Search

Introdução: De acordo com a OMS, cuidados paliativos é o tratamento não curativo, que busca oferecer uma melhor qualidade de vida a pacientes e familiares, tanto física quanto psicológica. No Brasil essa prática ainda é recente, e de acordo com a Academia Nacional de Cuidados Paliativos (ANCP), atualmente, existem 157 centros especializados no serviço, sendo que 60 se encontram no estado de São Paulo. Objetivo: Avaliar o número de pacientes internados nas enfermarias de um Hospital terciário com critérios de elegibilidade para cuidados paliativos (CP) antes e após a introdução de uma equipe multidisciplinar focada em CP nesse mesmo serviço. Método: Inicialmente foi realizada uma busca ativa com análise de 1199 prontuários de pacientes internados nesse hospital, a fim de definir o número de pessoas que estariam inclusas nos critérios de cuidados paliativos de acordo com a ANCP e que se beneficiariam com essa prática. Após a implementação do serviço de CP, foi analisada por um período de 12 meses a quantidade de pacientes internados nesse serviço e que receberam atendimento pela equipe multidisciplinar.Resultados: No primeiro mês foram analisados 1199 prontuários, sendo que 106 apresentaram indicações de paliação. Nos 12 meses seguintes, após a implementação do serviço apenas 179 pacientes foram admitidos no programa de CP. Discussão: A demanda dos 106 pacientes que poderiam ter se beneficiado com os cuidados paliativos enfatizou a necessidade da criação da equipe multidisciplinar no serviço. Entretanto, observou-se com os dados obtidos que muitos profissionais da saúde ainda desconhecem os critérios de elegibilidade para CP, bem como o momento para indicação desses cuidados, o que prorroga o sofrimento de pacientes e familiares. Conclusão: Sabe-se que o tema está se tornando cada vez mais frequente em nosso meio, não apenas pelos benefícios que traz ao paciente e seus familiares, mas também pela redução de custos ao serviço. Porém muitos profissionais da saúde ainda não sabem a real importância dos critérios para o correto encaminhamento para os cuidados paliativos. Além disso, poucos são os centros especializados nesse tipo de abordagem, pois no Brasil essa prática ainda é recente.

Marine ecosystems, ranging from coastal seas and wetlands to the open ocean, accommodate a wealth of biological diversity from small microorganisms to large mammals. This biodiversity and its associated ecosystem function occurs across complex spatial and temporal scales and is not yet fully understood. Given the wide range of external pressures on the marine environment, this knowledge is crucial for enabling effective conservation measures and defining the limits of sustainable use. The development and application of omics-based approaches to biodiversity research has helped overcome hurdles, such as allowing the previously hidden community of microbial life to be identified, thereby enabling a holistic view of an entire ecosystem's biodiversity and functioning. The potential of omics-based approaches for marine ecosystems observation is enormous and their added value to ecosystem monitoring, management, and conservation is widely acknowledged. Despite these encouraging prospects, most omics-based studies are short-termed and typically cover only small spatial scales which therefore fail to include the full spatio-temporal complexity and dynamics of the system. To date, few attempts have been made to establish standardised, coordinated, broad scaled, and long-term omics observation networks. Here we outline the creation of an omics-based marine observation network at the European scale, the European Marine Omics Biodiversity Observation Network (EMO BON). We illustrate how linking multiple existing individual observation efforts increases the observational power in large-scale assessments of status and change in biodiversity in the oceans. Such large-scale observation efforts have the added value of cross-border cooperation, are characterised by shared costs through economies of scale, and produce structured, comparable data. The key components required to compile reference environmental datasets and how these should be linked are major challenges that we address. LA/P/0101/2020 info:eu-repo/semantics/publishedVersion

PURPOSE This real-life cohort of patients describes the treatment patterns and compares the overall survival (OS) and hazard risk of utilization of multiple therapies. MATERIALS AND METHODS Electronic medical registries of patients with stage III non–small-cell lung cancer (NSCLC) regularly attended in 72 hospitals were included. Univariate and multivariate analyses were conducted to evaluate the primary patients' characteristics leading to better OS and cancer-specific survival. RESULTS A total of 3,363 patients with stage III NSCLC followed over 19 years were included in this study. The median age was 66.00 (58.00-72.00) years, 65% male, and 41.2% with squamous cell carcinoma followed by adenocarcinoma (34.6%) and undifferentiated carcinoma (13.1%) in clinical stage T3 (50.3%), T2 (29.3%), and T4 (12.3%). The median survival (in months) was 18.4 (95% CI, 16.9 to 19.5) in patients submitted to radiotherapy plus chemotherapy, 11.2 (95% CI, 10.5 to 12.1) to chemotherapy, 31.5 (95% CI, 25.9 to 37.7) to surgery plus chemotherapy, and 33.8 (95% CI, 28.3 to 47.8) to chemotherapy plus radiotherapy plus surgery. The median cancer-specific survival (in months) was 19.3 (95% CI, 17.9 to 20.9) in patients submitted to radiotherapy plus chemotherapy, 12.1 (95% CI, 11.1 to 12.9) to chemotherapy, 36.9 (95% CI, 29.6 to 43.2) to surgery plus chemotherapy, and 41.3 (95% CI, 32.1 to 61.3) to chemotherapy plus radiotherapy plus surgery. The patients treated with multiple chemotherapy plus radiotherapy followed by surgery had significantly better OS and lower mortality rates than those treated with other treatments (adjusted hazard ratio, 0.55; 95% CI, 0.45 to 0.66; P < .001). At the end of the study, 11.2% and 10.7% of the patients were living with and without cancer, respectively. CONCLUSION Our real-life 19-year cohort study has shown that only 30.3% of the total patients with stage III NSCLC have been submitted to standard chemotherapy and radiotherapy treatment. This may show a substantial difference between the recruited clinical trials' patients and the real-life patients' characteristics in daily routine treatment.

INTRODUCTION Nowadays the majority of the surgical procedures are video surgeries. Despite technological advances, some problems remain. The buildup of residues in front of the lens is an example of this problem. To solve it, Abreu et al. (Surg Technol Int 26:43-47, 2015) developed LacrimaSurg, which works as a lacrimal duct in the optics preventing fogging and residues buildup on it. This had 98.1% of efficiency in an experimental study. OBJECTIVE Study feasibility and safety of the device under real surgical conditions. MATERIALS AND METHODS A pilot study included 30 patients undergoing thoracic procedures using LacrimaSurg. Procedures were recorded for further analysis by investigators. The characteristics of patients (age, sex, body mass index, Charlton comorbidity index), data of environment (Temperatures variances), and data of procedures (type of surgery and duration of it) were recorded. The investigators watched the videos and recorded the residue buildup and fogging events that impaired surgeon's vision. The number of times the optics got dirty, need for further jets of crystalloid solution, and need for mechanical cleaning were collected to evaluate efficacy. Comparative serum measurements of electrolytes before and after surgery were studied. Data were organized and analyzed by simple linear correlations and t test for continuous variables and Fisher's test for categorical variables. RESULTS The use of the device allowed 97% of the procedures to be performed without interruption. No characteristics inherent to the patients or to the procedures that lead to fogging or filth of the optics were identified. There were no statistically significant differences between pre- and postoperative serum ions, and no postoperative complications related to the use of the device were observed. CONCLUSION The device was effective in preventing interruption of surgical procedures due to dirt or fogging, its use was considered safe, and did not cause postoperative complications.

Background In Low-Middle Income Countries (LMICs), resource optimization and infrastructure availability are recurrently in debate. In order to assist the development and implementation of guidelines, LMICs often exemplify from High-Income Countries protocols. At the final, it will be: content adaption is often needed. In this study, we demonstrated the preliminary analysis of the Brazilian experience by adapting the ERAS® Protocol for thoracic surgery patients (PROSM). Methods Patients' data were extracted from the surgical group database that operated in the city of Sao Paulo. Patients' data were organized for analysis after the institution's ethics committee gave their approval. Patients' variables were analyzed and compared to a control group. Subgroup analysis included patients without ICU Admission. Results PROSM patients had reduced ICU length of stay (LOS) (Mean of 0.3±0.58 days, 1.2±1.65 days, P=0.001), Hospital LOS (Mean of 1.6±1.32 days, 3.9±3.25 days, P=0.001) and Chest Drain duration (Median 1.0±1.00 days, 3.0±3.00 days, P=0.001). Analyses of patients that were not admitted to the ICU demonstrated reduced Hospital LOS and Chest drain duration. Cost analysis, such as procedure, daily, and post-surgical costs were also significantly lower towards PROSM group. Conclusions This study revealed important aspects for improvement of the delivered care quality and opportunity for expenditure management. We expect to assist more countries to improve knowledge under the implementation of enhanced protocols.

Important differences in Stage I non-small-cell lung cancer (NSCLC) are related to the delay in the diagnosis to the treatment, hospitals' specialised status, comorbidities, tumour stage and histological type.A 19-year retrospective cohort study was conducted, including 681 patients with NSCLC in clinical-stage IA-IB. The variables analysed were gender, age, schooling, type of health care provider, type of treatment, period of 5-year treatment, the time between first attendance to diagnosis and the time between diagnosis and treatment, and hospital's specialised status.Patients who underwent radiotherapy alone had three times more risk of death than those who underwent surgery alone (adjusted hazard ratio [adjHR] = 3.44; 95% confidence interval [CI]: 2.45-4.82; p 0.001). The independent risk of death factors was being treated in nonhigh complexity centres in oncology hospitals and having started the treatment more than 2 months after diagnosis (adjHR = 1.80; 95% CI: 1.26-2.56; p 0.001) and (adjHR = 2.00; 95% CI: 1.33-3.00; p 0.001), respectively. In addition, the patients diagnosed between 2011 and 2015 had a 40% lower risk of death when compared to those diagnosed between 2000 and 2005 (95% CI: 0.38-0.94; p = 0.027).The overall survival in curative intent Stage-I lung cancer patients' treatment was associated with the 5-year diagnosis group, the delayed time between diagnosis and treatment and the hospital qualification.

Background It is known that malignant pleural effusion (MPE) recurs rapidly, in a considerable number of patients. However, some patients do not have MPE recurrence. Since MPE is associated with an average survival of 4-7 months, accurate prediction of prognosis may help recognize patients at higher risk of pleural recurrence, aiming to individualize more intensive treatment strategies. Methods A prospectively assembled database of cases with pleural effusion treated at a single institution analyzed a subset of patients with symptomatic MPE. Prognostic factors for pleural recurrence were identified by univariable analysis using Kaplan-Meier method and the log-rank test was used for the comparison between the curves. Univariate and multiple Cox regression models were used to evaluate the risk (HR) of recurrence. Receiver operating characteristics (ROC) analysis determined the cutoff points for continuous variables. Results A total of 288 patients were included in the analysis. Recurrence-free survival was of 76.6% at 6 months and 73.3% at 12 months. Univariable analysis regarding factors affecting postoperative recurrence was: lymphocytes, platelets, pleural procedure, chemotherapy lines and number of metastases. The independent factors for recurrence-free survival were pleural procedure and chemotherapy lines. Patients who were submitted to pleurodesis had a protective factor for recurrence, with an HR =0.34 (95% CI, 0.15-0.74, P=0.007). On the other hand, patients submitted to the 1st and 2nd line of palliative CT had, respectively, an HR risk = 2.81 (95% CI, 1.10-7.28, P=0.034) and HR =3.23 (95% CI, 1.33-7.84, P=0.010). Conclusions patients receiving the first or second line of systemic treatment have a higher risk of MPE recurrence when compared to patients who underwent MPE treatment before starting the systemic treatment. The definitive treatment of MPE, such as pleurodesis, was associated with a lower risk of MPE recurrence.

BACKGROUND: It is known that survival from lung cancer can differ between countries and even between different regions of the same country. The variability between hospitals, the age and social profile, and the time when this patient was treated, can influence survival, and these factors are intrinsic to each region. Knowing the profile of patients, hospitals, and other factors associated with the treatment of stage I and II lung cancer in a given region is important to understand outcomes and propose improvements that can be replicated in any region of the world that presents the same profile of patients and care structure. This study evaluates survival and possible predictors in all patients with stage I and II lung cancer adenocarcinoma through the Hospital’s Cancer Registry (HCR), responsible for the State of Sao Paulo’s cancer registry, a geographical area with 40 million inhabitants. METHODS: Based on the HCR, an observational study was conducted, including 1,278 patients diagnosed with lung adenocarcinoma at clinical stages (CS) I and II. Sex, age at diagnosis, education, neighbourhood, CS at diagnosis, the time between diagnosis and treatment, 5-year periods in which patients were treated, treatment modality and hospitals where patients were treated were analysed. Cox univariate and multiple regression analyses were used to estimate the hazard ratio (HR). RESULTS: A total of 1,278 lung cancer patients with clinical lung cancer adenocarcinoma stages I and II were included. About 40.06% of patients did not receive surgery, and only 55.8% started the treatment within 2 months. The majority of the patients were treated in high complexity hospitals, 69%. Five-year overall survival (OS) was 45.6% in CS I and 27.5% in CS II. Patients treated in high complexity centres have lower mortality rates than those treated in Partial Hospital Complexity Centers in Oncology (PHCCO) (adjHR 1.18; 95% CI: 1.00–1.40; P=0.047). Patients diagnosed between 2010–2014 had a protective factor against the risk of death concerning patients diagnosed between 2000–2004. CONCLUSIONS: The 5-year OS has significantly improved as long as the 5-year group analysed. Also, the 5-year OS of the patients treated in high complexity hospitals is higher than those treated in PHCCO.

Introdução: Atualmente uma grande parte dos procedimentos cirúrgicos efetuados para o tratamento das mais diversas doenças são realizados com o emprego do vídeo. Apesar dos grandes avanços tecnológicos alguns problemas ainda atrapalham esta via de acesso. Um deles é o acúmulo de resíduos à frente da lente objetiva da óptica cirúrgica atrapalhando a visão do cirurgião. Para resolver o problema Abreu et al. (2015) desenvolveram um dispositivo, posteriormente chamado de LacrimaSurg, que funciona como um canal lacrimal da óptica prevenindo o embaçamento e acúmulo de resíduos na mesma, este dispositivo mostrou uma eficácia de 98,1% em estudo experimental ex vivo.Objetivos: Avaliar a viabilidade e a segurança do dispositivo em condições cirúrgicas reais. Métodos: Um estudo piloto in vivo incluiu 30 pacientes submetidos a procedimentos cirúrgicos torácicos empregando o LacrimaSurg. Os procedimentos foram gravados digitalmente para posterior análise pelos investigadores. As características dos pacientes (idade, sexo, índice de massa orporal, índice de comorbidades de Charlton), dados relativos ao ambiente cirúrgico (diferenças entre as temperaturas axilar do paciente e da sala cirúrgica) e dados inerentes ao procedimento em sí (tipo de cirurgia e tempo de duração de cada procedimento) foram registrados. Os investigadores assistiram aos vídeos cirúrgicos e registraram os eventos de sujeira e fogging da óptica que acarretaram em prejuízo da visão do cirurgião. Dados sobre o número de vezes que a óptica sujou, necessidade ou não de jatos de solução cristaloide e necessidade de limpeza mecânica da óptica foram coletados para a avaliação da eficácica. Dosagens séricas comparativas dos eletrólitos sódio e potássio pré e pósoperatórios foram registrados para a avaliação da segurança. Os dados foram organizados e analisados por meio de correlações lineares simples e teste t para as variáveis contínuas e teste exato de Fisher para as variáveis categóricas. Resultados: O uso do dispositivo permitiu que 97% dos procedimentos fossem realizados sem a necessidade de interrupção para limpeza mecânica da óptica. Não foram identificadas características inerentes aos pacientes ou aos procedimentos que colaborassem com o embaçamento ou sujeira da óptica. Não houve diferenças estatisticamente significativas entre os íons séricos pré e pós-operatórios dos pacientes, não foram observadas complicações pós-operatórias relacionadas ao uso do dispositivo. Conclusão: O dispositivo mostrou-se eficaz na prevenção de interrupções dos procedimentos cirúrgicos por sujeira ou embaçamento da óptica, seu uso foi considerado seguro não gerando complicações pós-operatórias. Introduction: Nowadays the great majority of the surgical procedures for the treatment of the most diverse kinds of diseases are video surgeries. Despite major technological advances, some problems still surgical modality. The buildup of residues in front of the lens hindering the surgeon\'s vision is one of this problems. To solve it, Abreu et al. (2015) developed a device called LacrimaSurg, which works as a lacrimal duct in the optics preventing fogging and residues buildup on it. This device showed an efficiency of 98.1% in an experimental ex vivo study. Objectives: Assess the feasibility and safety of the device under real surgical conditions. Methods: An in vivo pilot study included 30 patients undergoing thoracic surgical procedures using LacrimaSurg. The procedures were recorded for further analysis by the researchers. The characteristics of the patients (age, sex, body mass index, Charlton comorbidity index), data related to the surgical environment (differences between the axillary temperatures of the patient and the operating room) and data inherent to the procedure itself (type of surgery and duration of each procedure) were recorded. The investigators watched the surgical videos and recorded the residue buildup and fogging events that leaded to impaired surgeon\'s vision. Data regarding the number of times the optics got dirty, the need for further jets of crystalloid solution and the need for mechanical cleaning of the optics were collected to evaluate efficacy. Comparative serum measurements of sodium and potassium electrolytes before and after surgery were recorded for safety assessment. The data were organized and analyzed by means of simple linear correlations and t test for continuous variables and Fisher\'s exact test for categorical variables. Results: The use of the device allowed 97% of the procedures to be performed without interruption for mechanical cleaning of the optics. No characteristics inherent to the patients or to the procedures that contributed to the fogging or filth of the optics were identified. There were no statistically significant differences between pre- and postoperative serum ions, and no postoperative complications related to the use of the device were observed. Conclusion: The device was shown to be effective in preventing interruption of surgical procedures due to dirt or fogging of the optics, its use was considered safe and did not cause postoperative complications.

INTRODUÇÃO: A cirurgia torácica pode causar uma série de complicações pulmonares após o processo cirúrgico. O momento e a circunstância ideais para sedestação fora do leito e suas implicações clínicas, após cirurgias no tórax, ainda necessitam de padronização. Assim, faz-se necessário um tratamento de mobilização precoce adequado visando minimizar as complicações no período pós-operatório. OBJETIVOS: Objetivamos avaliar o efeito do atendimento fisioterapêutico no pós-operatório imediato de pacientes submetidos à cirurgia torácica. MATERIAIS E MÉTODOS: Este será um ensaio clínico randomizado, no qual um grupo de pacientes submetidos às cirurgias de ressecções pulmonares eletivas (segmentectomias, lobectomias ou pneumonectomias) com idade superior a dezoito anos receberão atendimento fisioterapêutico através do PROSM. Serão excluídos os pacientes incapazes de assinar o termo de consentimento livre esclarecido, com performance status comprometido (ECOG superior à 2), com peso corporal inferior à 60 Kg ou superior à 120 Kg, com alergia a qualquer uma das drogas utilizadas na anestesia, portadores de disfunção renal, disfunção hepática (Child B e C) e Insuficiência Cardíaca (classe Funcional III e IV). O instrumento de classificação do grau da dor por meio da Escala Visual Analógica (EVA) e instrumento de classificação da independência funcional por meio da Escala MIF (medida de independência funcional) serão aplicados antes do início e após o término de cada sessão de fisioterapia. Também será analisado o número de sessões de cada paciente e o tempo de internação. Para análise estatística será utilizado o programa SPSS Statistics e o teste de Shapiro-Wilk será usado para identificar a normalidade dos dados coletados. Espera-se um menor tempo de internação e melhor independência funcional na alta hospitalar nos pacientes submetidos ao PROSM.

The aim of this study is to evaluate the interaction between treatment delay and stage on the mortality from non-small cell lung cancer (NSCLC).We performed a survival analysis in a cohort of patients admitted to the reference cancer center. The following data were collected: age, gender, smoking status, tumor staging, type of lung cancer, and time from the date when the patient was diagnosed with cancer to the starting date of effective treatment. Univariable and multivariable Cox proportional hazard models were used to investigate the association between potential confounders identified during the study design. After the final adjusted model was determined, tests for interaction among all predictors were performed.Inclusion criteria were met by 359 patients. In the adjusted analysis, delayed treatment delivery was a protective factor for the risk of death, with a crude hazard ratio (HR) =0.75 (0.59-0.97; P=0.02) and an adjusted HR =0.59 (0.46-0.77; P0.001). However, a statistically significant interaction with mortality was observed between timely treatment and tumor stage. Patients with stage II disease who received delayed treatment had a higher risk of death [HR =3.08 (1.05-9.0; P=0.04)]. On the other hand, stage IV patients who received delayed treatment had a 52% reduction in mortality [HR =0.48 (0.35-0.66; P0.001)].Stage of disease influenced the association between start of the treatment and mortality, and only the subgroup of stage II patients seemed to benefit from early treatment.

This is the open peer reviewers comments and recommendations regarding the submitted GigaScience article and/or dataset.

Background and Objectives The aim of this study was to identify predictors of mortality only in patients with malignant pleural effusion (MPE) showing good performance status which required pleural palliative procedures. Methods All patients with MPE submitted to pleural palliative procedure were enrolled in a prospective study between 2013 and 2014. Patients with Eastern cooperative oncology group (ECOG) score zero, one, and two were considered with good performance status. The possible prognostic factors were tested for significance using the log-rank test (Kaplan–Meier method) and those with significance on univariate analysis were entered into a multivariable Cox model. Results A total of 64 patients were included in the analysis. Median follow-up time for surviving patients was 263 days. Median survival for the entire cohort was not reached yet. In the multivariate analysis, gastrointestinal primary site (P = 0.006), low albumin concentration in the pleural fluid (P = 0.017), and high serum NLR (P = 0.007) were associated with mortality. Conclusion In our cohort of ECOG 0–2 patients with MPE submitted to pleural palliative procedures, gastrointestinal malignancy compared to other sites, low pleural fluid albumin and high NLR were significantly associated with mortality. The identification of these prognostic factors may assist the choice of the optimal palliative technique. J. Surg. Oncol. © 2016 Wiley Periodicals, Inc.