Randomised controlled trials have aimed to assess the effectiveness of stereotactic ablative radiotherapy (SABR) with curative intent versus surgical resection for individuals diagnosed with early-stage non-small cell lung cancer (NSCLC) but have failed to recruit sufficient numbers of patients. Non-randomised studies for early-stage NSCLC have reported mixed outcomes following curative SABR versus surgical resection, but did not fully address confounding by indication. The Surgery Or RadioTherapy for early-stage cancer study (SORT) will assess the comparative effectiveness of SABR with curative intent versus surgical resection for NSCLC with a target trial emulation approach, as this can reduce biases in observational studies that aim to estimate the causal effect of interventions.
The SORT study will use the National Cancer Registry for individuals diagnosed with early-stage NSCLC in England during 2015–2020 (inclusive) who received SABR with curative intent or surgical resection. These data will be linked to Hospital Episode Statistics, National Radiotherapy Data Set and the Systemic Anti-Cancer Therapy dataset to obtain information on clinical and sociodemographic characteristics and the treatment received. This target trial emulation will define study population eligibility criteria and regimens for SABR with curative intent and surgical resection. We will reduce the risk of residual confounding with instrumental variable analyses that will exploit geographical variation across the National Health Service in England in the use of SABR with curative intent versus surgical resection for early-stage NSCLC. The primary outcome will be 3-year all-cause mortality after treatment initiation. Secondary outcomes will include 3-month, 6-month, 12-month and 24-month all-cause and lung-cancer mortality, time to death, numbers of hospitalisations, incremental costs and incremental cost-effectiveness.
Ethical approval was obtained from the London School of Hygiene and Tropical Medicine Research Ethics Committee (reference number 29 717–1). Results will be disseminated to clinicians, patients, policy-makers and researchers.
by Ana Paula Cândido Oliveira, Daniela Alencar Vieira, Cristiane Wanderley Cardoso, Tereza Magalhães, Rosangela Oliveira Anjos, Eduardo José Farias Borges Reis, Kionna Oliveira Bernardes Santos, Guilherme Sousa Ribeiro
Work ability is a subjective concept that reflects the balance between an individual’s perception of the physical, mental, and social demands of work and their competence and resources to meet those demands. The COVID-19 crisis significantly impacted health, work, and socioeconomic conditions worldwide. However, few studies have examined work ability in disadvantaged urban communities during this period. To analyze factors associated with work ability within the context of social vulnerability during the COVID-19 pandemic, we conducted a cross-sectional study in a low-income neighborhood in Salvador, Brazil, between February and June 2022. Sociodemographic, health, and labor data were collected, and work ability was assessed using the Work Ability Index (WAI), a widely used tool for evaluating work ability. Multivariable analyses based on a hierarchical model were run to investigate factors associated with low WAI scores. The study included 292 workers aged ≥16 years (59.6% women; median age 41 years). Most workers (84.6%) were classified as having adequate work ability based on their WAI scores. Multivariable analyses found that inadequate work ability was more frequent among women (prevalence ratio [PR]: 1.89, 95% confidence interval [CI]: 1.02-3.48), individuals who self-rated their health as moderate/good (PR: 5.91; 95% CI: 1.45-24.05) or poor/very poor (PR: 21.62; 95% CI: 5.14-90.91) compared to those with excellent/very good health, and those reporting diabetes (PR: 2.1; 95% CI: 1.13-3.9). Working >40 hours per week (PR: 0.47; 95% CI: 0.28-0.96) was negatively associated with inadequate work ability, suggesting that individuals with adequate work ability may be selected for longer working hours. A history of COVID-19 was not associated with inadequate work ability. These findings suggest that targeted interventions to improve work ability in low-income communities should prioritize women and workers with chronic health conditions, such as diabetes.Objetivo describir el acceso y el uso de los equipos de protección individual por parte de los profesionales sanitarios en el contexto de la pandemia de Covid-19. Estudio cualitativo descriptivo, realizado con profesionales de la salud en período de julio a agosto de 2020 a través de un formulario vía Google Forms. El análisis se realizó con el software Interface de R para el Análisis Multidimensional de Textos y Cuestionarios, mediante la Clasificación Jerárquica Descendente y análisis de similitud, aprobado por el dictamen 4.120.399. 42 profesionales de la salud participación del estudio. Se identificaron cuatro clases. En la clase 1, los profesionales informaron de la mala calidad de los equipos recibidos para la protección; en la clase 2, destacaron la compra de equipos de protección; en la clase 3, señalaron cómo la sustitución de los equipos pasa por la gestión y en la clase 4, informaron de la reutilización de estos insumos. Así, los profesionales denotan dificultades relacionadas con el acceso y uso de los equipos de protección individual, lo que merece una mayor atención por parte de los servicios, con el objetivo de mejorar la calidad de la protección de estos profesionales y garantizar la seguridad en el trabajo.
Objetivo: identificar los diagnósticos de enfermería y las intervenciones más frecuentes en la asistencia a los pacientes en hemodiálisis. Método: se realizó un estudio descriptivo, transversal, retrospectivo con un enfoque cuantitativo, realizado con 175 prontuarios de pacientes en hemodiálisis, asistidos en el servicio por un período de seis meses. Para la recolección de los datos, se utilizó la plataforma Google Forms®, generando una hoja de trabajo en Microsoft Excel®, un software que permite organizar, describir y analizar los mismos. Resultados principales: se identificaron tres diagnósticos de enfermería como más frecuentes: Riesgo de sangrado (67,2%); Riesgo de caída (56,5%) y Exceso de volumen de líquido (54,8%), en más de la mitad de los pacientes de acuerdo con los registros en los prontuarios. Las intervenciones de enfermería están dirigidas por el protocolo del procedimiento de hemodiálisis y no por los diagnósticos de enfermería. Conclusión: los diagnósticos más frecuentes se centran en las condiciones clínicas de la población estudiada, y no subvencionan las intervenciones de enfermería, que se definen con base en técnica de hemodiálisis.