1
|
Zhang P, Ling Y. A review regarding the article 'Supervised exercise training in heart failure with preserved ejection fraction: A systematic review and meta-analysis of randomized controlled trials'. Curr Probl Cardiol 2024; 49:102518. [PMID: 38492623 DOI: 10.1016/j.cpcardiol.2024.102518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 03/13/2024] [Indexed: 03/18/2024]
Abstract
Heart failure is a clinical syndrome with different etiologies and phenotypes. For all forms, supervised exercise training and individual physical activity are class IA recommendations in current guidelines. Over the past two decades it has become recognized that physical deconditioning may play a key role in the progression of symptoms and poor outcomes. A number of prior studies have assessed the ability of exercise training to improve functional capacity in patients with HF. Most of these previous studies showed positive effects of exercise training on exercise capacity, quality of life, and biomarkers and observed relatively few complications during training. These studies also suggested that exercise training might improve survival and decrease HF hospitalizations. Despite the failure of pharmacological interventions to reduce mortality and hospitalization in HFpEF, exercise training has shown efficacy in improving maximal exercise capacity, assessed through peak oxygen consumption (peak V˙o2), in clinically stable patients. Nonetheless, there remains a safety concern regarding exercise training in HF. Although the complication rate for patients participating in cardiac rehabilitation has been reported to be extremely low, the complication rate for HF patients in clinical trials of exercise training has been substantially higher. One potential reason is the 100-fold increased risk for myocardial infarction and 50-fold increased risk of sudden death that exercisers, who are habitually sedentary, experience when initiating exercise training. Additionally, comprehensive insights into the potential effects of exercise training, not only on critical clinical outcomes such as hospitalization, mortality, and cardiovascular events but also on cost-effectiveness, require longer-term trials.
Collapse
Affiliation(s)
- Ping Zhang
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
| | - Yunfei Ling
- Department of Cardiovascular Surgery, West China Hospital of Sichuan University, No. 37 GuoXue Xiang, Chengdu, Sichuan 610041, China.
| |
Collapse
|
2
|
Okwenna CM. Love and romantic relationship in the domain of medicine. Med Health Care Philos 2023; 26:111-118. [PMID: 36355230 DOI: 10.1007/s11019-022-10127-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/26/2022] [Indexed: 06/16/2023]
Abstract
In this paper, I explore the nature of medical interventions like neuromodulation on the complex human experience of love. Love is built upon two fundamental natures, viz: the biological and the psychosocial. As a result of this distinction, scientists, and bioethicists have been exploring the possible ways this complex human experience can be biologically tampered with to produce some supposed higher-order ends like well-being and human flourishing. At the forefront in this quest are Earp, Sandberg and Savulescu whose research works over ten years has focused on the good that could stem from the medicalization of love. I acknowledge the various criticisms that have been made against this stance. However, most of these criticisms have been directed towards the mere side effects and sociocultural disservices that could result from the process of using drugs to influence human romantic relationships and in the end, critiques endorse the medicalization of love on the basis that its benefits outweigh the disadvantages. Consequently, I advance two strands of arguments against "medically-assisted love," the ontological and the socio-ethical arguments. The former presupposes that beyond the possible side effects of medicalizing love there is something inherently mistaken about this effort and there is something intrinsically different about love that distinguishes it from its medically-engineered alternative. In the latter argument, I claim that drug interventions in romantic love contravene the very nature of medicine. Overall, I believe that critiques were still able to endorse medicalizing love despite their objections because they were only looking at one direction, the physical/cultural complications.
Collapse
Affiliation(s)
- Chrysogonus M Okwenna
- Department of Philosophy, Simon Fraser University, West Mall Centre, 8888 University Dr., Burnaby, BC, V5A 1S6, Canada.
| |
Collapse
|
3
|
van der Padt-Pruijsten A, Leys MBL, Hoop EOD, van der Heide A, van der Rijt CCD. The effect of a palliative care pathway on medical interventions at the end of life: a pre-post-implementation study. Support Care Cancer 2022; 30:9299-9306. [PMID: 36071303 PMCID: PMC9633459 DOI: 10.1007/s00520-022-07352-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 08/25/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE Adequate integration of palliative care in oncological care can improve the quality of life in patients with advanced cancer. Whether such integration affects the use of diagnostic procedures and medical interventions has not been studied extensively. We investigated the effect of the implementation of a standardized palliative care pathway in a hospital on the use of diagnostic procedures, anticancer treatment, and other medical interventions in patients with incurable cancer at the end of their life. METHODS In a pre- and post-intervention study, data were collected concerning adult patients with cancer who died between February 2014 and February 2015 (pre-PCP period) or between November 2015 and November 2016 (post-PCP period). We collected information on diagnostic procedures, anticancer treatments, and other medical interventions during the last 3 months of life. RESULTS We included 424 patients in the pre-PCP period and 426 in the post-PCP period. No differences in percentage of laboratory tests (85% vs 85%, p = 0.795) and radiological procedures (85% vs 82%, p = 0.246) were found between both groups. The percentage of patients who received anticancer treatment or other medical interventions was lower in the post-PCP period (40% vs 22%, p < 0.001; and 42% vs 29%, p < 0.001, respectively). CONCLUSIONS Implementation of a PCP resulted in fewer medical interventions, including anticancer treatments, in the last 3 months of life. Implementation of the PCP may have created awareness among physicians of patients' impending death, thereby supporting caregivers and patients to make appropriate decisions about medical treatment at the end of life. TRIAL REGISTRATION NUMBER Netherlands Trial Register; clinical trial number: NL 4400 (NTR4597); date registrated: 2014-04-27.
Collapse
Affiliation(s)
- Annemieke van der Padt-Pruijsten
- Department of Internal Medicine, Maasstad Hospital, Rotterdam, the Netherlands ,Department Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Maria B. L. Leys
- Department of Internal Medicine, Maasstad Hospital, Rotterdam, the Netherlands
| | - Esther Oomen-de Hoop
- Department Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | | |
Collapse
|
4
|
Abstract
As it has historically been the case with many pandemics, the Covid-19 experience will induce many philosophers to reconsider the value of medical practice. This should be a good opportunity to critically scrutinize the way medical research and medical interventions are carried out. For much of its history, medicine has been very inefficient. But, even in its contemporary forms, a review of common protocols in medical research and medical interventions reveal many shortcomings, especially related to methodological flaws, and more importantly, conflicts of interests due to profit incentives. In the face of these problems, we propose a program of "gentle medicine". This term, originally formulated by philosopher Jacob Stegenga, describes a form of medicine in which physicians intervene less than they currently do. As part of this general program, we advance a series of reform recommendations that could be enacted both by medical staff in their everyday practice, but also by public health officials and policymakers.
Collapse
|
5
|
Guo J, Zhuang P, Liu K, Wan Y, Wang X. Effects of an individualized analgesia protocol on the need for medical interventions after adenotonsillectomy in children: a randomized controlled trial. BMC Anesthesiol 2021; 21:41. [PMID: 33557762 PMCID: PMC7869251 DOI: 10.1186/s12871-021-01263-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 01/14/2021] [Indexed: 11/22/2022] Open
Abstract
Background It has been proposed that the dose of rescue opioids should be individually titrated to the severity of obstructive sleep apnea after adenotonsillectomy. However, a sleep study is not always available before adenotonsillectomy. This randomized, controlled and blinded trial evaluated a strategy of pain control individualized to the results of a fentanyl test, rather than the results of polysomnography, in children after adenotonsillectomy. Methods A total of 280 children (3–10 years old) undergoing elective adenotonsillectomy were randomized into an individualized protocol (IP) group or a conservative protocol (CP) group. All patients received a fentanyl test before extubation. Pain was assessed every 10 min in the recovery room, and rescue morphine was given when the Children’s Hospital of Eastern Ontario Pain Scale (CHEOPS) score was > 6. In the IP group, the dose of rescue morphine was individualized to the results of the fentanyl test (10 μg/kg in the case of a positive result and 50 μg/kg in the case of a negative result). In the CP group, the dose was fixed (25 μg/kg). The primary outcome was the percentage of patients requiring at least one medical intervention. The secondary outcome was the median duration of CHEOPS scores > 6. Results Fewer patients in the IP group than in the CP group required medical interventions [11.9% (16/134) vs 22.3% (29/130), P = 0.025]. The median duration of CHEOPS scores > 6 was shorter in the IP group than in the CP group [20 (95% CI: 17 to 23) min vs 30 (95% CI: 28 to 32) min, P < 0.001]. Conclusions Compared with a conservative dosing approach, this individualized protocol may improve analgesia without a significant increase in respiratory adverse events. Trial registration ClinicalTrials.gov NCT02990910, registered on 13/12/2016.
Collapse
Affiliation(s)
- Jian Guo
- Department of Anesthesia, Children's Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102, China
| | - Peijun Zhuang
- Department of Anesthesia, Children's Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102, China
| | - Kun Liu
- Department of Anesthesia, Children's Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102, China
| | - Yuanyuan Wan
- Department of Anesthesia, Children's Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102, China
| | - Xuan Wang
- Department of Anesthesia, Children's Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102, China.
| |
Collapse
|
6
|
Kiss L, Quinlan-Davidson M, Pasquero L, Tejero PO, Hogg C, Theis J, Park A, Zimmerman C, Hossain M. Male and LGBT survivors of sexual violence in conflict situations: a realist review of health interventions in low-and middle-income countries. Confl Health 2020; 14:11. [PMID: 32127913 PMCID: PMC7045597 DOI: 10.1186/s13031-020-0254-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 01/28/2020] [Indexed: 12/18/2022] Open
Abstract
Conflict-related sexual violence (CRSV) against women and girls has been the subject of increasing research and scholarship. Less is known about the health of men, boys and lesbian, gay, bisexual, transgender (LGBT) and other gender non-binary persons who survive CRSV. This paper is the first systematic realist review on medical, mental health and psychosocial support (MHPSS) interventions that focusses on male and LGBT survivors of CRSV. The review explores the gender differences in context, mechanisms and outcomes that underpin interventions addressing the health and psychosocial wellbeing of male and LGBT survivors. The aim is to contribute to the design and delivery of gender-sensitive and, when needed, gender-specific approaches for interventions that respond to specific needs of different groups of all survivors. We conducted a systematic search of academic and grey literature to identify medical and MHPSS interventions that included men, boys and LGBT survivors. We identified interventions specifically targeting women and girls that we used as comparators. We then purposively sampled studies from the fields of gender and health, and sexual abuse against men and LGBT people for theory building and testing. We identified 26 evaluations of interventions for survivors of CRSV. Nine studies included male survivors, twelve studies focussed exclusively on female survivors and one study targeted children and adolescents. No intervention evaluation focussed on LGBT survivors of CRSV. The interventions that included male survivors did not describe specific components for this population. Results of intervention evaluations that included male survivors were not disaggregated by gender, and some studies did not report the gender composition. Although some mental health and psychosocial consequences of sexual violence against men and boys may be similar among male and female survivors, the way each process trauma, display symptoms, seek help, adhere to treatment and improve their mental health differ by gender. Initiatives targeting male and LGBT survivors of CRSV need to be designed to actively address specific gender differences in access, adherence and response to MHPSS interventions. Models of care that are gender-sensitive and integrated to local resources are promising avenues to promote the health of male and LGBT survivors of CRSV.
Collapse
Affiliation(s)
- Ligia Kiss
- 1Institute for Global Health, University College London, London, UK
| | | | | | - Patricia Ollé Tejero
- All Survivors Project, Vaduz, Liechtenstein.,3London School of Economics, London, UK
| | - Charu Hogg
- All Survivors Project, Vaduz, Liechtenstein
| | | | | | - Cathy Zimmerman
- 6Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Mazeda Hossain
- 6Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.,7Centre for Women, Peace and Security, London School of Economics, London, UK
| |
Collapse
|
7
|
Daysal NM, Trandafir M, van Ewijk R. Low-risk isn't no-risk: Perinatal treatments and the health of low-income newborns. J Health Econ 2019; 64:55-67. [PMID: 30797113 DOI: 10.1016/j.jhealeco.2019.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 01/22/2019] [Accepted: 01/29/2019] [Indexed: 06/09/2023]
Abstract
We investigate the effects of perinatal medical treatments on low-income newborns who are classified as low-risk. A policy rule in The Netherlands states that low-risk deliveries before week 37 should be supervised by physicians and later deliveries only by midwives with no physician present. This creates large discontinuities in the probability of receiving medical interventions only physicians are allowed to perform. Using a regression discontinuity design, we find that babies born slightly before the week-37 cutoff are significantly less likely to die than babies born slightly later. Our data suggest that physician supervision of birth reduces the likelihood of adverse events such as fetal distress or emergency C-section. Our results indicate that low-income women benefit from receiving a higher level of medical care even if no explicit risk factors have been recognized, pointing to challenges in identifying all high-risk pregnancies. "Back-of-the-envelope" calculations suggest this additional care is highly cost-effective.
Collapse
Affiliation(s)
- N Meltem Daysal
- Department of Business and Economics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark.
| | - Mircea Trandafir
- Department of Business and Economics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark.
| | - Reyn van Ewijk
- Faculty of Law and Economics, Johannes Gutenberg University Mainz, Jakob-Welder-Weg 4, 55128 Mainz, Germany.
| |
Collapse
|
8
|
Barajas-Nava LA, Garduño-Espinosa J. Medical interventions for cancer treatment-induced symptoms in children: an overview. Bol Med Hosp Infant Mex 2016; 73:467-483. [PMID: 29421291 DOI: 10.1016/j.bmhimx.2016.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 11/29/2016] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Childhood cancer accounts for 0.5 to 4.6% of the total number of cases in any population. According to the treatment, some side effects are present. Most adverse reactions can cause severe consequences for the survival of the patient. The more effective interventions for the management and the prevention of treatment-induced symptoms (TIS) in children with cancer are necessary to know. The objective of this review was to identify and describe available scientific evidence on the efficacy and safety of interventions used for the management and prevention of TIS in children with cancer. METHODS We conducted a systematic review of the literature on studies that evaluated or described the effectiveness of interventions used for the management and prevention of TIS in children with cancer in some of the major electronic databases. Results were qualitative synthesized and presented as evidence tables. RESULTS We identified eight systematic reviews. The revisions included experimental studies. All participants, including children and adults, were patients diagnosed with some cancer about to receive or that received treatment. CONCLUSIONS The results showed only a reduced number of clinical trials that have evaluated the interventions for the management of TIS in children with cancer. In addition, the available evidence was limited and of poor quality. It is necessary to conduct more clinical trials with good methodological quality and high statistical power.
Collapse
Affiliation(s)
- Leticia A Barajas-Nava
- Unidad de Investigación de Medicina Basada en Evidencias, Hospital Infantil de México Federico Gómez, Mexico City, Mexico.
| | - Juan Garduño-Espinosa
- Dirección de Investigación, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| |
Collapse
|
9
|
Maret D, Peters OA, Vigarios E, Epstein JB, van der Sluis L. Dental screening of medical patients for oral infections and inflammation: consideration of risk and benefit. Microbes Infect 2016; 19:84-90. [PMID: 27773850 DOI: 10.1016/j.micinf.2016.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 10/06/2016] [Accepted: 10/09/2016] [Indexed: 12/30/2022]
Abstract
The primary purpose of preoperative dental screening of medical patients is to detect acute or chronic oral conditions that may require management prior to planned medical interventions. The aim of this communication is to discuss the background of preoperative dental screening and the link between dental pathologies and systemic diseases.
Collapse
Affiliation(s)
- Delphine Maret
- Laboratoire Anthropologie Moléculaire et Imagerie de Synthèse (AMIS), UMR 5288, CNRS, Toulouse, France; Faculté de Chirurgie Dentaire, Université Paul Sabatier, Centre Hospitalier Universitaire, Toulouse, France.
| | - Ove A Peters
- Department of Endodontics, University of the Pacific, Arthur A Dugoni, School of Dentistry, San Francisco, CA, USA
| | - Emmanuelle Vigarios
- Oral Oncology Department, Comprehensive Cancer Center Institut Claudius-Regaud, Institut Universitaire du Cancer, Toulouse, France
| | - Joel B Epstein
- Department of Surgery, Cedars-Sinai Medical Center, Los Angelès, CA, USA
| | - Lucas van der Sluis
- Center of Dentistry and Oral Hygiene, University Medical Center Groningen, The Netherlands
| |
Collapse
|
10
|
Bekkema N, de Veer AJE, Wagemans AMA, Hertogh CMPM, Francke AL. Decision making about medical interventions in the end-of-life care of people with intellectual disabilities: a national survey of the considerations and beliefs of GPs, ID physicians and care staff. Patient Educ Couns 2014; 96:204-209. [PMID: 24938912 DOI: 10.1016/j.pec.2014.05.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 05/09/2014] [Accepted: 05/13/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE This paper explores the personal beliefs and specific considerations of professionals regarding decisions about potentially burdensome medical interventions in the end-of-life care for people with intellectual disabilities (ID). METHODS A survey questionnaire covering decision making about potentially burdensome medical interventions was sent to nationally representative samples of 294 ID care staff-members, 273 ID physicians and 1000 GPs. RESULTS Professionals predominantly believed that considerations about quality of life are most important. Quality of life and wellbeing were also frequently considered in both decisions to start/continue an intervention and decisions to forgo/withdraw an intervention. Seventy percent believed that people with ID should always be informed about interventions, and 61% would respect a refusal by the person. The family's wishes were explicitly considered more often than the wishes of the person with ID. CONCLUSION Although respondents agree that the quality of life is highly important, the wishes of people with ID (especially of those with severe/profound ID) were often not considered in decisions about potentially burdensome medical interventions. PRACTICE IMPLICATIONS To enhance the active involvement of people with ID in decision making we recommend that professionals integrate collaborative principles in decision making and make use of pictorial and easy reading resources.
Collapse
Affiliation(s)
- Nienke Bekkema
- NIVEL, Netherlands Institute of Health Services Research, Utrecht, The Netherlands
| | - Anke J E de Veer
- NIVEL, Netherlands Institute of Health Services Research, Utrecht, The Netherlands.
| | | | - Cees M P M Hertogh
- Department of General Practice & Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; Expertise Center for Palliative Care Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Anneke L Francke
- NIVEL, Netherlands Institute of Health Services Research, Utrecht, The Netherlands; Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; Expertise Center for Palliative Care Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| |
Collapse
|