Category: Nevin Manimala

Am J Pharm Educ. 2021 Oct 29:8766. doi: 10.5688/ajpe8766. Online ahead of print.

ABSTRACT

Objective A virtual educational innovation was designed and implemented to simulate insurance processing for student pharmacists. Objectives of this manuscript are to evaluate the impact of a third party payer simulation on student knowledge and confidence and report student perceptions of the activity.Methods First, second, and third-year pharmacy students at four institutions completed the self-paced simulation. Knowledge was assessed by comparing results of multiple choice questions on the pre- and post-assessments and evaluated by Wilcoxon signed rank test. Confidence was assessed by the change in self-reported confidence scale measurements and compared using Chi-squared test.Results The simulation had a significant impact on student knowledge. The largest improvement was in P1s with a pre- to post-assessment average score difference (scale 0-100) of 16.55 compared to 7.17 for P2s and 10.23 for P3s. The majority of the knowledge questions demonstrated statistically significant improvement, with variation for certain questions between groups. All groups had significantly improved self-rated confidence in their abilities. Most students agreed that they would recommend this activity to other students (91.7%) and it encouraged them to think about the material in a new way (85%).Conclusions Through an innovative simulation on prescription insurance processing, positive results were seen across all 3 levels of learners. Knowledge assessments significantly improved and student confidence increased across all groups and all confidence questions. Participants recommend this activity to other students and felt it was an effective way to learn about insurance adjudication.

PMID:34716136 | DOI:10.5688/ajpe8766

Pediatr Neonatol. 2021 Oct 12:S1875-9572(21)00180-7. doi: 10.1016/j.pedneo.2021.06.020. Online ahead of print.

ABSTRACT

BACKGROUND: Kawasaki disease (KD) is a form of systemic vasculitis that primarily affects children under the age of 5 years old. Antibiotics are often prescribed for KD patients even before a diagnosis is made due to their prolonged fever and elevated inflammatory markers. Therefore, the purpose of this study was to investigate the impact of antibiotics usage on the disease outcome of KD.

METHODS: We carried out a retrospective chart review of children between 2005 and 2017 for initial immunoglobulin (IVIG) treatment of KD. KD children with initial IVIG treatment more than 10 days after the onset of symptoms were excluded.

RESULTS: In total, 280 children were eligible for this study, among which 209 had been treated with antibiotic(s) and 71 had not been. The IVIG resistance rates were 5.6% (4/71), 8.9% (10/112), and 21.6% (21/97) in non-users, single-drug users, and multiple-drug users, respectively (r = 0.205, p = 0.003). The IVIG resistance rate of the multiple antibiotics drug users in KD patients was significantly higher than the other two groups. Furthermore, the likelihood of IVIG resistance was found to increase with elevated C-reactive protein (CRP) values (1.010/unit, p < 0.001) but not with total white blood cell (WBC) count (p = 0.466).

CONCLUSION: The probability of IVIG resistance increases with elevated CRP values and the use of multiple IV antibiotics, thus indicating that physicians should be prudent in administering multiple IV antibiotics when treating assumed infections in KD children.

PMID:34716128 | DOI:10.1016/j.pedneo.2021.06.020

Am J Pharm Educ. 2021 Oct 29:8659. doi: 10.5688/ajpe8659. Online ahead of print.

ABSTRACT

Objective. This study’s principal aim was to assess the moral development of undergraduate pharmacy students and alumni at a university in Jordan.Methods. Using the Professional Ethics in Pharmacy (PEP) test, 512 pharmacy students’ and alumni’s moral reasoning was assessed in a cross-sectional design.Results. The response rate was 49%. The P-score median was 16.7, with no statistical difference observed across all five cohorts. No statistically significant differences in medians P-score between males and females were found (16.7 versus 20, respectively). Also, no statistically significant differences in medians P-scores were observed between students who have completed the ethics course against those who have not completed the ethics course at the time of data collection (median P-score 20 versus 16.7 respectively). No trends in median P-scores were observed, and there were no statistically significant differences in P-scores among the five cohorts.Conclusion. Professional moral reasoning of prospective pharmacists in this study was lower than expected. A further longitudinal study of the cohort, which attempts to correlate moral development with age, sex, education level, and moral education strategy, is warranted.

PMID:34716133 | DOI:10.5688/ajpe8659

Prim Care Diabetes. 2021 Oct 26:S1751-9918(21)00186-8. doi: 10.1016/j.pcd.2021.10.002. Online ahead of print.

ABSTRACT

AIM: To establish two scoring models for identifying individuals at risk of developing Impaired Glucose Metabolism (IGM) or Type two Diabetes Mellitus (T2DM) in Qatari.

MATERIALS AND METHODS: A sample of 2000 individuals, from Qatar BioBank, was evaluated to determine features predictive of T2DM and IGM. Another sample of 1000 participants was obtained for external validation of the models. Several scoring models screening for T2DM were evaluated and compared to the model proposed by this study.

RESULTS: Age, gender, waist-to-hip-ratio, history of hypertension and hyperlipidemia, and levels of educational were statistically associated with the risk of T2DM and constituted the Qatar diabetes mellitus risk score (QDMRISK). Along with, the 6 aforementioned variables, the IGM model showed that BMI was statistically significant. The QDMRISK performed well with area under the curve (AUC) 0.870 and .815 in the development and external validation cohorts, respectively. The QDMRISK showed overall better accuracy and calibration compared to other evaluated scores. The IGM model showed good accuracy and calibration, with AUCs .796 and .774 in the development and external validation cohorts, respectively.

CONCLUSIONS: This study developed Qatari-specific diabetes and IGM risk scores to identify high risk individuals and can guide the development of a nationwide primary prevention program.

PMID:34716113 | DOI:10.1016/j.pcd.2021.10.002

J Geriatr Oncol. 2021 Oct 26:S1879-4068(21)00239-3. doi: 10.1016/j.jgo.2021.10.007. Online ahead of print.

ABSTRACT

OBJECTIVES: To assess the toxicity patterns and effectiveness of doublet chemotherapy when administered at reduced doses of 20% (FOLFOX or FOLFIRI) in combination with anti-EGFR antibodies (cetuximab or panitumumab) in old, vulnerable patients with metastatic colorectal cancer (mCRC).

PATIENTS AND METHODS: We performed a retrospective observational study of RAS and BRAF wild-type, vulnerable patients aged ≥70 years with previously untreated mCRC. The primary endpoint was safety, and secondary endpoints were overall response rate (ORR), progression-free survival (PFS), and overall survival (OS).

RESULTS: One hundred and eighteen patients were collected from 14 selected Italian centres. The median age was 75 (range, 70-85). Geriatric screening by G8 tool gave a score ≤ 14 in all patients. In total, 75 and 43 patients received FOLFOX or FOLFIRI, respectively, in combination with panitumumab (53%) or cetuximab (47%). The overall incidence of grade (G) 3-4 neutropenia was 11.8%, and for skin rash 11%. The most frequent adverse events were G1-2 skin rash (49.1%), G1-2 diarrhea (21.1%) and G1-2 nausea (17.7%). The ORR was 57.3%. Stable disease was observed in 29.1% of patients, with a disease control rate of 86.4%. With a median follow-up of 18 months, the median PFS was 10.0 months (95% confidence interval [CI]: 8.5-11.4), while the median OS was 18.0 months (95% CI: 16.0-19.9). No statistically significant difference was observed between the regimens in terms of ORR, PFS (p = 0.908), and OS (p = 0.832).

CONCLUSION: This study shows that with an appropriate design, including reduced doses, vulnerable older patients best tolerate chemotherapy when combined with anti-EGFR antibodies.

PMID:34716122 | DOI:10.1016/j.jgo.2021.10.007

Int Orthod. 2021 Oct 26:S1761-7227(21)00125-X. doi: 10.1016/j.ortho.2021.10.002. Online ahead of print.

ABSTRACT

OBJECTIVE: The purpose of this study was to determine the effects of alveolar decortications (AD) closer and farther from the tooth on Orthodontic tooth movement (OTM) and root resorption.

MATERIALS AND METHODS: Twenty-four Wistar rats (age 17 weeks) were used in the study. Three groups were formed by randomly dividing the rats into: 1) Control Group (N=8): OTM (14 days) without any surgical insult; 2) Near Group (N=8) OTM (14 days)+Alveolar Decortications (AD) adjacent to roots of the maxillary first molar; 3) Far Group (N=8) OTM (14 days)+AD 5mm away from the roots of the maxillary first molar. OTM was performed using a closed coil Nickel-Titanium (NiTi) spring to apply a mesial force on maxillary first molars of 8-10 grams. AD was performed with high-speed quarter round bur on the palatal aspect of alveolar bone. The rats were euthanized after 2 weeks of OTM and microfocus computed tomography and histological analysis were performed.

RESULTS: Near-AD and Far-AD groups exhibited significantly increased OTM and reduction of Bone volume fraction compared to control. The root volume was significantly decreased (increased root resorption) in the Near-AD group. Histological analysis showed no statistically significant difference between the groups.

CONCLUSIONS: Alveolar decortications lead to a significant increase in the rate of OTM. Increased root resorption was observed when the alveolar decortications were performed close to the maxillary molar.

PMID:34716100 | DOI:10.1016/j.ortho.2021.10.002

J Basic Clin Physiol Pharmacol. 2021 Oct 29. doi: 10.1515/jbcpp-2020-0388. Online ahead of print.

ABSTRACT

OBJECTIVES: Ventilator-associated pneumonia (VAP) is the most common nosocomial infection in patients requiring mechanical ventilation in intensive care units (ICUs). VAP is associated with delayed extubation, prolonged hospital stays, increased healthcare costs and mortality rates. The aims of this study to evaluate the level of knowledge for the prevention of VAP among healthcare workers (HCWs) in ICUs and to assess their knowledge in relation to their socio-demographic characteristics.

METHODS: A descriptive, cross-sectional design was conducted to assess HCWs’ knowledge of the guidelines for prevention of VAP in the ICUs of public and private hospitals in Hodeida city, Yemen. Around 140 self-administered multiple-choice questionnaires were distributed between April and July 2017.

RESULTS: A total of 120 (85.6%) HCWs completed questionnaire were obtained (20 physicians, 20 anesthesia technicians and 80 nurses) in this study. The total mean score of the HCWs’ knowledge was low (41 ± 18). A statistically significant difference was found in the HCWs’ knowledge scores according to their specialties and gender. Anesthesia technicians had the highest knowledge score followed by physicians and nurses (52.2 ± 16.2, 45.6 ± 21.2 and 37.1 ± 16.9, respectively, p=0.002). Males had higher scores than females (Median [IQR] 4 [3-5] vs. 3 [2-4], p<0.001). Participants who received information about the prevention of VAP had better knowledge than those who did not (46.2 ± 17.7 vs. 36.8 ± 17.3, p=0.006).

CONCLUSIONS: HCWs had a low knowledge level of the guidelines for the prevention of VAP, which may affect their practice. HCWs’ knowledge was affected by their previous received information that increases the necessity to provide them with regular in-service education and training programs.

PMID:34714992 | DOI:10.1515/jbcpp-2020-0388

Stat Appl Genet Mol Biol. 2021 Oct 29. doi: 10.1515/sagmb-2021-0047. Online ahead of print.

ABSTRACT

The human gut microbiome has been shown to be associated with a variety of human diseases, including cancer, metabolic conditions and inflammatory bowel disease. Current approaches for detecting microbiome associations are limited by relying on specific measures of ecological distance, or only allowing for the detection of associations with individual bacterial species, rather than the whole microbiome. In this work, we develop a novel hierarchical Bayesian model for detecting global microbiome associations. Our method is not dependent on a choice of distance measure, and is able to incorporate phylogenetic information about microbial species. We perform extensive simulation studies and show that our method allows for consistent estimation of global microbiome effects. Additionally, we investigate the performance of the model on two real-world microbiome studies: a study of microbiome-metabolome associations in inflammatory bowel disease, and a study of associations between diet and the gut microbiome in mice. We show that we can use the method to reliably detect associations in real-world datasets with varying numbers of samples and covariates.

PMID:34714989 | DOI:10.1515/sagmb-2021-0047

Int J Biostat. 2021 Oct 27. doi: 10.1515/ijb-2020-0104. Online ahead of print.

ABSTRACT

This paper considers the problem of semi-parametric proportional hazards model fitting where observed survival times contain event times and also interval, left and right censoring times. Although this is not a new topic, many existing methods suffer from poor computational performance. In this paper, we adopt a more versatile penalized likelihood method to estimate the baseline hazard and the regression coefficients simultaneously. The baseline hazard is approximated using basis functions such as M-splines. A penalty is introduced to regularize the baseline hazard estimate and also to ease dependence of the estimates on the knots of the basis functions. We propose a Newton-MI (multiplicative iterative) algorithm to fit this model. We also present novel asymptotic properties of our estimates, allowing for the possibility that some parameters of the approximate baseline hazard may lie on the parameter space boundary. Comparisons of our method against other similar approaches are made through an intensive simulation study. Results demonstrate that our method is very stable and encounters virtually no numerical issues. A real data application involving melanoma recurrence is presented and an R package ‘survivalMPL’ implementing the method is available on R CRAN.

PMID:34714982 | DOI:10.1515/ijb-2020-0104

Dermatol Ther. 2021 Oct 29. doi: 10.1111/dth.15182. Online ahead of print.

ABSTRACT

AIM: Androgenetic alopecia (AGA) is a progressive hair loss disease that occurs with the effect of androgens and genetic predisposition. Hair thinning and hair loss affect people’s self-confidence and self-image more than is thought. In these patients, platelet rich plasma (PRP) treatment is used in addition to the limited medical treatments available. However, there is a lack of standardization for the application method of PRP treatment in the literature. The number of studies in which objective data and hair analysis parameters were revealed to demonstrate the effectiveness of PRP treatment is also very limited. In this study, it was aimed to show the efficacy of PRP treatment with trichoscan data in AGA patients and to compare dermapen-mediated microneedling and point by point technique injection application methods.

MATERIALS AND METHODS: The study was conducted with 62 male AGA patients, aged between 18-55 years, who applied to the University Faculty of Medicine, Department of Dermatology, and ranged from Norwood-Hamilton Stage II-V. The patients were randomly divided into two groups and one group was given microneedling with a dermapen, an electrical device that makes automatic needling, and the other group was given manual injection with point by point technique with a 30 gauge needle. Before the first treatment, each patient underwent a trichoscan hair analysis evaluation. A total of four sessions of PRP treatment were performed, as three sessions at two week intervals and the fourth session one month after the last session.

RESUTLS: The mean age of the cases was 33.13±6.36. According to Norwood-Hamilton staging, stage III was detected with the highest rate of 46% (29). Hair pulling test became significantly negative after treatment (p<0.05). Statistically significant differences were found in trichoscan analysis parameters for hair count, hair density, terminal hair count, and terminal hair density in both groups compared to pre-treatment (p<0.05). Between the groups, a statistically significant difference was found between the averages of anagen hair, telogen hair and hair length in the dermapen treated group compared to the group treated with the point by point technique.

CONCLUSION: In our study, the efficacy of PRP treatment for AGA patients was demonstrated by trichoscan parameters. Among the PRP application methods, dermapen-mediated application was found to be superior to the point by point technique in terms of anagen, telogen and average hair length parameters. This article is protected by copyright. All rights reserved.

PMID:34714961 | DOI:10.1111/dth.15182