Category: Nevin Manimala

Nurs Educ Perspect. 2021 Jun 22. doi: 10.1097/01.NEP.0000000000000840. Online ahead of print.

ABSTRACT

AIM: The purpose of the study was to examine the influence of academic nurse educator doctoral degree preparation on National League for Nursing (NLN) core competency skill acquisition.

BACKGROUND: Doctor of nursing practice (DNP) and doctor of philosophy (PhD) graduates frequently seek faculty positions, yet neither degree exclusively prepares graduates for careers in academia.

METHOD: A descriptive, correlational design was utilized to examine the influence of doctoral degree preparation on NLN core competency skill acquisition. A randomized, nationwide sample (N = 160) of full-time nurse educators teaching in American Association of Colleges of Nursing member schools across the United States completed the Nurse Educator Skill Acquisition Assessment.

RESULTS: PhD-prepared educators reported higher NLN core competency skill acquisition scores than DNP-prepared nurse educators. There were statistically significant differences in overall skill acquisition scores between DNP- and PhD-prepared nurse educators and for the “use assessment and evaluation” and “engage in scholarship” domains.

CONCLUSION: These findings provide opportunities for NLN core competency skill acquisition among DNP- and PhD-prepared faculty.

PMID:34155173 | DOI:10.1097/01.NEP.0000000000000840

J Pediatr Orthop. 2021 Jun 22. doi: 10.1097/BPO.0000000000001835. Online ahead of print.

ABSTRACT

BACKGROUND: We modified the original technique for percutaneous transphyseal screw which was described in 1998 by Metaizeau and colleagues for distal femoral coronal angular deformity correction; the modification is related to the screw direction, whereas the screw is administered in a retrograde pattern, starting from the epiphysis and directed toward the metaphysis. This technique opposes the original technique that was started with a metaphyseal entry point which aimed toward the epiphysis. This study evaluates the efficacy of the newly suggested surgical technique regarding the rate of correction and growth resumption after screw removal.

METHODS: This prospective study looked at 40 patients (65 distal femoral physes), who underwent a percutaneous retrograde transphyseal guided growth screw procedure, from October 2017 to September 2019. All the patients included had distal femoral coronal angular deformities; 52 in valgus and 13 in varus deformities. The study included 17 females with an average age of 11.75 (range: 8.4 to 14.5 y) for 29 femurs and 23 males with an average age of 13.75 (range: 11.75 to 15.6 y) for 36 femurs. The mechanical lateral distal femoral angle was measured initially, and then again was measured after reaching the desired corrected orientation. The patients were then followed up after the screw removal and followed up to maturity, if the physis had continued to grow postcorrection. The degree of correction per month was calculated, and the consequence of screw removal was detected. Follow-up average time was 12.6 months (range: 30 to 6 mo).

RESULTS: The average correction in the distal femur was 1.3 degrees per month (range: 0.5 to 1.857 degrees/mo). In all of the 65 segments (61 femurs had significant growth remaining and 4 femurs had reached skeletal maturity with suboptimal mechanical lateral distal femoral angle correction), the screws were removed at the time of angular correction. Rebound growth was observed in 15 physes with an average of 1.8 degrees (range: 2 to 3 degrees); they were stable in 42 physes and progressed in 4 physes with an average of 1.6 degrees (range: 1 to 2 degrees). Complications were minor and related to entrapment of soft tissue under the screw washer.

CONCLUSION: Percutaneous retrograde transphyseal guided growth screw for distal femur coronal angular deformity is a minimally invasive procedure, with a statistically significant correction rate when compared with the original transphyseal screw technique. The new technique has proven to have growth resumption after screw removal with minimal complication risk.

LEVEL OF EVIDENCE: Level III-prospective observational study.

PMID:34155176 | DOI:10.1097/BPO.0000000000001835

J Clin Pathol. 2021 Jun 21:jclinpath-2021-207595. doi: 10.1136/jclinpath-2021-207595. Online ahead of print.

ABSTRACT

AIMS: Novel prognostic markers are warranted for gastrointestinal stromal tumours. Caveolin-1 is a multifunctional protein that proved to be associated with outcome in multiple tumour types. Aim of this study was to investigate Caveolin-1 expression and prognostic efficacy in a series of gastrointestinal stromal tumours.

METHODS: Caveolin-1 expression was assessed by immunohistochemistry in a retrospective series of 66 gastrointestinal stromal tumours representative of the different molecular subtypes. Correlations with clinical, histopathological and molecular features were investigated. Statistical analyses were performed as appropriate.

RESULTS: Thirty-five cases out of 66 (53.0%) expressed Caveolin-1. Presence of Caveolin-1 expression correlated with favourable histopathologic and clinical traits, including a lower mitotic count (p=0.003) and lower relapse rate (p=0.005). Caveolin-1 expression also resulted associated with the presence of PDGFRA mutations (p=0.010). Outcome analyses showed a favourable prognostic significance of Caveolin-1 expression in terms of relapse-free survival (HR=0.14; 95% CI=0.03 to 0.63) and overall survival (HR=0.29; 95% CI=0.11 to 0.74), even after adjusting for the mutational subgroup (relapse-free survival: HR=0.14, 95% CI=0.04 to 0.44; overall survival: HR=0.29, 95% CI=0.11 to 0.51) and imatinib treatment (relapse-free survival: HR=0.14, 95% CI=0.02 to 0.81; overall survival: HR=0.29, 95% CI=0.17 to 0.48).

CONCLUSION: Caveolin-1 represents a novel prognostic marker in gastrointestinal stromal tumours. Further studies are warranted to validate these results and to explore the mechanisms linking Caveolin-1 expression with the PDGFRA oncogenic pathway.

PMID:34155091 | DOI:10.1136/jclinpath-2021-207595

Thorax. 2021 Jun 21:thoraxjnl-2020-215600. doi: 10.1136/thoraxjnl-2020-215600. Online ahead of print.

ABSTRACT

INTRODUCTION: Observational studies suggested lung function is inversely associated with cardiovascular disease (CVD) although these studies could be confounded. We conducted a two sample Mendelian randomisation study using summary statistics from genome-wide association studies (GWAS) to clarify the role of lung function in CVD and its risk factors, and conversely the role of CVD in lung function.

METHODS: We obtained genetic instruments for forced expiratory volume in 1 s (FEV₁: 260) and forced vital capacity (FVC: 320) from publicly available UK Biobank summary statistics (n=421 986) and applied to GWAS summary statistics for coronary artery disease (CAD) (n=184 305), stroke (n=446 696), atrial fibrillation (n=1 030 836) and heart failure (n=977 320) and cardiovascular risk factors. Inverse variance weighting was used to assess the impact of lung function on these outcomes, with various sensitivity analyses. Bidirectional Mendelian randomisation was used to assess reverse causation.

RESULTS: FEV₁ and FVC were inversely associated with CAD (OR per SD increase, 0.72 (95% CI 0.63 to 0.82) and 0.70 (95%CI 0.62 to 0.78)), overall stroke (0.87 (95%CI 0.77 to 0.97), 0.90 (95% CI 0.82 to 1.00)) and some stroke subtypes. FEV₁ and FVC were inversely associated with type 2 diabetes and systolic blood pressure. Sensitivity analyses produced similar findings although the association with CAD was attenuated after adjusting for height (eg, OR for 1SD FEV₁0.95 (0.75 to 1.19), but not for stroke or type 2 diabetes. There was no strong evidence for reverse causation.

CONCLUSION: Higher lung function likely protect against CAD and stroke.

PMID:34155093 | DOI:10.1136/thoraxjnl-2020-215600

Proc Natl Acad Sci U S A. 2021 Jun 29;118(26):e2026808118. doi: 10.1073/pnas.2026808118.

ABSTRACT

Most stars in the Universe are red dwarfs. They outnumber stars like our Sun by a factor of 5 and outlive them by another factor of 20 (population-weighted mean). When combined with recent observations uncovering an abundance of temperate, rocky planets around these diminutive stars, we are faced with an apparent logical contradiction-Why do we not see a red dwarf in our sky? To address this “red sky paradox,” we formulate a Bayesian probability function concerning the odds of finding oneself around an F/G/K-spectral type (Sun-like) star. If the development of intelligent life from prebiotic chemistry is a universally rapid and ensured process, the temporal advantage of red dwarfs dissolves, softening the red sky paradox, but exacerbating the classic Fermi paradox. Otherwise, we find that humanity appears to be a 1-in-100 outlier. While this could be random chance (resolution I), we outline three other nonmutually exclusive resolutions (II to IV) that broadly act as filters to attenuate the suitability of red dwarfs for complex life. Future observations may be able to provide support for some of these. Notably, if surveys reveal a paucity of temperate rocky planets around the smallest (and most numerous) red dwarfs, then this would support resolution II. As another example, if future characterization efforts were to find that red dwarf worlds have limited windows for complex life due to stellar evolution, this would support resolution III. Solving this paradox would reveal guidance for the targeting of future remote life sensing experiments and the limits of life in the cosmos.

PMID:34155109 | DOI:10.1073/pnas.2026808118

BMJ Open. 2021 Jun 21;11(6):e046545. doi: 10.1136/bmjopen-2020-046545.

ABSTRACT

OBJECTIVE: To examine the social determinants of influenza and pertussis vaccine uptake among pregnant women in England.

DESIGN: Nationwide population-based cohort study.

SETTING: The study used anonymised primary care data from the Clinical Practice Research Datalink and linked Hospital Episode Statistics secondary care data.

PARTICIPANTS: Pregnant women eligible for pertussis (2012-2015, n=68 090) or influenza (2010/2011-2015/2016, n=152 132) vaccination in England.

MAIN OUTCOME MEASURES: Influenza and pertussis vaccine uptake.

RESULTS: Vaccine uptake was 67.3% for pertussis and 39.1% for influenza. Uptake of both vaccines varied by region, with the lowest uptakes in London and the North East. Lower vaccine uptake was associated with greater deprivation: almost 10% lower in the most deprived quintiles compared with the least deprived for influenza (34.5% vs 44.0%), and almost 20% lower for pertussis (57.7% vs 76.0%). Lower uptake for both vaccines was also associated with non-white ethnicity (lowest among women of black ethnicity), maternal age under 20 years and a greater number of children in the household. The associations between all social factors and vaccine uptake were broadly unchanged in fully adjusted models, suggesting the social determinants of uptake were largely independent of one another. Among 3111 women vaccinated against pertussis in their first eligible pregnancy and pregnant again, 1234 (40%) were not vaccinated in their second eligible pregnancy.

CONCLUSIONS: Targeting promotional campaigns to pregnant women who are younger, of non-white ethnicity, with more children, living in areas of greater deprivation or the London or North East regions, has potential to reduce vaccine-preventable disease among infants and pregnant women, and to reduce health inequalities. Vaccination promotion needs to be sustained across successive pregnancies. Further research is needed into whether the effectiveness of vaccine promotion strategies may vary according to social factors.

PMID:34155074 | DOI:10.1136/bmjopen-2020-046545

BMJ Open. 2021 Jun 21;11(6):e047416. doi: 10.1136/bmjopen-2020-047416.

ABSTRACT

INTRODUCTION: The heterogeneity in people with borderline personality disorder (BPD) and the range of specialised psychotherapies means that people with certain BPD characteristics might benefit more or less from different types of psychotherapy. Identifying moderating characteristics of individuals is a key to refine and tailor standard treatments so they match the specificities of the individual participant. The objective of this is to improve the quality of care and the individual outcomes. We will do so by performing three systematic reviews with meta-analyses of individual participant data (IPD). The aim of these reviews is to investigate potential predictors and moderating patient characteristics on treatment outcomes for patients with BPD.

METHODS AND ANALYSIS: We performed comprehensive searches in 22 databases and trial registries up to October 6th 2020. These will be updated with a top-up search up until June 2021. Our primary meta-analytic method will be the one-stage random-effects approach. To identify predictors, we will use the one-stage model that accounts for interaction between covariates and treatment allocation. Heterogeneity in case-mix will be assessed with a membership model based on a multinomial logistic regression where study membership is the outcome. A random-effects meta-analysis is chosen to account for expected levels of heterogeneity.

ETHICS AND DISSEMINATION: The statistical analyses will be conducted on anonymised data that have already been approved by the respective ethical committees that originally assessed the included trials. The three IPD reviews will be published in high-impact factor journals and their results will be presented at international conferences and national seminars.

PROSPERO REGISTRATION NUMBER: CRD42021210688.

PMID:34155077 | DOI:10.1136/bmjopen-2020-047416

Cancer Epidemiol Biomarkers Prev. 2021 Jun 21:cebp.0016.2021. doi: 10.1158/1055-9965.EPI-21-0016. Online ahead of print.

ABSTRACT

BACKGROUND: Tobacco or human papillomavirus (HPV)-related oropharyngeal squamous cell carcinomas (OPSCC) represent different clinical and epidemiological entities. This study investigated the prevalence of HPV-positive and HPV-negative OPSCC in a reference cancer hospital in Brazil and its association with clinical and demographic data, as well as its impact on overall survival.

METHODS: HPV infection was determined by p16-immunohistochemistry (p16-IHC) in pre-treatment FFPE samples from all OPSCC patients diagnosed at Barretos Cancer Hospital between 2008 and 2018. The prevalence of HPV-positive cases and its temporal trend was assessed, and the association of clinical and demographic data with HPV infection and the impact on patient overall survival was evaluated.

RESULTS: A total of 797 OPSCC patients were included in the study. The prevalence of HPV-associated tumors in the period was 20.6% (95% CI: 49.3-54.4) with a significant trend for increase of HPV-positive cases over the years (APC = 12.87). In a multivariate analysis, the variables gender, level of education, smoking, tumor sub-location, region of Brazil and tumor staging had a significant impact in HPV positivity and a greater overall survival (OS) was observed in HPV-positive patients (5-year OS: 47.9% versus 22.0%; p-value = 0.0001).

CONCLUSIONS: This study represents the largest cohort of Brazilian OPSCC patients characterized according to HPV status. We report significant differences in demographics and clinical presentation according to HPV status, and an increasing trend in prevalence for HPV-induced tumors.

IMPACT: These findings can potentially contribute to a better stratification and management of patients as well as assist in prevention strategies.

PMID:34155066 | DOI:10.1158/1055-9965.EPI-21-0016

BMJ Open. 2021 Jun 21;11(6):e042302. doi: 10.1136/bmjopen-2020-042302.

ABSTRACT

INTRODUCTION: Daily multidisciplinary rounds (DMRs) consist of systematic patient-centred discussions aiming to establish joint therapeutic goals for the next 24 hours of intensive care unit (ICU) care. The aim of the present study protocol is to evaluate whether an intervention consisting of guided DMRs, supported by a remote specialist and audit/feedback on care performance will reduce ICU length of stay compared with a control group.

METHODS AND ANALYSIS: A multicentre, controlled, cluster-randomised superiority trial including 30 ICUs in Brazil (15 intervention and 15 control), from August 2019 to June 2021. In a parallel assignment, ICUs are randomised to a complex-intervention composed by daily rounds carried out through Tele-ICU by a remote ICU physician; development of local quality indicators dashboards coupled with monthly meetings with local leadership; and dissemination of evidence-based clinical protocols versus usual care. Primary outcome is ICU length of stay. Secondary outcomes include classification of the unit according to the profiles defined by the standardised resource use and the standardised mortality rate, hospital mortality, incidence of healthcare-associated infections, ventilator-free days at 28 days, patient-days receiving oral or enteral feeding, patient-days under light sedation or alert and calm, rate of patients under normoxaemia. All adult patients admitted after the beginning of the study in each participant ICU will be enrolled. Inclusion criteria (clusters): public Brazilian ICUs with a minimum of 8 ICU beds interested/committed to participating in the study. Exclusion criteria (clusters): units with fully established DMRs by an intensivist, specialised or step-down units.

ETHICS AND DISSEMINATION: The study protocol was approved by the institutional review board (IRB) of the coordinator centre, and by IRBs of each enrolled hospital/ICU. Statistical analysis protocol is being prepared for submission before the end of patient’s enrolment. Results will be disseminated through conferences, peer-reviewed journals and to each participating unit.

TRIAL REGISTRATION NUMBER: NCT03920501; Pre-results.

PMID:34155070 | DOI:10.1136/bmjopen-2020-042302

BMJ Open. 2021 Jun 21;11(6):e045741. doi: 10.1136/bmjopen-2020-045741.

ABSTRACT

INTRODUCTION: We will evaluate the feasibility of a randomised controlled trial to estimate the effectiveness and cost-effectiveness of a rehabilitation intervention on pain, function and health-related quality of life following neck dissection (ND) after head and neck cancer (HNC).

METHODS AND ANALYSIS: This is a pragmatic, multicentred, feasibility study. Participants are randomised to usual care (control) or usual care plus an individualised, rehabilitation programme (Getting Recovery Right After Neck Dissection, GRRAND intervention). Adults aged over 18 with HNC for whom ND is part of their care will be recruited from specialist clinics. Participants are randomised in 1:1 ratio using a web-based service. The target sample size is 60 participants. Usual care will be received by all participants during their postoperative inpatient stay consisting standard National Health Service care supplemented with a booklet advising on postoperative self-management strategies. The GRRAND intervention programme consists of usual care plus up to six individual physiotherapy sessions including neck and shoulder range of motion (ROM) and progressive resistance exercises, advice and education. Between sessions participants will be advised to complete a home exercise programme. The primary outcome is to determine recruitment and retention rates from study participants across sites. Outcomes will be measured at 6 and 12 months. Participants and physiotherapists will be invited to an optional qualitative interview at the completion of their involvement in the study. The target qualitative sample size is 15 participants and 12 physiotherapists. Interviews aim to further investigate the feasibility and acceptability of the intervention and to determine wider experiences of the study design and intervention from patient and physiotherapist perspectives.

ETHICS AND DISSEMINATION: Ethical approval was given on 29 October 2019 (National Research Ethics Committee Number: 19/SC/0457). Results will be reported at conferences and in peer-reviewed publications.

TRIAL REGISTRATION NUMBER: ISRCTN11979997.

STATUS: Trial recruitment is ongoing and is expected to be completed by 30 August 2021.

PMID:34155073 | DOI:10.1136/bmjopen-2020-045741