Tag: pubmed

Rev Assoc Med Bras (1992). 2022 Mar;68(3):329-336. doi: 10.1590/1806-9282.20210710.

ABSTRACT

OBJECTIVE: The objective of this study was to evaluate the quality of life of patients with noncystic fibrosis bronchiectasis during a 1-year follow-up by using the EuroQol – 5 Dimensions – 3 Levels (EQ-5D-3L) questionnaire.

METHODS: A cohort study was conducted with 100 patients with noncystic fibrosis bronchiectasis and followed up with face-to-face visits or by telephone contact every 3 months for 1 year. All patients were recruited from a single referral center for bronchiectasis. At the time of recruiting and at the end of 1 year, the EQ-5D-3L questionnaire was applied to evaluate the patients’ quality of life. Variables, such as exacerbation, emergency care, comorbidities, hemoptysis, colonization, and hospitalization, were assessed.

RESULTS: Of the 100 patients, 99 completed the study and 72% were women. There were no marked limitations in the mobility and self-care domains during the follow-up. At the end of the follow-up, 32 patients were extremely anxious or depressed. The quality of life assessed by using EQ-5D-3L had an initial mean score of 0.545 and of 0.589 after 1 year, which was statistically significant (p=0.011).

CONCLUSION: Patients with noncystic fibrosis bronchiectasis have a poor quality of life, and the EQ-5D-3L questionnaire may be a tool for monitoring patients with bronchiectasis.

PMID:35442359 | DOI:10.1590/1806-9282.20210710

Rev Assoc Med Bras (1992). 2022 Mar;68(3):389-394. doi: 10.1590/1806-9282.20211071.

ABSTRACT

OBJECTIVE: The aim of this study was to evaluate the anxiety experienced by health care workers in different branches during the COVID-19 pandemic.

METHODS: The cross-sectional study included 373 health care workers. Data were collected using an online questionnaire consisting of the Sociodemographic Form (32 items related to the working conditions of health care professionals during the COVID-19 pandemic) and the Penn State Concern Questionnaire.

RESULTS: The anxiety levels of the female workers were significantly higher (p<0.001). The total Penn State Concern Questionnaire points were determined to be statistically significantly higher in those who need to protect the family during the pandemic (p=0.03), who were dissatisfied with their profession (p<0.001), and those whose workload had increased during the pandemic (p=0.007).

CONCLUSIONS: The study results demonstrated that the levels of anxiety of health care workers during the COVID-19 pandemic could be increased by young age, low level of experience, female gender, increased workload, and dissatisfaction with the profession.

PMID:35442369 | DOI:10.1590/1806-9282.20211071

Rev Assoc Med Bras (1992). 2022 Mar;68(3):313-317. doi: 10.1590/1806-9282.20210259.

ABSTRACT

BACKGROUND: Serum tumor markers are molecules that are secreted by tumor cells and may be present in small amounts in the serum of healthy individuals. Their role as prognostic factors in lung cancer remains controversial.

OBJECTIVE: To assess the prognostic role of CEA, CA 19-9, CA 15-3, and CA 125 in non-squamous non-small cell lung cancer.

PATIENTS AND METHODS: A total of 112 patients with non-squamous non-small cell lung cancer from two Oncology Centers were retrospectively analyzed. Tumor marker levels were measured prior to treatment. Data regarding clinical characteristics and overall survival were collected.

RESULTS: Median overall survival of all patients was 15.97 months. Pre-treatment elevations of CA 125 and CA 15-3 were associated with shorter overall survival (p=0.004 and p=0.014, respectively). Single CEA and CA 19-9 elevations were not associated with a worse prognosis. Patients with two or more elevated markers had a statistically significant decrease in overall survival (p=0.008). In the multivariate analysis, smoking status and number of positive tumor markers at diagnosis were independently associated with a worse prognosis.

CONCLUSION: High pre-treatment levels of tumor markers were correlated with decreased survival in patients with non-squamous non-small cell lung cancer.

PMID:35442356 | DOI:10.1590/1806-9282.20210259

Arq Gastroenterol. 2022 Jan-Mar;59(1):129-136. doi: 10.1590/S0004-2803.202200001-22.

ABSTRACT

BACKGROUND: Deceased donor liver transplantation (DDLT) is the first choice, but living donor transplantation (LDLT) is an alternative to be considered in special situations, such as lack of donated organs and emergencies. So far, there is no consensus on which transplantation method provides better survival and fewer complications, which is still an open point for discussion.

METHODS: This meta-analysis compared the 1, 3, and 5-year patient and graft survival rates of LDLT and DDLT. We included studies published from April-2009 to June-2021 and adopted the generic model of the inverse of variance for the random effect of hazard ratios. The adequacy of the studies was determined using the Newcastle-Ottawa Scale – NOS (WELLS).

RESULTS: For patient survival analysis, we included a total of 32,258 subjects. We found a statistically significant better survival for the LDLT group at 1, 3 and 5 years, respectively: 1.35 HR (95%CI 1.10-1.66, P=0.005), 1.26 HR (95%CI 1.09-1.46, P=0.002) and 1.27 HR (95%CI 1.09-1.48, P=0.002). Our meta-analysis evaluated a total of 21,276 grafts. In the overall analysis, the 1-year survival was improved in favor of the LDLT group (1.36 HR, 95%CI 1.16-1.60, P<0.0001), while the 3-year survival (1.13 HR, 95%CI 0.96-1.33, P<0.13), and 5 (0.99 HR, 95%CI 0.74-1.33, P<0.96), did not differ significantly.

CONCLUSION: This metanalysis detected a statistically significant greater 1-, 3- and 5-years patient survival favoring LDLT compared to DDLT as well as a statistically significant difference better 1-year graft survival favoring the LDLT group.

PMID:35442323 | DOI:10.1590/S0004-2803.202200001-22

J Pediatr Gastroenterol Nutr. 2022 Apr 20. doi: 10.1097/MPG.0000000000003457. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate whether there are clinical subtypes in children with functional nausea based on comorbidities and responses to the Nausea Profile questionnaire.

METHODS: Patients from the Neurointestinal and Motility Program clinical registry at Lurie Children’s Hospital were included if they met Rome IV criteria for functional nausea. Patients completed the Nausea Profile, a multidimensional measure of nausea with gastrointestinal, emotional and somatic subscales. Comorbidities were assessed by chart review and self-report measures. Latent class analysis was used to identify patient groups based on comorbidities. To assess if model-identified groups were predictive of differences in nausea quality, Nausea Profile subscale means were compared between groups and used to predict group membership. Conversely, k-means analysis was used to divide the sample into groups based upon Nausea Profile subscale scores, to determine if identified groups had different comorbidities.

RESULTS: Seventy-two patients (n = 53 females) with a mean age (± SD) 14.5 ± 2.9 were included. Two clinical subtypes were identified based on comorbidities, with responses on the emotional subscale of the Nausea Profile predicting group membership (p < .04). When patients were grouped by nausea quality, the resulting clusters differed on psychiatric comorbidities (p < .001).

CONCLUSIONS: Our findings support the existence of nausea subtypes within the broad diagnosis of functional nausea. One such subtype is an emotional predominant nausea supporting the notion that anxiety and depression comprise a subset of patients with nausea. Thus, patients may benefit from a treatment approach that integrates both GI assessment and psychiatric support in their care.

PMID:35442247 | DOI:10.1097/MPG.0000000000003457

Rev Bras Enferm. 2022 Apr 15;75(4):e20210478. doi: 10.1590/0034-7167-2021-0478. eCollection 2022.

ABSTRACT

OBJECTIVE: to apply an empathy map to assess nursing professionals’ needs, desires, frustrations and aspirations regarding educational actions.

METHODS: a cross-sectional study, carried out in a hospital institution with 164 nursing professionals, who responded to the empathy map, which clarified their participation in institutional educational actions, which were collected from 2019 to 2020, and analyzed using descriptive statistics.

RESULTS: when using the empathy map, educational actions focused on routines predominated, with the sharing of knowledge; promotion of improvements in care; agreement of commitment with proposed actions; insufficient compliance; little incentive to participate; dispersed guidelines among professionals; increased labor demand; and educational activity during the working day.

CONCLUSIONS: the empathy map, applied as an instrument for assessing the institutional educational process, qualified as appropriate educational actions or opportunities to improve significant learning for professional nursing education.

PMID:35442308 | DOI:10.1590/0034-7167-2021-0478

J Pediatr Gastroenterol Nutr. 2022 Apr 20. doi: 10.1097/MPG.0000000000003456. Online ahead of print.

ABSTRACT

BACKGROUND: Ileocecectomy related to stricturing, fistula formation, or medically refractory disease is commonly required in patients with Crohn’s disease (CD). Limited research exists in endoscopic recurrence (ER) in pediatric inflammatory bowel disease (IBD). In this study, we sought to determine ER rates and the impact of therapy duration prior to surgery in pediatric patients with CD.

METHODS: This was a single-center retrospective review of patients with CD between the ages of 2-20 years who required ileocecectomy between January 2015 and December 2019 at Nationwide Children’s Hospital. Follow-up endoscopies, laboratory values, medications, and sPCDAI scores were recorded at 6, 12, 24, and 36 months post-resection where available. Modified Rutgeert scores (mRS) were independently assigned to post-resection colonoscopy images by 3 trained investigators. Post-resection outcomes were compared between patients on CD therapy >30 days prior to resection (late surgery) to those started on CD therapy <30 days prior to resection (early surgery).

RESULTS: A total of 48 patients underwent ileocecectomy, with a mean age at time of resection of 17 years (+/- 2.3). In total, 88% of patients had a post-resection endoscopy and 57% had an endoscopy within 12 months of resection. Twenty-nine percent had ER with a mRS ≥ i2. There was no statistical difference in endoscopic and clinical outcomes after resection between the early and late surgery groups.

CONCLUSIONS: Post-resection endoscopic recurrence after ileocecectomy was found in 29% of our center’s pediatric CD population based on mRS. Post-resection outcomes were not affected by therapy duration prior to resection.

PMID:35442239 | DOI:10.1097/MPG.0000000000003456

J Pediatr Gastroenterol Nutr. 2022 Apr 20. doi: 10.1097/MPG.0000000000003462. Online ahead of print.

ABSTRACT

BACKGROUND: Studies assessing adult inflammatory bowel disease (IBD) patient perspectives on biosimilar use revealed that most were unfamiliar with biosimilars and had a negative perception. The objective of this study was to evaluate the perspectives of pediatric patients with IBD and their caregivers regarding biosimilar use and non-medical switches.

METHODS: A survey was given to a cross section of patients with IBD ages 11-21 years receiving the intravenous anti-TNF originator and caregivers of patients with IBD ages 3-21 years receiving the originator. Recruitment occurred via mail, during clinic visits, and infusions. Fisher’s exact tests were used to test for statistically significant differences.

RESULTS: Response rate amongst caregivers was 49% (n = 98) and amongst patients was 35% (n = 67). Sixty-four percent of caregivers and 79% of patients had never heard of biosimilars. There was increased discomfort surrounding the use of biosimilars and switching to a biosimilar amongst caregivers who had previously heard of biosimilars compared to caregivers who had not previously heard of biosimilars (p < 0.05). Similar concerns were not seen in patient respondents. The length of time on the originator had no effect on patient or caregiver concerns related to biosimilar efficacy, side effects, or switches.

CONCLUSION: The majority of pediatric patients and caregivers had never heard of biosimilars. Caregivers that had heard of biosimilars prior to the study were more likely to have a negative perception of them. This study highlights the importance of providing thorough and accurate education to pediatric patients and families regarding the safety and efficacy of biosimilars.

PMID:35442227 | DOI:10.1097/MPG.0000000000003462

J Pediatr Gastroenterol Nutr. 2022 Apr 20. doi: 10.1097/MPG.0000000000003452. Online ahead of print.

ABSTRACT

OBJECTIVES: Sebelipase alfa is approved for treatment of lysosomal acid lipase deficiency (LAL-D). This single-arm, open-label study (NCT02112994) evaluated sebelipase alfa efficacy and safety in patients with LAL-D.

METHODS: Patients >8 months of age diagnosed with LAL-D received sebelipase alfa 1.0 mg/kg by intravenous infusion every other week (qow) for up to 144 weeks. Dose escalation to 3.0 mg/kg qow and subsequently to 3.0 mg/kg weekly was permitted, per protocol; dose reductions for tolerability were permitted to 0.35 mg/kg qow. Descriptive statistical analyses were conducted.

RESULTS: Thirty-one patients were enrolled and treated. Baseline median alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were 63.5 and 65.5 U/L, respectively. Twenty-eight patients completed 96 weeks of treatment, and 25 continued into the extended treatment period; 19 completed 144 weeks. From baseline to week 144, median ALT and AST levels changed by -42.0 and -22.0 U/L, respectively, median liver and spleen volumes changed from 1.4 to 1.3 and from 2.6 to 2.3 multiples of normal, respectively, median low-density lipoprotein cholesterol levels decreased by 52.6 mg/dL, and median high-density lipoprotein cholesterol increased by 9.8 mg/dL. Liver biopsies showed mostly improved or stable histopathology at 48 and 96 weeks versus baseline. Infusion-associated reactions were mild (n = 1) or moderate (n = 2). One patient (a candidate for liver transplant at baseline) discontinued treatment due to liver transplant (unrelated to treatment). Two patients tested positive for non-neutralizing, anti-drug antibodies on 1 occasion each.

CONCLUSION: Sebelipase alfa was well tolerated and resulted in sustained improvements in liver and lipid parameters.

PMID:35442238 | DOI:10.1097/MPG.0000000000003452

JMIR Mhealth Uhealth. 2022 Apr 20;10(4):e29985. doi: 10.2196/29985.

ABSTRACT

BACKGROUND: Drug-referencing apps are among the most frequently used by emergency health professionals. To date, no study has analyzed the quantity and quality of apps that provide information on emergency drugs.

OBJECTIVE: This study aimed to identify apps designed to assist emergency professionals in managing drugs and to describe and analyze their characteristics.

METHODS: We performed an observational, cross-sectional, descriptive study of apps that provide information on drugs for adult emergency care. The iOS and Android platforms were searched in February 2021. The apps were independently evaluated by 2 hospital clinical pharmacists. We analyzed developer affiliation, cost, updates, user ratings, and number of downloads. We also evaluated the main topic (emergency drugs or emergency medicine), the number of drugs described, the inclusion of bibliographic references, and the presence of the following drug information: commercial presentations, usual dosage, dose adjustment for renal failure, mechanism of action, therapeutic indications, contraindications, interactions with other medicinal products, use in pregnancy and breastfeeding, adverse reactions, method of preparation and administration, stability data, incompatibilities, identification of high-alert medications, positioning in treatment algorithms, information about medication reconciliation, and cost.

RESULTS: Overall, 49 apps were identified. Of these 49 apps, 32 (65%) were found on both digital platforms; 11 (22%) were available only for Android, and 6 (12%) were available only for iOS. In total, 41% (20/49) of the apps required payment (ranging from €0.59 [US $0.64] to €179.99 [US $196.10]) and 22% (11/49) of the apps were developed by non-health care professionals. The mean weighted user rating was 4.023 of 5 (SD 0.71). Overall, 45% (22/49) of the apps focused on emergency drugs, and 55% (27/49) focused on emergency medicine. More than half (29/47, 62%) did not include bibliographic references or had not been updated for more than a year (29/49, 59%). The median number of drugs was 66 (range 4 to >5000). Contraindications (26/47, 55%) and adverse reactions (24/47, 51%) were found in only half of the apps. Less than half of the apps addressed dose adjustment for renal failure (15/47, 32%), interactions (10/47, 21%), and use during pregnancy and breastfeeding (15/47, 32%). Only 6% (3/47) identified high-alert medications, and 2% (1/47) included information about medication reconciliation. Health-related developer, main topic, and greater amount of drug information were not statistically associated with higher user ratings (P=.99, P=.09, and P=.31, respectively).

CONCLUSIONS: We provide a comprehensive review of apps with information on emergency drugs for adults. Information on authorship, drug characteristics, and bibliographic references is frequently scarce; therefore, we propose recommendations to consider when developing an app of these characteristics. Future efforts should be made to increase the regulation of drug-referencing apps and to conduct a more frequent and documented review of their clinical content.

PMID:35442212 | DOI:10.2196/29985