Nevin Manimala

J Nurs Res. 2023 Nov 20. doi: 10.1097/jnr.0000000000000585. Online ahead of print.

ABSTRACT

BACKGROUND: Salary impacts nurse retention rates and thus is a factor affecting the nursing shortage both in Taiwan and around the world. Nurses in Taiwan earn a low salary compared with other health professionals and may be undervalued compared with their international counterparts.

PURPOSE: This study was designed to analyze the factors associated with nurse salary (NS) in Organisation for Economic Co-operation and Development (OECD) countries and to compare NS in Taiwan with those in OECD member states.

METHODS: Data were extracted from the OECD statistics database and official statistics for Taiwan. For the 28 OECD member countries considered in this study and Taiwan, 21 indicators characterizing healthcare systems, including demographics, socioeconomic status, health behaviors and risks, healthcare resources, health financing, healthcare utilization, health outcomes, and economic inequality, were examined for the period of 2009-2018. A random-effects model (REM) and a fixed-effects model (FEM) were used to investigate the associations between these indicators and annual NS levels. The expected annual NS for Taiwan was estimated and compared with the actual NS for Taiwan using the REM.

RESULTS: In the REM, higher NS in OECD countries was shown to be positively associated with gross domestic product per capita (0.49, 95% confidence interval [CI] [0.41, 0.56]), proportion of population aged 65 years and over (2.72, 95% CI [2.17, 3.26]), crude birth rate (1.02, 95% CI [0.56, 1.49]), number of computerized tomography scanners per million population (0.26, 95% CI [0.17, 0.35]), alcohol consumption per person (0.94, 95% CI [0.26, 1.61]), and prevalence of obesity (0.64, 95% CI [0.40, 0.89]) and to be in inversely associated with infant mortality rate (-3.13, 95% CI [-3.94, -2.32]), bed density (-0.99, 95% CI [-1.72, -0.25]), number of hospital discharges (-0.08, 95% CI [-0.11, -0.05]), household out-of-pocket expenditure as a percentage of health expenditure (-0.34, 95% CI [-0.56, -0.11]), and the Gini coefficient (-0.25, 95% CI [-0.50, -0.01]). The FEM results were similar to those of the REM. The predicted annual NS for Taiwan based on the REM rose from 29,390 U.S. dollars (corrected for purchasing power parity; 95% CI [22,532, 36,247]) in 2009 to 49,891 U.S. dollars (95% CI [42,344, 57,438]) in 2018. The actual annual NS in Taiwan in 2018 was approximately 12% lower than the model-predicted value.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Taiwan has a lower NS compared with its OECD counterparts. These findings may help policymakers, healthcare managers, and nurse organizations develop effective strategies to improve the remuneration system for nurses in Taiwan.

PMID:37988058 | DOI:10.1097/jnr.0000000000000585

J Biol Dyn. 2023 Dec;17(1):2285096. doi: 10.1080/17513758.2023.2285096. Epub 2023 Nov 21.

ABSTRACT

The work of Fred Brauer (1932-2021) broke new ground in several areas of mathematical population biology, especially mathematical epidemiology and population management. This special issue reflects his legacy: the lines of inquiry he opened, the impact of his research and his books, and his mentoring of generations of young researchers. This dedication highlights milestones in his career and connects his work to the contributions in this issue.

PMID:37988036 | DOI:10.1080/17513758.2023.2285096

Indian J Med Res. 2023 Nov 10. doi: 10.4103/ijmr.ijmr_2478_21. Online ahead of print.

ABSTRACT

BACKGROUND OBJECTIVES: Early warning systems (EWS) involve serial observations (track) with criteria (trigger) to timely identify patients at risk of complications. Carle designed a statistically based clinically modified obstetric early warning score (Carle’s OEWS). This study evaluated Carle’s OEWS and its individual components for predicting admission to the obstetric critical care unit (OCCU). Maternal near-miss and maternal mortality were the secondary outcomes.

METHODS: A prospective observational study was conducted among 1250 pregnant women with a period of gestation ≥28 week admitted in the labour wards of a tertiary centre over 18 months. The physiological parameters of OEWS were recorded and aggregate score was calculated at admission and at regular intervals thereafter, till discharge or OCCU admission.

RESULTS: The area under receiver operating characteristic (ROC) curve of OEWS was 0.975 for predicting OCCU admission, 0.971 for near-miss, and 0.996 for predicting maternal mortality and was significant for all outcomes. All individual parameters, except diastolic blood pressure, had a significant relative risk for predicting OCCU requirement.

INTERPRETATION CONCLUSIONS: Carle’s OEWS is a useful screening tool for predicting obstetric OCCU admission and can be routinely used in labour wards to ensure timely intervention.

PMID:37988032 | DOI:10.4103/ijmr.ijmr_2478_21

Am J Nurs. 2023 Dec 1;123(12):46-53. doi: 10.1097/01.NAJ.0000997232.94091.ba.

ABSTRACT

BACKGROUND: In response to the needs of patients infected with COVID-19, an interdisciplinary team was assembled to implement an adult extracorporeal membrane oxygenation (ECMO) program in the surgical ICU of a West Texas tertiary care hospital. Use of Extracorporeal Life Support Organization (ELSO) guidelines was essential to the development of this effort.

AIM: The aim of this project was to develop, implement, and evaluate an adult ECMO program.

METHODS: A logic model was used in designing and evaluating the adult ECMO program. A 35-hour ECMO specialist training course was developed, and training began in August 2020, a month before implementation of the project began. Patient outcomes were measured between September 2020 and December 2021. Descriptive statistics were used to measure the clinical outcomes of interest.

RESULTS: Seventeen newly trained ECMO specialists included experienced critical care nurses and respiratory therapists. Protocols were developed for the initiation of ECMO, and tracked patient outcomes included survival off ECMO, survival to discharge, major and minor complications, and length of stay. Nine patients had COVID-19 and demonstrated an 11.11% mortality rate after adult ECMO program implementation.

CONCLUSIONS: Use of the ELSO professional guidelines to design and develop this project led to the achievement of a sustainable ECMO program. Hospital leaders can now implement adult ECMO programs amid other demands for resources that may be created by future pandemics.

PMID:37988024 | DOI:10.1097/01.NAJ.0000997232.94091.ba

J Gastrointest Cancer. 2023 Nov 21. doi: 10.1007/s12029-023-00989-2. Online ahead of print.

ABSTRACT

PURPOSE: Recent studies suggested a protective role of metformin in the development of colorectal cancer (CRC) and its precursors. We aimed to investigate if metformin was associated with a lower prevalence and number of colorectal polyps in diabetic patients and also adenomas, high-risk adenomas, and CRC.

METHODS: Retrospective study on adult patients with diabetes mellitus followed in our hospital with a total colonoscopy between 2015 and 2019, treated with either metformin for > 5 years or other antidiabetic agent (control group). We assessed the number, size, and histopathology examination of proliferative lesions detected on colonoscopy.

RESULTS: We included 401 patients aged 69 ± 9 years, 57% males, divided into two groups: treated with metformin (n = 260) and without (n = 141). The number of polyps detected was significantly lower in patients under metformin (p = 0.014). There was a nonsignificant trend towards lower polyp detection rates in the metformin compared to the control group both in unadjusted analysis (50% vs 60%, p = 0.058) and multivariable adjusted analysis (odds ratio [OR] 0.68, 95% confidence interval [CI] 0.43-1.09, p = 0.111). In the latter, we identified male gender (OR 2.24, 95%CI 1.44-3.49, p < 0.001), age (OR 1.35 for every 10 years, 95%CI 1.07-1.71, p = 0.012), glycated hemoglobin value (OR 1.20 for every 1% increase, 95%CI 1.06-1.37, p = 0.005), and hypertension (OR 1.76, 95%CI 1.01-3.08, p = 0.046) as factors associated with a higher prevalence of polyps. We saw no statistically significant differences regarding adenoma (p = 0.231), high-risk adenoma (p = 0.810), and CRC (p = 0.705) diagnoses between groups.

CONCLUSION: In our study, metformin was associated with less colorectal polyps in diabetic patients compared to other treatment modalities. We observed a nonsignificant trend towards lower polyp detection rates in the metformin group both in unadjusted and adjusted analyses.

PMID:37987968 | DOI:10.1007/s12029-023-00989-2

Biometals. 2023 Nov 21. doi: 10.1007/s10534-023-00560-3. Online ahead of print.

ABSTRACT

Environmental mercury exposure possesses a significant risk to many human populations. At present there are no effective treatments for acute mercury toxicity. A new compound, N,N’bis-(2-mercaptoethyl) isophthalamide (NBMI), a lipophilic chelating agent was created to tightly/irreversibly bind mercury. A post hoc dose-dependent analysis of NBMI therapy was undertaken on data from a randomized controlled NBMI human treatment trial on 36 Ecuadorian gold miners with elevated urinary mercury concentrations. Study subjects were randomly assigned to receive 100 milligram (mg) NBMI/day, 300 mg NBMI/day, or placebo for 14 days. For each study subject daily mg NBMI dose/Kilogram (Kg) bodyweight were determined and plasma and urine mercury concentrations (micrograms (µg)/Liter (L)) on study day 1 (pre-NBMI treatment), 15 (after 14 days of NBMI treatment) and 45 (30 days after NBMI treatment) were correlated with NBMI dosing using the linear regression statistic in SAS. Regression revealed significant inverse correlations between increasing per mg NBMI/Kg bodyweight/day and reduced concentrations of urinary and plasma mercury on study day 15 (reduced by in urine = 18-20 µg/L and plasma = 2 µg/L) and study day 30 (reduced by in urine = 15-20 µg/L and plasma = 4 µg/L) and significant correlations between reductions in mercury concentrations in urine and plasma. Significant 30% reductions in urinary mercury concentrations per mg NBMI/Kg bodyweight/day administered for 14 days were observed. This study supports the dose-dependent ability of NBMI therapy to significantly reduce mercury concentrations, particularly in the urine, in an acutely mercury exposed human population. NBMI therapy should be evaluated in other mercury exposed populations.

PMID:37987955 | DOI:10.1007/s10534-023-00560-3

Int Urol Nephrol. 2023 Nov 21. doi: 10.1007/s11255-023-03872-y. Online ahead of print.

ABSTRACT

PURPOSE: In this study, the feasibility of tubeless percutaneous nephrolithotomy (PCNL) for the treatment of upper urinary tract stones was investigated.

METHODS: From January 2021 to December 2022, the clinical data of 273 patients who received tubeless PCNL (Group A) were studied. The control group includes clinical data from 302 patients (from January 2019 to October 2022) who received standard PCNL (Group B). The baseline characteristics were consistent between the two groups after using the propensity score matching (PSM) method. Compare the preoperative clinical characteristics, postoperative complications, residual stones, catheterization time, and hospital stay between the two groups.

RESULTS: 146 pairs of patients were successfully paired through PSM. There was no statistically significant difference in operative time, blood leukocyte counts, haemoglobin decrease, fever, urinary extravasation, sepsis, bleeding, blood transfusion rates, embolism, and residual stones after surgery between the two groups; Postoperative day 1 and discharge day, the VAS pain score in Group A was significantly lower than that in Group B. The catheterization time and hospitalization time of patients in Group A were significantly lower than those in Group B.

CONCLUSION: According to the inclusion and exclusion criteria, selecting suitable patients for tubeless PCNL is safe and effective, while significantly alleviating pain and reducing catheterization time and hospital stay.

PMID:37987954 | DOI:10.1007/s11255-023-03872-y

Environ Monit Assess. 2023 Nov 21;195(12):1502. doi: 10.1007/s10661-023-12001-2.

ABSTRACT

Environmental contamination especially air pollution is an exponentially growing menace requiring immediate attention, as it lingers on with the associated risks of health, economic and ecological crisis. The special focus of this study is on the advances in Air Quality (AQ) monitoring using modern sensors, integrated monitoring systems, remote sensing and the usage of Machine Learning (ML), Deep Learning (DL) algorithms, artificial neural networks, recent computational techniques, hybridizing techniques and different platforms available for AQ modelling. The modern world is data-driven, where critical decisions are taken based on the available and accessible data. Today’s data analytics is a consequence of the information explosion we have reached. The current research also tends to re-evaluate its scope with data analytics. The emergence of artificial intelligence and machine learning in the research scenario has radically changed the methodologies and approaches of modern research. The aim of this review is to assess the impact of data analytics such as ML/DL frameworks, data integration techniques, advanced statistical modelling, cloud computing platforms and constantly improving optimization algorithms on AQ research. The usage of remote sensing in AQ monitoring along with providing enormous datasets is constantly filling the spatial gaps of ground stations, as the long-term air pollutant dynamics is best captured by the panoramic view of satellites. Remote sensing coupled with the techniques of ML/DL has the most impact in shaping the modern trends in AQ research. Current standing of research in this field, emerging trends and future scope are also discussed.

PMID:37987882 | DOI:10.1007/s10661-023-12001-2

J Plast Reconstr Aesthet Surg. 2023 Oct 15;88:182-192. doi: 10.1016/j.bjps.2023.10.060. Online ahead of print.

ABSTRACT

BACKGROUND: Alopecia is a common and distressing medical condition that has been related to psychiatric disorders. Stem cell-derived conditioned medium (CM), a novel therapy for hair regeneration, has shown effectiveness in several trials.

METHODS: This meta-analysis aims to explore the effectiveness of stem cell-derived CM in improving hair growth for patients of alopecia. We prospectively registered this systematic review and meta-analysis in PROSPERO (CRD42023410249). Clinical trials that the enrolled participants suffering from alopecia applied stem cell-derived CM were included. We calculated the mean and standard deviation for the hair density and thickness.

RESULTS: Ten clinical trials were included in our analysis. On the basis of eight clinical trials (n = 221), our pooled results indicate that stem cell-derived CM is effective in increasing hair density (mean difference [MD]: 14.93, confidence interval [95% CI]: 10.20-19.67, p < 0.0001) and thickness (MD: 18.67, 95% CI: 2.75-34.59, p < 0.0001) (μm) in patients with alopecia. Moreover, our findings suggest that longer treatment duration is associated with significantly greater improvement than shorter treatment duration (p = 0.02). Three of the included studies were randomized controlled trials (RCTs), and when we specifically analyzed these RCTs; statistical significance could also be observed in terms of hair density (MD: 9.23, 95% CI: 1.79-16.68, p < 0.00001).

KEY MESSAGES: Stem cell-derived conditioned medium can effectively increase hair density and thickness for alopecia, and there is no difference between each method (topical application, microneedling, or injection).

PMID:37983981 | DOI:10.1016/j.bjps.2023.10.060

Clin Pharmacol Ther. 2023 Nov 20. doi: 10.1002/cpt.3110. Online ahead of print.

ABSTRACT

First-in-class (FIC) designation became a hallmark of innovation, however, even at the marketing authorisation stage, little is known about the clinical benefits these products deliver. We identified the provenance of the FIC drugs that entered the French market from 2008 to 2018 and matched these medicines to the clinical benefit grading by Haute Autorité de Santé (HAS) and Prescrire. Analyses were performed using descriptive statistics to present our findings by drug origin and therapeutic area and to establish the degree of concordance between HAS and Prescrire. Of the 135 FIC drugs identified, 71.1 % (n=96) originated from the industry, 16.3% (n=22) from academia and 12.6% (n=17) from joint partnerships. Three therapeutic areas accounted for most FIC medications: antineoplastic (25.9%, N=35), anti-infective (14.1%, N=19), and metabolic (11.1%, N=15) agents. HAS and Prescrire agreed on 60.74% of clinical benefit gradings. According to HAS, only 5% of all FIC drugs had substantial added benefit, and only 3%, according to Prescrire. HAS and Prescrire graded 45.9% and 68.2%, respectively, of FIC drugs as no clinical benefit and 48.9% and 28.9%, respectively, as some clinical benefit. FIC-designated drugs are primarily of industry (>70%) rather than academic origin. We found that 55% of FIC medicines that entered the French market over the 10-year period deliver no additional clinical benefit. Whilst FIC medicines may represent important scientific advancements in drug development, in >50% of cases, the new mode of action does not translate into additional clinical benefits for patients.

PMID:37983965 | DOI:10.1002/cpt.3110