ABSTRACT
Study design: Prospective observational study. Background: Despite dysphagia large prevalence and the growing ageing phenomenon occurring in European countries, aspiration events among inpatients are often underestimated, given their frequent spontaneous resolution or silent contribution to aspiration syndromes. Our main objective was to evaluate the incidence of aspiration events among medical inpatients and to identify risk factors influencing the outcome of the event. Methods: Data about aspiration events - day, hour, type and outcome of the event occurred - along with underlying patient clinical conditions at the admission were collected. Between May 2015 and September 2016, data about aspiration event occurred among medical inpatients were collected in three large Italian hospitals. Results: Patients affected by aspiration events were 135 on 102,619 cumulative days of hospitalization; they were mostly females (53%) with an average age of 82. The total incidence of aspiration events was of 1.4 every 1,000 days of hospitalization (C.I. 95%: 1.2-1.7) and the most frequent manifestation was cough (61.6%). The addition of drugs or an infection diagnosis during the 24 hours preceding the event acted as risk factors for those events that needed additional interventions during the hospitalization (OR 3.1 e OR 1.9 respectively), while the elimination of one or more prescribed drugs seemed to lead to aspiration events without impact on the hospitalization. Conclusions: Results showed a large incidence of aspiration events within medical wards, many of them influencing patient outcomes. Healthcare professionals' attention concerning aspiration events should be fostered during the first hours and days of hospitalization.
Subject(s)
Deglutition Disorders , Pneumonia , Aged, 80 and over , Deglutition Disorders/epidemiology , Deglutition Disorders/etiology , Female , Hospitalization , Hospitals , Humans , Inpatients , MaleABSTRACT
Mucosa-associated lymphoma antigen 1 (MALT1) is a lymphoma oncogene that regulates signal transduction as a paracaspase and an adaptor protein. Yet, the role of MALT1 in other solid cancers such as melanoma is not well-understood. Here, we demonstrate that MALT1 is overexpressed in malignant melanoma cells, and predicts a poor disease-free survival. MALT1 inhibition via shRNA-mediated gene silencing or pharmacologically with MI-2 compound markedly reduced cell growth and migration of A2058 and A375 melanoma cell lines in vitro. Subcutaneous tumor growth analysis revealed that MALT1 gene silencing significantly reduced tumor growth and metastasis to the lung. Consistently, the subcutaneous tumors with MALT1 loss had increased cell apoptosis and decreased proliferation. In addition, these tumors showed signs of mesenchymal-epithelial transition as indicated by the upregulation of E-cadherin and downregulation of N-cadherin and ß1-intergrin. Further molecular analysis revealed that MALT1 is required for c-Jun and nuclear factor-κB (NF-κB) activation by tumor necrosis factor-α. Forced expression of the c-Jun upstream activator MKK7 reversed the cell growth and migration defects caused by MALT1 loss. In contrast, NF-κB activation via expression of p65ER, a fusion protein containing NF-κB p65 and the tamoxifen-responsive mutant estrogen receptor, induced minimal effects on cell proliferation, but diminished cell death induced by MALT1 loss and TRAIL treatment. Together, these findings demonstrate that MALT1 promotes melanoma cell proliferation and motility through JNK/c-Jun, and enhances melanoma cell survival through NF-κB, underscoring MALT1 as a potential therapeutic target and biomarker for malignant melanoma.
ABSTRACT
OBJECTIVE: To describe the evaluation of a program to improve the recording of drug prescribing in medical records. DESIGN: Experimental study with before and after measurements, without a control group, of the medical files of all patients who consulted during 2 different weeks, 9 months apart. SETTING: Family Medicine Unit of Centre hospitalier de l'Université Laval. PARTICIPANTS: Teachers and residents in the Family Medicine Unit. MAIN OUTCOME MEASURE: Proportion of prescriptions for drugs having a systemic effect (n = 206 for week before, n = 257 for week after) for which the following information was recorded: concentration, dosage, quantity prescribed or length of treatment, number of renewals. RESULTS: After the program, recording frequency increased from 86% to 97% for concentration, 80% to 95% for dosage, 52% to 79% for the quantity prescribed, and 20% to 71% for number of renewals. Both groups of doctors showed a notable improvement, except for the recording of quantity prescribed by residents, which remained stable. CONCLUSION: We observed an improvement in the recording of drug prescriptions in medical files. The program had a greater effect on teachers who had been exposed to activities that are known to be effective in improving recording.
