Nevin Manimala

Stroke. 2022 Aug 26:101161STROKEAHA122039172. doi: 10.1161/STROKEAHA.122.039172. Online ahead of print.

ABSTRACT

BACKGROUND: A previously published conditional probability model optimizes prehospital emergency transport protocols for patients with suspected large-vessel occlusion by recommending the transport strategy, drip-and-ship or mothership, that results in a higher probability of an excellent outcome. In this study, we create generalized models to quantify the change in annual hospital patient volume, the expected annual increase in the number of patients with an excellent outcome, and the annual cost savings to a single-payer healthcare system resulting from these optimized transport protocols.

METHODS: We calculated the expected number of patients with suspected large-vessel occlusion transported by ambulance over a 1-year period in a region of interest, using the annual stroke incidence rate and a large-vessel occlusion screening tool. Assuming transport to the closest hospital is the baseline transport policy across the region (drip-and-ship), we determined the change in annual hospital patient volume from implementing optimized transport protocols. We also calculated the resulting annual increase in the number of patients with an excellent outcome (modified Rankin Score of 0-1 at 90 days) and associated cost savings to a single-payer healthcare system. We then performed a case study applying these generalized models to the stroke system serving the Greater Vancouver and Fraser Valley Area, BC, Canada.

RESULTS: In the Greater Vancouver and Fraser Valley Area, there was an annual increase of 36 patients with an excellent outcome, translating to an annual cost savings of CA$2 182 824 to the British Columbia healthcare system. We also studied how these results change depending on our assumptions of treatment times at the regional stroke centers.

CONCLUSIONS: Our framework quantifies the impact of optimized emergency stroke transport protocols on hospital volume, outcomes, and cost savings to a single-payer healthcare system. When applied to a specific region of interest, these models can help inform health policies concerning emergency transport of patients with suspected large-vessel occlusion.

PMID:36017703 | DOI:10.1161/STROKEAHA.122.039172

Circ Res. 2022 Aug 26:101161CIRCRESAHA122321295. doi: 10.1161/CIRCRESAHA.122.321295. Online ahead of print.

ABSTRACT

BACKGROUND: Despite mechanistic studies linking retinol and RBP4 (retinol binding protein 4) to the pathogenesis of cardiovascular diseases (CVD) and type 2 diabetes (T2D), epidemiological evidence is still conflicting. We investigated whether conflicting results of previous studies may be explained by differences in the association of retinol and RBP4 with cardiometabolic risk across subgroups with distinct sex, hypertension state, liver, or kidney function.

METHODS: We used case-cohorts nested in the EPIC (European Prospective Investigation Into Cancer and Nutrition)-Potsdam cohort (n=27 548) comprising a random sample of participants (n=2500) and all physician-verified cases of incident CVD (n=508, median follow-up time 8.2 years) and T2D (n=820, median follow-up time 6.3 years). We estimated nonlinear and linear multivariable-adjusted associations between the biomarkers and cardiometabolic diseases by restricted cubic splines and Cox regression, respectively, testing potential interactions with hypertension, liver, and kidney function. Additionally, we performed 2-sample Mendelian Randomization analyses in publicly available data.

RESULTS: The association of retinol with cardiometabolic risk was modified by hypertension state (P interaction CVD<0.001; P interaction T2D<0.001). Retinol was associated with lower cardiometabolic risk in participants with treated hypertension (hazard ratio_{per SD}, 95% CI: CVD, 0.71 [0.56-0.90]; T2D, 0.81 [0.70-0.94]) but with higher cardiometabolic risk in normotensive participants (CVD, 1.32 [1.06-1.64]; T2D, 1.15 [0.98-1.36]). Our analyses also indicated a significant interaction between RBP4 and hypertension on CVD risk (P interaction=0.04). Regarding T2D risk, we observed a u-shaped association with RBP4 in women (P nonlinearity=0.01, P effect=0.02) and no statistically significant association in men. The biomarkers’ interactions with liver or kidney function were not statistically significant. Hypertension state-specific associations for retinol concentrations with cardiovascular mortality risk were replicated in National Health and Nutrition Examination Survey III.

CONCLUSIONS: Our findings suggest a hypertension-dependent relationship between plasma retinol and cardiometabolic risk and complex interactions of RBP4 with sex and hypertension on cardiometabolic risk.

PMID:36017698 | DOI:10.1161/CIRCRESAHA.122.321295

J Nurs Manag. 2022 Aug 26. doi: 10.1111/jonm.13773. Online ahead of print.

ABSTRACT

AIM: This study aimed to explore the mediating effects of adversity quotient and the moderating effect of self-efficacy on the relationship between the organizational climate and the work engagement of intensive care unit nurses.

BACKGROUND: A good organizational climate can contribute to a high level of work engagement. Adversity quotient and self-efficacy are the key factors affecting nurses’ work engagement, while the mechanism of these factors in the organizational climate and work engagement remains unclear. This study was conducted to contribute to the relevant field research.

METHODS: The study used a cross-sectional research design and surveyed 323 intensive care unit nurses working in a public hospital in China. The data were analyzed using descriptive statistical methods: Pearson correlation analysis and PROCESS macro Model 7 in the regression analysis.

RESULTS: Organizational climate was positively correlated with work engagement and adversity quotient. The indirect effect of organizational climate on work engagement through adversity quotient was positive. Furthermore, self-efficacy moderated the relationship between the two factors.

CONCLUSION: Cultivating organizational climate and adversity quotients is an important strategy to improve the work engagement of intensive care unit nurses, particularly for nurses with high self-efficacy.

IMPLICATIONS FOR NURSING MANAGEMENT: Administrators should make efforts to create a good organizational climate and cultivate nurses’ adversity quotients and self-efficacy to decrease their intent to leave.

PMID:36017688 | DOI:10.1111/jonm.13773

Cytopathology. 2022 Aug 26. doi: 10.1111/cyt.13174. Online ahead of print.

ABSTRACT

This article serves as the second in a series that offers recommendations for optimal data reporting, specifically focusing on statistical methods most frequently reported by the Cytopathology audience. The inaugural article, Recommendations for Reporting Statistical Results when Comparing Proportions, dealt with the most common category of reported statistical tests over 2.5 years of Cytopathology articles – comparing proportions. Comparing samples using t-tests, Mann-Whitney U, Analysis of Variance, and Kruskal-Wallis tests was another common category of statistical test reported among this audience. An important distinction between these tests is based on whether the samples follow a normal distribution. Therefore, Parametric or Nonparametric Statistical Tests: Choosing the Most Appropriate Option for your Data is the second topic in the series. While this article will review considerations when selecting parametric or nonparametric statistical tests, an extensive review of each method is beyond the scope of this summary. The author encourages the reader to consult with a trained statistician to map out a thorough analytical plan (including their recommendations for the appropriate statistical test(s) to use) prior to data collection.

PMID:36017662 | DOI:10.1111/cyt.13174

Pediatrics. 2022 Aug 26:e2022057346. doi: 10.1542/peds.2022-057346. Online ahead of print.

ABSTRACT

OBJECTIVES: Antibiotics are commonly administered during labor and delivery, and research has suggested that fetal exposure to antibiotics can increase risk for autism spectrum disorder (ASD). We assessed whether antibiotic exposure during labor and delivery increased the risk of ASD in the offspring.

METHODS: This retrospective cohort study included everyone who delivered a live singleton-term infant in British Columbia, Canada, between April 1, 2000, and December 31, 2014. This cohort included 569 953 deliveries. To examine the association among pregnant individuals being treated for the same indication, we studied a subcohort of those who tested positive for group B Streptococcus. Cox proportional hazards models were used to estimate unadjusted and adjusted hazard ratios in both cohorts. A sensitivity analysis was conducted using length of first stage of labor as a proxy measure for dose to assess for a dose-response relationship.

RESULTS: In this population-based study, antibiotic use during labor and delivery was not associated with an increased risk of ASD in offspring. The unadjusted and adjusted hazard ratios were 1.29 (95% confidence interval, 1.24-1.35) and 0.99 (0.94-1.04), respectively; and 1.07 (0.90-1.27) and 0.88 (0.74-1.05), respectively, in the group B Streptococcus-positive cohort. We observed no substantial difference in the association between antibiotic exposure and ASD depending on length of the first stage of labor.

CONCLUSIONS: Our findings suggest that concern for ASD should not factor into the clinical decision on whether to administer antibiotics during labor and delivery. Future research is needed to examine longer durations of prenatal antibiotic exposure.

PMID:36017659 | DOI:10.1542/peds.2022-057346

Palliat Support Care. 2022 Aug 26:1-12. doi: 10.1017/S1478951522000979. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to explore perceptions of the meaning of life among Korean patients living with advanced cancer.

METHOD: The study employed a mixed-methods design, and 16 participants were included in the analysis. Qualitative data gathered from in-depth interviews were analyzed using Colaizzi’s phenomenological method. Quantitative survey data were analyzed using descriptive statistics, the Mann-Whitney U test, the Kruskal-Wallis test, and Spearman’s ρ correlation.

RESULTS: Participants experienced both the existence of meaning and the will to find meaning in terms of four categories: “interpersonal relationships based on attachment and cohesion” (three themes – family as the core meaning of one’s life, supportive and dependent interconnectedness with significant others, and existential responsibility embedded in familism), “therapeutic relationships based on trust” (one theme – communication and trust between the patient and medical staff), “optimism” (two themes – positivity embodied through past experiences and a positive attitude toward the current situation), and “a sense of purpose with advanced cancer” (two themes – the will to survive and expectations for the near future). The meaning in life questionnaire (MLQ) and the purpose in life scale (PIL) showed a significant positive correlation tendency with the functional assessment of chronic illness therapy-spiritual well-being scale (FACIT-Sp). The patient health questionnaire (PHQ-9) showed significant negative correlation tendency with both the MLQ-presence of meaning (MLQ-PM) and PIL-Initiative (PIL-I) questionnaires.

SIGNIFICANCE OF RESULTS: Finding meaning in life helps advanced cancer patients realize their will to live. It also acts as a coping mechanism that palliates negative experiences in the fight against the disease. In particular, among advanced cancer patients in the Korean culture, the dynamics of relationships with family and medical staff was a key axis that instilled optimism and will to live. These results suggest that considering the meaning of life in advanced cancer patients by reflecting Korean culture in the treatment process improves the quality of care.

PMID:36017653 | DOI:10.1017/S1478951522000979

Immunopharmacol Immunotoxicol. 2022 Aug 26:1-7. doi: 10.1080/08923973.2022.2117629. Online ahead of print.

ABSTRACT

BACKGROUND: Immune checkpoint inhibitors (ICI) have revolutionized care in oncology with improved overall survival in several cancer populations. Nivolumab has recently been approved for use in patients with upper gastrointestinal cancers. We quantitatively summarized the efficacy and safety of Nivolumab use in patients with advanced esophageal, gastroesophageal, and gastric carcinoma compared to standard chemotherapy.

METHODS: Systemic search of electronic databases was performed to analyze phase III randomized controlled trials (RCTs) comparing Nivolumab versus standard chemotherapy in patients with advanced upper gastrointestinal cancers. Primary endpoints were overall survival (OS) and progression-free survival (PFS). Data were pooled using random effects model via RevMan 5.4 software.

RESULTS: Four RCTs with a total of 3,369 patients and a median follow-up of 13 months were included. The patients’ mean age was 61 ± 20 years, 74.6% were males, and 26% had ≥1% PD-L1 expression. Compared to the chemotherapy group, Nivolumab group had a significantly favorable OS and PFS [HR 0.81;95% CI (0.74, 0.89), P < 0.001], [HR 0.82;95% CI (0.69, 0.98), P = 0.03], respectively. Nivolumab significant effect was only in patients with ≥1% PD L1 expression [HR 0.72; 95% CI (0.58, 0.89), P < 0.001]. No statistical difference was detected between groups regarding serious adverse effects (AE) [OR 1.47; 95%CI (0.94,2.31), P = 0.09].

CONCLUSIONS: Compared to standard chemotherapy, the use of Nivolumab in patients with advanced esophageal, gastroesophageal, and gastric cancers is associated with improved overall and progression-free survival, with similar rates of AE and AE leading to death. The improvement in survival was significant in patients with ≥1% PD L1 expression.

PMID:36017642 | DOI:10.1080/08923973.2022.2117629

J Endourol. 2022 Aug 26. doi: 10.1089/end.2022.0214. Online ahead of print.

ABSTRACT

BACKGROUND: Magnetic resonance imaging-guided transurethral ultrasound ablation (TULSA) is under investigation for whole gland ablation of low and intermediate risk prostate cancer. The ideal method for post-TULSA bladder drainage via postoperative suprapubic tube (SPT) versus indwelling urethral catheter (UC) has not been established. The objective of this study was to evaluate urinary outcomes after whole gland TULSA, comparing postoperative SPT to UC.

MATERIALS AND METHODS: Two-institution, retrospective analysis of whole gland TULSA for men with grade group 1 and 2 prostate cancer. One institution placed SPT at the time of TULSA with clamp trials (day 10) and removal once voiding. The second placed UC until void trial (day 7). Outcomes included the International Prostate Symptom Score (IPSS), urinary bother score, catheter reinsertion, stricture, clean intermittent catheterization (CIC), and incontinence.

RESULTS: Forty-five patients (median age 67) were analyzed. The UC cohort (N=26) was older (P=0.007) than the SPT cohort (N=19) but with similar baseline prostate volumes, IPSS and urinary bother scores. Patients receiving UC had fewer days with catheter (P=0.013). Although UC patients suffered more lower urinary tract symptoms at one-month post-TULSA, there was no significant difference between IPSS scores at six months after surgery and at baseline regardless of urinary management strategy, though the UC group noted significantly decreased urinary bother. Rates of infection were similar between groups. Six strictures were observed overall with more in the SPT group, though the difference was not significant (4/19 [21.1%] SPT; 2/26 [7.7%] UC). At 6 months, incontinence rates were low and similar between groups (2/19 [10.5%] SPT; 4/26 [15.4%] UC) and only one patient (UC) required CIC.

CONCLUSIONS: Our overall findings suggest that SPT and UC are both acceptable options for postoperative bladder drainage following whole gland TULSA, with statistically similar rates of urinary complications but a slightly different side effect profile.

PMID:36017622 | DOI:10.1089/end.2022.0214

Expert Rev Vaccines. 2022 Aug 26. doi: 10.1080/14760584.2022.2117695. Online ahead of print.

ABSTRACT

BACKGROUND: Pregnant women have a low uptake of influenza vaccination, although being recommended as a priority.

RESEARCH DESIGN AND METHODS: We conducted a cross-sectional questionnaire survey in China from June to July 2021. Hierarchical regression analysis and structural equation modeling were performed based on the extended theory of planned behavior, in which attitudes, subjective norms, perceived behavioral control, and intention each affect the vaccine hesitancy; four variables of response efficacy, knowledge, vulnerability, and severity were added as extended dimensions; vaccination history played a moderator role in this model-to test the validity of the framework.

RESULTS: Totally, 1283 pregnant women participated in this study. The intention existed as a mediator between attitude [β_indirect=0.142 (95% confidence interval (CI): 0.084, 0.206), P<0.001], subjective norms [β_indirect=0.568 (95%CI: 0.424, 0.754), P<0.001], perceived behavioral control [β_indirect=0.070 (95%CI: 0.025, 0.118), P=0.004] and vaccine hesitancy. Further, the differences in indirect effect between the two dimensions of attitude (P<0.001), perceived behavioral control (P<0.001), and subjective norms were each statistically significant. Vaccination history did not moderate the association between attitude (P=0.679), subjective norms (P=0.645), and hesitancy.

CONCLUSIONS: The subjective norms dimension has a strong association with influenza vaccine hesitancy. Vaccination history had limited ability to reduce hesitancy during pregnancy.

PMID:36017619 | DOI:10.1080/14760584.2022.2117695

Clin Chem Lab Med. 2022 Aug 26. doi: 10.1515/cclm-2022-0635. Online ahead of print.

ABSTRACT

OBJECTIVES: Fibroblast growth factor 23 (FGF23) plays a key role in the pathophysiology of chronic kidney disease (CKD) and of the associated cardiovascular diseases, ranking on the crossroads of several evolving areas with a relevant impact on the health-care system (ageing, treatment of CKD and prevention from cardiovascular and renal events). In this review, we will critically appraise the overall issues concerning the clinical usefulness of FGF23 determination in CKD, focusing on the analytical performances of the methods, aiming to assess whether and how the clinical introduction of FGF23 may promote cost-effective health care policies in these patients.

CONTENT: Our comprehensive critical appraisal of the literature revealed that we are currently unable to establish the clinical usefulness of FGF23 measured by ELISA in CKD, as stability issues and suboptimal analytical performances are the major responsible for the release of misleading results. The meta-analytical approach has failed to report unambiguous evidence in face of the wide heterogeneity of the results from single studies.

SUMMARY AND OUTLOOK: Our review has largely demonstrated that the clinical usefulness depends on a thorough analytical validation of the assay. The recent introduction of chemiluminescent intact-FGF23 (iFGF23) assays licensed for clinical use, after passing a robust analytical validation, has allowed the actual assessment of preliminary risk thresholds for cardiovascular and renal events and is promising to capture the iFGF23 clinically relevant changes as a result of a therapeutic modulation. In this perspective, the analytical optimization of FGF23 determination may allow a marriage between physiology and epidemiology and a merging towards clinical outcomes.

PMID:36008874 | DOI:10.1515/cclm-2022-0635