Category: Nevin Manimala

Nurse Educ Today. 2021 Jun 5;104:105000. doi: 10.1016/j.nedt.2021.105000. Online ahead of print.

ABSTRACT

OBJECTIVE: To examine the effectiveness of simulation-based interventions in improving empathy among healthcare students.

DESIGN: A systematic review and meta-analysis of randomized controlled trials and clinical controlled trials.

DATA SOURCES: Studies in English language were sourced from seven electronic databases (PubMed, Embase, CINAHL, PsycINFO, Web of Science, Scopus and ProQuest Dissertations & Theses Global) from their respective inception dates until October 2020.

REVIEW METHODS: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Random-effect meta-analyses were conducted. Heterogeneity was assessed using the I² statistics and Cochran’s Q chi-squared test. Quality appraisal was conducted using the Cochrane risk of bias tool and the Grades of Recommendation, Assessment, Development, and Evaluation approach. Publication bias was assessed using funnel plots.

RESULTS: Sixteen studies were included in this review. Meta-analysis reported statistically significant small, medium and very large effect sizes for empathy reported by healthcare students (SMD = 0.46, 95% CI: 0.25 to 0.66), simulated patients (SMD = 0.65, 95% CI: 0.41 to 0.89) and other personnel (independent observers, faculty members and examiners) (SMD = 1.27, 95% CI: 0.64 to 1.90) respectively, showing the effectiveness of simulation-based interventions in improving empathy among healthcare students. Subgroup analyses found that role-play was more effective than simulated patient and disease-state simulations. Multi-sessional interventions conducted for up to seven months and group-based simulation delivery were found to be more effective.

CONCLUSION: Educational institutions should conduct regular simulation-based interventions to continuously develop healthcare students’ empathy during their academic journey. Future trials should involve students from more diverse healthcare disciplines. Empathy should be measured in a standardized manner and rely less on self-reported measures. Role-play segments and group-based simulations could be added to increase interventions’ effectiveness. Studies should conduct longer follow-up assessments to determine the sustainability of students’ empathy following intervention. Future research is needed to corroborate the current findings.

PMID:34146845 | DOI:10.1016/j.nedt.2021.105000

Clin Res Hepatol Gastroenterol. 2021 Jun 16:101733. doi: 10.1016/j.clinre.2021.101733. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Postoperative pulmonary complications are frequent after hepatectomy. The aim of this retrospective study was to use preoperative and intraoperative data to establish specific factors associated with post-hepatectomy pneumonia (PHPN).

METHODS: Patients underwent minor or major hepatectomy for cancer or non-cancer treatment. Surgical procedure was performed by laparoscopy or laparotomy. PHPN was defined as a new radiologic finding associated with fever, leucocytosis and purulent bronchial secretions. The incidence, associated factors and prognosis of PHPN were investigated.

RESULTS: In 399 patients undergoing planned hepatectomy, 49 (12.3%) developed pneumonia. Of 81 patients (20.3%) with cirrhosis, 77 were Child-Pugh A and 4 were Child-Pugh B. Hepatectomy indication was cancer in 331 patients (of which metastasis in 213). Laparoscopy rate was 31.3%. In multivariate analysis, the main factors statistically associated with PHPN were: chronic obstructive pulmonary disease (COPD) (odds ratio [OR] = 4.17; 95% confidence interval [CI], 1.60-10.84; P = 0.003), intraoperative blood transfusion (OR = 2.46; 95%CI 1.01-5.70; P = 0.001), laparotomy (OR = 3.01; 95%CI 1.09-8.27; P = 0.03), and nasogastric tube maintained at day 1 (OR = 2.09; 95%CI 1.03-4.22; P = 0.04). Length of stay was significantly different between groups without PHPN (10.2 days) versus with PHPN (26.4 days; P < 0.001). Intra-hospital and one-year mortality were greater in the PHPN group than the pneumonia-free group (8.16 vs 0% and 18.4 vs 3.4%, respectively; P < 0.001).

CONCLUSIONS: COPD, transfusion and laparotomy (versus laparoscopy) are factors associated with PHPN and impaired survival.

PMID:34146724 | DOI:10.1016/j.clinre.2021.101733

Lung Cancer. 2021 May 31;158:107-114. doi: 10.1016/j.lungcan.2021.05.034. Online ahead of print.

ABSTRACT

OBJECTIVES: The aim of this study was to investigate the risk of TB in advanced non-small cell lung cancer (NSCLC) patients treated with Immune checkpoint inhibitors (ICI) after a platinum-based chemotherapy.

MATERIALS AND METHODS: A nationwide population-based retrospective cohort study using National health insurance dataset was designed. Patients who were diagnosed as lung cancer between September 1st, 2017 and August 31st, 2018 in South Korea were selected. Among them, those with NSCLC who initiated a platinum-based chemotherapy within 3 months were finally included and followed up until December 31st, 2018. Patients who received nivolumab, pembrolizumab, and atezolizumab within study period were classified as the ICI group. Cox proportional hazard model with time-varying covariates was used to determine effects of the duration of conventional chemotherapy, ICI, and consecutive use of systemic steroid on TB.

RESULTS: A total of 6335 patients were enrolled with 3568.7 years of total follow-up period. Among them, 899 patients underwent ICI treatment. Within the follow-up period, 15 TB cases were identified in the ICI group (incidence: 2582.5 per 100,000 person-years) and 63 TB cases were found in the conventional chemotherapy group (incidence: 2108.5 per 100,000 person-years). In a multivariable Cox proportional hazard model, treatment with ICI was not a significant risk factor for TB development (hazard ratio (HR): 1.21, 95 % confidence interval (CI): 0.45-3.26,p = 0.700). Instead, prolonged use of steroid was associated with an increased TB risk (HR: 1.91, 95 %CI: 0.89-4.08, p = 0.095), although its statistical significance was dependent on the operational definition of the effect duration. Previous TB history and older age were independent risk factors for TB disease.

CONCLUSION: In this real-world study, additional treatment with ICI did not increase the risk of TB in advanced NSCLC patients who underwent a cytotoxic chemotherapy. However, TB incidence in these patients was high regardless of ICI treatment.

CLASSIFICATIONS: Systemic Treatments.

PMID:34146757 | DOI:10.1016/j.lungcan.2021.05.034

Transbound Emerg Dis. 2021 Jun 19. doi: 10.1111/tbed.14193. Online ahead of print.

ABSTRACT

African Swine Fever Virus (ASFV) causes a deadly disease of pigs which spread through southeast Asia in 2019. We investigated one of the first outbreaks of ASFV in Lao Peoples Democratic Republic amongst smallholder villages of Thapangtong District, Savannakhet Province. In this study, two ASFV affected villages were compared to two unaffected villages. Evidence of ASFV-like clinical signs appeared in pig herds as early as May 2019, with median epidemic days on 1 and 18 June in the two villages, respectively. Using participatory epidemiology mapping techniques, we found statistically significant spatial clustering in both outbreaks (P < 0.001). Villagers reported known risk factors for ASFV transmission – such as free-ranging management systems and wild boar access – in all four villages. The villagers reported increased pig trader activity from Vietnam before the outbreaks; however, the survey did not determine a single outbreak source. The outbreak caused substantial household financial losses with an average of 9 pigs lost to the disease, and Monte Carlo analysis estimated this to be USD 215 per household. ASFV poses a significant threat to food and financial security in smallholder communities such as Thapangtong, where 40.6% of the district’s population are affected by poverty. This study shows ASFV management in the region will require increased local government resources, knowledge of informal trader activity and wild boar monitoring alongside education and support to address intra-village risk factors such as free-ranging, incorrect waste disposal and swill feeding. This article is protected by copyright. All rights reserved.

PMID:34146447 | DOI:10.1111/tbed.14193

Vet Med Sci. 2021 Jun 19. doi: 10.1002/vms3.557. Online ahead of print.

ABSTRACT

BACKGROUND: Teratogenic viral infections may proceed to hydranencephaly in cattle. Post-mortem and antemortem diagnosis can be achieved by necropsy or ultrasonography, CT-scan and MRI techniques.

OBJECTIVES: The aim of this study was to determine how effective ultrasonography approach is in detecting hydranencephaly in calves.

METHODS: In this study, ultrasonography images were obtained from brains of nine Holstein claves, of the same age, with neurological signs (due to Akabane virus infection), approaching from the caudal part of the temporal bone. To confirm the obtained images, the same approach was used to obtain images from a normal calf of the same age. The thickness of the temporal bone was measured and compared in seven affected and the healthy calves, using CT-scan images.

RESULTS: In ultrasonographic images, temporal bone (as a hyperechoic structure) and temporal cortical mantle (as an echogenic structure) were noted in the right and left side of the skull. The medial part of the image showed presence of fluid in an anechoic region, instead of brain parenchyma. Falx cerebri was also seen as a floating hyperechoic line in the middle part in all patients. There was no statistically significant difference between the thickness of temporal bone in normal and affected calves (p = 0.502). All findings were confirmed by necropsy.

CONCLUSIONS: Transtemporal approach is a novel and easy approach to study the brain in calves. This is the first study on the hydranencephalic brains of claves, using ultrasonography by transtemporal approach.

PMID:34146385 | DOI:10.1002/vms3.557

J Eur Acad Dermatol Venereol. 2021 Jun 19. doi: 10.1111/jdv.17460. Online ahead of print.

ABSTRACT

With the arrival of COVID-19, STI units decreased their activity or even closed and individuals avoided healthcare facilities. These factors conditioned the diagnosis of severe conditions¹ , including STI. The main objective of this study was to analyze the number of newly notified STI cases and HIV postexposure prophylaxis (PEP) in Barcelona during the COVID-19 pandemic.

PMID:34146425 | DOI:10.1111/jdv.17460

Risk Anal. 2021 Jun 19. doi: 10.1111/risa.13772. Online ahead of print.

ABSTRACT

Structured expert judgment (SEJ) is a method for obtaining estimates of uncertain quantities from groups of experts in a structured way designed to minimize the pervasive cognitive frailties of unstructured approaches. When the number of quantities required is large, the burden on the groups of experts is heavy, and resource constraints may mean that eliciting all the quantities of interest is impossible. Partial elicitations can be complemented with imputation methods for the remaining, unelicited quantities. In the case where the quantities of interest are conditional probability distributions, the natural relationship between the quantities can be exploited to impute missing probabilities. Here we test the Bayesian intelligence interpolation method and its variations for Bayesian network conditional probability tables, called “InterBeta.” We compare the various outputs of InterBeta on two cases where conditional probability tables were elicited from groups of experts. We show that interpolated values are in good agreement with experts’ values and give guidance on how InterBeta could be used to good effect to reduce expert burden in SEJ exercises.

PMID:34146431 | DOI:10.1111/risa.13772

Haemophilia. 2021 Jun 19. doi: 10.1111/hae.14360. Online ahead of print.

ABSTRACT

INTRODUCTION: Haemophilia research has traditionally focused on patients diagnosed with haemophilia and although research priorities are rapidly changing, there is still a lot more we need to understand about the experiences and psychosocial issues facing women who are diagnosed as carriers of haemophilia (Haemophilia, https://doi.org/10.1111/hae.14043). One study noted that the understanding of carriers’ experience of bleeding by healthcare professionals is limited and that many women have had negative experiences of healthcare (Haemophilia, 17, 2011, 237). The carrier population does not typically receive much support for themselves as individuals as they are often not registered at Haemophilia Centres in their own right.

AIM: This study aimed to look at the emotional wellbeing of carriers in more detail.

METHOD: This was initially investigated through the use of focus groups and individual interviews with 16 participants (Stage 1) and then widening the study using an online questionnaire battery developed from the themes identified from these interviews (Stage 2). The questionnaire battery was completed by 226 participants.

RESULTS: Descriptive statistics are reported on the endorsement of themes identified in Stage 1 and around participants’ experiences of their carriership and healthcare. Results demonstrated that the participants have had a number of difficulties with accessing helpful information and support during key times in their lives, for example, at diagnosis and when deciding whether to start a family. They also showed that although participants endorsing a higher number of bleeding symptoms scored statistically significantly higher in measures of depression, anxiety and negative affect, this difference was not clinically significant.

CONCLUSION: These results lend support to the growing evidence base that women who are carriers of haemophilia have a distinct set of (currently unmet) needs that need assessing and treating.

PMID:34146374 | DOI:10.1111/hae.14360

Pharmacoepidemiol Drug Saf. 2021 Jun 19. doi: 10.1002/pds.5310. Online ahead of print.

ABSTRACT

PURPOSE: The aim of this study was to analyse the epidemiology of polypharmacy in hospital psychiatry. Another aim was to investigate predictors of the number of drugs taken and the associated risks of drug-drug interactions and potentially inappropriate medications in the elderly.

METHODS: Daily prescription data were obtained from a pharmacovigilance project sponsored by the Innovations Funds of the German Federal Joint Committee.

RESULTS: The study included 47 071 inpatient hospital cases from 8 different study centers. The mean number of different drugs during the entire stay was 6.1 (psychotropic drugs = 2.7; others = 3.4). The mean number of drugs per day was 3.8 (psychotropic drugs = 1.6; others = 2.2). One third of cases received at least five different drugs per day on average during their hospital stay (polypharmacy). Fifty-one percent of patients received more than one psychotropic drug simultaneously. Hospital cases with polypharmacy were 18 years older (p < 0.001), more likely to be female (52% versus 40%, p < 0.001) and had more comorbidities (5 versus 2, p < 0.001) than hospital cases without polypharmacy. The risks of drug-drug interactions (OR = 3.7; 95% CI = 3.5-3.9) and potentially inappropriate medication use in the elderly (OR = 2.2; CI = 1.9-2.5) substantially increased in patients that received polypharmacy.

CONCLUSION: Polypharmacy is frequent in clinical care. The number of used drugs is a proven risk factor of adverse drug reactions due to drug-drug interactions and potentially inappropriate medication use in the elderly. The potential interactions and the specific pharmacokinetics and -dynamics of older patients should always be considered when multiple drugs are used.

PMID:34146372 | DOI:10.1002/pds.5310

J Community Psychol. 2021 Jun 19. doi: 10.1002/jcop.22637. Online ahead of print.

ABSTRACT

Domestic violence (DV) is a leading cause of homelessness for women, yet many DV agencies are just beginning to focus on helping clients stabilize their housing situations. The purpose of this study was to better understand the contexts and service needs of unstably housed and homeless DV survivors, to promote more efficient and successful service matching from DV agencies. We examined whether DV survivors could be grouped by particular features, histories, and contextual factors, and how these group differences impacted what they needed from DV agencies. The sample included 406 homeless and unstably housed DV survivors who had recently sought DV services. Latent class analysis supported the identification of four distinct classes: (1) highest disadvantages service seeker, (2) moderate disadvantages-criminal legal system service seeker, (3) moderate disadvantages service seeker, and (4) lower disadvantages service seeker. Additionally, we were able to profile each class, and test the types of services survivors in each class needed from agencies.

PMID:34146356 | DOI:10.1002/jcop.22637