Category: Nevin Manimala

JBI Evid Implement. 2023 Oct 17. doi: 10.1097/XEB.0000000000000385. Online ahead of print.

ABSTRACT

INTRODUCTION: Ward rounds are crucial inpatient activities during which patients’ conditions are discussed. Team-based models such as nurse-led ward rounds (NLWRs) have been conceptualized and trialled, with positive results.

METHODS: An evidence-based quality improvement pilot project to introduce NLWRs was implemented at a cardiovascular medical-surgical unit in a Singapore tertiary hospital. The JBI Evidence Implementation Framework was used to guide the project. The evidence-based NLWR format incorporated stakeholder feedback on NLWR frequency, preparation, coordination, and content. Baseline and 6-month post-implementation audits were carried out.

RESULTS: The 4 audit criteria improved from baseline, reaching 100% compliance for criteria 1, 2, and 3 associated with interprofessional communication and collaboration. An improvement from baseline (30% to 46.7%) was also observed for criterion 4 on patient involvement during medical ward rounds. Moreover, there were improvements in clinical outcome data such as patient hospitalization length, “best medical therapy” rates, and inpatient complications. A statistically significant improvement in nurses’ confidence to lead discussions during medical rounds was also observed (p = 0.026).

CONCLUSIONS: This project promoted greater compliance with NLWR criteria through audit and feedback cycles and the contextualization of implementation strategies. A well-supported program that prepares nurses for interprofessional communication also improves nurses’ confidence in team communication, bolstering their ability to provide high-quality patient care.

PMID:37846554 | DOI:10.1097/XEB.0000000000000385

Turk Neurosurg. 2023 Aug 18. doi: 10.5137/1019-5149.JTN.43674-23.1. Online ahead of print.

ABSTRACT

AIM: The pterional approach is a common procedure in neurosurgery but it has a broad degree of complications including temporal hollowing. The most of the patients who had temporal hollowing after pterional craniotomy have phychological, physical and social problems in rest of their lives. The purpose of this study is to investigate effect of osteoplastic pterional craniotomy on temporal hollowing and its sequelas.

MATERIAL AND METHODS: 97 patients who had pterional craniotomy for aneurysm surgery were analysed retrospectively. 63 of them were conventional pterional approach and 34 of them were osteoplastic pterional approach. Temporal muscle volume was calculated on postoperative 6th month CT bilaterally and differences between conventional pterional and osteoplastic approach were compared.

RESULTS: 97 patients, 45 of whom were female and 52 of whom were male, were included in the study. The mean age of these patients was 50.37 years. Of the patients in the conventional group, 31 were female and 32 were male. Of the patients in the osteoplastic group, 14 were female and 20 were male. The left and right temporal muscle volume difference is not statistically meaningful in osteoplastic approach group while the temporal muscle volume is slightly decreased in conventional pterional approach group when compared the non-operated side.

CONCLUSION: This study shows the osteoplastic pterional approach is superior to conventional pterional approach to keep muscle volume and function. Patients who underwent osteoplastic craniotomy demonstrated higher levels of satisfaction with their facial appearance compared to those who underwent craniotomy using the conventional pterional approach.

PMID:37846540 | DOI:10.5137/1019-5149.JTN.43674-23.1

Turk Neurosurg. 2023 Apr 12. doi: 10.5137/1019-5149.JTN.43003-22.3. Online ahead of print.

ABSTRACT

AIM: Carotid stenosis (CS) is one of the modifiable risk factors for stroke. We aimed to compare the postprocedural cerebral diffusion-weighted imaging (DWI) findings in cases of CS-related carotid plaques in terms of plaque morphology, degree of stenosis, and the use of a distal protection filter. We also used DWI to assess the asymptomatic cerebral embolism rates during carotid artery stending (CAS) operations performed for noncalcified versus calcified carotid plaques.

MATERIAL AND METHODS: Our study included 99 patients admitted to the Ankara City Hospital Stroke Center in 2022. All of our patients have been evaluated and scheduled for CAS as a result of a decision made by the council. Cases of stenosis of 50% in symptomatic patients and 70% in asymptomatic patients were included. The patients were grouped according to their Doppler ultrasonography results. All of the patients underwent DWI within the first 24 hours after the procedure, and then two groups of patients were compared.

RESULTS: A statistically significant difference was found between the distributions of the presence of silent micro-infarcts on DWI in terms of plaque characteristics (p 0.001). In the patients with normal DWI findings, the percentage of calcified plaques was 38.7%, while the percentages of hypoechoic plaques, plaques with low echogenicity, and ulcerated plaques were 91.3%, 85.7%, and 78.8%, respectively. The rates of calcified plaques and ulcerated plaques differed in the group of patients with silent micro-infarcts. The rate of silent micro-infarcts was 61.3% in the patients with calcified plaques, 8.7% in those with hypoechoic plaques, 14.3% in those with low-echogenicity plaques, and 21.2% in those with ulcerated plaques.

CONCLUSION: The study found that carotid stents implanted in calcified and ulcerated plaques had a higher correlation with the presence of periprocedural asymptomatic ipsilateral DWI findings than those implanted in hypoechoic plaques and low-echogenicity plaques.

PMID:37846536 | DOI:10.5137/1019-5149.JTN.43003-22.3

Turk Neurosurg. 2023 Feb 14. doi: 10.5137/1019-5149.JTN.43115-22.1. Online ahead of print.

ABSTRACT

AIM: Anterior cervical discectomy and fusion (ACDF) is a common spine procedure for cervical spinal cord decompression and treatment. In recent years, the incidence of obesity and public health awareness of the deleterious effects of obesity on surgical outcomes has increased. This study investigates the impact of obesity on ACDF postoperative morbidity and mortality.

MATERIAL AND METHODS: The American College of Surgeons’ National Surgical Quality Improvement Project (NSQIP) files from 2006 to 2019 were queried for all patients who underwent an ACDF. Fisher exact tests were used in analyzing univariate differences in preoperative comorbidities and postoperative morbidity and mortality between patients with and without obesity (BMI ≥ 30 kg/m2). Results with a p value 0.05 were considered statistically significant. Multivariable logistic regression models were used in determining the independent impact of obesity on ACDF postoperative morbidity and mortality. A p value 0.017 was required for multivariate statistical significance.

RESULTS: There were 96,882 patients who underwent an ACDF from 2006 to 2019 found. 53.77% had non-obese BMI. Patients had statistically significant differences in most perioperative comorbidities and postoperative outcomes on univariate analysis. On multivariate analysis, patients with obesity has decreased adjusted odds of wound infections (aOR = 0.7208, CI 0.574-0.9075, p = 0.0053), pulmonary events (aOR = 0.7939, CI 0.6903-0.9129, p = 0.0012), sepsis (aOR = 0.5670, CI 0.4359-0.7374, p = 2.32E-05), transfusion requirements (aOR = 0.5396, CI 0.4498-0.6473, p = 3.04E-11), return to operating room (aOR = 0.7537, CI 0.6727-0.8447, p = 1.17E-06), and length of stay 10 days (aOR = 0.7061, CI 0.6438-0.7744, p = 1.49E-13).

CONCLUSION: Obesity is a protective factor toward ACDF postoperative complications. Obesity as a marker of patient selection criteria for ACDF procedures should not be used by spine surgeons.

PMID:37846533 | DOI:10.5137/1019-5149.JTN.43115-22.1

Hum Reprod. 2023 Oct 16:dead210. doi: 10.1093/humrep/dead210. Online ahead of print.

ABSTRACT

STUDY QUESTION: Can emergency vitrification protect embryos and oocytes during natural disasters or other events that prevent normal practice to achieve satisfactory embryonic development and clinical outcomes at a later time?

SUMMARY ANSWER: Emergency vitrification of oocytes and Day 0-Day 5 (D0-D5) embryos during disasters is a safe and effective protective measure.

WHAT IS KNOWN ALREADY: When some destructive events such as floods, earthquakes, tsunamis, and other accidents occur, emergency vitrification in embryo laboratories to protect human embryos, oocytes, and sperm is one of the important measures of an IVF emergency plan. However, there are few detailed reports on emergency vitrification in a state of disaster, especially about oocytes and D0 zygotes. Therefore, the effectiveness and safety of emergency vitrification of oocytes and D0-D5 embryos in disaster states are still unclear.

STUDY DESIGN, SIZE, DURATION: A retrospective study was made in the Reproductive Medicine Center of the First Affiliated Hospital of Zhengzhou University from January 2018 to November 2022. The record rainstorms in Zhengzhou, China, caused severe flooding, traffic disruptions, and power outages. From 17:30, 20 July 2021 to 17:30, 21 July 2021, 1246 oocytes and D0-D5 embryos of 155 patients were vitrified whilst the laboratory had only an emergency power supply.

PARTICIPANTS/MATERIALS, SETTING, METHODS: As of 21 December 2021, 1149 emergency vitrified oocytes and D0-D5 embryos of 124 patients underwent frozen-thawed embryo transfer (FET). They were divided into the following four groups according to the days of embryo culture in vitro: oocyte group, Day 0-Day 1 (D0-D1) group, Day 2-Day 3 (D2-D3) group, and Day 4-Day 5 (D4-D5) group. Control groups for each were selected from fresh cycle patients who underwent IVF/ICSI from January 2018 to October 2021. Control and emergency vitrification patients were matched on criteria that included age, fertilization method, days of embryonic development, and number and grade of transferred embryos. A total of 493 control patients were randomly selected from the eligible patients and matched with the emergency vitrification groups in a ratio of 4:1. The results of assisted reproduction and follow-up of pregnancy were analyzed. The embryonic development, clinical outcomes, and birth outcomes in each group were statistically analyzed.

MAIN RESULTS AND THE ROLE OF CHANCE: A significant difference was observed in fertilization rate (81% versus 72%, P = 0.022) between the oocyte group and the control group. Significant differences were also observed in the monozygotic twin pregnancy rate (10% versus 0%, P = 0.038) and ectopic pregnancy rate (5% versus 0%, P = 0.039) between the D0-D1 group and the control group. No significant differences (P > 0.05) were observed between vitrified oocytes/D0-D1 embryos/D2-D3 embryos and the control group on the number of high-quality embryos (3.17 ± 3.00 versus 3.84 ± 3.01, P = 0.346; 5.04 ± 3.66 versus 4.56 ± 2.87, P = 0.346; 4.85 ± 5.36 versus 5.04 ± 4.64, P = 0.839), the number of usable blastocysts (1.22 ± 1.78 versus 1.21 ± 2.03, P = 0.981; 2.16 ± 2.26 versus 1.55 ± 2.08, P = 0.090; 2.82 ± 3.23 versus 2.58 ± 3.32, P = 0.706), clinical pregnancy rate (56% versus 57%, P = 0.915; 55% versus 55%, P = 1.000; 40% versus 50%, P = 0.488), miscarriage rate (30% versus 15%, P = 0.496; 5% versus 11%, P = 0.678; 17% versus 20%, P = 1.000), and live birth rate (39% versus 49%, P = 0.460; 53% versus 50%, P = 0.772; 33% versus 40%, P = 0.635). No significant differences (P > 0.05) were observed between the D4-D5 group and the control group on clinical pregnancy rate (40% versus 55%, P = 0.645), miscarriage rate (0% versus 18%, P = 1.000), and live birth rate (40% versus 45%, P = 1.000).

LIMITATIONS, REASONS FOR CAUTION: The retrospective study design is a limitation. The timing and extent of natural disasters are unpredictable, so the sample size of vitrified oocytes, zygotes, and embryos is beyond experimental control.

WIDER IMPLICATIONS OF THE FINDINGS: This study is the first study analyzing embryonic development, clinical outcomes, and birth outcomes of large samples of oocytes, D0 zygotes, and D1-D5 embryos after emergency vitrification under the disaster conditions. The results show that emergency vitrification is a safe and effective protective measure applicable to oocytes and D0-D5 embryos. The embryology laboratories need to be equipped with an emergency uninterrupted power supply capable of delivering for 6-8 h at full load.

STUDY FUNDING/COMPETING INTEREST(S): This work was supported by the National Natural Science Foundation of China (grant 81871206). The authors declare that they have no conflicts of interest. All authors have completed the ICMJE Disclosure form.

TRIAL REGISTRATION NUMBER: N/A.

PMID:37846525 | DOI:10.1093/humrep/dead210

Nicotine Tob Res. 2023 Oct 17:ntad202. doi: 10.1093/ntr/ntad202. Online ahead of print.

ABSTRACT

INTRODUCTION: Secondhand smoke (SHS) exposure during pregnancy is linked to adverse birth outcomes, such as low birth weight and preterm birth. While questionnaires are commonly used to assess SHS exposure, their ability to capture true exposure can vary, making it difficult for researchers to harmonize SHS measures. This study aimed to compare self-reported SHS exposure with measurements of airborne SHS in personal samples of pregnant women.

METHODS: SHS was measured on 48-hour integrated personal PM2.5 Teflon filters collected from 204 pregnant women, and self-reported SHS exposure measures were obtained via questionnaires. Descriptive statistics were calculated for airborne SHS measures, and analysis of variance tests assessed group differences in airborne SHS concentrations by self-reported SHS exposure.

RESULTS: Participants were 81% Hispanic, with a mean (SD) age of 28.2 (6.0) years. Geometric mean (SD) personal airborne SHS concentrations were 0.14 (9.41) µg/m3. Participants reporting lower education have significantly higher airborne SHS exposure (p=0.015). Mean airborne SHS concentrations were greater in those reporting longer duration with windows open in the home. There was no association between airborne SHS and self-reported SHS exposure; however, asking about the number of smokers nearby in the 48-hour monitoring period was most correlated with measured airborne SHS (Two+ smokers: 0.30µg/m3 vs. One: 0.12µg/m3 and Zero: 0.15µg/m3; p=0.230).

CONCLUSIONS: Self-reported SHS exposure was not associated with measured airborne SHS in personal PM2.5 samples. This suggests exposure misclassification using SHS questionnaires and the need for harmonized and validated questions to characterize this exposure in health studies.

IMPLICATIONS: This study adds to the growing body of evidence that measurement error is a major concern in pregnancy research, particularly in studies that rely on self-report questionnaires to measure secondhand smoke (SHS) exposure. The study introduces an alternative method of SHS exposure assessment using objective optical measurements, which can help improve the accuracy of exposure assessment. The findings emphasize the importance of using harmonized and validated SHS questionnaires in pregnancy health research to avoid biased effect estimates. This study can inform future research, practice, and policy development to reduce SHS exposure and its adverse health effects.

PMID:37846518 | DOI:10.1093/ntr/ntad202

J Cosmet Dermatol. 2023 Oct 17. doi: 10.1111/jocd.16032. Online ahead of print.

ABSTRACT

BACKGROUND: The application of nasolabial perforator flap for nasal reconstruction has been reported previously with satisfactory outcomes, but the outcomes and risk factors of postoperative adverse events have been unclear to plastic surgeons.

AIMS: To statistically analyze the effectiveness of the nasolabial perforator flap in nasal reconstruction and the risk factor of postoperative complications and re-operation.

PATIENTS/METHODS: This retrospective study evaluated 58 Chinese patients who underwent nasal reconstruction with the nasolabial perforator flap from 2009 to 2021. The esthetic and blood supply outcomes were measured by plastic surgeons on a 5-point Likert scale. Binary logistic regression was used to determine the risk factors associated with postoperative complications and re-operation.

RESULTS: The mean age of the cohort was 66.4 ± 2.0 years. The defect size ranged from 6.5 × 5.5 mm² to 40 × 70 mm² , and 48.3% of defects covered more than one nasal subunit. Venous congestion occurred in 4.9% of flaps, and the immediate overall postoperative score was 7.72/10. More than one nasal subunit of involvement was the risk factor associated with re-operation (p = 0.004), but no risk factor was associated with complications.

CONCLUSIONS: The nasolabial perforator flap is reliable for nasal reconstruction with good esthetic outcomes and fewer complications. However, a large number of involved subunits may lead to multiple surgeries for flap trimming in easterners.

PMID:37846506 | DOI:10.1111/jocd.16032

Eur J Dent Educ. 2023 Oct 17. doi: 10.1111/eje.12960. Online ahead of print.

ABSTRACT

INTRODUCTION: The use of simulation is extremely useful in pregraduate students. However, there is a very small number of simulators adapted to paediatric dentistry. A paediatric simulator was created to use in simulated scenarios for paediatric dentistry using an actress in the role of mother. The objectives of the present study were three. First, to analyse the perception of clinical competencies acquired by the students. Second, to examine the realism perceived by the students. Finally, to analyse the influence on the perception of clinical competencies after the integration of a handmade simulator in the Paediatric Dentistry III course.

MATERIALS AND METHODS: Eight clinical scenarios were carried out with a modified Erler Zimmer simulator for children, a professional actress in the role of the mother and two students (in the roles of dentist and assistant) on a paediatric dentistry case of pulpal pathology. The educational intervention was evaluated on 114 students by means of questionnaires with Likert-type answers applied pre- and post-simulation.

RESULTS: The perception of clinical competence in the students increased an average of 0.956 points in relation with the initial clinical evaluation, finding a strong correlation between the perception of subsequent competence and all the perceived realism, with significant statistical differences in all cases. The realism of the simulated participant (professional actress) was the best rated by the students, although not significantly. The realism of the mannequin was positively and strongly correlated with the perceived realism of the cabinet.

CONCLUSION: Simulation using a handmade mannequin with a professional actress in a simulated dental office increased the perception of clinical competence in 4th year dental students and raised the level of overall realism perceived by the student.

PMID:37846492 | DOI:10.1111/eje.12960

J Am Acad Audiol. 2023 Oct 16. doi: 10.1055/a-2192-5668. Online ahead of print.

ABSTRACT

BACKGROUND: Misophonia is a decreased tolerance of certain sounds related to eating noises, lip smacking, sniffing, breathing, clicking sounds, and tapping. While several validated self-report misophonia questionnaires exist, none focus solely on the impact of misophonia on the patient’s life. Additionally, there are no available validated pediatric self-report measures of misophonia. Therefore, a tool was needed to assess the impact of misophonia on both adult and pediatric patients.

PURPOSE: To evaluate the psychometric properties of the 8-item Misophonia Impact Questionnaire (MIQ).

RESEARCH DESIGN: This was a retrospective cross-sectional study.

STUDY SAMPLE: Patients who attended the Tinnitus and Hyperacusis Therapy Specialist Clinic (THTSC) in the UK seeking help for tinnitus, hyperacusis and/or misophonia (n = 256). A subsample of children aged 16 years or younger (n=15) was included for preliminary analyses of a version of the MIQ to be filled in by a parent (MIQ-P).

DATA COLLECTION AND ANALYSIS: Data were collected retrospectively from the records of patients held at the audiology department. These included demographic data, audiological measures and self-report questionnaires taken as part of routine care. Descriptive statistics and psychometric analyses were conducted. The MIQ was analyzed for item difficulty, factor structure, reliability, and construct validity.

RESULTS: Confirmatory factor analysis revealed that a one-factor model for the MIQ gave an excellent fit and its estimated reliability was excellent, with Cronbach’s α = 0.94. The total MIQ scores were highly correlated with scores for the Hyperacusis Impact Questionnaire (HIQ) and Sound Sensitivity Symptoms Questionnaire (SSSQ). MIQ scores were not significantly correlated with scores for the Tinnitus Impact Questionnaire (TIQ) or average hearing thresholds. Preliminary data from the sub-sample indicated excellent internal consistency for the MIQ-P, with Cronbach’s α = 0.92.

CONCLUSIONS: The MIQ is a promising questionnaire for assessing the impact of misophonia. Future studies should focus on establishing test/re-test reliability, identifying clinically significant change in MIQ scores, defining the severity of misophonia impact categories, and further exploring the psychometric properties of the MIQ-P.

PMID:37846484 | DOI:10.1055/a-2192-5668

Nurse Res. 2023 Oct 17. doi: 10.7748/nr.2023.e1903. Online ahead of print.

ABSTRACT

BACKGROUND: The best practice model states that the highest quality of scientific information in a discipline should be used when addressing pertinent problems. The usefulness of any measure depends on the least allowable error, which implies that best practice approaches must be used during analyses of rating scales. However, modern theories of objective measurement in advanced statistics suggest there are some shortcomings in reports of questionnaire analyses.

AIM: To highlight some common problems in questionnaire data and suggest techniques of constructing objective measures during rating scale analysis.

DISCUSSION: Questionnaires are frequently used as rating scales of latent variables, such as knowledge, anxiety and outcomes of treatments. However, reports of the steps involved before generating the final ‘measures’ often fail to present known limitations and robust solutions to the problems common to questionnaire data. Most designers of questionnaires generate variable measures for either educational or clinical research purposes without providing adequate explanations of the steps taken to address inherent limitations that may worsen the error terms in the outcome measure.

CONCLUSION: Cursory attention is given to the problems in questionnaire analysis as most users do not convincingly justify the measurement techniques they used before they present variable estimation. Reporting the techniques used to address data complexity by engaging objective measurement parameters ensures best practice and emphasises the credibility of the outcome measure.

IMPLICATIONS FOR PRACTICE: Among researchers, using the techniques outlined here will lead to standardisation of questionnaire analysis and elimination of avoidable errors in constructing variable measures, resulting in high-quality data suitable for parametric statistics. For clinicians, these methods will simplify the interpretation of numerical measures to equivalent indicators on Wright maps, thus avoiding inconsistencies and misinterpretations of variable measure.

PMID:37846471 | DOI:10.7748/nr.2023.e1903