Nevin Manimala

Sao Paulo Med J. 2023 Jul 31;142(1):e2022666. doi: 10.1590/1516-3180.2022.0666.R1.190523. eCollection 2023.

ABSTRACT

BACKGROUND: The epidemiology of potentially inappropriate medications (PIMs) in critical care units remains limited, especially in terms of the factors associated with their use.

OBJECTIVE: To estimate the incidence and factors associated with PIMs use in intensive care units.

DESIGN AND SETTING: Historical cohort study was conducted in a high-complexity hospital in Brazil.

METHODS: A retrospective chart review was conducted on 314 patients aged ≥ 60 years who were admitted to intensive care units (ICUs) at a high-complexity hospital in Brazil. The dates were extracted from a “Patient Safety Project” database. A Chi-square test, Student’s t-test, and multivariable logistic regression analyses were performed to assess which factors were associated with PIMs. The statistical significance was set at 5%.

RESULTS: According to Beers’ criteria, 12.8% of the identified drugs were considered inappropriate for the elderly population. The incidence rate of PIMs use was 45.8%. The most frequently used PIMs were metoclopramide, insulin, antipsychotics, non-steroidal anti-inflammatory drugs, and benzodiazepines. Factors associated with PIMs use were the number of medications (odds ratio [OR] = 1.17), length of hospital stay (OR = 1.07), and excessive potential drug interactions (OR = 2.43).

CONCLUSIONS: Approximately half of the older adults in ICUs received PIM. Patients taking PIMs had a longer length of stay in the ICU, higher numbers of medications, and higher numbers of potential drug interactions. In ICUs, the use of explicit methods combined with clinical judgment can contribute to the safety and quality of medication prescriptions.

PMID:37531493 | DOI:10.1590/1516-3180.2022.0666.R1.190523

Sao Paulo Med J. 2023 Jul 31;142(1):e2022644. doi: 10.1590/1516-3180.2022.0644.R1.24042023. eCollection 2023.

ABSTRACT

BACKGROUND: Stroke is a major cause of mortality worldwide. Renal dysfunction is an important risk factor for stroke. Brazilian studies on stroke knowledge are generally population based. Studies stratifying stroke knowledge according to comorbidities are rare. Scientific data are essential to guide the awareness of stroke.

OBJECTIVE: To assess stroke knowledge in patients with chronic kidney disease (CKD) on hemodialysis.

DESIGN AND SETTING: Cross-sectional analytical study of patients with CKD on hemodialysis in north-eastern Brazil.

METHODS: A self-administered questionnaire survey on stroke awareness was administered to patients with CKD on hemodialysis between April and November 2022. The chi-square test and other descriptive statistics were used. Univariate and multivariate analyses were performed using logistic regression.

RESULTS: A total of 197 patients were included in the analysis. The Brazilian acronym for stroke was used by 53.5% of the participants. Less than 10.0% of the sample showed optimal decision-making ability regarding stroke. Of the participants, 29.9% knew at least one risk factor and one symptom; however, this was considered as having below the minimum capacity because they did not know the emergency service call number. In the analysis adjusted for income and education, females (odds ratio [OR], 0.40%; 95% confidence interval [CI], 0.20-0.82), older patients (OR, 0.24%; 95% CI, 0.09-0.63) and having at most one comorbidity (OR, 0.48%; 95% CI, 0.23-0.98) were factors for lower levels of knowledge or ideal decision-making capacity against stroke.

CONCLUSIONS: Patients on hemodialysis, especially women and older people, have little knowledge about stroke.

PMID:37531492 | DOI:10.1590/1516-3180.2022.0644.R1.24042023

Sao Paulo Med J. 2023 Jul 31;142(1):e2022355. doi: 10.1590/1516-3180.2022.0355.R1.10042023. eCollection 2023.

ABSTRACT

BACKGROUND: There is a lack of studies evaluating the oral health of traditional indigenous communities in Brazil.

OBJECTIVES: Thus, the objective of this study was to describe the oral health characteristics of the indigenous Fulni-ô ethnic group in Northeast Brazil.

DESIGN AND SETTING: A cross-sectional observational investigation was conducted within the Project on Atherosclerosis among Indigenous Populations.

METHODS: This study included participants of both sexes from the Fulni-ô ethnic group. The participants included in this investigation underwent a comprehensive oral health evaluation by a registered and experienced dentist to assess oral health and identify potentially malignant oral lesions. Participants with suspicious lesions were referred for biopsy. Shapiro-Wilk, Mann-Whitney, and Student’s t-tests were used, and measures of central tendency and dispersion were described. Statistical significance was 5%.

RESULTS: A total of 104 individuals were included in this study. The prevalence of the use of tobacco derivatives was 94.0%, with similarities between sexes. The prevalence of oral changes in this study population was 84.4%. Fifty-one individuals who underwent oral reassessment were referred for oral lesion biopsy.

CONCLUSIONS: This study demonstrated a high prevalence of oral alterations in the Fulni-ô population. Histopathological analyses indicated the presence of mild oral epithelial dysplasia in five cases.

PMID:37531491 | DOI:10.1590/1516-3180.2022.0355.R1.10042023

Rev Bras Enferm. 2023 Jul 31;76Suppl 1(Suppl 1):e20220173. doi: 10.1590/0034-7167-2022-0173. eCollection 2023.

ABSTRACT

OBJECTIVES: to compare exclusive breastfeeding prevalence versus artificial feeding in newborns of mothers with COVID-19.

METHODS: a systematic review of prevalence, according to JBI. Searches in PubMed®, Embase, CINAHL, LILACS and Web of Science™ databases in August 2021. Cross-sectional, longitudinal or cohort studies were selected, without language and time limitations that showed breastfeeding prevalence or that allowed calculation.

RESULTS: fifteen articles published in 2020 and 2021, cohort (60%) or cross-sectional (40%) were analyzed. The average of exclusive breastfeeding in mothers with COVID-19 was 56.76% (CI=39.90-72.88), and artificial breastfeeding, 43.23% (CI = 30.99 – 55.88), without statistically significant differences.

CONCLUSIONS: despite the recommendations for maintaining breastfeeding, there was a reduction worldwide, when compared to periods prior to the pandemic. With advances in science, these rates have improved, showing the impact of evidence on practices. As limitations, study sources are cited. It is recommended to carry out new studies. PROSPERO registration CRD42021234486.

PMID:37531480 | DOI:10.1590/0034-7167-2022-0173

Arq Bras Cardiol. 2023 Jul 28;120(8):e20220939. doi: 10.36660/abc.20220939. eCollection 2023.

ABSTRACT

BACKGROUND: Complete thrombosis of the false lumen facilitates remodeling of type B aortic dissection (TBAD). Morphological characteristics affect thrombosis in the false lumen.

OBJECTIVES: Discuss the factors present before admission that influence false lumen thrombosis in patients with TBAD.

METHODS: We studied 282 patients diagnosed with TBAD in our hospital between January 2008 and December 2017. We divided the subjects into a thrombotic group and a non-thrombotic group based on whether any thrombus was detectable in the false lumen. We analyzed the differences between the two groups with respect to clinical data, the vertical length of the dissection, and the diameter of the aorta. P values < 0.05 were considered statistically significantly different.

RESULTS: Significant differences between the thrombotic group and non-thrombotic group were found with respect to age (53.92 ± 11.40 vs. 50.36 ± 10.71, p = 0.009) and proportion of patients with renal insufficiency (7.83% vs. 16.38%, p = 0.026). In zones 3-9, the true lumen diameter of the thrombotic group was significantly larger than in the non-thrombotic group (p < 0.05). Binary logistic regression analysis showed that true lumen diameter in zone 5 and renal insufficiency were independent predictors of false lumen thrombosis.

CONCLUSIONS: Age and renal function were associated with thrombosis in the false lumen. Potentially, the difference between the diameter of the true lumen diameter and that of the false lumen may influence the thrombosis of the false lumen.

PMID:37531471 | DOI:10.36660/abc.20220939

Arq Bras Cardiol. 2023 Jul;120(8):e20220370. doi: 10.36660/abc.20220370.

ABSTRACT

BACKGROUND: Chemotherapeutic agents (e.g., anthracyclines, trastuzumab) commonly used for treating malignant tumors have been demonstrated to have cardiotoxic effects, which is associated with poor prognosis. Three-dimensional echocardiography has been used to predict cancer chemotherapy-induced cardiac dysfunction.

OBJECTIVES: Evaluation of the diagnostic performance of strain parameters, global area strain (GAS), longitudinal strain (GLS), circumferential strain (GCS), and radial strain (GRS) by meta-analysis.

METHODS: Relevant studies were searched from the Embase, PubMed, and Web of Science databases. Statistical analysis was performed using Stata 12. The summary receiver operating characteristic curve, sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and corresponding 95% confidence interval for the four strain parameters were pooled. P<0.05 was considered statistically significant.

RESULTS: Nine studies involving 650 participants were included. GAS and GLS showed significant diagnostic advantages over GCS and GRS. For GAS, the sensitivity was 0.85 (0.70, 0.93) and specificity was 0.82(0.78, 0.86) with PLR of 4.76 (3.55, 6.39) and NLR of 0.18 (0.09, 0.39) and an area under the curve (AUC) of 0.85 (0.82, 0.88). For GLS, the sensitivity was 0.81 (0.74, 0.86) and specificity was 0.81(0.68, 0.90) with PLR of 4.35(2.42, 7.80) and NLR of 0.23 (0.17, 0.33) and an AUC of 0.85 (0.82, 0.88). The GCS showed a sensitivity of 0.63 and a specificity of 0.79 with an AUC of 0.77. The GRS showed a sensitivity of 0.74 and a specificity of 0.66 with an AUC of 0.73.

CONCLUSION: 3D-STI strain parameters GAS and GLS showed good performance in detecting early cardiac dysfunction in patients with tumors receiving chemotherapy.

PMID:37531470 | DOI:10.36660/abc.20220370

Sci Adv. 2023 Aug 2;9(31):eadh9920. doi: 10.1126/sciadv.adh9920. Epub 2023 Aug 2.

ABSTRACT

SARS-CoV-2 vaccines have been distributed at unprecedented speed. Still, little is known about temporal vaccination trends, their association with socioeconomic inequality, and their consequences for disease control. Using data from 161 countries/territories and 58 states, we examined vaccination rates across high and low socioeconomic status (SES), showing that disparities in coverage exist at national and subnational levels. We also identified two distinct vaccination trends: a rapid initial rollout, quickly reaching a plateau, or sigmoidal and slow to begin. Informed by these patterns, we implemented an SES-stratified mechanistic model, finding profound differences in mortality and incidence across these two vaccination types. Timing of initial rollout affects disease outcomes more substantially than final coverage or degree of SES disparity. Unexpectedly, timing is not associated with wealth inequality or GDP per capita. While socioeconomic disparity should be addressed, accelerating initial rollout for all over focusing on increasing coverage is an accessible intervention that could minimize the burden of disease across socioeconomic groups.

PMID:37531439 | DOI:10.1126/sciadv.adh9920

PLoS One. 2023 Aug 2;18(8):e0289148. doi: 10.1371/journal.pone.0289148. eCollection 2023.

ABSTRACT

BACKGROUND: Medication errors represent a significant challenge in healthcare, as they can lead to enduring harm for patients and impose substantial financial burdens on the healthcare system. To effectively mitigate medication errors, it is imperative to gain a comprehensive understanding of their frequency and the contributing variables. Thus, the primary objective of this study was to evaluate the occurrence of medication errors among patients with kidney diseases in Quetta, Pakistan.

METHODS: The objective of this study was to assess medication errors in patients diagnosed with kidney diseases in Quetta, Pakistan. The research was conducted at the Balochistan Institute of Nephro-Urology Quetta (BINUQ) Hospital, which serves as a tertiary care center specializing in the treatment of kidney diseases. A cross-sectional descriptive study design was employed over a period of six months. The study population consisted of patients admitted to the Nephro-urology wards at BINUQ Hospital during the specified duration. Data collection encompassed various methodologies, including checklist-guided observation, review of prescription order forms, documentation of drug administration, and comprehensive analysis of patient medical records. Descriptive and analytical analyses were conducted using SPSS version 23. Univariate analysis was employed to identify independent variables associated with medication errors, employing a significance level of p<0.01. The multivariate logistic regression analysis incorporated variables that exhibited a significant association with medication errors during the univariate analysis. Only those variables demonstrating a p-value of less than 0.05 at a 95% confidence level were considered significant predictors of medication administration errors within the final multivariate model.

RESULTS: Among the 274 medication errors identified in the study, documentation errors accounted for 118 cases (12.06%), administration errors for 97 cases (9.91%), prescribing errors for 34 cases (3.47%), and dispensing errors for 25 cases (2.55%). Statistical analysis revealed significant associations (p<0.05) between forgetfulness and duty shift, and medication errors in the documentation process. Similarly, inattention was significantly associated (p<0.05) with both prescribing and dispensing errors. Furthermore, the number of medications received emerged as the most influential factor associated with medication errors. Patients receiving 4-6 medications exhibited an odds ratio of 9.08 (p<0.001) compared to patients receiving 1-3 medications, while patients receiving more than 6 medications had an odds ratio of 4.23 (p<0.001) in relation to patients receiving 1-3 medications.

CONCLUSION: In conclusion, this study determined that documentation errors were the most prevalent medication errors observed in patients with kidney disease in Quetta, Pakistan. Forgetfulness and duty shift were associated with documentation errors, whereas inattention was linked to prescribing and dispensing errors. The significant risk factor for medication errors was found to be a high number of prescribed medications. Therefore, strategies aimed at reducing medication errors should prioritize enhancements in documentation practices, alleviating medication burden, and increasing awareness among healthcare providers.

PMID:37531387 | DOI:10.1371/journal.pone.0289148

Med Phys. 2023 Aug 2. doi: 10.1002/mp.16660. Online ahead of print.

ABSTRACT

BACKGROUND: Stereotactic radiosurgery (SRS) can be an effective primary or adjuvant treatment option for intracranial tumors. However, it carries risks of various radiation toxicities, which can lead to functional deficits for the patients. Current inverse planning algorithms for SRS provide an efficient way for sparing organs at risk (OARs) by setting maximum radiation dose constraints in the treatment planning process.

PURPOSE: We propose using activation maps from functional MRI (fMRI) to map the eloquent regions of the brain and define functional OARs (fOARs) for Gamma Knife SRS treatment planning.

METHODS: We implemented a pipeline for analyzing patient fMRI data, generating fOARs from the resulting activation maps, and loading them onto the GammaPlan treatment planning software. We used the Lightning inverse planner to generate multiple treatment plans from open MRI data of five subjects, and evaluated the effects of incorporating the proposed fOARs.

RESULTS: The Lightning optimizer designs treatment plans with high conformity to the specified parameters. Setting maximum dose constraints on fOARs successfully limits the radiation dose incident on them, but can have a negative impact on treatment plan quality metrics. By masking out fOAR voxels surrounding the tumor target it is possible to achieve high quality treatment plans while controlling the radiation dose on fOARs.

CONCLUSIONS: The proposed method can effectively reduce the radiation dose incident on the eloquent brain areas during Gamma Knife SRS of brain tumors.

PMID:37531209 | DOI:10.1002/mp.16660

J Med Internet Res. 2023 Aug 2;25:e43299. doi: 10.2196/43299.

ABSTRACT

BACKGROUND: Inconsistencies between a protocol and its umbrella review (UR) may mislead readers about the importance of findings or lead to false-positive results. Furthermore, not documenting and explaining inconsistencies in the UR could reduce its transparency. To our knowledge, no study has examined the methodological consistency of the protocols with their URs and assessed the transparency of the URs when generating evidence.

OBJECTIVE: This study aimed to investigate the inconsistency of protocols with their URs in the methodology and assess the transparency of the URs.

METHODS: We searched medical-related electronic databases from their inception to January 1, 2022. We investigated inconsistencies between protocols and their publications and transparencies in the search strategy, inclusion criteria, methods of screening and data extraction, quality assessment, and statistical analysis.

RESULTS: We included 31 protocols and 35 publications. For the search strategy, 39 inconsistencies between the protocols and their publications were found in 26 of the 35 (74%) URs, and 16 of these inconsistencies were indicated and explained. There were 84 inconsistencies between the protocols and their URs regarding the inclusion criteria in 31 of the 35 (89%) URs, and 29 of the inconsistencies were indicated and explained. Deviations from their protocols were found in 12 of the 32 (38%) URs reporting the methods of screening, 14 of the 30 (47%) URs reporting the methods of data extraction, and 11 of the 32 (34%) URs reporting the methods for quality assessment. Of the 35 URs, 6 (17%) were inconsistent with their protocols in terms of the tools for quality assessment; one-half (3/6, 50%) of them indicated and explained the deviations. As for the statistical analysis, 31 of the 35 (89%) URs generated 61 inconsistencies between the publications and their protocols, and 16 inconsistencies were indicated and explained.

CONCLUSIONS: There was a high prevalence of inconsistencies between protocols and publications of URs, and more than one-half of the inconsistencies were not indicated and explained in the publications. Therefore, how to promote the transparency of URs will be a major part of future work.

PMID:37531172 | DOI:10.2196/43299