Category: Nevin Manimala

Appl Clin Inform. 2023 May;14(3):575-584. doi: 10.1055/s-0043-1769912. Epub 2023 Jul 26.

ABSTRACT

BACKGROUND: In Taiwan, the number of confirmed cases of coronavirus disease 2019 (COVID-19) has risen significantly in May 2021. The second wave of the epidemic occurred in May 2022. mHealth (mobile health, social media communities) and eHealth (electronic health, Hospital Information System) can play an important role in this pandemic by minimizing the spread of the virus, leveraging health care providers’ time, and alleviating the challenges of medical education.

OBJECTIVES: This study aimed to describe the process of using mHealth and eHealth to build a medicalized quarantine hotel (MQH) and understand the physical and mental impact of COVID-19 on patients admitted to the MQH.

METHODS: In this retrospective observational study, data from 357 patients who stayed at the MQH were collected and their psychological symptoms were assessed using an online Brief Symptom Rating Scale (BSRS). Descriptive statistics, independent sample t-test, univariate analysis of variance, and multiple linear regression analysis were performed.

RESULTS: The patients’ mean age was 35.5 ± 17.6 years, and 52.1% (n = 186) of them were males. Altogether, 25.2% (n = 90) of the patients had virtual visits. The average duration of the hotel stay was 6.8 ± 1.4 days, and five patients (0.01%) were transferred to the hospital. The three most common symptoms reported were cough (39%), followed by the sore throat (22.8%), and stuffy/runny nose (18.9%). Most patients achieved a total BSRS score of 0 to 5 points (3,569/91.0%), with trouble falling asleep (0.65 ± 0.65), feeling tense or high-strung (0.31 ± 0.66), and feeling down or depressed (0.27 ± 0.62) scoring highest. The BSRS score was the highest on the first day. The sex of the patients was significantly related to the BSRS score (p < 0.001).

CONCLUSION: mHealth and eHealth can be used to further monitor an individual’s physiological and psychological states. Early intervention measures are needed to improve health care quality.

PMID:37494971 | DOI:10.1055/s-0043-1769912

Water Res. 2023 Jul 16;243:120372. doi: 10.1016/j.watres.2023.120372. Online ahead of print.

ABSTRACT

Wastewater surveillance has proved to be a valuable tool to track the COVID-19 pandemic. However, most studies using wastewater surveillance data revolve around establishing correlations and lead time relative to reported case data. In this perspective, we advocate for the integration of wastewater surveillance data with dynamic within-host and between-host models to better understand, monitor, and predict viral disease outbreaks. Dynamic models overcome emblematic difficulties of using wastewater surveillance data such as establishing the temporal viral shedding profile. Complementarily, wastewater surveillance data bypasses the issues of time lag and underreporting in clinical case report data, thus enhancing the utility and applicability of dynamic models. The integration of wastewater surveillance data with dynamic models can enhance real-time tracking and prevalence estimation, forecast viral transmission and intervention effectiveness, and most importantly, provide a mechanistic understanding of infectious disease dynamics and the driving factors. Dynamic modeling of wastewater surveillance data will advance the development of a predictive and responsive monitoring system to improve pandemic preparedness and population health.

PMID:37494742 | DOI:10.1016/j.watres.2023.120372

J Perinat Neonatal Nurs. 2023 Jul-Sep 01;37(3):252-260. doi: 10.1097/JPN.0000000000000697.

ABSTRACT

BACKGROUND: In light of the complex advances in neonatal intensive care units (NICU), it is essential that healthcare providers (HCPs) are equipped with the appropriate skills to effectively communicate between disciplines to provide safe, quality care. However, many HCPs acknowledge that they are not confident in their ability to communicate effectively with peers.

PURPOSE AND DESIGN: This study aimed to identify perceived barriers and facilitators of communication among HCPs in a NICU setting. This study took place in a 60-bed NICU that utilized multiple disciplines of HCPs. Using a qualitative, cross-sectional design, 2 surveys were administered, namely, a demographic survey with open-ended questions and the Safety Attitudes Questionnaire (SAQ).

RESULTS: Findings indicated inverse relationships in age/experience and perceptions of management. Total SAQ scores ranged from 45 to 77 (N = 28, M = 62.47, SD = 9.40). The SAQ highlight that total scores above 75 correspond with positive perceptions of safety in the NICU.

CONCLUSION: The statistical evidence derived from this study contributes to the evaluation of HCP-perceived communication barriers and facilitators. The identification of perceived barriers and facilitators of communication in an ICU setting may serve as a distinct, evidence-based foundation to develop interventions that emphasize the value of communication.

PMID:37494694 | DOI:10.1097/JPN.0000000000000697

Neuropsychopharmacol Hung. 2023 Jun 1;25(2):82-91.

ABSTRACT

The beneficial effects of yoga have been researched for decades, and in many countries it is also used in health care to maintain physical and mental health. Its effectiveness in the treatment of stress and anxiety, as well as in achieving a relaxed state, is supported by numerous studies. In the present research, our aim was to investigate the direct and subclinical effects of yoga on participants practicing it at least 10 minutes a day for two weeks. 25 average population, healthy participants were included between the ages of 18 and 30. We used the Smith Relaxation States Inventory (SRSI3) and its disposition-measuring version (SRSI3d), which examine 19 relaxation states (R-states) presumably related to relaxation, divided into 4 categories: basic relaxation, mindfulness, positive energy and transcendence. During the statistical analyses, the test values measured at the beginning of the research, before the first practice, were compared with the values taken directly after the last practice using the Wilcoxon test. Bonferroni correction was used to correct the fi rst-order error that increases when testing several hypotheses simultaneously. Immediately after practicing yoga, the participants were significantly more relaxed (M0=2.74, M1=4.24, p<0.0001), experienced more awareness (M0=2.71, M1=2.89, p<0.0001) and positive energy (M0=3.88, M1=4.81, p<0.0001) and also in the long term they experienced significantly more relaxation (M0=3.12, M1=3.94, p<0.0001), awareness (M0=3.41, M1=4.40, p<.0001), positive energy (M0=4.39, M1=5.14, p<0.001) and transcendence (M0=3.23, M1=4.05, p=0.001). Based on our results, yoga can be an effective additional tool in maintaining and improving health, but also in improving the condition and quality of life of mental and somatic patients.

PMID:37494675

Diabetes. 2023 Jul 26:db220852. doi: 10.2337/db22-0852. Online ahead of print.

ABSTRACT

Immunomodulation combined with antigen therapy holds great promise to arrest autoimmune type 1 diabetes, but clinical translation is hampered by a lack of prognostic biomarkers. Lowdose anti-CD3 plus Lactococcus lactis (L. lactis) bacteria secreting proinsulin and IL-10 reversed new-onset disease in non-obese diabetic (NOD) mice, yet some mice were resistant to the therapy. Using microRNA (miRNA) profiling, six miRNAs (i.e., miR-34a-5p, miR-125a- 3p, miR-193b-3p, miR-328, miR-365-3p, and miR-671-3p) were identified as differentially expressed in plasma of responder versus non-responder mice before study entry. After validation and stratification in an independent cohort, plasma miR-193b-3p and miR-365-3p combined with age and glycemic status at study entry had the best power to predict with high sensitivity and specificity poor response to the therapy. These miRNAs were highly abundant in pancreas infiltrating neutrophils and basophils with a pro-inflammatory and activated phenotype. Here, a set of miRNAs and disease-associated parameters are presented as predictive signature for the L. lactis-based immunotherapy outcome in new-onset type 1 diabetes, hence allowing targeted recruitment of future trial participants and accelerated trial execution.

PMID:37494666 | DOI:10.2337/db22-0852

WMJ. 2023 Jul;122(3):164-170.

ABSTRACT

INTRODUCTION: Availability of inpatient pediatric services declined across the United States from 2008 through 2018, with rural areas experiencing steepest declines. Despite the movement of pediatric care to children’s centers, most children are still cared for in community hospitals nationally. Assessing the availability and providers of inpatient pediatric care in Wisconsin is an important step in ensuring the health care needs of children in the state continue to be met.

METHODS: A cross-sectional survey was distributed to Wisconsin hospitals to determine pediatric services and physician workforce. The response rate was 130/138 (94%), including 56/58 (97%) critical access hospitals. Results of specific inpatient pediatric subdivisions were analyzed by descriptive statistics.

RESULTS: Hospitals that provide inpatient newborn care are mostly staffed by pediatricians and family physicians, while critical access hospitals are staffed by family physicians. Hospitals with neonatal intensive care units are staffed by neonatologists, with telemedicine utilized in critical access hospitals. Hospitals with general pediatric admissions are staffed by pediatricians or family physicians, while critical access hospitals are staffed by family physicians. Hospitals with pediatric intensive care units are staffed by pediatric intensivists.

CONCLUSIONS: Despite workforce disparities and shortages, hospitals across Wisconsin, including many critical access hospitals, continue to provide inpatient pediatric services. Family physicians play a major role in the pediatric health care delivery in Wisconsin hospitals. Robust inpatient pediatric training of family physicians may enable rural health authorities to continue addressing the gaps that persist in inpatient pediatric care accessibility.

PMID:37494645

R I Med J (2013). 2023 Aug 3;106(7):37-42.

ABSTRACT

BACKGROUND: The relationship between operative times and patient outcomes in total hip arthroplasty (THA) has not been well defined.

METHODS: From January 2016 to December 2019, data were prospectively collected for THA patients in the FORCE-TJR registry and hospital EMR of an academic total-joint center.

RESULTS: 1,123 patients were included. Operative times ranged from 36 to 366 minutes, with a mean operative time of 111.26+/-31.37 minutes. Unadjusted GLM showed HOOS pain, ADL, and QoL scores differed across operative times, with patients who had operative times between 106 and 120 minutes having significantly lower pain, higher function, and better quality of life at 12 months, especially compared to patients with operative times < 90 minutes. Patients who had operative times between 106 and 120 minutes had significantly better VR-12 PCS and MCS at 12 months. Although statistically significant, differences were small and did not persist after controlling for within-surgeon effects, patient socio-demographics and baseline patient-reported outcomes, suggesting that patient characteristics or within-surgeon effects may play a more significant role in these patient-reported outcomes than operative time.

CONCLUSION: This study showed that among THA patients, operative times were significantly associated with patient-reported outcomes at 12 months post-operatively, but is one of many surgeon and patient-related factors with effect on THA outcome.

PMID:37494626

J Pediatr Hematol Oncol. 2023 Aug 1;45(6):e702-e709. doi: 10.1097/MPH.0000000000002696. Epub 2023 Jun 26.

ABSTRACT

BACKGROUND: There is no practice standard regarding antibiotic duration in children with cancer and unexplained febrile neutropenia (FN). We hypothesized that absolute monocyte count (AMC) and absolute phagocyte count (APC= ANC + AMC + bands) are more sensitive, earlier, and safe markers of antibiotic cessation compared with absolute neutrophil count (ANC).

METHODS: A retrospective review of FN episodes (FNEs) in pediatric oncology patients was conducted between 2009 and 2016. Included patients were afebrile for 24 hours and without an identified infectious source at antibiotic cessation. Primary endpoints, including recurrent fever, readmission, bloodstream infection, microbiologically documented infection, and adverse outcomes, were assessed 10 days after antibiotic cessation and compared among different bone marrow recovery parameters (ANC, AMC, APC). Secondary endpoints included length of FN stay, antibiotic-free days, and cost.

RESULTS: Three hundred ninety-one FNEs in 235 patients were included. Three groups were compared based on ANC (cells/μL) at the time of antibiotic cessation: < 200 in 102 (26%), 200 to 500 in 111 (28%), and >500 in 178 (46%). No statistically significant differences in primary endpoints were identified among the 3 ANC groups; however, a trend toward unfavorable outcomes in the ANC ≤200 cells/μL group compared with the ANC >200 cells/μL was observed. Primary endpoints based on AMC >100 cells/μL at the time of antibiotic cessation showed statistically significant favorable outcomes compared AMC ≤100 cells/μL (80%, 88%, 90%, 89%, and 93% risk reduction in recurrent fever, readmission, new bloodstream infection, new microbiologically documented infection, and adverse events, respectively). Similar favorable results were seen when APC >300 cells/μL was used as a threshold for antibiotic cessation. The median length of stay for FN if discharged when AMC >100 cells/μL was 3 days shorter and associated with fewer unfavorable outcomes, thus resulting in fewer hospital days, fewer antibiotic days, and decreased cost.

CONCLUSION: Our results suggest that AMC >100 cells/μL (regardless of ANC) or APC >300 cells/μL may be safe thresholds for empiric antibiotic cessation and result in reduced unfavorable clinical outcomes within 10 days postdischarge, reduced antibiotic days of therapy and reduced health care costs. Further prospective studies are needed to validate AMC as an accurate surrogate marker for antibiotic cessation in FNEs in children with cancer.

PMID:37494607 | DOI:10.1097/MPH.0000000000002696

Environ Sci Technol. 2023 Jul 26. doi: 10.1021/acs.est.3c00796. Online ahead of print.

ABSTRACT

The Global Monitoring Plan of the Stockholm Convention on Persistent Organic Pollutants (POPs) was established to generate long-term data necessary for evaluating the effectiveness of regulatory measures at a global scale. After 15 years of passive air monitoring (2003-2019), MONET is the first network to produce sufficient data for the analysis of continuous long-term temporal trends of POPs in air across the entire European continent. This study reports long-term concentrations of 20 POPs monitored at 32 sites in 27 European countries. As of January 1, 2019, the concentration ranges (pg/m³) were 1.1-52.8 (∑₆PCB), 0.3-8.5 (∑₁₂dl-PCB), 0.007-0.175 (∑₁₇PCDD/F), 0.02-2.2 (∑₉PBDE), 0.4-24.7 (BDE 209), 0.5-247 (∑₆DDT), 1.7-818 (∑₄HCH), 15.8-74.7 (HCB), and 5.9-21.5 (PeCB). Temporal trends indicate that concentrations of most POPs have declined significantly over the past 15 years, with median annual decreases ranging from -8.0 to -11.5% (halving times of 6-8 years) for ∑₆PCB, ∑₁₇PCDD/F, HCB, PeCB, and ∑₉PBDE. Furthermore, no statistically significant differences were observed in either the trends or the concentrations of specific POPs at sites in Western Europe (WEOG) compared to sites in Central and Eastern Europe (CEE), which suggests relatively uniform compound-specific distribution and removal at the continental scale.

PMID:37494593 | DOI:10.1021/acs.est.3c00796

Radiol Oncol. 2023 Jul 26. doi: 10.2478/raon-2023-0032. Online ahead of print.

ABSTRACT

BACKGROUND: Stereotactic body radiation therapy (SBRT) precisely and non-invasively delivers ablative radiation dose to tumors in early-stage lung cancer patients who are not candidates for surgery or refuse it. The aim of research was to evaluate local control, overall survival (OS), local progression free survival (LPFS), distant metastases free survival (DMFS), disease free survival (DFS) and toxicity in early-stage lung cancer patients treated with SBRT in a single tertiary cancer centre.

PATIENTS AND METHODS: We retrospectively evaluated medical records and radiation treatment plan parameters of 228 tumors irradiated in 206 early-stage lung cancer patients between 2016 and 2021 at the Institute of Oncology Ljubljana.

RESULTS: After 25 months of median follow up, 68 of 206 (33%) patients died. Median OS was 46 months (CI 36-56), 1-year, 2-year and 3-year OS were 87%, 74% and 62% and 5-year OS was 31%. A total of 45 disease progressions have been identified in 41 patients. Local progress only was noticed in 5 (2%) patients, systemic progress in 32 (16%) and combined systemic and local in 4 (2%) patients. Local control rate (LCR) at 1 year was 98%, at 2 and 3 years 96% and 95% at 5 years. The 1-, 2- and 3-year LPFS were 98%, 96% and 94%, respectively and 5-year LPFS was 82%. One, 2-, 3- and 5-year DFS were 89%, 81%, 72% and 49%, respectively. Among 28 toxicities recorded only one was Grade 4 (pneumonitis), all others were Grade 1 or 2. No differences in LCR, LPFS, DFS were found in univariate analysis comparing patient, tumor, and treatment characteristics. For OS the only statistically significant difference was found in patients with more than 3 comorbidities compared to those with less comorbidities.

CONCLUSIONS: Early lung cancer treated with SBRT at single tertiary cancer centre showed that LCR, LPFS, DFS, DMFS and OS were comparable to published studies. Patients with many comorbidities had significantly worse overall survival compared to those with less comorbidities. No other significant differences by patient, tumor, or treatment characteristics were found for DMFS, LPFS, and DFS. Toxicity data confirmed that treatment was well tolerated.

PMID:37494591 | DOI:10.2478/raon-2023-0032