Category: Nevin Manimala

BMC Pediatr. 2022 Jun 24;22(1):361. doi: 10.1186/s12887-022-03428-6.

ABSTRACT

BACKGROUND: Neonatal Mortality Ratio (NMR) could not be reversed sufficiently in Ethiopia in the last couple of years. Neonatal bleeding is one of the major causes of neonatal deaths. Administration of vitamin K prophylaxis at birth is the proven strategy to reduce neonatal death which can be caused by vitamin K deficiency bleeding. Although World Health Organization (WHO) recommends universal supplementation of vitamin K prophylaxis for all neonates at birth, many neonates could not get it in many resource poor countries. Despite its importance, information is scarce about uptake of vitamin K prophylaxis in Ethiopia in 2016. Therefore, this study aimed to identify prevalence and factors associated with vitamin K prophylaxis utilization among neonates in Ethiopia in 2016.

METHODS: Secondary data analysis of EDHS 2016 was done to assess prevalence and predictors of vitamin K prophylaxis among neonates in Ethiopia five years before EDHS 2016. Multi-stage cluster sampling was used in EDHS 2016. Sample weight and complex analysis were used to minimize bias. Bivariate and multivariable logistic regression analyses were carried out to identify factors associated with vitamin K prophylaxis. Finally, adjusted odds ratio with 95% confidence interval was calculated and P-value less than 0.05 taken as the cuff of point for declaration of the statistical significant association.

RESULTS: Prevalence of vitamin K prophylaxis among neonates in Ethiopia in 2016 was found to be 4710(65.5%) in this study. Factors like: Institutional delivery (AOR = 2.2, 95%CI: 1.8, 2.7), neonates from richest family (AOR = 2.1, 95%CI: 1.6, 2.7), neonates from richer household (AOR = 1.4, 95%CI: 1.1, 1.8), starting of antenatal care from 3-6 months of gestational age (AOR = 2.9, 95%CI: 2.3, 3.6) were factors positively associated with vitamin K prophylaxis in Ethiopia.

CONCLUSION AND RECOMMENDATION: Compared with expected world health organization recommendation of universal supplementation vitamin K prophylaxis, vitamin K utilization is lower among neonates in this study. Hence, it is recommended that strengthen early antenatal care initiation and improving community awareness about vitamin K prophylaxis are the key interventions to improve its uptake. Furthermore, improving institutional delivery might increase uptake of vitamin K prophylaxis.

PMID:35739491 | DOI:10.1186/s12887-022-03428-6

J Clin Endocrinol Metab. 2022 Jun 23:dgac380. doi: 10.1210/clinem/dgac380. Online ahead of print.

ABSTRACT

OBJECTIVE: The primary objective is to develop a prediction model of 30-day hospital readmission amongst adults with diabetes mellitus (DM) whose index admission was DM-related. The secondary aims are to: internally and externally validate the prediction model; and compare its performance with two existing models.

RESEARCH DESIGN AND SETTING: Data of inpatients aged ≥18 years from 2008-2015 were extracted from the electronic medical record system of the National University Hospital, Singapore. Unplanned readmission within 30 days was calculated from the discharge date of the index hospitalisation. Multivariable logistic regression and 10-fold cross-validation were performed. For external validation, simulations based on prevalence of 30-day readmission and the regression coefficients provided by referenced papers were conducted.

RESULTS: 11.0% of 2355 patients reported 30-day readmission. The prediction model included four predictors: length of stay, ischaemic heart disease, peripheral vascular disease and number of drugs. C-statistics for the prediction model and 10-fold cross-validation were 0.68 (95% CI: 0.66, 0.70) and 0.67 (95% CI: 0.63 to 0.70) respectively. Those for the three simulated external validation datasets ranged from 0.64 to 0.68.

CONCLUSION: The prediction model performs well with good internal and external validity for identifying patients with DM at risk of unplanned 30-day readmission.

PMID:35738016 | DOI:10.1210/clinem/dgac380

Arch Pathol Lab Med. 2022 Jun 23. doi: 10.5858/arpa.2021-0481-OA. Online ahead of print.

ABSTRACT

CONTEXT.—: Medical education in pathology relies on the accumulation of experience gained through inspection of numerous samples from each entity. Acquiring sufficient teaching material for rare diseases, such as Hirschsprung disease (HSCR), may be difficult, especially in smaller institutes. The current study makes use of a previously developed decision support system using a decision support algorithm meant to aid pathologists in the diagnosis of HSCR.

OBJECTIVE.—: To assess the effect of a short training session on algorithm-assisted HSCR diagnosis.

DESIGN.—: Five pathologists reviewed a data set of 568 image sets (1704 images in total) selected from 50 cases by the decision support algorithm and were tasked with scoring the images for the presence or absence of ganglion cells. The task was repeated a total of 3 times. Each pathologist had to complete a short educational presentation between the second and third iterations.

RESULTS.—: The training resulted in a significantly increased rate of correct diagnoses (true positive/negative) and a decreased need for referrals for expert consultation. No statistically significant changes in the rate of false positives/negatives were detected.

CONCLUSIONS.—: A very short (<10 minutes) training session can greatly improve the pathologist’s performance in the algorithm-assisted diagnosis of HSCR. The same approach may be feasible in training for the diagnosis of other rare diseases.

PMID:35738006 | DOI:10.5858/arpa.2021-0481-OA

J Clin Oncol. 2022 Jun 23:JCO2200454. doi: 10.1200/JCO.22.00454. Online ahead of print.

NO ABSTRACT

PMID:35737925 | DOI:10.1200/JCO.22.00454

Am Nat. 2022 Jul;200(1):168-180. doi: 10.1086/720152. Epub 2022 Jun 2.

ABSTRACT

AbstractThis essay explores shifting scientific understandings of fish and the evolution of fisheries science, and it grapples with colonialism as a system of power. We trace the rise of fisheries science to a time when Western nation-states were industrializing fishing fleets and competing for access to distant fishing grounds. A theory of fishing called “maximum sustainable yield” (MSY) that understands fish species in aggregate was espoused. Although alternatives to MSY have been developed, decision-making continues to be informed by statistical models developed within fisheries science. A challenge for structured management systems now rests in attending to different systems of knowledge and addressing local objectives, values, and circumstances. To deepen and illustrate key points, we examine Pacific herring (Clupea pallasii) and the expansion of commercial herring fisheries and state-led management in British Columbia, Canada. A feedback between colonialism and fisheries science is evident: colonialism generated the initial conditions for expansion and has been reinforced through the implementation of approaches and tools from fisheries science that define and quantify conservation in particular ways. Some features may be unique to the herring illustration, but important aspects of the feedback are more broadly generalizable. We propose three interconnected goals: (a) transform the siloed institutions and practices of Western science, (b) reimagine and rebuild pathways between information (including diverse values and perspectives) and decision-making, and (c) devolve governance authority and broaden governance processes such that multiple ways of knowing share equal footing.

PMID:35737985 | DOI:10.1086/720152

Eur J Cardiovasc Nurs. 2022 Jun 23:zvac051. doi: 10.1093/eurjcn/zvac051. Online ahead of print.

ABSTRACT

AIMS: The symptom burden of patients with chronic heart failure (CHF), together with social determinants and psychosocial factors, results in limitations to maintain adequate social life and roles, participate in social events and maintain relationships. This situation’s impact on health outcomes makes it of utmost importance to develop meaningful social networks for these patients. The primary objective aimed to identify randomized controlled trials that impact the social dimension of people with CHF. The secondary objectives were to analyze the methodological quality of these interventions, establish their components, and synthesize their results.

METHODS AND RESULTS: A systematic review following PRISMA guidelines was conducted in Pubmed, Scopus, Cochrane CENTRAL, PsychINFO, and CINAHL databases between 2010 and February 2022. The Revised Cochrane risk-of-bias tool for randomized trials was used. The protocol was registered in PROSPERO. Eight randomized controlled trials were identified, among which two were at ‘high risk of bias.’ Interventions were synthesized according to the following categories: delivery format, providers and recipients, and the intervention content domains. Half of the studies showed statistical superiority in improving the intervention group’s social support in people with CHF.

CONCLUSION: This review has highlighted the scarcity of interventions targeting the social dimension of people with CHF. Interventions have been heterogeneous, which limits the statistical combination of studies. Based on narrative review and vote counting, such interventions could potentially improve social support and self-care, which are important patient reported outcomes, thus warrant further research. Future studies should be co-created with patients and families to be adequately targeted.

REGISTRATION: PROSPERO CRD42021256199.

PMID:35737922 | DOI:10.1093/eurjcn/zvac051

JCO Precis Oncol. 2022 Jun;6:e2100427. doi: 10.1200/PO.21.00427.

ABSTRACT

PURPOSE: Comprehensive tumor biomarker testing is a fundamental step in the selection of highly effective molecularly driven therapies for a variety of solid tumors. The primary objective of this study was to examine racial differences in biomarker testing and clinical trial participation in the United States using a real-world database.

METHODS: Patients in a real-world deidentified database diagnosed with advanced/metastatic non-small-cell lung cancer (NSCLC), metastatic colorectal cancer (CRC), or metastatic breast cancer were eligible. Biomarker testing and clinical trial participation was compared between Black and White racial groups using chi-squared test and stepwise logistic regression controlling for baseline covariates.

RESULTS: A total of 23,488 patients met eligibility criteria. Next-generation sequencing (NGS) testing rates differed significantly between White versus Black race before first-line therapy (36.6% v 29.7%, P < .0001) and at any given time (54.7% v 43.8%, P < .0001) in the nonsquamous NSCLC cohort. Similar disparities in NGS testing rates at any time during the study were observed among patients with CRC (White 51.6%; Black 41.8%, P < .0001). No differences were observed in the breast cancer cohort. Patients of Black race were less likely to be treated in a clinical trial in the overall NSCLC cohort when compared with White counterparts (3.9% v 2.1%, P = .0002). A statistically significant relationship between biomarker/NGS testing and clinical trial enrollment was observed in all cohorts (P < .003) after adjusting for covariates.

CONCLUSION: In a real-world database, significant disparities in NGS-based testing rates were observed between Black and White races in NSCLC and CRC. NGS and any biomarker testing were both associated with trial enrollment in all cohorts. There is a need for interventions to promote access to comprehensive testing for patients with advanced/metastatic tumors.

PMID:35737912 | DOI:10.1200/PO.21.00427

JMIR Form Res. 2022 Jun 8. doi: 10.2196/36206. Online ahead of print.

ABSTRACT

BACKGROUND: The COVID-19 pandemic has wreaked havoc on healthcare systems and governments worldwide. Although eHealth literacy is acknowledged as a critical component of public health, it was overlooked during the pandemic. To assist patients and their families, health professionals should be knowledgeable about online health information resources and capable of evaluating relevant online information. In a resource-constrained situation, the level of eHealth literacy among health professionals is not well documented.

OBJECTIVE: This study aimed to assess eHealth literacy level and its associated factors among health professionals working in Amhara regional state teaching hospitals, Ethiopia.

METHODS: A self-administered questionnaire was used in an institutional-based cross-sectional study design. Descriptive statistics were done to describe eHealth literacy statements and key variables using SPSS v.24. Bi-variable and multivariate logistic regression was fitted to identify factors related to eHealth literacy. Variables having a p-value < 0.05 were declared statistically significant predictors.

RESULTS: A total of 383 study participants completed and returned the questionnaire with a response rate of 90.5%. Health professionals have a moderate level of eHealth literacy (mean =29.21). Most of them were aware of the available health resources located on the Internet, and know how to search, and locate these resources. However, they lack to distinguish high-quality health resources from low-quality resources. Factors that are associated with eHealth literacy were computer access, computer knowledge, perceived ease of use, and perceived usefulness of electronic health information resources.

CONCLUSIONS: It is crucial to provide training and support to healthcare workers on how to find, interpret, and, most importantly, evaluate the quality of health information found on the Internet in order to improve their eHealth literacy level. Further study is needed to explore the role of eHealth literacy in mitigating pandemics in developing countries.

PMID:35737897 | DOI:10.2196/36206

Environ Sci Technol. 2022 Jun 23. doi: 10.1021/acs.est.2c01912. Online ahead of print.

ABSTRACT

We assessed mortality risks associated with source-specific fine particles (PM_2.5) in a pooled European cohort of 323,782 participants. Cox proportional hazard models were applied to estimate mortality hazard ratios (HRs) for source-specific PM_2.5 identified through a source apportionment analysis. Exposure to 2010 annual average concentrations of source-specific PM_2.5 components was assessed at baseline residential addresses. The source apportionment resulted in the identification of five sources: traffic, residual oil combustion, soil, biomass and agriculture, and industry. In single-source analysis, all identified sources were significantly positively associated with increased natural mortality risks. In multisource analysis, associations with all sources attenuated but remained statistically significant with traffic, oil, and biomass and agriculture. The highest association per interquartile increase was observed for the traffic component (HR: 1.06; 95% CI: 1.04 and 1.08 per 2.86 μg/m³ increase) across five identified sources. On a 1 μg/m³ basis, the residual oil-related PM_2.5 had the strongest association (HR: 1.13; 95% CI: 1.05 and 1.22), which was substantially higher than that for generic PM_2.5 mass, suggesting that past estimates using the generic PM_2.5 exposure response function have underestimated the potential clean air health benefits of reducing fossil-fuel combustion. Source-specific associations with cause-specific mortality were in general consistent with findings of natural mortality.

PMID:35737879 | DOI:10.1021/acs.est.2c01912

J Manag Care Spec Pharm. 2022 Jul;28(7):721-731. doi: 10.18553/jmcp.2022.28.7.721.

ABSTRACT

BACKGROUND: Cystic fibrosis (CF) is a rare, life-threatening disease that results in severe respiratory, digestive, and metabolic problems. Elexacaftor/tezacaftor/ivacaftor is an oral drug that was approved by the US Food and Drug Administration (FDA) on October 21, 2019, after demonstrating clinical improvements compared with previous CF transmembrane conductance regulator modulators. Use of CF transmembrane conductance regulator modulators has improved CF care, but their high costs exceed commonly used cost-effectiveness thresholds. The Institute for Clinical and Economic Review issued an access and affordability alert warning that these high costs could threaten sustainable access to high-value care. There exists little real-world evidence on the uptake of elexacaftor/tezacaftor/ivacaftor and the impact on total cost of care and other health care resource utilization. This exploratory study analyzed the uptake and total cost-of-care impact of elexacaftor/tezacaftor/ivacaftor using pharmacy and medical claims data in a commercially insured patient population. OBJECTIVE: To analyze the uptake of elexacaftor/tezacaftor/ivacaftor by members who qualified for treatment and to evaluate the differences in total cost of care and health care resource utilization in members who started treatment with elexacaftor/tezacaftor/ivacaftor. METHODS: Uptake and per-member per-month information was obtained from Prime Therapeutics databases using cystic fibrosis transmembrane conductance regulator (CFTR) modulator claims. The total cost-of-care and resource utilization analysis used pharmacy and medical claims from Prime Therapeutics and Blue Cross NC across approximately 1.34 million commercially insured members over 20 months. Members with CF were identified by 2 or more International Classification of Diseases, Tenth Revision codes (E84.xx) in any field at least 30 days apart or by a CFTR modulator claim. Only continuously enrolled members with CF with an elexacaftor/tezacaftor/ivacaftor pharmacy claim were included. The date of the first claim served as the index date. RESULTS: At 12 months after FDA approval, 77 (68%) Blue Cross NC members with CF were using elexacaftor/tezacaftor/ivacaftor. Of these, 33 had switched from a different CFTR modulator and 44 were naive to CFTR modulator therapy. Pharmacy and medical claims for 51 continuously enrolled members that initiated elexacaftor/tezacaftor/ivacaftor were analyzed. The average total cost of care increased by 52% (P < 0.00001). Hospitalizations decreased from an average of 7.7 (± 7.2) to 3.9 (± 5.5) (P < 0.00001). The sum and average number of Pseudomonas aeruginosa infections were numerically lower, but the results did not meet statistical significance. Use of other supportive medications was numerically lower, but no statistically significant differences were observed. CONCLUSIONS: The uptake of elexacaftor/tezacaftor/ivacaftor was rapid, and the total cost of care increased despite reductions in hospitalizations and nonpharmacy costs. Differences in use of other CF-related medications appeared to be minimally affected. DISCLOSURES: Dr Smith and Dr Borchardt have no financial conflicts of interest to report. Both authors are employed at BCBSNC at the time of writing. The project had no outside funding or sponsorship. The majority of the work and data analysis was completed as part of the requirements of the PGY1 Managed Care Pharmacy Residency program at BCBSNC during the 2020-2021 cycle year. This research does not meet the definition of human subject research as defined by the US Department of Health and Human Services at 45 C.F.R. § 46.102(f). According to definitions in section (e)(1), our research did not require either (i) information or biospecimens through intervention or interaction with any individuals or (ii) obtained, used, studied, analyzed, or generated private information or identifiable biospecimens. Therefore, institutional review board approval or a valid exemption is not required.

PMID:35737861 | DOI:10.18553/jmcp.2022.28.7.721