Proof-of-principle of a lung sealant based on functionalized polyoxazolines: experiments in an ovine acute aerostasis model.

OBJECTIVES: More effective lung sealants are needed to prevent prolonged pulmonary air leakage (AL). Polyoxazoline-impregnated gelatin patch (N-hydroxysuccinimide ester functionalized poly(2-oxazoline)s; NHS-POx) was promising for lung sealing ex vivo. The aim of this study is to confirm sealing effectiveness in an in vivo model of lung injury. METHODS: An acute aerostasis model was used in healthy adult female sheep, involving bilateral thoracotomy, amputation lesions (bronchioles Ø > 1.5 mm), sealant application, digital chest tube for monitoring AL, spontaneous ventilation, obduction and bursting pressure measurement. Two experiments were performed: (i) 3 sheep with 2 lesions per lung (N = 4 NHS-POx double-layer, N = 4 NHS-POx single-layer, N = 4 untreated) and (ii) 3 with 1 lesion per lung (N = 3 NHS-POx single-layer, N = 3 untreated). In pooled linear regression, AL was analysed per lung (N = 7 NHS-POx, N = 5 untreated) and bursting pressure per lesion (N = 11 NHS-POx, N = 7 untreated). RESULTS: Baseline AL was similar between groups (mean 1.38-1.47 l/min, P = 0.90). NHS-POx achieved sealing in 1 attempt in 8/11 (72.7%) and in 10/11 (90.9%) in >1 attempt. Application failures were only observed on triangular lesions requiring 3 folds around the lung. No influences of methodological variation between experiments was detected in linear regression (P > 0.9). AL over initial 3 h of drainage was significantly reduced for NHS-POx [median: 7 ml/min, length of interquartile range: 333 ml/min] versus untreated lesions (367 ml/min, length of interquartile range: 680 ml/min, P = 0.036). Bursting pressure was higher for NHS-POx (mean: 33, SD: 16 cmH2O) versus untreated lesions (mean: 19, SD: 15 cmH2O, P = 0.081). CONCLUSIONS: NHS-POx was effective for reducing early AL, and a trend was seen for improvement of bursting strength of the covered defect. Results were affected by application characteristics and lesion geometry.

Pre-treatment with systemic agents for advanced NSCLC elicits changes in the phenotype of autologous T cell therapy products.

The antitumor activity of adoptive T cell therapies (ACT) is highly dependent on the expansion, persistence, and continued activity of adoptively transferred cells. Clinical studies using ACTs have revealed that products that possess and maintain less differentiated phenotypes, including memory and precursor T cells, show increased antitumor efficacy and superior patient outcomes owing to their increased expansion, persistence, and ability to differentiate into effector progeny that elicit antitumor responses. Strategies that drive the differentiation into memory or precursor-type T cell subsets with high potential for persistence and self-renewal will enhance adoptively transferred T cell maintenance and promote durable antitumor efficacy. Because of the high costs associated with ACT manufacturing, ACTs are often only offered to patients after multiple rounds of systemic therapy. An essential factor to consider in producing autologous ACT medicinal products is the impact of the patient's initial T cell fitness and subtype composition, which will likely differ with age, disease history, and treatment with prior anti-cancer therapies. This study evaluated the impact of systemic anti-cancer therapy for non-small cell lung cancer treatment on the T cell phenotype of the patient at baseline and the quality and characteristics of the genetically modified autologous T cell therapy product after manufacturing.

Surgical bypass to the left subclavian artery: an extra-anatomical transpleural approach.

A distal anastomosis in zone 3 is technically demanding during the frozen elephant trunk procedure. Proximalization of the distal anastomosis to zone 2 with subsequent revascularization of the left subclavian artery is an attractive alternative. This video tutorial describes the technique of an extra-anatomical bypass from the aortic prosthesis to the infraclavicular left subclavian (axillary) artery in arch replacement with the distal aortic graft anastomosis in zone 2.

Intrinsic pulmonary sealing, its mechanisms and impact on validity and translational value of lung sealant studies: a pooled analysis of animal studies.

Background: No validated and standardized animal models of pulmonary air leakage (PAL) exist for testing aerostatic efficacy of lung sealants. Lack of negative control groups in published studies and intrinsic sealing mechanisms of healthy animal lungs might contribute to a translational gap, leading to poor clinical results. This study aims to address the impact of intrinsic sealing mechanisms on the validity of PAL models, and investigate the conditions required for an ovine model of PAL for lung sealant testing. Methods: An ovine acute aerostasis model was developed, consisting of a bilateral thoracotomy with lesion creation, chest tube insertion and monitoring of air leaks using digital drains (≥80 minutes), under spontaneous respiration. Healthy mixed-breed adult female sheep were used and all in vivo procedures were performed under terminal anesthesia. Superficial parenchymal lesions were tested post-mortem and in vivo, extended lesions including bronchioles (deep bowl-shaped and sequential lung amputation lesions) were tested in vivo. Experiment outcomes include air leakage (AL), minimal leaking pressure (MLP) and histology. Results: Two post-mortem (N=4 superficial parenchymal lesions) and 10 in vivo experiments (N=5 superficial parenchymal and N=16 lesions involving bronchioles) were performed. In contrast to the post-mortem model, superficial parenchymal lesions in vivo showed less air leak [mean flow ± standard deviation (SD): 760±693 vs. 42±33 mL/min, P=0.055]. All superficial parenchymal lesions in vivo sealed intrinsically within a median time of 20 minutes [interquartile range (IQR), 10-75 minutes]. Histology of the intrinsic sealing layer revealed an extended area of alveolar collapse below the incision with intra-alveolar hemorrhage. Compared to superficial parenchymal lesions in vivo, lesions involving bronchioles induced significantly higher air leak post-operatively (normalized mean flow ± SD: 459±221 mL/min, P=0.003). At termination, 5/9 (55.6%) were still leaking (median drain time: 273 minutes, IQR, 207-435 minutes), and intrinsic sealing for the remaining lungs occurred within a median of 115 minutes (IQR, 52-245 minutes). Conclusions: Lung parenchyma of healthy sheep shows a strong intrinsic sealing mechanism, explained pathologically by an extended area of alveolar collapse, which may contribute to a translational gap in lung sealant research. A meaningful ovine model has to consist of deep lesions involving bronchioles of >⌀1.5 mm. Further research is needed to develop a standardized PAL model, to improve clinical effectiveness of lung sealants.

Handgrip exercise in patients scheduled for cardiac surgery to attenuate troponin release: a feasibility study.

Cardiac surgery, including surgical aortic valve repair (SAVR) and coronary artery bypass grafting (CABG), are associated with ischemia-reperfusion (I/R) injury. Single bouts of exercise, including handgrip exercise, may protect against I/R injury. This study explored 1) the feasibility of daily handgrip exercise in the week before SAVR and/or CABG and 2) its impact on cardiac I/R injury, measured as postoperative cardiac troponin-T (cTnT) release. Sixty-five patients undergoing elective SAVR and/or CABG were randomized to handgrip exercise + usual care (intervention, n = 33) or usual care alone (control, n = 32). Handgrip exercise consisted of daily 4 × 5-min handgrip exercise (30% maximal voluntary contraction) for 2-7 days before cardiac surgery. Feasibility was assessed using validated questionnaires. Postoperative cTnT release was assessed at 0, 6, 12, 18, and 24 h [primary outcome area under the curve (cTnTAUC)]. Most patients (93%) adhered to handgrip exercise and 77% was satisfied with this intervention. Handgrip exercise was associated with lower cTnTAUC (402,943 ± 225,206 vs. 473,300 ± 232,682 ng · min/L), which is suggestive of a medium effect size (Cohen's d 0.31), and lower cTnTpeak (313 [190-623] vs. 379 [254-699] ng/L) compared with controls. We found that preoperative handgrip exercise is safe and feasible for patients scheduled for SAVR and/or CABG and is associated with a medium effect size to reduce postoperative cardiac I/R injury. This warrants future studies to assess the potential clinical impact of exercise protocols before cardiac surgery.NEW & NOTEWORTHY Daily handgrip exercise in the week before elective cardiac surgery is safe and feasible. Handgrip exercise is associated with a medium effect size for less troponin-T release. Future larger-sized studies are warranted to explore the impact of (handgrip) exercise prior to cardiac surgery on clinical outcomes and direct patient benefits.

Sealing effectiveness of a novel NHS-POx based patch: experiments in a dynamic ex vivo porcine lung.

Background: Sealants are used to prevent prolonged pulmonary air leakage (PAL) after lung resections (incidence 5.6-30%). However, clinical evidence to support sealant use is insufficient, with an unmet need for a more effective product. We compared a novel gelatin patch impregnated with functionalized polyoxazolines (NHS-POx) (GATT-Patch) to commercially available sealant products. Methods: GATT-Patch Single/Double layers were compared to Progel®, Coseal®, Hemopatch® and TachoSil® in an ex vivo porcine lung model (first experiment). Based on these results, a second head-to-head comparison between GATT-Patch Single and Hemopatch® was performed. Air leakage (AL) was assessed in three settings using increasing ventilatory pressures (max =70 cmH2O): (I) baseline, (II) with 25 mm × 25 mm superficial pleural defect, and (III) after sealant application. Lungs floating on saline (37 ℃) were video recorded for visual AL assessment. Pressure and tidal volumes were collected from the ventilator, and bursting pressure (BP), AL and AL-reduction were determined. Results: Per sealant 10 measurements were performed (both experiments). In the first experiment, BP was superior for GATT-Patch Double (60±24 cmH2O) compared to TachoSil® (30±11 cmH2O, P<0.001), Hemopatch® (33±6 cmH2O, P=0.006), Coseal® (25±13 cmH2O, P=0.001) and Progel® (33±11 cmH2O, P=0.005). AL-reduction was superior for GATT-Patch Double (100%±1%) compared to Hemopatch® (46%±50%, P=0.010) and TachoSil® (31%±29%, P<0.001), and also for GATT-Patch Single (100%±14%, P=0.004) and Progel (89%±40%, P=0.027) compared to TachoSil®. In the second experiment, GATT-Patch Single was superior regarding BP (45±10 vs. 40±6 cmH2O, P=0.043) and AL-reduction (100%±11% vs. 68%±40%, P=0.043) when compared to Hemopatch®. Conclusions: The novel NHS-POx patch shows promise as a lung sealant, demonstrating elevated BP, good adhesive strength and a superior AL-reduction.

Should nails be locked dynamically or statically in atypical femoral fractures? - A radiological analysis of time to union and reoperations in 236 displaced fractures with 4 years average follow-up.

INTRODUCTION: Atypical femoral fractures (AFFs) are associated with delayed union and higher reoperation rates. Axial dynamization of intramedullary nails is hypothesized to reduce time-to-union (TTU) and fixation failure as compared to static locking. METHODS: Consecutive acutely displaced AFFs fixed with long intramedullary nails across five centres between 2006 and 2021 with a minimum postoperative follow-up of three months were retrospectively reviewed. The primary outcome was TTU, compared between AFFs treated with dynamically or statically locked intramedullary nails. Fracture union was defined as a modified Radiographic Union Score for Tibial fractures score of 13 or greater. Secondary outcomes involved revision surgery and treatment failure, defined as non-union beyond 18 months or revision internal fixation for mechanical reasons. RESULTS: A total of 236 AFFs (127 dynamically locked and 109 statically locked) were analysed with good interobserver reliability of fracture union assessment (intraclass correlation coefficient = 0.89; 95% CI = 0.82-0.98). AFFs treated with dynamized nails had significantly shorter median TTU (10.1 months; 95% CI = 9.24-10.96 vs 13.0 months; 95% CI = 10.60-15.40) (log-rank test, p = 0.019). Multivariate Cox regression revealed that dynamic locking was independently associated with greater likelihood of fracture union within 24 months (p = 0.009). Reoperations were less frequent in the dynamic locking group (18.9% vs 28.4%), although the difference was not statistically significant (p = 0.084). Static locking was an independent risk factor for reoperation (p = 0.049), as were varus reduction and lack of teriparatide use within three months of surgery. Static locking also demonstrated a higher frequency of treatment failure (39.4% vs 22.8%, p = 0.006) and was an independent predictor of treatment failure in logistic regression (p = 0.018). Other factors associated with treatment failure included varus reduction and open reduction. CONCLUSIONS: Dynamic locking of intramedullary nails in AFFs is associated with faster time to union, lower rate of non-union, and fewer treatment failures.

Variations in current clinical practice of postoperative pericardial effusion: a questionnaire study.

OBJECTIVE: Postoperative pericardial effusion (PPE) occurs frequently after cardiac surgery, potentially leading to life-threatening cardiac tamponade. Specific treatment guidelines are currently lacking, possibly leading to variations in clinical practice. Our goal was to assess clinical PPE management and evaluate variation between centres and clinicians. METHODS: A nationwide survey was sent to all interventional cardiologists and cardiothoracic surgeons in the Netherlands, regarding their preferred diagnostic and treatment modality of PPE. Clinical preferences were explored utilising four patient scenarios, each with a high/low echocardiographic and clinical suspicion of cardiac tamponade. Scenarios were also stratified by three PPE sizes (<1 cm, 1-2 cm, >2 cm). RESULTS: In total, 46/140 interventional cardiologists and 48/120 cardiothoracic surgeons responded (27/31 contacted centres). Cardiologists favoured routine postoperative echocardiography in all patients (44%), whereas cardiothoracic surgeons preferred routine imaging after specific procedures, especially mitral (85%) and tricuspid (79%) valve surgery. Overall, pericardiocentesis (83%) was preferred over surgical evacuation (17%). Regarding all patient scenarios, cardiothoracic surgeons significantly preferred evacuation compared with cardiologists (51% vs 37%, p<0.001). This was also observed with cardiologists employed in surgical centres compared with non-surgical centres (43% vs 31%, p=0.02). Inter-rater analysis varied from poor to near-excellent (к 0.22-0.67), suggesting varying PPE treatment preferences within one centre. CONCLUSION: There is significant variation in the preferred management of PPE between hospitals and clinicians, even within the same centre, possibly due to the lack of specific guidelines. Therefore, robust results of a systematic approach to PPE diagnosis and treatment are needed to formulate evidence-based recommendations and optimise patient outcome.

Evaluating and developing sealants for the prevention of pulmonary air leakage: A systematic review of animal models.

Sealants may provide a solution for pulmonary air leakage (PAL), but their clinical application is debatable. For sealant comparison, standardized animal models are lacking. This systematic review aims to assess methodology and quality of animal models for PAL and sealant evaluation. All animal models investigating lung sealing devices (e.g., staplers, glues, energy devices) to prevent or treat PAL were retrieved systematically from Embase, Pubmed and Web of science. Methodological study characteristics, risk of bias, reporting quality and publication bias were assessed. A total of 71 studies were included (N = 75 experiments, N = 1659 animals). Six different species and 18 strains were described; 92% of experiments used healthy animals, disease models were used in only six studies. Lesions to produce PAL were heterogenous, and only 11 studies used a previously reported technique, encompassing N = 5 unique lesions. Clinically relevant outcomes were used in the minority of studies (imaging 16%, air leak 10.7%, air leak duration 4%). Reporting quality was poor, but revealed an upward trend per decade. Overall, high risk of bias was present, and only 18.7% used a negative control group. All but one study without control groups claimed positive outcomes (95.8%), in contrast to 84.3% using positive or negative control groups, which also concluded equivocal, adverse or inconclusive outcomes. In conclusion, animal studies evaluating sealants for prevention of PAL are heterogenous and of poor reporting quality. Using negative control groups, disease models and quantifiable outcomes seem important to increase validity and relevance. Further research is needed to reach consensus for model development and standardization.

Cuidados paliativos em idosos com dispneia: estudo de validação / Cuidados paliativos en el adulto mayor con disnea: estudio de validación / Palliative care in elderly people with dyspnea: A validation study

Objetivo: validar o conteúdo do cenário de simulação clínica sobre assistência ao paciente idoso hospitalizado em cuidados paliativos com dispneia, como ferramenta de ensino para estudantes de graduação em enfermagem. Materiais e método: estudo metodológico desenvolvido em três fases: revisão integrativa da literatura; entrevista com enfermeiros da área de gerontologia e cuidados paliativos; e validação do conteúdo do cenário de simulação. A validação contou com cinco juízes especialistas na área de simulação, gerontologia e cuidados paliativos entre abril e maio de 2022. O cenário criado foi baseado no pressuposto da Fabri: objetivos, material de estudo prévio, preparação, desenvolvimento, debriefing e avaliação. Utilizaram-se estatística descritiva e índice de validade de conteúdo. Resultados: foi identificado que os itens "duração do cenário", "características do paciente", "descrição do caso clínico", "caracterização do ator", "prebriefing" e "avaliação" obtiveram 0,80. O cenário de simulação obteve um valor geral de 0,91. Foram realizados ajustes no cenário referente à clareza da redação, às funcionalidades e à pertinência segundo as sugestões dos juízes. Conclusões: o cenário validado é uma ferramenta que auxilia no ensino da graduação em enfermagem, proporcionando uma formação nas áreas de gerontologia e de cuidados paliativos com um olhar diferenciado, o que pode levar a uma assistência humanizada e de qualidade.

Objetivo: validar el escenario de simulación clínica sobre la asistencia al adulto mayor hospitalizado en cuidados paliativos con disnea como herramienta de enseñanza para estudiantes de pregrado en enfermería. Materiales y método: estudio metodológico desarrollado en tres fases: revisión integrativa de la literatura; entrevista con profesionales de enfermería en el área de gerontología y cuidados paliativos; y validación del escenario de simulación. La validación contó con la participación de cinco jueces expertos en el área de simulación, gerontología y cuidados paliativos, y se llevó a cabo entre abril y mayo de 2022. El escenario creado se basó en el referencial de Fabri: objetivos, material de estudio previo, preparación, desarrollo, debriefing y evaluación. Esta investigación acudió al uso de estadística descriptiva y el índice de validez de contenido. Resultados: se identificó que los ítems "duración del escenario", "características del paciente", "descripción del caso clínico", "caracterización del actor", "prebriefing" y "evaluación" obtuvieron un valor de 0,80. El escenario de simulación obtuvo un valor general de 0,91. Se incorporaron algunos ajustes al escenario con respecto a la claridad de la escritura, las funcionalidades y su relevancia, de acuerdo con las sugerencias de los jueces. Conclusiones: el escenario validado se constituye en una herramienta que contribuirá al proceso de enseñanza del estudiante de enfermería, particularmente a la formación en las áreas de gerontología y cuidados paliativos, proporcionando una mirada diferente que redundará en cuidados de calidad y humanizados.

Objective: To validate the content of a clinical simulation scenario on the care provided to elderly patients with dyspnea hospitalized in palliative care as a teaching tool for undergraduate nursing students. Materials and method: Methodological study developed in three phases, namely: integrative literature review; interviews with nurses in the gerontology and palliative care area; and validation of the simulation scenario content. The validation phased engaged five specialist judges in the area of simulation, gerontology, and palliative care, and was conducted between April and May 2022. The scenario created was based on Fabri's assumption: objectives, previous study material, preparation, development, debriefing, and evaluation. Descriptive statistics and the content validity index were used. Results: The items "duration of the scenario", "patient characteristics", "description of the clinical case", "characterization of the actors", "prebriefing" and "evaluation" obtained a score of 0.80. The simulation scenario obtained an overall value of 0.91. Adjustments on the clarity in writing, functionalities, and the relevance of the scenario were incorporated, according to the judges' suggestions. Conclusions: The validated scenario could become a tool in the training process of undergraduate nursing courses, providing a different perspective for gerontology and palliative care training and fostering humanized and quality care.

Long-term follow-up of voice changes after cervical mediastinoscopy.

BACKGROUND: Vocal cord palsy after cervical mediastinoscopy is usually reported at less than 1%. However, its incidence might be underestimated and no follow-up studies are available. Our study aimed to evaluate the incidence of voice changes after cervical mediastinoscopy and report on long-term outcomes, including quality of life, after at least one-year follow-up. METHODS: A retrospective cohort study was performed, considering all patients who underwent cervical mediastinoscopy in our center between January 2011 and April 2016. Patients with pre-existing voice changes, voice changes only after pulmonary resection and patients who underwent neoadjuvant chemo(radio)therapy were excluded. Voice changes with full recovery within 14 days were attributed to intubation-related causes. Follow-up questionnaires, including the standardized Voice Handicap Index, were sent to patients with documented voice changes. RESULTS: Of 270 patients who were included for final analysis, 17 (6.3%) experienced voice changes after cervical mediastinoscopy, which persisted > 2 years in 4 patients (1.5%), causing mild to moderate disabilities in daily living. Twelve patients (out of 17, 71%) were referred for otolaryngology consultation, and paresis of the left vocal cord suggesting recurrent laryngeal nerve injury was confirmed in 10 (3.7% of our total study group). Additionally, 83% of the patients who were referred for otolaryngology consultation received voice treatment. Recovery rate after vocal exercises therapy and injection laryngoplasty was respectively 71% and 33%. CONCLUSIONS: Voice changes after cervical mediastinoscopy is an underreported complication, with an incidence of at least 6.3% in our retrospective study, with persisting complaints in at least 1.5% of patients, leading to mild to moderate disabilities in daily living. These findings highlight the need for appropriate patient education for this underestimated complication, as well as the exploration of possible preventive measures.

Timing of cardiac surgery during pregnancy: a patient-level meta-analysis.

AIMS: To investigate the association between the timing of cardiac surgery during pregnancy and both maternal and foetal outcomes. METHODS AND RESULTS: Studies published up to 6 February 2021 on maternal and/or foetal mortality after cardiac surgery during pregnancy that included individual patient data were identified. Maternal and foetal mortality was analysed per trimester for the total population and stratified for patients who underwent caesarean section (CS) prior to cardiac surgery (Caesarean section (CaeSe) group) vs. patients who did not (Cardiac surgery (CarSu) group). Multivariable logistic regression analysis was performed to evaluate predictors of both maternal and foetal mortality. In total, 179 studies were identified including 386 patients of which 120 underwent CS prior to cardiac surgery. Maternal mortality was 7.3% and did not differ significantly among trimesters of pregnancy (P = 0.292) nor between subgroup CaeSe and CarSu (P = 0.671). Overall foetal mortality was 26.5% and was lowest when cardiac surgery was performed during the third trimester (10.3%, P < 0.01). CS prior to surgery was significantly associated with a reduced risk of foetal mortality in a multivariable model [odds ratio 0.19, 95% confidence interval [0.06-0.56)]. Trimester was not identified as an independent predictor for foetal nor maternal mortality. CONCLUSION: Maternal mortality after cardiac surgery during pregnancy is not associated with the trimester of pregnancy. Cardiac surgery is associated with high foetal mortality but is significantly lower in women where CS is performed prior to cardiac surgery. When the foetus is viable, CS prior to cardiac surgery might be safe. When CS is not feasible, trimester stage does not seem to influence foetal mortality.

Anatomical analysis of variations in the bronchus pattern of the left upper lobe using three-dimensional computed tomography angiography and bronchography.

Background: The number of sublobar resections performed is increasing, thoracic surgeons must be familiar with bronchus anatomy and preoperative planning plays an important role in predicting anatomical variations. However, there is few report showing anatomic variations of the left upper lobe (LUL) using three-dimensional computed tomography angiography and bronchography (3D-CTAB), and no in Chinese population. The present study aimed to use 3D-CTAB to describe variations of the pulmonary bronchus of LUL in Chinese population. Methods: In this retrospective study, we analyzed 3D-reconstruction from patients that performed lobectomy, segmentectomy or subsegmentectomy of the LUL in 2020 at Fujian Medical University Cancer Hospital's Department of Thoracic Surgery. Patients with previous LUL surgery or absence of 3D-reconstruction or without surgery were excluded. Results: One hundred and sixty-six patients met our criteria. Branching of the left upper bronchus was classified into bifurcated type (99.4%) or trifurcated type (0.06%). The left upper divisional bronchus (B 1+2+3) arise as bifurcated (65.65%) or trifurcated type (34.34%). Apicodorsalis bronchus (B 1+2) always originated as bifurcated type, while ventralis bronchus (B 3) was either bifurcated (94.45%) or trifurcated (5.55%). Lingular bronchus (B 4+5) was observed as bifurcated (96.38%) or trifurcated (3.62%) type. When analyzing sublobar divisions of bronchi a total of 14 subtypes were identified, 6 of them were found in the upper divisional bronchus. Conclusions: Bronchial anatomy of LUL is highly variable, especially in upper divisional bronchus. 3D-CTAB is a useful tool to identify variations in the bronchi pattern, we recommend preoperative planning for sublobar resection.

Assistência de enfermagem ao idoso hospitalizado no final da vida: revisão integrativa / Nursing care for hospitalized elderly at the end of life: integrative review

Objetivo: analisar e sintetizar o conhecimento já produzido quanto à assistência de enfermagem no final da vida em idosos hospitalizados. Método: Revisão integrativa da literatura realizada nas bases de dados PubMed, Cumulative Index to Nursing and Allied Health (CINAHL), Embase, Web of Science, Scopus e Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS). Os estudos abordavam cuidados paliativos em idosos publicados entre 2005-2021. Para sumarização e síntese das pesquisas foi utilizado o softwareIramuteq (Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires). Resultados: 22 artigos foram selecionados, e após a análise foram categorizadas em: Suporte à família pelo profissional de enfermagem em cuidados paliativos; Formação e os impactos na assistência de enfermagem em cuidados paliativos; Ética na pesquisa envolvendo pacientes idosos em cuidados paliativos e seus familiares; Importância da comunicação efetiva em cuidados paliativos; e Declínio gradual de saúde em idosos e o manejo de sintomas pela enfermagem. Conclusão: a síntese auxiliou na compreensão da importância das evidencias em cuidados paliativos e que a enfermagem faz parte deste processo no cuidado.

Objective: to analyze and synthesize the knowledge produced regarding nursing care for hospitalized elderly at the end of life. Method: Integrative literature review carried out in PubMed, Cumulative Index to Nursing and Allied Health (CINAHL), Embase, Web of Science, Scopus and Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) databases. The studies addressed palliative care in the elderly published between 2005 and 2021. Iramuteq (Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires) software was used for research summarization and synthesis. Results: 22 articles were selected, and after analysis they were categorized into: Family support by nurses in palliative care; Training and impacts on nursing care in palliative care; Ethics in research involving elderly patients in palliative care and their families; Importance of effective communication in palliative care; and Gradual decline in health in the elderly and the management of symptoms by nursing. Conclusion: the synthesis helped to understand the importance of evidence in palliative care and that nursing is part of this care process.

Infodemic of covid-19 and repercussions on the mental health of the elderly from São Paulo / Salud mental e infodemia del covid-19 en adultos mayores de São Paulo / Repercussões na saúde mental e infodemia de covid-19 de idosos paulistanos

ABSTRACT Objective: To characterize and identify depressive symptoms, anxiety, and stress associated with the COVID-19 Infodemic in the elderly from São Paulo. Method: Exploratory and cross-sectional study with the elderly in the capital of São Paulo who had internet access. The sociodemographic profile, the COVID-19 infodemic, depressive symptoms, stress, and anxiety were analyzed. Results: A total of 411 older people participated in the study. There was a predominance of women (76.4%), with higher education (57.9%), using private health services, and with little income variation. Older people were more exposed to news or information about COVID-19 on the internet (45.3%), followed by television (34.5%), and radio (11.4%). The average stress was 19.96 points; 33.1% had anxiety, and 39.7% had depressive symptoms. The greater the number of people living with the elderly, the greater the stress (p = 0.001) and anxiety (p = 0.02). The hours of exposure to information on the internet led to stress (p = 0.001), depressive symptoms (p = 0.02), and anxiety (p = 0.02) in the elderly. Conclusion: During the pandemic, exposure to information on the internet triggered anxiety, stress, and depressive symptoms in the elderly. The findings highlight the need for multi and interdisciplinary interventions to mitigate such repercussions on the elderly's health.

RESUMEN Objetivo: Caracterizar e identificar síntomas depresivos, ansiedad y estrés asociados a la Infodemia COVID-19 en adultos mayores de São Paulo. Método: Estudio exploratorio y transversal con adultos mayores de la capital paulista con acceso a internet. Fueron analizados perfil sociodemográfico, infodemia de COVID-19, síntomas depresivos, estrés y ansiedad. Resultados: Participaron 411 adultos mayores. Predominio del sexo femenino (76,4%), con estudios superiores (57,9%), usuarios de servicios de salud privados y baja variación de ingresos. Los adultos mayores estuvieron más expuestos a noticias o información sobre el COVID-19 en internet (45,3 %), seguida de la televisión (34,5 %) y la radio (11,4 %). El estrés promedio fue de 19,96 puntos; el 33,1% tenían ansiedad y el 39,7% tenían síntomas depresivos. Cuanto mayor era el número de personas que vivían con los adultos mayores, mayor era el estrés (p = 0,001) y la ansiedad (p = 0,02). Las horas de exposición a la información en internet generaron estrés (p = 0,001), síntomas depresivos (p = 0,02) y ansiedad (p = 0,02) en los adultos mayores. Conclusión: Durante la pandemia, la exposición a información en internet desencadenó síntomas de ansiedad, estrés y depresión en los adultos mayores. Los hallazgos destacan la necesidad de intervenciones multi e interdisciplinarias para mitigar tales repercusiones en la salud de los adultos mayores.

RESUMO Objetivo: Caracterizar e identificar sintomas depressivos, ansiedade e estresse associados à Infodemia de COVID-19 em idosos paulistanos. Método: Estudo exploratório e transversal com idosos da capital de São Paulo com acesso à internet. Foram analisados o perfil sociodemográfico, a infodemia de COVID-19, os sintomas depressivos, o estresse e a ansiedade. Resultados: Participaram 411 idosos. Predomínio do sexo feminino (76,4%), com ensino superior (57,9%), do uso de serviço de saúde privado e baixa variação na renda. Os idosos foram mais expostos a notícias ou informações sobre COVID-19 pela internet (45,3%), seguida pela televisão (34,5%) e pelo rádio (11,4%). A média de estresse foi 19,96 pontos; 33,1% apresentaram ansiedade e 39,7% sintomas depressivos. Quanto maior o número de pessoas que vivem com o idoso maior o estresse (p = 0,001) e a ansiedade (p = 0,02). As horas de exposição a informações pela internet levou a estresse (p = 0,001), sintomas depressivos (p = 0,02) e ansiedade (p = 0,02) do idoso. Conclusão Durante a pandemia, a exposição às informações pela internet desencadeou ansiedade, estresse e sintomas depressivos nos idosos. Os achados evidenciam a necessidade de intervenções multi e interdisciplinares para mitigar tais repercussões na saúde dos idosos.

The effect of early mobilization on functional outcomes after hip surgery in the Chinese population - A multicenter prospective cohort study.

OBJECTIVE: To compare the functional status and quality of life (QoL) between patients who underwent an early mobilization scheme and those who underwent a late mobilization scheme after hip fracture fixation surgery in elderly Chinese patients. METHODS: This was a prospective cohort study. Patients (≥65 years old) with unstable intertrochanteric fractures treated with intramedullary nails were recruited from nine centers in China. Study centers either performed early mobilization or late mobilization scheme. All patients performed immediate in-bed mobilization after surgery and followed a standardized daily exercise program at home during the first 12 weeks. Functional status was measured by the Modified Barthel Index at postoperative visit, 6 weeks, and 12 weeks. QoL was measured by the EuroQol-5D (EQ-5D) at 12 weeks. RESULTS: One hundred and forty-eight patients were enrolled to early mobilization, and 136 to late mobilization. At 6 weeks, early mobilization resulted in a significantly better Modified Barthel Index than late mobilization (mean [SD]: 83.7 [12.0] vs. 67.0 [17.5], p < .001). Adjusted mixed effects model showed significantly higher Modified Barthel Index for early mobilization at postoperative visit, 6 weeks, and 12 weeks (all p < .001). Patients in the early mobilization group had slightly better EQ-5D Index at 12 weeks than patients in the late mobilization group (mean: 0.91 vs 0.87, p = .002). CONCLUSIONS: Early postoperative mobilization resulted in better functional outcomes up to 12 weeks. QoL was rated statistically significantly better in the early mobilization group, but the difference was small and may not be clinically relevant.

Surgery without preoperative histological confirmation of lung cancer: what is the current clinical practice?

BACKGROUND: There are discordances in the guidelines regarding the need to acquire histological diagnosis before surgical treatment of (presumed) lung cancer. Preoperative histological confirmation is always encouraged in this setting to prevent unnecessary surgery or when sublobar resection for small-sized tumors is considered. The aim of this retrospective cohort study was to assess the proportion of patients undergoing lung cancer resection in the Netherlands without preoperative pathological confirmation, based on the intraoperative pathological diagnosis (IOD) rate, and to determine characteristics that may influence IOD frequency. METHODS: Data on 10,226 patients, who underwent surgical treatment for lung cancer from 2010 to 2015, were retrieved from the Netherlands National Cancer Registry. We registered an IOD when the date of diagnosis equaled the date of the first surgical intervention. Tabulations and multivariable logistic regression were used to identify predictive parameters for IOD. RESULTS: 36% of surgical procedures were classified as IOD, and decreased with increasing tumor size and extent of surgery (57% for segmentectomy, 39% for lobectomy and 11% for pneumonectomy). IOD was more frequently observed in adenocarcinoma (41%), varied between hospitals from 13% to 66% and was less common when patients were referred from a hospital where thoracic surgery was not performed. Previous history of cancer did not affect IOD. CONCLUSIONS: More than one-third of patients with suspected lung cancer in the Netherlands was operated without preoperative histological confirmation. There was significant variation in IOD rates between different hospitals, which deserves further detailed analysis when striving for uniform surgical quality of care for patients with lung cancer.

Neuroinflammation in cognitive decline post-cardiac surgery (the FOCUS study): an observational study protocol.

INTRODUCTION: Postoperative cognitive dysfunction occurs frequently after coronary artery bypass grafting (CABG). The underlying mechanisms remain poorly understood, but neuroinflammation might play a pivotal role. We hypothesise that systemic inflammation induced by the surgical trauma could activate the innate immune (glial) cells of the brain. This could lead to an exaggerated neuroinflammatory cascade, resulting in neuronal dysfunction and loss of neuronal cells. Therefore, the aims of this study are to assess neuroinflammation in vivo presurgery and postsurgery in patients undergoing major cardiac surgery and investigate whether there is a relationship of neuroinflammation to cognitive outcomes, changes to brain structure and function, and systemic inflammation. METHODS AND ANALYSIS: The FOCUS study is a prospective, single-centre observational study, including 30 patients undergoing elective on-pump CABG. Translocator protein (TSPO) positron emission tomography neuroimaging will be performed preoperatively and postoperatively using the second generation tracer 18F-DPA-714 to assess the neuroinflammatory response. In addition, a comprehensive cerebral MRI will be performed presurgery and postsurgery, in order to discover newly developed brain and vascular wall lesions. Up to 6 months postoperatively, serial extensive neurocognitive assessments will be performed and blood will be obtained to quantify systemic inflammatory responses and peripheral immune cell activation. ETHICS AND DISSEMINATION: Patients do not benefit directly from engaging in the study, but imaging neuroinflammation is considered safe and no side effects are expected. The study protocol obtained ethical approval by the Medical Research Ethics Committee region Arnhem-Nijmegen. This work will be published in peer-reviewed international medical journals and presented at medical conferences. TRIAL REGISTRATION NUMBER: NCT04520802.