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1.
Kajal Gokal Deborah Wallis Samreen Ahmed Ion Boiangiu Kiran Kancherla Fehmidah Munir 《Supportive care in cancer》2016,24(3):1139-1166
Purpose
This study evaluated the effectiveness of a self-managed home-based moderate intensity walking intervention on psychosocial health outcomes among breast cancer patients undergoing chemotherapy.Methods
The randomised controlled trial compared a self-managed, home-based walking intervention to usual care alone among breast cancer patients receiving chemotherapy. Outcome measures included changes in self-report measures of anxiety, depression, fatigue, self-esteem, mood and physical activity. Fifty participants were randomised to either the intervention group (n?=?25), who received 12 weeks of moderate intensity walking, or the control group (n?=?25) mid-way through chemotherapy. Participants in the intervention group were provided with a pedometer and were asked to set goals and keep weekly diaries outlining the duration, intensity and exertion of their walking. Levels of psychosocial functioning and physical activity were assessed pre- and post-intervention in both groups.Results
The intervention had positive effects on fatigue (F?=?5.77, p?=?0.02), self-esteem (F?=?8.93, p?≤?0.001), mood (F?=?4.73, p?=?0.03) and levels of physical activity (x 2?=?17.15, p?=?0.0011) but not anxiety (F?=?0.90, p?=?0.35) and depression (F?=?0.26, p?=?0.60) as assessed using the HADS. We found an 80 % adherence rate to completing the 12-week intervention and recording weekly logs.Conclusion
This self-managed, home-based intervention was beneficial for improving psychosocial well-being and levels of physical activity among breast cancer patients treated with chemotherapy.Trial registration
Current Controlled Trials ISRCTN50709297.2.
Purpose
Sensitivity of contrast-enhanced ultrasound (CEUS) to microvascular flow modifications can be limited by intra-injection variability (injected dose, rate, volume).Procedures
To evaluate the effect of injection variability on microvascular flow evaluation, CEUS was compared between controlled and manual injections where enhancement was assessed in vitro within a flow phantom, in normal murine kidney (N?=?12) and in murine ectopic tumors (N?=?10).Results
For both in vitro and in vivo measurements in the renal cortex, controlled injections significantly improved reproducibility of functional parameter estimation. Their coefficient of variation (CV) in the renal cortex ranged from 4 to 19 % for controlled injection vs. 5 to 43 % for manual injections. For measurements in tumors, controlled injection only decreased the CV significantly for the mean transit time. In tumors, multiple injections of contrast agent with a 15-min delay between each were shown to strongly modify contrast uptake by facilitating penetration of microbubbles.Conclusion
Improved reproducibility of CEUS assessments in murine models should provide more robust quantification of flow parameters and more sensitive evaluation of tumor modifications in therapeutic models.3.
Gloria Roberti Luca Agnifili Francesca Berardo Ivano Riva Michele Figus Gianluca Manni Luciano Quaranta Francesco Oddone 《Advances in therapy》2018,35(5):686-696
Introduction
To compare the effects of a preservative-free (PF) ophthalmic solution containing hyaluronic acid (HA) 0.4% and taurine (TAU) 0.5% with those of a PF ophthalmic solution containing HA 0.2% on ocular surface signs, symptoms, and morphological parameters in glaucoma patients under multiple long-term topical hypotensive therapy.Methods
Eligible patients underwent evaluation of ocular surface parameters by ocular surface disease index (OSDI) and glaucoma symptom scale (GSS) questionnaires, breakup time test (BUT), Schirmer I test, corneal and conjunctival staining (Oxford scale), and conjunctival in vivo confocal microscopy (Heidelberg Retina Tomograph 3, Heidelberg Engineering GmbH, Heidelberg, Germany). After the baseline visit, patients were randomized to use a PF ophthalmic solution containing HA 0.4% and TAU 0.5%, QID, in both eyes (group 1) or to use a PF ophthalmic solution containing HA 0.2%, QID (group 2) in addition to the ongoing preserved hypotensive treatment. Follow-up visits were scheduled at 30 and 90 days.Results
Thirty-nine eyes of 39 glaucoma patients were included in the study. At baseline, results of study tests of both groups were similar. After 90 days in group 1 the BUT (p?=?0.01), the Oxford score (p?=?0.03), the conjunctival goblet cells (CGC) density (p?=?0.0005) ,and the two questionnaires score significantly improved (OSDI, p?=?0.003; GSS, p?=?0.003) compared to baseline values, while in group 2 all these parameters did not differ from baseline (BUT, p?=?0.39; Oxford score, p?=?0.54; CGC density, p?=?0.33, OSDI p?=?0.65, GSS, p?=?0.25). The BUT and the CGC density were statistically different between groups both at 30 and 90 days (p?=?0.04 and p?=?0.04, respectively). The Schirmer I test did not statistically change after 90 days in both groups.Conclusions
The PF ophthalmic solution with HA 0.4% and TAU 0.5% seems to improve CGC density and reduce signs and symptoms of dry eye in glaucoma patients under long-term multiple preserved hypotensive therapy.Trial registration
ClinicalTrials.gov identifier, NCT03480295.4.
Background
Nurses often have difficulties with using interdisciplinary stroke guidelines for patients with stroke as they do not focus sufficiently on nursing. Therefore, the Stroke Nursing Guideline (SNG) was developed and implemented. The aim of this study was to determine the implementation and feasibility of the SNG in terms of changes in documentation and use of the guideline in the care of stroke patients on Neurological and Rehabilitation wards, barriers and facilitators, and nurses’ and auxiliary nurses’ view of the implementation.Methods
A sequential explorative mixed method design was used including pre-test post-test measures and post intervention focus groups interviews. For the quantitative part retrospective electronic record data of nursing care was collected from 78 patients and prospective measures with Barriers and Facilitators Assessment Instrument (BFAI) and Quality Indicator Tool (QIT) from 33 nursing staff including nurses and auxiliary nurses. In the qualitative part focus groups interviews were conducted with nursing staff on usefulness of the SNG and experiences with implementation.Results
Improved nursing documentation was found for 23 items (N?=?37), which was significant for nine items focusing mobility (p?=?0.002, p?=?0.024, p?=?0.012), pain (p?=?0.012), patient teaching (p?=?0.001, p?=?0.000) and discharge planning (p?=?0.000, p?=?0.002, p?=?0.004). Improved guideline use was found for 20 QIT-items (N?=?30), with significant improvement on six items focusing on mobility (p?=?0.023), depression (p?=?0.033, p?=?0.025, p?=?0.046, p?=?0.046), discharge planning (p?=?0.012). Facilitating characteristics for change were significantly less for two of four BFAI-subscales, namely Innovation (p?=?0.019) and Context (p?=?0.001), whereas no change was found for Professional and Patient subscales. The findings of the focus group interviews showed the SNG to be useful, improving and providing consistency in care. The implementation process was found to be successful as essential components of nursing rehabilitation were defined and integrated into daily care.Conclusion
Nursing staff found the SNG feasible and implementation successful. The SNG improved nursing care, with increased consistency and more rigorous functional exercises than before. The SNG provides nurses and auxiliary nurses with an important means for evidence based care for patients with stroke. Several challenges of implementing this complex nursing intervention surfaced which mandates ongoing attention.5.
Purpose
Goals of care conversations have been suggested as a strategy for helping patients with advanced cancer manage the uncertainty and distress associated with end-of-life care. However, knowledge deficits about patient goals limit the utility of such conversations. We described the life and treatment goals of patients with incurable cancers, including goal values and expectancies. We examined the associations between paramount goals and patient prognosis, performance status, and psychological adjustment.Methods
Patients with advanced lung cancer, gastrointestinal cancer, or melanoma (N?=?84) completed measures of prognosis for 12-month survival, hope, optimism, depression, and anxiety. Oncologists provided patient performance status and prognosis for 12-month survival. We conducted interviews with a subset of patients (N?=?63), eliciting life and treatment goals, values, and expectancies.Results
Patient life goals resembled goals among healthy populations; whereas, treatment goals were perceived as separate and more important. Cure and fight cancer emerged as the most important goals. Patients who valued cure the most had worse performance status (M?=?1.46 vs. 0.78) and more depressive symptoms (M?=?6.30 vs. 3.50). Patients who valued fight cancer the most had worse self-prognosis (M?=?69.23 % vs. 86.11 %), fewer treatment goals (M?=?2.08 vs. 3.16), and lower optimism (M?=?15.00 vs. 18.32).Conclusions
Patients with advanced cancer perceive treatment goals as separate from and more important than life goals. They hold optimistic expectancies for achieving their goals and for survival. Valuing cure highly may put patients at risk for experiencing psychological maladjustment.6.
Masashi Hirooka Yohei Koizumi Yusuke Imai Atsushi Yukimoto Takao Watanabe Osamu Yoshida Masanori Abe Yoichi Hiasa 《Journal of Medical Ultrasonics》2018,45(4):555-564
Purpose
The aim of this study was to clarify whether ultrasound quantitative methods were positively correlated with volume of ascites evaluated by whole abdominopelvic CT.Methods
Sixty-eight patients with cirrhotic ascites were retrospectively analyzed. First, to confirm that virtual ultrasonography (VUS) is an alternative method to conventional ultrasound, 22 patients underwent both conventional ultrasonography and VUS. Second, the efficacy of US quantitative methods (3-point method, 4-point method, 5-point method, and Matsumoto’s method) was confirmed by VUS in 68 patients. We assessed whether the ascites volume predicted by VUS corresponded with that calculated by 3D-CT. Of the 68 patients, 23 patients were analyzed before and after administration of tolvaptan.Results
The predictive volumes calculated by VUS were remarkably relative to those yielded by conventional US. Correlations between exact volume and those measured by VUS were significantly high (3-point method: r?=?0.882, p?<?0.001; 4-point method: r?=?0.797, p?<?0.001; 5-point method: r?=?0.836, p?<?0.001; Matsumoto’s method: r?=?0.453, p?<?0.001). Correlations between decreasing volume on 3D-CT and that measured by VUS were also significantly high in patients with administration of tolvaptan.Conclusion
Ascites volume measured by ultrasound was effective, especially the 3-point and 5-point methods. It was useful to assess the efficacy of diuretics in cirrhotic patients.7.
Introduction
Takotsubo cardiomyopathy (TCM) is a life-threatening systemic consequence early after subarachnoid hemorrhage (SAH), but precise hemodynamics and related outcomes have not been studied. The purpose of this study was to investigate TCM-induced cardiac function by transpulmonary thermodilution and its impact on clinical outcome of SAH.Methods
We retrospectively analyzed 46 consecutive postoperative SAH patients who developed TCM. Patients were divided into two groups of echocardiographic left ventricular ejection fraction (LVEF) <40% (TCM with left ventricular (LV) dysfunction) and LVEF ≥40% (TCM without LV dysfunction). Cardiac function index (CFI) and extravascular lung water index (ELWI) were monitored by transpulmonary thermodilution in parallel with serial measurements of echocardiographic parameters and blood biochemical markers.Results
Transpulmonary thermodilution-derived CFI was significantly correlated with LVEF (r?=?0.82, P?<?0.0001). The CFI between days 0 and 7 was significantly lower in patients with LV dysfunction (LVEF <40%) than in patients with LVEF ≥40% (P?<?0.05). CFI had a better ability than cardiac output to detect cardiac dysfunction (LVEF <40%) (area under the curve?=?0.85?±?0.02; P?<?0.001). A CFI value <4.2 min?1 had a sensitivity of 82% and specificity of 84% for detecting LVEF <40%. CFI <4.2 min?1 was associated with delayed cerebral ischemia (DCI) (odds ratio (OR)?=?2.14, 95% confidence interval (CI)?=?1.33 to 2.86; P?=?0.004) and poor 3-month functional outcome on a modified Rankin Scale of 4 to 6 (OR?=?1.87, 95% CI?=?1.06 to 3.29; P?=?0.02). An extravascular lung water index (ELWI) >14 ml/kg after day 4 increased the risk of poor functional outcome at 3-month follow-up (OR?=?2.10, 95% CI?=?1.11 to 3.97; P?=?0.04).Conclusions
Prolonged cardiac dysfunction and pulmonary edema increased the risk of DCI and poor 3-month functional outcome in postoperative SAH patients with TCM. Serial measurements of CFI and ELWI by transpulmonary thermodilution may provide an easy bedside method of detecting early changes in cardiopulmonary function to direct proper post-SAH treatment.8.
Bram Peeters Philippe Meersseman Sarah Vander Perre Pieter J. Wouters Dimitri Vanmarcke Yves Debaveye Jaak Billen Pieter Vermeersch Lies Langouche Greet Van den Berghe 《Intensive care medicine》2018,44(10):1720-1729
Purpose
For patients suffering from prolonged critical illness, it is unknown whether and when the hypothalamus–pituitary–adrenal axis alterations recover, and to what extent adrenocortical function parameters relate to sepsis/septic shock, to clinical need for glucocorticoid treatment, and to survival.Methods
Patients still in ICU on day 7 (N?=?392) and 20 matched healthy subjects were included. Morning blood and 24-h urine were collected daily and cosyntropin tests (250 µg) performed weekly, repeated 1 week after ICU discharge on the regular ward.Results
In all patients free of glucocorticoid treatment up until ICU day 28 (N?=?347), plasma ACTH always remained low/normal, whereas free cortisol remained high (P?≤?0.002) explained by reduced binding proteins (P?≤?0.02) and suppressed cortisol breakdown (P?≤?0.001). Beyond ICU day 28 (N?=?64 long-stayers), plasma (free)cortisol was no longer elevated. One week after ICU discharge, plasma ACTH and (free)cortisol always rose to supra-normal levels (P?≤?0.006), most pronounced in long-stayers. Long-stayers always showed low incremental total (P?≤?0.001), but normal incremental free cortisol responses to weekly cosyntropin tests, explained by low cortisol plasma binding proteins. Sepsis/septic shock patients were not different from others, patients subsequently receiving glucocorticoids (N?=?45) were not different from those who did not, and non-survivors were distinguishable from survivors only by higher (free)cortisol.Conclusions
Irrespective of sepsis/septic shock, need for glucocorticoids and survival, low cortisol plasma binding proteins and suppressed cortisol breakdown determine systemic (free)cortisol availability in prolonged critical illness, the latter no longer elevated beyond ICU day 28. The uniform rise in ACTH and cortisol to supra-normal levels 1 week after ICU discharge indicates recovery of a central adrenocortical suppression while in ICU. Low cortisol plasma binding invalidates the cosyntropin test.9.
Carlo Cattaneo Jaime Kulisevsky Viviana Tubazio Paola Castellani 《Advances in therapy》2018,35(4):515-522
Introduction
Chronic pain is an important yet overlooked non-motor symptom of Parkinson’s disease (PD), caused by an imbalance of the dopaminergic and glutamatergic systems. Safinamide has a multimodal mechanism of action, dopaminergic (reversible MAO-B inhibition) and non-dopaminergic (modulation of the abnormal glutamate release), that might be beneficial for both motor and non-motor symptoms.Objectives
To investigate the long-term (2-year) efficacy of safinamide on PD chronic pain and to confirm the positive effects observed after 6 months of treatment.Methods
This is a post hoc analysis of the data from the 2-year study 018, focused on the reduction of concomitant pain treatments and on the scores of pain-related items of the Parkinson’s disease quality of life questionnaire (PDQ-39).Results
Safinamide, compared with placebo, significantly improved the PDQ-39 items 37 (“painful cramps or spasm,” p?=?0.0074) and 39 (“unpleasantly hot or cold,” p?=?0.0209) and significantly reduced the number of concomitant pain treatments by 26.2% (p?=?0.005). A significantly greater proportion of patients in the safinamide group was not using pain drugs after 2 years of treatment (p?=?0.0478).Conclusions
The positive effects of safinamide on PD chronic pain were maintained in the long term. Further investigations are desirable to confirm their clinical relevance.Funding
Zambon SpA.10.
Susanna W. L. de Geus Leonora S. F. Boogerd Rutger-Jan Swijnenburg J. Sven D. Mieog Willemieke S. F. J. Tummers Hendrica A. J. M. Prevoo Cornelis F. M. Sier Hans Morreau Bert A. Bonsing Cornelis J. H. van de Velde Alexander L. Vahrmeijer Peter J. K. Kuppen 《Molecular imaging and biology》2016,18(6):807-819
Purpose
The purpose of this study was to identify suitable molecular targets for tumor-specific imaging of pancreatic adenocarcinoma.Procedures
The expression of eight potential imaging targets was assessed by the target selection criteria (TASC)—score and immunohistochemical analysis in normal pancreatic tissue (n?=?9), pancreatic (n?=?137), and periampullary (n?=?28) adenocarcinoma.Results
Integrin αvβ6, carcinoembryonic antigen (CEA), epithelial growth factor receptor (EGFR), and urokinase plasminogen activator receptor (uPAR) showed a significantly higher (all p?<?0.001) expression in pancreatic adenocarcinoma compared to normal pancreatic tissue and were confirmed by the TASC score as promising imaging targets. Furthermore, these biomarkers were expressed in respectively 88 %, 71 %, 69 %, and 67 % of the pancreatic adenocarcinoma patients.Conclusions
The results of this study show that integrin αvβ6, CEA, EGFR, and uPAR are suitable targets for tumor-specific imaging of pancreatic adenocarcinoma.11.
Heringlake M Handke U Hanke T Eberhardt F Schumacher J Gehring H Heinze H 《Intensive care medicine》2007,33(12):2168-2172
Objective
The modified algorithm for the non-invasive determination of cardiac output (CO) by electrical bioimpedance—electrical velocimetry (EV®)—has been reported to give reliable results in comparison with echocardiography and pulmonary arterial thermodilution (PA-TD) in patients either before or after cardiac surgery. The present study was designed to determine whether EV®-CO measurements reflect intraindividual changes in CO during cardiac surgery.Design
Prospective, observational study.Setting
Operating room (OR) and intensive care unit (ICU) of a university hospital.Patients
Twenty-nine patients undergoing elective cardiac surgery.Interventions
None.Measurements
CO was determined simultaneously by PA-TD and EV® after induction of anesthesia (t1) and 4.9?±?3.5?h after ICU admission (t2).Results
TD-CO was 3.9?±?1.4 and 5.4?±?1.1 l/min at t1 and t2 (?p?0.0001). EV®-CO was 4.3?±?1.1 and 4.9?±?1.5 l/min at t1 and t2 (?p?=?0.013). Bland–Altman analysis showed a bias of ?0.4 l/min and 0.4 l/min and a precision of 3.2 and 3.6 l/min (34.3% and 67.4%) at t1 and t2, respectively. Analysis of the individual pre- to postoperative changes in CO with both methods revealed bidirectional changes in n?=?12 patients and unidirectional changes with a difference greater than 50% and less than 50% in n?=?9 and n?=?8 patients, respectively.Conclusions
The disagreement between PA-TD and EV®-CO measurements after anesthesia induction and after ICU admission, as well as the fact that thoracic bioimpedance did not adequately reflect pre- to postoperative changes in CO, questions the reliability of EV®-CO measurements in cardiac surgery patients and contrasts sharply with previous studies.12.
Anne-Marie H. Krebber Femke Jansen Pim Cuijpers C. René Leemans Irma M. Verdonck-de Leeuw 《Supportive care in cancer》2016,24(6):2541-2548
Purpose
The purpose of the study is to investigate screening in follow-up care to identify head and neck cancer (HNC) patients with untreated psychological distress.Methods
From November 2009 until December 2012, we investigated the use of OncoQuest (a touch screen computer system to monitor psychological distress (Hospital Anxiety and Depression Scale (HADS)) and quality of life (HRQOL; EORTC QLQ-C30 and H&N35 module) in routine follow-up care. Patients who screened positive for psychological distress (HADS-T >14, HADS-A >7, or HADS-D >7) were asked whether they received psychological or psychiatric treatment.Results
During the study period of 37 months, OncoQuest was used by 720 individual HNC patients, of whom 714 had complete HADS data. Psychological distress was present in 206 patients (29 %). Of those patients who fulfilled in- and exclusion criteria (n?=?137), 25 received psychological treatment (18 %). Receipt of psychological treatment was significantly related to a higher score on the HADS total scale (19.6 vs. 16.9; p?=?0.019), a lower (worse) score on the EORTC QLQ-C30 scale emotional functioning (46.0 vs. 58.6; p?=?0.023), a higher (worse) score on fatigue (58.2 vs. 46.4; p?=?0.032), problems with sexuality (44.1 vs. 34.4; p?=?0.043), oral pain (43.8 vs. 28.8; p?=?0.011) and speech problems (37.0 vs. 25.3; p?=?0.042).Conclusions
Screening for psychological distress via OncoQuest is beneficial because 82 % of HNC patients identified with an increased level of distress who do not yet receive mental treatment were identified. Patients who did receive treatment reported more distress and worse quality of life, which may be explained because patients with more severe problems maybe more inclined to seek help or might be detected easier by caregivers and referred to supportive care more often.13.
Rainbow T. H. Ho Ted C. T. Fong Phyllis H. Y. Lo Samuel M. Y. Ho Peter W. H. Lee Pamela P. Y. Leung David Spiegel Cecilia L. W. Chan 《Supportive care in cancer》2016,24(12):4929-4937
Purpose
This study aimed to evaluate the efficacy of supportive-expressive group (SEG) therapy and body-mind-spirit (BMS) intervention on emotional suppression and psychological distress in Chinese breast cancer patients.Methods
This three-arm randomized controlled trial assigned 157 non-metastatic breast cancer patients to BMS, SEG, or social support control group. SEG focused on emotional expression and group support, whereas BMS emphasized relaxation and self-care. All groups received 2-h weekly sessions for 8 weeks. The participants completed measurements on emotional suppression, perceived stress, anxiety, and depression at baseline and three follow-up assessments in 1 year.Results
Using latent growth modeling, overall group difference was found for emotional suppression (χ 2(2)?=?8.88, p?=?0.012), marginally for perceived stress (χ 2(2)?=?5.70, p?=?0.058), but not for anxiety and depression (χ 2(2)?=?0.19–0.94, p?>?0.05). Post-hoc analyses revealed a significant and moderate reduction (Cohen d?=?0.55, p?=?0.007) in emotional suppression in SEG compared to control group, whereas BMS resulted in a marginally significant and moderate fall (d?=?0.46, p?=?0.024) in perceived stress. Neither SEG nor BMS significantly improved anxiety and depression (d?<?0.20, p?>?0.05).Conclusions
The present results did not demonstrate overall effectiveness for either BMS or SEG therapy in the present sample of Chinese non-metastatic breast cancer patients. The participants appear to derive only modest benefits in terms of their psychological well-being from either intervention.14.
15.
Hironori Matsumoto Jun Takeba Kensuke Umakoshi Satoshi Kikuchi Muneaki Ohshita Suguru Annen Naoki Moriyama Yuki Nakabayashi Norio Sato Mayuki Aibiki 《Thrombosis journal》2018,16(1):17
Background
We conducted a prospective observational study for investigating coagulofibrinolytic changes and mechanisms of antithrombin (AT) alternations in trauma.Methods
Trauma patients hospitalized for more than seven days were analyzed for coagulofibrinolytic biomarkers. The patients were stratified into two groups according to AT activity level on admission (day 0), comprising normal AT and low AT patients.Results
Thirty-nine patients (median Injury Severity Score 20) exhibited initial coagulatory activation and triphasic fibrinolytic changes. AT activity did not show a negative linear correlation with levels of thrombin-antithrombin complex (TAT), a marker of coagulation activity and AT consumption, but was strongly correlated with levels of albumin (Alb), an index of vascular permeability, on day 0 (r?=?0.702, p?<? 0.001). Furthermore, Alb was one of the independent predictors for AT on day 0. IL-6 on day 0 and thrombomodulin (TM) levels during the study period, reflecting systemic inflammation and endothelial cell injury, respectively, were significantly higher in the lower AT group (n?=?10) than in the normal group (n?=?29) (IL-6, p?=?0.004; TM, p?=?0.017). On days 2 and 4, TAT levels in the lower AT group were significantly higher than in the normal group.Conclusions
Trauma caused clear triphasic coagulofibrinolytic changes. Decreased AT in the later phase might lead to a prolonged hypercoagulation. AT reduction in the initial phase of trauma is strongly associated with extravascular leakage as suggested by the association of Alb depletion with IL-6 and TM elevation, but not with AT consumption.16.
Raphaël Cinotti Nicolas Piriou Yoann Launey Thierry Le Tourneau Maxime Lamer Adrien Delater Jean-Noël Trochu Laurent Brisard Karim Lakhal Romain Bourcier Hubert Desal Philippe Seguin Yannick Mallédant Yvonnick Blanloeil Fanny Feuillet Karim Asehnoune Bertrand Rozec 《Intensive care medicine》2016,42(2):173-182
Purpose
Stress cardiomyopathy is a common life-threatening complication after aneurysmal subarachnoid hemorrhage (SAH). We hypothesized that left ventricular (LV) longitudinal strain alterations assessed with speckle tracking could identify early systolic function impairment.Methods
This was an observational single-center prospective pilot controlled study conducted in a neuro-intensive care unit. Forty-six patients with severe SAH with a World Federation of Neurological Surgeons grade (WFNS) ≥III were included. Transthoracic echocardiography (TTE) was performed on day 1, day 3, and day 7 after the patient’s admission. A cardiologist blinded to the patient’s management analyzed the LV global longitudinal strain (GLS). The control group comprised normal subjects matched according to gender and age.Results
On day 1 median (25th–75th percentile) GLS was clearly impaired in SAH patients compared to controls [?16.7 (?18.7/?13.7) % versus ?20 (?22/?19) %, p < 0.0001], whereas LVEF was preserved [65 (59?70) %]. GLS was severely impaired in patients with a WFNS score of V versus III–IV [?15.6 (?16.9/?12.3) % versus ?17.8 (?20.6/?15.8) %, p = 0.008]. Seventeen (37 %) patients had a severe GLS alteration (>?16 %). In these patients, GLS improved from day 1 [?12.4 (?14.8/?10.9) %] to last evaluation [?16.2 (?19/?14.6) %, p = 0.0007] in agreement with the natural evolution of stress cardiomyopathy.Conclusions
On the basis of LV GLS assessment, we demonstrated for the first time that myocardial alteration compatible with a stress cardiomyopathy is detectable in up to 37 % of patients with severe SAH while LVEF is preserved. GLS could be used for sensitive detection of stress cardiomyopathy. This is critical because cardiac impairment remains a major cause of morbidity and mortality after SAH.17.
Background
Withholding analgesics in acute abdomen for fear of masking clinical features and impairing diagnosis and decision-making is still being practiced despite recent evidence to the contrary. This study assesses the effect of preoperative analgesia on clinical findings, clinical diagnosis, and decision-making in patients with non-trauma acute abdomen.Method
This is a randomized, double-blind, placebo-controlled study using Tramal, a brand of tramadol, at the ED of LAUTECH Teaching Hospital Osogbo, Nigeria. Ninety-five patients between 18–60 years received Tramal (n?=?46) or placebo (n?=?49). The pain score, clinical findings, provisional diagnosis, and treatment plan were noted before and 15–20 min after administration of the analgesic or placebo. The final diagnosis arrived at after adequate investigation or operation was considered the gold standard. The pain scores, diagnosis, treatment plan, and decision between the two groups were compared. Statistical analysis was by SPSS 16. Results were considered statistically significant at p?<?0.05.Results
Demography and case distribution were similar in both groups. The improvement in pain was greater in the Tramal group (p?=?0.001). The abdominal palpation findings were also better in the Tramal group (p?=?0.02). There were more changes in the diagnosis after use of Tramal (p?=?0.01). There were more changes in the decision in the Tramal group (p?=?0.03). Most of the changes in diagnosis and decision in the Tramal group were for the better.Conclusion
The preoperative use of Tramal in acute abdomen improved the experience of pain and did not adversely affect the accuracy of the diagnosis or decision-making.18.
Olivier Anne Blanson Henkemans Marjolein Keij Marc Grootjen Mascha Kamphuis Anna Dijkshoorn 《BMC nursing》2018,17(1):41
Background
The StartingTogether program (in Dutch SamenStarten) is a family-centred method for early identification of social-emotional and behavioural problems in young children. Nurses in preventive child health care find it challenging to: determine family issues and need for care; provide education; refer to social services; increase parent empowerment. To mitigate these challenges, we developed and evaluated the StartingTogether App, offering nurses and parents conversational support, tailored education and information on social services.Methods
A mixed method design, consisting of a qualitative evaluation of the StartingTogether App, with group discussions with nurses (N?=?14) and a pilot test (N?=?5), and a randomized controlled trial, evaluating the effectiveness of the app. Nurses (N?=?33) made home visits to parents (N?=?194), in teams with or without the app. Nurses were surveyed on the challenges experienced during visits. Parents (N?=?166) were surveyed on their satisfaction with health care and app. Nurses were interviewed on the benefits and barriers to use the app.Results
Parents with the StartingTogether App were more satisfied with the visits than parents without (p?=?.002). Parents with a high educational level were more satisfied with the visits than the parents with a low educational level. With the app, their satisfaction level was similar (p?<?.001). Nurses using the app felt more equipped to communicate with parents (p?=?.012) and experienced that parents were more knowledgeable and skilled (p?=?.001). Parents felt that with the app the nurse was more polite (p?=?.02), listened more carefully (p?=?.03), and had more time (p?=?.02). Nurses with the app gave parents more opportunity to ask questions (p?=?.001) and gave clearer answers (p?<?.001). The qualitative evaluation indicated that some nurses needed extra time to develop the habit of using the app.Conclusions
The StartingTogether App contributes to parents’ satisfaction with home visits. An interaction effect between parents’ educational level and rating of home visits indicated that the app has an additional value for parents with a lower educational level. Applying mobile applications, such as the StartingTogether App, potentially has a positive effect on communication between nurses and parents about the family situation in relation to parent empowerment and the child’s development.Trial registration
The study is registered with ISRCTN under the number ISRCTN12491485, on August 23, 2018. Retrospectively registered.19.
Sunnie Kim James E. Signorovitch Hongbo Yang Oscar Patterson-Lomba Cheryl Q. Xiang Brian Ung Monika Parisi John L. Marshall 《Advances in therapy》2018,35(10):1564-1577
Introduction
nab-Paclitaxel plus gemcitabine (nab-P?+?G) and FOLFIRINOX (FFX) are among the most common first-line (1L) therapies for metastatic adenocarcinoma of the pancreas (MPAC), but real-world data on their comparative effectiveness are limited.Methods
This retrospective cohort study compared the efficacy and safety of 1L nab-P?+?G versus FFX, overall and under specific treatment sequences. Medical records were reviewed by 215 US physicians who provided information on MPAC patients who initiated 1L therapy with nab-P?+?G or FFX between April 1, 2015 and December 31, 2015. Study outcomes were overall survival (OS) and tolerability. OS was compared using Kaplan–Meier curves and adjusted Cox proportional hazards models.Results
In total, 654 medical records were reviewed, including those of 337 and 317 patients initiated on nab-P?+?G and FFX as 1L MPAC therapy, respectively. nab-P?+?G-initiated patients were older, less likely to have ECOG?≤?1, and had more comorbidities than FFX-initiated patients. Median OS (mOS) was 12.1 and 13.8 months for nab-P?+?G- and FFX-initiated patients, respectively (HR?=?0.99, P?=?0.96). Among patients with ECOG?≤?1, mOS was 14.1 and 13.7 months, respectively (HR?=?1.00, P?=?0.99). Among patients with 1L nab-P?+?G and FFX, 36.1% and 41.3% received 2L therapy and experienced mOS of 16.3 and 16.6 months, respectively (HR?=?1.04, P?=?0.76). The rates of diarrhea, fatigue, mucositis, and nausea and vomiting were significantly higher in the FFX than nab-P?+?G cohort.Conclusion
The real-world survival was similar between patients receiving 1L nab-P?+?G or FFX both overall and among patients who received active 2L treatments. In addition, nab-P?+?G was associated with significantly lower rates of common AEs compared with FFX.Funding
Celgene.20.
Aditya?Mantha Nathaniel?L.?Coggins Aditya?Mahadevan Rebecca?N.?Strehlow Matthew?C.?Strehlow S.V.?Mahadevan