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1.
Rev Clin Esp ; 223(5): 255-261, 2023 May.
Artigo em Espanhol | MEDLINE | ID: mdl-37124998

RESUMO

Introduction: Recent surgery is a well-known major transient risk factor for venous thromboembolism (VTE) due to the low risk of VTE recurrence after anticoagulation is discontinued. On the other hand, the risk of VTE recurrence among patients with COVID-19-associated VTE is unknown. This study aimed to compare the risk of VTE recurrence between patients with COVID-19- and surgery-associated VTE. Methods: A prospective observational single-center study was performed including consecutive patients diagnosed with VTE in a tertiary hospital from January 2020 to May 2022 and followed up for at least 90 days. Baseline characteristics, clinical presentation, and outcomes were assessed. The incidence of VTE recurrence, bleeding, and death was compared between both groups. Results: A total of 344 patients were included in the study: 111 patients with surgery-associated VTE and 233 patients with COVID-19-associated VTE. Patients with COVID-19-associated VTE were more frequently men (65.7% vs 48.6%, p = 0.003). VTE recurrence was 3% among COVID-19 patients and 5.4% among surgical patients, with no significant differences (p = 0.364). The incidence rate of recurrent VTE was 1.25 per 1000 person-months in COVID-19 patients and 2.29 person-months in surgical patients, without significant differences (p = 0.29). In the multivariate analysis, COVID-19 was associated with higher mortality (HR 2.34; 95% CI 1.19-4.58), but not with a higher risk of recurrence (HR 0.52; 95% CI 0.17-1.61). No differences were found in recurrence in the multivariate competing risk analysis (SHR 0.82; 95% CI 0.40 - 2.05). Conclusions: In patients with COVID-19 and surgery-associated VTE, the risk of recurrence was low, with no differences between both groups.

2.
Arch Virol ; 166(12): 3421-3425, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34618227

RESUMO

Simple and standardized approaches for genome analysis of human papillomavirus (HPV) by next-generation sequencing are needed. The aim of the study was to develop a protocol for direct deep sequencing of high-risk (hr) HPV strains, based on the widely used commercial Hybrid Capture 2 (QIAGEN) test, without any additional probe design. This protocol was applied to 15 HPV-positive and two HPV-negative cervical samples or cell lines and validated at the genotype level by comparing the sequencing results to those obtained using a commercial genotyping kit. The performance of our protocol, presented in this proof-of-principle study, supports its use for accurate characterization of genetic variants of hrHPV.


Assuntos
Alphapapillomavirus , Infecções por Papillomavirus , Neoplasias do Colo do Útero , Colo do Útero , DNA Viral , Feminino , Genótipo , Humanos , Papillomaviridae/genética , Sensibilidade e Especificidade
3.
Bull Entomol Res ; 111(5): 568-578, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33858528

RESUMO

The Mediterranean fruit fly, Ceratitis capitata (Wiedemann), is one of the main pests of fruit, worldwide, and the use of population suppression method with low environmental impact is an increasingly strong requirement of the consumer market. The aim of this study was to evaluate the effect of mineral and natural films on the physical-chemical properties of grapes (Vitis vinifera L.), cultivar Itália, and oviposition behaviour of C. capitata. Fruits were immersed in suspensions (100 and 200 g L-1) of mineral (kaolin Surround®WP, kaolin 607, kaolin 608, kaolin 611 and talc) and natural films (chitosan, cassava starch, potato starch and guar gum 5.0 g L-1) and distilled water (control). After drying, fruits were exposed to C. capitata pairs of males and females for 24 h in choice and non-choice tests; the number of punctures with and without eggs, eggs per fruit and behavioural response of fly to treated and untreated fruits were recorded. Results obtained in this study are promising, given the scientific evidence that films of mineral particles such as kaolin (Surround®, 607, 608 and 611) changed the firmness, luminosity, chroma and hue angle of grapes and reduced the oviposition of C. capitata. In addition, our results also showed that natural polymers do not deter C. capitata females, but rather seem to stimulate oviposition.


Assuntos
Ceratitis capitata/fisiologia , Filmes Cinematográficos , Oviposição , Vitis , Animais , Feminino , Frutas , Caulim , Masculino , Polímeros , Talco
4.
Int Endod J ; 53(9): 1181-1191, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32496605

RESUMO

AIM: To explore a set of inflammatory biomarkers obtained from dentinal fluid (DF) from patients with symptomatic irreversible pulpitis (IP), reversible pulpitis (RP) and normal pulp (NP). METHODOLOGY: A cross-sectional exploratory study was performed, recruiting 64 patients on the basis of their respective pulp condition. DF samples were obtained from all patients (23, from IP patients; 20, from RP patients; and 21, from NP patients). Quantification of biomarkers was performed using a Luminex® MAGPIX platform system and multiplex assay kits. The Kruskal-Wallis test was used for comparisons with regard to pulp state. A simple logistic regression model and the odds ratio (OR) with a 95% level of confidence (P = 0.05) were used to evaluate associations between biomarker levels and pulpal diagnosis. The performance discrimination of the biomarkers was evaluated through the construction of a receiver operating characteristic (ROC) curve by calculating the area under the curve (AUC) for IP versus RP after logistic regression modelling. Youden criteria were used to establish cut-off points for biomarkers alone with AUC > 70 and P-value < 0.05, or estimated probabilities from the multivariable logistic model. RESULTS: The biomarkers that had significantly higher values in participants with IP versus RP were IL-1α, VEGF-α and FGF acid (P < 0.05). FGF acid (OR: 12.62; P = 0.0085; CI 95% 1.91-83.29) and VEGF-α (OR: 2.61; P = 0.0252; CI 95% 1.13-6.03) were associated with pulp diagnoses of IP versus RP. The AUC-ROC curve for FGF acid was 0.79. The model containing FGF acid, IL-1α, IL-6 and TIMP-1 had an AUC-ROC of 0.92 for IP versus RP with a significant difference from the FGF acid ROC curve (P = 0.0231). CONCLUSIONS: Dentinal fluid could be used to assay pulpal mediators in the molecular diagnosis of pulpitis. Despite the limitation of the clinical diagnostics used in the present study, it was possible to detect a difference between irreversible symptomatic pulpitis and reversible pulpitis associated with the following combined biomarkers: FGF acid + IL-6 + IL-1α, +TIMP-1.


Assuntos
Pulpite , Biomarcadores , Estudos Transversais , Polpa Dentária , Líquido Dentinal , Humanos , Patologia Molecular
5.
Bull Entomol Res ; 109(3): 408-417, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30488810

RESUMO

Sexual behavioural isolation can result from sexual selection and represents a relevant factor associated with the speciation process. We analysed the pheromone emission pattern and the courtship of males of five different populations of the Anastrepha fraterculus cryptic complex: Brazil (Vacaria, Tucumán and Piracicaba), Colombia and Peru. The time of pheromone emission was recorded in each population every 30 min during the day. The behavioural sequences of courting were video recorded and analysed using EthoSeq software. Males from different populations have showed different period of pheromone emission - Vacaria, Piracicaba and Tucumán executed calling only during the morning, Colombia only in the afternoon and Peru during both periods. The general frequencies of the courtship units of the males were distinct among the populations. Three groups were formed in the classification from the function of 14 behavioural routines: Vacaria, Piracicaba and Tucumán formed a single group (Brazil-1), while Colombia and Peru formed two distinct groups. In the probabilistic trees generated, the behavioural units that most contributed to the occurrence of copulation were distinct among the three groups formed: Brazil-1 (Contact, Alignment and Arrowhead-1); Colombia (Flying, Mobile, Contact and Alignment); Peru (Flying, Arrowhead-1 and Calling). Our results indicated differences in sexual behaviour that may explain the behavioural isolation found between the distinct groups in addition with the temporal isolation found between the Brazil-1 and Colombia populations. The evolutionary implications for the A. fraterculus cryptic species complex are discussed.


Assuntos
Corte , Feromônios/metabolismo , Tephritidae/classificação , Tephritidae/fisiologia , Animais , Ritmo Circadiano/fisiologia , Especiação Genética , Masculino , Comportamento Sexual Animal/fisiologia , América do Sul , Especificidade da Espécie
6.
Int J Cancer ; 140(9): 2092-2100, 2017 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-28187495

RESUMO

Human Papillomavirus 16 (HPV16) causes 70% of invasive cervical cancers (ICC) worldwide. Interaction between HPV16 genetic diversity, host genetics and target tissue largely determine the chances to trigger carcinogenesis. We have analyzed the differential prevalence of viral variants in 233 HPV16-monoinfected squamous (SCC), glandular (ADC) and mixed (ADSC) ICCs from four continents, assessing the contribution of geographical origin and cancer histology. We have further quantified the contribution of viral variants and cancer histology to differences in age at tumor diagnosis. The model fitted to the data explained 97% of the total variance: the largest explanatory factors were differential abundance among HPV16 variants (78%) and their interaction with cancer histology (9.2%) and geography (10.1%). HPV16_A1-3 variants were more prevalent in SCC while HPV16_D variants were increased in glandular ICCs. We confirm further a non-random geographical structure of the viral variants distribution. ADCs were diagnosed at younger ages than SCCs, independently of the viral variant triggering carcinogenesis. HPV16 variants are differentially associated with histological ICCs types, and ADCs are systematically diagnosed in younger women. Our results have implications for the implementation of cervical cancer screening algorithms, to ensure proper early detection of elusive ADCs.


Assuntos
Adenocarcinoma/virologia , Carcinoma Adenoescamoso/virologia , Carcinoma de Células Escamosas/virologia , Neoplasias do Colo do Útero/virologia , Adenocarcinoma/epidemiologia , Adenocarcinoma/patologia , Adulto , Idoso , Carcinoma Adenoescamoso/epidemiologia , Carcinoma Adenoescamoso/patologia , Carcinoma de Células Escamosas/epidemiologia , Carcinoma de Células Escamosas/patologia , Feminino , Genótipo , Papillomavirus Humano 16/genética , Papillomavirus Humano 16/isolamento & purificação , Papillomavirus Humano 16/patogenicidade , Humanos , Pessoa de Meia-Idade , Infecções por Papillomavirus/virologia , Filogenia , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/patologia , Proteínas Virais/genética
7.
Mol Ecol ; 26(7): 1832-1847, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28206693

RESUMO

Plasmids are nucleic acid molecules that can drive their own replication in a living cell. They can be transmitted horizontally and can thrive in the host cell to high-copy numbers. Plasmid replication and gene expression consume cellular resources and cells carrying plasmids incur fitness costs. But many plasmids carry genes that can be beneficial under certain conditions, allowing the cell to endure in the presence of antibiotics, toxins, competitors or parasites. Horizontal transfer of plasmid-encoded genes can thus instantaneously confer differential adaptation to local or transient selection conditions. This conflict between cellular fitness and plasmid spread sets the scene for multilevel selection processes. We have engineered a system to study the short-term evolutionary impact of different synonymous versions of a plasmid-encoded antibiotic resistance gene. Applying experimental evolution under different selection conditions and deep sequencing allowed us to show rapid local adaptation to the presence of antibiotic and to the specific version of the resistance gene transferred. We describe the presence of clonal interference at two different levels: at the within-cell level, because a single cell can carry several plasmids, and at the between-cell level, because a bacterial population may contain several clones carrying different plasmids and displaying different fitness in the presence/absence of antibiotic. Understanding the within-cell and between-cell dynamics of plasmids after horizontal gene transfer is essential to unravel the dense network of mobile elements underlying the worldwide threat to public health of antibiotic resistance.


Assuntos
Escherichia coli/genética , Evolução Molecular , Transferência Genética Horizontal , Plasmídeos/genética , Adaptação Fisiológica , Antibacterianos/farmacologia , Cromossomos Bacterianos/genética , DNA Bacteriano/genética , Farmacorresistência Bacteriana/genética , Escherichia coli/efeitos dos fármacos , Sequenciamento de Nucleotídeos em Larga Escala , Análise de Sequência de DNA
8.
Heredity (Edinb) ; 118(2): 177-185, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-27624114

RESUMO

Using computer simulations, we evaluate the effects of genetic purging of inbreeding load in small populations, assuming genetic models of deleterious mutations which account for the typical amount of load empirically observed. Our results show that genetic purging efficiently removes the inbreeding load of both lethal and non-lethal mutations, reducing the amount of inbreeding depression relative to that expected without selection. We find that the minimum effective population size to avoid severe inbreeding depression in the short term is of the order of Ne≈70 for a wide range of species' reproductive rates. We also carried out simulations of captive breeding populations where two contrasting management methods are performed, one avoiding inbreeding (equalisation of parental contributions (EC)) and the other forcing it (circular sib mating (CM)). We show that, for the inbreeding loads considered, CM leads to unacceptably high extinction risks and, as a result, to lower genetic diversity than EC. Thus we conclude that methods aimed at enhancing purging by intentional inbreeding should not be generally advised in captive breeding conservation programmes.


Assuntos
Conservação dos Recursos Naturais/métodos , Genética Populacional , Endogamia , Modelos Genéticos , Cruzamento , Simulação por Computador , Variação Genética , Mutação , Densidade Demográfica
9.
Environ Monit Assess ; 188(3): 157, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26869047

RESUMO

The Mediterranean endemic seagrass Posidonia oceanica is widely used as a sensitive bioindicator of trace elements (TEs) in the coastal environment. Therefore, a bulk of data exist on TE levels from impacted versus unpolluted sites while only recent studies started comparing TE accumulation in plant compartments versus both water column and sediment characteristics. In this study, six TEs (As, Cd, Cr, Cu, Ni, Pb) were analyzed in P. oceanica shoots related to depth (-10 and -20 m) and to TE concentrations in the different grain size fractions of the sediment, from two Sites of Community interest (SIC) in the central Tyrrhenian Sea. TE concentrations in both shoots and sediment were generally low, except for Cr. Cu was the only element showing significantly different concentrations at the two sites while As differed significantly between samples taken at different depths. TE concentrations in the unsieved sediment were found uncorrelated to TEs in shoots except for the important nutrient Cu (positive correlation). The finest sediment fractions were enriched in TEs and significantly correlated to Cd, Cr, Cu, and Ni concentrations in the shoots.


Assuntos
Alismatales/metabolismo , Monitoramento Ambiental , Oligoelementos/análise , Poluentes Químicos da Água/análise , Mar Mediterrâneo , Água do Mar/química , Oligoelementos/metabolismo
10.
J Environ Manage ; 154: 128-37, 2015 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-25721980

RESUMO

An anaerobic sequencing batch biofilm reactor (AnSBBR) with recirculation of the liquid phase (at 30 °C with 3.5 L of working volume and treating 1.5 L per cycle) treating pure glycerin-based wastewater was applied to biohydrogen production. The applied volumetric organic load (AVOL) ranged from 7.7 to 17.1 kgCOD m(-3) d(-1), combining different influent concentrations (3000, 4000 and 5000 mgCOD L(-1)) and cycle lengths (4 and 3 h). The feed strategy used was to maintain the feeding time equal to half of the cycle time. The increase in the influent concentration and the decrease in cycle length improved the molar yield and molar productivity of hydrogen. The highest productivity (100.8 molH2 m(-3) d(-1)) and highest yield of hydrogen per load removed (20.0 molH2 kgCOD(-1)) were reached when the reactor operated with an AVOL of 17.1 kgCOD m(-3) d(-1), with 68% of H2 and only 3% of CH4 in its biogas. It was also found that pretreatment of the sludge/inoculum does not influence the productivity/yield of the process and the use of crude industrial glycerin-based wastewater in relation to the pure glycerol-based wastewater substantially decreased the production and composition of the hydrogen produced.


Assuntos
Reatores Biológicos , Glicerol , Águas Residuárias/química , Purificação da Água/métodos , Bactérias Anaeróbias/metabolismo , Biofilmes , Humanos , Compostos Orgânicos/metabolismo , Microbiologia da Água
11.
J Obstet Gynaecol ; 35(8): 821-4, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26082298

RESUMO

The prevalence of alcohol intake in women who become pregnant is similar to that found in the general population, especially in cases of unplanned pregnancies. Consequently, foetal exposure is high during the period of maximum vulnerability. The present study was carried out to determine the prenatal level of exposure to alcohol in Málaga, a Mediterranean region whose economy is based on the touristic sector (Costa del Sol). A cross-sectional, observational design was used to investigate the consumption of alcohol during pregnancy, based on a self-reporting questionnaire. A total of 451 women in the first, second or third trimesters of pregnancy were recruited. Consumption prevalences in each trimester were 40.7%, 25.5% and 17.1%. A higher educational level was associated with greater exposure to alcohol (risk ratio, 1.87 [1.30-2.69]). These results should alert the providers of obstetric care in touristic areas to the need for the adoption of adequate preventive measures.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Gravidez/psicologia , Adulto , Estudos Transversais , Feminino , Humanos , Região do Mediterrâneo/epidemiologia , Espanha/epidemiologia
12.
J Clin Microbiol ; 52(5): 1511-8, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24574284

RESUMO

In Catalonia, a screening protocol for cervical cancer, including human papillomavirus (HPV) DNA testing using the Digene Hybrid Capture 2 (HC2) assay, was implemented in 2006. In order to monitor interlaboratory reproducibility, a proficiency testing (PT) survey of the HPV samples was launched in 2008. The aim of this study was to explore the repeatability of the HC2 assay's performance. Participating laboratories provided 20 samples annually, 5 randomly chosen samples from each of the following relative light unit (RLU) intervals: <0.5, 0.5 to 0.99, 1 to 9.99, and ≥10. Kappa statistics were used to determine the agreement levels between the original and the PT readings. The nature and origin of the discrepant results were calculated by bootstrapping. A total of 946 specimens were retested. The kappa values were 0.91 for positive/negative categorical classification and 0.79 for the four RLU intervals studied. Sample retesting yielded systematically lower RLU values than the original test (P<0.005), independently of the time elapsed between the two determinations (median, 53 days), possibly due to freeze-thaw cycles. The probability for a sample to show clinically discrepant results upon retesting was a function of the RLU value; samples with RLU values in the 0.5 to 5 interval showed 10.80% probability to yield discrepant results (95% confidence interval [CI], 7.86 to 14.33) compared to 0.85% probability for samples outside this interval (95% CI, 0.17 to 1.69). Globally, the HC2 assay shows high interlaboratory concordance. We have identified differential confidence thresholds and suggested the guidelines for interlaboratory PT in the future, as analytical quality assessment of HPV DNA detection remains a central component of the screening program for cervical cancer prevention.


Assuntos
Papillomaviridae/genética , Infecções por Papillomavirus/diagnóstico , Neoplasias do Colo do Útero/diagnóstico , DNA Viral/genética , Detecção Precoce de Câncer/métodos , Feminino , Testes de DNA para Papilomavírus Humano/métodos , Humanos , Ensaio de Proficiência Laboratorial/métodos , Infecções por Papillomavirus/virologia , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Espanha , Neoplasias do Colo do Útero/virologia , Esfregaço Vaginal/métodos
14.
Radiography (Lond) ; 30(3): 896-907, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38608565

RESUMO

INTRODUCTION: Adapting radiotherapy services with workforce innovation using skills-mix or task-shifting optimises resources, supporting current and future demands. Advanced practitioners (APs) work at a different level of practice (beyond initial registration) across four pillars: clinical practice, leadership and management, education, and research. There is limited cross-country research on the advanced therapeutic radiographers/radiation therapists (TR/RTTs), particularly in Europe. This study aimed to investigate European radiotherapy stakeholders' perceptions regarding current and future advanced practice (AP). METHODS: From June to September 2022, one-to-one online semi-structured interviews were conducted in English, and audio and video were recorded. Full verbatim audio files were independently transcribed and checked by interviewer and interviewees. Braun and Clarke's seven steps guided the thematic analysis (using NVivo). RESULTS: Thirty-three interviewees working or studying in 16 European countries represented practitioners (n=14), managers (n=6), educators (n=4), professional bodies (n=4), students (n=3), and regulators (n=2). Four overarching themes emerged: "AP drivers and outcomes", "AP challenges vs enablers", "Current vs future AP", "Becoming and being advanced practitioner". Participants identified research as the neglected AP pillar due to a lack of protected time, limited staff skills, no research culture, no funding, workload, and clinical priorities. Interviewees highlighted the importance of consistency in job titles, harmonisation of education models and curricula, definition of AP requirements, and support for all AP pillars through job plans and workforce planning. CONCLUSION: Neither the profession nor education of TR/RTTs are harmonised across Europe, which is highly reflected in advanced-level practice. Advanced TR/RTTs should work across all pillars, including research, and these should be embedded in master's programmes, including leadership. IMPLICATIONS FOR PRACTICE: This study highlights a policy gap in the education and practice of APs in radiotherapy.


Assuntos
Radioterapia , Humanos , Europa (Continente) , Entrevistas como Assunto , Participação dos Interessados , Atitude do Pessoal de Saúde , Liderança , Pesquisa Qualitativa
15.
Rev Clin Esp (Barc) ; 224(3): 157-161, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38355098

RESUMO

INTRODUCTION: Persistent congestion after heart failure (HF) discharge is associated with a higher risk of readmissions. MATERIAL AND METHODS: eighty-two patients included after HF discharge. The aim of the study was to characterize semiquantitatively the degree of pulmonary congestion and its changes, describing the relationship between these findings and diuretic management. RESULTS: On the first visit, despite the absence of clinical congestion in the majority of patients, half of the had some degree of pulmonary congestion by ultrasound. After global assessment in this initial visit (clinical and ultrasound) the diuretic was lowered in 50 patients (60%), kept the same in 16 (20%) and it was increased in the rest. In the 45 patients without ultrasound congestion, diuretic reduction was attempted in 80%, being this strategy successful in the majority of them. CONCLUSIONS: Lung ultrasound, using simple quantification methods, allows its real incorporation into clinical practice, helping us in the decision making process.


Assuntos
Insuficiência Cardíaca , Edema Pulmonar , Humanos , Diuréticos/uso terapêutico , Alta do Paciente , Prevalência , Edema Pulmonar/complicações , Edema Pulmonar/epidemiologia , Pulmão , Insuficiência Cardíaca/complicações , Prognóstico
16.
West Indian Med J ; 62(3): 266-9, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24564053

RESUMO

Echinococcosis is a parasitic disease that involves dogs as definitive host and sheep as intermediate host. Humans become infected incidentally through fecal-oral contact, particularly in the course of playful and close contact with an infected dog. Mexico is considered a region that is virtually free of cystic echinoccocosis. This manuscript describes two cases that were referred to a tertiary-care oncology hospital with a diagnosis of cancer. In one case, the presumptive diagnosis was liver cancer because abdominal ultrasonography revealed a low-density mass in the right hepatic lobe. Drainage was performed and cytologic examination of the fluid showed multiple Echinococcus cyst as well as prostoscolex. The case was resolved with percutaneous drainage and administration of albendazole for two months. In the second case, the patient was referred with a diagnosis of disseminated cervical cancer A cyst was identified in the upper right lung lobe; a diagnostic puncture was performed showing an Echinococcus cyst. This resolved solely with two months of albendazole administration.


Assuntos
Equinococose Hepática/diagnóstico , Equinococose Pulmonar/diagnóstico , Neoplasias Hepáticas/diagnóstico , Neoplasias Pulmonares/diagnóstico , Adulto , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Neoplasias Pulmonares/secundário , México , Neoplasias do Colo do Útero/patologia
17.
Radiography (Lond) ; 29(3): 479-488, 2023 05.
Artigo em Inglês | MEDLINE | ID: mdl-36878157

RESUMO

INTRODUCTION: This study aims to assess the proficiency level of digital skills, the factors influencing that level and the training needs of Therapeutic Radiographers/Radiation Therapists (TR/RTTs), due to the differences in technology availability and accessibility, variations in the regulation and education of TR/RTTs in European countries, and the lack of a digital skills framework. METHODS: An online survey was distributed to TR/RTTs working in Europe to capture their self-assessment of proficiency levels of digital skills when performing their clinical role. Information was also gathered regarding training, work experience and level of information and communication technology (ICT) skills. Quantitative measures were analysed using descriptive statistics and correlation between variables, and qualitative responses using thematic analysis. RESULTS: 101 respondents from 13 European countries completed the survey. Digital skills in treatment planning followed by management and research were the least developed skills, while the most developed were transversal digital skills followed by digital skills in treatment delivery. The Radiotherapy areas of practice where TR/RTT has experience (e.g. Planning Image, Treatment Planning, Treatment), as well as the level of generic ICT skills (communication, content creation and problem-solving), was related to the level of proficiency of TR/RTT digital skills. Greater scope of practice and level of generic ICT were associated with a higher level of TR/RTT digital skills. Thematic analysis allowed the identification of new sub-themes to be included in the training of TR/RTTs. CONCLUSION: Education and training of TR/RTTs should be improved and adapted to the current needs of digitalisation to avoid differences in digital proficiency levels. IMPLICATIONS FOR PRACTICE: Aligning TR/RTTs' digital skill sets with emerging digitalisation will improve current practice and ensure the best care to all RT patients.


Assuntos
Radioterapia (Especialidade) , Humanos , Inquéritos e Questionários , Comunicação , Europa (Continente) , Atenção à Saúde
18.
Radiography (Lond) ; 29(2): 261-273, 2023 03.
Artigo em Inglês | MEDLINE | ID: mdl-36608396

RESUMO

INTRODUCTION: Advanced Practice (AP) roles in Radiotherapy (RT) over time are variable, often locally developed and not underpinned by professional standards which leads to conceptual and practical gaps. This study aimed to assess AP roles amongst Therapeutic Radiographers/Radiation Therapists (TR/RTTs) and identify educational gaps for this level across Europe. METHODS: An anonymous online survey was designed, validated, and distributed across Europe. Convenience sampling was used to recruit advanced TR/RTTs practitioners or TR/RTTs working in AP roles. Descriptive analysis from closed questions and thematic analyses from open questions are reported. RESULTS: A total of 272 responses were obtained, of which 189 eligible participations were from 21 European countries. 42% of respondents acknowledged additional education required to perform AP, and 25% reported a minimum of five years of RT practice to perform AP roles/tasks. There is a trend to work more on the clinical practice domain with a low percentage of working time allocated to research. Inconsistency was found in job titles, scopes of practice, and educational backgrounds across and even within countries. Education needs regarding knowledge about image-guided and adaptive RT, multimodal imaging and technologies, and advanced treatment planning were found. Training needs on leadership and management skills and clinical site-specific expertise were identified. CONCLUSION: This study clearly shows a gap in education support, a need for standardisation in job titles and scopes of practice across Europe. IMPLICATIONS FOR PRACTICE: As the first large-scale assessment of current AP roles and educational support amongst TR/RTTs across Europe, this study recommends the establishment of governance structure and role regulation. It also informs the curricula for master programmes to align the education with current and future practice.


Assuntos
Pessoal Técnico de Saúde , Radioterapia (Especialidade) , Humanos , Inquéritos e Questionários , Europa (Continente) , Atenção à Saúde
19.
Radiography (Lond) ; 29(2): 274-283, 2023 03.
Artigo em Inglês | MEDLINE | ID: mdl-36621178

RESUMO

INTRODUCTION: Global warming and the increase in greenhouse gases are a current concern worldwide. The healthcare sector constitutes about 4.4% of all emissions. This study aims to evaluate the knowledge, awareness and attitudes of Therapeutic Radiographers/Radiation Therapists (TR/RTTs) regarding environment-related concepts to inform the development of educational curriculum. METHODS: A validated self-designed survey was distributed to TR/RTTs across Europe by the SAFE EUROPE partners and via social media between October 2021 and February 2022. The survey was divided into six sections: (i) demographics, (ii) knowledge of Circular Economy (CE) and Green Skills (GS), (iii) personal attitudes, (iv) TR/RTTs attitudes, (v) the importance of CE, and (vi) education. Questions consisted of mostly Likert scales complemented with other closed- and open-ended questions. RESULTS: 31%-42% of participants are aware of national and departmental policies in CE and GS concepts. Even though half of the participants considered that they advocate and practice CE, the open questions indicated that participants only focus on waste management, ignoring all the other dimensions of CE in healthcare. Personal attitudes and lifestyles also did not reflect CE. TR/RTTs considered CE practices and GS development essential. However, the suggested academic level at which these skills should be developed was split between High School (44%) and Bachelor's degree (32%). CONCLUSION: It is essential to raise awareness among TR/RTTs about the various dimensions of CE applied to healthcare: "green transportation", "environment-friendly procurement", "hospital building design", "food process optimisation", "water reduction", "energy efficiency", and "waste management". IMPLICATIONS FOR PRACTICE: These GS must be developed by TR/RTTs to decrease their impact on the environment. Their training may need to be lifelong, starting during basic high school education and continuing as healthcare professionals after graduation.


Assuntos
Pessoal Técnico de Saúde , Currículo , Radioterapia (Especialidade) , Humanos , Pessoal de Saúde/educação , Inquéritos e Questionários , Radioterapia (Especialidade)/educação
20.
Rev Clin Esp (Barc) ; 223(5): 255-261, 2023 05.
Artigo em Inglês | MEDLINE | ID: mdl-36990384

RESUMO

INTRODUCTION: Recent surgery is a well-known major transient risk factor for venous thromboembolism (VTE) due to the low risk of VTE recurrence after anticoagulation is discontinued. On the other hand, the risk of VTE recurrence among patients with COVID-19-associated VTE is unknown. This study aimed to compare the risk of VTE recurrence between patients with COVID-19- and surgery-associated VTE. METHODS: A prospective observational single-center study was performed including consecutive patients diagnosed with VTE in a tertiary hospital from January 2020 to May 2022 and followed up for at least 90 days. Baseline characteristics, clinical presentation, and outcomes were assessed. The incidence of VTE recurrence, bleeding, and death was compared between both groups. RESULTS: A total of 344 patients were included in the study: 111 patients with surgery-associated VTE and 233 patients with COVID-19-associated VTE. Patients with COVID-19-associated VTE were more frequently men (65.7% vs 48.6%, p =  0.003). VTE recurrence was 3% among COVID-19 patients and 5.4% among surgical patients, with no significant differences (p =  0.364). The incidence rate of recurrent VTE was 1.25 per 1000 person-months in COVID-19 patients and 2.29 person-months in surgical patients, without significant differences (p =  0.29). In the multivariate analysis, COVID-19 was associated with higher mortality (HR 2.34; 95% CI 1.19-4.58), but not with a higher risk of recurrence (HR 0.52; 95% CI 0.17-1.61). No differences were found in recurrence in the multivariate competing risk analysis (SHR 0.82; 95% CI 0.40-2.05). CONCLUSIONS: In patients with COVID-19 and surgery-associated VTE, the risk of recurrence was low, with no differences between both groups.


Assuntos
COVID-19 , Embolia Pulmonar , Trombose , Tromboembolia Venosa , Masculino , Humanos , Fatores de Risco , Recidiva , Anticoagulantes
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