Nevin Manimala

MCN Am J Matern Child Nurs. 2021 Jun 18. doi: 10.1097/NMC.0000000000000738. Online ahead of print.

ABSTRACT

Purpose: Neonatal palliative care is widely endorsed as an essential aspect of neonatal intensive care unit (NICU) practice, yet inconsistencies in its use continue to exist. We examined neonatal nurses’ perceptions of barriers and facilitators to palliative care in their NICU setting.Study Design and Methods: A cross-sectional design using the Neonatal Palliative Care Attitude Scale (NiPCAS™©) was administered using an online survey distributed to neonatal nurses through the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) and National Association of Neonatal Nurses (NANN). Parametric statistical analyses were conducted to explore relationships between unit policy and neonatal palliative care (NPC) education, and the nurses’ perceptions.Results: Ninety-nine of 1,800 AWHONN members who identified as NICU nurses completed the survey, representing a response rate of 5.5% and 101 of 4,000 NANN members who subscribe to the MYNANN message boards completed the survey, reflecting a 2.5% response rate. N = 200 surveys were completed with minimal data missing, resulting in a final sample of 200. Exploratory factor analysis yielded these subconstructs: Unit Culture, Resources, and Perceived Inappropriate Care. Barriers identified were Perceived Inappropriate Care and Societal Understanding of NPC. A positive correlation was noted for NiPCAS™© scores and unit culture support (r(185) = .66, n = 187, p < .01), unit NPC policy (r(184) = .446, n = 186, p < .01), and NPC education (r(185) = .373, n = 187, p < .01).Clinical Implications: Nurses who work in a NICU with an NPC policy and who have received palliative care education demonstrated more favorable attitudes toward NPC. Policy and educational programs are important strategies to promote high-quality care for high-risk infants and their families.

PMID:34162793 | DOI:10.1097/NMC.0000000000000738

MCN Am J Matern Child Nurs. 2021 Jun 18. doi: 10.1097/NMC.0000000000000743. Online ahead of print.

ABSTRACT

Purpose: The purpose of this study was to determine maternal cotinine levels in saliva at the f.irst (T-1) and third trimesters of pregnancy (T-2), and postpartum (T-3) among women who reported smoking a consistent number of cigarettes. The goal was to generate data to provide suggestions about how nurses can improve patient outcomes for women who smoke.Methods: Saliva cotinine values obtained from the randomized controlled trial (BabyBEEP) were used for this secondary analysis. We examined variations in saliva cotinine between the first and third trimesters of pregnancy and postpartum among light and heavy smokers. Cotinine values for pregnant smokers who were in the control group (not randomized to any intervention) and reported smoking the same range of cigarettes during and after pregnancy were used for the analyses (n = 43). Descriptive statistics and repeated-measures ANOVA were used for analyses.Results: There were differences in maternal saliva cotinine levels across the different time points and between the groups. There was a significant interaction effect between time and group. Cotinine decreased from T-1 to T-2 in heavy smokers and increased from T-2 to T-3 among both light and heavy smokers. Cotinine at T-3 was higher than T-1 among light smokers.Clinical Implications: Findings support accelerated nicotine metabolism during pregnancy and need for smoking cessation efforts throughout pregnancy to help women stay smoke free at postpartum.

PMID:34162791 | DOI:10.1097/NMC.0000000000000743

J Hosp Palliat Nurs. 2021 Jun 22. doi: 10.1097/NJH.0000000000000780. Online ahead of print.

ABSTRACT

Health care providers have an ethical obligation to reduce suffering during a patient’s end of life (EOL), but few receive formal education on EOL care principles. The objective of this project was to determine the feasibility and potential benefits of an education initiative in which the principles of EOL care were taught to senior-level nursing students and practicing nurses. To assess feasibility, data regarding recruitment rates, retention rates, and implementation issues were collected. Workshop effectiveness was evaluated through use of the End-of-Life Nursing Education Consortium-Knowledge Assessment Test survey, which evaluates knowledge levels regarding EOL care principles. A mixed-effects linear model was used to test for changes from the preworkshop to postworkshop scores. Demographic information and satisfaction data were also collected. Nineteen students and 24 nurses participated (total N = 43). There was a statistically significant time difference (P = .0001), with the postworkshop scores being higher (43.5 ± 0.93) versus the preworkshop scores (41.2 ± 0.93). However, no statistically significant workshop date difference (P = .3146) emerged. Satisfaction data were positive. Retention for the second workshop was negatively affected by COVID-19. The unique needs of patients nearing their EOL are significant. This project describes the implementation and outcomes of an education initiative, focused on EOL care principles, that was both feasible and beneficial.

PMID:34162790 | DOI:10.1097/NJH.0000000000000780

J Vet Med Sci. 2021 Jun 23. doi: 10.1292/jvms.21-0258. Online ahead of print.

ABSTRACT

Meningioma is the most common primary brain tumor in cats, although there are few reports about their pathological features. To investigate the histopathological subtypes and immunohistochemical features including expression of cytokeratin and cell adhesion molecules, 45 cases of feline meningioma were examined. The mean age was 12.5 years (range 6-21 years). No statistically significant sex predilection was observed. Regarding the anatomical location of meningioma, tumors mostly developed in the cerebrum, followed by spinal cord and cerebellum, and multiple meningioma was observed in one cat. Microscopically, linear or focal mineralization was observed in 40 cases and cholesterol cleft was observed in 14 cases. Based on histopathological subtypes, there were 15 fibrous, 22 transitional, 2 meningothelial, 5 atypical, and 1 anaplastic meningiomas. These subtypes are classified into grade 1 (39 cases), grade 2 (5 cases), and grade 3 (1 case). There was no significant difference in the Ki-67 index among histological subtypes or grades. Immunohistochemically, the tumor cells were positive for cytokeratin in 5 cases (12.8%), vimentin in 17 cases (43.6%), E-cadherin in 36 cases (92.3%), β-catenin in 21 cases (53.8%), and N-cadherin in 1 case (2.6%), demonstrating the utility of E-cadherin-immunohistochemistry for the diagnosis of feline meningiomas.

PMID:34162785 | DOI:10.1292/jvms.21-0258

Proc Natl Acad Sci U S A. 2021 Jun 29;118(26):e2100474118. doi: 10.1073/pnas.2100474118.

ABSTRACT

During synthesis of membrane proteins, transmembrane segments (TMs) of nascent proteins emerging from the ribosome are inserted into the central pore of the translocon (SecYEG in bacteria) and access the phospholipid bilayer through the open lateral gate formed of two helices of SecY. Here we use single-molecule fluorescence resonance energy transfer to monitor lateral-gate fluctuations in SecYEG embedded in nanodiscs containing native membrane phospholipids. We find the lateral gate to be highly dynamic, sampling the whole range of conformations between open and closed even in the absence of ligands, and we suggest a statistical model-free approach to evaluate the ensemble dynamics. Lateral gate fluctuations take place on both short (submillisecond) and long (subsecond) timescales. Ribosome binding and TM insertion do not halt fluctuations but tend to increase sampling of the open state. When YidC, a constituent of the holotranslocon, is bound to SecYEG, TM insertion facilitates substantial opening of the gate, which may aid in the folding of YidC-dependent polytopic membrane proteins. Mutations in lateral gate residues showing in vivo phenotypes change the range of favored states, underscoring the biological significance of lateral gate fluctuations. The results suggest how rapid fluctuations of the lateral gate contribute to the biogenesis of inner-membrane proteins.

PMID:34162707 | DOI:10.1073/pnas.2100474118

CMAJ Open. 2021 Jun 23;9(2):E703-E710. doi: 10.9778/cmajo.20200181. Print 2021 Apr-Jun.

ABSTRACT

BACKGROUND: Recreational cannabis use was legalized in Canada in October 2018. We aimed to determine the prevalence and correlates of cannabis consumption among pregnant individuals in a single Canadian city following national legalization.

METHODS: Over the period May to October 2019, we distributed an anonymous cross-sectional survey to pregnant patients attending family practice, midwifery, and low-risk and high-risk obstetrics clinics in Hamilton, Ontario. Eligibility was based on English literacy and current pregnancy. The survey included questions regarding lifetime and in-pregnancy cannabis use, intent for postpartum use and patterns of use. We also collected demographic information. We calculated descriptive statistics and performed logistic regression analyses to explore the relations between cannabis consumption and demographic characteristics.

RESULTS: Of 531 pregnant individuals approached, 478 agreed and were able to participate, for a 90% participation rate. Among these 478 respondents, 54 (11%) reported consuming cannabis at some point during the pregnancy and 20 (4%) reported currently consuming cannabis. Among the 460 respondents who intended to breastfeed, 23 (5%) planned to consume cannabis during the postpartum period. Of 20 current users, 13 (65%) reported consuming cannabis at least weekly and 19 (95%) reported nausea, sleep problems or anxiety as reasons for use. Respondents without postsecondary education had 10.0-fold (95% confidence interval [CI] 4.6-23.5) greater odds of prenatal cannabis consumption than university-educated respondents. In addition, respondents who reported that their partners used cannabis had 3.9-fold (95% CI 2.2-7.3) greater odds of prenatal cannabis consumption than those who reported that their partners did not use cannabis.

INTERPRETATION: Lower educational attainment and partners’ cannabis consumption were associated with greater odds of inpregnancy cannabis use. These results may help to inform early intervention strategies to decrease cannabis consumption during this vulnerable period of fetal and neonatal development.

PMID:34162662 | DOI:10.9778/cmajo.20200181

Cancer Epidemiol Biomarkers Prev. 2021 Jun 22:cebp.1727.2021. doi: 10.1158/1055-9965.EPI-20-1727. Online ahead of print.

ABSTRACT

BACKGROUND: The American Cancer Society (ACS) and the National Cancer Institute collaborate every 5-8 years to update the methods for estimating numbers of new cancer cases and deaths in the current year in the U.S. and in every state and the District of Columbia. In this paper, we re-evaluate the statistical method for estimating unavailable historical incident cases which are needed for projecting the current year counts.

METHODS: We compared the current county-level model developed in 2012 (M0) to three new models, including a state-level mixed effects model (M1) and two state-level hierarchical Bayes models with varying random effects (M2 and M3). We used 1996-2014 incidence data for 16 sex-specific cancer sites to fit the models. An average absolute relative deviation (AARD) comparing the observed to the model-specific predicted counts was calculated for each site. Models were also cross validated for 6 selected sex-specific cancer sites.

RESULTS: For the cross-validation, the AARD ranged from 2.8% to 33.0% for M0, 3.3% to 31.1% for M1, 6.6% to 30.5% for M2, and 10.4% to 393.2% for M3. M1 encountered the least technical issues in terms of model convergence and running time.

CONCLUSIONS: The state-level mixed effect model (M1) was overall superior in accuracy and computational efficiency and will be the new model for the ACS current year projection project.

IMPACT: In addition to predicting the unavailable state-level historical incidence counts for cancer surveillance, the updated algorithms have broad applicability for disease mapping and other activities of public health planning, advocacy and research.

PMID:34162657 | DOI:10.1158/1055-9965.EPI-20-1727

Cancer Epidemiol Biomarkers Prev. 2021 Jun 22:cebp.0058.2021. doi: 10.1158/1055-9965.EPI-21-0058. Online ahead of print.

ABSTRACT

BACKGROUND: The inverse observational association between body mass index (BMI) and lung cancer risk remains unclear. We assessed whether the association is explained by metabolic aberrations, residual confounding and within-person variability in smoking, and compared against other smoking-related cancers.

METHODS: We investigated the association between BMI, and its combination with a metabolic score (MS) of mid-blood pressure, glucose and triglycerides, with lung cancer and other smoking-related cancers in 778,828 individuals. We used Cox regression, adjusted and corrected for within-person variability in smoking (status/pack-years), calculated from 600,201 measurements in 221,958 participants.

RESULTS: Over a median follow-up of 20 years, 20,242 smoking-related cancers (6,735 lung cancers) were recorded. Despite adjustment and correction for substantial within-person variability in smoking, BMI remained inversely associated with lung cancer (hazard ratio per standard deviation increase, 0.87 [95% confidence interval 0.85-0.89]). Individuals with BMI<25 kg/m2 and high MS had the highest risk (hazard ratio 1.52 [1.44-1.60] vs BMI{greater than or equal to}25 with low MS). These associations were weaker and non-significant amongst non-smokers. Similar associations were observed for head and neck cancers and oesophageal squamous cell carcinoma, whereas for other smoking-related cancers, we generally observed positive associations with BMI.

CONCLUSIONS: The increased lung cancer risk with low BMI and high MS is unlikely due to residual confounding and within-person variability in smoking. However, similar results for other cancers strongly related to smoking suggests a remaining, unknown, effect of smoking.

IMPACT: Extensive smoking-adjustments may not capture all the effects of smoking on the relationship between obesity-related factors and risk of smoking-related cancers.

PMID:34162656 | DOI:10.1158/1055-9965.EPI-21-0058

BMJ Open. 2021 Jun 23;11(6):e045897. doi: 10.1136/bmjopen-2020-045897.

ABSTRACT

INTRODUCTION: Respiratory distress syndrome is a complication of prematurity and extremely preterm infants born before 28 weeks’ gestation often require endotracheal intubation and mechanical ventilation. In this high-risk population, mechanical ventilation is associated with lung injury and contributes to bronchopulmonary dysplasia. Therefore, clinicians attempt to extubate infants as quickly and use non-invasive respiratory support such as nasal continuous positive airway pressure (CPAP) to facilitate the transition. However, approximately 60% of extremely preterm infants experience ‘extubation failure’ and require reintubation. While CPAP pressures of 5-8 cm H2O are commonly used, the optimal CPAP pressure is unknown, and higher pressures may be beneficial in avoiding extubation failure. Our trial is the Extubation CPAP Level Assessment Trial (ÉCLAT). The aim of this trial is to compare higher CPAP pressures 9-11 cm H2O with a current standard pressures of 6-8 cmH2O on extubation failure in extremely preterm infants.

METHODS AND ANALYSIS: 200 extremely preterm infants will be recruited prior to their first extubation from mechanical ventilation to CPAP. This is a parallel group randomised controlled trial. Infants will be randomised to one of two set CPAP pressures: CPAP 10 cmH2O (intervention) or CPAP 7 cmH2O (control). The primary outcome will be extubation failure (reintubation) within 7 days. Statistical analysis will follow standard methods for randomised trials on an intention to treat basis. For the primary outcome, this will be by intention to treat, adjusted for the prerandomisation strata (GA and centre). We will use the appropriate parametric and non-parametric statistical tests.

ETHICS AND DISSEMINATION: Ethics approval has been granted by the Monash Health Human Research Ethics Committees. Amendments to the trial protocol will be submitted for approval. The findings of this study will be written into a clinical trial report manuscript and disseminated via peer-reviewed journals (on-line or in press) and presented at national and international conferences.Trial registration numberACTRN12618001638224; pre-results.

PMID:34162644 | DOI:10.1136/bmjopen-2020-045897

Emerg Med J. 2021 Jun 23:emermed-2020-210586. doi: 10.1136/emermed-2020-210586. Online ahead of print.

ABSTRACT

BACKGROUND: The COVID-19 pandemic has led to a surge in critically unwell patients with type 1 respiratory failure. In an attempt to reduce the number of patients requiring mechanical ventilation, prone positioning (PP) of non-intubated patients has been added to many hospital guidelines around the world. We set out to conduct a systematic review of the evidence relating to PP in the non-intubated patient with type 1 respiratory failure secondary to COVID-19 and other causes.

METHODS: The review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. A literature search of major databases and grey sources was conducted. Studies were assessed for inclusion by two authors according to prespecified criteria. Data collection processes, analysis and risk of bias assessment were planned.

RESULTS: 31 studies were included for analysis. These consisted of prospective and retrospective case series, cohort studies and case reports. None of the studies included a comparison group. No statistical analysis was performed. Descriptive data of included studies and narrative synthesis are presented.

CONCLUSIONS: No high-quality randomised controlled trials were found and thus evidence in relation to PP as a treatment for non-intubated patients with type 1 respiratory failure is lacking.

PMID:34162630 | DOI:10.1136/emermed-2020-210586