Category: Nevin Manimala

BMC Ophthalmol. 2023 Mar 6;23(1):88. doi: 10.1186/s12886-023-02828-1.

ABSTRACT

PURPOSE: To report the time trends in basic patient characteristics and the number of specimens received at a national referral center for ophthalmic pathology.

METHODS: Data on patient sex, age at surgical resection and geographical location of the referring unit were obtained for all specimens received at the St. Erik Ophthalmic Pathology laboratory, Stockholm, Sweden, between January 1^st, 1959, and December 31^st, 2021.

RESULTS: A total of 33 057 specimens had been received, of which 14 560 (44%) came from men and 18 477 (56%) from women (for 20 patients, the sex was not specified). The average annual percent change (AAPC) in the number specimens received was + 10.5%, whereas the Swedish population increased with 0.5% per year. Patients became older throughout the period, with an average yearly increase of patient age at surgery of 0.3 years (AAPC 0.2%). Overall, women were three years older than men at surgery (59.4 versus 56.4 years, P < 0.0001) The number of specimens increased with patient age from the first to the 8^th decade, after which it decreased to zero in the 11^th decade. The largest portion of patients had undergone their surgery in one of the hospitals or clinics in the capital region, with four of the five largest sources corresponding to the most populous counties in the country.

CONCLUSIONS: During six decades, the growth in number of specimens sent to our national referral center for ophthalmic pathology has greatly outpaced the growth of the population, indicating an increasing demand for subspecialized services. Throughout the period, patients have become older, and a higher number of specimens have been submitted from female patients.

PMID:36879224 | DOI:10.1186/s12886-023-02828-1

Chin Med J (Engl). 2023 Jan 5;136(1):45-52. doi: 10.1097/CM9.0000000000002259.

ABSTRACT

BACKGROUND: Managing acute postoperative pain is challenging for anesthesiologists, surgeons, and patients, leading to adverse events despite making significant progress. Patient-controlled intravenous analgesia (PCIA) is a recommended solution, where oxycodone has depicted unique advantages in recent years. However, controversy still exists in clinical practice and this study aimed to compare two drugs in PCIA.

METHODS: We performed a literature search in PubMed, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, Chinese National Knowledge Infrastructure, Wanfang, and VIP databases up to December 2020 to select specific randomized controlled trials (RCTs) comparing the efficacy of oxycodone with sufentanil in PCIA. The analgesic effect was the primary outcome and the secondary outcome included PCIA consumption, the Ramsay sedation scale, patients’ satisfaction and side effects.

RESULTS: Fifteen RCTs were included in the meta-analysis. Compared with sufentanil, oxycodone showed lower Numerical Rating Scale scores (mean difference [MD] = -0.71, 95% confidence interval [CI]: -1.01 to -0.41; P < 0.001; I2 = 93%), demonstrated better relief from visceral pain (MD = -1.22, 95% CI: -1.58 to -0.85; P < 0.001; I2 = 90%), promoted a deeper sedative level as confirmed by the Ramsay Score (MD = 0.77, 95% CI: 0.35-1.19; P < 0.001; I2 = 97%), and resulted in fewer side effects (odds ratio [OR] = 0.46, 95% CI: 0.35-0.60; P < 0.001; I2 = 11%). There was no statistical difference in the degree of patients’ satisfaction (OR = 1.13, 95% CI: 0.88-1.44; P = 0.33; I2 = 72%) and drug consumption (MD = -5.55, 95% CI: -14.18 to 3.08; P = 0.21; I2 = 93%).

CONCLUSION: Oxycodone improves postoperative analgesia and causes fewer adverse effects, and could be recommended for PCIA, especially after abdominal surgeries.

REGISTRATION: PROSPERO; https://www.crd.york.ac.uk/PROSPERO/; CRD42021229973.

PMID:36878002 | DOI:10.1097/CM9.0000000000002259

Nurse Educ. 2023 Mar 3. doi: 10.1097/NNE.0000000000001386. Online ahead of print.

ABSTRACT

BACKGROUND: The COVID-19 pandemic has been a defining event for the next generation of the nursing workforce. Complex pandemic practice environments have raised concerns for the preparation and support of novice nurses, even as a multitude of nurses leave the profession.

PURPOSE: Researchers sought to examine nursing students’ and new graduate nurses’ impressions of the nursing profession in contrasting regions of New York State during the first wave of the COVID-19 pandemic.

METHODS: Inductive content analysis was performed on narrative text responses (n = 295) drawn from a larger multisite mixed-methods survey.

RESULTS: Five subconcepts were abstracted, leading to the main concept of shocked moral distress.

CONCLUSION: Nursing students and new graduate nurses have experienced high levels of moral distress but remain committed to the profession. Building moral resilience, fostering ethical decision making, and implementing protective policies can reduce the incidence of moral distress.

PMID:36877986 | DOI:10.1097/NNE.0000000000001386

Acta Med Port. 2023 Mar 6. doi: 10.20344/amp.18419. Online ahead of print.

ABSTRACT

INTRODUCTION: Preterm birth is increasing worldwide, representing a major cause of death and long-term loss of human potential among survivors. Some morbidities during pregnancy are well-known risk factors for preterm labor, but it is not yet known whether deviations from adequate dietary patterns are associated with preterm delivery. Diet may be an important modulator of chronic inflammation, and pro-inflammatory diets during pregnancy were reported to be associated with preterm birth. The aim of this study was to assess the food consumption during pregnancy of Portuguese women giving birth very prematurely and the association between the food consumption and the major maternal morbidities during pregnancy related with preterm delivery.

MATERIAL AND METHODS: A single-center cross-sectional observational study including consecutive Portuguese women giving birth before 33 weeks of gestation was conducted. Recall of eating habits during pregnancy was obtained within the first week after delivery, using a semi quantitative food frequency questionnaire validated for Portuguese pregnant women.

RESULTS: Sixty women with a median age of 36.0 years were included. Of these, 35% were obese or overweight at the beginning of pregnancy, 41.7% and 25.0% gained excessive or insufficient weight during pregnancy, respectively. Pregnancy-induced hypertension was present in 21.7% of cases, gestational diabetes in 18.3%, chronic hypertension in 6.7%, and type 2 diabetes mellitus in 5.0%. Pregnancy-induced hypertension was significantly associated with increased daily consumption of pastry products (31.2 vs 10.0 g, p = 0.022), fast food (39.6 vs 29.7 g, p = 0.028), bread (90.0 vs 50.0 g, p = 0.005), pasta, rice and potatoes (225.7 vs 154.3 g, p = 0.012). In a multivariate analysis, only bread consumption maintained a significant, albeit weak, association (OR = 1.021; 1.003 – 1.038, p = 0.022).

CONCLUSION: Pregnancy-induced hypertension was associated with increased consumption of pastry products, fast food, bread, pasta, rice, and potatoes, although only bread consumption had a weak but statistically significant association with pregnancy-induced hypertension in a multivariate analysis.

PMID:36877956 | DOI:10.20344/amp.18419

Biometrics. 2023 Mar 6. doi: 10.1111/biom.13851. Online ahead of print.

ABSTRACT

Multivariate functional data present theoretical and practical complications which are not found in univariate functional data. One of these is a situation where the component functions of multivariate functional data are positive and are subject to mutual time warping. That is, the component processes exhibit a common shape but are subject to systematic phase variation across their domains in addition to subject-specific time warping, where each subject has its own internal clock. This motivates a novel model for multivariate functional data that connects such mutual time warping to a latent deformation-based framework by exploiting a novel time warping separability assumption. This separability assumption allows for meaningful interpretation and dimension reduction. The resulting Latent Deformation Model is shown to be well suited to represent commonly encountered functional vector data. The proposed approach combines a random amplitude factor for each component with population based registration across the components of a multivariate functional data vector and includes a latent population function, which corresponds to a common underlying trajectory. We propose estimators for all components of the model, enabling implementation of the proposed data-based representation for multivariate functional data and downstream analyses such as Fréchet regression. Rates of convergence are established when curves are fully observed or observed with measurement error. The usefulness of the model, interpretations, and practical aspects are illustrated in simulations and with application to multivariate human growth curves and multivariate environmental pollution data. This article is protected by copyright. All rights reserved.

PMID:36877941 | DOI:10.1111/biom.13851

Wounds. 2023 Feb;35(3):36-40.

ABSTRACT

INTRODUCTION: Publications aimed at improving the quality of evidence in wound care clinical research have stressed the importance of minimizing study bias. In particular, lack of a universal definition of healing in wound studies leads to detection bias, resulting in noncomparable healing rates.

OBJECTIVE: This report analyzes the steps taken to reduce the main sources of bias in a particular RCT (the HIFLO Trial) that evaluated healing in DFUs using microvascular tissue.

MATERIALS AND METHODS: To address “definition of healing”-induced detection bias, 3 blinded adjudicators independently assessed each DFU using a rigorous 4-part definition of healing. Adjudicator responses were analyzed to assess reproducibility. Predefined criteria were also included to avoid bias owing to selection, performance, attrition, and reporting.

RESULTS: Rigor and comparability across sites were ensured through investigator training, consistent SOC, data monitoring, and independent statistical and ITT-only analysis. The level of agreement among adjudicators was greater than or equal to 90% for each of the 4-part healing criteria.

CONCLUSIONS: High-level agreement by blinded adjudicators confirmed that DFUs in the HIFLO Trial were consistently assessed for healing without bias, validating the most rigorous assessment criteria to date. The findings reported herein may prove beneficial for others seeking to minimize bias in wound studies.

PMID:36877939

Technol Cancer Res Treat. 2023 Jan-Dec;22:15330338231154094. doi: 10.1177/15330338231154094.

ABSTRACT

Objective: In this meta-analysis, we investigated the safety and efficacy of carbon nanoparticle (CNP) trace-guided lymph node (LN) dissection during radical gastrectomy. Methods: Literature on CNP tracing compared with non-CNP tracing in radical gastric cancer (GC) surgery was searched from PubMed, EMBASE (Ovid platform), Web of Science, and the Cochrane Library from the establishment of the library until October 2022. This meta-analysis was performed according to the preferred reporting items for systematic reviews and meta-analysis guidelines. Available data regarding the number of LNs dissected, number of metastatic LNs dissected, other surgical outcomes, and postoperative complications were analyzed in a pooled manner. Stata software (version 12.0) was used for the present meta-analysis. Results: This analysis included 7 studies with a total of 1827 GC patients (551 and 1276 in the CNP and non-CNP groups, respectively). The results of the meta-analysis showed that the CNP group had more intraoperative LNs detected [weighted mean difference (WMD) = 6.67, 95% confidence interval (CI): 3.71-9.62], more LN metastases (WMD = 1.60, 95% CI: 0.09-3.12), and less intraoperative bleeding (WMD = 11.33, 95% CI: 6.30-16.37) than the non-CNP group, all with statistically significant differences (P < .05). For postoperative complications (odds ratio [OR] = 0.88, 95% CI: 0.52-1.48) and operative time (WMD = -11.60, 95% CI: -40.53-17.34), there was no statistically significant difference between the 2 groups (P > 0.05). Conclusions: CNP was a significant tracer for the LNs of GC. It increased the number of LNs harvested while reducing intraoperative blood loss, without increasing the operative time or postoperative complications. CNP tracer-guided lymphadenectomy is considered safe and effective for gastrectomy.

PMID:36877933 | DOI:10.1177/15330338231154094

J Drugs Dermatol. 2023 Mar 1;22(3):271-273. doi: 10.36849/JDD.7165.

ABSTRACT

BACKGROUND: The well-established sequential use of topical calcipotriene and topical betamethasone dipropionate in combination has been shown to provide greater benefit than either monotherapy. A newer topical fixed combination formulation of calcipotriene 0.005% and betamethasone dipropionate 0.064% in a cream base (Cal/BD cream) is effective with high patient ratings for convenience and tolerability. The current study compares patient satisfaction between Cal/BD foam and Cal/BD cream formulations. Study Design and Patient Demographics: This is a single-use, split body, open label study involving 20 subjects. Ten subjects additionally had scalp psoriasis. Study treatments were applied by the investigator in a randomized manner and patients completed questionnaires to assess treatment preferences.

FINDINGS: Both Cal/BD formulations provided rapid and significant improvement in symptoms of pruritus, stinging, burning, and pain; with no statistically significant difference in response between the 2 treatments. Overall, Cal/BD cream outperformed Cal/BD foam on several key measures for vehicle features and patient satisfaction. For non-scalp application, 55% of subjects preferred Cal/BD cream over Cal/BD foam. For the scalp, 60% of subjects preferred Cal/BD cream over Cal/BD foam. No adverse events were reported during the study.

CONCLUSION: Results of this current study indicate high levels of patient satisfaction with Cal/BD cream and a preference for the cream base over foam for the treatment of body and scalp psoriasis. &nbsp; J Drugs Dermatol. 2023;22(3): doi:10.36849/JDD.7165.

PMID:36877880 | DOI:10.36849/JDD.7165

Catheter Cardiovasc Interv. 2023 Mar 6. doi: 10.1002/ccd.30613. Online ahead of print.

ABSTRACT

PURPOSE: The contribution of thoracic duct obstruction to lymphatic flow disorders has not been well-characterized. We describe imaging findings, interventions, and outcomes in patients with suspected duct obstruction by imaging or a lympho-venous pressure gradient (LVPG).

MATERIALS AND METHODS: Clinical, imaging, and interventional data, including the LVPG, of patients with flow disorders and imaging features of duct obstruction who underwent lymphatic intervention were retrospectively reviewed, collated, and analyzed with descriptive statistics.

RESULTS: Eleven patients were found to have obstruction, median age 10.4 years (interquartile range: 8-14.9 years). Pleural effusions were seen in 8/11 (72%), ascites in 8/11 (72%), both in 5/11 (45%), and protein-losing enteropathy in 5 (45%). Eight patients (72%) had congenital heart disease. The most common site of obstruction was at the duct outlet in 7/11 patients (64%). Obstruction was secondary to extrinsic compression or ligation 4 patients (36%). Nine patients (82%) underwent interventions, with balloon dilation in 7/9 (78%), massive lymphatic malformation drainage and sclerotherapy in 1, and lympho-venous anastomosis in 1. There was resolution of symptoms in 7/9 (78% who underwent intervention, with worsening in 1 patient and no change in 1. In these patients, preprocedure mean LVPG was 7.9 ± 5.7 mmHg and postprocedure gradient was 1.6 ± 1.9 mmHg (p = 0.014). Five patients in this series underwent intervention solely to alleviate duct obstruction and in 4/5 (80%) this led to resolution of symptoms (p = 0.05).

CONCLUSION: Duct obstruction may be seen in lymphatic flow disorders and can occur from intrinsic and extrinsic causes. Stenosis at the outlet was most common. Obstruction can be demonstrated by an elevated LVPG, and interventions to alleviate the obstruction can be beneficial.

PMID:36877806 | DOI:10.1002/ccd.30613

JMIR Form Res. 2023 Feb 28. doi: 10.2196/43759. Online ahead of print.

ABSTRACT

BACKGROUND: Post-intensive care syndrome (PICS) affects up to 50% of intensive care unit (ICU) survivors leading to long-term neurocognitive, psychosocial, and physical impairments. Approximately 80% of COVID-19 pneumonia patients who require ICU level care are at elevated risk for developing acute respiratory distress syndrome (ARDS). Survivors of COVID-19 ARDS are at high-risk for unanticipated healthcare utilization post discharge. Common to this group of patients are increased readmission rates, long term decreased mobility, and overall poorer outcomes. Multidisciplinary post-ICU clinics for ICU survivors are usually located in large urban academic medical centers providing in-person consultation. Data is lacking on the feasibility of providing telemedicine post-ICU care for COVID-19 ARDS survivors.

OBJECTIVE: We explored the feasibility of instituting a COVID-19 ARDS ICU survivor telemedicine clinic and examined its effect on healthcare utilization post hospital discharge.

METHODS: This randomized, unblinded, single-center, parallel-group exploratory study was conducted at a rural, academic, tertiary-care medical center. Study group (SG) participants underwent a telemedicine visit within 14 days of discharge, during which a six-minute walk test (6MWT), a EuroQoL 5-Dimension (EQ-5D) questionnaire, and vital signs logs (VSL) were reviewed by an intensivist. Additional appointments were arranged as needed based on the outcome of these review and tests. The control group (CG) received a telemedicine visit within six weeks of discharge and completed the EQ-5D questionnaire; additional care was provided as needed based on findings in this telemedicine visit.

RESULTS: Both SG (n=20) and CG (n=20) participants had similar baseline characteristics and dropout rate (10%). Among SG participants, 72.2% agreed to follow up in the pulmonary clinic compared to 50.0% of CG participants (P=.31). Unanticipated visits to the emergency department were 11.1% in the SG compared to 5.6% CG (not sig.). The rate of pain/discomfort was noted to be 66.7% in the SG compared to 61.1% in the CG (P=.72). The anxiety/depression rate was 72.2% vs. 61.1% (P=.59) in the SG compared to the CG. Participants’ self-assessed health rating scores was M=73.9, SD 16.1 in the SG compared to M=70.6, SD 20.9 in the CG (P=.59). Both primary care physicians (PCPs) and participants in the SG perceived the telemedicine clinic as a favorable model for post-discharge critical illness follow-up in an open-ended questionnaire regarding care.

CONCLUSIONS: This exploratory study found no statistically significant results in reducing healthcare utilization post-discharge and health related quality of life. However, PCPs and patients perceived telemedicine as a feasible and favorable model for post-discharge care among COVID-19 ICU survivors to facilitate expedited subspecialty assessment, decrease unanticipated post-discharge healthcare utilization, and reduce PICS. Further investigation is warranted to determine the feasibility of incorporating telemedicine-based post-hospitalization follow-up for all medical ICU survivors which may show improvement in healthcare utilization in a larger population.

PMID:36877802 | DOI:10.2196/43759