Nevin Manimala

Child Care Health Dev. 2021 May 22. doi: 10.1111/cch.12886. Online ahead of print.

ABSTRACT

BACKGROUND: Advancing physical therapy interventions for children and young people is a high research priority. This includes research to describe and specify the control condition, typically “current care”, for effectiveness trials. This paper aims to identify physical therapy outcomes commonly targeted, and intervention techniques and approaches commonly used, by physiotherapists working with children (aged 2-19 years) with mobility limitations in the United Kingdom.

METHODS: A cross-sectional survey. Participants were recruited through the interactive Chartered Society of Physiotherapy members-only online discussion forum, the Association of Paediatric Chartered Physiotherapists, direct emails and snowball sampling within the authors’ professional networks, and Twitter. Data were collected using a structured online questionnaire and analysed using descriptive statistics.

RESULTS: We received 146 responses, 95/146 (65.1%) of which were fully complete. Therapists reported targeting 367 unique outcome constructs of which 193 (52.6%) mapped onto activities and participation (e.g. moving around using equipment, maintaining body position, walking), 158 (43.1%) on body functions (e.g. muscle strength, joint mobility, gait functions), 11 (3.0%) on body structure (e.g. muscle length), and 3 (0.8%) on environmental factors (e.g. access home environment, access school environment, family confidence). The most commonly used interventions related to postural management (115/133 of respondents, 86.4%) and exercise therapy (116/137, 84.67%), and included techniques such as ‘use equipment’ (118/137, 86.1%), ‘instruct how to do something’ (117/137, 85.4%), ‘practice’ (105/137, 76.6%), and ‘stretch’ (99/137, 72.3%).

CONCLUSIONS: In designing trials, current care can be described as a combination of biomechanical and physiological techniques and approaches targeted at body functions and through that to activity and participation. While some environmental behaviour change techniques and strategies were reported, the explicit use of these in current care appears limited.

PMID:34022063 | DOI:10.1111/cch.12886

Pain Med. 2021 May 22:pnab176. doi: 10.1093/pm/pnab176. Online ahead of print.

ABSTRACT

OBJECTIVE: To examine the effectiveness and safety of epidural analgesia in the presurgical period on hip fracture patients undergoing surgical repair.

DESIGN: Systematic review.

METHODS: The study protocol was registered with the PROSPERO systematic reviews register: CRD42019140396. Electronic databases were searched for randomized controlled trials comparing preoperative epidural analgesia to other forms of pain management in hip fracture patients. The primary outcomes included perioperative cardiac events and mortality. Pain, non-cardiac complications, and adverse effects were also examined as secondary outcomes. Heterogeneity of the included studies was assessed using the I2 statistic and a random-effects meta-analysis was conducted once sufficient homogeneity was demonstrated.

RESULTS: Four studies met the inclusion criteria, which included a total of 221 patients. Preoperative epidural analgesia resulted in fewer cardiac events, which was a reported outcome in two included studies (RR 0.30; 95% CI 0.14-0.63; I2 = 0%). Preoperative epidural analgesia was also associated with decreased perioperative mortality in a meta-analysis of two studies (RR 0.13; 95% CI 0.02-0.98; I2 = 0%). Pain was not pooled due to variability in assessment methods, but preoperative epidural analgesia was associated with reduced pain in all four studies.

CONCLUSIONS: Preoperative epidural analgesia for hip fracture may reduce perioperative cardiac events and mortality, but the number of included studies in this systematic review was low. More research should be done to determine the benefit of early epidural analgesia for hip fractured patients.

PMID:34022058 | DOI:10.1093/pm/pnab176

Rheumatology (Oxford). 2021 May 22:keab456. doi: 10.1093/rheumatology/keab456. Online ahead of print.

ABSTRACT

OBJECTIVES: Knee joint distraction (KJD) has shown long-term clinical improvement and short-term cartilage restoration in young osteoarthritis (OA) patients. The current objective was to evaluate MRI cartilage thickness up to ten years after KJD treatment, using a three-dimensional surface-based approach.

METHODS: Twenty end-stage knee OA patients were treated with KJD. 1.5 T MRI scans were performed before and at one, two, five, seven, and ten years after treatment. Tibia and femur cartilage segmentation and registration to a canonical surface were performed semi-automatically. Statistical parametric mapping (SPM) with linear mixed models was used to analyse whole-joint changes. The influence of baseline patient characteristics was analysed with SPM using linear regression. Relevant weight-bearing parts of the femur were selected to obtain the average cartilage thickness in the femur and tibia of the most (MAC) and least affected compartment (LAC). These compartmental changes over time were analysed using repeated measures ANOVA; missing data was imputed. In all cases, p< 0.05 was considered statistically significant.

RESULTS: One- and two-years post-treatment, cartilage in the MAC weight-bearing region was significantly thicker than pre-treatment, gradually thinning after five years, but still increased at ten years post-treatment. Long-term results showed areas in the LAC were significantly thicker than pre-treatment. Male sex and more severe OA at baseline somewhat predicted short-term benefit (p> 0.05). Compartmental analyses showed significant short- and long-term thickness increase in the tibia and femur MAC (all p< 0.05).

CONCLUSIONS: KJD results in significant short- and long-term cartilage regeneration, up to ten years post-treatment.

PMID:34022055 | DOI:10.1093/rheumatology/keab456

Chest. 2021 Apr;159(4):1677-1678. doi: 10.1016/j.chest.2020.11.029. Epub 2021 Apr 6.

NO ABSTRACT

PMID:34021997 | DOI:10.1016/j.chest.2020.11.029

PM R. 2021 May 22. doi: 10.1002/pmrj.12645. Online ahead of print.

ABSTRACT

BACKGROUND: Rehabilitation outcomes of COVID-19 patients are unknown.

OBJECTIVE: The purpose of this study is to describe COVID-19 patients undergoing inpatient rehabilitation and their rehabilitation outcomes.

METHODS: Retrospective observational cohort study of all inpatients from a rehabilitation hospital between March 1 and September 30, 2020. Inclusion criteria are: ≥18 years of age and admission and discharge within the study time frame. The initial search yielded 920 patients; 896 met the inclusion criteria. Data was derived from the eRehabData database. Subjects were stratified by COVID-19 status and rehabilitation impairment. Data included age, gender, body mass index (BMI), length of stay (LOS), discharge location, and functional ability measures for self-care and mobility (FA-SC, FA-Mob). Descriptive statistics included age, BMI, gender, LOS, and discharge location. One-sample t-tests were used to assess the difference of age, BMI, LOS, FA-SC, FA-Mob, and FA efficiency between COVID-19+ and COVID-19- patients.

RESULTS: COVID-19+ patients were younger (59·4 years vs 62·9 years; t(894)= -2·05, p=0·04) with a higher mean BMI (32 vs 28; t(894)= 3·51, p<0·01) than COVID-19- patients. COVID-19+ patients had equivalent or superior improvements in FA-SC and FA-Mob, functional change efficiency, and LOS than COVID-19- patients. Comparing Medically Complex patients, those with COVID-19 had greater FA-SC and FA-Mob efficiencies than COVID-19- patients. COVID-19+ patients had similar rates of return to the community.

CONCLUSIONS: Patients with COVID-19 who meet the admission criteria for inpatient rehabilitation can benefit from inpatient rehabilitation similarly to their non-COVID-19 counterparts with similar rehabilitation-specific diagnoses. This article is protected by copyright. All rights reserved.

PMID:34021974 | DOI:10.1002/pmrj.12645

J Cosmet Dermatol. 2021 May 22. doi: 10.1111/jocd.14246. Online ahead of print.

ABSTRACT

BACKGROUND: Sensitive skin is subjective cutaneous hyperreactivity to environmental factors. Demodicosis is a skin disorder caused by Demodex.There may be a link between demodicosis and sensitive skin.

AIM: This study aimed to examine facial Demodex density and other factors associated with sensitive skin in patients.

METHODS AND METHODS: A total of 349 randomly selected patients who presented to the dermatology department. The research data were collected using a questionnaire form that included the participants’ sociodemographic and lifestyle characteristics, a sensitive skin questionnaire, the Dermatology Life Quality Index (DLQI), and European Health Interview Survey (EHIS). Patients underwent standardized superficial skin surface biopsy of 4 areas of the face. D. folliculorum count greater than 5 mites/cm² was considered positive.

RESULTS: In relation to Demodex, there was an increase in skin sensitivity with higher Demodex density (p =0,04). There was a statistically significant, weak positive correlation between skin sensitivity and DLQI score (r=0.33, p=0.00) and there was also a significant but very weak negative correlation between skin sensitivity and EUROHIS (r=-0.164, p=0.002). Skin sensitivity was more common in patients with a concomitant dermatological disease (p=0.01) and increased with more frequent cosmetic use (p=0.00).

CONCLUSION: Alongside other risk factors, for the patients presenting with complaints of sensitive skin, investigating Demodex population density may help alleviate sensitive skin symptoms with appropriate therapies and preventive measures.

PMID:34021963 | DOI:10.1111/jocd.14246

J Cosmet Dermatol. 2021 May 22. doi: 10.1111/jocd.14247. Online ahead of print.

ABSTRACT

BACKGROUND: The temporal lifting technique can provide lateral facial lifting when administering hyaluronic acid (HA) based soft tissue fillers into the subdermal plane of the temple. However, the central facial oval is not influenced by this technique.

OBJECTIVES: To identify the safety and aesthetic effectiveness of additional midfacial injection points (in addition to the temporal lifting technique) that can volumize the medial midface, lift the lateral face, increase jawline contouring when included into a full-face injection algorithm.

METHODS: The patient records of nine consecutive patients (all females) with a mean age of 35.0 (8.4) years and a mean body mass index of 21.7 (2.4) kg/m² were retrospectively analyzed after a full-face injection algorithm was performed using HA based fillers. The additional injection points target the supraperiosteal plane of the medial zygomatic arch, the lateral infraorbital region and the pyriform fossa using both needles and cannula.

RESULTS: No adverse events were observed during the 6-months retrospective observational period. The volume of the medial midface increased, the volume of the lateral midface decreased, and the contour of the jawline improved; all effects reached a highly statistically significant level with p < 0.001.

CONCLUSION: Despite each in dividual injection is currently performed on a daily clinical basis the evaluated injection algorithm following the temporal lifting technique shows some evidence that it is safe and aesthetically effective. Future studies will need confirm the results presented herein in a larger sample and with objective outcome measures to guide safe and effective aesthetic outcomes.

PMID:34021958 | DOI:10.1111/jocd.14247

Int J Clin Pract. 2021 May 22:e14384. doi: 10.1111/ijcp.14384. Online ahead of print.

ABSTRACT

BACKGROUND: We tend to find out whether BMI and weight have difference in the connection with the disease severity of AECOPD patients. Besides, we aim to explore the relationships between body fat (BF) and lean body mass (LBM) with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).

METHODS: Information like weight and body mass index (BMI) were recorded at hospital admission. BF and LBM were assessed using dual energy X-ray absorptiometry (DEXA). Logistic regression analysis, receiver operating characteristic (ROC) curves and other statistical analyses were performed.

RESULTS: Weight and BF + LBM showed significant linkages with the Global Initiative for Chronic Obstructive Lung Disease (GOLD) in multivariate logistic regression analysis (Model 3: OR = 0.932, p = 0.016; OR = 0.915, p = 0.006, respectively). And BMI did not show correlation with GOLD. In Stratification analysis, BF showed the predictive value for GOLD (AUC = 0.709, p = 0.004) while LBM showed the predictive ability for modified Medical Research Council scale (mMRC) (AUC = 0.761, p < 0.001).

CONCLUSION: BF + LBM and weight were better than BMI in the connection with the disease severity of AECOPD patients represtented by GOLD. BF and LBM may have different or even opposite effects on patients with AECOPD.

PMID:34021950 | DOI:10.1111/ijcp.14384

J Nurs Manag. 2021 May 22. doi: 10.1111/jonm.13384. Online ahead of print.

ABSTRACT

BACKGROUND: There is a scarcity of literature assessing the impact of job engagement and satisfaction in the nurse’s caring behaviors. This study aim to identify how these factors affect the caring behaviours of nurses.

METHODS: This study used a cross-sectional design and employed self-report questionnaires. A total of 549 nurses from private and government hospitals participated in the survey conducted in the year 2019. Descriptive and inferential statistics were utilized to analyse the data.

RESULTS: Results revealed that the nurses display high caring behaviours and job engagement and moderate sense of satisfaction. Remarkably there are no profile variables significantly related to the nurse’s caring behaviors. Findings suggest that job engagement and satisfaction are significantly associated with the nurses’ caring behaviours.

CONCLUSION: Factors such as job engagement and satisfaction affect nurses caring behaviours.

IMPLICATIONS TO NURSING MANAGEMENT: Health organizations must provide strategies to increase job engagement and satisfaction of nurses to yield high caring behaviours, which is vital to the achievement of patient safety.

PMID:34021940 | DOI:10.1111/jonm.13384

JPEN J Parenter Enteral Nutr. 2021 May 22. doi: 10.1002/jpen.2195. Online ahead of print.

ABSTRACT

INTRODUCTION: Hospital-acquired central line-associated bloodstream infections (CLABSI) are “never events” in U.S. healthcare. Efforts to eliminate CLABSI are critically important to children with intestinal failure (IF) who depend on long-term, daily use of a central venous catheter (CVC) and often undergo extended hospitalizations. They are also vital to the safety of any patient with a CVC. We sought to describe long-term outcomes of a multidisciplinary CLABSI elimination effort on a 24-bed medical-surgical unit caring for children with IF.

METHODS: Unit CLABSI events from 1/9/2012 to 4/16/2020 were evaluated in the context of multiple interventions aimed at preventing CLABSI; leveraging prospectively maintained clinical registries and National Healthcare Safety Network (NHSN) reporting data, patient and unit demographics, ethanol lock utilization, and unit CVC days. Interventions, including zinc oxide-based adhesive barriers, environmental cleaning, and simulation as part of staff education were developed utilizing consensus of hospital experts and Centers for Disease Control and Prevention guidelines with staff engagement. Descriptive statistics and tests of non-parametric data were employed for analysis.

RESULTS: Ninety-five patients with IF and 862 non-IF patients experienced a total of 1,629 admissions with 20,372 CVC days during the study period. Twelve hospital-acquired CLABSI events occurred, including 7 following NHSN definition change on 1/1/2015 (0.56 per 1,000 CVC days). Following the last unit CLABSI on 12/5/2016, there were 7,117 CVC days without CLABSI through study conclusion.

CONCLUSIONS: Use of described interventions in the context of an enhanced culture of collaborative care and ownership is associated with hospital-acquired CLABSI elimination. Success in a specific population translated to all other unit patients with a CVC. Findings suggest that CLABSI elimination is not the result of a single new product or practice but rather an approach that supports and empowers those most closely responsible for care of the patient and their CVC is key. This article is protected by copyright. All rights reserved.

PMID:34021937 | DOI:10.1002/jpen.2195