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Boleo-Tome C.,University of Lisbon | Monteiro-Grillo I.,University of Lisbon | Monteiro-Grillo I.,Hospital Universitario Of Santa Maria | Camilo M.,University of Lisbon | Ravasco P.,University of Lisbon
British Journal of Nutrition | Year: 2012

In the present study, we aimed to validate the Malnutrition Universal Screening Tool (MUST) for routine nutritional screening in the radiation oncology setting, thus enabling timely and adequate referrals of patients at risk for individualised or advanced intervention. Towards this objective, we conducted a prospective cross-sectional study in 450 non-selected cancer patients (18-95 years) referred for radiotherapy. The following were the nutritional parameters: BMI (categorised by WHO's age/sex criteria), weight loss >5% in the previous 3-6 months, Patient-Generated Subjective Global Assessment (PG-SGA-validated/specific for oncology) and nutritional risk by MUST. Sensitivity, specificity, predictive values and concordance were calculated to validate MUST v. PG-SGA and compare single parameters v. PG-SGA/MUST. BMI v. PG-SGA showed a negligible capacity to detect undernutrition: 0•27 sensitivity, 0•23 specificity, 0•35 positive predictive value and 0•31 negative predictive value. Conversely, percentage weight loss v. PG-SGA was highly effective: 0•76 sensitivity, 0•85 specificity, 0•79 positive predictive value and 0•85 negative predictive value. MUST v. PG-SGA successfully detected patients at risk: 0•80 sensitivity, 0•89 specificity, 0•87 positive predictive value and 1•0 negative predictive value; percentage weight loss v. MUST proved able to identify patients likely to be at risk: 0•85 sensitivity, 0•91 specificity, 0•90 positive predictive value and 1•0 negative predictive value. This is the first study in the radiation oncology setting to validate MUST: a simple and quick method applicable by any health professional, with a high validity for early screening, ideally to antedate a comprehensive nutritional assessment and guide for intervention. In this study, percentage weight loss in the previous 3-6 months does seem valid to predict nutritional risk, and may be the minimum in a busy routine. © 2011 The Authors.


Ravasco P.,Hospital Universitario Of Santa Maria
Nutrition | Year: 2015

Intensive individualized nutritional counseling requires nutrition professionals with specific experience in oncology. If the patient is unable to achieve his or her nutritional requirements via regular foods, nutritional supplements may be prescribed, the composition of which is based on detection of dietary deficits as well as a detailed intake questionnaire. Any nutritional intervention must be based on the need for an adequate intake and also must take into consideration other relevant factors such as digestive and absorptive capacity, the need for alleviation or arrest of symptoms, and any psychological issues. © 2015 Elsevier Inc.


Santos-Ribeiro S.,Vrije Universiteit Brussel | Santos-Ribeiro S.,Hospital Universitario Of Santa Maria | Polyzos N.P.,Vrije Universiteit Brussel | Haentjens P.,Vrije Universiteit Brussel | And 4 more authors.
Human Reproduction | Year: 2014

Studyquestion: Are low serum progesterone levels on the day of human chorionic gonadotrophin (hCG) administration detrimental for live birth delivery rates during in vitro fertilization (IVF)? Summary answer: Progesterone levels ≤0.5 ng/ml on the day of hCG administration hinder live birth rates. What is known already: Fundamental research has shown that the presence of late follicular phase progesterone is essential for follicular development, ovulation and endometrial receptivity. However, previous studies in patients undergoing ovarian stimulation have only assessed if progesterone levels in the higher range are detrimental for pregnancy or not. That said, information on the effect of the full range of late follicular progesterone on IVF outcomes is still lacking. Study design, size, duration: This was a retrospective, single-centre cohort study with 2723 cycles performed in patients aged between 19 and 36 and undergoing controlled ovarian stimulation between January 2006 and March 2012 for their first or second attempt of IVF followed by a fresh embryo transfer (ET). Participants/materials, setting, methods: All patients underwent ovarian stimulation using a gonadotrophin-releasing hormone (GnRH) antagonist for pituitary down-regulation. Final oocyte maturation was triggered with hCG 36 h before oocyte retrieval. On the day of hCG administration, serum progesterone evaluation was performed. Live birth delivery rates were compared amongst various ordinal and regular progesterone intervals (≤0.50, 0.50-0.75, 0.75-1.00, 1.00-1.25, 1.25-1.50, >1.50 ng/ml) using logistic regression. Main results and the role of chance: The average age of our sample was 30.5 years. Almost 82% of all embryo transfers were of a single embryo and 51.8%were performed with a Day 5 embryo. The average value (±standard deviation) of progesterone on the day of hCG administration was 1.02 ± 0.50 ng/ml and the live birth rate was 23.4%. The live birth rates (according to the above-described ordinal serum progesterone intervals) were 17.1, 25.1, 26.7, 25.5, 21.9 and 16.6%, respectively. The live birth rates were significantly lower in patients with both low (≤0.5 ng/ml) and high (>1.5 ng/ml) late follicular progesterone levels (P < 0.05). Limitations, reasons for caution: The main limitation of our study was its retrospective nature. Furthermore, our study was restricted to patients under GnRH antagonist pituitary suppression and requires confirmation in a GnRH agonist setting. Wider implications of the findings: This study comprehensively assessed the relationship between live birth delivery rates and progesterone levels on the day of hCG administration during ovarian stimulation for IVF. Clinically relevant lower (≤0.5 ng/ml) and higher (>1.5 ng/ml) progesterone level limits were determined. © The Author 2014.


Boleo-Tome C.,University of Lisbon | Chaves M.,University of Lisbon | Monteiro-Grillo I.,Hospital Universitario Of Santa Maria | Camilo M.,University of Lisbon | Ravasco P.,University of Lisbon
Oncologist | Year: 2011

Rationale. Nutritional risk screening should be routine in order to select patients in need of nutrition care; this conduct change has to rely on education. In this project, radiotherapy department health professionals were trained on how to use the Malnutrition Universal Screening Tool (MUST), to foster its integration into cancer outpatient management; we also aimed to identify those more adherent to screening. Methods. Research dieticians (the standard) conducted interactive sessions with all physicians, nurses, and radiotherapy (RT) technicians, who were closely supervised to facilitate routine MUST integration. There were two phases: after the first session, phase 1 assessed 200 patients over 4 months; after the second session, phase 2 screened 450 patients, always before RT. Validity was evaluated comparing results from the standard against all other health professionals, adjusted for number. Results. RT technicians were most adherent to the MUST: 80% of patients in phase 1, increasing to 85% in phase 2. Nurses doubled their input, from 19% to 36%. Physicians had poor MUST integration, yet they progressively incorporated percentage weight loss into patient records, increasing from 57% in phase 1 to 84% in phase 2, independently of diagnosis and stage. The highest concordance (_ coefficient) with dieticians was found with RT technicians' use of the MUST (p <002) and percentage weight loss determination by physicians (p <001). Conclusions. We show that systematic screening in cancer is feasible by all professionals involved, once a proximity teaching project is put into practice. RT technicians, who daily treat patients, were highly adherent to integrate the MUST and might be in charge of selecting at-risk patients. Physicians are unlikely to use the MUST, but acknowledged nutrition value and changed their routine by integrating recent percentage weight loss into their approach to patients. Our structured methodology may be used as a model for the development of teaching adapted to different departments with other realities. © AlphaMed Press.


Oliveira D.C.,Federal University of Santa Maria | Markus Lopes P.G.,Federal University of Santa Maria | Spader T.B.,Federal University of Santa Maria | Mahl C.D.,Federal University of Santa Maria | And 4 more authors.
Journal of Clinical Microbiology | Year: 2011

We studied 40 strains of the species complex formerly classified as the single species Sporothrix schenckii to identify new species within this complex and evaluate their antifungal susceptibility profiles. Based on phenotypic tests (ability to grow at 37°C, colony diameters, and pigmentation of the colonies, as well as assimilation of sucrose and raffinose) and molecular assays (amplification of a fragment of the calmodulin gene), here we report the identification of S. albicans, S. brasiliensis, S. luriei, and S. schenckii; two isolates of these species were detected as itraconazole-resistant strains. Copyright © 2011, American Society for Microbiology. All Rights Reserved.

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