Category: Nevin Manimala

Am J Health Syst Pharm. 2023 Aug 1:zxad172. doi: 10.1093/ajhp/zxad172. Online ahead of print.

ABSTRACT

DISCLAIMER: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

PURPOSE: With the implementation of a new electronic health record (EHR) system across Mayo Clinic, a project was approved to standardize and converge 9 region-specific large-volume infusion pump (LVP) drug libraries for Baxter SIGMA Spectrum pumps.

SUMMARY: The objectives of the project were to (1) develop recommendations for identified variances in practice, (2) consolidate regional drug libraries into a converged enterprise library, (3) improve the drug library management process, and (4) maintain or exceed previous Dose Error Reduction System (DERS) compliance for infusions administered. Harmonization efforts with infusion pumps decreased the number of drug libraries maintained, reduced content maintenance time, and increased readiness for smart infusion pump-EHR interoperability. Seven of the 8 regions for which change in DERS compliance was assessed showed improved compliance relative to baseline in the 30-day postwashout period. Furthermore, when comparing pre- and postimplementation DERS compliance, the number of regions meeting the minimum compliance rate of 95% increased from 5 to 6 regions.

CONCLUSION: The project improved the drug library management process, allowed for DERS compliance to be accurately compared across regions, and ensured that patients across the enterprise receive the same standard of care with the administration of intravenous medications.

PMID:37527506 | DOI:10.1093/ajhp/zxad172

J Infect Dis. 2023 Aug 1:jiad303. doi: 10.1093/infdis/jiad303. Online ahead of print.

ABSTRACT

BACKGROUND: The Global Influenza Hospital Surveillance Network (GIHSN) has since 2012 provided patient-level data on severe influenza-like illnesses from over 100 participating clinical sites worldwide based on a core protocol and consistent case definitions. To our knowledge, this is the first study to analyze multiple years of global, patient-level data generated by prospective, hospital-based surveillance across a large number of countries to investigate geographic differences in influenza severity.

METHODS: We used multivariable logistic regression to assess the risk of intensive care unit admission, mechanical ventilation, and in-hospital death among hospitalized patients with influenza and explored the role of patient-level covariates and country income.

RESULTS: The dataset included 73,121 patients hospitalized with respiratory illness in 22 countries, with 15,660 laboratory-confirmed for influenza. After adjusting for patient-level covariates we found a 7-fold increase in the risk of influenza-related intensive care unit admission in lower middle-income countries, compared to high-income countries (p = 0.01). The risk of mechanical ventilation and in-hospital death also increases by four-fold in lower middle-income countries, though these values were not statistically significant. We also find that influenza severity increased with older age and number of comorbidities. Across all severity outcomes studied and after controlling for patient characteristics, infection with influenza A/H1N1pdm09 was more severe than with A/H3N2.

CONCLUSIONS: Our study provides new information on influenza severity in under-resourced populations, particularly those in lower middle-income countries. Understanding the mechanisms responsible for these disparities will be important to improve management of influenza, optimize vaccine allocation, and mitigate global disease burden.

PMID:37527470 | DOI:10.1093/infdis/jiad303

Nicotine Tob Res. 2023 Aug 1:ntad133. doi: 10.1093/ntr/ntad133. Online ahead of print.

ABSTRACT

INTRODUCTION: Alaska Native and American Indian (ANAI) people have a smoking prevalence of 23%. Nicotine metabolite ratio (NMR) and genetic testing may enable tailored selection of tobacco cessation medication. The purpose of this study was to evaluate the relative contributions of NMR, cessation medication, demographics, and tobacco use history to cessation.

METHODS: Participants were recruited into an observational cohort study consisting of a baseline visit prior to their quit date and 6 week follow-up. Demographic and tobacco use surveys and blood, urine, and breath samples were collected at each visit. Electronic health records were queried for cessation medications. NMR was categorized into slow or normal nicotine metabolism phenotypes (<0.31 and ≥0.31 respectively). The main outcome was cessation at 6 weeks. Analyses consisted of descriptive statistics, medication/phenotype concordance, and estimates of relative risk of quitting.

RESULTS: We enrolled 151 ANAI adults who smoked cigarettes daily. Two-thirds had normal nicotine metabolism phenotype. Retrospective medication/phenotype concordance was 39%. The overall quit rate was 25%. No demographic factors or tobacco use history were associated with quit success. Varenicline and bupropion increased the likelihood of quitting (RR=2.93 [1.42, 6.03] and RR=2.52 [1.12, 5.64] respectively) compared to nicotine replacement therapy. Non-optimal medication/phenotype concordance decreased likelihood of quit success (RR=0.44 [0.22, 0.91]) compared to optimal concordance.

CONCLUSION: This exploratory study found associations between quit success and tobacco cessation medication as well as medication/phenotype concordance. Additional research is needed to assess use of NMR for treatment selection among ANAI people.

IMPLICATIONS: These results broadly support additional community-engaged research to improve medication/phenotype concordance in tribal health settings. Such interventional research holds promise to improve expectations, quit success, and health outcomes amongst individuals attempting to quit smoking.

PMID:37527452 | DOI:10.1093/ntr/ntad133

Toxicol Ind Health. 2023 Aug 1:7482337231191162. doi: 10.1177/07482337231191162. Online ahead of print.

ABSTRACT

Inhalation exposure to cosmetic talc has generated much scientific debate regarding its potential as a risk factor for mesothelioma, a rare, but fatal cancer. Barbers, hairdressers, and cosmetologists have regularly used cosmetic talc-containing products, but the collective epidemiological evidence for mesothelioma in these occupations has yet to be described. As such, we conducted a systematic review of PubMed and the National Institute for Occupational Safety and Health’s (NIOSH) Numbered Publications list to identify original epidemiological literature reporting measures of association between these occupations and incidence of or death from mesothelioma. Literature screening was performed independently twice, the results of which were summarized and tabulated and underwent a review for their accuracy. A total of 12 studies met our inclusion criteria, including three cohort, six case-control, and three proportionate mortality/registration studies. The data from these studies were collected in 13 European and North American countries, spanning more than 50 years. We supplemented this review with queries of occupational mortality databases that are managed by the Washington State Department of Health and NIOSH for 26 U.S. states. Most findings were null and if statistically significant, nearly all showed an inverse relationship, indicative of a protective effect of these occupations on mesothelioma risk. Overall, the epidemiological evidence does not support an increased risk of mesothelioma for these occupations. This research fills an important data gap on the etiology of mesothelioma in barbers, hairdressers, and cosmetologists, and provides a benchmark for those with comparatively less exposure, such as non-occupational users of similar cosmetic talc-containing products.

PMID:37527434 | DOI:10.1177/07482337231191162

Surg Infect (Larchmt). 2023 Aug 2. doi: 10.1089/sur.2023.030. Online ahead of print.

ABSTRACT

Abstract Background: Herpes simplex virus encephalitis (HSVE) is a rare post-operative infection that can be fatal if treatment is delayed. Herpes simplex virus type 1 (HSV-1) is a more common cause of encephalitis than herpes simplex virus type 2 (HSV-2), however, a significant overlap exists. The goal of this project was to understand the frequency and trend of HSVE after neurosurgery through a case series at our institution and in the literature with a focus on comparing HSV-1 versus HSV-2. Patients and Methods: A literature review of all published cases and case series of HSVE after neurosurgery was performed. Descriptive statistics comparing HSV-1 and HSV-2 encephalitis were computed. Data on demographics, symptoms, surgery, treatment, immunosuppression, imaging findings, steroids, and mortality were collected. Results: We identified 55 total cases of HSVE post-neurosurgery. These included 28 cases of HSV-1, 10 cases of HSV-2, and 17 cases of HSV-unspecified encephalitis. There were no differences in age, gender, symptoms, surgery, or latency between surgery and symptom onset between HSV-1 and HSV-2. Mortality was higher with HSV-1 versus HSV-2 although not statistically significant. The primary surgical indication varied substantially between HSV-1 and HSV-2. Conclusions: Herpes simplex virus encephalitis is often overlooked in the setting of encephalitis after surgery. A high index of suspicion is needed to prevent a delay in treatment.

PMID:37527427 | DOI:10.1089/sur.2023.030

West J Emerg Med. 2023 Jul 10;24(4):786-792. doi: 10.5811/westjem.57862.

ABSTRACT

OBJECTIVE: Patients discharged from the hospital with diagnoses of myocardial infarction, congestive heart failure or acute exacerbation of chronic obstructive pulmonary disease (COPD) have high rates of readmission. We sought to quantify the impact of a community paramedicine (CP) intervention on hospital readmission and emergency department (ED) and clinic utilization for patients discharged with these conditions and to calculate the difference in healthcare costs.

METHODS: This was a prospective, observational cohort study with a matched historical control. The groups were matched for qualifying diagnosis, age, gender, and ZIP code. The intervention group received 1-2 home visits per week by a community paramedic for 30 days. We calculated the number of all-cause hospital readmissions and ED and clinic visits, and used descriptive statistics to compare cohorts.

RESULTS: Included in the study were 78 intervention patients and 78 controls. Compared to controls, fewer subjects in the CP cohort had experienced a readmission at 120 days (34.6% vs 64.1%, P < 0.001) and 210 days (43.6% vs 75.6%, P < 0.001) after discharge. At 210 days the CP cohort had 40.9% fewer total hospital admissions, saving 218 bed days and $410,428 in healthcare costs. The CP cohort had 40.7% fewer total ED visits.

CONCLUSION: Patients who received a post-hospital community paramedic intervention had fewer hospital readmissions and ED visits, which resulted in saving 218 bed days and decreasing healthcare costs by $410,428. Incorporation of a home CP intervention of 30 days in this patient population has the potential to benefit payors, hospitals, and patients.

PMID:37527389 | DOI:10.5811/westjem.57862

West J Emerg Med. 2023 Jun 30;24(4):685-692. doi: 10.5811/westjem.58965.

ABSTRACT

INTRODUCTION: Point-of-care ultrasound (POCUS) is commonly used in the emergency department (ED) as a rapid diagnostic tool. Emergency medicine (EM) has been an early adopter of POCUS with indications expanding over the last 10 years. While the literature describes widespread use among academic sites, there is little data on clinical POCUS utilization at non-academic EDs. We sought to describe community emergency physician (EP) use of POCUS by quantifying the number and type of studies performed, characteristics of the performing physician, and quality metrics.

METHODS: Prior to the study period, all EPs underwent a standardized training and credentialing program. A retrospective review of all POCUS studies across 11 non-academic EDs from October 1, 2018-September 30, 2020 was performed by fellowship-trained physicians, who identified physician, exam type, and residency graduation year. The studies were then cross-referenced with quality review reports that assessed image acquisition, image interpretation, and image labeling. We performed descriptive statistics.

RESULTS: During the study period, 5,099 POCUS studies were performed by 170 EPs. Exams most frequently performed were cardiac (24%), focused assessment of sonography in trauma (21.7%), and pregnancy (16.2%). Recent EM residency graduates (<10 years) were higher utilizers of POCUS with a group mean of 1.3 exams per 100 patients. Of the studies done, 86% had no quality issues.

CONCLUSION: Community POCUS demonstrates a heavy focus on core exams performed by recent EM residency graduates with minimal quality issues after a standardized training program. This study is the first to quantify actual community POCUS use in multiple EDs and may impact credentialing and skills maintenance requirements.

PMID:37527388 | DOI:10.5811/westjem.58965

Radiat Res. 2023 Aug 1. doi: 10.1667/RADE-22-00189.1. Online ahead of print.

ABSTRACT

In radiobiology, and throughout translational biology, synergy theories for multi-component agent mixtures use 1-agent dose-effect relations (DERs) to calculate baseline neither synergy nor antagonism mixture DERs. The most used synergy theory, simple effect additivity, is not self-consistent when curvilinear 1-agent DERs are involved, and many alternatives have been suggested. In this paper we present the mathematical aspects of a new alternative, generalized Loewe additivity (GLA). To the best of our knowledge, generalized Loewe additivity is the only synergy theory that can systematically handle mixtures of agents that are malstressors (tend to produce disease) with countermeasures – agents that oppose malstressors and ameliorate malstressor damage. In practice countermeasures are often very important, so generalized Loewe additivity is potentially far-reaching. Our paper is a proof-of-principle preliminary study. Unfortunately, generalized Loewe additivity’s scope is restricted, in various unwelcome but perhaps unavoidable ways. Our results illustrate its strengths and its weaknesses. One area where our methodology has potentially important applications is analyzing counter-measure mitigation of galactic cosmic ray damage to astronauts during interplanetary travel.

PMID:37527362 | DOI:10.1667/RADE-22-00189.1

Am J Forensic Med Pathol. 2023 Jul 31. doi: 10.1097/PAF.0000000000000859. Online ahead of print.

ABSTRACT

Collecting and reporting accurate disaster mortality data are critical to informing disaster response and recovery efforts. The National Association of Medical Examiners convened an ad hoc committee to provide recommendations for the documentation and certification of disaster-related deaths. This article provides definitions for disasters and direct, indirect, and partially attributable disaster-related deaths; discusses jurisdiction for disaster-related deaths; offers recommendations for medical examiners/coroners (ME/Cs) for indicating the involvement of the disaster on the death certificate; discusses the role of the ME/C and non-ME/C in documenting and certifying disaster-related deaths; identifies existing systems for helping to identify the role of disaster on the death certificate; and describes disaster-related deaths that may require amendments of death certificates. The recommendations provided in this article seek to increase ME/C’s understanding of disaster-related deaths and promote uniformity in how to document these deaths on the death certificate.

PMID:37527356 | DOI:10.1097/PAF.0000000000000859

IEEE Trans Neural Netw Learn Syst. 2023 Aug 1;PP. doi: 10.1109/TNNLS.2023.3293888. Online ahead of print.

ABSTRACT

Traditional support vector machines (SVMs) are fragile in the presence of outliers; even a single corrupt data point can arbitrarily alter the quality of the approximation. If even a small fraction of columns is corrupted, then classification performance will inevitably deteriorate. This article considers the problem of high-dimensional data classification, where a number of the columns are arbitrarily corrupted. An efficient Support Matrix Machine that simultaneously performs matrix Recovery (SSMRe) is proposed, i.e. feature selection and classification through joint minimization of l_2,1 (the nuclear norm of L ). The data are assumed to consist of a low-rank clean matrix plus a sparse noisy matrix. SSMRe works under incoherence and ambiguity conditions and is able to recover an intrinsic matrix of higher rank in the presence of data densely corrupted. The objective function is a spectral extension of the conventional elastic net; it combines the property of matrix recovery along with low rank and joint sparsity to deal with complex high-dimensional noisy data. Furthermore, SSMRe leverages structural information, as well as the intrinsic structure of data, avoiding the inevitable upper bound. Experimental results on different real-time applications, supported by the theoretical analysis and statistical testing, show significant gain for BCI, face recognition, and person identification datasets, especially in the presence of outliers, while preserving a reasonable number of support vectors.

PMID:37527325 | DOI:10.1109/TNNLS.2023.3293888