Category: Nevin Manimala

BMJ Open. 2021 Nov 23;11(11):e054298. doi: 10.1136/bmjopen-2021-054298.

ABSTRACT

INTRODUCTION: Guidelines for hip fracture care state that patients with hip fracture should be mobilised on the day after surgery and at least once a day thereafter. However, compliance with these guidelines is poor. One approach that would assist physiotherapists to meet mobility guidelines after hip fracture is to delegate the provision of daily mobilisation to allied health assistants under their supervision. Therefore, we plan to conduct a randomised controlled trial to determine the feasibility of an allied health assistant providing daily inpatient rehabilitation to patients with hip fracture.

METHODS AND ANALYSIS: Using a parallel group randomised controlled design with one-to-one allocation, participants will be randomly allocated to an experimental group (allied health assistant management) or a comparison group (physiotherapist management). Inclusion criteria are: adult with diagnosis of hip fracture; inpatient in acute hospital; walked independently pre-hip fracture and able to communicate in conversational English. The experimental group will receive routine physiotherapy rehabilitation, including daily mobilisation, from an allied health assistant following initial physiotherapist assessment. The comparison group will receive routine rehabilitation from a physiotherapist. The primary outcome will be the feasibility of allied health assistant management of patients with hip fracture. Feasibility will be determined using the following areas of focus in Bowen’s feasibility framework: acceptability (patient satisfaction), demand (proportion of patients who participate), implementation (time allied health assistant/physiotherapist spends with participant, occasions of service) and practicality (cost, adverse events). Staff involved in the implementation of allied health assistant care will be interviewed to explore their perspectives on feasibility. Secondary outcomes include compliance with daily mobilisation guidelines, discharge destination, hospital readmission, falls, functional activity and length of stay. We aim to recruit 50 participants. Descriptive statistics will be used to describe feasibility and mobilisation rates will be calculated using Cox proportional hazards regression to compare compliance with mobilisation guidelines.

ETHICS AND DISSEMINATION: Ethics approval was obtained from the Peninsula Health human research ethics committee (HREC/63 005/PH-2020). The findings will be disseminated in peer-reviewed journals and conference presentations.

TRAIL REGISTRATION NUMBER: Australian and New Zealand Clinical Trial Registry; ACTRN12620000877987; Pre-results.

PMID:34815289 | DOI:10.1136/bmjopen-2021-054298

BMJ Open. 2021 Nov 23;11(11):e055902. doi: 10.1136/bmjopen-2021-055902.

ABSTRACT

BACKGROUND: The COVID-19 pandemic has resulted in a range of unprecedented disruptions to maternity care with documented impacts on perinatal outcomes such as stillbirth and preterm birth. Metropolitan Melbourne has endured one of the longest and most stringent lockdowns in globally. This paper presents the protocol for a multicentre study to monitor perinatal outcomes in Melbourne, Australia, during the COVID-19 pandemic.

METHODS: Multicentre observational study analysing monthly deidentified maternal and newborn outcomes from births >20 weeks at all 12 public maternity services in Melbourne. Data will be merged centrally to analyse outcomes and create run charts according to established methods for detecting non-random ‘signals’ in healthcare. Perinatal outcomes will include weekly rates of total births, stillbirths, preterm births, neonatal intensive care admissions, low Apgar scores and fetal growth restriction. Maternal outcomes will include weekly rates of: induced labour, caesarean section, births before arrival to hospital, postpartum haemorrhage, length of stay, general anaesthesia for caesarean birth, influenza and COVID-19 vaccination status, and gestation at first antenatal visit. A prepandemic median for all outcomes will be calculated for the period of January 2018 to March 2020. A significant shift is defined as ≥6 consecutive weeks, all above or below the prepandemic median. Additional statistical analyses such as regression, time series and survival analyses will be performed for an in-depth examination of maternal and perinatal outcomes of interests.

ETHICS AND DISSEMINATION: Ethics approval for the collaborative maternity and newborn dashboard project has been obtained from the Austin Health (HREC/64722/Austin-2020) and Mercy Health (ref. 2020-031).

TRIAL REGISTRATION NUMBER: ACTRN12620000878976; Pre-results.

PMID:34815291 | DOI:10.1136/bmjopen-2021-055902

BMJ Open. 2021 Nov 23;11(11):e050656. doi: 10.1136/bmjopen-2021-050656.

ABSTRACT

OBJECTIVES: To estimate occupation risk from COVID-19 among teachers and others working in schools using publicly available data on mortality in England and Wales.

DESIGN: Analysis of national death registration data from the Office for National Statistics.

SETTING: England and Wales, 8 March-28 December 2020, during the COVID-19 pandemic.

PARTICIPANTS: The total working age population in England and Wales plus those still working aged over 65 years.

PRIMARY AND SECONDARY OUTCOMES: Death with COVID-19 as a primary outcome and death from all causes as a secondary outcome.

RESULTS: Across occupational groups, there was a strong correlation between COVID-19 mortality and both non-COVID-19 and all-cause mortality. The absolute mortality rates for deaths with COVID-19 were low among those working in schools (from 10 per 100 000 in female primary school teachers to 39 per 100 000 male secondary school teachers) relative to many other occupations (range: 9-50 per 100 000 in women; 10-143 per 100 000 in men). There was weak evidence that secondary school teachers had slightly higher risks of dying with COVID-19 compared with the average for all working-aged people, but stronger evidence of a higher risk compared with the average for all professionals; primary school teachers had a lower risk. All-cause mortality was also higher among all teachers compared with all professionals. Teaching and lunchtime assistants were not at higher risk of death from COVID-19 compared with all working-aged people.

CONCLUSION: There was weak evidence that COVID-19 mortality risk for secondary school teachers was above expectation, but in general school staff had COVID-19 mortality risks which were proportionate to their non-COVID-19 mortality risk.

PMID:34815280 | DOI:10.1136/bmjopen-2021-050656

BMJ Open Respir Res. 2021 Nov;8(1):e001064. doi: 10.1136/bmjresp-2021-001064.

ABSTRACT

BACKGROUND: Multidrug-resistant tuberculosis (MDR-TB) drugs have never been associated with erythrocytosis. In Eritrea, however, several cases of incident erythrocytosis had been observed in the MDR-TB hospital. This study was aimed at exploring the association between MDR-TB drugs and secondary erythrocytosis, characterising the cases, and identifying other possible risk factors.

METHODS: A retrospective cohort study was conducted in Merhano National Referral MDR-TB hospital. Data were extracted from physically available clinical cards and laboratory results collected longitudinally between 23 June 2011 and 17 January 2021. Initially, univariate descriptive statistics (frequency, mean (SD), median (IQR) and range) were used as appropriate. Then, χ² or Fisher χ² test, and bivariate and/or multivariate Cox proportional hazard model were used to identify the predictors of incident erythrocytosis. All statistical analyses were conducted using R, and a two-sided alpha 0.05 was used to determine the statistical significance.

RESULTS: A total of 257 patients’ medical cards were screened, and 219 were eligible for further analysis. The median age of the patients was 38 years (range: 13-90 years) and 54.8% were males. During the follow-up time, 31 (14.2%) patients developed secondary erythrocytosis yielding an incidence rate of 7.8 cases per 1000 person-months. On average, the median time to onset of the event was found to be 5-months (range: 1-24 months). Males were more likely to develop the event than females (adjusted HR=7.13, 95% CI=1.66 to 30.53), and as body weight increases by 1 kg, the likelihood of developing secondary erythrocytosis was found to increase by 7% (adjusted HR=1.07, 95% CI=1.03 to 1.10). Moreover, all cases of secondary erythrocytosis were found to be possibly associated with the MDR-TB drugs.

CONCLUSION: The authors hypothesised that the incident erythrocytosis is possibly be associated with MDR-TB drugs, and further studies are required to substantiate this finding.

PMID:34815231 | DOI:10.1136/bmjresp-2021-001064

BMJ Open. 2021 Nov 23;11(11):e048782. doi: 10.1136/bmjopen-2021-048782.

ABSTRACT

INTRODUCTION: The quality of healthcare in childhood and adolescence is of key importance, in order to foster a healthy development and to avoid chronic health problems. Yet, data for Germany regarding the quality of healthcare for this patient group are lacking. The QualiPäd research project aims to estimate the quality of outpatient healthcare for children and adolescents in Germany, focusing on common psychiatric and physical disorders.

METHODS AND ANALYSIS: Quality indicators for seven common physical and mental childhood and adolescent clinical conditions (attention deficit/hyperactivity disorder, asthma, atopic dermatitis, depression, otitis media, conduct disorder/oppositional defiant disorder, tonsillitis) will be developed and ratified by experts, using the RAND/UCLA Appropriateness Method.Initially, 1400 medical records of children and adolescents with one of the aforementioned clinical conditions will then be randomly drawn from 40 outpatient practices in the German federal state of Hessen. The records will then be assessed regarding their adherence to the respective quality indicators. Based on this, the percentage of appropriate and inappropriate (eg, wasteful) healthcare of all clinical conditions (primary endpoint) will be estimated. Additionally, possible factors influencing the quality of care (eg, patient characteristics, type of condition, type of practice) will be identified using generalised estimation equation models.

ETHICS AND DISSEMINATION: This study will show for which of the studied clinical conditions and/or patients improvement of quality of care is necessary within the German health system. Also, the quality indicators designed for the study can afterwards be implemented in regular care and thus enable regular reporting of the outpatient care of this target group. The authors plan to disseminate their findings through international, peer-reviewed scientific publications, and through presentations at national and international paediatric and child psychiatric conferences.

TRIAL REGISTRATION NUMBER: DRKS00022408.

PMID:34815275 | DOI:10.1136/bmjopen-2021-048782

Am J Pharm Educ. 2021 Nov 23:8745. doi: 10.5688/ajpe8745. Online ahead of print.

ABSTRACT

Objective To assess how U.S. schools and colleges of pharmacy curriculum committees’ responsibilities, structure, functions, charges, and activities have evolved since 2011.Methods A total of 133 fully-accredited schools and colleges of pharmacy were included in the survey. Data collection occurred between March and September 2020, and survey questions pertained to the academic year (19-20). Data were collected on committee membership, leadership, functions, and charges. New questions explored ties to assessment and Standards 2016. Analysis included descriptive statistics and comparisons to the 2011 survey results.Results Response rate was 80%; one partial response was excluded from analysis. Most (93%) schools and colleges rely on a curriculum committee to provide curriculum oversight. Faculty and students remain the most frequent types of members but there has been an increase in the number of committees with members from other areas including experiential programs, staff, directors, librarians, and pharmacy residents. Committee charges have increased beyond the traditional curriculum planning, mapping, and review to include newer tasks (eg, EPAs, IPEs, PPCP, co-curriculum, certificates). Primary responsibility for various assessment activities is shared by both committees in 1/3 of the institutions.Conclusion. Curriculum committees remain a key part of pharmacy education but continue to evolve to meet their responsibility for new and increasing numbers of charges and finding ways to communicate and share duties with their assessment counterparts. Having clear guidance for the CC and reducing frequency of scheduled work to ensure the CC will be able to address new challenges as they emerge are recommended.

PMID:34815213 | DOI:10.5688/ajpe8745

Am J Pharm Educ. 2021 Nov 23:8801. doi: 10.5688/ajpe8801. Online ahead of print.

ABSTRACT

Objective. Student pharmacists must cultivate self-awareness to ensure that they can assess their skill development and abilities, including affective domain skills such as empathy. External feedback can augment development, but validated assessments are needed for accuracy. Thus, the objectives of this study were to: establish validity evidence of the KCES-R (Kiersma-Chen Empathy Scale-Revised), compare student self-perceptions and standardized patient (SP) perceptions of student empathy using a parallel patient scale (KCES-PV), and evaluate student reflections on the encounter.Methods. Student pharmacists completed an assessment of their self-perceptions of empathy (KCES-R) pre-/post-patient encounter. SPs completed the KCES-PV regarding student pharmacist empathy immediately post-encounter. Student pharmacists also watched their encounter videos and completed a self-reflection on their use of empathy. Descriptive statistics, Spearman’s rank-order correlations, exploratory factor analysis, Cronbach’s alpha, and Wilcoxon Signed-Rank test were computed. Reflections were explored using thematic analysis.Results. The KCES-R contains 2 factors with high internal consistency and shows the ability to detect changes in empathy. Student pharmacist self-perceptions of empathy ability appeared higher than the SP evaluation. Student pharmacists had a stronger belief in the importance of expressing empathy during patient encounters and indicated a need for further development.Conclusion. This study provides validity evidence for the use of the KCES-R and presents a parallel scale that may be used by SPs. Validated parallel scales along with reflective practice could be a potential avenue to grow self-awareness and empathy by allowing students to receive feedback and then reflect on their perceived vs actual demonstration of the skill.

PMID:34815215 | DOI:10.5688/ajpe8801

J Perianesth Nurs. 2021 Nov 20:S1089-9472(21)00144-1. doi: 10.1016/j.jopan.2021.06.004. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of this study was to evaluate the effect of an operating room nurse visit on the anxiety levels of surgical patients.

DESIGN: A prospective, interventional, quasi-experimental design.

METHODS: 80 patients were divided into the control group (n = 40) and the intervention group (n = 40). The control group was given routine care, and the intervention group was visited preoperatively by the operating room nurse in addition to routine care.

FINDINGS: The State-Trait Anxiety Inventory (STAI TX-1) mean score of the control patients who had information about anesthesia was low, while the STAI TX-1 mean score of the patients who had concerns about surgery was high. The STAI-TX-1 mean score of the control group patients who had information about anesthesia was significantly lower. There was no statistically significant difference in the STAI TX-1 scores between the two groups before and after surgery (P > .05). However, the STAI TX-1 mean score of the control patients was high in the post-operative period.

CONCLUSIONS: In an effort to reduce anxiety, the psychological preparation of the patient undergoing urological surgery should involve an anesthesia team member and the operating room nurse together.

PMID:34815164 | DOI:10.1016/j.jopan.2021.06.004

Am J Pharm Educ. 2021 Nov 23:8671. doi: 10.5688/ajpe8671. Online ahead of print.

ABSTRACT

Objective. To assess the six domains of worklife areas (Community, Control, Fairness, Reward, Workload Values) in pharmacy academicians that have been associated with burnout and poor job satisfaction.Methods. We aimed to assess the Areas of Worklife Survey (AWS) among a sample of pharmacy academicians attending a national meeting to evaluate personal, environmental, or workplace factors that may influence worklife environment. Data were analyzed using SPSS; descriptive statistics and Kruskal-Wallis and Pearson correlations were performed.Results. Participant response rate was 40.4% (n=49/121 attendees). Eighty-eight percent of participants reported working more than 40 hours per week. Mean AWS scores ranged from 2.7 to 3.9 with 1 representing a strong mismatch between person and work environment and 5 representing a strong match. Workload and Fairness domains were the lowest scores reported compared to Control being the highest. Higher mean scores were reported for Control and Reward in those with a mentor, and for Fairness in those reporting a hobby.Conclusion. Workload and Fairness were the lowest rated areas of worklife by participants. Developing targeted interventions such mentorship, hobbies, transparency in the work setting related in particular to workload and fairness may be an important step to prevent burnout in pharmacy academicians. Further studies in a larger population may further help to determine factors associated with low rated areas of worklife.

PMID:34815212 | DOI:10.5688/ajpe8671

Reprod Biomed Online. 2021 Aug 24:S1472-6483(21)00416-8. doi: 10.1016/j.rbmo.2021.08.019. Online ahead of print.

ABSTRACT

RESEARCH QUESTION: To evaluate the correlation between clinical and hormonal parameters and comorbidity burden in Caucasian women presenting for fertility treatment.

DESIGN: Monocentric cross-sectional study including a cohort of 3163 Caucasian women seeking medical care for fertility treatment. All patients underwent centralized laboratory testing for hormonal assessment. Complete clinical and laboratory data from the entire cohort were retrospectively analysed. Comorbidity burden score was assessed by the Charlson Comorbidity Index (CCI; categorized as 0 versus 1 versus ≥2).

RESULTS: Descriptive statistics and regression models tested the associations between clinical and laboratory parameters and CCI. Among the entire cohort of patients, a CCI = 0 was found in 2977 women (94.1%), and CCI = 1 and CCI ≥2 were found in 113 (3.6%) and 73 (2.3%) patients, respectively. Age (P = 0.009), gravidity (P = 0.001), anti-Müllerian hormone (AMH, P < 0.001) and TSH (P = 0.003) values were significantly different among CCI groups. In regression models, age at presentation and AMH emerged as independent indicators of CCI ≥ 1. Age at presentation <36 years (odds ratio [OR] 1.742, 95% confidence interval [CI] 1.284-2.364) and an AMH concentration ≤2.3 ng/ml (OR 1.864, 95% CI 1.29-2.69) were the most informative cut-off values for CCI ≥ 1 in the study population.

CONCLUSIONS: A younger age at presentation and lower AMH concentrations are significant independent indicators of decreased general health in women requiring clinical evaluation for fertility treatment. As observed for sperm parameters in men, AMH might serve as a proxy of women’s general health status.

PMID:34815158 | DOI:10.1016/j.rbmo.2021.08.019