Nevin Manimala

HERD. 2023 Mar 2:19375867231159130. doi: 10.1177/19375867231159130. Online ahead of print.

ABSTRACT

AIM: To examine how the spatial topology of the operating room (OR) within the medical center impacts surgical team communication.

BACKGROUND: Understanding the complex association between surgical team communication and the OR’s spatial network location is critical to patient safety. Effective surgical communication is associated with fewer adverse events and medical errors.

METHODS: We employed a cross-sectional, quantitative, case study, and network-centric study design. We studied the population of 204 clinicians in a large military medical center (36 perioperative nurses, 34 surgical technicians, 62 anesthesia providers, and 72 surgeons), focusing on surgical teams with cases completed within duty hours. Data were collected from December 2020 to June 2021 using an electronic survey. Spatial network analysis was done using electronic floor plans. Statistical analysis was done with descriptive statistics and linear regressions. The outcomes were general and task-specific communication, and team-level variables were aggregated from scores for all team members. Spatial effects were assessed with network centrality (degree, Laplacian, and betweenness).

RESULTS: The individual-level survey response rate was 77% (157 of 204). Data were collected on 137 surgical teams. On a 5-point scale, general and task-specific communication ranged from 3.4 to 5.0 and 3.5 to 5.0, respectively (for both, median = 4.7). Team size ranged from 4 to 6 individuals (median = 4). Surgical suites with higher network centralities were associated with significantly lower communication scores.

CONCLUSIONS: The OR’s spatial network location has important impacts on surgical team communication. Our findings have design and workflow implications for ORs and even surgical care in combat zones.

PMID:36866407 | DOI:10.1177/19375867231159130

J Public Health (Oxf). 2023 Feb 23:fdac169. doi: 10.1093/pubmed/fdac169. Online ahead of print.

ABSTRACT

AIM: The present study investigated regional differences in response behaviour for the Patient Health Quetionnaire-9. We tested for measurement invariance and differential item and test functioning between formerly divided East- and West-Germany: the former German Democratic Republic and Federal Republic of Germany. Diverging socialization experiences in socialist versus capitalist and collectivist versus individualist systems may affect culturally sensitive assessments of mental health.

SUBJECT AND METHODS: To test this empirically, we used factor analytic and item-response-theoretic frameworks, differentiating between East- and West-Germans by birthplace and current residence based on several representative samples of the German general population (n = 3 802).

RESULTS: Across all survey, we discovered slightly higher depression sum scores for East- versus West-Germans. The majority of items did not display differential item functioning-with a crucial exception in the assessment of self-harm tendencies. The scale scores were largely invariant exhibiting only small amounts of differential test functioning. Nonetheless, they made up on average about a quarter of the observed group differences in terms of effect magnitude.

CONCLUSION: We explore possible causes and discuss explanations for the item-level differences. Overall, analyses of East- and West-German depressive symptom developments in the wake of reunification are feasible and statistically grounded.

PMID:36866396 | DOI:10.1093/pubmed/fdac169

J Clin Hypertens (Greenwich). 2023 Mar 2. doi: 10.1111/jch.14646. Online ahead of print.

ABSTRACT

Although the effect of intensive systolic blood pressure lowering is widely recognized, treatment-related low diastolic blood pressure still worrisome. This was a prospective cohort study based on the National Health and Nutrition Examination Survey. Adults (≥20 years old) with guideline-recommended blood pressure were included and pregnant women were excluded. Survey-weighted logistic regression and cox models were used for analysis. A total of 25 858 participants were included in this study. After weighted, the overall mean age of the participants was 43.17 (16.03) years, including 53.7% women and 68.1% non-Hispanic white. Numerous factors were associated with low DBP (<60 mmHg), including advanced age, heart failure, myocardial infarction, and diabetes. The use of antihypertensive drugs was also associated with lower DBP (OR, 1.52; 95% CI, 1.26-1.83). DBP of less than 60 mmHg were associated with a higher risk of all-cause death (HR, 1.30; 95% CI, 1.12-1.51) and cardiovascular death (HR, 1.34; 95% CI, 1.00-1.79) compared to those with DBP between 70 and 80 mmHg. After regrouping, DBP <60 mmHg (no antihypertensive drugs) was associated with a higher risk of all-cause death (HR, 1.46; 95% CI, 1.21-1.75). DBP <60 mmHg after taking antihypertensive drugs was not associated with a higher risk of all-cause death (HR, 0.99; 95% CI, 0.73-1.36). Antihypertensive drug is an important factor contributing to DBP below 60 mmHg. But the pre-existing risk does not increase further with an additional reduction of DBP after antihypertensive drugs treatment.

PMID:36866395 | DOI:10.1111/jch.14646

Int J Ment Health Nurs. 2023 Mar 2. doi: 10.1111/inm.13131. Online ahead of print.

ABSTRACT

Globally, around half (55%) of the population live in fast-paced urban settings where many people find it challenging to manage their stress and respond to crises with a positive mindset. This resulted in prolonged distress where anxiety and fatigue caused physical and mental health concerns. Nature walks involving immersive exposure in the forest, and green spaces have been posited to offer physiological and psychological benefits. Therefore, in this systematic review, we evaluated the effects of forest bathing on psychological and physiological outcomes. We searched four English and five non-English databases (Chinese and Korean) for peer-reviewed studies published between January 2000 and March 2021. This review adhered to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-analysis Statement 2020. The primary outcomes explored in this review were mainly psychological, including anxiety, depression, mood and quality of life. The secondary outcomes were physiological outcomes such as blood pressure and heart rate. We conducted a meta-analysis on each outcome using the random-effects model. Heterogeneity was assessed by the I² statistic. Thirty-six articles (21 in English, 3 in Chinese and 12 in Korean) with 3554 participants were included in this review. Our meta-analysis suggested that forest bathing can significantly reduce symptoms of depression and anxiety. However, we did not observe as many benefits in physiological outcomes. Against the background of the negative effects of urbanization on mental well-being, this review highlighted the potential therapeutic role of forests in the contemporary world, lending further evidence-based support for forest conservation.

PMID:36864583 | DOI:10.1111/inm.13131

Magn Reson Med. 2023 Mar 2. doi: 10.1002/mrm.29620. Online ahead of print.

ABSTRACT

PURPOSE: To investigate the feasibility of combining simultaneous multislice (SMS) and region-optimized virtual coils (ROVir) for single breath-hold CINE imaging.

METHOD: ROVir is a recent virtual coil approach that allows reduced-field of view (FOV) imaging by localizing the signal from a region-of-interest (ROI) and/or suppressing the signal from unwanted spatial regions. In this work, ROVir is used for reduced-FOV SMS bSSFP CINE imaging, which enables whole heart CINE with a single breath-hold acquisition.

RESULTS: Reduced-FOV CINE with either SMS-only or ROVir-only resulted in significant aliasing, with severely reduced image quality when compared to the full FOV reference CINE, while the visual appearance of aliasing was substantially reduced with the proposed SMS+ROVir. The end diastolic volume, end systolic volume, and ejection fraction obtained using the proposed approach were similar to the clinical reference (correlations of 0.92, 0.94, and 0.88, respectively with p<0.05$$ p<0.05 $$ in each case, and biases of 0.1, 1.6 mL, and –0.6%$$ -0.6% $$ , respectively). No statistically significant differences for these parameters were found with a Wilcoxon rank test (p = 0.96, 0.20, and 0.40, respectively).

CONCLUSION: We demonstrated that reduced-FOV CINE imaging with SMS+ROVir enables single breath-hold whole-heart imaging without compromising visual image quality or quantitative cardiac function parameters.

PMID:36864561 | DOI:10.1002/mrm.29620

Orthop Surg. 2023 Mar 2. doi: 10.1111/os.13693. Online ahead of print.

ABSTRACT

OBJECTIVE: The optimal repair method for bursal-side partial-thickness rotator cuff tears (PTRCTs) involving >50% of the thickness remains a controversial topic. The study was aimed to compare the functional and magnetic resonance imaging (MRI) outcomes after in situ repair or tear completion before repair of bursal-side PTRCTs.

METHODS: A retrospective clinical study was conducted involving 58 patients who underwent in situ repair or tear completion before repair of bursal-side PTRCTs between January 2019 and December 2020. These patients were divided into two groups: the in situ repair group and the tear completion before repair group. Functional assessment consisted of active range of motion (ROM), visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, and Constant-Murley score. The percentages of patients in each group achieving the minimal clinical important difference (MCID) of the functional scores were determined. The healing status of the rotator cuff was assessed by postoperative MRI.

RESULTS: There were no statistically significant differences between the two groups in terms of demographic data. The mean follow-up period was 14.53 ± 2.64 months in the in situ repair group and 15.40 ± 2.66 months in the tear completion before repair group. At the final follow-up, the forward elevation, external rotation, and internal rotation improved significantly in both groups. The VAS, ASES score, and Constant-Murley score improved significantly in the in situ repair group (5.17 ± 2.00 points to 0.11 ± 0.41 points, p = 0.001; 44.04 ± 17.40 points to 95.47 ± 4.32 points, p = 0.001; 49.50 ± 14.38 points to 93.50 ± 3.49 points, p = 0.001) and in the tear completion before repair group (5.43 ± 3.32 points to 0.03 ± 0.18 points, p = 0.001; 41.50 ± 19.59 points to 95.94 ± 2.68 points, p = 0.001; 47.54 ± 17.13 points to 93.97 ± 2.61 points, p = 0.001). Postoperative MRI revealed that the re-tear rate was 7.1% (2/28) in the in situ repair group and 3.3% (1/30) in the tear completion before repair group. No significant differences were observed in terms of the functional scores, the percentages of patients achieving the MCID of the functional scores, and the re-tear rate between the two groups (p > 0.05).

CONCLUSIONS: Both in situ repair and tear completion before repair yielded satisfactory clinical outcomes for patients with bursal-side PTRCTs. No significant differences were observed in the functional and MRI outcomes between the two groups.

PMID:36864555 | DOI:10.1111/os.13693

Cereb Cortex. 2023 Mar 1:bhad030. doi: 10.1093/cercor/bhad030. Online ahead of print.

ABSTRACT

Schizophrenia is associated with a high prevalence of cigarette smoking. Neural dynamics are spatially structured and shaped by both microscale molecular and macroscale functional architectures, which are disturbed in the diseased brain. The neural mechanism underlying the schizophrenia-nicotine dependence comorbidity remains unknown. In this study, we aimed to test whether there is an interaction between schizophrenia and smoking in brain neural dynamics, and how the main effect of the 2 factors related to the molecular architecture. Functional magnetic resonance imaging data were obtained from 4 groups: schizophrenia and healthy controls with/without smoking. We identified 2 dynamics gradients combined with over 5,000 statistical features of the brain region’s time series. The interaction effect was found in the high-order functional network, and the main effect of schizophrenia was in the bilateral orbitofrontal cortices. Moreover, the disease- and smoking-related alteration in brain pattern was associated with spatial distribution of serotonin, cannabinoid, and glutamate. Collectively, these findings supported the self-medication hypothesis in schizophrenia-nicotine dependence with a neural intrinsic dynamics perspective.

PMID:36864548 | DOI:10.1093/cercor/bhad030

Contracept Reprod Med. 2023 Mar 3;8(1):22. doi: 10.1186/s40834-023-00217-z.

ABSTRACT

BACKGROUND: The under-five child mortality rate is a widely accepted indicator of the development of a country as well as reflects the country’s health care system and quality of life. Although the child mortality rate is decreasing over time in Bangladesh, the rate is still high among South Asian countries. The target of the Sustainable Development Goal-3.2 is to reduce the under-five mortality rate in all countries of the world to 25 or fewer per 1000 live births by 2030. The purpose of this study is to identify the socio-demographic factors which have an influence on under-five child mortality in Bangladesh as well as to examine whether contraceptive use has any effect on under-five mortality in Bangladesh. Finally, a comparison has been made between the results obtained from the Cox proportional Hazard Model and Weibull model to find out which model is more efficient for the study data.

METHODS: For the study, data was extracted from Bangladesh Demographic Health Surveys 2017-2018 (BDHS 2017-2018). The Kaplan-Meier survival function has been used to demonstrate the survival probabilities of under-five children. While multivariate analyses of the Cox Proportional Hazard model and Weibull model are used to estimate the under-five mortality risks for various predictors.

RESULTS: The study results show consistently higher survival probabilities for children of mothers who used modern contraceptives during survival periods. Other significant predictors for under-five child mortality include mother’s education level (higher education), mother’s age (> 20), wealth index (rich), source of drinking water (tube well), and division (Chittagong, Khulna, Mymensingh). Weibull model has given more efficient results than the Cox Proportional Hazard model except for one covariate (water source).

CONCLUSION: Contraceptives use significantly improves the survival chances of children under-five age. This underscores the importance of contraceptive use in the pursuit of a sustainable reduction in under-five mortality in Bangladesh. It also intensifies the need to address the present level of contraceptive use in the country. This may not be due to the use of contraceptives in itself but may be due to the substantial biological and socioeconomic benefits that are concomitant with contraceptive use which may promote both maternal and child health. So, Extra effort should be given by the policymakers to ensure the use of modern contraceptive methods to improve the under-five survival in Bangladesh.

PMID:36864535 | DOI:10.1186/s40834-023-00217-z

Ultrasound Obstet Gynecol. 2023 Mar 2. doi: 10.1002/uog.26189. Online ahead of print.

ABSTRACT

OBJECTIVE: Ventriculomegaly can be associated with long-term neurodevelopmental impairment. The prenatal diagnosis of ventriculomegaly is most often made at the routine second trimester anomaly scan. The value of first trimester ultrasound has expanded to early diagnosis and screening of fetal abnormalities. The objective of this study was to assess the predictive accuracy of first trimester choroid plexus to head/ventricle ratios for development of ventriculomegaly at a later gestation.

METHODS: This was a case-control study of fetuses with isolated ventriculomegaly diagnosed after 16 weeks’ gestation. The control group included normal fetuses (without ventriculomegaly). The exclusion criteria included aneuploidy, genetic syndromes or other brain abnormalities. Stored 2D first trimester ultrasound images were blindly analyzed offline and fetal biometry measured in axial view of the fetal head. The ratios of choroid plexus to lateral ventricle area (PA/VA), choroid plexus to lateral ventricle length (PL/VL), choroid plexus to lateral ventricle diameter (PD/VD), choroid plexus area to biparietal diameter (PA/BPD) and choroid plexus area to head circumference (PA/HC) were measured at 11-13+6 weeks’ gestation. Intra- and inter-observer variability of these fetal head biometry parameters at 11-13+6 weeks’ gestation were assessed in 20 normal fetuses using intra-class coefficients with 95% confidence intervals. The accuracy of first-trimester biometric measurements for prediction of ventriculomegaly was assessed using the area under the ROC curves (AUC).

RESULTS: The analysis included 683 singleton pregnancies; of which 102 fetuses were diagnosed with ventriculomegaly. The ventriculomegaly was mild in the majority (n=86; 84.3%) of cases, while it was severe in 16 (15.7%) fetuses. All first trimester fetal choroid plexus to ventricle/head ratios were significantly lower in the ventriculomegaly cases than in controls (p<0.05 all) with good inter- and intra-observer agreement (>0.95 for the majority of the fetal head biometry assessed). After adjusting for crown-rump length, both PL/VL ratio (AUC 0.87, 95% CI 0.73-0.98) and PA/VA ratio (AUC 0.90, 95% CI 0.82-0.98) showed good predictive accuracy for severe ventriculomegaly. PA/BPD ratio (AUC 0.73, 95% CI 0.54-0.90) had modest predictive ability, which was significantly lower than prediction using PA/VA ratio (P=0.003 and P=0.001, respectively). The predictive accuracy of PD/VD ratio was low with an AUC of 0.65 (95% CI 0.46- 0.84). Optimism adjusted AUC values obtained after cross-validation showed that PA/VA ratio offered the highest predictive accuracy with an AUC of 0.90 (95% CI: 0.82-0.98), followed by PL/VL ratio (AUC 0.87, 95% CI 0.73-0.98), PA/BPD ratio (AUC 0.73, 95% CI 0.54-0.90), and PD/VD ratio (AUC 0.65, 95% CI 0.47-0.84). Optimism-adjusted AUC values obtained after cross-validation showed that PA/VA ratio offered the highest predictive accuracy for mild ventriculomegaly with an AUC of 0.83 (95% CI 0.78-0.88), followed by PL/VL ratio (AUC 0.82, 95% CI 0.76-0.88), PA/BPD ratio (AUC 0.75, 95% CI 0.68-0.81), and PD/VD ratio (AUC 0.74, 95% CI 0.67-0.80). Calibration plots show both PA/VA and PL/VL ratios have good calibration CONCLUSION: First-trimester prediction of ventriculomegaly using fetal choroid plexus to ventricle ratios appears promising. Future prospective studies are needed to validate the predictive accuracy of these ultrasound markers as a screening tool for ventriculomegaly. This article is protected by copyright. All rights reserved.

PMID:36864532 | DOI:10.1002/uog.26189

Ultrasound Obstet Gynecol. 2023 Mar 2. doi: 10.1002/uog.26187. Online ahead of print.

ABSTRACT

OBJECTIVE: Having adequate reference ranges of the size of corpus callosum (CC) is necessary to better characterize CC abnormalities and improve parental counseling. The objective of this study was to evaluate the methodology used in developing different references charts for CC biometry.

METHODS: We conducted a systematic review of studies of fetal CC biometry using a set of predefined quality criteria of study design, statistical analysis and reporting methods. We including observational studies whose primary aim was to create ultrasound or MRI charts for size of the CC in normal population of fetuses. Studies were scored against a predefined set of independently agreed methodological criteria and an overall quality score was given to each study.

RESULTS: Twelve studies met the inclusion criteria. Quality scores ranged between 17.4% and 95.6%. The highest potential for bias was noted in the following fields : “sample selection” and “sample size calculation” where only 17% of the studies were population-based study with consecutive or random recruitment of patient and with a justification of the sample size; “number of measurement taken for CC biometrics” where in only 17% of the studies more one measure per fetus and per scan were performed; “description of characteristics of the study population” where only 9% of the studies clearly reported a minimum dataset of demographic characteristics.

CONCLUSION: Our review demonstrates substantial heterogeneity in methods and final biometry values of fetal CC measurement. The use of uniform methodology of the highest quality is essential in order to define a “short” CC and provide appropriate parental counseling. This article is protected by copyright. All rights reserved.

PMID:36864530 | DOI:10.1002/uog.26187