Category: Nevin Manimala

Qual Manag Health Care. 2021 Oct 4. doi: 10.1097/QMH.0000000000000338. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Length of stay is a common measure of efficiency of care. We aimed to reduce length of stay on a general medicine service through a structured quality improvement project.

METHODS: A reliable design strategy was implemented in successive stages at a 238-bed academically-affiliated VA hospital. Over a 2-year period, continuous improvement efforts were directed at discrete cohorts of patients deemed medically appropriate for discharge but who remained hospitalized because of discharge barriers. We compared the mean length of stay and medically-ready bed days of care for a hospital in statistical control charts. Pre- and post-intervention comparisons were made using t-tests.

RESULTS: In total, 5321 discharges were included in this improvement project, accounting for 35 852 bed days of care. Overall, average length of stay was reduced by 15.7%, from 7.62 to 6.40 days (P < .05). There was a significant reduction in the mean number of medically-ready bed days of care from 2.3 to 1.72. Statistical process control charts demonstrated special cause variation across patient cohorts.

CONCLUSION: A quality improvement project using reliable design principles was associated with shorter length of stay.

PMID:34611121 | DOI:10.1097/QMH.0000000000000338

Nat Commun. 2021 Oct 5;12(1):5840. doi: 10.1038/s41467-021-26027-y.

ABSTRACT

To gain insight into changes of scholarly journals’ recommendations, we conducted a systematic review of studies that analysed journals’ Instructions to Authors (ItAs). We summarised results of 153 studies, and meta-analysed how often ItAs addressed: 1) authorship, 2) conflicts of interest, 3) data sharing, 4) ethics approval, 5) funding disclosure, and 6) International Committee of Medical Journal Editors’ Uniform Requirements for Manuscripts. For each topic we found large between-study heterogeneity. Here, we show six factors that explained most of that heterogeneity: 1) time (addressing of topics generally increased over time), 2) country (large differences found between countries), 3) database indexation (large differences found between databases), 4) impact factor (topics were more often addressed in highest than in lowest impact factor journals), 5) discipline (topics were more often addressed in Health Sciences than in other disciplines), and 6) sub-discipline (topics were more often addressed in general than in sub-disciplinary journals).

PMID:34611157 | DOI:10.1038/s41467-021-26027-y

J Nurs Care Qual. 2021 Oct 4. doi: 10.1097/NCQ.0000000000000602. Online ahead of print.

ABSTRACT

BACKGROUND: COVID-19 negatively impacts many organ systems including the skin. One of the most significant skin-associated adverse events related to hospitalization are pressure injuries.

PURPOSE: The aim of this study was to determine 8 risk factors that would place hospitalized patients at a higher risk for hospital-acquired pressure injuries (HAPIs) during the COVID-19 pandemic.

METHODS: A retrospective, descriptive analysis was conducted in an urban academic health science center located in the southeastern United States.

RESULTS: There were 247 of 23 093 patients who had pressure injuries and 1053 patients who had a positive COVID-19 diagnosis. Based on the generalized estimating equation model, diagnosis of COVID-19, age, male gender, risk of mortality, severity of illness, and length of stay are statistically significant factors associated with the development of HAPIs.

CONCLUSIONS: Further study should explore pathology of COVID-19 skin changes and what interventions are effective against HAPIs in the COVID-19 population taking into consideration current treatments.

PMID:34611108 | DOI:10.1097/NCQ.0000000000000602

J Craniofac Surg. 2021 Oct 5. doi: 10.1097/SCS.0000000000008267. Online ahead of print.

ABSTRACT

This study aimed to conduct a biomechanical investigation of the effects of systemic irisin hormone application on the osseointegration of titanium implants in rat tibias. After surgical implementation of titanium implants in the metaphyseal part of the tibiae of rats, the rats were randomly divided into 2 equal groups: control group (n = 10) and irisin group (n = 10). After surgery in the control group, the rats received no further treatment during the 4-week experimental period. The rats in the irisin group were given 100 ng/kg irisin every day for the 4-week experimental period after surgery. At the end of the experimental period, the rats were euthanized. Implants and surrounding bone tissues were collected for biomechanical (Newton) bone implant connection analysis. The Student t test was used for statistical analysis. There were no significant differences in the biomechanical osseointeration values (Newton) of the groups (P > 0.05, P = 0.59). Also, in the irisin group, there was numerically but not statistically more bone implant connection than in the controls. Within the limitations of this study, irisin did not affect the osseointegration of titanium implants.

PMID:34611101 | DOI:10.1097/SCS.0000000000008267

J Craniofac Surg. 2021 Oct 5. doi: 10.1097/SCS.0000000000008261. Online ahead of print.

ABSTRACT

PURPOSE: Inferior alveolar neurosensory disturbance (IAND) is the most common complication of bilateral sagittal split osteotomy (BSSO). The aim of the present study was to evaluate IAND with subjective tests postoperatively and assess the relationship between three-dimensional measurements of the mandibular canal (MC) and IAND.

METHODS: Eighteen patients (Mean age: 24.05 ± 5.85 years) treated with BSSO were retrieved from the archive. Subjective tests (light touch, tactile sensitivity, 2-point discrimination, brush-stroke directional discrimination, sharp/blunt discrimination, dental vitality, questionnaire) and three-dimensional measurements related to MC and fixation screws were done postoperatively (on average 20.43 ± 8.76 months after surgery). Statistical significance was set at P < 0.05.

RESULTS: Subjective test results were found compatible with each other except brush-stroke directional discrimination test. According to the questionnaire, IAND was apparent in all patients immediately after surgery, and recovery after 1 to 2 years was statistically significant (P < 0.05). Preoperative ramus width, medial and lateral cancellous bone lengths, the decrease in MC length, and the presence of screw in MC were not related to IAND (P < 0.05).

CONCLUSIONS: There is a high incidence of IAND following BSSO, and the subjective tests are efficient to evaluate the disturbance. Spontaneous recovery of the nerve occurs during the follow-up periods. Instead of preoperative measurements of bone thickness, MC length, and the position of fixation screws, the surgical procedure seems to be more important in IAND occurrence.

PMID:34611107 | DOI:10.1097/SCS.0000000000008261

Ann Plast Surg. 2021 Oct 4. doi: 10.1097/SAP.0000000000003027. Online ahead of print.

ABSTRACT

A number of studies have already examined gluteal reconstruction with free flaps. Thus, the aim of this study was to investigate the reliability of free flap reconstruction for oncologic gluteal defects. This retrospective cohort study included 23 patients who underwent immediate soft tissue reconstruction for an oncologic gluteal defect. Fifteen patients underwent reconstruction with a free flap and 8 with a regional flap. The postoperative results were compared between the free and regional flaps. In the free flap group, the latissimus dorsi musculocutaneous flap was used in 12 patients, the thoracodorsal artery perforator flap in 2 patients, and the anterolateral thigh flap in 1 patient. Recipient vessels were the inferior gluteal vessels or their branches in 8 patients and the superior gluteal vessels or their branches in 7 patients. All flaps have fully survived in both groups without vascular compromise. Dehiscence of the gluteal wound tended to be more common in the regional flap group; however, the difference between the groups was not statistically significant. The use of free flap reconstruction for large oncologic defects in the gluteal region is a feasible and reliable option. Tension-free wound closure and simplified suture lines can provide reliable wound coverage irrespective of the postoperative patient’s position or movement. Because of the risk of postoperative compression on the vascular pedicle, selecting the appropriate recipient vessel and type of microvascular anastomosis is key for the success of free flap transfer in this region.

PMID:34611088 | DOI:10.1097/SAP.0000000000003027

Ann Plast Surg. 2021 Oct 4. doi: 10.1097/SAP.0000000000003021. Online ahead of print.

ABSTRACT

BACKGROUND: The deep inferior epigastric perforator flap (DIEP) is a widely known reliable option for autologous breast reconstruction. One common complication of DIEP procedures is fat necrosis. Consequences of fat necrosis include wound healing complications, pain, infection, and the psychological distress of possible cancerous recurrence. Clinical judgment alone is an imperfect method to detect at-risk segments of adipose tissue. Objective methods to assess perfusion may improve fat necrosis complication rates, reducing additional surgeries to exclude cancer and improve cosmesis for patients.

METHODS: The authors performed a retrospective review of patients who underwent analysis of DIEP flap vascularity with or without intraoperative indocyanine green angiography (ICGA). Flap perfusion was assessed using intravenous ICGA and was quantified with both relative and absolute value units of fluorescence. Tissue with observed values less than 25% to 30% relative value units was resected. Postoperative outcomes and fat necrosis incidence were collected.

RESULTS: Three hundred fifty-five DIEP flaps were included in the study, 187 (52.7%) of which were assessed intraoperatively with ICGA. Thirty-nine patients (10.9%) experienced operable fat necrosis. No statistically significant difference in incidence of postoperative fat necrosis was found between the 2 groups (P = 0.732). However, a statistically significant relationship was found between fat necrosis incidence and body mass index as both a continuum (P = 0.001) and when categorized as greater than 35 (P = 0.038).

CONCLUSIONS: Although ICGA is useful for a variety of plastic surgery procedures, our retrospective review did not show a reduction in operable fat necrosis when using this technology.

PMID:34611093 | DOI:10.1097/SAP.0000000000003021

Acta Med Indones. 2021 Jul;53(3):291-298.

ABSTRACT

BACKGROUND: Cardiac iron toxicity is a major cause of mortality in transfusion-dependent beta-thalassemia major patients. The main modality for detecting cardiac iron toxicity is MRI T2* with limited availability. This study aims to obtain iron toxicity profiles in transfusion-dependent beta-thalassemia patients; to see a correlation between iron toxicity and cardiac function.

METHODS: We conducted a cross-sectional study at the Adult Thalassemia Polyclinic of Cipto Mangunkusumo Hospital, Indonesia from December 2017 to March 2018. We performed the statistical analysis using Pearson/Spearman Test comparing MRI T2* values with ejection fraction and E/A ratio.

RESULTS: The median of 4-months mean of ferritin levels was 5130 ng/mL. The mean for cardiac T2* was 24.96 ms. Severe cardiac hemosiderosis (mean cardiac MRI T2* < 10 ms) occurred in 11.3% of the subjects. There was weak correlation between serum ferritin with cardiac iron toxicity (r=-0.272, p=0.032) and ejection fraction (r=-0.281, p=0.013). But, there was no correlation between cardiac iron toxicity with ejection fraction and E/A ratio.

CONCLUSION: Serum ferritin correlated weakly with cardiac iron toxicity and cardiac systolic function. Meanwhile, there was no correlation between cardiac iron toxicity with cardiac systolic and diastolic function.

PMID:34611068

Acta Med Indones. 2021 Jul;53(3):268-275.

ABSTRACT

BACKGROUND: Autologous platelet-rich fibrin (A-PRF) is an adjunctive method for diabetic foot ulcer (DFU) in addition to glycaemic control and debridement. This study aimed to evaluate the role of A-PRF + hyaluronic acid (HA), A-PRF and sodium chloride 0.9% (control) in DFU wound healing. Nowaday, the use of PRF autologous consider as adjuvant therapy in DFU treatment.

METHODS: This open-label randomized controlled trial was conducted at Koja District Hospital and Gatot Soebroto Hospital from July 2019 to April 2020. DFU patients with wound duration of three months, Wagner-2, and ulcer size < 40 cm2 were recruited and randomly assigned into A-PRF + AH, A-PRF and control group. On day-0, day-3 and day -7, samples and photographs were taken. Samples were analysed with ELISA and photographs were analysed with ImageJ to calculate granulation index (GI). Statistical analysis was performed using SPSS version 20.

RESULTS: Topical therapy with A-PRF + AH was associated with a significant increase in VEGF from day 0 (232.8 pg/mg) vs day 7 (544.5 pg/mg) compared to A-PRF on day 0 (185.7 pg/mg) vs day 7 (272.8 pg/mg), and the controls on day 0 (183.7 pg/mg) vs day 7 (167.4 pg/mg). On evaluation of VEGF swab, there is increasing significantly in A-PRF+HA group compare others group in day -3 ( p=0.022) and day -7 (p= 0.001).In the A-PRF + AH group, there was a significant decrease in IL-6 from day 0 (106.4 pg/mg) vs day 7 (88.7 pg/mg) compared with PRF on day 0 (91.9 pg/mg) vs day 7 (48,8 pg/mg). IL-6 was increased in the control group from day 0 (125.3 pg/mg) vs day 7 (167.9 pg/mg). On evaluation of IL-6 swab, there is decreasing significantly in A-PRF+HA group compare others group in day -7 (p= 0.041).

CONCLUSION: The PRF + HA combination increased angiogenesis and reduced inflammation in DFUs and may represent a new DFU therapy.

PMID:34611065

Acta Med Indones. 2021 Jul;53(3):276-281.

ABSTRACT

BACKGROUND: The MacNew heart disease health related quality of life tool is used widely in the cardiac populations to evaluate the impact of disease and intervention including rehabilitation. In addition to the English version, it is also available for several other languages except the Indonesian language. Therefore, the purpose of this study were 1) to translate the MacNew questionnaire from the English version to the Indonesian language and 2) to estimate the preliminary validity and reliability of the Indonesian MacNew for patients with coronary artery disease.

METHODS: Forward and backward translation procedure was used to develop the Indonesian MacNew. The Indonesian MacNew was administered to 24 patients after one week of revascularization surgery. Reliability was assessed by internal consistency and test-retest reliability. To evaluate concurrent validity, the correlation of the compatible domain of the Indonesian MacNew and SF-36 was assessed.

RESULTS: Internal consistency reliability of the Indonesian MacNew was confirmed with Cronbach’s α of the global scale and all three subscales exceeding 0.95. Test- retest reliability was acceptable with intraclass correlation coefficient of 0.66 for the global score. Furthermore, an acceptable concurrent validity was established with statistically significant correlation between Indonesian MacNew and SF-36 (pearson correlation ranging from 0.47 to 0.71).

CONCLUSION: The first results of the Indonesian MacNew indicate acceptable validity and reliability as a measurement tool to assess health related quality of life of Indonesian patients with coronary artery disease.

PMID:34611066