Category: Nevin Manimala

Clin Teach. 2022 May 31. doi: 10.1111/tct.13507. Online ahead of print.

ABSTRACT

BACKGROUND: Having previously shown that an interprofessional immersive course, AELPS (Academy for Emerging Leaders in Patient Safety) can change the way young clinicians think about patient safety, we surveyed them between 1 and 5 years later to determine its longer-term influence on careers, relationships with colleagues and with patients.

METHODS: All alumni from 2016 to 2019 (n = 116) were invited to complete a survey on the usefulness of their AELPS experience in: obtaining their current position; doing patient safety projects; understanding and working with patients; improving communication skills; breaking down hierarchies; networking; mentoring and using new skills in the workplace. Data were analysed using descriptive statistics and thematic analysis.

RESULTS: Response rate was 56%. Over 85% reported ongoing improvement in medication safety knowledge, communication with patients, use of graded assertiveness, communicating more effectively with colleagues, seeking views of their patients about treatment options and seeing things from the patient perspective. Sixty seven per cent agreed that AELPS helped them in their career choice and 57% agreed it had helped them obtain their current position. Skills transferred to the workplace included ability to make improvements, establish education initiatives and model patient-centred care. Stumbling blocks included a hierarchal culture and lack of accountability for patient safety practices in some hospitals.

DISCUSSION: An intensive, interdisciplinary program on patient safety can provide future health leaders with ongoing tools to improve communication, understand the patient view and speak up on behalf of the patient, all factors that contribute to improving safety of patients.

PMID:35642287 | DOI:10.1111/tct.13507

Food Sci Technol Int. 2022 May 31:10820132221105476. doi: 10.1177/10820132221105476. Online ahead of print.

ABSTRACT

In predictive microbiology, primary and secondary models can be used to predict microbial growth, usually in a two-step modelling approach. The inverse dynamic modelling approach is an alternative method to direct modelling methods, in which the primary and secondary models are fitted simultaneously from non-isothermal data, minimising experimental effort and costs. Thus, the main aim of the present study was to compare the prediction capabilities of the mathematical modelling approaches used for calculating growth kinetics of microorganisms in predictive food microbiology field. For this purpose, the bacterial growth data of Pseudomonas spp. in oyster mushroom (Pleurotus ostreatus) subjected to isothermal and non-isothermal storage temperatures were collected from previously published growth curves. Temperature-dependent kinetic growth parameters (maximum specific growth rate ‘µ_max‘ and lag phase duration ‘λ‘) were described as a function of storage temperature using the direct two-step, direct one-step and inverse dynamic modelling approach based on Baranyi and Huang models. The fitting capability of the modelling approaches was separately compared, and the one-step modelling approach for the direct methods provided better goodness of fit results regardless of used primary models, which leads the Huang model with being RMSE = 0.226 and R²_adj = 0.949 became best for direct methods. Like seen in direct methods, the Huang model gave better goodness of fit results than Baranyi model for inverse method. Results revealed there was no significant difference (p > 0.05) between the growth kinetic parameters obtained from direct one-step modelling approach and inverse modelling approaches based on the Huang model. Satisfactorily statistical indexes show that the inverse dynamic modelling approach can be reliably used as an alternative way of describing the growth behaviour of Pseudomonas spp. in oyster mushroom in a fast and minimum labour effort.

PMID:35642261 | DOI:10.1177/10820132221105476

J Oncol Pharm Pract. 2022 May 31:10781552221105584. doi: 10.1177/10781552221105584. Online ahead of print.

ABSTRACT

BACKGROUND: Chemotherapy drug handling and occupational exposure are topics of concern for a variety of oncology health care professionals. Inappropriate handling can pose health risks to practitioners particularly, those who handle them on a daily basis. Therefore, this study aimed to assess chemotherapy handling practices among oncology pharmacists and pharmacy technicians in Saudi Arabia.

METHODS: A cross-sectional study was conducted using an online survey with a structured pre-validated questionnaire. Data was collected from pharmacists and pharmacy technicians who handle chemotherapeutic agents in Saudi Arabia, and analyzed using descriptive and inferential statistics.

RESULTS: A total of 79 oncology pharmacy practitioners responded to the survey. The majority (92.4%) had written chemotherapy guidelines at their workplaces. Almost all participants (98.7%) reported the availability of protective gloves and gowns, however, the availability of eye protection was only 57%. Most used chemotherapy-designated gloves (83.6%), and gowns (86.1%). However, 54.4% have reused disposable gowns. The extent of utilization of most protective equipment ranged from 70% (always using closed system transfer device) to 98% (always using shoe cover); while the practice of always using eye protection and face shield was only 30.4% and 38%, respectively. With regard to cleaning practice, the work area was cleaned at least once a day by 35%; monthly decontamination (77%); certification by the biomedical department every 6 months (67%) and at least yearly (95%). Accidental exposure was reported by 28%, and the most common adverse effect was skin irritation (82%). There was no workplace medical surveillance available for 50%. The majority (88.6%) received relevant training, but not periodic updates on their training (38%). The main barriers against the use of personal protective equipment were: that some personal protective equipments were not always available (38%), and personal protective equipments were too uncomfortable to use (30.4%). The demographic variables did not have a statistically significant effect (p > 0.05) on the responses except for type of institution (workplace) on some of the cleaning practices that showed significant differences namely, the monthly decontamination and certification by the biomedical department.

CONCLUSIONS: Most protective equipment and chemotherapy guidelines were available, and the majority of pharmacy practitioners adhered to many aspects of chemotherapy safe-handling practices. Nevertheless, some areas such as medical surveillance programs, use of eye protection and face shields, the practice of re-using disposable gowns, some of the barriers against personal protective equipment use, and the provision of periodic training need improvement for better protection of the health care professionals.

PMID:35642271 | DOI:10.1177/10781552221105584

AIDS Care. 2022 May 31:1-12. doi: 10.1080/09540121.2022.2080802. Online ahead of print.

ABSTRACT

Although people living with HIV/AIDS (PLWHA) are known to be vulnerable to psychological distress (PD), little is known about the prevalence of PD among PLWHA. A systematic literature search of several databases was conducted from inception to August 2021 focusing on studies reporting on PD symptoms among PLWHA. The overall prevalence estimates were pooled using a random-effects meta-analysis. Differences according to study-level characteristics were examined using stratified meta-analysis. We pooled and analyzed data from 15 studies comprising 5593 PLWHA. The prevalence rate of PD among PLWHA was 43.7% (95% Confidence Interval: 29.9-57.5%). Subgroup analyses by gender, country, CD4 count, employment status and ever attended school found no statistically significant differences in the prevalence of PD. Heterogeneity in the prevalence of PD among PLWHA was partially explained by the assessment tool. Further large-scale studies of high quality are warranted to identify risk factors of PD in PLWHA in their respective socio-cultural contexts.

PMID:35642250 | DOI:10.1080/09540121.2022.2080802

J Pediatr Gastroenterol Nutr. 2022 Jun 1. doi: 10.1097/MPG.0000000000003491. Online ahead of print.

ABSTRACT

OBJECTIVES: 22q11.2 deletion syndrome (22q11.2DS) is the most common chromosomal microdeletion syndrome and has a multi-systemic presentation including gastrointestinal features that have not yet been fully described. Our aim was to examine lifetime gastrointestinal problems in a large cohort of patients with 22q11.2DS.

METHODS: All patients followed in the 22q and You Center at the Children’s Hospital of Philadelphia (n = 1,421) were retrospectively screened for 1) age ≥ 17 years, 2) documented chromosomal microdeletion within the 22q11.2 LCR22A-LCR22D region, and 3) sufficient clinical data to characterize the adult gastrointestinal phenotype. Gastrointestinal problems in childhood, adolescence, and adulthood were summarized. Statistical association testing of symptoms against other patient characteristics was performed.

RESULTS: Included patients (n = 206; 46% female; mean age 27 years; median follow up 21 years) had similar clinical characteristics to the overall cohort. Genetic distribution was also similar, with 96% having deletions including the critical LCR22A-LCR22B segment (95% in the overall cohort). Most patients experienced chronic gastrointestinal symptoms in their lifetime (91%), but congenital gastrointestinal malformations (3.5%) and gastrointestinal autoimmune diseases (1.5%) were uncommon. Chronic symptoms without anatomic or pathologic abnormalities represented the vast burden of illness. Chronic symptoms in adulthood associated with other chronic gastrointestinal symptoms and psychiatric comorbidities (p < 0.01) but not with deletion size or physiologic comorbidities (p > 0.05). One exception was increased nausea/vomiting in hypothyroidism (p = 0.002).

CONCLUSIONS: Functional gastrointestinal disorders (FGIDs) are a common cause of ill health in children and adults with 22q11.2DS. Providers should consider screening for the deletion in patients presenting with FGIDs and associated comorbidities such as neuropsychiatric illness, congenital heart disease, and palatal abnormalities.

PMID:35641891 | DOI:10.1097/MPG.0000000000003491

J Neurooncol. 2022 May 31. doi: 10.1007/s11060-022-04038-z. Online ahead of print.

ABSTRACT

INTRODUCTION: The treatment of brain metastases with stereotactic radiosurgery (SRS) in combination with immune checkpoint inhibitors (ICI) has become more common in recent years, but there is a lack of prospective data on cancer control outcomes when these therapies are administered concurrently.

METHODS: Data were retrospectively reviewed for patients with non-small cell lung cancer (NSCLC) and melanoma brain metastases treated with SRS at a single institution from May 2008 to January 2017. A parametric proportional hazard model is used to detect the effect of concurrent ICI within 30, 60, or 90 days of ICI administration on local control and distant in-brain control. Other patient and lesion characteristics are treated as covariates and adjusted in the regression. A frailty term is added in the baseline hazard to capture the within-patient correlation.

RESULTS: We identified 144 patients with 477 total lesions, including 95 NSCLC patients (66.0%), and 49 (34.0%) melanoma patients. On multivariate analysis, concurrent SRS and ICI (SRS within 30 days of ICI administration) was not associated with local control but was associated with distant brain control. When controlling for prior treatment to lesion, number of lesions, and presence of extracranial metastases, patients receiving this combination had a statistically significant decrease in distant brain failure compared to patients that received non-concurrent ICI or no ICI (HR 0.15; 95% CI 0.05-0.47, p = 0.0011).

CONCLUSION: Concurrent ICI can enhance the efficacy of SRS. Prospective studies would allow for stronger evidence to support the impact of concurrent SRS and ICI on disease outcomes.

PMID:35641840 | DOI:10.1007/s11060-022-04038-z

Clin Oral Investig. 2022 May 31. doi: 10.1007/s00784-022-04567-x. Online ahead of print.

ABSTRACT

OBJECTIVES: To compare the center of resistance (Cres) of the maxillary central incisor in models with and without the pulp cavity and to evaluate the association of pulp cavity/tooth volume ratio and difference in Cres position between the two models.

MATERIALS AND METHODS: CBCT images of the right maxillary central incisor were collected from 18 subjects. Pulp cavity/tooth volume ratio was measured, and finite element models of teeth and periodontal structures were generated. Cres location was presented as a percentage of root length measured from the root apex. Differences in Cres positions between models were compared using the paired t-test, while the correlation between pulp cavity/tooth volume ratio and a difference in Cres was evaluated by Pearson’s correlation coefficient.

RESULTS: For the pulp cavity model, the average location of the Cres measured from the apex of the root was 58.8% ± 3.0%, which resulted in a difference of 4.1% ± 1.1% (0.5 mm) apically, when compared with the model without pulp cavity. Differences in Cres between the models were statistically significant (P < 0.01), while the correlation between pulp cavity/tooth volume ratio and a difference in Cres between models was significantly positive (r = 0.709, P = 0.001).

CONCLUSIONS: In the pulp cavity model, the Cres was located in a more apical position. The difference in Cres between models increased as the pulp cavity/tooth volume ratio increased.

CLINICAL RELEVANCE: The line of force must be applied more apically in the pulp cavity model to achieve the desired orthodontic tooth movement.

PMID:35641835 | DOI:10.1007/s00784-022-04567-x

Nat Med. 2022 May 31. doi: 10.1038/s41591-022-01842-y. Online ahead of print.

NO ABSTRACT

PMID:35641824 | DOI:10.1038/s41591-022-01842-y

J Gastrointest Surg. 2022 May 31. doi: 10.1007/s11605-022-05368-z. Online ahead of print.

ABSTRACT

BACKGROUND: Sequential extended cholecystectomy (SEC) is currently recommended for T2 and higher gallbladder cancer (GBC) diagnosed after simple cholecystectomy (SC), but the value and timing of re-resection has not been fully studied. We evaluated the long-term oncologic outcomes of T2 GBC according to the type of surgery performed and investigated the optimal timing for SEC.

METHODS: Patients diagnosed with T2 GBC who underwent SC, extended cholecystectomy (EC), or SEC between 2002 and 2017 were retrospectively reviewed. Those who underwent other surgical procedures or those with incomplete medical records were excluded. Overall survival (OS) and disease-free survival (DFS) according to the types of surgeries and prognostic factors for OS and DFS were analyzed. Survival analysis was done between groups that were divided according to the optimal cutoff time interval between SC and SEC based on DFS data.

RESULTS: Of the 226 T2 GBC patients, 53, 173, and 44 underwent SC, EC, and SEC, respectively. The 5-year OS rate was 50.1%, 73.2%, and 78.7%, and the DFS rate was 46.8%, 66.3%, and 65.2% in the SC, EC, and SEC groups, respectively. EC (p = 0.001 and p = 0.001) and SEC (p = 0.007 and p = 0.065) groups had better 5-year OS and DFS rates than the SC group. Preoperative CA 19-9 level > 37 U/mL (HR 1.56; 95% CI 1.87-2.79; p < 0.001) and N1 stage (HR 2.88; 95% CI 1.76-4.71; p < 0.001) were associated with poorer prognosis. The optimal cutoff interval between SC and SEC was 28 days. Patients who underwent SEC ≤ 28 days after the initial cholecystectomy had better 5-year DFS rates than patients who underwent SEC after > 28 days (75.0% vs. 52.8%, p = 0.023).

CONCLUSIONS: SEC is recommended for T2 GBC diagnosed after SC, because SEC provides better survival outcomes than SC alone. A time interval of less than 28 days to SEC is associated with an improved DFS.

PMID:35641810 | DOI:10.1007/s11605-022-05368-z

Neurocrit Care. 2022 Jun 1. doi: 10.1007/s12028-022-01529-9. Online ahead of print.

ABSTRACT

BACKGROUND: Cerebral ischemia due to hypoxia is a major cause of secondary brain injury and is associated with higher morbidity and mortality in patients with acute brain injury. Hyperoxia could improve energetic dysfunction in the brain in this setting. Our objectives were to perform a systematic review and meta-analysis of the current literature and to assess the impact of normobaric hyperoxia on brain metabolism by using cerebral microdialysis.

METHODS: We searched Medline and Scopus, following the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement; we searched for retrospective and prospective observational studies, interventional studies, and randomized clinical trials that performed a hyperoxia challenge in patients with acute brain injury who were concomitantly monitored with cerebral microdialysis. This study was registered in PROSPERO (CRD420211295223).

RESULTS: We included a total of 17 studies, with a total of 311 patients. A statistically significant reduction in cerebral lactate values (pooled standardized mean difference [SMD] – 0.38 [- 0.53 to – 0.23]) and lactate to pyruvate ratio values (pooled SMD – 0.20 [- 0.35 to – 0.05]) was observed after hyperoxia. However, glucose levels (pooled SMD – 0.08 [- 0.23 to 0.08]) remained unchanged after hyperoxia.

CONCLUSIONS: Normobaric hyperoxia may improve cerebral metabolic disturbances in patients with acute brain injury. The clinical impact of such effects needs to be further elucidated.

PMID:35641804 | DOI:10.1007/s12028-022-01529-9