Nevin Manimala

Foot Ankle Int. 2022 Jul 1:10711007221108098. doi: 10.1177/10711007221108098. Online ahead of print.

ABSTRACT

BACKGROUND: There has been concern about lateral prominence pain at the osteotomy site following medial displacement calcaneal osteotomy (MDCO). However, no study has investigated this complication. This study aimed to investigate the incidence of lateral prominence pain following MDCO and examine the efficacy of crushplasty as a surgical technique to minimize this complication.

METHODS: This was a retrospective cohort study in which 137 patients (148 feet) who underwent MDCO were divided into 2 groups by whether they had concurrent crushplasty at the time of MDCO (crushplasty [n = 81] vs noncrushplasty group [n = 67]). Crushplasty was performed by flattening the bony step-off using a rongeur and bone impactor. Lateral prominence pain was defined as pain or irritating symptoms over the osteotomy site that persisted over 12 months after MDCO. The overall incidence of lateral prominence pain after MDCO and within each group was investigated. Multiple logistic regression analysis was used to determine the influence of possible risk factors on the development of postoperative lateral prominence pain.

RESULTS: The overall incidence of lateral prominence pain was 9.5% (14 of 148): 3.4% (3 of 87) in the crushplasty group, and 18% (11 of 61) in the noncrushplasty group, and χ² analysis showed a statistically significant relationship between crushplasty and lateral prominence pain (P < .05). A relationship between the amount of medial displacement and the development of lateral prominence pain was observed in the noncrushplasty group (OR = 5.31, 95% CI 2.35-16.4, P < .05), but this was not observed in the crushplasty group (P = .641). The amount of medial displacement was an independent risk factor for the development of lateral prominence pain (OR = 2.72, 95% CI 1.54-4.79, P < .05), and concurrent crushplasty had a negative relationship with lateral prominence pain development (OR = 0.12, 95% CI 0.03-0.57, P < .05).

CONCLUSION: This study revealed that lateral prominence pain is a significant complication of MDCO, especially in the setting of a larger displacement. The crushplasty following MDCO may minimize this complication, particularly when a greater degree of hindfoot correction is attempted.

PMID:35778871 | DOI:10.1177/10711007221108098

AIDS Res Hum Retroviruses. 2022 Jul 1. doi: 10.1089/AID.2022.0006. Online ahead of print.

ABSTRACT

INTRODUCTION: HIV cure research requires interrogating latent HIV reservoirs in deep tissues, which necessitates autopsies to avoid risks to participants. An HIV autopsy biobank would facilitate this research, but such research raises ethical issues and requires participant engagement. This study explores willingness to participate in HIV cure research at the end-of-life.

METHODS: Participants include Canadians with HIV (PWHIV) aged 55 years or older. Following a mixed-method study design, all participants completed a phone or online survey, and a subset of participants participated in in-depth phone or videoconference interviews. We produced descriptive statistics of quantitative data, and a thematic analysis of qualitative data. Barriers and facilitators were categorized under domains of the Theoretical Domains Framework.

RESULTS: From April 2020 to August 2021, 37 participants completed the survey (mean age=69.9 years old; mean duration of HIV infection=28.5 years), including 15 interviewed participants. About three quarters of participants indicated being willing to participate in hypothetical medical studies towards the end-of-life (n=30; 81.1%), in HIV biobanking (n=30; 81.1%), and in a research autopsy (n=28; 75.7%) to advance HIV cure research, mainly for altruistic benefits. Main perceived risks had to do with physical pain and confidentiality. Barriers and facilitators were distributed across five domains: social/professional role and identity, environmental context and resources, social influences, beliefs about consequences and capabilities. Participants wanted more information about study objectives and procedures, possible accommodations with their last will, and rationale for studies or financial interests funding studies.

CONCLUSION: Our results indicate older PWHIV would be willing to participate in HIV cure research towards the end-of-life, HIV biobanking, and research autopsy. However, a dialogue should be initiated to inform participants thoroughly about HIV cure studies, address concerns, and accommodate their needs and preferences. Additional work is required, likely through increased community engagement, to address educational needs.

PMID:35778845 | DOI:10.1089/AID.2022.0006

Med Sci Monit. 2022 Jul 2;28:e936844. doi: 10.12659/MSM.936844.

ABSTRACT

BACKGROUND During the Coronavirus disease 2019 (COVID-19) pandemic, personal protective equipment (PPE) is used during medical resuscitation aerosol-generating procedures (AGP). This simulation study aimed to evaluate the effects of PPE on the performance of emergency resuscitation by medical students from the University of Silesia, Katowice, Poland and non-medical personnel, and used a quality cardiopulmonary resuscitation (Q-CPR) medical manikin. MATERIAL AND METHODS A simulation study was conducted using the Resusci Anne quality cardiopulmonary resuscitation (Q-CPR) medical manikin (Laerdal Medical AS, Norway). Participants were divided into 2 groups: a medical group of 50 and a non-medical group of 52, matched in pairs. Each pair performed 10 min of manual CPR with a compression-ventilation ratio of 30: 2 wearing PPE for AGP. The reference method was manual CPR wearing casual clothes along with surgical masks and latex gloves. Data about compression and ventilation were gathered using the QCPR Training application from Laerdal Medical. RESULTS Data analyses indicated statistically significant differences between medical students using PPE for AGP and basic protection: average rate of chest compressions (123 vs 114 per min; P=0.004), chest recoil (69 vs 93; P=0.0050, correct depth of chest compressions (86.5 vs 97; P=0.0081), quality of ventilation (85 vs 89; P=0.0041). Among non-medical personnel however, a statistically significant difference was in the quality of ventilation (69-85.5; P=0.0032). CONCLUSIONS The findings from this study showed that the use of PPE for AGP during CPR was associated with slower average speed of chest compressions, less chest recoil, incorrect depth of chest compressions, and lower quality of ventilation.

PMID:35778812 | DOI:10.12659/MSM.936844

Ann Otol Rhinol Laryngol. 2022 Jul 1:34894221111097. doi: 10.1177/00034894221111097. Online ahead of print.

ABSTRACT

OBJECTIVE: To determine whether thyroid nodule surveillance compliance is influenced by patient demographics or plan type.

STUDY DESIGN: Retrospective case series from 2010 to 2018.

SETTING: United States Military Health System.

METHODS: There were 481 patients with a thyroid nodule fine-needle aspiration classified as atypia of undetermined significance for whom treatment and follow-up information were available. Demographic information and surveillance plan type were extracted from the medical record and statistical analysis was performed to determine whether these characteristics influenced compliance rates.

RESULTS: A total of 289 nodules were surveilled and 192 diagnostic lobectomies were performed. An initial surveillance plan was documented in 93% (268/289) and 86% (231/268) complied. The most common plans were repeat biopsy in 78% (210/268) or ultrasound in 20% (53/268). A second plan was documented in 88% (204/231) of those who complied with the first. The most common second plans were ultrasound in 87% (178/204) or repeat biopsy in 8% (17/204). Compliance with the second plan was 64% (130/204), significantly lower than with the first (OR 3.6, 95% CI: [2.3, 5.6], P < .0001). Only 45% (130/289) were surveilled twice. Age and gender did not significantly affect compliance rates. Compliance with primary care ultrasound surveillance was 40% (21/52), significantly lower than with a specialist (77% [137/179]; OR 4.8, 95% CI: [2.5, 9.3, P < .0001).

CONCLUSION: Compliance with surveillance of thyroid nodules classified as atypia of undetermined significance was poor in this military cohort. Ultrasound surveillance by a specialist may be more reliable than with primary care.

PMID:35778811 | DOI:10.1177/00034894221111097

Physiol Rep. 2022 Jul;10(13):e15363. doi: 10.14814/phy2.15363.

ABSTRACT

In humans and animal models, Cesarean section (C-section) has been associated with alterations in the taxonomic structure of the gut microbiome. These changes in microbiota populations are hypothesized to impact immune, metabolic, and behavioral/neurologic systems and others. It is not clear if birth mode inherently changes the microbiome, or if C-section effects are context-specific and involve interactions with environmental and other factors. To address this and control for potential confounders, cecal microbiota from ~3 week old mice born by C-section (n = 16) versus natural birth (n = 23) were compared under matched conditions for housing, cross-fostering, diet, sex, and genetic strain. A total of 601 unique species were detected across all samples. Alpha diversity richness (i.e., how many species within sample; Chao1) and evenness/dominance (i.e., Shannon, Simpson, Inverse Simpson) metrics revealed no significant differences by birth mode. Beta diversity (i.e., differences between samples), as estimated with Bray-Curtis dissimilarities and Aitchison distances (using log[x + 1]-transformed counts), was also not significantly different (Permutational Multivariate ANOVA [PERMANOVA]). Only the abundance of Lachnoclostridium [Clostridium] scindens was found to differ using a combination of statistical methods (ALDEx2, DESeq2), being significantly higher in C-section mice. This microbe has been implicated in secondary bile acid production and regulation of glucocorticoid metabolism to androgens. From our results and the extant literature we conclude that C-section does not inherently lead to large-scale shifts in gut microbiota populations, but birth mode could modulate select bacteria in a context-specific manner: For example, involving factors associated with pre-, peri-, and postpartum environments, diet or host genetics.

PMID:35778808 | DOI:10.14814/phy2.15363

Ann Pharmacother. 2022 Jul 1:10600280221108429. doi: 10.1177/10600280221108429. Online ahead of print.

ABSTRACT

BACKGROUND: Propofol and dexmedetomidine are routinely used in intensive care units (ICUs). Both are lipophilic, potentially leading to accumulation in adipose tissue. Limited evidence exists on what body weight to utilize in patients with morbid obesity.

OBJECTIVE: The purpose of this research was to evaluate the safety and efficacy of weight-based sedation with propofol and dexmedetomidine in ICU patients with morbid obesity.

METHODS: Retrospective review of ICU patients admitted from January 2018 to January 2020 who were sedated for ≥48 hours was performed. The primary outcome was the percentage of time within target sedation during the first 48 hours, stratified by body mass index (BMI) <40 or ≥40 kg/m². Additional outcomes included adverse events and the infusion rate to achieve target sedation. Data were evaluated using descriptive statistics.

RESULTS: A total of 80 patients were analyzed. Patients on propofol with a BMI <40 kg/m² were in their target Richmond Agitation-Sedation Scale (RASS) 11.7% versus 16.1% with a BMI ≥40 kg/m² (P = .580). Patients with a BMI <40 kg/m² on dexmedetomidine were in their target RASS 27.6% versus 10.7% with a BMI ≥40 kg/m² (P = .053).

CONCLUSION AND RELEVANCE: Body mass index did not significantly alter propofol target sedation attainment. However, patients with morbid obesity on dexmedetomidine demonstrated significantly less time in target sedation. An actual body weight dosing strategy of these drugs did not achieve desired target sedation for those with a BMI ≥40 versus BMI <40 kg/m². These findings support future research on the optimal sedation dosing strategy in this patient population.

PMID:35778805 | DOI:10.1177/10600280221108429

Mult Scler. 2022 Jul 1:13524585221106338. doi: 10.1177/13524585221106338. Online ahead of print.

ABSTRACT

We investigated the impact of disease-modifying therapies (DMTs) on the evolving tissue damage in iron rim multiple sclerosis lesions using a novel post-processing magnetic resonance imaging (MRI) approach, the T1/T2 ratio. In this study, on baseline and 1-year follow-up, T1/T2 ratios of iron rim lesions (IRLs) in patients starting DMT (dimethyl fumarate, fingolimod, ocrelizumab) did not statistically differ compared to patients without DMT. At the second follow-up, T1/T2 ratios were significantly lower in IRLs in patients without DMT (p = 0.002), suggesting that DMTs have a beneficial delayed effect on lesion evolution and tissue matrix damage in IRLs.

PMID:35778799 | DOI:10.1177/13524585221106338

Worldviews Evid Based Nurs. 2022 Jul 1. doi: 10.1111/wvn.12596. Online ahead of print.

ABSTRACT

BACKGROUND: Evidence-based practice (EBP) improves the quality of care, decreases healthcare costs, and improves job satisfaction. However, nurses and other clinicians, as well as their institutions, struggle to consistently implement EBP. The Advancing Research and Clinical practice through close Collaboration (ARCC©) Model established that a cadre of EBP mentors is key to improving EBP knowledge, beliefs, competency, and implementation in clinicians. Yet, there has not been a valid and reliable measure of EBP mentorship.

AIMS: The aim of this study was to determine the psychometric properties of the new 8-item EBP Mentorship Scale. This scale measures the degree to which clinicians perceive that EBP mentorship is available to them.

METHODS: The EBP Mentorship Scale data were obtained from a previous national cross-sectional descriptive study with 2344 nurses from 19 hospitals and healthcare systems. Descriptive statistics summarized the sample and distributions of the scale items. Cronbach’s alpha, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA) were conducted.

RESULTS: Cronbach’s alpha of the scale was 0.99. A one-factor model was supported by EFA and retained for CFA. Model fit indices for CFA indicated a good fit.

LINKING EVIDENCE TO ACTION: The new EBP Mentorship Scale is valid and reliable and can be used to assess the level of EBP mentorship support available in hospitals and healthcare systems. EBP mentors are key in sustaining an EBP organizational culture and enhancing clinician EBP knowledge, beliefs, competency, and implementation.

PMID:35778798 | DOI:10.1111/wvn.12596

Chemistry. 2022 Jul 1. doi: 10.1002/chem.202201655. Online ahead of print.

ABSTRACT

Construction of lanthanide heterometallic complex is important for engineering multifunction molecular containers. However, it remains a challenge because of the similar ionic radii of lanthanides. Herein we attempt to prepare chiral lanthanide heterometallic tetrahedron. Upon crystallization with a mixture of [Eu 2 L 3 ] and [Ln 2 L 3 ] (Ln=Gd, Tb and Dy) helicates, a mixture of heterometallic Eu n Ln’ 4-n ( L 6 ) (n=0-4) tetrahedra was prepared. Selective formation of heterometallic tetrahedron was observed as MS deconvolution results deviated from statistical results. The formation of heterometallic tetrahedron was found to be sensitive to ionic radii as well as the ratio of the two helicates used in the crystallization.

PMID:35778773 | DOI:10.1002/chem.202201655

Fam Pract. 2022 Jul 2:cmac069. doi: 10.1093/fampra/cmac069. Online ahead of print.

ABSTRACT

BACKGROUND: Timely diagnosis of heart failure (HF) is essential to optimize treatment opportunities that improve symptoms, quality of life, and survival. While most patients consult their general practitioner (GP) prior to HF, the early stages of HF may be difficult to identify. An integrated clinical support tool may aid in identifying patients at high risk of HF. We therefore constructed a prediction model using routine health care data.

METHODS: Our study involved a dynamic cohort of patients (≥35 years) who consulted their GP with either dyspnoea and/or peripheral oedema within the Amsterdam metropolitan area from 2011 to 2020. The outcome of interest was incident HF, verified by an expert panel. We developed a regularized, cause-specific multivariable proportional hazards model (TARGET-HF). The model was evaluated with bootstrapping on an isolated validation set and compared to an existing model developed with hospital insurance data as well as patient age as a sole predictor.

RESULTS: Data from 31,905 patients were included (40% male, median age 60 years) of whom 1,301 (4.1%) were diagnosed with HF over 124,676 person-years of follow-up. Data were allocated to a development (n = 25,524) and validation (n = 6,381) set. TARGET-HF attained a C-statistic of 0.853 (95% CI, 0.834 to 0.872) on the validation set, which proved to provide a better discrimination than C = 0.822 for age alone (95% CI, 0.801 to 0.842, P < 0.001) and C = 0.824 for the hospital-based model (95% CI, 0.802 to 0.843, P < 0.001).

CONCLUSION: The TARGET-HF model illustrates that routine consultation codes can be used to build a performant model to identify patients at risk for HF at the time of GP consultation.

PMID:35778772 | DOI:10.1093/fampra/cmac069