Category: Nevin Manimala

Am J Phys Med Rehabil. 2022 Dec 14. doi: 10.1097/PHM.0000000000002168. Online ahead of print.

ABSTRACT

OBJECTIVES: Neck pain (NP) is extremely common and represents a substantial economic burden to our society. We aimed to investigate risk factors for non-disabling and disabling neck pain in a large cohort of Italian adolescents with a cross-sectional study.

DESIGN: Six thousand, two hundred eighty-one students (14-19 years old) answered an online questionnaire, investigating: anthropometric data, lifestyle-related items, NP frequency and intensity, need for medical examination and several risk factors. Students who had to give up social activities due to neck complaints constituted the disabling NP group (DIS-NP).

RESULTS: Our findings revealed that sex, age, sports practice, hours of sleep and family history were risk factors (p < 0.001) for NP in our cohort. Moreover, DIS-NP suffered from NP more frequently (p < 0.001) and with higher levels of pain (p < 0.001) compared to the non-disabling group. The number of hours of sleep was the only risk factor that showed a trend to differ comparing the DIS-NP group with the non-disabling NP one (p = 0.057).

CONCLUSION: Different risk factors for NP were detected in a very large cohort of adolescents.This study may pave the way for future prospective studies and for the development of preventive strategies for NP in adolescents.

PMID:36729580 | DOI:10.1097/PHM.0000000000002168

J Am Assoc Nurse Pract. 2022 Dec 14. doi: 10.1097/JXX.0000000000000821. Online ahead of print.

ABSTRACT

BACKGROUND: High-flow oxygen therapy (HFOT) has been successful in treating acute hypoxic respiratory failure (AHRF) and acute respiratory distress syndrome (ARDS). Successful treatment with noninvasive ventilation and avoidance of mechanical ventilation (MV) has been associated with decreased mortality and positive patient outcomes. It is unclear whether the evidence supports the use of HFOT to treat coronavirus disease 2019 (COVID-19)-induced AHRF and ARDS.

OBJECTIVES: To determine whether the use of HFOT decreases the need for intubation or decreases mortality compared with MV in patients with AHRF due to COVID-19.

DATA SOURCES: A literature search was conducted in March 2022 using CINAHL, Embase, PubMed, and Scopus bibliographic databases. Ten studies comparing HFOT and MV in COVID-19 respiratory failure met inclusion criteria.

CONCLUSIONS: Nine studies found a statistically significant reduction in the need for intubation; eight studies found significantly decreased morality in patients who received HFOT. Study design and methodologies limited the findings.

IMPLICATIONS FOR PRACTICE: Based on the available evidence, the use of HFOT positively affected mortality and incidence of the need for intubation and MV. Further research needs to be conducted before HFOT is adopted as the standard of care for COVID-19-induced AHRF and ARDS. Nurse practitioners should be informed regarding the various respiratory support modalities and evaluate risk versus benefit when caring for patients with COVID-19-induced AHRF and ARDS.

PMID:36729579 | DOI:10.1097/JXX.0000000000000821

JMIR Mhealth Uhealth. 2023 Feb 2;11:e40844. doi: 10.2196/40844.

ABSTRACT

BACKGROUND: Chronic pain (CP) is 1 of the leading causes of disability worldwide and represents a significant burden on individual, social, and economic aspects. Potential tools, such as mobile health (mHealth) systems, are emerging for the self-management of patients with CP.

OBJECTIVE: A systematic review was conducted to analyze the effects of mHealth interventions on CP management, based on pain intensity, quality of life (QoL), and functional disability assessment, compared to conventional treatment or nonintervention.

METHODS: PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines were followed to conduct a systematic review of randomized controlled trials (RCTs) published in PubMed, Web of Science, Scopus, and Physiotherapy Evidence Database (PEDro) databases from February to March 2022. No filters were used. The eligibility criteria were RCTs of adults (≥18 years old) with CP, intervened with mHealth systems based on mobile apps for monitoring pain and health-related outcomes, for pain and behavioral self-management, and for performing therapeutic approaches, compared to conventional treatments (physical, occupational, and psychological therapies; usual medical care; and education) or nonintervention, reporting pain intensity, QoL, and functional disability. The methodological quality and risk of bias (RoB) were assessed using the Checklist for Measuring Quality, the Oxford Centre for Evidence-Based Medicine Levels of Evidence, and the Cochrane RoB 2.0 tool.

RESULTS: In total, 22 RCTs, involving 2641 patients with different CP conditions listed in the International Classification of Diseases 11th Revision (ICD-11), including chronic low back pain (CLBP), chronic musculoskeletal pain (CMSP), chronic neck pain (CNP), unspecified CP, chronic pelvic pain (CPP), fibromyalgia (FM), interstitial cystitis/bladder pain syndrome (IC/BPS), irritable bowel syndrome (IBS), and osteoarthritis (OA). A total of 23 mHealth systems were used to conduct a variety of CP self-management strategies, among which monitoring pain and symptoms and home-based exercise programs were the most used. Beneficial effects of the use of mHealth systems in reducing pain intensity (CNP, FM, IC/BPS, and OA), QoL (CLBP, CNP, IBS, and OA), and functional disability (CLBP, CMSP, CNP, and OA) were found. Most of the included studies (18/22, 82%) reported medium methodological quality and were considered as highly recommendable; in addition, 7/22 (32%) studies had a low RoB, 10/22 (45%) had some concerns, and 5/22 (23%) had a high RoB.

CONCLUSIONS: The use of mHealth systems indicated positive effects for pain intensity in CNP, FM, IC/BPS, and OA; for QoL in CLBP, CNP, IBS, and OA; and for functional disability in CLBP, CMSP, CNP, and OA. Thus, mHealth seems to be an alternative to improving pain-related outcomes and QoL and could be part of multimodal strategies for CP self-management. High-quality studies are needed to merge the evidence and recommendations of the use of mHealth systems for CP management.

TRIAL REGISTRATION: PROSPERO International Prospective Register of Systematic Reviews CRD42022315808; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=315808.

PMID:36729570 | DOI:10.2196/40844

J Med Internet Res. 2023 Feb 2;25:e39325. doi: 10.2196/39325.

ABSTRACT

BACKGROUND: The diabetes disease burden in China is heavy, and medical standards such as diabetes guidelines are the core reference guidelines for diabetes management for health care providers and patients. However, patients’ guideline compliance is too low, which correlates with the gap between guidelines and patients’ self-management needs. Incorporating patient needs into the guideline development would reduce this gap.

OBJECTIVE: We sought to capture the needs of patients with diabetes for self-management in everyday situations and to clarify the contradictions and misalignments between medical standards, such as guidelines, and patient needs.

METHODS: This study collected crawler-based data from 4 online health communities. We selected 1605 text records collected from Chinese patients with diabetes between March 2020 and July 2020 for analysis. The text analysis applied grounded theory to separate issues that concerned patients into 3 themes, 7 subthemes, and 25 entries.

RESULTS: Altogether, 69.03% (1108/1605) of texts were related to issues concerning disease treatment (theme B) and mainly inquired about medication use (B2 and B3; 686/1108, 61.91%), including medication choice, change in medication administration, side effects, and postmedication effects. In addition, 222 (N=1605, 13.8%) texts (theme A) concerned the explanation of disease etiology and knowledge of diabetes, and 275 (N=1605, 17.1%) texts (theme C) discussed lifestyle changes and various restrictions on life brought about by the disease.

CONCLUSIONS: Our findings suggest an urgent need to improve diabetes health education and guideline development strategies and to develop health management strategies from a patient perspective to bridge the misalignment between patient needs and current medical standards.

PMID:36729569 | DOI:10.2196/39325

Plast Reconstr Surg. 2022 Dec 19. doi: 10.1097/PRS.0000000000010066. Online ahead of print.

ABSTRACT

BACKGROUND: There remains a lack of clarity surrounding the benefits, risks and outcomes between two-stage expander/implant reconstruction and single-stage direct-to-implant reconstruction. This study utilised a national dataset to examine real-world outcomes of two-stage and DTI reconstructions.

METHODS: A cohort study was conducted examining patients in the Australian Breast Device Registry from 2015-2018 who underwent prosthetic breast reconstruction post-mastectomy. Direct-to-implant and two-stage cohorts after definitive implant insertion were compared. Rate of revision surgery, reasons for revision and patient-reported outcome measures were recorded. Statistical analysis was undertaken using Fisher’s exact or chi-square, Wilcoxon rank-sum or student t-tests, Nelson-Aalen cumulative incidence estimates and Cox proportional hazards regression.

RESULTS: 5,152 breast reconstructions were recorded, including 3,093 two-stage and 2,059 direct-to-implant reconstructions. Overall revision surgery rates were 15.6% for direct-to-implant (median follow-up 24.7 months), compared with 9.7% in the two-stage cohort (median follow-up 26.5 months) (p<0.001). Most common reasons for revision for DTI and two-stage were capsular contracture (25.2% vs 26.7%, p=0.714) and implant malposition (26.7% vs 34.3%, p=0.045). Multivariate analysis found acellular dermal matrix usage (p=0.028) was significantly associated with a higher risk of revision. The influence of radiotherapy on revision rates was unable to be studied. Patient satisfaction levels were similar between reconstructive groups; however, patient experience was better in direct-to-implant than two-stage.

CONCLUSIONS: The Australian Breast Device Registry dataset demonstrated that direct-to-implant reconstruction had a higher revision rate than two-stage, but with comparable patient satisfaction and better patient experience. Capsular contracture and device malposition were leading causes of revision in both cohorts.

PMID:36729564 | DOI:10.1097/PRS.0000000000010066

J Acquir Immune Defic Syndr. 2022 Dec 15. doi: 10.1097/QAI.0000000000003139. Online ahead of print.

ABSTRACT

BACKGROUND: To address challenges with delivery of an evidence-based HIV care coordination program (CCP), the New York City (NYC) Health Department initiated a CCP redesign. We conducted a site-randomized stepped-wedge trial to evaluate effectiveness of the revised versus the original model.

SETTING: The CCP is delivered in NYC hospitals, community health centers, and community-based organizations, to people experiencing or at risk for poor HIV outcomes.

METHODS: The outcome, timely viral suppression (TVS), was defined as achievement of viral load <200 copies/mL within four months, among enrollees with unsuppressed viral load (≥200 copies/mL). Seventeen original-CCP provider agencies were randomized within matched pairs to early (August 2018) or delayed (May 2019) starts of revised-model implementation. Data from three periods were examined to compare revised versus original CCP effects on TVS. The primary analysis of the intervention effect applied fully conditional maximum likelihood estimation together with an exact, conditional P-value and an exact test-based 95% confidence interval (CI). We assigned each trial enrollee the implementation level of their site (based on a three-component measure), and tested for association with TVS, adjusting for period and study arm.

RESULTS: Over three nine-month periods, 960 individuals were eligible for trial inclusion (intention to treat). The odds ratio of TVS versus no TVS comparing revised to original CCP was 0.88 (95%CI 0.45, 1.7). Thus, the revised program yielded slightly lower TVS, though the effect was statistically non-significant. TVS was not significantly associated with revised-CCP implementation level.

CONCLUSION: Program revisions did not increase TVS, irrespective of implementation level.

PMID:36729538 | DOI:10.1097/QAI.0000000000003139

J Dev Behav Pediatr. 2022 Dec 15. doi: 10.1097/DBP.0000000000001159. Online ahead of print.

ABSTRACT

OBJECTIVE: Differences of sex development (DSD) are congenital conditions in which individuals are discordant in their chromosomal, phenotypic, and/or gonadal sex. Treatment of DSD can involve surgical intervention to external genitalia to make anatomy seem male-typical (i.e., male genitoplasty). Caregiver-perceived decisional regret regarding young boys with DSD was explored quantitatively and qualitatively.

METHOD: Participants (N = 39) were caregivers of infants (N = 23) diagnosed with DSD (mean age = 8.9 months, standard deviation = 5.9 months) reared male participating in a longitudinal investigation of psychosocial outcomes. Qualitative data were collected at 6 to 12 months after baseline enrollment to evaluate caregiver decision-making corresponding to levels of regret concerning their child’s treatment. All but one infant received genital surgery before caregiver reporting on their decisional regret. Quantitative exploratory analyses evaluated longitudinal predictors of decisional regret at 6 to 12 months.

RESULTS: When completing a write-in item inquiring about decision-making and potential regret, most caregivers (n = 16, 76%) reported that their child’s genital surgery was their first medical decision. Two caregivers referenced gender assignment as a decision point. One-third of caregivers reported some level of decisional regret (33%), with 67% reporting no regret. No hypothesized predictors of decisional regret were statistically significant.

CONCLUSION: Many caregivers of infants with DSD reared male view genital surgery as a first health care decision. Approximately one-third of caregivers reported some level of decisional regret. Further research is warranted to explore long-term decisional regret; it will be particularly important to investigate the decisional regret of patients with DSD.

PMID:36729523 | DOI:10.1097/DBP.0000000000001159

Psychol Trauma. 2023 Feb 2. doi: 10.1037/tra0001379. Online ahead of print.

ABSTRACT

OBJECTIVE: Latinx youth who have experienced caregiver deportation show higher rates of posttraumatic stress disorder (PTSD) and internalizing symptoms compared to Latinx youth who have not. Thus, there is a need for culturally and linguistically appropriate therapeutic approaches to address psychiatric needs related to caregiver deportation. Positive Adaptations for Trauma and Healing (PATH) is a manualized 10-week group therapy for Latinx youth and their caregivers that integrates trauma-informed interventions with positive psychology and resilience interventions. The present study examined PATH for reducing trauma symptomatology for Latinx youth who endured at least three traumatic experiences in their caregiving system as well as differences for Latinx youth who experienced their caregiver’s deportation.

METHOD: Self-identified Latinx youth (N = 31) and their Spanish-speaking caregivers were recruited from two urban hospitals. All youth experienced three or more traumatic events. Pre- to postintervention mean change was measured with t tests; mixed-effects analysis of variance assessed whether the program was feasible for youth who had experienced a caregiver deportation versus Latinx youth who did not.

RESULTS: Assessment with the Trauma Symptom Checklist and the UCLA PTSD Index for Youth showed statistically significant reductions on Anxiety, Depression, Anger, and PTSD subscales. Latinx youth who experienced a caregiver’s deportation exhibited larger reductions in anger symptoms and PTSD symptoms.

CONCLUSION: Study results suggest that the novel group therapy intervention was feasible and acceptable for Latinx youth and their caregivers. Despite a small sample size, the intervention proved feasible for Latinx youth who experienced caregiver deportation. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

PMID:36729520 | DOI:10.1037/tra0001379

J Bone Joint Surg Am. 2022 Dec 19. doi: 10.2106/JBJS.22.00645. Online ahead of print.

ABSTRACT

BACKGROUND: Pain and function, as reflected by patient-reported outcome measures (PROMs), can influence improvement after total knee arthroplasty (TKA) and can reflect the extent of patient access to orthopaedic surgical care. We aimed to (1) categorize patients according to pain and function PROM phenotypes, (2) identify patient characteristics associated with poor preoperative pain and function, and (3) assess relationships between baseline characteristics and PROM phenotypes.

METHODS: A prospective cohort of 14,079 TKAs was enrolled. Demographics, comorbidities, surgical details, and preoperative PROMs were collected. Outcomes included preoperative Knee injury and Osteoarthritis Outcome Score (KOOS) Pain (P) and Physical Function (PS) subscores, stratified by demographics. Patients were then categorized into 4 PROM phenotypes defined on the basis of the cohort medians: above or equal to the median for both pain and function scores (P+PS+), below the median for both pain and function (P-PS-), above or equal to the median for pain but below the median for function (P+PS-), and below the median for pain but above or equal to the median for function (P-PS+). Descriptive statistics and multivariable regression analyses were calculated.

RESULTS: The largest PROM phenotype was P-PS- (39.4%), followed by P+PS+ (38.9%). The cohort with discordantly poor function but high pain scores (less pain) was the smallest cohort (9.9%). Preoperative KOOS-Pain and KOOS-PS scores at or below the 25th percentile were independently associated with younger age, female sex, higher body mass index (BMI), non-White race, current smoking, lower education, non-commercial insurance, and higher Charlson Comorbidity Index (CCI). Multivariate logistic regression showed that patients in the P+PS+ category were older (odds ratio [OR] = 1.56), were more likely to be male (OR = 2.00), had a lower BMI (OR = 0.67), had more education (OR = 1.63), had a lower CCI, and were less likely to be Black (OR = 0.80) or Other (OR = 0.62) race, be a current smoker (OR = 0.62), and have commercial insurance (OR = 0.74), compared with the P-PS- phenotype.

CONCLUSIONS: Younger age, obesity, non-White race, female sex, current or recent smoking, non-commercial insurance, and higher CCI were associated with worse pre-TKA PROMs and poor pain-function phenotype combinations. Such a pattern may indicate barriers to TKA access among these patient populations leading to advanced levels of impairment at the time of treatment.

LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

PMID:36729513 | DOI:10.2106/JBJS.22.00645

Clin Oral Implants Res. 2023 Feb 2. doi: 10.1111/clr.14042. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the effect of drilling sequence, guide-hole design, and alveolar ridge morphology on the accuracy of implant placement via static Computer-Assisted Implant Surgery (sCAIS).

MATERIALS AND METHODS: Standardized maxillary bone models including single tooth gaps with fresh extraction sockets or healed alveolar ridge morphologies were evaluated in this study. Implants were placed using different drilling sequences (i.e., complete (CDS) or minimum (MDS), and guide-hole designs (i.e., manufacturer’s sleeve (MS) or sleeveless (SL) guide-hole designs). The time for implant placement via sCAIS procedures was also recorded. The angular, crestal, and apical three-dimensional deviations between planned and final implant positions were digitally obtained. Statistical analyses were conducted by a non-parametric three-way ANOVA (α=0.05).

RESULTS: Based on a sample size analysis, a total of 72 implants were included in this study. Significantly higher implant position accuracy was found at healed sites compared to extraction sockets, and in SL compared to MS guide-hole design in angular, crestal, and apical 3D deviations, p≤0.048). A tendency for higher accuracy was observed for the CDS compared to the MDS, although the effect was not statistically significant (p=0.09). The MDS required significantly shorter preparation times compared with CDS (p<0.0001).

CONCLUSION: Implant placement via sCAIS resulted in higher accuracy in healed sites than extraction sockets, when using SL compared to MS guides, and tended to be more accurate when using CDS compared to MDS. Therefore, even though surgery time was shorter with MDS, its use should be limited to strictly selected cases.

PMID:36727584 | DOI:10.1111/clr.14042