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1.
HERD ; 17(2): 360-375, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38288612

RESUMO

AIM: To summarize the existing literature surrounding the influence of natural elements on course in hospital and to introduce clinicians to the concept of biophilic design and the potential for incorporation of nature into the hospital environment as a component of a therapeutic hospitalization. BACKGROUND: For decades, architects and designers have espoused the benefits of incorporating natural elements into the healthcare environment for therapeutic purposes. The benefits of this "biophilic" design philosophy has been investigated predominantly in long-term care or rehabilitation settings; however, some of the most appealing opportunities lie in the acute care setting. METHODS: This scoping review surveyed the literature surrounding the influence of exposure to nature on course in acute hospitalizations. After screening 12,979 citations, 41 articles were included. Exposures were divided into seven categories, the most common of which were the presence of a window/natural light, a natural scene through a window, and nature soundscapes. These articles were reviewed in a narrative fashion and thematic analysis was conducted. RESULTS: Studies were extremely heterogeneous in their design, research questions, and reported outcomes. Types of exposure to nature studied were exposure to a real natural scene through a window, presence of a window/nature light, nature in the healthcare environment, art depicting nature, direct contact with nature, nature soundscapes, and nature experienced through virtual reality (VR). CONCLUSIONS: Exposure to nature during an acute hospital admission appears to have a real but small therapeutic effect, predominantly on psychological metrics like anxiety/depression, pain, and patient satisfaction. Greater beneficial effects are seen with greater durations of exposure to nature and greater degrees of immersion into nature (e.g., creating multisensory experiences using emerging technology like VR).


Assuntos
Arquitetura Hospitalar , Natureza , Humanos , Arquitetura Hospitalar/métodos , Hospitalização , Pacientes Internados/psicologia , Ambiente de Instituições de Saúde , Tempo de Internação
2.
Respirol Case Rep ; 11(2): e01081, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36619889

RESUMO

Peribronchiolar metaplasia (PBM) is a histological finding of uncertain significance commonly seen in interstitial lung disease (ILD). PBM is thought to be secondary to small airway injury from insults such as tobacco smoke and other environmental exposures. The term PBM-ILD has been proposed for patients with ILD where PBM is the major histologic finding, however a lack of radiographic changes supportive of ILD in previously reported cases has limited recognition of the diagnosis. We present a rare case of welding-associated ILD with clinical, radiographic, and histologic evidence consistent with the proposed definition of PBM-ILD. We outline an approach to its consideration as a diagnosis based on our experience through multidisciplinary discussion.

3.
Br J Surg ; 109(1): 30-36, 2021 12 17.
Artigo em Inglês | MEDLINE | ID: mdl-34921604

RESUMO

BACKGROUND: Despite persistently poor oncological outcomes, approaches to the management of T4 colonic cancer remain variable, with the role of neoadjuvant therapy unclear. The aim of this review was to compare oncological outcomes between direct-to-surgery and neoadjuvant therapy approaches to T4 colon cancer. METHODS: A librarian-led systematic search of MEDLINE, Embase, the Cochrane Library, Web of Science, and CINAHL up to 11 February 2020 was performed. Inclusion criteria were primary research articles comparing oncological outcomes between neoadjuvant therapies or direct to surgery for primary T4 colonic cancer. Based on PRISMA guidelines, screening and data abstraction were undertaken in duplicate. Quality assessment was carried out using Cochrane risk-of-bias tools. Random-effects models were used to pool effect estimates. This study compared pathological resection margins, postoperative morbidity, and oncological outcomes of cancer recurrence and overall survival. RESULTS: Four studies with a total of 43 063 patients met the inclusion criteria. Compared with direct to surgery, neoadjuvant therapy was associated with increased rates of margin-negative resection (odds ratio (OR) 2.60, 95 per cent c.i. 1.12 to 6.02; n = 15 487) and 5-year overall survival (pooled hazard ratio 1.42, 1.10 to 1.82, I2 = 0 per cent; n = 15 338). No difference was observed in rates of cancer recurrence (OR 0.42, 0.15 to 1.22; n = 131), 30-day minor (OR 1.12, 0.68 to 1.84; n = 15 488) or major (OR 0.62, 0.27 to 1.44; n = 15 488) morbidity, or rates of treatment-related adverse effects. CONCLUSION: Compared with direct to surgery, neoadjuvant therapy improves margin-negative resection rates and overall survival.


Assuntos
Neoplasias do Colo/cirurgia , Terapia Neoadjuvante , Neoplasias do Colo/mortalidade , Neoplasias do Colo/terapia , Terapia Combinada , Humanos , Terapia Neoadjuvante/métodos , Resultado do Tratamento
4.
Curr Oncol ; 28(3): 2065-2078, 2021 05 29.
Artigo em Inglês | MEDLINE | ID: mdl-34072615

RESUMO

While adjuvant treatment of colon cancers that penetrate the serosa (T4) have been well-established, neoadjuvant strategies have yet to be formally evaluated. Our objective was to perform a scoping review of eligibility criteria, treatment regimens, and primary outcomes for neoadjuvant approaches to T4 colon cancer. A librarian-led, systematic search of MEDLINE, Embase, Cochrane Library, Web of Science, and CINAHL up to 11 February 2020 was performed. Primary research evaluating neoadjuvant treatment in T4 colon cancer were included. Screening and data abstraction were performed in duplicate; analyses were descriptive or thematic. A total of twenty studies were included, most of which were single-arm, single-center, and retrospective. The primary objectives of the literature to date has been to evaluate treatment feasibility, tumor response, disease-free survival, and overall survival in healthy patients. Conventional XELOX and FOLFOX chemotherapy were the most commonly administered interventions. Rationale for selecting a specific regimen and for treatment eligibility criteria were poorly documented across studies. The current literature on neoadjuvant strategies for T4 colon cancer is overrepresented by single-center, retrospective studies that evaluate treatment feasibility and efficacy in healthy patients. Future studies should prioritize evaluating clear selection criteria and rationale for specific neoadjuvant strategies. Validation of outcomes in multi-center, randomized trials for XELOX and FOLFOX have the most to contribute to the growing evidence for this poorly managed disease.


Assuntos
Neoplasias do Colo , Terapia Neoadjuvante , Quimioterapia Adjuvante , Neoplasias do Colo/tratamento farmacológico , Intervalo Livre de Doença , Humanos , Estudos Retrospectivos
5.
Colorectal Dis ; 23(8): 2146-2153, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33999494

RESUMO

AIM: The timing of ileostomy reversal has been the subject of controversy, with researchers investigating the safety of early versus late stoma closure. Anecdotally, a longer duration of faecal diversion is associated with a greater incidence of postoperative ileus. We sought to investigate the association between duration of diversion and postoperative ileus. METHOD: We conducted an institutional retrospective cohort study on 173 patients undergoing ileostomy closure between 2012 and 2018. Our primary outcome was ileus; secondary outcomes included postoperative complications and descriptive factors. We investigated the association between duration of diversion and ileus using several analyses to ensure that time was treated appropriately as a continuous, nonlinear variable. RESULTS: In all, 20.2% of patients had an ileus. Multivariate analysis did not identify a significant association between any independent predictors and ileus, although there was a trend towards increased risk of ileus with increasing duration of diversion. When treated as a categorical variable, a duration of diversion >328 days independently increased the odds of ileus (OR = 3.25, P = 0.033). Duration of diversion was associated with days to first flatus and to first diet (P = 0.025 and P = 0.004, respectively). When patients received nasogastric intubation, the mean duration of intubation was 3.2 days. CONCLUSION: Greater duration of diversion was associated with a trend towards increased risk of ileus; this risk tripled when diversion lasted more than 328 days.


Assuntos
Íleus , Obstrução Intestinal , Colostomia , Humanos , Ileostomia/efeitos adversos , Íleus/epidemiologia , Íleus/etiologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos
6.
Can Med Educ J ; 12(1): e193-e194, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33680256
7.
Surgery ; 170(2): 493-498, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33608150

RESUMO

BACKGROUND: Survey-based studies are often the basis of policy changes; however, the methodologic quality of such research can be questionable. Methodologic reviews of survey-based studies have been conducted in other medical fields, but the surgical literature has not been assessed. METHODS: All citations published in 9 major surgical journals from 2002 to 2019 were screened for studies administering surveys to health care professionals. Descriptive and methodologic data were collected by 2 reviewers who also assessed the transparency and quality of the methodology. Agreement between reviewers was assessed using a weighted κ-statistic. Survey quality metrics were measured, descriptive statistics were calculated, and regression analysis was used to assess the association between subjective overall study quality and objective quality metrics. RESULTS: We included 271 articles in our analysis; the weighted-κ for reviewer quality assessment was 0.69 and for transparency assessment was 0.71. Deficiencies were identified in questionnaire development methodology and reporting, in which the median number of developmental steps reported was 1 (of 8) and in the reporting of incomplete/missing data where 63% of studies failed to report how incomplete questionnaires were managed; 70% of studies failed to report missing data. Overall subjective quality was positively associated with objective quality metrics. CONCLUSION: The deficiencies identified in the surgical literature highlight the need for improvement in the conduct and reporting of survey-based research, both in the surgical literature and more broadly. Adoption of a standardized reporting guideline for survey-based research may ameliorate the deficiencies identified by this study and other investigations.


Assuntos
Cirurgia Geral , Pesquisa Qualitativa , Inquéritos e Questionários , Humanos , Reprodutibilidade dos Testes , Projetos de Pesquisa
8.
Diabetologia ; 64(3): 491-503, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33409572

RESUMO

AIMS/HYPOTHESIS: The association between a history of hypertensive disorders of pregnancy (HDP) and subsequent type 2 diabetes (referred to throughout as diabetes) remains inconclusive. We reviewed the most recent evidence to quantify the association of previous HDP with incident diabetes. METHODS: A systematic search of MEDLINE, Embase and CINAHL was performed up to 17 February 2020 to identify observational studies of the association between HDP (pre-eclampsia or gestational hypertension) and incident diabetes. Studies of women with pre-pregnancy diabetes were excluded. Two independent reviewers screened citations and abstracted results. Study quality was assessed in duplicate using the Newcastle-Ottawa Scale. Random-effects models were used to pool effect estimates. Heterogeneity was assessed using the I2 statistic. RESULTS: After screening 4617 citations, 16 cohort studies with a total of 3,095,457 participants were included (unspecified HDP n = 5, pre-eclampsia only n = 4, gestational hypertension and pre-eclampsia n = 7). Risks of subsequent diabetes were significantly higher in women with a history of any HDP (HDP: adjusted hazard ratio [aHR] 2.24, 95% CI 1.95, 2.58; gestational hypertension: aHR 2.19 [95% CI 1.69, 2.84]; pre-eclampsia: aHR 2.56 [95% CI 2.02, 3.24]; preterm pre-eclampsia: aHR 3.05 [95% CI 2.05, 4.56]). The association between HDP and diabetes persisted in studies that adjusted for gestational diabetes mellitus (aHR 2.01 [95% CI 1.77, 2.28]). CONCLUSIONS/INTERPRETATION: HDP are independently associated with a higher risk of diabetes. Further study is needed to determine how HDP contribute to diabetes risk prediction to develop evidence-based screening and prevention strategies. Graphical abstract.


Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Hipertensão Induzida pela Gravidez/epidemiologia , Adulto , Diabetes Mellitus Tipo 2/diagnóstico , Feminino , Humanos , Hipertensão Induzida pela Gravidez/diagnóstico , Incidência , Pessoa de Meia-Idade , Pré-Eclâmpsia/diagnóstico , Pré-Eclâmpsia/epidemiologia , Gravidez , Prognóstico , Medição de Risco , Fatores de Risco , Fatores de Tempo
9.
Obes Surg ; 31(1): 299-306, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32970257

RESUMO

PURPOSE: While cannabis is the most commonly used non-prescription drug in the USA and has established effects on weight, its implication for bariatric surgery has not been formally evaluated. We aimed to review the current literature on perioperative cannabis use in patients undergoing bariatric surgery. MATERIALS AND METHODS: Our systematic search of MEDLINE and Embase until March 2020 returned 169 citations. Screening and abstraction of results were performed in duplicate, and qualitative synthesis of the data was performed. Primary outcomes were cannabis use characteristics, weight loss outcomes, and 30-day postoperative morbidity. Study quality was assessed through the MINORS risk-of-bias tool. RESULTS: Six observational studies with a total of 1167 patients (78.6% female, median follow-up 12 months [3-38.4 months]) were included. A total of 9.9% of patients (n = 116/1167) used cannabis in the perioperative period. Compared with non-users, 1-year weight loss was significantly higher in a study evaluating 8 preoperative cannabis users (n = 8/239, p = 0.002); however, there were no differences in single-study data on 90-day total weight loss (n = 434, p = 0.89) nor 2-year excess BMI loss (n = 146, p = 0.631). There was no difference in 30-day minor (RR 0.91, 95%CI 0.49-1.71, p = 0.77) or major morbidity (RR 0.75, 95%CI 0.31-1.79; p = 0.50). CONCLUSION: There are only uncontrolled studies to date on cannabis use in bariatric surgery. While these have reported conflicting effects on weight loss and no effect on morbidity to date, validation in randomized trials is required to facilitate evidence-based recommendations.


Assuntos
Cirurgia Bariátrica , Cannabis , Obesidade Mórbida , Feminino , Humanos , Masculino , Obesidade Mórbida/cirurgia , Redução de Peso
10.
J Surg Educ ; 78(2): 548-560, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32768379

RESUMO

INTRODUCTION: Humanism in surgery is an emerging priority in surgical education. Its emphasis on the patient experience is a key component of the therapeutic relationship between surgeons and their patients. However, the documented high rates of compassion fatigue and burnout among surgical trainees and staff can serve as a barrier in delivering care with empathy and compassion. As such, this systematic review seeks to characterize the outcomes regarding interventions that aim to broadly improve humanism within surgery. METHODS: A systematic search of 4 electronic databases (EMBASE, MEDLINE, PsycINFO, and Cochrane CENTRAL) was conducted through an independent double selection and extraction process from database inception to March 20, 2020. The inclusion criteria consisted of interventional studies aiming to improve humanism in surgery at all levels of training. A qualitative synthesis and thematic analysis were performed. RESULTS: A total of 19 studies (1 RCT, 14 prospective cohort, and 4 cross-sectional studies), with 20 intervention arms, were included from the initial 745 studies that were eligible for title screening. Studies included a total of 1763 surgical trainees at varying levels of training. Two major strategies for improving humanism were identified: (1) directly through the development of empathetic communication skills (n = 11) and (2) indirectly through programs aimed at reducing levels of compassion fatigue and emotional exhaustion by addressing trainee burnout (n = 9). A total of 70% (14/20) of the studied interventions were successful in improving empathy in surgical trainees. CONCLUSION: Interactive workshops around the principles of empathetic communication with patient simulations and small group learning were effective at improving empathy in surgical trainees. Furthermore, mindfulness-based training and the provision of physical resources to support trainee well-being consistently improved rates of burnout among surgical trainees. Overall, further investigation is necessary to better understand methods of improving empathy in surgery.


Assuntos
Esgotamento Profissional , Fadiga de Compaixão , Esgotamento Profissional/prevenção & controle , Estudos Transversais , Empatia , Humanismo , Humanos , Estudos Prospectivos
13.
Mol Cell Proteomics ; 19(1): 50-64, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31678930

RESUMO

The RAS/mitogen-activated protein kinase (MAPK) signaling pathway regulates various biological functions, including cell survival, proliferation and migration. This pathway is frequently deregulated in cancer, including melanoma, which is the most aggressive form of skin cancer. RSK (p90 ribosomal S6 kinase) is a MAPK-activated protein kinase required for melanoma growth and proliferation, but relatively little is known about its function and the nature of its cellular partners. In this study, we used a proximity-based labeling approach to identify RSK proximity partners in cells. We identified many potential RSK-interacting proteins, including p120ctn (p120-catenin), which is an essential component of adherens junction (AJ). We found that RSK phosphorylates p120ctn on Ser320, which appears to be constitutively phosphorylated in melanoma cells. We also found that RSK inhibition increases melanoma cell-cell adhesion, suggesting that constitutive RAS/MAPK signaling negatively regulates AJ integrity. Together, our results indicate that RSK plays an important role in the regulation of melanoma cell-cell adhesion.


Assuntos
Cateninas/metabolismo , Adesão Celular/genética , Melanoma/metabolismo , Proteômica/métodos , Proteínas Quinases S6 Ribossômicas 90-kDa/metabolismo , Cateninas/genética , Linhagem Celular Tumoral , Células HEK293 , Humanos , Sistema de Sinalização das MAP Quinases/genética , Proteínas Quinases Ativadas por Mitógeno/metabolismo , Fosforilação , Interferência de RNA , Proteínas Quinases S6 Ribossômicas 90-kDa/genética , Transdução de Sinais/genética , delta Catenina
15.
J Neuroimaging ; 29(3): 376-382, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30640412

RESUMO

BACKGROUND AND PURPOSE: The anterior cingulate cortex (ACC) is involved in several cognitive processes including executive function. Degenerative changes of ACC are consistently seen in Alzheimer's disease (AD). However, volumetric changes specific to the ACC in AD are not clear because of the difficulty in segmenting this region. The objectives of the current study were to develop a precise and high-throughput approach for measuring ACC volumes and to correlate the relationship between ACC volume and cognitive function in AD. METHODS: Structural T1 -weighted magnetic resonance images of AD patients (n = 47) and age-matched controls (n = 47) at baseline and at 24 months were obtained from the Alzheimer's disease neuroimaging initiative (ADNI) database and studied using a custom-designed semiautomated segmentation protocol. RESULTS: ACC volumes obtained using the semiautomated protocol were highly correlated to values obtained from manual segmentation (r = .98) and the semiautomated protocol was considerably faster. When comparing AD and control subjects, no significant differences were observed in baseline ACC volumes or in change in ACC volumes over 24 months using the two segmentation methods. However, a change in ACC volume over 24 months did not correlate with a change in mini-mental state examination scores. CONCLUSIONS: Our results indicate that the proposed semiautomated segmentation protocol is reliable for determining ACC volume in neurodegenerative conditions including AD.


Assuntos
Doença de Alzheimer/diagnóstico por imagem , Giro do Cíngulo/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Doença de Alzheimer/patologia , Bases de Dados Factuais , Giro do Cíngulo/patologia , Humanos , Processamento de Imagem Assistida por Computador , Neuroimagem/métodos
16.
Can Med Educ J ; 9(4): e146-e147, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30498557
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