Category: Nevin Manimala

J Nurses Prof Dev. 2023 Dec 8. doi: 10.1097/NND.0000000000001021. Online ahead of print.

ABSTRACT

A successful pilot program served as a model for how educators in healthcare organizations can reduce the academic-practice gap by supporting preceptors. Preceptors received enhanced training using self-paced online modules and an asynchronous online problem-based learning. Statistically significant increases in self-efficacy and satisfaction with training were reported. Preceptor training included strategies for teaching prioritization, communication, and clinical judgment. Preceptors experienced sustained resilience, increased awareness of well-being, and more engagement in the precepting role.

PMID:38071643 | DOI:10.1097/NND.0000000000001021

Int J Pharm Pract. 2023 Dec 10:riad086. doi: 10.1093/ijpp/riad086. Online ahead of print.

ABSTRACT

OBJECTIVES: Pharmacists have been increasingly integrated into primary care teams, leading to improved health outcomes for patients. The two objectives of this study were (i) to describe how the COVID-19 pandemic impacted pharmacists’ role in mental health care within Canadian primary care teams and (ii) to describe Canadian pharmacists’ experiences collaborating with other healthcare providers in the delivery of mental health services during the COVID-19 pandemic.

METHODS: Cross-sectional observational study utilizing an online survey consisting of closed-ended and open-ended questions. Primary care pharmacists in Ontario were eligible to participate. Descriptive statistics were collated, and qualitative data underwent thematic analysis. A total of 51 pharmacists participated in the study.

KEY FINDINGS: The COVID-19 pandemic has led to the expanding role of pharmacists in attending to the mental health care of patients. Working within a collaborative, interprofessional healthcare environment, pharmacists support patients’ mental health in a variety of ways, including medication education and management, non-pharmacologic approaches and supportive conversations, and identification of resources, including referrals, wellness checks, and consulting with physicians. Increasing demand for mental health services has led to higher referrals to pharmacists, which will likely persist and require further education of pharmacists in mental health along with better access to deliver virtual care.

CONCLUSION: In response to the increasing mental health care needs of patients since the COVID-19 pandemic, primary care pharmacists reported increased attention spent on mental health care. Building capacity and ensuring support for pharmacists to continue to address the increasing mental health care demands is essential.

PMID:38071626 | DOI:10.1093/ijpp/riad086

Ophthalmology. 2023 Oct 27:S0161-6420(23)00795-9. doi: 10.1016/j.ophtha.2023.10.026. Online ahead of print.

ABSTRACT

PURPOSE: The current, 8^th Edition, of the American Joint Committee on Cancer (AJCC) anatomic classification and staging model for uveal melanoma does not fully separate survival estimates for patients in advanced stages of the disease (e.g., IIIB and IIIC). Furthermore, some tumors in higher size categories have a smaller volume than tumors in lower categories. Therefore, we develop a novel model for prognostication of metastatic mortality based on estimations of tumor volume.

DESIGN: Retrospective multicenter case series of patients with uveal melanoma involving the choroid and/or ciliary body.

SUBJECTS: Six thousand five hundred and twenty-eight consecutively registered patients treated at three tertiary ocular oncology centers on two continents between 1981 and 2022.

METHODS: Data on survival, tumor size, and extent were collected from all 6528 patients. Tumor volume was estimated using a simple equation based on largest basal diameter and thickness. Volume-based size categories and stages were developed and validated in independent patient cohorts using competing risk analyses, and correlations with cytogenetic and cytomorphological features were examined.

MAIN OUTCOME MEASURE: Cumulative incidence of metastatic death.

RESULTS: The 6528 patients were distributed over seven stages based on estimated tumor volume and anatomic extent (V-stages IA, IB, IIA, IIB, IIIA, IIIB, and IIIC), with a 15-year incidence of metastatic death ranging from 7 to 77 %. A new category, V1min, and corresponding stage IA, were introduced, indicating an excellent prognosis. Metastatic mortality in V-stage IIIC was significantly higher than that in V-stage IIIB (P=0.03), while incidence curves crossed for patients in AJCC stage IIIC vs. IIIB (P=0.53). Uni- and multivariate competing risk regressions demonstrated higher Wald statistics for V-stages compared to AJCC stages (1152 vs. 1038; and 71 vs. 17, respectively). The frequency of monosomy 3, gain of chromosome 8q, and epithelioid cytomorphology increased with tumor volume (R² 0.70, 0.50, and 0.71, respectively. P<0.001) and showed similar correlations with both AJCC and V-stages.

CONCLUSIONS: Anatomic classification and staging of ciliary body and choroidal melanomas based on estimation of tumor volume improves prognostication of metastatic mortality.

PMID:38071620 | DOI:10.1016/j.ophtha.2023.10.026

West Afr J Med. 2023 Dec 4;40(12 Suppl 1):S44-S45.

ABSTRACT

BACKGROUND: A current worrisome global trend is the emigration of health workers from resource-constrained areas especially Africa, with 1 in 4 doctors, and 1 in 20 nurses leaving for developed countries. This phenomenon has resulted in a shortfall of over 1.5 million health workers in the region. The factors contributing to the trend remain multifaceted, with provider burnout playing a crucial role in this phenomenon. Several studies have highlighted the burden of burn out among health workers in public facilities. However, there still exists a gap in research, particularly in the context of private healthcare facilities in Nigeria.

AIM: The aim of this study was to determine the prevalence and pattern of burnout in healthcare professionals working at a private hospital in Abuja, Nigeria.

MATERIALS AND METHOD: A descriptive cross-sectional study involving 100 healthcare professionals (doctors, nurses, and pharmacists) was conducted using a multistage sampling method. Data collection included socio-demographic information, occupational details, and the Burnout Clinical Subtype Questionnaire (BCSQ-12). Statistical analysis employed Pearson’s Chi-square with a significance level of p < 0.05.

RESULTS: The study revealed 85% prevalence of burnout, with 71% experiencing overload, 61% lacking development opportunities, and 18% feeling neglected. No significant associations were found between burnout and socio-demographic or occupational characteristics.

CONCLUSION: This study highlights the high prevalence of burnout among healthcare professionals. This emphasizes the urgent need for integrating burnout screening into routine health assessments for healthcare workers. Doing so can protect their well-being, which may be a vital step in addressing the healthcare workforce crisis in Africa.

PMID:38071597

J Eur Acad Dermatol Venereol. 2023 Dec 10. doi: 10.1111/jdv.19687. Online ahead of print.

ABSTRACT

BACKGROUND: Methyl aminolevulinate (MAL) photodynamic therapy (PDT) is commonly used for field treatment of actinic keratoses (AKs). In standard natural daylight PDT (n-DL-PDT) the first step, after the application of chemical solar filter, is removal of crusts and scales by curettage, followed by the application of MAL cream. Some patients experience intense pain during curettage and stinging after application of the photosensitizer to just curettaged skin.

OBJECTIVES: To evaluate whether n-DL-PDT without curettage, but preceded by application of keratolytics, would maintain a similar efficacy, based on clinical, dermoscopic, reflectance confocal microscopy (RCM) assessments, safety and patient satisfaction as standard n-DL-PDT with curettage.

METHODS: Forty patients with multiple AKs on the face and/or scalp were enrolled in this study. Patients were randomized into two groups of treatment as follows: (i) MAL n-DL-PDT without previous curettage, preceded by skin preparation at home with keratolytics (30% urea cream, twice a day for 7 days; -Cur group) and (ii) MAL n-DL-PDT preceded by skin preparation at the hospital with curettage (+Cur group).

RESULTS: Thirty-nine participants completed the study. Four hundred and twenty-one AKs in -Cur group and 337 AKs in +Cur group were treated. The mean reduction in the number of AK lesions 3 months after the treatment was 10.7 (-54.7%) in the -Cur and 10.4 (-58.7%) in the +Cur group. We found that the differences in terms of efficacy and patient satisfaction comparing the two treatment regimens were not statistically significant. The pain score reported during and after daylight exposure was similar and low in both groups. Moreover, no unexpected adverse events occurred during the trial period.

CONCLUSIONS: According to our results, curettage is not necessary to obtain the full treatment effect of n-DL-PDT. We experienced in a real-life setting that n-DL-PDT protocol could be changed by replacing curettage with keratolytics.

PMID:38071596 | DOI:10.1111/jdv.19687

J Nucl Med. 2023 Dec 7:jnumed.123.266273. doi: 10.2967/jnumed.123.266273. Online ahead of print.

ABSTRACT

Cerebral blood flow (CBF) may be estimated from early-frame PET imaging of lipophilic tracers, such as amyloid agents, enabling measurement of this important biomarker in participants with dementia and memory decline. Although previous methods could map relative CBF, quantitative measurement in absolute units (mL/100 g/min) remained challenging and has not been evaluated against the gold standard method of [¹⁵O]water PET. The purpose of this study was to develop and validate a minimally invasive quantitative CBF imaging method combining early [¹⁸F]florbetaben (eFBB) with phase-contrast MRI using simultaneous PET/MRI. Methods: Twenty participants (11 men and 9 women; 8 cognitively normal, 9 with mild cognitive impairment, and 3 with dementia; 10 β-amyloid negative and 10 β-amyloid positive; 69 ± 9 y old) underwent [¹⁵O]water PET, phase-contract MRI, and eFBB imaging in a single session on a 3-T PET/MRI scanner. Quantitative CBF images were created from the first 2 min of brain activity after [¹⁸F]florbetaben injection combined with phase-contrast MRI measurement of total brain blood flow. These maps were compared with [¹⁵O]water CBF using concordance correlation (CC) and Bland-Altman statistics for gray matter, white matter, and individual regions derived from the automated anatomic labeling (AAL) atlas. Results: The 2 methods showed similar results in gray matter ([¹⁵O]water, 55.2 ± 14.7 mL/100 g/min; eFBB, 55.9 ± 14.2 mL/100 g/min; difference, 0.7 ± 2.4 mL/100 g/min; P = 0.2) and white matter ([¹⁵O]water, 21.4 ± 5.6 mL/100 g/min; eFBB, 21.2 ± 5.3 mL/100 g/min; difference, -0.2 ± 1.0 mL/100 g/min; P = 0.4). The intrasubject CC for AAL-derived regions was high (0.91 ± 0.04). Intersubject CC in different AAL-derived regions was similarly high, ranging from 0.86 for midfrontal regions to 0.98 for temporal regions. There were no significant differences in performance between the methods in the amyloid-positive and amyloid-negative groups as well as participants with different cognitive statuses. Conclusion: We conclude that eFBB PET/MRI can provide robust CBF measurements, highlighting the capability of simultaneous PET/MRI to provide measurements of both CBF and amyloid burden in a single imaging session in participants with memory disorders.

PMID:38071587 | DOI:10.2967/jnumed.123.266273

Inj Prev. 2023 Dec 8:ip-2023-045107. doi: 10.1136/ip-2023-045107. Online ahead of print.

ABSTRACT

BACKGROUND: Early identification of non-fatal strangulation in the context of intimate partner violence (IPV) is crucial due to its severe physical and psychological consequences for the individual experiencing it. This study investigates the under-reported and underestimated burden of IPV-related non-fatal strangulation by analysing assault-related injuries leading to anoxia and neck injuries.

METHODS: An IRB-exempt, retrospective review of prospectively collected data were performed using the National Electronic Injury Surveillance System All Injury Programme data from 2005 to 2019 for all assaults resulting in anoxia and neck injuries. The type and mechanism of assault injuries resulting in anoxia (excluding drowning, poisoning and aspiration), anatomical location of assault-related neck injuries and neck injury diagnosis by morphology, were analysed using statistical methods accounting for the weighted stratified nature of the data.

RESULTS: Out of a total of 24 493 518 assault-related injuries, 11.6% (N=2 842 862) resulted from IPV (defined as perpetrators being spouses/partners). Among 22 764 cases of assault-related anoxia, IPV accounted for 40.4%. Inhalation and suffocation were the dominant mechanisms (60.8%) of anoxia, with IPV contributing to 41.9% of such cases. Neck injuries represented only 3.0% of all assault-related injuries, with IPV accounting for 21% of all neck injuries and 31.9% of neck contusions.

CONCLUSIONS: The study reveals a significant burden of IPV-related anoxia and neck injuries, highlighting the importance of recognising IPV-related strangulation. Comprehensive screening for IPV should be conducted in patients with unexplained neck injuries, and all IPV patients should be screened for strangulation events.

PMID:38071575 | DOI:10.1136/ip-2023-045107

Arch Dis Child Fetal Neonatal Ed. 2023 Nov 23:fetalneonatal-2023-326333. doi: 10.1136/archdischild-2023-326333. Online ahead of print.

ABSTRACT

OBJECTIVE: To systematically review and meta-analyse the effect of late surfactant administration versus placebo in reducing the incidence of death or bronchopulmonary dysplasia (BPD) in preterm infants.

DESIGN: PubMed, EMBASE, CINAHL and Cochrane CENTRAL were searched until 30 May 2023, for randomised controlled trials (RCTs) comparing administration of surfactant after 48 hours of age versus placebo in preterm ventilator-dependent neonates. The primary outcome was incidence of death or BPD at 36 weeks’ postmenstrual age (PMA). Secondary outcomes included incidence of BPD at 36 weeks PMA, pre-discharge mortality, use of postnatal steroids, post-discharge respiratory support, treatment with steroids or hospitalisation prior to 1-year corrected age.

RESULTS: Pooled analyses of four RCTs (N=850) showed no statistically significant difference between groups in the incidence of death or BPD at 36 weeks’ PMA (relative risk (RR) 0.99; 95% CI 0.90 to 1.10; Grades of Recommendation, Assessment, Development and Evaluation (GRADE): moderate). Late surfactant administration significantly decreased the need for post-discharge respiratory support prior to 1-year corrected age (two RCTs; N=522; RR 0.72; 95% CI 0.59 to 0.89; GRADE: low). Other secondary outcomes did not differ significantly between the groups.

CONCLUSIONS: Administration of late surfactant does not improve the rates of death or BPD at 36 weeks when administered to preterm infants with prolonged respiratory insufficiency. Additional adequately powered trials are needed to establish the efficacy of late surfactant therapy in preterm infants.

PROSPERO REGISTRATION NUMBER: CRD42023432463.

PMID:38071552 | DOI:10.1136/archdischild-2023-326333

Arch Dis Child Fetal Neonatal Ed. 2023 Dec 6:fetalneonatal-2023-326340. doi: 10.1136/archdischild-2023-326340. Online ahead of print.

ABSTRACT

This paper critically examines ‘kitchen sink regression’, a practice characterised by the manual or automated selection of variables for a multivariable regression model based on p values or model-based information criteria. We highlight the pitfalls of this method, using examples from perinatal/neonatal medicine, and propose more robust alternatives. The concept of directed acyclic graphs (DAGs) is introduced as a tool for describing and analysing causal relationships. We highlight five key issues with ‘kitchen sink regression’: (1) the disregard for the directionality of variable relationships, (2) the lack of a meaningful causal interpretation of effect estimates from these models, (3) the inflated alpha error rate due to multiple testing, (4) the risk of overfitting and model instability and (5) the disregard for content expertise in model building. We advocate for the use of DAGs to guide variable selection for models that aim to examine associations between a putative risk factor and an outcome and emphasise the need for a more thoughtful and informed use of regression models in medical research.

PMID:38071518 | DOI:10.1136/archdischild-2023-326340

Int J Ment Health Nurs. 2023 Dec 10. doi: 10.1111/inm.13275. Online ahead of print.

ABSTRACT

The high prevalence of mental health problems and underutilization of mental health treatment are more severe among the Native Hawaiian and Other Pacific Islander (NHPI) populations and remain misunderstood and understudied. Examining mental health literacy (MHL) – the knowledge and beliefs about mental disorders – aids their recognition, management, or prevention – has been shown to identify barriers to seeking and receiving care. This study aimed to assess the level of MHL in NHPIs and identify associated demographic variables. Data for this cross-sectional study were collected from 298 US NHPIs via an online questionnaire of the Mental Health Literacy Scale (MHLS). The overall mean MHLS score was 121 (SD = 17.3), with statistically significant higher scores in female participants, >31 years old, Tongan, more educated, and with higher income. This study demonstrated that overall MHL is comparable among NHPI compared to the current literature. However, NHPI men ≤30 years old and with lower income had lower MHL, which may be linked to the mental health disparities specific to this population. Current interventions should focus on increasing knowledge of risk factors, causes, self-treatments, and available professional help regarding mental disorders. Efforts to improve the MHL of NHPI should target men ≤30 years with lower income (<$50 000).

PMID:38071505 | DOI:10.1111/inm.13275