Category: Nevin Manimala

PLoS One. 2021 Apr 26;16(4):e0250226. doi: 10.1371/journal.pone.0250226. eCollection 2021.

ABSTRACT

While antimicrobial resistance (AMR) continues to be a major public health problem in Pakistan, data regarding trends of resistance among pathogenic bacteria remains scarce, with few studies presenting long-term trends in AMR. This study was therefore designed to analyze long-term AMR trends at a national level in Pakistan. We report here results of a comprehensive analysis of resistance, among pathogens isolated from blood and cerebrospinal fluid (CSF), between 2011 and 2015. Susceptibility data was obtained from a local laboratory with collection points all across Pakistan (Chughtai Laboratory). Resistance proportions to most commonly used antimicrobials were calculated for each pathogen over a period of five years. While Acinetobacter species demonstrated highest resistance rates to all tested antimicrobials, a sharp increase in carbapenem resistance was the most noticeable (50%-95%) between 2011-2015. Our results also highlight the presence of third and fourth generation cephalosporins resistance in Salmonella enterica serovar Typhi in Pakistan. Interestingly, where rise in AMR was being observed in some major invasive pathogens, decreasing resistance trends were observed in Staphylococcus aureus, against commonly used antimicrobials. Overall pathogens isolated from blood and CSF between 2011-2015, showed an increase in resistance towards commonly used antimicrobials.

PMID:33901205 | DOI:10.1371/journal.pone.0250226

PLoS One. 2021 Apr 26;16(4):e0250298. doi: 10.1371/journal.pone.0250298. eCollection 2021.

ABSTRACT

BACKGROUND: Hospital readmissions place a major burden on patients and health care systems worldwide, but little is known about patterns and timing of readmissions in Germany.

METHODS: We used German health insurance claims (AOK, 2011-2016) of patients ≥ 65 years hospitalized for acute myocardial infarction (AMI), heart failure (HF), a composite of stroke, transient ischemic attack, or atrial fibrillation (S/AF), chronic obstructive pulmonary disease (COPD), type 2 diabetes mellitus, or osteoporosis to identify hospital readmissions within 30 or 90 days. Readmissions were classified into all-cause, specific, and non-specific and their characteristics were analyzed.

RESULTS: Within 30 and 90 days, about 14-22% and 27-41% index admissions were readmitted for any reason, respectively. HF and S/AF contributed most index cases, and HF and COPD accounted for most all-cause readmissions. Distributions and ratios of specific to non-specific readmissions were disease-specific with highest specific readmissions rates among COPD and AMI.

CONCLUSION: German claims are well-suited to investigate readmission causes if longer periods than 30 days are evaluated. Conditions closely related with the primary disease are the most frequent readmission causes, but multiple comorbidities among readmitted cases suggest that a multidisciplinary care approach should be implemented vigorously addressing comorbidities already during the index hospitalization.

PMID:33901203 | DOI:10.1371/journal.pone.0250298

J Perinat Neonatal Nurs. 2021 Apr-Jun 01;35(2):188-195. doi: 10.1097/JPN.0000000000000547.

ABSTRACT

The purpose of this randomized controlled study was to determine the effect of 3 positions given to preterm infant during heelstick procedure on the pain and durations of crying and procedure. The sample of the study consisted of 90 preterm infants (30 in each group). The heelstick procedure was video recorded. Data from the pain scores, durations of crying, and procedure were collected watching the video recordings. It was determined that the pain mean score of the infants in the control group (supine on the crib) (5.50 ± 2.13) was statistically significantly higher than that of the infants in the positions of upright (3.00 ± 2.17) and supine on the lap (3.20 ± 2.46) (P < .01), and there was no difference between the positions of upright and supine on the lap (P > .05). Giving the positions of upright or supine on the lap during heelstick is effective in reducing pain, shortening the duration of crying, and calming down the infant. Heelstick in the position of upright on the lap shortened the procedure duration and allowed the infants to be subjected to less painful procedure. It is recommended for nurses to take the preterm infants on their laps during heel lancing and give them the upright position, in particular.

PMID:33900249 | DOI:10.1097/JPN.0000000000000547

J Strength Cond Res. 2021 May 1;35(5):1187-1193. doi: 10.1519/JSC.0000000000004031.

ABSTRACT

Walts, CT, Murphy, SM, Stearne, DJ, Rieger, RH, and Clark, KP. Effects of a flexible workout system on performance gains in collegiate athletes. J Strength Cond Res 35(5): 1187-1193, 2021-Although research on the topic of periodization is abundant, investigations into different flexible periodization strategies in collegiate athletes are limited. Furthermore, how state of readiness (SOR) and workout autonomy affect training improvements is largely unknown. Therefore, the purpose of this study was to determine if a flexible periodization (FP) program would elicit significantly greater performance gains compared with a nonflexible periodization (NP) program (significance set p ≤ 0.05). A total of 32 male and female intercollegiate lacrosse players completed performance measures of vertical jump, sprinting speed, change of direction, and strength in bench press and deadlift. After pretesting, subjects were matched and randomly assigned to either FP (n = 17, age = 19.4 ± 1.4 years, height = 1.72 ± 0.10 m, mass = 72.29 ± 13.73 kg) or NP (n = 15, age = 19.9 ± 1.5 years, height = 1.72 ± 0.08 m, mass = 71.68 ± 13.55 kg) training groups. Both groups trained 3 days per week for 8 weeks. The NP group completed all workout volume and intensity as prescribed by a certified strength and conditioning coach. However, the FP group modified workout volume and intensity based on a daily SOR questionnaire. Although appreciable pretest to posttest improvements were observed for the entire subject cohort, multivariate analysis of variance (ANOVA) and a series of ANOVA tests demonstrated no statistically significant between-group differences for pretest to posttest changes on any of the performance tests (range of p values: 0.17-0.95). Although FP does not seem to be more effective than NP for eliciting performance gains, it may provide greater opportunities for autonomy while eliciting equivalent improvement levels. Therefore, flexible periodization based on SOR may be a viable training strategy.

PMID:33900253 | DOI:10.1519/JSC.0000000000004031

Food Funct. 2021 Apr 21;12(8):3352-3365. doi: 10.1039/d0fo02808h. Epub 2021 Mar 31.

ABSTRACT

BACKGROUND: Radiotherapy-induced mucositis easily arouses oral ulceration, pain and xerostomia. Intense pain, difficulty swallowing and speaking greatly affect the quality of life and the treatment process.

OBJECTIVE: This study aimed to examine the effects of honey in preventing and treating radiotherapy-induced mucositis in patients with head and neck cancer using a different analytical strategy.

METHODS: Articles published until July 2020 were searched across PubMed, Embase, and Cochrane Library databases. Randomized controlled trials that evaluated honey were assessed by two reviewers. The number of mucositis incidences was the primary outcome. Weight loss, pain scale and incidence of severe pain were pooled to be calculated as secondary outcomes. Statistical analyses were conducted using RevMan5.3 software. The funnel plot was used to detect publication bias.

RESULTS: Overall, 11/179 records with 715 patients who received radiotherapy were included. Honey significantly reduced the incidence of grade 2 (OR: 0.43, 95%CI: 0.54-0.98, P = 0.03), grade 3 (odds ratio [OR]: 0.24, 95% confidence interval [CI]: 0.16-0.35, P < 0.001) and grade 4 mucositis (OR: 0.17, 95%CI: 0.08-0.36, P < 0.001). In grade 1 (OR: 1.54, 95%CI: 1.15-2.06, P = 0.003), and honey was not significant in preventing radiation-induced mucositis. The incidence of unbearable pain was lower in the honey group at all grades (OR: -0.20, 95%CI: -0.33 to -0.07). The effect of honey on weight loss and pain score was not statistically significant.

CONCLUSION: Honey can prevent and alleviate grade 2-4 mucositis, especially in high grade mucositis. Honey also provides some relief from severe pain. But, more evidence is required to prove that honey is an effective substance for relieving pain or minimizing weight loss.

PMID:33900311 | DOI:10.1039/d0fo02808h

Surg Laparosc Endosc Percutan Tech. 2021 Apr 23. doi: 10.1097/SLE.0000000000000944. Online ahead of print.

ABSTRACT

BACKGROUND: The aim of this study is to investigate the current management strategy of indirect hernia sac during laparoscopic inguinal hernia repair.

OBJECTIVES: The aim was to evaluate the various indirect hernia sac management strategies when performing laparoscopic inguinal hernia repair.

DATA SOURCES: Major databases (PubMed, Embase, Springer, and Cochrane Library).

REVIEW METHODS: MeSH and free-text searching include “laparoscopic inguinal hernia” “TAPP,” “TEP,” “inguinal hernia,” “indirect inguinal hernia sac,” “distal sac,” “sac transection,” “sac ligation,” and “sac reduction.”

RESULTS: The present study enrolled 7 trials, 4 studies compared the results of indirect hernia sac transection and complete sac reduction. The pooled results indicated that indirect hernia sac transection was associated increased seroma formation (odds ratio=2.74, 95% confidence interval: 1.41-4.31), and there was no statistical difference in the incidence of postoperative pain, operative time, hernia recurrence, and time to return to normal activity between the sac transection and sac reduction groups. Two studies reported the application of adjuncts in the management of distal sac during laparoscopic large inguinoscrotal hernia repair. The seroma formation could be reduced by adjuncts of fixing the distal hernia sac to posterior abdominal wall with either suture or tacks.

CONCLUSION: Indirect sac transection during laparoscopic indirect inguinal hernia repair is associated with a higher incidence of postoperative seroma. Additional adjuncts to the divided distal hernia sac, including distal sac fixation with either suture or tacks, are effective methods to prevent postoperative seroma.

PMID:33900225 | DOI:10.1097/SLE.0000000000000944

Otol Neurotol. 2021 Apr 26. doi: 10.1097/MAO.0000000000003152. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess clinical symptoms, signs, and radiographic evolution of middle cerebellar peduncle (MCP) diffusion restriction (DR) abnormalities following vestibular schwannoma (VS) resection.

STUDY DESIGN: Retrospective chart and imaging review.

SETTING: Tertiary-referral neurotology and neurosurgery practice.

PATIENTS: All consecutive patients who underwent translabyrinthine VS resection over a 2-year period (August 2017-May 2019).

INTERVENTION: Translabyrinthine craniotomy for VS resection.

MAIN OUTCOME MEASURES: Magnetic resonance imaging (MRI) obtained on postoperative day 1 were reviewed for DR within the pons and cerebellum, with 3 months follow-up MRI to assess for evolution of these vascular changes.

RESULTS: Of the 31 patients who met inclusion criteria, MRI demonstrated MCP DR consistent with acute ischemia in 29% (9/31). Of those, two showed corresponding T2 signal abnormalities on follow up MRI consistent with cerebrovascular accident (CVA) within the MCP. Both had severe gait ataxia and dysmetria requiring acute rehabilitation admission and significantly larger tumors (p = 0.02). The remaining seven were asymptomatic, and DR abnormality resolved without lasting radiographic changes. Brainstem compression was present in 100% of patients with postoperative MCP DR (mean MCP ipsilateral:contralateral ratio 0.59 ± 0.19), and 68.1% of those without (mean MCP ratio 0.71 ± 0.25), a difference that was not statistically significant (p = 0.14). In the two patients with CVA, MCP asymmetry persisted, whereas the asymmetry resolved in all others.

CONCLUSIONS: Asymptomatic acute MCP ischemia discovered incidentally does not require intervention. However, when the ischemic area is large and patients are symptomatic, especially if an acute rehabilitation admission is required, surgeons should suspect true CVA.

PMID:33900231 | DOI:10.1097/MAO.0000000000003152

J Perinat Neonatal Nurs. 2021 Apr-Jun 01;35(2):123-131. doi: 10.1097/JPN.0000000000000552.

ABSTRACT

Triage and the timing of admission of low-risk pregnant women can affect the use of augmentation, epidural, and cesarean. The purpose of this analysis was to explore these outcomes in a community hospital by the type of provider staffing triage. This was a retrospective cohort study of low-risk nulliparous women with a term, vertex fetus laboring in a community hospital. Bivariate and multivariable statistics evaluated associations between triage provider type and labor and birth outcomes. Patients in this sample (N = 335) were predominantly White (89.5%), with private insurance (77.0%), and married (71.0%) with no significant differences in these characteristics by triage provider type. Patients admitted by midwives had lower odds of oxytocin augmentation (adjusted odds ratio [aOR] = 0.50, 95% confidence interval [CI] = 0.29-0.87), epidural (aOR = 0.29, 95% CI = 0.12-0.69), and cesarean birth (aOR = 0.308, 95% CI = 0.14-0.67), compared with those triaged by physicians after controlling for patient characteristics and triage timing. This study provides additional context to midwives as labor triage providers for healthy, low-risk pregnant individuals; however, challenges persisted with measurement. More research is needed on the specific components of care during labor that support low-risk patients to avoid medical interventions and poor outcomes.

PMID:33900241 | DOI:10.1097/JPN.0000000000000552

Emerg Infect Dis. 2021 May;27(5). doi: 10.3201/eid2705.203583.

ABSTRACT

A surveillance system that uses census tract resolution and the SaTScan prospective space-time scan statistic detected clusters of increasing severe acute respiratory syndrome coronavirus 2 test percent positivity in New York City, NY, USA. Clusters included one in which patients attended the same social gathering and another that led to targeted testing and outreach.

PMID:33900181 | DOI:10.3201/eid2705.203583

J Med Internet Res. 2021 Apr 26;23(4):e25333. doi: 10.2196/25333.

ABSTRACT

BACKGROUND: Growing evidence supports the benefits of eHealth interventions to increase patient engagement and improve outcomes for a range of conditions. However, ineffective program delivery and usage attrition limit exposure to these interventions and may reduce their effectiveness.

OBJECTIVE: This study aims to evaluate the delivery fidelity of an eHealth intervention, describe use patterns, compare outcomes between low and high users, and identify mediating factors on intervention delivery and receipt.

METHODS: This is a mixed methods study of an internet-based intervention being evaluated for effectiveness in a randomized controlled trial (RCT). The intervention comprised medication and cardiovascular disease (CVD) risk data uploaded from the primary care electronic health record (EHR); interactive, personalized CVD risk score estimation; goal setting and self-monitoring; an interactive social forum; and optional receipt of heart health messages. Fidelity was assessed over 12 months. Trial outcomes were compared between low and high users. Data sources included program delivery records, web log data, trial data, and thematic analysis of communication records.

RESULTS: Most participants in the intervention group (451/486, 93%) had an initial training session conducted by telephone (413/447, 92.4% of participants trained), with a mean duration of 44 minutes (range 10-90 minutes). Staff conducted 98.45% (1776/1804) of the expected follow-ups, mostly by telephone or email. Of the 451 participants who commenced log-ins, 46.8% (211) were categorized as low users (defined as at least one log-in in 3 or fewer months of follow-up), 40.4% (182) were categorized as high users (at least one log-in in more than 3 months of follow-up), and 12.8% (58) were nonadopters (no log-ins after their training session). The mean log-in frequency was 3-4 per month in ongoing users. There was no significant difference between the groups in the primary trial outcome of adherence to guideline-recommended medications (P=.44). In unadjusted analyses, high users had significantly greater eHealth literacy scores (P=.003) and were more likely to meet recommended weekly targets for fruit (P=.03) and fish (P=.004) servings; however, the adjusted findings were not significant. Interactive screen use was highest for goal tracking and lowest for the chat forum. Screens with EHR-derived data held only an early interest for most users. Fidelity measures (reach, content, dose delivered, and dose received) were influenced by the facilitation strategies used by staff, invisible qualities of staff-participant communication, and participants’ responsiveness to intervention attributes.

CONCLUSIONS: A multifeature internet-based intervention was delivered with high fidelity to the RCT protocol and was regularly used by 40.4% (182/451) of users over 12 months. Higher log-in frequency as an indicator of greater intervention exposure was not associated with statistically significant improvements in eHealth literacy scores, lifestyle changes, or clinical outcomes. Attributes of the intervention and individualized support influenced initial and ongoing use.

PMID:33900204 | DOI:10.2196/25333