Nevin Manimala

Fam Pract. 2022 Oct 6:cmac110. doi: 10.1093/fampra/cmac110. Online ahead of print.

ABSTRACT

BACKGROUND: Glucagon-like peptide-1 receptor (GLP-1) agonists carry benefits and risks that must be evaluated prior to use and monitored throughout weight management therapy. Pharmacists possess the accessibility and extensive medication knowledge to evaluate and monitor the use of GLP-1 therapy in weight management patients.

OBJECTIVE: Evaluate the clinical and financial impact of a pharmacist-directed weight management service utilizing GLP-1 receptor agonists in a family practice setting.

METHODS: A retrospective cohort study including patients at 2 family practices, aged 18 and older, prescribed a weight management GLP-1 between October 1, 2021 and March 1, 2022 was performed. Patients who met inclusion and were prescribed a weight loss GLP-1 but were not managed by the clinical pharmacist were compared with the pharmacist cohort. Descriptive statistics and inferential statistics including an independent t-test were used in the data analysis.

RESULTS: There were 46 and 39 patients identified in the clinical pharmacist and primary care physician cohorts respectively. Patients in the clinical pharmacist cohort achieved a mean body weight reduction of 9.32% compared to 5.11% body weight reduction for patients in the primary care physician cohort (P = 0.01). There were 63 months identified of inappropriate GLP-1 therapy deprescribed in the clinical pharmacist cohort resulting in an estimated cost savings of $101,985.66.

CONCLUSIONS: The implementation of a pharmacist-led weight management clinic in 2 family medicine offices resulted in a significant reduction in body weight and reduction in total costs to the healthcare system compared to patients receiving weight management services from their primary care physician alone.

PMID:36200484 | DOI:10.1093/fampra/cmac110

Phys Ther. 2022 Oct 6:pzac133. doi: 10.1093/ptj/pzac133. Online ahead of print.

ABSTRACT

OBJECTIVES: The purposes of this study were to (1) describe and summarize the use of simulation-based education (SBE) with student physical therapists in the international literature and (2) describe the application and integration of standards of best practice (SOBP) for SBE reported in published physical therapy education research.

METHODS: Ovid MEDLINE, CINAHL, Web of Science, and ERIC databases were searched. The search included any study published that involved the use of SBE with student physical therapists. Because this was a scoping review, only descriptive statistics were compiled; no methodologic quality assessment was performed.

RESULTS: This scoping review revealed a significant increase in literature describing SBE with student physical therapists in the past 10 years. Simulation was used to address learning objectives across a variety of content areas and clinical settings. Communication skills were the most common objectives for simulation. Limited use of SOBP, published in 2016, was reported and use of author-generated outcome measures without validation was common.

CONCLUSIONS: Although there has been an increase in literature reporting the use of SBE with student physical therapists across many practice areas and settings, many articles reported limited use and integration of published SOBP and frequently utilized outcome measures that had not been validated.

PMID:36200401 | DOI:10.1093/ptj/pzac133

Pediatr Pulmonol. 2022 Oct 6. doi: 10.1002/ppul.26191. Online ahead of print.

ABSTRACT

BACKGROUND: Health related quality of life(HRQoL) scales are now widely used in children with Cystic Fibrosis(cwCF) which reflects the course of the disease. In this cross-sectional study,our primary aim was to compare the Pediatric Oral Health-Related Quality of Life(POQL) and Oral Health Score(OHS) between cwCF and healthy group. Our secondary aim was to evaluate the association between Pseudomonas Aeruginosa(PA) colonization, pulmonary function test, OHS and POQL in cwCF.

METHODS: The study population (age ranging 6-14) included 55 cwCF followed at the Marmara University Division of Pediatric Pulmonology compared with 50 healthy peers. A survey consisted of general questions(age, sex etc.) and the POQL instrument were filled by parents.The decayed, missing and filled teeth for both primary(dft) and permanent dentition(DMFT) was detected according to WHO criteria.Data like current body mass index(BMI z score), colonization status with PA, predicted value for forced expiratory volume in one second(FEV1pp) and any hospitalizations during the previous year were obtained from their medical.Differences between the groups were evaluated using Chi-square and Mann-Whitney U test with a significance level set at 0.05 RESULTS: There was no significant difference between PA colonized cwCF and healthy controls in DMFT(p = 0.916). For all domains of POQL(emotional function, social function, role function), scores of cwCF were significantly better than healthy controls(p<0.05).There were no statistically significant differences between all domains of POQL scores in PA colonized and non-PA colonized cwCF’ POQL scores(p>0.05).

CONCLUSION: Evethough POQL scores of cwCF were encouraging,dental caries prevention and regular follow-ups should be taken into consideration. This article is protected by copyright. All rights reserved.

PMID:36200396 | DOI:10.1002/ppul.26191

Phys Ther. 2022 Oct 6:pzac134. doi: 10.1093/ptj/pzac134. Online ahead of print.

ABSTRACT

OBJECTIVES: The purposes of this study were to describe the current use of: (1) simulation in student physical therapist professional education programs; (2) standards of best practice (SOBP) for simulation-based education (SBE) in physical therapist education.

METHODS: Two surveys were created about current use of SBE in student physical therapist professional education programs in the United States. The first survey contained questions about the program, including the best contact person regarding simulation. The second survey investigated simulation use within the context of SOBP. Survey data were analyzed using descriptive statistics.

RESULTS: Survey 1 was sent to the program director at all fully accredited physical therapist programs (N = 236), and 143 responses were returned (61% response rate). Survey 2 was sent to the 136 individuals identified in Survey 1 and we received 81 completed surveys (60%). Over 90% of programs reported including SBE in their curricula with 86% providing 3 or more experiences. A median of 1 core faculty at each program reported training in SBE, but 23% reported no training. A lack of training in specific elements of the SOBP for SBE was reported by 40% to 50% of faculty. Limited use of SOBP was reported and use of outcome measures without validation was common.

CONCLUSION: Although SBE is used commonly in physical therapist education, many faculties: (1) do not have training in SBE; (2) do not consistently follow the SOBP; and (3) utilize outcome measures that are not validated. Limited faculty training in SBE and inconsistent inclusion of the SOBP suggests student learning in simulation is not optimized.

IMPACT: These results show that, despite increased use of simulation in physical therapist education programs, there is a dearth of faculty trained in SBE and inconsistent use of SOBP. Addressing these deficiencies could help to optimize the benefits of SBE in physical therapist education.

PMID:36200392 | DOI:10.1093/ptj/pzac134

Infect Control Hosp Epidemiol. 2022 Oct 6:1-5. doi: 10.1017/ice.2022.239. Online ahead of print.

ABSTRACT

OBJECTIVE: To determine whether discontinuing active screening for vancomycin-resistant Enterococcus (VRE) in Alberta, Canada, acute-care facilities had an associated impact on the rate of rise of hospital-acquired (HA) VRE bloodstream infection (VRE-BSI).

SETTING: Acute-care facilities in Alberta, Canada.

PATIENTS: All patients who were admitted to Alberta Health Services or Covenant Health acute-care facilities between January 1, 2013, and March 31, 2020, and who met the definition for hospital-acquired VRE-BSI were included in the analyses.

METHODS: An intervention time-series Poisson regression was used to determine the slope change in VRE incidence between the pre- and postintervention (screening) periods. The patient population was separated into 3 cohorts: group 1 (low risk, VRE screening stopped), group 2 (high risk, VRE screening stopped), and group 3 (high risk, VRE screening continued). For all groups, a level- and slope-change model was used.

RESULTS: We did not find a statistically significant difference in the slope change or rate of rise in VRE-BSI before and after the intervention, with incidence rate ratio (IRRs) of 1.015 (95% confidence interval [CI], 0.982-1.049), 1.025 (95% CI, 0.967-1.086), and 0.989 (95% CI, 0.924-1.059) for groups 1, 2 and 3, respectively.

CONCLUSIONS: In Alberta, the rate of HA VRE-BSI has remained consistent, and our findings indicate that there has been no increase in the rate of rise of HA VRE-BSI in sites or units that discontinued screening for VRE, regardless of patient risk group.

PMID:36200345 | DOI:10.1017/ice.2022.239

Cardiol Young. 2022 Oct 6:1-6. doi: 10.1017/S1047951122003110. Online ahead of print.

ABSTRACT

BACKGROUND: Published guidelines for sports restriction for children with a bicuspid aortic valve remain controversial. We sought to describe practice variation and factors influencing sports restrictions in these children.

METHODS: This retrospective single-centre study included children (7-18 years old) with an isolated bicuspid aortic valve at baseline from 1 January, 2005 to 31 December, 2014. Sports restrictions, factors potentially influencing decision-making, and outcomes were collected. Descriptive statistics and multivariable mixed-effects logistic regression models were performed with providers and patients as random effects. Provider variation was estimated using intraclass correlation coefficients. Odds ratios, 95% confidence intervals, and p-values were reported from the models.

RESULTS: In 565 encounters (253 children; 34 providers), 41% recommended no sports restrictions, 40% recommended high-static and high-dynamic restrictions, and 19% had no documented recommendations. Based on published guidelines, 22% of children were inappropriately restricted while 30% were not appropriately restricted. The paediatric cardiology provider contributed to 37% of observed practice variation (p < 0.001). Sports restriction was associated with older age, males, greater ascending aorta z-score, and shorter follow-up interval. There were no aortic dissections or deaths and one cardiac intervention.

CONCLUSION: Physicians frequently fail to document sports restrictions for children with a bicuspid aortic valve, and documented recommendations often conflict with published guidelines. Despite this, no adverse outcomes occurred. Providers accounted for a significant proportion of the variation in sports restrictions. Further research to provide evidence-based guidelines may improve provider compliance with activity recommendations in this population.

PMID:36200342 | DOI:10.1017/S1047951122003110

Mol Ecol. 2022 Oct 6. doi: 10.1111/mec.16714. Online ahead of print.

ABSTRACT

Coastal refugia during the Last Glacial Maximum (~21 ka) have been hypothesized at high latitudes in the North Atlantic, suggesting marine populations persisted through cycles of glaciation and are potentially adapted to local environments. Here, whole-genome sequencing was used to test whether North Atlantic marine coastal populations of the kelp Alaria esculenta survived in the area of Southwestern Greenland during the Last Glacial Maximum. We present the first annotated genome for A. esculenta and call variant positions in 54 individuals from populations in Atlantic Canada, Greenland, Faroe Islands, Norway, and Ireland. Differentiation across populations was reflected in ~1.9 million single nucleotide polymorphisms, which further revealed mixed ancestry in the Faroe Islands individuals between putative Greenlandic and European lineages. Time calibrated organellar phylogenies suggested Greenlandic populations were established during the last interglacial period more than 100 ka ago, and that Faroe Islands were likely established following the Last Glacial Maximum. Patterns in population statistics, including nucleotide diversity, minor allele frequencies, heterozygosity, and linkage disequilibrium decay, nonetheless suggested glaciation reduced Canadian Atlantic and Greenlandic populations to small effective sizes during the most recent glaciation. Functional differentiation was further reflected in exon read coverage, which revealed expansions unique to Greenland in 337 exons representing 162 genes, and a modest degree of exon loss (103 exons from 56 genes). Altogether, our genomic results provide strong evidence that A. esculenta populations were resilient to past climatic fluctuations related to glaciations and that high latitude populations are potentially already adapted to local conditions as a result.

PMID:36200326 | DOI:10.1111/mec.16714

Photochem Photobiol. 2022 Oct 6. doi: 10.1111/php.13733. Online ahead of print.

ABSTRACT

The Antarctic region is a place of increasing interest. A growing number of personnel are working outdoors in extreme environmental conditions. They receive significant exposure to solar Ultraviolet radiation and are thereby at increased risk of adverse consequences. The aim of this study was to evaluate the UVR dose received by the outdoor workers at the Bulgarian Antarctic Base. Ten Caucasian healthy subjects, 8 male and 2 female with a mean age of 38 years (29-51) were enrolled. Of them 5 were scientists and 5 were logistic workers. We measured the accumulated daily dose of UVR assessed by Standard Erythemal Dose in the two groups. All subjects wore personal dosimeters located near the face – the only non-covered skin area. The dosimeters were factory calibrated for use in the Antarctic region. No statistical difference (p=0.441) could be revealed between the SEDs in the two groups. The maximum UVR dose detected in a single day was 67.9 SEDs and the highest cumulative dose was 548.03 SEDs. Study results are showing extreme measurements of UVR received by the members of the expeditions. We suggest meticulous UV protection for outdoor workers.

PMID:36200321 | DOI:10.1111/php.13733

Adicciones. 2022 Oct 1;0(0):1783. doi: 10.20882/adicciones.1783. Online ahead of print.

ABSTRACT

The Covid19 pandemic has led to many publications about its influence on the treatment and evolution of individuals with a substance use disorder, leading to contradictory results. In this study, the adherence and abstinence rates of patients who started treatment in an Addictive Behavior Unit during the pandemic are analyzed, compared with others who attended the previous year and comparing those who were attended in person or by phone. The results indicate that during the Covid19 period, patients had greater adherence to treatment after one month of follow up and when attended to by phone. At 3 and 12 months, greater adherence was maintained, although it was not statistically significant. Regarding abstinence, the small sample size made it difficult to obtain significant differences. The conclusion is that, despite a quantitative decrease in the number of patients beginning drug treatment, in qualitative terms the pandemic led to greater adherence in the short and medium term. Telephone attention can play an important and positive role at this point, complementary to other resources and interventions.

PMID:36200234 | DOI:10.20882/adicciones.1783

Adicciones. 2022 Oct 1;0(0):1778. doi: 10.20882/adicciones.1778. Online ahead of print.

ABSTRACT

One of the factors that increase the likelihood of adolescents starting to exhibit and consolidate anti-social behavior is drug use, with a consistent pattern of consumption of different substance found in young offenders (Aebi, Bessler & Steinhausen, 2021). A cognitive-behavioral group treatment program inspired by the positive psychology approach was developed and applied to drug use in minors deprived of liberty (experimental group); the results were compared to those of a group of adolescents with the same type of drug use in the same center (active control group) at two points in time: during and after incarceration. The fall in the rate of problems associated with drug use after incarceration in the experimental group was statistically significant compared to the control group, and the effect size of the experimental condition was large (ῆ^2 = 0.55), much higher than the control group (ῆ^2 = 0.16). The treatment program has proven to be an effective tool for reducing problems associated with drug use and is especially effective in reducing alcohol and cannabis consumption.

PMID:36200233 | DOI:10.20882/adicciones.1778