Nevin Manimala

Amino Acids. 2023 Jan 25. doi: 10.1007/s00726-023-03236-x. Online ahead of print.

ABSTRACT

We developed a hollow fiber centrifugal ultrafiltration (HFCF-UF) method to study the change of plasma levels of free glycine (Gly) in patients with acute ischemic stroke (AIS). Twenty-four patients with AIS confirmed by diffusion-weighted imaging (DWI) were enrolled. During the study period, the patients did not receive any supplemental amino acids therapy that could affect the obtained results. Our results showed that although AIS patients adopted different methods of treatment (thrombolytic and non-thrombolytic), the clinical NIHSS score of AIS showed a downward trend whereas Gly concentration showed increased trend. Moreover, plasma free Gly concentration was positively correlated with ASPECTS score. The correlation between Gly levels and infarct volume showed a statistical significance. That is to say, higher Gly level predicted smaller infarct size. Thus, the change of free Gly level in plasma could be considered as a potential biomarker of AIS.

PMID:36697969 | DOI:10.1007/s00726-023-03236-x

Ann Fam Med. 2022 Apr 1;(20 Suppl 1). doi: 10.1370/afm.20.s1.3098.

ABSTRACT

Context: In the midst of the COVID-19 pandemic- with undulating statistics of new cases and deaths and with schools set to reopen in the fall of 2020 after a long hiatus- the objective was to address the needs and methods of preparing children for a safe return to school. Objective: To educate 1st – 5th grade elementary school children about proper health and safety precautions during the COVID-19 pandemic. Study Design and Setting: Three monthly virtual sessions via zoom were implemented with focuses on hygiene, physical activity, and healthy coping mechanisms during a pandemic. The hygiene lecture included interactive demonstrations on handwashing, coughing/sneezing precautions, and appropriate mask-wearing behavior. During the coping mechanisms session, children were asked to use art or free text to answer the question “How has COVID-19 changed my feelings?” The physical activity session discussed safe ways for children to stay active during the pandemic. Both quantitative (pre and post-knowledge assessment quizzes) and qualitative (free text, drawings) data were collected through electronic surveys. Quizzes were designed for the appropriate grade level and used a combination of multiple choice, free text, checkboxes, and pictures to address common themes. Population studied and Intervention: School-aged children (1st-5th grade) at the Raindrop Foundation of San Antonio participated in educational sessions about maintaining proper COVID-19 hygiene. Outcome Measures and Results: Final results show six 1st – 2nd graders and nine 3rd – 5th graders consistently participated in the project. The children involved could identify proper mask-wearing etiquette, safe coughing habits, and when and how to wash their hands. Emotions reported were both positive (ex. happy) and negative (ex. Sad, bored). Reported activities were indoor electronic games and work. Children reported missing friends and going to parks. Conclusions: These educational sessions were organized to teach children safe practices for their return to school, develop coping skills, and also help them adapt to physical activity while maintaining social distancing. Participant 1st – 5th graders answered most questions correctly and displayed the basics of COVID-19 safety knowledge. The children surveyed are experiencing mixed emotions during the pandemic due to feelings of social isolation.

PMID:36696676 | DOI:10.1370/afm.20.s1.3098

J Healthc Qual. 2023 Jan 25. doi: 10.1097/JHQ.0000000000000378. Online ahead of print.

ABSTRACT

The National Quality Forum (NQF) evaluates healthcare performance measures for endorsement based on a broad set of criteria. We extracted data from NQF technical reports released between spring 2018 and spring 2019. Measures were commonly stewarded by federal agencies (44.29%), evaluated for maintenance (67.14%), classified as outcome (42.14%) or process (39.29%) measures, and used a statistical model for risk adjustment (48.57%). For 80% of the measures reviewed, a patient advocate was present on the reviewing committee. Validity was evaluated using face validity (65.00%) or score-level empirical validity (67.14%), and reliability was frequently evaluated using score-level testing (71.43%). Although 91.56% of all reviewed measures were endorsed, most standing committee members voted moderate rather than high support on key assessment criteria like measure validity, measure reliability, feasibility of use, and whether the measure addresses a key performance gap. Results show that although the Consensus Development Process includes multidisciplinary stakeholder input and thorough evaluations of measures, continued work to identify and describe appropriate and robust methods for reliability and validity testing is needed. Further work is needed to study the extent to which stakeholder input is truly representative of diverse viewpoints and improve processes for considering social factors when risk adjusting.

PMID:36696671 | DOI:10.1097/JHQ.0000000000000378

Menopause. 2023 Feb 1;30(2):218-224. doi: 10.1097/GME.0000000000002107. Epub 2022 Nov 7.

ABSTRACT

IMPORTANCE AND OBJECTIVE: Hot flashes (HFs) are a prevalent feature of menopause. Hot flashes can be bothersome and affect quality of life. However, HFs have also been associated with the risk for cardiovascular disease. Therefore, providing current evidence on the effect of therapies to reduce HFs can help patients and providers with decision making. This review provides details on the scientific evidence to date related to the effect of physical activity (PA) and exercise to alter the HF experience in women.

METHODS: The PubMed database was searched between June 2020 and June 2022 for currently available evidence regarding the relation between PA and exercise and HFs. Our analysis included randomized control trials on exercise training, epidemiological studies, and studies evaluating acute exercise on the self-reported and objectively measured HF experience in addition to systematic reviews on the topic published as of June 2022.

DISCUSSION AND CONCLUSIONS: The majority of evidence from randomized control trials indicates that aerobic and resistance exercise training lead to a decrease in subjectively experienced HFs. The limited available studies on acute exercise indicate that a bout of moderate-intensity exercise may decrease objectively measured and self-reported HFs but acute increases in PA intensity above accustomed levels may influence subjective HF experience. Some evidence suggests that for those with depression, habitual PA may be an effective way to reduce HF symptoms. Weighing the available evidence, for people who experience HFs, engaging in regular moderate-intensity PA, including aerobic and resistance exercise, may be an effective therapy to reduce HFs and women should be counseled on the benefits of regular, moderate exercise. However, significant gaps in knowledge remain about the optimal exercise prescription, effectiveness for a diverse population, meaning of differences between objective and subjective experience, and mechanisms that lead to changes in HFs.

PMID:36696647 | DOI:10.1097/GME.0000000000002107

Menopause. 2023 Feb 1;30(2):128-135. doi: 10.1097/GME.0000000000002096. Epub 2022 Nov 20.

ABSTRACT

OBJECTIVE: To document health care providers’ views regarding treatments for symptoms associated with menopause and discussions with patients about symptoms and treatment decisions. Results informed development of a data collection form for a retrospective medical record review (reported separately).

METHODS: Registered US gynecologists or primary care providers from all US regions were identified from local association directories and an in-house database and were invited to participate in a qualitative interview if they consulted with three or more patients per week presenting with menopausal symptoms. Participants provided demographic data, information about patients’ symptoms, and health care provider and patient views on prescription and nonprescription therapies. Key concepts/themes from interviews were identified.

RESULTS: Participating health care providers (10 gynecologists, 10 primary care providers) agreed there are effective treatment options for menopausal symptoms, particularly vasomotor symptoms and vaginal dryness and/or atrophy. Health care providers reported that treatment was generally dictated by symptoms that interfered with quality of life and/or daily activities, although patients often had symptoms for months before presentation. All health care providers said they prescribe hormone and/or nonhormone therapies for treatment of menopausal symptoms; half stated that they typically inquire about patients’ nonprescription therapy use, and 45% recommend specific nonprescription therapies. The most commonly cited barriers to initiation of any therapy for menopausal symptoms were patient concerns about risks and financial considerations (ie, insurance or cost).

CONCLUSIONS: US health care providers reported prescribing therapies for menopausal symptoms and noted that these therapies were perceived as generally effective; however, barriers to initiation of prescription therapy exist, and new treatment options are needed.

PMID:36696636 | DOI:10.1097/GME.0000000000002096

Am J Public Health. 2023 Jan;113(S1):S21-S28. doi: 10.2105/AJPH.2022.307079.

ABSTRACT

Objectives. To measure neighborhood exposure to proactive policing as a manifestation of structural racism and its association with preterm birth. Methods. We linked all birth records in New Orleans, Louisiana (n = 9102), with annual census tract rates of proactive police stops using data from the New Orleans Police Department (2018-2019). We fit multilevel Poisson models predicting preterm birth across quintiles of stop rates, controlling for several individual- and tract-level covariates. Results. Nearly 20% of Black versus 8% of White birthing people lived in neighborhoods with the highest rates of proactive police stops. Fully adjusted models among Black birthing people suggest the prevalence of preterm birth in the neighborhoods with the highest proactive policing rates was 1.41 times that of neighborhoods with the lowest rates (95% confidence interval = 1.04, 1.93), but associations among White birthing people were not statistically significant. Conclusions. Taken together with previous research, high rates of proactive policing likely contribute to Black‒White inequities in reproductive health. Public Health Implications. Proactive policing is widely implemented to deter violence, but alternative strategies without police should be considered to prevent potential adverse health consequences. (Am J Public Health. 2023;113(S1):S21-S28. https://doi.org/10.2105/AJPH.2022.307079).

PMID:36696607 | DOI:10.2105/AJPH.2022.307079

Retina. 2023 Jan 23. doi: 10.1097/IAE.0000000000003749. Online ahead of print.

ABSTRACT

PURPOSE: We examined the effect of ranibizumab with or without laser photocoagulation on retinal sensitivity in eyes with branch retinal vein occlusion (BRVO).

METHODS: Prospective randomized control study. Thirty patients with BRVO received intravitreal injection of ranibizumab in a monthly pro re nata regimen. Fifteen patients received ranibizumab monotherapy alone (monotherapy group). The remaining 15 patients received rescue laser therapy at 3 or 9 months (combined group). The retinal sensitivity was measured at 32 points within central 8 degrees, and the average of the main occlusion side among the 16 upper or 16 lower points was defined as the affected area sensitivity.

RESULTS: In comparing the monotherapy group and the combined group, the number of injections during the 12 months was 5.4 vs. 4.9, the change in retinal thickness (µm) was -254 vs. -197, the ETDRS letters of improvement was +18.3 vs. +19.6, and the change in the affected area sensitivity (dB) was +7.1 vs. +4.6. At 12 months, all these results were significantly improved compared to their respective baselines, but none of the differences between the two groups reached statistical significance.

CONCLUSION: Retinal sensitivity at 12 months improved in both the monotherapy group and the combined group. The additional laser did not reduce the number of injections or further improve visual acuity, nor did it affect retinal sensitivity.

PMID:36696603 | DOI:10.1097/IAE.0000000000003749

J Am Acad Orthop Surg. 2023 Jan 24. doi: 10.5435/JAAOS-D-22-00752. Online ahead of print.

ABSTRACT

INTRODUCTION: As rates of anatomic and reverse total shoulder arthroplasty (SA) continue to grow, an increase in the number of osteoporotic patients undergoing SA, including those who have sustained prior fragility fractures, is expected. The purpose of this study was to examine short-term, implant-related complication rates and secondary fragility fractures after SA in patients with and without a history of fragility fractures.

METHODS: A propensity score-matched retrospective cohort study was done using the PearlDiver database to characterize the effect of antecedent fragility fractures in short-term complications after SA. Rates of revision SA, periprosthetic fractures, infection, and postoperative fragility fractures were evaluated using multivariate logistic regression analysis. Risks of these complications were also studied in patients with and without preoperative osteoporosis treatment. Statistical significance was set at P < 0.05.

RESULTS: A total of 91,212 SA patients were identified, with 13,050 (14.3%) experiencing a fragility fracture within the 3 years before SA. Two years after SA, there were increased odds of periprosthetic fracture (odds ratio [OR] 2.24, 95% confidence interval [CI] 1.68 to 2.99), fragility fracture (OR 9.11, 95% CI 8.43 to 9.85), deep infection (OR 1.68, 95% CI 1.34 to 2.12), and all-cause revision SA (OR 1.68, 95% CI 1.44 to 1.96) within those patients who had experienced a fragility fracture within 3 years before their SA. Patients who were treated for osteoporosis with bisphosphonates and/or vitamin D supplementation before their SA had similar rates of postoperative periprosthetic fractures, fragility fractures, and all-cause revision SA to those who did not receive pharmacologic treatment.

CONCLUSION: Sustaining a fragility fracture before SA portends substantial postoperative risk of periprosthetic fractures, infection, subsequent fragility fractures, and all-cause revision SA at the 2-year postoperative period. Pharmacotherapy did not markedly decrease the rate of these complications. These results are important for surgeons counseling patients who have experienced prior fragility fractures on the risks of SA.

PMID:36696566 | DOI:10.5435/JAAOS-D-22-00752

Cancer Nurs. 2023 Jan 26. doi: 10.1097/NCC.0000000000001205. Online ahead of print.

ABSTRACT

BACKGROUND: Dysphagia is a leading cause of aspiration pneumonia and negatively affects tolerance of chemoradiotherapy in patients with esophageal cancer.

OBJECTIVE: This study aimed to assess a protocol for preventing the occurrence of aspiration pneumonia for adult patients with esophageal cancer experiencing swallowing dysfunction.

METHODS: This study tested a dysphagia intervention that included high-risk patients confirmed by the Eating Assessment Tool questionnaire and Water Swallowing Test. A protocol guide (Interventions for Esophageal Dysphagia [IED]) to prevent aspiration pneumonia during chemoradiotherapy was also implemented. Thirty participants were randomly assigned to an intervention or control group. The study period was 50 days; participants were visited every 7 days for a total of 7 times. Instruments for data collection included The Eating Assessment Tool, Water Swallowing Test, and personal information. The IED was administered only to the experimental group. All data were managed using IBM SPSS statistics version 21.0.

RESULTS: The IED significantly reduced the occurrence of aspiration pneumonia (P = .012), delayed the onset of aspiration pneumonia (P = .005), and extended the survival time (P = .007) in the experimental group.

CONCLUSION: For patients with esophageal cancer undergoing chemoradiotherapy, this protocol improved swallowing dysfunction and reduced aspiration pneumonia.

IMPLICATION FOR PRACTICE: The IED protocol should be included in continuous educational training for clinical nurses to help them become familiar with these interventions and to provide these strategies to patients.

PMID:36696534 | DOI:10.1097/NCC.0000000000001205

PLoS One. 2023 Jan 25;18(1):e0273181. doi: 10.1371/journal.pone.0273181. eCollection 2023.

ABSTRACT

BACKGROUND/AIM: The ever-increasing population and life expectancy worldwide increase the prevalence of ophthalmic diseases, and the need for ophthalmic research expands accordingly. In our study, we aimed to evaluate many aspects of the barriers, especially gender disparities, confronting ophthalmologists who aspire to conduct scientific research (SR).

MATERIALS AND METHODS: In this descriptive quantitative study, we distributed an online questionnaire to ophthalmologists in Turkey with 21 questions presented on a five-point Likert scale and two open-ended questions. The survey was prepared with Google forms. Participants were recruited via e-mail and social networks. A multicenter survey was conducted between January 29 and February 20, 2021, and a total of 210 valid responses were recorded.

RESULTS: Participants’ responses were grouped into four types of barriers: motivation, time constraints, research support, and competence. Participants’ motivation to conduct research was above average (3.54±0.96), but most stated that they have time constraints (3.74±0.97). Participants did not agree that there is adequate support for research (2.35±0.76), and they self assessed their level of the required competence to be average (2.87±1.08). Women were more motivated to do SR than men (p = 0.008), but there were no statistically significant differences between women and men in terms of time constraints, research support, and level of competence (p = 0.853, p = 0.482, and p = 0.558, respectively). Although there is no statistically significant difference between men and women regarding time constraints, female physicians mentioned more about the barriers arising from their personal responsibilities (p = 0.038).

CONCLUSIONS: Our study revealed that ophthalmologists are enthusiastic about doing SR but encounter obstacles with regard to time availability and research support. In addition, there is a need to reinforce competence in SR. Although female physicians are more motivated than men, they must deal with competing domestic responsibilities.

PMID:36696420 | DOI:10.1371/journal.pone.0273181