Category: Nevin Manimala

BMC Med Educ. 2022 Mar 1;22(1):134. doi: 10.1186/s12909-022-03191-3.

ABSTRACT

BACKGROUND: Among the various factors identified as relevant for primary care career choice, financial considerations have been consistently shown to have an impact. In Germany, reliable and easily understandable information on physicians’ earning opportunities in self-employed settings is difficult to obtain for medical students, leading to substantial misperceptions that may negatively affect respective career considerations. This study investigated medical students’ evaluation of a 45-min evidence-based workshop on earning opportunities, workload and job satisfaction in different specialties and settings to examine its effect on the perceived attractiveness of working self-employed and working in general practice.

METHODS: The workshop was implemented as part of a mandatory general practice clerkship in the fourth study year (of six). Post-hoc evaluations of all participants between October 2017 and September 2018 (one cohort) were analysed cross-sectionally including descriptive statistics, subgroup comparisons and qualitative analysis of free-text answers regarding students’ main insights.

RESULTS: Response rate was 98.1% (307/313). Participants were on average 25.0 years old, and 68.3% were women. Based on a ten-point scale ranging from 1 = ‘no influence’ to 10 = ‘very big influence’, 91.9% confirmed at least some (> = 2) and 57.3% a rather high (> = 5) influence of earning expectations on their career choice process. Regarding the workshop, 86.1% were overall satisfied, and 89.5% indicated they had gained new insights, primarily regarding earning opportunities in different specialties and work settings, and frequently regarding job satisfaction, workload and the structure of revenues and expenditures in a doctor’s office (according to qualitative analysis). In the opinion of 89.8% of students, the provided learning content should be part of the undergraduate curriculum. More than half of participants reported an increase regarding the attractiveness of working self-employed and working as a general practitioner, most frequently regarding earning opportunities, but also in general and in respect to job satisfaction, cost-benefit ratio and workload. This increase was significantly higher among students favouring or at least considering a general practice career.

CONCLUSIONS: The workshop and its content were appreciated by the students and showed clear potential to usefully complement undergraduate curricula aiming at increasing or reinforcing students’ interest in working self-employed and working in general practice.

PMID:35232434 | DOI:10.1186/s12909-022-03191-3

BMC Health Serv Res. 2022 Mar 1;22(1):276. doi: 10.1186/s12913-022-07657-4.

ABSTRACT

BACKGROUND: Clinical quality registries (CQRs) monitor compliance against optimal practice and provide feedback to the clinical community and wider stakeholder groups. Despite a number of CQRs having incorporated the patient perspective to support the evaluation of healthcare delivery, no recommendations for inclusion of patient-reported outcome measures (PROMs) in CQRs exist. The aim of this study was to develop a core set of recommendations for PROMs inclusion of in CQRs.

METHOD: An online two-round Delphi survey was performed among CQR data custodians, quality of life researchers, biostatisticians and clinicians largely recruited in Australia. A list of statements for the recommendations was identified from a literature and survey of the Australian registries conducted in 2019. The statements were grouped into the following domains: rationale, setting, ethics, instrument, administration, data management, statistical methods, and feedback and reporting. Eighteen experts were invited to participate, 11 agreed to undertake the first online survey (round 1). Of these, nine experts completed the online survey for round 2.

RESULTS: From 117 statements presented to the Delphi panel in round 1, a total of 72 recommendations (55 from round 1 and 17 from round 2) with median importance (MI) ≥ 7 and disagreement index (DI) < 1 were proposed for inclusion into the final draft set and were reviewed by the project team. Recommendations were refined for clarity and to read as stand-alone statements. Ten overlapped conceptually and, therefore, were merged to reduce repetition. The final 62 recommendations were sent for review to the panel members for their feedback, which was incorporated into the final set.

CONCLUSION: This is the first study to develop preliminary recommendations for PROMs inclusion in CQRs. Recommendations for PROMs implementation are critically important for registries to assure meaningful PROMs data capture, use, interpretation, and reporting to improve health outcomes and healthcare value.

PMID:35232454 | DOI:10.1186/s12913-022-07657-4

Zhonghua Xue Ye Xue Za Zhi. 2022 Jan 14;43(1):19-25. doi: 10.3760/cma.j.issn.0253-2727.2022.01.005.

ABSTRACT

Objective: This study analyzed the correlation between genetic mutation and prognostic significance in childhood acute lymphoblastic leukemia (ALL) . Methods: Targeted exome by next-generation sequencing (NGS) technology was used to carry out molecular profiling of untreated 141 children with ALL in Fujian Medical University Union Hospital from November 2016 to December 2019. Correlation of genetic features and clinical features and outcomes was analyzed. Results: Among the 141 pediatric patients with ALL, 160 somatic mutations were detected in 83 patients (58.9% ) , including 37 grade Ⅰ mutations and 123 grade Ⅱ mutations. Single nucleotide variation was the most common type of mutation. KRAS was the most common mutant gene (12.5% ) , followed by NOTCH1 (11.9% ) , and NRAS (10.6% ) . RAS pathway (KRAS, FLT3, PTPN11) , PAX5 and TP53 mutations were only detected, and NRAS mutations was mainly found in B-ALL while FBXW7 and PTEN mutations were only found, and NOTCH1 mutation was mainly detected in T-ALL. The average number of mutations detected in each child with T-ALL was significantly higher than in children with B-ALL (4.16±1.33 vs 2.04±0.92, P=0.004) . The children were divided into mutation and non-mutation groups according to the presence or absence of genetic variation. There were no statistically significant differences in sex, age, newly diagnosed white blood cell count, minimal or measurable residual disease monitoring results, expected 3-year event-free survival (EFS) and overall survival (OS) between the two groups (P>0.05) . On the other hand, the proportion of T-ALL and fusion gene negative children in the mutant group was significantly higher than the non-mutation group (P=0.021 and 0.000, respectively) . Among the patients without fusion gene, the EFS of children with grade I mutation was significantly lower than children without grade I mutation (85.5% vs 100.0% , P=0.039) . Among children with B-ALL, the EFS of those with TP53 mutation was significantly lower than those without TP53 mutation (37.5% vs 91.2% , P<0.001) . Conclusion: Genetic variation is more common in childhood ALL and has a certain correlation with clinical phenotype and prognosis. Therefore, targeted exome by NGS can be used as an important supplement to the traditional morphology, immunology, cytogenetics, and molecular biology classification.

PMID:35231988 | DOI:10.3760/cma.j.issn.0253-2727.2022.01.005

Psych J. 2022 Mar 1. doi: 10.1002/pchj.531. Online ahead of print.

ABSTRACT

Schizotypal traits have been found to be negatively associated with satisfaction with life but the underlying mechanisms are not well understood. This study investigated the association between schizotypal traits and satisfaction with life and explored the mediating role of trait anxiety and mind wandering in the relationship between those two variables in a sample of Chinese young adults. One hundred and two individuals with high schizotypal traits and 104 individuals with low schizotypal traits were screened using the Schizotypal Personality Questionnaire. They completed a series of questionnaires including the Satisfaction with Life Scale, Trait Anxiety Inventory, and Mind Wandering Questionnaire. Results showed that: First, the high schizotypal trait group showed lower satisfaction with life, and higher trait anxiety and mind wandering frequency than the low schizotypal trait group. Second, the high schizotypal trait group, trait anxiety, and mind wandering negatively predicted satisfaction with life. Third, mediation analyses showed that all indirect effect paths in the mediation model were significant, that is, trait anxiety and mind wandering alone and together mediated the relationship between schizotypal trait group and satisfaction with life. In conclusion, high schizotypal trait is a risk factor for low satisfaction with life. The association between schizotypal traits and satisfaction with life was mediated by the combination of trait anxiety and mind wandering. This study has implications for improving life satisfaction in individuals with high schizotypal traits.

PMID:35231958 | DOI:10.1002/pchj.531

J Trace Elem Med Biol. 2022 Feb 22;71:126961. doi: 10.1016/j.jtemb.2022.126961. Online ahead of print.

ABSTRACT

BACKGROUND: Elemental profiling is a tool that has been proposed to improve the traceability of seafood products. Small sources of variation can affect the outcome of elemental profiling and therefore pose to lower the overall accuracy of analyses. Here, we investigate two potential sources of variation through three experiments: laboratory variation (intra-, interlaboratory variation, and tissue matrix) and tissue variation.

METHODS AND RESULTS: Samples of whitleleg shrimp (Litopenaeus vannamei) were obtained from 20 farms in Ecuador and two farms in Alabama to be analyzed. In the first experiment of the study, samples from Ecuador were analyzed at three different laboratories and compared. Two out of the five elements reported were statistically different across the three laboratories (Cu and Se). In the second experiment, the effect of tissue matrix (ground vs whole tissue during acid digestion) was investigated. Altogether, five out of 29 elements analyzed were statistically different. In the third experiment, samples from two farms in Alabama were analyzed to understand the variation in element concentrations in different tissues (head on shell on (HOSO), headless shell on (HLSO), headless peeled (PLD) and headless peeled and deveined (PLDV)). Elemental concentrations varied across tissues, and patterns in elemental concentrations were site specific. The samples from the two farms were analyzed with a Random Forest classification model to site x tissue groupings with 94% accuracy.

CONCLUSION: The result of this study highlights the following: 1. Consistency in laboratory analysis important in studies that involve element concentrations, as minor differences in methodology can propagate as significant differences in results. 2. In shrimp, elements are compartmentalized in different tissues and elemental profiling should consistently use the same type of tissue.

PMID:35231879 | DOI:10.1016/j.jtemb.2022.126961

Audiol Neurootol. 2022 Mar 1:1-9. doi: 10.1159/000522051. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to study the effect of steroid treatment on new-onset sensorineural hearing loss (SNHL) in subjects presenting shortly after an audiometry-confirmed acute acoustic trauma (AAT) injury.

STUDY DESIGN: This is a case-control study.

METHODS: We identified healthy military personnel who presented with AAT injury to the Israeli Defense Forces Medical Corps Otolaryngology/Audiology Services during 2016-2020. Patients were nonrandomly allocated to a treatment arm, where they received steroids (prednisone, 1 mg/kg, 60 mg maximal daily dose), administered for either ≥7 days or <7 days, or to a control arm, in which no treatment was offered besides loud noise avoidance. Audiometries were conducted within 7 days following the AAT and within 1 month later. We compared changes in bone conduction (BC) and air conduction (AC) thresholds at 2-8 kHz.

RESULTS: Of the 263 enrolled subjects, 137 (52%) received steroids and 126 (48%) received no treatment. Subjects who were treated early (<24 h) with high-dose steroids and for ≥7 days demonstrated significantly better hearing outcomes, compared with the nontreatment group. Subjects in the steroids group demonstrated 13-14 dB average improvement in BC thresholds at 3 and 4 kHz (p = 0.001) and additional 7-8 dB average improvement in AC thresholds at 6 and 8 kHz, compared with the nontreatment group (p < 0.0001). These observations were more compelling in patients who initially presented with worse hearing losses (>35 dB). No statistically significant differences were observed in AC/BC pure tone average between the two groups.

CONCLUSIONS: Early oral steroids are recommended in AAT injuries and were shown to improve hearing outcomes within 1 month.

PMID:35231916 | DOI:10.1159/000522051

Psychiatry Res. 2022 Feb 20;310:114469. doi: 10.1016/j.psychres.2022.114469. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to investigate the relationship between childhood trauma and clinical correlates in bipolar depression.

METHODS: A total of 61 bipolar depression patients were enrolled and assessed based on the Childhood Trauma Questionnaire-Short Form (CTQ-SF), Patient Health Questionaire-15 (PHQ-15), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7) systems.

RESULTS: The age of onset in bipolar depression patients with either trauma or abuse or neglect was significantly lower than in patients without these factors. There were statistically significant negative correlations between the age of onset and the number of different trauma types in bipolar depression patients. Multiple variable regression showed a significant association between the number of trauma types and the age of onset. Furthermore, there was a significant negative correlation between the age of onset with CTQ-SF total score (CTS), emotional abuse score and emotional neglect score, and physical neglect score. However, multiple variable regression analysis revealed that there was a significant association between emotional abuse score and the age of onset of bipolar depression patients.

CONCLUSION: Our results suggest that childhood trauma may be associated with physical symptoms and the age of onset in bipolar depression patients.

PMID:35231875 | DOI:10.1016/j.psychres.2022.114469

Epilepsy Behav. 2022 Feb 26;129:108626. doi: 10.1016/j.yebeh.2022.108626. Online ahead of print.

ABSTRACT

INTRODUCTION: Genetic epilepsy with febrile seizures plus (GEFS+) is an epilepsy syndrome with clinical heterogeneity that was first described in 1997. Central auditory processing (CAP) is defined as the neurophysiological process in decoding sound waves from the outer ear to the auditory cortex. The present study aimed to analyze CAP and phonological disorders in preschool-age children with GEFS+.

MATERIAL AND METHOD: This is a prospective case-control study. Twenty-seven patients diagnosed with GEFS+ aged between 4 years and 6 years and 6 months and 31 healthy controls in the same age range were included in the study. Phonological sensitivity test (SAT) and auditory discrimination test (İAT) were applied to both groups, and the results of both groups were statistically compared.

RESULTS: The SAT and İAT raw and Z scores of the subjects in the study group were found to be significantly higher than those of the control group (p = 0.001; p < 0.01). Electroencephalography (EEG) status of the patients or the duration of antiseizure medication use did not have a statistically significant effect on the outcome.

CONCLUSION: Patients with GEFS+ have a significantly high impairment in both articulation and auditory discrimination of phonemes compared with the healthy population. Early diagnosis and early treatment of this condition can prevent potential literacy problems and the development of dyslexia in the future.

PMID:35231857 | DOI:10.1016/j.yebeh.2022.108626

Am J Emerg Med. 2022 Feb 20;55:6-10. doi: 10.1016/j.ajem.2022.02.023. Online ahead of print.

ABSTRACT

OBJECTIVES: Gender disparities continue to exist in emergency medicine (EM) despite increasing percentages of women in medical school and residencies. Prior studies in other male dominated industries have shown using masculine or feminine-coded language in job advertisements affects the proportion of male versus female applicants who choose to apply for those jobs. The goal of this study was to determine if gender-coding exists in EM job advertisements, and to see if there were differences between academic vs. non-academic jobs or administrative vs. non-administrative jobs.

METHODS: This was a cross sectional study of EM jobs advertised in the United States on 13 academic and non-academic medical job databases from September 2020-February 2021. Using a gender decoder program based on prior research by Gaucher et al. on gendered wording in job advertisements, we analyzed each job to determine if the job advertisement was overall highly masculine, masculine, highly feminine, feminine, or neutral. Each job was categorized as academic, non-academic, administrative, or non-administrative. Data were analyzed using descriptive statistics and chi-square analysis.

RESULTS: Seventy-four EM job advertisements were posted during the study period. Forty-four (59.4%) of these coded out as masculine or strongly masculine, 18 (24.3%) coded out as feminine or strongly feminine, and 12 (16.2%) were neutral. Only one job advertisement contained no gender-coded words. There were no differences in the gender-coding of academic, non-academic, or administrative jobs.

CONCLUSION: Job advertisements for EM physicians tend to contain more masculine-coded language. Almost all job advertisements for emergency medicine physicians in this study contained at least one gender-coded word. Further studies could explore whether changing the language of job advertisements in EM has an impact on the proportion of women who choose to apply to EM jobs.

PMID:35231866 | DOI:10.1016/j.ajem.2022.02.023

Schizophr Res. 2022 Feb 26;243:32-42. doi: 10.1016/j.schres.2022.02.026. Online ahead of print.

ABSTRACT

Relapses are frequent in the first years following a first episode of schizophrenia (FES), being associated with a higher risk of developing a chronic psychotic disorder, and poor clinical and functional outcomes. The identification and intervention over factors associated with relapses in these early phases are timely and relevant. In this study, 119 patients in remission after a FES were closely followed over three years. Participants came from the 2EPS Project, a coordinated, naturalistic, longitudinal study of 15 tertiary centers in Spain. Sociodemographic, clinical, treatment and substance abuse data were analyzed. 49.6% of the participants relapsed during the 3-years follow-up. None of the baseline demographic and clinical characteristics analyzed showed a statistically significant association with relapses. 22% of patients that finished the follow-up without relapsing were not taking any antipsychotic. The group that relapsed presented higher mean antipsychotics doses (381.93 vs. 242.29 mg of chlorpromazine equivalent/day, p = 0.028) and higher rates of antipsychotic polytherapy (28.6% vs. 13%, p < 0.001), benzodiazepines use (30.8% vs. 8.5%, p < 0.001), side effects reports (39.2% vs. 25%, p = 0.022), psychological treatment (51.8% vs. 33.9%, p = 0.03), and cannabis consumption (93.2% vs. 56.7%, p < 0.001). Clozapine use was notably higher in the group that reminded in remission (21.7% vs. 8.2%, p < 0.019). These findings may guide clinicians to detect subgroups of patients with higher risk to present a second episode of psychosis, focusing on measures to ensure an adequate treatment or facilitating cannabis use cessation. This study supports future research to identify relapse prevention strategies for patients in early phases of schizophrenia.

PMID:35231832 | DOI:10.1016/j.schres.2022.02.026