Nevin Manimala

J Occup Environ Med. 2021 Jun 1. doi: 10.1097/JOM.0000000000002251. Online ahead of print.

ABSTRACT

OBJECTIVE: To determine if repeat annual health risk assessments (RAHRAs) with intervention reduce 10-year cardiovascular disease (CVD) risk in financial sector employees.

METHODS: Retrospective analysis from RAHRAs in 13737 employees over 4-years. We report changes in 10-year Framingham risk score (FRS) for CVD (%) and risk factors after 1 (GR1), 2 (GR2) and 3 (GR 3) RAHRAs.

RESULTS: Mean FRS increased with RAHRAs (GR1: +0.4%; GR2: +0.7%; GR3: +0.8%) (p < 0.001) and was higher for GR3 vs. GR1 (p < 0.001) and GR2 (pairwise: p < 0.0355). RAHRAs were associated with increased inadequate fruit/vegetable intake (GR1: +5.4%; GR2: +9.8%; GR3: +15.8%) (all pairwise: p < 0.001) and overweight (GR1: +5.4% vs. GR2: +9.8%) (p < 0.001) and only hypercholesterolaemia decreased (GR1; -4.4% vs. GR3; -9.6%) (p < 0.001).

CONCLUSION: RAHRAs did not reduce 10-year CVD risk in financial sector employees. Role of RAHRAs in chronic disease management requires further study.

PMID:34074955 | DOI:10.1097/JOM.0000000000002251

J Am Assoc Nurse Pract. 2021 May 31. doi: 10.1097/JXX.0000000000000620. Online ahead of print.

ABSTRACT

BACKGROUND: Nearly 15 years after the introduction of the doctor of nursing practice (DNP) degree, stakeholders anticipate practice scholarship outcomes from graduates.

PURPOSE: To examine the frequency of engagement in practice scholarship, the relationship between the knowledge gained in DNP programs and the frequency of engagement in practice scholarship and the relationship between engagement in practice scholarship, work role, and years since graduation with a DNP degree, as reported by practicing nurses.

METHODOLOGY: This cross-sectional study recruited 306 practicing DNP graduates via a national organization and employed an electronic survey. Descriptive and inferential statistics, correlational analysis, and a one-way analysis of variance were conducted on demographics and outcome variables for 269 completed surveys.

RESULTS: The practice scholarship activity reported most frequently was evaluation of current clinical evidence and least frequently was dissemination of policy papers. Reported knowledge gained from DNP programs and frequency of engagement in practice scholarship indicate a weak positive correlation. There was a significant difference in the direct care work role and practice scholarship engagement compared with other roles, and between those practicing greater than 10 years and those with less experience.

CONCLUSIONS: Results highlight the underutilization of knowledge gained in DNP programs and engagement in practice scholarship. The study emphasizes the complexity of realizing practice scholarship outcomes of DNP-prepared nurses to influence patients, populations, systems, and policy as well as the advancement of the nursing profession.

IMPLICATIONS: This is a call to action for DNP graduates, academia, practice, and the nursing profession to support and value practice scholarship.

PMID:34074953 | DOI:10.1097/JXX.0000000000000620

JBI Evid Implement. 2021 Jun 1. doi: 10.1097/XEB.0000000000000286. Online ahead of print.

ABSTRACT

AIM: Integrated knowledge translation (IKT) is an increasingly recommended collaborative approach to minimize knowledge translation gap. Still, few studies have documented the impact of IKT to optimize knowledge uptake in healthcare settings. An IKT-based clinical algorithm (Algo) was deployed in Quebec (Canada) homecare services to support skill mix for selecting bathing equipment for community-dwelling adults. The objective of this study was to document the characteristics related to Algo’s IKT process.

METHODS: A multiple-case study with a nested concurrent mixed design was conducted in provincial homecare services. Based on Knott and Wildavsky’s seven-stage classification and the integrated-Promoting Action on Research Implementation in Health Services model, Innovation, Recipients, and Context, characteristics related to Algo’s levels of utilization were documented. Quantitative (electronic questionnaire) and qualitative (semistructured interviews and focus groups) data were collected for each case (i.e., homecare service). Descriptive statistics and thematic analysis were performed to describe each case through a mixed methods matrix, for intra/intercase analyses.

RESULTS: Knowledge translation characteristics of five Algo’s levels of utilization were documented: reception, cognition, reference, effort, and impact. Innovation characteristics (e.g., underlying knowledge) were found to facilitate its dissemination and its use. However, the Recipients (e.g., unclear mechanisms to implement change) and Context (e.g., organizational mandates nonaligned with skill mix) characteristics hampered its application through intermediate and advanced levels of utilization.

CONCLUSION: The knowledge translation analysis of Algo allowed for documenting the IKT-based benefits in terms of utilization in healthcare settings. Although an IKT approach appears to be a strong facilitator for initiating the implementation process, additional characteristics should be considered for promoting and sustaining its use on local, organizational, and external levels of context. Facilitation strategies should document the administrative benefits related to Algo’s utilization and contextualize it according to homecare services’ characteristics.

PMID:34074950 | DOI:10.1097/XEB.0000000000000286

J Chin Med Assoc. 2021 Jun 1. doi: 10.1097/JCMA.0000000000000561. Online ahead of print.

ABSTRACT

BACKGROUND: It is controversial that the association of hepatitis C virus (HCV) infection and chronic kidney disease (CKD). We wanted to investigate whether HCV really affect to renal function, also to analyze the association between clinical effects of CHC and decreased kidney function assessed by estimated glomerular filtration rate (eGFR) level.

METHODS: The 3360 patients with hepatitis C virus infection and 3360 age and sex matched community based control individuals without HCV were enrolled (1:1, case and control ratio) in this study between 2004 and 2016. We used the Modification of Diet in Renal Diseases (MRDR) for calculate eGFR. Demographic and laboratory parameters were assessed and appropriate statistical methods were performed for the analysis.

RESULTS: Multivariate logistic regression analysis revealed that serum alanine aminotransferase (ALT) (OR-0.998; 95% CI – 0.997-0.999; p=0.001) level, platelet (OR-0.997; 95% CI – 0.995-0.999; p=0.002) count and hypertension (OR-1.31; 95% CI – 1.03-1.66; p=0.027) were significantly associated with HCV infection and serum triglycerides (OR-1.001; 95% CI -1.00-1.002; p=0.005) level, platelet (OR-0.996; 95% CI – 0.995-0.997; p<0.001) count, BMI>25 (OR-1.43; 95% CI- 1.23-1.67; p<0.001), hypertension (OR-1.69; 95% CI – 1.42-1.99; p<0.001), hyperlipidemia (OR- 1.32; 95% CI – 1.02-1.71; p=0.035) and diabetes (OR-1.33; 95% CI-1.03-1.71; p=0.032) were significantly associated with low eGFR (<90ml/min/m3) in control subjects. The BMI >25kg/m2, hypertension, and diabetes were associated with low eGFR interaction with the HCV infection by multivariate analysis.

CONCLUSION: Our study indicated that the patients with HCV infection are associated with low eGFR compared with non HCV infected patients. This association is consistent in obese, diabetic and hypertensive patients.

PMID:34074934 | DOI:10.1097/JCMA.0000000000000561

JBI Evid Synth. 2021 Jun 1. doi: 10.11124/JBIES-20-00399. Online ahead of print.

ABSTRACT

OBJECTIVE: This review will assess the effectiveness and usability of mobile health applications to improve medication adherence in patients with heart failure.

INTRODUCTION: Inadequate medication adherence by heart failure patients is a major cause of negative clinical outcomes, high rates of hospital readmissions, and death, thus increasing the costs to patients and the health care system. Several studies have shown that the use of mobile health applications improves self-care by heart failure patients, including medication adherence. Therefore, gathering evidence on these studies will help researchers and clinicians understand the impact of such interventions on patient care.

INCLUSION CRITERIA: Eligible studies will evaluate medication adherence and include participants aged ≥18 years diagnosed with heart failure who are using app-based (software) interventions. Experimental and observational studies will be included. We will exclude studies with interventions that used mobile applications without functionality to assist the user in organizing and taking their medications.

METHODS: Articles published to the present day, without restrictions of language, will be selected from Embase, MEDLINE, LILACS, Scopus, Web of Science, CINAHL, and Cochrane Library. Two independent reviewers will perform article screening, assessment of methodological quality, and data extraction using JBI assessment and extraction instruments. Discrepancies will be solved by consensus and a third reviewer will be consulted if necessary. A narrative synthesis of findings will be presented, and statistical analysis will be used only when appropriate.

SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020147816.

PMID:34074907 | DOI:10.11124/JBIES-20-00399

Cornea. 2021 Jun 1. doi: 10.1097/ICO.0000000000002778. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of this study was to investigate the impact of transient elevations in postoperative intraocular pressure (IOP) on the clinical outcome of Descemet membrane endothelial keratoplasty (DMEK) surgery in non-glaucoma patients.

METHODS: Retrospective analysis from a prospective database of eyes without preexisting glaucoma that underwent DMEK with 90% anterior chamber and 20% sulfur hexafluoride endotamponade. Group A included eyes without postoperative IOP increase (IOP <30 mm Hg and a relative increase from preoperative value <10 mm Hg). Group B included eyes with IOP elevation (postoperative IOP ≥30 mm Hg or a relative increase from preoperative value ≥10 mm Hg) handled according to a standardized protocol. The impact of elevated IOP within 3 days after DMEK surgery was evaluated regarding best-corrected visual acuity (BCVA), central corneal thickness (CCT), and endothelial cell count (ECC) at 1, 3, and 6 months.

RESULTS: One hundred seventy-six eyes from 164 patients were included. An IOP increase after DMEK occurred in 20 eyes (11.3%; 19 patients, group B), and the mean peak IOP was 48 ± 12 mm Hg (range 32-69 mm Hg). There were no significant postoperative differences in BCVA, CCT, and ECC on comparing both groups. The BCVA increased significantly (P < 0.001, respectively), whereas CCT (P < 0.001, respectively) and ECC (P < 0.001, respectively) decreased significantly from preoperative values. The rebubbling rate tended to be higher in group B without statistical significance (6.4% vs. 10%, P = 0.648).

CONCLUSIONS: Temporary IOP elevation after DMEK may not affect functional and morphological outcomes in non-glaucoma patients. However, careful postoperative IOP monitoring and appropriate management are crucial to avoid irreversible ocular damage.

PMID:34074893 | DOI:10.1097/ICO.0000000000002778

ASAIO J. 2021 Jun 1. doi: 10.1097/MAT.0000000000001493. Online ahead of print.

ABSTRACT

Extracorporeal membrane oxygenation (ECMO) is a therapy used in severe cardiopulmonary failure. Blood is pumped through an artificial circuit exposing it to nonphysiologic conditions, which promote platelet activation and coagulation. Centrifugal pumps used at lower flow rates than their design point may lose pump efficiency and increase the risk of hemolysis. In this study, thrombogenic properties of two ECMO pumps designed for adult and neonatal use were evaluated using simulations in different flow scenarios. Three scenarios, adult pump in adult mode (4 L/min), adult pump in baby mode (300 ml/min), and neonatal pump used in its design point (300 ml/min), were simulated using computational fluid dynamics. The flow was numerically seeded with platelets, whose activation state was computed considering the stress history that acted along their respective path lines. Statistical distributions of activation state and residence time were drawn. The results showed that using the adult pump in baby mode increased the fraction of platelets with higher activation state confirming that low-pump flow rate impacts thrombogenicity. The neonatal pump showed a backflow at the inlet, which carried platelets in a retrograde motion contributing to an increased thrombogenic potential compared with the adult mode scenario.

PMID:34074850 | DOI:10.1097/MAT.0000000000001493

Am J Gastroenterol. 2021 Jun 1;116(6):1304-1312. doi: 10.14309/ajg.0000000000001149.

ABSTRACT

INTRODUCTION: Psyllium and prunes are proven treatments for chronic constipation (CC). Asian studies suggest that kiwifruit may also benefit CC symptoms. We report a partially randomized, comparative effectiveness trial evaluating kiwifruit, psyllium, and prunes in US patients with CC.

METHODS: Adults with CC at a US medical center were randomized to 3 natural treatments. Eligible patients had ≤3 complete spontaneous bowel movements (CSBMs) per week and were partially randomized to green kiwifruit (2/d), prunes (100 g/d), or psyllium (12 g/d) for 4 weeks. The primary endpoint was the proportion of patients in each group reporting an increase of ≥1 CSBM per week compared with baseline for at least 2 of 4 treatment weeks. Key secondary outcomes included stool frequency, stool consistency, and straining assessed daily. Treatment satisfaction and adverse events (AEs) were also measured. Standard statistical methods were used, and a P < 0.05 was considered significant.

RESULTS: Seventy-nine patients with CC (mean age = 42.7 years, 87% female, and 77% white) were partially randomized. Complete data were available for 75 patients (kiwifruit 29, prunes 24, and psyllium 22). For the primary endpoint, proportions of CSBM responders were similar for the treatments. For secondary outcomes comparing treatment weeks 3 and 4 to baseline, there was a significant increase in weekly CSBM rate with all 3 treatments (P ≤ 0.003); stool consistency significantly improved with kiwifruit (P = 0.01) and prunes (P = 0.049); and straining significantly improved with kiwifruit (P = 0.003), prunes (P < 0.001), and psyllium (P = 0.04). Patients randomized to the kiwifruit group reported significant improvement in bloating scores (P = 0.02). AEs were most common with psyllium and least common with kiwifruit. At the end of treatment, a smaller proportion of patients were dissatisfied with kiwifruit compared with prunes or psyllium (P = 0.02).

DISCUSSION: Kiwifruit, prunes, and psyllium improve constipation symptoms in patients with CC. Kiwifruit was associated with the lowest rate of AEs and dissatisfaction with therapy.

PMID:34074830 | DOI:10.14309/ajg.0000000000001149

AIDS. 2021 Jun 1. doi: 10.1097/QAD.0000000000002964. Online ahead of print.

ABSTRACT

OBJECTIVE: HIV-associated chronic lung disease (HCLD) is a common comorbidity in children and adolescents in sub-Saharan Africa (SSA). The pathogenesis of HCLD is unclear and may be driven by underlying dysregulated systemic immune activation and inflammation. We investigated the association between 26 plasma soluble biomarkers and HCLD.

DESIGN: Case–control analysis of baseline biomarker data from 336 children and adolescents (6-19 years old) with perinatal HIV infection (PHIV) and HCLD (cases) and 74 age-matched and sex-matched controls with PHIV but no CLD. HCLD was defined as having a forced expiratory volume in one second (FEV1) z score less than -1 with no reversibility.

METHODS: Cryopreserved plasma collected at recruitment was used in a multiplex bead assay (Luminex) to measure baseline levels of soluble biomarkers. Logistic regression alongside data-reduction and techniques quantifying the interconnectedness of biomarkers were used to identify biomarkers associated with odds of HCLD.

RESULTS: Biomarkers of general immune activation and inflammation (β2M, CRP, sCCL5, GCSF, IFN-γ, IP-10), T-cell activation (sCD25, sCD27), platelet activation (sCD40-L), monocyte activation (sCD14), coagulation (D-Dimer), cellular adhesion (E-selectin), and extracellular matrix degradation (MMP-1, MMP-7, MMP-10) were associated with increased odds of HCLD. Exploratory PCA and assessment of biomarker interconnectedness identified T-cell and platelet activation as centrally important to this association.

CONCLUSION: HCLD was associated with a large number of soluble biomarkers representing a range of different pathways. Our findings suggest a prominent role for T-cell and platelet activation in HCLD.

PMID:34074817 | DOI:10.1097/QAD.0000000000002964

Korean J Med Educ. 2021 Jun;33(2):87-96. doi: 10.3946/kjme.2021.190. Epub 2021 May 26.

ABSTRACT

PURPOSE: With the ongoing coronavirus disease 2019 (COVID-19) pandemic, health institutions and hospitals are increasingly relying on e-learning for continuing education. However, in many countries there is still limited data on the effectiveness of online learning particularly in the healthcare field. This study aims to evaluate whether webinar as a form of online educational intervention is satisfactory and effective for the continuing education of health professionals in Indonesia.

METHODS: We collected participants’ demographic information including health profession, place of work, work unit, and year of graduation. There were six independent webinars included in this study. Webinar outcomes included satisfaction and learning scores. Regarding satisfaction, participants were told to complete a satisfaction survey and asked whether they would recommend the webinar to their colleagues. Regarding learning, information on their mean pre-test and post-test scores was collected.

RESULTS: A total of 3,607 health professionals were enrolled, with the highest participation in webinars about emergency cases and COVID-19 management. The response towards satisfaction was overwhelmingly positive. In all six webinars, post-test scores were statistically significantly higher than pre-test scores. Recently graduated physicians scored higher in learning than senior physicians, while place of work and work unit did not significantly affect the scores.

CONCLUSION: The use of webinar for health professionals training in Indonesia was well-received amid the ongoing pandemic. In the future, health institutions and teaching hospitals should optimize the implementation of webinar training as it is associated with low cost, high flexibility, and less time commuting.

PMID:34062640 | DOI:10.3946/kjme.2021.190