Mamas tuberosas: reconstrucción mediante tejido autólogo, sin prótesis / Tuberous breast: autologous tissue reconstruction, without implants

Introducción y objetivo: La mama tuberosa es una entidad malformativa muy frecuente en mujeres jóvenes y un reto por su frecuencia y complejidad quirúrgica. Exponemos la transición que hemos llevado a cabo en el manejo de las mamas tuberosas en el servicio público de Cirugía Plástica del Hospital General Universitario Dr. Balmis de Alicante (España), sustituyendo la técnica con prótesis por técnica que emplea en exclusiva tejido autólogo. Material y método: Estudio descriptivo, retrospectivo, revisando los últimos 101 casos realizados en nuestro servicio entre noviembre de 2010 y junio 2022. Recogemos datos acerca de las técnicas quirúrgicas, número de intervenciones necesarias, así como la tasa de complicaciones a corto y largo plazo entre la técnica con material protésico que realizamos de forma habitual hasta 2013 y la técnica con tejido autólogo que utilizamos posteriormente. Describimos la técnica utilizada para corregir la alteración de la forma y la asimetría de volumen de las mamas tuberosas mediante el uso de colgajos glandulares, lipoinjertos y pexias mamarias. Resultados: En el periodo descrito empleamos tejido autólogo de forma exclusiva en el 87% de los casos, el 81% correspondientes a grados II y III de Grolleau, con una media de 2.1 tiempos quirúrgicos. La técnica más utilizada fue la remodelación glandular asociada a lipoinjerto. El índice de complicaciones a medio y largo plazo fue menor en comparación con la reconstrucción habitual con prótesis. Conclusiones: Según nuestra experiencia, la cirugía de la mama tuberosa mediante el uso exclusivo de tejido autólogo en pacientes seleccionadas, permite corregir esta malformación sin recurrir al uso de material protésico, con resultados reproducibles y con menos complicaciones a medio y largo plazo en comparación con la reconstrucción habitual con prótesis.(AU)

Background and objective: Tuberous breast is a very common malformative entity in young women and a challenge due to its frequency and surgical complexity. We present our transition in the management of tuberous breasts of our public Plastic Surgery Service at the Dr. Balmis General University Hospital in Alicante (Spain), replacing technique with prosthetic material for exclusive technique with autologous tissue. Methods: Descriptive, retrospective study, reviewing the last 101 cases performed in our service between November 2010 and June 2022. Data have been collected about the surgical techniques, number of necessary interventions, as well as the rate of shortand long-term complications between the technique with prosthetic material that we routinely performed until 2013 and the technique with autologous tissue that we used subsequently. The technique used to correct the alteration in shape and volume asymmetry of the tuberous breast is described, through using glandular flaps, lipografts and mastopexy techniques. Results: In the period described, the use of autologous tissue exclusively has been carried out in 87% of the cases, 81% corresponding to Grolleau grades II and III, with an average of 2.1 surgical times. The most used technique was glandular remodeling associated with lipograft. The rate of complications in the medium and long term is lower compared to the usual technique with prostheses that we previously performed. Conclusions: According to our experience, treatment of the tuberous breast through the exclusive use of autologous tissue in selected patients, allows this malforation to be fixed without using prosthetic material, with a lower number of complications compared to reconstruction with prosthetic material.(AU)

Methods for the Clinical Validation of Digital Endpoints: Protocol for a Scoping Review Abstract.

BACKGROUND: Clinical trials often use digital technologies to collect data continuously outside the clinic and use the derived digital endpoints as trial endpoints. Digital endpoints are also being developed to support diagnosis, monitoring, or therapeutic interventions in clinical care. However, clinical validation stands as a significant challenge, as there are no specific guidelines orienting the validation of digital endpoints. OBJECTIVE: This paper presents the protocol for a scoping review that aims to map the existing methods for the clinical validation of digital endpoints. METHODS: The scoping review will comprise searches from the electronic literature databases MEDLINE (PubMed), Scopus (including conference proceedings), Embase, IEEE (Institute of Electrical and Electronics Engineers) Xplore, ACM (Association for Computing Machinery) Digital Library, CENTRAL (Cochrane Central Register of Controlled Trials), Web of Science Core Collection (including conference proceedings), and Joanna Briggs Institute Database of Systematic Reviews and Implementation Reports. We will also include various sources of gray literature with search terms related to digital endpoints. The methodology will adhere to the Joanna Briggs Institute Scoping Review and the Guidance for Conducting Systematic Scoping Reviews. RESULTS: A search for reviews on the existing evidence related to this topic was conducted and has shown that no such review was previously undertaken. This review will provide a systematic assessment of the literature on methods for the clinical validation of digital endpoints and highlight any potential need for harmonization or reporting of methods. The results will include the methods for the clinical validation of digital endpoints according to device, digital endpoint, and clinical application goal of digital endpoints. The study started in January 2023 and is expected to end by December 2023, with results to be published in a peer-reviewed journal. CONCLUSIONS: A scoping review of methodologies that validate digital endpoints is necessary. This review will be unique in its breadth since it will comprise digital endpoints collected from several devices and not focus on a specific disease area. The results of our work should help guide researchers in choosing validation methods, identify potential gaps in the literature, or inform the development of novel methods to optimize the clinical validation of digital endpoints. Resolving these gaps is the key to presenting evidence in a consistent way to regulators and other parties and obtaining regulatory acceptance of digital endpoints for patient benefit. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/47119.

Molecular Detection of Metronidazole and Tetracycline Resistance Genes in Helicobacter pylori-Like Positive Gastric Samples from Pigs.

Antimicrobial resistance is a major public health concern. The aim of this study was to assess the presence of antibiotic resistance genes, previously reported in Helicobacter pylori, in gastric samples of 36 pigs, in which DNA of H. pylori-like organisms had been detected. Based on PCR and sequencing analysis, two samples were positive for the 16S rRNA mutation gene, conferring tetracycline resistance, and one sample was positive for the frxA gene with a single nucleotide polymorphism, conferring metronidazole resistance. All three amplicons showed the highest homology with H. pylori-associated antibiotic resistance gene sequences. These findings indicate that acquired antimicrobial resistance may occur in H. pylori-like organisms associated with pigs.

Saccharopolyspora sp. NFXS83 in Marine Biotechnological Applications: From Microalgae Growth Promotion to the Production of Secondary Metabolites.

Marine bacteria are a significant source of bioactive compounds for various biotechnological applications. Among these, actinomycetes have been found to produce a wide range of secondary metabolites of interest. Saccharopolyspora is one of the genera of actinomycetes that has been recognized as a potential source of these compounds. This study reports the characterization and genomic analysis of Saccharopolyspora sp. NFXS83, a marine bacterium isolated from seawater from the Sado estuary in Portugal. The NFXS83 strain produced multiple functional and stable extracellular enzymes under high-salt conditions, showed the ability to synthesize auxins such as indole-3-acetic acid, and produced diffusible secondary metabolites capable of inhibiting the growth of Staphylococcus aureus. Furthermore, when Phaeodactylum tricornutum was co-cultivated with strain NFXS83 a significant increase in microalgae cell count, cell size, auto-fluorescence, and fucoxanthin content was observed. Detailed analysis revealed the presence of clusters involved in the production of various secondary metabolites, including extracellular enzymes, antimicrobial compounds, terpenes, and carotenoids in the genome of strain NFXS83. Ultimately, these findings indicate that Saccharopolyspora sp. NFXS83 has a significant potential for a wide range of marine biotechnological applications.

Plant Growth Promotion, Phytohormone Production and Genomics of the Rhizosphere-Associated Microalga, Micractinium rhizosphaerae sp. nov.

Microalgae are important members of the soil and plant microbiomes, playing key roles in the maintenance of soil and plant health as well as in the promotion of plant growth. However, not much is understood regarding the potential of different microalgae strains in augmenting plant growth, or the mechanisms involved in such activities. In this work, the functional and genomic characterization of strain NFX-FRZ, a eukaryotic microalga belonging to the Micractinium genus that was isolated from the rhizosphere of a plant growing in a natural environment in Portugal, is presented and analyzed. The results obtained demonstrate that strain NFX-FRZ (i) belongs to a novel species, termed Micractinium rhizosphaerae sp. nov.; (ii) can effectively bind to tomato plant tissues and promote its growth; (iii) can synthesize a wide range of plant growth-promoting compounds, including phytohormones such as indole-3-acetic acid, salicylic acid, jasmonic acid and abscisic acid; and (iv) contains multiple genes involved in phytohormone biosynthesis and signaling. This study provides new insights regarding the relevance of eukaryotic microalgae as plant growth-promoting agents and helps to build a foundation for future studies regarding the origin and evolution of phytohormone biosynthesis and signaling, as well as other plant colonization and plant growth-promoting mechanisms in soil/plant-associated Micractinium.

Perception and Knowledge of Portuguese Veterinarians about the Zoonotic Transmission of Helicobacter pylori and Helicobacter suis: The Need for One Health Intervention.

Helicobacter species can colonize the gastrointestinal tract of both humans and animals, and are associated with gastrointestinal and extra-gastrointestinal diseases. Some studies indicate that animals, health professionals, and people in close contact with animals might be at higher risk for infection with gastric Helicobacter spp. Considering that veterinarians are professionals at risk for infection with zoonotic gastric Helicobacters and are also seen by many as health communicators concerning zoonoses, the aim of this study was to evaluate the Portuguese veterinarians' perception and knowledge of Helicobacter spp. infection and its zoonotic risk/potential. Therefore, a structured questionnaire composed of 34 dichotomic, multiple-choice, rating scale, matrix, drop-down, and open-ended questions was developed and given to Portuguese veterinarians via an online platform from May 2021 to July 2021, and statistical analysis was used to obtain results. There was a total of 149 respondents, most of them (73.8%) being females. Evidently, Portuguese veterinarians have a limited perception regarding Helicobacter spp. infections. Of the respondents that "have heard of Helicobacter", 17.6% do not know which animal species can be affected by it. Most of the companion animal veterinarians (76.2%) do not consider Helicobacter spp. infection a differential diagnosis when evaluating animals with gastritis. A significant percentage (37.2%) of the respondents that have "heard of H. suis" do not consider it a zoonotic bacterium. There is a need for education and sensitization of veterinarians regarding the potential zoonotic risk of Helicobacter spp. in order to elucidate these professionals to this One Health issue, as the number of reports of non-Helicobacter pylori Helicobacter in livestock, companion, and wild animals is increasing.

Molecular detection of Helicobacter spp. and Fusobacterium gastrosuis in pigs and wild boars and its association with gastric histopathological alterations.

Besides Helicobacter pylori, a Gram-negative bacterium that may cause gastric disorders in humans, non-Helicobacter pylori helicobacters (NHPH) may also colonize the stomach of humans and animals. In pigs, H. suis can induce gastritis and may play a role in gastric ulcer disease, possibly in association with Fusobacterium gastrosuis. In the present study, gastric samples from 71 slaughtered pigs and 14 hunted free range wild boars were tested for the presence of DNA of F. gastrosuis and gastric Helicobacter species associated with pigs, dogs cats and humans, using species-specific PCR assays, followed by sequencing of the amplicon. These gastric samples were also histopathologically evaluated. Almost all the pigs presented gastritis (95.8%). Helicobacter spp. were detected in 78.9% and F. gastrosuis in 35.2% of the animals. H. suis was the most frequently identified Helicobacter species (57.7% of the animals), followed by a H. pylori-like species (50.7%) and less often H. salomonis and H. felis (each in 2.8% of the animals). H. suis was most often detected in the glandular (distal) part of the stomach (pars oesophagea 9.9%, oxyntic mucosa 35.2%, antral mucosa 40.8%), while the H. pylori-like species was mainly found in the non-glandular (proximal) part of the stomach (pars oesophagea 39.4%, oxyntic mucosa 14.1%, antral mucosa 4.2%). The great majority of wild boars were also affected with gastritis (71.4%) and Helicobacter spp. and F. gastrosuis were detected in 64.3% and 42.9% of the animals, respectively. H. bizzozeronii and H. salomonis were the most frequently detected Helicobacter species, while a H. pylori-like species and H. suis were only occasionally identified. These findings suggest that these microorganisms can colonize the stomach of both porcine species and may be associated with gastric pathology. This should, however, be confirmed through bacterial isolation. This is the first description of the presence of F. gastrosuis DNA in the stomach of wild boars and a H. pylori-like species in the pars oesophagea of the porcine stomach.

Helicobacter spp. in the Stomach of Cats: Successful Colonization and Absence of Relevant Histopathological Alterations Reveals High Adaptation to the Host Gastric Niche.

In addition to Helicobacter pylori, many non-Helicobacter pylori Helicobacters (NHPH) are able to cause gastric disease in humans. Cats are a natural reservoir for many of these species. Accordingly, living in close and intimate contact with animals has been identified as a risk factor, and an important zoonotic significance has therefore been attributed to NHPH. To determine the prevalence and associated gastric histopathological changes of Helicobacter species, the gastric mucosa of 71 cats were evaluated. Only four presented normal histopathological mucosa with the absence of spiral-shaped organisms. Normal gastric mucosa and the presence of spiral-shaped bacteria were observed in 13 cats. The remaining animals presented histopathological changes representative of gastritis. Helicobacter species were detected in 53 cats (74.6%) by at least one detection method. None of the animals were positive for H. pylori or for H. ailurogastricus. Helicobacter heilmannii organisms were identified in 20 animals, predominantly in the body gastric region. Helicobacter salomonis was the second most prevalent species (57.1%), although it was mainly found in association with other NHPH. Helicobacter felis and H. bizzozeronii were less frequently detected. The great majority of the Helicobacter spp. PCR-positive animals presented normal features regarding fibrosis/mucosal atrophy, neutrophils, eosinophils, or other inflammatory cells and lymphofollicular hyperplasia. Given the controversy and the strong evidence of absence of significant histopathological alterations associated with the presence of Helicobacter spp. in cats, it is possible to hypothesize that these bacteria may be able to adapt to the feline gastric microenvironment or even to comprise part of the gastric microbiome of this animal species. Thus, prudency must be taken when prescribing an antibiotic therapy based solely on the presence of these bacteria in the feline stomach.

Understanding Mental Health Professionals' Perspectives and Practices Regarding the Implementation of Digital Mental Health: Qualitative Study.

BACKGROUND: Despite the potential of digital mental health to provide cost-effective mental health care, its adoption in clinical settings is limited, and little is known about the perspectives and practices of mental health professionals regarding its implementation or the factors influencing these perspectives and practices. OBJECTIVE: This study aims to characterize in depth the perspectives and practices of mental health professionals regarding the implementation of digital mental health and explore the factors affecting such perspectives and practices. METHODS: A qualitative study using in-depth semistructured interviews with Portuguese mental health professionals (N=13)-psychologists and psychiatrists-was conducted. The transcribed interviews were thematically analyzed. RESULTS: Mental health professionals deemed important or engaged in the following practices during the implementation of digital mental health: indication evaluation, therapeutic contract negotiation, digital psychological assessment, technology setup and management, and intervention delivery and follow-up. Low-threshold accessibility and professionals' perceived duty to provide support to their clients facilitated the implementation of digital mental health. Conversely, the lack of structured intervention frameworks; the unavailability of usable, validated, and affordable technology; and the absence of structured training programs inhibited digital mental health implementation by mental health professionals. CONCLUSIONS: The publication of practice frameworks, development of evidence-based technology, and delivery of structured training seem key to expediting implementation and encouraging the sustained adoption of digital mental health by mental health professionals.

Genomic insights into the plant-associated lifestyle of Kosakonia radicincitans MUSA4, a diazotrophic plant-growth-promoting bacterium.

The process of nitrogen (N) fixation by plant-associated bacteria plays an indispensable role in the development of novel agricultural solutions worldwide. In this sense, it is of extreme importance to identify and understand the properties of efficient plant-growth-promoting bacteria (PGPB) that are able to fix N. In this study, the characterization and detailed genomic analysis of the diazotrophic bacterium Kosakonia radicincitans MUSA4, isolated from the internal leaf tissues of a banana tree in Brazil, were undertaken. K. radicincitans MUSA4 presented several plant-growth-promoting traits, including indoleacetic acid, siderophore, acetoin and polyamine biosynthesis, phosphate solubilization, and nitrogen fixation. The strain was able to increase cucumber plant growth significantly, demonstrating its potential in beneficial interactions with plant hosts. Detailed genomic analysis of strain MUSA4 revealed the abundant presence of genes involved in plant colonization, stress resistance and plant-growth-promoting abilities. Moreover, the genome harbored the nif and anf gene clusters, encoding the Fe-Mo nitrogenase and Fe-Fe nitrogenase systems, respectively. Comparative genomic analysis also showed that strain MUSA4 possessed several strain-specific genes, which could be related to its evolutionary history in Brazilian mangrove environments. The results obtained in the present study revealed the plant beneficial role and biotechnological potential of K. radicincitans MUSA4, and provided new insights into plant colonization and plant growth promoting mechanisms employed by diazotrophic Kosakonia.

Development and Evaluation of the Usefulness, Usability, and Feasibility of iNNOV Breast Cancer: Mixed Methods Study.

BACKGROUND: Despite the efficacy of psychosocial interventions in minimizing psychosocial morbidity in breast cancer survivors (BCSs), intervention delivery across survivorship is limited by physical, organizational, and attitudinal barriers, which contribute to a mental health care treatment gap in cancer settings. OBJECTIVE: The aim of this study is to develop iNNOV Breast Cancer (iNNOVBC), a guided, internet-delivered, individually tailored, acceptance and commitment therapy-influenced cognitive behavioral intervention program aiming to treat mild to moderate anxiety and depression in BCSs as well as to improve fatigue, insomnia, sexual dysfunction, and health-related quality of life in this group. This study also aims to evaluate the usefulness, usability, and preliminary feasibility of iNNOVBC. METHODS: iNNOVBC was developed using a user-centered design approach involving its primary and secondary end users, that is, BCSs (11/24, 46%) and mental health professionals (13/24, 54%). We used mixed methods, namely in-depth semistructured interviews, laboratory-based usability tests, short-term field trials, and surveys, to assess iNNOVBC's usefulness, usability, and preliminary feasibility among these target users. Descriptive statistics were used to characterize the study sample, evaluate performance data, and assess survey responses. Qualitative data were recorded, transcribed verbatim, and thematically analyzed. RESULTS: Overall, participants considered iNNOVBC highly useful, with most participants reporting on the pertinence of its scope, the digital format, the relevant content, and the appropriate features. However, various usability issues were identified, and participants suggested that the program should be refined by simplifying navigation paths, using a more dynamic color scheme, including more icons and images, displaying information in different formats and versions, and developing smartphone and tablet versions. In addition, participants suggested that tables should be converted into plain textboxes and data visualization dashboards should be included to facilitate the tracking of progress. The possibility of using iNNOVBC in a flexible manner, tailoring it according to BCSs' changing needs and along the cancer care continuum, was another suggestion that was identified. CONCLUSIONS: The study results suggest that iNNOVBC is considered useful by both BCSs and mental health professionals, configuring a promising point-of-need solution to bridge the psychological supportive care gap experienced by BCSs across the survivorship trajectory. We believe that our results may be applicable to other similar programs. However, to fulfill their full supportive role, such programs should be comprehensive, highly usable, and tailorable and must adopt a flexible yet integrated structure capable of evolving in accordance with survivors' changing needs and the cancer continuum.

Plantas medicinais e fitoterápicos no cuidado da saúde mental em tempos de pandemia: uma revisão da literatura / Medicinal plants and herbal medicines in mental health care in times of pandemic: a literature review

Apesar do uso de plantas medicinais para tratamento de problemas de saúde ser tradicionalmente aceito, esta prática da medicina popular ainda encontra resistência por profissionais da saúde, sobretudo sob a alegação da falta de comprovação de seus efeitos. Durante o surto de Covid-19, houve aumento significativo do estresse, sintomas ansiosos e insônia e o uso de plantas medicinais e fitoterápicos surge como uma alternativa terapêutica. O objetivo deste estudo foi realizar uma revisão da literatura sobre a eficácia de plantas medicinais como terapia alternativa e/ou complementar para transtornos de ansiedade e insônia. As plantas investigadas foram selecionadas a partir do Formulário de Fitoterápicos e Memento Fitoterápico da Farmacopeia Brasileira, sendo utilizados como descritores o nome científico da planta e os termos "anxiety" e "insomnia" com recorte temporal de 2015 a 2020. 230 resultados foram encontrados, 42 selecionados (27 em humanos e 15 em animais). Foi possível demonstrar efeitos ansiolíticos para as plantas capim santo (Cymbopogon citratus), lavanda (Lavandula officinalis), melissa (Melissa officinalis), maracujá (Passiflora incarnata)e valeriana (Valeriana officinalis) e sedativos para melissa, maracujá e valeriana. A kava-kava (Piper methysticum) demonstrou apenas efeito sedativo e a camomila (Matricaria chamomilla) apresentou eficácia clínica ansiolítica. Portanto, a potencial aplicação clínica dessas plantas é indicada para tratamento dos sintomas de ansiedade e insônia, ajudando a reduzir os sintomas psicológicos decorrentes da pandemia de Covid-19. Contudo, vale ressaltar a necessidade da padronização dos procedimentos metodológicos e avanço da fitoterapia na prática médica. [au]

Although the use of medicinal plants to treat health problems is traditionally accepted, this practice of popular medicine still finds resistance from health professionals, especially under the allegation of lack of scientific proof of its effects. During the outbreak of COVID-19, there was a significant increase in stress, anxiety, and insomnia symptoms, and the use of plants and herbal medicines emerged as a possible therapeutic alternative. The objective of this study was to conduct a literature review about the effectiveness of medicinal plants as an alternative and/or complementary therapy for anxiety and insomnia disorders. The main medicinal plants were selected from the Phytotherapeutic Formulary and Phytotherapeutic Memento of the Brazilian Pharmacopoeia, using the 'scientific name' and terms 'anxiety' and 'insomnia' as descriptors between 2015-2020. 230 results were found and 42 studies were selected (27 in humans and 15 in animals). Anxiolytic effects have been demonstrated to Cymbopogon citratus, Lavandula officinalis, Melissa officinalis, Passiflora incarnata, and Valeriana officinalis and sedatives effects to M. officinalis, P. incarnata, and V. officinalis. Piper methysticum revealed only a sedative effect and Matricaria chamomilla showed anxiolytic clinical efficacy. Then, the potential clinical application of these plants in the treatment of anxiety and insomnia symptoms is indicated, helping to reduce the psychological symptoms resulting from the Covid-19 pandemic. However, it is worth emphasizing the need to standardize methodological procedures and advance phytotherapy in medical practice. [au]

Presence of Helicobacter pylori and H. suis DNA in Free-Range Wild Boars.

Helicobacter pylori (H. pylori) is a Gram-negative bacterium that infects half of the human population worldwide, causing gastric disorders, such as chronic gastritis, gastric or duodenal ulcers, and gastric malignancies. Helicobacter suis (H. suis) is mainly associated with pigs, but can also colonize the stomach of humans, resulting in gastric pathologies. In pigs, H. suis can induce gastritis and seems to play a role in gastric ulcer disease, seriously affecting animal production and welfare. Since close interactions between domestic animals, wildlife, and humans can increase bacterial transmission risk between species, samples of gastric tissue of 14 free range wild boars (Sus scrofa) were evaluated for the presence of H. pylori and H. suis using PCR. Samples from the antral gastric mucosa from two animals were PCR-positive for H. pylori and another one for H. suis. These findings indicate that these microorganisms were able to colonize the stomach of wild boars and raise awareness for their putative intervention in Helicobacter spp. transmission cycle.

From hospital to post-acute care organizations: the relationship between patient experience and health recovery.

OBJECTIVE: To determine to what extent patient health status and recovery in post-acute care organizations (PACO) is related to patient experience of the discharge process from hospital and to patient experience while staying in these facilities. DESIGN: Longitudinal study of patients discharged from hospitals to PACO. SETTING: 12 hospitals and 14 PACO Portuguese organizations. PARTICIPANTS: 181 patients participated in the both stages of data gathering. MAIN OUTCOME MEASURES: Patients' physical and mental health status was measured through the 36-item short form health survey scale. The experience of transition from hospital to PACO was measured with the Care Transition Measure. The Picker Adult In-Patient Questionnaire was used to measure patients' experience in these organizations. RESULTS: Patients reporting better physical condition in PACO had a better experience on discharge [b = 0.21, 95% confidence interval, CI (0.10, 0.31)] and perceive fewer problems inside facilities [b = - 0.19, 95% CI (-0.31, 0.08)]. The experience in PACO is significantly related to patients' mental health status [b = - 0.47, 95% CI (-0.59, - 0.36)]. Patients showing higher levels of physical recovery had a better experience on discharge [b = - 0.18, 95% CI (0.08, 0.28)], while those registering better mental recovery experienced fewer problems during their stay [b = - 0.41, 95% CI (-0.52, - 0.30)]. CONCLUSIONS: PACO play a key role in maintaining and promoting patients' health, and this goal is influenced by their experience both in the transition from hospitals to PACO and while staying in these facilities.

Enacting quality improvement in ten European hospitals: a dualities approach.

BACKGROUND: Hospitals undertake numerous initiatives searching to improve the quality of care they provide, but these efforts are often disappointing. Current models guiding improvement tend to undervalue the tensional nature of hospitals. Applying a dualities approach that is sensitive to tensions inherent to hospitals' quest for improved quality, this article aims to identify which organizational dualities managers should particularly pay attention to. METHODS: A set of cross-national, multi-level case studies was conducted involving 383 semi-structured interviews and 803 h of non-participant observation of key meetings and shadowing of staff in ten purposively sampled hospitals in five European countries (England, the Netherlands, Portugal, Sweden, and Norway). RESULTS: Six dualities that describe the quest for improved quality, each embracing a seemingly contradictory feature were identified: plural consensus, distributed connectedness, orchestrated emergence, formalized fluidity, patient coreness, and cautious generativeness. CONCLUSIONS: We advocate for a move from the usual sequential and project-based and systemic thinking about quality improvement to the development of meta-capabilities to balance the simultaneous operation of opposing ideas or concepts. Doing so will help hospital managers to deal with major challenges of change inherent to quality improvement initiatives.

The Practical Work of Ensuring Effective Use of Serious Games in a Rehabilitation Clinic: A Qualitative Study.

BACKGROUND: Many rehabilitation clinics adopted serious games to support their physiotherapy sessions. Serious games can monitor and provide feedback on exercises and are expected to improve therapy and help professionals deal with more patients. However, there is little understanding of the impacts of serious games on the actual work of physiotherapists. OBJECTIVE: This study aimed to understand the impact of an electromyography-based serious game on the practical work of physiotherapists. METHODS: This study used observation sessions in an outpatient rehabilitation clinic that recently started using a serious game based on electromyography sensors. In total, 44 observation sessions were performed, involving 3 physiotherapists and 22 patients. Observation sessions were documented by audio recordings or fieldnotes and were analyzed for themes with thematic analysis. RESULTS: The findings of this study showed that physiotherapists played an important role in enabling the serious game to work. Physiotherapists briefed patients, calibrated the system, prescribed exercises, and supported patients while they played the serious game, all of which amounted to relevant labor. CONCLUSIONS: The results of this work challenge the idea that serious games reduce the work of physiotherapists and call for an overall analysis of the different impacts a serious game can have. Adopting a serious game that creates more work can be entirely acceptable, provided the clinical outcomes or other advantages enabled by the serious game are strong; however, those impacts will have to be assessed on a case-by-case basis. Moreover, this work motivates the technology development community to better investigate physiotherapists and their context, offering implications for technology design.

Canine ovarian gonadoblastoma with dysgerminoma overgrowth: a case study and literature review.

BACKGROUND: Gonadoblastoma (GB) is a rare mixed germ cell-sex cord-stromal tumour, first described in humans, commonly found in dysgenetic gonads of intersex patients that have a Y chromosome. However, this entity in not recognized in the WHO classification of tumours of genital system of domestic animals. Herein, we describe a case of ovarian gonadoblastoma with proliferation of dysgerminoma and sex cord-stromal tumour components, in a phenotypically and cytogenetically normal bitch. CASE PRESENTATION: A 17-year-old cross-breed bitch had a firm, grey-white multinodular mass in the left ovary. The tumour was submitted to histopathological examination and Y chromosome detected through karyotype analysis and PCR studies. Microscopically, the ovary was almost replaced by an irregular neoplasm composed of three distinct, intermixed elements: dysgerminoma, mixed germ cell-sex cord-stromal tumour resembling human GB and a proliferative sex cord-stromal tumour component. The germ cells of gonadoblastoma and dysgerminoma components were immunoreactive for c-KIT. Sex cord-stromal cells of gonadoblastoma were immunoreactive for α-inhibin. The sex cord-stromal tumour was immunoreactive for AE1/AE3, occasionally for α-inhibin and negative for epithelial membrane antigen (EMA). The karyotype was 78, XX and PCR analysis confirmed the absence of the Y chromosome. CONCLUSION: Based on these findings, a diagnosis of gonadoblastoma with proliferation of dysgerminoma and sex cord-stromal tumour was made. This is the first case of ovarian gonadoblastoma in a female dog.

Cardiac involvement in trypanosomiasis in sheep experimentally infected by Trypanosoma vivax (Ziemman, 1905).

The objective of the present study was to evaluate the clinical signs, electrocardiographic signs and evolution of histopathological lesions in the heart of sheep experimentally infected by Trypanosoma vivax during the acute and chronic phases of infection as well as to investigate the presence of parasitic DNA in the heart using polymerase chain reaction (PCR). Twenty-two male sheep were divided into the following four groups: G1, which consisted of six sheep infected by T. vivax that were evaluated until 20 days post-infection (dpi; acute phase); G2, which consisted of six sheep infected by T. vivax that were evaluated until 90 dpi (chronic phase); and G3 and G4 groups, which each consisted of five uninfected sheep. At the end of the experimental period, electrocardiographic evaluations and necroscopic examinations were performed. Fragments of the heart were collected and stained by Hematoxylin-Eosin and Masson's trichrome, and the fragments were also evaluated by PCR for T. vivax. G2 animals presented clinical signs suggestive of heart failure and electrocardiogram alterations characterized by prolonged P, T and QRS complex durations as well as by a cardiac electrical axis shift to the left and increased heart rate. In these animals, mononuclear multifocal myocarditis and interstitial fibrosis were also observed. PCR revealed positivity for T. vivax in two G1 animals and in all G2 animals. Thus, these findings suggested that T. vivax is responsible for the occurrence of cardiac lesions, which are related to heart failure, electrocardiographic alterations and mortality of the infected animals.

Translating research on quality improvement in five European countries into a reflective guide for hospital leaders: the 'QUASER Hospital Guide'.

OBJECTIVE: The aim was to translate the findings of the QUASER study into a reflective, dialogic guide to help senior hospital leaders develop an organization wide QI strategy. DESIGN: The QUASER study involved in depth ethnographic research into QI work and practices in two hospitals in each of five European countries. Three translational stakeholder workshops were held to review research findings and advise on the design of the Guide. An extended iterative process involving researchers from each participant country was then used to populate the Guide. SETTING: The research was carried out in two hospitals in each of five European countries. PARTICIPANTS: In total, 389 interviews with healthcare practitioners and 803 hours of observations. INTERVENTION: None. MAIN OUTCOME MEASURE: None. RESULTS: The QUASER Hospital Guide was designed for leadership teams to diagnose their organization's strengths and weaknesses in the eight QI challenges. The Guide supports organizational dialogue about QI challenges, enables leaders to share perspectives, and helps teams to develop solutions to their situated problems. The Guide includes extensive examples of QI strategies drawn from the data and is published online and on paper. CONCLUSIONS: The QUASER Hospital Guide is empirically based, draws on a dialogical approach to Organizational Development and complexity science and can facilitate hospital leadership teams to identify the best solutions for their organization.