Category: Nevin Manimala

JMIR Public Health Surveill. 2023 Jan 30. doi: 10.2196/34579. Online ahead of print.

ABSTRACT

BACKGROUND: The COVID-19 pandemic has challenged public health efforts globally. Timely population-based surveillance is crucial to support public health programs and policies to limit the spread of COVID-19. In South Carolina (SC), the SC STRONG state-wide initiative was established to estimate population-level prevalence and immunity and characterize the transmission dynamics of the SARS-CoV-2 virus using community testing and online surveys.

OBJECTIVE: This paper aimed to leverage the survey data collected as part of the initiative to understand risk perceptions, testing practices and preventive behaviors, and identify risk factors for COVID-19 test positivity in SC over time.

METHODS: Probability proportionate to size cluster random sampling was used to select SC residents to participate in testing for COVID-19 infection and antibodies, and to complete an online survey. This paper focuses on data from the online surveys completed between November 2020 and June 2021. Descriptive statistics were performed to describe risk perceptions, attitudes and behaviors, and associated changes over time. Univariate and multivariate logistic regression models were used to identify factors associated with self-reported COVID-19 test positivity.

RESULTS: Among the 7,170 online survey respondents, 58.7% self-reported ever testing for COVID-19. The most commonly cited barriers to testing were inconvenient dates, time, and location and discomfort. Overall, 18.7% of respondents reported a history of COVID-19 test positivity. Multivariate logistic regression results indicated that individuals who were 50 years and older, self-identified as Black/African American, obese, and employed as frontline health care workers and nursing home staff were more likely to self-report COVID-19 test positivity. By contrast, there was a decreased likelihood of test positivity among respondents who were concerned about the burden of COVID-19 in their community and about getting infected.

CONCLUSIONS: Strategies to remove testing barriers should be implemented to improve access. Findings provide insights on statewide testing patterns, adoption of prevention behaviors and risk factors for infection and may inform public health strategies to curb transmission.

PMID:36720159 | DOI:10.2196/34579

N Engl J Med. 2023 Jan 26;388(4):299-309. doi: 10.1056/NEJMoa2204511.

ABSTRACT

BACKGROUND: Extracorporeal cardiopulmonary resuscitation (CPR) restores perfusion and oxygenation in a patient who does not have spontaneous circulation. The evidence with regard to the effect of extracorporeal CPR on survival with a favorable neurologic outcome in refractory out-of-hospital cardiac arrest is inconclusive.

METHODS: In this multicenter, randomized, controlled trial conducted in the Netherlands, we assigned patients with an out-of-hospital cardiac arrest to receive extracorporeal CPR or conventional CPR (standard advanced cardiac life support). Eligible patients were between 18 and 70 years of age, had received bystander CPR, had an initial ventricular arrhythmia, and did not have a return of spontaneous circulation within 15 minutes after CPR had been initiated. The primary outcome was survival with a favorable neurologic outcome, defined as a Cerebral Performance Category score of 1 or 2 (range, 1 to 5, with higher scores indicating more severe disability) at 30 days. Analyses were performed on an intention-to-treat basis.

RESULTS: Of the 160 patients who underwent randomization, 70 were assigned to receive extracorporeal CPR and 64 to receive conventional CPR; 26 patients who did not meet the inclusion criteria at hospital admission were excluded. At 30 days, 14 patients (20%) in the extracorporeal-CPR group were alive with a favorable neurologic outcome, as compared with 10 patients (16%) in the conventional-CPR group (odds ratio, 1.4; 95% confidence interval, 0.5 to 3.5; P = 0.52). The number of serious adverse events per patient was similar in the two groups.

CONCLUSIONS: In patients with refractory out-of-hospital cardiac arrest, extracorporeal CPR and conventional CPR had similar effects on survival with a favorable neurologic outcome. (Funded by the Netherlands Organization for Health Research and Development and Maquet Cardiopulmonary [Getinge]; INCEPTION ClinicalTrials.gov number, NCT03101787.).

PMID:36720132 | DOI:10.1056/NEJMoa2204511

J Speech Lang Hear Res. 2023 Jan 31:1-12. doi: 10.1044/2022_JSLHR-22-00413. Online ahead of print.

ABSTRACT

PURPOSE: We quantified pharyngeal residue using pixel-based methods in a normative data set, while examining influences of age, gender, and swallow task.

METHOD: One hundred ninety-five healthy participants underwent a videofluoroscopic swallow study following the Modified Barium Swallow Impairment Profile (MBSImP) protocol. ImageJ was used to compute Normalized Residue Ratio Scale and the Analysis of Swallowing Physiology: Events, Kinematics and Timing (ASPEKT) pharyngeal residue measures. Reliability was established. Descriptive statistics were performed for all residue measures. Inferential statistics were performed using ASPEKT total scores (i.e., %C2-4²). Logistic regression models explored predictors of residue versus no residue. Generalized linear mixed models explored predictors of nonzero residue. Spearman rho explored relationships between ASPEKT total residue scores and MBSImP Component 16 (Pharyngeal Residue) scores.

RESULTS: Majority of swallows (1,165/1,528; 76.2%) had residue scores of zero. Residue presence (%C2-4² > 0) was influenced by age (more in older [F = 9.908, p = .002]), gender (more in males [F = 18.70, p < .001]), viscosity (more in pudding, nectar, and honey [F = 25.30, p < .001]), and volume (more for cup sip [F = 37.430, p < .001]). When residue was present (363/1,528 = 23.8%), amounts were low (M = 1% of C2-4², SD = 2.4), and only increasing age was associated with increased residue (F = 9.008, p = .007) when controlling for gender and swallow task. Increasing residue was incremental (0.01% of C2-4² per year). As ASPEKT total residue values increased, MBSImP Component 16 scores also increased.

CONCLUSIONS: Pharyngeal residue amounts were very low in healthy adults. Residue presence can be influenced by age, gender, and swallow task. However, when present, the amount of pharyngeal residue was only associated with increasing age.

SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21957221.

PMID:36720117 | DOI:10.1044/2022_JSLHR-22-00413

J Agric Food Chem. 2023 Jan 31. doi: 10.1021/acs.jafc.2c07814. Online ahead of print.

ABSTRACT

Sulfanilamide (SFL) is used to prevent infections in honeybees. However, many regulatory agencies prohibit or establish maximum levels of SFL residues in honey samples. Hence, we developed a low-cost and portable electrochemical method for SFL detection using a disposable device produced through 3D printing technology. In the proposed approach, the working electrode was printed using a conductive filament based on carbon black and polylactic acid and it was associated with square wave voltammetry (SWV). Under optimized SWV parameters, linear concentration ranges (1-10 μmol L^-1 and 12.5-35.0 μmol L^-1), a detection limit of 0.26 μmol L^-1 (0.05 mg L^-1), and suitable RSD values (2.4% for inter-electrode; n = 3) were achieved. The developed method was selective in relation to other antibiotics applied in honey samples, requiring only dilution in the electrolyte. The recovery values (85-120%) obtained by SWV were statistically similar (95% confidence level) to those obtained by HPLC, attesting to the accuracy of the analysis and the absence of matrix interference.

PMID:36720110 | DOI:10.1021/acs.jafc.2c07814

J Pediatr Gastroenterol Nutr. 2023 Jan 31. doi: 10.1097/MPG.0000000000003718. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: There is a subset of intestinal failure patients with associated chronic intestinal inflammation resembling inflammatory bowel disease. This study aimed to evaluate factors associated with chronic intestinal inflammation in pediatric intestinal failure.

METHODS: This was a single-center retrospective case-control study of children <18 years old with intestinal failure. Cases were defined by abnormal amounts of chronic intestinal inflammation on biopsies. Children with diversion colitis, eosinophilic colitis, or isolated anastomotic ulceration were excluded. Cases were matched 1:2 to intestinal failure controls based on sex, etiology of intestinal failure, and duration of intestinal failure. Multivariable conditional logistic regression was used to compare clinical factors between cases and controls, accounting for clustering within matched sets. A subgroup analysis was performed assessing factors associated with escalation of anti-inflammatory therapy.

RESULTS: Thirty cases were identified and matched to 60 controls. On univariate analysis, longer parenteral nutrition duration (1677 vs 834 days, p=0.03), current parenteral nutrition use (33.3% vs 20.0%, p=0.037) and culture-proven bacterial overgrowth (53.3% vs 31.7%, p=0.05) were associated with chronic intestinal inflammation. On multivariable analysis, no variable reached statistical significance. On subgroup analysis, duration of intestinal failure, location of inflammation, and worst degree of inflammation on histology were associated with escalation of therapy.

CONCLUSION: Parenteral nutrition dependence and intestinal dysbiosis are associated with chronic intestinal inflammation in children with intestinal failure. Severity of inflammation is associated with escalation of therapy. Further analysis is needed to assess these associations and the efficacy of treatments in this population.

PMID:36720109 | DOI:10.1097/MPG.0000000000003718

J Pediatr Gastroenterol Nutr. 2023 Jan 31. doi: 10.1097/MPG.0000000000003714. Online ahead of print.

ABSTRACT

OBJECTIVES: We sought to evaluate the safety and effectiveness of fecal microbiota transplantation (FMT) for recurrent Clostridioides difficile infection (CDI) in pediatric immunocompromised (IC) patients.

METHODS: This is a multi-center retrospective cohort study of pediatric participants who underwent FMT between March 2013 and April 2020 with 12-week follow-up. Pediatric patients were included if they met the definition of IC and were treated with FMT for an indication of recurrent CDI. We excluded patients over 18 years of age, those with incomplete records, insufficient follow up, or not meeting study definition of IC. We also excluded those treated for Clostridioides difficile recurrence without meeting the study definition and those with inflammatory bowel disease without another immunocompromising condition.

RESULTS: Of 59 pediatric patients identified at nine centers, there were 42 who met inclusion and no exclusion criteria. Included patients had a median age of 6.7 years. Etiology of IC included: solid organ transplantation (18, 43%), malignancy (12, 28%), primary immunodeficiency (10, 24%), or other chronic conditions (2, 5%). Success rate was 79% after first FMT and 86% after one or more FMT. There were no statistically significant differences in patient characteristics or procedural components when patients with a failed FMT were compared to those with a successful FMT. There were 15 total serious adverse events (SAEs) in 13 out of 42 (31%) patients that occurred during the follow-up period; four (9.5%) of which were likely treatment-related. There were no deaths or infections with multi-drug resistant organisms during follow-up and all patients with a serious adverse event fully recovered.

CONCLUSIONS: The success rate of FMT for recurrent CDI in this pediatric IC cohort is high and mirrors data for IC adults and immunocompetent children. FMT-related SAEs do occur (9.5%) and highlight the need for careful consideration of risk and benefit.

PMID:36720105 | DOI:10.1097/MPG.0000000000003714

Medwave. 2023 Jan 16;22(1):e2668. doi: 10.5867/medwave.2023.01.2668.

ABSTRACT

Introduction: Knee osteoarthritis affects the quality of life, with knee arthroplasty being a cost-effective treatment for the severe stage of this disease. Access to knee arthroplasty is a health indicator of the Organisation for Economic Co-operation and Development. The objectives of this study are to determine the incidence of knee arthroplasty between 2004 and 2021 in beneficiaries of the National Health Fund in Chile, the proportion of patients who underwent surgery in the private system, and to estimate the patient’s out-of-pocket expenditure for surgery. Methods: Cross-sectional study. We used the Department of Statistics and Health Information database. Patients discharged from a Chilean health center who underwent knee arthroplasty surgery between 2004 and 2021 were investigated. We analyzed the proportion of patients by their National Health Fund category and whether their surgery was performed in public or private network facilities. Results: Of the 31 526 knee arthroplasty procedures, 21 248 (67.38%) were performed on National Health Fund patients and 16 238 in public institutions (51.49%). Patients from the National Health Fund showed a systematic increase in knee arthroplasty volume until 2019 but decreased in 2020 and 2021 by 68% and 51%. Of the total number of patients in the public system operated on for knee arthroplasty, 856 (9%) belonged to group A1, 12 806 (60%) to group B, 2044 (10%) to group C, and 4421 (21%) to group D. The expenditure incurred by these patients was estimated to vary between 24.4% and 27.2%. The historical proportions of access to this surgery in private institutions are 7% in group A, 13% in group B, 24% in group C, and 52% in group D. Conclusion: Fifty percent of knee arthroplasty surgeries are performed in public institutions, and two-thirds are performed on patients of the National Health Fund. Forty-six percent of the C and D groups were operated in the private system. The pandemic has increased the access gap, leading to a substantial increase in the proportion of patients from the National Health Fund of the B, C, and D groups who have migrated to the private system to access this surgery.

PMID:36720104 | DOI:10.5867/medwave.2023.01.2668

J Contin Educ Nurs. 2023 Feb;54(2):89-96. doi: 10.3928/00220124-20230113-08. Epub 2023 Feb 1.

ABSTRACT

BACKGROUND: Spiritual care helps individuals encounter the transcendent meaning of their crises. However, nurses report various barriers to providing spiritual care in clinical settings. To facilitate spiritual care among nurses, a more comprehensive understanding of this field is needed. This study was conducted to establish a path model for multiple factors predicting spiritual care among nurses working in hospitals.

METHOD: A cross-sectional descriptive design was used. The participants were 370 nurses with more than 6 months of experience working in general hospitals in South Korea. The measures used in this study were nursing workplace spirituality, a spiritual well-being scale, the Maslach Burnout Inventory-Human Services Survey for Medical Personnel, a scale for compassionate care, a general self-efficacy scale, and spiritual care in practice. Path analysis was performed using IBM SPSS Statistics, version 24.0, and SPSS Amos, version 20.0.

RESULTS: Workplace spirituality and spiritual well-being predicted higher spiritual care in practice by sequentially mediating burnout and compassionate care.

CONCLUSION: This study suggests that nurses’ spiritual care can be increased via the development of specific strategies focused on enhancing the nursing work-place spirituality of hospital organizations, promoting individual spiritual well-being and compassionate behavior, and reducing burnout among nurses. [J Contin Educ Nurs. 2023;54(2):89-96.].

PMID:36720095 | DOI:10.3928/00220124-20230113-08

J Clin Oncol. 2023 Jan 31:JCO2202186. doi: 10.1200/JCO.22.02186. Online ahead of print.

ABSTRACT

PURPOSE: The phase III ADAURA (ClinicalTrials.gov identifier: NCT02511106) primary analysis demonstrated a clinically significant disease-free survival (DFS) benefit with adjuvant osimertinib versus placebo in EGFR-mutated stage IB-IIIA non-small-cell lung cancer (NSCLC) after complete tumor resection (DFS hazard ratio [HR], 0.20 [99.12% CI, 0.14 to 0.30]; P < .001). We report an updated exploratory analysis of final DFS data.

METHODS: Overall, 682 patients with stage IB-IIIA (American Joint Committee on Cancer/Union for International Cancer Control, seventh edition) EGFR-mutated (exon 19 deletion/L858R) NSCLC were randomly assigned 1:1 (stratified by stage, mutational status, and race) to receive osimertinib 80 mg once-daily or placebo for 3 years. The primary end point was DFS by investigator assessment in stage II-IIIA disease analyzed by stratified log-rank test; following early reporting of statistical significance in DFS, no further formal statistical testing was planned. Secondary end points included DFS in stage IB-IIIA, overall survival, and safety. Patterns of recurrence and CNS DFS were prespecified exploratory end points.

RESULTS: At data cutoff (April 11, 2022), in stage II-IIIA disease, median follow-up was 44.2 months (osimertinib) and 19.6 months (placebo); the DFS HR was 0.23 (95% CI, 0.18 to 0.30); 4-year DFS rate was 70% (osimertinib) and 29% (placebo). In the overall population, DFS HR was 0.27 (95% CI, 0.21 to 0.34); 4-year DFS rate was 73% (osimertinib) and 38% (placebo). Fewer patients treated with osimertinib had local/regional and distant recurrence versus placebo. CNS DFS HR in stage II-IIIA was 0.24 (95% CI, 0.14 to 0.42). The long-term safety profile of osimertinib was consistent with the primary analysis.

CONCLUSION: These updated data demonstrate prolonged DFS benefit over placebo, reduced risk of local and distant recurrence, improved CNS DFS, and a consistent safety profile, supporting the efficacy of adjuvant osimertinib in resected EGFR-mutated NSCLC.

PMID:36720083 | DOI:10.1200/JCO.22.02186

Menopause. 2023 Jan 31. doi: 10.1097/GME.0000000000002138. Online ahead of print.

ABSTRACT

OBJECTIVE: Neurokinin (NK)-3 and NK-1 receptors have been implicated in the etiology of vasomotor symptoms (VMS) and sleep disturbances associated with menopause. This phase 2b, adaptive, dose-range finding study aimed to assess the efficacy and safety of multiple doses of elinzanetant (NT-814), a selective NK-1,3 receptor antagonist, in women experiencing VMS associated with menopause, and investigate the impact of elinzanetant on sleep and quality of life.

METHODS: Postmenopausal women aged 40 to 65 years who experienced seven or more moderate-to-severe VMS per day were randomized to receive elinzanetant 40, 80, 120, or 160 mg or placebo once daily using an adaptive design algorithm. Coprimary endpoints were reduction in mean frequency and severity of moderate-to-severe VMS at weeks 4 and 12. Secondary endpoints included patient-reported assessments of sleep and quality of life.

RESULTS: Elinzanetant 120 mg and 160 mg achieved reductions in VMS frequency versus placebo from week 1 throughout 12 weeks of treatment. Least square mean reductions were statistically significant versus placebo at both primary endpoint time points for elinzanetant 120 mg (week 4: -3.93 [SE, 1.02], P < 0.001; week 12: -2.95 [1.15], P = 0.01) and at week 4 for elinzanetant 160 mg (-2.63 [1.03]; P = 0.01). Both doses also led to clinically meaningful improvements in measures of sleep and quality of life. All doses of elinzanetant were well tolerated.

CONCLUSIONS: Elinzanetant is an effective and well-tolerated nonhormone treatment option for postmenopausal women with VMS and associated sleep disturbance. Elinzanetant also improves quality of life in women with VMS.

PMID:36720081 | DOI:10.1097/GME.0000000000002138