Nevin Manimala

BJU Int. 2021 Jul 4. doi: 10.1111/bju.15539. Online ahead of print.

ABSTRACT

OBJECTIVES: To develop and test the psychometric properties of a concise, patient reported questionnaire, designed to assess key aspects of the radical cystectomy (RC) patient pathway that are important to both patients and clinicians.

SUBJECTS/PATIENTS AND METHODS: Draft items were developed by a consultation with a 13 member expert clinical panel, and the in-depth qualitative analysis of 14 semi-structured interviews with patients who had received RC within the previous eighteen months. A further 9 cognitive interviews with patients refined the items and ensured they were easy to complete. Pilot testing in 122 patients recruited from five hospitals in England tested the properties of validity and reliability of the resulting 17-item questionnaire.

RESULTS: Patients and clinicians identified the following aspects as important for the delivery of quality patient care. These included timely referral and initial test results; an explanation of risk/benefits of treatment; access to a cancer nurse specialist; training and support in stoma management; timely surgery, surgical complications, and timely follow-up. Pilot testing showed missing data was low (≤3% for all items), and between 73% and 89% of the responses to items were the most positive about their care (indicating ceiling effects). 5 items were identified using factor analysis as being statistically related (Cronbach’s alpha 0.76, ICC test-retest reliability of 0.95) and formed the scored part of the tool ‘care and support’, scored 0-16. There was insufficient evidence at this stage to show the tool was capable of measuring differences between cancer centres.

CONCLUSION: We have developed a questionnaire which captures aspects of quality of care within the cystectomy patient pathway. The results support the validity and reliability of the 17-item Cystectomy-Pathway Assessment Tool (C-PAT). We envisage the tool can be the basis for audit of the patient reported assessment of the quality of care for individual cancer centres.

PMID:34218507 | DOI:10.1111/bju.15539

Dermatol Ther. 2021 Jul 4:e15052. doi: 10.1111/dth.15052. Online ahead of print.

ABSTRACT

BACKGROUND: The aim of this study is analysis of time to relapse after discontinuation of biologic treatment and identification of factors associated with risk of relapse.

METHODS: The analysis used real-world data of 705 patients treated with biologic drugs (adalimumab, ustekinumab, infliximab and etanercept) in Poland in 2013-2019. Time to relapse was analysed by Kaplan-Meier estimator. Data was stratified by the number of prior relapses. Determinants of risk to relapse were analysed with Prentice-Williams-Peterson model.

RESULTS: Kaplan-Meier estimate of time to the first relapse was 276 days, to the second relapse was 246 days, to the third relapse was 218 days and to the fourth relapse was 178 days. In multidimensional analysis statistically significant variables affecting risk of relapse were the following: biologic naivety (hazard ratio (HR) 0.707), adalimumab (HR 0.787), PASI at the last follow-up visit (HR 1.049), abnormal hemoglobin level (HR 0.794) and abnormal lymphocyte counts (HR 1.278).

CONCLUSIONS: The findings of this study suggest that periods to relapse after discontinuation of biologic drugs become shorter with the number of prior relapses experienced by the patient. 95% of observed relapses occurred within 613 days of the end of the first treatment cycle, within 478 of the second cycle and within 351 days of the third cycle. This article is protected by copyright. All rights reserved.

PMID:34218502 | DOI:10.1111/dth.15052

Health Econ. 2021 Jul 3. doi: 10.1002/hec.4378. Online ahead of print.

ABSTRACT

We analyze the timing, magnitude, and income dependence of pharmaceutical panic buying around the outbreak of the COVID-19 pandemic in Hungary. We use district-level monthly and daily administrative data on detailed categories of pharmaceutical purchases, merge them to income statistics, and estimate multilevel panel models. Our main results are as follows. First, the days of therapy (DOT) of pharmaceutical purchases increased by more than 30% in March 2020, when major lockdown measures were announced. This pattern holds for almost all categories of pharmaceuticals. Second, shortly after the panic reactions, the aggregate amount of pharmaceutical purchases returned to their preshock levels; however, the frequency of pharmacy visits decreased. Third, the panic buying reaction was significantly stronger in richer geographical areas, where-according to the daily data-people also reacted earlier to the pandemic-related news. Overall, the results suggest that panic buying of pharmaceuticals can have detrimental effects on vulnerable populations.

PMID:34218496 | DOI:10.1002/hec.4378

J Genet Couns. 2021 Jul 3. doi: 10.1002/jgc4.1464. Online ahead of print.

ABSTRACT

Rubinstein-Taybi syndrome (RTS) is a rare genetic disorder. Family-centered care (FCC) is a healthcare delivery approach that aims to create an equal partnership between caregivers and providers. FCC has been shown to improve parental wellbeing, their knowledge of the condition and care, and improve their feelings of self-efficacy and personal control. The purpose of this study was to explore the healthcare experiences of family caregivers of children and adults with RTS to understand the issues they encounter when working with medical professionals and to examine their perspectives on how to improve FCC. Primary family caregivers of individuals with RTS took an online mixed-method survey that contained three primary components: a demographic survey, the Measures of Processes of Care-20 (MPOC-20) [a measure of the FCC an individual feels they receive], and a qualitative assessment of negative and positive interactions with medical professionals and priority areas for improvement. Qualitative data were analyzed using thematic analysis. Quantitative data were analyzed with descriptive statistics. An analysis of variance test was used to determine whether values statistically differed between different-age groups of individuals with RTS being cared for. Sixty-three caregivers completed the survey. The average score of the Providing General Information subscale of the MPOC-20 was 3.18, lower than that seen in other studies. The average scores of the other subscales of the MPOC-20 ranged from 4.60 to 5.02, comparable to other studies of caregivers of children with other medical conditions. All aspects of FCC were ranked as important by caregivers. There were no differences in MPOC-20 values between those caring for the individuals with RTS in different-age groups reviewed. In the qualitative responses, parents noted that experiences with medical professionals would be improved if healthcare providers actively provided FCC, collaborated with parents and other providers, respected caregivers’ time and breadth of knowledge and lived experience, gave a more balanced description of the condition, showed greater respect toward their loved ones and included them in the conversation, and made an effort to learn about RTS. The changes that parents would like to see in their child’s care were not specific to one discipline and could be implemented by all healthcare specialists. While caregivers report that they receive moderate levels of FCC, they indicated that areas of FCC could be improved.

PMID:34218493 | DOI:10.1002/jgc4.1464

Clin Oral Implants Res. 2021 Jul 4. doi: 10.1111/clr.13806. Online ahead of print.

ABSTRACT

OBJECTIVES: Comparing PES/WES scores, modified success rate, survival, success, buccal bone thickness and patient-reported outcomes of immediate dental implants placed in fresh alveolar sockets using a flap or a minimal split-thickness envelope flap (MSTEF).

MATERIALS AND METHODS: Implants following random assignment into a flap or MSTEF group were placed immediately in anterior and premolar areas. Guided bone regeneration and autogenous connective tissue graft were used in all cases. A temporary prosthesis was provided followed by the final prosthesis at 16-18 weeks. Success and survival rates together with radiographic buccal bone thickness and patient satisfaction were evaluated at 12 months post-loading. The aesthetic outcome was evaluated through the Pink (PES) and White (WES) Aesthetic Score by 8 blind clinicians of different training background and incorporated in modified success criteria.

RESULTS: 28 implants were placed on 28 patients. No statistically significant differences were noted in PES (10.54 control vs. 10.80 test), WES scores (6.97 control vs. 6.95 test) or success criteria including aesthetic parameters (modified success criteria) for the different specialty groups (Range 69%-92%). In addition, no statistically significant differences were noted in survival (100%), success (100%), buccal wall thickness between control (0.72 +/-0.22) and test group (0.92+/-0.31) and patients’ reported outcomes.

CONCLUSIONS: Immediate dental implant treatment with flap/ MSTEF provided similar mean PES/WES scores, modified success rate, survival, mean buccal bone levels and patients’ satisfaction. However, aesthetic failures were common in both groups.

PMID:34218469 | DOI:10.1111/clr.13806

Clin Anat. 2021 Jul 4. doi: 10.1002/ca.23763. Online ahead of print.

ABSTRACT

INTRODUCTION: No clinical studies to date have compared the airway luminal area between supine and standing positions. Our aim was therefore to compare the airway luminal area between these two positions on computed tomography (CT) and to determine its correlation with forced expiratory volume in 1s (FEV1).

MATERIALS AND METHODS: Thirty-two asymptomatic volunteers underwent both conventional (supine position) and upright (standing position) CT during deep inspiration breath-holding. Pulmonary function tests were conducted on the same day. We measured the airway luminal area on CT in each position. Paired t-tests and Pearson’s correlation coefficients were used for statistical analysis.

RESULTS: The average luminal areas of the trachea, right and left main bronchi, and average third-generation airway were greater in the standing than the supine position by 3.4%, 6.1%, 5.5%, and 5.2%, respectively. The correlation coefficients between airway luminal areas and FEV1 tended to be higher in the standing than the supine position; this correlation was highest for the average third-generation airway (r=0.70, P <0.0001).

CONCLUSION: The airway luminal areas of the trachea, bilateral main bronchi, and average third-generation airway were greater in the standing than the supine position. The average third-generation airway area in the standing position had the highest correlation with FEV1. This article is protected by copyright. All rights reserved.

PMID:34218460 | DOI:10.1002/ca.23763

Int J Health Plann Manage. 2021 Jul 3. doi: 10.1002/hpm.3275. Online ahead of print.

ABSTRACT

BACKGROUND: Despite improvements in many health indicators, providing access to affordable healthcare remains a considerable challenge in Bangladesh. Financing incidence analysis will enable an evaluation of how well the healthcare system performs to achieve equity in health financing. The objective of this study is to assess the burden of out-of-pocket (OOP) cost on different socio-economic groups by assessing the health financing incidence because OOP cost dominates household expenditure on health in Bangladesh.

METHODS: The study was conducted using latest Household Income and Expenditure Survey (HIES) 2016. We focused mainly on four specific indicators: level of monthly household OOP cost on in-patient care, urban-rural differences in OOP cost, socio-economic status differences in different payment mechanisms and the Kakwani index. Descriptive statistics were employed to analyse and summarise the selected variables based on the SES and location of residence (e.g., rural and urban).

RESULTS: The study showed the overall OOP healthcare expenditure was 7.7% of the household monthly income while the poorer income group suffered more and spent up to 35% of their household income on healthcare. The Kakwani index indicated that the poorest quintile spends a greater share of their income on healthcare services than the richest quintile.

CONCLUSIONS: This study observed that OOP cost in Bangladesh is regressive, that is, poorer members of society contribute a greater share of their income. Therefore, policymakers should initiate health reforms for developing and implementing risk-pooling financing mechanisms such as social health insurance to achieve the Universal Health Coverage in Bangladesh.

PMID:34218437 | DOI:10.1002/hpm.3275

Acta Neurol Belg. 2021 Jul 3. doi: 10.1007/s13760-021-01727-w. Online ahead of print.

ABSTRACT

Migraine is considered an underdiagnosed disease in general population. Different studies show a higher prevalence in neurologists. However, there are few studies about its prevalence in doctors of other specialties, where it could also be superior than in general population. Our aim was to define migraine lifetime prevalence among doctors according to three parameters (previous diagnosis, self-diagnosis and positivity of a screening test). Single-center, descriptive, cross-sectional study based on online surveys with collection of sociodemographic and clinical variables, addressed to doctors of a tertiary hospital. Participants who reported 5 or more headaches throughout their lives were considered “headache sufferers” and were divided in different groups according to their position (specialists or trainees) and their specialty (medical, medical-surgical and surgical or specialties with no direct contact with the patient). The Spanish validated version of the Migraine Screen Questionnaire (MS-Q) was used as screening test. There were 217 participants (response rate of 29%), 72% were women and 56% trainees, mean age 34 years (SD10). 77% were “headache sufferers” Among all participants, migraine lifetime prevalence according to diagnosis by another physician was 15.2%, self-diagnosis 38.2% and positivity of the MS-Q 20.3%; those categories were not mutually exclusive Greater but not statistically significant coexistence of self-diagnosis and positive MS-Q was seen in specialists compared to trainees and in medical specialties. Migraine prevalence among doctors in a tertiary care hospital was higher than in general population, according to all three parameters analyzed. Self-diagnosis was the highest which could reflect an overdiagnosis; further studies are needed to determine this possibility.

PMID:34218428 | DOI:10.1007/s13760-021-01727-w

Theory Biosci. 2021 Jul 3. doi: 10.1007/s12064-021-00352-8. Online ahead of print.

ABSTRACT

This theoretical analysis considers a biomechanical model in which the Carreau fluid model characterizes the viscoelastic nature of growing human embryo and secreted fluid. This model incorporates transport mechanisms that involve the swaying motions of ciliary cells, peristaltic contractions of smooth muscle cells and pressure gradient at the ampullar region entrance. Series form solutions of the resulting partial differential equations are obtained using the regular perturbation method. A theoretical estimate of effects of the condition of pressure gradient, geometric parameters and fluid model parameters on the flow variables that have relevance to the problem of growing embryo transport in the human fallopian tube is presented through the discussion of graphs. Furthermore, an analogy between the linearly viscous fluid, and the shear thinning and shear thickening characteristics of the Carreau fluid model is also presented. The pertinence of the obtained results with growing embryo transport in the human fallopian tube revealed that when shear thickening characteristics of the Carreau fluid model are considered then complete mitotic divisions take place properly with an estimated appropriate residue time about 3-4 days. Smaller size trapped boluses of the secreted fluid make the smooth forwarding of the growing embryo in the human fallopian tube when shear thinning characteristics of the Carreau fluid model are taken into account. Key modulators: progesterone ([Formula: see text] and estradiol ([Formula: see text]), prostaglandin [Formula: see text] ([Formula: see text]) and prostaglandin [Formula: see text] ([Formula: see text]) constraint the growing embryo transport.

PMID:34218412 | DOI:10.1007/s12064-021-00352-8

Acta Gastroenterol Belg. 2021 Apr-Jun;84(2):311-316. doi: 10.51821/84.2.311.

ABSTRACT

BACKGROUND: Hepatitis C is a viral infection caused by the hepatitis C virus (HCV) with people who inject drugs as the main group at risk worldwide.

AIM: This study investigated the differences in uptake for HCV screening and treatment between persons in opioid substitution therapy (OST) and the other members of the Christian Health Insurance Fund in Belgium.

METHODS: Invoice data were retrospectively collected from the Christian Health Insurance Fund, representing 42% of the healthcare users. Information on demographics, screening, diagnostic tests, treatment and disease progression was obtained from 2008 till 2013. All people in this study were aged 20-65 year. Persons in the OST group were identified as having at least one prescription reimbursed for methadone. This group was compared to the other members of the Insurance Fund not on OST (NOST).

RESULTS: The Insurance Fund registered 8,409 unique OST and 3,525,190 members in the general group. HCV RNA screening rate was higher in the OST group after correction for age and gender (4.3% vs. 0.2%). Ribavirin reimbursement, did not differ between the OST and NOST group screened for HCV RNA (16.9% vs. 14.4%), though the probability of having ribavirin reimbursed was smaller for females than for males. Procedures concerning disease progression were reimbursed less frequently in the HCV RNA screened OST group compared to the NOST group (0.3% vs. 1.2%).

CONCLUSION: People on OST were screened more often for HCV RNA. However, the general uptake for HCV screening and treatment in both populations remained suboptimal.

PMID:34217181 | DOI:10.51821/84.2.311