Category: Nevin Manimala

BMJ Open. 2021 Dec 10;11(12):e053983. doi: 10.1136/bmjopen-2021-053983.

ABSTRACT

OBJECTIVE: To assess the effect of the first wave of the SARS-CoV-2 pandemic on the outcome of neurosurgical patients in Spain.

SETTINGS: The initial flood of COVID-19 patients overwhelmed an unprepared healthcare system. Different measures were taken to deal with this overburden. The effect of these measures on neurosurgical patients, as well as the effect of COVID-19 itself, has not been thoroughly studied.

PARTICIPANTS: This was a multicentre, nationwide, observational retrospective study of patients who underwent any neurosurgical operation from March to July 2020.

INTERVENTIONS: An exploratory factorial analysis was performed to select the most relevant variables of the sample.

PRIMARY AND SECONDARY OUTCOME MEASURES: Univariate and multivariate analyses were performed to identify independent predictors of mortality and postoperative SARS-CoV-2 infection.

RESULTS: Sixteen hospitals registered 1677 operated patients. The overall mortality was 6.4%, and 2.9% (44 patients) suffered a perioperative SARS-CoV-2 infection. Of those infections, 24 were diagnosed postoperatively. Age (OR 1.05), perioperative SARS-CoV-2 infection (OR 4.7), community COVID-19 incidence (cases/10⁵ people/week) (OR 1.006), postoperative neurological worsening (OR 5.9), postoperative need for airway support (OR 5.38), ASA grade ≥3 (OR 2.5) and preoperative GCS 3-8 (OR 2.82) were independently associated with mortality. For SARS-CoV-2 postoperative infection, screening swab test <72 hours preoperatively (OR 0.76), community COVID-19 incidence (cases/10⁵ people/week) (OR 1.011), preoperative cognitive impairment (OR 2.784), postoperative sepsis (OR 3.807) and an absence of postoperative complications (OR 0.188) were independently associated.

CONCLUSIONS: Perioperative SARS-CoV-2 infection in neurosurgical patients was associated with an increase in mortality by almost fivefold. Community COVID-19 incidence (cases/10⁵ people/week) was a statistically independent predictor of mortality.

TRIAL REGISTRATION NUMBER: CEIM 20/217.

PMID:34893486 | DOI:10.1136/bmjopen-2021-053983

Br J Ophthalmol. 2021 Dec 10:bjophthalmol-2021-319929. doi: 10.1136/bjophthalmol-2021-319929. Online ahead of print.

ABSTRACT

PURPOSE: Provide up-to-date insight in incidence of retinopathy of prematurity (ROP), logistics of screening and treatment in the Netherlands and influence of the new national ROP guideline in which more stringent screening criteria were implemented and the early treatment for ROP criteria (ETROP) were emphasised.

METHODS: Multicentre prospective nationwide study including all preterm infants, born in the Netherlands in 2017, and considered eligible for ROP screening. Anonymised data from ophthalmologists and paediatricians were merged. Outcome data were compared with the first national ROP inventory (NEDROP-1, 2009).

RESULTS: In 2017, 1492 infants were live born with gestational age (GA) <32 weeks (2009: 1662); 1287 infants were eligible for screening (2009: 2033). Ophthalmologists screened 1085 infants, versus 1688 in 2009, corrected with factor 1.114 for the difference in number of live births, a 28.4% (479/1688) decrease in screened infants was seen. Among surviving infants with GA <32 week, ROP was found in 305/1492 babies, 20.4% (2009: 324/1662, 19.5%) of which 49/1492 stage ≥3, 3.3% (2009: 30/1662, 1.8%). In all infants, report on presence or absence of plus disease was provided, according to the ETROP criteria. Treatment was performed in 39 infants. Of infants with ROP stage ≥3, 3/49 (6.1%) progressed to retinal detachment (2009: 6/30, 20.0%).

CONCLUSION: The overall ROP incidence expressed as a percentage, remained stable but the number of infants that developed severe ROP nearly doubled. A near one-third reduction in screened infants shows satisfactory implementation of the new screening criteria. A notable decrease in retinal detachment delineates improved treatment outcome.

PMID:34893474 | DOI:10.1136/bjophthalmol-2021-319929

BMJ Open. 2021 Dec 10;11(12):e052277. doi: 10.1136/bmjopen-2021-052277.

ABSTRACT

INTRODUCTION: The introduction of multiparametric MRI (mpMRI) has improved almost every aspect of the prostate cancer diagnostic pathway. However, the novel imaging technique, prostate-specific membrane antigen positron emission tomography (PSMA PET) may have demonstrable accuracy in detecting and staging prostate cancer. Here, we describe a protocol for a systematic review and meta-analysis comparing mpMRI to PSMA PET for the diagnosis of suspected prostate cancer.

METHODS AND ANALYSIS: A systematic search of MEDLINE, EMBASE, PubMed and Cochrane databases will be conducted. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines will be followed for screening, data extraction, statistical analysis and reporting. Included papers will be full-text articles providing original data, written in English articles and comparing the use of PSMA PET with mpMRI in the diagnosis of prostate cancer. All studies published between July 1977 and March 2021 will be eligible for inclusion. Study bias and quality will be assessed using Quadas-2 score. To ensure the quality of the reporting of studies, this protocol is written following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols 2015 checklist.

ETHICS AND DISSEMINATION: Ethical approval will not be required for this systematic review. Findings will be disseminated through peer-reviewed publications and presentations at both national and international conferences.

PROSPERO REGISTRATION NUMBER: CRD42021239296.

PMID:34893484 | DOI:10.1136/bmjopen-2021-052277

J Geriatr Oncol. 2021 Dec 7:S1879-4068(21)00258-7. doi: 10.1016/j.jgo.2021.11.012. Online ahead of print.

ABSTRACT

INTRODUCTION: Physical activity can attenuate cancer-related declines in physical functioning, improve emotional well-being, and prolong survival among older (≥65 years) breast cancer survivors. However, factors associated with physical activity among older breast cancer survivors are not well-understood.

MATERIALS AND METHODS: Participants were enrolled in the Women’s Health Initiative (WHI) Life and Longevity After Cancer (LILAC) study. Descriptive statistics, multiple linear regression, and relative risk [RR] regression were used to assess the association of demographic, clinical, physical and psychosocial variables with the total duration of and participation in physical activity among postmenopausal breast cancer survivors. Age-specific correlates (65-74 years vs. 75-84 years vs. ≥85 years) of physical activity were also examined.

RESULTS: The majority of participants (n = 3710, mean age = 78.8 ± 5.9) were white (90.7%) and had in situ/localized breast cancer (78.9%). Women who had higher education (RR = 1.47 for graduate/professional school versus high school or less, 95% CI: 1.32, 1.63), higher self-rated health (RR = 1.04 for 10 point increase, 95% CI:1.02, 1.07), higher physical functioning (RR = 1.03 for 5 point increase, 95% CI: 1.02, 1.04), and higher social support (RR = 1.41 for social support all of the time versus none of the time, 95% CI: 1.01, 1.96), were more likely to engage in any physical activity. Similar results were observed for duration of physical activity. Among women aged <75, radiation therapy, but not chemotherapy, was associated with longer duration of total physical activity (adjusted difference = 19.7 min/week, 95% CI: 6.1, 33.3), but was not associated with duration among older women. The association between pain and duration of moderate/strenuous activity also differed with age: among women aged <75, those with moderate pain averaged fewer minutes of moderate/strenuous physical activity than those with no pain (adjusted difference:-14.4 min/week, 95% CI:-28.5, -0.1). However, among women aged ≥85, those with moderate pain averaged more minutes of moderate/strenuous physical activity per week than those with no pain (adjusted difference:16.6 min/week; 95% CI:2.9, 30.3).

DISCUSSION: Multiple factors were associated with physical activity among older breast cancer survivors in the WHI. Future physical activity interventions should focus on age-related (e.g., comorbidities) and treatment-related factors (e.g., radiation) as well as certain subgroups, such as women with higher symptom burden.

PMID:34893462 | DOI:10.1016/j.jgo.2021.11.012

Am J Pharm Educ. 2021 Dec 10:8757. doi: 10.5688/ajpe8757. Online ahead of print.

ABSTRACT

Objective. The objective of this pilot study is to evaluate the attitudes and self-efficacy of Advanced Pharmacy Practice Experience (APPE) Conference Leaders (CLs) after completing the Well-being Promotion (WelPro) training program developed at the University of California, San Francisco (UCSF) School of Pharmacy.Methods. The WelPro training program was developed to equip CLs with the knowledge and tools to assist APPE students in distress and promote student wellness. After completing the WelPro training program, a 20-item survey was administered to ten CLs via a web-based survey tool Qualtrics (Qualtrics, Provo, UT) to assess their attitudes about burnout and self-efficacy in Assisting Students in Distress (ASD). Descriptive statistics were used to characterize attitudes and self-efficacy; Wilcoxon signed-rank and Mann-Whitney U tests were used for non-parametric ordinal data.Results. Ten CLs participated in the training program. Nine CLs reported experiencing burnout in their careers and all believed burnout within the pharmacy profession could be avoidable. Confidence levels of CLs, after the WelPro training program, significantly improved in the following areas: identification of students in distress, identification of resources for students, and recognition of when and how to refer students in distress.Conclusion. Increased self-efficacy of CLs to identify and assist students in distress could be translated into their improved ability to support students’ overall well-being. The WelPro training program can serve as a model for similar wellness training programs that directors and preceptors in experiential education can implement at their institutions.

PMID:34893467 | DOI:10.5688/ajpe8757

Eur Urol Focus. 2021 Dec 7:S2405-4569(21)00304-7. doi: 10.1016/j.euf.2021.11.004. Online ahead of print.

ABSTRACT

BACKGROUND: High-risk muscle-invasive bladder cancer (MIBC) has a poor prognosis. Old trials showed that external beam radiotherapy (EBRT) after radical cystectomy (RC) decreases the incidence of local recurrences but induces severe toxicity.

OBJECTIVE: To evaluate the toxicity and local control rate after adjuvant EBRT after RC delivered with volumetric arc radiotherapy.

DESIGN, SETTING, AND PARTICIPANTS: This is a multicentric phase 2 trial. From August 2014 till October 2020, we treated 72 high-risk MIBC patients with adjuvant EBRT after RC. High-risk MIBC is defined as ≥pT3-MIBC ± lymphovascular invasion, fewer than ten lymph nodes removed, pathological positive lymph nodes, or positive surgical margins.

INTERVENTION: Patients received 50 Gy in 25 fractions with intensity-modulated radiotherapy to the pelvic lymph nodes ± cystectomy bed.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The primary outcome is acute toxicity. We report on local relapse-free rate (LRFR), clinical relapse-free survival (CRFS), overall survival (OS), and bladder cancer-specific survival (BCSS).

RESULTS AND LIMITATIONS: The median follow-up is 18 mo. Forty-two patients (61%) developed acute grade 2 gastrointestinal (GI) toxicity. Four patients (6%) had acute grade 3 GI toxicity. One patient had grade 5 diarrhea and vomiting due to obstruction at 1 mo. Two-year probabilities of developing grade ≥3 and ≥2 GI toxicity were 17% and 76%, respectively. Urinary toxicity, assessed in 17 patients with a neobladder, was acceptable with acute grade 2 and 3 urinary toxicity reported in 53% (N = 9) and 18% (N = 3) of the patients, respectively. The 2-yr LRFR is 83% ± 5% and the 2-yr CRFS rate is 43% with a median CRFS time of 12 mo (95% confidence interval: 3-21 mo). Two-year OS and BCSS are 52% ± 7% and 62% ± 7%, respectively. Shortcomings are the nonrandomized study design and limited follow-up.

CONCLUSIONS: Adjuvant EBRT after RC can be administered without excessive severe toxicity.

PATIENT SUMMARY: In this report, we looked at the incidence of toxicity and local control after adjuvant external beam radiotherapy (EBRT) following radical cystectomy (RC) in high-risk muscle-invasive bladder cancer patients. We found that adjuvant EBRT was feasible and resulted in good local control. We conclude that these data support further enrollment of patients in ongoing trials to evaluate the place of adjuvant EBRT after RC.

PMID:34893458 | DOI:10.1016/j.euf.2021.11.004

J Nurs Manag. 2021 Dec 10. doi: 10.1111/jonm.13534. Online ahead of print.

ABSTRACT

AIM: To explore primary healthcare nurses’ mental health, concerns, and perceived safety and supports during COVID-19.

BACKGROUND: Respiratory pandemics have negative impacts on nurses’ wellbeing. While literature is replete with hospital nurses’ experiences, there is less exploration of COVID-19 impacts on primary healthcare nurses. Given the importance of primary healthcare nurses in the health system, understanding their experiences is vital.

METHODS: A cross-sectional survey of 359 primary healthcare nurses. The Depression Anxiety Stress Scales (DASS-21) was used to measure emotional state. Data were analysed using descriptive and inferential statistics.

RESULTS: DASS-21 scores indicated that 39.6% of participants were experiencing depressive, anxiety or stress symptoms. Of those, 41.8% were experiencing symptoms on one scale, 26.9% were experiencing symptoms on two scales and 31.2% were experiencing symptoms across all three scales. Most participants identified that their feelings were related to COVID-19.

CONCLUSIONS: COVID-19 is having a significant impact on primary healthcare nurses’ mental health. Nurse managers need to develop strategies to effectively address nurses’ concerns and support them to sustain the workforce during and after the pandemic.

IMPLICATIONS FOR NURSING MANAGEMENT: Findings from this study can inform the design of effective support programs to reduce mental health impacts and promote staff wellbeing.

PMID:34890472 | DOI:10.1111/jonm.13534

J Perinat Med. 2021 Dec 13. doi: 10.1515/jpm-2021-0542. Online ahead of print.

ABSTRACT

OBJECTIVES: To compare the immunohistochemical expression of IL-6 in placental membranes of late preterm delivery in women with histologically proven chorioamnionitis with and without preterm premature rupture of membranes (PPROM).

METHODS: Fetal membranes were collected from 60 women who had late preterm delivery with histologic chorioamnionitis with and without PPROM (30 in each group). Immunohistochemistry for IL-6 was performed on formalin fixed and paraffin-embedded sections. The two groups were matched for age, body mass index and parity. SPSS Version 17.0 was used for statistical analysis.

RESULTS: There was no difference in immunohistochemical expression of IL-6 in placental membranes of women with histologic chorioamnionitis regardless of the membrane status.

CONCLUSIONS: Chorioamnionitis has no impact on immunohistochemical expression of IL-6 in placental membranes of women with late preterm delivery despite the clinical presentation.

PMID:34890500 | DOI:10.1515/jpm-2021-0542

Hosp Pediatr. 2021 Dec 13:e2021006094. doi: 10.1542/hpeds.2021-006094. Online ahead of print.

ABSTRACT

CONTEXT: Artificial intelligence (AI) technologies are increasingly used in pediatrics and have the potential to help inpatient physicians provide high-quality care for critically ill children.

OBJECTIVE: We aimed to describe the use of AI to improve any health outcome(s) in neonatal and pediatric intensive care.

DATA SOURCE: PubMed, IEEE Xplore, Cochrane, and Web of Science databases.

STUDY SELECTION: We used peer-reviewed studies published between June 1, 2010, and May 31, 2020, in which researchers described (1) AI, (2) pediatrics, and (3) intensive care. Studies were included if researchers assessed AI use to improve at least 1 health outcome (eg, mortality).

DATA EXTRACTION: Data extraction was conducted independently by 2 researchers. Articles were categorized by direct or indirect impact of AI, defined by the European Institute of Innovation and Technology Health joint report.

RESULTS: Of the 287 publications screened, 32 met inclusion criteria. Approximately 22% ( n = 7) of studies revealed a direct impact and improvement in health outcomes after AI implementation. Majority were in prototype testing, and few were deployed into an ICU setting. Among the remaining 78% ( n = 25) AI models outperformed standard clinical modalities and may have indirectly influenced patient outcomes. Quantitative assessment of health outcomes using statistical measures, such as area under the receiver operating curve (56%; n = 18) and specificity (38%; n = 12), revealed marked heterogeneity in metrics and standardization.

CONCLUSIONS: Few studies have revealed that AI has directly improved health outcomes for pediatric critical care patients. Further prospective, experimental studies are needed to assess AI’s impact by using established implementation frameworks, standardized metrics, and validated outcome measures.

PMID:34890453 | DOI:10.1542/hpeds.2021-006094

J Am Geriatr Soc. 2021 Dec 10. doi: 10.1111/jgs.17594. Online ahead of print.

ABSTRACT

BACKGROUND: Males have worse outcomes after hip fracture than female counterparts. Cognitive impairment (CI) also increases the risk of poor recovery from hip fracture; however, CI is under-recognized. Patient sex may contribute to this under-recognition through differential misclassification. The objective of this study was to measure under-recognition and differential misclassification of CI by patient sex.

METHODS: A cross-sectional analysis of baseline data from an observational cohort study of community-dwelling hip fracture patients aged 65 and older (n = 339; females = 171, males = 168) recruited from eight hospitals in the greater Baltimore, MD area within 15 days of hospitalization for surgical repair with cognitive testing within 22 days of admission. Indication of Alzheimer’s disease or related dementias and/or delirium as a postoperative complication in the medical record was considered evidence of documented CI. Observed CI was measured with the Modified Mini-Mental State Examination (3MS, ≤78). Source of cognitive impairment identification (SCI) was defined as: “3MS Only,” “Hospital Record Only,” “Both,” “No CI” was compared between males and females using logistic regression.

RESULTS: Males had more comorbidities and worse physical status upon admission, but otherwise had similar hospital experiences. SCI distribution was 12.7% “3MS Only” (n = 42), 11.5% “Hospital Record Only” (n = 38), 9.4% “Both” (n = 31), and “No CI” (n = 219). Males were more likely to be identified with CI using the “3MS Only” and “Both,” and females were more likely to have no indication of CI.

CONCLUSION: There were sex differences in the documentation of CI versus observed impairment. Males had more CI using direct testing. This may be contributing to sex differences in recovery outcomes after hip fracture. Results support the implementation of cognitive testing in hip fracture patients to reduce the impact of differential misclassification by patient sex.

PMID:34890469 | DOI:10.1111/jgs.17594