Search

Background: Pharmacists need up-to-date knowledge and decision-making support in HIV care. We aim to develop MARVIN-Pharma, an adapted artificial intelligence-based chatbot initially for people with HIV, to assist pharmacists in considering evidence-based needs. Methods: From December 2022 to December 2023, an online needs-assessment survey evaluated Québec pharmacists' knowledge, attitudes, involvement, and barriers relative to HIV care, alongside perceptions relevant to the usability of MARVIN-Pharma. Recruitment involved convenience and snowball sampling, targeting National HIV and Hepatitis Mentoring Program affiliates. Results: Forty-one pharmacists (28 community, 13 hospital-based) across 15 Québec municipalities participated. Participants perceived their HIV knowledge as moderate (M = 3.74/6). They held largely favorable attitudes towards providing HIV care (M = 4.02/6). They reported a "little" involvement in the delivery of HIV care services (M = 2.08/5), most often ART adherence counseling, refilling, and monitoring. The most common barriers reported to HIV care delivery were a lack of time, staff resources, clinical tools, and HIV information/training, with pharmacists at least somewhat agreeing that they experienced each (M ≥ 4.00/6). On average, MARVIN-Pharma's acceptability and compatibility were in the 'undecided' range (M = 4.34, M = 4.13/7, respectively), while pharmacists agreed to their self-efficacy to use online health services (M = 5.6/7). Conclusion: MARVIN-Pharma might help address pharmacists' knowledge gaps and barriers to HIV treatment and care, but pharmacist engagement in the chatbot's development seems vital for its future uptake and usability. [ABSTRACT FROM AUTHOR]

Evidence from clinical trials and observational studies on the association between thiazide diuretics and colorectal cancer risk is conflicting. We aimed to determine whether thiazide diuretics are associated with an increased colorectal cancer risk compared with dihydropyridine calcium channel blockers (dCCBs). A population-based, new-user cohort was assembled using the UK Clinical Practice Research Datalink. Between 1990–2018, we compared thiazide diuretic initiators with dCCB initiators and estimated hazard ratios (HR) with 95% confidence intervals (CIs) of colorectal cancer using Cox proportional hazard models. Models were weighted using standardized morbidity ratio weights generated from calendar time-specific propensity scores. The cohort included 377,760 thiazide diuretic initiators and 364,300 dCCB initiators, generating 3,619,883 person-years of follow-up. Compared with dCCBs, thiazide diuretics were not associated with colorectal cancer (weighted HR = 0.97, 95% CI: 0.90, 1.04). Secondary analyses yielded similar results, although an increased risk was observed among patients with inflammatory bowel disease (weighted HR = 2.45, 95% CI: 1.13, 5.35) and potentially polyps (weighted HR = 1.46, 95% CI: 0.93, 2.30). Compared with dCCBs, thiazide diuretics were not associated with an overall increased colorectal cancer risk. While these findings provide some reassurance, research is needed to corroborate the elevated risks observed among patients with inflammatory bowel disease and history of polyps. [ABSTRACT FROM AUTHOR]

Purpose: Occupational health programmes have been successfully implemented to improve body composition, physical fitness and cardiovascular risk. However, most programmes have been small and have not included long-term evaluation. Therefore, we evaluated a twelve-month life-style change programme in a German refinery. Methods: We offered a supervised six-week endurance exercise programme (2 × 90 min/week), starting after a two-day life-style seminar. After the active intervention and a half-day refresher seminar, employees were encouraged to continue exercising over one year on their own, with monthly supervised sessions to maintain adherence. Anthropometry, bicycle ergometry, cardio-metabolic risk profile, inflammatory parameters, and vascular function e.g. endothelial function was studied at baseline, after three and after twelve months. Results: Of 550 employees, n = 327 (age 40.8 ± 9.7 years, 88% males) participated in the study. Twelve-month intervention was associated with a reduced waist circumference (92.6 ± 12.2 to 90.8 ± 11.7 cm, 95% confidence interval for the mean change (CI): -2.5 to -1.1 cm) and a gain in maximal exercise capacity (202 ± 39.6 to 210 ± 38.9 Watt; 95% CI: + 5.1 to + 10.9 Watt). Metabolic and inflammatory parameters likewise HbA1c and C-reactive protein improved in central tendency at a local 95% level of confidence. Vascular function e.g. Reactive-Hyperaemia-Index revealed a slight reduction, whereas no statistically robust changes in mean Cardio-Ankle-Vascular-Index and mean Ankle-Brachial-Index were observed. Conclusion: Health education added by a six-week supervised exercise programme was associated with minor long-term twelve-month improvements of body composition as well as physical fitness and a concomitant improvement of inflammatory state. These changes were, however, not clinically relevant and not accompanied by statistically robust improvements of vascular function. Trial registration: ClinTrialsGov: NCT01919632; date of registration: August 9, 2013; retrospectively registered. [ABSTRACT FROM AUTHOR]

BACKGROUND: Diabetes is a prevalent chronic condition that poses a major burden for patients and the health care system. Evidence suggests that patient engagement in self-care improves diabetes control and reduces the risk of complications. To provide effective interventions that aim to improve empowerment processes relating to diabetes, a comprehensive and valid measure of empowerment is needed. This article details the development and validation of the McGill Empowerment Assessment–Diabetes (MEA-D). METHODS: The development and validation of the MEA-D questionnaire comprised three steps: item generation, qualitative face validation, and factorial content validation. An initial version was created by combining existing items and inductively generated items. Items were mapped to an empowerment framework with four domains: attitude, knowledge, behavior, and relatedness. Semi-structured interviews were conducted with 21 adults living with diabetes to assess face validity. The questionnaire was revised by a team of clinicians, researchers, and patient-partners. Factorial content validation was then performed using responses from 300 adult Canadians living with type 1 or type 2 diabetes. RESULTS: The final version of the MEA-D contained 28 items. A moderately good item-domain correlation was found between the individual items within the four domains. Cronbach's α was 0.81 (95% CI 0.78–0.85) for attitude, 0.73 (95% CI 0.67–0.79) for knowledge, 0.84 (95% CI 0.81–0.87) for behavior, and 0.81 (95% CI 0.77–0.84) for relatedness. CONCLUSION: The evaluation of diabetes programs demands a validated measure of empowerment. We developed the MEA-D to address this need. The MEA-D may be adapted to measure patients' empowerment regarding other chronic health conditions. [ABSTRACT FROM AUTHOR]

Background: We have demonstrated the efficacy of a brief behavioral intervention for sleep in children with ADHD in a previous randomized controlled trial and now aim to examine whether this intervention is effective and cost‐effective when delivered by pediatricians or psychologists in community settings. Methods: Translational, cluster‐randomized trial of a behavioral intervention versus usual care from 19th January, 2015 to 30th June, 2017. Participants (n = 361) were children aged 5–13 years with ADHD and parent report of a moderate/severe sleep problem who met criteria for American Academy of Sleep Medicine criteria for chronic insomnia disorder, delayed sleep–wake phase disorder, or were experiencing sleep‐related anxiety. Participants were randomized at the level of the pediatrician (n = 61) to intervention (n = 183) or usual care (n = 178). Families in the intervention group received two consultations with a pediatrician or a psychologist covering sleep hygiene and tailored behavioral strategies. Results: In an intention‐to‐treat analysis, at 3 and 6 months respectively, the proportion of children with moderate to severe sleep problems was lower in the intervention (28.0%, 35.8%) compared with usual care group (55.4%, 60.1%; 3 month: risk ratio (RR): 0.51, 95% CI 0.37, 0.70, p < .001; 6 month: RR: 0.58; 95% CI 0.45, 0.76, p < .001). Intervention children had improvements across multiple Children's Sleep Habits Questionnaire subscales at 3 and 6 months. No benefits of the intervention were observed in other domains. Cost‐effectiveness of the intervention was AUD 13 per percentage point reduction in child sleep problem at 3 months. Conclusions: A low‐cost brief behavioral sleep intervention is effective in improving sleep problems when delivered by community clinicians. Greater sample comorbidity, lower intervention dose or insufficient clinician supervisions may have contributed to the lack benefits seen in our previous trial. [ABSTRACT FROM AUTHOR]

Background The lymph node status represents a major prognostic factor in colorectal cancer. However, it was demonstrated that neoadjuvant chemoradiotherapy (CRT) decreases the numbers of lymph nodes in the specimen. Several studies describe less than 12 lymph nodes in the resected specimen of rectal cancer patients after neoadjuvant radiation. This meta-analysis quantifies the influence of neoadjuvant CRT or radiotherapy (RT) only on the lymph node yield in rectal cancer patients. Methods We performed a systematic review and searched PubMed, EMBASE and the Cochrane Library without any language restriction from 1st of January 1980 until 31st March 2015. Two reviewers examined all publications independently and extracted the relevant data if the study assessed lymph node counts or positive lymph node yields of patients who received neoadjuvant treatment compared with patients who did not receive neoadjuvant treatment. Meta-analyses were conducted to quantify the mean difference in lymph node yield. Results A total of 34 articles (including 37 datasets) were included in the meta-analyses. Neoadjuvant CRT resulted in a mean reduction of 3.9 lymph nodes (95% confidence interval [CI] 3.7–4.1) and an average reduction in harvested positive lymph nodes of 0.7 (95% CI 0.2–1.2) compared with patients who received no neoadjuvant therapy. Individuals who received neoadjuvant RT had, in average, 2.1 lymph node less (95% CI 1.7–2.5) resected compared with their counterparts who received no neoadjuvant treatment. Conclusions Neoadjuvant CRT or RT only in rectal cancer patients leads to a decrease in lymph node harvest of approximately four and two lymph nodes, respectively. We therefore stress the importance of intensifying all efforts from involved subspecialities (i.e. surgeons and pathologists) to reach the benchmark harvest of 12 resected lymph nodes according to current guidelines. [ABSTRACT FROM AUTHOR]

Background: Previous investigations on the association of human papillomavirus (HPV) and human bladder cancer have led to conflicting results. The aim of this study was to determine if low and high risk HPV play a role in the etiology of superficial low grade and invasive high grade urothelial carcinoma of the bladder. Methods: We prospectively collected tumor samples of urothelial carcinoma of the bladder from 109 patients treated with transurethral resection or cystectomy, with bladder tissue from transurethral resection of the prostate serving as control. Unfixed, frozen tumor samples were analyzed for the presence of 14 high risk HPV types using real time PCR. Additionally, all specimens were tested for 35 low risk HPV types with a conventional PCR using degenerate primers located in the L1 region. Six frozen samples of cervical carcinoma served as positive controls. Results: We included 109 cases of bladder cancer with 41 superficial (pTa low grade) tumors, 56 invasive (pT1-T4) high grade tumors and 12 others (pTa high grade + pTis). We have not detected HPV-DNA in any sample (95 % Confidence Interval [CI] 0-3.3 %), superficial tumors (95 % CI 0-6.4 %) or in invasive tumors (95 % CI 0-8.6 %) with correct positive controls. Conclusions: Using a broad, sensitive assay with prospectively collected specimens of a Central European population we could not detect HPV-DNA in any of the cases. Our results suggest that it is unlikely that HPV infections play a major role in the development of urothelial bladder cancer. [ABSTRACT FROM AUTHOR]

The article presents a study on survival rates after combined osteochondral autologous transfer (OAT) and valgus high tibial osteotomy (HTO) in young and active patients with symptomatic osteochondral defects of the medial femoral condyle and concomitant varus malalignment. It mentions deep osteochondral defects of the medial femoral condyle in young patients that might lead to early osteoarthritis of the knee joint. Results showed combined OAT and valgus HTO can treat the disease.

Abstract: Background: Although resection is the only treatment option that offers a chance for prolonged survival in pancreatic cancer, R2 resections are controversial and not a generally accepted approach. Methods: A systematic review and meta-analysis of studies of patients with pancreatic cancer was performed to analyze R2 resections in comparison with palliative surgical bypass procedures. Trials were identified by searching MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials from 1966 to February 2011. Results: Four cohort studies were identified comparing 138 patients with R2 resections with 261 patients undergoing surgical bypass procedures. Morbidity and mortality were increased in the R2 resection group, with pooled risk ratios of 1.75 (95% confidence interval [CI], 1.35–2.26; P < .0001) and 2.98 (95% CI, 1.31–6.75; P = .009), respectively. R2 resections were associated with longer operating times (mean difference, 164 minutes; 95% CI, 127–201 minutes; P < .00001) and hospital stays (mean difference, 5 days; 95% CI, 1–9 days; P = .02). Pooled median survival times were 8.2 months for R2 resection and 6.7 months for palliative bypass procedures. Conclusions: Planned palliative R2 resections are not justified in patients with pancreatic cancer. [Copyright &y& Elsevier]

Aims: To develop a prediction model for withdrawal seizures (WS) and delirium tremens (DT) during moderate to severe alcohol withdrawal syndrome (AWS) in a large cohort of inpatients treated for AWS (n = 827). Methods: Re-analysis of a cohort study population treated between 2000 and 2009. All patients received a score-guided and symptom-triggered therapy for AWS. Multivariable binary logistic regression models with stepwise variable selection procedures were conducted providing odds ratio (OR) estimates. Results: In the multivariable regression, significant predictors of WS during AWS therapy were a delayed climax of withdrawal severity since admission [OR/10 h: 1.23; 95% confidence interval (CI): 1.1–1.4; P < 0.001)], prevalence of structural brain lesions in the patient's history (OR 6.5; 95% CI: 3.0–14.1; P < 0.001) and WS as the cause of admittance (OR 2.6; 95% CI: 1.4–4.8; P = 0.002). Significant predictors at admission for the occurrence of DT were lower serum potassium (OR/1 mmol/l 0.33; 95% CI: 0.17–0.65; P = 0.001), a lower platelet count (OR/100.000 0.42; 95% CI: 0.26–0.69; P = 0.001) and prevalence of structural brain lesions (OR 5.8; 95% CI: 2.6–12.9; P < 0.001). Conclusion: In this large retrospective cohort, some easily determinable parameters at admission may be useful to predict a complicated course of alcohol withdrawal regarding the occurrence of WS or DT. Using the provided nomograms, clinicians can estimate the percentage likelihood of patients to develop either WS or DT during their course of withdrawal. Prevalence of structural brain lesions in the patient's history does strongly warrant a careful observation of patients. [ABSTRACT FROM AUTHOR]

Background & Aims: There is controversy about the best way to treat esophageal anastomotic leakage. We evaluated the effects of treatment with self-expanding metal stents in patients with esophageal anastomotic leakage after esophagectomy or gastrectomy for cancer. Methods: We investigated outcomes and procedure-related complications of 115 patients who received endoscopic stents for anastomotic leakage after esophagectomy or gastrectomy at a university hospital from 2004 to 2009. We also performed a systematic literature review on stent therapy and compared outcomes with that of other treatment regimens for esophageal anastomotic leakage. Results: Among the 115 patients who received stents, the in-hospital mortality rate was 9% and complete anastomotic healing was achieved in 70% (95% confidence interval [CI], 64%–76%). Stent dislocation occurred in 53% of the patients (95% CI, 43%–62%), in all patients with esophagocolonostomy, in 61% with esophagojejunostomy, and in 49% with esophagogastrostomy. Three percent of patients (95% CI, 1%–5%) needed laparotomy to remove dislocated stents. Elective endoscopic stent removal was performed in 80% of the patients after a median of 54 days (range 17–427 d); 12% of these patients developed symptomatic anastomotic strictures after stent removal. Conclusions: Anastomoses completely heal in 70% of patients that receive endoscopic stents for anastomotic leakage after esophagectomy or gastrectomy. Stent therapy should be used in the management of patients with adequately perfused esophageal anastomotic leakage. However, stent dislocation remains a common problem after surgery. [Copyright &y& Elsevier]

Aims: To compare the clinical course, incidence of withdrawal seizures (WS) or delirium tremens (DT) and side effects during treatment of alcohol withdrawal in patients treated with either carbamazepine (CBZ) or valproate (VPA) as an adjunct to clomethiazole and clonidine therapy. Methods: Retrospective analysis of charts of two cohorts of inpatients treated during 2000–2009: CBZ 374 patients, VPA 453 patients. Results: At baseline, those treated with VPA and those treated with CBZ were similar except for a trend to younger age and a higher incidence of previous WS in the CBZ group. The median duration of pharmacological treatment (91 vs. 76 h; P < 0.001) and the length of stay (8 vs. 6 days; P < 0.001) as well as the need for intensive care treatment (7 vs. 2%; P = 0.001) were significantly higher in the CBZ than the VPA group. Additionally, withdrawal-related complications such as WS occurred more often in the CBZ group (9.6 vs. 5.5%; not significant after adjusting for potential confounders); the incidence of DT in the CBZ group was insignificantly higher (6.6 vs. 4.4%; P = 0.52). Admittance with seizures and older age were predictors of WS and DT, respectively. Adverse drug reactions, mainly affecting the central nervous system, were significantly more frequent with CBZ than VPA (7.6 vs. 2%; P < 0.001). Conclusion: During alcohol withdrawal, VPA may offer some benefits compared with CBZ due to favorable tolerability, possibly less incidence of WS and a shorter duration of pharmacological treatment. [ABSTRACT FROM PUBLISHER]

After esophageal/gastric resection with resulting truncal vagotomy, the incidence of gallstone formation seems to increase. The clinical relevance of gallstones and the role of simultaneous/incidental cholecystectomy in this setting are controversially discussed. Systematic analysis has been performed for retrospective/prospective studies on the incidence/symptoms of gallstone formation after esophageal/gastric resection. Pooled estimates of the incidence of cholecystectomies were calculated by random effect models. Risk analyses of simultaneous, acute postoperative cholecystectomy and long-term cholecystectomy were performed. Sixteen studies on gallstone formation after upper gastrointestinal (GI) surgery (3,735 patients) reported increased incidences of 5–60% with a pooled estimate of 17.5% (95% confidence interval (CI), 14.1–21.2%; inconsistency statistic ( I2) = 86%) compared with 4–12% in the control population. In 113 of 3,011 patients (12 studies), late cholecystectomies were performed for symptomatic cholecystolithiasis, corresponding to an estimated overall proportion of 4.7% (95% CI, 2.1–8.2%; I2 = 92%). In 1.2% (95% CI, >0–3.7%; I2 = 93%) of patients undergoing upper GI surgery, a cholecystectomy was performed because of acute postoperative biliary problems (4 studies, 8,748 patients). Simultaneous cholecystectomy had a higher morbidity of 0.95% (95% CI, 0.54–1.49%; I2 = 28%) compared with the calculated additional morbidity of early and late cholecystectomy of 0.45%. Approximately 6% of patients undergoing upper GI surgery are expected to require cholecystectomy during follow-up. Because late cholecystectomies can be performed safely and because the additional calculated morbidity for these operations is lower than the morbidity for simultaneous cholecystectomy, it cannot generally be recommended to remove a normal acalculous gallbladder during upper GI surgery. [ABSTRACT FROM AUTHOR]

Background & Aims: Increased alcohol consumption can lead to acute pancreatitis (AP). We investigated whether the incidence of alcohol-induced AP increased during the Munich Oktoberfest in 2008, at which 6.6 million liters of beer were sold within 16 days. Methods: We performed a multicenter, prospective study of 188 patients with AP (36.7% alcohol-induced, 34.6% biliary), treated at 27 hospitals in the greater area of Munich, Germany (2,970,000 inhabitants) during the 2008 Oktoberfest. Data were compared with that from two 18-day control periods. Results: During the Oktoberfest, the overall incidence of AP was 42.8/100,000 person-years, which is 117% higher than previously reported. The incidence of acute attacks of alcoholic pancreatitis (AAP) did not increase during the Oktoberfest, compared with control periods. AAP was independently associated with repeated episodes of AP (P = .001), high levels of chronic alcohol intake (P = .001), low body-mass index (P = .007), male gender (P = .033), and acute alcohol excess (P = .037). Biliary AP was associated with increased levels of alanine-aminotransferase and aspartate-aminotransferase (P = .003), old age (P = .014), and low levels of chronic alcohol intake (P = .032). Death (5/188 patients) was associated with baseline levels of blood urea nitrogen, receiver operating characteristic-area under the curve (ROC-AUC = 0.918), alkaline phosphatase (ROC-AUC = 0.861), and C-reactive protein (ROC-AUC = 0.855). Conclusions: The incidence of AP does not increase during the Oktoberfest, compared with other time periods; the incidence of AP in Munich is higher than previously described in Germany. AAP was associated with long-term, heavy alcohol exposure rather than short-term, excessive alcohol drinking. Levels of blood urea nitrogen were associated with mortality. [Copyright &y& Elsevier]

The article discusses research which was conducted to determine whether the ingestion of nonalcoholic beer (NAB) polyphenols for three weeks before and two weeks after a marathon would attenuate postrace inflammation and decrease upper respiratory tract infection (URTI) incidence. Researchers evaluated 211 healthy runners who were randomly assigned to NAB or placebo beverages before and after the Munich Marathon. They found that the consumption of NAB before and after marathon competition reduces postrace inflammation and URTI incidence.

Antiretroviral therapy effectively prevents sexual and vertical transmission of HIV. Yet, some women living with HIV report having unmet needs for reproductive health care. This study measured the prevalence of women discussing reproductive goals with any current healthcare provider and assessed the effect of the current HIV care provider's gender on such discussions and whether comfort was a mediator. We analysed baseline and 18-month survey data from 533 women living with HIV enrolled in the Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS) (2013–2017), a community-based participatory study, restricting the analysis to participants aged 16–45 years. We used causal mediation analysis to estimate direct and indirect effects of the gender of one's HIV care provider on reproductive discussions, incorporating mediating and interaction effects of women having any provider with whom they felt comfortable discussing reproductive goals. Between the baseline and 18-month follow-up surveys, 34.3% (183/533) of women discussed their reproductive goals with a healthcare provider. Having a woman HIV care provider was associated with a 1.18 excess relative risk (ERR) of discussion (95%CI: 0.15, 2.20). The mediating effect of comfort was primarily explained by the fact that those participants with women providers felt more comfortable discussing their reproductive goals compared to participants with men providers, accounting for 66% (95%CI: 32%, 99%) of the total effect. Findings support that HIV provider gender affects women's comfort and whether they discuss reproductive goals, which must be acknowledged and addressed in care delivery. [ABSTRACT FROM AUTHOR]

Abstract: Background: The intention of this study was to analyze the long-term results of the proximal closing wedge osteotomy for the correction of hallux valgus deformity, modified by adding a mini L-plate for osteosynthesis. Methods: The outcome of a proximal first metatarsal closing wedge osteotomy was retrospectively evaluated after a mean follow-up of 52 months. A total of 66 female patients (86 feet) participated in this study. The AOFAS-score was used to evaluate the postoperative results. Pre- and postoperative weight-bearing radiographs were used to evaluate the osseous development. Results: 95.5% of the patients were satisfied, 3 patients (4.5%) were not satisfied with the overall result of the operation. Transfer metatarsalgia was registered in 7 of 50 cases. The mean improvement of the HV-angle was 22.1° (36.4° to 14.3°) and the intermetatarsal angle was reduced from a mean of 17.6° to a mean of 6.5°. The mean first metatarsal shortening was 3.2mm. The mean AOFAS-score was 78 points. Conclusion: The results confirm, that the closing wedge osteotomy is indicated for moderate to severe hallux valgus. The shortening of the first ray is comparable with other well-established operative procedures. The risk of transfer metatarsalgia can only be lightly reduced by this procedure. [Copyright &y& Elsevier]