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Rev. latinoam. enferm. (Online) ; 31: e3864, ene.-dic. 2023. tab, graf
Artigo em Inglês | LILACS, BDENF | ID: biblio-1431836


Abstract Objective: to investigate the factors associated with extubation failure of patients in the intensive care unit. Method: unpaired, longitudinal, retrospective and quantitative case-control with the participation of 480 patients through clinical parameters for ventilator weaning. Data were analyzed by: Fisher's exact test or the chi-square test; unpaired two-tailed Student's t test; and Mann-Whitney test. Significant P values lower than or equal to 0.05 were admitted. Results: of the patients, 415 (86.5%) were successful and 65 (13.5%) failed. Success group: the most negative fluid balance, APACHE II in 20 (14-25), weak cough in 58 (13.9%). Failure group: the most positive fluid balance, APACHE II in 23 (19-29), weak cough in 31 (47.7%), abundant amount of pulmonary secretions in 47.7%. Conclusion: positive fluid balance and the presence of inefficient cough or inability to clear the airway were predictors of extubation failure.

Resumo Objetivo: investigar os fatores associados à falha de extubação de pacientes na unidade de terapia intensiva. Método: caso-controle não pareado, longitudinal, retrospectivo e quantitativo com a participação de 480 pacientes por meio de parâmetros clínicos para desmame ventilatório. Dados analisados por: Teste Exato de Fisher ou o teste Qui-quadrado; teste t de Student bicaudal não pareado; e teste de Mann-Whitney. Admitiram-se significantes valores de P menores ou iguais a 0,05. Resultados: dos pacientes, 415 (86,5%) tiveram sucesso e 65 (13,5%) falharam. Grupo sucesso: balanço hídrico mais negativo, APACHE II em 20 (14-25), tosse fraca em 58 (13,9%). Grupo falha: balanço hídrico mais positivo, APACHE II em 23 (19-29), tosse fraca em 31 (47,7 %), quantidade abundante de secreção pulmonar em 47,7 %. Conclusão: o balanço hídrico positivo e a presença de tosse ineficiente ou incapacidade de higienizar a via aérea foram preditores de falhas de extubação.

Resumen Objetivo: investigar los factores asociados al fracaso de la extubación de pacientes en la unidad de cuidados intensivos. Método: caso y control no apareado, longitudinal, retrospectivo y cuantitativo con la participación de 480 pacientes mediante parámetros clínicos para el destete de la ventilación. Datos analizados por: Prueba Exacta de Fisher o prueba de Chi-cuadrado; prueba t de Student de dos colas para datos no apareados; y prueba de Mann-Whitney. Se admitieron valores de P significativos menores o iguales a 0,05. Resultados: de los pacientes, 415 (86,5%) tuvieron éxito y 65 (13,5%) fracasaron. Grupo de éxito: balance hídrico más negativo, APACHE II en 20 (14-25), tos débil en 58 (13,9%). Grupo de fracaso: balance de líquidos más positivo, APACHE II en 23 (19-29), tos débil en 31 (47,7%), abundante cantidad de secreciones pulmonares en 47,7%. Conclusión: el balance hídrico positivo y la presencia de tos ineficaz o incapacidad para higienizar la vía aérea fueron predictores de fracaso de la extubación.

Humanos , Pacientes , Respiração Artificial/efeitos adversos , Estudos de Casos e Controles , Distribuição de Qui-Quadrado , APACHE , Secreções Corporais , Extubação/efeitos adversos , Unidades de Terapia Intensiva
BMC Res Notes ; 16(1): 72, 2023 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-37158948


OBJECTIVES: Breast cancer (BC) is one of the most common cancers with a high mortality rate in women worldwide. The advantages of early cancer diagnosis are apparent, and it is a critical factor in increasing the patient's life and survival. According to mounting evidence, microRNAs (miRNAs) may be crucial regulators of critical biological processes. miRNA dysregulation has been linked to the beginning and progression of various human malignancies, including BC, and can operate as tumor suppressors or oncomiRs. This study aimed to identify novel miRNA biomarkers in BC tissues and non-tumor adjacent tissues of patients with BC. Microarray datasets GSE15852 and GSE42568 for differentially expressed genes (DEGs) and GSE45666, GSE57897, and GSE40525 for differentially expressed miRNAs (DEMs) retrieved from the Gene Expression Omnibus (GEO) database were analyzed using "R" software. A protein-protein interaction (PPI) network was created to identify the hub genes. MirNet, miRTarBase, and MirPathDB databases were used to predict DEMs targeted genes. Functional enrichment analysis was used to demonstrate the topmost classifications of molecular pathways. The prognostic capability of selected DEMs was evaluated through a Kaplan-Meier plot. Moreover, the specificity and sensitivity of detected miRNAs to discriminate BC from adjacent controls were assessed by area under the curve (AUC) using the ROC curve analysis. In the last phase of this study, gene expression on 100 BC tissues and 100 healthy adjacent tissues were analyzed and calculated by using the Real-Time PCR method. RESULTS: This study declared that miR-583 and miR-877-5p were downregulated in tumor samples in comparison to adjacent non-tumor samples (|logFC|< 0 and P ≤ 0.05). Accordingly, ROC curve analysis demonstrated the biomarker potential of miR-877-5p (AUC = 0.63) and miR-583 (AUC = 0.69). Our results showed that has-miR-583 and has-miR-877-5p could be potential biomarkers in BC.

Neoplasias da Mama , MicroRNAs , Feminino , Humanos , Biomarcadores , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/genética , Biologia Computacional , MicroRNAs/genética , Pacientes
Am Soc Clin Oncol Educ Book ; 43: e397264, 2023 May.
Artigo em Inglês | MEDLINE | ID: mdl-37200592


A cancer diagnosis thrusts patients and caregivers into a foreign world of health care with systems, protocols, and norms that can leave little room for individual needs and circumstances. Quality and efficacious oncology care requires clinicians to partner with patients and caregivers to understand and incorporate their needs, values, and priorities into information sharing, decision making, and care provision. This partnership is necessary for effective patient- and family-centered care and access to individualized and equitable information, treatment, and research participation. Partnering with patients and families also requires oncology clinicians to see that our personal values, preconceived ideas, and established systems exclude certain populations and potentially lead to poorer care for all patients. Furthermore, inequitable access to participation in research and clinical trials can contribute to an unequal burden of cancer morbidity and mortality. Leveraging the expertise of the authorship team with transgender, Hispanic, and pediatric populations, this chapter provides insights and suggestions for oncology care that are applicable across patient populations to mitigate stigma and discrimination and improve the quality of care for all patients.

Neoplasias , Pessoas Transgênero , Humanos , Criança , Cuidadores , Hispânico ou Latino , Pacientes , Neoplasias/diagnóstico , Neoplasias/epidemiologia , Neoplasias/terapia
Stud Health Technol Inform ; 302: 817-818, 2023 May 18.
Artigo em Inglês | MEDLINE | ID: mdl-37203503


When patients with cancer develop depression, it is often left untreated. We developed a prediction model for depression risk within the first month after starting cancer treatment using machine learning and Natural Language Processing (NLP) models. The LASSO logistic regression model based on structured data performed well, whereas the NLP model based on only clinician notes did poorly. After further validation, prediction models for depression risk could lead to earlier identification and treatment of vulnerable patients, ultimately improving cancer care and treatment adherence.

Depressão , Neoplasias , Humanos , Depressão/diagnóstico , Pacientes , Aprendizado de Máquina , Medição de Risco , Processamento de Linguagem Natural , Registros Eletrônicos de Saúde , Neoplasias/complicações
Stud Health Technol Inform ; 302: 384-385, 2023 May 18.
Artigo em Inglês | MEDLINE | ID: mdl-37203697


Adverse Drug Reactions (ADRs) cause significant impact for patients' Quality of Life (QoL) and vastly increase costs, especially regarding chronic diseases. To this end, we propose a platform that aims at supporting the management of patients with Chronic Lymphocytic Leukemia (CLL), via an eHealth platform facilitating inter-physician interaction and the provision of treatment consultation by a specialized ADR management team comprised of CLL experts.

Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Leucemia Linfocítica Crônica de Células B , Médicos , Humanos , Leucemia Linfocítica Crônica de Células B/tratamento farmacológico , Qualidade de Vida , Pacientes , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle
Stud Health Technol Inform ; 302: 418-422, 2023 May 18.
Artigo em Inglês | MEDLINE | ID: mdl-37203708


The patient empowerment movement has highlighted the importance of providing information to the patients to improve care outcome. However, relatives of patients are not yet taken into consideration. This is especially problematic during surgeries since families are often left without real-time information about the trajectory of the patient, inducing worries. Based on this observation we have developed the SMS-Chir solution that connects our surgery service management system with the automatic sending of SMS at key moments in order to inform families about the progression of the surgery. The system has been conceived thanks to the results of a focus group involving four experts. The evaluation was done by monitoring the use of the system over time and by sending questionnaires after intervention. Results analysis shows a limited use of the system but a high satisfaction of the beneficiaries. This study highlights the importance of managerial factors (resistance to change) in order to onboard the necessary stakeholders in the process.

Participação do Paciente , Pacientes , Humanos , Grupos Focais , Inquéritos e Questionários , Família
Rev Esp Salud Publica ; 972023 May 10.
Artigo em Espanhol | MEDLINE | ID: mdl-37161836


It is estimated that colorectal cancer is the cancer disease with the highest incidence in Spain  due to the increase in life expectancy and changes in the lifestyle of the population . Early detection through disease screening programs allows for more effective treatment and a higher survival rate . Advances in treatment have been made, such as targeted therapies, which focus on specifically attacking cancer cells and preventing their growth . However, much remains to be done in terms of prevention and treatment of colorectal cancer. More research and medical advances are required to combat this disease.

Se estima que el cáncer colorrectal es la enfermedad oncológica que presenta mayor incidencia en España  debido al incremento en la esperanza de vida y a los cambios en el estilo de vida de la población . La detección precoz mediante los programas de cribado de la enfermedad permite un tratamiento más efectivo y una mayor tasa de supervivencia . Se han realizado avances en el tratamiento, como las terapias dirigidas, que se centran en atacar específicamente a las células cancerosas y prevenir su crecimiento . Sin embargo, todavía queda mucho por hacer en términos de prevención y tratamiento del cáncer colorrectal. Se requiere más investigación y más avances médicos para combatir esta enfermedad.

Neoplasias Colorretais , Pacientes , Humanos , Espanha , Expectativa de Vida , Estilo de Vida , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/terapia
Oncol Nurs Forum ; 50(3): 313-323, 2023 04 21.
Artigo em Inglês | MEDLINE | ID: mdl-37155974


PURPOSE: To explore patient, caregiver, and clinician perspectives on palliative care for patients undergoing hematopoietic stem cell transplantation (HSCT). PARTICIPANTS & SETTING: 8 patients who had undergone or would undergo HSCT, 4 caregivers, and 16 HSCT clinicians. METHODOLOGIC APPROACH: This qualitative, interpretive descriptive study used semistructured interviews conducted via telephone or videoconference. FINDINGS: Responses were categorized into the following two themes: concerns and challenges during and after HSCT, and tensions with integrating palliative care into HSCT. IMPLICATIONS FOR NURSING: The findings from this study highlight the unique and varied needs of patients and their caregivers during and after HSCT. More research is required to determine how to best integrate palliative care in this setting.

Transplante de Células-Tronco Hematopoéticas , Cuidados Paliativos , Humanos , Cuidadores , Pacientes , Pesquisa Qualitativa
Artigo em Inglês | MEDLINE | ID: mdl-37174147


There is a growing demand that ostomy patients receive more systematic and individualised follow-up by ostomy nurses. The purpose of the study was to explore how younger women experience everyday life after an ostomy and to map what healthcare personnel can do to ensure that the patient group can feel safe and looked after. This qualitative study included four younger women who had a stoma fitted. Individual in-depth interviews were conducted, and two participants were interviewed twice. The findings resulted in three main themes: (1) The importance of follow-up and information from healthcare personnel, (2) Experience with illness and freedom in everyday life and (3) Self-image and social relationships. We found that time to prepare before surgery and learning to live with the stoma provide a good basis for handling the new everyday life with a stoma. We conclude that ostomy nurses provide support and security to those undergoing ostomy operations. Healthcare professionals should focus on providing individually tailored information to ensure that patients are receptive to the information being shared with them. Having parts of a bowel removed can be experienced as relief, especially when the disease has previously contributed to poor self-image and social isolation.

Estomia , Humanos , Feminino , Pacientes , Pesquisa Qualitativa , Autoimagem , Qualidade de Vida
Artigo em Inglês | MEDLINE | ID: mdl-37174152


Clinical and economic burdens exist within the coronary artery disease (CAD) care pathway despite advances in diagnosis and treatment and the increasing utilization of percutaneous coronary intervention (PCI). However, research presenting a comprehensive assessment of the challenges across this pathway is scarce. This contemporary review identifies relevant studies related to inefficiencies in the diagnosis, treatment, and management of CAD, including clinician, patient, and economic burdens. Studies demonstrating the benefits of integration and automation within the catheterization laboratory and across the CAD care pathway were also included. Most studies were published in the last 5-10 years and focused on North America and Europe. The review demonstrated multiple potentially avoidable inefficiencies, with a focus on access, appropriate use, conduct, and follow-up related to PCI. Inefficiencies included misdiagnosis, delays in emergency care, suboptimal testing, longer procedure times, risk of recurrent cardiac events, incomplete treatment, and challenges accessing and adhering to post-acute care. Across the CAD pathway, this review revealed that high clinician burnout, complex technologies, radiation, and contrast media exposure, amongst others, negatively impact workflow and patient care. Potential solutions include greater integration and interoperability between technologies and systems, improved standardization, and increased automation to reduce burdens in CAD and improve patient outcomes.

Doença da Artéria Coronariana , Intervenção Coronária Percutânea , Humanos , Doença da Artéria Coronariana/cirurgia , Doença da Artéria Coronariana/diagnóstico , Intervenção Coronária Percutânea/métodos , Procedimentos Clínicos , Resultado do Tratamento , Pacientes , Fatores de Risco
Cuad Bioet ; 34(110): 13-24, 2023.
Artigo em Espanhol | MEDLINE | ID: mdl-37211542


Spirituality is the human dimension that helps human beings to reflect about their own existence, to try to answer to questions like: what are we living for? This search of meaning is still more pronounced in those who suffer an advanced and incurable disease. This clear need is nevertheless not always acknowledge by the patient, making it difficult to detect and manage it in the daily care by healthcare professionals. In an effort to establish an effective therapeutic relationship, they have to keep in mind also this spiritual dimension, already integrated in the concept of comprehensive care and usually offered to all patients, especially in those who are at the end of life. With this work we have tried, on the one hand, to know the opinion of nurses and TCAE about spirituality through a self-design survey. On the other hand, we wanted to know how this suffering experience may impact on the professionals, as well as if the development of their own spirituality, differently expressed, may have positive effects on the patients. To this end, healthcare professionals have been selected from an oncology unit, those who day by day are facing the impact of suffering and death of their patients.

Atitude do Pessoal de Saúde , Espiritualidade , Humanos , Pacientes , Inquéritos e Questionários , Morte
Pediatr Surg Int ; 39(1): 203, 2023 May 23.
Artigo em Inglês | MEDLINE | ID: mdl-37219695


BACKGROUND: We aimed to identify prognostic indicators in pneumatosis intestinalis (PI) in a pediatric oncology population. We hypothesized that neutropenia would be an independent risk factor for adverse outcomes, including the need for abdominal operation to treat PI and for the development of recurrent PI. METHODS: We performed a retrospective review of all patients treated for PI between 2009 and 2019 with a diagnosis of cancer or history of bone marrow transplant (BMT). RESULTS: Sixty-eight children were treated for their first episode of PI; 15 (22%) were not neutropenic at presentation; eight underwent urgent abdominal operation (12%). Patients with neutropenia were more likely to receive TPN, had a longer course of NPO, and received a longer course of antibiotics. Neutropenia at presentation was associated with a decreased risk of PI recurrence (40% vs 13%, p = 0.03). Children who required an abdominal operation were more likely to require vasopressors at diagnosis (50% vs 10%, p = 0.013). CONCLUSIONS: Among pediatric cancer patients, need for vasopressors at the time of PI is a marker of severe PI, with increased likelihood of requiring operative intervention. The presence of neutropenia is associated with lower rates of PI recurrence. LEVEL OF EVIDENCE: Level III.

Neoplasias , Neutropenia , Criança , Humanos , Antibacterianos , Pacientes , Fatores de Risco
Br J Nurs ; 32(10): S24-S29, 2023 May 25.
Artigo em Inglês | MEDLINE | ID: mdl-37219975


BACKGROUND: Teleconsultations were introduced for cancer surgery follow-up to ease pressure on hospital services and facilitate patients' access to those services. There is limited evidence on patients' perceptions of this swift shift in service provision. AIMS: The purpose of this qualitative systematic review was to explore patient experiences of teleconsultations within NHS cancer surgery follow-up services to better understand patient perceptions, satisfaction and acceptability of teleconsultations within cancer services. METHODS: Medline, Embase, PubMed and Google Scholar were searched up to 1 July 2022. Qualitative studies were synthesised using the Braun and Clarke framework. FINDINGS: There were three overarching themes: accessibility; patient experience; and consultation. CONCLUSION: Teleconsultations were widely accepted among cancer surgical patients. However, there were reports of a lack of rapport building and emotional support because of the absence of visual cues and patient camaraderie.

Consulta Remota , Humanos , Pacientes , Reino Unido