BMJ. 2024 Jul 23;386:q1553. doi: 10.1136/bmj.q1553.
NO ABSTRACT
PMID:39043391 | DOI:10.1136/bmj.q1553
Sci Prog. 2024 Jul-Sep;107(3):368504241266366. doi: 10.1177/00368504241266366.
ABSTRACT
OBJECTIVE: This retrospective chart review study aimed to investigate the differences in the Rorschach test and Minnesota Multiphasic Personality Inventory (MMPI)-II profiles among patients with Kraepelinian schizophrenia, those with DSM-wise schizophrenia, and controls. Kraepelinian schizophrenia is characterised by a chronic, deteriorative disease course and a predominance of negative symptoms.
METHODS: Patients with Kraepelinian schizophrenia were selected based on medical record reviews. We then compared their Rorschach test and MMPI-II results with those of the DSM-wise schizophrenia group and the control group.
RESULTS: The Rorschach test revealed a significant increase in DV2 score and a decrease in D score in patients with Kraepelinian schizophrenia compared to those with DSM-wise schizophrenia. In the MMPI-II profiles, patients with Kraepelinian schizophrenia exhibited an elevated L relative to those with DSM-wise schizophrenia.
CONCLUSION: Our results suggested the value of revisiting psychological tests in clinically delineated subgroups, such as Kraepelinian schizophrenia. Although patients fall under the same diagnostic category of schizophrenia, considering different phenotypes is important when interpreting psychological test outcomes. Additionally, our study indicated that both schizophrenia groups did not show as many abnormalities as expected compared to controls. This highlights the potential value of revisiting established profiles of certain psychological tests and calls for further research on other psychological tests.
PMID:39043381 | DOI:10.1177/00368504241266366
J Oncol Pharm Pract. 2024 Jul 23:10781552241266212. doi: 10.1177/10781552241266212. Online ahead of print.
ABSTRACT
PURPOSE: This study was developed to provide a resource for staffing model metrics for oncology pharmacies at healthcare organizations.
METHODS: The Hematology/Oncology Pharmacy Association Practice Outcomes and Professional Benchmarking Committee (POPBC) Oncology Pharmacy Staffing Model Task Force designed and distributed a survey to collect baseline data and staffing metrics for oncology pharmacies. The survey was first tested by four POPBC volunteers. The Staffing Model Survey was distributed in multiple phases between September 2021 and January 2022. The task force focused on several different domains including facilities, general metrics, outpatient infusion services, inpatient and outpatient services, informatics/technology, and training and residency programs. Descriptive statistics were used to evaluate the data.
RESULTS: A total of 67 responses were received from 68 surveys distributed (98.5%). Of the responders, the majority were from academic medical centers (AMCs) (n = 37, 55%) and community-based centers (CBCs) (n = 21, 31.3%). AMCs reported servicing more inpatient facilities than CBCs (2.1 vs 1.2). For all respondents, 20% tracked in-patient turn-around time compared with 39% of ambulatory sites. Patient education was tracked in all responding settings: 31% for inpatient and 27% for ambulatory. Most sites reported that pharmacy personnel were responsible for cleanroom cleaning (63%) or shared responsibility with an environmental service (37%). Of the 32 sites with ambulatory services, 19 sites were open on Saturday and 15 sites were open on Sundays. Sixty-eight percent of information technology respondents (n = 28) indicated that they use Epic/Beacon (EPIC Oncology Module) as their electronic health record. For the respondents, 89% used closed-system-transfer devices when compounding, 15% used gravimetric technology, and 11% used robotic technology.
CONCLUSION: Oncology pharmacy operations and staffing models are unique to each pharmacy and practice setting. The results of the pharmacy staffing model survey provide an insight into operations across the country and highlight a need for staffing model benchmarking and metrics.
PMID:39043373 | DOI:10.1177/10781552241266212
J Intensive Care Med. 2024 Jul 23:8850666241265190. doi: 10.1177/08850666241265190. Online ahead of print.
ABSTRACT
BACKGROUND: Central venous oxygen saturation (ScvO2) obtained from a central venous catheter (CVC) is often used to approximate oxygen delivery in critically ill patients. Despite their importance in administering medications and monitoring oxygen delivery, the use of CVCs can be associated with significant complications. Midline catheters are inserted via a peripheral vein above the antecubital fossa and provide a safe alternative to CVCs. This study aimed to determine the equivalence of ScvO2 and midline catheter oxygen saturation (SmO2) in critically ill patients.
METHODS: This was a single-center observational study of critically ill adult patients who had concurrently placed CVCs (internal jugular and subclavian) and midline catheters as part of standard ICU care. Venous oxygen saturation and lactate levels were measured from both catheters using the Abbott point-of-care i-STAT analyzer. Demographic and ICU admission data were collected. Continuous variables were compared using the paired t-test. Pearson’s correlation was used to evaluate the linear correlation between ScvO2 and SmO2. The systematic error (bias) was calculated using Bland-Altman analysis. Receiver operating characteristic curves were constructed to evaluate the sensitivities and specificities for different values of SmO2 to predict ScvO2.
RESULTS: Forty-eight patients (n = 48) were enrolled in the study. The mean ScvO2 and SmO2 were 65.5% +/- 11.2% and 62.7% +/- 17.6% respectively (p = 0.1197). In the Bland-Altman analysis, the mean bias between ScvO2 and SmO2 was 2.8% +/- 12.3% with 95% limits of agreement of -21.3% to 26.9%. More than 60% of the ScvO2 and SmO2 values diverged by ≥ 5%.
CONCLUSIONS: The difference between the mean SmO2 and ScvO2 was not statistically significant and the mean bias between SmO2 and ScvO2 is low. Despite this, the substantially large standard deviation and limits of agreement preclude the use of SmO2 as a direct surrogate of ScvO2.
PMID:39043372 | DOI:10.1177/08850666241265190
J Intensive Care Med. 2024 Jul 23:8850666241266475. doi: 10.1177/08850666241266475. Online ahead of print.
ABSTRACT
Objective: This study’s purpose is to better understand pediatric intensive care nursing perspectives on sedative management as a precursor to improving aspects of sedation assessment, titration, and communication. Methods/Design: We queried nurses in the pediatric intensive care unit at a 40+ bed quaternary care using an electronic survey about their experiences with sedation management. Data was collected using REDCap and statistical analyses were performed to assess for differences between experience levels in areas. Results: Seventy nurses responded with 42% response rate. More than 95% were comfortable calculating sedation and delirium scores. Those with less than 5 years’ experience were significantly more likely to consider sedation scores helpful (P = .04) and also significant more likely to agree that delirium scores are used effectively (P = .01). Eighty-eight percent of respondents were comfortable raising concerns about sedation to the multidisciplinary team, but those with less than 5 years’ experience were significantly less likely to express concerns to attending (P = .001). Conclusion: Newer nurses are more inclined to support use of standardized scoring systems for sedation and delirium, but less comfortable approaching attending clinicians with their concerns. Intensive care teams should pay careful attention to team dynamics, particularly as they apply to sedative management and work to improve communication, collaboration, and educational interventions to improve patient care. Further work understanding nursing perspectives and further attempts to improve interprofessional communication seems a wise investment and could obviate barriers that may exist.
PMID:39043371 | DOI:10.1177/08850666241266475
Acc Chem Res. 2024 Jul 23. doi: 10.1021/acs.accounts.4c00340. Online ahead of print.
ABSTRACT
ConspectusFlow chemistry has brought a fresh breeze with great promises for chemical manufacturing, yet critical deterrents persist. To remain economically viable at production scales, flow processes demand quick reactions, which are actually not that common. Superheated flow technology stands out as a promising alternative poised to confront modern chemistry challenges. While continuous micro- and mesofluidic reactors offer uniform heating and rapid cooling across different scales, operating above solvent boiling points (i.e., operating under superheated conditions) significantly enhances reaction rates. Despite the energy costs associated with high temperatures, superheated flow chemistry aligns with sustainability goals by improving productivity (process intensification), offering solvent flexibility, and enhancing safety.However, navigating the unconventional chemical space of superheated flow chemistry can be cumbersome, particularly for neophytes. Expanding the temperature/pressure process window beyond the conventional boiling point under the atmospheric pressure limit vastly increases the optimization space. When associated with conventional trial-and-error approaches, this can become exceedingly wasteful, resource-intensive, and discouraging. Over the years, flow chemists have developed various tools to mitigate these challenges, with an increased reliance on statistical models, artificial intelligence, and experimental (kinetics, preliminary test reactions under microwave irradiation) or theoretical (quantum mechanics) a priori knowledge. Yet, the rationale for using superheated conditions has been slow to emerge, despite the growing emphasis on predictive methodologies.To fill this gap, this Account provides a concise yet comprehensive overview of superheated flow chemistry. Key concepts are illustrated with examples from our laboratory’s research, as well as other relevant examples from the literature. These examples have been thoroughly studied to answer the main questions Why? At what cost? How? For what? The answers we provide will encourage educated and widespread adoption. The discussion begins with a demonstration of the various advantages arising from superheated flow chemistry. Different reactor alternatives suitable for high temperatures and pressures are then presented. Next, a clear workflow toward strategic adoption of superheated conditions is resorted either using Design of Experiments (DoE), microwave test chemistry, kinetics data, or Quantum Mechanics (QM). We provide rationalization for chemistries that are well suited for superheated conditions (e.g., additions to carbonyl functions, aromatic substitutions, as well as C-Y [Y = N, O, S, C, Br, Cl] heterolytic cleavages). Lastly, we bring the reader to a rational decision analysis toward superheated flow conditions. We believe this Account will become a reference guide for exploring extended chemical spaces, accelerating organic synthesis, and advancing molecular sciences.
PMID:39043368 | DOI:10.1021/acs.accounts.4c00340
Urology. 2024 Jul 21:S0090-4295(24)00594-6. doi: 10.1016/j.urology.2024.07.028. Online ahead of print.
ABSTRACT
OBJECTIVES: To evaluate the effect of a modified technique of posterior reconstruction by iliopectineal ligament suspension during robot-assisted radical prostatectomy (RARP) on recovery of early continence.
METHODS: A prospective, single surgeon, single center, randomized controlled trial was performed from August 2018 to March 2020 with 171 patients (92 control vs. 79 experimental). The posterior reconstruction was done using a standard technique in the control group and was modified for the experimental group by incorporating not only the “Rocco” stitch between Denonvilliers’ fascia and the rhabdosphincter but also the iliopectineal ligaments bilaterally to further improve posterior support with this suspensory ‘hammock’. Both groups of patients were followed for a year with questionnaires and 24-hour pad tests.
RESULTS: Both groups were comparable in terms of baseline demographic, clinical and pathological characteristics. With regards to recovery of urinary continence, no statistically significant differences were found for socially continent (0-1 pads per day) or fully continent (0 pads per day) rates at all time points examined (1, 3, 6, 12 months). Moreover, there was no statistically significant differences between the groups for presence of urinary symptoms, bowel symptoms, sexual function, and hormonal symptoms.
CONCLUSIONS: The modified technique of posterior reconstruction by iliopectineal ligament suspension is not associated with improved early continence as compared to the standard posterior reconstruction technique during RARP. Future studies may want to explore other variations of suspensory sutures that could strengthen posterior urethral support to achieve earlier recovery of continence.
PMID:39043340 | DOI:10.1016/j.urology.2024.07.028
J Dent. 2024 Jul 21:105257. doi: 10.1016/j.jdent.2024.105257. Online ahead of print.
ABSTRACT
OBJECTIVE: Evaluate the impact of a “fast” crystallization and simultaneous-glazing on the physicochemical properties of lithium-disilicate CAD/CAM-ceramic.
METHODS: Lithium-disilicate bars and crowns (IPS e.max CAD, Ivoclar-Vivadent) were divided into four groups (n=30): WG/F (WG=with glaze/F=fast crystallization), NG/F (NG=no glaze), WG/C (C=conventional crystallization), and NG/C. A liquid/powder glaze system was used (IPS Ivocolor®, Ivoclar-Vivadent). Specimens were crystallized (Programat P310, Ivoclar-Vivadent) using the P161 program for C (approx. 20-25min), and P165 for F (approx. 14-16min). Bars (n=30) underwent three-point bending tests (flexural strength-FS in MPa and modulus of elasticity-E in GPa) using a universal testing machine. Crowns were analyzed via scanning electron microscopy (SEM) after selective etching, and to Raman, FTIR-ATR, and X-ray diffraction (XRD) spectroscopies to assess chemical composition.
RESULTS: For FS, both factors/interaction were statistically significant. C (427.48±42.41MPa) showed significantly higher values than F (409.82±38.82MPa). WG (398.32±29.80MPa) exhibited significantly lower FS than NG (438.21±41.77MPa). For E data, both factors/interaction were significant. NG (90.28±14.71GPa) displayed higher E than WG (83.07±5.69GPa), while C (90.08±12.98GPa) exhibited higher E than F (83.46±9.40GPa). NG/C showed the best results for both variables. F groups showed (SEM) porous surfaces and crack-like marks on crystals. FTIR, Raman and XRD spectra confirmed the typical composition of a lithium-disilicate glass ceramic, and some attenuated signals and structural variations (XRD) in WG.
CONCLUSIONS: “Fast” crystallization and simultaneous-glazing produced weaker/less-rigid structures with irregular crystals and glassy phases. Simultaneous glazing may have hindered proper thermal distribution during crystallization.
SIGNIFICANCE: “Fast” crystallization and simultaneous glazing with non-recommended systems, can adversely affect the final properties of lithium disilicate restorations.
PMID:39043330 | DOI:10.1016/j.jdent.2024.105257
J Dent. 2024 Jul 21:105231. doi: 10.1016/j.jdent.2024.105231. Online ahead of print.
ABSTRACT
OBJECTIVES: This study aimed to assess the seating accuracy of resin composite CAD/CAM overlay restorations, employing various preparation designs and luting materials (pre-heated composite (HC) or resin cement (RC)).
METHODS: A human molar’s STL file was utilized to create 100 3D-printed resin tooth replicas, randomly distributed into 5 groups (n=20) based on finishing line preparation designs: 1) Rounded shoulder above the dental equator – DE (SA); 2) Chamfer above the DE (CA); 3) Butt joint above the DE (BJ); 4) Rounded shoulder below the DE (SB); 5) Chamfer below the DE (CB). Digital impressions were acquired for all replicas, and restorations milled using Tetric CAD (Ivoclar Vivadent). The restorations were luted with HC (Tetric Prime, Ivoclar Vivadent) or RC (RelyX Universal, 3M). Seating accuracy was evaluated through digital scans during try-in without any luting agent and post-cementation using a 3D analysis software (Geomagic wrap, 3D Systems). Data were statistically analyzed using Two-Way ANOVA (p<0.05).
RESULTS: The type of luting material (RC vs HC), preparation design, and their interactions significantly impacted 3D seating of the restorations (p<0.001). HC exhibited higer volumetric increase than RC. BJ and CA designs consistently demonstrated superior seating accuracy, irrespective of the luting material used.
CONCLUSIONS: The utilization of pre-heated composite resin could negatively influence the seating of overlay restorations, probably due to its higher viscosity when compared to the resin cement. However, when HC is selected as luting agent, preparation designs lacking internal angles are recommended for enhancing the precision of overlays seating.
PMID:39043328 | DOI:10.1016/j.jdent.2024.105231
J Affect Disord. 2024 Jul 21:S0165-0327(24)01174-1. doi: 10.1016/j.jad.2024.07.114. Online ahead of print.
ABSTRACT
BACKGROUND: Early life environments can have long-lasting impacts on future health and wellbeing. Maternal health during pregnancy, including experiencing stress or mood disorders, has been associated with psychopathology in later life. Anxiety disorders are one of the most prevalent mental health conditions, affecting approximately 7 % of children and adolescents globally, with a lifetime prevalence of 15-20 %. Identifying prenatal risk factors can support future and current public health interventions and maternity care.
METHODS: Data were obtained from the Growing Up in New Zealand longitudinal study of child development. Prenatally, mothers provided sociodemographic information as well as data on their mental health, potential teratogens, and lifestyle factors such as supplement intake and exercise levels. At 8-years old, 4922 children self-completed the PROMIS-SF anxiety measure. Bivariate analyses and backward stepwise regression were used to determine the best multivariable model.
RESULTS: Significant prenatal predictors of anxiety symptoms at 8-years old included elevated maternal depression symptoms, body mass index in the overweight/obese range, exercise patterns, and paracetamol, anti-inflammatory and alcohol intake.
LIMITATIONS: Sample attrition from baseline to 8-year may have affected statistical power. To further untangle the effect of timing and duration of the exposures reported in this study, larger sample sizes would be required.
CONCLUSIONS: Prenatal mental health and wellbeing was significantly associated with child anxiety symptoms at 8-years of age. This study highlights the importance of supporting expectant mothers’ health and wellbeing during pregnancy to ensure children have the best opportunity to have good mental health.
PMID:39043309 | DOI:10.1016/j.jad.2024.07.114