Nevin Manimala

Int J Audiol. 2023 Dec 13:1-8. doi: 10.1080/14992027.2023.2280454. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this project was to investigate the provision of counselling in adult audiological rehabilitation and to highlight training barriers and needs.

DESIGN: A service evaluation in which respondents completed a survey in which they rated their knowledge, confidence and competence in addressing the hearing, social and emotional needs of their patients. They were also asked to define counselling.

SAMPLE: 64 UK practising audiologists in adult audiological rehabilitation, aged 20->60 years (84% females, 16% males), with a range of years in clinical practice.

RESULTS: Counselling definitions fell into three main categories: the audiologist as the doer, the audiologist as the facilitator, and the audiologist and patient as partners. Respondents reported feeling more able to counsel the hearing related needs of their patients, than emotional or social needs. There were significant positive statistical associations between counselling training completed and self-rated counselling abilities for managing emotional needs. Clinical experience was not associated with self-rated counselling. Lack of supervision and training were identified as some of the main barriers to providing emotional support. Almost all respondents reported a desire for further training in delivering emotional support, with the belief that this would improve services and patient outcomes.

CONCLUSIONS: UK audiologists demonstrated person-centred thinking through their definitions of counselling. However, they reported significant barriers in being able to support the needs of adults with hearing loss. Training needs around emotional support in audiology counselling are not currently being met. It is important for clinical training programmes to address this gap by incorporating more counselling courses into their curricula.

PMID:38088152 | DOI:10.1080/14992027.2023.2280454

J Neuroendocrinol. 2023 Dec 13:e13360. doi: 10.1111/jne.13360. Online ahead of print.

ABSTRACT

Octreotide LAR is a long-acting somatostatin analogue (SSA) used in the management of metastatic gastroenteropancreatic neuroendocrine tumors (GEP NETs). It requires intramuscular (IM) injection. Missed IM injections cause subcutaneous nodules (SCNs) on radiologic images. We reviewed the rates of SCNs in a real-world cohort of GEP NETs receiving octreotide LAR and explored treatment outcomes. Patients commencing octreotide LAR between August 5, 2010 and March 8, 2018 at a single cancer center in Canada were identified from pharmacy records. Patients were included if they had a computed tomography (CT) scan performed at the time of progression and a preceding CT with pelvis included to enable assessment for the presence of nodules. Fisher’s exact test was used to examine predictors of SCNs, and Kaplan-Meier curves summarized differences in progression free (PFS) and overall survival (OS) that were compared with log-rank tests. Of 243 patients receiving octreotide LAR, 45 had all required CT images available for central review. SCNs were found in 20/45 (44%) of patients on the last scan showing stable disease before progression and were numerically but not statistically more likely in females (OR: 2.36, 95% CI: 0.66-8.29, p = .23). There was an increased risk of SCNs in patients with a skin-to-muscle distance >38 mm (the length of an octreotide LAR needle) on CT (OR: 5.09, 95% CI: 1.39-16.6, p = .018) and a trend toward increased risk in obese patients (OR: 5.71, 95% CI: 1.26-23.4, p = .061). PFS (HR: 1.01, 95% CI: 0.56-1.78, p = .98) and OS (HR: 0.86, 95% CI: 0.41-1.8, p = .70) was similar between those with/without SCNs. In conclusion, almost half of patients receiving octreotide LAR had SCNs; however, missed administration of SSA did not appear to result in worse survival in this small study. Factors such as sex, younger age skin-to-muscle distance, and obesity may affect SCN development and should be considered when choosing an SSA.

PMID:38088132 | DOI:10.1111/jne.13360

Rev Esp Salud Publica. 2023 Dec 13;97:e202312110.

ABSTRACT

OBJECTIVE: Multi-resistant Enterobacteriaceae (MRE) are a public health threat, with screening and isolation strategies being important to stop its dissemination. Multiplex PCR is a novel method capable of rapid diagnosis with high sensitivity and specificity. In this study, our objective was to evaluate its application to multidrug-resistant Enterobacteriaceae management since its implementation in our hospital.

METHODS: An observational retrospective descriptive study of multiplex PCR ALLPLEX TM ENTERO-DR results to screen inpatients colonized by MRE took place from November 2019 to May 2021. We calculated the percentage of positive, negative, non-identifiable or invalid results, identified microorganisms, reason for requesting it and subsequent actions. Median and I.R. from sampling time to partial and theoretical culture time, and since last colonization/infection depending on test results were calculated.

RESULTS: Resistance mechanisms were detected in 31.47% of tests, being E. coli ESBL (68.99%) the most frequently isolated microorganism. Median time to partial result was 5.75 hours (I.R.: 2.67), having statistically significant differences with theoretical time. The most important reason to request the test was screening (80.12%) and the most frequent action taken was not to isolate (41.70 %). Whenever forty-nine months or more since last colonization/infection have passed, only 14.81% of the samples tested positive.

CONCLUSIONS: Multiplex PCR is a useful test to manage colonized patients, capable of giving a rapid result and allowing for quicker decision-making, contributing to a good use of resources and patient comfort.

PMID:38088124

Kardiologiia. 2023 Dec 5;63(11):57-63. doi: 10.18087/cardio.2023.11.n2475.

ABSTRACT

Aim To evaluate 5-year results of the HREVS (Hybrid REvascularization Versus Standarts) study.Material and methods The study included 155 consecutive patients with multivessel coronary artery disease who were randomized into 3 groups: coronary artery bypass grafting (CABG) (n=50), hybrid coronary revascularization (HCR) (n=52) and percutaneous coronary intervention (PCI) (n=53) according to the consensus of the cardiology team on the technical and clinical feasibility of each of the three coronary revascularization strategies. The primary endpoint of the study was residual ischemia 12 months after revascularization according to data of single-photon emission computed tomography (SPECT). Secondary endpoints were major adverse cardiac and cerebrovascular events (MACCE) over 5 years of follow-up, which included all-cause death, myocardial infarction, stroke, and clinically determined repeat myocardial revascularization.Results Baseline characteristics of patients did not differ between study groups. Median residual ischemia determined by SPECT data after 12 months was not statistically significantly different in the CABG, HCR and PCI groups: 6.7 [4.6; 8.8]%, 6.4 [4.3; 8.5]% and 7.9 [5.9; 9.8]%, respectively (p=0.45). Mean follow-up period was 76.5 months (at least 60 months). There were no statistically significant differences in all-cause mortality between the CABG, HCR and PCI groups, 10.6, 12.8 and 8.2 %, respectively (p=0.23). Statistically significant differences between the groups of CABG, HCR and PCI in the incidence of myocardial infarction (12.8; 8.5 and 16.3 %; p=0.12), stroke (4.2; 6.4 and 10.2 % ; p=0.13), repeat revascularization for clinical indications (23.4; 23.4 and 34.7 %; p=0.11) were not observed either. However, the cumulative 5-year MACCE value was similar in the HCR group and the CABG group but significantly lower than in the PCI group (51.1, 51.1 and 69.4 %, respectively; p = 0.03).Conclusion HCR that combines advantages of PCI and CABG is a promising strategy for coronary revascularization in multivessel coronary artery disease. HCR demonstrates satisfactory long-term results comparable to those of CABG but superior to PCI. To confirm the safety and efficacy of HCR, a large multicenter study is required that would have a sufficient power to evaluate clinical endpoints.

PMID:38088113 | DOI:10.18087/cardio.2023.11.n2475

Kardiologiia. 2023 Dec 5;63(11):12-20. doi: 10.18087/cardio.2023.11.n2570.

ABSTRACT

Aim To study the relationship of blood serum concentration of endocan with indexes of apoptosis and clinical and instrumental characteristics of patients with ischemic heart disease (IHD).Material and methods The study included 176 subjects (105 men and 71 women). 150 of them were diagnosed with IHD and 26 were healthy volunteers. Anthropometric measurements, coronary angiography, echocardiography, duplex ultrasound scanning of extracranial parts of the brachiocephalic arteries were performed for all patients. Concentrations of endocan (ng / ml), glucose (mmol / l), and apoptotic markers Bcl-2 (ng / ml), Bax (ng / ml), Bcl-2 / Bax, TRAIL (pg / ml), and p53 (ng / ml) were measured in blood serum. Patients were divided into groups based on their SYNTAX scores: group 1 with moderate atherosclerotic lesions of the coronary arteries (CA) (score < 22, 78 patients); group 2 with severe CA atherosclerosis (score 23-32, 37 patients); and group 3 with extremely severe CA lesions (score >33, 35 patients). The control group consisted of healthy volunteers (26 subjects). All groups were age- and sex-matched. Differences were considered statistically significant at p<0.05.Results A correlation was found between endocan concentration and IHD severity (r=0.32, p<0.001). In group 1, the median endocan concentration was 14.57 ng / ml [8.21; 23.66], in group 2, 19.34 ng / ml [8.425; 26.645], in group 3, 32.13 ng / ml [18.2; 39.12], and in the control group, 6.92 ng / ml [4.62; 9.18]. Correlations of varying strength and significance were observed between the endocan concentration and a number of clinical and instrumental characteristics. Endocan concentrations significantly differed in groups of patients with multifocal atherosclerosis (p<0.01), angina pectoris (p<0.01), a history of myocardial infarction (p<0.001), and obesity (p<0.05) from patients without these signs. Also, a correlation was found between serum endocan concentration and apoptotic markers: TRAIL (r= -0.448, p<0.001); BCL-2 (r= -0.552, p<0.001), Bax (r= -0.519, p<0.001), Bcl-2 / Bax (r= -0.576, p<0.001) and p53 (r= -0.520, p <0.001).Conclusion The study demonstrated a potential role of endocan as a promising biomarker for risk stratification, prognosis and therapeutic monitoring of IHD patients.

PMID:38088108 | DOI:10.18087/cardio.2023.11.n2570

Minerva Cardiol Angiol. 2023 Dec 12. doi: 10.23736/S2724-5683.23.06368-8. Online ahead of print.

ABSTRACT

BACKGROUND: Paravalvular leakage (PVL) is a common finding after transcatheter aortic valve replacement (TAVR) and affects late clinical outcome. It is more frequent with self-expandable (SE) transcatheter-heart-valve (THV). Few is known about SE-THV expansion after implantation. The purpose is to assess SE-THV frame expansion and its possible influence on PVL.

METHODS: We designed a prospective pilot study to assess the time-course of SE-THV frame dimensions and PVL after TAVR. Consecutive patients undergoing TAVR with SE-THV were enrolled. Prosthesis fluoroscopy and echocardiography were prospectively performed immediately after TAVR (T0) and before discharge (T1) to grade PVL. Prosthesis diameters were assessed in 2 fluoroscopic orthogonal views. PVL reduction ≥1+ from T0 to T1 at echocardiography was the primary study endpoint.

RESULTS: Twenty-five patients were enrolled. Mean interval between T0 and T1 evaluations was 5 days. Grade 1 or 2 was present in 76% of patients at T0 and in 68% at T1 (P=0.034). A total of 7 patients (28%) improved PVL ≥1 grade from T0 to T1. Differences between T0 and T1 fluoroscopic diameters were not statistically significant. When comparing the diameter changes according to PVL evolution, patients with PVL improvement (as compared with those without) had significantly larger minimum diameter increase at both annulus/inflow (P=0.016) and outflow/distal edge (P=0.027).

CONCLUSIONS: PVL may improve in the early days after SE-THV and those patients with PVL improvement may have THV frame expansion. Further studies are needed to confirm such preliminary observations and to establish the clinical relevance of this phenomenon.

PMID:38088090 | DOI:10.23736/S2724-5683.23.06368-8

Urol J. 2023 Dec 13. doi: 10.22037/uj.v20i.7758. Online ahead of print.

ABSTRACT

PURPOSE: To analyze the risk factors for the relapse of prostate cancer (PC) after radical prostatectomy (RP) and build a nomogram as a predictive model. Materials andMethods: The patients who underwent PR from March 2019 to February 2022 were retrospectively enrolled in our hospital’s case system. During the follow-up process, two consecutive prostate-specific antigens (PSA) ≥0.2 μg/L were performed. And needle biopsy was performed to further determine whether the patient had prostate cancer recurrence. According to the follow-up results, the patients were divided into non-relapsed and relapsed groups.The related parameters of the two groups were collected. Independent risk factors for postoperative recurrence were determined using a Cox proportional hazards regression model. Statistical software, R, was used to build nomograms. R software was used to construct a nomogram, and the prediction effect of the nomogram was evaluated by the calibration curve and the area under the ROC curve (AUC).

RESULTS: Among the 367 patients who underwent RP, 112 (30.52%) had, and 255 (69.48%) did not have relapses after surgery. Cox multivariableregression analysis revealed that preoperative Gleason score, preoperative PSA, pathological staging, positive margin, and seminal vesicle invasion, were the risk factors for postoperative recurrence after RP (all P < 0.05). Verification of the predictive model by ROC curve demonstrated that the AUC of the ROC curves for patients’ relapses 3 and 5 years after RP was 0.986 (95%CI0.975-0.998) and 0.974 (95%CI0.961-0.987), respectively. This model validation showed that the results of the predictive model were basically consistent with the actual results, suggesting that the nomogram was able to accurately predict a patient’s relapse.

CONCLUSION: The nomogram of this study was a good predictor of postoperative recurrence of PC after RP, which will help doctors provide personalized treatment and follow-up strategies for patients.

PMID:38088088 | DOI:10.22037/uj.v20i.7758

Eur Psychiatry. 2023 Dec 13:1-36. doi: 10.1192/j.eurpsy.2023.2473. Online ahead of print.

NO ABSTRACT

PMID:38088068 | DOI:10.1192/j.eurpsy.2023.2473

Psychiatr Serv. 2023 Dec 13:appips20230134. doi: 10.1176/appi.ps.20230134. Online ahead of print.

ABSTRACT

OBJECTIVE: To examine potential health disparities due to a broad reliance on telehealth during the COVID-19 pandemic, the authors studied the impact of video-enabled tablets provided by the U.S. Department of Veterans Affairs (VA) on psychotherapy usage among rural versus urban, Black versus White, and female versus male veterans.

METHODS: Psychotherapy usage trends before and after onset of the COVID-19 pandemic were examined among veterans with at least one mental health visit in 2019 (63,764 tablet recipients and 1,414,636 nonrecipients). Adjusted difference-in-differences and event study analyses were conducted to compare psychotherapy usage among tablet recipients and nonrecipients (March 15, 2020-December 31, 2021) 10 months before and after tablet issuance. Analyses were stratified by rurality, sex, and race.

RESULTS: Adjusted analyses demonstrated that tablet receipt was associated with increases in psychotherapy visit frequency in every patient group studied (rural, 27.4%; urban, 24.6%; women, 30.5%; men, 24.4%; Black, 20.8%; White, 28.1%), compared with visits before tablet receipt. Compared with men, women had statistically significant tablet-associated psychotherapy visit increases (video visits, 1.2 per year; all modalities, 1.0 per year).

CONCLUSIONS: VA-issued tablets led to increased psychotherapy usage for all groups examined, with similar increases found for rural versus urban and Black versus White veterans and higher increases for women versus men. Eliminating barriers to Internet access or device ownership may improve mental health care access among underserved or historically disadvantaged populations. VA’s tablet program offers insights to inform policy makers’ and health systems’ efforts to bridge the digital divide.

PMID:38088041 | DOI:10.1176/appi.ps.20230134

Pharmacotherapy. 2023 Dec 13. doi: 10.1002/phar.2900. Online ahead of print.

ABSTRACT

BACKGROUND: Most patients receiving Low-molecular-weight heparin therapy do not require routine coagulation monitoring, but due to uncertainty in certain populations, clinicians may feel compelled to perform anti-Xa monitoring.

METHODS: This retrospective cohort study compared clinical outcomes in propensity-score matched adult inpatients from an academic health care system who did and did not receive anti-Xa monitoring of enoxaparin for venous thromboembolism prophylaxis. The primary outcome was the composite of any venous thromboembolism, any bleeding, and mortality in the 30 days following enoxaparin initiation. Secondary outcomes were the individual components of the composite outcome and major bleeding.

RESULTS: During the 13-month study period, a total of 6,611 patients received enoxaparin for venous thromboembolism prophylaxis, 301 in the anti-Xa monitored group and 6,310 in the unmonitored group (4.6% received monitoring). The mean age was 52.9 years and 52% of patients were male. The mean body mass index was 31 kg/m² and the mean creatinine clearance was 109 mL/min. Twenty percent of patients had active cancer. The most common indication for enoxaparin prophylaxis was hospitalization for medical illness (52%) followed by non-orthopedic surgery (37%). The adjusted odds ratio for the primary outcome comparing monitored to unmonitored patients was 1.26 (95% confidence interval, 0.75-2.11). None of the between group differences in the individual components of the composite outcome were statistically significant.

CONCLUSIONS: Thirty-day clinical outcomes in patients receiving enoxaparin for venous thromboembolism prophylaxis were not improved by anti-Xa monitoring. Our results support current evidence-based guideline recommendations against anti-Xa monitoring for patients receiving enoxaparin for venous thromboembolism prophylaxis.

PMID:38088033 | DOI:10.1002/phar.2900