Category: Nevin Manimala

Int J Pharm Pract. 2023 Dec 10:riad087. doi: 10.1093/ijpp/riad087. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to investigate patterns of extended pharmacy services (EPS) provided by Malaysian community pharmacists and their willingness to provide value-added services (VAS) in addition to EPS. Additionally, this study examined the barriers to the effective implementation of these two services.

METHOD: A cross-sectional survey was conducted using a self-administered questionnaire among community pharmacists in Selangor and Kuala Lumpur. Convenience sampling was done, and descriptive statistics and correlation analysis were performed.

RESULTS: Two hundred and thirty-six pharmacists participated. The most rendered EPS were nutritional supplements, hypertension management, and diabetic management, while chronic kidney disease management, smoking cessation, and mental health services were the least rendered. Pharmacists were willing to provide medication waste management and vaccination as VAS but were less inclined towards therapeutic drug monitoring and sterile compounding. Barriers included limited access to medical records of patients, lack of designated counselling areas, and concerns about remuneration. High sales pressure and busy workloads were additional barriers to providing VAS. Continuous professional development (CPD) positively influenced pharmacists’ engagement in EPS and VAS.

CONCLUSIONS: This study highlights service provision trends and areas for improvement. Addressing identified barriers, such as enhancing access to patient records and establishing designated counselling areas, can improve service delivery. Remuneration models and workload management strategies should be considered to alleviate barriers related to sales pressure and time constraints. Promoting CPD opportunities is crucial for enhancing pharmacist engagement and optimizing EPS and VAS.

PMID:38071745 | DOI:10.1093/ijpp/riad087

Cogn Sci. 2023 Dec;47(12):e13384. doi: 10.1111/cogs.13384.

ABSTRACT

Previous studies provided evidence for a connection between language processing and language change. We add to these studies with an exploration of the influence of lexical-distributional properties of words in orthographic space, semantic space, and the mapping between orthographic and semantic space on the probability of lexical extinction. Through a binomial linear regression analysis, we investigated the probability of lexical extinction by the first decade of the twenty-first century (2000s) for words that existed in the first decade of the nineteenth-century (1800s) in eight data sets for five languages: English, French, German, Italian, and Spanish. The binomial linear regression analysis revealed that words that are more similar in form to other words are less likely to disappear from a language. By contrast, words that are more similar in meaning to other words are more likely to become extinct. In addition, a more consistent mapping between form and meaning protects a word from lexical extinction. A nonlinear time-to-event analysis furthermore revealed that the position of a word in orthographic and semantic space continues to influence the probability of it disappearing from a language for at least 200 years. Effects of the lexical-distributional properties of words under investigation here have been reported in the language processing literature as well. The results reported here, therefore, fit well with a usage-based approach to language change, which holds that language change is at least to some extent connected to cognitive mechanisms in the human brain.

PMID:38071744 | DOI:10.1111/cogs.13384

Int J Gynaecol Obstet. 2023 Dec 10. doi: 10.1002/ijgo.15283. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of the study was to explore the utility of fluorescein sodium (FNa) as a contrast agent for colposcopy to detect premalignant and malignant lesions of cervix. The primary objective was to determine and compare the percentage detection of premalignant and malignant lesions of FNa and acetic acid (AA) positive areas.

METHODS: This study included 120 screen positive women who underwent colposcopy using both 3% AA and FNa (0.06%). Observations for FNa staining were made under blue filter and directed biopsies were taken from acetowhite and fluorescent green areas. Benign lesions were considered as disease-negative and low grade squamous intraepithelial lesions (LSIL), high grade SIL (HSIL), and invasive cancer were considered as disease-positive. Correlation between histopathology and FNa and AA was determined by Kappa statistics.

RESULTS: The mean age was 39.59 ± 10.73 years and median parity was 2. Out of 120 patients, 57 had benign lesions, 18 had LSIL, 33 had HSIL and 12 had invasive carcinomas. Sensitivity was 98.41% versus 64.91% respectively and specificity was 85.71% versus 35.09% respectively with FNa and AA. Diagnostic accuracy of FNa and AA was 82.50% versus 61.60%. There was good agreement between FNa staining and final histopathology and fair agreement between AA application and HPE (κ = 0.643 vs 0.213, P < 0.001).

CONCLUSION: Using FNa as a contrast agent during colposcopy results in greater accuracy for detection of premalignant and malignant lesions of the cervix as compared to AA.

PMID:38071725 | DOI:10.1002/ijgo.15283

Ann Surg Oncol. 2023 Dec 10. doi: 10.1245/s10434-023-14689-5. Online ahead of print.

ABSTRACT

BACKGROUND: Minimally invasive sub-lobectomy is sufficient in treating small early-stage non-small cell lung cancer (NSCLC). However, comparison of the feasibility and oncologic efficacy between robot-assisted thoracoscopic surgery (RATS) and video-assisted thoracoscopic surgery (VATS) in performing sub-lobectomy for early-stage NSCLC patients age 80 years or older is scarce.

METHODS: Octogenarians with clinical stage IA NSCLC (tumor size, ≤ 2 cm) undergoing minimally invasive wedge resection or segmentectomy at Shanghai Chest Hospital from 2011 to 2020 were retrospectively reviewed from a prospectively maintained database. Propensity score-matching (PSM) with a RATS versus VATS ratio of 1:4 was performed. Perioperative and long-term outcomes were analyzed.

RESULTS: The study identified 594 patients (48 RATS and 546 VATS patients), and PSM resulted in 45 cases in the RATS group and 180 cases in the VATS group. The RATS patients experienced less intraoperative bleeding (60 mL [interquartile range (IQR), 50-100 mL] vs. 80 mL [IQR, 50-100 mL]; P = 0.027) and a shorter postoperative hospital stay (4 days [IQR, 3-5 days] vs. 5 days [IQR, 4-6 days]; P = 0.041) than the VATS patients. The two surgical approaches were comparable concerning other perioperative outcomes and postoperative complications (20.00% vs. 26.11%; P = 0.396). Additionally, during a median follow-up period of 66 months, RATS and VATS achieved comparable 5-year overall survival (90.48% vs. 87.93%; P = 0.891), recurrence-free survival (83.37% vs. 83.18%; P = 0.782), and cumulative incidence of death. Further subgroup comparison also demonstrated comparable long-term outcomes between the two approaches. Finally, multivariate Cox analysis indicated that the surgical approach was not independently correlated with long-term outcomes.

CONCLUSIONS: The RATS approach shortened the postoperative hospital stay, reduced intraoperative bleeding by a statistically notable but clinically insignificant amount, and achieved long-term outcomes comparable with VATS in performing sub-lobectomy for octogenarians with early-stage small NSCLC.

PMID:38071721 | DOI:10.1245/s10434-023-14689-5

Int J Clin Pharm. 2023 Dec 10. doi: 10.1007/s11096-023-01661-2. Online ahead of print.

ABSTRACT

BACKGROUND: Agitation is a common clinical problem encountered in the intensive care unit (ICU). Treatment options are based on clinical experience and sparse quality literature.

AIM: The aim of this study was to describe the effect of valproic acid (VPA) as adjuvant treatment for agitation in the ICU, identify predictors of response to VPA and evaluate the independent effect of VPA on agitation compared to standard of care (SOC).

METHOD: This retrospective single center observational study evaluated adult patients admitted to the ICU for whom a psychiatric consultation was requested for agitation management, with agitation defined as a Richmond Agitation Sedation Score of 2 or greater. A descriptive analysis of the proportion of agitation-free patients per day of follow-up, the incidence of agitation-related-events, as well as the evolution of co-medications use over time are presented. A logistic regression model was used to assess predictors of VPA response, defined as being agitation-free on Day 7 and generalized estimating equations were used to evaluate the independent effect of VPA as adjuvant therapy for agitation in the critically ill.

RESULTS: One hundred seventy-five patients were included in the study with 78 receiving VPA. The percentage of agitation-free patients on VPA was 6.5% (5/77) on Day 1, 14.1% (11/78) on Day 3 and 39.5% (30/76) on Day 7. Multivariate regression model for clinical and demographic variables identified female gender as predictor of response on Day 7 (OR 6.10 [1.18-31.64], p = 0.03). The independent effect of VPA was non-significant when compared to SOC.

CONCLUSION: Although VPA used as adjuvant treatment was associated with a decrease in agitation, its effect when compared to SOC did not yield significant results.

PMID:38071694 | DOI:10.1007/s11096-023-01661-2

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