Category: Nevin Manimala

Int J Lang Commun Disord. 2023 Jun 27. doi: 10.1111/1460-6984.12921. Online ahead of print.

ABSTRACT

PURPOSE: To identify how speech-language pathologists (SLPs) in the United States are screening for and identifying dysphagia. To do this, we examined the approaches most often used to screen for dysphagia and the influence of contextual factors such as setting, continuing education and means of staying up to date with the most current literature on screening approaches.

METHOD: A web-based survey composed of 32 questions was developed and field tested for content, relevance and workflow. The survey was distributed online, via social media, online SLP forums and through the American Speech-Language-Hearing Association’s Special Interest Group 13 (swallowing disorders). One hundred and thirty-seven clinicians from the United States completed the survey and were included for analysis using descriptive statistics and linear regression modelling to assess associations of continuing education and years practicing with screening protocols and consumption of evidence.

RESULTS: Respondents worked in a variety of settings, including acute care, skilled nursing facilities, and inpatient rehabilitation. Most respondents worked with adult populations (88%). The most common screening protocols reported were a volume-dependent water swallow test (74%), subjective patient report (66%), and trials of solids/liquids (49%). Twenty-four percent (24%) reported using a questionnaire, the Eating Assessment Tool (80%) being most common. How clinicians consume their evidence was significantly associated with the types of screening approaches used. Continuing education hours were significantly associated with dysphagia screening protocol choice (p < 0.001) and how clinicians stayed up to date with evidence (p < 0.001).

CONCLUSIONS: Results from this study provide an in-depth look at the choices clinicians are making in the field regarding how to effectively screen patients for the presence of dysphagia. Contextual factors such as evidence base consumption patterns should serve researchers to continue seeking alternative ways to share evidence with clinicians, accessibly. Associations between continuing education and protocol choice show the need for continued evidence-based and high-quality continuing education opportunities.

WHAT THIS PAPER ADDS: This study provides an in-depth look at the choices clinicians are making in the field regarding effective dysphagia screening practices. Clinician screening choices are examined with contextual factors such as evidence base consumption patterns and continuing education. This paper increases knowledge of the most used dysphagia screening practices and context for clinicians and researchers to improve use, evidence and dissemination of best practices.

PMID:37376825 | DOI:10.1111/1460-6984.12921

Ophthalmic Physiol Opt. 2023 Jun 27. doi: 10.1111/opo.13193. Online ahead of print.

ABSTRACT

PURPOSE: To objectively quantify changes in corneoscleral profile, as evaluated by the limbus position and corneoscleral junction (CSJ) angle, as a consequence of wearing different soft contact lens (CL) materials.

METHODS: Twenty-two healthy participants wore silicone hydrogel (SiHy, MyDay, CooperVision) and hydrogel (Hy, Biomedics 1 day extra, CooperVision) soft CLs for 8 h per lens in their left eye. In each session, corneoscleral topography was captured before and immediately after CL removal with an Eye Surface Profiler. Previously validated automatic and objective algorithms for limbal position and CSJ angle calculation were applied to 360 semi-meridians to investigate the effect of short-term CL wear on corneoscleral topography, globally and by sectors, depending on the soft CL material worn.

RESULTS: Short-term soft CL wear significantly impacted limbal position (SiHy: 120 ± 97 μm, Hy: 128 ± 85 μm) and CSJ angle (SiHy: 0.57 ± 0.36°, Hy: 0.55 ± 0.40°); all p < 0.05. A statistically significant difference was found between the sectors with regard to limbus position and CSJ angle before CL wear that remained following lens wear (all pairwise comparisons, p < 0.001). Although individual differences were observed, there was no evidence that one material caused more substantial corneoscleral alterations.

CONCLUSION: Corneoscleral profile parameters were altered significantly following 8 h of soft CL wear. The observed changes in limbus position and CSJ angle support the importance of participant-material biocompatibility.

PMID:37376806 | DOI:10.1111/opo.13193

Epilepsia. 2023 Jun 27. doi: 10.1111/epi.17702. Online ahead of print.

ABSTRACT

OBJECTIVE: Social determinants of health, including the effects of neighborhood disadvantage, impact epilepsy prevalence, treatment, and outcomes. This study characterized the association between aberrant white matter connectivity in temporal lobe epilepsy (TLE) and disadvantage using a US census-based neighborhood disadvantage metric, the Area Deprivation Index (ADI), derived from measures of income, education, employment, and housing quality.

METHODS: Participants including 74 TLE patients (47 male, mean age=39.2) and 45 healthy controls (27 male, mean age=31.9) from the Epilepsy Connectome Project were classified into ADI-defined low and high disadvantage groups. Graph theoretic metrics were applied to multi-shell connectome diffusion weighted imaging (DWI) measurements in order to derive 162 x 162 structural connectivity matrices (SCMs). The SCMs were harmonized using neuroCombat to account for interscanner differences. Threshold-free network-based statistics were used for analysis and findings were correlated with ADI quintile metrics. A decrease in cross-sectional areas (CSA) indicate reduced white matter integrity.

RESULTS: Sex and age-adjusted CSA in TLE groups were significantly reduced compared to controls regardless of disadvantage status, revealing discrete aberrant white matter tract connectivity abnormalities in addition to apparent differences in graph measures of connectivity and network-based statistics. When comparing broadly defined disadvantaged TLE groups, differences were at trend-level. Sensitivity analyses of ADI quintile extremes revealed significantly lower CSA in the most compared to least disadvantaged TLE group.

SIGNIFICANCE: Our findings demonstrate: 1) the general impact of TLE on DWI connectome status is larger than the association with neighborhood disadvantage; however, 2) neighborhood disadvantage, indexed by ADI, revealed modest relationships to white matter structure and integrity on sensitivity analysis in TLE. Further studies are needed to explore this relationship and determine if the white matter relationship with ADI is driven by social drift or environmental influences on brain development. Understanding the etiology and course of the disadvantage-brain integrity relationship may serve to inform care, management, and policy for patients.

PMID:37376741 | DOI:10.1111/epi.17702

J Adv Nurs. 2023 Jun 27. doi: 10.1111/jan.15763. Online ahead of print.

ABSTRACT

AIMS: To analyse the compliments received from patients’ and companions and to describe the characteristics of high-quality nursing and midwifery care from the perspective of healthcare consumers.

DESIGN: Retrospective analysis of health service compliments data.

METHODS: All compliments specific to nursing and midwifery care received between July 2020 and June 2021 were extracted from the reporting database for six hospital sites of a large public health service in Victoria, Australia. Inductive coding captured the characteristics and qualities of nurses and midwives elicited from the compliments. Deductive coding used two frameworks: an adapted health complaints assessment tool, and 10 dimensions of nursing and midwifery care used in the health service. Descriptive statistics were used for analysis of coded data.

RESULTS: Of the 2833 records identified, 433 nursing and midwifery-specific compliments were identified; of these 225 consumer or care partner compliments were identified for analysis. Most compliments (80.4%, n = 181) were from the smaller hospital sites compared to 19.6% (n = 44) received at the largest hospital site; and from care programmes that typically care for older patients (42.7%, n = 113). Only 39% (n = 89) of compliments related to quality and safety of clinical care, 9% (n = 21) related to management and 17% (n = 38) to relationships. Forty-nine percent (n = 113) related to dimensions of fundamental nursing and midwifery care, with psychological care best represented (39.8%, n = 89). Most often, compliments related to characteristics or attributes of nurses.

CONCLUSION: Analysis of compliments reveals characteristics of nursing and midwifery care valued by healthcare consumers. Surprisingly, few compliments related to clinical dimensions of nursing and midwifery practice. Comments related to psychological aspects of nursing and midwifery care were most common. Understanding consumer perceptions of high-quality care provided by nurses and midwives provide guidance about care delivery that meets or exceed consumer expectations. The findings suggest low consumer awareness about professional and clinical aspects of nursing and midwifery work.

IMPACT: Compliments provide a unique insight into consumer perspectives of high-quality nursing and midwifery care. When making compliments, consumers most often commented about the attributes and characteristics of nurses and midwives, rather than clinical aspects of care. Compliments specific to nursing and midwifery care provide guidance to enhance care delivery to meet or exceed consumer expectations.

PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

PMID:37376718 | DOI:10.1111/jan.15763

J Adv Nurs. 2023 Jun 27. doi: 10.1111/jan.15752. Online ahead of print.

ABSTRACT

AIM: To describe psychometric validation of the newly developed Advanced Practice Nurse Task Questionnaire.

DESIGN: Cross-sectional quantitative study.

METHODS: The development of the questionnaire followed an adapted version of the seven steps described in the guide by the Association for Medical Education in Europe. A nationwide online survey tested the construct and structural validity and internal consistency using an exploratory factor analysis, Cronbach’s alpha coefficient and a Kruskal-Wallis test to compare the hypotheses.

RESULTS: We received 222 questionnaires between January and September 2020. The factor analysis produced a seven-factor solution as suggested in Hamric’s model. However, not all item loadings aligned with the framework’s competencies. Cronbach’s alpha of factors ranged between .795 and .879. The analysis confirmed the construct validity of the Advanced Practice Nurse Task Questionnaire. The tool was able to discriminate the competencies of guidance and coaching, direct clinical practice and leadership across the three advanced practice nurse roles clinical nurse specialist, nurse practitioner or blended role.

CONCLUSION: A precise assessment of advanced practice nurse tasks is crucial in clinical practice and in research as it may be a basis for further refinement, implementation and evaluation of roles.

IMPACT: The Advanced Practice Nurse Task Questionnaire is the first valid tool to assess tasks according to Hamric’s model of competencies independently of the role or the setting. Additionally, it distinguishes the most common advanced practice nurse roles according to the degree of tasks in direct clinical practice and leadership. The tool may be applied in various countries, independent of the degree of implementation and understanding of advanced nursing practice.

REPORTING METHOD: The STARD 2015 guideline was used to report the study.

PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

PMID:37376711 | DOI:10.1111/jan.15752

Viruses. 2023 Jun 16;15(6):1384. doi: 10.3390/v15061384.

ABSTRACT

In May 2022, for the first time, multiple cases of mpox were reported in several non-endemic countries. The first ever case of the disease in Greece was confirmed on 8 June 2022, and a total of 88 cases were reported in the country until the end of April 2023. A multidisciplinary response team was established by the Greek National Public Health Organization (EODY) to monitor and manage the situation. EODY’s emergency response focused on enhanced surveillance, laboratory testing, contact tracing, medical countermeasures, and the education of health care providers and the public. Even though management of cases was considered successful and the risk from the disease was downgraded, sporadic cases continue to occur. Here, we provide epidemiological and laboratory features of the reported cases to depict the course of the disease notification rate. Our results suggest that measures for raising awareness as well as vaccination of high-risk groups of the population should be continued.

PMID:37376683 | DOI:10.3390/v15061384

Viruses. 2023 Jun 9;15(6):1344. doi: 10.3390/v15061344.

ABSTRACT

During the early stages of the UK 2021-2022 H5N1 high-pathogenicity avian influenza virus (HPAIV) epizootic in commercial poultry, 12 infected premises (IPs) were confirmed by four real-time reverse-transcription-polymerase chain reaction (RRT)-PCRs, which identified the viral subtype and pathotype. An assessment was undertaken to evaluate whether a large sample throughput would challenge laboratory capacity during an exceptionally large epizootic; hence, assay performance across our test portfolio was investigated. Statistical analysis of RRT-PCR swab testing supported it to be focused on a three-test approach, featuring the matrix (M)-gene, H5 HPAIV-specific (H5-HP) and N1 RRT-PCRs, which was successfully assessed at 29 subsequent commercial IPs. The absence of nucleotide mismatches in the primer/probe binding regions for the M-gene and limited mismatches for the H5-HP RRT-PCR underlined their high sensitivity. Although less sensitive, the N1 RRT-PCR remained effective at flock level. The analyses also guided successful surveillance testing of apparently healthy commercial ducks from at-risk premises, with pools of five oropharyngeal swabs tested by the H5-HP RRT-PCR to exclude evidence of infection. Serological testing at anseriform H5N1 HPAIV outbreaks, together with quantitative comparisons of oropharyngeal and cloacal shedding, provided epidemiological information concerning the chronology of initial H5N1 HPAIV incursion and onward spread within an IP.

PMID:37376643 | DOI:10.3390/v15061344

Viruses. 2023 May 31;15(6):1303. doi: 10.3390/v15061303.

ABSTRACT

Respiratory viral infections are a leading global cause of disease with multiple viruses detected in 20-30% of cases, and several viruses simultaneously circulating. Some infections with unique viral copathogens result in reduced pathogenicity, while other viral pairings can worsen disease. The mechanisms driving these dichotomous outcomes are likely variable and have only begun to be examined in the laboratory and clinic. To better understand viral-viral coinfections and predict potential mechanisms that result in distinct disease outcomes, we first systematically fit mathematical models to viral load data from ferrets infected with respiratory syncytial virus (RSV), followed by influenza A virus (IAV) after 3 days. The results suggest that IAV reduced the rate of RSV production, while RSV reduced the rate of IAV infected cell clearance. We then explored the realm of possible dynamics for scenarios that had not been examined experimentally, including a different infection order, coinfection timing, interaction mechanisms, and viral pairings. IAV coinfection with rhinovirus (RV) or SARS-CoV-2 (CoV2) was examined by using human viral load data from single infections together with murine weight-loss data from IAV-RV, RV-IAV, and IAV-CoV2 coinfections to guide the interpretation of the model results. Similar to the results with RSV-IAV coinfection, this analysis shows that the increased disease severity observed during murine IAV-RV or IAV-CoV2 coinfection was likely due to the slower clearance of IAV-infected cells by the other viruses. The improved outcome when IAV followed RV, on the other hand, could be replicated when the rate of RV infected cell clearance was reduced by IAV. Simulating viral-viral coinfections in this way provides new insights about how viral-viral interactions can regulate disease severity during coinfection and yields testable hypotheses ripe for experimental evaluation.

PMID:37376603 | DOI:10.3390/v15061303

Viruses. 2023 May 30;15(6):1284. doi: 10.3390/v15061284.

ABSTRACT

BACKGROUND: Over the last two decades, honey bees (Apis mellifera) have suffered high rates of colony losses that have been attributed to a variety of factors, chief among which are viral pathogens, such as deformed wing virus (DWV), whose virulence has increased because of vector-based transmission by the invasive, ectoparasitic varroa mite (Varroa destructor). A shift in the experimental mode of transmission of the black queen cell virus (BQCV) and sacbrood virus (SBV) from fecal/food-oral (direct horizontal) to vector-mediated (indirect horizontal) transmission also results in high virulence and viral titers in pupal and adult honey bees. Agricultural pesticides represent another factor that acts independently or in interaction with pathogens, and they are also thought to cause colony loss. Understanding the molecular mechanisms underlying the higher virulence following a vector-based mode of transmission provides deeper insight into honey bee colony losses, as does determining whether or not host-pathogen interactions are modulated by exposure to pesticides.

METHODS: Through an experimental design with controlled laboratory, we investigated the effects of the modes of transmission of BQCV and SBV (feeding vs. vector-mediated via injection) alone or in combination with chronic exposure to sublethal and field-realistic concentrations of flupyradifurone (FPF), a novel agricultural insecticide, on honey bee survival and transcription responses by using high-throughput RNA sequencing (RNA-seq) analysis.

RESULTS: Co-exposure to viruses via feeding (VF) or injection (VI) and FPF insecticide had no statistically significant interactive effect on their survival compared to, respectively, VF or VI treatments alone. Transcriptomic analysis revealed a distinct difference in the gene expression profiles of bees inoculated with viruses via injection (VI) and exposed to FPF insecticide (VI+FPF). The number of differentially expressed genes (DEGs) at log2 (fold-change) > 2.0 in VI bees (136 genes) or/and VI+FPF insecticide (282 genes) was very high compared to that of VF bees (8 genes) or the VF+FPF insecticide treatment (15 genes). Of these DEGs, the expression in VI and VI+FPF bees of some immune-related genes, such as those for antimicrobial peptides, Ago2, and Dicer, was induced. In short, several genes encoding odorant binding proteins, chemosensory proteins, odor receptors, honey bee venom peptides, and vitellogenin were downregulated in VI and VI+FPF bees.

CONCLUSIONS: Given the importance of these suppressed genes in honey bees’ innate immunity, eicosanoid biosynthesis, and olfactory associative function, their inhibition because of the change in the mode of infection with BQCV and SBV to vector-mediated transmission (injection into haemocoel) could explain the high virulence observed in these viruses when they were experimentally injected into hosts. These changes may help explain why other viruses, such as DWV, represent such a threat to colony survival when transmitted by varroa mites.

PMID:37376584 | DOI:10.3390/v15061284

Viruses. 2023 May 25;15(6):1245. doi: 10.3390/v15061245.

ABSTRACT

AIM: This study evaluated the relationship between the systemic immune-inflammatory index (SII), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) with clinical findings of respiratory syncytial virus (RSV) infection among children with a diagnosis of lower respiratory tract infection (LRTI).

METHODS: The study was conducted between 1 January 2020 and 1 January 2022 in a pediatric clinic. This retrospective study included 286 consecutive patients between 0 and 12 years of age, 138 of whom were RSV (+) (48.25%) and 148 of whom were RSV (-) (51.75%). The detection of the RSV antigen was carried out using the chromatographic immunoassay method on nasopharyngeal swabbing samples.

RESULTS: CRP content was significantly higher in patients with RSV (+) than in children with RSV (-), while NLR, PLR, and SII, as inflammatory parameters, were significantly lower. Fever, coughs, and wheezing were the most common symptoms in the RSV (+) groups (100%). RSV infections were the highest in November, October, and December, in that order. The AUC was statistically significant for parameters in all groups. AUC values were 0.841 (95%: 0.765-0.917) for leukocytes, 0.703 (95%: 0.618-0.788) for lymphocytes, 0.869 (95%: 0.800-0.937) for CRP, 0.706 (95%: 0.636-0.776) for NLR, 0.779 (95%: 0.722-0.836) for PLR, and 0.705 (95%: 0.633-0.776) for SII. CRP was found to have both high sensitivity (80.4%) and high specificity (82.4%) among all parameters. While the ROC analysis results showed similar results for children under two years old, only CRP and NLR were statistically significant in this group.

CONCLUSION: CRP performed better than other blood parameters as a marker. The NLR, PLR, and SII index were significantly lower in LRTI patients with RSV (+) than in those with RSV (-), which implies a higher grade of inflammation. If the cause of the disease can be determined by this method, disease management will be easier, and unnecessary antibiotics could be avoided.

PMID:37376545 | DOI:10.3390/v15061245