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Background: Targeted therapies and immunotherapies are increasingly prescribed, but classic chemotherapy agents are still highly used in cancer treatment. Both therapies, the old and the new, are associated with cutaneous adverse events (CAEs) that can cause treatment interruptions or reduce the quality of life of patients. Methods: An observational, cross-sectional, single-center study that included consecutive cancer patients presenting CAEs. The main objective was to describe CAEs derived from antineoplastic drugs. Secondary objectives were to determine the number and severity of CAEs and if there were differences regarding CAEs between conventional chemotherapeutics and targeted therapies. Results: A total of 114 patients were included with a total number of 177 CAEs. Of the 114 patients, 64 presented a single CAE, 37 patients had two CAEs, and 13 patients presented three CAEs. The most frequent CAEs were pruritus, xerosis, palmar-plantar erythrodysesthesia (PPE), and alopecia. The majority of CAEs were mild (63.2%), followed by moderate (29.9%) and severe (6.7%) CAEs. Of the 114 patients, 103 (90.3%) received topical agents and 11 (9.7%) required systemic treatment for the management of CAEs. Prophylactic treatment for CAE was delivered to only 4/114 (3.5%) patients. No significant differences were found in the number or severity of CAEs between conventional chemotherapy and targeted therapy. Conclusions: Close collaboration between oncologists and dermatologists is essential to start preventive measures on time, enhance patient education, and avoid unnecessary dose reductions or treatment interruptions. The multidisciplinary approach can offer better management of skin toxicities.

Background: Despite growing interest in cutaneous adverse events (CAEs) and their management in patients with cancer, they are often underreported and there are no extensive data on their impact on quality of life (QoL). Healthcare professionals should consider this issue in order to minimize its negative impact on QoL and improve patient outcomes. This study evaluates the impact of CAEs on QoL in outpatients receiving anticancer drugs and aims to determine the differences in QoL between conventional chemotherapy versus targeted therapies. Methods: A total of 114 cancer patients with CAEs were included in this observational, cross-sectional study. Patient-reported outcomes instruments (Functional Assessment of Cancer Therapy – General, Dermatology Life Quality Index, and Skindex-16) were used. Results: Mean scores in QoL indices were 65.3±13.4, 8.4±5, and 30.8±16.9 in Functional Assessment of Cancer Therapy – General, Dermatology Life Quality Index, and Skindex-16, respectively. The CAEs that had the greatest impact on dermatologic-related QoL were hand–foot skin reaction, rash, palmo-plantar erythrodysesthesia, and papulopustular eruption. No significant differences in QoL indices according to the type of treatment (conventional chemotherapy versus targeted therapy) were observed. Conclusions: CAEs, and particularly hand–foot toxicities, rashes, and papulopustular eruptions, can have an impact on QoL in outpatients receiving anticancer drugs as evaluated with three different patient-reported outcomes instruments. No differences in QoL related to CAEs were observed between conventional chemotherapy and targeted therapy.

Resumen Objetivo Analizar el grado de conocimiento y la actitud sobre las voluntades anticipadas de las enfermeras que trabajan en 3 hospitales del Servizo Galego de Saude (Espana). Metodo Estudio descriptivo, transversal, multicentrico. Se realizo un muestreo estratificado a enfermeras de los complejos hospitalarios Universitarios de Ourense, Ferrol y Vigo. Se calculo un tamano muestral de 239 individuos. La recogida de los datos se realizo durante el primer semestre de 2018 mediante un cuestionario validado autocumplimentado («Cuestionario de conocimientos y actitudes de los profesionales sanitarios en el proceso de declaracion de voluntades vitales»). Resultados Participaron un total de 262 enfermeras. Un 50% cree que los profesionales sanitarios estan obligados a informar sobre las voluntades anticipadas. Un 2% considera que tiene suficiente informacion sobre el tema, y asi lo demuestran en las preguntas de conocimientos, donde entre un 61-93% fallan en las preguntas relacionadas con la documentacion, uso y aspectos legales de las mismas. Un 84% considera que tiene la obligacion de respetar los valores y creencias de los pacientes y un 89% que los pacientes tienen derecho a recibir y decidir sobre la atencion idonea. Un 13% considera que los pacientes no estan bien informados sobre voluntades anticipadas, y un 83% recomendaria a sus pacientes cronicos la realizacion del documento de voluntades anticipadas. Conclusiones Las enfermeras tienen un gran desconocimiento sobre los aspectos legales y el uso de las voluntades anticipadas, lo que les hace sentirse poco capaces para informar a sus pacientes sobre las mismas. A pesar de la falta de conocimiento, su actitud es positiva y la mayoria manifiesta que las recomendaria a sus pacientes.

Objective To analyse the level of knowledge and attitudes concerning living wills of nurses working in three hospitals of Servizo Galego de Saude (Spain). Method Descriptive, cross-sectional, multi-centre study. Stratified sampling was carried out with nurses from the University Hospital Complexes of Ourense, Ferrol and Vigo. A sample size of 239 individuals was calculated. The data was collected during the first semester of 2018 using a validated self-administered questionnaire (“Cuestionario de conocimientos y actitudes de los profesionales sanitarios en el proceso de declaracion de voluntades vitales”). Results A total of 262 nurses participated. Fifty percent believe that health professionals are obliged to inform about living wills. Two percent consider that they have enough information on the subject, and this is demonstrated in the knowledge questions, where between 61–93% fail in the questions related to the documentation, use, and their legal aspects. Eighty-four percent consider that they have the obligation to uphold the values ​​and beliefs of patients, and 89% that patients have the right to receive and decide on the right care. Thirteen percent consider that patients are not well informed about living wills, and 83% would recommend to chronic patients that they complete a living will. Conclusions Nurses have a great lack of knowledge about the legal aspects and the use of living wills, which makes them feel unable to inform their patients about them. Despite of the lack of knowledge, their attitude is positive and most of them state that they would recommend them to their patients.

Supplemental Digital Content is available in the text., IMPORTANCE: A Disintegrin and Metalloproteinase with Thrombospondin Motifs-1 is hypothesized to play a role in the pathogenesis of invasive infection, but studies in sepsis are lacking. OBJECTIVES: To study A Disintegrin and Metalloproteinase with Thrombospondin Motifs-1 protein level in pediatric sepsis and to study the association with outcome. DESIGN: Data from two prospective cohort studies. SETTING AND PARTICIPANTS: Cohort 1 is from a single-center study involving children admitted to PICU with meningococcal sepsis (samples obtained at three time points). Cohort 2 includes patients from a multicenter study involving children admitted to the hospital with invasive bacterial infections of differing etiologies (samples obtained within 48 hr after hospital admission). MAIN OUTCOMES AND MEASURES: Primary outcome measure was mortality. Secondary outcome measures were PICU-free days at day 28 and hospital length of stay. RESULTS: In cohort 1 (n = 59), nonsurvivors more frequently had A Disintegrin and Metalloproteinase with Thrombospondin Motifs-1 levels above the detection limit than survivors at admission to PICU (8/11 [73%] and 6/23 [26%], respectively; p = 0.02) and at t = 24 hours (2/3 [67%] and 3/37 [8%], respectively; p = 0.04). In cohort 2 (n = 240), A Disintegrin and Metalloproteinase with Thrombospondin Motifs-1 levels in patients within 48 hours after hospital admission were more frequently above the detection limit than in healthy controls (110/240 [46%] and 14/64 [22%], respectively; p = 0.001). Nonsurvivors more often had detectable A Disintegrin and Metalloproteinase with Thrombospondin Motifs-1 levels than survivors (16/21 [76%] and 94/219 [43%], respectively; p = 0.003), which was mostly attributable to patients with Neisseria meningitidis. CONCLUSIONS AND RELEVANCE: In children with bacterial infection, detection of A Disintegrin and Metalloproteinase with Thrombospondin Motifs-1 within 48 hours after hospital admission is associated with death, particularly in meningococcal sepsis. Future studies should confirm the prognostic value of A Disintegrin and Metalloproteinase with Thrombospondin Motifs-1 and should study pathophysiologic mechanisms.

Background The aim of the study was to assess health-related quality of life (HRQOL) in outpatients receiving anti-cancer treatment. Methods Observational, cross-sectional, single-center study that assessed HRQOL in cancer patients receiving antineoplastic treatment. Results A total of 184 patients were included in the study; the median total FACT-G score was 66 ± 12.9; the scores for the physical well-being, social/family well-being, emotional well-being and functional well-being domains were 17.8 + 4.8, 19.1 ± 4.4, 14.8 ± 3.8 and 14.3 ± 4.7 respectively. Patients with adverse events had poorer HRQOL compared to those without them (FACT-G score 62.2 vs. 67.3; p Conclusion In our study, the neoplastic disease and anti-cancer treatment toxicities had an impact on HRQOL. Patients had poorer scores in the functional well-being domain and higher ones in the social/family well-being domain. Variables associated with worse HRQOL were tumor stage, performance status (ECOG) and female sex.

Background Family caregivers of persons with dementia often experience a negative impact on their health. More studies based on nursing theories are needed to improve the provision of care. Aims To describe the care provided by family caregivers of persons with dementia and the impact on their health, as well as to analyse how personal variables of caregivers are related to care tasks and their health impact. Methods Multi-centric cross-sectional prospective study conducted on a sample of 423 primary family caregivers of persons with dementia from Spain. Data were collected through ICUB97-R questionnaire (January–April 2019), based on the fourteen needs of Virginia Henderson's Nursing Model. Data was analysed through one-way analysis of variance and Student's t-test. Results The caregiver profile was a middle-aged married woman without higher education living with the cared person, predominantly her mother. The most frequently provided care corresponded to “nutrition” and “movement” needs. Lack of free time, modifications on leisure activities, reduced sleep or rest and disruption of family life emerged as the greatest repercussions on the caregiver's health. The age of the caregiver and time caring showed differences on impact of care and care tasks, respectively. Conclusion The identification of the types of care provided, the health impact of caring and the variables affecting the family caregiver's vulnerability is essential to develop effective individualised nursing care plans, including health education interventions to improve the quality of life of both caregivers and persons cared for.

Background: Dementia is a brain syndrome that affects a growing number of persons worldwide and generates a strong and progressive demand for care from a family caregiver, usually females. Objective: We aimed to describe the care provided by family caregivers of persons with dementia as well as the impact on their health and its interrelation with gender. Patient involvement: This study was carried out in collaboration with the 13 associations of family caregivers of persons with dementia that are part of a Regional Federation. This partnership worked towards bettering patient care and proposing improvements to the public health system. Methods: A multi-institutional cross-sectional study. A total of 462 primary family caregivers of persons with dementia from north-west Spain were included. Data were collected between January and April 2019 with an anonymous self-administered validated questionnaire (ICUB-97) based on Virginia Henderson’s nursing care model. Results: The most affected needs in family caregivers are those related to “recreational activities”, “communication” and “rest and sleep”. Statistically significant differences between male and female participants’ pattern of care and health-related impacts were found, especially in issues related to work and family reconciliation. Discussion: Care plans should be developed taking gender perspective into account. From a nurse model point of view, more research is necessary to reduce health disparities. This study provides an assessment of gender differences in care and the impact on caregivers’ health. Practical value: Regarding the specific health conditions of female caregivers and from a holistic point of view, these findings could provide novel and interesting data that might help to implement gender perspective in nursing care plans, generally invisible in routine clinical practice This work was supported by the Xunta de Galicia (ED431C 2017/27; Red Gallega de Investigación en Demencias, IN607C-2017/02). The content is solely the responsibility of the authors and does not necessarily represent the official views of the participating Associations of Family Caregivers. The authors thank the support of the Federation of Galician Associations of Dementia’s sufferers and their families (FAGAL). We are grateful to Diego Lopez-Cao for his services in editing the manuscript SI

Background: despite the growing interest in cutaneous adverse events (CAEs) and their management in oncology patients, they are often under-reported and there are no extensive data on their impact on quality of life. Health care professionals should pay attention to this issue in order to minimize its negative impact on quality of life (QoL) and improve patient outcome. The aim of this study was to evaluate the impact of CAEs on QoL in patients receiving anticancer drugs and to determine differences in QoL between conventional chemotherapy versus targeted therapies. Methods: 114 cancer patients with CAEs were included in this observational, cross-sectional study. Patient-reported outcomes instruments (FACT-G, DLQI and SKINDEX-16) were used. Results: Mean (SD) score in FACT-G was 65.3 (13.4), while in DLQI it was 8.4 (5) and in SKINDEX-16 it was 30.8 (16.9), showing a moderate impact on QoL. No significant differences in QOL indices according to the type of treatment (conventional chemotherapy vs targeted therapy) were observed Conclusions: CAEs had a moderate impact on QoL in cancer patients, evaluated with three different PRO instruments, but having more severe or two or more CAEs had a significant negative impact on QoL. No differences between conventional chemotherapy and targeted therapy were observed.

The mechanisms of rotavirus (RV) infection have been analyzed from different angles but the way in which RV modifies the transcriptome of the host is still unknown. Whole transcriptome shotgun sequencing of peripheral blood samples was used to reveal patterns of expression from the genome of RV-infected patients. RV provokes global changes in the transcriptome of infected cells, involving an over-expression of genes involved in cell cycle and chromatin condensation. While interferon IFI27 was hyper-activated, interferon type II was not suggesting that RV has developed mechanisms to evade the innate response by host cells after virus infection. Most interesting was the inhibition of genes of the glycophorins A and B (GYPA/B) family, which are the major sialoglycoproteins of the human erythrocyte membrane and receptor of several viruses for host invasion. RV infection induces a complex and global response in the host. The strong inhibition of glycophorins suggests a novel defense mechanism of the host to prevent viral infection, inhibiting the expression of receptors used by the virus for infection. The present results add further support to the systemic nature of RV infection.

Background Sepsis and severe focal infections represent a substantial disease burden in children admitted to hospital. We aimed to understand the burden of disease and outcomes in children with life-threatening bacterial infections in Europe. Methods The European Union Childhood Life-threatening Infectious Disease Study (EUCLIDS) was a prospective, multicentre, cohort study done in six countries in Europe. Patients aged 1 month to 18 years with sepsis (or suspected sepsis) or severe focal infections, admitted to 98 participating hospitals in the UK, Austria, Germany, Lithuania, Spain, and the Netherlands were prospectively recruited between July 1, 2012, and Dec 31, 2015. To assess disease burden and outcomes, we collected demographic and clinical data using a secured web-based platform and obtained microbiological data using locally available clinical diagnostic procedures. Findings 2844 patients were recruited and included in the analysis. 1512 (53·2%) of 2841 patients were male and median age was 39·1 months (IQR 12·4–93·9). 1229 (43·2%) patients had sepsis and 1615 (56·8%) had severe focal infections. Patients diagnosed with sepsis had a median age of 27·6 months (IQR 9·0–80·2), whereas those diagnosed with severe focal infections had a median age of 46·5 months (15·8–100·4; pInterpretation Mortality in children admitted to hospital for sepsis or severe focal infections is low in Europe. The disease burden is mainly in children younger than 5 years and is largely due to vaccine-preventable meningococcal and pneumococcal infections. Despite the availability and application of clinical procedures for microbiological diagnosis, the causative organism remained unidentified in approximately 50% of patients.

Background:TheIFI27interferon gene expression has been found to be largely increased in rotavirus (RV)-infectedpatients.IFI27gene encodes for a protein of unknown function, very recently linked to epidermal proliferation andrelated to the epidermal growth factor (EGF) protein. The EGF is a low-molecular-weight polypeptide that is mainlyproduced by submandibular and parotid glands, and it plays an important physiological role in the maintenance oforo-esophageal and gastric tissue integrity.Our aim was to determine salivary EGF levels in RV-infected patients in order to establish its potential relationshipwithIFI27increased expression and EGF-mediated mucosal protection in RV infection.Methods:We conducted a prospective comparative study using saliva samples from 27 infants infected with RV(sampled at recruitment during hospital admission and at convalescence, i.e. at least 3 months after recovery) andfrom 36 healthy control children.Results:Median (SD) EGF salivary concentration was 777 (529) pg/ml in RV-infected group at acute phase and 356(242) pg/m at convalescence, while it was 337 (119) pg/ml in the healthy control group. A significant associationwas found between EGF levels and hospitalization length of stay (P-value = 0.022; r2=−0.63).Conclusions:The salivary levels of EGF are significantly increased during the acute phase of natural RV infection,and relate to length of hospitalization. Further assessment of this non-invasive biomarker in RV disease is warranted. This study received support from the Instituto de Salud Carlos III (Proyecto de Investigación en Salud, Acción Estratégica en Salud): project GePEM ISCIII/PI16/01478/Cofinanciado FEDER) (A.S.) and project Rotanext ISCIII/PI13/02382 and ReSVinext ISCIII/PI16/01569/Cofinanciado FEDER (F.M.T.); Consellería de Sanidade, Xunta de Galicia (RHI07/2-intensificación actividad investigadora, PS09749 and 10PXIB918184PR), Instituto de Salud Carlos III (Intensificación de la actividad investigadora 2007–2012, PI16/01569), Fondo de Investigación Sanitaria (FIS; PI070069/PI1000540) del plan nacional de I + D + I and ‘fondos FEDER’ (F.M.T.), and 2016-PG071 Consolidación e Estructuración REDES 2016GI-1344 G3VIP (Grupo Gallego de Genética Vacunas Infecciones y Pediatría, ED341D R2016/021)(A.S. and F.M.T) SI