Category: Nevin Manimala

Int J Nurs Stud. 2021 Aug 21;124:104069. doi: 10.1016/j.ijnurstu.2021.104069. Online ahead of print.

ABSTRACT

BACKGROUND: Responding to legal medically assisted dying requests may become the most frequent form of nurses’ participation in that service. Recent research has explored nurses’ discrete responses to requests about or for assisted dying; however, nurses likely hold intentions for multiple responses to these requests. These intentions form patterns shaped by individual factors such as attitude and beliefs. No research has investigated patterns of multiple responses to requests for assisted dying, how these patterns form profiles of nurses and factors that might explain these response profiles.

OBJECTIVES: Identify patterns of multiple responses that nurses intend for requests for assisted dying. Explore how these patterns form profiles of nurses’ who share similar patterns of intended responses. Finally, investigate how attitude, norms and beliefs distinguish response profiles.

DESIGN: Cross-sectional survey SETTINGS: Online survey of Australian nurses PARTICIPANTS: 365 experienced registered nurses (years in nursing mean = 23, SD = 14.21) working primarily with adults across various practice settings.

METHODS: Principal components analysis identified five types of intended responses. K-means cluster analysis was then used to develop profiles of nurses’ intended responses across these five responses. Multinomial logit regression was utilised to examine psychosocial variables that distinguished different profiles RESULTS: Cluster analysis resulted in five profiles that reflect different patterns of intended responses by nurses – Facilitator, Complier, Expediter, Objector, and Detached. Logit regressions of explanatory variables indicated that nurses’ attitude toward assisted dying, ethical beliefs, and social norms predicted nurses’ membership in intended response profiles. The overall model was statistically significant, χ²(20) = 106.527, p < .001, and the predictors accounted for 25.3% of the variance in the profiles (Cox and Snell test: Pseudo R² = 0.253).

CONCLUSION: Nurses intended responses have been usefully constructed as five patterns or profiles of multiple responses. These profiles represent different types and levels of engagement with requests. Further, attitude and social expectations distinguish profiles with stronger intentions to engage positively. Using a cluster analysis methodology provides a more holistic understanding of nurses’ intended responses to assisted dying requests by focusing on various responses and demonstrating that nurses have distinctive patterns of responses.

PMID:34592533 | DOI:10.1016/j.ijnurstu.2021.104069

Ecotoxicol Environ Saf. 2021 Sep 27;226:112794. doi: 10.1016/j.ecoenv.2021.112794. Online ahead of print.

ABSTRACT

BACKGROUND: Scientific studies have identified various adverse effects of particulate matter (PM) on respiratory disease (RD) and type 2 diabetes (T2D). However, whether short-term exposure to PM triggers the onset of RD with T2D, compared with RD without T2D, has not been elucidated.

METHODS: A two-stage time-series study was conducted to evaluate the acute adverse effects of PM on admission for RD and for RD with and without T2D in Beijing, China, from 2014 to 2020. District-specific effects of PM_2.5 and PM₁₀ were estimated using the over-dispersed Poisson generalized addictive model after adjusting for weather conditions, day of the week, and long-term and seasonal trends. Meta-analyses were applied to pool the overall effects on overall and cause-specific RD, while the exposure-response (E-R) curves were evaluated using a cubic regression spline.

RESULTS: A total of 1550,154 admission records for RD were retrieved during the study period. Meta-analysis suggested that per interquartile range upticks in the concentration of PM_2.5 corresponded to 1.91% (95% CI: 1.33-2.49%), 2.16% (95% CI: 1.08-3.25%), and 1.92% (95% CI: 1.46-2.39%) increments in admission for RD, RD with T2D, and RD without T2D, respectively, at lag 0-8 days, lag 8 days, and lag 8 days. The effect size of PM_2.5 was statistically significantly higher in the T2D group than in the group without T2D (z = 3.98, P < 0.01). The effect sizes of PM₁₀ were 3.86% (95% CI: 2.48-5.27%), 3.73% (95% CI: 1.72-5.79%), and 3.92% (95% CI: 2.65-5.21%), respectively, at lag 0-13 days, lag 13 days, and lag 13 days, respectively, and no statistically significant difference was observed between T2D groups (z = 0.24, P = 0.81). Significant difference was not observed between T2D groups for the associations of PM and different RD and could be found between three groups for effects of PM₁₀ on RD without T2D. The E-R curves varied by sex, age and T2D condition subgroups for the associations between PM and daily RD admissions.

CONCLUSIONS: Short-term PM exposure was associated with increased RD admission with and without T2D, and the effect size of PM_2.5 was higher in patients with T2D than those without T2D.

PMID:34592518 | DOI:10.1016/j.ecoenv.2021.112794

J Basic Clin Physiol Pharmacol. 2020 Nov 19;32(5):899-910. doi: 10.1515/jbcpp-2020-0107.

ABSTRACT

OBJECTIVES: The objective of this study is to explore the efficacy and safety of N-acetyl-cysteine (NAC) as adjuvant therapy in female infertility.

CONTENT: We performed a systematic literature search of PubMed, Cochrane Library, Embase, and Ovid databases through April 2019 for Randomized Controlled Trials (RCTs) evaluating the effectiveness and safety of NAC as adjuvant therapy in female infertility. The outcomes assessed were rates of ovulation, pregnancy, miscarriage and multiple pregnancy, presented as pooled odds ratio with 95% confidence interval (CI) using the random-effects model. Heterogeneity and inconsistency of the measurements were identified through Cochrane’s Q statistic and I2 statistic. We also performed a sensitivity analysis, publication bias (using funnel plot and Begg’s test), and subgroup analysis.

SUMMARY: Fifteen RCTs recruiting 2330 female receiving NAC were included. The pooled estimate showed the statistically insignificant improvement in outcomes; clinical pregnancy rate 1.55 (95% CI 0.98-2.47; I2=68%; p<0.01), ovulation rate 1.77 (95% CI 0.76-4.14; I2=90%; p<0.01), multiple pregnancy rate 0.83 (95% CI 0.34-1.99; I2=10%; p=0.31) and miscarriage rate 0.76 (95% CI= 0.37, 1.53; I2=0%; p=0.69) . NAC was found less efficacious and safe than metformin in all outcomes. Overall, NAC showed statistically insignificant (OR=0.98-2.47).

OUTLOOK: NAC can be an effective adjuvant in PCOS related and unexplained female infertility. The effect could be more profound in women with high BMI, insulin resistance, and oxidative stress. However, the findings need further confirmation in well-designed randomized controlled trials to examine clinical outcomes such as live birth rate in more extended follow-up periods.

PMID:34592079 | DOI:10.1515/jbcpp-2020-0107

Orthod Craniofac Res. 2021 Sep 30. doi: 10.1111/ocr.12539. Online ahead of print.

ABSTRACT

OBJECTIVE: To examine the level of agreement between the conventional method and a machine learning approach to facial midline determination and asymmetry assessment.

SETTINGS AND SAMPLE POPULATION: The study included a total of 90 samples (53 female; 37 male) with different levels of mandibular asymmetry.

MATERIALS AND METHODS: Two researchers placed predefined soft tissue landmarks individually on selected facial frontal photographs and created 10 reference lines. The midsagittal line was determined as perpendicular to the midpoint of the bipupillary line, and the same two reference lines and facial landmarks were automatically determined by the software using machine learning algorithms, and researchers created the other 8 reference lines using the facial landmarks that were determined automatically by the software. In the following stage, 2 linear and 10 angular measurements were made by a single researcher on 270 photographs, and the consistency and differences between the measurements were evaluated with a one sample t-test, an intraclass correlation coefficient (ICC) and Bland-Altman Plots.

RESULTS: The level of agreement of measurements between the researchers and the software was low for eight parameters (ICC˂0.70). The one-sample t-test revealed that differences between the software and researcher measurements of lip canting and pronasale deviation were not statistically significantly different (P>0.05). Aside from the body inclination difference in Group 3 (samples with a mandibular body inclination difference >6°), there was no clinically significant difference (˂3°) between the measurements of the two methods.

CONCLUSIONS: Machine learning algorithms have the potential for clinical use in asymmetry assessment and midline determination, and can help clinicians in a manual approaches.

PMID:34592067 | DOI:10.1111/ocr.12539

Int J Biostat. 2021 Sep 29. doi: 10.1515/ijb-2021-0012. Online ahead of print.

ABSTRACT

The accelerated failure time mixture cure (AFTMC) model is widely used for survival data when a portion of patients can be cured. In this paper, a Bayesian semiparametric method is proposed to obtain the estimation of parameters and density distribution for both the cure probability and the survival distribution of the uncured patients in the AFTMC model. Specifically, the baseline error distribution of the uncured patients is nonparametrically modeled by a mixture of Dirichlet process. Based on the stick-breaking formulation of the Dirichlet process, the techniques of retrospective and slice sampling, an efficient and easy-to-implement Gibbs sampler is developed for the posterior calculation. The proposed approach can be easily implemented in commonly used statistical softwares, and its performance is comparable to fully parametric method via comprehensive simulation studies. Besides, the proposed approach is adopted to the analysis of a colorectal cancer clinical trial data.

PMID:34592069 | DOI:10.1515/ijb-2021-0012

Eur J Pain. 2021 Sep 30. doi: 10.1002/ejp.1870. Online ahead of print.

ABSTRACT

OBJECTIVE: To develop a mapping and umbrella review with a meta-meta-analysis (MMA) to critically evaluate the current evidence of motor imagery (MI), action observation and mirror therapy (MT) on pain intensity.

METHODS: The study involved a systematic search of PubMed, PEDro, Scielo, EBSCO and Google Scholar, RESULTS: Ten systematic reviews were included in the qualitative synthesis, 70% of which showed high methodological quality. Three reviews found significant reduction in chronic musculoskeletal pain as the result of applying movement representation methods (MRM) plus usual-care (UC), with a large clinical effect (standardised mean difference [SMD] of -1.47; 95% CI -2.05 to -0.88; heterogeneity Q=1.66; p=0.44; I² =0%). However, two reviews showed no statistically significant reduction in acute and postsurgical pain as a result of applying MI plus UC. Four reviews showed no significant reduction in phantom limb pain (PLP) as a result of applying MT plus UC interventions. In four reviews, the MMA showed significant reduction in complex regional pain syndrome (CRPS) as a result of applying MT plus UC, with a large clinical effect (SMD -1.27; 95% CI -1.87 to -0.67; heterogeneity Q=3.95; p=0.27; I² =24%). In 2 reviews, the MMA showed no significant differences in poststroke pain as a result of applying MT plus UC.

CONCLUSION: Results show that MRM could be effective for chronic musculoskeletal pain, with low to moderate-quality evidence. The results also show a reduction in pain intensity through MT interventions in patients with CRPS, although these results were not found in patients with PLP or poststroke pain.

PMID:34592050 | DOI:10.1002/ejp.1870

Vet Med Sci. 2021 Sep 30. doi: 10.1002/vms3.649. Online ahead of print.

ABSTRACT

BACKGROUND: Septic arthritis (SA) due to Staphylococcus aureus is a major cause of lameness in poultry with improper response to antimicrobial therapy.

OBJECTIVES: The study evaluates the effect of prophylactic administration of vitamin C on SA induced by methicillin resistant S. aureus in chickens.

METHODS: One hundred and twenty chickens were randomly assigned into four groups: I. Negative control (NC), II. Positive control (PC) with SA induced at the age of 35 days by intra articular injection of S. aureus. III. Vehicle control (VC) and IV. Arthritic vitamin C-treated (VitC) group (15 g/100 L of drinking water from day 25 to the end of the experiment). Samplings were performed on day 44 (sampling 1) and day 54 (sampling 2) of age.

RESULTS: Arthritic birds showed an obvious decrease in body weight with severe clinical arthritis and lameness which were not significantly affected by vitamin C administration at both samplings. Moreover, marked increase in serum malondialdehyde (MDA) concentration of the PC group was observed in sampling 1. Administration of vitamin C successfully reduced MDA concentration at both samplings. In sampling 2, birds in the VitC group showed significantly higher total antioxidant capacity (TAC) than NC birds (p < 0.05). Interleukin-6 concentration in synovial fluid of chickens remained statistically similar among groups in both samplings, while histopathological changes were ameliorated in the VitC group in sampling 2.

CONCLUSIONS: Prophylactic administration of vitamin C especially for relatively longer period can ameliorate oxidative stress and histopathological changes due to staphylococcal arthritis in chickens, although it is not associated with a significant effect on clinical manifestations of the disease.

PMID:34592062 | DOI:10.1002/vms3.649

J Magn Reson Imaging. 2021 Sep 30. doi: 10.1002/jmri.27943. Online ahead of print.

ABSTRACT

BACKGROUND: The accuracy of the estimated diffusion tensor elements can be improved by using a well-chosen magnetic resonance imaging (MRI) diffusion gradient encoding scheme (DGES). Conversely, diffusion tensor imaging (DTI) is typically challenged by the subject’s motion during data acquisition and results in corrupted image data.

PURPOSE: To identify a reliable DGES based on the golden ratio (GR) that can generate an arbitrary number of uniformly distributed directions to precisely estimate the DTI parameters of partially acquired datasets owing to subject motion.

STUDY TYPE: Prospective.

POPULATION: Simulations study; three healthy volunteers.

FIELD STRENGTH/SEQUENCE: 3 T/DTI data were obtained using a single-shot echo planar imaging sequence.

STATISTICAL TESTS: A paired sample t-test and the Wilcoxon test were used, P < 0.05 was considered statistically significant.

ASSESSMENT: Two corrupted scenarios A and B were considered and evaluated. For the simulation study, the GR DGES and generated subsets were compared with the Jones and spiral DGESs by electric potential (EP) and condition number (CN). For the human study, the specific subsets A and B selected from scenarios A and B were used for MRI to evaluate fractional anisotropic (FA) map.

RESULTS: For the simulation study, the EPs of the GR (14034.25 ± 12957.24) DGES were significantly lower than the Jones (15112.81 ± 13926.08) and spiral (14297.49 ± 13232.94) DGESs. CN variations of GR (1.633 ± 0.024) DGES were significantly lower than Jones (1.688 ± 0.119) and spiral (4.387 ± 2.915) DGESs. For the human study, GR (0.008 ± 0.020) DGES performed similarly with Jones (0.008 ± 0.022) DGES and was superior to spiral (0.022 ± 0.054) DGES in the FA map error.

DATA CONCLUSION: The GR DGES ensured that directions of the complete sets and subsets were uniform. The GR DGES had lower error propagation sensitivity, which can help image infants or patients who cannot stay still during scanning.

LEVEL OF EVIDENCE: 2 TECHNICAL EFFICACY: Stage 1.

PMID:34592036 | DOI:10.1002/jmri.27943

Oral Dis. 2021 Sep 30. doi: 10.1111/odi.14037. Online ahead of print.

ABSTRACT

OBJECTIVE: The present study was aimed to comprehensively characterize the epidemiological, clinicopathological characteristics, treatments, and prognosis of intraoral spindle cell carcinoma (SpCC).

MATERIALS AND METHODS: Patients diagnosed with intraoral SpCC at our institution in the past 15 years (2005-2019) were screened from inpatient disease registry. All relevant data concerning patients with intraoral SpCC were retrieved. Previous reports about intraoral SpCC with adequate clinicopathological data in both English and Chinese literature were collected. Eligible cases were further reviewed and pooled for statistical analyses.

RESULTS: Six patients (5 females, 1 male; average age: 59 years) with intraoral SpCC were histopathologically diagnosed and surgically treated at our institution. The literature review identified another 63 published cases from 34 articles. Most cases were presented in the fifth to seventh decade of life with a male preponderance. Gingiva (23/69, 33.3%) was the most common site followed by the tongue (19/69, 27.5%), and buccal mucosa (8/69, 11.6%). Complete surgical ablation remains the primary treatment option. Tumor size, pathological grades, cervical node metastasis, and distant metastasis were significantly associated with reduced survival.

CONCLUSIONS: Intraoral SpCC is an uncommon and aggressive malignancy with dismal prognosis. Much attention and effort are needed to characterize this rare entity and improve its clinical outcomes.

PMID:34592043 | DOI:10.1111/odi.14037

Eur J Pain. 2021 Sep 30. doi: 10.1002/ejp.1866. Online ahead of print.

ABSTRACT

BACKGROUND: Internet-delivered cognitive behavioural pain management programs (PMPs) are effective, but less is known about their use outside of research trials. Five years of data from offering the internet-delivered cognitive behavioural PMP in an online therapy clinic was examined to assess effectiveness, acceptability, and predictors of outcomes.

METHODS: Patients (n = 293) were offered a previously validated 8-week internet-delivered cognitive behavioural PMP and administered measures at pre-treatment, post-treatment and 3-months.

RESULTS: There was growth in demand for an internet-delivered cognitive behavioural PMP over time (n = 64 first year to n = 133 fifth year). Moderate-to-large improvements on depression (post-treatment 35% reduction; 3-month 41% reduction) and anxiety (post-treatment 37% reduction; 3-month 41% reduction), and small-to-moderate improvements on disability (post-treatment 19% reduction; 3-month 20% reduction) were found. Lesson completion and satisfaction were high. Lower pain acceptance, lower pain self-efficacy, and higher pain intensity were associated with lower improvements on depression, anxiety and disability.

CONCLUSIONS: This longitudinal observational study provides support for internet-delivered cognitive behavioural PMPs when offered as routine care by an online therapy clinic.

PMID:34592026 | DOI:10.1002/ejp.1866