Nevin Manimala

Swiss Med Wkly. 2022 Jun 22;152:w30180. doi: 10.4414/smw.2022.w30180. eCollection 2022 Jun 20.

ABSTRACT

BACKGROUND: Due to Switzerland’s shortage of general practitioners (GPs), task shifting through interprofessional collaboration is needed to relieve GPs’ workload and allow the continued provision of quality care. The profession of specialized medical assistant (SMA) was created in Switzerland several years ago to provide a career advancement opportunity for medical practice assistants (MPAs) and intended to counteract the increasing scarcity of resources in primary care. Clinical specialized medical assistants (CSMAs) are trained to care for a set of chronic conditions, such as diabetes.

OBJECTIVE: We aimed to compare the quality of care for patients with type 2 diabetes in practices with and without CSMAs. Further, we aimed to investigate whether evidence exists that CSMA care models may allow for task shifting and the provision of interprofessional care while maintaining a high quality of care and to assess patient experiences with diabetes care in both care models.

METHODS: The present study was a paper-based cross-sectional survey of patient data. A total of 171 patients with type 2 diabetes who had been under the care of either a GP with CSMA (91 patients) or a GP without CSMA (80 patients) for at least one year were consecutively recruited for the study. Data were collected from mid-September 2020 to mid-June 2021. For the statistical analyses, we used descriptive statistics and t-tests.

RESULTS: Patients from both practice types were comparable in age, gender and diabetes-relevant factors such as Body Mass Index, smoking status and blood pressure. Overall, patients in both models received a high quality of care (Diabetes Treatment Satisfaction Questionnaire, DTSQ >32/36 points, SGED >75 points) and a low treatment burden (Treatment Burden Questionnaire, TBQ <20/150 points). When comparing patients’ DTSQ, SGED and TBQ in both groups, we found no significant differences in diabetes-specific satisfaction (32.1 [SD 3.6] vs. 32.4 [SD 3.8], p = 0.7), SGED score (80.2 [SD 8.5] vs. 75.9 [SD 4.8], p = 0.18) or treatment burden (19.2 [SD 15.6] vs. 18.8 [SD 21.4], p = 0.89).

CONCLUSION: Our comparison of patient-reported outcomes and SGED criteria of patients with type 2 diabetes in practices with and without CSMAs showed an equally high quality of care and a low treatment burden. More research is needed on the long-term effects and benefits of the care provided by CSMAs and which other tasks could be shifted to CSMAs to reduce the burden on GPs in the future. At the same time, an increasing number of patients with type 2 diabetes will require high-quality primary care.

PMID:35752968 | DOI:10.4414/smw.2022.w30180

Swiss Med Wkly. 2022 Jun 16;152:w30175. doi: 10.4414/smw.2022.w30175. eCollection 2022 Jun 6.

ABSTRACT

BACKGROUND: Over recent years, the incidence of renal cell carcinoma (RCC) has remained unchanged in Switzerland and is low compared with other European countries. Partial or radical nephrectomy is the mainstay of treatment in patients with localised disease.

METHODS: We conducted an analysis of data from the cancer registry of Eastern Switzerland on patients with surgery for RCC from 2009 to 2018, focusing on a comparison of surgical technique and outcome in tertiary and non-tertiary hospitals.

RESULTS: 492 nephrectomies were performed. Out of 441 curative procedures, 226 were radical and 195 partial nephrectomies (20 unknown). At the tertiary hospital, statistically significantly more partial nephrectomies were performed in non-metastatic patients than at non-tertiary hospitals. We demonstrate a trend towards better disease-free survival after partial compared with radical nephrectomy. The 5-year overall survival for patients diagnosed between 2009 and 2013 was 85%, 83%, and 70% in stage I, II, and III, respectively, compared with 96%, 78%, and 72% for patients diagnosed between 2014 and 2018.

CONCLUSION: RCC incidence in Switzerland has been stable during the past decade in contrast to other European countries, and no stage migration occurred. We demonstrated that patients with localised renal cancer at our tertiary centre were more likely to be treated with renal preserving surgery compared with non-tertiary hospitals. This analysis underlines the importance of local cancer registries in the comparison of treatment and outcome over time.

PMID:35752957 | DOI:10.4414/smw.2022.w30175

West Afr J Med. 2022 Jun 24;39(6):614-622.

ABSTRACT

BACKGROUND: Mini-Mental State Examination (MMSE) is one of the most widely used patient-rated assessment tools but may not be applicable among an overwhelming majority of Nigerians older adults. This is because MMSE was designed and adapted for English speakers, and some of its items are challenging to understand for those with low literacy levels.

OBJECTIVES: This study aimed at translating and adapting MMSE into the Hausa language and also evaluates the psychometric properties of the modified Hausa version of MMSE.

METHODOLOGY: The MMSE was translated and adapted into Hausa language by an Hausa language expert and focus group of experts and the validity of the adapted Hausa MMSE was evaluated against a gold standard (Diagnostic and Statistical Manual of Mental Disorder V criteria for neurocognitive disorders), among older adults participants (N=100). Descriptive statistics and inferential statistics (Receiver Operating Curve analysis and Cronbach alpha coefficient approach) were employed for data analysis and the alpha level was set at 0.05.

RESULTS: The adapted Hausa MMSE has item content validity index of 0.97 and the mean expert proportion relevant rating, across all the experts was 0.99. The adapted Hausa version of MMSE shows 66.7% sensitivity and 84.7% specificity, when the original MMSE cut off point of 24 was used. With ROC analysis, optimal cut-offs derived were 25 and 26 with Area Under Curve of 0.886 (95% CI: 0.816-0.956; Std.Err: 0.036; P=0.000). However, at the optimal cut off of 26, derived using ROC analysis, the modified Hausa MMSE had sensitivity of 93.3% and specificity of 71.8% and the tool internal consistency reliability had alpha value of 0.64.

CONCLUSION: Hausa adapted versions of MMSE is a valid cognitive screening tool for Hausa older adult patients although its use for Screening and for monitoring changes warrant considerations for two separate cut- off points.

PMID:35752953

West Afr J Med. 2022 Jun 24;39:609-613.

ABSTRACT

INTRODUCTION: This study determined the prevalence, obstetric characteristics and pregnancy outcomes in teenagers who delivered at a secondary health facility in a Southern State in Nigeria.

MATERIALS AND METHODS: A retrospective study was employed to review pregnancies that were managed in Central Hospital Warri, Delta State, Nigeria between 2014-2017. Patients’ notes were retrieved and analyzed with respect to the socio-demographic characteristics, pregnancy, labor and delivery complications and fetal outcome. Chi-square test was used to test the association between the independent variables and the main outcomes of the study with statistical significance set at p<0.05.

RESULTS: Out of the 14,067 pregnancies reviewed, the prevalence of teenage pregnancy was 2.8%. The mean age of the teenagers was 17.5 (±1.4) years, 243 (61.5%) of them had completed secondary school. Majority 286 (72.4%) delivered via spontaneous vaginal delivery, while 73 (18.5%) and 36 (9.1%) delivered via caesarean section and instrumental delivery respectively. The commonest complications encountered among the pregnant teenagers were perineal laceration (23.3%), iron deficiency anemia (17%) and delivery of low birth weight infant (14.9%). The younger teenagers were twice at risk of iron deficiency anaemia {OR (95%CI); p = 2.60 (1.08-5.92); p=0.028}. A similar association was seen between the age of the teenagers and route of delivery {OR (95%CI); p = 3.11 (1.34-6.93); p=0.002}, delivery of low birth weight infant {OR (95%CI); p = 3.12 (1.28-7.15); p=0.003} and perineal laceration {OR (95%CI); p = 2.54 (1.13-5.55); p=0.010}.

CONCLUSION: Teenage pregnancy is associated with high risk of complications, especially among younger teenagers. Increasing public awareness as well as improving educational, socio- economic and reproductive health opportunities for adolescent girls is recommended.

PMID:35752950

J Prosthodont. 2022 Jun 25. doi: 10.1111/jopr.13563. Online ahead of print.

ABSTRACT

PURPOSE: To assess the fracture resistance of monolithic zirconia crowns cemented with different types of cement on cement-retained implant abutments.

MATERIALS AND METHODS: Forty implant analogues were positioned in acrylic resin blocks, and cement-retained straight implant abutments were fastened to the analogues. Crowns were designed with/without occlusal vent holes and produced from monolithic zirconia blocks by the CAD-CAM technique. The two crown types were divided into two groups and cemented with resin and zinc-polycarboxylate cement under 5 kg weight. A universal testing machine applied compressive forces to the crowns until fracture. Fracture resistance values were analysed using two-way ANOVA and the independent samples t-test with statistical significance set at p < 0.05.

RESULTS: According to the two-way ANOVA results, although the crown design did not have a significant effect on fracture resistance (1417.65 ±337.39 N, 1565.16 ±517.12 N; crowns with and without vent holes, respectively), the main effect of the cement variable on the fracture resistance was significant. Zinc-polycarboxylate cement (1680.1 ±375.23 N) showed higher fracture resistance than resin cement (1302.71 ±420.64 N) in the crowns designed with vent holes (p< 0.005).

CONCLUSION: The use of cement-retained implant-supported monolithic zirconia crowns with an occlusal vent hole is safe, and zinc-polycarboxylate cement use may be an appropriate choice for cementation of these crowns. This article is protected by copyright. All rights reserved.

PMID:35752941 | DOI:10.1111/jopr.13563

J Inj Violence Res. 2022 Jun 26;14(3). doi: 10.5249/jivr.v14i3.1710. Online ahead of print.

ABSTRACT

BACKGROUND: Daily more than 3,000 children are injured or killed on the road, often along the school route. Road traffic crashes and resulting injuries are preventable. More can be done to reduce injuries and save lives. Traffic Conflict Techniques (TCTs) are simple methods of collecting observational data to evaluate the effectiveness of road safety interventions through counting and analyzing traffic conflicts. A TCT Toolkit was developed and piloted to analyze pedestrian-vehicle traffic conflicts in school zones in low- and middle-income countries.

METHODS: Three non-governmental organizations in Ghana, Vietnam, and Mexico applied three TCTs from the TCT Toolkit to collect traffic conflict data before (pre-intervention) and after (post-intervention) road safety intervention implementation. As the number of traffic conflicts was often less than 100, confidence intervals (CIs) based on gamma distributions were calculated for the traffic conflict rate. Using the calculated traffic conflict rate, the difference between pre- and post-intervention rates was assessed by determining overlap of the CIs. When CIs did not overlap, the difference was said to be statistically significant at the 0.05 level.

RESULTS: For each method, results indicated a decrease in traffic conflicts between pre- and post-intervention data collection periods. Pre- and post-intervention traffic conflict rates with non-overlapping CIs demonstrated the results were statistically significant, providing evidence that the road safety interventions were effective.

CONCLUSIONS: TCTs are relatively low-cost and simple techniques that provide an opportunity to base road safety improvement decisions on real-world data. TCTs are effective in objectively evaluating road safety interventions and can help decision-makers evaluate strategies for improving road safety, preventing injuries and saving lives.

PMID:35752931 | DOI:10.5249/jivr.v14i3.1710

J Nurs Scholarsh. 2022 Jun 25. doi: 10.1111/jnu.12796. Online ahead of print.

ABSTRACT

BACKGROUND: The outbreak of the Corona virus (COVID-19) pandemic led to a sharp rise in morbidity and hospitalizations, and a significant therapeutic burden fell on intensive care units (ICUs). Intensive care nurses reported physical and emotional stress in response to the extra workload caused by caring for critically ill COVID-19 patients. However, at the time of publication of the study, to the best of our knowledge there have been no studies that examined uncertainty, stress, or hope in the context of functioning among intensive care nurses.

AIM: To examine: (a) the challenges of operating and managing intensive care units during the COVID-19 pandemic among nurse managers in intensive care units, and (b) the relationships between uncertainty, stress, burnout, hope, and professional functioning among intensive care nurses during the COVID-19 pandemic.

DESIGN: This mixed-methods study was conducted in intensive care units (ICUs) at a large tertiary medical center in Israel, during February-May 2021.

METHODS: The data were collected in two phases. In the first phase, qualitative data were collected from focus groups attended by 15 senior managerial nurses. The second phase involved a cross-sectional study among 100 staff nurses working in 5 ICUs. The data were collected using a structured questionnaire.

RESULTS: Qualitative data analysis revealed two main themes: (a) challenges of the COVID-19 pandemic and (b) positive aspects of the COVID-19 pandemic. The nurses reported high levels of burnout, emotional stress and uncertainty, but moderate State Hope Scale scores, and moderate levels of professional functioning. There were no statistical differences in study variables by exposure to COVID-19 patients. State Hope Scale levels, uncertainty, and burnout variables contributed significantly and explained 46% of the variance of the professional functioning.

CONCLUSIONS: The intensity of the experiences and psych-social phenomena, is not affected by exposure to treatment of COVID-19 patients. The relationships between the study variables emphasize the importance of initiated and ongoing interventions to reduce uncertainty, address burnout, and strengthen hope. Improvement in these indices may lead to better ICU nurses’ professional functioning and their work life well-being.

PMID:35752928 | DOI:10.1111/jnu.12796

Health Serv Res. 2022 Jun 25. doi: 10.1111/1475-6773.14014. Online ahead of print.

ABSTRACT

OBJECTIVE: To introduce a novel analytical approach for randomized controlled trials that are underpowered because of low participant enrollment or engagement.

DATA SOURCES: Reanalysis of data for 805 patients randomized as part of a pilot complex care intervention in 2015-2016 in a large delivery system. In the pilot randomized trial, only 64.6% of patients assigned to the intervention group participated.

STUDY DESIGN: A case study and simulation. The “Distillation Method” capitalizes on the frequently observed correlation between the probability of subjects’ participation or engagement in an intervention and the magnitude of benefit they experience. The novel method involves three stages: first, it uses baseline covariates to generate predicted probabilities of participation. Next, these are used to produce nested subsamples of the randomized intervention and control groups that are more concentrated with subjects who were likely to participate/engage. Finally, for the outcomes of interest standard statistical methods are used to re-evaluate intervention effectiveness in these concentrated subsets.

DATA EXTRACTION METHODS: We assembled secondary data on patients who were randomized to the pilot intervention, for one year prior to randomization and two follow-up years. Data included program enrollment status, membership data, demographics, utilization, costs, and clinical data.

PRINCIPAL FINDINGS: Using baseline covariates only, Generalized Boosted Regression Models predicting program enrollment performed well (AUC 0.884). We then distilled the full randomized sample to increasing levels of concentration and re-analyzed program outcomes. We found statistically significant differences in outpatient utilization and emergency department utilization (both follow-up years), and in total costs (follow-up year two only) at select levels of population concentration.

CONCLUSIONS: By offering an internally valid analytic framework, the Distillation Method can increase power to detect effects by redefining the estimand to subpopulations with higher enrollment probabilities and stronger average treatment effects while maintaining the original randomization. This article is protected by copyright. All rights reserved.

PMID:35752926 | DOI:10.1111/1475-6773.14014

Stem Cell Res Ther. 2022 Jun 25;13(1):275. doi: 10.1186/s13287-022-02956-3.

ABSTRACT

BACKGROUND: Mesenchymal stromal cells (MSCs) therapy for acute respiratory distress syndrome (ARDS) is an emerging treatment, but most of the current trials of MSCs stay in the animal experimental stage, and the safety and efficacy of MSCs in clinical application are not clear. We aimed to analyze the safety, efficacy and biomarkers of mesenchymal stromal cells in the treatment of ARDS.

METHODS: For this systematic review and meta-analysis, we searched PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of science, CNKI, VIP and Wan Fang data, studies published between database inception and Mar 17, 2022. All randomized controlled trials (RCT) of stem cell interventions for ARDS were included, without language or date restrictions. We did separate meta-analyses for mortality, subjects with adverse events (AEs) and subjects with serious adverse events (SAEs). Since the trials data are dichotomous outcomes, the odds ratio (OR) is adopted for meta-analysis. The quality of the evidence was assessed with the Cochrane risk of bias tool.

FINDINGS: In total, 5 trials involving 171 patients with ARDS were included in this meta-analysis. A total of 99 individuals were randomly assigned to receive MSCs treatment, and 72 were randomly assigned to receive placebo treatment. Treatment with MSCs appeared to increase the occurrence of adverse events, but this result was not statistically significant (OR, 1.58; 95%CI, 0.64-3.91; P = 0.32). The occurrence of serious adverse events was lower in the MSCs group than in the placebo group (OR, 0.57; 95%CI, 0.14-2.32; P = 0.43); there seems to be no significant difference between the two groups in terms of 28 days mortality (OR, 0.93; 95%CI, 0.45-1.89); oxygenation index and biomarkers showed a tendency to improve in treatment, but there was a lack of more statistically significant clinical evidence to support them.

INTERPRETATION: Based on the current clinical trials, MSCs intervention has some safety for ARDS patients, but its effectiveness and predictive value of airspace biomarkers need to be determined by more large-scale, standard randomized controlled trials.

PMID:35752865 | DOI:10.1186/s13287-022-02956-3

Infect Dis Poverty. 2022 Jun 25;11(1):73. doi: 10.1186/s40249-022-00975-z.

ABSTRACT

BACKGROUND: Schistosomiasis and soil-transmitted helminths (STHs) contribute high disease burdens amongst the neglected tropical diseases (NTDs) and are public health problems in Angola. This study reports the prevalence, intensity and risk factors for schistosomiasis and STH infection in Huambo, Uige and Zaire provinces, Angola, to inform a school-based preventive chemotherapy program.

METHODS: A two-stage cluster design was used to select schools and schoolchildren to participate in parasitological and water, sanitation and hygiene (WASH) surveys across Huambo, Uige, and Zaire provinces. Point-of-care circulating cathodic antigen and urinalysis rapid diagnostic tests (RDTs) were used to determine the prevalence of Schistosoma mansoni and S. haematobium, respectively. Kato-Katz was used to identify and quantify STH species and quantify and compare with RDTs for S. mansoni. Urine filtration was used to quantify and compare with RDTs for S. haematobium. Descriptive statistics were used for prevalence and infection intensity of schistosomiasis and STH infection. Performance of RDTs was assessed through specificity and Cohen’s Kappa agreement with microscopy. A multivariate regression analysis was used to determine demographic and WASH factors associated with schistosomiasis and STH infection.

RESULTS: A total 575 schools and 17,093 schoolchildren participated in the schistosomiasis survey, of which 121 schools and 3649 schoolchildren participated in the STH survey. Overall prevalence of S. mansoni was 21.2% (municipality range 0.9-74.8%) and S. haematobium 13.6% (range 0-31.2%), with an overall prevalence of schistosomiasis of 31.4% (range 5.9-77.3%). Overall prevalence of Ascaris lumbricoides was 25.1% (range 0-89.7%), hookworm 5.2% (range 0-42.6%), and Trichuris trichiura 3.6% (range 0-24.2%), with an overall prevalence of STH infection of 29.5% (range 0.8-89.7%). Ecological zone and ethnicity were factors associated with schistosomiasis and STH infection, with older age and female sex additional risk factors for S. haematobium.

CONCLUSIONS: Most municipalities met World Health Organization defined prevalence thresholds for a schistosomiasis preventive chemotherapy program. A STH preventive chemotherapy program is indicated for nearly all municipalities in Uige and select municipalities in Huambo and Zaire. The association between ecological zone and ethnicity with schistosomiasis and STH infection necessitates further evaluation of home and school environmental, sociodemographic and behavioural factors to inform targeted control strategies to complement preventive chemotherapy programs.

PMID:35752864 | DOI:10.1186/s40249-022-00975-z