Nevin Manimala

J Clin Pharm Ther. 2022 Sep 17. doi: 10.1111/jcpt.13766. Online ahead of print.

ABSTRACT

WHAT IS KNOWN AND OBJECTIVE: Hyperkalaemia is a common medical emergency in patients admitted to hospital. There is a limited evidence base supporting some of the commonly applied treatment strategies. Although, NICE has recommended the use of sodium zirconium cyclosilicate (SZC) (TA599) and patiromer (TA623) in both acute and chronic hyperkalaemia, there is a limited evidence base for their use in acute hyperkalaemia in the hospital setting, particularly when compared to the present standard of care calcium polystyrene sulfonate (CPS).

METHODS: A retrospective review of the electronic patient record system across our hospital over a 6-month period identified 138 patients who received either SZC (65 patients) or CPS (73 patients) to manage hyperkalaemia, investigating their efficacy and cost effectiveness. Results were analysed using simple descriptive statistics. Based on the results a naïve cost comparison between the two drugs was made.

RESULTS AND DISCUSSION: CPS and SZC both effectively reduced plasm potassium concentrations in patients with hyperkalaemia (6.07 and 6.03 mmol/L respectively) by 1.17 mmol/L and 1.24 mmol/L taking a similar amount of time to work (2.97 days vs. 3 days). The principle causes of hyperkalaemia identified were acute kidney injury, medication, and chronic kidney disease. Cost comparison analysis which took into account raw product price and time needed to dispense medications revealed that CPS has slightly better cost effectiveness compared to SZC albeit at a cost of increased staff input.

WHAT IS NEW AND CONCLUSION: Both CPS and SZC were equally effective at lowering acutely raised potassium concentrations. The cost difference between the two products appears to be small. Claims regarding the benefits of newer agents over older established medications need to be properly explored in randomized trials rather than being based on small scale non-comparative studies.

PMID:36114759 | DOI:10.1111/jcpt.13766

Acta Paediatr. 2022 Sep 17. doi: 10.1111/apa.16544. Online ahead of print.

ABSTRACT

AIM: According to the Italian national statistical institute, severe bacterial infections (SBI) in Italy are responsible for 1.7% of mortality under five years of age and their recognition is often challenging, especially in the first stages of the disease. We tried to estimate the prevalence of SBI in our target population and to identify signs and symptoms that could guide in the initial evaluation of a child with a possible SBI.

METHODS: We designed a prospective, multicenter study and enrolled patients aged 0-14 years at the first evaluation to the emergency department with an acute illness lasting a maximum of five days. The presence of variables suggestive of SBI was collected for every enrolled patient. One week after the enrolment, every patient was followed-up by telephone.

RESULTS: SBI is more likely to be detected with the ‘gut feeling’ in both univariate and multivariate models (univariate OR: 7.16, 95%CI: 4.08-12.56; multivariate OR: 5.34, 95%CI:2.78-10.25), while abnormal breathing pattern resulted significative only in univariate model (OR 3.83, 95%CI: 1.98-7.40). Nevertheless, their associated sensitivity is low.

CONCLUSION: SBI is uncommon in the absence of paediatricians’ gut feeling and abnormal respiratory pattern.

PMID:36114734 | DOI:10.1111/apa.16544

Ground Water. 2022 Sep 17. doi: 10.1111/gwat.13252. Online ahead of print.

ABSTRACT

The scope of this work is to discuss the proper choice of macrodispersion coefficients in modeling contaminant transport through the advection dispersion equation (ADE). It is common to model solute concentrations in transport by groundwater with the aid of the ADE. Spreading is quantified by macrodispersivity coefficients, which are much larger than the laboratory observed pore-scale dispersivities. In the frame of stochastic theory, longitudinal macrodispersivity is related to the hydraulic conductivity spatial variability via its statistical moments (mean, variance, integral scales), which are generally determined by geostatistical analysis of field measurements. In many cases, especially for preliminary assessment of contaminant spreading, these data are not available and ad-hoc values are adopted by practitioners. The present study aims at recommending dispersivity values based on a thorough analysis of tens of field experiments. Aquifers are classified as of weak, medium and high heterogeneity and for each class a range of macrodispersivity values is recommended. Much less data are available for the transverse macrodispersivities, which are significantly smaller than the longitudinal one. Nevertheless, a few realistic values based on field data, are recommended for applications. Transport models using macrodispersivities can predict mean concentrations, different from the local ones. They can be used for estimation of robust measures, like plumes spatial moments, longitudinal mass distribution and breakthrough curves at control planes.

PMID:36114728 | DOI:10.1111/gwat.13252

J Diabetes Investig. 2022 Sep 16. doi: 10.1111/jdi.13899. Online ahead of print.

ABSTRACT

AIMS/INTRODUCTION: Clinical evidence is lacking about the influence of sodium-glucose cotransporter 2 inhibitors on white blood cell (WBC) counts, a commonly used and widely available marker of inflammation. The aim of the present analysis was to assess the effect of canagliflozin relative to glimepiride on WBC counts.

MATERIALS AND METHODS: This was a post-hoc subanalysis of the CANDLE trial (Effects of Canagliflozin in Patients with Type 2 Diabetes and Chronic Heart Failure: A Randomized Trial; UMIN000017669), an investigator-initiated, multicenter, open-label, randomized, controlled trial. A total of 233 patients with type 2 diabetes and concomitant heart failure were randomly assigned to either canagliflozin (n = 113) or glimepiride (n = 120) treatment for 24 weeks. Overall, patient baseline characteristics were as follows: mean ± standard deviation age, 68.6 ± 10.1 years; hemoglobin A1c, 7.0 ± 0.9%; left ventricular ejection fraction, 56.7 ± 14.4%; and median N-terminal pro-brain natriuretic peptide, 252 pg/mL (interquartile range 96-563 pg/mL). The mean baseline WBC counts were 6704 cells/μL (95% confidence interval 6,362-7,047) in the canagliflozin group and 6322 cells/μL (95% confidence interval 5,991-6,654) in the glimepiride group. There were no significant differences between treatment groups in terms of changes in WBC counts from baseline to weeks 4 and 12. In contrast, a group difference (canagliflozin minus glimepiride) from baseline to week 24 was significant (mean difference – 456 cells/μL [95% confidence interval -774 to -139, P = 0.005]).

CONCLUSIONS: Our findings suggest that 24 weeks of treatment with canagliflozin, relative to glimepiride, reduced WBC counts in patients with type 2 diabetes and heart failure.

PMID:36114704 | DOI:10.1111/jdi.13899

Nurs Open. 2022 Sep 16. doi: 10.1002/nop2.1363. Online ahead of print.

ABSTRACT

AIMS: To determine the effect of design thinking approach in interprofessional education programme of human sexuality course.

DESIGN: A pre-test and post-test of single-group quasi-experimental study.

METHODS: The 35 nursing students and seven psychology students in their third year were selected by the computer randomly sampling through the lottery method. The course proceeded between September 2019 and January 2020. The participants had received an 8-week, 16-hr design thinking approach in interprofessional education programme of human sexuality course (one section per week, 2 hr per section). We used the nursing attitude toward sexual healthcare scale, nursing intervention toward sexual healthcare scale to assess students’ attitude and behaviour intention toward sexual health care and competence of interprofessional education scale to assess students’ competence of cooperation before and after the teaching programme. Data analysis used descriptive statistics and t-tests. A qualitative reflection log was also provided and analysed for themes. The SQUIRE-EDU checklist was followed.

RESULTS: The students’ attitude and behavioural intention dimension score in the post-test is higher than those in the pre-test and reach statistically significant differences both in total and subscale. Interprofessional core competence score of Observation Experience, Reflective Feedback, Interprofessional Cooperation, Innovative Design, and Applied Technology score in the post-test is higher than those in the pre-test and reach statistically significant differences both in total and subscale. Design thinking in interprofessional education programme of human sexuality course could significantly improve both nursing and psychology students’ attitude, behaviour intention of providing sexual health care and competence of interprofessional cooperation.

PMID:36114695 | DOI:10.1002/nop2.1363

J Diabetes. 2022 Sep 16. doi: 10.1111/1753-0407.13315. Online ahead of print.

ABSTRACT

BACKGROUND: In the euthyroid state, the risk of developing diabetes according to changes in thyroid-stimulating hormone (TSH) levels remains controversial. Additionally, the correlation of various body indices affecting blood glucose levels according to changes in TSH levels over a certain period is not well known.

METHODS: Patients who underwent health check-ups twice at a 2 year interval at a tertiary university hospital between 2009 and 2018 were included. By dividing baseline TSH levels into quartiles (TSH_Q1, Q2, Q3, and Q4), various variables were compared, and their changes after 2 years (∆TSH_Q1, Q2, Q3, and Q4) were confirmed.

RESULTS: Among 15 557 patients, the incidence of diabetes mellitus after 2 years was 2.4% (377/15 557 patients). There was no statistically significant difference in the incidence of diabetes according to TSH_Q (p = 0.243) or ∆TSH_Q (p = 0.131). However, as TSH levels increased, skeletal muscle mass decreased (p < 0.001), and body fat mass and percent body fat significantly increased (p < 0.001). As ∆TSH increased, ∆fasting blood glucose and ∆body mass index also significantly increased (all p < 0.001). The incidence of diabetes decreased significantly as skeletal muscle mass increased (odds ratio 0.734, p < 0.001).

CONCLUSIONS: Owing to the short study period, it was not possible to prove a statistical relationship between the incidence of diabetes mellitus and TSH levels in the euthyroid state. Significant decreases in skeletal muscle mass and increases in body mass index and body fat mass according to baseline TSH levels were demonstrated. Therefore, a focus on improving physical functions, such as increasing muscle mass and decreasing fat, is required in this case.

PMID:36114679 | DOI:10.1111/1753-0407.13315

Mol Plant. 2022 Sep 16:S1674-2052(22)00301-X. doi: 10.1016/j.molp.2022.09.007. Online ahead of print.

ABSTRACT

Plants are natural experts in organic synthesis being able to generate large numbers of specific metabolites with widely varying structures in order to adapt to variable survival challenges. Metabolomics is a research discipline that integrates the capabilities of several types of research including analytical chemistry, statistics and biochemical expertise. Its ongoing development provides solutions for the systematic understanding of quantitative changes in the levels of these metabolites and is usually performed by targeting either a specific cell, a specific tissue, or the entire organism. Considerable advances in science and technology over the last three decades have propelled us into the era of multi-omics with metabolomics, although at an earlier developmental stage than genomics, transcriptomics and proteomics, offering the distinct advantage of studying the cellular entities which have the greatest influence on end-phenotype. Here we summarize the state-of-the-art of metabolite detection and identification, also illustrating this with case study applications including (i) comparing metabolite composition within and between species, (ii) assessing spatio-temporal changes in metabolism during plant development, (iii) mining characteristic metabolites in different ecological environments and upon exposure to various stresses, and (iv) the performance of metabolomics on panels of natural genetic variance as a means of functional gene identification, metabolic pathway elucidation and metabolomics-assisted breeding. We additionally highlight the prominent contributions of joint analysis of metabolomics with other-omics including genomics, transcriptomics, proteomics, epigenomics, phenomics, microbiomes and ion-omics. Finally, we provide an outlook for further directions and challenges of metabolomics in enhancing our understanding of plant metabolic diversity.

PMID:36114669 | DOI:10.1016/j.molp.2022.09.007

Eur J Heart Fail. 2022 Sep 16. doi: 10.1002/ejhf.2695. Online ahead of print.

ABSTRACT

BACKGROUND: Recent data suggest that guideline directed medical treatment of patients with heart failure with reduced ejection fraction (HFrEF) might improve clinical outcomes in patients with heart failure (HF) up to a left ventricular ejection fraction (LVEF) of 55-65%, whereas patients with higher LVEF do not seem to benefit. Recent data have shown that LVEF may have a U-shaped relation with outcome, with poorer outcome also in patients with supranormal values. This suggests that patients with supranormal LVEF may be a distinctive group of patients METHODS AND RESULTS: RELAX AHF-2 was a multicenter, placebo-controlled trial on the effects of serelaxin on 180-day cardiovascular (CV) mortality and worsening HF at day 5 in patients with acute HF. Echocardiograms were performed at hospital admission in 6128 patients. 155 (2.5%) patients were classified as HFsnEF (LVEF>65%), 1440 (23.5%) as HFpEF (LVEF 50-65%), 1353 (22.1%) as HFmrEF (LVEF 41-49%) and 3180 (51.9%) as HFrEF (LVEF<40%). Patients with HFsnEF compared to HFpEF were more often women, had higher prevalence of non-ischemic HF, had lower levels of natriuretic peptides, were less likely to be treated with beta-blockers and had higher blood urea nitrogen plasma levels. All-cause mortality was not statistically different between groups, although patients with HFsnEF had the highest numerical rate. A declining trend was seen in the proportion of 180-day deaths due to CV causes from HFrEF (290/359, 80.8%) to HFsnEF (14/24, 58.0%). The reverse was observed with death from non-cardiovascular causes. No treatment effect of serelaxin was observed in any of the subgroups.

CONCLUSIONS: In this study, only 2.5% of patients were classified as HFsnEF. HFsnEF was primarily characterized by female sex, lower natriuretic peptides and a higher risk of non-CV death. This article is protected by copyright. All rights reserved.

PMID:36114655 | DOI:10.1002/ejhf.2695

Comput Inform Nurs. 2022 Sep 16. doi: 10.1097/CIN.0000000000000972. Online ahead of print.

ABSTRACT

The application of data science resources can enhance our ability to reduce health disparities affecting communities across the country. In this paper, we use the Preferred Reporting Items for Structured Review and Meta-Analyses methodology to conduct a thematic analysis of selected studies and identify micro and macro themes within the literature. The authors of this analysis reviewed articles that included data science software applications and their role in focusing efforts to address health disparities affecting the health of citizens in specific communities across the country. Abstracts were reviewed for research relevance after duplicates were removed, and documents were eliminated from consideration during the screening based on the exclusion criteria. At the conclusion of the structured literature review, the results emphasized the strong utility of geographically directed assessment. This highlights the need for the integration of geo- and statistical methodologies in the use of data science software for healthcare applications, which can be a useful means to identify locations where health disparities are present and can focus efforts to resolve these health disparities. Nurses, physicians, and health educators can be dispatched to the geographical areas where health disparities are most prevalent.

PMID:36114637 | DOI:10.1097/CIN.0000000000000972

Psychogeriatrics. 2022 Sep 16. doi: 10.1111/psyg.12892. Online ahead of print.

ABSTRACT

AIM: Pain is prevalent in geriatric patients and is not only a signal of physical diseases but also a symptom of mental health problems. This study aimed to explore the relationship between pain and depression in geriatric patients scheduled for orthopaedic surgery.

METHODS: The study used a correlational and cross-sectional design. The study sample consisted of geriatric patients (n = 200) scheduled for orthopaedic surgery in a research and training hospital in northern Turkey. Data were collected by the researchers using the Geriatric Pain Measure and Geriatric Depression Scale. In the data analysis, descriptive statistics, Pearson’s correlation, and hierarchical regression analysis were used.

RESULTS: The patients’ mean age was 73.16 ± 8.27 years. It was found that 5.5% (n = 11) of the participants had mild pain, 45.5% (n = 91) had moderate pain, and 49% (n = 98) had severe pain. There was a positive and moderate significant relationship between the mean Geriatric Pain Measure and Geriatric Depression Scale scores (r = 0.479, P < 0.01). Age (β = 0.133; P < 0.05) and education (β = 2.484; P < 0.05) were statistically significantly associated with depression. There was a significant and positive relationship between depression and being dependent in activities of daily living (β = 5.098; P < 0.05).

CONCLUSION: This study demonstrated that geriatric patients who were older, illiterate, dependent in activities of daily living, and with higher levels of pain had higher depression. A multidisciplinary team approach including nurses should be utilised in pain management and it should not be ignored that severe pain may be associated with depression in geriatric patients.

PMID:36114633 | DOI:10.1111/psyg.12892