Nevin Manimala

Int Angiol. 2022 Feb 3. doi: 10.23736/S0392-9590.22.04799-X. Online ahead of print.

ABSTRACT

BACKGROUND: Percutaneous endovascular aneurysm repair (PEVAR) is becoming increasingly popular due to fewer access-related complications, shorter procedural times and length of stay (LOS). Our aim was to explore factors associated with access-related complications and their impact on procedural time and LOS.

METHODS: We retrospectively analysed consecutive aorto-iliac endovascular procedures in a tertiary hub comprising 2 institutions and 18 consultant vascular surgeons and interventional radiologists between 2016 – 2017. Access-related complications were defined as: bleeding requiring cutdown or return to theatre, acute limb ischaemia or common femoral artery (CFA) pseudoaneurysm requiring intervention and wound infection or dehiscence needing hospitalization.

RESULTS: Of 511 patients, 354 (69%) had a percutaneous approach via 589 CFA access sites. In this percutaneous group, access-related complications occurred in 11% of sites (65/589); Their rate varied with procedure type ranging between 3.6% to 17.6%. The most common complication was bleeding due to closure device failure in 8.5% (50/589) of access sites. When uncomplicated, percutaneous interventions were faster compared to open surgical access (p<0.0001). Operation time and median LOS (3 vs. 2 days) were longer for elective standard EVAR patients experiencing access-related complications (p=0.033). In the percutaneous group, multivariate regression analysis demonstrated significant associations between accessrelated complications and eGFR (odds ratio (OR) 0.984 [0.972-0.997], p=0.014), CFA depth (OR 1.026 [1.008-1.045], p=0.005), device used (Prostar vs. Proglide (OR 2.177 [1.236-3.832], p=0.007) and procedural type (complex vs. standard EVAR) (OR 2.017 [1.122-3.627], p=0.019). We developed a risk score which had reasonably good predictive power (C-statistic 0.716 [0.646-0.787],p<0.0001) for avoiding access complications.

CONCLUSIONS: Physiological (low eGFR level), anatomical (increased CFA depth) and technical factors (choice of device and complex procedures) were identified as predictors of access-related complications in this large retrospective series. These are important for safe selection of patients that would benefit from percutaneous access.

PMID:35112825 | DOI:10.23736/S0392-9590.22.04799-X

J Sports Med Phys Fitness. 2022 Feb 3. doi: 10.23736/S0022-4707.22.13495-X. Online ahead of print.

ABSTRACT

BACKGROUND: The experiment tested the effect of non-contact boxing training on the frequency and timing of anticipatory postural adjustments (APAs) resulting from self-induced postural perturbations in healthy adults.

METHODS: The 8-week non-contact boxing intervention study involved 33 healthy adults between 18 and 27 years of age who had no boxing experience (control group = 17 participants, boxing group = 16 participants). Pretests and posttests utilized rapid bilateral arm raising as a focal movement to elicit APAs. EMG in the anterior deltoid, thoracic and lumbar erector spinae, semitendinosus and soleus muscles was recorded. The boxing group completed twenty 90-min non-contact boxing training sessions over 8 weeks, whereas the control group kept physical activity consistent during the intervention period.

RESULTS: Non-contact boxing training caused APAs to become more frequent during the focal movement, in comparison to the control group, in the soleus and also in the semitendinosus after an outlier was removed. Non-contact boxing training caused earlier APA onset during the focal movement, in comparison to the control group, in the lumbar erector spinae after an outlier was removed.

CONCLUSIONS: Non-contact boxing training had a modest positive effect on the frequency and timing of APAs resulting from self-induced postural perturbations in healthy adults.

PMID:35112818 | DOI:10.23736/S0022-4707.22.13495-X

Intern Med J. 2022 Feb 3. doi: 10.1111/imj.15707. Online ahead of print.

ABSTRACT

BACKGROUND: Hospitalisation provides an opportunity for medication review and deprescribing. Patient-reported experience measures (PREM) for deprescribing in older patients in-hospital are not well-described.

AIM: To pilot test and describe PREM for deprescribing in older patients, compare PREM by patient characteristics, and investigate patients’ awareness of medication changes on hospital discharge.

METHODS: This prospective, multicentre, observational cohort study at two tertiary hospitals in Sydney, Australia, evaluated the PREM questionnaire developed by the NSW Therapeutic Advisory Group. It was completed by patients (or their next of kin) recruited from acute geriatric medicine and orthogeriatric services. Association with nine patient characteristics was analysed using the chi-square test and multivariable regression. Awareness of medication changes and test-retest reliability were analysed using descriptive statistics.

RESULTS: Overall, 201 participants completed the questionnaire, with 170 eligible for analysis; 34/170 (20%) were aware of reduction or cessation of their usual medications on discharge and reported involvement in decision making and receiving enough information to reduce or stop one or more of their usual medications (positive PREM). Independent predictors of positive PREM included respondent (next of kin), hospital (Hospital 1), language (English), and specialty (acute geriatric medicine). Overall, 92 of 155 (59.4%) patients with medication changes were aware of those changes on hospital discharge.

CONCLUSIONS: These PREMs are a feasible tool to examine older patients’ experiences of deprescribing in-hospital and may be applied to evaluate interventions to improve awareness, shared decision making, and provision of information when deprescribing for older patients. This article is protected by copyright. All rights reserved.

PMID:35112777 | DOI:10.1111/imj.15707

Biom J. 2022 Feb 3. doi: 10.1002/bimj.202100077. Online ahead of print.

ABSTRACT

The wide-scale adoption of electronic health records (EHRs) provides extensive information to support precision medicine and personalized health care. In addition to structured EHRs, we leverage free-text clinical information extraction (IE) techniques to estimate optimal dynamic treatment regimes (DTRs), a sequence of decision rules that dictate how to individualize treatments to patients based on treatment and covariate history. The proposed IE of patient characteristics closely resembles “The clinical Text Analysis and Knowledge Extraction System” and employs named entity recognition, boundary detection, and negation annotation. It also utilizes regular expressions to extract numerical information. Combining the proposed IE with optimal DTR estimation, we extract derived patient characteristics and use tree-based reinforcement learning (T-RL) to estimate multistage optimal DTRs. IE significantly improved the estimation in counterfactual outcome models compared to using structured EHR data alone, which often include incomplete data, data entry errors, and other potentially unobserved risk factors. Moreover, including IE in optimal DTR estimation provides larger study cohorts and a broader pool of candidate tailoring variables. We demonstrate the performance of our proposed method via simulations and an application using clinical records to guide blood pressure control treatments among critically ill patients with severe acute hypertension. This joint estimation approach improves the accuracy of identifying the optimal treatment sequence by 14-24% compared to traditional inference without using IE, based on our simulations over various scenarios. In the blood pressure control application, we successfully extracted significant blood pressure predictors that are unobserved or partially missing from structured EHR.

PMID:35112726 | DOI:10.1002/bimj.202100077

Rev Esc Enferm USP. 2022 Jan 28;56:e20210249. doi: 10.1590/1980-220X-REEUSP-2021-0249. eCollection 2022.

ABSTRACT

OBJECTIVE: To identify factors related to tissue complications resulting from insulin therapy.

METHOD: This is a descriptive, cross-sectional study carried out in a capital of northeastern Brazil. A semi-structured form and an observation guide were applied to assess the performance of insulin preparation and administration techniques. Descriptive statistics, association test, and multivariate logistic regression were used for data analysis.

RESULTS: Most participants were female (74.2%), aged between 51 and 70 years (50.0%), and had nine to eleven years of education (36.7%). The presence of some type of local complication in 73.5% of the participants and the failure to rotate the injection sites in 82.3% are highlighted. Being single/widowed and not rotating insulin application sites were related to local complications and increased the chances of their occurrence by 3.51 and 6.70 times, respectively.

CONCLUSION: Marital status and nonrotation of injection site were related to the increased chances of tissue complications resulting from insulin therapy.

PMID:35112702 | DOI:10.1590/1980-220X-REEUSP-2021-0249

J Clin Sleep Med. 2022 Feb 4. doi: 10.5664/jcsm.9930. Online ahead of print.

ABSTRACT

STUDY OBJECTIVES: Chronic pain is associated with insomnia. The objective of this clinical study is to compare the efficacy and safety of different prescribed doses of zopiclone and clonidine; for the management of insomnia in patients with chronic pain.

METHODS: A prospective observational crossover study of 160 consenting adult patients who underwent pain management. For insomnia treatment, each patient ingested different prescribed doses of zopiclone or clonidine on alternate nights. Each patient used a special validated sleep diary to collect data including pain score, sleep scores, sleep duration, sleep medication dose, and adverse effects. Each patient completed the diary for 3 continuous weeks. Pain was measured using the numeric pain rating scale. Sleep score was measured using the Likert sleep scale. A change in the pain or sleep scores by 2-points was considered significant. Of the 160 study participants, 150 (93.8%) completed the study successfully; and their data were analyzed. Data were analyzed with IBM SPSS Statistics 25 (IBM Corp, Armonk, NY); using Student’s t-test, ANOVA, Pearson Chi-square test, and regression analysis. P-value <0.05 was considered significant.

RESULTS: Pain score was lower with clonidine than zopiclone (p=0.025). Time to fall asleep was shorter with clonidine than zopiclone (p=0.001). Feeling rested on waking in the morning was better with clonidine than zopiclone (p=0.015). Overall sleep quality was better with clonidine than zopiclone (p=0.015). Total Likert sleep score was better with clonidine than zopiclone (p=0.005). Total sleep duration was better with clonidine than zopiclone (p=0.013). Adverse effects were commoner with zopiclone; including collapse, fall, confusion, amnesia, mood disorder, hallucination, nightmare, nocturnal restlessness, locomotor dysfunction, hunger, nausea and headache. Minor adverse effect of dry mouth was commoner with clonidine.

CONCLUSIONS: Clonidine is significantly better than zopiclone regarding sleep quality, analgesia, tolerability profile, and patient safety. Further studies will be beneficial to compare clonidine with other insomnia medications.

PMID:35112665 | DOI:10.5664/jcsm.9930

Acta Otolaryngol. 2022 Feb 3:1-4. doi: 10.1080/00016489.2022.2030880. Online ahead of print.

ABSTRACT

Background: Malignant neoplasms (MNs) in the head and neck are occasionally hidden in deep neck infections (DNIs) that require emergency treatment, which potentially leads to delayed diagnosis of MNs.Objectives: This study aimed to identify predictive factors that can prevent delays in diagnosing MNs in patients with DNIs.Methods: We retrospectively analysed data from 83 patients admitted to our hospital who were diagnosed with DNIs.Results: Four patients (4.8%) had DNIs veiling MNs in the head and neck. Statistical analyses revealed a significant association (p = .0481) of platelet to albumin ratio (PAR; ≥ 98.9 × 10³) with hidden MNs in DNIs. Furthermore, concomitant cervical lymphadenopathy, especially multiple lymphadenopathies and excluding abscesses, was higher in patients with DNIs veiling MNs (p = .0142 and p = .0023, respectively).Conclusions and Significance: The PAR, which can be easily measured and readily detected, was a potential predictive factor. Moreover, performing fine-needle aspiration for lymphadenopathies could help diagnose hidden MNs in DNIs.

PMID:35112650 | DOI:10.1080/00016489.2022.2030880

Curr Med Res Opin. 2022 Feb 3:1-14. doi: 10.1080/03007995.2022.2037847. Online ahead of print.

ABSTRACT

BACKGROUND: Histamine 2 receptor antagonists (H2RA) are amongst the most entrenched antacid therapies available including over-the-counter. They have an excellent safety profile including no known teratogenic risk. Fracture risk is generally recognized with chronic proton pump inhibitor (PPI) therapy in adults and children although the related mechanism is poorly understood. The analogous risk in H2RAs, including in children, is unclear. We studied the fracture risk and characteristics among hospitalized pediatric patients exposed to H2RA compared to an untreated cohort.

METHODS: The Pediatric Health Information System (PHIS) multicenter database was queried for hospital encounters of children aged 6 months – 15.5 years and between 7/2016 – 8/2017. Patients with comorbidities and medications including PPI that predispose for fractures were excluded from the cohort and a propensity matched control was identified. The subjects and controls were followed for 2 years for hospitalization with a fracture diagnoses.

RESULTS: Our cohort included 3,526 patients with exposure to H2RA and matched controls. Fractures were reported in 1% of patients (67) with no statistical difference between the groups. Upper, then lower extremity fractures were the most common in both groups. Axial skeleton fractures were the least frequently encountered fractures among both groups.

CONCLUSION: H2RA exposure is not associated with an increased risk of fracture in hospitalized children exposed to H2RA when compared with a matched untreated cohort, further studies are needed to determine if long-term exposure to H2RA may be associated with fracture risk in both those with and without comorbidities or on fracture predisposing medication.What is known Histamine-2-receptor antagonists (H2RA) are amongst the most widely used acid suppression therapy in children.H2RA therapy is regarded as safe in children including infants.Fracture risk associated with proton pump inhibitor (PPI) therapy in children has not been adequately studied in children.What is new The incidence of fractures in children aged 6 months through 15.5 years followed for 2 years after H2RA therapy was not increased when compared to a matched controlUse of H2RA therapy is safer than PPI therapy with respect to fracture risk in children with no other risk factors.Further studies are needed to assess the association of long-term exposure to H2RA with fracture risk in children without predisposing risk for fracture.

PMID:35112645 | DOI:10.1080/03007995.2022.2037847

Scand J Clin Lab Invest. 2022 Feb 3:1-7. doi: 10.1080/00365513.2022.2034038. Online ahead of print.

ABSTRACT

BACKGROUND: Viscoelastic tests (rotational thromboelastometry, ROTEM^®), together with the implementation of a specific algorithm for coagulation management in cardiac surgery, enable perioperative coagulopathy to be better controlled.

METHODS: Retrospective cohort study including 675 patients who underwent cardiac surgery with cardiopulmonary bypass. The incidence of allogeneic blood transfusions and clinical postoperative complications were analyzed before and after ROTEM^® implementation.

RESULTS: Following viscoelastic testing and the implementation of a specific algorithm for coagulation management, the incidence of any allogeneic blood transfusion decreased (41.4% vs 31.9%, p = .026) during the perioperative period. In the group monitored with ROTEM^®, decreased incidence of transfusion was observed for packed red blood cells (31.3% vs 19.8%, p = .002), fresh frozen plasma (9.8% vs 3.8%, p = .008), prothrombin complex concentrate administration (0.9% vs 0.3%, p = .599) and activated recombinant factor VII (0.3% vs 0.0%, p = .603). Increased incidence was observed for platelet transfusion (4.8% vs 6.8%, p = .530) and fibrinogen concentrate (0.9% vs 3.5%, p = .066), tranexamic acid (0.0% vs 0.6%, p = .370) and protamine administration (0.6% vs 0.9%, p = .908). Similar results were observed in the postoperative period, but with a decreased incidence of platelet transfusion (4.8% vs 3.8%, p = .813). In addition, statistically significant reductions were detected in the incidence of postoperative bleeding (9.5% vs 5.3%, p = .037), surgical reexploration (6.0% vs 2.9%, p = .035), and length of Intensive Care Unit (ICU) stay (6.0 days vs 5.3 days, p = .026).

CONCLUSIONS: The monitoring of hemostasis by ROTEM^® in cardiac surgery, was associated with decreased incidence of allogeneic blood transfusion, clinical hematologic postoperative complications and lengths of ICU stay.

PMID:35112642 | DOI:10.1080/00365513.2022.2034038

Ann Saudi Med. 2022 Jan-Feb;42(1):8-16. doi: 10.5144/0256-4947.2022.8. Epub 2022 Feb 3.

ABSTRACT

BACKGROUND: Postoperative pulmonary complications in patients who undergo open heart surgery are serious life-threatening conditions. Few studies have investigated the potentially beneficial effects of preoperative physiotherapy in patients undergoing cardiac surgery.

OBJECTIVES: Assess the effects of preoperative chest physiotherapy on oxygenation and lung function in patients undergoing open heart surgery.

DESIGN: Randomized, controlled.

SETTING: University hospital.

PATIENTS AND METHODS: Patients with planned open heart surgery were randomly allocated into an intervention group of patients who underwent a preoperative home chest physiotherapy program for one week in addition to the traditional postoperative program and a control group who underwent only the traditional postoperative program. Lung function was assessed daily from the day before surgery until the seventh postoperative day.

MAIN OUTCOME MEASURES: Differences in measures of respiratory function and oxygen saturation. Length of postoperative hospital stay was a secondary outcome.

SAMPLE SIZE: 100 patients (46 in intervention group, 54 in control group).

RESULTS: Postoperative improvements in lung function and oxygen saturation in the intervention group were statistically significant compared with the control group. The intervention group also had a statistically significant shorter hospital stay (P<.01).

CONCLUSION: Preoperative chest physiotherapy is effective in improving respiratory function following open heart surgery.

LIMITATIONS: Relatively small number of patients.

CONFLICT OF INTEREST: None.

REGISTRATION: ClinicalTrials.gov (NCT04665024).

PMID:35112592 | DOI:10.5144/0256-4947.2022.8