High-risk Pancreatic Anastomosis vs. Total Pancreatectomy after Pancreatoduodenectomy: Postoperative Outcomes and Quality of Life Analysis

AbstractPostoperative pancreatic fistula (POPF) still represents the major driver of surgical morbidity after pancreaticoduodenectomy. The purpose of this narrative review was to critically analyze current evidence supporting the use of total pancreatectomy (TP) to prevent the development of POPF in patients with high-risk pancreas, and to explore the role of completion total pancreatectomy (CP) in the management of severe POPF. Considering the encouraging perioperative outcomes, TP may represent a promising tool to avoid the morbidity related to an extremely high-risk pancreatic anastomosis in selected patients. Surgical management of severe POPF is only required in few critical scenarios. In this context, even if anecdotal, CP might play a role as last resort in expert hands.

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Quality of life and risk of feminicide in women victims of intimate partner violence in Campinas

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.1115 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

M Caicedo Roa ◽

L Gabrielle Dalaqua ◽

P Filizola ◽

R Cordeiro

Keyword(s):

Quality Of Life ◽

Domestic Violence ◽

Intimate Partner Violence ◽

High Risk ◽

Women Victims ◽

Partner Violence ◽

Public Health Problem ◽

Intimate Partner ◽

Increased Risk

Abstract Introduction Violence against women is a public health problem with severe consequences. Most women in situations of domestic violence are emotionally involved and/or economically dependent of their intimate partners contributing to the perpetuation and acceptance of violence. Objectives 1) To characterize the women who join the Reference and Support Center for Women (Ceamo) in Campinas, Southeast Brazil. 2) To measure the quality of life in women victims of intimate partner violence 3) To determine the risk of feminicide. Methods The Ceamo is a public specialized service from the mayor of Campinas, it provides psychological, social and legal guidance to women in situations of gender violence. Inclusion criteria: Women attending Ceamo services, speaking Portuguese, age ≥18 years old and having experienced intimate partner violence. Measure instruments: Danger assessment Scale and WHOQOL-BREF. Results During the 11 months of the study, 78 new users were recruited. Average age 38.3 years old, mostly married/stable union, most of them with children (88%). 64% of women do not work and 36% live with the abusive partner. Prevalent types of violence suffered during by the victims in the last year were psychological n = 76, physical n = 62, moral n = 54 and sexual n = 23. The domain most affected in the assessment of quality of life was the environment (average 42% /100%) and psychological domain (42%/100%). 49% of women were classified with increased risk, 22% with severe risk and 1% with extreme risk of femicide. The questions with the most positive answers were those related to believing that the partner can kill her (77%), jealous of the partner (76%) and controlling behavior (73%), being followed/spied by the partner (67%) and threat death (65%). Conclusions The service in general receive very vulnerable women with low perception of their own quality of life, precarious material conditions and high risk of femicide. Key messages The women in domestic violence situation attended by the Ceamo service are at high risk of femicide. Service users have very low perception of their quality of life and poor social conditions.

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Impact of monthly headache days on anxiety, depression and disability in migraine patients: results from the Spanish Atlas

Scientific Reports ◽

10.1038/s41598-021-87352-2 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

P. Irimia ◽

M. Garrido-Cumbrera ◽

S. Santos-Lasaosa ◽

M. Aguirre-Vazquez ◽

J. Correa-Fernández ◽

...

Keyword(s):

Quality Of Life ◽

High Risk ◽

Psychiatric Comorbidity ◽

Severe Disability ◽

Anxiety And Depression ◽

Headache Frequency ◽

Positive Linear Correlation ◽

Disabled Patients ◽

Anxiety Depression

AbstractIdentifying highly disabled patients or at high risk of psychiatric comorbidity is crucial for migraine management. The burden of migraine increases with headache frequency, but the number of headache days (HDs) per month after which disability becomes severe or the risk of anxiety and depression is higher has not been established. Here, we estimate the number of HDs per month after which migraine is associated with higher risk of anxiety and depression, severe disability and lower quality of life. We analysed 468 migraine patients (mean age 36.8 ± 10.7; 90.2% female), of whom 38.5% had ≥ 15 HDs per month. Our results show a positive linear correlation between the number of HDs per month and the risk of anxiety (r = 0.273; p < 0.001), depression (r = 0.337; p < 0.001) and severe disability (r = 0.519; p < 0.001). The risk of anxiety is higher in patients having ≥ 3HDs per month, and those with ≥ 19HDs per month are at risk of depression. Moreover, patients suffering ≥ 10HDs per month have very severe disability. Our results suggest that migraine patients with ≥ 10HDs per month are very disabled and also that those with ≥ 3HDs per month should be screened for anxiety.

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Maintaining musculoskeletal health using a behavioural therapy approach: a population-based randomised controlled trial (the MAmMOTH Study)

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-219091 ◽

2021 ◽

pp. annrheumdis-2020-219091 ◽

Cited By ~ 1

Author(s):

Gary J Macfarlane ◽

Marcus Beasley ◽

Neil Scott ◽

Huey Chong ◽

Paul McNamee ◽

...

Keyword(s):

Quality Of Life ◽

High Risk ◽

Primary Outcome ◽

Population Based ◽

Behavioural Therapy ◽

Short Course ◽

Life Years ◽

Secondary Outcomes ◽

Randomised Controlled

ObjectiveCognitive–behavioural therapy (CBT) has been shown to be effective in the management of chronic widespread pain (CWP); we now test whether it can prevent onset among adults at high risk.MethodsA population-based randomised controlled prevention trial, with recruitment through UK general practices. A mailed screening questionnaire identified adults at high risk of CWP. Participants received either usual care (UC) or a short course of telephone CBT (tCBT). The primary outcome was CWP onset at 12 months assessed by mailed questionnaire. There were seven secondary outcomes including quality of life (EuroQol Questionnaire-five dimensions-five levels/EQ-5D-5L) used as part of a health economic assessment.Results996 participants were randomised and included in the intention-to-treat analysis of which 825 provided primary outcome data. The median age of participants was 59 years; 59% were women. At 12 months there was no difference in the onset of CWP (tCBT: 18.0% vs UC: 17.5%; OR 1.05; 95% CI 0.75 to 1.48). Participants who received tCBT were more likely to report better quality of life (EQ-5D-5L utility score mean difference 0.024 (95% CI 0.009 to 0.040)); and had 0.023 (95% CI 0.007 to 0.039) more quality-adjusted life-years at an additional cost of £42.30 (95% CI −£451.19 to £597.90), yielding an incremental cost-effectiveness ratio of £1828. Most secondary outcomes showed significant benefit for the intervention.ConclusionsA short course of tCBT did not prevent onset of CWP in adults at high risk, but improved quality of life and was cost-effective. A low-cost, short-duration intervention benefits persons at risk of CWP.Trial registration numberClinicalTrials.gov Registry (NCT02668003).

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Randomized Controlled Trial of Azacitidine in Patients With the Myelodysplastic Syndrome: A Study of the Cancer and Leukemia Group B

Journal of Clinical Oncology ◽

10.1200/jco.2002.04.117 ◽

2002 ◽

Vol 20 (10) ◽

pp. 2429-2440 ◽

Cited By ~ 1200

Author(s):

Lewis R. Silverman ◽

Erin P. Demakos ◽

Bercedis L. Peterson ◽

Alice B. Kornblith ◽

Jimmie C. Holland ◽

...

Keyword(s):

Quality Of Life ◽

Randomized Controlled Trial ◽

High Risk ◽

Myelodysplastic Syndrome ◽

Supportive Care ◽

Controlled Trial ◽

Myelogenous Leukemia ◽

Leukemic Transformation ◽

Randomized Controlled

PURPOSE: Patients with high-risk myelodysplastic syndrome (MDS) have high mortality from bone marrow failure or transformation to acute leukemia. Supportive care is standard therapy. We previously reported that azacitidine (Aza C) was active in patients with high-risk MDS.PATIENTS AND METHODS: A randomized controlled trial was undertaken in 191 patients with MDS to compare Aza C (75 mg/m2/d subcutaneously for 7 days every 28 days) with supportive care. MDS was defined by French-American-British criteria. New rigorous response criteria were applied. Both arms received transfusions and antibiotics as required. Patients in the supportive care arm whose disease worsened were permitted to cross over to Aza C.RESULTS: Responses occurred in 60% of patients on the Aza C arm (7% complete response, 16% partial response, 37% improved) compared with 5% (improved) receiving supportive care (P < .001). Median time to leukemic transformation or death was 21 months for Aza C versus 13 months for supportive care (P = .007). Transformation to acute myelogenous leukemia occurred as the first event in 15% of patients on the Aza C arm and in 38% receiving supportive care (P = .001). Eliminating the confounding effect of early cross-over to Aza C, a landmark analysis after 6 months showed median survival of an additional 18 months for Aza C and 11 months for supportive care (P = .03). Quality-of-life assessment found significant major advantages in physical function, symptoms, and psychological state for patients initially randomized to Aza C.CONCLUSION: Aza C treatment results in significantly higher response rates, improved quality of life, reduced risk of leukemic transformation, and improved survival compared with supportive care. Aza C provides a new treatment option that is superior to supportive care for patients with the MDS subtypes and specific entry criteria treated in this study.

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