Nevin Manimala

J Intern Med. 2022 Apr 5. doi: 10.1111/joim.13492. Online ahead of print.

ABSTRACT

BACKGROUND: Previous studies reported regional differences in end-of-life care (EoLC) for critically ill patients in Europe.

OBJECTIVES: The purpose of this post-hoc analysis of the prospective multi-centre COVIP study was to investigate variations in EoLC practices among older patients in intensive care units during the coronavirus disease 2019 pandemic.

METHODS: A total of 3105 critically ill patients aged 70 years and older were enrolled in this study (Central Europe: n = 1573; Northern Europe: n = 821; Southern Europe: n = 711). Generalised estimation equations were used to calculate adjusted odds ratios (aOR) to population averages. Data were adjusted for patient-specific variables (demographic, disease-specific) and health economic data (GDP, health expenditure per capita). The primary outcome was any treatment limitation, and 90-day-mortality was a secondary outcome.

RESULTS: The frequency of the primary endpoint (treatment limitation) was highest in Northern Europe (48%), intermediate in Central Europe (39%), and lowest in Southern Europe (24%). The likelihood for treatment limitations was lower in Southern than in Central Europe (aOR 0.39; 95%CI 0.21-0.73; p = 0.004), even after multivariable adjustment, whereas no statistically significant differences were observed between Northern and Central Europe (aOR 0.57; 95%CI 0.27-1.22; p = 0.15). After multivariable adjustment, no statistically relevant mortality differences were found between Northern and Central Europe (aOR 1.29; 95%CI 0.80-2.09; p = 0.30) or between Southern and Central Europe (aOR 1.07; 95%CI 0.66-1.73; p = 0.78).

CONCLUSION: This study shows a north-to-south gradient in rates of treatment limitation in Europe, highlighting the heterogeneity of EoLC practices across countries. However, mortality rates were not affected by these results. This article is protected by copyright. All rights reserved.

PMID:35398948 | DOI:10.1111/joim.13492

J Orthop Res. 2022 Apr 10. doi: 10.1002/jor.25333. Online ahead of print.

ABSTRACT

Modic changes (MC) and endplate abnormalities (EA) have been shown to impact preoperative symptoms and outcomes following spinal surgery. However, little is known about how these phenotypes impact cervical alignment. This study aimed to evaluate the impact that these phenotypes have on preoperative, postoperative, and changes in cervical alignment in patients undergoing anterior cervical discectomy and fusion (ACDF). We performed a retrospective study of prospectively collected data of ACDF patients at a single institution. Preoperative magnetic resonance imagings (MRIs) were used to assess for the MC and EA. Patients were subdivided into four groups: MC-only, EA-only, the combined Modic-Endplate-Complex (MEC), and patients without either phenotype. Pre and postoperative MRIs were used to assess alignment parameters. Associations with imaging phenotypes and alignment parameters were assessed, and statistical significance was set at p < 0.5. A total of 512 patients were included, with 84 MC-only patients, 166 EA-only patients, and 71 patients with MEC. Preoperative MC (p = 0.031) and the MEC (p = 0.039) had significantly lower preoperative T1 slope compared to controls. Lower preoperative T1 slope was a risk factor for MC (p = 0.020) and MEC (p = 0.029) and presence of MC (Type II) and the MEC (Type III) was predictive of lower preoperative T1 slope. There were no differences in postoperative alignment measures or patient reported outcome measures. MC and endplate pathologies such as the MEC appear to be associated with worse cervical alignment at baseline relative to patients without these phenotypes. Poor alignment may be an adaptive response to these degenerative findings or may be a risk factor for their development.

PMID:35398932 | DOI:10.1002/jor.25333

Scand J Psychol. 2022 Apr 10. doi: 10.1111/sjop.12820. Online ahead of print.

ABSTRACT

Resilience is one of the protective factors for mental health. The aim of this study is to reveal the role of COVID-19 anxiety and intolerance of uncertainty in predicting resilience in adulthood. To this end, data were collected from 533 adults (359 women-174 men). A hierarchical regression analysis was performed, controlling for the effects of gender and presence of a chronic disease on the prediction of resilience. Results showed that intolerance of uncertainty and COVID-19 anxiety were statistically significant predictors of resilience. Gender and presence of a chronic disease were not statistically significant in predicting resilience. These results indicate that intolerance of uncertainty plays an important role in explaining resilience.

PMID:35398920 | DOI:10.1111/sjop.12820

Acta Paediatr. 2022 Apr 9. doi: 10.1111/apa.16355. Online ahead of print.

ABSTRACT

AIM: To evaluate an intervention where nurses in child health care services routinely talk to and inform parents about violence.

METHODS: The intervention included providing information during home-visits and individual conversations with mothers and fathers/partners in connection with screening for parental depression. A convergent mixed-methods design was used with a documentation form for each child (n=475) and results from focus group interviews with nurses. Quantitative data were analyzed using descriptive statistics and qualitative with manifest content analysis.

RESULTS: Almost all families participated in the intervention; individual conversations were conducted with nearly all the mothers, and to a somewhat lesser extent with the fathers/partners. Initially, the nurses felt slightly uncomfortable about these conversations, but described experiencing development and professionalization in their role of talking about violence. Parents’ reactions were generally positive and they expressed appreciation for this topic being raised.

CONCLUSION: The results show that the intervention has been carried out successfully. The newborn period is a phase in which mothers and fathers are interested and receptive to knowledge and support in sensitive matters. Prerequisites for implementation were the preparation phase for the nurses, the use of routine questioning, and a questionnaire as a basis for the conversations.

PMID:35398911 | DOI:10.1111/apa.16355

Clin Transplant. 2022 Apr 10:e14669. doi: 10.1111/ctr.14669. Online ahead of print.

ABSTRACT

INTRODUCTION: There are higher rates of depression and suicidal ideation among those with chronic diseases, including end-stage renal disease, diabetes mellitus and liver disease. Suicide is the tenth leading cause of death worldwide and is more prevalent among transplant recipients. Although transplantation has the potential to improve quality of life, many transplant recipients commit suicide each year. The extent to which sex, race, age, type of insurance coverage, time on wait list, comorbidities, immunosuppressive regimen and graft loss contribute to suicide risk in this population remains understudied.

METHODS: We queried UNOS data collected between 1990 and 2019 to determine what risk factors contribute to suicide in the transplant population. Suicide mortality rate was calculated by determining the fraction of organ recipients who died by suicide since 1990 and was expressed as deaths per 100000. Two groups (suicide and all other cause mortality) were compared via univariate and multivariate statistical analysis. Time to graft loss was estimated using a Kaplan Meier Product Limit method. A propensity score analysis was performed to match patients who committed suicide to those who did not, allowing us to balance the relatively small sample of size of the suicide cohort with the larger all other cause mortality group to minimize the effect of confounding variables. We estimated years of organ life lost using the restricted mean. Statistical significance was defined by p-value <0.05.

RESULTS: The data included 135432 transplant deaths in total; the majority were kidney recipients-82305 (61%). We determined suicide rates of 0.28%, 0.31% and 0.44% for kidney, liver and pancreas, respectively, with an overall rate of 0.3%. Across all three organs the most significant risk factor was male sex. Non-Hispanic whites were also at elevated risk (OR = 2.16, p<0.003). In the liver and kidney transplant groups, the odds of committing suicide were reduced by 4% with advancing age. The odds of taking one’s own life was inversely related to BMI in the kidney and pancreas groups. We observed a doubling of suicide rates from 0.3% in 2014 to 0.6% in 2018. There were no other statistically significant correlations.

CONCLUSION: Suicide is more prevalent among transplant recipients than in the general population. White males in particular are most at risk. The highest rate of suicide was in pancreas recipients. Advancing age and increasing BMI conferred some protective effect. There were no significant associations between suicide incidence and glucocorticoid use, type of insurance coverage, time on wait list or graft loss. The phenomenon has become more prevalent in recent years. This article is protected by copyright. All rights reserved.

PMID:35398909 | DOI:10.1111/ctr.14669

J Oral Rehabil. 2022 Apr 9. doi: 10.1111/joor.13331. Online ahead of print.

ABSTRACT

BACKGROUND: The evidence on the relationship between anxiety and depression and patients with distinct subtypes of temporomandibular disorder (TMD) is uncertain, so a thorough review study on the topic is still missing.

OBJECTIVES: This systematic review investigated the distribution and severity of anxiety and depression in patients diagnosed with different subtypes of TMD.

METHODS: The study is registered in PROSPERO (CRD42020150562) and it followed the PRISMA 2020 Statement. We searched in PubMed, Web of Science, Scopus, and SciELO databases (last search: 12 March 2021) and the reference list from the included studies. Study eligibility criteria consisted of: (i) patients diagnosed with TMD using the Research Diagnostic Criteria (RDC/TMD) or Diagnostic Criteria (DC/TMD) instruments; (ii) assessment of anxiety and/or depression with validated psychological instruments; and (iii) allocation of patients into a minimum of two distinct TMD subtypes with at least one group having myofascial pain (comparison group). Analyses were carried out using RevMan 5.3.5 statistical package and random- or fixed-effects models (α=0.05). The quality of evidence was assessed based on review authors’ judgment derived from a 10-item appraisal tool for prevalence studies and with the Newcastle-Ottawa Scale.

RESULTS: Out of the 4,086 records identified in total, 24 were eligible for inclusion; meta-analyses were conducted with 20 studies. In total, 3,678 subjects were included in the review. Most of the studies found that patients with myofascial pain showed similar occurrence and severity of anxiety/depression as compared to other subtypes of TMD, although the average prevalence seemed to be higher among the diagnoses consisting of myofascial pain (muscular TMD). Despite the moderate-to-high heterogeneity, anxiety and depression were more frequently distributed within patients with myofascial pain (p=0.001). TMD patients without myofascial pain presented less severe levels of anxiety and depression than patients with only myofascial pain (p≤0.01). The type of psychological instrument seems to affect the assessment of both anxiety and depression emotional states.

CONCLUSION: The findings of this review suggest that patients with myofascial pain are more anxious and more depressed than patients with other subtypes of TMD.

IMPLICATIONS: Considering that anxiety and depression are differently distributed within the TMD population, a proper assessment of the psychological state of patients seems essential to offer an adequate treatment and management of each specific subtype of TMD.

PMID:35398904 | DOI:10.1111/joor.13331

Photochem Photobiol. 2022 Apr 10. doi: 10.1111/php.13633. Online ahead of print.

ABSTRACT

The current study intended to evaluate the effect of photobiomodulation on the morphology and function of EVs secreted from mesenchymal stem cells (MSCs) derived from periodontal ligament (PDL) and the buccal fat pad (BFP) in vitro.These cells were irradiated at 660 nm or kept in dark as control. EVs were then isolated from each group using ultracentrifugation. EVs were defined by Flow cytometry and Western blot tests. Electron microscopy (SEM) was used to study the morphology of EVs. Then MTT and wound healing scratch assays were applied to compare the cell survival and migration of human dermal fibroblast (HDF) cells treated with the EVs obtained from the four groups. According to SEM images, isolated EV were round and cup-shaped in all groups showing no destructive effects of laser irradiation on EV morphology. MTT test results revealed statistically significant difference between the HDF cells treated with different EV groups from hPDLSCs-Dark in compared to control (0 μg/mL) (p <0.05) and treated with exosome from hPDLSCs-Irradiation cells compared to dark group (p <0.05). However, scratch wound healing assay did not show significant different between various groups (p ˃0.05). Further studies with different irradiation protocols are recommended to find an optimal strategy.

PMID:35398890 | DOI:10.1111/php.13633

Cancer Nurs. 2022 Apr 1. doi: 10.1097/NCC.0000000000001105. Online ahead of print.

ABSTRACT

BACKGROUND: Cancer is the second leading cause of death in the United States. Patients with metastatic cancer have a high symptom burden. Major global and domestic cancer care recommendations advise integration of palliative care services for these patients. Palliative care is specialized care that can decrease cost, improve symptom burden, and improve quality of life. Patient factors driving the use of palliative care remain poorly understood but may include both physiological and psychological needs, namely, pain and depression, respectively.

OBJECTIVE: The objective of this study was to identify patient-level predictors associated with inpatient palliative care use in patients with metastatic cancer.

METHODS: This was a secondary analysis of the 2018 New Jersey State Inpatient Database. The sample was limited to hospitalized adults with metastatic cancer in New Jersey. Descriptive statistics characterized the sample. Generalized linear modeling estimated the effects of pain and depression on the use of inpatient palliative care.

RESULTS: The sample included 28 697 hospitalizations for patients with metastatic cancer. Within the sample, 4429 (15.4%) included a palliative care consultation. There was a 9.3% documented occurrence of pain and a 10.9% rate of depression. Pain contributed to palliative care use, but depression was not predictive of an inpatient care consultation. Age, income category, and insurance status were significant factors influencing use.

CONCLUSION: Understanding demographic and clinical variables relative to palliative care use may help facilitate access to palliative care for adults experiencing metastatic cancer.

IMPLICATION FOR PRACTICE: Increased screening for pain and depression may expand palliative care use for adults with metastatic cancer receiving inpatient care.

PMID:35398871 | DOI:10.1097/NCC.0000000000001105

Cancer Nurs. 2022 Apr 9. doi: 10.1097/NCC.0000000000001099. Online ahead of print.

ABSTRACT

BACKGROUND: Breast cancer patients experience a range of disease- and treatment-related symptoms that seriously threaten their quality of life. Virtual reality (VR), an emerging complementary and integrative therapy, has been increasingly applied in clinical practice. However, there is insufficient evidence to support the effectiveness of VR-based interventions on symptom management in breast cancer patients.

OBJECTIVE: This article aimed to systematically examine the effects of VR on breast cancer-related symptom management.

METHODS: The PubMed, EMBASE, Cochrane Library, Web of Science, CINAHL, CNKI, Wan Fang, and VIP databases were comprehensively searched for randomized controlled trials (RCTs) and quasi-RCTs published up to April 10, 2021. Studies using VR-based interventions to manage breast cancer-related symptoms were included. Two investigators independently reviewed and extracted data and evaluated methodological quality. RevMan 5.3 was used for meta-analysis, and heterogeneity was evaluated using Higgins’ I2 (%) statistic.

RESULTS: Eight RCTs and 6 quasi-RCTs with 797 participants were included. Virtual reality-based interventions significantly improved symptoms of anxiety, depression, pain, cognitive function, and shoulder range of motion in breast cancer patients, but no significant improvements in grip and upper extremity function were observed.

CONCLUSION: Virtual reality-based interventions had a positive effect on symptom management for breast cancer patients.

IMPLICATIONS FOR PRACTICE: Health professionals, especially nurses, can apply VR in clinical practice to reduce symptoms and improve the quality of life of breast cancer patients. More studies are needed to draw higher quality conclusions and explore the best interventions and cost-effectiveness of VR.

PMID:35398864 | DOI:10.1097/NCC.0000000000001099

J Pediatr Hematol Oncol. 2022 Apr 6. doi: 10.1097/MPH.0000000000002458. Online ahead of print.

ABSTRACT

The purpose of the present study is to examine taste alteration in children with acute lymphoblastic leukemia (ALL) undergoing maintenance treatment. The population of the study was comprised of children with ALL between the ages of 7 and 18 who received maintenance treatment. The study sample was included 72 children (children with ALL:36 and healthy children: 36) determined by power analysis. This was a cross-sectional study. The children in both groups were applied to the taste test by the researcher. It was determined that there is a statistically significant difference (P<0.05) between sweet (sucrose), salty (sodium chloride), sour (citric acid), and bitter (quinine hydrochloride) taste test score averages of the children with ALL and healthy children and that the 4 taste test score averages are lower in the experiment group. The taste alterations were determined in the present study for children with ALL undergoing maintenance treatment. Problems of children with cancer such as loss of appetite, negative attitude toward food or weight loss can be reduced or prevented when taste alteration is determined in children with cancer thereby improving the feeding of the children thereby increasing their quality of life.

PMID:35398859 | DOI:10.1097/MPH.0000000000002458