Nevin Manimala

J Pediatr Hematol Oncol Nurs. 2022 Jul-Aug;39(4):231-242. doi: 10.1177/27527530211073737. Epub 2022 Apr 13.

ABSTRACT

Introduction: Work-related post traumatic stress disorder (PTSD) can develop in nurses. Pediatric oncology nursing is a potentially high-risk subspecialty for PTSD secondary to the nature of the work. This study aimed to describe the prevalence of PTSD symptomology and explore relationships between nurse psychological capital, workplace social supports, and PTSD symptomology in pediatric oncology nurses. Methods: The study utilized a cross-sectional correlational survey design. Pediatric oncology nurses working in direct patient care in the United States completed a demographics questionnaire, Psychological Capital Questionnaire (PCQ), Coworker Support Scale, Supervisor Support Scale, and the Post traumatic Checklist for Diagnostic and Statistical Manual of Mental Disorders (PCL-5). Descriptive and inferential statistics, including logistic regression models, were used to analyze data. A cutoff score of ≥31 on the PCL-5 was used to determine the prevalence of PTSD symptomology. Results: The sample included 424 nurses. The prevalence of PTSD symptomology was 13.4%. Work setting (inpatient), decreased coworker and leadership social support, and psychological capital were independently associated with PTSD symptomology. After controlling for covariates, only psychological capital was associated with PTSD symptomology. For a 1 unit decrease in PCQ score, pediatric oncology nurses were 4.25 times more likely to have PTSD symptomology. Discussion: PTSD prevalence rates in pediatric oncology nurses are aligned with rates found in other nursing specialties. Nurse psychological capital may play a protective role against PTSD symptomology. Implications for Future Research: Findings support PTSD as a serious workplace concern for nurses. Workplace programs that foster nurses’ psychological capabilities should be considered to protect against the development of PTSD symptomology.

PMID:35791851 | DOI:10.1177/27527530211073737

Dermatol Ther. 2022 Jul 6:e15693. doi: 10.1111/dth.15693. Online ahead of print.

ABSTRACT

BACKGROUND: Multiple approaches are used to treat acne scars, but some are expensive, ineffective, and cause complications. We aimed to evaluate the efficacy and safety of ultra-pulsed CO₂ fractional laser combined with 30% supramolecular salicylic acid in the treatment of acne scars in a prospective split-face control study.

METHODS: Twenty patients with facial symmetrical acne scars were enrolled. One side of face was randomly treated with 30% supramolecular salicylic acid, and two sides were treated with ultra-pulsed CO₂ fractional laser. The Echelle d’evaluation clinique des cicatrices d’acne (ECCA) scale was used to evaluate the clinical efficacy before and three months after treatment, and a quartile scale was used to self-evaluate the improvement of patients. A visual analog scale was used to record pain scores after each treatment, and side effects and other adverse reactions on the face were recorded.

RESULTS: All the patients completed treatment and follow-up. There was statistical difference in ECCA scores of bilateral facial acne scars after three treatments (P<0.001). ECCA scores on the combined side were lower after three treatments than those on the laser side (P=0.003). The patient satisfaction quartile scale on the combined side was higher than that on the laser side alone (P=0.015).

CONCLUSION: Ultra-pulsed CO₂ fractional laser combined with 30% supramolecular salicylic acid has better efficacy in the treatment of acne scars than laser alone, and patient self-assessment of combined treatment has a greater degree of improvement in acne scars, and does not increase patient pain scores and related adverse reactions. This article is protected by copyright. All rights reserved.

PMID:35791845 | DOI:10.1111/dth.15693

Clin Implant Dent Relat Res. 2022 Jul 6. doi: 10.1111/cid.13115. Online ahead of print.

ABSTRACT

BACKGROUND: The fracture of a Morse tapered abutment connection in an osseointegrated implant is one of the most serious mechanical complications, and it is extremely hard to deal with this complication in clinical practice.

PURPOSE: The aim of this study was to explore the cumulative mechanical complications focus on abutment of a platform switching Morse taper connection implant system after loading, and to perform a retrospective, approximately 1- to 9-year follow-up study to identify the predisposing factors.

MATERIALS AND METHODS: A total of 495 patients with 945 fitted implants were enrolled in this study with a follow-up from January 2012 to January 2020. The data of mechanical complications of the abutment, including abutment fracture (AF) and abutment screw loosening (ASL), and possible causative factors were extracted and evaluated statistically.

RESULTS: A total of 25 out of 945 (2.65%) cumulative abutment mechanical complications occurred. AF was the most common complication (n = 13, 1.38%), followed by ASL (n = 12, 1.27%). For AF, gender, type of prosthesis, abutment design, and implant diameter were identified as the causative factors. AF was mostly observed in the single crown of males in molar areas, while ASL was more likely to occur on an angled abutment than on a non-angled abutment. Moreover, the abutment with the positioning index (/X) had a higher incidence of fracture than the abutment without the positioning index (C/).

CONCLUSIONS: This study shows that the Morse taper connection is a safe abutment connection. AF occurs more frequently within single crowns in molar area of males, especially with the positioning index (/X), while ASL is more likely to occur in an angled abutment.

PMID:35791805 | DOI:10.1111/cid.13115

Acta Otolaryngol. 2022 Jul 6:1-6. doi: 10.1080/00016489.2022.2093967. Online ahead of print.

ABSTRACT

BACKGROUND: The short- and long-term effects of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on the medial olivocochlear reflex and outer hair cells in the cochlea remain largely unclear.

AIMS: The aim of this study was to investigate the efferent auditory system effects in adult patients with COVID-19.

MATERIALS AND METHODS: The study included 18-50 years old 44 volunteers: 26 individuals (52 ears) with COVID-19 in the study group and 18 healthy individuals (36 ears) in the control group. Otolaryngological examination, immitancemetric evaluation, distortion product otoacoustic emission (DPOAE), contralateral acoustic stimulation with DPOAE, audiometric evaluation, and high frequency audiometric evaluation were performed in all individuals participating in the study.

RESULTS: In our study, patients with COVID-19 had significantly lower DPOAE results with or without broadband noise at only 6 kHz frequency and contralateral suppression results at all frequencies compared to healthy individuals. A statistically significant difference was found between the study and control groups according to whether the participants had a response in the high frequency audiometry at 12 and 16 kHz frequencies.

CONCLUSIONS: COVID-19 affects many systems in the body. As a result of the findings obtained in the present study, it is shown that the auditory efferent system may also be affected.

PMID:35791801 | DOI:10.1080/00016489.2022.2093967

Int Endod J. 2022 Jul 6. doi: 10.1111/iej.13795. Online ahead of print.

ABSTRACT

AIM: Natural substances such as omega-3 have been used in the medical field due to their numerous properties and, in particular, modulating effect on the systemic and local inflammatory processes. Thus, this study evaluated the influence of omega-3 supplementation on the subcutaneous tissue response of endodontic sealers in Wistar Rats.

METHODOLOGY: Polyethylene tubes were implanted in the subcutaneous tissue of 48 animals (one empty for control and three filled with Sealapex, AH Plus or Endofill). The animals were treated with omega-3 (TO) or water (TW). Treatments started 15 days before implantation until euthanasia. After 5, 15 and 30 days (n=8), animals were euthanized and polyethylene tubes and surrounding tissue were removed and processed for histological analysis. The inflammatory reaction was analysed by Haematoxylin and Eosin stain and immunolabeling for IL-6 and TNF-α. The collagen maturity was analysed by picrosirius red stain and calcium deposition by von Kossa stain and polarized light. Results were statistically analysed (p<0.05).

RESULTS: Among TW sealers groups, Endofill evoked a more intense inflammatory infiltrate compared with AH Plus and control in the 30-day period (p=0.009). However, in TO sealers groups, there was no difference among the sealers and control in all periods (p>0.05). Comparing each sealer as a function of the supplementation with water or omega-3, there are differences for Endofill (p=0.001) and Sealapex (p=0.005) in the 30-day period, presenting lower inflammatory infiltrate in the animals treated with omega 3. A higher percentage of immature fibres was observed at 15 and 30 days in the TO group, compared with TW group (p<0.05). The deposition of calcium particles was observed only by Sealapex in all periods, despite the supplementation procedure.

CONCLUSIONS: Omega-3 supplementation influence the tissue reactions of endodontic sealers, modulating inflammation, the immunolabeling of IL-6 and TNF-α, the repair process and it does not interfere with calcium deposition.

PMID:35791796 | DOI:10.1111/iej.13795

Rev Esp Enferm Dig. 2022 Jul 6. doi: 10.17235/reed.2022.8777/2022. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the performance of magnetic resonance elastography (MRE) in staging liver fibrosis in patients with histologically confirmed nonalcoholic fatty liver disease (NAFLD) and to assess the impact of potential confounding factors in MRE diagnostic accuracy. Secondary objective was to compare MRE with other non-invasive methods for staging fibrosis such as transient elastography and non invasive scores(APRI and FIB-4) Methods: Sixty-five histologically confirmed NAFLD patients were prospectively enrolled at ‘Virgen del Rocío’ University Hospital (Seville). Liver stiffness was measured by MRE, transient elastography and non invasive scores(APRI and FIB-4). Fibrosis was assessed by liver biopsy using SAF score. We classified patients into 3 groups according to the consistency between MRE and histopathological findings: underestimation, concordance and overestimation group. Areas under the ROC curve (AUROC) and diagnostic performance were evaluated.

RESULTS: The area under the ROC curve (AUROC)of MRE in advanced fibrosis(≥F3) was 0.90[0.82-0.97], while transient elastography AUROC was 0.82[0.72-0.93](p=0.22) and lower for non-invasive test(FIB-4 0.67 and APRI 0.62). Inflammatory activity, steatosis grade and higher levels of liver biochemistry appeared to overestimate MRE results in univariate analysis, but only GGT was statistically significant in the multivariate analysis(p<0.01). Age, sex, BMI, weight, DM, HTA, platelets or lipidic profile did not affect MRE accuracy.

CONCLUSIONS: MRE is an effective and non-invasive method for detecting and staging liver fibrosis in NAFLD patients. MRE is more accurate than transient elastography and allows the study of liver anatomy. Histological inflammation and surrogate biomarkers of inflammation can overestimate liver stiffness, but only GGT was statistically significant in the multivariate analysis. Important features of NAFLD patients such as obesity, Mellitus diabetes, or lipidic profile did not affect MRE accuracy.

PMID:35791792 | DOI:10.17235/reed.2022.8777/2022

Hosp Pediatr. 2022 Jul 6:e2021006366. doi: 10.1542/hpeds.2021-006366. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Schwartz Rounds (SR) is an interdisciplinary program that focuses on compassionate care by allowing the formation of an interprofessional community around the human and emotional testimonies of caregivers. The purpose of this study was to examine the impact of implementing departmental SR on pediatric care providers at a tertiary care children’s hospital in New York.

METHODS: We applied the logic outcomes model for program evaluation to examine the impact of SR on pediatric providers. The standard evaluation form provided by the Schwartz Center was used to collect data after every SR. Descriptive statistics and qualitative data content analysis methods were used to analyze the evaluation data from the SR.

RESULTS: A total of 820 standard evaluation forms were collected from 17 of the 23 SR sessions offered (response rate: 74.8%). Most participants felt that, during the SR sessions, challenging social and emotional aspects of patient care were discussed and that they gained better perspectives of their coworkers and their patients/families. They reported less isolation and more openness to express their feelings about patient care to their coworkers. The analysis of 299 written comments identified 5 themes: understanding other people’s perspectives, the importance of communication, empathy and compassion, awareness of personal biases, and maintaining boundaries.

CONCLUSIONS: Schwartz Rounds can provide an effective venue for pediatric care providers to gain insights into coworker and patient/family perspectives and process emotional experiences while providing patient care in a variety of circumstances.

PMID:35791770 | DOI:10.1542/hpeds.2021-006366

Plast Reconstr Surg. 2022 Jul 6. doi: 10.1097/PRS.0000000000009441. Online ahead of print.

ABSTRACT

BACKGROUND: Targeted muscle reinnervation (TMR) has emerged as a technique to reduce neuroma and phantom limb pain after below knee amputation (BKA); however, the incidence of post-operative complications remains unknown. This multi-institutional study assessed the risk of post-operative complications among patients who underwent TMR at the time of BKA (BKA+TMR).

STUDY DESIGN: Patients who underwent BKA+TMR were propensity score-matched 1:3 to patients who underwent BKA only. Study outcomes included the incidence of major or minor complications within 60 days. Regression models were utilized to estimate the relative risk (RR) of major and minor complications.

RESULTS: Overall, 96 patients were matched including 31 BKA+TMR and 65 BKA only. In the matched sample, a higher incidence of major complications (29% vs. 24.6%), readmission (25.8% vs. 18.5%) and reoperation (19.4% vs. 10.8%) was seen after BKA+TMR compared to BKA only. Furthermore, patients who underwent BKA+TMR displayed a higher incidence of minor complications (25.8% versus 20.0%), blood transfusion (22.6% vs. 18.5%), wound healing complications (45.2% vs. 33.8%), and longer operative time (mean [standard deviation] 188.5 [63.6] vs. 88 [28.2] minutes). However, there was no statistically significant difference in the risk of major (RR:1.20, 90% confidence interval (CI):0.68, 2.11) or minor (RR:1.21, 90% CI:0.61, 2.41) complications between the two cohorts.

CONCLUSION: Despite an increased incidence of post-operative complications, undergoing BKA+TMR does not confer a statistically significant increased risk of major or minor complications. Future studies are needed to delineate patient selection criteria when assessing the suitability of TMR at the time of major limb amputation.

PMID:35791757 | DOI:10.1097/PRS.0000000000009441

Biostatistics. 2022 Jul 6:kxac020. doi: 10.1093/biostatistics/kxac020. Online ahead of print.

ABSTRACT

When evaluating the effectiveness of a treatment, policy, or intervention, the desired measure of efficacy may be expensive to collect, not routinely available, or may take a long time to occur. In these cases, it is sometimes possible to identify a surrogate outcome that can more easily, quickly, or cheaply capture the effect of interest. Theory and methods for evaluating the strength of surrogate markers have been well studied in the context of a single surrogate marker measured in the course of a randomized clinical study. However, methods are lacking for quantifying the utility of surrogate markers when the dimension of the surrogate grows. We propose a robust and efficient method for evaluating a set of surrogate markers that may be high-dimensional. Our method does not require treatment to be randomized and may be used in observational studies. Our approach draws on a connection between quantifying the utility of a surrogate marker and the most fundamental tools of causal inference-namely, methods for robust estimation of the average treatment effect. This connection facilitates the use of modern methods for estimating treatment effects, using machine learning to estimate nuisance functions and relaxing the dependence on model specification. We demonstrate that our proposed approach performs well, demonstrate connections between our approach and certain mediation effects, and illustrate it by evaluating whether gene expression can be used as a surrogate for immune activation in an Ebola study.

PMID:35791753 | DOI:10.1093/biostatistics/kxac020

Paediatr Anaesth. 2022 Jul 6. doi: 10.1111/pan.14519. Online ahead of print.

ABSTRACT

BACKGROUND: To reduce risk for intermittent hypoxia a high fraction of inspired oxygen is routinely used during anesthesia induction. This differs from the cautious dosing of oxygen during neonatal resuscitation and intensive care and may result in significant hyperoxia.

AIM: In a randomized controlled trial we evaluated oxygenation during general anesthesia with a low (23%) vs a high (80% during induction and recovery, and 40% during maintenance) fraction of inspired oxygen, in newborn infants undergoing surgery.

METHOD: Thirty-five newborn infants with postconceptional age of 35-44 weeks were included (17 infants in low and 18 in high oxygen group). Oxygenation was monitored by transcutaneous partial pressure of oxygen, pulse oximetry, and cerebral oxygenation. Pre-defined SpO2 safety targets dictated when to increase inspired oxygen.

RESULTS: At start of anesthesia oxygenation was similar in both groups. Throughout anesthesia the high oxygen group displayed significant hyperoxia with higher (difference -20.3kPa, 95% confidence interval (CI) -28.4 – -12.2, p < .001) transcutaneous partial pressure of oxygen values than the low oxygen group. While SpO2 in the low oxygen group was lower (difference -5.8%, 95% CI -9.3 – -2.4, p < .001) during anesthesia, none of the infants spent enough time below SpO₂ safety targets to mandate supplemental oxygen, and cerebral oxygenation was within the normal range and not statistically different between the groups. Analysis of the oxidative stress biomarker urinary F₂ -Isoprostane revealed no differences between the low and high oxygen group.

CONCLUSION: We conclude that in healthy newborn infants use of low oxygen during general anesthesia was feasible, while the prevailing practice of using high levels of inspired oxygen resulted in significant hyperoxia. The trade-off between careful dosing of oxygen and risks of hypo- and hyperoxia in neonatal anesthesia should be further examined.

PMID:35791748 | DOI:10.1111/pan.14519