Nevin Manimala

BMJ Glob Health. 2021 Sep;6(9):e006446. doi: 10.1136/bmjgh-2021-006446.

ABSTRACT

Latin America has struggled to control the transmission of COVID-19. Comparison of excess death (ED) rates during the pandemic reveals that Ecuador is among the highest impacted countries. In this analysis, we update our previous findings with the most complete all-cause mortality records available for 2020, disaggregated by sex, age, ethnicity and geography. Our study shows that in 2020, Ecuador had a 64% ED rate (95% CI 63% to 65%) or 64% more deaths than expected. Men had a higher ED rate, 75% (95% CI 73% to 76%), than women’s 51% (95% CI 49% to 52%), and this pattern of higher EDs for men than women held for most age groups. The only exception was the 20-29 age group, where women had 19% more deaths, compared to 10% more deaths for men, but that difference is not statistically significant. The analysis provides striking evidence of the lack of COVID-19 diagnostic testing in Ecuador: the confirmed COVID-19 deaths in 2020 accounted for only 21% of total EDs. Our significant finding is that indigenous populations, who typically account for about 5% of the deaths, show almost four times the ED rate of the majority mestizo group. Indigenous women in each age group have higher ED rates than the general population and, in ages between 20 and 49 years, they have higher ED rates than indigenous men. Indigenous women in the age group 20-29 years had an ED rate of 141%, which is commensurate to the ED rate of indigenous women older than 40 years.

PMID:34583975 | DOI:10.1136/bmjgh-2021-006446

Cancer Epidemiol Biomarkers Prev. 2021 Sep 28:cebp.0315.2021. doi: 10.1158/1055-9965.EPI-21-0315. Online ahead of print.

ABSTRACT

BACKGROUND: Circulating lipids and insulin-like growth factor 1(IGF-I) have been reliably associated with breast cancer(BCa). Observational studies suggest an interplay between lipids and IGF-I, however, whether these relationships are causal and if pathways from these phenotypes to BCa overlap is unclear.

METHODS: Mendelian Randomisation(MR) was conducted to estimate the relationship between lipids or IGF-I and BCa risk using genetic summary statistics for lipids(low-density lipoprotein cholesterol, LDL-C;high-density lipoprotein cholesterol,HDL-C; triglycerides,TGs), IGF-I and BCa from GLGC/UKBB(N=239,119), CHARGE/UKBB(N=252,547) and BCAC(N=247,173), respectively. Cross-sectional observational and MR analyses were conducted to assess the bi-directional relationship between lipids and IGF-I in SHIP(N=3,812) and UKBB(N=422,389), and using genetic summary statistics from GLGC(N=188,577) and CHARGE/UKBB(N=469,872).

RESULTS: In multivariable MR(MVMR) analyses, the OR for BCa per 1-SD increase in HDL-C or TG was 1.08(95%CI:1.04,1.13) and 0.94(95%CI:0.89,0.98), respectively. The OR for BCa per 1-SD increase in IGF-I was 1.09(95%CI:1.04,1.15). MR analyses suggested a bi-directional TG-IGF-I relationship (TG-IGF-I beta per 1-SD:-0.13;95%CI:-0.23,-0.04;and IGF-I-TG beta per 1-SD:-0.11;95%CI:-0.18,-0.05). There was little evidence for a causal relationship between HDL-C and LDL-C with IGF-I. In MVMR analyses, associations of TG or IGF-I with BCa were robust to adjustment for IGF-I or TG, respectively.

CONCLUSIONS: Our findings suggest a causal role of HDL-C, TG and IGF-I in BCa. Observational and MR analyses support an interplay between IGF-I and TG, however, MVMR estimates suggest that TG and IGF-I may act independently to influence BCa.

IMPACT: Our findings should be considered in the development of prevention strategies for BCa, where interventions are known to modify circulating lipids and IGF-I.

PMID:34583967 | DOI:10.1158/1055-9965.EPI-21-0315

Hosp Pediatr. 2021 Sep 28:hpeds.2020-005678. doi: 10.1542/hpeds.2020-005678. Online ahead of print.

ABSTRACT

BACKGROUND: Previous studies reveal that ineffective communication contributes to patient-safety events. Structured handoffs improve communication during shift change and transfers from outpatient clinics to emergency departments. We aimed to improve the perceived quality of admission handoffs from a baseline of 22.2% to 50% by the end of the study period through use of a standardized template between urgent care (UC) and inpatient providers.

METHODS: We used quality improvement methodology to identify key themes (clarity in illness severity, organization, completeness, and pace) that contribute to decreased quality communication. A survey to evaluate the perception of communication and key themes between the groups was administered. During the 15-month quality improvement study at a tertiary pediatric institution, we implemented a handoff tool with visual aids. Givers of information received formal training. Participants received iterative performance feedback. A control chart was used to monitor fidelity to the handoff tool. We used statistical analyses to compare changes in perceived communication between provider types before and after implementation of the handoff tool.

RESULTS: Both UC and inpatient providers had an increased rate of positive perceptions in the overall quality of communication after 12 months of using the admission handoff tool (22% vs 67.3%; P = .01). Complete fidelity to the admission handoff tool increased over time. There was no change in mean duration of handoff (4 minutes) after implementing the structured handoff.

CONCLUSIONS: A structured handoff during admission of pediatric patients from an off-site UC to inpatient setting improved the perception of the quality of admission handoff communication.

PMID:34583958 | DOI:10.1542/hpeds.2020-005678

J Nucl Med Technol. 2021 Sep 28:jnmt.121.262759. doi: 10.2967/jnmt.121.262759. Online ahead of print.

ABSTRACT

Rationale: COVID-19 has spread around the world. Its effects go far beyond health care: education has to be conducted so as to prevent infection among students and faculty. Accordingly, changes have occurred in Japan’s educational institutions, including methods related to examinations for nuclear medicine. To assess the quality of training for radiological technologists, we investigated the related changes undertaken at educational institutions. We investigated the lecture format for teaching nuclear medicine technology at Japanese institutions during COVID-19 and also efforts to ensure the quality of conventional education. Methods: We sent a questionnaire to 19 Japanese institutions. It addressed the lecture format and initiatives in examinations for nuclear medicine technology in the first and second semesters of 2020. Results: We obtained responses from 17 institutions. In the first semester of 2020, the lecture format for nuclear medicine technology included remote, hybrid (combination of remote and face-to-face), and video-on-demand lectures. To reinforce the effect of the new teaching formats, institutions adopted various methods, such as enhancing the possibility for students to ask questions, increasing the number of quizzes during lectures, delivering lectures to YouTube, and introducing an e-learning system. In the second semester of 2020, the lecture format included face-to-face, remote, hybrid, and video-on-demand lectures. In that second semester, the number of institutions providing face-to-face lectures while taking thorough measures against infection showed a marked increase. Conclusion: The institutions introduced various educational techniques and initiatives. They prioritized students’ understanding of lecture content and applied what they considered the best teaching methods. Sharing information about the changes adopted at different institutions should help promote good radiological technologists-even during a pandemic.

PMID:34583950 | DOI:10.2967/jnmt.121.262759

Evid Based Ment Health. 2021 Sep 28:ebmental-2021-300287. doi: 10.1136/ebmental-2021-300287. Online ahead of print.

ABSTRACT

BACKGROUND: The effects of COVID-19 on the shift to remote consultations remain to be properly investigated.

OBJECTIVE: To quantify the extent, nature and clinical impact of the use of telepsychiatry during the COVID-19 pandemic and compare it with the data in the same period of the 2 years before the outbreak.

METHODS: We used deidentified electronic health records routinely collected from two UK mental health Foundation Trusts (Oxford Health (OHFT) and Southern Health (SHFT)) between January and September in 2018, 2019 and 2020. We considered three outcomes: (1) service activity, (2) in-person versus remote modalities of consultation and (3) clinical outcomes using Health of the Nation Outcome Scales (HoNOS) data. HoNOS data were collected from two cohorts of patients (cohort 1: patients with ≥1 HoNOS assessment each year in 2018, 2019 and 2020; cohort 2: patients with ≥1 HoNOS assessment each year in 2019 and 2020), and analysed in clusters using superclasses (namely, psychotic, non-psychotic and organic), which are used to assess overall healthcare complexity in the National Health Service. All statistical analyses were done in Python.

FINDINGS: Mental health service activity in 2020 increased in all scheduled community appointments (by 15.4% and 5.6% in OHFT and SHFT, respectively). Remote consultations registered a 3.5-fold to 6-fold increase from February to June 2020 (from 4685 to a peak of 26 245 appointments in OHFT and from 7117 to 24 987 appointments in SHFT), with post-lockdown monthly averages of 23 030 and 22 977 remote appointments/month in OHFT and SHFT, respectively. Video consultations comprised up to one-third of total telepsychiatric services per month from April to September 2020. For patients with dementia, non-attendance rates at in-person appointments were higher than remote appointments (17.2% vs 3.9%). The overall HoNOS cluster value increased only in the organic superclass (clusters 18-21, n=174; p<0.001) from 2019 to 2020, suggesting a specific impact of the COVID-19 pandemic on this population of patients.

CONCLUSIONS AND CLINICAL IMPLICATIONS: The rapid shift to remote service delivery has not reached some groups of patients who may require more tailored management with telepsychiatry.

PMID:34583940 | DOI:10.1136/ebmental-2021-300287

BMJ. 2021 Sep 28;374:n2134. doi: 10.1136/bmj.n2134.

ABSTRACT

OBJECTIVES: To identify and assess the quality and accuracy of prognostic models for nephropathy and to validate these models in external cohorts of people with type 2 diabetes.

DESIGN: Systematic review and external validation.

DATA SOURCES: PubMed and Embase.

ELIGIBILITY CRITERIA: Studies describing the development of a model to predict the risk of nephropathy, applicable to people with type 2 diabetes.

METHODS: Screening, data extraction, and risk of bias assessment were done in duplicate. Eligible models were externally validated in the Hoorn Diabetes Care System (DCS) cohort (n=11 450) for the same outcomes for which they were developed. Risks of nephropathy were calculated and compared with observed risk over 2, 5, and 10 years of follow-up. Model performance was assessed based on intercept adjusted calibration and discrimination (Harrell’s C statistic).

RESULTS: 41 studies included in the systematic review reported 64 models, 46 of which were developed in a population with diabetes and 18 in the general population including diabetes as a predictor. The predicted outcomes included albuminuria, diabetic kidney disease, chronic kidney disease (general population), and end stage renal disease. The reported apparent discrimination of the 46 models varied considerably across the different predicted outcomes, from 0.60 (95% confidence interval 0.56 to 0.64) to 0.99 (not available) for the models developed in a diabetes population and from 0.59 (not available) to 0.96 (0.95 to 0.97) for the models developed in the general population. Calibration was reported in 31 of the 41 studies, and the models were generally well calibrated. 21 of the 64 retrieved models were externally validated in the Hoorn DCS cohort for predicting risk of albuminuria, diabetic kidney disease, and chronic kidney disease, with considerable variation in performance across prediction horizons and models. For all three outcomes, however, at least two models had C statistics >0.8, indicating excellent discrimination. In a secondary external validation in GoDARTS (Genetics of Diabetes Audit and Research in Tayside Scotland), models developed for diabetic kidney disease outperformed those for chronic kidney disease. Models were generally well calibrated across all three prediction horizons.

CONCLUSIONS: This study identified multiple prediction models to predict albuminuria, diabetic kidney disease, chronic kidney disease, and end stage renal disease. In the external validation, discrimination and calibration for albuminuria, diabetic kidney disease, and chronic kidney disease varied considerably across prediction horizons and models. For each outcome, however, specific models showed good discrimination and calibration across the three prediction horizons, with clinically accessible predictors, making them applicable in a clinical setting.

SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020192831.

PMID:34583929 | DOI:10.1136/bmj.n2134

J Med Imaging Radiat Sci. 2021 Sep 25:S1939-8654(21)00202-2. doi: 10.1016/j.jmir.2021.08.017. Online ahead of print.

ABSTRACT

INTRODUCTION: Two-stage collaborative group testing is an assessment format where students first complete a summative assessment independently, and then immediately convene in a small group to complete the same assessment again. Research on two-stage collaborative group testing has shown that it increases immediate learning, improves communication and teamwork, and can lead to enhanced retention of course material; the latter of which is especially important for basic anatomical concepts among health care professionals such as medical radiation technologists. However, such previous research has often employed quasi-experimental designs that may limit both internal and external validity.

METHODS: Using a randomized crossover design with both quantitative and qualitative data analyses including robust intra-individual statistical comparisons, this research compared the educational impact of the two-stage collaborative group testing format (the COL condition) to traditional independent testing (the IND condition). Students (n=196) from two successive renditions of an introductory anatomy course were randomly assigned into groups of 3-5 students. Groups worked together throughout the term on various course elements, including three in-class, non-cumulative term tests (TTs). After practicing the collaborative format during TT1, during TT2 half the groups were assigned to the COL condition while the other half were assigned to the IND condition. Groups crossed over for TT3. All students completed a cumulative final examination independently, with performance data from that examination coded and extracted according to previous TT condition. Educational impact was evaluated as both immediate learning (by comparing IND and COL performance on the associated TT) as well as retention (by comparing final examination performance for topics previously IND tested versus previously COL tested). Students’ qualitative reflections were coded into categories and juxtaposed against quantitative Likert-style feedback to comprehensively explore students’ perception of the testing format for evidence of enjoyment, acceptability, and influence on relevant CAMRT professional competencies.

RESULTS: 167 students (85%) consented to data inclusion, with a final course grade of 75.5 ± 10.0%. On average, TT performance was 13.6 ± 11.6% greater on the COL test (90.4 ± 7.6%) than the IND test (76.7 ± 14.3%) (p<0.01, r = 0.76), results that support immediate learning. Contrary to expectations, final examination performance specific to the two experimental conditions was similar, with students earning an average of 69.6 ± 18.3% on questions that pertained to material they were previously IND tested on, and 67.4 ± 19.1% on questions they were previously COL tested on (ns). Students’ overall perceptions of the two-stage collaborative group testing format were overwhelmingly positive, with 84% indicating a belief that the format was a constructive learning opportunity and 74% recommending continued use. Written reflections revealed that students believed that collaborative testing enhanced their learning by both clarifying previous mistakes and reinforcing correct knowledge. Relevant CAMRT professional competencies included oral communication and interprofessional skills, capacity for productive teamwork, and collaborative practice.

SIGNIFICANCE: Although the results of this study do not support the use of two-stage collaborative group testing for retention of course material, they simultaneously reveal how the testing structure may be uniquely beneficial to students studying within the field of medical radiation sciences while also presenting a pragmatic example of how to implement this unique testing format.

PMID:34583909 | DOI:10.1016/j.jmir.2021.08.017

J Am Pharm Assoc (2003). 2021 Sep 17:S1544-3191(21)00374-5. doi: 10.1016/j.japh.2021.09.004. Online ahead of print.

ABSTRACT

BACKGROUND: Emotional intelligence (EI) is known to improve teamwork, communication, and organizational commitment. The role of EI has also influenced pharmacists’ ability to empathize, control emotions, and actively listen. Although EI’s impact on work-related components, including occupational stress, job performance, and psychological affective well-being, has been studied, there are no data specific to the practice of pharmacy.

OBJECTIVE: The primary objective of this study was to determine whether a significant correlation exists between pharmacist EI and work-related components.

METHODS: A voluntary Qualtrics survey (Qualtrics, Provo, UT) was distributed electronically to all active pharmacists licensed by the Florida Board of Pharmacy, which included questions from valid and reliable assessment tools. Spearman correlations were used to examine the association between EI facets and dependent variables of occupational stress, job performance, and psychological affective well-being. A subanalysis was conducted to evaluate demographic data. Statistical significance was set at P < 0.05 for all tests. Incomplete survey responses were included in the analysis.

RESULTS: A total of 942 responses were received and analyzed. Most of the respondents were aged 44 years or younger (42.5%), female (46.9%), identified as Caucasian (52.8%), and worked 31-40 hours weekly (20.6%). Most of the respondents reported a primary employment setting within community (29.3%) or hospital (18.6%) pharmacy. Higher EI correlated with lower levels of occupational stress, higher job performance, and higher psychological affective well-being. Secondary outcomes reported increased stress for both females and those practicing in the community setting; hospital-based pharmacists reported higher job performance and psychological affective well-being. Stress decreased with both age and years of experience.

CONCLUSION: Higher EI may support overall wellness for pharmacists on the basis of the results of this study. Additional evaluation of demographic data, including practice settings, and a more robust cohort of participants would provide more insight in this area.

PMID:34583907 | DOI:10.1016/j.japh.2021.09.004

Surg Obes Relat Dis. 2021 Sep 3:S1550-7289(21)00410-X. doi: 10.1016/j.soard.2021.08.011. Online ahead of print.

ABSTRACT

BACKGROUND: Research shows that surgery patients who have undergone Roux-en-Y gastric bypass (RYGB) are at increased risk for an alcohol use disorder (AUD). However, the mechanisms through which this increased risk is incurred are poorly understood. A host of variables have been proposed as potentially causal in developing AUDs, but empirical examination of many of these variables in human samples is lacking.

OBJECTIVES: Our objective was to examine the extent to which alcohol pharmacokinetics (PK), the rewarding effects of alcohol, and the relationship between these variables change from before to after weight loss surgery.

SETTING: Large healthcare facility in the Midwest United States METHODS: Thirty-four participants completed assessments before and 1 year after RYGB. They completed laboratory sessions and provided data on the PK of alcohol and the extent to which alcohol was reinforcing to them at each timepoint.

RESULTS: Findings show that the PK effects of alcohol (P < .01) and how rewarding alcohol was reported to be (P < .01) changed from before to 1 year after weight loss surgery. Further, statistically significant increases in the association between these variables were witnessed from before to 1 year after surgery (P < .01).

CONCLUSION: These results implicate changes (from before surgery to one year after) in the reinforcing and PK effects of alcohol as possible mechanisms for increased risk of alcohol use disorder following Roux-en-Y gastric bypass surgery.

PMID:34583891 | DOI:10.1016/j.soard.2021.08.011

Neurologia (Engl Ed). 2021 Sep 25:S2173-5808(21)00143-7. doi: 10.1016/j.nrleng.2019.12.004. Online ahead of print.

ABSTRACT

INTRODUCTION: Manual therapy has been shown to reduce self-reported symptoms in patients with chronic tension-type headache (CTTH). However, simultaneous application of suboccipital muscle inhibition and interferential current has not previously been investigated. This study evaluates the effectiveness of combined treatment with suboccipital muscle inhibition and interferential current compared to standard treatment for pain, disability, and headache impact in patients with CTTH.

METHODS: Patients were randomly allocated to receive either standard treatment (n = 13) or the experimental treatment (n = 12), consisting of 20 minutes of suboccipital muscle inhibition plus interferential current twice weekly for 4 weeks. The primary outcome was improvement in pain, and secondary outcomes included improvement in headache-related disability and reduction in headache impact, which were assessed at baseline and at 4 weeks by a blinded rater.

RESULTS: Statistical analysis showed improvements in the experimental treatment group at 4 weeks for headache-related disability (Neck Disability Index: Hedges’ g = 1.01, P = .001; and Headache Disability Inventory: Hedges’ g = 0.48, P = .022) and headache impact (6-item Headache Impact Test: Hedges’ g = 0.15, P = .037) but not for self-reported pain (numerical rating scale: Hedges’ g = 1.13, P = .18).

CONCLUSIONS: Combined treatment with suboccipital muscle inhibition and interferential current in patients with CTTH did not significantly improve self-reported pain but did reduce disability and the impact of headache on daily life at 4 weeks. These improvements exceed the minimum clinically important difference, demonstrating the clinical relevance of our findings.

PMID:34583886 | DOI:10.1016/j.nrleng.2019.12.004