First-line Care Research Articles

Un llamado a dignificar la labor del personal de salud

In times of crisis, the magnitude and impact of situations that concealingly undermine well-being and situations that constitute protective factors for health and quality of life become evident. Several authors (1) point out the limitations of health models subjected to market dynamics, which, added to inequities, widen the gap for timely and quality care. Besides, they demand the effective recognition of the right to health.On the other hand, psychosocial conditions characterized by job uncertainty, presence of different types of violence, primary and institutional support networks fragmentation, and current conditions associated with the COVID-19 pandemic have a great impact on important areas for human beings such as social, family, and couple life, factors conducive to allow different kinds of emotional and behavioral expressions, which activate coping strategies in the individual, family, and community. Moreover, considering that health professionals are called to be the first line of care in these situations, coping expressions can be consolidated as a protective or risk factor for stress (2).Although this situation is present in the general population, health care workers experience the satisfaction of caring for life on the one hand, and higher levels of stress on the other hand (3), putting their mental health at risk due to the high demands of and commitment to their work, with the insufficient implementation of current regulations, and care conditions that violate the rights by health care providers.

First-line Treatment with Empagliflozin and Metformin Combination Versus Standard Care for Patients with Type 2 Diabetes Mellitus and Cardiovascular Disease in Qatar. A Cost-Effectiveness Analysis.

Sodium-glucose cotransporter 2 (SGLT2) inhibitors have shown to reduce cardiovascular events and mortality in patients with type 2 diabetes mellitus (T2DM), but they are currently not used as first-line therapy in clinical practice. This study sought to evaluate the cost-effectiveness of first-line empagliflozin plus standard care for patients with newly diagnosed T2DM and existing cardiovascular disease (CVD). A decision-analytic Markov model with one-year cycles and a lifetime time horizon was developed from the perspective of the Qatari healthcare system to compare first-line empagliflozin combined with metformin versus metformin monotherapy for patients aged 50 to 79 years with T2DM and existing CVD. Two health states were considered: 'Alive with CVD and T2DM' and 'Dead'. Patients could experience non-fatal myocardial infarction, non-fatal stroke, hospitalization for heart failure, hospitalization for unstable angina, and cardiovascular or non-cardiovascular death. Model inputs were ascertained from published and publicly available sources in Qatar. Costs and outcomes were discounted at 3% per annum. Sensitivity analyses were conducted to evaluate parameter uncertainty. The model predicted that adding empagliflozin to current standard care led to additional 1.9 years of life saved (YoLS) and 1.5 quality-adjusted life year (QALYs) per person, and an incremental cost of QAR 56,869 (USD 15,619), which equated to an incremental cost-effectiveness ratio of QAR 30,675 (USD 8,425) per YoLS and QAR 39,245 (USD 10,779) per QALY. Sensitivity analyses showed the findings to be robust. First-line empagliflozin combined with metformin appears to be a cost-effective therapeutic option for patients with T2DM and CVD.

Study protocol for You.Mind!: boosting first-line mental health care for YOUngsters suffering from chronic conditions with mindfulness: a randomised staggered within-subjects design

IntroductionAdolescents with chronic conditions often experience high levels of stress, anxiety and depression, and reduced quality of life. Mindfulness-based interventions (MBIs) have been found to improve emotional distress in clinical...

Child psychiatry expertise in the context of parental separation

IntroductionMarriages’ dissolution phenomenon had increased in recent years in Tunisia. The impact of divorce on children depends on the interweaving of several factors and is not inevitably pathological. We have noticed in our daily practice a concomitant increase in the number of request for expert opinions concerning children.ObjectivesDetermine the clinical children’s profile of separated parents carried out within the framework of legal expertise.MethodsWe carried out a retrospective study in the outpatient child psychiatry ward at Fattouma Bourguiba general hospital in Monastir, Tunisia. Including all the expert reports of children affected by parental separations during a period of two years (2017 to 2019).Results56 children were included in our study. The average age were (6.7 years) with a majority of males (58.2%). School failure concerned (24%). In most cases, the request for expertise was made in the context of mistreatment’s suspicion (60.7%), than following the parents’ separation (16.1%). Concerning the clinical picture: a normal psychiatric examination was found in the majority of cases (55.4%), anxiety symptoms concerned (32.1%). Cases of depression, global developmental delay and autism were also found.ConclusionsAccording to our study, the vast majority of children presented a normal psychiatric examination. Moreover, a preponderant part of the symptoms seemed to result from educational errors. While parental separation poses risks for children, research shows that these negative effects are not the same for everyone. Several factors can reduce these risks and promote children’s resilience. Thus, first-line psychosocial care should be offered for families and children in seprations’ context.DisclosureNo significant relationships.

Problemas de salud mental entre dermatólogos latinoamericanos durante la pandemia de COVID-19

Introduction. A mental health survey was done in the context of the COVID-19 pandemic among Latin American dermatologists through CILAD (Colegio Ibero-Latinoamericano de Dermatología) with the participation of both specialists and residents from twenty countries. Objective. To evaluate mental health problems among Latin American dermatologists during the COVID-19 pandemic. Material and Methods. This quantitative, cross-sectional comparative study took place between June and July 2020. The evaluation, made online, had two sections: the first one explored the socio-demographic variables, and the second was a filter including self-application instruments for the assessment of Post-Traumatic Stress Disorder (PTSD), general anxiety, health anxiety and somatic symptoms, and risk of depression. Results. The sample included a total of 554 subjects, most of them women and dermatologists. In the mental health assessment, there were differences between those dermatologists who care for COVID-19 and those who do not regarding a greater use of drugs; 21.5% of dermatologists reported being COVID-19 first-line care health personnel. The risk of having PTSD is significantly higher among them than among those who do not work with COVID-19 patients (36.8% vs. 16.6%); they have more insomnia incidence (21.8% vs. 10.8%); more risk of depression (66.6% vs. 47.6%) and greater consumption of substances (15.1% vs. 5.3%). Conclusions. Dermatologists and dermatology residents at the first line of care in the current pandemic show identifiable mental health problems; thus, mitigation measurements have to be taken about it.

Poly(ADP-ribose) polymeraseinhibitors in combination with anti-angiogenic agents for the treatment of advanced ovarian cancer.

Homologous recombination deficiencyand VEGF expression are key pathways in high-grade ovarian cancer. Recently, three randomized practice changing trials were published: the PAOLA-1, PRIMA and VELIA trials. The use of PARPinhibitors (PARPi) following chemotherapy has become standard of care in firstline. Combination of PARPiwith anti-angiogenic agents has demonstrated synergistic activity in preclinical study. This review summarizes the body of evidence supporting the efficacy and safety of the combination of PARPiand anti-angiogenic drugs in first-line homologous recombination deficiency high-grade ovarian cancer leading to USFDA and EMA approvals. This double maintenance is supported by: a large benefit with bevacizumab + olaparib compared with olaparib alone, a rationale for additive effect, and a good safety and cost-effective profile.

Cuidado de la salud mental del personal de salud durante COVID-19: recomendaciones basadas en evidencia y consenso de expertos

IntroductionThe crisis situation generated by COVID-19 and the measures adopted have generated social changes in the normal dynamics of the general population and especially for health workers, who find themselves caring for patients with suspected or confirmed infection. Recent studies have detected in them depression and anxiety symptoms and burnout syndrome, with personal and social conditions impacting their response capacity during the health emergency. Our aim was to generate recommendations for the promotion and protection of the mental health of health workers and teams in the first line of care in the health emergency due to COVID-19. MethodsA rapid literature search was carried out in PubMed and Google Scholar, and an iterative expert consensus and through electronic consultation, with 13 participants from the areas of psychology, psychiatry and medicine; the grading of its strength and directionality was carried out according to the international standards of the Joanna Briggs Institute. ResultsThirty-one recommendations were generated on self-care of health workers, community care among health teams, screening for alarm signs in mental health and for health institutions. ConclusionsThe promotion and protection activities in mental health to face the health emergency generated by COVID-19 worldwide can include coordinated actions between workers, health teams and health institutions as part of a comprehensive, community care, co-responsible and sustained over time.

Chronic Primary Pain of the Spine: an Integrative Perspective Part 2

The purpose of this review is to provide a follow-up discussion to a companion article reviewing current models of low back and neck pain, focused on chronic and disabling primary pain of the spine. While the preceding article addresses risk factors, etiology, pathophysiology, and differential diagnosis of low back and neck pain, this article discusses the best available research regarding current management strategies for chronic primary pain of the spine and expands upon ways to improve these strategies. A review of the English medical literature was performed using search terms “chronic primary pain,” “low back pain,” OR “neck pain” AND “management,” “treatment,” “prevention,” or “biopsychosocial.” Additional searches were made using Google Scholar and PubMed search engines through April 18, 2020. The authors reviewed and identified 136 relevant articles to be used in this discussion. While certain elements of societal and legislative infrastructure hinder optimized implementation of evidence-based care, clinical research and updated practice guidelines advocate for the safe and cost-effective nonpharmacological interventions typically offered by chiropractors, physical therapies, and other manual therapists as first-line care. The authors expand upon these therapies individually to determine their relevance and contextual purpose. A framework for an integrative perspective, adopting concepts from biopsychosocial and behavioral models, is called to action to provide an improved understanding of the nature of chronic primary pain and to aid in patient-centered clinical decision-making.

A Survey of Knowledge Level about Pediatric oral/dental Health among Pediatricians

Pediatricians play a central role in children’s health care and are the first line of care for oral/dentalconditions. The level of pediatrician knowledge about oral/dental health is not accurately determined.In this cross-sectional study, a previously adapted questionnaire was used to evaluate the level of oral/dental health knowledge among pediatricians affiliated with medical universities in Tehran, Iran. The datawere summarized through descriptive statistics and central index tests. In this study, 263 pediatricians(49.4% male) completed the questionnaire. The mean age was 43.9 years. Only 17 individuals (6.5%) hadcompleted a course of oral/dental health during their residency. The mean score was 5.9 ± 1.7. Questionnairescores were similar between male and female pediatricians. Time from graduation and completion of anoral/dental health course was not associated with better performance according to the questionnaire. Thelevel of knowledge about oral/dental health among pediatricians is inadequate. Most pediatricians havenot completed a training course on this matter. These findings highlight the need for integrated trainingprograms to improve pediatrician knowledge about oral/dental health.

KNOWLEDGE TOWARDS PREVENTION OF CERVICAL CANCER AMONG NURSING STUDENTS OF ANMTC BARH, BIHAR

ABSTRACT: Cervical cancer is the most common cancer among Indian women. Numerous studies were conducted on Nursing students towards the prevention of cervical cancer in India and all over the world. Previous studies disclosed there is a lack of knowledge regarding cervical cancer among nursing students. In this study, ANM students were selected as ANM are working in the community and are the first-line health care provider according to the Indian health care system. Therefore, the study to assess the knowledge of ANM students towards the prevention of cervical cancer is done. Purpose: the purpose of the study was to assess the knowledge towards the prevention of cervical cancer among nursing students and to find an association between knowledge and selected demographic variables. Methodology: A non-experimental descriptive study was conducted to assess knowledge towards the prevention of cervical cancer among 111 nursing students of ANMTC Barh, Bihar. The age group was 17-22 years. Both 1st and 2nd -year students, whoever was available during the data collection and willing were included in the study. A self-structured questionnaire was developed for assessing the level of knowledge among nursing students. The tool was found valid and reliable after testing. A purposive sampling technique was selected. The collected data were tabulated and analyzed by using descriptive and inferential statistics. Result: The majority of the students belonged to age 19 years (32.4%), almost 93.7% of students were Hindu. The main source of information was mass media (32.4%). Although a majority of the students (56%) were having average knowledge, the highest level of knowledge was present among 21 years age group and the lowest was present among 22 years of age group. Conclusion: The study showed that being health care providers also a majority of the students are having average knowledge towards prevention of cervical cancer which raises a concern, as preventive meas

Nursing care for patients in post-transplantation of hematopoietic stem cells: an integrative review.

to analyze the available evidence on the nursing care provided to patients after hematopoietic stem cell transplantation. integrative review with the search for primary studies in four databases and a virtual health library. A broad search strategy was used, including research published in English, Brazilian Portuguese, or Spanish, between 2008 and 2018, totaling a sample of 42 studies. the studies were grouped into three categories: multiple nursing care (n=19), first-line care (n=18), and self-management of care (n=5). nursing care is critical, comprising patients' physical, psychological and social aspects. It occurs in hospital and home contexts, mainly involving technical actions and health guidance. The evidence identified provide subsidies for decision-making; however, most studies are of the non-experimental type, indicating the need for conducting intervention research.

Letter from the Editors

Since it was established in 2014, the International Journal of Integrative Pediatrics and Environmental Medicine (IJIPEM) has strongly adhered to publishing ethics, followed a double-blind review process, and published high-quality papers. Our outstanding linguistic service has assisted many grateful authors for whom English is a second language.
 Last year was a hard year for everyone, but particularly for the first-line medical care providers. We have given priority to SARS-CoV-2-related manuscripts and published them for free, thereby contributing to our universal knowledge of this new disease. One of the most interesting papers was "Pregnancy and COVID-19, a brief review", one of the first articles published on the topic. Another paper, "The new face of Medicine – care flow strategies developed during COVID" by Dr. Sharon Jacob, addressed how to adjust clinic schedules during this unexpected Global disaster.
 We also published rare and interesting cases related to the journal's scope, which is focused on the interactions between children and their physical and psychological environment. We want to remind you that the journal topics center on modifiable factors, such as environmental pollution, child-parent relationships, social circumstances, quality of life of the sick child, ill-child school performance, mental health, and sensitivity to environmental factors. Topics concerning integrating conventional pediatrics with complementary and alternative medicine for children and research about environmental impacts on cellular and molecular mechanisms of development are of great interest. We will continue giving priority to manuscripts related to the impact of SARS-CoV-2.
 We are hopeful that the new year will be very fruitful for our goal of increased scientific knowledge and distribution of these discoveries. We are looking forward to reading, reviewing, and publishing your work. We will also see that it is preserved and recorded with DOI links and advertised widely. Manuscripts funded by NIH or their partners will be indexed as PubMed selected citations. We hope you will enjoy working with our editorial team.
 If you are reading this letter, you may well already be familiar with IIPEM. If you are interested in working with us, please, register as an author on the web at https://ijipem.com/index.php/ijipem/login. We will put our talents to work to make your paper readable and visible.

Eltrombopag use in chronic immune thrombocytopenia of childhood: results from nationwide therapeutic program

AbstractBackgroundThrombopoietin receptor agonists have been repeatedly confirmed to be safe, efficient, and well tolerated in pediatric patients with chronic immune thrombocytopenia (cITP).Material and methodsIn this report, we present data summarizing the Polish experience of the use of eltrombopag in cITP patients, refractory to standard first-line care. Our analysis was based on clinical and epidemiological data from the Nationwide Therapeutic Program 2018–2020. Quality of the response to the eltrombopag treatment was defined according to the International Consensus Guidelines as follows: complete response (CR) defined as platelet count (PLT) ≥100 × 109/L and absence of bleeding; response (R) defined as PLT ≥30 × 109/L and at least two-fold increase in the baseline count and absence of bleeding.ResultsWe evaluated 60 patients (33 boys and 27 girls) with chronic and refractory ITP. Median age at beginning of treatment was 9.5 years. Median PLT at the first eltrombopag administration was 30 × 109/L. The median follow-up was 7 months (range, 3–22 months). After 1 week of treatment, response (R) was noted in 53.3% (95% confidence interval [CI]: 40.7%–66.0%) patients, and complete response (CR) was seen in 21.6% (95% CI: 11.2%–32.1%). We evaluated the long-term duration of the response and found that it was obtained in 84.4% (95% CI: 71.8%–97.0%) and 88.9% (95% CI: 77.0%–100%) of patients after 6 and 12 months, respectively, of eltrombopag therapy, while CR was reached, respectively, in 46.9% (95% CI: 29.6%–64.2%) and 29.6% (95% CI: 12.4%–46.9%) patients. No serious adverse events were reported.ConclusionOur data support the safety and efficacy of eltrombopag use in cITP pediatric patients.

Self-reported management among people with rotator cuff related shoulder pain: An observational study

BackgroundRotator cuff related shoulder pain is the most common cause of shoulder pain. Whilst guidelines recommend conservative management prior to imaging, injection or surgical management, recent findings suggest that patients experience management contrary to guideline recommendations. ObjectivesThe aim of this study was to investigate self-reported management among people with rotator cuff related shoulder pain (RCRSP) and their beliefs towards management. Materials and methodsCross-sectional survey of people with RCRSP recruited when referred for imaging (n = 120). Electronic survey about demographic factors, management people had had (including imaging, injections, surgery, exercise, adjuncts), and beliefs about treatments. The frequency of various treatments was reported (separately for each cohort and traumatic onset) as well as the timing of interventions related to first-line care. ResultsMost people had tried exercise (99/120, 82.5%) but only one in five people reported exercise was helpful, and one in six reported it was unhelpful or made their symptoms worse. Approximately a third of the cohort reported not receiving activity modification advice (34.2%, 41/120), those that did received inconsistent information. People with both traumatic (imaging 31/43, 72.1%; injections 13/24, 54.2%, surgery 8/21, 38.1%) and atraumatic onset pain (imaging 43/77, 55.8%; injections 31/51, 60.8%, surgery 4/19, 21.1%) had similarly high rates of intervention prior to trialling conservative management. Patient beliefs in regards to management showed trends towards interventionalist care. ConclusionPatient reported management of RCRSP is often inconsistent with guideline recommended management.

Development of a light-weight deep learning model for cloud applications and remote diagnosis of skin cancers.

Skin cancer is among the 10 most common cancers. Recent research revealed the superiority of artificial intelligence (AI) over dermatologists to diagnose skin cancer from predesignated and cropped images. However, there remain several uncertainties for AI in diagnosing skin cancers, including lack of testing for consistency, lack of pathological proof or ambiguous comparisons. Hence, to develop a reliable, feasible and user-friendly platform to facilitate the automatic diagnostic algorithm is important. The aim of this study was to build a light-weight skin cancer classification model based on deep learning methods for aiding first-line medical care. The developed model can be deployed on cloud platforms as well as mobile devices for remote diagnostic applications. We reviewed the medical records and clinical images of patients who received a histological diagnosis of basal cell carcinoma, squamous cell carcinoma, melanoma, seborrheic keratosis and melanocytic nevus in 2006-2017 in the Department of Dermatology in Kaohsiung Chang Gung Memorial Hospital (KCGMH). We used the deep learning models to identify skin cancers and benign skin tumors in the manner of binary classification and multi-class classification in the KCGMH and HAM10000 datasets to construct a skin cancer classification model. The accuracy reached 89.5% for the binary classifications (benign vs malignant) in the KCGMH dataset; the accuracy was 85.8% in the HAM10000 dataset in seven-class classification and 72.1% in the KCGMH dataset in five-class classification. Our results demonstrate that our skin cancer classification model based on deep learning methods is a highly promising aid for the clinical diagnosis and early identification of skin cancers and benign tumors.

Post-Remission Treatment (Tx) Patterns for Patients (Pts) with Newly Diagnosed (ND) Acute Myeloid Leukemia (AML) in the Connect® MDS/AML Disease Registry

Post-Remission Treatment (Tx) Patterns for Patients (Pts) with Newly Diagnosed (ND) Acute Myeloid Leukemia (AML) in the Connect® MDS/AML Disease Registry

Clinical impact of monocyte distribution width and neutrophil-to-lymphocyte ratio for distinguishing COVID-19 and influenza from other upper respiratory tract infections: A pilot study.

The coronavirus disease 2019 (COVID-19) has become a pandemic. Rapidly distinguishing COVID-19 from other respiratory infections is a challenge for first-line health care providers. This retrospective study was conducted at the Taipei Medical University Hospital, Taiwan. Patients who visited the outdoor epidemic prevention screening station for respiratory infection from February 19 to April 30, 2020, were evaluated for blood biomarkers to distinguish COVID-19 from other respiratory infections. Monocyte distribution width (MDW) ≥ 20 (odds ratio [OR]: 8.39, p = 0.0110, area under curve [AUC]: 0.703) and neutrophil-to-lymphocyte ratio (NLR) < 3.2 (OR: 4.23, p = 0.0494, AUC: 0.673) could independently distinguish COVID-19 from common upper respiratory tract infections (URIs). Combining MDW ≥ 20 and NLR < 3.2 was more efficient in identifying COVID-19 (AUC: 0.840). Moreover, MDW ≥ 20 and NLR > 5 effectively identified influenza infection (AUC: 0.7055). Thus, MDW and NLR can distinguish COVID-19 from influenza and URIs.

Reader response: Thrombolysis for acute ischemic stroke in the unwitnessed or extended therapeutic time window.

The timely meta-analysis by Tsivgoulis et al.1 is an illustration of the transformative shift in hyperacute stroke management that has characterized the last several years. Focus has appropriately expanded beyond the classic mantra, “time is brain,” to view time as a necessary, but no longer sufficient, surrogate for predicting functional outcome and to recognize that, perhaps, now “penumbra is key.” Ultimately, this is an extraordinary advance for the more than 13 million people having new stroke each year2 and the first-line health care professionals who help treat them. The summation of these studies prompted the American Heart Association to update recommendations about thrombolysis in an extended time window. 2019 Guidelines now provide a Class IIa recommendation, supporting IV alteplase administration in select patients with unclear time of onset and MRI diffusion-positive FLAIR-negative lesions who have symptom recognition within 4.5 hours.3

Disaster Preparedness among Emergency Medical Service Providers: A Systematic Review Protocol

Background. The emergency medical service (EMS) provides first-line medical care to people who require urgent medical care in emergency and disaster situations. Preparedness is the most effective approach for the management of disaster risks, and it is essential for the emergency medical service (EMS) providers, such as paramedics, emergency medical technicians (EMT), and other EMS personnel. This systematic review will explore evidence on the preparedness of emergency medical service providers in emergency and disaster situations by reviewing peer-reviewed journal articles. Methods/Design. This study will be conducted on peer-reviewed articles published between 2005 and 2019 to explore the preparedness of emergency medical service providers in emergencies and disasters. Scopus, Web of Science, PubMed, and Google Scholar will be thoroughly searched to identify published studies on emergency and disaster preparedness. The following keywords will be used for searching the databases: “Medical Technician,” “Paramedic,” “Emergency Paramedic,” “Emergency Medicine Technician,” “Emergency Medical Technician,” “Emergency Prehospital Provider,” “Emergency Preparedness,” “Disaster Preparedness,” “Hospital Preparedness,” “Disaster management,” “Disaster Competencies,” “Disaster Readiness,” “Disaster,” “Disaster Role,” “Readiness, Preparedness, Terrorist,” “Mass Casualty Incident,” “Major incidents,” “Mass Casualty,” “Mass Gathering,” “CBRNE,” “Weapons of Mass Destruction,” and “Chemical, Biological, Radiological, Nuclear, and Explosive Event.” Discussion. To the best of our knowledge, no comprehensive review study has been conducted on the preparedness of emergency medical service providers in disaster situations. This study is the first attempt to address this gap. It will also explore the key dimensions in disaster preparedness of EMS providers and the strategies to enhance their preparedness. Identifying the key dimensions of disaster preparedness is the first step in designing and developing valid instruments to evaluate EMS provider's disaster preparedness and as well as adopting appropriate strategies to improve the level of their preparedness (This systematic review is registred in PROSPERO with CRD42020149689).

Referrals to secondary care in an outpatient primary care walk-in clinic for refugees in Germany: results from a secondary data analysis based on electronic medical records

ObjectivesThe aims of our study were to describe the disease spectrum of refugees, to analyse to what extent their healthcare needs could be met in an outpatient primary care walk-in...