Nevin Manimala

BMC Health Serv Res. 2024 Dec 3;24(1):1534. doi: 10.1186/s12913-024-12025-5.

ABSTRACT

BACKGROUND: Healthcare transformation is a multifaceted process that hinges on the collaborative efforts of various stakeholders. The success of a significant transformational project is contingent upon the readiness and acceptance among the healthcare workers.

AIMS: This study aims to assess the level of understanding and awareness of healthcare workers regarding healthcare transformation, with a specific focus on Vision 2030.

METHODS: A cross-sectional quantitative study was undertaken involving Saudi healthcare workers. The research employed bivariate correlations and multivariate linear regressions for statistical analysis. Survey data were collected from 456 healthcare workers to gauge their perspectives on healthcare transformation.

RESULTS: The findings reveal a robust correlation between awareness of healthcare transformation and the perceived significance of the transformation. Notably, participation in the planning and execution stages significantly enhances awareness levels. Conversely, a negative correlation is observed between awareness levels and concerns related to job security and other challenges faced by healthcare workers.

CONCLUSION: To ensure the success of the national transformation program, decision-makers should actively involve all potential stakeholders, particularly during the planning and execution stages. Reassuring healthcare workers about job security and addressing their concerns are crucial steps in overcoming resistance and fostering the necessary support for healthcare transformation initiatives.

PMID:39627826 | DOI:10.1186/s12913-024-12025-5

BMC Nurs. 2024 Dec 3;23(1):881. doi: 10.1186/s12912-024-02554-z.

ABSTRACT

BACKGROUND: Clinical nurses play a vital role in healthcare. Their innovative behavior is crucial for improving patient care, advancing the profession, and ensuring the healthcare industry’s continued success. Many studies have highlighted the importance of nurse innovative behavior, but the link between their innovative behavior, structural empowerment, and decent work perception remains unclear.

OBJECTIVES: This study aimed to investigate the relationship between innovative behavior, structural empowerment, and decent work perception among the Chinese clinical nurses and identify the mediating role of decent work perception.

METHODS: A cross-sectional correlational design was employed, and from July 2023 to April 2024, 1,513 clinical nurses were recruited from 8 tertiary grade-A hospitals across three cities in China. Data from the Demographic Characteristics Questionnaire, the Nurse Innovation Behavior Scale, the Conditions of Work Effectiveness Questionnaire-II, and the Decent Work Perception Scale were collected through convenience sampling and analyzed using descriptive statistics, univariate correlation, and process plug-in mediation effect analyses.

RESULTS: The total scores of innovative behavior, structural empowerment, and decent work perception were 28.36 ± 6.25, 51.15 ± 12.63, and 42.97 ± 9.25, respectively. Innovative behavior was significantly, moderately and positively correlated with structural empowerment (r = 0.657, p < 0.01) and decent work perception (r = 0.618, p < 0.01); decent work perception played a partial mediating role between innovative behavior and structural empowerment (52.5%).

CONCLUSION: The innovative behavior, structural empowerment, and decent work perception among the Chinese clinical nurses were relatively moderate, indicating a need for improvement. Structural empowerment perception can, directly and indirectly, impact innovative behavior through decent work perception among Chinese clinical nurses. Nursing managers should promote innovative behavior of clinical nurses by raising structural empowerment and decent work perception to improve the quality of clinical nursing. Thus, it can be improved by creating a positive empowerment climate for clinical nurses and providing them with the information, resources, support, and opportunities for their jobs and improving their level of structural empowerment and decent work perception.

PMID:39627823 | DOI:10.1186/s12912-024-02554-z

J Transl Med. 2024 Dec 4;22(1):1100. doi: 10.1186/s12967-024-05851-y.

ABSTRACT

BACKGROUND: Colorectal cancer (CRC) is the third most common cancer worldwide, with highly variable prognosis and response to treatment. A large subset of patients does not respond to standard treatments or develops resistance. As an alternative, adoptive immunotherapy based on chimeric antigen receptor (CAR)-transduced immune cells has been proposed, however with significant adverse events. We therefore evaluated alternative CAR targets already tested in other tumour types and employed the natural killer cell line NK-92 for CAR transduction because of its more favourable toxicity profile.

METHODS: As an alternative antigen, we considered mesothelin (MSLN), the most represented target in CAR-based clinical studies for solid tumours. MSLN RNA expression was analysed in large series of CRC tumours (n = 640) and cell lines (n = 150), to evaluate its distribution and to identify MSLN-overexpressing models. NK-92 cells were transduced with anti-MSLN CAR, and subsequently sorted and cloned. Activity of CAR-NK-92 cells against target-expressing ovarian and CRC cells was assessed in vitro and in vivo. Statistical significance of efficacy was evaluated by t-test and log-rank test.

RESULTS: Large-scale expression analysis highlighted that about 10% of CRCs overexpress MSLN at levels comparable to those of ovarian cancer, a typical target of MSLN-CAR-based therapy. Intriguingly, MSLN overexpression is more frequent in poor prognosis and KRAS/BRAF-mutant CRC. Lentiviral transduction of NK-92 cells with the MSLN-CAR, followed by sorting and cloning, led to the identification of one clone, MSLN.CAR.NK-92.cl45, stably expressing the CAR and retaining the NK phenotype. As expected, the clone demonstrated significant in vitro and in vivo activity against ovarian cancer cells. When repurposed against models of CRC expressing high MSLN levels, it displayed comparable efficacy, both in vitro and in vivo. Specificity of the clone was confirmed by the absence of activity on control models with low or absent MSLN.

CONCLUSIONS: Our results provide preclinical evidence that a subset of colorectal cancers expressing high mesothelin levels can be effectively targeted by MSLN-CAR-based immunotherapy. The potential therapeutic impact of these findings is enhanced by the fact that frequently MSLN-overexpressing CRCs display worse prognosis and resistance to standard care.

PMID:39627822 | DOI:10.1186/s12967-024-05851-y

World J Surg Oncol. 2024 Dec 3;22(1):324. doi: 10.1186/s12957-024-03548-6.

ABSTRACT

Gastric cancer (GC) treatment is increasingly undergoing laparoscopic total gastrectomy (LTG) procedures. However, we conducted this research to evaluate postoperative outcomes, particularly surgical complications associated with intracorporeal and extracorporeal esophagojejunostomies using linear or circular stapling techniques following LTG for GC treatment. We aimed to compare short-term postoperative outcomes, such as surgical complications and anastomotic outcomes, between the two groups. Method From January 2020 to August 2022, we conducted a retrospective analysis of data from 160 consecutive patients diagnosed with GC who received either IEJ (n = 35) or EEJ (n = 125) during LTG. We utilized the Mann-Whitney U test to ascertain the statistical significance between the two groups. For comparing categorical variables, including numbers and percentages, we employed either the Pearson chi-square test, continuity correction, or Fisher’s exact test as appropriate.ResultsThe operative time was similar (IEJ: 184.57 ± 36.489 vs. EEJ: 189.22 ± 43.584; P = 0.565), however, the number of positive lymph nodes was performed more in the IEJ group (IEJ: 4.71 ± 6.114 vs. EEJ: 6.39 ± 9.067 (P = 0.305). The blood loss in the IEJ group was lower than that of the EEJ (IEJ: 73.1429.182 vs. EEJ: 100.6461.693 mL, P = 0.012). There were three anastomosis leakages in the EEJ and one in the IEJ group (EEJ, 3.2% vs. IEJ, 2.8%; P > 0.999). Anastomosis bleeding only occurred in the EEJ (EEJ 1%; P = 0.003). Although the EEJ linear stapling technique had two deaths (EEJ, 1.6%).ConclusionAlthough EEJ is frequently utilized in the linear stapling technique, research indicates that the use of IEJ minimizes the incidence of complications in LTG.

PMID:39627814 | DOI:10.1186/s12957-024-03548-6

Nutr J. 2024 Dec 3;23(1):155. doi: 10.1186/s12937-024-01053-w.

ABSTRACT

BACKGROUND: Plant-based diets have been found to be associated with hypertension. Dietary intake is a dynamic and changing process that can be better characterized by trajectories of dietary indices. However, the associations between plant-based diet trajectories and hypertension over time remained unknown.

METHODS: We used data from the China Health and Nutrition Survey 2004-2015 to analyze a cohort of Chinese adults ≥ 18 years of age who had no hypertension at baseline. Plant-based diets were measured by an overall plant-based diet index (PDI), healthful plant-based diet index (hPDI), and unhealthful plant-based diet index (uPDI) based on three 24-hour recalls. Trajectories of PDI, hPDI, and uPDI (2004 to 2011) were identified using group-based trajectory modeling. The associations between trajectories of PDIs and the risk of new-onset hypertension were estimated using Cox proportional hazard models.

RESULTS: We identified three trajectories for PDI, two for hPDI, and four for uPDI among the 2853 participants with a mean follow-up of 9.6 years. Compared with the PDI “low and stable” class, the PDI “high and decreasing” class had a 23% decreased risk (HR: 0.77; 95% CI: 0.62-0.95) of hypertension. There was no significant association with PDI “low and increasing” class. Compared with the hPDI “low and stable” class, the hPDI “high and stable” class had a 24% decreased risk (HR: 0.76; 95%CI: 0.64-0.91). For uPDI trajectories, compared with the “low and decreasing” class, the “high and increasing,” “high and stable,” and “low and increasing” classes had increased risks of 43% (HR: 1.43; 95% CI: 1.06-1.94), 77% (HR: 1.77; 95% CI: 1.26-2.49), and 72% (HR: 1.72; 95% CI: 1.26-2.33), respectively.

CONCLUSIONS: This study underscores the importance of maintaining high intakes of healthful plant-based diets and low intakes of unhealthful plant-based diets overtime for hypertension prevention.

PMID:39627809 | DOI:10.1186/s12937-024-01053-w

Radiat Oncol. 2024 Dec 3;19(1):172. doi: 10.1186/s13014-024-02562-y.

ABSTRACT

BACKGROUND/AIM: Current approaches for locally advanced rectal cancer (LARC) typically recommend neoadjuvant chemoradiotherapy (nCRT) with 5-fluorouracil (5FU) or its oral analogs followed by surgery as the standard of care. However, the question of whether intensifying concurrent chemotherapy by adding oxaliplatin to the 5FU-based backbone can yield better outcomes remains unresolved. This study aimed to investigate the benefits of incorporating oxaliplatin into fluoropyrimidine-based chemoradiotherapy (CRT) to increase locoregional control and survival.

METHODS: Among 290 patients with LARC admitted to the Iran Cancer Institute’s radiation oncology department between January 2008 and December 2019, 29 received CAPEOX (capecitabine 625 mg/m²/bid on RT days and weekly oxaliplatin 50 mg/m²), whereas 293 received capecitabine (825 mg/m² twice daily or rarely 5FU in the first 4 days and last week of radiotherapy (RT)). Variables potentially affecting treatment outcomes were used for propensity score matching. Kaplan‒Meier and log-rank tests were employed for overall survival (OS) and disease-free survival (DFS) analyses and were adjusted with propensity score matching.

RESULTS: Data from 29 patients who received CAPEOX and 216 patients who received capecitabine were analyzed after propensity score matching without replacement. After propensity score matching, in the multivariate analysis, CAPEOX significantly increased the likelihood of achieving a pathologic complete response (pCR) by 4.38 times (CI: 1.90-10.08, p value < 0.001). However, CAPEOX did not demonstrate any statistically significant predictive value for DFS (P = 0.500) or OS (P = 0.449).

CONCLUSION: The addition of oxaliplatin resulted in a significantly higher rate of pCR without any translation into long-term survival outcomes.

PMID:39627803 | DOI:10.1186/s13014-024-02562-y

Sr Care Pharm. 2024 Dec 1;39(12):449-457. doi: 10.4140/TCP.n.2024.449.

ABSTRACT

Background: Cholinesterase (ChE) inhibitors enhance central cholinergic function and are considered as standard treatments to ameliorate symptoms relating to Alzheimer’s disease. Though anticholinergic medications directly antagonize the effects of ChE inhibitors, they are commonly prescribed among hospitalized adults. Objective: To determine the impact of high anticholinergic burden (ACB) on length of stay (LOS) and 30-day readmission rates among hospitalized patients receiving concomitant ChE inhibitors. Methods: This was a retrospective cohort study conducted at a tertiary care academic medical center involving hospitalized patients on medical floors who received any Food and Drug Administration-approved ChE inhibitors during their hospital stay from October 1, 2022, to September 30, 2023. The primary outcome of the study was to compare hospital LOS among patients with high (ACB ≥ 3) versus low (ACB < 3) ACB. The secondary outcome was to assess the impact of ACB burden on 30-day readmission rates. Results: Among hospitalized adults, patients with high ACB exposure had a significantly longer hospital LOS (median: 5.50 vs 4.25 days; P < 0.001) than patients with low ACB exposure, after adjusting for covariates. Analysis of secondary outcome revealed that though the high ACB group had a higher 30-day readmission rate compared with the lower ACB group (6.8% vs. 2.2%), the difference was not statistically significant (OR = 3.46, 95% CI 0.85-14.08; P = 0.083). Conclusion: A high ACB exposure among older individuals taking concurrent ChE inhibitors is associated with a longer hospital stay.

PMID:39627800 | DOI:10.4140/TCP.n.2024.449

BMC Pregnancy Childbirth. 2024 Dec 3;24(1):808. doi: 10.1186/s12884-024-07007-8.

ABSTRACT

BACKGROUND: Approaches to improve physical activity (PA), diet, and health-related quality of life (HRQOL) during postpartum in diverse women with elevated weight are needed.

METHODS: Health In Pregnancy and Postpartum (HIPP) was a randomized controlled trial that followed African American and white women with overweight or obesity from pregnancy through 12 months postpartum. Participants were randomized to a behavioral intervention grounded in social cognitive theory (n = 112) or standard care (n = 107). From enrollment (≤ 18 weeks gestation) through 6 months postpartum, the intervention group received two in-depth counseling sessions (one each during pregnancy and postpartum), counseling calls, behavioral podcasts, and access to a private Facebook group, while the standard care group received monthly mailings and podcasts focused on healthy pregnancy and infant development. PA (SenseWear armband), diet (ASA24), and HRQOL (SF-12) measurements were obtained from blinded assessors at baseline and 6- and 12-months postpartum. Linear or quantile regression models, depending on conformity to normality assumptions, were used to test differences between behavioral intervention and standard groups in PA outcomes (minutes/day of total PA, light PA, and moderate-to-vigorous intensity PA (MVPA), and total steps/day), dietary outcomes (diet quality and six measures of dietary intake), and HRQOL at 6- and 12-months postpartum, controlling for baseline values, race, parity, weight status, education, maternal age, gestational age, and caloric intake (for most diet models).

RESULTS: There were no statistically significant differences by group for any PA, diet, or HRQOL outcomes at 6 or 12 months postpartum. Irrespective of group assignment, all PA outcomes improved from pregnancy to postpartum, as did kcals and the mental component of HRQOL. Furthermore, while not statistically significant, virtually all PA outcomes, except MVPA at 12 months, and several dietary outcomes, including diet quality, had patterns favoring the intervention group but with small effect sizes.

CONCLUSIONS: Postpartum PA, diet, and HRQOL did not differ significantly between women in the behavioral intervention group and those in the standard care group. Given the increased responsibilities and stress that women face during the postpartum period, this appears to be a challenging time to make lifestyle changes.

TRIAL REGISTRATION: This trial was registered at ClinicalTrials.gov on 10/09/2014. Identifier: NCT02260518.

PMID:39627794 | DOI:10.1186/s12884-024-07007-8

BMC Musculoskelet Disord. 2024 Dec 3;25(1):990. doi: 10.1186/s12891-024-08132-3.

ABSTRACT

BACKGROUND: Musculoskeletal disorders are an extensive burden to society, yet few studies have explored and replicated modifiable prognostic factors associated with high societal costs. This study aimed to replicate previously identified associations between nine modifiable prognostic factors and high societal costs among people on sick leave due to musculoskeletal disorders.

METHODS: Pooled data from a three-arm randomised controlled trial with 6 months of follow-up were used, including 509 participants on sick leave due to musculoskeletal disorders in Norway. Consistent with the identification study, the primary outcome was societal costs dichotomised as high (top 25th percentile) or low. Societal costs included healthcare utilization (primary, secondary, and tertiary care) and productivity loss (absenteeism, work assessment allowance and disability benefits) collected from public records. Binary unadjusted and adjusted logistic regression analyses were used to replicate previously identified associations between each modifiable prognostic factor and having high costs.

RESULTS: Adjusted for selected covariates, a lower degree of return-to-work expectancy was associated with high societal costs in both the identification and replication sample. Depressive symptoms and health literacy showed no prognostic value in both the identification and replication sample. There were inconsistent results with regards to statistical significance across the identification and replication sample for pain severity, self-perceived health, sleep quality, work satisfaction, disability, and long-lasting disorder expectation. Similar results were found when high costs were related to separately healthcare utilization and productivity loss.

CONCLUSION: This study successfully replicated the association between return-to-work expectancy and high societal costs among people on sick leave due to musculoskeletal disorders. Other factors showed no prognostic value or inconsistent results.

TRIAL REGISTRATION: ClinicalTrials.gov NCT03871712, 12th of March 2019.

PMID:39627785 | DOI:10.1186/s12891-024-08132-3

BMC Med Imaging. 2024 Dec 3;24(1):327. doi: 10.1186/s12880-024-01494-z.

ABSTRACT

OBJECTIVE: Ductal carcinoma in situ (DCIS) of the breast has a wide disease spectrum with risks of progression to invasive cancer linked to pathological factors. High-grade histology, large tumor volume, and comedonecrosis are adverse prognostic factors. This study explores the correlation between conventional ultrasound (Con-US) and shears wave elastography (SWE) features with DCIS prognostic factors and evaluates their predictive efficacy.

METHODS: A retrospective analysis was conducted on clinical data, Con-US, and SWE imaging features of 83 DCIS patients who underwent surgical resection between June 2018 and December 2022. Binary logistic regression analysis was performed to explore the relationship between sonogram indices and pathological prognostic factors.

RESULTS: The results revealed that microcalcification observed on Con-US was an independent risk factor for high-grade DCIS and comedonecrosis [odds ratio (OR): 5.316 and 4.512]. In SWE analysis, the Emax value was significantly different between the non-high-grade and high-grade DCIS groups(P = 0.006), with an Emax value greater than 75.03 kPa identified as an independent risk factor for high-grade DCIS [OR:1.022, the area under the curve (AUC): 0.682, 95% confidence interval (CI): 0.555-0.808]. Additionally, the Ecolor, Emax, Emean, and Emean SD values were statistically different between the groups with and without comedonecrosis (P = 0.049, 0.006, 0.012, 0.022), with an Emean value exceeding 30.45 kPa identified as an independent risk factor for comedonecrosis (OR:1.025, AUC:0.708, 95% CI:0.562-0.854). Furthermore, combining microcalcification on Con-US with specific SWE indicators demonstrated an improved predictive specificity for high-grade DCIS and comedonecrosis (0.902 and 0.889, respectively). No significant difference was found in other indexes on SWE.

CONCLUSIONS: The microcalcification signs on Con-US, Emax and Emean values on SWE analysis are associated with the high nuclear grade and comedonecrosis of DCIS, the combination of Con-US and SWE can improve the predictive specificity of DCIS-related prognostic factors.

PMID:39627774 | DOI:10.1186/s12880-024-01494-z