Category: Nevin Manimala

Arch Gerontol Geriatr. 2023 Mar 28;111:105010. doi: 10.1016/j.archger.2023.105010. Online ahead of print.

ABSTRACT

OBJECTIVES: Limited and inconsistent findings have been reported on the link between social connections and support and emergency department (ED) visits in older populations. Moreover, the adequacy of informal care for older adults has rarely been considered. This study explored the associations of social connections, social support, and informal care with ED visits in younger-old (<78 years) and oldest-old (≥78 years) adults.

METHODS: This is a prospective cohort study based on community-living adults ≥60 years old participating in the Swedish National Study on Aging and Care in Kungsholmen (N=3066 at wave 1, 2001-2004; N=1885 at wave 3, 2007-2010; N=1208 at wave 5, 2013-2016). Standardised indexes were developed to measure social connections, social support, and informal care. The outcome variable was hospital-based ED visits within 4 years of the SNAC-K interview. Associations between exposure variables and ED visits were assessed through negative binomial regressions using generalised estimating equations.

RESULTS: Medium (IRR 0.77; 95% CI 0.59-0.99) and high (IRR 0.77; 95% CI 0.56-0.99) levels of social support were negatively associated with ED visits compared to low levels of social support, but only in oldest-old adults. No statistically significant associations were observed between social connections and ED visits. Higher ED visit rates were seen in oldest-old adults with unmet informal care needs, even if the differences did not reach statistical significance.

CONCLUSIONS: ED visits were associated with social support levels among adults aged ≥78 years. Public health interventions to mitigate situations of poor social support may improve health outcomes and reduce avoidable ED visits in oldest-old adults.

PMID:37058774 | DOI:10.1016/j.archger.2023.105010

Anesth Analg. 2023 May 1;136(5):913-919. doi: 10.1213/ANE.0000000000006171. Epub 2023 Apr 14.

ABSTRACT

BACKGROUND: Critically injured patients who are agitated and delirious on arrival do not allow optimal preoxygenation in the emergency area. We investigated whether the administration of intravenous (IV) ketamine 3 minutes before administration of a muscle relaxant is associated with better oxygen saturation levels while intubating these patients.

METHODS: Two hundred critically injured patients who required definitive airway management on arrival were recruited. The subjects were randomized as delayed sequence intubation (group DSI) or rapid sequence intubation (group RSI). In group DSI, patients received a dissociative dose of ketamine followed by 3 minutes of preoxygenation and paralysis using IV succinylcholine for intubation. In group RSI, a 3-minute preoxygenation was performed before induction and paralysis using the same drugs, as described conventionally. The primary outcome was incidence of peri-intubation hypoxia. Secondary outcomes were first-attempt success rate, use of adjuncts, airway injuries, and hemodynamic parameters.

RESULTS: Peri-intubation hypoxia was significantly lower in group DSI (8 [8%]) compared to group RSI (35 [35%]; P = .001). First-attempt success rate was higher in group DSI (83% vs 69%; P = .02). A significant improvement in mean oxygen saturation levels from baseline values was seen in group DSI only. There was no incidence of hemodynamic instability. There was no statistically significant difference in airway-related adverse events.

CONCLUSIONS: DSI appears promising in critically injured trauma patients who do not allow adequate preoxygenation due to agitation and delirium and require definitive airway on arrival.

PMID:37058727 | DOI:10.1213/ANE.0000000000006171

Clin Nurse Spec. 2023 May-Jun 01;37(3):139-143. doi: 10.1097/NUR.0000000000000740.

ABSTRACT

PURPOSE: The aims of this quality improvement project were to improve understanding and perceived confidence in using a tool that assesses patients at risk of violence.

PROJECT DESCRIPTION: The Brøset Violence Checklist is valid at assessing patients at risk of violence. Participants were given access to an e-learning module that demonstrated how to use the tool. Improvement in understanding and perceived confidence in using the tool were assessed preintervention and postintervention via an investigator-developed survey. Analysis of the data was conducted using descriptive statistics, and open-ended survey responses were analyzed using content analysis.

OUTCOME: Participants did not demonstrate an increase in understanding and perceived confidence after introduction of the e-learning module. Nurses reported that the Brøset Violence Checklist was easy to use, clear, reliable, and accurate and could be used to standardize assessments of at-risk patients.

CONCLUSION: Emergency department nursing staff were educated in use of a risk assessment tool for identifying patients at risk of violence. This supported the implementation and integration of the tool into emergency department workflow.

PMID:37058705 | DOI:10.1097/NUR.0000000000000740

JCO Oncol Pract. 2023 Apr 14:OP2200822. doi: 10.1200/OP.22.00822. Online ahead of print.

ABSTRACT

PURPOSE: Clinical trials are important for managing older patients with AML. We investigated differences in outcomes of older patients with AML on the basis of whether patients participated in intensive chemotherapy trials at community versus academic cancer centers.

METHODS: We used data from the Alliance for Clinical Trials in Oncology phase III trials that enrolled patients age ≥ 60 years with newly diagnosed AML between 1998 and 2002 in the Cancer and Leukemia Group B (CALGB) 9720 trial and between 2004 and 2006 in the CALGB 10201 trial. Centers funded by the NCI Community Oncology Research Program were identified as community cancer centers; others were designated as academic cancer centers. Logistic regression models and Cox proportional hazards models were used to compare 1-month mortality and overall survival (OS) by center type.

RESULTS: Seventeen percent of the 1,170 patients were enrolled in clinical trials in community cancer centers. The study results demonstrated comparable rates of grade ≥3 adverse events (97% v 93%), 1-month mortality (19.1% v 16.1%), and OS (43.9% v 35.7% at 1 year) between community versus academic cancer centers, respectively. After adjusting for covariates, 1-month mortality (odds ratio, 1.40; 95% CI, 0.92 to 2.12; P = .11) and OS (hazard ratio, 1.04; 95% CI, 0.88 to 1.22; P = .67) were not statistically different among patients treated in community versus academic cancer centers.

CONCLUSION: An older patient population, who have complex health care needs, can be successfully treated on intensive chemotherapy trials in select community cancer centers with outcomes comparable with that achieved at academic cancer centers.

PMID:37058684 | DOI:10.1200/OP.22.00822

Hepatol Commun. 2023 Apr 14;7(5):e0109. doi: 10.1097/HC9.0000000000000109. eCollection 2023 May 1.

ABSTRACT

BACKGROUND: In children with biliary atresia (BA), pathologic structural changes within the heart, which define cirrhotic cardiomyopathy, are associated with adverse perioperative outcomes. Despite their clinical relevance, little is known about the pathogenesis and triggers of pathologic remodeling. Bile acid excess causes cardiomyopathy in experimental cirrhosis, but its role in BA is poorly understood.

METHODS: Echocardiographic parameters of left ventricular (LV) geometry [LV mass (LVM), LVM indexed to height, left atrial volume indexed to BSA (LAVI), and LV internal diameter (LVID)] were correlated with circulating serum bile acid concentrations in 40 children (52% female) with BA listed for transplantation. A receiver-operating characteristic curve was generated to determine optimal threshold values of bile acids to detect pathologic changes in LV geometry using Youden index. Paraffin-embedded human heart tissue was separately analyzed by immunohistochemistry for the presence of bile acid-sensing Takeda G-protein-coupled membrane receptor type 5.

RESULTS: In the cohort, 52% (21/40) of children had abnormal LV geometry; the optimal bile acid concentration to detect this abnormality with 70% sensitivity and 64% specificity was 152 µmol/L (C-statistics=0.68). Children with bile acid concentrations >152 µmol/L had ∼8-fold increased odds of detecting abnormalities in LVM, LVM index, left atrial volume index, and LV internal diameter. Serum bile acids positively correlated with LVM, LVM index, and LV internal diameter. Separately, Takeda G-protein-coupled membrane receptor type 5 protein was detected in myocardial vasculature and cardiomyocytes on immunohistochemistry.

CONCLUSION: This association highlights the unique role of bile acids as one of the targetable potential triggers for myocardial structural changes in BA.

PMID:37058680 | DOI:10.1097/HC9.0000000000000109

Opt Lett. 2023 Apr 15;48(8):2206-2209. doi: 10.1364/OL.489165.

ABSTRACT

We investigate the statistical mechanics of the photonic Ablowitz-Ladik lattice, the integrable version of the discrete nonlinear Schrödinger equation. In this regard, we demonstrate that in the presence of perturbations, the complex response of this system can be accurately captured within the framework of optical thermodynamics. Along these lines, we shed light on the true relevance of chaos in the thermalization of the Ablowitz-Ladik system. Our results indicate that when linear and nonlinear perturbations are incorporated, this weakly nonlinear lattice will thermalize into a proper Rayleigh-Jeans distribution with a well-defined temperature and chemical potential, in spite of the fact that the underlying nonlinearity is non-local and hence does not have a multi-wave mixing representation. This result illustrates that in the supermode basis, a non-local and non-Hermitian nonlinearity can in fact properly thermalize this periodic array in the presence of two quasi-conserved quantities.

PMID:37058678 | DOI:10.1364/OL.489165

Opt Lett. 2023 Apr 15;48(8):2150-2153. doi: 10.1364/OL.485215.

ABSTRACT

Hopfield networks are iterative procedures able to solve combinatorial optimization problems. New studies regarding algorithm-architecture adequacy are fostered by the re-emergence of hardware implementations of such methods in the form of Ising machines. In this work, we propose an optoelectronic architecture suitable for fast processing and low energy consumption. We show that our approach allows effective optimization relevant to statistical image denoising.

PMID:37058664 | DOI:10.1364/OL.485215

Cancer Nurs. 2023 Apr 13. doi: 10.1097/NCC.0000000000001235. Online ahead of print.

ABSTRACT

BACKGROUND: There is no consensus on the best intervention for topical management of bleeding in malignant wounds. Although surgical hemostatic dressings are recommended, the use of calcium alginate (CA) is frequent among practitioners.

OBJECTIVE: The aim of this study was to evaluate the hemostatic efficacy of oxidized regenerated cellulose (ORC) and CA dressing in the management of bleeding from malignant wounds resulting from breast cancer.

METHODS: This was a randomized open clinical trial. The outcomes measured were total time to hemostasis and the number of hemostatic products used.

RESULTS: Sixty-one patients were potentially eligible for the study, 1 did not consent, and 32 were assessed to be ineligible, resulting in a sample of 28 who were randomized to 2 study groups. Total time to hemostasis was 93.8 seconds in the ORC group, with an average of 30.1 seconds (95% confidence interval, 18.6-189 seconds), and 67 seconds in the CA group, with an average of 30.4 seconds (confidence interval, 21.7 seconds to imprecise upper limit). The main difference was 26.8 seconds. Kaplan-Meier log-rank test, and Cox model showed no statistical significance (P = 0.894). A total of 18 hemostatic products were used in the CA group and 34 in the ORC group. No adverse effects were identified.

CONCLUSIONS: Although no significant differences were identified in terms of time, more hemostatic products were used in the ORC group, highlighting the effectiveness of CA.

IMPLICATIONS FOR PRACTICE: Calcium alginate may be the first choice in the management of bleeding in malignant wounds, favoring nursing in the most immediate hemostatic actions.

PMID:37058598 | DOI:10.1097/NCC.0000000000001235

Rev Esc Enferm USP. 2023 Apr 14;57:e20220309. doi: 10.1590/1980-220X-REEUSP-2022-0309en. eCollection 2023.

ABSTRACT

OBJECTIVE: To analyze the association between time of arrival at a reference hospital and mortality of people with ischemic stroke.

METHOD: Descriptive and inferential statistics were used. Modifying and confounding variables between time of arrival and mortality were observed in the multivariate analysis. The Akaike Information Criterion was used to choose the model. Statistical significance of 5% and risk correction using the Poisson Model were adopted.

RESULTS: Most participants arrived within 4.5 hours of symptom onset or wake up stroke to the referral hospital and 19.4% died. The score of the National Institute of Health Stroke Scale was a modifier. In the multivariate model stratified by scale score ≥14, arrival time >4.5h was associated with lower mortality; and age ≥60 years and having Atrial Fibrillation, to higher mortality. In the model stratified by score ≤13, previous Rankin ≥3, and presence of atrial fibrillation were predictors of mortality.

CONCLUSION: The relationship between time of arrival and mortality up to 90 days was modified by the National Institute of Health Stroke Scale. Prior Rankin ≥3, atrial fibrillation, time to arrival ≤4.5h, and age ≥60 years contributed to higher mortality.

PMID:37058593 | DOI:10.1590/1980-220X-REEUSP-2022-0309en

Sleep. 2023 Apr 14:zsad111. doi: 10.1093/sleep/zsad111. Online ahead of print.

ABSTRACT

The frequent appearance of newly learned information in dreams suggests that dream content is influenced by memory consolidation. Many studies have tested this hypothesis by asking whether dreaming about a learning task is associated with improved memory, but results have been inconsistent. We conducted a meta-analysis to determine the strength of the association between learning-related dreams and post-sleep memory improvement. We searched the literature for studies that 1) trained participants on a pre-sleep learning task and then tested their memory after sleep and 2) associated post-sleep memory improvement with the extent to which dreams incorporated learning task content. Sixteen studies qualified for inclusion, which together reported 45 effects. Integrating across effects, we report a strong and statistically significant association between task-related dreaming and memory performance (SMD = 0.51 [95% CI 0.28 0.74], p < 0.001). Among studies using polysomnography, this relationship was statistically significant for dreams collected from NREM sleep (n = 10) but not for dreams collected from REM sleep (n = 12). There was a significant association between dreaming and memory for all types of learning tasks studied. This meta-analysis provides further evidence that dreaming about a learning task is associated with improved memory performance, suggesting that dream content may be an indication of memory consolidation. Furthermore, we report preliminary evidence that the relationship between dreaming and memory may be stronger in NREM sleep compared to REM.

PMID:37058584 | DOI:10.1093/sleep/zsad111