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Resumen Objetivo: Explorar las dimensiones latentes presentes en los 20 ítems del constructo empatía, medido en docentes de una facultad de Odontología. Metodología: Docentes de odontología, pertenecientes a la Facultad de Odontología de la Universidad Andrés Bello, sede Santiago, constituida por 145 profesores de ambos sexos, en los cuales participaron el 88,27%. El instrumento aplicado es la Escala de Empatía de Jefferson para Profesionales de la Salud. La conformación del modelo de medida de la empatía se realizó mediante el análisis factorial exploratorio. El nivel de significación empleado fue de α<0,005. Resultados: Los resultados generales indican que los niveles de empatía son adecuados. Es posible establecer un modelo de tres factores. Dentro de la dimensión Cuidado Compasivo, perteneciente a la Empatía Emocional, se encuentra un ítem (14), el cual presentó una carga factorial significativa con Toma de Perspectiva con el paciente que pertenece a la Empatía Cognitiva. Conclusiones: Se establece un modelo tridimensional de la empatía en docentes de pregrado con el paciente. Los ítems de cada una de las dimensiones se correlacionaron entre sí, en concordancia con el modelo original de la empatía. Estos hallazgos deben ser corroborados por un análisis factorial confirmatorio.
Abstract Objective: To explore the latent dimensions, present in the 20 items of the empathy construct, measured in teachers of a dental school. Methodology: Dental teachers belonging to the Faculty of Dentistry of the Andrés Bello University, Santiago, consisting of 145 teachers of both sexes, in which 88.27% participated. The instrument applied was the Jefferson Empathy Scale for Health Professionals. Compliance with the model and the measurement of empathy levels was verified by means of exploratory factor analysis. The empathy measurement model was built using exploratory factor analysis. The level of significance used was α<0.005. Results: The overall results indicate that empathy levels are adequate. A three-factor model can be established. Within the Compassionate Care dimension, belonging to Emotional Empathy there is one item (14), which presented a significant correlation with Perspective Taking with the patient belonging to Cognitive Empathy. Conclusions: A three-dimensional model of empathy in undergraduate teachers with the patient is established. The items of each of the dimensions correlated with each other in agreement with the original model of empathy. These findings should be corroborated by a confirmatory factor analysis.
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Resumen Objetivo: caracterizar sociodemográficamente pacientes que padecen trastornos del estado de ánimo en Institución Prestadora de Servicios (IPS) de salud mental en Montería, departamento de Córdoba - Colombia, correlacionando este diagnóstico con variables de interés. Materiales y métodos: estudio descriptivo, retrospectivo-longitudinal, que correlacionó variables sociodemográficas con trastornos del estado de ánimo en 729 pacientes hospitalizados en una IPS, procedentes de municipios del departamento de Córdoba, en el período 2012- 2021-I. Resultados: hombres con edad promedio de 23 años presentaron mayor frecuencia de trastornos del estado de ánimo n=689 que mujeres n= 40; en su mayoría procedentes de municipios como Montería, Puerto Libertador, Valencia, Tierralta y Canalete; siendo Montería el municipio con mayor población y menor prevalencia; factores como lugar de procedencia, falta de apoyo familiar y estrés fueron quienes incidieron en recaídas, registrándose disminución en hospitalización de estos pacientes durante la pandemia COVID-19. Conclusión: existe correlación entre variables sociodemográficas como lugar de procedencia del departamento de Córdoba, falta de apoyo familiar y estrés como determinantes para la ocurrencia del diagnóstico de trastornos del estado de ánimo, en pacientes que proceden de municipios caracterizados por niveles de violencia alto y medio, baja cobertura educativa y pobreza multifuncional en población vulnerable.
ABSTRACT Objective : To sociodemographically characterize patients with Mood Disorders in a Mental Health Institution in Montería, Córdoba - Colombia, and correlate this diagnosis with variables of interest. Materials and Methods: This descriptive, retrospective-longitudinal study correlated sociodemographic variables with Mood Disorders in 729 hospitalized patients in an Institution of Mental Health, originating from municipalities in the department of Córdoba, during the period 2012-2021. Results: Men with an average age of 23 years presented a higher frequency of Mood Disorders (n=689) compared to women (n=40). The majority of patients originated from municipalities such as Montería, Puerto Libertador, Valencia, Tierralta, and Canalete. Montería, being the municipality with the largest population, showed a lower prevalence. Factors such as place of origin, lack of family support, and stress influenced relapses, with a decrease in hospitalizations of these patients during the COVID-19 pandemic. Conclusion: There is a correlation between sociodemographic variables such as the place of origin in the department of Córdoba, lack of family support, and stress as determinants for the occurrence of Mood Disorders diagnosis in patients from municipalities characterized by high and medium levels of violence, low educational coverage, and multifunctional poverty in vulnerable populations.
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Invasive infections caused by non-albicans Candida are increasing worldwide. However, there is still a lack of information on invasive candidiasis (IC) in the pediatric setting, including susceptibility profiles and clonal studies. We investigated the clinical, epidemiologic, and laboratory characteristics of IC, possible changes in antifungal susceptibility profiles over time, and the occurrence of clonality in our tertiary children's hospital. We analyzed 123 non-duplicate Candida isolates from sterile sites of pediatric patients in a tertiary hospital in southern Brazil, between 2016 and 2021. Data on demographics, comorbidities, and clinical outcomes were collected. Candida species distribution, antifungal susceptibility profiles, biofilm production, and molecular epidemiology of isolates were assessed using reference methods. The range of IC incidence was 0.88-1.55 cases/1000 hospitalized patients/year, and the IC-related mortality rate was 20.3%. Of the total IC cases, 42.3% were in patients aged < 13 months. Mechanical ventilation, parenteral nutrition, and intensive care unit (ICU) admission were common in this group. In addition, ICU admission was identified as a risk factor for IC-related mortality. The main site of Candida spp. isolation was blood, and non-albicans Candida species were predominant (70.8%). No significant clonal spread was observed among isolates of the three most commonly isolated species, and 99.1% of all isolates were biofilm producers. Non-albicans Candida species were predominant in this study. Notably, clonal expansion and emergence of antifungal drug resistance were not observed in our pediatric setting.
The epidemiology of invasive candidiasis has changed over time and there is still a lack of information in the pediatric setting. Non-albicans Candida species predominated in this study, clonal expansion and emergence of antifungal drug resistance were not observed in our pediatric setting.
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Antifúngicos , Candida , Candidíase Invasiva , Testes de Sensibilidade Microbiana , Centros de Atenção Terciária , Humanos , Centros de Atenção Terciária/estatística & dados numéricos , Antifúngicos/farmacologia , Antifúngicos/uso terapêutico , Candidíase Invasiva/microbiologia , Candidíase Invasiva/mortalidade , Candidíase Invasiva/epidemiologia , Lactente , Masculino , Feminino , Brasil/epidemiologia , Pré-Escolar , Candida/efeitos dos fármacos , Candida/isolamento & purificação , Candida/classificação , Criança , Hospitais Pediátricos/estatística & dados numéricos , Biofilmes/crescimento & desenvolvimento , Biofilmes/efeitos dos fármacos , Incidência , Farmacorresistência Fúngica , Adolescente , Recém-Nascido , Fatores de Risco , Estudos RetrospectivosRESUMO
PURPOSE: To determine the incidence of VTE and clinical outcomes in a cohort of cancer patients and COVID-19 infection, and to establish possible predictive factors of VTE. METHODS/PATIENTS: A single-center retrospective cohort study was performed to determine the incidence of VTE and mortality in 118 cancer patients with SARS-CoV-2 infection from March to August 2020. We calculated individual Khorana Risk and CATS-MICA scores in order to evaluate their utility to identify risk of VTE or death. Continuous variables were compared using Wilcoxon or Student's T test, and categorical variables were compared using the Chi-Square or Fisher's exact text among patients with and without VTE. A Log-Rank test was performed to detect mortality differences between the groups. RESULTS: A total of 118 patients were included. VTE global incidence was 4.2% (n = 5), and mortality 25.4% (n = 30). Obesity (p = 0.05), recent chemotherapy (p = 0.049) and use of steroids (p = 0.006) were related to higher risk of VTE in the univariate analysis, although they were not confirmed in the multivariate analysis as independent risk factors. Statistically significant differences in all-cause, COVID-19-related and cancer-related mortality according to the Khorana risk score (KRS) were observed. CATS-MICA score (CMS) also showed statistically significant differences in mortality between low- and high-risk patients. Prediction of risk of VTE development with these scores showed a tendency towards significance. CONCLUSIONS: In this cohort, VTE incidence was similar to previously reported in the general population with SARS-CoV-2 infection. KRS was associated with overall and specific-cause mortality, and might be a useful prognostic tool in this setting.
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OBJECTIVE: The aim of this study is to assess the efficacy of the doctor-nurse-patient workshop transitional care model on post-operative care for patients with laryngeal cancer and its influence on quality of life. METHODS: A total of 68 patients with laryngeal cancer who underwent surgical treatment at the hospital between 2021 and 2022 were included in the study. The patients were divided into two groups, a control group and a research group, each consisting of 34 patients, based on the chronological sequence of their surgeries. Patients in the control group received standard nursing care, while those in the research group received the doctor-nurse-patient workshop transitional care model in addition to standard nursing care. After 2 months of care, levels of albumin (ALB), total protein (TP), hemoglobin (Hb), and quality of life scores (measured using the Quality of Life Instrument for Head and Neck Cancer, QLICP-HN) were compared between the two groups. Additionally, the incidence of adverse events during the recovery period was assessed and compared between the two groups. RESULTS: Following 2 months of care, patients in the research group exhibited elevated ALB, TP, and Hb levels compared to those in the control group. Additionally, the average QLICP-HN scores were higher in the research group, while the incidence of adverse events was lower compared to the control group. CONCLUSION: Implementing the doctor-nurse-patient workshop transitional care model in home care for patients with laryngeal cancer can enhance their nutritional status post-surgery and improve their quality of life during home rehabilitation. This, in turn, leads to a reduction in the incidence of adverse events and complications during the recovery period.
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Introducción: Las características y complejidad de la diabetes mellitus tipo 2 motivan la necesidad de un abordaje multi e interdisciplinario. El estudio persigue caracterizar las representaciones sociales de la diabetes mellitus tipo 2 que posee un grupo de pacientes adultos, residentes en Área Metropolitana de Buenos Aires, Argentina Método: Estudio cuantitativo, descriptivo, corte transversal. Se aplicó cuestionario sociodemográfico elaborado ad hoc y técnica de palabras asociadas. Participaron 90 pacientes adultos, reclutados principalmente del servicio de diabetológica del Hospital de Clínicas "José de San Martin" dependiente de la Universidad de Buenos Aires. Resultados: El núcleo de la representación social estuvo integrado por palabras referidas al impacto y malestar emocional que causa esta patología; la identidad de la enfermedad y la necesidad de cuidado de la salud. La periferia contuvo los siguientes temas, de mayor a menor importancia: obesidad, complicaciones de la diabetes, plan alimentario, tratamiento médico y medicación. En menor medida, se mencionaron elementos como actividad física y sedentarismo. De manera tangencial, surgieron los elementos de desinformación y sexualidad. Discusión: La representación social de la diabetes mellitus tipo 2 en pacientes se caracteriza por reflejar, en su núcleo, el temor, impacto y malestar que causa esta enfermedad. La reproducción del discurso médico mediante los temas referidos a factores de riesgo, complicaciones y tratamiento, conforman el sistema periférico de la representación. Elementos importantes tales como actividad física, sedentarismo, desinformación y sexualidad, son poco mencionados. Se destaca la importancia de la salud mental, como una problemática central a abordar en este tipo de patologías. También se sugiere implementación de educación terapéutica.
Introduction: Characteristics and complexity of type 2 diabetes generates the need for a multi and interdisciplinary approach. The aim of the study is to characterize social representations of type 2 diabetes in a group of adult patients, living in the Metropolitan Area of Buenos Aires, Argentina. Method: Descriptive and cross-sectional design. An ad-hoc sociodemographic questionnaire and the associated words technique were applied. 90 adult patients participated, recruited mainly from a diabetes service of a public hospital. Results: The core of the social representation was made up of words referring to the impact and emotional discomfort caused by this pathology, the identity of the disease and the need for health care. The periphery contained the following topics, from most to least important: obesity, diabetes complications, eating plan, medical treatment, and medication. Elements such as physical activity and sedentary lifestyle were mentioned to a lesser extent. Also, misinformation and sexuality were mentioned tangentially. Discussion: Social representation of type 2 diabetes in patients is characterized by reflecting at its core, the fear, impact and discomfort that this disease causes. The reproduction of medical discourse, through topics related to risk factors, complications and treatment, make up the peripheral system of representation. Important elements such as physical activity, sedentary lifestyle, misinformation and sexuality are rarely mentioned. The importance of mental health is highlighted as a central problem to be addressed in this type of pathology. Also, it's suggested the implementation of therapeutic education.
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OBJECTIVE: This study was to investigate the role of serum Klotho, fetuin-A, and Matrix Gla Protein (MGP) in Coronary Artery Calcification (CAC) in patients with Maintenance Hemodialysis (MHD) and their predictive value for CAC. METHODS: 100 patients receiving MHD were selected. Serum Klotho, fetuin-A, and MGP levels were detected by ELISA. CAC scores were assessed by coronary CT scan. Multifactor analysis was used to evaluate the risk factors affecting CAC. The ability of serum Klotho, fetuin-A, and MGP levels to diagnose CAC was evaluated by receiver operating characteristic curves. RESULTS: Serum Klotho, fetuin-A, and MGP were independent risk factors for CAC. Serum Klotho, fetuin-A, and MGP were valuable in the diagnosis of CAC in MHD patients. CONCLUSION: There is a close relationship between Klotho, fetuin-A, and MGP levels in MHD patients and CAC.
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Biomarcadores , Proteínas de Ligação ao Cálcio , Doença da Artéria Coronariana , Proteínas da Matriz Extracelular , Glucuronidase , Proteínas Klotho , Proteína de Matriz Gla , Diálise Renal , Calcificação Vascular , alfa-2-Glicoproteína-HS , Humanos , Diálise Renal/efeitos adversos , Masculino , Feminino , Proteínas de Ligação ao Cálcio/sangue , Pessoa de Meia-Idade , alfa-2-Glicoproteína-HS/análise , alfa-2-Glicoproteína-HS/metabolismo , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/diagnóstico por imagem , Glucuronidase/sangue , Proteínas da Matriz Extracelular/sangue , Biomarcadores/sangue , Calcificação Vascular/sangue , Calcificação Vascular/diagnóstico por imagem , Idoso , Fatores de Risco , Ensaio de Imunoadsorção Enzimática , Adulto , Curva ROC , Calcinose/sangue , Calcinose/diagnóstico por imagem , Calcinose/etiologia , Valor Preditivo dos TestesRESUMO
Introduction Gastric cancer is a significant major global health concern, particularly prevalent in Asia. In recent years, a large number of new cases have been diagnosed worldwide, leading to a substantial number of deaths. The disease tends to present more aggressively in these cases, leading to debates about the prognosis and survival outcomes. Nonetheless, research has shown that survival rates improve significantly when the tumor is completely surgically resected. Materials and methods This retrospective study included patients between 16 and 45 years old, diagnosed with gastric cancer, with the support of the pathology department, who underwent surgery in the upper GI service, in the period from January 2006 to December 2012. Data collected encompassed variables such as gender, age, tumor size, type of surgery, overall survival, disease-free period, type and histological degree of the tumor, clinical stage of the cancer, and R0 resection (curative resection). All patients with a confirmed diagnosis of gastric cancer were included and treated with surgery and D1 limited dissection or extended D2 dissection. Patients who have received chemotherapy prior to surgical treatment and those who have been surgically treated outside the XXI Century National Medical Center were excluded. Results A total of 104 patients were included; the predominant histological type was diffuse adenocarcinoma accounting for 79.8% and 81.7% of the cases were histological grade 3. The most common clinical stage was IIIA in 41.3% of the cases. In 53.8% of the cases, we obtained an R0 resection. D2 lymphadenectomy was performed in 53.8% of the cases, with an overall survival rate of 82.69%. Significant prognostic factors for survival included T4 depth with an increase in risk for mortality (OR: 25.93; 95% CI: 6.41-53.54; p=0.001), lymph node status (OR: 14.76; 95% CI: 4.6-46.83; p<0.001), and size greater than 5 cm (OR: 1.8; 95% CI: 0.61-6.35; p<0.001). Conclusions Gastric cancer is more common in adults aged above 60 years old, but the incidence in young adults under 45 years old has been increasing. Although young gastric cancer patients present with more aggressive tumor behavior, these patients can have similar or even better overall survival compared to older patients, being 35% in some cases, especially in the resectable setting. Further research is still needed to fully characterize the unique biology and optimal management of gastric cancer in young adults.
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BACKGROUND AND AIMS: Correctly characterizing malnutrition is a challenge. Transthyretin (TTR) rapidly responds to adequate protein intake/infusion, which could be used as a marker to identify malnutrition. Nutritional therapy is used to prevent malnutrition. Parenteral nutrition (PN) requires daily monitoring to determine whether what is being offered is adequate. This article aims to investigate whether the practice of measuring TTR is justified. METHODS: Data from patients admitted to the ward or intensive care unit (ICU) were collected at three different times: within the first 72 h (T1) of PN use, on the 7th day (T2), and the 14th day (T3) after the initial assessment. RESULTS: 302 patients were included; the average age was 48.3 years old; the prevalence of death was 22.2%, and 61.6% of the sample were male. TTR values and the effectiveness of nutritional support in these patients were not associated with the outcome; however, meeting caloric needs was related to the outcome (p = 0.047). No association was found when TTR values were compared to the nutritional status. Thus, TTR was not a good indicator of nutritional risk or nutritional status in hospitalized patients. CONCLUSIONS: Undoubtedly, the TTR measurement was inversely proportional to CRP measurements. It was possible to conclude in this follow-up cohort of hospitalized patients that TTR values were not useful for determining whether the patient was malnourished, predicting death or effectiveness of nutritional support, yet based upon our analyses, a decrease in TTR greater than 0.024 units for every 1 unit increase in CRP might be due to ineffective nutritional supply.
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Estado Terminal , Desnutrição , Estado Nutricional , Nutrição Parenteral , Pré-Albumina , Humanos , Masculino , Pré-Albumina/metabolismo , Pré-Albumina/análise , Pessoa de Meia-Idade , Feminino , Estado Terminal/terapia , Estudos Prospectivos , Adulto , Desnutrição/diagnóstico , Biomarcadores/sangue , Idoso , Unidades de Terapia Intensiva , Avaliação Nutricional , Proteína C-Reativa/análise , Proteína C-Reativa/metabolismoRESUMO
BACKGROUND: Complementary and alternative (CAM) cancer treatment is often expensive and not covered by insurance. As a result, many people turn to crowdfunding to access this treatment. OBJECTIVE: The aim of this study is to identify the rationales of patients with cancer seeking CAM treatment abroad by looking specifically at crowdfunding campaigns to support CAM cancer treatment in Tijuana, Mexico. METHODS: We scraped the GoFundMe.com and GiveSendGo.com crowdfunding platforms for campaigns referencing CAM cancer clinics in Tijuana, initiated between January 1, 2022, and February 28, 2023. The authors created a coding framework to identify rationales for seeking CAM treatment in Tijuana. To supplement campaign metadata, we coded the beneficiary's cancer stage, type, age, specific treatment sought, whether the beneficiary died, gender, and race. RESULTS: Patients sought CAM cancer treatment in Tijuana because the (1) treatment offers the greatest efficacy (29.9%); (2) treatment offered domestically was not curative (23.2%); (3) the clinic treats the whole person, and addresses the spiritual dimension of the person (20.1%); (4) treatments are nontoxic, natural, or less invasive (18.2%); and (5) clinic offers the newest technology (8.5%). Campaigns raised US $5,275,268.37 and most campaign beneficiaries were women (69.7%) or White individuals (71.1%). CONCLUSIONS: These campaigns spread problematic misinformation about the likely efficacy of CAM treatments, funnel money and endorsements to CAM clinics in Tijuana, and leave many campaigners short of the money needed to pay for CAM treatments while costing beneficiaries and their loved one's time, privacy, and dignity. This study affirms that Tijuana, Mexico, is a very popular destination for CAM cancer treatment.
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BACKGROUND: Tackling client absenteeism in primary and secondary care settings is crucial to ensure the continuity of care for individuals, families and communities, as well as preventing waste of resources within healthcare systems. METHODOLOGY: This article is an integrative review to identify advancements in health technologies that address client absenteeism in primary and secondary care. The databases Medical Literature and Retrieval System Online (MEDLINE/PubMed®), Scientific Electronic Library Online and Virtual Health Library were consulted. The inclusion criteria were as follows: full papers, published between 2013 and 2023, in English, Portuguese or Spanish. The descriptors used were the following: patients, mobile applications, health services management, absenteeism and primary care, and secondary care. Eleven articles published from 2014 to 2021 were included. RESULTS: Most articles were identified in the MEDLINE/PUBMED database, employed a randomized controlled trial methodology (36.36%), and were published between 2019 and 2021 (90.0%) in English (63.7%). The applications had managerial, assistive and/or educational purposes. In addition to absenteeism control, these applications strived to promote client engagement with health services, increase health literacy and tackle structural barriers to care, such as language barriers. CONCLUSION: Efforts are needed to ensure that providers receive training to educate clients on the applications. Moreover, community-based participatory studies to ensure the feasibility of applications are warranted.
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Ovarian cancer (OC) is the leading cause of death in women with gynecological cancers. Its diagnosis is more likely in advanced ages, with the older population being the most seen in consultations. Poly(ADP-ribose) inhibitors (PARPi) have changed OC clinical practice and evolution, showing great benefit. However, there is a lack of evidence of PARPi in elderly population that can impact the therapeutic decision and the safety/efficacy. It is necessary to avoid age as limiting factor in PARPis prescription. We conducted a review of the most relevant randomized phase III trials of maintenance PARPi after first-line treatment of advanced OC. We observed the lack of a single criterion for considering older patients, varying among trials. There is a benefit of PARPis in different populations. However, PARPi effect on quality of life is not reported, something of great relevance considering their vulnerability. Measures are needed to benefit older patients to better adapt PARPi treatment.
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BACKGROUND: Acid-base imbalance has been poorly described in patients with coronavirus disease 2019 (COVID-19). Study by the quantitative acid-base approach may be able to account for minor changes in ion distribution that may have been overlooked using traditional acid-base analysis techniques. In a cohort of critically ill COVID-19 patients, we looked for an association between metabolic acidosis surrogates and worse clinical outcomes, such as mortality, renal dialysis, and length of hospital stay. AIM: To describe the acid-base disorders of critically ill COVID-19 patients using Stewart's approach, associating its variables with poor outcomes. METHODS: This study pertained to a retrospective cohort comprised of adult patients who experienced an intensive care unit stay exceeding 4 days and who were diagnosed with severe acute respiratory syndrome coronavirus 2 infection through a positive polymerase chain reaction analysis of a nasal swab and typical pulmonary involvement observed in chest computed tomography scan. Laboratory and clinical data were obtained from electronic records. Categorical variables were compared using Fisher's exact test. Continuous data were presented as median and interquartile range. The Mann-Whitney U test was used for comparisons. RESULTS: In total, 211 patients were analyzed. The mortality rate was 13.7%. Overall, 149 patients (70.6%) presented with alkalosis, 28 patients (13.3%) had acidosis, and the remaining 34 patients (16.2%) had a normal arterial pondus hydrogenii. Of those presenting with acidosis, most had a low apparent strong ion difference (SID) (20 patients, 9.5%). Within the group with alkalosis, 128 patients (61.0%) had respiratory origin. The non-survivors were older, had more comorbidities, and had higher Charlson's and simplified acute physiology score 3. We did not find severe acid-base imbalance in this population. The analyzed Stewart's variables (effective SID, apparent SID, and strong ion gap and the effect of albumin, lactate, phosphorus, and chloride) were not different between the groups. CONCLUSION: Alkalemia is prevalent in COVID-19 patients. Although we did not find an association between acid-base variables and mortality, the use of Stewart's methodology may provide insights into this severe disease.
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Objective: This article presents a literature review to explore and analyze the current situation of pressure ulcers or lesions or decubitus ulcers, pathophysiological, epidemiological aspects, and risk factors. The progress in evidence of the effectiveness of preventive repositioning in the appearance of these lesions in vulnerable hospitalized patients is also evaluated. Methods: Databases were reviewed in non-systematic manner, including the Cochrane Wounds Specialized Register; Medline, Scopus, PubMed, the Cochrane Central Register of Controlled Trials; MEDLINE (Ovid); EMBASE (Ovid), Web of Science, SciELO, and Lilacs. The general search terms included [pressure ulcers or pressure lesions or decubitus ulcers] and [prevention or preventive] and [repositioning or positioning or position changes or postural change] and [patient at risk or vulnerable] and [hospitalized or ICU or intensive care]. Systematic literature reviews, randomized clinical trials, observational studies, cost-effectiveness and qualitative studies in English or Spanish were included. Results: Although globally, the incidence, prevalence, and years of disability associated to these lesions has diminished between 1990 and 2019, the high impact on health persists. Evidence found on the effectiveness of repositioning in preventing pressure ulcers and health associated costs has been evaluated with certainty between low and very low, as a result of conducting research with serious methodological limitations that report results with high inaccuracy. Conclusion: The findings reported present that these lesions persist at hospital level and continue being a global social and health problem with high impact on health budgets. Likewise, there is a need to develop greater quality research on prevention strategies, such as repositioning, which validate their effectiveness, and justify their use.
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Hospitalização , Posicionamento do Paciente , Úlcera por Pressão , Úlcera por Pressão/prevenção & controle , Úlcera por Pressão/epidemiologia , Humanos , Hospitalização/estatística & dados numéricos , Posicionamento do Paciente/métodos , Fatores de Risco , Prevalência , Incidência , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
PURPOSE: Currently, there is no consensus regarding whether super-elderly (aged > 80 years) patients are suitable candidates for laparoscopic surgery. This study aimed to analyse the short-term outcomes and oncological prognosis of laparoscopic gastrectomy in super-elderly patients with gastric cancer (GC). METHODS: Following PRISMA and AMSTAR-2 guidelines, we searched the Web of Science, Embase, Cochrane Library, and Pubmed databases from inception until May 2024 and performed a meta-analysis. All published studies exploring the surgical outcomes and oncological prognosis of laparoscopic versus open gastrectomy in super-elderly patients with GC were reviewed. Statistical analyses were performed using RevMan 5.3. RESULTS: A total of 1,085 studies were retrieved, eight of which were included in the meta-analysis, comprising 807 patients > 80 years of age with GC. The meta-analysis showed that compared with open gastrectomy, patients with GC > 80 years old who underwent laparoscopic gastrectomy had a longer operative time (weighted mean difference [WMD] = 30.48, p < 0.001), less intraoperative blood loss (WMD = -166.96, P < 0.001), shorter postoperative exhaust time (WMD =-0.83, p < 0.001), shorter length of stay (WMD = -0.78, p < 0.001), fewer overall complications (Odds ratio [OR] = 0.54, p = 0.003), higher 5-year overall survival rate (OR = 1.66, p = 0.03) and disease-specific survival rate (OR = 3.23, p < 0.001). Furthermore, laparoscopic gastrectomy did not significantly affect the number of lymph node dissections, the rate of D2 radical gastrectomy, major postoperative complications, or postoperative pneumonia. CONCLUSIONS: Compared to open gastrectomy, patients with GC aged > 80 years who underwent laparoscopic gastrectomy may have better short-term outcomes. Age should not be a contraindication for minimally invasive surgery.
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BACKGROUND: The COVID-19 pandemic led to a global reduction in health care accessibility for both infected and noninfected patients, posing a particular burden on those with chronic conditions, including mental health issues. Peru experienced significant devastation from the pandemic, resulting in a collapsed health care system and leading to the world's highest per capita mortality rate as a result of COVID-19. Understanding the trends in health care utilization, particularly in mental health care, is crucial for informing pandemic response efforts and guiding future recovery strategies. OBJECTIVE: This study aims to analyze the trends of outpatient medical and psychiatric consultations during the COVID-19 pandemic in a national hospital in Peru. METHODS: This observational study was conducted at a national hospital in Lima, Peru. We analyzed data on user care across all services, including psychiatric services, from May 2019 to December 2022. The data were calculated for users served per month, including the number of users seen monthly in mental health services. Sociodemographic variables such as sex (female or male), age (≥0 years), type of medical appointment (regular or additional), and modality of care (in-person or teleconsultations) were taken into account. An interrupted time series regression model was conducted to assess the number of outpatient medical and psychiatric consultations. Subgroup analyses were performed based on service modality, including overall consultations, telemonitoring/teleconsultations only, or face-to-face only, for all service users and for mental health service users. RESULTS: A total of 1,515,439 participants were included, with females comprising 275,444/484,994 (56.80%) of the samples. Only 345,605/1,515,439 (22.81%) visits involved telemedicine. The total monthly outpatient visits were significantly reduced compared with the expected projection (P<.001) at the beginning of the pandemic, followed by a later monthly increment of 298.7 users. Face-to-face interventions experienced a significant reduction at the beginning of the pandemic (P<.001), gradually recovering in the following months. By contrast, telemedicine use initially increased but subsequently declined toward the end of the pandemic. A similar trend was observed in mental health units. CONCLUSIONS: During the pandemic years, health care utilization in both general and psychiatric services experienced a significant decrease, particularly at the beginning of the pandemic (March 2020). However, no significant trends were observed in either case throughout the pandemic period. Telemedicine consultations witnessed a significant increase overall during this period, particularly among mental health users.
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COVID-19 , Serviços de Saúde Mental , Consulta Remota , Humanos , COVID-19/epidemiologia , Peru/epidemiologia , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Serviços de Saúde Mental/estatística & dados numéricos , Adolescente , Adulto Jovem , Consulta Remota/estatística & dados numéricos , Criança , Idoso , Telemedicina/estatística & dados numéricos , Pré-Escolar , Pandemias , Lactente , Acessibilidade aos Serviços de Saúde/estatística & dados numéricosRESUMO
This study evaluated the barriers that interfere with access to diagnosis and treatment of tuberculosis (TB) from the perspective of the patient and health professionals globally. Using the PICo acronym, the question we asked was "What are the barriers that interfere with access to tuberculosis diagnosis and treatment (I) from the perspective of patients and/or health professionals (P) across countries globally (Co)?". We searched the following databases: EMBASE, Scopus, MEDLINE, Latin American and Caribbean Literature in Health Sciences (LILACS), and Web of Science. On Rayyan, duplicates were removed and extraction was done afterward by two authors independently, followed by a tiebreaker. Using a Critical Appraisal Tool proposed by the Joanna Briggs Institute, the methodological quality of the article was assessed. From 36 published articles, the barriers to tuberculosis diagnosis as obtained from our study include information scarcity/low TB knowledge, exorbitant cost of transport, sample collection challenges, long distance to health facility, gender limitations, lack of decentralized diagnostic services, payment for diagnosis and testing, medication side effects, multiple visits during therapy, delayed diagnosis, poor human resources, low knowledge of medical practitioners, concerns regarding the efficacy of treatment, poor facility coordination, poor socioeconomic factors, fear and stigmatization of TB, and wrong initial diagnosis. The review of studies on TB diagnosis and treatment barriers evidences the diverse barriers to the eradication of tuberculosis. Eliminating these barriers is an onus that lies on policy makers, citizens, and health workers alike, with the joint aim of reducing the global TB burden.
Assuntos
Acessibilidade aos Serviços de Saúde , Tuberculose , Humanos , Tuberculose/diagnóstico , Tuberculose/tratamento farmacológico , Saúde Global , Pessoal de SaúdeRESUMO
BACKGROUND: The present study aims to assess the interrater reliability of the Global Leadership Initiative on Malnutrition (GLIM) criteria, a framework to provide a consensus diagnosis of malnutrition. We also aimed to investigate its concurrent and predictive validity in the context of patients with cancer admitted to the intensive care unit (ICU). METHODS: Individuals aged ≥19 years with cancer who were admitted to the ICU within 48 h of their initial hospital admission were included. Nutrition status was assessed with the Nutritional Risk Screening 2002, the Subjective Global Assessment (SGA), and the GLIM criteria. Interrater reliability was assessed by the kappa test (>0.80). The SGA served as the established benchmark for assessing concurrent validity. To evaluate predictive validity, the occurrence of mortality within 30 days was the outcome, and Cox regression models were applied. RESULTS: A total of 212 patients were included: 66.9% were at nutrition risk, and 45.8% were malnourished according to the SGA. According to the GLIM criteria, 68.4% and 66% were identified as malnourished by evaluators 1 and 2, respectively (κ = 0.947; P < 0.001). The GLIM combination incorporating weight loss and the presence of inflammation exhibited sensitivity (82.4%) and specificity (92%). In the multivariate Cox regression models, most GLIM combinations emerged as independent predictors of complications. CONCLUSION: The GLIM criteria demonstrated satisfactory interrater reliability, and the combination involving weight loss and the presence of inflammation exhibited noteworthy sensitivity and specificity. Most GLIM combinations emerged as independent predictors of 30-day mortality.
Assuntos
Estado Terminal , Unidades de Terapia Intensiva , Desnutrição , Neoplasias , Avaliação Nutricional , Estado Nutricional , Humanos , Desnutrição/diagnóstico , Masculino , Estudos Prospectivos , Feminino , Neoplasias/mortalidade , Neoplasias/complicações , Pessoa de Meia-Idade , Idoso , Reprodutibilidade dos Testes , Modelos de Riscos Proporcionais , Redução de Peso , AdultoRESUMO
Chemotherapy-induced peripheral neuropathy (CIPN) and associated pain are prevalent adverse effects of pediatric cancer treatment, significantly affecting the patient's quality of life. Their impact and risk factors have yet to be assessed in our country. This study aimed to assess the prevalence and clinical characteristics of CIPN, as well as to explore associations with patient- and treatment-related variables, within a cohort of Argentinean pediatric oncology patients. Sixty-six patients diagnosed with malignant hematopoietic tumors and receiving the neurotoxic agent vincristine were included in this observational study. Variables analyzed included age, gender, anthropometric measurements, tumor type, chemotherapy treatment, development of pain and other symptoms, severity, and analgesic treatment. The study population consisted of 39 boys and 27 girls. Most patients received two or three neurotoxic drugs. Symptoms consistent with CIPN were identified in 15 children, reflecting a prevalence of 23%. The main symptom was pain in the lower limbs, with some patients reporting jaw or generalized body pain. Pain was categorized as moderate or severe in 60% and 27% of cases, respectively. NSAIDs, anticonvulsants, and/or opioids were prescribed. Among the patient- and treatment-related variables analyzed as potential risk factors, the use of vincristine in conjunction with cytarabine and the administration of a higher number of neurotoxic drugs demonstrated significant association with the development of CIPN. CONCLUSIONS: Combination therapy stands out as a risk factor for clinical CIPN. The high prevalence of moderate/severe pain underscores the importance of close vigilance given its potential to compromise the patient's overall well-being. WHAT IS KNOWN: ⢠Chemotherapy-induced peripheral neuropathy (CIPN) is a frequent adverse effect and dose-limiting factor in pediatric cancer treatment. ⢠Prevalence varies among regions and risk factors are still under study. WHAT IS NEW: ⢠Prevalence of symptomatic CIPN is 23% among pediatric patients undergoing treatment for hematopoietic tumors in a referral hospital in Argentina. Most patients report moderate or severe pain. ⢠Combining vincristine with cytarabine and using a higher number of neurotoxic drugs in combination therapies exhibit significant association with the development of CIPN-related symptoms.
Assuntos
Doenças do Sistema Nervoso Periférico , Vincristina , Humanos , Masculino , Feminino , Criança , Adolescente , Pré-Escolar , Doenças do Sistema Nervoso Periférico/induzido quimicamente , Doenças do Sistema Nervoso Periférico/epidemiologia , Vincristina/efeitos adversos , Argentina/epidemiologia , Fatores de Risco , Prevalência , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Dor/tratamento farmacológico , Dor/epidemiologia , Dor/etiologia , Lactente , Qualidade de Vida , Medição da DorRESUMO
Resumo Introdução: As ações desenvolvidas na Atenção Primária à Saúde são um dos pontos fortes de combate à tuberculose. Nesse nível de atenção, o contato contínuo do enfermeiro por meio da consulta de enfermagem permite manter relação com a população adoecida. Diante da relação enfermeiro-pessoa cuidada para o estabelecimento do vínculo e adesão ao tratamento contra tuberculose, compreende-se a importância do referencial teórico de Imogene King para estruturar a interação enfermeiro-pessoa cuidada e oferecer uma dinâmica para esse processo. Objetivo: Analisar a relação enfermeiro-pessoa afetada pela tuberculose fundamentada na Teoria do Alcance de Metas de Imogene King. Método: Estudo descritivo com abordagem qualitativa, com 14 enfermeiros da APS, selecionadas por conveniência. A coleta de dados ocorreu de agosto a novembro de 2018, por meio de entrevista semiestruturada, elaborada com base no Registro Meta-Orientado de Enfermagem de Imogene King. Os dados foram analisados de forme qualitativa pelo Software IRAMUTEQ. A pesquisa foi aprovada pelo Comitê de Ética. Resultados: Após a análise, emergiram quatro classes: 1) relação estabelecida com base no acolhimento; 2) relação enfermeiro-pessoa com tuberculose e o apoio de outros profissionais e familiares; 3) relação estabelecida com vistas ao cumprimento do tratamento; e 4) relação estabelecida para enfrentamento do preconceito diante da tuberculose. Conclusão: O acolhimento, a família e o vínculo entre profissional, paciente e equipe da Atenção Primária à Saúde fortalecem o enfrentamento da doença e reforçam a adesão ao tratamento medicamentoso.
Resumen Introducción: Uno de los puntos fuertes de la lucha contra la tuberculosis son las acciones desarrolladas en la atención primaria de salud. En este nivel asistencial, el contacto continuo de las enfermerías a través de la consulta de enfermería permite mantener una relación con la población enferma. Frente a la relación enfermería-persona para el establecimiento del vínculo y la adherencia al tratamiento contra la tuberculosis, se entiende la importancia del referente teórico de Imogene King para estructurar la interacción enfermería-persona y ofrecer una dinámica para este proceso. Objetivo: Análisis de la relación entre el personal de enfermería y las personas afectadas por la tuberculosis, a partir de la teoría del logro de objetivos de Imogene King. Método: Estudio descriptivo con abordaje cualitativo, con 14 enfermeras de atención primaria de salud, seleccionadas por conveniencia. La recolección de datos ocurrió de agosto a noviembre de 2018, a través de una entrevista semiestructurada, elaborada con base en el registro meta-orientado de enfermería de Imogene King. Los datos fueron analizados cualitativamente utilizando el software IRAMUTEQ. La investigación fue aprobada por el Comité de Ética. Resultados: Después del análisis, surgieron cuatro clases: 1) relación establecida con base en la recepción, 2) relación enfermería-persona con tuberculosis y apoyo de otras personas profesionales y familiares, 3) relación establecida con miras al cumplimiento del tratamiento y 4) relación establecida para combatir los prejuicios contra la tuberculosis. Conclusión: La acogida, la familia y el vínculo entre profesional, paciente y equipo de atención primaria de salud fortalecen el afrontamiento de la enfermedad y refuerzan la adherencia al tratamiento farmacológico.
Abstract Introduction: One of the main aspects in the fight against tuberculosis are the actions developed in Primary Health Care (PHC). At this level of care, the nurse's continuous contact through the nursing consultation allows them to maintain a relationship with the sick population. Regarding the nurse-patient relationship for establishing a bond and the compliance with tuberculosis treatment, we understand the importance of Imogene King's theoretical framework for structuring the nurse-patient interaction and offering a dynamic for this process. Objective: To analyze the nurse-tuberculosis patient relationship based on Imogene King's Theory of Goal Achievement. Method: A descriptive study with a qualitative approach, with 14 PHC nurses, selected by convenience. Data were collected from August to November 2018 through semi-structured interviews based on Imogene King's Meta-Oriented Nursing Record. The data were analyzed qualitatively using the IRAMUTEQ software. The research was approved by the Ethics Committee. Results: After the analysis, four classes emerged: 1) relationship established on the basis of welcoming; 2) nurse-tuberculosis patient relationship and the support of other professionals and family members; 3) relationship established towards treatment compliance; and 4) relationship established to confront prejudice associated with tuberculosis. Conclusion: The welcoming, the family, and the bond between the professional, the patient and Primary Health Care team strengthen the coping with the disease and reinforce the compliance with the pharmacological treatment.