Nevin Manimala

Rev Esp Salud Publica. 2023 Mar 22;97:e202303022.

ABSTRACT

OBJECTIVE: One in one hundred minors has some mental health problem. Symptomatology varies according to gender. Most research has been conducted with the general population. The objective of this paper was to analyze the moderating role of sex in the presence of internalizing (emotional disorders, anxiety and depression) and externalizing symptomatology (behavioral disorders and hyperactivity) in childhood, as well as to compare the general population with the clinical population.

METHODS: A descriptive cross-sectional study was conducted with 552 boys and girls between ten and twelve years of age, 94 mental health patients and 458 schoolchildren. Participants completed self-report measures: Strengths and Difficulties Questionnaire (SDQ-Cas), Modified Depression Scale (MDS) and a sociodemographic information questionnaire. For data analysis, descriptive statistics and multivariate and univariate mean comparisons were performed by parametric and re-sampling procedures.

RESULTS: Statistically significant differences were observed between clinical and school population groups in externalizing, internalizing and depressive symptomatology (p<0.001). No sex differences were found in externalizing and depressive symptomatology. Sex differences were found in internalizing symptoms (p<0.001, p_boot<0.001) as well as group interaction effects (p=0.016), girls had higher scores than boys, with greater differences in the clinical group (p<0.001, p_boot=0.003).

CONCLUSIONS: Research with mental health patients is essential to verify the existence or not of differences with the general population as well as differences by sex, which will allow adapting preventive and intervention strategies to each case.

PMID:36950951

Surg Innov. 2023 Mar 22:15533506231164895. doi: 10.1177/15533506231164895. Online ahead of print.

ABSTRACT

Background. Single anastomotic surgeries can increase the risk of reflux, marginal ulceration, and gastrointestinal complications. Braun anastomosis prevents bile reflux after gastric resection and gastrojejunal anastomosis surgeries. The present pilot study evaluated Braun’s efficacy in a single anastomosis sleeve ileal (SASI) bypass surgery.Methods. 28 patients with a history of SASI bypass surgery from October 2017 to September 2021 were included in the study. Patients were divided into 2 groups based on having Braun anastomosis to this surgical procedure; group A: underwent SASI bypass without Braun anastomosis; group B: underwent SASI bypass with Braun anastomosis. The surgical complications in terms of bile reflux, marginal ulcer, reflux esophagitis, and gastritis were evaluated and compared between the groups. Results. Bile reflux and reflux esophagitis were seen more in group A than in group B (37.5% vs 8.3% and 18.8% vs 8.3%, respectively). In contrast, 2 patients (16.7%) in group B had marginal ulcers compared to 1 (6.3%) in group A. Also, gastritis was seen in 1 patient in each group (6.3% in group A vs 8.3% in group B). However, the differences were not statistically different. Conclusions. Braun anastomosis is probably an effective procedure to reduce bile reflux, a concern of SASI bypass. Besides, further studies with a larger study population are needed.

PMID:36949026 | DOI:10.1177/15533506231164895

Jt Comm J Qual Patient Saf. 2023 Feb 9:S1553-7250(23)00028-4. doi: 10.1016/j.jcjq.2023.01.014. Online ahead of print.

ABSTRACT

BACKGROUND: Medicare’s Promoting Interoperability Program evaluates how often organizations completely reconcile differences between the internal medical record with problems, medications, and allergies received from outside electronic health records (EHRs) during hospitalizations. This quality improvement project sought to increase rates of complete reconciliation of patient problems, medications, and allergies to 80% of hospitalizations for 90 consecutive days at all eight hospitals in an academic medical system by December 31, 2021.

METHODS: Baseline characteristics were determined using monthly reconciliation performance from October 2019 to October 2020. The intervention period occurred from November 2020 to December 2021 and consisted of 26 Plan-Do-Study-Act cycles. Performance was monitored from January 2022 to June 2022 to observe the sustainability of the initiative. Statistical process control charts were used to identify special cause variation in system-level performance.

RESULTS: All eight hospitals successfully recorded 90 consecutive days of complete reconciliation above 80% in 2021, and seven of eight hospitals maintained this goal in the sustainability period. Average baseline reconciliation was 22.1%. System-level performance satisfied criteria for baseline shift after PDSA 17, when the average performance was recalculated as 52.4%. Criteria for a second baseline shift were satisfied during the sustainability period, when the average performance was recalculated at 79.9%. Overall performance has remained within the recalculated control limits throughout the sustainability period.

CONCLUSION: An intervention that included enhancing EHR workflows, training medical providers, and communicating division performance was successful in increasing and sustaining complete reconciliation of clinical information in a multihospital medical system.

PMID:36948985 | DOI:10.1016/j.jcjq.2023.01.014

Curr Pharm Teach Learn. 2023 Mar 20:S1877-1297(23)00021-7. doi: 10.1016/j.cptl.2023.02.021. Online ahead of print.

ABSTRACT

INTRODUCTION: The authors evaluated student achievement of interprofessional education (IPE) core competencies during two formats (one hybrid and one completely online) of an IPE simulation designed for pharmacy and nursing students.

METHODS: This IPE simulation was designed to teach students to use distance technologies to collaborate on patient care. In 2019, pharmacy (n = 83) and nursing (n = 38) students attended the hybrid (in-person and online) IPE simulation (SIM 2019) with the use of a telepresence robot. In 2020, pharmacy (n = 78) and nursing (n = 48) students attended the simulations completely online (SIM 2020), without the use of a robot. Both sessions aimed to achieve IPE core competencies through interprofessional student collaboration sessions using telehealth distance technologies. Students completed quantitative and qualitative evaluation surveys for both simulations. During SIM 2020, faculty and students used an observation tool to directly assess student team collaboration skills.

RESULTS: Statistically significant improvements in self-assessment of IPE core competency scores were found in both formats of the simulation sessions. There were no statistical differences in faculty ratings with student ratings of team skills using the direct observation of team collaboration. Qualitative results indicated that students found interprofessional collaboration to be the most important lesson learned from the activity.

CONCLUSIONS: Both formats for the simulation achieved core competency learning objectives. IPE is an essential experience for health care education and is achievable online.

PMID:36948979 | DOI:10.1016/j.cptl.2023.02.021

Injury. 2023 Mar 10:S0020-1383(23)00247-4. doi: 10.1016/j.injury.2023.03.011. Online ahead of print.

ABSTRACT

BACKGROUND: The sport of surfing has grown exponentially. Early studies of surfing injuries are outdated as newer and more accessible surf technology has become available. This study’s goal was to describe surfing injury patterns, incidence, and disposition of pediatric and adult surfers.

STUDY DESIGN: A retrospective review of surfing injuries from 2009 to 2020 of adult (>18 years of age) and pediatric (<18 years of age) patients was performed using the National Electronic Injury Surveillance System (NEISS) database. The consumer product code 1261 (Surfing) was used to identify injury patterns. Chi-squared test was performed on all categorical variables. Logistic regression was used on significant variables from the frequency tables. All analysis was performed with R-statistical programming software.

RESULTS: There was an overall decreasing trend of surfing injuries over time. Injuries for both adult and pediatric patients tended to occur most within the summer season (p<0.001). The odds of an adult surfing injury victim being male is 2.89 (95% CI 1.87-4.44). The head/neck/face were the most injured body part in both groups. The pediatric group had a significantly higher rate of concussions at 6.5% compared to the adult group at 3.2%. Overall, the most common injury type was to the skin (p<0.001). Disposition between groups were similar with most patients being discharged home. Mortality was rare with three reported fatalities in the adult group and none in the pediatric group.

CONCLUSION: The incidence of surfing injuries is continuing to decline despite more people surfing, revealing the improved safety of the sport over the last decade. Head/neck/face injuries are common injury locations, and pediatric surfers are particularly at increased risk of concussions. Continued education, usage of safety equipment such as protective headgear, and awareness of injury patterns, could further lessen potential injuries.

PMID:36948953 | DOI:10.1016/j.injury.2023.03.011

Nutr Metab Cardiovasc Dis. 2023 Feb 16:S0939-4753(23)00067-4. doi: 10.1016/j.numecd.2023.02.009. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Remnant cholesterol (RC) adversely contributes to cardiovascular disease (CVD) and overall survival in various diseases. However, its role in CVD outcomes and all-cause mortality in patients undergoing peritoneal dialysis (PD) is limited. Therefore, we aimed to investigate the association between RC and all-cause and CVD mortality in patients undergoing PD.

METHODS AND RESULTS: Based on lipid profiles recorded using standard laboratory procedures, fasting RC levels were calculated in 2710 incident patients undergoing PD who were enrolled between January 2006 and December 2017 and followed up until December 2018. Patients were divided into four groups according to the quartile distribution of baseline RC levels (Q1: <0.40 mmol/L, Q2: 0.40 to <0.64 mmol/L, Q3: 0.64 to <1.03 mmol/L, and Q4: ≥1.03 mmol/L). Associations between RC and CVD and all-cause mortality were evaluated using multivariable Cox models. During the median follow-up period of 35.4 months (interquartile range, 20.9-57.2 months), 820 deaths were recorded, of which 438 were CVD-related. Smoothing plots showed non-linear relationships between RC and adverse outcomes. The risks of all-cause and CVD mortality increased progressively through the quartiles (log-rank, p < 0.001). Using adjusted proportional hazard models, a comparison of the highest (Q4) to lowest (Q1) quartiles revealed significant increases in the hazard ratio (HR) for all-cause mortality (HR 1.95 [95% confidence interval (CI), 1.51-2.51]) and CVD mortality risk (HR 2.60 [95% CI, 1.80-3.75]).

CONCLUSION: An increased RC level was independently associated with all-cause and CVD mortality in patients undergoing PD, suggesting that RC was important clinically and required further research.

PMID:36948938 | DOI:10.1016/j.numecd.2023.02.009

Nutr Metab Cardiovasc Dis. 2023 Feb 23:S0939-4753(23)00072-8. doi: 10.1016/j.numecd.2023.02.014. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Overweight and obesity are well recognized as important and traditional risk factors for hypertension (HTN), but the prevalence of HTN tends to increase in non-overweight people. Triglyceride-glucose (TyG) index has been observed to be associated with HTN. However, whether such association still persists in non-overweight people remains unclear. The aim of our cohort study was to explore the link between TyG index and incident HTN in non-overweight Chinese population.

METHODS AND RESULTS: As many as 4678 individuals without HTN at baseline were involved, who underwent at least two years of health check-ups in the eight-year study period and maintained non-overweight at follow-up. According to baseline TyG index quintiles, participants were classified into five groups. Compared with the 1st quantile, those in the 5th quantile of TyG index had a 1.73-fold (HR 95% CI 1.13-2.65) risk of incident HTN. The results remained consistent when analyses were restricted to participants without abnormal TG or FPG level at baseline (HR 1.62, 95% CI 1.17-2.26). Furthermore, the subgroup analyses were conducted, the risk of incident HTN was still significantly increased with increasing TyG index for subgroups of older participants (age≥ 40 years), males, females and higher BMI group (BMI≥ 21 kg/m²).

CONCLUSIONS: The risk of incident HTN increased with increasing TyG index among Chinese non-overweight adults, so TyG index might be a reliable predictor of incident HTN among adults maintaining non-overweight.

PMID:36948935 | DOI:10.1016/j.numecd.2023.02.014

Women Birth. 2023 Mar 20:S1871-5192(23)00043-4. doi: 10.1016/j.wombi.2023.03.002. Online ahead of print.

ABSTRACT

BACKGROUND: The development of competent professional midwives is a pre-requisite for improving access to skilled attendance at birth and reducing maternal and neonatal mortality. Despite an understanding of the skills and competencies needed to provide high- quality care to women during pregnancy, birth and the post-natal period, there is a marked lack of conformity and standardisation in the approach between countries to the pre-service education of midwives. This paper describes the diversity of pre-service education pathways, qualifications, duration of education programmes and public and private sector provision globally, both within and between country income groups.

METHODS: We present data from 107 countries based on survey responses from an International Confederation of Midwives (ICM) member association survey conducted in 2020, which included questions on direct entry and post-nursing midwifery education programmes.

FINDINGS: Our findings confirm that there is complexity in midwifery education in many countries, which is concentrated in low -and middle-income countries (LMICS). On average, LMICs have a greater number of education pathways and shorter duration of education programmes. They are less likely to attain the ICM-recommended minimum duration of 36 months for direct entry. Low- and lower-middle income countries also rely more heavily on the private sector for provision of midwifery education.

CONCLUSION: More evidence is needed on the most effective midwifery education programmes in order to enable countries to focus resources where they can be best utilised. A greater understanding is needed of the impact of diversity of education programmes on health systems and the midwifery workforce.

PMID:36948913 | DOI:10.1016/j.wombi.2023.03.002

Am J Surg. 2023 Mar 13:S0002-9610(23)00106-X. doi: 10.1016/j.amjsurg.2023.03.009. Online ahead of print.

ABSTRACT

BACKGROUNDS: New methods such as machine learning could provide accurate predictions with little statistical assumptions. We seek to develop prediction model of pediatric surgical complications based on pediatric National Surgical Quality Improvement Program(NSQIP).

METHODS: All 2012-2018 pediatric-NSQIP procedures were reviewed. Primary outcome was defined as 30-day post-operative morbidity/mortality. Morbidity was further classified as any, major and minor. Models were developed using 2012-2017 data. 2018 data was used as independent performance evaluation.

RESULTS: 431,148 patients were included in the 2012-2017 training and 108,604 were included in the 2018 testing set. Our prediction models had high performance in mortality prediction at 0.94 AUC in testing set. Our models outperformed ACS-NSQIP Calculator in all categories for morbidity (0.90 AUC for major, 0.86 AUC for any, 0.69 AUC in minor complications).

CONCLUSIONS: We developed a high-performing pediatric surgical risk prediction model. This powerful tool could potentially be used to improve the surgical care quality.

PMID:36948897 | DOI:10.1016/j.amjsurg.2023.03.009

Ultrasound Med Biol. 2023 Mar 20:S0301-5629(23)00062-5. doi: 10.1016/j.ultrasmedbio.2023.02.010. Online ahead of print.

ABSTRACT

OBJECTIVE: Hepatic acute graft-versus-host disease (aGVHD) is a serious complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT) and is one of the leading causes of early non-recurrent death. The current diagnosis is based mainly based on clinical diagnosis, and there is a lack of non-invasive quantitative diagnosis methods. We propose a multiparametric ultrasound (MPUS) imaging method and explore its effectiveness in evaluating hepatic aGVHD.

METHODS: In this study, 48 female Wistar rats were used as receptors and 12 male Fischer 344 rats were used as donors for allo-HSCT to establish aGVHD models. After transplantation, 8 rats were randomly selected for ultrasonic examination weekly, including color Doppler ultrasound, contrast-enhanced ultrasound (CEUS) and shear wave dispersion (SWD) imaging. The values of nine ultrasonic parameters were obtained. Hepatic aGVHD was subsequently diagnosed by histopathological analysis. A classification model for predicting hepatic aGVHD was established using principal component analysis and support vector machines.

RESULTS: According to the pathological results, the transplanted rats were categorized into the hepatic aGVHD and non-GVHD (nGVHD) groups. All parameters obtained by MPUS differed statistically between the two groups. The first three contributing percentages of principal component analysis results were resistivity index, peak intensity and shear wave dispersion slope, respectively. The accuracy of classifying aGVHD and nGVHD using support vector machines reached 100%. The accuracy of the multiparameter classifier was significantly higher than that of the single parameter.

CONCLUSION: The MPUS imaging method has proven to be useful in detecting hepatic aGVHD.

PMID:36948895 | DOI:10.1016/j.ultrasmedbio.2023.02.010