Point of care thoracic ultrasound versus chest computed tomography in the approach of febrile neutropenia patients: A diagnostic accuracy cohort study.

Single-center prospective cohort diagnostic accuracy study. Our study aimed to evaluate the accuracy and reproducibility of Thoracic Ultrasound (TUS) in detecting pulmonary pathology in immunosuppressed patients. We conducted a single-center prospective study. Consecutive patients with febrile neutropenia who underwent CT (Computerized Tomography) underwent TUS evaluation within 24h of CT. Both studies were performed by an expert who was blinded to the clinical information and results of the alternative imaging modalities. 34 patients met the inclusion criteria. The median age was 39.9 years (±17 standard deviation). TUS as a diagnostic test had a sensitivity of 92.9% and specificity of 83.3%, negative predictive value of 71.4%, and positive predictive value of 96.3%. Substantial between-method agreement was demonstrated with a kappa of 0.71 (P = .001) between the TUS and chest CT findings. We obtained a kappa of 1 (P = .001) for the final diagnosis of Pleural Effusion (PE). We concluded that TUS is a promising screening test for immunocompromised individuals. The results showed good diagnostic performance of TUS compared to CT for the detection of pulmonary findings highly suggestive of pathology with high accuracy and reproducibility.

Low-dose rituximab in steroid-refractory chronic graft-versus-host disease.

BACKGROUND: Chronic graft-versus-host disease (cGvHD) is a major complication that puts patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT) at risk of death or infection. Currently, there is no gold standard for the first-line treatment of patients who do not respond to steroids, and there are several therapeutic options being evaluated in clinical trials for this disease to be used even in the first-line treatment for GvHD. There is evidence of the benefit of rituximab, an anti-CD20 antibody, at a standard dose of 375 mg/m2 weekly in the treatment of steroid-refractory chronic graft-versus disease (SR-cGvHD). OBJECTIVE: To demonstrate the safety and efficacy of low-dose rituximab in a middle-income center in northeastern Mexico STUDY DESIGN: We report the experience of 26 patients with chronic graft-versus-graft disease who received low-dose rituximab (100 mg weekly for 4 weeks). We utilized the advances in the National Institutes of Health (NIH) criteria for diagnosis, scoring, trial design, and assessment of treatment response. RESULTS: We obtained a 5-year overall survival of 23.6%, including four patients with complete response. The 1-year event-free survival was 70% for patients with rituximab. During the treatment, there were 3 hospitalizations, and the causes were: immune thrombocytopenia, a parapneumonic effusion, and a cerebral vascular event. The median length of hospital stay was twelve days. CONCLUSION: A low dose of rituximab is an available and cost-effective option for patients with steroid-refractory cGvHD.

The impact of health and wellness coaching on patient-important outcomes in chronic illness care: A systematic review and meta-analysis.

BACKGROUND: Health and Wellness Coaching (HWC) may be beneficial in chronic condition care. We sought to appraise its effectiveness on quality of life (QoL), self-efficacy (SE), depression, and anxiety. METHODS: We searched MEDLINE, EMBASE, CINAHL, PsycINFO, and Cochrane CENTRAL for randomized trials published January 2005 - March 2023 that compared HWC to standard clinical care or another intervention without coaching. We examined QoL, SE, depression, or anxiety outcomes. Meta-analysis utilizing the random-effects model was used to estimate the pooled standardized mean difference (SMD). RESULTS: Thirty included studies demonstrated that HWC improved QoL within 3 months (SMD 0.62 95 % CI 0.22-1.02, p = 0.002), SE within 1.5 months (SMD 0.38, 95 % CI 0.03-0.73, p = 0.03), and depression at 3, 6, and 12 months (SMD 0.67, 95 % CI 0.13-1.20, p = 0.01), (SMD 0.72, 95 % CI 0.19-1.24, p = 0.006), and (SMD 0.41, 95 % CI 0.09-0.73, p = 0.01) Certainty in the evidence for most outcomes was either very low or low primarily due to the high risk of bias, heterogeneity, and imprecision. CONCLUSION: HWC improves QoL, SE, and depression across chronic illness populations. Future research needs to standardize intervention reporting and outcome collection. PRACTICE IMPLICATIONS: Future HWC studies should standardize intervention components, reporting, and outcome measures, apply relevant chronic illness theories, and aim to follow participants for greater than one year.

Interlayer charge transfer in supported and suspended MoS2/Graphene/MoS2 vertical heterostructures.

In this letter, we report on the optical and structural properties of supported and suspended MoS2/Graphene/MoS2 vertical heterostructures using Raman and photoluminescence (PL) spectroscopies. Vertical heterostructures (VH) are formed by multiple wet transfers on micro-sized holes in SiO2/Si substrates, resulting in VH with different configurations. The strong interlayer coupling is confirmed by Raman spectroscopy. Additionally, we observe an enhancement of the PL emission in the three-layer VH (either support or suspended) compared with bare MoS2 or MoS2/Graphene. This suggests the formation of a spatial type-II band alignment assisted by the graphene layer and thus, the operation of the VH as a n++/metal/n junction.

Prevalence and associated factors of bullying in medical residents: A systematic review and meta-analysis.

OBJECTIVE: To assess the prevalence of bullying in medical residents and its associated factors. METHODS: In this systematic review and meta-analysis, articles from MEDLINE, EMBASE, Scopus, PsycInfo, Cochrane databases, and Web of Science were searched. Published and unpublished cross-sectional studies were included. Cochrane's Q test and I2 statistics were used to assess the existence of heterogeneity. Subgroup analysis and sensitivity analysis were performed on evidence of heterogeneity. Egger's test and funnel plots were performed to investigate publication bias. RESULTS: A total of 13 cross-sectional studies with a total of 44 566 study participants from different medical residencies were analyzed. The overall prevalence of bullying was 51% (95% CI 36-66). Furthermore, female residents and residents that belong to a minority group had higher odds of experiencing bullying compared to their peers. CONCLUSION: A high prevalence of bullying in medical residents exists around the world. There is a need for education, dissemination, and more effective interventions among the residents and authorities about bullying to build and promote adequate behaviors and diminish bullying prevalence.

A novel methodology for NETs visualization under light microscopy.

Neutrophils are the most abundant leukocytes in the bloodstream and are very important for the resolution of infection. One of the strategies used by neutrophils to eliminate a microorganism is the formation of extracellular traps. Different methods for neutrophil extracellular traps (NETs) visualization have been described along the years, usually requiring the use of a fluorescent, confocal or scanning electron microscope. This research aimed to visualize NETs using light microscopy as another way to study NETs prior to using the more expensive techniques, making NETs research more cost effective. We evaluated neutrophil purity, viability and function by analyzing the formation of NETs comparing DAPI with safranin. When evaluating NETs formation, neutrophils that were not stimulated did not form NETs and when neutrophils were exposed to PMA or S. aureus NETs were formed and visualized with safranin under light microscopy and DAPI under fluorescence microscopy. Our method demonstrates another way to visualize NETs that can be added to the standard methods of visualization of NETs, increasing the opportunities to generate knowledge in the topic in any lab around the world.

Career choice in primary care: pre- and post-comparison of Honduran physicians completing social service

[ABSTRACT]. Objective. To describe and compare patterns of specialty choice among physicians in Honduras before and after completing mandatory social service; and to identify and compare salary perceptions and factors that may influence their career choice. Methods. A quantitative methods approach was used on a cross-sectional questionnaire survey applied to 106 physicians completing social service in September 2015. Statistical analysis was performed using chi-square and factor analysis. Results. Interest in family medicine was low and declined from 2.2% before social service to 0.9% after. Median annual expected income was 19.5% lower overall compared to the beginning of social service, and in particular, for primary care specialties (US$ 17 733), it was significantly lower than for other specialties (US$ 27 281). Participants reported that the most important factors influencing career choice were: income potential (23.3%), making a positive difference in people´s lives (19.4%), challenging work (10.7%), and perceived prestige (7.8%). Two factors were significantly associated with a preference for specialties other than primary care: the opportunity to teach (P= 0.008) and “makes positive difference in people´s lives” (P = 0.005). When all categories were compared, “makes positive difference in people´s lives” (P = 0.043), and opportunities to practice with independence (P = 0.036) were factors significantly associated to career decision. Conclusion. Since interest in primary care among physicians decreased during social service and salary perception increased in favor of non-primary care careers, offering greater incentives for this specialty should be explored. Additional research to identify factors that might support the choice of a career in primary care are recommended.

[RESUMEN]. Objetivo. Describir y comparar los patrones de elección de especialidad de los médicos hondureños antes y después de completar el servicio social obligatorio. Establecer y comparar las percepciones sobre el salario y los factores que pueden influir en esa elección. Método. Se aplicaron métodos cuantitativos a un cuestionario transversal administrado a 106 médicos que terminaron el servicio social en septiembre de 2015. El análisis estadístico se realizó mediante ji cuadrado y análisis factorial. Resultados. El interés por la medicina familiar era escaso y descendió de 2,2% antes del servicio social a 0,9% después. La mediana de ingresos anuales previstos fue, en general, 19,5% inferior que al comienzo del servicio social y, en particular, fue significativamente inferior para las especialidades de atención primaria (US$ 17 733) que para otras especialidades (US$ 27 281). Los participantes informaron que los factores más importantes que influían en la elección de especialidad eran: posibles ingresos (23,3%), posibilidad de cambiar para mejor la vida de las personas (19,4%), trabajo estimulante (10,7%) y prestigio que pudiera otorgar (7,8%). Dos factores se asociaron significativamente con la preferencia por una especialidad fuera de la atención primaria: la oportunidad de enseñar (P= 0,008) y la posibilidad de “cambiar para mejor la vida de las personas” (P = 0,005). Cuando se compararon todas las categorías, “cambiar para mejor la vida de las personas” (P = 0,043) y la oportunidad de ejercer de forma independiente (P = 0,036) fueron factores que se asociaron significativamente con la decisión sobre la especialidad. Conclusión. Como el interés por la atención primaria entre los médicos disminuyó durante el servicio social y la percepción sobre el salario inclinó la balanza en favor de especialidades distintas a la atención primaria, se debe explorar la posibilidad de ofrecer mayores incentivos para esta especialización. Se recomienda realizar nuevas investigaciones para determinar los factores que podrían apoyar la elección de la especialidad de atención primaria.

[RESUMO]. Objetivo. Descrever e comparar os padrões de escolha da área de especialidade entre médicos hondurenhos antes e depois da prestação do serviço social obrigatório e identificar e comparar a percepção salarial e de outros potenciais determinantes da escolha profissional. Métodos. Estudo transversal com metodologia quantitativa conduzido com a aplicação de um questionário em uma amostra de 106 médicos que concluíram a prestação do serviço social obrigatório em setembro de 2015. A análise estatística foi realizada com o uso do teste de qui-quadrado e análise fatorial. Resultados. Verificou-se baixo grau de interesse em medicina da família, com redução do interesse de 2,2% a 0,9% após o serviço social. Houve, em geral, uma redução de 19,5% na mediana anual prevista de remuneração comparada ao início do serviço social, sendo particularmente significativa nas especialidades de atenção primária (US$ 17.733) e relação às outras especialidades (US$ 27.281). Os participantes informaram os seguintes principais determinantes da escolha da carreira profissional: ter potencial de remuneração (23,3%), contribuir para melhorar a vida das pessoas (19,4%), ser um trabalho estimulante (10,7%) e prestígio percebido (7,8%). Observou-se uma associação significativa entre os seguintes fatores e a preferência por especialidades fora da atenção primária: oportunidade de ensinar (P = 0,008) e contribuir para melhorar a vida das pessoas (P = 0,005). Quando se compararam todas as categorias, contribuir para melhorar a vida das pessoas (P = 0,043) e oportunidade de exercer a medicina de forma autônoma (P = 0,036) foram os fatores significativamente associados à escolha da carreira. Conclusão. Diante da perda de interesse por parte dos médicos pela área de atenção primária durante o serviço social e uma percepção salarial maior favorecendo carreiras fora da atenção primária, deve ser dado maior incentivo para que os profissionais optem por esta especialidade. Recomenda-se conduzir outros estudos para identificar os fatores que poderiam estimular a escolha de uma carreira profissional em atenção primária.

Career choice in primary care: pre- and post-comparison of Honduran physicians completing social service.

OBJECTIVE: To describe and compare patterns of specialty choice among physicians in Honduras before and after completing mandatory social service; and to identify and compare salary perceptions and factors that may influence their career choice. METHODS: A quantitative methods approach was used on a cross-sectional questionnaire survey applied to 106 physicians completing social service in September 2015. Statistical analysis was performed using chi-square and factor analysis. RESULTS: Interest in family medicine was low and declined from 2.2% before social service to 0.9% after. Median annual expected income was 19.5% lower overall compared to the beginning of social service, and in particular, for primary care specialties (US$ 17 733), it was significantly lower than for other specialties (US$ 27 281). Participants reported that the most important factors influencing career choice were: income potential (23.3%), making a positive difference in people's lives (19.4%), challenging work (10.7%), and perceived prestige (7.8%). Two factors were significantly associated with a preference for specialties other than primary care: the opportunity to teach (P= 0.008) and "makes positive difference in people's lives" (P = 0.005). When all categories were compared, "makes positive difference in people's lives" (P = 0.043), and opportunities to practice with independence (P = 0.036) were factors significantly associated to career decision. CONCLUSION: Since interest in primary care among physicians decreased during social service and salary perception increased in favor of non-primary care careers, offering greater incentives for this specialty should be explored. Additional research to identify factors that might support the choice of a career in primary care are recommended.

Career choice in primary care: pre- and post-comparison of Honduran physicians completing social service / Elección de especialidad en atención primaria: comparación entre médicos hondureños antes y después de completar el servicio social / Escolha da carreira profissional em atenção primária: comparação entre médicos hondurenhos antes e depois da prestação do serviço social

ABSTRACT Objective To describe and compare patterns of specialty choice among physicians in Honduras before and after completing mandatory social service; and to identify and compare salary perceptions and factors that may influence their career choice. Methods A quantitative methods approach was used on a cross-sectional questionnaire survey applied to 106 physicians completing social service in September 2015. Statistical analysis was performed using chi-square and factor analysis. Results Interest in family medicine was low and declined from 2.2% before social service to 0.9% after. Median annual expected income was 19.5% lower overall compared to the beginning of social service, and in particular, for primary care specialties (US$ 17 733), it was significantly lower than for other specialties (US$ 27 281). Participants reported that the most important factors influencing career choice were: income potential (23.3%), making a positive difference in people's lives (19.4%), challenging work (10.7%), and perceived prestige (7.8%). Two factors were significantly associated with a preference for specialties other than primary care: the opportunity to teach (P= 0.008) and "makes positive difference in people's lives" (P = 0.005). When all categories were compared, "makes positive difference in people's lives" (P = 0.043), and opportunities to practice with independence (P = 0.036) were factors significantly associated to career decision. Conclusion Since interest in primary care among physicians decreased during social service and salary perception increased in favor of non-primary care careers, offering greater incentives for this specialty should be explored. Additional research to identify factors that might support the choice of a career in primary care are recommended.

RESUMEN Objetivo Describir y comparar los patrones de elección de especialidad de los médicos hondureños antes y después de completar el servicio social obligatorio. Establecer y comparar las percepciones sobre el salario y los factores que pueden influir en esa elección. Método Se aplicaron métodos cuantitativos a un cuestionario transversal administrado a 106 médicos que terminaron el servicio social en septiembre de 2015. El análisis estadístico se realizó mediante ji cuadrado y análisis factorial. Resultados El interés por la medicina familiar era escaso y descendió de 2,2% antes del servicio social a 0,9% después. La mediana de ingresos anuales previstos fue, en general, 19,5% inferior que al comienzo del servicio social y, en particular, fue significativamente inferior para las especialidades de atención primaria (US$ 17 733) que para otras especialidades (US$ 27 281). Los participantes informaron que los factores más importantes que influían en la elección de especialidad eran: posibles ingresos (23,3%), posibilidad de cambiar para mejor la vida de las personas (19,4%), trabajo estimulante (10,7%) y prestigio que pudiera otorgar (7,8%). Dos factores se asociaron significativamente con la preferencia por una especialidad fuera de la atención primaria: la oportunidad de enseñar (P= 0,008) y la posibilidad de "cambiar para mejor la vida de las personas" (P = 0,005). Cuando se compararon todas las categorías, "cambiar para mejor la vida de las personas" (P = 0,043) y la oportunidad de ejercer de forma independiente (P = 0,036) fueron factores que se asociaron significativamente con la decisión sobre la especialidad. Conclusión Como el interés por la atención primaria entre los médicos disminuyó durante el servicio social y la percepción sobre el salario inclinó la balanza en favor de especialidades distintas a la atención primaria, se debe explorar la posibilidad de ofrecer mayores incentivos para esta especialización. Se recomienda realizar nuevas investigaciones para determinar los factores que podrían apoyar la elección de la especialidad de atención primaria.

RESUMO Objetivo Descrever e comparar os padrões de escolha da área de especialidade entre médicos hondurenhos antes e depois da prestação do serviço social obrigatório e identificar e comparar a percepção salarial e de outros potenciais determinantes da escolha profissional. Métodos Estudo transversal com metodologia quantitativa conduzido com a aplicação de um questionário em uma amostra de 106 médicos que concluíram a prestação do serviço social obrigatório em setembro de 2015. A análise estatística foi realizada com o uso do teste de qui-quadrado e análise fatorial. Resultados Verificou-se baixo grau de interesse em medicina da família, com redução do interesse de 2,2% a 0,9% após o serviço social. Houve, em geral, uma redução de 19,5% na mediana anual prevista de remuneração comparada ao início do serviço social, sendo particularmente significativa nas especialidades de atenção primária (US$ 17.733) e relação às outras especialidades (US$ 27.281). Os participantes informaram os seguintes principais determinantes da escolha da carreira profissional: ter potencial de remuneração (23,3%), contribuir para melhorar a vida das pessoas (19,4%), ser um trabalho estimulante (10,7%) e prestígio percebido (7,8%). Observou-se uma associação significativa entre os seguintes fatores e a preferência por especialidades fora da atenção primária: oportunidade de ensinar (P = 0,008) e contribuir para melhorar a vida das pessoas (P = 0,005). Quando se compararam todas as categorias, contribuir para melhorar a vida das pessoas (P = 0,043) e oportunidade de exercer a medicina de forma autônoma (P = 0,036) foram os fatores significativamente associados à escolha da carreira. Conclusão Diante da perda de interesse por parte dos médicos pela área de atenção primária durante o serviço social e uma percepção salarial maior favorecendo carreiras fora da atenção primária, deve ser dado maior incentivo para que os profissionais optem por esta especialidade. Recomenda-se conduzir outros estudos para identificar os fatores que poderiam estimular a escolha de uma carreira profissional em atenção primária.