Category: Nevin Manimala

J Pediatr Urol. 2024 Oct 11:S1477-5131(24)00531-X. doi: 10.1016/j.jpurol.2024.10.010. Online ahead of print.

ABSTRACT

INTRODUCTION: While not entirely understood, nocturnal enuresis (NE) has been considered pathophysiologically distinct from other non-neurogenic voiding disorders. We believe that a significant component of the pathology is due to bladder overactivity. Intravesical Onabotulinumtoxin A (OBTA) injections are utilized in overactive bladder management. We hypothesized that OBTA injections would be efficacious for NE management in pediatric patients with symptoms refractory to conventional therapies.

MATERIALS AND METHODS: A retrospective cohort analysis of patients <18-years-old with primary NE who underwent OBTA injections was performed. Injections were performed by a single surgeon at a single tertiary referral center per standardized protocol. Treatment response was defined as no improvement, greater than 50 % improvement in nightly accidents, or complete resolution of accidents. The primary outcome was treatment success, defined as greater than 50 % improvement in nightly accidents or complete resolution. Secondary outcomes included treatment response duration and complication data. Descriptive and bivariate statistics were performed as indicated. A Kaplan Meier analysis was performed to assess failure free survival following OBTA injection.

RESULTS: Fifty patients met inclusion criteria for this analysis. All patients had trialed at least one lifestyle modification, a bowel regimen, and at least two medications with symptom persistence. The median post-procedure follow-up time was 9.5 months (range 2-82). Improvement in incontinence symptoms compared to pre-operative baseline was seen in 94.0 % of patients, with 58.0 % demonstrating complete resolution of incontinence through most recent follow up. There was no difference in improvement rates or resolution rates in male vs female gender. The median failure free survival identified on Kaplan Meier analysis was 12.5 months (Figure 1) Minor post-operative complications (4 urinary tract infections; 1 retentive episode necessitating catheterization) were identified in five patients. There were no major post-operative complications.

DISCUSSION: Efficacy of OBTA injections was high, with treatment success demonstrated in 94 % of patients and failure free survival of 12.5 months. This procedure also demonstrated a favorable safety profile, with few minor post-operative complications identified. These results indicate that this procedure may be a beneficial therapeutic option for patients with NE refractory to multiple lines of conventional therapy. This study is limited by its retrospective design with short median follow up and potential for recall bias. It is strengthened by its large sample size and novelty.

CONCLUSIONS: To our knowledge, this is the first analysis of the efficacy of OBTA injections for management of primary NE. A follow up clinical trial is essential to further understand this association.

PMID:39482187 | DOI:10.1016/j.jpurol.2024.10.010

Child Abuse Negl. 2024 Oct 30:107099. doi: 10.1016/j.chiabu.2024.107099. Online ahead of print.

ABSTRACT

RATIONALE: Most child well-being and childhood adversity research is informed by proxy informants such as parents or teachers rather than children and youth. This may be due to concerns about perceived sensitivity, challenges accessing and engaging with children in research, ethical considerations, and apprehensions about causing undue harm and distress. This study aimed to understand adolescents’ identification of, and reactions to, questions in the context of participating in a survey of well-being and adversity.

OBJECTIVES: The aim of this study was to enhance our understanding of how adolescents identify and respond to potentially upsetting questions about well-being and life experiences, including childhood adversity.

METHOD: Data were from 1002 adolescent respondents aged 14 to 17 years. The Well-being and Experiences (WE) survey assessed several domains of life, including general health and well-being and early life adversity. Data were analyzed using descriptive statistics, logistic regression models, and thematic analysis approaches.

RESULTS: Few adolescent respondents reported feeling upset when completing the survey (11.2 %). Among those who reported feeling upset, 92.0 % indicated that it was still important to ask those upsetting questions, and only two respondents (1.8 %) thought upsetting questions should be removed. Ten themes emerged from the adolescents’ reflections on self-reported upsetting questions, including identity and life satisfaction, motivation, mental health, and school; childhood adversity was not primarily identified.

CONCLUSIONS: Findings indicate that conducting research on well-being and childhood adversity directly with adolescents is feasible and minimally distressing. Future research should consider how to engage youth directly in research to understand better the scope and outcomes associated with childhood adversity.

PMID:39482185 | DOI:10.1016/j.chiabu.2024.107099

J Voice. 2024 Oct 30:S0892-1997(24)00344-8. doi: 10.1016/j.jvoice.2024.10.001. Online ahead of print.

ABSTRACT

PURPOSE: The aim of this study is to assess the feasibility of an intensive voice therapy delivered via telepractice for pediatric vocal fold nodules (VFNs).

METHOD: Ten children with VFNs (mean age = 6 years, range = 5-8 years) were recruited in this study. Assessments including stroboscopic ratings, acoustic parameters, aerodynamic and auditory perceptual measures, and parent-reported Pediatric Voice Handicap Index were administered pretreatment and within 1 week post treatment. Eight resonant voice therapy sessions were provided three times a week via a secure online platform, which were completed within 3 weeks. The assessments were conducted in a clinical face-to-face modality in China, whereas the therapy sessions were all conducted online, with the participants and their caregivers in China and the speech-language pathologist in Taiwan.

RESULTS: All participants completed the therapy sessions as scheduled, and there were no dropouts. Statistical analyses showed that significant improvements in acoustic and aerodynamic parameters, as well as stroboscopic and auditory-perceptual ratings.

CONCLUSION: This study provides positive preliminary results indicating intensive voice therapy delivered via telepractice may be feasible and effective for the pediatric VFN population. Service providers and families may consider this delivery modality for ease of access when voice therapy is recommended.

PMID:39482182 | DOI:10.1016/j.jvoice.2024.10.001

Clin Ther. 2024 Oct 30:S0149-2918(24)00290-X. doi: 10.1016/j.clinthera.2024.09.027. Online ahead of print.

ABSTRACT

PURPOSE: Postoperative cognitive dysfunction (POCD) is a common neurologic complication that occurs after surgery, which prolongs the hospital stay of patients to a certain extent, increases the occurrence of complications, and even leads to the patient’s death. Intravenous lidocaine can reduce perioperative inflammatory response in patients undergoing surgery, but its effect on postoperative cognitive function has not been systematically evaluated. Notably, prior findings regarding the impact of intravenous lidocaine on postoperative cognitive function have been variable. Therefore, on this basis, this study explored the effects of intravenous lidocaine on postoperative cognitive function of patients undergoing general anesthesia through a systematic review and meta-analysis.

METHODS: Pubmed, Cochrane Library, Embase, Medline, Wanfang Medical Database, China Biomedical Literature Database, and China Academic Journals Full-Text Database were searched from inception to February 2024 for relevant studies that investigated effect of intravenous lidocaine on POCD in patients undergoing general anesthesia surgery. Key data obtained from the referenced literature included the prevalence of POCD, scores from the Mini-Mental State Examination (MMSE), and perioperative serum concentrations of neuron-specific enolase (NSE) and central nervous specific protein (S-100β) protein, serving as biomarkers for central nervous system specificity. Meta-analysis of data was performed using RevMan5.3 software. The software Trial Sequential Analysis (version 0.9) (TSA) was used to analyze high-quality literature focusing on POCD outcome indicators to explore the reliability of the results of meta-analysis.

FINDINGS: Twenty-five studies were included for quality evaluation and data analysis. The studies compared the effect of intravenous lidocaine on the incidence of POCD in patients undergoing surgery at different time points. Subgroup analysis was used to investigate the incidence of POCD at different time points. The results showed that intravenous lidocaine significantly reduced the incidence of POCD at 1, 3, 7, 9 days and 1 year after surgery compared with the control group (on the first day postoperatively: odds ratio (OR) = 0.48, 95% CI: 0.32-0.69, P < 0.001; postoperative day 3: OR = 0.42, 95% CI: 0.25-0.72, P = 0.002; postoperative day 7: OR = 0.34, 95% CI: 0.21-0.55, P < 0.001; postoperative day 9: OR = 0.32, 95% CI: 0.17-0.61, P < 0.001; 1 year postoperatively: OR = 0.39, 95% CI: 0.28-0.54, P < 0.001). The incidence of POCD in patients undergoing general anesthesia at postoperative day 1 with lidocaine was analyzed sequentially. The results showed that with the increase of the included sample size, the Z-curve still did not exceed the TSA boundary and did not reach the required information size. Fourteen studies compared MMSE scores before, 1, 2, 3, and 7 days after surgery between the 2 groups. The results showed that the MMSE score of lidocaine group was significantly higher than that of control group on the first and third postoperative day, with statistical significance (P < 0.05). Compared with the control group, the serum concentrations of neuron-specific enolase and central nervous specific protein in the lidocaine group significantly decreased postoperatively and on the first and third day postoperatively.

IMPLICATIONS: Perioperative intravenous lidocaine may improve postoperative cognitive function and reduce the incidence of POCD. However, limited to the current situation of low quality and small sample size, TSA analysis suggests the need for larger high-quality sample to confirm the accuracy of our findings.

CLINICAL TRIAL NUMBER: This is a systematic review, equivalent to a review, and does not require clinical trial registration. We have registered on PROSPERO.

REGISTRATION NUMBER: CRD42023493992.

PMID:39482176 | DOI:10.1016/j.clinthera.2024.09.027

J Pediatr Nurs. 2024 Oct 30:S0882-5963(24)00391-9. doi: 10.1016/j.pedn.2024.10.030. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to explore nurse perceptions of barriers and facilitators to weaning humidified high flow nasal cannula (HHFNC) in Australian paediatric settings.

DESIGN AND METHODS: A qualitative descriptive two phased study was conducted across Australia. Purposeful sampling and snowballing technique were used to recruit nurses with the study advertised widely on social media nursing groups. Phase One data collection was via a survey with open and closed ended questions, and Phase Two via semi-structured interviews. Data were analysed using descriptive statistics (Phase One) and thematic analysis (Phase One and Two) to identify themes and patterns in the narrative.

RESULTS: Phase one: 36(56.25 %) participants identified their workplace had clear guidelines, 57(89.06 %) received education on HHFNC and 34(57.63 %) experienced barriers when weaning. Three themes and nine subthemes were identified i) variable clinical process for weaning HHFNC, ii) knowledge and skills and iii) clinical observation and assessment of the child. Phase two: four themes and nine subthemes were identified, i) ‘There doesn’t seem to be any pattern’: no evidence to guide practice, ii) Nursing and medical led weaning, iii) Knowledge and skills and iv) Family centred approaches to weaning.

CONCLUSIONS: Current research on HHFNC does not consider best practice for weaning. This study identified barriers as inconsistency in weaning practice and availability of guidelines and facilitators were a robust education program and confidence in weaning. Multidisciplinary team need to collaborate to determine standardised weaning practice.

PRACTICE IMPLICATIONS: Further research is essential to determine best practice weaning methods and inform national/international guidelines.

PMID:39482166 | DOI:10.1016/j.pedn.2024.10.030

J Plast Reconstr Aesthet Surg. 2024 Oct 14:S1748-6815(24)00664-8. doi: 10.1016/j.bjps.2024.10.021. Online ahead of print.

ABSTRACT

BACKGROUND: There is currently no consensus on the efficacy of operative reinnervation at the time of post-mastectomy reconstruction. This review compares postoperative sensation between innervated and non-innervated flaps in breast reconstruction through systematic review and meta-analysis.

METHODS: EMBASE, Ovid, and CENTRAL were searched from inception to December 6, 2023. The primary outcome was level of sensation postoperatively. Secondary outcomes included presence of sensation, breast-related complications, operative time, and quality of life. Meta-analysis was conducted using mean difference (MD) or standardized mean difference (SMD) for continuous outcomes and odds radio (OR) for dichotomous outcomes. Quality of evidence was appraised using RoB-2/ROBINS-I. Certainty of evidence was assessed with Grading of Recommendations, Assessment, Development and Evaluations.

RESULTS: Twenty-eight studies were included; studies were observational studies except one randomized controlled trial. Common flaps were deep inferior epigastric perforator (11/28, 39.3%) and transversus rectus abdominis muscle (9/28, 32.1%). Innervated flaps were significantly associated with improved level of postoperative sensation (SMD: -0.94, 95% CI: [-1.35; -0.53], I²: 78%, p < 0.01), presence of postoperative sensation (OR: 11.4, 95% CI: [5.09; 24.5], I²: 0%, p < 0.01), and improved postoperative BREAST-Q scores (MD: 8.11, 95% CI: [4.33; 11.89], I²: 27%, p < 0.01). However, certainty of evidence was low/very low for all outcomes. Most studies had moderate risk of bias (56.5%). There were no statistically significant differences in breast-related complications or operative time.

CONCLUSIONS: Operative reinnervation in breast reconstruction is significantly associated with improved level and presence of postoperative sensation and BREAST-Q scores without significant increase in breast-related complications/operative time. More high-quality studies are required to improve the certainty of outcomes.

PMID:39482121 | DOI:10.1016/j.bjps.2024.10.021

Am J Crit Care. 2024 Nov 1;33(6):462-466. doi: 10.4037/ajcc2024422.

ABSTRACT

BACKGROUND: Social constructs like race can affect how patients are perceived and impact care. This study investigated whether mentions of race in notes for critically ill patients differed according to patients’ race.

METHODS: This retrospective cohort study included intensive care unit notes for adults (≥18 years old) admitted to any of 6 intensive care units at University of California, San Francisco, from 2012 through 2020. Notes were linked to National Provider Identifier records to obtain note writer characteristics. Logistic regression analysis with robust SEs clustered on note writers was adjusted for patient-, note- and clinician-level characteristics. Any race or ethnicity mention was the outcome of interest.

RESULTS: Among 5573 patients with 292 457 notes by 9742 unique note writers, 3225 patients (57.9%) self-reported their race as White, 997 (17.9%) as Asian, 860 (15.4%) as Latinx, and 491 (8.8%) as Black. Note writers documented race/ethnicity for 20.8% of Black, 10.9% of Latinx, 9.1% of White, and 4.4% of Asian patients. Black patients were more likely than White patients to have race mentioned in notes (adjusted odds ratio, 2.05 [95% CI, 1.49-2.82]).

CONCLUSIONS: Black patients were more than twice as likely as White patients to have race mentioned in notes. Note language containing information on social constructs has consequences for clinicians and patients reading notes and for algorithms trained on clinical notes.

PMID:39482093 | DOI:10.4037/ajcc2024422

Am J Crit Care. 2024 Nov 1;33(6):446-454. doi: 10.4037/ajcc2024898.

ABSTRACT

BACKGROUND: Various social determinants of health have been established as significant risk factors for COVID-19 transmission, prevalence, incidence, and mortality. Area deprivation index (ADI, a composite score made up of educational, housing, and poverty markers) is an accepted multidimensional social determinants of health measure. Little is known about how structural social determinants of health before hospitalization, including ADI, may affect mortality related to COVID-19 in critically ill patients.

OBJECTIVES: To examine the association of ADI with intensive care unit (ICU) mortality in patients with COVID-19 and compare its predictive power with that of clinical factors.

METHODS: This was a retrospective cohort study of critically ill adults with COVID-19 in 3 hospitals within a single health system. Multivariable logistic regression models (adjusted for demographic and clinical variables) were used to examine the association of ADI with ICU mortality.

RESULTS: Data from 1784 patients hospitalized from 2020 to 2022 were analyzed. In multivariable models, no association was found between national ADI and ICU mortality. Notable factors associated with ICU mortality included treatment year, age, van Walraven weighted score, invasive mechanical ventilation, and body mass index.

CONCLUSION: In this study, clinical factors were more predictive of mortality than ADI and other social determinants of health. The influence of ADI may be most relevant before hospital admission. These findings could serve as a foundation for shaping targeted public health strategies and hospital interventions, enhancing care delivery, and potentially contributing to better outcomes in future pandemics.

PMID:39482088 | DOI:10.4037/ajcc2024898

Am J Crit Care. 2024 Nov 1;33(6):468-472. doi: 10.4037/ajcc2024174.

ABSTRACT

BACKGROUND: Supporting the sleep health of surrogate decision-makers of patients in the intensive care unit is a research priority. However, few studies have approached sleep health as a multidimensional construct, instead focusing on 1 or 2 dimensions in isolation.

OBJECTIVE: To holistically examine the sleep health (satisfaction, timing, efficiency, duration) of surrogate decision-makers of critically ill patients.

METHODS: This secondary analysis involved surrogate decision-makers of incapacitated intensive care unit patients at a tertiary medical center in northeastern Ohio (n = 19). Sleep-health data were captured by means of a subjective scale (satisfaction) and objectively (timing, efficiency, duration) by means of a wrist-worn accelerometer (Actiwatch Spectrum Plus; Philips Respironics). Upon enrollment, participants completed the satisfaction scale and wore the Actiwatch Spectrum Plus for 3 consecutive days. Descriptive statistics of the study variables were evaluated.

RESULTS: A minority (15%) of the sample reported poor sleep satisfaction. Sleep timing variables were comparable to those found in other adult studies. Participants averaged approximately 6 hours of sleep per day with an average sleep efficiency of 83.7%.

CONCLUSIONS: Despite adequate satisfaction scores, intensive care unit surrogate decision-makers’ sleep duration is inadequate and sleep efficiency is suboptimal. Sleep-health interventions may be needed in this at-risk population. Future research should consider the impact of surrogate decision-maker sleep health on their capacity to serve in the surrogate decision-maker role.

PMID:39482083 | DOI:10.4037/ajcc2024174

Zhonghua Nei Ke Za Zhi. 2024 Nov 1;63(11):1087-1095. doi: 10.3760/cma.j.cn112138-20240410-00231.

ABSTRACT

Objective: To investigate the correlation between impulse oscillometry system examination indicators and conventional pulmonary ventilation function. Methods: The pulmonary ventilation function data of 10 883 patients from January 1, 2020 to December 31, 2022 at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology were included. The one-second rate [ratio of forced expiratory volume in the first second (FEV₁) to forced vital capacity (FVC)] measured as a percentage of the predicted value was ≥92% for the control group (n=3 478) and <92% for the pulmonary obstruction group (n=7 405). The obstruction group was subdivided into five groups according to the degree of pulmonary dysfunction: mild group (n=3 938),moderate group (n=1 142),oderate-severe group (n=917),severe group (n=737),and extremely severe group (n=671). Conventional pulmonary ventilatory function FVC, FEV₁, one-second rate, and forced expired flow at 50% of FVC (MEF50%), forced expired flow at 75% FVC (MEF25%), maximal mid-expiratory flow (MMEF), peak expiratory flow (PEF), and pulsed oscillation pulmonary function test were detected in both groups of patients. Impedance at 5 Hz (Z5) means total respiratory resistance, resistance at 5 Hz (R5) means total airway resistance, reactance at 5 Hz (X5) indicates the elastic recoil of the peripheral airways, and resistance at 20 Hz (R20) represents resistance of the central airways. R5-R20 reflects resistance in the small airways. Additionally, peripheral resistance (Rp), respiratory resonance frequency (Frex), and area under the reactance curve (Ax) were also measured. Correlation between the indicators of the two groups and the sensitivity and specificity of the impulse oscillometry system parameters for the diagnosis of obstructive pulmonary ventilation dysfunction were analyzed. Results: Pulmonary function force expiratory volume in the first second as a percentage of predicted value (FEV₁%Pre) [80.10 (54.95,97.10)%],one-second rate [62.43(48.67, 67.02)%],MEF50% [1.33 (0.62,1.97)L/s],MEF25% [0.28 (0.17,0.41)L/s], MMEF [0.85 (0.43,1.29)L/s],and PEF [5.64 (3.73,7.50)]L/s in the obstruction group were significantly lower than those in the control group (P<0.05). The differences within the subgroups of the obstruction group were also significant (P<0.05). Pulsed oscillation Z5 [0.42 (0.33,0.55)kPa·L^-1·s^-1],Rp [0.25 (0.20,0.45)kPa·L^-1·s^-1], R5 [0.39 (0.31,0.49)kPa·L^-1·s^-1], R20 [0.28 (0.24,0.34)kPa·L^-1·s^-1], R5-R20 [0.09 (0.05,0.17)kPa·L^-1·s^-1],Frex [16.32 (13.07,20.84)Hz], and Ax [0.67 (0.28,1.64)] indices in the obstruction group were significantly higher than those in the control group. X5 [-0.14 (-0.23, -0.10)kPa·L^-1·s^-1] was significantly lower than that in the control group (P<0.05). Z5, Rp, X5, R5, R5-R20, Frex, and Ax were statistically significant between different degrees of obstruction in the obstruction group (P<0.05). The impulse oscillometry system parameters Z5, Rp, R5, R20, R5-20, Frex, and Ax were negatively correlated with the indices of conventional pulmonary ventilation (r=-0.21-0.68, P<0.05), and the parameter X5 was positively correlated with the indices of conventional pulmonary ventilation (r=0.41-0.68, P<0.05). The pulsed oscillation pulmonary function test parameters X5 (58.60%-95.68%) and Ax (57.08%-98.06%) presented the best sensitivity; X5 (86.29%-98.82%), Frex (86.69%-94.71%), and Ax (88.10%-98.53%) displayed the best specificity; and R20 presented the worst sensitivity and specificity. The sensitivity and specificity were slightly better in female patients than in male patients. Conclusion: The technical parameters of the impulse oscillometry system showed significant correlation with relevant indices of conventional pulmonary ventilation function detection. These well reflect the changes of different degrees of pulmonary ventilation function and have greater significance for reference in evaluating the degree of pulmonary function impairment.

PMID:39482072 | DOI:10.3760/cma.j.cn112138-20240410-00231