Survival and pulmonary function in stage IA non-small cell lung cancer after sublobar resection versus lobectomy: An updated meta-analysis.

Traditionally, lobectomy was standard for stage IA non-small-cell lung cancer (NSCLC). Recent RCTs suggest sublobar resection's comparable outcomes. Our meta-analysis, incorporating 30 studies (including four RCTs), assessed sublobar resection's efficacy. Employing a random-effects model and I2 statistics for heterogeneity, we found sublobar resection reduced DFS (HR 1.31, p < 0.01) and OS (HR 1.27, p < 0.01) overall. However, RCT subgroup analysis showed no significant differences in DFS (p = 0.28) or OS (p = 0.62). Sublobar resection is a viable option for well-selected patients.

Conductas de salud en estudiantes universitarios: un análisis bayesiano / Health behaviors in college students: a Bayesian analysis / Comportamentos de saúde em estudantes universitários: uma análise bayesiana

En la actualidad, diversos estudios han explorado las diferencias de las conductas de salud en los estudiantes universitarios de acuerdo con características como edad, sexo y ciclo de estudio, no obstante, estos se han centrado en un enfoque frecuentista basado en la prueba de significancia de la hipótesis nula (NHST). Objetivo. Explorar las diferencias de las conductas de salud de acuerdo con el sexo, edad y ciclo académico, así como establecer la relación entre estas y la percepción de salud general en estudiantes universitarios peruanos, desde un enfoque bayesiano. Materiales y métodos. Se ejecutó un estudio cuantitativo, comparativo, correlacional y transversal, en una muestra de 708 universitarios seleccionados de manera intencional. Se utilizó el cuestionario de conductas de salud (CEJUV-R) y una ficha de datos sociodemográficos. Resultados. Los hallazgos muestran que los hombres tienen mejores hábitos de actividad y condición física y organización del sueño, con respecto a las mujeres. Asimismo, se observa una evidencia moderada a favor de la hipótesis alternativa del autocuidado en función de la edad y el ciclo académico. Finalmente, la actividad física, la organización del descanso, el autocuidado y la organización del sueño presentan evidencias muy fuertes (BF>100) de su relación con la percepción general de salud. Conclusión. El análisis bayesiano mostró evidencia a favor de la hipótesis alterna en algunas de las conductas de salud en función del sexo, edad y ciclo académico, lo que resaltan la importancia de promover conductas más saludables entre los estudiantes universitarios peruanos atendiendo a sus características personales.

Currently, several studies have explored the differences in health behaviors in university students according to characteristics such as age, sex and study cycle; however, these have focused on a frequentist approach based on the null hypothesis significance test (NHST). Objective. To explore the differences in health behaviors according to sex, age and academic cycle, as well as to establish the relationship between these and the perception of general health in Peruvian university students, from a Bayesian approach. Materials and methods. A quantitative, comparative, correlational and cross-sectional study was carried out in a sample of 708 intentionally selected university students. The health behaviors questionnaire (CEJUV-R) and a sociodemographic data sheet were used. Results. The findings show that men have better habits of activity and physical condition and sleep organization, with respect to women. Likewise, there is moderate evidence in favor of the alternative hypothesis of self-care as a function of age and academic cycle. Finally, physical activity, rest organization, self-care and sleep organization present very strong evidence (BF>100) of their relationship with the general perception of health. Conclusion. The Bayesian analysis showed evidence in favor of the alternative hypothesis in some of the health behaviors as a function of sex, age and academic cycle, which highlights the importance of promoting healthier behaviors among Peruvian university students according to their personal characteristics.

Atualmente, vários estudos exploraram as diferenças nos comportamentos de saúde em estudantes universitários de acordo com características como idade, gênero e ciclo de estudos; no entanto, eles se concentraram em uma abordagem frequentista baseada no teste de significância da hipótese nula (NHST). Objetivo. Explorar as diferenças nos comportamentos de saúde de acordo com o sexo, a idade e o ciclo acadêmico, bem como estabelecer a relação entre eles e a percepção da saúde geral em estudantes universitários peruanos, a partir de uma abordagem bayesiana. Materiais e métodos. Foi realizado um estudo quantitativo, comparativo, correlacional e transversal em uma amostra de 708 estudantes universitários selecionados intencionalmente. Foram utilizados o questionário de comportamento de saúde (CEJUV-R) e uma planilha de dados sociodemográficos. Resultados. Os achados mostram que os homens têm melhores hábitos de atividade física, condicionamento físico e organização do sono do que as mulheres. Também há evidências moderadas a favor da hipótese alternativa de autocuidado em função da idade e do ciclo acadêmico. Por fim, a atividade física, a organização do descanso, o autocuidado e a organização do sono mostram evidências muito fortes (BF>100) de sua relação com a percepção geral da saúde. Conclusão. A análise bayesiana mostrou evidências a favor da hipótese alternativa em alguns dos comportamentos de saúde em função do sexo, da idade e do ciclo acadêmico, destacando a importância de promover comportamentos mais saudáveis entre os estudantes universitários peruanos de acordo com suas características pessoais.

The Australian Traumatic Brain Injury Initiative: Systematic Review of the Effect of Acute Interventions on Outcome for People With Moderate-Severe Traumatic Brain Injury.

The Australian Traumatic Brain Injury Initiative (AUS-TBI) is developing a data resource to enable improved outcome prediction for people with moderate-severe TBI (msTBI) across Australia. Fundamental to this resource is the collaboratively designed data dictionary. This systematic review and consultation aimed to identify acute interventions with potential to modify clinical outcomes for people after msTBI, for inclusion in a data dictionary. Standardized searches were implemented across bibliographic databases from inception through April 2022. English-language reports of randomized controlled trials (RCTs) evaluating any association between any acute intervention and clinical outcome in at least 100 patients with msTBI, were included. A predefined algorithm was used to assign a value to each observed association. Consultation with AUS-TBI clinicians and researchers formed the consensus process for interventions to be included in a single data dictionary. Searches retrieved 14,455 records, of which 124 full-length RCTs were screened, with 35 studies included. These studies evaluated 26 unique acute interventions across 21 unique clinical outcomes. Only 4 interventions were considered to have medium modifying value for any outcome from the review, with an additional 8 interventions agreed upon through the consensus process. The interventions with medium value were tranexamic acid and phenytoin, which had a positive effect on an outcome; and decompressive craniectomy surgery and hypothermia, which negatively affected outcomes. From the systematic review and consensus process, 12 interventions were identified as potential modifiers to be included in the AUS-TBI national data resource.

Comparing Patient-Reported Outcome Measures for Pain in Women With Pelvic Floor Disorders: A Scoping Review.

Women with pelvic floor disorders (PFDs) typically undergo surgery involving transvaginal mesh implants; however, transvaginal mesh surgery is associated with many adverse events including post-surgical pain. Assessment of pain as a symptom is necessary using patient-reported outcome measures (PROMs). This scoping review aimed to describe and compare existing PROMs previously used to measure pain in women with PFDs. A scoping search of Ovid MEDLINE, EMBASE, CINAHL Plus, Ovid PsycInfo, and grey literature was conducted. Studies published in English describing the development, implementation, and application of PFD-associated pain PROMs among adult women before and after pelvic floor surgery were included. From each article, a descriptive summary organised by study first author, publication year, country, setting, aim, study characteristics, and results were extracted. From 2,604 articles identified, 54 studies were included, describing 44 PROMs. Most studies described at least 2 to 3 instruments. The Pelvic Floor Distress Inventory-20 was most commonly described by 12 studies followed by the Patient Global Impression of Improvement scale. Of the 44 PROMs, 27 were condition-specific, of which 9 included items on pain; 17 generic PROMs, 4 of which contained items on pain; and 6 pain-specific PROMs. PROMs identified in our review measured pain not related to PFDs or pelvic floor surgery and quantified the pain experienced. These PROMs did not measure all areas of pain including region, sensation, impact, and triggers. The findings of this review will assist with developing a new pain-specific PROM in this population. PERSPECTIVE: Women with pelvic floor disorders often undergo surgery involving transvaginal mesh, from which they experience debilitating pain. Pain is a major issue impacting women's lives. Patient-reported outcome measures can be used to assess the pain; however, it is unclear whether existing instruments are relevant.

Quality Indicators in the Clinical Specialty of Urology: A Systematic Review.

CONTEXT: In health care, monitoring of quality indicators (QIs) in general urology remains underdeveloped in comparison to other clinical specialties. OBJECTIVE: To identify, synthesise, and appraise QIs that monitor in-hospital care for urology patients. EVIDENCE ACQUISITION: This systematic review included peer-reviewed articles identified via Embase, MEDLINE, Web of Science, CINAHL, Global Health, Google Scholar, and grey literature from 2000 to February 19, 2021. The review was carried out under the Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines and used the Appraisal of Indicators through Research and Evaluation (AIRE) tool for quality assessment. EVIDENCE SYNTHESIS: A total of 5111 articles and 62 government agencies were screened for QI sets. There were a total of 57 QI sets included for analysis. Most QIs focused on uro-oncology, with prostate, bladder, and testicular cancers the most represented. The most common QIs were surgical QIs in uro-oncology (positive surgical margin, surgical volume), whereas in non-oncology the QIs most frequently reported were for treatment and diagnosis. Out of 61 articles, only four scored a total of ≥50% on the AIRE tool across four domains. Aside from QIs developed in uro-oncology, general urological QIs are underdeveloped and of poor methodological quality and most lack testing for both content validity and reliability. CONCLUSIONS: There is an urgent need for the development of methodologically robust QIs in the clinical specialty of general urology for patients to enable standardised quality of care monitoring and to improve patient outcomes. PATIENT SUMMARY: We investigated a range of quality indicators (QIs) that provide health care professionals with feedback on the quality of their care for patients with general urological diseases. We found that aside from urological cancers, there is a lack of QIs for general urology. Hence, there is an urgent need for the development of robust and disease-specific QIs in general urology.

Measurement of quality of recovery after surgery using the 15-item quality of recovery scale: a systematic review and meta-analysis.

BACKGROUND: There are very few patient-centred global outcome measures of recovery in the days or weeks after surgery. This meta-analysis evaluated the psychometric properties and clinical acceptability of the 15-item quality of recovery (QoR-15) scale. METHODS: We searched bibliographic databases for studies undertaking psychometric evaluation of the QoR-15 or using the QoR-15 as an outcome measure after surgery. Record screening, data extraction, and quality assessments were independently done by two researchers. Weighted averages estimating overall summary statistics across all the studies were calculated using random-effects meta-analysis. Pooled correlation coefficients were transformed using a Fisher z-transformation and then back-transformed to calculate pooled results. The four co-primary endpoints were validity, reliability, responsiveness, and clinical utility of the QoR-15 scale. RESULTS: A total of 26 unique studies met the eligibility criteria, yielding up to 22 847 patients across 16 countries, in 15 languages. A further 172 studies in a further 18 countries and six languages used the QoR-15 as an outcome measure. The QoR-15 had excellent discriminant validity, with the mean difference in QoR-15 scores in patients with and without postoperative complications (9.6; 95% confidence interval [CI], 5.9-13.3; P<0.001), and good convergent validity (for a global visual analogue recovery scale, pooled r=0.63; 95% CI, 0.54-0.71). There was excellent reliability: internal consistency (pooled α=0.85; 95% CI, 0.83-0.87), split-half reliability=0.80 (95% CI, 0.75-0.84), and test-retest reliability=0.97 (95% CI, 0.95-0.98). There was also high responsiveness (pooled standardised response mean=0.87; 95% CI, 0.65-1.08), patient recruitment into evaluation studies (96%; 95% CI, 93-99), and excellent completion and return rates (91%; 95% CI, 84-96). The mean time to complete the QoR-15 was 2.7 (95% CI, 2.2-3.1) min. CONCLUSIONS: The QoR-15 is a valid, reliable, and responsive patient-centred outcome metric in surgical patients. It is highly acceptable to both patients and clinicians. REGISTRATION: Open Science Framework Identifier: DOI 10.17605/OSF.IO/78HTA.

Biomarkers for the Early Diagnosis of Sepsis in Burns: Systematic Review and Meta-analysis.

OBJECTIVE: The aim of this study was to evaluate the diagnostic performance of all biomarkers studied to date for the early diagnosis of sepsis in hospitalized patients with burns. BACKGROUND: Early clinical diagnosis of sepsis in burns patients is notoriously difficult due to the hypermetabolic nature of thermal injury. A considerable variety of biomarkers have been proposed as potentially useful adjuncts to assist with making a timely and accurate diagnosis. METHODS: We searched Medline, Embase, Cochrane CENTRAL, Biosis Previews, Web of Science, and Medline In-Process to February 2020. We included diagnostic studies involving burns patients that assessed biomarkers against a reference sepsis definition of positive blood cultures or a combination of microbiologically proven infection with systemic inflammation and/or organ dysfunction. Pooled measures of diagnostic accuracy were derived for each biomarker using bivariate random-effects meta-analysis. RESULTS: We included 28 studies evaluating 57 different biomarkers and incorporating 1517 participants. Procalcitonin was moderately sensitive (73%) and specific (75%) for sepsis in patients with burns. C-reactive protein was highly sensitive (86%) but poorly specific (54%). White blood cell count had poor sensitivity (47%) and moderate specificity (65%). All other biomarkers had insufficient studies to include in a meta-analysis, however brain natriuretic peptide, stroke volume index, tumor necrosis factor (TNF)-alpha, and cell-free DNA (on day 14 post-injury) showed the most promise in single studies. There was moderate to significant heterogeneity reflecting different study populations, sepsis definitions and test thresholds. CONCLUSIONS: The most widely studied biomarkers are poorly predictive for sepsis in burns patients. Brain natriuretic peptide, stroke volume index, TNF-alpha, and cell-free DNA showed promise in single studies and should be further evaluated. A standardized approach to the evaluation of diagnostic markers (including time of sampling, cut-offs, and outcomes) would be useful.

Pregnancy planning health information and service needs of women with chronic non-communicable conditions: a systematic review and narrative synthesis.

BACKGROUND: Preparing for pregnancy and being in the best possible health before conception improves reproductive outcomes. For women living with a chronic non-communicable disease (NCD), pregnancy planning is essential to allow optimal disease control in preparation for pregnancy. AIM: The aim was to review the literature relating to the pregnancy planning health information and service needs of women with NCDs. METHOD: The MEDLINE (Ovid), Embase (Ovid), Emcare (Ovid), PsycINFO (Ovid), CINAHL and Scopus databases were searched. Studies were included if they were published in peer-reviewed English language journals between January 2010 and June 2020 and reported on the pregnancy planning health information and service needs of women with rheumatic diseases, asthma, cystic fibrosis, depression and/or anxiety, type 1 diabetes mellitus, epilepsy, or multiple sclerosis. Risk of bias was assessed using QualSyst. The characteristics of the studies were tabulated and summarised. Key findings of the included studies were analysed thematically using an inductive approach, where the study findings determined the themes. Findings are reported in a narrative synthesis. RESULTS: The database searches yielded 8291 results, of which 4304 remained after duplicates were removed. After abstract screening 104 full-text papers were reviewed. Of these 15 met inclusion criteria and were included in analysis. The narrative synthesis of the included studies revealed six themes: 'Women with chronic conditions have unmet preconception health information needs', 'Women with chronic conditions want personalised preconception health information', 'Preferred sources of preconception health information', 'Learning from the experiences of other women', 'Improving preconception health discussions with health care professionals', and 'Women want holistic care'. These themes were consistent across all studies, highlighting the similarity of experiences and needs of women with different chronic conditions. CONCLUSION: To improve pregnancy outcomes for women living with NCDs, health care providers need to ask women of reproductive age proactively and routinely about their pregnancy intentions and provide them with personalised advice on how to avoid unplanned pregnancy and be in optimal health when they wish to conceive. PROSPERO registration number CRD42020176308.

Access to preventive sexual and reproductive health care for women from refugee-like backgrounds: a systematic review.

BACKGROUND: Globally, the number of forcibly displaced women is growing. Refugee and displaced women have poorer health outcomes compared to migrant and host country populations. Conflict, persecution, violence or natural disasters and under-resourced health systems in their country of origin contribute to displacement experiences of refugee and displaced women. Poor health outcomes are further exacerbated by the migration journey and challenging resettlement in host countries. Preventive sexual and reproductive health (SRH) needs of refugee and displaced women are poorly understood. The aim was to synthesise the evidence about access to preventive SRH care of refugee and displaced women. METHODS: A systematic review of qualitative, quantitative and mixed methods studies of women aged 18 to 64 years and health care providers' (HCPs') perspectives on barriers to and enablers of SRH care was undertaken. The search strategy was registered with PROSPERO in advance of the search (ID CRD42020173039). The MEDLINE, PsycINFO, Embase, CINAHL, and Global health databases were searched for peer-reviewed publications published any date up to 30th April 2020. Three authors performed full text screening independently. Publications were reviewed and assessed for quality. Study findings were thematically extracted and reported in a narrative synthesis. Reporting of the review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. RESULTS: The search yielded 4083 results, of which 28 papers reporting 28 studies met inclusion criteria. Most related to contraception and cervical or breast cancer screening. Three main themes and ten subthemes relating to SRH care access were identified: interpersonal and patient encounter factors (including knowledge, awareness, perceived need for and use of preventive SRH care; language and communication barriers), health system factors (including HCPs discrimination and lack of quality health resources; financial barriers and unmet need; HCP characteristics; health system navigation) and sociocultural factors and the refugee experience (including family influence; religious and cultural factors). CONCLUSIONS: Implications for clinical practice and policy include giving women the option of seeing women HCPs, increasing the scope of practice for HCPs, ensuring adequate time is available during consultations to listen and develop refugee and displaced women's trust and confidence, strengthening education for refugee and displaced women unfamiliar with preventive care and refining HCPs' and interpreters' cultural competency. More research is needed on HCPs' views regarding care for refugee and displaced women.

Health system readiness for non-communicable diseases at the primary care level: a systematic review.

OBJECTIVE: To synthesise evidence on the primary healthcare system's readiness for preventing and managing non-communicable diseases (NCDs). DESIGN: Systematic review. DATA SOURCES: Ovid MEDLINE, EMBASE, CINAHL, PsycINFO and Scopus were searched from 1 January 1984 to 30 July 2021, with hand-searching references and expert advice. ELIGIBILITY CRITERIA: Any English-language health research with evidence of readiness/preparedness of the health system at the primary healthcare level in the context of four major NCDs: diabetes mellitus, cancer, chronic respiratory diseases (CRDs) and cardiovascular diseases (CVDs). DATA EXTRACTION AND SYNTHESIS: Two authors independently extracted data and assessed the bias. The full-text selected articles were then assessed using the Mixed Methods Appraisal Tool. Health system readiness was descriptively and thematically synthesised in line with the health system dynamics framework. RESULTS: Out of 7843 records, 23 papers were included in this review (15 quantitative, 3 qualitative and 5 mixed-method studies). The findings showed that existing literature predominantly examined health system readiness from the supply-side perspective as embedded in the WHO's health system framework. However, at the primary healthcare level, these components are insufficiently prepared for NCDs. Among NCDs, higher levels of readiness were reported for diabetes mellitus and hypertension in comparison to CRDs (asthma, chronic obstructive pulmonary disease), CVDs and cancer. There has been a dearth of research on the demand-side perspective, which is an essential component of a health system and must be addressed in the future research. CONCLUSION: The supply-side components at the primary healthcare level are inadequately ready to address the growing NCD burden. Improving supply-side factors, with a particular focus on CRDs, CVDs and cancer, and improving understanding of the demand-side components of the health system's readiness, may help to prevent and manage NCDs at the primary healthcare level.

Does aerobic exercise effect pain sensitisation in individuals with musculoskeletal pain? A systematic review.

BACKGROUND: Pain sensitisation plays a major role in musculoskeletal pain. However, effective treatments are limited, and although there is growing evidence that exercise may improve pain sensitisation, the amount and type of exercise remains unclear. This systematic review examines the evidence for an effect of aerobic exercise on pain sensitisation in musculoskeletal conditions. METHODS: Systematic searches of six electronic databases were conducted. Studies were included if they examined the relationship between aerobic physical activity and pain sensitisation in individuals with chronic musculoskeletal pain, but excluding specific patient subgroups such as fibromyalgia. Risk of bias was assessed using Cochrane methods and a qualitative analysis was conducted. RESULTS: Eleven studies (seven repeated measures studies and four clinical trials) of 590 participants were included. Eight studies had low to moderate risk of bias. All 11 studies found that aerobic exercise increased pressure pain thresholds or decreased pain ratings in those with musculoskeletal pain [median (minimum, maximum) improvement in pain sensitisation: 10.6% (2.2%, 24.1%)]. In these studies, the aerobic exercise involved walking or cycling, performed at a submaximal intensity but with incremental increases, for a 4-60 min duration. Improvement in pain sensitisation occurred after one session in the observational studies and after 2-12 weeks in the clinical trials. CONCLUSIONS: These findings provide evidence that aerobic exercise reduces pain sensitisation in individuals with musculoskeletal pain. Further work is needed to determine whether this translates to improved patient outcomes, including reduced disability and greater quality of life.

Doubly labelled water for determining total energy expenditure in adult critically ill and acute care hospitalized inpatients: A scoping review.

BACKGROUND & AIMS: Doubly labelled water (DLW) is considered the reference standard method of measuring total energy expenditure (TEE), but there is limited information on its use in the Intensive Care Unit (ICU) and acute care setting. This scoping review aims to systematically summarize the available literature on TEE measured using DLW in these contexts. METHODS: Four online databases (MEDLINE, Embase, Emcare and CINAHL) were searched up to Dec 12, 2020. Studies in English were included if they measured TEE using DLW in adults in the ICU and/or acute care setting. Key considerations, concerns and practical recommendations were identified and qualitatively synthesized. RESULTS: The search retrieved 7582 studies and nine studies were included; one in the ICU and eight in the acute care setting. TEE was measured over 7-15-days, in predominantly clinically stable patients. DLW measurements were not commenced until four days post admission or surgery in one study and following a 10-14-day stabilization period on parenteral nutrition (PN) in three studies. Variable dosages of isotopes were administered, and several equations used to calculate TEE. Four main considerations were identified with the use of DLW in these settings: variation in background isotopic abundance; excess isotopes leaving body water as carbon dioxide or water; fluctuations in rates of isotope elimination and costs. CONCLUSION: A stabilization period on intravenous fluid and PN regimens is recommended prior to DLW measurement. The DLW technique can be utilized in medically stable ICU and acute care patients, with careful considerations given to protocol design.

Clinical Clues for the Current Diagnosis of Acute Lower Limb Ischemia: A Contemporary Case Series.

BACKGROUND: Acute lower limb ischemia (ALI) is a limb and life-threatening condition whose treatment largely depends on the underlying cause. The clinical distinction between the main causes may have changed over the years because of changes in the epidemiology of this syndrome. The objective of this study was to determine the clinical pattern associated with the main causes of ALI in a contemporary series of cases. METHODS: We retrospectively reviewed all consecutive ALI cases admitted to a tertiary hospital between 2007 and 2019. ALI secondary to other conditions than embolism or NAT were excluded. The association between clinical variables and the ALI cause was assessed with multiple logistic regressions and the discriminative power of the resulting clinical predictive scores with the area under the ROC curve. RESULTS: The study group included 243 patients (mean age 77.2 years; 52.7% male), of which 140 (57.6%) were caused by an arterial embolism and 103 (42.4%) by a NAT. Among these latter, 78 (75.7%) were related to an atherosclerotic NAT and 25 (24.3%) to a complicated popliteal aneurysm. Independent risk factors associated with embolism included atrial fibrillation (OR 10.26, 95% CI 5.1 - 20.67) or female gender (OR 5.44, 95% CI 2.76 - 10.71), but not the severity of the episode or the presence of contralateral pulses. Those related to a NAT included a previous symptomatic peripheral arterial disease (OR 2.68, 95% CI 1.35 - 5.35) and seeking consultation more than 24 hours after the beginning of symptoms (OR 2.57, 95% CI 1.32 - 5), but not a higher rate of other vascular risk factors. Among patients with NAT, previous intermittent claudication (OR 8.34, 95% CI 2.42 - 28.72) and >24 hs delay of arrival of the patient (OR 4.78, 95% CI 1.48 - 15.43) were more frequent among those related to an atherosclerotic NAT, whereas higher hemoglobin levels (OR 1.60, 95% CI 1.21 - 2.11) and non-significantly the history of tobacco smoking (OR 2.95, 95% CI 0.84 - 10.36) among those with a popliteal aneurysm-related NAT. The discriminative power of the two clinical models resulting from these predictive variables for differentiating embolism from NAT and atherosclerosis-related NAT from popliteal aneurysm-related NAT was excellent (0.86 and 0.85, respectively). CONCLUSION: Certain clinical features appear to be no longer useful in the distinction between embolism and NAT, while others may help in the differential diagnosis between atherosclerotic and popliteal aneurysm-related NAT. Surgeons must be aware of possible changes in the presentation of ALI because time constraints are frequent and clinical data remain essential.

Satisfacción con la vida y Conductas de salud en estudiantes universitarios de nuevo ingreso / Satisfaction with life and health behaviors in incoming college students / Satisfação com a Vida e Comportamentos de Saúde em Novos Estudantes Universitários

En la actualidad resultan escasos los estudios que relacionen la satisfacción con la vida y las conductas saludables en estudiantes que inician sus estudios universitarios, aun cuando se sabe que la transición a la etapa universitaria puede originar diversos cambios con repercusiones importantes para la salud de los estudiantes. OBJETIVO: determinar la relación entre la satisfacción con la vida y las conductas de salud en estudiantes de primer semestre de una universidad pública venezolana. MÉTODO: estudio de naturaleza cuantitativa, no experimental, descriptivo, correlacional y transversal, utilizó una muestra conformada por 636 estudiantes (65% mujeres y 35% hombres) con edades entre los 15 y 27 años, seleccionados bajo un muestreo no probabilístico intencional. RESULTADOS: los estudiantes se caracterizan por estar satisfechos con su vida y presentan niveles moderados de conductas saludables en general. Asimismo, la satisfacción con la vida difiere según el sexo y el estrato socioeconómico, mientras que algunas conductas de salud difieren según el sexo, el estrato socioeconómico y la edad. Por otra parte, la satisfacción con la vida presenta relación significativa con las conductas de salud a nivel general y en las dimensiones conductas preventivas, sueño, actividad física, control en el consumo de drogas y chequeo médico. CONCLUSIÓN: la satisfacción con la vida resulta ser una variable protectora que fomenta conductas saludables en estudiantes universitarios, en especial los que recién inician los estudios, siendo importante considerarla en futuras intervenciones y programas de promoción de la salud.

Currently, there are few studies that relate satisfaction with life and healthy behaviors in students starting their university studies, even though it is known that the transition to the university stage can cause various changes with important repercussions on the health of students. OBJECTIVE: to determine the relationship between life satisfaction and health behaviors in first semester students at a Venezuelan public university. METHOD: a quantitative, non-experimental, descriptive, correlational, and cross-sectional study, using a sample of 636 students (65% women and 35% men) between 15 and 27 years of age, selected under a non-probabilistic intentional sampling. RESULTS: the students are characterized by being satisfied with their lives and present moderate levels of healthy behaviors in general. Also, life satisfaction differs by gender and socioeconomic status, while some health behaviors differ by gender, socioeconomic status, and age. On the other hand, life satisfaction is significantly related to health behaviors at the general level and in the dimension's preventive behaviors, sleep, physical activity, drug use control and medical check-up. CONCLUSION: life satisfaction turns out to be a protective variable that promotes healthy behaviors in university students, especially those who are just starting their studies, and it is important to consider it in future interventions and health promotion programs.

Atualmente, há poucos estudos que relacionam a satisfação com a vida e comportamentos saudáveis em estudantes que iniciam seus estudos universitários, embora se saiba que a transição para a etapa universitária pode causar diversas mudanças com repercussões importantes para a saúde dos alunos. OBJETIVO: determinar a relação entre satisfação com a vida e comportamentos de saúde em alunos do primeiro semestre de uma universidade pública venezuelana. MÉTODO: um estudo quantitativo, não experimental, descritivo, correlacional e transversal utilizou uma amostra de 636 estudantes (65% mulheres e 35% homens) com idade entre 15 e 27 anos, selecionados em amostragem não probabilística intencional. RESULTADOS: os alunos se caracterizam por estarem satisfeitos com suas vidas e apresentam níveis moderados de comportamentos saudáveis em geral. Além disso, a satisfação com a vida difere por sexo e status socioeconômico, enquanto alguns comportamentos de saúde diferem por sexo, estrato socioeconômico e idade. Por outro lado, a satisfação com a vida apresenta uma relação significativa com os comportamentos de saúde em nível geral e nas dimensões comportamentos preventivos, sono, atividade física, controle no uso de drogas e check-up médico. CONCLUSÃO: a satisfação com a vida acaba por ser uma variável protetora que incentiva comportamentos saudáveis em estudantes universitários, especialmente aqueles que estão apenas iniciando seus estudos, e é importante considerá-lo em intervenções futuras e programas de promoção da saúde.

Blood Biomarkers of Glioma in Response Assessment Including Pseudoprogression and Other Treatment Effects: A Systematic Review.

Imaging-based monitoring of disease burden in glioma patients is frequently confounded by treatment effects. Circulating biomarkers could theoretically augment imaging-based response monitoring. This systematic review aimed to present and evaluate evidence for differential expression and diagnostic accuracy of circulating biomarkers with respect to outcomes of tumor response, progression, stable disease, and treatment effects (pseudoprogression, radionecrosis, pseudoresponse, and pseudolesions) in patients undergoing treatment for World Health Organization grades II-IV diffuse astrocytic and oligodendroglial tumors. MEDLINE, EMBASE, Web Of Science, and SCOPUS databases were searched until August 18, 2019, for observational or diagnostic studies on multiple circulating biomarker types: extracellular vesicles, circulating nucleic acids, circulating tumor cells, circulating proteins, and metabolites, angiogenesis related cells, immune cells, and other cell lines. Methodological quality of included studies was assessed using an adapted Quality Assessment of Diagnostic Accuracy Studies-2 tool, and level of evidence (IA-IVD) for individual biomarkers was evaluated using an adapted framework from the National Comprehensive Cancer Network guidelines on evaluating tumor marker utility. Of 13,202 unique records, 58 studies met the inclusion criteria. One hundred thirty-three distinct biomarkers were identified in a total of 1,853 patients across various treatment modalities. Fifteen markers for response, progression, or stable disease and five markers for pseudoprogression or radionecrosis reached level IB. No biomarkers reached level IA. Only five studies contained data for diagnostic accuracy measures. Overall methodological quality of included studies was low. While extensive data on biomarker dysregulation in varying response categories were reported, no biomarkers ready for clinical application were identified. Further assay refinement and evaluation in larger cohorts with diagnostic accuracy study designs are required. PROSPERO Registration: CRD42018110658.

Infección por uncinarias en un lactante menor: Reporte de caso / Infantile hookworm infection: Clinical case report

La uncinariasis es endémica en zonas tropicales. Es común en preescolares y escolares pero infrecuente en lactantes antes de los 6 meses debido al mecanismo de transmisión que implica contacto de la piel con el suelo contaminado. La infección se caracteriza por anemia ferropénica secundaria a sangrado digestivo crónico. Una forma inusual de presentación es el sangrado digestivo masivo que causa anemia severa. Presentación del caso: Niña shuar de 4 meses sin antecedentes patológicos, referida del Hospital General Puyo por un cuadro de melenas de 3 meses de evolución. Al mes de edad inició con deposiciones melénicas ocasionales y palidez que empeoraron dos semanas antes del ingreso. Se apreció palidez generalizada, hipoactividad y edema en miembros inferiores. Presentó hemoglobina 2,8 g/dL, hematocrito 9%, volumen corpuscular medio 73 fl, ancho de distribución de eritrocitos 18%, reticulocitos 1% y eosinófilos 4%. El coprológico y coproparasitario reportaron heces alquitranosas, sangre positiva y huevos de uncinarias más Kato-Katz compatible con intensidad de infección moderada. Se diagnosticó anemia severa por sangrado digestivo secundario a uncinarias. Se trató con Albendazol 400 mg vía oral en una toma más transfusión sanguínea. A los 5 días mejoró la hemoglobina y disminuyó el edema. Las melenas cesaron. Se dió el alta para control ambulatorio. Conclusión: La uncinariasis es una enfermedad endémica cuya presencia e impacto en lactantes se ha subestimado pues no es considerada como causa de sangrado digestivo. Debe pensarse en esta parasitosis en contextos de zonas endémicas en niños que cumplan un perfil clínico similar al descrito

Hookworms are endemic nematodes from tropical regions. Infection is more common in preschool and school children, but it is less frequent in infants under 6 months, because of the transmission mechanism that implies contact between contaminated soil and skin. The clinical disease is characterized by manifestations related to iron-deficiency anemia, secondary to a chronic digestive blood loss. An unusual way of presentation is the massive digestive bleeding that causes severe anemia. Case report: A four month shuar girl with no significant medical history, referred from General Puyo hospital, presented upper digestive bleeding of 3 months duration. At month of age, the girl presented self-limited melenas and skin pallor that worsen two weeks before the admission. The girl was hypo active, with a pale complexion, and had edema of feet. Her blood count showed hemoglobin 2.8 g/dl, hematocrit 9%, mean corpuscular volume 73 fl, red cell distribution width 18%, reticulocyte count 1%, eosinophils 4%. Coprological analysis reported tarry stools, positive fecal occult blood test, and hookworm eggs determined by Kato ­ Katz as a moderate infection. It was diagnosed iron-deficiency anemia secondary to an upper digestive bleeding caused by hookworms. The infection was treated with a single oral dose of albendazole 400mg plus blood transfusion. After 5 days of treatment, hemoglobin increased and edema was reduced. Melenas disappeared completely. Finally the discharge was indicated for outdoor control. Conclusion: Hookworm infestation is an endemic disease whose presence and impact in infants has been underestimated because it is not necessary as a cause of digestive bleeding. This disease should be considered in contexts of endemic areas in children who meet a clinical profile similar to that described

Comparación de la utilidad clínica de datos antropométricos de recién nacidos prematuros empleando las gráficas Fenton e Intergrowth-21st / Comparison of the clinical utility of anthropometric data of preterm infants using Fenton and Intergrowth -21 st charts

Introducción: no existe consenso sobre la gráfica idónea para monitorizar el crecimiento de prematuros, sin embargo, Fenton es la más difundida. Desde el aparecimiento de INTERGROWTH-21st ésta se perfila como una herramienta eficaz. Nuestro objetivo fue comparar INTERGROWTH-21st y Fenton en la valoración antropométrica de prematuros. Población y Métodos: estudio transversal que analizó datos antropométricos de prematuros entre enero de 2014 a diciembre de 2016 mediante la revisión de registros. La clasificación se realizó por edad gestacional y sexo usando Fenton y se compararon con INTERGROWTH-21st categorizando los percentiles 10, 50 y 90. Se realizaron pruebas de correlación y concordancia (p < 0.05, intervalo de confianza 95%). Se mantuvieron los respectivos lineamientos éticos. Resultados: en 232 prematuros la prevalencia de peso bajo fue de 13.7% con Fenton y 15.9% con INTERGROWTH-21st y para peso elevado 2.5% y 6% respectivamente. Presentaron una concordancia de 0.7 peso y perímetro cefálico. De 194 prematuros adecuados para la edad gestacional por Fenton, INTERGROWTH-21st clasificó al 4% como bajos y altos y el resto como adecuados. Existió correlación positiva en los tres parámetros antropométricos. Tomando como estándar a INTERGROWTH-21st y como criterio a evaluar a Fenton, la especificidad fue mayor que la sensibilidad en la antropometría baja (98.4 y 78.3 peso, 98.3 y 62.5 longitud y 100 y 64.2 perímetro cefálico) y elevada (100 y 42.8 peso, 97.5 y 22.2 longitud y 96.3 y 70 perímetro cefálico). Conclusión: Fenton clasifica con menor frecuencia pesos bajos y elevados para la edad gestacional en relación a INTERGROWTH-21st.

Introduction: there is no consensus on the ideal graph to monitor the growth of premature infants; however, the Fenton graph is the most widespread. Since the appearance of the INTERGROWTH-21st chart, this is emerging as an effective tool. Our objective was to compare INTERGROWTH-21st and Fenton in the anthropometric assessment of premature infants. Population and methods: a cross-sectional study that analyzed anthropometric data of premature infants between January 2014 and December 2016 by reviewing records. The classification was made by gestational age and sex using Fenton and was compared with INTERGROWTH-21st by categorizing the 10th, 50th and 90th percentiles. Correlation and concordance tests were performed (p <0.005, 95% confidence interval). The respective ethical guidelines were maintained. Results: in 232 preterm infants the prevalence of low weight was 13.7% with Fenton and 15.9% with INTERGROWTH-21st and for high weight 2.5% and 6% respectively. Weight and cephalic perimeter presented a concordance of 0.7. Of 194 premature babies suitable for gestational age by Fenton, INTERGROWTH-21st classified 4% as low and high, the rest as adequate. There was positive correlation in the three anthropometric parameters. Taking as standard INTERGROWTH-21st and as a criterion to evaluate Fenton, the specificity was greater than the sensitivity in low anthropometry (98.4 and 78.3 weight, 98.3 and 62.5 length, 100 and 64.2 cephalic perimeter) and high (100 and 42.8 weight, 97.5 and 22.2 length, 96.3 and 70 cephalic perimeter). Conclusion: Fenton classified less frequently low and high weights for gestational age in relation to INTERGROWTH-21st.

La simulación clínica como estrategia de enseñanza-aprendizaje en ciencias de la salud / Clinical simulation as a teaching-learning strategy in health sciences

Las estrategias de enseñanza-aprendizaje en Salud han evolucionado sustancialmente, ubicando a la simulación clínica como parte esencial de los procesos curriculares y de acreditación; sin embargo, debido al tiempo e inversión que requiere, puede verse relegada de incorporarla de forma eficiente y temprana en los procesos educativos. Se expone una panorámica sobre su importancia en la docencia y cómo influye en las competencias clínicas para la atención de salud.

Health teaching-learning strategies have evolved substantially, locating clinical simulation as an essential part of curricular and accreditation processes; however, due to the time and the investment required, it can be relegated to incorporate efficiently and early to education processes. A panoramic view of its importance with teaching a

Mucoactive agents for adults with acute lung conditions: A systematic review.

BACKGROUND AND OBJECTIVES: Inhaled mucoactive agents are used to enhance airway clearance, however efficacy and safety are unclear in adults with acute respiratory conditions. METHODS: We systematically reviewed randomized controlled trials assessing respiratory function; safety; length of stay (LOS); mucus; radiology; and oxygenation. RESULTS: No adverse events were reported for dornase alfa (n = 63), N-acetylcysteine (NAC, n = 50), ambroxol (n = 140), hypertonic saline (n = 33), heparin (n = 384), mannitol (n = 20) or isotonic saline. During invasive ventilation, NAC, dornase alfa and saline had no effect on mucus. Postoperatively, mucus characteristics improved with NAC (n = 10). Ambroxol lowered LOS (mean difference 4 days) and halved complications following lung carcinoma resection (n = 140). Heparin improved ventilator-free days (n = 130, mean difference 3.9-4.6) and intensive care LOS (n = 223, 3.2 days), but not ventilator-acquired pneumonia. CONCLUSION: Dornase alfa, hypertonic saline and NAC were ineffective for atelectasis/mucus plugging while intubated. More data are required to support using NAC, ambroxol and heparin during acute illness.

Effect of Psychosocial and Vocational Interventions on Return-to-Work Rates Post-Acute Myocardial Infarction: A SYSTEMATIC REVIEW.

PURPOSE: To examine whether the effects of psychosocial and vocational interventions delivered in the first 3 mo post-acute myocardial infarction (AMI) are effective for improving work outcomes compared with other interventions. METHODS: A search was completed for English language publications up to March 2016 across 4 electronic databases and gray literature. Inclusion criteria were (1) psychosocial and/or vocational interventions; (2) adults 18 years or older with an AMI who were within the first 3 mo post-AMI; (3) randomized or clinically controlled trials; and (4) reporting of at least 1 return-to-work (RTW) outcome: including return to paid/unpaid employment, either full-time or part-time, to the previous job role or on modified duties. Studies were independently screened by 2 reviewers and graded using the Cochrane Collaboration tool for assessing risk of bias. A narrative synthesis and meta-analysis of the included studies was undertaken. RESULTS: Eighteen studies of varying quality were analyzed. Individually delivered psychosocial and vocational interventions may improve work rates at 3 mo (relative risk = 1.17; P = .05) when compared with usual care but there was no difference at 6 or 12 mo. People receiving group or individual psychological/vocational counselling returned to work 6.11 d sooner than those who received usual care (95% CI, -6.95 to -5.26; P < .001). CONCLUSIONS: Although psychosocial and vocational interventions show promise in people within 3 mo of AMI, compelling evidence is still limited. There is a need for more detailed, high-quality studies with valid comparison groups and adequate follow-up.