Category: Nevin Manimala

N Z Med J. 2021 Dec 17;134(1547):48-62.

ABSTRACT

AIM: This survey aimed to investigate patient perspectives, including preferences, needs and concerns, on the use of, and access to, individual healthcare information.

METHOD: A mixed-methods cross-sectional survey of adult patients (n=1,377) in Waitematā District Health Board inpatient and outpatient services during November-December 2020. The survey was online and on paper and available in 10 languages.

RESULTS: Over 80% of participants were comfortable with their health information being used across the scenarios presented (range: 81-89%). Māori were significantly more likely than non-Māori to be comfortable with their health information being combined with the health information of others to better understand population needs (p=0.006). The level of comfort with the use of individual health information was related to assurances that its use was for public good, data were stored securely, individual privacy was maintained, the information was accurate and there was communication on how it was used.

DISCUSSION: This study has shown that most healthcare consumers are comfortable with the health service using their de-identified health information beyond their care if it benefits others.

PMID:35728109

N Z Med J. 2021 Dec 17;134(1547):71-84.

ABSTRACT

AIM: In August 2016, a large waterborne campylobacteriosis outbreak occurred in Havelock North, New Zealand. This analysis describes the clinical complications of cases admitted to hospital as a result of acute infection, identifies risk factors for hospitalisation and compares deaths between hospitalised and non-hospitalised cases. Hospital admissions with post-infectious sequelae were excluded as they are the subject of a separate analysis.

METHODS: A case series analysis was undertaken by reviewing the electronic medical records of 933 residents of Hawke’s Bay District Health Board with probable and confirmed campylobacteriosis linked to the Havelock North Campylobacter outbreak.

RESULTS: A total of 67 hospital admissions, among 58 individuals, are described. Pre-existing comorbidity and advanced age were significant risk factors for hospital admission in univariate analysis. Dehydration (74.1%), electrolyte imbalance (35.8%) and acute kidney injury (27.6%) were common among hospitalised cases. The proportion of hospitalised cases that died within one year was significantly higher when compared to deaths among non-hospitalised cases (OR 5.0, 95% CI: 2.3-10.7), although this trend was not statistically significant after adjusting for age and comorbidity (OR 2.3, 95% CI: 0.96-5.3).

CONCLUSIONS: This study highlights the serious health impacts that occurred from a campylobacteriosis outbreak of this magnitude.

PMID:35728111

J Am Coll Health. 2022 Jun 21:1-7. doi: 10.1080/07448481.2022.2086010. Online ahead of print.

ABSTRACT

OBJECTIVE: This longitudinal study tested the relationship between cigarette and e-cigarette use and SARS-CoV-2 seroconversion among US college students.

PARTICIPANTS: Undergraduate students (n = 764), drawn from a randomly selected invitation-only pool from a large Midwestern university, that were initially negative for SARS-CoV-2 antibodies and were re-tested in November were included in this study conducted in Fall 2020.

METHODS: Demographics and cigarette and e-cigarette use behaviors (nicotine use) were collected in a baseline survey. SARS-CoV-2 antibody tests were administered in September (baseline) and November (endline) of 2020. Log-binomial regression analyses were conducted to test the association between nicotine use and SARS-CoV-2 seroconversion.

RESULTS: SARS-CoV-2 seroconversion was 5.2%. No statistically significant associations were found between nicotine use and SARS-CoV-2 seroconversion.

CONCLUSIONS: Contrary to prior results, we found no association between nicotine use and SARS-CoV-2 seroconversion. Nicotine use may not be a key risk factor for COVID-19 acquisition in predominantly healthy college-aged populations.

PMID:35728069 | DOI:10.1080/07448481.2022.2086010

Cancer Nurs. 2022 Feb 28. doi: 10.1097/NCC.0000000000001049. Online ahead of print.

ABSTRACT

BACKGROUND: In persons with lung cancer, sex and race are independent predictors of comorbidities and are associated survival. It is unclear how comorbidity profiles differ across sex and race.

OBJECTIVE: The objective was to examine comorbidity differences between men and women and Blacks and Whites.

METHODS: Data from the 2014, 2016, 2017, and 2018 Behavioral Risk Factor Surveillance System were analyzed using descriptive statistics, χ2 test of independence, and multiple logistic regression. Variables included sociodemographics and comorbidities.

RESULTS: Among individuals with lung cancer (N = 594), men were more likely to experience a heart attack (odds ratio [OR], 3.59; 95% confidence interval [CI], 1.62-7.96) and diabetes (OR, 2.83; 95% CI, 1.57-5.10) and less likely to experience depressive disorder (OR, 0.360; 95% CI, 0203-0.637). Black men (OR, 28.57; 95% CI, 9.22-88.55) and women (OR, 2.48; 95% CI, 1.02-6.05) were more likely to have a history of stroke.

CONCLUSION: Findings show that there may be differences in patterns of comorbidities among individuals with lung cancer. As we continue to move toward individualized medicine in cancer care, future work in this area should examine social determinants of health and how they may influence the patterns of comorbidities.

IMPLICATION FOR NURSES: Although nurses may be aware that certain groups have an increased risk for certain comorbid conditions, this study highlights what groups with lung cancer may be more likely to have certain comorbidities. Nurses can assess individuals for comorbidities and provide education on how to manage comorbidities during cancer treatment.

PMID:35728011 | DOI:10.1097/NCC.0000000000001049

Anal Chem. 2022 Jun 21. doi: 10.1021/acs.analchem.2c01001. Online ahead of print.

ABSTRACT

Single-atom catalysis is mainly focused on its dispersed high-density catalytic sites, but delicate designs to realize a unique catalysis mechanism in terms of target reactions have been much less investigated. Herein an iron single atomic site catalyst anchored on 2-D N-doping graphene (Fe-SASC/G) was synthesized and further employed as a biomimetic sensor to electrochemically detect hydrogen peroxide, showing an extremely high sensitivity of 3214.28 μA mM^-1 cm^-2, which is much higher than that (6.5 μA mM^-1 cm^-2) of its dispersed on 1-D carbon nanowires (Fe-SASC/NW), ranking the best sensitivity among all reported Fe based catalyst at present. The sensor was also used to successfully in situ monitor H₂O₂ released from A549 living cells. The mechanism was further systematically investigated. Results interestingly indicate that the distance between adjacent single Fe atomic catalytic sites on 2-D graphene of Fe-SASC/G matches statistically well with the outer length of bioxygen of H₂O₂ to promote a bridge adsorption of -O-O- for simultaneous 2-electron transfer, while the single Fe atoms anchored on distant 1-D nanowires in Fe-SASC/NW only allow an end-adsorption of oxygen atoms for 1-electron transfer. These results demonstrate that Fe-SASC/G holds great promise as an advanced electrode material in selective and sensitive biomimetic sensor and other electrocatalytic applications, while offering scientific insights in deeper single atomic catalysis mechanisms, especially the effects of substrate dimensions on the mechanism.

PMID:35727990 | DOI:10.1021/acs.analchem.2c01001

Br J Surg. 2022 Jun 21:znac074. doi: 10.1093/bjs/znac074. Online ahead of print.

ABSTRACT

BACKGROUND: Data on interventions to reduce postoperative pancreatic fistula (POPF) following pancreatoduodenectomy (PD) are conflicting. The aim of this study was to assimilate data from RCTs.

METHODS: MEDLINE and Embase databases were searched systematically for RCTs evaluating interventions to reduce all grades of POPF or clinically relevant (CR) POPF after PD. Meta-analysis was undertaken for interventions investigated in multiple studies. A post hoc analysis of negative RCTs assessed whether these had appropriate statistical power.

RESULTS: Among 22 interventions (7512 patients, 55 studies), 12 were assessed by multiple studies, and subjected to meta-analysis. Of these, external pancreatic duct drainage was the only intervention associated with reduced rates of both CR-POPF (odds ratio (OR) 0.40, 95 per cent c.i. 0.20 to 0.80) and all-POPF (OR 0.42, 0.25 to 0.70). Ulinastatin was associated with reduced rates of CR-POPF (OR 0.24, 0.06 to 0.93). Invagination (versus duct-to-mucosa) pancreatojejunostomy was associated with reduced rates of all-POPF (OR 0.60, 0.40 to 0.90). Most negative RCTs were found to be underpowered, with post hoc power calculations indicating that interventions would need to reduce the POPF rate to 1 per cent or less in order to achieve 80 per cent power in 16 of 34 (all-POPF) and 19 of 25 (CR-POPF) studies respectively.

CONCLUSION: This meta-analysis supports a role for several interventions to reduce POPF after PD. RCTs in this field were often relatively small and underpowered, especially those evaluating CR-POPF.

PMID:35727956 | DOI:10.1093/bjs/znac074

Annu Rev Vis Sci. 2022 Jun 21. doi: 10.1146/annurev-vision-100720-103343. Online ahead of print.

ABSTRACT

Vision and learning have long been considered to be two areas of research linked only distantly. However, recent developments in vision research have changed the conceptual definition of vision from a signal-evaluating process to a goal-oriented interpreting process, and this shift binds learning, together with the resulting internal representations, intimately to vision. In this review, we consider various types of learning (perceptual, statistical, and rule/abstract) associated with vision in the past decades and argue that they represent differently specialized versions of the fundamental learning process, which must be captured in its entirety when applied to complex visual processes. We show why the generalized version of statistical learning can provide the appropriate setup for such a unified treatment of learning in vision, what computational framework best accommodates this kind of statistical learning, and what plausible neural scheme could feasibly implement this framework. Finally, we list the challenges that the field of statistical learning faces in fulfilling the promise of being the right vehicle for advancing our understanding of vision in its entirety. Expected final online publication date for the Annual Review of Vision Science, Volume 8 is September 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

PMID:35727961 | DOI:10.1146/annurev-vision-100720-103343

Brain. 2022 Jun 21:awac221. doi: 10.1093/brain/awac221. Online ahead of print.

ABSTRACT

The underlying pathophysiology of paediatric mild traumatic brain injury and the time-course for biological recovery remains widely debated, with clinical care principally informed by subjective self-report. Similarly, clinical evidence indicate that adolescence is a risk factor for prolonged recovery, but the impact of age-at-injury on biomarkers has not been determined in large, homogeneous samples. The current study collected diffusion magnetic resonance imaging data in consecutively recruited patients (N = 203; 8-18 years old) and age and sex-matched healthy controls (N = 170) in a prospective cohort design. Patients were evaluated sub-acutely (1-11 days post-injury) as well as at four months post-injury (early-chronic phase). Healthy participants were evaluated at similar times to control for neurodevelopment and practice effects. Clinical findings indicated persistent symptoms at four months for a significant minority of patients (22%), along with residual executive dysfunction and verbal memory deficits. Results indicated increased fractional anisotropy and reduced mean diffusivity for patients, with abnormalities persisting up to four months post-injury. Multicompartmental geometric models indicated that estimates of intracellular volume fractions were increased in patients, whereas estimates of free water fractions were decreased. Critically, unique areas of white matter pathology (increased free water fractions or increased neurite dispersion) were observed when standard assumptions regarding parallel diffusivity were altered in multicompartmental models to be more biologically plausible. Cross-validation analyses indicated that some diffusion findings were more reproducible when approximately 70% of the total sample (142 patients, 119 controls) were used in analyses, highlighting the need for large-sample sizes to detect abnormalities. Supervised machine learning approaches (random forests) indicated that diffusion abnormalities increased overall diagnostic accuracy (patients vs. controls) by approximately 10% after controlling for current clinical gold standards, with each diffusion metric accounting for only a few unique percentage points. In summary, current results suggest that novel multicompartmental models are more sensitive to paediatric mild traumatic brain injury pathology, and that this sensitivity is increased when using parameters that more accurately reflect diffusion in healthy tissue. Results also suggest that diffusion data may be insufficient to achieve a high degree of objective diagnostic accuracy in patients when used in isolation, which is to be expected given known heterogeneities in pathophysiology, mechanism of injury, and even criteria for diagnoses. Finally, current results suggest ongoing clinical and physiological recovery at four months post-injury.

PMID:35727944 | DOI:10.1093/brain/awac221

Pediatr Emerg Care. 2022 Jun 22. doi: 10.1097/PEC.0000000000002789. Online ahead of print.

ABSTRACT

OBJECTIVE: The Transport Risk Assessment in Pediatrics (TRAP) and Transport Pediatric Early Warning Scores (T-PEWS) are transport-specific pediatric illness severity scores that are adjunct assessment tools for determining disposition of transported patients. We hypothesized that these scores would predict the risk of clinical deterioration in transported patients admitted to general pediatric wards.

METHODS: Activation of a rapid response team (RRT) in the first 24 hours of admission was used as a marker of deterioration. All pediatric transports between March 2017 and February 2020 admitted via critical care transport were included. Transports to the emergency department (ED) were excluded. This retrospective chart review evaluated TRAP and T-PEWS scores at 3 points: (1) arrival of transport team at referring hospital, (2) admission to the children’s hospital, and (3) RRT activation, if occurring within 24 hours of admission.

RESULTS: There were 1137 team transports during this period. Three hundred ninety-nine patients transported to the ED were excluded, leaving 738 included patients; 405 (55%) admitted to the general wards and 333 (45%) admitted to the pediatric intensive care unit. Twenty-five patients admitted to the wards (6%) had an RRT activation within 24 hours of admission. Statistical analysis used 2-sample t tests. There was a statistically significant difference in scores for ward admissions between those who had RRT activation and those who did not.

CONCLUSIONS: Both TRAP and T-PEWS can be used to predict the risk of clinical deterioration in transported patients admitted to general wards. These scores may assist in assessing which patients admitted to the wards need closer observation.

PMID:35727913 | DOI:10.1097/PEC.0000000000002789

BMJ. 2021 Jun 14;373:n1435. doi: 10.1136/bmj.n1435.

ABSTRACT

OBJECTIVE: To quantify the background incidence rates of 15 prespecified adverse events of special interest (AESIs) associated with covid-19 vaccines.

DESIGN: Multinational network cohort study.

SETTING: Electronic health records and health claims data from eight countries: Australia, France, Germany, Japan, the Netherlands, Spain, the United Kingdom, and the United States, mapped to a common data model.

PARTICIPANTS: 126 661 070 people observed for at least 365 days before 1 January 2017, 2018, or 2019 from 13 databases.

MAIN OUTCOME MEASURES: Events of interests were 15 prespecified AESIs (non-haemorrhagic and haemorrhagic stroke, acute myocardial infarction, deep vein thrombosis, pulmonary embolism, anaphylaxis, Bell’s palsy, myocarditis or pericarditis, narcolepsy, appendicitis, immune thrombocytopenia, disseminated intravascular coagulation, encephalomyelitis (including acute disseminated encephalomyelitis), Guillain-Barré syndrome, and transverse myelitis). Incidence rates of AESIs were stratified by age, sex, and database. Rates were pooled across databases using random effects meta-analyses and classified according to the frequency categories of the Council for International Organizations of Medical Sciences.

RESULTS: Background rates varied greatly between databases. Deep vein thrombosis ranged from 387 (95% confidence interval 370 to 404) per 100 000 person years in UK CPRD GOLD data to 1443 (1416 to 1470) per 100 000 person years in US IBM MarketScan Multi-State Medicaid data among women aged 65 to 74 years. Some AESIs increased with age. For example, myocardial infarction rates in men increased from 28 (27 to 29) per 100 000 person years among those aged 18-34 years to 1400 (1374 to 1427) per 100 000 person years in those older than 85 years in US Optum electronic health record data. Other AESIs were more common in young people. For example, rates of anaphylaxis among boys and men were 78 (75 to 80) per 100 000 person years in those aged 6-17 years and 8 (6 to 10) per 100 000 person years in those older than 85 years in Optum electronic health record data. Meta-analytic estimates of AESI rates were classified according to age and sex.

CONCLUSION: This study found large variations in the observed rates of AESIs by age group and sex, showing the need for stratification or standardisation before using background rates for safety surveillance. Considerable population level heterogeneity in AESI rates was found between databases.

PMID:35727911 | DOI:10.1136/bmj.n1435