Nevin Manimala

Comput Inform Nurs. 2023 Feb 4. doi: 10.1097/CIN.0000000000000991. Online ahead of print.

ABSTRACT

This study evaluated the effectiveness of the Transitional Care Model Stroke Turkey for stroke patients and caregivers as regards the competence of caregivers and patient outcomes. It is a parallel-group, assessor-blinded monocenter conducted with 126 participants in total (66 intervention included 33 stroke patients and 33 caregivers; 60 control groups included 30 stroke patients and 30 caregivers), between March and August 2018. The Transitional Care Model Stroke Turkey program lasts for 13 to 20 weeks. It includes a 12-week follow-up after discharge, a minimum of three hospital visits, one home visit, minimum 18 phone calls, and Web-based training. The intervention group exhibited better caregiver competence (13.48 ± 2.31), preparation for care (28.48 ± 4.74), and e-health literacy (34.42 ± 4.74) than the control group (respectively, 11.37 ± 2.48, 20.93 ± 7.10, 26.93 ± 8.53) (P < .001). Emotional exhaustion and depersonalization increased in the control group, but remained the same in the intervention group. Personal accomplishment decreased in the intervention group, unlike in the control group. Within 12 weeks of discharge, five patients from the intervention group and seven patients from the control group were rehospitalized. There was no statistical difference between stroke patients in either group in terms of having previously used home healthcare services. The Transitional Care Model Stroke Turkey is a practical model for stroke patients transitioning from hospital to home.

PMID:36749850 | DOI:10.1097/CIN.0000000000000991

Comput Inform Nurs. 2023 Feb 4. doi: 10.1097/CIN.0000000000001009. Online ahead of print.

ABSTRACT

The purpose of this study was to determine the effectiveness of a culturally responsive interactive gaming mHealth educational application designed to improve diabetes health literacy among an underserved urban population in India when compared with a traditional approach of verbal education. In addition, relationships between participant sociodemographic variables and participant knowledge were assessed. A randomized controlled trial was conducted using a two-arm parallel, single-blinded intervention and control group design. The parallel groups were the mHealth Education group serving as the intervention group and the Verbal Education group serving as the control group. The mHealth application was as effective in improving diabetes health literacy as verbal education. Results for the difference in posttest and pretest score between the two groups indicated there was no statistically significant difference between groups (P = .9306). However, there was a significant improvement in the difference in posttest and pretest scores for each group (P < .0001), indicating that the culturally responsive type 2 diabetes educational content was effective in improving type 2 diabetes health literacy among both groups. This study answers a call by the World Health Organization that advocates for evidence-based mHealth interventions that offer unique opportunities for cost-effective informatics service delivery in low- and middle-income countries.

PMID:36749847 | DOI:10.1097/CIN.0000000000001009

Am J Speech Lang Pathol. 2023 Feb 7:1-11. doi: 10.1044/2022_AJSLP-22-00257. Online ahead of print.

ABSTRACT

PURPOSE: Spinal pathology is very common with advancing age and can cause dysphagia; however, it is unclear how frequently these pathologies affect swallowing function. This study evaluates how cervical spinal pathology may impact swallowing function in dysphagic individuals observed during videofluoroscopic swallowing studies (VFSSs).

METHOD: A retrospective case-control study was performed on 100 individuals with dysphagia as well as age-/gender-matched healthy controls (HCs) with available VFSS. Spinal anatomy of patients was classified into two predetermined categories, and a consensus decision of whether spinal pathology influenced swallowing physiology was made. Validated swallow metrics, including Modified Barium Swallow Impairment Profile (MBSImP) component scores, Penetration-Aspiration Scale (PAS) maximum scores, and 10-item Eating Assessment Tool (EAT-10) scores, were compared between the spine-associated dysphagia (SAD), non-SAD (NSAD), and HC groups using Kruskal-Wallis one-way analysis of variance.

RESULTS: Most patients with dysphagia had spinal pathology. Spinal pathology was judged to be the primary etiology of dysphagia in 16.9% of patients with abnormal spine pathology. Median EAT-10 scores were statistically different among the three groups, with the NSAD group scoring the highest and the HC group scoring the lowest. Similarly, median PAS scores were significantly different between dysphagic groups and HCs. Median MBSImP Oral Total scores were significantly different only between the NSAD group and HCs, whereas Pharyngeal Total score was not significantly different among the groups.

CONCLUSIONS: Spinal pathology is commonly observed during VFSS and can contribute to dysphagia, resulting in worse swallowing-related outcomes when compared with HCs. Patients judged to have SAD tended to have better outcomes than patients with dysphagia from other etiologies, perhaps due to the progressive nature of spinal disease that allows for compensatory swallowing physiology over time.

PMID:36749843 | DOI:10.1044/2022_AJSLP-22-00257

Comput Inform Nurs. 2023 Feb 6. doi: 10.1097/CIN.0000000000001010. Online ahead of print.

ABSTRACT

Virtual reality simulation offers students the opportunity to acquire clinical and psychomotor skills in a safe and interactive environment. This study describes the usability of virtual reality simulation among undergraduate nursing and midwifery students. Participants were recruited using convenience and snowball sampling and engaged in a 20-minute virtual reality simulation scenario of their choice. They then completed a 21-item survey comprising a sociodemographic questionnaire, the System Usability Scale, a satisfaction questionnaire, and open-ended questions. Quantitative data were analyzed using descriptive statistics, and qualitative data were analyzed using deductive content analysis. Forty-three students participated in this study. The mean (SD) System Usability Scale score was 75.87 (13.7), indicating that virtual reality simulation was acceptable. Almost all participants were either “extremely satisfied” or “somewhat satisfied” with virtual reality simulation, which was perceived as informative and enjoyable, fostering safe and self-directed learning without causing patient harm. Participants recommended using virtual reality simulation to practice clinical skills, prepare for clinical placements, and learn about rare clinical situations. Virtual reality simulation needs to be underpinned by a strong pedagogy and aligned with learning outcomes. Educators and students should be trained in virtual reality simulation prior to its integration into the curriculum.

PMID:36749836 | DOI:10.1097/CIN.0000000000001010

JBRA Assist Reprod. 2023 Feb 7. doi: 10.5935/1518-0557.20220049. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this study was to evaluate the response to weight loss guidance in the anthropometric parameters of obesity and overweight infertile patients assisted fertilization treatment (high and low complexity).

METHODS: Retrospective cohort study. This survey was conducted in a population of overweight and obese infertile patients. In the first consultation at the assisted reproduction clinic (Human Reproduction Laboratory HC / UFG), obese and overweight patients were weighed, measured and instructed to lose weight and informed that being overweight could reduce the chances of success in the treatment.

RESULTS: We analyzed 56 overweight and obese patients admitted for infertility treatment at the Human Reproduction Center HC/UFG. The mean age of overweight and obese patients was 35.78 years, SD 3.70. After the orientation, only 8.92% of patients would achieve the normality rating for BMI, overweight 39.28% (decreased 14.29%), obesity I 37.5%, obesity II 10.71% and obesity III 3.57% (all degrees of obesity increased 1.79%). The mean weight of patients before and after guidance was statistically significant (p<0.0046). The mean values of BMI before and after guidance were also statistically significant (p<0.0038).

CONCLUSIONS: Weight loss guidance in this population had no effect on weight loss. On the contrary, the mean weight of patients after guidance was statistically higher than the mean in the first consultation (both weight and BMI). It is suggested that for obese and overweight infertile patients, in addition to guidance for reduction, an appointment with a nutritionist and/or endocrinologist should be immediately scheduled.

PMID:36749806 | DOI:10.5935/1518-0557.20220049

JBRA Assist Reprod. 2023 Feb 7. doi: 10.5935/1518-0557.20220078. Online ahead of print.

ABSTRACT

OBJECTIVE: The use of frozen embryos in the treatment of infertility with assisted reproductive techniques has been increased. Different methods are used to prepare the endometrium for frozen embryo transfer (FET). The aim of this study was to compare pregnancy outcomes after treatment with tamoxifen and hormonal replacement therapy (HRT) in FET.

METHODS: This randomized clinical trial was carried out with 214 infertile women in the infertility research center of Milad Hospital in Mashhad during 2018-2020. We had 84 patients receiving tamoxifen and 92 took HRT. Endometrial thickness (ET) and pregnancy outcome were measured in both groups.

RESULTS: Mean infertility duration (p=0.328), number of embryos (p=0.649), FSH (p=0.390), LH (p=0.051) and LH/FSH ratio (p=0.287) as well as type of infertility (primary or secondary) (p=0.295), causes of infertility (p=0.750) and pattern of menstruation (p=0.676) were not significantly different in the two groups. Mean ET in the TMX and HRT groups were 8.72±1.45mm and 9.00±1.69mm, respectively (p=0.423). There was no statistically significant difference between chemical pregnancy (p=0.663), clinical pregnancy (p=0.994) and ongoing pregnancy (p≥0.999) in the TMX and HRT groups.

CONCLUSIONS: Treatment with tamoxifen can be as effective as GnRH agonist for endometrial preparation in FET.

PMID:36749805 | DOI:10.5935/1518-0557.20220078

PLoS Comput Biol. 2023 Feb 7;19(2):e1010852. doi: 10.1371/journal.pcbi.1010852. eCollection 2023 Feb.

ABSTRACT

The spread of seizures across brain networks is the main impairing factor, often leading to loss-of-consciousness, in people with epilepsy. Despite advances in recording and modeling brain activity, uncovering the nature of seizure spreading dynamics remains an important challenge to understanding and treating pharmacologically resistant epilepsy. To address this challenge, we introduce a new probabilistic model that captures the spreading dynamics in patient-specific complex networks. Network connectivity and interaction time delays between brain areas were estimated from white-matter tractography. The model’s computational tractability allows it to play an important complementary role to more detailed models of seizure dynamics. We illustrate model fitting and predictive performance in the context of patient-specific Epileptor networks. We derive the phase diagram of spread size (order parameter) as a function of brain excitability and global connectivity strength, for different patient-specific networks. Phase diagrams allow the prediction of whether a seizure will spread depending on excitability and connectivity strength. In addition, model simulations predict the temporal order of seizure spread across network nodes. Furthermore, we show that the order parameter can exhibit both discontinuous and continuous (critical) phase transitions as neural excitability and connectivity strength are varied. Existence of a critical point, where response functions and fluctuations in spread size show power-law divergence with respect to control parameters, is supported by mean-field approximations and finite-size scaling analyses. Notably, the critical point separates two distinct regimes of spreading dynamics characterized by unimodal and bimodal spread-size distributions. Our study sheds new light on the nature of phase transitions and fluctuations in seizure spreading dynamics. We expect it to play an important role in the development of closed-loop stimulation approaches for preventing seizure spread in pharmacologically resistant epilepsy. Our findings may also be of interest to related models of spreading dynamics in epidemiology, biology, finance, and statistical physics.

PMID:36749796 | DOI:10.1371/journal.pcbi.1010852

JMIR Form Res. 2023 Feb 7;7:e44144. doi: 10.2196/44144.

ABSTRACT

BACKGROUND: Upper extremity (UE) vascularized composite allotransplantation (VCA; hand transplantation) is a reconstructive treatment option for patients with UE loss. Approximately 37 UE VCAs have been performed in the United States to date; thus, little is known about long-term psychosocial outcomes and whether the benefits outweigh the risks. To make an informed treatment decision, patients must understand the procedure, risks, and potential benefits of UE VCA. However, few educational resources are publicly available providing unbiased, comprehensive information about UE VCA.

OBJECTIVE: This paper described the development of a neutral, and accessible, educational website supporting informed decision-making about UE VCA as a treatment option for individuals with UE amputations.

METHODS: Website content development was informed by 9 focus groups conducted with individuals with UE amputations at 3 study sites. After initial website development, we conducted usability testing to identify ways to improve navigability, design, content, comprehension, and cultural sensitivity. Participants were administered the After-Scenario Questionnaire to assess user performance after completing navigational tasks, System Usability Scale to measure the perceived usability of the website, and Net Promoter Score to measure user satisfaction. Quantitative data were analyzed using descriptive statistics. Qualitative data were analyzed using rapid thematic analysis.

RESULTS: A total of 44 individuals with UE amputations participated in focus groups (n=37, 84%) and usability testing (n=14, 32%). Most participants in the focus groups and usability testing were male (24/37, 65% and 11/14, 79%, respectively) and White (27/37, 73% and 9/14, 64%, respectively), had unilateral limb loss (22/37, 59% and 12/14, 86%, respectively), and had mean ages of 48 (SD 9.2) and 50 (SD 12.0) years, respectively. Focus group results are organized into accessibility, website design, website development, website tone and values, sitemap, terminology, images and videos, and tables and graphics. Usability testing revealed that participants had a positive impression of the website. The mean After-Scenario Questionnaire score of 1.3 to 2.3 across task scenarios indicated high satisfaction with website usability, the mean System Usability Scale score of 88.9 indicated user satisfaction with website usability, and the mean Net Promoter Score of 9.6 indicated that users were enthusiastic and would likely refer individuals to the website.

CONCLUSIONS: The findings suggest that our educational website, Within Reach, provides neutral, patient-centered information and may be a useful resource about UE VCA for individuals with UE amputations, their families, and health care professionals. Health care professionals may inform UE VCA candidates about Within Reach to supplement current VCA education processes. Within Reach serves as a resource about treatment options for patients preparing for scheduled or recovering from traumatic UE amputations. Future research should assess whether Within Reach improves knowledge about UE VCA and enhances informed decision-making about UE VCA as a treatment option.

PMID:36749618 | DOI:10.2196/44144

Hum Vaccin Immunother. 2023 Feb 7:2173914. doi: 10.1080/21645515.2023.2173914. Online ahead of print.

ABSTRACT

Community-wide vaccine uptake remains sub-optimal. Healthcare provider (HCP) vaccine recommendations influence patient vaccination; however, provider vaccine recommendation behavior is highly influenced by one’s own vaccine attitudes and/or knowledge. We aim to describe vaccine knowledge, attitudes, and recommendation practices (KAP) among New York State HCPs. A survey to assess HCP KAP was developed and electronically distributed to NYS members of national medical organizations via their local chapter administrators. Descriptive statistical methods were used to define provider KAP. A total of 864 surveys were included, 500 (60%) and 336 (40%) primary and specialty care providers, respectively. Eighty-one percent (402/499) of primary care providers (PCPs) report encountering vaccine hesitant patients daily or weekly. Of the 500 PCPs who responded, only 204 (41%) stated strong agreement with confidence in their communications with vaccine hesitant patients. HCPs who correctly answered all four knowledge questions were more likely to self-report routine recommendations of standard vaccines to all patients when compared to those who correctly answered fewer questions (489/588 (83%) vs 135/241 (56%), p < .05). HCPs were more likely to routinely recommend standard vaccines to all patients if they also report initiating vaccine discussion (476/485 (98%) vs 148/344 (43%), p < .05) and reviewing and recommending vaccinations at each encounter (315/320 (98%) vs 308/508 (61%), p < .05). Vaccine hesitancy exists across healthcare specialties and provider roles. Focused interventions should include reaching all HCPs to promote vaccinations for disease prevention, tailoring messages to reduce HCP vaccine misperceptions, and increasing awareness of evidence-based office strategies known to facilitate immunizations.

PMID:36749617 | DOI:10.1080/21645515.2023.2173914

Ig Sanita Pubbl. 2023 Jan-Feb;80(1):13-26.

ABSTRACT

BACKGROUND: COVID-19 has hit every country in the world. Almost a quarter of a billion cases and nearly 5 million deaths reported globally as of late September 2021. Compared to over 6 billion doses of COVID-19 vaccine administered, the pandemic does not seem to disappear. The duration of protective immunity is currently not defined. Primary immune responses are inevitably declining and the continuous transmission of increasingly worrying viral variants.

OBJECTIVE: The primary objective of the study is to evaluate the antibody response at 120 and 180 days in employees of an hospital of Marche (Italy) who have completed the vaccination cycle with Pzifer-Biontech vaccine and to highlight the correlation with quantitative and qualitative variables. The secondary objective is to study the nature and frequency of adverse events in relation to variables such as comorbidity, age, gender, working areas and developed antibody titer.

MATERIALS AND METHODS: An observational retrospective study was carried out to evaluate the antibody response at 120 and 180 days. Subjects receiving a double dose of vaccine at least 21 days apart and those receiving the second dose of the same vaccine between 18 January 2021 and 31 March 2021 shall be considered. The study included non-probability sampling of convenience. All parties have provided informed written consent to access personal and clinical data.

RESULTS: The sample is composed by 1.115 subjects. The results of the study reveal an important immune response detected by IgG dosage, both at 120 and 180 days after the second dose of Sars-Cov-2 vaccine mRNA BNT162b2 vaccine (Pzifer-Biontech), other than very rare exceptions. Antibody values are higher among hospital workers compared to those working in other areas, both 120 and 180 days. These values are even higher in the health professionals who provide assistance in wards with positive Covid patients, both at 120 days (p=0.06) and at 180 days; the mean values of IgG are statistically higher in direct assistance of Covid patients at 180 days(p=0.029). The most frequent adverse drug events after the second dose of vaccine were pain at the site of inoculation of the vaccine (70.7%), fatigue (35%) and arthralgia (19%). It was finally shown that people with diabetes or smokers had an average antibody response statistically lower than 120 days and 180 days from the second dose.

DISCUSSION AND CONCLUSION: This study leads to the conclusion that the second dose of vaccine Sars-Cov-2 vaccine mRNA BNT162b2 vaccine allows a consistent antibody response. Further multicentric studies are needed to investigate the antibody response to vaccination Sars-Cov-2 mRNA BNT162b2.

PMID:36749593