Nevin Manimala

J Neurol Surg A Cent Eur Neurosurg. 2022 Feb 10. doi: 10.1055/a-1768-3797. Online ahead of print.

ABSTRACT

STUDY DESIGN: Randomized clinical trial.

OBJECTIVES: To compare two perioperative pain management procedures: a radioscopically-guided erector spinae plane (ESP) block versus the standard wound infiltration technique with local anaesthetics, in patients undergoing lumbosacral spine surgery.

METHODS: A randomized, double-blind clinical trial was performed, in which adults at our hospital undergoing lumbosacral surgery without fixation were randomly assigned to receive either the standard wound infiltration technique, employing long-term anaesthetics, or a radioscopically-guided ESP block. Postoperative pain severity, morphine consumption, number of patients immobilised due to wound pain, length of hospitalisation, and complications were recorded.

RESULTS: Over the first seven postoperative hours, pain relief was superior in the ESP block group among patients who underwent discectomies or one-level decompression (p<0.0001). Using an ESP block also was statistically superior at decreasing all postoperative variables recorded in patients scheduled for multi-level decompression: VAS pain severity over the first seven hours after the procedure (p=0,0004); number of patients with wound pain 1 (p=0.049), 7 (p<0.0001) and 24 hours (p=0.007) after surgery; length of hospitalisation (p=0.0007), number of patients immobilised for wound pain (p=0.0004) and rescue morphine consumption (p<0.0001).

CONCLUSION: The ESP block is a safe procedure which seems to outperform the infiltration wound technique for postoperative pain management in patients undergoing open spinal surgery. Future studies are needed to verify its effectiveness for arthrodesis/fixation and minimally-invasive procedures, and for chronic spine pain relief.

PMID:35144297 | DOI:10.1055/a-1768-3797

Methods Inf Med. 2022 Feb 10. doi: 10.1055/s-0042-1742671. Online ahead of print.

ABSTRACT

BACKGROUND: Numerous prediction models for readmissions are developed from hospital data whose predictor variables are based on specific data fields that are often not transferable to other settings. In contrast, routine data from statutory health insurances (in Germany) are highly standardized, ubiquitously available, and would thus allow for automatic identification of readmission risks.

OBJECTIVES: To develop and internally validate prediction models for readmissions based on potentially inappropriate prescribing (PIP) in six diseases from routine data.

METHODS: In a large database of German statutory health insurance claims, we detected disease-specific readmissions after index admissions for acute myocardial infarction (AMI), heart failure (HF), a composite of stroke, transient ischemic attack or atrial fibrillation (S/AF), chronic obstructive pulmonary disease (COPD), type-2 diabetes mellitus (DM), and osteoporosis (OS). PIP at the index admission was determined by the STOPP/START criteria (Screening Tool of Older Persons’ Prescriptions/Screening Tool to Alert doctors to the Right Treatment) which were candidate variables in regularized prediction models for specific readmission within 90 days. The risks from disease-specific models were combined (“stacked”) to predict all-cause readmission within 90 days. Validation performance was measured by the c-statistics.

RESULTS: While the prevalence of START criteria was higher than for STOPP criteria, more single STOPP criteria were selected into models for specific readmissions. Performance in validation samples was the highest for DM (c-statistics: 0.68 [95% confidence interval (CI): 0.66-0.70]), followed by COPD (c-statistics: 0.65 [95% CI: 0.64-0.67]), S/AF (c-statistics: 0.65 [95% CI: 0.63-0.66]), HF (c-statistics: 0.61 [95% CI: 0.60-0.62]), AMI (c-statistics: 0.58 [95% CI: 0.56-0.60]), and OS (c-statistics: 0.51 [95% CI: 0.47-0.56]). Integrating risks from disease-specific models to a combined model for all-cause readmission yielded a c-statistics of 0.63 [95% CI: 0.63-0.64].

CONCLUSION: PIP successfully predicted readmissions for most diseases, opening the possibility for interventions to improve these modifiable risk factors. Machine-learning methods appear promising for future modeling of PIP predictors in complex older patients with many underlying diseases.

PMID:35144291 | DOI:10.1055/s-0042-1742671

Thorac Cardiovasc Surg. 2022 Feb 10. doi: 10.1055/s-0042-1742364. Online ahead of print.

ABSTRACT

OBJECTIVE: According to our nationwide registry, total numbers of surgical aortic valve implantation (sAVR) are constantly declining, while transcathether aortic valve implantation (TAVI) indications are widened toward intermediate- and low-risk patients. So, is there still room for conventionally implanted valves? Can results compete with TAVI or will sAVR be marginalized in the near future?

METHODS: Between 2011 and 2019, 1,034 patients (67.1% male, mean = 72.2 years) were enrolled receiving stented biological valves with or without concomitant coronary artery bypass grafting (CABG), atrial ablation, or wrapping of the ascending aorta. Odds ratios for the early and late mortality were calculated regarding comorbidities as potential risk factors. Statistical analysis was performed using SPSS.

RESULTS: Overall, early mortality (EM) was 6.1%, 1-year mortality was 11.2%, and 5-year mortality was 19.9%. In low-risk patients (EuroSCORE II <4%), it was 1.0, 2.7, and 9.3%. Incidence of EM was significantly increased following decompensation, prosthetic valve, pacemaker carrier, dialysis, and pulmonary hypertension. Postoperative complications, such as systemic inflammatory response syndrome (SIRS), sepsis, multiorgan failure, hepatic failure, dialysis, gastrointestinal bleeding, and ileus, also increased EM. Late mortality was significantly increased by dialysis, hepatic cirrhosis, infected port system, aortic valve endocarditis, prosthetic valve carrier, and chronic hemodialysis.

CONCLUSION: Conventionally implanted aortic valves do well early and late. The fate of the patient is dependent on individual risk-factors. Particularly, in low-risk patients, sAVR can compete with TAVI showing overall good early, as well as late results being even superior in some important aspects such as pacemaker implantation rate. Thus, the time is yet not ripe for TAVI to take over primary indications for AVR in low-risk patient.

PMID:35144290 | DOI:10.1055/s-0042-1742364

Urol Int. 2022 Feb 10:1-7. doi: 10.1159/000521718. Online ahead of print.

ABSTRACT

INTRODUCTION: The primary aim of the study was to use the duration until the first postoperative analgesic requirement after two different block techniques to compare the analgesic effect. The secondary aims were to compare the two methods for postoperative Children’s Hospital Eastern Ontario Pain Scale (CHEOPS) scores, complications, and parental satisfaction level.

MATERIALS AND METHODS: This prospective, observational study was conducted with male patients aged 1-7 years in the ASA I-II group, who were scheduled for hypospadias surgery between November 2019 and April 2020. Ultrasound (US)-guided pudendal nerve block (PNB) or US-guided dorsal penile nerve block (DPNB) was administered under general anesthesia before the operation. Postoperative analgesic need, postoperative pain, complications, and parental satisfaction were noted. The STROBE checklist was followed for reporting.

RESULTS: The study was conducted with 30 patients in total, divided into 15 patients receiving PNB and 15 patients receiving DPNB. The effective minimum block duration was longer in the pudendal group at 22.22 ± 0.61 h than in the DPNB group at 22.19 ± 0.57 h. Additional analgesic was required in 4 subjects in the pudendal group and 5 in the DPNB group. There was no statistically significant difference in terms of the variables between the two groups (p > 0.05).

DISCUSSION: US-guided DPNB and PNB were shown to provide successful postoperative analgesia and to have similar effectiveness in pediatric patients undergoing hypospadias surgery in this first prospective study of its kind in the literature.

CONCLUSIONS: US-guided DPNB and PNB have been demonstrated to provide effective, safe, and long-term postoperative analgesia in pediatric patients who have undergone hypospadias surgery. Parental satisfaction in both groups is positively influenced by the minimum postoperative analgesia requirement, the long-term analgesic effect, and the lack of any complications.

PMID:35144265 | DOI:10.1159/000521718

J Phys Condens Matter. 2022 Feb 10. doi: 10.1088/1361-648X/ac53db. Online ahead of print.

ABSTRACT

The role of light irradiation on electronic localization is critically investigated for the first time in a tight-binding lattice where site energies are modulated in the cosine form following the Aubry-Andr'{e}-Harper (AAH) model. The critical point of transition from delocalized-to-localized phase can be monitored selectively by regulating the light parameters that is extremely useful to have controlled electron transmission across the system. Starting with a strictly one-dimensional (1D) AAH chain, we extend our analysis considering a two-stranded ladder model which brings peculiar signatures in presence of irradiation. Unlike 1D system, AAH ladder exhibits a mixed phase (MP) zone where both extended and localized energy eigenstates co-exist. This is the fundamental requirement to have mobility edge in energy band spectrum. A mathematical description is given for decoupling the irradiated ladder into two effective 1D AAH chains. The underlying mechanism of getting a MP zone relies on the availability of two distinct critical points (CPs) of the decoupled chains, in presence of second-neighbor hopping between the two strands. Using a minimal coupling scheme the effect of light irradiation is incorporated following the Floquet-Bloch ansatz. The localization behaviors of different energy eigenstates are studied by calculating inverse participation ratio, and, are further explained in a more compact way by calculating two-terminal transmission probabilities together with average density of states. Finally, the decoupling procedure is extended for a more general multi-stranded AAH ladders where multiple critical points and thus multiple mobility edges are found. Our analysis may provide a new route of engineering localization properties in similar kind of other fascinating quasiperiodic systems.

PMID:35144250 | DOI:10.1088/1361-648X/ac53db

Drug Alcohol Depend. 2022 Feb 3;232:109345. doi: 10.1016/j.drugalcdep.2022.109345. Online ahead of print.

ABSTRACT

PURPOSE: Cannabis use is increasing among emerging adults (ages 18-25), necessitating the need for prevention interventions. Using a novel platform – social media – we developed an 8-week motivational interviewing and cognitive-behavioral intervention targeting cannabis use among emerging adults. Herein, we report on the feasibility and acceptability of the intervention in a pilot trial.

PROCEDURES: For NCT04187989 we recruited N = 149 emerging adults who used cannabis (at least 3 times/week for the past month) using social media advertising. Their mean age was 21.0 years (SD = 2.2); 55.7% were female. Most were White (70.5%; 20.1% Black/African American, 9.4% Other races), with 20.1% identifying as Hispanic/Latinx. Participants were randomized to the 8-week intervention or an 8-week attention-placebo control condition, both delivered in secret Facebook groups by electronic health coaches (e-coaches). Follow-up assessments occurred at 3- and 6-months.

RESULTS: The intervention was well-received and follow-up rates were high; fidelity was good. Intervention participants rated e-coaches significantly higher in terms of helpfulness, warmth, etc., compared to control participants. Intervention participants were more likely to engage with and recommend the group. In terms of percentage reductions in cannabis outcomes, the intervention group evidenced absolute reductions over time in several measures of cannabis consumption across modalities. In an adjusted model, reductions in vaping days in the intervention group, relative to attention-control, reached statistical significance (p = .020, D =.40).

CONCLUSIONS: This social media intervention for emerging adults’ cannabis use was feasible and acceptable in the target population warranting future testing in a fully powered trial.

PMID:35144238 | DOI:10.1016/j.drugalcdep.2022.109345

Nurse Educ Today. 2022 Feb 3;111:105295. doi: 10.1016/j.nedt.2022.105295. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to synthesise the best available evidence on the effectiveness of education interventions to teach evidence-based practice (EBP) on nurse-related and patient-related outcomes.

DESIGN: This is a systematic review and meta-analytic paper.

DATA SOURCES: Published and unpublished studies in English were searched from 10 databases from 2005 to 2021.

REVIEW METHODS: Randomised controlled trials (RCTs) and clinical controlled trials (CCTs) describing education interventions to improve EBP knowledge, skills, attitude, confidence and behaviours among nurses were eligible. Two reviewers independently screened, appraised and extracted data. Meta-analysis was conducted using a random-effect model to synthesise data using review manager software. Standardised mean difference (SMD) represented an effect measure. Heterogeneity was assessed using Cochran-Q square test and I square statistics. Subgroup and narrative synthesis were also conducted.

RESULTS: Ten studies (6 RCTs and 4 CCTs) were selected for this review. Results from a CCT suggested that education interventions improved EBP knowledge with a large effect size (SMD = 2.01). Education interventions also enhanced EBP skills (n = 1), combined knowledge/skills (SMD = 0.48, N = 5), attitude toward EBP (SMD = 0.39, N = 4), confidence to conduct EBP (SMD = 0.43, n = 1) and EBP behaviour (SMD = 0.26, n = 5). None of the studies used patient-related outcomes.

CONCLUSION: Overall, education interventions improved nurses’ EBP knowledge, skills, attitude, confidence and behaviour. EBP education interventions should be part of nurses’ professional development in clinical settings. The interventions may be delivered through combined lectures, group discussions, hands-on practice via face-to-face and/or online learning. Future research should test education interventions using RCTs, large sample size, and in-depth qualitative data.

PMID:35144204 | DOI:10.1016/j.nedt.2022.105295

Nurse Educ Today. 2022 Feb 2;111:105290. doi: 10.1016/j.nedt.2022.105290. Online ahead of print.

ABSTRACT

BACKGROUND: Recently, moral sensitivity and professional values have become increasingly important in nursing education and have been tried to be improved.

OBJECTIVES: To investigate the effects of an ethics laboratory program integrated with the fundamentals of nursing course on the moral sensitivity and professional values of nursing students.

DESIGN: The present study was designed as a randomized controlled study. The 8-week ethics laboratory program was applied to the students in the intervention group. In the ethics laboratory program, interactive education methods, such as ethical scenarios, case studies, roleplay, group discussions, project papers and watching movies, were applied. Control group received the standard fundamentals of nursing curriculum.

PARTICIPANTS: The sample size was determined using stratified block randomization method, and 100 nursing students were assigned to intervention (n = 50) and control group (n = 50).

RESULTS: There was no baseline difference between the groups. The moral sensitivity average of the students in the intervention (82.66 ± 12.57) was lower than the average of the control group (85.64 ± 16.83) after the ethics laboratory program; however, the difference was not statistically significant (p > .05). Similarly, there were no significant differences between the intervention (132.32 ± 16.83) and the control group (131.81 ± 20.55) regarding the average score of professional values. In the responsibility sub-dimension of professional values, there was a statistically significant increase in the intervention group (p < .05).

CONCLUSION: The findings suggest that the ethics laboratory program for nursing students is effective in promoting responsibility sub-dimension of professional values. However, there was no significant effect on students’ moral sensitivity and other dimensions of professional values. Further refinements of interventional research in ethics education and measurement of learning outcomes should be developed.

PMID:35144203 | DOI:10.1016/j.nedt.2022.105290

Int J Hyg Environ Health. 2022 Feb 7;241:113943. doi: 10.1016/j.ijheh.2022.113943. Online ahead of print.

ABSTRACT

In the first national human biomonitoring study in the Slovenian population of adults (18-49 years), including men (n = 297) and lactating primiparous women (n = 304), exposure to polycyclic aromatic hydrocarbons (PAHs) was evaluated. Nine urinary metabolites of four parent PAHs were determined. These included 1-hydroxypyrene (1-OHPYR), 2-hydroxynaphthalene (2-OHNAP), 2-hydroxyphenanthrene (2-OHPHE), 3-hydroxyphenanthrene (3-OHPHE), 4-hydroxyphenanthrene (4-OHPHE), a combination of 2-hydroxyfluorene and 3-hydroxyfluorene (2/3-OHFLU) and a combination of 1-hydroxyphenanthrene and 9-hydroxyphenanthrene (1/9-OHPHE). For comparison, the analysed phenanthrene metabolites were reported as a sum (ΣOHPHE = 1/9-OHPHE + 2-OHPHE + 3-OHPHE + 4-OHPHE) and all the analysed PAH metabolites were reported as a sum (ΣOHPAH = 1-OHPYR + 2/3-OHFLU + 2-OHNAP + ΣOHPHE). All metabolites or their combinations were determined in more than 91% of the samples, except 4-OHPHE, which was determined in only 5% of the samples. The highest concentration was found for 2-OHNAP. This was followed by 2/3-OHFLU and the phenanthrene metabolites, while the lowest concentration was determined for 1-OHPYR. Among the phenanthrene metabolites, the highest concentration was determined for 2-OHPHE, followed by 1/9-OHPHE and then by 3-OHPHE. Values in units of volume and values adjusted for specific gravity were significantly higher in men than in lactating primiparous women for all metabolites, whereas values in units adjusted for creatinine were generally higher in lactating primiparous women than in men. The difference between the two study groups, men and lactating primiparous women, was no longer significant in statistical models adjusted for specific gravity, suggesting that smoking, wood-burning exposure, and/or education largely explained the difference in PAH exposure in both study groups. For most metabolites, predictors of exposure were less significant in lactating primiparous women than in men. Also, site-specific patterns of exposure were observed, with additional predictors identified in certain areas, namely, proximity to roads and release of particulate matter (PM₁₀) from industry. The time of year in which sampling took place appeared to be an important determinant in urban areas and in the case of participants who used wood for heating. Specific dietary factors could not be identified, as the study questionnaire did not include information on PAH-related diet. Despite the low number of paired partners (women and men living in the same household, n = 84), significant positive correlations for all metabolites were observed. This indicated that 31%-56% of variability in exposure could be explained by shared exposure to sources within the households (such as diet and wood-burning-related determinants).

PMID:35144196 | DOI:10.1016/j.ijheh.2022.113943

Nurse Educ Pract. 2022 Feb 1;60:103305. doi: 10.1016/j.nepr.2022.103305. Online ahead of print.

ABSTRACT

AIM: The study aims to determine nursing and medical students’ preferences for assessment in education and factors affecting their preferences for assessment.

BACKGROUND: It is crucial to design the evaluation and evaluation processes in education to develop desired behaviours in education and to determine whether the intended goals in education have been achieved. In earlier studies on assessment practices affecting student learning and academic achievement, it has been emphasized that students’ preferences for assessment and different practices in assessment have a significant effect on their academic performance.

DESIGN: This research was designed as nonexperimental and quantitative research of correlational design with linear regression statistical analyses approach.

METHODS: The participants consisted of 641 students (including 169 medical students with 472 nursing students), who were volunteered to participate in the study and reached with the method of convenience sampling. The ‘Assessment Preferences Inventory’ adapted to Turkish by Gulbahar and Buyukozturk (2008) was used as a data collection tool. To analyze the data, descriptive statistics, the Mann-Whitney-U test, the Kruskal-Wallis test and logistic regression with Bonferroni correction to control the type I error were applied.

RESULTS: In the study, it was found that male students preferred alternative assessment methods and complex/constructive assessment more than female students and male students expected more questions assessing cognitive processes while female students needed more preparations for assessment. In addition, it was determined that medical students preferred complex/constructive assessment more; on the other hand, nursing students preferred simple-multiple choice assessment more and had the need for pre-assessment preparations more. Besides, it was detected that the variables of the students’ grade level had an impact on their assessment preferences and that there was a minimal relationship between the students’ age and academic achievement with their assessment preferences.

CONCLUSIONS: This study showed that the department, gender and grade level were effective on assessment preferences.

PMID:35144163 | DOI:10.1016/j.nepr.2022.103305