Nevin Manimala

Med Care. 2024 Nov 1;62(11):748-756. doi: 10.1097/MLR.0000000000002057. Epub 2024 Oct 11.

ABSTRACT

BACKGROUND: Practice guidelines recommend patient management based on scientific evidence. Quality indicators gauge adherence to such recommendations and assess health care quality. They are usually defined as adverse event rates, which may not fully capture guideline adherence over time.

METHODS: For assessing process indicators where compliance to the recommended treatment can be assessed by evaluating a patient’s trace in linked routine databases, we propose using restricted mean survival time or restricted mean time lost, which are applicable even in competing risk situations. We demonstrate their application by assessing the compliance of patients with acute myocardial infarction (AMI) to high-power statins over 12 months in Austria’s political districts, using pseudo-observations and employing causal inference methods to achieve regional comparability.

RESULTS: We analyzed the compliance of 31,678 AMI patients from Austria’s 116 political districts with index AMI between 2011 and 2015. The results revealed considerable compliance variations across districts but also plausible spatial similarities.

CONCLUSIONS: Restricted mean survival time and restricted mean time lost provide interpretable estimates of patients’ expected time in compliance (lost), well-suited for risk-adjusted entity comparisons in the presence of (measurable) confounding, censoring, and competing risks.

PMID:39733232 | DOI:10.1097/MLR.0000000000002057

Med Care. 2024 Nov 1;62(11):723. doi: 10.1097/MLR.0000000000002078. Epub 2024 Oct 11.

NO ABSTRACT

PMID:39733231 | DOI:10.1097/MLR.0000000000002078

Nurse Educ. 2024 Oct 9. doi: 10.1097/NNE.0000000000001744. Online ahead of print.

ABSTRACT

BACKGROUND: Nursing students experience significantly more stress related diseases when compared to non-nursing students, and the state of their mental health can result in short-term increased attrition rates and increased nursing shortages.

PURPOSE: A preexperimental pre-post study design was used to examine mental health and healthy behaviors among prenursing students.

METHODS: Cohorts received the MINDSTRONG© program either in-person or virtually. Data analysis included Personal Wellness Assessments completed at both pre- and poststudy for all participants (n = 110).

RESULTS: Both groups postintervention had statistically significant decreases in anxiety, depression, and stress and statistically significant increases in healthy lifestyle behaviors and beliefs. Students with elevated depression and anxiety scores at baseline had greater decreases postintervention than the overall groups.

CONCLUSION: The outcomes for both cohorts were positive and effective in reducing stress, anxiety, and depressive symptoms. Healthy behaviors were improved and align with findings with an in-person format. Findings from this study support implementation of MINDSTRONG in synchronous sessions, either in-person or virtual.

PMID:39733228 | DOI:10.1097/NNE.0000000000001744

Sci Rep. 2024 Dec 28;14(1):31457. doi: 10.1038/s41598-024-83169-x.

ABSTRACT

Globally, the prevalence of coronary artery disease (CAD) is increasing, accounting for a third of all deaths worldwide including myocardial infarctions (MIs) which represent the most severe clinical manifestation of CAD and are among the most dangerous coronary events. Therefore, this study aims to assess the knowledge of symptoms and risk factors of MIs, as well as attitudes and beliefs regarding MIs and confidence in recognizing CAD symptoms in Riyadh, Saudi Arabia. A cross-sectional study was conducted among individuals living in Riyadh, Saudi Arabia between November 2023 and April 2024 to assess their knowledge and beliefs about CAD and MIs. Data collection was done using convenience sampling with pretested and validated questionnaire. Furthermore, recruiting more sample was achieved by distributing the questionnaires using the snowball technique. ANOVA and Student’s t-test were used to determine the association between variables, with a p-value of < 0.05 considered statistically significant. Among respondents, approximately 65.5% were male, 27.3%, fell between the ages of 26 and 30 and 59.1% held a master’s degree. In terms of marital status, the majority, 76.2%, were married. The majority (90%) stated that jaw pain was a symptom of a heart attack, followed by chest pain/pressure (85.9%), weakness/fatigue (85.8%), palpitations/rapid heart rate, and chest discomfort (83.4%). Most respondents (91.6%) were aware that smoking and obesity could increase the risk of MIs, while 85.3% believed that a family history of coronary heart disease could affect the risk of MIs. Additionally, 92.3% said they would seek medical care if they experienced chest pain within 15 min. The respondents’ gender (p = 0.001), age (p = 0.004), education (p = 0.001), and marital status (p = 0.004) were significantly associated with levels of knowledge of MI. The findings showed that half of the study population had good knowledge and were well-informed about jaw and chest pain as the main symptoms of MI. Despite understanding the clinical potential of MI, the majority expressed low confidence in their ability to identify heart attack symptoms and recommended health education about the illness to provide prompt assistance.

PMID:39733213 | DOI:10.1038/s41598-024-83169-x

Int J Bipolar Disord. 2024 Dec 28;12(1):44. doi: 10.1186/s40345-024-00367-2.

ABSTRACT

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is a common neuro-developmental disorder that often persists into adulthood. Moreover, it is frequently accompanied by bipolar disorder (BD) as well as borderline personality disorder (BPD). It is unclear whether these disorders share underlying pathomechanisms, given that all three are characterized by alterations in affective states, either long or short-term. BD is characterized by infrequent but intense mood shifts, while ADHD and BPD involve more dynamic emotional fluctuations. It is yet to be determined whether these disorders represent distinct phenomena or different points on a spectrum of affective dysregulation.

METHODS: This study seeks to distinguish the emotional dysregulation of BPD, ADHD, and BD by using digital phenotyping, a measurement burst electronic-diary method with different sampling rates, and accelerometry to measure participants’ activity. Our study will include 480 participants aged 14 to 50 (120 each from BPD, ADHD, BD, and healthy control groups) from five European sites. Participants’ smartphones will provide continuous data on their digital phenotypes, i.e., by indicators of physical activity and communication, for one year, along with daily evening ratings of mood and sleep. Moreover, five intensive measurement periods of five days each, called measurement bursts, will occur throughout the year, with electronic diaries asking participants to report on mood, self-esteem, impulsivity, life events, social interactions, and dysfunctional behaviors ten times a day. Moreover, participants will wear activity sensors during the five measurement bursts. Statistical analysis aims to identify whether affective dysregulation aspects share or differ across disorders. Specifically, data analysis aims to investigate the differences in parameters of affect fluctuation such as attractor strength and variability between disorders and to test the association of genetic risk factors for psychiatric disorders and resilience factors with critical parameters of affect modulation.

DISCUSSION: The results of this study offer the potential to link patients’ external exposures with their affective state, reduce misdiagnosis, and determine the best timing for therapeutic interventions. Potential limitations of the study include insufficient recruitment of patients and drop-outs due to various protocol violations.

TRIAL REGISTRATION: Study code: DRKS00028917, registered 27.07.2022, https://drks.de/search/de/trial/DRKS00028917 .

PMID:39733204 | DOI:10.1186/s40345-024-00367-2

Surg Endosc. 2024 Dec 28. doi: 10.1007/s00464-024-11457-8. Online ahead of print.

ABSTRACT

BACKGROUND: We performed a systematic review and network meta-analysis (NMA) of individualized patient data (IPD) to inform the development of evidence-informed clinical practice recommendations.

METHODS: We searched MEDLINE, Embase, and Cochrane Central in October 2023 to identify RCTs comparing Hartmann’s resection (HR), primary resection and anastomosis (PRA), or laparoscopic peritoneal lavage (LPL) among patients with class Ib-IV Hinchey diverticulitis. Outcomes of interest were prioritized by an international, multidisciplinary panel including two patient partners. Article screening, data extraction for IPD, and risk of bias appraisal were performed by two reviewers. We used a random-effects NMA to synthesize direct and indirect evidence. Heterogeneity was evaluated using the I² statistic. The panel appraised the certainty of the evidence using GRADE and CINeMA.

RESULTS: Fourteen reports of seven RCTs were derived from 4,659 articles. IPD data were available for 595/678 patients (88.8%) across trials. Patients had a mean age ± SD of 64.61 ± 13.64 years and a mean BMI ± SD of 26.12 ± 5.20 kg/m², representing Hinchey classes I (1.2%), II (1.0%) III (76.3%), and IV (12.1%), respectively. Using minimal important difference thresholds, in-hospital/30-day mortality was higher among patients receiving LPL versus HR [42 more per 1000, 95% CI (41 fewer to 331 more), moderate effect; low certainty] as well as PRA [45 more per 1000 patients, 95% CI (33 fewer to 340 more) moderate effect; low certainty] without heterogeneity (I² = 0%). Among 417 patients from four trials, there was a lower stoma rate among patients receiving PRA versus LPL [539 fewer per 1000, 95% CI (647 fewer to 306 fewer), large effect; low certainty].

CONCLUSION: PRA likely confers a lower stoma rate at 1 year compared to HR, while there may be no difference in 30-day/in-hospital mortality. LPL likely confers a higher in-hospital/30-day mortality rate compared to HR and PRA.

PMID:39733170 | DOI:10.1007/s00464-024-11457-8

Sci Rep. 2024 Dec 28;14(1):31451. doi: 10.1038/s41598-024-82983-7.

ABSTRACT

This study investigated the incidence of new-onset cardiovascular disorders up to 3.5 years post SARS-CoV-2 infection for 56,400 individuals with COVID-19 and 1,093,904 contemporary controls without COVID-19 in the Montefiore Health System (03/11/2020 to 07/01/2023). Outcomes were new incidence of major adverse cardiovascular event (MACE), arrhythmias, inflammatory heart disease, thrombosis, cerebrovascular disorders, ischemic heart disease and other cardiac disorders between 30 days and (up to) 3.5 years post index date. Results were also compared with a pre-pandemic cohort over similar observation duration (N = 64,541). Cumulative incidence and hazard ratios adjusted for competitive risks were analyzed. Compared to contemporary controls, hospitalized COVID-19 patients had significantly higher risk of developing MACE (aHR = 2.29, 95% confidence interval [2.27, 2.31], p < 0.001), arrhythmias (aHR = 2.54[2.50, 2.58], p < 0.001), inflammatory heart disease (aHR = 5.34[4.79, 5.96], p < 0.001), cerebrovascular (aHR = 2.05[2.00, 2.11], p < 0.001), other cardiac disorders (aHR = 2.31[2.26, 2.35], p < 0.001), thrombosis (aHR = 4.25[4.15, 4.36], p < 0.001), and ischemic heart disease (aHR = 1.89[1.86, 1.92], p < 0.001). Non-hospitalized COVID-19 patients had slightly higher risk of developing MACE (aHR = 1.04[1.03, 1.06], p < 0.001), arrhythmias (aHR = 1.10[1.08, 1.12], p < 0.001), inflammatory heart disease (aHR = 2.29 [2.03, 2.59], p < 0.001), cerebrovascular (aHR = 1.11[1.07, 1.15], p < 0.001), and ischemic heart disease (aHR = 1.10[1.08, 1.13], p < 0.001). Race and ethnicity were mostly not associated with increased risks (p > 0.05). aHRs with contemporary controls as a reference were similar to those with pre-pandemic cohort as a reference. We concluded that new incident cardiovascular disorders in COVID-19 patients, especially those hospitalized for COVID-19, were higher than those in controls. Identifying risk factors for developing new-onset cardiovascular disorders may draw clinical attention for the need for careful follow-up in at-risk individuals.

PMID:39733164 | DOI:10.1038/s41598-024-82983-7

Sci Rep. 2024 Dec 28;14(1):31398. doi: 10.1038/s41598-024-83009-y.

ABSTRACT

This study assessed the factors militating against the effective implementation of electronic health records (EHR) in Nigeria, the computerization of patients’ health records with a lot of benefits including improved patients’ satisfaction, improved care processes, reduction of patients’ waiting time, and medication errors. Despite these benefits, healthcare organizations are slow to adopt the EHR system. Therefore, the study assessed the factors militating against the effective implementation of the EHR system, the level of awareness of EHR, and the utilization of electronic health records; it also investigated the factors militating against the effective implementation of EHR. This is a descriptive cross-sectional study conducted among members of staff of the University of Medical Sciences Teaching Hospital (UNIMEDTH). Purposive sampling was adopted to select the study participants, and a structured questionnaire was used for data collection. Statistical Product and Service Solutions (SPSS) version 27 was used for data analysis, R and Microsoft Excel were used for data visualization. Findings revealed that the respondents had a high level of awareness of EHR with an average mean of 1.29. The study revealed a low utilization rate for EHR (mean 3.01, SD 0.115) and data storage (mean 3.00, SD 0.231), indicating major problems with EHR implementation. Financial limitations (mean 2.63, SD 0.486) and insufficient ICT resources (mean 2.62, SD 0.516) are the main challenges. The regression analysis revealed that EHR utilization is highly impacted by awareness (F = 4.26, p < 0.008), accounting for 15.1% of the variance. Governmental assistance and financial constraints showed a statistically significant negative correlation (r=-0.04, p < 0.05), while inadequate internet connectivity and epileptic power supply showed a statistically significant positive association (r = 0.1, p < 0.05). The results show that, more government support is needed to alleviate financial constraints, and a stable power supply may enhance internet accessibility. The study concluded that epileptic power supply, poor internet connectivity, financial constraints, and other factors mentioned in the study militate against the effective implementation of electronic health records. It was recommended that the management should implement electronic health records effectively for efficient and effective health care delivery.

PMID:39733158 | DOI:10.1038/s41598-024-83009-y

Sci Rep. 2024 Dec 28;14(1):31362. doi: 10.1038/s41598-024-82819-4.

ABSTRACT

Phthalocyanine derivative nanostructures are highly organized organometallic structures that exhibit two-dimensional polymeric phthalocyanine frameworks. We analyze phthalocyanine using the Zagreb-type indices, which offer important insights into the topological characteristics of the molecular structure. Furthermore, we use Pearson correlation analysis to examine the degree of relationship between various structural features and qualities. The significance of [Formula: see text] in materials research and the value of computational techniques in elucidating the chemical’s properties and possible uses as demonstrated by this multidimensional examination of the material. We use a Pearson correlation heat map to show the relation between indices and entropy.

PMID:39733151 | DOI:10.1038/s41598-024-82819-4

Sci Rep. 2024 Dec 28;14(1):31260. doi: 10.1038/s41598-024-82673-4.

ABSTRACT

Manganese (Mn) is a known toxicant and an essential trace element, and it plays an important role in various mechanisms in relation to cardiovascular health. However, epidemiological studies of the association between blood Mn and cardiovascular diseases (CVD) among U.S. adults are rare. A cross-sectional study of 12,061 participants aged ≥ 20 was conducted using data from the National Health and Nutrition Examination Survey 2011-2018. Logistic regression and restricted cubic spline were used to examine the relationship between blood Mn levels and total CVD risk and specific CVD subtypes. Bayesian kernel-machine regression (BKMR) and weighted quantile sum (WQS) analyses were performed to explore the joint effects of Mn with other metals on CVD. The results showed that individuals with the third quartile group of blood Mn levels had significantly lower risks of CVD, displaying a non-linear U-shaped dose-response relationship. A significant interaction of age on this association was observed. No significant associations were found between Mn levels and specific CVD subtypes. BKMR and WQS analyses showed a positive association between heavy metal mixtures and CVD risks, with no interaction between Mn and other metals. In conclusion, blood Mn levels were significantly associated with CVD risks with a U-shaped relationship in U.S. adults, with possible age-specific differences. Future larger prospective studies are warranted to validate these findings.

PMID:39733137 | DOI:10.1038/s41598-024-82673-4