Nevin Manimala

J Paediatr Child Health. 2021 Jul 5. doi: 10.1111/jpc.15639. Online ahead of print.

ABSTRACT

AIMS: To assess the outcomes of an early oxygen saturation screening programme in apparently healthy newborns for the detection of cardiac and non-cardiac disease. To describe the aetiology and incidence of infants with oxygen saturations <95% in the first 6 h of life and describe the management to discharge. In addition, we sought to identify any risk factors for failed early saturations.

METHODS: This is a retrospective hospital cohort assessing outcomes of an early saturation screening programme performed in apparently healthy newborns. Infants with oxygen saturations less than 95% were identified and their clinical notes were hand-searched. Descriptive statistics were used to present demographics, proportion of infants who passed or failed screening, subsequent diagnoses and short-term outcome. Multivariate logistic regression was used to identify independent associations of clinical factors (birthweight, gestation, elective caesarean section and gender) with failed screening.

RESULTS: Between 2014 and 2019, 14 956 healthy newborns were assessed within the first 6 h, 94 (0.63%) failed the early saturation screen. The most common causes for saturation <95% were respiratory disease or delayed transition. There were 31 (33%) infants admitted to the NICU with an additional baby requiring emergency transfer to a cardiac centre. Infants were 28 times more likely to have saturations <95% if born by elective caesarean section (odds ratio 28, conflict of interest (18.54-42.82)).

CONCLUSION: In apparently healthy newborns, early assessment of oxygen saturation, combined with clinical assessment and subsequent intervention can identify important conditions and should be considered as standard care.

PMID:34223680 | DOI:10.1111/jpc.15639

J Magn Reson Imaging. 2021 Jul 5. doi: 10.1002/jmri.27803. Online ahead of print.

ABSTRACT

BACKGROUND: Diffusion weighted imaging (DWI) is fundamental for prostate cancer (PCa) detection with MRI; however, limited by susceptibility artifact from hip prosthesis.

PURPOSE: To evaluate image quality and ability to detect PCa with quantitative T2-mapping and DWI in men with hip prosthesis undergoing prostate MRI.

STUDY TYPE: Prospective, cross-sectional study.

POPULATION: Thirty consecutive men with hip replacement (18 unilateral, 12 bilateral) undergoing prostate MRI from 2019 to 2021.

FIELD STRENGTH/SEQUENCE: 3-T; multiparametric MRI (T2W, DCE-MRI, echo-planar [EPI]-DWI), T2-mapping (Carr-Purcell-Meiboom-Gill), FOCUS-EPI-DWI, PROPELLER-DWI.

ASSESSMENT: Five blinded radiologists independently evaluated MRI image quality using a 5-point Likert scale. PI-RADS v2.1 scores were applied in four interpretation strategies: 1) T2W-FSE+DCE-MRI+EPI-DWI, 2) T2W-FSE+DCE-MRI+EPI-DWI+FOCUS-EPI-DWI, 3) T2W-FSE+DCE-MRI+EPI-DWI+PROPELLER-DWI, 4) T2W-FSE+DCE-MRI+EPI-DWI+T2-maps. Five-point confidence scores were recorded.

STATISTICAL ANALYSIS: ANOVA, Kruskal-Wallis with pair-wise comparisons by Wilcoxon sign-rank, and paired t-tests, P < 0.05 was considered significant. Cohen’s Kappa (k) for PI-RADSv2.1 scoring and proportion of correctly classified lesions tabulated for pathology-confirmed cases with 95% confidence intervals (CIs).

RESULTS: For all radiologists, T2-map image quality was significantly higher than EPI-DWI, FOCUS-EPI-DWI, and PROPELLER-DWI and similar (P = 0.146-0.706) or significantly better (for two readers) than T2W-FSE and DCE-MRI. PI-RADS v2.1 agreement improved comparing strategy A (k = 0.46) to strategy B (k = 0.58) to strategy C (k = 0.58) and was highest with strategy D which included T2-maps (k = 1.00). Radiologists’ confidence was significantly highest with strategy D. Strategies B and C had similar confidence (P = 0.051-0.063) both significantly outperforming strategy A. Twelve men with 17 lesions had pathology confirmed diagnoses (13 PCa, 4 benign). Strategy D had the highest proportion of correctly classified lesions (76.5-82.4%) with overlapping 95% confidence intervals.

DATA CONCLUSION: T2-mapping may be a valuable adjunct to prostate MRI in men with hip replacement resulting in improved image quality, higher reader confidence, interobserver agreement, and accuracy in PI-RADS scoring.

LEVEL OF EVIDENCE: 1 TECHNICAL EFFICACY STAGE: 2.

PMID:34223675 | DOI:10.1002/jmri.27803

J Clin Nurs. 2021 Jul 5. doi: 10.1111/jocn.15854. Online ahead of print.

ABSTRACT

AIMS AND OBJECTIVES: This study aimed to measure the frequency of spiritual needs, identify the factors associated with these needs among Korean and American persons living with an advance chronic illness and compare them from a cross-cultural perspective.

BACKGROUND: Persons with serious or life-limiting illnesses often have spiritual needs. Unmet spiritual needs are associated with poor well-being and threaten psychological health. Little is known about how specific spiritual needs vary across cultures.

DESIGN: A quantitative, cross-sectional, observational cross-cultural comparison was undertaken.

METHODS: The study has been prepared in accordance with the STROBE guidelines. Convenience sampling was used to recruit participants from outpatient clinics in South Korea and Southern California (N = 202). Spiritual needs were measured using the Spiritual Interests Related to Illness Tool (SpIRIT); demographic and illness-related variables were also assessed using paper-and-pencil questionnaires. Data were analysed using various parametric statistical tests, including multiple regression analysis.

RESULTS: The findings quantify the intensity and types of spiritual needs that persons living with an advanced chronic illness experience. Furthermore, they show how the spiritual needs of religiously diverse samples of South Koreans and Americans differ. The findings also indicate that self-reported spirituality and religiosity independently explain a substantial amount of the variance in spiritual needs.

CONCLUSIONS: In both the samples, spiritual needs were reported and associated with spirituality and religiosity. Although all the eight domains of spiritual needs assessed by the SpIRIT were pertinent to the Korean and American samples, they were prioritised differently.

RELEVANCE TO CLINICAL PRACTICE: Screening patients to ascertain how important spirituality or religiosity is to them may help clinicians focus their in-depth assessments on those who report high levels of spirituality or religiosity because these patients may experience the strongest spiritual needs. The SpIRIT shows promise as a measure of diverse spiritual needs.

PMID:34223672 | DOI:10.1111/jocn.15854

J Genet Couns. 2021 Jul 5. doi: 10.1002/jgc4.1457. Online ahead of print.

ABSTRACT

The objective of this study was to assess the level of interest in preconception carrier screening among reproductive-aged persons presenting for gynecologic care and to identify demographic factors predictive of pursuing screening. Patients aged 18-40 who were presenting for gynecologic care at a single U.S. academic medical center were provided with information about current options for preconception carrier screening and were offered genetic counseling referral with the possibility to undergo screening. Outcomes of interest were desire for genetic counseling referral and attendance at genetic counseling visit. Statistical analyses were performed as appropriate using R version 3.6.1 with variables significant at 0.1 included in a multivariable logistic regression. Of 193 participants, 79 (41%) desired genetic counseling referral. Participants aged 25-34 (OR 3.39, 95% CI 1.47-8.10) and nulliparas (OR 2.69, 95% CI 1.23-6.03) were more likely to desire referral. Thirty-five participants (44.3% of those who desired referral) attended a visit with genetic counseling. Having an advanced degree (OR 3.27, 95% CI 1.06-10.4) was associated with visit attendance. Thirteen participants underwent screening, and five were found to be a carrier of at least one X-linked or autosomal recessive condition. Surprisingly, presenting for a gynecologic visit directly related to planning a pregnancy was not associated with increased interest in preconception carrier screening. Nulliparas and those aged 25-34 likely expressed greater interest in referral due to high potential for future childbearing in these groups. The increased level of visit attendance in participants with advanced degrees is likely confounded by the high level of health literacy and financial resources in this group.

PMID:34223670 | DOI:10.1002/jgc4.1457

J Vet Intern Med. 2021 Jul 5. doi: 10.1111/jvim.16205. Online ahead of print.

ABSTRACT

BACKGROUND: In dogs, antiepileptic drugs (AED) cause lethargy but quantitative data regarding the effects of AED on activity levels are not available, and little is known about how AEDs affect sleep quality.

OBJECTIVE: To quantitatively compare activity levels and nocturnal activity in dogs previously diagnosed with idiopathic epilepsy (IE) receiving AEDs compared to age- and breed-matched control dogs.

ANIMALS: Sixty-two dogs with IE and 310 control dogs.

METHODS: This is a 3-month prospective parallel observational study. An activity monitoring device for dogs was used to measure daily activity levels and sleep scores in all dogs.

RESULTS: Dogs with IE treated with AEDs had an 18% average lower baseline activity level compared to control dogs (P = .005; point estimate = 0.82, 95% confidence interval [CI], 0.75-0.90). The combination of phenobarbital and potassium bromide (KBr) was associated with an average 28% decrease in activity in dogs with IE compared to control dogs (P = .03; point estimate = 0.72; CI, 0.62-0.82). Mean sleep scores were not significantly different in dogs with IE receiving AEDs compared to control dogs (P = .43). However, higher dosages of KBr were associated with lower sleep scores (P = .01).

CONCLUSIONS: Dogs with IE receiving AEDs have lower activity levels, but no difference in sleep scores, compared to controls. The combination of phenobarbital and KBr had the largest decrease in activity between groups. Higher doses of KBr may affect nocturnal activity in epileptic dogs.

PMID:34223667 | DOI:10.1111/jvim.16205

J Genet Couns. 2021 Jul 5. doi: 10.1002/jgc4.1443. Online ahead of print.

ABSTRACT

Lack of consistent insurance coverage for genetic counseling services billed under Current Procedural Terminology (CPT) code 96040 creates a barrier for access to this service. This retrospective study examined coverage and reimbursement for reproductive genetic counseling encounters billed under CPT code 96040 as a professional fee over an eight-year period at Rutgers Robert Wood Johnson Medical School, a regional perinatal center in New Jersey, a state requiring licensure. Descriptive statistics were tabulated to assess the disparity between Medicare/Medicaid, Managed Care Medicaid, and commercial insurance payers, including how often encounters were covered and if reimbursed, at what percentage of the amount billed. A comparison of individual plan types (Health Maintenance Organization, Point of Service, and Preferred Provider Organization) was carried out. Overall trends in reimbursement were assessed across payers. The study found 61% of 60-min encounters billed to Medicare/Medicaid, Managed Care Medicaid, and commercial insurance payers received coverage. Of all covered 60-min encounters billed to Managed Care Medicaid and commercial insurance payers, an average of 36% of the amount billed was reimbursed. Medicare/Medicaid encounters were never reimbursed. Commercial insurance covered 65% of encounters billed but this varied between payers. Across all payers, an overall downward trend of reimbursement was demonstrated over the eight-year period. Lack of consistent service coverage creates a barrier and patients cannot universally access genetic counseling services. Steps to improve coverage need to include passing of legislation, notably the next bill to replace the former H.R. 3235, ‘Access to Genetic Counselor Services Act of 2019’ and provisions within third-party payers that allow for credentialing of genetic counseling providers.

PMID:34223664 | DOI:10.1002/jgc4.1443

Risk Anal. 2021 Jul 5. doi: 10.1111/risa.13781. Online ahead of print.

ABSTRACT

Several reports in India indicate hospitals and quarantined centers are COVID-19 hotspots. To study the transmission occurring from the hospitals and as well as from the community, we developed a mechanistic model with a lockdown effect. Using daily COVID-19 cases data from six states and overall India, we estimated several important parameters of our model. Moreover, we provided an estimation of the effective (R_T ), the basic (R₀ ), the community (R_C ), and the hospital (R_H ) reproduction numbers. We forecast COVID-19 notified cases from May 3, 2020, till May 20, 2020, under five different lockdown scenarios in the seven locations. Our analysis suggests that 65% to 99% of the new COVID-19 cases are currently asymptomatic in those locations. Besides, about 1-16% of the total COVID-19 transmission are currently occurring from hospital-based contact and these percentage can increase up to 69% in some locations. Furthermore, the hospital-based transmission rate (β₂ ) has significant positive (0.65 to 0.8) and negative (-0.58 to -0.23) correlation with R₀ and the effectiveness of lockdown, respectively. Therefore, a much larger COVID-19 outbreak may trigger from the hospital-based transmission. In most of the locations, model forecast from May 3, 2020, till May 20, 2020, indicates a two-times increase in cumulative cases in comparison to total observed cases up to April 29, 2020. Based on our results, we proposed a containment policy that may reduce the threat of a larger COVID-19 outbreak in the future.

PMID:34223651 | DOI:10.1111/risa.13781

Phys Chem Chem Phys. 2021 Jul 5. doi: 10.1039/d1cp00652e. Online ahead of print.

ABSTRACT

Accurate calculation of absorption spectra of aqueous NO2- requires rigorously sampling the quantum potential energy surfaces for microsolvation of NO2- with at least five explicit water molecules and embedding the resulting clusters in a continuum solvent accounting for the statistical weighted contributions of individual isomers. This method, which we address as ASCEC + PCM, introduces several desired features when compared against MD simulations derived QM/MM spectra: comparatively fewer explicit solvent molecules to be treated with expensive QM methods, the identification of equilibrium structures in the quantum PES to be used in further vibrational spectroscopy, and the unequivocal identification of cluster orbitals undergoing electronic transitions and charge transfer that originate the spectral bands.

PMID:34223573 | DOI:10.1039/d1cp00652e

Neurotrauma Rep. 2020 Sep 18;1(1):78-87. doi: 10.1089/neur.2020.0027. eCollection 2020.

ABSTRACT

Convincing clinical evidence exists to support early surgical decompression in the setting of cervical spinal cord injury (SCI). However, clinical evidence on the effect of early surgery in patients with thoracic and thoracolumbar (from T1 to L1 [T1-L1]) SCI is lacking and a critical knowledge gap remains. This randomized controlled trial (RCT) sought to evaluate the safety and efficacy of early (<24 h) compared with late (24-72 h) decompressive surgery after T1-L1 SCI. From 2010 to 2018, patients (≥16 years of age) with acute T1-L1 SCI presenting to a single trauma center were randomized to receive either early (<24 h) or late (24-72 h) surgical decompression. The primary outcome was an ordinal change in American Spinal Injury Association (ASIA) Impairment Scale (AIS) grade at 12-month follow-up. Secondary outcomes included complications and change in ASIA motor score (AMS) at 12 months. Outcome assessors were blinded to treatment assignment. Of 73 individuals whose treatment followed the study protocol, 37 received early surgery and 36 underwent late surgery. The mean age was 29.74 ± 11.4 years. In the early group 45.9% of patients and in the late group 33.3% of patients had a ≥1-grade improvement in AIS (odds ratio [OR] 1.70, 95% confidence interval [CI]: 0.66-4.39, p = 0.271); significantly more patients in the early (24.3%) than late (5.6%) surgery group had a ≥2-grade improvement in AIS (OR 5.46, 95% CI: 1.09-27.38, p = 0.025). There was no statistically significant difference in the secondary outcome measures. Surgical decompression within 24 h of acute traumatic T1-L1 SCI is safe and is associated with improved neurological outcome, defined as at least a 2-grade improvement in AIS at 12 months.

PMID:34223533 | PMC:PMC8240887 | DOI:10.1089/neur.2020.0027

Palliat Med Rep. 2020 Nov 24;1(1):280-290. doi: 10.1089/pmr.2020.0086. eCollection 2020.

ABSTRACT

Background/Objectives: The serious illness conversation (SIC) is an evidence-based framework for conversations with patients about a serious illness diagnosis. The objective of our study was to develop and validate a novel tool, the SIC-evaluation exercise (SIC-Ex), to facilitate assessment of resident-led conversations with oncology patients. Design: We developed the SIC-Ex based on SIC and on the Royal College of Canada Medical Oncology milestones. Seven resident trainees and 10 evaluators were recruited. Each trainee conducted an SIC with a patient, which was videotaped. The evaluators watched the videos and evaluated each trainee by using the novel SIC-Ex and the reference Calgary-Cambridge guide (CCG) at months zero and three. We used Kane’s validity framework to assess validity. Results: Intra-class correlation using average SIC-Ex scores showed a moderate level of inter-evaluator agreement (range 0.523-0.822). Most evaluators rated a particular resident similar to the group average, except for one to two evaluator outliers in each domain. Test-retest reliability showed a moderate level of consistency among SIC-Ex scores at months zero and three. Global rating at zero and three months showed fair to good/very good inter-evaluator correlation. Pearson correlation coefficients comparing total SIC-Ex and CCG scores were high for most evaluators. Self-scores by trainees did not correlate well with scores by evaluators. Conclusions: SIC-Ex is the first assessment tool that provides evidence for incorporating the SIG guide framework for evaluation of resident competence. SIC-Ex is conceptually related to, but more specific than, CCG in evaluating serious illness conversation skills.

PMID:34223487 | PMC:PMC8241377 | DOI:10.1089/pmr.2020.0086