Nevin Manimala

Nurse Educ Today. 2022 Apr 6;113:105361. doi: 10.1016/j.nedt.2022.105361. Online ahead of print.

ABSTRACT

BACKGROUND: Hemorrhage is a frequent complication that nurses and midwives must recognize and manage to avoid life-threatening consequences for patients. There is currently no synthesis of evidence on educational interventions in nursing and midwifery regarding hemorrhage, thus limiting the definition of best practices.

OBJECTIVE: To map the literature on nursing and midwifery education regarding the recognition and management of hemorrhage.

DESIGN: Scoping review based on the Joanna Briggs Institute guidelines.

DATA SOURCES: Quantitative studies evaluating the effect of educational interventions with students, nurses, or midwives published in English or French, with no time limit.

REVIEW METHODS: Study selection, data extraction, and quality assessment were conducted by two independent reviewers. We characterized educational interventions based on the Guideline for Reporting Evidence-Based Practice Educational Interventions and Teaching. We categorized learning outcomes using the New World Kirkpatrick Model. Methodological quality appraisal was performed with tools from the Joanna Briggs Institute. Findings were synthesized using descriptive statistics and graphical methods RESULT: Most of the 38 studies used a single-group design (n = 26, 68%) and were conducted with professionals (n = 28, 74%) in hospital settings (n = 20, 53%). Most were of low (n = 14; 37%) or moderate (n = 18, 47%) methodological quality. Most interventions focused on postpartum hemorrhage (n = 34, 89%) and combined two or more teaching strategies (n = 25, 66%), often pairing an informational segment (e.g., lecture, readings) with a practical session (e.g., workshop, simulation). Learning outcomes related to the management (n = 27; 71%) and recognition of hemorrhage (n = 19, 50%), as well as results for patients and organizations (n = 9, 24%).

CONCLUSION: Considerable heterogeneity in interventions and learning outcomes precluded conducting a systematic review of effectiveness. High-quality, controlled studies are needed, particularly in surgery and trauma. Reflection on the contribution of nurses and midwives to the detection, monitoring, and management of hemorrhage could enrich the content and expected outcomes of hemorrhage education.

PMID:35429750 | DOI:10.1016/j.nedt.2022.105361

J Pharm Biomed Anal. 2022 Mar 30;215:114737. doi: 10.1016/j.jpba.2022.114737. Online ahead of print.

ABSTRACT

Acute exacerbation of pediatric asthma (AEPA) has always been one of the most common reasons for children to visit the emergency department, whereas unified diagnostic criteria in the clinic are lacking. The purpose of this study was to determine potential biomarkers, and provide a basis for predictive and diagnostics AEPA. Urine samples were collected from 40 pediatric patients, including 19 patients with AEPA (PA) and 21 healthy controls (HCs). The samples were analyzed by high-performance liquid chromatography-quadrupole orbitrap mass spectrometry (HPLC-Q-Orbitrap-MS), and the data were statistically analyzed by principal component analysis (PCA), partial least squares discriminant analysis (PLS-DA) and orthogonal partial least squares discriminant analysis (OPLS-DA). Differential metabolites were selected by VIP (variable importance for the projection) > 1, and a p value ≤ 0.05 was used as the standard. The corresponding metabolic pathways of differential metabolites were subjected to analysis by the KEGG database, and further analysis and characterization of differential metabolites were conducted through the HMDB database. A total of 26 potential biomarkers were selected, of which 17 were found to be associated with respiratory diseases. Nine metabolites with obvious fluctuations in patients with AEPA, such as 13-L-hydroperoxylinoleic acid, gentisate aldehyde, L-3-phenyllactic acid, hydrocinnamic acid, and gentisic acid, could be used as potential biomarkers to further explore the prediction and diagnosis of AEPA for the first time. The contents of 3 potential biomarkers showed a positive correlation. Abnormalities in seven metabolic pathways, such as phenylalanine metabolism, tyrosine metabolism and beta-alanine metabolism, are also related to AEPA. This study further confirmed the reliability of this method to detect differences in urine metabolites of patients with AEPA. By monitoring the content of these 26 potential biomarkers and their related metabolic pathways, it provides a basis for further effective prediction and diagnosis of AEPA to avoid further development of this disease.

PMID:35429725 | DOI:10.1016/j.jpba.2022.114737

Clin Microbiol Infect. 2022 Apr 13:S1198-743X(22)00208-7. doi: 10.1016/j.cmi.2022.03.041. Online ahead of print.

ABSTRACT

BACKGROUND: Precision dosing programs are promising tools for optimising antimicrobial dosing. Selecting the ideal program for local application may be challenging due to the large variety of available programs with differing characteristics.

AIMS: The objectives of this study were to systematically identify available precision dosing software programs to optimise antimicrobial dosing and describe the characteristics of each program. Details on the ability of programs to provide beta-lactam dosing support was also gathered.

SOURCES: A systematic review search strategy was used to identify candidate software programs described in the literature in Embase and PubMed. A detailed survey was then developed to identify characteristics of programs, including details on the underlying methodology driving dosing software recommendations, interface characteristics, costs and regulatory affairs. Software developers from all identified programs were invited to participate in the survey.

CONTENT: The systematic search results identified 18 programs. Fifteen developers responded to the survey (83%) and 11 programs provide dosing support for at least one beta-lactam. Fourteen programs can utilise measured drug concentrations to generate dosing recommendations, with 13 able to generate empiric dosing recommendations. Six programs integrate with local electronic health records and four are registered with at least one regulatory agency. Pharmacokinetic models in combination with Bayesian statistics is the most common methodology used to generate dosing recommendations, with 14 programs utilising this method.

IMPLICATION: There was significant variability in the available antimicrobial profiles and characteristics among dosing software programs. As healthcare providers will differ in their requirements within their local settings, clinicians should use these findings to identify potential candidate programs and, if feasible, trial these to ensure they meet their specific requirements.

PMID:35429656 | DOI:10.1016/j.cmi.2022.03.041

Heart Rhythm. 2022 Apr 13:S1547-5271(22)01884-7. doi: 10.1016/j.hrthm.2022.04.006. Online ahead of print.

ABSTRACT

BACKGROUND: Individuals with patent foramen ovale (PFO) routinely undergo transcatheter closure (TC) for secondary prevention of recurrent stroke. However, there has been some evidence suggesting that TC may increase the risk of new-onset atrial fibrillation (AF).

OBJECTIVE: To evaluate the risk of new-onset AF following PFO closure and to explore predictors of AF development.

METHODS: We created a retrospective cohort of all Ontarians over 18-years of age who received TC between October 2002 and December 2017 using administrative health data and the CorHealth cardiac registry. A Poisson regression determined event rates of AF and secondary outcomes such as stroke and mortality per 1,000 person-years. A multivariable Cox proportional hazards model identified predictors of new-onset AF following TC.

RESULTS: Of 1,533 patients, 96 (6.26%) developed new-onset AF following PFO closure, over an average follow-up time of 8.2 years. Age >60 years (HR =2.82; CI:1,76-4.51; p < 0.001) and diabetes (HR=2.49; CI:1.48-4.18; p <0.001) were statistically significant, independent predictors of AF according to the Cox model.

CONCLUSIONS: The incidence of new-onset AF after PFO closure was relatively low. Having diabetes and age > 60 years were the most important factors associated with new-onset AF in this population.

PMID:35429648 | DOI:10.1016/j.hrthm.2022.04.006

Brain Behav. 2022 Apr 16:e32586. doi: 10.1002/brb3.2586. Online ahead of print.

ABSTRACT

INTRODUCTION: The coronavirus disease of the 2019 (COVID-19) pandemic has created a sense of fear due to uncertainties in medical students’ personal and professional lives. Medical education is challenging and poses a more significant academic and emotional rigor when compared with other professional programs. With the COVID-19 having limited treatment options, health literacy (HL) is crucial for managing and responding to the pandemic. This research aims to examine the impact of HL on COVID-19-associated fear among Iranian medical students.

METHODS: A cross-sectional study was conducted measuring the HL and fear of COVID-19 using validated scales. Two hundred and seventy-eight survey responses were received and analyzed descriptively by using SPSS software inferential statistics.

RESULTS: Mean age of participants was 22.93 ± 5.427 years. The correlation between students’ total health literacy (HELIA) scores and their fear of COVID-19 (FCV-19S) scores was -0.279 (p value = .019). The FCV-19S has a negative correlation with total HELIA in the group of females and males, single and married people, bachelor and MD students, and students living in rural areas and urban areas. The negative correlation of FCV-19S with total HELIA in males and students who reside in rural areas was the only one that was not significant. In associate degree students, the correlation between FCV-19S and total HELIA was positive but not significant. Education grades had a significant impact on FCV-19S. Furthermore, the place of residence also had a significant impact on FCV-19S. However, the gender and marital status did not significantly impact FCV-19S.

CONCLUSIONS: The present study showed that students with higher HL scores had lesser fear of COVID-19. The key stakeholders require several positive strategies to reduce fear and improve health, and such vital policies will assist in improving the students’ health and achieving the sustainable developmental goals.

PMID:35429408 | DOI:10.1002/brb3.2586

Brain Behav. 2022 Apr 16:e2576. doi: 10.1002/brb3.2576. Online ahead of print.

ABSTRACT

BACKGROUND: There are gaps in our neurobiological understanding of functional movement disorder (FMD).

OBJECTIVES: We investigated gray matter volumetric profiles in FMD, and related findings to resting-state functional connectivity (rsFC) profiles using Human Connectome Project data.

METHODS: Volumetric differences between 53 FMD patients and 50 controls were examined, as well as relationships between individual differences in FMD symptom severity and volumetric profiles. Atrophy network mapping was also used to probe whether FMD-related structural alterations preferentially impacted brain areas with dense rsFC.

RESULTS: Compared to controls without neurological comorbidities (albeit with mild depression and anxiety as a group), the FMD cohort did not show any volumetric differences. Across patients with FMD, individual differences in symptom severity negatively correlated with right supramarginal and bilateral superior temporal gyri volumes. These findings remained significant adjusting for FMD subtype or antidepressant use, but did not remain statistically significant adjusting for depression and anxiety scores. Symptom severity-related structural alterations mapped onto regions with dense rsFC-identifying several disease epicenters in default mode, ventral attention, and salience networks.

CONCLUSIONS: This study supports that FMD is a multinetwork disorder with an important role for the temporoparietal junction and its related connectivity in the pathophysiology of this condition. More research is needed to explore the intersection of functional neurological symptoms and mood.

PMID:35429407 | DOI:10.1002/brb3.2576

J Infect Dis. 2022 Apr 16:jiac136. doi: 10.1093/infdis/jiac136. Online ahead of print.

ABSTRACT

INTRODUCTION: This study aims to examine the worldwide prevalence of post COVID-19 condition, through a systematic review and meta-analysis.

METHODS: PubMed, Embase, and iSearch were searched on July 5, 2021 with verification extending to March 13, 2022. Using a random effects framework with DerSimonian-Laird estimator, we meta-analyzed post COVID-19 condition prevalence at 28+ days from infection.

RESULTS: 50 studies were included, and 41 were meta-analyzed. Global estimated pooled prevalence of post COVID-19 condition was 0.43 (95% CI: 0.39,0.46). Hospitalized and non-hospitalized patients have estimates of 0.54 (95% CI: 0.44,0.63) and 0.34 (95% CI: 0.25,0.46), respectively. Regional prevalence estimates were Asia- 0.51 (95% CI: 0.37,0.65), Europe- 0.44 (95% CI: 0.32,0.56), and North America- 0.31 (95% CI: 0.21,0.43). Global prevalence for 30, 60, 90, and 120 days after infection were estimated to be 0.37 (95% CI: 0.26,0.49), 0.25 (95% CI: 0.15,0.38), 0.32 (95% CI: 0.14,0.57) and 0.49 (95% CI: 0.40,0.59), respectively. Fatigue was the most common symptom reported with a prevalence of 0.23 (95% CI: 0.17,0.30), followed by memory problems (0.14 [95% CI: 0.10,0.19]).

DISCUSSION: This study finds post COVID-19 condition prevalence is substantial; the health effects of COVID-19 appear to be prolonged and can exert stress on the healthcare system.

PMID:35429399 | DOI:10.1093/infdis/jiac136

J Clin Endocrinol Metab. 2022 Apr 16:dgac233. doi: 10.1210/clinem/dgac233. Online ahead of print.

ABSTRACT

PURPOSE: People characterized as late chronotype have elevated type 2 diabetes and cardiovascular disease risk compared to early chronotype. It is unclear how chronotype is associated with insulin sensitivity, metabolic flexibility, or plasma TCA cycle intermediates concentration, amino acids (AA), and/or beta-oxidation.

METHODS: The Morning-Eveningness Questionnaire (MEQ) was used to classify adults with metabolic syndrome (ATP III Criteria) as either early (n=15 (13F), MEQ = 64.7±1.4) or late (n=19 (16F), MEQ = 45.5±1.3) chronotype. Fasting bloods determined hepatic (HOMA-IR) and adipose insulin resistance (Adipose-IR) while a 120 min euglycemic clamp (40 mU/m 2/min, 5 mmoL/L) was performed to test peripheral insulin sensitivity (glucose infusion rate (GIR)). Carbohydrate (CHOOX) and fat oxidation (FOX) as well as non-oxidative glucose disposal (NOGD) were also estimated (indirect calorimetry). Plasma TCA intermediates, AA, and acyl-carnitines were measured along with VO2max and body composition (DXA).

RESULTS: There were no statistical differences in age, BMI, fat-free mass, VO2max or ATP III criteria between groups. Early chronotype, however, had higher peripheral insulin sensitivity (P=0.009) and lower HOMA-IR (P=0.02) and Adipose-IR (P=0.05) compared to late chronotype. Further, early chronotype had higher NOGD (P=0.008) and greater insulin-stimulated CHOOX (P=0.02). While fasting lactate (P=0.01), TCA intermediates (isocitrate, ꭤ-ketoglutarate, succinate, fumarate, malate (all P≤0.04)) and some AA (proline, isoleucine (P=0.003-0.05)) were lower in early chronotype, other AA (threonine, histidine, arginine (all P≤0.05)) and most acyl-carnitines were higher (P≤0.05) compared to late chronotype.

CONCLUSIONS: Greater insulin sensitivity and metabolic flexibility relates to plasma TCA concentration in early chronotype.

PMID:35429387 | DOI:10.1210/clinem/dgac233

Liver Transpl. 2022 Apr 16. doi: 10.1002/lt.26482. Online ahead of print.

ABSTRACT

Excellent short-term survival after paediatric liver transplantation has shifted attention toward the optimization of long-term outcomes. Despite considerable progress in imaging and other non-invasive modalities, liver biopsies continue to be required to monitor allograft health and to titrate immunosuppression. However, a standardized approach to the detailed assessment of long-term graft histology is currently lacking. The aim of this study was to formulate a list of histopathological features relevant for the assessment of long-surviving liver allograft health and to develop an approach for assessing the presence and severity of these features in a standardised manner. Whole slide digital images from 31 biopsies obtained ≥ 4 years post-transplant to determine eligibility for an immunosuppression withdrawal trial were selected to illustrate a range of typical histopathological findings seen in children with clinically stable grafts, including those associated with alloantibodies. Fifty histological features were independently assessed and, where appropriate, scored semi-quantitatively by 6 pathologists to determine inter- and intra-observer reproducibility of the histopathological features using unweighted and weighted kappa statistics; the latter metric enabled distinction between minor and major disagreements in parameter severity scoring. Weighted inter-observer kappa statistics showed a high level of agreement for various parameters of inflammation, interface activity, fibrosis, and microvascular injury. Intra-observer agreement for these features was even more substantial. The results of this study will help to standardize the assessment of biopsies from long-surviving liver allografts, aid the recognition of important histological features and facilitate international comparisons and clinical trials aiming to improve outcomes for children undergoing liver transplantation.

PMID:35429359 | DOI:10.1002/lt.26482

Int J Cancer. 2022 Apr 16. doi: 10.1002/ijc.34031. Online ahead of print.

ABSTRACT

We analyzed long-term incidence trends in liver cancer (including hepatocellular carcinoma and intrahepatic cholangiocarcinoma) with an aim to interpret the changes in terms of known risk factors and hypothesize that historical exposure to Thorotrast, a radiographic contrast medium emitting alpha particles, has changed population rates. The NORDCAN database was used to collect cancer registry data from Denmark (DK), Finland (FI), Norway (NO) and Sweden (SE), which we used from 1953 (DK, FI, NO) and 1960(SE) through 2019. Thorotrast, which caused a 100-fold risk of liver cancer was used in DK and SE, and probably also in FI between 1930 and 1950, but not in NO. The incidence trend for liver cancer showed a broad maximum at around 1980, most prominent and statistically significant in SE and DK men and women, and in all countries a a steadily increasing trend towards the end of follow-up. Incidence for NO was lower than for the other countries and the rates showed no peaking at around 1980. Birth cohort analysis identified a transient risk which could be dated to a period between 1930 and 1950 in countries other than NO. Considering a lag time between Thorotrast use and liver cancer appearance, the large incidence peak around 1980 in DK and DE was probably contributed by Thorotrast but considering the ecological nature of the findings, the association should be considered cautiously as hypothesis generating. The late increase in liver cancer risk is most likely life-style related and largely preventable.

PMID:35429352 | DOI:10.1002/ijc.34031