Standardization and diagnostic utility of the frontal assessment battery for healthy people and patients with dementia in the Chilean population

Background: The Frontal Assessment Battery (FAB) is a screening test that measures executive functions. Although this instrument has been validated in several countries, its diagnostic utility in a Chilean population has not been studied yet. Objectives: (1) To adapt FAB in a Chilean population; (2) To study the psychometric properties of the FAB in a Chilean population; (3) to assess the sociodemographic influence in the performance of the FAB in a sample of healthy controls, and (4) to develop normative data for this last group. Methods: A healthy control (n = 344) and a group of patients with dementia (n = 156) were assessed with the Chilean version of FAB. Results: FAB showed good internal consistency (Cronbach's alpha = 0.79) and acceptable validity based on the relationship with other variables. Factor analysis showed the unidimensionality of the instrument. Significant differences were found in the total FAB value between the healthy control and dementia groups. With the matched sample, the established cut-off point was 13.5, showing a sensitivity of 80.8% and a specificity of 90.4%. Regression analysis showed that education and age significantly predicted FAB performance in the healthy group. Finally, normative data are provided. Conclusions: The present study has shown that FAB is a useful tool to discriminate between healthy people and people with dementia. However, further studies are needed to explore the capacity of the instrument to characterize the dysexecutive syndrome in people with dementia in the Chilean population

Proceso de duelo y calidad de vida en pacientes oncológicas diagnosticadas con cáncer de mama de Lima

La presente investigación trata temas importantes para la psicooncología, una rama menos desarrollada dentro de la profesión, y aborda tanto la calidad de vida como los procesos de duelo en las mujeres diagnosticadas con cáncer de mama que se encuentran en tratamiento. El interés por desarrollar este tema partió de la necesidad de prestar atención a la calidad de vida y al duelo, como variables que se encuentran presentes en las mujeres con cáncer de mama, y de determinar si es que existe alguna relación entre ambas para poder hacer recomendaciones. El primer capítulo hace referencia al planteamiento del problema, formulándose la pregunta de investigación, así como los objetivos tanto generales como específicos. También se hace referencia a la importancia y justificación del estudio y las limitaciones del mismo, para que en posteriores investigaciones se tomen en cuenta y ello pueda enriquecerlas aún más. El segundo capítulo tiene que ver con el marco teórico, las investigaciones nacionales e internacionales relacionadas con el tema y las bases teóricas y científicas que sustentan este tipo de investigaciones. De manera específica, las diferentes teorías sobre duelo e información acerca de la conceptualización de la calidad de vida en personas que sufren de alguna enfermedad crónica o importante. Asimismo, se presentan las definiciones operacionales de términos básicos para entender la investigación. El tercer capítulo está referido a los supuestos científicos del estudio, se indican las hipótesis tanto generales como específicas y se detallan las variables que intervienen en la investigación. El cuarto capítulo tiene que ver con el método, y en él se hace referencia a la población y muestra, así como el tipo de investigación, se indican los instrumentos elegidos para la evaluación y se incluye la ficha técnica de ambas escalas utilizadas (EORTC QLQ-C30 y la Escala de Respuestas Psicológicas de Duelo ante la Pérdida de la Salud -RPD-PS-38). Asimismo, se describe el procedimiento y las técnicas para el procesamiento de los datos. El quinto capítulo tiene que ver con la presentación de los resultados y contiene también el análisis y discusión de los mismos. En este capítulo se describen los principales hallazgos de la investigación y se discuten a la luz de las hipótesis planteadas inicialmente. Para finalizar, en el sexto capítulo se presentan las principales conclusiones generales y las conclusiones específicas que surgen a partir del análisis de resultados del estudio. Del mismo modo, se hace referencia a las recomendaciones para posteriores estudios y se añade el resumen de la investigación. En la parte final del documento, se incluyen las referencias bibliográficas y los anexos, como el modelo de consentimiento informado y los cuadros de extracción correspondientes a la validación de ambas escalas

Rivaroxaban or aspirin for patent foramen ovale and embolic stroke of undetermined source: a prespecified subgroup analysis from the NAVIGATE ESUS trial

Background: Patent foramen ovale (PFO) is a contributor to embolic stroke of undetermined source (ESUS). Subgroup analyses from previous studies suggest that anticoagulation could reduce recurrent stroke compared with antiplatelet therapy. We hypothesised that anticoagulant treatment with rivaroxaban, an oral factor Xa inhibitor, would reduce the risk of recurrent ischaemic stroke compared with aspirin among patients with PFO enrolled in the NAVIGATE ESUS trial. Methods: NAVIGATE ESUS was a double-blinded, randomised, phase 3 trial done at 459 centres in 31 countries that assessed the efficacy and safety of rivaroxaban versus aspirin for secondary stroke prevention in patients with ESUS. For this prespecified subgroup analysis, cohorts with and without PFO were defined on the basis of transthoracic echocardiography (TTE) and transoesophageal echocardiography (TOE). The primary efficacy outcome was time to recurrent ischaemic stroke between treatment groups. The primary safety outcome was major bleeding, according to the criteria of the International Society of Thrombosis and Haemostasis. The primary analyses were based on the intention-to-treat population. Additionally, we did a systematic review and random-effects meta-analysis of studies in which patients with cryptogenic stroke and PFO were randomly assigned to receive anticoagulant or antiplatelet therapy. Findings: Between Dec 23, 2014, and Sept 20, 2017, 7213 participants were enrolled and assigned to receive rivaroxaban (n=3609) or aspirin (n=3604). Patients were followed up for a mean of 11 months because of early trial termination. PFO was reported as present in 534 (7·4%) patients on the basis of either TTE or TOE. Patients with PFO assigned to receive aspirin had a recurrent ischaemic stroke rate of 4·8 events per 100 person-years compared with 2·6 events per 100 person-years in those treated with rivaroxaban. Among patients with known PFO, there was insufficient evidence to support a difference in risk of recurrent ischaemic stroke between rivaroxaban and aspirin (hazard ratio [HR] 0·54; 95% CI 0·22–1·36), and the risk was similar for those without known PFO (1·06; 0·84–1·33; pinteraction=0·18). The risks of major bleeding with rivaroxaban versus aspirin were similar in patients with PFO detected (HR 2·05; 95% CI 0·51–8·18) and in those without PFO detected (HR 2·82; 95% CI 1·69–4·70; pinteraction=0·68). The random-effects meta-analysis combined data from NAVIGATE ESUS with data from two previous trials (PICSS and CLOSE) and yielded a summary odds ratio of 0·48 (95% CI 0·24–0·96; p=0·04) for ischaemic stroke in favour of anticoagulation, without evidence of heterogeneity. Interpretation: Among patients with ESUS who have PFO, anticoagulation might reduce the risk of recurrent stroke by about half, although substantial imprecision remains. Dedicated trials of anticoagulation versus antiplatelet therapy or PFO closure, or both, are warranted. Funding: Bayer and Janssen

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care. We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care