Nevin Manimala

Qual Life Res. 2021 Aug 3. doi: 10.1007/s11136-021-02964-5. Online ahead of print.

ABSTRACT

PURPOSE: The primary goal of this study was to compare the health-related quality of life (HRQoL) of people with lumbar radiculopathy to age- and sex-adjusted population norms. Additionally, it aimed to explore the associations between the HRQoL difference scores and measures related to pain cognitions, pain intensity, and endogenous nociceptive modulation.

METHODS: Using answers from the Short Form 36-item Health Survey and UK population norms, SF-6D difference scores were calculated. A one-sample t test was used to assess the SF-6D difference scores. Univariate and multivariate regression analyses were used to assess the associations between SF-6D difference scores and pain intensity [Visual Analogue Scale (VAS) for back and leg pain], pain cognitions [Pain Catastrophizing Scale (PCS), Tampa Scale for Kinesiophobia (TSK), Pain Vigilance and Awareness Questionnaire (PVAQ)], and correlates for endogenous nociceptive modulation using quantitative sensory testing.

RESULTS: One hundred and twenty people with lumbar radiculopathy scheduled for surgery were included in this study. The mean SF-6D difference score of – 0.26 [SD = 0.09] was found to be significantly less than 0 [95%CI: – 0.27 to – 0.24]. Univariate analyses showed a significant influence from PCS, TSK, and PVAQ on the SF-6D difference scores. The final multivariate regression model included PCS and PVAQ, with only PCS maintaining a statistically significant regression coefficient [b = – 0.002; 95% CI: – 0.004 to – 0.001].

CONCLUSION: People diagnosed with lumbar radiculopathy report significantly lower HRQoL scores when compared with age- and sex-adjusted UK norm values. Even though all examined pain cognitions were found to have a significant association, pain catastrophizing showed the most significant relation to the SF-6D difference scores.

CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov Identifier No. NCT02630732. Date of registration: November 25, 2015.

PMID:34342846 | DOI:10.1007/s11136-021-02964-5

Intern Emerg Med. 2021 Aug 3. doi: 10.1007/s11739-021-02811-y. Online ahead of print.

ABSTRACT

Medication reconciliation based on complete medication histories has been introduced to minimize medication errors and its associated healthcare costs in the transitions of care. In this study, to evaluate the routine process of medication reconciliation in an academic medical center, medication history taken at the time of admission by physicians and the first order prescribed in the hospital was compared to a comprehensive reconciliation form filled by a pharmacist using direct interview of the patients and caregivers, patient’s insurance records and medication packages they brought from home. Two hundred and fifty-seven patients admitted in the internal wards of an academic medical center between June and September 2019 were investigated. In 6% of the patients, drug history was not included in the medical history form. Other patients were using 8.59 drugs in average, with a mean of 3.55 medication discrepancies in the history-taking process. Most commonly occurring errors were drug omissions (2.23 per patient on average) and incorrect frequency (0.96 per patient on average). There was a mean of 0.7 potentially harmful discrepancies for each patient. The mean number of drug discrepancies in new prescriptions from the hospital was 1.25, and almost half of patients had a potentially harmful discrepancies reordered in the hospital. There was no statistically meaningful relationship between patients’ gender, physicians’ gender, or the time of history taking and the total number of medication errors. History of ischemic heart disease was significantly associated with higher number of medication errors (p = 0.05). The results suggest that the medication reconciliation process in this academic center is inefficient. Using a systematic approach in medication reconciliation and gathering the best possible medication history, with a pharmacist who has better understanding of drugs’ potential interactions and harmful errors can improve this process and prevent such errors in the future.

PMID:34342787 | DOI:10.1007/s11739-021-02811-y

J Thromb Thrombolysis. 2021 Aug 3. doi: 10.1007/s11239-021-02541-0. Online ahead of print.

ABSTRACT

Changes in coagulation system during pregnancy have been put forth as risk factors for cerebral venous sinus thrombosis (CVT), yet we still have limited knowledge on markers for predicting the risk of CVT in pregnant women. Therefore, we aimed to investigate the significance of vitamin D (VD) levels and C-reactive protein (CRP)/albumin ratio (CAR), an inflammation marker, as risk factors for CVT in pregnant women. 23 pregnant women who were followed up for CVT, 26 healthy pregnant women who had no pregnancy complications, and 31 non-pregnant fertile women were included in the study. CAR and VD levels were compared between groups. CAR was significantly higher in the pregnant CVT group compared to the other two groups (p < 0.001). CAR was also significantly higher in the healthy pregnant group than the non-pregnant fertile group (p < 0.001). VD levels were determined to be statistically significantly lower in the pregnant CVT group compared to the other two groups (p < 0.001). However, VD levels did not significantly differ between healthy pregnant group and non-pregnant fertile group (p > 0.05). We found no significant correlation between CAR and VD levels in any of the three groups. Pregnant women with CVT were found to have a high rate of severe VD deficiency. Low VD levels and high CAR levels in pregnant women may be associated with an increased risk of CVT.

PMID:34342785 | DOI:10.1007/s11239-021-02541-0

J Egypt Public Health Assoc. 2021 Aug 3;96(1):23. doi: 10.1186/s42506-021-00086-x.

ABSTRACT

BACKGROUND: Out-of-pocket (OOP) health expenditure is a pressing issue in Egypt and far exceeds half of Egypt’s total health spending, threatening the economic viability, and long-term sustainability of Egyptian households. Targeting households at risk of catastrophic health payments based on their characteristics is an obvious pathway to mitigate the impoverishing impacts of OOP health payments on livelihoods. This study was conducted to identify the risk factors of incurring catastrophic health payments hoping to formulate appropriate policies to protect households against financial catastrophes.

METHODS: Using data derived from the Egyptian Household Income, Expenditure, and Consumption Survey (HIECS), a multiplicative heteroskedastic probit model is applied to account for heteroskedasticity and avoid biased and inconsistent estimates.

RESULTS: Accounting for heteroskedasticity induces notable differences in marginal effects and demonstrates that the impact of some core variables is underestimated and insignificant and in the opposite direction in the homoscedastic probit model. Moreover, our results demonstrate the principal factors besides health status and socioeconomic characteristics responsible for incurring catastrophic health expenditure, such as the use of health services provided by the private sector, which has a dramatic effect on encountering catastrophic health payments.

CONCLUSIONS: The marked differences between estimates of probit and heteroskedastic probit models emphasize the importance of investigating homoscedasticity assumption to avoid policies based on incorrect evidence. Many policies can be built upon our findings, such as enhancing the role of social health insurances in rural areas, expanding health coverage for poor households and chronically ill household heads, and providing adequate financial coverage for households with a high proportion of elderly, sick members, and females. Also, there is an urgent need to limit OOP health payments absorbed by private sector to achieve an acceptable level of fair financing.

PMID:34342779 | DOI:10.1186/s42506-021-00086-x

Lasers Med Sci. 2021 Aug 3. doi: 10.1007/s10103-021-03391-1. Online ahead of print.

ABSTRACT

Conventional therapies have aimed to try to help individuals suffering with dentine hypersensitivity (DH/DHS). A relatively new approach, laser therapy claims to be beneficial while having immediate and long-lasting effect. Therefore, our analysis aims to explore the immediate and 1-month efficacy of near-infrared laser (NIR) therapy in treating dentinal hypersensitivity. A systematic literature search conducted in databases, and analysis was undertaken utilizing a meta-analysis approach. Randomized controlled clinical trials comparing near-infrared lasers and placebo/no treatment in patients (> 18 years) were included. The risk of bias for included studies was assessed using Cochrane RoB tool (for randomized studies). Random effects meta-analyses model of standardized mean differences and 95% confidence intervals were performed using RevMan 5.4 software. A comprehensive electronic and manual search yielded a total of 1081 potential articles. Following the implementation of the inclusion and exclusion criteria, a total of 6 studies were included in the analysis. Near-infrared laser therapy led to statistical significant reduction in immediate and 1-month follow-up VAS (visual analog scale) scores compared to placebo/no treatment (p < 0.05). Statistical heterogeneity across the studies was high (I²-96%). The findings suggest that near-infrared laser therapy does have a significant immediate effect in reducing dentine hypersensitivity compared to placebo/no treatment. Furthermore, this effect is not diminished and endured at 1-month follow-up.

PMID:34342772 | DOI:10.1007/s10103-021-03391-1

Breast Cancer Res Treat. 2021 Aug 3. doi: 10.1007/s10549-021-06341-1. Online ahead of print.

ABSTRACT

PURPOSE: Studies that report equivalent oncologic outcomes of sentinel lymph node biopsy (SLNB) alone versus axillary lymph node dissection (ALND) for T1-2N1mi breast cancers are heavily weighted with patients who received breast-conserving surgery (BCS). The impact of omitting ALND in N1mi patients treated with mastectomy is not well studied. It is also unknown if these patients would benefit from post-mastectomy radiotherapy (PMRT). This study reports the outcomes of patients with T1-2N1mi breast cancer treated by mastectomy without axillary therapy.

METHODS: Patients who had T1-2N1mi breast cancer and underwent mastectomy from January 1998 to December 2018 were identified from our multi-institutional prospective database. Axillary recurrence rate (ARR), disease-free survival (DFS), and overall survival (OS) are reported.

RESULTS: 260 patients with pT1-2N1mi breast cancer who had mastectomy were identified. They had either SLNB (35.4%) or ALND (64.6%). Majority of these patients received adjuvant systemic therapy (93.8%). 77 (29.6%) patients received radiotherapy, 31 after SLNB and 46 after ALND. At median follow-up of 61 months, ARR was 1.1% (n = 1) in the SLNB only group, vs. 0.6% (n = 1) in the ALND group (p = 0.752). DFS and OS were not significantly different between patients with SLNB alone versus ALND (p = 0.40 and p = 0.27, respectively). Among 92 patients who had SLNB only, no DFS or OS difference was observed with the use of PMRT.

CONCLUSION: In T1-2N1mi patients with mastectomy and SLNB, axillary recurrences were rare. No statistically significant differences were noted between patients with SLNB, ALND, or PMRT. Our findings suggest that these patients may be safely treated without axillary therapy.

PMID:34342766 | DOI:10.1007/s10549-021-06341-1

Clin Rheumatol. 2021 Aug 3. doi: 10.1007/s10067-021-05870-w. Online ahead of print.

ABSTRACT

INTRODUCTION/OBJECTIVE: Antineutrophil cytoplasmic antibodies (ANCA) serology can aid in the diagnosis and classification of ANCA-associated vasculitides (AAV). However, it is often ordered in patients without clinical manifestations of vasculitis. In this retrospective chart review, we aim to better understand the clinical practices on ANCA testing.

METHODS: We retrospectively reviewed patients’ charts for the indications and diagnostic outcomes of ANCA tests. All ANCA tests ordered at two Canadian hospitals (a community hospital and an academic tertiary hospital) between January and December 2016 were included in the study. Descriptive statistics are used.

RESULTS: A total of 302 ANCA tests were included. The majority (n = 198, 65.6%) were ordered without an indication for testing. For those patients with at least 1 clinical manifestation of AAV (n = 104), 25% were ANCA positive and 18.3% resulted in a diagnosis of AAV. In comparison, among those without a clinical manifestation of AAV (n = 198), only 1.5% were ANCA positive and none was diagnosed with AAV. All patients diagnosed with AAV had at least 1 indication for ANCA testing. The three most common clinical presentations in patients with a final diagnosis of AAV were glomerulonephritis (81.8%), pulmonary hemorrhage (45.5%), and multiple lung nodules (31.8%).

CONCLUSION: To our knowledge, this is the first study that evaluates patients with both positive and negative ANCA test results in an inpatient setting. We demonstrated a low rate of ANCA positivity and AAV diagnosis in patients without clinical manifestations of AAV. Overall, there is a high rate of ANCA testing without an indication at our academic institution. This over-testing may be curbed by strategies such as a gating policy, culture changes, and clinician education. Key Points • AAV is a clinical-pathological diagnosis, and despite the usefulness of ANCA testing, it does not confirm nor rule out AAV. • ANCA testing for the diagnosis of AAV is generally only indicated when there is a clear manifestation of AAV. • Although patients with AAV may occasionally present without classic signs and symptoms, the diagnostic utility of ANCA serology in this setting is low, and testing is more likely to result in a false-positive or false-negative test. • If clinical suspicion remains high despite negative ANCA testing, clinicians should seek consultation with a rheumatologist.

PMID:34342740 | DOI:10.1007/s10067-021-05870-w

Eur J Orthop Surg Traumatol. 2021 Aug 3. doi: 10.1007/s00590-021-03058-1. Online ahead of print.

ABSTRACT

PURPOSE: Gastrocnemius flaps provide reliable reconstructive solutions to soft-tissue loss of the knee and proximal tibia following orthopedic procedures. While this technique has been used and studied, little is known about its prophylactic application. Single-stage and delayed approaches were compared with respect to the timing of débridement, complications, and relationship between microorganisms and complications.

METHODS: Gastrocnemius flaps for soft-tissue defects of the knee joint were retrospectively reviewed. Success of the flap procedure was defined as a healed soft-tissue envelope, no evidence of infection, a good blood supply to the flap, and adherence of the flap to its bed. Independent sample t test was used to compare the corresponding parameters (level of statistical significance was 0.05).

RESULTS: Of 43 flaps (43 patients), 18 were performed during a single-stage procedure along with the orthopedic procedure and 25 were delayed. Success of the single-stage (100%) and delayed flaps (88%) was not significantly different (p = 0.083). Complication rate did not differ significantly for single-stage (11%) and delayed flaps (24%) (p = 0.272). We were unable to establish a relationship between complications and microorganisms.

CONCLUSION: Results indicate both approaches are reliable. Single-stage gastrocnemius flaps may eliminate the need for a second surgery.

LEVEL OF EVIDENCE: Level III (Therapeutic, Retrospective cohort).

PMID:34342731 | DOI:10.1007/s00590-021-03058-1

Acta Neurochir (Wien). 2021 Aug 3. doi: 10.1007/s00701-021-04931-y. Online ahead of print.

ABSTRACT

BACKGROUND: In the aging society, many patients with movement disorders, pain syndromes, or psychiatric disorders who are candidates for deep brain stimulation (DBS) surgery suffer also from cardiovascular co-morbidities that require chronic antiplatelet or anticoagulation treatment. Because of a presumed increased risk of intracranial hemorrhage during or after surgery and limited knowledge about perioperative management, chronic antiplatelet or anticoagulation treatment often has been considered a relative contraindication for DBS. Here, we evaluate whether or not there is an increased risk for intracranial hemorrhage or thromboembolic complications in patients on chronic treatment (paused for surgery or bridged with subcutaneous heparin) as compared to those without.

METHODS: Out of a series of 465 patients undergoing functional stereotactic neurosurgery, 34 patients were identified who were on chronic treatment before and after receiving DBS. In patients with antiplatelet treatment, medication was stopped in the perioperative period. In patients with vitamin K antagonists or novel oral anticoagulants (NOACs), heparin was used for bridging. All patients had postoperative stereotactic CT scans, and were followed up for 1 year after surgery.

RESULTS: In patients on chronic antiplatelet or anticoagulation treatment, intracranial hemorrhage occurred in 2/34 (5.9%) DBS surgeries, whereas the rate of intracranial hemorrhage was 15/431 (3.5%) in those without, which was statistically not significant. Implantable pulse generator pocket hematomas were seen in 2/34 (5.9%) surgeries in patients on chronic treatment and in 4/426 (0.9%) without. There were only 2 instances of thromboembolic complications which both occurred in patients without chronic treatment. There were no hemorrhagic complications during follow-up for 1 year.

CONCLUSIONS: DBS surgery in patients on chronic antiplatelet or anticoagulation treatment is feasible. Also, there was no increased risk of hemorrhage in the first year of follow-up after DBS surgery. Appropriate patient selection and standardized perioperative management are necessary to reduce the risk of intracranial hemorrhage and thromboembolic complications.

PMID:34342730 | DOI:10.1007/s00701-021-04931-y

Curr Oncol Rep. 2021 Aug 3;23(10):117. doi: 10.1007/s11912-021-01110-1.

ABSTRACT

PURPOSE OF REVIEW: This review aims to clarify the current role of minimally invasive surgery in the treatment of rectal cancer, highlighting short- and long-term outcomes from the latest trials and studies.

RECENT FINDINGS: Data from previous trials has been conflicting, with some failing to demonstrate non-inferiority of laparoscopic surgical resection of rectal cancer compared to an open approach and others demonstrating similar clinical outcomes. Robot-assisted surgery was thought to be a promising solution to the challenges faced by laparoscopic surgery, and even though the only randomized controlled trial to date comparing these two techniques did not show superiority of robot-assisted surgery over laparoscopy, more recent retrospective data suggests a statistically significant higher negative circumferential resection margin rate, decreased frequency of conversion to open, and less sexual and urinary complications. Minimally invasive surgery techniques for resection of rectal cancer, particularly robot-assisted, offer clear short-term peri-operative benefits over an open approach; however, current data has yet to display non-inferiority in terms of oncological outcomes.

PMID:34342706 | DOI:10.1007/s11912-021-01110-1