Hasi és agyi ultrahang-szűrővizsgálatok Neonatális Intenzív Centrumunkban [Abdominal and cranial ultrasound screenings in our Neonatal Intensive Care Unit]

Bevezetés: A Szegedi Tudományegyetem Neonatális Intenzív Centrumában a korábbi években minden újszülött ellátásának része volt a szűrő jellegű agyi és hasi ultrahangvizsgálat. Célkitűzés: A szűrő ultrahangvizsgálat során diagnosztizált eltérések összesítése, a szűrésként használt ultrahangvizsgálat szükségességének meghatározása. Módszer: A Neonatális Intenzív Centrumunkban 2014. január 1. és 2015. december 31. között elvégzett agyi és hasi ultrahangvizsgálatok eredményeit elemeztük retrospektív módon. A vizsgálatokat radiológus szakorvos végezte. Eltérés esetén a hazaadásig történt kontrollvizsgálatokat, illetve a 2 éves utánkövetést tovább vizsgáltuk. Eredmények: 2 év alatt összesen 579 betegből (átlagos gesztációs kor 34,2 hét [23–41, SD ± 4,04]) 562 (97,1%) esetben történt hasi, 560 (96,7%) újszülöttnél agyi ultrahangvizsgálat, átlagosan a 3,6. életnapon (0–18, SD ± 2,24). A hasi ultrahangvizsgálatok 87%-a (n = 488) szűrő jellegű vizsgálat volt, 140 (29%) esetben találtunk eltérést: pyelectasia (n = 67 [47,9%]), szabad hasi folyadék (n = 17 [12,1%]), köldökvéna-katéter szövődménye (n = 15 [10,7%]), echódús vesék (n = 13 [9,3%]), vesefejlődési rendellenesség (n = 9 [6,4%]), epe, máj, mellékvesék eltérése (n = 14 [10%]). A szűrővizsgálattal felfedezett vesefejlődési rendellenességek közül 4 esetben (0,8%) műtéti beavatkozás volt szükséges. A vesét érintő elváltozások fiú (p = 0,18) és bal oldali (p = 0,54) dominanciát mutattak. Az agyi ultrahangvizsgálatok 65%-a (n = 362) volt szűrővizsgálat, 51 (14%) újszülöttnél találtunk eltérést: plexuscysta (n = 21 [41%]), plexusvérzés (n = 9 [17,6%]), enyhe kamraaszimmetria (n = 8 [15,7%]), subependymalis vérzés (n = 5 [9,8%]), a periventricularis terület eltérése (n = 4 [7,8%]), colpocephalia, thalamusgóc, hydrocephalus externus, echódús meninx (n = 1-1 [1,9-1,9%]). Következtetés: A szűrő hasi ultrahangvizsgálat által észlelt eltérések közül a beavatkozást igénylő vesefejlődési rendellenességek, illetve a köldökvéna-katéter szövődményei bírnak klinikai jelentőséggel. Bár a legmagasabb számban enyhe pyelectasia került felismerésre, 4 vesefejlődési rendellenesség műtéti beavatkozást igényelt. További vizsgálatok szükségesek a rizikócsoportok meghatározására, amivel az egy pozitív találatra jutó szűrendő esetek száma csökkenthető volna. Az agyi ultrahang-szűrővizsgálat nem talált intrauterin, még nem diagnosztizált, beavatkozást igénylő eltérést. A szűrő agyi ultrahangvizsgálat által észlelt eltérések nem teszik indokolttá az univerzális agyi ultrahang-szűrővizsgálat végzését. Orv Hetil. 2023; 164(31): 1222–1230

Secondary analysis of routinely collected data from a specialist cancer rehabilitation service in South Wales, UK

Background: Evidence suggests worldwide that cancer rehabilitation has a positive effect on cancer-related health problems, such as fatigue and reduced lung capacity. In South Wales (UK), a specialist cancer rehabilitation service has been collecting outcome data as part of routine assessment since 2014 to monitor changes in people’s fatigue and functional status. People are assessed before and after a 12-week therapeutic episode which could comprise hydrotherapy, Tai Chi, exercise classes and individual therapy based on people’s needs and preferences. However, the data collected have not yet been comprehensively analysed. The aim of this study was to explore the routinely collected data and investigate change in functional outcomes from 2014 until 2017. Methods: Descriptive statistics were derived from demographic data (cancer site, gender) and outcome measures to explore the data. Pre and post-assessment Functional Assessment of Chronic Illness Therapy – Fatigue (FACIT-F), Timed up and go (TUAG), pain, shortness of breath and quality of life visual analogue scale (VAS) were compared with Paired-samples t-test and Wilcoxon signed-rank test to look for significant change. Missing data was listwise deleted. The study was approved by London South – East Research Ethics Committee (17/LO/2123). Results: Anonymised records (n=1645) were split into four years (2014, 2015, 2016 and 2017) and up to 12 attendance episodes (Ep1-12). There was significant (two tailed p<0.05) change between pre and post-assessment in most of the outcome measures during episodes 1-3 in each year. Fatigue (e.g.: FACIT-FEp1/2014 n=55, MedianPre=24.00 and MedianPost=31.00 , T=1159, p=0.000, r=0.48), pain (e.g.: PainEp1/2014 n=32, MedianPre=6.25 and MedianPost=3.50 , T=30, p=0.000, r=-0.68) and TUAG (e.g.: TUAGEp1/2014 n=78, MedianPre=7.61 and MedianPost=6.92 , T=665.5, p=0.000, r=-0.49) reduced. This could indicate that cancer rehabilitation provided by a specialist service in South Wales has positive influence on people’s health. However, shortness of breath was not significant in most episodes and years. Conclusion(s): Results imply that people could benefit from cancer rehabilitation provided by a specialist service in South Wales. However, change was mostly noticeable during early episodes (Ep1-3). This could indicate that people do not benefit from further interventions. Tailoring therapeutic episodes to individual needs may facilitate more effective use of resources

Massive Withdrawal Symptoms and Affective Vulnerability Are Associated with Variants of the CHRNA4 Gene in a Subgroup of Smokers

Peer reviewe

Realist evaluation of cancer rehabilitation services in South Wales (REEACaRS): a mixed methods study protocol

Introduction Long-term and late effects of cancer treatments can cause functional limitations and reduce quality of life. Cancer rehabilitation services, which can comprise physical exercise, psychological support and educational interventions depending on the individual’s needs, have been found to have a positive effect on health-related quality of life worldwide. However, accessibility or the lack of awareness on available help can act as barriers and influence the uptake of services, resulting in people having unmet rehabilitation needs. In Wales, UK, 41% of people, who have had health and social care needs resulting from cancer and its treatments, reported that they did not receive care when needed. The reason for this lack of support has not yet been fully investigated. The aim of this study is to investigate the conditions in which cancer rehabilitation services work and their underpinning mechanisms in South Wales, UK, specifically addressing barriers, facilitators and costs. Methods and analysis Realist evaluation, which explains for whom a service works in what circumstances and how through context-mechanism-outcome pattern conjunctions, will be used in three phases to investigate the conditions in which cancer rehabilitation services work and their underpinning mechanisms. Phase 1 will be secondary analysis of a cancer rehabilitation database from a local Health Board to give context to who are accessing rehabilitation. Phase 2 will be thematic analysis of face-to-face, semistructured rehabilitation participant (n=20) and healthcare professional (n=20) interviews to explore the mechanisms of how cancer rehabilitation works. Phase 3 will be two case studies and cost-consequences analysis of cancer rehabilitation services. Ethics and dissemination This study received favourable ethical opinion from London South-East Research Ethics Committee (17/LO/2123) in December 2017. This project is part of the author’s PhD thesis and it is expected that the findings will be disseminated in academic journals and at local and international conferences

Less is more: Antibiotics at the beginning of life.

Antibiotic exposure at the beginning of life can lead to increased antimicrobial resistance and perturbations of the developing microbiome. Early-life microbiome disruption increases the risks of developing chronic diseases later in life. Fear of missing evolving neonatal sepsis is the key driver for antibiotic overtreatment early in life. Bias (a systemic deviation towards overtreatment) and noise (a random scatter) affect the decision-making process. In this perspective, we advocate for a factual approach quantifying the burden of treatment in relation to the burden of disease balancing antimicrobial stewardship and effective sepsis management