Nevin Manimala

JMIR Med Inform. 2023 Nov 28;11:e44773. doi: 10.2196/44773.

ABSTRACT

BACKGROUND: The medical teams in intensive care units (ICUs) spend increasing amounts of time at computer systems for data processing, input, and interpretation purposes. As each patient creates about 1000 data points per hour, the available information is abundant, making the interpretation difficult and time-consuming. This data flood leads to a decrease in time for evidence-based, patient-centered care. Information systems, such as patient data management systems (PDMSs), are increasingly used at ICUs. However, they often create new challenges arising from the increasing documentation burden.

OBJECTIVE: New concepts, such as artificial intelligence (AI)-based assistant systems, are hence introduced to the workflow to cope with these challenges. However, there is a lack of standardized, published metrics in order to compare the various data input and management systems in the ICU setting. The objective of this study is to compare established documentation and retrieval processes with newer methods, such as PDMSs and voice information and documentation systems (VIDSs).

METHODS: In this crossover study, we compare traditional, paper-based documentation systems with PDMSs and newer AI-based VIDSs in terms of performance (required time), accuracy, mental workload, and user experience in an intensive care setting. Performance is assessed on a set of 6 standardized, typical ICU tasks, ranging from documentation to medical interpretation.

RESULTS: A total of 60 ICU-experienced medical professionals participated in the study. The VIDS showed a statistically significant advantage compared to the other 2 systems. The tasks were completed significantly faster with the VIDS than with the PDMS (1-tailed t₅₉=12.48; Cohen d=1.61; P<.001) or paper documentation (t₅₉=20.41; Cohen d=2.63; P<.001). Significantly fewer errors were made with VIDS than with the PDMS (t₅₉=3.45; Cohen d=0.45; P=.03) and paper-based documentation (t₅₉=11.2; Cohen d=1.45; P<.001). The analysis of the mental workload of VIDS and PDMS showed no statistically significant difference (P=.06). However, the analysis of subjective user perception showed a statistically significant perceived benefit of the VIDS compared to the PDMS (P<.001) and paper documentation (P<.001).

CONCLUSIONS: The results of this study show that the VIDS reduced error rate, documentation time, and mental workload regarding the set of 6 standardized typical ICU tasks. In conclusion, this indicates that AI-based systems such as the VIDS tested in this study have the potential to reduce this workload and improve evidence-based and safe patient care.

PMID:38015593 | DOI:10.2196/44773

J Addict Nurs. 2023 Oct-Dec 01;34(4):273-279. doi: 10.1097/JAN.0000000000000554.

ABSTRACT

The paucity of education and training on alcohol use disorders (AUDs) in nursing curricula is the main predictor of negative attitudes and results in limited knowledge access and delivery of health care for persons experiencing these problems. Although experts advocate increasing the time devoted to alcohol-related content in a crowded curriculum, didactic strategies for teaching about addiction in prequalifying nursing education have been discussed. This study aimed to verify the effectiveness of an educational experience that integrated clinical practicum experience in addiction treatment facilities for nursing students’ attitudes. A quasi-experimental one-group study with pre-and-post 3-month follow-ups was carried out with 108 nursing students who answered the Attitudes Scale toward Alcohol, Alcohol Use Disorder, and Patients with Alcohol Use Disorders. The effect of the clinical practicum was apparent, with statistically significant changes to more positive global attitude scores in all measures. Previous educational intervention for AUDs during nursing education was a predictor of positive attitudes (OR = 7.21, p < .04). Students’ self-perceived skills and professional preparation to deliver and direct care for patients with AUDs improved after the intervention, suggesting that clinical practice influenced students’ skills for AUD identification across nursing practice. Previous contact with this population with lack of training in substance use disorder seems to favor negative attitude development. Clinical practicum experience in addiction treatment facilities improved nursing students’ attitudes toward AUDs and patients with AUDs, and its effects were sustained 3 months later.

PMID:38015578 | DOI:10.1097/JAN.0000000000000554

J Addict Nurs. 2023 Oct-Dec 01;34(4):266-272. doi: 10.1097/JAN.0000000000000549.

ABSTRACT

Patients with substance use disorder (SUD) encounter many barriers to healthcare, including negative attitudes of healthcare personnel. Compared with other healthcare professions, nurses have been reported as having less tolerant attitudes toward patients with SUD. Knowledge acquisition combined with role support has been shown to improve therapeutic attitudes of nurses toward patients with SUD. Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based educational intervention aimed to improve the outcomes of patients at risk and with SUD. SBIRT education has been shown as an effective educational tool with licensed nurses. Therefore, the aim of this study was to evaluate whether a 2-hour educational session on SBIRT (Mitchell et al., 2013) improved the therapeutic attitudes of nurses toward patients with SUD. Peplau’s theory of interpersonal relations guided this study with an emphasis on the nurse-patient relationship. A quasi-experimental pretest/posttest design was used to evaluate nurses’ attitudes pre and post a 2-hour educational session. Participants included 65 registered nurses employed in a 247-bed teaching hospital in New England. Attitudes were measured before and after the educational session using the 20-item, five-subscale Drug and Drug Problems Perceptions Questionnaire. A paired t test was performed, showing statistically significant improvements in attitudes postintervention. Prior education on SUD significantly correlated with baseline attitudes. A standard regression model, with practice setting, family history of SUD, and prior education as dependent variables, was not predictive of baseline attitudes. The results suggest conducting SBIRT should be considered a mandatory nursing competency, both in undergraduate curriculum and among licensed nurses.

PMID:38015577 | DOI:10.1097/JAN.0000000000000549

Int Angiol. 2023 Nov 28. doi: 10.23736/S0392-9590.23.05108-8. Online ahead of print.

ABSTRACT

INTRODUCTION: Chronic venous disease (CVD) can lead to considerable morbidity and impact health-related quality of life (HRQoL). The aim of this review was twofold: (i) to provide a deeper understanding of how CVD affects HRQoL (physical, psychological and social functioning), and (ii) to review the impact of evidence-based veno-active drugs (VADs) on HRQoL.

EVIDENCE ACQUISITION: For the effect of CVD on HRQoL, information was gathered during an Expert Consensus Meeting, during which data were presented from both the patient and physician perspective assessed with validated quality-of-life measures. For the impact of VADs on HRQoL, a systematic literature review was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Electronic databases were searched for real world evidence or randomized-controlled trials (RCT) vs. placebo, reporting data on the influence of VADs on HRQoL in patients with CVD.

EVIDENCE SYNTHESIS: CVD can negatively affect daily life in a number of areas related to pain, physical function and social activities. The impact of CVD on HRQoL begins early in the disease and for patients the emotional burden of the disease is as high as the physical burden. In contrast, physicians tend to overestimate the physical impact. The database search yielded 184 unique records, of which 19 studies reporting on VADs and HRQoL in patients with CVD met the inclusion criteria (13 observational and 6 RCTs). Micronized purified flavonoid fraction (MPFF) was the most represented agent, associated with 12/19 studies (2 RCTs and 10 observational). Three of the 6 RCTs provided statistically significant evidence for improvement on HRQoL compared with placebo: two for MPFF (24.4% and 19.2% improvement in HRQoL vs. placebo, respectively) and one for a low-dose diosmin (20% improvement vs. placebo); for the other VADs improvements in HRQoL were not statistically different from placebo. MPFF was also associated with improvements in HRQoL in the observational studies, across all CEAP clinical classes, as monotherapy or in combination with other conservative therapy, and for all aspects of HRQoL: physical, psychological, and social. Real-world data for the other VADs were scarce. Ruscus extract, sulodexide and a semi-synthetic diosmin were each represented by a single observational study and these limited data were associated with statistically significant improvements compared with baseline in overall and subdomain scores across the range of CEAP clinical classes.

CONCLUSIONS: CVD can impair patients’ HRQoL significantly at all stages of the disease. MPFF has the greatest evidence base of clinical use in both RCT and real-world observational studies for effectiveness on HRQoL and is recognized by international guidelines.

PMID:38015554 | DOI:10.23736/S0392-9590.23.05108-8

Cell Mol Biol (Noisy-le-grand). 2023 Nov 15;69(11):30-35. doi: 10.14715/cmb/2023.69.11.5.

ABSTRACT

Colorectal cancer (CRC) is the third leading cause of cancer-related deaths worldwide. The tumor suppressor gene MT-CO1, and Kristen Rat Sarcoma Virus (KRAS), an oncogene are primarily responsible for controlling cell apoptosis, cell cycle arrest, and cell proliferation, and any irregularities in these genes could lead to cancer. This study aims to examine the expression of KRAS and MT-CO1 in CRC biopsy specimens and investigate their relationship with one another in CRC patients residing in the Erbil city of Kurdistan Region, Iraq. The study involved categorizing 42 sets of colorectal cancer tissues and their corresponding controls based on their types and patients’ clinical characteristics. The expression of KRAS and MT-CO1 in the samples was assessed using Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR), with statistical significance set at p<0.05. The expression of KRAS was found to be significantly higher in CRC compared to the control (n=42, p=0.0001). On the other hand, the expression of MT-CO1 did not exhibit significant differences compared to the control group with a p-value of 0.12. Furthermore, the Chi-square and correlation analysis results depicted that MT-CO1 expression negatively correlates with KRAS expression (p= 0.0001, r= -0.047) in CRC tissues. In conclusion, the variation in the expression of KRAS and MT-CO1, and their correlations could potentially serve as a good indicator in the detection and prognosis of CRC, which might lead to better translational research on the same. However, for a better understanding of the underlying mechanisms, further analysis is required.

PMID:38015545 | DOI:10.14715/cmb/2023.69.11.5

Cell Mol Biol (Noisy-le-grand). 2023 Nov 15;69(11):69-75. doi: 10.14715/cmb/2023.69.11.12.

ABSTRACT

This study aims to investigate the Interleukin (IL)-6 rs1800795 and peroxisome proliferator-activated receptor alpha (PPARA) rs4253778 polymorphism distributions in the relatively faster and slower subgroups of national cross-country skiing athletes and to identify advantageous genotypes for endurance performance. IL-6 is an inflammatory mediator that is effective in muscle tissue hypertrophy, repair, and the immune system. On the other hand, PPARA transcription factor is a molecule associated with fatty acid, sugar metabolism and inflammation formation. Total of 30 professional cross-country skiing athletes were examined in three groups as athletes, female athletes, and male athletes. DNA of the participants were isolated from blood and genetic polymorphisms were determined by RT-PCR. Athletes were divided into two subgroups as faster and slower referring to their “1-kilometer cross-country skiing time averages (CCSTA)”. Polymorphism distributions in these subgroups were analyzed statistically with Fisher’s exact test and descriptive tests. In addition, the 1 km-CCSTA values of the genotypes were determined by descriptive statistical methods and the time advantages were calculated. It was determined that the combination of IL-6 rs1800795 GC and PPARA rs4253778 GG genotypes was observed to be more prominent among the faster categories of cross-country skiing competitors, particularly in the athletes and male athletes categories, and it had a time advantage at 1 km-CCSTA. The GC genotype (p= 0.0098) and C-allele (p=0.0398) of IL-6 rs1800795 polymorphism were detected at a higher rate in the fast subgroup in male athletes. These genotypes may support endurance performance.

PMID:38015538 | DOI:10.14715/cmb/2023.69.11.12

Cell Mol Biol (Noisy-le-grand). 2023 Nov 15;69(11):92-102. doi: 10.14715/cmb/2023.69.11.15.

ABSTRACT

We aimed to analyze the effect of acute exercise on oral microbiota in regularly trained swimmers. As environmental factors may affect the oral microbiota; we also aimed to analyze the short-duration effect of swimming training on the oral bacteria relative difference in swimmers. Saliva samples of 20 swimmers both before and after the training were used for the oral microbiota metagenesis. The next-generation sequencing method targeting 16S rDNA gene fragments was used for genotyping. The Wilcoxon signed-rank test was used for the statistical evaluation of the taxons. The alfa diversity comparisons were assessed with the One-Way ANOVA, and the Kruskal-Wallis test was used to determine bacterial diversity. Decayed- Missed- Filled total (DMF-T) scores were the indicators of oral hygiene. A comparison of the before and after exercise microbiota of the swimmers gave rise to a statistically significant difference for Firmicutes (p=0.014) and Bacteroidetes (p=0.007) phylum; Clostridia (p=0.006) and Bacilli (p=0.048) classes; Clostridiales (p=0.004), Entomoplasmatales (p=0.009) and Bacillales (p=0.006) for ordo; Lachnospiraceae (p=0.001) family and Stenotrophomonas (p=0.013) genus. Although there were some differences within the other taxa of the bacteria, all were statistically insignificant. Streptococcus, Pseudomonas and Rothia mucilaginosa showed a correlation with the DMF-T values in swimmers. This study was the first in Turkish swimmers to investigate the relative abundance of oral microbiota. We showed that exercise within the pool water changed the oral bacteria’s relative abundance. To confirm our results and clarify the effect of pool water on oral bacteria relative abundance, more studies on dietary intake should be carried out.

PMID:38015535 | DOI:10.14715/cmb/2023.69.11.15

JAMA Netw Open. 2023 Nov 1;6(11):e2344691. doi: 10.1001/jamanetworkopen.2023.44691.

ABSTRACT

IMPORTANCE: There is limited evidence of the association of conditional cash transfers, an important strategy to reduce poverty, with prevention of adverse birth-related outcomes.

OBJECTIVE: To investigate the association between receiving benefits from the Bolsa Família Program (BFP) and birth weight indicators.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used a linked data resource, the Centro de Integracao de Dados e Conhecimentos Para Saude (CIDACS) birth cohort. All live-born singleton infants born to mothers registered in the cohort between January 2012 and December 2015 were included. Each analysis was conducted for the overall population and separately by level of education, self-reported maternal race, and number of prenatal appointments. Data were analyzed from January 3 to April 24, 2023.

EXPOSURE: Live births of mothers who had received BFP until delivery (for a minimum of 9 months) were classified as exposed and compared with live births from mothers who did not receive the benefit prior to delivery.

MAIN OUTCOMES AND MEASURES: Low birth weight (LBW), birth weight in grams, and small for gestational age (SGA) were evaluated. Analytical methods used included propensity score estimation, kernel matching, and weighted logistic and linear regressions. Race categories included Parda, which translates from Portuguese as “brown” and is used to denote individuals whose racial background is predominantly Black and those with multiracial or multiethnic ancestry, including European, African, and Indigenous origins.

RESULTS: A total of 4 277 523 live births (2 085 737 females [48.8%]; 15 207 among Asian [0.4%], 334 225 among Black [7.8%], 29 115 among Indigenous [0.7%], 2 588 363 among Parda [60.5%], and 1 310 613 among White [30.6%] mothers) were assessed. BFP was associated with an increase of 17.76 g (95% CI, 16.52-19.01 g) in birth weight. Beneficiaries had an 11% lower chance of LBW (odds ratio [OR], 0.89; 95% CI, 0.88-0.90). BFP was associated with a greater decrease in odds of LBW among subgroups of mothers who attended fewer than 7 appointments (OR, 0.85; 95% CI, 0.84-0.87), were Indigenous (OR, 0.73; 95% CI, 0.61-0.88), and had 3 or less years of education (OR, 0.76; 95% CI, 0.72-0.81). There was no association between BFP and SGA, except among less educated mothers, who had a reduced risk of SGA (OR, 0.83; 95% CI, 0.79-0.88).

CONCLUSIONS AND RELEVANCE: This study found that BFP was associated with increased birth weight and reduced odds of LBW, with a greater decrease in odds of LBW among higher-risk groups. These findings suggest the importance of maintaining financial support for mothers at increased risk of birth weight-related outcomes.

PMID:38015506 | DOI:10.1001/jamanetworkopen.2023.44691

Ann Am Thorac Soc. 2023 Nov 28. doi: 10.1513/AnnalsATS.202309-753OC. Online ahead of print.

ABSTRACT

RATIONALE: Around 20-35% of obstructive sleep apnoea (OSA) patients show supine-isolated OSA, where supine sleep avoidance could be an effective therapy. However, traditional supine discomfort-based methods show poor tolerance and compliance to treatment, so cannot be recommended. Supine-alarm devices show promise, but evidence to support favourable adherence to treatment and effectiveness at reducing excessive daytime sleepiness compared to continuous positive airway pressure (CPAP) remains limited.

OBJECTIVES: To establish if alarm-based supine-avoidance treatment in supine-isolated OSA patients is non-inferior to CPAP in reducing daytime sleepiness.

METHODS: Following baseline questionnaires and in-home supine-time and polysomnography assessments, patients with supine-isolated OSA and Epworth sleepiness scale (ESS) score ≥8 were randomised to ≥6 weeks of supine-avoidance or CPAP treatment, followed by cross-over to the remaining treatment with repeat assessments. Non-inferiority was assessed from change in ESS with supine-avoidance compared to CPAP using a pre-specified non-inferiority margin of 1.5. Average nightly treatment use over all nights, and treatment efficacy and effectiveness at reducing respiratory disturbances were also compared between treatments.

RESULTS: The reduction in sleepiness score with supine-avoidance (mean [95%CI] -1.9 [-2.8 to -1.0]) was non-inferior to CPAP (-2.4 [-3.3 to -1.4], supine-avoidance-CPAP difference -0.4 [-1.3 to 0.6]) and the lower confidence limit did not cross the non-inferiority margin of 1.5, p=0.021. Average treatment usage was higher with supine-avoidance compared to CPAP (mean ± SD 5.7 ± 2.4 versus 3.9 ± 2.7 h/night, p<0.001).

CONCLUSIONS: In patients with supine-isolated OSA, vibro-tactile supine alarm device therapy is non-inferior to CPAP for reducing sleepiness and shows superior treatment adherence.

PMID:38015501 | DOI:10.1513/AnnalsATS.202309-753OC

Diagnosis (Berl). 2023 Nov 29. doi: 10.1515/dx-2023-0158. Online ahead of print.

ABSTRACT

OBJECTIVES: We have planned this analysis to provide current statistics on mortality directly caused by Influenza viruses in recent years in the US.

METHODS: We performed an electronic search in the online database CDC WONDER to obtain current statistics on direct mortality caused by Influenza viruses in the US. Mortality data are derived from information on all death certificates issued in the 50 states and the District of Columbia, excluding deaths of nonresidents. Our basic query criteria included Influenza-specific ICD-10 codes.

RESULTS: Influenza caused an average of 7,670 deaths per year from 2018 to 2020 based on Influenza-specific ICD-10 codes, with a corresponding mean death rate of 2.3 × 100,000. The death rate increased in parallel with the age of the US resident population, from 0.2 × 100,000 in the 5-24 age group to 37.4 × 100,000 in US residents aged 85 years or older. No substantial differences were observed in males vs. females.

CONCLUSIONS: The results of this analysis show that Influenza remains a significant clinical burden in the general population, with a cumulative mortality rate of approximately 2.3 × 100,000, but increasing more than tenfold (to over 37 × 100,000) in older persons.

PMID:38015489 | DOI:10.1515/dx-2023-0158