Nevin Manimala

Am Surg. 2024 Apr 1:31348241241658. doi: 10.1177/00031348241241658. Online ahead of print.

ABSTRACT

24/7 critical care staffing has become more commonplace, and their impact on resident training must be carefully considered. At our institution, the Critical Care Resource Intensivist (CCRI) model was implemented to provide in-house dedicated faculty responsible solely for the provision of critical care overnight. An anonymous survey was distributed to all general surgery residents to evaluate CCRI’s impact on education and autonomy. Descriptive statistics were completed for quantitative data. Qualitative analysis of free text responses was completed to identify consensus themes. Responses from 26 residents demonstrated they associated CCRI with improved resident education, supervision, and patient care, without limiting autonomy. Qualitative analysis yielded 7 themes, reflecting improvements in patient care and safety, progression of care, operations and procedures, improved education, availability, and independence, but noted potential for conflict. Our findings show 24/7 dedicated intensivist staffing can enhance general surgery resident education without limiting autonomy.

PMID:38561216 | DOI:10.1177/00031348241241658

Percept Mot Skills. 2024 Apr 1:315125241244985. doi: 10.1177/00315125241244985. Online ahead of print.

ABSTRACT

Our main aim in this study was to analyze any differences in Win Percentages at Home (HW) that might represent a Home-Court Advantage (HA) in women’s professional basketball. A secondary objective was to analyze how team ability might modify the HA effect by comparing any interaction effect between HW and team ability in games played with and without fans. We collected data from first Spanish female basketball divisions, using a linear mixed model (LMM) for repeated measures to identify differences between time periods (games with fans vs. games without fans) for HA and HW. When comparing games with and without fans, we found no significant HA and HW differences (p = .283 and p = .872, respectively). In fact, interestingly, we observed higher win values when fans were absent. Additionally, during the COVID-19 shut down stage, HA increased; but it returned to pre-pandemic levels afterward, with no significant differences between these periods (p = .482). Similarly, while HW seemed to increase during the COVID-19 shut down period and continued improving in the post-pandemic phase, there were actually no statistically significant differences (p = .772). Higher HA and HW were evident without fans during the pandemic compared to the pre-pandemic period when fans were present in women’s professional basketball. During the post-pandemic period, HA decreased upon fans’ return, while HW continued increasing. We discuss possible bases for these unexpected findings.

PMID:38561202 | DOI:10.1177/00315125241244985

Eur J Public Health. 2024 Apr 1:ckae061. doi: 10.1093/eurpub/ckae061. Online ahead of print.

ABSTRACT

BACKGROUND: Some studies have reported an increase in suicides after the start of daylight saving time (DST), but the evidence is mixed and more research about proposed mechanisms (disrupted sleep, changing light exposure) is needed.

METHODS: In our preregistered study, we analyzed change in suicide rates in the 2 weeks before/after DST, based on data between 1980 and 2022 from Austria, Switzerland and Sweden, using Poisson regression models and changepoint analyses. To explore the impact of disrupted sleep, we repeated the analysis for retired people who are likely less bound to DST, and for younger people. To explore the effect of changed daylight exposure, we repeated the analysis for northern and southern regions because twilight and daylight exposure varies by latitude.

RESULTS: Suicide rates did not significantly increase after the start of DST (adjusted incidence rate ratio IRR = 0.98, 95% CI 0.91-1.06, P = 0.66, n = 13 362 suicides) or after DST ended (adjusted IRR = 0.99, 95% CI 0.91-1.07, P = 0.76, n = 12 319 suicides). There were no statistically significant findings among younger or older subgroups and also not in Sweden and Austria/Switzerland. No changepoints were detected.

CONCLUSIONS: There were no significant changes in suicide rates associated with DST and no clear evidence to support proposed mechanisms (light exposure, disruption of sleep). Our study is one of the largest and was adequately powered. Nonetheless, even larger studies to detect smaller effects could be important to inform the debate about harms and benefits of DST.

PMID:38561196 | DOI:10.1093/eurpub/ckae061

Arch Phys Med Rehabil. 2024 Mar 30:S0003-9993(24)00905-5. doi: 10.1016/j.apmr.2024.03.012. Online ahead of print.

ABSTRACT

OBJECTIVE: To determine if lower limb prosthesis (LLP) sophistication is associated with patient-reported mobility and/or mobility satisfaction, and if these associations differ by amputation level.

DESIGN: Cohort study that identified participants through a large national database and prospectively collected self-reported patient outcomes.

SETTING: The Veterans Administration (VA) Corporate Data Warehouse, the National Prosthetics Patient Database, participant mailings and phone calls.

PARTICIPANTS: 347 Veterans who underwent an incident transtibial (TT) or transfemoral (TF) amputation due to diabetes and/or peripheral artery disease and received a qualifying LLP between March 1, 2018, and November 30, 2020.

INTERVENTIONS: Basic, intermediate, and advanced prosthesis sophistication was measured by the accurate and reliable PROClass system.

MAIN OUTCOME MEASURE: Patient reported mobility using the advanced mobility subscale of the Locomotor Capabilities Index-5: mobility satisfaction using a 0-10-point Likert scale.

RESULTS: Lower limb amputees who received intermediate or advanced prostheses were more likely to achieve advanced mobility than those who received basic prostheses, with intermediate nearing statistical significance at nearly twice the odds (adjusted odds ratio (aOR) = 1.8, 95% confidence interval (CI), .98 – 3.3; p=.06). The association was strongest in TF amputees with over 10 times the odds (aOR = 10.2, 95% CI, 1.1 – 96.8; p=.04). The use of an intermediate sophistication prosthesis relative to a basic prosthesis was significantly associated with mobility satisfaction (adjusted β coefficient (aβ) = .77, 95% CI, .11 – 1.4; p=.02). A statistically significant association was only observed in those who underwent a TT amputation (aβ = .79, 95% CI, .09 – 1.5; p=.03).

CONCLUSIONS: Prosthesis sophistication was not associated with achieving advanced mobility in TT amputees but was associated with greater mobility satisfaction. In contrast, prosthesis sophistication was associated with achieving advanced mobility in TF amputees but was not associated with an increase in mobility satisfaction.

PMID:38561145 | DOI:10.1016/j.apmr.2024.03.012

J Glob Antimicrob Resist. 2024 Mar 30:S2213-7165(24)00058-4. doi: 10.1016/j.jgar.2024.03.009. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aims to estimate the overall in vitro activity of bedaquiline (BDQ) against clinical isolates of Mycobacterium abscessus complex (MABS) and Mycobacterium avium complex (MAC), considering BDQ as a repurposed drug for non-tuberculous mycobacteria (NTM) infections.

METHODS: We conducted a systematic review of publications in PubMed/ MEDLINE, Web of Science, and Embase up to April 15, 2023. Studies were included if they followed the Clinical and Laboratory Standards Institute (CLSI) criteria for drug susceptibility testing (DST). Using a random effects model, we assessed the overall in vitro BDQ resistance rate in clinical isolates of MABS and MAC. Sources of heterogeneity were analyzed using Cochran’s Q and the I² statistic. All analyses were performed using CMA V3.0.

RESULTS: A total of 24 publications (19 reports for MABS and 11 for MAC) were included. Using 1 μg/mL and 2 μg/mL as the breakpoint for BDQ resistance, the pooled rates of in vitro BDQ resistance in clinical isolates of MABS were found to be 1.8% (95% confidence interval [CI], 0.7-4.6%) and 1.7% (95% CI, 0.6-4.4%), respectively. In the case of MAC, the pooled rates were 1.7% (95% CI, 0.4-6.9%) and 1.6% (95% CI, 0.4-6.8%) for 1 μg/mL and 2 μg/mL, respectively.

CONCLUSION: This study reports the prevalence of BDQ resistance in clinical isolates of MABS and MAC. The findings suggest that BDQ holds potential as a repurposed drug for treating MABS and MAC infections.

PMID:38561143 | DOI:10.1016/j.jgar.2024.03.009

Transplant Cell Ther. 2024 Mar 30:S2666-6367(24)00301-4. doi: 10.1016/j.jtct.2024.03.028. Online ahead of print.

ABSTRACT

BACKGROUND: While curing a patient’s underlying disease is the primary goal of physicians performing hematopoietic cell transplantation (HCT), the ultimate objective is to provide patients with optimal post-HCT quality of life. For many survivors, this includes returning to work (RTW).

OBJECTIVE: We conducted a survey of one- to five-year post-HCT survivors at our center to evaluate their perspective on facilitators and barriers to RTW as well as to gauge interest in potentially useful RTW support interventions.

STUDY DESIGN: Survivors aged 18 to 65 years (n=994) were sent an annual survey that included 36 supplementary questions about post-HCT RTW. Survey questions were selected from published national cancer survivor surveys and then modified specifically for HCT survivors.

RESULTS: 344 (35%) survivors with a mean age of 53 years completed the survey, of whom 272 (79%) had worked prior to their diagnosis. Of those 272 patients, 145 (53%) were working currently and another 22 (8%) had attempted to go back to work following HCT but were not presently working. We found that having had an allogeneic vs autologous HCT (p=0.006) was associated with a decreased likelihood of currently working, whereas frequent employer communication (> once a month) (p=0.070) and having a more supportive employer (p=0.036) were associated with a greater chance of currently working. Of survivors currently working, 45% reported that they had made one or more changes to their work schedule (e.g., flexible schedule or part-time work) or environment (e.g., work from home) upon RTW. Ninety-five percent of responders reported that they could have benefited from RTW support provided by the transplant center, but only 13% indicated that they had received it. Education on RTW challenges, information on disability benefits, and access to physical therapy were among the most requested support interventions.

CONCLUSION: To improve post-HCT quality of life for survivors open to assistance, providers should address work status and goals, recognize barriers to successful return, and offer RTW support including working directly with employers. Allogeneic HCT survivors are particularly vulnerable to failing attempts to RTW and should be the target of retention interventions. A previously published manuscript on RTW guidance for providers of stem cell transplant patients endorsed by the American Society of Transplant and Cellular Therapy is available Open Access and can be used as a tool to counsel and support these patients.

PMID:38561139 | DOI:10.1016/j.jtct.2024.03.028

Radiother Oncol. 2024 Mar 30:110264. doi: 10.1016/j.radonc.2024.110264. Online ahead of print.

ABSTRACT

BACKGROUND: High-level evidence on hypofractionated proton therapy (PT) for localized and locally advanced prostate cancer (PCa) patients is currently missing. The aim of this study is to provide a systematic literature review to compare the toxicity and effectiveness of curative radiotherapy with photon therapy (XRT) or PT in PCa.

METHODS: PubMed, Embase, and the Cochrane Library databases were systematically searched up to April 2022. Men with a diagnosis of PCa who underwent curative hypofractionated RT treatment (PT or XRT) were included. Risk of grade (G) ≥ 2 acute and late genitourinary (GU) OR gastrointestinal (GI) toxicity were the primary outcomes of interest. Secondary outcomes were five-year biochemical relapse-free survival (b-RFS), clinical relapse-free, distant metastasis-free, and prostate cancer-specific survival. Heterogeneity between study-specific estimates was assessed using Chi-square statistics and measured with the I2 index (heterogeneity measure across studies).

RESULTS: A total of 230 studies matched inclusion criteria and, due to overlapped populations, 160 were included in the present analysis. Significant lower rates of G ≥ 2 acute GI incidence (2 % vs 7 %) and improved 5-year biochemical relapse-free survival (95 % vs 91 %) were observed in the PT arm compared to XRT. PT benefits in 5-year biochemical relapse-free survival were maintained for the moderate hypofractionated arm (p-value 0.0122) and among patients in intermediate and low-risk classes (p-values < 0.0001 and 0.0368, respectively). No statistically relevant differences were found for the other considered outcomes.

CONCLUSION: The present study supports that PT is safe and effective for localized PCa treatment, however, more data from RCTs are needed to draw solid evidence in this setting and further effort must be made to identify the patient subgroups that could benefit the most from PT.

PMID:38561122 | DOI:10.1016/j.radonc.2024.110264

J Gastrointest Surg. 2024 Mar 30:S1091-255X(24)00391-3. doi: 10.1016/j.gassur.2024.03.029. Online ahead of print.

ABSTRACT

BACKGROUND: Although many guidelines recommend performing lymph node dissection (LND) during surgery for intrahepatic cholangiocarcinoma (ICC), there is no evidence for incidentally detected ICC patients who did not undergo LND. This study aimed to identify the role of lymph node dissection in patients with incidental ICC.

METHODS: The data from 284 patients who had undergone radical surgery for ICC from 2000 to 2020 were retrospectively reviewed. The enrolled patients were divided into three groups according to their T stage (T1 vs. T2 vs. T3+4). Moreover, the patients of each T group were divided into three groups according to their nodal status (N0 vs. N1 vs. Nx) and their survival outcomes were compared.

RESULTS: Survival outcomes of Nx group were statistically similar to that of N0 group in T1 stage (Nx vs. N0: disease-free survival (DFS) (months), 129.0 [75.6-182.4] vs. 125.0 [65.7-184.3], p=0.948; overall survival (OS) (months), 175.0 [153.9-196.1] vs. 173.0 [109.0-237.0], p=0.443). On the other hand, survival outcomes of Nx group in the other T stage (T2 and T3+4) were poorer than that of N0 group and were better than that of N1 group. In addition, in the Nx subgroup analysis according to T stage, T1 group showed significantly better survival outcomes than the other groups. (T1 vs. T2 vs. T3+4: DFS (months), 129.0 [75.9-182.1] vs. 16.0 [9.8-22.2] vs. 13.0 [0.3-25.7], p<0.001; OS (months), 175.0 [153.9-196.1] vs. 53.0 [30.8-75.2] vs. 37.0 [17.6-56.4], p<0.001) CONCLUSION: ICC patients incidentally diagnosed with T2 or above T stage may consider additional LND.

PMID:38561087 | DOI:10.1016/j.gassur.2024.03.029

Int J Infect Dis. 2024 Mar 30:107021. doi: 10.1016/j.ijid.2024.107021. Online ahead of print.

ABSTRACT

OBJECTIVES: Evaluate and compare the efficacy and safety of molnupiravir and favipiravir in outpatients with mild to moderate COVID-19 and at risk of severe COVID-19.

METHODS: In an open-label, parallel-group, multicenter trial in Thailand, participants with moderate COVID-19 and at least one factor associated with severe COVID-19 were randomly assigned 1:1 to receive oral molnupiravir or oral favipiravir (standard of care). Phone calls for remote symptom assessment were made on Days 6, 15 and 29. Participants with worsening symptoms were instructed to return to the hospital. The primary endpoint was pulmonary involvement by Day 29, as evidenced by ≥2 of the following: dyspnea, oxygen saturation <92% or imaging.

RESULTS: 977 participants (487 molnupiravir, 490 favipiravir) were enrolled from 8 July 2022 to 19 January 2023. 98% had received ≥1 dose of COVID-19 vaccine and 83% ≥3 doses. By Day 29, pulmonary involvement occurred in 0% (0/483) in molnupiravir arm versus 1% (5/482) in favipiravir arm (-1.0%; Newcombe 95.2% CI: -2.4% to -0.0%; p=0.021); all-cause death in 0% (0/483) and <1% (1/482); COVID-19 related hospitalization in <1% (1/483) and 1% (3/482); treatment-related adverse event in 1% (5/483) and 1% (4/486); and serious adverse event in 1% (4/483) and 1% (4/486).

CONCLUSIONS: Favipiravir and molnupiravir had a similar efficacy and safety profile. Whether either of the two reduced the risk of complications during the omicron era in this population with a low risk of pulmonary involvement and a high vaccine coverage remains unclear. There were no differences in any of the safety endpoints.

THAI CLINICAL TRIALS REGISTRY ID: TCTR20230111009.

PMID:38561040 | DOI:10.1016/j.ijid.2024.107021

J Dent. 2024 Mar 30:104968. doi: 10.1016/j.jdent.2024.104968. Online ahead of print.

ABSTRACT

OBJECTIVES: To determine and compare the opportunistic respiratory pathogenic index (ORPI) and prevalence of respiratory pathogens between clean and unclean removable prostheses.

METHODS: A cross-sectional study was conducted among 97 removable prosthesis wearers at a teaching dental hospital. Participants’ prosthesis hygiene was grouped into clean and unclean. After prosthesis plaque samples were sequenced using the Type IIB Restriction-site Associated DNA Sequencing for Microbiome method, the prevalence was assessed for the presence of respiratory pathogens on each sample. The ORPIs for clean and unclean prostheses were quantified based on the sum of the relative abundance of respiratory pathogenic bacteria in a microbiome using a reference database that contains opportunistic respiratory pathogens and disease-associated information.

RESULTS: A total of 30 opportunistic respiratory pathogens were identified on the removable prostheses. Eighty-one (83.5%) removable prostheses harboured respiratory pathogenic bacteria. Stenotrophomonas maltophilia (34.0%), Pseudomonas aeruginosa (27.8%), and Streptococcus agalactiae (27.8%) were the top three prevalent respiratory pathogens detected in plaque samples. There was a significantly higher prevalence of respiratory pathogens residing on unclean than clean prostheses (P = 0.046). However, the ORPIs in both groups showed no statistically significant difference (P = 0.516).

CONCLUSIONS: The ORPIs for both clean and unclean prostheses demonstrated a similar abundance of respiratory pathogens. However, the high prevalence of respiratory pathogens residing on unclean prostheses should not be underestimated. Therefore, maintaining good prosthesis hygiene is still important for overall oral and systemic health, even though the direct link between prosthesis cleanliness and reduced abundance of respiratory pathogens has not been established.

CLINICAL SIGNIFICANCE: The association between the prevalence of respiratory pathogens and unclean removable prostheses has been demonstrated and might increase the theoretical risk of respiratory disease development.

PMID:38561038 | DOI:10.1016/j.jdent.2024.104968