Atopic dermatitis, diet, heart: Unravelling Gurk, K.; Quintana Pacheco, D.; Yahiaoui‐Doktor, M. ...
Journal of the European Academy of Dermatology and Venereology,
July 2024, Letnik:
38, Številka:
7
Journal Article
Physical activity (PA) helps prevention and aftercare of sporadic breast cancer (BC), cardiopulmonary fitness (CPF) being an age-independent predictor of tumor-specific mortality. Therefore, we ...wanted to identify predictors of CPF (represented by peak oxygen uptake: VO
) in BRCA1/2 mutation carriers whose risk of developing BC is high. We used cross-sectional data from 68 BRCA1/2 germline mutation carrying women participating in the randomized, prospective, controlled clinical study LIBRE-1. Assessments included cardiopulmonary exercise testing, medical and lifestyle history plus socioeconomic status. Additionally, the participants completed a psychological questionnaire regarding their attitude, subjective norms, perceived behavior control and intention towards PA. A multivariate logistic regression model was used to identify predictors for participants reaching their age- and sex-adjusted VO
reference values. 22 participants (median age: 40 years, interquartile range (IQR) 33-46) were cancer-unaffected and 46 cancer-affected (median age: 44 years, IQR 35-50). The strongest predictor for reaching the reference VO
value was attitude towards PA (Odds Ratio 3.0; 95% Confidence Interval 1.3-8.4; p = 0.021). None of the other predictors showed a significant association. A positive attitude towards PA seems to be associated with VO
, which should be considered in developing therapeutic and preventive strategies.Trial registrations: NCT02087592; DRKS00005736.
•An anxiety disorder, indicated by a GAD-7 showed statistically independent associations with prior diagnosis of cancer (especially in young women), but no association was found between an anxiety ...disorder and other life-threatening or chronic diseases such as myocardial infarction, stroke or diabetes.•We found no significant difference regarding the time passed since the initial cancer diagnosis: ≤5 years or 5–10 years or >10 years. For long-term survivors there seems to be a decrease in the risk of anxiety, but the difference was not relevant and significant.
Cancer patients can feel depression and anxiety any time after a cancer diagnosis. The Generalized Anxiety Disorder Scale (GAD-7) is an instrument for the assessment of anxiety.
The main objective of this work was to compare general anxiety levels between cancer survivors and individuals without a history of cancer in a population-based study (LIFE-ADULT) with 10,000 participants.
All participants (18–80 years) completed the GAD-7 and other psychological and medical questionnaires. A score of 10 or greater for GAD-7 (of total 21) indicates a probable generalized anxiety disorder.
954 participants reported a diagnosis of cancer in their medical history.
In the multivariate analysis an anxiety disorder was associated with prior cancer diagnosis (OR: 1.8; 95% CI 1.4–2.4), age -every additional year- (OR: 0.983; 0.976–0.991), female gender (OR: 1.8; 1.5–2.2) and low socioeconomic status (OR: 2.0; 1.7–2.5) all p < 0.001. There were no significant associations between general anxiety and other comorbidities, such as myocardial infarction (OR: 1.0; p = 0.948), stroke (OR: 1.4; p = 0.237) or diabetes (OR: 1.0; p = 0.326).
There was also no significant difference in anxiety disorder among cancer survivors regarding the time passed since the initial cancer diagnosis (OR: 1.1; 0.6–1.9, p = 0.804 comparing 5–10 years after a diagnosis of cancer vs. ≤5 years and OR: 0.6; 0.4–1.1, p = 0.107 comparing >10 vs. ≤5 years).
This study has a cross-sectional character, therefore, causal conclusions cannot be drawn.
Cancer survivors may require screening for anxiety disorders and long-term professional psychosocial support.
Zusammenfassung
Medikationsanalysen durch Stationsapotheker:innen sind eine wichtige Maßnahme der Arzneimitteltherapiesicherheit (AMTS). Dabei werden medikationsbezogene Probleme (Medication Related ...Problems MRPs) identifiziert und zusammen mit den behandelnden Ärzt:innen gelöst. Die Personalressourcen für erweiterte Medikationsanalysen und eine vollständige Dokumentation sind jedoch häufig begrenzt. Bisher müssen Daten, die für die Identifikation von Risikopatient:innen und für eine erweiterte Medikationsanalyse benötigt werden, oft aus verschiedenen Teilen der einrichtungsinternen elektronischen Patientenakte („Electronic Medical Record“ EMR) zusammengesucht werden. Dieser fehleranfällige und zeitaufwändige Prozess soll im Projekt INTERPOLAR durch die Nutzung eines durch die Datenintegrationszentren (DIZ) bereitgestellten IT-Werkzeuges verbessert werden.
INTERPOLAR (INTERventional POLypharmacy – Drug InterActions – Risks) ist ein „Use Case“ der Medizininformatik-Initiative (MII), der auf das Thema AMTS fokussiert. Die Planungsphase fand im Jahr 2023 statt, die Routineimplementation ist ab 2024 vorgesehen. AMTS-relevante Daten aus dem EMR sollen dargestellt und die Dokumentation der MRPs in der Routineversorgung erleichtert werden. Die prospektive multizentrische, clusterrandomisierte INTERPOLAR-1-Studie dient dazu, den Nutzen der IT-Unterstützung in der Routineversorgung zu evaluieren. Ziel ist es, zu zeigen, dass mithilfe der IT-Unterstützung mehr MRPs entdeckt und auch gelöst werden können. Dazu werden an 8 Universitätskliniken jeweils 6 Normalstationen ausgewählt, sodass 48 Cluster (mit insgesamt mindestens 70.000 Fällen) zur Randomisierung bereitstehen.
In an international cohort of surgical patients, satisfaction was strongly influenced by pain relief received, no desire to have received more pain treatment, and more allowed participation in pain ...treatment decisions.
Patient ratings of satisfaction with their postoperative pain treatment tend to be high even in those with substantial pain. Determinants are poorly understood and have not previously been studied in large-scale, international datasets. PAIN OUT, a European Union-funded acute pain registry and research project, collects patient-reported outcome data on postoperative day 1 using the self-reported International Pain Outcome Questionnaire (IPO), and patient, clinical, and treatment characteristics. We investigated correlates of satisfaction and consistency of effects across centres and countries using multilevel regression modelling. Our sample comprised 16,868 patients (median age 55years; 55% female) from 42 centres in 11 European countries plus Israel, USA, and Malaysia, who underwent a wide range of surgical procedures, for example, joint, limb, and digestive tract surgeries. Median satisfaction was 9 (interquartile range 7–10) on a 0–10 scale. Three IPO items showed strong associations and explained 35% of the variability present in the satisfaction variable: more pain relief received, higher allowed participation in pain treatment decisions, and no desire to have received more pain treatment. Patient factors and additional IPO items reflecting pain experience (eg, worst pain intensity), pain-related impairment, and information on pain treatment added little explanatory value, partially due to covariate correlations. Effects were highly consistent across centres and countries. We conclude that satisfaction with postoperative pain treatment is associated with the patients’ actual pain experience, but more strongly with impressions of improvement and appropriateness of care. To the degree they desire, patients should be provided with information and involved in pain treatment decisions.
PAIN OUT is a European Commission-funded project aiming at improving postoperative pain management. It combines a registry that can be useful for quality improvement and research using treatment and ...patient-reported outcome measures. The core of the project is a patient questionnaire-the International Pain Outcomes questionnaire-that comprises key patient-level outcomes of postoperative pain management, including pain intensity, physical and emotional functional interference, side effects, and perceptions of care. Its psychometric quality after translation and adaptation to European patients is the subject of this validation study. The questionnaire was administered to 9,727 patients in 10 languages in 8 European countries and Israel. Construct validity was assessed using factor analysis. Discriminant validity assessment used Mann-Whitney U tests to detect mean group differences between 2 surgical disciplines. Internal consistency reliability was calculated as Cronbach's alpha. Factor analysis resulted in a 3-factor structure explaining 53.6% of variance. Cronbach's alpha at overall scale level was high (.86), and for the 3 subscales was low, moderate, or high (range, .53-.89). Significant mean group differences between general and orthopedic surgery patients confirmed discriminant validity. The psychometric quality of the International Pain Outcomes questionnaire can be regarded as satisfactory.
The International Pain Outcomes questionnaire provides an instrument for postoperative pain assessment and improvement of quality of care, which demonstrated good psychometric quality when translated into a variety of languages in a large European and Israeli patient population. This measure provides the basis for the first comprehensive postoperative pain registry in Europe and other countries.
Rationale, aims and objectives
Management of post‐operative pain is unsatisfactory worldwide. An estimated 240 million patients undergo surgery each year. Forty to 60% of these patients report ...clinically significant pain. Discrepancy exists between availability of evidence‐based medicine (EBM)‐derived knowledge about management of perioperative pain and increased implementation of related practices versus lack of improvement in patient‐reported outcomes (PROs). We aimed to assist health care providers to optimize perioperative pain management by developing and validating a medical registry that measures variability in care, identifies best pain management practices and assists clinicians in decision making.
Methods
PAIN OUT was established from 2009 to 2012 with funding from the European Commission. It now continues as a self‐sustaining, not‐for‐profit project, targeting health care professionals caring for patients undergoing surgery.
Results
The growing registry includes data from 40 898 patients, 60 hospitals and 17 countries. Collaborators upload data (demographics, clinical, PROs) from patients undergoing surgery in their hospital/ward into an Internet‐based portal. Two modules make use of the data: (1) online, immediate feedback and benchmarking compares PROs across sites while offline analysis permits in‐depth analysis; and (2) the case‐based clinical decision support system offers practice‐based treatment recommendations for individual patients; it is available now as a prototype. The Electronic Knowledge Library provides succinct summaries on perioperative pain management, supporting knowledge transfer and application of EBM.
Conclusion
PAIN OUT, a large, growing international registry, allows use of ‘real‐life’ data related to management of perioperative pain. Ultimately, comparative analysis through audit, feedback and benchmarking will improve quality of care.
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