Category: Statistics

Injury. 2024 Dec 3:112075. doi: 10.1016/j.injury.2024.112075. Online ahead of print.

ABSTRACT

INTRODUCTION: The aim of this trial was to investigate the impact of early thoracic and shoulder girdle exercises on chronic pain and Health-Related Quality of Life in patients with blunt chest wall trauma, when compared to normal care.

METHODS: A multi-centre, parallel, randomised controlled trial, in which adult patients presenting to hospital with blunt chest wall trauma were allocated to either control or intervention group. The intervention was an exercise programme consisting of four simple thoracic and shoulder girdle exercises, completed for one week. Outcomes measures included prevalence and severity of chronic pain using the Brief Pain Inventory, health-related quality of life using EQ-5D-5 L, and cost effectiveness, measured at initial presentation and three months post-injury.

RESULTS: 360 participants were recruited. Participants’ mean age was 63.6 years (standard deviation (SD): 17.9 years) and 213 (59.8 %) were men. After loss-to-follow-up, the survey response rate at three months was 73.0 % (251/344 participants). The primary analysis, for chronic pain prevalence at three months post-injury, found no statistically significant differences between intervention and control groups, with lower rates in the control (intervention: 35/126 (27.8 %), control: 20/117 (17.1 %); adjusted odds ratio 1.862; 95 % CI: 0.892 to 3.893, p = 0.098). There were no statistically significant differences between intervention and control groups for pain severity at three months post-injury, (intervention mean (SD): 2.15 (2.49), control: 1.81 (2.10); adjusted difference 0.196, 95 % CI:0.340 to 0.731; p = 0.473); or Health-Related Quality of Life (intervention mean (SD): 0.715 (0.291), control: 0.704 (0.265); adjusted difference: 0.030; 95 % CI:0.033 to 0.094; p = 0.350). The health economic analysis found the intervention was associated with higher costs compared to normal care.

CONCLUSION: The results of this trial did not support a ‘one-size fits all’ simple, early exercise programme for patients with blunt chest wall trauma. Future research should consider the impact of a personalised exercise programme, commenced by the patient at least one week post-injury.

PMID:39674711 | DOI:10.1016/j.injury.2024.112075

J Pediatr Nurs. 2024 Dec 13:S0882-5963(24)00449-4. doi: 10.1016/j.pedn.2024.12.004. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the effect of instructional therapeutic play on acceptance of nasal lavage in children hospitalized for respiratory conditions.

DESIGN AND METHODS: This quasi-experimental study was conducted at a teaching hospital. For the therapeutic play session, disposable gloves filled with compressed air and designed to resemble a human face, syringes, and saline solution ampoules were used. Children’s acceptance behaviors were assessed before, immediately after, and 6 h after the therapeutic play session. The data were subjected to descriptive and inferential statistical analyses.

RESULTS: Children (N = 42) aged 3-6 years, 50 % female, with a hospitalization duration of 0.2-9 days, showed increased acceptance of nasal lavage (p = 0.01), with the child self-administering the saline solution (p = 0.01), and with reduction of all resistance behaviors to nasal lavage (p < 0.05).

CONCLUSIONS: Instructional therapeutic play was effective as an educational intervention for the acceptance of nasal lavage in hospitalized children.

PRACTICE IMPLICATIONS: This study demonstrates the potential of using instructional therapeutic play, innovating the field of pediatric nursing, and expanding the international knowledge frontier of this subject. In the future, there is a need for clinical trials with control groups, larger and more heterogeneous samples, and implementation studies.

PMID:39674703 | DOI:10.1016/j.pedn.2024.12.004

J Pediatr Nurs. 2024 Dec 13:S0882-5963(24)00448-2. doi: 10.1016/j.pedn.2024.12.003. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to evaluate the impact of structured Family-Centered Care training on pediatric nurses’ attitudes toward Family-Centered Care.

METHODS: This quasi-experimental study utilized a pretest-posttest control group design with 140 pediatric nurses (70 intervention, 70 control). Conducted in public hospitals from March to August 2024, the intervention group received a four-week Family-Centered Care training. The Family-Centered Care Attitude Scale was used to measure attitudes, and data collection included a demographic data form administered both before the training and six weeks after its completion. Statistical analysis included t-tests and chi-square tests.

RESULTS: Nurses in the intervention group showed significant improvement in their attitudes toward Family-Centered Care after training, with higher posttest scores compared to the control group (P < 0.05). The control group showed no significant changes between pretest and posttest scores. These findings confirmed the hypothesis that Family-Centered Care training positively influences pediatric nurses’ attitudes.

CONCLUSIONS: Structured Family-Centered Care training significantly improved pediatric nurses’ attitudes toward Family-Centered Care, emphasizing the importance of innovative educational methods in promoting Family-Centered Care adoption in pediatric nursing.

IMPLICATIONS FOR PRACTICE: Incorporating regular Family-Centered Care training into pediatric nursing practices can foster more Family-Centered Care approaches, improve patient and family satisfaction, and promote nurses’ professional growth, ultimately enhancing the overall quality of care in pediatric settings.

PMID:39674702 | DOI:10.1016/j.pedn.2024.12.003

Acad Radiol. 2024 Dec 13:S1076-6332(24)00886-9. doi: 10.1016/j.acra.2024.11.042. Online ahead of print.

ABSTRACT

RATIONALE AND OBJECTIVES: To comprehensively assess the feasibility of low-dose computed tomography (LDCT) using deep learning image reconstruction (DLIR) for evaluating pulmonary subsolid nodules, which are challenging due to their susceptibility to noise.

MATERIALS AND METHODS: Patients undergoing both standard-dose CT (SDCT) and LDCT between March and June 2023 were prospectively enrolled. LDCT images were reconstructed with high-strength DLIR (DLIR-H), medium-strength DLIR (DLIR-M), adaptive statistical iterative reconstruction-V level 50% (ASIR-V-50%), and filtered back projection (FBP); SDCT with FBP as the reference standard. Objective assessment, including image noise, contrast-to-noise ratio (CNR), and signal-to-noise ratio (SNR), and subjective assessment using five-point scales by five radiologists were performed. Detection and false-positive rate of subsolid nodules, and morphologic features of nodules were recorded.

RESULTS: 102 patients (mean age, 57.0 ± 12.3 years) with 358 subsolid nodules in SDCT were enrolled. The mean effective dose of SDCT and LDCT were 5.37 ± 0.80mSv and 0.86 ± 0.14mSv, respectively (P < 0.001). DLIR-H showed the lowest noise, highest CNRs, SNRs, and subjective scores among LDCT groups (all P < 0.001), almost approaching comparability with SDCT. The detection rates for DLIR-H, DLIR-M, ASIR-V-50%, and FBP were 76.5%, 76.3%, 83.8%, and 72.1%, respectively (P < 0.001), with false-positive rate of 2.5%, 2.2%, 8.3%, and 1.1%, respectively (P < 0.001). DLIR-H showed the highest detection rates for morphologic features (79.4%-95.2%) compared to DLIR-M (74.6%-88.9%), ASIR-V-50% (72.0%-88.4%), and FBP (66.1%-84.1%) (all P ≤ 0.001).

CONCLUSION: Sub-milliSievert LDCT with DLIR-H offers substantial dose reduction without compromising image quality. It is promising for evaluating subsolid nodules with a high detection rate and better identification of morphologic features.

PMID:39674695 | DOI:10.1016/j.acra.2024.11.042

J Microbiol Immunol Infect. 2024 Dec 13:S1684-1182(24)00221-4. doi: 10.1016/j.jmii.2024.12.001. Online ahead of print.

NO ABSTRACT

PMID:39674684 | DOI:10.1016/j.jmii.2024.12.001

J Public Health Afr. 2024 Nov 5;15(1):683. doi: 10.4102/jphia.v15i1.683. eCollection 2024.

ABSTRACT

BACKGROUND: Healthcare workers (HCWs) are a priority group targeted for vaccination because they are greatly exposed to infectious agents.

AIM: To determine the prevalence of coronavirus disease 2019 (COVID-19) vaccination and associated risk factors for vaccine hesitancy to recommend vaccine uptake strategies among student nurses.

SETTING: The study was carried out at the University of Namibia, main campus in Windhoek.

METHODS: A cross-sectional study was undertaken using a proportionate stratified sampling method. The total sample for the study was 509 students. Statistical Package for the Social Sciences (SPSS) 29 was used to analyse data. Frequencies and proportions were calculated. Bivariate analysis and multiple logistic regression were conducted to pronounce the predictors for vaccine hesitancy.

RESULTS: Only 31.40% students were vaccinated against COVID-19. Out of the vaccinated, 41.80% (p < 0.001) were previously infected with COVID-19. Participants who were not HCWs before nursing school were most likely not to be vaccinated (p < 0.001). Most unvaccinated students were hesitant because of a lack of information about the COVID-19 vaccine’s side effects (50.36%) and not knowing its effectiveness (38.13%). A total 60.80% of the participants believed a vaccine was needed to overcome the pandemic.

CONCLUSION: We recommend the creation of targeted awareness campaigns that shed more light on the benefits of vaccination and vaccine side effects.

CONTRIBUTION: The study identifies key factors that can be targeted to change student nurses’ behaviour towards vaccination and offers valuable data that can inform preparedness and response strategies for future pandemics in Namibia and similar regions.

PMID:39649438 | PMC:PMC11622604 | DOI:10.4102/jphia.v15i1.683

Curr Ther Res Clin Exp. 2024 Aug 24;101:100757. doi: 10.1016/j.curtheres.2024.100757. eCollection 2024.

ABSTRACT

PURPOSE: We describe nirmatrelvir/ritonavir (NMV/r) effectiveness in preventing hospitalization among COVID-19 patients at high risk of severe disease.

METHODS: An ongoing US population-based observational cohort study with retrospective and prospective collection of national electronic healthcare data collected from the US Optum® deidentified COVID-19 Electronic Health Record dataset during December 22, 2021-July 20, 2022. Participants were ≥12 years old; had a positive SARS-CoV-2 test, COVID-19 diagnosis, or NMV/r prescription; and were at high risk of severe COVID-19 based on demographic/clinical characteristics. Potential confounders between groups were balanced using propensity score matching. Immortal time bias was addressed. Hospitalization rates within 30 days from COVID-19 diagnosis were evaluated. Sensitivity analyses included 15-day hospitalization, chart review to investigate incidental hospitalization effects, and exclusion of patients identified as having COVID-19 based on NMV/r prescription alone. Outcomes were also evaluated by race, age, and COVID-19 vaccine status.

FINDINGS: Overall, 12,440 and 234,123 patients were included in the NMV/r and non-NMV/r groups, respectively. After propensity score matching, baseline characteristics were well balanced across groups (NMV/r, n = 12,439; non-NMV/r, n = 36,490). Incidence of hospitalization (95% CI) within 30 days was 0.90% (0.74%-1.08%) for the NMV/r group and 5.91% (5.67%-6.16%) for the non-NMV/r group, with relative risk (95% CI) of 0.15 (0.13-0.18; 85% risk reduction). NMV/r was comparably effective in Black patients (relative risk, 0.19 [0.10-0.34]; 81% risk reduction). Sensitivity analyses supported the main outcomes.

IMPLICATIONS: Real-world NMV/r effectiveness against hospitalization during Omicron predominance among COVID-19 patients at high risk of severe disease supports demonstrated clinical trial efficacy. Black patients underutilized NMV/r despite high effectiveness.

PMID:39649410 | PMC:PMC11625212 | DOI:10.1016/j.curtheres.2024.100757

Curr Res Microb Sci. 2024 Nov 17;7:100316. doi: 10.1016/j.crmicr.2024.100316. eCollection 2024.

ABSTRACT

Candida albicans and Staphylococcus aureus have been co-isolated from several biofilm-associated diseases, including those related to medical devices. This association confers advantages to both microorganisms, resulting in detrimental effects on the host. To elucidate this phenomenon, the present study investigated colony changes derived from non-physical interactions between C. albicans and S. aureus. We performed proximity assays by confronting colonies of the yeast and the bacteria on agar plates at six different distances for 9-10 days. We found that colony variants of S. aureus originated progressively after prolonged exposure to C. albicans proximity, specifically in response to pH neutralization of the media by the fungi. The new phenotypes of S. aureus were more virulent in a Galleria mellonella larvae model compared to colonies grown without C. albicans influence. This event was associated with an upregulation of RNA III and agrA expression, suggesting a role for α-toxin. Our findings indicate that C. albicans enhances S. aureus virulence by inducing the formation of more aggressive colonies. This highlights the importance of understanding the intricate connection between environmental responses, virulence and, fitness in S. aureus pathogenesis.

PMID:39649408 | PMC:PMC11621768 | DOI:10.1016/j.crmicr.2024.100316

Front Pediatr. 2024 Nov 22;12:1450121. doi: 10.3389/fped.2024.1450121. eCollection 2024.

ABSTRACT

BACKGROUND: Acquired spontaneous intestinal perforation or SIP occurs most commonly in the extremely premature infant population. As the incidence is rising, understanding modifiable factors such as common medication exposures becomes important for individualizing care.

METHODS: The primary outcome was SIP in premature infants with exposure to indomethacin, ibuprofen, or acetaminophen. The systematic review and meta-analysis were conducted following the Cochrane methodology and PRISMA guidelines.

RESULTS: The point estimates of three RCTs showed an increase in the risk of SIP with indomethacin exposure compared to no medication, the pooled estimate was not statistically significant. There is no statistically significant association between the risk of SIP for indomethacin with treatment use over prophylactic use and when holding feeds. Ibuprofen conferred less risk than indomethacin, and its route of administration did not alter the risk profile. There was not enough evidence to draw conclusions about the risk of SIP and acetaminophen exposure.

CONCLUSION: In studies of infants exposed to either indomethacin or ibuprofen in the last 40 years, the incidence of SIP is still commonly within 2-8%. Moving forward modifiable factors such as medication exposure will help guide care to minimize risk where possible.

SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/, PROSPERO (CRD42017058603).

PMID:39649405 | PMC:PMC11620902 | DOI:10.3389/fped.2024.1450121

Front Pediatr. 2024 Nov 22;12:1447956. doi: 10.3389/fped.2024.1447956. eCollection 2024.

ABSTRACT

OBJECTIVE: The increasing use of assisted reproductive technologies (ART) has led to a growing interest in the health outcomes of offspring. However, the impact of ART on the immune system of children remains poorly understood. While only two publications were found, their findings contradict each other and did not consider other risk factors in their analysis except for ART use. Therefore, this study aimed to examine the potential impact of ART on the immune system of offspring.

METHODS: A case-control study was conducted in Kazakhstan to investigate the immune system of ART-conceived children compared to those conceived naturally (NC). The study included participants who met certain criteria, such as having undergone a successful ART program resulting in the birth of either a single or multiple pregnancies. Patients who used donor oocytes/sperm, intrauterine insemination, or surrogacy were excluded. Anamnesis data were collected from children in both groups, and laboratory measurements were performed and analyzed using IBM SPSS Statistic 26.

RESULTS: A total of 120 children conceived by ART and 132 NC children under the age of five were included in our study. We observed that compared with NC group, ART children had lower IgA and IgG levels (p < 0.001), absolute lymphocytosis, high levels of active T-lymphocytes (p = 0.001), and pathological T-helper levels (p = 0.004). Therefore, the clinical presentation of respiratory diseases was lower in ART group. Children born after frozen embryo transfers showed significantly higher levels of T-cytotoxic and active T-lymphocytes compared to children born after fresh embryo transfers (p = 0.007 and p = 0.020, respectively). We utilized ordinal logistic regression to control for confounding variables such as multiple pregnancy, cesarean section, premature birth, and breastfeeding. Despite this, the significant impact of ART on immunogram parameters persisted, indicating the independent and influential nature of ART or other unaccounted factors.

PMID:39649404 | PMC:PMC11620871 | DOI:10.3389/fped.2024.1447956