Category: Nevin Manimala

N Z Med J. 2023 Apr 14;136(1573):27-54.

ABSTRACT

AIM: This study’s aim was to identify differences in invasive angiography performed and health outcomes for patients with non-ST-segment elevation acute coronary syndrome (NSTEACS) presenting to either i) a rural hospital, or an urban hospital ii) with or iii) without routine access to percutaneous intervention (PCI) in New Zealand.

METHODS: Patients with NSTEACS between 1 January 2014 and 31 December 2017 were included. Logistic regression was used to model each of the outcome measures: angiography performed within 1 year; 30-day, 1-year and 2-year all-cause mortality; and readmission within 1 year of presentation with either heart failure, a major adverse cardiac event or major bleeding.

RESULTS: There were 42,923 patients included. Compared to urban hospitals with access to PCI, the odds of a patient receiving an angiogram were reduced for rural and urban hospitals without routine access to PCI (odds ratio [OR] 0.82 and 0.75) respectively. There was a small increase in the odds of dying at 2 years (OR 1.16), but not 30 days or 1 year for patients presenting to a rural hospital.

CONCLUSION: Patients who present to hospitals without PCI are less likely to receive angiography. Reassuringly there is no difference in mortality, except at 2 years, for patients that present to rural hospitals.

PMID:37054454

J Am Acad Orthop Surg. 2023 Apr 12. doi: 10.5435/JAAOS-D-22-00303. Online ahead of print.

ABSTRACT

INTRODUCTION: Childhood fractures involving the physis potentially result in premature physeal closure that can lead to growth disturbances. Growth disturbances are challenging to treat with associated complications. Current literature focusing on physeal injuries to lower extremity long bones and risk factors for growth disturbance development is limited. The purpose of this study was to provide a review of growth disturbances among proximal tibial, distal tibial, and distal femoral physeal fractures.

METHODS: Data were retrospectively collected from patients undergoing fracture treatment at a level I pediatric trauma center between 2008 and 2018. The study was limited to patients 0.5 to 18.9 years with a tibial or distal femoral physeal fracture, injury radiograph, and appropriate follow-up for determination of fracture healing. The cumulative incidence of clinically significant growth disturbance (CSGD) (a growth disturbance requiring subsequent physeal bar resection, osteotomy, and/or epiphysiodesis) was estimated, and descriptive statistics were used to summarize demographics and clinical characteristics among patients with and without CSGD.

RESULTS: A total of 1,585 patients met the inclusion criteria. The incidence of CSGD was 5.0% (95% confidence interval, 3.8% to 6.6%). All cases of growth disturbance occurred within 2 years of initial injury. The risk of CSGD peaked at 10.2 years for males and 9.1 years for females. Complex fractures that required surgical treatment, distal femoral and proximal tibial fractures, age, and initial treatment at an outside hospital were significantly associated with an increased risk of a CSGD.

DISCUSSION: All CSGDs occurred within 2 years of injury, indicating that these injuries should be followed for a period of at least 2 years. Patients with distal femoral or proximal tibial physeal fractures that undergo surgical treatment are at highest risk for developing a CSGD.

LEVEL OF EVIDENCE: Level III Retrospective Cohort Study.

PMID:37054395 | DOI:10.5435/JAAOS-D-22-00303

J Am Coll Health. 2023 Apr 13:1-4. doi: 10.1080/07448481.2023.2198018. Online ahead of print.

ABSTRACT

This study examined the difference in the dynamic visual acuity test (DVAT) between collegiate athletes who are deaf or hard-of-hearing (D/HoH) (n = 38) and university club-level athletes who are hearing (n = 38). Dynamic visual acuity was assessed using the Bertec Vision Advantage (Bertec® Corporation, Columbus, Ohio, USA). No statistically significant differences between athletes who are D/HoH and who are hearing were found in DVAT for leftward (χ² = 0.71, p = 0.40) or rightward (χ² = 0.04, p = 0.84) head yaw rotation around an earth vertical axis. Dynamic visual acuity was similar for athletes regardless of hearing status. Baseline DVAT data may be of use for post-injury management of athletes who are D/HoH.

PMID:37053591 | DOI:10.1080/07448481.2023.2198018

J Am Coll Health. 2023 Apr 13:1-5. doi: 10.1080/07448481.2023.2198021. Online ahead of print.

ABSTRACT

Objective: To compare the experiences of Imposter Phenomenon and discrimination among non-Hispanic White (NHW) and racial and ethnic minority (REM) students at a predominantly White Institution (PWI). Participants: 125 undergraduate students (89.6% women, 68.8% NHW, and 31.2% REM). Methods: Participants completed an online questionnaire including the Clance Imposter Phenomenon Scale (CIPS), Everyday Discrimination Scale (EDS), demographic variables (class year, gender, first generation student status), and 5 items assessing students’ feelings of belonging and support. Descriptive statistics and bivariate analyses were performed. Results: Mean CIPS scores were similar for NHW (64.05 ± 14.68) and REM students (63.62 ± 15.90, P = . 882), but EDS scores were significantly higher among REM students (13.00 ± 9.24 vs. 8.00 ± 5.21, P = . 009). REM students more frequently felt that they don’t belong, are excluded, and lack resources to succeed. Conclusions: Racial and ethnic minority students at PWIs may need additional resources and social support.

PMID:37053586 | DOI:10.1080/07448481.2023.2198021

Pediatr Infect Dis J. 2023 Mar 29. doi: 10.1097/INF.0000000000003919. Online ahead of print.

ABSTRACT

BACKGROUND: To construct a predictive model for intravenous immunoglobulin (IVIG) resistant Kawasaki disease (KD) based on the gradient boosting decision tree (GBDT), so as to early identify children with IVIG resistance and actively take additional treatment to prevent adverse events.

METHODS: The case data of KD children hospitalized in the Pediatric Department of Lanzhou University Second Hospital from October 2015 to July 2020 were collected. All KD patients were divided into IVIG responsive group and IVIG resistant group. GBDT was used to explore the influencing factors of IVIG-resistant KD and to construct a prediction model. Then compared with previous models, the optimal model was selected.

RESULTS: In the process of GBDT model construction, 80% of the data were used as the test set, and 20% of the data were used as the validation set. Among them, the verification set was used to adjust the hyperparameters in GDBT learning. The model performed best with a hyperparameter tree depth of 5. The area under the curve of the GBDT model constructed based on the best parameters was 0.87 (95% CI: 0.85-0.90), the sensitivity was 72.62%, the specificity was 89.04%, and the accuracy was 61.65%. The contribution degree of each feature value to the model was total bilirubin, albumin, C-reactive protein, fever time, and Na in order.

CONCLUSION: The GBDT model is more suitable for the prediction of IVIG-resistant KD in this study area.

PMID:37053575 | DOI:10.1097/INF.0000000000003919

J Contin Educ Health Prof. 2023 Apr 12. doi: 10.1097/CEH.0000000000000508. Online ahead of print.

ABSTRACT

INTRODUCTION: Comprehending scientific information have been reported as a barrier in evidence-based practice (EBP) adoption. This survey research aimed to verify the preferred sources of information for acquiring knowledge about physiotherapy and the association between types of information source and barriers in EBP implementation.

METHODS: A total of 610 physiotherapists were included and answered an online questionnaire about the preferred sources for searching physiotherapy-related information and possible barriers in EBP implementation.

DISCUSSION: Physiotherapists reported scientific resources as the preferred source of information, scientific databases (31%), followed by scientific articles (25%). The main barrier cited in EBP implementation was the difficulty in obtaining full-text articles (34%), followed by lack of statistical knowledge (30%). The use of peer-reviewed resources as the most preferred source of information is associated with the presence of issues in comprehending scientific information.

CONCLUSIONS: Although the positive attitude toward the use of scientific information, the findings raised question regarding the proper translation of scientific information to clinical practice. The importance of scientific information seems to be a well-established attitude among physiotherapists. However, there is a clear need for strategies aiming to improve the understanding of scientific information and consequently facilitate EBP implementation.

PMID:37053570 | DOI:10.1097/CEH.0000000000000508

Nurs Educ Perspect. 2023 Apr 14. doi: 10.1097/01.NEP.0000000000001118. Online ahead of print.

ABSTRACT

Sense of belongingness in the academic environment has been associated with positive student outcomes and increased student success. To cultivate belongingness, graduate nursing students were invited to participate in a virtual fitness challenge. Sense of belongingness was measured through pre- (n = 103) and post-intervention (n = 64) surveys with three subscales: other students, faculty, and the university. Students reported improved sense of belongingness following the intervention for all subscales, with statistically significant improvements related to other students (p = .007) and the university (p = .023). A virtual fitness challenge may improve sense of belongingness among graduate nursing students.

PMID:37053558 | DOI:10.1097/01.NEP.0000000000001118

Am J Public Health. 2023 Apr 13:e1-e9. doi: 10.2105/AJPH.2023.307274. Online ahead of print.

ABSTRACT

Objectives. To analyze rural-urban differences in COVID-19 vaccination uptake, hesitancy, and trust in information sources in the United States. Methods. We used data from a large survey of Facebook users. We computed the vaccination, hesitancy, and decline rates and the trust proportions among individuals hesitant toward COVID-19 information sources for rural and urban regions in each state from May 2021 to April 2022. Results. In 48 states with adequate data, on average, two thirds of states showed statistically significant differences in monthly vaccination rates between rural and urban regions, with rural regions having a lower vaccination rate at all times. Far fewer states showed statistically significant differences when comparing monthly hesitancy and decline rates for urban versus rural regions. Doctors and health professionals received the highest level of trust. Friends and family were also among the most trusted sources in rural areas where the vaccination uptake was low. Conclusions. Rural-urban difference in hesitancy rates among those still unvaccinated was much smaller than the rural-urban difference in vaccination rates, suggesting that access to vaccines may be another contributor to the lower vaccination rates in rural areas. (Am J Public Health. Published online ahead of print April 13, 2023:e1-e9. https://doi.org/10.2105/AJPH.2023.307274).

PMID:37053528 | DOI:10.2105/AJPH.2023.307274

Diabetes Technol Ther. 2023 Apr 13. doi: 10.1089/dia.2023.0085. Online ahead of print.

ABSTRACT

Continuous glucose monitoring (CGM) systems are used in therapeutic decisions for diabetes management, however the impact of body composition on CGM accuracy is not known. Body composition variables (body mass index BMI, mid arm circumference, percentage fat and impedance) were collected in an observational study designed to determine the accuracy of an investigational Medtronic Guardian<TM>sensor 3. Seven days of sensor glucose data were analysed from 112 participants >7 years of age with mean BMI Z score 0.48 (< 18 years) and BMI 26.7 (≥18 years). The outcome was the weighted absolute relative difference (ARD). Data were analysed using generalised estimating equations to account for correlation between repeated measures. No statistically significant associations between measures of body composition and device accuracy were found. Body composition does not have a meaningful impact on the accuracy of CGM systems.

PMID:37053526 | DOI:10.1089/dia.2023.0085

Anesth Analg. 2023 Apr 12. doi: 10.1213/ANE.0000000000006483. Online ahead of print.

ABSTRACT

Factor V Leiden is the commonest hereditary prothrombotic allele, affecting 1% to 5% of the world’s population. The objective of this study was to characterize the perioperative and postoperative outcomes of patients with Factor V Leiden compared to patients without a diagnosis of hereditary thrombophilia. This was a focused systematic review of studies including adult (>18 years) patients with Factor V Leiden (heterozygous or homozygous) undergoing noncardiac surgery. Included studies were either randomized controlled trials or observational. The primary clinical outcomes of interest were thromboembolic events occurring from the perioperative period up to 1 year postoperatively, defined as deep venous thrombosis, pulmonary embolism, or other clinically significant thrombosis occurring during or after a surgical procedure. Secondary outcomes included cerebrovascular events, cardiac events, death, transplant-related outcomes, and surgery-specific morbidity. Pediatric and obstetrical patients were excluded, as were case reports and case series. Databases searched included MEDLINE and EMBASE from inception until August 2021. Study bias was assessed through the CLARITY (Collaboration of McMaster University researchers) Risk of Bias tools, and heterogeneity through analysis of study design and end points, as well as the I2 statistic with its confidence interval and the Q statistic. A total of 5275 potentially relevant studies were identified, with 115 having full text assessed for eligibility and 32 included in the systematic review. On the whole, the literature suggests that patients with Factor V Leiden have an increased risk of perioperative and postoperative thromboembolic events compared to patients without the diagnosis. Increased risk was also seen in relation to surgery-specific morbidity and transplant-related outcomes, particularly arterial thrombotic events. The literature did not support an increased risk for mortality, cerebrovascular, or cardiac complications. Limitations of the data include predisposition toward bias due in many study designs and small sample sizes across the majority of published studies. Variable outcome definitions and durations of patient follow-up across different surgical procedures resulted in high study heterogeneity precluding the effective use of meta-analysis. Factor V Leiden status may confer additional risk for surgery-related adverse outcomes. Large, adequately powered studies are required to accurately estimate the degree of this risk by zygosity.

PMID:37053508 | DOI:10.1213/ANE.0000000000006483