Nevin Manimala

Cardiovasc J Afr. 2021 Oct 11;32:1-5. doi: 10.5830/CVJA-2021-047. Online ahead of print.

ABSTRACT

AIM: In this study, we aimed to investigate the effect of the single aortic cross-clamp technique (SCT) (aortic cross-clamp only) versus the multiple-clamp technique (MCT) (aortic cross-clamp + side-biting clamp) on postoperative stroke in octogenarians undergoing coronary artery bypass grafting (CABG).

METHODS: A total of 171 patients aged 80 years and older who underwent isolated CABG were retrospectively analysed. The patients were divided into two groups according to the technique used during surgery: group 1 (n = 88) received the SCT, and group 2 (n = 83) received the MCT. Postoperative stroke was evaluated.

RESULTS: Of the patients, 127 were men and 44 were women. The mean age was 83.05 ± 8.81 years in group 1 and 82.14 ± 8.92 years in group 2. There was no statistically significant difference in the rate of postoperative stroke between the two techniques (p > 0.05).

CONCLUSIONS: Postoperative stroke in octogenarians may result from not only the cross-clamp technique used but also several other factors. We found that both techniques yielded similar outcomes.

PMID:34704588 | DOI:10.5830/CVJA-2021-047

J Obstet Gynaecol. 2021 Oct 27:1-5. doi: 10.1080/01443615.2021.1962820. Online ahead of print.

ABSTRACT

The rising caesarean section (CS) rate is a complex issue, particularly in an increasingly heterogenous nulliparous population. The study aim was to stratify the CS rate in nulliparous women by age and BMI to determine if any difference existed. This was a retrospective review of CS procedures of nulliparous women in two centres in Ireland (2014 through 2017). Data were obtained for 17,177 women from the hospital databases and CS procedures determined for each age and BMI category. Significant differences were observed when CS rates were stratified in this manner. The CS rates for women <20 years/BMI < 18.5 was 8.8 versus 57.6% for women 35 – 39 years/BMI 30 – 34 and 76 – 100% for all women >45 years (p<.005). The development of customised charts subdivided by age and BMI may be a useful counselling tool and assist in the comparison of rates between units.Impact statementWhat is already known on this subject? It is well known that along with rising CS rates globally, there have also been significant changes in maternal demographics-with increasing maternal age at first birth and increasing maternal BMI. It is well established that both of these factors affect the rate of CS in a population.What do the results of this study add? This study sought to stratify the CS rate in nulliparous women by age and BMI to determine if any difference existed. The results of the study showed an increasing CS rate for increasing age and BMI categories that was statistically significant.What are the implications of these findings for clinical practice and/or further research? Additional research using larger population data sets could allow the development of customised charts for nulliparous women subdivided by age and BMI which could act as a useful counselling tool in clinical practice, as well as assist in the comparison of CS rates between units.

PMID:34704524 | DOI:10.1080/01443615.2021.1962820

J Pers Assess. 2021 Oct 27:1-13. doi: 10.1080/00223891.2021.1991359. Online ahead of print.

ABSTRACT

The extent to which morality and being a moral person are important to one’s identity is most commonly assessed using Aquino and Reed’s (2002) Self-Importance of Moral Identity Scale (SIMIS). This study provided detailed psychometric examinations of the structure and discrimination levels of the SIMIS in a large (N = 2108) and heterogeneous sample. Results indicated that the SIMIS is clearly 2-dimensional, as expected. The Internalization and Symbolization subscales provided sufficient, and sometimes high levels of test information across the latent trait continuums. There were no redundant items and no bias based on gender. The most notable, albeit minor, shortcomings were that there are too many response options and that test information (discrimination power) was diminished at high levels of the Internalization latent trait continuum, apparently due to skewness. The fluctuating levels of measurement precision resulted in slightly greater attenuations in effect sizes for Internalization than for Symbolization across data for 31 other measures. The present findings from a large dataset and a variety of modern, revealing statistical methods provided relatively consistent, favorable findings for the measure.

PMID:34704515 | DOI:10.1080/00223891.2021.1991359

ESC Heart Fail. 2021 Oct 26. doi: 10.1002/ehf2.13673. Online ahead of print.

ABSTRACT

AIMS: Some risk assessment tools have been developed to categorize mortality risk in heart transplant recipients, but it is unclear whether these tools can be used interchangeable in different transplant regions.

METHODS AND RESULTS: We performed a retrospective single-centre study in 1049 adult German heart transplant recipients under jurisdiction of Eurotransplant. Univariable and multivariable Cox regression analysis was used to generate a risk scoring system. C-statistics were used to compare our score with a US score and a French score regarding their ability to discriminate between 1 year survivors and non-survivors within our study cohort. Of 38 parameters assessed, seven recipient-specific parameters [age, height, dilated cardiomyopathy (DCM), ischaemic cardiomyopathy (ICM), total bilirubin, extracorporeal membrane oxygenation (ECMO), and biventricular assist device/total artificial heart (BVAD/TAH) implant], one donor-specific parameter (cold ischaemic time), and one recipient-independent and donor-independent other parameter (late transplant era) were statistically significant in predicting 1 year mortality. The initial score was generated by using the regression coefficients from the multivariable analysis as follows: 1.70 * ln age – 4.0 * ln height – 0.9 * diagnosis (= 1 if diagnosis = DCM) – 0.67 * diagnosis (= 1 if diagnosis = ICM) + 0.33 * ln total bilirubin + 1.74 * ln cold ischaemic time + 0.98 * mechanical circulatory support (MCS) implant (= 1 if MCS implant = ECMO) + 0.47 * MCS implant (= 1 of MCS implant = BVAD/TAH) – 0.66 * transplant era (= 1 if transplant era = 2017-2018). The initial score was converted into the Bad Oeynhausen (BO) score as a positive integer variable by means of the following formula: BO score = (initial score + 8) * 3. In patients scoring 2 to <7 points (n = 112), 7 to <11 points (n = 580), 11 to <15 points (n = 339), and 15 to 20 points (n = 18), 1 year survival was 93.1%, 84.2%, 66.9%, and 27.8%, respectively. The c-index of our score was 0.73 [95% confidence interval (CI): 0.69-0.77]. Values were in our cohort for the US and French scores 0.66 (95% CI: 0.62-0.70) and 0.63 (95% CI: 0.59-0.67), respectively.

CONCLUSIONS: Data indicate that our score, but also risk assessment tools from other transplant regions, may be used as a reliable support for risk-adjusted organ allocation and potentially help to improve outcomes in heart transplantation. Further developments will have to include as yet unaccounted risk factors for even more reliable predictions.

PMID:34704397 | DOI:10.1002/ehf2.13673

Clin Exp Dent Res. 2021 Oct 26. doi: 10.1002/cre2.507. Online ahead of print.

ABSTRACT

OBJECTIVES: Decontamination of biofilm-colonized rough implant surfaces remains challenging. We investigated the effect of airflow with glycine powder (AFG) on decontamination of mature oral multispecies biofilm from a sandblasted and acid etched (SLA) titanium surface.

MATERIALS AND METHODS: Subgingival dental plaque was cultured on SLA disks anaerobically for 21 days. AFG with various settings and distances was applied directly on the disks with or without previous rinse of 0.9% NaCl. The specimens were then analyzed through scanning electron microscope and remaining bacteria on the implant surface were quantified and statistically compared.

RESULTS: Mature oral biofilm with cocci and rods as major morphotypes, as well as spiral- and filamentous-shaped organisms, was formed on the untreated disks. Saline rinsing removed the thick biofilm layer but left numerous of coccoid bacteria in rough surface pits. AFG effectively removed most of the bacteria from the pits. Both 25% and 50% power settings were equally effective at 3-mm distance. With 50% power, AFG successfully removed bacteria at both 3- and 6-mm distance. When AFG was applied on native biofilm without prior rinsing with saline, it effectively removed the biofilm including bacteria in the pits.

CONCLUSION: Application of AFG appears effective in removing bacteria from rough implant surfaces.

PMID:34704380 | DOI:10.1002/cre2.507

Nurs Open. 2021 Oct 26. doi: 10.1002/nop2.1099. Online ahead of print.

ABSTRACT

AIMS AND OBJECTIVES: To trial three mobile translation apps in the healthcare setting to address language barriers in everyday care between healthcare staff and older people with limited English proficiency (LEP).

DESIGN: A mixed-methods exploratory study.

METHODS: A two-month trial of three translation apps was conducted across four aged-care hospital wards. Observed interactions during use of translation apps were recorded, and staff surveys regarding the use of translation apps were collected at the end of the trial. Data were analysed using descriptive statistics and thematic content analysis of open-ended responses in the surveys and observations. Findings from the thematic content analysis are reported using the Standards for Reporting of Qualitative Research (SRQR) checklist.

RESULTS: Translation apps were mostly used for identifying pain and assisting with activities of daily living. Qualitative findings revealed that translation apps aided staff in providing care and improved rapport; however, practical shortcomings were identified.

PMID:34704379 | DOI:10.1002/nop2.1099

J Surg Educ. 2021 Oct 23:S1931-7204(21)00271-3. doi: 10.1016/j.jsurg.2021.10.002. Online ahead of print.

ABSTRACT

OBJECTIVE: Prior to 2015 residents in our Accreditation Council for Graduation Medical Education (ACGME) colon and rectal surgery training program were in charge of managing, with faculty oversight, the outpatient anorectal clinic at our institution. Starting in 2015 advanced practice providers (APPs) working in the division assumed management of the clinic. The effect of APPs on ACGME resident index diagnostic case volumes has not been explored. Herein we examine ACGME case log graduate statistics to determine if the inclusion of APPs into our anorectal clinic practice has negatively affected resident index diagnostic anorectal case volumes.

DESIGN: ACGME year-end program reports were obtained for the years 2011 to 2019. Program anorectal diagnostic index volumes were recorded and compared to division volumes. Analysis of variance (ANOVA) and analysis of covariance (ANCOVA) tests were conducted to assess whether the number of cases per year (for each respective case type) prior to the introduction of APPs into the anorectal clinic (2011-2014) differed from the number of cases per year with the APP clinic in place (2015-2018). A p-value <0.05 was considered statistically significant.

SETTING: Mayo Clinic, Rochester, Minnesota (quaternary referral center).

PARTICIPANTS: Colon and rectal surgery resident year-end ACGME reports (2011-2019).

RESULTS: ANOVAs revealed a marginally significant (p = 0.007) downtrend for hemorrhoid diagnostic codes, and a significant uptrend (p = 0.000) for fistula cases. Controlling for overall division volume, ANCOVA only reveled significance for fistula cases (p = 0.004) with the involvement of APPs.

CONCLUSIONS: At our institution we found the inclusion of APPs into our anorectal clinic practice did not negatively affect colon and rectal surgery resident ACGME index diagnostic anorectal case volumes. Inclusion of APPs into a multidisciplinary practice can promote resident education by allowing trainees to pursue other educational opportunities without hindering ACGME index case volumes.

PMID:34702690 | DOI:10.1016/j.jsurg.2021.10.002

Rev Clin Esp (Barc). 2021 Oct 20:S2254-8874(21)00170-3. doi: 10.1016/j.rceng.2021.06.006. Online ahead of print.

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2 infection, spreads swiftly in nursing homes and assisted living facilities, leading to a high degree of lethality. The data generated by an epidemiological surveillance program allow for obtaining valid information on the diseases’ epidemiology and possible prevention methods.

OBJECTIVE: This work aims to analyze COVID-19 epidemiology among healthcare staff based in the Seville healthcare district (Spain) and evaluate its role in outbreaks in nursing homes.

METHODS: This is an observational, descriptive study of 88 assisted living facilities located in the city of Seville from March 1 to May 23, 2020. Data were obtained via epidemiological surveys on staff at centers where there were outbreaks (n = 732 in 14 nursing homes). The cumulative incidence, epidemic curves, sociodemographic and clinical characteristics, and delays in isolation and notification of cases were calculated. For the statistical analysis, measures of central tendency and dispersion were used as well as confidence intervals and statistical hypothesis tests.

RESULTS: There were 124 cases in staff members (cumulative incidence 16.9%), 79.0% of which were in women. The majority presented with mild symptoms (87.1%). The most common symptoms were fever (31.5%) and cough (49.2%). The median number of days from onset of symptoms to isolation was three.

CONCLUSIONS: A high incidence in nursing home staff along with delays in isolation were observed, which could affect the dynamics of transmission in outbreaks. It is necessary to review disease identification and isolation practices among staff as well as emphasize rapid implementation of prevention measures.

PMID:34702684 | DOI:10.1016/j.rceng.2021.06.006

Acad Radiol. 2021 Oct 23:S1076-6332(21)00436-0. doi: 10.1016/j.acra.2021.09.021. Online ahead of print.

ABSTRACT

RATIONALE AND OBJECTIVES: To evaluate the relationship between quantitative breast parenchyma stiffness by using multiparametric shear wave elastography (mpSWE) and the potential risk factors of breast cancer.

MATERIAL AND METHODS: The Vmean, Vmax, Vmin, Vsd values were measured with mpSWE from each breast and each quadrant in all cases under and over the age of 40. Statistical analysis was performed to evaluate the relationship between breast stiffness and age, side, quadrant, menopausal status, mammographic breast density, and obstetric history.

RESULTS: The study cohort included 964 breasts of 482 patients, where 342 patients were ≥40 years of age; and 140 cases were <40 years of age with a mean age of 45.07 ± 10.96. No significant difference in breast stiffness was detected between right and left breasts (p > 0.05); however, upper quadrants were found to be stiffer than the lower quadrants (p < 0.05). The effect of age on all values was found to be significant (p < 0.05), and stiffness increased with age. All mpSWE values of post-menopausal cases were significantly higher (p < 0.05) than premenopausal cases. Nulliparous cases had higher values than cases with prior parity (p < 0.05). Cases with Type C and D breast density had higher stiffness values than those with Type A and Type B breast density.

CONCLUSION: Breast parenchyma shows increased stiffness in in post-menopausal, nulliparous and older patients and patients with dense breast density. Similar to the mammographic increased breast density, elastographically increased breast parenchymal stiffness may be used as a possible risk factor for breast cancer or as a predictor of breast cancer.

PMID:34702676 | DOI:10.1016/j.acra.2021.09.021

Radiography (Lond). 2021 Oct 23:S1078-8174(21)00165-6. doi: 10.1016/j.radi.2021.10.005. Online ahead of print.

ABSTRACT

INTRODUCTION: Previous studies have found that online booking systems may be the preferred scheduling tool when booking appointments with healthcare providers. The aim of this study was to examine I) if outpatients with cancer and relatives of cancer patients wanted to use an online booking system to book appointments for the CT examinations, and II) if they wanted to book specific radiographers for the CT examinations.

METHODS: An online questionnaire was distributed to outpatients with cancer and relatives of cancer patients registered in the user panel of the Danish Cancer Society. The questionnaires consisted of 13 questions for patients and eight questions for relatives. The study applied statistical analysis and qualitative content analysis with an inductive approach.

RESULTS: In total, 555 patients out of 760 (73%) and 115 out of 341 (34%) relatives were included in the present study and 54% of the patients and 65% of the relatives responded that they wanted, “To a high degree” or “To some degree”, to use an online system for booking the appointment of the CT examination. Furthermore, 49% of the patients and 60% of the relatives found it important, “To a high degree” or “To some degree”, that the appointment of the CT examination also suited their relatives. Only 37% of the patients, in contrast to 56% of the relatives, were interested in the opportunity to book specific radiographers. Approximately half of the patients (48%) and relatives (58%) were interested in being scanned by the same radiographers.

CONCLUSION: In this study, a majority of patients and relatives were interested in using an online booking system to book their CT examinations. Furthermore, while a majority of the relatives were more interested in booking specific radiographers for the CT examinations, only a few patients were interested in this function.

IMPLICATIONS FOR PRACTICE: Using an online booking system to book the appointment could benefit the overall experience for cancer patients and relatives when attending a CT examination to ensure that the appointment also suits the relatives.

PMID:34702667 | DOI:10.1016/j.radi.2021.10.005