Clinical evaluation of antifungal de-escalation in Candida infections: A systematic review and meta-analysis.

OBJECTIVES: De-escalation (DES) from echinocandins to azoles is recommended by several medical societies in Candida infections. We summarise the evidence of DES on clinical and microbiological cure and 30-day survival and compare it with continuing the treatment with echinocandins (non-DES). METHODS: We searched MEDLINE, Embase, Web of Science and Scopus. Studies describing DES in inpatients and reporting any of the outcomes evaluated were included. Pooled estimates of the tree outcomes were calculated with a fixed or random-effects model. Heterogeneity was explored stratifying by subgroups and via meta-regression. This systematic review is registered with PROSPERO (CRD42023475486). RESULTS: Of 1853 records identified, 9 studies were included, totalling 1575 patients. Five studies stepped-down to fluconazole; one to voriconazole and three to any of azoles. The mean day of DES was 5.2 (4.6-6.5) days. The clinical cure OR was 1.29 (95% CI: 0.88-1.88); the microbiological cure 1.62 (95% CI: 0.71-3.71); and 30-day survival 2.17 (95% CI: 1.09-4.32). The 30-day survival data into subgroups showed higher effect on critically ill patients and serious-risk bias studies. Meta-regression did not identify significant effect modifiers. CONCLUSIONS: DES is a safe strategy; it showed no higher 30-day mortality and a trend towards greater clinical and microbiological cure.

Pediatric morbidity after oral surgery procedures under general anaesthesia: A systematic review.

The aim of this study is to carry out a systematic review of the existing literature on postoperative morbidity after general anaesthesia (GA) in the dental care of paediatric patients, its frequency, characteristics and association with the intervention performed. MATERIAL AND METHODS: An exhaustive search of the literature published up to 23 February 2022 was carried out in PubMed, Web of Science, Cochrane and EBSCO, with the following strategy: (infant OR child OR adolescent) AND (Oral Surgical Procedures OR Dentistry, Operative) AND Anesthesia, General AND Postoperative Complications. RESULTS: The most frequent reason for the indication of general anaesthesia was dental caries and its complications (up to 91.0% of patients), followed by lack of cooperation/anxiety and/or fear for dental procedures in the office (between 39.8 and 47.9%). There is a higher prevalence for treatments in the special patient group reaching 87.7% compared to 63.3% in healthy patients. The main comorbidities recorded were: physical or mental disability, neurological, haematological, cardiac disorders, asthma, Down's syndrome; it was not possible to establish their association with the intervention performed. Regarding complications, complaints occurred between 43.0 and 98.9% of cases within the first 24 hours, the main reason being pain (between 14.0% and 95.0%). CONCLUSIONS: Pediatric dental procedures under GA carry a very low risk of major complications, but have a virtually universal incidence of minor complications.

A comparison of patient-reported outcome measures for dupuytren disease: A prospective view.

Treatment success in Dupuytren´s disease has traditionally been assessed by clinical examination and physical measures, but based on patient orientation, patient-reported outcome measures (PROMs) can be used to quantify treatment impacts and health-related quality of life. The aim of this study was to compare the most widely used PROMS in Dupuytren´s disease, their psychometric properties, and their association with objectively measured hand function. We show a prospective study in which two disease-specific questionnaires (URAM scale and SDSS) and two hand-specific questionnaires (briefMHQ and PEM) were administered before and a month after the treatment with collagenase. Psychometric properties (construct validity, internal consistency, test-retest reliability, internal and external responsiveness, reliability, and minimal clinically important difference (MCID)) were calculated for all the questionnaires. Ninety-two completed both sets of questionnaires. Pre- and post-treatment scores were strongly correlated (Spearman rho >0.6) for all questionnaires. High internal consistency (Cronbach alpha >0.88) was observed for all the questionnaires. Test-retest reliability was also significant, with an ICC of >0.50 in all cases. The MCID was similar for three of the questionnaires (URAM, 11.528/45=0.256; SDSS, 5.079/20=0.254; and PEM, 21.542/77=0.215) and somewhat lower for the briefMHQ (10.617/60=0.177). No correlations were observed between treatment outcome and treated hand (r = 0.107; p = 0.31), joint (r = 0.163; p = 0.12), or finger (r = -0.151; p = 0.15). In conclusion, we did not find that any one questionnaire performed better than the other in detecting perceived changes in health status among patients with Dupuytren´s disease treated with collagenase.

Sensitivity and Specificity of the Unité Rhumatologique Des Affections De La Main (URAM) Scale for Dupuytren Contracture: A Systematic Review and Meta-Analyses.

BACKGROUND: Unité Rhumatologique des Affections de la Main (URAM) is a novel and disease-specific questionnaire for Dupuytren contracture, a fibroproliferative disease that affects hands causing progressive contracture in flexion of the fingers. OBJECTIVES: To evaluate the sensitivity and specificity of the URAM scale in Dupuytren contracture. MATERIALS AND METHODS: We performed meta-analyses of 10 articles published in PubMed, Embase, Cochrane, Google Scholar, Latin American and Caribbean Health Sciences Literature (LILACS), and in various grey literature databases that describe the use of the URAM and Tubiana scales to assess treatment outcomes in Dupuytren contracture. We built three models: a hierarchical summary receiver operating characteristic (HSROC) model to determine the optimal threshold for defining Dupuytren contracture, a difference in means model to assess the magnitude of the effect of different treatment modalities, and a meta-regression model to determine the effect on patient quality of life questionnaires such as the URAM, according to variations in Tubiana scores after treatment. RESULTS: The HSROC and bivariate models showed a sensitivity of 80.23% (95% CI: 75.66 to 84.14) and an overall specificity of 2.61% (95% CI: 1.11 to 6.05). The second model showed an overall difference in means of 1.95 (95% CI: -2.86 to -1.04) for partial fasciectomy and collagenase Clostridium histolyticum (CCH) injections, and -1.30 (95% CI: -1.77 to -0.83) for partial fasciectomy, and -2.75 (95% CI: -4.73 to -0.78) for CCH. The coefficient obtained in the meta-regression model was -1.666 (95% CI: -4.183 to 0.851). CONCLUSION: The URAM scale is highly sensitive to changes in Dupuytren contracture but has low specificity. It also showed a strong correlation with worsening of finger contracture as measured by the Tubiana scale.

Determinants of the risk of intraoperative complications in phacoemulsification among patients with pseudoexfoliation.

PURPOSE: The purpose of the study was to study the relationship between pseudoexfoliation (PES) and other predictors in the development of complications in cataract surgery by phacoemulsification in patients with PES. METHODS: A retrospective cohort study of patients undergoing cataract surgery by phacoemulsification in the health area of Cee in northwestern Spain during the 2-year period from 2009 to 2010. Capsule rupture, choroidal hemorrhage, and vitreous loss were included as complications and intraoperative nucleus or lens dislocation as the independent variable. PES, age, hardness, type of cataract, myopia, preoperative visual acuity, antiplatelet use, anticoagulant uses, alpha agonist use, mydriasis prior to surgery, anterior chamber depth, and axial length were included as predictor variables. All predictive hierarchical models were tested using as a selection criterion the one minimizing the Akaike index. RESULTS: A total of 551 patients were initially identified from hospital register, of which 48 were excluded due to the presence of an exclusion factor. After the initial selection, the final sample was 681 eyes of 503 patients. Of the 8192 possible models, a model with the following seven variables was selected: PES, steroid use, alpha agonist use, nuclear hardness, mydriasis, anterior chamber depth, and axial length. The selected model had an Akaike index of 435.4 and an area under the curve of 0.7895 corresponding to a sensitivity of 6.2% and a specificity of 98.5%. CONCLUSION: PES, nuclear hardness, and alpha agonist use are risk factors strongly predictive of complications.

Pharmacometabolomics by NMR in Oncology: A Systematic Review.

Pharmacometabolomics (PMx) studies aim to predict individual differences in treatment response and in the development of adverse effects associated with specific drug treatments. Overall, these studies inform us about how individuals will respond to a drug treatment based on their metabolic profiles obtained before, during, or after the therapeutic intervention. In the era of precision medicine, metabolic profiles hold great potential to guide patient selection and stratification in clinical trials, with a focus on improving drug efficacy and safety. Metabolomics is closely related to the phenotype as alterations in metabolism reflect changes in the preceding cascade of genomics, transcriptomics, and proteomics changes, thus providing a significant advance over other omics approaches. Nuclear Magnetic Resonance (NMR) is one of the most widely used analytical platforms in metabolomics studies. In fact, since the introduction of PMx studies in 2006, the number of NMR-based PMx studies has been continuously growing and has provided novel insights into the specific metabolic changes associated with different mechanisms of action and/or toxic effects. This review presents an up-to-date summary of NMR-based PMx studies performed over the last 10 years. Our main objective is to discuss the experimental approaches used for the characterization of the metabolic changes associated with specific therapeutic interventions, the most relevant results obtained so far, and some of the remaining challenges in this area.

"Validation of a spanish version of the 'Unité Rhumatologique Des Affections De La Main' (URAM) scale".

BACKGROUND: In health care, quality-of-life surveys and questionnaires related to care are becoming increasingly important as a measure of its quality. There is currently no Spanish version of the Unité Rhumatologique des Affections de la Main (URAM) scale, which makes it suitable for hand pathology. The purposes of this study are to develop a Spanish version of the URAM and perform a transcultural adaptation of it, analyzing the result for reliability, validity, and sensitivity to changes. METHODS: The questionnaire was evaluated for patients with Dupuytren's disease and Carpal Tunnel Syndrome. The cohort study subjects were interviewed at three points in time (baseline, three days after intervention, and one month after), administering the QuickDASH, URAM, and SF-12 (CF12 = physical component, CM12 = mental component) questionnaires at baseline and after intervention; and only the URAM at 3 days. Content validity was evaluated using Cronbach's α. The distribution of the factorial loads of the items and the pattern of the answers were checked. Responsiveness was evaluated by the size of the effect and the reliable rate of change. Convergent and divergent validity was performed using Spearman's r between the different questionnaires. RESULTS: The study was conducted with 106 patients. The mean baseline scores were: URAM = 14.8, QuickDASH = 41.6, CF12 = 39.3 and CM12 = 49.4. Ceiling or floor effects were not observed in the Spanish URAM. The Cronbach α = 0.853 explains 49.6% of the variance. The study had a high reproducibility (intraclass correlation coefficient (ICC) = 0.939). Size effect, measured as differences in scores, was moderate for URAM (-0.69) and QuickDASH (-0.51); and low for CF12 and CM12. The correlation of URAM with QuickDASH was high (r = 0.716), and moderate with DD and CTS. CONCLUSION: The Spanish version of the URAM is a valid and reliable tool for use in assessing hand pathology.

Risk of Venous Thromboembolism Associated With Tofacitinib and Baricitinib: A Systematic Review and Indirect Meta-Analysis.

To conduct a systematic review and meta-analysis investigating the effect of tofacitinib and baricitinib on venous thromboembolism (VTE) risk. Search of PubMed, EMBASE, Web of Science, Scopus, ClinicalTrials.gov, LILACS, and Google Scholar databases to identify controlled observational and clinical trials reporting on adverse effects in patients treated with oral tofacitinib or baricitinib up to July 2020. The outcome measure was occurrence of VTE events. We analyzed 59 studies involving 14,335 patients treated with tofacitinib or baricitinib and 11,612 patients who received another active drug or placebo. The meta-analysis showed an odds ratio (OR) for VTE events of 0.29 (95% confidence interval [CI] = 0.10-0.84) overall for tofacitinib based on data from 10 clinical trials with 15 treatment arms; similar ORs were observed for the 10 mg/d dose (OR = 0.18; 95% CI = 0.02-1.60) and the 20 mg/d dose (OR = 0.19; 95% CI = 0.04-0.91). The ORs for VTE events for baricitinib were 3.39 (95% CI = 0.82-14.04) overall, 3.05 (95% CI = 0.12-75.43) for 2 mg, 3.64 (95% CI = 0.59-22.46) for 4 mg, and 3.0 (95% CI = 0.12-76.49) for 7 mg. The indirect meta-analysis comparing tofacitinib with baricitinib (10 clinical trials with 15 treatment arms) showed an OR for VTE events of 0.086 (95% CI = 0.02-0.51) for tofacitinib and a superior safety profile for VTE events. In the meta-regression analysis (19 clinical trials with 21 treatment arms), the effect was 0.02 (95% CI = -0.04 to 0.08) for tofacitinib and -0.01 (95% CI = -1.29 to 1.26 for baricitinib. Plotting of the data for tofacitinib showed that VTE risk increased with high doses. The effect, however, was less than 1 for the 10-mg and 20-mg doses, indicating a protective effect. This effect was not observed for baricitinib. Tofacitinib is not associated with an increased risk of VTE and has a superior safety profile to baricitinib in this respect. Tofacitinib may exert a protective effect against VTE.

Prevalence of cataract complications in patients with pseudoexfoliation syndrome in Northwestern Spain / A prevalência de complicações de catarata em pacientes com síndrome pseudoesfoliativa no noroeste da Espanha

ABSTRACT Purpose: To assess the relationship between pseudoexfoliation syndrome and incidence of complications and related clinical factors in patients undergoing cataract surgery. Methods: We conducted a retrospective cohort study of 503 of 551 patients who underwent phacoemulsification surgery over 2 years in a health care district in Northwest Spain. In total, 120 of 681 eyes undergoing the procedure had pseudoexfoliation syndrome. Data on the surgical procedure and associated complications were extracted from the medical record. Complications included any combination of posterior capsular rupture, vitreous loss, zonular dialysis, and nuclear or lens luxation. Results: We found a significant association between pseudoexfoliation syndrome and zonular dialysis (odds ratio [OR], 6.89; 95% CI, 2.27-20.93), intraoperative miosis (OR, 2.15; 95% CI, 1.10-4.22), and lens luxation >1.5 mm (OR, 9.49; 95% CI, 0.85-105.54). However, when adjusting for the overall risk of complications in pseudoexfoliation syndrome patients in consideration of myopia, use of anticoagulants or α-agonists, previous mydriasis, and anterior chamber length, the OR decreased to 1.02 (95% CI, 0.47-2.21) and was therefore not significant. Conclusion: Zonular dialysis and intraoperative miosis were intraoperative complications in cataract surgery patients with pseudoexfoliation syndrome when compared to controls.

RESUMO Objetivo: Avaliar a relação entre a síndrome de pseudoexfoliação e a prevalência de complicações e fatores clínicos relacionados em pacientes submetidos à cirurgia de catarata. Métodos: Foi realizado um estudo retrospectivo de coorte de 503 de 551 pacientes que se submeteram à cirurgia de facoemulsificação durante 2 anos em um distrito de saúde no noroeste da Espanha. No total, 120 dos 681 olhos submetidos ao procedimento apresentavam síndrome de pseudoexfoliação. Dados sobre o procedimento cirúrgico e complicações associadas foram obtidos dos prontuários médicos. As complicações incluíram qualquer combinação de ruptura da cápsula posterior, perda de humor vítreo, diálise zonular e luxação do núcleo ou do cristalino. Resultados: Encontramos uma associação significativa entre síndrome de pseudoexfoliação e diálise zonular (razão de probabilidade [RP]: 6,89; IC 95%, 2,27-20,93), a miose perioperatória (RP: 2,15; IC 95%, 1,10-4,22) e luxação do cristalino >1,5 mm (RP: 9,49; IC 95%, 0,85-105,54). Porém, ao ajustar para o risco global de complicações em pacientes com síndrome de pseudoexfolição em consideração à miopia, uso de anticoagulantes ou α-agonistas, midríase prévia e comprimento da câmara anterior, a RP diminuiu para 1,02 (IC 95%, 0,47-2,21) e não foi, portanto, significativo. Conclusão: A diálise zonular e a miose intraoperatória foram complicações intraoperatórias em pacientes submetidos à cirurgia de catarata com síndrome de pseudoexfoliação quando comparados aos controles.

Prevalence of cataract complications in patients with pseudoexfoliation syndrome in Northwestern Spain.

PURPOSE: To assess the relationship between pseudoexfoliation syndrome and incidence of complications and related clinical factors in patients undergoing cataract surgery. METHODS: We conducted a retrospective cohort study of 503 of 551 patients who underwent phacoemulsification surgery over 2 years in a health care district in Northwest Spain. In total, 120 of 681 eyes undergoing the procedure had pseudoexfoliation syndrome. Data on the surgical procedure and associated complications were extracted from the medical record. Complications included any combination of posterior capsular rupture, vitreous loss, zonular dialysis, and nuclear or lens luxation. RESULTS: We found a significant association between pseudoexfoliation syndrome and zonular dialysis (odds ratio [OR], 6.89; 95% CI, 2.27-20.93), intraoperative miosis (OR, 2.15; 95% CI, 1.10-4.22), and lens luxation >1.5 mm (OR, 9.49; 95% CI, 0.85-105.54). However, when adjusting for the overall risk of complications in pseudoexfoliation syndrome patients in consideration of myopia, use of anticoagulants or α-agonists, previous mydriasis, and anterior chamber length, the OR decreased to 1.02 (95% CI, 0.47-2.21) and was therefore not significant. CONCLUSION: Zonular dialysis and intraoperative miosis were intraoperative complications in cataract surgery patients with pseudoexfoliation syndrome when compared to controls.

Proposed model to determine satisfaction with computerised provider order entry systems in a long-stay hospital.

OBJECTIVES: Computerised provider order entry (CPOE) systems reduce medication errors, but are not without dangers. Knowing satisfaction with the CPOE helps to improve its implementation. Our objective was to determine the satisfaction of healthcare professionals with the CPOE in a long-stay hospital and to propose a single model. METHODS: A cross-sectional study in a long-stay hospital. Two questionnaires were distributed to determine satisfaction with CPOE, one for medical personnel (MP) and another for nursing personnel (NP). Data collected were: sex, age and work aspects. A strategy for item refinement and creation of a single scale was designed. RESULTS: The overall participation rate was 63.6%, with 68 responses from the target population of 107. Overall, 72.2% (13 of 18) of MP and 40% (20 of 50) of NP were satisfied with CPOE. Regarding the specific questions on satisfaction in the questionnaires, 88.9% (n=16) of MP were very satisfied but only 56.0% (n=28) of NP. The median of each question was 4, with the exception of those for NP referring to a faster process and improved coordination, which were 3 and 3.5, respectively. The items weighing more in the second component were eliminated and the questions merged. After refining the items, a final six-item model was obtained with a single component of high reliability (Cronbach's α=0.896), which accounts for 67% of total variance. CONCLUSION: The degree of satisfaction with CPOE in a long-stay hospital was high, though lower in NP than MP. Obtaining a single questionnaire can facilitate this process.

Evaluation of formaldehyde as an ocular irritant: a systematic review and Meta-analysis.

OBJECTIVE: The aim of this study was to use meta-regression to evaluate the safety of the maximum allowable dose of formaldehyde in terms of eye irritation symptoms. METHODS: We performed a systematic review of literature published in the PubMed, Embase, Lilacs, Web of Science, and Cochrane Library databases. We selected clinical trials, cohort studies, and case-control studies that compared eye irritation between patients exposed and not exposed to formaldehyde. Eighteen of the 2561 studies retrieved met the inclusion criteria. Data were extracted using structured forms and study quality was analyzed using the STROBE (STrengthening the Reporting of OBservational studies in Epidemiology) checklist. Odds ratios (ORs) were calculated using a random effects model with stratification by airborne dose and subsequent meta-regression analysis. RESULTS: The random effects model yielded an OR of 8.11 (95% CI: 5.85-10.37), with an I2 statistic of 99.8% and p < 0.00001. In the meta-regression analysis, we observed an I2 of 87.29% with an R2 of 23.96; the regression line for exposure had a slope of 1.466 (95% CI: 0.096-2.836) in relation to the Napierian log of the OR. Considering a safety level based on an OR of 2 relative to the unexposed group, an airborne concentration of formaldehyde of less than 0.001 mg/m3 can be considered safe. CONCLUSION: Although current formaldehyde exposure concentrations are relatively safe in terms of cancer risk, they continue to cause eye irritation.

[Staff burnout and psychosocial risk factors in a long-stay hospital in Spain]. / Burnout y factores de riesgo psicosocial en el personal de un hospital de larga estancia.

The aim of this study was to assess the relationship between psychosocial risks and burnout syndrome in a long-stay hospital in Spain. A cross-sectional study was conducted in 2017, applying the Spanish version of the MBI-HSS and the F-Psico 3.1 questionnaire of Spain's National Institute of Work Safety and Health. The predictive variables were sociodemographic characteristics, modulators, and psychosocial risk factors. The outcome variables were prevalence of burnout and the effects on his subscales. Associations between variables were measured by odds ratio. Burnout was directly associated with psychosocial risks related to workload, psychological demands, participation/supervision, role performance and social support, and consumption of anxiolytics. Meanwhile, protective factors were having children, feeling valued by patients and coworkers, satisfaction at work, optimism, and social support. The associations found on depersonalization were similar but weaker. Low personal fulfillment was directly associated with the psychosocial risks related to length of workweek, limited autonomy and variety/content of work, and role performance and social support. Low personal fulfillment was the subscale with the most modulating and protective sociodemographic variables included marital status, children, night shift, feeling valued by patients and family members, social support, self-efficacy, and optimism. According to our results, there is an association between psychosocial risks and burnout syndrome. Individuals with greater work satisfaction, self-efficacy, and optimism cope better with stress and are less vulnerable to psychosocial risks and burnout.

Nuestro objetivo fue evaluar la relación entre los riesgos psicosociales y el burnout en un hospital español de media-larga estancia. Se realizó un estudio transversal en 2017, aplicando la versión española del MBI-HSS y el cuestionario F-Psico 3.1 del Instituto Nacional de Seguridad e Higiene en el Trabajo. Variables predictoras: características sociodemográficas, moduladoras y factores de riesgo psicosocial. Variables resultado: prevalencia de burnout y afectación de sus subescalas. La asociación entre variables se cuantificó con odds ratio. El cansancio emocional se asoció positivamente a los riesgos psicosociales vinculados a carga de trabajo, demandas psicológicas, participación/supervisión, desempeño de rol, relaciones/apoyo social y al consumo de ansiolíticos; fueron factores protectores los hijos, sentirse valorado por pacientes y compañeros, satisfacción laboral, optimismo y apoyo social. Las asociaciones halladas para la despersonalización fueron similares, pero más débiles. La baja realización personal se asoció positivamente a los riesgos psicosociales vinculados al tiempo trabajado, autonomía, variedad/contenido del trabajo, desempeño de rol y apoyo social; fue la subescala que mostró mayor número de variables sociodemográficas/moduladoras protectoras: estado civil, tener hijos, trabajar de noche, sentirse valorado por pacientes y familiares, ilusión por el trabajo, apoyo social, autoeficacia y optimismo. Según nuestros resultados, existe asociación entre los riesgos psicosociales y el burnout. Los individuos con mayor satisfacción laboral, autoeficacia y optimismo, afrontan mejor el estrés y son menos vulnerables a los riesgos psicosociales y al burnout.

Nosso objetivo foi avaliar a relação entre os riscos psicossociais e a síndrome de burnout em um hospital espanhol de meia-longa permanência. Foi realizado um estudo transversal em 2017, aplicando a versão espanhola do MBI-HSS e o questionário F-Psico 3.1 do Instituto Nacional de Segurança e Higiene no Trabalho. Variáveis preditoras: características sociodemográficas, moduladoras e fatores de risco psicossocial. Variáveis de resultado: prevalência de burnout e afetação das subfaixas. A associação entre variáveis foi quantificada com odds ratio. A fatiga emocional foi associada positivamente aos riscos psicossociais vinculados a uma carga de trabalho, demandas psicológicas, participação/supervisão, desempenho de funções, relações/apoio social e consumo de ansiolíticos; por outro lado, foram fatores protetores: os filhos, se sentir valorados por pacientes e companheiros de trabalho, satisfação laboral, otimismo e apoio social. As associações encontradas para a despersonalização foram similares, entretanto mais débeis. A baixa realização pessoal foi associada positivamente aos riscos psicossociais vinculados ao tempo trabalhado, autonomia, variedade/conteúdo do trabalho, desempenho de funções e apoio social; foi a subfaixa que mostrou maior número de variáveis sociodemográficas/moduladoras protetoras: estado civil, ter filhos, trabalhar de noite, sentir-se valorizado por pacientes e membros da família, ilusão pelo trabalho, apoio social, auto-eficácia e otimismo. Segundo nossos resultados, existe uma associação entre os riscos psicossociais e a síndrome de burnout. Os indivíduos com maior satisfação laboral, auto-eficácia e otimismo afrontam melhor o stress e são menos vulneráveis aos riscos psicossociais e ao burnout.

Adverse effects associated with collagenase clostridium histolyticum in Dupuytren disease: A prospective study.

BACKGROUND: Collagenase clostridium histolyticum is now recognized as a viable treatment for Dupuytren disease. The high rate of adverse effects reported in patients continues to spark debate and raise questions about the true frequency of effects and their associated mechanisms of action. HYPOTHESIS: To investigate whether outcomes of CCH treatment are related to the number of adverse effects experienced. To evaluate short-term clinical outcomes in a series of patients. MATERIAL AND METHODS: Prospective single-center cohort study. The Primary End Point for effectiveness at 30 days was deficit of 0°-5°. Adverse effects were evaluated during CCH injection, removal of the dressing prior to finger extension, and finger extension. To investigate the relationship between adverse effects and treatment effectiveness, we analyzed the association between number of effects and clinical outcome at 30 days. RESULTS: A total of 208 injections were evaluated. The mean baseline contracture was 32.11°. Ninety-four patients (45.2%) had a mild contracture. Treatment was effective at 30 days in 194 of the injections (93.3%). The rate of effectiveness per joint was 93.5% for metacarpophalangeal joints (n=129) and 92.9% for proximal-interphalangeal joints (n=65). In total, 734 adverse effects were reported (mean, 3.53). No statistically significant associations were identified between disease severity and secondary effects. Variance analysis showed statistically significant differences in patients with severe contractures (mean, 3.91; 95% CI 3.57-4.25), and in patients with proximal-interphalangeal contractures (mean, 4.17; 95% CI 3.76-4.59). CONCLUSIONS: We found no relationship between number of adverse effects and treatment effectiveness at one month following CCH injection. LEVEL OF PROOF: IV, cohort prospective study.

Anesthesia for collagenase clostridium histolyticum injection in patients with dupuytren disease: A cohort analysis.

Procedural pain is one of the most common adverse effects reported by patients with Dupuytren disease (DD) treated with collagenase clostridium histolyticum (CCH). The aim of this study was to assess the effectiveness of wrist block before CCH injection in reducing procedural pain and to analyze its impact on adverse effects. We performed a prospective, single-center study in which we compared two groups of patients in a consecutive cohort. In the first group (NO-BLOCK), wrist block was only performed before finger extension, whereas in the second group (BLOCK), it was performed before CCH injection and finger extension. Pain was assessed on a 10-item numerical rating scale. Our results show that pain scores were clearlylower in the BLOCK group than in the NO-BLOCK group: 4.72 vs. 0.61 for CCH injection and 3.43 vs. 0.82 for finger extension. Patients who rated CCH injection pain with a score of 4 or higher were 11 times more likely to experience pain during extension. There was a weak correlation between the use of wrist block for CCH injection and the occurrence of skin lacerations (Spearman's rho = -0.222, p < 0.01) and the presence of pruritus (Spearman's rho = 0.183, p < 0.07). In conclusion, wrist block before CCH injection is an effective measure of decreasing perceived pain throughout the different stages of CCH treatment in patients with DD.

Burnout y factores de riesgo psicosocial en el personal de un hospital de larga estancia / Staff burnout and psychosocial risk factors in a long-stay hospital in Spain / Burnout e fatores de risco psicossocial em funcionários de um hospital de longa permanência

Resumen: Nuestro objetivo fue evaluar la relación entre los riesgos psicosociales y el burnout en un hospital español de media-larga estancia. Se realizó un estudio transversal en 2017, aplicando la versión española del MBI-HSS y el cuestionario F-Psico 3.1 del Instituto Nacional de Seguridad e Higiene en el Trabajo. Variables predictoras: características sociodemográficas, moduladoras y factores de riesgo psicosocial. Variables resultado: prevalencia de burnout y afectación de sus subescalas. La asociación entre variables se cuantificó con odds ratio. El cansancio emocional se asoció positivamente a los riesgos psicosociales vinculados a carga de trabajo, demandas psicológicas, participación/supervisión, desempeño de rol, relaciones/apoyo social y al consumo de ansiolíticos; fueron factores protectores los hijos, sentirse valorado por pacientes y compañeros, satisfacción laboral, optimismo y apoyo social. Las asociaciones halladas para la despersonalización fueron similares, pero más débiles. La baja realización personal se asoció positivamente a los riesgos psicosociales vinculados al tiempo trabajado, autonomía, variedad/contenido del trabajo, desempeño de rol y apoyo social; fue la subescala que mostró mayor número de variables sociodemográficas/moduladoras protectoras: estado civil, tener hijos, trabajar de noche, sentirse valorado por pacientes y familiares, ilusión por el trabajo, apoyo social, autoeficacia y optimismo. Según nuestros resultados, existe asociación entre los riesgos psicosociales y el burnout. Los individuos con mayor satisfacción laboral, autoeficacia y optimismo, afrontan mejor el estrés y son menos vulnerables a los riesgos psicosociales y al burnout

Abstract: The aim of this study was to assess the relationship between psychosocial risks and burnout syndrome in a long-stay hospital in Spain. A cross-sectional study was conducted in 2017, applying the Spanish version of the MBI-HSS and the F-Psico 3.1 questionnaire of Spain's National Institute of Work Safety and Health. The predictive variables were sociodemographic characteristics, modulators, and psychosocial risk factors. The outcome variables were prevalence of burnout and the effects on his subscales. Associations between variables were measured by odds ratio. Burnout was directly associated with psychosocial risks related to workload, psychological demands, participation/supervision, role performance and social support, and consumption of anxiolytics. Meanwhile, protective factors were having children, feeling valued by patients and coworkers, satisfaction at work, optimism, and social support. The associations found on depersonalization were similar but weaker. Low personal fulfillment was directly associated with the psychosocial risks related to length of workweek, limited autonomy and variety/content of work, and role performance and social support. Low personal fulfillment was the subscale with the most modulating and protective sociodemographic variables included marital status, children, night shift, feeling valued by patients and family members, social support, self-efficacy, and optimism. According to our results, there is an association between psychosocial risks and burnout syndrome. Individuals with greater work satisfaction, self-efficacy, and optimism cope better with stress and are less vulnerable to psychosocial risks and burnout.

Resumo: Nosso objetivo foi avaliar a relação entre os riscos psicossociais e a síndrome de burnout em um hospital espanhol de meia-longa permanência. Foi realizado um estudo transversal em 2017, aplicando a versão espanhola do MBI-HSS e o questionário F-Psico 3.1 do Instituto Nacional de Segurança e Higiene no Trabalho. Variáveis preditoras: características sociodemográficas, moduladoras e fatores de risco psicossocial. Variáveis de resultado: prevalência de burnout e afetação das subfaixas. A associação entre variáveis foi quantificada com odds ratio. A fatiga emocional foi associada positivamente aos riscos psicossociais vinculados a uma carga de trabalho, demandas psicológicas, participação/supervisão, desempenho de funções, relações/apoio social e consumo de ansiolíticos; por outro lado, foram fatores protetores: os filhos, se sentir valorados por pacientes e companheiros de trabalho, satisfação laboral, otimismo e apoio social. As associações encontradas para a despersonalização foram similares, entretanto mais débeis. A baixa realização pessoal foi associada positivamente aos riscos psicossociais vinculados ao tempo trabalhado, autonomia, variedade/conteúdo do trabalho, desempenho de funções e apoio social; foi a subfaixa que mostrou maior número de variáveis sociodemográficas/moduladoras protetoras: estado civil, ter filhos, trabalhar de noite, sentir-se valorizado por pacientes e membros da família, ilusão pelo trabalho, apoio social, auto-eficácia e otimismo. Segundo nossos resultados, existe uma associação entre os riscos psicossociais e a síndrome de burnout. Os indivíduos com maior satisfação laboral, auto-eficácia e otimismo afrontam melhor o stress e são menos vulneráveis aos riscos psicossociais e ao burnout.

Effectiveness of Intracameral Phenylephrine in Achieving Mydriasis and Reducing Complications During Phacoemulsification: A Systematic Review and Meta-Analysis.

PURPOSE: To compare the effectiveness of intracameral phenylephrine and topical mydriatics in achieving mydriasis and protecting against complications during phacoemulsification. METHODS: A systematic search of the literature comparing the mydriatic effect and surgical safety profile of intracameral phenylephrine and topical mydriatics in phacoemulsification was conducted in the Medline, Embase, Lilacs, Web of Science, Cochrane, ClinicalTrials.gov , and Teseo databases. The search targeted clinical trials, cohort studies, and case-control studies published between April 20, 2003 and August 14, 2016. Mydriatic effect was assessed by difference in means in pupil of all the patients in the studies [mean difference (MD)] and intraoperative complications were assessed by using inverse-variance weighted odds ratios (ORs), with adjustment for dose. A meta-regression analysis was also conducted, with adjustment for dose, use of epinephrine, tamsulosin use, and type of surgery and type of intraocular lens. RESULTS: We found 7 articles about mydriatic effect and another 7 about complications. Intracameral phenylephrine achieved a similar mydriatic effect to topical mydriatics, with a difference of less than 10% (MD -0.74 mm, 95% CI: -1.67 to 0.18, I2 = 95.8%, P < 0.0001). The pooled OR for complications was OR 0.50, 95% CI: 0.19-1.31, I2 = 0.0%, P = 0.670, and posterior capsular rupture was the most common complication in the different studies analyzed. CONCLUSION: Intracameral phenylephrine achieves a similar mydriatic effect to topical mydriatics (difference <15%) and is associated with a not-significant effect on reducing the odds of intraoperative complications.

Adverse Effects of Collagenase in the Treatment of Dupuytren Disease: A Systematic Review.

BACKGROUND: Collagenase clostridium histolyticum (CCH) has proven to be both safe and effective in the treatment of Dupuytren disease (DD). The medium-term outcomes are similar to those achieved with surgery, and most adverse effects are self-limiting and considered to be mild or moderate. OBJECTIVE: Our objective was to conduct a systematic review of the adverse effects of CCH in DD since the release of the drug to evaluate the incidence, severity, classification, and definitions of these effects. METHODS: We analyzed the literature in terms of modifications to the original treatment protocol and grouped adverse effects according to their pathophysiological origin. RESULTS: We included 28 clinical studies and five case reports or case series analyzing 4456 patients with a mean age of 63.6 years. Mean follow-up was 7.07 months (range 3-24); the mean number of patients per study was 148 (range 5-1082). The studies did not classify the adverse effects they reported into groups. The most common effects were peripheral edema (54.4%), bruising (42.9%), and upper limb pain (28.3%). Significant biases were observed for use of terminology, demarcation of sites of involvement, severity criteria, and assessment methods. CONCLUSION: A simpler and clearer consensus-based classification system would enable better evaluation and comparison of the adverse effects of CCH in the treatment of DD. Consideration of inflammatory phenomena as part of the drug's mechanism of action would significantly reduce overall rates of adverse effects.

Pain Associated With Treatment of Dupuytren Contracture With Collagenase Clostridium histolyticum.

PURPOSE: The primary objective of this study was to quantify the degree of pain associated with collagenase Clostridium histolyticum (CCH) injection and to determine whether it is related to other factors in the intervention. METHODS: A prospective study of 135 patients was performed to evaluate pain at 3 points during treatment: (1) after CCH injection, using a numerical rating scale (NRS), (2) a binary (positive/negative) assessment before manipulation 24 hours after CCH and after removing the bandage, and (3) after joint manipulation performed with wrist block anesthesia. RESULTS: The average NRS for pain during infiltration was 4.7. Pain was present before manipulation in 52.6% of patients. Pain from manipulation showed an average NRS score of 3.6. The amounts of pain at CCH infiltration, pain after 24 hours, and pain from the manipulation were correlated because patients who experienced pain during CCH infiltration were more likely to report experiencing pain during manipulation. CONCLUSIONS: Collagenase Clostridium histolyticum injection for treating Dupuytren contracture can be a painful process. There is a clear relationship between a patient's level of pain during injection of CCH and the likelihood that the patient will experience pain during manipulation, even with the use of local anesthesia. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic IV.

Intraocular lens dislocation in pseudoexfoliation: a systematic review and meta-analysis.

PURPOSE: To evaluate the impact of pseudoexfoliation syndrome on intraocular lens (IOL) dislocation after phacoemulsification cataract surgery and explore possible associations related to surgical technique. METHODS: We systematically searched the MEDLINE, Embase, Web of Science, Cochrane, and Lilacs databases and grey literature sources and identified (on March 1, 2016) 14 cohort and case-control studies comparing IOL dislocation in patients with and without pseudoexfoliation syndrome who had undergone phacoemulsification. Study quality was assessed using the STROBE scale. An inverse-variance fixed-effects model was used to calculate weighted odds ratios (ORs) and 95% confidence intervals (CI). RESULTS: The pooled analysis yielded an OR of 6.02 (95% CI: 3.7, 9.79) for IOL dislocation in patients with pseudoexfoliation, and similarly, high ORs were detected for both early and late (3 months after surgery) dislocation (OR 5.26; 95% CI: 1.05; 26.32 versus OR 6.02; 95% CI: 3.67; 10.17). No significant associations were detected when the results were stratified by year, incision size or use of hooks or retractors. CONCLUSIONS: Patients with pseudoexfoliation syndrome have a high risk of late IOL dislocation after phacoemulsification cataract surgery, and this risk may be related to the use of large incisions and hooks or retractors.