Category: Nevin Manimala

JAMA Intern Med. 2021 May 28. doi: 10.1001/jamainternmed.2021.1974. Online ahead of print.

ABSTRACT

IMPORTANCE: Patient reviews of health care experiences are increasingly used for public reporting and alternative payment models. Critics have argued that this incentivizes physicians to provide more care, including low-value care, undermining efforts to reduce wasteful practices.

OBJECTIVE: To assess associations between rates of low-value service provision to a primary care professional (PCP) patient panel and patients’ ratings of their health care experiences.

DESIGN, SETTING, AND PARTICIPANTS: This quality improvement study used Medicare fee-for-service claims from January 1, 2007, to December 31, 2014, for a random 20% sample of beneficiaries to identify beneficiaries for whom each of 8 low-value services could be ordered but would be considered unnecessary. The study also used health care experience reports from independently sampled beneficiaries who responded to the 2010-2015 Consumer Assessment of Healthcare Providers and Systems (CAHPS) Medicare fee-for-service survey. Statistical analysis was performed from January 1, 2019, to December 9, 2020.

MAIN OUTCOMES AND MEASURES: The main outcomes were health care experience ratings from Medicare beneficiaries who responded to the CAHPS survey from 2 domains, namely “Your Health Care in the Last 6 Months” (overall health care, office wait time, timely access to nonurgent care, and timely access to urgent care) and “Your Personal Doctor” (overall personal physician and a composite score for interactions with personal physician). Beneficiaries in both samples were attributed to the PCP with whom they had the most spending. For each PCP, a composite score of low-value service exposure was constructed using the 20% sample; this score represented the adjusted relative propensity of the PCP patient panel to receive low-value care. The association between low-value service exposure and health care experience ratings reported by the CAHPS respondents in the PCP patient panel was estimated using regression analysis.

RESULTS: The final sample had 100 743 PCPs, with a mean of approximately 258 patients per PCP. Only 1 notable association was found; more low-value care exposure was associated with more frequent reports of having to wait more than 15 minutes after the scheduled time of an appointment (a mean of 0.448 points lower CAHPS score on a 10-point scale for PCP patient panels who received the most low-value care vs the least low-value care). Although some other associations were statistically significant, their magnitudes were substantially smaller than those typically considered meaningful in other CAHPS literature and were inconsistent in direction across levels of low-value service exposure.

CONCLUSIONS AND RELEVANCE: This quality improvement study found that more low-value care exposure for a PCP patient panel was not associated with more favorable patient ratings of their health care experiences.

PMID:34047761 | DOI:10.1001/jamainternmed.2021.1974

Arch Environ Occup Health. 2021 May 28:1-13. doi: 10.1080/19338244.2021.1931796. Online ahead of print.

ABSTRACT

Among health care professionals, dentists are more prone to infection due to their direct contact with blood and saliva. This study highlights the level of compliance with infection control measures among dental students; and linked this to their knowledge and attitudes regarding infection control measures and proper vaccinations. The study is a multi-centre analytical cross-sectional survey. The sample size was 969 clinical years’ students from governmental and private dental colleges in Sudan and Saudi Arabia. A pre-coded, pre-tested, and anonymous questionnaire consisted of seven categories of knowledge, attitude, awareness, and practices, including 40 questions, was answered. The study has linked knowledge, attitude, and practice in dental clinics with possible COVID-19 transmission in dental clinics. The results showed that the use of some Personal Protective Equipment was low in Sudan and moderate in Saudi Arabia (statistically significant, p < 0.001). Moderate percentage of Hepatitis B vaccination status, with low percentage of Post HBV serology, was reported (p < 0.001). The percentages of major causes of percutaneous and/or eye exposure/injury, for examples, were as follows: anesthesia (33.3-62.7%, p 0.006) and suture needle (17.5-39.4%, p 0.037). In conclusion, dental students in the present study had good knowledge and positive attitudes regarding infection control in general, but showed moderate compliance with the recommended infection control guidelines.

PMID:34047677 | DOI:10.1080/19338244.2021.1931796

Parasite. 2021;28:46. doi: 10.1051/parasite/2021042. Epub 2021 May 27.

ABSTRACT

Dicrocoelium dendriticum is a trematode that infects ruminant livestock and requires two different intermediate hosts to complete its lifecycle. Modelling the spatial distribution of this parasite can help to improve its management in higher risk regions. The aim of this research was to assess the constraints of using historical data sets when modelling the spatial distribution of helminth parasites in ruminants. A parasitological data set provided by CREMOPAR (Napoli, Italy) and covering most of Italy was used in this paper. A baseline model (Random Forest, VECMAP^®) using the entire data set was first used to determine the minimal number of data points needed to build a stable model. Then, annual distribution models were computed and compared with the baseline model. The best prediction rate and statistical output were obtained for 2012 and the worst for 2016, even though the sample size of the former was significantly smaller than the latter. We discuss how this may be explained by the fact that in 2012, the samples were more evenly geographically distributed, whilst in 2016 most of the data were strongly clustered. It is concluded that the spatial distribution of the input data appears to be more important than the actual sample size when computing species distribution models. This is often a major issue when using historical data to develop spatial models. Such data sets often include sampling biases and large geographical gaps. If this bias is not corrected, the spatial distribution model outputs may display the sampling effort rather than the real species distribution.

PMID:34047693 | DOI:10.1051/parasite/2021042

JMIR Res Protoc. 2021 May 28;10(5):e26110. doi: 10.2196/26110.

ABSTRACT

BACKGROUND: Due to their ability to collect person-generated health data, digital tools and connected health devices may hold great utility in disease prevention, chronic disease self-monitoring and self-tracking, as well as in tailoring information and educational content to fit individual needs. Facilitators and barriers to the use of digital health technologies vary across demographics, including sex. The “femtech” market is growing rapidly, and women are some of the largest adopters of digital health technologies.

OBJECTIVE: This paper aims to provide the background and methods for conducting a scoping review on the use of person-generated health data from connected devices in women’s health. The objectives of the scoping review are to identify the various contexts of digital technologies in women’s health and to consolidate women’s views on the usability and acceptability of the devices.

METHODS: Searches were conducted in the following databases: Medline, Embase, APA PsycInfo, CINAHL Complete, and Web of Science Core Collection. We included articles from January 2015 to February 2020. Screening of articles was done independently by at least two authors in two stages. Data charting is being conducted in duplicate. Results will be reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist.

RESULTS: Our search identified 9102 articles after deduplication. As of November 2020, the full-text screening stage is almost complete and data charting is in progress. The scoping review is expected to be completed by Fall 2021.

CONCLUSIONS: This scoping review will broadly map the literature regarding the contexts and acceptability of digital health tools for women. The results from this review will be useful in guiding future digital health and women’s health research.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/26110.

PMID:34047708 | DOI:10.2196/26110

J Refract Surg. 2021 May;37(5):331-336. doi: 10.3928/1081597X-20210204-01. Epub 2021 May 1.

ABSTRACT

PURPOSE: To assess enlargement of the clear corneal incision site and functional outcome in patients with cataract, following the use of two preloaded intraocular lens (IOL) injectors.

METHODS: In this prospective, randomized, intraindividual comparative clinical study, 58 paired-eyes were randomly assigned for implantation with two preloaded injectors: AutonoMe with a Clareon IOL (Alcon Laboratories, Inc) and iSert with a Vivinex IOL (Hoya). The size of the corneal incision, 2 mm for the iSert and 2.2 mm for the AutonoMe, was measured before and after phacoemulsification and after IOL implantation. Patients were examined 3 months after surgery to assess keratometry, subjective refraction, and visual acuity.

RESULTS: The incision enlargement was 0.20 ± 0.10 mm for the AutonoMe and 0.29 ± 0.10 mm for the iSert, with a statistically significant difference (P < .05). The final wound size after IOL implantation was 2.41 mm for the AutonoMe and 2.35 mm for the iSert. The mean absolute surgically induced astigmatism (SIA) was 0.50 ± 0.25 diopters (D) in the iSert eyes and 0.45 ± 0.20 D in the AutonoMe eyes (P > .05). The 3-month postoperative uncorrected and corrected distance visual acuity (UDVA and CDVA) were similar in both groups, with a UDVA of 0.10 and 0.12 logMAR and CDVA of -0.04 and -0.03 logMAR, respectively for the AutonoMe and iSert.

CONCLUSIONS: The iSert injector caused more enlargement of the corneal wound during IOL implantation compared to the AutonoMe. Despite the initially different incision sizes, the final incision size and functional outcomes were similar in both groups. [J Refract Surg. 2021;37(5):331-336.].

PMID:34044690 | DOI:10.3928/1081597X-20210204-01

Int J Environ Health Res. 2021 May 28:1-10. doi: 10.1080/09603123.2021.1926439. Online ahead of print.

ABSTRACT

The soil is the part of the biosphere where heavy metal pollution is most common. Heavy metals pose a threat to animal and human health through plants. This study aimed to evaluate heavy metal concentrations in the soil of orchards of Bilecik Province and possible human health risks. In 2016, 42 soil samples were taken from peach orchards of Bilecik Province, and Cr, Fe, Ni, Cu, Zn, Cd, and Pb analyzed. Pollution indices (Enrichment Factor, Geoaccumalation Index, Contamination Factor, Ecological Risk Factor) were used to determine heavy metal pollution, and the effects on human health were determined by the hazard quotient (HQ) and hazard index (HI). The study area is moderate contaminated by Cd (3.64), Ni (2.38) and Cu (2.24) in terms of enrichment factor. Similarly, the study area soils were moderately contaminated by Cd (1.72), Ni (1.40) and Cu (1.38) in terms of the contamination factor. Besides, soils had moderate potential ecological risk by Cd (51.54). The principal component and correlation analysis showed Cd and Cu are anthropogenic and Ni is the lithogenic origin. Although soil pollution indexes show moderate pollution, there is no non-carcinogenic health risk for children (0.56) and adults (0.061).

PMID:34044701 | DOI:10.1080/09603123.2021.1926439

J Matern Fetal Neonatal Med. 2021 May 27:1-5. doi: 10.1080/14767058.2021.1909560. Online ahead of print.

ABSTRACT

OBJECTIVE: Assess women’s perceptions of the impact of COVID-19 on their health care and well-being, access to and satisfaction with medical care due to the changes in delivery of care triggered by the pandemic.

METHODS: An online survey of women having health care appointments in the outpatient facilities across all divisions of a Department of Obstetrics and Gynecology at a tertiary care referral center in North Central Florida. Patients had outpatient appointments that were scheduled, canceled or rescheduled, in person or by telemedicine, between 11 March 2020 and 11 May 2020, a time during which a COVID-19 stay-at-home order was enacted across our state. A total of 6,697 visits were planned. Patients with multiple visits were unified, leaving 6,044 unique patients to whom the survey was emailed between 20 July 2020 and 31 July 2020. The survey was closed on 21 August 2020. Analyses were focused on simple descriptive statistics to assess frequency of responses. Analyses of variance and chi-square analyses were conducted to compare outcomes when all cells were ≥ 10, based on sub-specialty and insurance status; otherwise, frequencies were examined for the entire sample only. Missing data were excluded listwise.

RESULTS: A total of 6044 patients were contacted. Completed surveys numbered 1,083 yielding a response rate of 17.9%. The most common sub-specialty visit was gynecology (56.7%) followed by obstetrics (31.5%,), pelvic floor disorders (4.8%), gynecological oncology (2.9%,), and reproductive endocrinology (0.5%). A substantial percentage of women had visits canceled (19.2%), rescheduled (32.8%) or changed (42.1%) to telemedicine. In our patient population, 32.6% were worried about visiting the clinic and 48.1% were worried about visiting the hospital. COVID-19 triggered changes were perceived to have a negative impact by 26.1% of respondents. Refusal of future telemedicine visits was by 17.2%, however, 75.2% would prefer to use both in-person and telemedicine visits.

CONCLUSION: During the initial COVID-19 surge with lockdown, the majority of survey respondents were following public health precautions. However, there were significant concerns amongst women related to obstetric and gynecologic medical appointments scheduled during that period. During pandemics, natural disasters and similar extreme circumstances, digital communication and telemedicine have the potential to play a critical role in providing reassurance and care. Nevertheless, given the concerns expressed by survey respondents, communication and messaging tools are needed to increase comfort and ensure equity with the rapidly changing methods of care delivery.

PMID:34044744 | DOI:10.1080/14767058.2021.1909560

Technol Cancer Res Treat. 2021 Jan-Dec;20:15330338211019511. doi: 10.1177/15330338211019511.

ABSTRACT

OBJECTIVE: In this study, by comparing coplanar and noncoplanar intensity-modulated radiation therapy (IMRT) treatment planning in treating tongue cancer, the significance of noncoplanar fields in the protection of the lip and buccal mucosa was determined, and a reasonable solution was selected.

METHODS: Forty-eight tongue cancer patients treated from June 2019 to February 2021 were selected and randomly divided into a coplanar field group and a noncoplanar field group. The mucosal dose limit changed from 15 Gy to 45 Gy for comparison of the two treatment plans. The evaluation indicators (conformal index (CI); homogeneity index (HI); D5, D50, and D98 of the target volume; and the dose of normal tissues) were calculated under different mucosal dose limits. The clinical observation of the lip and buccal mucosa of 48 cases was monitored and graded carefully according to NCI-CTCAE V4.0. Statistical analyses were performed.

RESULTS: The differences in CI, HI, D98, D50 and D5 between the two groups in the target volume tended to decrease when the mucosal dose limit was less than 30 Gy, with a significant difference (P < 0.05). When the limit exceeded 30 Gy, significant differences in other indicators except CI (P < 0.05) were still noted. In normal tissue, differences in doses between the two groups existed when the mucosal limit was less than 20 Gy, with a significant difference (P < 0.05). When the limit exceeded 20 Gy, no significant difference was noted. Patients in the noncoplanar group showed significantly better results than those in the other group in terms of the radiation-related toxicity of the lip and cheek membrane(P < 0.001).

CONCLUSIONS: Compared with coplanar field radiotherapy, noncoplanar field radiotherapy can effectively reduce the exposure dose to the lip and buccal mucosa. The application of noncoplanar treatment plans exhibits good clinical significance and deserves to be promoted.

PMID:34044671 | DOI:10.1177/15330338211019511

J Gerontol Nurs. 2021 Jun;47(6):27-34. doi: 10.3928/00989134-20210510-01. Epub 2021 Jun 1.

ABSTRACT

The current quality improvement interventional study aimed to determine whether an educational intervention focused on evidence-based practices of sepsis screening for RNs would increase accuracy of sepsis screenings performed among older adult patients in a 32-bed medical-surgical unit of a large urban trauma hospital. A total of 34 RNs participated in this study. Sepsis screenings of participants were collected and audited before and after the educational intervention to determine changes in sepsis screening accuracy. A dependent samples t test was used to assess the statistical difference between pre- and post-intervention sepsis screening scores. Results indicated that the educational intervention effectively increased sepsis screening accuracy in older adult patients at the study center (p = 0.007), with a mean increase of 22.06% accuracy. Accurate sepsis screening is crucial for early sepsis diagnosis and treatment to improve the clinical outcomes of older adult patients with sepsis, reduce health care costs, and decrease resource use. [Journal of Gerontological Nursing, 47(6), 27-34.].

PMID:34044685 | DOI:10.3928/00989134-20210510-01

J Refract Surg. 2021 May;37(5):294-302. doi: 10.3928/1081597X-20210121-01. Epub 2021 May 1.

ABSTRACT

PURPOSE: To study the feasibility, safety, comparison of intraoperative ease of dissection, and immediate visual outcomes with standard versus differential small incision lenticule extraction (SMILE) spot settings in eyes undergoing bilateral SMILE for myopia or myopic astigmatism.

METHODS: One hundred eyes of 50 patients (mean age: 25.4 years) were randomized to receive standard settings (4.5-µm spot and track spacing in cap and lenticule interface) in one eye and differential settings (4.5-µm spot and track spacing in cap interface and 4.2 µm in lenticule interface) in the contralateral eye. Opaque bubble layer (OBL) was graded using a new grading system and a surgeon questionnaire was obtained to grade the ease of dissection (from 0 to 5, with 5 being the easiest) at the end of each surgery. Visual results and optical quality were analyzed at 1 day, 2 weeks, and 3 months postoperatively.

RESULTS: The mean OBL score was significantly lower in the differential group (26.3%) compared to the standard group (35.3%) (P < .01). Consequently, the mean dissection score was significantly higher in the differential group (4.01) compared to the standard group (3.57) (P < .01). The uncorrected distance visual acuity, Objective Scatter Index, modulation transfer function cut-off, and higher order aberrations were comparable with no statistically significant difference between both groups at 1 day, 2 weeks, and 3 months postoperatively (P > .05 for all parameters). No eye in either group had any intraoperative or postoperative complication affecting visual recovery.

CONCLUSIONS: Differential spot settings resulted in less intraoperative OBL and easy separability. However, the visual results and optical quality were comparable between groups. [J Refract Surg. 2021;37(5):294-302.].

PMID:34044689 | DOI:10.3928/1081597X-20210121-01