Nevin Manimala

BMJ Glob Health. 2023 Sep;8(9):e013101. doi: 10.1136/bmjgh-2023-013101.

ABSTRACT

OBJECTIVE: To provide insights into the nature, risk factors, impact and existing measures for reporting and preventing violence in the healthcare system. The under-reporting of violence against healthcare workers (HCWs) globally highlights the need for increased public awareness and education.

METHODS: The Violence Study of Healthcare Workers and Systems study used a survey questionnaire created using Research Electronic Data Capture (REDCap) forms and distributed from 6 June to 9 August 2022. Logistic regression analysis evaluated violence predictors, including gender, age, years of experience, institution type, respondent profession and night shift frequency. A χ² test was performed to determine the association between gender and different violence forms.

RESULTS: A total of 5405 responses from 79 countries were analysed. India, the USA and Venezuela were the top three contributors. Female respondents comprised 53%. The majority (45%) fell within the 26-35 age group. Medical students (21%), consultants (20%), residents/fellows (15%) and nurses (10%) constituted highest responders. Nearly 55% HCWs reported firsthand violence experience, and 16% reported violence against their colleagues. Perpetrators were identified as patients or family members in over 50% of cases, while supervisor-incited violence accounted for 16%. Around 80% stated that violence incidence either remained constant or increased during the COVID-19 pandemic. Among HCWs who experienced violence, 55% felt less motivated or more dissatisfied with their jobs afterward, and 25% expressed willingness to quit. Univariate analysis revealed that HCWs aged 26-65 years, nurses, physicians, ancillary staff, those working in public settings, with >1 year of experience, and frequent night shift workers were at significantly higher risk of experiencing violence. These results remained significant in multivariate analysis, except for the 55-65 age group, which lost statistical significance.

CONCLUSION: This global cross-sectional study highlights that a majority of HCWs have experienced violence, and the incidence either increased or remained the same during the COVID-19 pandemic. This has resulted in decreased job satisfaction.

PMID:37696546 | DOI:10.1136/bmjgh-2023-013101

Ecol Lett. 2023 Sep 11. doi: 10.1111/ele.14305. Online ahead of print.

ABSTRACT

Ecologists have long sought to understand variation in food chain length (FCL) among natural ecosystems. Various drivers of FCL, including ecosystem size, resource productivity and disturbance, have been hypothesised. However, when results are aggregated across existing empirical studies from aquatic ecosystems, we observe mixed FCL responses to these drivers. To understand this variability, we develop a unified competition-colonisation framework for complex food webs incorporating all of these drivers. With competition-colonisation tradeoffs among basal species, our model predicts that increasing ecosystem size generally results in a monotonic increase in FCL, while FCL displays non-linear, oscillatory responses to resource productivity or disturbance in large ecosystems featuring little disturbance or high productivity. Interestingly, such complex responses mirror patterns in empirical data. Therefore, this study offers a novel mechanistic explanation for observed variations in aquatic FCL driven by multiple environmental factors.

PMID:37696523 | DOI:10.1111/ele.14305

J Am Pharm Assoc (2003). 2023 Sep 9:S1544-3191(23)00294-7. doi: 10.1016/j.japh.2023.09.002. Online ahead of print.

ABSTRACT

BACKGROUND: Inpatient hypoglycemia is associated with increased morbidity and mortality. After a hypoglycemic event, the likelihood of additional episodes increases. The Joint Commission recommends evaluating all episodes of hypoglycemia for root-cause analysis. Studies have shown that pharmacists’ involvement with glycemic control protocols can prevent hypoglycemia.

OBJECTIVES: To assess whether the implementation of pharmacists’ real-time assessment of hypoglycemic events using an electronic alert messaging system contributes to the reduction of the number of recurrent hypoglycemia during hospitalization.

PRACTICE DESCRIPTION: A community hospital that provides a wide range of healthcare services. The pharmacy department provides fully decentralized clinical services as well as team-based specialist services.

PRACTICE INNOVATION: The pharmacist-led hypoglycemia stewardship initiative included a comprehensive review of hypoglycemic alerts received via an automated message. The alerts generated in the EHR every time a patient’s blood glucose resulted in less than 70mg/dL if there was a documented administration of a hypoglycemic agent 48 hours prior to the hypoglycemia event. Once the alert was received by the pharmacists via an EHR in-basket, a real time review was conducted to identify the potential causes of the event and opportunities for therapy modification.

EVALUATION METHODS: A single-center retrospective observational study including a pre and post-implementation phase from January 1st to June 30th, 2020 and January 1st to June 30th, 2021 respectively. Continuous data was analyzed using paired and equal variance t-test. Non-continuous data was analyzed using Fischer exact and chi-square test. Descriptive statistics were used to describe distribution and frequency of data.

RESULTS: There was a 5.1% absolute reduction in recurrent hypoglycemic events (p<0.001) and a 0.6% reduction of severe hypoglycemic days (p=0.269 in the post-implementation group). The average time to pharmacist intervention was 4 (+ 3.5) hours with a 92% acceptance rate.

CONCLUSION: This study demonstrated the utility of pharmacist-led hypoglycemia reviews in the reduction of recurrent hypoglycemic events in the inpatient setting.

PMID:37696492 | DOI:10.1016/j.japh.2023.09.002

World Neurosurg. 2023 Sep 9:S1878-8750(23)01288-3. doi: 10.1016/j.wneu.2023.09.020. Online ahead of print.

ABSTRACT

The topic of current research is the development of a new approach to the diagnosis and treatment tactics of severe brain injury, considering its main pathophysiological mechanism – intracranial hypertension syndrome. Transcranial doppler imaging is a perspective method, which allows quick and noninvasive assessment of the intracerebral blood flow dynamics right at the patient’s bedside. Due to the operator-dependent nature of this method, clinical interpretation can often be contradictory. As a result, no clear criteria for therapy correction have yet been formulated based on this neuroimaging method. This predefines the goal of the study – to identify Doppler patterns of unfavorable craniocerebral injury conditions to form a consistent algorithm of treatment measures on their basis, which will reduce secondary brain damage in patients with severe craniocerebral trauma. Analysis of the therapy performed allowed authors to specify the options for the hyperosmolar solutions for the correction of IIH syndrome and demonstrated no statistically significant difference in effectiveness between mannitol and hypertonic saline solutions.

PMID:37696434 | DOI:10.1016/j.wneu.2023.09.020

J Vasc Interv Radiol. 2023 Sep 9:S1051-0443(23)00663-2. doi: 10.1016/j.jvir.2023.09.007. Online ahead of print.

ABSTRACT

PURPOSE: To develop a reproducible in vitro model simulating central venous catheter (CVC) exchange with high potential for air embolization and test the hypothesis that a closed catheter clamp over Glidewire exchange technique will significantly reduce the volume of air introduced during CVC exchange.

MATERIALS & METHODS: The model consisted of a 16 Fr valved sheath, 240 mL container, and pressure transducer submerged in water in a 1200 mL suction canister system. Continuous wall suction was applied to the canister to maintain negative pressure at-7 mmHg or -11 mmHg. Each trial consisted of 0.035″ hydrophilic Glidewire introduction, over-the-wire catheter exchange, and wire removal following clinical protocol. A total of 256 trials were performed, 128 trials at each pressure with the catheter clamp open (n = 64) or closed (n = 64) around the Glidewire.

RESULTS: There was a statistically significant lower volume of air introduced with closed clamp over-the-wire exchanges compared to open clamp exchanges at both pressures (two-tailed t-test, p < 0.001). At -7 mmHg, 48.0 mL ± 9.3 of air was introduced with open clamp and 20.6 mL ± 4.7 with closed clamp. At -11 mmHg, 97.8 mL ± 11.9 of air was introduced with open clamp and 37.8 mL ± 6.3 with closed clamp.

CONCLUSION: This study demonstrates the use of a reproducible in vitro model mimicking conditions causing air embolism during CVC exchange. Results show that CVC exchange using closed catheter clamp over Glidewire exchange technique significantly reduces the volume of air introduced per exchange.

PMID:37696430 | DOI:10.1016/j.jvir.2023.09.007

Hellenic J Cardiol. 2023 Sep 9:S1109-9666(23)00155-0. doi: 10.1016/j.hjc.2023.09.006. Online ahead of print.

ABSTRACT

BACKGROUND: – Tricuspid regurgitation (TR) adversely affects prognosis following mitral transcatheter edge-to-edge repair (TEER). We aimed to derive a risk stratification tool for patients undergoing TEER for mitral regurgitation while exhibiting significant TR.

METHODS: – This is a single-center, retrospective analysis of 217 consecutive individuals referred to an isolated mitral TEER who had moderate-to-severe or greater TR at baseline. The primary outcome was the 1-year composite of all-cause mortality or heart failure hospitalizations. The cohort was randomly split in a 75%-to-25% ratio, creating train (n=163) and test (n=54) datasets. Model development, discrimination and calibration were based on the train dataset. Internal validation was applied to the test dataset.

RESULTS: – Overall, 81 (37.3%) patients experienced the primary outcome. After multivariable analysis, a score for predicting the primary outcome was constructed that utilized a 0-to-3 scale, in which each point represented one of three baseline variables independently associated with this combined endpoint: serum B-natriuretic peptide (BNP) level >1,000 pg/mL, qualitative right ventricular (RV) dysfunction on transthoracic echocardiogram, and cardiac implantable electronic device (CIED). C-statistic of the model was 0.66 (95% CI, 0.57-0.75, p=0.002) and 0.75 (95% CI, 0.61-0.89, p=0.004) in the train and test datasets, respectively – representing comparable performance to current, more complex tools. Neither this BNP-RV-CIED (BRC) score nor other models were prognostically meaningful in 32 patients excluded from the main analysis who underwent a combined mitral-tricuspid TEER.

CONCLUSION: – The BRC score is a simple clinical prediction tool that may aid in the triage of isolated mitral TEER candidates with significant pre-existing TR.

PMID:37696418 | DOI:10.1016/j.hjc.2023.09.006

Sci Total Environ. 2023 Sep 9:166960. doi: 10.1016/j.scitotenv.2023.166960. Online ahead of print.

ABSTRACT

Gully erosion possess a serious hazard to critical resources such as soil, water, and vegetation cover within watersheds. Therefore, spatial maps of gully erosion hazards can be instrumental in mitigating its negative consequences. Among the various methods used to explore and map gully erosion, advanced learning techniques, especially deep learning (DL) models, are highly capable of spatial mapping and can provide accurate predictions for generating spatial maps of gully erosion at different scales (e.g., local, regional, continental, and global). In this paper, we applied two DL models, namely a simple recurrent neural network (RNN) and a gated recurrent unit (GRU), to map land susceptibility to gully erosion in the Shamil-Minab plain, Hormozgan province, southern Iran. To address the inherent black box nature of DL models, we applied three novel interpretability methods consisting of SHaply Additive explanation (SHAP), ceteris paribus and partial dependence (CP-PD) profiles and permutation feature importance (PFI). Using the Boruta algorithm, we identified seven important features that control gully erosion: soil bulk density, clay content, elevation, land use type, vegetation cover, sand content, and silt content. These features, along with an inventory map of gully erosion (based on a 70 % training dataset and 30 % test dataset), were used to generate spatial maps of gully erosion using DL models. According to the Kolmogorov-Smirnov (KS) statistic performance assessment measure, the simple RNN model (with KS = 91.6) outperformed the GRU model (with KS = 66.6). Based on the results from the simple RNN model, 7.4 %, 14.5 %, 18.9 %, 31.2 % and 28 % of total area of the plain were classified as very-low, low, moderate, high and very-high hazard classes, respectively. According to SHAP plots, CP-PD profiles, and PFI measures, soil silt content, vegetation cover (NDVI) and land use type had the highest impact on the model’s output. Overall, the DL modelling techniques and interpretation methods used in this study proved to be helpful in generating spatial maps of soil erosion hazard, especially gully erosion. Their interpretability can support watershed sustainable management.

PMID:37696396 | DOI:10.1016/j.scitotenv.2023.166960

Orthop Traumatol Surg Res. 2023 Sep 9:103683. doi: 10.1016/j.otsr.2023.103683. Online ahead of print.

ABSTRACT

BACKGROUND: The Non-Arthritic Hip Score (NAHS) used to evaluate the hip in younger patients is a self-administered questionnaire with 20 items in four sections: pain, symptoms, function, and activities. Although used in France, no transcultural version had been validated. The objective of this study was to translate the NAHS into French then assess the validity, reliability, and sensitivity to change of the French-language version (NAHS-Fr) in younger patients with hip conditions other than osteoarthritis.

HYPOTHESIS: The NAHS-Fr demonstrates good validity and reliability when used in younger French-speaking patients with hip pain.

MATERIAL AND METHODS: We conducted a prospective observational study in 105 patients (62 males and 43 females) scheduled for surgery on one or both hips (113 hips in total) to treat cam-type femoro-acetabular impingement or labral lesions. Before and 6 months after surgery, each patient completed the NAHS-Fr and Western Ontario and McMaster Osteoarthritis Index (WOMAC). Statistical tests were done to evaluate validity, reliability, and sensitivity to change, as recommended by the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN).

RESULTS: The response rate was 100%, confirming that the NAHS-Fr was easy to use. The NAHS-Fr was both valid and reliable. No ceiling or floor effect was detected for the total NAHS-Fr score. All items had Cronbach alpha coefficients greater than 0.8, indicating good internal consistency. External consistency between the NAHS-Fr and WOMAC was negative (-0.676) due to inversely proportional score indexing. Before surgery, the NAHS-Fr and WOMAC scores were strongly and significantly correlated (p<0.0001). The effect size was greater than 0.8, indicating good sensitivity to the change induced by surgery.

DISCUSSION: These results confirm the study hypothesis: the NAHS-Fr has the same good psychometric characteristics as does the original version and versions in other languages. The NAHS-Fr is useful for evaluating younger patients with non-osteoarthritic hip pain and can be used by French-speaking surgeons in everyday clinical practice.

LEVEL OF EVIDENCE: IV, prospective observational non-comparative cohort study.

PMID:37696391 | DOI:10.1016/j.otsr.2023.103683

Osteoarthritis Cartilage. 2023 Sep 9:S1063-4584(23)00912-3. doi: 10.1016/j.joca.2023.08.012. Online ahead of print.

ABSTRACT

OBJECTIVE: To forecast the number of primary total shoulder replacements (TSR) in Australia to the year 2035, and associated costs.

METHODS: De-identified TSR data for 2009-2019 were obtained from the Australian Orthopaedic Association National Joint Replacement Registry. Population data, including population projections to 2035, were obtained from the Australian Bureau of Statistics. Three forecasting scenarios were used: constant TSR rates from 2019 onwards (Scenario 1, conservative); continued growth in TSR rates using negative binomial regression (Scenario 2, exponential); and continued growth using negative binomial regression with monotone B-splines (Scenario 3, moderate). Healthcare costs were estimated using TSR projections and average procedure costs, inflated to 2035 Australian dollars.

RESULTS: The use of TSR increased by 242% in Australia from 2009-2019 (from 1,983 to 6,789 procedures for people ≥40 years). Under Scenario 1, the incidence of TSR is conservatively projected to rise to 9,676 procedures by 2035 (43% increase from 2019), at a cost of $AUD 312.6 million to the health system. Under Scenario 2, TSR incidence would increase to 45,295 procedures by 2035 (567% increase), costing $AUD 1.46 billion. Under Scenario 3, 28,257 TSR procedures are forecast in 2035 (316% increase) at a cost of $913 million.

CONCLUSIONS: Recent growth in TSR likely relates to prosthesis improvements, greater surgeon proficiency, and expanded clinical indications. Under moderate and exponential scenarios that consider rising TSR rates and population projections, Australia would face three- to five-fold growth in procedures by 2035. This would have profound implications for the healthcare budget, clinical workforce, and infrastructure.

PMID:37696387 | DOI:10.1016/j.joca.2023.08.012

J Equine Vet Sci. 2023 Sep 9:104917. doi: 10.1016/j.jevs.2023.104917. Online ahead of print.

ABSTRACT

The study aimed to assess Apgar scores and collect data on clinical, hemato-biochemical, and venous blood gas parameters in seven mules during their first 48h of life. Apgar scores, heart rate (HR), respiratory rate (RR), body temperature (BT), body weight (BW), time to achieve sternal recumbency, stand, nurse, and pass meconium were recorded. Blood samples were collected at birth (T0), 6 (T6), 12 (T12), 24 (T24), 48 (T48)h of life. Data distribution was verified and differences in laboratory parameters over time assessed. One foal had an Apgar score of 6/8, thus excluded from the statistical analysis. Three foals had an Apgar score of 7/8, three had a score of 8/8. All foals showed suckling reflex within 20 min and raised the head within 1 min; six foals reached sternal recumbency within 2 min. Times to stand and nurse were 38.7±13.4 and 72.3±30.5 min, respectively. Five foals passed meconium spontaneously in 416.3±401.8 min. The mean HR, RR, and BT values were 92±16.1 bpm, 50.2±5.9 bpm, and 37.6±0.3°C, respectively. Creatinine and lactate decreased from birth to 48h. Blood glucose increased from 12h. Mg increased from 12 to 24h. Compared to horses and donkeys, mules showed an intermediate BW, shorter time to stand and nurse, longer time to pass meconium, intermediate HR and lower RR. Compared to donkey mules showed lower BT. Other dissimilarities from the parental species were found in laboratory parameters. Our findings emphasize the need for reference ranges for a comprehensive evaluation of newborn mules.

PMID:37696367 | DOI:10.1016/j.jevs.2023.104917