Category: Nevin Manimala

J Hosp Palliat Nurs. 2021 Aug 4. doi: 10.1097/NJH.0000000000000778. Online ahead of print.

ABSTRACT

Chronic obstructive pulmonary disease (COPD) is a progressive, life-limiting illness. Despite significant symptom burden, access to advance care planning (ACP) and palliative care are limited. Early initiation of ACP enables patients to articulate the values that underpin the decisions they would make if, in the future, they are unable to speak for themselves. Nurses constitute the majority of health care workforce and are well placed to initiate these discussions. This study explored knowledge, attitudes, and practice regarding ACP for patients with COPD among Australian and New Zealand respiratory nurses. A cross-sectional online survey tested knowledge about ACP and canvassed attitudes about current practice. Data were analyzed using descriptive statistics and content analysis of text data. The 112 participating respiratory nurses had substantial knowledge and positive attitudes regarding ACP in COPD; however, they lacked confidence and clarity regarding their role. Despite advances in end-of-life care provision for chronic disease, well-established barriers remained (inadequate training, fear of distressing patients, and time), and discussion triggers were still linked to acute deterioration, diagnosis of severe disease, and patient initiation. Better articulating the role of the respiratory nurse in ACP and building capacity and confidence within this workforce may improve ACP access for people living with COPD.

PMID:34369423 | DOI:10.1097/NJH.0000000000000778

J Neurosci Nurs. 2021 Aug 6. doi: 10.1097/JNN.0000000000000608. Online ahead of print.

ABSTRACT

BACKGROUND: The sexuality of people with spinal cord injury (SCI) is a subject often neglected by healthcare professionals because of their lack of knowledge or understanding of how to proceed in this context. Different teaching strategies can be used to fill this knowledge gap, such as clinical simulation and peer-assisted learning. This study evaluates the effects of an educational intervention on nursing students’ knowledge acquisition about the sexuality of individuals with SCI and on the students’ self-confidence and satisfaction with the experience. METHODS: Quasi-experimental, pretest-posttest design was conducted with nursing students (N = 54). The intervention was the application by a senior-level nursing student of 2 scenarios of high-fidelity clinical simulation. The primary outcome was the knowledge about the sexuality of people with SCI. The secondary outcome was the satisfaction and self-confidence in learning. We performed descriptive and inferential statistics and built multiple linear regression models. RESULTS: The effect of the intervention on knowledge acquisition ranged from the mean of 1.26 in the pretest to 3.10 in the posttest. The means in the scores of satisfaction and self-confidence were considered excellent and correlated with knowledge acquisition. Previous attendance of a class on SCI positively interfered in the scale of knowledge acquisition. CONCLUSION: We verified an effect size ranging from medium to large magnitude for knowledge acquisition, and great satisfaction and self-confidence in learning through the use of simulated experience and peer-assisted learning.

PMID:34369432 | DOI:10.1097/JNN.0000000000000608

J Bronchology Interv Pulmonol. 2021 Aug 9. doi: 10.1097/LBR.0000000000000801. Online ahead of print.

ABSTRACT

RATIONALE: The benefit from applying suction during endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is unclear.

BACKGROUND: The purpose of this study was to evaluate the impact of applying suction during EBUS-TBNA of lymph nodes (LN) on the diagnostic yield and specimen quality of EBUS-TBNA smears and cellblocks.

METHODS: We conducted a randomized blinded cross-over trial comparing the diagnostic yield and quality of EBUS-TBNA samples obtained with suction (S+) and without suction (S-) from suspected malignant mediastinal LN. Each LN was aspirated 4 times in a randomly assigned alternating order: S+/S-/S+/S- or S-/S+/S-/S+, resulting in 2 matched S+/S- smears pairs and 1 matched S+/S- cellblocks pairs. Specimen were assessed by a blinded cytopathologist. The primary outcome was the diagnostic yield of EBUS-TBNA smears and cellblocks. Secondary analyses accounted for LN size (≤2 vs. >2 cm) and station (mediastinal vs. hilar).

RESULTS: Of 234 EBUS-TBNA smears and 114 cellblocks were obtained from 59 LN. The concordance of S+ and S- cellblocks diagnostic yield was low (43.8%; 95% confidence interval: 30.7-57.6) with a significantly higher diagnostic yield among S+ compared with S- cellblocks (56.1% vs. 10.5%, respectively, P<0.001), regardless of LN station and size. However, S+ and S- smears were moderately concordant (66.7%; 95% confidence interval: 57.4-75.1) with no overall difference in their respective diagnostic yield. Numerically higher diagnostic yield among S+ smears in LN≤2 cm or hilar LN was not statistically significant. Results were similar for specimen adequacy, sensitivity and diagnosis of malignancy.

CONCLUSION: Applying suction during EBUS-TBNA of suspected malignant LN enhanced the diagnostic yield of cellblocks regardless of mediastinal LN station or size, but not of smears.

PMID:34369402 | DOI:10.1097/LBR.0000000000000801

Ear Hear. 2021 Aug 6. doi: 10.1097/AUD.0000000000001110. Online ahead of print.

ABSTRACT

OBJECTIVES: The purpose of this study was to investigate the effect of a small change in reverberation time (from 0.57 to 0.69 s) in a classroom on children’s performance and listening effort. Aiming for ecological listening conditions, the change in reverberation time was combined with the presence or absence of classroom noise. In three academic tasks, the study examined whether the effect of reverberation was modulated by the presence of noise and depended on the children’s age.

DESIGN: A total of 302 children (aged 11-13 years, grades 6-8) with normal hearing participated in the study. Three typical tasks of daily classroom activities (speech perception, sentence comprehension, and mental calculation) were administered to groups of children in two listening conditions (quiet and classroom noise). The experiment was conducted inside real classrooms, where reverberation time was controlled. The outcomes considered were task accuracy and response times (RTs), the latter taken as a behavioral proxy for listening effort. Participants were also assessed on reading comprehension and math fluency. To investigate the impact of noise and/or reverberation, these two scores were entered in the statistical model to control for individual child’s general academic abilities.

RESULTS: While the longer reverberation time did not significantly affect accuracy or RTs under the quiet condition, it had several effects when in combination with classroom noise, depending on the task measured. A significant drop in accuracy with a longer reverberation time emerged for the speech perception task, but only for the grade 6 children. The effect on accuracy of a longer reverberation time was nonsignificant for sentence comprehension (always at ceiling), and depended on the children’s age in the mental calculation task. RTs were longer for moderate than for short reverberation times in the speech perception and sentence comprehension tasks, while there was no significant effect of the different reverberation times on RTs in the mental calculation task.

CONCLUSIONS: The results indicate small, but statistically significant, effects of a small change in reverberation time on listening effort as well as accuracy for children aged 11 to 13 performing typical tasks of daily classroom activities. Thus, the results extend previous findings in adults to children as well. The findings also contribute to a better understanding of the practical implications and importance of optimal ranges of reverberation time in classrooms. A comparison with previous studies underscored the importance of early reflections as well as reverberation times in classrooms.

PMID:34369418 | DOI:10.1097/AUD.0000000000001110

Cornea. 2021 Aug 6. doi: 10.1097/ICO.0000000000002803. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of this study was to describe demographics, predisposing factors, clinical features, treatment, and outcomes of microbial keratitis cases resistant to antimicrobials.

METHODS: A retrospective case series was conducted. All patients with microbial keratitis resistant to antimicrobials who underwent a corneal scrape and culture from 2012 to December 2016 at the Sydney Eye Hospital were included. Cases were identified from pathology and hospital coding data. Coagulase-negative staphylococci (CoNS), Staphylococcus aureus (S. aureus), and Corynebacterium spp. resistant to cefalotin, chloramphenicol, ciprofloxacin, or gentamicin were analyzed.

RESULTS: One hundred fifteen episodes had a resistant CoNS, 24 S. aureus, and 12 Corynebacterium spp. Antimicrobial resistance was associated with older women (67%, median age 83 years) with Corynebacterium spp. (P < 0.001), corneal graft, and previous topical steroid use. Larger epithelial defects (P = 0.203) and infiltrates (P = 0.180) were more likely to be associated with Corynebacterium spp., but not statistically significant. At the initial and final visits, resistant S. aureus (75% vs. 67%) and Corynebacterium spp. (78% vs. 80%) cases were more likely to be classified as blind (>3/60) compared with CoNS (45% vs. 28%) (P = 0.011 vs. P = 0.004). Corneal perforation occurred more often in resistant S. aureus cases (P < 0.001), whereas slow and nonhealing epithelial defects needing other procedures were more likely to occur with resistant Corynebacterium spp. (P < 0.001).

CONCLUSIONS: Patients with resistant CoNS were younger and presented with smaller ulcers and moderate vision loss. Visual and clinical outcomes were significantly better for resistant CoNS than for those with resistant S. aureus or Corynebacterium spp.

PMID:34369390 | DOI:10.1097/ICO.0000000000002803

Cornea. 2021 Aug 6. doi: 10.1097/ICO.0000000000002814. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of this article was to study the clinical, optical, and morphological correlates of visual function in patients with Fuchs endothelial corneal dystrophy (FECD).

METHODS: The case records were analyzed for patients diagnosed with FECD between September 2019 and March 2020. The best-corrected visual acuity (BCVA) was recorded as decimal visual acuity and converted to the logarithm of the minimum angle of resolution units. Contrast sensitivity was measured with the Pelli-Robson contrast sensitivity test. Corneal alterations, including central corneal thickness, depression of the posterior cornea, and corneal densitometry values, were evaluated using Scheimpflug images. Corneal epithelial thickness was measured by spectral-domain optical coherence tomography.

RESULTS: A total of 107 eyes of 61 patients (18 male and 43 female) with FECD were retrospectively investigated. The Spearman rank correlation coefficient showed moderate correlation between BCVA and contrast sensitivity (ρ = -0.66, P < 0.001), with some patients maintaining relatively good BCVA but having reduced contrast sensitivity. Logistic regression analysis demonstrated that age, central corneal thickness, depression of the posterior cornea, and epithelial thickening were negatively associated with contrast sensitivity but not with BCVA.

CONCLUSIONS: Contrast sensitivity is a useful tool for assessing visual dysfunction and should be incorporated into the assessment protocol of patients with FECD. Alterations in the cornea, including central corneal thickness, depression of the posterior cornea, and epithelial thickening, might be objective parameters that can help the clinician in grading the severity of the disease and tracking its progression.

PMID:34369393 | DOI:10.1097/ICO.0000000000002814

Explore (NY). 2021 Aug 3:S1550-8307(21)00147-6. doi: 10.1016/j.explore.2021.07.005. Online ahead of print.

ABSTRACT

BACKGROUND: A combination of yoga practices has been documented to reduce stress and stress-induced cortisol levels. The objective of the current study is to examine the effects of six months of a single pranayama practice (Bhramari [Bhr. P]) on reducing salivary cortisol response to the cold pressor test (CPT) among adolescents.

METHODS: Twenty-six healthy adolescents between the ages of 11 and 19 were randomly assigned to either yoga group (n-13) or control group (n-13). Yoga group participants were trained to do Bhr. P for 45 min, thrice a week for six months. All participants underwent CPT at baseline and at end of six months. Saliva samples were collected at baseline (t0), at 20 min (t1), 40 min (t2), and 60 min after the CPT (t3).

RESULTS: Contradictory to our hypothesis, participants in the yoga group exhibited a higher salivary cortisol response to the CPT at t1 (p = 0.04) when compared to the control group. However, the t3 salivary cortisol levels showed a statistically significant reduction (p = 0.03) in yoga group when compared to the control group. A significant interaction with time (F (1, 88) = 316.5, p = .001, ηp²:0.91) and between the group × time (F (3, 88) = 2.83, p = 0.04, ηp²:0.8) was found after the intervention.

CONCLUSIONS: An increase in the cortisol responsiveness observed in the study is an indication of the adaptive capability achieved through regular yoga training, evidenced by an initial rise in cortisol followed by a rapid fall below baseline after 60 min. Further research is required to conclusively determine the changes in cortisol levels over time in response to stress in long-term yoga practitioners.

PMID:34366293 | DOI:10.1016/j.explore.2021.07.005

Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi. 2021 Jul 20;39(7):527-530. doi: 10.3760/cma.j.cn121094-20200228-00093.

ABSTRACT

Objective: To understand the hazard degree of respirable dust (exhaled dust) in coal mine underground workplaces in China, and to provide reference for the prevention and treatment of pneumoconiosis. Methods: A total of 98 representative coal mines were selected from 2016 to 2018, and the dust concentration of the underground working face was detected by the methods of on-the-spot investigation and on-the-spot detection, the dust control measures of 29 coal mines were investigated, and the hazard degree of dust exhaling in the underground working place was analyzed statistically. Results: All 1238 samples of individual coal dust (exhaled dust) were detected in 98 underground coal mines, and the concentration was 4.0 (2.2, 7.3) mg/m(3), the over-standard rate was 73.3% (908/1238) . The concentration of coal dust (exhaled dust) in coal mining face was 5.4 (3.0, 10.6) mg/m(3), and the concentration of coal dust (exhaled dust) in heading face was 3.7 (2.1, 7.2) mg/m(3). The concentration exceeding standard rate of coal dust (exhaled dust) in coal mining face was higher than that in heading face, and the difference was statistically significant (P<0.05) . Coal seam water injection was found in 57.7% (15/26) coal mining face and 42.9% (9/21) heading face in the application of dust control measures, and the high pressure spray of shearer roadheader only accounted for 38.5% (10/26) and 28.6% (6/21) . Conclusion: The concentration of coal dust (exhaled dust) in the underground face of coal mine is seriously exceeding the standard, and the dust prevention measures have not been put in place.Compulsory standards for classified management of dust in underground coal mines should be formulated, and the research and implementation of dust control technologies should be strengthened.

PMID:34365765 | DOI:10.3760/cma.j.cn121094-20200228-00093

Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi. 2021 Jul 20;39(7):534-537. doi: 10.3760/cma.j.cn121094-20200904-00517.

ABSTRACT

Objective: To understand the chest CT features of aluminosis caused by alumina and to improve the understanding of the imaging findings of alumina pneumoconiosis. Methods: The chest CT findings of 17 cases of alumina-induced pneumoconiosis and 30 cases of silicosis (the control group) diagnosed in Zibo Occupational Disease Prevention Hospital from April 2015 to July 2020 were analyzed retrospectively. The characteristics of fibrosis of the two kinds of pneumoconiosis and the incidence of size, density, distribution, tractive bronchiectasis, pleural thickening and interlobular septal thickening of pneumoconiosis nodules were compared. Results: Alumina pneumoconiosis showed nodules with thickened interlobular septal of 66.67% (12/18) , honeycomb lung of 22.22% (4/18) , ground glass shadow of 61.11% (11/18) , simple nodules of 11.11% (2/18) , and no fusion mass. In the control group, the long-line fibrosis of nodules with thickened interlobular septal were 16.67% (5/30) , 6.67% (2/30) with honeycomb lung and ground glass density shadow, 23.33% (7/30) with fusion mass and 53.33% (16/30) with simple nodule. There were significant differences in CT findings of nodules with thickened interlobular septal, ground glass density shadow, fused mass and simple nodules between the two groups (P<0.05) . The interstitial beaded nodules were seen in 18 cases of alumina pneumoconiosis, 50.00% (9/18) of them were beaded nodules, 61.33% (46/75) of low density nodules and 38.89% (7/18) of central lobular nodules were seen in alumina pneumoconiosis. The average width of nodules was (1.29±0.38) mm. Central lobular nodules were seen in all 30 cases of silicosis, 10.00% (3/30) were mainly beaded nodules, low density nodules were 36.29% (90/248) , and the average width diameter of nodules was (1.85±0.58) mm. There were significant differences between the two groups (P<0.05) . Alumina pneumoconiosis was often accompanied by traction bronchiectasis, pleural thickening and interlobular septal thickening (11, 18, 17 cases, 61.11%, 100.00%, 94.44%) , compared with the control group (9, 18, 18 cases, 30.00%, 60.00%, 60.00%) . The differences were statistically significant (P<0.05) . The maximum CT value of noncalcified mediastinal lymphnodes in alumina pneumoconiosis was (103.43±26.33) HU, which was higher than that of the control group[ (75.22±16.70) HU], and the difference was statistically significant (P<0.05) . Conclusion: Alumina pneumoconiosis chest CT shows slightly low-density beaded nodules, thickened interlobular septal, and pulmonary interstitial fibrosis of ground-glass shadows, mostly combines with stretched bronchiectasis, thickened pleura, and mediastinum increased lymph node density.

PMID:34365767 | DOI:10.3760/cma.j.cn121094-20200904-00517

Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi. 2021 Jul 20;39(7):498-502. doi: 10.3760/cma.j.cn121094-20200513-00258.

ABSTRACT

Objective: To explore the noise exposure level and the health status of workers in transportation equipment manufacturing industry, and provide a scientific basis for guidance and implementation of intervention measures. Methods: From January to December in 2019, a total of 2088 noise workers from a large enterprise were selected by cluster sampling method in railway transportation equipment manufacturing, automobile manufacturing and aerospace aircraft manufacturing enterprises. The worker’s noise exposure level was detected. Occupational health checkups were performed on the noise workers including electrical audiometry, blood pressure and electrocardiogram. χ(2) test and trend χ(2) test were used to analyze the data. Results: The noise exposure level of 66.9% (1396/2088) workers exceeded 85 dB (A) , and the median noise level was 87.9 (84.3-90.3) dB (A) . Among them, workers of railway transportation equipment manufacturing enterprises had the highest noise exposure level[89.9 (87.8-91.6) dB (A) ]. The detection rate of high-frequency hearing loss, abnormal blood pressure and abnormal electrocardiogram of noise workers were 15.7% (327/2088) , 18.1% (378/2088) and 6.1% (128/2088) , respectively. The differences in the detection rates of high-frequency hearing loss, abnormal blood pressure, and abnormal electrocardiogram in workers of railway transportation equipment manufacturing enterprises, automobile manufacturing enterprises, and aerospace manufacturing enterprises were statistically significant (P<0.05) . Workers of railway transportation equipment manufacturing enterprises had higher detection rates of high-frequency hearing loss (17.6%, 186/1056) . Workers of aerospace manufacturing enterprises had higher detection rates of abnormal blood pressure and abnormal electrocardiogram (26.3%, 169/642; 10.0%, 64/642) . The differences in the detection rates of high-frequency hearing loss, abnormal blood pressure and abnormal electrocardiogram of noise workers were statistically significant in different age and working age groups, and gradually increased with age and working age (P<0.05) . The difference in the detection rate of high-frequency hearing loss of noise workers was statistically significant in different noise intensity groups, and the overall trend was increasing (P<0.05) . Conclusion: The transportation equipment manufacturing industry has serious noise hazards, especially the railway transportation equipment manufacturing industry. Long-term occupational noise exposure can adversely affect workers’ hearing and cardiovascular system. Enterprises should strengthen occupational health inspections, and at the same time, take personal protective measures to protect the health of workers.

PMID:34365758 | DOI:10.3760/cma.j.cn121094-20200513-00258