Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

BASIC PSYCHOLOGICAL NEEDS AND SELF-DETERMINED MOTIVATION IN PHYSICAL

The aim of this study was to test whether motivational regulations have a mediator role between students' basic psychological needs and physical fitness level in high school physical education. Students completed the questionnaire pack tapping their level of basic psychological needs satisfaction and motivational regulations. To assess students' health-related physical fitness level EUROFIT for adults physical fitness test battery was followed and ten motor fitness parameters (body mass index, sit and reach, flamingo balance, vertical jump, hand grip, plate tapping, sit ups in 30 seconds, bent arm hang, 20 m. shuttle run, 10x5 shuttle run) were assessed during the lesson. The mediation test was carried out through series regression analysis. The results revealed that the motivational regulations partially mediated the relationship between competence and the fitness score. Similarly, motivational regulations partially mediated the relationship between relatedness and the fitness score. The results support the tenets of Self-Determination Theory and manifests that physical education teachers can increase the students' physical fitness level by creating a lesson environment that satisfies their needs for competence and relatedness

Basic psychological needs and self-determined motivation in physical education to predict health-related fitness level

The aim of this study was to test whether motivational regulations have a mediator role between students' basic psychological needs and physical fitness level in high school physical education. Students completed the questionnaire pack tapping their level of basic psychological needs satisfaction and motivational regulations. To assess students' health-related physical fitness level EUROFIT for adults physical fitness test battery was followed and ten motor fitness parameters (body mass index, sit and reach, flamingo balance, vertical jump, hand grip, plate tapping, sit ups in 30 seconds, bent arm hang, 20 m. shuttle run, 10 × 5 shuttle run) were assessed during the lesson. The mediation test was carried out through series regression analysis. The results revealed that the motivational regulations partially mediated the relationship between competence and the fitness score. Similarly, motivational regulations partially mediated the relationship between relatedness and the fitness score. The results support the tenets of Self-Determination Theory and manifests that physical education teachers can increase the students' physical fitness level by creating a lesson environment that satisfies their needs for competence and relatedness. © 2018 Didactic Asociation Andalucia. All rights reserved

BASIC PSYCHOLOGICAL NEEDS AND SELF-DETERMINED MOTIVATION IN PHYSICAL

The aim of this study was to test whether motivational regulations have a mediator role between students' basic psychological needs and physical fitness level in high school physical education. Students completed the questionnaire pack tapping their level of basic psychological needs satisfaction and motivational regulations. To assess students' health-related physical fitness level EUROFIT for adults physical fitness test battery was followed and ten motor fitness parameters (body mass index, sit and reach, flamingo balance, vertical jump, hand grip, plate tapping, sit ups in 30 seconds, bent arm hang, 20 m. shuttle run, 10x5 shuttle run) were assessed during the lesson. The mediation test was carried out through series regression analysis. The results revealed that the motivational regulations partially mediated the relationship between competence and the fitness score. Similarly, motivational regulations partially mediated the relationship between relatedness and the fitness score. The results support the tenets of Self-Determination Theory and manifests that physical education teachers can increase the students' physical fitness level by creating a lesson environment that satisfies their needs for competence and relatedness

Do The Expressions of Epithelial-Mesenchymal Transition Proteins, Periostin, Integrin-Alpha 4 and Fibronectin Correlate With Clinico-Pathological Features and Prognosis of Metastatic Castration-Resistant Prostate Cancer?

Development of metastatic castration-resistant prostate cancer is a result of the lack of an apoptotic response by the tumor cells and loss of the ability to stick to adjacent cells through epithelial-mesenchymal transition. Although there are several strongly recommended biomarkers for determining prognosis of metastatic castration-resistant prostate cancer, only few of them may help decide the selection of the optimal treatment option. The mode of treatment sequencing in metastatic castration-resistant prostate cancer will be based on the individual characteristics of the patient. In this study, we aimed to explain the correlation between the expression characteristics of periostin, integrin-alpha 4, and fibronectin in metastatic castration-resistant prostate cancer patients and their clinico-pathological data comprising Gleason score, PSA levels, and metastatic sites in the process of epithelial-mesenchymal transition. We evaluated by using Western blotting, periostin, integrin-alpha 4, and fibronectin expressions in peripheral blood samples of metastatic castration-resistant prostate cancer patients (n=40), benign prostatic hyperplasia patients (n=20), and the healthy control group (n=20). Associations between changes in the protein expressions and clinico-pathological parameters were also analyzed in the metastatic castration-resistant prostate cancer group. When comparing BPH and healthy groups with the metastatic castration-resistant prostate cancer group, a reduced expression of integrin-alpha 4 was found in metastatic patients, albeit being statistically insignificant (P>0.05). Protein expressions of periostin and fibronectin in the metastatic castration-resistant prostate cancer group were higher than those in the BPH and heathy groups (P<0.001). Increased periostin expression in metastatic patients was significantly associated with bone metastasis (P<0.05). Elevated periostin and fibronectin levels in metastatic castration-resistant prostate cancer patients may be appropriate targets of therapeutic intervention in the future.Wo

Assesment life quality of familial mediterranean fever patients by short form-36 and its relationship with disease parameters

BACKGROUND: Familial Mediterranean fever is an auto-inflammatory disorder. Long term complications of the disease include decreased quality of life. The measurement of quality of life in the patients with chronic disease has become an important research topic during the last years. BACKGROUND: Familial Mediterranean fever is an auto-inflammatory disorder. Long term complications of the disease include decreased quality of life. The measurement of quality of life in the patients with chronic disease has become an important research topic during the last years. AIM: We aimed to evaluate life quality of the FMF patients by SF-36, and examine its relationship with the disease parameters. PATIENTS AND METHODS: One hundred voluntary patients (69 female, 31 male) admitted to the rheumatology clinic were included in the study. The control group consisted of 100 healthy individuals. All subjects in the study were asked to complete SF-36 questionnaire. Age of onset of FMF, age at diagnosis, age at the beginning of colchicine therapy, number of attacks per month, family history of FMF and dialysis were inquired of patients with FMF. Disease severity was determined using the FMF severity score. RESULTS: The mean age of the patient group was 31&plusmn;12 and that of the control group was 29&plusmn;9. Sixty-nine patients (69%) were female, and 31 patients were male (31%) in both groups. The mean scores of the physical function, physical role function, emotional role function, mental health, and general health parameters of the patients were statistically significantly lower than those of healthy volunteers (p &lt; 0.05). The difference in social function and vitality between two groups was found to be insignificant (p &gt; 0.05). CONCLUSIONS: We have shown that FMF had a negative impact on SF-36. FMF reduces quality of life both in physical and mental dimensions. &nbsp;</p