in a random sequence, performed 3 cough conditions: an additional baseline cough (baseline cough 2), supported cough, and supported cough preceded by maximal inspiration. In these test conditions a P < .008 was deemed to indicate a statistically significant difference. Twenty-one subjects participated. Thoracic support alone did not significantly affect CPEF or CEV (Bonferroni adjusted P > .008). With a maximal inspiration and thoracic support, CPEF and CPEV were significantly higher than in all other cough conditions (Bonferroni adjusted P < .008). Pain during cough was not influenced by the different cough conditions (P > .05). There was no significant difference in the cough variables or pain during the different cough conditions on the first day versus the second measurement day. Maximal inspiration increased CPEF and CEV, but the method of thoracic support we used did not reduce pain during cough or influence the cough values we measured.
    Respiratory care 08/2008; 53(8):1027-34. · 2.03 Impact Factor
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Publication Stats

25 Citations
18.22 Total Impact Points

Institutions

  • 2010–2013
    • University of Melbourne
      • Department of Physiotherapy
      Melbourne, Victoria, Australia
    • Victoria University Melbourne
      Melbourne, Victoria, Australia
  • 2008–2012
    • Universidade Federal de São Paulo
      San Paulo, São Paulo, Brazil
  • 2009
    • Universidade Cidade de São Paulo
      San Paulo, São Paulo, Brazil