Category: Nevin Manimala

J Cyst Fibros. 2021 Mar 11:S1569-1993(21)00049-7. doi: 10.1016/j.jcf.2021.02.014. Online ahead of print.

ABSTRACT

BACKGROUND: Home spirometry with regular symptom assessment is one strategy to track lung health to intervene early in episodes of pulmonary exacerbations (PE). In a multi-center randomized controlled trial home spirometry and symptom tracking demonstrated no significant differences regarding the primary clinical endpoint, FEV₁, compared to usual care, but did identify differences in healthcare utilization. We used data from the Early Intervention in Cystic Fibrosis Exacerbation (eICE) study to evaluate whether home monitoring of PE is a cost-minimizing intervention in the context of this randomized trial.

METHODS: We reviewed healthcare resource utilization of all 267 eICE participants, including outpatient visits, antibiotics and hospitalizations. Prices were identified in the IBM/Watson MarketScan^Ⓡ Commercial Claims and Encounters Databases and averaged over the 2014-2017 period. Using total healthcare utilization costs, we generated summary statistics by intervention and protocol arm (total cost, mean cost, standard deviation). We performed Welch Two Sample t-tests to determine if total costs and cost by type of utilization differed significantly between groups.

RESULTS: Outpatient visit costs were significantly higher by 13% in the Early Intervention (EI) than in the usual care (UC) arm ($3,345 vs. $2,966). We found no significant differences in outpatient antibiotic, hospitalization, or total health care costs between the arms.

CONCLUSIONS: Within the context of the eICE trial, outpatient visits were significantly higher in those with experimental home spirometry care, but that did not translate into statistically significant differences of overall health care costs between the two arms.

PMID:33715993 | DOI:10.1016/j.jcf.2021.02.014

Rev Esp Cir Ortop Traumatol. 2021 Mar 11:S1888-4415(21)00015-1. doi: 10.1016/j.recot.2020.10.010. Online ahead of print.

ABSTRACT

INTRODUCTION: Diaphyseal forearm fractures in skeletally immature patients are common injuries that account for 30% of upper extremity fractures in this age group. There are cases with unstable injuries or unacceptable reductions, in which surgical resolution by reduction and stabilisation with percutaneous elastic endomedullary nailing is indicated. One of the advantages of this system is that it avoids an approach to the fracture site, allowing closed reduction in the vast majority of fractures. However, it is not always possible to achieve an acceptable closed reduction and opening of the fracture site is necessary. The aim of this study was to determine whether there are preoperative factors to predict the difficulty of performing closed reduction in these patients.

METHODS: A retrospective study of skeletally immature patients with acute diaphyseal forearm fractures treated with elastic endomedullary nailing by the same paediatric surgeon was performed. The primary outcome variable was defined as the need for open reduction; considered as a direct surgical approach to the fracture site. Demographic characteristics of the included patients and radiographic characteristics of the fracture were analysed.

RESULTS: We found that the median percentage of preoperative radial shortening in the closed reduction and open reduction groups was 1 and 5%, respectively; resulting in a statistically significant difference (p = 0.04).

CONCLUSION: Radial shortening on preoperative radiographs predicts an increased risk of requiring an open reduction of the fracture (39% association); thus we understand that this variable should be considered by the general traumatologist as a prognostic factor in defining the referral of these patients.

PMID:33715982 | DOI:10.1016/j.recot.2020.10.010

Disabil Health J. 2021 Mar 5:101090. doi: 10.1016/j.dhjo.2021.101090. Online ahead of print.

ABSTRACT

BACKGROUND: People with disabilities and chronic health conditions rely on a range of services and supports to complete daily tasks, maintain health, and participate in the community. Preliminary research suggests the COVID-19 pandemic greatly disrupted these services and this population may be particularly susceptible to unemployment.

OBJECTIVE: Describe employment and service disruptions for individuals with disabilities and chronic health conditions during the onset of community-based spread of COVID-19 in the United States.

METHODS: Adults with disabilities and chronic health conditions completed online surveys to report employment and service changes via multiple choice and open-ended questions. Multiple choice questions were analyzed using descriptive statistics; open-ended responses were coded using content analysis.

RESULTS: Participants (n = 109): 79.8% female, 88.1% white, 77.121% completed a 4-year college degree or greater, 61.4% had annual income ≥$45,000. Only 14.9% of survey respondents reported disruptions in employment. On average, 54.0% of service changes were due to discontinuation, including loss of physical therapy, job coaching, community organizations, transportation, and peer supports. Other changes included a shift to virtual service delivery and family members taking the role of service providers.

CONCLUSIONS: Individuals with chronic health conditions and disabilities experienced service disruptions, even in a sample with considerably more economic, social, and educational privilege than the general population of people with chronic health conditions and disabilities in the United States.

PMID:33715986 | DOI:10.1016/j.dhjo.2021.101090

Vet J. 2021 Feb 27:105650. doi: 10.1016/j.tvjl.2021.105650. Online ahead of print.

ABSTRACT

Determining ideal pacing rates to meet physiological needs and optimizing programming to prevent unnecessary right ventricular pacing in dogs requires an understanding of heart rate profiles and applicable pacing technology. The heart rate and rhythm of the dog is complex necessitating investigation of rate requirements of activity and circadian influences. Overlaying this information are a multiplicity of other factors such as age, breed, temperament, cardiovascular disease and underlining rhythm disorders that contribute to the difficulty in making general conclusions. However, all such information permits better implementation of programming options with the goal of better outcomes. In this review (Part 1 of a two-part review) instantaneous heart rate, rolling average heart rate, simple average heart rate, heart rate tachograms, RR interval tachograms (2D, 3D and dynamic), and Poincaré plots (2D, 3D and dynamic) are discussed as they apply to decisions in the determination and examination of pacing rates for dogs programmed in the VVI pacing mode (Ventricular paced, Ventricular sensed, Inhibited pacing). The applicable pacing operations available for three pacemaker companies are reviewed (Abbott, Biotronik/Dextronix, and Medtronic). The programmable options considered include: slowest pacing rate without additional features to extend the pacing interval, sleep/rest rate preferences, hysteresis to lengthen pacing interval following intrinsic beats, and intermittent increases in pacing following abrupt loss of intrinsic rhythm. Recommendations are suggested for follow-up of individual dogs with examination of pacing statistics and Holter monitoring.

PMID:33715961 | DOI:10.1016/j.tvjl.2021.105650

J Craniomaxillofac Surg. 2021 Feb 27:S1010-5182(21)00078-0. doi: 10.1016/j.jcms.2021.02.021. Online ahead of print.

ABSTRACT

The aim of this study was to determine whether patients benefit from a secondary reconstruction since it carries the risks of no improvement or worsening of their current situation. Patients treated with individual computer-aided-design/computer-aided-manufacturing (CAD/CAM) ceramic implants were reviewed. To ascertain changes throughout the secondary reconstruction, the study investigators reviewed ophthalmological examinations, took volumetric measurements of the orbits and asked the patients for evaluation of their situation before and after the reconstruction. Points addressed were double vision, visual acuity, field of vision, limitations in daily life and aesthetic considerations. A total of 14 patients were reviewed and 11 answered the questionnaire. Ophthalmological examinations showed that the physical integrity of the eye was maintained. Volumetric measurements preopeatively (33.94 ± 3.24 cm³) and postoperatively (30.67 ± 2.07 cm³) showed that a statistically significant overcorrection of orbital volume leads to good functional and aesthetic outcomes. Patients’ subjective opinions were that they greatly benefitted, especially concerning limitations in daily life, which improved by 4.4 ± 2.8 points out of 10 possible points, and aesthetics, with an improvement of 5.9 ± 1.78 points. Based on these findings, we conclude that secondary reconstructions contribute to improvement of the patients’ quality of life and therefore should be considered as an option to improve patients’ condition.

PMID:33715966 | DOI:10.1016/j.jcms.2021.02.021

J Am Pharm Assoc (2003). 2021 Feb 19:S1544-3191(21)00075-3. doi: 10.1016/j.japh.2021.02.007. Online ahead of print.

ABSTRACT

OBJECTIVES: The purpose of this study is to evaluate the incidence of glycemic relapse in patients who attained their glycosylated hemoglobin (A1C) goal through a health system-wide collaborative primary care-based pharmacist- and Certified Diabetes Care and Education Specialist (CDCES)-led type 2 diabetes (T2D) management program and to identify relapse risk factors.

METHODS: This retrospective cohort study examined patients with T2D in the diabetes management program with a baseline A1C of at least 9% who attained their A1C goal. The primary outcome was incidence of glycemic relapse. Time to relapse was estimated using Kaplan-Meier curve, and a cox proportional hazards model was fitted to identify the risk factors for glycemic relapse.

RESULTS: Three hundred sixty-two patients were followed-up for a median of 10.5 (interquartile range 12.1) months after program completion; 38 patients (10.5%) experienced a glycemic relapse. Kaplan-Meier analysis estimated a 12-month relapse rate of 8.3%. The presence of a medication adherence barrier, presence of a higher number of chronic medications at baseline, presence of a baseline body mass index (BMI) of 30-39.9, and use of insulin at program completion increased risk for glycemic relapse in a univariate model. In multivariate regression, baseline BMI of 30-39.9 remained statistically significant. Older age at baseline was associated with a statistically significantly decreased relapse risk in both models.

CONCLUSION: This study highlights a low incidence of glycemic relapse for patients with T2D who reach their A1C goal through a collaborative primary care-based pharmacist- and CDCES-led T2D management program. The presence of risk factors for glycemic relapse may indicate a need for ongoing intensive care despite achieving A1C goal.

PMID:33715974 | DOI:10.1016/j.japh.2021.02.007

J Acad Nutr Diet. 2021 Mar 11:S2212-2672(21)00077-0. doi: 10.1016/j.jand.2021.02.004. Online ahead of print.

ABSTRACT

BACKGROUND: Consistent, evidence-based child feeding guidance targeted to parents of children ages birth to 24 months (B-24) is needed for early childhood obesity prevention.

OBJECTIVE: The aim was to develop and pretest a comprehensive set of child feeding and obesity prevention messages for parents of children ages B-24.

DESIGN: A qualitative, 2-phase protocol, grounded in social and behavior change, was used as a conceptual interview framework to pilot test early childhood feeding messages with parents.

PARTICIPANTS/SETTING: Participants were parents (n = 23) of children ages B-24.

METHODS: A core set of 12 messages and supporting materials were developed for parents of children ages B-24 based on previous research findings, current research evidence, and feeding guidance. Parents were individually interviewed using a semistructured script along with additional questions to rank perceptions of message qualities.

MAIN OUTCOME MEASURES: Overall comprehension, importance, believability, ease of implementation, and likelihood of use of messages were assessed.

STATISTICAL ANALYSIS PERFORMED: Data analysis included qualitative thematic analysis and descriptive statistics for Likert-scaled responses.

RESULTS: Participants were primarily female, non-Hispanic White, with a mean age of 33.3 ± 6.8 years and at least a bachelor’s degree. Overall, most messages were understood, believable, perceived as important, and feasible by parents. Messages related to starting solid foods, encouraging child control of intake and self-feeding, and food allergen guidance were perceived as more difficult and less likely to be implemented by parents.

CONCLUSIONS: Additional research is needed to evaluate actual implementation of messages by diverse parents and resulting outcomes including impact on child weight.

PMID:33715977 | DOI:10.1016/j.jand.2021.02.004

Intensive Crit Care Nurs. 2021 Mar 11:103028. doi: 10.1016/j.iccn.2021.103028. Online ahead of print.

NO ABSTRACT

PMID:33715957 | DOI:10.1016/j.iccn.2021.103028

Nurs Open. 2021 Mar 14. doi: 10.1002/nop2.852. Online ahead of print.

ABSTRACT

AIMS: To investigate the attitudes and beliefs towards the implementation of nurse prescribing among general nurses and nurse specialists.

DESIGN: A cross-sectional survey among general nurses and nurse specialists was conducted in seven provinces and one autonomous region in mainland China using convenience sampling method.

METHODS: The attitudes and beliefs towards nurse prescribing were assessed using the Nurse Attitudes and Beliefs towards Nurse prescribing scale, of which Cronbach’s coefficient was 0.902, retest reliability was 0.808. Respondents from eight hospitals across the country were employed to complete an online questionnaire.

RESULTS: Nurse specialists (n = 399) had statistically significantly more favourable intentions towards nurse prescribing than general nurses (n = 415; 105.64 ± 12.83 vs. 96.39 ± 13.16; p < .001). The years of clinical work experience, professional title, education degree were positively correlated with general nurses’ and nurse specialists’ attitudes and beliefs towards nurse prescribing (p < .05). Among nurse specialists, the variety of specialties and whether they work in nurse-led clinics on an outpatient basis have positively influence on their intentions towards nurse prescribing (p < .05).

PMID:33715286 | DOI:10.1002/nop2.852

Int J Ment Health Nurs. 2021 Mar 14. doi: 10.1111/inm.12846. Online ahead of print.

ABSTRACT

Despite the global prevalence of mental disorders being widely acknowledged, mental illness, complex trauma and the significant impact on individuals, families and communities continues to be poorly recognized, under-diagnosed and underreported. Based on the 2017 Australian census, one-in-five (20%) people have experienced some type of mental illness within the last 12 months (Australian Bureau of Statistics [ABS], 2019). The prevalence rate of mental illness in culturally and linguistically diverse (CALD) communities is difficult to estimate due to cultural and linguistic issues and underutilization of mental health services. In particular, little epidemiological data is available about the prevalence of mental illness in the Somali-Australian community. The aim of this study was to identify the perceived barriers to help-seeking for mental health for Somali-Australian women. A qualitative descriptive study incorporating focus group discussions with 31 Somali-Australian women was conducted in Melbourne, Australia. Braun & Clarke’s (2006) thematic analysis was applied to the data. Four themes relating to help-seeking barriers were abstracted. Influence of faith explored how Islam can impact the person views on mental illness. Stigma focused on the relationship between public and self-stigma and help-seeking. Mistrust of Western healthcare system describes the participants concerns about the cultural disconnect between the community and the Western healthcare system. Finally, denial of mental illness reflected the community views on mental health. This study provides an insight into the factors that influence the Somali-Australian community help-seeking with mental health services. The findings have implications for mental health professionals and the Somali-Australian community.

PMID:33715289 | DOI:10.1111/inm.12846