Category: Nevin Manimala

J Pharm Policy Pract. 2023 Jan 19;16(1):10. doi: 10.1186/s40545-023-00520-9.

ABSTRACT

BACKGROUND: Since 2015, the National Health Service (NHS) has funded pharmacists to work in general practice (GP practice) to ease workload pressures. This requires pharmacists to work in new roles and be integrated effectively in GPs. Independent prescribing is a key part of the GP pharmacist role, but little is known about pharmacists’ integration into GP practice as well as patients’ perceptions and experiences of the care provided by GP pharmacists. This study aims to explore the perceptions of pharmacist independent prescribers (PIPs) about their integration into GP practice and gain insight into patients’ perceptions about the care provided to them by pharmacists.

METHODS: A mixed-methods study comprising semi-structured interviews with PIPs (n = 13) followed by questionnaire-based assessment of patients’ (n = 77) evaluation of pharmacists’ care was conducted between December 2019 and March 2020. Quantitative data were analysed using descriptive statistics. Interviews and open comments of the survey were thematically analysed.

RESULTS: Pharmacist independent prescribers reported undertaking a range of patient-facing and non-clinical roles. Lack of understanding about PIPs’ clinical role and working beyond their clinical area of competence were some of the barriers to their integration into GP practice. Most patients were satisfied with the consultations they received from pharmacists and reported confidence in the pharmacist’s recommendations about their health conditions. However, a few patients (14%) felt they would still need to consult a general practitioner after their appointment and 11% were not sure if a further consultation was needed.

CONCLUSIONS: Pharmacist independent prescribers provide a range of clinical services for the management of long-term conditions which appear to be recognised by patients. However, there is a need to address the barriers to PIPs’ integration into GP practice to optimise their skill-mix and patient-centred care.

PMID:36658624 | DOI:10.1186/s40545-023-00520-9

Eur J Med Res. 2023 Jan 19;28(1):36. doi: 10.1186/s40001-022-00975-7.

ABSTRACT

OBJECTIVE: To investigate the predictive value of deep learning-based cardiac ultrasound flow imaging for hypertrophic cardiomyopathy (HCM) complicated by arrhythmias.

METHODS: The clinical data of 158 patients with hypertrophic cardiomyopathy were retrospectively collected from July 2019 to December 2021, and additionally divided into training group 106 cases, validation group 26 cases and test group 26 cases according to the ratio of 4:1:1, and divided into concurrent and non-concurrent groups according to whether they were complicated by arrhythmia or not, respectively. General data of patients (age, gender, BMI, systolic blood pressure, diastolic blood pressure, HR) were collected, a deep learning model for cardiac ultrasound flow imaging was established, and image data, LVEF, LAVI, E/e’, vortex area change rate, circulation intensity change rate, mean blood flow velocity, and mean EL value were extracted.

RESULTS: The differences in general data (age, gender, BMI, systolic blood pressure, diastolic blood pressure, HR) between the three groups were not statistically significant, P > 0.05. The differences in age, gender, BMI, systolic blood pressure, diastolic blood pressure, HR between the patients in the concurrent and non-concurrent groups in the training group were not statistically significant, P > 0.05.

CONCLUSIONS: Deep learning-based cardiac ultrasound flow imaging can identify cardiac ultrasound images more accurately and has a high predictive value for arrhythmias complicating hypertrophic cardiomyopathy, and vortex area change rate, circulation intensity change rate, mean flow velocity, mean EL, LAVI, and E/e’ are all risk factors for arrhythmias complicating hypertrophic cardiomyopathy.

PMID:36658623 | DOI:10.1186/s40001-022-00975-7

Int J Health Geogr. 2023 Jan 19;22(1):1. doi: 10.1186/s12942-023-00323-w.

ABSTRACT

BACKGROUND: The early detection of colorectal cancer (CRC) through regular screening decreases its incidence and mortality rates and improves survival rates. Norway has an extremely high percentage of CRC cases diagnosed at late stages, with large variations across municipalities and hospital catchment areas. This study examined whether the availability of physicians related to CRC primary diagnosis and preoperative investigations, or physician density, contributes to the observed geographical differences in late-stage incidence rates.

METHOD: Municipality-level data on CRC stage at diagnosis were obtained from the Cancer Registry of Norway for the period 2012-2020. Physician density was calculated as the number of physicians related to CRC investigations, general practitioners (GPs) and specialists per 10,000 people, using physician counts per municipality and hospital areas from Statistics Norway. The relationship was examined using a novel causal inference method for spatial data-neighbourhood adjustment method via spatial smoothing (NA approach)-which allowed for studying the region-level effect of physician supply on CRC outcome by using spatially referenced data and still providing causal relationships.

RESULTS: According to the NA approach, an increase in one general practitioner per 10,000 people will result in a 3.6% (CI -0.064 to -0.008) decrease in late-stage CRC rates. For specialists, there was no evidence of a significant correlation with late-stage CRC distribution, while for both groups, GPs and specialists combined, an increase of 1 physician per 10,000 people would be equal to an average decrease in late-stage incidence rates by 2.79% (CI -0.055 to -0.001).

CONCLUSION: The study confirmed previous findings that an increase in GP supply will significantly improve CRC outcomes. In contrast to previous research, this study identified the importance of accessibility to both groups of physicians-GPs and specialists. If GPs encounter insufficient workforces in hospitals and long delays in colonoscopy scheduling, they will less often recommend colonoscopy examinations to patients. This study also highlighted the efficiency of the novel methodology for spatially referenced data, which allowed us to study the effect of physician density on cancer outcomes within a causal inference framework.

PMID:36658603 | DOI:10.1186/s12942-023-00323-w

J Cannabis Res. 2023 Jan 20;5(1):2. doi: 10.1186/s42238-022-00169-2.

ABSTRACT

BACKGROUND: The purpose of this study was to examine the perceived influence of cannabis on sexual functioning and satisfaction. This study used Kaplan’s and Masters and Johnson’s sexual response cycle (desire, excitement, orgasm, plateau, resolution) and included satisfaction to complete the sexual response cycle. Given increased attention in the research literature to the potential benefits of cannabis and the lack of research on the sexual benefits of cannabis use, the current study was completed.

METHODS: Data were collected using the online survey tool “Qualtrics” from a self-selected, convenience sample of adults over the age of 18 who reported previous cannabis use. The survey, developed by the researchers based on previous literature, included demographic questions followed by a scale to measure sexual functioning and satisfaction in relation to cannabis use (α = 0.897).

RESULTS: The final sample was 811 participants ranging in age from 18 to 85 years old (M = 32.11). The majority of participants were identified as female (n = 536, 64.9%), White/Caucasian (n = 640, 78.9%), and college educated (n = 650, 80.1%). Almost 25% of the participants were identified as LGBTQIA+ (n = 187, 23.1%). Most of the participants reported being in a monogamous sexual relationship (n = 598, 73.7%). Data were analyzed using descriptive statistics, t-tests, one-way ANOVA, and multiple regression. Age and gender were not found to have significant effects on cannabis use and sexual functioning and satisfaction. Over 70% of participants reported increased desire (M = 4.05, SD = 0.962) and orgasm intensity (M = 4.05, SD = 0.884). Participants who reported masturbating indicated that cannabis enhanced their pleasure while masturbating (n = 620, 62.5%). Participants also stated that cannabis enhanced their sense of taste (n = 583, 71.9%) and touch (n = 576, 71.0%).

DISCUSSION: The results of this study contrast and establish new evidence within the literature. Demographic results indicate that the people who use cannabis are of a wide range of ages, from a variety of occupations, and have differing cannabis use preferences. The inclusion of LGBTQIA + respondents is a strength of this study. Overall, results indicated that both men and women perceived that cannabis use increased their sexual functioning and satisfaction, particularly increased desire and orgasm intensity.

CONCLUSION: This study updates the current literature on cannabis and sexuality and provides implications for improving sexual quality. Medical implications of this study include the possible use of cannabis for treating sexual dysfunctions, especially within women.

PMID:36658600 | DOI:10.1186/s42238-022-00169-2

Thromb J. 2023 Jan 19;21(1):7. doi: 10.1186/s12959-023-00451-0.

ABSTRACT

BACKGROUND: Several prior studies postulated an effect of hypertension on coagulation factors. However, population-based studies investigating the sex-specific associations between hypertension and hemostatic parameters are scarce. Therefore, we investigated the relationship between blood pressure and parameters of coagulation, namely activated partial thromboplastin time (aPTT), international normalized ratio (INR), fibrinogen, factor VIII, antithrombin III, protein C, protein S, and D-dimer in men and women from the general population.

METHODS: Based on 803 participants (376 men, 427 women) from the KORA-Fit Study the sex-specific relationship between systolic, diastolic, and pulse pressure and commonly measured coagulation factors were investigated using multivariable-adjusted linear regression models.

RESULTS: Hypertensive males had significantly higher median fibrinogen levels and factor VIII activity in comparison to normotensive males. There was a statistically significant difference between females with and without hypertension regarding the parameter fibrinogen, D-dimers, Protein S activity, and factor VIII activity. In multivariable linear regression analyses no significant association between systolic blood pressure, diastolic blood pressure, as well as pulse pressure and the investigated hemostatic parameters was found in men. In women, a significant positive association could be observed between systolic blood pressure and D-dimer level [β-estimate per mmHg increase 3.37 (95% CI 0.935-5.804; p = 0.007)] and between pulse pressure and D-dimer level [β-estimate per mmHg increase 5.351 (95% CI 1.772-8.930; p = 0.003)].

CONCLUSIONS: It appears that sex differences exist in the association between blood pressure parameters and commonly measured coagulation markers in the general population. Further studies are needed to identify the underlying causes.

PMID:36658589 | DOI:10.1186/s12959-023-00451-0

Cardiovasc Diabetol. 2023 Jan 19;22(1):12. doi: 10.1186/s12933-023-01736-4.

ABSTRACT

BACKGROUND: Patients with diabetes mellitus have an increased risk of incident atrial fibrillation (AF). The effect of accumulated hypertension burden is a less well-known modifiable risk factor. We explored the relationship between accumulated hypertension burden and incident AF in these patients.

METHODS: We evaluated data for 526,384 patients with diabetes who underwent three consecutive health examinations, between 2009 and 2012, from the Korean National Health Insurance Service. Hypertension burden was calculated by assigning points to each stage of hypertension in each health examination: 1 for stage 1 hypertension (systolic blood pressure [SBP] 130-139 mmHg; diastolic blood pressure [DBP] 80-89 mmHg); 2 for stage 2 (SBP 140-159 mmHg and DBP 90-99 mmHg); and 3 for stage 3 (SBP ≥ 160 mmHg or DBP ≥ 100 mmHg). Patients were categorized into 10 hypertensive burden groups (0-9). Groups 1-9 were then clustered into 1-3, 4-6, and 7-9.

RESULTS: During a mean follow-up duration of 6.7 ± 1.7 years, AF was newly diagnosed in 18,561 (3.5%) patients. Compared to patients with hypertension burden 0, those with burden 1 to 9 showed a progressively increasing risk of incident AF: 6%, 11%, 16%, 24%, 28%, 41%, 46%, 57%, and 67% respectively. Clusters 1-3, 4-6, and 7-9 showed increased risks by 10%, 26%, and 45%, respectively, when compared to a hypertension burden of 0.

CONCLUSIONS: Accumulated hypertension burden was associated with an increased risk of incident AF in patients with diabetes. Strict BP control should be emphasized for these patients.

PMID:36658574 | DOI:10.1186/s12933-023-01736-4

BMC Vet Res. 2023 Jan 19;19(1):14. doi: 10.1186/s12917-022-03559-z.

ABSTRACT

BACKGROUND: Classical swine fever and porcine reproductive and respiratory syndrome have seriously affected the development of the swine breeding industry in China. Vaccine immunization remains the main way to prevent these infections. The aim of this study was to establish an optimized protocol for vaccine immunization against classical swine fever virus (CSFV) and porcine reproductive and respiratory syndrome virus (PRRSV).

METHODS: Blood samples were collected from the anterior vena cava of pigs after immunization, and blood indices, secreted levels of specific antibodies and neutralizing antibodies associated with humoral immunity, the proliferation capacity of T lymphocytes as a measure of cellular immunity, and secreted levels of IFN-γ and TNF-α were determined.

RESULTS: The results showed that simultaneous immunization against CSFV and PRRSV infections induced strong and specific humoral and T-cellular immune responses, high levels of cytokine IFN-γ secretion and delayed secretion of cytokine TNF-α. Moreover, significantly higher lymphocyte percentages and red blood cell and leukocyte counts were found in the group simultaneously immunized against CSFV and PRRSV. However, no statistically significant differences were observed in hemoglobin values, neutrophil counts, and median cell percentages among the S + PRRS, PRRS-S, and S-PRRS groups.

CONCLUSION: This study demonstrated that simultaneous immunization against CSFV and PRRSV had the advantages of inducing a rapid, enhanced, and long-lasting immune response. These findings provide a theoretical basis for the establishment of a reasonable and optimized vaccine immunization protocol against CSFV and PRRSV in combination with a variety of other vaccine inoculations.

PMID:36658569 | DOI:10.1186/s12917-022-03559-z

BMC Med Educ. 2023 Jan 19;23(1):39. doi: 10.1186/s12909-023-04020-x.

ABSTRACT

INTRODUCTION: Clinical reasoning is a complex cognitive and metacognitive process paramount to patient care in paramedic practice. While universally recognised as an essential component of practice, clinical reasoning has been historically difficult to assess in health care professions. Is the Script Concordance Test (SCT) an achievable and reliable option to test clinical reasoning in undergraduate paramedic students?

METHODS: This was a single institution observational cohort study designed to use the SCT to measure clinical reasoning in paramedic students. Clinical vignettes were constructed across a range of concepts with varying shades of clinical ambiguity. A reference panel mean scores of the test were compared to that of students. Test responses were graded with the aggregate scoring method with scores awarded for both partially and fully correct responses.

RESULTS: Eighty-three student paramedic participants (mean age: 21.8 (3.5) years, 54 (65%) female, 27 (33%) male and 2 (2%) non-binary) completed the SCT. The difference between the reference group mean score of 80 (5) and student mean of score of 65.6 (8.4) was statistically significant (p < 0.001).

DISCUSSION: Clinical reasoning skills are not easily acquired as they are a culmination of education, experience and the ability to apply this in the context to a specific patient. The SCT has shown to be reliable and effective in measuring clinical reasoning in undergraduate paramedics as it has in other health professions such as nursing and medicine. More investigation is required to establish effective pedogeological techniques to optimise clinical reasoning in student and novice paramedics who are devoid of experience.

PMID:36658560 | DOI:10.1186/s12909-023-04020-x

J Orthop Surg Res. 2023 Jan 20;18(1):57. doi: 10.1186/s13018-023-03537-7.

ABSTRACT

BACKGROUND: Hybrid construction (HC) may be an ideal surgical strategy than noncontinuous total disc replacement (TDR) and noncontinuous anterior cervical discectomy and fusion (ACDF) in the treatment of noncontinuous cervical spondylopathy. However, there is still no consensus on the segmental selection for ACDF or TDR in HC. The study aims to analyse the effects of different segment selection of TDR and ACDF on cervical biomechanical characteristics after HC surgery.

METHODS: Twelve FEMs of C2-C7 were constructed based on CT images of 12 mild cervical spondylopathy volunteers. Two kinds of HC were introduced in our study: Fusion-arthroplasty group (Group 1), upper-level (C3/4) ACDF, and lower-level TDR (C5/6); Arthroplasty-fusion group (Group 2), upper-level (C3/4) TDR and lower-level ACDF (C5/6). The follow-load technique was simulated by applying an axial initial load of 73.6 N through the motion centre of FEM. A bending moment of 1.0 Nm was applied to the centre of C2 in all FEMs. Statistical analysis was carried out by SPSS 26.0. The significance threshold was 5% (P < 0.05).

RESULTS: In the comparison of ROMs between Group 1 and Group 2, the ROM in extension (P = 0.016), and lateral bending (P = 0.038) of C4/5 were significantly higher in Group 1 group. The average intervertebral disc pressures at C2/3 in all directions were significantly higher in Group 1 than those in Group 2 (P < 0.005). The average contact forces in facet joints of C2/3 (P = 0.007) were significantly more than that in Group 2; however, the average contact forces in facet joints of C6/7 (P < 0.001) in Group 1 group were significantly less than that in Group 2.

CONCLUSIONS: Arthroplasty-fusion is preferred for intervertebral disc degeneration in adjacent upper segments. Fusion-arthroplasty is preferred for patients with lower intervertebral disc degeneration or lower posterior column degeneration.

TRIAL REGISTRATION: This research was registered in Chinese Clinical Trial Registry (ChiCTR1900020513).

PMID:36658557 | DOI:10.1186/s13018-023-03537-7

BMC Psychiatry. 2023 Jan 19;23(1):52. doi: 10.1186/s12888-023-04545-x.

ABSTRACT

BACKGROUND: Continuity of care is considered an important treatment aspect of psychiatric disorders, as it often involves long-lasting or recurrent episodes with psychosocial treatment aspects. We investigated in two psychiatric hospitals in Germany whether the positive effects of relational continuity of care on symptom severity, social functioning, and quality of life, which have been demonstrated in different countries, can also be achieved in German psychiatric care.

METHODS: Prospective cohort study with a 20-months observation period comparing 158 patients with higher and 165 Patients with lower degree of continuity of care of two psychiatric hospitals. Patients were surveyed at three points in time (10 and 20 months after baseline) using validated questionnaires (CGI Clinical Global Impression rating scales, GAF Global Assessment of Functioning scale, EQ-VAS Euro Quality of Life) and patient clinical record data. Statistical analyses with analyses of variance with repeated measurements of 162 patients for the association between the patient- (EQ-VAS) or observer-rated (CGI, GAF) outcome measures and continuity of care as between-subject factor controlling for age, sex, migration background, main psychiatric diagnosis group, duration of disease, and hospital as independent variables.

RESULTS: Higher continuity of care reduced significantly the symptom severity with a medium effect size (p 0.036, eta 0.064) and increased significantly social functioning with a medium effect size (p 0.023, eta 0.076) and quality of life but not significantly and with only a small effect size (p 0.092, eta 0.022). The analyses of variance suggest a time-independent effect of continuity of care. The duration of psychiatric disease, a migration background, and the hospital affected the outcome measures independent of continuity of care.

CONCLUSION: Our results support continuity of care as a favorable clinical aspect in psychiatric patient treatment and encourage mental health care services to consider health service delivery structures that increase continuity of care in the psychiatric patient treatment course. In psychiatric health care services research patients’ motives as well as methodological reasons for non-participation remain considerable potential sources for bias.

TRIAL REGISTRATION: This prospective cohort study was not registered as a clinical intervention study because no intervention was part of the study, neither on the patient level nor the system level.

PMID:36658554 | DOI:10.1186/s12888-023-04545-x