Nevin Manimala

Am J Health Syst Pharm. 2022 May 23:zxac144. doi: 10.1093/ajhp/zxac144. Online ahead of print.

ABSTRACT

DISCLAIMER: In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

PURPOSE: The purpose of this quality improvement project was to evaluate the safety and feasibility of peripheral vasopressor administration in an attempt to minimize the placement and improve early removal of unnecessary central lines to reduce central line-associated bloodstream infection (CLABSI) rates.

METHODS: A retrospective chart review was conducted on patients who received vasopressors via peripheral infusion over 3 months, starting at the time of guideline implementation.

RESULTS: We identified 129 vasopressor orders among 79 patients that were administered peripherally. Among these orders, 3 events were documented as possible extravasation events. Forty-five patients (57%) did not require central line placement due to increasing vasopressor requirements. Standard utilization ratio data suggest minimal central line impact of the protocol implementation. December 2020 to February 2021 was associated with a large second peak of coronavirus disease 2019 (COVID-19) in our region. Utilization of central lines was less than predicted in December 2020 to February 2021 in 2 of our 3 intensive care units (ICUs); however, the differences were statistically significant on only 3 occasions. In the third ICU, utilization was greater than predicted, but this unit housed a majority of the most critically ill patients with COVID-19.

CONCLUSION: This study suggests that short-term use of select vasopressors at conservative doses is safe for peripheral administration and points toward efficacy at preventing central line placement. Further analysis is required to confirm efficacy.

PMID:35605137 | DOI:10.1093/ajhp/zxac144

J Orthop Trauma. 2022 May 20. doi: 10.1097/BOT.0000000000002412. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate two prognostic models for mortality after a fracture of the hip, the Nottingham Hip Fracture Score (NHFS) and Hip fracture Estimator of Mortality Amsterdam (HEMA), and to compare their predictive performance to physician assessment of mortality risk in hip fracture patients.

DESIGN: Prospective cohort study.

SETTING: Two level 2 trauma centers located in The Netherlands.

PATIENTS: Two hundred forty-four patients admitted to the Emergency Departments of both hospitals with a fractured hip.

INTERVENTION: Data used in both prediction models were collected at the time of admission for each individual patient, as well as predictions of mortality by treating physicians.

MAIN OUTCOME MEASUREMENTS: Predictive performances were evaluated for 30-day, 1-year and 5-year mortality. Discrimination was assessed with the Area Under the Curve (AUC); calibration with the Hosmer-Lemeshow goodness-of-fit test and calibration plots; clinical usefulness in terms of accuracy, sensitivity and specificity.

RESULTS: Mortality was 7.4% after 30 days, 22.1% after one year and 59.4% after five years. There were no statistically significant differences in discrimination between the prediction methods (AUC 0.73 – 0.80). The NHFS demonstrated underfitting for 30-day mortality and failed to identify the majority of high-risk patients (sensitivity 33%). The HEMA showed systematic overestimation and overfitting. Physicians were able to identify most high-risk patients for 30-day mortality (sensitivity 78%), but with some overestimation. Both risk models demonstrated a lack of fit when used for 1-year and 5-year mortality predictions.

CONCLUSIONS: In this study, prognostic models and physicians demonstrated similar discriminating abilities when predicting mortality in hip fracture patients. While physicians overestimated mortality, they were better at identifying high-risk patients and at predicting long-term mortality.

LEVEL OF EVIDENCE: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

PMID:35605101 | DOI:10.1097/BOT.0000000000002412

J Am Acad Orthop Surg Glob Res Rev. 2022 May 1;6(5). doi: 10.5435/JAAOSGlobal-D-21-00211.

ABSTRACT

INTRODUCTION: The modified Radiographic Union Score for Tibia (RUST) fractures was developed to better describe fracture healing, but its utility in resource-limited settings is poorly understood. This study aimed to determine the validity of mRUST scores in evaluating fracture healing in diaphyseal femur fractures treated operatively at a single tertiary referral hospital in Tanzania.

METHODS: Radiographs of 297 fractures were evaluated using the mRUST score and compared with outcomes including revision surgery and EuroQol five dimensions questionnaire (EQ-5D) and visual analog scale (VAS) quality-of-life measures. Convergent validity was assessed by correlating mRUST scores with EQ-5D and VAS scores. Divergent validity was assessed by comparing mRUST scores in patients based on revision surgery status.

RESULTS: The mRUST score had moderate correlation (Spearman correlation coefficient 0.40) with EQ-5D scores and weak correlation (Spearman correlation coefficient 0.320) with VAS scores. Compared with patients who required revision surgery, patients who did not require revision surgery had higher RUST scores at all time points, with statistically significant differences at 3 months (2.02, P < 0.05).

DISCUSSION: These results demonstrate that the mRUST score is a valid method of evaluating the healing of femoral shaft fractures in resource-limited settings, with high interrater reliability, correlation with widely used quality of life measures (EQ-5D and VAS), and expected divergence in the setting of complications requiring revision surgery.

PMID:35605095 | DOI:10.5435/JAAOSGlobal-D-21-00211

J Biopharm Stat. 2022 May 23:1-2. doi: 10.1080/10543406.2022.2065503. Online ahead of print.

NO ABSTRACT

PMID:35605090 | DOI:10.1080/10543406.2022.2065503

Vital Health Stat 3. 2022 May;(47):1-93.

ABSTRACT

This report presents the most current national results from the National Study of Long-Term Care Providers (NSLTCP), conducted by the National Center for Health Statistics (NCHS) to describe providers and services users in seven major sectors of paid, regulated postacute and long-term care services in the United States.

PMID:35604771

JMIR Mhealth Uhealth. 2022 May 23;10(5):e23887. doi: 10.2196/23887.

ABSTRACT

BACKGROUND: On-body wearable sensors have been used to predict adverse outcomes such as hospitalizations or fall, thereby enabling clinicians to develop better intervention guidelines and personalized models of care to prevent harmful outcomes. In our previous work, we introduced a generic remote patient monitoring framework (Sensing At-Risk Population) that draws on the classification of human movements using a 3-axial accelerometer and the extraction of indoor localization using Bluetooth low energy beacons, in concert. Using the same framework, this paper addresses the longitudinal analyses of a group of patients in a skilled nursing facility. We try to investigate if the metrics derived from a remote patient monitoring system comprised of physical activity and indoor localization sensors, as well as their association with therapist assessments, provide additional insight into the recovery process of patients receiving rehabilitation.

OBJECTIVE: The aim of this paper is twofold: (1) to observe longitudinal changes of sensor-based physical activity and indoor localization features of patients receiving rehabilitation at a skilled nursing facility and (2) to investigate if the sensor-based longitudinal changes can complement patients’ changes captured by therapist assessments over the course of rehabilitation in the skilled nursing facility.

METHODS: From June 2016 to November 2017, patients were recruited after admission to a subacute rehabilitation center in Los Angeles, CA. Longitudinal cohort study of patients at a skilled nursing facility was followed over the course of 21 days. At the time of discharge from the skilled nursing facility, the patients were either readmitted to the hospital for continued care or discharged to a community setting. A longitudinal study of the physical therapy, occupational therapy, and sensor-based data assessments was performed. A generalized linear mixed model was used to find associations between functional measures with sensor-based features. Occupational therapy and physical therapy assessments were performed at the time of admission and once a week during the skilled nursing facility admission.

RESULTS: Of the 110 individuals in the analytic sample with mean age of 79.4 (SD 5.9) years, 79 (72%) were female and 31 (28%) were male participants. The energy intensity of an individual while in the therapy area was positively associated with transfer activities (β=.22; SE 0.08; P=.02). Sitting energy intensity showed positive association with transfer activities (β=.16; SE 0.07; P=.02). Lying down energy intensity was negatively associated with hygiene activities (β=-.27; SE 0.14; P=.04). The interaction of sitting energy intensity with time (β=-.13; SE 0.06; P=.04) was associated with toileting activities.

CONCLUSIONS: This study demonstrates that a combination of indoor localization and physical activity tracking produces a series of features, a subset of which can provide crucial information to the story line of daily and longitudinal activity patterns of patients receiving rehabilitation at a skilled nursing facility. The findings suggest that detecting physical activity changes within locations may offer some insight into better characterizing patients’ progress or decline.

PMID:35604762 | DOI:10.2196/23887

JMIR Public Health Surveill. 2022 May 23;8(5):e37820. doi: 10.2196/37820.

ABSTRACT

BACKGROUND: Digital interventions are interventions supported by digital tools or technologies, such as mobile apps, wearables, or web-based software. Digital interventions in the context of public health are specifically designed to promote and improve health. Recent reviews have shown that many digital interventions target physical activity promotion; however, it is unclear how such digital interventions are evaluated.

OBJECTIVE: We aimed to investigate evaluation strategies in the context of digital interventions for physical activity promotion using a scoping review of published reviews. We focused on the target (ie, user outcomes or tool performance), methods (ie, tool data or self-reported data), and theoretical frameworks of the evaluation strategies.

METHODS: A protocol for this study was preregistered and published. From among 300 reviews published up to March 19, 2021 in Medline, PsycINFO, and CINAHL databases, 40 reviews (1 rapid, 9 scoping, and 30 systematic) were included in this scoping review. Two authors independently performed study selection and data coding. Consensus was reached by discussion. If applicable, data were coded quantitatively into predefined categories or qualitatively using definitions or author statements from the included reviews. Data were analyzed using either descriptive statistics, for quantitative data (relative frequencies out of all studies), or narrative synthesis focusing on common themes, for qualitative data.

RESULTS: Most reviews that were included in our scoping review were published in the period from 2019 to 2021 and originated from Europe or Australia. Most primary studies cited in the reviews included adult populations in clinical or nonclinical settings, and focused on mobile apps or wearables for physical activity promotion. The evaluation target was a user outcome (efficacy, acceptability, usability, feasibility, or engagement) in 38 of the 40 reviews or tool performance in 24 of the 40 reviews. Evaluation methods relied upon objective tool data (in 35/40 reviews) or other data from self-reports or assessments (in 28/40 reviews). Evaluation frameworks based on behavior change theory, including goal setting, self-monitoring, feedback on behavior, and educational or motivational content, were mentioned in 22 out of 40 reviews. Behavior change theory was included in the development phases of digital interventions according to the findings of 20 out of 22 reviews.

CONCLUSIONS: The evaluation of digital interventions is a high priority according to the reviews included in this scoping review. Evaluations of digital interventions, including mobile apps or wearables for physical activity promotion, typically target user outcomes and rely upon objective tool data. Behavior change theory may provide useful guidance not only for development of digital interventions but also for the evaluation of user outcomes in the context of physical activity promotion. Future research should investigate factors that could improve the efficacy of digital interventions and the standardization of terminology and reporting in this field.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/35332.

PMID:35604757 | DOI:10.2196/37820

J Consult Clin Psychol. 2022 May;90(5):446-458. doi: 10.1037/ccp0000727.

ABSTRACT

OBJECTIVE: Modeling cross-lagged effects in psychotherapy mechanisms of change studies is complex and requires careful attention to model selection and interpretation. However, there is a lack of field-specific guidelines. We aimed to (a) describe the estimation and interpretation of cross lagged effects using multilevel models (MLM) and random-intercept cross lagged panel model (RI-CLPM); (b) compare these models’ performance and risk of bias using simulations and an applied research example to formulate recommendations for practice.

METHOD: Part 1 is a tutorial focused on introducing/describing dynamic effects in the form of autoregression and bidirectionality. In Part 2, we compare the estimation of cross-lagged effects in RI-CLPM, which takes dynamic effects into account, with three commonly used MLMs that cannot accommodate dynamics. In Part 3, we describe a Monte Carlo simulation study testing model performance of RI-CLPM and MLM under realistic conditions for psychotherapy mechanisms of change studies.

RESULTS: Our findings suggested that all three MLMs resulted in severely biased estimates of cross-lagged effects when dynamic effects were present in the data, with some experimental conditions generating statistically significant estimates in the wrong direction. MLMs performed comparably well only in conditions which are conceptually unrealistic for psychotherapy mechanisms of change research (i.e., no inertia in variables and no bidirectional effects).

DISCUSSION: Based on conceptual fit and our simulation results, we strongly recommend using fully dynamic structural equation modeling models, such as the RI-CLPM, rather than static, unidirectional regression models (e.g., MLM) to study cross-lagged effects in mechanisms of change research. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

PMID:35604748 | DOI:10.1037/ccp0000727

J Consult Clin Psychol. 2022 May;90(5):381-391. doi: 10.1037/ccp0000734.

ABSTRACT

OBJECTIVE: This study assessed the efficacy of the marriage checkup, as adapted to integrated primary care settings and active-duty military couples, for improving relationship health and depressive symptoms.

METHOD: Married couples (N = 244, Mage = 32.4, 67.6% Caucasian) in which at least one member was active-duty Air Force were recruited from bases across the U.S. via online advertisement, emails sent from medical clinics to enrolled beneficiaries, social media posts, and flyers, and randomly assigned to active treatment or waitlist control. Treatment and control couples were linked in pairs sequentially and pairs completed nine sets of questionnaires at baseline, 1-, and 6-month posttreatment. Outcome measures included the Couples Satisfaction Index, Intimate Safety Questionnaire, Responsive Attention Scale, Partner Compassion Scale, Communication Skills Test, and the Center for Epidemiologic Studies Depression Scale.

RESULTS: A three-level multilevel model indicated, after adjustment for multiple comparisons, treatment couples experienced statistically significant small-to-moderate improvements compared to the control group (Cohen’s d from 0.21 to 0.55) at 1 month that were sustained at 6 months for relationship satisfaction, responsive attention, compassion toward their partners, communication skills, intimate safety, and depressive symptoms.

CONCLUSIONS: A longitudinal randomized control trial of the MC supports the hypothesis that the MC significantly improves relationship satisfaction, intimacy, communication, partner compassion, responsive attention, and depressive symptoms. Implications for theory, treatment, and dissemination are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

PMID:35604745 | DOI:10.1037/ccp0000734

J Consult Clin Psychol. 2022 May;90(5):367-380. doi: 10.1037/ccp0000725.

ABSTRACT

OBJECTIVE: Evaluate whether stimulant medication improves acquisition of academic material in children with attention deficit hyperactivity disorder (ADHD) receiving small-group, content-area instruction in a classroom setting.

METHOD: Participants were 173 children between the ages of 7 and 12 years old (77% male, 86% Hispanic) who met Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for ADHD and were participating in a therapeutic summer camp. The design was a triple-masked, within-subject, AB/BA crossover trial. Children completed two consecutive phases of daily, 25-min instruction in both (a) subject-area content (science, social studies) and (b) vocabulary. Each phase was a standard instructional unit lasting for 3 weeks. Teachers and aides taught the material to small groups in a summer classroom setting. Each child was randomized to be medicated with daily osmotic-release oral system methylphenidate (OROS-MPH) during either the first or second of the instructional phases, receiving placebo during the other.

RESULTS: Medication had large, salutary, statistically significant effects on children’s academic seatwork productivity and classroom behavior on every single day of the instructional period. However, there was no detectable effect of medication on learning the material taught during instruction: Children learned the same amount of subject-area and vocabulary content whether they were taking OROS-MPH or placebo during the instructional period.

CONCLUSIONS: Acute effects of OROS-MPH on daily academic seatwork productivity and classroom behavior did not translate into improved learning of new academic material taught via small-group, evidence-based instruction. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

PMID:35604744 | DOI:10.1037/ccp0000725