Author: Nevin Manimala

Altern Ther Health Med. 2024 Jul 19:AT9967. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim was to investigate the factors associated with cough persistence after thoracoscopic lung cancer resection in elderly lung cancer patients and preventive strategies.

METHODS: In this study, 103 elderly patients with lung cancer who attended the department of thoracic surgery of our hospital from March 2019 to January 2023 were selected for retrospective analysis, all of whom underwent thoracoscopic lung cancer resection and were divided into the cough group (n = 37) and the no-cough group (n = 66) based on the presence or absence of persistent cough in the postoperative period. The clinical data of the patients were analyzed using univariate analysis and multifactorial logistic regression analysis.

RESULTS: The findings of the study show that there was no statistically significant difference when comparing the data of the two groups in terms of gender, age, history of diabetes mellitus, history of hypertension, pathologic type, TNM stage, intraoperative blood loss, and postoperative pleural fluid (P > .05). However, multifactorial analysis showed that preoperative history of smoking, the side of the operation being the right side, the extent of the operation being the lobes of the lungs, the time of tracheal intubation ≥172 min, the peritracheal lymph node clearance, and the occurrence of postoperative acid reflux were independent risk factors for the occurrence of persistent cough in patients after thoracoscopic lung cancer resection, while preoperative respiratory training was a protective factor (P < .05).

CONCLUSION: There are many factors affecting persistent cough after thoracoscopic lung cancer resection. These factors need to be paid close attention to in the clinic and preventive measures should be taken to minimize the occurrence of persistent cough and promote postoperative recovery.

PMID:39038316

Altern Ther Health Med. 2024 Jul 19:AT8981. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the current state of nurses’ intentions to report harmful incidents in the hematology department, and the influencing factors, to provide a relevant basis for ensuring healthcare quality and patient safety.

METHODS: By using a stratified sampling technique, 80 nurses from the hematology department of our hospital between June 2020 and June 2022 were randomly chosen as the research objects. The Chinese version of intention to report adverse event questionnaire (15 items with a scale of 0 to 1), adverse event report cognitive questionnaire (8 items with a scale of 0 to 1), and adverse event reporting attitude questionnaire (25 projects with a scale of 0 to 4) were used to collect data. Multiple linear regression model was used to explore the influencing variables based on the single-factor indicators with statistical significance.

RESULTS: When adverse events caused serious casualties or even death, the majority cases (96.25%) were reported to the superior supervisor; when the adverse events did not cause relevant injury, and was in potential vulnerability, the proportion of discussing with colleagues was the most (90.00% and 88.75%, respectively). For cognition on adverse events, “whether they understand the medical safety event reporting system” accounted for the most proportion (98.75%). The nurses had the highest scores for reporting standard [(25.58 ± 6.19) points] and lowest score for reporting purpose [(8.62 ± 1.51) points]. Age, educational background, years of employment, and professional titles were influencing factors of nurses’ inclination to report unfavorable events (P < .05).

CONCLUSION: The cognition and reporting attitude of nurses in the hematology department on adverse events need further improvement. The intention of the nurses to report adverse events is influenced by age, educational background, years of experience, and professional titles. Patient safety education especially with simulation-based training should be implemented, to decrease frequency of adverse incidents.

PMID:39038315

Ann Intern Med. 2024 Jul 23. doi: 10.7326/M23-3109. Online ahead of print.

ABSTRACT

BACKGROUND: Limited evidence exists on the safety of pharmacokinetic interactions of cytochrome P450 (CYP) 2D6 (CYP2D6)-metabolized opioids with antidepressants among older nursing home (NH) residents.

OBJECTIVE: To investigate the associations of concomitant use of CYP2D6-metabolized opioids and antidepressants with clinical outcomes and opioid-related adverse events (ORAEs).

DESIGN: Retrospective cohort study using a target trial emulation framework.

SETTING: 100% Medicare NH sample linked to Minimum Data Set (MDS) from 2010 to 2021.

PARTICIPANTS: Long-term residents aged 65 years and older receiving CYP2D6-metabolized opioids with a disease indication for antidepressant use.

INTERVENTION: Initiating CYP2D6-inhibiting versus CYP2D6-neutral antidepressants that overlapped with use of CYP2D6-metabolized opioids for 1 day or more.

MEASUREMENTS: Clinical outcomes were worsening pain, physical function, and depression from baseline to quarterly MDS assessments and were analyzed using modified Poisson regression models. The ORAE outcomes included counts of pain-related hospitalizations and emergency department (ED) visits, opioid use disorder (OUD), and opioid overdose and were analyzed with negative binomial or Poisson regression models. All models were adjusted for baseline covariates via inverse probability of treatment weighting.

RESULTS: Among 29 435 identified residents, use of CYP2D6-metabolized opioids concomitantly with CYP2D6-inhibiting (vs. CYP2D6-neutral) antidepressants was associated with a higher adjusted rate ratio of worsening pain (1.13 [95% CI, 1.09 to 1.17]) and higher adjusted incidence rate ratios of pain-related hospitalization (1.37 [CI, 1.19 to 1.59]), pain-related ED visit (1.49 [CI, 1.24 to 1.80]), and OUD (1.93 [CI, 1.37 to 2.73]), with no difference in physical function, depression, and opioid overdose.

LIMITATION: Findings are generalizable to NH populations only.

CONCLUSION: Use of CYP2D6-metabolized opioids concomitantly with CYP2D6-inhibiting (vs. CYP2D6-neutral) antidepressants was associated with worsening pain and increased risk for most assessed ORAEs among older NH residents.

PRIMARY FUNDING SOURCE: National Institute on Aging.

PMID:39038293 | DOI:10.7326/M23-3109

J Med Internet Res. 2024 Jul 22;26:e55757. doi: 10.2196/55757.

ABSTRACT

BACKGROUND: The proliferation of digital technology has the potential to transform diabetes management. One of the critical aspects of modern diabetes management remains the achievement of glycemic targets to avoid acute and long-term complications.

OBJECTIVE: This study aims to describe the landscape of evidence pertaining to the relative effectiveness or efficacy and safety of various digital interventions for the self-management of type 2 diabetes mellitus (T2DM), with a primary focus on reducing glycated hemoglobin A_1c (HbA_1c) levels.

METHODS: A systematic literature review (SLR) was conducted by searching Embase, MEDLINE, and CENTRAL on April 5, 2022. Study selection, data extraction, and quality assessment were performed by 2 independent reviewers. Eligibility criteria for the SLR included randomized controlled trials (RCTs) and comparative observational studies evaluating interventions containing both human (eg, coaching) and digital components (eg, glucose meter) in adult patients with T2DM. The primary meta-analysis was restricted to studies that reported laboratory-measured HbA_1c. In secondary analyses, meta-regression was performed with the intensity of coaching in the digital intervention as a categorical covariate.

RESULTS: In total, 28 studies were included in this analysis. Most studies (23/28, 82%) used the reduction of HbA_1c levels as the primary end point, either directly or as a part of a multicomponent outcome. In total, 21 studies reported statistically significant results with this primary end point. When stratified into 3 intervention categories by the intensity of the intervention supporting the digital health technology (analyzing all 28 studies), the success rate appeared to be proportional to the coaching intensity (ie, higher-intensity studies reported higher success rates). When the analysis was restricted to RCTs using the comparative improvement of HbA_1c levels, the effectiveness of the interventions was less clear. Only half (12/23, 52%) of the included RCTs reported statistically significant results. The meta-analyses were broadly aligned with the results of the SLR. The primary analysis estimated a greater reduction in HbA_1c associated with digital interventions compared with usual care (-0.31%, 95% CI -0.45% to -0.16%; P<.001). Meta-regression estimated reductions of -0.45% (95% CI -0.81% to -0.09%; P=.02), -0.29% (95% CI -0.48% to -0.11%; P=.003), and -0.28% (95% CI -0.65% to 0.09%; P=.20) associated with high-, medium-, and low-intensity interventions, respectively.

CONCLUSIONS: These findings suggest that reducing HbA_1c levels in individuals with T2DM with the help of digital interventions is feasible, effective, and acceptable. One common feature of effective digital health interventions was the availability of timely and responsive personalized coaching by a dedicated health care professional.

PMID:39037772 | DOI:10.2196/55757

JMIR Form Res. 2024 Jul 22;8:e57529. doi: 10.2196/57529.

ABSTRACT

BACKGROUND: Limited guidance exists for analyzing participant engagement in provider-guided digital health interventions (DHIs). System usage is commonly assessed, with acknowledged limitations in measuring socio-affective and cognitive aspects of engagement. Nurse WRITE, an 8-week web-based nurse-guided DHI for managing symptoms among women with recurrent ovarian cancer, offers an opportunity to develop a framework for assessing multidimensional engagement.

OBJECTIVE: This study aims to develop a conceptual and analytic framework to measure socio-affective, cognitive, and behavioral engagement with provider-guided DHIs. We then illustrate the framework’s ability to describe and categorize engagement using Nurse WRITE as an example.

METHODS: A sample of 68 participants from Nurse WRITE who posted on the message boards were included. We adapted a prior framework for conceptualizing and operationalizing engagement across 3 dimensions and finalized a set of 6 distinct measures. Using patients’ posts, we created 2 socio-affective engagement measures-total count of socio-affective engagement classes (eg, sharing personal experience) and total word count-and 2 cognitive engagement measures-total count of cognitive engagement classes (eg, asking information-seeking questions) and average question completion percentage. Additionally, we devised behavioral engagement measures using website data-the total count of symptom care plans and plan reviews. k-Means clustering categorized the participants into distinct groups based on levels of engagement across 3 dimensions. Descriptive statistics and narratives were used to describe engagement in 3 dimensions.

RESULTS: On average, participants displayed socio-affective engagement 34.7 times, writing 14,851 words. They showed cognitive engagement 19.4 times, with an average of 78.3% completion of nurses’ inquiries. Participants also submitted an average of 1.6 symptom care plans and 0.7 plan reviews. Participants were clustered into high (n=13), moderate (n=17), and low engagers (n=38) based on the 6 measures. High engagers wrote a median of 36,956 (IQR 26,199-46,265) words. They demonstrated socio-affective engagement approximately 81 times and cognitive engagement around 46 times, approximately 6 times that of the low engagers and twice that of the moderate engagers. High engagers had a median of 91.7% (IQR 82.2%-93.7%) completion of the nurses’ queries, whereas moderate engagers had 86.4% (IQR 80%-96.4%), and low engagers had 68.3% (IQR 60.1%-79.6%). High engagers completed a median of 3 symptom care plans and 2 reviews, while moderate engagers completed 2 plans and 1 review. Low engagers completed a median of 1 plan with no reviews.

CONCLUSIONS: This study developed and reported an engagement framework to guide behavioral intervention scientists in understanding and analyzing participants’ engagement with provider-guided DHIs. Significant variations in engagement levels across 3 dimensions highlight the importance of measuring engagement with provider-guided DHIs in socio-affective, cognitive, and behavioral dimensions. Future studies should validate the framework with other DHIs, explore the influence of patient and provider factors on engagement, and investigate how engagement influences intervention efficacy.

PMID:39037757 | DOI:10.2196/57529

J Phys Chem Lett. 2024 Jul 22:7635-7644. doi: 10.1021/acs.jpclett.4c01664. Online ahead of print.

ABSTRACT

The complex ionic-electronic conduction in mixed halide perovskites enables their use beyond von Neumann architectures implemented in resistive switching memory devices. Although device fabrication based on perovskite compounds involves solution-processing at low temperatures, reducing further fabrication costs by eliminating expensive materials can improve their compatibility with upscalable deposition techniques. Notably, the substrate on which the perovskite active layer is developed has been reported to severely affect its quality and thus the overall device performance. Hereby, we demonstrate the sustainable manufacturing of memristive perovskite solar cells by replacing the expensive poly[bis(4-phenyl)(2,4,6-trimethylphenyl)amine] (PTAA) that serves as a hole transporting layer (HTL) with a self-assembled monolayer (SAM), namely [2-(3,6-dimethoxy-9H-carbazol-9-yl)ethyl]phosphonic acid (MeO-2PACz). Multiple sequential memristive current-voltage characteristics of single devices are reported, and average data of multiple reference and targeted devices are compared. Resistive switching memory devices based on SAM exhibit improved performance having reduced average SET voltage values and narrower statistical variation compared to reference devices with PTAA. It is shown that both PTAA and SAM based devices exhibit high ON/OFF ratio of about 10³ operating at low switching electric fields. Replacing an expensive polymer-based HTL with this approach reduces fabrication costs compared to PTAA.

PMID:39037751 | DOI:10.1021/acs.jpclett.4c01664

Int J Surg. 2024 Jul 22. doi: 10.1097/JS9.0000000000001952. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim is to assess and contrast the effectiveness and safety of employing robotic surgery versus traditional open surgery in managing cases of hilar cholangiocarcinoma.

METHODS: Computer searches were conducted in PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), and Wanfang Database to identify case-control studies comparing robotic surgery with traditional open surgery in the treatment of hilar cholangiocarcinoma from inception until July 2023. References from retrieved articles were reviewed to broaden the search. This review was prospectively registered in the PROSPERO database (PROSPERO ID: CRD42024527511) and reported in line with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and AMSTAR (Assessing the methodological quality of systematic reviews) Guidelines.The primary outcome measures included operation time, intraoperative blood transfusion rate, R0 resection rate, lymph node metastasis rate, incidence of postoperative complications, and postoperative hospital stay. Data analysis was performed using RevMan 5.4 software, calculating combined odds ratios (OR), mean differences (MD), and 95% confidence intervals (95% CI).

RESULTS: A total of 4 studies encompassing 267 patients diagnosed with hilar cholangiocarcinoma (177 males and 90 females, mean age of (58.8±5.7) years) were included in this analysis. Among these, 165 patients underwent open surgery, while 102 patients underwent robotic surgery. The results of the meta-analysis demonstrated comparable outcomes between the two groups. Specifically, the operation time between the robotic surgery and open surgery cohorts did not significantly differ (MD=-103.96, 95% CI: -216.90 to 8.98, P=0.070). Additionally, the intraoperative blood transfusion rate (OR=1.32, 95% CI: 0.43 to 4.07, P=0.630), R0 resection rate (OR=1.41, 95% CI: 0.71 to 2.81, P=0.330), and lymph node metastasis rate (OR=1.62, 95% CI: 0.46 to 5.63, P=0.450) showed no significant differences between the groups. Similarly, there were no statistically significant disparities observed in the incidence of postoperative complications (OR=0.60, 95% CI: 0.28 to 1.31, P=0.200) and postoperative hospital stay (MD=2.17, 95% CI: -11.56 to 15.90, P=0.760).

CONCLUSION: In the treatment of hilar cholangiocarcinoma, robotic surgery demonstrates comparable safety and feasibility to traditional open surgery. However, due to the limited quantity and quality of the included studies, these conclusions warrant validation through additional high-quality investigations.

PMID:39037741 | DOI:10.1097/JS9.0000000000001952

Int J Surg. 2024 Jul 22. doi: 10.1097/JS9.0000000000001981. Online ahead of print.

ABSTRACT

The management and outcomes of patients with thymoma associated with myasthenia gravis (TAMG) are heterogeneous. Here, we propose a novel classification system based on Masaoka stage and Myasthenia Gravis Foundation of America (MGFA) classification, aiming to guide surgical decisions and perioperative management for these patients. Considering both oncological and neurological factors, this novel TAMG classification provides valuable information on outcome stratification and clinical decision-making for TAMG.

PMID:39037728 | DOI:10.1097/JS9.0000000000001981

J Imaging Inform Med. 2024 Jul 22. doi: 10.1007/s10278-024-01195-7. Online ahead of print.

ABSTRACT

Adenomatous polyps, a common premalignant lesion, are often classified into villous adenoma (VA) and tubular adenoma (TA). VA has a higher risk of malignancy, whereas TA typically grows slowly and has a lower likelihood of cancerous transformation. Accurate classification is essential for tailored treatment. In this study, we develop a deep learning-based approach for the localization and classification of adenomatous polyps using endoscopic images. Specifically, a pre-trained EGE-UNet is first adopted to extract regions of interest from original images. Multi-level feature maps are then extracted by the feature extraction pipeline (FEP). The deep-level features are fed into the Pyramid Pooling Module (PPM) to capture global contextual information, and the squeeze body edge (SBE) module is then used to decouple the body and edge parts of features, enabling separate analysis of their distinct characteristics. The Group Aggregation Bridge (GAB) and Boundary Enhancement Module (BEM) are then applied to enhance the body features and edge features, respectively, emphasizing their structural and morphological characteristics. By combining the features of the body and edge parts, the final output can be obtained. Experiments show the proposed method achieved promising results on two private datasets. For adenoma vs. non-adenoma classification, It achieved a mIoU of 91.41%, mPA of 96.33%, mHD of 11.63, and mASD of 2.33. For adenoma subclassification (non-adenomas vs. villous adenomas vs. tubular adenomas), it achieved a mIoU of 91.21%, mPA of 94.83%, mHD of 13.75, and mASD of 2.56. These results demonstrate the potential of our approach for precise adenomatous polyp classification.

PMID:39037669 | DOI:10.1007/s10278-024-01195-7

Appl Psychophysiol Biofeedback. 2024 Jul 22. doi: 10.1007/s10484-024-09653-2. Online ahead of print.

ABSTRACT

To investigate the clinical efficacy of acupuncture combined with biofeedback electrical stimulation on female stress urinary incontinence. Ninety patients diagnosed in a hospital between January 2020 and January 2021 were randomly divided into three groups (A, B and C). Group A was treated with biofeedback electrical stimulation, 3 times a week for 30 min for 15 times. Group B used acupuncture treatment, including Guanyuan, Qihai, Zhongji, Zusanli, Sanyinjiao and Yinlingquan, once a day, Monday-Friday, 30 min each, for a total of 10 times. Group C was treated with acupuncture combined with biofeedback electrical stimulation. All three groups were combined with pelvic floor muscle training. Following treatment, the changes in class I and II muscle fibre strength, ICI-Q-SF score and urine leakage in the 1-hour pad test were compared. Prior to treatment, there was no significant difference in the general data of the three patient groups, as well as class I and II muscle fibre strength, ICI-Q-SF score and 1-hour urinary pad test (P > 0.05). Following treatment, class I and II muscle fibre strength in groups A and C improved compared with before, with statistical significance (P < 0.05); there was no significant difference in group B (P > 0.05). In the three groups, ICI-Q-SF scores and 1-hour urinary pad test results were lower compared with before (P < 0.05), with those in group C better than those in groups A and B (P < 0.05). The treatment efficiency of the three patient groups was 86.7%, 83.3% and 96.7%, respectively. Combined acupuncture and biofeedback electrical stimulation can improve pelvic floor muscle strength, urine leakage and quality of life, and can be superior to biofeedback and acupuncture treatment alone.

PMID:39037667 | DOI:10.1007/s10484-024-09653-2