Category: Nevin Manimala

Nurs Educ Perspect. 2021 Dec 21. doi: 10.1097/01.NEP.0000000000000920. Online ahead of print.

ABSTRACT

AIM: This study investigated the impact of an interprofessional mock code on students’ comfort and competency related to Parkinson’s disease (PD) medication administration during care transitions.

BACKGROUD: Patients with PD are at increased risk for medication errors during hospitalization. Individualization of PD medication creates vulnerability during care transitions.

METHOD: Four interprofessional groups took part in this study: baccalaureate degree senior nursing students (n = 113), master’s level nurse anesthesia students (n = 35), doctor of osteopathic medicine fourth-year students (n = 32), and doctor of clinical psychology fourth-year students (n = 22). Groups participated in an unfolding case study simulation involving a mock code with a focus on the omission of time-sensitive PD medication. Pre- and postsimulation test results were compared.

RESULTS: Findings indicated an increased understanding among three of the four groups relating to medication timing during care transitions.

CONCLUSION: All groups improved with respect to perceived comfort and competency.

PMID:34974503 | DOI:10.1097/01.NEP.0000000000000920

J Acquir Immune Defic Syndr. 2021 Dec 21. doi: 10.1097/QAI.0000000000002901. Online ahead of print.

ABSTRACT

BACKGROUND: The COVID-19 pandemic and its associated socio-economic disruptions has disproportionally affected marginalized populations including people living with HIV (PLHIV). Little is known about how the pandemic has impacted populations experiencing multiple forms of stigma, discrimination and violence such as female sex workers (FSW) living with HIV.

METHODS: We conducted a cross-sectional survey between August and December 2020 among 187 FSW living with HIV in the Dominican Republic (DR) to examine the impact of COVID-19. Using multivariable logistic regression, we examined associations between COVID-19-related financial concerns, mental health, substance use and partner abuse on engagement in HIV care and ART adherence. We conducted mediation analysis to assess whether mental health challenges mediated the impact of partner abuse or substance use on HIV outcomes.

RESULTS: Most participants reported no income (72%) or a substantial decline in income (25%) since the COVID-19 pandemic. Approximately one third (34%) reported COVID-19 had an impact on their HIV care and treatment. Greater COVID-19 financial concerns (aOR=1.14, 95% CI: 1.02-1.27), mental health challenges (aOR=1.38, 95% CI: 1.06-1.79) and partner emotional abuse (aOR=2.62, 95% CI: 1.01-6.79) were associated with higher odds of negatively impacted HIV care, respectively. The relationship between increased emotional partner abuse and negatively impacted HIV care was mediated by greater COVID-19-related mental health challenges.

CONCLUSION: FSW living with HIV in the DR have been significantly impacted by the COVID-19 pandemic. Targeted interventions that address structural (financial security, partner abuse) and psychosocial (mental health) factors are needed to sustain HIV outcomes and well-being.

PMID:34974474 | DOI:10.1097/QAI.0000000000002901

J Clin Gastroenterol. 2021 Dec 31. doi: 10.1097/MCG.0000000000001650. Online ahead of print.

ABSTRACT

OBJECTIVE: There is still no gold standard regarding the optimal circumference of antireflux mucosectomy (ARMS) in patients with treatment-refractory gastroesophageal reflux disease (GERD). The aim of this study is to assess the safety and effectiveness of resection procedures when the circumferences are different.

PATIENTS AND METHODS: Thirty-two patients with treatment-refractory GERD were allocated into group A (16 cases) and group B (16 cases) by randomization. In group A and group B, a 2/3 and 1/2 circumference, 1.5 cm wide mucosal resection of the gastric cardia was performed. Health-related quality of life (HRQOL), frequency scale for the symptoms of GERD (FSSG), DeMeester scores and acid exposure time (AET) were accessed at baseline and at 24 months after treatment. Physical component summaries (PCS), mental component summaries (MCS), and RE-specific summary (RES) scores were calculated.

RESULTS: All patients had successful surgical procedures and no bleeding, perforation, or dysphagia occurred. The PCS, MCS, and RES scores of post-ARMS were higher than those of pre-ARMS in groups A and B, and the FSSG, DeMeester scores and AET decreased after ARMS in both groups, with differences that were statistically significant (P<0.05). The changes in PCS, MCS, RES, FSSG, DeMeester scores, and AET were greater in group A than in group B, with significant differences in PCS, MCS, RES, and FSSG scores (P<0.05), but no significant differences in, DeMeester scores and AET (P>0.05).

CONCLUSION: ARMS is an effective treatment for treatment-refractory GERD. Moreover, we recommend the 2/3 circumference, 1.5 cm wide mucosal resection of the gastric cardia.

PMID:34974493 | DOI:10.1097/MCG.0000000000001650

Transplantation. 2021 Dec 28. doi: 10.1097/TP.0000000000004026. Online ahead of print.

ABSTRACT

BACKGROUND: Sex differences in kidney graft loss rates were reported in the United States. Whether these differences are present in other countries is unknown.

METHODS: We estimated the association between recipient sex and death-censored graft loss in patients of all ages recorded in the Scientific Registry of Transplant Recipients, Australia and New Zealand Dialysis and Transplant Registry, and Collaborative Transplant Study registries who received a first deceased donor kidney transplant (1988-2019). We used multivariable Cox regression models, accounting for the modifying effects of donor sex and recipient age, in each registry separately; results were combined using individual patient data meta-analysis.

RESULTS: We analyzed 438 585 patients. Young female patients 13-24 y old had the highest crude graft loss rates (female donor: 5.66; male donor: 5.50 per 100 person-years). Among young recipients of male donors, females showed higher graft loss risks than males (0-12 y: adjusted hazard ratio [aHR] 1.42, (95% confidence interval [CI], 1.17-1.73); 13-24 y: 1.24 (1.17-1.32); 25-44 y: 1.09 (1.06-1.13)). When the donor was female, there were no significant differences by recipient sex among those of age <45 y; however, the aHR for females was 0.93 (0.89-0.98) in 45-59 y-old and 0.89 (0.86-0.93) in ≥ 60 y-old recipients. Findings were similar for all 3 registries in most age intervals; statistically significant heterogeneity was seen only among 13-24-y-old recipients of a female donor (I2 = 71.5%, P = 0.03).

CONCLUSION: There is an association between recipient sex and kidney transplantation survival that is modified by recipient age and donor sex.

PMID:34974454 | DOI:10.1097/TP.0000000000004026

Optom Vis Sci. 2021 Dec 29. doi: 10.1097/OPX.0000000000001850. Online ahead of print.

ABSTRACT

SIGNIFICANCE: Psychophysical estimates of spatial and depth vision have been shown to be better following bilateral ReLEx small incision lenticule extraction (SMILE) refractive surgery for myopia, relative to Photorefractive Keratectomy (PRK) and Femtosecond-LASIK (FS-LASIK). The present study provides the optical basis for these findings using computational image quality analysis.

PURPOSE: To compare longitudinal changes in higher-order wavefront aberrations and image quality before and after bilateral PRK, FS-LASIK, and SMILE refractive procedures for correcting myopia.

METHODS: Wavefront aberrations and image quality of both the eyes of 106 subjects (n = 40 for FS-LASIK and SMILE and n = 26 for PRK) were determined pre-operatively and at 1-week, 1-month, 3-months, and 6-months post-operative intervals using computational through-focus analysis for 6 mm pupil diameter. Image quality was quantified in terms of its peak value and its interocular difference, residual defocus that was needed to achieve peak image quality (best focus) and the depth of focus.

RESULTS: The increase in RMS deviations of higher-order aberrations postoperatively was lesser after SMILE [1mth visit median (25th to 75th interquartile range): 0.34 μm (0.28 to 0.39 μm)] than after PRK [0.80 μm (0.74 to 0.87 μm)] and FS-LASIK [0.74 μm (0.59 to 0.83 μm)] (P ≤ .001), all relative to pre-operative values [0.20 μm (0.15 to 0.30 μm)]. The peak image quality dropped and its interocular difference increased, best focus shifted myopically by 0.5 – 0.75D and depth of focus widened significantly following PRK and FS-LASIK surgeries, all relative to pre-operative values (P < .001). All these changes were negligible but statistically significantly in a minority of instances following SMILE surgery (P ≥ .01).

CONCLUSIONS: While all three refractive surgeries correct myopia, the image quality and its similarity between eyes are better and closer to pre-operative values following SMILE, compared to FS-LASIK and PRK. These results can be explained from the underlying increase in higher-order wavefront aberrations experienced by the eye postoperatively.

PMID:34974458 | DOI:10.1097/OPX.0000000000001850

Transplantation. 2021 Dec 28. doi: 10.1097/TP.0000000000004042. Online ahead of print.

ABSTRACT

At the outset of solid organ transplantation, genetic variation between donors and recipients was recognized as a major player in mechanisms such as allograft tolerance and rejection. Genome-wide association studies have been very successful in identifying novel variant-trait associations, but have been difficult to perform in the field of solid organ transplantation due to complex covariates, era effects, and poor statistical power for detecting donor-recipient interactions. To overcome a lack of statistical power, consortia such as the International Genetics and Translational Research in Transplantation Network have been established. Studies have focused on the consequences of genetic dissimilarities between donors and recipients and have reported associations between polymorphisms in candidate genes or their regulatory regions with transplantation outcomes. However, knowledge on the exact influence of genetic variation is limited due to a lack of comprehensive characterization and harmonization of recipients’ or donors’ phenotypes and validation using an experimental approach. Causal research in genetics has evolved from agnostic discovery in genome-wide association studies to functional annotation and clarification of underlying molecular mechanisms in translational studies. In this overview, we summarize how the recent advances and progresses in the field of genetics and genomics have improved the understanding of outcomes after solid organ transplantation.

PMID:34974452 | DOI:10.1097/TP.0000000000004042

Restor Neurol Neurosci. 2021 Dec 30. doi: 10.3233/RNN-211156. Online ahead of print.

ABSTRACT

BACKGROUND: Childhood hearing impairment is a major disability associated with delayed motor development. The affected Fine motor performance in children with sensorineural hearing loss (SNHL) could be due to dynamic balance deficits and visual-motor incoordination.

OBJECTIVE: This study was designed to investigate the effects of fine motor exercises with or without balancing exercises on fine motor skills in children with SNHL.

METHODS: One hundred and eighty (180) children their age ranged from 8 to 18 years old diagnosed with SNHL were selected. They were divided into three groups, 60 children (control group) practiced only their ordinary activities of daily living, 60 children (fine motor exercises group) practiced fine motor exercises, and 60 children (fine motor and balance exercise) group practiced fine motor and balance exercises. The outcomes were assessed by the Bruininks Oseretsky Test of the motor proficiency second edition scale (BOT-2).

RESULTS: Generally, there was a statistically significant difference between control group and fine motor exercises group where (p < 0.05), besides, there was a statistically significant difference between control group and fine motor and balance exercises group where (p < 0.05). But, there was no statistically significant difference between fine motor exercises group and fine motor and balance exercises group where (p > 0.05).

CONCLUSIONS: The Fine Motor performance of children with SNHL has been improved by Fine motor with or without balancing exercises according to (BOT-2).

PMID:34974444 | DOI:10.3233/RNN-211156

J Parkinsons Dis. 2021 Dec 26. doi: 10.3233/JPD-212833. Online ahead of print.

NO ABSTRACT

PMID:34974437 | DOI:10.3233/JPD-212833

Int J Spine Surg. 2021 Dec;15(suppl 3):S54-S64. doi: 10.14444/8164.

ABSTRACT

BACKGROUND: From the 1990s, there has been growth in the literature demonstrating the feasibility of minimally invasive approaches for treating variety lumbar spinal disorders. There is still much work to be done in overcoming the technical challenges and explicate relative advantages of endoscopic techniques in lumbar spine surgery. In this comprehensive literature review, we discuss the history, indications, contraindications, surgical techniques, learning curves, technical tips, adverse events, and examine peer-reviewed studies addressing uniportal endoscopic interlaminar decompression in lumbar spinal surgery.

METHODS: This literature review was conducted with keywords “endoscopic,” “minimally invasive,” “uniportal endoscopic decompression,” “interlaminar decompression,” and “lumbar spinal surgery” using PubMed, Embase, ClinicalKey, and Google Scholar.

RESULTS: Review of 423 patients who underwent uniportal endoscopic interlaminar lumbar decompression showed satisfying results with 82% of patients no longer having leg pain, and 13% of patients having only occasional pain, with no significant operation-related deterioration in leg or back pain. To compare the outcomes between endoscopic and microscopic technique, a comparative review of 192 lumbar lateral recess stenosis patients demonstrated the uniportal endoscopic group had 29% shorter operation duration, 1.2% fewer perioperative complications, and significantly reduced postoperative pain (visual analog scale) over 5 days, and reduced use of pain medications. Multiple retrospective studies echoed the outcomes of endoscopic decompression surgery, showed shorter hospitalization time, lower mean dural expansion, lower increment of horizontal displacement measured, and less elevated levels of postoperative serum CPK (creatine phosphokinase) and CRP (c-reactive protein). Lastly, a systematic review and meta-analysis that enrolled 994 patients found that patients who received the full-endoscopic decompression technique showed statistically lower levels of back pain and leg pain and a 40% lower chance of having complications compared with those receiving microscopic decompression in lumbar stenosis.

CONCLUSIONS: Based on our literature review, there are multiple positive outcomes with endoscopic interlaminar lumbar decompression, which reduces operation duration, perioperative complications, and better postoperative outcomes. However, the technical challenge highlights the importance of further training and innovation in this rapidly evolving field.

PMID:34974421 | DOI:10.14444/8164

Int J Med Educ. 2021 Dec 31;12:274-299. doi: 10.5116/ijme.61b3.56ee.

ABSTRACT

OBJECTIVES: To investigate the acceptability and the effectiveness of a virtual adaptation of a well-established, mandatory, community-based pre-clinical remote area health placement in which medical students learn about the social and environmental determinants of health in remote Australia; and make recommendations to guide the delivery of future learning experiences.

METHODS: A mixed-methods convergent design was used. All 99 students, 36 placement hosts and 10 staff were invited to complete an online survey and 27(27%), 12(33%) and 10(100%), respectively, contributed data. Qualitative data were collected via semi-structured interviews from four students, four hosts and six staff. Survey data were analysed using descriptive statistics (frequency and percentage) and open-ended responses summarised to provide supporting contextual evidence. Interview transcripts were analysed and coded independently, then corroborated to identify and summarise common themes using thematic analysis.

RESULTS: Survey and interview data indicated that the virtual placement was acceptable to students and hosts and enabled students to achieve intended learning objectives. Virtual activities enabled students and hosts to develop authentic, genuine interpersonal relationships, which in turn were facilitated when hosts and students had practiced videoconferencing beforehand with good high-speed internet connections via mobile devices. Pastoral care and access to IT support were essential.

CONCLUSIONS: Virtual placements can be used in combination with and are an option for students and hosts who cannot attend/courses that cannot fund physical placements. Careful design and further research is required to ensure that virtual placements enable “head, heart and hands” learning and do not create/reinforce inequities.

PMID:34974431 | DOI:10.5116/ijme.61b3.56ee