Does stage‐based smoking cessation advice in pregnancy result in long‐term quitters? 18‐month postpartum follow‐up of a randomized controlled trial

AIMS: To evaluate the effect on quitting smoking at 18 months postpartum of smoking cessation interventions based on the Transtheoretical Model (TTM) delivered in pregnancy compared to current standard care. It has been claimed that TTM-based interventions will continue to create quitters after the end of the intervention period. DESIGN: Cluster randomized trial. SETTING: Antenatal clinics in general practices in the West Midlands, UK. PARTICIPANTS: A total of 918 pregnant smokers originally enrolled in the trial, of which 393 women were followed-up at 18 months postpartum. INTERVENTIONS: One hundred general practices were randomized into the three trial arms. Midwives in these practices delivered three interventions: A (standard care), B (TTM-based self-help manuals) and C (TTM-based self-help manuals plus sessions with an interactive computer program giving individualized smoking cessation advice). MEASUREMENTS: Self-reported continuous and point prevalence abstinence since pregnancy. FINDINGS: When combined together, there was a slight and not significant benefit for both TTM arms compared to the control, with an odds ratio (OR) 95% confidence interval (CI) of 1.20 (0.29-4.88) for continuous abstinence. For point prevalence abstinence, the OR (95%CI) was 1.15 (0.66-2.03). Seven of the 54 (13%) women who had quit at the end of pregnancy were still quit 18 months later, and there was no evidence that the TTM-based interventions were superior in preventing relapse. CONCLUSIONS: The TTM-based interventions may have shown some evidence of a short-term benefit for quitting in pregnancy but no benefit relative to standard care when followed-up in the longer-term.     

Long‐term outcomes of obscure gastrointestinal bleeding after CT enterography: Does negative CT enterography predict lower long‐term rebleeding rate?

Background and Aim: Computed tomography enterography (CTE) is a promising modality for small bowel imaging. However, the role of CTE in the evaluation of obscure gastrointestinal bleeding (OGIB) has not been established. We investigated the efficacy of CTE in diagnosing OGIB and the long‐term outcomes based on CTE findings, with special reference to negative CTE. Methods: A total of 63 consecutive patients who had undergone CTE for OGIB were enrolled, and their pre‐ and post‐CTE clinical data were collected. “Specific treatments” were defined as treatments directly aimed at resolving presumed bleeding causes, including hemostasis and operation, while “non‐specific treatments” were defined as symptomatic treatments for anemia. Results: Among 60 patients for whom long‐term follow‐up data were available, positive lesions were found in 16 patients (26.7%). The overall rebleeding rate was 21.7% during a mean follow up of 17.6 ± 4.7 months. There was no significant difference in the cumulative rebleeding rates between patients with positive and negative CTE results (P = 0.241). All patients who received specific treatments after CTE did not rebleed (0/8). In positive CTE patients, specific treatments significantly reduced the rebleeding rate (P = 0.023). Conclusions: CTE has a high rate of detecting overt OGIB. However, negative CTE results do not predict lower long‐term rebleeding, and such patients with OGIB should be closely observed. In patients with positive CTE, more vigorous management significantly reduces the incidence of rebleeding.     

Long‐term follow‐up of patients with bone metastases from differentiated thyroid carcinoma – surgery or conventional therapy?

OBJECTIVE: Surgery of bone metastases from differentiated thyroid carcinoma seems indicated in individual patients. This study was performed (1) to analyse retrospectively patients with bone metastases from differentiated thyroid carcinoma and (2) to evaluate the impact of surgery of bone metastases on survival. PATIENTS AND DESIGN: We analysed 41 consecutive patients with bone metastases from differentiated thyroid carcinoma who had undergone thyroid surgery at Vienna University Hospital since 1966. The median follow-up time was 12 years. There were 24 females and 17 males with a mean age of 60 +/- 12 years. Primary tumour histology was follicular in 35 and papillary in six patients. Radioiodine treatment was performed in 32 with a mean administered activity of 27 +/- 24 GBq 131I. Metastases restricted to the skeleton were found in 22 whereas in 19 individuals additional extraskeletal distant metastases were seen. Twenty-seven patients had multiple bone metastases. In 21 individuals, up to five bone metastases were surgically removed with the intention of cure. RESULTS: Univariate analysis identified total thyroidectomy (P = 0.003), lymph node surgery (P = 0.001), radioiodine therapy (P = 0.036), and the absence of extraskeletal distant metastases (P = 0.017) as significant predictors of survival. Multivariate analysis failed to identify significant prognostic factors. In the subgroup of patients with distant metastases limited to the bones, univariate analysis identified, in addition to thyroid and lymph node surgery, the surgical extirpation of the bone metastases as a significant prognostic factor associated with improved survival (P = 0.025). CONCLUSIONS: These findings indicate that in patients without additional extraskeletal distant metastases, the radical surgical extirpation of bone metastases from differentiated thyroid carcinoma might be associated with improved survival.     

Incidence and natural history of neonatal isolated ventricular septal defects: Do we know everything? A 6‐year single‐center Italian experience follow‐up

Background

Despite ventricular septal defects (VSDs) are the most common congenital heart diseases (CHDs) in the neonatal period, their incidence and natural history are still debated and their follow‐up and management strategies remain controversial. Our aim was to evaluate the incidence and natural history of isolated VSDs.

Methods

From January 1996 to December 2015 all neonates with a CHD suspicion were referred to the Cardiological Department of Grosseto Misericordia Hospital. Only newborns with confirmed isolated VSD were enrolled in this study and followed for 6 years.

Results

Our 343 newborns with an isolated VSD (incidence of 10.45/1000/births) account for 64% of all detected CHDs. VSDs location were as follows: muscular (73.8%), perimembranous (11.3%), inlet (1%), and outlet (0.8%). Of the located VSDs, 90% were small, 7.5% moderate, and 2.5% large, respectively. Spontaneous closure was observed in 96 (29.2%) of the VSD patients at 6‐month, 198 (60.2%) at 1‐year, 261 (79.3%) at 2‐year, and in 302 (91.8%) at 6‐year follow‐up. Risk factors for defect persistence were a perimembranous location (P = .001; HR: 0.508, CI: 0.342‐0.755), detection of multiple defects (P = .043; HR: 0.728, CI: 0.536‐0.990), and male gender (P < .048; HR: 0.783, CI: 0.615‐0.998), respectively.

Conclusions

We here provide an incidence and natural history of neonatal isolated VSDs in a neonatal Caucasian population. These data may be useful for the development of expert consensus/standard recommendation guidelines for the follow‐up and VSD management, data that are currently lacking.     

Are patients on long‐term oxygen therapy followed up properly? Data from the Danish Oxygen Register

OBJECTIVES: The aim of the study was to assess the extent and quality of follow-up of patients on LTOT. SETTING: The Danish Oxygen Register. SUBJECTS: A total of 890 chronic obstructive pulmonary disease (COPD) patients who were on long-term oxygen therapy (LTOT) during the period from 1 November 1994 to 31 August 1995. MAIN OUTCOME MEASURES: The extent and quality of follow-up. RESULTS: Only 38.5% of the patients were followed up in the study period, and only 17.5% had a 'sufficient follow-up' defined as at least one follow-up visit within 10 months which included measurement of arterial blood gases or pulsoximetry with oxygen supply, verification that the patient used oxygen > or =15 h day-1 and was nonsmoker. Female gender, LTOT initiated 3-12 months ago, LTOT started by a chest physician at pulmonary department and LTOT prescribed > or =15 h day-1 were found to be significant predictors of 'sufficient follow-up' (odds ratio (OR): 1.7, 2.0, 3.7 and 1.9, respectively). CONCLUSIONS: The extent and the quality of follow-up of patients on LTOT were poor, especially if a nonpulmonary physician initiated LTOT. We recommend that more attention should be paid on proper monitoring of LTOT, and that only chest physicians should be able to prescribe and re-evaluate LTOT.     

Do lifestyle interventions during pregnancy have the potential to reduce long‐term postpartum weight retention? A systematic review and meta‐analysis

Reducing postpartum weight retention is a promising strategy for addressing the rising prevalence of overweight and obesity in women. This systematic review and meta‐analysis explored whether lifestyle interventions during pregnancy have the potential to reduce weight retention at 4 months postpartum and beyond. A search of five electronic databases for randomized controlled trials comparing the effect of weight‐related lifestyle interventions beginning in pregnancy on postpartum weight retention to standard prenatal care groups was performed. Postpartum weight retention data was synthesized in a random‐effects meta‐analysis. Data from 14 studies of 7116 participants showed that the intervention group retained statistically significant less weight than the control group (weighted mean difference: ?0.73 kg, 95% CI: ?1.32 to ?0.14, P = 0.015). Subgroup analysis showed this effect to be largest in studies with follow‐ups from 4 to 6 months (weighted mean difference: ?1.32 kg, 95% CI: ?2.11 to ?0.53, P = 0.001), but it remained significant until 12 months postpartum (weighted mean difference: ?0.68 kg, 95% CI: ?1.28 to ?0.09, P = 0.023). In studies of women with a body mass index above 25.0 kg/m², no significant intervention effect was observed. More high‐quality studies with a follow‐up beyond 12 months postpartum are needed.     

Do Disordered Eating Behaviours Have Long‐term Health‐related Consequences?

Objective

Long‐term health‐related consequences of disordered eating behaviours of young adults remain poorly understood. We examined whether disordered eating behaviours in mid‐20s are associated with physical and mental health 10 years later.

Methods

Women (n = 2631) and men (n = 2394) from a population‐based FinnTwin16 cohort were assessed using three subscales of the Eating Disorder Inventory‐2 at age 24. Self‐rated health, body mass index (BMI), waist circumference and psychological distress were assessed at age 24 and reassessed 10 years later.

Results

In crude models, disordered eating behaviours at age 24 were associated cross‐sectionally and prospectively with poor self‐rated health, higher BMI, larger waist circumference and psychological distress in both sexes. In models adjusted for baseline BMI and potential confounders, disordered eating behaviours predicted increased psychological distress in both sexes and poor self‐rated health in men.

Conclusions

Among young adults, disordered eating behaviours are associated with long‐term health‐related consequences, particularly psychological distress. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.     

Short‐ and long‐term risks of splenectomy for benign haematological disorders: should we revisit the indications?

Splenectomy has represented a key treatment option in the treatment of many benign haematological diseases, including immune thrombocytopenia (ITP) and disorders associated with ongoing haemolysis (thalassaemia major and intermedia, sickle cell disease, and hereditary or acquired haemolytic anaemias). Improvements in surgical techniques have reduced perioperative complications and mortality. Preventive measures (new protein conjugate vaccines, antibiotic prophylaxis, and increased vigilance) are thought to greatly reduce the risk of overwhelming post-splenectomy infection (OPSI), although their implementation is inconsistent. Nevertheless, there is increasing documentation of the short- and long-term risks of splenectomy, which vary according to the underlying indication. Splenectomized patients are at increased risk of venous thromboembolism, particularly within the splenoportal system. The long-term thromboembolic risk is higher in haematological disorders associated with ongoing haemolysis, particularly in thalassaemia intermedia, which has led to a more conservative approach. In comparison, patients with ITP appear to be at lower risk of adverse effects of splenectomy, which maintains its place as the potentially most curative and safe second-line treatment. However, a splenectomy-sparing approach is also emerging for ITP, and recent guidelines recommend that this procedure is deferred until ≥ 12 months from ITP diagnosis, to allow sufficient time for possible remission.     

Declining use of orthopedic surgery in patients with rheumatoid arthritis? Results of a long‐term,population‐based assessment

Objective

To describe the use of orthopedic surgery, including joint replacement surgery, in a well‐defined, population‐based cohort of patients with rheumatoid arthritis (RA) and to identify characteristics that predict such use.

Methods

A retrospective medical record review was performed of cases of RA incident in Rochester, Minnesota, during the years 1955–1995. All joint surgeries were recorded.

Results

Of the total 609 RA incident cases, 242 patients underwent 1 or more (maximum of 20/patient) surgical procedures involving joints during their followup. Overall, this RA cohort had 7.4 surgeries per 100 person‐years of followup; the cumulative incidence for joint surgery for RA‐related joint disease at 30 years was 33.7% ± SEM 3.8%. The risk of having a disease‐related joint surgery for RA is increased in patients who are women, younger, positive for rheumatoid factor, and have rheumatoid nodules. When adjusted for duration of followup, patients with RA diagnosed after 1985 were significantly less likely to have undergone joint surgery for RA (P < 0.001). Survival of patients who underwent total joint arthroplasty was similar to those who did not.

Conclusion

Reconstructive surgeries are common in RA, although patients diagnosed after 1985 are less likely to require joint surgery. These findings may reflect trends in medical disease management and have importance for health care resource utilization planning.

     

Do glucocorticoids decrease mortality in acute respiratory distress syndrome? A meta‐analysis

BACKGROUND AND OBJECTIVES: Glucocorticoids have been shown to improve survival when used in patients with septic shock. The aim of this study was to analyse the role of glucocorticoids in decreasing mortality in acute respiratory distress syndrome (ARDS) both in the acute and the fibroproliferative phases. METHODS: We searched the MEDLINE database for relevant studies published between 1980 and 2006, and included studies if the study design was a randomized controlled trial or observational study (comparing historical controls). The study population included patients with ARDS treated with glucocorticoids. We calculated the odds ratio and 95% confidence intervals (CI) for the outcome of mortality. RESULTS: Six trials met the inclusion criteria; three investigated the role of steroids in early stage disease (n = 300) and three investigated the role of steroids in late stage disease (n = 235). The odds of glucocorticoids decreasing mortality in patients with early ARDS were 0.57 (95% CI: 0.25-1.32) with a number needed to treat of 10 for benefit (818 harm to 5 benefit) whereas the odds of glucocorticoids decreasing mortality in patients with late ARDS was 0.58 (95% CI: 0.22-1.53) with a number needed to treat of 15 for harm (6 harm to 21 benefit). However, there was significant heterogeneity. CONCLUSIONS: Current evidence does not support a role for corticosteroids in the management of ARDS in either the early or late stages of the disease. More research is required to establish the role of steroids in specific subgroups of patients with severe sepsis and early ARDS who have relative adrenal insufficiency and patients with late ARDS 7-14 days after the onset of disease.