Category: Nevin Manimala

Risk Manag Healthc Policy. 2023 Aug 18;16:1611-1620. doi: 10.2147/RMHP.S423108. eCollection 2023.

ABSTRACT

PURPOSE: Adverse events bring pain to patients, prolong hospitalization, and may even endanger life, it is necessary to effectively identify and manage adverse events. However, in Chinese mainland, there are few studies on adverse events in Central Sterile Supply Department. The purpose of this study was to investigate the prevalence of adverse events in Central Sterile Supply Department and offer suggestions for enhanced quality management.

MATERIALS AND METHODS: A retrospective study was conducted to assess the prevalence of adverse events in a tertiary hospital from January 2020 to December 2022, employing a convenient sampling approach. The occurrence of adverse events of CSSD shall be collected for the basic information of the principal person of adverse events and the information of the adverse event. Descriptive statistics are described by frequency (percentage) and are analyzed by using X² test.

RESULTS: A total of 101 adverse events were reported, with the majority being attributed to substandard cleaning quality (34, 33.66%), followed by faulty instrument assembly (25, 24.75%) and defective marking (7, 6.93%). Additionally, incorrectly sterilized items (6, 5.94%), occupational exposures (3, 2.97%) and late distribution (5, 4.95%) were also observed, accidents (8, 7.92%) and other types of adverse events (13, 12.87%). The highest risk chain for adverse events was identified as inspection and packaging (49, 48.51%) and device cleaning (32, 31.68%), with the majority of adverse events occurring on a scale of three (30, 29.7%) and four (70, 69.31%), respectively. Furthermore, it was determined that the type of person responsible, education, years of work and the structure of the device, the number of instruments in the operating kit, and the size of the kit may be factors in the occurrence of adverse events (P < 0.05).

CONCLUSION: Adverse events occur frequently in central sterile supply department, thus necessitating strict supervision during cleaning and inspection of packaging. Managers should pay special attention to staff with low working life and education. Furthermore, a grading system, in line with the central sterile supply department, should be implemented to ensure the management of adverse events and the quality of services provided is harmonized.

PMID:37614961 | PMC:PMC10443689 | DOI:10.2147/RMHP.S423108

Front Med (Lausanne). 2023 Aug 8;10:1214277. doi: 10.3389/fmed.2023.1214277. eCollection 2023.

ABSTRACT

BACKGROUND: Osteoporosis is a silent chronic obstructive pulmonary disease (COPD) comorbidity that is often under-detected. We aimed to study the prevalence and potential predictors of osteoporosis in COPD. Dynamic changes in bone mass density (BMD) and treatment efficacy of bisphosphonate were also assessed.

METHODS: This prospective cohort study included COPD patients between January 2017 and January 2019. Demographics data, spirometric parameters, and C-reactive protein (CRP) were collected. Bone mineral density (BMD) at the lumbar spine (L2-4) and both femoral necks were measured after enrollment and the 12-month follow-up. Participants were categorized into three groups per the baseline BMD T-score: normal (≥ – 1.0), osteopenia (between -1.0 and – 2.5), and osteoporosis (≤ – 2.5). In the osteoporosis group, alendronate 70 mg/week with vitamin D and calcium was prescribed.

RESULTS: In total, 108 COPD patients were enrolled. The prevalence of osteoporosis and osteopenia were 31.5 and 32.4%, respectively. Advanced age, lower body mass index (BMI), history of exacerbation in the previous year, and high CRP levels were significant predictors of osteoporosis. After 12 months, 35.3% in the osteoporosis group reported new vertebral and femoral fractures, compared to none in the non-osteoporosis group (p < 0.001). In the normal BMD and osteopenia groups showed a further decline in BMD after 12-month. Conversely, the osteoporosis group showed a statistically significant improvement in BMD after anti-resorptive treatment (p < 0.001).

CONCLUSION: The prevalence of osteoporosis was high in Thai COPD patients. Advanced age, lower BMI, history of exacerbation, and high CRP levels were potential predictors. A rapid decline in BMD was observed in COPD patients without treatment.

PMID:37614952 | PMC:PMC10442549 | DOI:10.3389/fmed.2023.1214277

Front Med (Lausanne). 2023 Aug 8;10:1226090. doi: 10.3389/fmed.2023.1226090. eCollection 2023.

ABSTRACT

BACKGROUND: Soft tissue sarcomas (STS) are rare malignancies which prognosis varies significantly by primary site, histological subtype, and tumor stage. Their low incidence, and the complexity of their clinico-pathological characteristics demand standardized, cancer-tailored diagnostics and therapies managed at high-volume, multidisciplinary care centers. This study evaluates the quality of STS management in north-east Italy (Veneto Region) through a list of ad hoc defined clinical indicators.

METHODS: This population-based study concerns all incident cases of STS in 2018 (214 cases) recorded in the adult population censored by the Veneto’s regional Cancer Registry. Based on the international literature, a multidisciplinary working group of experts identified a set of indicators for monitoring the quality of diagnostic, therapeutic, and end-of-life clinical interventions. The quality of care was assessed by comparing the reference thresholds with the indicators’ values achieved in clinical practice.

RESULTS: Diagnostic procedures showed poor adherence to the thresholds, with a low percentage of histological diagnoses validated by a second opinion. The indicators relating to the surgical treatment of superficial, small, low-grade STS, or of medium, high-grade STS of the head-neck, trunk, or limbs were consistent with the thresholds, while for intermediate, high-grade (large-sized, deep) and retroperitoneal STS they fell significantly below the thresholds.

CONCLUSION: A critical evaluation of the clinical indicators allowed to uncover the procedures needing corrective action. Monitoring clinical care indicators improves cancer care, confirms the importance of managing rare cancers at highly specialized, high-volume centers, and promotes the ethical sustainability of the healthcare system.

PMID:37614947 | PMC:PMC10442531 | DOI:10.3389/fmed.2023.1226090

Can Prosthet Orthot J. 2021 Jun 29;4(1):35297. doi: 10.33137/cpoj.v4i1.35297. eCollection 2021.

ABSTRACT

BACKGROUND: Clinical outcome assessments provide important input for the rehabilitation of individuals with transfemoral amputation. Differences in prosthetic knee designs may influence clinical outcomes.

OBJECTIVES: The aim of this study was to compare functional mobility, balance, prosthetic satisfaction and quality of life in individuals with unilateral transfemoral amputation with microprocessor-controlled (MPK) and non-microprocessor knee designs (Non-MPK).

METHODOLOGY: The study included ten experienced MPK (Rheo Knee) users (Group 1) and ten experienced Non-MPK (Total Knee^® 2000) users (Group 2). For mobility; the 6 Minute Walk Test (6MWT), for balance; the Berg Balance Scale (BBS), Single Leg Stand Test (SLST) and Four Square Step Test (FSST), for quality of life; the Nottingham Health Profile (NHP) and for prosthetic satisfaction; the Satisfaction with Prosthesis Questionnaire (SATPRO) were administered.

FINDINGS: 6MWT results of the MPK group were significantly higher than Non-MPK group (p<0.05). In the MPK group a strong negative correlation was found between the FSST and the 6MWT (r=-0.661, p=0.038). No statistically significant differences were found between the groups (p>0.05) comparing balance, prosthesis satisfaction and quality of life values.

CONCLUSION: The findings will inform about the patient’s prognosis and the expected clinical outcomes when prescribing an MPK or an Non-MPK. Individuals with unilateral transfemoral amputation covered longer distances using an MPK compared to Non-MPK.

PMID:37614931 | PMC:PMC10443503 | DOI:10.33137/cpoj.v4i1.35297

Can Prosthet Orthot J. 2021 Aug 16;4(1):36833. doi: 10.33137/cpoj.v4i1.36833. eCollection 2021.

ABSTRACT

BACKGROUND: The prevalence of lower-limb amputations (LLA) in older adults is increasing. Due to the substantial resources required for rehabilitation, there is growing interest in exploring prosthesis use as well as the factors that impact use for individuals with LLA.

OBJECTIVES: To examine how older adults, those over 50 years old, with a new LLA use their prostheses following rehabilitation and to identify factors that increase or decrease prosthesis use after discharge from a rehabilitation hospital.

METHODS: The StepWatch Activity Monitor, the Prosthetic Profile of the Amputee Questionnaire, and a semi-structured interview were used to measure prosthesis use and factors affecting use at 12 weeks post-discharge from a rehabilitation hospital. Descriptive statistics were calculated for the quantitative data and the qualitative interviews were analyzed using the International Classification of Functioning and Disability.

RESULTS: Two user profiles emerged from the 11 participants’ use patterns. The Regular Users integrated their prosthesis into their lives, using it for various types of activities, while the Strategic Users wore their prosthesis to perform specific activities of daily and instrumental activities of daily living tasks. Body functions (e.g., pain), personal (e.g., feeling of independence), and environmental factors (e.g., home adaptations or social support) impacted prosthesis use.

CONCLUSIONS: The emergence of profiles suggests variability in how older adults with LLA use their prosthesis after rehabilitation. However, the factors affecting prosthesis use were similar between the profiles. Therefore, while it is important for rehabilitation teams to consider patients’ individual needs when setting goals for prosthetic training, they must also consider common factors affecting prosthesis use.

PMID:37614929 | PMC:PMC10443515 | DOI:10.33137/cpoj.v4i1.36833

Curr Zool. 2022 Jul 16;69(4):456-474. doi: 10.1093/cz/zoac055. eCollection 2023 Aug.

ABSTRACT

Morphological analyses are critical to quantify phenotypic variation, identify taxa, inform phylogenetic relationships, and shed light on evolutionary patterns. This work is particularly important in groups that display great morphological disparity. Such is the case in geomyoid rodents, a group that includes 2 of the most species-rich families of rodents in North America: the Geomyidae (pocket gophers) and the Heteromyidae (kangaroo rats, pocket mice, and their relatives). We assessed variation in skull morphology (including both shape and size) among geomyoids to test the hypothesis that there are statistically significant differences in skull measurements at the family, genus, and species levels. Our sample includes 886 specimens representing all geomyoid genera and 39 species. We used the geometric mean to compare size across taxa. We used 14 measurements of the cranium and lower jaw normalized for size to compare shape among and within taxa. Our results show that skull measurements enable the distinction of geomyoids at the family, genus, and species levels. There is a larger amount of size variation within Geomyidae than within Heteromyidae. Our phylomorphospace analysis shows that the skull shape of the common ancestor of all geomyoids was more similar to the common ancestor of heteromyids than that of geomyids. Geomyid skulls display negative allometry whereas heteromyid skulls display positive allometry. Within heteromyids, dipodomyines, and non-dipodomyines show significantly different allometric patterns. Future analyses including fossils will be necessary to test our evolutionary hypotheses.

PMID:37614926 | PMC:PMC10443661 | DOI:10.1093/cz/zoac055

Front Pediatr. 2023 Aug 8;11:1237074. doi: 10.3389/fped.2023.1237074. eCollection 2023.

ABSTRACT

BACKGROUND: Acute Respiratory Infections (ARIs) are a major cause of morbidity and mortality worldwide. Human Adenovirus (HAdV), responsible for 5%-10% of children’s ARIs, is one of the most prevalent pathogens. Our study aimed to analyze the epidemiology and phylogenesis of HAdV in pediatric patients with ARIs in Hangzhou during the COVID-19 pandemic.

METHOD: Between November 2020 and March 2021, we collected 1,442 nasopharyngeal swabs from children with ARIs at Children’s Hospital, Zhejiang University School of Medicine. Epidemiological statistics, phylogenetic and amino acid (AA) mutation analysis were conducted.

RESULTS: Our findings revealed that 386 (26.77%) samples tested positive for HAdV, with the highest rate in children aged 6-18 years and the lowest in children aged 0-1 year, indicating a different age preference of HAdV compared with pre-pandemic period. Outpatients had a significantly higher positive rate than inpatients. Moreover, patients with HAdV-coinfection exhibited more severe clinical symptoms than those with HAdV-single infection. Our phylogenetic analysis demonstrated that species HAdV-C (type 1, 2, 6) were the predominant circulating strains in Hangzhou during the COVID-19 pandemic. Further AA mutation analysis identified seventeen mutations of particular concern for biological characterization.

CONCLUSION: In conclusion, our study provides valuable epidemiological and molecular data that will aid in epidemiological surveillance, antiviral therapies and the development of specific vaccine types, leading to improve public health.

PMID:37614906 | PMC:PMC10442704 | DOI:10.3389/fped.2023.1237074

Front Pediatr. 2023 Aug 8;11:1204171. doi: 10.3389/fped.2023.1204171. eCollection 2023.

ABSTRACT

BACKGROUND AND AIMS: Since the COVID-19 pandemic, several studies have reported a decrease in adolescents’ well-being. We aim to describe life satisfaction over the last decade and examine the factors associated with its variations between 2020 and 2021 among French students in their last year of middle school (around 14-15 years old).

METHODS: Data were drawn from a repeated biennial cross-sectional national survey conducted in French schools over the last decade (EnCLASS study), using a self-administered questionnaire. After describing life satisfaction trends between 2012 and 2021 using the Cantril ladder, we examined individual changes in life satisfaction between 2020 and 2021 and their associations with housing and studying conditions during the COVID-19 lockdown, using multinomial logistic regression analysis (decrease, increase, no change as reference).

RESULTS: Among the 17,686 survey respondents, an overall slight decrease in the prevalence of adolescents reporting high life satisfaction (i.e., Cantril score ≥6) was observed since 2012 with the lowest proportion reported in 2021 (77.4%). Between 2020 and 2021, 16.3% of French adolescents experienced an improvement in life satisfaction, while 17.7% experienced the opposite. Decrease in life satisfaction between 2020 and 2021 was more likely experienced by adolescents living in reconstructed families [aOR 2.09 (95%CI, 1.58-2.77)], those who did not have their own room [aOR 1.58 (1.16-2.15)], nor access to the Internet to interact with their friends during the lockdown [aOR 1.47 (1.09-1.98)]. Interestingly, more girls than boys were represented in both those reporting increase and decrease in life satisfaction [aOR 1.82 (1.40-2.37) and 1.43 (1.14-1.79), respectively].

CONCLUSIONS: This study shows that the way adolescents experienced the first 2020 lockdown in France was not uniform, and that one must consider sex as well as housing and studying conditions when interpreting adolescents’ life satisfaction decrease during the COVID-19 pandemic.

PMID:37614904 | PMC:PMC10443644 | DOI:10.3389/fped.2023.1204171

Proc (Bayl Univ Med Cent). 2023 Jul 5;36(5):582-585. doi: 10.1080/08998280.2023.2230541. eCollection 2023.

ABSTRACT

BACKGROUND: The primary aim of our study was to determine the attendance of postpartum visits stratified by race and if the COVID-19 pandemic affected racial disparities in postpartum visit attendance.

METHODS: We searched our labor and delivery records from July 1, 2019 to December 31, 2019 and from July 1, 2020 to December 31, 2020 and included patients who delivered liveborn infants. The final analysis was restricted to patients who identified as White or Caucasian only, Black or African American only, or Hispanic. We then performed joint tests on the logistic regression with an interaction term of race and year of delivery to determine the final model.

RESULTS: The odds ratio of Black or African American and Hispanic patients attending a postpartum visit was 0.589 (95% CI 0.456, 0.760; P < .001) and 0.836 (95% CI 0.676, 1.034; P = 0.099), respectively, compared to White or Caucasian patients. The interaction term of race and year of delivery was not statistically significant.

CONCLUSION: Black or African American patients at our hospital had a clinically and statistically significant lower utilization of postpartum visits compared to White or Caucasian patients and this disparity was not exacerbated by the COVID-19 pandemic.

PMID:37614862 | PMC:PMC10443978 | DOI:10.1080/08998280.2023.2230541

Proc (Bayl Univ Med Cent). 2023 Jul 6;36(5):592-599. doi: 10.1080/08998280.2023.2228180. eCollection 2023.

ABSTRACT

BACKGROUND: Endoscopic sleeve gastroplasty (ESG) has emerged as an effective endoscopic bariatric procedure over the past decade. Data comparing short-term outcomes of ESG based on operator specialty is scarce. We aimed to assess the impact of operator specialization on patient outcomes using a large bariatric-specific database.

METHODS: We identified a retrospective cohort of patients who underwent ESG by gastroenterologists using the Metabolic and Bariatric Surgery Accreditation Quality Improvement Program database (2020-2021). A matched comparison cohort of patients who underwent ESG by surgeons was identified and underwent 1:1 propensity score matching based on age, race, gender, American Society of Anesthesiologists physical status classification, and preoperative body mass index.

RESULTS: After matching, 154 patients were included in the final analysis. Of these, 77 patients underwent ESG by surgeons and 77 by gastroenterologists. In the matched cohort, the median operation time was lower in ESG by surgeons compared to gastroenterologists (P < 0.001). The median percent body mass index decrease was higher in the gastroenterologist cohort compared to the surgeon cohort (4.9% vs 3.8%, P = 0.04). The median percent weight loss after ESG was 4.8% in the surgeon cohort and 5.9% in the gastroenterologist cohort (P = 0.09). There was no statistically significant difference in postoperative emergency department visits (P = 0.65), reoperations (P = 0.15), or reinterventions within 30 days (P = 0.87) between the cohorts. There was no difference in major adverse effects between the groups (0% each).

CONCLUSIONS: Operator choice does not affect ESG-related adverse events or 30-day outcomes in patients undergoing ESG.

PMID:37614858 | PMC:PMC10443959 | DOI:10.1080/08998280.2023.2228180