Nevin Manimala

J Palliat Med. 2021 Aug 23:1-9. doi: 10.1089/jpm.2021.0121. Online ahead of print.

ABSTRACT

Background: Early, high-quality advance care planning discussions are essential for supporting goal-concordant care among glioblastoma (GBM) patients. Objective: Using mixed methods, we sought to characterize current serious illness (SI) communication practices at our institution. Methods: The electronic medical records of 240 deceased GBM patients cared for at the Abramson Cancer Center in Philadelphia, PA between 2017 and 2019 were systematically reviewed for documented SI conversations about four domains: prognosis, goals, end-of-life planning, and code status. Patient outcomes and SI conversation characteristics were analyzed using descriptive statistics. Standardized interviews about GBM care were held with five clinicians. Interview transcripts were analyzed using grounded-theory coding to identify emergent themes. Results: Nearly all patients (96%) had at least one documented SI conversation (median: 4, interquartile range [IQR] 2-7), mostly outpatient with medical oncology physicians. Median timing of first SI conversation was 360 days before death. SI conversations were not significantly associated with patient outcomes, including inpatient death and hospice enrollment. Seven themes emerged from clinician interviews: balancing hope and reality, anticipatory guidance, neglect of the “big picture,” need for earlier conversations, care coordination, the role of clinical expertise, and communication training. Conclusion: SI conversations were documented early and often in our sample, but their quality was difficult to assess. Contrary to our quantitative findings, interviewees reported that SI conversations were late, infrequent, inadequate, and fragmented across specialties, failing to explore critical issues such as prognosis and functional decline.

PMID:34424777 | DOI:10.1089/jpm.2021.0121

J Laparoendosc Adv Surg Tech A. 2021 Aug 23. doi: 10.1089/lap.2020.0812. Online ahead of print.

ABSTRACT

Purpose: We performed a retrospective study to determine the effectiveness and feasibility of articulating linear stapler in laparoscopic total splenectomy (LTS) and laparoscopic partial splenectomy (LPS), focusing on technical laparoscopic skills that could help pediatric surgeons to avoid intra- and postoperative complications. Methods: Retrospective cohort study of children younger than 18 years who underwent laparoscopic spleen surgery between January 2008 and March 2020. Age, sex, indication for surgery, operative time (OT), intra- and postoperative complications, and postoperative length of hospital stay (LHS) were analyzed. Data from parenchymal resection and vessels sealing techniques were obtained. Results: Thirty patients, 19 LTS and 11 LPS, were included. The mean age of the patients was 10.9 years, and 16 patients were male and 14 were female. For hematologic diseases, LTS was the elective surgery, associated with cholecystectomy in 5 cases. LPS was the common procedure for splenic cysts. The stapler was used in LTS to close the hilum vessels and in LPS for parenchymal resection. No statistically significant differences in OT were observed comparing LTS and LPS. Two conversions occurred in LTS; none in LPS. The mean LHS was 6 days in both groups. No recurrence or major complications appeared in both groups at 1-12 years of follow-up. In particular for LPS, there are no relapse of cyst neither reduction in splenic function. Conclusions: This study shows the effectiveness, feasibility, and safety of mechanic stapler in splenic surgery both for hilum vessels sealing and for parenchymal resection. The use of this device can reduce risk of hemorrhagic recurrences or major surgical complications improving the safety of the operation.

PMID:34424747 | DOI:10.1089/lap.2020.0812

Am J Hum Biol. 2021 Aug 23:e23670. doi: 10.1002/ajhb.23670. Online ahead of print.

ABSTRACT

OBJECTIVES: Connecting traits to biological pathways and genes relies on stable observations. Researchers typically determine traits once, expecting careful study protocols to yield measurements free of noise. This report examines that expectation with test-retest repeatability analyses for traits used regularly in research on adaptation to high-altitude hypoxia, often in settings without climate control.

METHODS: Two hundred ninety-one ethnic Tibetan women residing from 3500 to 4200 m in Upper Mustang District, Nepal, provided three observations of hemoglobin concentration, percent of oxygen saturation of hemoglobin, and pulse by noninvasive pulse oximetry under conditions designed to minimize environmental noise.

RESULTS: High-intraclass correlation coefficients and low within-subject coefficients of variation reflected consistent measurements. Percent of oxygen saturation had the highest intraclass correlation coefficient and the smallest within-subject coefficient of variability; measurement noise occurred mainly in the lower values. Hemoglobin concentration and pulse presented slightly higher within-subject coefficients of variation; measurement noise occurred across the range of values. The women had performed the same measurements 7 years earlier using the same devices and protocol. The sample means and SD observed across 7 years differed little. Hemoglobin concentration increased substantially after menopause.

CONCLUSIONS: Analyzing repeatability features of traits may improve our interpretation of statistical analyses and detection of variation from measurement or biology. The high levels of measurement repeatability and biological stability support the continued use of these robust traits for investigating human adaptation in this altitude range.

PMID:34424596 | DOI:10.1002/ajhb.23670

J Cosmet Dermatol. 2021 Aug 22. doi: 10.1111/jocd.14390. Online ahead of print.

ABSTRACT

BACKGROUND: Major epidemic outbreaks create an increased demand for healthcare workers (HCWs) and pose increased health risk and psychological distress to them as well.

AIM: The aim of this cross sectional study was to find out the prevalence of depression, anxiety and stress among Egyptian dermatologists and their possible predictor factors.

PATIENTS/METHODS: A cross sectional study was designed and data were collected using structured self-administered online depression, anxiety, and stress scale (DASS-21).

RESULTS: The depression scale of DASS was 18.98 ± 9.56 among which 38% of dermatologists had either severe or extremely severe depression and 34.2% complained of moderate depression. Meanwhile, the anxiety scale was 12.92 ± 7.75 and 35.4 % of surveyed dermatologists had either severe or extremely severe anxiety. Thirty three percent of dermatologists were normal on stress score. Female dermatologists possessed more significant depression and stress than males (19.70 ± 9.71 vs. 16.62 ± 8.68, p = 0.003; 21.42 ± 9.53 vs. 17.40 ± 8.49, p <0.001 respectively). On the contrary, male dermatologists expressed more anxiety than female dermatologists however this was not statistically significant (13.26 ± 7.99 vs. 12.82 ± 7.69, p = 0.625).

CONCLUSION: To our knowledge, this is the first study to explore the differential impacts of the COVID-19 pandemic on Egyptian dermatologists. Mental health care and support are of extreme importance to physicians mid this pandemic.

PMID:34423565 | DOI:10.1111/jocd.14390

Clin Implant Dent Relat Res. 2021 Aug 22. doi: 10.1111/cid.13044. Online ahead of print.

ABSTRACT

BACKGROUND: Immediate implant placement (IIP) associated with the use of bone substitutes and collagen matrices (CM) seems to reduce the amount of resorption at peri-implant areas. Recently, customized healing abutments (CA) appeared as another solution in order to seal the socket and preserve the original soft tissue contour.

PURPOSE: To evaluate peri-implant tissues dimensional changes after using customized healing abutments compared with the use of xenogeneic collagen matrices as socket sealing options in flapless maxillary immediate implant placement.

MATERIAL AND METHODS: The present study was designed as a prospective, randomized, controlled clinical trial. Patients were allocated into two groups depending on the socket sealing option: in the CM group a collagen matrix was used and in the CA group a customized abutment. Digital impressions were taken prior to extraction, 1, 4, and 12 months after implant insertion and the digital files allowed to evaluate linear buccal changes (MBC) and the buccal volumetric variation (BVv) between the different time points at peri-implant tissue areas. Additionally, mucosa variation was computed assessing the papilla presence and the midfacial mucosa height. Statistical significance was set at 0.05.

RESULTS: Twenty-eight patients were observed during a 12-month period. Significant differences between mean values of BVv at the first month were observed at the CM and CA group (-9.75 ± 6.65% and -4.76 ± 5.29%, respectively) (p = 0.043). At the 1-year follow-up, no significant differences were found in terms of BVv between the two groups, although the thin bone phenotype (≤1 mm) significantly influenced the volumetric variations that occurred in each group. No significant differences were noticed in midfacial mucosa and papillae alteration between groups, after 1 year of treatment.

CONCLUSION: Both treatment options are predictable solutions for socket sealing in IIP, although a higher volumetric variation can be expected in the presence of thin bone phenotypes.

PMID:34423560 | DOI:10.1111/cid.13044

Andrology. 2021 Aug 22. doi: 10.1111/andr.13101. Online ahead of print.

ABSTRACT

BACKGROUND: Testicular MRI parameters, including apparent diffusion coefficient, fractional anisotropy, magnetization transfer ratio and normalized metabolite concentrations represent useful noninvasive fingerprints of nonobstructive azoospermia (NOA). NOA etiology might correlate with the spermatogenesis status.

OBJECTIVES: To assess possible association between apparent diffusion coefficient, fractional anisotropy, magnetization transfer ratio and metabolite concentrations with NOA etiology.

MATERIALS AND METHODS: This retrospective study included 48 consecutive men with NOA and 18 age-matched controls. All participants underwent scrotal MRI. Testicular apparent diffusion coefficient, fractional anisotropy, magnetization transfer ratio and normalized metabolite concentrations were calculated. NOA men were classified into three groups, based on etiology: group 1, idiopathic; group 2, genetic causes; and, group 3, non-genetic causes. Parametric and nonparametric statistical tests were used to evaluate differences in MRI parameters between NOA groups and normal testes (group 4). Regression analysis was performed to assess the most predictive MRI factor of NOA etiology.

RESULTS: Differences in mean apparent diffusion coefficient (P < .001), fractional anisotropy (P < .001), magnetization transfer ratio (P < .001), and normalized concentrations of total choline (P = .005), glucose (P = .012), myo-inositol (P = .024), and lipids (P = .010) were observed among groups. Regression analysis failed to identify the most discriminating MRI feature for NOA etiology.

DISCUSSION AND CONCLUSION: Apparent diffusion coefficient, fractional anisotropy, magnetization transfer ratio and normalized concentrations of total choline, glucose, myo-inositol, and lipids are helpful in discriminating NOA etiology. MRI may provide useful, noninvasive information on microstructural and biochemical milieu of NOA testes. This article is protected by copyright. All rights reserved.

PMID:34423558 | DOI:10.1111/andr.13101

Clin Teach. 2021 Aug 22. doi: 10.1111/tct.13411. Online ahead of print.

ABSTRACT

BACKGROUND: The Clinical Teacher Training (CTT) programme was originally developed as an interprofessional, blended learning programme, to support health professionals working across health services within Australia, although it has also been delivered internationally. With the disruption of COVID-19, we rapidly moved to ‘online only’ delivery. We sought to modify the programme, ensuring that the constructivist paradigms important for our learner experience through the original blended format were maintained in the online platform.

APPROACH: Consisting of 10 modules on a range of topics, the new CTT online only programme was facilitated online across 6 weeks with asynchronous and synchronous assessable activities, and provision of peer and facilitator feedback. The learning outcomes for each module were similar to the ‘blended learning’ format. The new programme was delivered three times throughout 2020 and completed by a total of 208 health professionals from across 10 metropolitan and rural health districts.

EVALUATION: The focus of our evaluation was on the programme’s final 2020 iteration, for which we had ethics approval. Participants (n = 59) were from diverse health professions, across five metropolitan and rural health districts. We prioritised the learner experience in constructing our evaluation strategy. Quantitative and qualitative data were collected by post-course questionnaire and analysed using descriptive statistics and thematic analysis. Twenty participants (34%) responded to the post-course questionnaire. Participants valued the structure, topics, clear outcomes, timeframe, online resources, small group activities, feedback and the flexibility and accessibility afforded by online only delivery. However, participants identified a need for additional ‘real-time’ engagement in activities. Faculty were surprised by the time required to adequately facilitate online learning, and similarly, valued the real-time interactions.

IMPLICATIONS: The online only CTT programme provided an excellent, scalable framework to ensure continued provision of a relevant and accessible training resource for clinicians working in metropolitan and regional/rural health services. Learner-reported achievement of programme learning outcomes was not negatively impacted by online only delivery. Balancing these resource advantages with learner preferences and our desire to build active teaching networks, we will continue to host the majority of the programme online, while offering short face-to-face sessions within local contexts.

PMID:34423533 | DOI:10.1111/tct.13411

Dermatol Ther. 2021 Aug 22. doi: 10.1111/dth.15107. Online ahead of print.

ABSTRACT

Recently, topical Tranexamic acid (TXA) has been used in melasma management. On detail search of literature, this may be the first study assessing efficacy on combining of Topical TXA with GA peel in melasma. To assess efficacy, safety and improvement in quality of life index on combining 30% GA peel with 5% TXA solution topically in melasma of epidermal type. 60 patients of epidermal melasma were categorised into two groups: Combination group were treated with 30% GA peel at 2 weekly intervals with 5% TXA solution applied twice daily and Control group were treated with only 30% GA peel every 2 weeks for 12 weeks. Melasma area severity index (MASI) was used for assessing clinical improvement. Hi-MELASQOL and HRQOL scales were used to measure Melasma related quality of life and were compared between both groups. At each visit adverse effects were noted. A significantly decreasing trend was seen regarding the MASI score when compared within the group, but the difference was statistically not significant between the two groups at 12 weeks. Similarly, there was significant improvement in Hi-MELASQOL and HRQOL in both the groups, but the difference between them was statistically not significant. Side effects experienced by patients in both groups were trivial and did not requiring stoppage of therapy. Topical TXA with GA peel has comparable result with GA peel alone, but the therapeutic response was achieved in patients of combination group earlier in comparison to control group patients. This article is protected by copyright. All rights reserved.

PMID:34423510 | DOI:10.1111/dth.15107

J Occup Health. 2021 Jan;63(1):e12270. doi: 10.1002/1348-9585.12270.

ABSTRACT

OBJECTIVES: This study aimed to evaluate the effectiveness and feasibility of functional movement screen (FMS) evaluation system and individualized intervention measures in preventing military training injuries.

METHODS: A total of 420 recruits from a unit of the People’s Liberation Army of China were included as the research object. According to random grouping method, they were divided into observation group (Group A) and control group (Group B), with 210 patients in each group. Before recruit training, individual FMS was performed, and functional correction training was performed in the observation group according to the test scores, while no intervention measures were applied in the control group. After 3 months of training, the tests were repeated. Age, body mass index (BMI), and incidence of military training injuries were recorded during the training period.

RESULTS: There was no statistical difference between the two groups in age, BMI, FMS score before the training (P > .05). After receiving functional correction training, the FMS score of the Group A was higher than that of the Group B, and the difference was statistically significant (P < .05). The incidence of military training injury in Group A and Group B was 20.95% and 44.02%, respectively (P < .05), and the difference was statistically significant.

CONCLUSION: The evaluation system of FMS and individualized intervention measures are feasible and effective in predicting and reducing the occurrence of military training injuries.

PMID:34423506 | DOI:10.1002/1348-9585.12270

Oncologist. 2021 Aug 22. doi: 10.1002/onco.13949. Online ahead of print.

ABSTRACT

LESSONS LEARNED: Long-term safety of radium-223 with enzalutamide was confirmed in this clinical trial. PSA-PFS2 was prolonged with the combination compared with enzalutamide alone.

BACKGROUND: Previously, we showed the combination of radium-223 and enzalutamide to be safe and associated with improved efficacy based on a concomitant decline in serum bone metabolism markers compared with enzalutamide alone in a phase II trial of men with metastatic castration resistant prostate cancer (mCRPC) [1].

METHODS: Secondary endpoints were not included in our initial report, and we include them herein, after a median follow-up of 22 months. These objectives included long term safety, PSA progression-free survival (PFS), and radiographic progression-free survival ; PSA-PFS2 (time from start of protocol therapy to PSA progression on subsequent therapy); time to next subsequent therapy (TTNT); and overall survival (OS). Survival analysis and log-rank tests were performed using the R statistical package v.4.0.2 (https://www.r-project.org). Statistical significance was defined as p < .05.

RESULTS: Of 47 patients (median age, 68 years), 35 received the combination and 12 enzalutamide alone. After a median follow-up of 22 months, final safety results did not show any increase in fractures or other adverse events in the combination arm. PSA-PFS2 was significantly improved, and other efficacy parameters were numerically improved in the combination over the enzalutamide arm.

CONCLUSION: The combination of enzalutamide and radium-223 was found to be safe and associated with promising efficacy in men with mCRPC. These hypothesis-generating results portend well for the ongoing phase III PEACE-3 trial in this setting.

PMID:34423501 | DOI:10.1002/onco.13949