Nevin Manimala

Nurs Open. 2022 Mar 27. doi: 10.1002/nop2.1200. Online ahead of print.

ABSTRACT

AIMS AND OBJECTIVES: The aim of this study was to investigate the prevalence, emotional and follow-up burden of insulin injection-related needle-stick injuries among clinical nurses.

BACKGROUND: needle-stick injures introduce statistically significant occupational hazards to healthcare workers. Although the large proportion of the needles injuries attributed to insulin injection, research evidence about the prevalence, emotional and follow-up burden of such injures is lacking.

DESIGN: Cross-sectional study.

METHODS: 5389 nurses were recruited from 45 hospitals in Shaanxi, China, from November 2018 to July 2019. Participants were administrated with a questionnaire specifically developed for this study. Descriptive statistics were used to present the findings.

RESULTS: All 5,389 nurses responded to the survey, of which 396 (7.4%) participants experienced 620 insulin injection-related needle-stick injuries in the past year, representing an annual prevalence of 115.0 per 1000 nurses. The annual prevalence of infection caused by the injuries was 18.7 per 1000 nurses. The injuries occurred most frequently when nurses were recapping the needle (42.4%). In the majority (98.4%) of the injuries, the hurt nurses took proper immediate actions. However, only 30.3% of nurses reported the injuries to the administrative staff, and in 43.2% of the injuries, the nurses refused or discontinued the suggested follow-up. A large proportion (58.6%) of the hurt nurses experienced emotional changes. Multivariate logistic regression showed that department, removing and/or setting back needle caps with bare hands, frequency of insulin pen and syringes are associated with the incidence of insulin injection-related needle-stick injuries. This paper is reported following the STROBE recommendations.

CONCLUSIONS: This survey demonstrated a considerably high prevalence of insulin injection-related needle-stick injuries among clinical nurses. Even though the majority of the hurt nurses took proper immediate actions, a large quantity of them failed to report the accidents to the administrative staff and complete the suggested follow-up. Nurses who suffered from insulin injection-related needle-stick injuries were subject to various negative emotional changes. It portends a statistically significant risk to occupational health management for nurses.

RELEVANCE TO CLINICAL PRACTICE: Scientific preventive and management strategies are desirable in order to minimize the consequences of insulin injection-related needle-stick injuries.

PMID:35343081 | DOI:10.1002/nop2.1200

Orthop Surg. 2022 Mar 27. doi: 10.1111/os.13251. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the clinical outcomes of the treatment of unilateral unstable sacral fractures by fixation with the posterior INFIX (posterior pelvic ring screw-rod internal fxation).

METHODS: Data of 60 patients with unilateral unstable sacral fractures who underwent surgery from March 2013 to March 2020 were retrospectively analyzed according to the selection criteria. All patients were associated with anterior pelvic ring injuries, and the operations were performed by the same team of surgeons. According to the different types of internal fixation, the patients were divided into two groups, which both included 30 patients: the posterior INFIX group and iliosacral screw fixation group. The demographic and clinical data of the two patient groups, such as age, sex, sacral fracture types based on the Denis classification, operation time, amount of intraoperative bleeding, intraoperative fluoros copy time, Majeed pelvic score at final follow-up, and quality of fracture reduction based on Mears and Velyvis’s imaging classification criteria were collected by the same researcher and compared statistically.

RESULTS: All patients were continuously followed up for 23.17 ± 3.34 months (range, 12 to 46 months). All sacral fractures healed with an average healing time of 9.3 ± 2.24 months (range, 6 to 18 months). None of the patients had re-displacement of the fracture or fixation failure. Compared to the iliosacral screw group, the posterior INFIX group patients had more intraoperative bleeding (t = 3.59, P < 0.001), shorter operation time (t = 4.49, P < 0.001), and shorter intraoperative fluoroscopy time (t = 6.26, P < 0.001). There were no statistical differences between the two groups in terms of age, sex, fracture type, Majeed score, and quality of fracture reduction (P > 0.05). In the posterior INFIX group, one patient had a superficial wound infection and one patient complained of discomfort due to a prominent fixation. In the iliosacral screw fixation group, one patient had intraoperative iatrogenic S1 nerve injury and vessel injury. The posterior INFIX fixation was a simpler manipulation with higher safety, shorter time of operation and intraoperative fluoroscopy, and similar clinical outcomes compared to iliosacral screw fixation.

CONCLUSION: For the treatment of unilateral unstable sacral fractures, the posterior INFIX fixation can be recommended in clinic application.

PMID:35343061 | DOI:10.1111/os.13251

Liver Int. 2022 Mar 27. doi: 10.1111/liv.15261. Online ahead of print.

ABSTRACT

BACKGROUND & AIMS: We used real-world data to evaluate the efficacy and safety of tenofovir alafenamide (TAF) compared with tenofovir disoproxil fumarate (TDF) in treatment-naïve patients with CHB.

METHODS: We analyzed 2,747 patients with CHB under TAF (n=502) or TDF (n=2,245) treatments. Virological responses (VR: HBV DNA <15 IU/mL), on-treatment ALT normalization, the incidence of HCC, renal function, and lipid profiles were compared between these groups. Propensity score matching of 495 pairs was conducted for these comparisons.

RESULTS: The mean age of the total cohort was 48.6 years and 58.2% of the subjects were male. Cirrhosis had a 33.3% prevalence in the population. VRs at 12-, 24-, and 36 months were achieved in 70.3%, 81.2%, and 83.3% of the TAF and 67.9%, 84.3% and 86.1% in the TDF cases, respectively (P>0.05 for all). Normalized ALT, as determined by local laboratory criteria (<40 U/L), occurred in 79.7%, 90.6%, and 86.2% of TAF the group and 78.2%, 85.8%, and 85.7% of the TDF group at 12-, 24-, and 36 months, respectively (P>0.05 for all). The HCC risk did not statistically differ across the entire cohort or in the PS-matched cohort. The TAF group showed a lower median increase in serum creatinine from baseline during the early study period. Compared with the TAF, the TDF group showed significant decreases in total cholesterol, triglyceride, and HDL, but not in LDL.

CONCLUSIONS: Real-word data indicate that TAF has comparable efficacies to TDF in terms of VR and ALT normalization, with no higher risk of HCC.

PMID:35343041 | DOI:10.1111/liv.15261

J Nurs Manag. 2022 Mar 27. doi: 10.1111/jonm.13606. Online ahead of print.

ABSTRACT

AIM: To investigate the perceived empowerment and turnover intention of middle nurse managers before and after the implementation of a major reform of the healthcare system in Cyprus, which also includes the transition of public hospitals towards administrative and financial autonomy.

BACKGROUND: The empowerment of Nurse Managers is important since previous studies have shown that it is associated with performance at work and may have an impact on their turnover intention.

METHODS: This is a repeated cross-sectional study, which was conducted in March 2019 (first phase) and was repeated in March 2020 (second phase), after the introduction of major changes. The target population was all nurse managers of the public hospitals. The final sample consisted of 175 (RR 94%) participants in the first phase and 178 (RR 95.6%) in the second.

RESULTS: Measurements at both time points revealed moderate levels of perceived empowerment among Cyprus Nurse Managers. Empowerment appeared slightly lower at the repeat measurement compared to the first, but the observed difference was not statistically significant. Among the categories of empowerment «opportunities» was presenting statistically significant differences between the two phases. At the second phase, mean scores of empowerment were consistently lower among those who stated YES compared to those who stated NO in relation to: a) the intention to change department, b) the intention to change profession and c) the intention to change organization/hospital.

CONCLUSIONS: This study demonstrated lower levels of empowerment among Nurse Managers with turnover intentions. It is therefore needed to be investigated further whether lower empowerment levels are the main reason for turnover intentions. It also suggests the need for senior management to create opportunities and to develop and implement interventions which aim to maintain and further improve the empowerment of the Nurse Managers and assess their effectiveness in terms of turnover intention in the organization.

IMPLICATIONS FOR NURSING POLICY: The senior management of the hospitals need to adopt retention strategies by establishing an empowered positive working environment for Nurse Managers. Nurse Managers need to collaborate with the senior management and seek more access to opportunities, information, support and resources which will enable them to perform their duties with efficiency and be more effective.

PMID:35343017 | DOI:10.1111/jonm.13606

J Magn Reson Imaging. 2022 Mar 27. doi: 10.1002/jmri.28174. Online ahead of print.

ABSTRACT

BACKGROUND: Methods for accurate quantification of lung fluid in heart failure (HF) are needed. Dynamic contrast-enhanced (DCE)-MRI may be an appropriate modality.

PURPOSE: DCE-MRI evaluation of fraction of fluid volume in the interstitial lung space (v_e ) and vascular permeability (K^trans ).

STUDY TYPE: Prospective, single-center method validation.

POPULATION: Seventeen evaluable healthy volunteers (HVs), 12 participants with HF, and 3 with acute decompensated HF (ADHF).

FIELD STRENGTH/SEQUENCE: T₁ mapping (spoiled gradient echo variable flip angle acquisition) followed by dynamic series (three-dimensional spoiled gradient-recalled echo acquisitions [constant echo time, repetition time, and flip angle at 1.5 T]).

ASSESSMENT: Three whole-chest scans were acquired: baseline (Session 1), 1-week later (Session 2), following exercise (Session 3). Extended Tofts model quantified v_e and K^trans (voxel-wise basis); total lung median measures were extracted and fitted via repeat measure analysis of variance (ANOVA) model. Patient tolerability of the scanning protocol was assessed.

STATISTICAL TESTS: This was constructed as an experimental medicine study.

PRIMARY ENDPOINTS: K^trans and v_e at baseline (HV vs. HF), change in K^trans and v_e following exercise, and following lung congestion resolution (ADHF). K^trans and v_e were fitted separately using ANOVA. Secondary endpoint: repeatability, that is, within-participant variability in v_e and K^trans between sessions (coefficient of variation estimated via mixed effects model).

RESULTS: There was no significant difference in mean K^trans between HF and HV (P ≤ 0.17): 0.2216 minutes^-1 and 0.2353 minutes^-1 (Session 1), 0.2044 minutes^-1 and 0.2567 minutes^-1 (Session 2), 0.1841 minutes^-1 and 0.2108 minutes^-1 (Session 3), respectively. v_e was greater in the HF group (all scans, P ≤ 0.02). Results were repeatable between Sessions 1 and 2; mean values for HF and HV were 0.4946 and 0.3346 (Session 1), 0.4353 and 0.3205 (Session 2), respectively. There was minimal difference in K^trans or v_e between scans for participants with ADHF (small population precluded significance testing). Scanning was well tolerated.

DATA CONCLUSION: While no differences were detected in K^trans , v_e was greater in chronic HF patients vs. HV, augmented beyond plasma and intracellular volume. DCE-MRI is a valuable diagnostic and physiologic tool to evaluate changes in fluid volume in the interstitial lung space associated with symptomatic HF.

LEVEL OF EVIDENCE: 2 TECHNICAL EFFICACY STAGE: 2.

PMID:35343008 | DOI:10.1002/jmri.28174

Hippocampus. 2022 Mar 28. doi: 10.1002/hipo.23417. Online ahead of print.

ABSTRACT

Preconditioning is a mechanism in which injuries induced by non-lethal hypoxia or seizures trigger cellular resistance to subsequent events. Norwood et al., in a 2010 study, showed that an 8-h-long period of electrical stimulation of the perforant pathway in rats is required for the induction of hippocampal sclerosis. However, in order to avoid generalized seizures, status epilepticus (SE), and death, a state of resistance to seizures must be induced in the hippocampus by a preconditioning paradigm consisting of two daily 30-min stimulation periods. Due to the importance of the subiculum in the hippocampal formation, this study aims to investigate differential gene expression patterns in the dorsal and ventral subiculum using RNA-sequencing, after induction of a preconditioning protocol by electrical stimulation of the perforant pathway. The dorsal (dSub) and ventral (vSub) subiculum regions were collected by laser-microdissection 24 h after preconditioning protocol induction in rats. RNA sequencing was performed in a Hiseq 4000 platform, reads were aligned using the STAR and DESEq2 statistics package was used to estimate gene expression. We identified 1176 differentially expressed genes comparing control to preconditioned subiculum regions, 204 genes were differentially expressed in dSub and 972 in vSub. The gene ontology enrichment analysis showed that the most significant common enrichment pathway considering up-regulated genes in dSub and vSub was steroid metabolism. In contrast, the most significant enrichment pathway considering down-regulated genes in vSub was axon guidance. Our results indicate that preconditioning induces changes in the expression of genes related to synaptic reorganization, increased cholesterol metabolism, and astrogliosis in both dSub and vSub. Both regions also presented a decrease in the expression of genes related to glutamatergic transmission and an increase in expression of genes related to complement system activation and GABAergic transmission. The down-regulation of proapoptotic and axon guidance genes in the ventral subiculum suggests that preconditioning may induce a neuroprotective environment in this region.

PMID:35343006 | DOI:10.1002/hipo.23417

J Oral Rehabil. 2022 Mar 28. doi: 10.1111/joor.13325. Online ahead of print.

ABSTRACT

OBJECTIVE: The literature on orofacial myofunctional therapy (OMT) in children and adults with obstructive sleep apnea (OSA) was systematically reviewed to investigate the effects of OMT on patients with OSA by age and disease severity to verify the effect of OMT on OSA.

DATA SOURCES: All the comparative literature was retrieved from the PubMed, Embase, and Cochrane libraries.

METHOD: We searched the articles published up to February 12, 2022 and followed the preferred reporting project for systematic review and meta-analysis of reports. The quality of the studies was evaluated using the Newcastle-Ottawa scale.

RESULTS: Of the primary indicators for evaluating OSA, 13 studies reported on the apnea index (AHI), showing a decrease in the mean standard deviation of AHI from before OMT to after OMT (P < 0.00001). The lowest oxygen saturation was reported in nine studies, and the mean standard deviation of the lowest oxygen saturation increased from before to after OMT (P = 0.0009). Ten studies reported the Epworth Sleepiness Scale (ESS), indicating that the mean standard deviation of the ESS decreased from before to after OMT (P < 0.00001). The subgroup analysis showed that the AHI scores indicating mild and moderate OSA were significantly reduced, and the AHI scores indicating severe OSA also decreased, but this was not statistically significant. The lowest oxygen saturation increased obviously in patients with both mild and moderate and severe OSA. Of the secondary indicators of OSA, there was a statistically significant improvement in snoring intensity (P = 0.0002).

CONCLUSION: Oral and facial muscular function therapy can be used as a simple and non-invasive new technique to improve the AHI, minimum oxygen saturation, ESS, and snoring intensity in patients with mild and moderate OSA and the lowest oxygen saturation in patients with severe OSA.

PMID:35342989 | DOI:10.1111/joor.13325

Echocardiography. 2022 Mar 27. doi: 10.1111/echo.15345. Online ahead of print.

ABSTRACT

BACKGROUND: Little data exist regarding interreader variability of diastolic measurements and their application by the 2016 American Society of Echocardiography left ventricular (LV) diastolic function guidelines.

METHODS: Volunteers (n = 49) were recruited from an outpatient cardiology practice. The presence and grade of diastology dysfunction (DD) was determined by the 2016 LV diastology guideline algorithm. We determined the mean, standard deviation, coefficient of variation, and intraclass correlation coefficient (ICC) for each measurement and Fleiss K-statistic to define differences in grading DD. We determined predictors associated with disagreement of DD grade using odds ratios.

RESULTS: The mean LVEF was 56%, LAVI 32 ml/m² , and peak TR velocity was 2.3 m/s. The ICC for mitral inflow and tissue Doppler velocities were >.90, for LV volumes were .80-.86, and for LA volume was .56. The Fleiss K-value for the agreement of the presence of DD was .68 and for DD grade was .59. Variables with increased odds of disagreement were (1) at least one reader considering a TR signal uninterpretable (OR 12.0; 95% CI 1.3-109.6), (2) at least one reader assessing both LVEF 50%-55% and LAVI 29-39 ml/m² (OR 9.3; 95% CI 1.0-87), and (3) at least one reader assessing LVEF 50-55% (OR 3.8; 95% CI 1.1-13.4).

CONCLUSIONS: Using the 2016 ASE/EACVI diastology guidelines, we found excellent interrater reliability of Doppler measurements, moderate-good interrater reliability of volumetric measurements, and moderate-good but not excellent agreement for diastology grade.

PMID:35342988 | DOI:10.1111/echo.15345

J Oral Rehabil. 2022 Mar 28. doi: 10.1111/joor.13320. Online ahead of print.

ABSTRACT

BACKGROUND: Conflicting results exist between somatosensory profiles of patients with temporomandibular myalgia (TMDm). The objective of this review was to examine whether adults with TMDm show altered responses to dynamic quantitative sensory tests compared with healthy controls.

METHODS: We searched five electronic databases for studies, excluding those without suitable controls or where TMDm was associated with confounding non-musculoskeletal disorders. Risk of bias was assessed with the SIGN case-control study checklist. Findings were structured around dynamic quantitative sensory tests and their localization. Where possible, we performed meta-analysis with a random inverse variance model to compare patients with TMDm and healthy controls. Statistical heterogeneity was estimated with Chi² test and inconsistency index, I².

RESULTS: We extracted data from 23 studies comprising 1284 adults with chronic TMDm and 2791 healthy controls. Risk of bias was assessed as high for 20 studies. Mechanical temporal summation, the most studied phenomenon (14 studies), is increased in the upper limb of patients with TMDm (SMD = .43; 95% CI: .11 to .75; p = .0001) but not in the jaw area (p = .09) or in the cervical area (p = .29). Very little evidence for altered thermal temporal summation (five studies), conditioned pain modulation (seven studies), exercise-induced hypoalgesia (two studies), placebo analgesia (two studies), stress-induced hypoalgesia (one study) and offset analgesia (one study) was found.

DISCUSSION: A major limitation of this review was the risk of bias of included studies. Future studies would benefit from following methodological guidelines and consideration of confounding factors.

PMID:35342987 | DOI:10.1111/joor.13320

Muscle Nerve. 2022 Mar 27. doi: 10.1002/mus.27539. Online ahead of print.

ABSTRACT

INTRODUCTION/AIMS: Guillain-Barré syndrome (GBS) is generally considered to be monophasic, but some patients experience recurrences. The purpose of this study was to clarify the possible link between thyroid parameters and recurrent GBS (RGBS) patients in China.

METHODS: This retrospective study enrolled patients who were admitted to the Department of Neurology of the First Affiliated Hospital of Zhengzhou University from 2014 to 2020 and fulfilled the diagnostic criteria of GBS or Miller Fisher syndrome (MFS). We evaluated clinical characteristics, cerebrospinal fluid (CSF) parameters, serum levels of thyroid-stimulating hormone (TSH), free thyroxine (FT4) and free triiodothyronine (FT3) in 320 individuals, including 302 with monophasic GBS and 18 with recurrent GBS.

RESULTS: Serum levels of TSH in monophasic GBS patients were significantly lower than those in RGBS patients (P<0.001), whereas FT3 levels were higher in the monophasic GBS group (P=0.022). Age at onset, incidence of antecedent illness, time from onset to nadir, proportion of acute inflammatory demyelinating polyradiculoneuropathy (AIDP), and Hughes Functional Grading Scale (HFGS) at nadir were statistically significant between monophasic GBS patients and RGBS patients (P<0.05). The multivariate regression analysis revealed that antecedent illness, AIDP and high TSH were independent risk factors for RGBS. Our ROC curve analysis showed that the risk of recurrence in GBS patients increases when the TSH concentration is higher than 3.87uIU/mL.

DISCUSSION: Our results demonstrate an association between TSH and RGBS. Oxidative stress is one of the possible interpretations for this association.

PMID:35342963 | DOI:10.1002/mus.27539