Category: Nevin Manimala

Health Technol Assess. 2022 May;26(26):1-156. doi: 10.3310/OLUE3796.

ABSTRACT

BACKGROUND: Colonoscopy surveillance is recommended for some patients post polypectomy. The 2002 UK surveillance guidelines classify post-polypectomy patients into low, intermediate and high risk, and recommend different strategies for each classification. Limited evidence supports these guidelines.

OBJECTIVES: To examine, for each risk group, long-term colorectal cancer incidence by baseline characteristics and the number of surveillance visits; the effects of interval length on detection rates of advanced adenomas and colorectal cancer at first surveillance; and the cost-effectiveness of surveillance compared with no surveillance.

DESIGN: A retrospective cohort study and economic evaluation.

SETTING: Seventeen NHS hospitals.

PARTICIPANTS: Patients with a colonoscopy and at least one adenoma at baseline.

MAIN OUTCOME MEASURES: Long-term colorectal cancer incidence after baseline and detection rates of advanced adenomas and colorectal cancer at first surveillance.

DATA SOURCES: Hospital databases, NHS Digital, the Office for National Statistics, National Services Scotland and Public Health England.

METHODS: Cox regression was used to compare colorectal cancer incidence in the presence and absence of surveillance and to identify colorectal cancer risk factors. Risk factors were used to stratify risk groups into higher- and lower-risk subgroups. We examined detection rates of advanced adenomas and colorectal cancer at first surveillance by interval length. Cost-effectiveness of surveillance compared with no surveillance was evaluated in terms of incremental costs per colorectal cancer prevented and per quality-adjusted life-year gained.

RESULTS: Our study included 28,972 patients, of whom 14,401 (50%), 11,852 (41%) and 2719 (9%) were classed as low, intermediate and high risk, respectively. The median follow-up time was 9.3 years. Colorectal cancer incidence was 140, 221 and 366 per 100,000 person-years among low-, intermediate- and high-risk patients, respectively. Attendance at one surveillance visit was associated with reduced colorectal cancer incidence among low-, intermediate- and high-risk patients [hazard ratios were 0.56 (95% confidence interval 0.39 to 0.80), 0.59 (95% confidence interval 0.43 to 0.81) and 0.49 (95% confidence interval 0.29 to 0.82), respectively]. Compared with the general population, colorectal cancer incidence without surveillance was similar among low-risk patients and higher among high-risk patients [standardised incidence ratios were 0.86 (95% confidence interval 0.73 to 1.02) and 1.91 (95% confidence interval 1.39 to 2.56), respectively]. For intermediate-risk patients, standardised incidence ratios differed for the lower- (0.70, 95% confidence interval 0.48 to 0.99) and higher-risk (1.46, 95% confidence interval 1.19 to 1.78) subgroups. In each risk group, incremental costs per colorectal cancer prevented and per quality-adjusted life-year gained with surveillance were lower for the higher-risk subgroup than for the lower-risk subgroup. Incremental costs per quality-adjusted life-year gained were lowest for the higher-risk subgroup of high-risk patients at £7821.

LIMITATIONS: The observational design means that we cannot assume that surveillance caused the reductions in cancer incidence. The fact that some cancer staging data were missing places uncertainty on our cost-effectiveness estimates.

CONCLUSIONS: Surveillance was associated with reduced colorectal cancer incidence in all risk groups. However, in low-risk patients and the lower-risk subgroup of intermediate-risk patients, colorectal cancer incidence was no higher than in the general population without surveillance, indicating that surveillance might not be necessary. Surveillance was most cost-effective for the higher-risk subgroup of high-risk patients.

FUTURE WORK: Studies should examine the clinical effectiveness and cost-effectiveness of post-polypectomy surveillance without prior classification of patients into risk groups.

TRIAL REGISTRATION: This trial is registered as ISRCTN15213649.

FUNDING: This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 26. See the NIHR Journals Library website for further project information.

PMID:35635015 | DOI:10.3310/OLUE3796

Ann Med. 2022 Dec;54(1):1570-1577. doi: 10.1080/07853890.2022.2082518.

ABSTRACT

OBJECTIVES: Faecal calprotectin is an important biomarker used in the evaluation of inflammatory bowel disease. The aim of this study was to establish the value of faecal calprotectin concentration as a predictor of remission in ulcerative colitis and its correlation with laboratory, endoscopic and clinical findings.

METHODS: The single centre study included 126 adult patients with established diagnosis of ulcerative colitis consecutively visiting our Day clinic from March 2017 to March 2019. We measured serum biomarkers- CRP, haemoglobin, leukocytes and platelets. Faecal calprotectin was determined from stool, and endoscopy was performed with calculation of MAYO endoscopic subscore system (MES 0-1: remission, and MES 2-3: active disease). Clinical assessment was done by using Mayo score for ulcerative colitis (clinical Mayo score <2:remission, >5: active disease).The statistical analysis was performed using an univariate and multivariate model of disease remission prediction using logistic regression.

RESULTS: According to univariate analysis the increase of faecal calprotectin concentration by 10 ug/g is associated with an 8% decrease in probability of disease remission (OR 0.9921, p < .05). In the multivariate analysis, faecal calprotectin remained a significant predictor of disease remission (OR 0.9948, 95% CI 0.9914-0.9982, p = .0028), however, with a significant contribution of C-reactive protein (OR 0.8340, 95% CI 0.7085-0.9818, p = .0292). According to our model the cut off value for faecal calprotectin was 154 ug/g.

CONCLUSION: Our results have shown that faecal calprotectin is an independent predictor of remission in UC patients. The results of our study represent real-life data from a single university centre dealing with FC as a prognostic marker in patients with UC. KEY MESSAGESFaecal calprotectin is an independent predictor of remission in UC patients.Recent studies have suggested that calprotectin correlates well with endoscopic activity of inflammation but correlation of faecal calprotectin in a phase of remission hasn’t been evaluated yet.We have found that other inflammatory biomarkers do not correlate well with either endoscopic or clinical activity in ulcerative colitis.

PMID:35635011 | DOI:10.1080/07853890.2022.2082518

J Cosmet Dermatol. 2022 May 30. doi: 10.1111/jocd.15133. Online ahead of print.

ABSTRACT

OBJECTIVE: Detect the expression of Interleukin-6(IL-6) in the serum of patients with systemic sclerosis (SSc) and assess its association with clinical and laboratory features of the disease.

METHODS: The clinical data from 50 patients with SSc in the affiliated hospital of Xuzhou Medical University, China were retrospectively analyzed. The level of IL-6 in peripheral blood of systemic sclerosis patients was compared between the different clinical phenotypes groups. Spearman correlation test was used to analyze the correlation of the IL-6 with C-reactive protein(CRP), erythrocyte sedimentation rate (ESR), creatinine, and cystatin C.

RESULTS: IL-6 increased in the disease course ≥ 5 years, systemic sclerosis- Interstitial lung disease(SSc-ILD), pulmonary arterial hypertension(PAH), gastrointestinal involvement, and cardiac involvement group compared with the group with disease course < 5 years, no SSc-ILD, PAH, gastrointestinal involvement, and no cardiac involvement group. The differences were statistically significant (P<0.05). Correlation analysis showed that IL-6 in the group with disease course ≥ 5 years had a positive correlation with ESR (Rs=0.438, P=0.022) and CRP (Rs=0.825, P<0.001), whereas it was negatively correlated with creatinine (Rs=-0.481, P=0.011). Nevertheless, when it came to disease course < 5 years, the figures had no statistically significant difference.

CONCLUSION: Serum IL-6 in patients with systemic sclerosis is related to different clinical phenotypes. IL-6 helps to diagnose various phases of diseases, monitor severities of diseases, and predict the prognosis of patients.

PMID:35634998 | DOI:10.1111/jocd.15133

Perfusion. 2022 May 29:2676591221105610. doi: 10.1177/02676591221105610. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate a restrictive transfusion policy of red blood cells (RBC) and platelets in pediatric patients submitted to extracorporeal membrane oxygenation (ECMO).

METHODS: Retrospective descriptive study of pediatric patients supported with ECMO, from January 2010 to December 2019. Hemoglobin, platelet, lactate and mixed venous oxygen saturation (SvO2) values of each patient while on ECMO, were collected. Transfusion efficiency and tissue oxygenation were statistically evaluated comparing pre-transfusion hemoglobin, lactate and SvO2 with post-transfusion values. Ranges of hemoglobin and platelets were established, and the number of transfusions registered. The bleeding complications and outcome were documented.

RESULTS: Of a total of 1016 hemoglobin values, the mean value before transfusion was 8.6 g/dl. Hemoglobin and SvO2 increased significantly post-transfusion. Red blood cell transfusion varied with hemoglobin values: when hemoglobin value was less than 7 g/dl, 89% (41/46) were transfused but just 23% (181/794) when greater or equal to 7 g/dl. In the presence of active bleeding, the frequency of RBC transfusion increased from 32% to 62%, with hemoglobin between 7 g/dl and 8 g/dl.The mean value for platelet transfusion was 32 x 10⁹/L. Thirty-eight (43%) platelet values between 20 x 10⁹/L and 30×10⁹/L, and 31 (40%) between 30 x 10⁹/L and 40 x 10⁹/L led to platelet transfusion; between 40 x 10⁹/L and 50 x 10⁹/L, only 7 (9%) prompted platelet transfusion.Comparing the 2010-2015 to 2016-2019 periods there was a decrease in RBC and platelet transfusion threshold with similar survival (p = .528). Survival to discharge was 68%.

CONCLUSIONS: Using a restrictive RBC and platelet transfusion policy was safe and allowed a good outcome in this case series. The presence of active bleeding was an important decision factor when hemoglobin was above 7 g/dl and platelets were above 30 x 10⁹/L.

PMID:35634987 | DOI:10.1177/02676591221105610

West Afr J Med. 2022 May 27;39(5):521-528.

ABSTRACT

BACKGROUND: Depression is a significant contributor to the global burden of disease. Several studies have shown that depression in resident doctors is more common than that in the general population. However, data on the prevalence of depression among resident doctors in Nigeria is limited.

OBJECTIVES: The aim of this study is to determine the prevalence of depression as well as factors associated with depression among resident doctors.

METHODS: A cross-sectional study design was employed with semi-structured questionnaires on socio-demographic and other factors associated with depression in resident doctors. The proportionate sample size in hospitals across the six geopolitical zones with multi-stage sampling and systematic random sampling technique was used to recruit resident doctors. The Beck’s Depression Inventory was employed. The data was analyzed using Epi info version 3.5.3 (2011) and Stata 14. A p-value of less than 0.05 was statistically significant.

RESULTS: The prevalence of depression was 18.9% among the resident doctors. Negative binomial regression used showed that depression in resident doctors was significantly associated with age (IRR=1.07, 95%CI:1.01-1.13, p=0.017), female gender ((IRR=1.75, 95%CI: 1.00-3.05, p=0.049) and being a resident in the surgical specialties (IRR=2.31, 95%CI: 1.35-3.94, p=0.002), respectively.

CONCLUSION: The prevalence of depression among resident doctors showed that older age, female gender, and surgical specialties were determinants of depression.

PMID:35633637

West Afr J Med. 2022 May 27;39(5):508-515.

ABSTRACT

BACKGROUND: Medicinal plants have been used for years in daily life all over the world. Herbal medicines (HM) may be beneficial but are not completely harmless especially with unregulated use.

AIM: To assess the knowledge, preference and use of HM in a rural setting, western Nigeria.

METHODOLOGY: This was a cross-sectional study among 417 residents of Epe Local Government Area, Lagos State Nigeria conducted in mid 2016. Respondents were selected using a multi-stage sampling technique. Data were collected using a structured pretested interviewer-administered questionnaire and analyzed using Epi- info version 7.1.5.2. Descriptive and inferential statistics were done. P-value of <0.05 was considered statistically significant.

RESULTS: Nearly half (48.7%) of the respondents were between the ages of 18-33 years, over three fourths (78.4%) were married and majority (89.2%) were Yoruba. About half 207(49.6%) of respondents had good knowledge of HM. Over two thirds (67.6%) would use HM as first line treatment and 69.3% perceive it more effective than conventional medicine. Almost all (95.7%) respondents have used HM, majority (87.4%) in the last six months prior to study. Factors significantly associated with knowledge of HM are age (p=0.001) and sex of respondents (p=0.014). Significant factors influencing HM use include level of education (Fisher’s exact p=0.017), religion (Fisher’s exact p=0.001), and ethnicity (Fisher’s exact p<0.001).

CONCLUSION: Participants were fairly knowledgeable about herbal medicine but most were oblivious of its potential side effects. Majority were HM users mainly because of its perceived effectiveness. There is need for health education in rural areas on the side effects and safe use of herbal medicines.

PMID:35633631

West Afr J Med. 2022 May 27;39(5):451-458.

ABSTRACT

OBJECTIVES: To investigate the uterine artery Doppler parameters and endometrial characteristics in women with unexplained infertility.

METHODS: A prospective case-control study of 42 women with unexplained infertility and 42 fertile controls. Their mid-luteal phase transvaginal Doppler parameters of both uterine arteries and endometrial characteristics (endometrial blood flow, thickness and volume) were investigated and analysed. P values < 0.05 was statistically significant.

RESULTS: The mean uterine artery pulsatility index (PI) and resistivity index (RI) of the cases (women with unexplained infertility) were significantly higher compared to the values in the fertile controls (PI = 2.81±0.61 vs 2.15±0.65; p=0.001) (RI= 0.87±0.08 vs 0.82±0.07; p=0.003). In addition, the end-diastolic volume (EDV) (6.12±4.17 vs 9.37±5.14; p=0.007) and endometrial-subendometrial blood flow (p=0.036) were significantly lower in the cases compared to the controls. Multivariate logistics analysis showed that PI was independently associated with infertile status (p=0.006). There was no significant difference in the mean PSV (48.69±10.9 vs 50.58±11.30; p=0.602), endometrial thickness (10.30+3.13 vs 10.72+3.10; p=0.544), endometrial volume (7.82+1.56 vs 8.23+1.71; p=0.323), mean age (32.28±4.062 vs 31.91±3.58 years; p=0.502), body mass index (26.15±2.71kg/m2 vs 25.24±2.85 kg/m2; p=0.18) menstrual bleeding days (4.07±0.89 days vs 4.02±0.95 days; p=0.481) duration of menstrual cycle (28.02±1.09 days vs 27.64±1.36 days; p= 0.162), smoking history (p=0.909) and alcohol intake (p=0.507) of the infertile women compared with the fertile controls, respectively.

CONCLUSION: Women with unexplained infertility have increased uterine artery Doppler PI and RI and reduced endometrial-subendometrial perfusion compared with fertile controls.

PMID:35633622

West Afr J Med. 2022 May 27;39(5):459-464.

ABSTRACT

AIM: The study assessed the Plaque and Gingival scores of rural Nigerian school children before and after supervised school brushing program.

METHODS: This was an interventional study of 96 children aged 6 to 12 years in selected rural primary schools in Enugu, Nigeria. Data on sex, age, type of school, Plaque score and Gingival score were collected. Data was analyzed using SPSS version 20 and student’s t- test was used to compare means. P<0.05 was considered significant.

RESULTS: There were 45(46.9%) male and 51(53.1%) female participants and their mean age was 8.45±1.83years. Forty nine(51.0%) children attended private school while 47(49.0%) attended public school. Only 10(10.4%) had good Plaque score while 8(8.3%) had healthy gingiva. Before intervention, 83(86.5%) children used tooth brush as cleansing tool, 7(7.3%) children brushed twice a day while after the intervention, 96(100.0%) children used toothbrush and 39(40.6%) children brushed twice a day. Also, before intervention, there was significant association between Plaque scores (p=0.012), Gingival scores (p<0.001) and type of school attended. The mean plaque score for the school children before and after intervention was 2.17±0.57, and 1.28±0.49 respectively and the change was statistically significant (p=0.01). The mean gingival score before and after intervention was 1.23±0.67 and 0.31±0.49 respectively and the change was also statistically significant (p<0.001).

CONCLUSION: Children who attended private schools had better Plaque and Gingival scores than those who attended public schools. Supervised school tooth brushing program improved the plaque and gingival scores of rural primary school children in the study population.

PMID:35633623

Addict Behav. 2022 May 6;132:107357. doi: 10.1016/j.addbeh.2022.107357. Online ahead of print.

ABSTRACT

OBJECTIVE: To estimate the total number of alcohol-related consequences students experience during 4 years of college and examine early college indicators that result in higher rates of consequences.

METHOD: Undergraduate drinkers (N = 1,744; 58% female; 87% White; 5% Hispanic) at a large northeastern university completed an online survey at the end of the fall and spring semesters during their first (T1, T2), second (T3, T4), third (T5, T6), and fourth (T7, T8) years of college (87% retention across the study). First, descriptive statistics were calculated to estimate the total number of alcohol-related consequences students experienced across all 4 years of college. Second, a structural equation model was examined to identify early college indicators that influence individuals experiencing more cumulative consequences.

RESULTS: Students experienced an average of 102 (SD = 89.91) alcohol-related consequences during 4 years of college. Next, early parental approval of consequences, but not peer drinking norms, were positively associated with students’ willingness to experience consequences, which in turn, were positively associated with higher alcohol consumption and greater total consequences.

CONCLUSIONS: Results estimated that, on average, students experienced 102 alcohol-related consequences across all 4 years of college. Parental approval of consequences influenced students’ total consequences through their willingness to experience consequences and drinking behaviors. Findings from the current study have several important implications for interventions.

PMID:35633615 | DOI:10.1016/j.addbeh.2022.107357

Nurse Educ Today. 2022 May 21;115:105408. doi: 10.1016/j.nedt.2022.105408. Online ahead of print.

ABSTRACT

BACKGROUND: Despite efforts to promote inclusion of people living with disabilities in health and human service education and professions, students and clinicians living with disabilities continue to face powerful barriers, arising most notably from the stigma and negative attitudes of their peers. Increased awareness of these lived experiences are needed to affect attitudinal changes and reduce barriers to participation in those professions. To achieve this, information (stories) must be presented to learners in a way that promotes emotional engagement and highlights these issues from multiple perspectives. The following study measures the impact of a Research based Theatre play, based on the collected experiences of people living with disabilities in health and human service professions, as a teaching approach for knowledge and attitudinal change among audiences.

METHOD: This mixed-methods study (pre and post surveys, groups and individual interviews) aimed at measuring the impact (knowledge and attitudinal change) incurred among audience members. In total, a 174 students, faculty, staff, and clinicians in health and human service professions across two major Canadian cities completed the surveys before and after witnessing the play. Of these, 20 participants also participated in follow-up interviews. Two-way repeated measures ANOVA was used to compare the pre and post surveys while thematic content analysis was used for the interviews.

RESULTS: Two main themes emerged from combined analysis of both the quantitative and qualitative data. First, quantitative data revealed a significant change in participants’ attitudes towards people living with disabilities which was corroborated by interview participants who expressed more comfort in their interactions with students and clinicians living with disabilities. Second, learners also reported meaningful and statistically significant change in their knowledge about the experiences of health and human service professionals living with disabilities.

CONCLUSIONS: The results of this study support applying Research-based Theatre as a teaching approach that can promote knowledge and attitudinal change among audiences and increase the inclusion and equity of people living with disabilities in health and human service education. Future research in this area might investigate Research-based Theatre’s pedagogical impact using a randomized control design and measuring longer term impact.

PMID:35633604 | DOI:10.1016/j.nedt.2022.105408