Nevin Manimala

J Dr Nurs Pract. 2024 Aug 5;17(2):100-109. doi: 10.1891/JDNP-2021-0010.

ABSTRACT

Background: Adolescents affected by childhood cancer experience various degrees of psychosocial distress, social isolation, and social support throughout the treatment process. Objective: To create and implement an evidence-based practice project consisting of a pilot half-day camp program to improve social support and connectedness for adolescents affected by childhood cancer. Methods: A pilot half-day camp program was implemented. Twenty adolescent patients, survivors, and siblings (ages 13-18 years) participated in the program. Participants provided basic demographic information and completed pretest, immediate posttest, and 4-week posttest surveys to assess their levels of social support and camp connectedness. Data were analyzed using descriptive statistics and two-tailed Wilcoxon signed-rank test. Results: All measures of social support in adolescent participants affected by childhood cancer trended upward following the conclusion of the program, then trended downward over time, with overall social support and family social support significantly decreasing over time postintervention. Camp connectedness was not significantly impacted by the program. Conclusions: Social support decreases as participants are further out from attending a half-day camp program. This pilot program demonstrated the feasibility of a short-term, local, cost-effective camp program that is scalable to larger groups. Implications for Nursing: Providers should refer adolescents affected by childhood cancer to camp programs for social support. More research is needed to determine if more frequent camp programs sustain a high level of social support in participants.

PMID:39103192 | DOI:10.1891/JDNP-2021-0010

J Dr Nurs Pract. 2024 Aug 5;17(2):86-99. doi: 10.1891/JDNP-2023-0060.

ABSTRACT

Background: Despite the innovative advancements in diabetes care, providers may not recognize patients with type 2 diabetes mellitus (T2DM) who qualify for a continuous glucose monitoring (CGM) device or the benefits of a telemedicine program for improving self-management behaviors. Objective: This quality improvement (QI) project aimed to determine if an advanced practice registered nurse (APRN)-led telemedicine program using CGM could improve glycemic control and self-management in patients with insulin-dependent T2DM. Methods: A 6-week telemedicine program was developed and implemented using the CGM’s time-in-range to deliver patient-specific education. Clinical metrics were collected at each visit. All patients completed a pre- and postintervention Diabetes Self-Management Questionnaire-Revised (DSMQ-R) survey. Results: A repeated measures analysis of variance revealed that the telemedicine program had a statistically significant impact on time-in-range outcomes, F(2, 14) = 18.203, p < .001. Paired-samples t tests indicate that APRN-led education improved body mass index, t(8) = 4.232, p = .002; decreased systolic blood pressure, t(8) = 2.90, p = .010, and diastolic blood pressure, t(8) = 3.21, p = .007; and increased self-management skills as evidenced by DSMQ-R, t(8) = -5.498, p < .001. Conclusions: This QI project highlights multiple interventions for improving diabetes management in a primary care facility. Implications for Nursing: An APRN-led telemedicine program integrating CGM time-in-range data can improve glycemic control and self-management skills in patients with T2DM who administer insulin.

PMID:39103191 | DOI:10.1891/JDNP-2023-0060

Biostatistics. 2024 Aug 5:kxae030. doi: 10.1093/biostatistics/kxae030. Online ahead of print.

ABSTRACT

The under-5 mortality rate (U5MR), a critical health indicator, is typically estimated from household surveys in lower and middle income countries. Spatio-temporal disaggregation of household survey data can lead to highly variable estimates of U5MR, necessitating the usage of smoothing models which borrow information across space and time. The assumptions of common smoothing models may be unrealistic when certain time periods or regions are expected to have shocks in mortality relative to their neighbors, which can lead to oversmoothing of U5MR estimates. In this paper, we develop a spatial and temporal smoothing approach based on Gaussian Markov random field models which incorporate knowledge of these expected shocks in mortality. We demonstrate the potential for these models to improve upon alternatives not incorporating knowledge of expected shocks in a simulation study. We apply these models to estimate U5MR in Rwanda at the national level from 1985 to 2019, a time period which includes the Rwandan civil war and genocide.

PMID:39103178 | DOI:10.1093/biostatistics/kxae030

BMJ Ment Health. 2024 Aug 4;27(1):e300971. doi: 10.1136/bmjment-2023-300971.

ABSTRACT

QUESTION: For parents of children and young people (CYP) with diagnosed mental health difficulties, what are the levels of parents’ well-being and psychological need?

STUDY SELECTION AND ANALYSIS: Medline, PsycINFO, EMBASE, AMED, CINAHL, Web of Science and Cochrane Library of Registered Trials were searched from inception to June 2023.

INCLUSION CRITERIA: parents of CYP aged 5-18 years with formal mental health diagnosis. Data were extracted from validated measures of well-being or psychological needs with established cut-off points or from a controlled study.

FINDINGS: 32 of the 73 310 records screened were included. Pooled means showed clinical range scores for one measure of depression, and all included measures of anxiety, parenting stress and general stress. Meta-analyses showed greater depression (g=0.24, 95% CI 0.11 to 0.38) and parenting stress (g=0.34, 95% CI 0.20 to 0.49) in parents of CYP with mental health difficulties versus those without. Mothers reported greater depression (g=0.42, 95% CI 0.18 to 0.66) and anxiety (g=0.73, 95% CI 0.27 to 1.18) than fathers. Narrative synthesis found no clear patterns in relation to CYP condition. Rates of parents with clinically relevant levels of distress varied. Typically, anxiety, parenting stress and general stress scored above clinical threshold. Quality appraisal revealed few studies with a clearly defined control group, or attempts to control for important variables such as parent gender.

CONCLUSIONS: The somewhat mixed results suggest clinical anxiety, parenting and general stress may be common, with sometimes high depression. Assessment and support for parents of CYP with mental health problems is required. Further controlled studies, with consideration of pre-existing parental mental health difficulties are required.

PROSPERO REGISTRATION NUMBER: CRD42022344453.

PMID:39103177 | DOI:10.1136/bmjment-2023-300971

BMJ. 2024 Aug 5;386:q1732. doi: 10.1136/bmj.q1732.

NO ABSTRACT

PMID:39103172 | DOI:10.1136/bmj.q1732

BMJ. 2024 Aug 5;386:e073515. doi: 10.1136/bmj-2022-073515.

NO ABSTRACT

PMID:39103171 | DOI:10.1136/bmj-2022-073515

BMJ. 2024 Jul 30;386:q1694. doi: 10.1136/bmj.q1694.

NO ABSTRACT

PMID:39103166 | DOI:10.1136/bmj.q1694

J Dermatolog Treat. 2024 Dec;35(1):2386973. doi: 10.1080/09546634.2024.2386973. Epub 2024 Aug 5.

ABSTRACT

BACKGROUND: Biological therapies are effective for psoriasis, but patient responses vary, often requiring therapy switching or discontinuation.

OBJECTIVES: To identify physicians’ prescribing patterns of biological therapies at a referral tertiary center in Saudi Arabia and assess the probability of biologic persistence following treatment initiation.

METHODS: We conducted a retrospective study of biologic-naïve adult psoriasis patients who initiated therapy from October 2013 to July 2022 in Dammam. Descriptive statistics and a Kaplan-Meier analysis evaluated treatment persistence at 6, 12, 24, and 36 months.

RESULTS: A total of 151 patients received adalimumab (n = 89), etanercept (n = 17), risankizumab (n = 30), ustekinumab (n = 14), and ixekizumab (n = 1). At 6 months, all therapies demonstrated 100% persistence. At 12 months, persistence was highest for ustekinumab (100%) and lowest for etanercept (88.2%). At 24 months, ustekinumab maintained 100% persistence, followed by risankizumab (96.6%), adalimumab (94.3%), and etanercept (76.4%). At 36 months, risankizumab had the highest persistence (96.6%), followed by adalimumab (83.1%), ustekinumab (78%), and etanercept (70.6%). The most common reasons for discontinuation were lack of effectiveness and intolerability.

CONCLUSION: This study shows changing psoriasis treatment patterns with new therapies. Risankizumab demonstrated high long-term persistence, while etanercept and ustekinumab showed declining persistence, suggesting evolving treatment considerations.

PMID:39103160 | DOI:10.1080/09546634.2024.2386973

J Oral Maxillofac Surg. 2024 Jul 20:S0278-2391(24)00652-9. doi: 10.1016/j.joms.2024.07.011. Online ahead of print.

ABSTRACT

BACKGROUND: Postoperative pain after orthognathic surgery is commonly managed with opioids, which can cause nausea and vomiting.

PURPOSE: The purpose of this study was to determine whether regional nerve blocks during bimaxillary surgery reduced postoperative pain and vomiting compared with patient-controlled analgesia (PCA).

STUDY DESIGN, SETTING, AND SAMPLE: This retrospective cohort study recruited patients who underwent bimaxillary surgery between August 2018 and September 2020 at the Fourth Military Medical University Hospital. Participants whose procedures involved the cheekbone, temporomandibular joint, mandibular angle, or an autogenous iliac bone graft and those who were admitted to the intensive care unit after surgery were excluded.

PREDICTOR VARIABLES: The primary predictor variables were postoperative analgesia management, regional maxillary and inferior alveolar nerve blocks, and PCA.

OUTCOME VARIABLES: The primary outcome variables were moderate-to-severe postoperative pain and postoperative vomiting (POV) during the first 24 hours. Moderate-to-severe pain was defined as pain numerical rating scale ≥4, POV was defined as vomiting of gastrointestinal contents.

COVARIATES: The study covariates included demographic, surgical, and anesthesia characteristics.

ANALYSES: Statistical analyses were conducted using an unpaired t-test, χ² test, or Fisher’s exact test for the bivariate analysis. A multivariate logistic regression analysis was performed to assess the associations between the primary predictor variables and outcomes. Statistical significance was set at P < .05.

RESULTS: 354 participants were included in the study (262 in the nerve block group, mean age 22.5 ± 4.0 years; 92 in the PCA group, mean age 22.6 ± 4.4 years; P = .81). There was no significant difference in sex between the groups (63.4 and 55.4% females in nerve block and PCA groups, respectively, P = .18). The multivariate regression analyses demonstrated that nerve blocks did not decrease moderate-to-severe postoperative pain (7.6 vs 10.9%, adjusted odds ratio = 0.67, 95% confidence interval: 0.22-2.01, P = .48), although they were associated with decreased POV (38.5 vs 65.2%, adjusted odds ratio = 0.34, 95% confidence interval: 0.18-0.65, P = .001).

CONCLUSION AND RELEVANCE: For bimaxillary surgery, regional nerve blocks as opioid-free postoperative analgesia were not significantly associated with decreased postoperative pain but were associated with a low POV risk.

PMID:39103152 | DOI:10.1016/j.joms.2024.07.011

J Oral Maxillofac Surg. 2024 Jul 20:S0278-2391(24)00651-7. doi: 10.1016/j.joms.2024.07.010. Online ahead of print.

ABSTRACT

BACKGROUND: Retrusive profiles show an appearance of aging with an under-projected vermilion and pronounced nasolabial folds due to deficient bone support.

PURPOSE: A study was made of the association between orthognathic surgery and changes in the nasolabial and vermilion areas in patients with retrusive profiles.

STUDY DESIGN, SETTING, SAMPLE: A retrospective cohort study evaluated patients subjected to bimaxillary surgery according to the Barcelona Line (BL) protocol during 2021 at Teknon Medical Center (Barcelona, Spain). Subjects with craniofacial syndromes, facial esthetic procedures, and dental rehabilitations involving lip changes, were excluded.

PREDICTOR VARIABLE: The predictor variable was the timing of cephalometric measures, reported as T0 (preoperatively), T1 (1 month after surgery), and T2 (after 1 year of follow-up).

MAIN OUTCOME VARIABLE: The outcome variable corresponded to the soft tissue changes of the nasolabial and vermilion area, reported as the nasolabial fold length and angle, nasolabial angle, upper lip concavity, vermilion length, and upper lip sagittal distance from BL.

COVARIATES: The covariates comprised patient demographic data, the surgical-orthodontic protocol, and the magnitude and direction of the skeletal movements.

ANALYSES: Descriptive and inferential analyses were performed based on analysis of variance, the Bonferroni test, Pearson’s linear coefficient, the nonparametric Mann-Whitney U-test, Kruskal-Wallis test, and multiple linear regression models. Statistical significance was considered for P < .05.

RESULTS: The sample comprised 27 subjects with a mean age of 32.5 ± 11.2 years. A mean decrease in nasolabial angle of 5.5 ± 6° was recorded (P < .001), with a shortening of the nasolabial fold length of 4.4 ± 7.6 mm (P = .019). An increase in upper lip concavity angle of 14.4 ± 12° was recorded (P < .001), along with a vermilion lengthening of 1.6 ± 1.3 mm (P < .001) and an increase in upper lip sagittal distance to BL of 5.7 ± 7.3 mm (P = .001), indicating a more projected and everted upper vermilion.

CONCLUSIONS AND RELEVANCE: When adequate dentoskeletal support is provided by specific positional changes of the jaws planned through orthognathic surgery, the length of the nasolabial fold decreases, and the upper vermilion lengthens and becomes slightly everted.

PMID:39103151 | DOI:10.1016/j.joms.2024.07.010