Surviving rectal cancer at the cost of a colostomy: global survey of long-term health-related quality of life in 10 countries

Background Colorectal cancer management may require an ostomy formation; however, a stoma may negatively impact health-related quality of life (HRQoL). This study aimed to compare generic and stoma-specific HRQoL in patients with a permanent colostomy after rectal cancer across different countries. Method A cross-sectional cohorts of patients with a colostomy after rectal cancer in Denmark, Sweden, Spain, the Netherlands, China, Portugal, Australia, Lithuania, Egypt, and Israel were invited to complete questionnaires regarding demographic and socioeconomic factors along with the Colostomy Impact (CI) score, European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ-C30) and five anchor questions assessing colostomy impact on HRQoL. The background characteristics of the cohorts from each country were compared and generic HRQoL was measured with the EORTC QLQ-C30 presented for the total cohort. Results were compared with normative data of reference European populations. The predictors of reduced HRQoL were investigated by multivariable logistic regression, including demographic and socioeconomic factors and stoma-related problems. Results A total of 2557 patients were included. Response rates varied between 51-93 per cent. Mean time from stoma creation was 2.5-6.2 (range 1.1-39.2) years. A total of 25.8 per cent of patients reported that their colostomy impairs their HRQoL 'some'/'a lot'. This group had significantly unfavourable scores across all EORTC subscales compared with patients reporting 'no'/'a little' impaired HRQoL. Generic HRQoL differed significantly between countries, but resembled the HRQoL of reference populations. Multivariable logistic regression showed that stoma dysfunction, including high CI score (OR 3.32), financial burden from the stoma (OR 1.98), unemployment (OR 2.74), being single/widowed (OR 1.35) and young age (OR 1.01 per year) predicted reduced stoma-related HRQoL. Conclusion Overall HRQoL is preserved in patients with a colostomy after rectal cancer, but a quarter of the patients interviewed reported impaired HRQoL. Differences among several countries were reported and socioeconomic factors correlated with reduced quality of life. In this global survey among 2557 individuals with a colostomy after rectal cancer, generic and stoma-specific HRQoL differed significantly between countries; however, it resembled that of country-specific population norms. The most important predictors of stoma-related reduced HRQoL were stoma dysfunction and being financially burdened by the colostomy

Resultados ponderales y metabólicos de la gastrectomía vertical en pacientes con obesidad mórbida y súper-obesidad

La tesi doctoral s'ha estructurat en tres treballs fruit de l'activitat investigadora en l'Unitat de Cirurgia Endocrina Bariàtrica i Metabòlica de l'Hospital Universitari Vall d'Hebron. Un primer treball analitza les complicacions peritoperatorias, complicacions tardanes i tassa de reintervenció de pacients intervinguts de gastrectomia vertical en funció de l'índex de massa corporal inicial. El següent treball avalua els resultats ponderals i de resolució de malalties relacionades amb l'obesitat dels pacients intervinguts de gastrectomia vertical i analitza el seu paper dins de l'estratègia terapèutica de pacients amb súper-obesitat, examinant possibles factors predictors de pitjor evolució en aquesta subpoblació. Finalment, un tercer treball avalua els resultats de la tècnica Single anastomosis Duodeno-ileal bypass with Sleeve gastrectomy (SADI-S) com a segon temps quirúrgic després de la gastrectomia vertical en pacients súper-obesos o pacients amb obesitat mòrbida i pèrdua de pes insuficient o persistència de comorbiditats.La tesis doctoral se ha estructurado en tres trabajos fruto de la actividad investigadora en el seno de la Unidad de Cirugía Endocrina Bariátrica y Metabólica del Hospital Universitari Vall d'Hebron. Un primer trabajo analiza las complicaciones peritoperatorias, complicaciones tardías y tasa de reintervención de pacientes intervenidos de gastrectomía vertical en función del índice de masa corporal inicial. El siguiente trabajo evalúa los resultados ponderales y de resolución de enfermedades relacionadas con la obesidad de los pacientes intervenidos de gastrectomía vertical y analiza su papel dentro de la estrategia terapéutica de pacientes con súper-obesidad, examinando posibles factores predictores de peor evolución en esta subpoblación. Finalmente, un tercer trabajo evalúa los resultados de la técnica Single anastomosis Duodeno-Ileal bypass with Sleeve gastrectomy (SADI-S) como segundo tiempo quirúrgico tras la gastrectomía vertical en pacientes súper-obesos o pacientes con obesidad mórbida y pérdida de peso insuficiente o persistencia de comorbilidades.The doctoral thesis has been structured in three works as a result of the research activity within the Endocrine Bariatric and Metabolic Surgery Unit of the Vall d'Hebron University Hospital. A first study analyzes the peritoperative complications, late complications and reoperation rate of patients undergoing sleeve gastrectomy based on the initial body mass index. The following work evaluates the weight and resolution of obesity-related diseases results in patients undergoing sleeve gastrectomy and analyzes their role within the therapeutic strategy of patients with super-obesity, examining possible predictors of worse evolution in this subpopulation. Finally, a third study evaluates the results of the Single anastomosis Duodeno-Ileal bypass with Sleeve gastrectomy (SADI-S) technique as a second surgical time after sleeve gastrectomy in super-obese patients or patients with morbid obesity and insufficient weight loss or persistent comorbidities.Universitat Autònoma de Barcelona. Programa de Doctorat en Cirurgia i Ciències Morfològique

The phonological adaptation of loanwords with unstressed and stressed mid-vowels in Catalan. State of the art and experimental analysis

L’objectiu d’aquest estudi és descriure i analitzar les realitzacions dels manlleus en què concorren una vocal mitjana tònica i una vocal mitjana àtona en la varietat del català central parlada a l’àrea de Barcelona. Amb aquesta finalitat, s’ha dut a terme un experiment de producció i un experiment de judicis de naturalitat amb vint parlants de l’àrea de Barcelona, deu dones i deu homes d’entre 30 i 46 anys. Els participants han hagut de pronunciar — a partir d’estímuls visuals— un conjunt de noranta-tres manlleus plans i aguts amb concurrència de vocals mitjanes tòniques i àtones, i han hagut de valorar — a partir d’estímuls sonors acompanyats d’imatge— la naturalitat dels diferents patrons de realització vocàlica possibles per a cadascun dels noranta-tres manlleus enquestats (390 estímuls en total, tenint en compte que la majoria de manlleus considerats admeten quatre patrons possibles i que una minoria n’admeten més de quatre). Els resultats, fruit d’una anàlisi estadística que combina variables estructurals i socials, demostren que la solució més freqüent és la manca de reducció vocàlica combinada amb la manca d’obertura de la vocal mitjana tònica (no nativització), mentre que la resta de solucions possibles, l’aplicació de tots dos processos (nativització), o l’aplicació de només un dels processos implicats (nativitzacions parcials), són més aviat marginals i la seva ocurrència està subjecta a variables com ara el caràcter oxíton o paroxíton del manlleu, la coincidència o discrepància de timbre de les vocals en el marc del mateix manlleu, i el caràcter anterior o posterior de les vocals tòniques i àtones. L’estudi també considera variables socials, com ara el sexe, i mostra que els patrons innovadors, no presents en el lèxic natiu del català, són més freqüents en les produccions de les dones que no pas en les dels homes.The aim of this study is to describe and analyze the phonological adaptations of loanwords in which a stressed and an unstressed mid-vowel co-occur in the variety of the Catalan language spoken in the Barcelona area. To this end, we conducted an utterance test with 20 subjects (10 females and 10 males) aged between 30 and 46. Participants were asked to pronounce – through visual stimuli – 93 oxytone and paroxytone loans, all with a stressed and an unstressed mid-vowel. We further conducted a perception test in which the same subjects were asked to assess – through 390 sound stimuli – the degree of naturalness of the different possible phonetic adaptations for the same 93 loans. The results, obtained from a statistical analysis that combines structural and extralinguistic variables, show that the most common solution is the absence of vowel reduction and the absence of vowel opening (non-nativization), whereas the rest of the patterns, with a full nativization or a partial nativization of the loans, are marginal, and their occurrence depends on factors such as the oxytone or paroxytone character of the loan, the vowel quality discrepancy or coincidence within the loan, and the front or back character of the unstressed and stressed vowels involved. The study also considers social variables, such as sex, and shows that innovative patterns which are not present in the native Catalan lexicon are more frequent in the utterances of women than in those of men

Life with a stoma across five European countries-a cross-sectional study on long-term rectal cancer survivors

Purpose Stoma-related problems are known to be important to patients and potentially affect everyday life. The prevalence of stoma-related problems in rectal cancer survivors remains undetermined. This study aimed to examine aspects of life with a long-term stoma, stoma management, and stoma-related problems and explore the impact of stoma-related problems on daily life. Methods In total, 2262 patients from 5 European countries completed a multidimensional survey. Stoma-related problems were assessed using the Colostomy Impact score. Multivariable regression analysis, after adjusting for potential confounding factors, provided odds ratio (OR) and 95% confidence intervals (CI) for stoma-related problems' association with restrictions in daily life. Results The 2262 rectal cancer survivors completed the questionnaire at a median of 5.4 years (interquartile range 3.8-7.6) after stoma formation. In the total sample, leakage (58%) and troublesome odour (55%) were most prevalent followed by skin problems (27%) and pain (21%). Stoma-related problems were more prevalent in patients with parastomal bulging. A total of 431 (19%) reported feeling restricted in daily activities in life with a stoma. Leakage, odour, skin problems, stool consistency, and frequent appliance changes were significantly associated with restrictions in daily life. The highest risk of experiencing restrictions was seen for patients having odour (OR 2.74 [95% CI: 1.99-3.78]) more than once a week and skin problems (OR 1.77 [95% CI: 1.38-2.27]). Conclusion In this large cohort with rectal cancer, stoma-related problems were highly prevalent and impacted daily life. Supportive care strategies should entail outreach to patients with a long-term stoma

Translation and international validation of the Colostomy Impact score.

AIM: Optimal oncological resection in cancers of the lower rectum often requires a permanent colostomy. However, in some patients a colostomy may have a negative impact on health-related quality of life (HRQoL). The Colostomy Impact (CI) score is a simple questionnaire that identifies patients with stoma dysfunction that impairs HRQoL by dividing patients into 'minor' and 'major' CI groups. This aim of this study is to evaluate construct and discriminative validity, sensitivity, specificity and reliability of the CI score internationally, making it applicable for screening and identification of patients with stoma-related impaired HRQoL. METHOD: The CI score was translated in agreement with WHO recommendations. Cross-sectional cohorts of rectal cancer survivors with a colostomy in Australia, China, Denmark, the Netherlands, Portugal, Spain and Sweden were asked to complete the CI score, the European Organization for Research and Treatment of Cancer (EORTC) quality of life 30-item core questionnaire, the stoma-specific items of the EORTC quality of life 29-item colorectal-specific questionnaire and five anchor questions assessing the impact of colostomy on HRQoL. RESULTS: A total of 2470 patients participated (response rate 51%-93%). CI scores were significantly higher in patients reporting reduced HRQoL due to their colostomy than in patients reporting no reduction. Differences in EORTC scale scores between patients with minor and major CI were significant and clinically relevant. Sensitivity was high regarding dissatisfaction with a colostomy. Regarding evaluation of discriminative validity, the CI score relevantly identified groups with differences in HRQoL. The CI score proved reliable, with equal CI scores between test and retest and an intraclass correlation coefficient in the moderate to excellent range. CONCLUSION: The CI score is internationally valid and reliable. We encourage its use in clinical practice to identify patients with stoma dysfunction who require further attention.RD&E staff can access the full-text of this article by clicking on the 'Additional Link' above and logging in with NHS OpenAthens if prompted.Accepted version (12 month embargo

Decreased mortality among patients with catheter-related bloodstream infections at catalan hospitals (2010-2019)

Background: The incidence of catheter-related bloodstream infections (CRBSI) has fallen over the last decade, especially in intensive care units (ICUs). Aim: to assess the existence of concomitant trends in outcomes and to analyse the current risk factors for mortality. Methods: A multicentre retrospective cohort study was conducted at 24 Catalan hospitals participating in the Surveillance of healthcare associated infections in Catalonia (VINCat). All hospital-acquired CRBSI episodes diagnosed from January 2010 to December 2019 were included. A common protocol including epidemiological, clinical and microbiological data was prospectively completed. Mortality at days after bacteraemia onset was analysed using the Cox regression model. Findings: Over the study period, 4,795 episodes of CRBSI were diagnosed. Among them, 75% were acquired in conventional wards and central venous catheters were the most frequently involved (61%). The 30-day mortality rate was 13.8%, presenting a significant downward trend over the study period: from 17.9% in 2010 to 10.6% in 2019 (HR 0.95 [0.92-0.98]). The multivariate analysis identified age (HR 1.03 83 [1.02-1.04]), femoral catheter (HR 1.78 [1.33-2.38]), medical ward acquisition (HR 2.07 [1.62-2.65] and ICU acquisition (HR 3.45 [2.7-4.41]), S. aureus (HR 1.59 [1.27-1.99]) and Candida sp. (HR 2.19 [1.64-2.94]) as risk factors for mortality while the mortality rate associated with episodes originating in peripheral catheters was significantly lower (HR 0.69 [0.54-0.88]). Conclusions: Mortality associated with CRBSI has fallen in recent years but remains high. Intervention programs should focus especially on ICUs and medical wards, where incidence and mortality rates are highest

Intraoperative transfusion practices in Europe

Transfusion of allogeneic blood influences outcome after surgery. Despite widespread availability of transfusion guidelines, transfusion practices might vary among physicians, departments, hospitals and countries. Our aim was to determine the amount of packed red blood cells (pRBC) and blood products transfused intraoperatively, and to describe factors determining transfusion throughout Europe. We did a prospective observational cohort study enrolling 5803 patients in 126 European centres that received at least one pRBC unit intraoperatively, during a continuous three month period in 2013. The overall intraoperative transfusion rate was 1.8%; 59% of transfusions were at least partially initiated as a result of a physiological transfusion trigger- mostly because of hypotension (55.4%) and/or tachycardia (30.7%). Haemoglobin (Hb)- based transfusion trigger alone initiated only 8.5% of transfusions. The Hb concentration [mean (sd)] just before transfusion was 8.1 (1.7) g dl and increased to 9.8 (1.8) g dl after transfusion. The mean number of intraoperatively transfused pRBC units was 2.5 (2.7) units (median 2). Although European Society of Anaesthesiology transfusion guidelines are moderately implemented in Europe with respect to Hb threshold for transfusion (7-9 g dl), there is still an urgent need for further educational efforts that focus on the number of pRBC units to be transfused at this threshold

Switching TNF antagonists in patients with chronic arthritis: An observational study of 488 patients over a four-year period

The objective of this work is to analyze the survival of infliximab, etanercept and adalimumab in patients who have switched among tumor necrosis factor (TNF) antagonists for the treatment of chronic arthritis. BIOBADASER is a national registry of patients with different forms of chronic arthritis who are treated with biologics. Using this registry, we have analyzed patient switching of TNF antagonists. The cumulative discontinuation rate was calculated using the actuarial method. The log-rank test was used to compare survival curves, and Cox regression models were used to assess independent factors associated with discontinuing medication. Between February 2000 and September 2004, 4,706 patients were registered in BIOBADASER, of whom 68% had rheumatoid arthritis, 11% ankylosing spondylitis, 10% psoriatic arthritis, and 11% other forms of chronic arthritis. One- and two-year drug survival rates of the TNF antagonist were 0.83 and 0.75, respectively. There were 488 patients treated with more than one TNF antagonist. In this situation, survival of the second TNF antagonist decreased to 0.68 and 0.60 at 1 and 2 years, respectively. Survival was better in patients replacing the first TNF antagonist because of adverse events (hazard ratio (HR) for discontinuation 0.55 (95% confidence interval (CI), 0.34-0.84)), and worse in patients older than 60 years (HR 1.10 (95% CI 0.97-2.49)) or who were treated with infliximab (HR 3.22 (95% CI 2.13-4.87)). In summary, in patients who require continuous therapy and have failed to respond to a TNF antagonist, replacement with a different TNF antagonist may be of use under certain situations. This issue will deserve continuous reassessment with the arrival of new medications. © 2006 Gomez-Reino and Loreto Carmona; licensee BioMed Central Ltd

Global Impact of the COVID-19 Pandemic on Cerebral Venous Thrombosis and Mortality

BACKGROUND AND PURPOSE: Recent studies suggested an increased incidence of cerebral venous thrombosis (CVT) during the coronavirus disease 2019 (COVID-19) pandemic. We evaluated the volume of CVT hospitalization and in-hospital mortality during the 1st year of the COVID-19 pandemic compared to the preceding year. METHODS: We conducted a cross-sectional retrospective study of 171 stroke centers from 49 countries. We recorded COVID-19 admission volumes, CVT hospitalization, and CVT in-hospital mortality from January 1, 2019, to May 31, 2021. CVT diagnoses were identified by International Classification of Disease-10 (ICD-10) codes or stroke databases. We additionally sought to compare the same metrics in the first 5 months of 2021 compared to the corresponding months in 2019 and 2020 (ClinicalTrials.gov Identifier: NCT04934020). RESULTS: There were 2,313 CVT admissions across the 1-year pre-pandemic (2019) and pandemic year (2020); no differences in CVT volume or CVT mortality were observed. During the first 5 months of 2021, there was an increase in CVT volumes compared to 2019 (27.5%; 95% confidence interval [CI], 24.2 to 32.0; P CONCLUSIONS: During the 1st year of the COVID-19 pandemic, CVT hospitalization volume and CVT in-hospital mortality did not change compared to the prior year. COVID-19 diagnosis was associated with higher CVT in-hospital mortality. During the first 5 months of 2021, there was an increase in CVT hospitalization volume and increase in CVT-related mortality, partially attributable to VITT