Nevin Manimala

Int Braz J Urol. 2024 Jul 26;50. doi: 10.1590/S1677-5538.IBJU.2024.9915. Online ahead of print.

ABSTRACT

PURPOSE: The continuous improvement and development of fertility care, internationally, requires ongoing monitoring of current delivery processes and outcomes in clinical practice. This descriptive and exploratory mixed-methods study was conducted in eight countries (Brazil, China, France, Germany, Italy, Mexico, Spain and the United Kingdom) to assess the unmet needs of fertility patients (male and female), and existing challenges, barriers and educational gaps of physicians and laboratory specialists involved in human fertility care during the COVID-19 pandemic.

MATERIALS AND METHODS: The study was deployed sequentially in two phases: 1) in-depth 45-minute semi-structured interviews (n=76), transcribed, coded and thematically analysed using an inductive reasoning approach, 2) an online survey (n=303) informed by the findings of the qualitative interviews, face validated by experts in reproductive medicine, and analysed using descriptive and inferential statistical methods.

RESULTS: The integrated results of both phases indicated numerous areas of challenges, including: 1) investigating male-related infertility; 2) deciding appropriate treatment for men and selective use of assisted reproductive technology; and 3) maintaining access to high-quality fertility care during a pandemic.

CONCLUSIONS: The paper presents a reflective piece on knowledge and skills that warrant ongoing monitoring and improvement amongst reproductive medicine healthcare professionals amidst future pandemics and unanticipated health system disruptions. Moreover, these findings suggest that there is an additional need to better understand the required changes in policies and organizational processes that would facilitate access to andrology services for male infertility and specialized care, as needed.

PMID:39059016 | DOI:10.1590/S1677-5538.IBJU.2024.9915

JMIR Res Protoc. 2024 Jul 26;13:e56163. doi: 10.2196/56163.

ABSTRACT

BACKGROUND: Significant reforms are occurring in health practitioner regulation across Canada. Within the nursing profession, growing workforce challenges and health system demands have accelerated the pace of changes to nursing regulation policies and practices. There is significant political investment to modernize and harmonize nursing regulation across Canada, and evidence is needed to guide regulatory decision-making. To better understand the current state of scholarship and the gaps that exist, a comprehensive understanding of the available literature informing nursing regulation in Canada is first warranted.

OBJECTIVE: The objective of this scoping review is to examine the nature, extent, and range of literature focused on nursing regulation in Canada.

METHODS: The review will be conducted in accordance with the Joanna Briggs Institute guidelines for scoping reviews. We will search electronic databases, including Ovid MEDLINE, Ovid EMBASE, CINAHL, Scopus, and Web of Science Core Collection. We will also search for grey literature using the websites of Canadian nursing regulatory bodies, nursing organizations, and other leading Canadian regulatory organizations. No limitations will be placed on the year of publication. The review will include papers that explore nursing regulation in Canada, including topics such as education program accreditation or approval, licensure, standards of practice and code of conduct/ethics development and enforcement, continuing competence, discipline and conduct, regulatory models, governance, and reform. We will extract data using a predeveloped tool. Data will be analyzed using descriptive statistics and conventional content analysis.

RESULTS: A preliminary search in Ovid MEDLINE was undertaken on December 7, 2023, and a full search was conducted in 5 academic databases on March 15, 2024. Findings will be presented using evidence tables and a narrative summary. Reporting will follow the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) guidelines. This scoping review is expected to be completed in early 2025.

CONCLUSIONS: The results will be disseminated through conference presentations and a publication in a peer-reviewed journal. The findings will provide a comprehensive overview of the state of nursing regulation literature across Canada and inform the development of a focused research agenda.

TRIAL REGISTRATION: Open Science Framework osf.io/3qk8t; https://osf.io/bm7jv.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/56163.

PMID:39059008 | DOI:10.2196/56163

JMIR Res Protoc. 2024 Jul 26;13:e55155. doi: 10.2196/55155.

ABSTRACT

BACKGROUND: The UK medical education system faces a complex landscape of specialty training choices and heightened competition. The Factors Affecting Specialty Training Preference Among UK Medical Students (FAST) study addresses the need to understand the factors influencing UK medical students’ specialty choices, against a backdrop of increasing challenges in health care workforce planning.

OBJECTIVE: The primary objectives of the FAST study are to explore UK medical students’ preferred specialties and the factors that influence these choices. Secondary objectives are to evaluate students’ confidence in securing their chosen specialty, to understand how demographic and academic backgrounds affect their decisions, and to examine how specialty preferences and confidence levels vary across different UK medical schools.

METHODS: A cross-sectional survey design will be used to collect data from UK medical students. The survey, comprising 17 questions, uses Likert scales, multiple-choice formats, and free-text entry to capture nuanced insights into specialty choice factors. The methodology, adapted from the Ascertaining the Career Intentions of UK Medical Students (AIMS) study, incorporates adjustments based on literature review, clinical staff feedback, and pilot group insights. This approach ensures comprehensive and nondirective questioning. Data analysis will include descriptive statistics to establish basic patterns, ANOVA for group comparisons, logistic regression for outcome modeling, and discrete choice models for specialty preference analysis.

RESULTS: The study was launched nationally on December 4, 2023. Data collection is anticipated to end on March 1, 2024, with data analysis beginning thereafter. The results are expected to be available later in 2024.

CONCLUSIONS: The FAST study represents an important step in understanding the factors influencing UK medical students’ career pathways. By integrating diverse student perspectives across year groups and medical schools, this study seeks to provide critical insights into the dynamics of specialty, or residency, selection. The findings are anticipated to inform both policy and educational strategies, aiming to align training opportunities with the evolving needs and aspirations of the future medical workforce. Ultimately, the insights gained may guide initiatives to balance specialty distribution, improve career guidance, and improve overall student satisfaction within the National Health Service, contributing to a more stable and effective health care system.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/55155.

PMID:39059007 | DOI:10.2196/55155

J Med Internet Res. 2024 Jul 26;26:e53404. doi: 10.2196/53404.

ABSTRACT

BACKGROUND: The rate of suicide death has been increasing, making understanding risk factors of growing importance. While exposure to explicit suicide-related media, such as description of means in news reports or sensationalized fictional portrayal, is known to increase population suicide rates, it is not known whether prosuicide website forums, which often promote or facilitate information about fatal suicide means, are related to change in suicide deaths overall or by specific means.

OBJECTIVE: This study aimed to estimate the association of the frequency of Google searches of known prosuicide web forums and content with death by suicide over time in the United States, by age, sex, and means of death.

METHODS: National monthly Google search data for names of common prosuicide websites between January 2010 and December 2021 were extracted from Google Health Trends API (application programming interface). Suicide deaths were identified using the CDC (Centers for Disease Control and Prevention) National Vital Statistics System (NVSS), and 3 primary means of death were identified (poisoning, suffocation, and firearm). Distributed lag nonlinear models (DLNMs) were then used to estimate the lagged association between the number of Google searches on suicide mortality, stratified by age, sex, and means, and adjusted for month. Sensitivity analyses, including using autoregressive integrated moving average (ARIMA) modeling approaches, were also conducted.

RESULTS: Months in the United States in which search rates for prosuicide websites increased had more documented deaths by intentional poisoning and suffocation among both adolescents and adults. For example, the risk of poisoning suicide among youth and young adults (age 10-24 years) was 1.79 (95% CI 1.06-3.03) times higher in months with 22 searches per 10 million as compared to 0 searches. The risk of poisoning suicide among adults aged 25-64 was 1.10 (95% CI 1.03-1.16) times higher 1 month after searches reached 9 per 10 million compared with 0 searches. We also observed that increased search rates were associated with fewer youth suicide deaths by firearms with a 3-month time lag for adolescents. These models were robust to sensitivity tests.

CONCLUSIONS: Although more analysis is needed, the findings are suggestive of an association between increased prosuicide website access and increased suicide deaths, specifically deaths by poisoning and suffocation. These findings emphasize the need to further investigate sites containing potentially dangerous information and their associations with deaths by suicide, as they may affect vulnerable individuals.

PMID:39059004 | DOI:10.2196/53404

R I Med J (2013). 2024 Aug 1;107(8):21-27.

ABSTRACT

AIMS: To assess institutional compliance with, and test characteristics of, a child abuse screen performed by emergency department (ED) nurses for children <5 years old who were diagnosed with fractures.

METHODS: A secondary analysis of a retrospective observational study of children 0-5 years old with fractures seen at a pediatric ED between January 2018 and April 2023 was performed. We analyzed demographics, ED visit data, and results of the nurse-completed abuse screen. Screen results were compared to ED clinician concern for abuse to calculate test characteristics.

RESULTS: The mean age of the 2,705 children identified was 38.4 months (SD 19.8). Out of the total patient cohort, 2,449 (90.5%) had a nurse-completed screen. Among these, 65 patients (2.4%) screened positive for possible abuse. We found no statistically significant difference in screen completion by age group, race, ethnicity, language, or insurance type. Of 312 (11.5%) encounters with clinician concern for abuse, 17.6% screened positive, 76.0% screened negative, and 6.4% had an incomplete screen. The sensitivity and specificity among screened children aged 0-5 were 19.2% [95% CI 14.7-23.8%] and 99.5% [95% CI 99.3-99.8%]. The PPV and NPV were 84.6% [95% CI 75.8-93.4%] and 90.3% [95% CI 89.1-91.5%]. Comparatively, among children <12 months, the sensitivity was 24.4% [95% CI 18.0-30.8%], specificity was 98.1% [95% CI 95.4-100%], PPV was 95.5% [95% CI 89.3-100%], and NPV was 43.7% [95% CI 37.3-50.1%].

CONCLUSIONS: Although there was high compliance with this nurse-completed abuse screen, it is an inadequate sole modality for screening young children with fractures, with a low probability of a positive screen given clinician concern for potential abuse for the entire cohort and among high-risk infants.

PMID:39058986

Medwave. 2024 Jul 26;24(6):e2903. doi: 10.5867/medwave.2024.06.2903.

ABSTRACT

Leukemia is associated with exposure to radiation, benzene derivatives, and pesticides. Previous research has documented an increase in work-related leukemia in the Latin American Andean region. To date, there are only few studies in Ecuador on the impact of oil exploitation on adjacent indigenous communities. Our study aims to show the impact of leukemia on the working-age population. For the calculation of morbidity and mortality rates, we used hospital discharge and death records from the National Institute of Statistics of Ecuador. These data were collected and adjusted to the corresponding province’s population for further analysis. Large differences were observed between provinces in adjusted rates of leukemia mortality and morbidity in the working-age population. The variations in altitude among different areas in Ecuador give the provinces a distinct geographic identity. Likewise, the provinces with the highest morbidity and mortality rankings, such as Azuay, Loja, Imbabura, and Tungurahua, have an average altitude above 2000 meters. As a result, there are variations in the average temperature, exposure to solar and cosmic radiation, and mining and farming methods. The observed differences warrant the future collection of geolocation data for affected individuals. This could help to better understand how leukemia cases have demogrpahic hotspots in the country, identify possible risk factors associated with the disease in each region, and design more effective prevention and control strategies.

PMID:39058981 | DOI:10.5867/medwave.2024.06.2903

J Clin Oncol. 2024 Jul 26:JCO2400038. doi: 10.1200/JCO.24.00038. Online ahead of print.

ABSTRACT

PURPOSE: There have been no previous longitudinal assessments of health-related quality of life (HRQoL) during treatment for pediatric Hodgkin lymphoma (HL). The addition of brentuximab vedotin (BV) to a multidrug chemotherapy backbone demonstrated superior efficacy to standard chemotherapy for patients with pediatric high-risk HL in the AHOD 1331 trial. However, the impact on HRQoL is unknown.

PATIENTS AND METHODS: After treatment random assignment, 268 participants older than 11 years were enrolled in a prespecified, longitudinal, patient-reported outcomes substudy. HRQoL was assessed using the seven-item Child Health Ratings Inventories (CHRIs)-Global scale before treatment (T1) and at cycle 2 (T2), cycle 5 (T3), and end of treatment (T4). A clinically meaningful increase in HRQoL was considered 7 points on the CHRIs-Global. Multivariable linear regression estimated associations between demographic/clinical variables and HRQoL at T1. Linear mixed models estimated changes in HRQoL across the treatment arm.

RESULTS: Participant characteristics were balanced by treatment arm. Ninety-three percent of participants completed the CHRIs at T1, 92% at T2, 89% at T3, and 77% at T4. At T1, female sex and fever (P < .05) were each associated with worse HRQoL. By T2, participants in the BV arm experienced a statistically and clinically significant improvement in HRQoL (β = 7.3 [95% CI, 3.2 to 11.4]; P ≤ .001), which was greater than the change in the standard arm (difference in change β = 5.1 [95% CI, -0.2 to 10.3]; P = .057). The standard arm did not experience a statistically or clinically significant increase in HRQoL until T4 (β = 9.3 [95% CI, 4.7 to 11.5]; P < .001).

CONCLUSION: These data demonstrate successful collection of serial HRQoL from youth with high-risk pediatric HL and improvement in HRQoL over the course of initial therapy, sooner and to a greater extent in the group receiving the novel agent BV.

PMID:39058966 | DOI:10.1200/JCO.24.00038

Pain. 2024 Jul 26. doi: 10.1097/j.pain.0000000000003333. Online ahead of print.

ABSTRACT

Female sex is a prominent risk factor for chronic pain, although the underlying mechanisms are not fully understood. This cross-sectional study aimed to investigate the relationship between age at menopause, reproductive lifespan, and chronic pain in a sample of postmenopausal women aged 40 to 93 years. Data were collected from the Tromsø study conducted in Norway between 2015 and 2016 (Tromsø7). Chronic pain was assessed using a single question, which formed a sample size of 5741 participants. Chronic widespread pain was evaluated using the more comprehensive Graphical Index of Pain, resulting in a sample size of 5920 women. Premenopausal women and those who experienced menstrual cessation due to chemotherapy/radiation or hormonal intrauterine devices were excluded from the analysis. Adjusted relative risk ratios with 95% confidence intervals were calculated to determine associations. The results showed that early menopause was associated with a 1% increase in the prevalence of chronic pain for each year of earlier onset at menopause (0.992, CI 95% 0.985-0.998). This association was also observed in women who experienced natural menopause only. However, the association between menopause and chronic widespread pain did not reach statistical significance in the fully adjusted analysis (0.996, CI 95% 0.975-1.017). There were no significant associations found between reproductive lifespan and either outcome. In conclusion, the findings suggest that early menopause in postmenopausal women is linked to a higher prevalence of chronic pain. However, reproductive lifespan does not appear to have a significant impact on chronic pain or chronic widespread pain.

PMID:39058956 | DOI:10.1097/j.pain.0000000000003333

Blood Adv. 2024 Jul 26:bloodadvances.2024013623. doi: 10.1182/bloodadvances.2024013623. Online ahead of print.

ABSTRACT

Optimal therapy for the growing number of patients with lenalidomide (LEN)-refractory multiple myeloma (MM) in first relapse remains poorly defined. We therefore undertook a randomized phase II study evaluating the efficacy and safety of combining the oral proteasome inhibitor ixazomib (IXA) with pomalidomide (POM) and dexamethasone (DEX) for this patient population. The overall response rate (ORR) for POM-DEX was 43.6% and 63.2% for IXA-POM-DEX. Depth of response, as measured by attainment of a very good partial response or better favored the triplet over the doublet, 28.9% vs 5.1%, respectively (p = 0.0063). A pre-planned interim analysis after 75% of the progression events had occurred demonstrated a progression-free survival (PFS) advantage favoring IXA-POM-DEX that crossed the predefined boundary of superiority, leading to release of the study results. With additional follow-up, the median PFS for POM-DEX was 7.5 months (95% confidence interval [CI] 4.8 – 13.6 months) vs 20.3 months for IXA-POM-DEX (95% CI 7.7 – 26.0 months, hazard ratio 0.437 [upper 90% bound = 0.657]). ORR and median PFS for the 26 of 30 eligible patients who crossed over from the doublet to the triplet at progression was 23.1% and 5.6 months, respectively. Overall survival was similar between the two groups. More hematologic toxicities were seen with the triplet, but non-hematologic adverse events were similar between the two arms. Our data support further testing of this all-oral triplet vs current standard triplet therapy in the context of phase III studies for patients with LEN-refractory disease in first relapse. This trial is registered at www.clinicaltrials.gov as NCT02004275.

PMID:39058954 | DOI:10.1182/bloodadvances.2024013623

Am J Audiol. 2024 Jul 26:1-10. doi: 10.1044/2024_AJA-24-00009. Online ahead of print.

ABSTRACT

PURPOSE: Spatial hearing is necessary for adequate sound awareness and speech perception abilities; however, research indicates that children have difficulties on these spatial hearing tasks that affect functioning in their daily environment. The purpose of this study was to validate a pediatric version of the Spatial Hearing Questionnaire (P-SHQ) for determining binaural hearing benefits and spatial hearing ability in children.

METHOD: We recruited parents and guardians of 68 children ages kindergarten through eighth grade to participate. Parents completed the P-SHQ, the Speech, Spatial and Qualities of Hearing Scale-Parent version, and a demographic questionnaire. To determine the factor structure of the P-SHQ, we conducted an exploratory factor analysis and reliability was assessed by calculating correlation coefficients.

RESULTS: Three factors emerged during factor analysis: Factor 1 = sound localization, Factor 2 = speech-in-noise perception, and Factor 3 = speech perception in quiet. The P-SHQ has good internal consistency reliability (α = .97), and high item-total correlations were found. The correlation between scores from the P-SHQ questionnaire and the SSQ-Spatial subscale questionnaire provides evidence for the construct validity of the P-SHQ.

CONCLUSIONS: The P-SHQ is a reliable and valid questionnaire to assess spatial hearing ability in children. This quick-to-administer tool can be incorporated into audiological care to determine the spatial hearing skills of a child and assist in counseling, making it a valuable assessment for hearing health care professionals.

PMID:39058953 | DOI:10.1044/2024_AJA-24-00009