Nevin Manimala

J Nurs Care Qual. 2022 Sep 8. doi: 10.1097/NCQ.0000000000000647. Online ahead of print.

ABSTRACT

BACKGROUND: Inconsistent and nonstandardized patient handoffs can increase the risk of adverse events. Using change theory may promote adoption of effective handoff processes.

LOCAL PROBLEM: A Midwest emergency department (ED) had no standardized practice for shift change handoffs. Previous handoff quality improvement efforts had been unsuccessful.

METHODS: A pre/postintervention pilot project design was used. Nurses’ compliance with the new handoff protocol was evaluated.

INTERVENTIONS: Using Diffusion of Innovation (DOI) theory, an evidence-based shift change protocol was designed and implemented, which included a comprehensive handoff tool specific to the ED.

RESULTS: Four elements in the new shift change process saw statistically significant improvements after implementation, including discussion of the patient’s illness severity (P = .001), synthesis of the patient’s care (P < .001), completing a bedside safety checklist (P < .001), and providing a formal transition-of-care process (P < .001).

CONCLUSIONS: Using DOI theory may improve the adoption of new shift change practices.

PMID:36731061 | DOI:10.1097/NCQ.0000000000000647

Int J Gynecol Pathol. 2022 Oct 10. doi: 10.1097/PGP.0000000000000884. Online ahead of print.

ABSTRACT

In this study, we compared the placental T-cadherin staining intensity of pregnant women with placenta percreta (PP) and asymmetrical fetal growth restriction (FGR) compared with healthy control pregnancies. Placental T-cadherin levels of the placenta of 86 pregnant women in total, 25 with FGR, 30 with healthy pregnant subjects, and 31 with PP, were examined using monoclonal anti-T-cadherin (CDH13) antibody for immunohistochemical examination. In immunohistochemistry, H-scores were used for each group to compare the expression of T-cadherin in extravillous trophoblast (EVT) cells. T-cadherin H-score of EVTs was highest in the FGR group and the lowest in the PP group. The difference in H-score between the FGR group and the control group was not statistically significant (P=0.344). The difference between the PP group and the other 2 groups was significant (P<0.0001). Multivariable linear regression analysis with a stepwise elimination method was performed in order to identify demographic and clinical parameters with significant effects on the T-cadherin H-score of EVTs. The estimation results identified only the disease group as a significant predictor of the H-score of EVTs (R2=0.340, P<0.0001). The highest T-cadherin H-score of EVTs was found in the FGR group and the lowest in the PP group. The low T-cadherin H-score values in the PP group suggest that low T-cadherin EVTs may be associated with increased placental invasion. Likewise, despite the statistical insignificance, a higher T-cadherin H-score of EVTs in FGR compared with controls implies a decreased invasiveness of the placenta in FGR.

PMID:36731049 | DOI:10.1097/PGP.0000000000000884

J Craniofac Surg. 2022 Oct 13. doi: 10.1097/SCS.0000000000009076. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this study was to evaluate the accuracy of 3-dimensional (3D) facial scans taken with a low-cost facial scanner compared with cone-beam computed tomography (CBCT).

MATERIALS AND METHODS: Twenty-five patients had their CBCT scan and 3D facial scan taken on the same day. Facial scans were taken with a low-cost facial scanner (Bellus3D, ARC-1 scanner) in an upright position. The facial scans were imported into Invivo5 software and were integrated with the corresponding CBCT scans. Then, 16 soft tissue landmarks were identified on the CBCT scans and the 3D-integrated facial scans. The 6 vertical, 7 horizontal, 10 oblique linear, and 11 angular anthropometric measurements were obtained and compared between the CBCT scans and 3D-integrated facial scans using paired t test and Bland-Altman plots.

RESULTS: The differences between CBCT scans and 3D-integrated facial scans showed no statistical significance except for 2 vertical measurements. Bland-Altman plots showed that all anthropometric measurements were within the limit of agreement. The differences between CBCT scans and 3D-integrated facial scans were <1.5 mm or 1.5 degrees except for 2 vertical measurements.

CONCLUSIONS: Three-dimensional facial scans taken with facial scanner showed a clinical acceptance when compared with CBCT scans.

PMID:36731044 | DOI:10.1097/SCS.0000000000009076

J Clin Rheumatol. 2022 Sep 28. doi: 10.1097/RHU.0000000000001902. Online ahead of print.

ABSTRACT

BACKGROUND/OBJECTIVE: This study aims to evaluate ibandronate clinical effectiveness in the prevention of osteoporosis-related vertebral fractures (VFs) and nonvertebral fractures (NVFs) in the treatment of postmenopausal osteoporosis.

METHODS: This systematic review was conducted in accordance with the Centre for Reviews and Dissemination’s guidance and reporting in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement 2020. A literature search was performed in PubMed and EMBASE since their inception until February 7, 2022. Randomized controlled trials (RCTs), meta-analysis, experimental, and observational studies evaluating adult patients treated with ibandronate and assessed to osteoporotic fractures prevention were included. The risk of bias was assessed according to study design. Data were analyzed using descriptive statistics.

RESULTS: Eight references from 4 RCTs, 7 meta-analyses, and 6 observational studies were included. In RCTs, oral ibandronate was superior to placebo in the prevention of VF. However, the doses were lower than those approved. The meta-analyses confirmed these results and showed that adequate doses of oral ibandronate reduce the risk of NVF compared with insufficient doses. In observational studies, oral ibandronate (in approved doses) reduced the risk of VF compared with no treatment or risedronate or alendronate and the risk of NVF versus risedronate or alendronate; the risk of hip fractures was similar between ibandronate and other oral bisphosphonates.

CONCLUSIONS: There is strong evidence that ibandronate reduces the risk of VF in postmenopausal osteoporosis. The available evidence further suggests that ibandronate may reduce the risk of NVF versus insufficient doses of ibandronate, as well as risedronate or alendronate.

PMID:36731043 | DOI:10.1097/RHU.0000000000001902

J Head Trauma Rehabil. 2022 Oct 14. doi: 10.1097/HTR.0000000000000825. Online ahead of print.

ABSTRACT

OBJECTIVE: To determine whether exposure to traumatic brain injury (TBI) before 10 years of age is associated with development of a mood or anxiety disorder by 25 years of age, and whether sex or injury severity influences this risk.

SETTING: Olmsted County, Minnesota.

PARTICIPANTS: A total of 5518 persons born from January 1, 1976, through December 31, 1982.

DESIGN: Population-based, birth cohort study. Children sustaining TBI before 10 years of age (index date) were confirmed by manual record review and classified by injury severity using the Mayo Classification System. Each TBI case was age- and sex-matched to 2 referents from the same birth cohort without a history of TBI at the index date. Cox proportional hazards models were fit to compare the risk of a subsequent clinically diagnosed mood or anxiety disorder by 25 years of age between TBI cases and referents. Separate analysis was performed stratified by sex and injury severity.

MAIN MEASURES: Incidence of mood and anxiety disorders determined through clinical diagnostic codes and manual record review.

RESULTS: The study included 562 children (238 females [42.3%] and 324 males [57.7%]) with TBI before 10 years of age (mean [SD] age at TBI: 4.7 [2.8] years). At least 1 mood or anxiety disorder was diagnosed for 115 persons with TBI and 215 referents. No statistically significant association existed between childhood TBI status and anxiety disorder (adjusted hazard ratio [aHR], 1.01 [95% confidence interval (CI), 0.71-1.43]; P = .97) or mood disorder (aHR, 1.16 [95% CI, 0.92-1.47]; P = .21). However, females who sustained TBI had a significantly increased risk of a subsequently diagnosed mood disorder compared with age-matched female referents (aHR, 1.40 [95% CI, 1.04-1.89]; P = .03).

CONCLUSIONS: This study suggests that isolated TBI before 10 years of age is not significantly associated with an increased risk of anxiety or mood disorder by 25 years of age, though females may be at an increased risk.

PMID:36731039 | DOI:10.1097/HTR.0000000000000825

J Clin Neurophysiol. 2022 Oct 3. doi: 10.1097/WNP.0000000000000971. Online ahead of print.

ABSTRACT

PURPOSE: To characterize the epilepsy network as reflected in intracranial electroencephalography (iEEG) across the full spectrum of iEEG frequencies and different phases of epilepsy, using a single, conceptually straightforward mathematical measure.

METHODS: The authors applied the spectral Granger causality techniques to intracranial electroencephalography recordings and computed contact-by-contact inward, outward, and total causal flow across frequencies and seizure phases in a selected group of three patients with well-defined, nonlesional seizure foci and prolonged responses to invasive procedures. One seizure and one interictal sample were analyzed per subject.

RESULTS: A prominent intracranial electroencephalography network was identified by Granger causality at both high and low frequencies. This network persists during the preictal and interictal phases of epilepsy and closely matches the visible seizure onset. The causal inflow network corresponded to seizure onset electrode contacts in 8 of 12 conditions, including ripple, infraslow, preictal, and interictal phases of epilepsy. Its most striking feature is the consistent dominance of causal inflow rather than outflow in the vicinity of the seizure onset zone.

CONCLUSIONS: Findings of this study indicate that a stable intracranial electroencephalography epilepsy network persists, and it can be characterized by a single Granger causality measure from infraslow to ripple frequencies and from the interictal to the immediate preictal phases of epilepsy.

PMID:36731034 | DOI:10.1097/WNP.0000000000000971

Comput Inform Nurs. 2022 Oct 14. doi: 10.1097/CIN.0000000000000956. Online ahead of print.

ABSTRACT

The adoption of smartphone-based electronic medical records is increasing in the healthcare sector. Nurses are the largest group using mobile electronic medical records. This study examined the system quality, information quality, service quality, usefulness, and ease of using mobile electronic medical records, the effects of the three qualities of the mobile electronic medical records on the usefulness and ease of use, and nurses’ preference for using mobile electronic medical records. The participants were 210 nurses using a mobile electronic medical record system for over a month. An instrument modified from existing instruments was used. The data were analyzed using descriptive statistics and multiple regression analysis. The participants perceived the system and information quality more positively than the service quality of the mobile electronic medical records. They perceived the mobile electronic medical records as being useful and easy to use. System quality and information quality significantly affected the perception of the usefulness and ease of using the mobile electronic medical record. They preferred to use it as a means to identify patients’ conditions at any time. For user satisfaction and the implications for nursing practice, the usability and functionality of a mobile electronic medical record system should be continuously assessed.

PMID:36731012 | DOI:10.1097/CIN.0000000000000956

Am J Ther. 2022 Oct 18. doi: 10.1097/MJT.0000000000001569. Online ahead of print.

ABSTRACT

BACKGROUND: Direct oral anticoagulants (DOACs) have been associated with less calcification and coronary plaque progression than warfarin. Whether different DOACs have different effects on coronary plaque burden and progression is not known. We compared the 12-month effects of apixaban and rivaroxaban on plaque characteristics and vascular morphology in patients with atrial fibrillation through quantitative cardiac computed tomographic angiography.

STUDY QUESTION: In patients with nonvalvular atrial fibrillation using apixaban or rivaroxaban, are there differences in plaque quantification and progression measured with cardiac computed tomography?

STUDY DESIGN: This is a post hoc analysis of 2 paired prospective, single-centered, randomized, open-label trials with blinded adjudication of results. In total, 74 patients were prospectively randomized in parallel trials: 29 to apixaban (2.5-5 mg BID) and 45 to rivaroxaban (20 mg QD). Serial cardiac computed tomographic angiography was performed at baseline and 52 weeks.

MEASURES AND OUTCOMES: Comprehensive whole-heart analysis was performed for differences in the progression of percent atheroma volume (PAV), calcified plaque (CP) PAV, noncalcified plaque (NCP) PAV, positive arterial remodeling (PR) ≥1.10, and high-risk plaque (Cleerly Labs, New York, NY).

RESULTS: Both groups had progression of all 3 plaque types (apixaban: CP 8.7 mm3, NCP 69.7 mm3, and LD-NCP 27.2 mm3; rivaroxaban: CP 22.9 mm3, NCP 66.3 mm3, and LD-NCP 11.0 mm3) and a total annual plaque PAV change (apixaban: PAV 1.5%, PAV-CP 0.12%, and PAV-NCP 0.92%; rivaroxaban: PAV 2.1%, PAV-CP 0.46%, and PAV-NCP 1.40%). There was significantly lower PAV-CP progression in the apixaban group compared with the rivaroxaban group (0.12% vs. 0.46% P = 0.02). High-risk plaque characteristics showed a significant change in PR of apixaban versus rivaroxaban (P = 0.01). When the propensity score weighting model is applied, only PR changes are statistically significant (P = 0.04).

CONCLUSIONS: In both groups, there is progression of all types of plaque. There was a significant difference between apixaban and rivaroxaban on coronary calcification, with significantly lower calcific plaque progression in the apixaban group, and change in positive remodeling. With weighted modeling, only PR changes are statistically significant between the 2 DOACs.

PMID:36731003 | DOI:10.1097/MJT.0000000000001569

J Clin Gastroenterol. 2022 Oct 20. doi: 10.1097/MCG.0000000000001784. Online ahead of print.

ABSTRACT

BACKGROUND/OBJECTIVE: Patients with metabolic syndrome (MetS) are likely to have nonalcoholic fatty liver disease (NAFLD), which can progress to advanced fibrosis. Early recognition of those at highest risk may ameliorate outcomes. Noninvasive liver fibrosis assessment through validated scoring systems such as the fibrosis-4 (FIB-4) index is helpful to identify these high-risk patients, with the process ideally beginning in the primary care setting. The primary objective of this study was to determine rates of disease recognition and initial management of patients with NAFLD and advanced fibrosis in a diverse primary care setting. The secondary objective was to define demographic and clinical predictors of NAFLD identification and management in this population.

METHODS: Medical charts from patients seen at three university-based primary care practices in New York City from January 2016 to December 2019 were reviewed. Inclusion criteria consisted of: age 18 years and above, persistent alanine transaminase (ALT) elevation (2 values ≥40 IU/mL ≥6 mo apart), and body mass index ≥30 kg/m2. Patients with viral hepatitis or alcohol misuse were excluded. Patients were defined as likely having NAFLD if they met 2 of the following criteria indicating MetS: systolic blood pressure >135 mm Hg or diastolic blood pressure >85 mm Hg or active treatment for hypertension; high-density lipoprotein <40 g/dL; triglycerides >150 mg/dL or active treatment for hyperlipidemia; or hemoglobin A1c ≥5.7% or active treatment for insulin resistance. The primary study endpoints were the frequency of providers’ recognition of NAFLD and referral to specialist and/or for imaging based on visit diagnosis codes or chart documentation. The secondary endpoints were frequency of detecting those with NAFLD and advanced fibrosis utilizing previously defined FIB-4 index cutoffs as well as predictors of disease recognition and management. Analysis was completed using descriptive statistics and logistical regression modeling.

RESULTS: A total of 295 patients were identified as having persistently elevated ALT, a body mass index ≥30 kg/m2, and MetS consistent with likely NAFLD diagnosis. In patients meeting these criteria, ALT elevation was documented by primary care providers in 129 patients (43.7%), NAFLD was noted in chart documentation in 76 patients (25.8%), and a NAFLD ICD-10 diagnosis was assigned to 7 patients (2.4%). 50 patients (16.9%) were referred for ultrasound. Among 51 patients (17.2%) at high risk for advanced fibrosis based on FIB-4 >3.25, 23 patients (45.1%) had NAFLD recognized by their provider and 3 (5.9%) were referred to a specialist. On logistic regression, female gender, dyslipidemia, and private insurance were predictors of disease identification by the primary care physician.

CONCLUSION: ALT elevation and NAFLD are under recognized among patients with MetS in the primary care setting. Importantly, while 17.2% of patients with likely NAFLD in our cohort were high risk for advanced fibrosis, less than half of this group had a NAFLD diagnosis recognized by their primary care provider and only three were referred to a liver specialist. Further investigation of disease recognition and management algorithms in the primary care setting are necessary to enhance NAFLD detection, implement clinical care pathways, and reduce disease progression and complications.

PMID:36731002 | DOI:10.1097/MCG.0000000000001784

Chin Med J (Engl). 2022 Oct 20. doi: 10.1097/CM9.0000000000002099. Online ahead of print.

ABSTRACT

BACKGROUND: Patellofemoral joint (PFJ) degeneration has traditionally been regarded as a contraindication to unicompartmental knee arthroplasty (UKA). More recently, some researchers have proposed that PFJ degeneration can be ignored in medial UKA, and others have proposed that this change should be reviewed in PFJ degenerative facets and severity. This study aimed to systematically evaluate the effect of PFJ degeneration on patient-reported outcome measures (PROMs) and revision rates after medial UKA.

METHODS: Electronic databases (PubMed, Embase, Web of Science, etc.) were searched for studies assessing the influence of PFJ degeneration on medial UKA. A random-effects meta-analysis was conducted for the Oxford knee score (OKS), Knee society score (KSS), and revision rates and stratified by PFJ degenerative facets (medial/lateral/trochlear/unspecified), severe PFJ degeneration (bone exposed), and bearing type (mobile/fixed). Heterogeneity was assessed by the Cochran Q test statistic and chi-squared tests with the I-squared statistic.

RESULTS: A total of 34 articles with 7007 knees (2267 with PFJ degeneration) were included (5762 mobile-bearing and 1145 fixed-bearing) and 100 unspecified. Slight to moderate degenerative changes in the medial and trochlear facets did not decrease the OKS and KSS, and only lateral facets significantly decreased the OKS (mean difference [MD] = -2.18, P < 0.01) and KSS (MD = -2.61, P < 0.01). The severity degree of PFJ degeneration had no additional adverse effect on the OKS, KSS, or revision rates. For mobile-bearing UKA, only lateral PFJ degeneration significantly decreased the OKS (MD = -2.21, P < 0.01) and KSS (MD = -2.44, P < 0.01). For fixed-bearing UKA, no correlation was found between PROMs/revision rates and PFJ degeneration.

CONCLUSION: For medial mobile-bearing UKA, slight to moderate degenerative changes in the PFJ, except lateral facet, did not compromise PROMs or revision rates. For medial fixed-bearing UKA, although it might not be conclusive enough, PROMs or revision rates were not adversely affected by PFJ degeneration (regardless of the facet).

PMID:36730986 | DOI:10.1097/CM9.0000000000002099