Nevin Manimala

OTJR (Thorofare N J). 2023 May 30:15394492231175069. doi: 10.1177/15394492231175069. Online ahead of print.

ABSTRACT

Eating and mealtime challenges are common in autistic children, yet intervention access is limited. Telehealth may provide opportunities to address this gap and increase access for underserved families. This study examined the occupational therapy practitioner’s perceptions of transitioning from a caregiver-mediated, in-home eating, and mealtime intervention for autistic children to telehealth owing to COVID-19 while considering the impact on accessibility, challenges, and benefits. Family characteristics were compared between groups. Thematic analysis of semi-structured interviews explored practitioners’ experiences of telehealth. Statistical findings and themes were directly compared and contrasted. The following three themes emerged: Intervention Adaptations, Challenges for Interventionists, and Benefits of Telehealth. The differences in the families’ geographic location were identified. Themes and family characteristic differences supported increased intervention accessibility for the telehealth group. This study provides preliminary evidence that telehealth can increase access to specialized services. There are benefits and challenges to implementing telehealth with families and autistic children.

PMID:37248963 | DOI:10.1177/15394492231175069

Hosp Pediatr. 2023 May 30:e2022006838. doi: 10.1542/hpeds.2022-006838. Online ahead of print.

ABSTRACT

BACKGROUND: Tobacco use commonly starts during adolescence and is the leading cause of preventable disease, disability, and death in the United States. Secondhand smoke (SHS) exposure increases asthma and respiratory infection hospitalizations and contributes to sudden unexpected infant death. Few pediatric hospitalist-led smoking cessation studies are formal quality improvement (QI), with most at academic institutions and studying caregivers.

OBJECTIVES: To increase SHS exposure/tobacco use screening, smoking cessation discharge instructions, and Smokers’ Helpline referrals for community hospital pediatric patients/caregivers through QI.

METHODS: All pediatric, newborn, and NICU admissions were eligible. The baseline period was December 2019 through November 2020 and intervention period December 2020 through June 2021. Interventions included hospitalist education, standardizing documentation, visual reminders, and Helpline wallet cards. The primary measure was monthly percentage of patients screened for SHS exposure/tobacco use. Secondary measures were percentage of patients/caregivers positive for SHS exposure/tobacco use who received (1) discharge instructions or (2) Helpline referral. Length of stay was a balancing measure. Primary and balancing measures were analyzed with statistical process control. Secondary measures were monitored on run charts.

RESULTS: Average SHS exposure/tobacco use screening rates increased from 14% to 90%, meeting special cause variation beginning December 2020. Median discharge instructions increased from 0% to 56%. Helpline referrals increased from 0% to 17%. Length of stay remained approximately 2 days.

CONCLUSIONS: Pediatrician-led QI can increase SHS exposure/tobacco use screening and interventions in the community hospital setting to encourage smoke exposure reduction and smoking cessation for patients and caregivers.

PMID:37248946 | DOI:10.1542/hpeds.2022-006838

J Xray Sci Technol. 2023 May 25. doi: 10.3233/XST-230026. Online ahead of print.

ABSTRACT

BACKGROUND: Due to the wide application of the cone beam computed tomography (CBCT) in clinical practice, it is important to assess radiation dose of CBCT more accurately and efficiently in different clinical applications.

OBJECTIVE: This study aims to calculate effective and absorbed doses in CBCT measured in an anthropomorphic phantom using computer-based Monte Carlo (PCXMC) software, and to conduct comparative evaluations of MOSFET (metal- oxide- semiconductor field-effect transistor) and radiophotoluminescence glass dosimeters (RPLGD).

METHODS: Effective and absorbed organ doses are compared with those obtained using MOSFET and RPLGD dosimetry in an anthropomorphic phantom given the same exposure settings. Effective and absorbed organ doses from CBCT during scout and main projections are calculated using PCXMC and PCXMCRotation software, respectively.

RESULTS: The mean effective dose from CBCT calculated using PCXMC software is 233.8μSv, while the doses calculated using dosimetry (MOSFET and RPLGD) are 266.67μSv and 268.78μSv, respectively. The X-ray source variation is 0.79%. The prescription limits based on the Friedman test for MOSFET and RPLGD pre-points (i.e., in an analytical analysis of diagnostic names in CBCT) are not statistically significant. The calculated correlation coefficient between MOSFET- and RPLGD-derived absorbed dose values with respect to a field of view CBCT parameter of 17×13.5 mm is r = 0.8623.

CONCLUSIONS: The study demonstrates that the PCXMC software may be used as an alternative to MOSFET and RPLGD dosimetry for effective and absorbed organ dose estimation in CBCT conducted with a large FOV in an anthropomorphic phantom.

PMID:37248944 | DOI:10.3233/XST-230026

Work. 2023 May 20. doi: 10.3233/WOR-220384. Online ahead of print.

ABSTRACT

BACKGROUND: Active patient engagement and adherence are essential for successful rehabilitation outcomes, particularly in complex cases such as work-related musculoskeletal injuries. Although the therapist-patient relationship is a significant component of successful care coordination, there has been limited examination of this relationship within upper extremity musculoskeletal rehabilitation.

OBJECTIVE: To explore therapists’ perspectives on how the therapist-patient relationship intersects with engagement and adherence in the provision of holistic and collaborative rehabilitation services.

METHODS: Data were collected from four therapists over three months. Descriptive statistics were generated from the Sport Injury Rehabilitation Adherence Scale (SIRAS) and the Rehabilitation Therapy Engagement Scale (RTES) completed by therapists following visits from a sub-sample of patients (n = 14). Weekly semi-structured group interviews (n = 13) were analyzed using an iterative grounded theory-informed process. Emerging themes were identified, refined, and situated within the context of quantitative results.

RESULTS: SIRAS scores averaged 14.4 (SD: 1.0) and RTES scores averaged 42.5 (SD: 3.5), indicating high perceived patient engagement and adherence. Four themes emerged from therapist interviews: (1) dynamic power; (2) co-constructed engagement; (3) emotional states; (4) complementary therapy contexts.

CONCLUSION: In this engaged and adherent setting, therapist-patient relationships were complex and intimate, and extended beyond education and physical interventions. Careful management of this relationship was central to active patient participation and engagement. Incorporating holistic techniques may provide more structure for managing and communicating these aspects of care. These findings provide a preliminary understanding of the impact of therapeutic relationships on engagement and collaborative care.

PMID:37248936 | DOI:10.3233/WOR-220384

Work. 2023 May 20. doi: 10.3233/WOR-220038. Online ahead of print.

ABSTRACT

BACKGROUND: In India, where agriculture is the prime occupation among the rural population, farmers are extensively using pesticides in crop production without taking adequate precautions.

OBJECTIVE: The current study aimed to examine pesticide usage patterns, usage of personal protective equipment (PPE), knowledge on pesticide toxicity, and attitude towards occupational safety among farmers diagnosed with leukaemia (n = 60), lymphoma (n = 33), and breast cancer (n = 30) visiting a tertiary cancer care hospital in Hyderabad, India.

METHODS: Face-to-face interviews were conducted using a pre-tested questionnaire and the data collected were analysed with statistical software SPSS 23.

RESULTS: The survey revealed that the participants had an average of 19.6 years of farming experience and women were predominantly involved in the mixing of pesticides and other agricultural work apart from spraying. All of them were not using any PPE and the majority of them did not have any knowledge on the route of exposure, toxicity symbols, and safe handling of pesticides. Statistical analysis showed no significant association between educational status and knowledge, attitude and practices (p > 0.05).

CONCLUSION: Even though the majority of the farmers were educated, their lack of adequate knowledge on pesticides had enabled them to adopt risky behaviours in handling and storage of pesticides. There is a need for continuous training programs for farmers to promote awareness and minimize the hazards of occupational exposure.

PMID:37248931 | DOI:10.3233/WOR-220038

J Alzheimers Dis. 2023 May 20. doi: 10.3233/JAD-230425. Online ahead of print.

ABSTRACT

BACKGROUND: Dementia and urinary incontinence (UI) are etiologically complex clinical syndromes. Dementia and UI often occur in the same individuals, but underlying factors connecting them are incompletely understood.

OBJECTIVE: Query data from a community-based autopsy series to assess pathologies that underlie UI.

METHODS: Included research subjects came to autopsy from the University of Kentucky Alzheimer’s Disease Research Center longitudinal cohort. A total of 368 research volunteers met inclusion criteria for this cross-sectional study. The average age at death was 85.3 years and the average number of annual clinic visits was 5.2 visits. Statistical models were run to evaluate which pathologies were associated with UI. Data included pathologies scored according to conventional stage-based systems, and these studies were complemented by quantitative digital neuropathology.

RESULTS: Dementia was diagnosed at the final clinical visit in 208 (56.7% of the sample) and UI was documented in 156 (42.7%). UI was associated with depression and dementia (both p < 0.001). More women than men had a history of UI (p < 0.04), and women with UI had had more biological children than those without UI (p < 0.005). Participants with limbic predominant age-related TDP-43 encephalopathy neuropathologic changes (LATE-NC) were more likely to have UI than those without LATE-NC (p < 0.001). The presence of LATE-NC (Stage > 1) was associated with UI with or without severe Alzheimer’s disease neuropathologic changes and/or Lewy body pathology.

CONCLUSION: In this community-based autopsy cohort, multiple factors were associated with UI, but the neuropathologic change most robustly associated with UI was LATE-NC.

PMID:37248909 | DOI:10.3233/JAD-230425

J Alzheimers Dis. 2023 May 20. doi: 10.3233/JAD-230142. Online ahead of print.

ABSTRACT

BACKGROUND: Alzheimer’s disease (AD) is a complex neurodegenerative disease, and increasing evidence has linked dysregulation of amino acids to AD pathogenesis. However, the existing studies often ignore the chirality of amino acids, and some results are inconsistent and controversial. The changes of amino acid profiles in AD from the perspective of enantiomers remain elusive.

OBJECTIVE: The purpose of this study is to investigate whether the levels of amino acids, especially D-amino acids, are deregulated in the peripheral serum of AD patients, with the ultimate goal of discovering novel biomarkers for AD.

METHODS: The chiral amino acid profiles were determined by HPLC-MS/MS with a pre-column derivatization method. Experimental data obtained from 37 AD patients and 34 healthy controls (HC) were statistically analyzed.

RESULTS: Among the 35 amino acids detected, D-proline, D/total-proline ratio, D-aspartate, and D/total-aspartate ratio were decreased, while D-phenylalanine was elevated in AD compared to HC. Significant age-dependent increases in D-proline, D/total-proline ratio, and D-phenylalanine were observed in HC, but not in AD. Receiver operator characteristic analyses of the combination of D-proline, D-aspartate, D-phenylalanine, and age for discriminating AD from HC provided satisfactory area under the curve (0.87), specificity (97.0%), and sensitivity (83.8%). Furthermore, the D-aspartate level was significantly decreased with the progression of AD, as assessed by the Clinical Dementia Rating Scale and Mini-Mental State Examination.

CONCLUSION: The panels of D-proline, D-phenylalanine, and D-aspartate in peripheral serum may serve as novel biomarker candidates for AD. The latter parameter is further associated with the severity of AD.

PMID:37248903 | DOI:10.3233/JAD-230142

J Back Musculoskelet Rehabil. 2023 May 18. doi: 10.3233/BMR-220352. Online ahead of print.

ABSTRACT

BACKGROUND: Marathon running is an extreme sport with a distance of about 42 kilometers. Its relationship to high-sensitivity cardiac troponin (hs-cTn) remains controversial.

OBJECTIVE: As the gold standard for detecting myocardial injury, the trends of hs-cTn before and after a marathon were investigated and analyzed.

METHODS: A literature search was conducted in PubMed, EMBASE, and Cochrane Library databases by combing the keywords marathon and troponin, and studies regarding high-sensitivity cardiac troponin I (hs-cTnI) and high-sensitivity cardiac troponin T (hs-cTnT) concentrations before and after marathon running (not for half-marathon and ultra-marathon) were included. “Quality Assessment Tool for Before-After (Pre-Post) Studies With No Control Group” were used to assess the risk of bias. Statistical analysis was performed using Review Manager, presenting data as mean values and 95% confidence intervals (CIs). Sensitivity analysis and subgroup analysis were performed if there was high heterogeneity among studies based on I2 statistic.

RESULTS: A total of 13 studies involving 824 marathoners were included in this systematic review and meta-analysis. Both hs-cTnI (MD 68.79 ng/L, [95% CI 53.22, 84.37], p< 0.001) and hs-cTnT (MD 42.91 ng/L, [95% CI 30.39, 55.43], p< 0.001) were elevated after running a marathon, but the concentration of hs-cTnT returned to baseline after 72 to 96 h post-race (MD 0.11 ng/L, [95% CI -1.30, 1.52], p= 0.88). The results of subgroup analysis demonstrated that the 99th percentile upper reference limit of hs-cTnT might be the source of heterogeneity.

CONCLUSION: The concentrations of hs-cTnI and hs-cTnT were increased after marathon running, but the change of hs-cTnT is usually not seen as irreversible myocardial injury.

PMID:37248881 | DOI:10.3233/BMR-220352

J Back Musculoskelet Rehabil. 2023 May 18. doi: 10.3233/BMR-220288. Online ahead of print.

ABSTRACT

BACKGROUND: The incidence rate of degenerative spinal deformity (DSD) has gradually increased in the elderly. Currently, the relationship between the functional status of trunk muscle and the spinal-pelvic parameters of DSD patients remains unclear.

OBJECTIVE: This paper aims to explore the relationship between the two factors and provide new clues for exploring the mechanism of the occurrence and development of DSD.

METHODS: A total of 41 DSD patients treated in our hospital (DSD group) and 35 healthy volunteers (control group) were selected. Muscle strength was evaluated using an IsoMed-2000 isokinetic dynamometer, and the trunk flexor and extensor peak torque (PT) of subjects was measured at a low, medium, and high angular velocity of 30∘/s, 60∘/s, and 120∘/s, respectively. Hand grip strength (HGS) was assessed using an electronic grip dynamometer and Surgimap software was used to measure the spinal-pelvic parameters, including the sagittal vertical axis (SVA), thoracic kyphosis (TK), lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), pelvic incidence rate (PI), and PI-LL, and the relationship between trunk muscle function and various parameters was analyzed.

RESULTS: Under the three angular velocities, the flexor and extensor PT values in the DSD group were lower than those in the control group, and only the extensor PT showed a statistically significant difference (P< 0.05). There was no significant difference in HGS between the two groups (P> 0.05). In the DSD group, the extensor PT at 30∘/s was significantly negatively correlated with SVA (P< 0.05). At 60∘/s and 120∘/s, the extensor PT was significantly negatively correlated with SVA and PT (P< 0.05).

CONCLUSION: Trunk extensor strength is significantly lower in DSD patients than in normal controls. The decline in trunk extensor strength in DSD patients is a type of local muscle dysfunction more closely related to the deformity, which is likely involved in the compensatory mechanism of DSD and may reflect the overall imbalance of the trunk.

PMID:37248878 | DOI:10.3233/BMR-220288

Int J Nurs Knowl. 2023 May 30. doi: 10.1111/2047-3095.12427. Online ahead of print.

ABSTRACT

PURPOSE: This research was planned to follow the healing process of the oral mucosa in patients in intensive care with an “Impaired Oral Mucous Membrane Integrity” nursing diagnosis based on the “NOC (1100) Oral Health Assessment” outcome criteria.

METHOD: This study, which was planned in a methodological and descriptive type of research, was carried out with 50 patients who were hospitalized in the intensive care clinic of a state hospital between June and December 2022, with a nursing diagnosis of “Impaired Oral Mucous Membrane Integrity.” Data were collected using a Patient Information Form and the “NOC (1100) Oral Health Evaluation Scale” for the nursing outcomes classification. In the analysis of the data descriptive statistical methods, Pearson correlation test, Friedman test as well as Cohen’s kappa test were used to evaluate the agreement between two independent observers.

FINDINGS: In the study, content validity index value of the NOC scale was calculated to be 0.90. The examination of the participants’ mean scores on the NOC (1100) Oral Health Assessment Scale showed that there were statistically significant differences in terms of the repeated evaluations, except for the NOC indicators of “Oral mucosal integrity,” “Gum integrity,” and “Tooth integrity” (p < 0.01). No statistically significant correlation was found between the mean NOC scale scores of the patients according to the variables of age, body mass index, mechanical ventilation time, and length of stay in the intensive care unit (p > 0.05).

CONCLUSIONS: The findings showed that the Turkish version of NOC (1100) Oral Health Assessment Scale was a valid tool for monitoring the healing process of the oral mucosa in patients in intensive care.

IMPLICATIONS OF NURSING PRACTICE: With the use of NOC (1100) Oral Health Assessment Scale, a common language will be formed in the evaluation for monitoring the healing process of the oral mucosa in nursing care.

PMID:37248868 | DOI:10.1111/2047-3095.12427