Nevin Manimala

PRiMER. 2023 Apr 26;7:13. doi: 10.22454/PRiMER.2023.967474. eCollection 2023.

ABSTRACT

INTRODUCTION: Point-of-care ultrasound (POCUS) has high interest among learners and educators, but many barriers inhibit training and clinical use. Interest and barriers may differ between educators, trainees, and practicing physicians. This study investigates interest in POCUS, confidence in POCUS skills, and barriers to POCUS use for residents, academic family physicians, and community providers.

METHODS: Online surveys sent to current residents, faculty, and graduates of an academic family medicine residency compared current use, comfort, training, perceived importance, barriers, and interest in future use of POCUS.

RESULTS: Most participants (95.6%) agreed that POCUS was somewhat or extremely important to family medicine. Most participants also reported interest in all POCUS indications, other than obstetrics. Very few (5.4%) reported being extremely comfortable using POCUS. Most residents were somewhat comfortable, whereas most faculty and graduates were not at all comfortable. A majority in each group reported inexperience with equipment and interpreting images as a barrier. One-third of faculty and graduates reported “not billable” as a barrier. Statistically significant differences were found between groups’ reports of prior training, current use, and interest in POCUS for obstetrics.

CONCLUSIONS: Family medicine residents, faculty, and community physicians reported high perceived importance of and interest in nonobstetric POCUS, but low comfort level in performing POCUS. Resident and faculty barriers may vary according to practice environment and differing time constraints. Senior faculty may have less POCUS training and comfort using POCUS than residents, highlighting the importance of continuing faculty education.

PMID:37465839 | PMC:PMC10351427 | DOI:10.22454/PRiMER.2023.967474

PRiMER. 2023 May 8;7:15. doi: 10.22454/PRiMER.2023.918491. eCollection 2023.

ABSTRACT

OBJECTIVES: This project analyzed the culture of safety quality improvement at the Family Medicine Center (FMC). The Agency for Healthcare Research and Quality (AHRQ) Culture of Safety Survey was used as a benchmark for internal and external comparison.

METHODS: The AHRQ Culture of Safety Survey was administered to health care staff in 2015, 2017, and 2019, respectively, at the Family Medicine Center. Baseline perceptions of safety and quality were established using the data from the AHRQ Culture of Safety Survey in 2015. We performed multiple large-scope quality improvement projects that focused on identified deficiencies. The changes in perception were monitored over time every 2 years. We analyzed the results using the Kruskal-Wallace test (P=.05).

RESULTS: The AHRQ Culture of Safety Survey showed statistically significant improvement in patient centeredness, effectiveness, timeliness, efficiency, equitableness, and overall patient safety from 2015 to 2019. Some inconsistencies were seen between different sections of responses, likely due to wording interpretations by the participants.

CONCLUSION: Overall, the AHRQ Culture of Safety Survey is an effective way to help monitor employee perception of multiple domains that lead to a safe and effective clinical environment as compared to other practices across the country. Clinic-wide implementation of quality and patient care strategies resulted in significant improvements in nearly every category of the survey.

PMID:37465832 | PMC:PMC10351433 | DOI:10.22454/PRiMER.2023.918491

J Acute Med. 2023 Jun 1;13(2):58-64. doi: 10.6705/j.jacme.202306_13(2).0002.

ABSTRACT

Background: COVID-19 infection can occur as a mild, moderate, or severe illness. How patients will be more serious has not been fully revealed so far. To investigate the role of systemic inflammation index (SII), platelet-to-lymphocyte ratio (PLR), mean platelet volume (MPV), mean platelet volume to platelet ratio (MPR), and neutrophil-to-lymphocyte and platelet ratio (NLPR) in determining the severity of COVID-19 patients. Methods: We retrospectively studied 397 patients with confirmed COVID-19 who were admitted to the emergency departments (EDs) between January and June 2020. According to the criteria recommended by World Health Organization, patients were divided into two groups as severe and non-severe cases. Demographic, clinical characteristics, and inflammation parameters of patients were evaluated. Results: The NLPR, SII, MPR, and PLR were significantly increased in severe COVID-19 patients compared to the non-severe patients (p < 0.0001, p = 0.0002, p = 0.0441 , p = 0.0469, respectively). On the other hand, the MPV value did not show a statistically significant difference between cases. In ROC analysis calculated for inflammatory biomarkers in the prediction of COVID-19 severity, NLPR exhibited the largest area under the curve (AUC) at 0.705, with the highest specificity (81.45%) and sensitivity (56.25%) at the optimal cut-off of 0.024 (p < 0.0001). SII (AUC: 0.670) was the second inflammatory parameter with high specificity (63.21%) and sensitivity (66.67%) following NLPR value (p = 0.0002). Conclusion: NLPR and SII may be new inflammatory markers to identify severe COVID-19 patients at the time of admission to the ED.

PMID:37465827 | PMC:PMC10351405 | DOI:10.6705/j.jacme.202306_13(2).0002

Int J Billing. 2021 Jun;25(3):483-499. doi: 10.1177/1367006920951870. Epub 2020 Aug 29.

ABSTRACT

PURPOSE: The purpose of the present study was to document the out-of-home exposure to English and Spanish experienced by children from Spanish-speaking homes in the United States during the preschool years.

METHODOLOGY: Primary caregivers of 149 children from Spanish-speaking homes in South Florida reported on their children’s language exposure.

DATA AND ANALYSIS: Descriptive statistics and paired-samples t-tests described and compared children’s exposure to English and Spanish outside the home. Multi-level modeling described trajectories of change and the influence of family characteristics on English and Spanish out-of-home exposure.

FINDINGS: Children heard more English than Spanish outside of their homes. Grandparents were the primary out-of-home source of exposure to Spanish. Language exposure in preschool and extracurricular activities was primarily English. From 30 to 60 months, English exposure increased, while Spanish exposure decreased. Within this general pattern, there was variability in children’s out-of-home language exposure as a function of parents’ language backgrounds and maternal education.

ORIGINALITY: Studies of bilingual children’s language exposure have focused on home language use. The present study shows that out-of-home experiences are a significant source of exposure to societal language (SL) for children from language minority homes.

IMPLICATIONS: For children in immigrant families, the home and family members outside the home are the primary sources of heritage language exposure. Out-of-home language experience is SL-dominant and increasingly so as children get older, although the degree to which this is the case differs depending on parental characteristics.

PMID:37465823 | PMC:PMC10352523 | DOI:10.1177/1367006920951870

Int J Chron Obstruct Pulmon Dis. 2023 Jul 13;18:1431-1444. doi: 10.2147/COPD.S411437. eCollection 2023.

ABSTRACT

PURPOSE: Routinely collected healthcare data on the comparative effectiveness of the long-acting muscarinic antagonist/long-acting β₂-agonist combination umeclidinium/vilanterol (UMEC/VI) versus tiotropium bromide/olodaterol (TIO/OLO) for chronic obstructive pulmonary disease (COPD) is limited. This study compared rescue medication prescriptions in patients with COPD in England receiving UMEC/VI versus TIO/OLO.

PATIENTS AND METHODS: This retrospective cohort study used primary care data from the Clinical Practice Research Datalink Aurum database linked with secondary care administrative data from Hospital Episode Statistics. Patients with a COPD diagnosis at age ≥35 years were included (indexed) following initiation of single-inhaler UMEC/VI or TIO/OLO between July 1, 2015, and September 30, 2019. Outcomes included the number of rescue medication prescriptions at 12-months (primary), and at 6-, 18- and 24-months (secondary), adherence at 6-, 12-, 18- and 24-months post-index, defined as proportion of days covered ≥80% (secondary), and time-to-initiation of triple therapy (exploratory). Inverse probability of treatment weighting (IPTW) was used to balance potential confounding baseline characteristics. Superiority of UMEC/VI versus TIO/OLO for the primary outcome of rescue medication prescriptions was assessed using an intention-to-treat analysis with a p-value < 0.05.

RESULTS: In total, 8603 patients were eligible (UMEC/VI: n = 6536; TIO/OLO: n = 2067). Following IPTW, covariates were well balanced across groups. Patients initiating UMEC/VI had statistically significantly fewer (mean [standard deviation]; p-value) rescue medication prescriptions versus TIO/OLO in both the unweighted (4.84 [4.78] vs 5.68 [5.00]; p < 0.001) and weighted comparison (4.91 [4.81] vs 5.48 [5.02]; p = 0.0032) at 12 months; consistent results were seen at all timepoints. Adherence was numerically higher for TIO/OLO versus UMEC/VI at all timepoints. Time-to-triple therapy was similar between treatment groups.

CONCLUSION: UMEC/VI was superior to TIO/OLO in reducing rescue medication prescriptions at 12 months after treatment initiation in a primary care cohort in England, potentially suggesting improvements in symptom control with UMEC/VI compared with TIO/OLO.

PMID:37465818 | PMC:PMC10351530 | DOI:10.2147/COPD.S411437

Cureus. 2023 Jun 17;15(6):e40574. doi: 10.7759/cureus.40574. eCollection 2023 Jun.

ABSTRACT

INTRODUCTION: The model for end stage liver disease (MELD), model for end stage liver disease-sodium (MELD Na), and Child-Turcotte-Pugh (CTP) score are independent predictors of mortality in cirrhotic patients. Approximately 43% of cirrhotic patients with advanced disease are frail and can have detrimental effects on the disease prognosis and survival including delisting from the transplant list and increased risk of post-transplant complications. Therefore, our aim was to determine the correlation of MELD, MELD-Na, and CTP score with frailty in patients with hepatitis C virus (HCV) related cirrhosis.

METHODS: This cross-sectional study was conducted at the Department of Hepato-gastroenterology, Sindh Institute of Urology and Transplantation from 1^st January 2022 to 30^th June 2022. All the patients of either gender aged between 18 and 70 years with serological evidence of HCV and features of cirrhosis on ultrasound abdomen were included in the study. Patients with conditions over estimating frailty were excluded from the study. Liver Frailty Index (LFI) was calculated using grip strength measured in kilograms, timed chair stands, and balance testing. CTP and MELD-Na scores for each patient were also recorded. All the data were analyzed using SPSS version 22.0 (IBM Corp., Armonk, NY). The correlation of MELD, MELD-Na, and CTP with LFI was analyzed using the Pearson correlation coefficient and a p-value < 0.05 was considered statistically significant.

RESULTS: A total of 274 patients were included in the study. Out of them, 185 (67.5%) were males. The mean CTP score was 8.1 + 2.1, MELD score of 13.6 + 7.1, MELD-Na score of 15 + 6.6, and LFI of 4.1 + 0.83. LFI was found to be weakly correlated with MELD (r = 0.278) (p < 0.001), MELD-Na score (r = 0.41) (p < 0.001), and CTP score (r = 0.325) (p < 0.001).

CONCLUSION: Weak correlation was noted between LFI, CTP, MELD, and MELD-Na scores in HCV-associated chronic liver disease. Therefore, frailty along with MELD, MELD-Na, and CTP must be assessed before considering the patients for liver transplantation.

PMID:37465808 | PMC:PMC10351912 | DOI:10.7759/cureus.40574

Res Synth Methods. 2023 Jul 18. doi: 10.1002/jrsm.1657. Online ahead of print.

ABSTRACT

Systematic reviews (SRs) of preclinical studies are marked with poor methodological quality. In vitro studies lack assessment tools to improve the quality of preclinical research. This methodological study aimed to identify, collect, and analyze SRs based on cell culture studies to highlight the current appraisal tools utilized to support the development of a validated critical appraisal tool for cell culture in vitro research. SRs, scoping reviews, and meta-analyses that included cell culture studies and used any type of critical appraisal tool were included. Electronic search, study selection, data collection and methodological quality (MQ) assessment tool were realized. Further, statistical analyses regarding possible associations and correlations between MQ and collected data were performed. After the screening process, 82 studies remained for subsequent analysis. A total of 32 different appraisal tools were identified. Approximately 60% of studies adopted pre-structured tools not designed for cell culture studies. The most frequent instruments were SYRCLE (n = 14), OHAT (n = 9), Cochrane Collaboration’s tool (n = 7), GRADE (n = 6), CONSORT (n = 5), and ToxRTool (n = 5). The studies were divided into subgroups to perform statistical analyses. A significant association (OR = 5.00, 95% CI = 1.54-16.20, p = 0.008) was found between low MQ and chronic degenerative disorders as topic of SR. Several challenges in collecting information from the included studies led to some modifications related to the previously registered protocol. These results may serve as a basis for further development of a critical appraisal tool for cell culture studies capable of capturing all the essential factors related to preclinical research, therefore enhancing the practice of evidence-based.

PMID:37464457 | DOI:10.1002/jrsm.1657

Otol Neurotol. 2023 Jul 18. doi: 10.1097/MAO.0000000000003963. Online ahead of print.

ABSTRACT

OBJECTIVE: Compare cochlear implant (CI) performance between patients with ipsilateral sporadic vestibular schwannoma (VS) and NF2-related schwannomatosis (NF2). Compare CI performance according to VS management modality.

STUDY DESIGN: Historical cohort.

SETTING: Tertiary academic center.

PATIENTS: Forty-nine patients (52 ears) undergoing cochlear implantation in the setting of ipsilateral sporadic (n = 21) or NF2-associated VS (n = 28).

INTERVENTIONS: CI ipsilateral to VS.

MAIN OUTCOME MEASURES: Auditory thresholds, consonant-nucleus-consonant (CNC) word scores, and AzBio sentences in quiet scores.

RESULTS: Among all patients, median post-CI pure tone average was 28 dB HL (interquartile range [IQR], 21-38), CNC word score was 39% (IQR, 6-62), and AzBio sentences in quiet score was 60% (IQR, 11-83) at a median of 12.5 months postimplantation. Despite the NF2 cohort having larger tumors, when comparing patients with sporadic versus NF2-associated VS, there were no statistically significant differences in CNC word (49% [30-70] vs. 31% [0-52]) or AzBio sentences in quiet (66% [28-80] vs. 57% [5-83]) scores. Regardless of NF2 status, all patients managed with observation, and radiosurgery achieved open-set speech. In patients who underwent microsurgery, 6 (46%) of 13 with NF2 achieved open-set speech recognition compared with 4 (67%) of 6 with sporadic disease.

CONCLUSION: Select patients with VS achieve successful hearing rehabilitation with a CI. In this cohort, tumor management strategy significantly influenced CI performance, whereas differences in NF2 status exhibited less effect. Specifically, all patients managed with observation or radiosurgery achieved open-set speech perception, whereas approximately half of people with NF2-related VS and two-thirds of people with sporadic VS achieved this outcome after tumor microsurgery. When disease permits, observation and radiosurgery should be considered in patients who may later pursue a CI.

PMID:37464449 | DOI:10.1097/MAO.0000000000003963

J Orthop Surg Res. 2023 Jul 18;18(1):507. doi: 10.1186/s13018-023-04007-w.

ABSTRACT

BACKGROUND: This study explores the latest epidemiological characteristics of posterior malleolus fracture and compares the epidemiological differences of posterior malleolus fracture in different periods, regions, and adult age groups.

METHODS: Clinical information of inpatients with posterior malleolus fracture in Shanghai Tongji Hospital and Karamay Central Hospital from January 2014 to February 2022 was reviewed and collected. The imaging data of patients were acquired using the Picture Archiving and Communication Systems. A statistical analysis was performed as to gender, current age, year of admission, injury mechanism, fracture type, and posterior malleolus fracture classification. Moreover, a comparative analysis was conducted on the injury mechanisms and morphological differences of posterior malleolus fracture at different periods, regions, and age groups.

RESULTS: A total of 472 patients (210 patients from Shanghai Tongji Hospital and 262 patients from Karamay Central Hospital) with posterior malleolus fracture and an average age of 48.7 ± 15.6 were included in this study. The peak of posterior malleolus fracture occurs in the age group of 50-59. The injury mechanisms mainly involve low-energy fall and sprain (411 cases, 87.1%), followed by traffic accidents (52 cases, 11.0%), and fall injury from height (9 cases, 1.9%). With aging, the number of fall and sprain cases increases and reaches the peak at the age of 50-59, followed by progressive decline. Traffic accidents presents a relatively flat small peak in the age group of 40-59. The number of cases according to different fracture types shows the following ascending order: trimalleolar fracture-supination external rotation (335 cases, 71.0%) > bimalleolar fracture (60 cases, 12.7%) > trimalleolar fracture-pronation extorsion (43 cases, 9.1%) > posterior malleolus + tibial shaft fracture (19 cases, 4.0%) > simple posterior malleolus fracture (15 cases, 3.2%). The numbers of cases corresponding to the Haraguchi I Type, II Type, and III Type of posterior malleolus fractures were 369 (78.2%), 49 (10.4%), and 54 (11.4%), respectively. The Tongji IIA Type represented the highest number of cases (249 cases, 52.8%), followed by the IIB Type (120 cases, 25.4%), I Type (54 cases, 11.4%), IIIB Type (36 cases, 7.6%), and IIIA type (13 cases, 2.8%). The trimalleolar fracture-supination external rotation, Haraguchi I Type and Tongji IIA Type of posterior malleolus fractures all presented an obvious peak of incidence in the age group of 50-59. However, no obvious statistical difference was observed in the injury mechanism, Haraguchi classification, and Tongji classification of posterior malleolus fractures among different years and regions in recent years (P > 0.05).

CONCLUSIONS: The injury mechanism of posterior malleolus fracture mainly involves low-energy fall and sprain cases. The trimalleolar fracture-supination external rotation, Haraguchi I type and Tongji IIA type of posterior malleolus fracture are predilection fracture types, and all present an obvious incidence peak in the age group of 50-59. Elderly patients have high risks of falling and their bones are more fragile, conditions which are potential risk factors of posterior malleolus fracture. Early positive control has important significance. This study provides references for relevant basic and clinical studies of posterior malleolus fracture.

PMID:37464426 | DOI:10.1186/s13018-023-04007-w

BMC Med Educ. 2023 Jul 18;23(1):514. doi: 10.1186/s12909-023-04500-0.

ABSTRACT

BACKGROUND: Numerous studies have demonstrated that the increasing racial and ethnic diversity of the US population benefits from access to healthcare providers from similarly diverse backgrounds. Physician assistant (PA) education programs have striven to increase the diversity of the profession, which is predominantly non-Hispanic white, by focusing on admitting students from historically excluded populations. However, strategies such as holistic admissions are predicated on the existence of racially and ethnically diverse applicant pools. While studies have examined correlates of matriculation into a medical education program, this study looks earlier in the pipeline and investigates whether applicant – not matriculant – pool diversity varies among PA programs with different characteristics.

METHODS: Data were drawn from the 2017-2018 Central Application Service for PAs admissions cycle. Applications to programs with pre-professional tracks and applicants missing race/ethnicity data were excluded, resulting in data from 26,600 individuals who applied to 189 PA programs. We summarized the racial and ethnic diversity of each program’s applicant pools using: [1]the proportion of underrepresented minority (URM) students, [2]the proportion of students with backgrounds underrepresented in medicine (URiM), and [3]Simpson’s diversity index of a 7-category race/ethnicity combination. We used multiple regressions to model each diversity metric as a function of program characteristics including class size, accreditation status, type of institution, and other important features.

RESULTS: Regardless of the demographic diversity metric examined, we found that applicant diversity was higher among provisionally accredited programs and those receiving more applications. We also identified trends suggesting that programs in more metropolitan areas were able to attract more diverse applicants. Programs that did not require the GRE were also able to attract more diverse applicants when considering the URM and SDI metrics, though results for URiM were not statistically significant.

CONCLUSIONS: Our findings provide insights into modifiable (e.g., GRE requirement) and non-modifiable (e.g., provisionally accredited) program characteristics that are associated with more demographically diverse applicant pools.

PMID:37464417 | DOI:10.1186/s12909-023-04500-0