Cancer-Related Fatigue – Clinical Evaluation Scales and Interventions: A Systematic Review

Background: Cancer-related fatigue (CRF) is one of the most frequent and prevalent symptoms expressed by cancer patients and cancer survivors. It is a multifactorial phenomenon that causes a direct detrimental impact on quality of life. Objectives: This systematic review aims to identify different clinical evaluation scales and interventions available for fatigue associated with cancer. Materials and Methods: A methodology of the systematic literature review was carried out. Two separate databases PubMed and Google Scholar searches were performed using different MeSH terms. Results: A total of 2611 research articles were screened and identified 10 unidimensional scales (four with one item scales and six with numerous item scales) and 13 multidimensional scales which are available for the screening and clinical evaluation of fatigue. Reviews have also revealed non-pharmacological interventions such as exercise, complementary therapies, nutritional and psychoeducational interventions, sleep therapy, energy therapy, bright white light, restorative therapies upcoming anthroposophical medicine, and various pharmacological agents effective in managing CRF. Conclusion: Clinical evaluation of fatigue and its management is crucial for improving the quality of life. Yet, more rigorous research studies with higher statistical power need to be conducted on these interventions to generate adequate evidences for managing the CRF.

Risk of Mortality in Association with Pregnancy in Women following Motor Vehicle Crashes: A Systematic Review and Meta-Analysis

The aim of the study was to provide a systematic review and meta-analysis of studies examining the association between mortality risk and motor vehicle crashes (MVCs) in pregnant women compared with nonpregnant women. We used relevant MeSH terms to identify epidemiological studies of mortality risk in relation to MVCs from PubMed, Embase, and MEDLINE databases. The Newcastle–Ottawa Scale (NOS) was used for quality assessment. For comparison of mortality from MVCs between pregnant and nonpregnant women, the pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated using a random effects model. The eight studies selected met all inclusion criteria. These studies included 14,120 injured victims who were pregnant at the time of the incident and 207,935 victims who were not pregnant. Compared with nonpregnant women, pregnant women had a moderate but insignificant decrease in mortality risk (pooled OR = 0.68, 95% CI = 0.38–1.22, I2 = 88.71%). Subgroup analysis revealed that the pooled OR significantly increased at 1.64 (95% CI = 1.16–2.33, I2 < 0.01%) for two studies with a similar difference in the mean injury severity score (ISS) between pregnant and nonpregnant women. Future studies should further explore the risk factors associated with MVCs in pregnant women to reduce maternal mortality.

Performance of Ultrasound for Identifying Morphological Characteristics and Thickness of Cutaneous Basal Cell Carcinoma: A Systematic Review

Advances in ultrasound technology and non-surgical treatments of basal cell carcinomas (BCCs) have raised the need to study the performance of high-frequency ultrasound (HFUS) in BCCs. We aimed to assess the performance of HFUS in the evaluation of BCCs to formulate recommendations for its uses and conducted a systematic review of the literature to do so. A search of Central, Medline, Embase, CINHAL, and Web of Science was performed using key/MESH terms “ultrasonography” and “basal cell carcinoma” (January 2005–December 2020). We included primary studies reporting biopsy-confirmed BCCs for which the target intervention was ultrasound assessment at 15 MHz or higher frequency. Thirty articles were included, studying a total of 1,203 biopsy-confirmed BCCs. HFUS provides accurate depth measurements, especially for BCCs &#x3e;1 mm. The definition of lateral margins in vivo needs further studies; however, ex vivo margin assessment seems convincing. There is a diagnostic role for HFUS in identifying higher recurrence risk BCC subtypes, which can help in risk stratification. Performance of HFUS is significant in BCC management. Pre-surgical scans may support case selection for Mohs. HFUS can improve safety when used to plan brachytherapy treatments, help with case selection and adjunct treatment choice pre-photodynamic therapy. Finally, HFUS can help follow lesions after intervention, particularly non-surgical management, and support the decision to observe or re-intervene. HFUS can enhance clinical practice by providing useful information that cannot be deducted from the clinical examination. It would be recommended to evaluate the extent, mainly depth, and detect the aggressiveness of the BCCs.

Application and Progress of Raman Spectroscopy in Male Reproductive System

Raman spectroscopy is a fast-developing, unmarked, non-invasive, non-destructive technique which allows for real-time scanning and sampling of biological samples in situ, reflecting the subtle biochemical composition alterations of tissues and cells through the variations of spectra. It has great potential to identify pathological tissue and provide intraoperative assistance in clinic. Raman spectroscopy has made many exciting achievements in the study of male reproductive system. In this review, we summarized literatures about the application and progress of Raman spectroscopy in male reproductive system from PubMed and Ovid databases, using MeSH terms associated to Raman spectroscopy, prostate, testis, seminal plasma and sperm. The existing challenges and development opportunities were also discussed and prospected.

Assistência fisioterapêutica na unidade de terapia intensiva à paciente com COVID-19: uma revisão integrativa

A infecção COVID-19 causada pelo coronavírus (SARS-CoV-2) se alastrou tornando-se uma pandemia mundial levando a uma alta taxa de morbimortalidade. Os Fisioterapeutas, como profissionais que atuam na linha de frente da pandemia, devem estar sempre atentos às atualizações e ter habilidades para tomar decisões, realizar a detecção de novos casos e definir o tratamento adequado nas UTI. Objetivo: Analisar a assistência fisioterapêutica na Unidade de Terapia Intensiva à pacientes com COVID-19. Métodos: Trata-se de uma pesquisa bibliográfica do tipo revisão integrativa da literatura, na qual foi utilizado as bases de dados Bireme e PubMed, e os descritores em saúde e mesh terms para elaboração da estratégia de busca. Resultados: Foram incluídos nove estudos nesta revisão, estudos versaram sobre a assistência fisioterapêutica na UTI a pacientes com COVID-19. Destaca-se a experiência de fisioterapeutas e discutem os desafios e estratégia para o manejo clínico desses pacientes em UTIs de diferentes especialidades, como UTI cardiológica, neurológica, pediátrica, adulto etc. Conclusão: A assistência prestada deve focar em prevenir futuros agravos e fortalecer os pacientes de modo a melhorar a capacidade de troca de gases e oxigenação. Neste aspecto, o fisioterapeuta trabalha junto ao paciente buscando realizar atividades de prevenção e tratamento, além de oferecer apoio emocional, pois estes clientes, na maior parte dos casos, se encontram fragilizados física e psicologicamente.

Atuação do enfermeiro em situações de desastres naturais: uma revisão integrativa

Os desastres podem acontecer por diversos fenômenos naturais, as vezes pela junção de dois ou mais, sendo classificados em tecnológicos ou naturais. Estes eventos adversos geralmente atingem pessoas que já se encontram em situação de vulnerabilidade, podendo estar relacionada diretamente a transtornos psicológicos, podendo ainda, afetar os profissionais. O trabalho teve como objetivo geral analisar com base na literatura científica a atuação do enfermeiro em situações de desastres naturais. Trata-se de uma pesquisa bibliográfica do tipo Revisão Integrativa (RI) da literatura, que utilizou os Descritores em Ciências da Saúde (DeCS) e dos títulos da Cumulative Index to Nursing and Allied Health Literature (CINAHL) e Mesh terms. Ao todo foram selecionados onze estudos, a maior parte apresentou abordagem qualitativa dos dados, correspondendo a sete (63,3%) trabalhos, em que a base de dados da National Library of Medicine apresentou o maior número de estudos (45,4%). A maior parte das publicações concentraram-se no ano de 2019 (36,3%) e 2020 (27,2%). Quanto ao idioma dez (90%) das publicações estavam na língua inglesa; em que o Brasil foi o país com o maior número de publicações (27,2%). A assistência prestada aos pacientes vítimas de desastres naturais, deve ser focada em aspectos físicos e psicológicos. Nesse caso, a enfermagem deve entrar em ação lidando diretamente com o sujeito e prestando esclarecimentos acerca do procedimento realizado por ele, além de realizar escuta ativa, quando o paciente tem condições e deseja verbalizar, oferecer conforto e utilizar o toque como fonte de segurança aos clientes.

Acute Herpetic Nasopharyngitis in an Adult Patient: A Case Report and Literature Review

Objective: To report a case of herpes virus-associated nasopharyngitis in an adult patient. Methods: The patient’s medical record was reviewed for demographic and clinical data. For literature review, all case reports or other publications published in English literature were identified using Pubmed with the MeSH terms “herpes,” “nasopharyngitis,” and “upper respiratory infection.” Results: A 40-year-old male presented for nasal congestion and a suspected nasal mass. Computed tomography of the sinuses revealed edematous changes in the nasopharynx which exerted a downward mass effect at the right aspect of the soft palate. Flexible fiberoptic laryngoscopy (FFL) revealed a lesion arising from the posterior aspect of the soft palate with extension into the posterior nasal cavity as well as copious mucopurulent secretions consistent with a superimposed acute sinusitis. Rigid nasal endoscopy demonstrated a friable and ulcerated lesion arising from the aforementioned anatomical location. Biopsy of this lesion and subsequent immunohistochemical analysis revealed a diagnosis of herpetic nasopharyngitis. Conclusions: Herpetic infection should be in the differential diagnosis of patients presenting with atypical symptoms of nasopharyngitis. Early accurate diagnosis and appropriate specific management can limit the duration of disease course and prevent further complications.

Efficacy and safety of dupilumab in adult moderate-to-severe atopic dermatitis: An update narrative literature review

Background: Adult atopic dermatitis (AD) is defined as a continuum of childhood AD or the development of the disease in adulthood, accounting for 7.7–59.7% of adult AD cases varying in severity and manifestations. The symptomatology of moderate-to-severe adult AD may significantly impact the overall health and quality of life of the patient. The “classic” topical treatments used in mild-to-moderate cases, such as emollients and topical corticosteroids, are usually not adequate to control the symptoms of most of the patients with moderate-to-severe disease. For many years these patients were managed with systemic corticosteroids and immunomodulators, leading to substantial side effects with questionable efficacy. The introduction of dupilumab, the first biologic agent approved by the Food and Drug Administration for use in adult moderate-to-severe AD, has commenced a new era in the management of AD. This narrative literature review addresses the question of how patients with moderate-to-severe AD may achieve a recession or improvement in the overall progression of the disease with the use of dupilumab in both an efficient and safe way. Material and Methods: A search in the PubMed, Embase, and Cochrane databases was conducted using the following combination of MeSH terms: “dupilumab” AND “atopic” (“dermatitis” OR “eczema”). The searches were limited to RCTs written in the English language published before January 25, 2021. The literature used included phase II and III RCTs examining the efficacy and/or safety of dupilumab compared to placebo or other treatments in adults with moderate-to-severe AD. Moderate-to-severe AD was defined by an IGA score of 3 (moderate) or 4 (severe) and EASI 16 or higher at screening and baseline. Additionally, we searched the website clinicaltrials.gov for any unpublished or ongoing RCTs. The search was done independently by two authors in all databases and followed by the exclusion of duplicates. Results: Upon reviewing all randomized controlled trials, dupilumab was found to be an effective and safe option for managing adult moderate-to-severe AD with long-term therapeutic effects. Conclusion: The best results for maintaining long-term disease recession were achieved with the combination of dupilumab and topical corticosteroids.

Medical Burnout

The WHO defines burnout as an inadequate response to chronic workplace stress, with emotional exhaustion, depersonalization, and reduced professional efficacy. Its growing incidence among physicians may adversely affect their personal and professional lives. Mindfulness aims to reach a state of consciousness in which one's attention is purposefully focused on the present. This chapter uses a narrative review of articles published between 2015 and 2019, with the MeSH terms “Burnout,” “Professional,” “Mindfulness,” and “Health Personnel.” Sixty-six articles were obtained, of which one meta-analysis, two systematic reviews, and two randomized clinical trials (RCT) met the inclusion criteria. All studies showed some degree of burnout improvement, more statistically significant as regards emotional exhaustion. One RCT also showed a reduction in heart rate. Available evidence suggests that mindfulness may improve physicians' well-being, mental health, and resilience, asserting itself as a possible coping strategy for burnout, namely regarding emotional exhaustion.

Flipped Classroom Experiences in Clinical Dentistry – A Strategic Mini-Review

Background: Pedagogy in dental education has evolved over the decades. Today, many alternative modes of content delivery are being used as an adjunct to the traditional classroom. A flipped classroom is one among those that are being explored for teaching clinical dentistry. Objective: This mini-review is aimed at evaluating the available evidence in the efficacy of flipped classrooms and its related aspects in the learning curve of clinical dentistry. Methods: A thorough literature search on electronic databases for all the studies focusing on the following evidence-based question: “Is Flipped classroom in clinical dentistry a useful mode of pedagogy delivery? was performed. A combination of MeSH terms using Boolean operators “AND,” “OR:” FLIPPED [All Fields] AND (“dental health services” [MeSH Terms] AND “health” [All Fields] AND “services” [All Fields]) OR “dental” [All Fields]) AND (“learning” [MeSH Terms] OR “learning” [All Fields]). Specific terms such as “Perio” OR “Prostho” OR “Restorative” OR “Ortho” OR “Oral medicine” OR “Maxillofacial surgery” OR “Pediatric” OR “endo” was also used. Data from these articles addressing the aim of this study was extracted. Results: A total of 16 articles were considered for the review. The majority of the studies considered flipped classroom as a successful model of pedagogy. The most common mode of outside classroom activity was pre-recorded videos. In-classroom activities, a combination of seminars, interactive discussions, and quiz were explored. Time constraints, lack of faculty development programs are considered to be negative factors for the success of the flipped classroom. Conclusion: Within the limitation of the study, flipped classroom can be adapted as a method of pedagogy in clinical dentistry.