Nevin Manimala

Intensive Crit Care Nurs. 2021 Oct 28:103160. doi: 10.1016/j.iccn.2021.103160. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the muscle strength and functional level of patients discharged from intensive care unit (ICU) in relation to the swimmer position as a nurse intervention during pronation.

METHODS: Prospective study conducted in the hub COVID-19 center in Milan (Italy), between March and June 2020. All patients with COVID-19 discharged alive from ICU who received invasive mechanical ventilation were included. Forward continuation ratio model was fitted to explore the statistical association between muscle strength grades and body positioning during ICU stay.

RESULTS: Over the 128 patients admitted to ICU, 87 patients were discharged alive from ICU, with available follow-up measures at hospital discharge. Thirty-four patients (39.1%) were treated with prone positioning as rescue therapy, for a total of 106 pronation cycles with a median duration of 72 (IQR 60-83) hours. Prone positioning did not influence the odds of showing particular level of muscle strength, in any of the evaluated districts, namely shoulder (OR 1.34, 95%CI:0.61-2.97), elbow (OR 1.10, 95%CI:0.45-2.68) and wrist (OR 0.97, 95%CI:0.58-1.63). Only in the shoulder district, age showed evidence of association with strength (OR 1.06, 95%CI:1.02-1.10), affecting people as they get older. No significant sequalae related to swimmer position were reported by physiotherapists or nurses.

CONCLUSION: Swimmer position adopted during prone ventilation is not associated with worse upper limb strength or poor mobility level in COVID-19 survivors after hospital discharge.

PMID:34789437 | DOI:10.1016/j.iccn.2021.103160

Surg Obes Relat Dis. 2021 Oct 23:S1550-7289(21)00512-8. doi: 10.1016/j.soard.2021.10.014. Online ahead of print.

ABSTRACT

BACKGROUND: Biliopancreatic diversion with duodenal switch (BPD/DS) is a procedure that has long been considered to have a higher early postoperative morbidity than Roux-En-Y gastric bypass (RYGB). However, patients who undergo BPD/DS have more baseline co-morbidities that may affect the reported early postoperative morbidity.

OBJECTIVE: To compare 30-day postoperative morbidity and mortality between BPD/DS and RYGB propensity score-matched cohorts obtained from the MBSAQIP database.

SETTING: Analysis of data obtained from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database.

METHODS: Retrospective analysis of 21-variable propensity score-matched patients in the BPD/DS and RYGB groups obtained from the MBSAQIP database between 2015 and 2019. Variables included age, sex, body mass index, American Society of Anesthesiologists (ASA) class, and pertinent medical co-morbidities. Data were analyzed for 30-day postoperative morbidity, mortality, reoperation, reintervention, and readmissions.

RESULTS: Before matching, RYGB and BPD/DS cohorts contained 134 188 and 5079 patients, respectively. After multivariable propensity score matching, each cohort contained 5050 patients. The RYGB group had a higher rate of surgical-site infections than the BPD/DS group (1% versus .5%, P = .007) and a higher rate of blood product transfusions (1.1% versus .6%, P = .018). The rate of other early postoperative complications was similar between the 2 groups (P > .05). There was no statistically significant difference in the 30-day mortality, readmission rate, reoperation rate, or reintervention rate between the 2 groups (P > .05).

CONCLUSION: When matched for baseline body mass index and co-morbidities, BPD/DS does not lead to a higher 30-day postoperative morbidity and mortality than RYGB. Patients can be counseled that in the short term, BPD/DS is as safe as RYGB.

PMID:34789419 | DOI:10.1016/j.soard.2021.10.014

Spectrochim Acta A Mol Biomol Spectrosc. 2021 Nov 8:120591. doi: 10.1016/j.saa.2021.120591. Online ahead of print.

ABSTRACT

In this study, a facile, rapid, and sensitive spectrofluorimetric method was evolved to analyse two antihypertensive drugs, namely, metolazone (MTZ) and valsartan (VST), in pharmaceutical and biological matrices. Both analytes exhibited intrinsic fluorescence activities which were significantly affected by environmental factors such as pH and solvent systems. However, simultaneous determination of MTZ and VST by conventional spectrofluorometry cannot be achieved simply because of the strong overlap between their fluorescence spectra. Thus, a combination of derivative and synchronous spectrofluorometry was conducted to overcome this dilemma. The proposed method relies on measurement of the first-order derivative of synchronous fluorescence intensity of the studied drugs at Δλ = 160 nm using 0.1 M acetic acid as the optimum solvent. The amplitudes of the first derivative synchronous fluorescence spectra of MTZ and VST were recorded at 236.0 nm (zero-crossing point of VST) and at 262.8 nm (zero-crossing point of MTZ) for simultaneous analysis of MTZ and VST, respectively. The fluorescent method was optimized efficiently to get the maximum selectivity and sensitivity by investigating different solvents, different buffer pHs, and different surfactants. The highest sensitivity and selectivity were achieved when 0.1 M acetic acid was used as a solvent. The method showed a linear concentration range of 10.0-100.0 ng mL^-1 and a limit of detection of <3.0 ng mL^-1 for each analyte. Statistical data analysis confirmed that no significant difference between the proposed spectrofluorometric method and the reference methods. The validity of the proposed spectrofluorometric method approved its suitability for quality control work. The proposed spectrofluorometric method was applied to assay the studied drugs in pharmaceutical dosage and in biological matrices with acceptable %recoveries and small RSD values.

PMID:34789407 | DOI:10.1016/j.saa.2021.120591

J Am Pharm Assoc (2003). 2021 Nov 2:S1544-3191(21)00448-9. doi: 10.1016/j.japh.2021.10.029. Online ahead of print.

ABSTRACT

BACKGROUND: Students in health professions, including student pharmacist, are at an increased risk of psychological distress. Unfortunately, effective efforts to combat burnout for student pharmacists are still lacking in the literature and create a void in schools and colleges of pharmacy that seek to assist their students.

OBJECTIVES: The objective of this study was to explore how increasing positive out-of-class interactions between the student pharmacists and faculty members affect burnout, especially in work exhaustion and interpersonal disengagement. Professional fulfillment was also assessed as a primary outcome.

METHODS: The institutional review board approved this study consisting of 4 faculty members and 12 students. After providing informed consent, the participants were assigned to one of 4 groups. Each group included 1 faculty member and 3 students. At the start of the study, each participant completed a modified Stanford Professional Fulfillment Index questionnaire to measure baseline burnout characteristics and initial level of professional fulfillment. For 8 weeks, the groups met weekly to discuss a topic related to burnout and professional fulfillment. After 8 weeks, each participant completed the postquestionnaire. Wilcoxon signed-rank tests were performed to the mean scores (pre vs. post) in each of the 3 constructs. The statistical significance was set at P < 0.05.

RESULTS: The results of the Wilcoxon signed-rank analysis showed a statistically significant difference in the burnout constructs, work exhaustion and interpersonal disengagement. There was not a statistically significant change in professional fulfillment.

CONCLUSIONS: Improving relationships between student pharmacist and faculty through increasing out-of-class interactions benefits individuals who are at risk of experiencing burnout. Future initiatives can focus on effective strategies that target work exhaustion and interpersonal disengagement and build on the social networks that develop in pharmacy school.

PMID:34789404 | DOI:10.1016/j.japh.2021.10.029

Eur Urol. 2021 Nov 14:S0302-2838(21)02117-5. doi: 10.1016/j.eururo.2021.10.016. Online ahead of print.

ABSTRACT

BACKGROUND: The taxanes docetaxel and cabazitaxel prolong overall survival for men with metastatic castration-resistant prostate cancer (mCRPC), with cabazitaxel approved in the postdocetaxel setting only. Recent data suggest they have similar efficacy but a different safety profile in the first-line mCRPC setting.

OBJECTIVE: To assess patient preference between docetaxel and cabazitaxel among men who received one or more doses of each taxane and did not experience progression after the first taxane.

DESIGN, SETTING, AND PARTICIPANTS: Chemotherapy-naïve patients with mCRPC were randomized 1:1 to receive docetaxel (75 mg/m² every 3 wk × 4 cycles) followed by cabazitaxel (25 mg/m² every 3 wk × 4 cycles) or the reverse sequence. Randomization was stratified by prior abiraterone or enzalutamide use.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The primary endpoint was patient preference, assessed via a dedicated questionnaire after the second taxane. Secondary endpoints included reasons for patient preference, prostate-specific antigen response, radiological progression-free survival, and overall survival. This clinical trial is registered at ClinicalTrials.gov as NCT02044354.

RESULTS AND LIMITATIONS: Of 195 men randomized, 152 met the prespecified modified intent-to-treat criteria for analysis. Overall, 66 patients (43%) preferred cabazitaxel, 40 (27%) preferred docetaxel, and 46 (30%) had no preference (p = 0.004, adjusted for treatment period effect). More patients preferred treatment period 1 (43%, 95% confidence interval [CI] 36-52%) versus period 2 (27%, 95% CI 20-34%). Patient preference for cabazitaxel was mainly related to less fatigue (72%), better quality of life (64%), and other adverse events (hair loss, pain, nail disorders, edema). Adverse events were consistent with the known safety profile of each drug.

CONCLUSIONS: A significantly higher proportion of chemotherapy-naïve men with mCRPC who received both taxanes preferred cabazitaxel over docetaxel. Less fatigue and better quality of life were the two main reasons driving patient choice.

PATIENT SUMMARY: Men with metastatic castration-resistant prostate cancer preferred cabazitaxel over docetaxel for chemotherapy, mainly because of less fatigue and better quality of life.

PMID:34789394 | DOI:10.1016/j.eururo.2021.10.016

Eur Urol. 2021 Nov 14:S0302-2838(21)02133-3. doi: 10.1016/j.eururo.2021.10.030. Online ahead of print.

ABSTRACT

BACKGROUND: It is hypothesised that simulation enhances progression along the initial phase of the surgical learning curve.

OBJECTIVE: To evaluate whether residents undergoing additional simulation, compared to conventional training, are able to achieve proficiency sooner with better patient outcomes.

DESIGN, SETTING, AND PARTICIPANTS: This international, multicentre, randomised controlled trial recruited 94 urology residents with experience of zero to ten procedures and no prior exposure to simulation in ureterorenoscopy, selected as an index procedure.

INTERVENTION: Participants were randomised to simulation or conventional operating room training, as is the current standard globally, and followed for 25 procedures or over 18 mo.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The number of procedures required to achieve proficiency, defined as achieving a score of ≥28 on the Objective Structured Assessment of Technical Skill (OSATS) scale over three consecutive operations, was measured. Surgical complications were evaluated as a key secondary outcome. This trial is registered at www.isrctn.com as ISCRTN 12260261.

RESULTS AND LIMITATIONS: A total of 1140 cases were performed by 65 participants, with proficiency achieved by 21 simulation and 18 conventional participants over a median of eight and nine procedures, respectively (hazard ratio [HR] 1.41, 95% confidence interval [CI] 0.72-2.75). More participants reached proficiency in the simulation arm in flexible ureterorenoscopy, requiring a lower number of procedures (HR 0.89, 95% CI 0.39-2.02). Significant differences were observed in overall comparison of OSATS scores between the groups (mean difference 1.42, 95% CI 0.91-1.92; p < 0.001), with fewer total complications (15 vs 37; p = 0.003) and ureteric injuries (3 vs 9; p < 0.001) in the simulation group.

CONCLUSIONS: Although the number of procedures required to reach proficiency was similar, simulation-based training led to higher overall proficiency scores than for conventional training. Fewer procedures were required to achieve proficiency in the complex form of the index procedure, with fewer serious complications overall.

PATIENT SUMMARY: This study investigated the effect of simulation training in junior surgeons and found that it may improve performance in real operating settings and reduce surgical complications for complex procedures.

PMID:34789393 | DOI:10.1016/j.eururo.2021.10.030

Injury. 2021 Oct 31:S0020-1383(21)00907-4. doi: 10.1016/j.injury.2021.10.035. Online ahead of print.

ABSTRACT

AIM OF THE STUDY: The aim of this study is to identify if there is any association between neuromuscular disorders and prosthetic dislocation in patients treated with hip hemiarthroplasty for neck of femur fractures.

PATIENTS AND METHODS: Our study is a retrospective analysis of data collected over 34 years for patients with intracapsular neck of femur fracture who underwent hip hemiarthroplasty. Pathological fractures and patients treated with other treatment modalities were excluded. The study population is composed of four groups; patients with no neuromuscular disorders, patients with Parkinson’s disease, patients with previous stroke, and patients with mental impairment.

RESULTS: A total of 3827 patients were treated with hip hemiarthroplasty. For the 3371 patients with no neuromuscular condition (Group I) the dislocation rate was 1.1%. 219 patients had Parkinsonism (Group II) with a dislocation rate of 3.2%, 104 patients had a previous stroke with weakness on the fracture side with a dislocation rate of 1.0% (Group III), and 984 patients had severe mental impairment with a dislocation rate of 1.8% (Group IV). The increased dislocation rate for those with Parkinson’s disease was statistically significant (p = 0.02) while none of the other neuromuscular conditions were statistically significant.

CONCLUSION: Our study demonstrates an increased risk of dislocation after hemiarthroplasty for patients with Parkinson’s disease in comparison to other groups. No increase was apparent for those with mental impairment or weakness from a previous stroke.

PMID:34789388 | DOI:10.1016/j.injury.2021.10.035

Injury. 2021 Nov 14:S0020-1383(21)00912-8. doi: 10.1016/j.injury.2021.11.007. Online ahead of print.

ABSTRACT

BACKGROUND: The majority of neck of femur (NOF) fractures are treated operatively in the United Kingdom. The literature reports the advantages of operative management for these patients. However, whilst a subset is treated non-operatively, there is currently no clear guidance for the selection and subsequent management of these patients. This study aims to explore the incidence, demographics, inpatient stay, use of imaging and outcomes of patients who have non-operatively managed NOF fractures.

METHODS: A 6-year retrospective review (2013-2019) of all non-operatively managed NOF fractures at a tertiary teaching hospital and major trauma centre was conducted. Electronic patient records, radiographs and National Hip Fracture Database (NHFD) data were used to obtain information. We noted demographic details, fracture classification, rationale for non-operative management, mortality, clinical frailty score (CFS), use of imaging and analgesia requirements. Patients who were repatriated or transferred to other sites for specialist surgery were excluded.

RESULTS: 3.2% (99/3132) of NOF fractures were managed non-operatively. The two commonest reasons for non-operative management were either ‘comfortable mobilisation’ (n = 44) or ‘patient frailty/medically unwell’ (n = 50). 74% (37/50) of the patients in whom operative risk was thought to outweigh benefit died within the 30 days of admission and 1-year mortality for this group was 92% (46/50). Of the “comfortable mobilisation” subgroup only 18% (8/44) of this patient subgroup subsequently required surgical intervention for failed non-operative management. The 30-day mortality for this cohort was 6.8% with a 1-year mortality rate of 25% (11/44).

CONCLUSION: For a select group of patients whose fractures are stable enough to allow them to mobilise comfortably, non-operative management resulted in a 25% 1-year mortality rate and average length of stay of 10.1 days. This is comparable to statistics for overall NOF fracture management in the literature according to the NHFD January 2021 report. 82% of this group of patients were successfully managed without an operation indicating that there is a place for the consideration of non-operative management in a small select subgroup of hip fracture patients with minimally displaced, stable fractures. Further analysis is necessary to assess the functional outcomes of this subgroup, as well as the potential cost implications.

PMID:34789387 | DOI:10.1016/j.injury.2021.11.007

Cortex. 2021 Oct 22:S0010-9452(21)00327-0. doi: 10.1016/j.cortex.2021.10.001. Online ahead of print.

ABSTRACT

The role of the dorsolateral prefrontal cortex (DLPFC) in implicit sequence/statistical learning has received considerable attention in recent cognitive neuroscience research. Studies have used non-invasive brain stimulation methods to test whether the DLPFC plays a role in the incidental acquisition and expression of implicit sequence learning. In a recent study, Prutean et al. has concluded that stimulating the left or the right DLPFC might not affect the expression of implicit sequence learning measured by the Serial Reaction Time (SRT) task. The authors speculated that the previous results revealing improved implicit sequence learning following DLPFC stimulation might have been found because explicit awareness accumulated with the use of Alternating Serial Reaction Time (ASRT) task. Our response presents solid evidence that the ASRT task measures implicit sequence learning that remains unconscious both at the judgment and structural level. Therefore, contrary to the conclusion of Prutean et al., we argue that the DLPFC could have a crucial effect on implicit sequence learning that may be task-dependent. We suggest that future research should focus on the specific cognitive processes that may be differentially involved in the SRT versus ASRT tasks, and test what the role of the DLPFC is in those specific cognitive processes.

PMID:34789384 | DOI:10.1016/j.cortex.2021.10.001

Dtsch Arztebl Int. 2021 Sep 6;118I processed the file.I’m waiting for feedback tomorrow(35-36):587-594. doi: 10.3238/arztebl.m2021.0231.

ABSTRACT

BACKGROUND: Metatarsal fractures are among the most common foot and ankle injuries, with an annual incidence of 6.7 per 100 000 persons. Approximately 30% of metatarsal fractures affect the base of the fifth metatarsal bone. Nevertheless, no evidence-based treatment recommendations are available to date.

METHODS: The three fracture localizations according to Lawrence and Botte (zone I, proximal to the intermetatarsal joint between the fourth and fifth metatarsal bones; zone II, in the area of the joint; zone III, at the distal end of the joint) are analyzed on the basis of a systematic literature search. Studies were included that compared the treatment of two types of fracture in the same manner, or that compared two different treatments for a single type of fracture.

RESULTS: Nine studies compared different treatments of zone I fractures. Two of these were randomized controlled trials (RCTs); in one RCT, patients given functional therapy returned to work much sooner than those treated with immobilization (11 vs. 28 days; p = 0.001), with otherwise similar outcomes. The non-randomized studies revealed a faster return to full function (33 vs. 46 days; p<0.05) with early functional therapy, and similar outcomes for immobilization and surgery. One RCT that compared functional therapy with immobilization for zone II fractures revealed no statistically significant difference. Five studies compared fractures in zones I and II that were treated in the same manner, revealing similar outcomes. One RCT compared surgery and immobilization for zone III fractures: surgery led to statistically significant improvement of the outcome in all of the measured parameters.

CONCLUSION: Fractures in zones I and II should be treated with early functional therapy. There seems to be no reason to consider zone I and II fractures as two separate entities, as the outcomes in the two groups are similar. In contrast, fractures in zone III should primarily be treated surgically.

PMID:34789369 | DOI:10.3238/arztebl.m2021.0231