Nevin Manimala

J Foot Ankle Res. 2022 Mar 2;15(1):18. doi: 10.1186/s13047-022-00523-w.

ABSTRACT

BACKGROUND: There is a lack of high quality evidence to guide the optimal management of diabetes-related foot infection, particularly in cases of severe diabetes-related foot infection and diabetes-related foot osteomyelitis. This study examined the opinions of surgeons about the preferred management of severe diabetes-related foot infection.

METHODS: Vascular and orthopaedic surgeons in Australia and New Zealand were invited to complete an online survey via email. The survey included multi-choice and open-ended questions on clinical management of diabetes-related foot infection. Responses of vascular surgeons and orthopaedic surgeons were compared using non-parametric statistical tests. Open-text responses were examined using inductive content analysis.

RESULTS: 29 vascular and 20 orthopaedic surgeons completed the survey. One-third (28.6%) used best-practice guidelines to assist in decisions about foot infection management. Areas for guideline improvement identified included more specific advice regarding the indications for available treatments, more recommendations about non-surgical patient management and advice on how management can be varied in regions with limited health service resource. The probe-to-bone test and magnetic resonance imaging were the preferred methods of diagnosing osteomyelitis. Approximately half (51.2%) of respondents indicated piperacillin combined with tazobactam as the preferred antibiotic choice for empirical treatment of severe diabetes-related foot infection. Negative pressure wound therapy was the most common way of managing a wound following debridement. All vascular surgeons (100%) made revascularisation decisions based on the severity of ischemia while most orthopaedic surgeons (66.7%) were likely to refer to vascular surgeons to make revascularisation decisions. Vascular surgeons preferred using wound swabs while orthopaedic surgeons favoured tissue or bone biopsies to determine the choice of antibiotic. Respondents perceived a moderate variation in management decisions between specialists and supported the need for randomised controlled trials to test different management pathways.

CONCLUSIONS: Most vascular and orthopaedic surgeons do not use best-practice guidelines to assist in decisions about management of diabetes-related foot infection. Vascular and orthopaedic surgeons appear to have different preferences for wound sampling to determine choice of antibiotic. There is a need for higher quality evidence to clarify best practice for managing diabetes-related foot infection.

PMID:35232476 | DOI:10.1186/s13047-022-00523-w

BMC Health Serv Res. 2022 Mar 1;22(1):277. doi: 10.1186/s12913-022-07637-8.

ABSTRACT

BACKGROUND: Cardiovascular disease (CVD) is the first cause of death globally, with huge costs worldwide. Most cases of CVD could be prevented by addressing behavioural risk factors. Among these factors, there is physical and amateur sports activity (PASA), which has a linear negative correlation with the risk of CVD. Nevertheless, attempts to encourage PASA, as exercise prescription programmes, achieved little impact at the community-wide level. A new frontier to promote PASA is represented by mobile health tools, such as exergaming, mobile device apps, health wearables, GPS/GIS and virtual reality. Nevertheless, there has not yet been any evident turnabout in patient active involvement towards CVD prevention, and inactivity rates are even increasing. This study aims at framing the state of the art of the literature about the use of m-health in supporting PASA, as a user-centric innovation strategy, to promote co-production health policies aiming at CVD prevention.

METHODS: A mixed-method systematic literature review was conducted in the fields of health and healthcare management to highlight the intersections between PASA promotion and m-health tools in fostering co-produced services focused on CVD prevention. The literature has been extracted by the PRISMA logic application. The resulting sample has been first statistically described by a bibliometric approach and then further investigated with a conceptual analysis of the most relevant contributions, which have been qualitatively analysed.

RESULTS: We identified 2,295 studies, on which we ran the bibliometric analysis. After narrowing the research around the co-production field, we found 10 papers relevant for the concept analysis of contents. The interest about the theme has increased in the last two decades, with a high prevalence of contributions from higher income countries and those with higher CVD incidence. The field of research is highly multi-disciplinary; most of documents belong to the medical field, with only a few interconnections with the technology and health policy spheres. Although the involvement of patients is recognized as fundamental for CVD prevention through PASA, co-design schemes are still lacking at the public management level.

CONCLUSIONS: While the link between the subjects of motor activity, medicine and technology is clear, the involvement of citizens in the service delivery process is still underinvestigated, especially the issue concerning how “value co-creation” could effectively be applied by public agencies. In synthesis, the analysis of the role of co-production as a system coordination method, which is so important in designing and implementing preventive care, is still lacking.

PMID:35232456 | DOI:10.1186/s12913-022-07637-8

BMC Health Serv Res. 2022 Mar 1;22(1):276. doi: 10.1186/s12913-022-07657-4.

ABSTRACT

BACKGROUND: Clinical quality registries (CQRs) monitor compliance against optimal practice and provide feedback to the clinical community and wider stakeholder groups. Despite a number of CQRs having incorporated the patient perspective to support the evaluation of healthcare delivery, no recommendations for inclusion of patient-reported outcome measures (PROMs) in CQRs exist. The aim of this study was to develop a core set of recommendations for PROMs inclusion of in CQRs.

METHOD: An online two-round Delphi survey was performed among CQR data custodians, quality of life researchers, biostatisticians and clinicians largely recruited in Australia. A list of statements for the recommendations was identified from a literature and survey of the Australian registries conducted in 2019. The statements were grouped into the following domains: rationale, setting, ethics, instrument, administration, data management, statistical methods, and feedback and reporting. Eighteen experts were invited to participate, 11 agreed to undertake the first online survey (round 1). Of these, nine experts completed the online survey for round 2.

RESULTS: From 117 statements presented to the Delphi panel in round 1, a total of 72 recommendations (55 from round 1 and 17 from round 2) with median importance (MI) ≥ 7 and disagreement index (DI) < 1 were proposed for inclusion into the final draft set and were reviewed by the project team. Recommendations were refined for clarity and to read as stand-alone statements. Ten overlapped conceptually and, therefore, were merged to reduce repetition. The final 62 recommendations were sent for review to the panel members for their feedback, which was incorporated into the final set.

CONCLUSION: This is the first study to develop preliminary recommendations for PROMs inclusion in CQRs. Recommendations for PROMs implementation are critically important for registries to assure meaningful PROMs data capture, use, interpretation, and reporting to improve health outcomes and healthcare value.

PMID:35232454 | DOI:10.1186/s12913-022-07657-4

BMC Med Educ. 2022 Mar 1;22(1):134. doi: 10.1186/s12909-022-03191-3.

ABSTRACT

BACKGROUND: Among the various factors identified as relevant for primary care career choice, financial considerations have been consistently shown to have an impact. In Germany, reliable and easily understandable information on physicians’ earning opportunities in self-employed settings is difficult to obtain for medical students, leading to substantial misperceptions that may negatively affect respective career considerations. This study investigated medical students’ evaluation of a 45-min evidence-based workshop on earning opportunities, workload and job satisfaction in different specialties and settings to examine its effect on the perceived attractiveness of working self-employed and working in general practice.

METHODS: The workshop was implemented as part of a mandatory general practice clerkship in the fourth study year (of six). Post-hoc evaluations of all participants between October 2017 and September 2018 (one cohort) were analysed cross-sectionally including descriptive statistics, subgroup comparisons and qualitative analysis of free-text answers regarding students’ main insights.

RESULTS: Response rate was 98.1% (307/313). Participants were on average 25.0 years old, and 68.3% were women. Based on a ten-point scale ranging from 1 = ‘no influence’ to 10 = ‘very big influence’, 91.9% confirmed at least some (> = 2) and 57.3% a rather high (> = 5) influence of earning expectations on their career choice process. Regarding the workshop, 86.1% were overall satisfied, and 89.5% indicated they had gained new insights, primarily regarding earning opportunities in different specialties and work settings, and frequently regarding job satisfaction, workload and the structure of revenues and expenditures in a doctor’s office (according to qualitative analysis). In the opinion of 89.8% of students, the provided learning content should be part of the undergraduate curriculum. More than half of participants reported an increase regarding the attractiveness of working self-employed and working as a general practitioner, most frequently regarding earning opportunities, but also in general and in respect to job satisfaction, cost-benefit ratio and workload. This increase was significantly higher among students favouring or at least considering a general practice career.

CONCLUSIONS: The workshop and its content were appreciated by the students and showed clear potential to usefully complement undergraduate curricula aiming at increasing or reinforcing students’ interest in working self-employed and working in general practice.

PMID:35232434 | DOI:10.1186/s12909-022-03191-3

Zhonghua Xue Ye Xue Za Zhi. 2022 Jan 14;43(1):19-25. doi: 10.3760/cma.j.issn.0253-2727.2022.01.005.

ABSTRACT

Objective: This study analyzed the correlation between genetic mutation and prognostic significance in childhood acute lymphoblastic leukemia (ALL) . Methods: Targeted exome by next-generation sequencing (NGS) technology was used to carry out molecular profiling of untreated 141 children with ALL in Fujian Medical University Union Hospital from November 2016 to December 2019. Correlation of genetic features and clinical features and outcomes was analyzed. Results: Among the 141 pediatric patients with ALL, 160 somatic mutations were detected in 83 patients (58.9% ) , including 37 grade Ⅰ mutations and 123 grade Ⅱ mutations. Single nucleotide variation was the most common type of mutation. KRAS was the most common mutant gene (12.5% ) , followed by NOTCH1 (11.9% ) , and NRAS (10.6% ) . RAS pathway (KRAS, FLT3, PTPN11) , PAX5 and TP53 mutations were only detected, and NRAS mutations was mainly found in B-ALL while FBXW7 and PTEN mutations were only found, and NOTCH1 mutation was mainly detected in T-ALL. The average number of mutations detected in each child with T-ALL was significantly higher than in children with B-ALL (4.16±1.33 vs 2.04±0.92, P=0.004) . The children were divided into mutation and non-mutation groups according to the presence or absence of genetic variation. There were no statistically significant differences in sex, age, newly diagnosed white blood cell count, minimal or measurable residual disease monitoring results, expected 3-year event-free survival (EFS) and overall survival (OS) between the two groups (P>0.05) . On the other hand, the proportion of T-ALL and fusion gene negative children in the mutant group was significantly higher than the non-mutation group (P=0.021 and 0.000, respectively) . Among the patients without fusion gene, the EFS of children with grade I mutation was significantly lower than children without grade I mutation (85.5% vs 100.0% , P=0.039) . Among children with B-ALL, the EFS of those with TP53 mutation was significantly lower than those without TP53 mutation (37.5% vs 91.2% , P<0.001) . Conclusion: Genetic variation is more common in childhood ALL and has a certain correlation with clinical phenotype and prognosis. Therefore, targeted exome by NGS can be used as an important supplement to the traditional morphology, immunology, cytogenetics, and molecular biology classification.

PMID:35231988 | DOI:10.3760/cma.j.issn.0253-2727.2022.01.005

Psych J. 2022 Mar 1. doi: 10.1002/pchj.531. Online ahead of print.

ABSTRACT

Schizotypal traits have been found to be negatively associated with satisfaction with life but the underlying mechanisms are not well understood. This study investigated the association between schizotypal traits and satisfaction with life and explored the mediating role of trait anxiety and mind wandering in the relationship between those two variables in a sample of Chinese young adults. One hundred and two individuals with high schizotypal traits and 104 individuals with low schizotypal traits were screened using the Schizotypal Personality Questionnaire. They completed a series of questionnaires including the Satisfaction with Life Scale, Trait Anxiety Inventory, and Mind Wandering Questionnaire. Results showed that: First, the high schizotypal trait group showed lower satisfaction with life, and higher trait anxiety and mind wandering frequency than the low schizotypal trait group. Second, the high schizotypal trait group, trait anxiety, and mind wandering negatively predicted satisfaction with life. Third, mediation analyses showed that all indirect effect paths in the mediation model were significant, that is, trait anxiety and mind wandering alone and together mediated the relationship between schizotypal trait group and satisfaction with life. In conclusion, high schizotypal trait is a risk factor for low satisfaction with life. The association between schizotypal traits and satisfaction with life was mediated by the combination of trait anxiety and mind wandering. This study has implications for improving life satisfaction in individuals with high schizotypal traits.

PMID:35231958 | DOI:10.1002/pchj.531

Audiol Neurootol. 2022 Mar 1:1-9. doi: 10.1159/000522051. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to study the effect of steroid treatment on new-onset sensorineural hearing loss (SNHL) in subjects presenting shortly after an audiometry-confirmed acute acoustic trauma (AAT) injury.

STUDY DESIGN: This is a case-control study.

METHODS: We identified healthy military personnel who presented with AAT injury to the Israeli Defense Forces Medical Corps Otolaryngology/Audiology Services during 2016-2020. Patients were nonrandomly allocated to a treatment arm, where they received steroids (prednisone, 1 mg/kg, 60 mg maximal daily dose), administered for either ≥7 days or <7 days, or to a control arm, in which no treatment was offered besides loud noise avoidance. Audiometries were conducted within 7 days following the AAT and within 1 month later. We compared changes in bone conduction (BC) and air conduction (AC) thresholds at 2-8 kHz.

RESULTS: Of the 263 enrolled subjects, 137 (52%) received steroids and 126 (48%) received no treatment. Subjects who were treated early (<24 h) with high-dose steroids and for ≥7 days demonstrated significantly better hearing outcomes, compared with the nontreatment group. Subjects in the steroids group demonstrated 13-14 dB average improvement in BC thresholds at 3 and 4 kHz (p = 0.001) and additional 7-8 dB average improvement in AC thresholds at 6 and 8 kHz, compared with the nontreatment group (p < 0.0001). These observations were more compelling in patients who initially presented with worse hearing losses (>35 dB). No statistically significant differences were observed in AC/BC pure tone average between the two groups.

CONCLUSIONS: Early oral steroids are recommended in AAT injuries and were shown to improve hearing outcomes within 1 month.

PMID:35231916 | DOI:10.1159/000522051

J Trace Elem Med Biol. 2022 Feb 22;71:126961. doi: 10.1016/j.jtemb.2022.126961. Online ahead of print.

ABSTRACT

BACKGROUND: Elemental profiling is a tool that has been proposed to improve the traceability of seafood products. Small sources of variation can affect the outcome of elemental profiling and therefore pose to lower the overall accuracy of analyses. Here, we investigate two potential sources of variation through three experiments: laboratory variation (intra-, interlaboratory variation, and tissue matrix) and tissue variation.

METHODS AND RESULTS: Samples of whitleleg shrimp (Litopenaeus vannamei) were obtained from 20 farms in Ecuador and two farms in Alabama to be analyzed. In the first experiment of the study, samples from Ecuador were analyzed at three different laboratories and compared. Two out of the five elements reported were statistically different across the three laboratories (Cu and Se). In the second experiment, the effect of tissue matrix (ground vs whole tissue during acid digestion) was investigated. Altogether, five out of 29 elements analyzed were statistically different. In the third experiment, samples from two farms in Alabama were analyzed to understand the variation in element concentrations in different tissues (head on shell on (HOSO), headless shell on (HLSO), headless peeled (PLD) and headless peeled and deveined (PLDV)). Elemental concentrations varied across tissues, and patterns in elemental concentrations were site specific. The samples from the two farms were analyzed with a Random Forest classification model to site x tissue groupings with 94% accuracy.

CONCLUSION: The result of this study highlights the following: 1. Consistency in laboratory analysis important in studies that involve element concentrations, as minor differences in methodology can propagate as significant differences in results. 2. In shrimp, elements are compartmentalized in different tissues and elemental profiling should consistently use the same type of tissue.

PMID:35231879 | DOI:10.1016/j.jtemb.2022.126961

Psychiatry Res. 2022 Feb 20;310:114469. doi: 10.1016/j.psychres.2022.114469. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to investigate the relationship between childhood trauma and clinical correlates in bipolar depression.

METHODS: A total of 61 bipolar depression patients were enrolled and assessed based on the Childhood Trauma Questionnaire-Short Form (CTQ-SF), Patient Health Questionaire-15 (PHQ-15), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7) systems.

RESULTS: The age of onset in bipolar depression patients with either trauma or abuse or neglect was significantly lower than in patients without these factors. There were statistically significant negative correlations between the age of onset and the number of different trauma types in bipolar depression patients. Multiple variable regression showed a significant association between the number of trauma types and the age of onset. Furthermore, there was a significant negative correlation between the age of onset with CTQ-SF total score (CTS), emotional abuse score and emotional neglect score, and physical neglect score. However, multiple variable regression analysis revealed that there was a significant association between emotional abuse score and the age of onset of bipolar depression patients.

CONCLUSION: Our results suggest that childhood trauma may be associated with physical symptoms and the age of onset in bipolar depression patients.

PMID:35231875 | DOI:10.1016/j.psychres.2022.114469

Am J Emerg Med. 2022 Feb 20;55:6-10. doi: 10.1016/j.ajem.2022.02.023. Online ahead of print.

ABSTRACT

OBJECTIVES: Gender disparities continue to exist in emergency medicine (EM) despite increasing percentages of women in medical school and residencies. Prior studies in other male dominated industries have shown using masculine or feminine-coded language in job advertisements affects the proportion of male versus female applicants who choose to apply for those jobs. The goal of this study was to determine if gender-coding exists in EM job advertisements, and to see if there were differences between academic vs. non-academic jobs or administrative vs. non-administrative jobs.

METHODS: This was a cross sectional study of EM jobs advertised in the United States on 13 academic and non-academic medical job databases from September 2020-February 2021. Using a gender decoder program based on prior research by Gaucher et al. on gendered wording in job advertisements, we analyzed each job to determine if the job advertisement was overall highly masculine, masculine, highly feminine, feminine, or neutral. Each job was categorized as academic, non-academic, administrative, or non-administrative. Data were analyzed using descriptive statistics and chi-square analysis.

RESULTS: Seventy-four EM job advertisements were posted during the study period. Forty-four (59.4%) of these coded out as masculine or strongly masculine, 18 (24.3%) coded out as feminine or strongly feminine, and 12 (16.2%) were neutral. Only one job advertisement contained no gender-coded words. There were no differences in the gender-coding of academic, non-academic, or administrative jobs.

CONCLUSION: Job advertisements for EM physicians tend to contain more masculine-coded language. Almost all job advertisements for emergency medicine physicians in this study contained at least one gender-coded word. Further studies could explore whether changing the language of job advertisements in EM has an impact on the proportion of women who choose to apply to EM jobs.

PMID:35231866 | DOI:10.1016/j.ajem.2022.02.023