Nevin Manimala

Brachytherapy. 2024 Dec 13:S1538-4721(24)00443-4. doi: 10.1016/j.brachy.2024.10.014. Online ahead of print.

ABSTRACT

PURPOSE: This study aims to evaluate the outcomes of patients treated for low-risk (LR) and favorable intermediate risk (FIR) prostate cancer with brachytherapy (BT) in monotherapy with LDR or HDR and its relationship with nadir PSA (nPSA).

MATERIALS AND METHODS: We retrospectively analyzed 139 patients (2005-2019) with exclusive LDR (46%. 145/160 Gy) /HDR (54%. 2 implants of 13.5 Gy each separated 10 days). 69% LR and 31% FIR. PSA nadir was grouped into two categories: ≤ 0.2 ng/mL and > 0.2 ng/mL.

RESULTS: Median patient age was 69 years (46-84). Seventy-six patients (55%) received androgen deprivation therapy, and 37% received neoadjuvant therapy. Median follow-up period was 90 months. Actuarial biochemical failure-free survival (BFFS), local control (LC), overall survival (OS), and cause-specific survival (CSS) rates for the total cohort were 78%, 87%, 68%, and 98% at 10 years, respectively. BFFS, LC, OS and CSS in nPSA ≤ 0,2 ng/ml was 90%, 96%, 67%, 100% at 10 years respectively, whereas, those with a nPSA > 0.2 ng/ml had a BFFS, LC, OS and CSS of was 37%, 51%, 72%, 90% at 10 years respectively Statistical significance between both groups was reached in BFFS (p=0,000), LC (p=0,000) and CSS (p=0,007)). In the univariate analysis, there was no difference between risk stratification, BT technique, ADT, or the development of bouncing.

CONCLUSIONS: Prostate brachytherapy as monotherapy (LDR and HDR) is an effective treatment option for patients with LR and FIR prostate cancer. nPSA ≤0,2 ng/ml is a representative value that provides prognostic information for favorable outcomes in this group of patients.

PMID:39674772 | DOI:10.1016/j.brachy.2024.10.014

Pain Manag Nurs. 2024 Dec 13:S1524-9042(24)00308-4. doi: 10.1016/j.pmn.2024.11.005. Online ahead of print.

ABSTRACT

OBJECTIVE: The main objective of this review is to demonstrate the use of Peripheral Percutaneous Electrical Nerve Stimulation (PENS), together with its most up-to-date protocols, for the treatment of neuropathies.

DESIGN: We conducted a systematic search for randomised clinical trials evaluating the effectiveness of PENS on pain intensity, sleep quality, oral analgesic intake and depression in patients with neuropathic pain.

DATA SOURCES: The search was performed in Pubmed, PEDro and Cochrane databases.

ANALYSIS METHODS: The meta-analysis was conducted using RevMan 5.4 software. The mean difference was applied for variables with the same measurement scale, while the standardized mean difference was used for different scales. The inverse variance method was employed for statistical analysis, with heterogeneity assessed using the I² and Cochrane Q statistics.

RESULTS: Four articles that met the search requirements were included. After qualitative and quantitative synthesis, the results obtained were an improvement in pain intensity (-3.57 [-4.01, -3.13]; p < .05) and sleep quality (2.48 [1.96, 3.00]; p < .05) and a reduction in medication intake (-2.37 [-4.26, -0.47]; p < .05) and depressive behaviours (-1.10 [-1.55, -0.66]; p < .05). The overall methodological quality was rated as moderate and the risk of bias as unclear.

CONCLUSIONS: The scientific evidence found is still limited for the use of PENS in neuropathies. However, this study suggests an encouraging future for the use of this therapy as a treatment tool in physiotherapy.

NURSING PRACTICE IMPLICATIONS: PENS requires nurse education on electrode/needle placement and patient instruction, with documentation of key parameters. This review emphasizes the need for further research to establish standardized protocols and optimal application parameters for different neuropathic pain conditions.

PMID:39674759 | DOI:10.1016/j.pmn.2024.11.005

Encephale. 2024 Dec 13:S0013-7006(24)00209-4. doi: 10.1016/j.encep.2024.10.002. Online ahead of print.

ABSTRACT

OBJECTIVES: Physicians demonstrate low rates of help seeking for psychiatric disorders, occupational stress, and burnout due to perceived stigma. The Stigma of Occupational Stress Scale for Doctors (SOSS-D) is a brief standardized tool designed to measure stigma (personal, perceived other, and perceived structural) in physicians. The aim of this study was to gather validity evidence for a French version of the SOSS-D.

METHODS: The SOSS-D was translated into French and piloted with 12 physicians. The scale was administered to physicians at the Geneva University Hospitals. We computed descriptive statistics and internal consistency coefficients. Construct validity was analyzed using exploratory (EFA) and confirmatory factor (CFA) analyses.

RESULTS: In total, 323 physicians participated in the survey. The internal consistency coefficient for the French SOSS-D was 0.72, 0.55 for the personal stigma subscale, 0.66 for the perceived other stigma subscale, and 0.65 for the perceived structural stigma subscale. CFA indicated a marginal fit. EFA revealed three factors: personal, perceived other, and perceived structural stigma.

DISCUSSION: Our findings support the hypothesis that stigma is a multi-dimensional construct. However, the French version of the SOSS-D scale did demonstrate some differences when compared to its English version. Identifying stigmatization beliefs among physicians may allow for increased identification of physicians at risk, and increased communication concerning preventive actions. Moreover, being aware of and fighting stigma can reduce barriers to help seeking and increased access to care resources for burnt-out physicians.

CONCLUSION: The results provide evidence of the validity and reliability of the French version of the SOSS-D indicating its suitability for use in a French-speaking physician population.

PMID:39674755 | DOI:10.1016/j.encep.2024.10.002

Nutr Metab Cardiovasc Dis. 2024 Nov 19:103799. doi: 10.1016/j.numecd.2024.103799. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Whether the new standard of metabolic dysfunction-associated fatty liver disease (MAFLD) has more pronounced clinical and population screening diagnostic value than nonalcoholic fatty liver disease (NAFLD) is unclear. This study evaluated the utility of MAFLD and NAFLD for predicting major cardiovascular disease (CVD) risk.

METHODS AND RESULTS: A prospective cohort study approach was utilized to collect 19,399 study participants without CVD at baseline who completed follow-up from the Jinchang cohort platform during 2011-2017. According to clinical ultrasonic diagnosis results and disease diagnosis criteria, the baseline population was divided into MAFLD, NAFLD, Both-FLD and No-FLD groups. Based on the multifactorial Cox proportional risk model to analyze the relationship between three kinds of patients and CVD, the score prediction model of CVD was constructed with reference to the Framingham Risk Score (FRS) and the model was evaluated. Compared with No-FLD, the HRs and 95 % CIs for the risk of CVD development in patients with NAFLD, MAFLD, and Both-FLD were 1.54 (1.34-1.76), 1.57 (1.37-1.79), and 1.62 (1.41-1.87), in that order. The scoring model showed a range of 5.90%-84.59 % risk of CVD in the three groups. As the risk score increased, the risk of developing CVD gradually increased. Evaluation metrics of all three models in the training set and validation set showed that the models have good prediction efficacy.

CONCLUSION: In terms of CVD risk and prognosis, MAFLD had no advantage over NAFLD. However, Both-FLD was found to predict a higher risk of CVD and to have superior predictive efficacy.

PMID:39674723 | DOI:10.1016/j.numecd.2024.103799

Nutr Metab Cardiovasc Dis. 2024 Nov 19:103797. doi: 10.1016/j.numecd.2024.103797. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Patients with metabolic dysfunction-associated steatotic liver disease (MASLD) often manifest a combination of cardiometabolic risk factors of varying severity. The cardiometabolic phenotypes and their associations with advanced liver fibrosis and all-cause mortality among patients with MASLD warrant further investigation.

METHODS AND RESULTS: A total of 4209 and 1901 eligible participants were obtained from the National Health and Nutrition Examination Survey and included in the original and replication datasets, respectively. In the original dataset, three distinct and stable cardiometabolic phenotypes were identified using unsupervised cluster analyses, including mild cardiometabolic risk factor (MCMRF) phenotype, overweight combined with high diastolic blood pressure dominated (OCHBP) phenotype, and severe glucose and lipid metabolic dysfunction dominated (SGLMD) phenotype. The above phenotypes were subsequently replicated in the replication dataset, demonstrating similar characteristics. After adjusting for potential covariates, the results of logistic and Cox regression models showed that OCHBP and SGLMD phenotypes were significantly associated with higher odds of advanced liver fibrosis (OCHBP: OR = 4.37, 95 % CI: 1.54-12.35, P = 0.020; SGLMD: OR = 9.66, 95 % CI: 4.76-19.61, P = 0.002) and an increased risk of all-cause mortality (OCHBP: HR = 1.39, 95 % CI: 1.17-1.65, P < 0.001; SGLMD: HR = 2.51, 95 % CI: 1.86-3.40, P < 0.001) compared to the MCMRF phenotype. Moreover, the observed associations remained statistically significant in most subgroups, and a series of sensitivity analyses further confirmed the robustness of these findings.

CONCLUSION: Three heterogeneous cardiometabolic phenotypes were identified among participants with MASLD, showing significant associations with two critical outcomes. These novel phenotypes may be of great importance to precision medicine in MASLD.

PMID:39674720 | DOI:10.1016/j.numecd.2024.103797

J Prosthet Dent. 2024 Dec 13:S0022-3913(24)00730-3. doi: 10.1016/j.prosdent.2024.10.034. Online ahead of print.

ABSTRACT

STATEMENT OF PROBLEM: The relationship between hemoglobin A1c (HbA1c) levels and the clinical outcomes of ultrahydrophilic, smooth collar implants in the maxillary molar region remains underexplored.

PURPOSE: The purpose of this clinical study was to investigate the relationship between the HbA1c levels and clinical outcomes of ultrahydrophilic, smooth collar implants in the maxillary molar region of patients with type 2 diabetes mellitus.

MATERIAL AND METHODS: In total, 35 participants with type 2 diabetes mellitus who had received dental implants in the maxillary molar region between January 2016 and June 2020 were enrolled. Marginal bone levels (MBLs) were assessed from radiographs immediately and 1 to 2 years after restoration. Peri-implant tissue health was evaluated clinically and radiographically, and patient satisfaction was measured using the Oral Health Impact Profile-14 scale. The data were organized using a spreadsheet and statistically analyzed with a statistical software package. A t test was used to determine significant differences between groups, specifically comparing patients with HbA1c levels <7% and ≥7% in terms of MBLs, bleeding on probing (BOP), probing depth (PD), and patient satisfaction (OHIP-14 scores) (α=.05). Furthermore, a linear correlation analysis was performed to assess the relationship between HbA1c levels and PD, as well as HbA1c levels and OHIP-14 scores.

RESULTS: Of the 35 participants, 27 were successfully followed up, and 27 ultrahydrophilic, smooth collar implants with a mean ±standard deviation length of 9.30 ±1.16 mm were placed. All implants were considered clinically successful 1 to 2 years after restoration. Those with HbA1c levels <7% exhibited no mesial or distal bone loss, while those with HbA1c levels ≥7% experienced a mean ±standard deviation distal marginal bone loss of 0.25 ±0.30 mm and a mean ±standard deviation mesial marginal bone loss of 0.14 ±0.16 mm. The overall satisfaction and total Oral Health Impact Profile-14 scores in patients with HbA1c levels ≥7.5% significantly differed from those with HbA1c levels <7.5% (P<.05).

CONCLUSIONS: Ultrahydrophilic, smooth collar implants demonstrated favorable clinical and patient satisfaction outcomes in patients with type 2 diabetes mellitus, with HbA1c levels serving as strong indicators of peri-implant health.

PMID:39674716 | DOI:10.1016/j.prosdent.2024.10.034

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