Validation of the Portuguese Version of the Postoperative Quality Recovery Scale (PostopQRS)

Introduction: The Postoperative Quality Recovery Scale is a brief instrument of six domains designed to assess quality of recovery from early to long term after surgery. This study aims to validate the Portuguese version of the Postoperative Quality Recovery Scale.
Material and Methods: In this observational study 101 adult patients undergoing elective surgery completed the Postoperative Quality Recovery Scale at 15 minutes and 40 minutes, one and three days after surgery. Three constructs were assessed for validity: increased recovery over time; effect of gender and recovery association with muscle strength. Reliability, responsiveness, feasibility and acceptability were also assessed.
Results: Construct validity was shown by increased recovery over time; worse recovery for female patients in emotive, nociceptive, activities of daily living and overall recovery; improved muscle strength in recovered patients. Internal consistency for activities of daily living was acceptable at all-time points (Cronbach's α value of 0.772 or higher), indicating scale reliability. The scale was able to detect differences in postoperative quality of recovery between the neuromuscular blockade reversal agents, neostigmine and sugammadex, indicating scale responsiveness. The time to conduct the Portuguese version at baseline was 95 - 581 seconds (median 319 seconds) and it was reduced with subsequent assessments. The proportion of patients completing all scale items was 87%, 75%, 65% and 94% for the four time periods evaluated, indicating scale feasibility and acceptability.
Discussion: This study shows that the Portuguese version of the Postoperative Quality Recovery Scale, demonstrates construct validity, reliability, responsiveness, feasibility and acceptability.
Conclusions: This study allowed validation of the Portuguese version of the Postoperative Quality Recovery Scale.

https://ift.tt/2CT6LPh

Genetic Polymorphisms Associated with the Onset of Arterial Hypertension in a Portuguese Population

Introduction: Arterial hypertension is a complex, multifactorial disease, controlled by genetic and environmental factors.
Objective: Evaluate the genetic susceptibility for developing arterial hypertension and its association with the traditional risk factors in the outbreak of this pathology.
Material and Methods: Case-control study with 1712 individuals, mean age of 51.0 ± 7.9 years (860 hypertensive patients and 852 controls). Biochemical and traditional risk factors, and genetic variants were evaluated: ACE I/D rs4340, ACE A2350G rs4343, AGT T174M rs4762, AGT M235T rs699 AGTR1 A1166C rs5186, CYP11B2 -344 C/T rs1799998, ADRB1 R389G rs1801253, ADRB2 R16G rs1042713, ADD1 G460W rs4961, SCNN1G G173A rs5718, GNB3 C825T rs5443, ATP2B1 A/G rs2681472, CYP17A1 T/C rs11191548, SLC4A2 C/T rs2303934. The risk of each gene for hypertension was estimated by the dominant, recessive, co-dominant and multiplicative models. By logistic regression, variables associated with hypertension were evaluated. ROC curves were first performed with traditional risk factors and then adding the genetic variants associated with hypertension. Data were analyzed by SPSS for Windows 19.0 and MedCalc v. 13.3.3.0.
Results: The genetic variants ADD1 G460W, GNB3 C825T, ACE I/D, ACE A2350G were associated with hypertension. ROC curve with traditional risk factors and these variants showed an increase in the predictive capacity of hypertension (p = 0.018).
Discussion: According to the results of our study, the genetic variants found to be associated with hypertension were: ACE I/D rs4340, ACE A2350G rs4343, ADD1 G460W rs4961 and GNB3 C825T rs5443. The first two variants are associated with hypertension by interfering with the renin-angiotensin-aldosterone system, which plays an important role in regulating blood pressure. It should be noted that genes encoding the components of renin-angiotensin-aldosterone system are natural candidates for the development and progression of hypertension. In our population alpha-aducin polymorphism (ADD1 G460W rs4961) was also associated with hypertension. In a Portuguese population, known to have high salt intake, it makes sense that this polymorphism which is relevant in salt and water management may consequently be relevant in the onset of hypertension. The genetic variant GNB3 C825T rs5443 that affects intracellular signalling was also found to be a strong risk candidate for hypertension. Initially, with the elaboration of the ROC curve and calculation of the AUC using only with traditional risk factors and later by adding the variants ADD1 G460W, GNB3 C825T, ACE I/D and ACE A2350G to the traditional risk factors, we verified that genetic polymorphisms increased the predictive risk of hypertension, when compared to the risk given only by traditional risk factors, with statistical significance (p = 0.018). This suggests that hypertension is a multifactorial disease that results from the interaction of environmental, genetic and lifestyle factors that interact with each other and lead to the advent of this important pathology.
Conclusion: In our study, the hypertension-associated polymorphisms are linked to the renin-angiotensin-aldosterone axis (ACE I/D, ACE A2350G), as well as to salt and water management (ADD1 G460W, GNB3 C825T). Through a multivariate analysis, it was concluded that these two last genetic variants together with four of the traditional risk factors (smoking, alcohol consumption, obesity and diabetes) are associated in a significant and independent way with essential hypertension. In a predictive model of hypertension, the introduction of genetic variants slightly increases the predictive value of the model.

https://ift.tt/2P4mqml

Development and Evaluation of a Global Burnout Index Derived from the Use of the Copenhagen Burnout Inventory in Portuguese Physicians

Introduction: The Copenhagen Burnout Inventory was developed to overcome what some authors have proposed as potential limitations of existing burnout measures. Specifically, the Copenhagen Burnout Inventory measures the main component of burnout (i.e. exhaustion) in three domains: personal-, work- and patient-related. Additionally, some authors have argued the necessity to have available a global burnout index.
Material and Methods: This study followed a cross-sectional design in a sample of Portuguese physicians (n = 1348). A confirmatory factor analyses was conducted and the Copenhagen Burnout Inventory´s three-factor structure was tested. In addition, a model with a 2nd order factor was tested with the goal of achieving a one-factor structure that would allow a global burnout index.
Results: The confirmatory factor analyses showed a good model fit for both the three-factor and one-factor model, having the latter a significant better fit. The Copenhagen Burnout Inventory showed good psychometric properties for both structures, with good reliability according to Chronbach`s alphas and average variance extracted between factors. The Copenhagen Burnout Inventory I was statistically and positively correlated with depression, anxiety and stress symptoms, as well as rumination, and negatively correlated with life satisfaction.
Discussion: The current study shows that the Copenhagen Burnout Inventory is a psychometrically valid measure of burnout in Portuguese physicians, and contributes with an instrument able to produce a global index of burnout. This measure provides comprehensive information on different dimensions associated with the development of burnout, as well as presents a global burnout score. Results show that participants who had more burnout also presented higher levels of depressive, anxiety and stress symptoms, as well as present more ruminative thinking, and less life satisfaction.
Conclusion: The Copenhagen Burnout Inventory is a psychometrically valid measure of burnout that allows for exploratory studies on the overall level of exhaustion, thus making it possible the comparison between groups in a way that is not restricted to occupation specific aspects.

https://ift.tt/2CUdsAr

Reasons for Perfectionism and Intolerance to Frustration in Medicine Students of University of Coimbra

Introduction: Perfectionism and intolerance to frustration are the main factors of vulnerability to psychological stress observed in students of the Integrated Master Degree in Medicine of the Faculty of Medicine, University of Coimbra, a study claims. We aimed to ascertain their reasons, seeking for their prevention.
Material and Methods: An observational triangulation study was performed, collecting the main reasons according to the opinion of a students focus-group, organized in a questionnaire completed with epidemiologic data, applied online to all students of the Integrated Master Degree in Medicine of the Faculty of Medicine, University of Coimbra. Statistical analysis was performed.
Results: A representative sample, of n = 368, 77.7% female, was studied. The most important responded reasons were 'intrinsic factors' and 'medical profession demands', with, respectively, 91.1% and 91.8% of 'important'/'very important' answers; 'environmental pressure' is the less important, with 68.2% attributing those classifications. Students satisfied with curricular life attribute less importance to 'environmental pressure' (p = 0.004), 'insecurity about professional training' (p = 0.017), 'curricular evaluation methods' (p = 0.002) and 'Integrated Master Degree in Medicine of the Faculty of Medicine, University of Coimbra curricular demands' (p = 0.002); female students assign more importance to 'Integrated Master Degree in Medicine curricular demands' (p = 0.001); students involved in an extracurricular activity consider less important the 'environmental pressure' (p = 0.007).
Discussion: In this Integrated Master Degree in Medicine of the Faculty of Medicine, University of Coimbra students sample, vulnerability to psychological stress associated to perfectionism and intolerance to frustration is due essentially to self-demanding personality. Insecurity about professional demands, associated to suffering in anticipation and the absence of professional perspectives, represent another important cause.
Conclusion: Psychological support, involvement in specific extracurricular activities and curricular reorganisation appear to be means of reducing the vulnerability to stress in medical students.

https://ift.tt/2P496yf

The Crisis in Scientific Publishing: A Holistic Perspective About Background Issues Associated with Predatory Publishing

N/A.

https://ift.tt/2CUdnN9

Choosing Wisely Portugal – Wise Health Decisions

n/a.

https://ift.tt/2P22ZKO

Cancers, Vol. 10, Pages 415: Profiling Immune Escape in Hodgkin’s and Diffuse large B-Cell Lymphomas Using the Transcriptome and Immunostaining

Cancers, Vol. 10, Pages 415: Profiling Immune Escape in Hodgkin's and Diffuse large B-Cell Lymphomas Using the Transcriptome and Immunostaining

Cancers doi: 10.3390/cancers10110415

Authors: Sarah Péricart Marie Tosolini Pauline Gravelle Cédric Rossi Alexandra Traverse-Glehen Nadia Amara Camille Franchet Elodie Martin Christine Bezombes Guy Laurent Pierre Brousset Jean-Jacques Fournié Camille Laurent

Therapeutic blockade of PD-1/PD-L1 shows promising results in Hodgkin’s lymphoma (HL) and in some diffuse large B-cell lymphoma (DLBCL) patients, but biomarkers predicting such responses are still lacking. To this end, we recently developed a transcriptional scoring of immune escape (IE) in cancer biopsies. Using this method in DLBCL, we identified four stages of IE correlated with overall survival, but whether Hodgkin’s lymphomas (HL) also display this partition was unknown. Thus, we explored the transcriptomic profiles of ~1000 HL and DLBCL using a comparative meta-analysis of their bulk microarrays. Relative to DLBCL, the HL co-clustered at the advanced stage of immune escape, displaying significant enrichment of both IE and T-cell activation genes. Analyses via transcriptome deconvolution and immunohistochemistry showed more CD3+ and CD4+ tumor-infiltrating lymphocytes (TILs) in HL than DLBCL. Both HL and non-GCB DLBCL shared a high abundance of infiltrating CD8+ T-cells, but HL had less CD68+CD163+ macrophages. The same cellular distribution of PD-1 and TIM-3 was observed in HL and DLBCL, though HL had more PD-L1 tumor cells and LAG-3 ME cells. This study illuminates the advanced stage of immune activation and escape in HL, consistent with the response to checkpoint blockade therapies for this type of lymphoma.

https://ift.tt/2SvSKMZ