Nevin Manimala

Burns. 2021 Nov 6:S0305-4179(21)00305-3. doi: 10.1016/j.burns.2021.10.018. Online ahead of print.

ABSTRACT

INTRODUCTION: The first states began implementing the Medicaid expansion provisions of the Patient Protection and Affordable Care Act (ACA) in 2014. Studies have yet to address its impact on burn patients.

METHODS: Burn patients in geographic regions that expanded Medicaid coverage were compared to patients in regions that did not expand Medicaid before and after implementation of the ACA using bivariate statistics and a difference-in-differences model. A multivariable logistic regression was used to identify factors associated with having Medicaid insurance. The primary outcome of this study was the rate of Medicaid insurance.

RESULTS: Of 25,331 discharges, we found greater increases in Medicaid coverage after the ACA in the Medicaid expander regions (23.4-40.2%) compared to the non-expander regions (18.5-20.1%). The difference-in-differences estimate between the expander and non-expander regions was 0.15 (95% CI: 0.11-0.18, p < 0.001). Patients admitted in expander regions were more likely to be insured by Medicaid (OR 1.57 [95%CI 1.21-2.05]), as were patients of Black race (OR 1.25 [95%CI 1.19-1.32), Hispanic ethnicity (OR 1.29 [95%CI 1.14-1.46]), and female sex (OR 1.59 [95%CI 1.11-2.27]). We also found a significant interaction between time period (pre-ACA/post-ACA) and expander region location (OR 2.10 [95%CI 1.67-2.62]).

CONCLUSIONS: The Medicaid expansion provision of the ACA led to increased Medicaid coverage among burn patients which was significantly higher in areas with widespread implementation of the expansion.

PMID:34903411 | DOI:10.1016/j.burns.2021.10.018

J Hand Surg Am. 2021 Dec 10:S0363-5023(21)00620-1. doi: 10.1016/j.jhsa.2021.09.024. Online ahead of print.

ABSTRACT

PURPOSE: The second palmar interosseous muscle is innervated solely by the ulnar nerve, and second palmar interosseous pinch (2IP) strength may be a good indicator of ulnar nerve motor function. The goal of this study was to describe the 2IP test and establish its normative values, stratified by age, sex, and dominance.

METHODS: Volunteers were recruited to participate in this study at various community locations. Patients over the age of 18 years were eligible for this study. Demographic information on all subjects was collected. The volunteers were asked to pinch a hydraulic pinch gauge between the index and middle finger proximal phalanges with the proximal and distal interphalangeal joints flexed and without recruiting the thumb. Three 2IP measurements were taken for each hand. Descriptive statistics and analysis of covariance were performed to determine the effect of age, sex, dominance, and side on 2IP. We analyzed the 2IP strength using the 2IP test across 3 trials to determine whether it was affected by repeated testing.

RESULTS: Two hundred thirty-eight patients met the inclusion criteria (45 ± 21 years, 55% women, 87% right-hand dominant). There was no statistically significant difference between dominant and nondominant hands or among the 3 trials. There was a statistically significant correlation between age and 2IP strength ranging between 0.32 and 0.44 kg. Age and sex showed a statistically significant association with 2IP strength, with patients of older age and women having weaker 2IP.

CONCLUSIONS: We determined normative values for 2IP strength using a sample from a normal population. More studies are needed to validate these results.

CLINICAL RELEVANCE: Second interosseous pinch strength may be a useful tool to assess ulnar nerve function.

PMID:34903391 | DOI:10.1016/j.jhsa.2021.09.024

Gynecol Oncol. 2021 Dec 10:S0090-8258(21)01625-5. doi: 10.1016/j.ygyno.2021.11.021. Online ahead of print.

ABSTRACT

INTRODUCTION: Chemotherapy plus radiation (Cis-RT + CP) did not demonstrate superiority in prolonging relapse-free survival compared to chemotherapy alone in patients with stage III or IVA endometrial carcinoma. The impact of treatment on quality of life (QOL), neurotoxicity (NTX) and psychometric properties of the gastrointestinal (GI) symptoms subscale during treatment and up to 1 year are described herein.

METHODS: QOL assessments were scheduled at baseline, 6 weeks (post completion of RT (Cis-RT + CP) or prior to cycle 3 (CP)), then 18 weeks (end of treatment) and 70 weeks (1 year after the end of treatment) after starting treatment. QOL instruments included the FACT-En TOI, FACT/GOG-neurotoxicity (Ntx) subscale (short), and the gastrointestinal (GI) symptoms subscale.

RESULTS: At the end of treatment, patients receiving Cis-RT + CP reported a statistically significant decreased QOL when compared to CP. The decline in QOL was reflected in physical well-being, functional well-being, and endometrial cancer specific concerns, but the minimally important differences (MID) were not considered clinically meaningful. Patients in both groups reported increased chemotherapy-induced Ntx symptoms with the CP group having worse scores and reaching peak symptoms at the time of chemotherapy completion. Patients on Cis-RT + CP reported statistically significantly worse GI symptoms after radiation therapy compared to patients on CP, this occurred across assessment intervals, though the MID was not meaningful. Psychometric evaluations indicated that the GI symptom scale is reliable, valid, and responsive to change.

CONCLUSIONS: PROs indicate that the chemoradiotherapy group experienced worse HRQoL and GI toxicity compared to patients randomized to chemotherapy alone for locally advanced endometrial cancer though based on the MID, these were not clinically meaningful differences. The GI symptom subscale was a reliable and valid scale that has value for future trials.

TRIAL REGISTRATION: NCT00942357.

PMID:34903380 | DOI:10.1016/j.ygyno.2021.11.021

Am J Surg. 2021 Dec 4:S0002-9610(21)00728-5. doi: 10.1016/j.amjsurg.2021.12.002. Online ahead of print.

ABSTRACT

OBJECTIVES: The 21st Century Cures Act requires that institutions release all electronic health information (EHI) to patients immediately. We aimed to understand patient and clinician attitudes toward the immediate release of EHI to patients.

METHODS: Patients and clinicians representing distinct specialties at a single academic medical center completed a survey to assess attitudes toward the immediate release of results. Differences between patient and clinician responses were compared using chi-square and student’s t-test for categorical and continuous variables, respectively. A two-sided significance level of 0.05 was used for all statistical tests.

RESULTS: 69 clinicians and 57 patients completed the survey. Both patients (89.7%) and clinicians (80.6%) agreed or strongly agreed-here after referred to as agreed, that providing patients with access to their health information is necessary in delivering high-quality care. However, 62.7% of clinicians agreed that results released immediately would be more confusing than helpful, whereas the minority of patients agreed with this statement (15.8%) (p < 0.05). Providers were also more likely to disagree that patients are comfortable independently interpreting blood work results (p < 0.05), radiology results (p < 0.05) and pathology reports (p < 0.05). With regard to timing, the majority of patients (75.1%) felt their provider should contact them within 24 h of the release of an abnormal result, whereas only 9.0% of clinicians agreed with this timeframe (p < 0.05).

DISCUSSIONS: Patients and clinicians value information transparency. However, the immediate release of results is controversial, especially among clinicians. The discrepancy between patient and clinician perceptions underlines the importance of setting expectations about the communication of results. Additionally, our results emphasize the need to implement strategies to help improve patient comprehension, decrease patient distress and improve clinician workflows.

PMID:34903369 | DOI:10.1016/j.amjsurg.2021.12.002

Br J Anaesth. 2021 Dec 10:S0007-0912(21)00747-9. doi: 10.1016/j.bja.2021.11.019. Online ahead of print.

ABSTRACT

BACKGROUND: Exposure to general anaesthesia in children may be related to deficits in certain areas of cognition. It is unclear if these deficits could be measured in the immediate postoperative period in young children. The goal of the current study was to evaluate the trajectory of cognitive function in the domains of processing speed, working memory, and fine motor skills amongst children aged 2.5-6 yr who underwent general anaesthesia for elective surgery.

METHODS: Children who were scheduled to receive general anaesthesia for surgery were recruited for assessment of cognitive function at three times: preoperatively, 1-2 weeks postoperatively, and 3 months postoperatively. Assessments included processing speed, working memory, and fine motor skills. To assess longitudinal changes in the cognitive outcomes, linear mixed models were built with visit number included as a categorical variable and subject-specific random intercepts.

RESULTS: Sixty-one children (33 girls [54%]) enrolled in the study. Twenty-three children (38%) had received general anaesthesia previously. Significant improvements in picture memory, cancellation, and the processing speed composite were found at Visit 2. The improvement in cancellation and processing speed composite remained significant at Visit 3. Statistically significant improvement in Mullen fine motor score was noticed at Visit 3 compared with Visit 1. The pattern of results did not depend upon prior anaesthesia exposure.

CONCLUSIONS: General anaesthesia for elective surgery in young children was not associated with declines in working memory, processing speed, and fine motor skills in the first 3 months postoperatively, including in children with prior exposure to anaesthesia.

PMID:34903364 | DOI:10.1016/j.bja.2021.11.019

Am J Cardiol. 2022 Jan 1;162:49-57. doi: 10.1016/j.amjcard.2021.08.059.

ABSTRACT

Transradial (TR) access for percutaneous coronary intervention (PCI) improves outcomes and reduces the risk of major bleeding compared with transfemoral (TF) access. However, data on gender-stratified outcomes based on vascular access are limited. Databases were queried to find relevant articles. Primary outcomes, including major bleeding complications, mortality, and secondary outcome including major adverse cardiovascular events (MACEs), myocardial infarction, and cerebrovascular accidents, were analyzed using a random-effect model to calculate unadjusted odds ratio (OR) of TR-PCI and TF-PCI between the genders. A total of 9 studies comprising 3,889,257 patients (389,580 in the TR arm and 3,499,677 in the TF arm) were included. Males comprised 73% and 67% of the TR and TF arms, respectively. TR-PCI was associated with lower major bleeding (pooled OR 0.51, 95% CI 0.40 to 0.64, p = 0.00; female OR 0.49, 95% CI 0.34 to 0.71, p = 0.00; male OR 0.54, 95% CI 0.40 to 0.73, p = 0.00) and mortality (pooled OR 0.54, 95% CI 0.45 to 0.66, p = 0.00; female OR 0.56, 95% CI 0.44 to 0.71, p = 0.27; male OR 0.54, 95% CI 0.39 to 0.75, p = 0.00) regardless of gender as compared with TF-PCI. Furthermore, TR-PCI also showed lower MACE (pooled OR 0.74, 95% CI 0.66 to 0.84, p = 0.00; female OR 0.64, 95% CI 0.59 to 0.70, p = 0.00; male OR 0.81, 95% CI 0.66 to 0.98, p = 0.00) as compared with TF-PCI in both genders. On analysis of interaction magnitude of the difference of favor of female and male for TR-PCI showed no statistically significant measurable difference. Periprocedural myocardial infarction and cerebrovascular accidents were not statistically different in TR and TF-PCI and were not different based on gender. In conclusion, TR-PCI was associated with a lower risk of major bleeding, mortality, and MACE irrespective of gender. In conclusion, TR-PCI should be the default access.

PMID:34903346 | DOI:10.1016/j.amjcard.2021.08.059

J Health Popul Nutr. 2021 Dec 13;40(1):53. doi: 10.1186/s41043-021-00278-3.

ABSTRACT

BACKGROUND: Evidence indicates the lower intake of fruits and vegetables than the recommended daily amount. Study aimed at determining the effects of peer education intervention on the consumption of fruits and vegetable in housewives.

METHODS: A quasi-experimental was conducted with 130 housewives referring to health care centers in Bandar Abbas, Iran. Sixty-five subjects were recruited in each of the intervention and the control groups. Intervention group were divided into three subgroups each receiving a seven-sessions educational programs (lecturing and group discussion) through peers about the importance of benefits of fruits and vegetables consumption. Participants were followed for two months. Data were collected using a questionnaire in two stages of pre- and post-intervention. Differences in the outcome before and after the intervention were tested using T-test and paired T-test.

RESULTS: The daily servings of fruits and vegetables in the intervention group increased from 1.73 to 4.20 and in the control group from 1.96 to 2.16; a statistically significant difference was also observed between the groups (P < 0.001). After the intervention benefits and self-efficacy of fruits and vegetables consumption significantly increased and perceived barriers of fruits and vegetables consumption significantly decreased in the intervention group (P < 0.001).

CONCLUSION: Peer education improves benefits and self-efficacy, reduces barriers, and increases the daily servings of fruits and vegetables in housewives.

PMID:34903305 | DOI:10.1186/s41043-021-00278-3

Perioper Med (Lond). 2021 Dec 14;10(1):46. doi: 10.1186/s13741-021-00217-0.

ABSTRACT

OBJECTIVES: This meta-analysis aimed to evaluate the efficacy and safety of antimuscarinics for the prevention or treatment of catheter related bladder discomfort (CRBD).

METHODS: The MEDLINE, EMBASE, and Cochrane Controlled Trials Register (from 1987 to July 2021) were used to search randomized controlled trials. The PRISMA checklists were followed. RevMan5.4.0 was used for statistical analysis.

RESULTS: Eleven studies involving 1165 patients were involved in the analysis. The study reported that the incidence of CRBD observed in the antimuscarinics group was significantly lower than that of the control group at 0-, 1-, 2-, and 6-h after drug therapy (P = 0.001, P < 0.0001, P = 0.0005, and P = 0.001, respectively). For side effects, there were not statistical differences between the antimuscarinics group and the control group, mainly including dry mouth (risk ratio (RR) = 1.31, 95% confidence interval (CI) = 0.95 to 1.80, P = 0.09), postoperative nausea and vomiting (RR = 1.02, 95% CI = 0.55 to 1.90, P = 0.87), facial flushing (RR = 1.06, 95% CI = 0.43 to 2.61, P = 0.90), and blurred vision (RR = 0.95, 95% CI = 0.35 to 2.58, P = 0.91). Besides, rescue analgesics were required less in the antimuscarinics group than in the control group (RR = 0.51, 95% CI = 0.32 to 0.80, P = 0.003).

CONCLUSIONS: Compared with the control group, the antimuscarinics group had a significant improvement on CRBD, the patients were well tolerated and the use rate of rescue analgesics was low.

PMID:34903279 | DOI:10.1186/s13741-021-00217-0

Plant Methods. 2021 Dec 13;17(1):126. doi: 10.1186/s13007-021-00826-2.

ABSTRACT

BACKGROUND: The bacterial leaf pathogen Pseudomonas syringae pv tomato (Pst) is the most popular model pathogen for plant pathology research. Previous methods to study the plant-Pst interactions rely on destructive quantification of Pst colonisation, which can be labour- and time-consuming and does not allow for spatial-temporal monitoring of the bacterial colonisation. Here, we describe a rapid and non-destructive method to quantify and visualise spatial-temporal colonisation by Pst in intact leaves of Arabidopsis and tomato.

RESULTS: The method presented here uses a bioluminescent Pst DC3000 strain that constitutively expresses the luxCDABE operon from Photorhabdus luminescens (Pst::LUX) and requires a common gel documentation (Gel Doc) system with a sensitive CCD/CMOS camera and imaging software (Photoshop or Image J). By capturing bright field and bioluminescence images from Pst::LUX-infected leaves, we imaged the spatiotemporal dynamics of Pst infection. Analysis of bioluminescence from live Pst bacteria over a 5-day time course after spray inoculation of Arabidopsis revealed transition of the bacterial presence from the older leaves to the younger leaves and apical meristem. Colonisation by Pst:LUX bioluminescence was obtained from digital photos by calculating relative bioluminescence values, which is adjusted for bioluminescence intensity and normalised by leaf surface. This method detected statistically significant differences in Pst::LUX colonisation between Arabidopsis genotypes varying in basal resistance, as well as statistically significant reductions in Pst::LUX colonisation by resistance-inducing treatments in both Arabidopsis and tomato. Comparison of relative bioluminescence values to conventional colony counting on selective agar medium revealed a statistically significant correlation, which was reproducible between different Gel Doc systems.

CONCLUSIONS: We present a non-destructive method to quantify colonisation by bioluminescent Pst::LUX in plants. Using a common Gel Doc system and imaging software, our method requires less time and labour than conventional methods that are based on destructive sampling of infected leaf material. Furthermore, in contrast to conventional strategies, our method provides additional information about the spatial-temporal patterns of Pst colonisation.

PMID:34903271 | DOI:10.1186/s13007-021-00826-2

Clin Epigenetics. 2021 Dec 13;13(1):218. doi: 10.1186/s13148-021-01206-2.

ABSTRACT

BACKGROUND: Colon cancer (CC) is treatable if detected in its early stages. Improved CC detection assays that are highly sensitive, specific, and available at point of care are needed. In this study, we systematically selected and tested methylated markers that demonstrate high sensitivity and specificity for detection of CC in tissue and circulating cell-free DNA.

METHODS: Hierarchical analysis of 22 candidate CpG loci was conducted using The Cancer Genome Atlas (TCGA) COAD 450K HumanMethylation database. Methylation of 13 loci was analyzed using quantitative multiplex methylation-specific PCR (QM-MSP) in a training set of fresh frozen colon tissues (N = 53). Hypermethylated markers were identified that were highest in cancer and lowest in normal colon tissue using the 75th percentile in Mann-Whitney analyses and the receiver operating characteristic (ROC) statistic. The cumulative methylation status of the marker panel was assayed in an independent test set of fresh frozen colon tissues (N = 52) using conditions defined and locked in the training set. A minimal marker panel of 6 genes was defined based on ROC area under the curve (AUC). Plasma samples (N = 20 colorectal cancers, stage IV and N = 20 normal) were tested by cMethDNA assay to evaluate marker performance in liquid biopsy.

RESULTS: In the test set of samples, compared to normal tissue, a 6-gene panel showed 100% sensitivity and 90% specificity for detection of CC, and an AUC of 1.00 (95% CI 1.00, 1.00). In stage IV colorectal cancer plasma versus normal, an 8-gene panel showed 95% sensitivity, 100% specificity, and an AUC of 0.996 (95% CI 0.986, 1.00) while a 5-gene subset showed 100% sensitivity, 100% specificity, and an AUC of 1.00 (95% CI 1.00, 1.00), highly concordant with our observations in tissue.

CONCLUSIONS: We identified high performance methylated DNA marker panels for detection of CC. This knowledge has set the stage for development and implementation of novel, automated, self-contained CC detection assays in tissue and blood which can expeditiously and accurately detect colon cancer in both developed and underdeveloped regions of the world, enabling optimal use of limited resources in low- and middle-income countries.

PMID:34903270 | DOI:10.1186/s13148-021-01206-2