Nevin Manimala

J Pak Med Assoc. 2021 Oct;71(10):2415-2419.

ABSTRACT

Couple Years of Protection (CYP) is a proxy indicator for birth control protection. Using data from Pakistan Bureau of Statistics, spatial distribution of CYP percent change from 2015-2016 with 2016-2017 was compared by district for Population Welfare Departments, Health departments, and Lady Health Workers in the Punjab province. Spatial profile of CYP showed discernable differences by the three service providers. Local indicators of spatial autocorrelation showed significant districts by type of spatial autocorrelation including high-high, low-low, spatial clusters, as well as spatial outliers. The three service providers had different profile of clusters for percentage change from 2016 to 2017. Cluster and significance maps depict districts where CYP percent change is statistically significantly different or same from the neighbouring districts, and as such underscoring districts where additional focus on service delivery in terms of contraceptives provision could yield improved outcomes.

PMID:34974581

J Pak Med Assoc. 2021 Oct;71(10):2330-2334. doi: 10.47391/JPMA.01-107.

ABSTRACT

OBJECTIVE: To compare the characteristics of connective tissue disease-associated interstitial lung disease with idiopathic pulmonary fibrosis at a tertiary care hospital.

METHODS: The retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised demographical, clinical and radiological data of patients with interstitial lung disease between October 2016 and October 2017 accessed through the outpatient data registry. Data was compared in terms of characteristics and key features of patients with connective tissue disease-associated interstitial lung disease with those of idiopathic pulmonary fibrosis. Statistical analysis was done using STATA 12.

RESULTS: Of the 184 patients, 52(29.3%) had connective tissue disease-associated interstitial lung disease and 62(35%) had idiopathic pulmonary fibrosis. The most prevalent conditions among connective tissue disease-associated interstitial lung disease patients were rheumatoid arthritis 22(42.3%) and scleroderma 13(25%). Compared to patients with idiopathic pulmonary fibrosis, those with connective tissue disease-associated interstitial lung disease were predominantly younger (p<0.001) and female (p<0.001). History of gastroesophageal reflux disease was also significantly lower in connective tissue disease-associated interstitial lung disease (p=0.05).

CONCLUSIONS: Connective tissue disease-associated interstitial lung disease patients were found to be younger and predominantly female compared to patients of idiopathic pulmonary fibrosis.

PMID:34974565 | DOI:10.47391/JPMA.01-107

J Pak Med Assoc. 2021 Oct;71(10):2325-2329. doi: 10.47391/JPMA.01-085.

ABSTRACT

OBJECTIVE: To evaluate the effect parental attitudes have on the dental caries experience of children.

METHODS: The cross-sectional observational study was conducted at Yeditepe University, Istanbul, Turkey, from March to September 2019, and comprised mothers of children who came to the Department of Paediatric Dentistry for treatment of children. Multi-variable poisson regression model was run to predict prevalence of dental caries. Mothers’ attitudes in family were measured using the parental attitude research instrument scores. Data was analysed using Stata 15.

RESULTS: There were 258 mothers of as many children aged 6-15 years. Among the children, 150(58%) were boys and 108(42%) were girls. ‘Rejection of traditional housewife role’ and ‘level of discipline’ had a statistically negative correlation (p<0.05), while ‘level of marital conflict’ had a statistically positive correlation with the prevalence of caries.

CONCLUSIONS: Healthy family environment and empowering parental style had a positive effect on the oral health of children.

PMID:34974564 | DOI:10.47391/JPMA.01-085

Clin J Pain. 2021 Dec 31. doi: 10.1097/AJP.0000000000001017. Online ahead of print.

ABSTRACT

OBJECTIVES: First, we aimed to determine the feasibility of virtual reality (VR) distraction for children with cancer undergoing subcutaneous port (SCP) access. Second, we aimed to estimate preliminary treatment effects of VR compared to an active distraction control (iPad).

METHODS: A single-site pilot randomized controlled trial (RCT) comparing VR to iPad distraction was conducted. Eligible children were aged 8-18 years undergoing treatment for cancer with upcoming SCP needle insertions. Intervention acceptability was evaluated by child, parent, and nurse self-report. Preliminary effectiveness outcomes included child-reported pain intensity, distress, and fear. Preliminary effectiveness was determined using logistic regression models with outcomes compared between groups using pre-procedure scores as covariates.

RESULTS: Twenty participants (mean age 12▒y) were randomized to each group. The most common diagnosis was acute lymphocytic leukemia (n=23, 58%). Most eligible children (62%) participated, and one withdrew after randomization to the iPad group. Nurses, parents, and children reported the interventions in both groups to be acceptable, with the VR participants reporting significantly higher immersion in the distraction environment (P=0.0318). Although not statistically significant, more VR group participants indicated no pain (65% vs. 45%) and no distress (80% vs. 47%) during the procedure compared to the iPad group. Fear was similar across groups, with approximately 60% of the sample indicating no fear.

DISCUSSION: VR was feasible and acceptable to implement as an intervention during SCP access. Preliminary effectiveness results indicate that VR may reduce distress and distress compared to iPad distraction. These data will inform design of a future full-scale RCT.

PMID:34974512 | DOI:10.1097/AJP.0000000000001017

Cancer Nurs. 2021 Dec 30. doi: 10.1097/NCC.0000000000001052. Online ahead of print.

ABSTRACT

BACKGROUND: Patients with advanced cancer are increasingly experiencing financial hardship (FH) and associated negative health outcomes.

OBJECTIVE: The aims of this study were to describe FH and explore its relationship to quality of life (QOL) in patients with advanced cancer receiving outpatient palliative care (PC).

METHODS: Validated questionnaires assessed FH, QOL dimensions, symptom burden, and sociodemographic and clinical characteristics. Descriptive statistics characterized the sample and described FH. Pearson correlation and linear regression assessed relationships between FH and QOL.

RESULTS: The average participant (n = 78) age was 56.6 (SD, 12.2) years. Most were female (56.4%), White (50%) or Black (46.2%), and had a range of education, partner statuses, and cancer diagnoses. Median time since cancer diagnosis was 35.5 months (interquartile range, 9-57.3 months). Highest mean symptom burden scores were for pain (2.5 [SD, 1.0]) and fatigue (2.0 [SD, 1.1]), on a 0- to 3-point scale (higher score representing worse symptom burden). The median COST (COmphrehensive Score for financial Toxicity) score was 15.0 (interquartile range, 9.0-23.0). Most (70%) had some (n = 43) or extreme (n = 9) difficulty paying for basic needs. Greater than 28% (n = 21) incurred cancer-related debt. Multivariate models indicated that FH negatively affected role limitations due to physical health (P = .008), pain (P = .003), and emotional well-being (P = .017) QOL dimensions.

CONCLUSIONS: Financial hardship, QOL, and symptom burden scores demonstrate need for continued support for and research among patients with advanced cancer. Data support links between FH and important QOL dimensions. Larger, longitudinal studies are needed to understand how FH affects QOL in patients with advanced cancer.

IMPLICATIONS FOR PRACTICE: Proactive financial assessment and interventions are needed to support patients with advanced cancer experiencing the cumulative effects of cancer and its treatment.

PMID:34974507 | DOI:10.1097/NCC.0000000000001052

Nurs Educ Perspect. 2021 Dec 21. doi: 10.1097/01.NEP.0000000000000920. Online ahead of print.

ABSTRACT

AIM: This study investigated the impact of an interprofessional mock code on students’ comfort and competency related to Parkinson’s disease (PD) medication administration during care transitions.

BACKGROUD: Patients with PD are at increased risk for medication errors during hospitalization. Individualization of PD medication creates vulnerability during care transitions.

METHOD: Four interprofessional groups took part in this study: baccalaureate degree senior nursing students (n = 113), master’s level nurse anesthesia students (n = 35), doctor of osteopathic medicine fourth-year students (n = 32), and doctor of clinical psychology fourth-year students (n = 22). Groups participated in an unfolding case study simulation involving a mock code with a focus on the omission of time-sensitive PD medication. Pre- and postsimulation test results were compared.

RESULTS: Findings indicated an increased understanding among three of the four groups relating to medication timing during care transitions.

CONCLUSION: All groups improved with respect to perceived comfort and competency.

PMID:34974503 | DOI:10.1097/01.NEP.0000000000000920

J Clin Gastroenterol. 2021 Dec 31. doi: 10.1097/MCG.0000000000001655. Online ahead of print.

ABSTRACT

INTRODUCTION: Intravenous immunoglobulin (IVIG) has been shown in a small pilot series to be helpful for some patients with gastroparesis that is refractory to drugs, devices, and surgical therapies. Many but not all patients have serologic neuromuscular markers. We hypothesize that those patients with serologic markers and/or longer duration of therapy would have better responses to IVIG.

MATERIALS AND METHODS: We studied 47 patients with a diagnosis of gastroparesis and gastroparesis-like syndrome that had all failed previous therapies including available and investigational drugs, devices, and/or pyloric therapies. Patients had a standardized 12-week course of IVIG, dosed as 400 mg/kg per week intravenously. Symptom assessment was done with Food and Drug Administration (FDA) compliant traditional patient-reported outcomes. Success to IVIG was defined as 20% or greater reduction in average symptom scores from baseline to the latest evaluation.

RESULTS: Fourteen patients (30%) had a response, and 33 (70%) had no response per our definition. Patients responding had a higher glutamic acid decarboxylase 65 positivity (64% vs. 30%, P=0.049, missing=3) and longer duration of therapy (>12 wk/continuous: 86% vs. 48%, P=0.09).

CONCLUSIONS: In this moderately sized open-label series of refractory patients with gastroparesis symptoms treated with IVIG, 30% of patients responded. While serologic markers and extended therapies show a trend to greater response, neither was statistically significant, except for glutamic acid decarboxylase 65 which showed a higher positivity rate in responders. We conclude that a clinical trial of IVIG may be warranted in severely refractory patients with gastroparesis symptoms.

PMID:34974494 | DOI:10.1097/MCG.0000000000001655

J Clin Gastroenterol. 2021 Dec 31. doi: 10.1097/MCG.0000000000001650. Online ahead of print.

ABSTRACT

OBJECTIVE: There is still no gold standard regarding the optimal circumference of antireflux mucosectomy (ARMS) in patients with treatment-refractory gastroesophageal reflux disease (GERD). The aim of this study is to assess the safety and effectiveness of resection procedures when the circumferences are different.

PATIENTS AND METHODS: Thirty-two patients with treatment-refractory GERD were allocated into group A (16 cases) and group B (16 cases) by randomization. In group A and group B, a 2/3 and 1/2 circumference, 1.5 cm wide mucosal resection of the gastric cardia was performed. Health-related quality of life (HRQOL), frequency scale for the symptoms of GERD (FSSG), DeMeester scores and acid exposure time (AET) were accessed at baseline and at 24 months after treatment. Physical component summaries (PCS), mental component summaries (MCS), and RE-specific summary (RES) scores were calculated.

RESULTS: All patients had successful surgical procedures and no bleeding, perforation, or dysphagia occurred. The PCS, MCS, and RES scores of post-ARMS were higher than those of pre-ARMS in groups A and B, and the FSSG, DeMeester scores and AET decreased after ARMS in both groups, with differences that were statistically significant (P<0.05). The changes in PCS, MCS, RES, FSSG, DeMeester scores, and AET were greater in group A than in group B, with significant differences in PCS, MCS, RES, and FSSG scores (P<0.05), but no significant differences in, DeMeester scores and AET (P>0.05).

CONCLUSION: ARMS is an effective treatment for treatment-refractory GERD. Moreover, we recommend the 2/3 circumference, 1.5 cm wide mucosal resection of the gastric cardia.

PMID:34974493 | DOI:10.1097/MCG.0000000000001650

J Acquir Immune Defic Syndr. 2021 Dec 21. doi: 10.1097/QAI.0000000000002901. Online ahead of print.

ABSTRACT

BACKGROUND: The COVID-19 pandemic and its associated socio-economic disruptions has disproportionally affected marginalized populations including people living with HIV (PLHIV). Little is known about how the pandemic has impacted populations experiencing multiple forms of stigma, discrimination and violence such as female sex workers (FSW) living with HIV.

METHODS: We conducted a cross-sectional survey between August and December 2020 among 187 FSW living with HIV in the Dominican Republic (DR) to examine the impact of COVID-19. Using multivariable logistic regression, we examined associations between COVID-19-related financial concerns, mental health, substance use and partner abuse on engagement in HIV care and ART adherence. We conducted mediation analysis to assess whether mental health challenges mediated the impact of partner abuse or substance use on HIV outcomes.

RESULTS: Most participants reported no income (72%) or a substantial decline in income (25%) since the COVID-19 pandemic. Approximately one third (34%) reported COVID-19 had an impact on their HIV care and treatment. Greater COVID-19 financial concerns (aOR=1.14, 95% CI: 1.02-1.27), mental health challenges (aOR=1.38, 95% CI: 1.06-1.79) and partner emotional abuse (aOR=2.62, 95% CI: 1.01-6.79) were associated with higher odds of negatively impacted HIV care, respectively. The relationship between increased emotional partner abuse and negatively impacted HIV care was mediated by greater COVID-19-related mental health challenges.

CONCLUSION: FSW living with HIV in the DR have been significantly impacted by the COVID-19 pandemic. Targeted interventions that address structural (financial security, partner abuse) and psychosocial (mental health) factors are needed to sustain HIV outcomes and well-being.

PMID:34974474 | DOI:10.1097/QAI.0000000000002901

Optom Vis Sci. 2021 Dec 29. doi: 10.1097/OPX.0000000000001850. Online ahead of print.

ABSTRACT

SIGNIFICANCE: Psychophysical estimates of spatial and depth vision have been shown to be better following bilateral ReLEx small incision lenticule extraction (SMILE) refractive surgery for myopia, relative to Photorefractive Keratectomy (PRK) and Femtosecond-LASIK (FS-LASIK). The present study provides the optical basis for these findings using computational image quality analysis.

PURPOSE: To compare longitudinal changes in higher-order wavefront aberrations and image quality before and after bilateral PRK, FS-LASIK, and SMILE refractive procedures for correcting myopia.

METHODS: Wavefront aberrations and image quality of both the eyes of 106 subjects (n = 40 for FS-LASIK and SMILE and n = 26 for PRK) were determined pre-operatively and at 1-week, 1-month, 3-months, and 6-months post-operative intervals using computational through-focus analysis for 6 mm pupil diameter. Image quality was quantified in terms of its peak value and its interocular difference, residual defocus that was needed to achieve peak image quality (best focus) and the depth of focus.

RESULTS: The increase in RMS deviations of higher-order aberrations postoperatively was lesser after SMILE [1mth visit median (25th to 75th interquartile range): 0.34 μm (0.28 to 0.39 μm)] than after PRK [0.80 μm (0.74 to 0.87 μm)] and FS-LASIK [0.74 μm (0.59 to 0.83 μm)] (P ≤ .001), all relative to pre-operative values [0.20 μm (0.15 to 0.30 μm)]. The peak image quality dropped and its interocular difference increased, best focus shifted myopically by 0.5 – 0.75D and depth of focus widened significantly following PRK and FS-LASIK surgeries, all relative to pre-operative values (P < .001). All these changes were negligible but statistically significantly in a minority of instances following SMILE surgery (P ≥ .01).

CONCLUSIONS: While all three refractive surgeries correct myopia, the image quality and its similarity between eyes are better and closer to pre-operative values following SMILE, compared to FS-LASIK and PRK. These results can be explained from the underlying increase in higher-order wavefront aberrations experienced by the eye postoperatively.

PMID:34974458 | DOI:10.1097/OPX.0000000000001850