Category: Nevin Manimala

J Patient Saf. 2023 Jan 19. doi: 10.1097/PTS.0000000000001104. Online ahead of print.

ABSTRACT

OBJECTIVES: Improving patient safety by investigating sentinel events (SEs) is hampered by the focus on isolated events within hospitals and a narrow scope of traditional root cause analysis methods. We aimed to examine if performing cross-hospital aggregate analysis of SEs applying a novel generic analysis method (GAM) bearing a human factor perspective can enhance learning from SEs.

METHODS: A retrospective cross-sectional review of SE reports from 28 Dutch general hospitals using the GAM to reanalyze events was performed. A qualitative approach was used to identify contributing factors and system issues. Findings were discussed with a patient safety expert panel. Descriptive statistics and measures of associations between domains were calculated.

RESULTS: Sixty-nine SE reports were reviewed. Applying the GAM provided a more holistic SE analysis than a traditional method. Of the 405 identified contributing factors in all SEs, the majority was related to the persons involved (patients and professionals, n = 146 [36.2%]) and the organization (n = 121 [30%]). The most frequently recurring pattern was the combination of factors related to the persons involved, the technology used, the tasks of professionals, and organizational factors influencing the event. Cross-hospital aggregate GAM analysis of SEs helped to identify system issues and propose more system-oriented overarching recommendations.

CONCLUSIONS: This study found that applying the GAM to analyze SEs across hospitals can help to improve learning from SEs and may result in proposing stronger recommendations. The method can support hospitals, working together in a network of hospitals, to jointly learn from SEs.

PMID:36652656 | DOI:10.1097/PTS.0000000000001104

ACS Appl Mater Interfaces. 2023 Jan 18. doi: 10.1021/acsami.2c17198. Online ahead of print.

ABSTRACT

Water management in the catalyst layers (CLs) of proton-exchange membrane fuel cells is crucial for its commercialization and popularization. However, the high experimental or computational cost in obtaining water distribution and diffusion remains a bottleneck in the existing experimental methods and simulation algorithms, and further mechanistic exploration at the nanoscale is necessary. Herein, we integrate, for the first time, molecular dynamics simulation with our customized analysis framework based on a multiattribute point cloud dataset and an advanced deep learning network. This was achieved through our workflow that generates simulated transport data of water molecules in the CLs as the training and test dataset. Deep learning framework models the multibody solid-liquid system of CLs on a molecular scale and completes the mapping from the Pt/C substrate structure and Nafion aggregates to the density distribution and diffusion coefficient of water molecules. The prediction results are comprehensively analyzed and error evaluated, which reveals the highly anisotropic interaction landscape between 50,000 pairs of interacting nanoparticles and explains the structure and water transport property relationship in the hydrated Nafion film on the molecular scale. Compared to the conventional methods, the proposed deep learning framework shows computational cost efficiency, accuracy, and good visual display. Further, it has a generality potential to model macro- and microscopic mass transport in different components of fuel cells. Our framework is expected to make real-time predictions of the distribution and diffusion of water molecules in CLs as well as establish statistical significance in the structural optimization and design of CLs and other components of fuel cells.

PMID:36652634 | DOI:10.1021/acsami.2c17198

Stress Health. 2023 Jan 18. doi: 10.1002/smi.3225. Online ahead of print.

ABSTRACT

Being a family carer is associated with increased risk of experiencing depressive symptoms. Despite many decades of research investigating the association between coping strategies and depressive symptoms in carers results across studies remain contradictory. The objective of this study was to systematically review evidence on the association between depressive symptoms and coping strategies in carers of dependent people aged 18 and over and investigate potential sources of heterogeneity of findings. The study design was a systematic review and meta-analysis. We searched Pubmed, CINAHL, PsycINFO and LILACS up to April 2021. We performed meta-analyses following the PRISMA statement and several subgroup analyses to investigate whether cause of caring dependency, study design, and controlling for several biases influenced results. Fifty-nine studies met our inclusion criteria. We found a robust and statistically significant association between greater use of dysfunctional coping and higher depressive symptoms. Greater use of emotion-focused coping was associated with fewer depressive symptoms only in studies controlling for confounding bias. Use of problem-focused coping was related to fewer depressive symptoms in carers of frail older people. The combined use of both problem-focused and emotion-focused coping was associated with lower symptoms of depression. Our review concludes that the broad domain of dysfunctional coping is consistently associated with higher levels of depressive symptoms in carers. After controlling for confounders, emotion-focused coping and several of its individual strategies were consistently associated with fewer depressive symptoms. Whilst problem-focused coping and some of its individual strategies are also associated with lower depressive symptoms, these strategies may not be as helpful in all caregiving groups.Clinical Impact Statement: fcBoth broad dimensions of coping and individual coping strategies are important correlates of depressive symptoms in family carers, and should be utilized in informing and improving the effectiveness of future caregiving interventions. This article is protected by copyright. All rights reserved.

PMID:36652619 | DOI:10.1002/smi.3225

JMIR Form Res. 2022 Dec 20. doi: 10.2196/34074. Online ahead of print.

ABSTRACT

BACKGROUND: Due to the COVID-19 pandemic, telehealth has become a safer way to access healthcare. The telehealth industry has rapidly expanded over the last decade as a modality to provide patient-centered care. However, the prevalence of its use and patient acceptability remains unclear in the Middle East and North Africa (MENA) region.

OBJECTIVE: The primary aim was to assess the prevalence of telehealth use before and during the pandemic by utilizing social media (Instagram) as an online platform for survey administration across different countries simultaneously. Our secondary aim was to assess the perceptions regarding telehealth usage amongst those utilizing it.

METHODS: An online social media platform (Instagram) that reaches 130,000 subjects daily was used to administer a questionnaire that assessed the current prevalence of telehealth use and public attitudes and acceptability towards this modality of healthcare delivery during the COVID-19 pandemic.

RESULTS: 1524 respondents participated in the survey (females 89.0%; median age 31 years), of whom 97.6% lived in the Gulf Cooperation Council (GCC). Prior to COVID-19, 1350 (88.6%) had no exposure to telehealth. Following the COVID-19 pandemic, telehealth usage increased by 251% to a total of 611 users (40% of all users). About 89% of telehealth users used virtual visits for specialist visits. Of the 642 participants who reported using telehealth, 236 (36.8%) reported their willingness to continue using telehealth, 241 (37.5%) were unsure, and 164 (25.5%) did not wish to continue to use telehealth after the COVID-19 pandemic. An inverse trend, although not statistically significant, was seen between willingness to continue telehealth usage and the number of medical comorbidities (OR= 0.81, p= 0.094). Compared to the respondents who chose only messaging as their used modality for telehealth, respondents who chose both messaging and phone calls were significantly less likely to recommend telehealth (OR= 0.42, p= 0.009). Overall, there was general satisfaction with telehealth usage and respondents reported that telehealth consultations made them feel safer and saved both time and money.

CONCLUSIONS: Telehealth usage increased dramatically after the COVID-19 pandemic and usage was found to be acceptable among some young adult groups on Instagram. However, further innovation is warranted to increase acceptability and willingness to continue telehealth use for the delivery of healthcare.

PMID:36652596 | DOI:10.2196/34074

J Nurs Educ. 2023 Jan;62(1):47-50. doi: 10.3928/01484834-20221109-08. Epub 2023 Jan 1.

ABSTRACT

BACKGROUND: Traditional clinical education does not prepare future nurses well for practice. Clinical immersion models are recommended to enhance critical thinking, clinical judgment, and confidence with nursing roles and skills. This study explored the effects of implementing an innovative clinical immersion model on readiness for nursing practice for accelerated Bachelor of Science in nursing students.

METHOD: The Casey-Fink readiness for practice survey was used to determine graduate students’ confidence and comfort with nursing roles and skills based on descriptive statistics for each survey question.

RESULTS: Study results indicated students who experienced the clinical immersion model had high levels of confidence with nursing roles and felt prepared for practice.

CONCLUSION: Nursing programs should consider implementing clinical immersion models in undergraduate nursing education programs. [J Nurs Educ. 2023;62(1):47-50.].

PMID:36652578 | DOI:10.3928/01484834-20221109-08

J Chin Med Assoc. 2023 Feb 1;86(2):246-253. doi: 10.1097/JCMA.0000000000000854. Epub 2023 Jan 18.

ABSTRACT

BACKGROUND: The Greulich-Pyle (GP) and Tanner-Whitehouse 3 (TW3) methods are two common methods for assessing bone age (BA). The applicability of these methods for populations other than those in the United States and Europe has been questioned. Thus, this study tested the applicability of these methods for Taiwanese children.

METHODS: In total, 1476 radiographs (654 boys, 822 girls) were analyzed. A subset of 200 radiographs was evaluated to determine intrarater and interrater reliability and the time required to yield a BA assessment. BA was determined by two reviewers using the GP method and two of the TW3 methods (the Radial-Ulnar-Short bones [RUS] method and the carpals method [Carpal]). The GP and TW3 methods were directly compared using statistical techniques. A subgroup analysis by age was performed to compare BA and chronological age using a paired t test for each age group.

RESULTS: The average times required to yield an assessment using the GP and TW3-RUS methods were 0.79 ± 0.14 and 3.01 ± 0.84 min (p < 0.001), respectively. Both the intrarater and interrater correlation coefficients were higher for the GP method (0.993, 0.992) than the TW3-RUS (0.985, 0.984) and TW3-Carpal (0.981, 0.973) methods. The correlation coefficient for the GP and TW3-RUS methods was highest in the pubertal stage (0.898 for boys and 0.909 for girls). The mean absolute deviations for the GP and TW3-RUS methods in the pubertal stage were 0.468 years (boys) and 0.496 years (girls). Both the GP and TW3-Carpal methods underestimated BA for boys in the prepubertal stage. Both the GP and TW3-RUS methods overestimated BA for girls in the pubertal and postpubertal stages.

CONCLUSION: The GP and TW3-RUS methods exhibit strong agreement in the pubertal and postpubertal stages for both sexes. With appropriate adjustments based on Taiwanese data, both methods are applicable to our children.

PMID:36652571 | DOI:10.1097/JCMA.0000000000000854

J Chin Med Assoc. 2023 Feb 1;86(2):155-165. doi: 10.1097/JCMA.0000000000000840. Epub 2022 Nov 4.

ABSTRACT

BACKGROUND: It is unclear whether hydroxymethylglutaryl-CoA reductase inhibitor (statin) therapy decreases the risk of mortality and cardiovascular disease (CVD) in patients undergoing peritoneal dialysis (PD).

METHODS: We performed a literature search of PubMed, Cochrane Library, Embase, and other databases for research publications up to June 2022. The outcomes of interest were fatal and nonfatal CVDs, all-cause mortality, and changes in the biochemical profiles. Hazard ratios (HRs) with 95% confidence intervals (CIs) were pooled and synthesized using a random-effects model. The certainty of the evidence was determined using Grading of Recommendations, Assessment, Development, and Evaluation.

RESULTS: Nine studies, including 2,933 patients undergoing PD, were included. Among them, three studies, including 2,099 patients, reported all-cause mortality, and three, including 1,571 patients, reported CVDs. In these patients, pooling results of two observational studies (very low-certainty evidence) showed that statin therapy significantly reduced CVDs (HR = 0.67; 95% CI = 0.54-0.84; p = 0.0004). Moreover, statin therapy was associated with significantly reduced low-density lipoprotein cholesterol, total cholesterol, and C-reactive protein levels (very low certainty of evidence). However, the effects of statin therapy on triglyceride, high-density lipoprotein, and albumin levels were not statistically significant.

CONCLUSION: Although statin therapy was associated with significantly reduced low-density lipoprotein cholesterol, total cholesterol, and C-reactive protein levels, the probable beneficial effect of statins on CVD risk in patients undergoing PD could not be concluded firmly. Additional high-quality studies are required to assess the potential beneficial effects of statin therapy in PD patients.

PMID:36652565 | DOI:10.1097/JCMA.0000000000000840

Int J Low Extrem Wounds. 2023 Jan 18:15347346221144937. doi: 10.1177/15347346221144937. Online ahead of print.

ABSTRACT

Objective: Through clinical trials, this study observes the therapeutic effect of platelet-rich plasma (platelet-rich plasma, PRP) on diabetic foot ulcers and explored the relationship between the relationship between PRP and autophagy. Methods: Thirty patients with diabetic foot ulcer who met the relevant criteria were randomly divided into PRP treatment group and control group. In the PRP treatment group, the formed PRP gel was coated and bandaged on the diabetic foot ulcer wound, and the PRP treatment was repeated on the seventh day. The control group was covered with normal saline sterile gauze. Observe the healing rate of the wound in 7 days, 14 days and 21 days, the pain in 5 consecutive days and the healing time of the wound after treatment, collect wound granulation tissues before and twenty-first days after treatment then detect the expression of autophagy-related proteins (LC-3, P62) and inflammatory factors (IL-6, IL-10) in diabetic foot ulcer wound to investigate the potential relationship between PRP treatment of diabetic foot ulcers and autophagy and inflammatory responses. Results: The wound healing rate of diabetic foot ulcer patients in the PRP treatment group was higher than that in the control group on the seventh, 14th and 21st days, the healing time (31.40 ± 4.47) was better than that in the control group (43.20 ± 5.03) days, and the pain improvement was better than that in the control group (P < .05). The results of Western blot analysis and quantitative PCR of autophagy-related proteins (LC-3 and p62) in granulation tissue showed that the values of LC3 and LC3-II/LC3-I and the expression of LC3 gene in wound granulation tissue of PRP group were significantly higher than those before treatment (P < .05). The value and gene expression of P62 protein were lower than those before treatment (P < .05). In the control group, there was no significant difference in LC3 and P62 protein gray level and gene expression before and after treatment (P > .05). The level of autophagy in the wound of PRP group increased after treatment, while there was no statistical significance in the control group. The results of ELISA showed that the concentration of IL-6 in granulation tissue of the PRP treatment group was lower than that before treatment (P < .05), while there was no significant difference in IL-6 in the control group after treatment. The concentration of IL-10 increased in both groups after treatment, but the concentration in PRP group was higher than that in control group (P < .05). Conclusions: This study shows that PRP gel has advantages in accelerating wound healing, relieving pain, shortening healing time and reducing inflammatory response in treating diabetic foot ulcers wound, which may be related to autophagy, and provides new ideas for the treatment of diabetic foot ulcers.

PMID:36652558 | DOI:10.1177/15347346221144937

Stat Methods Med Res. 2023 Jan 18:9622802231151204. doi: 10.1177/09622802231151204. Online ahead of print.

ABSTRACT

Advances in biologic technology enable researchers to obtain a huge amount of genetic and genomic data, whose dimensions are often quite high on both phenotypes and variants. Testing their association with multiple phenotypes has been a hot topic in recent years. Traditional single phenotype multiple variant analysis has to be adjusted for multiple testing and thus suffers from substantial power loss due to ignorance of correlation across phenotypes. Similarity-based method, which uses the trace of product of two similarity matrices as a test statistic, has emerged as a useful tool to handle this problem. However, it loses power when the correlation strength within multiple phenotypes is middle or strong, for some signals represented by the eigenvalues of phenotypic similarity matrix are masked by others. We propose a divided-and-combined omnibus test to handle this drawback of the similarity-based method. Based on the divided-and-combined strategy, we first divide signals into two groups in a series of cut points according to eigenvalues of the phenotypic similarity matrix and combine analysis results via the Cauchy-combined method to reach a final statistic. Extensive simulations and application to a pig data demonstrate that the proposed statistic is much more powerful and robust than the original test under most of the considered scenarios, and sometimes the power increase can be more than 0.6. Divided-and-combined omnibus test facilitates genetic association analysis with high-dimensional data and achieves much higher power than the existing similarity based method. In fact, divided-and-combined omnibus test can be used whenever the association analysis between two multivariate variables needs to be conducted.

PMID:36652550 | DOI:10.1177/09622802231151204

J Sports Sci. 2023 Jan 18:1-9. doi: 10.1080/02640414.2023.2167257. Online ahead of print.

ABSTRACT

This study aimed to report the goal patterns in cerebral palsy (CP) football for a better understanding of the performance of this para-sport. All goals (270) of the 48 2019 IFCPF World Cup matches were analysed through match reports, and 65% of them were analysed by video footage. The results showed 5.6 goals per match. Teams that scored more and conceded fewer goals correlated to a better ranking position in the championship (r= 0.72-0.73; p< 0.01). The distribution of goals scored was not biased by halves (49.3% vs 50.7%; χ²= 0.1; p= 0.88) nor by 15-min periods (26.3% vs 23.0% vs 23.3% vs 27.4%; χ²= 0.5; p= 0.92). In 91.7% of the matches, the team which scored the first goal went on to win the match (χ²= 81.5; p< 0.01). FT3 players scored more goals by player (χ²= 22.1; p< 0.01), while there were no statistical differences in the distribution of goals conceded by goalkeepers according to their sport class (χ²= 4.7; p= 0.09). The goals were scored mainly from organized attacks (74.4%), from the penalty area (52.5%) and through individual action (51.9%). All this information could be crucial for coaches in CP football to plan their game strategies.

PMID:36652545 | DOI:10.1080/02640414.2023.2167257