Category: Nevin Manimala

NPJ Breast Cancer. 2021 Sep 10;7(1):119. doi: 10.1038/s41523-021-00325-6.

ABSTRACT

We conducted a systematic review and meta-analysis investigating the association between overweight and outcome in triple-negative breast cancer (TNBC) patients. We searched PubMed and Embase using variations of the search terms triple-negative breast cancer (population), overweight and/or obesity (exposure), and prognosis (outcome). Based on the World Health Organization guidelines for defining overweight, we included longitudinal observational studies, which utilized survival statistics with hazard ratios (HRs) in our analysis. The included studies measured body mass index at the time of diagnosis of TNBC and reported disease-free survival and/or overall survival. Study quality was assessed with the Newcastle-Ottawa Scale and study data were extracted using the Meta-analysis of Observational Studies in Epidemiology (MOOSE) checklist, independently by two authors. Random-effects models were used to combine the effect sizes (HRs), and the results were evaluated and adjusted for possible publication bias. Thirteen studies of 8,944 TNBC patients were included. The meta-analysis showed that overweight was associated with both shorter disease-free survival (HR = 1.26; 95%CI: 1.09-1.46) and shorter overall survival (HR = 1.29; 95%CI: 1.11c1.51) compared to normal-weight. Additionally, our Bayesian meta-analyses suggest that overweight individuals are 7.4 and 9.9 times more likely to have shorter disease-free survival and overall survival, respectively. In conclusion, the available data suggest that overweight is associated with shorter disease-free and overall survival among TNBC patients. The results should be interpreted with caution due to possible publication bias.

PMID:34508075 | DOI:10.1038/s41523-021-00325-6

Am J Phys Med Rehabil. 2021 Sep 9. doi: 10.1097/PHM.0000000000001876. Online ahead of print.

ABSTRACT

OBJECTIVE: Individuals with chronic ankle instability (CAI) experience recurring sprains and impaired proprioception, and the effect of external support in the proprioception of injured ankles is still inconsistent in existing studies. Therefore, this study aimed to investigate whether external support could enhance the proprioception of injured ankles in patients with CAI.

DESIGN: Systematic review and meta-analysis.

RESULTS: Eight studies from PubMed, Embase, Cochrane Library, Web of Science, SPORTDiscus, Scopus, and CINAHL were finally included after applying the exclusion criteria. Meta-analyses revealed a significantly higher joint position sense (JPS) on inversion with a weighted mean difference (WMD) of 1.25° and plantar flexion (WMD = 1.74°) and lower kinesthesia in eversion (WMD = -0.70°) with the application of external support in the injured ankles of patients with CAI.

CONCLUSION: Applying external support has statistically significant negative effects on kinesthesia and a positive effect on the active JPS in the injured ankles of patients with CAI. However, this study did not support the restoration of proprioception deficits as a mechanism of external support in preventing reinjuries, due to its potentially negative effect on kinesthesia, clinically small changes in proprioception, and poor methodological quality of existing studies.

PMID:34508060 | DOI:10.1097/PHM.0000000000001876

Nat Commun. 2021 Sep 10;12(1):5390. doi: 10.1038/s41467-021-25558-8.

ABSTRACT

The smooth conduct of movements requires simultaneous motor planning and execution according to internal goals. So far it remains unknown how such movement plans are modified without interfering with ongoing movements. Previous studies have isolated planning and execution-related neuronal activity by separating behavioral planning and movement periods in time by sensory cues. Here, we separate continuous self-paced motor planning from motor execution statistically, by experimentally minimizing the repetitiveness of the movements. This approach shows that, in the rat sensorimotor cortex, neuronal motor planning processes evolve with slower dynamics than movement-related responses. Fast-evolving neuronal activity precees skilled forelimb movements and is nested within slower dynamics. We capture this effect via high-pass filtering and confirm the results with optogenetic stimulations. The various dynamics combined with adaptation-based high-pass filtering provide a simple principle for separating concurrent motor planning and execution.

PMID:34508073 | DOI:10.1038/s41467-021-25558-8

J Patient Saf. 2021 Sep 9. doi: 10.1097/PTS.0000000000000913. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to record the type and frequency of errors, with an emphasis on omissions, during administration of medicines to inpatients and to investigate associated factors.

METHODS: This was a descriptive observational study. The medication process in 2 medical wards was observed by 2 observers using a structured observation form. χ2 Test, Kruskal-Wallis test, and regression analysis were used to explore associations between factors and errors.

RESULTS: From the 665 administrations observed, a total of 2371 errors were detected from which 81.2% were omissions and 18.8% were errors of commission. Omissions in the infection prevention guidelines (46.6%) and in the 5 rights of medication safety principles (35.8%) were a predominant finding. In particular, omitting to hand wash before administering a drug (98.4%), omitting to disinfect the site of injection (37.7%), and omitting to confirm the patient’s name (74.4%) were the 3 most frequently observed omissions. Documentation errors (13.1%) and administration method errors (4.5%) were also detected. Regression analysis has shown that the therapeutic class of the drug administered and the number of medicines taken per patient were the 2 factors with a statistical significance that increased the risk of a higher number of errors being detected.

CONCLUSIONS: Errors during drug administration are still common in clinical practice, with omissions being the most common type of error. In particular, omissions in the basic infection and safety regulations seem to be a very common problem. The risk of a higher number of errors being made is increased when a cardiovascular drug is administered and when the number of medicines administered per patient is increased.

PMID:34508041 | DOI:10.1097/PTS.0000000000000913

J Patient Saf. 2021 Sep 9. doi: 10.1097/PTS.0000000000000879. Online ahead of print.

ABSTRACT

OBJECTIVES: Inpatient falls are the most commonly reported safety incidents and are associated with serious injuries. This study aimed to use multifactorial interventions to reduce the delays to the diagnosis of serious injury in a time series analysis after serious incidents relating to falls within a central London Trust.

METHODS: A multiprofessional project team undertook process mapping to identify opportunities for improvement at different stages in the management of a fall. The interventions included an educational teaching session aimed at doctors, a lanyard card designed by doctors using the plan-do-study-act methodology, a falls-specific pager for radiographers, and a new system to refer to portering. Quantitative data were obtained using an serious incident database where serious injury occurred (SI data; n = 65) and routinely collected incident reporting database on falls regardless of injury (IR data; n = 178). Qualitative questionnaire data (n = 70) were also used to evaluate doctors’ confidence in falls assessment before and after interventions.

RESULTS: Results in the IR data demonstrated a significant reduction in the median (interquartile range) minutes delay in the time to review a patient after a fall from 81 (43-180) to 51 (26-112; P = 0.003) and the time to order imaging from 102 (45-370) to 50 (33-96; P = 0.04). Analysis of the SI database demonstrated a nonstatistically significant reduction in the overall time taken to detect serious injury after a fall from 348 (126-756) to 192 (108-384) minutes (P = 0.070). Furthermore, analysis using statistical process control charts showed evidence of special cause variation and a shift in the process in detecting serious harm after a fall. Junior doctors’ confidence in investigations improved from 53% to 76% (P = 0.04) after the intervention.

CONCLUSIONS: The cumulative application of multiple interventions with small individual effects resulted in a substantial positive effect on delays and variability in diagnosis of serious harm. Given a similar institutional context, the more effective interventions in our study could be adopted elsewhere.

PMID:34508042 | DOI:10.1097/PTS.0000000000000879

Comput Inform Nurs. 2021 Sep 10. doi: 10.1097/CIN.0000000000000829. Online ahead of print.

ABSTRACT

This research was conducted to determine the effect of computer-based discharge training on patients with lumbar disc surgery on self-care agency and independence in daily living activities. A randomized controlled study was conducted on 60 patients, 30 in the intervention group and 30 in the control group. Computer-based lumbar disc surgery discharge training and a CD containing the training content were given to the intervention group after the surgery, whereas the control group received routine discharge training in the ward. The data of the study were collected using a Patient Information Form, the modified Barthel Index, and the Exercise of Self-Care Agency Scale. The increase in the modified Barthel Index and Exercise of Self-Care Agency Scale scores after training in the intervention and control groups were statistically significant (P < .001). The increase in Exercise of Self-Care Agency Scale scores after the training was found to be higher in the intervention group than in the control group. There was no difference between the modified Barthel Index mean scores before and after the training between the groups (P > .05). Computer-based discharge training improved the participants’ independence in their daily living activities and increased the self-care power of the patients compared with the control group.

PMID:34508021 | DOI:10.1097/CIN.0000000000000829

J Cardiopulm Rehabil Prev. 2021 Sep 9. doi: 10.1097/HCR.0000000000000638. Online ahead of print.

ABSTRACT

PURPOSE: Exercise-based cardiac rehabilitation (CR) is essential for treating cardiovascular disease, and modifying risk factor modification, including hypertension. Because the causes of hypertension and benefits of CR are faceted, we examined the influence of phase II CR on resting blood pressure (BP).

METHODS: Outcomes straddle the release of the updated BP guidelines, and study emphases included CR session number, sex, race/ethnicity, insurance provider, and referring diagnosis.

RESULTS: Patient files of 31 885 individuals uploaded to the Montana Outcomes Project registry indicated that lowered systolic and diastolic BP were further improved after the release of the revised BP guidelines. The CR session number was proportional to improvements in diastolic BP. Blood pressure improved independent of sex, although female patients exhibited lower diastolic BP before and after CR. Race/ethnicity analyses indicated that Asian and White patients experienced drops in systolic and diastolic BP, while diastolic BP was improved in Hispanic patients. Neither American Indian nor Black patients exhibited statistically altered BP. Medicare, Veterans Administration, and privately insured patients had lowered systolic and diastolic BP, while Medicaid patients had lower diastolic BP, and the uninsured had lower systolic BP. Blood pressure outcomes were generally improved independent of the primary referring diagnosis, while those with peripheral artery disease showed no improvements.

CONCLUSIONS: Findings demonstrate that phase II CR is highly effective in the control of BP, although improvements are not equally distributed to all individuals according to differences in sex, race/ethnicity, and access to insurance-funded health care.

PMID:34508034 | DOI:10.1097/HCR.0000000000000638

Clin J Am Soc Nephrol. 2021 Sep 10:CJN.04860421. doi: 10.2215/CJN.04860421. Online ahead of print.

ABSTRACT

Background: People receiving maintenance dialysis must often rely on family members and other close persons to make critical treatment decisions toward the end of life. Contemporary data on family members’ understanding of the end-of-life wishes of members of this population are lacking. Methods: Among 172 family members of people undergoing maintenance dialysis, we ascertained their level of involvement in the patient’s care and prior discussions about care preferences. We also compared patient and family member responses to questions about end-of-life care using percent agreement and the kappa statistic. Results: The mean (SD) age of the 172 enrolled family members was 55 (±17.0) years, 136 (79%) were women, and 43 (25%) were Black. Sixty-seven (39%) family members were spouses or partners of enrolled patients. A total of 137 (80%) family members had spoken with the patient about whom they would want to make medical decisions,108 (63%) about their treatment preferences, 47 (27%) about stopping dialysis and 56 (33%) about hospice. Agreement between patient and family member responses was highest (though still fair) for the question about whether or not the patient would want cardiopulmonary resuscitation (CPR) (percent agreement 83%, kappa 0.31) and substantially lower for questions about a range of other aspects of end-of-life care including preference for mechanical ventilation (62%, 0.21), values around life prolongation versus comfort (45%, 0.13), preferred place of death (58%, 0.07), preferred decisional role (54%, 0.15) and prognostic expectations (38%, 0.15). Conclusions: Most surveyed family members reported they had spoken with the patient about their end-of-life wishes but not about stopping dialysis or hospice. While family members had a fair understanding of patients’ CPR preference, most lacked a detailed understanding of patients’ perspectives on other aspects of end-of-life care.

PMID:34507967 | DOI:10.2215/CJN.04860421

Ann Surg. 2021 Sep 9. doi: 10.1097/SLA.0000000000005114. Online ahead of print.

ABSTRACT

OBJECTIVE: This paper aims to evaluate the pediatric surgery training pipeline vis-à-vis the pediatric surgery match and operative experience of pediatric surgery fellows.

SUMMARY BACKGROUND DATA: Pediatric surgery remains a competitive surgical subspecialty. However, there is concern that operative experience for pediatric surgery fellows is changing. This paper examines the selectivity of the pediatric surgery match, along with the operative experience of pediatric surgery fellows to characterize the state of pediatric surgery training.

METHODS: The pediatric surgery fellowship match was analyzed from the National Resident Matching Program data from 2010 to 2019. Selectivity among fellowships was compared using ANOVA with Dunnett’s test. Operative log data for pediatric fellows was analyzed using the Accreditation Council for Graduate Medical Education case logs from 2009 to 2019. Linear regression analysis was used to evaluate trends in operative volume over time.

RESULTS: Pediatric surgery had the highest proportion of unmatched applicants (47.2% ± 5.3%) and lowest proportion of unfilled positions (1.4% ± 1.6%) when compared to other NRMP surgical fellowships. ACGME case log analysis revealed a statistically significant decrease in cases for graduating fellows (-5.3 cases/year, p0.05). Total index cases decreased (-4.7 cases/year, p < 0.01, R2 = 0.83) such that graduates in 2019 completed 59 fewer index operations than graduates in 2009.

CONCLUSION: Although pediatric surgery fellowship remains highly selective there has been a decline in the operative experience for graduating fellows. This highlights the need for evaluation of training paradigms and operative exposure in pediatric surgery to ensure the training of competent pediatric surgeons.

PMID:34508011 | DOI:10.1097/SLA.0000000000005114

Am J Pharm Educ. 2021 Sep 10:8676. doi: 10.5688/ajpe8676. Online ahead of print.

ABSTRACT

Objective. The objective of this study was to assess factors impacting metacognition during the advanced pharmacy practice experience (APPE) year for student pharmacists at five different institutions. Methods. Student pharmacists completed a pre- and post-APPE year survey, which collected data on demographics, curricular and co-curricular experiences, and the 19-item modified metacognition assessment inventory (MAI). Additionally, the post-APPE survey collected data on learning activities completed during the APPE year. Matched survey responses were analyzed using paired t-tests and Spearman’s correlation to identify associations between change in MAI and individual experiences. Results. A total of 139 matched responses were analyzed. A statistically significant improvement in overall student pharmacist metacognition was seen in matched pre- versus post-APPE surveys. Several statistically significant, moderate to weak correlations were associated with a change in MAI over the APPE year. Conclusion. The APPE year resulted in a statistically significant change in student pharmacists’ metacognition at five institutions. This improvement was multifactorial as individual factors had minimal association with the change in metacognition.

PMID:34507955 | DOI:10.5688/ajpe8676